Mr. AMA

Marvin died a couple weeks ago. Ventricular arrhythmia. Cardiac arrest. He drank and drank until his heart was a flimsy plastic bag full of blood. It stretched and reshaped until its electrical wires were shot, and V-Fib was an inevitability.

Marvin got shocked, and Marvin came back to life. To what life, you may ask? Back to a couple fifths of R&R a day. Back to living in the woods. Back to bed bugs and lice. He returned to the hospital 8 times in a month, flirting with cardiogenic shock each time. Eight times he left against medical advice, opting instead for his own intoxicating brand of medicine.

So Marvin is back in the woods. And Marvin will die again soon, I'm sure of it.  Each day he knowingly sips a bottle of his own demise.

It's a strange thing to have the foresight of someone's death, especially when it seems avoidable. It doesn't sit well.

Soteriology

Snap, crackle, pop. With each compression I felt the man's chest wall crunch under my weight. I straddle the side of his bed, my knees resting against his yellowish, cold arm, my feet dangling four feet above the fluorescent-lit floor.  This is the most violent and barbaric act I have ever performed against another human being. The irony of prolonging a life. 

I balk at the phrase "saving a life," because no such concept exists. We prolong, not save. To think otherwise demands a hubris and carelessness that I refuse to entertain. The man whose rib cage I destroyed was "saved." Twice. His heart failed his body completely, and twice restarted, albeit with the aid of copious amounts of epinephrine and electricity. Success is measured in heartbeats.

In the aftermath, once the obliging mob vacated the scene, he remained alone. I stood at his doorway a while and watched him. Propped up in bed he almost looked human. Air entered his lungs again, now through a beeping machine. Color returned to his face, highlighting his pencil-thin mustache. Blood surged through his half-starved tissues once again, like a flooding river washing the debris and detritus downstream. But this river flows in a circle. There is no delta, no escape. 

I watched this man, knowing he was in the final moments of his life. We had paralyzed him, broken him, and prolonged him. We had traded his body and his dignity for an extra hour of chaos. This brand of salvation, I think, may be the most powerful drug we feed the dying.

Wet Vet

I saw a veteran the other day. He shuffled into the room. Parkinsons. He had a rash on his rear-- dry hypertrophied skin with a small amount of ulceration and dried blood. When I asked him to drop his trousers to examine him he wet himself.  All over the floor. Then, we biopsied his ass rash.

This man likely served in Korea or WWII. He served his country. Now he has trouble walking, has trouble controlling his bladder, and has a chunk missing from his backside. Dignity is a fickle thing.

I think when I was younger I had a fixed view of what a "veteran" was. Young people often have fixed views, you know. My view was, shamefully, one of superiority, perhaps even one of scorn, for those who chose the military life. But these men and women deserve honor and respect, not merely because they donned the uniform, but because these are men and women.

Solemn declaration

I have now declared the deaths of two people.  I don't think it's something I could easily get used to.  One of them was in her late 20s, and I watched her grieving father fill out an autopsy form. He said to me, "I never thought I'd be doing this," and I had no words for him.  I watched her grieving mother sit by her bedside for hours after she passed, weeping and talking with her.

Parenthood scares the hell out of me after moments like this.

X-rays from Beira

Often mistaken for an effusion (note the costophrenic angle is clear)

 TB: numerous cavitations with an obstructive disease picture

TB: just a mess in so many ways.

Fascist Train Ride?

I approached the dusty station before the sunrise. The gates were locked, but a mass of people had already gathered-- men and women sitting separately in the dirt with an assortment of makeshift bags and luggage; baskets of fruit, vegetables, peanuts, a few chickens gripped at the ankles (if chickens have ankles).
The sun came up slowly, shedding a grim and reluctant light over the scene before me. The Train came into view between the station bars. This was no silver bullet. The cars visible did not shine or sparkle in the morning light. They were rusted, busted metal tombs with sliding doors and one small window a piece. Storage cars. Cattle cars.
The guards called us to attention. In an instant two lines formed at the gate-- one for men, the other for women. Visions of the Holocaust swept through my mind. Was I to be deloused as well? Was my destination Nampula or Auschwitz? I no longer knew.
Hasn't man advanced sufficiently such that he no longer subjects his fellow man to such harrowing mass transit? Don't they see the parallels? And what's more, I had PAID to be treated like cattle, like a prisoner of war, like so many victims of genocide and Nazism. Oh Capitalism! Fiend of Fiends! Thief in the Night! Have you no scruples? No respect for history, for human dignity?

Of course I was mistaken.
My head and unsettled stomach had leapt far ahead of my eyes and reason. The passenger cars sat plainly behind the storage cars, previously obscured from view by the whitewashed walls of the station. While still far from comfortable, they had benches and windows. And my faith in humanity soared...

Bunny Hop

I just taught myself to bunny hop at the age of 26.
Maybe someday I'll learn to whistle.
Hope springs eternal.