Three procedures and still alive

ATLANTA (Associated Press) — Griffin Bell, 90, the shrewd Southern lawyer who grew up with Jimmy Carter and later became U.S. attorney general after Carter was elected president, died Monday in Atlanta. He was being treated for complications from pancreatic cancer, kidney disease and being 90.

From the perspective of someone still in relatively good health, it often seems like medicine can go too far in treating the ravages of time. I think there comes a point when you feel like you’ve lived a rich, full life and now it’s time to go do something else, like maybe die. Throwing the incredible expenses of the modern healthcare establishment at the elderly and infirm just doesn’t always seem wise, especially if you hit one of them in the eye with an otoscope.

I’ve been incredibly fortunate with my health for over 55 years, and haven’t spent a night in the hospital since that whole birthing thing back in 1953. I’ve had my fair share of the usual modern maladies that almost everybody goes through – measles, mumps, mole removal, molar removal. I had what we politely called a “nervous stomach” in my teens, I’ve had a couple of lower back issues that kept me prone for days at a time, and I got chicken pox as a Christmas present from my son about ten years ago. Only three times have I gone through anything more serious.

My first such episode occurred in 1989. For years, I had noticed a brownish area just inside the top of my left ear. I chalked it up to poor hygiene until one day when it started bleeding. I knew that blood was only effective when it was coursing through your veins and that having it drip off the end of your earlobe wasn’t as good. I made a visit to the dermatologist who took one look at the wound and made his frightening pronouncement – ear cancer.

Well, not exactly ear cancer. It was a skin cancer that happened to be on my ear. All those hours I’d spent on college break in Miami laying out on my parents’ patio without benefit of sunscreen hadn’t been wasted after all. I was referred to a cosmetic surgeon despite my protests that I already looked damned good, but they explained he’d be the one carving off thin layers of my cartilage until all the cancer was removed, then would rebuild what was left into some semblance of an ear. The procedure I’d be undergoing was called “Moe’s surgery,” which sounded like it might involve a conk on the head rather than traditional anesthesia, but actually turned out to be Mohs surgery.

The operation was done in a Charlotte doctor’s office while I was fully awake but feeling no pain. Everything went as planned and the doctor assured me that all the malignancy was removed. I couldn’t look at the cosmetic results right away, since they wrapped my whole upper head in a bandage. I was able to return to work the same day, looking like that guy playing a fife in the middle of that iconic Revolutionary War painting, except that I had a $4,000 doctor’s bill sticking out of my pocket. But my coworkers we really impressed at the dedication I showed by coming in with such an apparently brutal head wound.

My next significant experience came in 2003 while I was planning my first business trip to India. I had noticed occasional discomfort in my groin for a few weeks before a particularly acute episode sent me home from work to wander restlessly around my house. When I went to the doctor later that morning, he immediately recognized the wandering as a symptom of kidney stones (go figure). X-rays confirmed the presence of a crystalline mass lodged firmly in my urethra. “It’s about six millimeters in diameter,” the technician told me, but failed to note whether that was considered small, medium or super-sized. Regardless, it was bad enough to require what they refer to in the business as a urologic intervention. Unless I passed the stone naturally or wanted to risk the male equivalent of childbirth while 35,000 feet in the air over the Middle East, I needed to get this taken care of.

Shortly before the outpatient procedure, called a “simple basket extraction,” I thought I might’ve avoided it entirely. After using the urinal at work, I looked down to see a corn-kernel-sized piece lying next to the scent cake. Had I painlessly expelled the stone and avoided costly surgery? Unfortunately, it turned out to be exactly what it looked like – a piece of corn – though I fail to understand even today how it got there.

Going ahead with the physician-assisted removal turned out to be fairly simple, at least for me. The trickiest part was counting backwards from 100, and then waking up to ask when we were going to start, only to discover the doctor had not only finished but left the building. The nurses kept watch on me until I was able to wiggle my toes and pee on my own, which took only a few hours. Recovery was quick and relatively pain-free, and I’ve survived to this day without another incident.

