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medical *
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Thur Dec 22 6 AM. The queasiness and soreness in my mouth have been gone today. Pain has been minimal. I'm hoping the chemo effects are past.
Round 1 had about 5 or 6 days of symptoms. Round 2 was longer at 7 or 8 days but combined with steroid withdrawal. It was the most intense and painful.
Round 3 has had the longest run of side-effects, 13 days with the most prominent symptom being nausea.
During this last round I have used long-acting opiates, oyxcontin 10 mg twice a day and added additional pain relief on top of that. On Monday I had a reprieve from pain and nausea and forgot a few doses of pain medication and had definite signs of opiate withdrawal.
Fri Dec 23 7 A.M. I got out yesterday. Drove the van to the post office. Went to a movie, George Clooney in The Descendants. I thought it was pretty mediocre and couldn't decide if it was a comedy or not. Pales in comparison to Up In The Air or Michael Clayton. But it was great to get out.
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As you might imagine, I've had a lot of thoughts and dreams about my present situation. In a few dreams, I've gotten a reprieve with cures and a vanishing of tumor. My waking thoughts seldom go to tumor and personal death, but are more about the dying process itself. Here I am dealing with an entity, the tumor, that is my own cell line. Cells from this tumor are a closer match to my functioning cells than exist anywhere in the world. Right now this tumor is trying to occupy all of my intrathoracic space, the space that my lungs need in order to function properly. In addition, the tumor is releasing cells into my blood stream for colonization of distant sites in my body. It has successfully implanted in two of my vertebrae and in my shoulder. When I get a headache, and I've had a few recently, I wonder what is going on. Is it tumor in my brain? If it is, am I likely to want to do anything about it?
So, that is the medical battle that is going on. However, I am at a place in my life where I don't have to worry much about bills or being responsible for others. I have medical insurance that will enable me to get what I need without the fear of bankruptcy or loss of my home. I live in a very comfortable house and can see the ocean from where I am writing this. But, I know that there are thousands of people struggling with terminal illness at this moment who are cold, hungry, and alone and too sick to properly care for themselves. I wonder what would happen if, instead of saying 'hello' I started saying 'may you die in peace.' I guess that would raise eyebrows at least with strangers.
In the prison in San Luis Obispo, a chaplain started a program for lifers that involved "keeping watch" with other prisoners who were dying. In a previous post, I mentioned Viktor Frankl's book, Man's Search for Meaning. Most of us want to make some difference in the world and we can often fulfill that need by doing for family and loved ones. For those with a conscience, the life sentence may equate to a meaninglessness life--a more severe penalty in the long run than loss of freedom for life. I think it is interesting that there is a long waiting list to "keep watch" in the San Luis prison. I know that some of it may be brushing up the resume for the parole board, but I've met enough of them to believe that most of it is well meaning.
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Smith Island 2
In 1986 or 1987 Tom Horton, a reporter for the Baltimore Sun interviewed me and included the material in his book "Island Out of Time."
I think that he did a good job of pulling the material together and describing much of my life there. He talked to me at length at a time that was contemporaneous with my leaving and is likely to be more accurate than my memory twenty-five years later, so I've elected to take his work and insert it at the end of this post. In the meanwhile, I'll just sketch out some thoughts and memories of almost four years on the island.
A Map of Ewell
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| A partial map of Ewell. The distance from one edge to the other, left to right, is less than 2000 feet. |
The Children's Life
It was quite a change from Montana where there were no playmates in walking distance and a bus or ride to school was required. On the Island the boys could walk the three blocks to the school. Their interest in learning and overall intelligence was stimulating for their teacher as well. She was very impressed when Keith asked her where Zimbabwe was on a classroom map of Africa. The map in use was too old to have incorporated modern changes on that continent.
For Brian, there was a ready made group of children around age 8. For Keith there were only a couple of playmates which meant that he and I were playmates for much of the afternoon of Kindergarten. His mother had spent hours reading to him and teaching him phonics. One morning, it had all kicked in. I woke up and he was reading Green Eggs and Ham out loud and he's never stopped. We both love history and today we exchange boxes of books that we have completed.
The boys were never particularly interested in catching crabs but we spent many hours playing basketball and touch football. Very few fathers have failed to stop as many baskets as I, some of it my lack of ability but much of it the result of playing time.
Both of the boys acquired the Island dialect, Keith more so than Brian. It sounds illiterate to proper speaking folks, like a Caucasian analogy to Ebonics. I'm sure it made Molly cringe.
