How are you feeling?

"So,  Can I ask... how do you feel?"

Meeting New Patients.  The ultimate  wild card, blind date, wild ride.  Anything can happen.   You meet someone new,  who knows  if they need pain medication, anti psychotics, an air tight alibi?

These folks need a new doctor, their old doc is retiring. Two rules in modern medicine:
 1) The best psychiatrists take only  cash and 2) The best internists don't accept  new patients.   I sympathize  with the psychiatrists.  Insurance does not reimburse the talking cure.


"Your  staff says you've been (  beat)  sick and you're back part time. How do you feel?"

Boundaries.  My staff has been overly  protective.  I appreciate it, but  really,  is my medical history  pertinent?  Of course it is.

I'm caught off balance. I should ask the questions.

" How do you feel?"  I flash on an old girlfriend,  who would reply " I have a mild headache" whenever asked about her health.

Turns out, I have a mild headache

 More to the point what's an appropriate  answer?
I try out responses :

"Its none of your Goddamn business"
" I'm great! how are you?"

They have a right to know. They have a right to know if I am  in the big fade, they need to know if their doctor is a ghost  slowly  slipping the surly bonds of a 15 minute office visit.

 it's none of their business.

Aren't  there laws about this? Aren't there laws that   keep ones medical  history a secret, isn't the state of my health privileged  information?
On the other hand, I ask  the most  intimate, complex questions of strangers   so  it  seems fair to give an honest, non sarcastic response
I answer  accurately, if not a wee bit curt:  "I have good days and bad days."

"So.... is this a good day?"
It is not.  It is not a good day.  I glance at my arms,  now covered with purple, livid  splotches, the  result of  taking an anti fungal along with coumadin. The  fungal mediation has  shorted my liver, leaving me unable to produce  clotting factor.
This is , in itself, not critical, unless of course, the bleeding is in my brain

Did I just say I had a headache? Uh oh.

Quick, do serial 7s.... 100-7 is...93.. 93 minus 7 is... is what?

No ifs ands or buts

Spell world backward

Draw a clock, make it 10;30

You are not dying

That would be bad.

I am worried.  Am I bleeding into my Pons?   I call  Jim, my cardiologist to adjust my coumadin dose.  His advise disorients me.

"Don't have rigorous sex" is his advice.


He's not joking.
Do I mention this to my patients ?

 ' I'm OK as long as I avoid vigorous sex?" I'm OK if I avoid the  Gym, sharpening  axes and the  Venus butterfly?

I'm clearly flummoxed.

The patient smiles sympathetically .

"DO you think you;re getting better?"

I haven't the vaguest idea.

"Better?"  Any pain free day  is better
Now I'm just whining.
But I need to see new patients.

There arent many GPs out there any more.  When our  children contemplate med school, we  sing some version of " Mommy don't let your babies grow up to be internists."  Isn't that what we tell Jeff?    He'll emerge from state  med school a quarter million in debt. That's an awful lot of sore throats or one knee replacement
I smile, stalling for time.

 "I have every intention of  increasing my hours, returning to work, hanging around here" as I struggle to  add a note of sincerity.


I just received  a memo "Dr Weinreb is not taking new patients" Why?    Something I did? said? didn't do? I am grateful, actually. Although my salary increases when my patient numbers increases, making money is not on my mind today.


 The patient looks doubtful.   Maybe she can find a  Doctor who isn't covered with Gin Blossoms.

I ask a few more questions, make sure they  see my diplomas from Cornell and SUNY upstate to prove Im not a fraud.

Perhaps the headache is starting to resolve.

Great. ask me again..... how am I feeling?

A sovereign Cure

It’s 4:30 AM. I am wide-awake.   I pat myself down, conduct a quick Pain inventory. The Foot report trickles in, setting the stage for the official USDA’s dawn corn report

The official corn and bunion report will show some minor scattered cramping along the left lateral gastrocnemus.   I am pain free but haunted of memories of recent pain, oral and esophageal discomfort so overwhelming and pointless that it must serve some useful, evolutionary purpose. Perhaps HaShem just enjoys watching us tap dance across our darkened floors at 3 AM. Automatons in search for peace. .  What did Joan Didion write about migraine pain?  

