Thursday, February 28, 2008


On a recent trip to Osage Hills we saw the following year birds for the family.

29. Red-Headed Woodpecker
30. Red-Bellied Woodpecker
31. Turkey Vulture.

We didn't see any Wild Turkey, which are quite common there and almost tame. We did see, and hear an unidentified hawk. It sounded like a Red-Tail, and probably was, but it didn't look like one. Maybe a juvenile. According to the TV and movies all raptors sound like Red-tails, so you just never know.

Wednesday, February 27, 2008

The White Tree

When I was about 6 my grandparents bought a piece of property in Delaware County in Northeastern Oklahoma. There was a small box canyon with a stream issuing from a cave directly in front of the house. In the canyon, there was a huge sycamore tree. My grandparents named the place Sycamore Springs. I've since learned that sycamores need to pretty close to water in order to survive. Many years later, after I moved to Bartlesville, I started visiting Osage Hills State Park. There is an observation tower overlooking the Sand Creek valley. I have noticed that in winter you can track the course of the stream beds by noting the line of white trees in the midst of the leafless oaks.

In the Hamlet, there are lines that indicate that he is about thirty years old. He is also described as fat. Despite this, there is an overwhelming impression from the play that Hamlet is young and athletic. In this case, there is some scholarly debate as to whether Hamlet should be considered fat and thirty, or whether the lines are errors of transmission. Regardless, we bring our own interpretations to literature. In the Lord of the Rings, the White Tree of Gondor has a major symbolic place. When I create a mental image of the White Tree I always come up with something close to a Sycamore. (Or at least I did before I saw the movie.) Tolkien gives a detailed description of the White Tree in the book, and it doesn't match a Sycamore. It doesn't matter. I read the words White Tree, and I see a sycamore. I like it that way. It gives the fantasy a very real grounding in my world. I think that Tolkien would understand. He wrote that Faerie "contains many things besides elves and fays, and besides dwarfs, witches, trolls, giants, or dragons: it holds the seas, the sun, the moon, the sky; and the earth, and all things in it: tree and bird, water and stone, wine and bread, and ourselves, mortal men, when we are enchanted."

Monday, February 18, 2008


Another work week(end) has passed, and I am once again reminded of a now familiar joke in the OR.

What are an Oklahoma redneck's last words? "Hey, y'all, hold my beer and watch this."

Rule #21 for scrub techs: You can't see through blood.

Thursday, February 14, 2008

Illuminated manuscripts, the beginning

Manuscript illumination, in the broadest sense, covers the decoration or illustration of any written text. The practice started with the Egyptians, who would illustrate portions of The Book of the Dead that would be buried with mummies. One can assume that they illustrated other texts, but so few of those survive it is hard to tell. They certainly would have had to have illustrations in geometry texts. The oldest surviving illustrated text is in fact not from The Book of the Dead, but of a play written to celebrate the accession of Pharaoh Senusret I. It dates to about 1980 BC. Surely other illustrated texts existed.

The Greeks seemed to have learned the practice from the Egyptians. It is significant that there is no evidence of the Greeks illustrating texts before the conquests of Alexander. The Greeks used what Kurt Weitzmann called the "papyrus style", which the Egyptians also used. Since the texts were written on scrolls, heavy paint could not be applied, like it can be to flat pages, as the repeated rolling would cause it to flake off. Instead quick pen and ink drawings were inserted into the columns of text. Pictured here is a papyrus fragment known as the Heracles Papyrus (Oxford, Sackler Library, Oxyrhynchus Pap. 2331) . It tells a portion of the tale of the Twelve Labors of Heracles (or Hercules, if you're feeling Roman), specifically that of the Nemean Lion. Three simple drawings of are inserted into the text columns illustrating the story. Perhaps the drawings were inserted to help a reader quickly find his place in the text, or perhaps because people like pictures. This fragment dates to 3rd century AD, and is one of the few fragments from the classical period illustrating a literary text. Because so few fragments survive, it is impossible to tell if scrolls existed with a higher quality of illustration.

