Today ends a thirty day stretch -- encompassing service on oncology, PICU, and the ventilator/CF unit -- in which I was either (a) working all day (b) working all night, too, or (c) home sick over my three-day Christmas break.

That was not a particularly pleasant holiday season.

Could have been worse, tho. Could have been a lot worse.

A little bit of down time before beginning the morning's work and morning patient rounds, this first day of the new year, this first day of the new decade.




There have been many entries by many friends looking back at the decade that was. I too did the same. So much *has* happened in the ten years from January 1st, 2000, unto today.

So many changes.

So many journeys.

So many hellos.



A few goodbyes.




We remember and celebrate, as is appropriate, the journeys we have made in the ten years that has passed since the last decade turned. We celebrate the company of the people we shared that journey with, companions old and new.

But not all of us made it all the way. Not everyone is here with us now. And these times of rememberance and memory are, for me, a time to acknowledge them, too. Remember those we cared deeply about, who were with us at decade's beginning, who are not with us here at decade's end. Wherever they are now, we take a moment to pause, and remember.

For me, I remember a tall, handsome African-American-Japanese young gentleman with a warm smile, a gentle heart, and hands that could make music explode from them like unleashed lightning.

For me, I remember a beautiful geek young lady from Montreal who proudly wore her Engineer's Ring, loved chocolate and big floofy stuffed animals, and filled the mighty gothic heights of St. James cathedral with the voice of an angel.

He would have been 35 this year. She would have been 32.

We should have had more time.

We should have had *much* more time.





In fairness, tho, we recall too those we cared about deeply who in this decade *won* their duels with the abyss, rather than lost. Those we feared we might lose, who *were* saved. Friends whom we had real cause to fear they might not make it to decade's end, but *are* with us here now. All the might and will of the modern profession of medicine isn't enough to win every contest against death. But we do win some of them. And we remember with gratitude and joy those friends of ours who, thanks to medicine and miracle, are with us still now.

The decade ahead will bring many things to us all, of course. Our journeys will take us to places we can barely imagine, lead us to new friends we don't even now know exist. There will be many new hellos, of course. There will also be, inevitably, more goodbyes.

That is the way of life. The certain knowledge that not all of us who celebrate together this decade's beginning, will be with us at this decade's end. That even we ourselves might not get to that farther shore. The quiet understanding that all futures are uncertain, even our own. And the fierce resolve to live life to the fullest. Make the most of the time we are given. Leave nothing doable undone, nothing that needs saying unsaid. And to fight like hell, for every moment that remains, in every way that we can.

Life's short, family and friends precious; got to make magic when and while we can.

Inspired by silmaril and bkleber, and in what has become a tradition in my Journal; here at the end of this year, a look back at the year that was...

Broken: Neuro / Neurorehab / Epilepsy Hephaestus' Heart: Cardiac Intensive Care Unit The Spot: Adolescent Community Clinic

Tales of the Third Genome: Genetics Lost: Pediatric Intensive Care Unit Ribbons of Grey: Neurooncology

Medicine, with +3 Awesome Hat: Emergency Department Winter is Coming: The 2009 H1N1 Pandemic With a Pen, Instead of a Fist: Child Protection Service

The Long Trail Silver and Swan Kazoos and Swedes Old, New, Borrowed, Blue The Mists of June The Fortune of Sixty Years Merry Evenings in Mundanity the Great Forest Park Balloon Race Great Falls on the Potomac Dragon and Phoenix Light from the White Hart Days of November Sunshine The Twenty-Sixth Mistress' Gift

Here at decade's end, one last look back.




And then, a look forward.




Happy holidays to you all. :-)




For last year's words
belong to last year's language
and next year's words
await another voice.
And to make an end
is to make a beginning.


- T. S. Elliot

The very wide circle of friends I've had the great fortune of making over the years embrace an equally wide diversity of faiths, with various celebrations important to them throughout the December calendar. My own personal solution to the issue of "different folks, different holidays" was born of my years in Japan.

The history of Japan is notable for the incredible transformation known as the Meiji Restoration. A summary of those remarkable years is well beyond the time I have, alas. But in brief: Japan in 1853 was a mid-medieval feudal society, arguably technologically equivalent to Europe at the end of the Dark Ages. Japan in 1903 was a fully modern industrial and technological power. Japan in 1853 was completely powerless to stop the four paddle-wheel and sail-powered frigates of American Commodore Perry's naval detachment from sailing right into Tokyo Bay and demanding terms. Just over fifty years later, three squadrons of the Imperial Japanese Navy utterly annihilated the Russian Pacific battleship Fleet at the Battle of Tsushima, one of the first major clashes of all-modern warships in history, and the largest naval battle since Trafalgar. In the reign of a single Emperor, Japan totally modernized itself, leaping 500 years forward in technology in just over fifty.

The New Year had always been an important celebration in Japan, steeped in traditions thousands of years old. When the Japanese switched from the ancient lunisolar calendars to the Gregorian calendar on 1 January 1873, they also simply moved the New Year's celebrations and traditions wholesale from the traditional (Chinese) New Year to the Western one. The Nengajo is the traditional New Year's greeting cards sent by Japanese to each other, to celebrate the New Year. And so it has been these past many years, and this year to come, that I adopted the same, write my cards and send my gifts in anticipation of the one significant date that we all share in common.

Ringing the Bells is one of my personal favorite entries I've ever written, on the subject of oshogatsu and thoughts related. And as I close out the year with a week of back-to-back-to-back shifts on the Oncology service, powering right through into the New Year, my thoughts reach out to all of you who so kindly have shared this journey with me, in this past year, and every other.

Warmest thoughts and best wishes to you all. :-)

A happy New Year! Grant that I
May bring no tear to any eye
When this New Year in time shall end
Let it be said I've played the friend,
Have lived and loved and labored here,
And made of it a happy year.

- Edgar Guest

After the janitors were done, the room at the head of the ICU hallway was spic and span, shiny and clean. You'd never know that just a few hours earlier, the bed and the floor were slick with blood and bits of human brain.

The case was probably hopeless from the second the bullet blasted a hole in our young patient's head.

But they tried like hell anyway.




One more thirty hour shift in the ICU, and then home for Christmas.

He is one of the merry crew of musical Rennie geek folks that I was lucky enough to fall into the spring evening long ago when silmaril mischieviously asked if I'd like to try this thing called medieval dancing.

He introduced me to Fluxx.. He wowed us with mad physics demonstrations. We've shared merry fiddle sessions and glorious days at Faire and all kinds of high geekery. And today is his birthday.








Moving on from Wash U to Hopkins/NIH will, sadly, take me farther from many wonderful friends in St. Louis. It will actually be a net even, distance wise, from family and home in Michigan and my kind friends in Cynnabar. But it will actually bring me *to* many dear friends in Markland. Friends like the musical, merry, generous and gentlemanly fiddler and geek bkleber. And I look forward to much music and adventure and all else in the days yet to come.

Happy birthday, bkleber. Sláinte!

In between back-to-back thirty-hour shifts, a moment of happy rememberance.











In Cynnabar, where I came from, we called it Wassail.

In Three Rivers, where I am now, we call it Winter Court.

And in Markland / Atlantia, where I am going, surely they too ring in the holiday season with a celebration of their own.




This December has been frustratingly packed with hospital duty, in 13 and 30 hr chunks one after the other, with nary a day or breath for celebrating the season. But I remember better times in days ago, filled with carols and friends. And I look forward with hope to better days ahead.

So here's to the Wassails of days past.

And here's to the Wassails of days to come. :-)



Wassail! Wassail, all over the town /
Our toast it is white /
And our ale it is brown!
Our bowl it is made
Of the white maple tree
With the Wassailing bowl
We drink to thee!

The department holiday party was in full swing, complete with white-gloved waiters ferrying drinks, hobnobbing faculty and residents, and a pianist in the corner playing live music. Including 50's swing tunes. And so my friend Jamie (Cups and Courage) mischieviously asked me if I'd like to dance, right there in the middle of the Holiday Party.

Well, when a gorgeous lady asks you to dance...






I'm not a very good swing dancer at all, and have very minimal practice at doing it. Haven't had much chance. But I *can* do very, *very* basic swing dance, thanks to kind lessons over the years by silmaril (Teleute and the Doctor) and Jesse (Cloud Gate Swing), in happy dances in days past. I only know a few turns, a few rocks, just a little bit. But enough for a song.

Noone else was dancing -- I'm not sure, maybe too self-conscious? -- but I've never been one to worry too much about that. Anyway, live music, a hardwood floor, and a gorgeous lady friend -- dancing, I think, is obligatory. And I didn't even step on her feet. :-)




To those of you for whom the holidays is a time of trial and duty: I wish you strength.

To those of you for whom the holidays is a time of vacation and freedom: I wish you joy.

And to all of you this holiday season: I wish you the best of things, now, and in the year to come. :-)

I'm really hoping he takes my offer. He really ought to spend New Year's with his own wife and kids, and not working a cancer floor.



Holidays always kick our work schedules up a notch; after all, medical need knows no holiday. In fact, if anything, *more* people get in trouble over Christmas and New Years, as people travel and gather and make poor choices that land them in trauma bays and ICUs.

I have a thirty hour shift today-tomorrow double-covering oncology and neurology/epilepsy/neurotrauma, crash at my apartment overnight, do another thirty hour shift the next day in the Pediatric ICU, crash, another thirty hour shift in the Pediatric ICU, then immediately race out to the airport post-call. I get to fly home for two days for Christmas Eve and Christmas Day, then come right back to holding down the whole cancer floor and BMT unit for seven 7a - 8p shifts in a row, then jump right into the madness of January in the Emergency Room.

Over the week of New Year's, I work 7a - 8p on the cancer floor, and my friend Jesse works the night shift. We'll trade off, day for night for day for night, for that whole week, me on days, he on nights.

And then yesterday, it suddenly occured to me: why am I making him spend New Year's Eve away from his wife and kids?




In 41 day stretch, I work 38 of them on four different units. I have and will work eighteen days straight leading into Christmas Eve. I literally don't even pay attention anymore exactly when or where or how long because, frankly, it doesn't matter. I just go where they tell me. (It's not so bad -- it's only 90-100 hrs/wk, which is *way* easier than it was just a few years ago. If I hadn't delayed starting residency to do my PhD, I would have been one of the last pre-work hour limits classes, and I would have been working 120-150 hrs/week.) But it does get easy to lose track of days and nights, since, frankly, they don't matter.

Which is why it didn't occur to me until yesterday that, since I worked days and Jesse worked nights, he'd be spending New Year's Eve evening at work, instead of with his wife and kids. Which, well, why should he be forced to do that... when I could cover it for him? I could, after all. I was working the day shift before and the day shift after; all I had to do was cover the night shift in between, too. It's just another thirty hour call.

But I remember how important holidays were for me with my parents when I was a little kid -- how important they remain to me now. I remember as a little kid staying up late with my parents playing games until midnight and watching the ball drop, and how exciting it was. And getting up the next day and watching the Rose Parade with my parents. Jesse's little kids deserve that, too.

