medical *
***************
It's Tue Dec 6 at 9:30 PM as I begin this. Jasmine and I traveled to Redwood City to a Stanford Imaging Center for CTs of the Chest, Abdomen, and Pelvis. I found it incredibly tiring. On the way back we stopped at a Chevy's Fresh Mexican restaurant in Gilroy, the garlic capital of the world. We were home about 5 PM and I've slept almost all of this time.
I obtained a CD of the scans and I've looked around but can't be sure what I'm looking at much of the time. However, the lesions in T2 appear to have now occurred in T1. I don't see any difference in the lung. I'm supposed to see Dr. Palchak WED and I'll take the scan to him.
I'm currently taking Oxycontin 10 mg twice a day with supplements of oxycodone 5 mg and tylenol or advil four times a day.
By the way, Anonymous, from a comment on 12/5/11. I really do appreciate those kind words, but I would like to send you a box of adjectives for Christmas so that you can dial me in a little more realistically. Please let me know your email address.
Wed at Dr. Palchak
He notes the new findings in the Spine but points out that the lung mass is no larger. He indicates that differences between the scans doesn't allow him to say exactly whether the tumor in the chest has gotten smaller, but definitely not larger.
Now, it's Friday and I'm at Stanford sitting in the infusion room. I started a burst of the steroid decadron yesterday and I Feel GRREATTTT! So, good that I drove the RV here this morning. My lab work was good. My shortness of breath continues but I was able to look at my pulse oximeter while jogging in place. The oxygen content in my blood never dropped below 94% but my heart rate went up to 135 or so. If the pulse ox had dropped significantly, it might have indicated "shunting" meaning that some significant amount of unoxygenated blood from the right heart was being directed to areas of the lung that were not receiving oxygen. I was afraid that I was shunting. But this didn't happen. So I've been told to get out and start exercising. Archie will appreciate that. My directions were take whatever pain meds were necessary to begin doing more exercise.
The Stanford experts reviewed my scans today. The bad news is more bone involvement at L1 and L2 and they also saw a new spot in my right scapula. There is also pain now in the mid-back consistent with the tumor in the bone. The good news is that there has been tumor regression in an abdominal lymph node and a slight regression in the size of the lung tumor.
So I was told that with new findings, the disease is labelled as "progressing." However, they believe that there is enough evidence of regression in the lymph node and lung to be hopeful.
*****************************
the well-prepared infusion patient *
*****************************
In case you are interested in my preparations for a day at Stanford, I've got a list of what is in my wheeled basket.
2 pairs of dark-colored underware (dark colored) just in case!
2 extra shirts
1 pair of jeans
1 small ice chest with 5 Yoplait yogurts, 3 peanut butter and jelly sandwiches, 3 bottles of water
1 flask of coffee
1 bipap machine with power supply for sleep apnea so I can nap while being poisoned with anticancer medications
Asus Laptop computer with power supply
I phone with charger
All of my medications, including what I need for pain but no pot
Roasted coffee for people who drive nails into your veins and doctors. I want them all invested in my continued appearances at regular intervals.
What to wear.
Redskin wool cap
crocs no sox
shorts--easier to deal with for exams
knit shirt -- easy to remove
photographer vest with too many pockets
heavier jacket (NFL Redskin starter given to Keith 20 years ago and appropriated when he left home)
lots of napkins for my nose that runs so easily since I have lost all of my nasal hair
For the car.
Several maps and google instructions
An FM radio transmitter that dials in an unused FM station for my Iphone's Ipod
An inverter that lets me plug into 12 volt and charge any appliance such as laptop and Iphone.
Saturday Dec 10.
It's 11 PM. I've had a good day. Only immediate side-effect is loss of taste for food.
I'm reducing steroids by half today and will do the same the next two days until off.
I've been given the go-ahead to exercise. I happen to have an electric-assist bike that I used to commute the twelve miles to work at the prison. It has been sitting idle since September. I peddled around the neighborhood for about a half hour and then went to see Mark Ward, M.D. who does geriatric internal medicine in our county. He is the medical director of one of the hospices--the one I think that I will need. I had been working with him in nursing homes for the past year.
We had a cup of coffee and got into the deep of losses of parents. He was talking about his Dad and the feeling of sadness at not having the chance to speak with him before his death. We had a little cry together. I love Mark. He is a wonderful guy, an electrical engineer before moving to medicine.
We both have Sprinter Vans. I told him that I had thought about being buried in mine but that the EPA would probably object to a full tank of diesel fuel being stuck in ground in less that a million dollar container. He loves his van, too. He agreed and suggested that there should be a place for the man with his "vessel" whether a ship, boat, plane, van, or car. In other words, a cemetery that understands and honors such requests. Clearly, such a place will require a lot of land. Maybe somewhere in the Mojave between Barstow and Las Vegas. He suggested that this final resting place might actually fit into the definition of palliative care. Would Medicare reimburse?
While I was there, his daughter, Hattie Mae, was eating her Buckwheat pancakes. She is about 11 months and she brought me a pancake and handed it to me. I wasn't sure what she wanted. I thought about just eating it, but thought better of that and just took a bite and handed it back to her. She smiled and ran off and brought me another and ran off leaving it with me. I did eat that one.
Later I was thinking about this interaction in the car with Jasmine and remarking that I hadn't run across a discussion of this kind of behavior from Hattie Mae anyplace and, yet, it represented "sharing" an important social interaction. How should I have handled it? Well, Jasmine has been an internist, an anesthesiologist, and a community pediatrician in Britain before coming to the U.S. to train in psychiatry. She gave me this wonderful analysis.
