Eclectic Playlists

I have a pretty eclectic taste in music.

By eclectic, I don't mean "cutting edge" or "unusual." Rather, I mean that my musical tastes cut a broad swath across most genres of popular music. Country, rock, folk, Motown, New Age, 80's, rap, classical, Christian, alternative, oldies: I like something (but not everything) from each of these groups.

To some, the very idea of music being popular stigmatizes it, rendering it unlistenable. Others pigeonhole themselves as liking only a certain type, quarantining themselves from all others.

But give me a good tune, some vocal talent, and some meaningful or clever lyrics, and I'll probably like the song. Throw in a good memory or two associated with it, and I might download it onto my iPod

I've put nearly 3,000 songs on my iPod in the last 6 months, mostly transferred from my own CD collection. I've got playlists ranging from John Mayer to John Denver, from Sting to Stevie Wonder, from Norah Jones to the Dixie Chicks. They all get about equal play.

I've recently started downloading a few songs from iTunes. The first fourteen will give you a good idea of how widely my taste ranges.

• Just My Imagination by the Tempations
• King's Highway by Tom Petty & the Heartbreakers
• I'll Be Your Baby Tonight by Bob Dylan
• Islands In The Stream by Kenny Rogers and Dolly Parton
• Karma Chalmeleon by Culture Club
• Love Will Turn You Around by Kenny Rogers
• Heaven Is A Place On Earth by Belinda Carlisle
• Tunnel Of Love by Bruce Springsteen
• The End Of The Innocence by Don Henley
• Heads Carolina, Tails California by Jo De Messina
• Hook by Blues Traveler
• Love Will Come to You by Indigo Girls
• Ghost by Indigo Girls
• 1979 by Smashing Pumpkins

Maybe my musical tastes are not as sophisticated or selective as others are. Basically, the only important question I ask about a song is, "Do I like it?" I have no other pretentious qualifying conditions. To me, that freedom is liberating; I can't stand being limited by artificial boundaries, in music or anything else.

So if you see me lip-synching to Belinda Carlisle or Boy George on my iPod, know that I'm in my own little piece of, well, heaven on earth.

The Dastardly D's

My daughter's kindergarten class learns a new letter every week.

This week, I choose to highlight the letter D. Every Foster boy worth his salt should know by heart the "D" song, which showcases all of the dark, dastardly, demented connotations of words that start with the letter D. While still in late childhood, I set these D words to an ingeniously hypnotic cadence. I consider this D song a brilliant prologue to my future poetic and musical genius. (Substantial props must be given to my brother Matt, who helped round out the piece. But the glory is still mine.)

So here is my challenge: post a comment, and attempt to reproduce--in exact order--the 9 D's that are strung together in this seminal song. The winner will receive an official recognition on my widely read and immensely popular blog. International fame is sure to follow.

And here's a secondary challenge: attempt to add unto the 9 known D's with your own (meager) contributions.

Hint: it begins with "Death, doom, destruction . . ."

Waste no time; immortality awaits.

Intestinal Fortitude

During a big college football game this weekend, I watched a quarterback receive a vicious hit. As he lithely bounced back to his feet, the announcer commented on his "intestinal fortitude."

I reflected upon that curious phrase, and how it has come to have its current meaning in the lexicon of sports. I now bless you with my ruminations.

Intestinal fortitude: the phrase means "courage," "mental toughness" or "resiliency." But what do any of those things have to do with the healthiness of one's intestines?

What if the announcer instead had exclaimed, "Look at his tenacious colon!"?

Or, "My, what a durable duodedum!"

Or, "How about those hardy bowels!"

Similarly, we say a fearless person has a lot of "guts."

Is this some vestigial linguistic phenomenon, belying a medieval belief that a person's courage and constitution originate from the belly? That strength of soul is drawn into the body through the umbilicus?

I guess if personal valor depends upon abdominal girth, then the Mick's the bravest of us all.

From a physician's standpoint, I'm all in favor of intestinal fortitude. To that end, eat a high fiber diet, avoid processed meats, and get a screening colonoscopy after the age of fifty to make sure you don't have a developing cancer. If you do these simple things, then perpetual intestinal fortitude will be your likely destiny.

You may then be able to go and take a lickin' from a 300-pound linebacker, though it is unlikely you will quickly bounce back to your feet; unfortunately, despite the vim and vigor of your entrails, his whole body fortitude will undoubtedly far surpass your own.

So while you may take the hit, he'll probably knock the--shall we say, tar-- out of your fortitudinous intestines.

God and Science

TIME ran a cover story last week entitled, "God vs. Science," as if the two subjects were exclusionary. It promised, "a spirited debate between atheist biologist Richard Dawkins and Christian geneticist Francis Collins."

Instead, it presented a polite, thoughtful defense of faith and science by Dr. Collins, and a histrionic, scattershot retort by a belligerent Professor Dawkins. In the end, Dr. Collins bludgeoned poor Professor Dawkins with the weight his own circuitous, post-modern, relativistic philosophy.

The whole dialogue is worth reading, but here is a characteristic exchange between the two:


Dawkins: (attempting to explain away some of the universe's mysteries) . . . there could be something incredibly grand and incomprehensible and beyond our present understanding.

Collins: That's God.

Dawkins: Yes. But it could be any of a billion Gods. It could be the God of the Martians or of the inhabitants of Alpha Centauri. The chance of its being a particular God, Yahweh, the God of Jesus, is vanishingly small . . .


I got the feeling throughout the debate that Dr. Dawkins is an intelligent but close-minded man who has risen to some degree of popularity by advocating a narrow-minded philosophy to his like-minded scientific colleagues, but that in Dr. Collins he finally met his match. When confronted with a man whose scientific credentials and brilliance dwarf his own, Dawkins was reduced to pathetic attempts at mental bullying, leaving him conspicuously flailing in his own philosophical quicksand.

Their dialogue immediately conjures to my mind the Book of Mormon debate between the prophet Alma and his atheist antagonist, Korihor. In fact, Collins' and Dawkins' respective arguments veer so closely to their Book of Mormon counterparts that it reinforces to me the modern-day applicability of the Book of Mormon.

I believe that the whole dialectic revolves around two key points:

1) You cannot prove that God exists.

2) You cannot prove that he does NOT exist.

And yet while irrefutable scientific proof of God will always remain elusive, all things in nature, including human nature's hardwired longing for the divine, speak of design and thus a Designer; of creation and thus a Creator; of good and evil, and thus of God.

Absolute proof? Not there.

An abundance of otherwise unexplainable evidence pointing towards a higher power? It's all around us.

I believe that the existence of God is self-evident in the extraordinary order and exquisite design found in nature, in the human body, in physics and chemistry. He is also found in our collective, eternal longing for divinity, expressed through acts of altruism, through poetry and music, and through family relations and love.

Could the incomprehensible complexity of the human body have evolved through random collisions of molecules and purposeless mutations of DNA, even if it had 10 billion years to do so? Possibly, but extremely unlikely.

Isn't it infinitely more likely that a rarely seen but divine force has gently molded creation towards it present state, leaving conspicuous tracks for even the least educated to observe, and thus to begin to build faith in a higher power?

It's Occam's razor, baby. The most likely explanation for the world we inhabit is the presence of a Creator, a being who wants us to observe His works, seek His love, and exercise our faith. He will always reward that earnest effort, no matter what denomination or religion the seeker professes.

It's not "God vs. Science;" it's "God through Science." His presence is all around us, patiently waiting to be discovered and worshipped.

Free Time

What is free time? For most of the past seven years, it has been a concept completely foreign to me. Every minute not spent as a slave to medical school or residency seemed to be consumed with every other responsibility I had been forced to set aside: husband, father, church member, neighbor, citizen. Even vacation was not really "free time," as I oxymoronically felt obligated to maximally recreate and forcibly relax for an allotted time, until the realities of life encroached upon me again. And in every nook and cranny of every conceivably "free" moment, there was always the pressure of impending or deferred commitments, unaffectionately referred to as the loathsome "longitudinal curriculum."

I have not suddenly, entirely burst out of that oppressive cavern. But now, I have found myself with hours, even days, WITH NOTHING TO DO. Days where nothing is due or overdue or soon-to-be overdue. Hours where the kids are in bed, the house is clean, and I find myself wondering, "Well, what should I do now?"

