Monday, February 25, 2013

Fail-Safe

     Swatting at the stray strand of hair that insisted upon skimming her right eye's sparse fringe of lashes, she sighed, waiting for the drive-thru barrista to fill her coffee order, a "tall latte with just enough milk to make it tan." Same order, different day. She closed her eyes, melting into the upholstery, bathed by the ribbons of warm October sun that managed to stream through her hopelessly grimy windshield. Her breathing relaxed and slowed itself. The palpable crescendo of blood rhythmically pulsating behind her eardrums triumphed as the tension from another hectic day in the operating room gradually dissipated. She could almost hear her poor, supratentorial-space starved neurons congratulating her.


Haight-Ashbury, October 2007
     She'd been a hot mess for some time now--a contained one, thankfully--emotionally disarrayed, but physically confident. This time next week, she'd be in San Francisco. With him. The American Society of Anesthesiologists accepted the problem-based learning module she'd submitted for publication, scoring her a week of departmentally-funded professional leave, the tail end of which she'd arranged a wine country tour for two. "Here's your coffee, hon," purred the silky-voiced barrista. Careful to avoid the claw-like acrylic nails that were clutching her 40 percent post-consumer recycled paper grail of caffeinated rejuvenation, she pressed a couple of bucks into the woman's waiting palm. Driving home, she wondered why she wasn't more excited about her upcoming trip. Same shit, different day.

     Despite the infidelity, narcissism, and lack of reciprocation, he was safe. Familiar. Predictably disappointing. She'd settled for the kind of less that's incapable of ever being more, a languid déjà vu of unilateral apathy which absolutely crushed any possibility for true affection or spontaneity. Plus ça change, plus c'est la même chose, n'est-ce pas? Idealism was her Achilles heel. Their reunion after two mostly incommunicado decades was proof that, unlike a reliable Napa Valley vintage, some things are better relegated to the past; they simply don't improve with age.


"Kick-boxer Guy"
     Stepping onto the treadmill, she contemplated the other issue at hand: tonight's blind date. The nature of her long distance relationship warranted keeping an active online dating profile, even though the pickings were disgustingly slim. There was no harm in having a fail-safe, was there? She didn't know anything about the surprisingly handsome guy she was meeting this evening except that he had nice teeth and enjoyed kick-boxing, the Detroit Red Wings, and drinking coffee. After a couple of e-mail exchanges, he suggested they meet for a cup of joe. Java love was something they had in common, safe yet satisfying, a buzz guaranteed to be uncomplicated by regret. Maybe indifference would cure her ambivalence.


     A week ago, she'd had a semi-disastrous first and last date with a physics professor. He seemed so normal online. They'd met at a wine bar, and within the first few minutes of conversation, it was apparent that he was still enamored with his ex-wife. A total yawnfest, indeed. When the check arrived, he searched his wallet, mournfully declaring, "I'm afraid I can't cover my half...I've only got twelve dollars." You've gotta be kidding me! Clearly, he was testing to see if she was one of those grateful 40-something professional women who'd cheerfully foot the bill in exchange for a mercy fuck. Settling for less hadn't made her desperate. Whipping her head around in Exorcist-like fashion to look him squarely in the eye, she countered graciously, "Well, I'm sure you've got a credit card you can use." He hesitated, pulling out one card, then another. If this loser was looking for a sugar mama, he was certainly barking up the wrong tree. Placing his card along with hers inside the check cover, she summoned the waitress, murmuring with the steely-sweet lilt of a Georgia peach, "I think we're done here."


"She Likes Her Dress...But Will He?"
     Forty-five minutes of running left her invigorated, yet relaxed. The kids were at her ex's house this week, so she didn't have to worry about cooking dinner or helping them with homework. Luxuriating in the time she had to cool down before her shower, she studied the art gracing the walls of her living and dining rooms, all of it original, her own work as well as that of her father and an artist friend. Her eyes were drawn to the inscription on a mid-80s ceramic piece made for her by her girlfriend, Elaine: "She Likes Her Dress...But Will He?" How apropos. Somewhere between figuring out what to wear and deciding not to wash her hair, her thoughts returned to San Francisco, the deflated anticipation of next week's trip contrasting sharply with the delicious apprehension of tonight's unknown. Maybe coffee wasn't so safe after all.