I was surprised at the level of pornographic materials that were in circulation on the Island...fairly hard core stuff with the portrayal of women as sexual objects. It wasn't the nudity as much as the profanity of the situations portrayed. My guess is that all Island children were exposed to some of it. I'd be very curious to know what the level of exposure to such material is for all children in our society. In a previous post I mentioned how erroneous information that I received had been incorporated into my own masturbation fantasies--that we may have a Lovemap from an early age. Rather than bullshit porn, it might be better for kids to see consensual sex such as Lady Chatterley's Lover. By attempting to keep our children from seeing "good" or "healthy" sex, we may be condemning them to the pornographers idea of sex. I'll take D.H. Lawrence any day.
Movement to the Island in 1983 corresponded to my acquisition of a VHS player. My sister was kind enough to send me about 50 movies on tape. I'm not sure if I have ever thanked her enough. These were a godsend when living in a place with poor television receptions. In a way it was a blessing for me as well. I found that when I felt overwhelmed or bummed out, joining the boys who were watching a movie was good therapy. I just shut up and enjoyed their enjoyment of each other, the movie, and the moment.
Cooking was not my forte. I had a few standards like Shepherd's pie, spaghetti, and stew in a crockpot. Breakfast was much easier with French toast, cereal, eggs, oatmeal, and pancakes. Lunch was generally peanut butter and jelly or cheese sandwiches. A lot of evening meals were done at Ma Willie's before clinic hours.
One of the advantages of a one-room schoolhouse is that a child can advance at his own pace. Brian had finished the sixth grade curriculum within a couple of years and was given some independent study. Keith had nearly maxed out at the end of third grade.
The Spring of 1987 was the last possible year that Brian could spend on the Island without having to travel to the mainland for school on a daily basis. Although the school boat was one of the most modern on the Island, the Tangier sound was still a formidable body of water and it worried me. The school day was extended by two hours for transportation alone and the strict boat schedule made extra-curricular activities almost impossible.
So, in April or May of 1987, I began looking for housing on the mainland. My plan was to continue to come to the Island two days a week, to continue working the day a week in the Emergency Room in Crisfield, and to find another job to boost income.
Some Interaction With the Islanders
When first arriving on the Island, I had trouble with the clothes dryer. This was most inconvenient when living in a house with multiple leaks in the roof. However, there were clothes lines in the back yard and Charlie's Store sold clothespins. So I was in luck and I began hanging out laundry. According to Reverend Z, this was quite a shock to the men--to see a male hanging clothes. So be it.
The camaraderie among Islanders is quite remarkable. It could best be found on stormy mornings when the boats were confined to port. The place to experience it was Charlie's General Store at about 6:30 A.M. when he opened. By that time, he had a fire going in the pot bellied stove off and the fishermen began showing up to drink their coffee and smoke cigarettes. It was common on the Island for coffee drinkers to add cheddar cheese instead of cream to their coffee. I wondered if it went back to times when their were no fresh dairy products.
Sitting around the stove, the banter and stories would begin--but so good natured it was hard for anyone to take offense.
Terry Laird and The New Light
One morning at about 3 A.M. I got a call from Terry Laird. A man on Tylerton was having severe chest pain. Would I come? Of course.
I got my cardiac bag and went down to Terry's boat, a couple of hundred feet away, near Ruke's store. He fired up his engine and we pulled backed into the Big Thoroughfare. We proceded a few hundred feet and made a left into the main channel (upper right corner of the satellite picture).
Terry was a native of Tylerton and his mother still lived there. It was pitch black and there was no moon. We turned off of the main channel and headed south on the approach to Tylerton. The lights of the village grew closer when all of a sudden a shower of sparks and hisses began at the top of our fishing masts. We had jumped out of the navigation channel and were 50 or 100 feet east of it. Our masts were stuck in the power lines to the village.
Terry was able to back out and slide over into the navigation channel.
What happened? Terry had made that trip hundreds of time in his life. He navigated by heading for the last in a line of street lights in the village. Recently, an additional light had been added to the line. Terry was using the new light and had put us into the power poles.
The patient was suffering from unstable angina. We were able to get excellent helicopter air transport but the patient died within 48 hours.
Taking the Time to Save My Engine
One morning in the middle of a storm I went to check on my boat. It had sunk. However, the engine had been removed and was sitting on the county dock. Later that day, Later that day Joe Kitching told me that he noticed that my boat was taking on water and he had removed the engine to keep it from sinking with the boat. An outboard that sinks in salt water is likely to be ruined.
