Miranda, Carol, and the Cunning Fennec Fox, (cont)

2 May 2014

0741 hrs

            Good morning, Patient Reader.  Today the school is closed for some sort of in-service.  I think that’s why.  I suppose we could be going Communist and celebrating May Day . . .  (workers of the world Unite!) but . . . probably not.  You know; the whole Occam’s Razor dealie.

            But I am up here, anyway.  Today Austin, his Sarah, my Sarah and I are shooting the Ballerina Film.  I’ll tell you the rest of the story after we get done with all of that.  It’ll be in post-production, hopefully, by next weekend.  Pretty excited ‘bout that.

            I’m sitting here in my office, which is really just my favorite table in the Mess Hall up here at the school.  The weather is gorgeous, and the temp is only supposed to get into the low 70’s.  So I look forward to NOT having to ramble about in the rain.  Course, now that I write that, it’ll piss rain like angel’s tears.

            Well, I’m going to try to finish up with my cancer rant, here.  As you know so well by now, Patient Reader, I tend to wander in my thoughts, and digress.  I know you’re saying to yourselves, “No way . . .” but it’s true.  Thanks for your, erm, patience, Patient Reader.

            So without further adieu, I would like to press on.  Shall I? 

Splendid!

Miranda, Carol, and the Cunning Fennec Fox (cont.)

The Bodhisattva of Wisdom

            Those of us in the Neurodiagnostics Department were far too inured to the sound of bounding children at play in our bright corridors.  The hospital was loud with the relentless and frenetic energy of youth. 

            Most medical schools have three hospitals:  The main University Hospital, the VA Hospital, and the Children’s Hospital.  Thusly, medical students get a well-rounded education.

            There were no such loud celebrations at the main hospital on campus, our University Hospital.  Adults tend to hold their emotions in check, inwardly frowning and grimacing against the Pandorean Sicknesses.  They faced their demons and ghosts with stoicism; rarely did one see their hurtings displayed as tears or let’s-all-be-strong smiles, weakened by sights looming on the horizon.

            Neither did the VA hospital have loud mournings.  Soldiers, Marines, and Airmen have all learned long ago that tears, however powerful in their strange Magick, cannot raise the dead.  Silences at the VA could only be pierced by the sleeping dreamer screaming.

            We remember that Miranda will not know the things that the denizens of the VA know.  She will not suffer the loss of comrades over and over and over.  This is the paradoxical hope we have for all the Mirandas, whether we realize it or not.

            We forget that the servicemen and women will not know Miranda’s pain. 

            Am I not the Bodhisattva of Compassion?  Can I not, through Love alone, heal the broken brain?  Were I to know what Love actually was, could I amass enough to shower all, curing all?  Could I not, through true enlightenment, be Panacea?

            But I do not know Love; she is a stranger to me.  I sought her and found her and lost her and learned her ways . . . and they vexed me until they did not.  Realizing I had no control over the how the Heart yearns has taught me to control how the Heart feels the yearning.  Mine is my servant, now.  I allow it only to function as the bloody pump it is, before it became sentient a million years ago.

            Because I do not know the Compassion of Love, I must turn my face to the path of Wisdom, which I wear comfortably, like a robe.  Wisdom as knowledge, wielding it as a scalpel to excise the madness from Miranda’s brain.  Then am I become The Bodhisattva of Wisdom?  I would gladly forego my own Nirvana, my own happiness, for wisdom enough to grant wishes.

            But this is an easy sacrifice; I know that Nirvana, like Love, is intangible, and like the horizon, recedes as we approach it.

            When I must decide between Wisdom and Compassion, I conclude, rightfully in my mind, that it is only Wisdom that can cure the sick. 

            I cannot, by moving soft words over another, stunt the migrant mass.  I cannot, by the holding of hands, by the murmured benediction, by vitalic exhortation of Love from the rooftops, keep a bullet from ruining a brain.

            If your loved one becomes ill, you rattle the chicken bones over frail frames failing; I will use Medicine.

            I have heard the argument countless times:  “Studies show that patients for whom they were prayed heal more quickly than those who were not . . .” We have a term for that where I come from:  Fucking Bullshit.

            You’re mean to tell me that no one prayed for this control group?  I know folks, children especially, who pray for everyone on the planet.

            I remember Madalyn Murray O’Hare, founder of the American Atheists who died in 1995 or ’96; even she was prayed for as she was dying, despite her protestations, otherwise.

            I am of the opinion that christians do this maliciously.  Not all, just most.  They pray for atheists and pagans not because they truly wish the “souls” be saved, but because it’s the last word in an argument they’ve already lost.

            Did y’all know that Mormons baptize the dead?  By proxy, of course.  Did you also know that they were baptizing members of all faiths into the Church of Jesus H. Christ of Latter Day Saints?  Did you know that this includes Jews who died in the Holocaust?  Have I made my fucking point?

            Knowing that Wisdom should and does override Compassion in my own self, what is it then I can give to Carol?

            I have diagnosed the daughter.  What can Carol get, she who, as all of us do, so richly deserves pleasure?  Even for the briefest of moments, pleasure is something we can cherish.

            Could Carol receive pleasure, however brief?  Could she get it from me?

            My psychological skills left wanting, I was unable to adequately discuss her “feelings.”  All I could have done was nodded and soothed; handing out my there, theres like Halloween candy.  I have a sense of timing.  I would have dispensed them perfectly and accurately like Pez.  She would have received nothing but pure and hypocritical salve from the empty words that would have soiled my mouth.  