…I had no brain tumor, no eyestrain, no high blood pressure, nothing wrong with me at all: I simply had migraine headaches, and migraine headaches were, as everyone who did not have them knew, imaginary. I fought migraine then, ignored the warnings it sent, went to school and later to work in spite of it, sat through lectures in Middle English and presentations to advertisers with involuntary tears running down the right side of my face, threw up in washrooms, stumbled home by instinct, emptied ice trays onto my bed and tried to freeze the pain in my right temple, wished, only for a neurosurgeon who would do a lobotomy on house call, and cursed my imagination

Kindred Spirit Joan.

I am trying to remain perfectly still in the tepid water. The liquid still holds some vague charged animal  energy, Dan and his crew were here a few hours ago, before the spit of the evening turned dawn-ward.

This is what it’s like to die. All options exhausted, no good medications available. No where to turn. I am up to my brain stem in warm water.. Any activity could trigger yet another pain cascade. This is how the end comes, not with a bang but with a whimper.

Last night’s pain reverberates in echoes,  small waves  against the  hot tub’s plastic walls. Last night was brutal. Complex cases . Another salary drop.  Angry patients, demanding patients.  By 8 PM, at shift’s end, my mouth was swollen and sore, a nefarious confrontation of GVHD and  thrush from the  steroids I gargle to keep the  disease at bay. We’ve reached an impasse .

            It’s  cloudy  in West Hartford.  Cloudy and quiet. The pain has subsided but I can’t return to bed, I associate our lovely tempurdedic mattress with pain. What next? Do I move to a Hampton inn where I have no pain associations?

Cyn is calling. It is starting to drizzle and she imagines I will fall asleep and then be flash fried in a lightening strike. It happens.

The point is…  so what? We all suffer in some way. My 95-year olders bring in gnarled useless fingers. Is their suffering less than mine?  What did Anne Lenox sing?

Now every one of us is made to suffer
 every one of us is made to weep
 but we've been hurting one another


And now the pain has cut too deep

So take me from the wreckage
 save me from the blast
 Lift me up and take me back
 don’t let me keep on walking on broken glass

 The mind wanders.  I think of Ray Bradbury on moonless night.   Ray described the central tenant of life:  We are born alone, we life alone we die alone. Pain and longing keeps us separate. I think of his short stories, where the protagonists are separated by space, desire or fear.

His astronaut candidates are   uniquely qualified to explore space because they have no friends, no entanglements.  Michael Creighton   discusses this theory in the Andromeda strain, where he describes the “lone man” hypothesis.   Only astronauts lacking personal connections can be called upon to do the right thing under pressure.  Perhaps only the lonely can tolerate pain, it becomes their constant companion. Am I the lone man?  In Ray’s world, People escape to Mars to flee the stench and crowds of earth.  His message was clear. You will die. You will die alone. Your classmates will lock you in a closet on Venus so you will never ever see the sun.  Your father, the astronaut is already a dead, the actual fact of his death is just one more piece of information that will complete your life.

Pain is numbing, isolating, really, the perfect Bradbury vehicle.  We are all alone in our selfish, intrusive pain.

Our Synagogue had “ projects” when I was young, the idea was to spend time with the congregants less desirable members. We’d buy groceries or read to our fellow congregants. I remember visiting their dark houses with sad wall hangings, sullen gifts given by a least favorite nephew. I remember the shut ins weeping, over loneliness, pain, and isolation. Even as a child, it made an impression on me: Don’t complain. It’s not helpful and makes others pity you.   My pain is transforming me into one of those old, old men who accepted our baked goods with ambiguous thanks, they never seemed happy we had taken some of our day to visit. The drama of the transplant is long gone, now its time to…fit in.

 I am one of those pathetic people.

 What to do about the discomfort?  What to do about the hot poker   that wends its way down my throat?  What I need is a sovereign remedy.

 I think about a cure for Melancholia, a typical  sexist  Bradbury story about a woman affected by the vapors, a woman dying without a diagnosis. 

Send for some leeches; bleed her," said Doctor Gimp. "She has no blood left!" cried Mrs. Wilkes. ""You but tell us as you go out what we told you when you came in!" "No, more! Give her these pills at dawn, high noon, and sunset. A sovereign remedy!"

I had become some  20 year old  hysterical  Victorian woman.

"Where do you hurt?" "My arms. My legs. My bosom. My head. How many doctors - six? - have turned me like a beef on a spit. No more. Please, let me pass away untouched."

