Friday, 20 July 2018

The Ex-Doctors Dilemma. Pt 2.

   So, the next morning, (see previous post if this needs explanation), I started off at Pen Club.  The London, Ontario, Pen Club is a rather remarkable club.  Its only rule is that there are no rules and that any attempt to introduce them will immediately result in expulsion from  the club.   So far there have been no expulsions.   Since we meet every Saturday morning without exception unless Christmas day falls on a Saturday morning (even Yom Kippur does not qualify  in cancelling a meeting!), there is usually adequate time to philosophize and  solve the world's  problems after the Pen  discussions.   In fact, I  have suggested on many occasions that we should extend  our title to 'The London Pen Club and Philosophical Society'.   None of the other members of the club seemed enthusiastic about that,so we left things as they were.   Nevertheless,  I continue  to regard the club as my 'ex-doctor medical lab' and listen to the comments, complaints and sometimes praise of the health  care system.
   A couple  of weeks ago one of my club co-members and friend, whom I will call PC2 was concerned about having an angiography and stent placement.
   " You've had that done, how was it?"he said to me.
   " I wrote a piece in the "Medical Letter" describing it in  what I hope was as humorous a way as one can.  I'll post it in my blog or re-write it  for  you." 
      I did and I hope it brought him a little enlightenment and humour.
    In  the meantime he'd had and survived the procedure and felt better now  that the stent was in place..  We discussed details.   My stent has lasted ten years.  Then we discussed pens because PC2 knows more about Pens than I ever knew about stents!
     
   That evening, I received a call from a relative, we'll call her FM3.  Shortly into our conversation she asked me,  "What do you think of this whole Valsarten issue?"
   Me: "What  Valsarten issue?"  
   Valsarten is a blood pressure and cardiac medcation.  It was even around when I was practicing full-time and considered an effective medication as it is today.
   FM3: "Some batches of it have been found to cause cancer.  Not the actual stuff, but something used in its manufacture, by some companies."
   All my family think I'm brilliant and know everything!
   "News to me.  I'll have to look it up."
 FM3: "The pharmacist phoned and told me to bring the remainder back and to talk to my doctor about a new prescription."
   I looked it up in the FDA site and there it was.  A list of formulations containing NDMA, (look it up) apparently used in the manufacture or somehow appearing as a contaminant in some of the formulations.  
   " I'll certainly have to follow up on that one!"
            I'll follow that one carefully!

   Later on, my lovely bride said to me, 
      " Oh I've got this funny pain in my elbow.  Want to take a look at it?"
     Me,"Oh it's probably old folks arthritis," I diagnosed glibly.
     MLB, "It sort of feels like a splinter.  Want to take a look at it?'
     Me, "I can't see anything there."
     MLB, "You don't have your glasses on, feel it!"
     I grudgingly admit I can feel something.                  
   "I'll get my magnifying glass."
      I find a tiny splinter that could have been a speck of glass.  I get some alcohol (not to  drink) and a needle and sterilize the needle and the operation site,  I'm pleased to report the surgery was sucessful!
     It's almost like being a doctor again! 
     God help me!!
     - and my poor patients!!
  
     
   
  

Saturday, 14 July 2018

The Ex-Doctors Dilemma.

The Ex-Doctors Dilemma.

