November 13, 2009

Moby Me ?: Tale of a Liver Biopsy



“He jests at scars, that never felt a wound.”

-- William Shakespeare 1564-1616: “Romeo and Juliet” (1595)


Having postponed multiple previous liver biopsy appointments designed to check the status of my liver scarring post chemotherapy, and having not had this procedure in 5 years, I decided it was time to allow the liver docs a look. In truth, I would have postponed again, had I not promised to participate in a research study.

In the fall of 07’, when I spent a lot of time at the UM Cancer Center, I had many blood draws. I rehash this here as a preface to the story I’m about to tell. The nurses who do the blood draws at the UMCC are pros. Oftentimes you can’t even tell you’ve been poked. Yesterday was different. Mind you, that which follows is small potatoes compared to the plight of some of my other ailing friends, but I’ll try to make it interesting to those of you who enjoy a bit of squeamishness. Appropriate, don’t you think, for this Friday the 13th?


So this pert little Howellite comes in, has me sign off on every possible complication. You know, the usual: collapsed lung, internal bleeding, and death. She then informs me that she, a research assistant, rather than a nurse, will be drawing my blood. As these things go, I’ve had enough experience that I’m fairly calm about these thing. So, when she misses the veins in my right arm on three tries, spraying my contaminated blood all over the room, I tell her to try my left arm. Her ineptitude now has her agitated, so she starts behaving in a way that I’m sure many of you have experienced yourselves: she tells me "I’M" not relaxed. It’s classic Freudian projection in its most typical manifestation. Switching arms, she drops the syringe on the floor, and begins to sweat while trying to make some boring small talk meant to distract attention from her obvious lack of medical skills. She tells me that she would never move from Howell (home of the Michigan KKK) because she wouldn’t want her children to grow up in a liberal Sodom and Gomorrah like Ann Arbor. All the while my criminal child, a thoroughly corrupted bubble girl from A2, is grinning like a coon. Having warned her that the veins in my left arm might require some serious digging and gouging, it was no surprise to me when she couldn’t find any blood. With this, she just gave up and said she had collected enough from the right.


After 20 minutes of needling, and multiple bloody punctures later, they wheeled me down to the MPU (Medical Procedures Unit) where the biopsy would take place. The patient is placed on their left side on a stryker frame, the right arm is extended up and behind the head, the right leg is draped over the left, the body is then stretched in a way that the torso is splayed sufficiently that the cartilage between the ribs presents the maximum surface (so that the needle might avoid piercing the bone). The insertion area, about nipple level slightly to the back of the side, is then swabbed and numbed up with lidocaine, after the fashion of a dental visit (including the short, sharp, stinging sensation on the skin’s surface), after which a 1/8 inch incision is made to accommodate the needle. The patient then takes a half breath, blows out all the way and holds (so that the lung is not punctured and thus collapsed), at which point the physician plunges the ultra-thin trocar deep into the liver and extracts the sample tissue.



Now that I’ve set the scene, allow me to introduce the players. Upon entering, I’m greeted by the attending physician, Dr. K. (I don’t think the last name was Kervorkian), a resident, Ryan something, a nurse, and the infernal health wench that botched the blood draw. Then, using a magic marker to delineate the proper target area, the attending shows the resident how to locate the optimal point of entry. So here we go.



Patiently resigning myself to bend to their will, and donning an attitude of dutiful compliance, I steel myself for the command to take a half breath, blow it out, and hold it. The order comes. I blow and hold…whump…it’s just as I remembered it, or better, a reminder of why I had been so quick to forget it. Imagine a long ice pick heated up on an electric stove burner being suddenly plunged into your gizzard. It only takes a second, but what a second. The nurse says, “breathe, it’s over.”



The attending physician walks over, looks at the core sample and says, “not enough tissue. We’ll need to do it again.” I think, “Fuck you,” and silently resolve to stop everything and have them take me to the recovery area. But I don’t. Instead I say, “what do you think I am, ‘Moby Dick’?” The attending, with almost a glare, tells me he’ll do the procedure this time. With a twisted kind of a soulless half shit-eatin’ sadistic grin he says, “blow and hold.” He then plunges the trocar deep into my liver. The millisecond of blinded by the light pain comes again and is gone. “We’ve got enough now,” he says, barely concealing his glee at harpooning an uppity patient.

By the way, he says, as I’m wheeled out, “since we had to take two samples, you’ll be here four, rather than two, hours.”


Love - Randy

November 10, 2009

Animals, Death, and Trash







“To my mind, the only possible pet is a cow. Cows love you…They will listen to your problems and never ask a thing in return. They will be your friends forever. And when you get tired of them, you can kill and eat them. Perfect.”

