Timeline at 10/31/2011
A short post to review (1) current symptoms probably from tumor (2) symptoms of chemotherapy (3) current functions (4) known illness timeline to date
1. Current Symptoms:
Occasional coughing...3 to 10 huh! huh! huh!s. No paroxysms which might include coughing to point of gagging which was present a few weeks ago.
Previous chest pains, front and back, and worse on inspiration have subsided.
2. Symptoms from treatment:
Corticosteroids (dexamethasone, prednisone) have taken my appetite through the roof. I had been losing weight and normal appetite had been depressed, but I've gained 10 lbs in less than 2 weeks and I have had a craving for carbohydrates.
My blood sugar has doubled to over 200. Corticosteroids promote diabetes.
I may have 1 to 2 episodes of skin flushing per day, where I feel very warm for an hour or so.
The onset of side-effects from chemotherapy infusion started at about the 48 hours mark with a feeling of aching and tiredness in both legs, most prominent around my hips and knees. The pains have continued to ache but there are now multiple short, sharp pains, some less than a second, some up to 10 or 15seconds. They are not overwhelming by any means, but they keep me from drifting off to sleep.
3. Current function:
From the 4th until the 11th of October I was miserable. I was told not to take Ibuprofen until after bronchosopy and biopsy in order to reduce my risk of bleeding. During this week, I had incredibly irritable airways--anything could set me off coughing in long paroxysms that would frequently end with gagging. None of this has occurred again since being able to use either Ibuprofen (or other Non-steroidal Anti-inflammatory drugs) or Corticosteroids, like decadron and prednisone.
I'm able to climb one flight of stairs at normal rates without being short of breath. Two flights makes me stop to catch my breath.
I do have times where tiredness grabs me very quickly and I use those opportunities to try to nap and get in an hour or two of sleep.
4. Review of known illness timeline.
Naturally you go back and try to piece together the emerging awareness of the illness. The book "The Doctor, The Patient, and His Illness," was written by Michael Balint in the early 1950's. I have found no better writing about this process (but the book is relatively expensive). He compares the initial awareness of the illness as akin to an artistic process (now you just have to read this book, don't you?). After a struggle with trying to find a meaning or name for what is happening, the patient may share this occurrence with another (which begins the externalization of the process).
Here is my recollection for what it is worth--hard to believe that it comes from the mouth of a non-believing physician.
Smith Island 1987: I am lying in bed and feel and deep, sharp, searing, pain in my left chest which feels like it is going to explode. My teeth and jaw hurts. The pain lasts less than 15 seconds. There are no after effects. On that day and for the next 19 years there is no recurrence or body sensations that call this incident to mind. My internal, mythical representation is? I was hit by a disease lightning bolt that planted a seed, or a diseased cell has reached out to the gods and called in a "smart bomb " that contains a potential illness. I am still smoking cigarettes at the time and still trying to quit as I had been doing for the past 15 years. I stopped completely for 12 times for 1 month or more before successfully stopping cigarettes.
Las Vegas 2004: Loss of daughter and mother. Plunged into work to push away paralysis of grief. Traumas lower immune functioning.
Las Vegas 2006: I begin to experience occasional episodes of pressure in the center of my chest that pushes backward between my shoulder blades. It is a "squeezing" sensation, the pain beginning at a relatively low level of 3-4 / 10 and gradually increasing over a minute or so to a 9/10 where it hangs for a couple of minutes before subsiding. I feel jaw pain when it occurs. Pain described in this manner can be heart-related, esophagus/stomach related, lung related, etc. I have maybe 3 or 4 instances a week for a couple of weeks. The week or two time period, I would characterize as an episode, a grouped set of instances occurring in a definable, relatively short amount of time. These episodes occurred every two or three months or so.
Las Vegas 2006: I have a radiologist friend who offers to let me join a study using x-ray imaging to collect data that must usually be gathered by angiography of the coronary arteries (the feeders to the heart and source of heart attacks...like the Left Anterior Descending Artery..."the widow maker."). The technique is interesting but not important for my story. I didn't find a clear, non-technical description in a brief look at WEB, but here is a link you may find interesting..
http://www.rochestermedicalcenter.com/Cat%20Scan.htm#uses
Las Vegas 2006: I received a gated CT of heart that eliminates coronary artery disease as a likely culprit for back discomfort. A nodule is seen in the Left Upper lobe. I have a history of childhood TB exposure. Total body scanning is negative for any significant activity at chest nodule. It is just sitting there. The Nodule is followed by CT scan and chest x-ray...nothing happens during the next 2 years. Cancers are believed not to just sit around but to grow from the outset.
CA 2007: Have moved and changed jobs after death of father-in-law. Lots of work to end a practice and sell it in Las Vegas, to come to CA to find jobs, housing, etc. Wife and I unable to find work in same institution. She gets a job 12 miles from new home. I have travel to central valley and live there 4 days a week for work.
I develop zoster, an indication of possible reduction in immune competence which is also important in cancer detection and combat within the body. I also suffer a vitreous detachment in left eye at that time.
CA 2010: About to retire from brief 5 year vesting period in State of CA which will give me a little retirement income while I find another type of practice. I am anxious about how I will next employ myself.
MT 2011 Jan : I go to visit former office worker dying of breast cancer with liver and lung metastases. We have a great couple of days. I catch a "flu-like illness" that lasts 3 weeks.
CA 2011 Feb: Have a productive cough. I know that I have chronic bronchitis. I begin a two week course of a tetracycline and it resolves.
CA 2011 Mar: Develop painful swelling in right ankle diagnosed as gout. Use of gout meds causes me belly pain and back pain, some of which appear to mimic the episodes experienced in Las Vegas in 2006.
I am aware that onset of gout can be associated with malignancy but INSTEAD OF FACTORING IN MY CIGARETTE SMOKING HISTORY I go to the GI person and ask for the endoscopy to see if I have a major problem in the upper GI. I also schedule a colonoscopy to search screen for malignancy there.... never get around to it because medical events overtake the indication for the test. My biggest cancer risk was from prior Tobacco smoking. A chest xray in March would have been indicated and may have changed my stage from the currently incurable to one with possibility of cure. The retrospectoscope...I see it all the time in medical practice.
CA 2011 Apr: I use a CPAP machine. I notice a much heavier accumulation of post nasal mucous in AMs but don't think much of it. I'm not coughing.
CA 2011 June: My second episode of gout in same ankle. This time Ice packs are most helpful. I'm also not feeling like myself. I take a part time job in a central valley prison.
CA 2011 July: Another episode of gout, very severe in left great toe. Have made myself go back on Colchicine.
CA 2011 Aug: Onset of cough, minimum sputum.
CA 2011 Sep: I feel like shit. I do have a cough.
Sept 16 I go to my GP and tell him I need a Chest XRay which was done on Friday Sept 16. I see the x-ray and know it is bad. Most likely dx CA. better diagnoses are Community Acquired Pneumonia, TB, and Valley Fever. I give the sputum for TB and Valley Fever. I am scheduled for a three week trip to the East Coast, driving an RV and visiting along the way. I take meds for Community Acquired Pneumonia and head out on the trip but get sicker. I turn around and return home after 5 days.
Sept 30 I get a ct scan that shows CA. I immediately get on a phone to a lung center. I tried UCDavis...get a low level person who tells me a bunch of rules required for admission.
I call Stanford and am immediately switched to nurse coordinator for thoracic cancers. She gets information from me, identifies sources of medical records, schedules me for an appoint on the 2nd business day.
Oct 4 First evaluation at Stanford--review of records, physical examination, plan for staging
Oct 6 Pulmonary Function studies locally
Oct 7 Brain MRI appears clean
Oct 10 CHEST/PET chest.....shows disseminated disease. This changes the nature of my pending bronchoscopy. Not need to stage because already Stage 4 and I'm looking for Herman Cain's doctor!
Oct 11 APPT with Lawyer...medical will, power of attorneys, etc.
Oct 11 APPT with locol oncologist Palchak who makes me more comfortable with steroids.
Oct 12 Bronchoscopy at Stanford
Oct 18 Tumor Board and consult at Stanford was offered Clinical Trial not run by Drug Company
Oct 19 Met with Dr. Palchak who told me I was being offered state of art.
Oct 24 Blood work done prior to chemotherapy
Oct 27 Phone consult with study nurse re: drugs to be started before chemo. Discuss chemo complications.
Oct 27 Obtain meds faxed in orders from Stanford to Local drug store. Take prep meds.
Oct 28 First chemotherapy.
Oct 30 After 48 hours, first significant symptoms from chemo--bony pain in long bones.
TIme from awareness of cancer to treatment about 30 days. Cautious workup saved a much more difficult surgery on Oct 12. They knew it was Stage IV and were able to forego staging biopsies, since these would be irrelevant.
Have taken some tylenol and codeine today. Will look into medical marijuana as a method of control of nausea...the other drugs make me too sleepy. I'll let you know about this process.
Monday, October 31, 2011
Sunday, October 30, 2011
Racism Part I
Racism Part I
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medical *
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Saturday: I was unable to sleep more than about 4 hours. I have a nasal septal deformity and severe nasal allergies. I've been a mouth breather and snorer since teen years and have had sleep apnea since my thirties, a condition that worsened with age and gaining weight. In my forties and early fifties I drank about 20 cups of coffee a day, right up to bedtime without realizing that I was using it to stay awake in the day.
In 1996 and 1997 I started to have REM intrusions during waking hours. I could be writing a progress note in a patient chart and look more carefully and see that I was writing gibberish as I started to dream while working. I got a sleep study and started on a night-time respirator called CPAP (continuous positive airway pressure). With obstructive sleep apnea, the soft tissues of the mouth and throat relax during sleep and cover parts of the airway leading to snoring and eventual occlusion so that air cannot be moved into the lung. As the oxygen concentration in the brain declines, a distress signal is sent to "WAKE UP AND BREATHE." This happened to me tens of times an hour so that I never go to the deeper stages of sleep. The CPAP is adjusted to provide enough pressure to keep the airway open at all time. The pressure varies depending upon the individual's degree of obstruction.
Well, the pressure of my device had to account for my hairfever and swollen nasal tissues. Lately, however, I am taking hefty doses of corticosteroids that work wonders for reducing inflamed tissue. The result is that the quarter inch pipe that directed a stream of hair into my nose has expanded a one inch pipe (using a plumbing analogy)...too much air and now my sinuses are filling and I'm sneezing when sleeping. I haven't figured out how to reprogram this particular machine (manufacturers tend to keep this a secret from users) and so I'm trying to reduce the flow in various mechanical ways without full success.
The steroids also give me a "high" with more energy, less desire to sleep, voracious appetite, etc. My blood sugar has doubled. I must continue these meds for the next few days, then I'll try to do without.
I also feel a warmth in the balls of my feet and toes and wonder if this is a reflection of the peripheral neuropathy which can interfere with treatment, sometimes described as a severe burning. In my case, it just feels like my normally cold feet are covered with magic slippers.
I was warned that the medication that I am taking to avoid nausea was constipating. I may have overdone it with a laxative last night. Three times and counting.
In discussing nausea, a hospice physician told me that marijuana is frequently useful for nausea and loss of appetite. The oncology fellow confirmed that pot was often effective and that they would provide me with documentation if I desired, but he said that he didn't think I would have a problem at any dispensary. I'll keep you posted about this.
Sunday: It is 36 hours since I finished my first round of chemotherapy. I can't say that I'm aware of any major side-effects up until this point. I remain on a very large dose of dexamethasone and I have not needed any pain medication in more than 24 hours. There are a few minutes of pain that are a 6/10 or 7/10 but they subside quickly. I imagine the pains to be my medications stabbing away at tumor. Since dexamethasone, a corticosteroid, is strongly anti-inflammatory, I'm thinking that most of my pain has been my body's inflammatory response to the growth of tumor pushing around on other structures in my chest.
Corticosteroids (like prednisone and dexamethasone) and Non-steroidal Anti-inflammatory drugs (like Ibuprofen) are ulcerogenic. I'm already taking omeprazole to decrease acid production. Trying to reduce my Ibuprofen is an attempt to spare my stomach to the greatest extent possible under the circumstances. I can put up with a certain amount of pain to reduce my risk of developing a peptic ulcer.
It is a clear morning in Morro Bay at 4:30 A.M. I can see the milky way despite a bright street lamp less than 100 feet away. My zenith is between Castor-Pollux and Orion. The Big Dipper is very bright to the East. Looks like it will be a beautiful day. They all feel beautiful to me.
Racism: Dedicated to Steve Groark
This is a complicated subject for me to approach--so complicated that I doubt that I have enough time left in my life to organize my thinking in the most effective manner. That leaves me with another option, and that is to just free associate to some extent and hope to make some sense of it. So here goes.
Recently I had a conversation with a friend who was talking about the low crime rate in Toronto when compared to Jersey City. Immediately out of my mouth, unobstructed by any attempt at censorship by my frontal lobes, came "I'll bet there is a much lower black population in Toronto." I didn't have any evidence at hand to prove the truth of this statement. It reflected a deeply held belief on my part that cities, at least in the U.S. with large black populations are likely to have high crime rates. AND THIS IS THE ME OF AGE 67 AT THE TIME. I didn't like looking at this. How big a racist does this make me? It made me think more about my view of race during the next few months that followed this conversation.
My Upbringing:
I grew up in White Washington, D.C. My mother's family had been in Maryland and then D.C. for many generations. My father's family was from New York and included a Jew and a Native American. It was more diverse culturally and New York City was more culturally diverse as well. The word "nigger" would have been as common a description for a black person in our household as the word "colored," especially from my mother. She told the story of being about 6 years old and "this colored boy came up to me and grabbed me between the legs." I ran home and mother told me not to play with "coloreds." She viewed "colored" as having loose sexual morals and probably attributed that to race rather than economic situation.
As a child, I remember seeing black children chased from Turkey Thicket playground and my mother explained that only white children could play there, no niggers.
Nigger was a common word for blacks in most of my mother's family. Recently, I was listening to a tape of my aunts and uncles made in about 1980. My godmother, Kay, was describing an event from 1932 when she and her husband were looking "for corn liquor that the niggers always made in the woods back there."
My father was more urbane--Negro more often than Nigger when he was younger, but he became more upset when attempts to address racial imbalance were imposed by law. When drunk, my dad also had bad things to say about blacks who had been in combat in his areas during the war. A tank unit that was manned by blacks had opened fire on his unit and several of his buddies had been killed in a friendly fire tragedy. He claimed also to have seen incidents of terrible judgment--driving tanks and trucks into streams at non-fording positions and creating problems with extracting the armor from the water.
My father was capable of taking his impulses to immediate extremes. I remember being driven to school one day when he was cut off by another car. He whipped that Dodge into second gear and caught up to the black man driving the offending vehicle. Dad rolled down the window at a light and yelled, "Look! A chimpanzee that can drive!" My ears were red and I was humiliated to be in the same car.
Later in life, during the Nixon years, he gravitated to groups that opposed school busing when my brother was in a school to be affected. Dad was also critical of the work habits of minority summer students hired under government mandates at his office. He said that they were a joyful group to be around, tried very hard to please, but had minimal clerical skills, didn't know the alphabet for filing, had a terrible command of both spoken and written English, etc.
In our grade school yard, Nigger and Kyke would have been commonly used words for African-Americans and Jews. When my 7th grade nun tore all of the books and papers out of my desk because it was such a mess, she told the class "It looks like a nigger shanty." There was an occasional black student in our suburban Catholic school, but never in my class and I had no chance to interact on a person to person basis at regular intervals until high school.
This attitude clearly flew in the face of the religious doctrine that we were being taught in school. All were equal in the eyes of God. Why make the distinction on earth?
But the old order was creaking and coming down oh so slowly. In the book "Mississippi Mud" which describes the flood of 1927, it looked just like slavery--the imprisonment of black men by shotgun toting whites to work on the levees as the water rose. This was more than 60 years after emancipation.
Integration was forced upon the armed services in the 40's over the objection of much of the brass. Hubert Humphrey's 1948 Democratic convention speech laid down a gauntlet and the Southern Democrats rebelled and remained a block that could defeat attempts at Equality Legislation right up through 1965. The Civil Rights activities of the 50's and 60's focused the attention of the white majority and the rest of the world on the plight of black America and things began to stir. The assassinations of blacks in the 1960s and finally Martin Luther King in 1968 brought the rage to the surface and it spilled over in generalized rioting in large cities.
