DR. C. PAUL MARTIN, M.D., CONTRIBUTED THE NEXT THREE STORIES

Dr. C. Paul Martin, M.D., is retired from a busy medical practice in the far southwestern part of Minnesota. Boarded in internal medicine as well as family practice, at mid-career he added Dermatology to his repertoire by way of a Bush Fellowship. Skillful, jovial, a man of a thousand interests, he applied zest to medicine. He is a raconteur of the first order, and if you want to catch his attention, ask him about The Baker Street Irregulars. While not a charter member of that distinguished organization, he can lay claim to missionary zeal in spreading appreciation for the redoubtable Sherlock Holmes. May I introduce Dr. Paul Martin, using his words to bring you tales from his own practice:

We Know Ourselves

Skin ulcers caused by varicose veins are those terrible spots elderly patients suffer when the heart’s pumping action cannot keep up with the gravity pulling on their legs. These large, irritated patches of broken skin are usually wrapped with snug Ace bandages to both heal and hide the sores. Often, it is a constant battle to keep the wounds healing and their owner comfortable.

I became acquainted with Maurice Mulqueen years ago when varicose veins had produced open sores in his legs. We had had success in treating Maurice’s ulcers, and he was free of pain and irritation. Now, his eighty-eight-year-old heart labored to keep him alive, yet he always had a smile for me when I checked his wounds and adjusted medications during bimonthly visits.

An early morning call from the hospital alarmed me when I heard that Maurice had presented himself there with chest pain. He, like many of my patients, never missed an appointment, but rarely called after hours. A brief interview, examination and review of his tests showed what I usually would have considered a mild heart attack. We talked about his need to remain in the hospital and my optimism for a good result.

Maurice disagreed. “This is it,” he said. “Keep me comfortable.” I was puzzled, since Maurice was usually optimistic, and my medical sense predicted a benign course.

Throughout the day, I checked him frequently and carefully. He received the usual cardiac care, and looked stable. However, about 4 o’clock his blood pressure dropped, his pulse weakened, and his usual ruddiness paled. I said goodbye to him as he entered another life at 5 p.m.

Somehow, Maurice knew and accepted what his doctor did not want to think. We indeed should know ourselves.

Critical Cosmetics

A rural hospital emergency room is often the site of strikingly dissimilar medical conditions. Over the years, I have seen children with mundane sore throats being evaluated alongside catastrophic abdominal injuries. Acumen and experience of physicians and nurses organize order from chaos.

Joe Fielder’s injury raised no doubt about his need for urgent action.

January in Minnesota brings temperatures well below zero, along with a need for heat in the house. Joe’s family enjoyed the warmth of their fireplace, which assisted an over-stressed gas furnace. One Sunday afternoon, Joe set out to replenish the supply of firewood by cutting up some old oak logs. When he explained the accident, he described the wood as “tough.” His chain saw strained and he leaned into it to increase pressure. The saw bucked straight back and hit him in the face. Stunned, he dropped the saw, put his scarf to his face and called for help. His father was working nearby; he brought Joe to the hospital.

My first look at what Joe had accomplished jolted me like an electric current. His forehead and chin were intact, but his nose...

Brightly illustrated anatomy books show structures deep within the nasal cavities. Interesting. Sanitized. Joe, in the flesh, offered an identical view. The saw had created two open gates from his nose.

The nearest plastic surgeon was one hundred miles away. Joe wanted me to fix it. When I explained what needed to be done, and my lack of experience in such a venture, he said simply, “Let’s do it.”

I had repaired lacerations of all kinds, and in all areas of the body. I rolled up figurative sleeves and went to work. I aligned the two sides of his nose, using many small sutures, all the while carrying on a conversation with Joe about his “cut.” An hour and a half later, he had one nose—and a big smile.

I removed the stitches a week afterward. Joe got his first good look at his face.

“My nose is better than before, Doc,” he smiled. “I’m almost handsome.”

Isolation

The image of rural America in the minds of many people is often one of idyllic and bucolic scenes: far meadows, streams and small towns. Everyone knows everyone else and friendliness abounds. Strife, grief, sadness and conflict are unwelcome visitors. Yet rural life has its quiet despairs.

One of my additional duties in Armstrong and Godfrey County was that of county coroner. This legal duty usually led me to sites of acute or chronic sorrow. A visit to rural Armstrong one fall day defined the atmosphere of death and isolation I often encountered.

I never knew Charlie Christopher as a patient. He and his two friends, Tom Prosper and Moral St. Claire, were retired farmhands who “hired out” at harvest time. Most of the time, they would appear at local restaurants, uniformly dressed in faded blue bib coveralls and seed-corn caps, bachelors all.

The sheriff called me on the Wednesday before Thanksgiving. Tom and Moral had breathlessly reported finding Charlie under his bed and that he was blue and cold. Off I went to Charlie’s home to ensure that his demise was unaided and from natural causes.

A small, faded, prairie farmhouse had been home for Charlie. When I entered, I was struck with the stillness and isolation of the house. Remarkable for its plainness, the front room housed a large oil-burning stove, only gently warm, and a threadbare couch. Just one picture interrupted the monotony of the walls, a tinted aerial view of the house and farm taken during the better times of half a century before. An ancient cooking stove, long unused, filled a corner of the grimy kitchen. No refrigerator or table was present, and a solitary chair faced empty, dusty shelves, long relieved of any burden of food.

Evening light shone through uncurtained windows into a small bedroom. Charlie’s body lay on the floor next to his bed, a simple frame containing a naked spring mattress covered with a thin blanket. There was no evidence of foul play. His position and color suggested that coronary heart disease had ended Charlie’s life.

And freed him from stark isolation.

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