Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, September 28, 2007

True Story

This is one of those things you hear about, as in "someone told me that someone told me that someone really said it." In this case, it happened to a real honest to goodness person (if you consider lawyers to be people, that is) whose name I know (quite well) but cannot share for privacy concerns. But really! It really happened!

The setting: Lawyer being deposed about something that happened a decade ago.

Q. Mr. Smith, at one time was Mr. Wesson a partner of yours?
A. Yes.
Q. Is he still a partner of yours?
A. No.
Q. Could you tell me why not?
A. One reason is that he's deceased.

Wouldn't you have loved to be a little devil on the shoulder of the questioner and urged him to ask, "Are there any other reasons?"

Thursday, September 27, 2007

What He Should Have Said

Apologies galore for the delay, but when you combine five days away with a late-night, west-to-east return trip, mix in one solo office gone nuts and toss in a late run for a pennant, blogging finds itself on the back burner.

Many thanks to all for joining in the fun, especially the newly returned dear Dr. Dork. (The blogosphere is so much dorkier with you around. By definition.) Now, to business:

With apologies to William the Coroner, we all understand that there were so many things he couldn't say; the game was what *should* he have said. That said, frankly there were some great lines that he could have actually gotten away with. In no particular order, here they are:

Church related:
  • If you're looking for God, I might be your man.
  • So help me God.
  • I work everywhere but since God's employees are not supposed to moonlight in retail, let me help you by finding a salesperson.
  • On a consulting basis, how may I help you?
  • Only in the sense that God is everywhere, and I am His servant.
  • Sure, except on Sunday.

Shoe related:
  • I have been called to save souls, not fit them.
  • I do "soul" work, even here at Kohl's.
  • Yes, and in this shoe department we have heavenly soles.
  • Well, last I checked I was a Catholic Priest. But, give me a minute, and we'll see. You know what they say, if the shoe fits...
  • I shall wash the feet of the lepers, wherever they may be...
  • Yes, I pray for heeling.
  • Yes, but I am only allowed to sell black shoes.
  • Are you kidding? Do I look "Shoeish" to you?
  • I'm sorry, but I only handle feet on Holy Thursday.

A little too edgy, but funny:
  • For Christ sakes, what do you think?
  • Oh Vey, no way!!
  • There's a wonderful optometrist in our parish . . .
  • Of course! God's work is done everywhere. Care to step into a fitting room for confession?
  • Why yes. I do. We have a lot of people drop dead the moment they see our low prices.
  • No, I was told the Devil wears Prada, so I am here to perform an exorcism. [my favorite of this group]
  • WTF, Do I look like I work here?
  • Yes, I'm always doing the Lord's work. Now tell me which of these shoes looks better, and I'll absolve you of all of your sins.
  • Blessed are the myopic, for they shall inherit the hearth.
  • Sorry, I'm in advertising, not selection.
  • Dang I've misplaced my pulpit again!

Way over the top but funny as hell:
  • "Sister Mary Aloysius," he glances around furtively and loudly whispers. "I though we agreed that today YOU'RE the store clerk and I'M the shoplifter! You got to wear the handcuffs the last three times and now it's my turn! Now go back there behind the hosiery section and wait for me to put these sneakers under my cassock..."

Hands down, my favorite:
  • Is the Pope Jewish?
And finally, what he really should have said:
  • I must confess, I do not.

Regarding the idea of voting in the comments, I changed my mind: I hereby appoint myself sole and final judge and I declare that both of the final two entries ("My Favorite" and "What He Really Should Have Said") are the winners. But because the last one was posted by that prolific commenter "Anonymous" I have no way to send a prize. Congratulations, though, Anon; well done. Zany Mom, email me and we can talk loot.

We now return you to your regularly scheduled Dinosaur.

[A note on the semi-serious side: There are going to be some changes in the rhythm of my life, now that the kids are gone and the office starts to pick up, first with flu shots and then with flu-and-other-winter-illness season hard upon us. I fully intend to continue blogging, but -- especially if this week is any indication -- I may find the frequency decreasing just a smidge. There are some interesting essays I have percolating, but there are also over 200 Bloglines posts to catch up on, a novel in progress, family 85th birthday parties to attend (ok; only one of those on the calendar) and Ultimate Frisbee tournaments at which to cheer sons on. Hopefully my blogging will make up in quality what little drop in quantity may ensue as I embark on this new chapter of life.]

