Count to Ten

I can recognize a baby who is failure-to-thrive almost immediately. At three months old, she barely had any body fat, she couldn't track or engage visually, and she had a patch of hair missing from the back of her head, which indicates she spent a lot of time lying on her back.

Mom is 19, there is no Dad involved. The baby lives in a house with Mom and three of her girlfriends. Infant care is shared by all, as well as smoking. Doesn't sound like an ideal environment in which to raise a child, but with my patient population, this family situation has become the norm.

As I enter the room I see that Mom has already laid the baby in the crib and she and another friend are sitting a short distance away. I observe the infant: dark brown hair, blue eyes, pale skin, and a distant affect. She is a pretty baby, but very disengaged. A healthy three-month-old will smile, laugh, make eye contact, and track with me. She gazes off and does not respond to my voice as I coo over her.

Mom also seems very checked out, though not tripping (which is always good). She cannot answer specific quesitons about her baby, such as how many hours a night the infant sleeps, and defers to her friend, who is also unable to answer the question. As I complete my admission assessment, it becomes very apparent to me that this sweet little baby, whom I will call Kara, is nothing more than a burden to these girls... one more pain-in-the-ass thing that they have to take care of, one more hinderance to their dating/party life.

As Kara began to cry, I observed Mom propping a bottle on a blanket, and then returning to her chair. I was furious. Infants do not begin to grasp their own bottle until about eight months of age, and even then it is most beneficial to the child's development to hold her while she's eating, even though she can hold her own bottle. Bottle-propping is detrimental to an infant for many reasons... it hinders bonding and development of the baby, increases frequency of ear infections, and tooth decay (as soon as teeth appear). I believe that the most dangerous side effect of bottle propping is that infants are left alone in their cribs, and their needs for affection, touch, and interaction are sorely unmet. This can deter their physical and psychological growth and development, as well as reinforcing long-term emotional deficits.

I immediately told Mom that bottle propping would hurt her baby, and why. She seemed to be paying attention while I was talking to her, however, within the first few hours of Kara's hospital stay, I heard her crying and ran down the hall to find her alone in her room. Mom was out on a smoke break with her friends, and the bottle had fallen off the blanket. Kara was hungry. Her cry was weak and helpless, as if she knew that no one was going to come.

I picked her up, she wouldn't look at me. I tried to talk to her, but she would not engage. In her brief three months of life, she had learned that people didn't care, and that trying to communicate with anyone was hopeless. I looked at the bald patch on the back of her head. They are ruining her, I thought to myself.

I called the social worker on this case immediately. This was a neglect situation and a child was suffering. It's never easy, and can be a tough call, but some situations just scream "help" to me.

I made a lot of internal judgements about Kara's mother. Every time I walked out of her room I was thinking about how selfish this woman was, how heartless, how clueless (I'm sure I thought worser things as well). I wanted so much to help Kara, but that help took on a much different form than I ever would have anticipated.

Much in the same way that I was, the other nurses were very judgemental of Kara's Mom. "Protective Services" was mentioned more than once. But it was strange... the more time I spent with this Mom, the more I found myself feeling compassion for her just as much as I did for her baby. I watched the grandmother interact with Mom and it became very apparent to me, that Kara's Mom had no idea what she was doing as a Mom, because she hadn't had a loving, attentive mother herself. How can we expect people to be parents when they don't know how, when they themselves have not had good parents?

My attitude changed. I decided to treat Kara's Mom with extreme respect. I went into her room the next day, and asked her if I could massage her baby. She agreed. I spoke to Kara softly and tenderly, and rubbed her little legs and feet with gentle touch. Mom watched, and said nothing.

When I returned to the room a half hour later, Mom was sitting in the crib, holding Kara in her lap and talking to her in a soft voice.

I spoke with the social worker later that day and we decided to get Kara's Mom set up with some parenting classes. I hope that they helped. It was just a brief moment that I interfaced with this Mom and her baby, but they taught me something very valuable... count to ten before you judge someone. We have no idea where people have been, what they have been through, what they have not been through. To help this baby, I needed to help her Mom, to treat her with respect, and patience. Not everyone is going to demonstrate teachability like she did, but everyone deserves the benefit of the doubt.

