Life in Pocomoke City

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medical     *
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Tues Jan 10  A very encouraging day.
I'm essentially pain-free this morning. Yesterday I had an MRI of the brain. There were no metastases noted. I have experienced a large increase in the number of "floaters" in the right eye. A few years ago I had a "vitreous detachment" in the left eye that seemed very similar to this current episode. I'll go back to the optometrist sometime this week and let Tiffany Smart, O.D. give it a look. She does a thorough examination and she will send me on to an ophthalmologist if needed.

Today I have an appointment with Dr. Stella for radiation oncology to see if there is some pain relief that he can give me with radiation of the diseased rib and perhaps even the tumor in the spine.

The fact that the brain appears to remain clean encourages me to do what I can to use that brain as long as I can.

Wed Jan 11 Midnight
I saw Dr. Stella today. He examined me and reviewed my chest scans. My left 5th rib has deteriorated at the point where it attaches to the spine. It is an area that is "busy" anatomically, with a lot of nerve traffic. Since things are much better, he has recommended that I keep taking the Fentanyl and wait to see what transpires in the future. I have an appointment to see him again in 6 weeks.

Thur Jan 12
I saw Dr. Palchak yesterday. He detected some weakness in my ability to lift my left leg--for example, it is  hard to put on my underpants and to lift my leg over the bathtub wall.  He ordered yet another scan for me, an MRI of the Lumbar spine. He suggested that any tumor compressing a major nerve might benefit from spot radiation.

My bottom line in all of this has to do with my brain. I believe that the purpose of my body is to carry around my brain. As long as my brain continues to work reasonably well, I'm willing to do "tumor nips and tucks" that help me maintain a reasonable level of functioning. Should invasion of the brain occur, I'll be less inclined to seek aggressive treatments.

My Medical Team
I think I'm in very good shape going forward. Dr. Neal at Stanford is doing my Chemo and essentially calling my treatments shots. Dr. Palchak  has graciously agreed to take over my care here in San Luis County if the trips to Stanford become too much. My Pain Management doctor is Mark Ward. He is also medical director of one of the local hospices. The odds say that I'll be needing those hospice services before I am done with this. Finally, Dr. Garry Kolb is my local primary care physician--a wonderful human being and doctor. And then--I'm married to Jasmine--I have my own psychiatrist who made soup for me this evening.
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Life in Pocomoke City
The boys had mixed feelings about moving off of Smith Island in 1987. They were leaving 4 years of accumulated friendships to a new home and school. On the island they had lived in an all-Caucasian cocoon. Exposure to other ethnicities and cultures had only really occurred while they were with their mom, Molly, in Northern Virginia. They expressed some anxiety at attending a large school (compared to a one-room school house) with a racially mixed population.
http://en.wikipedia.org/wiki/Pocomoke_City,_Maryland

Pocomoke is a very rural, Eastern Shore of Maryland town, with almost equal numbers of blacks and whites (simpler language here). It is a community that is very much involved in youth sports and the practice fields are heavily used on Saturday mornings with soccer and field hockey for ages 5 and up. The basketball program is excellent and little Pocomoke high school is frequently in contention for the State basketball championship. Among the boys, the soccer teams were mostly white while the basketball teams were mostly black. My kids and I had played basketball for recreation for several years. After purchasing a house, one of the first things that I did was to add a basketball court in the backyard. I only wish I had spent a little more money and upgraded the backboard and hoops.

The boys were growing like weeds. Brian was taller than me by seventh grade and didn't stop until he was 6'4"-- he is more slender and wiry...like his mother. Keith is 6'2" and strong as a bull. He is more thickly built like me. Both of them are smart and quick on their feet. Keith is particularly witty when he take jibes at himself.

In 1990 I was invited to meet with the school board about some issue that slips my mind. I said something about segregation and a couple of members interrupted me and wanted to know what I was talking about.
"Well, a very obvious example is the use of the movie theater. On Friday nights, the white children go to the movies, while on Saturday, the black children go."
"But that's because they like to do it that way."
I pointed out that this was called de facto segregation--a carry over from an older era. Although there was no law or ordinance that required that the two groups behave in this manner, there was a tradition and an expectation on the part of parents that their children conform in this behavior.
However, in my seven years in Pocomoke, I never felt any racial tension or animosity. The high school sports scene was a major bonding experience for the community where most folks were within a five or ten minute drive to the high school gymnasium. It was so much easier to attend a game when compared to difficulties one is likely to incur in suburbia.
Our home was on the main street and had been well-built in 1912. It was spacious with high ceilings, a roomy entry hall way with a large staircase to the right. The downstairs had full-size living room, dining room, full bath, pantry and country kitchen. There was a back staircase leading from the kitchen to the second floor. When the extended family came to visit, the children loved running a circular route over the two stairways.
As soon as I had accumulated a little money, I renovated the attic and put in some skylight and a comfortable shower. The boys took over the second floor.
It was like living in a fraternity house much of the time. I had pushed my work schedule back into the early morning. For much of the time there, I was able to get up around 4 A.M., get in a quick run, shower, and be working by 5:30 A.M. I seldom left the institution for lunch and was generally home from work by about 5 P.M. So, I was putting in 10-11 hour days as a matter of course. I was also on call most weekends. That meant that I would go to the facility on Saturday or Sunday with my hours flexed around the boys' schedules. Even though I spent about 60 hours most weeks in the facility, there was a negligible commuting time and and more than 15 hours of work spent during times when the boys were getting up and getting off to school. So, I was able to eat evening meals with the boys. Sometimes these weren't much. I know that we gave Pizza Hut a ton of business, but our evenings were generally together. One Christmas I bought them each a "Lazy Boy" and the living room became our "man cave."

