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Read to me

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Oh, I say, Maurice Sendak died. Remember when you took me to his book signing, those many decades gone? I still have the book, dedication scrawled across the title page, and of course the memory. The rumpus was wild that afternoon, indeed. She does not, cannot, reply.

From Goodnight Moon to Murakami, Tom Kitten to Tom Sawyer, and countless more between, books were a world to us, a window, and a wonder. I remember when she told the school librarian to let me have as many as I wanted, never mind the limit. She knew what they meant to me, and she understood my hunger for the treasures they contained.

Her eyelids flutter so, so softly, and she murmurs as the morphine drips its slow, slow magic. This bed, this hospital, are no fictions, and we are no characters with finely scripted parts. This death is all too real, too sudden, and too soon. We sit, restless against unkind plastic chairs, and keep awkward vigil.

An eon or an instant passes, and there is no fluttering. I touch two fingers to her neck, and feel only skin–soft, warm, motionless. This gesture harkens back to internship, made always and only for the same sad reason–pronouncing death. What a phrase, I think–how is death pronounced, exactly? What sound can any other words receive once that one has been uttered? It hovers, thickening the air in the silent room the slightest hint, and she is free.

It’s been two years this spring, but I still feel her, like a secret character the author hadn’t met, as I turn the pages of a novel or a history. I still want to share my finds with her, and greet her new discoveries. I’m starting a new book tomorrow, Mom, I say. I’m sure you’ll like it.

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This piece aired as part of KQED FM’s Perspectives series on 4/10/14; you can hear the audio here.

Because

Too much Facebook, Twitter, Insta, Outlook, webmail, gmail, HuffPo, IM and txt; too much Netflix, laundry, errands, cleaning, gardening, farming, and work; too much of everything but time.

Something had to give, and after my mother’s death two years ago I wasn’t in the mood for blogging for some months. Then I began to feel guilty about not posting, and every few weeks I’d resolve to post again…and not do it. Always a good reason, but what it boiled down to was a lack of time and energy, a sense that no one really reads it anyway, and the added pressure I’d put on myself by adding photos to my most recent posts. That may not sound like a big deal, but it meant a lot of time and energy selecting the right images, editing and sizing them, and deciding where they fit best in a given post. Blogging shouldn’t feel like a duty or a chore; don’t we all have enough of those already?

So for a while I think I’ll ease back into things, just words with nothing fancy, and see how it goes. To start off, I’ll catch up with some of my radio commentaries that haven’t been posted here. Feedback greatly appreciated.

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It’s more than a bit ironic that my mother died, quite unexpectedly, only a few weeks after my last post. As you might imagine, that’s a lot to deal with….and I will address it here in a while. Blogging hasn’t been foremost in my mind the past few months as a result but light is beginning to creep over the horizon. Here’s a piece I wrote yesterday.

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Bambi is relentless. Oh, sure, he’s cuter than just about anything–especially when he’s new and tiny, all decked out in bright white polka dots. Those enormous, outsized ears, the tender inky nose twitching at the slightest hint of danger or excitement, the dark, moist, long-lashed eyes, and endless spindly legs would make anyone smile and coo. Anyone, that is, except a gardener.

Bambi, it turns out, has a voracious appetite–and he’s not alone. Mother, aunts, cousins, and siblings join him on patrol, irregular brigades of Bambis fanning out along the edges of the day in search of anything, and everything, that might be tasty or digestible.

I know this, of course, having shared my forest home with Bambi and his crew for years now. I’ve got deer fencing around my garden beds, and the fruit trees are in their own secure enclave. Other plants are deer-resistant, or ample enough to share. The yellow plum, for one, bears way more fruit than we can use, and Bambi’s welcome to the windfalls and whatever’s hanging out beyond the fence. I’m thankful that I have this wild and lovely space, and glad for our (mostly) peaceful coexistence.

Recently, however, I transported a young Meyer lemon tree and left it–overnight–outside the fence. After breakfast, I found it barely recognizable–every leaf, bar none, nibbled to oblivion, branches utterly denuded and forlorn. It was my own fault, to be sure, but every single leaf? Talk about a low blow!

Fortunately, the tree–which I immediately moved into the enclosure–recovered, and actually looks better now than before its run-in with the Bambis. And I’ve relearned a lesson about being a good neighbor–sometimes, it really is about good fences.

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The good towels

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They sit on the shelf, soft, fluffy, and reproachful as kittens whose dinner is unaccountably delayed. They are colorful, rich, and neatly folded, just like their cousins in my mother’s linen closet. Like her, I’ve been saving them–for what, exactly, I’ve lately begun to wonder.

The good towels–the ones reserved for guests–are kept out of circulation to stay fresh and new, unsullied and unworn. They’re plusher than the daily ones, more expensive too. The idea, I think, is twofold: to impress visitors with this subtle signal of prosperity, and to treat them better than we treat ourselves. Look, the good towels say, we’ve saved the best for you, our most honored special guest.

