Monday, July 22, 2013
The View from Above
by Liam Heneghan
Every year, for a number of years, I received a letter about my body from a man who was neither a family member, nor an especially intimate friend. Invariably they started: “Dear Liam, thank you for your recent visit. I am happy to confirm that you are largely in a healthy condition.” The earliest of these letters was handwritten with a fountain pen, as if to confirm that, though not physically remarkable, I was nevertheless, in his eyes, a very special fellow.
The greetings and general summary thus dispatched, he would describe my physical condition meticulously. I was taller, by an inch, back then apparently. Perhaps I am not physical shriveling and merely relaxed now and less inclined to stretch to impress. On the other hand, I was less weighty back then, and having always had an ability to convert food into more me, I have slowly, and incrementally, squeezed out more Liam, becoming a shorter, heavier version of myself.
My correspondent recorded his observations on my pulse, and noted my blood pressure which was, in the old classification at least, high normal. Today, I understand, these number would be regarded with an arched eyebrow. Consolingly he informed me that “we’ll keep an eye on it.”
There was always in these letters some ominous tones, as if to say that though everything looked normal, potential horrors lurked around the corner. The price: eternal vigilance in matters of the flesh. My liver, for instance, didn’t seem enlarged. He reiterated my self-reported alcohol consumption. “You consume, you say, no more than two drinks a day.” I detected in this a whiff of disbelief, as if his intuition over-ruled both the evidence of his palpations and his ears.
His was not an especially expansive vocabulary. Once he described as “loose” both my stools and my testicles. The former condition I may have mentioned to him; the latter condition he detected for himself after each had descended like imperfect plover’s eggs into the grabby nest of his latexed hand. I coughed. By the mysteries of internal plumping something softly leapt within. I was not herniated.
Fathers should tell their sons what is involved in prostate exams. I swear I had no idea, though the terse preparatory directions make it clear. I was living in Georgia when first this test was administer to me.“This might make you tearful..”, my doctor drawled.
I was also in Georgia when I got the results of my first blood exam. This Georgian doctor, who shared a name with a major snack manufacturer, had the disconcerting habit of dictating notes to himself into a small tape recorder. “Mr Heneghan” he once murmured, “is a 33 year old, attractive, white male.” “His belly is soft,” he went on, “but healthily so..”, as if discussing a chicken he was considering purchasing for the family supper. My blood was immaculate back then. Good enough to bring home to your mother, if your mother was a vampire. Every element that was bad in blood was low in me, every good element I had plentifully. All neutral metrics hugged the center of the scale. When informing me of my chemistry Dr Snack Food whistled softly. “Well I suppose it’s your European diet” he speculated. He may not have known that the Irish diet largely consisted of lard. That being said I was dietarily more cautious than the average, eating rashers of bacon only a couple of times, at most four times, a week. “If your blood was the only thing, you’ll live till a hundred…” he chuckled, “but with your heart you could be dead in a week.” This was disconcerting news and it’s only now that I suspect he may have rehearsed it, maybe into his voice recorder, for dramatic effect.
Now, I had known for some time that I had a dodgy heart valve, but as it turned out, Dr Snack Food had inadvertently misapplied the leads on his EKG machine, and confused, temporarily, my ventricles with my auricles. My heart appeared to him as if inverted in my chest, making my prognosis less than jolly. His blunder did, however, have the salutary effect of encouraging me to have my heart more thoroughly inspected at the Athens Regional Medical Center. “At some point”, they told me “that valve will have to come out. How does pig sound to you?” I remembered, disconsolately, the bricks and bricks of rashers I’d consumed.
Later in Illinois when I started to get those handwritten medical dispatches, my doctor annually expressed concern over my aortic regurgitation, explaining to me, once again, that which I had known for quite some time that my heart was defective, a defect that would, at some point call for surgical intervention. “But not this year”, he assured me. “Let’s just keep an eye on the situation.”
The letters from Dr Chicago closed with the usual leave-takings. He’d see me again next year. Later in our epistolatory relationship when things became less cordial, at least I still had these earlier missives to remind me of the good times.
Hanging on the walls of Dr Chicago’s office were his acceptance letter into medical school, a prestigious one, and snapshots of him fishing. I will say this: the man looked good with a dead salmon in his hands. He beamed, reserving, seemingly, for fishes his broadest smiles; for the living, his face was a study in professional gravitas. From the installations on his wall, I knew what debts my payments were clearing, and what fun activities they were sponsoring. I have seen such documentation of both credentials and recreation in the offices of a couple of medical men now. What does it communicate? Perhaps it assures us that our doctors are both qualified and refreshed.
