Friday, October 24, 2003
Sext
Mirabile dictu, I got some work done today. One of the "little hours," high noon, sext. There's a wonderful website that's about the flora and fauna of the Charles River area. I found it yesterday, and spent a long time looking through its lovely photos.
SEXT, FRIDAY, THE RIVERWALK
October noon. The sun can barely clear
the phone pole’s cross before it nods and sinks.
The town’s crewcut the pathside down to lawn
up to the tangled shrubs, and vine-choked trees
that line the riverbank, good husbandry,
but I miss August’s crazy underbrush.
All gone, the horseweed, thistle, tansy, vetch,
burdock and primrose. A few spared grasses bend,
still knuckled with their seeds. Close-up, back-lit,
they seem phalanges, porous, much like mine,
age-bleached and fragile. Asters -- purple, white --
froth at the foot of headless phragmites,
pure lateness, last to flower, last to fade.
And, suddenly, I buckle like a stalk
too frail to stand before such radiance.
I’m stripped of seedhead, godhead, dry, alone,
pure incarnation, compost, on my knees
beside the bike path, asking nothing more
from high noon’s little hour than darkness. Please.
SEXT, FRIDAY, THE RIVERWALK
October noon. The sun can barely clear
the phone pole’s cross before it nods and sinks.
The town’s crewcut the pathside down to lawn
up to the tangled shrubs, and vine-choked trees
that line the riverbank, good husbandry,
but I miss August’s crazy underbrush.
All gone, the horseweed, thistle, tansy, vetch,
burdock and primrose. A few spared grasses bend,
still knuckled with their seeds. Close-up, back-lit,
they seem phalanges, porous, much like mine,
age-bleached and fragile. Asters -- purple, white --
froth at the foot of headless phragmites,
pure lateness, last to flower, last to fade.
And, suddenly, I buckle like a stalk
too frail to stand before such radiance.
I’m stripped of seedhead, godhead, dry, alone,
pure incarnation, compost, on my knees
beside the bike path, asking nothing more
from high noon’s little hour than darkness. Please.
Thursday, October 23, 2003
Of All The Cabs In All The Cities...
I once wrote a poem referring to a state institution that was "tucked" into "the landscape of the fucked." I liked the hard, vulgar rhyme. The institution was a local state school for the retarded where experiments were done in the 1950's that involved serving radioactive breakfast cereal to the residents. The landscape is a swath of land that includes this school, a state mental hospital, since closed, and, of course, at the high end of the spectrum of the fucked, McLeans.
Today I felt I had entered a similar zone: one of Boston's gargantuan teaching hospitals where my CT scan, bone scan and neck xrays were scheduled today.
It was snowing, it was cold, and it was rush hour. My cab driver seemed anxious. I was anxious. The hospital was teeming with the afflicted. The rhyme of my poem occurred to me. Oxygen tanks, casts, wheelchairs, beds, worried faces, lost expressions, limps, canes: and me among them, one of them, human, afflicted, mortal, frightened. Not the powerful doctor, no. The suffering patient. A card carrying denizen of the landscape of the fucked. Golgotha. Welcome to incarnation.
My tests went fine: folks were prompt, courteous, helpful. And, for the bone scan, I got to lie on my back for a full 45 minutes without the Aspen AKA Albert DeSalvo Collar that I've been wearing for a month. That was bliss. Heaven. I walked a few blocks and had lunch at a little soup joint I'd seen dozens of times from the MBTA. They had vegan soup. It was delicious.
Then I went for my neurosurgery appointment.
The receptionist peered up at me.
"Oh, your appointment was canceled," she announced.
I grew peevish and asked, calmly but sarcastically, mightn't it have made sense to inform me of this fact ? To, say, call me ? I pointed out that I've been out of work for a month, enduring the DeSalvo Collar for a month, had just had a morning's worth of tests and might just begin to cry.
At that, she went to fetch some Ubersecretary from the depths of the office. A fellow patient looked me in the eye with an expression that clearly said: isn't that always the way !
Now if it had been that the doc was called away for emergency surgery -- no problem ! But they didn't say that. It simply sounded like a schedule change that they simply hadn't told me about.
Ubersec arrived, apologizing, but not explaining. Rescheduled the appointement for 11/3. Too deflated and discouraged to lobby for anything sooner, or to even think of asking to have the doc call me with the xray reports, or to insist that they take the MRI I'd obtained from the other hospital for him and have him read it, I slunk away.
And summoned a cab.
It came promptly, and an extremely cheerful driver greeted me effusively in French: ca va bien au'jourd'hui ? I replied as best I could in French, and was immediately -- embraced and buoyed are the only words I can think of -- in and by his warmth and good cheer. As we drove and conversed, and he discussed his large family and his kids, I suddenly realized that he was the very same cab driver who ferried me home at dawn from the Grossly Inconvenient Community Hospital On The Outskirts Of Nowhere (vide infra, Oct 21, "Audite") at the end of my 24 hours of medical hell last May !
"Do you ever drive in the early morning ?" I asked.
"Oh, yes," he replied. "I begin at two AM !"
"And did you pick me up last spring at GICHOTOON ER -- remember, it was dawn, and the inside door panel of the cab came loose !"
"Yes, yes !" he cried, remembering perfectly well. Both of us were amazed at the serendipity and strangeness of our reunion. It's a big city with lots of cabs, after all.
I told him how, at the end of my terrible 24 hours last spring, he had so immensely cheered me up -- and here he was again, doing the same thing !
Doctor Fritz, my guardian angel, thank you and God Bless.
Today I felt I had entered a similar zone: one of Boston's gargantuan teaching hospitals where my CT scan, bone scan and neck xrays were scheduled today.