Maybe Jesse can spend New Year's with his kids. Or maybe he can get a babysitter, and he can go out on the town with his wife, celebrate the turn of the year with tux and champagne. Brunch with his wife and kids the first morning of the New Year, and watching the Rose parade. Something like that. Point being, for heaven's sake, nobody who can spend New Year's with their wife and kids should have to spend it instead running around like a madman on a cancer floor. Not when someone else can do it for them. Like me. His wife and kids deserve better. *He* deserves better.

I didn't think of this until yesterday. He never asked, because I'm pretty sure he wouldn't dare ask -- which is why it's up to me to offer. I know I'd never dare ask a classmate to do a thirty-hour call without payback. Which is why I'm *volunteering*. I'm already working 38 out of 41 days, anywhere between eleven to thirty hours in a row. I already have to work until 8PM New Year's Eve; I'm already scheduled to work starting 7 AM the next day. Another eleven hours work in between -- another thirty hour shift -- isn't even going to matter. But Jesse's wife and his kids -- and Jesse himself -- deserve better than to be separated on the holiday. I can help make it happen. And I'm really, really hoping he takes me up on the offer.






This is my friend Jesse. That's his daughter Evie and his son Sam.

Our lives may be far easier than those of our predecessors (Work Hours Follies), but they're hard and brutal and grim enough; most importantly in ways that have nothing to do with mere hours. If we don't make it easier for each other in whatever ways we can; if we don't carry each other through this: no one else can. No one else will.

The place was the American Medical Association's House of Delegates. The year was 1997. He was a medical student trustee from the Medical Society of the State of New York, and I was a first-timer medical student from the Michigan State Medical Society. And that beginning, told in Closed Doors, Open Windows, was where my friendship with resonance42 began.

Many years did we spend fighting side by side in medical activism, meeting again and again at the great national medical meetings, at the Houses of Delegates at Lobby Days in Washington DC. But like culfinriel and mdrnprometheus, my friendship with resonance42, born the fire of medical activism, grew into something far deeper and richer than merely the collegiality of comrades in shared struggle.










Every picture links to a story. Every story tells of an adventure. Finally, recent years have given resonance42 the opportunity to share time and adventures together not merely as part of the medical activist duties which had originally brought us together, but simply as friends. To share adventures in music and dance and fantasy and geekery. And to introduce each other to the circles of friends we each are so fortunate to share in the world beyond the wards and the halls of power.

Titles and power come and go. The issues over which such heated battles were fought fade as events overtake them. The fiercely contested language of reports and resolutions, the bitterly fought motions and votes -- history moves along relentlessly and all of that work is left behind. Politics comes and politics goes. But long after the reports are archived and the debates are forgotten, friendships -- true friendships -- endure.

Happy birthday, resonance42. May the years ahead be filled with music and joy. :-)

Jumping from the PICU to oncology/neurotrauma 30-hr call and genetics / metabolism / congenital birth defect day service. In the midst of an 18 day straight work run.

Behind on work. Even more behind on everything that *isn't* work.

Spending my Christmas-New Years holidays doing *both* PICU and oncology. Should hopefully keep the work hours under 100 / wk, if all goes well.

I do get to go home for Christmas Eve and Day, tho. That's something.




Sometimes, it takes an outsider to give us perspective on our own situations. A close friend doing his training in psychiatry, is in the midst of doing his required three-month stint with the rest of us in the world of wards medicine. And he offers his very astute "outsider" perspective on the world the rest of us spend our years and careers within, in his entry here.

My last night on this tour of duty in the Pediatric ICU.



Was it cancer? Was it autoimmune? Was it something else entirely? No one ever figured it out -- not us, not the other senior academic medical centers she had come from and gone to in her journey. No one had ever successfully figured out what the process was that had attacked her bone marrow and her brain. Once upon a time she had been a beautiful, happy, playful girl. She still remained beautiful, even now. But the disease -- whatever it was -- had gradually silenced everything else.

We -- and others -- had done our best to treat, based on our best guesses. She had been through chemo, bone marrow transplants, the most powerful antibiotics known to man. Literally every team in the hospital -- ours, and elsewhere -- had been involved, had thought hard and fought hard. She too had fought hard, fought with every ounce of her strength, never flagging, putting out her maximum effort to do what she could. Even as the disease slowly stripped her strength, and then her function, she always was happy and playful for the staff who worked for her and the family who loved her, always cooperative, always brave. And everyone who worked with her came to love her deeply, even as the disease gradually took over.

She stopped getting out of bed. Then she stopped moving her limbs. She lost her ability to talk, regained it briefly, then lost it again. Gradually lost her ability to swallow and protect her airway, had to be intubated, failed multiple attempts to get off, had a more permanent breathing tube put in through a tracheostomy. She became sleepier and sleepier, waking only for briefer and briefer periods, farther and farther apart. Then she stopped waking up at all. Gently, ever so gently, her breathing grew slower and slower and we had to go up further and further on her support. It was just a little a day, day after day, for weeks. But the trends all went completely in one single direction.

As the last of a series of residents taking care of her, tracking her subtle decline day after day, I was the one who first assembled all the data and trends. Discussed with all the teams. Systematically ruled out all the other possibilities. Calculated where the numbers suggested we were going. As the resident most responsible for her day-to-day care and tracking, I was therefore the one who finally, formally presented the case for what everyone in their gut already suspected. After weeks of gentle decline, of her doing less and less and the machines doing more and more, what was left now, was all machine. Oxygen and carbon dioxide still entered and left her lungs; nutrition still entered by catheter and urine still left the same way. But there was no longer any evidence that there was a brain, a mind, in the middle of it all. We never truly figured out what the disease was. But the disease had won.

Her parents were very well educated, very well informed, and deeply involved with their daughter's care. They in their hearts had long before suspected and guessed what we now confirmed for them. They had done all they could, just as we and others elsewhere had done what we could. And now, with the same methodical, patient thoroughness they had approached the entire rest of her care, they thanked us for our efforts, gathered the family, and said goodbye.




In the old legends, the valkyrie -- the lady warrior guard of the Lords of Valhalla -- were heralded in their coming and going by wings of storm. Apropos, then, that our beautiful young lady fighter should take her last leave of us, as the fierce winds of winter roared through the towers of the medical center.




Gather on the sand
Let your voices
Carry to the sky
Rise in light
And let the Gods
Look down on this
And wonder

- Marian of Heatherdale

A happier tale.



Today, the wonderful Mistress cantigajoy surprised me with the gift of a recorder. Hooray! :-)





I had just written in my LJ about being inspired to learn the recorder. And so today, at the Barony of Three Rivers Winter Court (our annual holiday celebration / feast), Mistress cantigajoy gifted me a brand new recorder of my own. Hooray hooray hooray! :-)





My next thirty hour shift on the Pediatric ICU begins in a few hours.

But tonight, an evening of music and singing, feasting and dancing, laughter and hugs.

And as I celebrated with friends here in Three Rivers, I thought of my friends in Cynnabar, whose Baronial arms I wore on my left. Of silmaril and texas_tiger and fortuna_juvat, whose hand-woven favors hung on my right. Of _constantine, who first gave me the belt everything else was hung on, and thette, who had gifted me with the silver drop cross around my neck. And so many, so many others, friends with whom I've celebrated these past few weeks; friends whom I've celebrated with these many happy years.

Wassail to you all, this holiday season. Thinking of you all.

Taking a moment of condolence for a friend who lost his sister to (probable) H1N1 today.

I have been inspired to learn how to play the recorder. :-)

With voice and fiddle, many of the happy moments snatched admist the fury of clinical duty over these past many years have been celebrations of music shared with so many friends. Be it great balls in grand halls, or informal musical jams at a friend’s home or around a campfire, music has been an escape for me, thanks to the so many who kindly shared that escape with me; and thanks to the parents who first gifted music to me. And although what lies ahead next year will be far harder than anything I’ve ever done, coming to the East Coast will put me in easy reach of an entire world of musical adventures, from Boston to North Carolia, from Carolingia down to Windmaster’s Hill, and a wonderful community of musicians and Rennies and SCAdians all around.

Thanks to the gift of my parents, I already know how to read and play and think music, learned first on the violin; and the violin will always be my first and primary love. But even with the travel violin resonance42 kindly helped me obtain, it still remains a somewhat cumbersome – and weather-finicky – instrument. A recorder, on the other hand, is both extremely portable *and* practically indestructible, as instruments go. I can slip a recorder into any backpack or garment bag for travel. Holster it on the belt of my medieval garb as so many other friends do. Carry a recorder without worry into almost any weather or condition – it’s just a solid piece of tough plastic, after all – and have enough musical range to play most medieval/Ren music, anywhere, anytime. With a recorder, I could carry a musical instrument into almost the worst imaginable weather -- a driving thunderstorm or the cold of winter -- and have music ready at a moment’s notice. I could carry a recorder to the beach, out on the water, hiking into the deepest forest, and be neither encumbered nor worry for the instrument. Where many SCA/Rennies carry a belt dagger at the hip, I could just carry a recorder. I’m more a musician than a fighter, anyway. :-)

I’d actually have to find time to actually *learn* how to play the recorder, of course; that’s not likely before the autumn of 2011. What I need is a stretch of time I could just spend hours a day at it to lock the fingerings into my head. But *all* I need to learn is how to actually finger a recorder for music. Once I get a handle on how to get the notes I want out of a recorder, I already know the music. And while not easy, it’s also a fair bit simpler than learning the piano or violin, at least for the very basic purposes I’m interested in. I’m not looking to be concert proficient in the recorder; just to be good enough to strike up a tune for a dance, or play for fun in an informal consort.

This happy autumn of musical events, from Gryffon’s Mark to Ayerton to Revel Grove – has inspired me to want to try someday to add the recorder to my musical arsenal. Many are the recorder players among my friends – among this fellowship – and your thoughts would be much appreciated. But while not easy, to gain basic competence on the recorder is something elementary school children do all the time. I figure I at least have even odds of doing as well. :-)

One tradition in our department of Pediatrics is a holiday party which gathers the combined faculty and residents of the department. As part of that is the showing of a slide show featuring the graduating residents. For that slide show, we were asked to contribute photographs, as well as reminding the slide show compiler what our plans for next year were.

I sent in a recent family photo (seen here) and the requisite information about next year. I got a reply from the complier thanking me for my submission, but asking if I could also send in a "fun" photo as well. An "action shot" of me doing something I enjoyed.

An action shot? Well... :-)




There were several different photos I considered, and I went back and forth a lot. I decided in the end to submit as my second photo this one:





The photo shot and kindly provided to me by resonance42 is not just a neato fiddle action shot. It also features Lady Teleri's spiffy, spiffy garb in the foreground left, the Master and Mistress Saltatoris' own spiffy garb in the background right, and the spectacular setting of the Ida Noyes attic ballroom, painted murals and all, in the background. And every single person in the frame is in full-blown medieval garb -- no overt mundanes or mundanity visible in the picture. Of many photographs I like a lot, it is the most completely, sumptuously "period" photo I have in sufficent quality for the purpose. And so it will feature on my slide to be shown at the holiday festivities, together with my family portrait and my name and 2010 destination.

If I were still a first-year intern, I might have been less bold in showing off a medieval recreation photo. After all, most ordinary folks -- most "mundanes" -- don't "get it", have all kinds of misconceptions about our hobby, etc. Even more so among the faculty and senior department leadership who will be present at the slide show. If I was a first-year intern, I might be more cautious about what I chose to show, more concerned about the possible effect on what my fellow physicians thought of me.