Monday, February 11, 2008

The Golden Car

If my count is correct, I have owned or driven on a regular basis 13 cars in my life. Some have been total wrecks. Two have been brand new. Nine of them were driven into the ground. One I still have. Of all of these cars, one will always stand out in my memory. It wasn't even my car. It belonged to my brother, but since we were living together and had only one car between us, I drove it as much as he did, although he always drove it when we were both in it. It was a giant station wagon, like they used to make before mini-vans and SUVs. It was painted a dull gold. I don't remember the make or model, but it was big and it was gold.

I remember this beast so well because of one trip. When my brother bought the car, we were living in El Paso. Mike had just parted ways with the Army, and we were slowly starving to death. At the time we were both very active in the SCA, and we drove the beast all over southern New Mexico going to events. It was a handy car to have because we could haul quite a lot of stuff. Since Richard, the head of our household, liked to build things, it came in handy. We had quite a lot of fun, but there was that slowly starving thing going on at the same time. Mike and I finally decided that we needed to call it quits and move back to Tulsa.

The trip back to Tulsa is what enshrines this car in my memory. We packed everything we could into this car. It had a big wheel well in the cargo section for a full sized spare. We filled all of the spare space in it. We dropped the back seat and filled every cubic inch of that large space. We stacked stuff in the front seat and floor board so that passenger passenger had about 14 inches in which to sit. We put so much stuff in the back of the car that the front of the car started to float off the ground. We solved that problem by putting weights, including a spent artillery slug Mike had found at MacGregor Range, inside the front bumper. That pulled the front down some. I am certain that we exceeded every weight restriction conceivable for that car.

Did I mention the cats? We had four cats that we brought back. Each cat got an upside down milk crate for a cage and small dish of cat food. They went right behind the front seat, with a little bit cleared of the top so the air could get to them. They quit complaining after only a few hours.

We set out in the morning, after getting a late start. About twenty mile outside of El Paso, we blew a tire. Remember all that stuff packed over and in the wheel well? It all had to come out by the side of the road. Not too much farther down the road we blew a radiator hose. As luck would have it, there was a road crew nearby, from whom we begged a couple a gallons of water. We wrapped the hose in electrician's tape, and limped a few miles down the road to the next town. As soon as we got off the highway, we found an auto parts store. They had a hose. A flexible, one hose fits every car, special hose. It cost twenty dollars. Fifteen more than we could afford. The guy suggested that the other auto parts store in town might have a hose which would fit. When we walked into the store, we were struck by the roughly forty two million hoses hanging from the ceiling. We timidly asked if they might have a radiator hose for our fifteen year old beast. He though for a minute, and said "Which one? I got both." A few minutes later, for a cost of three dollars, we were installing our new hose.

By this time, what with the hose and the tire, and the late start we were almost seven hours behind schedule, and we were still west of the Pecos. The rest of the trip was an endless blur. I remember passing through the Midland/Odessa well after dark. The flares from the oil refineries struck me as vision of hell. At some point, while still in Texas, we pulled off at a roadside rest stop to sleep. Remember that fourteen inches of passenger space? Not the best place to sleep. Somewhere around Sapulpa the oil light came on. We kept driving. We finally arrived at our mother's house, exhausted, dirty and stiff.

There is the scene in the Blues Brothers movie after Jake and Elwood drive up to the county courthouse. They jump out of the car, and it falls to pieces. It wasn't quite like that, but it was close. We went to an SCA event in Stillwater that weekend. (I got my AoA there from the King of the Outlands there.) The car made it there and back. It made it a few times across Tulsa. And then it stopped moving. Mike was able to sell for scrap, for there was a lot of metal there. It was old, big and kinda of ugly, but it got us home. Our golden car.

Saturday, February 9, 2008

The grossness of surgery

People often tell that they could never do my job because they couldn't stand all of the blood and gore of surgery. I usually reply that what you see in surgery is not that gross. It's the smell.