It was snowing, it was cold, and it was rush hour. My cab driver seemed anxious. I was anxious. The hospital was teeming with the afflicted. The rhyme of my poem occurred to me. Oxygen tanks, casts, wheelchairs, beds, worried faces, lost expressions, limps, canes: and me among them, one of them, human, afflicted, mortal, frightened. Not the powerful doctor, no. The suffering patient. A card carrying denizen of the landscape of the fucked. Golgotha. Welcome to incarnation.
My tests went fine: folks were prompt, courteous, helpful. And, for the bone scan, I got to lie on my back for a full 45 minutes without the Aspen AKA Albert DeSalvo Collar that I've been wearing for a month. That was bliss. Heaven. I walked a few blocks and had lunch at a little soup joint I'd seen dozens of times from the MBTA. They had vegan soup. It was delicious.
Then I went for my neurosurgery appointment.
The receptionist peered up at me.
"Oh, your appointment was canceled," she announced.
I grew peevish and asked, calmly but sarcastically, mightn't it have made sense to inform me of this fact ? To, say, call me ? I pointed out that I've been out of work for a month, enduring the DeSalvo Collar for a month, had just had a morning's worth of tests and might just begin to cry.
At that, she went to fetch some Ubersecretary from the depths of the office. A fellow patient looked me in the eye with an expression that clearly said: isn't that always the way !
Now if it had been that the doc was called away for emergency surgery -- no problem ! But they didn't say that. It simply sounded like a schedule change that they simply hadn't told me about.
Ubersec arrived, apologizing, but not explaining. Rescheduled the appointement for 11/3. Too deflated and discouraged to lobby for anything sooner, or to even think of asking to have the doc call me with the xray reports, or to insist that they take the MRI I'd obtained from the other hospital for him and have him read it, I slunk away.
And summoned a cab.
It came promptly, and an extremely cheerful driver greeted me effusively in French: ca va bien au'jourd'hui ? I replied as best I could in French, and was immediately -- embraced and buoyed are the only words I can think of -- in and by his warmth and good cheer. As we drove and conversed, and he discussed his large family and his kids, I suddenly realized that he was the very same cab driver who ferried me home at dawn from the Grossly Inconvenient Community Hospital On The Outskirts Of Nowhere (vide infra, Oct 21, "Audite") at the end of my 24 hours of medical hell last May !
"Do you ever drive in the early morning ?" I asked.
"Oh, yes," he replied. "I begin at two AM !"
"And did you pick me up last spring at GICHOTOON ER -- remember, it was dawn, and the inside door panel of the cab came loose !"
"Yes, yes !" he cried, remembering perfectly well. Both of us were amazed at the serendipity and strangeness of our reunion. It's a big city with lots of cabs, after all.
I told him how, at the end of my terrible 24 hours last spring, he had so immensely cheered me up -- and here he was again, doing the same thing !
Doctor Fritz, my guardian angel, thank you and God Bless.
Wednesday, October 22, 2003
Toast. Apples.
Why "Paula's House of Toast" ?
It's DK's phrase, his ironic name for my mythic toast restaurant. It reminds me, however, of a patient from my first internship way back when, 1977 probably. Back in the day, back when titans trod the earth.
I admitted some poor, elderly woman who'd been home subsisting on ice-cream cones sans ice cream for months and months. The tasteless, paper-and-air waffle kind, too: not tasty sugar cones. I wish I could remember what specific deficiency she'd been admitted with, but I can only remember being profoundly impressed by her diet of empty ice cream cones. What a strange asceticism !
We all have our secret fetishes. Some sexual, some oral.
I lived for months, once, in college, on apples and Special K. No milk.
The apples remind me of a book that impressed me in med school, in the days when I wanted to become a psychoanalyst. It was by a Swiss analyst, a woman; it was about schizophrenia, and her curing a female patient of it by feeding her apple slices, some kind of silly oral regression therapy.
That, in turn, takes me slightly farther back to the apple farm I stopped at during my first weeks at med school on my impulsive drive home to announce to my parents I was quitting medical school. I remember three green apples in my blue VW beetle. Sour apples. I remember my parents' horror. Quitting ? I'd barely begun ! Was I nuts ? Must be !
So they hauled me to a shrink. That very night, I think. Who in turn eventually referred me to The Alienist, who became apple of my eye for all those couchy years.
Still, I wonder. If they'd let me quit...
Those three green apples mark a real waystation in my life. They were witness to my remaining in medical school, my developing a transference-fueled wish to become a psychoanalyst, my ill-advised flight to the University of Chicago and a few miserable months of a psychiatry residency that, this time, I managed to actually quit, my quite accidental and unconsidered return to an internal medicine residency, my marriage to PMS, my accidental pregnancy, my long hiatus from the pregnancy-interrupted residency doing general practice in state prisons, divorce, remarriage, and, finally, the return to complete residency and become board certified: at the same teaching hospital where Alienist was still in the department of psychiatry. That's a twenty year circle.
I could say crop circle, but that's another story.
How do you like them apples ?
What I loved about psychoanalysis was how it honored language and image and metaphor. Arieti's book on schizophrenic language blew me away. A more recent book of a less academic genre but on the same topic is Lauren Slater's "Welcome to My Country." She's a therapist and wonderful writer who has, herself, struggled with bipolar illness. In this book she "reads" the verbal productions of the most difficult patients with loving attention, and deep, empathic understanding.
She's the sort of reader that all poets and all patients crave.
It's DK's phrase, his ironic name for my mythic toast restaurant. It reminds me, however, of a patient from my first internship way back when, 1977 probably. Back in the day, back when titans trod the earth.
I admitted some poor, elderly woman who'd been home subsisting on ice-cream cones sans ice cream for months and months. The tasteless, paper-and-air waffle kind, too: not tasty sugar cones. I wish I could remember what specific deficiency she'd been admitted with, but I can only remember being profoundly impressed by her diet of empty ice cream cones. What a strange asceticism !