Mrs. Sneade
She was about 85 and very hard to please. She grumbled so much that she was cute. I was about 40 at the time when I said to her, "You may have this problem, but you are going to outlive me."
"I certainly hope so was her reply."
The Inebriated Teen
It was late one Saturday evening and someone called me from Charlie's store and said there was a drunk boy lying on the lawn. He was not from the island but had apparently come to visit friends and had missed the boat. He was barely responsive to pain and he smelled of alcohol.
I had no idea of his blood alcohol. I called the State Police for the rescue helicopter. The dispatcher questioned a transport for alcohol intoxication, but I explained that we had no way of determining the severity of the child's condition and they sent the helicopter at once. I never received any feedback until three years later when I was working at the prison in Princess Ann. One of the guards told me that I had saved his grandson's life, or at least that's what they said in the ICU at the Salisbury hospital after he was admitted.
Personal Crabbing
Netting
I've tried a few methods of crabbing, including setting out pots, using chicken necks and strings to bring them to the surface where they can be netted, scraping the bottom with a net, and netting from a skiff. My favorite method is from the skiff.
In netting from a skiff, the crab net has two functions: it is used as a pole to move the boat about and it is used to net the crab itself. Crisfield, Md. advertises itself as the crab capital of the world, but even here you will be not able to purchase a ready made, suitable crab net for this purpose. You will need to make one.
To fish for crabs in this manner, you will be standing on the front of a small boat. You will use the net to move the boat to explore adjacent areas of the bottom or to move the boat toward a crab that you have spotted, in which case, you will want to position the boat so that you can use your net to strike at the prey.
You could decide to move the boat only using the bare end of the net, but generally this will be less efficient. By using the net itself against the bottom, you are in a better position to immediately bring the net to bear upon your prey.
In order to use the net part for pushing, it must be very heavy duty. The handle is a wooden pole up to 10 feet long, and generally the thickness of a closet pole, at least 1" in diameter. The net hoop itself is not one of those wimpy things you see in the store. Instead, it is a heavy galvanized double ring with a stem of several inches. A central channel is drilled into one end of the pole to receive the stem. Epoxy resin can be used to fill any space in the cavity. A screw clamp is often added for increased bracing around the end of the pole that holds the net hoop.
You won't find ready made string nets. You are best off weaving them yourself.
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| Net Weaving Shuttles. They are loaded with string. |
Now with the small boat and the crab net and a few bushel baskets, you are ready to set off. You may also want to keep a waterproof container on board. If you run across a soft shell crab, you will will want to be able to keep it moist.
On a perfect, day there will be very little breeze so that the surface is as undisturbed as possible. The more that the surface is rippled, the less likely you are to get a good view of the bottom. Sometimes you can squirt fish oil in the area you are working. It does cut down on rippling. (Oil on water actually works!)
You want to be in water as shallow as possible. It increases your visibility and gives you a better percentage of successful netting because the crab will have less ability to avoid you in the vertical plane.
Here is pretty good picture of a blue fin crab.
The predominant color of the animal is a greenish brown, exactly the color of the grass. The grass is not continuous, like a lawn. Instead there are multiple, interspersed "bald" spots where the mud of the bottom is exposed. The color of the bottom is generally a light brown. In addition, there will be sunlight that will "ripple" across the bottom in your field of vision and appear to cause motion.
So the crab is in a habitat where he is well disguised. You spot him based upon shape, color, and movement. A clump of "bottom" is in the shape of a crab. You may see a flash of blue from the claws or the back swimming fin. You may see him swimming.
Using your net you push the boat toward the crab and then position the boat so that you can take a whack. Generally the crab backs up before launching himself in some direction, so it's nice to aim the net directly behind him as you make your move. If the crab begins to swim away, you can make an estimate of where he will be and try to get the net there. It's hours of fun for me.
I did it whenever I could, when low tide fit into my schedule and when it wasn't too breezy. I would give away or sell my crabs. At night, after a day of netting, it wasn't unusual for me to close eyes and to have the sense that I was still crabbing, to see in my mind's eye the rippling of sunlight over the bottom and the sense of rocking in the boat.
Netting kept my weight down and was good exercise for core muscles. There was a lot of torquing of the hips and spine in order to move and position the boat.
Scraping
One of the problems with netting is that weather conditions have to be ideal. If I really needed a crabbing fix, I would sometimes crab scrape.
Scraping was the primary method of catching crabs on the Island during the summer.
