Monday, May 30, 2005

Memorial Day

It's a beautiful, bright sunny day. That seems kind of ironic when we're remembering great sacrifices and difficult deeds. But we'll enjoy the sunshine today.

Memorial Day
the sun shines on sacrifice
we do not forget.

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Sunday, May 29, 2005

Haikus

Freshman44 posted a "haiku" found on a bottle of tea she was drinking, that went like this:

where you danced
bright shapes scorch
the autumn chill

by Elizabeth G. Scheib, USA.



and issued the challenge

C'mon, my bloggy friends. You can do at least that well.

My reply:


Lacking three lines of
five, seven, five syllables
it can't be haiku.

Haiku is a fixed
syllabic poetic form
by definition.

Take away that form,
it may be a verse of sorts
but not a haiku.

All right, I see you
groaning and shaking your head
at my lame haikus.

I've made my point now
with much verbiage, little pith;
I'll leave you in peace.



Anyone else want to join the fun? Haikus are extremely easy to write--just count the syllables in each line.

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Saturday, May 28, 2005

Word of the Day: Cryptomnesia

This a followup to my earlier post about plagiarism vs. inspiration.

Fellow blogger Richard Lawrence Cohen said in a comment under that thread, PK, your point that "it's essentially statistically impossible that those similarities will be extensive in any truly original piece" is one that Jorge Luis Borges might disagree with. In his short story "Pierre Menard, Auithor of the Quixote," a modern man becomes so obsessed with DON QUIXOTE that he is ultimately able to sit down and "write" two chapters of it, not by copying or memorizing but by reproducing it from his innermost depths. The two versions of the great novel -- Cervantes' and his -- are seen to be different works with different meanings, because of their different contexts, even though they are word-for-word identical. Was Borges right? I think that he invented a brilliant illustration of the importance of context. But his fictional character could only reproduce two chapters of Quixote, not the whole thing. And after all, it's only a story. In real life it would be plagiarism.

I hadn't heard of that story, Richard--thanks for mentioning it. It is very interesting.

However, we need not turn to fiction for examples of accidental plagiarism. There are a number of historical examples of someone unintentionally plagiarizing someone else's work simply because it had become such a part of their consciousness that they didn't even realize they were copying it.

There's actually a word for this phenomenon: cryptomnesia. That was my new word for today. :)

Merriam-Webster's Medical Dictionary defines cryptomnesia as "the appearance in consciousness of memory images which are not recognized as such but which appear as original creations." In other words, it's something you remember without remembering, thinking it's your own creation when really it is from some other source.

Historical examples of cryptomnesia include Mark Twain, Hellen Keller, and possibly George Harrison and even Friedrich Nietzsche and Carl Jung.

The most famous (and most extensive) example of cryptomnesia is the famous blind and deaf woman Helen Keller. She is the only person we know of who was able to unconsciously reproduce extensive selections from others' writing that were very close to the original. Other authors have reproduced only small sections, and a person would have to have a truly amazing memory to be able to do what Hellen Keller did.

Helen was able to reproduce entire stories, poems and large excerpts from other literature with only minor changes, sometimes years after hearing them only once.

At the age of 11 or 12, she wrote a story called "The Frost King" which was later discovered to be a very close reproduction of Dorothy Canby's story "The Frost Faeries", which had been read to her by a family friend two or three years earlier and not repeated since. Helen had no memory of having had this story read to her and was devastated to realize that she had accidentally copied someone else's work as her own.

Dorothy Canby wrote in a letter to Helen's teacher Anne Sullivan, "What a wonderfully active and retentive mind that gifted child must have! If she had remembered and written down accurately, a short story, and that soon after hearing it, it would have been a marvel; but to have heard the story once, three years ago, and in such a way that neither her parents nor teacher could ever allude to it or refresh her memory about it, and then to have been able to reproduce it so vividly, even adding some touches of her own in perfect keeping with the rest, which really improve the original, is something that very few girls of riper age, and with every advantage of sight, hearing, and even great talents for composition, could have done as well, if at all. Under the circumstances, I do not see how any one can be so unkind as to call it a plagiarism; it is a wonderful feat of memory, and stands ALONE, as doubtless much of her work will in future, if her mental powers grow and develop with her years as greatly as in the few years past. I have known many children well, have been surrounded by them all my life, and love nothing better than to talk with them, amuse them, and quietly notice their traits of mind and character; but I do not recollect more than one girl of Helen's age who had the love and thirst for knowledge, and the store of literary and general information, and the skill in composition, which Helen possesses. She is indeed a 'Wonder-Child.'"

I think part of the reason Helen was able to do this is that she was not, like most of us, exposed to a constant stream of variations in language and expression. Most of us hear words and phrases from so many different sources and contexts at once that we assimilate all of it and mix it up so well that it's nearly impossible to unknowingly reproduce an extensive portion of any one source. But Helen was not even exposed to language at all until much later in life than most of us, and almost all of her exposure to it was in large, cohesive chunks of literature. She never experienced, for example, sitting in a room and hearing or seeing mixed conversations taking place all around her. Her only exposure to language and even most sensory experience was through the words of others, one source at a time.

Mark Twain said, in a letter to Helen Keller, "Oh, dear me, how unspeakably funny and owlishly idiotic and grotesque was that "plagiarism" farce! As if there was much of anything in any human utterance, oral or written, except plagiarism! The kernel, the soul--let us go farther and say the substance, the bulk, the actual and valuable material of all human utterances in plagiarism. For substantially all ideas are second hand, consciously or unconsciously drawn from a million outside sources and daily use by the garnerer with a pride and satisfaction born of the superstition that he originated them; whereas there is not a rag of originality about them any where except the little discoloration they get from his mental and moral calibre and his temperament, which is revealed in characteristics of phrasing. . . .

Then why don't we unwittingly reproduce the phrasing of a story, as well as the story itself? It can hardly happen--to the extent of fifty words--except in the case of a child; its memory tablet is not lumbered with impressions, and the natural language can have graving room there and preserve the language a year or two, but a grown person's memory tablet is a palimpsest, with hardly a bare space upon which to engrave a phrase. It must be a very rare thing that a whole page gets so sharply printed on a man's mind, by a single reading, that it will stay long enough to turn up some time or other to be mistaken by him for his own. No doubt we are constantly littering our literature with disconnected sentences borrowed from books at some unremembered time and how imagined to be our own, but that is about the most we can do. In 1866 I read Dr. Holmes's poems, in the Sandwich Islands. A year and a half later I stole his dedication, without knowing it, and used it to dedicate my "Innocents Abroad" with. Ten years afterward I was talking with Dr. Holmes about it. He was not an ignorant ass--no, not he; he was not a collection of decayed human turnips, like your "Plagiarism Court," and so when I said, "I know now where I stole it, but who did you steal it from,"he said, "I don't remember; I only know I stole it from somebody, because I have never originated anything altogether myself, nor met anyone who had!"


I think Mark Twain said it well. For most of us, it is not even possible that we would be able to reproduce more than bits and pieces of someone else's work without intentionally copying it. If we know it well enough to extensively reproduce someone else's unique phrasing, we will almost certainly know that we are copying it.

It is only bits and pieces, an idea here and a turn of the phrase there, from a million different sources, that become a part of our consciousness in such a way that we can use them with originality.

For example, in college I wrote a poem which contained these lines:

Here is a fragment of robin's-egg shell--
A tiny blue dome like a piece of the sky
Where, feathered, its long-ago occupant flies.


I was certainly aware when I wrote it that the stanza was inspired by these lines from one of my favorite poets, Gerard Manley Hopkins, in his poem Spring:

Thrush’s eggs look little low heavens, and thrush
Through the echoing timber does so rinse and wring
The ear, it strikes like lightnings to hear him sing ;


I'm confident that Hopkins was not the first or only writer by far to compare a blue egg to the blue sky. He did it in a unique way, though, and my variation on it was completely different even though inspired in some way by the image he created. That's an example of inspiration without plagiarism.

However, I did a Google search for pages that included the phrase "little low heavens" but not the word Hopkins, and found a music piece with the title Look Little Low Heavens. If the author of this music piece does not give credit to Hopkins, this would be unmistakable plagiarism. Even though it's only 4 words, the phrase "look little low heavens" is so unusual and unique (especially leaving out the word "like" as it would normally be phrased) that we can be certain it was copied directly from Hopkins.

A series of studies by cognitive psychologists Marsh, Landau and Hicks "showed that the rate of cryptomnesia was greater under specific conditions. It increased, for example, when there were fewer perceptual and contextual cues--such as the distinctiveness of the voice associated with other-generated information--that participants could use to perform source monitoring during the task, when less time was provided during which participants could monitor the source of incoming information, and when sources of incoming information were more credible. In contrast, plagiarism rates dropped when participants were asked to focus on the origins of their ideas, heightening their awareness of the source of ideas."

