To Be Thankful

written by Deborah Anne Ramos

Our thoughts are likely to be varied as we gather to give thanks. What we give thanks for is similarly varied. The overarching sentiment, though, is to count our blessings. How many, how few, will depend upon the person. Are they giving thanks for their material possessions, or are they giving thanks on a more “spiritual” level? When Sister Janice assigned this topic for class, my classmates and I wondered what we are going to write about. Sister was sure we wouldn’t have much of a problem with the topic of Thanksgiving. Yes, it was the beginning of the school year and we had five weeks to gather our thoughts and fashion them into a cogent, thought-provoking composition. Her only advice was, “write what you know.

I decided to write about “Counting Our Blessings“. I asked mom what were her blessings. I asked dad what were his blessings. And, I asked Elizabeth what were her blessings. Mom and dad, both, easily answered that Elizabeth and I were their blessings to have two, beautiful daughters. We were intelligent and gifted, that we would be able to do whatever we set our minds to do. While the compliment was very flattering, to say the least, beyond that, I asked what were their true blessings. Tears welled in mom’s eyes. Dad spoke softly about how loss shapes us into becoming better individuals. I didn’t press my question any further. I asked Elizabeth what were her blessings. She said, “A cool sister, some nice friends. Most of all, mom and dad.” I asked my sis what were her true blessings. She struggled with the question, before finally answering, “You know, I miss her with all my heart. And, I know you miss her as much. Mom and dad, they miss her most of all.” I had narrowed my topic from a broad, unwieldy one to a more defined one of “Blessings Lost and Unseen“.

“lighting our way”


If you know my family, we are not defined, or known, by what we have or what we have accomplished. We are defined by which our character and strength, and our faith, are tested. Having lost can be a blessing itself. It enriches life, and makes one stronger. Our faith and trust in God allows us to count the blessings bestowed upon us, and to help shoulder our hurts and burdens.

As we gather to give thanks, we remember our missing family, our missing friends, at our table. We remember them with moist eyes, but, most of all, we remember them from the heart.


About this article

This post was originally written for a requirement in a composition course at Machebeuf Catholic High School in 2010. While the paper was required to be at least 5 pages in length, Deborah’s text, which you see above, was not quite a page and a half (double-spaced). Though her grade for the assignment could have been easily docked, Deborah received an “A”.


About the author

Deborah Anne Ramos is a fourth-year senior attending the University of Colorado. Her degree studies is in the field of biology, specifically animal science. She graduated with highest honors from Machebeuf Catholic High School in Denver in 2012.

She is a highly decorated equestrian with the Rustler Riding Club, earning Horse of the Year and Rider of the Year awards. Additionally, she has won multiple blue ribbons, and other placement ribbons, with Comet, Captain Andrew Evan Stedman and Secret Agent Man.

Grilling Out

It was a Saturday night cookout.

Though it was a bit chilly, we had been saving the steaks to grill. Both Laurie and Andrea had birthdays in the past few days. Laurie’s birthday was yesterday, on the 21st. Andrea’s was on the 17th. Both moms had the best present, watching their girls have a grand time riding their horses at the JN Ranch. The 15 inches of snow and the high drifts from this past Monday and Tuesday, they were distant memories at the ranch with the sun and warm ground making short work of them.

With warmer weather today and tomorrow, more grilling is on the docket. Anytime one can grill in late November, it is an opportunity to take advantage of the nice weather.

Winter Driven

Coming home from the Las Vegas National Horse Show, my daughters and I knew we would likely run into the storm on our way home. We had kept an eye on the weather forecast indicating a winter storm was taking shape. From our stopover spot in Utah, we made an early start Monday morning. The plan was to be ahead of the worst part of the storm as much as possible. The last place we wanted to be was in the mountains, in blizzard conditions, with the horses. We stayed on schedule, Monday morning, with my girls having their turns in driving.

Snow began to fall when we made our way through the very scenic Glenwood Canyon. We stopped at the Hanging Lake Rest Area to check on the horses, and, if possible, get an update on the weather. The horses were good, very comfortable in their warm trailer. The weather update, not so good. Snow was beginning to fall heavily between Vail Pass and the Eisenhower Tunnel farther to the east. By the time we made Vail Pass in the early afternoon, I-70 was pretty much snowpacked. Before making our run up the pass, it was time to chain up. We pulled up behind a trucker who was chaining up also. After I finished chaining up, the trucker asked what kind of horses I had in the trailer. I told him we had show horses, four of them of the hunter/jumper kind. “Sounds expensive,” he replied. The trucker offered to lead us up to the tunnel. I accepted his kind gesture.

snow and ice on the window, right (middle-row) passenger side (taken at Vail Pass, I-70 eastbound)
photo credit: Elizabeth


Slowly, and steadily, we drove from Vail Pass to the Eisenhower Tunnel. In winter conditions, it is one of the most difficult stretches of I-70 through the mountains. We passed several slide-offs and accidents along the way, which became more numerous between Silverthorne and the tunnel. About 10 minutes after we passed the Silverthorne exit, the Colorado State Patrol closed I-70, east and west, due to the numerous accidents.

