Tuesday, April 30, 2013

New York City

There are a number of experiences which can be transformative. While I have never swallowed the concept " What you eat you are", I am convinced we have all been molded, for better or for worse, by our crossroad encounters. Having reinvented myself on a number of occasions, the results are usually intertwined with concurrent people, places or events. We all become a blend of seminal occurrences beyond any control, with contrivances of hopefully positive consequence. At age 19, I traveled to New York City with a definite plan to become a different person. Failing to do so seemed dangerous .

Paul Simon followed Bob Dylan who followed Woody Guthrie who likely followed someone else to New York City. Generations of painters, novelists, and dancers  have done the same. For many "The City" represented  recognition, fame and fortune. I enjoyed anonymity and had my own agenda. I was suffocating.

After World War II, the returning veterans, including my father, finished their training and education, married, had children and moved to the suburbs. Life in America became a classic fifties TV script. In my high school years, it was classes during the day, ball practice in the late afternoon, dinner with the family, one TV program, homework and bed. The weekends were generally filled with extracurricular functions directed through the high school. This was fine with me. I had a nice family and even an attractive girlfriend. Rarely did my mind wander. In college, there were slightly different rhythms. It was still a "script" however, which was no longer acceptable.

I attended Georgia Tech which had the largest cooperative educational program of any school in the country. "Co-op" students attended school for a quarter, worked for a quarter and returned to school over 3 calendar years, finishing the last 2 years conventionally. The job opportunities were protean, the locations, for the most part, stifling. Everyone appeared excited about career enhancement through the co-op experience. They signed on at the likes of a nuclear power plant, far away from any meaningful civilization. The thought of a permanent job in such isolated environs never crossed my mind. I needed New York City and enough money to live.

I was hired by Pan-American World Airways which was the only NYC job I found. There was no homework or brutal Georgia Tech type tests to worry about, so every night and every weekend was completely free. Living in Queens, a waste land of unattractive apartment buildings, I was within walking distance of the subway. As mentioned in an earlier entry, I was one the worst Pan Am employees on record, likely contributing to the Airline's downfall. Unconcerned, I was just happy to be finally living in New York and for 20 cents, within easy reach of the Imperial Borough of Manhattan.

I knew nothing about "culture" and suddenly it was everywhere. I was joined by a few like minded fellow travelers. My winter clothes, purchased by my mom in our home town of Miami, were predictably inadequate. Apparently naive to the concept of a clothing store or perhaps so out of it not to notice the locals' different attire, I nearly froze on our first nightly excursions. I solved this problem by always carrying a half pint of cheap scotch in my back pocket, taking a nip just before shivering. For $2.50 we could stand at the back of the Orchestra for all the great Broadway plays. There was free Shakespeare in Central Park, the Met, and  MOMA. I loved the small gallery photography exhibits, Andy Warhol films and acts such as Randy Newman playing  in a small mid town bar. Mentally energized, I was able to read a novel a week. It was here, not at Georgia Tech, where "education" became sacred. Incidentally, I haven't had a scotch since.

Five years earlier, sitting in a friend's room and listening to the radio, I heard the Beatles for the first time. I was astounded. The minute the song ended I told him "This will change everything.".  For me the change was suspended for awhile, but in New York City, it finally bloomed. Cultural education gave way to a general hunger for knowledge. Knowledge provided some confidence in making career decisions. It was there in New York City, I decided to go to medical school, initially more attracted by wealth of information I knew I would obtain, than the idea of actually being a doctor.

After 4 years of medical school in Gainesville, Florida  I had an opportunity for a one-year " return voyage" to New York. I had signed on for a 3 year neurology residency in Gainesville, but before this started, I could go anywhere for a mandatory one year of internal medicine training. I was passionate about contemporary music and had been reading about a nascent "underground" sound in New York City- Punk Rock/New Wave, rooted in performers such as Lou Reed, Iggy Pop and the New York Dolls, all of whom I loved. Most of my friends were into James Taylor, Joni Mitchell, Crosby, Stills and Nash, who to me were just OK. To see this first hand in its infancy was a huge draw. I signed up for a university program on Long Island, concerned about leaving Charlotte alone in the big city while I was on duty all night every third or fourth day. At CBGBs and Max's Kansas City, I was able to see almost all of those performers and to accurately predict who would really make it: Talking Heads, Patti Smith, The Ramones and the Clash (from London) had a better chance for success than Nick Detroit and the Void Oids, Television, and Neon Leon, though the latter groups did have cooler names.

