Toby

This family has never had a pet. We have had some unsatisfactory substitutes.  A few years ago I ordered one of those self-sustaining enclosed ecosystems developed by NASA, where shrimp and algae and bacteria live in perfect harmony, forever, in a sealed glass globe. As I was describing it to the kids on the way home from school, Saskia (then 9) interrupted me with, "Mom! What you're telling us, is that you got us a pet!" The depth of emotion in that exclamation made me feel quite terrible. When the shrimp arrived, I wondered why they were pink; turns out they overheated in transit, and the colour transformation from greyish brown was the same phenomenon one sees when they're sauteed in butter and garlic.

A couple years later we got a Roomba, one of those robotic vacuum cleaners. The kids watched the demonstration video with me.  As a fleet of three Roombas hummed down a hallway in formation, Leif said reverently, "This is better than Planet Earth." 

We agreed we'd get a dog once Ilia was out of diapers. But then Pete and I, who've never had any difficulty making decisions together, could not settle on a breed. I like my dogs big and dignified. Pete likes a dog that can fit on your lap and makes the tiniest poos imaginable. A few times we tried to compromise on something mid-sized like a miniature Australian Shepherd, but we were both too resentful.

So we got a kitten. 

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I thought I'd find a free kitten in the classifieds. It doesn't work that way anymore. Kittens aren't free, at least not west of Chilliwack. They're not exactly sold, either; you'll get flagged if you post a pet in the "for sale" section of Craigslist. They're under "community," and they're available to be "rehomed" or "adopted" - but for a fee. They're $50, $100, more, and they go like hotcakes. Finally I found a litter for $45 a piece, in Abbotsford, that had one kitten remaining when I called an hour after the ad was posted. We'd wanted the experience of picking a kitten from the litter, not taking the leftover. I put it to the kids. We set off for the Valley.

The kitten was a tiny five-week old tabby that had been orphaned and bottle-fed. The kids were instantly smitten. No question - this little guy was moving to Deep Cove. 

His name is Toby, and he's got the undiluted affections of four kids directed at him, which he doesn't seem to mind. Ilia slings him over her arm like a purse, and he hangs there resignedly, front and back halves stretching down almost to the floor. He's figured out that Leif's bedroom door is the one that won't quite click shut, and in the night he'll body slam it open and curl up on Leif's wool blanket. He waits at the top of the entry hall stairs when the kids come home from school, eager, like a dog. 

Pete and I were out to dinner a few weeks ago and our conversation turned to meta living. I was saying that a life preoccupied with how one ought to live - while one of my very favourite topics - sometimes strikes me as ridiculous and exhausting. That’s why I love running - the animal, very present sensation of heart thudding and limbs cycling. It’s a relief to pull back from the big picture of life - or is it a pulling back? Maybe it's actually an embracing? There. I’m doing it again. “That’s why the cat is awesome,” said Pete. “He doesn’t think about it - he  just does. Eat. Drink. Play.” Looks like Toby will be my muse. 

He's not without his challenges. He was out exploring the cliffside behind our house when the neighbour's dog cleared their deck railing it a fit of overexcitement. Toby scaled a cedar tree in terror and remained there for the entire day until the neighbours brought out their ladder and rescued him. He tried a similar trick a few weeks later, necessitating Pete climbing onto our roof and setting up a kind of 2x4 balance beam to the treetop for the kitty to mince down. 

He chews plants, he flies at my legs from under the bed during the evening witching hour, and he is not absolutely odourless, as I prefer pets to be. When Pete and I are lounging on the couch on the deck in the evening, though, and Toby spots us from the yard and comes up and across the deck straight for us, shoulders bobbing up and down purposefully in this funny happy gait he has, I forgive him. He's a sweet little beast, and part of the gang. 

Bocconcini salad

Two girls walk into a bar.  A bistro, actually, a block from the Park Theatre on Cambie Street, where The Grand Budapest Hotel is playing. And we're not exactly girls anymore, with seven kids and two thousand patients between us. The bistro has a bar, though, and my visiting girlfriend Erin and I have a half hour till showtime.

She has a beer and I have a whiskey sour. The place is packed, Saturday night noisy. I’m poking at the ice in my glass with a straw, and Erin’s telling me about a patient from her practice in Comox. The server approaches with a tomato and bocconcini salad, a glorious trifecta of tomatoes, basil and cheese with the balsamic drizzled artfully across the plate. I expect her to pass by, but she stops and reaches over to set it down between us. 

“That’s not ours,” I say, regretfully. 