My vicious cycle of therapy continues: Steroid mouthwash and oral prednisone, resulting in oral thrush. So I gulp Diflucan an antifungal which sort of works,  Then zantac,.  My pill  bottles  line my bookshelf,  a  yellow landing  strip along the runway of my dresser.

In the Ray Bradbury book, the  elders decide Camellia needs an exposure to moonlight.  I’m way ahead of you all, lying in out hot tub at 5 AM

Y

But let us hoist Camellia, cot and all, maneuver her downstairs, and set her up outside our door." "Camellia?" Mrs. Wilkes turned to her daughter. "I may as well die in the open," said Camilla, "where a cool breeze might stir my locks as I . . ." "Bosh!" said the father. "You'll not die. Jamie, heave! Ha! There! Out of the way, wife! Up, boy, higher!" "Oh," cried Camellia faintly. "I fly, I fly . . . !"

r2

 "She's not well." The man scowled. "She does poorly." "Does poorly-" Mr. Wilkes wrote, then froze. "Sir?" He looked up suspiciously. "Are you a physician?" "I am, sir." "I thought I knew the words! Jamie, take my cane, drive him off! Go, sir, be gone!" But the man hastened off, cursing, mightily exasperated. "She's not well, she does poorly . . . pah!" mimicked Mr. Wilkes, but stopped. For now a woman, tall and gaunt as a specter fresh risen from the tomb, was pointing a finger at Camillia Wilkes. "Vapors," she intoned. "Vapors," wrote Mr. Wilkes, pleased. "Lung-flux," chanted the woman. "Lung-flux!" Mr. Wilkes wrote, beaming. "Now, that's more like it!" 2

" The Dustman's smile flashed like warm sunlight in the growing dusk. "I have but one advice." He gazed at Camillia. She gazed at him. , "It is the night of the Full Moon. So," said the Dustman humbly, unable to take his eyes from the lovely haunted girl, "you must leave your daughter out in the light of that rising moon." "Out under the moon!" said Mrs. Wilkes. "Doesn't that make the lunatic?" asked Jamie. "Beg pardon, sir." The Dustman bowed. "But the full moon soothes all sick animal, be they human or plain field beast.  "It may rain-" said the mother uneasily. "I swear," said the Dustman quickly. "My sister suffered this same swooning paleness. We set her like a potted lily out one spring night with the moon. She lives today in Sussex, the soul of reconstituted health!"

"Mother," said Camillia. "I feel it. The moon will cure me, it will, it will . The last lights out. London asleep. The moon rose. And the higher the moon, the larger grew Camillia's eyes as she watched the alleys, the courts, the streets, until at last, at midnight, the moon moved over her to show her like a marble figure atop an ancient tomb."for it was told me, the moon is my cure." . "Am I then my own affliction? How sick I make myself! Even now, feel my heart!" "I feel it, so." "My limbs, they burn with summer heat!" "Yes. They scorch my fingers." "But now, the night wind, see how I shudder, cold! I die, I swear it, I die!" "I will not let you," he said quietly. "Are you a doctor, then?" "No, just your plain, your ordinary physician, like another who guessed your trouble this day. The girl who would have named it but ran off in the crowd." "Yes, I saw in her eyes she knew what had seized me. But, now, my teeth chatter. And no extra blanket!" 
Somewhere, cats sang. A shoe, shot from a window, tipped them off a fence. Then all was silence and the moon . . .

"Shh . . ." Dawn. Tiptoeing downstairs, Mr. and Mrs. Wilkes peered into their Sweet Camillia, alive and well, made whole again!" They bent by the slumbering girl. "She smiles, she dreams; what's that she says?" "The sovereign," sighed the girl, "remedy." "What, what?" The girl smiled again, a white smile, in her sleep. "A medicine," she murmured, "for melancholy."
My disease bores me, my  pain bores me and I need a carefully  controlled assortment of  medication to  beome whole again.  I debate  raising my prednisonerendoisone dose,  increasing the anti fungals and regulate my  pain medication.  My leukemia  reminds me of Camilla's treatment, sometimes,  sometimes the best therapy  consists of lying in the moon light and waiting for the GVHD gods to  burn themselves out. 

The sun rose over West Hartford, , the pain faded.  Mike and Ellen visited,  The pain ebbs at sunrise  and I spend the day leaning on them, hoping they don’t notice how I need them for support.

I may be coming to the end of my career.  I don't have a lot of choices. I cant  work in pain, can't work sedated.  I have one goal, to shut off the pain.  If I can accomplish  this, then I will have found a sovereign remedy. 

