Call me out of it, but I don’t get modern marriage customs at all.

The other day the scrub tech announced that he was planning to get engaged – had been picking out the ring with his girlfriend, had been choosing where to take her to propose, and when. So the attending, a woman, asked as if it was the most natural thing, whether they were going to move in with each other now. And he said no, but just because her parents were so old-fashioned, and might not be too happy with that. So I guess now it’s automatic that if you’re so benighted as not to live togther prior to being engaged, certainly once you’re past that point (and remember that engagements routinely last for years now) you’re expected to be living together. (And since when is the woman informed of the proposal in advance? What counts as the proposal or engagement then, the monetarily valuable moment when the ring is handed over, or the emotionally valuable moment when the need for the ring is confirmed?)

And then of course there’s the routine style of talking which all the residents – male and female – adopt, of talking concerning engagements as though the man has been trapped into a life of misery. I wonder what their wives do to them to cause them to talk so. If I were the woman, I would be insulted – or perhaps concerned about what character flaw would do that; but the women join in. Or perhaps the men ought to be insulted – that they’re considered incapable of commitment and family building without being entrapped. Why has the rise of feminism produced a social more where men are expected not to care for families, and women are expected to be as lighthearted about the whole subject as the men are?

Americans scoff at the old arranged marriages, and the Eastern regard for virginity; but I don’t see any evidence that our modern “freedoms” produce any kind of happiness.


Some of my colleagues asked me for the first time today about why I don’t use curse words at all. At the beginning of the year, I’d been expecting some kind of comment. By this point, I’d gotten used to no one apparently noticing that I don’t use about half the vocabulary of a typical surgery resident, and so I stumbled over the answer. It’s funny, because I’ve heard them exulting over another guy in the program, senior to me, who looks and acts like the perfect Southern gentleman, but is apparently starting to develop the temper and accompanying vocabulary which the other residents seem to expect from each other. Hearing that made me even more determined not to join them; but it’s hard, listening to this stuff fifteen hours a day, not to let it slip out when you get angry.

The really strange thing, or sad, I suppose, is that when I tried to explain that I think taking God’s name in vain is wrong, they didn’t even seem to have the concept that some things are wrong to say. Our society accepts such an amazing level of filth and obscenity in common speech that there is no shame left.

I must have read too many Victorian novels. It used to be that even saying “leg” in front of a lady was frowned upon – let alone all the rest of it. (That’s where skirts on beds and chairs came from – even the furniture’s legs were supposed to be covered.) I admit that, trying to join an old boys’ club as I am, I can’t expect to be treated as a lady. But even the concept of appropriate and inappropriate, decent and obscene, seems to be totally foreign to modern minds. Strangely enough, many of these guys still will open doors for the women on the team. I don’t know why that one last vestige of civilization remains.

With this background among my professional colleagues, it’s touching when one of my patients – usually an older man, but sometimes younger ones too – will apologize for letting quite mild words slip out. I smile and nod, and refrain from telling them that I’m used to much worse.

O give thanks unto the Lord, for he is good: for his mercy endureth forever.
Let the redeemed of the Lord say so, whom he hath redeemed from the hand of the enemy, and gathered them out of the lands, from the east, and from the west, and from the north, and from the south.

They wandered in the wilderness in a solitary way; they found no city to dwell in.
Hungry and thirsty, their soul fainted in them.

Then they cried unto the Lord in their trouble, and he delivered them out of their distresses;
And he led them forth by the right way, that they might go to a city of habitation.

~ Oh that men would praise the Lord for his goodness, and for his wonderful works to the children of men!
~ For he satisfieth the longing soul, and filleth the hungry soul with goodness.

Such as sit in darkness and in the shadow of death, being bound in affliction and iron, because they rebelled against the words of God, and contemned the counsel of the Most High:
Therefore he brought down their heart with labor; they fell down, and there was none to help.

Then they cried unto the Lord in their trouble, and he saved them out of their distresses.
He brought them out of darkness and the shadow of death, and brake their bands asunder.

~ Oh that men would praise the Lord for his goodness, and for his wonderful works to the children of men!
~ For he hath broken the gates of brass, and cut the bars of iron in sunder.

Fools because of their transgression and because of their iniquities are afflicted.
Their soul abhorreth all manner of meat; and they draw near unto the gates of death.

Then they cry unto the Lord in their trouble, and he saveth them out of their distresses.
He sent his word and healed them, and delivered them from their destruction.

~ Oh that men would praise the Lord for his goodness, and for his wonderful works to the children of men!
~ And let them sacrifice the sacrifices of thanksgiving, and declare his works with rejoicing.

They that go down to the sea in ships, that do business in great waters:
These see the works of the Lord, and his wonders in the deep.
For he commandeth, and raiseth the stormy wind, which lifteth up the waves thereof.
They mount up to the heaven, they go down again to the depths; their soul is melted because of trouble.
They reel to and fro, and stagger like a drunken man, and are at their wits’ end.

Then they cry unto the Lord in their trouble, and he bringeth them out of their distresses.
He maketh the storm a calm, so that the waves thereof are still.
Then are they glad because they be quiet; so he bringeth them unto their desired haven.

