Friday, April 28, 2006

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.

Friday, April 21, 2006

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.

Sunday, April 16, 2006

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!