Why Is This Country So Big?

Well, it is a traveling medicine show. I am hitting the road tomorrow. Ohio to Berkeley. 36 hours. Oh mercy. Books on tape. A little NPR. No sweat. Oh mercy.

If anyone checked out this personal essay, you couldn’t help but notice that I’ve tried this before. Without success. But the allure of the Bay Area is apparently irresistible, and I’m headed west again.

So I’ll probably be out of touch for a while, but I will post as soon as possible. It’s the classic Edinburgh-Europe-Ohio-San Francisco circuit. Well worn. Up and away.


Veteran’s Affairs–A Ring’s Tale (Part 4, final)

I spoke to my commanding officer, he was real stand-up guy, you know? And he made a phone call. He said I would have to go to the High Commission for North Africa run by the Free French. They might know something. I made it to their offices and explained my business to some kind of functionary in the lobby. He asked me to wait which I did for about forty-five minutes. I was finally shown into a large office with a big wooden desk. The clerk had me sit in a small seat facing it.

A few minutes later, a stern looking older man in a crisp French officer’s uniform entered the room, sat down and considered me from across the huge desk. ‘You speak French, I assume,’ he stated. I said I did. “Very good,’ he said. ‘May I ask what interest you have in these matters?’ I explained that a friend had asked me to inquire. ‘An American serviceman should be wary of making curious friends in Algiers. These are complicated and dangerous times.’ I didn’t say a word. ‘Very well, then. The name of him you seek?’ I gave him the name. ‘Ibrahim Sefrouk,’ he intoned, and pulled a series of files from a sleeve by the desk. He opened one and looked through some pages. ‘Yes, Sefrouk. Arrested January third on suspicion of conspiring to assassinate the High Commissioner. He is alive, yes. He is in a work camp awaiting trial.’

I felt tremendous relief. I had feared the worst, as I knew his parents must still. I asked him if there was anyway to help him or if his parents could visit him. The officer looked at me with disgust. ‘Young man, you should understand that the only reason we are having this conversation is because of a call from your commanding officer whom I hold in high regard. If you think I am accustomed to spending my time answering inquiries after terrorists you are sorely mistaken. I would also strongly advise that you break off relations with these curious acquaintances of yours before you get wrapped up in something you cannot wriggle out of. As I’ve said, these are complicated times.’ With that he showed me out of the office.

“I returned to my base and thanked my commanding officer who agreed I should make no further inquiries and that there was, in any case, nothing we could do.”
“That must have been frustrating.”

“Yes, very frustrating. It was injustice wrapped up tight in an impenetrable bureaucracy. But, the next afternoon I returned to the Sefrouk home and knocked on the door. It opened and there they both were, just standing there wringing their hands. Not wanting to prolong their anguish, I blurted out that Ibrahim was alive. They let out great sighs — he bent with his hands on his knees, she with her hand over her mouth as tears welled up in her eyes. They ushered me in. I recounted in detail everything I had found out. At least he was alive. We sat down to lunch: a stew of sweet potatoes and carrots with what seemed like matzoh balls, but with spicy meat inside.

We talked about anti-Semitism in Algeria, how property had been confiscated, professionals forced out of jobs and on and on. They were not surprised that his French Comrades had betrayed Ibrahim. They kept thanking me for what I had done, and it made me feel sorry I couldn’t do more. ‘We have something for you,’ the husband said, rising from the table. He returned with a ring and before he handed it to me he said, ‘this is to remind you of a time when you touched the lives of strangers, and filled with hope a mother’s heart.’ He handed me the ring and I slipped it on.”

“That’s incredible.”

“So you see, I have always tried to help people since then. If only in little ways. That was the only medal I received in the war and I wouldn’t have it any other way.”
Mr. Flint shut his eyes and eased his head back on the pillow. I sat in silence listening to the ping of the heart monitor. “Hey there,” a voice startled me from behind. I turned around. It was Pete standing at the door. He came in and sat down next to me. “You see the neurology note?”
“I did. Persistant vegetative state.”
“Yeah, no wakey.”
“No wakey.”
“You gonna keep that ring?”
“I think I will.”
“You still think he’s Jewish?” Pete asked smiling, pushing his glasses higher up the bridge of his nose.
“That, I guess, we’ll just never know.”

Published in: on May 26, 2007 at 9:39 am  Comments (2)  

Veteran’s Affairs–A Ring’s Tale (Part 4)

“North Africa. Well, I had been in Italy. I landed in Anzio in February, 1944. Not the first wave, but a few weeks after the beachhead was established. I was in a communications unit. We carried big radios and tried to stay out of the fray, which was really impossible because the front lines kept moving around. We got sent here and then there without really knowing what was going on. One day I was called into a command tent to meet with the commander of my division. I sat down in front of his desk, which was covered with maps and charts, and he looked at me with weary eyes. He said, ‘Flint, you speak French.’ ‘Yessir’ I said. ‘How’d that come to be?’ he wants to know. ‘My mother’s family is from Quebec, Sir,’ I tell him. ‘I see. Flint, you are being transferred. You are going to Algeria.’ Now I didn’t know this then, but we were planning the invasion of France and the army was consolidating French speakers in different areas for various forms of logistical support.”

“And just like that they sent you off.”

“Just like that. I took a transport to Algiers and began my new job. I mostly translated and relayed messages to resistance elements within France. I also translated in meetings between officers and members of the resistance in Algiers. It wasn’t bad work and it was safe at least.”