"It would probably be better to thank her and pretend to take a bite and to chew and to enjoy it. Depending on the parents, they might not want her to be trading saliva with you. So a game is the safest way." Does this give you any idea of why I love being with this wise woman? This is just off the top of her head.
We also talked about a change in her perspective about my condition--that with the rapid weight loss and cough in September, she felt that there was a very rapid downhill course, but that things are looking a little better now. The thought of extending my future presents certain other problems, like what to do with more time. Jasmine says "just love your wife and your children." (by that she means the human, canine, and feline).
I'm still wrestling with the mixed information that I received yesterday--I can look at it as the "joker" trying to chip away at my current sense of finality and peace with a very short future. If I am fortunate enough to be in the 25% to survive the first year, I'll have to do something more than prepare for death in weeks or months. One of the advantages of a quick death is a quick loss of some sense of responsibilities.
So, I'm going to try to get off my butt and find a little bit of work. I'm the only psychiatrist in the county that accepts Medicare as insurance and I know that there is a lot of need out there. Maybe I can find two or three hours of work a week to start.
Billings MT 3
For at least 3 of our 5 years in Billings, Molly's sister, Debbie, stayed with us. She was good company, generally cheerful and great with the children.
I worked as an independent contractor with the hospital and I found them to be good people to work for.
 |
| Despite a front page Sunday article in the local daily, there was no demand. I scrapped the business after 3 months. |
Later that day, I got a call from Dr. Nelson who asked me to see him during evening rounds. It was about 7 PM when we got together and we started down to the cafeteria to get some coffee. As we walked through the administration offices, everything was dark and closed up tight. We looked at each other and burst out laughing. We didn't have to say anything. Administration workers got out of work on time. Physicians never knew when they would be done.
Lack of a fixed schedule played hell with family life. Everyone in our household was busy by 1981. Debbie was working in the hospital lab. Molly was in school with a heavy course load and cooking much of the time. The kids were in day care. I was spending about 45 hours a week in direct patient care and 10 hours a week in my automobile. I was also doing the software project with Ed Puckett. It had a corny name, LITMAS, for literature manipulation system.
In 1981 I bought a 1961 Mercedes 220 S. My vehicle had double vertical headlamps in the front rather than the headlights shown in the picture.
 |
| What a beautiful auto. A 1961 Mercedes 220 S 4 door sedan. Mine was off white with a sunroof and lots of rust. |
The first day that I drove the car to work, a truck backed into my grill and headlights at a traffic light. The cost for repair was more than $800. I settled for $400 and used the identical parts from the 1963 car. So, my initial cost was $750 less the $400 I had saved with the parts car. Accountant student that she was, Molly looked at the cars and said: "That's just the downpayment." She was right of course.
I was fortunate to live next to "Swede," a retired mechanic. He and his wife drank quite a bit and you wanted to avoid their company after about 8 P.M. when they could become verbally abusive to one another. Swede had begun working on cars since the age of 10 in Sweden during WWII. He came to the U.S. in the late 1940s and spent most of his life working as a truck mechanic all across Wyoming. He had bad coronary artery disease and polycythemia which required that red blood cells be removed on a monthly basis to thin his blood and to remove excess iron from his system.
 |
| Swede: I provided hours of amusement for him as I tinkered with an old car. |
When I met Swede he was working on a 12 cylinder Jaguar that he had picked up for a song after the 2nd engine had broken down. Swede rebuilt the engine and it blew up a again. He traced the problem to a seal that failed when the engine heated and parts expanded. He went with a flexible silicone seal and the 4th rebuild held. Before we left Billings, he had also located a BMW motorcycle that had been run into the Yellowstone River. He obtained it for salvage and was redoing it.
He took an interest in my attempt to get the Mercedes into dependable running shape. I'm someone who never remembers where he left a tool. I get so caught up in the moment that I don't think ahead. It's as if I'll never need the particular tool again. This amused Swede no end and he decided to supervise me and taught me quite a bit along the way.
I began with the brakes--it seemed reasonable to be able to stop the car. I made a list of the various pins and bolts used in the 1961 and went to the Mercedes Parts store and gave them the list. They never told me that the price would be over $500. I refused delivery and went back and cleaned up the parts that I had and only purchased replacements for the ones that were bent. I began to realize just how valuable a parts car can be. One time Swede pointed out that the rear end of the 1963 auto was worth perhaps $5000. When I laughed, he said simply: "Go try to buy one."
With Swede's help, I did get the car on the road and drove it from Montana to D.C. and back during a visit with the family. However, my uncle Bill (Navy Bill) looked at the rust and shook his head and asked who had died in the car.
The Patients
Patients in the Huntley Project were only slight gentrified when compared to their country cousins in Glendive. There was the same kind of understanding of sickness and death because of their experiences in farming and ranching. There was the same lack of entitlement and appreciation for medical care.
Linda, the Incredible Cowgirl
I had delivered her previous child and she had a normal prenatal course. I got a phone call from her early one morning that she had decided to stay home with her labor pains and had delivered her boy herself. It was a very cold, nasty day. She asked me if I could possibly come by the house to do the exam on the baby and to given the Vitamin K and the required eye treatment. I had people in the hospital and a busy day in the office and I couldn't come until after clinic. Her husband was at work and there was no easy way to get the baby to the clinic. So I agreed to come as soon as I could.
I got to her double wide trailer set on several acres. She was a real cowgirl and had competed in rodeos in South Dakota since childhood. Her husband worked at the airport. They had two or three children. She raised pugs in her home and had a stable and horses. She taught riding and roping.