We all have our secret fetishes. Some sexual, some oral.
I lived for months, once, in college, on apples and Special K. No milk.
The apples remind me of a book that impressed me in med school, in the days when I wanted to become a psychoanalyst. It was by a Swiss analyst, a woman; it was about schizophrenia, and her curing a female patient of it by feeding her apple slices, some kind of silly oral regression therapy.
That, in turn, takes me slightly farther back to the apple farm I stopped at during my first weeks at med school on my impulsive drive home to announce to my parents I was quitting medical school. I remember three green apples in my blue VW beetle. Sour apples. I remember my parents' horror. Quitting ? I'd barely begun ! Was I nuts ? Must be !
So they hauled me to a shrink. That very night, I think. Who in turn eventually referred me to The Alienist, who became apple of my eye for all those couchy years.
Still, I wonder. If they'd let me quit...
Those three green apples mark a real waystation in my life. They were witness to my remaining in medical school, my developing a transference-fueled wish to become a psychoanalyst, my ill-advised flight to the University of Chicago and a few miserable months of a psychiatry residency that, this time, I managed to actually quit, my quite accidental and unconsidered return to an internal medicine residency, my marriage to PMS, my accidental pregnancy, my long hiatus from the pregnancy-interrupted residency doing general practice in state prisons, divorce, remarriage, and, finally, the return to complete residency and become board certified: at the same teaching hospital where Alienist was still in the department of psychiatry. That's a twenty year circle.
I could say crop circle, but that's another story.
How do you like them apples ?
What I loved about psychoanalysis was how it honored language and image and metaphor. Arieti's book on schizophrenic language blew me away. A more recent book of a less academic genre but on the same topic is Lauren Slater's "Welcome to My Country." She's a therapist and wonderful writer who has, herself, struggled with bipolar illness. In this book she "reads" the verbal productions of the most difficult patients with loving attention, and deep, empathic understanding.
She's the sort of reader that all poets and all patients crave.
Tuesday, October 21, 2003
Audite
I love telling this story. That I love telling it probably bespeaks a terrible character flaw. The story has two titles. One is "How To Diagnose Adult Rickets Colonoscopically." The other is, "Lose Hope, Patients. Doctors Don't Even Listen To Patients Who Are Doctors." The other, less savage title, could be the first word from St Benedict's Rule: "Audite." Listen.
So, as we all know, one ingests a "prep" prior to the unmentionable colon intubation one earns as a rite of passage upon turning 50. To clean out the aforementioned organ. So that it may be scrutinized. Our HMO uses the nasty little prep with a gazillion millimoles of sodium phosphate. Fleet's Phosphosoda, citrus flavored. Like four ounces of bad lime kool aid laced with eighteen heaping tablespoons of table salt. So, good patient that I am, I choked it down.
Next morning I'm lying there in the GI suite of Upscale Suburb Community Hospital waiting (and waiting and waiting and waiting) for the procedure to begin, parched as hell, my teeth are vibrating (really !), there's a bizzarro twitch at the base of my right thumb, but I figured, what the hell, maybe I'm a little dehydrated.
Turns out the doc who was supposed to do my scope, some guy I'd never even met (since colonsocopies occur in a wierd never-neverland annex to the doctor-patient relationship, an impersonal assembly line of specialists and orifices) was off somewhere in New Hampshire giving a lecture. (OOPS ! SNAFU ! FUBAR !) But, fear not, announced the harried nurse who finally delivered this message, the "awesome" (her word) "chief of GI" had consented to do all the mis-scheduled procedures if that was OK with me.
Needless to say it was fine w/ me. Did not relish another quaff of the old Phospho Soda. No blushful hippocrene, that.
So the nurse slapped on a tourniquet to start an IV and my hand promptly curled up into a crampy, spastic little ball. This, as any medical student knows, is the classic, tourniquet-induced "carpal spasm," AKA Trousseau's sign, indicating either low blood calcium or blood rendered overly alkaline by hyperventilation.
Now I do not DO hyperventilation. EVER. I am a model of perfect GRAVITAS. The upper lip ? She is stiff.
Plus, as any medical student knows, PHOSPHATE (as in Fleet's PHOSPHO soda) BINDS IONIC CALCIUM, causing it to precipitate OUT of the bloodstream.
So I announced to the nurse, gingerly, trying not to do the arrogant I-know-best-I'm-a-physician schtick, that I'm an internist and explained all of the above to her and I was concerned my serum calcium might be low. She looked confused, mumbled something and scuttled off. In addition to Trousseau's sign, a very low calcium can cause seizures, arrhythmias and cause one's larynx to spazz up as well. Preventing air from entering one's body. So I was a bit, oh, worried. Silly me.
Then Nurse #2 came in and took my blood pressure in the other arm. Again, tourniquet; again Trousseau's sign in the other hand. Again, I pointed this out, offered physiologic explanation, complete with my credentials as an INTERNIST. "Awww," she said, hooking me up to the cardiac monitor, "you just need a nice HAND MASSAGE." And proceeded to knead my spastic palm. (It did feel rather good.)
Finally, in swanned the "awesome" chief of GI, introducing himself, and offering his credentials as the AWOL GI guy's "boss." I figured I'd go for broke. YET AGAIN, I proffered MY medical credentials. YET AGAIN, I reiterated the Trousseau's sign, phosphate prep, possible low calcium speech, acknowledging that hyperventilation can cause carpal spasm, but noting I was not hyperventilating, and this time I even threw in the twitching -- fasciculating, as we docs like to say -- thumb.