Part II: Detour
Part III: Marvelously Fresh, Decidedly Vague
Part IV: From Cupcake Epiphany to The Future Now




   

     

Sunday, February 17, 2013

Holy Doughnuts!


My nuclear family, circa 1972 (I'm the one with blond ponytails)
     Many of my fondest childhood memories are centered around the myriad evening meals my family and I shared together. With six to ten of us at any given time, dinner was a noisy, chaotic affair. First of all, we ate together every single night of the week--even when my sister and I were teenagers, we couldn't accept phone calls or go out with our friends until after we'd had dinner. The amount of dirty dishes, pots, and pans we generated was absolutely staggering. But, we always used real plates and silverware. My grandmother consistently fed part of her meal to our dog, Andy, which drove my mother crazy. Even though Andy mysteriously developed an annoying habit of begging at our knees under the table, my grandmother vehemently denied giving him table scraps, insisting that she'd dropped the Polish meatball he was chewing on by accident onto the floor. There was always a crying, high-chair bound baby, and at least one picky eater who was whining about the lima beans or Brussels sprouts Mom had prepared. Someone was always trying to sneak a bite of food before Mom had a chance to sit down, or even worse, before grace had been said. Every night, my siblings and I took turns saying the following blessing:

"Bless us, O Lord
And these thy gifts
Which we are about to receive from thy bounty
Through Christ Our Lord
Amen."

     As anyone who grew up in a big Catholic family can probably relate, that prayer quickly became stripped of any unnecessary syllables in a contest to see who could say it the fastest. Our version more closely resembled the pressured speech of an auctioneer:

"Blessusalord'n'these-eye-gifts-ch-we're-bout-traceive-fum-thy-bouny-thru-Christ-a-lord-Amen."

An idea of what dinner at our house was like...
     It seemed like there was always a disproportionately large amount of tossed salad in comparison to kid-friendly favorites. From an early age, I learned that no matter how much milk you add, you just can't stretch a box of Kraft mac & cheese to satisfactorily feed eight people. Likewise, a 2.5 serving carton of Stouffer's spinach souffle yields only about a tablespoon of fluffy green goodness per plate in families as big as ours. Needless to say, these items were always gobbled up first. Depending upon how hungry or finicky you were, the rest of the stuff on your plate was either a blessing or a curse.
                                                                                                                             

I joined Dad's Clean Plate Club in infancy!
     In our house, my father considered it a sin to waste food. Aside from hearing his stories about near-starvation during his series of imprisonments during WWII, we were constantly urged to "think about all of the poor, starving children in India." To motivate us to eat everything on our plates, he devised the Clean Plate Club. In order to obtain membership in this exclusive club, we had to be able to hold our plates upside-down over our heads without any morsels of food falling off. Sadly, some of my siblings never achieved the conditions necessary for induction into the CPC. For hours after dinner ended, he or she could be found still sitting at the table, scowling with chin on fists at the stone-cold mound of whatever it was they'd refused to eat. Ironically, these siblings were later rewarded with offspring who were ten times pickier than they'd ever dreamed of being.

Master of Leftovers
     Just like my dad, I hate seeing good food go to waste. I've always enjoyed cooking, and once I began shopping and planning meals for my own family, I developed a real flair for repurposing leftovers. The unique nature of the ingredients in these flash-in-the-pan dishes meant they could never be exactly replicated. But, they always left the men in my life begging for more. Because I rarely follow recipes, I've amassed a repertoire of variations and permutations on these family favorites that closely approximate the original masterpiece of frugality. I've gotten so good at improvising that within moments of perusing my fridge to see what I've got on hand, I can visualize a casserole or one-pot meal of some sort, without having to grocery shop. The internet has made this process even easier. The other day, I googled "tofu, kale, mushroom, butternut squash" and found the most delicious recipe for a savory strudel. Luckily, I happened to have a box of Pepperidge Farm puff pastry in my freezer, so I had everything I needed to make this elegant-looking but deceptively easy, super-tasty dish.