When I got to the house, I could hear the dogs barking at the door bell but there was no answer. After a minute, I just walked into a mudroom. The dogs were behind a barrier to the left. The rest of the house was to the right. Her husband was sitting in the living room. The TV was blaring and he jumped a little in surprise when he saw me. He told me that his wife was out in the barn. I walked to the barn and there she was with a pitchfork in her hands breaking up a bundle of hay and distributing it. She explained that she her husband didn't like horses and that she felt more comfortable not asking him to deal with the animals.
We went inside. The baby was fine. I gave him the medications and sat with Linda over a cup of coffee. Then I examined her in the bed room. There were no tears and no bleeding. There was some colostrum and the baby was breast feeding vigorously. Oh! Those northern plains women!
The Kids
The time in Billings was probably ideal for the boys. In addition to both of their parents, they had an aunt to pester as well. I really enjoyed watching the sibling rivalry play out, like the time Brian walked through the living room and just happen to step on year-old Keith's hand as he was trying to crawl. Two years later, Brian at least had the courage to tell us in less than a few minutes that he had convinced Keith to eat a mushroom from the backyard.
 |
| Keith birth picture 1978 Glendive MT Brian shortly after birth 1975 Hagerstown MD |
Previously Brian had invented his own physician outfit that included a tupperware hat and a kitchen tool that represented his stethoscope.
 |
| Brian as the New Age Physician |
 |
| Keith with Chickenpox. He was very tough. |
One of the problems with Montana was distance. We lived on two acres and there was only one child within walking distance for routine play. They were pretty much limited to playmates who attended the same daycare center. The boys spent a lot of time with each other and to this day, they are fun to be around.
 |
| Family Portrait 1982: Clockwise Top Left, Molly, Eric, Brian, Keith |
Serious Contemplation
One night in the Fall of 1981, Swede had been feeling poorly but he had come over to kibitz. I walked him home and when I tried to trot back to my house, I became very short of breath. I was running for exercise at the time and there had been episodes afterwards where I had an irregular heart beat for less than a minute. On this particular occasion, the irregular heart beat lasted for a couple of hours. I called John Malloy, who was my partner. He saw me in the clinic and documented the Atrial Fibrillation and started me on digitalis. My arrhythmia converted within an hour, much too soon to have been from the digitalis, so I stopped it. The following day, I called the cardiology group that we used for our patients and received an appointment for an evaluation two weeks later.
I was miffed at having to wait two weeks, but it turned out to be a life-changing opportunity--to think about how I was living. If I had a significant heart problem, it would most likely be coronary artery disease. My father had a heart attack in his early 50s. My maternal grandfather had died of a heart attack at 69. Coronary artery disease was far and away the most common condition that would be found in a male 39 who had smoked heavily, ate anything he wanted, and who had rarely practiced regular aerobic exercise.
If had I had Coronary Artery Disease, bypass surgery might be recommended. That was something I would try to avoid by any means--I would change my profession and lifestyle first. As I looked at my job in my mind's eye, I saw myself trapped in a cave on a treadmill. The cave was not high enough for me to stand up--instead I was stooped forward and trying to run. The light at the end of the tunnel was so far away as to be a pinpoint.
Then I saw my marriage. I was no longer in love and there was no longer any passion. I didn't feel loved. (Of course, given my behaviors why would I think that was possible--but nevertheless, I didn't feel loved and I felt lonely.) Then I thought about my children who were 6 and 3. There were only ten or twelve years left of their childhood and I was working at a job that invariably put someone's sore throat ahead of their birthday party. I knew that the most important job in my life was my children. Where would the time for them come from?
The more I thought about it the more certain I became that I would fundamentally change my life if told that I had a serious heart problem.
The two weeks passed and the day came for a treadmill. I passed with flying colors. I went home. The kids were in daycare and Molly was at school. I made myself something to eat and went to work. When I arrived at work, the office nurse said that she had called my house and reached Molly and inquired: "How did the test go?" Apparently Molly said, "I don't know. He left before I got home. But I assume everything is alright because he left the butter out."
In a previous post I talked about Molly's sharp wit. Molly knew that I was worried about coronary artery disease and that if I had been given that diagnosis, I would have already forsworn dairy fats that same day. However, this truth didn't feel very good coming from my wife at a time when I had been worried about my health. Coupled with my mental image of feeling like I was on a treadmill in a cave, I felt like I was a laboratory rat that went to work every day so that we could pay bills, pay for daycare, and pay for Molly's education.
When I look back it seems ridiculous that someone who has trashed his marriage like I did would feel wounded by such a remark. It is an example of a narcissistic injury and the truth is that narcissists are very sensitive to perceived slights and much more likely to have such "injuries" to feelings and self-esteem. Furthermore, since narcissists are unlikely to see themselves as such, they are cannot see the truth and are more likely to carry around the "wound" and watch it fester. And I did. I believed in my heart of heart's that Molly's true feelings toward me were exactly the message that I was perceiving--and had been hidden behind the humorous riposte.
Well, I had escaped the clutches of coronary artery disease and I was free to go back to continue my life. But I was still thinking about my situation and concluded that there was something very wrong if, in the face of death, I would completely change my life. I suspected that the well-lived life would not change with a foreshortened future--one would want to see old friends and tie up lingering conversations, but there wouldn't be a need to make a major change.
Trying to Find a Way
In 1978 or 1979 Molly decided to go back to school. I asked her recently why she chose accounting and she was kind enough to reply.
