A Caricature

 

Dear Dr. Imaginary

 

11/02/21

Dear Doctor C___,

Your call is important to me. No, honestly, it is. As I mentioned in my original message through the website days ago, this isn't in reference to anything life-threatening, at least not so far as I know. But then how would I know, come to that? Obviously I'm not the doctor. Let's assume not-life-threatening. No, I just had a question and you were to get back to me, which you did, again via messaging, suggesting we arrange a telephone consultation. Now that sounds simple enough. Over the past long while we've actually talked on the phone more than once. I confess that when you actually called me unprompted once, just to follow up, I was terribly surprised. I mean, there you were, on the phone, big as life and calling me without so much as a half hour wait, three previous booking agents, virtual chats with third parties, physicians' assistant interventions, nothing. I didn't want to say so at the time, but I don't mind telling you I nearly cried when you did that, that one time. It was like getting a call from the Queen for my hundredth birthday! It was special. I was actually quite touched. No lie. 

Today's been a bit different, more usual if I'm being honest. You suggest a phone call. I try to arrange one via messaging and the automated phone system etc., and well... here we are. I've got a message pending on the website, two failed return calls from a robot, and I am writing an imaginary letter you will never read because it may be "up to 48 hours" before I can expect a response. I have tried doing this sort of thing through the website before. An enquiry, followed by sincere response, followed by... very long pauses. I am always tempted to just start writing something lengthy and more personal just to fill the time. I don't know if you know this, but even were I to break this sort of thing up into entries that would not exceed the designated length, at some point the system simply won't allow for it. Just today I started to write about the green beans I rather thought we might have tonight with the buttermilk fried chicken the beloved husband is planning. I didn't feel I could afford to actually get up from my computer and go snap beans though because then I would be dependent on just the phone app again and it refuses to retain my password, despite insisting that the facial recognition software has already let me into the site. You know what I'm talking about. Happens all the time. Then I panic and can't remember my password and then the whole disastrous undertaking just cascades into tears and curses -- mostly curses. Today when the robot called me back it would not respond to "Hello?' and just insisted I "press any button," but I didn't have a keypad displayed when I answered the call and when I tried to get to it I hung up the call. Disaster! So now I'm sitting downstairs in my office, getting a bit chilly because I didn't wear my robe and still afraid that if I go back up I will miss something. A call was it? Who remembers now frankly, but the anxiety lingers on, my dear doctor and we both know what that does for a man with heart problems, but what to do?

What was I talking about? Oh, yes. Green beans. Now I know it's mad to even think of typing away about green beans while waiting for the doctor, but it may pass the time. And I should think it looks even worse typing away about green beans and buttermilk chicken wings on the actual site of one's  Health Care Provider. I'm not a complete fool. I would probably have deleted everything about the beans -- and certainly any mention of fried chicken -- before I hit "send" but then it wouldn't have mattered anyway, or even have happened because of the website's restrictions on messaging length, so I might as well just natter away here, talking to my imaginary doctor as it were, as doing so has the undeniable advantage of not requiring so much as a wink from you. 

At least here at my own desk, even if it's a bit cold and my day is wasting away to nothing, I am not actually on hold listening to smooth jazz or to a recorded robot voice, or pressing "1" sixteen times to avoid inadvertently switching into Serbo-Croatian or requesting a Pap smear or something.  

Which reminds me how genuinely amusing it is on the website when attempting to book an "e chat" that among my eight options -- not one less, not one more -- besides "I am dying of COVID19" one of the only other available listings is "heel pain." What CAN that mean?! I keep meaning to ask you when and if we ever get the chance again. Why specifically "heel pain"? Is that a major concern? Is it indicative of some larger issue? Is it better to ask in this subtle way because heel pain is actually the first sign of myocardial infarction or Dengue fever or something and you don't want people to panic before they've actually taken the time to virtually book what will probably only be a "televisit"? Is it actually already too late by the time there's heel pain? Is it more common for instance than toe pain? (I'd have put money on arches.)