I sure am glad there's a learning curve in this thing called life...

Wanting White

Four-wheel drive, hot chocolate, wool sweaters, knee-deep in the back bowls. And then I return to reality, September.

When my thoughts drift... they go to Vail.

War Photographer

I have recently become a documentary junkie... one more venue to feed my passion for learning. I found this one very intriguing... photojournalist James Nachtwey is a middle aged man who has dedicated his life to the art of photography and the cause of bringing justice to human suffering. "War Photographer" is a very slow moving doc, but the testimony of James Nachtwey is worth the pains of time. When he speaks, he tells the facts and shows very little emotion; his words are simple and somewhat monotone. About fifteen minutes into the movie, I became irritated with his very slow, stoic, composure, but as the story progressed, his passion, and tactics for survival in the field, brought purpose and explanation to his affect. I found myself admiring what had previously annoyed me. Kind of like a piece of art that I could care less about at first glance, but then when I read about the artist's vision and intent, I see the work with whole new eyes, and it becomes something beautiful to me.

Nachtwey decided to become a war photographer in the early 1970's. He felt that the brutality of the Vietnam war was not being effectively communicated through the media and government (imagine that!) but photographs taken by journalists in the field were showing a more authentic presentation of the conflict. Since then he has photographed glimpses of war in Kosovo, South Africa, and Rwanda. He also spent time focusing on poverty in Indonesia, and epidemics of cholera and famine in Africa. His pictures tell stories, communicate emotion, and beg for justice. He says that many people whom he requests to photograph welcome him because they want their stories told. In many cases they are recipients of incredible injustices, and Natchwey's photos provide a way for that injustice to be known to the world. He gives hurting people a voice by using his incredible gift as an artist.

In the first scene of this doc, Natchwey is photographing the funeral of a victim of war in Kosovo. Initially I was offended because I thought that he was exploiting the pain of these people, however, as I understood more of his purpose in giving suffering people a voice, I realized that it wasn't exploitation, it was an opportunity for the oppressed to speak and be heard. I was also struck by the sincerity of Natchwey's respect for the people he was photographing, which really distinguishes him from other combat photographers. At the conclusion of his story, he states: "I know that if I ever allow genuine compassion to be overtaken by personal ambition, I will have sold my soul. The only way I can justify my role is to have respect for the other person's predicament. The extent to which I do that is the extent to which I become accepted by the other, and to that extent I can accept myself."

Natchwey becomes part of the events that he photographs, and that is evident in his work. While photographing in Asia, he pled for the life of a man who was being killed for sport, and witnessed his murder. His pictures do speak an incredible justice, yet they have come at a great cost to him. In an interview he was asked, "How do you endure the suffering of so many?" To which he replied, "I channel my emotions into my work." And it shows.

While Natchwey was in Indonesia, he spent a month photographing a family that lived by the train tracks. The parents had four children and the father was missing an arm and leg due to being run over by a train a few years previous. The family had no shelter, they slept in the open on a blanket, and they bathed in a polluted river. Life Magazine did an article on the family, displaying Natchwey's pictures. A few months later Natchwey received a letter from a person who had read the article and was so moved that they committed to sending $20/month to the family. This person appologized for not being able to send more, but their social security check only provided $396/month. Now that is beautiful. It reminded me that we are so fortunate to be able to give, out of whatever it is that we have.

I think that the most inspiring aspect of Natchwey's work, aside from the unique marriage of art and philanthropy, is the fact that he puts his life on the line for people who have no means to repay him. Throughout the course of his career he has been wounded in crossfire four times and has endured horrible diseases. With this I am reminded that character is doing something for someone who can do nothing for you.