What you’ll doubtless be glad to hear is the last experience I’ll recount was the highly recommended (by doctors, not by patients) diagnostic colonoscopy. As veterans of this wonder of medical science will tell you, the worst part comes the day before when you have to drink huge amounts of a foul liquid designed to cleanse your system of everything you’ve ever consumed. Once this is accomplished, you’re ready for your outpatient visit at the hospital. There was no backward counting this time; instead, you get an injection that puts you into a “dream sleep” where your dream consists of someone putting the proctological equivalent of a Swiss army knife (including a light, camera, scalpel, eraser, fountain pen and comb, I seem to recall) several feet up your colon. I do remember lying on my side and watching a TV show where the plot consisted of a cute little pink character named “Polyp” being snipped by a “Mr. Scissors”. The next thing I remember after that, I was arguing with my doctor about the billing.

It seems there’s a loophole in the way most insurance companies view the colonoscopy. They urge you to get one, they tell you it’s fully covered because it’s purely diagnostic in nature, but if they find anything that needs to be removed (which they apparently always do), then the diagnostic designation disappears and you’re suddenly responsible for a percentage of the $5,000 cost. Or, you could choose to have them maintain the status quo by shouting “hey, leave that thing alone” during your dream sleep. I almost came to the point of demanding that my gastroenterologist reinstall the polyp before I finally knuckled under and paid the fee.

I seriously doubt that any of these conditions, left untreated, would’ve led to my untimely demise. I suppose I could’ve had colon cancer, renal failure or an ear fall off, though chances are excellent I would’ve survived at least two out of three. Had they occurred later in life, I think I might’ve considered that option more seriously. I hope Griffin Bell didn’t suffer too much from treatments for the kidney and pancreas problems when his larger issue was that he was 90 years old. I’m not sure living to a ripe old age just for the sake of hitting a really high number is a worthy goal. It seems like the oldest living person is dying every other day anyway.

Giving until it bleeds

There was a lot of negative talk out there after my Friday posting claiming that gift-receiving was so much better than gift-giving http://davisw.wordpress.com/2008/12/26/giving-vs-receiving-which-is-best/. The Internet was absolutely abuzz, if you count the guy who said I was a “seflish idoit” and the email I got from my mom asking if that’s the way she raised me.

To prove the point that I can also be a very caring individual who feels deeply the importance of giving back to his community, I’ll be hauling a load of stuff over to Goodwill at the end of the tax year on Wednesday. I also went to the bloodmobile Saturday to give the gift of life.

Talk about giving of yourself, this is the most selfless contribution one can make short of a lung. My wife and I have been giving this annual donation right around Christmas for the past five years or so. She’s actually way ahead of me in the quantity given, having started in college. I was only introduced to the concept when the local Starbucks began sponsoring the event with the incentives of free coffee and a baked good for all donors. I also wanted to see if it was true that you’d get drunker on a couple of beers after your body had been sapped of almost a quarter of its life-force.

We arrived early enough to be first on the list of those signing up. While the rest of the nearly overflowing coffee shop was lounging around concerned only about number one (that coffee goes right through you), Beth and I read through the pre-donation materials to be sure we were still eligible. Easily clearing the requirement that I was at least 17, weighed at least 110 pounds and had at least one arm, I signed where they told me and soon was called out to the parking lot where the bloodmobile was parked.

I was directed to the tiny interview room by a middle-aged South Asian woman. This was a good start: my past experience with the workers who staff these events was that they tended to be either young Hispanic- or African-American women who were fast on the take but still required several jabs to hit the right spot, or else they were older Southern white women who were equally jab-happy but much slower about it. I’ve seen enough cardiologist ads in the paper to recognize that Indians make great healthcare professionals. In addition, when it was discovered the scanner connection to the laptop wasn’t working properly, she was able to troubleshoot that without calling home.

We huddled together in a space about the size of an airliner bathroom while she ran through the extremely personal health history questions she kept assuring me she was required to ask. Was I a hemophiliac? No. Have I had an organ transplant in the last 60 days? I don’t recall one. Have I ever had sex with another man? No. Have I ever had sex with a hemophiliac or transplant recipient who was a man? Have I ever been in prison? Have I ever been to Africa? Have I ever killed and consumed the flesh of another person? If so, did that person have hepatitis? Was I bitten by a crazy cow in the United Kingdom between 1980 and 1996? No, no, no, no, and no, that unfortunate cow encounter was in 1997.