“It sounds exciting.”

“ Oh, it was exciting to be in a new place and all, but with all work, it really was a bit boring day to day. But it was an exciting time for a young man. I wasn’t much younger than you must be. Anyway, a week after arriving, I had a day off and decided to explore the city with a guy from my new unit. He was a nice fellow but I could tell he looked down on my French Canadian accent. His parents were Parisians and he had studied at a French-American school in New York. Ooh La La. Anyway, a nice guy overall. We went to a café and drank a couple glasses of muscatel, and feeling fortified, as they say, we headed for the casbah. Now Algiers already felt pretty exotic, but we had been holed up in a complex of buildings on the outskirts of the city. But now, out here in the real town, it was from a storybook.

The muezzins called from high in minarets, such a hustle-bustle of commerce, the smell of spices and leather, incense, dung. We entered the market itself and it was nothing we could ever have imagined. Tiny little alleys and corridors covered with makeshift ceilings of tarps and blankets against the sun. Children running and laughing. Hills of vegetables and spices and dry goods. Carts of all shapes racing around. Donkeys braying and jingling their bells. We wandered around wondering how we could ever retrace our steps in this labyrinth. The sheer number of things for sale was overwhelming. The whole casbah was laid out by category. There would be ten stalls of oranges in a row, and then five of gadgets and then twenty of spices. We came to an area specializing in live animals: ducks tied to string, goats, chickens in wicker cages and mountains of eggs. Ten stalls in a row had just eggs. It was quite a site, and the women at the stalls, who presumably were in competition, yammered at each other from behind their piles. My friend thought it would be better for business if they spread themselves out.”

“It was a different business model,” I suggested.

“I suppose. Well, I had in the back of my mind to find a place to get my watch fixed and at one point we strolled into an area filled with artisans and tinkerers of all sorts. Cobblers banged on shoes from within cubby-sized kiosks. All around, men were beating on leather, screwing things into metal sheets, and a hundred other little activities. I approached a shriveled man with a goatee and a big apron. His hands were black with something, and I asked him in French if he knew where I could get my watch fixed. He just stared at me. My friend said the problem was my accent and asked him again. Still nothing, hah! A young man approached us and said something in Arabic to the man, then turned to us and said in French, ‘He only speaks Arabic, my friends. A watchmaker exists this way.’ He pointed toward a steep, wide stone stairway. I thanked him and approached the stairs. My friend suddenly said he needed to get back and made his way around the corner.”

“Was he mad that his French didn’t work either?”

“Maybe, or he had just had enough. It was a lot to take in. It was an assault on the senses. So I’m headed, I hope, to the watch mender when I’m stopped short by the sight of a young boy and his cart hurtling toward the stairway. Incredibly, he went straight down under fairly good control. You see, he had tied a tire on the back of the cart with a rope, and stood on the tire to control his speed. I thought it was ingenious.”

“Were you worried about being alone in the market?”

“Well, maybe I should have been, but no. And, of course, I was armed. Anyway, I found a little kiosk with some watches on display and I approached it. A man inside was concentrating on some task and had magnifying loupes on his glasses. I stood there until he looked up. ‘Good afternoon’ he says to me in strongly accented English. I greeted him.
“I am hoping to find someone to fix my watch, I told him. He put out his hand and I fished the watch out of my pocket. He stared at the face and flipped it over. He read the inscription out loud: ‘Montreal 1939.’ Family reunion, I told him. He shook his head as if he were thinking then said, ‘I will mend. You come back tomorrow.’ I thanked him and made my way out of the market carefully taking note of the way.”

“I never would have made it out of there with my sense of direction.”

“It’s funny you say that because mine’s not great either, and I used a compass to help me. Well, the next day I returned and found the man again hunched over some project. He saw me and looked up. He was an older fellow. But then that’s from a twenty-four-year-old’s perspective. He may have been fifty. Anyway, he reached under the counter and produced my watch, which he put down in front of me. ‘A spring’ he said, and named a phenomenally low price. I thanked him, gave him a bill, and as I was about to leave, I noticed a tiny Jewish star on a chain just below his shirt collar. He saw me looking at it and straightened up so it fell again below his collar line. ‘Are you Jewish,’ I asked him? He appeared very uncomfortable and looked around. ‘I’m Jewish,’ I said quietly. ‘I’m Jewish, too.’ He smiled and looked at the name on my patch. ‘Goodness,’ he said. ‘Jewish. You must meet my wife.’ I told him I really had to get back, but he insisted, explaining that he lived only a minute away. He said something to his neighbor in Arabic, and came out from behind his counter. ‘This way,’ he said.”

“We wound our way through the market until the streets became so narrow I could touch the buildings on either side at the same time. We stopped at a door and I noticed a mezuzah on the jamb. He unlocked it and we entered. It was a small living area, but very tidy and colorfully decorated. A nice looking older woman with a thick, dark ponytail entered the room wiping her hands on her apron. She took a gander at me and a stricken look came over her. My host spoke to her softly in Arabic and she looked me over. I could feel her eyes linger on my name patch. They exchanged a few more words and she approached us. He said, ‘I am sorry, but my wife is very wary of soldiers.’ He sat me in a chair and exchanged a few more words with his wife, who pulled a book from a chest by the doorway to the kitchen. She handed it to me and said something in Arabic. ‘I am sorry, she does not speak English,’ my host explained. I turned to her, and in French said, ‘you have a very lovely home ma’am’. She didn’t respond but opened the book in my hands and said in French, ‘please read this’. They had a curt exchange in Arabic. I looked down; it was Hebrew. After a long pause, I began to read. It was a prayer from the morning service, and I rattled it off.

