People with their throats cut generally look dead; my first death

I never saw anyone with their throat cut but what they looked the worse for wear; in fact, they looked dead and they didn’t die smiling either. Judy (that would be Doctor Judy) says not to worry, that she cuts two and three throats a week sometimes. What I want to know is how she finds that many people who (a) need their throats cut and (b) are willing to let someone do it.

I had my first serious surgery about eight years ago. It was such a new and unusual procedure that I had to drive 110 miles to the Oregon Health Sciences University to see the one doctor in Oregon who knew how to do it. Dr. Hwang was so young, and little, and smart, and cute—not to mention caring—that I would have adopted him in a heartbeat. He suggested that I have the surgery in two parts to minimize the risk, but I wanted it ASAP, and I had no qualms about trusting him to do it up right. The morning he was to operate, the anesthesiologist came in first (as they always do), and offered to give me a little something for anxiety. I told him I wasn’t the least bit anxious—I was just enthusiastic. He thought I was putting him on, and we got into an argument about whether I was anxious. When he saw that he couldn’t win that one, he left. I thought he might hold it against me, but he and Hwang both did bang up jobs in surgery and, what with being awake but stoned out of my gourd, I enthused all over the place about what great doctors they were.

God, but I miss those days when trust was a given and surrender came easily. By now I know the routine well—the pre-dawn drive to the hospital, the forms to sign, the wrist-bracelet, the humiliating gown, the hasty “vitals,” the endless questions from the endless procession of nurses about why I am there and when I last ate, Peggy’s attempt at casualness, the anesthesiologist’s visit, the trip to the bathroom with a nurse carrying my IV, the stretcher ride to the holding area with the lights passing overhead and the curious strangers looking down at me, the inevitable crashes at corners, and finally into surgery. There, the many people in masks and gowns, the perfunctory courtesy, the move from the stretcher to the operating table, my diseased fingers turning white from the cold, my arms being stretched to either side like the crucified Jesus, the additional warm blankets that are never enough, feeling helpless and exposed, waiting eagerly for an injection of happy juice. Then recovery. I will have stayed awake for surgery if possible, so I pass the time listening to other patients moan and puke, and trying to recollect everything that happened. If the surgeon gives a shit, he comes by to tell me how it went.

Is recovery where I’ll be told if I have cancer? Probably not. I’ll be put to sleep this time, so I’ll be among the moaners and pukers. Probably Peggy will know first, and probably Peggy will be alone. Then again, maybe no one will know. The surgeon said that calcification might make an early diagnosis impossible. If this is so, and if I have cancer, it will mean a second surgery to replace the bone. Or not. I’m not going balls-to-the-wall unless I have a decent chance of survival.

I used to wonder how a doctor tells a patient he has cancer. I thought they would have learned some special words in medical school. I’ve had four doctors this year (three in October and one in January when I had hernia surgery) throw out the possibility, and I was struck by their casualness. The neurologist who brought it up in October told me over the phone. Phone calls from a doctor usually mean bad news, but I wasn’t expecting anything like what I heard. “It might be cancer, and if it is, it would have spread from someplace else—possibly the prostate. You need to see your internist about what to do next. Good bye and good luck.”

If someone who didn’t know English had tried to judge the nature of the call from the tone of the caller, he might have thought that Blockbuster was telling me I had a movie overdue. I imagined that this doctor never gave me or my problem another thought after he hung up. And why should he?

I first watched a man die when I was a fourteen-year-old ambulance attendant. The call came at 7:30 on a Sunday night, right in the middle of Mission Impossible. We found the man alone and unconscious on his partially mopped kitchen floor, and he died as we lifted him into the white Ford station wagon that passed as a Mississippi ambulance. CPR hadn’t been invented, and when I started to apply an oxygen mask, the boss laughed and told me not to waste his money.

As we drove back through town, the streetlights were still burning, the man at the filling station was still pumping gas, and people were still leaving church. I had expected the world to stop, and it hadn’t even slowed down. That was forty-five years ago. My belief that my kind was the center of the universe and the pinnacle of God’s creation also died that day.

If only I have enough time to finish editing my journals, I will be grateful. If I don’t have cancer at all, maybe my other problems won’t seem quite as bad.

What good is God?

It takes about four hours to do the yard up right, and I don’t remember a time in my adult life—except once when I had the flu and twice when I had strep—that the job would have tired me out, yet I only lasted 45 minutes today before I had to slow down. After ninety minutes, I felt the need to take an extended break. This is how I am spending my break.

My fatigue made me remember my neighbor, John. Five years ago, he drove 120 miles over the Cascades, climbed a 10,358 foot peak, and drove home, all on the same day. Few people could do as much at any age, but John did it at 55. Instead of being pleased, he was upset that it drained all his energy. He went to the doctor the next week, and died of prostate cancer the next year. While I was working in the yard, I seriously entertained the thought that I really might be facing death.

It was this melancholy realization that made me think of Eugene Sledge, a World War II soldier who wrote about the battles on Pelieu and Guadalcanal. Sledge said that new soldiers typically think they’re too smart to get killed. When they observe that more experienced soldiers than themselves get killed all the time, they conclude that they could die, but that they probably won’t because they’re special to God, and God will protect them. Then they see their friends die—sometimes horribly—and they are forced to ask themselves what makes them more special than those people. When they can’t think of anything, they conclude that, not only might they die, they are almost certainly going to die.

Then I remembered Dana Reeve, the wife of Christopher Reeve, who died of lung cancer less than a year after his death. I saw her on a DVD about health care recently. She was well dressed and appropriately made-up, but her eyes were tired, and her pauses for air came too often and lasted too long. I admired the hell out of that woman because she radiated such incredible courage by trying to help other people live longer when she was so near death herself. I had the thought that a good death would go a long way toward making up for a life that, if not failed, is nothing to brag about either.

When I listen to Pachebel’s Canon in D, I often reflect that, if Johann Pachebel didn’t do another thing but to write that one piece of music, a piece that comes nearer to embodying the divine than anything else I’ve ever seen or heard, it would have justified his entire 53 years. What, then, have I done to justify my years?

The one thing that I just cannot see my way to bear is my knowledge that I will be leaving Peggy alone. If only I could have her hypnotized so that she would come home from the funeral wondering how she ever put up with me to begin with and glad that I was dead, I would prefer that a million times better than to think that she will experience a grief that is beyond anything I can imagine. I picture her here, in this house, crying alone in the wee hours. I picture her coming home at night without me to greet her and without her supper on the table. I picture her taking her bike out for a ride while my bike remains behind. I picture her sitting in this chair, at this computer, getting things all fouled up, and not knowing how to straighten them out, and not having me to call.

If I could imagine now everything she will feel then, she might feel less alone for knowing that I traveled the same road ahead of her, but I know I cannot. Writers from Job to Eugene Sledge were right; God’s favors are not bestowed according to merit. What then, is the good of God?

Fun with having my throat slit

I finally had my appointment with the neurosurgeon. She will be my first woman surgeon (no, my second, come to think of it—I must be having too many surgeries). She is probably in her thirties; probably a lesbian; wore corduroy jeans, cartoon socks, and funky tennis shoes; didn’t blanch when I called her by her first name; and seemed utterly confident of her skills but without any trace of arrogance. She gave me a prescription for ninety Percocets (Percocet being the best thing short of morphine), and I added them to my narcotic’s stash.

“Are you saving up to kill yourself?” Peggy asked. “No. I just remember what it’s like to be in the worse pain of my life, and have no way to control it.” Actually, I had about sixty Vicodins and Percocets on hand (from my last two surgeries) when I was hurting my worst, but I was afraid to take them for fear I might need them even more later. Now that I have six weeks worth of narcotics and a couple of doctors who actually give a rip when I’m in pain, I feel secure.

The CT scan showed a line of grayish vertebra in the midst of which was one glaringly white vertebra. A five year old could have pointed to the problem. I am scheduled for a “Biopsy C5 Vertebral Body—Possible C5 Corpectomy w/Interbody Graft C4-C6 w/Anterior Plate C4-C6” next Monday. What the big words mean is that I am a terribly smart patient for whom small words aren’t adequate. Besides that, they mean that the doctor is going to slit the front of my throat to examine the fifth vertebra at the back of my neck. If my fifth vertebra is malignant, she will cut it out, replace it with part of a dead man’s lower leg bone (either the tibia or the fibula—I didn’t ask), and attach a metal plate to the fourth and sixth vertebras to hold my neck together until the dead man’s bone has a chance to grow. Have you ever heard of anything more fun?! Don’t you wish you were me?! Peggy doesn’t. When I told her that I had rather it be me than her, she agreed.

