Toad in the Hole August 2005 Archives

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August 25, 2005

Hunger and Memory

Pica commented on the rant below that we can't imagine the kind of protein starvation Barbara Kingsolver described in The Poisonwood Bible. She's mostly right; I'm convinced that the letter-writer I was ranting about was guilty more of a failure of informed imagination than even of arrogance... though those might be synonyms.

I didn't exactly have to imagine it. I've seen kids starve to death on the most expensive diet on the planet.

They starved because they didn't have enough small intestine to digest even that carefully designed diet -- which was a powder we mixed with sterile water and put into a hanging bag for continuous NG-tube slow feeding. As I recall it cost something like $385.00 a can at pre-1980 prices, and which lasted a few days to a week depending on the size of the child and how much supplement we could deliver parenterally -- that it, through another line that ran into a scalp vein and down through the neck to (again IIRC) the vena cava.(It's possible I'm naming some wrong vessels here; this was a long time ago. I do remember the reasons and the arrangement.) It took surgery to place this line, and we had to be very careful the child didn't pull it out. This meant carefully placed restraints. We did manage to get time, or assign a helper sometimes, to free the kids' hands and play with them.

This location was necessary because the nutritious stuff was also quite caustic to blood vessels, so it had to be run into the vessel with the most volume and fastest possible flow, to dilute and move it enough that it wouldn't erode the line it was poured into. It ran continuously too. I don't know what the solution cost, and I'm not even factoring in the cost of all the plumbing, most of which had to be changed at least daily. (Fortunately, it's easy to put an NG tube in a baby; I could do that myself as a mere LVN. Bet I still could.)

Typically, these were infants who'd suffered an intussusception, in which the small bowel telescopes on itself and ends up becoming necrotized -- gangrenous. When the dead gut is cut out, there's little left to digest with.

An infant's or young child's nutritional needs are less flexible than an adult's; there was (at least 20 years ago) often no way to get enough calories and nutrients into them, even with all this parenteral nutrition and continuous tube feeding, to keep them alive, let alone let them grow. I have heard of adults living for years on Total Parenteral Nutrition, but that's recent, and they were adults.

Sometimes we did get one healthy enough to go home, even to grow and prosper. That's why we didn't give up, even when we wished we could stop the struggle, even when the child's parents wanted to. Nobody knew, except through experience, what the lower limit was, and I remember seeing one chubby three-year-old I'd taken care of, when his mom brought him back for a visit. I also remember a beautiful kid I fell in love with, who had 10 centimeters of small intestine left. He died, after two big-shot hospitals had tried their best for him, at about two and a half. When I knew him, he was also uncommonly cheerful, curious, bright, playful. And I swear to the god of your choice that he had slightly pointed elven ears.

Starvation hurts, if you're conscious, if you're otherwise healthy. (I've seen elderly people just give up eating and dwindle away, and that didn't look painful. There's definitely something else going on when you get into neurological problems.) Starving babies get furious, then irritable, then detached, then listless. They move as if moving hurts. They want to be held, they they don't want to be touched. They get cold. Actually, they get cold early on, and this process I'm describing in the nursery is so on the razor's edge that we had to watch them closely for shivering and such, because they could shiver away all the calories we'd managed to pump into them in one night.

That kid I fell for, his mother wanted to give up several times, especially after he'd pulled his parenteral tube and had to go to the OR to have it replaced... again. In retrospect, she was right. But I stayed neutral, let her cry on my shoulder when she could come in (she, her husband, and their two other kids lived hours away) and let the docs persuade her yet again, because like them I'd seen that chubby three-year-old.

If you want a moral education, try a few years working where there's no right answer, and you can't even tell what's merciful.

Posted at 08:43 PM | Comments (1)

August 24, 2005

Swat

Joe and I wrote a piece for the recent-but-one issue of Earth Island Journal about Heifer International, formerly known as The Heifer Project. It was basically a totally sincere puff piece; they knocked our socks off.

I suspect that might have been partly because we went to their conference in Little Rock a couple of weeks into a month-long driving trip to Arkansas, in the month before last years' election. After dealing with the godbotherers for rather too long, we were both relieved to hear somebody say that what their Christianity moves them to do is not to prosyletize, let alone condemn, but to love their neighbors in concrete ways.

In fact, they have rules about cultural sensitivity, which they integrate in most interesting ways with matters like women's rights. They consciously give women power; gender justice and equity is one of their principles. This from a denomination that's the next thing to Mennonites, who are the next thing to Amish.

Anyway, when you write something for EIJ that mentions livestock and eating meat, you know you'll get some veggie-sermons. Chris said there were only two letters, which was a surprise, though we'd specifically handled many possible objections, briefly, in the article. EIJ repeated a bit of the original piece by way of reply, but I want to add to it here.