But I'm a third year senior resident. I've been here two and a half years -- and like all residents, spent as much work time here as most normal people spend in five. I'm not a newbie -- I'm someone everyone already knows in the context of work. I already *have* a reputation.

My department has a long history and an explicit mission of training pediatric physician-scientists, and prides itself on such. While our department trains many generalist pediatricians, what it *really* wants are future pediatric academic research faculty, to continue the long line which have come from our program over the last fifty years. And so, even at the same time my fellow residents and faculty puzzle, or laugh with, that photo of me in full medieval fiddler form, they'll also be reading the caption on the slide reminding them what I'm doing next year. I might be the fiddler in the funny fancy clothes, but I'm also the fiddler in the funny fancy clothes who's going to be a physician-scientist fellow at Johns Hopkins / NIH. And in the mind of the senior faculty whose opinion I might be most concerned about... that's really all that matters.

I might be more cautious if I were a first year intern trying to establish a reputation. But as a third-year resident who already *has* a strong one... it's time to take advantage of it to show off a little. To have a little fun. And maybe draw a few geeks and Rennies out of the closet. :-)

Stuck in airports flying home for Thanksgiving gave me time to write. So today, another story.





Once upon a time, I was a commoner without title or rank, and she was my Queen. The Sovereign upon the Dragon Throne when I was one of her thousands of ordinary subjects. And yet she had kindly taken the time to hand-write a reply note to me long ago, a stranger she’d never met in person; the original story told long ago in A Note from the Cleftlands. The chance to repay that kindness was not something I thought I would ever have, given the vast distance in rank between us in the Society, for what need hath a great noble like her of anything from a simple commoner like me?

Thanks to kind friends in Cynnabar and Three Rivers who petitioned the Crown on my behalf, in the years since I had been granted the first levels of noble rank in the Society for Creative Anachronism, the SCA. Her heraldic titles still towered far over mine, for now she was a Countess, outranking Knights and Masters of the Orders, outranking all but the vanishingly few Dukes and Dutchesses and the reigning Crowns themselves. But she was also a third year medical student and MD/PhD candidate who was thinking about becoming a pediatric oncologist, and I was an MD/PhD senior resident in pediatrics who had already won his fellowship in pediatric hematology/oncology. And so it was, when she had asked by e-mail if I had a moment for a few questions that I was humbled and honored to reply.







It was at Midrealm Coronation that we met, a few weeks later; met at the grand pagent written of in Dragon and Phoenix. By sheerest luck, resonance42 was there, too, himself two years ahead of me and now a faculty member in Pediatrics at the University of Chicago, able to add his greater perspective and advice to mine.

All three of us were players in the great game of Ren Faires and medieval recreation societies and living fantasy. All three of us were also physician-scientists, fellows of the NIH MD/PhD Medical Scientist Training Program, at NYU, U. Michigan, and Case Western, respectively. All of us wrestled with the same questions common to all physician-scientists. Balancing laboratory and clinical. Balancing continuing to specialize vs. getting out of training and making a full salary. Balancing work and life. And so in a brief pause between the pagentry of Coronation and the merry swirl of the evening ball, the three of us talked about applying to residency, life in pediatrics, choosing between fellowship and general service, all the key, life-defining decisions a young physician-scientist must make. And about those things universal to all who care for the sick: of dealing with the frustration of fighting within a broken system; of the horror that is the thousand ways a child can suffer; of the grief of losing patients you come to love.

The great cathedral had rung just an hour earlier with the traditional Oaths taken with the ascension of each new SCAdian Crown. To be the shield of the weak / foremost in battle / champion of the right and good; to remember courtesy and kindness / to prize justice above personal gain / to labor for the common good. To fight bravely even in the face of nearly hopeless odds; to serve humbly with courtesy and compassion; to battle to strength's end in defense of the helpless; the ideals celebrated in our SCAdian songs and legends, were central also to the profession we were honored to serve and share. And so there was a certain apropos about talking about life at medicine's furthest forward edge while dressed like figures from medieval legend. About sharing experiences fighting for the sickest of the sick in a hall that sounded just an hour before with the herald's cries and the ring of sword steel.





And [Death] comes for my kinfolk, and [Death] comes for my horse
[Death] comes to take my sword away / And I'll greet Him with force
For my soul still shines brightly / And I'll wait with baited breath
For the last foe, a soldier has / Is the enemy called Death.

- lyrics by Baron Syr Alexander Kyppyn Kirkcaldy

Stuck in airports flying home for Thanksgiving gave me time to write. So today, one of a series of happy stories. Enjoy.



Sometimes, Size. Does. Matter.

Like in drums. :-)





I had heard rumors of the Great Drum of Doom. The mighty wardrum from medieval manuscript blueprints that aelkiss and niquerio had acquired for their rapidly growing arsenal of instruments. But I'd not *seen* the Cynnabar Wardrum with my own eyes until they unpacked it from their car on arrival here for grand Crystal Ball. And it was still yet more impressive to hear -- to *feel* -- it's thunder in action. The mighty wardrum underlined stately dances with a basso authority, and made the wild fast dances roar. It was awesome. It kicked ass. And so did the whole of the weekend of the twenty-sixth Crystal Ball, the third year in a row I was able to celebrate a day of music and dance with friends from all across the SCA here in my own home territory.





Crystal Ball! Mighty Crystal Ball -- a whole day of music and dancing and friends from near and far. Surrounded by dear Calontiri friends from local; surrounded by dear Midrealm friends from afar -- from my old home Barony of Cynnabar, from across Pentamere and Ayerton and so many places else. Full of happy joy had been my first (Where Falcon and Dragon Dance) and my second (Crystal and Doublet). And this third edition was even more so!




It was thanks to resonance42's generous offer of a drive that I had been able to take advantage of a Chicago Craigslist posting to pick up a dirt cheap travel violin just weeks earlier. It was thus with great joy I was able to offer him the exact same spare violin just weeks later, to play as a part of Mistress cantigajoy's merry orchestra. resonance42 hadn't played the violin seriously in years; he'd never really heard the music before; but he had, once upon a time, had music along with biology as his Yale full double major. And he always had been a man of singular talents. So it was through a merry day and night, that resonance42 and I were able to fiddle, side by side, through all the old favorites and many others, fiddling side by side. So it was we were able to also dance together, at a second dance event just weeks after resonance42's first (Dragon and Phoenix). A friendship born of nearly a decade of shared medical service and activism, now blossoming in music and storytelling -- huzzah! :-)






And another wish fulfilled -- for many years, long have I wanted to make music with Delric, my lady Dancemistress' husband; Delric, a systems adminisrator who also does professional gigs as a folk/Irish musician. Out in the late november sun, he and I and old dear friends niquerio and aelkiss and others gathered. In an unseasonably warm november day, we gathered to fiddle, led by a lady fiddler with a treasure of a dark-wood violin over three hundred years old. By flute and fiddle and guitar, we msde mudic before the music, till the sun began to slip and it was time for the ball itself...









Amidst the splendor there was a special moment of pagentry. For just as knights in the society have the privilege of taking squires; so Mistresses of the Order of the Laurel, holder of the Society's Knight level award for the Arts, have the privelege of taking Apprentices. To take a student with the formal bonds of Mistress and Protege, linked by the symbol of the green belt. And so it was, in ceremony simple yet profound, my close friend and Dancemistress Tsire (Merry Evenings in Mundanity) took my close friend Arina (Birthdays, November 26th) as one of Her Own.





And the ball -- oh, he ball! There was singing, and there was dancing, and there was music playing, and there was music playing *while* dancing, and so much, so much more! Through dance after dance; through set after set; to midnght and the traditional playing of the dance Saturday Night / Sunday Morning; and well, well beyond. For this year, I had no duty to report to the next day, no need to end the night early so I could see patients the next morning. And so it was I joined the ranks of the hardcore, who danced and played and danced until just before dawn.




Three glorious Crystal Balls have there been since I came to Three Rivers, the twenty-fourth through the twenty-sixth. A year from now, when the twenty-seventh comes 'round, I will have moved away, but not moved on; though once again my career will have moved me, this time to Atlantia / Markland, my friends here in Three Rivers will remain as close and dear to me as my friends in Cynnabar have been in the years since I left there. The Society -- the Great Game -- is national in scope, with distances of geography meaning little in the love of music and dance that we all share. There will be Pennsics and Knowne World Dance Symposia, and Balls east and west, north and south. Wherever I am, there will be joy with old Calontiri friends and old Midrealm friends, and friends awaiting and friends yet to be made in Atlantia, Markland, the old East Kingdom, and everywhere love of poetry in motion and music is held dear.

So Vivat to the past! So vivat to the future! Vivat to dances fondly remembered, and the dances to come. As was said by Lord Byron long ago, and in another entry, another dance, another tale:


On with the dance! let joy be unconfined;
No sleep till morn, when Youth and Pleasure meet
To chase the glowing hours with flying feet.

Stuck in airports flying home for Thanksgiving gave me time to write. So today, one of a series of happy stories. Enjoy.





Every visit before, the way was barred.




November 2007

We had been to St. Louis' magnificent City Museum many times before, the marvelous place of tunnels and secrets shared before in the tale Sunday at the City Museum. We had explored with many friends from the Museum's deepest caverns up to the top of the highest stair -- but no further. For on every visit before, we were not permitted to follow the endless stair all the way up to open sky. But this time, amidst the last warmth of a late Indian Summer, the way was open. And for the first time for us, out onto the City Museum's once forbidden roof we ran.






November 2009


There was a giant slide, it's peak almost twelve stories above ground. There was an old fashioned ferris wheel and a scampering pond and more. And there were all the other areas of wonder that are the St. Louis City Museum, on and over and through we romped until the sun set and evening turned into late, late into the night. And the weekend had just begun!




It was less than two weeks since I had celebrated the glorious close of the 2009 Maryland Renaissance Festival season with many friends, among them Zach and Jesse (Light from the White Hart. By sheerest luck, Zach's work just happened to bring him to St. Louis just two weeks later, I just happened to have a rare conincidental weekend free of clinical duty, and so they decided to make a trip of it, in one of my last few months in St Louis. They had arrived on Thursday night in time for a splendid dinner at one of the city's most famous Italian restaurants, Friday evening at the City Museum after my clinical duties had ended for the day, and then onwards into a glorious Indian Summer weekend...

Even for southerly St. Louis, a early November weekend with the mercury flirting with 80 degrees is unusual. Eighty degrees, sunny, and not a trace of the cloying humidity which usually curses warm days on the Missisipi floodplain -- a glory whose timing was perfect. And so it was to mighty forest park we went to spend the day.







Built for the 1905 Worlds Fair and Olympics, the great forests and fountains had been the setting of many tales told before in this journal: of sledding (Art Hill and Bum Hollow) and music (Painted on an Autumn Evening's Sky) and balloons (The Great Forest Park Balloon Race). Now, we partook of another old st louis tradition; paddleboats from the boathouse, a picnic on the waters, lazy cruising across the lagoons and old sailing songs as a warm november sun fired the autumn leaves with gold.


