DR. ROBERT P. MEYER, M.D., CONTRIBUTED THE NEXT TEN STORIES

Dr. Robert P. Meyer, M.D., Fellow In The American College Of Surgeons, practiced general surgery in Faribault, Minnesota, from 1952 through retirement in 1996, interrupted only by a two-year stint in the U.S. Navy. May I introduce to you my former medical school roommate and longtime friend, using his own words:

A Fitting Memorial

“The Lake” is a modest puddle in the broad pantheon of Minnesota’s many bodies of water. Geographers rank it Number 13,263 out of a total of 14,644 in a compendium of these, our glorious assets. It had been named for a Civil War general. So far as anyone knows, that dignitary was never aware of the honor. Little survives about the general’s military achievements, although he is rumored to have once challenged Abraham Lincoln to a duel. Fortunately for the nation, Honest Abe paid the man no heed.

Included among my patients was a man we’ll call Martin. The man lived on a reedy shore of our featured lake. He had spent thousands of hours fishing on it, knew every sandbar, weedbed and fish hideout. He understood The Lake’s moods better than he had those of his once-upon-a-time spouse. Martin often claimed that he “thought just like a damn bass,” an attribute when stalking such a wily fish.

Time exacts its toll on each of us. Martin lay on his hospital deathbed. He gathered family and friends to his side that final day and announced that he wanted to have his body cremated. He invited all present to bring his ashes to his lakeshore cabin and share a final round of drinks before rowing out to deposit his remains in his favorite fishing hole. His voice was a whisper ebbing on the tides of mortality. “Cast me... into my beloved waters... so I may spend eternity among my bass.”

He folded his hands on his chest, smiled... and died.

Unless you fish, you may not understand how major was this concession. No honorable angler discloses the location of a productive fishing hole! Isaac Walton wrote compellingly on the issue: “Death is not to be considered a valid excuse for disclosure.” Directions to Martin’s favored hole, its coordinates and depth, had been placed in a sealed envelope, located in his cabin. It was to be opened in the presence of all concerned on the fateful day.

Final preparations were made. The mortician released a classy little urn containing Martin’s last remnants. Friends and family, fifteen strong, gathered at the cabin.

A cousin somberly raised high a can of Hamm’s. “To Martin. A real man.”

Murmurs rose, “Hear, hear.”

A brother favored Pabst Blue Ribbon. “Never did a man have a better brother.”

More, “Hear, hear.”

A younger sister recalled, “He was sometimes kind of mean, though. When we were kids. Once he tied my braids back around a tree.”

“Hear, hear.”

A guy from two lakes west, a friend from high school, offered, “Known old Martin since...” The guy from two lakes west favored whiskey, so his tribute droned on for quite a spell.

Fifteen toasts take a while. A single round demands an encore, then a third, and light of day didn’t last until the accolades had fizzled out. It came on 11 p.m. and someone remembered that they had not yet carried out Martin’s wishes. The classy little urn still sat on the kitchen table, looking a bit accusatory when it caught the light just right.

A wind had awakened. Waves became more than a chop. The entourage trouped outside for a look around; a lantern pushed away darkness no more than a few feet. Fifteen well-toasted lads and lasses glanced from one to the other.

“Dunno,” said the guy from two lakes west.

“I get seasick,” muttered little sister.

A cousin decided he didn’t particularly want to drown.

Back inside Martin’s cabin, they formed a circle around the table and its classy little urn.

“Should do somethin’,” muttered Joe, Martin’s uncle once removed.

What to do? Honor and ill-advised promises.

Thor lived on the same lake, across the bay. “Know what? Danged health department keeps a-claimin’ ever’t’ing flushed down the dang toilet ends up out thar in the... danged... lake...”

There wasn’t room for all fifteen mourners to crowd into the bathroom, it being, after all, nothing more than a converted closet. As many as could stand and still breathe crammed inside. Being closest, Bessie, who was ex-brother-in-law Tom’s cousin’s second wife’s sister, actually tipped the flusher that consigned Martin to eternity.

“Amen.”

Sounded like old Luther’s voice.

A Signal Honor

To many people, the terms “country doctor” and “house call” bond to each other as surely as do Scottish and frugal. Old Doc Lonsdale was a fine member of the profession, from the generation ahead of mine. He practiced in small-town Minnesota, in the southeastern corner of the state.