I really, really wanted to study law (I always wanted to be a Supreme Court Justice) but there was no law school in Billings. So I decided that perhaps I should be practical and study something that would make me employable in the godforsaken places I seemed to end up. So I looked in the paper in Billings and there were lots of job openings for accountants--a subject in which I had little interest. But I thought a) I could certainly learn accounting (I hadn't considered the boredom factor related to taxes), b) if I had a CPA, it wouldn't matter what college I got my degree from, and c) I could always find a job in a hospital (kind of a given with your career path) with an accounting degree. And I was at least right about the employable part--although GAO* was way more excited about my English degree than my accounting degree. As someone said to me during my interviews, it is much easier to teach someone credits and debits than how to write a decent paragraph.
* GAO is General Accounting Office in 1983. I think it is now the General Accountability Office.
In 1982 Molly passed the CPA examination. She was now a professional and she wanted to work. We began to talk about our options. She was hoping that I could find a way to assume more child care responsibilities. She suggested that I consider doing emergency room work--that it paid well and there seemed to be a need.
I thought her suggestion underestimated the wear and tear of that aspect of the medical profession. I had covered emergency rooms in Charles Town and Glendive but that really wasn't the same as doing the job full-time in a large city where a hundred or two hundred patients come through the facility in 24 hours. I was no longer knowledgeable enough for that kind of practice. To do it would require additional training.
I thought her suggestion underestimated the wear and tear of that aspect of the medical profession. I had covered emergency rooms in Charles Town and Glendive but that really wasn't the same as doing the job full-time in a large city where a hundred or two hundred patients come through the facility in 24 hours. I was no longer knowledgeable enough for that kind of practice. To do it would require additional training.
It is also very stressful. To this day I have intrusive thoughts and images from my internship, such as the man who has just lost his right arm in grinder who is crying and asking how he will ever be able to work again, the worker who has just had phosphorous pentasulfide blown into his eyes and comes to the emergency room with terrible pain and a chemical sucking water out of his corneas to make Hydrogen Sulfide, or the woman whose husband has just died after collapsing in the parking lot asking "How can he be dead. We haven't even started to live." Or the baby who has aspirated a hot dog that is lodged in his trachea and that we are unable to extract in time, etc. etc. etc. more than I want to think about right now.
In fact, we had already found a way. The previous four years had benefited both of us. Molly now had a job skill that was marketable anywhere in the United States. If we went our separate ways, it would be on a more equal footing than our parting in West Virginia. What was most different was that I had no immediate need to establish myself in a career, whereas Molly was in her late 30's and needed to do so.
I'm not sure when we began to talk openly about separation but Molly had floated the idea of finding two homes within a couple of blocks of one another so that we could share child care responsibilities in the easiest possible way with the least amount of disruption for the boys. I wasn't too enthusiastic about that kind of an arrangement because it seemed to require a medium-size to large city in order to meet both of our employment needs.
I reminded Molly that when we had first started dating in 1969 she had indicated some deep fears about motherhood and made me promise that I would take responsibility for children. (I know that this was my recollection in 1983. I can't swear that it is true or that Molly would remember or agree with it's accuracy. My recollection is that she said something back about at being doable if it were within a driving distance of less than 200 miles.)
I became more interested in making a lifestyle change that would net me time with the boys.
There are two relationships that I won't discuss in any intimate details in this blog, my third and fourth marriages. I haven't asked either for permission to do so and my family is aware of most of the ups and downs associated with them.
In the spring of 1983, I had decided that I would complete my contract with St. Vincent and find other employment. There were three opportunities that I seriously considered.
Saudi Arabia
I had read a book by Hedrick Smith called The Kingdom, a recent history Saudi Arabia. I was fascinated by the idea of spending time in the desert. It was also possible for an American physician to make a very good living there, to have housing provided for the family, and to manage to avoid US Income Tax by limiting time spent in the U.S. I had not saved at money in my career and I was now turning 40. I calculated that a three-year tour in Saudi Arabia would allow me to save about $250,000 and provide the beginnings of an educational fund for the children and a nest-egg to boot. Annual pay, well over $100K and most bankable.
Family Practice Fellowship, Columbia Missouri
In 1978 I had looked at a position in the Family Practice program at the University of Missouri. It was a well run, established program. This would have provided me the opportunity for increased training and credibility and would have put me in an academic program where my interest in holistic and preventive medicine could be developed further. I didn't get the position. However, there were fellowship opportunities available in 1982 and 1983. These were available and I was offered one. Pay less than $40 K but opportunities for moon-lighting.
Smith Island, Maryland
This was a position on the last inhabited island in Maryland's Chesapeake Bay, in the poorest county in the state. This was remote. Normal ferry connections were with the Eastern Shore of the Bay and a 2 to 3 hour drive to Washington D.C., whereas Point Lookout on the Western Shore was a 2 hour drive without regular service.
However, it was within about 150 miles of Washington, D.C. and did meet the criterion in Molly's offhand remark about the an acceptable driving distance.
I investigated the situations. A job was available for 1984 in Saudi Arabia with pay close to $150K. My children were still young enough to stay with family in the Kingdom. Apparently, the Saudi's insist that children above a certain age be educated elsewhere because of possible problems between what Europeans and Americans might consider a "childhood prank" and something that Sharia law would consider more seriously. I was told that although liquor was banned in the Saudia Arabia, there were many stills operating in American homes. There would be restrictions on women driving and dress.
I traveled to Columbia and Smith Island. They were interested in Columbia and a job was mine if interested. However, when I submitted my travel voucher, I didn't like the nickel and diming process. They had agreed to my flight. I thought they owed me flight money less the D.C. portion but they wouldn't pay it. I took it as an indicator of my possible future dealings with the finance department of the University.