And there was the Zoo, lions and tigers and bears; and there was sunday brunch on the plaza of the Coronado; and there was the splendor of the Cathedral Basilica. But before all too soon it was time to part at the airport, with one last round of hugs, they back to Ann Arbor; my back to duty in the ICU.

Another weekend of warm memories, days of November sunshine and summer.

I started this Thanksgiving Day intending to write a little drive-by posting of thanks. It became something quite a bit more than that.






I was at first startled the other day to see playing on a medical center television a "end of the decade" retrospective. But it is, isn't it? It is the eve of the end of a decade, as these things are counted. And a good time as any to look back and take stock on the ten years that were...






From the most important angle of my life -- from that of family; it has been an extraordinarily good decade. After the departures of both my grandmothers after long, fufilling lives, there were no further subtractions from the family. None. No further departures in any of the forms of tragedy and sadness by which a family becomes smaller. By that single measure alone, this has been an exceptional decade.

But it wasn't just mere stability, as extraordinary and precious as that gift is. In this decade, my family grew steadily by addition -- by engagement, by marriage, by adoption, and by birth, growing by new spouses and new children. Our family didn't merely not shrink; it grew, welcoming new members to a family already rich in love; including the engagement of Gauss to his to-be wife, herself an old friend from college days.

I could stop this entry right here, and it would say everything that needed saying about the decade that was.






There was the girl who wanted mustard. There was Julia and Amazing Technicolor Fingernails. There was Madame and the boy in search of his missing inch, the little girl with the funny elbow and the young lady who wanted to know where stars were born. And countless more, a few whose tales I've been honored to share here in my Journal.

The greatest honor a physician can recieve is the lives of the patients she is priveleged to become a part of. And there have been many in the ten years since I began my first clinical service, as a newly minted third year medical student starting a year on pediatric hematology/oncology. I hope that I was able to help at least a few of them in some small way. And if I was able to do at least that, then this last decade was a decade spent well.






Twenty years ago, I was an eighth grade boy borrowing from the library a copy of the book American Association of Medical Colleges: Medical School Admissions Requirements, the pre-med's bible.

Ten years ago, I was a fresh-out-of-the-classroom medical student applying for a place in the Medical Scientist Training Program, the national MD/PhD fellowship that included resonance42 and mdrnprometheus.

Through my BS/MD pre-med personal statements in high school, through my medical school applications in college, through the MSTP Career Goal statement I was writing ten years ago, all that I had done was aimed torwards the same goal. For before I was born, oncologists had saved the life of one of my older cousins, a cousin now thirty-plus years in remission and married to his lady love.

The price other men had paid had given our family a prize beyond count. Our family owed a debt to the profession of medicine and oncology we could not possibly repay. But I wanted to, in my own little way, try. And that was the destination I had begun striving for since I was old enough to answer the question.

Twenty years -- even ten years -- is a long time in such a journey. Many folks begin a decade with one goal, and end up somewhere else. Many medical students begin the MD or MD/PhD training program with one vision, and end up somewhere very different years later. Plans change, ideas change, life circumstances change, and there is no shame or dishonor in that.

I was one of the lucky ones. Lucky enough to get all the chance breaks. Lucky enough to have all the stars line up right. Ten years ago in my MD/PhD application statement I set among my goals to become a scientist; to become a physician; to become a pediatrician; and win a place in the profession of pediatric hematology/oncology. And thanks to the extraordinary generosity of many, and luck beyond counting, here at the end of that decade, I won them all.

I *don't*, honestly, know if I am up to the challenge ahead. Better men than I have fallen away and aside; stronger people than me have been broken. And I know that no novice, no beginner, no outsider just preparing to come in, can really understand the true shattering depth of the sacrifice required. I'd be lying if I claimed I wasn't nervous. I'd be lying if I'd tried to claim I wasn't scared.

But long ago, other oncologists helped my own family. All I've ever asked for was the chance to try to follow in their footsteps. For twenty years I have wondered if I have the steel to earn a place in the field of pediatric hematology/oncology. The strength and courage to fight for other families with cancer, as others fought for mine. And now, here at the end of this decade, here at the end of that journey, on the shores of the Maryland Atlantic seaboard we will settle that question, once and for all.






If you asked me at the beginning of this decade what my hopes were for the following ten years, I would say that I would hope my family would continue to be well. And I would say I would hope I might have won the chance to try to help kids with cancer. My life at home and my life at school/work; this decade has been kind to me in both those key fronts. And if that were all that this decade brought to me, I would be profoundly grateful and deeply content.

But that wasn't *all* this decade brought. After all, as overwhelmingly important as my family life and my life in academics were and are, this decade also, for the first time in my life, brought me far, far more...

At the beginning of this decade, I really didn't *have* a life beyond my life with my family and my life at school/work. Don't get me wrong -- I was and remain deeply and richly blessed with many friends *from* school and work. Friends from high school and college and medicine whose friendship I value and treasure deeply, to this very day, with whom many merry adventures have been had in these last ten years. Many friends I first met in academics and in service whom I've had the privelege to introduce to the rest of you. But at the beginning of this decade, *every* friend I had came from that narrow universe of study, work, and worship. The previous ten years from junior high to medical school was a blowtorch-intense direct march with no time for the world beyond. And as rich a life as I had with such a narrow focus, I had just no idea when the decade began how richer a universe was about to open up to me.

Beginning just a few weeks into the new decade, when, out of the blue, a certain wonderful, witty, sassy force-of-nature Aes Sedai from Toledo decided on her own accord to drop into my ICQ box and introduce herself. :-)

The story of that beginning, and all that follows, I have told before. rasfwr-j, the Wolves Glen Pub, the SCA, the RenFaire circuit, LiveJournal and the Open Diary before it, my first roller coasters, my starting to play the violin again, three weddings I have or will have the honor of being best man in, and the one wedding I (without purposefully intending to) matchmade -- all of it, *all* of it, all beginning that one first night.

I don't think missysedai had any idea just how much mischief, merry chaos, adventure and more she was going to get me into over the next ten years. I sure as hell had no inkling myself. But one thing led to another led to another led to another, like all of the above -- and so much more this Journal has captured.

It has been one hell of a merry ride that began from nowhere on January 26th, two-thousand-and-ought. And I wouldn't have missed it -- or all the precious friendships that began because of it -- for the world.






I still do hope that I will someday be as lucky as my brother Gauss or my cousin littleholly or so many of my friends: lucky enough to share that incredible blessing where one's best friend is also one's spouse. I know what the cynics say about the subject. And I've seen enough real-life examples to know the cynics are wrong. If others can find such love, I hope I can too.

Honesty compels me to admit that, if you asked me in 1990 whether I hoped to be married by the year 2010, I would have feverently said yes. If you asked me the same question in 2000, I would have honestly answered the same. I would have hoped that the ten years since 2000, or the fifteen years since I left home to go to college, might have been long enough to find that kind of fortune. But then, I'm hardly the only person still waiting for that stroke of lightning. And considering everything else -- the vast, vast, *vast* wealth of fortune and family and friends that these past ten years -- and the whole of my life -- has been blessed with; I'm not even going to *dare* to sound a sour note on that regard.

I still fervently hope I might yet have the privelege of becoming a husband and a father (and a grandfather, and a great-grandfather.) I hope that, should I win that right, I can be a husband and father my wife and children can be proud of and treasure. But in the meantime, I know I have been absurdly lucky in family and friends -- and the chance to fight for them all. And that is more than enough for any man.






And that, in the end, was the story of the decade that was. The love of family; the honor of service; and a new world of adventures and friendship beyond both I could never have imagined. Any *one* out of three would have been extraordinary. To have all of the above is more than any man has any right to ask for, let alone get. I've been a very, very lucky man. I hope this Journal over the years captures in some small way a bit of the depth with which I feel in that regard.

I had started this Thanksgiving Day off intending to write a short little thing. It ended up turning into quite a bit more. But I think, in the end, the most important things ever worth saying are thank you. And so, for each and every one of you who played a part in the journey: my deepest and profoundest thanks.




From happy homes
And warm beginnings
To distant and uncertain ends

One thing worth
The trial of the journey
Is the love of family
And the laughter of friends




- found written on a rock
on the shore of Lake Michigan
at Northwestern University
Summer, 1997

There are almost one thousand hospital beds at the University of Michigan Medical Center. Over fifteen hundred at Wash U. There are twenty four - and four overflow - in the Pediatric Intensive Care Unit I'm serving on right now. Twelve in the next door Cardiac ICU. We filled them all my last thirty-hour call shift. We filled them all the one I was on before that. And I imagine we'll do the same tonight.

With the H1N1 and the economy, we have been routinely running at near to over capacity, turning my call nights into absolute non-stop, absolutely exhausting admit-and-transfer ASAP as we shuffle and shuffle again the least-critically ill patient out of the unit so that the a even more critically ill child can get in.

Every one of those occupied beds is a family that will be split this Thanksgiving. A family member unable to be at Thanksgiving dinner. I will go into this coming thirty-hour overnight shift fighting with the rest of my team to keep as many of them alive as possible; I will do the same in the thirty-hour shift two days after that.

But in between, for the first time since I returned to clinical duty as a third year medical student four years ago, I myself will get to spend Thanksgiving with my own family at home.

I'll run to my plane immediately after signout on Wednesday, fly eight hundred miles back to Michigan, spend Thanksgiving day, race eight hundred miles back, and leap right into my next thirty-hour hell-shift. It might sounds exhausting -- I'll admit, it's not exactly a walk in the park -- but it's better than the other three members of my team will get, who will be working to cover my absence as I have these past many years for others.

And far better than the hundreds upon hundreds of families whose loved one will also spend the holiday with us at the hospital. And the countless among them who will never go home.



When your own program director tells you you look like shit, you know you're not just imagining things are rough. But things are far harder for the patients we're fighting to help, the families whose loved one's life hangs in the balance we labor like titans to tip. Compared to them, we have it easy.

And for us lucky ones able to fly home for a brief -- too brief -- moment with the families we love, we remember the most important truth which led us to this place long ago: some prizes are worth paying a fearsome price. And some things things are worth fighting for to the end of strength.



Off to my shift now. Wishing you all the best in this Thanksgiving Season.

Today, I received my medical license from the Maryland Board of Physicians.

At a frustrating and difficult time for many, catching up on happier tales.



Just a few weeks before, resonance42 and I had danced together with many Midrealm friends at the grand Midrealm 40th (as told in Dragon and Phoenix, now with added photos kindly shot by him).





And now it was an evening with silmaril and blueeowyn and friends in College Park, dancing with the same fellows of Thrir Venstri Fœtr, the very same group with whom silmaril had introduced me to the whole world of medieval recreation years and years ago. Another evening of English country with old friends, at the beginning of a week of activist and scientific work in Washington DC. A week which began with the American Academy of Pediatrics meeting at the convention center, and a happy dinner with friends at Prince George's Station, and an afternoon with vvalkyri at Great Falls (Great Falls on the Potomac). A weekw which segued into days of wild wild science, and culminated in the beloved traditional Closing Weekend at Maryland Renaissance Festival.

