Extreme Bootstrapping

She procured the calf, raised and slaughtered it, tanned the hide, made the boots, attached the straps, lifted herself up.

Written in response to a challenge to craft a twenty-word composition, this is the story of a young woman who lost her father at age six, then through a series of family crises landed in foster care. She “aged out” of foster care at eighteen and became homeless. By some miracle, she entered college with the help of a special program the state of Virginia developed for former foster youth. She is about to graduate, carrying a 4.0, and will soon start an MBA program, probably at Johns Hopkins. She is Tara Westover of “Educated.” She is Damon Fields of “Demon Copperhead.” Extreme bootstrapping indeed.

This piece was published in the literary magazine Ink In Thirds (https://inkinthirds.org/vol-6-i-2/)

Movie Trauma

They flocked to the clinic after Saving Private Ryan, grizzled veterans awash in fifty-year-old memories. One shuffled into my office chair, gaunt and haggard, wearing a bulky foot brace, his white hair curling beneath a ball cap with a 1st Marines patch. “What happened to your foot?” Great salty droplets began to stain his cheeks. “Shot at Guadalcanal. A round hit my sciatic nerve. One year in a cast, left with a permanent foot drop. Never a day without pain since.” He swiped at the tears with one knuckle and sniffed. The wound as raw as the day it happened.

This piece was published in the online literary magazine Five Minutes (https://www.fiveminutelit.com/movie-trauma)

You Have the Controls

We flew over the Alabama countryside outside Fort Rucker, my hands resting easily on the helicopter’s controls and feet on the pedals, with my instructor pilot, Craig, watching my every move. The Virginia Army National Guard had sent me to the U.S. Army Flight Surgeon course. At the time, flight surgeon training included ten hours of flight instruction. Stick time. Most of us docs welcomed all the Army allowed. 

In aviation, when the instructor pilot says, “I have the controls,” the student pilot responds, “You have the controls,” and turns loose of everything. Hands off the controls, feet off the pedals. Pronto. 

That day Craig had asked me to fly a simple cross-country: fifty miles out, then back. As we cruised along, chatting, monitoring the instruments, we flew over an open field, plowed and ready for spring planting. 

Realize that aviators, as a cohort, run a little crazy.

Suddenly, Craig said, “I have the controls.”

I turned loose of everything. What the . . .

He banked the helicopter sharply, cut the power and pushed down the nose. We dropped like a peregrine falcon chasing its dinner. 

“See ‘em? Look.”

“See what?”

“There, look there.” Craig pointed.

I saw. Turkeys. Caught in the open in the field, an unfortunate flock of wild turkeys scurried for the treeline, trying to escape the raucous monster descending from above. 

Yes, a little crazy. Craig had decided to go turkey hunting in a helicopter or at least enjoy terrorizing the wildlife.

What, Me Worry?

Wanderlust seems to be a hereditary condition. My grandfather had a severe case that did not abate until late in life. An otherwise responsible citizen, he would disappear for weeks or months, leaving his wife to care for a slew of kids, then pop back into their lives as if he had just gone to the corner store for a loaf of bread.

Worrying may also have a hereditary component. My mother was a professional. She trained me so I became a semi-pro. But my son, Matt, cured me of it. 

He joined the army out of high school and we were off to the races. After his first tour, he finished college and medical school. A martial artist from a young age, as a medical student he boxed at a gym in inner city Norfolk. Me, a neurologist, with a son participating in a sport whose aim is to concuss your opponent. Neuroirony.

He was also a kickboxer and came home to Richmond once for a fight. He caught a foot upside the head that knocked him out cold. After his normal CT scan, I sat with him on the couch all night, where my suddenly hyperactive son said every five or ten minutes, “Let me get this straight. I got kicked in the head by a bad to the bone Thai fighter.“

What, me worry?

After internship at Walter Reed, he spent a tour delivering combat casualty care at a forward base in Iraq, where he earned a Bronze Star. He suffered another concussion in an explosion from an IED carried by a five-ton truck that blew a massive hole in the compound where he was staying. 

After he left the Army, the Peruvian guards at the American embassy in Baghdad recruited polyglot Matt as one of their docs. He’d worked hard at mastering Spanish and it now paid off. He would work three intense months then have three months off, when the game truly became Where in the World Is Matt. 

