Coffee at Slocum, The Cooler

I had my surgical follow-up yesterday, and, my other errands having gone smoothly, arrived 45 minutes early. I wanted a cup of coffee, but Slocum Clinic (which, despite its name, doesn’t treat sex disorders) no longer gives away coffee—they sell it. I already resented the change, but after I woke up in post-op, and was told that I couldn’t have a cup of coffee unless I could find someone to go downstairs and buy me one, I really resented it; and resolved that I would never drink another cup before I would buy it from Slocum. So, there I was, riding my bike around the block looking for another place to buy coffee. The only establishment I saw was a bar called The Cooler.

I haven’t been to a bar in maybe twenty years, but, remembering that Eugene bars are smoke free, I decided to take a chance. I intended to buy my coffee and drink it at Slocum (figuring on an act of civil disobedience if challenged), but the atmosphere under The Cooler’s gambrel ceiling suited me. I found a deeply stuffed chair and got out a couple of books (I always take books to appointments). Then it struck me that I frequent bars so seldom that I should take inventory. These are my findings: soft fifties music was playing at a respectable volume; the floor, walls, and ceiling were all natural wood; and there were only four other customers. Two were middle-aged men who were drinking alone, and the other two were a man my age and his companion—a good-looking blond two-thirds my age. I also counted one marlin (stuffed), one moose head (also stuffed), three pool tables, ten mute TVs (on nine channels), a variety of neon liquor signs, and a fair amount of college football regalia.

I enjoyed myself so much that I fantasized becoming a regular, but, right away, I hit upon a problem. The coffee was $1.25, and I tipped the barmaid a quarter. If I went to The Cooler five days a week, fifty weeks a year, that would come to $375. Considerations like this are why I drink my beer and coffee at home. If everyone held my values, a lot of businesses would go out of business.

My doctor’s appointment went well. I’m doing fine he assured me, and I agreed. Then I raised hell about the coffee situation, saying that the nurses hate it too (they can’t even have a coffee pot in their break room) and that one of them told me about the patients who wake up with headaches (having been NPO all day) and mad because they can’t have their coffee. He explained the situation thoroughly to his satisfaction, and concluded by saying that he is on the committee in charge of the coffee cartel, and will see that, “A free cup of coffee comes with every surgery.” We left on good terms.

Sleep Apnea

Obstructive sleep apnea is caused by loose tissue (turbinates, tonsils, uvula, soft palate, etc.) blocking the airway. The problem appears during sleep because that’s when everything relaxes, and it gets worse with age because that’s when everything relaxes more. There are five treatments: tracheostomy, surgery, dental devices, weight loss (if the patient is fat), and a breathing machine called the CPAP. Trachestomies are for when nothing else works. Surgery and dental devices aren’t terribly effective, and surgery also has some curious side effects like making the patient talk like a duck and drop food from his nose. With another surgical method, the patient’s jaw is broken and pulled forward throwing his teeth out of alignment. I’ve already had two sleep-related surgeries. One was for a deviated septum, the other for the same thing plus chiseling bone from my sinuses and tissue from my turbinates. Without the second surgery, I couldn’t have gone as long as I have without a CPAP.

The CPAP (continuous positive airway pressure) does pretty much what it sounds like it does: it pumps air down one’s throat continuously so the airway remains open. How much air varies. Most machines pump a steady amount, but I have a “smart-PAP” that adjusts from a low of ten (cm H2O) to a high of sixteen. Sixteen is one shit-load of air.

The patient wears either a mask or a fat cannula. The first mask I tried created a pressure sore on my nose, and the next three leaked, so I’m using a cannula. The problem with both masks and cannulas—even when they fit—is that they occasionally allow air to escape, especially when the patient turns over. This requires a certain delicacy of movement and considerable adjustment and readjustment throughout the night. Otherwise, the wind that is supposed to go down my throat is blowing loudly across my face or into my eyes, creating the risk of an eye infection.