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| Crab scrape showing handle, rectangular scrape and trailing net |
The term "lick" is used for once cycle, i.e. from tossing the empty scrape to completion of sorting and tossing the scrape again. (I went one day with Rukie Dize as he scraped. These bags end up weighing a hundred pounds and must be maneuvered on board and dumped out. I pulled in perhaps one out of six licks that day and went home exhausted and slept for eight hours.)
After dumping the scrape net on the sideboard of the boat, the material is sorted for hard shell crabs, softshell crabs, peelers (crabs likely to molt soon), and other material of interest, such as fish and shrimp.
It was all fun and I miss it.
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I warned you I was going to cheat. Here it is.
The italicized text that follows is copied verbatim from An Island Out of Time by Tom Horton, Paperback Edition W.W.Norton & Co.
Pages 221-224 is a section subtitled "Island Doctor. Eric Sohr"
I think it's a great book and recommend highly as a study of one our interesting subpopulations.
• The day in 1983
I first went to see the island, the captain bringing me over asked, did I need
help getting aboard. Before I could answer, he said, "Because if you do,
doc, we don't need you here." The accents there were very strange, and I
remember thinking how dirty the place seemed—at the time there was an open
dump, and half a mile of rusted cars lining the one main road. So many of the
docks and shanties seemed just patched together, and the waterfront was full of
junk.
I was recently
separated, a single father of two boys, four and seven, and looking to get off
the treadmill of a family practice in Montana. I had three choices: a
fellowship at the University of Missouri; moving to Saudi Arabia and making an
enormous amount of money; and Smith Island, where I was not sure I could
survive financially. Years before, I practiced in a town on the Eastern Shore
mainland. I didn't like the town, but I became absolutely addicted to crabbing.
The day I first visited the island, I listened to the men in Tylerton's church,
talking about all the ways there were to catch a crab. I was impressed. The job
would include a house, rent-free, and my utilities paid. For making house calls
I acquired a skiff and a bicycle. I arranged to work a weekly, twenty-four-hour
emergency room shift in Crisfield's little hospital to make ends meet, and that
was how I became the island's first doctor in fourteen years. When there was
slow time in the E.R., I sometimes passed it by weaving crab nets as the islanders
taught me.
The island was a
good place to be a single parent. The boys were always in a crowd of kids. I
felt like I had a hundred sets of grandparents. The people were so affectionate
and polite. There was just a gentleness to them. In nearly four years there, I
got very little business from fights. The islanders were very good at not
taking offense. They have worked out non-violent ways of living better than
most.
It seemed
resident doctors had served the island, periodically, for at least a century.
Other times, there had been nurses; also, in modern times, a number of dentists
and doctors and nurses from the western shore—including the National Institutes
of Health, Johns Hopkins, and Georgetown University—had volunteered time there.
Most recently, several of the local volunteer firemen and
women have trained as Emergency Medical Technicians.
I was struck by
how motivated to work the islanders were. If injured, their first question was
always how they might get back to work in spite of it. Both men and women were
that way. I don't think I have ever seen such a strong work ethic except among
cowboys I treated in the West. Islanders had a heritage of taking care of
problems on their own. They would talk about old-timers like the man who got
blood poisoning after a crab bit him. With red streaks shooting up his arm, he
decided to "walk it off." For two days and nights, in agony, he paced
back and forth in his house, sometimes putting a jacket or blanket over his
head to try and blot out the pain. A young woman with no health insurance said
she had treated herself for what must have been quite severe burns from a
kitchen accident that scalded all over her thighs. It was not unusual for men
to do minor surgery on themselves—for infection around fingernails, for
example; and I recall a housewife setting her own dislocated elbow.
I was very
impressed by the physical strength of the men, from pulling scrapes and pots
and tongs all their lives. One crab scraper in his late seventies came to me
with a bicep muscle that had ripped completely loose on one end. Soon after, he
was back on the water, pulling in scrapes that, moving through the water, were
like lifting 100-pound weights.
For all that, I
would not say islanders were an unusually healthy population. Diabetes and
heart disease seemed to run in some families with extraordinary frequency, and
there was more obesity than on the mainland. Some of it was lifestyle and diet.
I gained ten pounds a year, every year I lived there. They ate lots of seafood,
but mostly deep fried; and they put sugar in everything, even lasagna. Also,
though they worked hard, aerobic activity in such a confined place was easily
avoided. Smoking was rampant, especially among men. It is that way on the whole
Delmarva Peninsula, which has one of the nation's highest rates of lung cancer
deaths.