Visit to Smith Island, July 1983
Finally, I visited Smith Island with my daughter, Kris who was now 16. Since moving to Montana, Kris had come every summer and spent a few weeks. There were times when she asked to come to live with me but these were usually during times when she was in conflict with her mother and I always told her no. Even though her mother was a relatively persistent source of irritation to me as well, I couldn't let my daughter split us in such a fashion. Something that I "should" have done was to have taken the request more seriously and arranged a meeting between Kristin, her mother, and me and have handled Kristin's request face-to-face instead of long distance from Montana.
I think my relationship with Kristin was generally close up until the time she began started college in about 1985 and then again from the time she started graduate school in about 1992 until she died.
When she was fifteen, I asked her if she were sexually active.
"Dad, you don't have any right to ask me that question?"
"Maybe I do, if I am willing to accept any answer that you give me."
"Yes, I am."
"Are you using contraception?"
"Yes, I'm on the pill."
As you might imagine, I am not liking this information that I'm getting here but I also know that I am pretty much powerless and the best that I can hope for is damage control.
"Kris, are you just sleeping with one person?"
Exasperated expression in her voice: "Yes, Dad. I'm with one person."
I don't remember the rest of the conversation. I am relieved in some ways--contraception at least espoused and a single partner. It could be worse. I've had a girl or two in the practice who has slept with the entire basketball team at the high school.
On this trip together to Smith Island, the shoe is on the other foot and I'm explaining to Kris, that things are not working out for me with Molly and that I'm thinking about leaving. I'm looking at Smith Island as a possible place because I'm hopeful that Molly will let the boys live with me while she starts her career. Kris is angry with me.
We were supposed to take the early boat from Crisfield, Md. to Ewell from the pier. Kris and I were not able to find the boat given our directions from the letter from the preacher. We finally grabbed the excursion boat run by Alan Tyler to Rhodes Point and then the bus from Rhodes Point to Ewell.
My first observation about the Island was how unkempt things were. There was a lot of floating trash, and plastic bottles around the dock. The road from Rhodes Point to Ewell was only a mile but we passed through a smoldering dump and also a graveyard of hundreds of rusting vehicles that had accumulated over decades.
The Islanders have a speech that seems just the opposite of cockney. With cockney, the vowels are short and there is almost a staccato of consonants, a pressure to the speech with contractions of neighboring syllables--you can dump a lot of information out in a short period of time, lots of words per minute. With the Islanders, the speech is slower. The vowels are longer and there appears to be no attempt to speak faster. Such speech lends itself very well to story-telling one of the things that Islanders and Crisfielders do best. I think that my peers from high school and college would have considered such speech and indicator of ignorance. However, my two favorite uncles, Bus and Phil, were generally easy talkers...no rush. I liked the musicality of Islander speech. If the Island sounds interesting to you, there are two wonderful books about crabbing:
An Island Out of Time: A Memoir of Smith Island in the Chesapeake, by Tom Horton
Beautiful Swimmers by William Warner
I think that they are both beautiful books, but then again, I'm fascinated by crabs. It is interesting to me that my probable final illness is Cancer, a Latin word for crab and a constellation supposedly resembling the shape of a crab.
Alan Tyler dropped us at the parsonage. Where I met the preacher, Henry Zollinhofer and his new bride, Jan Evans. My first observation was a considerable difference in ages. Jan looked only a couple of years older than Kris.
Henry Zollinhofer is one of the most optimistic, upbeat people in the world. He was a skilled carpenter and cabinetmaker until the Jesus bug hit him and he decided to become a preacher. He had been married and had an ex-wife on the Western shore of the bay. He loved living on Smith Island and Jan was from one of the more prominent families. They had looked for me and Kris on the earlier boat and assumed that we had changed our minds and were not coming.
We sat and talked for an hour or so, feeling one another out. Donald Wood, M.D. is a cardiologist who had been my chief resident when I was an intern at South Baltimore Hospital. (I had been most impressed when he was in the E.R. for a heart patient and saw me trying to get a hold of the OB-GYN resident for a woman with uterine bleeding after a miscarriage. Don simply took the case, called anesthesia, took the woman to the Operating Room and did the D&C to stop the bleeding.) In my search for work within striking distance of D.C. but in a rural area, I had called Don who suggested that I might look at Smith Island as a place of interest and he had given me the preachers contact number.
Then Henry and Jan gave us a tour of Ewell and fed us lunch at Ruke's grocery store where wonderful crab cake sandwiches and cheese steak subs are served in a rustic environment. Then we took the preacher's van back down the 1 mile road to Rhodes Point where Alan Tyler was going to ferry us to the third village of the island, Tylerton. Alan helped my daughter in the boat. Then he helped Ann, a nurse who was going with us. Then Alan looked at me. "Do you need help, Doc?" I told him no. "That's good because if you do, we don't need you here."
We took the boat about for 1-2 miles to Tylerton and I was introduced to four or five men sitting in a room in the basement of the church in Tylerton. Henry had received a phone call that he had to take and was tied up for the next hour or so. So I waited with the little group in the basement and the men soon forgot about me and began talking about their passion--crabs. Little did they know it was one of mine. When describing crabbing to my family and peers, I got blank looks. Here I was feeling right at home. These guys were the professionals. This was the NFL of crabs. The hell with medical practice--this is it--this is place! I'm getting much more excited. I don't care if the preacher is robbing the cradle and is perhaps a little too smooth. These guys here are not smooth. They are passionate.
I forget what we talked about after Henry joined us.