Taking time off

I'm doing it. I'm taking time off. I thought returning  to work would serve as salvation,  rebirth.  Redux, as  John Updike would say.
I may have been wrong

 I never understood Kafka's blather  about  the crucial skill of sitting tranquilly  in ones' room  amid books and papers. I need to be busy, obsessed, absorbed . I have experienced rich reward in work.  Much of what I do has no parallel in  the real world of Salaryman.

I've known many of my patients for decades. We have grown  old together,  developed diabetes and cancer , my patients and I . Part  of the miracle of my job is that my patients  understand  I am frail and mortal just like them,   We are  flawed, but we have each other.

My   support group  has protected me from the war roiling around us at work   Docs are leaving the group, and I cant  blame them. We work long hours and we are understaffed. If we cat work on a Saturday we must arrange our own coverage.  I suspect the   administration's  response to revenue shortfalls is to  make us work harder,  for longer hours . Reminds me of the  joke

 The beatings Will Continue Until Morale improves

 Why don't I leave? A cynic   would point out  the administration's  has me by the shorts.  The docs who regard their  patients as family will never leave.   The docs who view their job as an upper middle-class-carrer that could earn  big bucks if one gave Botox in the backroom  will eventually leave, anyway.
I remember when I returned to work  my mantra was  "I'd do this for free"  And I would. And, on some level, I do,  I am one phone call away from telling Solvy at Prudential the grand experiment of my retuning to  work did not work out.  I ca watch and re watch The Wire three times, I can re-watch  Arrested Development ,  pretend to  finish  A team of Rivals" again  which should bring us to 2019.

Which brings us  to today's  blog.  Pain.  Pain. Pain.   So much pain.  Comical,  out sized,  sarcastic.  Pain to make the tears flow freely  while I examine a patient and ask about an ill conceived ta too.  Its creepy.
  I can't work like this. the GVHD is back, a blind dentist  flaying around in the mouth  leaving  wreckage in its place.


Dilemma. Can't work in pain,  Cant work with  narcotics coursing in one's veins.  That sort of behavior ends on the first page of the Hartford Courant pic of me with  my  white coat  over my head,  reporters asking , in my estimation, how many died because I was taking medication. Dreamt last night I never went to med school,  I decided to be a lawyer ( or an Indian chief, the dream was unclear. Who  wears the   bird feather  headdress? ) I feel real fear in the dream content,  I may never work again.   The impaired physician is a cliche,  a pathetic  caricature. Me.

Shit shit shit.  This is the sort of blog  I never want to write, yet often seem to do so.   The blog  contains all the earmarks of post modern literature,  the inside  jokes,  pointless, self-serving, self pity

Funny story: I'm at the pharmacy  today picking up my meds. All my  scripts are stamped  DANA FARBER HEMATOLOGICAL  Malignancies  Department.  Its a free pass. No one 's gonna question my need for  drugs since I have the  big C. I feel as if I could buy a copy of  JUGGS magazine without a hint of embarrassment  "He's buying a titty magazine? Let him. he has cancer. poor guy, I hope the distraction helps"

I do a horrible thing: I open the  pills in the parking lot, junkie style.

Yikes. I should have 20  tablets of Ichor, I have 16.  Furious dazed, aching.  Some lab tech is having his own private party in some stairwell celebrating with my little white rounds of  tranquility and peace.

I am  not able to count to twenty, let alone remember the 8 diagnostic  features of  polycythemia vera . I storm into the pharmacy "You shorted me!"  I howl in righteous indignation, The  other  customers  swivel  to get a better look, some guy is going berserk.

Not the pharmacy's fault.

 For some reason, they distributed the pills  in various bottles. Why?  More to the point, I'm now that creepy guy, the guy you stare and and then slowly edge away from, the  stoned geezer  who pays cash for his narcotics to avoid the DEA.  After I apologize profusely, the pharmacist asks,  "Is it the heat?"  implying  the major side effect of sun exposure is a sense of being under dosed.

I return home .I can stop  wandering the house scaring the cats and kids,  mumbling "why doesn't god kill me now?"  This must be a key phrase one  learns at marriage counseling to avoid   I suspect "God Kill me now" is up there with  "I'm sleeping with your  sister" as what they call red-button expressions that have no place in life but enhance every  Coen brother movie .