Medical science is a genuine mystery to me, I must say. I've always assumed there was a fair amount of arithmetic and that was enough to put me right off the idea. Memorization too. And blood of course, though I'm not terribly squeamish. The beloved husband loves medical shows which I do not but even he has to turn away sometimes from some of the incredibly realistic looking and surprisingly elaborate surgical interventions. Now I think of it, I've never seen anyone rushed into the surgery complaint of "heel pain," Not once. I may have exaggerated the potential importance of that, but then the options really are quite limited and there isn't even an "other" option any more. Did you know that? There is not. The list is basically "I am dying of COVOD19," pregnancy, acne, smoking cessation, (...), (...), and heel pain. Pick your poison, people! It is remarkable how you've managed to narrow that list down. Even still, all of that must be awfully complicated to study and treat. Heel pain alone must be volumes. I would not be up to anything like. I can't even get beans snapped and the morning is long gone and the afternoons are so short now it's autumn. 

I do hope you had a chance to get out and see at least a little of the glorious Fall color on those two sunny days we had between the more usual Northwest weather systems. I was actually working during most of the daylight hours, so it was more a glimpse for me than a leisurely country drive or anything like that. Have I ever mentioned that I'm from back east? Only thing I really miss, the changing leaves. I mean I miss a lot of things, now I'm in my fifties. I miss bookstores, lots of them in one place if you're even old enough to remember such a thing or would much care. (When would you have had the time?!) I still miss smoking, believe it or not. Smoking was cool. I know it's horrifying, but it genuinely was. You'll just have to trust me on that. I miss actual receptionists. I know that sounds odd, but consider the context of me writing and it shouldn't be too hard to justify saying so. This will be one of those old-man-on-a-park-bench moments, but I genuinely do miss receptionists. They all had names like Molly and they were terribly harassed women mostly, with beautiful manners and very restrained voices and they just made the world go 'round whether it was a GP's office or a hair salon or the lobby of some intimidating building downtown to which no one willingly went even back then. If one wanted anything actually done in this world one was far better off if a friend could be made of the receptionist. Later they even let a few of the gays do this sort of thing. Was always glad to see a gay receptionist. At a certain point though the receptionist went the way of the telephone operator. I remember when every receptionist was transformed overnight into an office manager. Now there may well have been office managers before then, in addition to the receptionists, but then there was just the one title and the one poor woman doing God knows how many jobs and it was definitely not the same anymore. Office managers were far less likely to be made friends of. There was a change of atmosphere, a very real chill.  Who wants to speak to a manager these days? Never a good thing.

Not to moan, but what I wouldn't give for even an office manager now! There really isn't anyone in a doctor's office for whom one might drop off a cookie-plate at Christmas time nowadays, or even flowers, is there? Even that phlebotomist I particularly admired in your clinic, I think he would be a bit taken aback were I to just show up with a box of unopened candy. The nicest pharmacist the world, and I frankly don't remember the last one that made eye-contact, would go quite wide-eyed at some anonymous card-holder popping up in line with a numbered chit and a bouquet, and quite right too. 

I'll be frank, during my longish illness earlier this year, when I seemed to be in touch with nearly everybody in the organization except you, I encountered quite a few very nice people, and not just nurses either. There were Physicians' Assistants as well. (No luck with gastroenterologists, you'll remember, but one very nice surgeon who nearly redeemed that much villianized category of MDs for a moment there!) That said, the ones for whom I honestly felt the most genuine sympathy were those poor benighted souls on the telephone who actually had to book appointments once the valued member of ____ had actually negotiate his or her or their way through the Sleeping Beauty thorn bushes of the automated system. Finally get to the twenty-seventh person in the holding pattern and surprise! That person is unhappy, just like the previous twenty-six. It's hard to have any sympathy at all with the demonic capitalist assholes who designed the business model or the  pocketed politicians who maintain this plantation and call it "health care." Even harder almost to feel anything but burning hatred for the programmers who designed the public interface to run so very smoothly and attractively unless and until one needs it to, you know, DO something. Those motherfuckers all need to get ass cancer. Seriously. I know that's an outlandishly cruel thought, and why them and not the investors who raped the public hospitals and privatized charitable institutions and monetized human suffering on a scale undreamt of by the Popes, but remember why I am here just now, pretending to write to my doctor who's face I frankly can not remember for the life of me. The life of ME. (Sorry, again for the cursing, and the whole "ass cancer" business. Remember, I'm not a doctor. I should have said, "heel pain.")