However exciting and energizing the locale and the music, it wasn't enough to carry me through the year. My  first months as a "doctor" were a disaster. I sucked as a intern. I had incorrectly assumed the book knowledge, which I felt confident about, along with a little supervision, would translate to great success. One, or the other, or both, fell way short. In those days your contact with the resident, the immediate superior, was to him or her saying:
                           "Call if you need me, but don't call me."
 I was lucky if I spoke to an attending physician 10 minutes a month.

Overwhelmed by the patients suffering, and in the spirit of camaraderie, I had my first total meltdown. Staying up all night on call, blended into being unable to sleep on off nights. With no sleep, my marginal physician's skills gave way to near total incompetency. I wasn't even able to drive, and  had to have Charlotte take me to the hospital every day. I never looked out of the car window on the way in, for fear of seeing buzzards flying along side, so obvious were my shortcomings. While awake in the wee hours, I tried to read up on cases I was bungling, but I could not concentrate well enough to make any gains. If there was anything comical about this nightmare, no one seemed to notice. Puzzled by this dichotomy, I initially hoped I was being overly self critical. I eventually concluded no one up the chain of command gave a shit.

In a complete free fall I was giving up all hope of landing. I started looking around for those Queens type buildings from which to jump. Late one evening my mother called to say my brother's close friend Bobby had killed himself. Bobby was the most talented person I had ever known. He scored the highest grade on the entrance exam to our somewhat elite high school. He was the fastest runner, the most agile football player, and was chosen as the best lead guitar in all of South Florida by a well known area radio DJ, putting together the ultimate garage band. He was handsome and funny. After college he reminded me of Tom Buchanan in The Great Gatsby, previously a football star at Yale, and, despite still a young man, surmises "everything afterwards savors anticlimax". Likely this realization was more than Bobby could handle.

I am certain I had not shed a tear for greater than a decade. I dropped the phone and I sobbed uncontrollably for hours. I then fell into a deep sleep. When I woke the next morning, I felt perfectly normal. The anxiety which had tormented me for months seemed to have been wiped away as easily as raindrops on a car windshield. I immediately went to work reading and analyzing everything I could find relative to my patient responsibilities. " Never again", as Scarlet O'Hara vowed in Gone with the Wind, referring to being hungry, would I, referring to being ignorant, let this happen.

The connection of the physical, the sobbing, to the mental, was noted. There is something in my DNA, I learned, requiring intense physical activity to function adequately with this brand of stress, the likes of which, would  never cease, as long as I stayed in medicine. The trick was to address this need BEFORE the next crisis. I then dusted off my Atala , the beautiful white Italian steel bike now hanging over my desk at work, and I was on it every spare moment. Over the remainder of that year I became a pretty good intern, though, as before, no one seemed to give a shit.

I do not want to trivialize the tragedy of Bobby's death. It was a seminal event, likely more so, for many others as well. I have always had the unsettling feeling, that in a mysterious way, he died for my sins. I look forward to seeing him on the other side.

Friday, April 5, 2013

Ground Zero

Little darling, it's been a long cold lonely winter
Little darling, it seems like years since it's been here
Here comes the sun
Here comes the sun, and I say ....... *  

IT'S NOT ALL RIGHT. In fact it has been pretty freakin far from all right. 

Greetings. Sorry for the sabbatical.
It has been a tough Winter and, like several others in the past, I am lucky to have survived it. The recovery from The Fall was unnecessarily prolonged by unscientific suggestions introduced by an iconic Orthopedic professor circa 1970. He declared it was forbidden to walk or stand on the leg closest to this type pelvic fracture for a full three months. His view has gone unchallenged by the next two generations of Orthopedic surgeons, and reminds me of the medieval  'bleed the patient for any infection' position. It took 500 years for someone to notice 'bleeding' was not helpful.

