suannsong

Live long and explore the natural world.

Wondering About the Nature of Thinking

 

I wonder what goes through a physician’s mind when they move from one patient to another?

How do they wipe their concern and compassion for the previous patient from their consciousness before listening to the next patient’s complaints?

My own physician of over 30 years is kind and compassionate as well as being astute and practical.  In the past few months, I have developed a yet-undiagnosed problem so have had ample time to observe his motion from one exam room to another.

“What can I do for you today?” Is a typical greeting.  He uses a laptop to record my pertinent symptoms and complaints.  He always has to search for previous lab results or consults — I am grateful for computerization because my paper file is about 7 cm thick!  After my visit is complete, he walks to the next exam room — a new patient with a unique history, signs, symptoms, diagnostic findings, etc.

While in the waiting room I have ample time to glance into the office area and its hallway leading to the exam rooms.  I see Dr. L. walk from exam room to exam room.  Always, he seems deep in thought, almost trance-like, sometimes gazing at an open folder (old-fashioned paper, probably containing the patient’s latest “entering complaint”).

His colleage, a younger man, appears in the hall also as he moves from patient to patient.  His demeanor is more extroverted — his gestures are wide and if he is carrying a folder he is swinging it.  He makes more visits to the front desk and the receptionist than does Dr L.  What happens in his mind?  Is there simply more room in his young brain? Is there no need to purge previous details as he goes on to the next patient?  After all, they are stored in the computer’s hard drive.

And does one’s demeanor really give a clue to what is going on in one’s mind?  Adopting the appearance of Rodin’s “The Thinker” may not produce more profundity of thought.  I do still wonder, though, how a busy physician who sees a patient every 10 to 15 minutes, from 8 a.m. to 5 p.m. can accommodate each patient’s needs without completely “wiping the slate clean” after each patient.  Yet there remain many physicians who seem to genuinely relate to a patient.

I don’t know where I am going with my peregrinations so I will close for now.  As a veterinarian, I do not get to engage in a dialogue with my patients; instead, I must carefully dissect what information is presented to me by the human who is attached to the animal.  But that’s another blog…

Listen, Stop, Look

 A few weeks ago, late in the day, I sought refuge from the heat by walking with my dogs in Lighthouse Park.  Running was out of the question because I do not fare well at temperatures above 17 or 18 degrees Celsius.  I didn’t feel guilty about skipping my usual run because I had just worked out at the gym.  I’d had enough exercise for that day and had no need for an aerobic workout.  Walking rather than running gave me a chance to take my binoculars along.

Walking also afforded me a chance to keep my eyes out for newly-sprouted sprigs of holly so I could pull them up, thus making a small contribution to ridding the Park of invasive species.  (Here, I insert a plug for the Lighthouse Park Preservation Society, a small but dedicated group who have been successful in clearing English ivy, holly and Scotch broom from almost all of the park through mass efforts on certain Saturdays through the year).

My eyes often turned upward to the massive douglasfirs and western red cedars, trees which always fill me with a sense of awe.  My ears were tuned to bird sounds.  I heard a very high-pitched, two part sound, coming from high in the canopy.  I wondered if it could be a golden-crowned kinglet.  But at this time of year (late summer), the kinglets are at higher elevations.  I plunked myself down on a large log and began “pishing”.  (Pishing is a technique to attract songbirds – one makes a ridiculous-sounding series of “spishh” sounds and one is often rewarded by several birds coming close, scolding and flitting about).

Still transfixed with a particular tree trunk, I looked through my binocular at the trunk, scanning upward.  Lo and behold, a brown creeper came into close view.  He/she was doing as creepers do – “creeping” upwards and foraging for food items from the crevices in the bark.  I noticed a downy and fresh look to the feathering of this individual.  Could it be a newly-fledged bird?

I had the sense that the sound which had originally caught my attention had come from behind me.  I was right!  The call came again. Then, to my delight, the bird which was calling flew towards the youngster as if to check it out.  Perhaps the parent was reassuring itself that its young one was able to feed itself successfully because it then flew to another tree.  The young one quickly followed.

Such a simple experience; but I was struck by my luck at witnessing this family interaction.  Creepers are cryptically marked, their greyish tan, streaked-with-brown feathering make them almost invisible against the bark of a tree.  If I had not listened, stopped and looked, I would have missed those delightful moments.

Later on the same walk, I heard an eagle call from above.  Why didn’t I stop?  What was the difference between that sound and the one which had intrigued me so?  Maybe it was because I had 100% confidence there was an eagle calling and I was 99% sure I had no chance of seeing it through the dense canopy. (Eagles don’t come down into the lower story of the forest, no matter how much pishing you do!)

My hearing is very good; I can only hope it stays that way throughout my senior years to come.  I may not stop and look for each bird which makes a sound, but identifying birds by ear gives me much pleasure as well as plenty of challenges.