These studies suggest that we will normally use bits and pieces of things we take in during our own communication, but that if we pay attention to where ideas come from while composing we'll greatly reduce the likelihood of accidental plagiarism. When we come up with a phrase or paragraph that seems unusually wonderful or seems to write itself, we would do well to stop and think about where we might have heard it before. If we develop the habit of noticing and giving credit when we use an idea or phrase we've heard elsewhere, we'll be much less likely to engage in cryptomnesia.

In other words, most cryptomnesia (at least if extensive) is the result of not caring enough to pay attention to the fact that we're plagiarizing. Cryptomnesia is no excuse for real plagiarism.

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Friday, May 27, 2005

Plagiarism vs. Inspiration

Richard Cohen has a great discussion on his blog today about plagiarism, inspiration and the art of writing. Cohen and some of the posters in the comments made some very good points. I posted a comment there and then decided to rework it a bit and post it here, too. Communication is always a subject I enjoy communicating about. :)

Something that's always fascinated me about language is that a limited number of symbols--quite a small collection of letters, sounds and words--can be combined infinite ways to express thoughts.

It seems a miracle to me every time I think about it that we can actually use these symbols to communicate a thought or idea from one mind to another. Communication is a beautiful and awe-inspiring thing. The fact that a combination of sounds or marks on paper (or a computer screen) can effectively tell you what is going on in my mind is nothing short of magical.

Because of the way language works--because it utilizes a relatively limited number of building blocks--it is inevitable that more than one person will independently combine some of those building blocks in the same way as someone else.

As in music or art, those building blocks can also be used as inspiration for a piece that is truly unique even though it is influenced by something else. (Not to say, of course, that credit shouldn't be given to the influencer.)

However, because the ideas we can communicate and the ways we can combine these building blocks are infinite, it's essentially impossible that those similarities will be extensive in any truly original piece.

We can expect that a phrase or a sentence might be the same, but used differently, in various pieces of writing. But if several paragraphs or more are identical or nearly so, that's pretty good evidence of plagiarism.

Because ideas and concepts are infinite, it's highly unlikely that two people would carry out the same idea almost exactly the same way in something they write. So I would think that having two pieces with exactly the same unusual series of thoughts, storyline or concepts (even expressed in different words) is very unlikely to happen without plagiarization.

A truly good writer can express unique ideas in a common way, common ideas or experiences in a unique way, or unique ideas in a unique way. But a writer who says the same thing in almost exactly the same way as everyone else is original in neither thought nor expression. Even if what they write isn't exactly plagiarized, who would want to read it?

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Legalizing Infanticide

Two things got me thinking about infanticide this morning:

First, this post from Freshman44, who says, "There is no point at which a fetus is an independent human being. None. You have to get born first. "Fetus" = "independent" does not compute."

Secondly, an article at scotsman.com about infanticide: "Professor Alan Craft, president of the Royal College of Paediatrics, said that mothers who killed their infants were disturbed and needed help rather than imprisonment.

He called for such women, particularly those alleged to have suffocated their babies, to be dealt with in the civil, not the criminal, courts.

Prof Craft said: "Accusing mothers of murdering their babies in the first year of life is not the right way to deal with it. "

Wow. I've been wondering when we were going to start seeing more arguments like this.

Prof. Craft couches his arguments in terms like, "They are generally mothers who need help, and locking them up for life is not the best way to help them."

But what he really seems to be advocating is that killing a child under the age of 1 is not as serious a crime as other murder cases--not really a crime at all. He's not advocating that no murderer be prosecuted as a criminal, or even that no mother under the influence of postpartum depression be criminalized; only mothers who murder children under the age of one.

Really, it's not much of a step from seeing issues like abortion or the euthanization of severely disabled people as morally neutral, to this type of thinking.

Babies under a year old are completely dependent on others for their very life. Young babies who are completely breastfed are still receiving all their nourishment from their mother's body, much as they did when the mother was pregnant. They can't communicate on a level we can clearly understand, and most of their actions are governed by reflex or instinct. Therefore they aren't really rational beings and they aren't capable of opinions or cognitive thought in the same way as adults. They are completely dependent on others for their survival and for the most basic care. They can't meet any of their own needs.

These are the same criteria used by many to judge whether someone is really a "person" or not.

In earlier times, and still today in some cultures, the abandonment, sale and/or killing of unwanted children was a common and accepted practice. People could leave a child in the wilderness for wild beasts to devour, sell it as a slave, drown it or use it as a human sacrifice to their gods without penalty or social stigma.

An article by Dr. Alvin Schmidt, Professor Emeritus of Sociology at Illinois College, The Sanctification of Human Life, summarizes much of the early historical evidence of this, and says:

"Historical research shows that infanticide was common not only in the Greco-Roman culture but in many other cultures of the world as well. Susan Scrimshaw notes that it was common in India, China, Japan, and the Brazilian jungles as well as among the Eskimos.5 Writing in the 1890s, James Dennis shows in his Social Evils of the Non-Christian World that infanticide was also practiced in many parts of pagan Africa. He further states that infanticide was also 'well known among the Indians of North and South America,' 6 that is, before the European settlers, who reflected Christian values, outlawed it. . . .

If unwanted infants in the Greco-Roman world were not directly killed, they were frequently abandoned--tossed away, so to speak. . . . In neither Greek nor Roman literature can one find any feelings of guilt related to abandoning children."

Dr. Schmidt argues that it was not until the influence of Christianity that these trends started to change. He gives examples of many early Christian writers who wrote and spoke about the value of human life and the wrong of killing/abandoning children, and took real action to help the situation such as establishing orphanages and adopting abandoned children themselves.

An article in The Columbia Encyclopedia notes that Christianity, Islam and Judaism all "[condemn] infanticide as murder."

Professor John Boswell in his book, The Kindness of Strangers : The Abandonment of Children in Western Europe from Late Antiquity to the Renaissance, covers the issue of child abandonment through history in depth. Here's a site with fairly extensive excerpts and summaries from the book.

As the national and world environmentent changes to be more influenced by neo-Darwinism, humanism and utilitarianism, we are seeing steady progress toward the legalization of infanticide.

It makes sense in a worldview where human life has no inherent value.

In the wake of several Dutch doctors openly admitting to killing infants, the response has been to push the creation of laws to legalize the killing of disabled infants. A number of prominent doctors and ethicists, including Dr. Ronald Cranford, promote the use of brain-damaged or disabled infants as organ donors along with promoting euthanization.

This article on The Abortion/Infanticide Link: The Dehumanization of Infants notes, "Michael Tooley, a philosophy professor at the University of Colorado . . . has argued that there should be "some period of time, such as a week after birth, as the interval during which infanticide will be permitted." (Philosophy & Public Affairs 2 (Fall 1972) pp. 37-65 (c) 1972 Princeton University Press) Other "philosophers" have argued that parents should be able to kill their children "up to the time the (baby) learns how to use certain expressions.""

[Note: the bold emphasis in all these quotes is mine.]

Dr. Peter Singer, a strong utilitarian who promotes the idea that humans are no different than animals and advocates that parents should be able to kill their children up to 30 days after birth, has received several prominent ethics awards.

Here's an excerpt from Singer's article Taking Life: Humans (Excerpted from Practical Ethics, 2nd edition, Cambridge, 1993, pp. 175-217) in which he states, "I do not deny that if one accepts abortion on the grounds provided in Chapter 6, the case for killing other human beings, in certain circumstances, is strong. As I shall try to show in this chapter, however, this is not something to be regarded with horror, and the use of the Nazi analogy is utterly misleading. On the contrary, once we abandon those doctrines about the sanctity of human life that - as we saw in Chapter 4 - collapse as soon as they are questioned, it is the refusal to accept killing that, in some cases, is horrific. . . .

In Chapter 4 we saw that the fact that a being is a human being, in the sense of a member of the species Homo sapiens, is not relevant to the wrongness of killing it; it is, rather, characteristics like rationality, autonomy, and self-consciousness that make a difference. Infants lack these characteristics. Killing them, therefore, cannot be equated with killing normal human beings, or any other self-conscious beings. This conclusion is not limited to infants who, because of irreversible intellectual disabilities, will never be rational, self-conscious beings. We saw in our discussion of abortion that the potential of a fetus to become a rational, self-conscious being cannot count against killing it at a stage when it lacks these characteristics - not, that is, unless we are also prepared to count the value of rational self-conscious life as a reason against contraception and celibacy. No infant - disabled or not - has as strong a claim to life as beings capable of seeing themselves as distinct entities, existing over time."