My answer so far has been varied. I've read books and poetry. I played way too much Weboggle. I've gotten mesmerized by the computer mystery game, Riven. I've posted lame entries on my blog. I've watched football games, played flag football, exercised. I've gotten captivated, frustrated, and re-captivated by "Lost." I've done yardwork, gone hiking, played with my kids, planned with Elizabeth.

Fun stuff, all. A lot of it, however, is a complete waste of time. Now, I don't believe that wasting time is always a bad thing; a certain amount of brain-disengaging activity can be relaxing, and even healthy. (Re: Weboggle). But as these free minutes and hours and days and weeks and months pile up, what will be the sum result of all of my "free time?"

Deep inside me, I have long had some big-time goals: writing a Steinbeckian novel, becoming a rugged mountain explorer, making a difference in politics, investing wisely and expertly, serving whole-heartedly in the church.

Is this what free time is, the moments given to us to expand, give voice to and flesh out our deepest desires? I would guess that only a small percentage of history's great one's arrived there through sheer innate genius, like Mozart. The rest arrived there through the diligent application of above-avergage gifts, like Lincoln or Edison.

I've begun reading a biography of Teddy Roosevelt, a truly remarkable American. He was blessed with ordinary gifts but extraordinary courage, resolve and ambition. He pushed himself, forced himself, towards greatness in politics and life.

Do we all have the seed of greatness within us? If so, do we nourish it, water it, cultivate it in our free time?

Or do we sit back and play yet another game of Weboggle? (Thanks, Ty and Dana. Hey, I got all the way up to #3 one night! That's greatness, isn't it?)

Football Weather

The blaze of autumn leaves. Crisp, frosty mornings. The scent of apple cider on the stove. And football, baby. Football.

These are the signature flavors of autumn, my favorite season of the year.

On the heels of wins by both BYU and the Broncos this weekend, I thought I'd jot down my thoughts about this autumnal, violent, and thrilling American game of football.

First of all, I had a wave of nostalgia on Saturday while watching BYU beat the snot out of San Diego State. The calico pattern of the autumn scrub oaks on the snow-capped Wasatch mountains, set against a brilliant Cougar blue sky, brought back the excitement of Cougar football. In fact, my very first Cougar game, back in the fall of 1992, was against SDSU. (I believe that was the game where Marshall Faulk ran for 299 yards and 6 touchdowns against us. Ouch!) After several down years, BYU seems to have found the winning touch again, led chiefly by the cool excellence and precision of their quarterback, John Beck. Fui Vakapuna has not only a great name, but moreso a ferocious aggression and a nasty habit running over people: the man simply cannot be stopped by mere mortals. Add to that mix a stout defense, and the Cougars are set to run the table in the Mountain West Conference and get themselves into a quality bowl game. It's disappointing that they lost 2 of their first 3 games on the last play, due largely to their own implosions. But now they're gelling, and all I can say is, "Rise and shout, the Cougars are out!!!" (Unless they lose their next game. Then they stink.) :)

The Broncos similarly stunk it up in their first game of the year, but have now strung together a number of good wins. Tonight's win against Baltimore wasn't pretty, but it was impressive. The defense is setting records every week (tied for fewest touchdowns ever allowed in the first 4 games of the season). The much-maligned Jake Plummer--who will never get a fair shake in his fickle city inebriated with a false memory of John Elway's invincibility--put together a few great drives when he had to. In the rain. Against arguably the league's best defense. On national TV. To stage another 4th quarter comeback.

To the city of Denver, I say this: get over John Elway, and stand by your man. For now, that's Jake Plummer, who had a career year last season, leading you to the brink of a Super Bowl. He's not always been pretty this year, but he's winning games. In fact, his Bronco's winning percentage is better than John Elway's ever was. Cut the man some slack.

But back to the season at hand: warm some apple cider on the stove; go rake a big pile of leaves and jump in them; breathe in deep the brisk, frosty mornings; cheer on your favorite football team--as long as they're the Cougs or the Broncs.

Savor autumn--the best season of the year.

Ethical Dilemmas

Every day, I encounter some dilemma of medical ethics.

Usually, it's a small thing: a patient demanding an inappropriate medicine; confidentiality issues involving sexually active teenagers; end-of-life care for elderly, demented patients.

Occasionally, I have been intimately involved in gut-wrenching, life-altering family dramas: removing ventilator support from a beloved mother who barely survived her own suicide attempt; administering chemically-castrating medication to a sweet (but potentially pedophilic) retarded teenager at his mother's request; whether to perform heroic (but futile) resuscitation to an essentially brain-dead child whose mother cannot let her go.

Nationally, medical ethics are all over the front page of the newspaper: Terry Schiavo, stem cells, organ transplantation, universal healthcare, cloning, physician-assisted suicide, emergency contraception . . . the list goes on.

When I first delved into medical ethics, I found it very frustrating that there did not seem to be a right answer. And in fact, there rarely is such clarity. Rather, in a true ethical dilemma, there are two "true"ethical tenets competing against each other: one valid tenet, "right" within its own sphere, infringes directly upon another "right" tenet when it is fully exercised. Abortion is the classic example: who can deny that a woman should have the right to control her own body? But conversely, who can argue that killing a fetus is a moral act? One trumpets choice, the other reveres life. Both are right; both have limits.

At some point in your life, devoted reader, you will confront your own ethical dilemma involving your (or a loved one's) health care. A framework to consider such dilemmas could be helpful. Here's a primer on fundamental Western medical ethics, founded on four basic tenets:

1) Autonomy: individuals have an inherent right to make their own choices in regard to their healthcare.

2) Beneficence: healthcare providers are bound to do good, or what is in the patient's best interests.

3) Non-maleficence: healthcare providers are bound to do no harm, or to refrain from what would be against the patient's interest.

4) Justice: a society must distribute healthcare goods and services in a fair and equitable manner.

Here's a brief case to cut your teeth on:

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Transfusion Error

A 70 year-old woman is rushed to the hospital in shock and semi-comatose. She is found to be hemorrhaging internally due to an unintentional overdose in blood thinners. She survives after being resuscitated with fluids and a number of blood products.

When she is removed from a ventilator a few days later, she asks a nurse what happened. The nurse responds that she almost bled to death, but that she's okay now. The patient states, "Well, at least they didn't give me any blood." The nurse cautiously asks, "What do you believe about blood products?" The patient responds, "Oh, honey. People that get transfusions go to hell and suffer for eternity. I'm glad that's not me."

The nurse leaves the room and calls the physician. Should she tell the patient the truth, even if it were to cause her unbearable emotional harm?

********************************************

This is a classic confrontation between Autonomy and Non-Maleficence. Which is paramount--our duty to respect her autonomy and tell her the truth? Or our duty to respect her well-being and avoid undue harm?

Theories are great, but you're a man or woman of action. Something must be done. What would you do? How do you justify your action? Please post a comment with your opinion.

(Remember, the good thing about medical ethics is there's no right answer--except for mine, of course.)

Small Town Roller Coaster

Here's a picture of one of Worland's many thrilling attractions, the "Screaming Dragon" Roller Coaster at Six Flags Over Worland . . .

Just kidding. You may be surprised, but there's nothing quite so spectacular as a roller coaster in these parts. There is, however, a kiddie park with a twisty slide.

But major theme parks aside, we have ridden a roller coaster of another sort in our first six weeks here, both enjoying and struggling with the realities of small town living. This weekend provided a stark contrast in our feelings for Worland.

Friday was supposed to be my day off. Since I had to drop Joy off at school anyway, I thought I'd stop by the hospital to finish a few things up. Four frustrating hours later, I stumbled home for a late lunch, my head reeling from a number of difficult, stressful, and wholly unexpected encounters: drug-seeking patients, complicated referrals, very abnormal lab results, scheduling issues, difficult families, delinquent charts, etc. It was the curse of the small town doctor visiting me for the first time: the inescapability from patients and problems.

Luckily, I had something to look forward to that night: Elizabeth's and my first Worland date.