She looks confused.

“It’s not ours,” I say again. “Not unless someone ordered it for us.”

She takes it back, apologetic. “Your face just lit up when you saw it,“ she says.

"It does look delicious," I admit. We laugh, she brings it to the couple a few feet up the bar, and Erin and I are back to our drinks and conversation.

Ten minutes later, the waitress approaches with another tomato and bocconcini salad. She sets it down in front of me. It’s déjà vu,, except this time the bartenders and another server pause to watch, smiling.

“Someone ordered this for you,” she says. We stare at the plate. 

“The guy that was sitting at that table over there, " she says, gesturing behind us. "He ordered this for you." I turn, and he’s gone, just a crumpled napkin and the bill folder on the table. 

Our show is about to start, but I enjoy every slice of Roma tomato, every pale oval of cheese, every basil leaf, and with each bite I think happily: A stranger bought me a bocconcini salad, anonymously, simply to delight. 

Photo by Steve Brown, from Australian Good Taste. 

Photo by Steve Brown, from Australian Good Taste. 

* * * * * *

A few years ago I came across a description by Phyllis Theroux, American essayist, of an ecstatic experience where she watched the morning sun light the cockleburrs next to a sleeping porch. This was an experience from which she drew strength later: 

Could it be, and this is the question of a speculative,  unmarveling adult, that every human being is given a few sights like this to tide us over when we are grown? Do we all have a bit or piece of something that we instinctively cast back on when the heart wants to break upon itself and causes us to say, "Oh yes, but there was this," or "Oh yes, but there was that," and so we go on?

- (California and other States of Grace, p 55) 

She’s referring to childhood experiences in nature, but the idea of clinging to the recollection of an extraordinary experience of goodness in moments of despair resonated with me.  

A few weeks ago I saw pictures of captured Iraqis before and after execution by militants. I saw their faces and hands. I struggled to grasp that humans treat each other this way, and I couldn’t make sense of it.

Then I read this article in the Guardian about men being raped in war, and it fit exactly with my experiences at the refugee clinic. A person, deliberately, severely damaged by another person. Multiplied by a thousand people, over a thousand wars. 

These days, when my heart wants to break upon itself and I’m desperate for a small reassurance to hold on to, I remember this story:  the one about the guy who bought the girl at the bar a bocconcini salad.

Oh yes, but there was that. Humans do that to each other, too.

Two points for knowing what you don't know

I’m driving the kids home from school, winding along Dollarton with afternoon sun glinting off Burrard Inlet, and Saskia’s telling me about the Gauss Mathematics Contest she wrote that morning.

“I left one question blank,” she begins. It’s a confession: a perfect score is off the table. She doesn’t add up test scores, she works back from 100. She goes on, “But I did that because of how the scoring system worked. You got six points for a right answer, two points if you left it blank, and zero points for a wrong answer. I wasn’t sure about the last question, so I just left it.”

I make her repeat that, making sure I have it right, because I know I’ll be chewing on this for days.

They were rewarded for leaving alone what they didn’t know.

Making a wild stab at an answer was worth less than no response at all.

For once, it wasn’t about doing one’s best, but about acknowledging one’s limitations.

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I was assigned to a family practice when I began residency in 2000, for several 4-week blocks over the two year program, and callback every Thursday afternoon. It was an established practice on Broadway and Granville, and a good group of doctors, but I dreaded seeing the patients, mostly well-heeled reproductive aged women.

Making a diagnosis and treatment plan on my surgery rotation, or in the emergency room, wasn't a problem, but these women kept presenting with issues that weren’t in any textbook. One couldn’t interpret her baby’s cries; another needed advice on dealing with strangers’ remarks on her child’s birthmark; the next had discovered her teenage son’s porn collection. Working at this family practice was by far my least favourite rotation, and I was doing a family medicine residency. That worried me.

My preceptor and her partners took the entire clinic out for Christmas lunch that first year, between morning and afternoon clinics packed with patients wanting to be seen before the holidays. I remember Sarah pausing during the meal and saying to me congenially, “You know when we knew you were okay?”

I had no idea, but I was relieved they’d arrived at that conclusion.

“Remember that rash?” she asked. “The four-year-old with the vesicles on his legs who’d just come back from camping?”

I remembered. Yet another patient that had had me stumped.

“When I asked what you thought it was, you said ‘I don’t know,’” she went on. “That’s when we knew we had a good resident.”

The other physicians agreed. “We don’t care what you know,” said Joan. “We care that you know what you know.”

