Life in the ER - When diplomacy fails.

Dealing with ER patients is mostly straightforward.  Be polite.  Remember that most of them are having a Bad Day.  Practice good medicine.  You will generally do fine even with what some would regard as challenging patients.

But one category requires special handling....kids from about age 2 to 10.  This is a demographic that is too old to fool and too young to reason with.  They are often quite frightened, especially so if they have had previous difficult encounters with the medical system.

Dealing with parents is the topic of another post entirely, but I will mention in passing that you have to always remember, even if the reason for bringing the kid in looks rather silly objectively, that they are motivated by concern for their child.  This is always worthy even if practiced to excess.

But back to the suspicious toddler types.

Always move slowly.  You can do things gently or you can do them quickly.  Unless you have a genuinely life threatening situation on your hands, or if the ER is collapsing under the burden of multiple messes, you just have to take your time with things.

I always try to sit down when dealing with patients.  If you tower over them you just make them more nervous.  This is especially true of children.  Of course I have to talk to the parents, but I keep watching the child out of the corner of my eye.  Usually I catch the kid doing the same thing.  It helps if they think of you as more of a "co-conspirator".

You never want to have to use brute force.  I for instance will not restrain a child for stitches. You use whatever pain control measures are necessary, hopefully in a good tasting oral form, then wait for it to work.  Tell stories while you work.  I have some excellent ones.

It helps to distract them when necessary.  There are a few minor magic tricks that can be done with tape measures, tongue blades and reflex hammers....

And if diplomacy and trickery fall short, well, there is always BribERy.

We have child sized containers of ice cream.  We have stickers.  Combine the two.  "Hey, want some Spiderman/Princess Ice Cream?".  I will usually offer either one and can say that the gender predictable choice is opted for about 95% of the time.

And if that does not work....

This is Coban, a dressing material sometimes called "Vet Wrap".  It is stretchy stuff that sticks to itself but not other stuff.

"Would you like a Ninja Turtle Head Band?".  Usually the answer is yes.  I could show you some really cute examples but, hey, privacy rules and all.  I sometimes put one on in solidarity with my young patient and I have no qualms on this point.

Having extensive kid experience raising my three boys, I consider this my comfort zone. Little girls are something of an enigma to me.  So I am always asking them about stuff.  It came to my attention that almost all of them have seen the movie "Frozen", and that the average number of tiaras that they own is about 2.5.  Well, since they went on sale at Target recently I just stocked up on them.  Can a gal, or I suppose to be fair, a guy, ever have too many tiaras?

I suppose the average reader still thinks of physicians as being August, somewhat Aloof professionals.  Thinks perhaps that the dignity of the Healing Arts precludes me modeling ER bribery Princess swag.

Happy to disprove that theory for you!

Hey, one never knows.  The Next Generation may include one or more little girls.  Gotta work on my Tea Party skills!

Rome - Some Minor Monuments

Sometimes in Rome you are just walking along and have to stop and say: "What is THAT?"  This big slab of ancient masonry just sticks out of some buildings on Via dell' Arco della Ciambella.  It is a surviving bit of the Baths of Agrippa, circa 25 BC.  These remains by the way are a gentle curve, part of a remaining niche or semi-circular room.  The other half is out of frame to the left.  The name of the street you are standing on here reflects this....it means approximately "Doughnut Street".

The next two pictures are not so much monuments as, I think, some sort of graffiti.  They are both from the Palatine Hill, so they were in spitting distance of the Imperial Palace.  When I saw the first one I figured it might be some kind of game board.  You see odd things carved on stone that we assume were used for some now forgotten amusement.  

But then I saw this one that makes my understanding harder.  Faintly carved but on a very tough basalt paving stone.  Was this some kind of "Palatine logo"?

In the Campus Marti neighborhood they had a lot of problems with flooding.  In various places you see these "Flood Tablets"  These are on the wall of Santa Maria sopra Minerva....and fairly high up on said wall I might add.  Oh, and the river is half a mile away.  These tend to be rather whimsical inscriptions.  The largest one shown here reads:

IN THE YEAR OF THE LORD 1530

ON 8 OCTOBER

BUT IN THE SEVENTH YEAR

OF THE LORD POPE CLEMENT THE SEVENTH

THE TIBER ROSE TO THIS POINT

AND NOW ALL ROME WOULD HAVE BEEN OVERWHELMED

HAD NOT THE VIRGIN

PROFFERED SWIFT AID.

