Tag: Medical

Memoir, Personal Essays

Foreward to My New Book

stephenzuckerman

Dear Readers: I realize that it has been a little while since we last connected. There’s a valid reason for that, I assure you: I’ve been hard at work on getting my latest manuscript ready to be published! I’m happy to say that I’m almost there, and that I will be posting clips from that memoir to this blog over the next few months. In the meantime, I’m posting a Foreward by my former editor that will be included in the memoir. This writing dives into the heart of my story, and posits questions to the reader that I hope you’ll find as engaging as I do. It can sometimes be very flattering to read what others think about you, which is certainly the case with this Foreward. I’m very grateful to Stephanie for her lovely piece of writing, and I think it will make a wonderful addition to my new book. Enjoy!

Forward by Stephanie Ericsson

When I began working with Dr. Stephen Zuckerman in 1998 on his first book, it quickly became apparent that his ideas were multilayered, often built upon one another, even, at times, holographic in their dimensions. These were concepts that pummeled at comfortable paradigms to make way for new ways of thinking. Some were not really so new but rather were more complete, or more compassionate, or more far reaching. In this age of the almighty sound byte and TV’s 7-and-a-half-minute-attention-span, the very art of thinking is in jeopardy of becoming extinct. It is easier to think in clichés or stereotypes, especially with the information overload that we live in.

It is the mark of enduring idea when it continues to bear fruit even after many pluckings. Over the years of working with Dr. Zuckerman and his ideas, I am still discovering layers of meaning within his words and concepts that on first, second or even fiftieth glance had escaped me. Many of these ideas are disguised in such simplicity that it is easy to believe one caught the entire meaning right away. Yet again and again, surprising ah ha’s! have burst upon me from ideas that I thought I’d understood in total. The interconnection of one idea to another, or a larger meaning tucked into a goofy word-play or a concept that suddenly offers a new tool for dealing with some private torment of my own—these experiences have captured me as much as a reader as they have as his editor.

No idea of Zuckerman’s was more challenging than his experience of hearing G-d’s voice. Who, in their right mind, would believe such a thing? Certainly no one who values their credibility! Not other doctors, not psychiatrists, not upstanding businessmen in today’s techno-culture. Certainly, it succeeded in getting him incarcerated in his own Kesey-ian Cuckoo’s Nest. But it also proved to be a brilliant co-conspirator, taskmaster, conscience, mentor and spiritual guru. It succeeded in testing the medical legal system, the patience of his associates, and the odds at the racetrack. It outsmarted doctors, judges, and the DMS-4. It forced him to throw his professional and personal credibility to the dogs and literally got him a prognosis so hopeless that he spent 3 months in the kind of state institution where most inmates never leave. Even so, in taking so much from him, it did not leave him bankrupt.

When Zuckerman first described The Voice and the story of his encounter with G-d, I had a difficult time believing that he was fully sane. But over time, I found that there was nothing about him that supported those doubts. Nothing in his past history, his medical or familial history supported the diagnosis of psychosis. He’d lived a life that was relatively unscathed by misfortune—no physical or emotion abuse from childhood that pointed toward the pathological. Nor was he religiously fanatical—or religiously savvy, for that matter. He’d been raised by his parents as a secular Jew—typical of their generation—who attended synagogue once a year on Yom Kippur, held a Seder at Passover and the rest of the time worked long, hard hours to provide opportunities for their children. He’d never been traumatized like so many men of his generation who’d been drafted into the insanity of Vietnam. And although he was passionate about his work, he wasn’t drive to obsession, but rather led a balanced life most people would have envied for its sanity. He had no history of alcohol or drug abuse and he was physically fit and had been healthy his entire life.

His parents loved him and raised him in relative middle class comfort so he wasn’t tormented by the privation of poverty as so many Jewish families had been during and after World War II. His sense of humor and playful nature seemed to make his long hours as a doctor not only bearable, but thoroughly enjoyable. He had endless patience, was quick to forgive, slow to judge and nearly impossible to rouse to anger. Although he was brilliant, his wasn’t a tormented intelligence, as so many highly gifted people suffer from. In short, there was nothing that pointed to Stephen Zuckerman as a nutcase.

So, I believed him when he told me that he and G-d had conversed over a period of months just after he’d turned 50. His descriptions, both in conversations and in his writing, were always consistent, never indulgent or dramatic, and just quirky enough to be believable.

But when I decided to ‘believe’ his story, I found that I had to do so on more than just a personal level—I had to believe him on a professional level as well. I had to believe him as his editor, otherwise I would find myself either condescending to him as my client, or entirely unable to work with him. Naturally, the process of writing is an intensely interior one, and in order for an editor to be effective, he or she must enter that concentrated interior with the writer, as an observer, as a guide, as a muse and as a critic. Since the nature of the writing is to express what is seen through the eyes of the writer’s soul, the editor must perform all of these roles invisibly and unobtrusively. An editor must coax the writer’s ideas into maturity while being careful not to inject his own ideas into the process or the message of the writer. Often a writer is unaware at first of what he is trying to say—he is merely being pushed along by some deep compulsion to say it. Words themselves are alive and know exactly where they belong so the writer must discover his role as the vehicle of the message by getting out of the way while at the same time surrendering to the forces that are compelling the message. For this to happen, the writer has to disengage from his own ego, while, at the same time, he must so deeply believe in the idea that he will not give up through its arduous birth.

It is the role of the editor to walk beside the writer through this journey. Believing that Dr. Zuckerman had a three month conversation with God was more of a challenge to me personally than professionally. I had to suspend the part of me that was agnostic. I had to challenge the skeptic modernist in me while calling on the Catholic training of my childhood. I read everything I could find that might lead me to the key. I wrote in my own personal journal about it, and even went back to the church. I meditated on my own and secretly hoped that Zuckerman’s God would pay me a visit too. I spoke to mystics and found that things like visions and apparitions were more of a pain than a blessing and anyone with any sense would not wish for one. St. John of the Cross and St. Teresa of Avila had said the same thing, both being infinitely down-to-earth and pragmatic.

Ultimately, it was a matter of letting go of my blocks to believe and having the courage to simply listen to the message. Did it make sense? Did it sound real? Did it speak to me?

These are the questions that anyone who has picked up this book will have to answer for themselves. Some of what Zuckerman describes is supported in scripture, tradition and history and some will be debatable.

And so, Gentle Reader, in the end, it will be as it always has been—a matter of faith.

 

Humor Writing, New Cliches for the 21st Century, zuckerisms

Positive Feedback

stephenzuckerman

My books have been up on Amazon for a while now, but we’re doing some new promotions for Medical Humor at its Best . It’s now available in paperback AND as an audiobook. Plus the Kindle version is only $.99!

zuckerman-new-cover

For less than a dollar, you can get hundreds of witticisms, insights, and life advice that’s only a little tongue-in-cheek. The book is getting a lot of 4 & 5 star reviews these days, so it’s definitely worth the low price. Here’s what some other people are saying:

Andrei: “Creatively written and mind-stimulating, this book challenges readers to go deep into their thoughts and analyze each word, saying, quotes, and thoughts the the writer has presented in this book. Creative writing is at its finest, the poetic approach of this book is just beyond amazing.”

Wylie A.: “A few years ago I began jotting down phrases that people said and the context in which they used them. It amazes me how many cliches and idioms we use daily without really thinking about where they originated, or in some cases, what the expressions actually mean. I was certainly not disappointed. So much work and research went into this book that it is difficult to even fathom. I would highly recommend this book to anyone interested in the development of our language and the many ways that we sprinkle our speech with metaphors.”

Bryan: “I wasn’t exactly sure what to expect with this one, but I’m very glad I took the leap of faith. This book made me laugh, it made me think, it gave me inspiration, and it entertained me from beginning to end. There was never a dull moment from the moment I started reading.”

Aleksa: “I had fun reading this book… I think that we need books like one in order to lighten up when the burdens of the world seem to be heavier everyday. There were so many pages that actually made me laugh.”