Well, it's already dark out. I've checked again -- actually I've been checking every five minutes until I finally had to make myself stop and I don't think I'm getting any messages or responses or acknowledgment today, so I'd better just wrap this up and see if there's still any point in snappin' them beans. The husband's been home for awhile now, and here I sit.  Better just shut this down for now. I'm sure we'll talk again soon, at least here.

And it really was a pleasure. It really was. Don't remember the last time. I hope you take care and I'll wait to hear what you have to say about that question I asked. I'll be interested to know. I really will. I'd tell you to say hello to the receptionist for me if you still had one. In the absence of, tell anyone about the place at this hour that I am thinking about them and genuinely wishing them well. Can't be easy for any of us, what with all the heels.

With all due respect and genuine affection,

Member# _______, date of birth __/__/__

The Sharp Stick

 

Nothing quite so dreary as other people's illnesses, just as there is supposed to be nothing quite so fascinating as our own. Half right. It seems that there are enthusiasts of illness, otherwise perfectly nice, well intentioned people eager to sympathize and condole in the expected way who are also genuinely curious as to the specifics. I can not imagine why. I'm not squeamish as such and practical experience has taught me I can muck in without judgement or disgust beyond the usual, but I am very far from wanting to know any more than is practical to the task at hand. I don't much marvel at the wonders of the gastrointestinal or find the adrenal fascinating, etc. Medicine, like engineering is a closed book to me. Best that things work and when they don't I largely trust to those better educated to repair what's come undone. Happy to sweep up after if that would help, otherwise I'd say everyone's better off if I stay out of the way. As to the inner working of my own much neglected innards, I am not so much indifferent as inattentive. To be sick is a distraction. Pain however is consuming, and all the more boring for being so.

We are most of us largely helpless in the presence of real and persistent pain. Even to witness it is debilitating. I've seen it. So probably have you. What I know of it just now I would hope to forget. Physical suffering makes no memories worth having. We learn nothing worth knowing from it. From it we make cruel nothings: false and cautionary fables, cold monuments to ambition, even colder theologies. Pain makes us cowards. Joy, love, even the memory of comfort, these are what make us brave. The alleviation of pain is noble. Joy divine. Pain is. Nothing to be said for that. Cold as the space between the stars and just as empty. 

While the scandalous monetizing of addiction in the past twenty years of pharmaceutical malfeasance may yet prove to have taught us nothing else, it might at least remind us that remediation is no cure. One of the most frustrating parts of my own recent and ongoing experience with serious pain has been the willingness of my doctors and their support staffs to prescribe without examination, bless 'em. Kindly meant. I find I dislike the side-effects of serious pain medications almost as much as I dislike the system that prioritizes everyone's time but mine over treatment and diagnosis. It seems there is a way things are done; as inexorable as an algorithm, and as grinding as a Wagnerian explaining Parsifal -- again. Meanwhile, try this cream, pill, ointment, pillow, prayer. "We apologize for the additional wait time..." All I find I want is to be done talking on the phone, and no, I shouldn't like to try a different pill.   

I should like to see a doctor.

It's a cliche to say that pain makes a body selfish. Illness of any kind I think does that -- thus it's unhappy reputation as a topic of conversation outside of nursing homes. Better to say that pain has made me impatient with my own good manners. For fear of offense and or causing unspecified trouble, I do not like to bother even the poor souls whose job it is to book appointments with doctors they will nowadays never meet. (If you are in any kind of Health Care System bigger than a veterinary clinic you are not likely to talk more than once to anyone you may know unless and until some anonymous soul has "booked" you an appointment to do so. This is now the way of things in the new, more efficient day of "tele-visits" and website messaging.) Aurelius tells us that "... there is a proper dignity and proportion to be observed in the performance of every act of life." What pain does to dignity doesn't bear reviewing, honestly. Suffice it to say the Emperor would not approve.  After an hour trying to rebook a canceled colonoscopy, Zeno would weep with frustration. Since my complaint began last February I have had more graphic and unpleasant conversations with total strangers and described my symptoms to people who seem never to read charts more times than I would ever have thought possible. Worse, I have carried on so shamelessly in emergency rooms (rebranded as "Urgent Care" without apparent irony) I wonder I was raised by decent people and allowed to vote in local elections. On at least one occasion, if I'd thought running naked through the gift shop would have got me in any sooner to see a doctor, they would still be looking for my underwear in the greeting cards. 