Now this is an oddball, and one that I find documented nowhere on the internet.  It is on the Capitoline Hill, out back behind the Museum.  Its located next to a little path that nobody seems to walk on and is among some scrubby foliage.  The inscription translates to:  "Oak given to the Italian sword team that won the XI Olympiad in Berlin".  This and a very similar adjacent stone recognize two Italian fencing teams that won Gold at the controversial 1936 Berlin Olympics.  I got to wondering....with World War Two right around the corner, how many of these Italian young men - in a rather martial sport - ended up dying in the war?

Answer....none, they all lived to ripe old ages.  You might think that this says something about the Italian war effort, but actually fencing is a somewhat aristocratic sport in which the highest level competitors are usually on the mature side.  These fellows were mostly too old for combat by 1939.

As a very odd, very off topic aside, Helene Mayer who won the Woman's Silver for Germany is felt to have been Jewish, but was still invited to be on the team.

My last example is in the Trastevere neighborhood.  The translation on this one is difficult...

But it says something like this:  "By order of the Honorable President of the Road it is forbidden to make a dumping of filth in this alley under penalty of ten scudi (this was a silver coin) and other corporal punishments"

Since this was posted in  December of 1763 things have gone down hill considerably!

Note, an interesting further discussion of these No Dumping signs can be found HERE

Ignoring the Pantheon for a few minutes.

Ah, the Pantheon.  One of the great monuments of ancient times and a structure that has inspired many architectural visions throughout history.

Eh, not going in there today.

The image above is not one of mine, the day I went to the Pantheon we had blazing early morning sun that washed out the view from this angle.  Tip of the hat and photo credit to a fellow named Jean-Pol Grandmont off of Wikimedia commons.

No, today we are going to visit North, South, East and West of the Pantheon, checking out some bits of history that are seldom considered.

From the photo above, I suggest we first turn around and look to the North.

The Piazza della Rotonda gets its name from the dome of the Pantheon.  A rotunda (from the Latin rotundus) is a building with a circular plan.  The Piazza is a fun, busy place with lots of pedestrians enjoying themselves.  It used to be a little less savory, the inscription shown is on the north edge of the square and translates to:

IN THE TWENTY-THIRD YEAR OF HIS OFFICE PIUS THE SEVENTH

SUPREME PONTIFF, IN AN EMINENTLY WISE ACT OF DEMOLITION

FREED FROM ITS HATEFUL DISFIGUREMENT

THE SQUARE BEFORE MARCUS AGRIPPA'S PANTHEON

WHICH WAS ENCUMBERED BY TAWDRY SHOPS,

AND BADE IT TO COMMAND A CLEAR VIEW.

Sounds OK, although I personally enjoy the occasional visit to an "Ignobilibus Taberna".  But the inscription is a bunch of nonsense.  Pope Pius VII was notorious for claiming credit for the work of others.  This 1822/23 inscription actually refers to demolition work done during the French occupation of 1809-14.  And what Napoleon had in mind was not eminently wise, he had issued decrees for wholesale demolition to create a big traffic circle. Events elsewhere in Europe ended French rule of Italy before he could commit this horrid deed.

Now we look on the east side of the Pantheon.  You can see its wall on the left of the photo:

That is the original ground level down there.  The walls you see are part of something interesting.

The Septae Julia was a large open courtyard space designed, logically enough, by Julius Caesar. Completed after his death by his friend Agrippa,  it was initially where Roman citizens would gather to vote. Sometimes they had gladiatorial combat there.  Later it became a mixed use space with the temple of Minerva in the middle and with market spaces along the sides.  These spaces were called porticoes and in a preserved letter of Cicero it is said that they totaled a mile in length.  The side adjacent to the Pantheon was The Portico of the Argonauts after artwork located there that depicted the famous mariners.  A nice reconstruction of the neighborhood can be seen HERE.