Henry's phone call had been about the sudden death of his infant grandson. Henry later told me that he had been disappointed with me when I failed to provide what he thought to be a more reasonable amount of emotional support to him at that moment. I think he was right. I was pretty self-absorbed at the moment, still considered him to be a stranger, and someone with whom I was negotiating.
Kristin was put up for the night with a bed and breakfast in Ewell and I slept in the two story medical office/doctor's house. The basement of the house was at ground level had a utility and furnace room with a circular stair case leading to the second story. There was a small waiting room, an examining room and a half-bath off of the examining room. There was a sterilizer and a small desk in the exam room. There was another space in the waiting room that could be set aside for a desk and file cabinets for the medical records.
The night in the doctor's house was very peaceful. I reflected back on the day and the many elderly couples who had greeted me at various times. I was able to bond with them immediately. It was as if they were grandparents. I had two "visions" by which I mean strong kinds of intrusive daydreams, one was a woman in a nightgown in her forties or fifties, another was an older man in his sixties or seventies. Both of them appeared to be ill. The sense of connection with the past was similar to the way I had felt when spending time in the Nowlan Street house in Glendive before moving in and before Stan and Joan had arrived. It felt good. It was peaceful.
Ann, a resident nurse on the island, was married to a grocer on the island. She had a small nursing practice, gave some B12 shots, took blood pressures, and advised about care in various illnesses. She was friendly and welcoming and did not seem to be concerned about there being any sense of competition between us.
In evaluating the situation, it was clear that despite subsidy for housing, the Island would not necessarily be a cheap place to live. There would be expenses in getting the children back and forth to the mainland. The food came by boat and there were freight charges. For incidentals, items purchased at stores on the island were more expensive, etc. I also had child support obligations for Kristin.
There was no recent census for the Island. The population was somewhere around 500 souls, all of whom had established medical connections on the mainland. So it would be a very small practice, much smaller than that need to support us. I would need another income stream.
Kristin and I left the following morning. I had an appointment with the Administrator of the Crisfield Hospital. He offered me a 24 hour shift in the Emergency Room of the hospital from Monday A.M. until Tuesday A.M. at a rate of $15.00 an hour...approximately $360 dollars for 24 hours. The going rate for that work ten years before in Baltimore had been $40 an hour. Quite a difference, but the E.R. wasn't terribly busy. I would have time to read and to do computer work--it seemed manageable.
The Decision
I returned to Billings leaning very far towards Smith Island. In addition to the obvious advantage--that it was the place that was most appealing--it was a probable killer for my marriage to Molly. It was unlikely that she would be able to settle there and it would be close enough to Washington, D.C. to have access to the kids and the job opportunities of Baltimore, D.C., and Annapolis.
I didn't have the courage to just say "I'm leaving you." A small practice that shifted that actual child care to me would eliminate concerns about child care payments and would free her up to "get after it" in terms of being able to commit dedicated blocks of time to a career start-up. This was a highly intelligent woman who had been isolated from a supportive and rewarding professional career for almost ten years while living in isolated places with a narcissistic man who was a philanderer to boot. What was perhaps worse, he was probably genetically wired to fall in love with a person to whom he became sexually involved.
Despite my obvious shortcomings, she did have many years of evidence of my active interest in childcare and my willingness to take them on for at least short periods of time without her assistance.
And so things were finalized, sort of. I would move to Smith Island. I would temporarily hang on to the boys while she looked at the lay of the land in D.C. She would have an opportunity to see how things worked out with the boys and me. There was no doubt that our custody would be "joint." She could take her time with a more final decision about the actual custodial parent.
And that's what we did. She left Billings in September 1983 with the children. She stayed with her parents and with friends in Harper's Ferry for a time. We were fortunate in selling our Billings house almost immediately by agreeing to take a second mortgage for a year. I packed up the rest of the house and items from the clinic and left Billings in the middle of October.
In fact, we had already found a way. The previous four years had benefited both of us. Molly now had a job skill that was marketable anywhere in the United States. If we went our separate ways, it would be on a more equal footing than our parting in West Virginia. What was most different was that I had no immediate need to establish myself in a career, whereas Molly was in her late 30's and needed to do so.
I'm not sure when we began to talk openly about separation but Molly had floated the idea of finding two homes within a couple of blocks of one another so that we could share child care responsibilities in the easiest possible way with the least amount of disruption for the boys. I wasn't too enthusiastic about that kind of an arrangement because it seemed to require a medium-size to large city in order to meet both of our employment needs.
I reminded Molly that when we had first started dating in 1969 she had indicated some deep fears about motherhood and made me promise that I would take responsibility for children. (I know that this was my recollection in 1983. I can't swear that it is true or that Molly would remember or agree with it's accuracy. My recollection is that she said something back about at being doable if it were within a driving distance of less than 200 miles.)
I became more interested in making a lifestyle change that would net me time with the boys.
There are two relationships that I won't discuss in any intimate details in this blog, my third and fourth marriages. I haven't asked either for permission to do so and my family is aware of most of the ups and downs associated with them.
In the spring of 1983, I had decided that I would complete my contract with St. Vincent and find other employment. There were three opportunities that I seriously considered.
Saudi Arabia
I had read a book by Hedrick Smith called The Kingdom, a recent history Saudi Arabia. I was fascinated by the idea of spending time in the desert. It was also possible for an American physician to make a very good living there, to have housing provided for the family, and to manage to avoid US Income Tax by limiting time spent in the U.S. I had not saved at money in my career and I was now turning 40. I calculated that a three-year tour in Saudi Arabia would allow me to save about $250,000 and provide the beginnings of an educational fund for the children and a nest-egg to boot. Annual pay, well over $100K and most bankable.