Women
I was very busy in Pocomoke and there was loneliness as well. I had not reached a point of emotional security such that I was able to feel fulfilled living on my own. I missed sex, but I missed physical closeness and companionship even more. I did have a live-in girl friend for several months. We had a great companionship but it wasn't love. We both moved on.
I dated M, an African-American schoolteacher for several months. She had a young son of 3 and she occasionally spent an overnight with me in Pocomoke. It was almost always when the boys were in D.C. with their mother, but every once in a while, we were all in the house at the same time. Given the size of the house, there were no privacy issues to speak of and my boys got a kick out of her child. But I felt no need on my part to lie to my children.
It was very interesting to experience first-hand the discrimination against African-Americans and "mixed" couples that occurred in Salisbury. When M and I went out to eat, it commonly occurred that we had long waits for service and/or errors in our food orders.
I dated  Carmen, who was from St Bart's in the French Virgin Islands. She was one of 17 children. She had her own business as a hairdresser in Salisbury and she was an incredibly hard-working person. We had good companionship cooking and dancing together. This woman had spent half a lifetime cooking regularly for twenty people a meal. I liked smoking Turkeys outdoors and throwing together ratatouille with Eastern Shore vegetables. She liked plantains and fried bread, spicy meats with Caribbean zip, and seafood. Many Sundays would find us working in the kitchen together, while the boys were out playing basketball with their friends in the yard. These remain special memories.

Making Money
Prior to working in prison, I had never been in a position where I was paid for every hour of medical work. I would estimate that 10-20% of my time as a family physician ended up being "pro bono" or noncollectable. However, by 1990 I was working more than 2500 hours a year. I had started out with a contract that pain $40 an hour in 1987 and by 1992, I was at about $60 an hour. My small, fixed salary and on-call pay brought my earnings up over the $150K mark and I had begun saving for retirement. Financially, things were much brighter for me. I had also become very interested in some of the medical and psychological aspects of prison medicine and I had begun work on a small book about the management of "Difficult Patients." This was a labor intensive project but it overlapped with the work that I was doing at the prison.

The Return of the Past
As my children began to pass through adolescence, I began to spend more time reflecting on my own childhood. When my father died in 1988 I was in the process of remodeling the attic of my house into a large Master suite. I let the contractor go, and I began to do the dry wall work myself. While I did it, I pretended that I was working on the project with my father. (You might recall my father's adventure digging out the basement and his use of male offspring to push the shovel and wheelbarrow. In the Pocomoke attic it was just me and Army Bill for a few months.)
It was during my own adolescence that I had begun engaging in self-destructive kinds of behaviors, partly as a rebellion against my father's control of my life and partly as a means of proving to the little hoods in our neighborhood that I was not an ass-kissing nerd. I was tired of being mocked for being smart.
The self-destructive behaviors were cigarette smoking, beginning to drink alcohol while attending high school, taking myself out of the high school honors class, and refusing to do more than about 60% of my homework.
Well, by 1988 I was the father of a very bright 13 year-old boy who was working out his own adolescence issues. I was also 45 years old and looking back at some of the wreckage that my wide wake had left behind.  I could see the relationship between Bill and Kathy Henderson as something very special, a free-flowing love with natural give and take. The administrator at our prison and his wife both worked on site and they managed a wonderful work and couple relationship. Relationships had failed me, or to be accurate, I had failed my relationships.
Later on in life, while practicing psychiatry, I came to believe that it was fairly common for parents to revisit their own past prompted by the growth and development of their children. In Las Vegas, there was a severe shortage of child psychiatrists. Most of them would not accept insurance for office visits. I did general psychiatry and I was happy to see most children. It frequently occurred that the parent could recall experiencing a rough psychological patch at an age generally corresponding to the current age of the child brought for treatment.

