Archive for November, 2010

Road Trip 10: Indiana, erudition, and memories of academic dishonesty

November 30, 2010

You see, I’m not in a hurry.

As we lunched on a very fine curry,

    Conversation won’t fail

    With an old friend from Yale

And erudition flew in a flurry.

I sat in the library in Bloomington, Indiana and studied, not for the first time.

My prestigious degree received in 1972 came with no marketable skill set.  In the days of low employment and stagflation, I had no concrete plans for employment after graduation.  At a particular point I found myself in Columbus, Indiana, with my best friend from high school and his wife.  In graduate school at the time and similarly impoverished, he had taken to writing papers for a paper writing service.

Nowadays one can go online and download a paper on almost any topic.  In those days if the deadline approached too rapidly you could go to the service, give them the assignment and have your essay delivered in three to five days.  Those who planned to not plan could ask for their paper two weeks ahead of time and save money.

I ignored the issues of intellectual honesty, to my regret.  I couldn’t pretend I didn’t know that the essays I wrote were being used for academic credit.

I had very few choices at that time (I would have considered McDonald’s but the PhD’s had that market sewed up).  Still, it was cheating.

On the other hand, I got paid for doing the same work I had paid to do. 

My papers did well; I never wrote anything less than an A paper, and I learned a lot in the process.  I fell into a rhythm: get the assignment, go to the library, read, take notes, go back to Columbus, Indiana, write a rough draft by hand, go to sleep; then get up the next morning, and type the final draft and deliver it in Bloomington.

Some of the assignments were literary.   I read books I otherwise wouldn’t have read, like The Outsider (at the time there were nineteen books in print with that title so I’m not giving any identifying information out).  Strangely, I never got a request for a Spanish assignment. 

I learned a lot about pollution control and the Gary steel mills; wet scrubber technology has been available since 1963.

This time I read the Advanced Trauma Life Support textbook, getting ready for the course this weekend.  The money I’m paying for the course is a capital investment with a very good cost:benefit ratio.

This time I was in Bloomington because I was visiting Amoret and Scott in Columbus, Indiana.

Amoret and I go back to our Yale days.  One December she joined me for the hitchhike west; in Kansas we got the ultimate ride in a converted school bus.

She works in Bloomington now and lives in Columbus. 

At lunch, the three of us met at an Indian restaurant.  Over curry, naan, and saag paneer, we talked about marginal cost benefit, granitic and basaltic volcanoes, Frank Lloyd Wright, Stratfordian theories of Shakespeare, Rommel and the Valkyrie conspiracy to kill Hitler in WWII, J. Edgar Hoover, and the history of the Mannlicher-Carcano 6.5 mm bolt-action rifle, among others. 

I love having friends I can talk to like that.

Road Trip 9: West Virginia, love, grief, and mortality

November 28, 2010

I went out to visit my niece,

Grateful I’d brought along fleece

     It started to snow

    As we heard, don’t you know,

The honking of south-flying geese.

I’m visiting my niece and her three children, five-year-old twins and a three-year-old singleton, in West Virginia.  The house sits on thirty acres with five distinct ecologic zones; fossil ammonites decorate the kitchen floor.

I like children, and I had the chance to play with them.   I did yoyo tricks and I tried to teach them how to flare their nostrils and make other faces.  After supper I played with the kids some more and told them stories and sang them songs at bedtime.

 We talked a lot about dinosaurs.  Well-versed at an early age on the fine points of fossil creatures, they don’t shy from words with six or seven syllables.

As an undergraduate I worked at the Yale Peabody Museum of Natural History, separating bone from stone with a microscopic sandblaster called an AirDent.   I worked the most with Deinonychus inflexus, a carnivorous dinosaur that hunted in packs.  This reptile received a lot of publicity in the years after the movie and book Jurassic Park.  My great-niece brought up a picture of a bipedal dinosaur with a tail projecting straight back.  I asked her if it were a Deinonychus.  She looked intensely at the illustration and said, “No, it doesn’t have an uptoe.”

Portia and I share nerdliness; we enjoy geology and paleontology and can bandy about terms like Permian and ornithischian and understand each other.  Last year when I visited we went to a privately owned tourist exhibit cave to see cave orchids. 

She illustrates dinosaurs for magazines like National Geographic and Scientific American.  In 2003 she drew a picture of a four-winged feathered dinosaur.  A music group picked up her art work and did a song about her; we found it on the web and listened to it.  I had no idea.