Not Yet Decrepit

“The years between 50 and 70 are the hardest. You are always being asked to do things and yet are not decrepit enough to turn them down.”

T. S. Eliot at age 62, inTime Magazine, 1950

 

When I discovered this apt quote, it was unattributed.  Today I decided to research its origin.  45 minutes later, I have found at least four variations of the wording but am settling on the one above (I found it on this obscure site: http://72.232.177.26/quotes/quote.directory.php?orderBy=source&direction=DESC&page=27.  I chose that version because of the reference details.

I resisted the impulse to read “The Wasteland” again, although I must admit I went downstairs to my library and pulled out Volume II of “Major British Writers” to confirm my memory of studying that epic poem back in 1961 during my first year of college.  There it was, the last selection of the volume.  The introductory notes stated, “In many ways the most influential poem of this century, …”  — of course referring to the 20th century which was still young in 1922.

I love the quote.  It reminds me of the paradox of this stage of my life.  I want to devote most of my time to keeping fit, both mentally and physically so I can fully experience life; but I feel a bit guilty at not devoting more time to my volunteer activities.  Maybe I should feign senility.  I could drool a bit more.  I could complain more.  I could go to bed at 9 pm.  I could stop removing my chin hairs.

That won’t happen.  I will continue to do speeches for Toastmasters and probably join an additional club this fall; I will say, “Yes” when asked to answer questions on the air (Almanac Vancouver); I will continue to serve on committees and Boards when asked.  I can’t imagine those who ask for my help think of me as “decrepit”.  Such a colorful word.  What comes after I become decrepit?  Replacement parts become unavailable?

In less than 2 years, I will be 70.  Will I then cross Eliot’s arbitrary threshold of decrepit-ness? 

Decrepit I may be, but not decrepit enough to stop saying, “Yes”; not just yet.

Brain to World

GETTING STUFF OUT OF ONE’S BRAIN FOR THE PURPOSE OF RECORDING OR COMMUNICATING

Couldn’t think of a title.  The theme which keeps recurring in my blog-brain pertains to difficulties in communicating one’s thoughts to another person. It is easy enough to mess up our verbal communications; and we all know how notorious email communications are for being mis-understood.

The specific example which is occupying all too much of my time right now concerns how different individuals use different processing methods to get their thoughts and messages through to the recipient of those thoughts.

My long-time, very dear friend is of my approximate vintage and has the same degree of education.  He is a North American.  He is well-read. In speech and writing he is expressive and concise.  His vocabulary is huge – greater than mine, for sure.  Yet he does not see why I revel in composing communications via a word processing program vs. his method (typewriter or longhand).  He refuses to get an email address.  I respect that.  Today, I am not blogging about his choice, but rather about his apparent inability to wrap his mind around my comfort with (and, yes, dependence upon) computers when it comes to expressing myself.

His recent letter was a response to a handwritten letter I sent him as a response to several of his communications from earlier in the year.  In it, he mused, “…I continue to be mystified and unimpressed by the email craze.  It reminds me of cultism.  That is, in either case, you must first type out your communique (sic). Then, you must either hit the “send” key or hit the “fax” key. BFD.  What’s the difference for you?…

Now I must point out that Word cannot duplicate the true appearance of the excerpt above.  My friend had used his black ink fountain pen to underline “must” and “type out”.  He added an asterisk after “key” in the second sentence, with the hand-written footnote, “*as I understand it”.

His entire 3 page letter was peppered with corrections and insertions, using that very black, bold pen.  The entire letter was delightful to read; I am not complaining about how he conveys written communications.  I was amused that he compared an email “craze” to cultism.  What would he think of Twitter?  And I am fully cognisant of the fact that many “old” terrific authors and writers can only work in longhand or on a regular typewriter.  Perhaps twirling the platen, striking the carriage return handle, and hearing the sound of the keys are sensory stimulants to creativity for some people.  Double spacing leaves room for hand-written corrections and editing…

In composing this blog, I have used the backspace key at least 100 times.  I have changed formatting; I have rephrased mid-sentence at least a dozen times. I’ve reviewed and added/subtracted.  Is it taking me longer to compose this posting than it did for my friend to compose his 3-page letter to me?  Maybe.  But the rapidity of keystrokes felt good when the thoughts emerged on the fake paper on the blue background in front of me.  Long ago, circa 1989, why did my brain take immediately to composing reports and other communications via word processing? (Why do I still long for Corel Word Perfect?).  I digress.

I understand my friend’s comfort with the style of his choice and have adapted to communicating with him using snail mail and fax.  What I don’t understand is his failure to understand and accept there is some neurologically-based reason for our differences.  He may see this blog if someone prints it out for him.  We can talk about it in real time when I see him.

Skype, anyone?