He peered down at me. "Ah yes, fasciculations," he intoned, gravely. "Well, you should certainly discuss those with your doctor. I get them too, sometimes." (I caught his subtext. Fasciculations are the first sign of ALS, Lou Gehrig's disease, but everyone gets benign twitches from time to time.) "And," he continued,"Your potassium is probably a little low. But the cardiac monitor looks fine." (Yes, asshole, I'm not flatlining yet, and low potassium doesn't cause Trousseau's sign !) He continued to peer down his awesome nose at me, and concluded, " You're probably just blowing off a little carbon dioxide."
Blowing off a little carbon dioxide ? Blowing off ? A Little carbon dioxide ?
In otherwords: YOU'RE HYPERVENTILATING, YOU HYSTERICAL WOMAN. ROLL OVER AND SHUT UP, I DON'T HAVE TIME FOR THIS !
(Do you think that if I had been a MALE internist he might have ordered a stat serum calcium level ?)
By the time I truly woke from my demerol and benzodiazepine induced stupor (I don't even remember getting home) at about six that evening, my whole body was doing the carpal spasm thing even without the tourniquets.
So I called my HMO.
I explained everything to a nurse. She connected me to some physician's assistant doing urgent care. I went through the whole thing AGAIN, this time venturing that maybe the standard dose of the prep was too much phosphate for a 105 pound woman. "No, no," she interrupted, peevishly, "we give the same dose to everyone," and continued to explain that they were really extremely busy, there was nothing they could do for me tonight, if I REALLY wanted to (as if it were a frivolous option only the most flagrant of hypochondriacs would choose) I could go to an ER. And if I chose that option I had to go to Grossly Inconvenient Community Hospital On The Outskirts Of Nowhere, which I shall henceforth call, acronymically, GICHOTOON. Would she call them and apprise them of my arrival ? Couldn't possibly. Too busy.
So off we schlepped to the GICHOTOON ER. By the time we got there it was 7 pm and I could barely hold and/or let go of the pen they gave me to sign in with. I told the story yet again to an uninterested, suspicious and harried looking triage nurse, she drew a few tubes of blood to send off to the lab, and consigned -- condemned -- me to the (Hell That Is Known As The GICHOTOON) ER waiting room. Where there are TWO TELEVISIONS on full blast, set to two different stations. Where, apparantly, one sits and awaits the arrival of the grim reaper and his tumbril, while being driven clinically insane by sit com laugh tracks, loud potato chip advertisements, and bad Tom Hanks movie sound tracks.
Soon, in addition to the muscle spasms, I began to feel like long wisps of hair were flagellating my cheeks. They weren't. And that I was wearing a pair of electric gloves. I wasn't.
At 11 PM I announced I would rather die than wait another moment in that hell, and a dubious but cowed DK, after the receptionist informed him she could not possibly even consider trying to obtain even an estimate of how much longer it would take before I could be seen, drove me home. It was not one of my better moments. I "eloped," as we docs like to say, from the ER. Thus placing me for eternity in the category "nutjob patient."
Once home we found, on the answering machine, an alarmed message from an ER doc, Dr X, "who'd just come on shift" and been handed my lab reports. He said I'd better get my butt back to the ER because my blood was, well, FUBAR.
Well, duh.
Of COURSE my calcium was low. I'd only been telling them that ALL FUCKING DAY ! (My potassium was in the basement, too, but my calcium was in the sub sub basement.)
So DK ferried (as in Styx) me back to the ER where young (extremely handsome and very patient) Dr X brought my lab tests and body back into the not-quite-right-but-almost-compatible-with-life range. They'd apparantly been having a night from Hell. I felt sorry for them. I felt sorry for me.
And took a taxi home at dawn. Later phoned up my internist who was horrified and made it a point to phone up Awesome GI Chief to give him the rest of the story, as it were. She ordered repeat labs. I had 'em. Calcium improving. But LOW phosphate. Huh ? Low ? I looked in Harrison's Principles of Internal Medicine and had an OMiGod moment. What causes low calcium and a low phosphate ? Of course.
Vitamin D deficiency.
(Am 2 year vegan, 10 year non-milk drinking vegetarian who gets little or no sunshine. Your basic troglodyte.)
Phoned up internist again. Asked her to add on a vit D level. It came back, well, zero. Compensatory hormone, PTH, which basically chews up bones, valiantly attempting to restore blood calcium to normal, was through the roof. Bones ? Translucent. Endocrinologist ? Deeply impressed.
Long dark winter of odd and semi-crippling hip, foot and rib pains ? Resolved with return of the sun and massive doses of D and Calcium.
Results of colonoscopy ? Hemorrhoid.
Apology from Chief Awesome ? None.
Mention of any of my Three Calcium Speeches in Upscale Suburb Community Hospital Medical Record ? None.
Bill For Co-Pay From The Hell That's Known As GITCHOTOON ER ? You bethcha.
Audite. It's good to remember that exhortation.
So, as we all know, one ingests a "prep" prior to the unmentionable colon intubation one earns as a rite of passage upon turning 50. To clean out the aforementioned organ. So that it may be scrutinized. Our HMO uses the nasty little prep with a gazillion millimoles of sodium phosphate. Fleet's Phosphosoda, citrus flavored. Like four ounces of bad lime kool aid laced with eighteen heaping tablespoons of table salt. So, good patient that I am, I choked it down.
Next morning I'm lying there in the GI suite of Upscale Suburb Community Hospital waiting (and waiting and waiting and waiting) for the procedure to begin, parched as hell, my teeth are vibrating (really !), there's a bizzarro twitch at the base of my right thumb, but I figured, what the hell, maybe I'm a little dehydrated.