Get your copy now!

Memoir, Personal Essays

Asylum, Part 3

stephenzuckerman

Third and final part of my time spent at Brainard Hospital. If you missed the previous posts, be sure to catch up on part one and part two. 

In time, I began to frequent a room we called the Smoker, and, although not a smoker myself, I adjusted to the languid smoke-filled terrain of our den of inequity. Layer upon layer, the yellow walls were stained nicotine brown. Scraped, scarred and slashed Salvation Army chairs circled eight-foot round rough-hewn tables that were scattered in clusters. A myriad of ashtrays — both on the floor and the tables — were always full of ashes, butts, and spittle. At the head of the Smoker stood two wooden rectangular tables under the naked glare of ceiling lights that cast shadows into the grimy recesses of the large room.

The head tables were for the employees in charge of maintaining decorum in the Smoker. They doled out cigarettes to momentarily abate the incessant cravings of the inmates. One cigarette per customer per 15 minutes 24 hours a day. The line established itself just before the quarter-hour and the dolers regularly shortchanged the clock to avoid being nagged. I supposed it was also a gesture of good will.

The rights to cigarettes were obtained in a variety of ways that included exchanging your disability welfare check for your favorite brand, being a beneficiary of the covert founder of the cigarette endowment, guilting what family and friends still recognized your existence, theft and, above all, mooching. The cigarette cult permeated our society-in-exile and the Smoker was its capital.

I had met a woman in Brainard named Jeanne. Soon she became ‘my woman’ and we had a sort of romance that was born of necessity as much as desire. She and I held intriguing meetings in the Smoker, where we shared butts, kissed and fondled each other in the dingy shadows.

Jeanne liked to deny my fondling both inside and outside of that drab room. With a lean, poised body, darting clear blue eyes, and subtle breasts, she entertained herself by play-acting a fear of being defiled by men. Her mind was seeded with paranoia and she spent most of her free time calling lawyers and begging for their help. She demanded that they comprehend her plight and secure her freedom. In every call, she recanted the sins heaped upon her that were now destroying her brain and infesting her body. A sexy child-woman, over-medicated, frightened and pushy, she was beyond even electro-shock to pull her back from the edge of sanity.

One random morning at two am, all was well in the smoker. John had his head-set radio scattered all over the large round wooden table and was attempting to use black tape to repair its bare guts. For four dollars, he’d just bought at least twenty dollars’ worth of radio from a new incarcerate. Fixing, breaking, re-fixing—his hands flew between waist-attached tape players with head-phone privacy, an army of batteries, double AA, alkaline, triple AAA-used, new, no good at all, and the prized cassette tapes. Barter, borrow, buy and hide away for the needy day. He was hoping to tap into that electronic music sub-culture, an elitist indulgence for the intelligentsia. How utterly sublime to soar through one corridor after another, to sit in the dank Smoker while enveloped in Berlioz’s Symphonie Fantastique! And only he would be able to hear and dance to its rhythms.

Randy, another inmate, postured out of the gloom. His presence was ostensibly to help John, but we all knew he would fail as usual. Randy’s air of monotonous superiority was more boring than offensive, even a bit entertaining at times. John wouldn’t give in to Randy’s attempt to help — or dominate, one could say — and he collected the pieces of his electronic world and left. Randy bantered on, pointing fingers and sermonizing on the need for order and rules. He bragged, as he often did, that his myriad of contacts on the ‘outside’ were waiting for his release. Then he paraded proudly up to the head table and preached at the cigarette dolers. Was it to provoke, ingratiate or simply to relieve his boredom? Maybe all three. But the people in charge were used to his biteless bark and even admired him as they would a strutting peacock.

It was a shame that Randy ran off John. He was the sweetest, brightest and most caring soul I have met in a long time. Like with the radio, he was always tinkering with something, piecing together parts into a whole that never quite came together. I didn’t believe that his Rube Goldberg-style inventions were a sign of what got him institutionalized, but rather the result of 22 years of drugs and institutions. Often he launched into a tirade that lacerated drug psychiatry. “None of this shit works,” he’d say. Because according to John, he “ain’t really sick.”

I was always fully entertained and pleasantly distracted by John’s lectures on bizarre, erudite articles, published by the psychiatric towers of Babel that preach success through correct labeling within their 280 categories. John had spent most of his 35 years in institutions, and reveled in his theory that he was blowing the hell out of the State’s mental health budget. It was his way of killing them as they’d tried to kill him over the years.

One day, Jeanne simply disappeared. Word was she’d been discharged, though no one had informed any of us, her friends. Thanks to our conversations, I knew the only place she had to go was back to her drunken, abusive father. She was back in a week with fresh tales of mistaken identities, demonic psychiatrists, drug blackouts and a new pair of cowboy boots that accentuate her slender sexiness. Our romance resumed its former function — as a calming background noise that distracted me and allowed her to obsess over the brain damage she sensed was slowly, invisibly enveloping her. She was terrified that the drugs were permanently “fixing” her.

“Can I stay at your house?” she asked me once. “Won’t you take care of me?” Sure I would. Just give me $50,000 a year and a social worker who actually cared. It was clear that our relationship didn’t have much shelf life outside the institution and we both knew it. Jeanne could barely function in the real world and I didn’t have the resources to care for her. She was one of those poor souls doomed to be institutionalized until the monster was slain and a rational treatment for humans with emotional disturbances was invented. For the time being, it was easier to lock her up and drug her: out of sight, out of mind.

Close to my release, someone informed on me and I was caught spitting out my pills. After that I got mouth checks. I could no longer be trusted. I also couldn’t afford to dwell on the fifty years of being sane that I already had under my belt. They did not recognize my credibility in Brainard, and arguing to the contrary would have only set me back further. Like my fellow inmates, I was quite cognizant of the dangers in this prison — after all, we aren’t that crazy.

John had begun to posture — his body became distorted, his arms and hands askew. He took a step and re-postured, another step and again re-postured. With his wicked sense of humor, I first mistook this for a new parody he was creating. But I suddenly realized that it was the tradive dyskinesia of Haldol. Because of the meds, his face became fixed in a grimace to which he added his own sardonic flare. Seasoned by my own suffering, I convinced John to mouth his poison and advised him to be more careful than I was. He needed to use the water fountains to dump the pills and avoid the toilets with their prying eyes.

John had already informed the monster about his previous problems with Haldol (which he did not need in any case), but this is the world of which Kafka wrote. Orders were issued from The Great Oz, who may or may not have read John’s chart, who may have erred but was beyond reproof, and whose capriciousness always wreaked havoc. John mouthed his Haldol, recovered, and the balance was restored again.

Life in Building One went on, with its inhabitants, myself included, trying to piece together our shredded selves into some form of supportive society. All the while, our Keepers fought a stiffly organized resistance against our need to belong. I groped for love, for kindness, for hope — blurred as I was, I was instinctually drawn to this community of comrades.

The time finally came when I became expendable. The system did not need me any longer. It had justified my incarceration, my diagnosis, my druggings, and finally, my disgorgement. Ironically, the admonishment I received upon being vomited from the belly of the beast was, “Don’t come back!” (Almost all do — again and again.) My prognosis was “guarded,” a polite medical term for “hopeless.”

I left my sheltered world, my comrades, and was folded into the darkest cocoon of my mind. By my keepers’ standards, I was cured. Months later, in the sanctuary of my sister’s home, I picked up the trail of my life and hesitantly emerged, clinging to the thought that today was a millimeter better than yesterday. In the face of the monumental incline ahead, it took only minute signs of progress to rally me forward. I had survived in order to live anew — now metamorphosed into yet a deeper understanding of what it is to be human.

