Saturday, July 23, 2016

Did the original Bridge of the Gods have a toll?

This is my first rough draft of the second chapter. Struggles remain with this story and in some ways I feel compelled to just get stuff onto "paper" so I can clean it up and reorganize while knowing full well that I may not even like what I have. The idea of writing about historical events in fiction is so very intriguing to me and in that sense, I really want to make this work. However, my thoughts of how to do so are divided and it is showing in the writing -- the action is happening too fast -- huge momentous action scenes, such as an earthquake causing a mountainside to fall into a river, creating a huge wave that sets a canoe on the opposite shore's cliffside is a crazy, Hollywood-esque scene. I start and finish it with a few paragraphs. In chapter two, I have a man tumble down a huge set of rapids, nearly drowning and then saved within a few paragraphs. Perhaps I'm writing short story yet and I just haven't come to terms with it yet! And that is okay -- I'm used to being told things by my subconscious that I may not really like. 

Chapter 2

            The early flames of panic began to lick the mind of Nuua-Slingit. His canoe was laden with pelts and grains and admittedly, a canoe the size he was piloting really needed two people to safely navigate. He had seen the rapids as he ported his canoe and goods while going upstream. He was now coming upon them as he headed back home, downstream. The violent nature of the rapids, with huge boulders and boiling pools of green water made the decision to circumvent the water an obvious decision. This was his first trip from his home with the Clatsop people on the coast at the mouth of his river, to the Walla Walla tribe, who lived on the same river but three weeks east, into the dry lands.

As he approached these rapids from the eastern aspect he was on the north side of the river and unbeknownst to him, there was no place to pull the canoe ashore, as there was on the south side. A rocky shelf that abruptly ended, plunging into the river was all that the north shore provided. He had frantically tried to grab the rock to slow the canoe but only earned bloody and torn hands. When it became obvious he would enter the rapids with his canoe, he jumped into the cold water and held on to the side of the canoe in hopes of pushing off into relatively quiet pool close to shore. As soon as the canoe hit the first drop it pushed the back of the canoe, where Nuua-Slingit was holding on, violently sideways. He was flung backwards. The last thing he remembers is the searing pain in his back and gasping for air as his breath was knocked out of him.

            The small village of fishermen on the south side of the river had seen this seen unfold – they had yelled to him but the river was so wide that Nuua-Slingit could not hear them. One of the men had run to a small canoe on the sandy beach positioned downstream from the rapids. He paddled out into the river to find what he assumed would be the body of the unfortunate sailor. To his surprise Nuua-Slingit was alive, but bleeding and not breathing. The man pulled his upper body into his canoe and turned back to the river’s south shore. Nuua-Slingit coughed and river water shot out of his mouth. He began to gasp for air. By the time the rescuer had circled around to head to the south shore, the debris of the destroyed canoe and cargo was slowly bobbing away from the rapids.

            Nuua-Slingit’s survival was looked at with awe by the people who lived in this small village. Hundreds of people had accidently gone through the river’s gauntlet in the people’s memory and very few had survived, most were never found. For the first day he was delirious, refusing water and food and speaking gibberish. The eldest man, who functioned as the tribe’s doctor for most of his life, stayed with Nuua-Slingit in the same long-house. Through observation, the doctor recognized, by pressing his ear to his chest, that breath sounds were decreased on the patient’s right.  Also, the rise of the ribs was not the same, with the left side moving more. He had seen this previously and had learned from his mentor to craft a dried lambskin tube and insert it into the throat and push until the tube was in the chest. By marking the tube intermittently while it lay on the patient’s chest he could tell how far the tube was inserted. The tube was inserted and the doctor placed his moth around the end of the tube protruding from the mouth. Matching the inhalation pattern of the agitated patient he blew hard into the dried lambskin tube. He repeated this until the chest rose symmetrically.

            The days turned into a week and the delirium continued to slowly fade. Instead of fighting the sips of water offered by the doctor, he eagerly took them. His appetite returned with vigor.

            Nuua-Slingit stood by the fire for many hours after the others had gone to sleep. He had improved significantly in the past weeks since he had been recuperating from his disastrous canoe accident, but still struggled to sleep from the pain while lying down. Initially, the pain from his body weight pressing against his fractured ribs was enough to find sleep while in a sitting position. That had abated, but still, the very act of breathing was enough to keep all but the most desperate slumber at bay. Rib fractures are notorious slow to heal, as they must remain in motion. Nuua-Slingit had broken his arm as a child and knew the pain of a fractured bone.