Family Practice Fellowship, Columbia Missouri
In 1978 I had looked at a position in the Family Practice program at the University of Missouri. It was a well run, established program. This would have provided me the opportunity for increased training and credibility and would have put me in an academic program where my interest in holistic and preventive medicine could be developed further. I didn't get the position. However, there were fellowship opportunities available in 1982 and 1983. These were available and I was offered one. Pay less than $40 K but opportunities for moon-lighting.
Smith Island, Maryland
This was a position on the last inhabited island in Maryland's Chesapeake Bay, in the poorest county in the state. This was remote. Normal ferry connections were with the Eastern Shore of the Bay and a 2 to 3 hour drive to Washington D.C., whereas Point Lookout on the Western Shore was a 2 hour drive without regular service.
However, it was within about 150 miles of Washington, D.C. and did meet the criterion in Molly's offhand remark about the an acceptable driving distance.
I investigated the situations. A job was available for 1984 in Saudi Arabia with pay close to $150K. My children were still young enough to stay with family in the Kingdom. Apparently, the Saudi's insist that children above a certain age be educated elsewhere because of possible problems between what Europeans and Americans might consider a "childhood prank" and something that Sharia law would consider more seriously. I was told that although liquor was banned in the Saudia Arabia, there were many stills operating in American homes. There would be restrictions on women driving and dress.
I traveled to Columbia and Smith Island. They were interested in Columbia and a job was mine if interested. However, when I submitted my travel voucher, I didn't like the nickel and diming process. They had agreed to my flight. I thought they owed me flight money less the D.C. portion but they wouldn't pay it. I took it as an indicator of my possible future dealings with the finance department of the University.
Visit to Smith Island, July 1983
Finally, I visited Smith Island with my daughter, Kris who was now 16. Since moving to Montana, Kris had come every summer and spent a few weeks. There were times when she asked to come to live with me but these were usually during times when she was in conflict with her mother and I always told her no. Even though her mother was a relatively persistent source of irritation to me as well, I couldn't let my daughter split us in such a fashion. Something that I "should" have done was to have taken the request more seriously and arranged a meeting between Kristin, her mother, and me and have handled Kristin's request face-to-face instead of long distance from Montana.
I think my relationship with Kristin was generally close up until the time she began started college in about 1985 and then again from the time she started graduate school in about 1992 until she died.
When she was fifteen, I asked her if she were sexually active.
"Dad, you don't have any right to ask me that question?"
"Maybe I do, if I am willing to accept any answer that you give me."
"Yes, I am."
"Are you using contraception?"
"Yes, I'm on the pill."
As you might imagine, I am not liking this information that I'm getting here but I also know that I am pretty much powerless and the best that I can hope for is damage control.
"Kris, are you just sleeping with one person?"
Exasperated expression in her voice: "Yes, Dad. I'm with one person."
I don't remember the rest of the conversation. I am relieved in some ways--contraception at least espoused and a single partner. It could be worse. I've had a girl or two in the practice who has slept with the entire basketball team at the high school.
On this trip together to Smith Island, the shoe is on the other foot and I'm explaining to Kris, that things are not working out for me with Molly and that I'm thinking about leaving. I'm looking at Smith Island as a possible place because I'm hopeful that Molly will let the boys live with me while she starts her career. Kris is angry with me.
We were supposed to take the early boat from Crisfield, Md. to Ewell from the pier. Kris and I were not able to find the boat given our directions from the letter from the preacher. We finally grabbed the excursion boat run by Alan Tyler to Rhodes Point and then the bus from Rhodes Point to Ewell.
My first observation about the Island was how unkempt things were. There was a lot of floating trash, and plastic bottles around the dock. The road from Rhodes Point to Ewell was only a mile but we passed through a smoldering dump and also a graveyard of hundreds of rusting vehicles that had accumulated over decades.
The Islanders have a speech that seems just the opposite of cockney. With cockney, the vowels are short and there is almost a staccato of consonants, a pressure to the speech with contractions of neighboring syllables--you can dump a lot of information out in a short period of time, lots of words per minute. With the Islanders, the speech is slower. The vowels are longer and there appears to be no attempt to speak faster. Such speech lends itself very well to story-telling one of the things that Islanders and Crisfielders do best. I think that my peers from high school and college would have considered such speech and indicator of ignorance. However, my two favorite uncles, Bus and Phil, were generally easy talkers...no rush. I liked the musicality of Islander speech. If the Island sounds interesting to you, there are two wonderful books about crabbing:
An Island Out of Time: A Memoir of Smith Island in the Chesapeake, by Tom Horton
Beautiful Swimmers by William Warner
I think that they are both beautiful books, but then again, I'm fascinated by crabs. It is interesting to me that my probable final illness is Cancer, a Latin word for crab and a constellation supposedly resembling the shape of a crab.
Alan Tyler dropped us at the parsonage. Where I met the preacher, Henry Zollinhofer and his new bride, Jan Evans. My first observation was a considerable difference in ages. Jan looked only a couple of years older than Kris.
Henry Zollinhofer is one of the most optimistic, upbeat people in the world. He was a skilled carpenter and cabinetmaker until the Jesus bug hit him and he decided to become a preacher. He had been married and had an ex-wife on the Western shore of the bay. He loved living on Smith Island and Jan was from one of the more prominent families. They had looked for me and Kris on the earlier boat and assumed that we had changed our minds and were not coming.