*        *        *        *        *       *       *

I teach residents myself, now, and it’s true - I don’t pay particular attention to how comprehensive their knowledge bank is, but to whether they recognize what’s missing. Nothing raises a red flag like a learner who already has all the answers.

And then there are the patient encounters where you can’t turn to UptoDate for backup. Sometimes there really isn’t an answer, in that brisk bullet point way that physicians love. Sometimes the P of SOAP feels terribly inadequate; writing ‘counseled’ or ‘conservative’ or ‘follow’ feels like a fail.  Physicians get the God-complex jokes all the time, but from where I sit, we're keenly aware of our limitations. Medicine teaches you how very much is unknown.

That's using the Gauss scoring lens to look at one field in one profession. Imagine if we approached everything from a place of humility.

I read comments on news articles on refugee matters, vociferous ones, that are ignorant of the basic facts of the system. I’ve heard someone predict the eternal destiny of another person’s soul with the same degree of certainty that they state their summer vacation plans. I’ve seen someone with no more than Biology 11 comment with the authority of an immunologist on vaccines.  

I can't say that those lessons I've learned in medicine have overflowed into every other part of my life, either. 

So how about each of us, the next time we’re in a conversation - with a client, in a staff meeting, on social media or out to dinner - consider whether we truly know the answer to the question at hand.

And if not, take two points for keeping our mouths shut.

cross-posted at Mothers in Medicine

Crab hunting

Collecting crabs is a favourite pastime of all my kids. We're a short walk from several Deep Cove beaches, and when the tide is out, the kids search out the promising rock 5-10 lb rocks, roll them, and catch as many crabs as possible as they scuttle for the nearest shelter. They've done this since they were babies; none of them have outgrown it yet. 

I love the joy and camaraderie in these pictures. It always strikes me how thoroughly engaged my kids are at the beach, or in the woods, even when they've come barehanded.  The things that exasperate me in the house fit in naturally here: messes, climbing and jumping, excited raised voices, brandished sticks. We need to spend more time outside.

I won't pretend I'm not pleased to have daughters that can handle a crustacean without screaming. Look at that: Sunday dress, black rubber boots, dandelions in one hand and a crab in the other. These pictures make me feel like a good mother.

Oahu

Every spring break we do a road trip, heading south on the I-5 in search of weather warm enough for bare legs. Last year we drove to Santa Barbara. On the way home, somewhere mid-Oregon, I was silently, guiltily wondering if I'd outgrown this kind of vacation, when Pete announced, "I think next time we should just fly somewhere." It's no longer money we need to be frugal about, but time. So this year: Oahu, Hawaii. 

Every vacation package out there is tailored to a family of four; I gave up on a resort or hotel. We found an oceanfront house on the North Shore on VRBO instead. View from the front yard beach looking back at the old plantation house, and toward the ocean:

We snorkeled. We ate pineapple every day. We ate at shrimp trucks and shave ice shops. The kids chased feral chickens and searched for lizards. We read voraciously and took surf lessons (and Pete has his fourth consult with orthopedics this week for a sea urchin spine embedded in his foot). 

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There was a moment on the third day when I looked at my kids at the kitchen table - happy, but very noisy and very dirty - and I remembered that I don't usually go more than two days where I'm with them 24/7. I always get that break where I deal with death and disease for a few hours and return to the family refreshed. But this vacation was for them, not me, and a parenting marathon on a tropical island isn't exactly a sacrifice. 

Success! The kids unanimously voted it the best vacation ever. There was weeping the day we returned, the ultimate affirmation. And while in Hawaii, I registered for a vacation that would be all mine: a three day medical writing conference in Iowa.

Now, back to patients who invariably greet my return with, "You went away! Didn't you take a vacation last year?"

Doubt

Wednesday, March 5, 2014

Queen Elizabeth Theatre

Every seat is taken. The theatre's lights are dimmed over a throng of excited Vancouverites, most dressed in black, some in pearls. After interminable introductions, Hillary Rodham Clinton strides in from stage right, in a navy pantsuit, stilettos and large glasses. She takes the podium and begins her speech on women's issues. She's funny, smart, engaging. 

I'm here for the curiosity, not the politics. I was offered a ticket that morning; I didn't even know she was in town. She doesn't disappoint. Her presentation is riveting. 

"One of the greatest blocks to the advancement of working women is their own self-doubt and perfectionism," she says.

Yes. That resonates.

