Saturday, January 31, 2004
Tell Me A Story
Probably because my sleep was interrupted by the the vice grip of my former consort Al DeSalvo, AKA Aspen Collar, and I was spending more time than usual awake in a silent house, I realized a few months ago that there was a pretty continuous pure tone mid frequency morse-code like tinnitus in my right ear. Very faint, probably nothing, but nonetheless present.
I decided to check it out.
So I arranged an ENT consultation. As I sat in the waiting room of the surgical specialties department of my health center, I noticed that across the hall, near the lab and pharmacy, there was a large posterboard sign depicting a lovely woman's face. It was advertising cosmetic surgery. It creeped me out.
After filling out a history questionnaire, I followed the nurse into the exam room. I noticed a business card tacked to the wall. The otolaryngologist I was about to see had a subspecialty in "facial plastic surgery." I was feeling more wrinkled and wattled by the minute. Was that my tinnitus, or was the word BOTOX issuing subliminally from the heating vents ?
Before long a pleasant young man breezed in, and introduced himself. The doctor. Everything about his body language said: hurry.
I began telling him what I thought he should know. The narrative. My story. He began to peer into my nose and ears even before I'd finished.
There were three or four things that HE wanted to know. Which ear. Was the hearing affected. Were there attendant neurological symptoms. Was I over-using caffeine or aspirin.
He seemed indifferent to the episodes of vertigo, deafness and tinnitus I'd had in 1985, the recurrance I'd had in 1992 which had prompted vestibular and audiometric tests and an MRI, and the C2 fracture I'd had three months prior.
He wanted to cut to the chase.
As a physician I knew that his questions were the important questions. The questions that would direct the work-up and lead to the diagnosis, or at least exclude the bad things that make ears ring. But as a patient I wanted to say, "Hey, buddy, shut up for a minute and let me tell my story my way."
I don't think he knew that his patient was herself a doctor.
"Drink less caffeine, schedule a hearing test and see me after that," he concluded cheerfully, and breezed out.
A large part of what doctors do is listen to patients' stories. We say "What brings you here today," or "Tell me about your illness," and step back to listen. When the patient stops talking, we ask for elaboration. "Tell me more about X." And when all the narrative details have been filled in, we ask the additional specific questions we need to ask. And conclude: "Is there anything else you feel is important for me to know ?"
Patients shape and color their stories like artists. Some open with a detailed background, like a novel's opening family history. Others go by strict chronology. How the symptom began. How it evolved. Others plunge in media res: this pain, right there, right now. Some emphasize character, reaction: I am so afraid. I have been so tired, angry, frustrated. Some narratives are fragmented, replete with non sequiturs, nearly avant garde. Others overflow with detail. Oatmeal for breakfast. What the mailman left. The dirty drapes. Some patients supply their own diagnoses. Some are showmen, comedians, actors with a well-rehearsed script. Others begrudge giving the least detail, just want a prescription to make it better. Others are simply inarticulate. The doctor faces a hermeneutic challenge. We must elicit, then interpret the words, and the gestures. And the silences.
Doctor: Have you had any chest pains ?
Patient: (long pause. looks away.) Not really.
That's when one begins, mentally, arranging a bed in the CCU.
The very act of telling one's story is therapeutic. As in catharsis. Confession. It is good to be heard. To unburden. To let it all out. To be heard, understood, accepted, validated. Connection is encouraging, energizing. We feel better afterwards. We are our bodies and our stories. We, like writers, appreciate being read with care and attention. To have our narratives admired and praised.
I did not like having the story of my tinnitus so ruthlessly edited.
I wanted to begin with the loud roaring, hissing typhoons of tinnitus I had in 1985 and go on to describe its subtle and ghostly return seven years later; I wanted to allude to the odd little munching sound I heard for a few weeks last summer and end with the tiny da dah da dahhh da da I hear now fluting in my ear when the room is silent. I tried to give him lush, descriptive prose.
He wanted dry, minimalist reportage.
I decided to check it out.
So I arranged an ENT consultation. As I sat in the waiting room of the surgical specialties department of my health center, I noticed that across the hall, near the lab and pharmacy, there was a large posterboard sign depicting a lovely woman's face. It was advertising cosmetic surgery. It creeped me out.
After filling out a history questionnaire, I followed the nurse into the exam room. I noticed a business card tacked to the wall. The otolaryngologist I was about to see had a subspecialty in "facial plastic surgery." I was feeling more wrinkled and wattled by the minute. Was that my tinnitus, or was the word BOTOX issuing subliminally from the heating vents ?
Before long a pleasant young man breezed in, and introduced himself. The doctor. Everything about his body language said: hurry.