    When I retired from practicing medicine three or four years ago after a satisfying lifetime in medicine I thought I had had enough. There were a host of talented young men and women ready to take up the mantle. They were well trained state -of -the- art physicians When I made new friends or acquaintances, unless directly asked I carefully avoided bringing up my erstwhile occupation. Indeed, since I was an academic I could honestly give my profession as being a university professor rather than as a practicing physician. Nevertheless, there were frequent leaks, as they call them nowadays and medical issues sometimes dominated the conversation when that was not my wish. I was not insensitive to the fact that the exchange was not always 'story-telling', but sometimes reflected a real need for information that should have been conveyed to a patient by their physician. As a teacher for many years who emphasized the importance of communication between physician and patient I was disappointed how frequently that communication and the understanding that it brings is lacking. In this era of episodic care, it often barely exists, if at all and I frequently encounter people who for whatever reason need to be heard and informed . I suppose it is partly the consequence of the ten minute consultation (impossible!) imposed by government when it interprets the fee schedule and of other cost-cutting measures like abolishing the Annual Medical Examination, that golden opportunity when the patients got to know the physician and the physician got to know and understand the patients and their problems. So now that I have unlimited time to listen (I was always a good listener) and no patients, I try to shed a little light or whatever it takes to help when I think I need to. There is rarely a shortage of customers to listen to my unlicensed, non state of the art, pro-bono medical opinions or explanations. I rarely give advice.!
   In the past twelve hours .....................................
   Last night,my wife and I went out to dinner with some friends. The husband requires two canes to walk and keep his balance. After dinner, as we walked back to our car, I noted they were parked quite a distance away from the restaurant, although there were handicapped parking spots sitting empty right outside.
I remarked that he should have had a disabled persons parking pass and told him he should ask his doctor to compete the form. His wife told me he had done so and the doctor refused. I considered this unreasonable and told them so. I hope they will take some action. When I asked them the name of the doctor they wouldn't tell me. 
(Later she told me she was mistaken and that it was something else that the doctor refused.).  Regardless, I think it is the doctor's responsibility to firmly recommend a parking pass to someone who would clearly be at risk traversing an icy parking lot in the Canadian winter. Obviously, the ten minute consultation time often allows only the most pressing needs of the patient to be addressed.
  My wife mentioned I had been having a little knee trouble and that I had bought a elastic compression sleeve from Amazon which was very effective. His wife had a sore knee too. I sent her the link! God bless Amazon!!
   As we pulled up to our own door I saw an elderly man (i.e. about my age) shuffling around and looking lost.
   Irene: "That old man looks lost."
   Me: "Yes, I think he is."
   I go over to the well groomed old man. 
"Are you lost, Sir?"
   "Yes, I think I am." "He points up a rather steep hill in the condo complex. "I think I live somewhere up there.".
  "Hey, I don't think I could walk up there right now. Hop into the car" I say.
  "Oh, I'm okay.". He shuffles on.
  " What number do you live in?"
  He looks puzzled. "Er, I think it's 56."
  "Hop in the car and I'll drive you up there."
  We drive up there. There's a car in the driveway, otherwise the place is dark. He gets out of the car, knocks on the door. No answer.
  "Do you think it's where you live?" I ask.
  "Well, that's not our car in the drive."
  "Do you have a phone number?" Yes, but he didn't know what it was.
  "Do you have a wallet?" Yes, but he left it at home.
  "I'll just get out of the car and have a look around." he said.
  "Not a good idea, stay in the car and we'll cruise around." He had already told me his wife would be getting worried as it was getting dark.
   We drove around the complex. It was getting dark and I saw a young woman finishing up her gardening. I pulled into her drive.
  "Miss, " I said,"this gentleman is lost and I'm trying to find out where he lives. Do you know where he lives? "
    She knew who he was, knew he had Alzheimer's and knew approximately where he lived.
   "Jump in the car and let's take a look."
   That's what we did and found his wife frantically looking for him. She was very grateful and I spent a few minutes educating her as to how to prevent recurrences in the future by making sure he was identifiable.
   The number of his house actually turned out to be 65. If he had wandered out of the condo complex it could have been dangerous.
   As one of my friends says when I tell him I'm not a doctor, "Once A Doctor, always a Doctor".
  "No," I say, "but for those with the vocation once a doctor always a Samaritan!"
I didn't have another case to deal with until the next morning at Pen Club!
   

       

Saturday, 7 July 2018

Old Cabbage - Coronary Artery Bypass Surgery. Pt2.

A personal story!

When I sprung it on relatives, colleagues and friends that I was planning to have bypass surgery, the first response tended to be reassurances as to how healthy I looked, and questions as to how long I was ill.    Funny, because I never considered myself ill at all.   After all, all I had experienced was a bit of breathlessness and a little tightness in my chest when I exerted myself.  I could swim laps indefinitely, as long as I used commonsense and didn’t try to break records.   And after all, I was sixty-nine, no spring chicken in anyone’s language.   How was that to be equated with illness, I was never ill a day in my life.   Never missed a day of school or university or work.   Ill indeed, I thought indignantly!  In fact, quite honestly, I was really only proceeding with surgery prophetically, because the genetic scales were so heavily weighted against me.  Was I just going to sit around and wait for those obstructed coronaries that I had looked at on the angiogram to totally plug and kill a huge chunk of my myocardium, or even me.  I was determined to get those obstructed coronaries before they got me.    So I carried on going to work every day, waiting to hear from my surgeon’s office as to when I would be having my surgery.   Meanwhile, I was daily fielding a litany of phone calls from relatives and other well wishers, including dutiful nephews and nieces who no doubt were responding to their parents exhortations and gracefully did their duty.