The Volvo Mystery
When my older son, Brian, reached driving age I sold off my little turbo charged Ford Probe and found a used Volvo 740 to add to my 1984 Oldsmobile station wagon. I figured that these were perfect automobiles for a 16 year old driver. I had no illusions about the need for any self-respecting teen male to test the maximum speed of all fleet vehicles. I looked upon that as inevitable.
Until Brian was 16, either Molly or I made the trip with the boys back and forth to D.C. for visitation. With Brian driving, it would be possible for the boys to make the trip on their own.
At last the day came for the boys to make the 150 mile journey together. It was a Friday afternoon and they left after school. I was at work. I received the first phone call about an hour later. Brian told me that the windshield had been cracked by flying stones from a car pulling off of the shoulder. This was followed by another phone call 45 minutes later, again from Brian. He had become concerned about a "hitch" in the steering and he had pulled into a Volvo dealer in Easton, Md. where they told him that the steering should be fixed immediately for several hundred dollars. I was already aware of this situation and had checked it out with my local mechanic who told me that it was not an urgent matter. I told Brian to keep on driving.
The boys were scheduled to return on Monday. I was at work on Monday and received the next call. The secretary told me that it was my son who was calling to inform me that there had been a little accident. Thinking that Brian was telling me about the windshield again, I told the secretary that I already knew about it and I continued working.
When I got home that evening, I found that the poor Volvo had taken another hit. The right front fender had been pushed in with the loss of the headlight. I looked at Brian. He looked at me and suggested that "A bra will cover that right up." Of course, this wasn't what I wanted to hear. "What in the hell happened?"
Brian's story is that he was waiting patiently at a stop sign about to turn left onto a one way street when a speeding car nicked the right front fender and sped off. It seemed like a weak story to me. I told him that he needed to take the car to the body shop the next day to repair the headlight immediately and to get an estimate on the fender. 
The following day, I called home to check the status of the car. Keith was there alone and informed me that Brian had taken the Volvo to a local park to play basketball. At this point I was very angry. I hadn't given permission for the use of the car. I told my co-workers I would be gone for an hour or two and I headed home. I realized I was too angry to be effective at that moment, so I called my brother, Dana, and told him that I was having murderous thoughts about my older son. He calmed me down.
It's twenty years later. I still don't know what happened to that damn car. I've pleaded with my son on several occasions, most recently in October, to tell me the whole story. I've pointed out the cruelty involved in forcing me to go to my grave in ignorance. He says that he is sticking to his story at the current time.


The boys were generally respectful and kind. From the age of 12 they did their own laundry (of course some of the loads were single shirts or pants). Pocomoke City was about 1.5 miles in length which made it possible to walk to any location and eliminated concerns about chauffeuring them. Both became very involved in high school basketball and I could be home in time to pick them up from practice when necessary. It was a very laid-back life if one were willing to accept a rural lifestyle. I couldn't think of a better place for raising children.

When I think back to those years, I often recall a trip taken in 1992.

Disney World
Roller Coasters
In order to maintain my Maryland license I needed to attend 25 hours of medical education or instruction every year. Mostly I had used mail order sources--they are much cheaper than flying somewhere and staying in a hotel while attending a conference.
However, in 1992 I considered mixing a conference for me with a vacation for the boys. There was an infectious disease conference in Orlando FL at Disney World. As a part of the conference "package" it was possible to purchase discounted passes to several parks in Orlando. The whole intent was to balance the professional's need to get credit and to have the family vacation during the day the physician was in the classroom. The family could be together in the evenings.
Keith and Brian were interested in roller coasters and it was easy to talk them into going with me on the trip where they could ride several. There was also shuttle service from the hotels to each of the parks. It would be possible for me to provide the boys with a pass to a different park each day. These are not inexpensive passes. I recall them being on the order of $50 each. 
We flew to Orlando and checked into a hotel that was about 2 blocks from the conference hotel. Each morning I gave the boys a pass to a park and then I went to the conference. Normally I would eat lunch with a friend or a colleague. However, on the third day I went back to the hotel at lunch time to retrieve something. The boys were sitting around watching the NCAA March Madness. 
"When are you guys taking off for the park?"
"We've been."
"The park's only been open for an hour and a half."
"Yeah. Well we just wanted to ride the roller coaster."
"Did you ride it more than once?"
"No, it wasn't that great."


Space Shuttle
While we were in Orlando, NASA was trying to launch a Space Shuttle flight. I told the boys that we were going to make the two hour drive to the coast in the morning to see if we could get a look at it.
"So, we are going to have to get up early."
"What time?"
"Well, they say they are trying to launch at 5:30, so we will need to leave here right after 3 A.M."
Neither wanted to go. Neither could imagine getting up that early. I was really surprised at the lack of adventure. (Maybe it was the strong teen drive to avoid being seen with an adult who might be construed as a parent.)
"We'd rather watch it on TV."
Of course with enough nagging at 3 AM they did get up and were good sports about it after we had left Orlando an hour behind. There was a delay in the launch of about an hour, so we did not see a launch in the dark. But my--what a sight and sound. It was like the sun ascending.
Recently I received a pat on the back--sweet appreciation.
I miss teen-age boys.