It may sound odd, but I’d never before considered this practice, though it’s been decades since I left my parents’ home to make my own. It was just one of those things we take for granted, received wisdom translated into practice without question. I was happy to let sleeping towels lie–that is, till recently.

I’m a radiologist, which means I interpret x-rays, CT scans, and more. Every day I sit before a bank of monitors and study images, puzzling out the meaning in the many shades of grey. Sometimes it’s a broken bone, or pneumonia, or appendicitis. Sometimes it’s a cancer in retreat, white flag waving from the screen. But every day, it seems, there’s at least one patient for whom my report will bring devastation. It’s the most timeworn cliche, but life really is short sometimes–as, too often, is the notice that we get.

I go to the linen closet, and pull out a neatly folded, pristine whisper. I hold it to my face and take a slow, deep breath of summer, happiness, and home. This small luxury I will allow myself–and you should too, every chance you get.

Counting ribs redux

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I’ve been puzzling over something for a goodly time now, and have–defeated–thrown in the towel. At your mercy, I must ask for your indulgence, and assistance. In return, your questions too shall be addressed and, I hope, answered to your satisfaction.

What is my conundrum? Simply this: since the debut of my blog, the stats gathered by the WordPress servers consistently indicate large number of views for my post “Counting Ribs”, more than any other. Many, apparently, result from searches such as ‘how to count ribs,’ ‘counting ribs on chest x-ray,’ and the like. Of course, if you read that post you quickly realize that it isn’t really about the ribs, much less an instruction manual for how to count them. Seeing the stats month after month, and imagining the disgust or disappointment of those who find my offering deficient, I confess I feel no small twinge of guilt. Read on, and I will remedy the earlier deficiency. First, though, a few words about the ribs and their various afflictions.

Well, ok, first I need you to read the standard disclaimer: this site and blog post are not intended to provide medical advice, nor do they in any way represent the organization I work for. If you are having health issues you should seek the care of a medical professional–in person.

I can’t help but wonder why so many people seek this information. Do they have a rib fracture, or other problem? Do they know someone who does? Do they think the precise locus of this issue carries a unique, particular import? Has their doctor diagnosed a rib disorder, but not shown them its ghostly tracing on their x-ray? Are they having pain, or have they found a lump, and wonder which rib might be the offender?

In most cases, the exact site of a rib fracture matters relatively little. It makes no difference whether a fracture finds itself in the sixth rib, the eighth, or the fifth, or on the left side versus the right. An important exception concerns fractures of the first 3 ribs: these tight curved flutes, huddled close against the apex of the lung, are not easily disrupted. A break in one, or all, of them implies trauma to the chest sufficient to cause other, more serious damage–to the large arteries or veins in the chest, to the pleura (the lining of the chest cavity that surrounds the lung), or even to the heart. This generally occurs in high-speed car crashes, or falls from great heights, and is a well known sign of important chest injury. Every first-year radiology resident is taught to look for it, and to raise the red flag whenever it is found.

Another exception relates to other structures in the neighborhood that could be injured by the initial insult, or by the broken edges of a fractured rib. Fracture of the lower ribs, for example, can be associated with, or lead to, damage to the liver, spleen, or other organs. These too are often the result of major trauma, and aren’t as important in their own right as for what they signify. The number of ribs that are fractured can be important, as a string of five or more can cause the chest wall to break ranks when the patient tries to breathe, moving out when it should move in and vice versa–or not moving at all. This condition, known as flail chest, can cause major compromise of gas exchange. There’s also a high chance of pneumothorax, or punctured lung, when more than a single rib is broken.

Other things that can befall the ribs include a panoply of tumors, benign or malignant, infection, cysts and other non-tumorous growths, metabolic problems, and assorted other rarities. For most of these, their specific location isn’t important.

All that aside, the thing about counting ribs is that it’s tricky. First of all, not everyone has the same number of the things: twelve on each side is standard, but some of us have eleven, while others have 13….and there can be asymmetry between left and right sides. Extra ribs, if present, may be at the top or bottom end. For this reason, it’s most accurate–though also, potentially, most confusing–to start counting from the top, rather than the bottom if you really need to know exactly which rib is acting up. That’s harder because, as I noted earlier, the first few ribs are small and jammed together tightly in the upper chest. As a result, they overlap on chest x-rays, creating all manner of perplexing curves and shadows. The good news is that extra ribs at the upper end of the spine, so called ‘cervical ribs’, are easy to recognize and discount. That’s because they are generally very small and don’t look at all like the neighboring normal ribs.