In previous years, the entire trip was built explicitly around celebrating the Faire. But between the crush of clinical duty before the trip, and the massive effort of setting up and preparing for eleven scientific interviews that week, and then the furious effort of actually *going* back and forth between the AAP meeting, the NIH campus at Bethesda, the Hopkins campus in East Baltimore, and the home of Jesse's family, who kindly hosted me for the week, my actual time at Faire this year was but brief. Brief, but no less wonderful.







The rains came with a vengence many times this season, I'm told, and so they did on Saturday, driving Jesse and Zach and I out before we had a chance to meet with Breno silmaril and other old friends. But Sunday, the very last Sunday, turned out for glorious autumn weather, and we were there at Opening Gate.

A tradition, I am told, is the (semi)-open musical jam session right after the cannon's roar begins the Sunday Faire day, an hour of free-for-all music in the square just inside the main gate admist those invited. This year, faireraven both kindly offered me an invitation and a fiddle to play with her and bkleber and everyone else, and much merry fun it was.







As was the whole rest of the beautiful fall day, lazily strolling with Jesse and Zach and bkleber through shows both familiar. Encounters with mavis_maude and blueeowyn and many other old friends. All the way to the traditional Dance Macabre faireraven always organizes. All the way to the last, very last Pub Sing at the White Hart Tavern, shared with Jesse and Zach at my side and vvalkyri on my lap, and all the old familiar songs ringing from a hundred voices until the stars began to twinkle in the sky. One last celebratory dinner at bkleber's home, and then onwards, back to the airport, back to St. Louis, back to duty.




Many happy years it has been since my first Maryland Renaissance Festival. Many happy memories, shared with so many friends, near and far. The first Faire I ever went to; the first Faire I ever performed at, Maryland Renaissance Faire has always had a special place in my heart. I have always thought of it as my "home" Faire, even when I was eight hundred to a thousand miles away. And next autumn, it will be my *local* Faire. I'm going to be able to make not just one weekend. I'll be able to make them all.

The normal Gate price is $18. A season-long unlimited pass pays for itself completely after just five Faire days -- and there are nineteen in the MDRF season. With a Fairever pass, I could come out for every Sunday morning musical jam session, come out to see the one-weekend only special events, come out for all the informal gathers, host friends from near and far, all whenever I have a day free from clinical duty. Which is why I'll almost certainly get a MDRF season pass along with my Hopkins ID and NIH badge, if not next year, then the year beyond.

There are many friends I want to introduce to the splendor and glory that is MDRF. Many other friends I hope to share favorite traditions with. Revel Grove is already a place rich with happy memories with friends far and near. And the best is, fate willing, still yet to come, as I transition from annual visitor, to regular local.

I wore my black everyday hospital work shoes to MDRF. The soles, even now, have a faint patina of brown Revel Grove dust. And admist the petty stupidity, grinding exhaustion, bitter frustration, and occasional crushing tragedy that is life in a critical-care unit; sometimes when I have a second to catch my breath in a chair admist thirty-hour straight-no-sleep shifts, when I cross one foot over my lap sitting down I catch a glimpse of the dirt stubbornly hanging onto the bottoms of my shoes. Dust carried all the way from the streets of Revel Grove.

I think of all the happy memories, bright laughter, and warm hugs from so many friends over the years. The cheers for the performers, the spectacle of the Joust, raised songs and raised glasses and friends held close as the last evening light fades at the White Hart tavern. And for a moment, I smile.




When the daylight fades
And the shadows fall
Let the light from the White Hart shine on me
And the weather watch
Spies a coming squall
Let the light from the White Hart shine on me.

And the sun sinks low
In a troubled sea
Let the light from the White Hart shine on me
And the night winds blow
And the rain falls free
Let the light from the White Hart shine on me.

Her cart neatly piled high with instruments -- doumbeks, bongos, guitars, tambourins, bodhrans -- she strides purposefully through the hospital wards, from patient room to patient room.

Her name is Christy. And she is the Wash U / St. Louis Children's Music Therapist.





Like the travelling troubadours of old, Christy is a jack-of-all trades. She can play any of a plethora of instruments, improvise on a drop of a hat, sing low or high with proficency. But she is far more than an musician; she also is trained in physical therapy and occupational therapy and psychology. More than just music for music's sake, her education and her experience allows her to use music as a tool to help her children -- *our* children -- push themselves torwards recovery.

Watching Christy in action is to see her pull constantly from her bag of tricks -- figurative and literal -- to address the myriad challenges each child faces. Music, for example, is a way to get a burn victim to stretch contractured, scarred down limbs. It is very hard to convince a five year old to reach out and stretch, especially when it hurts to do so -- but much easier to convince them to reach out and bang a drum, or ring a chime. Convincing a young restrictive-lung disease patient to make the effort to get up out of bed and sit in a chair -- with all the effort before and during the exercise -- is a lot easier when they're getting out of bed to play an impromptu guitar duet. Christy can find ways to wrap monotonous or painful therapy into a musical adventure, and helping children do the things they must in order to get better. She can also use music as an icebreaker, as a means of building connection and trust, and get children and adolescents to open up their feelings and concerns to her in a way they hesitate to do with their medical team or even their own family members. And often, music and the joy that comes is the sole purpose, giving a child too sick to even go outside something to look forward to on a regular basis, something other than bleak hours waiting between rounds of wracking chemo or painful dressing changes.

In a facility filled with specialists clocking long hours in the effort to help the sickest of children, Christy is no exception. She is here every day before dawn, often here well after dusk, Monday to Friday, day in and day out. She makes her rounds from service to service, room to room, all the way from the first floor Surgical clinics all the way to the 12th floor neurotrauma wards. The whole hospital is her beat, from the intensive care units to the cancer wards, from the rehabilitation facilities to the epilepsy beds. She works with her fellow physical therapists and occupational therapists, the child life specialists and the in-hospital teachers, seamlessly adding her note to each child's personal rehabilitation and therapy plan. We all have personally written for "Music therapy" as a specific order; it even has it's own specific drop-box in the computer order entry system. And as someone who myself has a deep love of music and many, *many* fond memories of shared joy in music with family and friends; as someone whose own patients have found laughter and song with Christy the Music Lady; I count myself as one of Christy's big-time fans.

Life for a critically ill child is hard and bleak. Many of our children will spend weeks and months unable to leave their rooms. For too many of them, they never will. And while we on the medical staff fight night and day to keep them alive, our colleagues like Christy try to give them a little something to actually live *for*. A little bit of brightness, a moment of escape, from the unrelenting reality of needles and nausea and pain.

Our privelege is to fight for the sickest of children, to fight against disease and death and despair. There is a place in this fight for the masters of the blade. There is a place in this fight for the scholars of the arcane. And there is a place for this battle for the bard, keeping the darkness at bay with doumbek and whistle and steel-stringed guitar.

A friend once made an observation which made -- and continues to make -- a lot of sense.

As Boy Scouts, as early as when we were ten years old, they taught us to shoot arrows from bows, fire guns, start fires, chop wood with axes, and make objects out of heavy power tools. As boys, we had *awesome* fun. I remember making shaping wood with band saws, jacking closed the chamber on a 22-caliber rifle and lining up sights on a distant paper target, building campfires, and it was a *hell* of a lot of fun. It also, obviously, had potential for extreme risk. I could have easily, if I screwed up or screwed around, lopped off a finger or literally killed someone. The response wasn't, of course, to bar us from doing it; it was to spend a hell of a lot of time talking in great depth about the risks and how to minimize them. We weren't barred from shooting guns just because we could easily kill someone; we were simply taught very carefully how to do it *right*. And the same went for hand axes and kerosene and everything else. The idea, of course, was that by the time we *were* old enough to do these sorts of things unsupervised, we'd know how to do them safely unsupervised.

So why not teach sex the same way?

I mean, sure, sex has the potential to be dangerous. Sex has the potential for severe, life-altering -- or even life-threatening -- consequences even if you do everything right. But the same goes for shooting rifles or using a table saw or anything else. Teach kids about the dangers, teach them about the risks, teach them how to do things as safely as possible, and that's the best way to make sure if and when they *do* choose to do something, they'll do it as safely as possible and they'll do it right. That's how we learned archery, that's how we learned shooting, that's how we learned fire and blades and saws. Stands to reason that's the way we should teach sex.

When it came to guns, we were taught guns could be very dangerous. Guns could *kill*. We were taught that, if there was no adult around, and we saw a gun, we should stay the hell away from it and let an adult know. But we were also taught that, someday, when we *were* old enough to shoot guns, always keep the barrel pointed away from people; always make sure the safety is on when not firing, always make sure the chamber is clear when done shooting, etc, etc, etc. Someday, we *would* be old enough to shoot guns on our own; and when that day came, doing X and Y and Z would keep us as safe as possible. (We were also allowed, under supervision, to actually shoot guns, but no analogy is perfect.) Point being, just because we weren't old enough to shoot unsupervised, didn't stop anyone from teaching us how to do it safely when the time came. Why shouldn't, my friend pointed out, we teach sex the same way? If your kid is old enough to ask the question, they're old enough to get the answer. If they're old enough to shoot rifles and bows, use hand axes and saws, start fires, they're old enough to *learn* about sex. Made sense to me then. Makes sense to me now.

Yes, even if you do everything right, it doesn't make sex 100% safe. We all know condoms can break, birth control pills can fail, etc etc etc. We all know there is always, even when you and your partner do everything perfectly, some chance something can go wrong and someone ends up pregnant, or with an STD. We all know the only totally, absolutely, perfectly safe way to have sex is abstinence. But the same applies to guns -- the bullet can always zing off a hidden rock, the bowstring could always snap, the wind could always just happen to blow funny. As long as people are going to do it, pretending it doesn't isn't going to protect anyone. Teach the risks fully, make sure the risks are clearly understood, teach every way to keep oneself safe -- that's the way to really *teach*.

For me personally, for my own conduct of my own life: I always kept thinking about the non-zero chance of me getting a woman pregnant, if I were to have sex. No matter how careful we were, anytime I might have sex with a woman, I might make her a mother. Even if you do absolutely everything right, that chance is not zero. Because it was not zero, if I was going to have sex, I had to be ready to be a father with the woman I was having sex with. And if the woman I was thinking about having sex with was someone I trusted enough and loved enough to potentially spend the next twenty years raising a child with, I ought to marry her. ;-)

It's not so much that I have a policy of no sex before marriage. After all, it doesn't matter the slightest bit to me whether my future wife has had sex before or not. In fact, it totally does not matter to me whether a theoretical future girlfriend -> wife has had a past sexual history with men, women, or both. Her sexual history before we begin a relationship is her business and her business alone; and our sexual history together will obviously be a matter of joint agreement. [1][2]

It's more that any woman I trusted and loved enough to potentially raise a child with is someone I ought to be marrying. That I should only court the risk of pregnancy that comes with sex only when and unless I met a woman I trusted and loved that much. But that's just my own brand of risk assessment. I know from my own training just how small the risks are of getting a woman pregnant with properly used birth control. After all, part of my job is teaching teens those very same facts. I'm just unwilling to run even those small odds. Small isn't zero, after all; and if I'm not ready to be a dad, I'm not ready to have sex. [3]

But just becuase I have come to the conclusion in my own life that sex is not something I'm going to do until I'm married and ready to raise children with my sexual partner, doesn't mean that I think abstinence-only education is a worthwhile social policy. As an activist and as a pediatrician, it has always severely irked me the number of people and politicians who somehow think that not talking about the subject at all is somehow supposed to be an effective protection mechanism. As our computer scientist friends would say: security through obscurity is no security at all.