I told her about my current career hiatus and the people I’ve connected with on this road trip and the things that I’ve done, including going to my mother-in-law’s headstone unveiling yesterday.

I loved my mother-in-law, and I grieved for her when she died.  Easy to love without ambivalence, more than a hundred people came to the cemetery on a Friday in windy, cloudy, rainy weather.  My brother-in-law did a great job leading the service. 

My father-in-law, widowed after sixty-one years of marriage, misses his wife, and stands as an example of marital loyalty.

My niece listened patiently while I held forth my theories on gender and the human condition.

Certain closely linked realities transcend deniability: mortality, human love, and grief.  We wouldn’t grieve if we didn’t love, we wouldn’t love if we were immortal.  All people carry imperfections, we can improve the imperfect world but we can’t perfect it. 

Outside, the first snow began to fall.  Winter approaches quickly, I’m on my way to my next assignment.

Roadtrip 8: Thanksgiving in Virginia, waking hypnosis and suggestibility of drunks

November 25, 2010

I tried for cooperation

In a man with inebriation

    Not out of the question

   With waking suggestion

He thought he was out on vacation.

More than thirty years ago, as a medical student I did a month rotation at a remote location in a western state.  I got help and supervision when I asked for it, but I took my share of call.  One evening an inebriated man came in after a knife fight with a number of cuts on his face.  For the sake of the story, I’ll call him Paul, because he didn’t go by that name. 

At the time, instantaneous breath alcohol level testing remained in the realm of science fiction, so I can’t quantify his level of drunkenness.  But the amount of alcohol he’d ingested prevented him from remembering three things for five minutes.  He didn’t want to cooperate, and even if he’d wanted to, he forgot instructions in half that time.

Pharmacology taught us that alcohol makes a person more suggestible.  The third time I asked him not to pull the surgical drape off, I pushed back and I said, “Paul, you look pretty tired to me.  Are you feeling tired?  You look like you might need to take a nap.  Would you like to take a nap?  It’s OK, if you want to just lay back.  We have a really comfortable bed right here.  Go ahead, take a nap.”  His eyes shut as he lay back abruptly and started to snore.  Two or three minutes later he tried to sit up and fight, and I repeated myself.  Sometimes I told him he’d forgotten his head was glued to the pillow.  (I can still remember the lacerations: two on the forehead, one on the left cheek, one on the upper lip, and two on the scalp.)  It took me an hour and a half; I compared the process to trying to tattoo the Mona Lisa on the back of a running buffalo.

I had never tried waking suggestion or hypnosis before, my first try succeeded beyond my expectations.  I’ve told the tale many times since.  It’s a good story, appropriate for medical and non-medical audiences; I use body language to show myself a callow medical student, and I use the tonal nuance of my voice to demonstrate how I felt when I believed in a principle but lacked experience.

The family gathering for Thanksgiving in Virginia included (among others) my daughter Jesse, currently in her second year of family practice residency.  As we finished turkey, gravy (see yesterday’s post), mashed potatoes and stuffing, she told about using waking hypnosis on an intoxicated, combative patient to render him cooperative so she could sew up facial cuts.  Three minutes after she finished, the patient started fighting and busting the joint up. 

We slapped high fives for the joys of waking hypnosis.

In the age of the internet, connectivity, and information retrieval, the story remains the quantum unit of teaching.

Road trip 7: Making gravy in Manassas, Virginia

November 24, 2010

I don’t care what you have heard

On this I can give you my word

     Gravy I made

     With flavor first grade

From the broth of the Thanksgiving bird 

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  While my one-year non-compete clause ticks off I’m having adventures.  I’ve worked in Barrow, Alaska and Grand Island, Nebraska.  Currently I’m on a road trip from western Iowa to eastern Iowa by way of New York and Virginia.   

During my residency my friend, Les, now an FP in Anchorage, (see my posts from August) told me that a good broth would make a good sauce better than good drippings.  In one sentence, he brought my cooking a quantum leap forward.

To make turkey gravy, start simmering the giblets in 3 cups water in a covered sauce pan at the same time you start roasting the turkey.  Check the giblets from time to time, adding water as necessary.  You should finish with 2 cups of broth.  When the turkey is done, so are the giblets.  Add the drippings from the bottom of the pan to the giblets broth, and skim the fat if you want to.  Thicken with cornstarch:  add ½ cup cold water, wine or apple cider to ½ cup cornstarch (don’t try to add cornstarch to liquid, you’ll get frustrated), stir that mixture into the broth/drippings, and gradually bring it to a boil while stirring constantly.  The mixture will thicken suddenly.  You get lumps by adding cornstarch when to liquid too close to boiling, trying to warm it too quickly, or adding extra cornstarch after it has thickened.

