Dec 21, 2005! Elizaveta Tanya LaMarr Merritt 5 lbs 9 oz
Our little girl was a surprise, coming 5 weeks early in an emergency c-section. Maya Anechka saved her life when she told me to call the doctor in the morning, she hadn't felt our baby kick the day before and knew that it wasn't right.
Dr. Morrison from Ocshner in Louisiana saved her life too by telling us to get to the hospital ASAP.
She's such a beautiful little girl...

waiting for Mama Tanya at the Tampa airport,
April 2005

The wonderful world of dictation

My new favorate activity? ...dictating discharge summaries.

Nurse Practitioner F. took us down to the dictating room on the second floor and tought us how to use the system. There's a small study-like room with 3 cubicles, each with a telephone. Over the phone, we dictate a summary of the patients latest stay into an answering machine, which is later transcribed and entered into the chart. The wonderful thing about it for me is that I can spend 30 minutes with the phone and the chart and review all the important information we learned about a patient. Information that I likely missed (or forgot) in the week or so that the patient was in the hospital.

Like all new toys, I know that my enthusiasm for the activity will probably fade; I've never met a doctor who sounds excited about his dictations. But for now I'm going to let my mind wrap itself around the wonderful world of dictating. What's more, Nurse F has a whole shelf of patients she hasn't gotten around to dictating. If I go through them all and catch her up, I think it just might be helpful when it comes time to asking for letters of recommendation... ;)

Lessons from a renal patient

"I twy to sh--, ba aw I do iss fah fah fah" said Mr. P when I asked him about his bowel movements while in the hospital. His medications, his urine toxicity, and having his dentures out, all make his speech almost incomprehensible, but he still tries as hard as he can.

We all feel for him, he came in with a complaint of 2+ months of difficulty urinating, probably expecting to get an antibiotic and go home. When the ER doc suspected a stone, he did an ultrasound. It showed a large mass in the bladder, encompassing the ureters, which is what had been causing his symptoms. He has lost 30+ lbs in the last couple months, and his urine output is now reduced and red with blood and transitional cells. We haven't done a biopsy yet, but all indications point to bladder cancer.

We attempted percutanious nephrostomies twice, trying to restore flow past the obstruction, with no success. With his renal function getting worse every day, we've decided to transfer him to New Orleans, where they have a much larger caseload of this type. While we're waiting for a bed, we'll give him dialysis to "polish him up."

Despite his condition, Mr. P has been quite pleasant to work with. I've learned a lot from him. Following the case has given me a window from which to learn renal disorders, but, more importantly, has affected me on a personal level. His prognosis may be poor, but treating him and giving him the best care we can is making life better not just for him, but for us as well.

that nagging feeling

One of the signs that we're growing up is when we start to see the other side of an argument. It develops as that nagging feeling, the feeling that our competetor's view, the one against which we were moments ago so determinedly opposed, might contain a grain of truth.

In my youth, this realization was largely absent. The childhood I remember was largely black and white. I seem to have felt as if, by special gift of providence, I was fated to be born into circumstances which endowed me with an enlightened perspective. Friends at school who went head-to-head against me and the values of my family had simply missed the boat; parents, when they confonted me on the values of my youth, just didn't get it; and brothers and sisters can be just plain wrong.

But then, gradually, almost imperceptably, they all started to gain ground on me. They began to haunt me as I laid in bed at night, replaying the days events in my head. I certainly didn't wake up one morning and admit that, in a given set of arguments, I was wrong. Early on, the arguments bothered me more than they used to. Boisterous youthful exchanges turned more painful and labored. Soon (as behaviorally conditioned creatures always do), I found myself avoiding the painful stimulus altogether.

Perhaps we never really stop arguing our point, but for me it's become less frequent, and more muted. That didn't do me much good today though, as the ugly head of confrontation reared it's ugly head. But perhaps I can take consolation in a trend away from that nagging feeling of adolescence.

Anya and I and the boys at our wedding

...a picture of my recent wedding in Tampa Florida, April 17, 2005. From left: my brothers Dr. Bryan Merritt and Ellis Merritt, my dad Dr. John L. Merritt, my wonderful, beautiful wife Anya Merritt, me (the one with the big proud grin :) ), and my oldest brother Dr. John Lawrence Merritt II.

to lead a fulfilled life...