Tuesday, February 5, 2008


The sword fighting lessons Sophia and I go to on Tuesdays are held at the Tulsa Library. We went down early today so that I could turn in an application to the library. I'm looking for a part time gig shelving or any thing like that. The pay sucks, but I am seriously considering going back to school to get an MLS (Master of Library Science), and would like some experiencing working in a library before I jump off the deep end, even if it is just scut work. Anyway, the lesson got bumped by a library event, but they forgot to notify us. Oh well, half a day wasted. On the birding front, Sophia pointed out that my lists didn't have House Sparrows on them. Of course we've seen them, and heard them, and cursed them. Make that 28 year birds for the family. I'm too tired to do a manuscript tonight. Maybe two tomorrow.

Monday, February 4, 2008

Caligula Troper

This is a page from the Caligula Troper (British Library, MS Caligula A XIV). A troper is a collection of tropes, which were new music inserted into the chants of the mass for special feast days. This book was intended to be used by a soloist, and was of a small scale. The opulence of the decoration indicate that it was made for an important patron. The tropes included in the manuscript indicate that it may have been made in Winchester or Worcester. It was made in about 1050. This page has an image of the Wise Virgins (Matthew 25:1-13) as an illustration for the mass for Virgin Saints. The Virgins hold the lamps and torches from the parable, along with branches, which may represent the the palms of martyrdom. The Hand of God blesses them from above. The Virgins' robes are abstracted into a geometric pattern and the are placed against a gold background which gives an unworldly, spiritual feel to the illustration.

The manuscript names comes form its position in the Cotton Library. Robert Cotton was a 17th century bibliophile. He kept his manuscripts in case above which were busts of Roman emperors and Ladies. These busts were used to Catalog the manuscripts. This manuscripts shelfmark, Caligula A XIV meant that the manuscript was in the case under the bust Caligula, on the first shelf, and 14th book from the left. When the Cotton Library became one of the foundational collections of the British Library, its shelfmarks were retained.

More Birds

Since the weather was so great today, we decided to do a little birding trip today. The plan was to get out of the house at 9:00 AM, swing by Copan, Hulah, the Tallgrass Prairie Preserve and Osage Hills and get back in time for Sophia's ballet lesson at 5:30. As we were leaving town about 11:15, we realized we wouldn't make everything. As it turned out we made Copan, and the Tallgrass Prairie. We did some walking through the woods at Copan point. It was very birdy area. We decided that every where else around Copan was too muddy. (Note, we must get better shoes for everyone.) Time constraints meant that we couldn't do the little hike we planned at the Prairie Preserve. We picnicked on the veranda at the Preserve headquarters. I did a little birding while while April watched the girls run around the yard. We made it back to Bartlesville about 5:00.

The list of birds seen and heard is as follows. Year birds for the family are in bold.

American Kestrel
Meadowlark (Probably Eastern)
Rock Pigeon
European Starling
Northern Cardinal
Dark-eyed Junco
Red-winged Blackbird
Ring-billed Gull
American Goldfinch
American Robin
American Crow (heard only)
Scissortail Flycatcher
Great Blue Heron
Northern Mockingbird
Eastern Bluebird
Common Grackle
Brown-headed Cowbird

Only 17 species, but 5 year birds bringing the family year list total to 27. One frustrating note. I saw at least three different species of sparrows, but was not able to ID any of them. I need to work on this.

Tedium and tragedy

It is Monday morning, and I am recovering from my weekend at work. I often describe my job as "tedium punctuated by tragedy." Now, this weekend was not a bad weekend, and nothing really horrible happened. We didn't have to work for twelve hours without a break. We didn't have any crash cases. We all got lunch. None of the surgeons were assholes. It was just a typical weekend. But thinking about it can be depressing. There was the fasciotomy. A fasciotomy is done when a patient has a condition called compartment syndrome. This is when a muscle becomes traumatically injured and starts to swell. However the fascia, which is a tough membrane surrounding the muscle, won't allow the muscle to swell, causing pressure. The pressure can be so great that it can cut off the circulation to the muscle, killing it. The solution is to split the fascia, relieving the pressure. If this is done quickly enough, the muscle can be saved. This patient had been pinned under a truck for upwards to twelve hours. The surgeon told us that he had treated people with similar injuries after an earthquake in the Philippines when he was in the military. Every one of them died within a few days.