On November 5, 1952 I began delivering newspapers for the Washington Times Herald which was soon absorbed by the Washington Post. For the next 8 years, I read most of the news during brief work breaks from carrying and tossing the papers. I could follow what was happening in the racial pushing and shoving that was occurring politically. Communism and Race were the big issues. The Post was a liberal paper and stopped identifying the ethnicity of crime perpetrators. In Northern cities, there was a white flight to the suburbs after the great migration of blacks from the south during and after World War II in their search for better economic opportunities. Conservatives and the FBI often managed to view the search for equality as part of a communist plot.
Whites were realistically concerned about loss of property values in neighborhoods where a black family moved in. Whites believed that there was a conspiracy afoot, something called "blockbusting," where an outside group overpays for the first house in an all white neighborhood with the result that remaining house values are reduced and the "ice" has been broken so to speak. Real estate agents routinely denied rental and sale opportunities to blacks. Laws and mores were changing but not very fast. It looked fast if you were white. It was snail's pace if you were black.
The most shameful racially significant event in my early life occurred when I was 12 at a boy scout camp on the Chesapeake Bay. Our troop was all white. Our neighboring troop all black. We did activities together, warily at first, but more enthusiastically as the week went on. At a campfire event, I was sitting next to a black camper, a kid that I had interacted with canoeing. In the course of talking about someone outside of the immediate group, I said; "Oh, he's just a nigger." Immediately I felt a sickening feeling in the pit of my stomach--that old familiar feeling from the chaos in my own family at age 6--and the attempt to apologize to my neighbor froze in my throat. I couldn't look him. I swallowed and pretended that I hadn't said anything, but I didn't look his way for the rest of the function and it felt like my ears were burning. I avoided any eye contact with him for the rest of the week. I realized that I been incredibly hurtful and I was ashamed...and it still feels shameful when writing about it now. I didn't have enough strength to even apologize to him.
In our household, my father became interested in the activities of Martin Luther King, Jr. and bought a book or two in the mid-fifties. My father was also upset at the foot-dragging that occurred after the Brown vs Board decision in 1954. He believed that integration had to be encouraged and that the races had to be able to "fit together" in some way. He had the usual bias against interracial marriage using the same general types of arguments that the fundamentalist religions use against "mixed marriages."
He said that the smoothest solution to Brown vs. Board would have been the immediate integration of a grade a year. It probably would have satisfied the court as deliberate speed so that by 1966 all secondary schools in the U.S. would be integrated. Instead, states fought implementation for years and one of our nearby Virginia counties closed its school system in 1957 rather than admit blacks.
Reading the Post everyday kept me informed about the struggle, but it was intellectual and didn't touch the heart. My high school was integrated, but there were few blacks. Nate Adams was our reigning Greek scholar in high school. I met him in 9th grade. He had an excellent mind and terrific work ethic. It made an impression on me with respect to the inherent mental potential of blacks.
However, in 9th grade I had a very colorful history teacher, Father Burke. We all loved him. I think he was probably the early political mentor of Patrick Buchanan and William Bennett. The following vignette is my first memory of Father Burke.
Father Burke, I still love him
It is my first history class in high school. History is my favorite subject. When it was introduced into the curriculum in 4th grade, I had read my entire year's worth of material by the third day of school. Who would my teacher be?
About 5 minutes late, an elderly, paunchy, white-haired man in a rumpled cassock entered the room. Instead of going to the front of the class, he went to the back and opened up an enormous window. He took the stub of a cigarette out of some inside pocket and lit it up and puffed away. He had not said a word. All of the students were craning their heads to see what was happening. Finally he spoke. "What's the matter? Haven't you ever seen a white man smoke?"
He was a stimulating teacher. The class was ancient history. Out of five days of class, ancient history would have been mentioned twice--very briefly on Friday when he handed out a list of 10 questions that covered a section of our textbook. We were expected to be able to write a sensible essay on any of those questions by Monday. This required about 15 minutes of class time on Friday. On Monday, the session was devoted to writing two or three ten-minute essays. This required about 30 minutes.
All of the rest of class time was devoted to either a discussion of current events, or Father Burke's view of modern American history and political thought. I first heard the ditty about Franklin and Eleanor from Father Burke: "You kiss the niggers and I'll kiss the Jews. We'll stay in the White House as long as we choose." Likewise, a joke about the three most recent U.S. presidents as of 1957. "Roosevelt proved that you could be president as long as you wanted. Truman proved that ANYONE could be a president. Eisenhower has proved that we don't really need a president."
Father Burke believed that the U.S. had pursued an Anglophile foreign policy under Roosevelt, that the most serious threat to the U.S. was communism and that Lend Lease to the Russians had prevented the Germans from grinding the Soviet Union to a pulp. He viewed this as a terrible mistake. I don't recall him talking much about the holocaust. He believed that our policy toward the Japanese was a deliberate provocation and thought that Pearl Harbor was a cover up--that Roosevelt knew that an attack was imminent and failed to fully buttress American exposure there.
I had heard all of these arguments in discussions with my father since an early age. I wasn't particularly moved by them. However, I loved the give and take of Father Burke's class. No matter your position, you were always treated with respect. We loved his vulnerability, the fact that he was willing to say "bullshit" to the expected manner of teaching his class and going his own way.
Now the Jesuits monitored their schools in a very systematic fashion. Auditors would sit in on classes, generally without notice, and observe teaching methods. One day Father Burke came in early to class. He was cleaned up nicely. No growth of beard, hair trimmed, fresh Cassock. He sat down and made a little speech.
"Boys I'm too old now to be sent back to the Phillipines. You need to help me. A little bird has told me that someone will come in during this class and observe what we do. Today we will be doing history. Please open your books to page 137. Now, I will begin to read from the chapter. From time to time, I will look up and ask a question about the material. You can participate whether you know the answer or not. If you don't know the answer, raise your left hand. If you are sure you know the answer, raise your right hand. I will call on one of you. If you are wrong, don't worry about it." We were happy to participate in the ruse.
By the first year of high school I had read about the intellectual giant, Frederick Douglass, and his relationship with Lincoln and had read biographies of most well-known American black scientists and educators, such as George Washington Carver, Booker T Washington and Charles Drew. My reading didn't extend to the Abolitionist literature or materials about the Underground Railway, although I lived in the State in which Harriet Tubman was born. Another student in our high school was Darryl Hill, a track and football athlete who went to the Naval Academy, but transferred to the University of Maryland as a sophomore and integrated the Atlantic Coast Conference in 1963. http://en.wikipedia.org/wiki/Darryl_Hill_(American_football)
However, the N word was in common use in our high school. One of my friends had a policeman for a father. I stayed over at his house one night. In the morning as we made ourselves breakfast, I noted his father's clothes and holstered side-arm hanging on the chair. I asked my friend if his father had ever shot anyone. The answer was yes. He had "shot and killed some nigger" in a gunfight.
In my childhood what boy could not see the power of Jim Brown, the beauty of Willie Mays, the basketball revolution brought by Bill Russell and Wilt Chamberlain. Despite all of the evidence from these experiences, the following vignette illustrates the continued naivete of my thinking after two years of exposure to a marginally integrated educational system:
Herman's Market
In 1957 I started high school in a black neighborhood in Washington, D.C. There were no white neighbors. As 9th and 10th graders we were not permitted to smoke cigarettes within a block of the school. This left us with two choices. We could walk a couple of blocks south on North Capitol Street to the People's drug store and have coffee or a coke and smoke at the lunch counter. Or we could walk 1 block west to Herman's Delicatessen at 1st and Eye Northwest. Herman's it was most of the time.
Herman's was also a common destination for many of the black children on their way to school. Herman sold large 1-cent oatmeal cookies. A few cookies and a pepsi were the usual breakfast for many of these little children. So there were generally 6 to 10 white high schoolers dressed in coats and ties smoking their cigarettes while a stream of little children did the Herman Fast Food morning run. Herman stood there with his cigar talking up a storm mostly about his son who was studying podiatry. He told us of a junior student who had been expelled for farting at an assembly at Gonzaga a few years before. He had all the gossip accumulated over the previous few years.
I recall standing at Herman's after the death of a well-known Negro preacher (wealthy one at that). Were there any that were not wealthy that were reported in white newspapers? I was asking the older black children at Herman's if they intended to go to the viewing of Daddy Grace, the dead preacher? As if all blacks would have been members of his congregation. Talk about hasty generalization. But it reflects the extent of my ignorance at the time.
http://www.blackpast.org/?q=aah/grace-charles-manuel-sweet-daddy-1881-1960
I guess the point that I am trying to make is that I came by my racism honestly. It was inherited from my childhood culture. Just like the brainwashing of religion, that early influence was hard to shake and parts remain active today.
Like many of my generation, my first sexual experience was with a black prostitute.
The Lady of Sty
I had my first sexual experience in the company of George, the son of a D.C. policeman, in the Spring of 1962 during my Freshman year of college. He was home for the weekend and I was driving a our family 2nd car, a Hillman Husky. We headed to D.C. where we could drink beer at a hangout near Catholic University. After a couple of beers he said, "Let's go, I want to show you something. "
He directed me to the area around 14th St. It was about 11 PM and there was a lot of activity on the street with cars at slowed paces and men running up to the cars for conversations. There were garishly dressed women on the street as well. George rolled down his window and began talking to one of the black men dressed in a tank-top shirt. George turned to me and said, "Pull over and park. I did." I now realized that George was looking for a prostitute. I was a virgin and totally out of my element. I was scared but I had some additional courage from the few beers. I didn't even think to tell him that I was angry that I had not been included in this decision making.
The pimp introduced us to two black women, one more attractive than the other. I intrinsically knew that I would be with the chubby one with the large sty on her right eye. The pimp led us into a row house. In the front room several black men were playing cards. They were friendly and asked us if we wanted drinks. I told them that I wanted a condom. My friend gave me a negative head shake but I insisted. I had done enough reading and heard enough stories from friends in the military to know enough to keep myself as safe as possible. It would cost me a dollar and I had to wait several minutes while one of the men left the house to go find one. George went upstairs with his "date." My date was very friendly and I followed her up to the 3rd floor to a bedroom at the front of the house. The room was relatively bare. There was a brass bed against one wall and a short dresser against the wall next to the door.
She told me to put $5.00 on the dresser. I told her that I was a few cents short of that. "That's okay then, but we're supposed to get $5.00." There was a sheet on the bed. The pillows were uncovered and showed raw ticking. I took off all of my clothes. She didn't get fully undressed, just hiked up her skirt around her waist and pulled off her panties. Despite my anxiety, that was more than enough for an erection. She knew a lot about condoms and I let her put it on.
I had no idea of what I was doing, but she got me started. "Don't touch my hair." Probably the condom was cheap and thick, but I was coming nowhere close to a climax and I was 19 years old, very horny, very sweaty, and still going strong after what must have been more than 10 minutes.
Finally she said, "Just give me a minute, honey, I have to use the bathroom." She got up and left. I got out of bed and stood there at the head. There was minimal illumination in the room from the outside street lights. I waited and I waited for her to return. Then the door opened and a light went on.
There was a naked bulb hanging in the middle of the room. There were no curtains in the room. I was naked, with an erection, wearing a condom in full view of anyone walking down the street. I was looking into the kind face of an elderly, black man. He looked at me quizzically as if to ask "What are you doing here?"
I backed a little away from the window and said, "I'm waiting for her. She said she'd be right back"
"Oh, no, son. She right down there on the street right now. She's not coming back."
I turned off the light, got dressed and went down to the car. George was already there. He told me what a "great fuck" that was. I didn't say anything. I was still in shock from my very recent nude public exposure, the white guy wearing the even whiter condom.
That was my first sexual experience and my last session with an acknowledged prostitute. My revenge on George was hearing of his treatment for Gonorrhea shortly thereafter.
Since high school I have read a great deal of U.S. history and have seen models of the slave ships, seen hundreds of hours of film, come to agree with Ken Burns that Lincoln may have viewed the awful carnage of the Civil War as the necessary blood sacrifice (blood atonement) for the national sin of Slavery. I can see that the early destruction of the black family and the legal proscription of education for males had a crushing influence on the ability to regroup as a culture, particularly when a minority culture within a country that failed to grant them citizenship for more than 100 years after emancipation. It appears that something is terribly wrong when modern day Africans can come to the U.S. and assimilate more easily than Americans of African descent.
Steve Groark
Steve was a classmate at Gonzaga. He was tall, thin of of face and body, with long, spindly fingers that I always noticed when he held his long Pall Mall cigarettes. He had a very fine hand tremor. He was originally a friend of my chum, Johnny Robson. Both of them had parents that were a little less controlling than my own, so they had spent some time running around D.C. to various drinking spots. Steve was verbally teased by our classmates who would often pronounce his last name GROARK very quickly in a low pitched voice that placed the accent on the last syllable so the it sounded like a frog croak. He never seemed to complain, and often pretended that he didn't notice.
Although Steve's parents were quite conservative, the neighborhood of Greenbelt, Maryland was not. Several liberal arts teachers from the University of Maryland lived around him and Steve gravitated to their children. He was very much into jazz and other elements of black culture. He frequently went to the Howard theater to see performers and was often one of the few whites there.
He introduced us to a coffee house/beer joint called "The Cave" at 14th and U NW. It was a popular hangout for Howard University students. There was a regular jazz group of students from Howard, the JFK Quintet, who played on weekends. There was a powerful folk singer, Valentine Pringle. The beer was expensive at $.75 a bottle (minimum wage was less than a dollar an hour) but it had a great atmosphere, wonderful entertainment--just a great date when you could scrape up the 10 bucks that it was likely to run.
Steve collected records and had eclectic tastes, mostly jazz and blues. I accumulated some black gospel music and Porgy and Bess which I enjoyed trying to sing when off by myself walking down an empty road or out in the woods. My father's cousin Olive had a large collection of 78 RPM records including early Nat Cole and the Wilbur Sweatman Jazz band among many others.. During the freedom rides of the 1960s I wondered what would have happened if Nat Cole and Lena Horne had gone to a white's only restaurant to eat. Would celebrity have mattered?
I was curious about the history of blacks who refused to return to the U.S. after World War II because of the live and let live attitude toward race that was easier to find in Europe. I was ambivalent about the case of Paul Robeson, all American Football player, actor, opera singer. It seemed to me he viewed Russian communism favorably based upon his experiences with "equality"--a single issue in view of the belief in justifications for killing in the name of a materialistic religious belief about the nature of man and the endpoint of history. Ambivalent or not, how can you not love this?
http://www.youtube.com/watch?v=5jrPhY1GHNQ
Steve was the first white person I knew to be a serious student and fan of African-American culture and to be totally comfortable in the presence of blacks. He and I got closer as the result of an adventure in our senior year of high school. A requirement for graduation was the completion of a retreat at a Jesuit facility. It was done in lieu of three days of school and, judging from the reports of my classmates, may have been a last big push to gather more priests for the flock. There was a lot of big talk among us of sneaking off during some night and finding the local action, but believe me, this place was so isolated that the only action would have been farm animals.
We were supposed to be observing the rule of silence but there were some breaks allowed. Steve and I went outside the first night to smoke a cigarette and he began a conversation. He was very upset. His family was in turmoil. His brother, who was in the Navy, was engaged (or had married...I can't recall) a girl from Bermuda who was black. Steve's parents were pushing to destroy the relationship and it looked like his brother was about to accede to their wishes.
After we finished talking, we tried to re-enter the house and were met by the retreat-master. We apologized for missing the bell. He said he would talk to us in the morning. However, at breakfast he made the general announcement to the entire assembly that two people were being booted.
The retreat master had said he would discuss this with us in the morning. He never did. We were told to pack up and we were driven to the end of the estate driveway that abutted US Route 301. We hitch hiked back to D.C. and reported to the headmaster. He listened to the story and said that we would have to show up at school and do class work for the next two days in lieu of time at the retreat. He told us that the retreat was a requirement for graduation and we would have to go with another group. He then dismissed us.
Three months after he called us back into his office. He told us the retreat master insisted on an apology before readmitting us for a retreat. Our headmaster, Father McHale, surprised us when he said that he didn't think we owed an apology. He dismissed the requirement for completion of the retreat.
This experience was my eternal bond with Steve Groark, but I don't think that I ever really knew him. There was a quiet suffering there and an awkward desire to fit in but an inability to make more than feeble overtures. I visited him a few times during my last year of high school and met his friends whose bohemian values and behaviors made me very nervous. Even with his group of friends, Steve very much stayed on the periphery, more an observer and often clumsy when trying to participate. I think this is the way he was in high school as well.