            Despite the pain and the growing fear of how he was to get home, Nuua-Slingit began to enjoy the sleepless nights as best he could. The doctor, who was busy during the day tending to his own family and the ailments of the tribe would often stay up and talk with him. Nuua-Slingit was a young man, all of 23 years old and recently married with a baby one the way. He supposed that the baby may have already been born, as he planned his return to coincide with the delivery.

            The doctor told many stories – stories of triumph and heartbreak with all the people he had treated in his life. Nuua-Slingit’s favorite topic was the stories of how the rapids had formed – after all, the fishing village was close enough to the water’s edge so that the whitewater’s roar was ever present. Also, as he grew stronger he began to feel a sense of pride, albeit somewhat misplaced, that he had survived his calamitous accident.

            Ten generations earlier, a direct ancestor of the doctor was one of the few survivors from the tribe that inhabited the small fishing village, which at the time was not so small. A great shaking of the earth powerful enough to cleave the towering mountain on the north side of the river struck during a warm summer day. There was still evidence of this landslide, as the shear cliffs that apparently were only on the southern aspect of the mountain peak were striking. No trees grew there. The doctor said that if one were to climb one of the surrounding mountains and gain a bird’s perspective, it became clear that a landslide had pushed into the river, creating a bow in what was mostly a straight and broad river, for dozens of miles on either side. The river was noticeably narrower at the point where the rapids were, and clearly, the rapids were nothing more than the collapsed mountain that deigned to bury the river.

            Proudly the doctor told Nuua-Slingit how his forbearer survived when no one else did. He was saved by the river itself, as he fished with his net in the river, in his canoe, when the earthquake occurred. The massive movement of soil, trees and boulders pushed into the river creating a wave of gigantic proportions, one that lifted the canoe high into the air and as the wave crashed over the land, destroying the village and all living things in and around it, his ancestor was behind the crashing wave and ended up being gently deposited on the steep hillside that overlooked the village and river. As the water receded he watched from the side of the cliff as his loved ones and all he had known were swept into the river in a swirling mass of logs, trees, animals and people. The river itself had saved him and this was why the people who lived here revered the river and made their homes as close to the river’s edge as possible.

            Nuua-Slingit delighted in his imagination of what life was like for people who lived long before him. In his village there were stories of an earthen bridge that traversed the river, and this was collaborated with other stories the doctor told him during the cool sleepless nights. The landslide had come to rest on the south side of the river. It had created a damn, with a lake quickly forming behind it. The former place of the village was now a part of the earth, swallowed up with no trace left other than the debris floating to the sea. The lake continued to grow and push against the damn. Over the years, with the lake now many times wider than the original river, it pushed out the dirt from under the damn. At this point, the damn had become a conduit between the northern and southern tribes, which before had to rely on boats to ferry people and goods to each other. The river bed downstream still had water in it, but until larger tributaries further down stream joined the river, it was only a ribbon of flowing water with a mud field on either side.

            The river is relentless and turned the damn into a bridge. The lake drained and a surge of water pressed towards the ocean, yearning to make up the lost time. The shallow rapids that nearly killed him were the collapsed remnants of that earthen bridge.

Nuua-Slingit was nearing full health and he set out to build a canoe that would take him home to see his wife and firstborn child.


Friday, July 22, 2016

Meany - ful Use

Earlier this year I felt great relief when I matched into a graduate medical education program that would allow me to train for three years and at the end, allow me to take a test in which I could earn a board certification in internal medicine. During these three years a great transformation takes place -- a doctor in practice replaces a doctor in name only. After those three years I would spend two years learning how to be an intensive care doctor -- an intensivist. A good portion of my life's efforts for the past ten years had been in the name of this process. I've taken on over $400,000 worth of debt in this process.

"Why do you want to be a doctor?"

This is a question that any pre-medical student hears frequently. I came up with many clever and thoughtful answers (not mutually exclusive) during that time, and over the years since my numerous medical school interviews. At the heart of it all was a desire to have a job where at least an element of "noble" potential remained. Physicians, by no means, have this type of job cornered. A customer service representative that does a good job helping people may enjoy a more noble career than some physicians I've met. I wanted a career which had a high ceiling for this esoteric idea of being noble, and that mixed with the other components of science, medicine and intrigue sealed the deal.