The operation. 
     Thursday was a fairly normal day at work although I did finish a little early in order to complete my paper work as Friday was 'coronary artery bypass surgery day'. I had my martini (of course) and a light supper and a visit from David, a great support as always. 
     11/19 /04 up at 5 am And David picked Irene and I up at 5.30 for our morning apt.  In more civilized times patients were admitted the night before surgery to get acclimatized to the hospital environment and to get rested up before the surgery.  "The system" (i.e. the administridiots who have destroyed it) no longer concerns itself with such things as long as it saves a few bucks.
     At 6 am I was through the admitting area hardly noticing all those other poor souls with their problems small and great but none I was sure, as  great as mine. 

     A kiss goodbye to my wife. A word of encouragement: clothes deposited in a plastic bag; then on to the stretcher in to the OR .

      The Anesthesiologist greeted me at the door

So you are Davids  dad?'' he smiled effortlessly sliding the IV needle into my vein.

     "Yes, that's me,” I managed to smile back, trying to think of  some smart answer.

     The lights went out.  

      I opened my eyes.  The lights came on! The anesthesiologist was gone. The operation was over and I was surprised at how little pain I had. Just like my niece Maureen had said describing some recent surgery - 'lights off, lights on.'

     Now I had to get the damn breathing tube out of my throat.   My God, I couldn't talk!   I made as much noise as I could to attract attention and look as though I was really suffering, - maybe that way I could get rid of it!   The Nurse leaned over me.

          “Are you having a lot of pain?” she asked sympathetically.

          I shook my head - no, but harrumphed and coughed as much as I could to make it quite clear I wanted this tube out of my throat.    Maybe if I coughed hard enough I'd manage to propel the thing across the room. 

          I could hear the machine behind me, but couldn't see anything.    Where the hell was I anyway?    Alive, at least, and no sign of any stroke or paralysis or anything else horrible as far as I could determine.    I seemed as sharp as ever!   I tried to cough up the tube.   The nurse injected something into the IV tubing and I drifted into some pleasant place.



         I woke up with vague pain everywhere, and a horrible nauseated feeling.    A nurse strolled by.   “Something for the pain?” she said, deftly depositing a little cardboard container with two pills in it, into my hand, and launching the whole shoulder, arm, hand unit in the right direction.   I swallowed them and soon dozed off again.

          “Are you on these pills too?” I politely asked the woman just to the right of my shoulder when I woke up.   I couldn't figure out why she was wearing the pretty bonnet right in the ICU.  I managed to twist my neck around, to get a better look at her and saw this was an electric fan that somehow looked like a woman's face, framed in a bonnet.   I gave a little chuckle to myself, as I realized my delusion- no wonder the poor old geriatrics got wingy after a few days on narcotics.   I had at least one other similar episode.   I looked at the clock, 11.10, must be at night, I thought.   I drifted off to sleep again, and had a long deep sleep.   I woke up again, and looked at the clock.   11.20!

Maybe I had slept right around the clock and it was twenty four hours later.   Then I noticed people all hustling around and going somewhere!    It looked like some sort of a set from the movies, something funny was going on here.   Everyone was leaving.   Nevertheless, someone was offering me pills again.

          “I think I'm going to throw up,” I said.   

          “Hold on a minute,” the nurse said, a large basin appearing from nowhere.

          I felt horrible, retched and threw up a large amount.   The relief was immediate and wonderful.   I closed his eyes and drifted into a deep sleep.    When I looked at the clock a long time later, it was 11.30.



          Somehow, the night crept by, a nanosecond at a time, but at least I could see that the morning would come eventually.
    Two days later I was back on the ward.