I next ran into him at the University of Maryland in 1963. He had originally started school in Iowa in Mathematics but transferred back to the state school to study literature. He had managed to rejoin his group of friends who had become involved in attempts to integrate eating places in nearby Laurel, Maryland. Even though I now had a friend involved in the Civil Rights Movement, I wasn't able to see it as my business or my moral obligation. The thought of confrontation with the red neck toughs of my race frightened me. I'd been scared of these people since escaping from the Smiths down the street at age 8. I wanted no part of the violence. I thought that things were moving in the right direction with or without me.
Although the King Rally in 1963 occurred within 10 miles of my house, I decided to watch it on television and was surprised to see some of my white friends from Catholic University out in force. I had no strong political convictions at the time. By the time I started medical school in 1965, the rhetoric of the Nation of Islam seemed foolish and the increasing stridor of the more radical elements of the movement scared the hell out of me.
I had started high school located in one of the tough black ghettos of Washington, D.C. but there did not appear to be great animosity between the races in 1957. At age 14 or 15 we could walk a few blocks from school to Ollie's bar, a black establishment and buy beer, or go to Buster's Hamburger Shop and chow down for a dime a burger. Steve Groark routinely went to the Howard Theater and many of us went to mixed restaurants and bars such as "The Cave." I felt safe walking all around Washington, D.C. until graduation from high school in 1961.
But things were changing. How could African-Americans not be upset about their treatment by the white government? Waves of immigrants had arrived in America and had managed to filter up into the middle class. Why hadn't blacks managed to do the same? Clearly they had been treated as less "American" than immigrants who passed easily into the military services.
I was a white male who had been the beneficiary of a system stacked in my favor. I was also capable of enough empathy to realize how angry I might be to have been born black into such a system. Given such anger, where would I likely direct it if I could? After seeing a race riot with black on white violence in the fall of 1962 and after my brother was beaten by a group of black teenagers because of the school jacket he was wearing, I believed that I was seeing physical evidence of that anger.
As the political turmoil increased, I was having my own set of struggles with medical school, the need to make money, a new family, turbulence in my marriage, etc.
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this is a long post which I'll break here... around this general thought...
One of the benefits of death to our society is the wiping away of misinformation. I believe that my attitudes toward race are, to some extent indelible and primal with attitudes laid down at such an early age, that they are not removable. I think these indelible and primal "filters" for reality, can immediately come to the surface when I am in a strange situation. Now, I've learned generally to compensate for these racist, stereotypical biases, but the fact that they exist in the first place will have some effect on the outcome of an encounter.
I have talked about race. But I know that I have a bucket list of false beliefs running around in my brain. Death removes those kinds of opinions and belief from the world and is a major change agent. Change is necessary in order to work toward a better world.
My daughter's world in terms of racial stereotyping was much different than mine.
Kristin Sohr and Bobby Waxman in 1973 or 1974.
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medical *
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Saturday: I was unable to sleep more than about 4 hours. I have a nasal septal deformity and severe nasal allergies. I've been a mouth breather and snorer since teen years and have had sleep apnea since my thirties, a condition that worsened with age and gaining weight. In my forties and early fifties I drank about 20 cups of coffee a day, right up to bedtime without realizing that I was using it to stay awake in the day.
In 1996 and 1997 I started to have REM intrusions during waking hours. I could be writing a progress note in a patient chart and look more carefully and see that I was writing gibberish as I started to dream while working. I got a sleep study and started on a night-time respirator called CPAP (continuous positive airway pressure). With obstructive sleep apnea, the soft tissues of the mouth and throat relax during sleep and cover parts of the airway leading to snoring and eventual occlusion so that air cannot be moved into the lung. As the oxygen concentration in the brain declines, a distress signal is sent to "WAKE UP AND BREATHE." This happened to me tens of times an hour so that I never go to the deeper stages of sleep. The CPAP is adjusted to provide enough pressure to keep the airway open at all time. The pressure varies depending upon the individual's degree of obstruction.
Well, the pressure of my device had to account for my hairfever and swollen nasal tissues. Lately, however, I am taking hefty doses of corticosteroids that work wonders for reducing inflamed tissue. The result is that the quarter inch pipe that directed a stream of hair into my nose has expanded a one inch pipe (using a plumbing analogy)...too much air and now my sinuses are filling and I'm sneezing when sleeping. I haven't figured out how to reprogram this particular machine (manufacturers tend to keep this a secret from users) and so I'm trying to reduce the flow in various mechanical ways without full success.
The steroids also give me a "high" with more energy, less desire to sleep, voracious appetite, etc. My blood sugar has doubled. I must continue these meds for the next few days, then I'll try to do without.
I also feel a warmth in the balls of my feet and toes and wonder if this is a reflection of the peripheral neuropathy which can interfere with treatment, sometimes described as a severe burning. In my case, it just feels like my normally cold feet are covered with magic slippers.
I was warned that the medication that I am taking to avoid nausea was constipating. I may have overdone it with a laxative last night. Three times and counting.
In discussing nausea, a hospice physician told me that marijuana is frequently useful for nausea and loss of appetite. The oncology fellow confirmed that pot was often effective and that they would provide me with documentation if I desired, but he said that he didn't think I would have a problem at any dispensary. I'll keep you posted about this.
Sunday: It is 36 hours since I finished my first round of chemotherapy. I can't say that I'm aware of any major side-effects up until this point. I remain on a very large dose of dexamethasone and I have not needed any pain medication in more than 24 hours. There are a few minutes of pain that are a 6/10 or 7/10 but they subside quickly. I imagine the pains to be my medications stabbing away at tumor. Since dexamethasone, a corticosteroid, is strongly anti-inflammatory, I'm thinking that most of my pain has been my body's inflammatory response to the growth of tumor pushing around on other structures in my chest.
Corticosteroids (like prednisone and dexamethasone) and Non-steroidal Anti-inflammatory drugs (like Ibuprofen) are ulcerogenic. I'm already taking omeprazole to decrease acid production. Trying to reduce my Ibuprofen is an attempt to spare my stomach to the greatest extent possible under the circumstances. I can put up with a certain amount of pain to reduce my risk of developing a peptic ulcer.
It is a clear morning in Morro Bay at 4:30 A.M. I can see the milky way despite a bright street lamp less than 100 feet away. My zenith is between Castor-Pollux and Orion. The Big Dipper is very bright to the East. Looks like it will be a beautiful day. They all feel beautiful to me.
Racism: Dedicated to Steve Groark
This is a complicated subject for me to approach--so complicated that I doubt that I have enough time left in my life to organize my thinking in the most effective manner. That leaves me with another option, and that is to just free associate to some extent and hope to make some sense of it. So here goes.
Recently I had a conversation with a friend who was talking about the low crime rate in Toronto when compared to Jersey City. Immediately out of my mouth, unobstructed by any attempt at censorship by my frontal lobes, came "I'll bet there is a much lower black population in Toronto." I didn't have any evidence at hand to prove the truth of this statement. It reflected a deeply held belief on my part that cities, at least in the U.S. with large black populations are likely to have high crime rates. AND THIS IS THE ME OF AGE 67 AT THE TIME. I didn't like looking at this. How big a racist does this make me? It made me think more about my view of race during the next few months that followed this conversation.
My Upbringing:
I grew up in White Washington, D.C. My mother's family had been in Maryland and then D.C. for many generations. My father's family was from New York and included a Jew and a Native American. It was more diverse culturally and New York City was more culturally diverse as well. The word "nigger" would have been as common a description for a black person in our household as the word "colored," especially from my mother. She told the story of being about 6 years old and "this colored boy came up to me and grabbed me between the legs." I ran home and mother told me not to play with "coloreds." She viewed "colored" as having loose sexual morals and probably attributed that to race rather than economic situation.
As a child, I remember seeing black children chased from Turkey Thicket playground and my mother explained that only white children could play there, no niggers.
Nigger was a common word for blacks in most of my mother's family. Recently, I was listening to a tape of my aunts and uncles made in about 1980. My godmother, Kay, was describing an event from 1932 when she and her husband were looking "for corn liquor that the niggers always made in the woods back there."
My father was more urbane--Negro more often than Nigger when he was younger, but he became more upset when attempts to address racial imbalance were imposed by law. When drunk, my dad also had bad things to say about blacks who had been in combat in his areas during the war. A tank unit that was manned by blacks had opened fire on his unit and several of his buddies had been killed in a friendly fire tragedy. He claimed also to have seen incidents of terrible judgment--driving tanks and trucks into streams at non-fording positions and creating problems with extracting the armor from the water.
My father was capable of taking his impulses to immediate extremes. I remember being driven to school one day when he was cut off by another car. He whipped that Dodge into second gear and caught up to the black man driving the offending vehicle. Dad rolled down the window at a light and yelled, "Look! A chimpanzee that can drive!" My ears were red and I was humiliated to be in the same car.
Later in life, during the Nixon years, he gravitated to groups that opposed school busing when my brother was in a school to be affected. Dad was also critical of the work habits of minority summer students hired under government mandates at his office. He said that they were a joyful group to be around, tried very hard to please, but had minimal clerical skills, didn't know the alphabet for filing, had a terrible command of both spoken and written English, etc.
In our grade school yard, Nigger and Kyke would have been commonly used words for African-Americans and Jews. When my 7th grade nun tore all of the books and papers out of my desk because it was such a mess, she told the class "It looks like a nigger shanty." There was an occasional black student in our suburban Catholic school, but never in my class and I had no chance to interact on a person to person basis at regular intervals until high school.
This attitude clearly flew in the face of the religious doctrine that we were being taught in school. All were equal in the eyes of God. Why make the distinction on earth?
But the old order was creaking and coming down oh so slowly. In the book "Mississippi Mud" which describes the flood of 1927, it looked just like slavery--the imprisonment of black men by shotgun toting whites to work on the levees as the water rose. This was more than 60 years after emancipation.
Integration was forced upon the armed services in the 40's over the objection of much of the brass. Hubert Humphrey's 1948 Democratic convention speech laid down a gauntlet and the Southern Democrats rebelled and remained a block that could defeat attempts at Equality Legislation right up through 1965. The Civil Rights activities of the 50's and 60's focused the attention of the white majority and the rest of the world on the plight of black America and things began to stir. The assassinations of blacks in the 1960s and finally Martin Luther King in 1968 brought the rage to the surface and it spilled over in generalized rioting in large cities.
On November 5, 1952 I began delivering newspapers for the Washington Times Herald which was soon absorbed by the Washington Post. For the next 8 years, I read most of the news during brief work breaks from carrying and tossing the papers. I could follow what was happening in the racial pushing and shoving that was occurring politically. Communism and Race were the big issues. The Post was a liberal paper and stopped identifying the ethnicity of crime perpetrators. In Northern cities, there was a white flight to the suburbs after the great migration of blacks from the south during and after World War II in their search for better economic opportunities. Conservatives and the FBI often managed to view the search for equality as part of a communist plot.
Whites were realistically concerned about loss of property values in neighborhoods where a black family moved in. Whites believed that there was a conspiracy afoot, something called "blockbusting," where an outside group overpays for the first house in an all white neighborhood with the result that remaining house values are reduced and the "ice" has been broken so to speak. Real estate agents routinely denied rental and sale opportunities to blacks. Laws and mores were changing but not very fast. It looked fast if you were white. It was snail's pace if you were black.
The most shameful racially significant event in my early life occurred when I was 12 at a boy scout camp on the Chesapeake Bay. Our troop was all white. Our neighboring troop all black. We did activities together, warily at first, but more enthusiastically as the week went on. At a campfire event, I was sitting next to a black camper, a kid that I had interacted with canoeing. In the course of talking about someone outside of the immediate group, I said; "Oh, he's just a nigger." Immediately I felt a sickening feeling in the pit of my stomach--that old familiar feeling from the chaos in my own family at age 6--and the attempt to apologize to my neighbor froze in my throat. I couldn't look him. I swallowed and pretended that I hadn't said anything, but I didn't look his way for the rest of the function and it felt like my ears were burning. I avoided any eye contact with him for the rest of the week. I realized that I been incredibly hurtful and I was ashamed...and it still feels shameful when writing about it now. I didn't have enough strength to even apologize to him.
In our household, my father became interested in the activities of Martin Luther King, Jr. and bought a book or two in the mid-fifties. My father was also upset at the foot-dragging that occurred after the Brown vs Board decision in 1954. He believed that integration had to be encouraged and that the races had to be able to "fit together" in some way. He had the usual bias against interracial marriage using the same general types of arguments that the fundamentalist religions use against "mixed marriages."
He said that the smoothest solution to Brown vs. Board would have been the immediate integration of a grade a year. It probably would have satisfied the court as deliberate speed so that by 1966 all secondary schools in the U.S. would be integrated. Instead, states fought implementation for years and one of our nearby Virginia counties closed its school system in 1957 rather than admit blacks.
Reading the Post everyday kept me informed about the struggle, but it was intellectual and didn't touch the heart. My high school was integrated, but there were few blacks. Nate Adams was our reigning Greek scholar in high school. I met him in 9th grade. He had an excellent mind and terrific work ethic. It made an impression on me with respect to the inherent mental potential of blacks.
However, in 9th grade I had a very colorful history teacher, Father Burke. We all loved him. I think he was probably the early political mentor of Patrick Buchanan and William Bennett. The following vignette is my first memory of Father Burke.
Father Burke, I still love him
It is my first history class in high school. History is my favorite subject. When it was introduced into the curriculum in 4th grade, I had read my entire year's worth of material by the third day of school. Who would my teacher be?
About 5 minutes late, an elderly, paunchy, white-haired man in a rumpled cassock entered the room. Instead of going to the front of the class, he went to the back and opened up an enormous window. He took the stub of a cigarette out of some inside pocket and lit it up and puffed away. He had not said a word. All of the students were craning their heads to see what was happening. Finally he spoke. "What's the matter? Haven't you ever seen a white man smoke?"
He was a stimulating teacher. The class was ancient history. Out of five days of class, ancient history would have been mentioned twice--very briefly on Friday when he handed out a list of 10 questions that covered a section of our textbook. We were expected to be able to write a sensible essay on any of those questions by Monday. This required about 15 minutes of class time on Friday. On Monday, the session was devoted to writing two or three ten-minute essays. This required about 30 minutes.
All of the rest of class time was devoted to either a discussion of current events, or Father Burke's view of modern American history and political thought. I first heard the ditty about Franklin and Eleanor from Father Burke: "You kiss the niggers and I'll kiss the Jews. We'll stay in the White House as long as we choose." Likewise, a joke about the three most recent U.S. presidents as of 1957. "Roosevelt proved that you could be president as long as you wanted. Truman proved that ANYONE could be a president. Eisenhower has proved that we don't really need a president."
Father Burke believed that the U.S. had pursued an Anglophile foreign policy under Roosevelt, that the most serious threat to the U.S. was communism and that Lend Lease to the Russians had prevented the Germans from grinding the Soviet Union to a pulp. He viewed this as a terrible mistake. I don't recall him talking much about the holocaust. He believed that our policy toward the Japanese was a deliberate provocation and thought that Pearl Harbor was a cover up--that Roosevelt knew that an attack was imminent and failed to fully buttress American exposure there.
I had heard all of these arguments in discussions with my father since an early age. I wasn't particularly moved by them. However, I loved the give and take of Father Burke's class. No matter your position, you were always treated with respect. We loved his vulnerability, the fact that he was willing to say "bullshit" to the expected manner of teaching his class and going his own way.
Now the Jesuits monitored their schools in a very systematic fashion. Auditors would sit in on classes, generally without notice, and observe teaching methods. One day Father Burke came in early to class. He was cleaned up nicely. No growth of beard, hair trimmed, fresh Cassock. He sat down and made a little speech.
"Boys I'm too old now to be sent back to the Phillipines. You need to help me. A little bird has told me that someone will come in during this class and observe what we do. Today we will be doing history. Please open your books to page 137. Now, I will begin to read from the chapter. From time to time, I will look up and ask a question about the material. You can participate whether you know the answer or not. If you don't know the answer, raise your left hand. If you are sure you know the answer, raise your right hand. I will call on one of you. If you are wrong, don't worry about it." We were happy to participate in the ruse.
