Monthly Archives: August 2013

Mothers and Daughters

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Bizarro

See wonderful cartoons at this site.( bizarro comics.com)

Freud analyzed her. Eminem rapped about her. Faye Dunaway portrayed her with a wire hanger in hand. Let’s face it: Mothers are the go-to figures in songs, stories and screenplays for good reason.

Oprah magazine

I have found the best way to give advice to your children is to find out what they want, and then advise them to do it. 


— Harry Truman

Who are you? No doubt you’d like to think of yourself as unique, the end result of a shiny one-time blueprint used only to to bring YOU into the world. I used to feel that way, special and self-assured, until I reached the age when I would look at myself in the mirror and see my mother looking back.

I realize that my mother and I only share 50% of my DNA, but as a daughter I have come to understand that a mother has considerably more influence in a daughter’s life than just what goes into the hard drive. In fact, the soft ware that a mother gives her daughter is equally potent. In medicine I see mother/ daughter relationships and whether they are deeply loving or testy they are always intimate, intense,vulnerable, emotional and complicated. For many women it is the singular most determinant relationship of a lifetime. When conflict arises in these relationships it almost always fuelled by disagreements over power, authority and acceptance.

I think for every female our mother is the anvil upon which we forge ourselves to create our own identity, she is the whetstone for your blade, or if you prefer a movie approach, the mother figure is an avatar of colossal power. During my formative years I spent extraordinary effort honing my individuality against the grain of whom I perceived my mother to be ( I was wrong, as I discovered in later life when we were inseparable.) and it was my criticisms of her that provided the motivational grist. I wanted to be better, to be different, to be more.

The idiocy of rejecting everything a parent is and has to teach is, of course, called adolescence. Some are brave enough to call it individuation. Some never leave this turbulent purgatory and do not know that adolescence can extend far beyond the teen years and even into old age. The best part about being older is the development of an understanding, it is the quiet acceptance that your mother is/was just another flawed human being after all, and the struggle for every woman is recognizing that our mother is not always right, but neither is she always wrong. She may come bearing criticism but she also comes to you bearing gifts.

I think that the true definition of being a woman comes at the age when you stop blaming your mother for all that is wrong in your life. It is true that a mother’s influence is profound, but until that magic moment when you step up to the plate and say, “ This is my life and I am responsible for it”, you are not an adult. Without this acknowledgement you are never in charge.

When I look I the mirror I may see my mother but more importantly, I see myself. Although she is now gone, she is as integral a part of me as an arm or a leg, but I no longer see those parts we share as a cross to bear. I see them as gifts from my mother, recognized and valued and as well, I see more, qualities that she did not possess. Athleticism, determination, independence,  leadership- these are characteristics I possess different from her template, that I developed in adolescence to escape from her gravity, but I possess them only because she  was the whetstone for my blade.On further reflection I see things that belong to me alone; happiness, contentment, a stable family, a long standing marriage and good health. I realize that I have become more than the sum of the parts of me that are both my mother and myself and that in my small way, I have changed our collective history.

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Anesthesia- From Life or Death to a Dining Experience?

Aside

The Ether dome, first anesthesia

Massachusetts General Hospital, 1846. The first anesthesia.

It is over: she is dressed, steps gently and decently down from the table, looks for James; then turning to the surgeon and the students, she curtsies- and in a low, clear voice, begs their pardon if she has behaved ill. The students- all of us- wept like children; the surgeon happed her up.

 John Brown describing a 19th century mastectomy (taken from The Emperor of All Maladies by Siddhartha Mukherjee).

I have 9 toes.  I was born with 10 but along the way I lost one due to the complications of frostbite and finally, the surgeon’s knife. There are perks ( cheaper,quicker pedicures ) and drawbacks ( no flip-flops) to the revised me, but I have no regrets. In retrospect, sacrificing a digit was a small price to pay for freedom from for the daily pain of a seemingly incurable osteomyelitis (bone infection).

The surgery was uneventful. I walked into the hospital with 10 toes and left with 9. In between I had a pleasant conversation with the surgeon and the anesthesiologist and a really good sleep. I have had other operations in the past and I can say that I have never had a bad experience. Although general anesthesia should never be undertaken unnecessarily, and never should it be employed in Michael Jackson style as a drug for sleep, modern-day anesthesia for the healthy patient is relatively straightforward thanks to better anesthetic agents and the expertise of anesthesiologists.

As much as one may take elective surgery and general anesthesia for granted today, the process has not always been so uneventful. For most of history, surgeries were performed cold, that is, conscious, without the benefit of anesthesia. Early physicians employed various agents to induce sleep or dissociate the patient from the pain of the procedure and to this end combinations of opium, marijuana, belladonna, cocaine, alcohol, mandrake or jimsonweed were all tried with variable success and significant toxicity.  None of these agents worked especially well or for very long and as a result the decision to undergo surgery was a daunting one, made only by the courageous patient on the threshold of life and death. Under such primitive conditions one can only imagine with pity and horror the fates of young men centuries past who, when wounded on the battlefield, underwent amputation with the appallingly inadequate combination of a bottle of liquor, opium and a saw,

Under such circumstances it is not surprising that the reputation of a 19th century surgeon was built upon the speed of his surgery. In the 1840s Robert Liston ( a distant cousin of my husband) was considered a skilled surgeon because he could perform an amputation in 2 and ½ minutes. For additional speed he would hold his surgical knife between his teeth freeing up both hands for the procedure. As the germ theory of disease would not be recognized until 1865, fifty percent of surgical patients succumbed to postoperative infection and died.

In 1846, an event occurred that would propel the field of surgery into the future. In the packed medical amphitheater of Massachusetts General, a Mr. Gilbert Allen was the ground zero patient for effective anesthesia. While a gallery of surgeons watched, ether rendered him unconscious and amnesic and a lump was swiftly removed from Mr. Allen’s jaw. This historic breakthrough in the field of anesthesia occurred just in time to be made available to the 50,000 men who underwent amputation on the battlefields of the American Civil War (Chloroform was discovered around the same time but tended to cause fatal cardiac rhythms).

Civil War OR

Surgeries were performed without sterile technique.

The advancements in anesthesia in the past 167 years are miraculous and the process of going under has gone from a harrowing ordeal to an experience that, for the healthy patient, more resembles a dinner of several courses (albeit a horizontal one). At the risk of being facetious, let me explain.  Start by thinking of the OR as the restaurant of choice. A reservation is made beforehand and you are taken to the appropriate table. The experience commences with a starter of oxygen, propafol (induces anesthesia) and rocuronium (paralyzing agent). Feeling a little dry?  The IV fluids will help. Then the general anesthesia, desflourane or a similar agent, would be your main course as it keeps you under for the duration of your stay. Having a little discomfort from the surgery? A little analgesic via your IV will help.  Any individual needs that arise during your stay will be immediately addressed by staff as you are the only customer. In this restaurant, dessert is included. It comes in the form of the reversal agents, to wake you up. The procedure is over and it’s off to the post op recovery room and time for the staff to prepare the next setting. The whole experience was not to your liking? Relax, you won’t remember a thing but when you are recovered, think of how anesthesia is just one more reason to feel  lucky to be living in this time and place.

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