The Voice paid a final visit to me during those months of reconstitution when, as a free man, I could finally stop the medications. I was delighted at first, for I had learned to love that mysterious voice in my deaf ear and had feared the drugs had destroyed it. But the Voice told me that it would no longer speak to me. There was no more reason to continue a dialogue it said. And thought I was disappointed, I understood what it meant. It would never truly leave me — it couldn’t. The Voice was me. My inner, most intuitive me. If it were to remain ‘a voice in my head,’ it would always be something separate from me, not part of me. Therefore, it was time to end the dialogue and begin to act on what I had learned. It was time to be what I had become.

Memoir, Personal Essays

Asylum, Part 2

stephenzuckerman

Here’s a continuation of my 3-part story, Asylum. To read part 1, click here. And check back on the blog next week for the final installment of my time spent in the Brainard State Hospital.

Asylum, Part 2

Before the first court hearing, most of my time at the University Psych ward was filled with these conversations with The Voice. I began to see a pattern in our talks, a purpose in all the seeming strangeness, not only in regard to my own little world, but to the world at large. Step by block, my spiritual house was taken apart and analyzed down to its foundation — its fundamental intuitive self. I began to see that I was being re-made through the drama of these dialogues with what appeared to be an all-knowing, purposeful mountebank.

But The Voice in my ear was not content simply with dialogue alone. Before being locked up, it had challenged me to drop my social decorum and call people on their dishonesty. At a board meeting where I was a member, The Voice asked if it could ‘take over’ and give hell to a member whose smugness had always irritated me. Hesitantly, I agreed to allow what I, myself, would never have contemplated doing on my own. WHAM! The Voice took off on a diatribe fit for my father’s Manhattan schmatah business. On four or five more occasions, The Voice led outbursts that caused serious concern among my colleagues. But what really got me into trouble with the Mind Police was when The Voice told me I was God.

Initially, I objected vehemently — I was absolutely NOT God! No way, no how. I was just one of the 6 billion schmucks on earth with no special talents or successes. However, The Voice persisted. Being a good human, not superhuman, was all that was necessary to be God. Any human could be God too, The Voice helped me realize, each with a unique ability to express godliness. This line of reasoning impressed me and I began preaching it whenever I felt there was a reason to do so. To talk of God is, of course, anti-psychiatry, which is a religion of its own, built on atheism. Fundamental to psychiatry is the belief that hearing voices (known as auditory hallucinations) is the most dire symptom of psychosis — not a spiritual intervention.

During the time I was entranced in dialogues with The Voice, I tried, as a scientifically trained professional, to figure out what it actually was. Could it be a telepathic alien who’d come to infect me as a means of establishing itself on planet Earth? Or could it really be The Voice of God in my ear?

I wasn’t much of a believer in God but I wasn’t an atheist, either. I considered myself to be more of an a-religious Jew. It was difficult to buy that The Voice, who at times cursed and threatened me in a very un-God-like manner, was really a spiritual voice in my ear. Maybe it was an alien being reaching out from another world? Or just my own mind playing tricks on me? But try as I might, I could not reconcile The Voice’s brilliant explanations and insights with those of my own. It constantly enlightened me on new ways of seeing the world, and possessed information that I could not have known on my own. After a while, I was convinced that The Voice had to be a superior intelligence that had somehow, for whatever reason, slipped into my mind and was speaking through my deaf ear. Or else, I really was cuckoo.

Regardless, The Voice was certainly trying to be useful. It promised to bail me out of my commitment hearing, and as we were filing out of the courtroom it suddenly told me: “Tell the judge you have a brain tumor.”

So I did. But I had no idea that my ‘off-the-record’ comment would create a major dilemma for the judge. If I was acting strangely due to a ‘real’ medical disorder, then incarceration and the use of neuroleptics were actually dangerous. If a tumor was my problem, the court couldn’t permit the university to force anything on me. The judge was compelled to grant the University only the right to incarcerate me, but denied them the right to force neuroleptic medications on me until they had proven that I did not have a brain tumor.

I had won an advantage: unless I allowed them to examine me, the University could never prove that I didn’t have a brain tumor. At that point, I became psychiatry’s Catch-22.

For two months and two stalemated trials, I remained incarcerated at the University’s psyche ward. Then, early one morning, I was shanghaied to Brainard State Hospital.

That fateful morning, I was awakened violently by two sheriff’s deputies who ambushed me with handcuffs and threatened to get rough if I resisted. I’ll never forget the helplessness I felt as those two hostile officers threw my possessions in a bag and dragged me to their police van, where they locked me in a steel-mesh cabin.

Ten years earlier, I’d been a medical consultant at the very hospital they were transferring me to. I remembered the vast, isolated and desolate campus of archaic institutional buildings. To be locked up at Brainard State meant you were beyond hope. Now, it was my turn to be on the inside of this somber hell.

The university psychiatrists had made a final appeal to the Attorney General and won. His signature erased my human rights. When I arrived at Brainard State Hospital, I was held down by six aids, injected with a sedative and forced through a CAT scan to prove that my brain tumor was a hoax, which, of course, it was. I wondered how many of those aids would have denied their actions under penalty of perjury if I had taken them to court. But for now, like all prisoners, I was forced to accept that the system held all the cards.

Throughout my tribulations, I always felt that I was in control of the seemingly out-of-control me. Even though I went on to try and outsmart the system, to this day I believe that my loss of freedom and nearly all hope were my destiny—one I desired on some level and brought on myself.

After the CAT scan found no tumor, I was put on a multi-drug neuroleptic cocktail that was in vogue at the time. Even though the drugs severely impaired my thinking, I still had the wherewithal to know I would die unless my medications were changed or stopped. I wasn’t wrong. Not long after they started the medications, I was rushed to the area medical hospital with a toxic reaction.

My medications were adjusted, but the manic pacing continued. I still knew I had to persuade the rarely visible wizard of our Oz, Dr. Walker, into changing my drugs or I would crash again. I’d wait in ambush for him, obsequiously badgering his nurses on his whereabouts within the hospital. Was he even here yet? Was he in a meeting? Would he be here by 3 P.M.? Why was he delayed? I worked them over daily, but it only seemed to fuel their disdain for me as some annoying and disenfranchised creature.

I tempered my own anger until it became a white glow in the middle of my brain. I knew that the day would come when I would ensnare them all — Dr. Walker and this infernal, inhuman monster-machine of psychiatric incarceration. One day, I would try to destroy it. But for now, guerrilla warfare was my only available tactic. If I bit the monster directly on the neck, it would label me untreatable. Then it could crush me with more drugs, solitary confinement, shock therapy and lock-up forever.

I finally succeeded in cornering Dr. Walker, who listened to my pleadings for all of 30 seconds and later changed my medications. But to what? The new mix, of course, was none of my business, according to the nurses — after all, I was incapable of any rational comprehension.

Four times a day, the announcement blared out: “Medication time!” All of us inmates lined up dutifully for drugs at the tellers’ windows. Only then would we know our medication had been changed as the pills and liquids changed colors and shapes and turbidity.

I balked at being forced to swallow them and crossed an invisible line by asking questions. The drug teller tersely rattled off the names of a half dozen drugs. When I objected, she threatened to call the guards, who would gladly force my medication on me.

How I dreaded swallowing those multi-colored toxins that had caused me all forms of psychological and physiological aberrations! Once downed, the side effects were unavoidable. In truth, they weren’t side effects at all, but effects of poisons. I adapted, somewhat, to the debilitating effects of the drug regime, but I braced myself for new horrors. After a while, Walker put me on another concoction, and this time the results were less devastating. The anxiety, the pacing and the showers all stopped.

With my medication stabilized, I searched for a way out. Day after day, I beseeched my social worker, Tom Littlehawk, to clarify my status. He was a busy man—which meant, in his limited vocabulary, that a mere stroke of his pen could cause me either great harm or great good.

In the end, Tom Littlehawk turned out to be one of ‘us.’ He’d returned to the system to milk it for dough and power. He now had the best of all worlds, considering the blows life had dealt him as a Chippewa Indian who’d been alcoholic and ‘crazy’ to boot. He knew the system inside and out. He had the power to torment us or help us. He did both. But I found that he generally kept his word when he gave it.

