Monday 24 May 2021

My Left Foot.

 Christy Brown  and Others.

My Left Foot.
Christy Brown.
I stood there, a lone medical student, at the bottom of bed number thirty-six. I had been dispatched to do my first solo history and physical examination. Of course I had done many before, but always as part of a team or with at least one other student or intern.
Lying on the bed was a young man, about my age writhing in spastic, athethoid movement, neck extended and rigid contractures of the arms and legs and a more shocking example of the physical misfortunes than I had ever seen. He seemed to totally lack any sort of control over his body, until my shocked eyes fell on his left lower extremity. Between the big toe and the second toe of his left foot he was holding a pen, and despite the spastic movements of the rest of his body, he was writing in a small , precise cursive hand (foot!) on a stabilized notebook. It was amazing to watch.
After I got over the shock of seeing a human being who seemed to be dealing in some way with the unimaginable devastation, I managed to pull myself together and said apprehensively, " I'm Stan Smith, a medical student, and they sent me down to take a history and do a physical examination. Is that alright?" He nodded affirmatively.
The patient, Christy Brown, later internationally known as the author of the book and subject of the movie "My Left Foot," and "Down all the Days" and a number of other books and paintings was kind to an apprehensive new clinical student.
His speech was dysarthric and difficult to understand, his manner kindly. He was obviously used to this teaching hospital routine. I won't attempt to replicate his spastic speech - that would just make him - and me sound stupid!!
"Yes, I know you students have to learn from someone," he replied in the dysarthric staccato drawl.
I was grateful I could understand him and he me.
I took a history of sorts, more social than medical. He told me he nearly died during delivery and that he had suffered serious brain damage. We got on to his life.
Christy was born at the Rotunda Hospital in 1932, - three years before I was born. He had twenty-two siblings, (Yes, 22 !) out of which thirteen lived. His parents were urged to commit him to hospital as he was so spastic, but deferred. He was thought to be mentally impaired and received most of his education from his mother.
"So what do you do most of the time?" I asked him.
" I write," he said. "I've started doing a bit of painting too," he said.
He had a certain leprechaun- ish look about him that precluded an overly sympathetic attitude and made me feel that somehow he was managing to get some fun out of life, as indeed he was. If you want to know how, read "Down all the Days". He was addicted to alcohol, which I am sure brought more to his life than ever took from it. His brothers pulled him around in a cart, mainly to the local pub and fed him Guiness.
Daniel Day Lewis played the role of Christy Brown with great insight and the movie itself kept reasonably close to the facts.
The only other famous 'medical case' I (almost) met in my student days, was Douglas Bader, the legless RAF Air ace, who was a double lower limb amputee as a result of an air crash and talked his way back into combat missions sans legs, until he was shot down and became a prisoner of war. He came to the Meath Hospital to encourage and reassure pediatric amputees regarding their future life, though I don't think he was recommending that they become fighter-pilots!
An even more remote potential patient was Her Majesty, Queen Elizabeth, who visited Saskatoon many years ago when I was Chair of the Department of Family Medicine and the Emergency Department. Her Majesty, of course, traveled with her own team of Physicians but as their access to all of the facilities of University Hospital had to be through a duly qualified physician with full privileges I was selected and thus I can claim to have been duly appointed Physician to the Queen for two days! Unfortunately, I wasn't smart enough to request a written testimony at the time. Fortunately, Her Majesty and her physicians didn't require my services!!

Thursday 6 May 2021

Cabbage Pt. 3

 Cabbage Pt 3. The Nortel Pillow.

Cabbage 3 -Post Surgery.

   Much of my discomfort came later and was due to a hyperesthesia (super-sensitivity) of the scar. So much so that even touching the area was painful.. The touch of clothes brushing over the hypersensitive scar tissue was more painful that some of the really big stuff that seemed relatively painless. How is it no one has ever thought of a little plastic cradle one could tape over the scar to prevent clothes from brushing against the hypersensitive skin? Maybe I need to invent such a gizmo? It would be relatively easy. I thought maybe I'd do it when I was better! Needless to say, I never did. Somehow, that night crept by, a nanosecond at a time, it is true, but a least I could see that the morning would come eventually.

          Morning at last! Moved out of the ICU and to the step-down unit. I had been in the ICU for two days instead of one, not because I needed to be there, but because they had nowhere else to put me. Another day there and I’d really have been crazy, but now I had windows and daylight and could see the sky. Oh happy day!

   My surgeon, the guy who was holding my heart in his hands just hours ago, was standing at the bottom of the bed, relaxed and easy.

