Sunday, February 14, 2010

Handed to me from the past

Today was a bread-baking day: I fed my sourdough starter last night, measured out the flours, salt, and water (oh, and a pinch of yeast...in the winter, the starter tends to lag; we keep our thermostat in the high 50's overnight), set the mixer on the counter.

Feeding the starter, kneading the dough, shaping the loaves: the process brings my family history to life. I think about my grandmother, for whom I was named. She taught me the craft of baking: "Add enough water to make the dough; you'll know how much because it will feel 'right'"; "stretch the strudel dough with the back of your hands; that way your fingers won't poke a hole in the dough." I can sense her spirit looking over my shoulder as I work in my kitchen, blessing my work. It's comforting; with her there with me, I DO know when the dough feels right.

As my hands work the bread dough, I also think of my great-grandfather. He is a figure I only know from pictures: a slender man of slight build, with a VanDyke moustache, his eyes serious yet kind. Franz's roots were in eastern Austria, in the province of Burgenland. After marrying Louisa, he brought his young family to the New World, to Pittsburgh. I am not sure if that is where he learned the baking trade, but after a few years he returned to Europe, crossing what must have been only a theoretical national border--the lands were likely the Austro-Hungarian Empire at that time--to settle in a small village in Hungary. And there he opened his bakery.

I imagine what daily life must have been like for Franz, a white apron wound around his middle, his soft, floured hands mixing multi-loaf batches of dough. Shaping ovals of rye bread, to be slashed and glazed with egg before baking. Rounds and rounds of rolls--semmeln--the tops creased into five parts like a crown, in honor of the Emperor Franz Josef. (Yes, that's where Kaiser rolls got their name.) They would be of white flour, precious and delicate, the crusts light brown and crisp. Best eaten fresh, lovely at breakfast, which would mean that Franz had likely set the sponge the night before, only to rise at 3 AM, perhaps earlier, to make the final dough, proof and shape and rise and bake by the time the housewives appeared at 6 AM for the morning meal. The oven would be wood-fired, and thus never permitted to go out completely; the bricks would glow with heat, probably close to 600 degrees. Sweltering in the summer, welcome in the winter. I wonder who built the oven for Franz and where it was...and if it might still be there, buried under the rubble of a Communist takeover.

I wield my peel to shunt the loaves into the oven and picture Franz deftly handling his peel, sliding bread onto the hot bricks,the bottoms crusting instantly; and in his skill, being able to reverse the process, scooping out the browned, crackling loaves to cool on a rack on the table.

I read baking books which talk about precise measurements of ingredients, water at exactly 76 degrees, cold proofing for flavor (the retard, it's called) at 54 or 45 degrees, depending on scheduling. The baking instructions that recommend a 40 minute bake at 460F with two minutes of steam at the start and two more bursts of steam over the next ten minutes. Bake until an internal temperature of 205F is achieved.

I think of Franz. He must have developed calibrated hands--able to form his palm into a cup which would hold a portion of yeast or firm starter. Knowing by feel that the water was warm enough to enliven the starter. Able to judge the temperature of the oven by inserting his hand into its mouth and counting the seconds he could tolerate the heat. To be capable of flicking or knocking on the bottom crust of a loaf and know it was done.

I'm not that adept yet. I think I have many, many more loaves to bake until I am. However, I'm glad that Franz's spirit is looking over my shoulder too.

Friday, February 12, 2010

An Olympian Effort

People are surprised to learn that I don't watch TV...that we don't even OWN a TV. I do realize this has left me with a huge social handicap (it's not the first time this has happened in my life) in that I can't participate in conversation about the ending of that made-for-TV docudrama that was too frightening to watch and too intriguing to forget...heck, I don't even know which stars are dancing...or even why.

There's a logical backstory, and it has nothing to do with trying to raise my children in a pristine environment or coerce them into choosing creative endeavors instead of mind rot. No, the reasons are totally financial.

We had been using a relative's TV anyway, a hulking CRT that could do serious damage should it even tip over--which was likely, since the dang thing was so top-heavy. The kids, early elementary age at that time, would plop on the sofa in from of the tube and watch the most mind-numbing programming (OK, it was Pokemon. But I still reserve the right to call it "mind-numbing"). And we lived in this unenlightened style until one Thanksgiving. The TV was working fine that Tuesday; Wednesday evening we headed north to the grandparents for a long weekend. We returned on Sunday only to discover that Zenith had reached its nadir; during the long weekend, it had passed quietly from this world to the dump next. It went peacefully; it had no pain at the end.