We sat and talked for an hour or so, feeling one another out. Donald Wood, M.D. is a cardiologist who had been my chief resident when I was an intern at South Baltimore Hospital. (I had been most impressed when he was in the E.R. for a heart patient and saw me trying to get a hold of the OB-GYN resident for a woman with uterine bleeding after a miscarriage. Don simply took the case, called anesthesia, took the woman to the Operating Room and did the D&C to stop the bleeding.) In my search for work within striking distance of D.C. but in a rural area, I had called Don who suggested that I might look at Smith Island as a place of interest and he had given me the preachers contact number.
Then Henry and Jan gave us a tour of Ewell and fed us lunch at Ruke's grocery store where wonderful crab cake sandwiches and cheese steak subs are served in a rustic environment. Then we took the preacher's van back down the 1 mile road to Rhodes Point where Alan Tyler was going to ferry us to the third village of the island, Tylerton. Alan helped my daughter in the boat. Then he helped Ann, a nurse who was going with us. Then Alan looked at me. "Do you need help, Doc?" I told him no. "That's good because if you do, we don't need you here."
We took the boat about for 1-2 miles to Tylerton and I was introduced to four or five men sitting in a room in the basement of the church in Tylerton. Henry had received a phone call that he had to take and was tied up for the next hour or so. So I waited with the little group in the basement and the men soon forgot about me and began talking about their passion--crabs. Little did they know it was one of mine. When describing crabbing to my family and peers, I got blank looks. Here I was feeling right at home. These guys were the professionals. This was the NFL of crabs. The hell with medical practice--this is it--this is place! I'm getting much more excited. I don't care if the preacher is robbing the cradle and is perhaps a little too smooth. These guys here are not smooth. They are passionate.
I forget what we talked about after Henry joined us.
Henry's phone call had been about the sudden death of his infant grandson. Henry later told me that he had been disappointed with me when I failed to provide what he thought to be a more reasonable amount of emotional support to him at that moment. I think he was right. I was pretty self-absorbed at the moment, still considered him to be a stranger, and someone with whom I was negotiating.
Kristin was put up for the night with a bed and breakfast in Ewell and I slept in the two story medical office/doctor's house. The basement of the house was at ground level had a utility and furnace room with a circular stair case leading to the second story. There was a small waiting room, an examining room and a half-bath off of the examining room. There was a sterilizer and a small desk in the exam room. There was another space in the waiting room that could be set aside for a desk and file cabinets for the medical records.
The night in the doctor's house was very peaceful. I reflected back on the day and the many elderly couples who had greeted me at various times. I was able to bond with them immediately. It was as if they were grandparents. I had two "visions" by which I mean strong kinds of intrusive daydreams, one was a woman in a nightgown in her forties or fifties, another was an older man in his sixties or seventies. Both of them appeared to be ill. The sense of connection with the past was similar to the way I had felt when spending time in the Nowlan Street house in Glendive before moving in and before Stan and Joan had arrived. It felt good. It was peaceful.
Ann, a resident nurse on the island, was married to a grocer on the island. She had a small nursing practice, gave some B12 shots, took blood pressures, and advised about care in various illnesses. She was friendly and welcoming and did not seem to be concerned about there being any sense of competition between us.
In evaluating the situation, it was clear that despite subsidy for housing, the Island would not necessarily be a cheap place to live. There would be expenses in getting the children back and forth to the mainland. The food came by boat and there were freight charges. For incidentals, items purchased at stores on the island were more expensive, etc. I also had child support obligations for Kristin.
There was no recent census for the Island. The population was somewhere around 500 souls, all of whom had established medical connections on the mainland. So it would be a very small practice, much smaller than that need to support us. I would need another income stream.
Kristin and I left the following morning. I had an appointment with the Administrator of the Crisfield Hospital. He offered me a 24 hour shift in the Emergency Room of the hospital from Monday A.M. until Tuesday A.M. at a rate of $15.00 an hour...approximately $360 dollars for 24 hours. The going rate for that work ten years before in Baltimore had been $40 an hour. Quite a difference, but the E.R. wasn't terribly busy. I would have time to read and to do computer work--it seemed manageable.
The Decision
I returned to Billings leaning very far towards Smith Island. In addition to the obvious advantage--that it was the place that was most appealing--it was a probable killer for my marriage to Molly. It was unlikely that she would be able to settle there and it would be close enough to Washington, D.C. to have access to the kids and the job opportunities of Baltimore, D.C., and Annapolis.
I didn't have the courage to just say "I'm leaving you." A small practice that shifted that actual child care to me would eliminate concerns about child care payments and would free her up to "get after it" in terms of being able to commit dedicated blocks of time to a career start-up. This was a highly intelligent woman who had been isolated from a supportive and rewarding professional career for almost ten years while living in isolated places with a narcissistic man who was a philanderer to boot. What was perhaps worse, he was probably genetically wired to fall in love with a person to whom he became sexually involved.
Despite my obvious shortcomings, she did have many years of evidence of my active interest in childcare and my willingness to take them on for at least short periods of time without her assistance.
And so things were finalized, sort of. I would move to Smith Island. I would temporarily hang on to the boys while she looked at the lay of the land in D.C. She would have an opportunity to see how things worked out with the boys and me. There was no doubt that our custody would be "joint." She could take her time with a more final decision about the actual custodial parent.
And that's what we did. She left Billings in September 1983 with the children. She stayed with her parents and with friends in Harper's Ferry for a time. We were fortunate in selling our Billings house almost immediately by agreeing to take a second mortgage for a year. I packed up the rest of the house and items from the clinic and left Billings in the middle of October.
No comments:
Post a Comment