Note to myself on Dec 2.  2004

Apropos of nothing, but in the light of some of my recent thoughts, I was interested in this paragraph I just read in the NY Times Review of Books, from the review of the book by Harold Bloom entitled " Where  shall wisdom be found?"

     Bloom: "It reminds me of the experience of a friend years ago, when, awakening from major surgery, she heard in the recovery room a faint voice reciting the Easter soliloquy in which Goethe's Faust comes back from the brink of suicide to the joy of life.    Through her anesthetic haze, she wondered to whom the voice belonged until she recognized it as her own; speaking a poem she had known by heart in childhood and somehow retrieved from deep memory during induced sleep." 

          Now if only I had known Goethe's Faust so well........



My notes from a few days later:


A bath!   Oh, what a pleasure, oh what a joy!    And, oh, how much muscle power it takes to get in, wash yourself and to get out!     Amazing how much leverage, torsion and other forces involved in just sitting up, pushing yourself on to your feet, while praying that your feet don't slip away from under you, cracking your cracked thorax on the side of the tub, and ending back in the hospital.



And where does all that disgusting dirt in the water come from, when you haven't been out of your house and barely out of your bed since the last bath?    Anyway, it confirms that the simple joys are great!


Monday, 2 July 2018




Some belated Father's Day thoughts.






    My father was a conversationalist, a communicator, a wit and a punster, and a bit of a philosopher, who loved his family and his country. He was born in and loved Dublin and had some very close Irish friends in all walks of life.. He used to say to me, “Son, you may travel the world you’ll never find a finer place”. (In fact I couldn't wait to get out of that tight little island!)
    For a man whose formal education ended when he was fourteen he was very well-informed and I remember as a child seeing the National Geographic and a journal called Psychology Today lying around the house. There was no topic he was unwilling or unable to discuss. He was a master of the allegory, always ready and able to illustrate his point with an anecdote, a story or a song (and he had a collection of songs both sad and funny that no oneelse seemed to have heard of).
   I have quoted him freely and still do. Indeed we were
suspicious that some of his songs were made up, until we managed to find a number of them on the internet. In retrospect, many of his stories and jokes, had a profundity that I didn’t really appreciate until adulthood and which resonate until this day, when I am thirty years older than my father was when he died.
   He was an upholsterer by training and built up a small business. He was truly an artisan of the old school and loved to restore old period furniture which he did painstakingly himself, sure that it was too delicate for even his most competent employees. He had magic hands, he could repair anything and even singlehandedly, built a fair-sized room onto our house, doing everything from the brick-laying to the electrical work and the final decorating himself. A wonderful gift, it seems to have skipped my generation, though I see the same painstaking preoccupation with perfection in my son. I spent some time as an orthopedic house officer assisting very capable orthopedic surgeons, and feeling sorry that my father’s superior manual skills were not applied to surgery.
   
He taught me about respect for others. His friends were either honorary aunts and uncles, or Mr. or Mrs. No first name addresses by seven year olds to adults.   No cheeky, smart-ass retorts. He also taught me about respect for myself and for the young girls and boys I associated with..
   When all the other teen-agers (I’m talking about 1 7 or 1 8 year olds) were sneaking into their homes quietly to avoid discovery by waking up their parents, I knew I was going to find my father sitting reading the newspaper waiting for me no matter what time I arrived. He would look at his watch and say, “You’re late tonight, where were you?” Then, “who were you
with?”   I'd tell him the truth (usually!) and then he’d offer me a cigarette and we would sit chatting, in front of the fire, often for a long time, about every topic from world politics to scientific developments. Sometimes my mother would wake up upstairs and call down, “are you two going to sit up all night?”
   The Conversation, the conversation was all, I knew how he thought, and he knew how I thought. We shared love, rapport, respect.  I never, ever, remember my father raising his voice to me. Sometimes, when there was something on his mind, something worrying him, he would tell me about it. Often it was about financial issues, as mass production drove him out of business.  Invariably, he would finish by saying “don’t worry, it will be alright, and you needn’t worry your mother about it”. My parents never yelled at each other. The closest they
came to that was when my mother would say to him, in exasperation at me, “Talk to him, Davey,” and he would say ‘Hello Stanley’. That’s about as close as it got!
   They're not making his kind anymore.

Tuesday, 26 June 2018

The Smartphone and the Franco Whistle.

