I'm kind of partial to lies, myself. There's more future in them. - MARK TWAIN
Well, your pulse is great.
The emergency room nurse is bending over my foot, his tattooed deltoid rippling with fine movements of support for the hand that reaches to feel my ankle. His words, the last to come from the ER staff after a six-hour visit, are, I assume, intended to reassure, which they do, arriving like carriers of some thread of connection between us, a fellowship perhaps, a gesture both well intended and well received. And I do feel better, better able to face the tremors in my muscles, fatigued by hours of clenching a tight protection for the red-hot joint, now diminishing after the long needle's nip, the suck-out of orange reticulated fluids and the push of Novocain and steroids to soothe the singe. I am in the aftermath, in the place where the body luffs in its wheelchair like sails in a dying wind. And here, in this place, his words do mean something to me, even though I know he's lying.
You see, the problem is he palpated the wrong place, not behind the inside of my ankle, where the posterior tibial artery runs like a river of renewal, but - a common mistake - behind the outside, where it does not. That he chose to tell me the pulse was great even though he didn't feel it - couldn't possibly have felt it - let me know he meant to say something grander, maybe something that sounds more like best wishes or you're going to be all right.
What puzzles me is that even though I knew his mistake as he was making it, that contrary knowledge did not prevent the good deed from happening or being well received. I'm a doctor, for Christ's sake. A scientist. I know that he was lying, and, even knowing the lie, the lie still landed its effect. What was it, then, given the factual error he'd made, that kept this interchange from disaster?
Here was this macho kind of guy who'd just finished dressing me again around the searing pain of my swollen joint - this pox of ingratitude I received like a Job's carbuncle for trying to rescue my son - who probably didn't need rescuing in the first place - rescue him from the ski accident I imagined he was about to have, and, in my awkward fatherly haste, crossed skis with him. Hours later the crystalline ooze of malevolence that comes along with the fangs and grip of that obscure condition called pseudogout starts its sinister little game - all this has landed me securely in the wheelchair, where I was to wait another hour to be picked up, trembling in the aftermath of pain and exhaustion - his report on the status of my pulse floating in like a gesture only part of a larger gesture that signaled something to me - maybe only that I was being cared for. For although skill and accuracy were missing, intention was there. And somehow intention was enough.
So here I sit not minding the chill of my body so much, not minding the wait so much, sustained at least partly by the effort, though flawed, the nurse had made to try and make me feel better.
And for whatever the hell reason, I do.
He is the best physician who is the best inspirer of hope. - JOHN KEATS
It's the Orange Wire Problem, he said. Then he leaned back in his camp chair and looked me straight in the eye, raising one eyebrow in a manner intended to say that, beyond question, everyone should know what the Orange Wire Problem is.
In this way he put me at a calculated disadvantage, simultaneously in a state of deficiency and curiosity. I now possessed the best combination of qualities for an audience about to be abused by a storyteller.
Dinner and dominoes had been cleared away, and the fire was crackling in the pit beyond our tired, rapacious feet. Though a member in good standing in this men's club for many years, I am seldom present at these late-night gatherings, partly because I am busy being busy, partly because I felt it strange to socialize without women present. What keeps me coming back is the opportunity to play the great classics in the club orchestra, where I play French horn, and the slow discovery that men in the absence of women are very different animals. They can actually be quite interesting. Without the drive for female attention men relax and open up a bit.
It's one of the fundamental ideas of the universe, he said, half figuring we thought he was lying, half tantalizing us with a possible truth.
Then, as bait, he left a little agitated silence that called forth a feeling of awkwardness, knowing what was expected, knowing he required some kind of gesture to entreat him - just a little playful begging before he'd consent to go on.
I bit the bait. What is? I said.
Let me tell you about this, he said.
By this time of the encampment we'd already had the long dinner-table talks we always have about chemistry and health. Nicolas is a brilliant engineer, quick, authoritative, and, at the same time, an outspoken medical agnostic. Something in his past made him distrust doctors and the stuff they spew they call science. He took as his hero not James Watson or Francis Crick but Andrew Weil. He surfs the Net. He comes up with all the cancer preventatives and cures that sound, on the surface, astounding but, as I occasionally point out, lack the science to hold water.
Whereupon we would discuss again the opposing truths of Koch's postulates - the cornerstones of science, which hold that anything true is only observable as true in a strictly controlled circumstance and that it must, in identical circumstances, be able to be reproduced exactly - scientific method, in a word, as opposed to the art of empirical observation. I myself am a poet and somewhat of a doubter, one who has recognized the inadequacy of science as it is currently imagined to explain all the mysteries of the universe, and so Nicolas knew he had in me an audience that would not reject him outright.