If a ten year old can learn how to shoot properly, if they can be taught how to use power tools safely, if they can be taught how to do all kinds of potentially lethal things; they can be taught about the risks, dangers, and responsible management of sex. Even if, like guns and bows and arrows and fire and saws and power tools, sex is not something we want them doing unsupervised until they are much older. If you want children to be safe, teach them to *be* safe.

There's a huge difference between learning about the odds and choosing abstinence as a personal life choice -- as I have done -- and pretending that abstience only education works. The answer to kids hurting themselves because of ignorance is knowledge, not more ignorance.






Footnotes:

[1]Actually, it might be helpful if *she's* had some experience with sex, since I certainly won't have had any of my own!

[2] Yes, there are some strictly medical implications of her having had sex before and me not. But we have tests for those things which can be done once we've decided to get married. And it's not like I would break an engagement or sue for divorce simply because we discovered my wife had a STD acquired from before we knew each other, any more than I would break an engagement or sue for divorce for any other medical problem.

The woman I loved enough to marry would be a woman I loved enough to sacrifice for -- die for -- without hesitation or pause. A little thing like an HIV+ diagnosis wouldn't stop that. Even if it mean we could never have sex safely... well, I've gone this long without sex. For a woman I loved enough to die for, I could go the rest of the way. I wouldn't break an engagement just because she got hit by a car, paralyzed, and became unable to have sex. Or just because she got cervical cancer and required a hysterectomy. So why would being unable to have sex because of HIV+ status be any different? In sickness and in health...

[3] In biological theory, I *could* just walk away from the woman I made pregnant -- tons and tons of men seem fit to just that, as my own constant work with single mothers as a pediatrician makes very clear. I biologically *could* do that. But I couldn't do that, not and be the kind of man I hope to be.

We were winning. We had backed her away from the edge of the abyss, threw into the fight powerful antibiotics and multiple pressors and artificial lung support and actually hauled her back from the brink. And then something inside her brain tore apart in a gush of blood.

We were winning. We had his seizures finally under control. We were getting ready to propose to the family a treatment plan which might even fix them once and for all. And then he exploded into a series of uncontrolable spasms and we had to emergently hit him with so many anticonvulsants to save his brain we also had to take over his breathing. Now he lies in his bed with a ventilator pushing air into his lungs as we wait to see when -- if -- he'll wake up.

We were winning. Our transport team had somehow managed to get the critically ill boy alive to our hospital, with almost a dozen pumps blasting life-sustaining meds into his system, a helicopter medical flight of the stuff of legends. They did more flying at two thousand feet at six hundred miles an hour than most other hospitals can do on an ordinary day. He got to the hospital alive. He didn't last much longer than that.

Stories from the Pediatric ICU.




Thirty hour shift before the weekend. Thirty hour shift after. But this weekend, like last weekend; a little time for music and joy and friends from afar.

Family and friends make lighter a long journey.

In recent years, we've come to understand that there is far more to DNA than just the sequence.

Human diseases whose root lies in the control of cell operations by DNA -- like pediatric cancers -- have driven the need to understand exactly how a diseased cell's DNA differs from their normal counterparts. And we have come to better understand that those differences often go beyond differences in the actual sequence *of* that DNA. For example, it is becoming clear that one mechanism by which DNA activity is regulated by cells is through carefully controlled methylation -- the addition of a methyl group -- to sequences of DNA.

Thus, being able to map DNA -- not just it's sequence, but it's modifications like methylation and many other characteristics -- would be an extremely useful tool for being able to compare, for example, cancer cells to normal cells. Being able to map them across the entire genome would be especially useful, to give us clues on why cancer cells do what they do -- and what we can do about them. This, however, is a substantial challenge. There are approximately three billion base pairs in the human genome, after all. To have any reasonable shot at routinely doing this kind of mapping would require the development of machines that can process vast quantities of DNA in rapid succession.

As it happens, there already *are* machines that can process vast quantities of DNA. Our cells, after all, do it every single second of our lives. The nuclei of our cells contain a whole arsenal of tiny, complex protein machines which spindle, fold, assemble, disassemble, and label DNA with extreme speed and fidelity. So why re-invent the wheel -- or the polymerase, helicase, gyrase, methylase, etc? Why not just take these molecular DNA-handling machines from our cells and strap them onto microscopic assemblies of electrical sensors, micro-fluid chambers and pumps, building a half-biological, half-mechno-electrical machine that can scan DNA for the characteristics of interest with a cell's speed? After all, electrical engineers are very good at fabricating millions of complex machines at a molecular scale. Why couldn't them incorporate biological molecular machines into their computer-chip assemblies? It's just chemistry, after all. MacGyver the cell's own machinery into a computer matrix, like a bacteria-sized cyborg?

The first machines to do just that are just beginning to appear as prototypes in some of the most cutting edge research laboratories in the world. They've quietly, silently been spending the last few years working the kinks out of the process, and now they're ready to actually unleash the new technology on real discovery. It's like ship builders who have spent years learning how to build ships that can sail against the wind, and now they're ready to actually take their vessels out over the horizon to see what's there. Engines of discovery so radical they aren't even available for commercial sale yet. Technology so advanced only the working prototypes are in operation in a select few laboratories in all of the world, just waiting for scientists to use them to apply them to the study of cancers still resistant to everything we know.

And that's the sort of stuff I got a sneak peek at, over four days in October of meeting potential research mentors at Johns Hopkins and the National Cancer Institute @ NIH. A peek at the kinds of work I have the chance to join in a year's time.




The work that has already been published is groundbreaking. But the stuff that hasn't been published *yet* -- the stuff that is being written up, the stuff that is still secret, the stuff still underway -- is totally mind-blowing. To crack the unsolved, unconquered, uncurable problems in oncology is going to require radical new techniques, radical new advances, and radical new technology. And the investigators and engineers at the furthest forward edge of medicine are rising to the challenge, looking at cancers in ways totally beyond what we know now, and doing it with machines like something out of a cyberpunk novel.

Investigators identifying novel biochemical pathways cancer cells use to turbocharge their metabolisms, firing up energy-processing systems their normal neighbors can't touch. Investigators making cells dance between the normal mature state, their forever-young stem cell origins, and their Mr. Hyde cancer counterparts. Investigators diving into the vast sequences of our genome which don't directly code for genes, and exploring the constellations of regulatory mechanisms hiding out in what was once thought to be "junk" DNA. Across four days at Hopkins and NCI, I got the chance to meet with over a dozen faculty, each allowing me a chance to look at *all* the revolutionary projects and data they have, well beyond the stuff they've already published or shown, well beyond the stuff *anyone* in the world has yet done. Professor after professor, laboratory after laboratory, each taking a totally different approach, looking at wild new angles in oncology with prototype machines custom built for the purpose. And inviting me to come aboard for the journey.

We have made tremendous progress torwards the treatment of cancer. When my most senior pediatrics attendings began their careers, pediatric leukemia was a total death sentence. Now, forty years later, 90% of our kids diagnosed will walk away cured. That progress was made possible by generations of systematic, national clinical trials, decades of courageous patients and their families, the effort detailed in the story Legion of the Brave. But it depended upon generations of basic science advances making those cures even possible, generations of research which form the foundation for the ground-breaking, mind-blowing, "holy $%#%!!" work I was invited to take a sneak peek at. And as far as we've come, we still haven't gotten far enough.

Our best as a profession still isn't enough for too many of our patients and their families. A 90% survival rate for pediatric leukemia is just another way of saying one out of ten of our children will die. And for most other cancers, the survival rate varies from nowhere near as good to absolute zero. Not good enough. Until every child with cancer has the chance to grow up -- not good enough.

We've come a long way. We have much farther to go. Somewhere over the horizon lies the scientific keys to defeating not just cancer, but all the other devastating diseases which threaten those we love, bound together by the common science and biology that links them all. In hunting for what makes cancer cells go bad, we will learn too how to fix broken kidneys and broken nerves and broken brains and everything else. Knowledge is power, and to hunt for that knowledge -- to push forth after those cures -- bold engineers and scientists have built engines of discovery beyond anything anyone outside of the very greatest research centers in the world have ever seen or even dreamed of. They await the next generation of physician-scientists to grab hold of the wheel and set sail. And I am humbled to have the chance to earn a place as one of them.

Twenty years of work from eighth grade to the end of my pediatrics residency was just to get to this point. Now the real adventure begins.




The future stretches forth like the vast undiscovered country it is, a journey to places barely imagined and glimpsed. On a personal level, I hope that I might yet earn the privilege of a lady wife's love, of a child's hug. On a professional level, I hope that I might yet be able to make a difference in the fight and cause I am grateful to be given the chance to serve. I have no illusions about the challenges or my chances, but no road worth travelling was ever either easy or certain. And I excited about the new wonders we'll see along the way, voyaging on the furthest edge of the scientific unknown; and the company of the friends and family we'll share the journey with.




Come, my friends,
'Tis not too late to seek a newer world.
Push off, and sitting well in order smite
The sounding furrows; for my purpose holds
To sail beyond the sunset, and the baths
Of all the western stars, until I die...

Though much is taken, much abides; and though
We are not now that strength which in the old days
Moved earth and heaven; that which we are, we are,
One equal-temper of heroic hearts,
Made weak by time and fate, but strong in will
To strive, to seek, to find -- and not to yield.

At a difficult time for one of my very oldest friends, we still take a moment to mark his birthday today. And better words I do not have, than those I wrote on his birthday years ago.

The story again, for his birthday today.

Catching up with blogging about happy events...






In 1969, armored fighters gathered for battle at a science fiction convention in Wisconsin. And when the tourney was over, Cariadoc of the Bow became the first SCAdian sovereign by right of arms of the newly established Kingdom of the Middle, the Midrealm.

Forty years later, admist the phoenix banners of the University of Chicago, SCAdians from across the four daughter Kingdoms of Cariadoc's original fiefdom gathered to celebrate four decades of history and story. And I rejoined old friends for a day of music and dance and pagentry. :-)






My first medieval event was the evening dance practice silmaril kindly brought me to in Atlantia. But my first true SCAdian home was in the Barony of Cynnabar. And while illness struck at last minute many who had planned to come, still many other old friends were able to make the journey, from near and far. And it was wonderful to see them all again.





And wonderful too was the chance to share an SCA event with resonance42, my old friend and comrade from medical activist days, a friendship which began almost thirteen years ago at the House of Delegates in Dallas, and continues yet. Long before he was a professor of pediatrics, long before he was a leader in national advocacy efforts, he was a proud LARPer and geek. And it was wonderful to share this event with him.




resonance42 also very kindly drove me to the far southern suburbs of Chicago during a lull in the day's action, where from Craigslist I managed to pick up a prize long sought -- a violin cheap enough that I would not fear the often less-than-perfect weather at SCAdian or Rennie events. A travel or "beater" violin. Even "inexpensive" violins -- with bow and case -- cost hundreds upon hundreds of dollars, enough to make one wary of rain or fog or mud. I had always planned on scouting Craigslist or used instrument shops for a decent violin cheap enough I could risk it on less-than-perfect conditions. By sheerest luck, that weekend I managed to find on Chicago Craigslist a completely, totally functional violin -- with bow and case -- for a ridiculously low price. A total cost less than I've spent just for *strings* for my good violin. And thanks to the generosity of resonance42 who kindly drove me out to get it, I now have my travel violin, bow, and case, just in time for the evening ball. :-)







There was all the majesty, pomp and circumstance as befit the crowning of the Midrealm's 80th Crowns, arch of swords and banners flying and all else, captured better by resonance42's expert camera and those of others. And then there was an evening of dance and music and celebration with old friends under the hammer-beam roofs of Ida Noyes Hall, flying feet and whirling dresses and joy.