I began telling him what I thought he should know. The narrative. My story. He began to peer into my nose and ears even before I'd finished.
There were three or four things that HE wanted to know. Which ear. Was the hearing affected. Were there attendant neurological symptoms. Was I over-using caffeine or aspirin.
He seemed indifferent to the episodes of vertigo, deafness and tinnitus I'd had in 1985, the recurrance I'd had in 1992 which had prompted vestibular and audiometric tests and an MRI, and the C2 fracture I'd had three months prior.
He wanted to cut to the chase.
As a physician I knew that his questions were the important questions. The questions that would direct the work-up and lead to the diagnosis, or at least exclude the bad things that make ears ring. But as a patient I wanted to say, "Hey, buddy, shut up for a minute and let me tell my story my way."
I don't think he knew that his patient was herself a doctor.
"Drink less caffeine, schedule a hearing test and see me after that," he concluded cheerfully, and breezed out.
A large part of what doctors do is listen to patients' stories. We say "What brings you here today," or "Tell me about your illness," and step back to listen. When the patient stops talking, we ask for elaboration. "Tell me more about X." And when all the narrative details have been filled in, we ask the additional specific questions we need to ask. And conclude: "Is there anything else you feel is important for me to know ?"
Patients shape and color their stories like artists. Some open with a detailed background, like a novel's opening family history. Others go by strict chronology. How the symptom began. How it evolved. Others plunge in media res: this pain, right there, right now. Some emphasize character, reaction: I am so afraid. I have been so tired, angry, frustrated. Some narratives are fragmented, replete with non sequiturs, nearly avant garde. Others overflow with detail. Oatmeal for breakfast. What the mailman left. The dirty drapes. Some patients supply their own diagnoses. Some are showmen, comedians, actors with a well-rehearsed script. Others begrudge giving the least detail, just want a prescription to make it better. Others are simply inarticulate. The doctor faces a hermeneutic challenge. We must elicit, then interpret the words, and the gestures. And the silences.
Doctor: Have you had any chest pains ?
Patient: (long pause. looks away.) Not really.
That's when one begins, mentally, arranging a bed in the CCU.
The very act of telling one's story is therapeutic. As in catharsis. Confession. It is good to be heard. To unburden. To let it all out. To be heard, understood, accepted, validated. Connection is encouraging, energizing. We feel better afterwards. We are our bodies and our stories. We, like writers, appreciate being read with care and attention. To have our narratives admired and praised.
I did not like having the story of my tinnitus so ruthlessly edited.
I wanted to begin with the loud roaring, hissing typhoons of tinnitus I had in 1985 and go on to describe its subtle and ghostly return seven years later; I wanted to allude to the odd little munching sound I heard for a few weeks last summer and end with the tiny da dah da dahhh da da I hear now fluting in my ear when the room is silent. I tried to give him lush, descriptive prose.
He wanted dry, minimalist reportage.
Spillway
Off the south bank of the Charles River at the small dam just east of the footbridge there is an astonishing cleft in the water. It seems a wonder and a paradox that onrushing fluid can present with something as apparantly static as a hole. It looks like someone has pickaxed a wedge right out of the water. It is the obverse of a standing wave. Stasis in motion.
But, after all, what is a river ?
From childhood, I've carried a sense that a river is, above all, treacherous: dark water, full of hidden perils, with powerful currents set to sweep a person away. Unfathomable, malign darkness and power. Something alive and dangerous.
One day I had a revelation. I think I was driving into Boston on one of the two parkways that parallel the Charles. The roads -- Memorial Drive and Storrow -- are busy, sinuous, congested, and, in spots, quite close to the river. Catastrophizers like myself can't help picturing our car wiping out on a curve and sailing into the river. Although I confess that in decades of living near Boston, I've never once heard of anyone doing so. (Storrow Drive is mostly notorious for truckers who ignore the posted height restrictions and get their rigs wedged under its low bridges.)
So one day I was driving and catastrophizing and suddenly I found myself mentally dissecting the river: I drained it. And realized that what was left was simply a ditch. Across which I could stroll. Ditch, water, motion. Somehow that act of reduction and abstraction diminished the river's menace.
I have no doubt that, under the upstream Charles River water's cleft, is a cloven stone.
Just as I have no doubt that the person who was led to the House of Toast today by a Yahoo search on "pictures+of+vaginas+from+girls+ages+11-16" was disappointed.
I would like to find a mental operation to diminish my distress at the thought of someone doing that search. To drain the notion of its onrushing, predatory sexual implication. To reduce it to dry ditch and flat fluid. But I can't. I can't conjure up a staid, disinterested anatomist as author of that search string. Someone wants to look. Maybe to have. Please, not that. I think of a camera's disinterested eye opening; of the prurient gaze behind it. Of violation. Trespass. Force.