I thought her answer lacked a certain romantic element, but what we both meant was that I can better deal with being a patient. What I also meant was that I had rather die than to see her die. If she too prefers that I be the one to go, I’m just glad that that’s the way things might play out. She will no doubt spend a lot of lonely nights wondering if hers was the easier path after all, but I think it likely she will at least survive (and eventually flourish), whereas I’m not confident I would.

I questioned that the surgery is a good idea since my fifth cervical vertebra is one of the few body parts that isn’t bothering me, but Peggy and the surgeon considered the operation a no-brainer. Their argument was that I need to know what’s going on in case it needs treatment. That made sense, but it seemed to me that there are also risks in having my throat slit and part of my backbone taken out, and that maybe the information gained won’t be worth those risks. They disagreed, and the surgeon added that she also disagreed with my last neurologist about the tingling in my right arm being unrelated to my spine (although she’ll need a second surgery to fix the problem). I signed on the dotted line—all ten of them—my thought being that Peggy is too freaked out to let things be, and that the orthopedist won’t operate on my shoulders until my back problem is out of the way. This means I’m facing at least four operations, which will bring my lifetime total to fifteen.

I asked the surgeon why, when I can put my hand behind my neck and feel my vertebra, she needed to approach it from the front. She (I’ll call her by a made-up name since I’m going to paraphrase her rather loosely, i.e. lie like a dog about some of the nonmedical stuff) said she can’t take a bone sample from the back because the vertebra is too thin there. “Well, uh, won’t all that stuff in my throat—trachea, esophagus, major arteries, and such—be a problem if you go in from the front?” “Nope, I use spreaders. Put those suckers in there and crank them to the sides, and everything just gets right out of lil’ ole Doc Judy’s way.”

I asked if there was any way she would let me stay awake during all this since I’ve stayed awake during lots of surgeries by now, and REALLY prefer it that way and REALLY do good that way, and REALLY, REALLY hate being knocked out.” “Nope, you’d be gagging like you’ve never gagged before. Altogether too stimulating,”

“Too stimulating? Is that a euphemism for ‘patient jumped from table and ran out door’?”

“Hell yeah, gagging all the way!”

While we spoke, the The Ballbusters and other fem groups were belting out their music in the background. The only song I recognized was a Castraette’s hit that was set to an old Beatles’ tune, “I wanna debone my maaaaaan…. I wanna debone my man.” I noticed a poster on the wall that depicted a big woman on a big Harley. She was heavily tattooed and dressed in black leather. Her bike was parked atop a bookish looking little man in thick spectacles who appeared to be pleading for his life as she snuffed out a cigarette on his throat. The caption read, “Sic Semper Tyrannis.” I looked back at my doctor and saw that she and Peggy were rubbing legs under the table. I pretended not to notice.

“Are there any serious risks to this surgery?” I asked.

“Hell, son, all of life is a risk. The only question is whether you’re man enough to face it.” Then the doctor laughed. Then Peggy laughed. Then they both pointed at me and kept on laughing. “Yes,” I said in a quiet voice that would have been reminiscent of Clint Eastwood if my pitch hadn’t kept changing. “I am man enough, darn it. I really am.”

“Oooooh,” they cooed, and laughed some more.

Peggy and I went from the doctor’s office to the anesthesiologist’s office to get my pre-op out of the way. I picked up a New Yorker magazine and looked at the cartoons. In one cartoon, two women were sitting on a couch talking. One of the women was holding a photo of her late husband. “No, he didn’t suffer,” she said. “And that is my only regret.” Peggy, predictably, didn’t get it.

This is a good time for having a morbid sense of humor. I just hope I can laugh all the way to the hospital at 5:15 Monday morning. Peggy doesn’t find humor in sickness and death, so things are harder for her. I’ve wondered if she might actually hold up better if I were falling apart. I tell her that I’m fine and that nothing she says will scare me, and this gives her permission to tell me some things she might not otherwise say. Whether sharing terror dissolves it or makes it grow, I can’t say.

I’ll try to get the house cleaned and the yard work done. I’ll also make out a will and a medical power of attorney. I don’t know that I need a will since everything is in both our names anyway; and the surgeon said I don’t need a medical power of attorney. But it doesn’t take much imagination to picture myself lying brain dead in a Catholic hospital, and Peggy having to go to court to get my feeding tube disconnected. I keep asking myself whether it’s still true that I don’t fear death. Yes, it is still true. I fear suffering, and I grieve in advance to think about Peggy being alone, but death holds no terrors for me.

Still no appointment

I still have not seen the neurosurgeon. First, her staff lost my referral, then she cancelled three appointments at the last minute due to emergencies. These cancellations are understandable but frustrating since Peggy took off from work to go with me, and I even left a funeral early to get to one of them. Also, the doctor’s nurse told me to stop taking my anti-inflammatory a week ago in preparation for an early biopsy, and this has caused my pain to grow exponentially, yet she will not schedule an operating room until I see the doctor.

On the good side (maybe) I’m told that my next appointment (tomorrow at 8:00 a.m.) is a”100% sure thing.” Right. Sort of like when I call a doctor’s office and the receptionist says, “I’m going to put you on hold for just a moment.” Now, I would define “just a moment” as longer than a second but shorter than a minute. People who work in doctors’ offices have a different definition. They define “just a moment” as an indefinite quantity of future time that would normally transpire before the caller dies—assuming that the caller is not too sick or old, and his call is not disconnected. This means that a “100% sure thing” could mean, as I define it, a 0.4% sure thing, or a 50% sure thing, or anything else.

I took the following summary to the neurosurgeon's office today along with some other forms:

A Summation of Why I Have Come

I have impingement problems in both shoulders. When the pain got so bad that I could not carry on a normal life, I went to Shapiro for surgery. Shapiro said that a tingling/burning sensation in my right arm was not connected to the impingement problem, and that I would need to see a neurologist before he operated. I waited six weeks for an appointment with Balm who said Shapiro was probably wrong, but that he would test me anyway. He did an EMG and a nerve conduction study, and ordered an MRI and a CT scan. These tests proved Balm right, but they also showed a “shiny fifth cervical vertebra.” Balm suggested that I see my internist, Jacobsen, to determine whether I have metastatic cancer that, he speculated, might have originated in my prostate.

I told Balm that the pain in my shoulders (and to a lesser extent in my back) often leaves me just short of tears, but that despite my fervent and repeated requests for adequate pain relief, Shapiro had not seen fit to prescribe anything stronger than 25mg Elavil (of which he said I could take a whole tablet if I needed it—the first night I took two tablets and still got little if any relief). Balm gave me a prescription for hydrocodone, but it makes me itch so bad that I rarely take it. I partially control the pain by: taking Piroxicam each morning and Elavil, Ambien, and Requip at bedtime; sleeping with a heating pad under my back and a pillow under each shoulder; and not doing any physical activity that involves my arms if I can avoid it (I even keep my hands in my pockets when I walk, and I ride my bike with only my left hand on the handlebars as much as possible).

I also went to an acupuncturist for eight visits. I wasn’t sure he helped (or if it was my constant experimentation with other measures that accounted for the pain reduction), but I observed that he stuck me in the same places each time, so I ordered some needles and have been doing almost daily acupuncture on myself. I’m not sure what combination of measures I can attribute it to, but I have reduced the pain sufficiently that I am no longer obsessed with suicide as a means to escape it.

Jacobsen suggested that I see you. Bridget lost my referral, and three appointments on three consecutive days were cancelled by your office at the last minute, so it has taken me three weeks to get in. Last week, Debbie suggested that I go off the Piroxicam in order to obtain a speedier biopsy. I did this, and the shoulder pain and the pain from an arthritic left knee is getting worse.