   My Uncle Leon had a whistle that could be heard several blocks away.  He put a thumb and an index finger in his mouth and blew: the earth trembled; the water in the nearby Grand Canal in Dublin rippled; my big tough cousin CB shivered and raced home as fast as he could in response to his Dad's shrill call.   He didn't dare not to!
  Uncle Leon didn't need a cell phone!!
   
   My parents and other uncles had a more genteel whistle that had a definite rhythm to it.   I am not sexist, but women didn't whistle in those days (at least not the ones I knew).  My maternal grandfather and his brothers ran a photographic studio in Dublin under the name of Franco Photographic studios and the whistle was known to all members of the family as the Franco Whistle.  At a moments notice all members of the family could be rounded up, no matter how many people were present by the Franco whistle and once one got it they echoed it until the whole tribe vibrated with it.  Indeed, in later years when I was married the Franco whistle often saved me from losing my wife and infants in the teaming department store jungles, in those pre-internet days.  
   We didn't need a cell phone!

   Nowadays, I watch smartphones turning on their people and forcing them to maintain eye contact. Not even allowing them to drag their eyes away for such dangerous endeavors as crossing the road.  I wonder if we have made as much progress as we think we have.  
   It still surprises me to see what in my day would have been considered a 'courting couple', sitting across from each other, remain hypnotized by their respective Phones, exchanging occasional bored glances at each other before enthusiastically returning their focus to their phone.  They think they are 'connected' and they are - to their smartphone.  I wonder how we used to manage to stay fascinated and excited by each other.  Somehow we managed and often remained in a state of suspended excitement for a long periods. It may just have been something to do with testosterone which in those days used to reach very high levels.

eMail/SchmeMail!
   I, being the old curmudgeon I am remain convinced that there is no substitute for pen and paper.  The superficial and rather meaningless connections on Facebook and other social media do allow us to vent our frustrations or boast our achievements without effort and often without thought. Communications and connections  with family and friends that were worth the effort of writing a letter, were often kept and cherished for a lifetime and formed the basis of many a biography or memoir and provided insights the like of which I have never seen in the tossed-off comments on Facebook.  Writing did need some effort.  You needed a pen and paper, the patience and skill to think about and express your thoughts and the ability to write legibly.  The pen is connected to the fingers and eventually to the brain, if the writer has one.  No such process takes place between the keyboard and the brain, which may at least partially explain why we read such unmitigated rubbish much of the time. Thus, although you may argue that the volume of communication has never been so great, the quality has never been so low.
   I hope the Franco Whistle never makes its way onto Facebook.
   I am a busy man.  Please do not waste my time by commenting!

Sunday, 17 June 2018

O Cannabis, our own our native plant..............

   As the LWLs of the Liberal establishment demean the once-great nation of Canada and turn a population descended from hardy, hard-working pioneers who worked a harsh frigid  rocky land into, if not a paradise, at least an honorable, prosperous nation where almost everyone who was prepared to work made a decent, comfortable living.   Those who through fate or misfortune couldn't or wouldn't work had a safety-net, which although modest would allow them to live and eat and have some form of shelter.  Not enough, perhaps, but more than many of their parents and grandparents could have hoped for.
The pioneers were tough but they made sure that the next generation of Canadians would be better off.
   The plan for the future somehow went astray.  After only a generations or two, the recipients of the benefits that their forebears bestowed upon them began to feel entitled to receive benefits that they had done little to deserve.   In addition, some began to think of the achievements of their parents and grandparents as somehow dishonorable, although that never prevented them from enjoying the benefits.  They began to believe that the extraordinary efforts of their parents and grandparents really meant nothing because it was at the expense of 'others'.   Meanwhile, they did not feel that the personal benefits that they themselves enjoyed were actually criminal, because they 'cared'; they apologized; they did everything they could without sacrificing any of the comforts they enjoyed.  They were working for the cause.  They were 'noble', virtuous, ready to apologize for the sacrifices that their forbears made to ensure their security and comfort.  They ameliorate their guilt for benefits they enjoy every day by sticking it to the hardworking taxpayer, who are dumb enough to pay for them.  These crybabies need 'safe-spaces' to cower in and recover from the micro-aggressions inflicted upon them.  An innocent comment can send them into a paroxysm of rage and hatred towards those who disagree with them. 
     And what do these LWLs have in store for Canada. Now they revel in the prospect that Canada is about to compete with the worlds major marijuana drug and perhaps other drug pushersCanada is already being labelled as the 'world's number one Cannabis exporter.    
     It is not the Canada I emigrated to!! 
     Apart from the financial rewards to the Treasury which will surely be generous, it is appalling that a government can be so indifferent to the safety of its citizens, that it can allow the legislation to proceed before there are methods available to safeguard the roads, the construction sites, the school zones, the workplace for its citizens. 
     The technology exists to monitor impairment and is  gaining momentum.  Unfortunately, the dollar signs take precedence over public safety in a political setting where irresponsible profligacy has been the rule.

