Month: August 2015

Little Things

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It’s not the Persian carpet,

the house , car or jewels,

but the little things

That whisper or suggest

even when they’re silent

what I little know,

Of where, when, why,

who or even what

about her life gone by:

Her medicine chest,

kitchen and pantry,

bedsheets and closets;

Eleven hard drives

in a plastic zip-lock

meticulously destroyed;

An unspent bullet

in still stale air

and cluttered dark.

Crochet hooks, a sewing kit,

items for recycling,

old photographs,

TP and paper towels,

bank statements, letters,

perfume, and lotions,

Detergents, linens;

the dog dish and bird feeder

half full.

A mail box, still alive,

when emptied, cries out

for a little more,

Until rewarded with

delicious junk mail

and collection letters.

Pills, notions, lotions,

purses, shoes, clothes,

tight hand written pages

In a lined spiral notebook

exhaling fear and voices

speaking in silent audibles.

Dry plants, and flower beds,

disconnected sprinklers,

old hoses and garden tools.

Cruel little things speak

in their sharp edged

forked foreign tongue;

Sad little things

hint of little pleasures,

big plans, and hope of love.

I follow the footpaths

through the underbrush

of her tangled troubled life.

I walk there barefoot

aware and wary of thorns,

adders, asps, and broken glass;

But the little things

leave weeping little wounds

that still wait and want to heal.

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A Compleat* Diary 1961- 2015

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Rows of red books titled ‘Daily Reminder’ start with 1961. Somewhere they begin to proclaim themselves ‘Standard Diary’ but without any other change. 2007 was attacked by a puppy and lost a corner. One is partly empty because it went AWOL until captured on a train by a thoughtful young woman.There are two that escaped but have never been caught. I still sometimes hope to find those two  unrepentant deserters; I remember where one left- when my attention was diverted at the Cattleman’s Restaurant near Dixon,  CA. I am reminded of this because today 2015 is missing. It went AWOL on Thursday; this is Saturday so I have been without for three days; fortunately 2015 was apprehended and will be extradited on on Monday.

1961 has  a reservation card  pasted at Jan 2, for The Chancellor, then a comfortable but modest, nicely located small old San Francisco hotel– still there I believe ; It reads:

Single – $8: 2 persons double bed – $10 : two persons twin beds $12.

That is the sort of thing that is a shock when one looks back so far. But I recall that in my small group GP practice the cost of complete OB care from diagnosis to delivery, including PAP smear and all labs was $75. On credit.1968 reports a discussion and decision to raise that inclusive fee to $95.

At Jan 28, 1961 is brochure for a conference at U C San Francisco School of Medicine titled:

MAN AND CIVILIZATION; CONTROL OF THE MIND

It was one of several  Seymore Farber put together, arguably believing  Compleat physicians were philosopher scientists; or scientific philosophers; this one was loaded with non physicians and writers.

There is nothing written there to explain what induced me to drive alone to USF Med Center for that particular weekend symposium. A mailing perhaps. I had been practicing in Woodland only two years. I was 29. A fourth child was 8 months old. I knew no physician at UCSF School of Medicine; and to my surprise, when I arrived there  a distant uncle and his wife appeared. They were quite beloved, cloistered intellectuals and I had only met them once before; and once since. He had been an intelligence officer in Turkey during WW I and forever after shaved his head, and taught English and Art at Menlo College. I have a little book of his Omar Kayaam style poems. Maybe you can take the man out of Turkey but not Turkey out of the man. The list of speakers suggests why they there. It included:

Aldous Huxley

Arthur Koestler

Wilder Penfield

Holger Hayden

Martin D’Arcy, S.J.

I will never forget sitting in the front row of that old Medical Science Auditorium’s steep semicircle of seats while those remarkable speakers peered up from the place where dissections, and demonstrations were formerly done. The tuition, including Saturday lunch with address by Huxley: $25.

For more than a half century the diaries have saved the stuff of living for me: names, places, times, driving directions, my children’s creations, ticket stubs, news cuttings, programs, notes, letters, addresses; and the almost-legible  cursive fast-scratch of this former med student. Today an e.diary might be preferred by many: more easily search-able, link-able, and reproduction embed-able. But I relish the feel of paper, its simple, frank honesty, the substance of yellowing originals; and for searches, my standard business diary ‘monthly cash account’, at the back of each book becomes an index of topics.

Yet we live in a time when paper is as moribund as typewriters, books, or newspapers; even traditional libraries are  musty mausoleums of books and places for the homeless to escape the cold or heat or go on line. My word processor, kindle, and browser make them only curiosities like the reference collections pictured below: Will and Ariel Durant’s 14 volume History; The Britannica Series of Great Books, and a 1908 Britannica First Edition; the Harvard Great Book Series; and a shelf of reference books. .

 

 

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They are replaced by this, a place which is better and faster more productive:IMG_0882

 

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So I never open my old reference books now, preferring to use this  blog- Nwalmanac.wordpress.com  – as a living repository for my writing, and editing;and my kindle for reading.

Even so the diaries  hold little entries I would never find elsewhere,  never otherwise remember. For example, the diary page that is source material for the blog post called  Homar and the Alluvial Fan is about an episode where the narrator risks his life. At the top of the page is written ‘Con la muerte en el ano’.  That expression, which I had forgotten, is  so powerful, so apt, so nuanced that I have to rescued it for use in English, ‘with death in the (his) ass’ … where it becomes startling.