Tuesday, September 18, 2007

Another Contest: What He Should Have Said

I'm going away for five days to chill, relax and re-charge, but just so as not to leave y'all high and dry I thought I'd share this TRUE patient story, again with enthusiastic permission from said patient. In addition, I thought it would be fun to include a contest to see who can come up with the kickass-est comeback line my patient wishes he could have thought up on the spot.

A Catholic priest goes straight from work to Kohl's to purchase some sneakers. He is dressed for work; as a Catholic priest, that is: black shirt, square of white cardboard at the collar, black pants, black shoes. He's standing in an aisle perusing shoe boxes when a woman comes up to him. Right up to him. Maybe five feet away. Directly in front of him. Face to face. While he's in full Catholic priest clothing.

And says to him:
Do you work here?
What should he have said? Let your imagination run wild and share it with us.

Contest rules:
  1. Two ways to enter: in the comments or via email (notdeaddinosaur-at-msn-dot-com)
  2. Upon my return I'll go through all half-dozen or so entries, pick my favorites and share them in another post.
  3. Readers may vote in the comments of the second post.
  4. Prize: to be determined (leaning towards "A copy of my book along with knowledge of my true identity," but will consider chocolate if the winner already knows me and/or has read my book.)

Monday, September 17, 2007

So That's How it Happens

From a brittle old parchment unearthed during a treacherous archaeological adventure into the nether regions of my desk:

In the Beginning was the Plan.

And then came the Assumptions.

And the Assumptions were without form.

And the Plan was without substance.

And darkness was upon the face of the Workers.

And they spoke among themselves, saying:
"It is a crock of shit and it stinks."

And the Workers went unto their Supervisors and said:
"It it a pail of dung, and none may abide the odor thereof."

And the Supervisors went unto their Managers, saying:
"It is a container of excrement, and it is very strong, such that none may abide by it."

And the Managers went unto their Directors, saying:
"It is a vessel of fertilizer, and none may abide its strength."

And the Directors spoke amongst themselves, saying to one another:
"It contains that which aids plant growth, and it is very strong."

And the Directors then went unto the Vice Presidents, saying unto them:
"It promotes growth, and it is very powerful."

And the Vice Presidents went unto the President, saying unto him:
"This new plan will actively promote the growth and vigor of the company, with powerful effects."

And the President looked upon the Plan, and saw that it was good.

And the Plan became Policy.

This is how Shit Happens.

Sunday, September 16, 2007

How to Learn New Curse Words

Making the most of an opportunity:
  1. Call husband of Darling Spouse's niece; the one who lives in Brooklyn and lives and dies by the Mets.
  2. Casually ask if he happened to catch today's baseball game (Phillies 10, Mets 6)
  3. Listen carefully.
  4. Take notes.
Extra credit:
  1. Ask what he thought of Mets' relief pitcher Jorge Sosa walking in the tie-breaking run in the 6th inning.
  2. Ask what he thought of pinch-hitter Greg Dobbs' 6th inning Grand Slam home run right after the aforementioned tie-breaking walk.
Taking one's life in one's hands:
  1. Say, "I lost count; how many errors did the Mets have?" (Answer: 6)
  2. Say, "Remind me: how many times in a row now have the Phils beaten the Mets?" (Answer: 8)

Bleached Blonde Moment

Lady comes in for a checkup. Only complaint is of a painful area on the right side of her chest, just below her armpit. No breast masses. Too young for mammography. No family history of breast cancer.

Show me where it hurts, I ask.

She lifts her shirt and palpates around the side of the breast, up under the arm; finally locates the spot. "Here."

I look. "Put your arm back down," I say while still holding the shirt up. "Is it right there at the spot where the underwire from your bra hits?"

Why yes, it was. Fancy that. And she wasn't even a natural blond. Apparently just bleaching your hair for too many years has the same effect.

(Posted with the patient's enthusiastic consent. We both shared a huge laugh from this visit.)

Saturday, September 15, 2007

You Know They're Growing Up When...

One of the coolest things about Family Practice is watching children grow up, especially when they're basically healthy and you only see them once a year or so. There's a flip side to this, though, that was driven home to me the other day with the force of a 25 gauge needle.

