Boston Teaser

So a good friend of mine called the two nights ago and told me he was in town (well, really, a town just south of Boston) and was wondering what I was doing. Now you have to understand that this gentleman is one of my good friends, whom I haven't seen since 2008, almost two years ago. If you have succumbed to the Facebook craze, drop him a line here: Gospel of Health.

But I found myself driving what seemed like short hours to Boston (it's only about 3) to have dinner with this guy, and just burn the midnight oil talking in a way you just can't on the phone.

I landed in town in the middle of a Bible Study. He's doing an informal series for the local youth group, and were going through the book Steps to Christ when I arrived. And for a few short minutes, time stopped, and it was as if we had not been apart in years. The only difference is that we had more time to call each other friend and brother.

After close, we took the local youth with us to the Cheesecake Factory for a meal (I hadn't had dinner, I came straight from the office). And because one of the kids lived in the City, the vote returned with jaunt into Boston (or as it turns out, the local suburb, Copley).

So the cool thing about Boston is that there is a lot of history there. Now I had just driven to see Cofer, but couldn't help wonder about all the old buildings and what was this or that. We walked around town and talked and did low-light photography. Below is the Copley Public Library.

I stayed the night with Cofer and we talked until early morning. I Iook a quick nap and then headed back up to Maine to go to work. Check the sign (Bosten, to the left) in the lower photo. I hadn't seen my bed for almost 48 hrs. But it was good to see Cofer. (Photos taken with the Canon S90. Next time, I'm coming back to spend the day on the Freedom Trail!

Verbally Convincing

There are collection of adjectives that, by their nature, cannot be used in verbal self-declaration. One that comes to mind is the word: Humble. One cannot turn to another and make the claim, no matter how simply put, that "I am humble." We do not find any truly humble person making this kind of proclamation, as if verbal convincing were necessary to notify others of that characteristic that inherently must be apparent to others without being stated.


Another example is the virtue of being lady-like. The tongue-in-cheek phrase has a ring of truth to it:

"Being a lady is such that if you have to convince others that you are, then you aren't."

This virtue of being lady-like, in a way is like humility. Another is 'modesty'. And 'righteous'. These traits are of such lofty caliber that others outside of one's self must be pointed out, if one truly is in their possession.

In a way, these are gifts that a worthy person would long to possess, but once in one's possession cannot be told to others, or else it is lost by one's own declaration of having it.

So if we really think we're humble or modest or gentlemanly or lady-like (or any character worthy of possession) ... has someone else let you know, or is it something you decided on your own?

Can any of you think of other traits like these? Please drop a comment if one comes to mind.

"…further measures of resuscitation would be futile … do you concur, doctor?"

A phrase I thought was reserved for geriatric specialists, palliative care physicians, internal medicine hospitalists, and critical care docs. It hit me like I imagine a phaser gun would out of a science fiction novel. The words seemed to ram a shockwave with rippling effects through my reality.


I was called to the ER that morning. It was an infant in cardiac arrest with the paramedics doing full CPR en route, could I come immediately? The only time I've run as fast was once before when they paged the team overhead immediately to the Operating Room (unlike TV drama, an overhead page to the OR/ER is a rare occasion, pagers are generally used). But this time was just as critical, to say infants rarely have cardiac arrest is a gross understatement.

I arrived into the middle of a full code, Dr. R was at the helm. I asked where were we were in the process, and looked over to see the scribbles of epinephrine given. I looked over to see the interosseous line, and the chest wall response, but what struck me was the color and appearance of the infant. My first *Blink* response was, "we're too late, it's been too long." She could have easily been a mannequin and this could have been a mock code. I reached over to verify my instinct, and the cap refill was so delayed, I'm not sure it ever returned to its original color. The skin felt like cool rubber, not the soft resilience we anticipate the perfect skin of a young baby to be. We were in the middle of a med push, and Dr. R was checking cardiac response at interval. The guardian arrived, so feeling the current progress sufficient, I spoke with the aunt. Verbal hysteria was directed by a few well placed questions, I needed to know what could help us direct the remaining treatment with intentionality. I had nothing to give her in comfort except that the team was doing their best help the little girl's heart. I returned to the bedside to see a new tube being placed. Cardiac monitors still erratic with artificial heart beat wave forms. All the meds had been tried, we were running out of options. We couldn't even attempt electrocardioversion, her heart was so unresponsive. I recounted the history of the morning with Dr. R, and we reviewed our options. I asked a few questions whose answers satisfied me that everything had been tried. I looked up at the clock, and it had just been over half an hour. Reviewing everything that had been attempted, at the best case scenario, this baby had been receiving CPR for over an hour and a half. Worst case scenario, her brain had not received oxygen for almost 3 hours. She should have grown up without any complications. Her history was clear except a slight premature birth. She should have learned to crawl in 7 months, learned to walk in about a year like they all do. Learned to say no, and take piano lessons, reduce fractions, parallel park, and make it to a prom. All before she leaves her doctor's practice.