I looked up and saw the woman had a big smile on her face. She said something to her husband and they both began to laugh. My host put his arm around my shoulder and the woman approached me, put both hands on my head and softly kissed my temple. ‘You will stay for lunch,’ she said.

“It must have been an event for them to meet an American Jew,” I said.

“It seemed to be, but it was more than that. Anyhow, the meal was delicious: braised lamb with rice and turnips. It tasted very unfamiliar, smoky, spicy. After lunch we sat in their parlor and drank sweet tea. They told me the story of their son Ibrahim, how he’d joined the French Resistance. They explained how the Vichy government had come to Algeria and stripped Jews of their French citizenships and imposed other restrictions as they had in France. Ibrahim had joined a resistance cell that helped topple the Vichy when the Americans invaded in 1942. Everyone had been ecstatic and their son was a hero, but the Americans proceeded to reinstate a former Vichy official, Francois Darlan, as High Commissioner, and the restrictions on Jews remained.”

“I guess that explained their wariness.”

“Yes. It was a difficult time, and they tried to keep a low profile. So it was hard enough, but when Darlan was then assassinated, there was murmuring of plots and questions of allegiance and the rest. A month later there was a knock on their door. Four young Frenchmen entered asking for Ibrahim, and his parents could tell from his face that he had known the four. They said that Ibrahim was being arrested for conspiring to assassinate Francois Darlan. Ibrahim protested, and he was removed at gunpoint. That was the last they had seen or heard of him.”

“That’s terrible,” I said. “Who were they?”

“The parents thought they were from his resistance unit. They had turned on him, looking for a scapegoat. So the woman looks at me with these big desperate eyes and says, ‘Can you help us? We don’t know where to turn.’ I said I would try, but that I had very limited power. ‘Please try,’ my host says to me. ‘Whatever you can find out.’ I promised to return the next day and to find out what I could in the meantime. I left with a bag full of fruit and returned to my base.

Tomorrow, final part

Published in: on May 25, 2007 at 2:04 pm  Leave a Comment  

Veteran’s Affairs–A Ring’s Tale (Part 3)

I sat upright as he looked around the room warily. “You’re in the hospital Mr. Flint,” I offered more loudly than necessary. “You’re in the VA hospital.” He looked at me, some lucidity trying to dawn.
“The VA,” he acknowledged. He yawned and shifted beneath the blankets. “You my doctor?”
“Well, I am one of the interns here. I helped your doctor last night when you first came in. You were in serious heart failure, Mr. Flint. Your brain wasn’t getting the blood it needed.”
“Since when is my brain getting enough blood? And don’t call me Mr. Flint young man. I’m retired. That Mr. Flint is retired.”

“OK, Myron then.” It felt strange to call a patient of his generation by his first name. He shifted in the bed to a somewhat sitting position and stared at the nametag on my lab coat.
“A Jewish name,” he suggested.
“What are two nice Jewish boys like us doing in a rotten place like this?” He laughed and I smiled. I knew it, I thought.
“How are you feeling?”
“Well, under the circumstances, not bad. I feel pretty good. Nothing like a good night’s sleep, I guess.”
“Your friend called the ambulance. He found you unconscious.”
“Ah, I see.”
“Do you remember last evening?” I asked. He thought a moment.
“I remember being light headed and laying on the couch.”
“Is that all?”
“I…yes, that’s it.” He shook his head.
“If you don’t mind my asking, your name: it sounds…”
“Not Jewish. I know. Some charitable bastard at Ellis Island relieved my family of Fleinzschutz or something like that. I used to know it.”
“Right.” I couldn’t wait to tell Pete.

“How long am I gonna be here?” he asked.
“I don’t know. Your doctors will have some idea tomorrow morning when they come around.”
“So, if you’re not my doctor, why are you sitting here? Not that I mind of course.”
“Well, I was wondering about something. When you came in, you…” I paused.
“I what?” He said, yawning.
“Well, you had a ring on your penis.” I shifted uncomfortably in my chair.
“A ring,” he replied impassively. “Oh, yes. Well, you understand I don’t do my best thinking at night. I wouldn’t have remembered it if you hadn’t told me. You know, those water pills the doctors have me on can create quite a situation. I have a problem with incontinence as it is and it can drive you crazy. I thought that the ring might help. I was really not myself, you understand.”
“Oh, I understand. It’s just that we had to cut it off.”
“Cut it off?” he responded, pulling himself up in the bed. “Where is it?”
“We had no choice. There was a lot of swelling…”
“I don’t care about swelling. Do you have it?” he asked, scanning around the room with his eyes. I reached into my lab coat and pulled it out. Leaning forward I placed it in his large hand. He stared at the ruined piece, nodding his head slowly.

“I’m really sorry.”
“Oh, it’s my fault, ” he said softly without lifting his eyes from his palm. “These things happen.”
“It means a lot to you.”
“It does. It did.” He closed his fist around the ring. “Is there some water I might have?” I walked over to pour a cup of water from the plastic pitcher on his nightstand. I handed it to him, and he drank it down in a single go. “In one end out the other,” he said, gesturing to the full catheter bag. I returned to my chair.