During the Roman Imperial period the Portico of the Argonauts was the place to go if you wanted to purchase art and antiquities.  Imagine the sculptures - Greek original and Roman copies - that were bought and sold in what is now a neglected little trench.

Now lets walk around to the south side of the Pantheon:

Again we have the original ground level and a set of surviving columns from the Basilica of Neptune. Rome being basically a land power whose relationship with oceans was a bit uneasy, it is interesting to see two nautically themed sites adjacent to each other.  The explanation is that the entire area, Pantheon, Porticus of the Argonauts, Basilica of Neptune were all the work of one man, Marcus Vipsanius Agrippa.  As the man mostly responsible for the naval victories that put Augustus in firm command of the Empire, the nautical theme makes sense.  Some of this project was Agrippa giving thanks for his success, other aspects of it were public praise for it.

Sometimes I like to focus my attention and camera on a tiny detail that has no relevance.  The wide cement ledge that separates the modern street from the archaeological remains is of course new.  But I liked the silly little metal bobs on it.  What purpose could they ever have served?

And speaking not of purposes but of porpoises, here are a few details that survive of the Basilica of Neptune:

It has the look of something that was found down below in a bunch of pieces and was stuck back on the wall in what they hoped was the right spot.  The Basilica of Neptune is one of those ancient structures that it is very difficult to visualize.  It has for one thing been sliced in half by a modern street, and certainly there was some more recent building that made it contiguous with the Pantheon.

To complete our circumnavigation of the Pantheon you could look to the West.  But here you will not see any ancient remains.  This was the site of the Stagnum Agrippae, a large pool of standing water associated with the Baths of Agrippa.  Stagnum means "standing" and gives us our modern word "stagnant" in English.  The etymology of this complex of words is way beyond my pay grade, similar sounding spin offs appear to include "status, stasis and stare" in English.  And in Italian when you ask somebody "Come sta?" you are literally asking "How are you standing?".

Archaeology of Rome and of the English language......

Regards the Pantheon I will take you at least up to the front door some day soon.

Rockets and Ruins

Well now, what have we here?

A fireworks stand with ancient stone columns in the background!  Huh.

Another view from a different angle, this time showing the "chainsaw art" establishment behind it. This odd little emporium is on my way north to the the cabin so if I ever want a full sized rustic carving of a bear I know where to stop.

This is all part of an odd little town that is centered around a saloon.  The owners, or perhaps some previous owners, had very eclectic tastes and the place is festooned with old metal signs, lumberjack implements, pinatas, bicycles....you get the idea.  I assume that the columns, and they are genuine granite, were hauled in as part of this kitsch-fest.  The conversation around the dinner table that night must have been interesting:

"Dearest?"

(long pause)  ".....yes?"

"I bought some big stone pillars off of a Carnegie Library.  They're being delivered on Tuesday."

(silence in which room temperature drops perceptibly).

So, rockets and ruins albeit the latter are somewhere between faux, folly, and spolia.

It has been a bad stretch for genuine ancient ruins of late.  Callous despots don't mind hiding ammunition dumps in them and the chaotic savages that seem to swirl in the wake of unrest have actually begun taking hammers to our collective heritage.  As they are simultaneously at war with the Past and the Future there seems to be no way to appeal to any common ground.  Whatever your political inclinations I think we can all share an abhorrence of these twisted beings - more orc than human - who transgress all constraints of human decency and of the true tenets of their religious heritage in fevered pursuit of a dark and inchoate dream.

I sure hope not, but is it possible that some far distant archeologists will look at an obscure little Wisconsin hamlet as the apparent last enclave of ancient Roman civilization?  Scholars have made sillier mistakes when presented with nothing but a jumbled pile of splintered debris.

It is the Fourth of July.  A time when we Americans celebrate what is right with our great experiment. With apologies to my British friends I suggest that we all do the same each in our own ways.  For all the troubles of the world there is still much to be proud of, much to aspire to.  Perhaps for one day we can forget what is wrong and celebrate the better aspirations, not just of America but of all lands where the Rule of Law is respected and where people hope for a better tomorrow.

Fourth of July Themes - 2015

I used to like fireworks a lot.  When my boys were of an age to enjoy them we would always purchase a few, sometimes within the boundaries of loosely enforced laws, sometimes just a bit over them.  Nowadays it is not a particular interest of mine, but I still wander by the colorful fireworks stands once in a great while, just to see how things change.