Bill Bryson 1951-- : “Neither Here Nor There” (1991)

ANIMALS

At Kerrytown Market there is a butcher shop, “Sparrow Meats,” that specializes in free-range, organic meats. On Sunday I stopped there and bought some Berkshire pork chops. As I sit here pondering the current events passages I’ve selected as daily writing prompts, I’m reminded of these succulent little roasts. It seems researchers found that pigs, when enclosed in pens appointed with mirrors, used the mirrors to locate and monitor their food.

This scrupulously followed routine of hoarding and guarding their food immediately reminded me of the gustatory practices followed by the Tessier family. Of the five boys in that litter, my brother, Paul, would have made the so-called “lower animals” most proud. For Paul Michael, knives and forks were used less as utensils than protective weapons. More than once did he bury his fork to the hilt in my forearm, as if that could stop me from snatching the Mrs. Paul’s fish sticks he was so zealously guarding. In our house, it was more stable manners than table manners.

Now, sophisticated and wise in my geriatric decrepitude, I take comfort in knowing that assessing my brother to be a pig may have been a compliment rather than insult, albeit unknown to me at the time. I now learn that “pigs might rank with apes, dolphins and other species that have passed the famed ‘mirror self-recognition test’ thought to be a marker of self-awareness and advanced intelligence.”

Ok, I’ll begrudgingly admit Natalie Angier’s Science Times article exonerates Paul’s behavior somewhat, but it still can’t account for the way he dismissed the mirror image of his multiple chins as a sign of his gustatory satisfaction rather than an affirmation of his vanity. Which, according to Angier, is normal, after all, “why should the pigs waste precious mirror time inspecting their teeth or straightening the hairs on their chinny-chin-chins, when they could be using the mirror as a tool to find a far prettier sight, the pig heaven that comes in a bowl?

And what a sight it was for Bro Paul. I won’t say we were poor, but one of his favorites was cheerios fried in bacon fat. In all fairness to my brohammer, his being part pig, of sorts, would explain his skills at football, herding, Nintendo, and making vaguely communicative grunts. We’ll leave the last word on this to Ms. Angier: “Pigs can do a circus’s worth of tricks: jump hoops, bow and stand, spin and make wordlike sounds on command, roll out rugs, herd sheep, close and open cages, play videogames with joysticks, and more.” Natalie Angier (NYT 11/10/09)

But enough about pigs, what about dogs? As we speak I’m listening to my message machine, it’s Detroit Edison, asking that I keep my doggie inside, lest one of their meter readers be harassed in the course of duty. Shadow don’t play that way. What an insult! This noble mastiff diagnosed my cancer, negotiated down my credit card debt, spell-checked my last published article, put in my sump-pump, cleaned my gutters, solved my unfinished crossword puzzles, and has single-pawedly eradicated my urges to kill and mutilate myself. What a dog! That’s it! I’m renaming her Sudoku!

But seriously, if they’re that afraid of Shadow they might just as well ask her to read off the numbers. Even more seriously, I would say that dogs do NOT think like us. If they did I wouldn’t own one. Dogs are loyal beyond question. Jack London’s, “To Build a Fire,” is a fine read, and probably my favorite London short story, but the subtle character judgments he attributes to the dog are more in line with the thinking of men than animals. Here’s some recent doggie chatter from the times:

“The matter of what exactly goes on in the mind of a dog is a tricky one, and until recently much of the research on canine intelligence has been met with large doses of skepticism. But over the last several years a growing body of evidence, culled from small scientific studies of dogs’ abilities to do things like detect cancer or seizures, solve complex problems (complex for a dog, anyway), and learn language suggests that they may know more than we thought they did.Their apparent ability to tune in to the needs of psychiatric patients, turning on lights for trauma victims afraid of the dark, reminding their owners to take medication and interrupting behaviors like suicide attempts and self-mutilation, for example, has lately attracted the attention of researchers. Sarah Kershaw (NYT 11/01/09).

DEATH

When Cub Koda died some years ago, Kim French and I attended the funeral. He was buried in a fine grave in the Napoleon (maybe it was Waterloo) graveyard. What was most striking about the ceremony was the informal nature of the friends and family’s interactions, and the humorous nature of the instructions Cub left us. At the climax of the ritual, just as Cub was about to be lowered into his final resting place, a boom-box was fired up, and a wig-singeing rendition of the Trashmen’s “Surfin’ Bird” (1963) served as the irreverent funeral hymn that ushered Cub into the great beyond. Papapaoommaomao….