“Were you in North Africa during the war?”
“Yes. North Africa and Italy. He closed his eyes tightly and we sat in silence for several minutes. I was considering standing up to leave, when his eyes popped back open. “Did your father serve? Grandfather, I guess it would be.”
“Yes, my grandfather was in the Coast Guard.”
“The Coast Guard,” he replied, animated. “That’s a nice service. Did a nice job over there. Where was his boat?”
“They were mostly in the North Atlantic.”
“North Atlantic. Protecting shipping lanes. Very good.”
“I know they hunted U-boats and I saw some pictures of him with Inuit.”
“Oh, Eskimos.”
“Eskimos. Isn’t that something?” We sat silently for a minute.
“Would you mind if I asked you about that ring?”
“This?” he said opening his fist and considering the contents. “Well there’s no secret about it, but it’s a bit of a story. I’m sure you have more…”
“Oh, I am done for the day, so if…but I’m sure you’re tired. I could hear it another time.”

“Young man, at my age, no time like the present takes on a real immediate significance,” he said, sitting up a bit more. He sat silently for a moment looking off at nothing in particular. Then he looked at me and began. “North Africa.”

Tomorrow, Part 4

Published in: on May 24, 2007 at 12:31 pm  Leave a Comment  

Veteran’s Affairs–A Ring’s Tale (Part 2)

He was a handsome guy: strong chin, receding salt-and-pepper hair. His dry lips were motionless, though his eyelids fluttered occasionally. Pete checked the IV bag and went to tell the nurse she could now place the Foley catheter. I joined him in the nursing station and we sat looking at the patient’s chart.

“Flint, Myron Flint,” Pete muttered.
“Jewish,” I stated matter-of-factly.
“Flint?” Pete returned.
“Myron?” I shot back.
“With you everyone is of the tribe until proven otherwise. I mean, you assumed the Beatles were Jewish for chrissake.” Another childhood anecdote to regret having shared.

I went back to the call room and lay on the covers, turning the ruined ring over and over in my hands. A silver ring on a penis would certainly not reach the top twenty list of medical ward oddities, but the inscription intrigued me: Algiers, the war. I usually tried not to think too much about the patients’ personal lives or their stories. As an inevitable part of medical training I had developed a wall between me and the endless suffering in which I was daily immersed. It was a simple mechanism of emotional preservation, and it usually worked. It was difficult to predict when the mechanism might fail. It could be the resemblance of a patient to someone else, an ineffable quality of suffering, a flavor of affliction that for some reason resonated, or simply being dead tired with energy to all systems ebbing. The shrill chirping of my pager cut short my reverie. I closed my fist around the ring and hustled off to the ER.

The next morning after attending rounds, I sat down at a computer in the resident’s lounge and googled “Algiers 1944”. There was much written by British veterans about their time there, though since North Africa was solidly under Allied control by then, it was all fairly dry and administrative. I surfed through images of Algiers from that time: colorful garb, bustling casbah, pith helmet and fez.

After a while, overcome by drowsiness, I rested my head in the crook of my arm, and was awash almost instantly in dreamscape: Pete is excitedly leading a group of Arab-looking men through a narrow alley, his blue scrubs washed-out in the film’s black and white. Then they are shuffling down a hallway in the VA, murmuring in some incomprehensible and guttural tongue. They approach me with a large wicker basket. I am terrified, imagining pulsing, swollen genitalia inside. Pete throws back his head, laughing as he lifts the lid to reveal a mountain of silver rings all covered in Arabic, and says, “This is it. This is the answer.” And laughing menacingly, “It’s about the silver, not the goddamn Yiddish Beatles!” He laughed, louder and louder, until his laugh blended with and was then overtaken by the bleeping of my pager. I raised my head, shook away the cobwebs, and headed off.

After a few hours of work, with everything in fairly good order, I headed to the cafeteria for coffee. I ran into Pete, and we sat down together. “How’s your heart failure on seven?” I asked sipping at my weak brew.
“Myron? Unconscious and peeing a river.”
“How’d our colleagues deal with their dropped ball?”
“Surprisingly well. I mean, once the blood returned to their faces.”
“Did it come up on rounds?”
“Come on,” Pete protested. I knew he would never disparage other residents in front of the attending physician, but I liked to get him going on issues of protocol and propriety. “Even if they were a couple of simpering ass-kissers (and I’m not saying they are, mind you) who need to be taken down a notch, that is not the way to do it. There are rules, and one should strive to follow them.”
“It’s what separates us from the… non-rule followers,” I offered.

I fished the ring out of my jacket pocket and placed it on the table between us. Pete stared at it a minute, then looked at me. “You know, I look at you and I think: worry beads, maybe a rabbit’s foot, but not a trinket cut off some old guy’s prick.”
“We don’t choose our talismans. They find us. It speaks to you or it doesn’t,” I said, taking the ring up again from the table.
“Yes, it spoke to me: ‘please get me off this guy’s penis, it said.’ The part I missed was, ‘and then carry me around forever in your jacket.’ ” I laughed and dropped the ring into my pocket. “You know,” Pete said, “he may want that back. I mean, if he wakes up.”
“What about that? Is he comatose?”
“Yes. I mean we are not sure what his deal is. He’s not conscious or responding to pain. Neurology is supposed to come around and take a peek at him later today and sort it out.”