But, boy, was that a bomb (or a fire), as driving down the main drag, we saw the venerable, ancient Worland Community Center engulfed in smoke and flames. We spectated there with the other half of Worland for a bit, then headed to a very lousy (but free) meal at a local Mexican restaurant. With the meal stomached and the Community Center burning to the ground, we then looked for something fun to do.

But nothing came to mind. We could have gone bowling, or . . . what else? We couldn't think of anything else, so we drove in the country around town for a hour, burning gas and talking, which was fun. But looking out from the edges of town across the barren desert stretching endlessly in every direction provoked a feeling of intense isolation for the first time since we've been here. We came home feeling bored, lonely, and stuck. We comiserated for the rest of the night, as both of us vented some negative feelings about the town that we've been politely withholding from each other.

But Saturday morning, something great happened. We met two new friends who have kids with similar ages to ours at a local park. The kids played wonderfully together while Elizabeth and I played tennis with the other couple . . . and we had a wonderful time. The weather was perfect the courts were fantastic (a very cool astro-turf court with light layer of sand over it that plays like clay), and we were very evenly matched with a fun and friendly couple. Then, we got to go home, and I enjoyed a Saturday full of great football games.

Overall, I love living here. And other than a few hours on Friday night, I haven't felt deprived of any big city conveniences. There are downsides to living anywhere, but a few good friends, some nice amenities (minus a community center), nearby mountains, and a strong church make this a most desirable place.

Now if we could just get a decent restaurant . . .

A Developing Philosophy

As the new doctor in Worland, I was asked to write an article for the local newspaper explaining what a "D.O." means. It was interesting for me to express in writing my developing philosophy of medical practice--to "fling my banner to the wind," as A.T. Still once did.

I have benefitted greatly from both osteopathic and allopathic training, and I find my resultant personal philosophy to be an interesting mixture of both, coupled with a heaping dose of my own feelings about medical ethics and end-of-life care. Throw into that cauldron some natural medicine philosophy from Dr. Andrew Weil, and you have the healthy soup (chicken noodle?) that I want to offer my patients.

While I deeply appreciate all of the wonderful mentors and teachers I have had that have contributed to this philosophy, I must admit an ecstatic feeling of liberation that I can now more fully express, without the sometimes restraining oversight of preceptors, my own philosophy about the practice of medicine. Not that I do anything too radical. In fact, I do my best to adhere to national consensus, evidence-based guidelines. But I believe there are far too many needless prescriptions handed out and surgeries being done; I believe that people need to take responsibility for their health by practicing healthy habits and preventative care; and I believe everyone needs to understand their own mortality and the limits of modern medicine, and to accept the end gracefully when it comes.

Here is a reprint of my article:

Hello, Worland! Thank you to everyone here for helping my family feel so welcome.

I am Dr. Mark Foster, DO, and I have just joined WMC Clinic’s family practice with Drs. Jamey Jessen, MD, and Kjell Benson, MD. Some of you may wonder why I have the title “D.O.” after my name rather than “M.D.” I hope to explain the important similarities and differences in the space below.

D.O. stands for Doctor of Osteopathy. Osteopathy is a distinct branch of American medicine, founded in 1874 by Dr. Andrew Taylor Still. Dr. Still was a classically trained frontier doctor who became increasingly frustrated with the inadequacies of 19th Century mainstream medicine (known as allopathic medicine), some of whose toxic remedies included arsenic, bloodletting, and mercury bathing. When three of his own children were taken by spinal meningitis while he looked helplessly on, Dr. Still first became despondent, then resolute towards finding a better way to practice medicine.

A devoted anatomist, he was inspired by the miraculous structure of the human body and its capacity for self-healing. He noted how the healing systems of the body worked better when the musculoskeletal system was in proper working order. Through experimentation, he devised a system of “manipulations” to restore the proper functioning of first the musculoskeletal system, and secondarily of the entire human body. He felt that a physician’s responsibility was not just to treat disease, but more importantly to find health. He named his new philosophy of healthcare “Osteopathy.”

Initially, Dr. Still’s intent was to separate from mainstream allopathic medicine. However, through the early twentieth century, Dr. Still’s successors at the helm of Osteopathic Medicine accepted and then practiced the breakthroughs of modern medical science: antibiotics, insulin, surgery, pharmacology, etc.

Today, osteopathic physicians practice with the full scope of modern medical advancements. There are D.O.s that practice in all major medical specialties in all fifty states: cardiologists, neurosurgeons, pediatric endocrinologists, and family medicine specialists. D.O.s prescribe medicines, order CT scans, perform surgeries, deliver babies, give immunizations, and practice medicine in much the same way that their M.D. counterparts do, with a few important distinctions: D.O.s are trained in performing musculoskeletal manipulations; and D.O.s adhere to a unique philosophy of healthcare.

As a D.O., I practice in accordance with the American Osteopathic Association’s refined Tenets of Osteopathic Medicine (2002):
1 A person is a product of dynamic interaction between body, mind, and spirit.
2 An inherent property of this dynamic interaction is the capacity of the individual for the maintenance of health and recovery from disease.
3 Many forces, both intrinsic and extrinsic to the person, can challenge this inherent capacity and contribute to the onset of illness.
4 The musculoskeletal system significantly influences the individual’s ability to restore this inherent capacity and therefore to resist disease processes.

In short, I believe that if you take care of your body, your body will take care of you, and so I emphasize healthy habits and preventive medicine. When things go wrong in spite of this, I believe that medications are sometimes the right answer, but that often they are not. The purpose of my training is to know the difference. Finally, I am able to perform a range of manipulations if your musculoskeletal system needs some special attention.

Above all, I am devoted to you as a patient, and to discovering with you how to optimize your health and happiness. I am honored to work with Drs. Jessen and Benson, and to help complement their continued delivery of compassionate, patient-oriented healthcare to Washakie County. Feel free to come and visit!

The Most of It

We went camping as a family this weekend in the Bighorn Mountains, next to beautiful pine-covered West Ten Sleep Lake. It drizzled a bit in the evening and then got quite cold at night.

Fortunately (or unfortunately), all four of us slept in one little tent. Fortunately, because it actually remained quite toasty with all of the body heat. Unfortunately, because one little man who shall remain nameless (Grant) is a piggly wiggly who squirmed and kicked and whimpered all night long, keeping the rest of us from sleeping hardly at all.

At about 3 a.m., Elizabeth and I were still awake due to Grant's antics, crammed together with Joy into the left third of the tent, with Grant himself comfortably sprawled across the other two-thirds of it. While having a whispered discussion of our sad plight, we broke into a muffled hysterical laughter, acknowledging the power of one little man to make three other people so miserable, and to look so cute doing it. We christened him, "The Ultimate Bed Hog," and laughed for a good while before reverting to our prior state of sleepless misery.

At about 4:30 a.m, I had had enough of lying with my face crammed against the wet tent wall, so I thought I would just get up, restart the fire, and think for a bit. After blowing the buried embers back into a warm blaze, I took a short hike down to the lake. The skies had cleared and there was no moon; the unfiltered starlight bathed the whole scene in a surreal hue of pale violet. Across the lake, a granite rock face spilled down into the water, surrounded on every side by towering pines. Not a single man-made light or structure could be seen polluting the wilderness beyond.

I was suddenly struck with a triple epiphany (not a melancholic one). Number one: the pure joyous beauty of a pre-dawn mountain lake for its own sake. Here was nature, devoid of any hidden metaphor or attached meaning; it was what it was, and probably appeared the same way it did a thousand years ago. That I happened to be there at this moment to enjoy it was a happy accident . . . but its essential being was unaffected and would continue on unaltered (hopefully) for another thousand years.

Epiphany number two: the striking resemblance of the scene to the mountain lodge where we stayed on Grand Mesa last year, while working in Cedaredge. (Only ten months ago???) Our hearts broke with the rapid, unexplained dissolution of what had seemed to be the perfect opportunity, not so much because of the job, but because of the location. We felt that in the Grand Mesa, we had found one of the hidden jewels of Colorado, and then it was uncerimoniously stripped away from us. So now, to be five hundred miles away and peering out over a pine-carpeted mountain lake every bit its equal in sublime beauty, I felt somewhat of a prayerful vindication: thank you for our new perfect opportunity.

