⭐⭐⭐⭐⭐ The Measure Of My Days Book Report

Wednesday, July 07, 2021 5:12:16 PM

The Measure Of My Days Book Report



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BARBARIAN DAYS by William Finnegan // MARKO BOOK CLUB SUMMER 2019 Beach Read

After college and her elopement with Harry, they adopted a son whom they later discovered was mentally retarded and emotionally impaired. But ALS is altogether different. It is a rare and invariably fatal neurologic disorder that whittles away at the body's functional capacities, rendering useless, first the limbs, then the larynx, and finally the muscles of swallowing and breathing. Elena had come to the second stage of her illness when I paid her that first call. I remember watching her struggle, nodding and grunting at a plexiglass message board as she tried to express herself with the remnants of a language.

Two letters constructed, then three; a word, then another, until they strung together in a simple phrase. From my vantage I noticed the panic in Elena's eyes, saw the desperation in the wave of her head. Finally she could go no further, her efforts washed away by a flood of tears. The palpable tension between husband and sister who had been hovering behind Elena now ignited into petty bickering. At that moment I vowed to get Elena a computer and find a way to make it work. After several phone calls and a long talk with a local computer aficionado a plan was hatched: we would need a Macintosh computer, software that displayed a keyboard on the screen, and a pointing device that responded to head movement and a puff on a straw.

How long could Elena maintain the necessary strength and head control, or have the lung capacity for puffing? I didn't know. When the materials finally arrived, I brought my computer to her home temporarily while I hunted for a loaner, just to get her started. And so began my early morning junket to the office in search of a computer from my personal use. Despite telephone calls and a personal visit to the Kodak Center for Creative Imaging in nearby Camden, I could not secure a computer for Elena.

A week went by without leads. I lost patience, sunk into despair, imagined myself "The Writer" who had sacrificed his principal means of self-expression for his patient. It was a lovely, romantic, ennobling thought until the reality struck home: my computer was allowing a dying patient, with no use of her limbs or voice, to peck a bare-bones message--nothing but the basics of need and desire--to family and home health aides, who waited with Job-like patience at the computer's side. In a few days, Elena developed a head cold. The abundance of mucous and saliva, difficult to clear or suction from the throat under the best of circumstances, was now audibly gurgling in her chest, and causing her, and those around her, untold mental anguish.

Elena once confessed to me, while speaking of her prognosis, her two greatest fears: choking to death and dying alone. Before I could return a telephone call to the family, they had summoned the ambulance and whisked Elena to the hospital, where I would care for her over the next five days. It was a trial run, working out the kinks for the more urgent journey they saw looming ahead; Elena's X-ray, blood counts, vital signs were all normal, and she happily discovered the security and attention that a hospital could offer. The oxygen and IV antibiotics had done little more than justify the necessity of her admission.

In the meantime, I seized the opportunity to take my computer back and puttered happily on it for the few days that Elena recuperated in the hospital. As the discharge date neared, I explained to her that I was looking for a larger screen, something easier to work with. True, I admitted to myself, but far-fetched. Three days passed and still no computer in Elena's home. My great pleasure--my mornings at the computer--was now guilt-ridden by the injustice: I had stolen Elena's computer for my own use, solely for the recreation of it. I must give it up Five days after Elena's return from the hospital, I brought back her Macintosh with apology and regret.

I watched intently as she marched the first eleven letters onto the screen: nice machine. Red-faced, I now felt redeemed by the Elena's quick, accepting smile. For whatever the reason, after the computer, after that trip to the hospital Elena changed. For the first time in months, she asked to leave her home in order to visit her mother in a nursing home. She typed messages to her nurses, a moving account of which was reported to me yesterday.

When asked about the most difficult part of having ALS, she listed, first, her inability to speak; second, her struggle to get an itch properly scratched. Now the computer sings sonnets for Elena. And in the past two weeks, there has been new movement, rediscovered strength in those stubby fingers, in her limp and dangling legs, and a growing stamina for holding herself erect, a posture essential for puffing at the computer.

But recovery is virtually unknown in ALS. Elena attributes her improvement to the oxygen she received in the hospital, reading somewhere that patients with multiple sclerosis benefit from hyperbaric oxygen. If not from that, then from the antibiotics. What Elena has "recovered" from, at the very least, is the hopelessness of her condition. She has reclaimed a life and the possibility of living, perhaps more fully and for however long, in the good fight against her relentless slide toward that moment when at last she will be stripped clean of all her capacities.

