Dead Drawer

One of the old metal desks I inherited when I took over this practice sits in the hall outside of my exam rooms. I don't notice it often. There's a large plant on it. Sometime pharmaceutical reps leave ephemera on it. The large drawer, the one that files fit in, is my dead drawer. It is where I put the charts of those people who have ceased to breathe. There's a certain protocol I follow when adding a new resident to the dead drawer. First I write "deceased" and the date discretely on the cover of the chart. Then I write a medical abbreviation for the cause of death. The chart remains in "purgatory" on my desk until I have spoken with the next of kin and/or sent a note of condolence. Once I've accomplished this I file the chart alphabetically in the dead drawer.

The drawer has seen a lot of action this week. Three deaths since Monday. The first a shocker, the second expected and the third not really a surprise. I will not tell you the stories of these souls. They lived and died and that is all you need to know. I find it interesting and peculiar that their charts and the often hieroglyphic notes they contain can bring them back to my mind as if they still breathed. It is as if I'm looking at a photograph of the person. All that data some of it quite intimate is like a composite sketch and when I see it I recognize the half forgotten face. Usually I get a series of recollections. Unfortunately the first memory is of their dying; one half millimeter slice of time in the long process of departure. Next is the first time I met them or the first time I managed to connect with them. It floods back so fast it's as if I have the memory equivalent of a split screen. It is either morbid or silly or neither that I sometimes visit the other denizens of the dead drawer when I have the occasion to introduce a neighbor. I scan the names and the chart covers. Did I print deceased neatly? In all caps? Did I write in my leisurely script in which all the letters of each word are present, discernible and artfully depicted? Or is it the busy scrawl in which only the two d's can be identified? Did I let someone else write it?

At the beginning of this year I had to prune the dead drawer and move the longer gone souls to make room for the more recently departed. I will miss them: the ones that are now in a box in the basement and inaccessible for all but the most occasional reminiscences. I confess however that I allowed one chart to stay behind in the dead drawer a little longer. I did it because I knew that I would be placing her husband's chart next to it in the drawer soon enough and I wanted her to be there waiting for him when I did.

Four

Four Jobs I've Had:
Corn Detasseler: This was a great job to get. You only had to be 14 because it was farm work and it paid twice minimum wage at the time. Basically you rode a school bus out to some field somewhere at 5AM and walked the rows of corn pulling the tassels off of the female plants so they wouldn't self-fertilize. At the end of the day we would emerge from the fields muddy and covered with spider webs. Once in a while they'd bring in this piece of machinery. Basically a tractor with big arms from which baskets hung. We'd climb into the baskets and roll through the field grabbing the tassels. It was actually worse than walking. When I slept at night I would dream about rows and rows of corn sliding past me.

Handwriting Decipherer: That wasn't the actual job title. I was a graduate assistant. But what I did was squint at the quill scratchings of a French 18th century noble woman and try to figure out what she had written. She was not a good speller. Someone else had the job of transcribing the bulk of her writing and just left me the tough bits. I had recourse to some period dictionaries and the microfiche of the original documents. Once or twice a year someone, never me, went to the Rare Books Library at Yale to look at the actual documents and tried to figure out the ones I couldn't get. Not being a good speller and having peculiar handwriting I felt a kinship with her. I have justified my lack of effort at improvement by saying I am potentially creating employment for future graduate students.

HIV Test counselor: This was San Francisco, 1989. A different world.

Bus "boy" at the IHOP. My sister got me the job. She was waitressing there. I got to wear a little bow tie. I'm pretty sure I was underage.

Four Movies I Can Watch Over and Over:

Stuart Little
Monsters, Inc
Lilo and Stitch
Cinderella

While I was a resident I did back to back in-patient teaching service months June and July. While working the in-patient teaching service we got two days off in the entire month. By the second month I was in pretty bad shape. To make matters worse the new residents start in July so there were all these clueless newbies to watch over. Every single day for the entire month of July I came home and put in my tape of Stuart Little. I rarely made it all the way through. I have used the other movies similarly.

Four Places I Have Lived:

Des Moines, Iowa
The Midwest was a lot more remote when I was a kid.
Aix-en-Provence
Total culture AND climate shock for an 18 year old Iowa girl.
Berkeley, California
Some people leave their hearts in San Francisco but mine is in Berkeley.
Pittsburgh, Pennsylvania
Been here for over 10 years now.

Four TV Shows I Like to Watch:

American Idol: It has an effect on my brain similar to Stuart Little.

Golf: Great back ground sound for a nap on the couch. Reminds me of Saturdays at my grandparents.

Lawrence Welk: Turn off the sound. The color and movement is beautiful. Color TV was so new that they really put some time and effort into it.

Medium: I like Patricia Arquette.

Four Places I've Been on Vacation:

Vacation? What's a vacation? Must have been those long car rides we took when I was a kid. In that case it would be:

Disneyland, Rocky Mountain National Park, Philadelphia, St Louis.

Four Favorite Dishes:

Pasta Fagiole, Tortellini in Brodo, Butter Bean Casserole, and Kraft Macaroni and Cheese.