PBS's "guns germs and steel" miniseries, based on the book of that name, closes with a quote from a Zambian health care worker in which she says, "The control of malaria will mean an improvement in the welfare of the people, and an improvement in the welfare of the people will mean increased productivity, and increased productivity will mean that we will be a wealthy nation, because that will mean that then people will have sufficient, not only food but sufficient time to do things that make a human being complete and whole and able to lead a fulfilled life."

...To lead a fulfilled life. These are big words. There is so much behind the idea of leading a fulfilled life; and the factors that lead one person to live such a life, when another does not, seem almost beyond comprehension. I too, in my greatest estimation of myself, am dedicated to seeing that people around me are able to lead a fulfilled life. Most of us are, it seems.

And this is why it is so difficult for many of us... for me... when those around us fall short. We, I, wish to impose my will upon them, to give them the gift of fulfillment. But fulfillment can only come from within. We can create the environment for fulfillment, increase the chances that if one desires to attain fulfillment, they have that oppertunity. But we cannot give it to them. We cannot wrap it up in a box and leave it at their door. They must themselves, not only reach out and grab it, but strive for it every day... by themselves.

And waiting for them is the hardest part. Who is to say that they will finally get there? How do we know that they are determined to stay on the path? Must we have faith that all will work out in the end? How many have lived before us, only to have this same faith misplaced and unrewarded?

Sojourners magazine, the Sabbath, and Jim Wallis

I'm encouraged by the title of Jim Wallis' book God's Politics : Why the Right Gets It Wrong and the Left Doesn't Get It, his magazine "Sojourners", and this article I read about the Sabbath in his magazine. His selling point, as the Amazon editorial puts it, is that "the true mission of Christianity--righting social ills, working for peace--is in tune with the values of liberals who so often run screaming from the idea of religion."

I often wonder at the audacity of television personalities and political parties. I wonder, how conservatives so devorce themselves from the causes that they hear espoused every week in their churches, namely protecting G-d's creation, feeding the poor, and equal rights for all people? And how, equally mystifying, can liberals not see the that the ethics of religion provide a moral basis for the causes that they themselves demand? Finally, and most frighteningly, what forces are at work to diminish the voices of reason in mitigating this conflict. Why is it that only the screaming heads are allowed to speak?

Seperately, as a Sabbath-observer, I found the article about the Sabbath in his magazine quite refreshing as well. The idea is that observing a day of rest (not just any day, but the 7th day, the day G-d commanded) never was just a rule observed by a people by rote. This day, for it's observants, provides psychological rejouvination, and a reminder every week that there are things, ethical things, that we as a people maintain, from which we will not shy away. Every week, we have a physical reminder that we separate our inner selves to G-d.

There's so much more to say. I'm not going to say it all here.

Life in the armpits??!!!!!

Metaphors are often more graphic than we realize. The latest edition of the Economist has an article entitled "Life in the armpits of palestine." The article describes some of the day-to-day hardships of living in regions of the West Bank of Israel which will be surrounded by the new security fence.

The reason the title cought my eye was that I've recently discussed this same metaphor to my new wife, who moved here from Odessa Ukraine. We're moving next week to the bayou in Louisiana and a couple of my relatives before the wedding described the region as "the armpit of America." As english-speakers, the words just roll off the tongue; kind of a cutsey way to say that it can be hot (and humid) there. But to someone who hasen't heard the metaphor it sounds horrific. Who in their right mind would ever want to live there!??? Have we made a profound mistake by moving there??

I spent a lot of conversation time prophilacticly trying to steer the conversation away from such allusions. I demonized similar comments publicly so as to make clear that I wanted to put a better light on the subject. For the most part, it seems to have worked. The more tactful of my family quickly cought on and made sure to mention some of the more interesting things about the region ("you can always find something to do in New Orleans").

But the thing about it all that strikes me is the power that can be behind such a silly little phrase (armpits are gross!!!). A funnier one I always remember explaining is "love-handles." People talk about them all the time, but try explaining the allusion to someone unfamiliar with the term and it gets a whole lot more interesting...

We can be on the lookout for more of these. They're everywhere, I know. Perhaps we should be more careful with them; perhaps we can enjoy language more by thinking about what we're saying more often. Something to think about...