Late in the afternoon, I went up to the seventh floor and grabbed Mr. Flint’s chart. I flipped through and skimmed the notes left by the various teams involved in his care: internal medicine, nutrition, neurology. After replacing it in the rack, I walked over to the patient’s room. Peering in through the door, I noticed the Foley bag filled with clear urine. He lay unmoving surrounded by the tubes and wires of his IV and monitors. I walked in and sat in the chair next to the head of his bed. His eyelids still twitched occasionally. I sat looking at him. Occasionally his face would grimace, but would then settle back into its plaintive stillness. I tried to picture what he must have looked like half a century ago. Why was he all alone? It’s terrible to be all alone. Just terrible, I thought as the irresistible pull of drowsiness dragged me deeper into the comfy chair.

Just then, his eyes fluttered open.

Published in: on May 23, 2007 at 1:01 pm  Comments (1)  

Veteran’s Affairs–A Ring’s Tale (Part 1)

My eyes popped open. A moment’s disorientation gave way as I took in the scene: running shoes, scrubs, bleak little room — I was on call. My pager was bleeping away. Call to me was a dreamy, sort of psychedelic experience. I would have difficulty sleeping the night before, and so would begin the thirty-six hour stint already somewhat deprived. By the middle of the call night, I would feel sluggish and somewhat giddy. If there was any sleep to be had, it would be intense, dream-rich and brief, leaving me dazed upon waking. I would talk to nurses on the phone in the dark from under the covers, giving orders and answering questions, but remaining in a wavy grey area between sleep and wakefulness.

I looked over to my pager as I swung my legs over the side of the bed and sat for a long moment collecting myself. I had just accomplished an unusual two hours of uninterrupted sleep, and my mind resisted being pulled back into consciousness. Sighing deeply, I took a look at the call back number. It had a 666 suffix denoting another intern paging. It was a little trick we employed as a courtesy and to expedite a call back.

I knew it was Pete since at 2:39 AM no other house staff but those on call would be around. I picked up the phone.
“You gotta come up here.”
“Where are you?”
“Seventh floor.”
“What’s up?”
“Just come up. What are you sleeping?”

Pete never slept on call. If not busy, he would sit and read, drinking Coke and bouncing his knees. I opened the call-room door and steered out into the corridor. The VA had huge turn-of-the-century corridors with lots of wood and tile that I found forbidding but evocative. It was easy to imagine this hallway ninety years ago: an entourage of white-coated sycophants bobbing in the wake of some luminary clinician, his stentorian baritone bouncing from tile to tile as he held forth on the topic of the day. In fact, with slight variations of style and topic, in about five hours a similar scene would be played out here. Pete would be spiritedly leading the whitecoats, less brown-nosing than simply riding his caffeine wave; I still found it unseemly.

I arrived at the seventh floor nursing station to find Pete in an unusual state of calm. “So what’s up?” I asked him.
“You just gotta see.” We moved to a room just down the corridor, Pete slowly shaking his head. We entered. An elderly man lay on the bed asleep or unconscious, with IV’s and monitors bleeping away. “This is Myron Flint,” Pete began, adjusting his glasses with a crinkle of his nose. “Mr. Flint was admitted early this evening by two of our esteemed colleagues. Mr. Flint is in heart failure. Our colleagues, who are surely at home sleeping like angels, prudently began Mr. Flint on an aggressive regimen of diuretics.”
“Yeah,” I said waiting for the punch line.

“Nurse came in to place a Foley.” A Foley is an indwelling bladder catheter. It would be a standard order for a patient like this.
“OK,” I responded, wincing a bit as the possibilities unfolded in my sleepy mind.
“Little issue,” he said, grabbing the edges of the sheet and blanket and slowly peeling them back. I narrowed my eyes. Pete reached up and adjusted his glasses on the bridge of his nose.
“Oh my, my, my,” I slowly intoned.
“Yeah.” Pete nodded. “Yeah. Seems our colleagues weren’t so thorough in their examination.”
“Seems not.” We silently turned to the dispenser on the wall and gloved up. I moved to the opposite side of the bed facing Pete. He reached down and took hold of the patient’s penis. At the base was a solid silver ring, expanded to an oval at the top. The tissue beyond was grotesquely swollen. Pete parted the swollen flesh surrounding the ring’s flat plate revealing a roughly etched “Algiers 1944.” The writing was sandwiched between a simple design suggesting two half suns, the rays beaming towards the plate’s edges.

“Algiers 1944. Huh,” I said quietly.
“Now that there is commemorative,” he suggested. Pete went to the ER to get a ring cutter, and I grabbed the chart: born 1920, two previous admissions for heart failure, no family, lives alone.

Pete returned a few minutes later and we set to work. It was difficult to steer the tool’s guard under the ring with all the swollen and sensitive skin, but we managed and began turning the grinding disk.

We both recoiled at the sound of grinding metal issuing from such a delicate locale. Silver flecks gathered among the engorged tissue. We took turns cranking the device, having to make cuts on both sides to free it. As it gave way, the swollen member flopped onto the patient’s thigh like a landed elephant seal. “That’s progress,” Pete stated gruffly.
“A definite step in the right direction,” I agreed, examining the ring’s remaining top portion. “What’s the story behind this?” I asked, mostly to myself.