I add a teaspoon or two of soy sauce.  Variations can include garlic, curry powder, ginger, lemon, basil, cilantro, you get the picture.  If you add an herb, don’t over do it.

But here in Manassas I made gravy without drippings.

No problem.

Once, decades ago I set out to make broth and got distracted.  I didn’t add water, and when I came back the broth had boiled away to glue and then the glue had started to brown.  Such accidents had happened before, but this time I stopped the process before the product burned.  I added water and tasted the accidentally delicious result.  I had succeeded in synthesizing drippings.

I put half the broth from the turkey giblets into a fry pan and reduced it over high heat till glue-like bubbles started to form, then turned down the heat and watched the color slowly turn to brown.  I added the rest of the broth, deglazing the pan, and thickened it with cornstarch.

The resulting gravy has almost no fat. 

During my poverty days I learned to make broth from whatever bones remained from whatever animal or bird had graced my table, a rare occurrence at the time.  Chicken or turkey giblets serve the function as well.  Put the bones in the slow cooker when you leave in the morning and when you return the broth will be ready. 

Or, after the Thanksgiving feast, separate turkey meat from bones, put the carcass into the slow cooker, and when you get up in the morning you’ll have broth ready to be frozen or turned into gravy, perfect for topping hot turkey sandwiches.

If you need calcium supplementation, add a cup of white vinegar to the pot where the bones boil.  The finished broth will contain the calcium but the vinegar flavor will have boiled off.

Roadtrip 6: Manhattan to Long Island

November 23, 2010

I came to my first cousin’s door,

We discussed the effects of the war

     Our parents give us a script

     Which we can edit and clip        

And make the good moments more.

I visited my only first cousin and her family on Long Island.

The drive out of New York frightened me.  Tall building blocked satellite signals, rendering my GPS useless till I got out of the city.  I’m used to low traffic flow, courteous drivers, and uncrowded roads.  I stick to speed limits and I get nervous when I have to speed to survive.

Once out of the city and on Long Island, traffic became bearable and I drove the speed limit with minimal risk.  I arrived an hour behind schedule.

I did yoyo tricks for the two children, my first cousins once removed, and I taught the nine-year-old the basics of yoyo play:  the basic throw comes from the shoulder and ends palm up. 

Over dinner, take-out Chinese,  we talked about my father’s war experience.

Few people remember that before D-Day, the Allies invaded southern France. 

My father volunteered for the Army in 1942; he joined the Texas 36th from a Replacement Depot (“Repple Depple”) in Oran in North Africa.  He invaded Palermo under General Mark Clark; they fought north through Italy and in the spring of 1944 his unit transferred to southern France.  From there he saw action into the Alsace-Lorraine.  Captured by Germans during the Battle of the Bulge, he survived because he threw away the dogtags that identified his religion.  He came back to the States and married the woman he’d met at the second mixer of his freshman year.   My sister arrived in 1946 and I arrived in 1950.

My cousin and her husband listened attentively, we talked about how my father’s war experience colored the rest of his life.

Most families carry a degree of dysfunction; I recall reading that a functional family resembles Susquatch: reported but not proven.

Still, our family had more of its share of craziness.  We talked about the cycles of insomnia, isolation, depression and drug abuse and what we do to try to make the world a better place.  We’ve been in counseling off and on over the years, we shared what worked and what didn’t work. 

In the final analysis, someone can accept responsibility for only one person.  Our parents hand us a script we didn’t write but we can edit.  Everyone can find good things in their past along with bad things; the object is to make a better script with a happier ending.

I left her home in the dark, driving under the speed limit and watching for deer, thinking till I got to the other side of New York City.  I switched on The Rise and Fall of the Third Reich on my iPod. Time after time the Allies might have stopped Hitler and I have the urge to think contrafactually, but I would not have been conceived if the war had been different.  In the end I want to live.

Road Trip 5: Dinner in Manhattan

November 23, 2010

The hypothesis might seem to be nil

By now we all know the drill

     The truth that we saw

     Is old Murphy’s Law.

