|
|
| |
|
Community For Better Health Care
|
|
|
Voices of Medicine
Current
Issue: (previous
issue) (past issue)
|
A Review of Local and Regional Medical Journals and
the Lay Press
|
Inside Medicine:
Mixed feelings after lecturing for Saudis, By Dr. Michael Wilkes - Sacramento Bee, May 11, 2008
The large, modern,
wood-paneled hospital auditorium was filled to capacity as I finished
my lecture at a new medical school in Riyadh, Saudi Arabia.
I had decided to make a
special effort not to ignore the distant back-left corner of the
auditorium. That is where the 100 or so female doctors were sitting.
They all appeared to be dressed alike, wearing the jet-black abaya
(robe), a head shawl, and a feesha, or facial covering. All that could
be seen were their dark-brown, inquisitive eyes. Just below the hem of
their robe was the only fashion statement visible - shoes of all sorts
of designs and colors from shimmering gold and silver to a pair of
bright-red sneakers.
Following the lecture,
there was a flurry of questions from the audience, but none from the
women. During the short break that followed I was surrounded by women
who had insightful, informed medical questions. Many of the women spoke
English far better than their male counterparts. It was an odd feeling,
as not one person looked me in the eyes when they asked a question.
After 20 minutes there was only one woman left. Her veil was unusually
low on her face - almost to her neck - allowing me to see her entire
face. She wore dark mascara and tiny, gold earrings. Below her robe I
could barely make out the hem of her white slacks.
She shook my hand - the
men all greeted me with a handshake as they introduced themselves. But
such contact between a man and a woman is strictly forbidden in Saudi
Arabia.
"I could see you
are making a special effort to speak to the women doctors," she
said.
She introduced herself
to me as Anna, and appeared to be in her mid-30s. She asked permission
to ask me a personal question, then went on to explain that for nine
years she had lived in California, where she and her brother went to
school, hoping she would learn the skills of an American pediatrician
and bring them back to Saudi Arabia to train future doctors. . .
Anna had been back in
Saudi Arabia for two years. As we spoke, we strolled toward the back of
the auditorium and sat down on two folding chairs. She described how
much she appreciated having a chance to train in the United States. She
reported learning so much - some of it medicine, but some not. She made
a number of friends, learned to drive a car and to have the confidence
enough to socialize as an equal with men, to wear western clothing, and
to learn about other religions and worldviews. She also learned to
advocate for herself.
But the blessing was
mixed. She now finds her life in Saudi Arabia intolerable - both
personally and professionally. She cannot build her career because men
are threatened by her knowledge and her ideas for change; they won't
even meet with her. Socially, she can't go out at night or socialize
with men. Professionally, she must sit in the back of the auditorium,
she can train only females, and she must wear traditional attire.
Her question to me was
simple: Should she stay and try to change the system so other women
would benefit? She described this route as amounting to a lifetime of
battles, a stagnant career and the likelihood that she might never find
a husband who would tolerate her free spirit and western thoughts.
Or, she could return to
the United States, where she would be welcomed back to her old job and
live her life as she wished, although this would bring shame to her
family. . .
Out of nowhere, an
older woman came up to Anna and whispered something in her ear. As the
woman walked off she told me, "I must go. It is not proper for me
to be sitting here with you without another woman present."
We were, after all,
sitting in the back of a 500-person auditorium. I asked if she'd prefer
to step outside the building, where there were many women (the men were
all congregating in the air-conditioned lobby).
"No, this would
not be proper for you to join the women."
I asked if we could
talk later, but she didn't reply. Over the next week I looked for her
in the auditorium.
Each time I spotted her
she gave me a little wave. But she never came up to me again.
As Americans reach out
to train foreign doctors, nurses and researchers, our intentions are
great, and in most cases I hope that their society ends up the better
for our efforts.
But I wonder how often
we create internal chaos for those who come to learn science, but also
learn about the American way of life that can not be duplicated back
home.
About
the writer: Michael Wilkes, M.D., is a professor of medicine at the
University of California, Davis. Identifying characteristics of
patients mentioned in his column are changed to protect their
confidentiality. Reach him at drwilkes@sacbee.com.
To
read the entire VOM, go to www.sacbee.com/107/v-print/story/926046.html.
subscribe
|
Previous
Issue: (current
issue) (past issue)
|
A Review of Local and Regional Medical Journals
|
|
Bulletin of the
California Society of Anesthesiologists, Fall, 2007
On Your Behalf ...