Like many physicians, I tend to say the same things over and over. We can usually get away with it, as we see so many different people. But now and then we're startled (well, I am) when patients remember what we say and point out that we're repeating ourselves. What can I say? I have my spiel, and generally it works for me.

I was seeing a 14-year-old girl I had taken care of from age 7. Due to shifting immunization recommendations over the years, there have been several occasions when I've had to give her a shot. This kid really hates shots, though she's gotten better about it over the years, as most kids do. Still, she clearly wasn't happy when I began my spiel about the meningitis shot to her father and her. The dad agreed it was a good idea, so the kid knew she had no choice.

But I started in on her with my usual patter: I'm really good (read: fast) at giving shots. It wouldn't be that bad -- as virtually every other patient in my practice has said upon receiving a shot from me. She wasn't buying it, though:
That's what you always say. Then you give me the shot and it hurts. You say you're sorry and draw a smiley face on my band-aid.
What could I say -- after I managed to stop laughing, that is?

"You're right. It's gonna hurt a bit. Deal with it."

After the shot (which hurt, she claimed) I offered her a band-aid. She accepted. I asked, "Do you want me to draw a baseball diamond on it instead of a smiley face this time?" (small round band-aid with square pad oriented on its corner; just begs for filling in the bases at the corners of the pad.)

"You drew a baseball diamond on it last year."


Friday, September 14, 2007

More Nieceling Exploits

Although my 4-year-old niece is doing just fine with her language development, apparently her mother is concerned because she isn't quite up to snuff with her gross motor milestones. Specifically, she cannot yet stand or hop on one foot.

Her mother's response to this is encouragement:

Mom: Can you stand on one foot?
Kid: No.

Mom (later): Can you hop on one foot?
Kid: No.

Mom (several more times): Can you stand on one foot?

Finally, my niece went over and stood on her mother's foot.

Correlation Does Not Mean Causation; Except When it Does

It's important to remember that epidemiological axioms -- "Correlation does not equal causation" -- do not always apply to individual patient scenarios.

I saw a 40 year-old woman with a recent diagnosis of interstitial cystitis who told me of some weird symptoms she'd had a few days prior. She was shopping and suddenly found she couldn't read. Being a "person" first and a "patient" a distant second, she ignored it and continued shopping. On the drive home her left arm and hand went numb. Then a few hours later she began with a pounding left-sided headache accompanied by nausea and photophobia. Her mother said it sounded like a migraine, and suggested she take Excedrin, which she did. It took awhile, but the headache went away. She had never had a headache nor preceding symptoms like this before, and there was no family history of migraine.

Her neuro exam was completely normal but her age and the absence of any history or family history of migraine alarmed me enough to get an MRI of her brain. It was normal. When I called to tell her that, she relayed that she'd just had another similar episode. She also mentioned that the urologist had given her something called Urelle for her interstitial cystitis, telling her to take it on an as-needed basis. She had also been given a special diet for her bladder that was actually working quite well, so she hadn't taken the medication much. However she now realized that the two times she'd taken it were on the days she'd had the neuro symptoms and the headaches.

It turns out that Urelle contains several things, including hyoscyamine: a smooth muscle relaxant. It's used for bladder spasms because the bladder contains smooth muscle. Another function of smooth muscle in the body, though, is in the walls of blood vessels. Relax it there and blood vessels dilate. One of the suggested mechanisms of migraine is dilation of blood vessels in the brain. I may be just a little old family doc, but the causal connections seemed damn plausible to me. I suggested she stop taking the Urelle, which she was happy to do. She knows to call me if she has another episode even without it, but it hasn't happened yet.

Moral of the story: to explain new symptoms, think of new medications. Although the plural of "anecdote" is not "data", correlation very often equals causation in patient care. (Just not in epidemiology.)

Thursday, September 13, 2007

Speaking of Ear Wax

Rob over at Musings of a Distractible Mind was writing about ear wax -- also known as "cerumen" to those of us in the med biz -- and I was reminded of a nifty answer I came up with to one of my kids' questions several years back.