Turns out the doc who was supposed to do my scope, some guy I'd never even met (since colonsocopies occur in a wierd never-neverland annex to the doctor-patient relationship, an impersonal assembly line of specialists and orifices) was off somewhere in New Hampshire giving a lecture. (OOPS ! SNAFU ! FUBAR !) But, fear not, announced the harried nurse who finally delivered this message, the "awesome" (her word) "chief of GI" had consented to do all the mis-scheduled procedures if that was OK with me.
Needless to say it was fine w/ me. Did not relish another quaff of the old Phospho Soda. No blushful hippocrene, that.
So the nurse slapped on a tourniquet to start an IV and my hand promptly curled up into a crampy, spastic little ball. This, as any medical student knows, is the classic, tourniquet-induced "carpal spasm," AKA Trousseau's sign, indicating either low blood calcium or blood rendered overly alkaline by hyperventilation.
Now I do not DO hyperventilation. EVER. I am a model of perfect GRAVITAS. The upper lip ? She is stiff.
Plus, as any medical student knows, PHOSPHATE (as in Fleet's PHOSPHO soda) BINDS IONIC CALCIUM, causing it to precipitate OUT of the bloodstream.
So I announced to the nurse, gingerly, trying not to do the arrogant I-know-best-I'm-a-physician schtick, that I'm an internist and explained all of the above to her and I was concerned my serum calcium might be low. She looked confused, mumbled something and scuttled off. In addition to Trousseau's sign, a very low calcium can cause seizures, arrhythmias and cause one's larynx to spazz up as well. Preventing air from entering one's body. So I was a bit, oh, worried. Silly me.
Then Nurse #2 came in and took my blood pressure in the other arm. Again, tourniquet; again Trousseau's sign in the other hand. Again, I pointed this out, offered physiologic explanation, complete with my credentials as an INTERNIST. "Awww," she said, hooking me up to the cardiac monitor, "you just need a nice HAND MASSAGE." And proceeded to knead my spastic palm. (It did feel rather good.)
Finally, in swanned the "awesome" chief of GI, introducing himself, and offering his credentials as the AWOL GI guy's "boss." I figured I'd go for broke. YET AGAIN, I proffered MY medical credentials. YET AGAIN, I reiterated the Trousseau's sign, phosphate prep, possible low calcium speech, acknowledging that hyperventilation can cause carpal spasm, but noting I was not hyperventilating, and this time I even threw in the twitching -- fasciculating, as we docs like to say -- thumb.
He peered down at me. "Ah yes, fasciculations," he intoned, gravely. "Well, you should certainly discuss those with your doctor. I get them too, sometimes." (I caught his subtext. Fasciculations are the first sign of ALS, Lou Gehrig's disease, but everyone gets benign twitches from time to time.) "And," he continued,"Your potassium is probably a little low. But the cardiac monitor looks fine." (Yes, asshole, I'm not flatlining yet, and low potassium doesn't cause Trousseau's sign !) He continued to peer down his awesome nose at me, and concluded, " You're probably just blowing off a little carbon dioxide."
Blowing off a little carbon dioxide ? Blowing off ? A Little carbon dioxide ?
In otherwords: YOU'RE HYPERVENTILATING, YOU HYSTERICAL WOMAN. ROLL OVER AND SHUT UP, I DON'T HAVE TIME FOR THIS !
(Do you think that if I had been a MALE internist he might have ordered a stat serum calcium level ?)
By the time I truly woke from my demerol and benzodiazepine induced stupor (I don't even remember getting home) at about six that evening, my whole body was doing the carpal spasm thing even without the tourniquets.
So I called my HMO.
I explained everything to a nurse. She connected me to some physician's assistant doing urgent care. I went through the whole thing AGAIN, this time venturing that maybe the standard dose of the prep was too much phosphate for a 105 pound woman. "No, no," she interrupted, peevishly, "we give the same dose to everyone," and continued to explain that they were really extremely busy, there was nothing they could do for me tonight, if I REALLY wanted to (as if it were a frivolous option only the most flagrant of hypochondriacs would choose) I could go to an ER. And if I chose that option I had to go to Grossly Inconvenient Community Hospital On The Outskirts Of Nowhere, which I shall henceforth call, acronymically, GICHOTOON. Would she call them and apprise them of my arrival ? Couldn't possibly. Too busy.
So off we schlepped to the GICHOTOON ER. By the time we got there it was 7 pm and I could barely hold and/or let go of the pen they gave me to sign in with. I told the story yet again to an uninterested, suspicious and harried looking triage nurse, she drew a few tubes of blood to send off to the lab, and consigned -- condemned -- me to the (Hell That Is Known As The GICHOTOON) ER waiting room. Where there are TWO TELEVISIONS on full blast, set to two different stations. Where, apparantly, one sits and awaits the arrival of the grim reaper and his tumbril, while being driven clinically insane by sit com laugh tracks, loud potato chip advertisements, and bad Tom Hanks movie sound tracks.
Soon, in addition to the muscle spasms, I began to feel like long wisps of hair were flagellating my cheeks. They weren't. And that I was wearing a pair of electric gloves. I wasn't.
At 11 PM I announced I would rather die than wait another moment in that hell, and a dubious but cowed DK, after the receptionist informed him she could not possibly even consider trying to obtain even an estimate of how much longer it would take before I could be seen, drove me home. It was not one of my better moments. I "eloped," as we docs like to say, from the ER. Thus placing me for eternity in the category "nutjob patient."
Once home we found, on the answering machine, an alarmed message from an ER doc, Dr X, "who'd just come on shift" and been handed my lab reports. He said I'd better get my butt back to the ER because my blood was, well, FUBAR.
Well, duh.
Of COURSE my calcium was low. I'd only been telling them that ALL FUCKING DAY ! (My potassium was in the basement, too, but my calcium was in the sub sub basement.)