I-70 (eastbound) before the steep grade to the entrance of the Eisenhower Tunnel
photo credit: Deborah


Slow and steady remained our pace up the steep grade to the tunnel entrance. In making the steep grade, everyone kept their momentum going forward. When the tunnel entrance is reached, one cannot help but to relish the drive through the tunnel. No snow, no wind. And, a short stretch of dry road.

at the western entrance to the Eisenhower Tunnel (I-70 eastbound)
photo credit: Deborah


It was snowing heavily, probably more heavily, as we drove out of the tunnel. We pulled over to the side where many truckers were checking their chains, before making the long drive down the steep grade. The trucker who led us up was glad to see we made it through. He thought he had lost us. I told him some other cars got in between us, but we kept sight of his rig. I thanked him for his generosity, that it was much appreciated.

While the intensity of the snowfall was varied, it was time to heavily concentrate, again, on winter driving, but in diminishing daylight and on icy roads. Driving downhill was easier, but it is also keeping the speed under control. With the icy road and snowpacked conditions, you couldn’t use your brakes too much. Apply too much brake, the horse trailer would fish tail. The horses wouldn’t like it, and neither would I.

the steep downgrade from the Eisenhower Tunnel (I-70 eastbound)
photo credit: Deborah


The last road section of concern was Floyd Hill below Georgetown. It is the curvy part of I-70 coming out of the mountains. In snowy and icy conditions, Floyd Hill is notorious for accidents. But, if taken with caution, it is easy to navigate the curves.

The remainder of our drive home was largely a slushy one. The only remaining icy and snowpacked spot was Monument Hill, also another accident magnet in winter conditions. Having driven Monument Hill many times in winter, it is the matter of keeping the speed under control on the downgrade.

A longer than normal drive because of the winter conditions, it was a safe one. When we reached the JN Ranch to stable the horses, Monday night, they had four inches on the ground and more still falling. Though it was windy, the blizzard conditions came very late in the overnight. By Tuesday morning, the JN Ranch had 15 inches of snow and drifts at 6-7 feet in height. This morning, they were finally able to clear the snow from their access road. Here at home, we had a couple of inches but plenty of wind.

It’s safe to say winter has begun.

November 11

“Quiet heroes do not seek recognition. They only see themselves of having done their job.”

Several years ago, Dr. Elizabeth Samet, an English professor at the US Military Academy at West Point, wrote an editorial piece for Bloomberg Online. She wrote about the awkwardness of the phrase, “thank you for your service,” for the giver and the recipient. In many ways, it has become almost obligatory in its form and practice.

A civilian professor at the Point, Dr. Samet has a unique perspective of seeing the interaction between soldier and civilian when she accompanies cadets into NYC. The interaction Dr. Samet observes is quite universal. Some individuals go out of their way to cross paths to say “thank you“. Others will keep their heads down, say the phrase, and keep on with whatever they are doing. A few will give a disdainful glance instead.

Living in an area with a large military community, active and retired, the phrase isn’t heard much as one would expect. It is easy to wonder about the sincerity of the individual saying, “thank you for service.” When it is said to my dad, he is a little surprised by it all. Though appreciative of the sentiment, as a military retiree, he does not expect it. When someone discovers I served 15 years, most are surprised by that alone. And, when they say, “thank you for service,” I do not expect it either. The both of us, the expression of thanks is unneeded. Many have given much more, done much more than either of us combined.

*     *     *     *

Much of this “thanks” seems to be an outgrowth of the long hangover from the Vietnam War experience. Many veterans returning from the war experienced shameful conduct from the anti-war crowd and sentiment that enveloped the times. Returning servicemembers were advised to dress in civilian clothes rather than their uniforms when off base. Servicemembers who didn’t go to Vietnam were similarly advised to do the same. There were many anecdotal accounts of maltreatment in which servicemembers were assaulted. Some of the most hurtful maltreatment came from a few sons and daughters of the veterans themselves. They had bought into the anti-war rhetoric, often saying they hated their dads for going to Southeast Asia “to kill babies and rape women“.