~ Oh that men would praise the Lord for his goodness, and for his wonderful works to the children of men!
~ Let them exalt him also in the congregation of the people, and praise him in the assembly of the elders.

He turneth rivers into a wilderness, and the watersprings into dry ground; a fruitful land into barrenness, for the wickedness of them that dwell therein.
He turneth the wilderness into a standing water, and dry ground into watersprings;
And there he maketh the hungry to dwell, that they may prepare a city for habitation, and sow the fields, and plant vineyards, which may yield fruits of increase.
He blesseth them also, so that they are multiplied greatly, and suffereth not their cattle to decrease.

Again, they are diminished and brought low through oppression, affliction, and sorrow.
He poureth contempt upon princes, and causeth them to wander in the wilderness, where there is no way.
Yet he setteth the poor on high from affliction, and maketh him families like a flock.

The righteous shall see it, and rejoice; and all iniquity shall stop her mouth.
Whoso is wise, and will observe these things, even they shall understand the lovingkindness of the Lord.

~~Psalm 107 

This psalm is so many things in one: a record of God’s saving power to bring the Israelites out of Egypt to the Promised Land; praise for his work in bringing each one of his children out of the darkness and despair of sin into the light of his salvation in Christ; a description of his providence through all of life; and an invitation to all who find themselves in darkness and the shadow of death, in trouble or distress, longing and hungry souls, tossed by the tempests of life. Call to God in your distress, and he will answer and save you out of your troubles. I know that this is true. 

The other night we admitted a woman with a chronic condition in a very severe exacerbation. She sat huddled up in bed, looking very sick, and pretty much refusing to talk, so most of the history came from an attentive husband. He explained that she’d been diagnosed some seven years ago, “but in 2002 she was healed, so she hasn’t needed any medicines since then.” Umm, right. Turns out she had been in the hospital once in between, but whether because of a misdiagnosis at that time, or because of patient refusal, had not restarted the usual medications. The husband concluded his explanation of the most recent events by saying, “We’re born-again Christians, and we’re just waiting for Jesus to heal her.”

I gave them a fairly supportive answer, and went to report to my senior, who uses Jesus’ name frequently, but not with any decency. I felt obliged to mention their story about healing, since they would undoubtedly tell it to him when he went in, and because it was rather relevant as an explanation of why her disease had been untreated for so long. He shook his head. “That’s nonsense. You can’t be healed of that disease.” Although not the ground I would have chosen, I felt obliged to say something, because I don’t intend to spend the month listening silently to his atheism. “Well, theoretically, I think you can be healed of anything.” “Not metastatic disease!” “Well, yes, that too, if God wants too. Nothing is impossible for God.” “That’s your philosophy.”

But I do wish these folks would have some better sense of tactics. It’s bad enough trying to tell any doctor that you’ve been miraculously healed; it produces a less skeptical response if you actually have been healed, or at least have minimal symptoms. Being on death’s door and requiring an operation is not the position from which to state that you’ve been healed. Please, folks; it makes it hard for the rest of us. (And for consistency’s sake, and politeness, don’t show up to the hospital and let yourself be admitted, and then insist to all and sundry that you’re just waiting for supernatural healing. If you’re here, you have to admit to God’s use of means on occasion.) (But I would still be thrilled if she were miraculously healed, just for the sake of my atheist colleagues.)

The best thing about life these days is the CD of early American hymns in my car. (Stop me if you’ve heard this before – I have to rhapsodize about this music every few months on here.) My latest CD is of songs entirely by William Billings, a prolific self-taught composer who started life as a tanner, became the most widely-published sacred music composer in New England, and died bankrupt (which must seal his legacy as a great man, considering all the company he has).

My favorite track on this CD (listen to samples here) is “I Am the Rose of Sharon.” The insert falsely describes this as a secular love song, which shows that the insert author doesn’t know what he’s talking about. It’s a glorious arrangement of lines from the Song of Solomon, open to both secular and sacred interpretation. Given the deep spirituality evident in Billings’ work, and the time period when this was written (late 1700s), the love of Christ and the church was probably more prominently in view. “I am the Rose of Sharon, and the Lily of the Valleys. As the apple tree among the trees of the field, so is my Beloved among the sons. . I sat down at his banqueting table, and his banner over me was love. . .” For the lines, “leaping upon the mountains, skipping upon the hills,” Billings created a perfect cascade of melody, with the choir’s voices tangling into a perfect picture of flight and pursuit across the hilltops.

Second best is an arrangement of Psalm 42. “As the hart panteth for the water brooks, so my soul longeth after thee, O Lord.” At one point, the song seems to halt completely in rapt meditation on the phrase, “for the Living God,” as the two halves of the choir answer each other over and over again with these words, the sum of all desire.

Other songs on this CD include “The Lord is Ris’n Indeed,” an Easter hymn which celebrates Christ’s victory over death, and humanity’s inclusion in that victory; “Samuel the Priest,” written for the death of a Boston minister named Samuel, which uses some of the saddest lines from the psalms of lament; “David’s Lament for Absalom,” with a heart-breaking arrangement of the words, “O Absalom, my son, my son: would to God I had died for thee, O Absalom my son!”; “They that go down to the sea,” an expansion on the verse in the Psalms about seafarers seeing the works of God follows a ship through a dreadful storm (with amazing word pictures on waves rising into heaven, and sailors staggering on the deck), the calm that follows, and the joyful return to harbor.