I am not blind to the irony of all this. Most 55 year olders are  frolicking with grandchildren, wintering in  Boca and  reading John Grisholm's word.  But I cant  stop working  Who is going to tell  Ms Z that her cancer is back but to do it with such  affection and concern she honestly thanks me for the news.

I flash on Bonnie Franklin, One day at a time who died of pancreatic cancer last year


So while you’re here enjoy the view
Keep on doing what you do
So hold on tight we’ll muddle through
One day at a time, One day at a time.

Feh, less significance  than I remember    Nonetheless,  The enemy  is the doubt, The  not knowing. I called  the office , not coming tomorrow. Maybe not Friday.  Have to be off the pain meds.  This is obvious , too. There appears to be no answer.  Except to get better.  More doubt.    

Col Chamberlin

Josuah Chamberlin

It's 2:30 AM and I contemplate lieutenant Josuah Chamberlin, a personal hero.  He was ordered  to defend little round top during the battle of Gettysburgh.  He struggled to halt General Robert Lee's attempt to  cut the Union forces in two.
" Defend your position at all costs"

  His superiors never knew he  was  out of ammunition.  He would defend against the  confederates armed only with fixed  bayonets.

 Chamblerlin stopped the Grayback   advance. He   halted the enemy attack and kept the Union whole.

  This part of the  story is  remarkable, but doesn't explain my admioration for this union  officer.  He was repeatedly wounded during the War, and  lived with a pelvis filled with  Confederate lead until the day he died at the dawn of world war I

 I have done nothing so bold, so grand, so life affrimning. After the Civil War, Chamberlin became the Governor of Maine and then the  president of Bowdoin college.  He  lived a daily existance of  constant  pain.

  Daylight is three hours off. I gulp   the same morphine derivatives Chamberlin used 150 years ago.  We share one similarity    Neother of us is terminally ill, our dangerous pasts  replaced by the  merely nettlesome present.  The pain won't kill us and the question becomes: How to remain useful,  productive, happy  in a world of discomfort?
I am thankful,   grateful.  My  situation is not unique.  Many of us struggle with pain.  Cyn's back throbs, I have friends with trigeminal neuralgia  that feels like an electronic probe  surging pain into a jaw.

 How to remain  productive in pain -cloged days? Meditation? Medication?   I stuggled to  extricate myself from the prednisone and pain medictaion,   my  once and future constant companions To be useful. Beit Shamai argues in the  old testiment  that it would have been better never to have been born. He may be right.

My dear parents, I suspect , would have been much much happier  had they been childless.   I don't doubt their love for us, but still, makes you wonder.    Mom is an intellectual, she would have been happy  teaching,  reading, thriving in a  childless life with my dad. My dad is an engineer. His slice of heaven included his slide rule,  his  engineering journals and  his graph paper.  Children are messy, random and demanding. Had we never been born, my brother and I would have been spared much grief.
So why be born, how to explain existence without becoming facile, glib or  fatalistic? In my 2 AM persopetive, I will always be in pain,   I will go through my  remaining days with a fixed expression stretched to my face,  my patients will ask why  I am crying at work.  What to tell them?
 I am here for two reasons. I feel a real obligation to  Mark Heller, my  late father in law. He would have  said we are all soldiers " Come home on your  shield or with it," he'd say.


I'm finsihing Donna tart's The Secret history

She writes

πληθὺν ταρβήσας: τὸ δὲ ῥίγιον αἴ κεν ἁλώω
μοῦνος: τοὺς δ᾽ ἄλλους Δαναοὺς ἐφόβησε Κρονίων.
ἀλλὰ τί ἤ μοι ταῦτα φίλος διελέξατο θυμός;
οἶδα γὰρ ὅττι κακοὶ μὲν ἀποίχονται πολέμοιο,
ὃς δέ κ᾽ ἀριστεύῃσι μάχῃ ἔνι τὸν δὲ μάλα χρεὼ
ἑστάμεναι κρατερῶς, ἤ τ᾽ ἔβλητ᾽ ἤ τ᾽ ἔβαλ᾽ ἄλλον.

or, in the Samuel Butler translation:

"Alas," said he to himself in his dismay, "what will become of me? It is ill if I turn and fly before these odds, but it will be worse if I am left alone and taken prisoner, for the son of Saturn has struck the rest of the Danaans with panic. But why talk to myself in this way? Well do I know that though cowards quit the field, a hero, whether he wound or be wounded, must stand firm and hold his own.”