She continues, "I've worked with many young people over the years, and almost invariably, when I offer more responsibility to a woman, the response is, 'Let me think about,' or 'Do you really think I could do it?' I have never once offered a promotion to a young man who did not feel more than entitled to it." 

I post that to Twitter. 

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Friday, March 7, 2014

Residence, Deep Cove 

I'm going through pictures of my brother's wedding from the week before when I come across this:

Whoa. How'd that happen? I've got a girl who babysits, attends youth group and just submitted her course selection for high school. If she goes to McGill for university as she intends, I have just over five more years of seeing this face at the breakfast table every morning. 

Her childhood has always stretched ahead of me as far as I could see. The chances to do things with her, to become the mother I want to be - I live as if they will continue indefinitely. So how can it be that I can count on one hand the summer vacations remaining until she graduates high school? 

Wait! I think, and I suddenly feel scared, sad. I was going to read all of the childhood classics alongside her - A. A. Milne, Roald Dahl, L. M. Montgomery. I collected them from used bookstores, and she's read them, but I never got around to it. I still haven't made her bedroom an idyllic nest; the board is on PInterest but the brown carpet lives on. The plan at the back of my mind was to raise her somewhere with goats and an orchard; we live on a rocky cliff side without even a gerbil. 

I was going to become an excellent mom, or even just a really good one, the one she deserves. I could always see just how I'd be one day when I'd conquered all my personal faults. Calm and patient, attentive and selfless. I was going to start going along on field trips and watching her floor hockey tournaments. We would have long conversations lying on her bed in the evenings. I was not going to take her for granted, ever. 

I look at the face in the picture above, sweet and spotted, pretty and confident. A flight of conflicting responses pass through me. Pride, panic, affection, sorrow. What to do?

Do I say with satisfaction - Look at that. She knows she is loved, and knows how to love. She's an excellent student, a kind friend. Tucked into the past twelve years are moments I didn't, couldn't have planned. Dissecting a cow heart for her class, sharing anecdotes about her baby sister, playing Clue after dinner for nights on end. I'm irritable and impatient, yes, but I've always been up for adventure. I devote a large part of myself to patients, and she sees the joy that good work can bring. 

Or do I say, Hold up a minute! There's still time. Not a lot, and I'm going to have to be very deliberate about this, but there's still time. There are changes to be made, to home and work and heart, and we're turning this ship around, starting tomorrow.

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Saturday night, March 8, 2014

Residence, Deep Cove

"Are you the father you wanted to be?" I ask Pete. I bring these things up in bed, lights out. 

"I've never thought about it," he says. I can't believe it. But I do, deeply envious.

"Scale of 1 to 10."

"Ummm. Seven." No trace of guilt or sorrow.

I can't help myself. "Seven's kind of low. Don't you feel bad about that?"

"When you imagine being a parent, you have no idea what it involves. Once you're doing it and you find out what it's really like, you cut yourself some slack. Lots and lots of slack." 

The price is right

The most important thing I did last week was fix my grandmother's television.

My grandfather died a few weeks ago, and Oma (92) lives alone now in their little apartment. She's made a few discoveries of messages he left her, like a note tucked into his Bible, and these leave her weeping with gratitude and grief. I visit her on Thursday mornings, and asked her the week after Opa died what she missed most about him. "His care," she said simply. 

We wondered what would become of Opa's chair, the reclining green leather fixture in the corner of the living room, where he always sat. But Oma's taken it over, and when she did she discovered that he had taped to the table next to it a list of her favourite shows and their channels: The Price is Right, Jeopardy, Wheel of Fortune. He controlled the remote, and he knew she'd need help when he wasn't there to do it. 

credit: Grace Humphries Illustration

credit: Grace Humphries Illustration

Since he died, though, the television had been uncooperative, and despite the best efforts of a stream of visiting grandchildren, she had gone three weeks without the shows that were a staple in their daily routine.

I was visiting last week and I dutifully played with the remote. The television flickered on. Oma cheered. I turned it off so we could visit. A minute later, with a sense of foreboding, I tried the remote again. The TV refused to work. More fiddling and buttons and twisting of wires and it came to life again. Oma actually shouted: "Leave it! Don't turn it off! Just keep it on!"

She settled back in the chair, and I went to pack up Opa's clothes in the bedroom. 

Their bedroom had been a hallowed place my entire life, understood to be supremely private and off limits to exploring grandchildren. And here I was, alone in the sanctuary: a small bedroom in builder's beige with a double bed covered in an orange and brown crocheted afghan. A photo of myself at age 8, with sisters and cousins in braids and bright dresses, above the bed. My sister's kindergarten picture tucked into the frame of the mirror. Wedding pictures of children and grandchildren on the dresser. And a wardrobe with Opa's clothes: two suit jackets, a few pairs of pants and a handful of plaid shirts. 