There was, as expected, deep grief on the part of the under-30 set. But their father offered them the opportunity to memorialize the TV by getting a replacement. Only there was a catch: each kid had to cough up a $50 contribution to the cause, with us parents offering a matching grant towards the purchase of another Tube. The kids all nodded their heads solemnly in agreement with the plan.

It is eight years later. We are still waiting for them to amass the funds.

This post opened with a lie. I actually do watch TV. Only I do it for two consecutive weeks in alternate years and I limit myself to sporting events (probably because I lack any semblance of motor coordination; walking on level surfaces in flat shoes is a challenge, so I delight in living vicariously)performed by a cadre of international athletes.

I gotta watch the Olympics!

So this is my dilemma: no TV and a severe viewing need rising to a crescendo.

I was in a thrift store this evening, eying a small set (only $15!) and my daughter stared me down, shaking her head. I left the set there. And then I realized: we have a small set in our cabin, about 15 miles away, and I will be in that area tomorrow. Saved! Until my middle son reminded me of the significant snowfall and the very high probability that the dirt road to the place has not been plowed. This could be a 1/4 mile hike in drifts up to my knees, and then lugging the set back to the car. This could be serious effort, a good piece of work.

I think I can get it done in under 30 minutes.

Thursday, February 11, 2010

The Right Words

I've read some fascinating material recently on communicating effectively...which is especially relevant to me at this time: the hospital where I work kicked off 2010 with an organization-wide training on patient safety and medical error reduction. My colleague is directly involved in the committee developing the training, and she has a role in the didactic sessions. "Safety" has become the word she mentions in every meeting, every communication.

By virtue of her involvement, she's become invested in this project. It's the way she now thinks. It's her culture.

Which was the goal of this project at the outset: the organization doesn't just want to discuss safety as a theoretical construct, or a set of routines. They want safety to be the "culture." This is the way we ALL think about our work. The hospital wants everyone, at every level, including patients and their families, to call "time out!" if they think an error may happen. Did you wash your hands? Is that the right pill? Why are you doing another x-ray?

Naturally, there's some push-back. Physicians, especially, have been schooled to be leaders, to take responsibility for the team and make the tough decisions. I know what I'm doing; why do I need to invite another person to give me feedback?

And to expect patients and families to point out errors is another challenge. Hey, these people are physicians and nurses, experts in their field, much more knowledgeable about my illness and treatment than I'll ever be. Plus I'm sitting in bed wearing nothing but a flimsy hospital gown that doesn't even cover me, and you want me to feel empowered?

Since I haven't yet gone through the training, I can't judge its effectiveness, but I wonder: have the trainers really look at what it would take to "change a culture"?

Malcolm Gladwell, in a chapter on airline safety in "Outliers," talks about hierarchy in cultures and how it impacts the ability of one person to give feedback to another. In Asian cultures, where status and experience (and age) are highly respected, it is nearly impossible for a subordinate to give direct constructive criticism to a superior. That would be considered extremely offensive. However, in Australia--remember, this is a former penal colony!--there is hardly any hierarchy. Everyone's a "mate" and it is culturally acceptable to give direct advice to another. So in the cockpit, the first officer in a low hierarchy culture will be more likely to speak up if he or she perceives the pilot is in error...thereby increasing the chance that a mistake can be avoided.

Now to take that to the bedside: hospitals are famous for their hierarchy. Just among physicians there are ranks (watch out for those people with the short white coats), and the MDs are at the top of the food chain relative to the other professional staff. And patients, by virtue of feeling ill and all the emotional vulnerability that accompanies a diagnosis (not to mention the embarrassing wardrobe)feel overwhelmingly inferior. And we want these folks to feel comfortable questioning a fully-dressed professional wielding an icy stethoscope?

Although I love the place that I work, it has its flaws, and among them is the communications it provides to its customers. It's a teaching hospital, it's an academic center, and it wears those robes proudly: why say something in 5 words when a paragraph of explanation is so much more scholarly?