Hard to resolve  this.  Self  destruction or , more accurately, non  existance, would be cowarly, selfish.  We are here for others. If  Chamberlin had stayed at Bowden, the South might have won the war and Michelle Obama would be a slave.

   I have an obligation to raise the family, to set an example for my kids, his grandchildren. I have patients who need me.  Despite the pain, the battle rages on.  

We are not here  to  to enjoy  great meals, see great sights,  read great books, We are here because in the endless wash of eternity, we have  sentience  for a  precious scond of time,  before the draft ends  and we return to stable state,  our eternity as a wisp of silica dust spinning in some faceless corner of the sky.   Carl Sagan  wrote  we are Star Stuff.  In this perspective, all martter waits its turn to turn sentient, every atom gets its chance  to gaze through   conscience's   telescope, observe the   universe and contemplate our role in an indifferent  heaven.  

Whats a little splash of pain in an eternity of unconsciousness?  Don't worry the dentist warns,  this will only for a moment.

I come from the land of ice and snow. Idiot.

On the plus side, it appeared we had another 2 weeks of daylight. Alternatively   my immediate survival was in serious doubt.  I remember cold. Wet, damp. People talking at me, their faces etched with sudden strange concern.  They were speaking in swedish.  Maybe it was the wind.

The dreaded death spiral.

Could they land a helicopetr up here to airlift me out? Would I ask dear friend Allen to  fireman carry me down the 1000 foot lava field to safety?  Are there donkeys up here? I know there are asses.

Embarrassment.  I was about to force ten lovely  eco tourists  to change their plans from "a  sprightly  romp across the  boiling mud fields"  to "A scene from the Buthan death march  transporting some idiot who should not have  attempted  apline hiking while  gobbing prednisone and percocet  to fight the GVHD fire in his mouth."

Iceland’s summers are cold.  The air holds a vague Nantucket trace,  cool fog condenses on the fishing fleet bobbing in the bay. We had planned this trip last year as a lark, a hoot, a race among the runes. Four  hours from Boston.
We were standing at the exact spot Led Zeplin had wrtitten the immigant song  40 years ago

 I come from the land of ice and snow
 from the midnight sun
where the hot springs flow.

 I am stupid man, Stupid stupid man.  I think my IQ was clocked in at 150 something, but  I lack  the   sense that god gave geese.

On the plus side I rely on a near death experiences to  trigger   strange new blogs.

  I want to prove  I am intact, bold, rough, a AARP card carrying eccotourist  decked out in a 1000 dollers worth of high tech,  drip dry  synthetic, colorful  fabrics.
Eccotourist . A new word that  refers to anyone willing to use a staddle toilet and risk Hep A while on vacation.

The guide looks concerned " Do you have any health issues?" he asks. I laugh.

The vacation has been wonderful.  We biked the streets of Reykjavik, biked past Bjorn’s sea side house,  feasted on  cod tongue and swam the silicated  viscous waters of the blue lagoon.  Reykavyk has a  ski town feel, slightly tacky and shabby,  but a town with heart, soul,  people with ideas. Glad to be here.

Who can avoid dangerous drama?  It's wonderfully distracting. More to the point, If your only goal in life is not to lose consciousness and continence,    you can elegantly avoid life's real issues: A daughter who is one phone call from  joining an Amsterdam  boyfriend to open a vegan restaurant in the Hague.  She's running a YMCA camp this  summer,  exposed to  Bob cats and deer ticks.

As I  struggled with  losing consciousness  I feel  relief  I am suddenly spared obsessing over my parents' heath,  the  gun epidmeic in the US and the inexorable  fact  we are sliding  into  war with Russia.

  You can't hide from danger, no matter how  carefuly you try. Jeffrey is  spending his summer in Guatamala city,  learning  spanish and treating the local populace for parasites.  Guatamala city. Death squads, 45, 000 people dissapeared in the 1980s.  When his body goes missing  will our friends roll their eyes?   they'd NEVER let their  son work in a war Zone.  The  central American  tragedies were 30 years ago,  but Jeff walks on ground staurated with human  bone meal.

Be careful, I want to warn him.  Be careful.  Dont accept rides from  men in  military fatigues.

These warnings are useless.   What if you are a 19 year old American in love, who wants to visit a girlfriend in Kuala Lampur?    Does  flying 33,000 over a war zone count as  risky business? Was he a moron?