I don’t know why Billings’ work is not more widely known. In my opinion, it’s equal to Bach’s choral works for complexity of melodic lines (Billings was a master of the fuguing style) and complete harmony between the words and the pictures painted by the melodies. You can listen to a song six times, and every time notice a new combination of voice lines. There are so many details, they can’t be grasped in just one or two hearing. (Plus, it’s in English, and written by an American. Forget about Fitzgerald and Hemingway. Billings is an American genius.)

From rounds:
Med student: “. . . Besides which, her white count is up today from 16 to 18,000.”
Attending: “What’s the difference between 16,000 and 18,000?”
Med student (obviously thinking he’s got an easy question this time): “Um, 2,000?”
Attending: “No, zero, because it’s within the range of lab error.”
After which the chief ordered cultures anyway.

From the OR:
After we’d moved the patient from the OR table to the bed:
Anesthesia resident: “He’s desaturating. . . ambu-bag, please. . . this isn’t working, I’m going to have to intubate him again.”
Surgery resident, to the ceiling: “Interesting, that’s exactly what happened last time.”
Anesthesia resident, curious: “You mean this happened before?”
Surgery resident: “Yes, when we did the first surgery four days ago, he had to be reintubated after moving off the table. Good thing he’s got an easy airway.”
Moral, not to assume that people know things. You’d think that such a significant event occurring only a few days ago in this very hospital would be mentioned between members of the anesthesia team caring for this guy; but I guess not. It’s our fault, anyway, for assuming that the anesthesia resident knew what had happened. We should have told him. Better to remind your colleagues of something they already know, than for everyone to overlook an important fact. (The patient is doing fine.)

From the floor:
Nurse: “You’d better come see this patient. Something’s going to happen.”
Me: “Why, what are his vital signs?”
Nurse: “Pressure’s ok, but he says he’s got to go see the Blessed Mother, that she’s in the room calling to him.”
Me: “See who?” (I’m not used to the Catholic phrases that are so common around here.)
Nurse: “Mary and Jesus. He says they’re talking to him. You’d better come. The last three patients who told me that died within an hour.”
Fortunately, this patient didn’t. We had a long and rather wild delirious theological conversation with him, attempting to persuade him that Jesus and Mary could wait for a while (good thing at least one of the nurses was devoutly Catholic too, since my Protestant tendencies are too strong to allow me to discuss visions of the Blessed Mother with a straight face). The next day the anesthesia drugs finally wore off, and he became quite lucid; still devout, but not as frightening.

Other than that, this service is starting to get to me. Too many cancer patients. I guess I didn’t realize how much cancer showed up in general surgery; I thought you had to go into surgical oncology to get this involved. We sent yet another patient home to hospice today, we added on an emergency case for which the final diagnosis is probably going to be cancer, and we shortened the OR schedule considerably by opening one of my favorite patients, taking a quick look and a few biopsies, and sewing up again because the cancer was so widespread. Then there’s the poor little lady with advanced cancer who looks like a skeleton, literally. She’s scaring the nurses, because you have to watch for a couple minutes to be sure she’s breathing. They keep moving her closer and closer to the nurses’ station because she makes them so nervous. For some reason, the attending hasn’t talked to her and her family about DNR status yet, or at least hasn’t signed the papers, which makes signout pretty uncomfortable: “And then there’s Mrs. Smith, whom you know; she’s still a full code, I’m sorry, I’m really hoping it doesn’t happen tonight.”

I have this weekend off, and then no more days till vacation at the end of the month. That’s my chief’s idea. Technically, it fulfills the rule of “average one day off a week over the course of a month.” But I don’t fancy this interpretation at all. When I’m chief (what a funny idea) I will try to arrange things more to the biblical pattern of one day every week; even if it isn’t Sunday, it’s still more biblical and more physiological that way.

But I got to cook and clean, and go to morning church service, perhaps for the only time this month. We sang Psalm 137 and 126 together, the first being a psalm of mourning for exile from Jerusalem, and the second a psalm of rejoicing for the return. I do love how singing psalms on a regular basis makes one roll unashamedly through verses like, “Remember, O Lord, the children of Edom in the day of Jerusalem, who said, Raze it, raze it even to the foundation thereof. O daughter of Babylon, who art to be destroyed: happy shall he be, that rewardeth thee as thou hast served us. Happy shall he be, that taketh and dasheth thy little ones against the stones.” Which I think must be an appropriate thing to say with regard to the atrocities that are occurring in the Sudan, and the persecution of Christians in Indonesia, and the babies being murdered in China. May God bring judgment on the perpetrators of these evils, and that very soon. Vengeance is mine, saith the Lord, I will repay. It’s not wrong to ask God to take his vengeance, only to try to take it ourselves.

And from Psalm 126: “The Lord has done great things for us, whereof we are glad.”

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