Finally cleared to proceed, I walked out to the main aisle of the mobile. My interviewer asked which arm I wanted to use, and here’s where I must admit I puffed up a little with pride. If you read my previous posting about selling my body to a company that was doing shingles research http://davisw.wordpress.com/2008/11/08/a-second-career-perhaps/, you might remember how exceptional the main vein in my right arm is. The inside of that elbow has been widely admired for the way in which the blue vessel protrudes in a come-hither fashion just below the thinnest layer of skin. Since the right-armed donation loungers were all full, I was asked if I wanted to offer my left arm instead. But when I showed the admiring circle of blood ladies my right vein, they all agreed I should wait. One of them marked the vein with a pen, then posed next to it for a photo to show her family. I took a seat to wait my turn.

After about ten minutes, Beth finished her session and I was able to take her spot. The needle went in effortlessly and soon the blood was flowing. I sat back and relaxed as much as I could while workers scurried perilously close to my connection and the intercom played Christmas songs. And, wouldn’t you know it, two of them were from my “Worst Christmas Songs of All Time” list http://davisw.wordpress.com/2008/12/20/worst-christmas-songs-ever/ and a third was Bob Seger’s boozy rendition of “Little Drummer Boy.” (I don’t know if I was starting to get a little light-headed or what, but the line “the ox and lamb kept time” struck me as absolutely hilarious.)

My languor was soon interrupted when one of the workers reported that an “overflow situation” was developing somewhere in my vicinity. I tried to look behind me where my bag hung to see if the room was starting to look like a Quentin Tarantino film and I was preparing to bleed out. Apparently it was only a minor overflow so I was able to avoid infecting the whole bus with Creutzfeldt-Jakob Bovine Spongiform Encephalopathy, or whatever it was that wacky British cow gave me.

I was disconnected from the tubing, had a gauze bandage affixed to my magnificent vein and was told to raise my arm high in the air. After a minute or so, a role of colored tape was brought out and a length was cut off and wrapped around my arm. Everyone else who’d been through this step in the process was asked what color tape they wanted, so I already had my eye on a nice pale green that would contrast nicely with my hazel eyes. But I was assigned the blue with no questions asked in what would turn out to be the only disappointment of the experience.

As Beth and I headed back into Starbucks to collect our premiums, I began thinking what kind of bakery item I’d be selecting for my freebie. When I placed my order at the counter for a tall-low-fat-mocha-no-whip and a slice of coffee cake, I flashed my bandaged arm at the barista and told her I’d just given blood. The point was to communicate that I shouldn’t be charged for my order but apparently the counter people hadn’t been told how this worked so she rang me up for $5.57. I got the confusion straightened out easily enough, but the embarrassment I endured for those few seconds when she thought I was just showing off my bandage to impress her lingered longer than it should have.

Now if I could’ve shown her my vein, that would’ve been a different story.

I beg (urp) your pardon (achoo!)

I wrote not too long ago about my annoyance with the social convention that demands a verbal response from bystanders when someone sneezes. Just as we properly fail to comment when our friends and coworkers make other kinds of unprompted nasal or oral outbursts -- like snorting or saying “hi” -- so too should we mind our own business for the sneeze.

The most common response always seemed a little presumptuous to me anyway. “God bless” sounds too much like an order to the deity. He’s supposed to stop whatever grand enterprise He might be involved in so He can heed your command to bless Bob from accounting simply because he (Bob) had an irritation of the nasal passage that caused a sudden, forceful expulsion of air and God knows what else? Even the most focused of us has to concentrate when creating worlds or smiting errant Methodists; we don’t need to be distracted by requests for trivial blessings, especially when we all know that Bob makes it louder than he has to just because he craves attention.

Saying “God bless” is second nature to many of us, yet would other cultures similarly demand their gods do such casual bidding? Can you imagine hearing “Shiva, hand me that stapler,” or “Yahweh, tell that guy to knock off the humming”? I don’t think so.