I've been farting around with this, hoping I could just import the letter from EIJ online, but the recent issue's not up yet. (Come on Matthew!) So I'll just have to type bits of the letter here, with my sore and bleeding fingers, and intersperse my reply.

Someone named Warren Jones, of San Francisco, wrote this:

I was very disappointed to see the article about Heifer International, a well-intentioned group that provides animals to impoverished people.

OK, two buzzwords in the very first sentence. Ever notice how people use "disappointed" to establish their moral superiority when they have none? It's the written equivalent of steepling. And there's the devastating "well-intentioned." Judith Larner Lowry handled that one well in writing about people who took her group to task for uprooting the pwetty widdle nastily invasive broom bushes along roads in Marin County. (Those people actually analogized what Judith was doing to racism.) Read her Gardening with a Wild Heart for some inspiring fun.

The problem is that what these people really need are tools and education on how to grow organic fruits, vegetables, whole grains, and legumes. These are the foods that will keep them healthy.

It's hard to know where to begin with this one.

What the fuck does this guy think these people are eating? Whopperburgers? Twinkies? White bread? Eeeevilll white sugar??

And what the fuck does he think they're growing them with? ConAgra's latest formula?? Vigoro??

They're eating organic foods already, just not enough of them! They're trying to scratch a living out of too little, too depleted soil, in some plot they've been driven to by the forces we in the USA subsidize no matter what we eat or how pious we are.

They aren't suffering from the ills of plenty, from arteriosclerosis or obesity or any such thing. They're fucking starving, they're poor, and it's not like US inner-city or even most rural poverty, marked by trans-fatty fat. They are not getting enough to eat.

They are not getting the means to wear enough clothing to keep themselves warm when it's cold. They are losing teeth to diseases of undernutrition, to calcium deficiencies, not sugar-fostered caries. When they suffer from vitamin deficiencies, it's because they aren't getting enough quantity or enough variety in their diets, not because they're stuffing themselves with junk food!

Has this guy ever worked on an "organic" farm? Where does he think all that nice manure fertilizer comes from? Does he know what a luxury it is to have enough land to grow the nitrogen your soil needs as "green manure"? Does he have a fantasy that all the human-inhabited land on Earth is deep humusy bottomland, in which one can grow "organic" fruits and vegetables for more than a year or two without adding some serious nitrogen? Has he ever looked at, let alone tried to grow food in, the thin soils of mountain Peru, Nepal, the rockier parts of Appalachia? Has he ever grown his own living, rather than buying it at a store?

Does he really think he's smarter than these people, who tell Heifer what they need? Does he think they're poor because they're dumb?

Did he miss the part where Heifer workers pass ideas along from one group to another, ideas about how to get the most nutrition out of the least land with the smallest possible environmental impact? You know, that stuff that sounds suspiciously like permaculture. That stuff that uses knowledge that people who have made their livings and their lives in the places Heifer reaches, for generations and have some idea of what the local soils can offer, and what their limitations are?

Does he know that tropical soils are often equally thin of nutrients, because tropical ecosystems keep most of their biomass aboveground in the greenery? Does he know what red soil means??

Does he know that one good reason humans started keeping livestock is because grazing animals, seemingly by a miracle, convert the biomass of grasses that we can't digest into meat that we can digest? Does he know that furthermore, decent grazing is less disruptive to ecosystems -- you know, the lives we don't see unless we sit quietly and look for them -- than digging up the land for plants we can eat? That grass thrives under the right kind of grazing? That browsing has gone on in forests for millennia without harming them? That this all matters because screwing up ecosystems has real consequences, and kills animals as well as plants?

Does he really have this fantasy that if These People only knew what he knew, they would suddenly have enough land to grow the scenes he sees on the labels in his pantry, on the shelftags in his market? Does he have any remote idea of what their lives are actually like, of what they actually have to work with? Does he suppose that people who don't have the means to go buy a goat can somehow acquire precious acres? Does he think Heifer has a magic wand to expand the continents, and give them this land? Does he think there's such a thing anywhere as "empty land"?


In addition, the animals are not treated humanely. Their web site and brochures feature photos of people hugging and holding animals. They don't show them slitting their throats. They don't show the animals writhing in pain.

Evidently the only way one can treat an animal "humanely" by the writer's lights is to keep him or her as a pet. And he has never seen a kosher or halal slaughter, or even a merely skillful one. If you can't kill an animal painlessly, learn how. North American slaughterhouses are not the standard of the world, and their methods are recently invented. "Writhing in pain" happens in fevered imaginations or industrial settings, but is wasteful if you're actually living on the edge where that bit of protein matters. Does he think that farm kids aren't genuinely affectionate towards the animals who will pay for their college educations? Does he think the people in the photos are any less grateful, or that their affection doesn't translate into decent living conditions for their animals? Maybe he should look again at the economic base that supports him.