The New York Times published an article by Stephen Pinker called "Why They Kill Their Newborns" in which Dr. Pinker argues that infanticide (which he calls neonaticide or filicide) isproductuct of "the biological design of our parental emotions" and that "in most cultures, neonaticide is a form of this triage."

He comments, "Full personhood is often not automatically granted at birth . . . It seems obvious that we need a clear boundary to confer personhood on a human being and grant it a right to life. Otherwise, we approach a slippery slope that ends in the disposal of inconvenient people or in grotesque deliberations on the value of individual lives. But the endless abortion debate shows how hard it is to locate the boundary. . . . Neonaticide forces us to examine even that boundary. To a biologist, birth is as arbitrary a milestone as any other. . . .

What makes a living being a person with a right not to be killed? . . . the right to life must come, the moral philosophers say, from morally significant traits that we humans happen to possess. One such trait is having a unique sequence of experiences that defines us as individuals and connects us to other people. Other traits include an ability to reflect upon ourselves as a continuous locus of consciousness, to form and savor plans for the future, to dread death and to express the choice not to die. And there's the rub: our immature neonates don't possess these traits any more than mice do. . . .

Several moral philosophers have concluded that neonates are not persons, and thus neonaticide should not be classified as murder. Michael Tooley has gone so far as to say that neonaticide ought to be permitted during an interval after birth. . . . So how do you provide grounds for outlawing neonaticide? The facts don't make it easy."

Will we see a return to a moral environment where a parent can, without penalty, kill any child under a certain age? I hope not. But it certainly looks possible.


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Thursday, May 26, 2005

Why talk about PVS recovery/misdiagnosis statistics?

Let me explain my reasons for bringing up these issues publicly.

My goal in bringing these issues to wider attention is to hopefully encourage people to hold the medical community accountable in several areas:

First, to study this issue more. There is much uncertainty, and many things we thought were certainties have been disproved. We obviously need more research in the area of consciousness, PVS and minimally responsive patients.

We also desperately need more research about medications and treatments that can help PVS patients recover more awareness and ability to communicate.

Secondly, to encourage a policy that living PVS patients continue to receive therapy and new treatments whenever possible rather than being relegated to a corner where they receive nothing other than simply being kept alive. In other words, treat every PVS patient as though they have at least some chance of recovery, even if small, rather than as though their chance is 0.

Research clearly shows that there is at least a small chance of recovery at the very least up to 36 months after injury. So don't treat living patients that have a chance of recovery as though they're already dead.

(I am choosing not to deal with the issue of when to justify the use or removal of specific treatments here, just saying don't treat them as 100% hopeless when they're not.)

Third, be honest with the families. Even a 1.6% chance of recovery is many times the acceptable 0.1% margin of error in judging someone completely unable to recover. Doctors should tell families the true chances and that there IS a chance, even if very small, of recovery. Instead, many try to push families into removing life-sustaining treatment by telling them the patient has absolutely no chance or almost no chance of recovery.

The difference between 0 or 0.01% chance and 1.6% or even a 11-14% chance is huge to some people. Even a 1.6% chance is significant. It won't seem like a big difference to some, but to others it will be hugely significant.

There is no reason not to give accurate statistics based on BOTH the original pool and the pool of patients with the same type and duration of injury as the patient currently has. People are smart enough to deal with that information and take both statistics into account when making their decisions.

Fourth, to encourage the development and use of more effective ways of allowing severely disabled patients to communicate and demonstrate awareness. This would lower the rate of misdiagnosis when patients actually are aware, but it is not plainly obvious to an outside observer.

Along with this goes higher standards in the amount and type of testing and observation before someone can be diagnosed as PVS in the first place. NOBODY should ever be diagnosed as in a permanent vegetative state by a doctor who has spent an hour or less with the patient, and certainly not only a month or three months after their injury. Yet this happens routinely.

Finally, I hope to encourage people to reconsider the standards used in removing life-sustaining treatment, and the judgments of valuation of life. I'll deal with this and some related questions in a separate post. I'm working on that one and will post it as a new article.

9 Comments links to this post

More on PVS misdiagnosis and recovery statistics

[Revised and new info. added June 1, 2005]

This is a follow-up to my earlier posts about recovery rates in several studies regarding the persistent/permanent vegetative state, Calculating PVS recovery statistics from the pool of those available to recover and PVS Recovery Rates.

My earlier posts apparently didn't make it clear how I came up with the numbers, so I'm going to repost some of the information from a discussion in the comments thread of one of those posts.

There were a number of different studies dealing with PVS recovery, and each came up with slightly different statistics. It's important to note that none of these studies contained very large pools of patients, so drawing any air-tight conclusions from them is virtually impossible. However, looking at all the available research from the various studies together can at least provide some relevant information.

There are two articles about medical aspects of the persistent vegetative state written by the Multi-Society Task Force on PVS and published in the New England Journal of Medicine. If you can't get to the links I've provided directly from the NEJM site, these can be found reprinted in text form here (part 1) and here (part 2).

An article in the New England Journal of Medicine from Jan 1996 titled Late Improvement in Consciousness after Post-Traumatic Vegetative State deals with two of these studies:

"The American Academy of Neurology and the Multi-Society Task Force on Persistent Vegetative State consider the vegetative state permanent if it lasts for 12 months or more after traumatic injury. Irreversibility is established when the risk of prognostic error is "exceedingly small." The acceptable risk of prognostic error was defined as 0.1 percent by the American Medical Association's Council on Scientific Affairs. The Multi-Society Task Force on Persistent Vegetative State empirically estimated the risk of prognostic error at 1.6 percent (7 cases of known recovery after 12 months divided by 434 cases of vegetative state 1 month after injury).

More relevant is the risk of prognostic error in patients in a persistent vegetative state who survive for 12 months. The available data are insufficient to provide a trustworthy estimate of the incidence of late improvement, because of erratic follow-up, incomplete reporting, and uncertain diagnosis. Only the Traumatic Coma Data Bank reliably defined persistent vegetative state and reported follow-up on patients after 12 months; 6 of 25 patients recovered consciousness 1 to 3 years after injury. However, the Multi-Society Task Force believed the condition of three of these six patients had improved before one year (and Ashwal S: personal communication). If we assume that there was no improvement in the condition of patients who were lost to follow-up, a conservative estimate of the incidence of improvement after permanent post-traumatic vegetative state is therefore 14 percent (3 of 22 patients), which is substantially larger than 1.6 percent."


Study 1: National Traumatic Coma Data Bank. The original pool was 93 adult patients. By 12 months there were 25 still alive and in a PVS. Those 25 were diagnosed as being in a permanent vegetative state.

6 of those 25 either recovered between 1 and 3 years after their injury or were misdiagnosed as to their being in a PVS at 12 months in the first place (according to the task force evaluation, three of them were not in a PVS at all at 12 months--even though they were diagnosed in a permanent vegetative state at a year post-injury).

6 of 25 is 24% (or 6.45% of the original 93 patients).

Almost a quarter of the patients diagnosed as being in a permanent vegetative state in this study were misdiagnosed, either because they weren't actually in a PVS or because they recovered after that diagnosis.

14% of those who were actually in a vegetative state at 12 months emerged from the vegetative state between 12 and 36 months after their injury.

The way they came up with the 14% rate of recovery is by subtracting the three patients who the Task Force judged were not actually in a PVS at 12 months (misdiagnosed completely) from the 25, giving us 3 out of 22 that recovered after being diagnosed in a permanent vegetative state. 3 of 22 is 13.64 percent, which they rounded correctly to 14%. I did not come up with the 14% number, I simply copied it out of the article.

Again, the actual rate of error revealed in this particular study (patients diagnosed as in a permanent vegetative state when their actual condition was not permanent and/or not vegetative) was 24% if you don't take out the three who may have been misdiagnosed at 12 months rather than recovering after 12 months.


Study 2: Different study, different group of patients.

Here's a quote from the Intersociety Task Force on PVS's article Medical Aspects of the Persistent Vegetative State— Second of Two Parts about that study:

"Data were available on 434 patients in a vegetative state one month after a severe head injury (Figure 1 and Table 3). Recovery of consciousness varied with time. Three months after injury, 33 percent of the patients had recovered consciousness; 67 percent had died or remained in a vegetative state. Recovery had occurred in 46 percent of the patients at 6 months and in 52 percent at 12 months. Recovery after 12 months was reported in only 7 of the 434 patients. One patient recovered consciousness 30 months after injury and remained severely disabled."

Table 3. Incidence of Recovery of Consciousness and Function in Adults and Children in a Persistent Vegetative State (PVS) after Traumatic or Nontraumatic Brain Injury.



We have a starting pool of 434 adult patients with traumatic head injury. The table in the Task Force article says that at 12 months, 33% had died, 52% had recovered consciousness, and 15% were diagnosed as being PVS.