And number three: the setting from a favorite Robert Frost poem, "The Most of It," seemed to vividly materialize before my drowsy eyes. I first read this poem in a frenzied rush while composing a response essay for my AP English exam. I have since returned to it many times, savoring its powerful, somewhat dispassionate imagery.

It narrates the story of man shouting across a stony, wooded lake, pleading with the cold universe for some sign of love or validation. Instead, he hears only his echo, and then a crash into the water across the lake. Eventually, a large buck reveals itself, pushing through the water before emerging onto the rocky shore right in front of him, then crashing off into the woods, and "that was all." Here it is in its entirety:

The Most of It

by Robert Frost

He thought he kept the universe alone;

For all the voice in answer he could wake

Was but the mocking echo of his own

From some tree-hidden cliff across the lake.

Some morning from the boulder-broken beach

He would cry out on life, that what it wants

Is not its own love back in copy speech,

But counter-love, original response.

And nothing ever came of what he cried

Unless it was the embodiment that crashed

In the cliff's talus on the other side,

And then in the far-distant water splashed,

But after a time allowed for it to swim,

Instead of proving human when it neared

And someone else additional to him,

As a great buck it powerfully appeared,

Pushing the crumpled water up ahead,

And landed pouring like a waterfall,

And stumbled through the rocks with horny tread,

And forced the underbrush--and that was all.

While meditating on these three epiphanies, the eastern sky began to pale with the first inkling of dawn, and a deep tiredness crept over me anew. I stumbled back to the campground, threw a few more logs on the smoldering fire, and lay down on the dirt next to it. An hour later, I awoke to the crisp, salmon-colored skies with my left arm totally numb from having slept at an odd angle.

As my family slept peacefully a dozen yards away, I arose, shook out my hand, and stoked the fire to life again. From neighboring camps, the rustlings of morning creaked and yawned to life.

Life is many things, I thought: beautiful, uncomfortable, tiring, inspirational--human interpretations of what it should mean. But this mountain morning did not reveal itself to me with any secret meaning. It simply was. And that was all.

Melancholic Epiphanies

Sometimes, when life has beaten you down, a wry voice enters the mind, and in laconic prose declares an incontrovertible truth: the melancholic epiphany.
Tonight was not at all melancholic. On the contrary, after a difficult day at work, Elizabeth and the kids threw a great 32nd birthday party for me. We played games, opened gifts, wrestled, danced, laughed, and then had my perennial "Funfetti" cake: multi-colored cake, white icing, and Cookies & Cream. Mmmm . . . delicious.
And oh-so-rich. So rich that approximately thirty minutes after devouring the sweet morsel, a profound lethargy crept upon the entire family--a post-prandial, hyperglycemia-induced, glucagon-mediated stupor. We lay prostrate on the bed. The kids needed to brush their teeth, the dishes need to be done, this blog post needed to be written, but our listless bodies lacked the vitality necessary to overcome the birthday cake inertia. At this point, my lovely wife sighed, looked at me, and stated, "I guess we ate a little too much cake."

When a birthday cake takes down an entire family, when the much anticipated big-game ends in a humiliating rout, when the opportunity to express your truest self ends instead with your foot firmly inside your mouth, when your chance to display your technical prowess results in a convincing display of ineptitude that winds up in the local paper, when you're the new family in church and were asked to say the opening prayer on Sunday (but forgot) and so you arrived five minutes late to hear your name echoing through the empty foyer, when you venture to the local retail store to buy your son a much anticipated new trike as a reward for his improved behavior only to have him throw a spectacular eardrum-shattering tatrum in front of thirty of the local citizens, when your best efforts to care for a patient end in a tirade against you by a confused mother, when you loan your brother a truck that's never caused you a single problem and within three weeks it needs $1,000 worth of repairs . . . well, then, you're ripe for a melancholic epiphany. :)

If you're having trouble formulating these feelings of betrayal, humiliation and despair into coherent thoughts, then visit www.despair.com. They will formulate your thoughts very well for you, and give you ample cause for a sardonic belly-laugh.

In all reality, life is good for us. Very, very good, in fact. I feel more at ease and healthier and more content than I can remember in a long time. I love Worland, I love my wife and kids, I love my job. But the past week has provided some potent reminders (see above) that life is a constant battle to stay between the shores of pridefulness and humiliation.

So be thou humble, or be thou humiliated.

(Hey, that's a good one . . .)

What recent melancholic epiphanies has the cement mixer of life blessed you with? Share them with the world (or at least with the five or six other people that read my blog) by commenting below.

Wonderful Wyoming

The Grand Teton Range

I have spent many years ridiculing the barren desolation of southern Wyoming, but now I feel I must publicly admit the error of my ways.

The Wind River Range

(Picture taken by yours truly)

Make no mistake: the stretch of southern Wyoming along I-80 is pure desolation. But as Wyoming folks are fond of saying, they're glad it's so ugly down there because it keeps outsiders from discovering the awesome grandeur of the state up here.

One of the things that makes Wyoming so great is that it is so sparsely populated: ranked 9th in size but 50th in population. You can go for miles and miles and not see any people or dwellings.

Ten Sleep Canyon

(30 miles east of Worland)

Last weekend, we drove back from Utah over Teton pass and then down along the Wind River Range, through the Wind River Canyon to Worland. Though I'll always be partial to Mt. Sneffels and the Colorado Rockies, they've got nothing on the Wyoming Tetons when it comes to sheer majestic power. In fact, between the Tetons, Yellowstone, the Wind Rivers, and the Big Horns, Wyoming holds some of the most beautiful terrain not just in the USA, but in the world.

Worland itself, while a great small town, is not particularly scenic. However, there are two gorgeous canyons less than half an hour away; the Big Horn mountains are only forty minutes away; the Wind Rivers and Yellowstone are only two hours away; and the Tetons are only four hours away. In other words, a spectacular array of wilderness beckons within a short drive, and there's hardly anyone else you have to share it with.

The Wind River Canyon

(30 miles south of Worland)

So Wyoming, I apologize. You're more beautiful than I ever imagined. I hope to make it up to you by exploring and relishing your wilderness for many years to come!

And to any friends or family who may be reading this, you will always be welcome to come visit us and explore our new beautiful state.

(But shhhhh . . . don't tell anyone else about it!)

The Wind River Range (again)

Every Dog Has His Day

You know it's a small town when you move in and they throw a parade in your honor . . .

Just kidding. Yesterday was the Parade for the Washakie County Fair, and my welcome section was just one of 40 or so "floats," right behind the (annoying) Shriners. (Question: Why the silly hats?)

It was, all things considered, quite the experience. Joybear rode her bike the whole mile of the parade route while Elizabeth trotted behind. Grant Guy and I cruised on a four wheeler alongside my two partners, who also rode with their sons. (That was the gimmick, all the docs with the cool rides.) All three of us watched as two pregnant employees (including my nurse) walked down the parade route, drenched in sweat. (We offered the four wheelers, but they refused. Honest!)It was a hundred degrees, and we tossed flaccid Otter Pops to the adoring throngs, as well as to the cranky old dude who yelled at me from the street corner, "How long 'til they run ya outa town?"

It was fun and hot and silly, but a memorable experience.

I'm reminded of some Dave Matthews' lyrics:

"Every dog has its day,
and every day has its way
of being forgotten.
Mom, it's my birthday!
What would you say?"

A Paradoxical Summer

Sometimes life moves at a snail's pace, sometimes at breakneck speed. And rarely, paradoxically, it does both at the same time. This last month was just such a paradox for us.

But first, allow me to digress.

In the short-term retrospect of American historians, 1969 was a pivotal, earth-shaking year--a year that everything changed for our nation politically, culturally, economically and socially. (Even Bryan Adams wrote a rock anthem to the effect.) To be sure, that year did not suddenly exist de novo as a social fulcrum, but rather it was the culmination and climax of a number of swelling, surging cultural movements; it was the year the crescendoing wave crested, broke and scattered foam far up onto the distant beaches of society, its debris still being collected, categorized and understood to this day.