A merry event, a happy day with many friends, another in a long series of such since that first night in College Park long ago. And with eager thoughts looking forward to this weekend, to the great Crystal Ball to come. :-)

From the day we together helped move him into Ann Arbor, to the last days when he helped me tremendously with errands as I moved *out* of Ann Arbor, and countless adventures in between, many, many adventures with aelkiss over the years. Many more in the years since I left Ann Arbor. A few of those stories captured in the stories the above photos link to. And many more to come.


Computer scientist, musician, SCA/Rennie, musician, singer, musician, gentleman and close friend, a sincerest happy birthday to aelkiss! :-)

Five years ago, when I served on the University of Michigan Faculty Senate Civil Liberties Board, and the voters of Michigan struck down equal rights for same sex marriages, I wrote the entry Proposal 2 and the Arrows of Thermopylae.

When a year ago, the voters in California struck down equal rights for same sex marriages, that entry still spoke for me.

And this year, when the voters in Maine struck down equal rights for same sex marriages, that entry still speaks for me.



Onwards we will fight, clawing, scraping, scaping for every muddy, bloody inch between here and where this story ends, while time and strength remain. Even in the arrows' shade.

I was originally planning on talking with my friend about the Pediatric ICU patients I will be taking over next week.

But then they had six Code Blues in a four hour period.

I figured I'd come back another day.




I wasn't originally scheduled to do another month of Pediatric ICU next month. In fact, originally, I was scheduled for a nice, easy, no weekend, no overnight call month.

I *traded* that month away in exchange for the 80+/hr wk PICU month I'm starting instead.

The ICUs have the sickest, most challenging, most difficult patients in our medical center -- and being who we are, that means the sickest patients *anywhere*. The most frightening patients are the ones you learn the most from, the ones who push you the hardest, the ones who make you better. And I owe it to my kids to come to Hopkins/NIH with the absolute best training I can get for myself. The American Board of Pediatrics sets a maximum limit of six months ICU training time and I've pushed it right to the limit. (Actually, I'm over that limit, but there is some creativity allowed in accounting.) I will be a better doctor for throwing myself into the furnace one more time.




Still, tho, I'm glad I have one last weekend before then, with a happy surprise visit from old friends in Ann Arbor.

"So," vvalkyri brightly suggested while we were driving north, "want to see Great Falls?"

A detour for scenic natural beauty on a crisp autumn day with a wonderful lady friend? Sounds good to me! :-)






As always, click on thumbnails for full images

I had no idea Great Falls existed before vvalkyri suggested we go visit them, on the way up after a lunch meeting recalcitranttoy for the first time in person (yay!), despite having been to Washington DC almost two dozen times in the last ten years. Where the Appalachian Piedmont gives way to the Atlantic Coastal plain, the Potomac river is funneled into a narrow gorge of rock, turning the placid river into rushing waters. Here at Great Falls, the Potomac stumbles down a series of successive falls, plunging a total of seven stories in height through a series of cascading channels.






From the Maryland side a wide trail leads to a series of bridges which span a succession of gorges, through forests perched on spits of rock, leading out to the vista over the Great Falls themselves. The scale of the rapids can be gauged by the full-size trees on the far side; stunningly, there have been historical floods that have filled the entire gorge up to the level of the trees at top. Even now, the scene is impressive, made more so by the frame of autumn leaves and sky.







But along the wilder river runs the placid waters of the old Cumberland and Ohio canal. A dream originally envisioned by the founding fathers, it runs from the Chesapeake at Washington DC all the way to Cumberland. I had actually strolled the shores of the same canal at Georgetown with hoya99 years earlier, years before rasfwr-j and all that came from it. And now with vvalkyri we explored the locks and canals and friendly wildlife along the wide, sandy trails. Volunteers in period costume escorted real, working canal boats up and down the canal waters, and exhibits captured the lost history of the canal's brief heyday.

The trip to Great Falls was very neat for many reasons. But above all, it was another chance to share a comfortable afternoon exploring natural wonders with a merry friend. :-)

And the early autumn night was alive with the soft glow of the balloons, lit by roaring tongues of flame...

As always, click on thumbnails for larger pictures

St Louis' Great Forest Park Balloon race is one of the oldest and most prestigious balloon races in the nation. For over twenty five years, this invitation-only event has gathered some of the nation's most experienced hot air balloon racers across the urban landscape of St. Louis.

The "race" is actually more a three-dimensional game of "follow-the-leader" rather than a contest of speed. The lead balloon -- nicknamed "The Hare" -- takes off 15 minutes ahead of the rest of the balloons. The rest of the balloons -- as many as sixty or eighty others -- then give chase to the lead balloon as closely as they can follow. The "Hare" balloon goes as far as weather conditions and daylight permit, chased by a pack of "Hounds" all across Metro St. Louis. Eventually, once either weather conditions or daylight begin to wane, the lead balloon picks a site to touch down at, lands, anchors, and the crew then lays out a giant "X" marks the spot. Fifteen minutes later, the chasing balloons soar overhead, and each chasing balloon crew attempts to drop their marker as close to the center of the lead balloon's "X" as they can, before finding places themselves to land. The winning balloon is the balloon which manages to get their marker as close as possible to the lead balloon's "X".

This giant game of follow-the-leader is complicated by a number of factors. First, a hot air balloon pilot has only a very limited ability to actually *steer* his balloon. A hot air balloon pilot can only directly control his altitude -- fire the burners to rise, pop the vent at top to sink. The horizontal direction of the balloon is then completely dependent on the prevailing winds at the altitude the balloon is at -- which can change radically just a few hundred feet up or down. The best a chasing balloon pilot can do, therefore, is to try to match the altitude of the lead balloon as closely as possible, hoping to catch the same wind currents that drove the lead balloon forward; and try her best to gauge what direction the wind is at various altitudes above and below based on how the other balloons in the pack are moving.

Second, in contrast to many other balloon races held in prairies or deserts, this balloon race takes off right from the middle of a major city. Hot air balloon pilots must contend with skyscrapers, radio antennas, active hospital helipads, high voltage power lines, and commercial aircraft making final approach to the region's most active airport. Having perused pilot's charts of the area as part of my Transport Physician briefings, I can second that our airspace is awfully messy. Not to mention it getting even messier when it comes time to actually *land*. Much of the immediate metro area, after all, is heavily forested, criss-crossed with power lines, traffic, river flats, and of course the rivers themselves. Hence the "invitation-only" nature of the race, invitations issued only to pilots known to have sufficent experience to navigate the thicket of challenges our urban enviroment gives. This race is definitely on the upper end of difficulty, as balloon races go, and with it the prestige.




Of course, the flip side of making the pilots take off from the middle of a city is that the whole city gets to watch the fun. For the past two years, I've been able to watch the balloons do their thing from the upper windows of Children's Hospital, while working. This year, being my last year before moving on to Hopkins/NIH, I made certain to clear my schedule enough to partake in the celebrations with M, a wonderful friend and fellow MD/PhD in the Pediatrics residency program. Originally a graduate of thette's Karolinska, M had come from Sweden to Wash U to pursue her Pediatric Neurology combined training program at one of the founding institutions of the specialty, and many merry adventures we've had over the years.

We kicked off with Opening Night for the St. Louis Symphony Orchestra out on the lawn, a repeat engagement of the marvelous night of music under the stars told in Music Painted on an Autumn Evening's Sky. (Among highlights of this year's concert: the conductor turning to the audience and saying, "There's some music you'll recognize right from the very first chord,", and then launching off into this:



Yep, I had it on the very first chord. M. watched in amusement as I leaped off the picnic blanket, pumping my fist like a grinning manic. Whoo! :-) )




The next evening was the pre-race Balloon Glow, when the more than sixty balloons fire up and light up in a colorful spectacle that fills the heart of Forest Park with color and light. M. and I strolled admist the crowds and the aisles of balloons, and then enjoying a picnic dinner for the second night in a row, this time packed and cooked by her in her own kitchen. The sights were beautiful, the night cool and comfortable, and the company delightful. :-)




And then came the day of the race itself. Balloons soaring upwards into a mild grey sky, from the simple orbs of the standard hot air balloon to the giant Energizer Bunny. One after another the crews raced to get airborne, before the lead balloon got too far away. Strangely enough this day, the prevailing winds were blowing south-west, taking the balloons away from the usual eastbound course up and over the medical center, making it especially fortunate we could come out and see the balloons personally.

A delightful tradition, a wonderful day with a merry friend. Huzzah! :-)

Today's XKCD is especially wonderful: The Lord of the Rings, Star Wars IV, V, and VI, and other films represented as narrative pictograms.

What has the geek in me particuarly going "Awww" is this: in the narrative picogram for The Lord of the Rings, at the end of the ideogram, the artist groups Legolas and Gimli going off together, rather than simply grouping them with the rest of the cast we see last at Aragorn's coronation.

From a strictly film perspective, there's no reason to do that, since the film (as I recall) does not touch on what happens to Legolas and Gimli after their last scenes in the film. In fact, the last place I think we see them is at the coronation, and based just on that, you would expect Legolas and Gimli to be grouped with Aragorn, Eomer, et al.

But Tolkien afficianados know that, as one of the last notes in the Red Book, as seen in the appendicies to The Lord of the Rings...

When King Elessar gave up his life Legolas followed at last the desire of his heart and sailed over Sea. We have heard tell that Legolas took Gimli Gloin's son with him because of their great friendship, greater than any that has been between Elf and Dwarf. If this is true, then it is strange indeed: that a Dwarf should be willing to leave Middle-earth for any love, or that the Eldar should receive him, or that the Lords of the West should permit it. But it is said that Gimli went also out of desire to see again the beauty of Galadriel; and it may be that she, being mighty among the Eldar, obtained this grace for him.

The film makes no hint of this. But the artist, presumably, knew; and chose to embrace a bit of artistic license as tribute to the greater story from upon which the films drew. And bring a smile to Tolkien afficionados everywhere, like me. :-)

Given that we are a Children's Hospital, naturally, on the last work day before Halloween, we break out the costumes. :-)

Naturally, not every unit can participate -- my unit for example, costumes in the Burn rooms would not be a good idea. But for those unit which do, an effort is made by each floor team to come up with a common theme for the team's costumes.

And so, this year, below the cut, a few of the best team costumes...

( Read more... )

Working on various American Academy of Pediatrics stuff.

An amusing note: for many years, there has been a Section on Residents at the AAP. Last year, the AAP decided to change the name of the section to be inclusive of all trainees, which is of course a laudable idea.

The new name they chose was the American Academy of Pediatrics - Section on Medical students, Residents, and Fellows.