I begged Tom for a transfer to Sector B, and got it.

My new room faced north. The summer sun no longer inflamed my bed. Best of all my new roommates were old-timers who’d calmly settled into the horror, with savvy and without guilt. My new compadres.

These new roommates taught me the art of mouthing pills so I could spit them out later. They taught me about radios and tape players and how to hustle our keepers to get batteries. They showed me the secrets of getting smokes day or night, how to protect your coffee stash, who to share it with, how to tap hot water from a myriad of out-of-bound faucets and—most vitally—how one should act if one is caught. In short, they taught me how to retain my humanity while trapped in the belly of the monster.

Memoir, Personal Essays, short story

Asylum

stephenzuckerman

This is the first of a three-part essay about my time spent in Brainard State Hospital.  

Asylum: Part 1

“How can it be,” asked the spider of his brother,

“that the fly ensnared only one of us?”

“Good fortune,” lied his brother.

 

For five days I had suffered an overwhelming drug-induced anxiety that didn’t allow me a moment’s respite. I fed my body in five-minute forced spurts, afraid of starving, but unable to alight for a second longer. I hobbled about my prison corridors in a daze, sleep alluding me. I lay down a thousand times, but only tossed and turned in agony.

At some point I hit critical mass and my sweat-drenched body frantically righted itself — fatigued beyond fatigue — pulled on its clothes, shoes and socks to, once again, thrust itself into the openness of those shadowy corridors. The incessant anxiety drove me to pace my confinement: down Corridor A, the suicide protection unit, then through the blue fumes of the Smokers’ Inferno where bleary-eyed lobotomized puffers hid in its smoky recesses. On to Corridor B, rank with the piss- stench of communal toilets. Past the stark 4-bed dormers strewn with other prisoners. Creeping by the cloudy surveillance mirror, I barely recognized my reflection, seemingly headed in an opposite direction. Lastly, I’d reach the padded lock-up room that marked the end of my pilgrimage and the beginning of my next revolution. The only relief from my jangling nervous fits were the 15 or 20 cold showers I took daily, dutifully charted in my dossier by the nursing wardens.

And so it went again and again.

I existed. Period. My mind was full of mandatory medication and involuntary exhaustion. My bedroom was filled with stifling August heat and three menacing strangers who were also newly imprisoned and besieged by ominous tomorrows.

Like me, my cellmate, Nervous Cat, performed his own yo-yo-like ritual. He’d fling himself violently onto his cot, thrash about amidst his sheets, kick his locker and then curse himself into a frenzy, only to finally bolt upright and disappear down Corridor A, dressed only to the waist, to vent his rage in the Smoker.

My other two roommates were barely visible. We communicated to one another in grunts and gestures — each of us recently trapped, caged and helpless. Our four bare cots were each adorned with black striped mattresses of 2” thickness, a coarse pillow, a sheet that no one bothered using, and a thin cotton blanket. Each cot had matching rickety, green metal lockers, battered by previous inmates as their only legacy — perhaps in hopes someone would remember them. We each had a crude, waist-high dresser with four sticky drawers and no mirror. The two large windows, sans drapes, welcomed in the summer swelter, with only smaller-than-human-girth transoms to prevent suffocation. This was my ‘personal’ space in captivity.

Brainard State Hospital was my fall from grace. At 50-years-old, I’d gone stark raving mad (so some said), to the horror and intrigue of my family, business associates and friends, who had never expected this emotional rock to crumble.

Personally, I sensed why, but how it came about had shocked everyone, including myself. Spiritually, I’d been pregnant for some time with an overwhelming need to change my life. Now this pent up force had taken over. Frightened, but willing (did I have a choice?), I plunged forward.

Those around me, many of whom were in the medical field — psychiatrists included, assumed that I was in the throes of an attack of mania. Not unexpectedly, four months into my evolution, I was arrested by a psychiatrist at the behest of a good doctor friend and my brother, both of whom assumed I was mad. I was locked up in the rather gentile psychiatric ward at the University of Minnesota. My prevailing impulse was to resist any and all treatment offered by my jailers — a common reaction among those like myself who are involuntarily detained.

The psychiatrists’ protocol was to threaten resistors with a court commitment hearing, which almost always resulted in being committed for six months. I was told that if I voluntarily committed myself, I would be treated less harshly. But I firmly believed in myself, my sanity and my purpose for changing. I refused to volunteer.

The ensuing series of unfathomable, legal maneuvers first allowed a doctor to lock me up for 72 hours (actually 120 hours because weekends don’t count), and then be brought before a county mental health judge for a “dual-commitment hearing.” It all seemed like a mad comedy of errors to me, but evidently, it was standard operation for the University Psychiatric Department. In this hearing, the judge would decide not only if I should be locked up for a prolonged period, but also whether or not the psychiatrists could use their frightening neuroleptic drug arsenal on me.

The day of the hearing, my lawyers told me that my chances of avoiding commitment were one in a hundred. But I had done my own research. I hired my own psychiatrist to examine me and testify in my defense. I never allowed the psychiatrists from the University or the county psychiatrist to interview me. In spite of this, both of them testified at the hearing that I was seriously ill and needed commitment as well as neuroleptic medication.

My own shrink came to my defense. He testified that I could easily be treated as an outpatient and expressed his doubts that neuroleptics were necessary. Out of the three expert opinions, none suggested that I was, in any way, a threat to others or suicidal, only that my behavior had become bizarre and was “disrupting” my societal status. A few other witnesses: my brother, my ex-girlfriend, and a close friend gave ragtag testimonies under oath, which, considering their own character twitches, made the hearing more of a Gilbert & Sullivan operetta than a serious decision about my destiny. Not that their testimonies mattered. Apparently, standard procedure dictated that only the doctored-evidence gathered while I was imprisoned at the University and the arresting psychiatrists’ statements would actually be considered by the judge.

Just as we were leaving the courtroom, I was suddenly inspired to tell the judge I had a brain tumor — shooting an arrow into the Achilles heel of psychiatry. The inspiration for mentioning a “brain tumor” is another story.

One evening, months before my commitment, I heard a voice in my deaf ear. Although it terrified me, I was also intrigued by this sudden presence. Over the next four months, an on-going dialogue with The Voice took place and ransacked every nook and cranny of my belief system.

These were not benign conversations. Initially, they were full of The Voice’s threats, accusations and seeming attempts to degrade me. But I soon recognized that The Voice was unearthing all my secret pockets of shame and inadequacies.

The first issue that The Voice had made me tackle was the question of whether or not I was a good person. I insisted that I was. But The Voice responded with a single haunting word: “Evil.” I defended myself with a litany of good deeds, but again, The Voice only said, “Evil.” Again and again, I protested, but the answer I got was the single word: “Evil.” Finally, I succumbed. Maybe I was evil? All the times I had acted selfishly, ignored others in need, lied, came flooding in. But after an agonizing moral inventory, I realized I wasn’t evil. Just human. Full of human frailties. I was not exceptionally good or exceptionally bad — merely perfectly imperfect.

I came to the conclusion that there was no such thing as “Evil” or the “Devil” but rather that everything was about love and God. What we call “evil” I concluded was really the inability to express love. Once I understood this, I felt no further need to focus on my unworthiness. I also felt a contentment that I had not felt before in my life.

Following this, I developed a repartee with The Voice that was filled with humor, delight — even wonder. Each conversation was like an advanced yeshiva on the Big Picture: What is our purpose as human beings on this planet? Did the future already exist? How did spiritual forces give form to the material universe? And always, these were integrated with intimate dissections of my own relationships. I examined the nature of my personal loneliness, which in turn, gave me insight into the loneliness of others.

Check back on the blog next week for Asylum, Part 2!

Humor Writing, Personal Essays

The Baking Soda Acid Test

stephenzuckerman

A tip about stomach acid from a friendly doctor:

Recently there has been described in the literature a simple, inexpensive and safe method for detection and quantification of stomach acid production. This tool should prove most valuable in diagnosing those with hyperacidity (too much stomach acid) and also the effectiveness of antacid treatments such as Tums and Rolaids.