Tuesday, 12 June 2018

The Angiogram.



    Its fourteen years now since I had my coronary artery bypass surgery.   Just a few days ago, a friend of mine who is booked for an angiogram and may be having a similar procedure asked me about it and I responded as accurately as I could.  I mentioned to him I had taken notes at the time and that I had later published an article in a medical newspaper, The Medical Post describing the procedure.  Although I have yet to locate the article, I still have my post surgical notes that I offered to share with him.
   Here they are starting with the angiogram




Bypass.  Pt 1.   The Angiogram.

I stared straight upward at the overhead camera, a chagrined that I had asked what it was, when I should have known perfectly well what it was.  But I wasn't thinking clearly right then, I was rationalizing the risk statistics of the procedure and knew I took a bigger risk every time I took the freeway.   Cardiac arrest, well that was easy enough to deal with, a couple of good electrical shocks and it either started up again or it didn't.   And if it didn't, nothing too serious, you didn't even know about it.    No, I wasn't worried about that, or about a hemorrhage from the thigh artery; they can always fix that.   The only thing I was really worried about, was stroking out, ending up like a close friend, a helpless prisoner in his own body.   Death was a lot easier to handle.   Not that I wanted to die; I still had plans and ambitions.  Far more pressing than any of the above thoughts, was the itching and burning in my groins, despite the copious shaving cream and the fresh new razor I had used when following the instructions.   My sympathy for the poor metrosexuals, who shaved this area on a regular basis as a part of their daily ablutions had increased.   

 I had kissed my wife goodbye and walked toward the Cath Lab, double gowned.   Modern sensibilities and sensitivities ensured that patients no longer wandered hospital corridors with 'back to front gowns', their tails hanging out for general condemnation or admiration.   I'd been issued with two gowns, one opening at the front and one at the back, providing total coverage.  I held my clothes in a white plastic bag, in my right hand.
The Nurse introduced herself. 
"I'm sorry we're running a bit late," she said.   "What do you want us to call you?   Dr. Smith or Stan?"
"Stan will do," I said. "And that's okay, I haven't anything else to do today," I said, and I meant it.
All of a sudden, a masked pirate, swung into the cath lab.  
He wore a red floral bandana, with the collar of a bright red shirt peeping above the drab green of operating room attire.   Was this really the balding middle-aged doctor, with a rather peculiar sense of humour, that I had spent a half an hour with last week?   I guessed it was.   Whatever it was, I sensed a deep respect from the surrounding staff.
"He's got a rather peculiar sense of humour" warned the nurse whispering into my ear.
I smiled back weakly and nodded.
'Don't worry," the pirate said to me, "this won't be too bad."
"Very few things in this life are as bad - or as good as they are reputed to be", I replied, the homespun philosopher as usual.
The pirate pondered for a moment, and then said, "I think that sums up life pretty accurately."    A slight note of appreciation in his voice.
  
He had told me last week that the rare complications of the procedure included hemorrhage, stroke and cardiac arrest, just to name the most severe.   "If you hemorrhage we'll just have to do open surgery to stop it, if you stroke out, there's not much we can do, but if you arrest we can just defibrillate you on the table," he said benignly, making it clear that the latter was by far the most desirable of the choices.   Obviously, the one he would have chosen for himself, if he had to.  

