Sunday 31 July 2011
Thursday 28 July 2011
joy
Up in the night for VBAC in posterior position, pushing without progress against a swollen anterior cervical lip. Pushed back the cervix and applied the vacuum cup as posterior as possible, rotating with descent until a healthy baby was delivered. Then home but unable to sleep so I read for a while and finally sleeping again when another call came. I got up and looked out the window at the earliest light of dawn.
The moon was still shining but the sun was fast approaching. I went to work .
Returning later the new day had begun.
The moon was still shining but the sun was fast approaching. I went to work .
Returning later the new day had begun.
I felt joyful for the first time in days.
wigs and a tea cosy
My wife is home. She brought wigs, and a tea cosy which
she knitted from yarn I had found at a craft market.
Wednesday 27 July 2011
sinking
A thought from two am last night following three hard sets of tennis.After putting down my book, turning off the bedside light, sinking down under the covers, and hugging the pillow to my cheek: sleep is delicious.
Tuesday 26 July 2011
filk
How many days do we hear something for the first time? Filk music. Folk music by science fiction fans often shared in a circle, taking turns rather than jamming. The term created by typographical error.
I don't want to hear it.
I don't want to hear it.
fell asleep
Want to write but keep falling asleep sitting up. I wake up choking and coughing each timedddddddddddddddddddd
Monday 25 July 2011
unlimited wealth
Later, youngest child has returned from schoolfriend's house.They had to share a single bed with broken supports. Nobody wins in a divorce and financial hardship is common. This relates to the homework essay which she is doing right now: what would she do if she had unlimited money?
This is also similar to the question which troubles me: what do you do with the hours of your days? Theoretically an endless supply of money would allow endless possibilities but there is not much difference in the human experience once basic needs have been met. If you are warm,well fed and have companionship then unlimited wealth doesn't offer a lot. You can travel in greater comfort but family, friends and work are still the greatest source of fulfilment. If I lost my possessions but had those three things my life would still be good.
Back in Teenage Girl World money will unashamedly buy you travel, expensive houses in rich suburbs and unlimited shopping time with your new famous friends. You can have guitar lessons from the best player in the world and learn kite surfing from experts. You can have a personal maid, hairdresser and fashion designer but I suspect that it is never as good in reality as in concept. To my way of thinking there would be no struggle, no sense of achievement, and no purpose but don't tell that to my daughter.
This is also similar to the question which troubles me: what do you do with the hours of your days? Theoretically an endless supply of money would allow endless possibilities but there is not much difference in the human experience once basic needs have been met. If you are warm,well fed and have companionship then unlimited wealth doesn't offer a lot. You can travel in greater comfort but family, friends and work are still the greatest source of fulfilment. If I lost my possessions but had those three things my life would still be good.
Back in Teenage Girl World money will unashamedly buy you travel, expensive houses in rich suburbs and unlimited shopping time with your new famous friends. You can have guitar lessons from the best player in the world and learn kite surfing from experts. You can have a personal maid, hairdresser and fashion designer but I suspect that it is never as good in reality as in concept. To my way of thinking there would be no struggle, no sense of achievement, and no purpose but don't tell that to my daughter.
Sunday 24 July 2011
border survival
We have a small front lawn with a central path which creates two areas, each of which has border garden bed for the purpose of giving structure to the setting.Three different plantings have been tried and failed. White azaleas were maintained for years in the hope that they would become established. Dead plants were frequently replaced but the garden boundary looked like a smile with some teeth missing.
A more resilient variety of azalea was also unsuccessful. These were replaced by Hebe, which did well until summer. On one notorious day when the temperature reached forty six degrees those plants in the direct sunlight literally cooked. The resemblance to dental decay returned as the affected plants first transformed into lifeless twigs then slowly crumbled. Since then there has been an occasional dispirited discussion about finding a new candidate to define the perimeter of the grass.
The frontrunner is lavender, of which there are a few varieties. They are generally attractive, drought tolerant(since we will never think to water them), not too large and easily trimmed. On the negative side we have one son who finds the smell of lavender nauseating. Rosemary and Dwarf (Is this word discriminatory?) Box are also under consideration. It is not an easy area for a plant to flourish in since it is in shade in winter but receives the full summer sun due to the seasonal change in the angle of the light.
Some energetic people might consider planting a new display of annuals each year but that is beyond the capacity of this family. So lavender it is and perhaps less visits from our younger son when the warmer air broadcasts that distinctive aromatic scent.
A more resilient variety of azalea was also unsuccessful. These were replaced by Hebe, which did well until summer. On one notorious day when the temperature reached forty six degrees those plants in the direct sunlight literally cooked. The resemblance to dental decay returned as the affected plants first transformed into lifeless twigs then slowly crumbled. Since then there has been an occasional dispirited discussion about finding a new candidate to define the perimeter of the grass.
The frontrunner is lavender, of which there are a few varieties. They are generally attractive, drought tolerant(since we will never think to water them), not too large and easily trimmed. On the negative side we have one son who finds the smell of lavender nauseating. Rosemary and Dwarf (Is this word discriminatory?) Box are also under consideration. It is not an easy area for a plant to flourish in since it is in shade in winter but receives the full summer sun due to the seasonal change in the angle of the light.
Some energetic people might consider planting a new display of annuals each year but that is beyond the capacity of this family. So lavender it is and perhaps less visits from our younger son when the warmer air broadcasts that distinctive aromatic scent.
waiting
Approaching four am again.Alone most of the day after the boys returned to the city and my younger daughter caught the train to a friend's house. Not ideal for a thirteen year old to travel unaccompanied but it is a short trip in daylight, on a country service, and she does have a black belt in one of the martial arts.
My wife is not coming home. She has been suffering headaches so she will stay a little longer.
I often think about how I fill the minutes of my day, how I would ideally like to spend my limited time. Am I afraid of the emptiness? Should I think more of the larger picture and let the infinite moments look after themselves? Perhaps I perceive the passing of time too poignantly if I am not occupied, reminding me too much of my mortality. Perhaps I am driven by a work ethic which is ultimately only useful for calming my anxiety. As an only child I should be resilient to episodes of inactivity and perhaps I am, but I am just not sure if that is the best plan.
What would I do if I could do anything? I don't think money is a significant factor. I could own more stuff, drive a more expensive car, but that's not it. I could meet famous people but I would still have to live within the limited floorspace of my own head. In principle I feel that I should be creating something useful, some new construction or knowledge, art or literature. Although... I have created a number of useful things(my children) which are making their gradual way into the world and simply being available may be my most useful contribution to their continued development. It doesn't feel like I am doing something; just waiting isn't the best example of a life for a young person. I would like to retire to my own selfish pursuits but for now I will continue to do the same work, providing a kind of reliable stability while hoping that I will still be capable of intellectual and physical adventure when I am finally free.
Tomorrow I will wait as long as required until my daughter wants to be brought home.
My wife is not coming home. She has been suffering headaches so she will stay a little longer.
I often think about how I fill the minutes of my day, how I would ideally like to spend my limited time. Am I afraid of the emptiness? Should I think more of the larger picture and let the infinite moments look after themselves? Perhaps I perceive the passing of time too poignantly if I am not occupied, reminding me too much of my mortality. Perhaps I am driven by a work ethic which is ultimately only useful for calming my anxiety. As an only child I should be resilient to episodes of inactivity and perhaps I am, but I am just not sure if that is the best plan.
What would I do if I could do anything? I don't think money is a significant factor. I could own more stuff, drive a more expensive car, but that's not it. I could meet famous people but I would still have to live within the limited floorspace of my own head. In principle I feel that I should be creating something useful, some new construction or knowledge, art or literature. Although... I have created a number of useful things(my children) which are making their gradual way into the world and simply being available may be my most useful contribution to their continued development. It doesn't feel like I am doing something; just waiting isn't the best example of a life for a young person. I would like to retire to my own selfish pursuits but for now I will continue to do the same work, providing a kind of reliable stability while hoping that I will still be capable of intellectual and physical adventure when I am finally free.
Tomorrow I will wait as long as required until my daughter wants to be brought home.
Saturday 23 July 2011
home wife
Wife coming home this weekend. She is usually full of positive energy mixed with some disappointment in my poor housekeeping - but what woman wants to return home to find that she isn't needed?
On call and still have a cold. I should sleep.
On call and still have a cold. I should sleep.
synchronicity
Had enough time to notice the first small flowers on the ornamental pear tree, dappled by the delicate morning sunlight.
Arrived in theatre on time but first patient not there. Visited my patients in labour - my secretary's daughter, and the sister of a friend from my tennis competition - both in good early labour. I had promised my friend I would be there for his sister's delivery.Needless to say, my secretary had been telling me for months how important it was for me to be there for her daughter also.
The first operation finally began, a laparoscopy which was more difficult than expected, requiring conversion to an open operation and painstaking dissection to avoid serious injury.The list was running late so we hurried on to another laparoscopy when the midwife rang to say that my secretary's grandchild had a severely depressed heart rate.I hurried to labour ward to arrange an emergency Caesarean section (since there was no resident all week to help) then back to theatre to complete the laparoscopy as the Caesarean was being set up next door. Then I was told that the other heart rate was causing concern.