I’d get a phone call out of the blue. “Where ya been, Matt?”

“In Brazil, studying judo with the Gracie brothers.” Or, “In Borneo, working at a mountain camp. There’s three of us: a cook, a maintenance guy and me. My job is to take tourists out at night to see the big cats.” 

Or, “In Bangkok, learning kick boxing from the masters. These guys are good. One of them kicked me in the chest so hard it fractured a rib and partially collapsed a lung.” “Did you go to the hospital?” “Nah. Those things usually heal on their own.”

During one call, months after the episode, he told me about a week spent sweating and shivering through a bout of dengue fever, alone in his bunk in some jungle somewhere. Untreated. A disease with a potential mortality of ten to twenty percent.

What, me worry?

At other times, he would pop back into our lives, just like my grandfather. He’d stay a while then tell us he was taking a trip, either not saying where or giving us some destination we thought ersatz but could never be sure. This was a man, after all, who’d once gone to Kazakhstan to work as an English teacher, where he was served sheep’s eyelid, a local delicacy, as the honored guest at a banquet. There was no destination too exotic or outlandish for our Marco Polo man. Then he’d come back.

“Where ya been, Matt?” “Colombia.”  Or, “Where ya been, Matt?” “Cuba”

Jesus.

He’d long ago proven to me, I thought, that fretting was futile and useless. Then we received an email saying, “Ya’ll don’t worry but I’m in Liberia taking care of Ebola patients.”

The wanderlust at last seems to have mostly abated. He is now contently settled down with a job practicing medicine and a wife, she a fond and lasting remembrance of a past trip. 

The Star-Spangled Banner

On rounds one day at Walter Reed, a patient and I began swapping stories about pranking our kids. He laughed about his twelve-year-old son’s outrage when mocking by his friends led to a realization that the anthem’s opening line was not “José, can you see,” as his father had been singing lustily for years.    

The Missing Lip

I stared at the hole in her face where her lower lip once was, tags at the ends the only remnants. 

“What on earth happened.” 

“My boyfriend. We’d split up but he wanted to get back together. We met, started to kiss and he just bit my lip off. Clean off.” 

“Where’s the lip, we might be able to reattach it.” 

“He stepped on it. Ground it into the pavement with his heel.” 

The on-call surgeon performed an amazing Z-plasty. Made her look almost normal if nothing like her former self. She asked for a mirror, peered into it, touched the fresh stitches with cautious fingertips and made tentative mouth movements.

As I snapped off my bloody gloves, a nurse held out the phone. “It’s her boyfriend,” she said. “He wants to know if she’s going to be okay.”

Stepbrothers

The stepbrothers, one dark-haired and the other blond, became inseparable. Blackie had a miscreant streak, talked a big game but would run at any sign of trouble. Blondie, sweet, easy going and courageous never backed down.  

As they entered senescence, a stroke robbed Blondie of his mobility but not his spirit. Blackie gamely soldiered on.  

 When Blondie crossed the rainbow bridge, Blackie took it poorly. Lost his appetite, slept all day, moped around, eyes glazed over, luxurious coat turned dull and lifeless. 

 A year later, he crossed the bridge to join his brother. 

 Grief is not only a human thing.

Spreadeagled on a Rock

As an Army reservist, I once provided the medical support for the Vermont Army National Guard’s Mountain Warfare School. 

One beautiful June day they took us rock climbing. The task involved climbing up the sheer face of a rock wall about one hundred feet high. They had us roped in and dependably belayed, and with numerous instructors to advise and assist the risk was minimal. 

After scrabbling and clawing my way up the rock, I sat exhilarated on top, beside one of the instructors, looking out over the beautiful mountains. Vermont had put on her finest greenery for my visit and foliage of every conceivable shade blanketed the ridges as they marched toward the horizon.

I said, as much to myself as the instructor “That was the most fun I’ve had in a long, long time. What makes this so much fun?” 

The instructor replied, and I’ve always remembered these words, “Sir, when you’re spreadeagled on the rock, looking for a move, it’s hard to think about anything else.” 

