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Archive for the ‘Patient care’ Category

I really like my University of Michigan clothing. My son has sent me a sweatshirt and heaven only knows how many different T-shirts in maize and blue emblazoned with Michigan swimming and diving on them. In fact, it was just such a combination of sweatshirt and T-shirt that I was wearing Tuesday morning as I prepared for my morning exercise routine at Planet Fitness. The muscle ache on the right side of my chest and in my right shoulder, I attributed to lifting one too many weights.

At the gym, and before working out, I sat at one of the client tables in one of the hand-shaped chairs, feeling that this shoulder and arm pain really weren’t getting any better. “Aw, to hell with it,” I thought and headed to my car instead of to the bike awaiting me at the gym. Home I toddled, laying down beside my sleeping partner carefully in order not to rouse her from slumber. After a few minutes of restlessness, I decided that the pain might just not be the result of a muscle pull or tear. Time to get this checked out.

At 6:15 in the morning, one does not go to the local physician. Instead, I took the direct route to Newton-Wellesley Hospital. In a situation not dissimilar from going to the dentist for a toothache only to have it disappear just before you get there, the pain began to subside…and I began to feel like a damned fool. Nurses came and nurses went. Doctors came and off they went. Blood was drawn and it too disappeared into the ‘who-knows-where’ cloud of something or other.

“I’d like to run another test,” said the attending physician, who shall remain nameless to protect the innocent. This one, I knew, was to determine if there was somewhere, floating around in this magnificent 81-year old body, a nasty little thing called a blood clot. These are fine unless they happen to wind up in your brain where they can cause a stroke or in your lungs where they can cause the ultimate step.

“The scan is clear; the x-ray is clear, but the blood enzyme is borderline,” said the doctor. I was acutely aware of what he was saying, having been through three prior heart attacks. “Are you saying this is an infarction?” I asked. “No, he replied,” obviously impressed that I could use such a terrific technical term – no dummy, this kid – but the troponin level is such that I think we should do another test. I will pause here to tell you that enzyme testing is an excellent way of diagnosing whether or not what the patient is experiencing is heart related or not. The only problem is that enzyme tests have to be performed six hours apart. By now, it was getting nigh on to noon and that meant that it would be well into the evening before the results were known. Now, I don’t know about you, but I don’t care to spend any more time in a hospital than absolutely necessary. They’re filled with germs and sick people and they are real morale busters. “You want to admit me, don’t you?” I glared with steely eyes (like that?). “Yes,” he said, with a look that matched my own. After arguing the advantages and disadvantages, I had to admit that his case for staying was somewhat stronger than my own arguments for leaving, thus I was taken to a bed in the main hospital, prepared for a sleepless night. Who the hell can sleep in a hospital?

Sometime after dark, this same emergency room doctor came smiling into 543A and proudly announced that my enzyme level had risen, thus indicating a heart “concern.” Translation: You have had a heart attack and we have stabilized you. Okay, that was heart attack number four, but the first one where any semblance of pain had occurred. Heart attacks are funny things. They don’t always behave as we have been told time and time and time again. Pain is not a necessity. Radiating tingling in the left arm doesn’t have to happen. Symptoms of a heart attack are all over the place, bear witness that the muscle ache (I thought) was on the right side, not the left, and while the muscle ache extended to the shoulder, it hardly “radiated” down the right arm. Still, it was a heart attack.

The following morning, there was no pain and I was ready to get in the car. It was over and all was right with the world, right? Young doctor whozit abused me of that idea early on. “We’re sending you in town for a cardiac catheterization,” He said. For those unfamiliar with this procedure – I had been there and done that so was fully prepared (yeah, right), a needle is inserted into the femoral artery [mistake one] in the groin and is threaded up through the heart, looking for blockages. If everything is clear, so is the patient. If a blockage is found, it is cleaned out and a stent implanted. A stent is a tiny piece of wire mesh that is used to keep the offending artery open. “Piece of cake,” I thought. “No pain; everything should be clean and clear [mistake two].

Late Wednesday afternoon, I was taken by wheelchair to the “cath lab.” They prepped the groin area and when the surgeon came in, he announced, “We’re going through the wrist.” I had heard of this procedure, but the radial artery seems so much smaller than the femoral that I didn’t understand how this would be possible. In addition, having a probing needle thrust into my wrist was not something to which I was looking forward. “Don’t worry,” said one of the nurses, “you won’t feel a thing.” While I was conscious throughout this ordeal, she was right. Whatever Kickapoo joy juice I had been given put me on cloud 9 and 10 and 11…good stuff.

I have no idea how long I was on that table, but it seemed like forever. When it was all over and the lights came up, I remember asking if everything was clear. Hardly, replied some doctor from somewhere. It seems that one artery was blocked 99.9 percent and a few others needed some plaque removal. Ergo, I was one lucky sumbitch that a doctor in the emergency room at Newton-Wellesley refused to let me make a fool of myself and go home.

To Doctor Adam Lurie; to Ryan Flanagan; to Doctor Colin Hirst and his team; and to all of the wonderful people I met at both hospitals, thanks for your dedication, patience, warmth, and understanding. Nursing care at both hospital was fantastic and guess what…I even liked the meatloaf lunch I was served just before departing for home on Thursday…in my Michigan sweatshirt and T-shirt.