Milk thistle. Nicolas was taking inordinate amounts of milk thistle based upon some uncontrolled observations that it was supposed to be good for the liver. It has always struck me as curious that, to use Andrew "Pop" Ivy and Linus Pauling as examples, brilliance in one area of science guarantees no safe passage to another. Pop with his Krebiozen, Linus with his vitamin C, and now Nicolas, a hard science engineer with his milk thistle. To be sure, there are, hidden within the urges and intuitions of alternative medicine, clues to the truths we seek, but, paradoxically, there is in the minds of great thinkers a nodule of inclination like a blind spot, which, when emotionally engaged, will switch on an inexplicable suspension of critical thinking.
Nicolas settled in. His audience settled in.
It promised to be an adventure into the intuitive.
My friend built a car, he said. From the nuts up. I watched him out in his backyard with parts spread all around, smoking like meteors from a lava shower. Months this way he was out there tinkering and swearing.
Nobody moved. Nick was on a roll.
It was an obsession. He skipped meals, missed meetings, let the phone ring ... Finally, in springtime, he finished. A glimmering red Maserati-like bitch of a car - and he'd built every goddamn inch of it.
I went out with him. Towed it to a spot in the country with a lot of road and not a lot of cops. Fired it up, and it ran great! Topped out at a hundred ten. Only one problem ...
Now if I'd been able to move my eyes at this point, I would have seen that our circle had grown, attracting other listeners like tufts of lint to a ball of static electricity.
Everything was great ... except for one little thing. Ran fine. Handled good. But as soon as the engine warmed up - he paused here for dramatic effect - it quit.
A little shock wave pushed me back in my chair. The old coot. We'd talked earlier in the day about my wife's Volkswagen Rabbit. Did the same thing. Damn inconvenient to be in the fast lane of some superhighway somewhere and have all your power go out like a snuffed candle. Dangerous, pretty damn. We'd taken it to several mechanics, and no one could find the answer. We quickly learned not to reveal this history of failure - which now like a strange and inexplicable pox seemed to spread by itself - couldn't reveal it because to do so would scare the next bunch of mechanics away. Mechanics hate to look bad, we found out. And the odds are, if other respectable mechanics haven't found the trouble, they won't find it either. The car might have been fixed by now, but by now it was a dead duck. Even the Car Talk guys wouldn't call us back.
Just sell it, my cycling buddy said. But the car had belonged to Joan's ex-father-in-law, and she was attached. She liked the car. Eventually, she donated it to the Kidney Foundation, since that's what the father-in-law died of. I guess it eased the pain, both ways.
Nick had heard me tell this story. He waited till now, the fox, to play out his response.
We took it to the mechanic, he said. They checked the gas cap air vent, the distributor head, spark plugs. (This was sounding very familiar.) Changed all the distributor wires. They threw up their hands.
So my friend took the car apart right down to the frame and built it back again ... Same damn thing.
So I told him, listen, what you need is a psychic. My friend looked at me like he was going to punch me out on the spot - and then we didn't speak to each other for a really long time. Every now and then I'd call him up and ask, Car running?
He'd just hang up the phone.
Eventually, he got so beat up by the failure of it all, he called me up and asked for her name.
I went with him. She said it was the orange wire.
Orange wire? Orange wire? He was furious. I built that goddamn car, he said, and there isn't a goddamn orange wire anywhere near it.
It's the Orange Wire Problem, she said.
He pushed the car into the backyard and let it sit there. He let the rain fall on it. Dogs pissed on it. He pissed on it.
Then the next spring, without any warning, he was out there taking it down to the nuts again. And there, my good friends, running along the chassis near the gear box was a little orange wire on its way to the fuel pump. Turns out, when the box heated up, the wire stopped conducting. You guessed the rest. He moved it over an inch, rebuilt the car, and ever since it's run like a cheetah. Nick leaned back in his chair with an expression of "now I've done gone and got you under my thumb" on his face.
The story needed no explanation, and Nick was smart enough not to give one. He just looked up like he knew he got us good this time.
And that, gentlemen, he said, just to drive it home one more time, is the Orange Wire Problem.
* * * Next morning at breakfast we returned, without a backward glance, to the usual, Nicolas saying he'd discovered that the PSA most doctors order is not the critical PSA, and how can anyone know if there is cancer there if you're dealing with inaccurate numbers in the first place?
I sort of knew what he was talking about but also sort of didn't. It's like knowing something lightly until the pressure comes hard and head-on, and then it seems nothing whatsoever is stored in those brain cells. And believe you me, it's kind of hard to fake it if it's Nicolas staring you down with his just-off-the-Internet knowledge about the pure direction of the universe.