I was ready to start the Caesarean the moment the epidural anaesthetic top-up was effective. I looked at the clock as I started - the baby was out in sixty seconds, in good health with no obvious cause for the abnormality. I raced through the closure and ran upstairs to the labour ward to find the baby delivered by one of our GP obstetricians in good condition. It was fortunate that she was available, but I was disappointed and apologetic as I repaired the episiotomy.
It seems that I can be in two places at once but not three.
One operation was postponed and the remainder of the list completed, then on to Friday afternoon clinic.There was a call from the local ultrasound service about a twin patient who seemed to have twin-twin transfusion. She needed phone calls and faxes to organize assessment at the teaching hospital department of maternal-fetal medicine but no resident to help and my secretary missing with her office locked (lured away by a new grandson). Nobody answering in the big city hospital. Nobody works on a Friday afternoon. Eventually we agreed to organize the referral on Monday, by which time I was running over an hour late again.
At the end of the day I picked up fish and chips for two sons and youngest daughter, a Friday tradition, though late. While they ate I cleaned up cat droppings and unblocked the toilet, then took one son to a film, returning at nearly midnight.
By then it seemed a lifetime since I had Iooked at those tiny flowers in the pale morning sun.
Friday 22 July 2011
sleep drug
Met my older son coming in this morning as I was going out to work. He is on a mid-year break, staying up all night online, gaming and chatting, going to bed as I am getting up. We hugged and discussed a new social network then I had to leave for clinic.
Discussing care of children with a patient I have known for years. She has a history of attention deficit disorder as a teenager and possible schizoaffective disorder. She has had treatment for anxiety for a long time but says she doesn't need it now because she never gets enough sleep. I know what she means. The tiredness is like a sedative or the effects of mild inebriation.
I went to sleep after four again last night and now I am removed enough from reality to cope with my existence, like taking off your glasses so that the world looks softer, out of focus. I expect there are side effects. The immune system is probably suppressed. Some would say that judgement may be compromised but I disagree. If I had any good judgement to compromise then I wouldn't be doing this work in the first place.
Running from clinic to labour ward and back. Two inductions for fulminating pre-eclampsia, both on hydralazine infusions, one on magnesium as well. One foetal heart rate plummeted, with the head in posterior position. Epidural enough to weaken pushing but not good enough pain relief for rotational forceps. However no rotation or effective descent from vacuum cup, heart rate very slow, so applied forceps and pulled out the baby still facing forwards. Sewed up the tear, wrote up the notes and returned to clinic only an hour behind, apologising to each patient like a recorded message. For saving a life; or at least saving a lot of brain cells from hypoxic death........
..too tired...
Discussing care of children with a patient I have known for years. She has a history of attention deficit disorder as a teenager and possible schizoaffective disorder. She has had treatment for anxiety for a long time but says she doesn't need it now because she never gets enough sleep. I know what she means. The tiredness is like a sedative or the effects of mild inebriation.
I went to sleep after four again last night and now I am removed enough from reality to cope with my existence, like taking off your glasses so that the world looks softer, out of focus. I expect there are side effects. The immune system is probably suppressed. Some would say that judgement may be compromised but I disagree. If I had any good judgement to compromise then I wouldn't be doing this work in the first place.
Running from clinic to labour ward and back. Two inductions for fulminating pre-eclampsia, both on hydralazine infusions, one on magnesium as well. One foetal heart rate plummeted, with the head in posterior position. Epidural enough to weaken pushing but not good enough pain relief for rotational forceps. However no rotation or effective descent from vacuum cup, heart rate very slow, so applied forceps and pulled out the baby still facing forwards. Sewed up the tear, wrote up the notes and returned to clinic only an hour behind, apologising to each patient like a recorded message. For saving a life; or at least saving a lot of brain cells from hypoxic death........
..too tired...
Wednesday 20 July 2011
just breathe
No reason and every reason to be anxious. No reason because it is no help. Every reason because there is potential for disaster in every part of my practice. However, I resolve today to monitor my level of physical tension and loosen the knot in my stomach and the band round my head. Slow breaths. A sigh.
Think of snowdrops, so hopeful despite the chill winds of winter.
No time for lunch, running late then called to labour ward for abnormal foetal heart rate. As I make an assessment the heart rate drops dramatically. She is not yet suitable for vaginal delivery but I set up for it in the hope that it will be suitable by the time we are organized. She is given oxygen and the vacuum cup applied. It allows the head to rotate and descend but it is slow because an epidural weakens her ability to push. I remove the vacuum cup and apply forceps. The baby is born in good condition without any need for stitches to the mother. I am trembling as usual when I return. My secretary says that my antenatal patients are angry at the delay. Good, I expect that. However, they are all charming when I see them.
I am starting to worry about dinner for my daughter...perhaps a convenience meal...they taste better than my cooking.
Saw a woman who had bleeding and was told she had a miscarriage but later found there was a viable embryo. She has been overjoyed at her good fortune but now I cannot find the heartbeat at ten weeks. She is getting changed for a vaginal scan right now............bad luck. Tears. Discussion. Prefers a curette to waiting for a miscarriage to come away but theatre list already too full. We will make inquiries tomorrow. Meanwhile she will go home and tell her husband the news. Prepare her for people's well-meaning advice and attempts at consolation. It seems reasonable to remind someone who has had a miscarriage that they are lucky to have two other healthy children,but to the woman with the pregnancy loss it sounds more like, "Never mind. At least you have two left. So it's really not so bad." Although if you lose another one that might be a problem.
I have learned not to offer consolation to people who are suffering. If you can't fix it then it is better to empathize and just say: "That sucks" when it does.
Still late but clinic ended a little earlier than expected after the last client abused my secretary for the delay then left.We had organized an appointment and operation date at short notice for her benefit ......deep slow breaths .
The other diabetic in labour is making poor progress......sigh.
Think of snowdrops, so hopeful despite the chill winds of winter.
No time for lunch, running late then called to labour ward for abnormal foetal heart rate. As I make an assessment the heart rate drops dramatically. She is not yet suitable for vaginal delivery but I set up for it in the hope that it will be suitable by the time we are organized. She is given oxygen and the vacuum cup applied. It allows the head to rotate and descend but it is slow because an epidural weakens her ability to push. I remove the vacuum cup and apply forceps. The baby is born in good condition without any need for stitches to the mother. I am trembling as usual when I return. My secretary says that my antenatal patients are angry at the delay. Good, I expect that. However, they are all charming when I see them.
I am starting to worry about dinner for my daughter...perhaps a convenience meal...they taste better than my cooking.
Saw a woman who had bleeding and was told she had a miscarriage but later found there was a viable embryo. She has been overjoyed at her good fortune but now I cannot find the heartbeat at ten weeks. She is getting changed for a vaginal scan right now............bad luck. Tears. Discussion. Prefers a curette to waiting for a miscarriage to come away but theatre list already too full. We will make inquiries tomorrow. Meanwhile she will go home and tell her husband the news. Prepare her for people's well-meaning advice and attempts at consolation. It seems reasonable to remind someone who has had a miscarriage that they are lucky to have two other healthy children,but to the woman with the pregnancy loss it sounds more like, "Never mind. At least you have two left. So it's really not so bad." Although if you lose another one that might be a problem.
I have learned not to offer consolation to people who are suffering. If you can't fix it then it is better to empathize and just say: "That sucks" when it does.
Still late but clinic ended a little earlier than expected after the last client abused my secretary for the delay then left.We had organized an appointment and operation date at short notice for her benefit ......deep slow breaths .
The other diabetic in labour is making poor progress......sigh.
Tuesday 19 July 2011
eyes, pies
Another Monday morning, eighth day on call.Getting another cold. Forgot to take the bins down last night so no rubbish collected.
Start theatre with a twin Caesarian, then a couple of curettes and a hysterectomy. Transfer a twenty-five week pregnancy with heavy bleeding and threatened labour by helicopter and treat two women with hyperemesis who are both sitting in the corridor of the casualty department, both greenish and exhausted; then a ward round including an insulin-dependent diabetic with pre-eclampsia who would rather be home. I say to her: me too.
I do manage to get home for lunch and a few minutes of quiet reading
while the cat enjoys the brief anomalous sunshine in the middle of a miserable cold wet day, lying on the rug we bought in Turkey on a windsurfing holiday we thought would be one of many but has not been repeated in twenty-five years.
It is a traditional hand-made kelle from Milas using only natural dyes such as tobacco and cochineal, and avoiding any images of living things. It is not as bright as the more popular designs but gives us a feeling of natural warmth and constantly reminds us of our sunny Mediterranean holiday.
Returning to work it becomes dark and rains heavily.
The afternoon clinic is a random selection. One of my patients is taking "chia" for the calcium content. I have not heard of it so I look it up on Wikipedia. It is a type of Salvia (Salvia hispanica), the largest group in the mint family, which includes culinary sage (Salvia officinalis) and a number of ornamental garden plants. It doesn't look very appetising.
My last patient has a familiar family name and I find that she is the niece of a friend from my schooldays, my old chemistry prac partner who dropped out of medicine to have a baby.There is a strong family resemblance. It is distracting to be looking at those same eyes that I once knew so well, evoking emotional memories from my turbulent adolescence. There was some interest on both sides, I like to think, but possibilities were overtaken by events, and now here I am, disconcertingly staring into the same eyes. She tells me a little of her many aunts and uncles, but they are not an important part of her life which revolves more around her marriage and religious community.At length I recover myself and continue with the consultation. God forbid that your doctor once fancied your aunt in ancient times.