If we’re all going to agree that spontaneous eruptions from the mouth or nose need some kind of acknowledgment, let’s at least be consistent and come up with some standards that make a little bit of sense. I think I’m as competent as anyone to start the discussion.

For sneezing, I proposed we switch over completely to the more secular “Gesundheit.” I believe that translates from the German to “good health,” which is probably too late to hope for if the cold germs are already in the trachea but seems like a nice sentiment anyway.

For coughing, I think we should say “Schadenfreude.” Again, turning to the Germanic tradition feels appropriate and, since the translation has to do with taking delight in the failure of others more successful than you, a certain bitterness is properly communicated.

For hiccupping, I would suggest something along the lines of “Sorry you’ve had a convulsive gasp caused by the involuntary contraction of the diaphragm. Let’s agree that it won’t happen again.”

For burping, let’s go with “Jacksonian democracy.” Admittedly it makes no sense, but it should at least prompt a change of subject to 19th century American history. I think we also need to acknowledge the pause in conversation you’ll sometimes detect when someone just barely manages to suppress a burp. Your boss says “I really think that in order to cut costs further we’re going to have to (pause, slight puffing of jowls and slight lowering of jaw) lay off our entire workforce and outsource our production to Chimp Haven, the retirement home for lab monkeys” and you’re thinking “Wow, that was a close one; I should probably say something.” That something should be “jubilee.”

For yawning, no response should be required unless the yawn is accompanied by an audible sound. If it is, let me propose either “need a nap?” or the equally appropriate “please close your mouth as soon as possible.”

For throat clearing, keep in mind that this is usually done as a preface to an interruption, so a good reply might be “what the hell do you want?” If instead, a true backup of phlegm was actually involved and the “ahem” was sincere, say nothing but instead evacuate the area immediately.

For chewing gum in such an insistent manner as to cause a cracking sound, we should say (into the nearest 911-enabled telephone) “The nature of my emergency is that my friend has apparently swallowed Bubble Wrap.”

For sniffing or sniffling, like when you’re try to get air through a slightly congested sinus, I’m tempted to suggest the caustic “Oh, boo-hoo, what a baby” but that seems a little harsh, even to me. I think I’ll recommend tactful silence unless – and this is a very important exception – the sniff is accompanied by a high-pitched tweet, which should prompt the response “There seems to be a bird in your nose; let’s join together to kill it.”

Nose-blowing, even the most subtle variety, is an abomination that I can’t believe is sanctioned in polite company. Considering that it’s far less spontaneous than other expulsions – the blower even premeditates (if we’re lucky) his or her move by producing a hanky – it should not be tolerated, much less tacitly endorsed with a friendly comment. Nose-blowing should only be done under the care of a healthcare professional on an in-patient basis at the nearest major medical center, or at least not in the same room as me.

Horking, mostly done by cats trying to expel a hairball though occasionally heard from elderly gentlemen, should be met with the Spanish phrase “se me olvido me cuaderno,” or, literally, “I forgot my notebook.”

I think I’ve provided an adequate framework for the transition from our current methods of recognizing these outbursts to something much more fair and equitable. I realize that there may be some categories I haven’t covered, in particular those hybrid explosions that combine two or more of the above-defined events: the sneef (sneeze + cough), the curp (cough + burp), the york (yawn + hork) and the never-documented but often-theorized snickup (sniffle + hiccup). But I can’t both create and manage this new system, and will have to rely on the good sense of average citizens to take it to the next level if that’s what’s needed.

I don’t want to appoint a Language Czar to oversee my plans though, if necessary, I understand George W. Bush may soon be available.

Don't forget to get Alzheimer's

Like many people approaching late middle-age, I’m starting to have some concerns about my memory. I’m not sure where on the continuum from a few “senior moments” to full-blown Alzheimer’s I might be, and even if a neurologist could pinpoint it, I wouldn’t be able to remember what he said.

It’s that short-term memory that I seem to be having the most trouble with these days. I guess this is something everyone struggles with to an extent; even the twenty-ish cashier who I just paid for my tea had notes scribbled all over the back of her hands, including a scrawl that looked suspiciously like “kill.” (You’d think a chore that life-altering would tend to stick with you, but maybe she’s got a lot of holiday-related obligations -- parties, cards, gifts for the nephews, etc. -- on her mind.)