So DK ferried (as in Styx) me back to the ER where young (extremely handsome and very patient) Dr X brought my lab tests and body back into the not-quite-right-but-almost-compatible-with-life range. They'd apparantly been having a night from Hell. I felt sorry for them. I felt sorry for me.
And took a taxi home at dawn. Later phoned up my internist who was horrified and made it a point to phone up Awesome GI Chief to give him the rest of the story, as it were. She ordered repeat labs. I had 'em. Calcium improving. But LOW phosphate. Huh ? Low ? I looked in Harrison's Principles of Internal Medicine and had an OMiGod moment. What causes low calcium and a low phosphate ? Of course.
Vitamin D deficiency.
(Am 2 year vegan, 10 year non-milk drinking vegetarian who gets little or no sunshine. Your basic troglodyte.)
Phoned up internist again. Asked her to add on a vit D level. It came back, well, zero. Compensatory hormone, PTH, which basically chews up bones, valiantly attempting to restore blood calcium to normal, was through the roof. Bones ? Translucent. Endocrinologist ? Deeply impressed.
Long dark winter of odd and semi-crippling hip, foot and rib pains ? Resolved with return of the sun and massive doses of D and Calcium.
Results of colonoscopy ? Hemorrhoid.
Apology from Chief Awesome ? None.
Mention of any of my Three Calcium Speeches in Upscale Suburb Community Hospital Medical Record ? None.
Bill For Co-Pay From The Hell That's Known As GITCHOTOON ER ? You bethcha.
Audite. It's good to remember that exhortation.
Monday, October 20, 2003
Vegan Sangha Which
I've been thinking about -isms today. About subscribing to a body of belief; signing on, as it were, to a club that allows one to announce I am a(n) .... -ist. Complete with lapel pin, handshake, password, lawn ornament. I've always hankered for this sort of belonging. Me: the eternal outsider looking in, the poor little match girl. I do say to people, "I am a vegan," when the issue of what I will or won't eat arises, but I'm not even sure I am a dyed-in-the-synthetic-fleece "vegan."
Over ten years ago I decided not to eat animals as "a gesture of peace." This was the phrase I used in articulating the decision to myself. There may have been a vaguely Buddhist context or impetus. After that, I felt uneasy about wearing leather shoes, and about the bits of leather on my winter coat. Hypocritical.
Two or three years ago I learned that the factory farming methods that produce eggs and milk are as cruel as the ones that result in slaughter, so, to be consistent, finally, in my "gesture of peace," I eliminated these things, along with leather, wool and silk from items I eat and use.
For awhile I because obsessed with the micro-ingredient aspect of veganism: incredible numbers of chemicals used in food are animal-derived. The forest vanished; so, in fact did the trees -- I was down there with the chloroplasts and the xylem and phloem. I still buy vegetable-based bars of soap, but could never get used to vegan toothpaste, laundry soap or shampoo. And can't break my peppermint life-saver addiction. And, on rare occasion, I use non-dairy coffee creamer (which, of course, is chock full of dairy material) in coffee. So of course there's guilt. And rationalization. Maybe I'm a "reform vegan," not an orthodox one, etc etc.
There's a great line from the Simpsons -- a greenpeace type guy one-ups Lisa's vegetarianism by saying something like "I am a sixth degree vegan. I only eat things that don't cast a shadow."
Plus being a "vegan" seems like having a religion that's focused on food and animal rights. Culinary and political. It seems like one's metaphysics should involve something grander, and the respect for animals and the dietary observances should be corrollary. Or something. "I am a Vegan" feels like the center's in the wrong place. If I'm going to embrace an -ism, it should be the right one.
So I'm probably not technically a vegan. So what am I?
I was baptised Christian (Groveland Congregational Church, 1960, Reverand Donald Tatro !) and am a registered Democrat. Do those count ? I am a card carrying member of the AAA, a useful organization indeed, and our new cards just arrived today ! I used to think that I might want to take refuge in Buddha Dharma and Sangha, but never did.
I'm thinking of HNF, the card carrying schizophrenic I knew years ago, crazy but not un-insightful, and very smart. He looked at a policeman once and commented: The only thing that's holding that man's personality together is his uniform.
Some mornings, in the clinic, when I put on my white coat and stand outside of the door of the first patient of the day, it feels like he was talking about me.
Over ten years ago I decided not to eat animals as "a gesture of peace." This was the phrase I used in articulating the decision to myself. There may have been a vaguely Buddhist context or impetus. After that, I felt uneasy about wearing leather shoes, and about the bits of leather on my winter coat. Hypocritical.
Two or three years ago I learned that the factory farming methods that produce eggs and milk are as cruel as the ones that result in slaughter, so, to be consistent, finally, in my "gesture of peace," I eliminated these things, along with leather, wool and silk from items I eat and use.
For awhile I because obsessed with the micro-ingredient aspect of veganism: incredible numbers of chemicals used in food are animal-derived. The forest vanished; so, in fact did the trees -- I was down there with the chloroplasts and the xylem and phloem. I still buy vegetable-based bars of soap, but could never get used to vegan toothpaste, laundry soap or shampoo. And can't break my peppermint life-saver addiction. And, on rare occasion, I use non-dairy coffee creamer (which, of course, is chock full of dairy material) in coffee. So of course there's guilt. And rationalization. Maybe I'm a "reform vegan," not an orthodox one, etc etc.
There's a great line from the Simpsons -- a greenpeace type guy one-ups Lisa's vegetarianism by saying something like "I am a sixth degree vegan. I only eat things that don't cast a shadow."
Plus being a "vegan" seems like having a religion that's focused on food and animal rights. Culinary and political. It seems like one's metaphysics should involve something grander, and the respect for animals and the dietary observances should be corrollary. Or something. "I am a Vegan" feels like the center's in the wrong place. If I'm going to embrace an -ism, it should be the right one.