It was winter. Automobiles were a noisy and sometimes undependable mode of travel in his era. Doc Lonsdale hewed to the old ways, made his country calls in a sleigh drawn by a team of chestnut horses. They pranced along smartly, a harness bell marking the gait. Driving a team along a deserted country road requires less concentration than does steering a gasoline-powered automobile. It grants time to reflect, to enjoy the scenery, the crisp air. Gems of philosophy incubate. Dusk lurked in the west, but it was still daytime, with light gentle to the eye.

Suddenly...

Doc Lonsdale jerked to attention. From high in the sky a searingly bright light appeared. He watched it bear in on him, true as Robin Hood’s arrow targeting Nottingham’s sheriff. Doc was immobilized like a deer in a spotlight.

A clap, thunder on a cloudless winter afternoon, shattered his hypnosis. The horses reared and bucked, breaking some of their harness leather. The doctor fought their fright and regained control. He blinked, afterglow reddening slowly in his eyes until he could discern his surroundings. What looked like firebox ash lay on the snow about his sleigh. He got out and knelt. Gray, the substance was gritty to the feel.

He dug a specimen bottle out of his travel grip and scraped some of the odd material into it. Upon returning to town, he mailed the vial to the University of Minnesota with an account of his story. In time, he received a reply: Dust from a consumed meteorite.

Dr. Lonsdale claims the distinction of being the first physician in the nation to have sustained a direct hit from an outer-space rock while on a home visit.

And people wonder why we doctors are reluctant to make house calls!

Faith is a Wondrous Thing

Communication. Words. Fundamental tools in a physician’s role as healer. Information passes between patient and doctor. Or not, if the words merely confuse. Russian to one speaking English? Kindly physician to terrified child? Doctor steeped in science to a patient convinced that wishful thinking equates with wish fulfilled? Periodically, I stubbed a toe over patient communication. I am not unique!

Call the lady Mrs. Smith. She was typical of so many older patients, her body frayed from a lifetime of hard work. Arthritis of the type known as degenerative joint disease translates as parts wearing out. Aches and stiffness were her lot, where youth had known no constraints. Who among us cheerfully embraces grumbling discomfort and loss of agility? If the diagnosis be the demons of tumor or heart disease, at least it provokes concern from others, a melancholy sort of melodrama. Sympathy ebbs away when complaints due to wear and tear stretch into years.

I had invested time and empathy in my dealings with Mrs. Smith. I explained the pathology, the “wrongness” of her parts. From what lexicon do you find words that can cross the gap between a doctor’s training and a patient’s life experiences? Honestly explain the limits of medical science? Prescribe those things that reduce discomfort but fail to cure the incurable?

“Why won’t you fix it, Doctor?” was her response.

So what do the Mrs. Smiths of our lives do? Joe spent $2,000 for the chance to sit for a few hours in an abandoned uranium mine in Montana. No physical examination or troublesome tests required, but bring cash. Alfie spent more than $5,000 receiving “chelation” treatments in Mexico at a “clinic” where the sole “treatment” for any who entered its doors was the same advertised injection. What do these “treatments” have in common? That they have no power to heal is never broached.

One day Mrs. Smith listened to her radio. The Right Reverend Billy John Healer was speaking. “To be cured, dear friends in radio-land, send ten dollars to my foundation, then put your hand on your radio, right there in your own living room. Feel the power, friends! Pray with me! Free your soul from its bonds to the Devil, do it now, do it. Send your money and I will make you well. Ten dollars is all it takes. Do it!”

Mrs. Smith sent her money and waited for the Right Reverend Billy John Healer’s next program. He began speaking while Mrs. Smith dawdled over her morning coffee. She labored out of her kitchen chair. She explained what happened during her next visit to my office.

“His divine message came on, and I started toward the radio, but my knees were stiff and sore. I could see I wasn’t going to make it in time. Then, it came to me! I knew the radio and the refrigerator were on the same 110-volt power line, so I put my hands on my refrigerator instead. Doctor, it made me feel so much better.” Mild anxiety appeared on her face. “Do you think it will last?”

Long Distance Medicine

During the 1950s and ’60s, rural telephone service was often provided via “party lines.” From two to as many as eight farm homes would be like extensions of one telephone hookup.

One day I received a call from Charlie.

“You got to help me with these blamed hemorrhoids, Doc.”

“I’d be happy to see you at the office to discuss the problem.”

“Can’t do that, got no money right now. Just tell me what to do.”

I grumped silently but said, “What are your symptoms?”

“Piles symptoms, of course.”

“Which include?”

“You know.”

“Charlie, the signal is getting weaker; I can barely hear you. Maybe someone else is on the line.”