To be quite overly melodramatic, I believe that Elizabeth and I will view the Summer of 2006 in a similar way in our personal lives. Up until June 23rd, we had been cruising along in somewhat of a holding pattern--quiescent if not entirely content. Life was good, could have been better, but there was no particularly dramatic frameshifts in motion. However, a whole new weather pattern was hovering just over the horizon, tantalizing close but still remote enough to be neither disturbing or distracting.

Then the storm broke in its enthralling and terrifying glory. A raucous graduation, a paradisiacal romantic getaway to Costa Rica, a furious flurry of high intensity entanglements in red tape as we struggled to get licensed in Wyoming and secure our loan repayment, a miraculous sale of our home in a stagnant realty market, a frantic purchase of our Worland home, a joyous reunion at the Ranch, a torrid move to Wyoming, a new city, home, job, church, lifestyle . . .

At times the last month was as gentle as a sea breeze blowing on a shimmering Pacific beach, at times as tempestuous as a summer lightning storm in the Rockies. Certainly it's too soon to make sense of all that's happened. I guess this is a feeble effort to process it all to some degree. All I know for sure is that life looks entirely different than it did one month ago.

And yet the more things change, the more they stay the same. I still have Elizabeth and Joy and Grant. I have my family and my faith. I have my career, my interests, my weaknesses . . . my blog? (They can't ever take that away from me!:) To quote Bono and the Boys: "The only baggage you can bring is all that you can't leave behind."

Now that the dust is settling into a semblance of routine, I hope to renew my weekly postings here.

Yes, yes. I know. The burden of my absence has been too much for you to bear. There, there. It's going to be alright. Markie's back.

Kid Fears

As a young child, nothing struck fear deeper into the heart of myself and my brother Matt than this fearsome, loathsome aquatic terror, the trigger fish.

I am posting this picture now for one sole reason: I know that the instant Matt opened this page and saw this image, his heart dropped in his chest, his breath quickened, and he flushed with cold sweat-- just for an instant. Then, his rational adult brain took over and convinced him that there is nothing to be afraid of. (Right, Matt?)

I know he felt this because that's what I felt recently when I accidentally opened a long-forgotten Childcraft book to this very page. A chill ran down my spine before I steadied myself, before I gave reason for my children to doubt my manhood.

As kids, Matt and I used to flash this page open, shriek, and then slam the book closed--repeatedly. It was a sort of terrifying fun, but it haunted our dreams at night. I remember being too frightened to open the book alone, as if the trigger fish would burst out of the page and snap its jaws into my throat.

Now all grown up, Matt and I have more substantive things to be afraid of: money, responsibility, terrorism, boredom, insignificance, failure, even success. And then there is the relentless encroachment of time and age that marches on and promises to render us obsolete and forgotten. These are real fears, tangible dangers that we all must face daily when we throw the covers off and stumble out of bed.

But for all of us, some vestigial childhood fear--deep-seated, reflexive, like the trigger fish--forever lurks in the quiet lagoons of our subconscious, ready to get medieval on us, pick our bones clean, and leave our carcasses floating down the river.

It's not real; it can't harm us. So why does it still evoke such terror?

What would you give for your kid fears?

My Valuable Time

I came across this cartoon recently at another doctor's office. Very funny, but only in jest, of course.

My Kiddos

Nothing is more important to me than my two great kiddos, and so I would like to devote this posting to them.

First of all, here's my daughter Joy, affectionately known as"The Joybear." Few children have ever been named so fittingly. She is happy, funny, active, courageous, smart, caring, independent, and friendly. She's Daddy's Best Buddy, Mommy's Special Helper, and Grant's Best Friend. She's quite a soccer player, a great colorer, and an avid "reader" of kids' books. If she had her choice, her upcoming birthday would be themed a Butterfly Soccer Princess Birthday Party.

Tonight, she was telling me the names of her various dolls. There was a Katelyn, and similarly a Catlyn, Cotlyn, and Carrotlyn. Then, out of the blue, she pointed to a boy doll and christened him "Ringay Dandossio." Where did that come from? The Joybear's fertile imagination, I guess. We laughed about it for a long time.

Then of course, there's the Little Man, Grant. He's coming up on three years old. He's a rough-and-tumble boy, but a sweetheart as well. He's a little prankster and gets a big kick out of his jokes. He loves to wrestle with me at all times, and often my time at home is spent with him hanging off me at various odd angles while I repel his continuous attacks. He's a very talkative, bright, funny, and indepedent boy.

Like all two year olds, Grant Guy tests our limits. As his Daddy, I often draw the line and hold him to it, and the resulting confrontations have been likened by Elizabeth unto "two billygoats butting heads." He's very much like me in his stubbornness.

One very endearing trait that has recently surfaced is an uncompromising commitment to integrity. To illustrate: last night he was being very picky and not eating his dinner. I told him several times that unless he ate his dinner, he couldn't have Mommy's delicious pie afterwards. He pushed his peas around for a while and then got up without eating anything more. A while later, it was pie time, and I frankly had forgotten about his "logical consequence." But Grant did not. When I asked, "Who wants pie?", Grant solemnly responded. "I can't have pie, Daddy. I didn't eat my dinner." When Mommy hinted that he could still have pie, Grant firmly, sincerely responded, "No, I can't. I didn't eat my dinner." As Mommy and Daddy's hearts broke, we hatched a solution: if Grant ate his peas now, then he could still have pie. He was up for that, so we all enjoyed our pie, having learned a bit about honesty and keeping your word from our little man.

I love these two kids. The innocence of their childhood is what it's all about. Really, the worries and concerns of adulthood pale in importance to the discovery, wonder, and purity of their childhood. I'm grateful to my own parents for providing me with a sanctuary at home in which to grow and learn and love, and I only hope that I can provide that same level of guidance, protection, and love for my children.

The Joybear and the Grant Guy. What a pair!

To Sleep, Perchance to Dream

Who needs sleep?

I do, and lots of it. Without sleep, I don't function well. I get grouchy, sloppy, despondent, and my activity slows to a turtle's pace. None of those descriptors are what you want attached to your doctor when your life is on the line.


Even though recent laws have been passed that restrict resident work hours to 80 hours per week, the time honored tradition of the 30 hour shift still persists. For most people, a 10 hour work day is a long one. Imagine doing that, then doing it again, and then doing it one more time, back-to-back-to-back, without a break and under conditions of extremely high intensity, when any mistake on your part could result in the death of someone else.

Except for my residency colleagues, I don't think anyone else reading this can truly understand how difficult it is. It is something that can only be appreciated through experience. And we do it every 5th night. All hyperbole aside, we are not superheroes. We adapt, we learn to pace ourselves, we learn to prioritize, we sleep when things are (rarely) quiet. Thank goodness for epinephrine (a.k.a adrenaline) that kicks in in the clutch and makes our minds sharp when needed most.

Sometimes, when we're really dumb, we work extra hours to make a few extra bucks. For example, over Memorial Day weekend I volunteered to work at the Yuma, Colorado Hospital for a 72 hour shift. Yuma is a small town near Kansas with a 12 bed hospital. I did the same thing last year, and it was a piece of cake. I hardly worked for 2 of the 3 days, so I had high hopes for a repeat this year. I brought Elizabeth and the kids with me so that we could spend some time together.

We were all sorely disappointed, as a whirlwind of badness descended over Yuma, coinciding with my arrival for the weekend. Several major motor vehicle accidents, several major orthopedic fractures, a slovenly procession of drunks and deadbeats, a death, a premature labor, 6 patients transported emergently out of town via helicopter and ambulance, and 30 ER visits later, and I was about done for. I had nothing left in the old tank. I got ZERO sleep on Friday night and the badness just kept rolling in uninterrupted until almost 24 hours later. Mercifully, I climbed zombie-like into bed around midnight on Saturday night and proceeded to get about 6 hours of uninterrupted sleep, which refilled my tank enough for me to make it through the next 36 hours. By Monday evening, the hospital nurses were only half-joking when they asked me to never come back, as they assumed it was my bad mojo that had precipitated the weekend's carnage.

When we pulled out of town late Monday night, a feeling of exhaustion, relief and triumph swept through me. I had done a very long, legendarily difficult shift. I had made a few mistakes, but had also saved a few lives, rendering quality medical care to the good people of Yuma despite some adverse circumstances. And I had accumulated a litany of war stories which I have relived with my fellow physicians over the past week.