Legislative and Practice Affairs Division
Everyone I Know By
Jason A. Campagna, M.D., Ph.D., Associate Editor, and Marco S. Navetta,
M.D.
In 1968, after losing
the general election to Richard Nixon, George McGovern and his
supporters were stunned and visibly shaken. To them, the loss seemed
inexplicable. The country was mired in a highly unpopular war, and
McGovern's platform of withdrawal from Vietnam had such popular appeal
that the Republicans were also in support of ending the war. Such
observations bolstered so-called "Popular Wisdom," which
foretold a McGovern win by landslide. In this case, of course, Popular
Wisdom turned out to be terribly wrong. Our purpose here, however, is
not to dissect this loss, but rather to use it as an instrument to
learn about what such collective "Wisdom" says about the
future of our own profession, and how much faith, if any, to put in
that wisdom.
Regardless of the
specific source of one's information, the future of anesthesiology is
painted in some color palate that includes multiple shades of gray and
black. Dire warnings about collapsing compensations, the dearth of
academic productivity, the encroachment by nurses and other
paraprofessionals - all collectively create a popular notion that the
future of anesthesia looks bleak. . .
Sadly, as Mr. McGovern learned in 1968, Popular Wisdom is a
fickle companion, and throughout history, her reassuring and seductive
siren has lured many to their peril. Such Wisdom pays no mind to the
emotional investments we may make in it, nor does it much care for our
grand plans based upon such investments.
What can we learn, then, from Mr. McGovern and his certain win
that can perhaps help us to better prepare for our own future?
Shortly after the
general election had ended, the New York Times printed an
interview with a prominent New York socialite, philanthropist, and
ardent McGovern supporter. In that interview, a well-heeled,
well-connected, and well-known woman expressed shock, disbelief, anger,
and fear over the fact that her candidate, the certain winner, had
in fact, lost. "[I] never saw it coming," she was quoted as
saying and more interestingly, "Everyone I know voted for
him, how could he have lost!" . . .
What this woman was making clear was that she, and other
McGovern supporters (her friends and socialite companions), were
living, and speaking, in an echo chamber. Everyone she knew agreed with
her; therefore, they must be in the majority. No doubt this
woman, and her cohort, committed an intellectual error of enormous
proportions. How sad, we say, as we mock this woman for her seclusion;
nay, her ignorance. . . How
many people do we - readers of the CSA Bulletin, members and
directors and leaders of the CSA - know, and how many are in our echo
chamber? . . .
During the meeting, The
ASA Associate Director for Federal Affairs (ADFA) was speaking and he
was simultaneously boasting of strong membership across the CSA and the
ASA, while also informing us of our poor political representation in
state (GASPAC) and national (ASAPAC) political action committees. . . .
The following morning
we were having breakfast with this very bright, very motivated and very
passionate ADFA, and he again reminded us how fewer than 15 percent of
anesthesiologists nationally make political contributions to anesthesia
related PACs. We, then, having heard this number the day before, asked
him: "What about the other 85 percent? Why aren't they
giving?" His silence was all the answer we needed because it
served to crystallize for us our fears of the night prior. This was the
perfect example of George McGovern's agony in slow, forward motion. The
15 percent of like-minded persons all talking, to one another! Our
passion, our emotion, our efforts, our anger, our certitude of our
cause - and no one to disagree with us. What is the lesson here? Like Dewey in '46 and Kerry in
'04, and all the others in between, regardless of how much we might
think we are right, we are, in fact, the minority. The lesson for our
profession: we will lose as well. . . .
Some may argue, at this
juncture, that in fact we are wrong because a small, vocal minority can
indeed effect change and perhaps even win. . . Such an outcome, short of the
use of force, can only be true under one condition: that a majority
eventually agrees with that minority.
The minority, regardless of their passions and emotions and
certitude, affect nothing unless the majority comes to agree with them.
. . What is the "lesson" here for our profession? Obviously,
our political organizations have yet to craft a message that speaks to
the whole. Crafting that message is beyond the scope of this article;
but highlighting the need for such a message is not. There will be no
forward progress until the minority engages the majority. If physicians
cannot engage their own, how can they expect to sway the public? We are
losing the war of sound bites within our ranks and outside them.