Lorna, in Jacobsen’s office, told me that two other doctors said a biopsy was too dangerous, but that you are willing to do one. I don’t know why they thought as they did or why you think as you do. No one who I have spoken with knows any more than I do.

My poor opinion of Christianity

I came across the blog of a young man who is studying Catholic theology and challenged his assertion that suffering is invariably a lesson from God. He replied with a polite but paternal note in which he did nothing more than reiterate the point I had challenged. I wrote a second time asking him to explain what he thought God’s lesson was for starving infants and abandoned dogs. He then accused me of showing contempt for God (or at least his version of God) and for himself (I had no intention of being disrespectful), and suggested that I not visit his blog again. I apologized for having caused offense, not because my challenge was unreasonable but because I expressed it bluntly.

I respect the right of the blogger to hold any opinion about anything as long as that opinion doesn’t cause him to infringe upon the rights of others. But what is his rationale in demanding that I show respect for the opinions themselves, and did he believe that he was doing as much for me? I daresay he would argue that my opinion was sacrilegious, and that reciprocity was therefore impossible.

I was not taken aback so much by his unwillingness to address my questions as by the vehemence of his response. His blog was about love and peace, and I assumed from this that he was loving and peaceful. This tendency to take people at face value is a failing in someone of my age and experience.

…I have a great many objections to Christianity, regardless of the version offered. I have made several attempts to be a Christian, it is true, but this was not because I assented to Christianity intellectually, but because I wanted the comfort it promised; and it was this attempt to squash my intellect that eventually defeated me. I might as well have tried to squash a coiled spring or a slab of foam rubber, objects that have infinitely more patience and tenacity than I.

Even so, I might have overcome my intellectual reservations if only I had seen Christianity delivering what it promised. Namely, if Christians have the guidance of the Holy Spirit, why isn’t this evident? I have known people who were strong and people who were weak; people who were honest and people who were crooks; but I have never observed that Christians were stronger or had more integrity than non-Christians. If anything, I’ve wondered if they were as good; my speculation being that Christianity might appear most attractive to those who are weakest of character.

The “defense” of Christians about why the guidance of the Holy Spirit doesn’t enable them to stand out as moral examples runs along the lines of, “Christians aren’t perfect, just forgiven,” but this doesn’t address the argument; it ignores it. In regard to the really bad things that Christians have done (inquisitions, religious wars, frightening children, burning heretics, etc.) I have heard Christians offer that atheists are just as bad (Communists being the example given). That Christians would attempt to mitigate the behavior of their fellow Christians by pointing out that it is no worse than that of the very people who they consider the lowest of the fallen strikes me as extraordinary. It also misses the point. Atheists don’t claim the benefit of divine guidance, and there is a vast difference in Christians persecuting people in the name of God versus atheists doing it in the name of Communism. I have yet to hear of a single atheist killing anyone in the name of atheism.

I don’t believe that the failures of Christians to live up to their own teachings is entirely their fault, and this leads me to another serious flaw of Christianity, namely that it is not grounded in reality. I’ll give an example. Jesus commanded those who are robbed of the jackets to offer the robbers their coats also. Does anyone live this way? Should anyone live this way? I see signs in church parking lots that read, “Unauthorized Vehicles Will Be Towed At Owner’s Expense.” What if, instead of towing cars, churches followed the spirit of Jesus and gave two parking spaces to everyone who took one parking space? What if, instead of calling the police when their houses were being burglarized, Christians helped the burglars carry heavy objects and gave them more than they had intended to steal?

There is practically no end to my objections to Christianity, and I don’t recall that even one of them has been answered in a manner that made the least bit of sense to me, this despite my very great desire to embrace the Christian faith. Yet, I have known many people who, though not Christians, expressed a great admiration for Jesus. Have they actually read all of the things he supposedly said? The part about abandoning your family and following him, or selling everything you own to buy a sword, or hiding the truth from those whom God doesn’t want to save?

There is the Jesus of the Bible and there is the Jesus of popular culture, and the Jesus of popular culture is kindly, patient, tolerant, peaceful, and forgiving. The Jesus of the Bible might have taught some of these virtues on occasion, but he was inconsistent in his teachings. He was also bad-tempered, humorless, prone to sweeping generalizations, intolerant of sects other than his own, disrespectful of his mother, had an adolescent zeal for offending his elders unnecessarily, insisted on teaching in parables even though his own disciples couldn’t figure out what he meant, and often acted contrary to what he professed to believe. Of course, most Christians seem to hold that Jesus meant for very little of what he said to be taken at face value. Well, okay then—I’ll leave it to them to interpret the words of their verbally challenged deity. Unfortunately, they can’t agree among themselves as to what he intended.

Out of mind, out of body; out of body, out of mind

I see my new neurosurgeon tomorrow to hear her thoughts about a spinal biopsy. Peggy is sick with worry and can’t understand why I am not. I tell her that my biggest fear is pain; my second fear is disability; and my last fear is death. I still have hope that I can stop the pain. The other two fears may or may not be realized, but pain is the only one I don’t think I can handle, yet it is the only one I am having to handle.

Permanent and unalterable pain would, in all likelihood, lead me to suicide. I should imagine that Peggy could better survive my demise if it wasn’t voluntary, and that is one reason I fear a fatal illness less than I fear pain. In the face of unalterable pain, a fatal illness would be a godsend. In the absence of a fatal illness, I might feel it necessary to continue my life on Peggy’s account alone.

I just hope I have time to finish editing my writing. When everything has been added to my blog, I will create a synopsis. Whether I am gifted at recording my life on paper, I cannot say, but there it is, the exemplary and the shameful, the trivial and the profound, the sane and the crazy, the boring and the entertaining; a quarter of a century worth. Very little will be left out; it will just be cleaned up for the sake of readability. I entertain little hope that anyone will be interested in it, and I can’t even think of a compelling reason why they should be, but such considerations are of no great importance; only the work is important.

If I had the wherewithal, I would seek publication, but that would mean taking topically oriented portions of what I have written out of journal form and putting them into chapter form. Next would come working with others to make my work saleable. I do not say that this is a low end, it is just not an end that I can see my way to accomplishing.

I’m tripping today, and I haven’t even taken any mind-altering medications since last night. I don’t altogether like the feeling because it’s too near the outer edge of control. I’ve been here before, and I know that all I have to do is ride it out as if I were a surfer…. I feel tired, cold; every thought and every fact seems equally and unbearably profound; every object looks equally distant. It is a very old feeling; it puts me in touch with my childhood, as if what I feel now, I felt then, and what I felt then, I feel now; as if time hasn’t moved, as if my whole life is happening at once, and I’m observing my life through eyes that aren’t entirely my own.

I think my present state comes from being too inwardly focused. I’m not taking on projects, not seeing people, not exercising, and not leaving home except to run errands; my mind is feeding on itself. I am tempted to stop surfing, to lie back and see what will happen, how bad it will get, and then to see what lies beyond how bad it will get. When we come to an intersection, are we really free to choose which way we go?

Do-It-Yourself acupuncture, fun with pain, fun with drugs for pain

I went to the acupuncturist eight times. Seven of those times, I saw no improvement. After the eighth, my shoulders felt better for a few days, and I could only think of two possible explanations. One was the acupuncture; the other was that the pain had gotten so bad that I had stopped doing almost everything. To test the first theory, I went to the acupuncturist one last time and asked him to do whatever he had done on the previous visit. This treatment didn’t work the same magic, but I took careful note of where he stuck me, ordered a box of needles, and have been doing acupuncture on myself. There seems to be a slight improvement, but since I am experimenting with other self-help approaches, I can’t pin it down (ha) to the acupuncture.

One of the humorous aspects of pain itself and the narcotics that relieve it is that you become a complete idiot. Yesterday, I got out the dogs’ collars, leashes, and poop bags; put on my windbreaker and bicycle helmet; and went for a walk. Pretend you are taking an IQ test, and you are asked to identify something that doesn’t belong in the above sentence. Right! But I didn’t find the correct word or words until I was halfway down the street, at which point I sheepishly returned home and put on my cap. Also yesterday, I was frustrated by not being able to find my keys. After a few minutes of furious looking, I discovered them……in my hand.