James Natchwey sees his photography as an antidote to war. By admiring his work, I am in no way advocating that war is in all circumstances, unnecessary. Unfortunately the world that we live in necessitates war at times, because evil must be stopped and the innocent must be defended. Yet the work and testimony of James Natchwey is truly admirable. His career as War Photographer has been an integration of talent, passion, conviction, character, and a compassion that exceeds the word "philanthropy."

Not to belittle our sufferings here, as I will testify to the weight of them, yet this doc reminded me that America is a very small slice of reality.

In the words of James Natchwey, "We are required to do what we can. If we don't, then who will?"

In an Instant

They were driving home from the lake, still in swimsuits and barefeet. In a black suburban with picnic leftovers in the cooler. In the backseat the two-year-old slept in her carseat and the nine-year-old gazed out at overcast skies and a light drizzle. Very unusual weather for Colorado in August. Dad turned the volume down on the radio. Mom remembered that the whites needed to go in the dryer as soon as they got home.

We drove past the scene just minutes after it happened... the suburban was turned sideways in the northbound lane. The Forrester was part way into the ditch, with a smashed hood. There was blood, and the man in the Forrester could not get out, but he was talking to one of the people who had stopped to help. I saw a nine-year-old boy sitting beside the suburban, his head bowed low. He looked alright. A few feet away two people were holding a woman in their arms. She was breathing. I think she belonged to the Forrester.

"Should we stop?" I asked my friends. I wanted to stop, but I was afraid. I was driving us home from our girls' weekend in the mountains, cozy and comfortable in my new Rav 4. We had all gotten our mochas earlier, Bono was singing quietly in the background.

"No, keep going," one of them replied. And then, "Wait - you're a nurse..."

I pulled over, slammed the door, and began running toward the scene. As I approached the black suburban, I saw a woman, in her barefeet and beachware... her eyes were bloodshot, with no tears. She was gripping her chest. Shock.

"Ma'am, I'm a nurse, what can I do to help?"

Her desperation hit me like nails... "Oh, thank God... please help my baby! She's hurt!" She pointed me towards the backseat. "Do whatever you can to help her, please! She's bleeding!"

I climbed into the backseat. There was another woman there, feeling the child's feet for pulses and applying pressure to her head. The baby was still strapped in her carseat.

"Should we lay her down?" another person asked.

"No, keep her still," I said. "Is she conscious?"

"She's coming in and out," the other woman said. "Kayla, wake up, Baby." She was stroking the child's feet and hands, while still applying pressure to her head.

"She has good pulses," I said. "Keep her conscious." I saw the baby move her foot, but her eyes remained closed.

"The paramedics will be here in 3-5 minutes! She's our #1 priority!" The police officer shouted from behind.

There is nothing as chilling as a child with blood on her face, or as sobering as a mother with the terror of death in her eyes. "Kayla, wake up, Baby, stay with us, honey." The ambulance arrived and I got out of the way, returning to my car. It was silent. Bono had been turned off.

"What happened?!" My chest ached.

Why am I writing about this? So many of my blogs are about the "beautiful" moments in life, and this scene was a taste of hell. Witnessing this tragedy brought two things to mind... that anyone's life can change in an instant, and every moment, no matter how seemingly mundane, matters. I was also struck by the reality of compassion unfolding all around me. There is so much evil in this world, you don't have to look very far to realize that. But the beauty of compassion and genuine love was overwhelming me, as I watched people (with their own lives and places to go) pull off the side of the road and embrace the blood of total strangers. Now that is truly beautiful.

Humbled by the fact that I had done very little to help, I thanked God that compassion was so alive in the people around me, and begged Him to allow little Kayla to run marathons one day.

Steamboat Springs

Two California girls, Two Colorado girls... Hahns Peak, Beaujos, four bottles of wine, Strawberry Hot Springs, a little cabin in the woods, Fish Creek Falls, a lightening storm, and a whole lot of organic fruits and vegetables... that was my labor day weekend.
















...Perry Mansfield Cabins




















... The Trailhead

... The Hike

...The Top

...The View






...Ally's first off-road experience

Some new friends...

Fish Creek Falls...