In medicine days become long. The more efficient you are the longer the days become.
Among the magic you create there seems to be an assumption that time can be arranged
stopped and birthed. The quicksand is forever pulling you. You realize you have been
allowed to join the fraternity of physicians for so many reasons but also for the
hardwired way you will add “just one more thing” to a day with optimism to fix.
I’m running behind again. I’m in a constant state of late. A stomach ulcer I self
diagnosed to explain the pain in my epigastric area since residency running is the
cancer I live with. It has become such a familiar feeling at the pit of my stomach
that when I don’t feel it I am lost and self critical. I eat to sooth the hand
tremors of low blood sugar and gastric acids of worry. I decide to not thirst for
fear of wasted time urinating. “If I drink that much I have to find a bathroom!”my
colleague bemoans and reasons when I told her to drink 60 oz a day. “Who has time to
do that?” I joke reconcile and agree. The work week has no time for petty things
like eating and peeing.
Richard came in with his usual pile of books flagged pages and crumpled print outs.
He was wearing white boxing shoes laced to just below his knee. He had on a white
tshirt with a hole in the left sleeve and white boxing shorts. His gray hair was
flying. His glasses would cloud over because of the fast breathing from excitement.
It was October and he was in all white without a care for weather or fashion laws.
He just obeyed himself. Even then he had a hard time knowing how to do that.
He had with him this time a portable DVD player. Intriguing.
I shut the door and the time clock started.
“I got … I got these for you. These are your copies. This one here. This one says
here no here right here the telomeres are my problem. I have CRP that’s 32. I don’t
want 32. I need 10 maybe 15. This one here … See this? This no this is good. It
has plant extract. Did you know the Joshua tree can live hundred of years? It’s
there. It’s there. And this. You will like this! He says … This is the NIH. It
says here that the cells my cells your cells they need this,” Richard rattles on and
grabs another book and opens it then another then unfolds a page from his pocket
then another pubmed abstract with highlighter all over. He turns to exact pages. He
runs his finger down the words and smacks the page when he finds what he’s looking
for. He has read Harrison’s Internal Medicine cover to cover. He has memorized
portions and knows exactly where the word “telomere” shows up 147 time per him. I
can’t argue. I didn’t count the number of times “telomere” shows up.
I’m typing my initial remarks about his labs and medications and mental
presentation. I’m not looking fully at him. He’s not looking fully at me. He never
looks fully at anyone. Why should I demand it.
I ask him inbetween his sermons and sharing of the conspiracy of aging the review of
systems. His sodium level is again 129.
“Richard, how much water so you drink? Did you see your psychiatrist? You seem
manic? Do you feel manic?” I ask in rapid sequence because his energy sets me off
“3 gallons a day. I know. I know. I need 4,” he says. “You got to hear this. Doc,”
He turns on the DVD player. I am curious why he has brought it. He plays a self
recording of him playing Gershwin and as it plays he mimes the fingering and utters
“You see? Dun dun. Dun dun dun dun. Dun. Dun dun? So I’m thinking if you and then
Dr. Choi and Dr. Patel can be in it. Be in the song with me the telomeres will
listen. See? See?”he says while the song plays on. He is missing notes on the video.
“Richard. Sit,” I say.
He has been standing the whole time and the boxing shoes are keeping him on the
balls of his feet bouncing from article to thought to thought to video to me.
I examine him. We talk more. He tells me he paid 150 dollars to get his telomeres
tested. He produces a file of lab results. I have no clue what these labs are. They
are all “out of range”. I resist the look of horror that someone took his money to
test his telomeres.
“I’m getting old, Doc,” he says sadly.
“We all are Richard. We can’t lie forever. The telomeres have a set time frame.
We’ve done a lot to increase life,” I assure him.
“I can do 2 times a telomere,” he says.
“What does that mean?” I think.”You can try. Is this person going to test you
again?” I ask protective.
“Yeah. Yeah. In 3 months. I got 3 months to be fit,” he says now bouncing on the
balls of his feet again.
I figure 3 months to get fit is actually not bad advise so I go with it.
“Ok Richard. Ok. Get fit but don’t drink 4 gallons of water. Just 60-90 oz ok?” I
I am thinking of medical school psychiatry rotation. I am think of a lock down unit
where I am asked to do a full history and physical on a patient. I select a small
round African American woman holding a doll. I go to talk to her and she looks
leery. I realize I have never had a look like that filled with a touch of anger. I
wonder if she will scratch me. I decide to ease up. Easily move. Easily talk. She
says no, no, NO. I have an assignment. I don’t think going back to report that she
won’t talk to me will go over well. What if this is real? What if I choose
psychiatry and can’t get anyone to talk to me? What a ridiculous problem! I finally
decide I will lie a little.
“Brenda,” I say. “I’m just here to write a story about you,” I entice. Will she bite
the idea instead of me? “Can I write it? I just need you to help me so the story is
Brenda’s eyes soften. She moves closer to me. “A story about me?”she asks curious.
“Yes. Just you. Help me with the details ok? So it’s right.”
She agrees now happy and answers about a dozen questions then starts to look leery
again. I think she’s onto me. I ask my last two questions because she disengaging
and setting sail. She may scratch me as she departs.
“Brenda, why don’t you take your medicines?” I ask.
“No. They…. They make me feel… Not myself. I’m not me. I’m not…” She trails of
stroking the doll.
“That is very helpful Brenda,” I share. “Brenda, last question why do you have the
She looks only at the doll. After a long pause, “I’m going to have Jeaus. Women have
babies. I’m a woman. I’ve never been with a man so I’m going to have Jesus. This
baby. This baby here,” she says stroking the baby doll.
Lesson of human wants: I want to be myself. I want to have something i know I can’t
I talk with Richard in a way to let him have a space to be himself. I tell him he
needs to see his psychiatrist because it’s all getting a bit disruptive to his
health to be so manic. I use the example of the water he is drinking. “Richard, your
body can’t keep up with your thoughts. Let it rest. Ok?” I know being someone else
to suit me will hurt him.
He stops bouncing. “Ok. Ok, Doc. See you. See you 1145 3 months?”
I open the door and say to the staff as always, “1145 in 3 months.”
It’s 1 now.
The 1145 slot is known as my witching hour. It’s where I give up any lunch time to
feed certain patients that can’t possibly fit into 15-30 minute slots. It’s the
understood time for specific patients. New girls will accidentally book another slot
for these patients and I will be sour and very late that day. They quickly learn the
if I say specifically 1145 I mean to create a space, to open a worm hole in time. I
mean to let someone be themselves just for a bit. To hear what the want to have but
Create a space and time for certain souls you know need it.