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Medicine has come a long way since the days when the Egyptians were performing lobotomies without the aid of anesthesia. Since 1846, when a dentist, Dr. William Thomas Green Morton first used ether as an inhalation anesthetic to accomplish painless surgery to today, when a variety of drugs are used for that purpose, medicine has jumped by leaps and bounds…except for one small problem. It seems to me that medicine and its practitioners have been working in a vacuum by not, until very recently, considering the cause and effect of outside influencers on medical advances, eg, how severely concussions and Chronic Traumatic Encephalopathy (CTE) can affect one’s life.

Dr. Robert Cantu and his team at Boston University are at the forefront in the study of CTE, which, to quote from their website, “is a progressive degenerative disease of the brain found in people with a history of repetitive brain trauma, including symptomatic concussions as well as subconcussive hits to the head that do not cause symptoms.” Brandy Chastain, FIFA Gold Medalist soccer player and coach, recently made news by willing her brain to the CTE Center at BU, and, hopefully, other athletes in other sports, professional and amateur, will follow in her footsteps.

Back in the days when my basketball career was in full bloom – what a crock – nearly any type of contact would result in a foul. As a consequence, it was rare for us to get really knocked around while playing the game. Today, it’s a different story. I watch, as collegians and professional hoopsters hit the floor and often bounce their heads off the hardwood. Are they concussed? I don’t know, and it’s very possible that they have no effects. It is my understanding that these “subconcussive” blows to the head may also lead to CTE. To once more quote Dr. Cantu and the BU team, “At this time the number or type of hits to the head needed to trigger degenerative changes of the brain is unknown. In addition, it is likely that other factors, such as genetics, may play a role in the development of CTE, as not everyone with a history of repeated brain trauma develops this disease. However, these other factors are not yet understood.”

All of this raises a number of questions on my part. For example, when a diver falls 33 feet or dives from the 10 meter platform, what is the effect on his or her head when they hit the water? Is it possible that the subconcussive effect of this effort, repeated hundreds or even thousands of times depending on the extent to which the diver competes, say up to the Olympic level, a potentially dangerous form of competition that could lead to CTE?

If you’ve never had a concussion, you’re fortunate. To the best of my knowledge, my experience centers around three events. The first was a slip on ice in the driveway very early in the morning in which I was unconscious for less than a minute. I lost my glasses, saw more stars than were actually shining down on me, and was somewhat nauseous. The second time was at an automotive repair shop when I skidded on some unseen sand and grease. The fall wasn’t quite the caliber of the first but the stars returned and the dizziness was in full bloom. The final tumble took place as I was leaving the gym. A new medication was working in consort with an older one; combined with what had been a good workout, the two dropped my blood pressure to “pass out range.” I awoke to find an IV in my arm and my body in an ambulance headed to the hospital. The most interesting part of this fall was that at no time during my day-long stay at the hospital did one doctor or nurse tell me that I was concussed. The egg on the back of my head told me that a concussion was a genuine possibility. I treated it as such and remained as flat as possible with the lighting kept to the barest minimum. It wasn’t until a few days later, when I was speaking with my primary care physician, that the subject of concussion even came up.

Now that we know the extent to which concussions and subconcussive blows to the head can lead to degenerative brain disease, it seems to me that we should be taking a second, third, fourth, and more looks as to how our children’s heads are protected during athletic competition. How safe are the helmets worn in football, baseball, lacrosse, and hockey competition? What other sports should be considering the use of helmets? What are the sports equipment manufacturers doing to lessen the impact on the brain? Before parents allow their children to become involved in certain types of athletic competition, maybe they should consider the consequences that could occur later in life.

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“Well, then, why don’t you write a travel piece?”

“A what?” I asked.

“Oh, you know, a piece about where you’ve been and what you’ve seen; the fascinating sights, restaurants, museums, and so forth?”

“You talkin’ to me?” I queried.

“Well…sure…” he replied, now growing a bit hesitant.

“The places I’ve been; the fascinating sights, restaurants, museums, and so forth?” I said, looking quizzically at this person I thought I had known for over 50 years…and actually turning around to see if he might be speaking to a complete stranger behind me.

“I DON’T TRAVEL,” I screamed as though speaking with a dolt, adding, “WHAT THE HELL ARE YOU THINKING ABOUT?”

That brought the conversation and companionship to a rather rapid close as he stormed off, waving his hands in the air in an “I give up; what the hell’s the use,” fashion. This, by the by, is not the first, nor will it, in all probability, be the last time one of our conversations has ended in such a manner, ie, with one of us throwing our hands in the air – why do we do that, anyway – and trudging away.

So, here I am, stuck with a blank page on the computer, still in a quandary over with what to fill this clean white sheet of screen. “Why write anything?” you ask.

“Well, writing is what keeps my sanity intact, what remains of it that is.” I enjoy writing. Actually, I enjoy writing pieces that make people think…one way or the other. They agree or disagree with my postulations, and it doesn’t matter a damn to me which way they go. As a matter of fact, I prefer it when people violently disagree with me – well, not violently perhaps, but you know what I mean – and they respond with their own clearly stated – most of the time – positions.