In her trip to the hospital, Elena had faced death and flown home again. And she continues to live, ever so convincingly, with the love and attention of her husband, son, and caregivers--and with that homely little box that has given her a voice. After returning from three days of vacation, mounds of charts towered above my desk and clamored for attention: abnormal laboratory tests; requests for disability reports; phone messages from visiting nurses and referring physicians; phone messages from patients needing a clarification of their prescriptions, their diet, their progress, all begging for "only a minute of your time, doctor. Before breakfast with Lindsay and Clare at A. No doubt I will disappoint her; my role is peripheral, just a twelve-hour plug in the hospital dike.

It promises to be quite a year: I am the reputed age of Jack Benny and will engage my fortieth year in a few fleeting months. But more ominous is the failing health of my mother. She convalesces now in a nursing home, following surgery at University Hospitals to evacuate a blood clot beneath her skull. She had fallen at home, a victim of her drinking and memory loss and poor balance, all of which will continue to plague her after the surgery. She will never return home. Her apartment, in my hometown of Rolfe, Iowa, lies waiting, furnished and heated and hauntingly empty. But Mom is growing accustomed to the security of her new surroundings, the reliability of three square meals and the companionship of her nurses and neighbors.

Fortunately, with her poor memory, she does not press the issue of going home. And the chances diminish with each passing day. As her life crumbles, I in turn lose that Maginot Line that separates youth from old age. Is this not the cause of the midlife crisis, rather than what they would have you believe: the slip-sliding away of your youthful dreams, or the discovery that the promise of material success was an empty one? Another momentous decision faces Lindsay and me: will we add to our family, give Clare a sibling, or call it quits in our advancing years? Our four-year-old has raced beyond infancy. Could we recapture it with the life of another, toss the dice once more for a package of healthy genes, brace ourselves for the sleepless nights and endless interruptions, scramble our plans again for God knows how long?

I am covering the Fourth of July weekend for family practice. At a moment's notice I could be summoned for a hospital admission, emergency room consultation, obstetrical delivery, medical examiner's case, telephone call from a worried patient, or a surgical assist. The beeper at my waist is the devil's plaything. On most occasions I suffer the "on-call" role gladly. Patients appreciate you more on weekends, especially the tourists passing through. The work is considered "extra," something above and beyond the call of duty, and sets the doctor apart, marks his devotion, elevates his cause, and earns his place at the banquet where the chronically overworked and underpaid are said to feast.

A beeper, moreover, provides a convenient excuse for a late arrival or early departure at the Hospital Aide Potluck Dinner. But it cuts both ways; it may equally deprive me of a moment's peace, a quiet run, a warm supper with my family, or an uninterrupted night's sleep. I have, over these last eight years, made peace with the beeper.

I now try to erase every expectation from the on-call weekend, and accept whatever morsel of free time falls my way. Before, I resented the burden, hated the patients who abused me, who got sick "stupidly" or at the most inopportune time, or who waited too long and by rights should be forced to wait a day or two longer. The illusion of freedom, the wisp of hope that I could enjoy such a weekend, became my curse and suffering. Cursing and suffrage brought me to the crux of the matter: After choosing this career, could I swallow the responsibility? But only after doing so could I enjoy a life in medicine. The idea sounds saintly--perhaps even dysfunctional, in the way martyrdom has been revisioned--but it is key to a country doctor's survival.

One patient of mine is in labor; six others rest comfortably in their hospital beds. I have only a few clinical quandaries left hanging from the workweek: a child, feverish and fussy and eating poorly for three days, whose illness I am calling viral; an emphysematous man with chest pain, right-sided and knifelike. A chest X-ray would be useless in the diagnosis of pneumonia or bronchitis, so I will treat the pain only. I am reassured by the absence of cough, fever, or shortness of breath and suggest that he take ibuprofen. A young woman with abdominal pain has defied my testing; her thick chart suggests an hysterical personality, but she rejects any suggestion that stress or anxiety may be contributing to her pain.