Later I collect some pies from the supermarket for dinner with my daughter. As I enter the driveway the bins are still sitting undisturbed by the road. Over dinner I tell my daughter about this patient who reminds me of my past life, keeping confidentiality of course. She waits for me to finish and says that she likes the pies, and can I take her into school tomorrow?
Start theatre with a twin Caesarian, then a couple of curettes and a hysterectomy. Transfer a twenty-five week pregnancy with heavy bleeding and threatened labour by helicopter and treat two women with hyperemesis who are both sitting in the corridor of the casualty department, both greenish and exhausted; then a ward round including an insulin-dependent diabetic with pre-eclampsia who would rather be home. I say to her: me too.
I do manage to get home for lunch and a few minutes of quiet reading
while the cat enjoys the brief anomalous sunshine in the middle of a miserable cold wet day, lying on the rug we bought in Turkey on a windsurfing holiday we thought would be one of many but has not been repeated in twenty-five years.
It is a traditional hand-made kelle from Milas using only natural dyes such as tobacco and cochineal, and avoiding any images of living things. It is not as bright as the more popular designs but gives us a feeling of natural warmth and constantly reminds us of our sunny Mediterranean holiday.
Returning to work it becomes dark and rains heavily.
The afternoon clinic is a random selection. One of my patients is taking "chia" for the calcium content. I have not heard of it so I look it up on Wikipedia. It is a type of Salvia (Salvia hispanica), the largest group in the mint family, which includes culinary sage (Salvia officinalis) and a number of ornamental garden plants. It doesn't look very appetising.
My last patient has a familiar family name and I find that she is the niece of a friend from my schooldays, my old chemistry prac partner who dropped out of medicine to have a baby.There is a strong family resemblance. It is distracting to be looking at those same eyes that I once knew so well, evoking emotional memories from my turbulent adolescence. There was some interest on both sides, I like to think, but possibilities were overtaken by events, and now here I am, disconcertingly staring into the same eyes. She tells me a little of her many aunts and uncles, but they are not an important part of her life which revolves more around her marriage and religious community.At length I recover myself and continue with the consultation. God forbid that your doctor once fancied your aunt in ancient times.
Later I collect some pies from the supermarket for dinner with my daughter. As I enter the driveway the bins are still sitting undisturbed by the road. Over dinner I tell my daughter about this patient who reminds me of my past life, keeping confidentiality of course. She waits for me to finish and says that she likes the pies, and can I take her into school tomorrow?
Sunday 17 July 2011
sunday market
On call but allowed to sleep overnight so woke up fresh to go to a country market. Could not get daughter to come. Bed too nice. So went alone.
Disconcertingly my secretary was directing traffic at the gate. She smiled and said hello as I drove past to the parking area.
There was a man selling Stick Insects.
A stall was selling olive oil from my home town.
My favourite was the cupcakes.
The surrounding countryside was a picture of rural tranquillity.
Disconcertingly my secretary was directing traffic at the gate. She smiled and said hello as I drove past to the parking area.
There was a man selling Stick Insects.
A stall was selling olive oil from my home town.
My favourite was the cupcakes.
The surrounding countryside was a picture of rural tranquillity.
Saturday 16 July 2011
foggy then fine
Nearly two am and I can hear my thirteen year old talking to her older sister on Skype.At least it is the weekend.They have been together during the week, watching romantic films and going to dance exercise classes, while their mother is having treatment and I have been too busy to stop for a meal.
............................................
I woke up to a foggy morning and drove in for the operating list.
There were two in labour ward exhausted from irregular but persistent contractions. Between cases arranged for an epidural and oxytocin infusion for each, and did a ward round. Told that all our residents are away on exam leave next week. I will have to do all their clerical work as well as manage labour ward and clinic, starting after eight days and nights already on call. I'm not sure if I can cope, not so much psychologically but logistically. Ok, psychologically too.
No surgical complications, finished on time for once so home briefly for lunch and talk with my mother who comes over and does housework every couple of days. We have come so far since my childhood yet here we are again, just me and my mother, in a tiny oasis of time, all of our mutual history telescoped into a few minutes of sunshine and tea stolen from the working day. She has ironed my shirts and put away the dry dishes. We discuss the news of the day and the progress of the children, now moving into the world so fast, and suddenly I am in clinic counting down the appointments until the end of the week.
I run up to the labour ward for a delivery which is quick but followed by more than a litre of blood loss.It settles then back to clinic. The other patient in labour seems to be making no progress . I feel pessimistic but allow labour to continue. The clinic also goes on. I see a woman who bled over three litres with her last baby nearly four years ago.She has had difficulty dealing with her reactions to the birth and her nearness to death but is pregnant again. I used nearly every treatment to stop her bleeding, finally succeeding by inserting a balloon device inside the uterus. She still has misgivings but cannot turn back.
The resident calls during the last consultation of the day. That other patient now has a worrying foetal trace and has not progressed in the last few hours. I concede and suggest we organize a Caesarian delivery while I finish in the rooms.I am disappointed as my daughter will have returned and will be on her own at home.I had hoped to prepare a meal. I call her and suggest she heat up a meal I had saved.
As I leave the room a midwife calls to say the trace is now normal and the patient would like to try a little longer. I agree but decide to stay and do some paperwork, checking results and calling patients. Nothing happens so I call my daughter and say I will join her for the meal. As I insert the car key in the ignition, my phone rings. The foetal heartbeat has worsened. I hurry to the labour room without time to call my daughter.
The cervix is fully dilated so the baby is delivered by vacuum cup, fortunately in vigorous good condition but there is bleeding. I massage the uterine fundus to help it contract and pull gently on the cord which immediately detaches from the placenta - still stuck inside the uterus and preventing the uterine contraction which is required to stop the bleeding. Blood pours freely from the vagina. The patient is given nitrous oxide gas as I reach in to remove the placenta. It will not come easily. A major portion is firmly attached to the lower segment of the uterus. It needs to be removed as the bleeding is not slowing down and yet the lower segment contains few muscle fibres and so will not contract well therefore potentially adding to the bleeding problem. By this stage the gas and blood loss have resulted in loss of consciousness so I reach inside the uterus and detach the placenta piece by tiny piece, removing my hand at intervals to try to pull out the whole placenta. It refuses to come out in one piece. Looking down, my arm has disappeared into the vagina to half way up my forearm which is coated with still clotting blood. At times my patient groans and she momentarily wakes up in the middle of the procedure. The bleeding continues. The laboratory is cross-matching blood as quickly as possible. We are running in fluid through the drip.
Eventually the last of the placenta has been removed but this leaves a seemingly huge floppy area with unconstricted blood flow. She has been given oxytocin, ergometrine and rectal misoprostol without much effect. I bimanually compress the flaccid posterior lower uterine segment which does seem to somewhat reduce the flow. I ask for an intra uterine balloon device and, while keeping my arm inside the pelvis to maintain pressure, survey the surrounds for blood loss. There are two kidney dishes full of blood, each holding at least a litre, and quite a lot of blood soaked into into packs and bedding. Then the midwife looks under the bed to find a spreading pool of blood and clots, probably another litre or more. If much more blood is lost the bleeding will become even worse from lack of clotting factors and the possible development of disseminated intravascular coagulation, from which there might be no return.
The husband leaves the room looking paler than his wife.
In total there is probably well over three litres of blood loss and more collecting above my hand in the vagina when the balloon catheter arrives. As usual it has a thick instruction booklet so we look at a diagram to ensure it is properly set up then I guide it into the uterine cavity. Five hundred ml of fluid is gradually inserted into the balloon. I can feel the apparatus slowly pushing against the tissues, firmly in the end, and remove my hand from the pelvis with trepidation.The bleeding has stopped.
Blood arrives and transfusion commenced. The husband returns and looks at the baby with his wife who is now awake with only a hazy memory of events. I write notes and drive home in a post adrenaline daze wondering what my reputedly self-obsessed teenage daughter has made of my absence. I can smell cooked food as I enter but I am disheartened to see that there is none left in the container.Then I look up to see my daughter smiling .The table is set for two and dinner is served with a freshly made pot of tea.
She asks me how my day has been and shows me the clothes she bought in the city.
Later she talks to her sister on Skype.
............................................
I woke up to a foggy morning and drove in for the operating list.
There were two in labour ward exhausted from irregular but persistent contractions. Between cases arranged for an epidural and oxytocin infusion for each, and did a ward round. Told that all our residents are away on exam leave next week. I will have to do all their clerical work as well as manage labour ward and clinic, starting after eight days and nights already on call. I'm not sure if I can cope, not so much psychologically but logistically. Ok, psychologically too.
No surgical complications, finished on time for once so home briefly for lunch and talk with my mother who comes over and does housework every couple of days. We have come so far since my childhood yet here we are again, just me and my mother, in a tiny oasis of time, all of our mutual history telescoped into a few minutes of sunshine and tea stolen from the working day. She has ironed my shirts and put away the dry dishes. We discuss the news of the day and the progress of the children, now moving into the world so fast, and suddenly I am in clinic counting down the appointments until the end of the week.