To what can I reduce this, then ?
Desire. Restless, fluid, meandering. Taking the form of its submerged topographies. Admixed with strange elements, it churns up into froth.
Desire and revulsion, two eddies, clockwise and counterclockwise.
Canoeing on the Saco River in Maine: two memories from my first marriage.
On the first trip, it is cold and damp. Overcast, with intermittant mist. The river is deep and fast. I am new to this, and afraid. We are navigating a narrow stretch of river where the banks' branches overhang. Fallen branches and stumps just below the dark surface reach up, scrape the boat, threaten to overturn it. I stare at the oncoming water, terrified. Hands, grabbing for me.
On the second trip, it is warm and bright. Summertime. The river is crowded with canoers. There is an atmosphere of celebration and happiness. The water is clear, the bottom is clean and sandy. In places it is so shallow the boat scrapes the bottom. Seven months pregnant, I step out of the canoe and splash in the warm, calm water. It ripples around my ankles.
How wholesome.
That day was the first time I ever had heartburn, from greasy chicken we devoured on the drive home. My copy of Adrienne Rich's Poems, Selected and New 1950-1974 is moldy and watermarked from the dip in the river it took that day. I take it out and I notice that, on its cover, there's a picture of green water falling over green rock. The cover is creased, the page edges curl.
Does everyone have secrets ? Secret wishes, secret appetites. Secret fantasies. Shameful secrets, kept contained between banks.
The river overflows its banks, sweeps the children away.
And who is that carefree mother-to-be splashing in the placid, August river ?
Sunday, January 25, 2004
Gotcha !
The Perks of Practice
It's 6 o'clock, Thursday, and I'm sitting at my desk writing the last notes of the day, trying to remember whose throat was mildly erythematous and whose left ear drum was injected and retracted. All the patients are gone. I too will soon be gone. My phone rings -- my private line, an outside call. I answer.
It is, as is often the case at this hour, DK. And, as is sometimes the case, he's playing a game: "The Wife, On Call."
Hellooooo. (A simpering voice.) This is Mr Jones ! I...I...have fractured my -- spleen !! Yes, my spleen. It is fractured, and my doctor gives me medication. But the medication has fallen right into the toilet ! And then my dog lapped it up, every last pill !
(I play along) And what medication is this, sir ?
Only one medication works for my pain -- it's called parca-, no, porco- , uh, no, perky- ....
Percodan ?
Yes, yes ! That is it ! My doctor ususally gives me 4,000 tablets and eight refills !
Hearing "fractured spleen" come out of my absolutely non-medical spouse's mouth amuses me no end. The problem of patients exhibiting possible "drug-seeking behavior" in my walk-in practice is not at all amusing.
I don't know what's more disturbing, am obviously disingenous attempt to "remember" the word "percocet," or a nickname basis familiarity with common narcotics -- perks, vikes, oxys, T-3's.
I remember a case from my first internship, circa 1978 -- a group of adolescents had broken into a pharmacy owned by one of their fathers and taken large numbers of "Percogesic" -- do they still make the stuff ? -- an over the counter combination of tylenol and and antihistamine, whose perc- containing brand name clearly capitalized on the "percodan" mystique.
And here I am, 25 years later, still cringing at that perky little syllable.
It is, as is often the case at this hour, DK. And, as is sometimes the case, he's playing a game: "The Wife, On Call."
Hellooooo. (A simpering voice.) This is Mr Jones ! I...I...have fractured my -- spleen !! Yes, my spleen. It is fractured, and my doctor gives me medication. But the medication has fallen right into the toilet ! And then my dog lapped it up, every last pill !
(I play along) And what medication is this, sir ?
Only one medication works for my pain -- it's called parca-, no, porco- , uh, no, perky- ....
Percodan ?
Yes, yes ! That is it ! My doctor ususally gives me 4,000 tablets and eight refills !
Hearing "fractured spleen" come out of my absolutely non-medical spouse's mouth amuses me no end. The problem of patients exhibiting possible "drug-seeking behavior" in my walk-in practice is not at all amusing.
I don't know what's more disturbing, am obviously disingenous attempt to "remember" the word "percocet," or a nickname basis familiarity with common narcotics -- perks, vikes, oxys, T-3's.
I remember a case from my first internship, circa 1978 -- a group of adolescents had broken into a pharmacy owned by one of their fathers and taken large numbers of "Percogesic" -- do they still make the stuff ? -- an over the counter combination of tylenol and and antihistamine, whose perc- containing brand name clearly capitalized on the "percodan" mystique.
And here I am, 25 years later, still cringing at that perky little syllable.