The fundamental principal involved in the acid quantifying procedure involves well understood chemical interactions. Sodium Bicarbonate, Na2HCO3, also known as baking soda, dissolved in water, is ingested by the human subject to be tested. This leads to an almost instantaneous reaction of the dissolved sodium bicarbonate and stomach acid (hydrochloric acid or HCL). The results of this interaction produces water (H20), table salt (NaCl) and carbon dioxide (CO2). The carbon dioxide production leads to eructation (belching). The subject being tested eructates into a scored Zuckerman acid quantifying balloon. The amount of eructated CO2 in the balloon is roughly equivalent to the amount of acid in the subject’s stomach. The subject’s height, weight, sex, age, race have no proven effect on the accuracy of this simple inexpensive test that any person can perform on themselves once they have obtained a carton of baking soda and a scored Zuckerman acid balloon!

Note of caution – suppressing the desire to belch can lead to gastro-explosion, stomach rupture, and ensuing death!

Note – use of baking soda for diagnosis. The baking soda acid test can also be used to help diagnose chest pain. Immediate relief of chest pain symptoms, on ingestion of baking soda, indicates the pain was due to acid indigestion and not angina, heart pain. Many a visit to the emergency room has been avoided by the baking soda acid test.

Memoir, Personal Essays

It’s a Bummer

stephenzuckerman

This is the story of my heart attack, and all the worrying, thinking, wondering, and fear that accompanied it. Enjoy!

I couldn’t believe it: I had a heart attack! Well, I had heart damage, and a leaky heart valve to boot. Suddenly, life was moment-to-moment, with yesterday’s indifference becoming a vanishing Eden. I wouldn’t live to my anticipated 85 anymore, instead hoping for 70 with the constant guidance of a cardiologist incubus on my back.

To tell you the truth, life had already become a bore, stuck, redundant. I would even go so far as to say I wished this illness upon myself. I’m a physician, so I know that if you don’t croak right out the minions of cardiology have an ever-proliferating number of drugs, angioplasties, surgeries, diet and exercise mantras to keep the sanguine flow pulsating through your coronary arteries and preserve what’s left of your ticker. Sure you become their patsies, subject to daily assaults by yummies of all shapes, colors, and coatings. You have to be on the lookout for side effects, hair color changes, diarrhea, swelling of the end of your nose. It’s all a royal pain in the ass, a strike against manhood, freedom and wilderness adventure. I felt my life contracting like a prune out to dry. On the other hand, my contracting horizons made my life take on value. I had a sudden desire to grovel, to cling to whatever false bone was thrown before me that might push death’s bite back a bit. Even the thought of being filleted open, having my coronary arteries rerouted, a feared adventure in basic plumbing, seemed desirable. The pain, suffering, the zippered chest scar and possible pump head complications was a price that suddenly seemed worth paying.

My mind reeled forward, reconstructing the new me, the cardiac, with my shrunken life horizon. Yes, I was a 60-year-old, too young to quit my job, though who would want to hire a cardiac cripple? I wouldn’t be able to get a new health insurance policy. Forget life insurance. The angiogram was somewhere in my future and I dreaded it, though both my mother and father went through the procedure without complaining and I had sent innumerable patients to the cath lab without a wink.

As for my colleagues, I was a bit older than most – I would become an incubus they might have to ‘carry.’ Of course, my condition might invoke empathy and human kindness. Maybe I could milk that one. I figured as long as I could stand up they’d have to put up with me. The thought made me feel surprisingly safe.

My girlfriend seemed sympathetic, caring, but I suspected she had some hesitations about how to deal with damaged goods. Was I no longer her corporeal hero? She was a winnowy 5’8”, size 4, with a great ass and long, undulating legs that made men sweat when she wore tight jeans or short skirts. Vigorous sexiness was her dial, regularly giving men the glad eye so they would sweat. Would she be repulsed, see me as a cardiac sex invalid (no rough stuff)? Would my money (and her lack of it) help sustain her climaxes or would fear, disgust, or – worse yet – contagion invert her, dry her womb, zero out her lust and chuck us both into impending greyhood? I always told her marriage would be important to me when I had to bow to the necessity of having someone push my wheelchair. Would I marry her now, not out of desire, but out of desperation? Would she marry me and willingly push my wheelchair? I worried that if she left me I would have to seek out that class of women who are devoted to caring for wounded men, men who are safe bets to stay home, faithful and civil.

Once a patient of mine, an old kraut, broke every bone in his body due to a clumsy arthritic fall from a trellis he was repairing. I asked him if this was a clumsy suicide attempt or a way to prove he was omnipotent. He all but died, and when he didn’t he was treated to two months of rehabilitation in a nursing home. His wife wailed to me, saying that his verbal abuse was worse than ever; he blamed her for his prolonged detention in the land of the living dead. With tears streaming she stated, “All my life he has never let me talk. I have no friends. He wouldn’t let me even go to my parents’ funeral because they hated him.” She felt she couldn’t bear to have him come home if his verbal violence remained at the same intensity. I felt she never wanted him back under any circumstances.

We met, the three of us, in my medically sterile cubicle of an office, and went about changing a 50-year marriage in 15 brisk, brutally direct minutes. I liked the old boy’s stiffness, which made slicing him in half all the more of a thrill. The kraut was emasculated. “You either kiss your wife’s ass or stay locked up in the shitter until damnation rings,” I spouted. He kissed the flesh. Perverse as it was, this event registered as an epiphany, an awakening, in the couple’s journey through their married life. Was I to be the next to do some kissing?

Dr. L, my cardiologist, was a good man: he balanced the business of my heart attack with humor, and a ‘life will go on’ sense of encouragement. He bent wisely to my ‘in denial,’ Cleopatra-like needs. He pushed my diagnoses forward, always supplying me with both the facts and the ambiguities we would likely encounter, and the odds involved in taking action versus sitting on one’s hands. He gave me his home telephone number, which I liked, and didn’t get angry when in a panic I called him at 2 AM, waking and worrying his wife. He was good. Still, as newer diagnostic results revealed or confused my cardiac state, my mind searched for a firm grip and transferred my care to a new bosom friend, a prominent cardiologist who loved me. Years ago I had lived with the Trukese tribesmen who had taught me the magic in the uniting of love and death. I always try to teach this to my patients, and now I was the patient.

But how to share my crisis with my close ones? I’d had a heart attack, but I wasn’t sure where it fell on the scale of seriousness. Was I facing eminent death or was this a minor cardiac event, with me living for many years to come? My girlfriend knew of my evolving concerns. My colleagues were vaguely informed. They all expressed mixed curiosity and apprehension. My work schedule did not change. My compulsive roommate, ten years my junior, was the one who got it right. He demanded all the details. With the ceiling lighting bouncing off his bald head, I felt the heat of his interrogation. He then exclaimed how upset he was. When I asked him why, he blurted out, “I could be next.”

Indeed, three weeks later he landed in the Fairview Southdale Hospital Coronary Care Unit, complaining of chest pain. In the middle of the night he drove himself groggily to the ER, chest pain accelerating with each mile, occupied with impending doom. He only called his soon-to-be frightened out of her wits wife on admission to the coronary care unit.

How vividly I remember the ancient, revered Yiddish cardiologist, Dr. Dressler, admonishing his residents when he was stricken by a heart attack in the far past. At the time I still bore the ignominy of being a medical student at SUNY Downstate Medical Center in Brooklyn. Dr. Dressler’s name was forever attached to the post myocardial infarction syndrome, a cardiac condition he was the first to describe. When told he would be admitted to the newly conceived coronary care unit, of which he was the medical director no less, he declared, “Never! That’s only for the patients.” He croaked two days later, in the wards of Maimonides Hospital, a survivor of Hitler’s attempt to annihilate his people, surrounded by those who had similarly not been annihilated, presumably content with his choice.