My options are limited. To write about any of the five presidential wannabee’s merely gets my blood boiling since there’s not one who is worthy of the highest office in the land. Seriously, think about it: Trump wants to build walls, allow his cronies to do anything they damn well please, up to and including criminal behavior. He wants to make abortion a crime and he hasn’t a clue about foreign policy. Ted Cruz wants to carpet-bomb the Middle East and tough tomatoes for anyone in the way. The way he’s talking, all Muslims would wind up in WWII-like ghettos. John Kasich and Bernie Sanders would each get eaten alive by Congressional foes, and that brings us to Hillary. Sooner or later, she will be indicted for something. I liken Hillary to John Gotti…she’s the Teflon pol to whom nothing seems to stick; Whitewater didn’t stick; Benghazi didn’t stick; e-mail messages aren’t sticking so far. Not a damned thing seems to stick. Ergo, who is going to run the country? As Felix the Cat (for those who remember) might say, eeeeeeeeek!

So politics is out. Perhaps I should write about Senate Bill 524…it’s a pisser! It’s called the “Comprehensive Addiction and Recovery Act of 2016,” and its purpose is to “authorize the Attorney General to award grants to address the national epidemics of prescription opioid abuse and heroin use.” What, we’re now making the Attorney General find a new way to fight the drug war. I guess we’ve given up trying to fight the cocaine war. It appears that Congress, in its investigative role, has found that, “The abuse of heroin and prescription opioid painkillers is having a devastating effect on public health and safety in communities across the United States. According to the Centers for Disease Control and Prevention, drug overdose deaths now surpass traffic accidents in the number of deaths caused by injury in the United States. In 2014, an average of more than 120 people in the United States died from drug overdoses every day.” My reaction to this is that it’s a great way to reduce the gene pool! Who are these 120 people who have chosen to die by drug overdose?  The circle of Kumbaya singing, well-meaning-but-wearing-rose-colored-glasses crowd will call me harsh, but that’s okay, because these 120 will not breed and they will not vote. Let them die and then let’s go after the doctors who prescribed a 20 or 30 day prescription for Percocet, oxycodone, OxyContin, or hydrocodone. I have had nearly 20 surgeries in my life, and I believe I’ve taken one Percocet pill. Did the surgeries hurt? You bet your butt they did? Were they as painful as some others might be? No! However, if doctors don’t warn patients about the addictiveness of these pills, the docs aren’t doing their job. Why did some of these addicts turn to heroin? Because (a) it can be cheaper than some of the prescription medication; (b) they couldn’t find another doctor who would authorize the pills; and (c) heroin worked better and faster. As a consequence of all this, Congress now wants to play nursemaid to people who don’t have the intelligence or desire not to become drug addicts. Sorry, that’s not where I want my tax dollars spent.

But, Congress responds, “According to the National Institute on Drug Abuse (“NIDA”), the number of prescriptions for opioids increased from approximately 76,000,000 in 1991 to nearly 207,000,000 in 2013, and the United States is the biggest consumer of opioids globally, accounting for almost 100 percent of the world total for hydrocodone and 81 percent for oxycodone.” And “Opioid pain relievers are the most widely misused or abused controlled prescription drugs (CPD) and are involved in most CPD-related overdose incidents. According to the Drug Abuse Warning Network (“DAWN”), the estimated number of emergency department visits involving nonmedical use of prescription opiates or opioids increased by 112 percent between 2006 and 2010, from 84,671 to 179,787.

Feel free to give me reason after reason for drug addiction in this country, but don’t tell me; please don’t tell me that I have to be part of a legally-adopted payment plan to help junkies rid themselves of an addiction.

Perhaps I should have written that travel piece after all…here goes. I’ve driven and flown from Massachusetts to LA and to Florida. I’ve driven the northern route which is New York State through Indiana, Illinois, Ohio, etc., and I came back the southern route through Arizona, Nevada, New Mexico, Texas, etc. Our son was married in a hillside chapel in Tennessee, so I’ve been to Gatlinburg, and driven over the Smokey Mountains into North Carolina. My travel has been limited to the United States, parts of Canada, and four unforgettable trips to Bermuda. Unlike many other people, I have not been to Europe or any exotic locales. I’d like to have seen the pyramids, but I have a thing about suicide bombers or kneeling in an orange robe and a drugged stupor while some jerk removes my head from the rest of me. Could I be more expansive about my travels? Certainly, but this little essay is now approaching 1,200 words – go ahead and count, ya damned fool – and my fingers are getting tired. Hope you enjoyed the tirade and that you’ll return again soon.

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Friend of mine returned to the gym after about a week and a half away. Since it was too short a time for a vacation, I asked where he’d been. He said that he had some minor day surgery, but it was enough to keep him away from the gym for a while. Then his face took on a funny look, and he asked, “You know what those bastards gave me.” Any number of things came to mind but not wanting to appear any more stupid that I already am, I answered no. “They gave me a prescription for 20 oxycodone pills.” It didn’t surprise me that Pete was upset since I’ve had similar experiences.