So I'm probably not technically a vegan. So what am I?
I was baptised Christian (Groveland Congregational Church, 1960, Reverand Donald Tatro !) and am a registered Democrat. Do those count ? I am a card carrying member of the AAA, a useful organization indeed, and our new cards just arrived today ! I used to think that I might want to take refuge in Buddha Dharma and Sangha, but never did.
I'm thinking of HNF, the card carrying schizophrenic I knew years ago, crazy but not un-insightful, and very smart. He looked at a policeman once and commented: The only thing that's holding that man's personality together is his uniform.
Some mornings, in the clinic, when I put on my white coat and stand outside of the door of the first patient of the day, it feels like he was talking about me.
Sunday, October 19, 2003
Beside Myself
In my dream I was standing beside myself on the edge of a cliff. My other self extended her hand toward me and invited me to jump. The cliff was sheer, and the ground beneath was trash-strewn. No, I replied, frightened, but she insisted. We held hands, my fear dissipated, and we jumped. That's it.
Where did the dream come from ?
Last night DK and I watched a snippet of the Steve Reich video "Hindenberg," his usual minimalist schtick, a chorus chanting "It was not a technological failure," over a film montage of the famous shots of the falling dirigible -- the egg shaped flying machine drifting down, exploding, the terrified crowds fleeing from it toward the camera.
I thought of the horrible, riveting raw film of the World Trade Center collapse, especially of the people jumping. Jumping hand in hand. There's an interesting essay by Tom Junod about one particular photo he calls "The Falling Man," a photo that has been accused of "turning tragedy into leering pornography." Junod considers it the "cenotaph" of this anonymous "Unknown Soldier," a document of honorable witness, not crude invasion.
There's an iconic photo from WWII that's engraved within my consciousness: the picture of a stark field, a woman clutching a child to her breast, and a Nazi pointing a long rifle at the both of them. After I had my son, it was as if a gaping hole opened up in me that I felt compelled to fill with as much knowledge of that grim time as I could. It became an obsession. As if the newly forged mother-son connection opened up a whole new possible world of unimaginable loss and grief about which I had to learn everything, immediately. Why ? To ward it off ? To reassure myself about our own safety ? To convince myself that unspeakable things only happened in black-and-white, long ago, to other people ? There is a sense in which it was like pornography: the vicariousness, and the intensity of emotion with which it filled me. Grief porn, not sex porn. Safe grief. A rehearsal. Or was it mourning for the inutterable sadness of the world ? Or both ?
Last night I wondered about a composer appropriating 9-11 images in a fashion similar to Reich's. I asked DK. "Too soon," he opined. There's a real sense that artists are tomb raiders -- stealing from history, from the tradition. There is transgression. There are boundaries. There are places that seem raw, untouchable, sacred. One must almost ask forgiveness in advance before entering. Or perform some act of ablution, expiation. Maybe there is no way to do it that is not shameless plunder and invasion.
I have put the Holocaust into poems, but not often. I felt my "permission" to write this one was that it was about a Nazi medical "researcher" Dr Rascher, a fellow physician. I wrote it in 1995. I had worked for over ten years as a doctor in state prisons. But, to this date, I am not sure that it is permission enough.
DR RASCHER'S HEAVENLY CHARIOT
It was a secret
within a secret
It made even
Himmler sick,
the tall box on wheels
behind Block 5
in Dachau
It could simulate
a vertical dive
from 32,000 feet
with or without oxygen
Dr Rashcher
had a deadline to meet
October 25
the great
Luftwaffe Conference
on Freezing
and Nuernberg
is so lovely
in the fall, Fraulein,
we could walk together on the bank
of the River Regnitz
under the tall lindens
and I could give you nylons
and a tin of potted meat perhaps
after the Scientific Sessions
if you would only, if you...
He was worried
They brought him
a 37 year old Jew
in good general condition
They brought him
four Gypsy women
from another camp
He gave them all a ride
in his heavenly chariot
recording his
meticulous observations
in a careful hand
male subject at 12 Km
no supplemental oxygen
subject breathed
for 30 minutes
diaphoresis
and myoclonus
appeared at four
tetany at five
tachypnea at six
unconsciousness by ten
and then a gradual
slowing of the breath
to three per minute
with deepening cyanosis
and foam at the lips
until breathing ceased at thirty;
electrocardiographic activity
continued for another twenty
and at autopsy,
the atria still quivered
even after the spine was severed
and the brain pulled
from its heavy, subarachnoid
oedema
(applause)
He was worried about
the warming with body heat experiments
Himmler was insisting
But, damn it, he’d so meticulously documented
the results of cooling !
The excitation, the progressive rigors,
the flexion contractures, the tonic-clonic activity
and how when he chilled them
to 26.5 C rectally
it was the submersive chilling of the occiput
that would invariably result in fatality --
paresis of the thermoregulatory
centers of the brainstem
he’d speculate learnedly
(applause)
.... then arm in arm, Fraulein,
flush in a lovely season,
the Regnitz flowing
beneath our balcony
thanks to our gracious
Reichsfuehrer
it could mean a University
appointment after the war
crimson leaves upturned
spinning downstream
I will run a finger
under the silk
of your gown
at the shoulder
in the shadows
But warming with body heat.
Oh, let’s dial in
a fall from 10 Km,
and then
two hours in the ice pool
at 2C,
yes, yes the helmet
and kapok vest,
and this time keep
the damned occiput up
for heaven’s sake
and the rectal thermistor secured
for my meticulous observations
maybe this one will live
long enough to rewarm...