An updated account of how things have played out

When I last updated, the diagnostic neurologist had referred me back to the internist for cancer screening. The internist ordered a vertebral biopsy, said it could take a week to get it done, and told me to expect a phone call from whomever he referred me to. Unknown to me, he faxed referrals to three specialists (he apparently had doubts about which one was appropriate). When I received no call, I called the internist’s office repeatedly—or rather the internist’s office answer machine—to ask what was happening. I finally learned that two of the specialists had declared the procedure too risky (I have no idea why despite my best efforts to find out) and that the third specialist was insisting upon an open incision instead of a needle biopsy. I got the name of the third specialist and called her office. I was told that no referral had been received, so I commenced more calls to internist’s office. His referral clerk finally called back, and insisted that the referral was faxed a week ago. And so it goes, and so I wait… A procedure that was supposed to take one week won’t be done in two.

My dealings with doctors and their employees have led me to be more surprised when things go well than when they get fouled up, so I am far from childlike naiveté. Even so, having to struggle continually just to get people to do what they said would do, what they were hired to do, is awfully wearying. Clearly, if I had not badgered the internist’s office, I would not have heard from anyone. I have no doubt but what sick people die because they get lost in the shuffle and lack the strength to fight their way to the top. My problem is that the longer I have to put up with all this bullshit, the more obnoxious I am tempted to become. I can imagine calling twelve times a day to rub myself in their faces for being such fuckups. I don’t do this only because I know it would hurt rather than help.

My father had a spinal tumor removed in 1955. The surgeon told him that there was a greater chance of death than of recovery, but Dad said he didn’t really care as long as he escaped the pain. For months he had only been able to sleep standing in a corner propped on crutches. I always thought of my father as emotionally weak. Now I am in awe that he was able to keep from blowing his head off. Doctors then were even more reluctant to provide adequate pain relief than doctors today.

I took three different pills last night to knock myself out, yet I awakened five hours later in pain. I took a Vicodin when I got up, and wish I had something stronger, although I hate taking any narcotic because of the side effects and because the more I anesthetize myself now, the harder it will be to anesthetize myself after I start having surgeries. I had to get the Vicodin from the diagnostic neurologist—my surgical orthopedist just told me to go home and apply ice. I wish for him that he will someday feel the pain that I am experiencing.

It is hard for me to accept that I am but one patient among scores to my many doctors, and that most of them really and truly don’t give a rip. If they see me at all, it is only as whatever body part they specialize in. I can call their offices all I please, but I rarely get a real person, and when I do finally hear back, the caller is often someone who knows less than I did before I called. Then when I go in for an appointment, the typical doctor is in a hurry to get rid of me. I don’t take this personally. That’s the problem; the system is impersonal. No one means to behave badly; they’re just not rewarded for behaving well. The more patients, the more money and the more praise from their employers. The average doctor visit lasts six minutes.

Even so, I can’t say that all this has been a totally negative experience because it has given me a greater appreciation of my strength. Even with Lexapro, there are days when I am obsessed with suicide, and find a strange comfort in fantasizing how I would accomplish it (my latest plan is to make a paste of my medications and wash it down with cognac). Yet I know I won’t harm myself, at least not until I’m pronounced hopeless, and maybe not then. My reasoning used to be that it would hurt Peggy too much. That is still true, but I have also learned that good can—and already has—come from my suffering, and that it would be a mistake to block that good.

I used to be too willing to blame other people for their pain, to think that all they needed to do was to exercise, or think positively, or clean up their diet, or stop taking so many prescription drugs. Now, I see that it’s not the Army Rangers who are the toughest of the tough but the people whose lives might appear to be a complete mess. City buses invariably contain old people with walkers and bent up people in wheelchairs. With all my pain and disability, I look at them, and I don’t know how they do it. Their bodies are shriveled, yet their spirits keep moving. I can still walk, and see, and hear, and use my arms for something other than pushing a knob on a motorized wheelchair. No one has to shave me or change my underwear or cook my food. What I can no longer do is a loss, but what I can do is a miracle. There are times when several minutes pass during which I don’t think about how much I hurt, and I am more grateful for those minutes than I used to be for my entire life. There truly can be redemption in suffering, not that I would wish for another moment of it if I had the power to choose.

Buford Stewart and the unpardonable sin

I cursed God when I was twelve. I was delivering newspapers on my bicycle, and I remember the exact spot where it happened. By this time in my life, I was having serious misgivings about Christianity, and my recollection is that I let loose on God out of frustration. As I saw it, God had given Gideon not one sign but two really impressive ones, so I figured he could give me a sign too. Even a mediocre sign would do, I said, but the heavens remained silent, and my anger waxed hot. The curse was hardly out of my mouth before I remembered the Bible verse about the unpardonable sin, and there came into my heart an UH-OH feeling that would torment me for years.

“Assuredly, I say to you, all sins will be forgiven the sons of men, and whatever blasphemies they may utter; but he who blasphemes against the Holy Spirit never has forgiveness, but is subject to eternal condemnation” (Mark 3:28-30)

Now, you would think that God would have gone to great pains to spell out just what constituted the unpardonable sin so that nobody would stumble into it accidentally, but he did not. Some think the sin is apostasy because, as they argue, an apostate wouldn’t ask forgiveness, and that would be the reason the sin was unpardonable. Others think it’s cursing the Holy Ghost, but why would God forgive a person for cursing two-thirds of his august being but not the final third? And why hold this one sin above all the others anyway? If God can’t forgive it, then he is not all-powerful; but if he won’t forgive it, he isn’t all-loving—or so it seemed to me.

In any event, I spent the next several years in mortal terror. Not everyday to be sure, but a lot of days. I would go through periods when my own certain damnation was all I could think about, but just when I thought I couldn’t take it anymore, the fear would lessen. I couldn’t see living that way indefinitely, but I couldn’t see telling anyone what I had done either. When I was sixteen, I screwed up enough courage to drive out in the country to Buford Stewart’s house, Brother Stewart being a preacher whom I regarded highly. I posed my problem in what I hoped would pass for intellectual terms, something on the order of, “Brother Stewart, I’ve been thinking a lot lately about the unpardonable sin, and I just sort of thought I would drive out to your house at nine o’clock on a Tuesday night in the hope that you might be able to tell me exactly what a person would have to do to commit it.” I don’t recall what he said, and I have no idea if he ever figured out where I was really coming from.

Brother Stewart died several years ago, and I miss him—or at least I miss knowing that he still walks upon the earth, for I hadn’t seen him since I was eighteen. He took me along on a revival to Kentucky once, to the area below Bowling Green. The families in whose homes we stayed were poor, and he and I were often obliged to sleep in the same bed. One night, he rolled over and put his arm around me. I knew he was sound asleep and thought himself home with his wife, so I lay real still—so as not to embarrass him—and he finally turned the other way. A poor man himself, he still turned down a pay raise so that the money could be used to “advance the gospel,” and I was mightily impressed by that since I knew there was no way I would have turned down more money, whether for the sake of Jesus or anyone else.

But what stands out in my mind most about him was how kindly and uncondescending he was to kids like myself—and how much he loved cornbread and buttermilk. As a boy, I could no more understand why a man would get all worked up about something so plain and omnipresent as I could understand why pigs loved slop. Now I too love cornbread and buttermilk, more than almost anything else, even more than things like lemon meringue pie and banana pudding made with vanilla wafers, and I often think of Brother Stewart when I eat them. Alas, like Father Abraham, I have moved to a heathen land where the people know not how to make cornbread the way God meant it to be made, neither do they know how to eat it, and I must therefore make my own. Selah.

May the Good Lord bless you, Buford Stewart, wherever you are, and may he be a far better God than your Church of Christ theology allowed you to imagine.

After death

Peggy fears being dead because she doesn’t know what awaits. I don’t fear being dead because I envision death as an everlasting sleep. There is irony in our divergence. Peggy was never a religious person. True, she was taken to church three times a week as a child, and was sent away to a Baptist College that required chapel and Bible classes; but religion never held any interest for her. She neither embraced nor rejected it—she simply didn’t think about it.

My parents were haphazard church-goes. If my father was in one of his religious phases; my family went. If he was in an atheistic period; we stayed home. Everyone but me, that is. I’ve belonged to four churches, visited scores of other Christian and non-Christian groups, and was even a non-resident editor for American Atheist Magazine. What I’ve never been in regard to religion was uninterested. If I don’t think about it so much anymore, it’s only because I’ve turned over every leaf and run out of leaves.