Which may go to the question of why we sign up for the sleepless, stress-filled nights, when there are plenty of easier ways to make a buck. Why? The sense of fulfillment, the underlying compassion for humanity (sometimes masked by the necessary cynicism), the sense of purpose, the adrenaline rush, the prestige, and the glory somehow compensate for the bloodshot eyes, the mental cobwebs, and the eleven years of preceding poverty.

Is it worth it? There have been plenty of sleepless call nights when I head down to admit another drunk criminal and I feel the gaping abyss of despair open beneath me that I would have emphatically stated no. But now on the precipice of completing my training, as the attributes and skills of a physician are permanently coalescing within me, I can retrospectively state, "Yes, it has been worth it. I have climbed the mountain and can understand the purpose of what seemed to be an endless trek. Veni vidi vici."

Now, if you'll excuse me, I need some sleep

Interdependence

As Western society becomes more complex, specialized, and technologically advanced, we all have an increasing interdependence upon each other. Sometimes I dream of pulling a "Mountain Family Robinson", moving to a log cabin somewhere, severing all ties with other human beings except for my family, and living a life of self-subsistence in the wild, just me and the bears and the mountain goats. But when I realize that we'd all be dead within a week, I reconsider.

I think that, in our day and age, no one person can possess all of the subsets of skills necessary to thrive--or even survive--in modernity. We need and rely on each other to specialize in certain areas of life. For instance, I'm a doctor. If while you are reading this, you develop a cardiac arrest and drop dead on the floor--which, if sheer boredom can kill, is conceivable--and if I happened to be in your close proximity, lucky for you. I possess the training, skills, and experience necessary to resuscitate you. (Of course, I would need a defibrillator, a bag-mask, an IV, medications, EKG, nursing help, etc. Keep those handy, too.)

But if, while you are reading this, your washing machine goes kaput, your computer becomes irrevocably infested with spyware, or your gas-line starts to leak, then having me in your close proximity is no advantage.

All three of these things happened to us in the past week, and we suffered immeasurably because of them, weeping in despair at our complete incompetence in dealing with these dilemmas. And we would have persisted in our state of pathetic debilitation, if not for the kindly expertise and service of Don and Ron.

First, Don is an employee of Walt's Appliance and (conveniently) Computer Repair. One call, and within a few days he was at our house. It took him fifteen minutes to expertly diagnose our washing machine (slow leak, rusted "wig-wag", old belt, and pump failure--hey, this thing is 20+ years old). Then, within minutes, he had diagnosed our computer virus that has crippled us for weeks, though he needed to take the computer with him to access the appropriate virus-cleaning tools. Now today, our washing machine is operational, our computer is free and clear, and a semblance of order has returned to our interdependent existence, all for the low price of $213.00.

Next, Ron is an exceptionally good-natured employee of Atmos Energy, our local gas company. When Elizabeth and I both smelt a sudden, strong gas odor in our home at 10:30 pm on Wednesday night, we got the kids in the car, pulled out into the street, called the gas company, and watched our home explode into flames.

Just kidding, no explosion. But Atmos promptly dispatched the on-call technician to our home, Ron. He arrived within fifteen minutes, calmly and cheerily proceeded to identify that there was no gas leak, but that our pilot light had gone out on our hot-water heater. A small amount of gas had probably escaped into the air, was drawn upstairs quickly by our attic fan, but was now all gone. He lit our pilot light, then proceeded to track down the entire length of our gas line, including underground, to ensure that there was no problem. He then pronounced our house safe for our return, and as we slinked back in, he called after us to let us know he'd be back in a jiffy if there were any more problems. No charge. We slept well that night.

So whether it be the above problems, auto work, legal needs, medical care, or any other of the hundreds of necessary survival skills for today's world, we all have two options. The first would be to go to school or otherwise educate ourselves, and then fix the problem on our own. The only catch with this plan is that it would be time-consuming, cumbersome, and impossible. It would take more than our entire lifespans to acquire the necessary experience just to make the rest of our lives livable. Therefore, the second option is the only realistic one: we must trust our fellow humans and rely on each others' experience and expertise to get us out of a jam.

Modern medicine is a microcosm of our greater society out there, in the sense that it has become highly sub-specialized. I am currently working with a dermatologist, whose twenty-plus years of experience allow him to instantly diagnose most skin conditions, the same conditions that I, as a family practitioner, spend thirty minutes reading about, consulting with other doctors, and ultimately scratching my head, saying, "I don't know what the heck is wrong with you, but it's crazy!" (Patients don't respond well to this display of bewilderment.) :)

That being said, I think that there is a greater need than ever for the well-rounded family physician, the one doctor who can take all the different pieces of the puzzle and make them fit into a coherent picture. I would say that I can appropriately and expertly manage about eighty percent of the health problems that patients come to me with. The other twenty percent? I'm glad there are specialists out there who can ride to the rescue. But ask the dermatologist to manage hypertension or a child's ear infection, and he would probably give you the same look of bewilderment I give when looking at a complicated skin problem.

So in the end, it's all about trust and interdependence. Thanks to all those from whose expertise I have benefitted in my life. I need you, you need me, look how happy we can be. (Is this starting to sound like Barney?)

My Next Thirty Years

Here's a picture of the two beautiful girls in my life on Elizabeth's 30th Birthday!
(No, there are not thirty candles on the cake, but a man can't be expected to plan everything right, can he?)

Tim McGraw said it well:

I think I'll take a moment, celebrate my age

The ending of an era and the turning of a page

Now it's time to focus in on where I go from here

Lord have mercy on my next thirty years

Hey my next thirty years I'm gonna have some fun

Try to forget about all the crazy things I've done

Maybe now I've conquered all my adolescent fears

And I'll do it better in my next thirty years

My next thirty years I'm gonna settle all the scores

Cry a little less, laugh a little more

Find a world of happiness without the hate and fear

Figure out just what I'm doing here

In my next thirty years

And here's my cute son, Grant, chowing down on an ice cream cone. Check out the ice-cream soul patch . . . What's he going to do in his next thirty years?

If it involves ice-cream, he's there!

I'm coming up on the big 3-2 this summer, and unlike most of my previous 10 or so birthdays, some major changes will be taking place. Mainly, a real job and a new home. Career-wise, I've spent my first 32 years preparing to be able to now go and practice medicine in rural Wyoming. I've gotten so accustomed to being in school or training, to always preparing, to always looking beyond what I'm currently doing towards a more distant goal . . . how am I going to handle actually being there?

I remember after my mission and before I got married, my younger brother Jeff and I went on a couple of long summer roadtrips across the west, to Yellowstone, Yosemite, Glacier, Mt. Whitney, Death Valley. These were highly anticipated, loosely planned summer adventures that were to appease a pervasive sense of Wanderlust, the desire to explore and experience the greater world out there. They were wonderful, funny, memorable trip: camping secretly in the rain on someone's private property, scrounging up gas money from the change we dug out of the carseats, surviving major mechanical failure of our car in Death Valley, and seeing some of the most beautiful country in the world.

But even though I was where I wanted to be, doing what I wanted to be doing, I was still driving 95 mph across desert interstates, restless to get to wherever I was going next, even if it was just a barren, windy campground in the middle of the Montana plains called Dead Mand's Basin. There was joy in the journey, but it seemed to be mostly in anticipation of the journey's end.

So, now I'm approaching the end of one journey and then starting a new one. Here's to finding peace and joy in the here and now.

Here's to the next thirty years!

Rocky Mountain High

A wonderful spring day in Colorado! This is the type of day that makes me sad to be leaving for Wyoming soon. And so here is a farewell tribute to my favorite state:

1)The Rocky Mountains: Any discussion of Colorado's virtues begins and ends with the mountains. They give the state such stature and strength, not to mention a million postcards. Recently, I flew from Phoenix to Denver on a perfectly clear day, and I was amazed at the number of landmark mountains that I could pick out, all capped in a deep, smooth layer of virgin snow.