I run up to the labour ward for a delivery which is quick but followed by more than a litre of blood loss.It settles then back to clinic. The other patient in labour seems to be making no progress . I feel pessimistic but allow labour to continue. The clinic also goes on. I see a woman who bled over three litres with her last baby nearly four years ago.She has had difficulty dealing with her reactions to the birth and her nearness to death but is pregnant again. I used nearly every treatment to stop her bleeding, finally succeeding by inserting a balloon device inside the uterus. She still has misgivings but cannot turn back.
The resident calls during the last consultation of the day. That other patient now has a worrying foetal trace and has not progressed in the last few hours. I concede and suggest we organize a Caesarian delivery while I finish in the rooms.I am disappointed as my daughter will have returned and will be on her own at home.I had hoped to prepare a meal. I call her and suggest she heat up a meal I had saved.
As I leave the room a midwife calls to say the trace is now normal and the patient would like to try a little longer. I agree but decide to stay and do some paperwork, checking results and calling patients. Nothing happens so I call my daughter and say I will join her for the meal. As I insert the car key in the ignition, my phone rings. The foetal heartbeat has worsened. I hurry to the labour room without time to call my daughter.
The cervix is fully dilated so the baby is delivered by vacuum cup, fortunately in vigorous good condition but there is bleeding. I massage the uterine fundus to help it contract and pull gently on the cord which immediately detaches from the placenta - still stuck inside the uterus and preventing the uterine contraction which is required to stop the bleeding. Blood pours freely from the vagina. The patient is given nitrous oxide gas as I reach in to remove the placenta. It will not come easily. A major portion is firmly attached to the lower segment of the uterus. It needs to be removed as the bleeding is not slowing down and yet the lower segment contains few muscle fibres and so will not contract well therefore potentially adding to the bleeding problem. By this stage the gas and blood loss have resulted in loss of consciousness so I reach inside the uterus and detach the placenta piece by tiny piece, removing my hand at intervals to try to pull out the whole placenta. It refuses to come out in one piece. Looking down, my arm has disappeared into the vagina to half way up my forearm which is coated with still clotting blood. At times my patient groans and she momentarily wakes up in the middle of the procedure. The bleeding continues. The laboratory is cross-matching blood as quickly as possible. We are running in fluid through the drip.
Eventually the last of the placenta has been removed but this leaves a seemingly huge floppy area with unconstricted blood flow. She has been given oxytocin, ergometrine and rectal misoprostol without much effect. I bimanually compress the flaccid posterior lower uterine segment which does seem to somewhat reduce the flow. I ask for an intra uterine balloon device and, while keeping my arm inside the pelvis to maintain pressure, survey the surrounds for blood loss. There are two kidney dishes full of blood, each holding at least a litre, and quite a lot of blood soaked into into packs and bedding. Then the midwife looks under the bed to find a spreading pool of blood and clots, probably another litre or more. If much more blood is lost the bleeding will become even worse from lack of clotting factors and the possible development of disseminated intravascular coagulation, from which there might be no return.The husband leaves the room looking paler than his wife.
In total there is probably well over three litres of blood loss and more collecting above my hand in the vagina when the balloon catheter arrives. As usual it has a thick instruction booklet so we look at a diagram to ensure it is properly set up then I guide it into the uterine cavity. Five hundred ml of fluid is gradually inserted into the balloon. I can feel the apparatus slowly pushing against the tissues, firmly in the end, and remove my hand from the pelvis with trepidation.The bleeding has stopped.
Blood arrives and transfusion commenced. The husband returns and looks at the baby with his wife who is now awake with only a hazy memory of events. I write notes and drive home in a post adrenaline daze wondering what my reputedly self-obsessed teenage daughter has made of my absence. I can smell cooked food as I enter but I am disheartened to see that there is none left in the container.Then I look up to see my daughter smiling .The table is set for two and dinner is served with a freshly made pot of tea.
She asks me how my day has been and shows me the clothes she bought in the city.
Later she talks to her sister on Skype.
Friday 15 July 2011
modern medicine
Operating theatre early this morning then afternoon clinic and weekend on call. The days are passing slowly. Our youngest daughter returns to school next week, but my wife plans to spend another week in hospital.
Whenever I call her she is driving her car.
Whenever I call her she is driving her car.
mediocre
Driving to work in sunshine after overnight rain. Bare branches of the deciduous trees glistening. The grass green and fresh. Suddenly I feel self loathing. I should get up earlier and do a proper ward round. I should organise my clinics better so I have time for other work. I should support the residents more, be like the stern confident consultants who taught me.I am inadequate. I make poor choices. Poor choices. I don't review my patients often enough, always stuck in clinic, but never able to see enough. My waiting time is too long. I should have worked in the city, earned more money, had more time for everything.
People are too kind. The resident respectfully waits to discuss the progress of the inpatients. In the clinic the public are friendly and polite.I don't deserve their consideration. I am a fraud.
After answering a question I tell one woman that I really can't speak with any authority. I am just making it up as best I can. She laughs and thanks me for my effort anyway.
The relentless clinic rolls on. GPs call me for advice and I tell them I don't really know but perhaps they could try my suggestion. They would almost certainly get a more correct response from another specialist, but they seem happy with my proposals.
As the day progresses the hallway is being painted. The paint fumes are so strong and pervasive that I start to feel loose, relaxed, slightly high. I care a little less.
Someone fails to attend so I do a ward round and sort things out like a real doctor. Although I felt that they must resent me, the midwives seemed pleased to see me. Plans are established and confidence rises. Responsibility is being taken.
The day eventually ends. I am drained but less afflicted with despair. As I am packing to leave I am called to the labour ward to manage a third degree tear. I am supposed to be off duty for this one night except for emergencies but I feel oddly cheerful about this injustice as I go up to assess the injury. Subsequently, in contrast with my mood of crushing inadequacy, the repair is surprisingly easy. The staff seem to value my work but a more impressive obstetrician, the one I once hoped to be, would have arranged a formal procedure in theatre. I just leaned over and sewed it back into place. My technique has always had a good long-term outcome despite the informality but I am sure it would be frowned upon in a big city hospital. The patient was treated quickly, with good anatomical apposition, and wasn't separated from her newborn baby. That will have to suffice. I am a mediocre country workhorse but better than nothing.
Perhaps it is the effect of the paint fumes, but for the moment I feel that I can live with that.
People are too kind. The resident respectfully waits to discuss the progress of the inpatients. In the clinic the public are friendly and polite.I don't deserve their consideration. I am a fraud.
After answering a question I tell one woman that I really can't speak with any authority. I am just making it up as best I can. She laughs and thanks me for my effort anyway.
The relentless clinic rolls on. GPs call me for advice and I tell them I don't really know but perhaps they could try my suggestion. They would almost certainly get a more correct response from another specialist, but they seem happy with my proposals.
Someone fails to attend so I do a ward round and sort things out like a real doctor. Although I felt that they must resent me, the midwives seemed pleased to see me. Plans are established and confidence rises. Responsibility is being taken.
The day eventually ends. I am drained but less afflicted with despair. As I am packing to leave I am called to the labour ward to manage a third degree tear. I am supposed to be off duty for this one night except for emergencies but I feel oddly cheerful about this injustice as I go up to assess the injury. Subsequently, in contrast with my mood of crushing inadequacy, the repair is surprisingly easy. The staff seem to value my work but a more impressive obstetrician, the one I once hoped to be, would have arranged a formal procedure in theatre. I just leaned over and sewed it back into place. My technique has always had a good long-term outcome despite the informality but I am sure it would be frowned upon in a big city hospital. The patient was treated quickly, with good anatomical apposition, and wasn't separated from her newborn baby. That will have to suffice. I am a mediocre country workhorse but better than nothing.
Perhaps it is the effect of the paint fumes, but for the moment I feel that I can live with that.
Wednesday 13 July 2011
wednesday
Woke with the cat peering intently into my face, nose against the tip of my nose. Then late to work after discovering that the cat has been using the lounge room carpet as a toilet. He will spend his nights in the laundry for the next week or so.
In the clinic:
Abnormal cervix though smear report was ok. GP would like it checked. Everyone naturally anxious at these appointments so I just keep talking. People often ask about my family so I tell them about my children or anything from my past which might resonate or distract. I am not a very private person.
Labour ward is collecting women - two inductions of labour, a planned vaginal birth after Caesarian, and now another with bleeding and pain at twenty eight weeks. Meanwhile the clinic goes on.
Check after laser treatment. Waiting to find out if it is safe to try for a pregnancy. Pretty, but with a turned eye, which would have been prevented if she had been born here. Taking her folate tablets, but wants to know if her husband should be taking any tablets as well. Not been asked that before.
Heavy painful periods despite intrauterine hormonal treatment. Wants hysterectomy. In view of pain and tenderness and failed conservative management - agreed.
Heavy painful periods with fibroid but significant medical problems, not ideal but safer to do endometrial ablation. She would prefer hysterectomy but nearly at menopause so may not need to put her at risk. Arranged ablation.
Vulval itch despite oestrogen, steroid cream, swabs. Biopsy.
Must pay urgent tax bill but no time, wife usually does it. Secretary rings her in hospital - can she pay online with smartphone? Now one and a half hours behind in clinic and may need to go to labour ward.
Left ovarian mass, small, unchanged in six months, benign looking on ultrasound today. Review in six months.
Antenatal reviews by fifteen, and new antenatal patient for repeat VBAC, but concerned about size of baby. Last baby 4.5 kg.
Twins then triplets.
Wife has paid bills from her hospital room. She seems quite well if a little bright.