Due to a few personal reasons I've taken a step back and am not in residency. My classmates, for the most part are approaching the end of their first block of residency; their intern year 1/12 complete. I'm proud of them. They are averaging less than minimum wage pay per hour in the hopes of becoming competent enough to truly improve their patient's lives. And, it is not about the money. Physicians will be better off financially than most of the patients they treat. What it is about is being able to use the expertise and years and years of intensive training to practice medicine. Physicians in the United States have given this away, as if it meant nothing. One could argue it was wrestled away, but this is besides the point.

I've been working as a clinical consultant helping physician's deal with a new electronic medical record implementation in their clinic.

The frustration of being handicapped by administrative decisions is apparent.

The bitterness imbued by a bureaucratic machine that scolds physicians for writing pain medication prescriptions per their expert judgment (and makes it an enormous pain in the ass for the patient and amazingly large time sink for the clinic) but ties their compensation to patient satisfaction, is front and center.

The worry for patients that can't afford their medications, procedures, or imaging -- much less their deductibles detracts from the joy of catching a serious diagnosis early or reassuring a new mother.

The disrespect from patients who are frustrated with navigating the inhuman and cold machinery that is American healthcare is understandable, but slowly eroding the will to continue clinical medicine.

I thought I wanted to be an intensivist. I thought I wanted to help the sickest people and respectfully usher the dying and their families through the final phase of life which is waiting for us all. I would be good at it but the price to pay is not something that I'm willing to do.

Instead I am redoubling my efforts in areas that I believe allow for noble efforts that will be supported by me being a fully licensed physician. I started a consulting company aimed at creating education for medical professionals and patients. I wish to write in a capacity which fosters understanding that things are not "okay" and "business as usual" when it comes to medicine in this country. And, yes, it's not all about the money, but I am worried for my family's future when most of my student loans accrue interest at over 8% with a recapitalization of the interest annually. I feel compelled to have one foot in medicine and one in business and that is what I'm doing this year: assuming a businessman pose while re-entering residency a year from now. Oh yeah -- and getting my fat-ass in shape, too.

Thursday, July 7, 2016

Ruff Draught

A complete rewrite of the first chapter. I read the other chapter, with some editing, at a writing workshop last week and it fell flat. I received many solid critiques, namely that I was overreaching with my flashback scenes in the rough draft and that my mixing of modern "white-man" terms with Native American terms was confusing, and a little patronizing. I also took the outright references to the landmarks, rivers and mountains out and described them without the names. Simple things, like describing the canoe as being the length of 5 men laid end to end, versus a canoe 30 feet long. It has to be kept simple, though, and describing long distances, such as the width of the river is more difficult. We'll see how it shakes out. It will be an ongoing challenge to balance this particular facet of the story telling. I'd be lying if I said I wasn't looking forward to the modern stories. 

Chapter 1 (first major rewrite)

The biggest were the size of my hand. The thick line of raised scaly ridges broke the water close enough for me to touch them. It prompted my dad, in the front of the dugout canoe, to thrust his fishing net into the cold swift river water. I could see the fish now, which was at least half-as long as this canoe, which measured 5 grown men from head-to-toe long. It swam into the net. The canoe lurched forward ensuring my dad, at the front, my mother in the middle and me in the back went tumbling backwards. I hit my head hard on a cedar box secured to the stern of the canoe, dislodging a pile of sea otter pelts and burying my upper body in stinky oily fur. 

            I climbed out from under the pelts with much effort and found my parents holding their bellies from laughter. The sturgeon had taken the net when my dad lost his grip and we could see the wooden handle bob across the surface of the river. This was not the first time a net was lost and there were more in the canoe. 

            “We're getting close to the waterfalls. Let us stay close to shore as we come around the next bend.” My father said, still smiling while he watched me restack and tie down the pelts. 

            Now that I was thirteen years old I was expected to be able to man the most posterior position and handle all the responsibilities concerning paddling this large canoe. I had grown a lot in the past year but was still a smaller version of my father. We both had the long black hair separated into a handful of braids with seashells as clasps; his was much longer than mine. We also shared broad shoulders upon which hung determined muscles of our torsos, his much more developed than mine. 

            Sunshine and a warm breeze filled the gorge through which a mighty river flowed. We had started our journey in this canoe three weeks prior, from the southern aspect of where this river meets the sea. A wide tumultuous area of water, where the sweet water mixes with the dominating saltwater; this, along with the winds and frequent storms characterizes the nature of the river where we lived. Learning to pilot a canoe in dangerous waters like that allowed for carefree enjoyment of paddling the canoe on this protected stretch of river. On both sides of the river rose vertical granite walls. This was the beginning of summer and the waterfalls that plummeted over the cliffs looked like slivers of clamshell interiors stacked up along the cliff. 