Yet, of us two, the one who never entertained questions about God fears death, and the one who has been consumed by the search for God has no such fear. Does this mean then that I am so sure that death is a state of non-being that I will admit no doubt? No, I could be wrong, but then I could be wrong about a lot of things that lack evidence. I could be wrong in thinking the earth is older than 6,000 years, or that polar bears and hummingbirds were divinely cursed because of an unfortunate incident involving a snake and a fruit tree. I could even be wrong in denying—as a branch of my early church believed—that an angry god will condemn to everlasting flames anyone who uses more than one cup for the “Lord’s Supper.” By the same logic, I must admit that my garage could be inhabited my invisible space aliens. After all, I can’t prove that it’s not.

I only fear being in pain while I’m still alive. The longer I hurt, and the more death looms as a real possibility, the less I fear it for itself. I would regret leaving Peggy, and I grieve in advance for all the other good things I would lose; yet I know that such grief is for the living, that the house of the dead is empty.

Here is my account of how things have played out

Here is my account of how things have played out current to yesterday. Most of it is actually true.

Early in 2006, an orthopedic surgeon operated on my left knee and made it worse.

I went to a yoga instructor because yoga is good for worse knees.

I went to an internist because yoga made my shoulders hurt.

I went to an orthopedic shoulder surgeon because that’s what the internist told me to do.

I went to a physical therapist because that’s what the orthopedic shoulder surgeon told me to do.

When physical therapy didn’t help, I went to a massage therapist who made my shoulders even more worse, and who told me to go to a dermatologist about some “funny looking moles.” (Ha, ha.)

I went to an acupuncturist because the more I read about shoulder surgery, the more scared I got—and because I remembered how my last joint surgery turned out. The acupuncturist stopped just short of offering me a money-back guarantee that he could “heal” my shoulders. $550 later my shoulders were worse. “That means the treatment is working,” he explained. “And what would it mean if they had gotten better?” I asked. “It would mean the same thing,” he offered. “WOW!” I said, scarcely able to believe my luck.

I then went back to the orthopedic shoulder surgeon who said, “Alas and alack, you have new symptoms that could mean you will need spinal surgery before you have the two shoulder surgeries; I am sending you to a neurological diagnostician.”

The neurological diagnostician ordered an MRI, a CAT, an EMG, an IRA, a thousand shares of Eli Lilly, and a nerve conduction study.

The radiologist who read the MRI and the CAT said, “Alas and alack, this man might have metastatic cancer in his fifth cervical vertebra.” He and the neurological diagnostician jumped up and down waving their arms in the air, squealing like little girls, and screaming, “Oh, gross!”

When they calmed down, the neurological diagnostician sent me to the internist whom I saw in the first place. “I thought you’d be back someday,” he grinned while rubbing his palms together in a manner reminiscent of a mortician I used to know whenever he had sold a rosewood coffin. The internist ordered a WBC, an HGB, an HCT, an RDW, a MCHC, an LDL, a PSA, and an XJ6. Everything but the XJ6 was a blood test so it’s not like I had to drive all over town to get them done—which was pretty much what I had been doing.

Meanwhile, I finally got in to see a dermatologist, and he presented me with a clean bill of dermatological health. He obviously missed class the day they taught new doctors to refer their patients to other new doctors in a permanent circle broken only by a patient’s death or insurance cancellation. This was the same day when all the new doctors hugged, cried, and knew they were full-fledged members of the medical fraternity.

Then I returned to the internist whom I saw in the first place to ask if he was happy with my blood tests and his vintage Jag. He said, “Alas and alack, you might indeed have cancer, but then again you might have osteonecrosis.” “DEAD BONE!?” I screamed, putting the root words together. “Dead bone,” he repeated sadly. “Worse yet, my XJ6 won’t be here in time for the weekend…. Now, where was I? Oh, yeah, I’m sending you to a neurological surgeon for a biopsy.” I told him I was truly sorry about his XJ6. His eyes moistened with gratitude, and I patted his hand.

He then became thoughtful, turned pale, and upchucked some sturgeon eggs. “Please excuse me Mr. Thomas, but rotting bone marrow smells SO GROSS that even thinking about it makes me want to puke.” “More than ‘want to’ I would say, Mr. Doctor Man.”

That was yesterday. I am now waiting for a call from the office of the neurological surgeon. I’m told that I won’t hear anything until he hears from insurance, and that this could take a week or more. I am excited about having a bone biopsy because the anesthesiologist will give me Vercid before I am stabbed in the back with a humongous needle, and Vercid is an entertaining drug even if it does make me say things that I later regret.

Many doctors have made many monies, but no doctor has helped my shoulders, and now my back hurts too, and I might be dying—but I doubt it because I still have upwards of two million dollars in insurance coverage, enough to keep me alive at least until early January and maybe into February. My savings might be in the pockets of Wall Street bankers, Exxon Mobil executives, Communist China, and the military industrial complex, but, by god, I’ve got insurance, and if I’m lucky my everything will get well by itself before it’s all gone.

cancer a possibility

My neurologist called yesterday to say that he ordered the CAT scan because my fifth vertebra “didn’t look right” on the MRI. It looked no better on the CAT scan, and he thinks I could have cancer. Since cancer rarely originates in that location, it would probably have metastasized from someplace else—my prostate, he speculated. He said he had spoken with my internist, and that I should expect a call from him. This is my second cancer scare this year--I had a lymph node biopsy in February.

Peggy got in late yesterday and left early today (she works three, ten hour shifts each week), so I didn’t give her the news because she wouldn’t have slept. She had called me from work to ask if I had heard from the neurologist, and I could truthfully tell her at that time that I had not. My thought is still that I could accept such news for my sake, but I don’t know how I could accept it for hers.

timing the market versus loyalty to Bogle

I told Peggy in May that I was so pessimistic about stocks that it was all I could do to stay in the market. She said that maybe I shouldn’t, but my market philosophy came from John Bogle (the father of indexing), and I felt that I would be disloyal to him if I sold. So it is that I’ve received yet another lesson in the fact that, when I get screwed because I trusted an expert, the expert seldom if ever gets screwed with me.

So what did Bogle say that caused me to stay astride a horse that was running pell-mell toward a cliff? He demonstrated to my satisfaction that no market guru has ever demonstrated anything close to a consistent ability to time the market, and that effective market timing requires getting it right twice—once when you sell and again when you buy back (bull markets typically post their highest gains early on). I know he’s right, yet I don’t recall a single instance in which my own hunches were wrong. I have regretfully avoided buys because they seemed risky only to see them soar while my less volatile buys dropped. Now I’ve lost a third of our savings because I trusted John Bogle more than I did myself.

The trouble is that I don’t know if my hunches were a matter of intelligence or luck. Since I didn’t record them, I can’t even prove to myself that I was right as often as I think I was. It could be that I simply remember the times I lost money because I didn’t listen to my hunches while forgetting the times I made money because I listened to John Bogle. After all, no one remembers the thousands of times he drove to the supermarket safely; he only remembers the one time he had a wreck.

Having ignored my correct hunch to sell, let’s see how right I am over the coming months about my belief that now is the time to buy. Sure, the market looks risky, but if you wait until things have quieted down, you’ll miss out on its biggest gains.

Lullaby--by William Blake (1757-1827)

O for a voice like thunder, and a tongue
To drown the throat of war! - When the senses
Are shaken, and the soul is driven to madness,
Who can stand? When the souls of the oppressed
Fight in the troubled air that rages, who can stand?
When the whirlwind of fury comes from the
Throne of God, when the frowns of his countenance
Drive the nations together, who can stand?
When Sin claps his broad wings over the battle,
And sails rejoicing in the flood of Death;
When souls are torn to everlasting fire,
And fiends of Hell rejoice upon the slain,
O who can stand? O who hath caused this?
O who can answer at the throne of God?
The Kings and Nobles of the Land have done it!
Hear it not, Heaven, thy Ministers have done it!

the neurologist calls for another test, thoughts about dying

I had my MRI night before last. The neurologist’s office called at 8:00 this morning to say that he had ordered a CAT scan, and that the CAT scan people would call me. The CAT scan people called at 9:00, and said to get there ASAP, that they would work me in. This made me wonder what the dickens the MRI showed—or else didn’t show.

