Anesthesia

 

Alhumdullilah! My surgery was successful, as expected. Twenty-four hours later, I am much better, with very little pain, and able to type!

Just before administering anesthetic, the anesthesiologist will ask the patient to imagine him/herself in a relaxing, happy setting. My doctor told me the reason for this, and it’s not simply to make a little joke before surgery. According to my anesthesiologist, there is an approximate thirty-second window between wakefulness and full anesthetic stupor. The mental state of the patient during this very short time can help determine whether the patient has a smooth or a rocky post-anesthetic recovery.  All patients have some degree of anxiety before surgery, but if they can conjure up a happy image just before konking out, they’ll wake up more easily and feel better during the immediate post-op recovery.

So, in the OR, my doctor said to me, “Now is the time I want you to think of a lovely place, a place in which you are happy and comfortable. Everything went all right. We’re finished. You are awake now.”

I was confused. I picked up the blanket with my left hand and was amazed to see my right forearm all bandaged nearly to the elbow!

I perceived his statements back to back, as if no time passed between them. In fact, the surgery took the exact forty-five minutes my surgeon had predicted.  I felt great. In fact, I missed the little day dream I had prepared for myself, that of being at my daughter’s house, playing with my little grandchild. I hope I at least said, “Bismillah.”

Medical science does not know how anesthesia works at the molecular level. It’s more about consciousness than neurology. The topic has been bothering me all day.

Anesthesia is not like sleep.  From sleep, you wake up knowing that some time has passed.  You wake up feeling differently than you did upon going to sleep. You may remember a dream, or at least the sense that you did dream.

From anesthesia, you wake up before you know you’ve been gone. What happens? Where does consciousness go? The answers that suggest themselves are disturbing for someone like me, of little faith, and in need of proof.

Grotesque

 

Learning Tajweed, Part Two

 

The class met every weekday after Asr prayer til Maghreb. Basically, it was a memorization class. The teacher would recite a phrase, and we’d repeat it in unison. When her sensitive ear perceived improper pronunciation, the offender was singled out and corrected. No one took offense. In fact, we were amused at each other’s regional accents. We were a collection of Arabs (all except me) from the surrounding Arab countries. We all had issues with certain Arabic letters, because the Qur’an is recited in perfect language, yet they were all accustomed to speaking in dialect.

Their challenge was to purge their pronunciation of regional variations, and my challenge was to master the letters that Westerners cannot pronounce with ease.

I enjoyed the reciting, and I improved my pronunciation, but I could not get comfortable in that class. There I sat, a Westerner who could read their native language while they could not, and I disliked having to ignore that fact. Perhaps they could not get comfortable with me, either. I could read, but I could not speak very well. No one understood that.

Before long, I asked to be moved into a more advanced class. I had to prove my reading ability, which was not difficult, and when the director heard my accent, she agreed immediately that I could graduate to the next level.

The women in the new class looked much like those in the first class; middle aged or older, mostly from Egypt, Syria, or Saudi Arabia, and all sitting in a circle, draped in black, heads covered. I wanted to remove my scarf, but was told that one must cover while reading the Qur’an. I knew this was not true, but who was I to speak up?

So I sat hot, yet happy to be there, and looking forward to learning. While waiting for the instructor, a Syrian woman sitting to the left of me leaned over and asked, “Min fayn inti?” Where are you from?

I said, “Amreeka,” and she turned to the woman on her left and whispered, “Amreeka”. That woman turned to the woman on her left and repeated, “Amreeka.” Each one repeated, “Amreeka” in a whisper to the one next to her, until the entire circle had been informed. Eyebrows either raised or descended, while mouths frowned or opened in amazement.

The next question from the Syrian woman was the predictable, “Min fayn zowjik?” Where is your husband from?

“Misr,” I said– Egypt. Again, my response was repeated in whispers from one woman to the next, while I looked at each one of them as they talked about me without embarrassment and little restraint.

The self-appointed spokeswoman asked me all the vital statistics– what did my husband do? How many kids did I have? Boys or girls? How long had I been Muslim? How long had I been in the Kingdom? Each answer got whispered around the circle like the answers before them, and by the time the teacher entered the classroom, they knew more about me than I’d ever learn about them.

Such began my experience in the classroom with the literate ladies.

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Learning Tajweed

Hijab, women’s rights, Islam, and East vs. West are subjects that never fail to stimulate a good, often repetitive, conversation.

Learning Arabic is another such topic. I am tempted to repeat my laments about my failure to achieve fluency, and the difficulty of the language, and my lack of helpful cooperation from my kids, etc. All of that is mundane.

I’d rather tell a story about how I studied tajweed.

After I had studied Arabic grammar two years at the ladies community college, conveniently located down the block from my Riyadh apartment (across from the TV tower, for anyone who wishes to investigate), my husband suggested I start tajweed. 

I confess, I would have rather continued grammar, but the college offered no further courses. I enrolled for tajweed at a local madrassa, also within walking distance from home.