So the number of adult patients alive and in a PVS at 12 months after traumatic injury was 15% of 434, or 65.1 patients. Since you can't have a tenth of a person, we can safely assume it was actually 65 patients.

Between 12 months and 3 years 7 of those 65 recovered. 7 is 10.77 percent of 65, which I rounded to 11% (all of the studies rounded to the whole percentage for any number over 2%). 1.6% of the original pool of 434 and 11% of those alive and in a PVS at 12 months recovered consciousness between 12 and 36 months. The study ended at 36 months (3 years).

Here's their chart detailing each group's probability of recovery between 3 and 12 months:



Remember that in this study, there were also 7 adults in the traumatic injury category who recovered after 12 months. They are not included in the statistics in this chart, since this one deals only with the likelihood of recovery by the 12 month point.

Study 3: Another chart in the Task Force article dealt with still a third group. This one explored the extent of recovery in 5 patients with late recovery (past 3 months for non-traumatic and past 12 months for traumatic injury). In other words, 5 patients who were supposedly in a permanent vegetative state and then emerged from the PVS.

We don't know what the original pool was in this case (the Task Force article didn't give that information), but we know that there were 5 patients judged to be permanent who had verified recovery after the point of permanency. Out of those 5, 3 had severe disability and 2 had moderate disability. I'll transcribe the whole chart for you when I get a chance--it includes type of injury and number of months before recovery.

One of the two patients with moderate disability recovered 8 months after anoxia (non-traumatic injury) and the other recovered 36 months after subarachnoid hemorrhage.

Here's that chart: Table 5. Verified Reports of Five Patients with a Late Recovery from a Persistent Vegetative State (PVS).



Here's the Task Force's explanation of the standards used for determining level of recovery for this data:

"The Glasgow Outcome Scale classifies outcome in five categories: good recovery, moderate disability, severe disability, persistent vegetative state, and death108. Patients with a good recovery have the capacity to resume normal occupational and social activities, although there may be minor physical or mental deficits or symptoms. Patients with moderate disability are independent and can resume almost all activities of daily living. They are disabled to the extent that they can no longer participate in a variety of social and work activities. Patients with severe disability are no longer capable of engaging in most previous personal, social, and work activities. Such patients have limited communication skills and abnormal behavioral and emotional responses. They are partially or totally dependent on assistance from others in performing the activities of daily living."

I just found an excellent article by what appears to be another task force on PVS, The International Working Party on the Vegetative State. This is a bit more recent than the other task force and scientific studies I've been able to find.

It spends a lot of time evaluating PVS vs. other states of consciousness and discussing diagnosis, treatment, etc. I would recommend reading the whole thing.

Here are some excerpts:


International Working Party Report On The Vegetative State - 1996
Royal Hospital for Neuro-disabilityDec. 1996


LONG-TERM IMPLICATIONS OF VEGETATIVE STATE
There is very little information in the world literature about the outcome of very severely disabled people. . . .

LATE RECOVERY
Although it has been stated that patients who are still vegetative at three months following the brain damage do not make significant levels of recovery there are several reports in the world literature of patients who have made a late recovery. Andrews113 described a number of patients who recovered from the Vegetative State between 4-8 months after the brain injury, though many of these remained severely disabled. Rosenberg et al114 describe the case of a 43 year old man who was in a Vegetative State for 17 months following anoxic brain damage before showing the first signs of awareness. He progressed to being able to tell stories and jokes though was unable to recognise complex collections of objects in pictures and was unable to read. In another case115 a 44 year old man in a Vegetative State showed signs of recovery only one year following a subarachnoid haemorrhage to regain nearly normal physical and mental capabilities.

Information from the Traumatic Data Bank23 of 84 PVS patients who were followed up long-term (by phone rather than by clinical examination) found that 6% made some recovery between one and 2.5 years.

In a five year follow up116 of 30 patients in PVS, five recovered from PVS between one and five years though only two recovered to a level where they could communicate. One was a 61 year old lady who was vegetative for three years following a subarachnoid haemorrhage. The other was a 26 year old man who was vegetative for 8 months before beginning to respond. Both reached levels where they could read, watch television, write, calculate simple mathematical addition and subtraction, tell the time, feed themselves, were wheelchair independent and could speak well.- 45 - -->

Other reports of recovery after a considerable length of time include that of an 18 year old lady in a Vegetative State for two and a half years following a road traffic accident. She progressed to a state within the following three years of being able to comprehend and communicate, take a considerable interest in her environment and able to establish interpersonal relationships114.

An even longer period of six years in a Vegetative State is described concerning a 25 year old woman who was involved in a road traffic accident. After 14 months of rehabilitation she was able to feed and groom herself and could dress and transfer with some assistance whilst her speech and cognitive function improved considerably. 118

It is recognised that there is a lack of long-term follow up studies of those patients still vegetative beyond 2-3 years. This is understandable since the number of patients is small and the patients are usually widely dispersed in hospitals, nursing homes or at home away from academic centres. The information on patients who have survived, say 20 years, has to be considered in terms of the health and social care available at the time of onset and may therefore not be applicable to those entering the Vegetative State at the present time.

CONCLUSION
The Vegetative State is an uncommon disorder which, especially for the long-term care, has not been widely studied. This has created problems in carrying out research and, therefore, there is a lack of good quality information to help in policy decision making.

There are still difficulties, even for those clinicians with a special interest in Vegetative State, to agree on the terminology to be used. [My note: a number of them wanted to get rid of the terms persistent/permanent altogether in light of the uncertainty of these prognoses and just go with Vegetative State; others wanted to coin a new term altogether.] It was one of the more disappointing aspects of the Working Party that we were unable to reach agreement on categorisation and terminology. It is a high priority that such agreement is reached in the near future since without such agreement on terminology it is difficult for clinicians and researchers to communicate. This in turn is limiting further development of clinical management and meaningful policy decision making.

There has been a negative attitude to the potential for recovery and it seems possible that the full potential of many vegetative patients has not been reached.

Whilst there was general agreement on most forms of management there is still uncertainty about the specific role of sensory regulation and stimulation techniques within the total management programme.

There is still much to learn and there is a need for further good quality research before definitive statements can be made about the management potential (or lack of) of vegetative patients.- 46 - -->

I really wanted to post the entire executive summary, but it's very long so I'll post it either on another page or in the comments under this post.


The Issue of Misdiagnosis:

On another note, we have the fact that several studies have shown a significant rate of misdiagnosis of PVS in the first place in the study groups.

A Texas study Accuracy of diagnosis of persistent vegetative state published by Childs et al in the NEMJ showed that 37% of patients in their study group had been misdiagnosed as being in a PVS. It's a very short article, so I'll copy the whole thing here.

"We reviewed pre-admission diagnosis in all patients referred for inpatient brain injury neurorehabilitation over a 5-year period (n = 193). All patients more than 1 month postinjury with diagnosis of coma or persistent vegetative state were selected for review (n = 49). We found that 18 (37%) of these patients were diagnosed inaccurately. Inaccurate diagnosis was more likely if the injury was more than 3 months before admission and the etiology of injury was trauma (48%). Results were statistically significant when traumatic injuries were compared with anoxic injuries.

Another study published in Neurology magazine showed that 43% of the patients in the study who had been diagnosed in a PVS actually were aware of their environment and able to communicate when observed and tested in ways that would maximize their ability to communicate.

Here's the abstract and the researchers' summary of the most important points:

Abstract

Objective: To identify the number of patients who were misdiagnosed as being in the vegetative state and their characteristics.
Design: Retrospective study of the clinical records of the medical, occupational therapy, and clinical psychology departments.
Setting: 20 bed unit specialising in the rehabilitation of patients with profound brain damage, including the vegetative state.
Subjects: 40 patients admitted between 1992 and 1995 with a referral diagnosis of vegetative state.
Outcome measures: Patients who showed an ability to communicate consistently using eye pointing or a touch sensitive single switch buzzer.

Results: Of the 40 patients referred as being in the vegetative state, 17 (43%) were considered as having been misdiagnosed; seven of these had been presumed to be vegetative for longer than one year, including three for over four years. Most of the misdiagnosed patients were blind or severely visually impaired. All patients remained severely physically disabled, but nearly all were able to communicate their preference in quality of life issues--some to a high level.

Conclusions: The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made, even by the most experienced clinician, from a bedside assessment. Accurate diagnosis is possible but requires the skills of a multidisciplinary team experienced in the management of people with complex disabilities. Recognition of awareness is essential if an optimal quality of life is to be achieved and to avoid inappropriate approaches to the courts for a declaration for withdrawal of tube feeding.