By the first year of high school I had read about the intellectual giant, Frederick Douglass, and his relationship with Lincoln and had read biographies of most well-known American black scientists and educators, such as George Washington Carver, Booker T Washington and Charles Drew. My reading didn't extend to the Abolitionist literature or materials about the Underground Railway, although I lived in the State in which Harriet Tubman was born. Another student in our high school was Darryl Hill, a track and football athlete who went to the Naval Academy, but transferred to the University of Maryland as a sophomore and integrated the Atlantic Coast Conference in 1963. http://en.wikipedia.org/wiki/Darryl_Hill_(American_football)
However, the N word was in common use in our high school. One of my friends had a policeman for a father. I stayed over at his house one night. In the morning as we made ourselves breakfast, I noted his father's clothes and holstered side-arm hanging on the chair. I asked my friend if his father had ever shot anyone. The answer was yes. He had "shot and killed some nigger" in a gunfight.
In my childhood what boy could not see the power of Jim Brown, the beauty of Willie Mays, the basketball revolution brought by Bill Russell and Wilt Chamberlain. Despite all of the evidence from these experiences, the following vignette illustrates the continued naivete of my thinking after two years of exposure to a marginally integrated educational system:
Herman's Market
In 1957 I started high school in a black neighborhood in Washington, D.C. There were no white neighbors. As 9th and 10th graders we were not permitted to smoke cigarettes within a block of the school. This left us with two choices. We could walk a couple of blocks south on North Capitol Street to the People's drug store and have coffee or a coke and smoke at the lunch counter. Or we could walk 1 block west to Herman's Delicatessen at 1st and Eye Northwest. Herman's it was most of the time.
Herman's was also a common destination for many of the black children on their way to school. Herman sold large 1-cent oatmeal cookies. A few cookies and a pepsi were the usual breakfast for many of these little children. So there were generally 6 to 10 white high schoolers dressed in coats and ties smoking their cigarettes while a stream of little children did the Herman Fast Food morning run. Herman stood there with his cigar talking up a storm mostly about his son who was studying podiatry. He told us of a junior student who had been expelled for farting at an assembly at Gonzaga a few years before. He had all the gossip accumulated over the previous few years.
I recall standing at Herman's after the death of a well-known Negro preacher (wealthy one at that). Were there any that were not wealthy that were reported in white newspapers? I was asking the older black children at Herman's if they intended to go to the viewing of Daddy Grace, the dead preacher? As if all blacks would have been members of his congregation. Talk about hasty generalization. But it reflects the extent of my ignorance at the time.
http://www.blackpast.org/?q=aah/grace-charles-manuel-sweet-daddy-1881-1960
I guess the point that I am trying to make is that I came by my racism honestly. It was inherited from my childhood culture. Just like the brainwashing of religion, that early influence was hard to shake and parts remain active today.
Like many of my generation, my first sexual experience was with a black prostitute.
The Lady of Sty
I had my first sexual experience in the company of George, the son of a D.C. policeman, in the Spring of 1962 during my Freshman year of college. He was home for the weekend and I was driving a our family 2nd car, a Hillman Husky. We headed to D.C. where we could drink beer at a hangout near Catholic University. After a couple of beers he said, "Let's go, I want to show you something. "
He directed me to the area around 14th St. It was about 11 PM and there was a lot of activity on the street with cars at slowed paces and men running up to the cars for conversations. There were garishly dressed women on the street as well. George rolled down his window and began talking to one of the black men dressed in a tank-top shirt. George turned to me and said, "Pull over and park. I did." I now realized that George was looking for a prostitute. I was a virgin and totally out of my element. I was scared but I had some additional courage from the few beers. I didn't even think to tell him that I was angry that I had not been included in this decision making.
The pimp introduced us to two black women, one more attractive than the other. I intrinsically knew that I would be with the chubby one with the large sty on her right eye. The pimp led us into a row house. In the front room several black men were playing cards. They were friendly and asked us if we wanted drinks. I told them that I wanted a condom. My friend gave me a negative head shake but I insisted. I had done enough reading and heard enough stories from friends in the military to know enough to keep myself as safe as possible. It would cost me a dollar and I had to wait several minutes while one of the men left the house to go find one. George went upstairs with his "date." My date was very friendly and I followed her up to the 3rd floor to a bedroom at the front of the house. The room was relatively bare. There was a brass bed against one wall and a short dresser against the wall next to the door.
She told me to put $5.00 on the dresser. I told her that I was a few cents short of that. "That's okay then, but we're supposed to get $5.00." There was a sheet on the bed. The pillows were uncovered and showed raw ticking. I took off all of my clothes. She didn't get fully undressed, just hiked up her skirt around her waist and pulled off her panties. Despite my anxiety, that was more than enough for an erection. She knew a lot about condoms and I let her put it on.
I had no idea of what I was doing, but she got me started. "Don't touch my hair." Probably the condom was cheap and thick, but I was coming nowhere close to a climax and I was 19 years old, very horny, very sweaty, and still going strong after what must have been more than 10 minutes.
Finally she said, "Just give me a minute, honey, I have to use the bathroom." She got up and left. I got out of bed and stood there at the head. There was minimal illumination in the room from the outside street lights. I waited and I waited for her to return. Then the door opened and a light went on.
There was a naked bulb hanging in the middle of the room. There were no curtains in the room. I was naked, with an erection, wearing a condom in full view of anyone walking down the street. I was looking into the kind face of an elderly, black man. He looked at me quizzically as if to ask "What are you doing here?"
I backed a little away from the window and said, "I'm waiting for her. She said she'd be right back"
"Oh, no, son. She right down there on the street right now. She's not coming back."
I turned off the light, got dressed and went down to the car. George was already there. He told me what a "great fuck" that was. I didn't say anything. I was still in shock from my very recent nude public exposure, the white guy wearing the even whiter condom.
That was my first sexual experience and my last session with an acknowledged prostitute. My revenge on George was hearing of his treatment for Gonorrhea shortly thereafter.
Steve Groark
Steve was a classmate at Gonzaga. He was tall, thin of of face and body, with long, spindly fingers that I always noticed when he held his long Pall Mall cigarettes. He had a very fine hand tremor. He was originally a friend of my chum, Johnny Robson. Both of them had parents that were a little less controlling than my own, so they had spent some time running around D.C. to various drinking spots. Steve was verbally teased by our classmates who would often pronounce his last name GROARK very quickly in a low pitched voice that placed the accent on the last syllable so the it sounded like a frog croak. He never seemed to complain, and often pretended that he didn't notice.
Although Steve's parents were quite conservative, the neighborhood of Greenbelt, Maryland was not. Several liberal arts teachers from the University of Maryland lived around him and Steve gravitated to their children. He was very much into jazz and other elements of black culture. He frequently went to the Howard theater to see performers and was often one of the few whites there.
He introduced us to a coffee house/beer joint called "The Cave" at 14th and U NW. It was a popular hangout for Howard University students. There was a regular jazz group of students from Howard, the JFK Quintet, who played on weekends. There was a powerful folk singer, Valentine Pringle. The beer was expensive at $.75 a bottle (minimum wage was less than a dollar an hour) but it had a great atmosphere, wonderful entertainment--just a great date when you could scrape up the 10 bucks that it was likely to run.
Steve collected records and had eclectic tastes, mostly jazz and blues. I accumulated some black gospel music and Porgy and Bess which I enjoyed trying to sing when off by myself walking down an empty road or out in the woods. My father's cousin Olive had a large collection of 78 RPM records including early Nat Cole and the Wilbur Sweatman Jazz band among many others.. During the freedom rides of the 1960s I wondered what would have happened if Nat Cole and Lena Horne had gone to a white's only restaurant to eat. Would celebrity have mattered?
I was curious about the history of blacks who refused to return to the U.S. after World War II because of the live and let live attitude toward race that was easier to find in Europe. I was ambivalent about the case of Paul Robeson, all American Football player, actor, opera singer. It seemed to me he viewed Russian communism favorably based upon his experiences with "equality"--a single issue in view of the belief in justifications for killing in the name of a materialistic religious belief about the nature of man and the endpoint of history. Ambivalent or not, how can you not love this?
http://www.youtube.com/watch?v=5jrPhY1GHNQ
Steve was the first white person I knew to be a serious student and fan of African-American culture and to be totally comfortable in the presence of blacks. He and I got closer as the result of an adventure in our senior year of high school. A requirement for graduation was the completion of a retreat at a Jesuit facility. It was done in lieu of three days of school and, judging from the reports of my classmates, may have been a last big push to gather more priests for the flock. There was a lot of big talk among us of sneaking off during some night and finding the local action, but believe me, this place was so isolated that the only action would have been farm animals.
We were supposed to be observing the rule of silence but there were some breaks allowed. Steve and I went outside the first night to smoke a cigarette and he began a conversation. He was very upset. His family was in turmoil. His brother, who was in the Navy, was engaged (or had married...I can't recall) a girl from Bermuda who was black. Steve's parents were pushing to destroy the relationship and it looked like his brother was about to accede to their wishes.
After we finished talking, we tried to re-enter the house and were met by the retreat-master. We apologized for missing the bell. He said he would talk to us in the morning. However, at breakfast he made the general announcement to the entire assembly that two people were being booted.
The retreat master had said he would discuss this with us in the morning. He never did. We were told to pack up and we were driven to the end of the estate driveway that abutted US Route 301. We hitch hiked back to D.C. and reported to the headmaster. He listened to the story and said that we would have to show up at school and do class work for the next two days in lieu of time at the retreat. He told us that the retreat was a requirement for graduation and we would have to go with another group. He then dismissed us.
Three months after he called us back into his office. He told us the retreat master insisted on an apology before readmitting us for a retreat. Our headmaster, Father McHale, surprised us when he said that he didn't think we owed an apology. He dismissed the requirement for completion of the retreat.
This experience was my eternal bond with Steve Groark, but I don't think that I ever really knew him. There was a quiet suffering there and an awkward desire to fit in but an inability to make more than feeble overtures. I visited him a few times during my last year of high school and met his friends whose bohemian values and behaviors made me very nervous. Even with his group of friends, Steve very much stayed on the periphery, more an observer and often clumsy when trying to participate. I think this is the way he was in high school as well.
I next ran into him at the University of Maryland in 1963. He had originally started school in Iowa in Mathematics but transferred back to the state school to study literature. He had managed to rejoin his group of friends who had become involved in attempts to integrate eating places in nearby Laurel, Maryland. Even though I now had a friend involved in the Civil Rights Movement, I wasn't able to see it as my business or my moral obligation. The thought of confrontation with the red neck toughs of my race frightened me. I'd been scared of these people since escaping from the Smiths down the street at age 8. I wanted no part of the violence. I thought that things were moving in the right direction with or without me.
Although the King Rally in 1963 occurred within 10 miles of my house, I decided to watch it on television and was surprised to see some of my white friends from Catholic University out in force. I had no strong political convictions at the time. By the time I started medical school in 1965, the rhetoric of the Nation of Islam seemed foolish and the increasing stridor of the more radical elements of the movement scared the hell out of me.
I had started high school located in one of the tough black ghettos of Washington, D.C. but there did not appear to be great animosity between the races in 1957. At age 14 or 15 we could walk a few blocks from school to Ollie's bar, a black establishment and buy beer, or go to Buster's Hamburger Shop and chow down for a dime a burger. Steve Groark routinely went to the Howard Theater and many of us went to mixed restaurants and bars such as "The Cave." I felt safe walking all around Washington, D.C. until graduation from high school in 1961.
But things were changing. How could African-Americans not be upset about their treatment by the white government? Waves of immigrants had arrived in America and had managed to filter up into the middle class. Why hadn't blacks managed to do the same? Clearly they had been treated as less "American" than immigrants who passed easily into the military services.
I was a white male who had been the beneficiary of a system stacked in my favor. I was also capable of enough empathy to realize how angry I might be to have been born black into such a system. Given such anger, where would I likely direct it if I could? After seeing a race riot with black on white violence in the fall of 1962 and after my brother was beaten by a group of black teenagers because of the school jacket he was wearing, I believed that I was seeing physical evidence of that anger.
As the political turmoil increased, I was having my own set of struggles with medical school, the need to make money, a new family, turbulence in my marriage, etc.
**********
this is a long post which I'll break here... around this general thought...
One of the benefits of death to our society is the wiping away of misinformation. I believe that my attitudes toward race are, to some extent indelible and primal with attitudes laid down at such an early age, that they are not removable. I think these indelible and primal "filters" for reality, can immediately come to the surface when I am in a strange situation. Now, I've learned generally to compensate for these racist, stereotypical biases, but the fact that they exist in the first place will have some effect on the outcome of an encounter.
I have talked about race. But I know that I have a bucket list of false beliefs running around in my brain. Death removes those kinds of opinions and belief from the world and is a major change agent. Change is necessary in order to work toward a better world.
My daughter's world in terms of racial stereotyping was much different than mine.
Kristin Sohr and Bobby Waxman in 1973 or 1974.
Friday, October 28, 2011
Consultant US Public Health Service 1971. The Interview
Consultant US Public Health Service 1971
*************
medical *
*************
Today I'm sitting in a chemotherapy infusion room at Stanford. Jasmine is a very private person and I don't really have permission to talk about her in these blogs but she is too sick today to comfortably make the trip. My brother Geoff is here and I insisted that she stay home.
We left Morro Bay at about 3:40 A.M. I drove and we got here a little after 8. The set-up in the clinic is great...the electronic medical record system lets the lab know what is needed. Ms. Villalobos (not the cab driver in Pulp Fiction) drew my blood and started my IV for infusion...very professional, a slick needle insertion..beautiful eyes as well.
I met with the fellow, Rodeep Brar, M.D., a "California boy." He was very sharp, picked up a problem in medications and solved it immediately. We then had a very frank conversation about my future. He gave me an even chance of surviving a year. He pointed out that my treatment is more designed for quality than length of life.
I was very curious about my various possible pathways to death. He advised me to watch carefully for leg swelling--even low platelet counts can be associated with deep venous thromboses and pulmonary emboli. Other acute problems could be dehydration and pneumonia secondary to lowered white counts and immune suppression
He said that they would be happy to life-flight me to Stanford if called by my local hospital. I told him that I would want to avoid that and receive treatment near my home. He asked about my advanced directives and we were able to speak frankly about forgoing resuscitation attempts should I have a cardiac arrest.
As physicians we are both aware that death eventually comes. As an oncologist, he has certainly seen his share. He related that the most common pathway is gradual loss of energy and difficulty breathing as the tumor progresses. Because I will be scanned so frequently, he thinks that I will know about the progression from the imaging before I am aware of it physically.
We talked about my greatly reduced muscle mass, a reflection of the humoral influence of the muscle and the use of steroids which reduces muscle mass as well. ((No matter how hard I try, Schwarzeneggers Encyclopedia of Body Building will not work for me at this stage of my life ((or any stage I suspect.))) Gee, I wrote this sentence that reminds me of computer code.)
Denise is my infusion nurse. Again... consumate professional...this whole place reeks of it. Denise has reviewed my orders and gives me several medications, pre-infusion. There is a large dose of Dexamethasone, a steroid, Diphenydramine which blocks the Histamine 1 receptor and Pepcid which blocks Histamine 2. The histamine receptors are implicated in allergic reactions, so the drugs are used to mitigate the risk. Dexamethasone will also reduce the risk of allergic reactions through another mechanism.
The Diphenydramine (benadryl) is a downer. These tend to affect me very quickly and profoundly. I warn her and tell her not to let me tell her any dirty jokes. She promises that she will see that I behave appropriately at all times.
The preops take a while. The first infusion, Taxol, takes about three hours and ends about 4 PM. There are no significant side effects, a little cold sensation at injection site for 20 minutes, warmness of fingertips and toes that lasts less than 30 minutes although my feet continue to feel a little warmer than usual.
http://en.wikipedia.org/wiki/Paclitaxel
Next they hang Carboplatin. It slides in within 40 minutes. There is a little burn above the injection site that lasts for a few seconds and doesn't recur.
http://en.wikipedia.org/wiki/Carboplatin
Avastin is the last drug. Generic name Bevacizumab. It will take 90 minutes to run in. I try to persuade her to increase the rate knowing that she can't.
http://en.wikipedia.org/wiki/Bevacizumab
I am very curious about the origin of the generic name and did a cursory search and did not find it. If someone out there knows, will you please post a comment? As I am receiving this I have a sudden urge to defecate that passes in a few seconds. I've brought a couple of changes of underpants and some workout shorts just in case I have an accident on the way home. It could be a long 200 miles. I'll let you know. It's also making me cough, which has not been an issue for a few days. I wonder if these drugs are throwing spears into the sleeping dragon. I sure hope so.