According to the Substance Abuse and Mental Health Services Administration (ASAM), drug overdose is the number one cause of accidental deaths in America. There were 47,055 lethal drug overdoses in 2014 and that number is continuing to grow. Of those deaths, nearly 19,000 were related to prescription pain relievers. To give you an idea of how fast this epidemic is growing, “…the overdose death rate in 2008 was nearly four times the 1999 rate; sales of prescription pain relievers in 2010 was four times those in 1999; and the substance use disorder treatment admission rate in 2009 was six times the 1999 rate. In 2014, 467,000 adolescents – those 12 to 17 years old – were current nonmedical users of pain reliever with 168,000 having an addiction to prescription pain relievers.” 1

When you are recovering from surgery, and you know this as well as I, there is often pain involved. That wonderful ‘kickipoo joy juice’ they give you to knock you out is great stuff, and if you’re having what I call “laundry service surgery,” that is, in by nine and out before five, the drugs in your system are probably still dulling the pain. Once the Versed and whatever else is in your system wears off, you hurt. How much you hurt depends a great deal (a) on what was done, and (b) your tolerance for pain. In all probability, you will receive, with your discharge directions, a prescription for some kind of pain relief. All too often, that prescription drug will be an opioid. “Opioids are a class of drugs that include the illicit heroin as well as the licit prescription pain relievers, oxycodone, hydrocodone, codeine, morphine, fentanyl, and others.”1

In an article by Dr. Celine Grounder, a public health specialist and a medical journalist, she asks the question, “How did doctors, who pledge to do no harm, let the use of prescription narcotics get so out of hand?” Would that there were some simple answers. One reason is because an article that was written for Pain and a letter sent to The New England Journal of Medicine. In both cases it was suggested that opioids/narcotics could be safely used to treat non-cancer patients on what seems to be a longer term basis with little concern for addictive behavior. That opened the flood gates for pharmaceutical manufacturers of these narcotics to market their products aggressively for other kinds of pain. In other words, it became open season to create a new group of drug addicts…and it was all legal.

In doing some research for this essay, I came across one article which indicated that “A recent review of medical studies showed that addiction to narcotic pain medications exists, but is not too common. On average, only about 4.5% of patients using narcotic pain relievers developed an addiction to narcotic pain medication!” I really wanted to ask the author to which medical studies he was referring and also to ask what rock he’s been living under for the past decade. Every day, about 60 people die from opioid overdose; 44 of those are from painkillers and 16 are from heroin.

Why do I keep mentioning heroin? We all know it’s an illegal drug, but as I said above, it is one short step away from many of the legal pain relievers prescribed by physicians. In a 2014 survey of people in treatment for opioid addiction, ninety-four percent said they chose to use heroin because prescription opioid prescriptions were ‘far more expensive and harder to obtain.’”2 Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing (PROP) maintains that the pharmaceutical industry misled the medical community about the safety of opioids beginning around 1996. He believes that this led to a tremendous overprescribing of oxycodone and hydrocodone. In a speech given last September, he told the audience, “These two chemical alterations of opium are so similar to heroin they should be called ‘heroin pills.’”

Pete’s wife filled his prescription. He told me that because he has young kids and didn’t want that $**t around, he took them to the police station. I have to admit that my bottle is still in a cabinet but we don’t have callers so I’m not too concerned.

There’s no question that we have an opioid epidemic in this country. It will continue to result in more and more overdoses until such time as pharmaceutical companies are forced by law to chemically alter their “heroin pills” to reduce potential addiction. In addition, doctors should consider the patient and the potential consequences before so easily prescribing opioids. However, the most important person here is the patient. Yes, there are times when surgical pain can be tough and require medication, but does it really require something that could hook and then kill you?

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  1. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  2. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014:71(7):821-i826

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Four score and a bit over a year, it has come to me that the Lord, yes, the same God who judges us all after we exit stage left, right, or into the orchestra pit, has a remarkable sense of humor. Man works like hell to solve problems, and it seems that just when he has the answer to one, the Good Lord smiles and tosses man another little problem to solve. Examples? How about the diseases that plagued London in the 18th Century? There was sewage in the streets and filth everywhere; smallpox was killing people by the thousands. Bye the 19th Century, however, man had semi-conquered smallpox with a new device and sera called vaccinations. No sooner was smallpox considered more of a minor irritant than cholera and typhoid appeared. It was rather like the God saying, “If you’re going to do nothing about sewage and cleanliness, I’m just gonna keep tossin’ these little diseases attcha until you wake up!” Of course, mankind did finally wake up, which is perhaps one of the reasons for the cliché, “Cleanliness is next to Godliness,” but let us attempt to keep the clichés to a minimum.

In 1845, the Great Famine that killed over a million people in Ireland was another little gem tossed to the beings on the planet. It took 168 years to figure what the hell it was, but in 2013, scientists finally figured what the infestation was that caused crop failures worldwide, but that hit Ireland particularly hard. According to one source, Ireland has yet to recover its full population.

I really shouldn’t say the God is responsible for the famine and disease that has plagued the earth since the time Eve took the first bite of an apple. Man seems to have done a fairly good job of mucking up the gene pool on his own. The Native Americans were far healthier than the European settlers who landed in North America. According to Native American Netroots, “The diseases brought to this continent by the Europeans included bubonic plague, chicken pox, pneumonic plague, cholera, diphtheria, influenza, measles, scarlet fever, smallpox, typhus, tuberculosis, and whooping cough. The diseases introduced in the Americas by the Europeans were crowd diseases: that is, individuals who have once contracted the disease and survived become immune to the disease. In a small population, the disease will become extinct. Measles, for instance, requires a population of about 300,000 to survive. If the population size drops below this threshold, the virus can cause illness and death, but after one epidemic, the virus itself dies out.” Nonetheless, our European forbearers did a pretty good job of infecting the Native Americans with disease. Other than stealing their land, this seems to be a pretty good reason for the Indians to be pissed at the settlers.