So when Dr. R posed the question, I realized that I was the second doctor. I looked around the room, and I was the youngest man there, and the only other physician. Despite the seasoned experience of the respiratory therapist securing the airway, and the dignified gray haired gentleman who was a physician's assistant coming to run a case by Dr. R, it was incumbent on me to agree with Dr. R's decision that enough had been done. I thought, well, maybe I only hoped, this was for other people. Even the crash c-sections in the past had all resuscitated well, and with a little work and my very able staff, they came back to see me. But the question was posed, "… further measures … futile … concur?"

I knew the probability of survival was low, but this wasn't a geriatric patient with multiple MI's or a PE we were talking about. From the phone call until now, I had bent my mind with such determination to make the next step in attempt, reviewed where we had been, sparring almost, with Dr. R, to make sure we had taken the right course, then probing my repertoire of options to synthesize another endeavor. I remember stepping from the charting nurse's clipboard to assure myself of the attempts made, then spinning a slight left to face the monitor, seeing the flat line when the cardiac response was checked, and in my recollection a blur. Then the words. Futile? Concur? And realized that we had been trying, as a team, for more than ninety minutes.

Until then, we had been speaking with each other and our team members with the efficiency and clarity that comes with a focus of urgent duty, but when Dr. R turned to face me with the question, it sounded like someone else was speaking, like I was in myself but somehow different, almost an auditory blur. Everyone else seemed to fade out of consciousness, and it was just the two of us in the room, deciding if we were done. It took a little time to have it sink it.

My options had run out. My response was weak, not because I was unsure of my duty as a doctor, but because my mental movement had been clipped. I was being asked, essentially, to concur that we had run out of options, that each contingency plan had failed. It was this fact I found so exhausting about stopping a code. The futility was draining. My words, "I concur" were an acknowledgment.

After today's events, I couldn't just leave it at that. It occurred to me, as God had often used the analogy of healing with that of our redemption, then today's efforts are a marked comparison to these end times. Maybe two thousand years ago, we were cripple and blind. But today, we're crashing and about to flat line. The gentle touch that would heal a despairing soul, Christ now replaces with the urgent direction of an almost desperate Physician. Desire of Ages tell us that though some methods may seem harsh to us, there is no other way to arouse us to our condition. The extreme measures He takes with us we must see as an indication of the dire position we are in, to the extent that only God can see. Why must He afflict us with pain, why must we endure this loneliness, why must we face the harsh censure of the people he places in our path though they may claim to be Christian? He does these acts not out of a desperation of His own inadequacy, but out of a desperation bred from our own inability to see. If we could only see our failing heart and cooling limbs, we would let Him have His way with us in every aspect. Oh, our arrogance as a people, as a race, a denomination! Oh, if we could know that God is running the code for our resuscitation, for our redemption. And it may not be the gentle endeavor our crippled minds wish to perceive. If we could only see the costly effort Christ is putting into our salvation, not just at the cross, but even now in the heavenly sanctuary, we would trust Him a with reciprocating desperation.

So maybe it hurts now. Chest compressions hurt. And maybe it's painful. Intubation can be painful. And maybe we're crying tears no one else can see and we don't understand. Then now is the time to believe like no other, because we're coding now. But Christ is at the helm.

Romans 8:32 - He that spared not his own Son, but delivered him up for us all, how shall he not with him also freely give us all things?

I want to ask God for a faith that only He can give.

Retro Vol. 2: Road Trip from California to Maine, detour Vermont

Dad, this one's for you (Don't forget to click on each picture to see it bigger.) Instead of the common I-40 route to trek across the Lower 48, I took the less traveled I-15 to I-70 across to Upstate New York, then state highways to Maine (Via Vermont, you'll see why on a later post). For the first day (of 4), I took my time, miscalculated my pace and allotted time, and consequently took a mild stroll through some of the more picturesque parts of America, west of the continental divide.

Above you'll see a plateau found in the central-eastern part of Utah, while driving on the I-70 after the Spotted Wolf Canyon, and before Grand Junction. The purplish color of the dirt was quite notable and made quite a convincing argument to pull over and squeeze the trigger. Great photos are all about the light and this one was in part due to the fantastic light of early morning. For those interested: Manual Settings: 1/125th seconds, f32, ISO 800, at 140mm using the 70-200mm f/2.8L IS on Canon's 5D Mark II, Circular Polarizing Filter.

Although that was probably the most remarkable shot. I did get to see some other fun things on the way. Below is the Hoover Dam, coming from the east side on Hwy 93, in Nevada. I found myself mistakenly on the I-40, so I had to turn around. Y'know how it is in the desert, you can go for miles without a place to make a legal U-turn.


Canon 5D Mark II with 17-40 f/4L at 17mm. Manual settings: 1/320 second, f16, ISO 400. Quite an elaborate structure. If I had more time, I would have taken the tour. You can probably guess by the photo, that this route set me back some considerable amount of time.