If a thing can go wrong, then it will

After an afternoon of IKEA assembly with my brother, we went out to dinner in Manhattan with his girlfriend, two of our sisters, and their mates. 

I told stories about Alaska; I tried to explain a very different world.  People would starve without whale hunting there; no roads lead into or out of Barrow.  Every household has firearms because sometimes polar bears come to town looking to snack on people.  People hunt for food most of the summer.  No paved streets, very little theft, a pedestrian accessible airport, no fast food or Starbucks.   Barrow cannot differ more from New York.

My brother talked with passion about his work in illustration and advancing his education as an artist.  My sister, Rebecca, told us about her work in psychology.  My sister, Marcia, showed us some of her work from painting class. 

After a while, we got my brother-in-law, Steve, to talk about economics and the stock market. 

I do not understand the things that Steve does with money, except to appreciate the complexity of an esoteric discipline.  He told us about the Flash Crash.

This year in May, the stock market behaved irrationally; some stocks went to zero, others went extremely high.  The ten-minute event brought ruin to some who had been financially secure.  Steve said that the usual brake that prevents such things, a human being reviewing a trade, went missing under new trading rules from the FTC; transactions come as close to instantaneous as rules of physics allow.

Steve explained exactly how it happened, and what the FTC hasn’t figured out, but I didn’t follow the discussion, due to ambient noise, poor hearing, and lack of understanding of how the stock market works.   

We concluded that nothing substitutes for human judgment, and even an extremely unlikely event will eventually happen.

Another way of stating Murphy’s Law:  If anything can go wrong, it will.

All of us agreed that market or price prediction comes easily to Warren Buffet and to no one else. 

But we kept coming back to the idea that unlikely events eventually happen.  The more we find out about the Cuban missile crisis the narrower our margin of escape becomes.  Boris Yeltsin failed to launch nuclear missiles despite a radar shadow from a US launch of a peaceful project. 

I recounted a beautiful morning in 1971.  As the training supervisor at WYBC in New Haven I had ignored the repeated alarm bells from the teletype machine, saying “Either it’s a mistake or it’s the end of the world,” and making the radio trainees laugh.  Forty-five minutes later, during a break, I ripped the yellow paper from the chattering machine.  I removed the envelope, containing the monthly update authenticator code, from the bulletin board, and opened it.  I brought both pieces of paper into the control room and announced the end of the world.

The message had been sent by mistake.

The authenticator code was HATEFULNESS/HATEFULNESS.

Roadtrip 4: Pittsburgh to New York

November 22, 2010

I drove rather fast down the Pike

It’s not a pace that I like

     But fixing the mirror

     Made it two hours dearer

Still a six hour hike.

After a night on Burdette’s couch in Pittsburgh, we chatted while she got ready for the job she calls a dead-end.  She made herself a peanut butter and jelly sandwich. 

Her mother, Nancy, bathed us together when we were toddlers, and made my mother laugh when they lived close together.  Her father, Pierce, had a great sense of humor and a wonderful intellect.  When I grew up I re-established contact between the families.  I had great fun with the lot of them.

I didn’t see the dysfunction, the alcoholism and bipolarity. 

After I finished college I lost contact with them, and the tragic deaths struck one after another without my knowledge.

My missing left mirror and the narrow, crowded alley complicated backing out; Burdette had to direct me.

I drove winding streets in neighborhoods screaming for paint and re-roofing, narrow blue-collar houses rubbing shoulders against a backdrop of spectacular geology.

The brunt of traffic bypasses streets with nicer homes.  Burdette grew up in a fine old house; it brought me comfort and shelter in my college years when I hitchhiked from Connecticut to Colorado. 

At the dealership I struck up a conversation with the young woman at the service counter when she observed how happy I seemed.  I gave her my card and told her to check my blog.

Two hours later, my mirror replaced, I checked out.  In the waiting area, in front of an audience, the young woman showed me a rash she’d had for a while, getting worse despite use high-powered meds.

Raised, flaking borders on flat, rounded lesions about the side of a nickel: skin fungus (ringworm) most likely, after that nummular eczema, other diagnoses possible.

It doesn’t take 27 years of formal education to figure out that if something doesn’t work you need to try something else.

I would have told her to get TSH and Vitamin D levels checked, try over the counter Cortaid and/or Eucerin, or even consider using an OTC antifungal like Lotrimin, but that would have constituted practicing medicine without a license in Pennsylvania. 