Can't run can't hide.  Last month a Danish tourist stepped off the path up here  and was instrantly parboiled. Really.  As he's lying there  frozen,  scalded and dying, did his tour  leader think  

heimskulegt Dane, þú ekki vara hann við að villast úr t leið?

 Stupid Dane didnt I warn him to stray from the path?


So many of my stories involve  near death experiences. I count my cherished freinds as people who have actively  intervened  to save my life.  God bless Allan, you saved my life in the  lava flows.  Thanks Tony, thanks Martha, I wouldnt be here if not for you.

Let's leave the sickening scene. I'm in my high tech rain gear, in the rain,  fog and steam.  I am hallucinating, frozen and  spiraling  toward the big sleep.  I can't stop shaking. It's 52 degrees.  Cyn  steps over,  embraces me and I start to feel the earliest trickle of warmth filtering back into my core. The Swedish mom has given me an extra sweater and a chocolate bar.  The hallucinations  fade. I will live.  I will be OK, even if it's not. We have no choice.

GVHD for you and me but mostly me

I'm back

Distant memories provoked Proust's creative juices  it appears my muse is the queen of pain

Pain focuses the brain,  creates barriers to  resist the  endless tide of  electrical fire racing through one;s mouth

Makes us whiny. Needy, unpleasant.
Welcome to my world. Again.

 I should not complain,  I have reached the season some of you have reached with me, the season of sick parents and friends of  failing organs and  children no longer children who insist on making  dangerous, destructive choices you had hoped they'd out grow by the time they could buy liquor or rent a car.

I planned long a illustrious decline.  I would  see patients, I would  cut back my hours, spend more time with Cyn and the  kids, slowly defusing across the  country, vital  life forces I am no longer able to control or regulate.

Let me tell you what's going on.

I was told to stop blogging.  I was warned it could hurt my practice.  Too bad. My old boss is gone.  I have things to say and life is just too short to cower.  We'll let the lawyers sort this out, that's what they are paid for.

Life was swell.  I had renounced  narcotics and steroids. My  skin stopped blossoming in a livid riverscape every time I bumped a gym locker.
The lack of stress was quickly replaced by the stresses all of us go through: An alarming birthday ( 55? No shit, I'll be dead soon) My parents' friends, whom, I remember as young sparking adults are now dropping like, well, like the  oldsters they are. My parents are holding up ( ptooo ptoo) but their lives and bodies are  sand castles along a stormy shore. What did Bob Dylan say?

It's an endless ocean,but it stops at the shore.


And so the distractions returns. Am I living ouy a useful decline?  Are my parents suffering?  Do I have to attend yet another Shiva   and speak fondly of a man I knew in 1972?

And then. The pain. Or rather, THE PAIN
  My mouth exploded in fire,  the sensation of sucking on  a  polishing  drill bit.  GVHD, GVHD GHVD

 I though I out grew this shit.  Cyn likes it, on some level, calls it my insurance . She likes the thought the German have re armed are are once again patrolling my mouth, searching for spies stragglers and invaders

And I have returned to, shall we say, medical management. The meds suppress the pain for 6 hours or so and then the red tide returns.
Its not all bad.  I have lost a lot of weight. I am re notching my belt. My facial skin is tightening up,  my million dollar face lift. Yay.
There must be a  market for Graft Versus host disease. I have patients who underwent surgical mutilation to lose weight.  They  had their  stomachs air lifted out  so their diabetes would abate, their clothing would fit. Their  misery strikes me as much worse than a little GVHD . Throw in a  face lift, we are golden. doesn't Jennifer Gardner  talk about her new  skin cream, the one that contains stem cells? Or am I confusing this with  Cameron Diaz wiping  Ben Stiller's DNA on her hair. Whatever.
Whatever.
Problem :Can't see patients with involuntary tears running down my face. Cant see patients  hopped up on a magical medical cocktail. Cant stay home and watch reruns of Modern Family
Cant Cant Cant. The daily Cant.
Cyn says it will get better. The prednisone will work, Ill feel better, I'll return to work.
Welcome back

Da

Da

I am sick. Again.

Shout it from the rafters,  cry it  ‘cross the divide of time and space. I’m sick, sick as a dog.

Dogs….

I flash on Auden:

Stop all the clocks, cut off the telephone,

Prevent the dog from barking with a juicy bone,

Silence the pianos and with muffled drum

Bring out the coffin, let the mourners come.