Many people try to find a way to figuratively spreadeagle themselves on a rock, searching for some activity demanding enough concentration to quiet the everyday worries. A way to forget for a bit the rent is due. Something physically challenging but not insane, like downhill skiing or martial arts or surfing. Or something less physical but still challenging, like painting or playing an instrument or needlework.

This thing you’re holding in your hands right now has been my way of spreadeagling myself on a rock.

Short Order Heroism

“Are you a cop?” I asked the man with the gun when he walked into the Waffle House. The place was packed for Sunday morning breakfast. We were seated just inside the door, waiting for a table. The trim, short-haired, forty-something man wore a holstered pistol on his belt. 

“No, I’m not a cop.”

“Then why are you bringing a gun into Waffle House on a Sunday morning?”

That set him off. His voice rising in pitch and volume, he spun to face me. “Virginia is a right to carry state. I have a constitutional right to carry this gun anywhere I want. I served two tours in Iraq and I know how to use this weapon. How dare you question me. I am a veteran.”

Never rising from my seat or raising my voice, I said, “I’m retired military. Probably served longer than you did but I don’t go around wearing a gun.”

Cheeks colored, now screaming, his speech becoming a word salad about the constitution, guns, his rights and my ancestry.

The Waffle House grew quiet. Forks poised mid-air. People standing.

Suddenly a wall of four large, Black men formed between me and the gun nut. Waffle House cooks. Heroes.  

“Sir, you will have to leave.”

They took a half step toward him and he backed toward the door. Then another half step. The Waffle House held its breath. He left.

Breathing again, the Waffle House slowly resumed its breakfast.

Shell Shock

Walking home one day from a trip to the corner store, I spied an old man coming toward me down the sidewalk, half jogging, stumbling, stooped over, going faster and faster, his upper body stretching farther and farther out in front of his frantically moving feet as his lower body scrambled to keep up. A block away, he pitched forward onto the pavement. I ran to help and found him sprawled face down, trying valiantly to get up. His palms and elbows were scraped and bleeding, his pants scuffed and dirty at the knees. All the heave I could muster from my sixteen-year-old body helped him stand.

“Where do you live?” I asked.

Raising a trembling finger, he pointed toward a nearby house. We slowly walked there together, me holding one elbow, him shuffling with half steps, hands shaking, head bowed. His daughter answered the doorbell. This was not the first time a stranger had brought her father home.

“Is he OK?” I said.

“Yeah, he’s fine. He just has shell shock from the war.”

I concluded shell shock was some bad juju. A few years later, as a medical student, I understood that what I had seen that day was someone with the stooped posture, tremor, impaired balance and festinating gait of end-stage Parkinson’s disease. Even if his family doctor had made the right diagnosis, and maybe he did, little effective treatment existed until the advent of levodopa, the miracle drug of Oliver Sacks’s Awakenings. 

It was not available in time to help the shell-shocked old veteran.

Secret Santa

Santa has found it challenging at times to find helpers. My daughter was my accomplice a few times. My granddaughter served as wingwoman once. That was memorable. Store employees have lent a hand occasionally. But an employee snitched on me once and a manager caught me in the produce section and tried to call a reporter. 

A couple of years ago, as I ambled through Walmart scouting for a helper, past me walked an elf. I stopped, did a double take, pondered a moment then set off in pursuit. I had not been hallucinating. There she was, wearing a green tunic, frilly green tutu, red and white tights, pointy green elf shoes and an elf hat. Too good to be true. Turned out she was a patient rep at a local medical center.

She agreed to serve as my girl Friday and off we set searching for shoppers buying toys. Walmart shoppers can always use a little extra cash, but parents shopping for toys at Christmas, that’s special. Even more than buying people’s Yuletide groceries. Once slipped money to a cashier to pay for her next customer’s order. The lady tried to refuse but the cashier told her it was a done deal, so she said fine, then I’ll pay for the person behind me. 

I spied a little from around the nearest endcap, saw the jaws drop, saw the elf get the hugs, saw the occasional tears. That’s a story that will be told and a memory that will stick: “I was shopping for toys at Christmas and an elf came up and handed me money.”

Funds depleted, I engaged in a little PDA with my henchwoman and we made plans to repeat Operation Elf the following Christmas.

Overscheduled

“When could you work me in?” 

“Well, she has a swim meet that day and won’t be done till late. He has soccer practice, then a music lesson.” 