Four Websites I Visit Daily(or almost):

Caleb Walker; my sister's blog: Life on the Other Side; My Daily Yoga; Art Underfoot (I'm ever hopeful)

Four Places I'd Rather Be Right Now:

• Home in bed.
• New York City
• Paris
• Anywhere with my sister.

Four People to Tag (meaning people who should do this, too):

Well, obviously Art Underfoot, Life on the Other Side, AC, and Ohmygod, I don't know anybody else!

My New Toy

Thanks to Caleb Walker I have a new internet toy. I mean tool. It's PBWiki.

See?
They say it's as easy as making a peanut butter sandwich. Personally I don't use as many of the funky keys on the keyboard when I make a peanut butter sandwich as when I use PBwiki. Like all new things I'm expecting it to revolutionized my world. Or at least clear some of this crap off the surface of my desk. I will also finally have some place to post my buprenorphine talks. It's not much to look at right now. But if you want to know where I like to buy my shoes you should check it out. This is where you can go if you want to see what their about in general. If you want one of your own. Click here. (Oops.)

What a Pain

The first person who says this'll make me a more compassionate physician gets popped in the nose. I don't care how much it hurts me. I remember laying on a gurney in the ER having painful exam after painful exam while they tried to determine if my appendix needed to come out when the attending surgeon of all people had the nerve to say just that. It's a good thing his neck was not in reach. For starters it was not what I would call a teachable moment. I also found it very presumptuous of him to assume first of all that I wasn't already sufficiently compassionate and second that I hadn't perhaps already had enough experience with pain in my life to have learned my lesson if indeed I needed one.

Fast forward several years and you find me, you guessed it, treating all kinds of people with all kinds of pain. I have my ups and downs with it. Some days I don't want to deal with it anymore. It just seems like too much. Trying to piece together a diagnostic work-up spread out over many years and several hospitals. Trying to get a coherent story out of a person who has become accustomed to being mistrusted and is often in significant unrelieved pain while trying to tell the story. Trying to filter through the various emotional overlays of grief, resentment, humiliation and fear that have accumulated over the years. I feel like giving up. Then I have a fraction of a second to think and I realize my patient doesn't have that luxury or for that matter any other doctor to whom to turn. So I hang up a Frieda Kahlo calendar in the hall and soldier on.

Now in December for no apparent I suddenly remembered this book I'd read in med school called The Gift of Pain by Paul Brand. I loaned it to someone years ago and never got it back. I decided it was time to reread it and got myself a new copy. Before I could get around to reading it my hands started to hurt. I was stunned. At first I tried to believe I had developed hand pain because I just inherited about 100 patients with hand pain from a surgeon who retired. But really, I'm just not that suggestible. Nevertheless my hands hurt and they continue to hurt. It hurts to hold a book. It hurts to take a cap off a pen. It hurts to pull the covers up in bed. It hurts to drive. It hurts to open a door. It hurts to palpate somebody's belly. It hurts to take a blood pressure. It hurts to pick up a chart. It hurts to lift a pan of food off the stove. Long story short, I've been driven to seek medical attention from someone other than myself and I appear to have either arthritis or carpal tunnel syndrome. I take acetomenophen. I take ibuprophen. I nearly burn myself with the heating pad. I sit immobile like a sick cat. I grump at innocent bystanders. I have pain. I am a pain.

I'm glad I've taken pain seriously all these years. I just wish the karmic pay off was coming sooner.

Good News Bad New

I had truly hoped that we'd have at least a week of "New at 11: The Steelers won the Superbowl!" But, unfortunately we went straight back to the arsons, shootings, and hit and runs. The two weeks leading up to the Superbowl proved that we don't actually need to know all of that stuff in order to conduct our daily lives. The entire evening news would be about the Steelers with an occasional "Oh, by the way all the coal mines in West Virginia have been closed because they are unsafe. But, the Steelers are still going to the Superbowl!" I've decided the television stations need to make two evening news programs. One for good new and one for bad news. Can't you just see it? News teams fanning out over the city looking for boys helping old ladies across the street and firemen getting cats out of trees? They could cover kindergarten graduations and tree plantings. Wouldn't that be great? I'm sure there are viewers out there ready to tune in and advertising dollars out there to pay for it.

A Super Dish in a Bowl

"What the hell are these beige lumps?"
That was my reaction the first time I encountered Butter Beans ala My Beloved. His traditional family recipe involves opening a can of them, heating them on the stove and plopping them on your plate. He was needless to say disappointed when I didn't care for them. Recently I discovered a recipe that makes those dreary beige lumps quite tasty. It is a big hit at home. And, it is good for you. So, here is my ever so slightly tweaked recipe from the Vegan Society:

1 large onion, chopped
garlic to taste
2 large carrots, sliced
2 good size leeks, sliced
100g mushrooms, sliced
1 large can of tomatoes
1 large can of beige lumps, drained
1 TBS tomato paste
"dried mixed herbs"
salt and pepper

saute the onion, garlic, carrot and leek until onions are translucent and carrots are softening. Add mushrooms and cook a little longer. Add everything else. I usually use thyme and basil. Put it all in an ovenproof dish and bake for 30 minutes at 375F.

Eat until all gone.