OK, I won't go for the cheap line that "this is why people get contemptuous about vegetarians" -- because in fact I'm not contemptuous of vegetarians -- or even vegetarian prosyletizers. I do wonder if things like this mis-aimed sermonette aren't why some people are contemptuous of First World prescriptivists. Or preachers.

Posted at 05:28 AM | Comments (5)

August 21, 2005

That Recurring Nightmare

I've been rassling with some paid work lately, so I haven't been blogging much.

Last evening, I saw something in one of Pharyngula's comments that answered a question I'd had in the back of my head for decades, about a possible reason for a bunch of anencephaly and meningocele admissions we'd had in the NICU I worked in 20 - 25 years ago. (To condense: Anencephaly, especially, correlates with high fever at a certain stage of pregnency, so, say, a flu epidemic could lead to a rash of cases.)

Last night I woke from a familiar nightmare I hadn't had in a long time. It's effectively the nightmare many of us have about school: last day of the semester, there's a vital class you haven't gone to or known about all semester, and there's an exam foir it now, and you can't find the room and/or you've forgotten the name and of course you don't know any of the material. Modify ad lib, but it seems to be a common dream.

After I started my brief (just under a decade) nursing career that dream switched for me. I'm at work in a hospital, and it's the end of the shift, and I realize I've forgotten to even check on one patient, or I had one patient I somehow didn't know about. Ungh. I call it the same dream because it feels the same.

Last night's dream involved not just one but several patients; I was assigned a few on one floor and a few on another, in a weirdly chaotic situation. I didn't know any of the nurses around me (which was the case most of the time when I worked out of the registry the first year after school; a nursing registry is a temp pool for nurses and allies) or much about the layout of the place (ditto) and this one was set in a series of open-air mezzanines, which was actually pleasant. It also had lots of new tech stuff that I wasn't familiar with, which would actually be the case if I were to go back now.

As I hastened to leave so I could get to my car in a big parking garage on the other side of some bigger, airy, glassy civic space, an opera house or something like, I was angry, fearful, of course guilty. I was telling myself I didn't belong in this job, I wasn't suited for this kind of work -- along with the big Oh Shit! and Now What? and Is Patient OK? and a very primitive Am I Caught?/How Do I Cope? that all occur simultaneously in that dream. I think that anger was new.

I wonder about the structure of dreams. Mine are rarely coherent narratives, so I typically have trouble describing them. They're vivid pictures, sometimes tied together, sometimes abruptly and mysteriously switching. Maybe I forget the transitions. Maybe I don't bother with them. Sometimes I suspect that there really isn't any narration to my dreams, that they're a succession of feeling-states that I attach narrative to by way of rationalization and explanation, or as a memory aid.

The image I have of this is of being suspended in water on which floats a swirl of colors, like the setup one makes with water and oil paints in a pan to make marbled paper. When I wake up, I'm being drawn up out of the water and the narrative, the pattern of swirling paint, clings to me in whatever order it happens to occur on the surface. But it's almost incidental to the dreaming state -- except that the light coming through the surface to where I'm dreaming is colored and patterned by the floating paints. Still, the pattern I've been dreaming underneath is only a little like the pattern left on my skin when I've been drawn up through the surface.

Posted at 05:45 PM | Comments (2)

August 13, 2005

Alt-Med Meets MSM

Submitted for your comment, what I hope is a better way to affect people's behavior than the rant I was tempted to. Well, actually, I was sincere in praising the SF Conservatory of Flowers for checking its material out with several sources after someone showed it to a nurse friend who said Waitaminnit. They ended up with a nicely nuanced exhibit.

Any excuse to visit the Conservatory ought to be seized. I've never seen a better recon/rehab/renewal job; the place is gorgeous.

This shows I am susceptible to charm, I'll admit.

Posted at 04:46 PM | Comments (0)

August 10, 2005

Don't Leave Me Alone With This, #2

Knitting again! And it's even worse than the crocheted uterus!

Janis, what is it with you people???

(Warning: Adult content, for certain popular vlues of "adult." Not work-safe if your monitor's in anyone else's view.)

Posted at 04:46 PM | Comments (0)

Breakfast Table Conversation

Or, Why There's Still Print Media

"Looks like the Iraquis have invented the municipal coup d'etat."

"?"

"The Shi'ite mayor of Baghdad was deposed by a squad of more radical Shi'ites. Even in Berkeley, we've never done that."

