Deja Vu All Over Again

Almost exactly ten years ago I had to undergo the same surgery I am anticipating having on Monday. I was a medical student and had just enough knowledge to be petrified. I had the surgery the first day of a two week scheduled break from school. Dad came to look after me since I lived alone and all my friends would be out of town on the last vacation before our clinical rotations started. Being a touch hypervigilant Dad makes a pretty good nurse. I thought the worst part was going to be waking up from anesthesia screaming for help and trying to put my abdomen back together. I was sure they'd left me wide open. Worse however was trying to go back to school two weeks to the day after surgery. I had an incision about six inches long across the lower portion of my abdomen. It was not exactly symmetric so it interfered a little more with the forward motion of my left leg than it did my right. My top speed could only be described as processional. With effort I could stand up almost completely straight but I couldn't hold this position for long. My forward progress was slow and loping. It caused people to stare.

Nevertheless I reported for duty on my first day of third year to the department of orthopedic surgery. If you've ever visited a hospital you may have noticed the flocks of doctors in white coats swooping like swallows down the corridors. I was definitely the runt swallow. Outside of the OR orthopedic surgeons see about 10 patients an hour in the office and round at the hospital on untold legions. Hospitals are designed so that the more relevant two departments are to one another the further apart they are. My limping and gimping along caused the entire team to have to ride elevators instead of heroically storming the stairs, pouring out of obscure doorways unexpectedly and causing alarm in hallways all over the hospital.

The operating room was another level of hell altogether. Orthopedic surgery requires fluoroscopy, a sort of adjustable X-ray, in order to judge the integrity and alignment of the bones and hardware being pieced together. Consequently the surgeon and every other soul in the operating room has to wear lead. About 40 pounds of it. Front and back, top and bottom, even a little piece for the front of your neck. I thought I was just going to die right there. Crushed like a soda can. I could feel the adhesions forming in my abdomen. I had no choice but to last as long as I could each day and try to look alert. Any wonder a month off looks like a vacation to me?

Deja Vu

Spring break my senior year of high school all the cool kids went to Ft. Lauderdale or the San Padre Islands. I had my wisdom teeth pulled. The dentist was Young Dr. McNamara the newly graduated son of Old Dr. McNamara my dentist from childhood. The extraction did not go smoothly. He was probably shockingly inexperienced but also my teeth apparently had really long roots. I remember with great clarity him bracing his foot against the side of the chair I was reclining in and pulling with all his might. He was so delighted with himself when he freed a particularly difficult one he exclaimed "Wow! You wanna see this one?" waving the tooth still clamped in pliers in front of my face. I closed my eyes and said "Ogh Ooh". I hope he's gotten a little more professional since then. Later I rode home in the backseat of mom's Chevy Cavalier with blood I couldn't feel running down my numb face. I was fine when school started a week later. Everyone else had a nice tan and I had fewer teeth.

Surgical Vacation

I can't wait until my surgery. I'm going to ask the anesthesiologist for a double. I was comparing medical leave notes with a couple people last week and was amused and relieved to find out that I am not the only one that thinks of major surgery as a vacation. A nurse practitioner friend of mine referred to his last hernia repair as "ten days off with pain meds." At the Medical Society Board Meeting one of I mean the other woman doctor told me how much she'd enjoyed having her foot operated on because she couldn't walk for a month. One of the staff members of the Medical Society over heard us and said "You need a new travel agent."

Count Down

My sister is counting down to her sentencing. I am counting down to my surgery. It's a week away excluding the weekend which is more of a tangent of time than a direct link. The week just finished was my last normal week. I use normal a little loosely here. On Monday I have to have some preop testing done and I see my surgeon for clearance on Wednesday. Meanwhile I will be on a critical mission to clear my desk and shelves of any pending results. I will also try to clear the hospital of my patients. I want everybody tucked in for the duration. This is a fantasy of course. There is no way in hell I can get everybody well or even plugged into a fixed trajectory. I am compelled to try out of concern for them and compassion for the physicians who will be covering me without compensation of any sort. I am on call the weekend before my surgery so when not dealing with patient phone calls I will be desperately shoveling off my desk. Sunday night I sign out. I sign out of all this that makes up my daily professional life. I barely think about the surgery. My preparations now are not particularly different from what I have to do to try and get out of town for a day or two. Maybe I'm going on vacation. My patients very kindly wish me a good time while I'm "off" in July.

