Help, I'm talking and I can't shut up!

My sister can talk. She can talk and talk and talk and keep on talking and then she talks some more. It is convenient when I'm feeling lazy or a little tired because the conversation requires no effort on my part. She eventually covers anything I might have asked her about and loads of other informative and amusing stuff along the way. She generously provides sound effects and instant replays when needed. She is so exactly like she was when we were kids. It was like listening to a sentimental sound track and being carried right back to a by-gone time. I remember playing quietly side by side with her listening to the world in my head but with one ear on her for signs of trouble brewing so I could dodge the volatile outbursts that routinely peppered the day. It was just normal then. It is exhausting now. She talked while I made Tuna Casserole a la Mom. She talked while we ate. She talked while we cleaned up. She talked and laughed and cried along and my heart opened right up and my arms are still mentally folded around her now.

Family

Missing: My Sister

I feel like I've been time travelling. For the first time ever my sister came to visit me all by herself. I don't actually think we've been alone together for more than a few minutes since she moved out when she was 17. We haven't lived in the same town for 20 years. She missed my medical school graduation. She missed my wedding. I guess you could say she had other stuff going on. When she didn't turn up outside baggage claim at the appointed time last Thursday there was a brief panic. My Beloved was driving in circles around the airport with a dead cell phone. Dad reported watching her get through security at the airport at home. She didn't respond to the overhead page at the Pittsburgh Airport. I started wondering if she'd made a run for it, but that is something I would do, not her. Finally a kind hearted woman at Delta who couldn't tell me if she got on the plane in Cincinnati or not said "If I were you I'd meet the flight that arrives in Pittsburgh at 4:22pm." God bless her. So our happy reunion took place after all right next to our grandmother's old desk as I wrapped up the day here at the office.

family

Dr. Pepper

Somewhere in the air between here and Dallas I became aware I was entering the South. I cannot remember the last time I even heard of Dr. Pepper never mind hearing it ordered all around me. I suppose American Airlines must have to keep it stocked on all flights in or out of their Dallas/Ft. Worth hub. It was beautiful weather in Dallas, but I was repeatedly told with great emphasis that soon it would be HOT. The shuttle driver on the way in seemed uncomfortable with silence and so chatted along in correct but heavily accented English about the Grassy Knoll etc. Honestly I had forgotten there was any history of interest attached to Dallas and realized as we drove by that for me until that moment the Texas School Book Depository, knoll and all, had existed only in the past. Downtown Dallas is a timewarp mosaic with buildings here and there like the old court house firmly anchored at the turn of the century while others clearly reside in roughly the 1950's. The McDonald's and Greyhound stations are examples of this "time zone." Then there are jazzy examples of the 1960's still alive in bizarrely adorned parking garages and smoked glass buildings from the 70's all just sitting there waiting for their second wind.
A relocated Pittsburgher collected me one evening and showed me around the town a little bit. As is typical for Pittsburghers we went and ogled the blocks and blocks of fancy stores and jammed restaurants over flowing with under 30's. I was relieved to see that in this age bracket the hair in definitely done but not overly large. The effect was one of masses of Stepford women artfully rendered completely unnatural. Based on a picture in the Dallas Design Book in my hotel room big hair happens around age 40. The photo of real estate agents d'un certain age was enough to put me off pseudo-Chanel suits for ever and ever.

travel

Chemical Copers

That's not copping that's coping. Two different things. Most of us are in danger of becoming chemical copers if we aren't already. Tired? Well don't go try and get enough sleep! Drink some coffee instead. Got heartburn? What ever you do don't lay off the cigarettes and booze. Take one of those purple pills. I once had a patient tell me that she took a xanax because she got really "anxious" after eating a really sweet piece of birthday cake. Xanax as treatment for a sugar rush. "You mean it was what happens to the kids when they eat too much sugar?" she asked me after I explained it to her. A while back a lady asked me to prescribe Strattera for her son because she wanted him to be like those kids on their ads. I had to tell her those kids are actors. Best argument so far for putting an end to direct to the public pharmaceutical advertisments.

medicine

6 AM

The mourning doves wake up first and let out a few choruses of plaintive hooting. This alerts the sparrows to rejoice at waking anew with a cheery round of "cheepity-cheep". At six the bells at Immaculate Conception ring the hour. Soon thereafter my Beloved harumphs onto his back and begins a soft whirring snore. Princess fluffs up onto the bedside with a "Hmm?" and tries to stare me awake with googley eyes. When this fails she starts her bath. Finally comes the immortal voice of the PAT bus stopping at the corner and urgently pronouncing "downtown." It is time to get up.