------------------------------------------
Winter 1970 - 1971
I've been thinking about that winter more than 40 years ago and I think it was the happiest time in my life up until that point. I missed Kristin. Her mother had decided to take her to Europe for an extended period of time. She had sole custody and there were little in father parental rights in Maryland at that time. I had no say and there was minimum communication. She never told me when she expected to be back and I only found out about her return and her whereabouts by accident. She told me where to send the support checks.
Although I had lost my expected job and our money prospects had dwindled, Molly and I weren't destitute and we could go out and eat roast beef sandwiches and drink beer once a week after classes often meeting friends at a place called Pappy's on Rt 40.
After Christmas we really were broke and we survived pretty much with tuna fish sandwiches on home-made bread. But, Molly makes great tuna fish with olives.
The Interview
I met with Bruce Waxman in December 1970. He was the chief of the Technology Branch of the National Center for Health Services Research and Development (NCHSRD) which was in turn a part of the Health Services and Mental Health Administration (HSMHA), etc. The Acronyms Increased from bottom to top of the chain.
The NCHSRD's mission was to address issues of access, cost, and quality of medical care. After its creation, a hodgepodge of existing, funded grants and contracts from across the Public Health Service were dropped into this agency for funding and management. The agency never managed to carve out a strong foundation and was subject to the political forces of the day, leading to several attempts to reorganize it into more meaningful definitions of priorities and divisions of labor.
Bruce Waxman was about 44 when I met him. His hair was heavily greyed. He was short, cared little about his dress, had an enormous belly that created problems for his pants and belts--he was always tugging them up--a boisterous, charming voice that was completely under the control of the master, except when he lost his temper, a not uncommon event. He had come from the NIH where he was instrumental in seeing the value of the Mini-computer.
The following wikipedia article describes the PDP-8.
http://en.wikipedia.org/wiki/PDP-8
Notice that the LINC computer built by Clark and Molnar is cited as a principal inspiration for the PDP-8. Bruce Waxman had worked with Wes Clark to make affordable computers available to bench scientists (computers in biomedical research, the phrase used in Waxman's book). This had occurred the NIH. The two remained life-long friends.
Waxman moved from the NIH to the Chief of Technology at the National Center for Health Services Research. He apparently brought several projects with him in the move and maintained his network at NIH through proteges there. Waxman was a masterful bureaucrat. He had years of experience in the so-called NIH study sections, the means by which NIH made funding decisions for scientific projects. The study section model was carried over throughout the NCHSRD.
The basic division between NIH and NCHSRD was supposed to be pure medical science versus delivery of advances in medical science and services to the people. NIH would be the ivory tower. NCHSRD was designed to become active in the way in which the provision of medical services occurred. This meant that NCHSRD had to get into bed with service organizations and physicians who delivered the medical care--a challenging, messy task.
The Interview
I needed a job, badly.
When I met Bruce, he was very friendly--a booming voice called out to his secretary, "Winnie, can you please get Dr. Sohr a cup of coffee." He had a spacious office with a conference table in the front, his personal desk in the back of the room and a couple of armchairs in front of his desk.
He walked out from behind his desk and sat in one armchair and I sat in the other. He lit his pipe. He quizzed me--
what was my background?
what had I done recently?
why didn't I want to practice medicine?
did I want to join the Public Health Service as an enlisted officer because he could arrange a commission that would solve any of my draft issues?
It's hard to fully describe the liveliness of the man or his fluency. He should have been named Bruce WaxPoeticMan. His vitality, magnetism, and self-echoing voice could take control of most rooms, even when he was uttering pure bullshit, which he sometimes did, generally for effect.
I didn't want a commission in the Public Health Service. To me it meant using the military to avoid the draft, like National Guard. He said he didn't have any current Civil Service positions open although he expected several in the summer and would like me to return later in the spring.
As we spoke, he was called away from his office. While he was out, I looked at all of the objects in his office, his coffee cups, badly done cartoon portraits, his tea pot, copies of his book, and personal photos. I kept coming back to what appeared to be a family photo, but there was something odd about it. The youngest person in the picture was an African American boy who appeared to be about Kristin's age. Maybe he had an African American child.
Well, here was my race card and the opportunity to do one of the slimiest things in my life. I decided to use the story of the young black drowning victim in Cambridge based upon my belief that he would be more likely to see me as a kindred soul if he had that knowledge.
When he returned I told him I was very grateful for his offer of a commission, but that I could not morally accept working in any branch of military service during the current war, even a branch that had been formed to meet the needs of US merchant mariners.
I don't think Dr. Waxman was wedded to morality although I think he was honorable (and dishonorable in some of the same areas of life as I was). He loved his country. He desperately wanted to make a difference. He had a large streak of narcissism that motivated him to work harder in identifying "stars," medical people who were doing important things who needed funding and who would be ever grateful to him for managing to get it to them. He worked very hard for them, but made sure that they knew how hard he was working. I don't think he understood a moral decision to turn down military service, but he was a tolerant man in many ways, able to accept what he saw as the foibles of people around him.
I then went on to tell him I really liked graduate school and was still looking for part time medical work. I informed him that my financial situation appeared set when I matriculated but I had been scrounging around for work sources after a hospital and I parted ways suddenly in September. (This was the bait. Prospective employers are always interested in this kind of information. Was I drunk on the job? Did I get caught having sex with a female employee? He would have to follow this up. When he did the information would not appear to be easily offered.).
I explained that my preference was still to remain in school, that finals were coming in the next three weeks, and that I could borrow if necessary until the pieces of a medical income came together. I told him there were house call opportunities available, that I did have a few ER shifts lined up, that there were locums possibilities in practices, and other chances for work here and there.
I told him that I had come for this interview because Larry Weed had recommend I call him. I told Bruce that I saw his shop as the place I would like to come with a degree in computer science--a few years down the road. I explained that by summer, my financial situation would be resolved, I would be hooked into a department at Maryland and I might find it difficult to leave an academic situation. I reiterated that I was incredibly excited by what I saw his office doing, but I was worried that I did not have sufficient knowledge of several areas, including computer hardware, communications theory, operations research, and mathematics.
He brushed that aside. He said there were very few people in the country with my credentials, a practicing physician with a solid background in programming with knowledge of a couple of higher level languages and the assembler language for the Univac computer at the University of Maryland.
Then he asked me about the problem at the hospital. I told him I was fired. He asked for all the details. I didn't embellish. The story stood on its own. My intention was for him to get the information in a manner that would not seem the gratuitous ploy that it was.
Then he revealed to me that he and his wife had mostly raised their four children and wanted more but couldn't have them. They decided to adopt and believed that it was important to adopt children that others were less likely to want. He described his difficulty in obtaining a black child and dealing with the bureaucracy of the time and the emnity of black organizations that totally disapproved of chldren of African heritage being raised by Caucasian, "much less Jews," he laughed.
Then he said, master Mandarin that he was, "Dr. Sohr, I don't have any positions, but I think I know how to work around it. Perhaps it would be possible for me to bring you aboard as a consultant. It would be a straight fee per day, no holidays, leave, retirement...straight up pay. $50 dollars a day. Talk with Dr. Cohen.
Bruce left and Dr. Cohen appeared. He laughed and said, I heard Bruce say $50 a day. We can't do that for someone with your qualifications. It'll be $75 a day. How will that work out?
"I'm very happy to accept your offer!"
*************
medical *
*************
Today I'm sitting in a chemotherapy infusion room at Stanford. Jasmine is a very private person and I don't really have permission to talk about her in these blogs but she is too sick today to comfortably make the trip. My brother Geoff is here and I insisted that she stay home.
We left Morro Bay at about 3:40 A.M. I drove and we got here a little after 8. The set-up in the clinic is great...the electronic medical record system lets the lab know what is needed. Ms. Villalobos (not the cab driver in Pulp Fiction) drew my blood and started my IV for infusion...very professional, a slick needle insertion..beautiful eyes as well.
I met with the fellow, Rodeep Brar, M.D., a "California boy." He was very sharp, picked up a problem in medications and solved it immediately. We then had a very frank conversation about my future. He gave me an even chance of surviving a year. He pointed out that my treatment is more designed for quality than length of life.
I was very curious about my various possible pathways to death. He advised me to watch carefully for leg swelling--even low platelet counts can be associated with deep venous thromboses and pulmonary emboli. Other acute problems could be dehydration and pneumonia secondary to lowered white counts and immune suppression
He said that they would be happy to life-flight me to Stanford if called by my local hospital. I told him that I would want to avoid that and receive treatment near my home. He asked about my advanced directives and we were able to speak frankly about forgoing resuscitation attempts should I have a cardiac arrest.
As physicians we are both aware that death eventually comes. As an oncologist, he has certainly seen his share. He related that the most common pathway is gradual loss of energy and difficulty breathing as the tumor progresses. Because I will be scanned so frequently, he thinks that I will know about the progression from the imaging before I am aware of it physically.
We talked about my greatly reduced muscle mass, a reflection of the humoral influence of the muscle and the use of steroids which reduces muscle mass as well. ((No matter how hard I try, Schwarzeneggers Encyclopedia of Body Building will not work for me at this stage of my life ((or any stage I suspect.))) Gee, I wrote this sentence that reminds me of computer code.)
Denise is my infusion nurse. Again... consumate professional...this whole place reeks of it. Denise has reviewed my orders and gives me several medications, pre-infusion. There is a large dose of Dexamethasone, a steroid, Diphenydramine which blocks the Histamine 1 receptor and Pepcid which blocks Histamine 2. The histamine receptors are implicated in allergic reactions, so the drugs are used to mitigate the risk. Dexamethasone will also reduce the risk of allergic reactions through another mechanism.
The Diphenydramine (benadryl) is a downer. These tend to affect me very quickly and profoundly. I warn her and tell her not to let me tell her any dirty jokes. She promises that she will see that I behave appropriately at all times.
The preops take a while. The first infusion, Taxol, takes about three hours and ends about 4 PM. There are no significant side effects, a little cold sensation at injection site for 20 minutes, warmness of fingertips and toes that lasts less than 30 minutes although my feet continue to feel a little warmer than usual.
http://en.wikipedia.org/wiki/Paclitaxel
Next they hang Carboplatin. It slides in within 40 minutes. There is a little burn above the injection site that lasts for a few seconds and doesn't recur.
http://en.wikipedia.org/wiki/Carboplatin
Avastin is the last drug. Generic name Bevacizumab. It will take 90 minutes to run in. I try to persuade her to increase the rate knowing that she can't.
http://en.wikipedia.org/wiki/Bevacizumab
I am very curious about the origin of the generic name and did a cursory search and did not find it. If someone out there knows, will you please post a comment? As I am receiving this I have a sudden urge to defecate that passes in a few seconds. I've brought a couple of changes of underpants and some workout shorts just in case I have an accident on the way home. It could be a long 200 miles. I'll let you know. It's also making me cough, which has not been an issue for a few days. I wonder if these drugs are throwing spears into the sleeping dragon. I sure hope so.
------------------------------------------
Winter 1970 - 1971
I've been thinking about that winter more than 40 years ago and I think it was the happiest time in my life up until that point. I missed Kristin. Her mother had decided to take her to Europe for an extended period of time. She had sole custody and there were little in father parental rights in Maryland at that time. I had no say and there was minimum communication. She never told me when she expected to be back and I only found out about her return and her whereabouts by accident. She told me where to send the support checks.
Although I had lost my expected job and our money prospects had dwindled, Molly and I weren't destitute and we could go out and eat roast beef sandwiches and drink beer once a week after classes often meeting friends at a place called Pappy's on Rt 40.
After Christmas we really were broke and we survived pretty much with tuna fish sandwiches on home-made bread. But, Molly makes great tuna fish with olives.
The Interview
I met with Bruce Waxman in December 1970. He was the chief of the Technology Branch of the National Center for Health Services Research and Development (NCHSRD) which was in turn a part of the Health Services and Mental Health Administration (HSMHA), etc. The Acronyms Increased from bottom to top of the chain.
The NCHSRD's mission was to address issues of access, cost, and quality of medical care. After its creation, a hodgepodge of existing, funded grants and contracts from across the Public Health Service were dropped into this agency for funding and management. The agency never managed to carve out a strong foundation and was subject to the political forces of the day, leading to several attempts to reorganize it into more meaningful definitions of priorities and divisions of labor.
Bruce Waxman was about 44 when I met him. His hair was heavily greyed. He was short, cared little about his dress, had an enormous belly that created problems for his pants and belts--he was always tugging them up--a boisterous, charming voice that was completely under the control of the master, except when he lost his temper, a not uncommon event. He had come from the NIH where he was instrumental in seeing the value of the Mini-computer.
The following wikipedia article describes the PDP-8.
http://en.wikipedia.org/wiki/PDP-8
Notice that the LINC computer built by Clark and Molnar is cited as a principal inspiration for the PDP-8. Bruce Waxman had worked with Wes Clark to make affordable computers available to bench scientists (computers in biomedical research, the phrase used in Waxman's book). This had occurred the NIH. The two remained life-long friends.
Waxman moved from the NIH to the Chief of Technology at the National Center for Health Services Research. He apparently brought several projects with him in the move and maintained his network at NIH through proteges there. Waxman was a masterful bureaucrat. He had years of experience in the so-called NIH study sections, the means by which NIH made funding decisions for scientific projects. The study section model was carried over throughout the NCHSRD.
The basic division between NIH and NCHSRD was supposed to be pure medical science versus delivery of advances in medical science and services to the people. NIH would be the ivory tower. NCHSRD was designed to become active in the way in which the provision of medical services occurred. This meant that NCHSRD had to get into bed with service organizations and physicians who delivered the medical care--a challenging, messy task.
The Interview
I needed a job, badly.
When I met Bruce, he was very friendly--a booming voice called out to his secretary, "Winnie, can you please get Dr. Sohr a cup of coffee." He had a spacious office with a conference table in the front, his personal desk in the back of the room and a couple of armchairs in front of his desk.
He walked out from behind his desk and sat in one armchair and I sat in the other. He lit his pipe. He quizzed me--
what was my background?
what had I done recently?
why didn't I want to practice medicine?
did I want to join the Public Health Service as an enlisted officer because he could arrange a commission that would solve any of my draft issues?
It's hard to fully describe the liveliness of the man or his fluency. He should have been named Bruce WaxPoeticMan. His vitality, magnetism, and self-echoing voice could take control of most rooms, even when he was uttering pure bullshit, which he sometimes did, generally for effect.
I didn't want a commission in the Public Health Service. To me it meant using the military to avoid the draft, like National Guard. He said he didn't have any current Civil Service positions open although he expected several in the summer and would like me to return later in the spring.
As we spoke, he was called away from his office. While he was out, I looked at all of the objects in his office, his coffee cups, badly done cartoon portraits, his tea pot, copies of his book, and personal photos. I kept coming back to what appeared to be a family photo, but there was something odd about it. The youngest person in the picture was an African American boy who appeared to be about Kristin's age. Maybe he had an African American child.
Well, here was my race card and the opportunity to do one of the slimiest things in my life. I decided to use the story of the young black drowning victim in Cambridge based upon my belief that he would be more likely to see me as a kindred soul if he had that knowledge.
When he returned I told him I was very grateful for his offer of a commission, but that I could not morally accept working in any branch of military service during the current war, even a branch that had been formed to meet the needs of US merchant mariners.
I don't think Dr. Waxman was wedded to morality although I think he was honorable (and dishonorable in some of the same areas of life as I was). He loved his country. He desperately wanted to make a difference. He had a large streak of narcissism that motivated him to work harder in identifying "stars," medical people who were doing important things who needed funding and who would be ever grateful to him for managing to get it to them. He worked very hard for them, but made sure that they knew how hard he was working. I don't think he understood a moral decision to turn down military service, but he was a tolerant man in many ways, able to accept what he saw as the foibles of people around him.
I then went on to tell him I really liked graduate school and was still looking for part time medical work. I informed him that my financial situation appeared set when I matriculated but I had been scrounging around for work sources after a hospital and I parted ways suddenly in September. (This was the bait. Prospective employers are always interested in this kind of information. Was I drunk on the job? Did I get caught having sex with a female employee? He would have to follow this up. When he did the information would not appear to be easily offered.).
I explained that my preference was still to remain in school, that finals were coming in the next three weeks, and that I could borrow if necessary until the pieces of a medical income came together. I told him there were house call opportunities available, that I did have a few ER shifts lined up, that there were locums possibilities in practices, and other chances for work here and there.