Finished clinic at eight thirty, without a break since nine am, after calling patients with results, and returning calls. Rising beta hCG after ectopic pregnancy - will need methotrexate; good response to clomiphene - can continue with current dose; severe dysplasia - needs to arrange a day for laser treatment.Unexplained foetal death at seventeen weeks has just delivered, but no sign of the cause. Order tests but small chance of finding an answer.
No immediate problems in labour ward, so home until called in.
In the clinic:
Abnormal cervix though smear report was ok. GP would like it checked. Everyone naturally anxious at these appointments so I just keep talking. People often ask about my family so I tell them about my children or anything from my past which might resonate or distract. I am not a very private person.
Labour ward is collecting women - two inductions of labour, a planned vaginal birth after Caesarian, and now another with bleeding and pain at twenty eight weeks. Meanwhile the clinic goes on.
Check after laser treatment. Waiting to find out if it is safe to try for a pregnancy. Pretty, but with a turned eye, which would have been prevented if she had been born here. Taking her folate tablets, but wants to know if her husband should be taking any tablets as well. Not been asked that before.
Heavy painful periods despite intrauterine hormonal treatment. Wants hysterectomy. In view of pain and tenderness and failed conservative management - agreed.
Heavy painful periods with fibroid but significant medical problems, not ideal but safer to do endometrial ablation. She would prefer hysterectomy but nearly at menopause so may not need to put her at risk. Arranged ablation.
Vulval itch despite oestrogen, steroid cream, swabs. Biopsy.Must pay urgent tax bill but no time, wife usually does it. Secretary rings her in hospital - can she pay online with smartphone? Now one and a half hours behind in clinic and may need to go to labour ward.
Left ovarian mass, small, unchanged in six months, benign looking on ultrasound today. Review in six months.
Antenatal reviews by fifteen, and new antenatal patient for repeat VBAC, but concerned about size of baby. Last baby 4.5 kg.
Twins then triplets.
Wife has paid bills from her hospital room. She seems quite well if a little bright.
Finished clinic at eight thirty, without a break since nine am, after calling patients with results, and returning calls. Rising beta hCG after ectopic pregnancy - will need methotrexate; good response to clomiphene - can continue with current dose; severe dysplasia - needs to arrange a day for laser treatment.Unexplained foetal death at seventeen weeks has just delivered, but no sign of the cause. Order tests but small chance of finding an answer.
No immediate problems in labour ward, so home until called in.
Tuesday 12 July 2011
time out
Six fifteen, no lunch and still an hour of antenatal clinic to go.
No one is at home tonight anyway.....
finished at eight thirty.....
but it has been nine forty three all day by the clock on the wall.
No one is at home tonight anyway.....
finished at eight thirty.....
but it has been nine forty three all day by the clock on the wall.
first day back
Theatre list, new medical students to tutor, a week of test results to review, an unexpected foetal death to counsel, late in the clinic and now an abnormal foetal heart rate in an insulin dependent diabetic in labour -not quite ready for vaginal delivery but almost. Is it safe to wait or not? In another room the foetal heart rate is too slow but also not enough to intervene...
now the diabetic heart rate is improved enough to wait. Though it could need urgent action at any time, the clinic must go on....
clinic finished, no one delivered yet, and now two cases of severe pre-eclampsia admitted for management, need to cook dinner for daughter since no one else home. Up to labour ward and hope there is time to get home for long enough to get a meal ready.
The night entry is dark and deserted. Labour ward is bright. I visit everyone then come back to the one who needs delivery. I follow the rules. If the safety criteria are met then so far mother and baby have always been well. The head is well in the pelvis, cervix fully dilated, position clearly known though directly OP, and there is an effective epidural. Forceps are easily applied, the head easily rotated, then as soon as traction is applied the foetal heart rate drops, then is undetectable, possibly ok but not certain. With the strong epidural maternal push is reduced and delivery is slow. The midwife checks but theatre staff are not in the hospital, so Caesarian section would take a long time. There is gradual descent, but it seems to be barely moving, imperceptible, then minute, then a slight change, and another small advance, while a sickening anxiety seeps into my spirit, catastrophic scenarios flowering in my imagination.
The paediatrician arrives and I feel a little more secure. The head is definitely progressing but is it too slow? I persist in a state of despair. It is now certain to deliver vaginally. I cut an episiotomy which I would not usually do but I want every possible advantage for the delivery... then the head comes through.....but the shoulders are stuck, pulling on the head is not working, so I reach up into the pelvis and then abdomen and grasp the axilla, pulling the shoulder down and rotating shoulder and head so that the other shoulder also comes down and the baby is delivered.
I place the floppy wet baby on its mother's abdominal skin with a sinking feeling....its head lolls back tonelessly. The mother cranes forward and her pale stunned husband leans over and asks if the baby is alright. It is momentarily obscured while I hear a faint sound, and I dare to hope. Next time I am sure the baby has given a faint cry and the paediatrician takes her to the resuscitation cot.
Within a minute she is pink. A few minutes later, when I am suturing the perineum, I glance up to see the little girl looking intently into her father's eyes with that unnervingly direct newborn gaze. There will be forceps marks for a few days but all is well and everyone else seems unfazed. I am covered in a cold sweat, trembling as I stitch, unable to shed my depressing feeling of despondency despite the happy outcome. I struggle with a loss of hope and confidence. After finishing the repair I write my notes, talk briefly to the resident doctor and a medical student then return home to cook dinner for my daughter and myself, expecting to do it all again later tonight, and the next eight days and nights in a row.
now the diabetic heart rate is improved enough to wait. Though it could need urgent action at any time, the clinic must go on....
clinic finished, no one delivered yet, and now two cases of severe pre-eclampsia admitted for management, need to cook dinner for daughter since no one else home. Up to labour ward and hope there is time to get home for long enough to get a meal ready.
The paediatrician arrives and I feel a little more secure. The head is definitely progressing but is it too slow? I persist in a state of despair. It is now certain to deliver vaginally. I cut an episiotomy which I would not usually do but I want every possible advantage for the delivery... then the head comes through.....but the shoulders are stuck, pulling on the head is not working, so I reach up into the pelvis and then abdomen and grasp the axilla, pulling the shoulder down and rotating shoulder and head so that the other shoulder also comes down and the baby is delivered.
I place the floppy wet baby on its mother's abdominal skin with a sinking feeling....its head lolls back tonelessly. The mother cranes forward and her pale stunned husband leans over and asks if the baby is alright. It is momentarily obscured while I hear a faint sound, and I dare to hope. Next time I am sure the baby has given a faint cry and the paediatrician takes her to the resuscitation cot.
Within a minute she is pink. A few minutes later, when I am suturing the perineum, I glance up to see the little girl looking intently into her father's eyes with that unnervingly direct newborn gaze. There will be forceps marks for a few days but all is well and everyone else seems unfazed. I am covered in a cold sweat, trembling as I stitch, unable to shed my depressing feeling of despondency despite the happy outcome. I struggle with a loss of hope and confidence. After finishing the repair I write my notes, talk briefly to the resident doctor and a medical student then return home to cook dinner for my daughter and myself, expecting to do it all again later tonight, and the next eight days and nights in a row.
Monday 11 July 2011
work-dread
Sunday night work-dread worse after a week off. It seems increasingly hard to do.
A cold wind is gusting in the dark.
A cold wind is gusting in the dark.
Sunday 10 July 2011
blur
Sleep after six am, up at eleven to take F and friends to station for train trip to city to go on the Ferris Wheel. I drop them and drive directly to the city, passing the Wheel while they are still on the train, but for the girls the journey is definitely more important than the destination.
Visit my wife. She seems well. We soon run out of conversation so I read the paper. She doesn't want to go outside so I explore the local shops.
I buy a present for the cat.
When I return her brother is relating his latest romantic debacle in epic detail in the cafeteria. None of the children are free so I eat on my own at a Chinese restaurant......
and return home.
The trip is a blur.....
then I am inside the house....
forced to watch latest episode of Glee. They lose. But learn lessons.
Give present to cat.
Up early tomorrow for last day of holiday
Must cut fingernails.
.
Visit my wife. She seems well. We soon run out of conversation so I read the paper. She doesn't want to go outside so I explore the local shops.
I buy a present for the cat.
When I return her brother is relating his latest romantic debacle in epic detail in the cafeteria. None of the children are free so I eat on my own at a Chinese restaurant......
and return home.
The trip is a blur.....
then I am inside the house....
forced to watch latest episode of Glee. They lose. But learn lessons.
Give present to cat.
Up early tomorrow for last day of holiday
Must cut fingernails.
.
Saturday 9 July 2011
Friday 8 July 2011
film review group
Saw the film "Tree of Life" with the three younger children, and, as we did earlier this year after watching "Sucker Punch", we gathered afterward in a pancake-themed restaurant for drinks (non-alcoholic) and analysis of the film.But first about Sucker Punch.
We found SP to be so interesting to understand and interpret that later we each individually read the reviews of the film to compare insights.We each then had the disappointment of finding those reviews to be superficial and critical ( mainly because the girls in the film are sexually objectified - yet that is part of the point the film is making visually, and their various outfits are not nearly as lewd or revealing as the reviewers repeatedly write) in the same repetitive way. Eventually there were one or two blogs with a perceptive translation of the film's many-layered and multiply coexisting possible realities. Yes the reviewers were potentially correct in their literal interpretations of the basic plot but failed to recognize or acknowledge the overlapping alternatives.