I think my cohort is supposed to be trained in safety culture in the next few months. I'm curious to experience the training. I'll wonder if the messages are short and effective. And what tools we can give families--and staff--to perceive each other as equals, as partners. To be able to ask, "Are you sure you want to do that?" To say "stop" before an error occurs.

Maybe we need a wizard. Because for this to work best, we have to act as if we're in Oz.

G'night, mate!

Monday, February 8, 2010

Typical

"Remember, you're unique; just like everyone else."

I love bumper stickers (although the ones I have are utilitarian rather than clever: organ donation, childhood cancer, a local radio station). As I walk through a parking lot or drive down the street, I find my gaze naturally drifting to the back end of cars, looking for a bit of entertainment: the license plate of a Saab laden with all the extras ("SNAAB"); the car magnet on a dented hatchback ("Support Magnetic Ribbons"); the sticker on the bumper of a nurse's sedan ("Midwives: They help people out.").

The proverb that opened this post is one that I've seen at touristy gift shops and tee shirt websites, variously attributed to Carlin or Wright or that old wag, Anon. (Digression: did you know that in Budapest, Hungary, there is actually a statue in memory of the greatest philosopher that ever lived...Anonymous?)

It might be overused, but I like it. Clever enough to make one pause to think it through, true enough to remember. And it is just a twinge off from what I have told my children as they grew. Is it not one form of a mother's love--in addition to the hugs and the bedtime stories and the favorite meals and the inside jokes and the comfort for a broken arm or a broken heart--to tell her children that they are special? That their ideas and thoughts and imaginings are unique and valuable? That they should dream those really big dreams that no one has ever before experienced? I look at them around the dinner table, all teens, the same genes scrambled three ways coming out with three completely different combinations.

And yet, there are things they do that make me wonder if in the development of humans, there are certain stages that must be passed through. And thus it has been through all the ages.

Like "Rock Star." (mandatory for teenage boy; optional for girl. I wonder: did Jesus go through a stage like this?).

My oldest son thinks he's Keith Moon. Or Zack Starkey. Or Ringo himself.

Every object in the house is a drum head. Or a cymbal. Or high hat, snare, tambourine, kick drum. And who needs drumsticks? This is why God gave us hands. I hear music blaring from his room (not that I mind; he's got pretty good taste and the bands he prefers are melodic and write intriguing lyrics) accompanied by pounding, banging, thumping. His new desk has a nice resonance. The floor isn't bad either. I am just hoping he does not give himself whiplash from the accompanying head movements.

Stage 2: "Mysterious Recluse." (works for either male or female child).

My middle son appears to have intermittent hearing loss. Because I can call his name and get no response. Yelling helps; touch usually gets a positive response. Oh, right, let me take the iPod headphones out of your ears and let me repeat myself. There, that's better.

Mom, attempting to bond with her child, "Hey, what are you listening to?"
Son, serious and sincere: "Music."
Mom, still trying to initiate conversation: "Which band?"
Son, oblivious: "Mrghsmphs."

OK, let's try this again. Son invested in mod activity with other online players.
Mom, trying to be interested in her kid, "Whatcha doing?"
Son, nodding, hypnotized by screen: "Garry's mod."
Mom, really trying hard now: "Who with?"
Son, oblivious: "Friends."

This from a kid who turns dinnertime into a re-creation of "The People's Court" or "So You Want to Be a Millionaire." Where were you on the night of January 28, 2007?

Stage 3: "Vegetarian," or Social Justice Meets Nutrition (mandatory for teen girl; optional for teen boy. As my oldest explained, teen boys have "blood lust" for meat. Real men eat meat.)

Daughter, picking up package of cheese: "Does this contain rennet? Rennet comes from animals, you know."

Daughter, stirring pot of vegetable soup (hey, I learn quickly) on stove: "Did you use vegetable broth in this? I can't eat it if it has meat broth."

Now let it be known to the court that I tend to prepare foods that are relatively close to the source. I can count on one hand the "processed" foods I buy: spaghetti sauce (and only because my crockpot burned the last batch. Which likely explains why the pot was such a good sale price at the store); cereal; crackers; canned tomatoes, beans, olives; pizzas; pepperoni. Ok, pierogies a couple times a year. Let it also be known that my hamburger has NEVER been helped, and that I have never prepared a meal using a "kit."