Stepping outside our echo chamber is imperative. We better find out
what those other 85 percent are thinking. We had better talk more to
them and less to ourselves, and learn that, "Everyone I
Know" is very, very far indeed from Everyone.
To read the entire OpEd,
go to www.csahq.org/pdf/bulletin/issue_18/LPAD_56_3.pdf.
Marco
Navetta, M.D., is an anesthesiologist with the Anesthesia Medical Group
of Santa Barbara, California. Dr. Navetta completed his residency at
the University of California, Los Angeles in 2002. Prior to his
residency, Dr. Navetta completed his Bachelors Degree in Biological
Sciences and his Medical Degree at the University of California,
Irvine.
|
Past
Issue: (current
issue) (previous
issue)
|
A Review of Local and Regional Medical Journals and
the Press
|
|
Bulletin of the California Society
of Anesthesiologists, Winter, 2008
In Vino Veritas: Anesthesia
& Mystical Truth, By George A. Mashour, M.D., Ph.D.
All the Adventures of a Curious Character
I have known Dr. George Mashour
since our overlapping days at the Massachusetts General Hospital, and
as I pen this introduction, I appreciate anew just why George truly is
in a class of his own. Now comfortably ensconced at the University of
Michigan, George is by many measures as curious a character as the
famous Dr. Richard Feynman from whom I have pilfered the title of this
introduction. Beginning with this issue of the Bulletin, we shall be
reprinting a variety of his "writings." I can assure you that
you will not want for entertainment.
I first met George when he came to the MGH for his anesthesia
residency. Although that institution sports its fair share of talented
souls, George stood out even within that group. He had, by the time of
our first meeting, already completed a Ph.D. in Neuroscience, a
residency in psychiatry, and was one of a small group of esteemed
Fulbright Scholars. When he showed up in our OR and introduced himself,
it was, to quote Bogie's famous old line, "the beginning of a
beautiful friendship." Although George may tell audiences that I
had a substantial impact on parts of his career, I would counter that
George is the one who had an impact on mine. He was one of those
residents that all academic faculty dream of finding: bright,
energetic, creative and ever so full of the capacity "to do."
The opportunity to call him one of my “students” validated my
fundamental rationale for being in academia. I have made it my habit to
sample each and every one of his writings, some dating from the
earliest days of his residency, each reflecting his truly masterful
fluency with classical and modern learning. It is, however, his first
major anesthesia publication dating from 2004 and a recent talk he gave
to my group in Santa Barbara based on a 2005 publication that best
reflect the breadth of his intellectual and literary talents. . .
It is this broad talent - his
ability to convey the mystery of our trade, to stir in us the emotion
associated with that mystery, yet simultaneously making all of us just
a bit wiser about our humble and small place in the eons-long struggle
against human suffering - that makes his works worthy of our attention.
Enjoy!
Gentle reader, how
fortunate you are to be living in the great state of California. No, it
is not because of the sunny climes, nor the vast expanses of the fair
Pacific, nor even the sculpted pectoralis majors of your governor. It
is, in fact, because of the editor of the CSA Bulletin: you are
unequivocally blessed to have a wise soul like Dr. Stephen Jackson as
the literary elan vital of your Society. Although I have
never met the man personally, I became thoroughly convinced of his
exquisite taste and discerning mind when he lauded a series of essays I
penned during my chief residency as "most brilliantly
written" and "vastly entertaining." Here, I said to
myself, is a man with vision. Here, I exulted, is a man with his finger
on the pulse of the emerging field of literary anesthesiology.
Don't get me wrong,
people: I previously have had the experience of submitting articles to
other savvy editors in California. Yet, with no offense to them
intended, it seems to me that they have an almost irrational obsession
with trivialities such as "data" and
"proof," expecting me to beat upon my delicate insights with
such blunt instruments as "statistics." Indeed, I often
comfortably begin my rebuttal letters with "you're just not
getting it!" Dr. Jackson, on the other hand, is a man who seems to
understand that the deepest truths cannot be taught, but rather
are caught.
On that note, the
present treatise reflects on the topic of anesthesia and mystical
truth, a story that has its origins in antiquity and touches on the
deepest quandaries of our field. One of the fundamental scientific
questions in anesthesiology is the mechanism by which general
anesthetics extinguish consciousness, a question that becomes yet more
complex when we consider that - somewhere along the road to sweet
oblivion - anesthetics can also produce heightened, even mystical states
of consciousness.