I told him that I had come for this interview because Larry Weed had recommend I call him. I told Bruce that I saw his shop as the place I would like to come with a degree in computer science--a few years down the road. I explained that by summer, my financial situation would be resolved, I would be hooked into a department at Maryland and I might find it difficult to leave an academic situation. I reiterated that I was incredibly excited by what I saw his office doing, but I was worried that I did not have sufficient knowledge of several areas, including computer hardware, communications theory, operations research, and mathematics.
He brushed that aside. He said there were very few people in the country with my credentials, a practicing physician with a solid background in programming with knowledge of a couple of higher level languages and the assembler language for the Univac computer at the University of Maryland.
Then he asked me about the problem at the hospital. I told him I was fired. He asked for all the details. I didn't embellish. The story stood on its own. My intention was for him to get the information in a manner that would not seem the gratuitous ploy that it was.
Then he revealed to me that he and his wife had mostly raised their four children and wanted more but couldn't have them. They decided to adopt and believed that it was important to adopt children that others were less likely to want. He described his difficulty in obtaining a black child and dealing with the bureaucracy of the time and the emnity of black organizations that totally disapproved of chldren of African heritage being raised by Caucasian, "much less Jews," he laughed.
Then he said, master Mandarin that he was, "Dr. Sohr, I don't have any positions, but I think I know how to work around it. Perhaps it would be possible for me to bring you aboard as a consultant. It would be a straight fee per day, no holidays, leave, retirement...straight up pay. $50 dollars a day. Talk with Dr. Cohen.
Bruce left and Dr. Cohen appeared. He laughed and said, I heard Bruce say $50 a day. We can't do that for someone with your qualifications. It'll be $75 a day. How will that work out?
"I'm very happy to accept your offer!"
Thursday, October 27, 2011
Summer and Fall 1970
Summer and Fall 1970
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medical *
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It was a good day until late afternoon on Wednesday. Dr. Palchak recommended that I use Glutamine regularly as a prophylaxis against peripheral neuropathy. I looked at the information online. It appears that the NIH did a study that showed no benefit. However, there appears to be no harmful side-effects and I'm going to give it a try.
At around 5 PM I had another episode of chills, much milder than a few days ago. I took a nap and awoke with a low grade fever and some pain in the right shoulder and neck which responded to a boost in ibuprofen. I'm keeping my fingers crossed that I don't have any problem that will jeopardize receiving chemotherapy on Friday.
Internship Ends
Internship ended on June 30, 1970. Richard Fisher was continuing on at South Baltimore General in Internal Medicine. Tom Shawker, my roommate was off to continue training in radiology. I'm the only one who decided to opt out of further medical training. The advantages of leaving were more money than training wages, an opportunity to reduce my work week to 40 hours from 80 hours with an increase in my opportunities for sleep, and the chance to begin a new career path that was non-standard and for which there were no models. I intended to use my medical training to work a part-time job at relatively high wages while obtaining an advanced degree in Computer Science.
Just as most computer programmers of the time, I was self-taught. I had worked for a brief time at the NASA facility in Greenbelt, MD and had the opportunity to learn a programming language. When I moved on to Android and Jimmie Osborn, I was being tutored by a man who had begun his career punching cards and hard wiring IBM sorting machinery in the Navy at age 18. At the time, I would venture that mathematicians as a class tended to look down on computer programming as a pedestrian, non-creative occupation.
While a junior in medical school, I had done a rotation in psychiatry at the University of Maryland and had run across Malcolm, a genius mathematician with the fixed delusion that he had created the world during an episode of vomiting. There was no doubt that he was extremely bright, almost certainly genius-level IQ. I was assigned to his team of caregivers for 4 weeks and he took a liking to me. Malcolm had entered college at age 12 or 13 and stopped attending any formal classes before his 16th birthday. Now age 26, he taught courses involving the "theory of problem solving" and "heuristics." Naturally, he was someone who fascinated me. Here is the wiki link should you be interested in learning something more about his area of interest.
http://en.wikipedia.org/wiki/Heuristic
Malcolm insisted on playing chess a couple of times a week and I was a very weak opponent. He often said to me: "Sohr, you lack imagination." Once I asked him if he thought there was any hope for me in spite of that and he just laughed.
At the end of internship, I had spent five years of my life in formal medical training. Much of it was interesting, but these years had ground me down. I was 27, married and divorced and about to marry again. Family responsibilities had reduced the amount of time and energy available for medicine. As I think about this, my cancer is draining away my muscle mass much as medical education consumed the decade of my 20's.
Now, at the end of my internship, I was looking forward to a jump in wages and a reduction in work responsibility that would make life more pleasant. In addition, I was about to become a student in a field that excited me intellectually in a way that was different than medicine. I would wake up some parts of my brain that had not exercised much for the previous few years.
On the down side, I would be making enough money such that alcohol was always available in my budget. Also, I had recently been introduced to marijuana and I was fascinated with the notion of altered states of consciousness. Books like "Doors of Perception," "The Island," and Timothy Leary's work on programming LSD experiences, had sparked my interest in the "mystical" possibilities of psychedelic drugs.
I had been introduced to marijuana at the end of my third year of medical school when my wife brought back a couple of joints from her trip to California to meet a nursing school girl-friend. (She also brought back the telephone number of some guy that she had met there and she seemed to reach a new level of verbal criticism directed at this "getting-fat" man who greeted me in the mirror every morning.)
I kept trying marijuana and had actually came to believe that it must be the "emperor's new clothes." For the first 7 or 8 times, I didn't feel a thing. Then in March or April of 1969 I found myself in an IHOP in Baltimore talking to my friend Michael. I was in the middle of a complaint about the lack of effectiveness of the joint when I happened to look at my fork, which was loaded with several tiers of pancakes and dripping with raspberry syrup. I put the fork down and looked again and burst out laughing.
There was more opportunity for experimentation when working as the intern in the emergency room where the schedule was two 12 hours shifts on consecutive days followed by a full day off.
Why, you ask? What did marijuana do for you? At least initially, it seemed to give me "time." The rush of my schedule had abated. I could lie back and listen to music without constantly worrying about the next thing on my schedule of tasks. I could bake bread with Molly and have several laughs while kneading the dough.
As I'm thinking about this now, Rhapsody in Blue comes to mind. An experience with Marijuana seems like the first minute or so of the work. It is slow but alive, like a cat stretching out her muscles. As the music continues, one enters a much busier world, not one that feels chaotic, but is filled with activity--analogous to the every day work world. If you'd care to hear what I mean, you can try:
http://www.youtube.com/watch?v=1U40xBSz6Dc
I particularly liked the time distortion with marijuana. For me it packed an hour of relaxation into a few minutes. Music came alive again. I hadn't really "listened" to music while I was in medical school. It had lost the importance of the shared experience with friends in grade school and with dances in high school. But now with marijuana, it had returned in spades. And there was so much good stuff out there in 1969! Marijuana seemed to help me align my mood with the music. Molly was very much into music. I remember spending a Sunday afternoon with her after I had smoked something and listening to a Donovan album that moved me beyond words with its beauty. It probably helped that I was falling madly in love with this deep, intelligent woman with the incredibly biting sense of humor.
My perception of the spiritual side of the drug experience was probably an attempt to replace the loss that I was experiencing in my continuing attempts to push the Catholic octopus out of my thinking.
A New Job
The city of Cambridge, MD was having difficulty recruiting a physician for its emergency room in the summer of 1970. Barak Obama would say that it was on the wrong side of history in 1960. It acquired notoriety during the Civil Rights struggle when the courthouse was bombed.
http://en.wikipedia.org/wiki/H._Rap_Brown
Maryland was a slave state and the Mason-Dixon line which separated slave-holding states from free states during Lincoln's era ran along the northern border of the state.
For such a geographically small area, Maryland has a variety of topography and shares the Chesapeake Bay which actually has more miles of coast line than California. It was settled by Catholics at St. Mary's City on the Potomac River in 1632. It was the 4th British colony. Shortly thereafter, Protestant dissenters sailed to Smith Island in 1634 and formed the community where I would practice medicine for a few years and where I hope to have some of my ashes scattered.
The religious wars in England were echoed in Maryland with bloodshed on both sides. When we look at the intolerance that appears as doctrine in some version of Islam, we can see corresponding insanity in Christianity, even during our American colonial period.
German migration into Maryland became significant in the 18th century and by the time of the Civil War, a German language newspaper had the 2nd or 3rd most numerous circulation. The Germans were not slave holders and the State became divided over political lines, the eastern and southern most parts of the state being slave holding, while the northern and western parts were not. Some opponents labelled Abraham Lincoln a tyrant based upon the Federal occupation of Baltimore in May 1961 and martial law was declared throughout the state.
Suffice to say that Maryland was deeply divided by the civil war. The villain of the era, John Wilkes Booth, was a Marylander as were most of the conspirators in the Surratt house where the plot was hatched that resulted in Lincoln's assassination.
In the 1950's a bridge was built across the Chesapeake Bay that made it possible for people on the Western Shore (including Washington, D.C. and Baltimore) to drive to the sea at Ocean City, Maryland in about 3 to 4 hours. Prior commutes had required driving around the Bay or using a Ferry service. This opened up tourism to the Eastern Shore, an area that looked more like Selma, Alabama than Baltimore with respect to differential treatment of blacks and whites. Refusal of restaurant seating to blacks was common all along Route 50, the major corridor to the coast. Freedom rides to integrate restaurants were begun.
Here is a selection from http://www.crmvet.org/tim/timhis61.htm that illustrates some of that history.
Cambridge is the capitol of Dorchester County. In 1960 one-third of Cambridge residents are Black, all of whom live in the 2nd Ward which has been represented for six decades by the only Black on the five-member City Council. There are three Blacks on the police force, but they are limited to patrolling the Black neighborhood and are not allowed to arrest whites anywhere. The schools are segregated, with Black schools receiving half as much funding as those attended by whites. All lunch counters, cafes, churches, and entertainment venues are segregated. The local hospital does not admit Blacks who have to travel to Baltimore two hours distant by car (longer by bus). Nor do Black doctors have privileges at the segregated Johns Hopkins hospital.
By 1962, Cambridge has fallen on hard times. The city's major manufacturer, a food-processor, has closed its Cambridge plants and the jobs are gone. For whites, unemployment is over 7%, twice the national average, and Black unemployment is a devastating 29%. Two of the remaining factories, both defense contractors, have a tacit agreement with their white workers and the city council — the companies will not hire Blacks in return for the workers rejecting any attempt at unionization. Under Federal poverty regulations, Dorchester County is in the same category as Appalachia.
By the end of 1961, efforts to desegregate public accomodations along the highways between Washington and the north have largely succeeded. Led by Clarence Logan and other Morgan State College students, Baltimore's Civic Interest Group (CIG) — a SNCC affiliate — begins sit-ins and freedom rides in towns on Maryland's Easternshore.
In January of 1962, CIG/SNCC organizers Reggie Robinson and Bill Hansen arrive in Cambridge. Protests commence in Cambridge with 100 activists marching downtown to desegregate various establishments. Half of the protesters are Cambridge high school students, the other half are students mobilized by CIG from Morgan State and Maryland State Colleges, along with a few white supporters from Johns Hopkins. Some of the demonstrators are arrested. Hostile whites jeer, and in some cases, assault them. Bill Hansen is beaten by a mob and then arrested for "Disorderly Conduct." The Cambridge Mayor blames the violence on "outside agitators," and calls Hansen a "professional integrationist."
More than 300 Black residents attend a mass meeting that night at Waugh Church to show support for the protesters, and in the following days they found the Cambridge Nonviolent Action Committee (CNAC) — pronounced "See-Nack" — to support and continue the protests. Frederick St. Clair and Enez Grubb are elected CNAC co-chairs at a mass rally. A week after the first protests, CIG and CNAC organize a second "freedom ride" into Cambridge, this time including supporters from CORE, SNCC, Northern Student Movement (NSM), Black students from Howard University, Morgan, Lincoln, and Maryland State Colleges, and white students from Swarthmore, Haverford, and Bryn Mawr. Again white vigilantes attack some of the protesters, again Bill Hansen and others are beaten, and again Hanson and others are arrested. White students are beaten more than Blacks.
Penny Patch, a white student from Swarthmore, recalls "Everyone sang, the songs bound us together and made us strong. [The white mob] gathered around us, screaming, waving baseball bats. I was scared. But I also drew enormous strength from the songs we sang." She later goes on to become a full-time SNCC field secretary in Albany Georgia and the Mississippi Delta.
CIG expands the freedom rides and sit-ins to other Eastshore towns such as Chestertown, Princess Ann, Salisbury, and Easton, an effort that evolves into the Maryland Easternshore Project" a summer campaign of CIG/CNAC. Meanwhile, CNAC continues demonstrations in Cambridge, relying on local high school students led by Donna Richardson, Lemuel Chester, Dinez White, and Dwight Cromwell. For awhile, Edward Dickerson, a local white student, defies family and community to take part in CNAC protests. His parents kick him out of their home and threaten to commit him to a mental institution.
Maryland Governor Tawes asks the legislature to pass an anti-discrimination bill to end segregation in public accomodations throughout the state. But Easternshore legislators weaken the bill by allowing counties to exempt themselves. In other words, Easternshore counties like Dorchester where segregation is widespread can choose to ignore the law. In Cambridge, the police allow white racists to beat nonviolent protesters, and then arrest the demonstrators. The all-white, volunteer Rescue & Fire Company (RFC) is a major civic institution. It runs the swimming pool and skating rink on a segregated, white-only basis, and those facilities become targets of CNAC protests. In retaliation, the RFC threatens to deny ambulance service to Blacks.
Howard University graduate Gloria Richardson is drawn into CNAC by her daughter Donna, one of the main high school activists. Gloria soon becomes CNAC's most prominant leader. Throughout the Southern Freedom Movement, women play significant leadership roles, but men typically hold the prominant positions. That is not the case with CNAC, which is primarily led by women at all levels. In the spring of 1962, Gloria and Yolanda St. Clair are sent by the community to attend a SNCC conference in Atlanta, and CNAC becomes a SNCC affiliate.
By the end of summer, most Cambridge eating facilities are still segregated as are entertainment venues such as the movie theater and skating rink. Protests taper off when school resumes in the fall, and CNAC begins deep organizing down at the grassroots, developing activists and leaders throughout the 2nd Ward, and broadening its base among poor and working class Blacks.
Said one unemployed Black war veteran: "Here if you are a colored person and go looking for a job, they tell you they only want skilled workers. If you have the particular skill, the vacancy suddenly 'has been filled.'" Said another unemployed Black man, "Things for us can't get any worse. We have nothing to lose and maybe something to gain by backing [CNAC]. I don't have anything but time and my life to give to the Movement. I'm willing to give both if necessary."
To the dismay of the traditional upper-class Black elite — long accustomed to being the community leaders — CNAC adds a factory worker and a welfare recipient to its executive committee rather than additional ministers, a move that signals CNAC's committment to the issues and priorities of those at the bottom of the economic ladder. And CNAC rejects the gradualist, conciliatory, approach favored by the Black elite.
So that was the environment that made recruiting for a job in Cambridge more difficult.
It so happened that my best friend was dating the daughter of Erik Cripps, a British photographer who lived on the remains a plantation on the Miles River. The estate had a number of buildings including an old chapel that had been renovated into a living area that included a loft space for a bedroom. There was a large dock into the River that we were able to use for boating and crabbing. Also, Mr. Cripps was gone for the summer and we had the occasional use of the large estate house with multiple bedrooms.
Molly and I married in August and the estate house was the scene of a party that lasted for more than 24 hours. I only make it through the first 16 and when I awoke I ran into two characters, David and Russ who had been drinking the entire night. When I bumped into them in the kitchen, they clinked their glasses with my coffee cup and gave the toast: "To the loneliness of the long-distance drinker."
It was an idyllic 10 to 12 weeks. Lots of time off living in a beautiful location on water encouraged a constant stream of friends visiting from Baltimore. Kristin, aged 3, at the time joined us and proceeded to run around as a nudist for a few weeks, only dressing up when a red-haired teen-ager would appear one or two mornings a week to ride his motorcycle and cut the grass. I applied for graduate school at the University of Maryland and they accepted me as a "Special Student." They would look at my performance in a few courses before making a decision about admitting me to their computer science department to work toward the doctoral degree.
In addition to the party aspects of my life, I was also starting a new job, the first one outside of a training environment. My one contact there was Dr. James "Jimmy" McCarter who was at least 8 years my senior and was highly recommended by Nurse Evelyn Wade, M.D. as a very bright, excellent physician. To some extent, this colorful physician took me under his wing and gave me the lay of the land and told me of the people I'd best avoid.
