05-SEP-A-17

TODAY’S CLINIC HAD A GATEKEEPER FILTER,

AND PROTOTYPIC PATIENTS “NORMA” WHO

RELATES TO ME THE STORY OF “PINEAPPLE”

WHILE THE “TAG TEAM” MAKES A FLYING VISIT

WITH THE BRASS GENERALS AND TV CREWS

September 15, 2005

            We saw fewer patients today, since we had a hard-nosed set of gatekeepers, who were commissioned to filter out the “candy store is now open for freebies” drug seekers.  We wearied of being taken advantage of by a few folk who came out when the first rock was turned over and out crawled a group who would come out and give high fives outside yelling “I got mine!”  With a bunch of pill bottles in hand, most made out for Vicodin, Xanax and Soma—the “Louisiana cocktail” that is so irrational that someone has had to make that up and push this irrational blend for the sake of pure profiteering, these patients were assured at the gate that we were not in the at business and would like to discourage that sort of drug program here or anywhere.   So, the patients we saw had a need for our services by the time they were permitted to get to us at the tables inside the school cafeteria where we and our drug stocks are located.

            I did not tell you about two unusual requests that came along yesterday—one from a staff member and one from a patient, both of them rather archetypical in their appearance and request.  The first was a big ICU nurse (and I do mean large) who raised here hand during the general muster, and asked: “Since you are saying security is getting better so that we can go in convoy with the sirens and flashers of the emergency vehicles without necessarily having an armed escort fore and aft, can’t we just take a bus and ride around?”  At first Colonel Beach did not understand, thinking she had meant she was uncomfortable in the back of an ambulance and wanted to be in an escorted bus, many of which are now being brought in.  “No, for sightseeing!”  I was amazed at the naiveté and outright out loud request.   “No way!” said Beach; “Security is no where near that good and New Orleans is still shut down and even this area is under curfew.”  He might have added  “What are you thinking of?   Do you want to be one of the rescuees rather than a rescuer by getting lost, mugged or otherwise troublesome in the heart of the free fire zone where you can be no earthly good and a whole lot of trouble for people who have quite enough to do already?”  That was the request of the frail nurse anesthetist who was with us for only a couple of days agitating always for an independent and escorted flyer into New Orleans flooded out zone “So I can see it.  I came down here to see it and I don’t want to go back until I have seen it, but I am not doing anything here so I want them to take me over there now!”  She was shipped out on the earliest return flight.  And we still have people who seem to be the least fit but are curious about what it is like in there and “just want to see it.”

            Second was a “hottie” in a short skirt and sleeveless tight top showing a lot of highly decorated skin.  She was sent over to me with her Honduran boyfriend with whom she was living since she came from the Algiers district which is off limits for returnees where only one of thirty houses has any resident according to the Red Cross worker who went door to door in search of any resident who could not get out. The Red Cross Worker said the mud had receded leaving a lot of slime, and it looked like a neutron bomb aftermath since it still had structure but appeared lifeless.  She still found two elderly people who had declined to be moved out but who needed medicines, and she was going back there.  That annoyed the young chick who had once worked as a cosmetologist, and in her off moments she had her friends and coworkers tattoo her with a lot of abundantly evident body art.  She had an otitis externa for which I got her the Otic Suspension of a combination of antibiotics and steroids, and she also needed immunizations.  That posed a problem.  The Hepatitis A would go in one arm, and the tetanus in the other.  On the left arm there was a voluptuous nude, and the Hep A might have to go smack into her nose, but on a compromise, we pierced the nude tattoo’s ear on one side, and on the other arm we did the opposite ear of the other nude tattoo.  For me, it was a little like “coapting “ the tattoo skin lines in the last of the goiters I had done thyroidectomy for in Eritrea, hoping that an additional skin marking would not add any other meanings to the tattoo inserted by a western hand.

PATIENT “NORMA” AND HER NEIGHBOR “PINEAPPLE”

            Our “Bravo group” clinic at Lincoln Elementary was a point of pride for the brass to see and tour and they were coming down from Maryland in a special plane with the TV crews and print still photographers and reporters accompanying the TAG Team= Tactical Adjutant General.  I was talking with Norma when the whole crew moved in unannounced and swarmed over me and her.  But her story is more significant than the circus around us.