...O Savior of the noble
Luftwaffe, Dr Sigmund Rascher,
Professor Untersturnfuerher Rascher, in the
shadows above the lovely river,
along the shoulder of the lovely Fraulein
I slowly run my finger
along the supraclavicular hollow
down the costochondral ridge
to xiphoid, rectus, navel, pubes
thanks to our gracious
Reichsfuehrer Himmler
if only he
lives
if only he
will warm
if only he
Prepare the bed !
get the Gypsy whores
from Station RF, bastard,
and drag the shivering bastard from the pool,
that’s it, oh it’ll take two at least,
throw them on, that’s right,
right on top of him,
now warm him, you dogs,
warm him
warm him
warm him !
Where did the dream come from ?
Last night DK and I watched a snippet of the Steve Reich video "Hindenberg," his usual minimalist schtick, a chorus chanting "It was not a technological failure," over a film montage of the famous shots of the falling dirigible -- the egg shaped flying machine drifting down, exploding, the terrified crowds fleeing from it toward the camera.
I thought of the horrible, riveting raw film of the World Trade Center collapse, especially of the people jumping. Jumping hand in hand. There's an interesting essay by Tom Junod about one particular photo he calls "The Falling Man," a photo that has been accused of "turning tragedy into leering pornography." Junod considers it the "cenotaph" of this anonymous "Unknown Soldier," a document of honorable witness, not crude invasion.
There's an iconic photo from WWII that's engraved within my consciousness: the picture of a stark field, a woman clutching a child to her breast, and a Nazi pointing a long rifle at the both of them. After I had my son, it was as if a gaping hole opened up in me that I felt compelled to fill with as much knowledge of that grim time as I could. It became an obsession. As if the newly forged mother-son connection opened up a whole new possible world of unimaginable loss and grief about which I had to learn everything, immediately. Why ? To ward it off ? To reassure myself about our own safety ? To convince myself that unspeakable things only happened in black-and-white, long ago, to other people ? There is a sense in which it was like pornography: the vicariousness, and the intensity of emotion with which it filled me. Grief porn, not sex porn. Safe grief. A rehearsal. Or was it mourning for the inutterable sadness of the world ? Or both ?
Last night I wondered about a composer appropriating 9-11 images in a fashion similar to Reich's. I asked DK. "Too soon," he opined. There's a real sense that artists are tomb raiders -- stealing from history, from the tradition. There is transgression. There are boundaries. There are places that seem raw, untouchable, sacred. One must almost ask forgiveness in advance before entering. Or perform some act of ablution, expiation. Maybe there is no way to do it that is not shameless plunder and invasion.
I have put the Holocaust into poems, but not often. I felt my "permission" to write this one was that it was about a Nazi medical "researcher" Dr Rascher, a fellow physician. I wrote it in 1995. I had worked for over ten years as a doctor in state prisons. But, to this date, I am not sure that it is permission enough.
DR RASCHER'S HEAVENLY CHARIOT
It was a secret
within a secret
It made even
Himmler sick,
the tall box on wheels
behind Block 5
in Dachau
It could simulate
a vertical dive
from 32,000 feet
with or without oxygen
Dr Rashcher
had a deadline to meet
October 25
the great
Luftwaffe Conference
on Freezing
and Nuernberg
is so lovely
in the fall, Fraulein,
we could walk together on the bank
of the River Regnitz
under the tall lindens
and I could give you nylons
and a tin of potted meat perhaps
after the Scientific Sessions
if you would only, if you...
He was worried
They brought him
a 37 year old Jew
in good general condition
They brought him
four Gypsy women
from another camp
He gave them all a ride
in his heavenly chariot
recording his
meticulous observations
in a careful hand
male subject at 12 Km
no supplemental oxygen
subject breathed
for 30 minutes
diaphoresis
and myoclonus
appeared at four
tetany at five
tachypnea at six
unconsciousness by ten
and then a gradual
slowing of the breath
to three per minute
with deepening cyanosis
and foam at the lips
until breathing ceased at thirty;
electrocardiographic activity
continued for another twenty
and at autopsy,
the atria still quivered
even after the spine was severed
and the brain pulled
from its heavy, subarachnoid
oedema
(applause)
He was worried about
the warming with body heat experiments
Himmler was insisting
But, damn it, he’d so meticulously documented
the results of cooling !
The excitation, the progressive rigors,
the flexion contractures, the tonic-clonic activity
and how when he chilled them
to 26.5 C rectally
it was the submersive chilling of the occiput
that would invariably result in fatality --
paresis of the thermoregulatory
centers of the brainstem
he’d speculate learnedly
(applause)
.... then arm in arm, Fraulein,
flush in a lovely season,
the Regnitz flowing
beneath our balcony
thanks to our gracious
Reichsfuehrer
it could mean a University
appointment after the war
crimson leaves upturned
spinning downstream
I will run a finger
under the silk
of your gown
at the shoulder
in the shadows
But warming with body heat.
Oh, let’s dial in
a fall from 10 Km,
and then
two hours in the ice pool
at 2C,
yes, yes the helmet
and kapok vest,
and this time keep
the damned occiput up
for heaven’s sake
and the rectal thermistor secured
for my meticulous observations
maybe this one will live
long enough to rewarm...
...O Savior of the noble
Luftwaffe, Dr Sigmund Rascher,
Professor Untersturnfuerher Rascher, in the
shadows above the lovely river,
along the shoulder of the lovely Fraulein
I slowly run my finger
along the supraclavicular hollow
down the costochondral ridge
to xiphoid, rectus, navel, pubes
thanks to our gracious
Reichsfuehrer Himmler
if only he
lives
if only he
will warm
if only he
Prepare the bed !
get the Gypsy whores
from Station RF, bastard,
and drag the shivering bastard from the pool,
that’s it, oh it’ll take two at least,
throw them on, that’s right,
right on top of him,
now warm him, you dogs,
warm him
warm him
warm him !