“That’d be Susie G. She’s got the same dang problem I do, wants to hear what to do about them.” There was a determined click in my ear, followed by a choir of sputtering feminine laughter from other phones along the line. Charlie’s voice boomed loud again. “Susie’s too cheap to come and see you.”

Special Nurse

Narcotic pain medications make the post-operative time bearable. Nature in her frugal wisdom frequently assigns more than one function to a given hormone or other bodily secretion. A neurotransmitter is a chemical essential to functioning of the brain. A narcotic imitates these naturally occurring brain secretions, not a surprise if one thinks about it. Effect number one, relief of pain, goes in lock-step with effect number two, suppression of intestinal activity. Television programs are peppered with ads promoting this or that for what is delicately termed Irregularity. I plan to be equally delicate. Up to a point. Information must still be transmitted.

So, post-operative surgical patients always have problems in the realm of Regularity, caused primarily by those blessed, heavenly, thank-God-for-’em pain-relievers. Only, inevitably, they turn off the intestinal peristalsis switch at the same time. (Is that delicate enough?)

Making evening rounds on the surgical floor of our community hospital was an ongoing chore. Registered nurse Mrs. W. regularly accompanied me on those tours. She kept asking things like, “Dr. Bob, may I give Mrs. X an enema?” or, “Is it all right if Mr. Y was to have milk of magnesia?” or, “Might I give Mrs. Z a Fleet enema for her fecal impaction?” (Hard to be delicate there.)

One night I told her, “Mrs. W, you have wide and varied experience. You don’t have to ask me about such things; you have complete bowel privileges.”

A few days later, nurse W. arrived on duty wearing a new pin beneath her RN badge. It read, Mrs. W., C.B.P. When challenged to explain, she smirked, a distinct twinkle in her blue eyes. “Dr. Bob assigned me Complete Bowel Privileges.”

See, delicacy gets you only so far.

A Trip to the Hospital

In my part of southern Minnesota, prairie country offers scant shelter from a winter storm. Snow hurtles along the ground on the shoulders of winds recently out in the Dakotas or Canada. Drifts pile up before your eyes and form crusts firm enough that a man can walk on them.

Reinhold decided to use storm-enforced isolation on his farm to repair a cattle stanchion in the barn. He strained and twisted. A loop of bowel slid into his long-standing groin hernia. He could not reduce the bulge and pain began. He knew his pickup would not make it out of his driveway, buried under two to three feet of shifting snow. He and a son started his John Deere tractor and chugged onto the county road running past his house. Snow deeper than the tractor’s axles immobilized it. He floundered painfully back to the house and called me. He explained and I mentally set the clock of urgency to ticking, that enforced by nature when a bowel loses its blood supply.

“Wondered if you could come and get me, Doc,” Reinhold said.

I said, “I’d never make it, either.”

“Maybe the rupture’ll go way.”

“Not likely. You need to have an operation, and soon, before the bowel dies.”

“Fine, but how am I going to get there?”

How?

“Maybe the sheriff can help you,” I said. Phone lines hummed in three-way conversations, and a plan evolved.

Reinhold climbed bare-backed onto his twenty-five-year-old horse, Beau, an honored retiree from those days when such an animal mattered around a farm. He rode him across-country, through fields, tight in the lea of a windbreak, along a fenceline, past his nearest neighbor’s house to a rendezvous at two county roads a couple of miles distant. One can only imagine Reinhold’s torment.

The deputy sheriff, Jake by name, had managed to plow through drifts in a county rig equipped with heavy chains. He told me later that when old Reinhold loomed out of a cloud of hurrying snow he looked like the famous statue of an exhausted Indian warrior on his last trail, slumped over the reins of his pony.

Jake slapped the old horse on the rump and sent it slogging through snow, back toward the home barn. Reinhold arrived at the hospital in town, riding in Jake’s county car. I was waiting in the emergency room. An operation relieved the trapped bowel in time, and I closed the defect for good.

The project begun that snowy day, repairing a cattle stanchion, was finished eight weeks later, and without incident. Course, it was spring by then.

Is there a moral to the story? I choose to call it courage. Pioneer blood still flows through the veins of many a Minnesota prairie farmer.

Alternative Medicine

Science demands controlled studies when some new therapy is put to the test. Caution and skepticism are watchwords. Does result A lead from treatment B or is a dreaded coincidence involved? Then, there is to consider the remarkable effectiveness of what physicians call a placebo effect. A patient’s eagerness to please the nice doctor, the mysterious control wielded by psyche over soma, can befuddle the most carefully designed therapeutic test. Lastly, one of the oldest “treatments” known is one a wise physician learns to use: the Elixir of Time. Don’t interfere with a body’s ability to heal itself!