            She had run out of medicines since the last time she went in to get them done, just her Glaucoma eye drops cost over $60, so she had to postpone the rest.  She had high Blood Pressure and needed medicines for that as well as her diabetes, and she had a coronary artery bypass two years ago and needed Nitro four times since the Hurricane.  When the storm was coming, she prayed to her Jesus to take care of her house, and especially her neighbor Raymond whom they all called “Pineapple” since he only had one leg and could not get around.  She and all four generations of the family around here whom I saw and treated today were packed not a vehicle and drove fourteen hours north to get out of the storm’s path and found themselves in Alexandria exhausted.  But they were also worried about their little shotgun house and the neighbors like Pineapple who could not get away, so after only three days they made the long fourteen hour return trip to see that their house had little enough storm damage—only the air ventilators of the bathroom had been torn off the roof and a little leak was suspected “But you better believe, I am not hauling my big fat ass up on the roof to patch it up or put a tarp up there Child!” she said to me with a big laugh.  But, her house had been broken into and ransacked and almost everything taken and carted away—her grandchildren’s toys, and the trampoline in the back yard (not an easy carry) and the Microwave, her principle cooking implement (take it from a bachelor cook, I know!) and the TV.  But although the kids were wailing with their loss, Norma hefted her bulk down the steps and waddled over to the neighbors’ to see if she could find Pineapple.  The neighborhood was all ransacked and looked like the march of Sherman across the South with all doors hanging askew off hinges and the stuff of their meager lifetimes missing, as were all the people.  They did hear that Pineapple was found later.  Pineapple was one of the bodies found in the SuperDome after they evacuated the refugees from the interior to ship them to Texas.  There was lonely Pineapple, with no one to recover him but his neighbors all of whom had fled, and he had apparently been picked up by the police and brought to the SuperDome where NO one had looked after him or cared, and he was found there among the litter after the crowd of those still living was moved out.  Raymond, alias Pineapple, was not all alone in the world—just at the time of his death by neglect in a big crowd of strangers.

            Just as I had filled out here numerous needed prescriptions and had given her a short acting medication to bring her BP down from the stroke-flirting levels of 248/128 to a more comfortable 200.104 (probably more from having her sit and ventilate and laugh with me than just the meds I had given) the TV cameras came over to her.  She had just told me “Lord, how I love to cook for my Chilluns—and I can’t wait to get you over to my house, since I would make you up a plate of red beans that would make you slap your Momma!”  “OK, both of my Grandbabies here are too fat, but you sure could use a couple more weeks down here if I could have at you and you would go back to where you came form knowing you had crawfish the way it should be done and you would look a passel lot better after it was over.”  Then came the TV cameras, and without missing a beat, she turned to them and said right into the camera along side the Baltimore TV reporter who was caught speechless:  “You people out there listen up: the Lord Jesus is good to me and will be to you if you walk in His way.  He gave me one house and I trust in Him to give me another.  This storm don’t mean nothing if your heart is right.  You pray for each other and take care of each other the way this nice young man done in coming here to take care of me.  Now, you go and do like this fella here for someone a lot nearer to you than he was to me, and now look at him—all the way from way up there wherever and sitting here and holding hands with me like I was his Momma too!”

            The reporter shrugged at me, without a word, and Norma kept exhorting them all about how good the Lord is to them who love Him, in a moving, simple testimony that was entirely unfeigned.  Norma knows whereof she speaks, and it was more than just here blood pressure normalized and pill bottles filled that had resulted form her being here.  She did not talk to them about having lost everything to looters, nor even about having lost her neighbor Pineapple from the loss of his social net which had supported him.  She only told them in accentuating the positive what I had known from having previously heard the negative that she knew what she was saying.  And she wants to fatten up her “nice young doctor” (who just happens to have a few years up on her, but cannot compete in the avoirdupois department)—she came to this clinic hoping for a little help, but not without planning to give back double.  “Gifts from the poor.”