He described himself as moving to the community as a new surgeon and deciding to operate on his own wife's appendix rather than having the other surgeon in town do the case. McCarter said that he knew that he was stepping on a political beehive but he said that he felt that his wife's safety was his primary concern and that if the procedure were to be done in Cambridge, then he would have to do it himself.
There was still talk about him locally because of his arrest for performing abortions at a time when the Maryland law was about to change, but still wasn't there. Rumors had it that Nursing Students at Johns Hopkins had managed to find safe abortions in a hospital environment in Baltimore for many years, but I had friends who in 1966 and 1970 had to go the "back alley route." Anyone who remembers those days is unlikely to wish to return to them. It is interesting that there is a book "End of the Road" by John Barth who was raised in Cambridge, Maryland that deals with some of those issues. It was written in 1954 and I think it is among his best work.
Dr. McCarter spoke about his abortion arrest. He was not ashamed of it and looked upon it as a part of his obligation to his patients. He then described, the Internal Revenue Service auditing his practice shortly thereafter. The state wasn't really able to silence him through the medical board and medical practice act. The internal revenue service had been called upon to do the execution.
However, he escaped their clutches. "You know, Eric, I kept a log of each abortion that I did, the amount charged and the amount received. I paid taxes on all of that income." He smiled and said "You can do almost anything that you want in the United States, as long as you give the Government its fair share. Remember that no matter what you do."
Some of the practices that I saw in Cambridge bothered me. One time there was a cardiac arrest in the operating room. The nurses ran to tell me about it. When I got there, the patient was without a heartbeat but no one was doing chest compression. The anesthesiologist was still masked at the patient's head and giving him oxygen by ambu bag ("bagging the patient"). However, the surgeon was still suturing the gall bladder wound incision rather than doing chest compression. I had to say, "Excuse me doctor, in order to get past the surgeon to the patient to do CPR."
Another incident occurred one evening in the emergency room. A young African American came to the emergency room by ambulance. In a motor vehicle accident, a one-car rollover, he had sustained a through and through vertical laceration of his left ear that extended from the top edge, the helix, almost to the tragus. The top of th ear was diced in half.
The surgeon had a faint smell of alcohol on his breath at the time that he arrived but there was no evidence of speech slurring or clumsiness. Many people in the area had a drink with dinner, so alcohol on a physician's breath at 6:30 PM when he was not really "on call" would not have been out of the ordinary. I asked if it would be wiser to send the fellow to plastic surgeon a few miles up the road in Easton. "No...this won't be bad."
I was still on call and was interested. I knew the ear was very tricky and that the cartilage was hard to preserve. If the cartilage dies, the ear rolls up like a cabbage...a boxer's ear. As the surgeon prepared the wound he began a paternalistic conversation about the auto accident itself. The kid had a heavier smell of alcohol on his breath and claimed that a deer had stepped out of the shadows. "A deer!," said the surgeon, "I might have guessed."
The surgeon used no anesthesia. I expected the surgeon to close the wound in three layers--fine sutures to reapproximate the cartilage itself and then separate suturing of the front and back skin. So the three layers would be 1. back skin 2. cartilage 3. front skin. However, the surgeon repaired the ear as a single layer. The needle and suture material passed through all three layers. At the time and as inexperienced as I was, I knew that this was a sadistic man doing a very sloppy repair that was destined to leave severe scarring for life. I felt powerless.
I had a wonderful case that I still reflect upon from time to time. A middle aged couple was travelling back from the beach at Ocean City to the D.C. area on a Monday afternoon. She had chest pain on the highway and her husband drove her to the Cambridge Hospital. She arrested as soon as she was brought into the treatment area. However, she responded quickly to oxygen and defibrillation and resuscitated easily. I had never seen anyone come in from the street and respond so quickly.
Even more interesting and memorable was her husband. This was a time before I had extensive psychiatric training. He seemed to be blase about his wife's condition. He nodded appreciatively at the good news about her improved condition, but he was anxious to tell me about his new invention which promised almost limitless energy. "Of course there is no such thing as a perpetual motion machine--that would violate the second law of Thermodynamics," he said. I nodded in agreement.
http://en.wikipedia.org/wiki/Second_law_of_thermodynamics
He proceeded to tell me that it was possible to begin tapping the rotational energy of the earth. He was so glib and so positive that I sat there not sure if he were delusional or really on to something. Remember, many pioneers in science and engineering had been considered crackpots at the time they expounded upon their thinking. Unfortunately, Crackpot! A delusion.
I had counted on this job in the emergency room to last me through the fall. That was the agreement on July 1--continued employment on weekends after the tourist season. I was promised 2 or 3 weekends of work a month. This would carry us through the basic expenses while Molly and I attended classes.
However, there was an incident around labor day that ended my relationship with the hospital.
It started with an ambulance call about a drowning in a quarry or swimming hole. The rescue crew was on the way to the hospital and stated that the patient had a pulse at one time in the ambulance but that they had lost it. I asked the nursing supervisor to get the crash cart into the treatment room. Then we waited for the ambulance.
At the time of the patient's arrival, the history we had was that the patient had been in the water for around 20 minutes before being found and that he was pulseless at the scene. The ambulance crew reported a pulse in route but there were no observed respiratory attempts. There was no specific history of attempts at CPR. We started CPR immediately but it was not possible to move air by either mouth to mouth or bag. I couldn't feel anything in the mouth that was obstructing airflow. I needed to pass a laryngeal airway.
I turned to get a laryngoscope and the airway from the crash cart. It was still locked. I looked at the nurse. She said, "We can't find the key to the crash cart."
I couldn't believe it. I said "Get a fucking axe and break the lock and open the crash cart." At least a minute went by. A fireman was able to find a crowbar and break the lock on the cart. As soon as the cart was opened, it was like a jack in the box...it seemed as if a hundred 4" x 4" bandages jumped at least 3 feet.
I found the laryngoscope...there was no light. Batteries were dead. There were no extra batteries on the cart. Someone found a flashlight and scavenged the batteries. The laryngoscope bulb did work and I passed the endotracheal tube. There was no visible large obstruction but the airway resistance was incredibly high and I could not ventilate him. The ekg monitor had been a flat line since arrival. The man was dead and probably dead for some time.
I believed it most likely that the "pulse" noted in the ambulance was an error. It is notoriously difficult to detect pulses in moving vehicles traveling at high rates of speed over rough roads.
Nothing attracts crowds like an attempt at CPR. We had loads of hospital staff there plus the volunteer fire department. It was an embarrassing attempt--shameful in 1970. This case would be a source of gossip in the community for next few days. Anyone with any medical knowledge would know that this was abysmal medical practice. I thought that the victim being a black male made the matter that much worse. "Maybe even whitey doctors don't care."
A couple of weeks later, the hospital chose to fire me for the use of the f* word in that incident. They wouldn't acknowledge their own negligence in the debacle. I had used the crash cart on a few occasions and never had problems before. After that incident I have made it a practice to check the crash cart myself before any shift done in an emergency room where I work.
For Molly and me, our expected source of income was suddenly gone. I scrambled around to find other work. For physicians, it's not always so easy. Approval by hospital governing boards can take time and emergency room schedules are often constructed months in advance. There was some intermittent work in a local emergency room where I had a contact, but it wasn't steady enough to pay the bills.
I loved my course work at the University that looked at the foundations of computing, linear programming, operations research, and modern algebra, but it was starting to feel like my first year of medical school where I was too broke to continue to go to classes.
Molly and I took a trip to Burlington, Vermont to visit my friend Allen Leadbetter. He told me that Larry Week, M.D., the father of the problem-oriented medical record, had a large computer project attempting to automate the medical record. I managed to visit with Dr. Weed. The work was impressive with early use of touch screens to make selections for data input. Although he had no available work, he gave me a list of contacts in the Washington, D.C. area--people working on medical computing applications.
I returned home to Baltimore made some calls. I was invited to Rockville, Md. and the Public Health Service for an interview where I met my next mentor, Bruce Waxman, Ph.D. (**), the author of "Computers in Biomedical Research." This turned out to be a love-hate relationship that lasted for a couple of decades. As I write this, I really can't remember why we never spoke after about 1985 (okay, it just came to me!). Anyway, he was one of a kind, a remarkable personality. I'm sure that he received a great deal of the anger that I felt toward my father. He dealt out his own brand of shit in return, the origin of which I'm less sure of.
At any rate, Bruce Waxman was in a position that allowed him personal access to nearly everyone involved in medical computing. Why? Because he exercised a significant amount of control over a stream of funding from the Public Health Service for persons doing technology innovation in medical care delivery.
Bruce had Bucks!
He also combined the thinking of a visionary with Mandarin-class understanding of the NIH bureaucracy. If you wanted to go to California to examine several ongoing projects, Bruce could find a way for you to go and to take your wife as well for the cost of the second plane ticket.
Bruce had bucks and Bruce had balls!
It was an exciting time in my life.
** explanation later
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medical *
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It was a good day until late afternoon on Wednesday. Dr. Palchak recommended that I use Glutamine regularly as a prophylaxis against peripheral neuropathy. I looked at the information online. It appears that the NIH did a study that showed no benefit. However, there appears to be no harmful side-effects and I'm going to give it a try.
At around 5 PM I had another episode of chills, much milder than a few days ago. I took a nap and awoke with a low grade fever and some pain in the right shoulder and neck which responded to a boost in ibuprofen. I'm keeping my fingers crossed that I don't have any problem that will jeopardize receiving chemotherapy on Friday.
Internship Ends
Internship ended on June 30, 1970. Richard Fisher was continuing on at South Baltimore General in Internal Medicine. Tom Shawker, my roommate was off to continue training in radiology. I'm the only one who decided to opt out of further medical training. The advantages of leaving were more money than training wages, an opportunity to reduce my work week to 40 hours from 80 hours with an increase in my opportunities for sleep, and the chance to begin a new career path that was non-standard and for which there were no models. I intended to use my medical training to work a part-time job at relatively high wages while obtaining an advanced degree in Computer Science.
Just as most computer programmers of the time, I was self-taught. I had worked for a brief time at the NASA facility in Greenbelt, MD and had the opportunity to learn a programming language. When I moved on to Android and Jimmie Osborn, I was being tutored by a man who had begun his career punching cards and hard wiring IBM sorting machinery in the Navy at age 18. At the time, I would venture that mathematicians as a class tended to look down on computer programming as a pedestrian, non-creative occupation.
While a junior in medical school, I had done a rotation in psychiatry at the University of Maryland and had run across Malcolm, a genius mathematician with the fixed delusion that he had created the world during an episode of vomiting. There was no doubt that he was extremely bright, almost certainly genius-level IQ. I was assigned to his team of caregivers for 4 weeks and he took a liking to me. Malcolm had entered college at age 12 or 13 and stopped attending any formal classes before his 16th birthday. Now age 26, he taught courses involving the "theory of problem solving" and "heuristics." Naturally, he was someone who fascinated me. Here is the wiki link should you be interested in learning something more about his area of interest.
http://en.wikipedia.org/wiki/Heuristic
Malcolm insisted on playing chess a couple of times a week and I was a very weak opponent. He often said to me: "Sohr, you lack imagination." Once I asked him if he thought there was any hope for me in spite of that and he just laughed.
At the end of internship, I had spent five years of my life in formal medical training. Much of it was interesting, but these years had ground me down. I was 27, married and divorced and about to marry again. Family responsibilities had reduced the amount of time and energy available for medicine. As I think about this, my cancer is draining away my muscle mass much as medical education consumed the decade of my 20's.
Now, at the end of my internship, I was looking forward to a jump in wages and a reduction in work responsibility that would make life more pleasant. In addition, I was about to become a student in a field that excited me intellectually in a way that was different than medicine. I would wake up some parts of my brain that had not exercised much for the previous few years.
On the down side, I would be making enough money such that alcohol was always available in my budget. Also, I had recently been introduced to marijuana and I was fascinated with the notion of altered states of consciousness. Books like "Doors of Perception," "The Island," and Timothy Leary's work on programming LSD experiences, had sparked my interest in the "mystical" possibilities of psychedelic drugs.
I had been introduced to marijuana at the end of my third year of medical school when my wife brought back a couple of joints from her trip to California to meet a nursing school girl-friend. (She also brought back the telephone number of some guy that she had met there and she seemed to reach a new level of verbal criticism directed at this "getting-fat" man who greeted me in the mirror every morning.)
I kept trying marijuana and had actually came to believe that it must be the "emperor's new clothes." For the first 7 or 8 times, I didn't feel a thing. Then in March or April of 1969 I found myself in an IHOP in Baltimore talking to my friend Michael. I was in the middle of a complaint about the lack of effectiveness of the joint when I happened to look at my fork, which was loaded with several tiers of pancakes and dripping with raspberry syrup. I put the fork down and looked again and burst out laughing.
There was more opportunity for experimentation when working as the intern in the emergency room where the schedule was two 12 hours shifts on consecutive days followed by a full day off.
Why, you ask? What did marijuana do for you? At least initially, it seemed to give me "time." The rush of my schedule had abated. I could lie back and listen to music without constantly worrying about the next thing on my schedule of tasks. I could bake bread with Molly and have several laughs while kneading the dough.
As I'm thinking about this now, Rhapsody in Blue comes to mind. An experience with Marijuana seems like the first minute or so of the work. It is slow but alive, like a cat stretching out her muscles. As the music continues, one enters a much busier world, not one that feels chaotic, but is filled with activity--analogous to the every day work world. If you'd care to hear what I mean, you can try:
http://www.youtube.com/watch?v=1U40xBSz6Dc
I particularly liked the time distortion with marijuana. For me it packed an hour of relaxation into a few minutes. Music came alive again. I hadn't really "listened" to music while I was in medical school. It had lost the importance of the shared experience with friends in grade school and with dances in high school. But now with marijuana, it had returned in spades. And there was so much good stuff out there in 1969! Marijuana seemed to help me align my mood with the music. Molly was very much into music. I remember spending a Sunday afternoon with her after I had smoked something and listening to a Donovan album that moved me beyond words with its beauty. It probably helped that I was falling madly in love with this deep, intelligent woman with the incredibly biting sense of humor.
My perception of the spiritual side of the drug experience was probably an attempt to replace the loss that I was experiencing in my continuing attempts to push the Catholic octopus out of my thinking.
A New Job
The city of Cambridge, MD was having difficulty recruiting a physician for its emergency room in the summer of 1970. Barak Obama would say that it was on the wrong side of history in 1960. It acquired notoriety during the Civil Rights struggle when the courthouse was bombed.
http://en.wikipedia.org/wiki/H._Rap_Brown
Maryland was a slave state and the Mason-Dixon line which separated slave-holding states from free states during Lincoln's era ran along the northern border of the state.
For such a geographically small area, Maryland has a variety of topography and shares the Chesapeake Bay which actually has more miles of coast line than California. It was settled by Catholics at St. Mary's City on the Potomac River in 1632. It was the 4th British colony. Shortly thereafter, Protestant dissenters sailed to Smith Island in 1634 and formed the community where I would practice medicine for a few years and where I hope to have some of my ashes scattered.
The religious wars in England were echoed in Maryland with bloodshed on both sides. When we look at the intolerance that appears as doctrine in some version of Islam, we can see corresponding insanity in Christianity, even during our American colonial period.
German migration into Maryland became significant in the 18th century and by the time of the Civil War, a German language newspaper had the 2nd or 3rd most numerous circulation. The Germans were not slave holders and the State became divided over political lines, the eastern and southern most parts of the state being slave holding, while the northern and western parts were not. Some opponents labelled Abraham Lincoln a tyrant based upon the Federal occupation of Baltimore in May 1961 and martial law was declared throughout the state.
Suffice to say that Maryland was deeply divided by the civil war. The villain of the era, John Wilkes Booth, was a Marylander as were most of the conspirators in the Surratt house where the plot was hatched that resulted in Lincoln's assassination.
In the 1950's a bridge was built across the Chesapeake Bay that made it possible for people on the Western Shore (including Washington, D.C. and Baltimore) to drive to the sea at Ocean City, Maryland in about 3 to 4 hours. Prior commutes had required driving around the Bay or using a Ferry service. This opened up tourism to the Eastern Shore, an area that looked more like Selma, Alabama than Baltimore with respect to differential treatment of blacks and whites. Refusal of restaurant seating to blacks was common all along Route 50, the major corridor to the coast. Freedom rides to integrate restaurants were begun.
Here is a selection from http://www.crmvet.org/tim/timhis61.htm that illustrates some of that history.