Some of their
problems likely were genetic. A western shore doctor to whom I showed photos
from the island remarked that just from some of the faces, he could tell there
was inbreeding. He acted as if he had already decided they were somehow
inferior. To my knowledge, no one has ever done a careful study of the island's
genetic situation. On Tangier Island, a similar population to Smith, a study in
the 1960s identified a rare genetic abnormality that causes elevated
cholesterol, enlarged liver, spleen, and tonsils. It is known as Tangier
Disease, and only a few dozen cases have been documented worldwide.
Of course the
gene pool is less diverse for Smith Island than most of mainland America. On
the other hand, it is scarcely as if people are going around marrying their
first cousins. This stuff about the islanders all being descended from the same
families who founded the place a few centuries ago is over-
stated. You find
out, when you start talking to them, that quite a few people, in just the last
few generations, came from other places, often through marriage. Several of the
kids there, some of them now grown and married, were adopted from the mainland.
There is a branch of the Smiths that is unrelated to the other Smiths. The
family was established on the island around the turn of the century when a
Smith from Manhattan, to get away from an abusive home situation, found work on
an oyster dredge boat and settled here. It's said there were some marriages
that brought Native American blood over here several decades back. At any rate,
you quickly grow to see through the faces; and what you see are some of the
most interesting and beautiful people you will ever meet.
Other medical
conditions are what you would expect from people in the occupations they follow
there: bone spurs from standing so much on boat decks; eye trauma and
precancerous skin growths from constant exposure to the sun's glare. A
gynecologist on the mainland said it was not uncommon to see women with hernias
and other problems aggravated by the heavy lifting they do, horsing bushels and
boxes of seafood on and off boats and into crab steamers.
I never expected
my practice would be a normal one. My first emergency house call I set off on a
bike, down a wet, slick road, with my emergency defibrillator dangling from the
handlebars. I had not been there a month when a woman came over from church
with asthma. I was working on her when the State Police Medevac helicopter
landed, and this trooper comes running in with an emergency medical pack and a
gun in his shoulder holster. We tried, but she kept arresting and died in the
office. Afterward an islander remarked it was a shame she couldn't have gone en
route, on the 'copter. I asked why. Been a little closer to the Home Office, he
said.
Three days a
week, I made house calls, a day for each town. For Tylerton, I went down in my
little skiff. A third of the population there was over sixty, and medically,
the most important place to see older people is in the home. I would find a
reason to peek in the refrigerator, to see if they were eating right; use the
bathroom, to look in the medicine cabinet to make sure they were taking their medications—with
so many same last names on the island, it could be a problem making sure the
right person got a prescription.
The island can be
a hard place to stay when you get old; but I have never seen a place where it
is harder on old people to have to leave. "They throb with this island,
like the bay with tide," a former preacher said. I don't think it is
strange that all three churches say special prayers every Sunday for "all
those in the nursing homes."
They valued a
doctor, and were good about paying their bills—the most honest people I ever
treated as far as expecting to pay for services and not expecting to get
anything for free. They didn't have enormous expectations; just expected you
to be straight with them. A far bigger concern for me was tourists in the
summer. You became an E.R. for strangers, and that made me nervous, because
unlike the islanders, they could be litigious. I don't think I ever made more
than $20,000 a year from the island practice. The mainland E.R. shift and some
small savings allowed me to survive.
I have a personal
interest in alcoholism, so I was attuned to alcohol abuse on the island. Even
so, it seemed of major proportions. At least five young men in a decade had
died, essentially, from drinking, even if that was not what the death
certificate usually said. Some of it may have been genetic. One part of the
island called me out so much on Saturday nights with alcohol-induced panic
attacks that I doubled my usual fee of $20 a visit in those cases, and after
that the calls stopped.
Maybe the
drinking also had to do with the fact that people were seeing their whole
culture implode, their way of life dwindle as the seafood declined and the
population dropped. They have gone from subsistence to consumerism on the
island awfully fast, in little more than a generation. People's time wasn't as
free any more, they said.
I had guaranteed
to stay a year, and I stayed almost four. I moved because my oldest was getting
near the age when he would leave the island every day for school on the
mainland—not a school that impressed me, either. I still miss the nature of the
place, the way the reality of work was so apparent. You saw your dad and mom
working right around you; watched your whole community harvesting a living as
you rode across the Sound to school. Your surroundings were so connected to
your whole being. And I remember the people, how beautiful their voices
were—they loved to sing. And of course the crabbing, which I came for, was just superb.
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Merry Christmas!
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Merry Christmas!
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