Shopping for weird food items near Berkeley, CA
      Last night, my son Rory came over for dinner. I had a little time to kill, and thought I'd make something special for dessert. I came across a can of chestnut puree that I've had for quite some time, purchased on a whim from a gourmet food store. I've never cooked with it before, so I googled "baking with chestnut puree." Up popped a French recipe for a crustless tart, calling only for chestnut puree, eggs, and butter. Yum! What's not to love about a "rich, faintly sweet chestnut cloud"? The only problem was, the recipe specified 500 grams of puree, and my can contained only 435 grams. In baking, measurements usually need to be precise. I wanted to substitute an additional 65 grams of something, and one more Google search revealed pureed sweet potato as the perfect replacement. Since I always have a couple of cans of sweet potato or pumpkin puree in my pantry, this was a no-brainer. Sixty-five grams of sweet potato amounts to about two tablespoons, so this meant I'd need to figure out something to do with the rest of the can. In the meantime, I covered it up and put it in the fridge. The tart ended up being delicious, like a velvety flourless cake, perfect with a glass of Chilean cabernet.

Who needs a bakery when you've got pans like these?
 Sunday mornings have come to mean one thing in my household: Revolution doughnuts. Located conveniently within walking distance of our loft, it's nearly impossible to resist rolling out of bed for one of their freshly-baked, sugary pillows of doughnuty goodness. As I perused Revolution's Facebook site to see what today's offerings were, I remembered the forlorn can of sweet potato puree, chilling out in my fridge. It was literally calling to me, "Time to make the doughnuts!" Amongst my collection of baking pans are a couple of barely-used doughnut tins, relics of my brief foray into gluten-free baking. Hmmm...


     Pleased to immediately find a baked sweet potato doughnut recipe online, one which used whole wheat pastry flour, lots of fragrant spices, and very little added sugar, I mentally tweaked it to make it even more healthy by substituting coconut oil for the butter. The batter came together quickly, and into the pans it went. The kitchen smelled fabulous. I still had a couple of tablespoons of sweet potato left, so I made a gingered powdered sugar glaze, using the remaining puree in place of the usual milk or cream.

      Holy doughnuts!!!! The results were freakin' amazing. After his first bite, my son Nick suggested that I trot one of my spicy-sweet confections over to Revolution ASAP. "They're really that good!" he exclaimed. What a revelation! Somewhere between Dad's Clean Plate Club, the years of living on a shoestring, and my fondness for spontaneity and innovation, I cultivated a deep reverence for the blessing of leftovers, and it's finally paid off. Today's doughnuts were exceptionally hole-y :-)
Homemade sweet potato doughnuts with gingered glaze


Friday, February 8, 2013

Insurance

(list of medical terminology specific to this chapter is included below)

     Acutely aware of her growing impatience, Sarah pushed 40 milligrams of intravenous succinylcholine, observing as Minerva, now deeply anesthetized, defasciculated into flaccid paralysis. After positioning a rubber bite block between Minerva's pristine incisors, Sarah cupped her left hand gently around the plastic face mask covering her patient's mouth and nose, her right hand rapidly and rhythmically squeezing a distended green breathing bag that delivered oxygen from the anesthesia machine through a corrugated circuit, hyperventilating Minerva's lungs to optimize her seizure threshold before the "shock." Another day in ECT paradise. Glancing at her end-tidal CO2 waveform, Sarah alerted the busily chattering psychiatric team, "We're ready to treat." The procedure nurse applied a round probe loaded with conductive gel to the crown of Minerva's head, and Sarah manually occluded her jaw as the amperage began to flow. "Hmm, 100 milliCoulombs and we're still sub-threshold," Dr. Stevens, the chief of psychiatry, remarked with disappointment upon seeing no motor or EEG evidence of a seizure. "I'll kick it up another notch. You ready, Dr. Livingston?" "Yes, ready. We need to work quickly, though," replied Sarah, having already resumed aggressive hyperventilation. "The Brevital's gonna wear off soon." Let's speed things up here, guys, we've still got fifteen cases to go!

