Archive for November, 2009


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Orders. That’s what we doctors give to nurses, technologists, and other so-called ‘ancillary’ healthcare workers. We’re telling, not asking, them to do something our patient needs. That’s how the system works, and for good reason—someone has to sit in the director’s chair and maintain consistent vision.

Like the military, medicine has a hierarchy, clearly defined and known to all. This promotes efficiency, delineates responsibilities, and generally functions well. Communication lines are set; players know their boundaries. The accepted argot does not rely on niceties, and everybody’s fine with that.

Too often, though, it seems power really does corrupt: doctors behave badly, treating those below them on the ladder with scorn and condescension. Yes, we work too many hours, we stay up all night on call or miss our kids’ games because we’re in the OR, we don’t have time or energy to exercise, and we are ever mindful that the buck stops smack on top of us. We’ve spent a big chunk of our lives in school, and we know an amazing amount of stuff. But that doesn’t make us gods, or entitle us to act like jerks.

Recently a colleague blew up at one of our techs. She’d been trying to help him with an urgent scan, and pointed out an error in his order. Later he apologized, sort of, but insisted that his rank trumped all and should have been respected.

Rudeness is popping out all over these days, not just in medicine. Like other nasty things, it tends to be contagious, and little lapses can have larger consequences—studies have shown, for example, that patient outcomes are worse in ICUs where incivility is rampant.

Perhaps our culture needs to step back, do a little yoga breathing, and get our collective blood pressure down a notch or two. Courtesy isn’t just a virtue, it’s crucial for society to function. Respect is definitely a two-way street.

This essay aired on KQED-FM (88.5 in the SF bay area) on 3/22/2010 as part of its ‘Perspectives’ series. See their website for downloadable MP3. (program = perspectives; search = peggy hansen)


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This fall they are enormous. Leaves like dinner plates at every turn, gold and brown and yellow, all but eclipse the forest floor. Each seems larger than the last, and I scramble from one to the next in disbelief: how big can these monsters be? This sets me on a quest to find the largest, the king of maple leaves, in all Fall Creek. That’s no small challenge, since miles and miles of trails percolate through the redwoods in this corner of the universe.

I’ve got food, and water, and all day to be nowhere but here. I head off light as laughter, free of cell phones, computers, and concerns. My digital camera, sole remnant of the world that ended at the parking lot, is both companion and accomplice. The sun on its morning course paints impressionistic arcs onto the duff as it works to penetrate the mat of branches overhead. It’s a canvas to get lost in, beyond time and memory. The camera and I step off the edge together, deep into the heart of it.

Hours, or maybe days, later I emerge, clutching my leafy treasure and heading wearily toward the parking lot. I’m thirsty, hot, and spent. My feet berate my intemperance, as does my stomach—I’ve drunk all my water and eaten all my snacks some time ago. All I want is to get these boots off and sit down somewhere soft and comfy, but it’s still a half-mile to the car.

Did you took a picture of your fun leaf?
The voice is high and small, and takes me by surprise: I’d been looking down at the trail, and hadn’t noticed the child and her mother coming toward me. The three massive gilded leaves I held in one hand, the camera in the other, and the magic they contained were all but forgotten. I looked up and met her open, milk-toothed smile. ‘Yes,’ I told her. ‘Yes, I did.’

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Don’t sweat the small stuff, don’t lose the forest for the trees–great advice, generally. But little things sometimes make all the difference, as I’ve learned in both my profession and my passion.

My day job is radiology. I sit before a bank of flat screens and look at x-rays, ultrasounds, CTs, and MRIs—thousands of images a day. Each must be evaluated carefully, on its own and with its fellows, for every case. Often there’s just one that shows the crucial finding—an errant lymph node, a wedge of fluid where none belongs, a wayward spot in an unsuspecting brain. Sometimes it’s what we call a ‘corner shot,’ a flicker at the edge of vision. Far from the center of attention, like a kidney mass on the last image of a chest CT, these may be overlooked. Every detail, though, is created equal in my world, and as such must be respected. Of course, that doesn’t mean losing sight of the patient. Getting these details right is a necessary first step to seeing the whole picture.

Photography, my other occupation, is no different. Here too every detail counts, from gear to composition. Did I set the aperture right for the depth of field I wanted? What about the exposure comp? Did I remember to charge my spare batteries? Will this scene look better as a vertical, or a horizontal? And do I want a fast shutter, a slow one, or something in between? The crucial question is this: what image do I hold in my head, what am I striving to create? Sure, some things can be tweaked in Photoshop, but the fundamentals must be right before the shutter snaps.

Though I love the vastness of the forest, I recognize the value of each tree—not to lose myself in, but as pieces of that prized larger picture. That small stuff can be pretty big.

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I should have done it weeks ago, but I just couldn’t. Now it’s mid-November, and I can’t ignore it any longer. Summer is long gone, and fall not far behind: there will be no more tomatoes, and the vines must go.

They are tall and proud, if a bit wilted and yellow with the turn of seasons, somehow still putting forth new flower trusses despite the cold. I hate to take them down, but I need the space for another crop. So I snip the ties that bind them to their cages, support for fruit long since harvested and eaten. I disentangle branches from the wires, and pull the cages free. The vines collapse like swooning gentlewomen, prostrate and dramatic. I kneel down and begin to turn the earth, cleaving root from soil and making sure that none remains. There is no going back.

Soon enough the roots are free, as much soil shaken or massaged loose as I can manage, and the vines are all unmoored. I’m about to toss them to the compost when I spot a pale green orb, about the size of a key lime, clinging to one fallen lady’s skirts. Carefully, tenderly, I pluck it from the stem and put it in my pocket. This is the last tomato, summer’s final shout of joy and lust. It whispers like an emerald—alluring, secretive, and precious.

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Demon Wheels

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Much as I love the ease, I am convinced my wheeled suitcase is the devil’s work. Capacious and accommodating, it entices me to make use of all that empty space—and so I do. I pile in clothes I know I won’t need, shoes I know I won’t wear, and books I know I won’t read on my trip. But why not—there’s plenty of room in there! And since I have to check a bag, I might as well fill it.

By the time the void is filled, I can barely lift the suitcase. It’s below the weight limit for extra fees, though not in any meaningful way. Thence springs our love-hate relationship: those little wheels mean I don’t have to carry it, so I am free to abandon the idea of traveling light. Those little wheels mean I can give in to the American way of excess without consequence, despite my best intentions.

Sit in any airport terminal for five minutes, and you’ll see this submission is nearly universal—the relentless clack of small plastic wheels against floor tiles marks our collective embrace of convenience. In itself that isn’t evil, but the intense desire to avoid anything requiring effort is another story.

Our unwillingness to exert ourselves, even in a small thing like carrying our own suitcases, does not suggest openness to solving problems that may call for sacrifice and self-restraint along with inconvenience. Climate change and the obesity epidemic come to mind, perhaps because I’m watching the American parade while waiting for a flight.

Next time I travel, I promise myself, I will pack only what I can carry under my own steam—and so restrict myself to what is truly needed. Will that solve the planet’s woes? Of course not; it won’t even solve mine. But it will make me feel more self-reliant, and less slothful. As for the suitcase, it may feel rejected, but that weight I can easily shrug off.

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