As kids we thought our grandparents were fantastically rich. It wasn't until my adult life that I realized I had mistaken generosity for wealth.

So there I was, folding his pants, removing lapel pins from suit jackets, and checking his shirt pockets. In my mind my grandfather was tall, expanisve, so much bigger than myself, but lining up the creases in his pants I was struck by how short the legs were. I tried on his belt, and it didn't wrap around my waist three times as I'd expected. 

And while I stood there having these childhood illusions smashed, I could hear Oma in the next room contentedly murmuring, "Ja, ja, ja," as contestants shouted over each other and bells rang.

When I had packed his entire wardrobe into three Safeway bags and returned to the living room, she looked peaceful, the happiest I'd seen her in a month. I realzed she was never going to risk turning the TV off ever again. I showed her how the mute button worked. "For when you need to go to bed," I said. She kissed me good-bye. I showed myself out.

And that is how, in a very full week of patients and meetings and decisions and children, the most important work I did involved a game show. 

Owning 2014

For the first time, the idea of New Year's resolutions bores me. I've carried them out for thirty-something years, and if there are any self-improvement projects outstanding, I'm willing to accept that this is as good as I get. This cyclical reinventing is tiring me out. 

This year, I'm going to own what I already have.

I'm going to own having four kids; no more whispering Three was actually the perfect number! to onlookers. I'm going to own being a family physician at the refugee clinic. No teasing myself with ads for R3 residency positions this year, and no peeking at the eye-popping figures some of my medical school classmates bring in.

Also to be owned in 2014: this weathered house on stilts on the cliffs of Deep Cove, including wobbly walkway pavers and yellowing bathroom linoleum; a body that's borne four kids and carries me around without complaint, ever; a face with ever-darkening under eye smudges that still laughs every day with kids and patients. 

Let's include living in Vancouver, vibrant and gorgeous, despite property costs that make me sweat when I see what proportion of the mortgage payments went to interest. And friends, whom I don't keep up with enough - I'm going to own them, too. And family: my grandparents in their little New Westminster condo, my sisters who got the good hair in the family, in-laws and nieces - they're mine for life, and I'm going to own them.

All the unfortunate things I will do in 2014? They're mine. Any irritability, ridiculously late email replies, or impatience when you question immunization - I take responsibility. Any good ideas, generosity, incredible diagnoses? Also mine. 

So yeah. Even without resolutions, I think I've got a lot to work with. Funny how even better than dreaming is recognizing the parts of your life that you'd dream for if they weren't already yours. 

Happy 2014. Own it.

Once upon a beast 2014 Calendar by Hillary Kupish.

Once upon a beast 2014 Calendar by Hillary Kupish.

James Moes' portraits of our family in the woods.

A few years ago, I was reading an article when the accompanying photograph caught my eye. It was attributed to James Moes. There had been someone by that name in the very small ethnoreligious group in which I grew up, a younger sibling of my schoolmates. It didn't take much sleuthing to determine that yes, it was him, and he was now a Seattle-based photographer with an art degree and a breathtaking portfolio.

His work was different from the slightly overexposed, closely cropped photos I seemed to see everywhere else. He made great use of landscape in his portraits, and wide-angle lenses, and shadows. I followed his blog (now defunct, unfortunately), and joined his 1.2 million (yes, you read that right) Pinterest followers. I didn't enquire about hiring him because he lived in Seattle and didn't feature any family shoots in his portfolio. Also, he didn't post his fees on the website. The last time I enquired about something without a price tag was at a Granville Street art gallery, and they began by offering me financing. 

What follows is one of the reasons I'm still on Facebook - because for all the nothingness on there, there's the occasional prize. Pete's cousin posted a link to an auction that was to be held to help fund an adoption by James' cousin. I idly scrolled through the list of items, and, buried in there among gift baskets and wooden benches was a photography session with James Moes. This was it. I was certain that (a) few people in our shared community of origin would truly recognize the extent of James' talent, and (b) they wouldn't be willing to pay for it even if they did. Culturally-ingrained frugality runs deep in this group. 