Key messages

Many patients who are misdiagnosed as being in the vegetative state are blind or have severe visual handicap; thus lack of eye blink to threat or absence of visual tracking are not reliable signs for diagnosing the vegetative state

Any motor activity, no matter how slight, that can be used for communication by the profoundly disabled patient should be identified at an early stage and repeated at regular intervals

Identification of awareness in the presence of profound and complex neurological disabilities requires the skills of a multidisciplinary team experienced in long term management of disability due to brain damage


This study also quoted several other studies which came to similar conclusions:

It has been pointed out that neurodiagnostic tests can neither confirm the diagnosis of a vegetative state nor predict the potential for recovery. Giacino and Zasler have also pointed out the limitations of clinical assessment in the identification of "internal awareness" in a patient who otherwise lacks the motor function to show their awareness.

The Royal College of Physicians' report on the permanent vegetative state supports the view expressed by others that the diagnosis requires regular assessment and taking into account the observations by carers and family. However, even these conditions can result in misdiagnosis. Childs et al reported that 37% of patients admitted more than one month after injury with a diagnosis of coma or persistent vegetative state had some level of awareness. In a group of longer term patients in a nursing home, Tresch et al found that 18% of those diagnosed as being in the persistent vegetative state were aware of themselves or their environment.

The diagnosis of the vegetative state can have a major influence on decision making about the level of care or services provided and may lead to an application being made to the courts for a directive on withdrawal of tube feeding. Clinicians should therefore be aware of the risk of misdiagnosis and the factors associated with it.


The study concluded:

"It is disturbing to think that some patients who were aware had for several years been considered to be, and treated as being, vegetative. It must be extremely distressing to be aware but unable to make contact with family or clinical carers. It is possible that we have been referred an unrepresentative sample of patients. This is possible since the unit is the only one in Britain specialising in the management of this group of people. However, similar figures for misdiagnosis have been described for patients at an earlier stage after brain damage,7 and figures of about half our level have been reported for patients in long term care.8 These findings are not a criticism of the referring clinician but emphasise both the complex nature of profound brain damage and the difficulties of caring for patients experienced by staff who see very few patients in this condition.

We also emphasise that a quarter of those diagnosed as vegetative by the referring team remained vegetative and were almost certainly, from our experience, likely to remain so. These findings are therefore not an argument against the withdrawal of artificial nutrition and hydration but do emphasise the importance of accurate diagnosis of the vegetative state being made after expert assessment and provision of a rehabilitation programme by a very experienced team. "

I think what the writers of this study were saying is that (in their opinion) they wouldn't argue that no PVS patient should ever have artifical nutrition and hydration withdrawn, but that those making the decision need to be aware of the possibility of misdiagnosis and make sure that adequate and careful evaluations have been done.

In other words, it's certainly true that many PVS patients are correctly diagnosed and will not recover. But the evidence is pretty strong that there is at least a possiblity of misdiagnosis and/or recovery. So care providers and family members need to take that possibility into account when making decisions.

The Childs et al study is the one discussed above; I'd like to find the Tresch et al study and take a closer look at it.

Please note that the patients in these studies weren't patients who recovered--these were patients thought to be unable to communicate or interact with their environment until they were given a chance to do so in ways that were manageable for them.

Since many of these cases of misdiagnosis were not discovered until many months or sometimes years after the diagnosis, you can't convincingly make the case that accuracy in diagnosis is significantly higher after a period of time, although there should theoretically be at least a slightly higher degree of accuracy with time and more doctors. Some of these patients weren't correctly diagnosed until 2 years or more after their injury, and one only after almost a year of researchers' working very hard to find evidence of consciousness.

In most of the cases there was no change in the patient or their responses--the only variable that changed was the method of examination and the amount of time spent examining them.

As I said in one of my earlier discussions of PVS:

Look at the case of patient B in the study we've been discussing from the BMJ article--it took researchers 25 weeks (175 days!) of intense efforts trying to find any kind of non-reflexive response before they realized that if they sat him in the chair just right he could communicate with 100% accuracy by a small twitch of his shoulder. This is a guy who was thought to be completely unaware and unresponsive for about two years, but when they were finally able to communicate with him they found that he had been aware and able to process and mentally respond to his environment all that time.

If they hadn't just happened to find the one way in which he was reliably able to communicate, after 25 weeks of intense efforts trying things that didn't work, he would still be being treated as and considered PVS to this day.


So unless we develop and maintain better ways of diagnosing PVS and use more extensive testing to tell (as much as possible) whether a patient is aware and able to communicate, it is likely that at least some patients in a PVS in the USA (these studies suggest a possible number between 15 and 45 percent, but we can't know for certain without more research) have been misdiagnosed.

That's not taking into account the ones that were correctly diagnosed but will later recover.

Between misdiagnosis and patients who aren't "supposed" to be able to recover actually having a chance, however small, of recovery, a few things seem clear: We need more research into diagnosis and treatment of PVS, and we shouldn't be too hasty to assume any patient will absolutely not recover. Also, we need better standards and methods for making a PVS diagnosis in the first place, as well as for detecting awareness and response.

Care providers and family members still have to make decisions about the level and type of care to provide or withold, of course. As things stand, each will have to do their own analysis and take the information they have into account when making those decisions. It's a position all of us hope never to find ourselves in.

Here are links to some of my previous related articles:

Medical Aspects of Terri Schiavo's verdict

PVS vs. MCS

Where is the burden of proof--for showing consciousness or lack of it? (diagnosing PVS according to Florida law)

Diagnosing PVS

The Doctors' Definitions of PVS

Does the burden of proof lie with proving or disproving awareness?

"Reliable" standards and procedures for diagnosing PVS available--but were they used?

Brain Function in the Vegetative State, and the Multi-Society Task Force's standards for diagnosing PVS

Reflex vs. response

Is it possible neither party is lying about Terri's responsiveness?

PVS commonly misdiagnosed.

PVS diagnosis subject to circular reasoning

Timeline and documents, including trial transcripts

Raising Questions and Dispelling Myths

My concerns regarding the Terri Schiavo case

Once a bad diagnosis has been made . . .

What does a functioning but damaged brain look like?

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Wednesday, May 25, 2005

Dating my husband

Woohoo! I have arranged for a babysitter. DH and I are going to get to go on a date away from home this week for the first time in about 6 weeks. We'll go out to dinner and talk--don't know if we'll do anything else or not.

If anyone has any great ideas for cheap but fun dates with a spouse, I'd love to hear them.

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Tuesday, May 24, 2005

Eleventy-One Things About Me, 20-25 --University Edition

Here are a few university-related things about me.


20. I went to two universities for a total of 4 1/2 years with a very good GPA at both, but I don't have a college degree. The credits didn't transfer very well, so if I went back to school I'd probably essentially have to start over.

21. Someday I want to finish my bachelor's degree.

22. I'd really love to get a master's degree, but am not sure that will ever happen. We'll see--anything is possible I guess. I'm really interested in going to a seminary near here for their certificate in Women's Ministries, which is supposed to be a really excellent series of courses. That would be a little more attainable. :)

23. My first semester in college, I took 21 credits--these included research paper English, pre-med Biology (which I was taking "just for the fun of it"), History of Civilization (very tough teacher with lots of memorizing of names and dates--not my strong suit), a New Testament class which included a large amount of Scripture memorization, and a 4-credit Home Furnishings class that should have been 6 credits for the amount of homework it had. For the Home Furnishings class we had to build a notebook with all our class notes typed up and illustrated with appropriate pictures cut from magazines--a certain number for each point in the outline, such as sconce lighting, triadic color schemes, etc.

Technically, students (especially freshmen in their first semester) weren't allowed to take that many credits at once, but my advisor made an exception for me because of my "chutzpah"--he thought I could handle it.

I survived the semester, but barely.

If you are a high school senior about to enter college, please take my advice: Never, never do this to yourself.

24. My majors were creative writing, journalism and Bible (double major at the second school). My minors were art and public speaking.

Can you tell I love creativity and communication?

25. Spanish is my second language--I learned a lot from my dad growing up and then took it in high school and college. (Dad isn't technically Hispanic, but he spent his childhood in Mexico and used to speak Spanish better than English. He imbibed much of the culture as well. Between living in the Pacific Northwest, Oklahoma, and Mexico, occasionally he'll say words in ways nobody else ever says them. :) )

The really ironic thing is that taking college Spanish, although it expanded my grammatical and vocabulary knowledge, caused my formerly good accent to deteriorate significantly. College Spanish class was the first time I'd heard the language spoken primarily by non-native speakers, and I picked up a lot of the dreaded "gringo" accent from required conversation time with my classmates. :)

I used to be fairly fluent in Spanish but have lost a lot of it over the past few years. Now I'm starting to pick it up again as my girls have become interested in it and A has asked me to teach her. DH is learning it along with the kids, too.