By way of background, you need to know the following line that priests, rabbis, ministers and assorted other clergy have all told me they use when asked at an outdoor event to pray for good weather, or "put in a good word with the Man upstairs," or however the request is phrased:
Sorry; I'm in Sales, not Production.
So there I was explaining to my younger son about how the ear canal produces wax for lubrication and protection and all those other nifty other functions of cerumen, when he asked what appeared to be a perfectly reasonable question about cerumen impaction: Why does the ear keep making wax once the canal is plugged up? I thought for a second, and then came up with this:
Sorry; I'm in Maintenance, not Design.

Wednesday, September 12, 2007

Musings of an Unaffiliated Jew on Erev Rosh Hashanah

After more than twenty years as an active participant in a Reform congregation, I am about to begin my third year as an unaffiliated Jew.

This is entirely my choice. Darling Spouse is equally comfortable affiliated or not, and has expressed nothing but support for me in this decision. We've disagreed over whether or not I'll eventually go back. I say no. Darling Spouse believes otherwise, but the discussion is moot; I'm not ready to go back yet.

A word about Jews and community: Although there are many blessings and prayers that individuals (mainly orthodox) can and do say on a daily basis, public worship requires a minyan -- quorum -- of 10 adult Jews. To read Torah, to recite Kaddish, to hear the Shofar on Rosh Hashanah or Kol Nidre on Yom Kippur, Jews must come together in community. What could have so gotten to me that the community that succored and supported me for so many years became more burden than comfort? As with so many other things in life, the causes are multifactorial. Still, the break continues to be a relief; a time-out from a game I'm not yet ready to re-enter.

So how do I cope with the High Holy Days? Find a different community to join in the capacity of "visitor" just for the occasion? Fashion some kind of personal ritual to observe the New Year, the Days of Awe and the Day of Atonement? Or just ignore them altogether?

Frankly, I lean toward the latter, as I admit that a good part of my "break" is a form of rebellion. But some things are still too deeply ingrained to ignore: although I will work on Rosh Hashanah, I shall fast on Yom Kippur.

Darling Spouse, though, is insisting on a special holiday dinner tonight, the beginning of the Jewish New Year: roast chicken with all the trimmings, and a round challah. I'm looking forward to it, especially given the luxury of not having to rush-rush-rush around to get all dressed up in our holiday best and still get to synagogue an hour ahead of time for last-minute choir stuff. How relaxing, the prospect of leisurely dinner, with time to get the dishes done instead of having to leave them soaking in the sink until after services.

Interesting, isn't it: however you look at it, it's all about the food.

Tuesday, September 11, 2007

9/11: What We Squandered

The air is going to be thick with remembrances today. Where we were six years ago; how the world changed forever; all that stuff.

I don't have any special remembrance tale. It was an ordinary morning. The weather was nicer than today; bright, crystal clear blue sky vs. (desperately needed) rain. Everyone knows what happened. Almost everyone had the same sense of unreality; of desperation; of chaos; of sadness. I also remember the ensuing days of surreality: of grounded airplanes; of unnaturally clear skies and the serendipity of unplanned layovers. Also the shock, which then gave way to rescue and cleanup along with grief and mourning.

But I also remember the unity. The sense of all being in this together. "American" finally stood with meaning, ethnic prefixes banished. The idea of war -- real war -- to go after the men behind this heinous act was strangely acceptable to many of the most doveish among us. Osama bin Laden took his rightful place beside Hitler, Stalin and Caligula as evil incarnate.

What changed? When?

Too soon the Robertsons and Falwells opened their mouths and poisoned the air far more than did the micronized concrete of lower Manhattan. Too soon the Man Who Would be Baseball Commissioner hijacked the tsunami of patriotism more surely than swarthy men with box cutters overpowered flight crews, snatching away his greatest opportunity for true leadership and allowing it to morph into his version of a Father's Day gift. Six years later, the opportunity for a United America to have made a true incursion into the war on real terrorism lies in shambles, bathed in the blood of over 3,000 Americans. How did we go so quickly from near world unity to the butt of world opinion even lower than 9/11/2001?

Would leadership have made a difference? What if we had had a Lincoln; a Roosevelt; a Churchill; a Meir? A Clinton with a closed zipper? The cynical would say no: we get the leadership we deserve; Americans are too self-destructive to maintain that kind of unity. All that bullshit.

Whether or not I believe differently, it saddens me that we will never know.