Echocardiography is elegant simplicity – sound waves bounce off the heart and are reported as a cinema of cardiac motion. Good hearts move rhythmically and with courageous strokes. Damaged hearts hesitate, flap about, move discordantly. As I watched my heart’s performance in real time, with narration provided by the eager seasoned tech, I was treated to the viewing of a small area of ‘hypokinesia,’ at the inferior margin of my heart. There was also a jet of red, in a sea of blue. “Back flow through a leaky mitral valve,” the tech told me. His matter of fact detailing of my echocardiogram, portraying damage, was not encouraging. I was now truly the patient, the damaged, the sufferer. The tech attempted to sooth me. “I have seen it before,” he said. But no words would make it better. I was the health care deliverer, now on the other side of the fence. As much as I tried to climb back over the fence, the faulty performance of my heart on that video haunted me.

How would my kids deal with a wounded dad, no longer their fearless, faultless defender? The thought crushed me. I needed a good work out. I went home that day, grey with information. I had had a heart attack, a small one, which in itself could be a minor event. The echocardiogram strongly suggested my other heart vessels were okay but my mitral valve structures may have been damaged causing the valve to leak, possibly enough to complicate life for years to come.

The next night, my daughter Gabrielle and I had our usual two week dinner hour at her favorite Sushi Restaurant. She was 28-years-old, her tall, stately body molded more by the menarche suppressing effects of her childhood ballerina training than by parental genetics. She’d had many relations over the years, but she’d avoided marriage, avoided an occupation. Gaby had never avoided life experiences though, and I loved her dearly.

That night, I told her of my heart attack. I cried, she cried. She relieved me of my burden. She wasn’t crushed; my daughter was already sufficiently rooted in herself. The evening went well, and I started to realize that my mortality, my death was okay.

My new cardiologist was a prince of his profession – a philosopher, scientist and discoverer. I brought him the ‘echo,’ the most damaging evidence of heart damage so that he could evaluate for himself its message. Echo interpretation is in the eye of the beholder, art and opinion. In the university expert’s opinion, the video’s quality was suspect, my heart’s performance was even more suspect than previously thought to be. I was chilled. I never hesitated (half ignorance was hell), but the issue now was to directly visualize my coronary arterial system and to end the anxiety ridden ambiguity. ECG’s, echo’s and blood tests are all safe but never definitive – only the invading coronary angiogram settles the issue. It was scheduled for four days hence.

I blocked out the date, tried to stop time, closed my eyes, and let it happen to me. Once again, I had a front row, real-time seat to the main event. Fifteen years before, I had shared the fluoroscopy screen with Dr. Sewell Gordon as he squeezed barium gingerly about my small bowel looking for the devil that had caused me so much pain. We both observed the sentinel marker of incurable cancer at the same moment – in a rush I felt disbelief and belief at the same time. I saw my death and simultaneously exiled my mind from the bedeviled image in the fluoroscope. In the end I survived. But now another moment of fluoroscopic truth awaited me, soon to be self-evident in three to five second segments of a video. This time I was emotionally seasoned and forewarned. One moment I was preparing for a filet job, coronary bypass surgery, the next a much more benign assault on my status quo – angioplasty, weight loss, medications. The angiogram would tell me which life would soon be the real one. I had both scenarios ready to be rolled out, and I found myself shifting between the two, like an uprooted plant waiting to be put back into the ground.

But first came the awkward hospital gown, the shaved right groin accomplished by amateur barbers, a cold slab table, gowned and masked performers, cameras and meters everywhere and three needle pricks in my bared-groin, ready for launch. The placement of the catheter in my femoral artery was accomplished with only a sense of pressure. My view of the 18-inch fluoroscopic screen, eight feet away and up to the left, was unobstructed. A clear view of my destiny.

How many wounds has my mind, my body incorporated into me? Jacob became Israel in his night-long tussle with the angel and limped ever after. Virginhood, the Garden of Eden, both unacceptable to human kin­­d, were only starting points. I could feel the universe, gravity pulling me forward into the light, and fully embracing revelation (or perhaps it was all the sedative?).

The black catheter slipped rapidly through the gray space of my body. Suddenly its tip began to beat rhythmically, then a gush of squid-like ink discovered the mouth of a mighty river. The catheter snaked into the river, the left coronary artery, the major arterial system bringing oxygen and sugar to my ever hungry beating heart. The next second a large gush of black shot out of the catheter and outlined the major river, lighting up all its myriad tributaries. I was enthralled by the river’s marvelously smooth branching esthetics – a clear left coronary! The big one down, one still to go. The catheter snaked into the right coronary artery. Again, a rapid black gush revealed a pulsating river, again what a wonderful branching, pulsating vessel. The chief of the masked men pointed out a blocked distal channel, the culprit revealed. The decision was to open this clogged channel so that in the future it might succor other nearby vessels, if they ever became clogged. The balloon catheter entered the involved area and opened the blocked channel. It caused an aching pain in my chest while it did its duty, and then black ink swarmed freely through the previously blocked channel – a stent was placed and all was back to normal. The ventriculogram – accompanied by a swarm of tasty dye induced heat that traversed through my whole body – confirmed a near normal ventricle. The only blemish was a small limp area caused by the occluded vessel. Forever the limp, but life goes on. My cardiologist said it all: “Now at least you know you are normal.”

In the past, there were times I was deemed insane, depressed, inconsiderate, isolated, insensitive, loved, unloved, cursed, willing to die, fearless, fearful, incapable of controlling my bowels, etc. Now, I welcomed them and all other descriptions I would be called in years to come.

Bring on the rest of my life, I am ready.

Memoir, Personal Essays

5 Seconds Worth, Please

stephenzuckerman

Forty one years later, the anguish over what could have been still remains as horrifying, if not worse. Disaster did not happen – there was only a five second period in which life and death hung in the balance – yet that five seconds is indelible and undiminished in its intensity. How different these past forty one years would have been had the balance tipped toward death.

My two-year-old son, Josh, and I were home alone playing on the living room floor of our rented house in South Minneapolis. As a young doctor I had wandered from the normal path. I had not established an office practice, rather, full of indecision, I developed an itinerant internal medicine practice in rural MN, three days a week. I had lots of time to spend with my family, my wife Kathleen, four-year-old Gabrielle, and Joshua. Both children were happy and healthy. Aside from my indecisiveness, family life was good.

One of my joys was to wildly tickle my children. I had become a master tickler, knowing all Josh and Gaby’s’ “weak” spots. As Josh lay on his back, I rapidly countered his every move to cover his armpits, his belly, his knee caps, his neck, the soles of his feet. He writhed in joyous laughter.

Suddenly, a look of bewilderment mixed with fear came over Joshua’s face. His breathing stopped. Faced with sudden immediate death they say your whole life flashes before you in an instant. Josh was lying in my arms. A riot of thoughts pushed through my brain. Contact! I plunged my right index finger into Joshua’s mouth following the inside of his left cheek into the back of his throat. There blocking his bronchus was a hard object. I dislodged it. Josh gasped once or twice and then his breathing returned to normal.

Five seconds, no more, had elapsed.

Yes, Josh admitted he had been playing with a nickel in his mouth when I took up tickling him.

Had Josh died at age two we would have never lived in Truk Lagoon, where I taught him to swim amongst the coral gardens and tropical fish, and to appreciate and not fear the ever so graceful reef sharks. There never would have been those fishing trips to the Florida Keys to catch Tarpon, snapper, trout and red fish. No Bar Mitzvah at the University of Minnesota Hillel, no tennis matches or high school acting career, no Children’s Theater School, no living and growing into manhood in Barcelona, no wife named Lisa, no granddaughters, Ruby and Ava, no talking about the meaning of life.

Years later, my cell phone rings: “Hi, Josh. Would you like to come to Minneapolis for a few days and help the old man rehab from hip surgery? Can you get away from Lisa and the kids for a short stay?”

“Sure, Dad, I love you. See you soon.”