We are planning a family trip to Mexico one of these years, and I'm really excited about taking DH and the girls (none of whom have ever been to South America or any Spanish-speaking country) to my favorite place in the world next to the Pacific Northwest.

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Cravings

There's no chocolate in the house. No crackers, no pretzels. Nothing munchy or snacky. I already tried cucumber and baby carrots. They just don't do the trick.

So I decided to make no-bake fudge cookies. Chocolatey with lots of sugar, yes. But they also have protein and fiber in them . . . at least some nutritional value. And they are chewy and textured enough to feed the munchies.

The recipe isn't in my recipe box. Moment of panic. Am I going to have to call Mom to get it yet again? Oh, here it is in a pile of papers on the counter.


Recipe for: No Bake Fudge Cookies
From the Kitchen of: Mom and Grandma

Mix together 2 c. sugar, 3 Tbs. baking cocoa. Add 1/2 c. milk, 1 cube margarine or butter. Bring to boil and boil for 5 minutes. Stir in 1 tsp. vanilla, 1/2 cup peanut butter, 3 cups rolled oats (Old Fashioned are best). Remove from heat and drop by spoonfuls on waxed paper.


So I get out the ingredients. Oh, no! We only have about a half cup of rolled oats, and they're the quick ones at that. A triple-check of the pantry reveals little I can use as a substitute. Here we go: oat bran and cheerios. They're both made out of oats, and maybe the differences in volume and texture will balance each other out.

Half a cup of rolled oats, fill up to 2 cups with the rest of the oat bran. Add a cup of Cheerios. Okay, we're ready to go. Let's use almond butter instead of peanut butter--better nutritional content and less likely to give the baby allergies. I can use lactose-free milk; it shouldn't change the texture too much.

Measure, mix and stir. The sugar, cocoa and vanilla are boiling now. Ooops, I was supposed to wait to put in the vanilla. Oh, well. Hopefully it will still solidify.

It needs to be stirred constantly at this point so it won't scorch. Well, I'll cheat a little and just stir it really frequently.

I'd better put the waxed paper on cookie racks. Last time I found out why my mom always put paper bags underneath: the waxed paper left big round wax spots on the counter where each hot cookie had been poured.

Oh, no! The cookie racks are in the sink waiting to be washed. This stuff is bubbling like crazy with 2 minutes to go. I know from experience that if you cook it too long or wait too long to spoon it onto the waxed paper, it will crumble into something only good for ice-cream topping instead of sticking together to make cookies. Hmm, I wonder how fast I can wash cookie racks in the sink with one hand while stirring the pot on the stove frequently with the other?

Beep! Time to stir in the almond butter and oats--or whatever you call this mixture. Lay the waxed paper on the cookie racks, quick. Doesn't matter that they're sort of damp.

The almond butter is really stiff and chunky at the bottom of the jar. I'm having a hard time getting it to blend in smoothly. I'm probably cooking it too long--better take it off the burner while I get out the wire wisk and try to get rid of the chunks of almond butter.

Something doesn't look right, but maybe it just needs the oats. Dump in the oat stuff. Now I know it doesn't look right: it's not stiff enough. Maybe putting the vanilla in early DID mess it up. Cook it some more.

Spoon some onto the wax paper. It's awfully runny. We're going to be eating it with a spoon. Turn the burner back on. Now the oat bran is getting mushy. I'd better stop cooking it before the Cheerios get mushy too.





Well, here they are. Very flat, and some of them ran together. They're a bit oddly-textured and a little too sweet without the rolled oats, but they did harden. Next time, though, I think I'd use more Cheerios and less oat bran.

What do you want to bet the kids and DH will take one look at them and refuse to eat them? Haha, that will just leave more for me.

[Update: The kids love them. They looked at them doubtfully and asked, "What's in them?" I said, "Chocolate and Cheerios." "Ooh, yummy!!"]

Actually, they're not bad. I've eaten four so far--or was it five?

Maybe this wasn't such a good idea after all.

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Parenting tip of the day . . . "Stop" and "Come Here"

In thinking about PhantomScribbler's woes of trying to get L.G. to stop doing something, I remembered something we haven't done in a while and probably need to start doing again.

When I was taking care of a 2 1/2 year-old boy in addition to my 2 and 3 year old girls, we had a lot of problems with antagonizing each other, pushing, unwanted tickling, etc.--not to mention issues with listening to me when I asked them not to do something. They were three kids between the ages of 2 and 3, after all. :)

So I made up a game called "Stop!" I would have the kids do something like run in a circle, and when I called "stop" they were supposed to immediately freeze in place. Then I'd say "go" and they'd take off again.

We started off with running, jumping, crawling and all kinds of physical activities, and progressed to tickling each other, yelling, singing, and anything else I could think of.

The kids loved the game and we all laughed a lot. They liked to take turns being the one to suggest an activity and saying stop and go, too.

It really made an amazing difference. Since they were used to stopping whatever they were doing (and thinking of it as a game) immediately whenever they heard the word "stop", it really helped to get them to respect each other's "no" better and to obey me more promptly. It helped minimize the chance of creating a standoff if I said it in a somewhat playful voice and reminded them about our game.

We use games and practice drills a lot with our kids.

When they were just learning to walk, we worked with them on "come here" by practicing in non-threatening situations and sort of making a game/drill out of it. We'd just pick random times to say, "Come here, please" and then praise them profusely if they came. If they didn't come, we wouldn't ask twice, but we'd immediately go and get them by the hand and bring them to where we were standing, saying, "When Mommy/Daddy says come here, that means you need to come."

Whenever we started having problems with them not coming right away when called, one of us would take whichever child it was on an outing or just off to the side and practice the drill until they were obeying right away again. It was a little more work in the short run, but it worked very well for us.

I'd love to hear any other tips and tricks anyone would like to share.

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Monday, May 23, 2005

Is it bad to laugh at your kids?

A little bit pregnant discussed the issue of laughing at our kids a few days ago: "Here is why I don't call myself an attachment parent: I cannot find it in me to take Charlie completely seriously when he's screaming in rage if he also happens to be wearing a butter-yellow hoodie with ducks on it.

Oh, sure, I'll comfort him. I'll strive to figure out why he's howling. I'll do my very best to make things right in his tiny world. But does it count if I'm chuckling while I do it? . . . I insist that it's funny when someone wearing alphabet pants is so mad he spits out his binky with an audible, disdainful ptui."


The first time my then-3-year-old (A) and the 2-year-old (M) had a really big fight about trains (more about fights over trains in my post earlier today), I could not believe my ears.

I said, "You need to give three of those trains to M, please."

A said, "But Mommy, I want to play with all of them. If I give three trains to M then I will only have four. I WANT SEVEN TRAINS!" Sob, sob.

I was so flabbergasted at her mathematical prowess and struck by the contrast between her abilities and the maturity level she was exhibiting at the moment, that I had to step out of the room to laugh and tell DH the story before I finished dealing with the situation. It was just so funny/amazing that I couldn't contain myself.

And then there's M, the 2-year-old (almost 3 now). She is going through a stage where she finds it utterly offensive to be asked/told to do anything at all.

"Please go wash your hands now. Did you hear me? It's time to wash your hands."

She starts crying pitifully. "Mommy, don't tell me. You hurt my feelings!" Then she does this fake trembly-lip thing. I can't help laughing at her.

We try to be careful not to minimize or discredit our kids' feelings or real pain. But sometimes I think it's healthy to chuckle at the absurdity of the situation--even if we have to step out of the room to do it. In certain situations it may even be healthy for them to see us doing it.

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Trains

The girls are up from their naps and taking the trains to and from "the zoo" now. I just had to share some photos of our great train layout.





Yes, they're barefoot. It's a warm day.

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Is it nap time yet?

Since so many bloggers seem to be writing about unruly children this morning, I may as well join in.

It's been one of those days already: whining, arguing, cheerios spilled on the floor, a shattered teacup (I thought Corelle wasn't supposed to break?). All morning it's been two toddlers antagonizing each other while all Mommy really wants to do is go back to bed.

At one point A was pretending to be a dog while M, instead of enjoying the game, was screaming in terror, crying and running wildly. A wouldn't stop chasing her despite both M's and my yells, until I finally caught up to them and went into full lecture mode. Long guilt-inducing lectures are so effective with toddlers (or people of any age). Not.

I am typing right now with a sniffling 4-year-old in my lap. The problem? Trains. My girls are usually very good at playing together, but for some reason trains bring out the worst of the won't-share-I-want-ALL-of-them-itis.

We have an extensive train set, with Brio and Brio-compatible parts, and a large area to set them up in. There are at least a dozen train cars, which would seem to be plenty to go around between two kids. Of course, half of them are usually missing at any given time, but there are still at least 7 or 8 in the playroom this morning.