ER Dilemma

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On a Communication Dilemma of the Emergency Veterinarian

I watched a reality program on Life channel many years ago.  It was about real life human ER cases.  A six-year-old child was presented by the parents to the ER after falling down stairs and being briefly unconscious (or at least unresponsive/somnolent).

After some routine tests (Neurological Exam and CT of brain) showed no visible damage, the ER physician spoke to the parents at the bedside of their little girl. The doctor explained the findings.  He spoke gently but with conviction when he said that he wanted to keep the child overnight for close monitoring of her status.  The parents expressed concern,

“Is that really necessary?” 

“She will be lonely and may cry a lot.”

“We would really like to have her home with us”.

“She seems so normal now, I’m sure she will be fine”

The wise physician answered, “The chances of a serious problem developing overnight are very slim.  But if she should have a delayed bleeding into the brain, we would be able to detect this quickly enough to make the difference between life and death. The chances of this happening would be about one in three thousand.  If this little girl were mine, I wouldn’t take the chance.  I have to say that I feel I must advise you of the risk, however small, of taking your child home now.”

The parents chose to take their daughter home.  She was “perfectly fine” as the owners predicted.

I have a long experience of communicating the urgent needs of the patient to the parents of non-human children.  I have found that very few of the “parents” come back later to accuse me of coercing them into a thorough treatment/diagnostic plan for their pet.  That is the good news.

 The bad news is that on occasion some owners do complain when the outcome is not as bad as we feared:  “You were trying to scare us so you could rip us off”.  And, “You said he could die and you caused us a lot of stress”. 

There is the ethical question:  as ER clinicians, we live in constant fear – yes, fear – that if we are wrong with our assessment of the urgency of a situation, it could mean the difference between life and death.  How far do we go, ethically, to sway an owner’s decision to accept treatment, diagnostic work, surgery and other plans which we genuinely feel are necessary?

 We struggle to not appear alarmist when we discuss our initial plan for a patient.  Sure, sometimes we have happy news, “Your pet does not have chicken bones stuck in his throat; he has kennel cough!”  But many times we have detected ominous signs (such as a suspicious gas pattern on an X-Ray) which, if undertreated or ignored could end up costing more in dollars for the owners as well as a toll on the patients.  How do we practice true emergency medicine rather than “band-aid” medicine and not appear to be pushing owners into agreeing to procedures which, in the cold grey light of dawn (or the grey tones on a repeat X-Ray), may not have been needed?

 In the human ER example I gave above, the doctor did not judge the parents for their decision.  He was upbeat and did not make them feel guilty.  The plan for the parents was to take shifts through the night to supervise the child, waking her hourly (!), checking to see if she was behaving normally.

 I have to ponder how many parents, given the same scenario but who decided to leave the child overnight, would have come down heavily on the doctor for wanting to hospitalize the child “unnecessarily” when they took home a healthy happy child the next day?

Not a one, I think.  Is this because, with pets, there is a monetary factor, often large in an ER setting?

It weighs heavily on me and my bright, young associates when, after a possibly serious situation turns out “just fine”, the owners of the patient direct comments and criticisms our way that imply we had motives other than wanting the best for their patient AND its owner.

Before the establishment of emergency clinics, veterinarians were called out of bed for emergencies.  I can remember many phone calls which awoke me; some could be resolved over the phone.  Most conversations were good ones.  I can remember one in particular from a woman with a dachshund with (I think), bloody diarrhea.  I told the woman we should see her dog at the hospital.  She did not want to travel to the hospital late at night so decided to treat her dog conservatively at home.  The next morning, she called me at work to say her dachshund had died.  But she wanted to thank me very much for talking to her.  She said she had felt so much better after our conversation in the wee small hours of the night. 

Yes, communicating urgency is fraught with complications.

 

Miss Bennee, my English teacher

Blogging is new to me.  Today I will post an old pre-blog rant which I stored on my hard drive.  Reading it today fills me with embarassment.  Not only was I nit-picking, but also I realized the piece is scattered with grammar and syntax mistakes of my own!

Miss Bennee’s teaching during my four years of high school English classes helped mold me into the nit-picker I am today.  Perhaps I will blog about her sometime but for now, here is the rant from earlier this year:

Miss Bennee’s protégé

Is it a curse or a blessing?  My talent (?) for spotting misplaced apostrophes has become an annoyance.  I can’t read past the glaring apostrophes.

This morning, as I was reading the January edition of the Canadian Veterinary Journal, I came across an ad for the highly respected Atlantic Provinces Veterinary Conference (APVC).  Two page spread!  “The Best CE Value in Canada!”

My eyes involuntarily scanned the entire two pages.  AH – HA!  In the lower right hand corner of the second page under “Fees”, popping out (to the exclusion of everything else) was a flurry of misplaced apostrophes.