I am curious about the strange careers of family doctors. There is the frenzy of activity preparing for medical school, a ghoulish and frenetic training, a competitive and nerve wracking search for a practice, and then decades of sitting in an office listening to chesty coughs. I have always assumed that after a while diseases of increasingly higher caliber come as a relief to doctors. The exceptional occurrence of bubonic plague no doubt is greeted with subdued glee. But rare disorders being what they are — rare — a doctor may have to content himself with such things as adequate stationary, state-of-the-art dictation equipment and so on. Folksy, hand-written letters may take some of the sting out of the daily grind.
Dr Chicago was swift to medical judgment and even when it later emerged that he was wrong, and expensively so, I admired his authoritative audacity. A painful jaw, for which my dentist could find no dental blemish, became Eagle’s syndrome, a rare jaw condition. It was not, in fact, Eagle’s syndrome, but in fairness it required a new dentist to identify the simple abscess which had remained elusively beneath the surface of a molar like oil under a dust-bowl farm.
Diagnosing my ailments, truthfully, has never been an easy matter as I only present acutely. Once, for instance, my arm started to slowly puff up. Starting at the elbow, the swelling migrated down my arm like a slow moving wave before crashing upon the fleshy inlets of my fingers. My hand looked as if it were sheathed in an inflated rubber glove. A blood clot, was the diagnosis, and I was started on treatments of an anticoagulant. A few days on an antibiotic dermatological cream, which my wife V suggested, cleared that cellulitis right up, and later an ultrasound ruled out clotting. Neck pain he diagnosed as advanced arthritis, and, honestly, I thought I could just about see what Dr Chicago was talking about when vaguely he pointed at the X-rays. However, the tender ministrations of my wife V permanently relieved, in a single session, that chronic condition.
Because of her success in assessing my medical calamities, I took V with me into the Dr Chicago’s office for some subsequent visits, an arrangement more typically observed in young boys and elderly men. Dr Chicago was not a man to be easily knocked off his grave game, and he proceeded initially as if she were not there. V is not one easily silenced. Her special ability in such matters is to quiz not like just one person asking one question, but rather like an entire examining board, grilling a candidate for board qualifications. There are always at least three questions hanging unanswered in the air. Once or twice, witheringly, he answered her, and then shuttled us out of the door. What small spell Dr Chicago cast over me had been broken. What had seemed gravitas now seemed arrogant; what seemed audacious now seemed, well… arrogant. I lost confidence in him; not just in his diagnostic éclat, but in his overall medical swagger.
My epistolatory relationship with Dr Chicago ended for a variety of reasons. He set up a new practice, and moved offices. Visiting him became less convenient requiring two buses to see but one doctor. One day, seemingly out of the blue, he asked me if the letters he sent me were valuable. I conceded that they were. “Well,” he said, happy no doubt to have wrung the admission from me, “I can’t go on providing this service for free. I am asking my patients to pay for them.” In the circumstance of having conceded their value to me, it would have been difficult to declare that $25 was a little steep. So I purchased them. But now Dr Chicago’s heart was no longer in them, as if in making them part of his billable practice they lost their missionary value. Their opening salvos were no longer so chipper, their content less thorough; and no longer were there hints that something slightly apocalyptic lay only skin deep.
The end came in an exchange over my weight. In reporting my dimensions he calculated the simple ratio of my body mass divided by the square of my height to give the Body Mass Index (BMI). The results according to his charts indicated my obesity. To clarify the measurement and its significance he offered the following helpful advice. “When you are undressed, look down and if you cannot see your penis, you are obese.” I admired his return to form: this, indeed, was exciting advice. Alas, when I checked his numbers he had misreported my weight by many pounds and made some subsequent calculation errors. I was at that time “high normal”, which is quite possibly the state of my being. I wrote back to him. It was, now that I think about it, the first letter that I’d every sent to him. I reported his error, recalculated my BMI and concluded: “I tried your charming test at my first opportunity and I am pleased to report that I had a perfectly good view of my penis.”
The penis letter was the last I received from him. Mainly for reasons of proximity I started visiting another doctor in my neighborhood. He has never once written a letter to me.
Posted by Liam Heneghan at 12:20 AM | Permalink