The girls were playing nicely for a few minutes and then pandemonium broke out. I'm still not exactly sure what happened, but I can make a pretty good guess from the sounds. It sounded like M had a train car that A wanted, and A tried to trade but M didn't want to. So A tried to take it by force, resulting in much screaming and running.

By the time I arrived in the playroom, M was lying on top of a pile of train cars (all but one of them) with both arms stretched out to protect her stash, and A was throwing a tantrum.

So I implemented a logical solution. We piled all the train cars together and I had the girls take turns each picking one. All went well until the third round of choices, when M made her choice and A went ballistic. "I want that one! No, No! I WANT THAT ONE!!!!"

I explained that it was M's turn to pick, and A had already had two turns to pick and could have chosen that one and didn't. I pointed out that there were still three train cars to choose from in the pile, and that A was going to get two of them (because M had chosen first, so the odd-numbered one would go to A). No amount of of reasoning worked. She had several train cars she had chosen, but suddenly she didn't want any of them. All she cared about was the third car M had picked out. When I wouldn't make M give it to her, A threw herself on the floor and screamed.

Now, the problem with A throwing a tantrum is that her tantrums can become so violent that she gives herself what looks like a mini-seizure and passes out. She thrashes on the floor or runs around crazily until her head flops around, her back arches and her limbs flail as her eyes roll back in her head and then she goes limp. After what seems like an eternity, she slowly wakes up and is disoriented for a few minutes. It's very frightening to watch. We've taken her to a neurologist and had an EEG, and the verdict was that she most likely has "fits." I think that's just another name for severe tantrums. Apparently she should grow out of the passing-out episodes by school age; meanwhile we try to prevent them by keeping her from getting too worked up. So a tantrum is no small thing here.

I managed to calm A down enough to get her to stand up and walk to her room (she doesn't get as worked up without an audience), where she spent the next 10 minutes or so crying very loudly. "I want the white train! I don't want M to play with it; I want it!" Finally I went in and told her that was enough of that. I talked to her about the importance of sharing and being kind, and informed her that she was going to stay in her room until she was done throwing her tantrum and was ready to play nicely. Meanwhile, M was happily playing with all the trains.

A few minutes later A came quietly out of her room, still breathing in sobs. She climbed into my lap and glued her sniffling self to me.

I suggested all sorts of things, from going outside to eating lunch, but she just wanted to be held. It's very hard to type with a 4-year-old kneeling in your lap hanging on your arms, neck, and anything else she can grab--especially when you don't have much of a lap in the first place.

I don't know what's in the air this morning that's making kids and parents grumpy, but I think it's time for an early lunch.

Several hours later . . .

Well, it's finally nap time. Oh blessed hour!

I prepared lunch earlier while two whiny children got in and out of their chairs and antagonized each other. A was making writing motions in the air with her finger while M screamed, "Mommy, A is coloring me!" from across the room.

Once the food was on the table, though, things seemed to settle down. They devoured sandwiches and melon, wanted seconds of everything, and chatted quite nicely.

After lunch all three of us sat down and made a gargantuan trainyard using every single piece of track as well as some blocks. We got so absorbed in building bridges and trying to make intersections match up that I lost track of time. All was peaceful and companionable. I didn't realize it was way past nap time until M plopped herself in my lap and informed me that she was tired and wanted to go to bed.

Of course, now that she's actually in bed she's singing at the top of her lungs. But she's in bed.

A is sitting happily in her bed studying a book on home repairs. Last time I peeked in she was sprawled out on her stomach examining the page on plumbing fixtures and clogged pipes. She seemed especially interested in a diagram showing how to take apart the pipes underneath a sink. Let's just hope she doesn't find a wrench and try it herself--I wouldn't put it past her.

Some days the kids just can't seem to do anything without whining, arguing, or getting into some catastrophe. Those usually coincide with days I'm particularly tired and short-tempered. My only real goal is to make sure we all survive until nap time.

These are what Anne of Green Gables called "Jonah days"--the days when nothing seems to go right. They are the days when I most want the girls (and everyone else) to go away and leave me alone. I want to escape to housework, my computer, or anything but interacting with whiny, demanding, annoying kids.

I've discovered, though, that if I succumb to my intense desire to withdraw and disconnect, it only makes things worse. The only thing that really helps on these days (other than naps and meals, which can also work wonders) is if I press in and do the one thing I don't want to do at the moment.

It's amazing to me what a difference my concentrated attention and involvement makes to the kids. If I try to skip that, I only end up resenting them. On days like this I can't get anything else done anyway. But if I take the time to get down on the floor with them we usually all end up enjoying it and each other a lot more. Then later I'm usually able to take some time to do other things without a problem. Their hunger for my presence has to be filled before they can do without it.

I'm very aware of a parallel in my own life right now. I've noticed that I'm feeling out of sorts, discontented and empty the last few days. My tendency is to withdraw or distract myself with unproductive busyness. But I think a large part of what's wrong is a lack of time face-to-face with my Heavenly Father. When I don't get that, nothing is right in my world.

I need to take a nap while the kids are quiet. But first, I think I'll sit down with my Bible and have some time recharging spiritually with God. I need that more than anything else.

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Sunday, May 22, 2005

But enough about you; let's talk about me.

Ann Althouse wrote a post today about jokes and anecdotes.

She quotes an article in the New York Times titled Seriously, the Joke Is Dead. "[S]cholars say, in a social situation wit plays better than old-style joke telling. Witty remarks push the conversation along and enliven it, encouraging others to contribute. Jokes, on the other hand, cause conversation to screech to a halt and require everyone to focus on the joke teller, which can be awkward."

Althouse says, "So, then, is recounting anecdotes dead too? It seems to me this is a modern preference for a conversation that rotates fairly quickly. No one wants any one person to talk too long. I don't think this is just a cultural "A.D.D.," but a positive understanding that people in a conversation are developing a social relationship that needs to work well. So no one should dominate."

This struck a chord with me. I grew up with a conversational style largely dominated by joke- and anecdote-telling, or more accurately novellista-narrating.

There are some contexts where telling anecdotes or jokes can be an enjoyable and appropriate part of the conversation. This conversational style can be a great ice-breaker or a fun way to pass the time.

But I've noticed that when one person has a story for every comment someone else makes, it does deflect attention from others. Often the person is so busy thinking about what quip they're going to make next and so eager to relate THEIR experience in that area that they don't really listen to the person talking.

That's something I have to work really hard at. Talking is much easier than listening for me. But I find that I'm a much better conversationalist when I can respond to someone's story by saying something simple like, "Wow, that must have been painful," or asking a question about what they just said. That makes people feel heard and valued.

If I respond instead by saying, "Oh, that reminds me of this . . . " I may be deflecting from their experience and just using them as a jumping-off-place to talk about myself.

I've noticed that those kinds of conversations often become one-upmanship contests. Each person is more interested in telling a funnier joke or a more amazing story than in hearing the other person's thoughts and feelings.

Have you ever heard a group of moms at the park talking like this?

"My Janie learned to walk today!" "Oh, how sweet. My Johnny was walking by 11 months and by the time he was your baby's age he was already running."

"My 5-year-old read her first word yesterday." "That's great! My 5-year-old is already reading at a second-grade level. But, of course, every child is different."

The first mom walks away feeling that her child's accomplishments have just been chewed up and spit out. A few more conversations like that and she'll vow never to have another playdate with Mrs. My-child-is-better-than-your-child ever again.

Almost every first-time mom has been subjected at some point in her pregnancy (usually at her baby shower) to this phenomenon. A group of been-there-done-that moms will feel it their duty to have a childbirth horror story contest in her presence.

Their stories are full of italics: "Oh, you think your labor was bad! Mine was sixty-two hours, and when the baby finally did come I hemorrhaged and almost died. Then the baby had jaundice and wouldn't nurse, and on top of that his poor little heart wasn't working right, and we thought he was going to die."

A few rounds of that game and the mom-to-be (who's supposed to be celebrating this joyous occasion) is debating between escaping the room or trying to find a way to escape labor and delivery altogether.

I must admit that the "my boss is worse than your boss" stories can be amusing and sometimes therapeutic. But often there's a fine line between being funny and insightful, and being boring and self-centered--or even damaging. Anecdote-telling can easily turn into hurtful gossip or unproductive griping, too.

It's much more difficult to listen well and ask someone questions about themselves than to talk about ourselves or show off our collection of jokes and anecdotes. In a way, we're more vulnerable when we listen to and focus on the other person. When we encourage someone else to talk, we're giving up control of the conversation.

We don't like to give up control. But if we do, we may find that the conversation is really more interesting and interactive--and that others enjoy talking with us a lot more.