Cambridge MD — 1962
See Desegregate Route 40 Project for background and previous events.Cambridge MD is a small industrial town on the Easternshore of Chesapeake Bay. Racism and segregation are far more virulent on the Eastshore than in the urban areas around Baltimore or the western portion of the state, a condition of long historical standing — at the time of the Civil War it was said that the Easternshore was slave-holding Dixie, while the area to the west of Baltimore was practically Pennsylvania.
Cambridge is the capitol of Dorchester County. In 1960 one-third of Cambridge residents are Black, all of whom live in the 2nd Ward which has been represented for six decades by the only Black on the five-member City Council. There are three Blacks on the police force, but they are limited to patrolling the Black neighborhood and are not allowed to arrest whites anywhere. The schools are segregated, with Black schools receiving half as much funding as those attended by whites. All lunch counters, cafes, churches, and entertainment venues are segregated. The local hospital does not admit Blacks who have to travel to Baltimore two hours distant by car (longer by bus). Nor do Black doctors have privileges at the segregated Johns Hopkins hospital.
By 1962, Cambridge has fallen on hard times. The city's major manufacturer, a food-processor, has closed its Cambridge plants and the jobs are gone. For whites, unemployment is over 7%, twice the national average, and Black unemployment is a devastating 29%. Two of the remaining factories, both defense contractors, have a tacit agreement with their white workers and the city council — the companies will not hire Blacks in return for the workers rejecting any attempt at unionization. Under Federal poverty regulations, Dorchester County is in the same category as Appalachia.
By the end of 1961, efforts to desegregate public accomodations along the highways between Washington and the north have largely succeeded. Led by Clarence Logan and other Morgan State College students, Baltimore's Civic Interest Group (CIG) — a SNCC affiliate — begins sit-ins and freedom rides in towns on Maryland's Easternshore.
In January of 1962, CIG/SNCC organizers Reggie Robinson and Bill Hansen arrive in Cambridge. Protests commence in Cambridge with 100 activists marching downtown to desegregate various establishments. Half of the protesters are Cambridge high school students, the other half are students mobilized by CIG from Morgan State and Maryland State Colleges, along with a few white supporters from Johns Hopkins. Some of the demonstrators are arrested. Hostile whites jeer, and in some cases, assault them. Bill Hansen is beaten by a mob and then arrested for "Disorderly Conduct." The Cambridge Mayor blames the violence on "outside agitators," and calls Hansen a "professional integrationist."
More than 300 Black residents attend a mass meeting that night at Waugh Church to show support for the protesters, and in the following days they found the Cambridge Nonviolent Action Committee (CNAC) — pronounced "See-Nack" — to support and continue the protests. Frederick St. Clair and Enez Grubb are elected CNAC co-chairs at a mass rally. A week after the first protests, CIG and CNAC organize a second "freedom ride" into Cambridge, this time including supporters from CORE, SNCC, Northern Student Movement (NSM), Black students from Howard University, Morgan, Lincoln, and Maryland State Colleges, and white students from Swarthmore, Haverford, and Bryn Mawr. Again white vigilantes attack some of the protesters, again Bill Hansen and others are beaten, and again Hanson and others are arrested. White students are beaten more than Blacks.
Penny Patch, a white student from Swarthmore, recalls "Everyone sang, the songs bound us together and made us strong. [The white mob] gathered around us, screaming, waving baseball bats. I was scared. But I also drew enormous strength from the songs we sang." She later goes on to become a full-time SNCC field secretary in Albany Georgia and the Mississippi Delta.
CIG expands the freedom rides and sit-ins to other Eastshore towns such as Chestertown, Princess Ann, Salisbury, and Easton, an effort that evolves into the Maryland Easternshore Project" a summer campaign of CIG/CNAC. Meanwhile, CNAC continues demonstrations in Cambridge, relying on local high school students led by Donna Richardson, Lemuel Chester, Dinez White, and Dwight Cromwell. For awhile, Edward Dickerson, a local white student, defies family and community to take part in CNAC protests. His parents kick him out of their home and threaten to commit him to a mental institution.
Maryland Governor Tawes asks the legislature to pass an anti-discrimination bill to end segregation in public accomodations throughout the state. But Easternshore legislators weaken the bill by allowing counties to exempt themselves. In other words, Easternshore counties like Dorchester where segregation is widespread can choose to ignore the law. In Cambridge, the police allow white racists to beat nonviolent protesters, and then arrest the demonstrators. The all-white, volunteer Rescue & Fire Company (RFC) is a major civic institution. It runs the swimming pool and skating rink on a segregated, white-only basis, and those facilities become targets of CNAC protests. In retaliation, the RFC threatens to deny ambulance service to Blacks.
Howard University graduate Gloria Richardson is drawn into CNAC by her daughter Donna, one of the main high school activists. Gloria soon becomes CNAC's most prominant leader. Throughout the Southern Freedom Movement, women play significant leadership roles, but men typically hold the prominant positions. That is not the case with CNAC, which is primarily led by women at all levels. In the spring of 1962, Gloria and Yolanda St. Clair are sent by the community to attend a SNCC conference in Atlanta, and CNAC becomes a SNCC affiliate.
By the end of summer, most Cambridge eating facilities are still segregated as are entertainment venues such as the movie theater and skating rink. Protests taper off when school resumes in the fall, and CNAC begins deep organizing down at the grassroots, developing activists and leaders throughout the 2nd Ward, and broadening its base among poor and working class Blacks.
Said one unemployed Black war veteran: "Here if you are a colored person and go looking for a job, they tell you they only want skilled workers. If you have the particular skill, the vacancy suddenly 'has been filled.'" Said another unemployed Black man, "Things for us can't get any worse. We have nothing to lose and maybe something to gain by backing [CNAC]. I don't have anything but time and my life to give to the Movement. I'm willing to give both if necessary."
To the dismay of the traditional upper-class Black elite — long accustomed to being the community leaders — CNAC adds a factory worker and a welfare recipient to its executive committee rather than additional ministers, a move that signals CNAC's committment to the issues and priorities of those at the bottom of the economic ladder. And CNAC rejects the gradualist, conciliatory, approach favored by the Black elite.
So that was the environment that made recruiting for a job in Cambridge more difficult.
It so happened that my best friend was dating the daughter of Erik Cripps, a British photographer who lived on the remains a plantation on the Miles River. The estate had a number of buildings including an old chapel that had been renovated into a living area that included a loft space for a bedroom. There was a large dock into the River that we were able to use for boating and crabbing. Also, Mr. Cripps was gone for the summer and we had the occasional use of the large estate house with multiple bedrooms.
Molly and I married in August and the estate house was the scene of a party that lasted for more than 24 hours. I only make it through the first 16 and when I awoke I ran into two characters, David and Russ who had been drinking the entire night. When I bumped into them in the kitchen, they clinked their glasses with my coffee cup and gave the toast: "To the loneliness of the long-distance drinker."
It was an idyllic 10 to 12 weeks. Lots of time off living in a beautiful location on water encouraged a constant stream of friends visiting from Baltimore. Kristin, aged 3, at the time joined us and proceeded to run around as a nudist for a few weeks, only dressing up when a red-haired teen-ager would appear one or two mornings a week to ride his motorcycle and cut the grass. I applied for graduate school at the University of Maryland and they accepted me as a "Special Student." They would look at my performance in a few courses before making a decision about admitting me to their computer science department to work toward the doctoral degree.
In addition to the party aspects of my life, I was also starting a new job, the first one outside of a training environment. My one contact there was Dr. James "Jimmy" McCarter who was at least 8 years my senior and was highly recommended by Nurse Evelyn Wade, M.D. as a very bright, excellent physician. To some extent, this colorful physician took me under his wing and gave me the lay of the land and told me of the people I'd best avoid.
He described himself as moving to the community as a new surgeon and deciding to operate on his own wife's appendix rather than having the other surgeon in town do the case. McCarter said that he knew that he was stepping on a political beehive but he said that he felt that his wife's safety was his primary concern and that if the procedure were to be done in Cambridge, then he would have to do it himself.
There was still talk about him locally because of his arrest for performing abortions at a time when the Maryland law was about to change, but still wasn't there. Rumors had it that Nursing Students at Johns Hopkins had managed to find safe abortions in a hospital environment in Baltimore for many years, but I had friends who in 1966 and 1970 had to go the "back alley route." Anyone who remembers those days is unlikely to wish to return to them. It is interesting that there is a book "End of the Road" by John Barth who was raised in Cambridge, Maryland that deals with some of those issues. It was written in 1954 and I think it is among his best work.
Dr. McCarter spoke about his abortion arrest. He was not ashamed of it and looked upon it as a part of his obligation to his patients. He then described, the Internal Revenue Service auditing his practice shortly thereafter. The state wasn't really able to silence him through the medical board and medical practice act. The internal revenue service had been called upon to do the execution.
However, he escaped their clutches. "You know, Eric, I kept a log of each abortion that I did, the amount charged and the amount received. I paid taxes on all of that income." He smiled and said "You can do almost anything that you want in the United States, as long as you give the Government its fair share. Remember that no matter what you do."
Some of the practices that I saw in Cambridge bothered me. One time there was a cardiac arrest in the operating room. The nurses ran to tell me about it. When I got there, the patient was without a heartbeat but no one was doing chest compression. The anesthesiologist was still masked at the patient's head and giving him oxygen by ambu bag ("bagging the patient"). However, the surgeon was still suturing the gall bladder wound incision rather than doing chest compression. I had to say, "Excuse me doctor, in order to get past the surgeon to the patient to do CPR."
Another incident occurred one evening in the emergency room. A young African American came to the emergency room by ambulance. In a motor vehicle accident, a one-car rollover, he had sustained a through and through vertical laceration of his left ear that extended from the top edge, the helix, almost to the tragus. The top of th ear was diced in half.
The surgeon had a faint smell of alcohol on his breath at the time that he arrived but there was no evidence of speech slurring or clumsiness. Many people in the area had a drink with dinner, so alcohol on a physician's breath at 6:30 PM when he was not really "on call" would not have been out of the ordinary. I asked if it would be wiser to send the fellow to plastic surgeon a few miles up the road in Easton. "No...this won't be bad."
I was still on call and was interested. I knew the ear was very tricky and that the cartilage was hard to preserve. If the cartilage dies, the ear rolls up like a cabbage...a boxer's ear. As the surgeon prepared the wound he began a paternalistic conversation about the auto accident itself. The kid had a heavier smell of alcohol on his breath and claimed that a deer had stepped out of the shadows. "A deer!," said the surgeon, "I might have guessed."
The surgeon used no anesthesia. I expected the surgeon to close the wound in three layers--fine sutures to reapproximate the cartilage itself and then separate suturing of the front and back skin. So the three layers would be 1. back skin 2. cartilage 3. front skin. However, the surgeon repaired the ear as a single layer. The needle and suture material passed through all three layers. At the time and as inexperienced as I was, I knew that this was a sadistic man doing a very sloppy repair that was destined to leave severe scarring for life. I felt powerless.
I had a wonderful case that I still reflect upon from time to time. A middle aged couple was travelling back from the beach at Ocean City to the D.C. area on a Monday afternoon. She had chest pain on the highway and her husband drove her to the Cambridge Hospital. She arrested as soon as she was brought into the treatment area. However, she responded quickly to oxygen and defibrillation and resuscitated easily. I had never seen anyone come in from the street and respond so quickly.
Even more interesting and memorable was her husband. This was a time before I had extensive psychiatric training. He seemed to be blase about his wife's condition. He nodded appreciatively at the good news about her improved condition, but he was anxious to tell me about his new invention which promised almost limitless energy. "Of course there is no such thing as a perpetual motion machine--that would violate the second law of Thermodynamics," he said. I nodded in agreement.
http://en.wikipedia.org/wiki/Second_law_of_thermodynamics
He proceeded to tell me that it was possible to begin tapping the rotational energy of the earth. He was so glib and so positive that I sat there not sure if he were delusional or really on to something. Remember, many pioneers in science and engineering had been considered crackpots at the time they expounded upon their thinking. Unfortunately, Crackpot! A delusion.
I had counted on this job in the emergency room to last me through the fall. That was the agreement on July 1--continued employment on weekends after the tourist season. I was promised 2 or 3 weekends of work a month. This would carry us through the basic expenses while Molly and I attended classes.
However, there was an incident around labor day that ended my relationship with the hospital.
It started with an ambulance call about a drowning in a quarry or swimming hole. The rescue crew was on the way to the hospital and stated that the patient had a pulse at one time in the ambulance but that they had lost it. I asked the nursing supervisor to get the crash cart into the treatment room. Then we waited for the ambulance.
At the time of the patient's arrival, the history we had was that the patient had been in the water for around 20 minutes before being found and that he was pulseless at the scene. The ambulance crew reported a pulse in route but there were no observed respiratory attempts. There was no specific history of attempts at CPR. We started CPR immediately but it was not possible to move air by either mouth to mouth or bag. I couldn't feel anything in the mouth that was obstructing airflow. I needed to pass a laryngeal airway.
I turned to get a laryngoscope and the airway from the crash cart. It was still locked. I looked at the nurse. She said, "We can't find the key to the crash cart."
I couldn't believe it. I said "Get a fucking axe and break the lock and open the crash cart." At least a minute went by. A fireman was able to find a crowbar and break the lock on the cart. As soon as the cart was opened, it was like a jack in the box...it seemed as if a hundred 4" x 4" bandages jumped at least 3 feet.
I found the laryngoscope...there was no light. Batteries were dead. There were no extra batteries on the cart. Someone found a flashlight and scavenged the batteries. The laryngoscope bulb did work and I passed the endotracheal tube. There was no visible large obstruction but the airway resistance was incredibly high and I could not ventilate him. The ekg monitor had been a flat line since arrival. The man was dead and probably dead for some time.
I believed it most likely that the "pulse" noted in the ambulance was an error. It is notoriously difficult to detect pulses in moving vehicles traveling at high rates of speed over rough roads.
Nothing attracts crowds like an attempt at CPR. We had loads of hospital staff there plus the volunteer fire department. It was an embarrassing attempt--shameful in 1970. This case would be a source of gossip in the community for next few days. Anyone with any medical knowledge would know that this was abysmal medical practice. I thought that the victim being a black male made the matter that much worse. "Maybe even whitey doctors don't care."
A couple of weeks later, the hospital chose to fire me for the use of the f* word in that incident. They wouldn't acknowledge their own negligence in the debacle. I had used the crash cart on a few occasions and never had problems before. After that incident I have made it a practice to check the crash cart myself before any shift done in an emergency room where I work.
For Molly and me, our expected source of income was suddenly gone. I scrambled around to find other work. For physicians, it's not always so easy. Approval by hospital governing boards can take time and emergency room schedules are often constructed months in advance. There was some intermittent work in a local emergency room where I had a contact, but it wasn't steady enough to pay the bills.
I loved my course work at the University that looked at the foundations of computing, linear programming, operations research, and modern algebra, but it was starting to feel like my first year of medical school where I was too broke to continue to go to classes.
Molly and I took a trip to Burlington, Vermont to visit my friend Allen Leadbetter. He told me that Larry Week, M.D., the father of the problem-oriented medical record, had a large computer project attempting to automate the medical record. I managed to visit with Dr. Weed. The work was impressive with early use of touch screens to make selections for data input. Although he had no available work, he gave me a list of contacts in the Washington, D.C. area--people working on medical computing applications.
I returned home to Baltimore made some calls. I was invited to Rockville, Md. and the Public Health Service for an interview where I met my next mentor, Bruce Waxman, Ph.D. (**), the author of "Computers in Biomedical Research." This turned out to be a love-hate relationship that lasted for a couple of decades. As I write this, I really can't remember why we never spoke after about 1985 (okay, it just came to me!). Anyway, he was one of a kind, a remarkable personality. I'm sure that he received a great deal of the anger that I felt toward my father. He dealt out his own brand of shit in return, the origin of which I'm less sure of.
At any rate, Bruce Waxman was in a position that allowed him personal access to nearly everyone involved in medical computing. Why? Because he exercised a significant amount of control over a stream of funding from the Public Health Service for persons doing technology innovation in medical care delivery.
Bruce had Bucks!
He also combined the thinking of a visionary with Mandarin-class understanding of the NIH bureaucracy. If you wanted to go to California to examine several ongoing projects, Bruce could find a way for you to go and to take your wife as well for the cost of the second plane ticket.
Bruce had bucks and Bruce had balls!
It was an exciting time in my life.
** explanation later
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