“They stay busy.” 

“They do. Keeps them out of trouble.” 

“I’m flexible, time wise.” 

“I know but they’re not.” 

“Do they ever have free time?” 

“Very little. The extracurriculars are almost like a full time job. Then there’s homework. Whenever they have a free moment, they fall asleep.” 

“Would another day work better? 

“Not really. We hardly see them ourselves.” 

“Remind me what grades they’re in.” 

“He’s in kindergarten. She’s in third grade.” 

Ohm’s Law

The family expressed concern that grandpa’s memory problems had become too severe to ignore any longer. The distinguished-looking octogenarian sat quietly glancing around the exam room. 

Standardized mental status testing—Trump’s famous person, woman, man, camera, TV—may prove misleading in formerly high-functioning patients. Better to personalize the questions. 

“What did he do for a living?”

“Electrical engineer, spent decades as a professor of electrical engineering.” 

“Mr. Armstrong, please tell me what Ohm’s Law is?” 

Ohm’s Law, a concept from first semester, drew only a blank look from this man with a PhD.

The electrochemical circuits in his brain fried, he loo

Not an Alcoholic

It finally dawned on the Jeff Foxworthy fan. If you are standing in a bookstore scanning for a book on how to control your drinking, you might be an alcoholic. If you take an online quiz to see if your drinking is excessive, you might be an alcoholic. If you start keeping a drinking diary, you might be an alcoholic. If you buy a home breathalyzer, then think it’s broken, you might be an alcoholic. If you keep a fifth in your trunk, you might be an alcoholic. If you wonder how that dent happened, you might be an alcoholic.

Military Misadventures

The forty-something man scooted his chair into my office. He was as dapper as one could expect for someone under such circumstances: nicely trimmed beard on a formerly rugged face now turning a bit pudgy, clean Nike golf shirt, fashionable slacks with the bulge of a urine leg bag above one ankle. 

I had not seen him before but knew he’d come for a follow-up visit to adjust the medications he took for spasticity. We were reaching high dosage levels of baclofen, our most effective drug, with only marginal benefit and there was talk of installing a pump to deliver the drug directly into his spinal canal via an indwelling catheter. 

We saw many such patients in the Veterans Affairs hospital neurology clinic. 

His heel cords were tight and his knees wedged together. His lower extremity reflexes were hyperactive. All evidence of severe spasticity, a common feature of patients with paraplegia due to a spinal cord injury. 

“How were you injured?” I asked.

“During our invasion of the Dominican Republic.”

“What! When did we invade the Dominican Republic. Never knew about that.”

“It was 1965 and Johnson sent us there for some bullshit reason. I was in the 82nd  Airborne out of Fort Bragg. As I floated down toward the drop zone, they began to pepper us with ground fire. I was dangling there helpless and took a round to my spine. My legs were gone before I hit the ground.”

I thought back to Reagan sending our guys into Grenada over some other bullshit. Another American military misadventure. 

Minor conflicts. Not so minor to some. 

I Smell the Golf Course

When Ben uttered those words, internal klaxons wailed. With him lying in a hospital bed, it could only mean a seizure emanating from the temporal lobe of his brain. Moments later, his left hand began to twitch as the seizure spread. We loaded him on a gurney and ran for the ICU. After intravenous anticonvulsants and a close brush with a ventilator, the seizures stopped. Turned out they’d been caused by a medication injected not long before. 

A few months later, I was surprised to see Ben’s name on my faculty practice outpatient appointment list, though I’d been following his case for several years.

Ben and his wife walked in. Nice people. We’d become close.

“Ben, what’re you doing here? I got a notice you’re suing me.”

“I know, Doc,” Ben said. “I’m sorry about that. We got a big ICU bill. We asked the hospital to cancel it. They refused. We just want to get out from under this bill.”

“It wasn’t our fault,” Ben’s wife said.

“And it wasn’t your fault,” Ben said. “It was the drug company’s fault. We’re suing them too. I still want you to be my doctor.”

“I’ll ask,” I said.

I asked.

“Are you out of your mind?” “Under no circumstances.” “Discharge that patient immediately.”

Ben and his wife returned. They sat in the comfortable, leather chairs facing my desk, looked at me expectantly.

I smiled.