In spite that my black wraps looked like everyone else’s black wraps, I stood out like a horse in a herd of camels.The ladies all looked at me like camels look at people– directly, standing still, amazed, and wondering what comes next. I was their first face-to-face Westerner.

They put me in the elementary class, with the illiterate women; no one believed I could read. We all sat on the floor, in a circle, and the teacher started taking attendance.

“OmAhmed? OmMariam? OmFaisal? OmNur?” One by one, the women raised their hands, and grunted something to indicate their presence.

“OmHammama?” (Mother of the pigeon.) They all laughed at this.

When she came to me, she raised her eyes, looked at me, and said, “OmAysh?” meaning, “The mother of whom?”

I said, “Ismi Marahm.” My name is Marahm.

“OmMarahm?”

“La. Ismi Marahm, wa bas.” No, my name is Marahm, that’s all.

“OMAYSH?” she repeated loudly, with wide eyes, as everyone in the room focused upon me, and no one moved.

“OmRanya,” I said meekly. So much for my Western idea of personal identity. I nearly got up and ran out, but that would have drawn even more attention.

Such began another two years of study, during which I suffered additional insults, but developed an appreciation of the Qur’an worth every minute. More later.

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Diversity Sessions

fractal compliments of Susie of Arabia

Like many large, American organizations, the one I work for recently decided that diversity in the workplace needs to be celebrated. We now attend semi-annual meetings for the purpose of learning to appreciate diversity. Our group is sizable, allowing for five separate sub-groups to meet over a two-week period.

Each group also contains men as well as women, a few blacks, an occasional Hispanic, and perhaps a gay or two, but I wouldn’t know about that; if gays are amongst us, they are not out of the closet. All speak English with an American accent.

At our first meeting, the facilitator handed out colored cartoon drawings of animals: a rabbit, a chameleon and a pit-bull. We were asked to “take a few minutes” and determine which animal characterized our personal style of conflict. The rabbit runs from it, the chameleon pretends to fade into the background, and the pit-bull attacks. None of us needed a few minutes.

We were then asked to sort ourselves into groups—the rabbits on one end of the table, the chameleons on the other end and the pit-bulls in the middle. Then we talked about how a conflict might look when a rabbit encounters a pit-bull or a chameleon, or a pit-bull meets another pit-bull, and so forth.

This is what they call diversity?

I suppose it is a sort of diversity, the kind that is visible, observable in behavior, and predictable in outcome, but it doesn’t approach the kind of diversity that underlies it, the diversity that gives rise to such behavior in the first place.

Ann, sitting on the other end of the table with the rabbits, is dealing with a mom whose Alzheimer’s is getting worse by the week. No wonder she sits with the rabbits.

Kathy, a smiling pit-bull, is working nearly full time while studying nursing full time and raising a daughter without a husband. That kind of stress will bring out the pit-bull in anyone.

Steve, a chameleon, is on the transplant list, though for what organ I do not know. I didn’t catch all of the conversation upon which I was eavesdropping last week. I, too, blend in with the chameleons, and they’ll never know why or to what extent.

Jessica is the only one of us who weighs in excess of three hundred pounds, with two-thirds of it distributed evenly on either side of the great divide. She refrains from joining a group.

I suppose the concept of diversity is flexible. By all standards of definition, I lived more diversity during my years in Riyadh than these people will see in their entire lives.

Three groups of people staffed my section in the Riyadh hospital in which I worked: Westerners, Filipinos and Arabs. By Westerners, I do not mean Americans, I mean people who came from English speaking countries. By Arabs, I mean people who came from Arabic speaking countries, and there were many of them.

The official language of the workplace was English, but that didn’t mean we didn’t listen to various Arab dialects, Tagalog, or English inflected with accents so thick that newcomers had difficulty understanding each other. Language, however, proved the least of our challenges.

When Noura, a Saudi university student, came to us for training, some of us wondered how we were going to work with a woman who not only covered her head in black, but half her face as well.

There was Ibrahim, a Saudi man, who called in sick too often, but knew every theory and principle behind every procedure in the book.

The assorted Arabs thought they need not report to work promptly at 0700 every morning. It took more than a year to impress upon them that punctuality was more than a quirky American character trait.

The Filipinos worked like donkeys, never called in sick, always responded pleasantly to tasks at hand, but were most resistant to observing the English-only guidelines of the section. Non-Filipinos would complain about having to listen to Tagalog, secretly suspicious that the Filipinos were talking about them behind their backs.

The Westerners did not refrain from talking openly about their latest escapades into the forbidden fruit of social mixing.

Then we had the great religious divide, the Muslim/non-Muslim dichotomy. On the non-Muslim side, only Christianity existed, because Jews were not allowed in the Kingdom; Hindus and Buddhists were not even acknowledged. As for Christians, the various denominations lost all significance whatsoever. This dichotomy did not run parallel to the national dichotomy, as some Arabs were Christians, and some Westerners were Muslims.

None of us needed diversity sessions.

 

Great Tool

Windows Live Writer, http://get.live.com/writer/overview has more and better features than Blogdesk for writing off line.