Based upon her terror of cancer (as opposed to her experience as a nurse) and her subsequent tendency to diagnose it at the drop of a hat, Peggy thinks I have bone cancer. She would not have shared this particular bit of information if we hadn’t been fighting at the time. Fortunately, Peggy’s fears are seldom my fears, so they don’t affect me except to make me sad that she has them.

Even if her direst prediction is right, death scares me mostly because she would have to carry on without me. Maybe I would be scared for me too if I really believed I was dying, but I think I would mostly worry about her and feel guilty that I was abandoning her. This is not because she couldn’t make it on her own (and even find satisfactions that she would not otherwise have known), but because it would be hard for her to do so. Our marriage has been through a lot during these 37 years, but it has generally gotten better since I stopped having affairs, and I would even go so far as to say that it’s pretty good now. This means that another thing that would make it hard to die would be knowing that I didn’t try as hard as I should have to deserve Peggy.

Doctor-Go-Round, Prescription Cornucopia, Chronic Pain, the Cause of Depression

My week. Monday: surgeon. Tuesday: neurologist, acupuncturist, and hand rehabilitation therapist. Wednesday: MRI. Thursday: acupuncturist and dentist.

My daily prescription regimen: Lexapro (for depression), Elavil (for sleep), Ambien (for sleep), Requip (for sleep), Vicodin (for pain), Feldene (for inflammation).

Yesterday, the surgeon declined to operate on either shoulder because he thinks I have a vertebral problem that will require surgery first. This is why I saw the neurologist today. The neurologist ordered an MRI and a nerve conduction study. I will have the first done tomorrow night and the second next Wednesday.

The hand rehab therapist blamed the failure of my wrist to heal from carpel tunnel surgery (last April) on the impingement in my right shoulder and the unnatural way I hold my body in order to avoid pain.

My acupuncturist suggested that I sleep with several pillows under my head and my chest so as to suspend my shoulders above the mattress, and that advice represents the most I got for my $550. That very night, I slept ten hours. The trouble was that the chest pillows hurt my ribs more with each passing night. I substituted various combinations of blankets, foam wedges, and air mattresses, and I even tried compromising so that some weight remained on my shoulders, but to no avail. Since my back long ago became too painful to sleep on—even in a recliner—I am in an unenviable situation.

I can no longer bike, and I can only walk without shoulder pain if I keep my hands in my pockets. When that doesn’t control the pain, I fold my arms. When that fails, I cross them atop my shoulders. Housework is a nightmare, and I don’t know how I’m going to rake the leaves, yet inactivity and feeling like I am not pulling my share of the load is even more difficult.

Yet, I cannot say that living with pain has been a total loss. I haven’t gained in compassion—as one might expect—but I have gained in a more immediate understanding of how flimsy and temporal our lives are. Only the very young are without wounds or ailments, and oftentimes not even them. Yet, despite this—and even because of it—beauty and meaning are possible. As I write, I am listening to Loreena McKennitt. How sweet her voice is, and how such grandeur as my race can achieve sustains me through the long nights. Pain reduces a person to elementals.

The Lexapro has been such a boon that I can almost imagine it being worth the thousand dollar a year price tag. Without it, I don’t know how I would get through this….

Few people presume to tell those with cancer or a bad heart that their problem will go away if they count their blessings or stop taking life so seriously; but I have received much such advice over the years, and I would compare it to telling a person who is drowning that he needs to swim.

Years ago, I was in an informal support group, and was surprised to learn that a great many of my fellows actually did believe that all manner of mental and physical ailments were entirely a matter of troubled thinking, so that all a paraplegic, for example, needed to do to walk was to envision himself as being able to walk. Such a belief is like religious faith in that it is impossible to argue against it because its holders—who tend to be young and healthy—see it as coming from a higher plane than mere evidence or logic and therefore unassailable by mere evidence or logic. It is also like much religious faith—and much advice to the depressed—in that it is smug and insulting. If I can think like a “normal” person simply by taking a pill that alters my brain chemistry (while a “normal” person would not be affected by the same pill), this surely implies that my brain chemistry might have been the cause of my depression.

I’m aware that everyone from the excessively timid to the grossest overeaters wants to be thought of as having a disease, partly because it takes away the moral stigma and the onus of personal responsibility. But what if they’re right? I know I couldn’t be a drunk if I tried just as I couldn’t weigh 400 pounds if I tried. Besides, the fact that such problems might not be entirely a matter of choice doesn’t diminish the responsibility of the person who is suffering from them anymore than the fact that my shoulder problems were not a matter of choice diminishes my responsibility for dealing with them. Even if a person should deny his own responsibility all the way to the grave, he would be no less dead.

Thoughts on chronic pain, modern medicine, alternative medicine, acupuncture, surgery, and anti-depressants

I started Lexapro a week ago. My primary care doc gave me a sample back in March, but I hate taking that kind of thing except as a last resort. On Tuesday, I thought that, well, it’s last resort time, so I looked Lexapro up on the net and learned that it’s for depression and anxiety in the worse-off of the worst-off. I’m not altogether catatonic, but close enough.

I can feel it raising that old familiar floor beneath my emotions that desipramine, Prozac, Wellbutrin, and Zoloft erected, only maybe higher and stronger. “And, lo, the Lord, Lowell’s God, looked upon that floor and saw that it was very good, and he sayeth unto Lowell, ‘Lo, Lowell, this floor, it is very good, but let us maketh it better by raising it higher, even until it is above thy head,’ and Lowell answereth the Lord, Lowell’s God, by saying, ‘Lo, Lord, the same floor cannot be both beneath my feet where it will doeth me good and above my head where it won’t, and the Lord, Lowell’s God, answereth back unto Lowell, ‘Lo, Lowell, all things are possible for the Lord, Lowell’s God,’ to which Lowell sayeth, ‘Oh.’ And the floor was raiseth, and Lowell fell out from under it.”

For most of my life, I had but one doc whom I rarely saw. This year, I’ve had one sleep specialist, three surgeons, two anesthesiologists, countless radiologists, two neurologists, one dermatologist, and one primary care physician. Today, I added a hand specialist (to help break down scar tissue from my carpal tunnel surgery) and an acupuncturist (for my back and shoulders) to my entourage of nurses, aides, phlebotomists, x-ray techs, massage therapists, physical therapists, and lab techs. One of the dominant labels that I now place upon myself is that of patient.

Medical doctors, are, by and large, less than pleasant people. They’re harried, impatient, unreachable except during paid visits, think of me as an assemblage of parts, don’t recognize me when they see me, and have offices that are brown and gray with nothing of solace or beauty except maybe a single print that looks to have been added as an afterthought.

My primary care doctor is somewhat the exception. His office is the worst of all, but he encourages me to talk about any and everything, and he listens good. He is also my only doctor who is not young enough to be my child. In fact, he is my exact age—fifty-nine. He’s a little more wrinkled than I, perhaps, and a lot more stooped. He also shuffles when he walks and has a tremor. You might say that he looks like hell. You might say that he looks like he should be my patient rather than I his, but maybe I flatter myself. In any event, I leave his office with the suspicion that I am better off with my problems than I would be with his.

Alternative practitioners are the opposite of regular doctors. Maybe it’s because they lack the scientific cachet, or maybe it’s because their patients are mostly people who are disenchanted with regular doctors, or maybe it’s just that they all happen to be supremely sensitive spiritual types. Whatever the reason, they are given to hemp clothing and to decorating their offices with Buddhas, waterfalls, potted plants, pastel paints, and rice paper prints—with meditative music in the background.

I go away from doctors’ offices disappointed that my “healer” had no interest in me except for a single joint or organ. When the acupuncturist I saw today tried to draw me out by saying, “You must be really frustrated by all this pain,” I immediately lowered the drawbridge and sent the archers to the castle walls. “What the the hell are you trying to do here?! I thought. “I’ve only known you for fifteen minutes. I’m not going to open up to you.” A while later he said he needed to leave the room for a moment, and I wondered, “Why are you leaving the room? Am I that hard to deal with? Don’t you like me?” It’s not that I’m impossible to please (no, not I), just that I’m ambivalent.