The Babydoll character might possibly be intended as real, and might really have fought off an attempted sexual assault only to find that this causes her sister to be the next victim who she then accidentally kills while trying to protect her.The gruesome mental institution might also possibly be real as might the rather one dimensional inmates.But there is something so archetypal about the characters and the setting that they would seem more likely to be metaphors for the psychological reactions which have occurred in a victim of sexual abuse. They are her defence mechanisms for the survival of her essential self. Since they represent different aspects of her personality and coping behaviour it is then no surprise that they have limited character development.The fearsome harshness of the building and its ludicrous name ("Lennox House for the Mentally Insane" - what other type of insanity is there?) represent her psychological reality.
Even the identity of the main protagonist is debatable, either Babydoll if you believe in the physical reality of the highly stylized story as presented, or Sweetpea who is suggested in voiceover and is the obvious survivor at the end.
There is also a theme of guardian angels such as the Wise Man who becomes the bus driver rescuer at the end, and may also include all of the girls with their different contributions to survival. The opening voiceover says"Everyone has an angel, a guardian who watches over us. We can't know what form they'll take: one day old man, next day little girl....... they are not here to fight our battles but to whisper from our heart, reminding that it is.....every one of us who holds the power over the worlds we create." Babydoll herself could be a real person, a real person who is also acting as an agent of a guardian angel, an actual guardian angel, or a survival mechanism which may represent her compliance with her own or her sister's abuse, her ability to block out her abuse or her courage in enduring the abuse.
The more obvious fantasy scenes of fighting back might be a type of psychological resistance but, contrary to the interpretation of most reviews, they are not a gallant direct defiance of her abuser since they occur during episodes strongly implying sexual violation. They seem designed to hide the defilement from her own awareness, since the viewer never sees what is really happening during those episodes. If Babydoll's battles represent her fight for emotional survival while still hiding the actual abuse behind the cloak of a mesmerising dance then her lobotomy at the conclusion of the film represents an end to this collusion and supports the notion that Sweetpea has made her real-life escape, or has made progress towards her psychological recovery by refusing to hide the crimes any more and allowing help to come. Help doesn't arrive until Babydoll, that unrealistic and inappropriate combination of the child-like and erotic,is gone. For the viewer who has become attached to her as a real character this is a bitterly unhappy ending, a metaphorical sucker punch, and a likely cause of some of the obvious dissatisfaction with the film.
As a whole the film shows how uncontrolled male aggression can threaten the very integrity of the female mind, causing it to fragment in order to survive. There is also a message that rescue may come too late for some.
In any case very little of this potential complexity was in any newspaper or established online film review. The film was accused of being a puerile and prurient form of pornography.I cannot recall one reviewer who described it as a film about a girl who is a victim of sexual abuse, yet that is the primary undeniable reality of the film. While I see it as a largely visual representation of her complex psychological response, I think that this failure to engage with the main theme supports the idea that most reviewers offer a glib and shallow dismissal of the film due to their discomfort with the underlying topic.
It is certainly bold for a man to write such a story and most likely presumptuous but that doesn't invalidate its truth, nor do the presence of similar structural and visual mannerisms to those of previous films, even including video game elements. It is disappointing to think that these uncomfortable opinions will influence assessments of this inventive film for a long time. I can only hope that eventually a more thoughtful appraisal will emerge.
As a consequence of this experience I use Sucker Punch as a way of judging the ability of a reviewer [the same as I quickly check the competence of a dictionary by looking up the definition of irony]. If I want an opinion I can respect then I look at their review of that film first. If they show some insight then I will be willing to look at the new film through their eyes. Unfortunately this technique wasn't possible with the reviewers of Tree of Life, since only the usual cliched criticisms of Sucker Punch were in their archives.So I watched the film without prejudice and read the reviews later.
Tree of Life presents the fragmented memories of a fiftyish man with worldly success but spiritual dissatisfaction who is contemplating the meaning of his life on what seems to be the anniversary of his brother's death long ago at nineteen years of age. It is not a conventional plot-driven mainstream theatre entertainment. It is an attempt to represent the great and subtle forces which compete to create our concept of ourselves as seen through the mind's eye of one man who is searching for enlightenment. As in any life many things are open to interpretation and many are personal and idiosyncratic.
Tree of Life tries to visually express the almost incomprehensible magnitude of the evolution of the universe and life towards the unlikely but inevitable truth of our individual existence, an idea simultaneously trite and awesome. Is the little dinosaur our ancestor, and is it spared because nature does not kill for the sake of it (unlike people); or because the unexpected reprieve is just part of the enormous cosmic chance that formed us; or was this critical few seconds in the creation of our species influenced by a higher power? This presentation illuminates, and contrasts with, the mundane events of a daily life which can serve to distract us from the astonishing fact of our existence.
There is an interplay of mother and father, right and wrong, kindness and selfishness, peace and aggression, nature and construction, heart and mind, life and death, grace and nature. His parents symbolize a choice between spirituality and materialism as his memories play out. They are no doubt selective and perhaps even unrepresentative of the true nature of his parents as individuals but they truly symbolize that choice for him. In his memory his mother is beatific and ethereal; spontaneous, kind, sensual and spiritual. She represents the interconnectedness of nature and spirit. And yet young Jack chooses his father's path, becoming an architect who enforces man's designs over nature. The film has many striking but rigid, cold and desolate architectural constructions, contrasting with recurring natural themes of trees and water. Again, it may be obvious, but the film openly implies that many people in our society, men in particular, are profoundly unhappy and disconnected, and need to change their way of relating to the world.
The cinematography is beautiful, carrying the message of the film's creator without words. A tree is planted and comes to flower. Trees connect as they grow, and reach towards the sky or heaven. They need water to grow.There are images of the mother washing her feet, at the same time evoking the watering of a tree and the biblical humility of the washing of the feet, the water representing the nourishment of our spiritual growth. The scene with the DDT truck, both shocking and visually beautiful, shows our folly when we try to defeat rather than work with the natural world.
The story parallels the myth of the castle of the Fisher King. Of the many variations of the tale there is a common theme of a young man (such as Parsifal) who one day in his youthful enthusiasm comes upon a castle (such as the castle of the Fisher King) where he has a mysterious and overwhelming experience in the court of a wounded king. Too soon the castle is gone, leaving the young man yearning for understanding and the opportunity to return.He feels lost and also wounded. He can only find personal fulfilment when he finds the castle again, but for many years, during which he is matured by his many life experiences, it evades him, until one day he finds it again. With his hard-won manhood he can enter the castle and it is told that he is now able to heal the king after which the waters flow and the lands of the king come to life. The castle never disappears again.
The psychoanalyst Robert A. Johnson believes that such myths have survived because they contain important truths about human nature. This legend is deemed to hold particular meaning for men (or, if you want to be really clever, for the masculine component of our personality).It is held that men, in contrast to women, do not easily feel an empathy with nature or the interconnectedness of everything. They feel isolated, that something is missing. At some time in their youth most men have momentarily felt at one with life, perhaps stimulated by the beauty of nature in a sunrise or perhaps a moment of pure unguarded love.They have entered the castle for the first time. But it doesn't last, and it is painful to lose it. The castle has disappeared. They search in vain for it. Eventually with maturity they find it again, and it stays with them from that time.
They find it in themselves, in my opinion, through an unconditional love that, for those fortunate enough, was planted and watered by the grace of their mothers before they went out into the world. It heals their damaged masculinity.
There is a lot of evidence of immature masculinity in our society. Unnecessary impatience, anger and selfishness assault us when simply driving a car. It must be unpleasant to live in such a state of tension. Pointless urgency creates a false projection of self-importance, only desired by those who feel unimportant, who feel no connection to the true power. Real masculinity does not posture, and it is not unkind . It is humble but not weak. It works for justice not praise.
We have an image of a real man and it is not the heavyweight boxing champion, although it might be him later when he is broken down but finally wise. It is not the rich or the famous, tainted as they are by self- concern. It is no accident that To Kill A Mockingbird is still among the most popular books and films ever made, for it contains likeness of that hero.
Written by a woman, it demonstrates the qualities that we recognize and admire in a fully realized man.He works hard to be skilled. He stands for justice. He doesn't boast : even his own children are unaware of his expertise with a gun until it is needed to kill the rabid dog. He is willing to do what is right to protect his community regardless of personal risk, either confronting a rabid dog or standing up for justice. He is not prejudiced against those who are different. And, as illustrated when he is spat upon in the street, he is humble and forgiving if only his dignity is at stake. He would not go to war over an insult, and would take no more than is fair. Atticus is capable of genuine masculine aggression but only when required for the good of others. A real man has self-control. He keeps his powder dry.The role model is there for us all, and comes from a the sense that we are all a part of something greater .
That greater something does not necessarily belong to any particular religion. It may be found by an openness to grace. It is what the grown-up Young Jack is looking for in his recollections of childhood, of his spiritual mother and forgiving brother. It is shown on the beach at the end when his mother offers up the life of her son, his brother. And it is the image of our humble little dinosaur ancestor, submitting itself to the divine judgment of life, unaware of the extent of its powerful destiny.