            I shook hands with both General Flynn who was bragging to the TAG General Veach I had recognized from the sendoff handshake at the Martin State Air Base as we boarded the C-130’s  (about four months ago, it seems) about a prior patient he had seen me treat two days before when he had made his only other visit here, as he was escorting the TAG Team and would go back to Maryland with them and the reporters to day.  As abruptly as they had arrived, the entourage left, leaving me with Norma’s kin to treat, and to introduce them to a truly “nice young man” (despite that designation she had applied to me) who looks remarkably like my son Michael.

            Ryan Hebert was born about three blocks from here and then moved at age three over to Crown Point.  His granddaddy trapped on the land they now live on, and as a high school student he himself had packed off nutria pelts to sell as a way of getting through school.  Now, grandson of a Homa Indian and Cajun parentage, he is a Yale University rising junior medical student, the kind of success story Norma had been telling me about that she hoped for her athletic grandson who would be going “to college ‘sho  ‘nuff!”

            Ryan will shadow me here in his own territory and we quickly got the clearances to have him do so despite the all-Maryland restrictions so far for the matter of licensure and liability risk.  He has a story of his own.  He had been a sophomore last year and they were being taught physical exam techniques.  On the subject of the male genitalia, the instructor Dr. Foster told the male students, “Now you go home and examine yourselves the way you will be examining the patients tomorrow.”  Ryan did so, and found something he thought unknown and came back with his findings.  “Right!  Every Sophomore always gets every disease he is just then studying, Right?”

            This one was a pure embryonal testicular carcinoma.  He had orchiectomy and a periaortic node dissection with 23 nodes negative.  That knocked him back a bit in his school term, and at Yale each student has to do a thesis.  His will be on B-cell enhancement of T-cell response to HIV and he will go back in October to New Haven to work with his “PI” Principal Investigator.”  Meanwhile he came home to Crowne Point and drove over in his truck since he had remarkably little storm damage there and knew this neighborhood as his birthplace was particularly hard hit and had stopped in to help. I had talked with him about my experiences abroad and here and the common threads of each and had told him that the most valuable teachers that a young medical student could have in an impressionable time in his career would be a great teacher like Norma.  So, I had talked with her at length and now sat down with her and him and transferred her to him to continue the dialog as I worked with her daughter and her kids.  They are real neighborhood folk, and I was impressed to see that Ryan was getting really into it.  He came to me and said “I will be over again tomorrow as soon as I can.”

CHAPLAINCY ROUNDS

            Chaplain Captain Shane Pair of the Arkansas Air National Guard 188^th Fighter Wing came over to see me as I was talking about the weaponry the troops on “Amber” alert have to have within arm’s length—a clumsy position to be in when lifting boxes with one hand dangling an M-16 with its knobs and levers clanking into every elbow, knee or other sensitive parts with a loaded clip swinging around and digging into things.  We were talking about the kind of things the guys seem to like to hear best (deer hunting, fishing and the world record brown trout of 39 pound 8 ounces from the White River through Fiddler Arkansas.  The chaplain came to me and I told him about the transformation in the troops just shipping out today who were my guard until day before yesterday and their view of Islam having returned form Iraq an dour later off-loading the Islamic Zakat truck’s donations.  I also told him about my private crusade against the predation on the poor of the “pain prescription pills” rip off.  I introduced him to the psychologist Eric from the Annapolis Naval Academy and the Psych Nurse Bill Bean from Garret County who have been talking about a post-Iraq debriefing session for the troops as they are about to go home. That is being set up among the three of them.  Capt Pair and his wife are both pastors, and I mentioned to him I had heard about his marriage ceremony celebrated at the Ames Elementary School yesterday and showed him the pictures I had taken. He had an interview on that and wanted me to forward the pictures and story to his information officer.  I will try to do so.

 It was about time to pack up for the day form clinic. I had one more pair of patients, who were two guys who seemed to be an “item” who had houses in Algiers although they are not yet allowed for a visit, and closer here in Marrero where they are going to visit.  They had seen it, and were amazed that with about a week’s work they could fix it up, and they had a for sale sign on it as the hurricane had hit.  The woman interested in it was calling to ask if it were still for sale, since there seems to be a boom time for housing in this area and the price might actually rise!  The two guys had just returned from Houston Texas and told me that they were overwhelmed with what the people of Texas had done to receive them.  They would go to a restaurant and order dinner, and when the bill would come Frank would produce his driver’s license to prove the identity on the credit card, and when they saw the New Orleans address, the maitre‘d would rip up the bill to say it was on the house.  This happened repeatedly.  They were grateful for the public response, and eager to be back to see what was left of the two house life they had hoped to join into one residence. It sounds like they may actually come out ahead.  Some are lucky.