When I was a child (okay; no wisecracks; no, I did not know Adam and Eve…or their kids), my world was terrified of chickenpox and measles. It was believed that exposing us to a neighbor child who had one of the diseases would give us a lesser case or at the very least would give us immunity after the disease had run its course. Today, we know that the chickenpox virus remains in the system and can result in shingles in later life. It was just last year that my own doctor recommended a vaccination to prevent the virus from resulting in shingles. In addition, I don’t believe it’s any accident that one of my pox scars later turned into a basil cell carcinoma, a form of skin cancer that is rather easily cured.

Another frightening disease throughout my childhood was infantile paralysis or polio. It’s a disease that has been around probably has long as man has been here. In The History of Vaccines, it is noted that “Polio reached epidemic proportions in the early 1900s in countries with relatively high standards of living, at a time when other diseases such as diphtheria, typhoid, and tuberculosis were declining. Indeed, many scientists think that advances in hygiene paradoxically led to an increased incidence of polio. The theory is that in the past, infants were exposed to polio, mainly through contaminated water supplies, at a very young age. Infants’ immune systems, aided by maternal antibodies still circulating in their blood, could quickly defeat poliovirus and then develop lasting immunity to it. However, better sanitary conditions meant that exposure to polio was delayed until later in life, on average, when a child had lost maternal protection and was also more vulnerable to the most severe form of the disease.” The one thing that I know for certain is that a 16-year old named Jerry left work at the A&P in Rockland on a Saturday night in 1951 feeling great. On Tuesday Jerry was dead from polio. I still pray for his soul. He was a good kid, and I’m sorry I never got to know him better. Thanks to Dr. Jonas Salk and company, polio has nearly been eradicated, although 250,000 cases still appear annually in lesser developed countries.

Like polio, cancer has been around for thousands and thousands of years. Hippocrates, yep, the same guy for whom the oath was named, used the terms, “carcinos,” and “carcinoma” when describing some ulcer like sores that spread and killed. Today, we are still fighting the fight to find a cure for the disease. I do not know of one person I have ever met who has not, in some way, been affected by cancer. I lost my wife, my Dad, and two grandparents to the disease. You have either lost someone or know somebody who has lost a parent, child, or some other relative. Cancer is the most insidious disease I have ever known. Yes, Jerry died of polio and that was terrible. Worse is watching as your spouse, the mother of your children, waste away and stop breathing. Cancer will not be cured in my lifetime. Hopefully, it will be eradicated by the time my great grandchildren are born.

It’s easy to toss a lot of the disease and death in God’s lap. ”Man plans and God smiles.” No, that’s not really it. Perhaps the Good Lord did throw us a few speed bumps when things first got going, but we have certainly done a fine job of creating our own little killer bugs. I wonder what’s next on the agenda.

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“I’m dying,” she said. Simple, direct, no drama to it all.

“Yes,” I replied, “I’m aware of that.”

“Can you help?” she asked.

“A rather strange question,” I responded. “Help in what manner?”

“Can you ease the pain? There’s a great deal of pain, you know. I don’t really mind the pain, but if there was a manner in which it could be eased, I think I’d feel better about the dying if there weren’t quite so much pain.” Always the pragmatist.

“There are drugs. Is that what you want? It might be for the best if you took them. They’ll ease the pain for a while.” It always seemed strange to me that when the doctors know someone is dying, how so many of them still seem reluctant to turn the dying patient intro a drug addict even though it might just allow their transition to be easier. I wonder why that’s so?

“I’m not big on drugs, you know; never cared for them; always thought they messed up my stomach. Guess I’ll just have to make some choices.”

“Yes, I guess you will.” She’s always been somewhat stubborn about drugs…as well as doctors. Had she not collapsed in the store, we probably would have learned she was dying after the fact…rather, a fait accompli. That’s really not very nice. She’s been dying for several years now. None of us had the courage to confront her with that fact which she would have denied had we mentioned it. I suppose that, as her husband, it was my place to speak up, but why irritate a person who’s dying and who already feels badly enough about the whole thing.

“Do you still love me?” she asks.

“Yes, I still love you,” I reply.

“Not as you once did, however,” she queries.

“No, not as I once did,” I respond. “I love you now without doubt, without fear, without any of those things that could call into question my love for you. I love you now with trust. Trust goes beyond the intimacy of youth, the molding of ourselves to one another; the attempt at altering the other’s opinions. This is, perhaps, the final stage of our love. Somehow, it seems more than appropriate, don’t you think?”

“We did have our times, however,” she says, attempting a small smile.

“Take this,” I say. Although she’s been on morphine for months, she appears to believe that what she takes is medicine. Perhaps this is some form of delirium, denial, or whatever. At least she’s coherent. Unfortunately, there are times when she’s not. Her milky eyes will stare at me and gibberish comes from her tongue. This is the time to stare back and nod. The tears have stopped; both hers and mine. Tears are useless at this stage. One might say, ‘all cried out,’ but that wouldn’t be quite right. I don’t think one can ever reach that point.

Her tongue comes out and the dropper releases its copper measure of relief. It won’t take long, but neither will it do much good. Should I continue to refill the dropper until the bottle is empty? Is that fair to her, to me?

Minutes pass; her eyes close; open briefly, and she is gone.

Too much?