Now that I think of it though, my mid-term memory is also suffering. I recently made a list of all the places we’ve gone on vacations over the years so I wouldn’t forget the tremendous time we had in Montreal or that great walk along Fisherman’s Wharf in San Francisco. My wife would suggest that if these events were so memorable, then I’d remember them, and I suppose she has a point. But I did shoot photographs and took video on both of these trips, so why should have to waste cranial storage space when I can just as easily root around in the dusty bags stashed in the top of the coat closet to recall such precious times?

What tends to be most bothersome to family members, and I’ve heard this is a symptom I share with the most desperately neuron-deficient, is that my long-term memory remains quite good. The problem is that it’s not important lifetime milestones like weddings and births that I remember with such clarity. I do vaguely recollect that my wife had some sort of child a while back, and I’m pretty sure it was a boy because that’s what we have walking around the house now 17 years later. But the details of that event are roughly equivalent to my recall of the ’63 Dodgers and the record-setting 104 steals made by Maury Wills on their way to the World Series. The emergence of a living being who represents my own flesh and blood from the womb of my beloved life partner is a truly magical experience but, c’mon… 104 stolen bases in one season?

What worries me is that it’s neither long- nor medium-term memory that allows you to get through the day in some sort of organized, survivable fashion. It’s the immediate stuff that’s most important to daily life. I can’t imagine arriving at the airport having forgotten my passport and yet getting a reprieve from the screeners because I can remember the actress who played Granny on “The Beverly Hillbillies” (Irene Ryan).

For just one example, with this being the Christmas season, I am expected to remember hints dropped by loved ones about the type of gifts that would be most dear to them. I barely even realize that it’s the most wonderful time of year until we’ve run out of Thanksgiving leftovers, and that still hasn’t happened yet. My wife and son already have an estimated four presents either in-hand or on-order for me, and I’ve yet to visit a single retail website (unless you can count ESPN.com). I think Beth said she wants an iPod or socks or tea, or something in that general area. But these kinds of things come in such a huge variety of options these days that it’s very challenging to pick out exactly the correct item. Beth has kindly promised to get me to the website of choice this weekend and position the cursor directly on the gift she wants, then turn away as I click so that there’ll be at least some element of surprise.

It’s exactly this kind of immediacy that enables me to function with some measure of decency. I’ve borrowed a term from modern manufacturing techniques to give credibility to the technique I’ve developed. Called “Just in Time” – for the idea that you don’t build something until right before someone wants it – I want to learn what I need to know just before I need to know it. Don’t tell me several weeks in advance that my mom’s birthday is coming up. I need to know at the very last minute so I can spend three times the necessary amount on rush postage and still be two days late.

Aside from occasions like gift-giving and breaking the heart of my dear mother, the other major handicap I’m learning to live with has to do with following directions to get from one location to another. Visiting my son’s high school the other day, I asked at the main office to be directed to a particular room number. I was told go out this door, turn right, go down the hall and through the double doors, walk across the open area to building E and take the first hall to the right all the way to the end. I moved my head up and down and put the most understanding look I could summon on my face as the sounds being made by the secretary in front of me went whizzing by my head. It was at this point that I wished I’d put a Garmin GPS on my Christmas gift list.

There is one major benefit to a severely deficient memory, and that comes while watching television. I can’t tell a first-run TV show from a rerun even if it stars Bernie Mac, Heath Ledger and Pope John Paul II. I can blissfully sit through every episode of “Seinfeld” or “The Office” that I’ve ever seen and enjoy the jokes like I’m hearing them for the first time. This annoys my wife to no end, since she has the memory of a wolverine and can recite dialog from foreign films she hasn’t seen for years, and do it in French. Plot twists already known to millions hit me out of left field, like an errant throw from Orlando Cepeda trying to gun down the speedy Wills on his record-breaking dash for third base.

I’m just hoping to hang on till retirement, when I can while away my remaining days, remembering to drool now and then but not much else.