A “SEPARATION ANXIETY” AT AMES SCHOOL

As we made our escorted trip over to Ames School, the site of yesterday’s wedding (a total of over $750 has been raised from the group for the young “couple plus two” along with a prospect of a job for him) when another drama began to unfold.  The group all posed with the Hummer and the centerpiece one of the spacier young women had “adopted.”  These are the same people who had been on such an emotional high after the tear-jerking wedding that they were going to pull off another “salvage.”  The group had a dog come in to the school and the one girl had adopted it, named it Katrina and had planned to live happily ever after with this non-mutt whom she planned to carry back with her not only just on the bus, but into the Hospital which we are using as a hotel and then through the military facilities and onto a C-130 and carry home “Katrina” as her own private “rescue.”  The dog is obviously not a stray, but belongs to someone who has been feeding it for sure, and just happened to stop off in the school to day whereby there was instant love and affection with this young girl whose fiancé had just propped to her before she had come down here.  Her expectations were a little unreal.  But when they posed for a picture and she picked up the dog and carried him onto the bus, Roy Smoot went ballistic.  “The dog is off the bus, or the bus does no move.”  He asked Carreno who is that group’s Team leader to handle the situation and Carreno replied” I can’t do anything with her.”  She would not leave with out the dog, (probably “dognapping”) and the bus could not leave with the dog—remember there is no history of the dog’s rabies vaccination or any other public health concerns which make grabbing a dog off the street anywhere a rather unrealistic idea. She was inconsolable and was mourning this cruel reversal of fate that had dashed her instant dream of having a dog named “Katrina.”  But the dog was evicted and she came back with a very bad view of this whole trip based on her disappointment of an unrealistic plan of her own to “adopt” a dog (and how irrational can petophilia be is well known) named, of course, “Katrina.”

AND, NOW, A DREAM OF MY OWN FULFILLED:

NO, NOT JUST THE SPARE RIB DINNER BY THE EMERIL CHEF, BUT A GOOD RUN, AROUND THE SECURED PERIEMTER OF THE HOSPITAL WITH A PICKUP RUNNING MATE NOT ONLY FROM MONTGOMERY COUNTY—BUT ETHIOPIA!

I am just in from an hour run—around and around the guarded perimeter of the hospital and its adjacent office building and parking structures. I had hoped to do this for the two weeks I have run not a single step while gorging on the ever available fast foods and snacks and getting no exercise after consistent fifty mile weeks.  When I went out front to try to ascertain the legal limits of the secured perimeter, I met a pharmacist from Montgomery County (the only other fellow County person I have found here!) and on the run I asked him where he was from.  “No where you would know!”  I said: “Oh?  Are you Amharic-speaking and possibly from the Ethiopian capital of Addis?”  Bull’s-eye!  So we had a good long running conversation to be followed tomorrow also on the run.   Kassa Mesfin is going to run with me and we will talk further about political and medical events in Eritrea and Ethiopia and I will show him the photos I just happen to have with me! 

So, life is good, as Norma has reminded me, (unless of course, you are a dog lover with an illicit adoption of an uncertified pet named Katrina, in which case life is also grossly unfair to one’s dreams, whoever poorly though out.)  Life is normalizing around me in Jefferson Parish and I am told the postcards I had written and stamped may even be picked up out of the mail drops my patients have carried them to some time next week.  The clinic is being “routinized” and we are screening out some of the most egregious “drug-seeking behavior” to prevent our being exploited for the same kind of advantage taken by those who preyed upon these poor people before our arrival.  But there is a spirit of uncrushable faith and optimism in some—the indomitable “Norma’s” of Jefferson Parish—who is my neighbor, now that Pineapple is gone from her life.

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