 

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I don’t believe that anyone can ever know the feelings of true pain and agony until they have watched a loved one waste away to some horrible disease knowing full well that there is nothing they can do to stop or even slow down the horror of what is happening; I’m told that being kicked in the balls by a kangaroo might come in a close second, but I’m not from Australia and the only kangaroos I’ve ever seen have been on television. Therefore, it’s somewhat difficult to experience what the feeling might be like when it’s coming to you from a forty-two inch, high definition flat screen television set. There may be people with a better imagination than I who could double up and scream in pain upon seeing this, but they are, I’m quite certain few and far between.

Do I make light – or lite if one is a beer drinker – of watching a loved one die? Unless you’ve been there, don’t even think about criticizing me. One minute you think you’re doing all the right things to make them comfortable; the next minute you know that you’re just deluding yourself and you ask over and over again, “Why can’t I do more?” Another question that will pop up somewhere along the line, that is if you believe in a higher power, is, “Why are you punishing her this way, God? Why won’t you stop the pain?” All good questions, but you and I won’t learn the answers until we stand before whoever or whatever it is we will stand before in final judgment. I certainly hope it’s not a kangaroo.

I’m old. That means that I’m not only on the downhill side of the mountain; it means I’ve crossed the desert, forded the river, traveled the forest, walked the yellow brick road, and am well on my way to making that final turn into the homestretch and the checkered flag. It’s not the checkered flag that scares the daylights out of me, but that friggin’ homestretch. It may be long and painful or short and so quick that I’m gone before I even realize the pain…although I doubt that will be the case…just as long as it doesn’t consist of a mob, troop, or court of kangaroos doing their happy dance.

I have come to understand that it’s okay to joke about death…not to someone who is dying, of course – that would be rather crass – but I remember my late wife saying at one point, “You know, this really should be you laying here. It would be so much easier for me.” She still had a good sense of humor at that time. As many others, I believe, have wondered, “Why was it him or her? Why not me? He or she was such a good person. Why did it have to be…?” Maybe we learn the answers; maybe we don’t. Guess we just have to die to find out. Certainly, a kick in the balls from a kangaroo isn’t going to answer the question.

And don’t get me wrong; I have nothing against kangaroos…except…well…you know…oooh! Just thinking about it sort of freaks me out. I mean it’s not like camels; they’re just plain mean. They spit and bite and they smell. Ostriches can give you a hell of a kick, but not like a kangaroo…they take aim.

Is this supposed to be funny? Well, I’d have to think about that. On the one hand, yeah, yeah, it’s supposed to be a bit humorous, but on the other hand, there is very little humor in losing someone about whom you care deeply. It leaves a hole in your life; not in your heart necessarily…that’s the baloney that the poets push…but it leaves an emptiness in you that is always there. Sometimes, you can hide it; then, other times, it jumps up and punches you right in the gut. That’s the time when you just want to work things out by yourself…because I’m not gonna kid you, it hurts like a bitch. Somehow, you do manage to get through it…usually…but it’s like a tornado has passed by, sucking the air from you.

For those who haven’t reached the top of the mountain yet, don’t forget to stop and admire the view; it’s like nothing you will ever see again.  If you’re in the desert, fording the river, or going through the forest, slow down and look around. Absorb the beauty of all that surrounds you. Before you know it, you will have walked the yellow brick road and see that homestretch and the checkered flag. Before you reach it, soak up all of the good and beautiful you can…oh, yeah, and watch out for the kangaroos.

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The Ebola epidemic in Africa appears to be creating a panic on the part of certain people in the United States. The talking heads seem to be putting on their “disaster” faces when talking about the death of Thomas what’s-his-name in Texas and the two health care workers who are currently showing symptoms of the disease at the hospital. It’s not that I don’t remember Mr. Duncan’s name; I just don’t give a damn about it. He can probably now be called “US patient zero” for bringing a disease which I believe he knew he had contracted into this country. You don’t give a damn about us; we don’t give a damn about you.

Ebola is a terrible disease. Doctors in Nebraska and several other states are knowledgeable about it and how to prepare to receive anyone with symptoms. It has become all too apparent that the staff at Texas Presbyterian Hospital in Dallas cannot be rated as knowledgeable, and that is unfortunate. It is also clear that Dr. Thomas Friedan of the Centers for Disease Control (CDC) is tap dancing faster than Gene Kelly or Fred Astaire in an effort to demonstrate how poorly prepared the CDC was for what has taken place. Training does not mean sending out a bunch of instructions that you hope hospital personnel will take the time to read. Whenever he said, “We have a team ready to go anywhere to train hospital staff,” I damn near pissed my pants laughing. Excuse me sir, but we have nearly 320 million people in the United States. In addition, we have 5,273 hospitals in the country…and you have “a team;” what turnip truck did you just fall from?

Ebola kills people…but…it doesn’t kill everyone. Ebola can be treated and steps can be taken to prevent the spread of the disease. The CDC and nearly everyone else in a position to know say that Ebola cannot be spread other than by contact with an infected person’s bodily fluids. So, if an Ebola patient sneezes while I’m inhaling, can I become infected, or, if it happens to be a woman, do we have to “swap spit,” so to speak?