My dad, who served in Vietnam toward the end of his military career, he didn’t particularly care what the anti-war crowd thought or believed. He saw them as an ill-tempered, ill-mannered rabble who didn’t know much of anything, and had no responsibilities of any kind. I was proud of my dad. He went halfway around the world to do his job, a job he did very well. He helped in saving the lives of his fellow soldiers, a very high calling in my book. My dad, he was just doing his job.

I am still proud of him, more so now.

I think it is the only thanks he desired, and the one that mattered the most.


About the photo

In the photo is my dad, with a pair of young medics behind him. He led his squad of young medics to fill sandbags at the inner perimeter of the base camp for the 1st ID at Lai Khe, South Vietnam. Dad said as they filled sandbags, North Vietnamese and Vietcong snipers took occasional “pot shots” at them from the tree line. He said you could “feel” the bullets as they flew past. Also, he said fortunate for them, the enemy snipers were very poor marksmen. When the sandbag filling was completed, dad reported the sniper activity. Less than an hour later, SF snipers suppressed the enemy sniper activity.

Rounds: A Day In The Life

co-written with Lauren Westin, MD and Andrea Kanakredes, RN, MSN

The day begins early for Laurie and Andrea. It is not uncommon for both to wake around 4:00 am after going to bed around 11:15 – 11:30 pm the previous night. After getting their first cup of coffee, both settle at their desks in a darkened home office. They carefully review the overnight notes on their patients, at their respective monitors. They often chat in hushed whispers as not to wake the rest of the household. A couple of the kitties sit with them, carefully watching the printers in action. After reading the overnight notes and print-outs, they take their turns walking 2½ miles on the treadmill before having breakfast. A little after 5:15 am, both have changed into their scrubs but still walking around in their slippers. They’re pretty much talking about the day’s schedule, and those patients who may need extra care and checks. In between the “shop talk”, they’re talking about everything else. By 5:45 am, they are on the way to work.

A trauma surgeon by profession, Laurie handles some of the most difficult surgical cases coming directly from the emergency room. When not handling a trauma case, Laurie specializes in thoracic and abdominal surgery. Andrea is the lead nurse on Laurie’s surgical team. They work in concert, making sure there is no seam or mistake made in patient treatment and care. The slightest oversight could impair a patient’s recovery, or worse yet, result in their passing.

*     *     *     *

A couple of years ago, a new medical drama debuted on Cinemax called “The Knick“. The opening scene of the first episode riveted your attention. A young woman in the late stages of her pregnancy, hemorrhaging heavily, is wheeled into the surgical theatre. It is very much a theatre as other doctors watch from the gallery above. The doctors trying to save the young woman and her baby are also instructing the doctors in the gallery on their new procedure. Unfortunately, the procedure fails despite the best efforts of the deputy chief surgeon performing the emergency C-section. Both mother and child pass. The chief surgeon, who was overseeing both the procedure and the instruction, commits suicide afterwards. Very, very dramatic.

Often, medical dramas have their stories set in a sea of “managed chaos” along with a heavy dose of melodrama. Quite the opposite is the norm. No one is rushing around. No one is shouting. Monitors are not alerting every few seconds. Instead, it is very ordered in which everything moves like a well-choreographed ballet. While it may appear to be chaotic on a hectic day, all remains very ordered though it doesn’t seem that way. The more interesting stories are those of the patients themselves. Each have their own, more compelling than one conjured from a writer’s imagination. And, stories devoid of the melodrama. For some, their story may be touching and emotional. Others, very funny, especially when they are facing a serious condition. Many, though, see their story as a “normal” one.

*     *     *     *

Arriving shortly after 6:00 am, the first order of business is gathering any additional information beyond the overnight notes. It is the tidbit of information or observation that didn’t quite make it into the patient charts for whatever reason. While the shift change among the overnight residents and nursing staff is already in progress, a few are always around for a quick chat before they head out. This allows Laurie and I to prioritize the patient order during morning rounds with the more urgently ill patients always seen first. Also, it helps Laurie to determine which cases to let her three residents participate while on rounds. When the residents do participate, Laurie expects much of them. Not only in thinking, but also in listening along with observing and doing. They are learning their craft as doctors.

Once rounds are completed, it is a short question and answer session with her residents. What did they observe or didn’t observe? What did they hear or didn’t hear? What were their impressions from today versus from the day before? Though she knows the answer to every question, Laurie expects her residents to have concise, specific answers. If they cannot, that’s their homework assignment for tonight. The other part of the continuing lesson is interacting with the patient (the bedside manner).