Random Recollections

Some bits of our recent road trip keep floating up in my mind. One is the image of the little Missouri town of Marmaduke. Almost every structure we saw as we passed through was bandaged with blue tarp. Evidence of a tornado which blew through a couple weeks before. Then there's the look on My Beloved's face when he realized the middle aged white guy not 4 feet away from him was the one providing the vocals to "Love and Happiness" as we sat idle after dinner at Josie's in Waldenburg. He had just been speaking mockingly about lousy kareoke singers. The man went on to serenade us with a little more "Memphis music" but I forget now what he sang. I also keep thinking about the photo we have of Hazel as a girl standing on the porch of the bungalow which she showed us last year. She told us that in the picture her fist is closed around a nickel she had just received and prized highly. She could still recall the feel of that nickel against her palm. Finally I remember sitting at the Thanksgiving table next to Hazel. My Beloved's sisters and their mother were trying to drum up some drama around a perceived misdeed of some kind. Not being a fan of drama I sighed and dismissed the whole thing aloud with a "Live and learn." My jaw dropped open when Hazel completed the phrase with "Die and forget it all."

A Shot but No Beer

I should have taken a picture of it. At the beginning of May I had to have an injection. We already know I'm a geek so let me just say: it was the coolest syringe I've ever seen. It was packaged in it's own little pink box about the size of one of those little pistols for ladies to carry in their handbags. Inside was this giant honkin' thing with a big fat needle on it. I was going to ask sweetie to give it to me but she took one look at it and simply refused. The really intimidating thing was that it had two chambers one behind the other like train cars. The contents of one chamber was powder and the other contained a liquid. I read the directions each step of which started with the words "While holding the syringe upright" and found that I simply needed to twist the plunger and slowly push the liquid into the powder until the powder dissolved. Then it was time to jab myself. In between patients I put a little lidocaine gel on my leg using a couple freckles as landmarks. One patient later I painlessly administered the shot. I was so proud of myself. Now all I had to do was wait for the side effects to start. The first thing was the pain in my leg once the lidocaine wore off. The stuff actually irritated the muscle so badly I limped for two weeks. It's all okay though because it just served to promote the notion that I'm having back surgery.

It's not the Apple a Day

Ever wonder why doctors don't go to the doctor much? Sure we're busy people. We probably also already know what is wrong with ourselves. But, I think the main reason why we don't go to the doctor when we are sick is because we cringe to hear the words of our patients coming out of our own mouths. "Doctor, it hurts when I do this." Cringe cringe. "All of a sudden I was weak and dizzy all over." Cringe some more. Or better yet: "First it was yellow and sticky. Now it's green, well light green, and kind of runny. I think it smells off too." This will cause cringing such that your head will actually shoot off your shoulders and blow a hole in the ceiling. On the other hand it seems foolish to present yourself to another physician and say something like "I have a migrain." His or her response will probably be: "Unless you want narcotics what are you doing here?" I find it is easiest to see a surgeon. Surgeons are very practical. "Clearly you are here to have me remove that 3 pound growth from the side of your head." they say alleviating all need for discussion. Gotta love those surgeons. Lacking in bedside manner a lot of them but like I tell my patients: "You don't want him to be your new best friend. You just want him to be good with his knife."

What's Wrong with Her?

"Physician Heal Thyself." This is said to me regularly usually by people with a smart-alecky look on their faces. The other clever statement I hear a lot is "You need a doctor." I usually manage to chuckle as if I've never heard anything so witty before. Maybe it's because I know so much about them but my patients seem to think they have some right to know what's wrong with me. I don't try to hide being human. I'm occasionally observed entering or leaving a bathroom. Once at the grocery store I ran into a patient who exclaimed "You shop?" My patients knew when I got married and they know when I go home to visit my folks. I don't feel the least bit bad about telling half truths to those of my patients silly enough to ask for details about my condition. While I genuinely like many of them and would choose them as friends if only they didn't choose me as their doctor our intimacy is strictly professional. There is no quid pro quo on personal information between patient and physician. I also think it is kinder to tell my patients my back is out instead of the actual truth which might be more along the lines of "She just couldn't bear the thought of listening to all your whining today and is at home with the covers over her head."