And let it also be said, for the record, that I cook a vegetarian meal at least twice a week, and sometimes more often.

I have one child that is ovo-lacto-fisho but no shrimp (which is Mom's lifesaver when I forgot to plan ahead; did you know shrimp thaw in running water in about 5 minutes?)

I have one that has a cheese phobia. And cheese paranoia. (This should be a new category in the DSM-V. BTW, there are ways to hide cheese in foods. Don't tell.).

I have one that cannot bring himself to eat seafood of any kind, unless it's Farmer John's fresh smoked trout (Farmer John being a friend of our family from Buffalo, who morphed into a snowbird. End of trout.).

I am ready to set up TPN for each of them. And headphones. They should listen to music while I set up the boluses. They're teenagers, after all.

Thursday, February 4, 2010

Bracing

Having grown up in the suburbs of Buffalo, NY, I've lived through my share of storms. The Blizzard of '77 was certainly impressive--I will never forget that my dad was stuck at work (a bakery: at least it was a warm place with food)and my mom and I were nailing blankets to the doors to keep the wind out. The layout of the house and garage was such that gusts would swirl on the front steps, creating a snow pyramid in front of the door, of course; the one in '77 reached the rooftop.

I remember an early dismissal from High School one January, as a storm quickly moved in. The schoolbus wasn't even attempting to drive into our unplowed neighborhood, but dropped us at the corner right at the major road. A man from the next street gave a few of us a ride to our streets in his big boat of a Chevy, the car fishtailing in the six inches of fresh fall.

I wonder how the White Christmas of '02 managed to miss my parents' house in the snow belt but drop 7 feet of snow on the city of Buffalo. It was meant to be, I guess; that day I realized my oldest son was seriously ill--my intuition told me he had leukemia--and had the roads been passable, he would have been admitted to Children's of Buffalo...and maybe stuck there for the whole of his treatment.

I follow the weather daily: studying the front maps and watching the cloud cover scud across the USA, puzzle over mixed fronts, and wonder if and where hurricanes will make landfall. It's long interested me, but I also think it's a function of being married to a pilot, and a glider pilot at that; his head is always craned skyward to guess at the clouds and judge if the day is or will be flyable. We joked at one time about returning to school to become his-and-hers meteorologists.

So in the midst of this weather obsession (OK, it also helps me plan what to wear to work. Tomorrow I need to wear something black, because I'm going to head out in boots and my work shoes are black. Plus a sweater; it will be cold. There is deep logic at work here.) I of course tease apart the weather reports, especially the "Public Information Statement", which is typically a watch or a warning of something that will befall--literally!--us, and what the websites have taken to call "Local Storm Report"...which satisfies my curiosity about what my friends, acquaintances, and colleagues are facing in their driveways, or occasionally, their basements. But it seemed almost anticlimactic this week when we received a trace of snow. In all seriousness, you can call that a "storm"?? Any precip that requires a yardstick to measure, yes, we'll call a "storm", but when the grass to snow ratio is more green than white, call it something else. How about "weather" for pete's sake. (A few years ago my parents--the Buffalonians, remember!--were visiting in January when we received about 6 inches of snow. My parents were particularly tickled to hear newscasters refer to the event as "Snowstorm Ernie." No idea who Ernie is, and since when did snowfall get its own name?)

Since I became a weather junkie, though, I have learned the truth in the proverb. There truly is a lull before a storm; the world becomes unusually quiet, muted somehow. And then all that snow serves as wonderful sound insulation as well. The world becomes a more peaceful place in the snow.

In fact, I can sense the lull now. There is a storm forecast to hit tomorrow starting at 6 pm, leaving us with 8 to 12 inches of snow. For Philly, that's a generous amount. Part of me is apprehensive about coordinating the kids to clear the driveway come Saturday (You try making a teen do something he/she would rather avoid!). And part of me is thinking about making chocolate chip cookies, watching movies, drinking hot tea (or mulled wine; hey, there's an idea!), cooking stews, and just simply hibernating, watching the flakes swirl and accumulate. Battening down the hatches, staying warm.

Let's hope Mother Nature doesn't disappoint.