The next stop is checking the whiteboard with today’s surgical schedule. With three surgeries on our schedule, and posted on the board, we’ve been given the second slot on the trauma level.

Joining us today will be Laurie’s three residents as observers, watching off the video monitors. Our assisting surgeon is Jeff, from a previous rotation, a very sharp young man. And, rounding out our team today are two new nurses in the nurse-three position. They are new in the sense they’re moving from pre-op into the surgical suite. They will be setting up the instrument trays in addition to overseeing the instrument count. Should we be given a trauma surgery case, Shelly will become our assisting surgeon. She’s a very impressive, very skilled young lady. And, we’ll have trauma-experienced nurses in the nurse-two and nurse-three positions.

*     *     *     *

With the residents in place, anesthesia given, we’re ready to operate on our first patient. He’s a 12-year old patient in for an appendectomy. While a laparoscope would be used in most instances, in pediatric cases it is not recommended. Through the open incision, the appendix is easily located and removed. No infection is found at the site, but a thorough clean-up is done nonetheless. One more inspection, we’re ready to close. Unlike the “TV surgeons”, I don’t hand it off to my assisting surgeon to close the incision. Good job to everyone. In the waiting room, I bring the parents over to where we have some privacy to talk. I tell them their boy will be fine. His appendix was enlarged, but not to the point where it was ready to burst. We caught it early. I tell the parents their son will be in recovery until the anesthesia wears off before he’ll be returned to his room. In the meantime, I let Jeff conduct a short Q&A with the residents. He’s impressed with their knowledge but said they need to be more precise. An excellent observation on his part, and not much different from mine.

It’s an hour before the next patient will have their surgery. I tell my residents not to wander off too far afield. Squirreled away in one of the prep rooms, I re-read my notes and review the imaging scans of my next patient. He’s in his early 50s, here to have another hernia repaired. Complicating the case is his history of multiple hernias. I told him that I’d like to make this his last hernia repair ever. He said he would like it too. In my patient’s case, his multiple hernias have occurred near his diaphragm. Though not hiatal, they could have easily been so.

I collect my residents and we head to the surgical suite we’ll be using. With the scans on the lightbox, I explain to them what will be going on during the operation. A full incision will be done instead of a laparoscopic procedure with his past history of hernias. The aim is not only to fix the hernia, but also to

make this his last repair ever. While the residents take their place around the video monitors, I briefly walk Jeff through the procedure. Everything seems straightforward, and so that’s our hope everything will go according to plan. And, indeed everything does go smoothly. The hernia is located and repaired. Though there was some infection at the site, that’s cleaned up nicely. Jeff helps in palpitating and visually sighting for any additional hernias. Three small ones are found and fixed. A tension suture or a synthetic mesh can be used to tighten things up. While a mesh would be ideal in light of my patient’s hernia history, I opt for a tension suture. I can adjust the tightness (or tension) as needed. Done correctly, the likelihood of another hernia repair is reduced. This procedure wraps up nicely.

Before taking a break for lunch, I check on my appendectomy patient from earlier today. He’s awake, ready to head back to his room. Vitals are strong. The young man asks if I’m from Australia. I ask him if he would be disappointed if I was to say I was from Texas. Not really was his reply. “I’m from Texas. My accent just turned out this way.” He nods okay.

*     *     *     *

While the day has that hectic feel, Laurie and Andrea use their lunchtime to relax. They chat about how well the riding season has been for the girls. Both are looking forward to spending a few days watching them ride. They were amused by Pinky and Susie studiously watching the printer in action earlier in the morning. “They’ll catch a page being printed one of these days.” Soon, their conversation turns to the exploratory surgery scheduled for the afternoon. Andrea said their patient is very scared, afraid of what will be found. Laurie said she’ll talk with her in pre-op and try to calm her fears. Being anxious is rather normal. A million things can run through a patient’s mind. It is a time when a person has very little control. It is a time when a person senses their mortality.

In talking with patients, Laurie sees this as the most important part of being a doctor. While there is a mixed opinion on the efficacy of the bedside manner, it lends the patient a sense of comfort and hope. It goes far in reassuring the patient and easing their anxiety level. A more confident patient makes them better able to handle any kind of news and makes for a better recovery process.

*     *     *     *

Laurie and I can understand our patient’s anxiety. She is in her early 30s with two young children at home, and a very worried husband. Experiencing abdominal cramps, her primary care doctor referred her to a gynecologist, who then referred her to an oncologist after seeing the initial imaging scans. A second round of imaging was unable to gain a better resolution over the initial imaging, hence the need for an exploratory. Laurie sits next to her anxious patient in pre-op, getting her to laugh to break the ice. It is in this one-on-one moment where you see Laurie at her best. The calmness and steadiness in her voice, so very reassuring. Her patient hears and receives the reassurance she needs and wants. The advances in imaging, technology, and treatments are no substitute for the human touch.