Book Notes

Many years ago I picked up a book called Miners and Medicine: West Virginia Memories by a second generation coal camp doctor namedClaude A. Frazier. He collected recollections from people who had lived in coal camps where he either grew up or worked and compiled them into this book. Well, lots of other stuff got my attention and held it so I never got around to reading it until recently. Earlier this year when there was a mining disaster near by here I started to wonder where this book had gone and with effort finally remembered to look for it on my shelves in the office. Most medical books have been relegated to the office to relieve the groaning shelves at home. Unfortunately it is usually at home that I wish I could consult one of them. So I finally read it and will share a few excerpts from it here.

"The camp doctor treated just about every contingency either in the patient's home or in his office. Anyone needing his help would leave a request at the mine office or the company store. The doctor would pick up the calls around ten in the morning and again at three in the afternoon. He would keep office hours six days a week, and always took night house calls. If a patient needed more medical treatment than could be provided in the patient's home, the doctor would hold night office hours and would stay on duty as late as it took to take care of everyone."

"Littleton remarked that often people would brag with a smile that they never needed a doctor, but that if they did, the expected him to come at once. And he observed that then the smile would disappear and a deadly serious expression would take its place. He decided that they never considered that he might be out on another emergency when theirs arose..."

A nurse speaking of her husband: "As many as five years would go by without his seeing his parents. If he ever left home to go fourteen miles away to the drugstore, he would return to find a dozen patients on our porch demanding to know where he had been and insisting that he was needed immediately."

I don't find things have changed much.

No Place Like Home

Our trip to Arkansas included some animal related adventures. Dogzilla took a worm bath on the banks of the Mississippi in Kentucky and the cats spent their time installing some yarn art in the kitchen. Once we did get home we all did some chilling out in the back yard and My Beloved finished the huge trellis project he had started Memorial Day weekend. Paul sent us a wonderful gift basket of teas and tea related paraphernalia which we sat on the back porch and consumed. And last but not least we had a surprise visitor come roaring into town on his new BMW motorcycle. Life is grand.

Hazel Put to Rest

Hazel was laid out at Emerson's Funeral Home and Ambulance Service. (I guess we know what happens to the ones for whom the ambulance is too late.) Her coffin sat in the place were My Beloved's mother's had been 8 months before. It was a simple affair. Visitation started at 9:30 and at 10:45 we moved to the cemetery where Hazel's minister performed a service. In the summer months funeral services are held early due to the heat. The little shelter they'd erected just barely shaded those in attendance and even at that hour the minister had to dab his forehead with a folded white handkerchief while he delivered his eulogy. I've been to a lot of wakes and visitations but rarely have I attended a funeral service that wasn't either Catholic or Quaker. I felt the lack of formal prayer and bible passages. The entire service consisted of the minister's eulogy. A nice man really. Hazel liked him and chose him for this duty. Poor fellow wasted rather a lot of breath exhorting us to find salvation through Jesus though. Hazel would have known this was a wasted effort but she'd have been too nice to point it out. The next day we revisited the grave site on our own and found our wilted roses from the garden at her grave. We never had the pleasure of showing Hazel our little house. I think she would have appreciated the home grown bouquet. I found the sight of her brother Alvis' grave stone spattered with the dirt from her grave touching although I never knew Alvis.

Hazel in Pittsburgh

Hazel came up to Pittsburgh every year before Thanksgiving and stayed through Christmas. The first time I met her was the first time she flew up instead of driving. This was long enough ago that we were able to go and meet her at the gate. When I saw her I remarked on how like My Beloved's mother she looked. She must have been a striking lady in her time. In her early 80's she was still spry. Indomitable might be more accurate. At the airport gate I made to take her carry-on from her but My Beloved stopped me. He took it from her shoulder himself and I noticed he had to really put his back into it. He carefully shepherded her to the car stoutly carrying the bag the whole time. Later he would set it down with a grunt near the "extra" fridge in the basement. I then helped Hazel unload it and was surprised to find it contained frozen ducks, a ham, and various canned goods not available here in the North. She would spend the Holidays cooking and cleaning and making My Beloved tote items around the house and paint things. He did this happily in exchange for eggs, bacon, and fresh biscuits every morning at 5:30. Usually the first week of Hazel's stay included various shopping trips. Not downtown to Sak's like Lady Tremane and her brood but to the Dollar Store and Foodland. The Giant Eagle down the street was out of the question because their prices were "highway robbery". These trips were rather a trial for My Beloved. Hazel would slowly work her way up and down every single aisle carefully price comparing the sale items and the family size items while sorting through her coupons. Frequently she would send him back to aisles already visited to pick up forgotten items or double check a price. He usually took advantage of these opportunities to run out the front door of the store and have a few drags off of a cigarette before dodging back in and retrieving the item or information pretending he'd gotten lost or couldn't find it right away. I don't really think Hazel fell for this and sometimes I think she sent him on these errands just to get him out of her hair.