New diseases seem to crop up on a regular basis, and Ebola seems to fall into that group. Notably, it has chosen to arise in some of the poorer countries of Africa. This doesn’t appear to be unusual. From Africa, it will normally descend on Europe and then on to North and South America. We have faced many epidemics or pandemics long before Ebola. We have conquered the majority of them without too much trouble, and doctors have shown that the fight against Ebola can also be won.

When Europeans first arrived on the shores of the New World, they brought with them something called smallpox. It wiped out entire tribes of Native Americans during the 1633-1634 periods. According to Healthline, “…the native population in New England dropped by over 70 percent.” The last reported case of smallpox in this country was in 1949, and that was someone who had never been vaccinated.

If you’re looking for something a bit more recent, how about the Spanish Flu that infected soldiers fighting in World War I and who were from any number of countries. This epidemic/pandemic left 20 million dead in a matter of months before its spread could be stopped. In the United States, this flu killed an estimated 675,000 men, women and children. Today, a flu shot is available that will prevent or ease our chances of catching the flu in one of its many forms.

The peak of the polio epidemic in the United States was around 1952. “The first major polio epidemic in the United States had occurred in 1916. In the 1940s and 50s, polio outbreaks created frenzy, frightening parents and prohibiting travel from city to city within the United States. Some towns were quarantined to protect the public from affected individuals. It reached a peak in 1952 when over 58,000 cases were reported, including 3,145 deaths.” One of those deaths was a kid I had been working beside on a Saturday. By the following Tuesday, he was dead. Thanks to Jonas Salk, we no longer worry too much about polio.

There have been many other epidemics in America’s more recent history. The one with which we have the greatest familiarity is perhaps the AIDS epidemic that started in 1981. “…the epidemic we now know as HIV began to appear as a rare lung infection characterized by a weakened immune system. It remains the leading cause of death in the United States among people age 25 to 44. Research has found many ways to put AIDS into remission and I, for one, have no doubt that the time will come when a cure will become possible.

There is, of course, one disease against which we are continuing to fight with only moderate success. Cancer is the most insidious of the diseases we fight; yet, that’s not fair. Multiple Sclerosis, Muscular Dystrophy, Cerebral Palsy, and a ton of other diseases that could be named are still out there to be fought and research is ongoing. However, I don’t believe there is a single person in the United States who has not been touched by cancer in some way. Whether it was a member of the family, a friend, colleague, teammate, or the neighbor across the street, we all know the tragedy of cancer. It killed my Dad, my wife, my grandparents, and too many other non-family members for me to count. Just when the researchers think they’ve found the answers to a particular cancer, it mutates, and they have to begin their fight all over again.

Ebola is not cancer. A cure will be found. The big question mark becomes how will the manufacturers of the vaccine to cure Ebola get into the hands of those who need it? Countries such as Liberia, Sierra Leone, and Guinea are too poor to be able to afford the price of the cure. Here’s another opportunity for the world to show its humanitarian side and not be concerned about the bottom line.

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How many dry skin creams have you tried? Winter comes on; the skin starts to crack, and it’s “Okay, which one shall I try today?” It’s worse when you’re old. Your skin has thinned out. You definitely don’t have the seven layers with which you were born. There are some creams or lotions that you try and you have to rub the darned things in for the day. If anyone went to grab your arm they’d slip away as if you were the greased pig at the fair.

I think I’ve probably tried every skin cream known to man, including…yes, I admit it…some of those one o’clock in the morning television ad creams that you know are fake. I have two bottles of Vaseline Intensive Care sitting in my nightstand. I can’t make them work for me. Neutrogena proved a failure from the outset when a finger-full slipped off and landed on my new khakis. Like most of the rest of them, it stains. Clinique, Oil of Olay, Gold Bond, and a variety of others have also been wanting. The reason I bring this up is that the skin of the elderly loses its moisture. When you get an itch and go to scratch it, you stand a good chance of removing enough of what’s left to draw blood. It is ugly. So then you bleed all over the book you’re reading or the dinner you’re preparing – don’t gag – or whatever else it is you’re doing and it’s very, very embarrassing. ‘No, the meat isn’t that rare; it’s just me.” I mean, come on, you want to say that to your guests…tacky, tacky, tacky!

All of these skin creams must be absorbed into the skin for them to work, right? This does not mean that one dabs on a light application and pray for osmosis. It means that the lotion/crème/gel/whatever, must be rubbed into the skin. Let it be sucked up by the epidermis, the dermis, and the hypodermis. That’s fine, except that the sneaky epidermis, the one that is supposed to be the outermost, strongest layer that gives us such great protection also has some layers. These are the stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and the stratum corneum [you don’t have to remember this; it won’t be on the test]. So or Therefore or yuk, it appears from an article in The Journal of Dermatology, that the epidermis does, in fact, lose cells to some degree as we age. In one study that was done, they took skin from near the navel to study. I don’t know much about this but it seems to me that if they were going to do that, they should also have taken some from the face or any other area that is more exposed during a lifetime. I mean, how many people do you know who rub Aveeno around their navel?

Anyway, I have concluded from all of my Internet research that I am completely and utterly screwed when it comes to using any skin softening crème, or lotions for my poor hands and arms; I will just {head thrown back and the back of one hand gently touches the brow in an expression of “I’m doomed} suffer through the winter months with skin that tears like tissue, fingers cracked and bleeding..ah, suck it up and behave like a man you wimp!

Okay!