I couldn't make it out to the auction, but there was the option of submitting a maximum bid online. One of the host's friends would act on the absentee bidder's behalf. Though I wanted to point out the conflict of interest in this setup, I went ahead and entered my bid and contact information. My phone rang minutes later. The caller apologetically told me that she had received my entry, but unfortunately it was garbled. She laughed and told me the ridiculously excessive bid amount she had received. "That IS my bid," I told her. The call ended awkwardly for both of us.

Next morning, I received the email announcing my win, at 2/3 of my bid limit. And it really was a win, even though I'd paid for it. 

A few months ago, James and our familly hiked up to Quarry Rock in Deep Cove. We've lived here for almost eight years, and the forest and water, trails and sword ferns, feel like our natural habitat. I love that they feature so prominently in the portraits. Here's a sampling:

You can find James at his website, on Twitter and on Pinterest.

In-flight medical emergency

The Italy vacation wasn't all cathedrals and olive groves. On the trip over, I encountered my first in-flight medical emergency. 

We're two hours into a nine-hour Vancouver-Frankfurt flight. To celebrate embarking on this trip I'm wearing my new hacking jacket, a grey wool blazer with leather patches on the elbows. The back of the Airbus is extremely warm, though, and I'm sweltering. I feel a little self-conscious about removing the coat and sitting in a public space in a camisole, but Pete assures me it's not a problem. 

I've just folded up my coat when a man four rows up stands and begins shouting in alarm and pointing at the fellow across the aisle, who's slumped over, unconscious. I rush to attend to him, only briefly considering and reluctantly rejecting the idea of taking the time to put my jacket back on. So there I am, kneeling beside this man, in skinny jeans, cowboy boots and a black camisole, announcing I'm a doctor. I don't think I cut a convincing figure. 

Meanwhile, they've made an overhead announcement calling for doctors on board, and an internist arrives from first class. She looks every bit a doctor: professionally dressed, mature yet attractive haircut, and self-assured. "It's awfully hot in here," she announces. "It's a lot cooler up front where I am."

As we tend to the patient together, who's short of breath and looks unwell, she tells me, "I know for a fact that there's a cardiologist on board. He's in first class with me, and I saw him going over his presentation slides." There's a reason that airline reservations offer a tick-box for Dr, and there's a reason physicians don't select it. 

Suddenly the patient's chest starts to heave. He looks around desperately and then tilts his head back and turns toward the aisle. Too late I recognize what's about to transpire. A fountain of vomit hits me, splattering me from my hair to my boots. His own face is covered in it. The flight crew rush up with towels, horrified for me, but I can't clean myself up before the patient is assessed and stable. I wave them away and call for barf bags as he retches again. Three helpful neighbours thrust one at me.

The internist and I move him to the galley. We go through the on-board medical equipment and find a stethoscope and blood pressure cuff. Soon he's feeling much better, his vitals are stable and we've dressed him in a grey button-down worker shirt donated by Lufthansa. 

The flight crew watch all of this with interest. One of them remarks, "Did you see that guy back there who jumped up to get a t-shirt form his own carry-on to give to this man?" Everyone murmurs at how remarkable that is. It pleases me no end to reply, "That was my husband." This is well-received. "He's not medical," I say, "but he does what he can."

They kindly offer me the same airline shirt they gave the patient, sealed in plastic, and I squeeze into the tiny washroom to wash up and change. It's next to impossible to rinse my hair. I do what I can to make the shirt work: unbutton a few top buttons, roll up the sleeves, half tuck it into my jeans. They don't have regulation pants, so I'm left to dab my jeans off with a damp paper towel. 

The internist and I make a plan for monitoring the patient, the flight attendant takes my contact information and assures me I'll be hearing from them, and I return to my seat. My beloved jacket is where I left it, folded and clean, and I realize how narrowly it missed an assault that no amount of dry-cleaning could undo.

Some kind of chemical absorbent has been spread over the surfaces which had contact with vomit: his seat, a little up and down the aisle, and a substantial pile exactly where I'd been positioned. The flight is fully booked, so when the patient returns to his seat a few hours later, he has no choice but to sit in the same now-soggy seat he started in. 

It takes me a while to wind down from doctor mode. I'm on high alert, ready for the next event. It takes hours for the indignity of the experience to sink in. It isn't until I notice a substance on my watch strap, missed in the wash-up, that I feel some revulsion.

When we disembark at Frankfurt, I see the man at the gate, chatting with the internist, fully recovered. It's good to see him well. 

Waiting for our next flight, looking around at the airport bustling with people, it strikes me what unusual beings humans are. When one of us goes down, even a stranger to the group, without fail another sounds the alarm, and others rush to help. I like that.