I flipped it over in my palm a few times and dropped it into my jacket pocket. Pete leered at me from over his glasses. “What are you gonna carry that around with you?”
“Don’t worry,” I replied. “I plan to rinse it in tepid water. Were you planning to send it to pathology for analysis?” Pete laughed.
“Hey, enjoy, enjoy. I doubt he’ll miss it.”
“Has he been awake?” I asked.
“According to the nurse, he was found unconscious by his friend and hasn’t raised an eyelid.” We tossed our gloves and pulled the blankets up to Mr. Flint’s neck.

Tomorrow, Part 2

Published in: on May 22, 2007 at 12:28 pm  Comments (3)  

9 Years, A Full Circle, And A Pinch Of Goo Gone

Can this formula get you unstuck?

My blog has lo these many weeks occupied a space in my head formerly reserved for such things as the pile of mail I wasn’t dealing with. Late bills? Notification of being named in a malpractice suit? Or the 11th grade research paper I wasn’t doing–on which passing to senior year was contingent. Or not figuring out what to do with my life.

Which is to say a dark nook to keep things that upon being reminded of their existence (in the case of my blog, the link on my toolbar that leers menacingly every time I look at my browser) causes a lusty feeling of neglectfulness, of being remiss, of leaving one’s post, of falling down on he job.

Yet, my response to any slip of light which might illuminate this dark nook has been to run, to avoid, to numb my senses, leaving me in a state of paralysis, of being stuck.

Nine years ago, I left my neurology residency and headed, with Hatbox Louie, to the San Francisco Bay. My idea was to work for a non-profit, world-changing, peace and social justice organization. The trevails of this sorry misadventure are chronicled here.

The anxiety of being adrift, the compulsion to immediately find something lofty and great to do in order to mitigate the abomination of having left medicine, and a healthy dose of naivete, led to the failure of the escapade and ultimately to my return to medicine. I couldn’t take the heat.

Since then, I have completed a residency, worked as a clinician, volunteered my medical skills in Ecuador and Bolivia, traveled, fixed up two old houses, and tried to find a place for myself in academics. Some small successes, mild satisfactions, a few bucks. But ultimately wrong for me. All of these endeavors have amounted to stop-gap, temporizing measures. I have avoided facing that dark nook in my brain that held the truth of what I wanted to do as if the door were guarded by demons.

Well, at some point there is nowhere to run, there are no more quick little fixes; the demons must be excorcised. And so by sheer force of will, I have done so (and oddly, temporally coincident with the death of Jerry Falwell). What I really want to do, what I’ve always wanted to do, is write. At this point I don’t even care what I write. Science and medicine seem like logical starting points, but anything.

So I’ve come full circle. I’m going to relocate to the Bay area, where Hatbox Louie and I have great, interesting friends who know lots of people and are excited about new ideas and projects, and where there is an almost palpable feeling of possibility.

Nine years later, I have seen alot, thickened my skin, and no longer feel like I have to apologize for not pursuing a career that every day deadened another little piece of my soul. This time I’m going to make it work.

And I can’t very well decide to get unstuck and be a writer and at the same time let my blog fizz out like the idea of citizenship or the cassette tape. I believe it was Benjamin Disraeli who said, “Oy! Get up off your arse you bollocky tosser!” Well, ok Ben. Ok.

Living In O’Bolivian

The friends we are staying with were cleaning out their old emails and came across this one I had sent them a while back. Hatbox Louie and I were working on a medical project in tropical Bolivia. It struck me how radically different the chapters of one’s life can be. Staying with friends under the freezing suburban skies of Ohio–sweating bullets in the heavy, smoky air of lowland Bolivia. Blinding-white conventionality versus grinding-dark poverty. A world apart. Still searching, I am again at sea.

The email:

Hatbox Louie has informed me that it is my turn to write an
email so I will. It was a very odd week here in
Bolivia. It began on Sunday. We were setting out on
A 5 day boat trip down river–northeast towards Brazil
and the Amazon–to visit a number of remote villages.

Early that morning we met at the clinic to load meds
and materials into our truck and then drove down to
the river. We packed the boat–a 30 foot narrow
longboat with a tarp awning–with our big red bags
of meds, scores of liters of water, food, tents, a
stove. It was a very full boat and sat low in the water.
The stern held 2 huge barrels of fuel. There is no place to
refuel and the trip is long–particularly
the return–where we chug back against the current.

I noticed there were 3 life vests dangling from a
rafter. There would be 6 of us aboard. Now I don’t
claim to be a whiz with numbers but…I remarked to
Hatbox Louie that it was like one of those jokes: a priest,
A rabbi and two gringos get on a boat with 3
vests…At one point the two of us and Lola, our nurse,
were alone and I said to her on the sly-ok there are 3 of us and 3
of those, are we cool?