            “How soon until we land, dad?” 

            Here the riverbank was rocky and uneven with no obvious good place to pull the canoe ashore. Stories that my dad had told me since I was old enough to understand him described the stretch of river we were coming upon. The year I was born, my father had been on the return leg of this very same journey and nearly drowned. At no point was this a lazy river but this area was impassable by any ship, marked by rapids and numerous disjointed waterfalls. Even the salmon had to fling themselves out of the water in hopes of climbing the smaller boulders as they returned home to spawn. The people who lived here had constructed boards that jutted out over the whitewater allowing them to catch a flying fish with their net. 

            “Don’t worry, Nuua-Chaahh” said my dad, “in a just a bit we’ll have a sandy beach that will allow us to push up right out of the water.”

            My father, Nuua-Slingit had done this every summer for the past fifteen years and knew what he spoke of. As soon as we passed the bend and I could see past the rocky outcropping, the still dull roar of the rapids surrounded us. The sandy beach that eased out from the river on the beach was obvious and I started to point the bow in that direction.  I began to breath hard as I paddled, trying to gain enough speed to beach our canoe. At first I was not sure if the low rumbling was in my ears alone but suspicion was confirmed with the look on my mother’s face. Wide-eyed she was staring at the northern shore, across the river from us, which was shaking back and forth. I turned my head back around and saw the beach, which we were fast approaching, shaking back and forth, too. I resumed paddling, imagining that we should beach the canoe and run into the forest. We hit the beach with a lurch. This time we were all ready for it and jumped out started to pull the canoe up onto the land. 

            We had the canoe half way out of the water and the earth was still shaking; it had been at least 20 seconds thus far. The roaring of the shaking was marked by a sound like I had never heard before; like a stone striking another stone but so loud and pervasive that we all turned to face the mountain peak north of the river. The side of the mountain facing the river has falling towards us, towards the river. The David Douglas trees, which sat so majestic and silent, reaching for the sky, were now pointed towards us -- and coming fast.

            “Laana-Tshimshian! Nuua-Chaahh! Get the boat back into the water!” My father yelled frantically at my mother and I. I was still frantically was pulling the canoe onto the sand, not understanding why he wanted the boat back into the river. 

            The side of the mountain continued to separate and fall towards us. Whether or not the earthquake had subsided none of us knew. The sound and vibrations from the mountain on the move took up where the earthquake would have left off. My father had run around the side of the canoe and was now pointing and pushing for my mother and I to get the canoe back into the water. It was clear that there was no arguing with him.  

            We pushed off into the water and with my father in the back of the canoe he told us to paddle straight out from the shore. We did. The mountainside had reached the basin and was now entering the water with full force. It became obvious that wave of water that was to result from this intrusion into the river would be of significance. My mother and I exchanged glances and we both could tell the other was unsure about continuing to paddle into the river. We were now three times as long as the canoe in distance from the shore. My father yelled for us to continue paddling. The wave began to take shape and was gaining height. We continued to paddle towards it; the wave hurdled towards us, lifting the river upwards towards the peaks of the southern rim of the gorge. We paddled; the lip of the wave was now high enough that we could not see what remained of the mountains on the northern aspect. The bow of our dugout canoe began to rise and we were lifted upwards and backwards. We all stopped paddling at this point and were holding on to the sides of the canoe. We accelerated, moving backwards away from the still moving landslide, which we could now see as we were on the crest of the wave. It felt like we were flying – perched on the crest of the wave, unable to see where we were going, facing backwards. This continued for an unbelievable amount of time; I raised my head and looked behind me and saw the still immobile trees of the southern shore getting larger. We were riding the crest of the wave past the river shore and up into the forest where the cliffs began. We hurtled towards the tips of the trees while the wave began to break into a chaotic blur of pine needles and whitewater. The day's third lurch of the canoe overshadowed the two previous. The wave had let us down into the trees and I was now falling out of the canoe and through the wet arms of the trees, I didn’t know whether to prepare to drown or fall to my death but I tumbled and tumbled, with no orientation known until I stopped falling. The large fish just down the hill from me, with a fishing net around his head, flapped occasionally, knocking the surrounding trees with the fishing net handle. That and the dripping of water from the trees was the only sound besides my own breathing.  

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