So what’s my point? Only this. We’ve gone beyond the poems, prayers, and promises that have always served as a proper sendoff for our dead, near and dear. Nowadays we’re trending more and more towards the idea that we can somehow keep the dead alive the in our memories, dead, but not forgotten.

Writing in the 11/01/09 New York Times, Thomas G. Long reminds us that “current funeral fashions….illustrate the sad truth that, as a society, Americans are no longer sure what to do with our dead.” We can laud the deceased as much as we want, but when they’re gone they’re gone. “’A good funeral,’” says Thomas Lynch, a poet and undertaker in Milford, Mich., ‘is one that gets the dead where they need to go and the living where they need to be.’

Here’s more from Long:

“Rituals of death rest on the basic need, recognized by all societies, to remove the bodies of the dead from among the living. A corpse must be taken fairly quickly from here, the place of death, to somewhere else. But no healthy society has ever treated this as a perfunctory task, a matter of mere disposal. Indeed, from the beginning, humans have used poetry, song and prayer to describe the journey of the dead from “here” to “there” in symbolic, even sacred, terms. The dead are not simply being carted to the pit, the fire or the river; they are traveling toward the next world or the Mystery or the Great Beyond or heaven or the communion of the saints.

….Today, however, our death rituals have become downsized, inwardly directed, static and, as a result, spiritually and culturally impoverished. We tend now to recognize our dead only for their partial passions and whims. They were Mets fans, good for laughs at the office, pleasant companions on the links. At upbeat, open-mike “celebrations of life,” former coaches, neighbors and relatives amuse us with stories and naïvely declare that the dead, who are usually nowhere to be seen and have nowhere to go, will nevertheless live always in our memories. Funerals, which once made confident public pilgrimage through town to the graveyard, now tread lightly across the tiny tableau of our psyches.

….A corpse is a stark reminder that human beings are inescapably embodied creatures, and that a life is the sum of what has been performed and spoken by the body — a mixture of promises made and broken, deeds done and undone, joys evoked and pain inflicted. When we lift the heavy weight of the coffin and carry the dead over the tile floor of the crematory or across the muddy cemetery to the open grave, we bear public witness that this was a person with a whole and embodied life, one that, even in its ambiguity and brokenness, mattered and had substance. To carry the dead all the way to the place of farewell also acknowledges the reality that they are leaving us now, that they eventually will depart even from our frail communal memory as they travel on to whatever lies beyond.

‘Show me the manner in which a nation cares for its dead, and I will measure with mathematical exactness the tender mercies of its people,’ William Gladstone, the British statesman, is said to have observed. Indeed, we will be healthier as a society when we do not need to pretend that the dead have been transformed into beautiful memory pictures, Facebook pages or costume jewelry, but can instead honor them by carrying their bodies with sad but reverent hope to the place of farewell. People who have learned how to care tenderly for the bodies of the dead are almost surely people who also know how to show mercy to the bodies of the living.”

Thomas G. Long, a professor at the Candler School of Theology at Emory University, is the author of “Accompany Them With Singing: The Christian Funeral.”

Since I mentioned Jung’s speculations about the afterlife in my last post, I would be remiss to not include an excerpt from Edward Rothstein’s splendid obituary of Claude Lévi-Strauss’ in the 11/04/09 NYTimes:

“His monumental work “Mythologiques” may even ensure his legacy, as a creator of mythologies if not their explicator. The final volume ends by suggesting that the logic of mythology is so powerful that myths almost have a life independent from the peoples who tell them. In his view, myths speak through the medium of humanity and become, in turn, the tools with which humanity comes to terms with the world’s greatest mystery: the possibility of not being, the burden of mortality.”

TRASH

Think about it, a floating dump twice the size of Texas!

“ABOARD THE ALGUITA, 1,000 miles northeast of Hawaii — In this remote patch of the Pacific Ocean, hundreds of miles from any national boundary, the detritus of human life is collecting in a swirling current so large that it defies precise measurement.

Light bulbs, bottle caps, toothbrushes, Popsicle sticks and tiny pieces of plastic, each the size of a grain of rice, inhabit the Pacific garbage patch, an area of widely dispersed trash that doubles in size every decade and is now believed to be roughly twice the size of Texas. But one research organization estimates that the garbage now actually pervades the Pacific, though most of it is caught in what oceanographers call a gyre like this one — an area of heavy currents and slack winds that keep the trash swirling in a giant whirlpool.

Scientists say the garbage patch is just one of five that may be caught in giant gyres scattered around the world’s oceans. Abandoned fishing gear like buoys, fishing line and nets account for some of the waste, but other items come from land after washing into storm drains and out to sea.”

Lindsey Hoshaw NYT 11/10/09