Antonio–boat guy, pharmacy guy, truck guy–pulled the rope
to start the motor and swung us out into the current. It was
very chilly and the Bolivians were all bundled. I
was in short sleeves hoping to hoard some of the
coolness for later use. As we motored downstream, the
dense-green mountains gave way to rolling hills and
the river widened. Antonio expertly maneuvered
around submerged logs and occasional small rapids. We sat
on the vests as a small comfort against the hard planks
and enjoyed the view and the air. Frieda–a Bolivian
doctor who is in charge of public health stuff and
training the health promoters from the villages
began to prepare breakfast. Hatbox Louie and I had eaten granola
before we left, so we politely declined. I was a bit hungry but
could not justify a beef sandwich as a post-breakfast

Suddenly the motor kicked off and Antonio restarted
it. Then again. This time he looked concerned and
asked if oil had been added to the gas. Como se dice
“oops”? He turned us around and we headed back with
the motor misfiring all the way upriver. After about
45 minutes, we landed the boat where we started. As it was,
our schedule downriver was tight, and we
began to speculate on how to work things out if we managed
to get back on our way. Within 2 minutes, Antonio had
comandeered a motorcycle and returned with a
barefoot mechanic. Together they lifted the motor off and
carried it away. The damage: some kind of blown ring.
A result of the improper gas mixture. The
replacement part: a short 20 hours away in La Paz.

We went home, had a meeting and decided to switch
weeks with a different trip we could make by truck. We thus
headed to Tigre– a community about 6 hrs away–3 hours
on the dirt highway to Ixiamas where we turn onto a
terrible little road for 2-3 brain-jangling hours
of rutted, washed-out driving paradise.

We were about an hour into this rough part when we
stopped to watch a family of monkeys twisting and
somersaulting in the high canopy. We pressed on,
fording little rivers and large arroyos. About 20
minutes away from our destination, we stopped in a
village to visit a doctor who was stationed there by
the ministry of health.

She sauntered out of her thatch house with a baby in her arms,
the two of them rather grimy. The doctor was only distinguishable
from the locals by her relatively fashionable hair cut. She
was there with no meds or real treatment materials!!??
Very useful. Like a chef in a kitchen without food
or pans or knives–he will come to your table and
discuss delicious dishes and the smells they would generate
in their cooking. Though he has none, he might suggest a wine
to compliment this sumptuous theoretical feast. Welcome to Bolivia.
She gets a difficult to attain salary, and some schmuck
in La Paz gets to claim he is providing health care in the region.

We continued on towards Tigre. Tigre is composed of
2 communities which formerly lived in Potosi in the
highlands way to the south of La Paz. The 2
communities had been fighting each other for years
over land issues. There were people killed on both
sides. About 7 years ago they were exiled from the
Andes. The government got fed up and stuck them all
together in the jungle by plane with 6 months-worth of food
and no real way out. Like a gettin’ to know you
cooperation game from summer camp. Pretty kooky.
They seem to be getting along ok though.

We finally got to within 300 yards of the place.
That is, we got totally stuck in the mud as we
approached. Why did this suck? Well this place is a
focus of leishmaniasis– a disease you get from the bite of a
sandfly. If you get it, a long, arduous course of
painful and toxic injections MAY cure you. If not, years later it
can attack your mucous membranes, and you basically lose face.
The fly is very active at sundown. As we were struggling to
get out of the mud, the sun began to set.

Hatbox Louie and I had our buzzoff shirts, pants tucked
into socks, permethrin-soaked bandanas around our necks,
and enough 100% deet covering whatever skin remained
exposed that it felt like we had just crawled out of
Love Canal. Antonio wore a tank top. We had to carry
all our stuff–meds, gear, everything–
into the village and put up our tents in the dark
knowing the sandflies were beginning to feed.

By the way, we were so late because that morning we
had to attend a meeting with regional health
authorities to answer allegations by some half-assed
Bolivian NGO that we were experimenting on villagers
with our strange and wicked-strong American drugs.
I joked that the allegations were patently false: it is not experimentation–there is
no data compiled or control subjects. It is simply
haphazard and evil overdosing.

We managed to get our tents up, and the next day had
a very busy clinic before turning back up the road.
Antonio had extricated the vehicle with about 15
guys from the village. Before we left, we had lunch in a
smokey thatch-and-board house with the wife of the health
promoter we were training. She had apparently
killed a chicken for us which is sad, though judging
by the texture, it had lived a long, long life prior to making
the ultimate sacrifice. Well, we made it back and now we are
preparing for our next trip. Hope all are well, and more soon.

Nervus Intermedius-How Gross Anatomy Almost Made A Cadaver Of Me-Part 5-End

The exam began as they all had: a mass of stressed out students milling about, pulsing out enough manic power to re-animate the dead. Ding! And we were off. As I made my way around the room, my skin tingled with prickly heat. I breathed evenly and tried to stay focused. I thought I was doing OK, but it was impossible to be sure. The new material covered the most anatomically complex part of the body: the cranial nerves. These come directly off the brainstem and control everything from the neck up. It is an impossible tangle of branching wires winding around and through imponderably tiny spaces, sinuses and structures all packed into a space the size of a grapefruit. Branches to the ears and eyes, the tongue and face. So complicated, so disorienting.

Circling the room, fatigue set in and my confidence flagged. I pictured another year with Julia Child of the dark arts — another year unable to rid my nostrils of the acrid-sweet odor of death and formaldehyde. Just Breathe. I was at the last station. I was breathing, breathing. I looked down, and what I saw made me audibly gasp. Now most people would have been horrified. But it wasn’t the fact that I was standing before a human head sliced in half lengthwise through the face. Maybe once, but not anymore. No. It was that the cut was made at a strange angle, off the sagittal, in order to render the way we had learned the anatomy useless to us.