Let aeroplanes circle in  fog white and thick;

Scribbling on the sky the message He Is sick, he is sick, he is sick

Terribly sick, crazily sick, deliriously sick.

Symptoms?  Of course I have symptoms!  What are you implying?

 I’ m coughing up all this mucous, I’m a little short of breath. My muscles ache.

I’ve become Richard Feder.

I’ve gained weight, my face broke out, I’m nauseous, I’m constipated, my feet swelled, my gums are bleeding, my sinuses are clogged, I got heartburn, I’m cranky and I have gas. What should I do?”

Did I mention the clamminess?

No fever, not short of breath, but with every breath, I emit a short musical note, that Sam, my pulmonary doctor, would  describe as a  little pitchy B sharp. 

I have a cold?   And for this pedestrian diagnosis  I gain no sympathy, just a  brief roll of the  eye, a sad shake of the head?

         You tell me I suffer from  a terminal case of lack of perspective.  I struggled through the valley of the shadow of death. Now that I dabble my toes in the warm waters of the stream of sullen misery, my symptoms seem…. Petty?

         And that’s the paradox.  Sick is sick,  regardless of whether a harbinger of lethal Strep Viuridans or a pesky rhinovirus.

 I’ve always been a cranky,whiny  patient.  A little  leukemia didn’t  change my basic nature. It just gave me a past, a context, a prisim through which I must judge all further illness.

          I woke last Tuesday achy and nauseous from  swallowed phlegm, I staggered to the bathroom, seeking succor. What sovereign medicines to sooth a fractured sinus system?

Abandoned Big Boy medicines spill from my medicine cabinet. How about a little zofran for the nausea? Nausea is nausea, after all, whether from  phlegm or chemotherapy.

         What about antibiotics? I spent the last month  explaining  to my patients they don’t need antibiotics for their cold symptoms. Yet, here I am in the bathroom, examining bottles of Gorillimycin as if they were rare vintages that could cleanse my body of its viral load .

I feel a little better, and visit Jeff for my yearly physical,  embarrassed I haven’t seen him in  three years . Three years have elapsed since I deigned visit a mere GP for  the  signs and symptoms of  middle age.  We talk of my  weight, up 16 pounds in three months. He listens to my lungs and orders an inhaler and a PSA that I refused when the reaper dwelled at my door.  Visiting Jeff always bothers me: Even if it leaves me terrified, I  don’t resent  visiting the cancer doctors, I  probably didn’t give myself cancer. I resent visiting a GP,  because I made myself overweight,   and therefore diabetic,hypertensive and  hyper lipidemic.

         We speak of my cold symptoms, and I’d rather talk of my leukemia, my badge of honor,  proof  I am bold, strong and proud. I don’t want to linger on my sinus symptoms, any pathetic wretch can catch cold. Any pathetic fool can cure him or herself of a viral illness, just  drink tea, complain to loved ones and  wait it out.

         I leave Jeff’s office thinking of Da, a  1970s Leonard Hughs play. Da revolves around a grown son whose father embarrasses him. The son returns to his ancestral home and finds his fathers’ ghost, who departs gaily  with the son who, in the end, realizes he can’t escape his past and must learn to live with bittersweet memories.

         I realize the Leukemia is my ghost.  It will always be a part of me, even after I move on to  silly, simple illness, its damp ache  will haunt my deepest fears and nightmares forever.

         I  turn the idea over in my head.  We are a  product of our pasts, and now I  am the proud possessor of a cocktail- party- stopping tale of valor and fear. And draining sinuses.        

         I wake in the night,  troubled. The leukemia reminds me of Da, but it dawns on me in the pre-dawn hour that  Da reminds me more of Da.

         This isn’t a blog about my childhood. I expect my proud papa is out there, reading this, honored to be a part of his  adult child’s life. I am grateful for the way I was raised, in an intellectual, affectionate household. I also know my parents’ words were sometimes unkind, and I carry their jibes with me, and forever  will.

         How often have I hurt my children with an ill-considered word?  I hope they’ve forgiven me, or, at very least, forgotten when I was too tired or ill to carefully consider my words.  

         Can’t change the past. Without the past, I’d be some whiny guy with a cold.  With all I’ve been through, I’m a whiny guy. With a cold. Who was really, really sick once.

         In the past.