We found SP to be so interesting to understand and interpret that later we each individually read the reviews of the film to compare insights.We each then had the disappointment of finding those reviews to be superficial and critical ( mainly because the girls in the film are sexually objectified - yet that is part of the point the film is making visually, and their various outfits are not nearly as lewd or revealing as the reviewers repeatedly write) in the same repetitive way. Eventually there were one or two blogs with a perceptive translation of the film's many-layered and multiply coexisting possible realities. Yes the reviewers were potentially correct in their literal interpretations of the basic plot but failed to recognize or acknowledge the overlapping alternatives.
The Babydoll character might possibly be intended as real, and might really have fought off an attempted sexual assault only to find that this causes her sister to be the next victim who she then accidentally kills while trying to protect her.The gruesome mental institution might also possibly be real as might the rather one dimensional inmates.But there is something so archetypal about the characters and the setting that they would seem more likely to be metaphors for the psychological reactions which have occurred in a victim of sexual abuse. They are her defence mechanisms for the survival of her essential self. Since they represent different aspects of her personality and coping behaviour it is then no surprise that they have limited character development.The fearsome harshness of the building and its ludicrous name ("Lennox House for the Mentally Insane" - what other type of insanity is there?) represent her psychological reality.
Even the identity of the main protagonist is debatable, either Babydoll if you believe in the physical reality of the highly stylized story as presented, or Sweetpea who is suggested in voiceover and is the obvious survivor at the end.
There is also a theme of guardian angels such as the Wise Man who becomes the bus driver rescuer at the end, and may also include all of the girls with their different contributions to survival. The opening voiceover says"Everyone has an angel, a guardian who watches over us. We can't know what form they'll take: one day old man, next day little girl....... they are not here to fight our battles but to whisper from our heart, reminding that it is.....every one of us who holds the power over the worlds we create." Babydoll herself could be a real person, a real person who is also acting as an agent of a guardian angel, an actual guardian angel, or a survival mechanism which may represent her compliance with her own or her sister's abuse, her ability to block out her abuse or her courage in enduring the abuse.
The more obvious fantasy scenes of fighting back might be a type of psychological resistance but, contrary to the interpretation of most reviews, they are not a gallant direct defiance of her abuser since they occur during episodes strongly implying sexual violation. They seem designed to hide the defilement from her own awareness, since the viewer never sees what is really happening during those episodes. If Babydoll's battles represent her fight for emotional survival while still hiding the actual abuse behind the cloak of a mesmerising dance then her lobotomy at the conclusion of the film represents an end to this collusion and supports the notion that Sweetpea has made her real-life escape, or has made progress towards her psychological recovery by refusing to hide the crimes any more and allowing help to come. Help doesn't arrive until Babydoll, that unrealistic and inappropriate combination of the child-like and erotic,is gone. For the viewer who has become attached to her as a real character this is a bitterly unhappy ending, a metaphorical sucker punch, and a likely cause of some of the obvious dissatisfaction with the film.
As a whole the film shows how uncontrolled male aggression can threaten the very integrity of the female mind, causing it to fragment in order to survive. There is also a message that rescue may come too late for some.
In any case very little of this potential complexity was in any newspaper or established online film review. The film was accused of being a puerile and prurient form of pornography.I cannot recall one reviewer who described it as a film about a girl who is a victim of sexual abuse, yet that is the primary undeniable reality of the film. While I see it as a largely visual representation of her complex psychological response, I think that this failure to engage with the main theme supports the idea that most reviewers offer a glib and shallow dismissal of the film due to their discomfort with the underlying topic.
It is certainly bold for a man to write such a story and most likely presumptuous but that doesn't invalidate its truth, nor do the presence of similar structural and visual mannerisms to those of previous films, even including video game elements. It is disappointing to think that these uncomfortable opinions will influence assessments of this inventive film for a long time. I can only hope that eventually a more thoughtful appraisal will emerge.
As a consequence of this experience I use Sucker Punch as a way of judging the ability of a reviewer [the same as I quickly check the competence of a dictionary by looking up the definition of irony]. If I want an opinion I can respect then I look at their review of that film first. If they show some insight then I will be willing to look at the new film through their eyes. Unfortunately this technique wasn't possible with the reviewers of Tree of Life, since only the usual cliched criticisms of Sucker Punch were in their archives.So I watched the film without prejudice and read the reviews later.
Tree of Life presents the fragmented memories of a fiftyish man with worldly success but spiritual dissatisfaction who is contemplating the meaning of his life on what seems to be the anniversary of his brother's death long ago at nineteen years of age. It is not a conventional plot-driven mainstream theatre entertainment. It is an attempt to represent the great and subtle forces which compete to create our concept of ourselves as seen through the mind's eye of one man who is searching for enlightenment. As in any life many things are open to interpretation and many are personal and idiosyncratic.
Tree of Life tries to visually express the almost incomprehensible magnitude of the evolution of the universe and life towards the unlikely but inevitable truth of our individual existence, an idea simultaneously trite and awesome. Is the little dinosaur our ancestor, and is it spared because nature does not kill for the sake of it (unlike people); or because the unexpected reprieve is just part of the enormous cosmic chance that formed us; or was this critical few seconds in the creation of our species influenced by a higher power? This presentation illuminates, and contrasts with, the mundane events of a daily life which can serve to distract us from the astonishing fact of our existence.
There is an interplay of mother and father, right and wrong, kindness and selfishness, peace and aggression, nature and construction, heart and mind, life and death, grace and nature. His parents symbolize a choice between spirituality and materialism as his memories play out. They are no doubt selective and perhaps even unrepresentative of the true nature of his parents as individuals but they truly symbolize that choice for him. In his memory his mother is beatific and ethereal; spontaneous, kind, sensual and spiritual. She represents the interconnectedness of nature and spirit. And yet young Jack chooses his father's path, becoming an architect who enforces man's designs over nature. The film has many striking but rigid, cold and desolate architectural constructions, contrasting with recurring natural themes of trees and water. Again, it may be obvious, but the film openly implies that many people in our society, men in particular, are profoundly unhappy and disconnected, and need to change their way of relating to the world.
The cinematography is beautiful, carrying the message of the film's creator without words. A tree is planted and comes to flower. Trees connect as they grow, and reach towards the sky or heaven. They need water to grow.There are images of the mother washing her feet, at the same time evoking the watering of a tree and the biblical humility of the washing of the feet, the water representing the nourishment of our spiritual growth. The scene with the DDT truck, both shocking and visually beautiful, shows our folly when we try to defeat rather than work with the natural world.
The story parallels the myth of the castle of the Fisher King. Of the many variations of the tale there is a common theme of a young man (such as Parsifal) who one day in his youthful enthusiasm comes upon a castle (such as the castle of the Fisher King) where he has a mysterious and overwhelming experience in the court of a wounded king. Too soon the castle is gone, leaving the young man yearning for understanding and the opportunity to return.He feels lost and also wounded. He can only find personal fulfilment when he finds the castle again, but for many years, during which he is matured by his many life experiences, it evades him, until one day he finds it again. With his hard-won manhood he can enter the castle and it is told that he is now able to heal the king after which the waters flow and the lands of the king come to life. The castle never disappears again.
The psychoanalyst Robert A. Johnson believes that such myths have survived because they contain important truths about human nature. This legend is deemed to hold particular meaning for men (or, if you want to be really clever, for the masculine component of our personality).It is held that men, in contrast to women, do not easily feel an empathy with nature or the interconnectedness of everything. They feel isolated, that something is missing. At some time in their youth most men have momentarily felt at one with life, perhaps stimulated by the beauty of nature in a sunrise or perhaps a moment of pure unguarded love.They have entered the castle for the first time. But it doesn't last, and it is painful to lose it. The castle has disappeared. They search in vain for it. Eventually with maturity they find it again, and it stays with them from that time.They find it in themselves, in my opinion, through an unconditional love that, for those fortunate enough, was planted and watered by the grace of their mothers before they went out into the world. It heals their damaged masculinity.
There is a lot of evidence of immature masculinity in our society. Unnecessary impatience, anger and selfishness assault us when simply driving a car. It must be unpleasant to live in such a state of tension. Pointless urgency creates a false projection of self-importance, only desired by those who feel unimportant, who feel no connection to the true power. Real masculinity does not posture, and it is not unkind . It is humble but not weak. It works for justice not praise.
We have an image of a real man and it is not the heavyweight boxing champion, although it might be him later when he is broken down but finally wise. It is not the rich or the famous, tainted as they are by self- concern. It is no accident that To Kill A Mockingbird is still among the most popular books and films ever made, for it contains likeness of that hero.
Written by a woman, it demonstrates the qualities that we recognize and admire in a fully realized man.He works hard to be skilled. He stands for justice. He doesn't boast : even his own children are unaware of his expertise with a gun until it is needed to kill the rabid dog. He is willing to do what is right to protect his community regardless of personal risk, either confronting a rabid dog or standing up for justice. He is not prejudiced against those who are different. And, as illustrated when he is spat upon in the street, he is humble and forgiving if only his dignity is at stake. He would not go to war over an insult, and would take no more than is fair. Atticus is capable of genuine masculine aggression but only when required for the good of others. A real man has self-control. He keeps his powder dry.The role model is there for us all, and comes from a the sense that we are all a part of something greater .