Another tired truism of medical science is that we do not remember the actual sensation of pain, only our relief in its absence or something like that. That's as maybe. Like nearly everything else, pain makes us, or me at least impatient of larger conclusions. That would seem to be the point, or at least mine. Trust me, I will be absolutely thrilled to forget. Looking forward to it. Just now as I finally have a diagnosis and some hope of recovery, I feel I can finally afford to look if not up or forward at least back a little ways, as we say back home. What then do I see in the months behind me?

No work worth doing -- though my illness accounts for only part of that. Furloughed due to the pandemic well before this ugly business in my body started. Nothing made or bettered or shared. When even food becomes something to be feared and sleep a rare thing, one does not much care to make art, darling. So be it. I've never needed so good an excuse to not do good work. I am weirdly proud to say that my personal hygiene suffered less than it might have done, all things considered. It is in just such pathetic victories that the ill can still find pride, sad to say. My already limited contact with the world -- see the afore mentioned pandemic and furlough -- quickly became an almost willful isolation from even the rudiments of human contact. I made myself spend time on social media. I made myself call a sick friend, phone my elderly mother, write letters when I was well enough to sit up. I tried not be utterly cheerless in the company of beloved husband, himself not in the best of health now. 

What else? Curiously, and this may well be the only interesting thing I will have had to say in this whole exercise, I found I could not give a sitting, walking, or running damn about the fate of Dorothea Brooke or any other fictional person. In all other illnesses, at nearly any other time when I have had both enforced leisure and sleepless nights, novels have been my better friends. Somehow being in physical pain made me quite unsympathetic to the psychic pain and even the mortal danger of characters I otherwise love sometimes better than real people and always better than most people's pets or children. (Not yours, dear, you know how I love them.) For whatever reason not being able to find a comfortable position in which to sit or stand or stretch-out made me look on imaginary persons both on the page and when broadcast as just so many empty cyphers; nothing but shadows on the wall, thin and as empty of meaning as a Republican's promise of equality before the law. The experience was most disconcerting and new.

What I did read, what I still am reading has been history, old, dusty, obsolete history of a kind written when prose mattered and assumptions were made that would now bring a blush to a Tory. I do not recommend this to sensitive young persons. You have other, better priorities and much bigger problems to address. I am aware the world, for example is burning. I do not expect to have my enthusiasm widely shared. I read historians of an earlier age not because I find comfort in Empire or because I believe in the inevitability of progress or any of that sort of antique sentiment. When I read the old historians usually I do so because they wrote well and what they wrote had in their own day some influence for good. I read them normally as I read old fiction, always aware that good and even great writing was never done by perfect and seldom even wholly good men -- and yes it was mostly men, particularly writing history. I think during my illness that somehow the very quality of obsolescence in everything I read was soothing to me. Pain robs us of any future but its end. The present is unbearable mostly. The past, and specifically the company of the dead describing the even longer gone gave me something I can only think was a kind of distance. I wanted nothing so much as to not be where and as I was, and where and as I sadly still largely am. What better company than ghosts? Who else have I been fit for?

And so at three in the morning I went to Ramillies, and I shook my head at the fate of Scythians, and followed the progress of Corn Laws and wondered again at the abstinence of ascetics and the obstinacy of kings and the duplicity of politicians and the touching decency, now and then, of even exalted people. And none of it mattered and all of it mattered and none of it matters now and some of it still does.  I was distracted as best I could be from what's been happening in my body by what seems to have mattered most to men long dead. Carlyle said, "Happy the people whose annals are tiresome," but nobody writes much of that, do they? But then all history becomes a bit tiresome over time (and in nearly every classroom) and so maybe that is why it's given me rest. 