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Not too long ago, I posted on this blog, Adventures in fainting. Before we go much further, let me advise you to read that before you feast your eyes on what follows. I suppose we could call it part deaux, but that would create an unnecessary disquieting on the part of those who have already read the ‘first adventure.’

One of the things about which I had not been told at the hospital to which I was taken was this: When a sic foot, one inch, two-hundred and fifty pound person hits the floor with his or her head, it creates something called a concussion. Since this was my first ‘faint,’ and since I have been wise enough my entire career – at least up to this point – not to get involved in athletic endeavors where one’s head is continuously smashed against some other object, I deduced, in my best Sherlock Holmsian manner that I had a concussion. This was further supported by the number of people in the emergency room who kept commenting on the size of the egg on my head.  No one, however, ever used the word, “concussion.” Here, I would digress and tell you that being married for fifty years; having had three children who were involved in athletics; having coached a Little League team for several years, and; having had a wonderful wife who, at times, could be a bit of a klutz [me too], concussions were not totally foreign to me. Any time you hit your head and see stars, you have probably suffered a mild concussion. Any time you have hit your head, seen stars and been knocked out for a count of ten or more, you definitely have a concussion. How they measure the severity of the concussion is something of a mystery. I have read articles from the Public Library of Medicine about the Wayne State Tolerance Curve and a number of other pieces that are so medical in their descriptions and discussions, I just wanted to vomit. I had the feeling that in the final analysis, they were not attempting to blind me with their brilliance so much as they wanted to baffle me with their bullshit.

Concussions have consequences…for all recipients. These consequences may be mild all the way up to severe. They may occur shortly after the trauma to the brain, ie, a concussion, or they may occur days, weeks, or even months later. While I’m delighted that something is finally being done about post-concussion syndrome, as it’s called, I believe that football regulators have known for far too long the consequences of concussions and not until they were pressured sufficiently by parental, medical, and financial groups, did they begin to seriously look at the long-term consequences of traumatic brain injury.  One of the sources I looked at for post-concussion syndrome (PCS) was WebMD. That site listed the following as symptoms of PCS:

  • Headache
  • Dizziness
  • Sleep problems
  • Psychological symptoms such as depressed mood, irritability, and anxiety
  • Cognitive problems involving memory, concentration, and thinking.1

Three weeks to the day passed before I finally went to a hospital…a Friday. This time, it was my ‘home’ medical palace. Waiting for the shift change, I arrived at about 7:30 am. I shared the printed results with the nurse at registration, the nurse assigned in the emergency room, two lab technicians, a physician’s assistant, and finally a doctor. I also shared orally my post-concussion symptoms which they all agreed were post-concussion symptoms…hmmm!The printed discharge papers indicated that I should call my pulmonary specialist on Monday. Okay, that meant that I had Saturday and Sunday to ponder the “small mass” on the right lung. Was it cancer; it had already claimed my wife. Was it a blood clot; I’d already been through the trauma of one of those. Was it a…WHAT THE HELL WAS IT? Early Tuesday morning, before the day had really begun, the phone rang. It was the doctor. I vowed to be non-pissed. He hadn’t been told that I was hospitalized on Friday and hadn’t checked his computer for messages on Monday because his schedule was so tight. His apologies were profuse. I was nonplused. What could I do but ask if he had access to the notes. “There right here,” he said. “I just didn’t check anything yesterday. Wait a minute.” He was gone less than 30 seconds, looking at the scan. “It’s a small bunch of lymph nodes,” he told me. “It’s nothing to worry about but something to watch. We’ll repeat the scan in a few months. It’s good news. We’ve identified something early enough that we can keep an eye on it.” We chatted about nothing – at least I can’t remember what it was – and said our goodbyes. Saturday, Sunday, Monday…how do you say ‘frightened?’ Then came Tuesday…and how do you say ‘relief?’ They haven’t invented that word quite yet, but I now sure know what it feels like.

Rest assured that Monday morning, as early as possible, I called the pulmonary specialist. When he hadn’t called back an hour later, I called again [impatient son-of-a-bitch that I am] and was told, “He has your note and will be calling.” He didn’t; he didn’t call for the rest of the morning, and he didn’t call for the rest of the afternoon. Finally, shortly before the office was supposed to close, I called again…too late; Friday afternoon; everyone left a bit early. Oh shit!

Since a sufficient period of time had passed since the initial injury, they indicated that it would be wise to perform some of the same tests once more. It was exactly what I was hoping they would say, and I instantly became a fan of their deductive reasoning. Most of the scans, thankfully, showed nothing. There was no bleeding into the brain; there was no lasting trauma of any kind. There was, however, one thing that bothered them. It was an unidentifiable “small mass” on the right lung. They ran another test – a contrast dye test – that indicated the same thing. It had not shown up in any previous x-rays done at the hospital. My pulmonary specialist had left for the weekend by the time they attempted to contact him, and so I was released with a huge question mark hanging over my head.

“Such symptoms can affect day-to-day life, and inhibit the ability to perform in situations like work.” It was within a week that every one of these symptoms entered my life. While I have published several articles on the blog during the three-week period following the initial injury, I won’t go back and look at them because I might believe they were done by someone else. The headaches were the worst since I rarely suffer from them. Getting up from a chair was always an adventure, and sleeping became an exercise in watching the numbers change on the bedside clock…it’s luminous; what can I tell ya?

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1. WebMD

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