I try to think of my CPAP affectionately, but that is like thinking of a wheelchair affectionately. On the one hand, I am glad I have it, but on the other, it is noisy, bulky, ugly, bothersome, expensive, requires daily cleaning, and makes it impossible for me to wander from an electrical outlet. This last part is the worst of all because I don’t trust technology to always be there, and because I have a powerful need to escape it occasionally.

I often lie in bed listening to my CPAP, and trying to understand why it behaves as it does. Last night, just as I was getting to sleep, the pressure started going up and down at regular intervals, as if the machine was a large beast breathing on its own. The trouble was that its breath didn’t match mine. It would force me to inhale for too long, but not allow me enough time to exhale, so I felt like I was suffocating. I tried to breath normally in the hope of forcing it to breath with me, but this required that I work really hard, and I soon lost sense of what a normal breath felt like.

I didn’t know what else to do, so I took the same ineffective steps over and over, things like rerouting the six-foot hose, readjusting the cannula, resetting the switch, and even repositioning the machine. I also wondered if I was imagining the problem. After all, it takes some people weeks to work up to using a CPAP for one whole night, yet I’ve used mine all night every night, so maybe the strain was getting to me. I thought and thought about it—which wasn’t easy while struggling to breathe. After awhile, either the machine or I settled down, and the rest of the night passed peacefully.

The main difference I notice with the CPAP is that I dream A LOT. This was even evident in the sleep lab. Without the machine, I dreamed little (and those dreams were often about suffocating). With the machine, I have one colorful and richly detailed dream after another. Maybe I had built up a dream deficit. My theory is that apneas would end whatever dream I was having, and it would take me awhile to settle back into REM sleep, only to be hit by more apneas as soon as I did.

I’ve also noticed that I don’t wake up headachy and exhausted. Instead, I wake up with my nose raw and achy due to the cannula pushing upward against my nostrils. I also wake up with a devilishly itchy throat if I don’t sleep with a harness that keeps my mouth closed. Since I also use a toothguard to prevent me from grinding my teeth to powder, getting ready for bed is tedious, although it’s not the work I mind, but the thought that I will have to do it for the rest of my life.

My father preferred death to pills because—along with his belief that the pharmaceutical industry was ripping him off—he felt that a life that had to be permanently preserved out of a pill bottle was beneath his dignity. I understand his point, and a CPAP strikes me as worse than a whole boatload of pills, but dignity is subjective and death extreme. I don’t know how Dad felt about the indignity of snot, shit, and the bizarre appearance of human genitals, but he survived all of them. This leads me to suspect that—in his mind—the indignity of pills consisted of the dependency he felt upon the despised industry that provided them.

Food for life, he could, and usually did, grow for himself, but pills for life were from an alien source and made of alien materials. They made him feel powerless in a way that congestive heart failure did not, and by choosing death, he regained his power. It was his choice, and I respect it. Most of us never acknowledge that there comes a right time to die. We say we long for heaven, but we will spend any amount of money and put others to any amount of trouble just so our sorry carcasses can breathe for one more day. Like my father, I believe there comes a time when dignity demands that a person say “no more.” I am closer to being there than I was even five years ago, but I hope to tarry a while longer.

Where was my responsible adult?

When you’ve been anesthetized for surgery, you’re advised to spend the rest of the day with a responsible adult, and warned not to make any important decisions. So why, then, is there a ten-pound bag of Costco chocolate chips draped over my kitchen table like a dead moose? Where was my responsible adult, and what was she thinking to let me buy that?

I woke up this morning—following my first night with a CPAP—rested and refreshed for the first time in memory. By contrast, I usually wake up headachy and exhausted after a succession of nightmares, my mattress wet with sweat. According to my polysomnograms, I awaken seven times an hour, and I stop breathing 43 times per hour—during which my oxygen level drops to 83%. I also grind my teeth and jerk my limbs. People die from such sleep. Nobody wants to pass the night with a noisy air pump and a mask that either feels too tight or leaks, but it sure beats the hell out of hardly sleeping at all.

My hand is greatly swollen, my wrist feels like someone drove a spike halfway through it (which is, actually, pretty much what happened), but I feel terrific. Maybe I will soon have the freedom to think more of things other than my health.