Posted at 04:18 PM | Comments (0)

August 07, 2005

Saturday Science History Blogging

In 1985, Joe and I took a vacation and made a second visit to a birding site wed loved in 1980: Cave Creek Canyon, in way-southern Arizona. Its on the eastern side of the Chiricuahuas, a sycamore canyon formed by a creek in the desert, flowing out of the mountains. Gorgeous place, great birds.

There are campgrounds strung along the creek, and they were filled with birders. This was congenial, as we knew people would have tips to pass along and no one would be making noise all night. One fellow birder was a little old man with a home-rigged camper van, parked up at the end of the loop we camped in. One evening he walked to our site and introduced himself his name was John Manley -- and asked if he could buy a ride up to the top of the canyon the next day. Hed heard us telling someone we were going there, and his van was having engine trouble, probably caused by the ford at the entrance to the camp. His engine was mounted just a bit lower than ours, evidently, and the distributor cap had been splashed and needed time to dry out.

Oh, and he had a good red-faced warbler location up there.

That warbler was what we were going up there to see, and he was a fellow birder of course wed take him, no payment necessary.

So up we went, and sure enough he produced a male red-faced warbler. (I nearly broke my neck seeing it, as I was perched on the side of the roadcut trying to photograph an alligator juniper at the time.) There were other birds, and those trees, and he turned out to be good company. Splendid day.

As we drove back down the canyon and the conversation continued, John rather cautiously got into why he was familiar with Berkeley, where we live. Hed said he knew it from many business trips from his home in Los Alamos. Turned out a lot of those business trips were about his work in the Manhattan Project.

"Wow, really?? Tell us all about it!" evidently hed been apprehensive that wed react differently, negatively, being from Berkeley and all Hmph. But over the next few days, after dinners or during the universal siesta hour in the hot afternoons, he continued the story and we continued a fascinating conversation.

Oh, and he explained several aspects of automotive engines that I hadnt quite grasped till then, with the clarity and patience of a born teacher, as he cleaned and dried out his distributor cap and a few other bits. And that van was a marvel of compact cleverness foldout bed, table, seating, desk; kitchen including a fridge powered by either gas or battery, as the situation demanded; lighting, book storage Everything seemed to be able to unfold into several other things.

I dont think we ever asked him about Hiroshima. He answered some few questions before we asked him: Why had he become involved with the project?

Of course, the big driving force was getting there before the Germans. It was known they were working on a similar bomb, and whatever qualms anybody had and they did were overridden by that consideration. The Bomb wasnt dropped until after the European armistice, but all the work of inventing and producing it had happened before that and of course no one had any way of knowing when, or if, that would happen without it, or before the Nazi government had its own bomb.

But the big attraction was that the government had the only funding and resources sufficient to attack what John called "for a physicist, the sweetest problem in the world" atomic structure, splitting the atom. There was only one place to work on the real cutting edge of that science, and he and his colleagues considered themselves lucky to be in it.

John had had what he considered some annoying responsibilities, including supervisory ones. Hed supervised Oppenheimer, who he apparently respected, and Edward Teller. Over a beer one evening, I blurted a question: "Was Teller always such an asshole?"

There was a moment of silence, during which I thought, "Uh-oh. I just put my foot in it, and bad. I bet he liked the guy."

John actually steepled at me, and leaned forward over the table.

"To hear Ed Teller play the piano once

(pause) (ulp, fidget)

" was to hate him forever."

Imagine my relief, and illumination. "Oh yeah! We had a nun like that in school the music folks called her The Clydesdale of the Keys. "

John insisted on taking us to the only restaurant in Portal, the nearest town, when we all had errands to run there. Well, we have a policy, "Never turn down a meal," and camp food gets boring. Besides, more chat time.

As we walked to the restaurant, John told us the scariest story Ive ever heard in my life. Before he retired, theyd been working on a successor to the hydrogen bomb: the cobalt bomb, which would be more powerful, and I suspect dirtier. Some general was quizzing John about the chances of its working, and in his enthusiasm told John what he personally wanted to do with it: give it to the United Nations.

I must have some political instincts; I was so gut-deep scared by this that I actually stumbled, my knees got weak. And if you think about it, you might see why. And its not about letting other nations control this weapon. Its about monopoly, and who would actually be in control, of the weapon and the UN.

Posted at 06:38 AM | Comments (3)

August 01, 2005

Add Verbs 'R' Us

Nothing I could hope even in my rare optimistic moods to write with these feverishly damp, yet oddly smooth in the most unlikely places, from what activities I leave the reader to imagine in his or her 3AM Ambien-and-vodka-concocted dreams, fingers on this crumb-befouled but still-perky keyboard could possibly hope to shine like even the least of glimmering half-damp matchheads in the blazing prosaic desert-noon-sun of this year's Bulwer-Lytton Award winners.

Posted at 05:50 AM | Comments (0)