The acupuncturist is my last hope before surgery, so I read all I could about him and about acupuncture in general before I saw him. Almost every scientific study concludes: “Couldn’t come to a firm conclusion. More research needed.” Great. So, I questioned today’s acupuncturist as closely as I could without being obnoxious, and I couldn’t be sure, but I thought that maybe he didn’t like it. The truth is that nobody likes to be challenged. Even if they say they do, they don’t. Even if I try to be really, really tactful, they don’t.

He stuck needles into my lower arms, abdomen and feet. The pain in my right shoulder went from a two to a six (eight being about what it would take to bring tears). He noticed my discomfort, and put a pillow under my upper arm. “Does that help?” “Yes, I feel better now.” “Are you sure?” “Well, maybe you could lower it a little.” He did, and then stood looking at me in earnest silence. Next he put a pillow under my shoulder. “That’s even better,” I said. Then he put a second pillow under my head. “That’s better than when I came in!” I exuded. Night after night, I toss and turn in pain, yet it never occurred to me to use an extra pillow.

I hadn’t paid for moxibustion, but he did moxibustion. I hadn’t paid for magnets, but he put one on my neck and one on my right shoulder. Then he left me while these things did their magic, His potted ficus looked down upon me sympathetically, as if it too were a healer. But will magnets and needles and burning mugwort help? I divide treatments into things that make sense and will probably work, things that don’t make sense but might work anyway, and things that seem too stupid to even consider; and I’m open to the first two categories. Nothing Tom did seemed stupid.

The thing about medical doctors that bothers me most is that they are a lot more interested in treating symptoms than treating causes. In fact, they are often completely uninterested in causes. Maybe this is because they are expected to see several patients per hour. Or maybe it’s because symptoms are obvious, quantifiable, and approachable. Until three years ago, I was in pretty good shape. Then I had knee debridement so that I could hike twelve miles over steep terrain without a knee ache. Thanks to that very simple and very routine surgery, I can no longer walk more than a few blocks without pain, and I’ve gone downhill like a pig on a greased slide. If I were a doctor, I would be curious about that, but even my primary doc just kind of throws up his hands and grabs for his prescription pad. “Depressed about your declining health? How about a nice sample of Lexapro? It’ll do you good. Besides, Forest Pharmaceuticals often buys lunch for my staff and me—not that I would let it influence me any.”

Just as carpenters see every problem as requiring a hammer, surgeons call for a scalpel, so if you don’t want surgery, don’t go to a surgeon. That shoulder surgery (subacromial decompression, which translates into “take the pressure off the area beneath a bone called the acromium”) I cancelled two weeks ago has a four-month recovery period. In other words, the surgeon would injure me so severely that I would need four months, not to recover from the ailment, but from the treatment. Does that sound like anything YOU would jump into? Sure it’s a simple surgery (for the doctor), and sure it’s routine, but then my knee surgery was even more simple and more routine; and because of how IT turned out, I never lose sight of the fact that, if the worst happens, it’s not the doctor who will be screwed. What’s more, the doctor might not even care. Mine certainly didn’t want to be reminded of his failure.

Maybe my primary doctor is right about the brain. Maybe it’s all (or at least mostly) physiological—what goes on in there. It sure looks that way. A stroke, or a head injury, or a pill, can dramatically change a person. I’ve seen it from the inside. When I’m on an anti-depressant, all the dark thoughts that I had are still lurking in the shadows, and they still seem more real somehow than the positive thoughts, yet they have been robbed of their power. It’s as if I’m standing behind a bulletproof window, and can see the darkness coming at me, only it can’t penetrate the glass. Pills don’t make me into a flaming optimist; they just make me indifferent to sadness.

Unfortunately, it’s not just sad thoughts that bounce off the glass, it’s also my ability to be deeply touched by love, art, music, nature, innocence, heroism, and compassion. Poignancy becomes just another word in the dictionary that I can understand but can’t personally relate to. In short, to deaden what I hate about myself, the drug must also deaden what I love most, the two being somehow intertwined. That is why I don’t take the damn stuff unless I’m so screwed up that I become fixated on suicide. In the current circumstances, it’s not that I want to die; it’s that I want the pain to die. Unless you’ve been awakened time after time, night after night, by one of the worst pains you’ve ever had, you won’t know what I’m talking about. When the acupuncturist asked me to describe it, I said that it’s like someone stuck ice picks deep into both shoulders. If the pain were any worse, I would howl like a dog.

I’m reading a mediation book (break through pain by Shinzen Young) about the spiritual growth that is possible with chronic pain. He says that the pain is not the BIG problem; it’s the terror, the outrage, the refusal to accept the pain that’s the BIG problem. Yes, I can see that. Heads or tails. Suicide or saintliness.

I can’t hike because of my knee. Now I can’t bike because of my shoulders. I’ve never much cared for meditation, but at least meditation is something I CAN do. Maybe, for now, I need to accept that life is not NORMAL, and might not be normal for a long, long time, and that, just maybe, something good can come from that.

Sleeplessness

It’s a chilly Labor Day, too soon to start the furnace, but too cold to be comfortable without it. I am wearing both a sweater and a light jacket.

Two weeks ago, I postponed shoulder surgery, partly because I was afraid it either wouldn’t help or leave me worse off, partly because I dreaded the long recuperation (for the first ten weeks, my arm wouldn’t even be able to support its own weight), and partly because I wanted to give physical therapy another month or two. At the time, I showed little progress with therapy, and, to tell the truth, couldn’t actually say but what it was hurting more than it was helping. Since then, I’ve deteriorated greatly—a deep massage plus my reluctance to forego exercise seems to have triggered my decline—and now I don’t dare exercise at all.

Shoulder pain keeps me from sleeping on either side, and now my back is hurting me as much as my shoulders. Since my sleep apnea mask doesn’t allow me to sleep on my stomach, I’m challenged to get any sleep at all. An Ambien, plus an anti-inflammatory, plus Tylenol, plus heating pads and ice packs, enable me to sleep, at most, for a few hours before I awaken in pain. They also make me nauseous. Even if I went ahead and had the surgery, I would feel worse for weeks if not months before I felt better—and that on one side only—and I don’t see how I could bear it.

Of such problems as I have had, sleeplessness is the worst. To be so tired yet be unable to rest engenders a feeling very near panic. Just the thought of lying down fills me with dread although I can scarcely stay awake.

I suppose I will try a chiropractor and maybe an acupuncturist, although I can find little evidence to support them. But then the evidence for surgery is mixed too. My particular surgeon boasts of a 96% success rate (how would he know?), but the average seems to be more on the order of 80%.

I wish to god that I knew what to do. I am finding it hard to direct my actions from moment to moment much less to make major decisions.

Bears, Mountain Lions, and Surgery

The best times to go to the woods are in late spring and early summer when the most flowers are in bloom, and in mid to late summer when the berries are ripe. On our last trip, we dined on raspberries, dewberries, blackberries, thimbleberries, red huckleberries, salal, and even the strange tasting Oregon grape. My favorite, the lush orange salmonberry, was all gone, and I will grieve its loss until next summer. When we go to the woods again (we venture out once a week), we will take berrying buckets and stock our freezer.

The coast range has far more berries than the Cascades, and far more bears to show for it. On our last bike trip before Peggy’s mother died, an adult bear crossed the road 300 feet in front of us. As I grew abreast of the spot, a movement caught my eye, and I spied its cub frantically climbing a small tree no more than ten feet away. “Oh, look at the little baby bear,” I cooed to Peggy—who had not seen it. She made no response, and when I looked back at where she had been, she was disappearing down the mountain in a cloud of dust, and I was unable to catch up with her for quite some time. When I finally did, I said simply, “You were going for help, I suppose,” knowing full well that Peggy had considered it a case of every man, woman, and dog for itself—her being powerfully afraid of bears. My only terror is of mountain lions, and I worry mostly about our dogs because the question in my mind is not whether a mountain lion would eat them, but why wouldn’t a mountain lion eat them.

Peggy took a spill last weekend, and came away with some bruises and road burns. Logging roads are often paved with poorly packed rocks of uneven size, so it is not unusual for our wheels to be thrown several inches to the side. No one can bike in such places without an occasional wreck.