The same surgeon fixed three broken hips. I like these operations. They are technical, but I understand them well. They keep me busy and they don't last too long. There is the satisfaction in moving through a well-rehearsed dance. Underlying it all, however, is the knowledge that half of these patients will be dead within a year. Old people's health, and it is almost always old people who break their hips, is often like a spinning top. One push can destabilize it quickly and lead to its collapse. My grandfather died this way.

I got lucky and didn't have to do the PDA on the 1 Kg baby in the NICU. I hate going up to NICU. There's no space, it's hot, and there are too many people. The babies are all so small. They always run all the parents out so that we can operate and I know from experience how frustrating that can be for the parents of the other kids. There is always a gaggle of parents crowding around the door as we leave. The all seem so young, and so tired.

On the plus side we did a couple of normal appendectomies. Nice healthy people, with a single problem, that we fix. People used to die a horrible, painful death from appendicitis. We are saving these people's lives. But it is all so routine.

The weekend is over. I have the satisfaction of knowing that we helped people. We even saved people's lives. Perhaps the fasciotomy patient will survive. Perhaps all three of the hips will be in the half of people whose tops keep spinning. The appendectomy patients will hurt for a week and continue with their lives. Their surgery will a become a minor part of their past. The other patients will likewise continue. By next month I will have forgotten about most of them. Because although the job can be depressing to think about, the dirty secret is we don't. We do the job and move on. That is all.

Friday, February 1, 2008

Vatican Virgil

This is a page from the Vatican Virgil (Vatican, Biblioteca Apostolica, Cod. Vat. lat. 3225). This is one of the oldest surviving illuminated manuscripts, dating to about 400. It is one of only three surviving illustrated manuscripts of classical literature from the classical period. In a one sense, this is where manuscript illumination started. The style is similiar to the frescoes found at Pompeii and in the Roman catacombs. They are typical of late Roman painting, showing an illusionistic treatment of space and modeling of the human form. There are 77 surviving leaves with 50 illustrations. The manuscript originally probably had about 440 leaves and 280 illustrations.

Rules for Scrub Techs

Today was a work day, and I was reminded of the set of rules I have been formulating for scrub techs. I was inspired by the Fat Man's rules in The House of God by Samuel Shem. Some of these are serious, a few are well known aphorisms in ORs around the country, and a few are just a bit cynical. Work for 16 years in an OR and you will end up that way too.

1. You can never have too many towels.
2. Puss is always under pressure.
3. There is no point in having preference cards if you refuse to believe them. (A preference card is a listing of what a particular surgeon will want for a particular case. They used to be actually in index cards. Now they are usually computer files.)
4. The preference card is always wrong.
5. It doesn't matter what the preference card says, never open an abdomen without having stick-ties open.
6. Never suck on the brain.
7. Sterility is a state of mind.
8. Give the Doctor what they need, not what they ask for. Only do this if you know what the Doctor needs.
9. Muscles are in the way. This is all a scrub really needs to know about them.
10. Know the boundaries of your circulating nurse's ignorance.
11. Sometimes it is as important to know the names of the surgeon's children as it is to know the names of the instruments.
12. A doctor who says he only needs three things for a case will need ten.
13. The patient is not on the back table.
14. Knowing why is more important than knowing when.
15. Never turn down a break.
16. Sit whenever you can.
17. Almost every time a sponge has been left in a patient, there was a correct count.
18. Every surgery, no matter how minor, is an opportunity to kill someone.
19. In a pinch, all you need on your mayo stand to start a case is a scalpel, two hemostats, a pair of pickups and pair of scissors. Everything else can be faked.
20. When setting up, the ideal is to touch everything once and only once.

There are more rules, but I can't think of them now. Maybe later.