     The morning had started off like cold molasses, a slow-motion rodeo of the demented and down-trodden, each case sadder than the last. Sarah didn't get too involved with these patients, but Minerva's situation had impressed her because they were exactly the same age. So were their sons. She'd caught a glimpse of Tyler on Peter's iPhone as she was scribbling down Minerva's pre-op assessment. "What a cutie!" she'd responded automatically, trying to sound enthusiastic. Her throat tightened with regret as bittersweet thoughts of her own son flooded her consciousness. Fighting back the same tears she'd already cried too many times, Sarah returned to her paperwork. I've gotta keep myself together in that courtroom today. 

     In less than an hour, she'd be attending the final custody hearing in her long, drawn out divorce. Two years ago, her husband, Carter, blind-sided her with the news that he'd filed for divorce as well as sole physical custody of their son, Dylan. It literally came out of nowhere, hitting her like a ton of bricks. Carter had lost his job in pharmaceutical sales when the economy collapsed, so he played house-husband while she went back to working full-time with her old anesthesia group, taking extra call to cover their expenses. Dylan was only three then. Transitioning from being a stay-at-home mom to working 60 hours a week was tough on all of them, especially Dylan--he'd always been such a mama's boy. She recalled a recent conversation she'd had with her girlfriend, Viv, an ENT surgeon/divorcée. "Medicine is insidious--it'll suck the life right out of ya," Viv philosophized. "Under the guise of altruism, that deeply ingrained sense of responsibility we learned as medical students holds us hostage somewhere between our unachievable ideals and incomparable standard of living." This immediately called to mind the two million dollar life insurance policy that had been mandated in the terms of Sarah's divorce. "Ain't that the truth?" Sarah quipped. "I just mailed off a $2500 insurance premium check. Hell, I'm worth more dead than alive!" Rolling her eyes while slicing her throat with her index finger, she'd added, "If only it weren't for that two year exclusion on suicide." Hearing herself say this made Sarah flinch; it sounded so cynical. Although she and Viv shared a commiserating "been there, done that" laugh, the truth was that Sarah had seriously contemplated ending her life. But, that was normal under circumstances like hers, right? Surely she was just disillusioned, having forgotten what it was like to hold Play-Doh, instead of life, in her hands.

     Long story short, Carter was going to get Dylan, their mountain cottage, and half of her 401K, as well as a small fortune in child support and alimony. This was the thanks she got for supporting him all those years. Once Dylan started school, Carter had nothing but time on his hands, time to devise an airtight defense which portrayed her as cold and chronically unavailable, "an absentee mother and unfaithful wife, who is married to her work," according to the original complaint. She never would have asked Carter for a divorce. Sure, neither of them was happy, but wasn't that just marriage-with-kids in general? Doesn't everyone's sex drive suffer when life becomes a monotonous routine? Mediation had failed, and because of the custody dispute, the case went before a judge. During the divorce proceedings, she was dumb-founded at the judge's obvious sympathy for Carter, but her attorney insisted there was no recourse. "It's the luck of the draw, Sarah," he'd told her defeatedly upon learning Judge Dixon was appointed to their case. "I wish judges could be hand-picked because you've gotten stuck with a real lemon." To make matters worse, Carter was starting a job on the West coast next month, and Dylan could hardly wait. "Daddy's gonna teach me how to surf and ski, Mommy!" He wasn't quite grasping the distance that would soon be separating them. Sarah chastised herself for feeling irritated by the unfiltered ignorance contained within Dylan's childish innocence, and for wishing that he loved her the most.

     After depositing Minerva in the recovery room, Sarah gave report and washed her hands. "It's normal for this lady to wake up crying," she'd informed the nurse. "Try not to give her any Ativan if you can help it." Sarah didn't need any complications today. One of her partners was coming to relieve her in just a few minutes so she could appear in court, and she was trying to lighten his load as much as possible, insuring future favors she eventually hoped to return. Upon exiting the ECT lab, she noticed it was raining again. Having forgotten a raincoat or umbrella, Sarah dashed out to her car, shielding her hair from the rain with her purse. Even though she felt herself becoming increasingly more unglued, she was determined to at least look composed. Fuck 'em. In six years, Dylan can make up his own mind about which one of us he'd rather live with.