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Saturday, May 21, 2005

The Eye Meme, expanded (Eleventy-One #19)

19. My eyes are my favorite physical feature about myself.

I also love to look at other people's eyes. You can see so much about their personality, mood and what they're thinking.













These are two of the same sets of eyes, with glasses on.






There's a blog meme (idea passed from blog to blog) going around where you post a picture of your eyes.

I am not sure who started it . . . looks like Jo(e) (inspired by Scrivenings and Dr. H) and Shakespeare's Sister may have gotten the idea about the same time. But I've seen it on several blogs (Dr. H is making a list), and it's really fun to look at all the pictures of people's eyes.

It doesn't tell enough about someone's looks so I would recognize them on the street (which is probably why so many are willing to do it). But it makes me feel like I know them a little better somehow, and it gives me a visual window into who they are.

I really liked Mystery Mommy's picture of her own eyes in glasses, even though she normally wears contact lenses.

Jo(e) carried the idea to a new level and added gorgeous pics of her kids' eyes.

Phantom Scribbler noted in her kids' eyes meme post, "If you don't have kids but want to play along with this meme, why not take a tip from Russian Violets, and do this?"

I'm taking it one step farther still.

You'll have to guess whose eyes they are.

[Update: I'm tagging Mark C, the other Mark, Xinnamon, Ann Althouse, Allison and Kevin for this meme.]

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Friday, May 20, 2005

This Is Just To Say (Eleventy One Things # 18)

18. I like to read and write poetry.

O.M. over at The Columnist Manifesto recently posted a spoof he wrote of William Carlos Williams' "This Is Just to Say." It brought back some great memories for me.

In college, I got to take a poetry writing class. That was one of the most enjoyable classes I ever took. Part of it, of course, was the teacher and the matierial. But another thing that made it so great was that it was a small class with a very fun and unique mix of personalities.

One of our class exercises was to do a parody of Williams' poem. This isn't the best example of my poetry-writing, but I promised O.M. I would post it. :)

THIS IS JUST TO SAY, by William Carlos Williams

I have eaten
the plums
that were in
the icebox

and which
you were probably
saving
for breakfast

Forgive me
they were delicious
so sweet
and so cold


Here was my version:

I dropped
your wedding dress
out of the window

Forgive me
It looked so lovely
floating
twenty stories down

--Until it
landed
in the
street

by AJW

Here are a couple of my favorites from my classmates.


Kamilla Faye Smith wrote:

I have taken
the phone
off the wall
and thrown

it out of the
window on the
sixth floor.

I'm sorry. But it screamed
with such agony,
I thought it would be
happier that way.



Jason Nicholas wrote:

I have pulled the
Pin from that grenade
On the desk.

Forgive me.
I thought it was
My keyring,
And

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Gregory Johnson's appeal is denied

Update on Gregory Johnson: The parole board has denied his request for a reprieve.

An NBC article says, "The Indiana state parole board decided Friday not to delay the execution of a prisoner to allow him time to donate part of his liver to his ailing sister.

Gregory Scott Johnson will be executed next week unless Gov. Mitch Daniels overturns the board's decision."


Apparently, at least some on the parole board felt Johnson's request was just an attempt at manipulating the system to gain more time.

I still think they should come up with a way to execute prisoners that wouldn't damage organs, so they could opt to be organ donors if they desired.

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The desecration of Beethoven

MysteryMommy mentioned that her child loves this new CD series, Beethoven's Wig and Beethoven's Wig 2. They're "Sing-Along Symphonies"--famous classical pieces put into words. Very silly words.

It's a terrible desecration, but kind of fun. For instance, Eine Kleine Nachtmusik by Mozart becomes Please Don't Play Your Violin at Night. "Wolfgang, I'm still not sleeping. Please stop the music . . . Night music must stop. (man) Night music is inspiring. (woman) Night music is too tiring! (man) The melody is soaring. (woman) And I wish I was snoring . . . "

Pizzicato from Sylvia by Delibes is now called Drip, Drip, Drip: "Oh Sylvia, the situation's such a pain. The water keeps on dripping and the problem here is very plain. The drops won't all fit down the drain. The house is getting irrigated, Sylvia. And I am getting irritated, Sylvia."

Fur Elise by Beethoven as Just For Elise: "It was all right. To her delight, Elise can play her piece all night. And if you hear Beethoven's piece played by your nephew or your niece, nephew or niece, perform this piece . . . "

La donna e mobile by Rigoletto, Verdi is Sing Verdi Very Loud: "Sing Verdi very loud. La-la-la. Louder! La-la-la. Louder!"

Wedding March, from A Midsummer Night’s Dream, by Mendelssohn becomes Wow What a Wedding Cake: "Look at the bride, she is aglow. Look at the groom ready to go. Where is the real star of the show? Wow, what a wedding cake, it stands over six stories high! It took a year to bake, nine months for the icing to dry."

It's kind of fun to listen to as a novelty, but I think I would find it irritating after a while. I don't think I'd want my kids to grow up listening to it. I wouldn't want to sentence them to a life of never being able to hear those great classical pieces without these corny words and imagery in their heads. I don't want to deprive them of the great joy of creating pictures in their own minds to let the music tell a unique story just for them. I don't want to rob them of being able to hear the songs with the message and intent the composers intended.

But my kids like it. When the samples from Amazon.com ended, A said, "Mommy, let your computer sing! Don't stop it."

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Thursday, May 19, 2005

Eleventy-One Things About Me #17

17. I like funky socks.

Here are the ones I'm wearing at the moment:



I love to wear these kinds of socks because they're just the right weight to go inside my ankle boots. When I wear them with short boots I feel a little daring, but nobody sees them unless I take my shoes off. It's like my own secret little flamboyancy. :) When I'm feeling really daring or in a "I like what I like and don't care what anybody else thinks" mood (or when we're running short on clean laundry), I'll wear them with more open shoes or even sandals. Sometimes I'll be wearing a very tailored, classy outfit and then have a pair of funky socks on underneath.

I can't find them at the moment (I'll post a picture of them when I do), but one of my favorite pairs is by Sol Mates at socklady.com. They're made to be purposely mismatched. They go with just about anything. :) Socklady's motto is, "Life's too short for matching socks!"

I guess my kids come by their attitudes about clothes naturally.

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Paul to Titus--a new look at Titus 1:1-4

In our home group, we're reading and discussing the book of Titus. This week we looked at chapter 1, verses 1-4.

Here it is in the New American Standard Version:

1 Paul, a bond-servant of God and an apostle of Jesus Christ, for the faith of those chosen of God and the knowledge of the truth which is according to godliness,

2 in the hope of eternal life, which God, who cannot lie, promised long ages ago,

3 but at the proper time manifested, even His word, in the proclamation with which I was entrusted according to the commandment of God our Savior,

4 To Titus, my true child in a common faith: Grace and peace from God the Father and Christ Jesus our Savior.


By the way, talk about a run-on sentence--that's 90 words in one sentence!

We took an interesting angle on the first 4 verses this week by rewriting them in our own words after first reading them in several different translations.

It was a fun exercise to do and helped us read and think more in depth about the message in the verses rather than just the words. It was a 5-minute on-the-spot exercise, so of course it's not honed writing. I thought some of you might enjoy doing this exercise yourself and/or reading ours. If you'd like to write one of your own, feel free to post it in the comments.

Here are the paraphrases we came up with. (You might want to skip reading our paraphrases until after you write your own if you're planning to do the exercise.)





1. From Paul:

I serve God and proclaim Jesus' truth, working to build the faith of the church and teaching the truth about God. The more we know, the better we obey. Everything I proclaim is based on our certainty, based on God's promise, that we will be with Him forever. He's had this in mind from the start, and is now using me to reveal it to the world.

To Titus: I introduced you to this journey. You're with me on it all the way. Remember how much God gives you through Jesus and rest in that!


2. Paul, God's messenger serving God by spreading faith in the word that leads to Godliness. The foundation of this faith is the hope of eternal life that God promised to us. God gave me his word when he thought the time was right and told me to spread it. To my brother Titus; God bless you.


3. Paul, who serves God & spreads the Good News of Jesus Christ for the people of the church that they may know the Word and live by it; because there is hope of eternal life which was guaranteed by God before we can comprehend, and in God's own time He delivered the truth through his messenger who he trusted to obey Him

To Titus, God's faithful son: know that the Lord is with you in your journey.



4. Hi! It's me, Paul.

I'm writing to you, Titus, my dear son in the faith: that faith which we both share because of God's faithfulness, as we also share the work He has given us. He chose this time and us as His messengers carefully, and gave us our instructions: to build up the faith and knowledge of those He has chosen, to bring us all to a closer walk and greater obedience to God.

May our father God and our Savior Jesus Christ give you grace and peace.

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