I am scheduled for rotator cuff surgery toward the end of the month. I can hardly sleep for fear, only fear is too weak a word. I try to calm myself by reciting poetry, but I can scarcely focus long enough to get through a single verse. My days are less terrible than my nights only because I can at least distract myself with work, even if I am so panicked that I make one stupid mistake after another. One might think that with all the surgeries I’ve had, I would handle myself better, but the reverse is true. Even when I have confidence in my surgeon, I have no confidence in my luck. It’s not that I consider myself unlucky, but that so much can go wrong, and so much of what can go wrong can never be made right. How many times have I wished I could have screamed “Don’t do it!” at myself as I walked to the hospital for knee surgery, even that short walk being longer than most of the ones I have made in the years since. My intention was to prolong my hiking years, not to end them altogether. Now I can but bike, and I won’t even be able to do that for four months after my next surgery. I won’t be allowed to so much as lift my arm for six weeks, and nothing more than my arm for another month.

Some might interpret my terror as a premonition, but I have little to no faith in premonitions. What I do have faith in is my ability to made prudent decisions, but no matter how prudent I try to be, there is always uncertainty, and there is always the possibility that I will learn something after the fact that would have led me to choose differently. Oddly enough, the more fearful I become, the harder it would be for me to back out of surgery in the absence of a really good reason to do so.

I have spent hours combing the Internet for alternative treatments, but the trouble with alternative treatments is that they are seldom supported by hard data. I can find study after study about surgery, but no studies whatsoever about Rolfing, Tragering, acupuncture, chiropractic, and so forth. If they could but offer me some reason to believe in them (other than their own authority and the anonymous testimonials of their patients), I would jump at the chance. Yes, medical doctors sometimes kill their patients whereas homoeopathists never do; and, yes, medical doctors are glorified parts’ technicians whereas alternative therapists treat the whole person. But I see no other option. I can have surgery now, or I can have surgery later. Or—as I’m told—I can have surgery now, and still have surgery later since an enlarged tendon can’t be reduced. The most that a surgeon can do is to remove some of the risk factors that might lead to a tear.

Friendship's End

(This entry contains slang sexual references.)

Mark and I got together a lot until we both moved to other parts of the country, and didn’t see one another for twenty-five years. What follows is the post mortem of our friendship, not that I am in a position--a month after it ended--to fully understand what happened, or to know if I might have done better.


I wrote:
You wrote that you seldom use your Frequent Flyer mileage. Maybe we could cut a deal.


Mark wrote:
Now when did you start needing somebody like me to foot your travel? Get online, find some rich ole horny woman to fly you wherever you want to go! You still throw down don’t you? That’s my plan when I get to be your age.


I wrote:
If I had something I didn’t want, and you did want it, I would either give it to you or sell it to you. Such is what I had in mind. Why would you throw something away rather than to let someone else have it?


Mark wrote:
I’m just busting your chops. I’m just trying to accumulate enough to get platinum status. That’s when the perks really kick in...


I wrote:
Busting my chops? Yes, the image of being hit in the mouth fits.

Several weeks ago, I suggested accompanying you on one of your foreign trips, if you would have time away from work for me. This was a significant way for me to reach out to you as I rarely leave the county much less the country. My image was of us having fun together while broadening our intellectual horizons and renewing our face-to-face friendship. Your response was to ask why should you want to go with me when you could go with your latest piece of ass.

I was reminded of the time I drove to Missouri to see a friend who had moved there from Mississippi. As it turned out, he had no time for me because he had a new honey. When I complained, he assured me that he liked me, but that, after all, why would he want to be with someone who looked like me when he could be with someone who looked like her.

I concluded that you are of the same mind, that a male friend is only of value as a diversion when you are between females. I gave up any thought of ever going out of my way to see you, and I questioned whether it was even worthwhile to write to someone who holds me—as a male—in so little esteem.

You wrote that you DIDN’T use your frequent flyer miles because they were too much hassle. Peggy and I go out of our way to accumulate such miles, and she, at least, uses them to visit her family. When I suggested that you either sell or give them to us, you implied that I’m a freeloader. When I asked why you preferred to throw away something you didn't use as opposed to letting someone else use it, you said that you DO use your frequent flyer miles. Why?


Mark wrote:
Well, there is an unwritten rule among men that opportunities to get laid have to be observed, so I can completely understand if a friend wants to spend time with his woman vs. time with his male friends. As far as male friends, they are nice, we get together once a month to drink beer and yak, but I spend probably 10 times more time with my female friends. So yeah, I guess I am of the same mind in some regards.

So what have you got against just going out and buy a plane ticket like 95% of people who fly? You aren’t the one putting up with the bullshit security, cramped seats, crappy food, delays, cancellations, lost luggage, etc... so the one little perk I do have is an opportunity to upgrade with the miles I do have. Once I get platinum status life only gets better, and you want me to give that up? *ahem*...


I wrote:
“I guess I am of the same mind…”

This is very sad for me to know, and strikes me as an awfully shallow way to live. If you should ever reach a point in your life at which you value friendship over orgasms, I’ll be here.


Mark wrote:
Okay, shallow and laid, or intellectual and unlaid... that is the question... it might help to explain why there aren’t many intellectual people out there.


I wrote:
“Okay, shallow and laid, or intellectual and unlaid... that is the question...”

No, that is not the question. The question has nothing to do with how much a man knows about any number of particular subjects. The question is one of values, of character. No one can be friends with a drug addict because a drug addict will betray him. Women are your drug. You say you are of “the same mind” as Carlos, the man I visited in Missouri. Carlos was excited about my visit until he found a girlfriend. By saying that you are of “the same mind,” you are telling me that I am of no more importance to you than I was to him. You are telling me that you are willing to betray a male friend in a heartbeat, and not even because you LOVE a particular woman, but simply to get inside her pussy. A male is nothing to you; a female is something to masturbate into. Since you are of “the same mind” as Carlos, what happened to me when I visited him might just as easily happen to me if I visited you. Aside from the frequent flyer mileage and which time you were being dishonest (whether you don’t use it or whether you value it highly as a recompense for all your airline related suffering), you are telling me that, as a male, I should accept my unimportance to you as an “unwritten rule.”

You called me one night several years ago, and called me brother. That meant a great deal to me, maybe the moreso because the only brother I ever had was a half brother who chose not to have any relationship with me. I imagined that it meant a great deal to you too. Now you tell me that you are no better than a man who, if a slab of pussy was on one side of a balance scale and a longtime friend on the other, he would grab the pussy.

At 59, my lust for women has diminished greatly. Things about them that drove me crazy years ago now strike me as empty or even silly. Hormones clouded my view. They made that which was of little rational importance appear to have paramount importance. I can well understand why I betrayed Peggy (just as I can understand why you would betray your male friends). Lust can feel as urgent to extinguish as having your hair on fire. Peggy could never understand its power over my life. I can understand its power over your life. However, I can also tell you in complete sincerity that lust caused me to value the trifling over the profound. It caused me to betray a good woman for a string of sluts, and it caused me count my male friendships as less interesting, profound, and important than my female friendships (i.e. my latest piece of ass). Now, I don’t miss any of those women, but I miss my male friends (some of whom are dead) terribly. True friendship is of infinitely greater value than pussy; and male-to-male friendships are, at their best, of greater value than male-to-female friendships, because women will ever be like an alien species to us.

I have often been impressed by your empathy and compassion toward suffering animals, and I know that these virtues are permanent whereas your lust for women is largely hormonal and therefore temporary. Yet, for now, you have told me straight-out that you place little value on our friendship. What would you have me do with that information? I could hang around hoping that you don’t mean it, but I have found that people generally do mean what they say when they are telling me something that they know I won’t like hearing. Or, I could say that it’s okay that you don’t value me, but that would mean that I don’t value myself. My other option would be to think of you as someone who I also hold in little value, but we go back too far—and were once, I thought, too close—for that. While you were never my best friend, you were my good friend, and I imagined that you valued me similarly. Ironically, if I had never made a move toward becoming closer to you—by visiting—none of this would have come up, and I would have been left thinking that you valued me more than you do.