Memoir, Personal Essays, short story

Tyranny

stephenzuckerman

“You’re fired,” not by Donald Trump, but by Dr. Kurt, a middle management medical administrator at Allina Health Care System. For 23 years, from age 51 to age 73, I was a PCP, a primary care physician extraordinaire at East Lake Street Clinic in Minneapolis. East Lake served an ever-changing inner city population. The euphemism, ‘Hennepin County Hospital South,’ gave East Lake Street Status relative to the county hospital. We were figuratively and literally one stop up from ‘the bottom.’

To work at ELS you need to be dedicated to the less privileged, less educated, less motivated, less compliant, less healthy, less skilled, more drug and alcohol addicted, more criminalized, more mentally and physically ill, more jobless, more poor, more on welfare, more diabetic, more diseased, more obese, more prone to violence, without being patronizing, without being judgmental, with an open heart and head. Otherwise you’re toast, you are going to fail and you might as well move to the suburbs!

As a student at the old Kings County Hospital in East Flatbush, Brooklyn, I already had experience with a place like ELS. How well I remembered the dingy, poorly lit 10 bed wards filled with groans of suffering patients. A famous saying around Brooklyn was “if I get shot, take me to Kings County” – and many in the neighborhood did get shot.

Next it was on to Michael Reese in Chicago’s south side, followed by Mt. Zion Hospital in the Fillmore in San Francisco during the height of the Haight and LSD. I routinely got high on second-hand marijuana smoke on daily rounds through Mt. Zion’s wards – it was all very Cheech and Chong.

After earning my medical license, my first work was found in Central MN, with its post-glacial lakes and rocky soil, its poverty, its tacky fishing resort and its tar-paper shacks.

Then my odyssey took me to Truk Islands in Micronesia, driven by my love of the sea and a romantic vision of escaping to the South Pacific ala Paul Gauguin. The Trukese didn’t consider themselves poor if they had a breadfruit and a pandanus tree, land with brackish soil to grow taro, a piece of the barrier reef to fish on and most of all, a multi island extended family to rely on.

In ELS, my patient population included African Americans, Native Americans, Somalis, white blue-collar workers, newly minted immigrants of all races, drug addicts of all races. All of these were my ‘extended family.’ I gave to them and they gave to me. I studied their varied lingo, their mannerisms and made them my own. I ‘stole’ their pearls of wisdom and made them my own. I became, over time, intimate with my patients, redefining the definition of ‘medical boundaries’ and making our relationship the meeting of souls: naked, open, always with as much humor as could be injected into often catastrophic circumstances. I became my mentor, Gabriel Kirshenbaum, the Don of Williamsburg, Brooklyn.

At age two and a half, Kirshenbaum charged head-long into my life and instantaneously inspired me to go into medicine. A huge bear of a man, gruff, alert, always moving forward and always out to make you better, to protect you even from yourself, even if he had to sacrifice himself to do it. And who, in all of Williamsburg, no matter white, black, Jewish or Christian, didn’t love the irrepressible force that was Kirshenbaum. G-ds tool, an avatar, a Kabbalah Tzadek, a Jewish Saint.

As much as I proclaimed, as a young man, that I had to make a choice between theatre and medicine, there really was only medicine. I had stage fright; I feared forgetting my lines on opening night and never recovering from the trauma. Yet theatre was always on my mind.

This why the examining room became my stage, ad-lib my style, my patients my co-thespians. With each new patient I expanded my repertoire. I kept thinking of my exam room as my medical ‘house of illusions,’ where reality played out.

“Did the cardiologists tell you how long you have to live?” I asked a patient once.

“Well, they said I was late stage and I guess that means not too long.” He had hypertrophic cardiomyopathy, a condition of an ever-enlarging heart that finally cannot pump blood – he was ‘end stage,’ having maybe 1-3 years to live. The condition was inherited: his daughter has it, his uncle died from it. The ‘cure’ is cardiac transplant, but he was being denied a transplant because he was positive for Hepatitis C. At 55, overweight, living on SS disability checks, he was depressed and had given up trying.

My job was to provide a ray of hope, not only for him, but through him to his daughter. The University of MN was less rigid in its transplant criteria. If his Hepatitis C could be cured, if he stopped smoking, he could be a transplant candidate. “I don’t know if I can do all that, go to the University and start all over,” he said to me.

“What about your daughter?” I asked.

“She won’t go to a doctor. She’s 16 and won’t listen to me, but she knows she has it.”

“If you die, she’s next.”

“I suppose so.”

“What if you somehow make it, somehow get the transplant and live?”

I met with him every month or more often. He went to the university. “They say they have transplanted other patients who got their Hepatitis C cured,” he told me.

It took time, but he gradually stopped smoking with the help of E-Cigs. The treatment of Hepatitis C was undergoing a revolution. “I really feel fortunate, the G.I. people at the University said they could pretty much guarantee they could cure my Hep C.”

Now his original doctors say they can transplant him too if he gets cured of his Hep C. “I know my daughter is watching what I’m going through. It seems to be helping her deal with it.”

The dance goes on. Will he make it to transplant and will it be successful? Hope, encouragement, that’s my role.

“Oh, I am so afraid to die.” Doris Redhorse shudderingly informed me.

“Why?” I asked, “Are you afraid to go to Hell?”

“No, no, I just don’t want to die like my older sister did. She had diabetes too, but didn’t take care of herself. I want to take care of myself, but you know I had to move out of my house and had all my medicine stolen. I didn’t even have money to buy my insulin or syringes.” Doris was 60 years old, modestly overweight, and all but homeless. Her type II diabetes had been out of control for years. Her fear of death was all but paralytic. She stopped drinking alcohol 5 or 6 years before but still smoked. She was ready to change, fear was driving her, but she has no road to travel on.

Doris and I hit it off. Through it all she still loved to laugh. “You know when we were kids we would hide my grandfather’s shoes. His memory wasn’t too good, so he would get blamed for misplacing them and then get all angry. We’d sneak ‘em back right under his chair. Boy, did that confuse him even more!”

“How about the Barking Walleye,” I said, not fully understanding the Native American reference. But just mentioning it makes Doris laugh.

“You know Jewish people believe animals are made to talk to tell G-ds truth. A carp in a barrel in a Jewish market in the Lower East Side in Manhattan told a Latino worker that the ‘End of the world was near,’ scaring the dickens out of him even though he didn’t understand English. He ran to get the Jewish owner of the shop and when the carp told him the same thing the frightened owner killed the carp!! Whose world did end?”

We both laughed.

Doris Redhorse slowly gave up cigarettes, she lost a few pounds and went faithfully to see the diabetes educator. She takes her insulin regularly, now. She sees me monthly to share jokes. Her last hemoglobin A.C. was 7.6 – down from 12. “I can’t believe it, this is the first time in years my diabetes is normal!” And her anxiety is, well, better too.

Sometimes it’s not so easy.

“Please call Dick Young at the Hennepin county coroner’s office regarding Evelyn Chace.” Evelyn was 65, has chronic arthritic pain and was on a modest dose of oxycodone, which she got when she saw me monthly. She was a model opiate-taking patient, clean urines, never a day early for her prescription refills, never asking for medication increases.

“Hello, this is Dr. Zuckerman, is Mr. Young in?”

“Yes, he is, hold on.”

“Hi, this is Dick Young, is this Dr. Zuckerman?”

“Yes it is, how can I help you?”

“Is Evelyn Chace your patient?” I don’t want to answer yes; I know what’s coming.

“Yes.”

“Ms. Chance was found dead in her apartment two days ago. There were a number of bottles of medication in her possession with your name on them.” I must be hyperventilating, because my lips and fingers are numb and I feel like fainting.

“Did she O.D.? Were there signs of trauma?”

“There were no signs of trauma but we haven’t finished the autopsy or the drug analysis yet. Was she ill with any chronic disease that could have killed her?”

“No.”

“Well, I will get back to you in 3-4 days with our results.”