Pimento Cheese Sandwiches.

One striking thing about My Beloved is that he keeps his friends for life. He has friends that go back as far as third grade. One friend who has appeared on the blog in the past in Paul the NOLA conservative. Paul puts up with us despite our unwise left leaning tendancies. I don't know why. Paul was our own personal refugee from last August's Hurricane Katrina and still requires monthly "aid packages" from us. Paul and My Beloved met on the road selling concert t-shirts all over the US. This experience is the reason why My Beloved had actually been inside the Des Moines city limits before he met me. He estimates he's been in every city in the US with a population larger than 30,000. Paul went with him to a lot of those places. At every opportunity the stopped in Jonesboro. Hazel kept a shelf in the closet ready with the extra pillows and blankets for the young men to sleep on the floor of her tidy living room. She did their laundry and mended their clothes. She mended t-shirts I would have tossed out. She fixed them four meals a day starting with breakfast at 5:30. They never left town without visiting My Beloved's Aunt at the nursing home and some other ladies there Hazel introduced them to. There was one in particular who I later met for whom they always brought tacos from Taco Bell. It's a sad statement but Taco Bell is apparently a delicacy when one is shut away in a home. They also never left town without a bag of food. Cold fried chicken, egg salad sandwiches and these frankly awful pimento cheese sandwiches which they only ate if they were truly desperate although they never told Hazel this. I was served a pimento cheese sandwich by Hazel at one time and I managed to get it down but by this time I was already a resident and was conditioned to eat anything that didn't try to bite me first.

Pentecostal Catfish Cafe

As far as I know you cannot be in the Mid-South without eating catfish. I guess they don't let you leave until you've had some. Usually we go to the all-you-can-eat buffet called Ed's Catfish. It was our habit to sneak out a piece of fish swaddled in napkins to keep our pockets from getting grease stains. The fish was for Hazel of course who didn't get catfish at the nursing home. This trip the cousins wanted to eat at the Catfish Cafe. You get waited on there but they do bring you all the hushpuppies you can eat. I highly recommend that you never, ever, ever under any circumstances eat as many hushpuppies as you could actually fit into yourself. I'm fairly convinced your gallbladder explodes if you do that. At dinner one of the cousins nodded toward the speakers high up on the wall and said "Banjo music. The Pentecostals always play banjo music. You can always tell a Pentecostal place the minute you walk in from the banjo music." Apparently there are several "Catfish Cafes" in the area. All of them Pentecostal. I can tell you this much: we wouldn't have needed as many napkins for Pentecostal catfish since it was considerably less greasy. The Pentecostals also had frog legs on the menu while Ed's does not. So we had a nice dinner but I left dissatisfied because nobody could tell me how they knew which catfish were Pentecostal.

State Road 593

My Beloved calls this the "new" bridge over the Mississippi. He likes to reminisce about the trips back and forth between Jonesboro and Pittsburgh when he was a kid. His grandmother drove it countless times right up into her 80's. She always drove straight through and just stopped for a nap at a truckstop or rest stop. This scandalized her friends back home who thought she was brave to the point of foolishness. To reach the old bridge one drove straight through downtown Cairo and on the other side worked one's way along the highway to visit downtown Hayti. These towns go by unseen now that there's the "new" bridge and bypasses. Still today the interstate peters out soon thereafter and we connect the dots through the Missouri "Boot Heal" (or "Boot Hill" if you speak Southern) to Kennett, Paragould and finally Jonesboro. This trip we missed Kennett (the home town of Sheryl Crow as I've been repeatedly told) because My Beloved (AKA: Rand McNally) missed a turn. We ended up on State Road 593 and had to pull into Paragould via Highway 49 rather than on the "Kennett Highway" from the east. Paragould used to be a bigger town than Jonesboro but now it is the last place to buy alcohol before entering Craighead County which is "dry" as they so quaintly put it. Whenever My Beloved would visit Hazel as an adult she would get numerous phone calls "Hazel, I saw your car at the county line."