   “Everything went well; you’re good for another thirty years!”

   I was glad to hear that.

   Soon my family were sitting by the bed and had obviously seen a good deal more of me in the past 48 hours, than I had of them. They reassured me of how good I looked, and in fact I wasn’t feeling too bad as long as I was lying fairly still in the bed. But I knew that the therapists wouldn't let me lie in bed for too long and, after adequate numbing with narcotics, they had me walking a few steps later the same day.

  The following day my surgeon came around to see how I was doing.

   “You are good for another twenty years,” he smiled.

   “Not so fast,” I threw at him, “yesterday you said thirty, so that’s thirty percent deterioration in one day.”

   He laughed indulgently..

   My main complaint, until now, had been nausea, and had been controlled mainly by living on juices and apple sauce and processed fruit, and sending my set meals back without even looking at them. Now I was ready to tackle something a little heartier. Normally, I am not a fussy eater. The meals came, as I found out later, from some central depot. Before taking the lid off, they looked like Air Canada meals (economy), which when I used to fly a lot were not too bad. I remember the choices – “fillet, chicken or fish?” Any resemblance finished on lifting the outer plastic cover. What took place under the cover defied description. Once the lids were whipped off these dishes any inclination to eat was gone. Irene took one look and vowed that my food would be coming from home! Subsequently it did.


The Nortel Pillow.

   Nortel was a Canadian communications company in the days when Canada was a successful country. After an outstanding performance it went into a nosedive and a lot of people lost a lot of money. China (Huawei) denied that it had reverse engineered the product and destroyed Nortel. Most of us knew better. On post op day two I was moved to the step-down unit. Because post op breathing and coughing is important the physiotherapist gave us a pillow to clutch to take the tension off the scar when we coughed. Having taken a beating on my Nortel stock when that company went bankrupt I was more than a little surprised to see beautifully embroidered on the pillow 'with the compliments of Nortel Networks'. Nortel had cost me a lot of money and the irony of the situation left me uncertain of whether to laugh or to cry. I decided to laugh even though it hurt! (After all, I had my pillow to hug!) The guy in the bed next to me heard me laughing. We chatted a little. A healthy looking fifty -five year old, he had found his way into the cardiac unit as a result of forcefully pulling open his car door and hitting his subcutaneously implanted cardiac pacemaker so hard with the edge of the door that it was totally wrecked and needed immediate replacement.

   "What's the joke?" he asked. I told him.

   He examined his pillow. He laughed. "I guess I have the same twenty grand pillow!"

  We laughed so much that the nurse came over to see what was wrong.

  Thereafter we referred to the pillows as our twenty thousand dollar pillows, because that's about what they cost us. There are no free lunches!

  On day three my surgeon popped in to make sure I was doing okay and my scar was okay.

     "I have two important questions to ask you today. "

     "Okay, fire away."

     "One, when can I get out of here?" I asked.

     "A couple of days."

     "Maybe tomorrow?" I bargained. "If you look out of the window you can see my condo. I could be in emergency quicker from there than you can get me down from here." I was on a higher floor in the hospital so that statement was probably true.

     "We'll see how you are tomorrow. The other question?"

     "When can I have a martini?"

     "As soon as you can get some to bring you one." he intoned, his Scottish accept a little more prominent than usual.

     I love the Scots!

   The next day he arrived after his operating list and I was ready for him.

   "I think I'm ready to go home today," I said cheerily. I could see I was starting to wear him down.

   He countered with, "You can go as soon as you have had a bowel movement." Sometimes the bowels are a little slow to start functioning after major surgery,

   " I've just been," said I triumphantly.

   And that's how I managed to go home on the fourth day after my quintuple bypass!

Some post surgery thoughts:

  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 at the hospital. And where does all that disgusting dirt in the water come from anyway, 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!

Note to Friend on Dec 2. (while still under the influence of medication!)

   Apropos of nothing, but in the light of some of our recent discussions, I thought you might be 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?"

"It reminds me of the experience of a friend years ago,” he wrote, “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 since childhood and somehow retrieved from deep memory during induced sleep."

   Oh, what strange  things we store in that three pounds of jelly in our skull!


   Finally, A colleague phoned and was pressing me for information about the pain and pinning me down for some descriptors. My bottom line and I knew him well enough to know he would understand the simile, “ - like coming home hungover, getting into a fight and having your chest and ribs kicked in!”  Not very eloquent, but I think more accurate than described in any medical text!