I had successfully repaired a hernia for... call him Amos. In the days following the procedure, Amos gradually blossomed out with a widespread skin rash, itchy and red. Dermatology is one of those areas in medicine where cause and effect can be particularly difficult to unravel. Skin has a limited repertoire of responses to the zillions of insults it sustains. Suppose you were restricted to a vocabulary of ten words only, then asked to discuss a complicated topic. Each word would quickly founder in a welter of ambiguous multiple meanings. Skin responses share a similar limitation.

I tried the usual treatments, which these days means one from a pantheon of cortisone salves. No improvement. So I did what most of us non-dermatologists do, I referred Amos to a specialist, in the Twin Cities.

Amos’ rash spread, unfazed. Next, I sent the fellow to a large, rather famous medical clinic in a nearby southern Minnesota city. The rash hung on in defiance of the efforts by those dermatologists as well.

A therapeutic failure can create an effect on the physician as well as the patient. Doctors call it the Back Door Phenomenon, BDP in case you like acronyms. That is, when your latest problem patient’s name appears on the day’s appointment list, chagrin prods you toward the back door of the clinic.

Weeks later, the BDP afflicted me. One day, I noticed that Amos was on my list of patients. I peered around the door of his examination room. Amos was not scratching. His face was free of blemishes. His arms were merely farmer tan, a hue stopping at mid-biceps where a rolled-up shirtsleeve usually lay.

Curiosity got the better of common sense and I commented, “I’m happy to see that we finally conquered that dermatitis of yours.”

“What do you mean ‘we,’ Doc? Cured it myself. See, I was in the barn one day, itching like from a dose of poison ivy. Then, I spied them, there on the barn floor, fresh and steamy. Horse apples. I cut one in two and rubbed it on every last spot of that rash. A few days later, no more derma-whatchamacallit. That’s how come I’m here today, I wanted to show you. Figured you could use the knowledge next time you get a patient with a rash like mine, and maybe you could tip off those high-priced specialists.”

A Complication of Surgery

One day Hubert, a man in his thirties, arrived at my office, referred by a doctor from a nearby village. Hubert walked with that gait which, viewed from a distance of one hundred feet, practically broadcasts a diagnosis of appendicitis. He shuffled cautiously, avoiding any motion that might jiggle his abdomen, and his face wore a gaunt expression. I took a medical history: pain beginning around the umbilicus, then shifting into the right lower quadrant, loss of appetite and one episode of vomiting. Tenderness in Hubert’s abdomen promised peritoneal irritation, located in the proper place. Laboratory tests supported my diagnostic impression. The fellow had appendicitis.

The sole treatment for the disease is an operation, the earlier the better. I explained what was happening and what I needed to do about it.

“No,” Hubert muttered.

“What do you mean, ‘No?’” I demanded.

“No operation.”

I explained again, from the beginning.

“No.”

“But you could die. Without an operation, you will.”

“No.”

We doctors do not take humbly to having a patient ignore advice. I’ve been told that when a patient flips off my directives, my face reddens, my hair stands upright and my voice becomes strident. If the issue is one of lifestyle, say a diabetic convinced that cutting out a candy bar once a week will substitute for a diet actually tailored to his needs, it is one thing. For a patient who has an acute and life-about-to-be-terminated problem, who then refuses the procedure that will save him, steam accumulates in the doctor’s emotional boiler.

I reacted. Hubert remained sullenly adamant.

Time crept along its appointed rounds. One hour. Two hours. I stomped back into the hospital room where Hubert huddled in bed.

My voice crackled. “This is crazy. I am opposed to watching a man commit suicide.” Some new religious dictum? “At least tell me why!”

Pain is a magnificent motivator. Hubert licked dry lips and muttered, “There ain’t any other way? No shots or pills?”

“No.”

Hubert sighed like a leaky bagpipe, then winced and clutched his abdomen tightly. “You don’t know what you’re askin’, Doc.”

“People almost never have to die from appendicitis anymore. There’s still time to get it out of there. And I’ve done the operation hundreds of times.”

“Oh, it ain’t you. Okay, Doc. Guess I gotta take my chances. It’s see, like, I’ve heard you use this whatyoucall sodium pentothal to go to sleep. Right?”

“To begin anesthesia. Later we shift to another modality.”

“I don’t care about all that. See, like, I’ve heard that that stuff is whatyoucall, truth serum.”