Monday, September 10, 2007

Just Being Healthy

Saw a patient last week, who kept insisting he just wanted to be healthy. His health was very important to him. Here's what he was doing to get and stay as healthy as he could:
  • He was exercising three times a week. He'd even gotten a personal trainer.
  • He was taking all kinds of vitamins and supplements, including a multivitamin, calcium, vitamin E and fish oil capsules.
  • He was taking colon flushes, to rid his body of toxins.
Here's what he wasn't willing to do just yet:
  • Get a colonoscopy (despite his age of 56 and a family history of colon cancer.)
  • Take meds for his LDL cholesterol of 195.
  • Stop smoking.
Believe it or not, I actually managed to keep a straight face. Where on earth to even begin?*

Did you know that self-inflicted tongue lacerations heal beautifully all by themselves? No sutures or prophylactic antibiotics necessary, either. Thank goodness for small favors.

*What I actually did, of course, was congratulate him for exercising; let him know that he'd probably be better off without the fish oil and vitamin E; and tell him that the colon flushes were woo. Mentioned that colonoscopy wasn't really that bad; neither were statins, though he wouldn't take a script; and talk him into trying Chantix.

Sunday, September 09, 2007

When Barking Dogs Don't

A patient was telling me about the 15-year-old Canine American who shares her home. While she was on vacation, the dog had a seizure. Or maybe a stroke. According to the vets, it can be hard (ie, impossible) to tell the difference in a dog.

I can understand.

(Insert Scrubs-style fantasy of a doggie neuro exam: "Follow my finger. Can you hear this? Stick your tongue out. Hold your leg up and don't let me push it down.")

But then she added, "I haven't heard her bark since it happened."

Whoa! Aphasia in a dog? Do doggie brains have a speech center? What about a Broca's area?

More: "It's kind of sad. She just stands outside the door when she wants to come in, but doesn't bark anymore."

It boggles the mind.

Saturday, September 08, 2007

Just Answer the Damn Phone

"You have reached the number you dialed. Please listen carefully as our prompts have recently changed."

UroStream has a recent post about the frustrations of dealing with the ubiquitous Automated Telephone Answering Systems that seem to have invaded businesses large and small. Not only do I agree completely with the sentiments expressed, I would go one step farther and claim that in the context of solo physicians' offices, those systems are not only annoying but an unnecessary waste of time and money.

Here's the thing: however many options, menu trees and voicemail systems you have, YOU'RE GOING TO HAVE TO PICK UP THE PHONE EVENTUALLY! Why the hell would you want to piss people off before you've even had the chance to say hello? Despite the advertising spiel by the vendors of Automated Telephone Answering Systems, they don't really allow you better control over when you pick up the phone. They merely create that illusion by putting callers on hold for you automatically, albeit with lots of other bells and whistles (read: things to drive callers stark raving mad) first.

Why bother?

Call my office. A person picks up the phone and listens to what you want. If there's another line ringing or on hold, or a patient checking in or out, or for whatever reason we can't help you right that instant, you'll be asked to hold. But at least we know who you are and what you want. If you're just asking for the fax number or office hours or if we're taking new patients, it's far easier to give you your quick answer and say good-bye than to put you through the nonsense of an Automated Telephone Answering System. Cheaper, too. Because we know who you are and what you want, the next person who picks up the phone is usually going to be able to help you more quickly.

I've run across far too many SOLO offices who use Automated Telephone Answering Systems, and the only reason I can think of is that they think they're supposed to. As far as I'm concerned, they're just putting on airs; trying to exude an air of "We're such important people we can't be bothered talking with you, just like all those other big doctor groups in town." It's just stupid.

Pick up the damn phone already.

Friday, September 07, 2007

More Blogs

The old: Midwife with a Knife; mega-apologies for blogrolling tardiness.

The new(er): WhiteCoat Rants. His post A Nation of Enablers is probably the most cogent take on what's wrong with medical care in America.

The go-pee-before-you-read-or-you'll-be-sorry (thanks to Cranky Epistles, who rates the same warning): Frozen Tootsies, the blog of a rabid squirrel, who refers to herself in the third person when commenting.

Welcome to the blogroll.