Let me break these down individually into my favorites:

--The San Juan Mountains: a lesser known range, but so spectactularly beautiful that they take your breath away when coming across Dallas Divide, bursting upon you, looming over you like towering cathedrals. Mt. Sneffles is the centerpiece of this range, and Telluride is its heart.

--The Lone Cone: a perfectly conical peak that will always be near and dear to the old Markster's heart. My love of this peak developed while working at Derald Skalla's ranch. Every day, no matter what field I was working in, I could look up and see the Lone Cone. Eventually, I took a Jeep trip up towards the top and I made it to just below timberline. I was a lone man at the time, and it seemed like the Lone Cone was my only companion that summer. I love going to the Ranch now and having its picturesque beauty be omnipresent there as well.

--Long's Peak: I see this towering peak greets me every day on my way home from work, and it reminds me that I'm still in Colorado and only an hour from the mountains.

--Rocky Mountain National Park: A fortress of alpine beauty.

--Grand Mesa: one of Colorado's best-kept secrets. A lush, cool outdoor paradise. A thousand lakes, a million aspens, and a billion lodge pole pines on a mesa top that has infinite uses. If you ever want a great hike, try Crag Crest, a spine of rock 11,000 ft high that splits the mesa. You can see hundreds of miles in every direction.

--Other favorite spots include: Mt. Falcon, Breckenridge, Steamboat, the Cimmaron range, Powderhorn, Glenwood Canyon, the Weiminuche Wilderness, and Mesa Verde.

2) Denver: what a great city! So many amenities: museums, zoos, theatre, parks, professional sports, restaurants, 16th Street Mall, great airport. When we moved to Denver in 1989, the city was just emerging from a huge economic slump. But over the last 18 years, has any American city made greater strides and become more usable and enjoyable? I attribute its success solely to the Fosters' arrival. :)

3) The Economy: when I drive around the Valley or Highlands Ranch, I often ask myself, where does all of this money come from? While there are areas of spotty economic development, for the most part the state is happily esconced in its upper-middle class lifestyle that affords an excellent and enjoyable quality of life. Even if you don't have a lot of money (like us), the cities and parks are clean, safe, and friendly.

4) The People: there's just something cool about a Coloradoan. A certain easy-goingness, hipness, spirit of adventure, openness and friendliness. The leather jackets, the "Respect Life" license plates, the friendly ski dude sitting next to you on the lift, the hearty ranchers on the eastern plains. Good stock, all.

5) The Politics: no place can be perfect in this regard, but Colorado makes a good effort. It's an open-minded, fairly progressive state that is solidified in its bedrock conservative values. I think that the even mixture of Republicans and Democrats keeps everybody honest and willing to compromise . . . though it does make campaign season very annoying.

6) Finally, the Seasons: I love our four distinct seasons. Living in Arizona for a while and then returning here has made me realize just how much I love them. I have a hard time deciding which one is my favorite: is it the spring time, the rebirth of the trees and grass, the warm sun and the May thunderstorms? Is it the perfect summers in the mountains, the always-cool evenings, the camping, whitewater rafting, backpacking and softball? Is it the fall, the golden aspen, the Broncos games and the smell of firewood and leaves? Or is it the first snow, the shimmering peaks, the first ski run of the season? Every season offers a fullness of outdoor adventure and sublime atmosphere, and every years spills welcomingly into the next.

For all of the above reasons and many more, I love Colorado. Chime in with what you love about this great state . . .

One Day More . . .

Today is my last day as OB service chief in residency. While I had envisioned yelping "Hallelujah!" on this last weekday, two factors are tempering my exuberance: the fact that I still have to work this whole weekend, and an unexpected feeling of nostalgia that has settled in. While I am truly ecstatic to almost be done, I'm also a bit sad that this phase of my life is approaching the end.

But not that sad.

The title of today's posting comes both from this sense of closure, but moreso from the climactic chorus at the end of the first act of Les Miserables. Elizabeth and I saw the traveling production last night at the Buell Theatre in Denver. Few things in life truly move me the way Les Miserables does, and this song in particular.

The song begins with Jean Valjean on stage, questioning how Javert has come to persecute him yet again on his "never-ending road to Calvary." Next, Marius and Cosette are fawning over each other and their new love that will come to an abrupt end tomorrow as they are to be separated and Marius is to die. Then add the revolutionary students and their shrill, violent exhortation to fight for the people and for economic equality. Then add Javert, hot on Valjean's trail yet again, hungry at last to see his foil brought to justice. Now add the lecherous Thenardiers as they salivate over the possibilities of mining the gold from the mouths of the fallen soldiers. Then, just for good measure, throw in Eponine's plantive cry about her unrequited love for Marius. Mix all of those elements in a swelling chorus of sublimely interwoven melodies until at the breaking point the voices all unify and declare, "Tomorrow is another day, tomorrow is the judgment day. Tomorrow we'll discover what our God in heaven has in store. One more dawn. One more day. One day more!!!"

Or said more a bit more succinctly: throw anguish, fear, guilt, justice, duty, revenge, freedom, friendship, bloodlust, envy, shameless greed, infatuation, faith, anxiety, humor, hope, virtue, vice and unrequited love into a cauldron of revolution, boil it over a fire of full symphonic power, add clever and powerful rhyme, and pepper it with searing vocals . . . and that's your song, "One Day More." It is the near sum or human hopes, fears, and sorrows rolled into one climactic song. Everything hangs in the balance. Fear and hope permeate the air: "Tomorrow we'll discover what our God in heaven has in store."

Another thing I find moving about Les Miserables is what I view as its artistic intention. The musical was written, in my interpretation, not to be just entertainment or a faithful adaptation of Hugo's work, but rather as a vehicle to change the world, to shake us out of our modern, materialistic slumber and to remind us of our connection to God and each other. This vision is best articulated, fittingly, in the very final scene, as Fantine, Valjean, and Eponine sing as angels to Marius and Cosette that,"To love another person is to see the face of God."

Fade out. Then a barely-audible backstage chorus begins to crescendo:

Do you hear the people sing lost in the valley of the night?
It is the music of a people who are climbing to the light.
For the wretched of the earth, there is a flame that never dies.
Even the darkest night will end and the sun will rise.

They will live again in freedom in the garden of the Lord.
They will walk behind the plough-share,
They will put away the sword.
The chain will be broken and all men will have their reward.

Will you join in our crusade? Who will be strong and stand with me?
Somewhere beyond the barricade is there a world you long to see?
Do you hear the people sing? Say, do you hear the distant drums?
It is the future that they bring when tomorrow comes!"

These aren't the lyrics of entertainment. They're the cadences of the pulpit, an exhortation to hope for the best in the future and to treat each other kindly in the present. Who can see this production and not feel overwhelmed by its sweeping portrayal of the human condition? Even a jaded cynic with dessicated tear ducts (like myself) finds the tears flowing. I once read a critic who said, "If you see Les Miserables and aren't moved, it says more about you than about the play."

So be nice to each other. Look towards Christ as a beacon of hope in a troubled word. And give your kids a big hug tonight.

Life is short, wonderful, horrible, and ultimately, desperately, deeply meaningful.

Live your life well . . . one day more.

An Unnatural Peace

I sat in my truck at a stoplight late this last Tuesday evening with basketball sweat still cooling on me, a soft breeze sifting through the open window, and had an epiphany of sorts.

I had just finished my weekly game of pickup ball at the church building and was now on my way home. I had played well--though not great--and was enjoying the increasingly familar muscle aches that my aging thirty-something body suffers after these games. I say "enjoy", because I have always liked the healthy exhaustion I feel after playing a good game of hoops, just like I used to relish the painful sting of floorburn on my knees in the shower after a high school game--a sign that I'm still alive and kickin'.

John Mayer was crooning "Why, Georgia, Why?" on the stereo, and my soul seemed oddly at ease. I found myself gently grooving to the beat as I scanned the nighttime scene: red stoplights, orange streetlamps, blue flashes of cars, bright autodealers, big box stores, chain restaurants and endless pavement. I was struck suddenly by how completely unnatural everything around me was, and yet simultaneously I felt at peace with it all.

Is it possible to feel at peace with modernity? I have always associated peace with nature: mountains, streams, oceans, clouds, sunsets. And I usually associate the trappings of modernism with frenzy, anxiety, worry, anger, and displacement.