When I was a young lad with a book of matches, most fireworks were made in the Portuguese colony of Macau, one of those odd little dots of foreign territory grafted onto the coast of China.  All of these have since been absorbed by their gigantic neighbor, so most of the fireworks we see for sale today are from the original home of gunpowder, China.

This makes for some interesting twists.  The Fourth of July is the quintessential patriotic American holiday, but these highly visible symbols of it are made in a Communist nation that varies from lukewarm alliance through opportunistic neutrality and on occasion out into patient opposition to American interests.  I wonder how the pitch meetings go between the fireworks art designers and the Party Commissar at Pyrotechnics Factory 77.

"Your request to include Frodo Baggins is approved.  He demonstrates appropriate anti-fascist politics.  Your request to include 'Rambo' is denied.  Please report to the Re-Education committee to begin the self denunciation process as outlined in your Employee Manual."

It has been a while since my last trip to the Fireworks Stand.  I remember then seeing quite a few items referencing the 9/11 attacks and the subsequent War on Terror.  I think these will all be gone.

So, in anticipation of my visit I am wrote down four themes that I figured would be present in 2015.

1. Drones.  Hey, in the news.  They fly.  The blow up, makes sense.

2. Kardashians  Because American Pop Culture is pretty much everywhere.

3. Non specific warships and tanks  The Chinese military is doing a little flexing these days...

4. Retro military art. I don't even recall just what I had in mind on this one.

Well, never mind what I expected to find, what I actually did come across was....tacky and egregious Copyright Infringement.

Tutti Frutti...a Little Richard song and a brand of yoghurt.  Also 48 dollars worth of brief, explosive entertainment.

I rather doubt that the cultured Hannibal Lector would approve of his image being used this way. And whose disapproval would you most dread, his or the legal team from Orion Pictures?

I expect a certain level of cheerful low brow culture at the fireworks stand.  This is frivolity, plain and simple.  But there are lines they should not cross.  With apologies I present something that is way over such a line...

Shame on you Pyrotechnics Factory 77.  Shame, shame....

Warden Churchyard, Northumberland

Almost all church yards are dense with history, and in the UK you find some really remarkable examples.

Up in Northumberland, near Corbridge we made a brief stop at a place called Warden Churchyard.

The church proper is very old, with the squared off, military look to its tower leading some to speculate that the Saxon architect of this place might have used a still extant Hadrian's Wall turret as his inspiration.

You find all different layers of history.

Here, next to the door of the church we find what is felt to be a very worn down former Roman altar. It has a later carving of The Green Man on it.  Green Man was an odd hold over of pagan fertility cultism that the Church just looked at and shrugged.

I did read one source that fancifully claimed that the break in the middle was to "release" any pagan influences before the stone was allowed onto hallowed ground.  This is somewhat unlikely, stones have a tendency to break on their own.

Here's something you don't see every day....

A series of graves with iron cages on top.  No, not a concern about the Dead Rising Up as zombies. But something slightly unpleasant.

This is probably a "Mortsafe".  For a long time there was a stigma against dissecting dead bodies for medical education.  In medieval times it was opposed by the Church and even into the modern era it was not regarded favorably.  Medical students who wished to study anatomy would sometimes turn to "Resurrection Men".  For a fee these guys would go out under dark of night and dig up a nice fresh corpse for you.  The practice was wide spread, both in the UK and elsewhere.  It was especially prevalent and reviled in Scotland, where beliefs in the resurrection of the body after death were quite strong.

As a result measures designed to stop grave robbing were the most elaborate in the immediate vicinity of Scottish medical schools.  My examples from above are "over the border" in England but not by that much.

I actually question whether the intent here was preventing grave robbing.  Warden Churchyard is a long ways from any plausible market for a dead body, and the shelf life would be, er, limited.  Also, grave robbing was much reduced after the passage of the Anatomy Act of 1832 made access to unclaimed bodies much easier for students of medicine.  The death dates on these stones are all much later.  I can see an 1862 clearly and there was another that seemed to be from 1891.  Perhaps this was a mortician selling out old stock.  Or maybe somebody just indulging a rather macabre whim.