“What pills were found in her apartment, any opiates?” I asked.

“Yes, a bottle of 5 mg oxycodone prescribed by you ten days ago.”

“How many are left in the bottle?”

“About 45.”

Some relief, I had written the prescription for only 90. I figured if Evelyn wanted to O.D. on oxycodone she would have taken them all.

“Thanks, Doc,” the coroner concludes.

I try not thinking about Evelyn – it doesn’t work. If she O.D.ed on oxycodone, well – I have been down this road before. Ten years ago a patient went into withdrawal when she couldn’t get “enough” dilaudid from me. She had been shooting the medication instead of taking it by mouth. I never noticed the needle tracts. The Board of Medical examiners raked me over the coals even though the patient lived, even though I monitored her and had no previous problem with opiate prescribing. It was two years of hell.

After hearing about Evelyn, I didn’t sleep the next three nights.

“Hello, is this Dr. Zuckerman?”

“Yes.”

“This is Dick Young from the coroner’s office. The autopsy on Evelyn Chase is finished.” Here it comes. Heads or tails I think to myself. My stomach anticipates the worst.

“What did you find?”

“The patient had a lethal level of Methadone in her serum. She died of a Methadone overdose.”

My prescription hadn’t killed her. I vow to never give any patients opiates again. But I will.

“I have to be on disability, I have been working for thirty years for peanuts, with no man to help me. Can’t you get me disabled?” Caroline, my 60-year-old patient asked, demanded.

“Physically you ain’t there, mentally you might make it,” I say. “I’ll take it, I know I’m crazy.”

And Caroline did make it. I referred her to psychiatry where she got certified. Caroline carried her work ethic into her disability retirement years, taking her medication compulsively, exercising, coming to her appointments. She manages her SS payments and thanks me for “making her crazy,” and for the most part she is.

My Ethiopian patient returns from a trip home with a gift for me, a carved wooden bowl inlaid with pieces of porcupine quills. I now know porcupines live in Ethiopia. Another patient proudly presents me with two lbs of canoe-harvested wild rice, another with warm pastries baked by her husband that I waste no time heating up and eating. Others send me cards, “Thank you for being our doctor all these years,” or “You saved my life,” or “I can talk to you,” or “My husband, may he rest in peace, loved coming to you,” or “You are the funniest and best doc I ever had, don’t retire, my husband and I need you!”

My health is good, my brain still facile, I can do computers, eMR, well enough I feel. I am ‘booked solid’ a month in advance. I feel at the top of my career, the most accomplished as a human being. And then suddenly it is over, I am fired, at a time when I feel the most capable of being a PCP. The corporate megalith, Allina, that has bought our doctor-run group has other criteria than patient allegiance, patient satisfaction. I am at first bewildered by the computerized score sheets that claim to quantify the quality of my care and my patients’ satisfaction (patient experience is the new title). I am told I am unprofessional (for first time in my 60 year work career) and overly negative, buck authority and “have few friends in administration.” It feels like its character assassination – why? Well, a little, but well informed bird says I communicated about a pet concern of someone in power, in a manner that was inappropriate, out of “chain of command.”

I protest, East Lake Street is not the suburbs. I write a poem extolling East Lake Street (Ode to East Lake Street Clinic) that echoes Emma LaZarus. “The new Colossus,” I reproduce “letters to the staff at Allina,” from Ken Paulus, CEO, Rod Christianson, Medical Director, and others, requesting “feedback” from the rank and file – to no avail. The request for feedback is a ruse. I come to realize the doctors in administrative roles have truly gone over to “the Dark Side.”

Dr. Kurt is no longer my colleague, I cannot deal with him as such. If he spouts intellectual dishonesties, that is what corporate talk demands and he will obey. The corporate computer generates gobbledygook reports based on inscrutable alchemist’s formulas.

Socrates’ choice, to be ostracized, or sentenced to death by the cup of Hemlock. I chose “retirement,” at least from Allina.

I am angered by being cornered into giving up my practice, my patients. “Stephen Zuckerman, they are not your patients, they belong to Allina,” I’m told. My patients rail against my being fired, vote me savior, likeable and funny – all to no avail. I hate Dr. Kurt for his cold bloodiness. His indifference to all but his concocted reality ignores my relations with my patients – yet I thank him. He has freed me from the tyranny imposed by my vision of my needy patients. I could never abandon them until I was invalided or the grave opened up to suck me in.

Since the Allina buy-out, my work days have been tainted with the angst caused by the badgering of the likes of Dr. Kurt. I bite my nails and cuticles, I eat knosh food (caramel corn, tortillas chips, dried fruit for constipation, jelly beans, roasted, unsalted cashews) incessantly and avoid lunch to lower the daily caloric count. I really don’t want this type of practice anymore!

As for the Allinas and their Dr. Kurts, I feel they are building a square wheel, which will give them a lot of bad headaches and, worse yet, screw up their “bottom line.” New schemes will be invented, the same culprits will scramble to stay in power, but that’s no longer my concern, I suppose.

Doc What's Up?, Humor Writing, Inventions

Snore-No-More

stephenzuckerman

As I’ve mentioned before, I have quite a few inventions sprinkled in the pages of Doc What’s Up?. The Snore-No-More is one of these, responsible for saving marriages everywhere.

SNORE-NO-MORE
Does sleeping in the doghouse get you down? Is your wife’s divorce lawyer claiming mental cruelty because you have snored incessantly for years when she does not snore at all?

Well, at last snorers are coming out! Out of the bedroom, out of the doghouse—into Dr. Zuckerman’s office to be cured!!

Untitled

“At first, I was skeptical,” says Joe Morphus of Snoozeville. “No doctor ever gave me any advice except ‘give your wife a set of golden ear plugs.’ I hadn’t spent the night in my wife’s or my girlfriend’s bed in years. I’d just show up for sex and then get kicked out.”

“Now I sleep when and where I want to, fearlessly. Sure, I’ve had a few relapses, but when that happens, it’s back to Dr. Zuckerman for a night of treatment and I’m snore-free for another 6-12 months.”

How Dr. Zuckerman’s Snore-No-More Works…

Following an intake interview, those who clearly are snoring sufferers are given an appointment to spend a night at the Snore-No-More (TM) Lab. There you are fitted with special inner ear amplifiers. A microphone is used to capture your snores so that they can either—be played back to you instantaneously amplified or—trigger the transmission of your personally most-feared sounds to the inner ear amplifiers, sounds like a grizzly bear attack, a car crash, or your tax attorney’s voice…

Built into the cost of a night at the Snore-No-More Lab is a CD recording of your snoring, taken during your night in our lab—so that you can hear, for yourself, just how bad you’ve snored and how effective the Snore-No- More treatment is.

The History of Snoring

I am a fellow snoring sufferer who has had numerous humiliating experiences like: having a string tied around my toe to wake me when I snore, being screamed at and poked into rude consciousness, exiled to the living room couch and threatened with involuntary surgery.

Sound familiar? I had to find some way to cure myself, but I also wanted to exonerate snoring as a loathsome, useless activity. I searched back into ancient times, all the way back to the cave and there, I pieced together the preservation function that snorers must have played in the survival of our species.

Man’s nature is to sleep at night—a time when most large predators hunt their prey. Thus, not only was man vulnerable while he slept, but he slept at the precise time that he was being hunted. No doubt, once fire was mastered, some poor insomniac (they too, served to save society) was forced to tend the nocturnal fire at the cave’s mouth. But what did man do before fire?

The perfect solution had to have been that the loudest, most obnoxious snorers slept at the cave’s entrance. No beast would doubt that his human prey was awake and in an ornery mood. Meanwhile, everyone else slept in blissful safety.

Therefore, the snorer played a critical role by allowing society to evolve beyond the need for his service.

But—is the snorer revered for his past efforts? How quickly we forget what others have done for us!

The cost of one night of guaranteed therapy in the Snore-No-More lab is a lot cheaper than a second bedroom or a divorce!