Breakfast in Cairo

It's strange to have made this trip enough times that we have favorite places to stop along the way. Since we leave Pittsburgh in the evening we tend to need breakfast right about Cairo Illinois. I try to eat healthily but I really look forward to "my" biscuit sandwich at the "Cairo Truckstop." The same woman is at the counter each morning we visit. I've never seen the cook nor have I ever heard a single sound come through the little window connecting the counter area to the kitchen. After my order is taken I go to the cashier and pay then take coffee out to My Beloved. By the time I return breakfast is in a brown paper bag on the counter and I grab it like it's a bag of dope and scoot out to the car to wolf it down. This visit My Beloved noticed a puzzling sign. It read "Escorts Available." We agreed immediately that the most obvious interpretation of this sign was the least probable. We were miles down the road before we realized that the escorts in question were those cars that precede and follow wide loads and slow moving trucks.

King Tut

Since Cairo, Illinois is not pronounced Cairo but "Kay-Ro" I had never realized there was an actual Egyptian theme in the region. Just before reaching Cairo this trip we had to gas up so stopped early at a truckstop near Marion. I was the first to notice that it was named "King Tut" and pointed this out to My Beloved when he commented on the signage indicating Lake Egypt was near by. We each took a turn inside the place glancing at people and tchochkies en route to the toilets. Back in the car we compared notes and found that each of us had seen the people wearing federal prison guard uniforms. The difference was that My Beloved (AKA Mr. Gift of Gab) had engaged them in conversation. Yes indeed there is a federal prison nearby. Yes it's at Marion. And yes, it is a "supermax." Apparently when he asked if there were any notorious criminals there they clammed up. Can't imagine why.

One Hour into Ohio

It takes about 12 hours to drive to Jonesboro from Pittsburgh unless you are under doctor's orders to get out of the car and walk every hour. I was feeling about as energetic as a wet noodle when we pulled into the McDonald's parking lot. I was going to just stand up near a bush Dogzilla could use but My Beloved suggested I take my walk into the McDonald's and get him a coffee while he had a cigarette.

So in I went and oh, the humanity! Being tired and in poor physical condition I think I was in a heightened state of sensitivity because what I found was McDonald's a la Fellini. Reeling from the shock of the brightly lit plastic environment my eyes fell upon two horribly disfigured children. The girls were in softball uniforms and I truly believed them to suffering from some dreadful birth defects only before my brain started to generate a differential diagnosis I realized they were just fat. Their deformity was adipose in nature. I looked away more disturbed by the sight than I think I would have been if they'd had two heads a piece.

I studied the floor carefully while I waited and eventually it was my turn. I stepped forward and raised my gaze to the cashier. I was in for another shock. Behind the cash register stood one of those painfully awkward boy-men. Very child like in appearance only tall and adorned with downy whiskers. To complete the effect he was sporting a 2 day old black eye. Before I could stagger back out to the car I received my change in the form of the dirtiest and most worn looking dollar bills I've ever seen that weren't just dug up from a tin in the back yard.

Vignettes from the Road

Thursday morning I was lying awake in bed pretending to be asleep but actually contemplating the meaning of illness when My Beloved came upstairs. He quietly leaned his face close to my ear and without attempting to wake me said softly "Hazel died this morning." My Beloved called her virtually every morning. Usually before seven. He liked to catch her before she left her room for breakfast. Wednesday she hadn't wanted to stay on the phone saying she didn't feel well. On this morning it was a nurse who answered her phone. They had discovered her dead at 6:30. The nurse had been calling all the contact numbers she had for Hazel's kin but no one was answering so it happened that Craig was the first to know. It seems fitting that it should be so since they were so dear to one another. I'm grateful he got the news from a caring nurse and not from some hostile relative. It seems more private. More personal. More about Hazel and less about people and their games. For the next little while I will be telling you little stories from the road. The road to Jonesboro and the road of Hazel's life.