     It was 10:15 when Sarah pulled out of the parking lot, giving her ample time to deal with any weather-induced traffic she might encounter. Court didn't start until 11:00, so she'd be able to grab a coffee to go. There was a coffee shop along the way, in the strip mall just past the public elementary school. This route had become a regular detour for her on court days, and despite the fact that Dylan attended private school across town, she still imagined him among the kids she saw, playing kickball or waiting for their buses to arrive. Lost in pleasant thoughts of the days when she heard "Mommy" a thousand times, when all of Dylan's hurts could be healed by her kisses, she barely noticed her phone ringing. Fumbling for her phone, she was simultaneously distracted by the sight of a young boy, scaling the outstretched limb of a massive tree 50 yards in front of her. For a split second, she watched in horror as the child lost his balance, attempting to recover what appeared to be a lunch box dangling from a branch just beyond his reach. Veering spontaneously off the rain-slicked street to avoid possible collision with the faltering child, she barreled into a huge oak tree. Startled to find herself now hovering above the tree tops, she observed as the boy righted himself, grasping his lunchbox and the gnarled limb resolutely with both hands, hanging on for dear life twelve feet off the ground. Vaguely bothered by the fact that he didn't seem to hear her, she kept screaming at him. "Hold on tight, baby! Don't let go!" Below her, amidst the gathering crowd and the flurry of emergency vehicles screeching onto the scene, a lifeless woman slumped over the steering wheel of a crumpled sedan that was wrapped inextricably around an oak tree, the pre-existing condition under which she'd desperately stashed syringes and several vials of propofol and rocuronium inside her glove box no longer an obstacle to her insurance.

Part I: The Appointment
Part II: Amplitude
Part III: Redemption


Terminology
ECT: electroconvulsive therapy (shock therapy), used to treat severe refractory depression
Flaccid: lacking in tone; limp
Succhinylcholine: a short-acting, depolarizing paralytic agent which paralyzes skeletal muscle.
Defasciculation: the prevention of muscle twitches
Hyperventilation: rapid breathing that lowers the blood's CO2 level as well as seizure threshold
End-tidal CO2: expired CO2, a measurement of ventilation
milliCoulombs: a unit of electric charge in amps/second
EEG: electroencephalogram. A wavelike recording of the brain's electrical activity
Brevital: methohexital, a short acting barbiturate used to induce general anesthesia
Ativan: a benzodiazepine, like Valium or Xanax, used to produce sedation and treat anxiety
Propofol: an IV anesthetic, used to induce deep sedation and general anesthesia (aka "the Michael Jackson drug")
Rocuronium: a rapid onset, non-depolarizing paralytic agent, used to paralyze skeletal muscles during general anesthesia.






Friday, February 1, 2013

Redemption


     His feet jiggling excitedly as if they didn't belong to the rest of his body, Tyler calculated the minutes until the school bell rang. He liked learning how to tell time. After his Little League game last Saturday, Grandpa and Grandma had come over for dinner, and Grandpa pulled him aside, telling him he'd brought a big surprise. "But first, Tyler," he'd said, peering over his tiny Mr. Potato Head glasses, "you have to eat seventeen of those delicious peas on your plate." Tyler hated peas, especially the kind with tiny onions in slimy sauce. Grandpa must've been watching as he raked his wrinkled green mortal enemies beneath a miniature volcano of mashed potatoes. Gulp. "Do I have to, Grandpa? How about if I just eat one?" "Tell ya what, Tyler, how about we make it an even eleven?" Solemnly, Tyler pushed eleven peas onto his fork, raising them to his mouth with the same apprehension of a dead man walking. He could feel Grandma, Grandpa, and Daddy observing him with amused anticipation. "Stop lookin' at me!" Mommy, please come out of your room. The peas were smushy and yucky, and Tyler swallowed them without even chewing, washing them down as quickly as he could with an entire glass of chocolate milk because he already knew the surprise was a Mickey Mouse watch with a grey wristband; he'd seen it inside the clear plastic box that was poking out of Grandma's purse.