So the diaries, as obsolete as cursive, destined to be recycled into corrugated cardboard, paper cups or TP are still filled with little gems, treasures, quotes, stolen metaphors. For now, i treasure them, refer to them often, and still wantonly hope to catch the two deserter years.

 

 

 

 

 

 

 

 

 

 

 

 

 

  • See The Compleat Angler by Isaak Walton,  first published in 1653

 

Her Killers

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There is a laundry list of her murderers: The failed social/ political system that denies mentally and drug sick folk civilized long term easy access to inpatient mental care– we leave that to jails and streets in the ‘village’– where people preach but don’t care to get involved or to pay; Inherited DNA that both gives and takes away– (her family history included violence and homicide); and a violent drug- sick environment. Yet she was hard working and brilliant becoming wealthy until suffering increasingly severe psychotic episodes during the last 35 years of her life.

The list includes physicians who thoughtlessly gave her narcotics and other toxins for headaches; the famous Stanford Neurosurgeon who hacked her temporal lobe, even after all the rest of the neurologists and neurosurgeons proclaimed her deep brain cyst was benign–it would have been prudent to take serial CT scans. He neither mentioned hacking her temporal lobe, nor finished the operation, but took off for SE Asia letting an underling botch the closure that required two further repairs; and the long series of physician killers who prescribed aderal and ritalin, whose effects are almost identical to cocaine but faster and longer acting. The last killer-prescriber  declared to the court, despite pleas from her family, that she was not a danger to herself or to others– just hours before she shot herself. 

Add to her killer list the men who–while not altogether well or drug free– suckered and sucked her dry and spit her out; and in her last long sad 15 years, those men who moved on her when she was sick, alone and lonely in a little mobile home; the last was named Fenwick, a creation of her psychotic, paranoid, and drugged mind who  became real, and shot her with the gun she herself put to her head.

Her first killer, however,  was also a physician who, with some exceptions, was an absent father. It was a time when many physicians did not belong to one family, but were priest-scientists, benefactors of humanity, whose family was the world.

I was that physician, blindly devoted to my own grandness, ambitions, and responsibilities. I was ‘called’. In marriage  I ran from confrontation; when my resentful  wife squandered our money I remained silent, arrogantly self-contained. She always had full day help five days a week, while I put in 14 hour days because I hoped to continue my work with children of migrant farm workers. The ‘because’ was my contribution of course.  Always exhausted, and marinated in self importance, I tended to withdraw into myself.

A parent has no idea how parental anger may be interpreted by a child. I had been spanked as a child, but that never troubled me; though my father was an angry man, I was the benefactor of unconditional love from four grandparents with whom I spent at least several months every year. Yet I firmly believe that corporeal punishment of children is wrong; deadly wrong. It also is training in adult violence.

I very clearly recall an episode my daughter left buried in extensive in hand written autobiographical notes. I had spanked her in anger over- nothing; she told, and defended, a lie. What child wouldn’t when facing an angry father? A specific detail not recorded there is one I hate to even think about: Her bedroom was upstairs. After spanking her, I felt terrible, and apologized. But later I went up and found a mason jar with a stool in it. I can see that mason jar even now, and can only think that she was too terrorized to go down to the bathroom.

I was- and am- so shamed that I never spanked a child again. Yet I was her first killer; and there is no cure for either of us.

To W.X. Sickbe MD

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To: W. X. Sickbe, M.D. Aug 2, 2015

Psychiatric Health Center

From: A B C D …V: Your dead patient’s family.

Re Y Z… Your former patient.

Consider the following, from the your facility mission statement:

We’re committed to you – your health, wellness and providing the best care possible for you and your loved ones.” (italics mine).

If that is true, why not be more interested and willing to hear those who have known your patient longest? Isn’t it possible to listen without breaking any ethical or legislative rules of practice?

Of course Y’s case was complex.  It went back to adolescence; and farther: It included a very strong multi-generational history of paranoid psychosis, and violent death including homicide; there was abuse, and an ill-advised surgical injury to her temporal lobe. Perhaps she denied or failed to tell of her recurring psychotic episodes, usually associated with the use of prescription drugs you prescribed, especially cocaine analogues like Ritalin. She left reams of hand written notes, often about suicide. Over many years she made multiple attempts; at least two very nearly succeeded.

But you chose, in professional hauteur, only to hear from your your patient. And the Court? Despite testimony from family, the court could not impose long-term involuntary treatment without firm support from her psychiatrist; from you, who relied on your own isolated and (catastrophically bad) judgment.

Considering the care available to her– or imposed on her and her family– in which you were a long time professional prime mover, perhaps– ultimately– her suicide became quite rational. What else?

The last time you declared her not a danger to herself or to others was just before she took a gun and discharged it into her head.

We hope you will seriously reflect on Y’s case and on similar cases seen everywhere on our streets, in our homes, in our jails and in the so-called ‘senseless’ killings associated with mental illness. None are senseless. What is senseless is the way we fail to rationally diagnose and care for the mentally ill. I hope you will try to end the insane and cruel sort mental health care that is inflicted on mentally ill people in our country, on their families, and on the public; or at least avoid contributing to it further yourself.