Surgery day

The anesthesiologist had said he would knock me out just long enough to get the primary painkiller started, leaving me awake for the surgery. The next thing I knew, I was waking up in another room. I looked at my wrist, saw that it was bandaged, and tried to wiggle my fingers. To my utter joy, they moved. Two hours and fifteen minutes after Peggy and I arrived at the clinic, we left. The doctor said I could do anything I felt well enough to do, so I shopped at Costco, then came home and helped my neighbor dig dandelions. Then Peggy and I went to pick-up a CPAP machine (continuous positive airway pressure) for my sleep apnea, came home, and took a nap. She vociferously opposed biking with the dogs, so we took them for a walk around the neighborhood. Now, she’s cooking supper.
Typing hurts, so I will stop doing it.

Thoughts before carpel tunnel surgery

Not long ago, the anesthesiologist called about my surgery tomorrow. “You’ll be given two painkillers,” he said, “the first to kill the pain of the second until the second takes effect.” Drugs are funny. One doctor wrote me a prescription for Ambien recently. “This medication has been known, in rare cases, to cause violent behavior,” the packaging warned. A few days later another doctor gave me a prescription for Requip. “This drug has been known, in rare cases, to lead to compulsive gambling,” the packaging advised. “Oh, great,” I thought, “I’m going to be a violent gambler.”

Last night, I was too manic to sleep, so today I took a Vivarin. Since I don’t do caffeine anymore, an occasional Vivarin makes me really manic. I was that way when the anesthesiologist called, and was consequently so bubbly that I wondered whether I sounded drunk. After we hung-up, I went back to my yard work. As I crossed the backyard, I passed Bonnie walking the other way. “Hello, Bonnie,” I said. Then I remembered that Bonnie was in the front yard, and that the gate was latched. I thought that, well, maybe I just thought the gate was latched, so I went to check. It was latched. Things could be worse, I suppose. I could be hallucinating a dog that is dead or never existed.

I’ve spent days doing all the work around the house that I won’t be able to do during my convalescence. Last night, I baked crackers, biscuits, and cornbread. I actually started baking crackers two weeks ago because each batch takes two hours, and that’s if I don’t double it. I was raised on store-bought loaf bread, but my mother kept the larder stocked with homemade biscuits and cornbread. Of course, they were inferior to what I bake. I never use shortening—much less lard—or sugar, and all my breads contain several whole grain meals or flours. There are only two things that I love to cook. One is soup and the other bread; and of the two, I prefer bread. My father believed that whole grains were for hogs (he claimed that bleached flour was purer because it was white), so he was challenged to eat my bread when he came to live with us.

I am more nervous about this surgery than any I’ve had, because the ligament that the surgeon will cut is directly above the nerve that makes my hand function. I’ve thought about what it would be like to go through life with a purely decorative right hand, and whether the odds of that happening are small enough to justify the risk of surgery. I dealt with the issue by opting to stick with the decision I’ve already made, my thought being that I would need new information to back out with any integrity.

My hernia surgery (in January) was hours late, so I had a lot of time to lie on my stretcher and think. I really wanted to walk out of that place while I still could. I remembered my friend, Hulene (a woman after my own heart, her last act before surgery was to write me a letter), who died during hernia surgery five years ago. I also thought about my surgeon, and how I didn’t entirely trust him because he always seemed so harried. I finally reconciled myself to the fact that, having made the best decision I could, and having no new information that would justify a change of heart, I needed to trust the thinking I had done when I was less emotional. Even if it was wrong, it was the best I could do. This is what will make it possible for me to lie down upon yet another stretcher tomorrow. Meanwhile, I do dread the long night ahead.

Thoughts about supporting private and governmental evil

My neighbor, Ellie, also has carpal tunnel problems. Hers is advanced, so a return to normalcy is unlikely even with surgery, but Ellie is obliged to sell plasma just to get by, so surgery is out of the question.

One of my Masonic brethren, Nathan, changed jobs recently, and his new insurance wouldn’t take effect for ninety days. During that time, Nathan came down with an undiagnosed illness that caused his fever to hit 104ΒΊ. He couldn’t afford a doctor, so he rode his illness out at home.