Still I enjoyed the time I spent talking to her.

When I plugged the address for my dinner date into my GPS, I realized I miscalculated my time frame.  I called my brother.  What time did we expect to meet for our sister’s birthday?  If I hurried, if there were no traffic, I’d barely make it in time. 

So for the first time in months I rushed. 

Digestive problems forced a stop after five hours, and I reexamined my motivation to be punctual.  I searched for loperamide and decided that I just wouldn’t arrive in time.  I called my brother and apologized.

Slowing down had relieved my gut problems and food intolerances, rushing brought them back.

As I inched through the glacial Holland Tunnel congestion, glad that I’d had the sense to quit hurrying an hour before, I wished I’d done so hours before that. 

I arrived a half-hour after my brother and sister and their mates, but dinner continued for two hours, one dish at a time, talking between courses.  All of us have passion for our work and love our jobs.  I gave my thoughts on Obamacare.

We reviewed the meal over sorbet and agreed that the star had been a seared black rock fish.

As we left the upscale Japanese restaurant I thought about my morning.  

Contrast is the essence of meaning.

Road Trip 2: Chicago

November 19, 2010

My daughter’s the third generation

She’s had enough education

     To make a diagnosis

     Infer a prognosis

And legally prescribe medication

My father did two years of medical school at University of Missouri and transferred to Harvard.  His Barnes internship gave him one day a month off.  He finished residency in Pittsburgh, and when I was six we landed in Denver for his American Heart Fellowship; he went into cardiology. 

I wrestled with my career choice for years but, unlike my father, I didn’t battle racist admissions policies. Family practice internship and residency meant a mere 100 hours per week.

My daughter, Jesse, a third generation physician, didn’t hesitate to choose medicine.  She had to learn a great deal more during her med school years than either her father or grandfather.  Halfway through residency now, in theory her work week stops at 80 hours (reality differs).

I stopped to see her in Chicago to visit her after an easy day’s drive.

She looks good; she carries herself with confidence and personal strength.  We had a great time talking about cases and patients and the meaning of medicine in the larger scheme of things. 

Nostalgia can lead one to a quagmire; in medicine it risks a journey to a swamp at a toxic waste dump.  Medical care now beats any medical care of the past.  Even if the hours look shorter, medical education get more difficult every year because every year the body of knowledge expands.

I hope but can’t prove that doctors who work sustainable hours will function as doctors more years than ones who don’t.

Society, the world, and medicine have changed since my father carried his microscope into the histology lab in 1948.  I had that microscope refurbished in 1975.  A fun toy, but microscopy skills add little to a practicing physician’s ability to take care of patients. 

We talked about cases and the front-line reality of life.  Every disease carries a human cost and the impact ripples outwards from the patient to the family and the workplace and the society.

She told me about syphilis’s resurgence in Chicago.  I told her how it always started with a chancre (a soft ulcer at the site of infection) when I began med school, but ten years later it rarely did.  She talked about her disappointment at the delivery she had attended the day before, when the breech presentation necessitated C-section.  I observed that when I started private practice in ’87 we sometimes delivered breech babies vaginally (and got some pretty beat-up babies) but by 1989 we’d stopped.

If medical office paperwork doesn’t flow functionally, it will flow dysfunctionally, I told her; this I have learned on my walkabout.  

Her ten-doctor office runs with one nurse and five Medical Assistants, which amazed me.

We went out to eat with her boyfriend (also a Family Practice resident); over Pad Thai and sashimi I got to tell stories about bring up my daughters, liberally sprinkled with observations about thyroid disease and vitamin D.  I watched vigilance exact its toll while he ate, and his OB patient labored; he kept waiting for his beeper to go off.

Doctors will always pay a price for being doctors, tradeoffs are inevitable.

Road Trip 3: Pittsburgh

November 18, 2010

The friend I’ve had longest, Burdette,

Was easy to find on the net.

     We’re not shedding tears

     After thirty-three years,

We’re living the moments we get.

I came to Pittsburgh to see the friend I’ve known the longest.

In the prefabs of post-War University of Chicago, two women sized each other up while hanging out their wash.  One, my mother, couldn’t think of anything else to-day, and said, “My husband went to Harvard.”  The other, Nancy, said, “Really?  My husband went to Yale.”  They stalked into their homes but the next day they took in their wash and became best friends.  Their two husbands moved to Pittsburgh for different reasons; the women stayed friends for years and bathed their children together.  They corresponded even after we moved to Denver.  When they got together over the years they would laugh and talk so hard their jaws ached.