I mumbled something that probably revealed more than I intended.
I'll bet not one doctor in ten knows what I'm talking about, he said.
On that I could agree. And did so. Intelligibly this time.
Richard looked at my plate. Speaking of doctors, he said, let's see if the doctor follows his own advice.
I was grateful for the unexpected assault.
Since when, I said, do doctors do that?
Eggs, do we see eggs? Richard jeered.
Yeah, but notice I didn't eat the yolks.
Nothing wrong with a little cholesterol. It was Nicolas, rising to my defense. You need some of that stuff for hormones and bile salts, he said. Besides, a lot of this fear of fats is just fabricated bullshit. And with that he held up a soggy piece of sausage, dipped it in his egg yolk, and chomped it down.
I was of two minds about that. He was right and not right. But it took a lot of energy to sort out what allowed some people to eat fats with relative impunity and required others to avoid them. I said something that approximated that idea and then skillfully turned the conversation to the Mozart Fifth Symphony, which we were rehearsing at the time and through which we could view together Mozart's youthful brilliance.
* * *
A month later on a routine blood test Nicolas turned out to have an elevated PSA. Three times normal, for Christ's sake. So I called him up.
Sounds like something ought to be done about a PSA like that, he said.
Then, because I knew he would agree in friendship and disagree in practice and run screaming from traditional medicine, I said that he should at least hear what the experts had to say.
I knew what he meant, but I ignored him. Well, there's a urologist here who not only is the reigning leader of prostate cancer surgery in the region but also embraces alternative methods of treatment.
No biopsy, Nick said.
How do you know for sure how to distinguish prostate hypertrophy from cancer?
The superspecific PSA.
I wasn't so sure how dependable that was, but on his turf he was calling the shots. Anyway, the urologist would have something to say about that.
Can I make you an appointment with this guy anyway?
No, it can't, I said. Especially since you're not going to let him go near you.
And he didn't. Oh, he went. But the advice to get biopsies and consider either radiation or surgery along with diet, meditation, and group meetings made him curdle and clabber and run the hell away.
From time to time at rehearsal I would ask if he was paying attention to the P problem.
He'd found this doctor in Boston who didn't do any of the above ... and then it got real vague about what he did do. I wasn't certain if the confusion I felt arose from my unfamiliarity with the circumstance or his.
Well, as long as you're paying attention, I said.
Oh yes, I'm flying out tomorrow. Or maybe next week, depending.
* * *
Summer returned. And with it the little wildness of men running among trees.
We've got to get this domino problem solved, Nicolas said.
Nick is gifted. He could look at a line of dominoes and give you an accurate sum of the spots in the time it took to snap your fingers. He counted "tiles." He knew what was played and what was not and pretty well figured out by watching the way you played which of those remaining were in the bone pile and which were in your hand. I can beat anybody but a fool, he said.
A fool doesn't know what he's doing. Therefore, he can't be figured out.
Men in woods. Dominoes everywhere. He'd sneak up behind me, look over my shoulder, and say, You've only got one play ... and that wasn't it. Then he'd laugh hard and long. It was funny. He was either so right or so confident it didn't much matter.
The domino problem was that our camp had not won the club tournament since old Dick Foster had won it three years running back in the eighties. We've got a tradition to uphold, Nick said. There's no reason why I can't train a bunch of you luggards to be at least half-decent.
Well, everyone but that John Chambers. And he's just plain hopeless.
John was my partner at the time, sitting across the table, and that was, of course, the reason why Nick let fly.
Oh, sorry, John, he intoned, his face beaming with unrestrained glee. I didn't see you sitting there.
Yeah right, Nicolas. Right.
We hadn't talked PSA for some time now. I guess we'd shifted into that quality of interaction that falls under the heading of the unstated agreement. Which, to my mind, went something like this: I got to say what I thought, and then he went and did what he thought. That little philosophy of behavior pretty well matched the truth of the matter, and the only consolation it gave me was that it made both of us feel like we were discharging our responsibilities.
In reality, the issue found itself among the forgotten. The problem that wants to be left alone moves from center stage to a nagging afterthought. I didn't think prostate cancer when I looked at Nicolas. I wasn't in a clinical mode when discussing cholesterol at breakfast or what breadth of knowledge or lack thereof the average physician on any given Thursday is likely to possess. I didn't know what he was doing about "the problem." In short, it was history.
Excerpted from the orange wire problem and other tales from the doctor's officeby David Watts Copyright © 2009 by University of Iowa Press. Excerpted by permission.
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