And she flaunts the episode when--after eleven days of hospital testing--a surgeon opened her belly and found the adhesions that were responsible for her pain. Now the family is outraged that "these doctors" cannot fix her. I am temporizing, playing for time, hoping to find my patient an honorable out when the tests return negative. She does not need any more surgery, which has already cost her several dispensable organs. But the more tests we perform, the longer the hospital stay, the more inflated the bill, the higher the stakes. And, as I am frequently reminded, tests can be wrong. Maybe this weekend I can turn the compost, mow the lawn, go for a long run, fly a kite with my daughter, treat her to lunch in the hospital cafeteria, or play long enough for my wife to make a hospice visit.

But, as is often the case, maybe I can't. It was a dismal showing, yesterday's log. A long and arduous labor ended in cesarean section at P. She had consumed most of the day's worry. She had been laboring for two days, stop and go, when I finally ruptured her bag of waters. There was every good reason to get on with it: she was five days overdue, had a ripened cervix, and was running low on energy and optimism.

When a strong contraction pattern did not ensue, I gave her a sedative. She woke up often during the night with irregular pains, and by morning the contractions were still five to eight minutes apart. So Pitocin was started to intensify the pains and narrow their frequency. It worked well enough; the cervix reluctantly widened, and by P. The deep decelerations that had plagued her earlier continued into the second stage, so I remained close by. Finally, after three hours of pushing in every conceivable position and with no descent of the head, I called for a C-section.

These are the worst of labors: hours of intense pain that come to naught under the quick and anesthetized slice of the surgeon's scalpel; fretting over falling fetal heart rates, suffering the cries and moans of the labor bed, hesitating to call for the section despite the mounting need, and finally summoning the OR crew on a sunny holiday afternoon. A doctor learns most about himself in the face of adversity. Coming to the correct diagnosis, initiating appropriate treatment, assuring the cure of a patient through the glorious exercise of science Most of the time, the patient gets better regardless of what we know or do.

After a few years in the trenches, doctors face this truth and adjust accordingly. The more basic need is for companionship in the patient's struggle. Our patients ask us to help them bear the pain, quiet their fears, face the certain diagnosis of cancer or an incurable condition. Often our own bellies tighten as we see ourselves, or our families, in the frantic eyes of the patient, and we shudder at that reality. I cannot sit with a laboring mom without reliving, in some small way, my wife's three hours of pushing before the birth of our daughter. I cannot erase the anger of patients or their families who felt I hesitated too long in ordering a C-section; cannot forget the limp and ghostly babies I have pulled from between their mothers' legs after a series of deep decelerations in the fetal heart rate, or the embarrassment of calling in the surgical cavalry only to have the mother deliver in the wings of the OR.

Any doctor can make the right diagnosis and do the right thing; our regimented training secures that claim. But how do we, individually, connect with our patients, knowing when and in what ways they will need our support, our frankness, our heavy-handed opinions? At best, I serve as their guide. Doctors have grown familiar with the terrain of pain and fear. Patients trust us to stare without blinking at their base instincts and unguarded moods, having seen them all, having grown accustomed to our own. We are expected to recognize the truth of their lives without messy revelations. Surprisingly, we sometimes do. But these understandings cannot be taught in the way a skill or technique can be taught. They are not a shamanic gift.

They rather emerge slowly over time to those who outlast a million complaints in a thousand stuffy exam rooms, over the wail of toddlers, in the instant before the patient permits your escape. It is a waiting game out there along the parade route of cures and declines. Of the many chores I had hoped to accomplish yesterday, I succeeded in finding only fifteen minutes for the compost. It is now a dense, rich, aromatic mixture of grass clippings, leaves, kitchen scraps, and other organic debris. How satisfying to watch nature digest itself. I enjoy the outdoor, backbreaking work, the steamy stench of it all, the smell of silage wafting from my Iowa boyhood, this tiny token for the environment.

Now, if only our manure man would deliver, our compost could attract even fatter worms, which are the gardener's benchmark of good soil. Of course I lay no claim to the title "gardener. I am here for the spading, the lugging, the sheer progress of it all. You cannot take the farm out of the Iowa-born boy. The most depressing part of the long weekend was yesterday's endless showers. Lindsay played Leonard Cohen and we ran the furnace to lift the damp and chill; at noon it was fifty degrees out of doors. Last night we celebrated an Olde-Fashioned Fourth by racing around the backyard with jumbo sparklers. Afterward, we hunted for night crawlers. Clare is unabashed about grabbing almost any slithery thing except slugs, which she prefers to skewer with a stick and is apprenticing in the art of hunting crawlers.