Here are a few images of the ribs in various projections (degrees of obliquity), without and with annotations to show the count. Note that it’s best to start where each rib joins the spine and follow it outward (laterally). The initial portion of each rib is more or less straight, but they curve downward as you follow them around the side to the front of the chest–hence the apparent jumble and overlap of numbers in some areas. You may need to try it a few times, but just remember to start near the spine and work your way out from there. Give it a go….and leave me a comment about why you’re interested in counting ribs!

frontal view of the ribs, without numbering

frontal view with numbering

oblique view #1

oblique view #1 with numbering

oblique view #2

oblique view #2 with numbering

Night Light

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copyright 2011 Peggy Hansen

Photography is all about the light: chasing it, capturing it, using it to make an image that brings that light to life in someone else’s eyes. Light, good or bad, can make or break a picture–think the golden hour, that magic span of breaths before the sun goes down, or the low, soft light right after sunrise.

copyright 2011 Peggy Hansen

How, then, to make a photograph at night, with no sunlight at all? And why would this be worth doing in the first place? Our eyes, it turns out, are but poor guides: things are happening at night that we can’t perceive, seeing as we do in tiny bursts of time that follow on each other’s heels but never quite connect to tell a longer story. At night, the long exposures needed to make images without added light stitch those fleeting bursts into a quilt of mystery, suspense, and revelation: you never know quite what you’ll see after the shutter’s been open 10, 20, even 30 minutes at a stretch.

copyright 2011 Peggy Hansen

The answer, often, is nothing like what you imagined. Over many minutes, moonlight, stars, and the play of shadows compress and combine to make a strange and unexpected beauty. Perhaps most surprising is the color: hues lost to our eyes in the dark loom extravagant in night-time photographs, luxuriant and ripe as orchids.

copyright 2011 Peggy Hansen

Next full moon, go out and find the night, wherever you may be. Sit, or stand, with no goal, desire, or thought in mind for 10 or 20 minutes–just listen, watch, and feel the night around you for a time. Let your ears take in its sounds, your eyes grow accustomed to its subtleties, and your skin absorb its complex texture. Now, if you’re really feeling bold, get your camera, a tripod, and a timer. Frame your shot, open up the shutter, and see what magic you and the night can make together.

copyright 2011 Peggy Hansen

In any language

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copyright 2011 Peggy Hansen

One of the world’s oldest beverages, beer is mentioned in ancient Sumerian poetry, Egyptian texts, and Norse mythology. First brewed as early as 9500 BC, it remains beloved: after water and tea, it’s the third most popular drink worldwide. Though brewed primarily at home for millennia, these days most beer is commercially produced–a change that isn’t always an improvement.

copyright 2011 Peggy Hansen

Like any devotee, I love to try new beers, especially when traveling. This often creates disappointment, but every now and then lightning strikes and I find a new treasure. On a recent trip to Brazil, I followed my custom and tried some of the local beers–produced by large national breweries–and found them devoid of character and charm.

copyright 2011 Peggy Hansen

A quick internet search turned up a possible antidote, and a handful of us agreed to give it a whirl. The congested streets of Sao Paulo, a massive sprawl that covers over 750 square miles, hold many unlikely gems tucked between suco stands and airless shops crammed with cheap T shirts and bootleg DVDs. One such prize, in the center of Pinheiros, is Cervejaria Nacional–a small brew-pub that offers unpasteurized, preservative-free artisanal brews that are a welcome counter to the undistinguished ‘yellow beers’ found elsewhere.

copyright 2011 Peggy Hansen

The entry level showcases gleaming steel fermentation tanks behind plate-glass, an enticing promise that draws visitors upstairs to the bar or restaurant. In the bar, we read the legends of Brazilian spirits Y-iara, Mula, Kurupira, and Sa’Si, as well as the Domina Weiss (the ‘woman in white’ of folklore the world over), and tried to choose among their namesake brews. Chalkboards on the wall displayed SRM (Standard Reference Measure, a scale of color density), IBU (International Bitterness Units–pretty much just what it sounds like, and a reflection of a beer’s ‘hoppiness’ ), and alcohol content for the current batch of all five house-produced beers on tap.

copyright 2011 Peggy Hansen

The sampler, generous glasses of the whole quintet, sparked lively debate about our favorites, and of course required deeper exploration. Accompanied by spicy linguica, delicate farofa, light and crispy batatas frita da casa, tender cubes of polenta frita, and smoky vegetais grelhados, the weiss beer, IPA, and stout were savored by all as we discussed their flavor, color, and complexity. But for the melodic Portuguese being spoken all around us, and the fragrant remnants of the meal, we could have been in any bar, in any country, where beer is loved and celebrated.

copyright 2011 Peggy Hansen

Beer, it seems, is a lot like love. True believers speak a universal language, understood the world over. Malt or malte, cor or color, bouquet or aroma, it’s all about the mystery, experience, and exploration. What happy combination of soil and sunlight, hops and yeast, malt and time, shines in your glass like jewels bright on velvet, and how will it compare to others that have gone before? You never know until you taste, and that anticipation is a sweet intoxicant….near as sweet, and timeless, as the beer itself.

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