I was told putting weight on the leg, transfers a force to your pelvis, through your femur and hip joint, precluding proper healing. This translated to the use of crutches without any weight bearing on my right side, and, needless to say, no bike riding either. The 'Theory' makes no medical sense. First of all the pelvic fracture was bolted together with two long screws and then internally belted by a large piece of titanium. It would have taken a jack hammer to move anything. Secondly, the force through the leg while standing is identical to the force your ischial tuberosity (butt bone) delivers to the pelvis when sitting. Hell, no one told me to sit with one cheek in the air as if passing gas, a skill, incidentally, I acquired long ago. While I'll concede walking could possibly deliver an extra force with each step if one bounces when moving, it is my contention, that if necessary, I can float while walking. There was no compelling reason for me to use crutches for 3 months
While the short lived physical pain from the injury was annoying, the resulting lack of physical activity took an emotional toll far more disturbing - mental pain being my Achilles heel. While I was able to return to work fairly quickly, it was hard to be inconspicuous, walking around the Hospital on crutches. There were the predictable queries of concern and it didn't take long for me to tire of telling the true story which was not just unflattering, but in reality, totally humiliating.

"You just fell off your bike without hitting anything or being clipped by car? Say it ain't so."
"I'm afraid it is kid"
"You just went down on your own???"
Then, mercifully, people would shake their heads and walk away, no doubt muttering to themselves "The guy is a moron", quite the opposite image a consultant wishes to convey.

Within days I abandoned the truth and went creative:

 "I was jumped by a group of angry Neurosurgeons in the parking lot and had the shit kicked out of  me."

Each successive recount inspired more detail, along with a better explanation on what provoked them to do so. (I later noticed others doctors were steering wide to avoid the Neurosurgeons in the hallways.) The patients, burdened with their own challenges, could have cared less, if they noticed at all.

Unable to ride even a stationary bike, I had to find something physical to do. Swimming was recommended but I could not do so because of two torn rotator cuffs I was to have had repaired earlier last year, but for reasons too embarrassing to discuss, I bailed on just before the surgery. Seeking relief, I mentally scrolled back through all my previous physical passions, and eventually hit on an old friend of mine of whom I had never soured: Dirt.

Georgia Dirt Angel

I have always loved Dirt, and have messed with it in a variety of creative ways. I began manically digging  in the back yard when I was a toddler. Before the age of 5, my brother and I tried to go straight to China through the earth's center. Our parents brought that saga to a close when they decided  we were ruining the yard. I remember being far more upset by this unfair restriction than my brother, who clearly had a more keen sense of order. When under performing in Elementary school I was chided by my parents  I likely would turn out to be a "ditch digger" which, to me, seemed to be an ideal vocation

I never lost my love of the earth. Early in Med School I took up gardening and eventually completed a 3 month course to become a 'Master gardener'. I was introduced the science of dirt composition and how to best amend it. 'Dirt' became passe, the proper term being 'soil'. I know the difference but still prefer to call it 'dirt', no matter how alive it has become.

As a cripple I was able to hobble around the yard and work in my gardens, focusing on bringing the dirt to life. First I  constructed two huge worm reservoirs adding everything necessary to have them teeming with worms in short order. Charlotte gave me a small bench I could slide around on, and I spent hours removing EVERY weed in each bed. 'Compost' was delivered by the truck load and it was not much of an athletic maneuver to get on my tractor, which has both a front end loader and a large tiller off the back. Slowly I began to find my physical rhythm: Weeding, tilling, then adding  the worms and compost, working both in by hand. This was just enough activity over a long period in a beautiful setting to prevent total mental collapse.

In early Winter I was cleared to walk and even permitted to ride the bike, with the worrisome instructions not to fall off for 2 years?? I started on a pitiful recumbent stationary bike, then the rollers and eventually the real bike. With such a long hiatus, it has not gone well, note earlier allusion. Many body parts seem to have stiffened and it has been difficult to stay on the bike long enough to make significant gains. Being a permanent "geezer" seems a real threat. Perhaps I have placed too great an importance on physical conditioning, but it has always provided me with a type of grace, now gone. Once a very fit, legitimate rider, flying high and heading across the USA, I am now older and slower; literally and figuratively, back to ground zero. Spring is here and that will change.

* George Harrison  Abbey Road Inn