Then, he went on to tell me that I would feel a strange warm feeling, when the dye was injected into the intravenous which had been set up right at the beginning of the procedure.
"You'll feel hot and wet all over, and might even feel as though you had lost control of your bladder, but don't worry, you won't and I'll be standing right there," he said with a strange sensitivity, as though that would help.
He injected the local anesthetic into my groin, and after a few moments I felt nothing, but the miraculous relief of the itching and burning of the razor burn.
Dr. Pirate brandished the sleek cardiac catheter like a rapier.
"Now I just take a run at you with this!" He laughed.
The nurse bent over and she whispered reassuringly into my ear, "he's just kidding", and even though I knew it was just joking, I wondered how many times I myself had caused a frisson of anxiety in a patient, with a light word, meant to be humorous and to reassure.
It surprised me that I felt nothing at all, as the catheter ran up through my femoral artery, up my aorta and into my heart.
"You can see it all there on the monitor," the male nurse said, "if you don't mind seeing that sort of thing."
I looked at the x ray of my heart beating.   I saw the thin line of the catheter thread its way into my coronary artery, like a wire coat hanger being threaded into a key hole.  I hoped it would leave enough room for the blood to get through.
"Take a deep breath and hold it," commanded the Pirate.  
I did as I was told, until it started to hurt, I waited a few moments. 
"It's starting to hurt," I said, knowing that was because he was depriving my poor myocardium of much needed blood.
"That's okay, it's supposed to.   You can let it out now."
The pain resolved quickly.  
Okay, now I'm learning how to play this game, I thought.
As soon as I started to feel some discomfort as the next coronary artery was being threaded, I didn't wait.   "It's starting to hurt".   Save my myocardium.
"Okay, you can breathe out."
Ah, now I've got it mastered, I thought, there's a solution to every problem.
The procedure was repeated a few more times, with little discomfort and the monitor show continued.
After a few more thrusts, peppered with light commentary, the show was coming to an end.   
"We are just about coming to the end of this, and I'm going to be thrusting my fist into your groin, to make sure there is no bleeding."  he said. "You just lie perfectly still and we will get these three big strong nurses to lift you over to the stretcher.
Two of the nurses were fairly slight young women and the other was a slight young man.   They picked up the stretcher sheet corners and whooshed me over on to the stretcher. 
No wonder they all have back pain, I thought, knowing that many of the patients they lifted were twice or three times my weight.
A fist was thrust into my groin, applying firm pressure.   The impatient Pirate took control of the gurney with his other hand and wheeled it quickly out into the corridor. 
A couple of words in my ear, "your right coronary is a hundred percent blocked, your left anterior descending about fifty percent blocked, and the obtuse marginal and posterolateral branch of the circumflex eighty to ninety percent.  I think you are a bypass candidate."   This guy didn't waste any time.
No time to wait for orderlies or porter, we headed straight down to the ICU.    Irene was waiting outside the Cath Lab. 
"Are you alright?" she asked me, the pirate pushed on.   "Are you……?" she directed her question to the pirate.
"I'm the orderly," interrupted the man with the strange sense of humour.
"He’s the doctor" said Stan, "this is Irene, my wife."
"Hello," said the Pirate, pushing right on for the ICU, where Irene wasn't allowed to follow.
"I'll see you as soon as they move you," she called out.
And there he stood with his fist pushing into my groin for the next ten minutes.
"Drink lots and wash out all that dye," he said, "and keep lying absolutely flat for the next hour or so.  I don't even want you to raise your head, then we'll move you to the observation ward."
Every few minutes the nurse solicitously bent over me, with a glass of water and a flexible straw.
I gulped greedily at first, but then started to think of the consequences of pushing the fluids too enthusiastically.    I didn't want to have to empty my bladder while I was lying flat on my back, and that was going to be at least the next hour.   Better to wash the dye out a little more slowly, and a little later when I could at least sit up, it might be easier.