With this afternoon considerably more busy than earlier today, the delay in getting into a surgical suite was about 15 minutes. To an anxious patient, 15 minutes can seem to be quite long. But, we get our surgical suite ahead of time. The residents who followed Laurie this morning, they have moved on to their other duties. Jeff, our assisting surgeon, was needed to help on another surgery. Laurie managed to find Shelly was available to assist.

*     *     *     *

Shelly and I walk into the surgical suite, and meeting us is Dr. M., our patient’s oncologist. He explains where he wants us to investigate during the exploratory using the patient’s imaging scans. Then, I describe what I’d like to do.

The aim of any exploratory is primarily to obtain an extensive view of the area of concern and retrieve biopsy samples. Depending upon what is observed, excising the abnormal tissue may occur. If we have eyes on a tumorous growth, and if it’s manageable in size, we would proceed to remove it completely. It would save the patient from another surgery in two or three days later. If there are orphan tumorous growths in the area, we would harvest some of the smaller growths for biopsy.

Shelly continues to review the imaging scans and a copy of my notes to familiarize herself with the case as I continue discussing it with Dr. M.  It is my intent to keep the procedure fairly straightforward as possible. As our discussion draws to a close, our patient is ready to go. It is scrub time. She’s fully anesthetized. Her vitals monitored, they are strong.

I ask Shelly if she has any questions before we begin. Her first question is if we find a tumorous growth, do we excise it? Only if it’s manageable in size and we are in a good time position. Second question, are any complications likely? I don’t expect any, but. Shelly nods in agreement. Two trays of instruments are moved into position. We’re ready to begin.


Andrea and Gail, the other surgical nurse, both anticipate which instrument Shelly and I will need during the course of the operation. It is this kind of teamwork that makes a procedure go smoothly. And, smoothly was an apt description of the first part as we reach the area of concern. Slowly and deliberately, we visually inspect and palpitate the suspect tissue and the adjacent tissue as thoroughly as possible. The orphan growths are numerous. We collect a broad “cross-section” of these smaller growths from the affected area for biopsy. While I hoped for a more encouraging situation, you have what you have. Except for some very, very minor bleeding, the exploratory ended well. Another job well done for my team.

Afterward, I spoke with Dr. M. and described what I saw and felt in the area of concern, and offered my recommendations. One is for additional imaging since we now know what we are looking at. With the rush on the biopsies, we should also know whether the growths are malignant or benign in 2-3 days. It’ll give the patient time to rest and recover a bit before the next surgery in a few days.

*     *     *     *

Though it is late afternoon, it is not the end of the day for either Laurie and Andrea. An afternoon check on her two surgical patients from earlier today. And, both have some paperwork to complete. Maybe head home by 6:00 pm, which is early for them. Returning home shortly after 7:00 pm, the two are able join us at the dinner table tonight. No warmed plate of dinner, which is their standard fare. With a chance to relax, both have changed into more comfortable summer clothes. They unwind a little more before both adjourn to the home office to work on reports for tomorrow, and reading reports they had requested.

By the time they are finished, it is almost 11:00 pm. Laurie and Andrea go through their late-night routines before slipping into bed and sleep. In a few hours, they will start anew with that early morning cup of coffee.

The long hours. The studying and reading. It is about applying every scrap of knowledge and experience they have. It is work both Laurie and Andrea love. It is their higher calling. It is a life, and professions, they would not trade for anything.

And, if you thought this day was a challenge, the next day was more challenging with a nearly 5½ hour surgery on a critically-hurt accident victim.


Photo credit: The surgery photos are courtesy of Andrea. They were taken with her Blackberry Q10 phone.

Black Cat Saturday Night

A perfect autumn day turns into a spooky, dark night.

Then, it begins. Tiny ghosts and goblins, witches, and other assorted tricksters come out. They run from one door to another in hopes of receiving a treat. But, we keep out lights out.

One says to another, Don’t go there.”

“Why?” asks in reply.

“That’s where the only black cat in the world lives,” he answered back. “She knows who I am.”


“She watches everyday with the others.”

Do you suppose, Egypt, those little things have catnip in their bags?” Midnight asks.

“I don’t think so, Midnight. If they did, all the outdoor cats would be chasing them and taking their treats bag.”


Have a good Black Cat Saturday Night!