Here, almost nothing I could see in any direction was "natural", except for the scraggly brown grass that crept along the highway. There were no trees, no animals, no rivers, no peaks. The wash of lights and signs shrouded away even the stars and the moon. Yet here I was, feeling just peachy in my modern groove. Was there anything wrong with that?

My train of thought then jumped track, and I envisioned how this same piece of earth, now buried beneath my truck and the pavement, would have looked four hundred years ago. I imagined a fierce Lakota warrior standing triumphantly over a slain buffalo, scooping out its liver and tasting of it, hot and bitter on his tongue, wolves howling into the starlight of the high plains, the smell of sage and blood, the cool dust under his bare feet. Would he have felt a similar--but more organic--sensation of being alive and enveloped by his environment, a warrior's peaceful, easy feeling, so to speak?

The light jumps to green and my truck roars into gear. The wind flaps more fervently through the window, and I correspondingly turn up the volume to match it. I accelerate towards home into an endless sea of suburbia.

The fierce warrior has intruded upon my thoughts, and I sense a familiar post-modern guilt creeping in. But I push it away. This is how I live. This is who I am. Should I feel guilty for feeling at peace with myself and my environment? Not tonight, I convince myself.

Tonight, nothing but props to the modern man.

Here's to you.

End of the Week

No profound musings this time. Just a brief sigh at the end of a busy, frustrating and fascinating week. And I finally have a weekend completely free! It's been such a long time. And I'm so grateful the weather is supposed to be good.

Yesterday was a rough day--I worked about 16 hours straight of pure stress and saw over 5o patients in that time (at the hospital, in the clinic, and at Loveland First Care). On long days like that, each patient comes with their own issues and expectations, and I try to come into each encounter with a fresh perspective, devoting them my full attention and mental capacity (which is not much). But by the end of a day like that, it's tough to maintain my equanimity, and the reservoir of compassion runs low. Like the upset grandma (the actual mom looked about 12 yrs old) who could not be convinced that her grandbaby's rash was benign and self-limiting and not at all concerning. What did she want me to do? Grrrr. And she wasn't very nice about it.

Today was a much different story. I had a pleasant and relaxing clinic full of fairly reasonable people and cute kids. And in the middle of it I was able to do an "external version" on my private OB patient, which involved manipulating the baby from a breech position to a vertex, or head down, position. Very, very cool.

I also presented a case at our bioethics committee meeting today. It's a committee made up of doctors and lawyers and ethicists and social workers that meets once a month to argue about ethics cases. It used to be frustrating to me because nothing would actually be decided or agreed upon--just lots of vocal, unsubstantiated opinion. But what arena could be more appropriate for a Foster? It's a chance to discuss the fascinating grey areas of medical ethics, and it's something I greatly enjoy. Almost everyday I encounter some grey area of ethics--not a hypothetical case, but a real breathing patient or family that is attempting to make life altering decisions. While I am a believer in absolute truth, there are rarely clear-cut answers in medical ethics. Most always, the dilemmas involve the competing effects of two ethical tenets. For example, Autonomy often conflicts with Non-malificence (Do no harm), as in the case of physician-assisted suicide. Which one trumps the other? But that's a discussion for another day.

So now it is Friday evening, and I'm heading home for the weekend! Elizabeth and I are going out for Mexican food tonight. As we say in espanol . . . una enchilada.

New Life on Easter

It's Easter evening at 9 pm, and I am sitting on the Labor and Delivery Unit, awaiting the imminent delivery of a preterm infant. The mother is at 34 1/2 wks gestation (5 1/2 wks early), and has dilated to 7 centimenters, so it could be any time that she delivers. Or it could be all night until it happens. Or a few weeks. You never can tell.

She is far enough along in her pregnancy that we are not doing any aggressive interventions to try and stop her delivery, though we are not attempting to hurry things along either. 34-35 wks is a gray area. Prior to 34 wks, we would aggressively give her "tocolytics"--medicines to break her contractions--and give the mother steroids, which hasten fetal lung maturity. But at 34 wks, steroids are ineffective, and so little is gained by attempting to stop her contractions. (And anyways, most drugs that we use to stop contractions, when studied, are competely ineffective in preventing preterm delivery by more than a day or two.) By 36 wks, you can almost guarantee lung maturity in the absence of diabetes. But here we sit, in between, at 34 1/2 wks, expectantly managing her preterm labor, hoping that she may hold off for a few more days, but ready to deliver her in the next few hours.

Interestingly, Elizabeth and I had a relevent discussion last night, related to obstetrics and preterm birth and our religious convictions: when does the spirit enter the body of a newborn?

You would think that, having delivered somewhere around 250 babies, this would be something that I have frequently pondered. But actually no. With modern technology allowing us to look at life within the womb from early in pregnancy and throughout labor, some of the surprise--but not the wonder--seems to have vanished. A baby's emergence from the birth canal and its first "breath of life" has become just the next step of a journey, not a de novo incarnation of a previously soul-less organism. So last night's discussion challenged my beliefs.

The beauty of birth will always be there for me; the mother's final scream and the baby's first cry still bring me near tears. (Elizabeth will attest that, by all accounts, I am incapable of actually shedding true tears.) But it's the literal sweat, blood and tears (and numerous other bodily fluids--birthing has a sweet stench all its own), the exhaustion and triumph of the moment, that grip my heart, not an awareness of a spirit descending into a previously uninhabited body.

I believe, for a variety of ethical and religious reasons, that "life" begins at conception, at the creation of a new set of chromosomes harbored in a cell that has the capacity to become a complete human being. This nascent life, though not yet viable, has the full capacity to become so, and thus should be given its ethical dues.

I also believe that each of us human beings exists as a duality of spirit and substance, our eternal intelligence animating our flesh and bones. The spirit dwelling within the body constitutes a living "soul," created in the image of God. Prior to inhabiting our bodies, our spirits dwelt in His presence, sent to Earth to gain a body and to be tested and tried. Birth is then both a forgetting and a launch; all of our memories of premortal life are withdrawn, shrouded by a thin veil that then impels us to exercise faith on our journey back towards God.

If that is the case, then at what point in time does a spirit leave God's presence and enter into the fetus or infant? The Bible recounts how John the Baptist, out of recognition of the Son of God, "leaped" in the womb when Elizabeth approached the pregnant Mary, suggesting a intrauterine presence of John's (and Christ's) spirit. But then the Book of Mormon details how Christ's voice spoke to Nephi on the night before his birth: "On the morrow come I into the world," suggesting that his Spirit had not yet come into the womb. Contradictions abound: we do not recognize miscarried or stillborn fetuses as "children" on official church records, whereas we do acknowledge the life of a baby that takes one breath and then dies. This discrepancy constitutues a major ontological distinction, but is it truly a significant physiological one?

Regardless of how we recognize or legitimatize a birth, what is acutally happening at the moment? When does a viable fetus receive an intelligent spirit and become a living soul? Obviously I don't have the answer, only a supposition: that the birth of a soul is a nine month process, a vessel slowly docking and anchoring at a port over time. Defying Newtonion physics, this would qualify as a sort of wave-particle duality: the spirit at at once drifting in a harbor and simultaneously tethered to a dock, drawn daily closer to permanent anchor. A preterm baby, then, might be drifting languidly into port, only to be pulled roughly and unexpectedly into dock through the last few yards of water.

Or so it seems to me. But while trying to wring sense from these metaphysical mysteries, reality interrupted, and we safely delivered the 34 weeker an hour and a half ago. She weighed in at a whopping--and surprising-- 6 lbs 8 oz, vigorous and screaming. Just to be safe, we'll keep her in the intensive care nursery overnight to make sure she transitions well. It seems likely she will.

So whether her little spirit has been dwelling in her body for nine months or just ninety minutes, she looks a little shellshocked right now. She's a fighter, though. Since she has so recently been one of the two key participants in this whole birthing process, maybe I should ask her for the real answers to my deep questions. She probably would impertinently look at me and say, "What does it matter? I'm here now, aren't I?"

Yes. Here and hungry. Welcome home, little one. For now at least, that's what this place will be.

Happy Easter!