Linda, the technician who hooked me up to the monitors for my recent polysomnogram, was injured in an accident and unable to work for seven months. Her insurance ran out after six, leaving her $30,000 in debt.
I don’t look for such stories, but now that I have become so dependent upon insurance and so aware of how different my life would be without it, they leap out at me. It’s like never noticing a certain make of car until you buy one.

There is really no way around the fact that, as individuals and as a nation, we spend money on that which we value. I value financial security, so I save money. My sister-in-law values foreign travel, so she spends money on that even though she has to borrow against her house. As a country, we value the War in Iraq. We also value health care for poor people in other countries, although the money has to come partially from the taxes paid by the poor people in our own country, people who cannot afford health care. We say to our own poor that their lives are of less importance than countless other things that we spend money on. If Nathan should die or Ellie should become permanently disabled, well, that’s very sad to be sure, but Africans with AIDS need our help more, even if we are obliged to borrow the money from China.

I am amazed that we Americans put up with as much as we do, but then I am one of those by whom I am amazed. But what to do about it… I met a man last week who was going door-to-door to gather support for Barack Obama, and I wished mightily that there was a candidate who I believed in that much. Hell, I just wish I believed in the goodness of our democratic system that much.

“All voting is a sort of gaming, like checkers or backgammon, with a slight moral tinge…. I cast my vote, perchance, as I think right; but I am not vitally concerned that right should prevail. I am willing to leave it to the majority…. Even voting for the right is doing nothing for it. It is only expressing to men feebly your desire that it should prevail.” Thoreau

I have long admired Thoreau because he writes as if he were beside me, contemplating the same problem that I am contemplating. No matter that the steam engine was cutting edge technology in his day, his issues then are my issues now. Ah, but he knew what to do about them. He avoided marriage partially because marriage would make moral compromise easier, but I embraced marriage because I had yet to meet the issues, and because I naively thought I could have it all. Still, I would not choose to live alone. But what would I do differently if I were alone? I would bury my money in a hole in the ground (figuratively or literally), so the IRS couldn’t find it, and I would stay in Oregon most of the year so I wouldn’t have to pay a sales tax. I feel little compunction to eradicate evil, but a great compunction to abstain from supporting it.

Yesterday, I received a bill for $465 for the carpal tunnel surgery that I haven’t had yet. The letter explained that this should cover my portion—after insurance—of the clinic’s operating room. This means that the clinic is going to charge $2,325 for the half hour that I will spend in that room. If not for the insurance company’s required write-off, the charge would be closer to $3,000. The letter also explained that the surgeon and anesthesiologist will bill me separately.

Last night, I could scarcely sleep for knowing that I am supporting a merciless and avaricious health care system. During one of the short lulls in my wakefulness, I dreamed that I was required, before surgery on Friday, to pay $499.99 in advance for a bath in a stainless steel tub. The tub turned out to be a thin vinyl mattress that was painted to look like stainless steel, and the bath was a damp washcloth with which I was told to wipe myself off.

My father died partially because he was unwilling to support what he considered a greedy healthcare system. People generally thought he was a nutty eccentric, but, for what it’s worth, Thoreau would have made the same choice. Of course, people in Thoreau’s day thought he was a nutty eccentric too. People who won’t support evil no matter what the cost to themselves are ever seen in such a light.

I look at things this way. My wrist hurts and my hand tingles. I sleep in a brace. I avoid certain activities. I am guardedly optimistic that surgery will change all this. On the other hand, if I refuse the surgery, what good will I have accomplished? None, externally. But would I respect myself more? Maybe, but I am still going to put my money into surgery, because I value my health more than I value my own moral approval, especially in regard to a decision that won’t make the world better or worse anyway. How do I live with this choice? I tell myself that the surgery will soon be over, and that I will move on. I usually prize expediency above principal, and I feel bad about this at times, and not so bad at other times. Mostly, I try not to think about it. In fairness to myself, those around me seem to knuckle under more than I do. They just ponder it less.