More importantly for WordPress bloggers, it allows an easy upload of posts using different fonts and sizes than that puny, dull black script they give us as a default. 

You’ve probably found out that you cannot always cut and paste from Microsoft Word.

It simply doesn’t work right.

I have yet to try Open Office, but I plan to stick with Live Writer.

Try it, especially if you: 1.Write off line, 2. Use WordPress, and 3. Like to experiment with fonts and photos.

The Season Changes

 

Finally, after a long and unpleasant winter, the first flowers of spring are up, and we are able to plant the small impatiens seedlings that will grow into large globes of blossoms by the end of August.  My mother has planted these flowers around our house each spring for the past thirty years, but this year, my father will not be with us to enjoy them.

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The season change causes us to weep. Why should we weep any more during the season change than on any other day ?

Unfortunately, I know the answer.

A friend, who lost both parents more than five years ago, said recently, “I’m beginning to forget what they looked liked.”

So, that’s what happens? You forget what they looked like? Insult is added to injury, and the beauty fades away with the pain? No! I prefer the pain, with its clear image of my father as he reclines in his easy chair in front of the TV, as he jokes with his grandchildren, as he sits at the dinner table, or at a restaurant, or behind the wheel of his car, or as he walks in the mall for his daily exercise.  

The change of seasons takes us a little further from the days my father was with us. The budding leaves put a soft cloak over not only the branches, but over those last days of winter and my father’s life, those bitter, awkward and awful days.  The greening of the vegetation forms a magic carpet, an undulating cushion upon which we sit and must stay as it transports us into a new season, whether we want to go or not.

So we weep, knowing that soon we, too, will begin to forget, whether we want to or not. Oh, we’ll have photographs– those flat, frozen, scraps that somehow serve as potent time travel devices.  We’ll have the tangible proof of his existence– ourselves, his accomplishments both tangible and intangible–and we’ll have each other’s prompts that will reassure us that we have not become totally unhinged from our own lives.

Soon, the season will change again, and peak summer will splash intense colors in front of us, such that we’ll not have much room for looking at other things, and then we’ll remember other summers, other changes of seasons.  We’ll smile, and recount stories of family  affairs, and then we’ll know something we do not yet know now.

This summer won’t really be so much different from the others, will it?

 

In The Lab

 

At the microscope, I notice that the patient’s urine is alive with Trichomonas– a writhing, one-celled creature.  I glance at the computer screen.  She’s in the Emergency Room because of abdominal pain.  This is not an emergency, unless some other problem plagues her.   I don’t know. I don’t have access to her history.  I’m a medical technologist, not a doctor, and my job tonight is to analyze the urine of patients throughout the entire hospital. 

 

Tomorrow night I’ll rotate to the other side of the lab, where I’ll prepare bone marrow specimens.  The next night, I’ll operate the analyzer that counts blood cells. The night after that I’ll be at the microscope looking at those cells, but tonight, I am the Pee Queen of Tinkletown. 

 

I check the macroscopic results for the patient afflicted with Trichomonas.  Nothing else stands out as particularly abnormal, so I punch in my observations and send the report to the ER.

 

Eight specimens are lined up waiting for microscopic examination, two of which are also from the ER, so I pluck those from the line and look at them first.

 

In many ways, my job is nothing more than a manipulation of numbers.  I churn out sets of numbers that doctors use to make treatment decisions.  Several hundred specimens enter the lab every night, many of which pass through my hands.  They are interesting, in an abstract sort of way, especially when they are abnormal or atypical.  Sometimes we recognize certain patient’s names because we see their bloods day after day until they either recover or die.  Occasionally, one of us gets to meet a patient when we assist a pathologist at a bone marrow aspiration.

 

We seldom know more; therefore I have acquired the habit of reading the daily obituaries.  Sometimes I see a familiar name and maybe a photo. Then, I know that the patient was not just a case, or a series of specimens.  He or she had a family, or a dear friend, and was loved, and had a place in society.  I get sad, sometimes, and then I know why I became a medical technologist instead of a nurse.   I’d never learn how to lose a patient.  They say one gets used to that sort of thing, but I doubt it.

 

If I had a choice, I wouldn’t work at all. I’d write, and only when I felt like it. Until retirement, when I plan to do exactly that, I’ll continue coming to the lab every day and churning out the numbers that let other caregivers know, exactly, what is wrong with the patient, and/or how the patient is responding to treatment. I like this work, because it is exacting, demanding, and contributes directly to the well-being of patients.

 

It’s contributed directly to my well-being, too, in a different way. This is the work that took me to Saudi Arabia. I would never have gone there had I majored in English, Psychology or Foreign Languages, fields that claimed more of my interest. I can’t imagine not having lived in Saudi Arabia all those years.  I owe those years to my profession. I could go back again, I’m sure, and slip into my former position as if I’d never left, but I won’t do that. Retirement beckons. Five more years, insha’ Allah…That’s the plan, and Allah knows best.