A nurse I hadn't seen before breezed into the room.  
"I'm taking you down to the recovery unit," she said, wheeling the gurney out of the cubicle it had been occupying for the last hour.   She got almost out of the unit, when the Pirate swung in.
"Where are you taking him?" he barked.
I wondered if I had just been saved from a hijacking.
The unfortunate nurse flushed and said, "just to the recovery room."
"No one leaves here until they have been checked by me," he commanded gruffly.   "I have to make sure they are not bleeding."
He rolled the gurney back behind the curtain, pulled back the gown and looked into my groin, was satisfied and said quietly, "okay, you can go."
She rolled me to the West Wing, where I was deposited in a two bed ward, the other bed was empty.   Irene awaited anxiously.
“Are you okay?”
“Yes, everything feels numb right now,” I said.
The ward nurse was cheerful and pleasant.  
“You’ve got to drink lots of water," she said cheerily, "wash all that poison out of you.   And I bet you're starving.   What would you like to eat?"
"What's on the menu?" I hadn’t eaten since the day before.
"Sandwiches, cookies, whatever you'd like.   But you have to drink lots, juices, ginger ale, cranberry juice, whatever you fancy.   If you do real well, I'll let you stand out of the bed to pee." She smiled.
This was the best offer I'd had all day.   I gulped down a glass of cranberry juice through the flexible straw and ate a tuna sandwich.   It was a little easier to drink now that I had been promoted to sitting up a few degrees.   What was it that they'd said a few degrees every hour?   I was starting to want to pee. The nice nurse whisked by with the water.  
"Have a nice big drink now and I'll let you stand out at the side of the bed," she said.  
I thought that one over and decided it was a deal.   I sucked down a big gulp of water and looked over at the side of the bed to the bedside table, where amidst the debris of sandwiches and small juice containers, I saw the new, pristine, disposable urinal.   A far cry from the old stainless steel ones, which were handed out when I was a student.   I flipped off the lid and tried it on for size.   It seemed fine.   I swung my legs over the side of the bed, barely sitting on the edge of the bed.   I was lucky my weight was propped on the bed for as soon as I put some weight on the right leg, it collapsed under me.   I tried to feel it; it was completely numb.   Totally anesthetized!   I carefully propped himself against the edge of the bed, put the urinal in place, and was all ready to pee, when the commotion behind the drape that surrounded my bed distracted and inhibited me.   The nurse stuck her head through the drapes,
"You've got a new neighbor," she said,
Irene, who had stepped outside for a moment popped back in.
"Everything okay?" she asked.
"Yes," I sighed, giving up on the bottle, and swinging back into the bed.
Irene sat on a chair near the end of the bed.   The New Man's wife sat on a chair at the end of his bed.  They were nice friendly people; I had seen the New Man come into the intensive unit soon after me.   They started talking to Irene immediately.   I felt overwhelmed with a desire to sleep, so I kept eyes closed and didn't pull back the drape.
I heard them talking and Irene replying, and then I drifted to another place where I was lying on a chaise, on a beautiful sunny day dozing, before diving into David's pool to swim another twenty laps, just to show myself I could do it without any chest pain.
I woke up about half an hour later, and thought I ought to be more sociable.    Just as long as the New Man or Mrs. New Man didn't discover my occupation!  
"Hi," I said to Mr. and Mrs. New Man.
"Hi," said Mr. New Man, "have a nice sleep?"
"Yes, thanks," I answered.   Now I really wanted to go to the bathroom.
"What do you do, Stan?" asked Mr. New Man.
No, I thought, I'm the patient, today, I can’t tell him I’m a physician.
"I work in Mount Brydges," I answered, leaving it there.
Mr. New Man left it at that.
"Is your leg numb?" I asked.
"No, never was."
"Been to the bathroom yet?"
"Yes, the nurse let me go just before you woke up."
 I had a bit of feeling in my right leg now.   How come Mr. New Man had already been allowed the luxury of actually navigating to the lavatory on his own two feet?      Well, I was going to make my own way there.   I slid out of the bed, could feel my right leg ready to buckle when I tested it for weight, found I could stabilize it with my hand, and hobbled the few paces to the bathroom.    There was a convenient bar to hold on to, which made it easy.   Ahhhhh, heaven!
It was easy after that.   I joined in the conversation, checking for sensation in my leg at frequent intervals.  After all, I didn’t want to be in here a moment longer than necessary and the nurse said I would be able to go as soon as my leg would support me sufficiently to independently walk down the corridor and back.
And Sure enough another hour made all the difference and I could indeed walk down the corridor under the watchful eye of the nurse.    She whisked me into a wheelchair and out to the waiting car
"Good luck for your surgery " she called after me as I got into the car.  
Part 2, the Bypass Surgery- next week.