     Mickey's little hand was almost on the 3, and his big hand was between the 8 and 9. Three more minutes. I won't forget my lunchbox today, Mommy. Mrs. Purcell's mouth started moving, and she was holding up a yellow flashcard with "4 + 6" on it, but her voice sounded like a Transformer robot, and Madison was eating paste again, and Zachary was digging inside his nose, and Kayla's arm was shooting up into the air like a rocket, her hand flapping just like the brook trout he and Grandpa had caught last summer, raising out of her seat and bringing her desk up with her because she knew the answer was "ten." Outside, it was still raining, but only just a little bit. Sunday had been rainy, too, and he and Bob Boxley were stuck inside, looking for buried treasure, but Mommy came out of her room in her pajamas with her hair sticking up, saying they couldn't be pirates inside the house because she had a headache, and could they "please play more quietly?"

     Mommy had lots of headaches. She was so sad and tired now that Daddy asked their housekeeper, Mrs. Kelly, if she'd come to live with them. Mrs. Kelly wore a hairnet, and she was fat and smelled like cabbage. She drank brownish water from the flat silver bottle she hid under her skirt, and after she cleaned the house, she'd lock herself in the bathroom, smoking cigarettes and talking on the telephone, the fumes of orange Glade curling out from around the edges of the door. Tyler hated Mrs. Kelly even more than he hated peas. When she was downstairs doing the laundry, he'd take the can of air freshener from the windowsill and spray it right into his nose, intrigued by how much it smelled just like a real orange. If the can was empty, it would spray a different kind of spray, not the kind that smelled like oranges, but the kind that made the walls wobbly. Mrs. Kelly? You've got a hole in your head. He'd told Daddy about the hole in Mrs. Kelly's head, hoping that maybe he'd seen it, too, but Daddy kept reading his newspaper. "Tyler, sweetie, you're just imagining that," he'd said without looking up. "Why don't you and Bob Boxley go outside to play?

     When Mickey's big hand pointed at the 9, the bell rang. Tyler bolted from his desk into the hallway, through the double doors, across the playground, and onto the sidewalk in front of the school where the buses parked. He could see his lunchbox, right where he'd left it, dangling from the outermost branches of an old oak tree that was across the street. Last Friday, he and Robbie Johnson were messing around after school, waiting for Mr. Ernie's bus, and Robbie had sailed his baseball mitt into the tree's crown to see if he could hit an old bird's nest, but it got stuck, so he grabbed Tyler's lunchbox and flung it upward as hard as he could, trying to knock down the mitt. The box's plastic handle immediately looped over a stubby outgrowth directly beneath the hopelessly wedged mitt, eliciting peals of hearty boy laughter. "Hey, it looks like your mitt's a hand, holding onto my lunchbox," Tyler observed. Climbing onto Mr. Ernie's bus that afternoon, Tyler hadn't given his lunchbox a second thought. Now, he was on a mission to retrieve it. Maybe if he started remembering things like his homework and his lunchbox, and not leaving his shoes outside in the rain, Mommy wouldn't be so sad.

     The rain had made the tree trunk slick, but there were plenty of low-lying branches to use as rungs. Tyler was a natural at tree-climbing. Daddy liked to kid him about being "part monkey, just like Curious George." Today, he was wearing his baseball cleats because his brand new shoes were still wet, and they offered good traction as he scaled the trunk, inching his way toward redemption along the high slippery scaffold limb, until the rogue lunchbox was almost within reach. Almost there. See Mommy, I didn't forget! Hugging the limb tightly, as if he was embracing his mother's thighs, he strained and let go of his right hand, extending his arm as far as he could, desperately wrapping his outstretched fingers around the lunchbox's handle just as his weight started to shift, and determination gave way to gravity.

Part I: The Appointment
Part II: Amplitude
Conclusion: Insurance