Daily Life

Conan O'Brien

Mr. O'Brien you will be happy to know that your number one fan will be just fine. A little cold that's all. Nothing a few tablets won't fix up. She can tell me every time your show is broadcast. She had to get a new roommate at the group home because strangely enough her roommate did not want to stay up all night watching you. Your tenth anniversary video is constantly playing in her room. She would not leave my office today until she had exhausted my newest People magazine for any photos of you. She has eight such pictures already. She was momentarily distracted by a photo of a grizzly bear which is her second favorite thing. In between looking in her throat and in her ears she noticed it is David Letterman's birthday. After I listened to her lungs she informed me that it is your birthday on Monday. Apparently you are only turning 42. Happy Birthday.

Phone Calls and Other Risky Behaviors

I work 12 hours a day most everyday. I'm not complaining. This is just a statement of fact. I did after all sign up for this. While I was a resident we handled the after hours calls for the resident and faculty clinic. Some of the residents would return patient phone calls and initiate the call by saying: "This is Dr. Soandso. What is your emergency?" If the patient actually heard the words which came after "Doctor" they would stammer: "Well I don't know if it's an emergency but..." I always thought this was a little hostile since there is really no reason to expect the average person to reliably distinguish between an emergency and a mere urgency. If he/she could do that then what would they need me for? There is also no reason to expect the average person to know what other important activities I might be engaged in at the time of their pseudo-emergency. TV after all does make it look like we spend a lot of time standing around and talking. If we aren't standing around talking then we're probably sitting quietly reading a medical journal, right? Just killing time waiting for your call. And when I'm done talking to you I'm going to punch out and go home.

Well. I still do not take the hostile approach to returning calls although I do not go out of my way to shield the caller from my environment. If I was asleep, I sound sleepy. If I was cooking dinner, I stay next to my sizzling food on the stove. If I am at the hospital I do not move away from the beeping monitors. If the dog barks then the dog barks. Some people acknowledge this some do not. Many a time I have gotten a call at 9am at the office from some truly sick old soul who really would have been justified calling me at 2am but didn't want to bother me. But, most of the time the complaint is something like "My throat has been hurting for 3 weeks now and I haven't bothered to make it enough of a priority to call you during the day or actually, God forbid, make an appointment but suddenly now at 11:30pm on Thursday feel like it is important enough to bother you and your entire family at home." Painfully, I muster up my therapeutic tone of voice, ask appropriately interested questions and tell the patient to call first thing in the morning to make an appointment.

Then there are the calls that come in all day long. Calls like "Tell the doctor I have a cough and want" choose one of the following: 1) a chest x-ray, 2) this specific antibiotic and no other, 3)Hycodan. When I ask them to come in at their earliest convenience right now if need be, my already booked schedule be damned, they ignore me and call the next day with the same complaint. This can go on for quite a while and is the primary function of my receptionist. These scenarios sometimes end up with the final phone message consisting of "Guess what!? I went to the ER and they said I have heart failure just like you said I might!"