When I was in my late teens and hitchhiking between Yale and Denver I stopped in Pittsburgh to visit Nancy, her husband Pierce, their daughters Burdette (with whom I bathed as a toddler) and Lisa and their son Eben.  I found everyone in the home easy to like, generous to a fault and fun; warmth and welcome filled the house.

While in med school, I stopped to visit on my way to my Yale reunion; I hadn’t been back since.  I hadn’t called for five years.

Despite a thirty-three year absence, Burdette’s unique name came easily on the Internet.

I drove into Pittsburgh at night.  I recognized bridges that I used to see on my way to kindergarten.  The steel mills are gone, the air is cleaner.

Jonas Salk worked on his vaccine here while I went to kindergarten; because my father was in his internal medicine residency then, I received the immunization before the release date.  My parents had no wish to repeat the horror of my sister’s polio.

I can’t say I blame them.

I got to meet Burdette’s daughter, Amy, and I got to see pictures of Burdette’s son’s child and hear about the joys of being a grandparent.

Burdette and I talked about the times I visited during my college years; she doesn’t remember our early childhood times together.

Neither of us have living parents; we talked about how they died.  I asked after her brother, now deceased.  We have known each other so long that the truth is all we tell each other.

Together we have come to the same conclusions by different routes. 

Time comes in moments.  You get better days if you focus on the good moments, get over the bad moments as soon as you can and don’t revisit them;  don’t think about bad moments that haven’t even happened.

Some people die of old age, some die of the effects of diseases they didn’t have a choice about.  More die of broken hearts, bitterness, amorality, and over-indulgence, no matter what the death certificate says.

Roadtrip I: Iowa City, my daughters’ friend, Indian food.

November 15, 2010

This trip is still out to the jury

I said while eating my curry.

    My life isn’t narrow

    Since I got back from Barrow

I’m traveling but not in a hurry.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  I’m slowing down so I don’t burn out.  I’m honoring my one-year, thirty-mile noncompete clause and having a lot of adventures; so far I’ve been to Alaska, Massachusetts, San Diego, and Grand Island, Nebraska. 

I’m off on a road trip; I”ve not had time for one since 1975, the year I started med school

I took the summer off that year and rode my bicycle from Denver to San Diego.  Back then I had hearing so keen I could hear the bats at the South Rim of the Grand Canyon.  On that trip I rode from twenty miles north of Prescott, Arizona to Blythe, California, 184, miles in twenty hours.  I made the trip in ten days and didn’t hurry.  After dropping off the Mogollon rim to Yarnell, Arizona at sunset I pedaled through the Chocolate Mountains without dropping out of high gear.  No traffic, no wind, no major hills, no mechanical problems, nighttime temperature about seventy degrees, averaged twenty-three miles an hour for a hundred miles.  I had to ride on Interstate 10 for twelve miles, into Blythe, but I arrived hours ahead of schedule, and lay down in the desert with a rock for my pillow till the sun gave enough light to ride on the Interstate.

I took it easy that summer; I knew that med school would demand all my time for the next four years. I should have foreseen that residency’s hundred-hour weeks would follow right after or that I’d spend the next thirty years struggling to wring every microsecond out of every day.

I’m not rushing this year.  I packed the car this morning and drove five hours to Iowa City.  My host, Lindsey, has given me permission to give the information below. 

Her mother and grandmother babysat for my children, and I did their medical care.  In elementary school she developed a draining infection in front of her left ear; after three courses of antibiotics the drainage hadn’t resolved and I referred her to an ears-nose-throat (ENT) doctor.  Eventually, I assisted at the surgery; we removed what turned out to be a small lymph node.

The pathology report showed that it was infected with Mycobacterium avian, a cousin of tuberculosis (see yesterday’s post); we made the diagnosis of scrofula.  I have not seen another case before or since.

Lindsey grew up and married and works in the lab at the VA hospital in Iowa City.  Even though I know where to look for the scar from the surgery I have trouble finding it; the ENT did a really bang up job.  Our families have stayed close enough through the years that all three of my daughters were in her wedding. 

Over great Indian food in Iowa City she and her husband Jeff and I talked about whaling and Nalukaataaq injuries, alcoholism and seasonal affective disorder, our families with their joys and imperfections.