I cocked an eyebrow. “Guess so, but that’s not why we use it.”

Truth serum?

The nagging question followed me into the scrub room where I prepared for the operation. The anesthesia went smoothly.

The reason that sodium pentothal is used to induce anesthesia is because its action is so prompt. A patient can be talking, squinting and concerned one moment, but after a syringe-full of the drug is injected smoothly, he or she is blotto in seconds.

The operation went as usual, no complications. I returned to Hubert’s room later that afternoon to check on his condition.

Jake was a sheriff’s deputy. He sat in a chair beside the door to Hubert’s room.

What?

“Hi, Doc,” Jake said and stood to shake my hand. “You helped us out here. We’ve been looking for Hubert.”

This time, I said “What?” out loud.

Jake grinned. “Hubie drove the get-away car in last week’s bank robbery over in... (he named a nearby village). Thing is, he backed up so hard he slammed into a snowbank and left a perfect imprint of his license plate etched in it. Deputy Luke was here at the hospital to see his new kid and by gar, there she sat in the parking lot. Hubie’s car.”

Small towns can really suck. Ask Hubie.

Miss Coughlin

A doctor who chooses to practice in his hometown faces unique situations. If I arrive in a new community as a finished product, my past is mine to acknowledge. But return to one’s roots? Can a lad who was a scamp live down his reputation? Will the girl who grew up next door be granted the authority accorded a physician?

I practiced general surgery in the same southern Minnesota town where I grew up. That meant that people from my past sometimes became patients.

Miss Coughlin had been my seventh-grade penmanship teacher. She ran the class with the assurance of a Marine Corps drill sergeant.

One day her regular physician admitted her to the hospital with a diagnosis of small bowel obstruction. I was called in for a consultation. I walked into her hospital room and introduced himself.

She studied me for a moment, then said, “You are Robert. You were in my penmanship class in 1936.”

Memory is such an odd thing. An odor will plunge one back fifty years to a day when Grandma was baking sugar cookies. A fleeting glimpse of an everyday situation drags open a dusty file long closed; we call it de’ja` vu. A voice carrying that certain aura of authority snags the child buried deep in each of us. Primal.

Miss Coughlin. Authority’s prim certainty. I had to suppress memory’s electric jolt. I did those things necessary to establish a full diagnosis before returning to her room. “You have a blockage of the small bowel, a mechanical problem that requires a mechanical solution, an operation to free adhesions. We need to take care of things immediately.”

She inspected me for a moment, then said, “I will expect you to do your best work, Robert. Tomorrow morning you may give me a full report.”

I said, “Yes, Miss Coughlin.”

A ward nurse regularly accompanies the doctor on hospital visits. The nurse is needed to carry patient charts; to say, “Yes sir,” when protocol requires it, to lend pomp to circumstance. Miss Johnson was the nurse tagging after me when we left Miss Coughlin’s room. Her face had assumed the shades of a glorious sunset, pink and red. A fist held at her mouth stoppered some emotion other than awe of the doctor.

I need to digress. To those out of the know, let it be said that doctors as a group... excuse me, Doctors... grow accustomed to the robes of high office. Life and death decisions. “Do as I say, pitiful patient.” Subordinates stand at attention, properly, when “The Doctor” enters a hospital nurses’ station. I am willing to acknowledge that we surgical brethren are even more exalted than ordinary, peon-type doctors... excuse me, Doctors... in the sacred hierarchy of physicians. Ask a surgeon. Any surgeon.

There, I’ve done penance.

I could not avoid noticing Miss Johnson’s odd behavior.

“What?” I demanded.

Miss Johnson was of a liberated breed of nurses (a widespread problem these days) and she spoke right up. “I would never have believed it if I hadn’t seen it with my own eyes. She had you completely browbeaten!”

I drew myself stiffly erect. Dignified. “No one argues with Miss Coughlin.”

And Finally...

One of the pioneer doctors in my area of southern Minnesota told this story.

Dr. Pioneer was called out to an isolated farmhouse at 2:00 a.m. The patient was a middle-aged woman, lying in bed in the upper story of a cramped, creaking old building. A twenty-five-watt electric bulb hung from a dangling ceiling outlet above the bed. Pioneer Doc checked her temperature, blood pressure and listened to her heart and lungs, still bemused as to why he had been summoned.

He plopped onto a chair beside the bed and asked, “Maybe you could explain in a little more detail what is bothering you.”

The woman pondered for a few moments, then said, “I don’t enjoy sex anymore.”

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