medicine

Breathing I

It was an almost warm day in later winter. One that teases you to come out without a coat but makes you shiver. I distinctly remember standing in the parking lot and looking up at the pale blue sky and being aware of the chill on my skin under my clothes. If felt like I and my surroundings were simultaneously contained by and distorted by a fish eye lens. In the center of the lens was not me but Mrs. A. Or not Mrs. A. but Mrs. A.'s mortal coil. I had just ceased CPR. Maybe 10 minutes earlier I had been in an exam room having a routine visit with a routine patient concern. My front office person, Zed, knocked on the door. My umpteenth interruption of the morning. The face that greeted me was flushed and frightened. A rush of words: Mr. A. just walked in. His wife got her blood taken downstairs and when she got back in the car she passed out. I dispatched Zed and Sweetie my only staff with a wheelchair and blood pressure cuff. I wrote a prescription and dismissed my patient took my cell phone and walked through the full waiting room and out the only door to the office. "Just ignore the phone." I said over my shoulder. In the parking lot I see a car with both front doors open. Mr and Mrs. A are side by side inside. The small cluster of people parts to make way for the doctor. I see Zed's face. Redder still. 911 she says. I nod. Mrs A. is waxen and still. Very clearly dead. I look at Mr A. who knows this. "I'm just going to check for a pulse." I say placing my hand on her neck. "Mr. A. do you want me to try CPR?" "If you think it'll help." he says. I don't but I try anyway. I find the lever and recline the seat. A precordial thump produces nothing. A rescue breath causes her rib cage to rise and fall. I compress her chest three times and repeat. One minute. No pulse. No surprise. Her lips are blue now. Ruben from the lab comes and offers to breath for me. We carry on. Four minutes. Nothing. We stop. "Mr. A. we're not going to be able to bring her back." An unmarked police car pulls up. Two plain clothes detectives climb out. They have badges hanging from chains around their necks like dog tags. Sweetie explains what's going on. "Do you think she would want us to keep trying?" I can hear sirens. I'm counting the minutes it took Mr. A. to try to rouse her, come back into the building, catch the elevator, come down the hall, return with Zed and Sweetie. She was most likely without oxygen for at least 5 minutes. I know she has atrial fibrillation, depression, she's been loosing weight. When she was in the hospital last time she was miserable and frightened the entire time. She believed Mr. A would die of his colon cancer long before anything happened to her. "Not unless she was going to be okay." is his reply. The paramedics are here. I give them the story in medical-speak and explain the decision Mr. A. and I have made. They radio their supervising physician, a person I know is an Emergency Medicine Resident who rides around in a jeep that says "physician" on it and reads Board Review books in a coffee shop. They tell me that they have been instructed to take Mrs. A. to the hospital. I do a little more quick math, this of the metaphysical type however. My patient is now Mr. A. What will be best for Mr. A.? See me make a scene literally over his wife's dead body or have her corpse subjected to pointless resuscitation efforts? I opt for the latter. They scoop up her corpse and whisk her away. Mr. A. refuses to be driven. The detectives follow him to the hospital. I call the ER and tell them to cease all efforts upon her arrival. I give a statement to the police who've arrived in the meantime. I order some tests on the blood specimen at the lab to help detect a cause of death. Zed is already rescheduling the rest of the day. Sweetie saw her own father die of a heart attack and is very shook up. She and I go over to the hospital to meet Mr. A. and make sure he's okay. The next time he sees his wife she has a tube protruding from her mouth and is wearing a hospital gown. He is shocked by these things. We help him remove her wedding ring.

medicine

Uncle John-Paul II

When John-Paul II was made Pope I was in high school. Being as it was a Catholic school the deaths of the previous couple of Popes were announced on the PA system and then we were led in prayer. I remember there being some rapid turn over in that job for a while sort of around the same time the Soviets went through a few Premiers. The occasion of the selection of the new Pope was also a public event at my school. TV's on great big carts were wheeled out into study halls and the cafeteria so we could watch for the little clouds of smoke to come out of the roof of the Vatican. I imagined the cardinals huddled around a pot-bellied stove like on Little House on the Prairie. I feel sad for him now a lot like I might for a grandparent who is too demented to recognize anybody. I guess this surprises me since I'm not overly fond of the Catholic Church as an institution. On top of that I really did not enjoy high school. I did grow up in an Italian home though. One where a gilt framed picture of the Pope hung in the living room and in which my life was still a blastocyst of potential. It seemed perfectly normal to me that the new Pope would come and visit my godforsaken hometown and say mass out in the fields. For me it seems John-Paul II connects the time before cynicism and my abiding desire to trust in the future.