Our last stop today is a sad one.  Have a look.

An especially fine military monument in a country that lost so many of her best and bravest.

Now take a closer look.

Poor Private Thomas Harrison.  He died on the last day of World War One.  Literally on the 11th day of the 11th month.  For all we know it might have been on the 11th hour, the exact moment that the guns fell silent.

His name is relatively common, so I have not been able to find out much about him.  The designation
N.F. stands for Northumberland Fusiliers.  This was a long established Regular Army regiment that during the course of the Great War expanded into a bewildering 51 battalions and fought from the beginning to the bitter, bitter end.

I am not sure why Private Harrison died in Cardiff, Wales.  A reasonable guess might be that he died of wounds while in hospital.  The 3rd Western General Hospital there was a rather large establishment.

A Tomb with a View at High Rochester

It is natural to think of Hadrian's Wall as the frontier of the Roman Empire.  It stood astride the lofty hills with keen eyed sentries marching ceaselessly, ever vigilant as they looked northward into the dark, barbaric lands beyond.

But that was not entirely true.

The Wall, and earlier the Stanegate frontier that it roughly paralleled, were not a static, rigid edge of Empire.  At various times the Legions marched practically to the furthest extremity of Scotland in their attempts to chastise and/or subjugate the stubborn inhabitants.  For a while the Antonine Wall was the northern frontier.  And even when Hadrian's Wall was where Rome officially ended, there were a series of outpost forts further north.

We don't quite understand this situation.  In some instances they may have been an early warning system.  Certainly they were linked by a system of signal towers to the main defensive line.  In other cases they were friendly territory, tribesmen in the lowland regions might have been allied subordinate kingdoms or bought and paid mercenaries.  Perhaps in other cases these really were the armed camps with lurking hostiles that our imagination would make them.

On our recent trip to Vindolanda we made a quick trip up to one of these outpost forts, a place called High Rochester.  In Roman times it was called Bremium, and was located about 15 miles north of Hadrian's Wall on what is now called Dere Street.

Dere Street was one of the main north south roads heading north into Scotland, and High Rochester was an early site, built by Agricola on his punitive campaign after the Boudiccian revolt.

But today lets leave the fort aside.  The most interesting thing at High Rochester are the tombs outside the fort.

This artist's conception appears in The Outposts of Hadrian's Wall by R. Embleton.  It is based on what information can be pieced together from early antiquarian accounts.  The circular tomb on the left remains today.  The three rectangular tombs had their stones robbed out to make field walls, and have pretty much lost their shapes entirely.  The site today:

On our little road trips we do tend to strike poses suitable for 1970's album covers.

As you can see the upper earthen dome is no longer present.  A lot of it was probably removed when an Inland Revenue officer named William Coulson took a break from his usual job of intercepting whiskey shipments long enough to excavate this feature.  He fount an urn with cremated remains , presumably of a Roman officer, and a coin of Septimus Severus (222-235).

One one of the stones there is a carving of a long eared animal of some sort.  Fox, bunny, donkey, take your pick I guess.

The tombs at High Rochester are on a windy hillside.  Sheep wander about.  You are standing on the modern day border between England and Scotland.  There is not much in the way of land marks although in places you can see the track of the ancient Roman road.  We had heard that there were other tombs nearby so we scrambled up and down a while eventually running into a farmer who pointed us in the right direction.

There turned out to be about a dozen of these things, earthen mounds with a ditch around them.  You can make out a row of three in this picture.  Presumably these were the graves of lesser folk, or perhaps it is just a matter of any stone work being long gone.  There are no records regarding excavations, but it is hard to imagine that there has not been a bit of midnight digging over the years.

Pete relaxing atop an ancient Roman grave.  I am not sure why this struck me as a bit more cheeky than the entire bunch of us standing on top of the bigger example.  Maybe because I knew the occupant of that one had moved elsewhere circa 1850?  We had another week of excavation ahead of us so I decided to play it safe.  After Pete got up I carefully put a 10 pence coin down as an offering to the Manes and the Lares.  As we went on to have a very productive week my little gesture must have done some good.