The key, of course, is to search on the eve of a steady rain, shortly after dusk, skimming the beam of a flashlight over the bare earth. First identify the tip of the crawler, then swoop toward the end nearest the hole. Crawlers escape at lightning speed and exert a tremendous pull once they have gained a toehold. A soft approach and quick wrist are the essentials of the art.

Yesterday morning I toured the hospital, visiting my convalescing patients in the ICU, OB department, and medical-surgical floor. In the afternoon, I admitted a patient with severe bullous emphysema, saw another with lobar pneumonia a dwarf known as Yoda in the nursing home in the emergency room, and consulted on an orthopedic patient with delirium. The hardest part of the weekend was OB. When obstetrics is good, it is very, very good, but when it is bad it is horrid. My patient presented to OB at Sunday evening, with a recurrent, irregular backache that had deprived her of sleep the night before.

Now her cervix was seven centimeters dilated, membranes bulged with each contraction, and we conspired to rupture them, thus calling labor's bluff. Active labor ensued. By P. Almost the same history, I recalled, as the patient we sectioned two days ago. We prodded her into a squatting crouch next to the bed, then onto her hands and knees, and finally into an upright sitting position supported by a horizontal bar. She simply could not budge the head beyond the narrows of her pelvis. Stuck, frustrated, exhausted. I stayed with her throughout most of her gymnastics, coached and supported her in labor, tried not to show my concern when two hours had elapsed, then another half hour, then another.

Finally I approached her with the options, waited for her nod of approval, met the eyes of that wide gentle face now drained of all vitality and dotted red from pushing. Labor wound down to this moment of truth, when the patient and her doctor abandoned hopes for a "natural" birth. It had been a good, hard, well-managed campaign. Why a baby cannot pass is almost never known, hence the vague alibi "failure to progress. Questions gnaw in the minds of the doctor, the mother, her family: why did we fail; should we have persevered longer, intervened sooner, tried one more maneuver or an aliquot of Pitocin? I return to the medical-surgical floor at A. I owe my mother a telephone call. It has been put aside for two weeks as one day's duties have spilled into the next.

But her forwarded mail--volumes of Medicare and Blue Cross "explanations of health care benefits"--jogs my memory. As Mom's power-of-attorney, I also collect her interest earnings and dividend checks, money that offsets the high cost of convalescence. On my last visit to Rolfe I finally looked squarely into her finances. She had been after me to do it for years, wedging her requests into the first fifteen minutes of every visit home.

Mary and Rosella my aunt and uncle, our closest relatives will take care of the funeral arrangements, pick out the dress, see to the obituary. Just don't you kids fight. I spent two hours in a stuffy cubicle at the Rolfe State Bank sorting through legal documents from the family estate. It was, in ways I could not have imagined, a nostalgic time. Here was material proof of my father's hard work and devotion, the evidence to support his claims. I was twelve years old the year before he died.

How clearly I can remember the five of us seated around the supper table, listening to my father's declaration, while his hand hit the table like a gavel, "I just want you kids to know that, when I die, you will be well taken care of. When I die! We might as well worry, as my mother once did, about being nailed by falling Skylab debris. But there it was, irrefurable proof. After his death, our material lives marched on: we still vacationed at Lake Okoboji, bought a new Chevrolet every third year, pursued our college interviews, received help with mortgage down payments and the much-needed checks at Christmas time and after the arrival of our first child, Clare. And still there was an estate, built by my father during a scant fifteen years in general practice, and preserved by my mother with the motto "Never go into principle.

It was, to an older generation, proof of parental love, of family values, of duty and devotion, of a responsibility fulfilled. It sustained my sense of importance, the feeling that I was set apart, endowed, heir to something beyond a tiny farming community and the glory of high school success. I am sure that love and attention and sacrifice were the active agents in the creation of what is now popularly called self-esteem, but accomplished with an impressive sleight of hand. I never knew it then. And what remains is my parents' estate. So now, as I handle my mother's retirement checks, earned on the house calls and home deliveries that took my father from us, I have a greater sense of their love. These are not a substitute for horsey rides on my father's knee, or whisker rubs, or home movies in which I was the star, but they are love just the same, in a different package.

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