After the first photo, and before Green River, Utah, one comes across this beautiful curving road. I had to pull over for the signs and take a quite snapshot of this notch, the Spotted Wolf Canyon. The dirt is remarkably red, and Springtime has the added benefit of contributing other colors to the rich hues of the rock.


Manual Settings: Canon 5D Mark II, 70-200mm f/2.8L IS at 140mm, 1/125 sec, f22, ISO 1600, Circular Polarizing Filter.

The final photograph did not mean that there were less opportunities to photograph compelling countryside. It simply meant I was pressed for time, as I recalculated estimated arrival times, and figuring in time to drop by Vermont, and fax some paperwork for my Medical License (or else I would be driving to Maine exclusively for the wedding), and then deciding what time to arrive at the Howe's on Friday night.

Here is the view right before Grand Junction, Colorado. The clouds make the photo, but the open green doesn't hurt much either.


Manual Settings: Canon 5D Mark II, 17-40mm f/4L at 29mm, 1/250 sec, f22, ISO 400.

From Denver, it was a longer, faster push, with Rest Area naps, and eating at Chevron Foodmarts. If I only had a TPN and a catheter, that would have helped. Traveling in Spring made a lot of it bearable, since the flowers were out, and Spring rain means skies beautifully textured with clouds. Iowa actually had some wonderful examples of these, but again, I ran out of time. And of course, Upstate New York, and all of New England were invariably scenic as well.

Next time, I'm taking a week!

Retro Vol. 1: Road Trip from Vermont to California, detour Virginia

It's raining in Maine, so I thought I'd catch you all up to what happened after the Maple Syrup ran and my finding new homes for my gear in Augusta. The most significant part was a detour from my California drive from Vermont, to stop by and see Hartland Institute, where Matt is attending the modern day Schools of the Prophets.


The 100 plus acre compound boasts several lakes, one of which is this picture, close to the sun going down. I arrived at the main building [first photo] where services are held, the library is housed, and the students are fed. While waiting for Matt to be retrieved by the helpful attendants, I found him playing the lumber jack below and doing his share of manual labor, making sure the students have enough cords of wood to last the upcoming winter.


We spent that afternoon chopping wood, and adjusting my body to the motion and balance required to wield an axe, and split felled logs. Matt was gracious enough to not poke too much fun, but he did have a good laugh at my inability to lay the axe head straight down the center. It's a good thing wood burns no matter what its shape.


The grounds are lush and since it was Spring Time when I came to visit, everything was green. Despite the photographs, I didn't carry my camera everywhere we went. I left it in the room when we went to knock on doors, and when we went to church. Pastor Restrepo, the new President Elect, was on campus for the Week of Prayer that he was giving. I had a chance to see Matt's every day routine, even sitting in on an A&P class he had to take on Friday morning. It was enjoyable, but Matt would not take the answers I was trying to feed him underneath my breath as we reviewed Cardiac Output, and rudimentary heart physiology.

Sabbath morning we took a short walk around the front lakes, and captured the morning light on the foliage. Matt was ever exuberant, and brought a fresh joy to Sabbath, despite the early morning fog and chill. The diffuse light made some of the angles look quite beautiful.


My initial plan was to stop by for lunch and a quick refreshment, and see and chat with Matthew. One thing led to another, and I ended up staying four days, hearing 3 sermons, helping out in Sabbath School, and giving a late night Bible Study in one of the dorm rooms they put me up in, and some camera time to boot. I also saw some friends I knew from the speaking circuit when I was in London back in 2007. Amazing how everything seems to be connected. But before I knew it, the short-lunch-turned-long-weekend was already up and it was time to repack my gear and make the 2400 mile trek to California.

Thanks, Matt. The time spent was profitable. I'll come by to see you again, you're only 10 hrs from Maine. A relatively short jaunt.

Finding Homes (for the stuff)

Today marked the arrival to the new apartment and new assignment: Maine General Hospital and Kennebec Pediatrics. Tomorrow starts the routine of picking up the pager, taking the hospital tour (they'll show me useless stuff like the Cafeteria, without showing me useful stuff like how to get a radiograph read after hours), having my photo taken for the ID badge and security clearance, EMR review, and clearance codes. In the afternoon I finally get to see kids. But this evening......we find new homes for all the gear.

Above is a picture of my new townhome/apartment with the contents of my Jeep emptied out on the living room floor. Don't worry, Mom, there is a full service kitchen. Daniel and Byron, there is enough room to house more people that at Mid-Week Prayer meeting. We'll see how that goes.

But included in all the wood paneling, floor molding, and wooden furniture is (finally!) working high-speed internet access, and a dry erase board! Now for all you faithful readers of this obscure blog, I can finally catch everyone up to speed (because the last time you all checked, it was maple syrup season in Vermont).

Oh, and for all you low tech (pen and post-it) people, you can actually leave comment below, just leave your email or postal address. And if you haven't figured out, you can click on the picture to make it bigger.