A New Sideline

That the human brain is a hugely complex blob of tissue is one of those aphorisms doctors often haul out. These days, damage to this magnificent organ can be plotted with an accuracy down to the function of a single cell. I have heard learned authorities say with conviction that an adult brain has more functioning cells within it than there are galaxies in the known universe, and that a single neuron is capable of storing a memory, by itself. When something happens to such a vast but intricate entity...

Elias managed the local propane company. In a place more than one hundred miles from the nearest natural-gas pipeline, his was a vital service. Folks seem as prone to run out of propane on a Sunday afternoon during a Vikings football game, or at midnight on Christmas Eve, as they are to realize belatedly that Junior’s fever and cough might need attention. Elias and I have compared notes, sort of a piss and moan contest. We were pretty close to even in this matter of annoying “emergency” calls.

Elias was more than a prosaic delivery man. He sold home appliances and was skillful at keeping them in repair. When my wife, Barbara, and I built our new house on the shore of our favorite lake, Elias supplied the dryer and washing machine.

Elias’ heart attack gave no warning. Tugging on the hose of his propane truck one moment, he dropped to his knees the next. Experts agree that a full-blown myocardial infarction, a plugged coronary artery shutting off vital blood to parts of the heart itself, is one of the most painful experiences the nervous system can record. I arrived in the hospital emergency room, where Elias lay on the ambulance gurney. He was white as the snow into which he had fallen, drenched with the sweat provoked by shock. He moaned softly, muttered to me, “Hurts, Doc.” Scandinavian understatement.

Treatment available at the time of Elias’ attack included oxygen, morphine for pain, intravenous fluids, as much to keep open a vein as a need for fluid replacement. When carefully injected intravenously, the local anesthetic drug lidocaine (Novocaine) had been found to reduce alarming heart rhythm disturbances provoked by damaged cardiac muscle. Adrenaline-like drugs provided a boost to flagging blood pressure.

Elias weathered those grim first few days and settled into a smooth recovery. We all breathed sighs of relief.

But...

A consequence of medical progress is that every doctor collects a nightmare file of cases in whom today’s knowledge would have spared yesterday’s catastrophe. Science and life and good intentions are never retroactive.

What we failed to recognize in the days when Elias had his attack was that if the inner lining of the heart chamber had been damaged, nature regarded it as a place needing a “patch.” Platelets adhered, blood began to clot in the area affected. Silently, with no warnings then understood.

Until...

Elias was nearly ready to return home when it happened. The clots that had fastened themselves to the wall of his left pumping chamber broke free, slid randomly through blood vessels, and ended up going to his brain.

Elias had a stroke, or perhaps a swarm of small ones.

Today the initial problem can be identified and prevented by a juggling act involving anticoagulant drugs.

Elias could no longer run his business. He recovered gradually, remained more philosophical, even cheerful, than I felt myself. Brain scans were unheard of back then, so assessment of which function had vanished showed where damage had occurred. His disabilities were varied and as capricious as though one had thrown darts at a map of his brain. He knew everyone, he had no paralysis, he could care for himself without unusual assistance. Freed from the constraints of commerce, he chose to visit old friends each day at the downtown coffee shop, a few short blocks from his home. Watching him interact, it was not obvious that he had sustained injury—until he was ready to return home. He could not dependably recall the familiar route leading to his house and had to be escorted.

One day the clothes dryer we had purchased from Elias developed some malady and quit. Elias had been the only repair person in town, and no one had filled his shoes. Not knowing what else to do, I called Elias and spun him our tale of woe, asked if he knew of anyone who could fix the machine.

“Come and get me, Doc, and I’ll see what I can do.”

Feeling like Simon Legree for imposing on him, I went to Elias’s home and picked him up. He brought an assortment of parts and tools.

We confronted the balky dryer and Elias turned his back to it. “The way this is going to work, Doc, you take things apart and tell me what you find. Then, I’ll tell you what to do.”

“But, you don’t want to see it?” I sputtered.

“Soon as I look at something I’ve known all my life, I can’t figure it out, but as long as I don’t see it, I’m okay in my head.”

I did as he told me. He identified the problem sight unseen, and when I put everything back together, the dryer worked the way it was meant to.

He grinned at me. “Don’t get any ideas, Doc. Don’t reckon we should go into business together.”

We had a brief debate before he would let me pay him.