More though, reading old history has reminded and reassured me that indeed there are and have always been other people in the world. Other people, real people suffered and triumphed and loved and felt joy. Other people after them found all of this important enough to record it and to be inspired and comforted by it. None of them it seems were wrong even when they might have been in the details. Life seems to go on even when we can't quite imagine why it should. There's a kind of hope in that, isn't there? Easy to forget that, rocking back and forth in the wee hours. I don't have to talk to them, these other people, which is convenient, 'cause these are all dead and I'm not much in the mood. Not to be churlish, but none of them can ever be interested in my bowels or ask me if I've had a good night which I haven't. Maybe that's what pain has reduced me to, I can sympathize with no one but the dead. Certainly it's made me a bit grim, hasn't it?  

Apologies. Where are my manners? I am not myself.

They also used to say where I grew up that something unpleasant was "still better than a sharp stick." Sometimes we read to not be alone. Sometimes we read because we find we are not very good company even to ourselves. Better days? Still better.

Daily Dose

From The Man Who Mistook His Wife for a Hat and Other Clinical Tales, by Oliver Sacks

SO

"So it would happen, with variations, every time -- with improvisations, always prompt, often funny, sometimes brilliant, and ultimately tragic."

From Chapter 12, A Matter of Identity

Daily Dose

From Who Says You're Dead? Medical and Ethical Dilemmas for the Curious and Concerned, by Jacob M. Appel, MD

BUT NOT ALL

"If we cut off care to Edith, we must watch a visible victim suffer and die. This is highly unpalatable to most physicians and much of the public."

From Chapter 59, A Most Expensive Patient

Daily Dose

From Arrowsmith, by Sinclair Lewis

YOU BOYS

"'You know, I like you boys -- I'm sorry for what I've got to do to you. But may the saints help you, because it's just a question of time when I learn you not to monkey with the buzz-saw.'"

From Chapter 24, II

Imperial Clerihew

SIDDHARTHA MUKHERJEE

Siddhartha Mukherjee,
That Emperor of Maladies,
Explores yet another -- to me -- deep mystery
In The Gene: An Intimate History.

Daily Dose

From One of Ours, by Willa Cather

COUNTRY

"The country people never had to spend money for doctors, but cured all diseases with roots and herbs, and when the old folks had the rheumatism they took 'one of dem jenny-pigs' to bed with them, and the guinea-pig drew out all the pain."

From Book Three, Chapter X

Daily Dose

From White Sands: Experiences from the Outside World, by Geoff Dyer

MRI

"as the fractal geometries and strobes of colour gathered pace it became impossible to tell whether these glowing patterns and acid flashes were emanations of an external world or if they were in your head.  Deep space or inner space?  Either way it was like a glimpse of infinity.  Infinity not eternity.  The experience lasted ten minutes; it was possible to lose track of oneself but not of time.  I would have liked to spend hours in there, a whole day even."

From Beginning

Breakfast at the Bookstore #62

Daily Dose

From Religio Medici & Other Writings, by Sir Thomas Browne

DIAGNOSIS

"He that is Weak-legg'd must not be in Love with Rome, nor an infirm Head with Venice or Paris."

From Letter to a Friend

Breakfast at the Bookstore #8

Daily Dose

From Flesh in the Age of Reason: The Modern Foundation of Body and Soul, by Roy Porter

JOHNSON

"He could not get death off his mind.  'Is not the fear of death natural to man?' Boswell asked him, equally death-obsessed.  'So much so, Sir,' replied his mentor, 'that the whole of life is but to keep away the thought of it.'"

From Chapter 10, Johnson and Incorporated Minds

Daily Dose

From Rats, Lice and History: A Study in Biography, Hans Zinsser

THESE THINGS

"These things are pleasing to remember, but discursiveness has been the ruination of this book up to the present time, and we feel that, at last, we should endeavor to get on with typhus."

From Chapter XII