The Temple of Apollo in
Delphi was among the most sacred sites of Ancient Greece, because
within those hallowed halls was perched the Oracle. The Oracle
was typically a woman from Delphi who underwent a mystical initiation
that transformed her into a prophetic priestess, or Pythia.
These seers would induce themselves into a trance-like state, from
which sprung the cosmic truths that guided the lives of the ancients.
The Pythia, however, was not simply high on life. As Strabo (64 B.C.-A.D.
25) writes:
They say that the seat
of the oracle is a cavern hollowed deep down in the earth, with a
rather narrow mouth, from which rises a pneuma [the ancient
Greek word for gas, vapor, or breath] that produces divine possession.
A tripod is set above this cleft, mounting which, the Pythia inhales
the vapor and prophesies.
The vapors emanating
from the chasm under the Temple thus imbued the Pythia with a mystical
force - or did they? Around 1900 an English classicist named Adolphe
Oppe visited French archeological excavations at Delphi and found no
evidence of a chasm or any source of gas. The tales of old appeared to
be debunked, and the mysterious vapors of Delphi were regarded as
nothing more than legend throughout the greater part of the 20th century.
A more recent
investigation by John Hale and colleagues revealed that, in fact, there
were hidden faults under the Delphic Temple.1 Analysis of the
spring water around the site of the Oracle identified the gases
methane, ethane, and ethylene. It was the sweet aroma of ethylene that
fit Plutarch's ancient description of the Temple's vapors as expensive
perfumes. What finally helped reveal the secret of the gases were not
the records of the historian Plutarch, but rather the investigation of
one of the great women in the history of anesthesiology. In 1899,
Isabella Herb was an anesthetist for Charles Mayo at the Mayo Clinic
and, in the 1920s, introduced the anesthetic ethylene into clinical
practice.2 (Figure 1) Her publications on ethylene from the 1920s and
1930s indicate that its administration in lower doses evokes a
trance-like state leading to euphoria and mystical experiences.
Occasionally, however, patients under the influence of ethylene would
thrash about uttering incoherent screams - descriptions like these fit
ancient reports of the Oracles periodically having violent reactions
instead of prophecies. The mystery of Delphi appeared to be solved.
The relationship of
anesthesia to mystical truth has a more academic manifestation in
modernity, indeed, in the Harvard of the late 19th century. Renowned psychologist William
James's experiments with nitrous oxide influenced one of his greatest
works, The Varieties of Religious Experience.3 (Figure 2) In the
midst of a nitrous reverie, James once scribbled, "That sounds
like nonsense, but it is pure on sense!" James published more
formal reflections of his nitrous experiences in an 1898 article
entitled "Consciousness Under Nitrous Oxide." This treatise
was inspired by the work of one who has been called "anesthesia's
philosopher and mystic," Benjamin Paul Blood.4 In 1874, Blood
published a book entitled The Anaesthetic Revelation and the Gist of
Philosophy, which heavily influenced the thinking of James. Blood
attempted to formulate a foundation for philosophy based on his 14-year
investigation into the mysteries of the mind using ether and nitrous
oxide. Blood regarded the anesthetic experience as a key to resolving
the typical dualistic thinking of Western philosophy. Oscar Wilde,
after receiving anesthesia for a tooth removal, elegantly expressed
this synthetic experience in a letter to William James:
The next experience I
became aware of, who shall relate! My God! I knew everything. A
vast inrush of obvious and absolutely satisfying solutions to all
possible problems … an all-embracing unification of hitherto
contending and apparently diverse aspects of truth took possession of
my soul by force … Then, in a flash, this state of intellectual
ecstasy was succeeded by one that I shall never forget … a state of
moral ecstasy. I was seized with an immense yearning to take back this
truth to the feeble, sorrowing, struggling world in which I had lived.
So it is that
anesthesia conditioned the sense of truth in both the ancient and
modern worlds. Perhaps one day the cognitive neuroscience of
anesthesiology will grasp these mystical phenomena that may seem like
nonsense, but in fact are a most intriguing on sense.
To
read the entire article, go to www.csahq.org/pdf/bulletin/mashour_57_1.pdf.
top
|
|
For other issues, please visit our archives. We
invite you to sign up for this
biweekly newsletter.
|
|
|