Abbreviated, of course, AAP-SMRF.



Figure A: La, la, la-la-la-la...





This year, when we returned to the AAP national convention, the name had been mercifully changed. :-)

On a happier note...

Even though I don't have a copy of the book, I share the same excitement as so many of my friends at the release of the latest volume of the Wheel of Time fantasy series, the excitement which ripples through their recent entries and discussions.

I have to sheepishly admit that I don't even, off-hand, know how far behind I am in the series. The last volume I had the chance to read cover-to-cover was Lord of Chaos; I was only able to speed/skim through the subsequent two volumes, and haven't had the chance to read the volumes after that at all. I'll catch up on it all someday. :-)

In the meantime, a toast: to the continuation of the story which brought us all together. And everything that began, long ago, in a place called the Two Rivers, and by the pen of a man called by some James Rigney, called by most Robert Jordan, and known to us as The Creator. :-)



With fondness and celebration,

- turnberryknkn

Gaidin to missysedai

And Brother-in-arms to dscotton, silmaril, and thette

Professional chemist, armored fighter, ruling Baron and good friend, today is armoredchemist's birthday.




With armoredchemist at picture left, and his Lady elaine242 at picture right; at the marvelous graduation party charles_midair and elaine_alina kindly hosted for me.

Happy birthday, your Excellency. Vivat! Vivat! Vivat!. :-)

Hanging is a pretty horrible way to die.

Especially if you only mostly, but not completely, succeed.

And why does a fifth grader try to hang themselves?




Another week on night ED / Transport / Burn unit duty. Then onto another month on the Pediatric Intensive Care Unit.

One night, summoned at 3 AM to duty at an emergency delivery of premature infants, the attending physician on duty arrived to check on how things were going for me and the fellow. This by itself is not unusual. What was surprising (to me), was that the attending physician who came by, also happened to be the second-highest ranking physician at Wash U / Children's.

One would have thought a senior physician leader with as much as he has on his plate -- Chief Medical Officer, Vice Chairman of Pediatrics, active principal investigator -- wouldn't still be taking 3 AM call, not after literally thirty years of duty. But then, there's something to be said about leading by example. And that's pretty much the way Dr. Cole is.

The Neonatal Intensive Care Unit -- the world catpured in stories of my own, like A Voice from Cardiff -- is Dr. Cole's area of specialty. And the Wall Street Journal recently highlighted another important story I myself hadn't had the chance to tell. Their article, featuring our unit, is less about our unit itself, and less about Dr. Cole; and more importantly about the lessons and ideals we are taught by mentors like him.

The article can be found here.

Even in the midst of a ferociously busy week in Washington DC, Johns Hopkins and NIH, there have been a few moments snatched aside with old friends.

An afternoon at Great Falls with vvalkyri. A night dancing with silmaril and blueeowyn and resonance42. A glorious Closing weekend at Faire, rich with music and song and dancing and the brilliant golds of autumn. From Friday night dinner at Prince George's to a last Sunday night dinner in Columbia, admist the furious pace of research meetings and conference seminars, happy time spent with old friends.

Now to pack, and an early morning flight, and returning to duty in the burn unit. But a thank you to so many wonderful people, for, admist a thunder of meetings, moments of laughter. :-)

Like so many of my friends, iliana_sedai and I first met through the Wheel of Time (although indirectly, as I was a part of the rec.arts.sf.written.robert-jordan constellation and she was mistress of Silklatern.) Role player, storyteller; fellow BS/MD veteran, fellow fantasy enthusiast and fellow devoted Christian, after many years of correspondence I finally got the happy chance to meet her and her gaidin (and their kitty!) in person almost exactly a year ago, when they kindly hosted me at their home. And today is her birthday. :-)






Fandom communities fade, but friendships endure. Happy birthday, iliana_sedai. :-)

It was the end of the second day of the American Academy of Pediatrics meeting. Two days of perpetual cold misty rain and water-soaked squelchy ground, miserable weather through for dashing from convention center to convention hotel and back again for session after session. And after a long day, I was finally leaving.

A wrong shuttle bus, a wrong direction train, and a few more wrong turns later, I found myself waiting at Metro Center for a long while for my next train. And while I was down there, all of a sudden large rain-soaked crowds started filtering in from above. Crowds of people with soaked hair and clothing. Each person carrying a floating red helium balloon lit from within by a tiny little disposable flashlight. The glowing red balloons bobbed up and down on their little string leashes, like paper floating lanterns of yore.

From ancient times, various Asian cultures set paper lanterns afloat or aflight in memory of loved ones passed beyond. Lit tiny lights in the darkness, to guide the spirits of their beloved into the beyond. Set paper lanterns with small candles to be carried out to sea, or to float upwards torwads the stars, to honor and remember. I do not know if these were the original inspiration for the annual Light the Night walks sponsored by the Leukemia and Lymphoma Society. But for Light the Night the crowds had gathered with their little floating balloon lanterns. And despite the soaking, cold, clammy, miserable weather, the great crowds had indeed come, for the Light the Night walk which had taken place on the Mall that night.

The station swelled with the rain-soaked crowds. Group after group of teeming folk wearing the Light the Night t-shirts, or team t-shirts of their own creation, shirts which bore a smiling photo of someone they had loved. "In Memory." "Never Forgotten." "Always in our Hearts." The weather was cold and wet and miserable, the kind of weather they used to call "catch a cold rain", and the crowds had still come to defiantly circle the mall, glowing red balloons held high in the driving cold rain. In memory. In challenge. In honor.

There were whole families in their t-shirts and balloons, from little kids up to elderly folks pushing walkers. There were crowds of sorority sisters and fraternity brothers, with their letters worn proudly and a smiling photo of a friend on their backs. There were huge groups that formed little mobs within the bigger mob and single individuals who walked purposefully alone, balloon in hand. Wet hair plastered to their heads, t-shirts soaked over ponchos and coats, a lot of sneezing and coughing. But there was a energy and a vibe, a defiance whose power warmed better than the space heaters above. This was no beaten-down, sullen crowd. The weather had thrown everything it had against them. The weather clearly had lost.

They had gathered in defiance of the storm. A vast throng whose lives had been changed forever by the terrible power of cancer, and who were determined to do what they could to fight back, the weather be damned. Each of them had steadfastly walked together with their loved ones that terrible road that began with the diagnosis, through long brutal months of chemo and rads and surgery, to the end of hope and the last precious days beyond, all the way to the very end. Walked with children they had raised from birth, significant others they had shared a lifetime of dance and hugs, friends they had shared a lifetime of secrets and stories. Through the most hellish experiences a human can experience, they had steadfastly walked by the side of those they loved and honored, bonds of friendship and family unbreakable even by death itself. To hopes end I rode / And to hearts breaking. A little damned rain wasn't going to stop them now.

The crowds packed the station and the trains, such that getting wet from the balloon-holding person next to you was inevitable. That was fine. I had plenty enough time for my suit to dry out before I would need it again in a few days time, for interviews at NIH and Hopkins with some of the foremost cancer research laboratories in the world. Appointments with thirteen different faculty in this wave of interviews for the research laboratory I would begin my oncology career within, to find the place I would get the chance to try to begin to strike a blow of my own.

I was tired and worn, for reasons far more than just the rain. Ninety hour weeks and grinding stress and being the whipping boy for the frustration of everyone from families to nurses to attending physicians, ignored when everything goes right, damned for the slightest thing that goes wrong, no matter how little control one had over it. Day after day, week after week, month after month, year after year -- under all that, I feel the same way any of you would feel.

These haven't been the easiest few months or years, and I'm as human as any other man. The road yet ahead will be even harder and darker, and I'm no more immune to fear and doubt and weariness than anyone else. But the energy of the crowds gathered that stormy evening for the Light the Night walk, their fierce determination: if they could meet their own storms with such courage and sprit, I could try to be that strong, too.

Pay any price. Bear any burden. Meet any hardship. Support any friend. Oppose any foe.

It was three years ago, now, since that happy night...





It was almost exactly three years ago, at one of the marvelous Socials missysedai has hosted for us all over the years. Three years ago, admist a evening of song and music in missysedai's living room, when close friends encouraged me to see if I still remembered how to play the violin -- and I discovered, to my happy shock, the music was still there. That happy tale remembered in A Fiddler Still.

And the rest, as they say, is a happy tale. Or several. :-)










Each photo above, itself linked to a story. Each story only one of several. Here in Calontir, I am known primarily as Peter the fiddler, since the very first time they met me, at that very first Three Rivers meeting, when I came with my fiddle in my hand. My Three Rivers friends have no idea of the years I spent away, at first too busy to play the violin, and then too cowardly to find out whether I had lost the touch. Fortunately and happily, close friends helped push me that night three years ago to rediscover the violin just as I returned to clinical duty. Just when I would need that magic the most.

Even in the midst of everything that comes with service on the wards -- all that I and my fellow med friends have written about -- there have been many happy moments with a fiddle in my hands and friends all around, since that first evening of rediscovery three years ago. My parents said over and over again, when I was a little boy, that if I learned to play the violin, someday, when I was grown, when things were grim and dark I could pull the violin out and play, and push the shadows away, just for a little while. Like with everything else, they were right. And I am forever grateful to my parents for first giving me that gift, and to my friends who encouraged me that evening three years ago to have the guts to find out if the gift was still there. Many happy moments of music and song and friendship, up to including this past Midrealm 40th for which photos and stories are still forthcoming, and the weekends upcoming.

I seriously thought about bringing my travel violin with me on the airplane tomorrow -- the ridiculously cheap but perfectly servicable "beater" travel violin I now own, with sincerest thanks to resonance42, in a tale of Midrealm 40th that too yet will be told. I decided against attempting to take the violin with me on the airplane for practical reasons; and also, because, time is on my side. Yes, it would be awesome and wonderful to have a violin and be able to fiddle with many close friends at the events we'll share this weekend, with wonderful fellow fiddlers like B. and Zach and faireraven and mavis_maude. But even if I can't bring a violin with me on the airplane this year, there's always next year... when I'll be able to *drive* myself and my violin to Faire. Next year, when I'll have traded Missouri for Maryland car tags, traded a Wash U ID for a Hopkins one.

With my Cynnabar and Three Rivers friends there has been much merry fiddling (and singing and dancing and all of that) in the years before. And there will be much, much more in the years to come we will share in the great game we call the SCA -- indeed, I'll have a *better* chance of joining my Calontiri and Midrealmer friends at Pennsic once I'm a short four hour drive from Hopkins, rather than the all-day journey from St. Louis. I may leave St. Louis but I'll always be a part of the Calontir -- of the Three Rivers -- family, just as I'd left Ann Arbor but remain a happy part of Cynnabar. And in Markland / Atlantia awaits far more music to come, in the coming few days, and the seasons to follow.

A toast, then -- to the music, to the magic, and to all the merry souls who help make it so. :-)




What gift can I find in return for this prize?
All the genuine kindness I see in your eyes
I can learn of your dreams and this much I can do
For this moment, it seems, I can give them to you...

I will fashion a rhyme with a twist of my tongue
I will turn back the time to when all things were young
I will give to this earth of myself, right or wrong
For you kindness is worth my lifetime of song.

- Heather Alexander,
Lifetime of Song