Wednesday, September 05, 2007

Nothing Better To Do

Via Medpundit:

Social Services in the UK are planning to take away a woman's baby at birth because she "is deemed capable of emotional abuse," based on past mental health issues. The decision was based solely on the report of a pediatrician who had never met her, and was made despite evidence submitted by current treating mental health providers that the mother was fine. Full article here.

I'm just thrilled that child abuse and neglect in the UK no longer exists; that Children's Services is finally able to go after children -- even before they are born -- who "might" be abused, instead of using their time and resources to help those already-born kids who are beaten, neglected and sexually abused. After all, if there were still children being emotional or physically abused by their families then of course the moral imperative would be to help them first. It would be unconscionable to expend their limited energies merely on the potential for abuse if true abuse were going on right in front of their noses, wouldn't it?

Monday, September 03, 2007

Shattered Lives - Part Two

Six AM; getting ready for work; the phone rings. The son of a dear friend has shot himself. I suppress a gasp. An accident? "He's not going to make it." No. The friend's friend promises to call back later, and could I please call in something to the pharmacy for them. Of course I will.

I collapse in a chair for a moment, my fist in my mouth, trying to catch my breath; easier said than done over my racing heart. Or had it just stopped altogether?

One of my dearest friends has just joined that most unwanted of clubs: she has lost a child. Twenty years old; the same age as my twins; by his own hand. Or has she? Was he actually gone yet? Was there a chance he just might still make it? Or had he been pronounced at the scene? My insides are roiling. It's all I can do to function at work, waiting for the call.

The only way to deal with patients is to forcibly push the thoughts from my mind. Then, every few hours, I feel guilty as hell for not having thought about it. Where are they now? What's happening? All accompanied by that heaviness of heart that sinks right down to the stomach and just sits there, like undigested food I never ate in the first place.

The call came about half an hour before closing. He was gone. He had been depressed for a long time, but had just promised to go back to counseling. I didn't ask where he'd gotten the gun. It happened in the middle of the night. He had been airlifted to the regional trauma center where he'd been declared brain dead, but kept on life support so his sisters could come say goodbye and his organs could be harvested. They had just gotten back from the hospital. No arrangements had been made yet. She'd call tomorrow and let us know.

There was no point in asking how she was doing. She sounded exhausted and numb. As I hung up, the tears that had been welling up as she spoke finally spilled over, and I sat alone in the empty office for a few minutes, sobbing. Again, part of the misery was the feeling of fraud: my kids were fine. Guiltily, I blew my nose and headed for home, filled with melancholy. A pall of sadness hung over my every thought, although I realized my emotions were but a pale echo of my friend's. I both could and couldn't imagine what she must be going through.

Somehow I got through the rest of the week without seeing her.

I called. She was staying at one of her sisters' along with the rest of her family. She couldn't bear to go back to the house yet. She invited me to come out before I could ask, and I was grateful. I needed to see her, even though I knew by definition there was nothing I could do.

The house was crowded with people and thick with cigarette smoke. It was not the time for a tobacco intervention. They all knew I was a doc, so they asked me to help out with my friend's mother, who had broken out with shingles. Her regular doc's response -- after two days and numerous unanswered calls -- was "go to the ER", so after eyeballing the rash to confirm the diagnosis I called in an antiviral and some pain meds, "Just to get through the funeral." It was an exception I was happy to make.

The older sister was inconsolable. I held her as she sobbed against my shoulder. The brother was angry and not handling it well at all. The younger sister held it all in, as did the father. They were still just numb.

I found my friend on the deck by the pool. They made room for me to sit next to her. I held her for a moment, and then just sat. Her eyes were empty. Details flowed: the last day; the shot; the hospital; the transplant team; the final goodbyes; the arrangements so far. Tears flowed, were dried, and then flowed some more. Raw emotions washed over me as I sat there, telling myself that was all I needed to do. There were no right words and a million wrong ones, which I tried not to say.

That young man may have shot himself in the head, but the bullet tore through the hearts of his family at the same time, changing them forever even as it destroyed his brain. Oh, parts of his body will live on, a testament to his mother's determination to find whatever "good" could possibly be had from tragedy. But the pain of just witnessing this kind of pain is intense. There's nothing for them to do but feel it, and nothing for the rest of us to do but feel it along with them.