The list of Fees started out with: “Veterinarians”  and listed the fees.

Next heading under “Fees” was: “AHT’s & Vet’s Assistant’s”

Arghh!

I noted the third category was “Managers” – Well, they got that right.

OK, what exactly was the creator of the ad thinking?  Do the AHTs and the Vets “own” the Assistant(s)?  If only one assistant is possessed by the AHTs and the Vets, what in the world does the “Assistant(s)” possess?  Ah ha!  I got it…. The Assistant(s) possess(es) the FEES!

 Or did the creator or copy person fall into the deplorable habit of adding an apostrophe after an acronym lest we not “get it” that there could be more than one AHT unless they gussy-up the “s” by putting an apostrophe before it?  I guess the writers of the ad fing creating plurals of acronyms is soooooo much more challenging than creating plurals of regular nouns.

Almost Dry!

Almost Dry

I had a wonderful experience on Tuesday at about 7 pm.  It had rained heavily all day.  I was coming back to my house from a short, wet walk with the dogs when I noticed two fledgling chickadees near the ground beside the driveway.  They were soaked right through to their pink skin.  They were perched precariously on small branches of a low-lying plant, at the foot of a sheer rock wall.  Above, I could see the parents flitting about in the tall cedars and pines, calling for their babies.

I put the dogs inside and went out to figure out what to do.  First observation was that the chicks of course could not fly because their feathers were soaked.  I did notice the parents flying down to feed them and saw at least one successful feeding.  I was sure these two were the same fledglings I had seen being fed suet from my feeder on Monday–I knew they had just fledged that day because both their parents had been making solo trips back and forth from my suet for many days previous to Monday — they were taking food back to the babes in the nest.  The young ones were still dependent on the parents for food.  They would wait patiently in the tree near my suet feeder for their suet ‘n nuts feedings.  Their flying skills seemed good, as they would fly from limb to limb for frequent handouts.

Back to that rainy, pre-dusk evening:  I surmised that the place the chicks needed to be was up on the bluff, maybe under the canopy of a big cedar.  A quick call to the inside line of the Wildlife Rescue Association confirmed that my plan to take them inside and dry them off and then re-locate them was the best thing.  Otherwise, they would surely die overnight.  Sunset wasn’t until 9 pm, thank goodness.

As I grasped them from their perch to gently stuff them into a makeshift nest, they let me know they were much more inclined to perch strongly on my fingers than to settle in to the nest.  “We are grown up now; we are programmed to perch and get fed by our mom and dad”.  I managed to dislodge them while I kept them covered and secured for the trip downstairs to my bathroom counter.  I closed the doors to the bathroom so the dogs and cat could not get at them.

I was astounded to find how compliant the babes were!  As I pried them off my finger again, I set them against the rim of the fruit box where they perched, unmoving.  I put the hair dryer on low and started the task of gently blowing them dry.  I used a wooden dental pick (“Stimudents”) to preen their feathers and was amazed again that the feathers slowly regained their form. (The appearance of the feathers when I started was identical to that of an oiled bird’s feathers — I couldn’t believe that simple drying would have such an instant restorative effect).  Doh!  The chicks made me feel dumb because they quickly started to preen themselves.  Wow!  It was really happening — I thought at that point they may have a chance.  This might really work!  The photo attached is at about the 1/2 way mark of the 20 minute session; I wish I had taken one at the very beginning but I was so intent on my mission that I didn’t think of it.

Once I was satisfied with the process of drying and feather fluffing, I took them (in a secure, closed box) up the bluff.  It was still raining.  The parents were flitting about, but were very attentive to me, not in a scolding way, but just “keeping close”.  I will interject at this point that these parents probably recognised me as the entity who also made trips to the feeder to fill it with fresh suet and often called to them with a “pishing” sound.  I placed the chicks, one at a time, on a cedar branch under the canopy, as high as I could reach.  They immediately started calling for Mom and Dad!  Then, much to my continuing amazement, THEY FLEW higher in the tree!  Yippee!  I watched as one headed closer to one parent, the other chick headed the other way towards its favorite parent.  When both were fed, I retreated, feeling so elated.

The postscript to the story is that I have seen the foursome daily around the gardens and the bluff.  And just now, ironically (as I write this account), the parents are taking the last of the suet from the feeder.  I just had the pleasure of opening the deck door and standing close to the feeder.  Neither parent seemed disturbed.  Their kids were calling noisily from the mountain ash tree near the deck.  The overworked parents, with a chunk of suet each in their beaks, flew in to the tree with the goods, greeted with open mouths.  Yes, each parent had their own needy kid.  And it has been raining heavily all day.  The time is 7 pm, just 24 hours after yesterday’s troubles.

 Now, if only the darn neighbors would keep their cats inside…

Poppies_Lesvos