I stared into this head — which lay like a split coconut — trying to get oriented. The minute was ticking away and its very passage kept me from focusing. I thought, This could be the question. The one I need. This one could save me. I know this goddamn anatomy. I need this. Touch nothing. But that’s not the same as cheating right? I can’t see where I am. I’ll just be gentle. What sinus is that? It looks all wrong. What if I just…. I’m going to be a doctor, right? It’s just the laying on of hands. What am I looking at?

“You have ten more seconds,” said Julia to Jacques. I looked to my left. I looked to my right. Everywhere murmuring, scribbling, pondering. I reached down carefully and slowly brought the two halves together. As they approached, it was like a familiar old road map had opened: internal acoustic meatus, seventh nerve, nervus intermedius! It’s nervus intermedius, of course. I gently let the coconut roll open again. I looked around for witnesses. Nothing. I jotted my answer, then closed my eyes, feeling my heart thump against my breast bone. I released a deep breath. Of course, nervus intermedius, what else? Ding!

My three dissection partners and I went out immediately for beer. It was crucial to beat the rest of our class to the pub so that we would have a couple drinks in us before being exposed to all the malignant post-exam energy. Even after such a well-demarcated climax, they would never stop talking about anatomy, the probable pass mark, specific exam questions, “whadja put for this, oh you did? I thought it was…” They had no off or even pause buttons. It was as if, years ago, they had gotten all worked up about their SATs and just stayed that way. But after a couple pints, we wouldn’t much care.

The Delicate Flower would take pleasure in shutting up our closest neighbors. They would leave in a huff, the vacuum would be filled, and the process would continue. “Alright Dumb and Dumber, I just got through telling your little buddies Itchy and Scratchy over there — you want to talk about the exam, you do it out of my earshot. Now beat it.”

But for now we were alone and we raised our glasses high.

Me: Marty number one, there may be others, but we’ll never forget you.

Frat boy: Marty could party.

Comic book man: Mahty old mate, we feel propa charlie about givin’ ya the ol’ slicey dicey, but lovely to have made your howdydo, and cheers a lot for the glands.

Delicate Flower: Marty, we didn’t know you in life, but in death you became our friend. You were there when we needed you. And what a package.

Male chorus: Fluids. Shifting fluids. Recognized phenomenon.

Delicate flower: My ass. Marty, the ladies of Baltimore salute you.

All: To Marty.

Nervus Intermedius-How Gross Anatomy Almost Made A Cadaver Of Me-Part 4

Yes, the written exams were children’s puzzles — comparatively stress-free accountings of our scholastic progress. What really filled our hearts with dread, what kept us up late picking through the stinking organs of our cadavers was the practical exam.

You arrive at the anatomy lab as close to the appointed time as possible so as to avoid soaking up too much of the frantic, hyperverbal, fidgety stress energy of the early arrivals. The doors open. The rules are explained. You have one minute at each of the fifty stations after which, a bell will ring and you must move on. Each station has a specimen with a series of small flags pinned to structures of interest. Answer the questions associated with each flag. Touch nothing.

This last bit was clearly included to discourage some students’ nasty little habit of sabotaging exams for others in order to improve their own place on the grading curve.

Our knowing the anatomy was just a jumping off point for the noble sadists who were our faculty. You see a flag and recognize the structure, relief washes over you until you realize you must answer a convoluted question about that structure. Ding! You move on lest the super intense, bespectacled classmate coming in behind you encourages you forward with a forearm shiver.

Next station: muscles of the anterior thigh. But so much has been stripped away it takes most of the time allotted just to get your bearings. Ding! On and on. Joints disjointed, tiny bits of disembodied tissue without a clue to its origins, things confusingly twisted out of position.

It really wasn’t about learning anatomy. It was about performing under the most stressful conditions that could be mustered, about bridling one’s fear, but also just about meanness. Like the family abusers who were themselves abused, the cycle was propagated. And it would be our job to punish the next generation for having the temerity to think they could master the material. Oh, and if you fail any practical exam, you fail the course even though your overall average might be adequate. Sorry. Ding!

And, what’s more, I had a handicap. A learning disability really, though in academic matters it rarely surfaced. I have no sense of direction. As a child, I would become lost in my own elementary school building, trying to retrace my steps and feeling ever more frantic as I kept passing the same damned fire extinguisher and obviously making no progress. Or I’d be running happily with a group of older kids until they turned the block and disappeared leaving me unable to recall how we had reached that corner or how to return.

Over time, I taught myself how to use landmarks and to meticulously log the details of important routes. Even today, if I cross a street and enter a store, when I exit, if I forget that I crossed the street, it will feel very natural for me to walk in the wrong direction.

In time, I realized that the problem was generally a weakness of spatial orientation. In organic chemistry, as an undergrad, I struggled to imagine a complex three-dimensional molecule in my head in order to create its mirror image. With time I could manage it. And I had time. It was college. Sitting comfortably at my desk I would practice working the molecule over and around in my mind. It was akin to learning your neighborhood, where taking on human anatomy was trying to memorize a three-dimensional world atlas, then recreating it amidst the bells and frantic med student murmuring of the anatomy practical.

It was the end of the year. Several of our colleagues had already succumbed and would be taking the entire course again. Their pathetic specters hung low over the dissecting tables as we made preparations for the final exam. It was to include all the new material as well as stations reviewing the vast entirety of what we had learned. I had passed the last practical by a single question. I had no wiggle room.

Continued Tomorrow

Published in: on December 10, 2006 at 12:33 pm  Comments (3)