That greater something does not necessarily belong to any particular religion. It may be found by an openness to grace. It is what the grown-up Young Jack is looking for in his recollections of childhood, of his spiritual mother and forgiving brother. It is shown on the beach at the end when his mother offers up the life of her son, his brother. And it is the image of our humble little dinosaur ancestor, submitting itself to the divine judgment of life, unaware of the extent of its powerful destiny.
Wednesday 6 July 2011
won a hand towel
Played tennis last night and won a hand towel, though I lost a hard-fought singles match in a tie-break.The doubles matches are more fun but there is pride in a singles victory so we push a little harder.Here is my partner warming up for the night's competition:
The one in the foreground.
With the beer.
Once we are out on the court there are no excuses. I never complain that I am at a disadvantage from being thirty or more years older than my opponent, from carrying an injury, lack of sleep from labour ward duty the night before or unfamiliarity with a new technique from my tennis lesson. Because that would devalue my opponent's efforts. It would be unsporting.
Ok, so I might make some excuses, and yes it is a bit embarrassing to win after saying how sick I am but I do try my best. I run for the hopeless return, throw my racquet on the ground (synthetic grass) and swear loudly. It surprises people that an obstetrician should behave this way, but then how should anyone act away from their job? I am not consulting with a patient. I am giving respect to my adversary. There is nothing more unsatisfactory than winning against someone who is obviously not trying, so juvenile petulance is not frowned upon, but savoured as one of the fruits of victory.Although I doubt that such behaviour is approved in women's competition, I find it exhilarating to be so uninhibited in a life otherwise choked with caution.
With the beer.
Once we are out on the court there are no excuses. I never complain that I am at a disadvantage from being thirty or more years older than my opponent, from carrying an injury, lack of sleep from labour ward duty the night before or unfamiliarity with a new technique from my tennis lesson. Because that would devalue my opponent's efforts. It would be unsporting.
Ok, so I might make some excuses, and yes it is a bit embarrassing to win after saying how sick I am but I do try my best. I run for the hopeless return, throw my racquet on the ground (synthetic grass) and swear loudly. It surprises people that an obstetrician should behave this way, but then how should anyone act away from their job? I am not consulting with a patient. I am giving respect to my adversary. There is nothing more unsatisfactory than winning against someone who is obviously not trying, so juvenile petulance is not frowned upon, but savoured as one of the fruits of victory.Although I doubt that such behaviour is approved in women's competition, I find it exhilarating to be so uninhibited in a life otherwise choked with caution.
Tuesday 5 July 2011
earthquake
Woke up with the house shaking during heavy wind and rain. Not sure what was happening at first since I was groggy from sleep and I could see the wild weather which was also hitting our hilltop dwelling.
A little frightening for a few seconds - should I go to some safer part of the house or jump up and run out into the coincidental rainstorm? What about my daughter who I could hear in the kitchen? Was there a real risk of collapse? This is not an earthquake area so we don't believe anything really bad could happen. In the end I didn't move and the tremor stopped without obvious harm.Later I asked F what she thought was happening and she said,"Was that an earthquake? I just thought it was lightning or something," as she continued with a phone call. The cat pressed up against me closely, purring very loudly.
Outside - if you weren't looking - the wind and rain sounded like the crashing of waves on rocks.The dairy herd was trying to escape the elemental onslaught but was stopped by the fence. Closer up, however, they seemed typically stoical.
Inside, the cat was no longer concerned.
Monday 4 July 2011
breakfast
Someone in the shower. Pop music playing a cheerful tune with banal lyrics.Cat stretched out asleep beside me. Lift my head to see a cool windswept day.Usually finishing the theatre list at this time but only just waking up. Feeling a little disorientated.Having lunch for breakfast.
Going shopping with youngest child again then visiting my wife although she is never lonely in hospital.She finds people to help and makes friends easily. She will often introduce us to a new lifelong comrade shortly after her arrival much to our daughter's cool displeasure.
Stay calm.
Stay calm.
Sunday 3 July 2011
visitors
Looking for kindred spirits online when car headlights light up the far wall of the bedroom.Go to the front door to welcome son H and friend J who have come for an impromptu visit at four am.We discuss PCOS(Polycystic ovary syndrome), since they are medical students and it is the current gynaecological fashion diagnosis (having taken over from endometriosis ), while H looks for something with sugar in it - an ice cream will suffice - and I make a pot of tea: Pai Mu Tan looseleaf white tea, my favourite.
Now five am.They find their beds and I must also sleep before a big day of clothes shopping with F, the youngest and most fashion obsessed.
The cat joins me while the wind whistles outside.
Now five am.They find their beds and I must also sleep before a big day of clothes shopping with F, the youngest and most fashion obsessed.
Saturday 2 July 2011
who/m
My wife's inescapable alarm awakes me to the sleepy meanderings of my dreaming mind.
I am thinking of the feminine style of receptiveness; how women attract people, draw attention, receive admirers, listen to problems, nurture, support; the different tastes of men and women, such as reality television, shows involving indirect competition for votes, sports with subjective scoring systems.In the background is the uneasy feeling that I shouldn't think these things; I should not be looking for stereotypes. They limit people's potential, discourage individuality;and yet I feel a resentment because I like looking for patterns in behaviour and everything else. My thoughts turn towards politically correct speech, designed to limit politically incorrect thinking, but designed by who[ I like who here even though I suspect that whom is grammatically correct. It is certainly what you would say in speech, ignoring the affectation that we speak the same as we write]? Well that is interesting. Designed by whom? Just trying out the sound of that.
Who are these people who try to remove prejudice by the use of language, who change not only behaviour but the underlying thought processes, who avoid direct confrontation while intuitively embracing the new inclusiveness, who fight racism, sexism and disempowerment even in casual conversation?
I can't say.
I am thinking of the feminine style of receptiveness; how women attract people, draw attention, receive admirers, listen to problems, nurture, support; the different tastes of men and women, such as reality television, shows involving indirect competition for votes, sports with subjective scoring systems.In the background is the uneasy feeling that I shouldn't think these things; I should not be looking for stereotypes. They limit people's potential, discourage individuality;and yet I feel a resentment because I like looking for patterns in behaviour and everything else. My thoughts turn towards politically correct speech, designed to limit politically incorrect thinking, but designed by who[ I like who here even though I suspect that whom is grammatically correct. It is certainly what you would say in speech, ignoring the affectation that we speak the same as we write]? Well that is interesting. Designed by whom? Just trying out the sound of that.
Who are these people who try to remove prejudice by the use of language, who change not only behaviour but the underlying thought processes, who avoid direct confrontation while intuitively embracing the new inclusiveness, who fight racism, sexism and disempowerment even in casual conversation?
I can't say.
last day
Dinner in the city last night with oldest child and her boyfriend,at a table next to an open fire. We discussed the theoretical constructs of our favourite philosophers,the introduction of the semi-colon into written English in the early seventeenth century, and vigorously debated the comparative use of kireji and caesurae in Japanese and Latin poetry respectively. I was particularly harsh on Husserl's Phenomenology while still crediting his influence on the development of Existentialism.Then another late drive home and little sleep before waking early for theatre on my last working day before a week's holiday, my overstimulated brain still in an intellectual turmoil.
It seemed I would not escape easily: an overbooked operating list running past the start of the afternoon clinic which then ran late while I took the usual stream of Friday afternoon emergency calls augmented by those who wanted to catch me before I was unavailable for a week plus the need to review all outstanding results.I was required in clinic, casualty and labour ward at the same time, a surprisingly common quantum challenge for a gynaecologist. Labour ward comes first,then clinic, since the resident doctor can assess the outpatients with my advice while I attend to those who have been waiting four months for their appointment.Blood in the urine, minimal invasion on a cervical biopsy, three hours in the second stage of labour: phone discussion, oncology referral, forceps delivery in that order.Premature labour with rapid foetal heart rate, nine out of ten pelvic pain of unknown cause, inpatient with scan suggesting a pelvic abscess: admit, admit, already admitted - needs surgery but can't be done yet. Meanwhile clinic continues with high risk antenatal first visits, criticisms of previous care and missing test results. There is a lot of anxiety requiring concrete responses and specific plans not just empty reassurances. Time dissolves in a shower of demands.Then it is eight pm on Friday night and I am suddenly alone in the consulting room, alone in the clinic,tired and hungry.I pack up, turn off the lights and go home.
There is no one home, no meal, no message.There is no one to share the joy of my temporary freedom. It is against my nature to place my happiness in the hands of others but I feel a little sorry for myself. Luckily there is still some leftover beetroot and fresh chili risotto which I cooked after coming home late two nights ago.Pink risotto cheers me up.Then I sit down at the computer to send my daughter photos from our meal last night where we didn't really discuss philosophy and linguistics.However, I do genuinely struggle to see an unambiguous case for the use of the semi-colon; and I cannot stomach the turgid pedantics of Husserl's phenomenology.
There is no one home, no meal, no message.There is no one to share the joy of my temporary freedom. It is against my nature to place my happiness in the hands of others but I feel a little sorry for myself. Luckily there is still some leftover beetroot and fresh chili risotto which I cooked after coming home late two nights ago.Pink risotto cheers me up.Then I sit down at the computer to send my daughter photos from our meal last night where we didn't really discuss philosophy and linguistics.However, I do genuinely struggle to see an unambiguous case for the use of the semi-colon; and I cannot stomach the turgid pedantics of Husserl's phenomenology.
Four am . Goodnight.
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