            Would you, Patient Reader, rather hear the lie, or would you rather the truth tumble, however uncomfortably, from my lips?

            I thought so, too.

           

     Staff Notes, Neurophys consult addendum            27 May

1100 hrs

Pt returning to neurodx with increasing seizure frequency and severity.

     Pt arrived lethargic and obtunded due to post-ictal state

C/O seizures, secondary generalized tonic/clonic, circa three per hour

     Recommend EEG to r/o status epilepticus;

     Recommend EEG to rule out subclinical seizures

     Obtain EEG, please

            I read through her chart, which was still labelled with the red tape which meant, “Neurology.”  It should have, long ago, bore the blue tape indicating, “Neurosurgery.”

            “Why hasn’t she been transferred to NSR?” I asked Annie, my Medical Director’s nurse.

Miranda had come over to the NRO Clinic straight from the ER where Carol brought her.  Obviously, her seizures had worsened, and I entered into the Staff Notes the notations above.

            Annie shook her head and shrugged.  I dug deeper into the chart.  Her labs indicated a Dilantin level that would have been therapeutic had Miranda’s disorder not been intractable.

            I saw that her radiology reports did not reflect the MRI that I recommended and should have been ordered a month or more ago. 

            To Annie: “How come she hasn’t had an MRI?”

            I saw there was never an order for one even as Annie asked if there was.

            The staff notes I wrote weeks ago had been acknowledged and signed off by my boss, the Chairman of Neurology.  Someone down-line did dropped the ball. 

            I waited for the EEG and read it when it was completed.  I was not surprised (as I am never surprised) to see that electrographically, the girl had deteriorated.  The focal slowing had worsened, and the tell-tale spike/wave discharges had increased in both amplitude and frequency.  She had even had a clinical seizure while the EEG was running and the tech who took it, as was all the techs under my supervision, was an excellent historian.  She documented the eye-deviation and all the other clinical demonstrations presented by the seizure.  It was over 2 minutes in duration.  I was right.  I am always right.  This was bad.

            It confirmed, in my mind, that menacing glioblastoma etiology I suspected long ago. 

            Without an actual image of the tumor, its presence was speculation.  I knew what this was, as did my boss, surely, and his colleagues and theirs.  Helen, the wise technologist, knew it, too.  I entered more notes into the chart:

            Recommend head MRI to r/o lesion in L parieto-temporal area

     Upon imaging of lesion, tx to NSR service, please

     There.  I drew those fuckers a MAP. 

            If there is no imaged tumor, she merely has a seizure disorder and is neurology’s “problem.”  NSR, in the strangest of Catch-22s, cannot take her on.  The tumor must be imaged before it can be acknowledged, and cannot be resected until it is acknowledged.  I cannot be imaged until an M.D. writes an order for it.  Brilliant.  All we need is an M.D. to write the order, for chrissakes.

            I explained all of this, diplomatically, to Carol, who nodded in numb and weary horror.  Her dark brown eyes were not mirrored by Miranda’s, whose recessive blue peepers were a contribution form Carol’s ex.

            “Where is he?” I asked.

            “North Carolina,” Carol answered.  The state tasted like sour milk in Carol’s mouth.

            “When did he see her last?”  I asked, knowing the answer. 

            “They never met . . . He left a few days after she was born.  Never even saw her.”

            I already knew some of the rest.  Miranda was an only child.  Carol was a lovely twenty-five, going on a progeria-like forty.

            She worked as many shifts in --------- as she could get.  She worked 40 miles south of where we both stood, mere inches apart.  You could have measured the distance with a ruler.

            Carol’s sister watched Miranda when Carol was working, but since the girl’s illness worsened, it was too difficult for the aunt to care for her alone.

            “I’ll figure out what’s going on,” I pledged, “we’ll figure it all out.”  My promise was falling on ears that were growing deaf.  Carol has heard broken promises her whole, short life.

            Miranda, back in her wheelchair, whimpered from its prison-like confines.  The seatbelt needed fastening because she was too weak to sit up comfortably. 

            With so many seizures and the post-ictal lethargica that followed them, getting out of the chair voluntarily was impossible.  She would only seize, and be right back in it.

            DME, Durable Medical Equipment, of which a wheelchair is considered an item, is quite expensive, even to rent.  Carol had no insurance, and the wheelchair was costing Carol every cent of her overtime.

            My exam room, #7, was empty now, save for the three of us.  Annie had popped in and out, but had to go to the floors for rounds with Dr. ----- and the residents. 

            Carol stepped up to me and we kissed one another at the same time.  There was no mistake; no excuse.  She lunged or I lunged and the other did not parry.  I reached and willingly she came under my out-stretched hand.  Her body was soft yet strong; wiry.  She was bundles of muscle tense from fitness and heartbreak.  Her scent, gardenias and Woman, filled my aching lungs.  Her touch on me was firm and needful; she was fists and strokes and I was ready; anticipatory; aroused.

            Well, Dear and Patient Reader.  There is more to the story than I realized.  I must beak for now as the Film Project is about to begin.  Don’t worry, those of you who are into the story; more is soon to follow. 

            All of you who are not into the story, stay tuned anyway; there’s something for each and every one of you, too.

Always I remain,

The Cunning Fennec Fox . . .