Time is both friend and enemy. Enemy, because the funeral isn't until next week. Until then the limbo continues. The viewing and burial will be at least a public version of "closure", although everyone knows there's no such thing. Still, it's a necessary event to "get through" as it looms ahead, welcome and dreaded at the same time. Friend, in that the only thing that will lessen -- not eliminate -- the pain will be time. One day at a time; bad ones with rare good ones interspersed. With grace, eventually that ratio will flip. But it's not yet time to talk about things like that. Not just "one day at a time" but "one minute at a time" is the watchword for now. All I can do is be there. And I will; pain and all.

Saturday, September 01, 2007

Shattered Lives - Part One

Several years ago I went downtown once a week to sing with a University choir. It was musically intense, which was what made it fun. The people, mostly medical, were nice enough and several pre-rehearsal and post-concert parties provided some social interaction.

One young Peds resident was a particularly nice guy. He was married to one of the altos, who was something other than a physician. I chatted with him several times, and was impressed with how enjoyable the interactions were. He had a sweet, gentle way about him that made even passing conversations memorable. He was also funny as hell and had a lovely baritone voice.

About three weeks after the Winter Concert -- where he did a beautiful job with a difficult solo -- I came home to the following message on my machine:
Michael Smith passed away yesterday.
followed by information about the memorial service.

To say I was stunned is to say Antarctica is chilly. What the hell had happened?

It has been referred to as the Black Dog. Some have recently opined that we are overdiagnosing it; medicalizing the normal vicissitudes of life. However you feel about those issues, it cannot be denied that depression can be a fatal disease.

If I had been asked to line up everyone in that choir in order of likelihood that they were depressed, Mike would have been at the very end of the line. I had had no idea. It turned out no one had. Whether or not he was under treatment, he hid his misery masterfully; right up until the end. It was a gun. His wife found him. No further details were forthcoming; none were needed.

The service was on a weekday afternoon in an old stone church in a quiet neighborhood in New Jersey. It took forever to find a place to park. Cars crowded along both sides of the tree-lined street. It was startling to see how many people managed to squeeze into the tiny church. I knew practically no one but it didn't matter.

His wife read this, by W. H. 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 moaning overhead
Scribbling on the sky the message He is Dead.
Put crepe bows round the white necks of the public doves,
Let the traffic policemen wear black cotton gloves.

He was my North, my South, my East and West,
My working week and my Sunday rest,
My noon, my midnight, my talk, my song;
I thought that love would last forever: I was wrong.

The stars are not wanted now; put out every one,
Pack up the moon and dismantle the sun,
Pour away the ocean and sweep up the wood;

For nothing now can ever come to any good.
I was able to hold back my tears, until her voice cracked. Then I lost it, as did many others. People spoke of him; his gentle nature; his humor; his music. The agony was palpable, seeming to congeal into the unspoken word "Why?" asked over and over, because it was unanswerable.

After the service there was a receiving line of sorts, filing through to greet the family. His wife was the only person I knew. The older lady with the parchment skin and vacant eyes was clearly his mother; the sturdy man beside her obviously his father; the girl with red-rimmed eyes so like his had to have been his sister.

What do you say? You murmur, "I'm so sorry" and hope it sounds at least as sincere as the thousand other times they've already heard it. They say, "Thank you for coming," over and over, and eventually you realize they're not really listening. Their bodies are there, overdressed for the time of day though not for the occasion, but their souls are twisted in grief somewhere far away. They aren't crying, but only because it's the first time in days they've been able to stop.

I got pulled over for speeding on the way home. I apologized to the plainclothes cop and told her I was distracted, that I had just come from a funeral. I hadn't intended it as an excuse, though, so I was pleasantly surprised and grateful when she came back with just a warning. I felt like an intruder; an interloper; a fraud. Why did this hit me so hard? I hardly knew the guy. Still, my distress and grief were real.

I lost my mother twenty-one years ago and a dear uncle five years ago. I've lost patients -- including some young and unexpectedly -- though none to suicide. I've been at arm's length to my fair share of life's tragedies and in general I tend to cope well enough. But that one really got to me, and I never did figure out exactly why.

Gradually I was able to stop thinking about Mike every day. The sadness lifted. I can only hope his family has found some measure of peace in the ensuing years, though I really didn't know them, so there was no way to keep in touch. Life has moved on.

But now it's happened again.