Room 333

I knock on the door. I never quite know what I will find on the other side.

The little frail man was sitting in a chair at the foot of his bed. White hair all disheveled and crunched down by the elastic straps of the breathing mask providing warm, moist, oxygen-enriched air to his lungs.

His wife, across the bed, slumped comfortable in a chair of her own.

“Good morning. Mr. [ ]?” in my theatrical upbeat way.

“I don’t know about the ‘mister’ part, but I’m the rest of it.”

The wife snorted.

“That works for me.” And I make a quick visual assessment of his anthropometrics.

I have already reviewed his chart, made notes on my worksheet that I have gleaned from its various sections to include the p.o. [by mouth] intake from the “Graphics” page. I have a general impression of the situation from the H&P (history and physical), quick review of recent orders, assessment of his labs, notations from the progress notes, and the triggers that prompted my visit with this patient at this time.

“So how are you and your appetite getting along?” I had already sensed that he was well enough to banter a little. I know from the graphics that his p.o. intake was less than 50%. But I wanted to hear it from him, and why, and what together, we might be able to do about that.

The trigger was “unintentional weight loss.” Significant weight loss. Greater than 6% in two weeks.

“No appetite at all. Nasty! It’s not your food, it’s all food. Just plain nasty!”

Our conversation progressed about why and what causes changes in appetite. How the taste can be altered to perceive things as “nasty.” How medications are frequently the culprit. Probably half the medications in the pharmacy have side effects that effect taste, give a metallic after-taste, or oral hydration, or dry mouth, or nausea . . .

“And I’m on 9 different medicines,” as he looked to his wife for confirmation.

But it is the reduction in sodium that is, for him, making it the nastiest of all.

“I’m an old salt-lick from away back.” He moaned. “I miss my salt.” And the 2gm sodium restriction to help alleviate his congestive heart failure and chronic obstructive pulmonary disease was to him, worse than the disease itself.

“But I am drinking this,” as he points to a can of oral beverage supplement. “And if I can just get canned pe . . .”

He is talking through the breathing treatment apparatus, and I have to carefully listen.
“Pears. Canned pears. I love canned pears.”

His wife is interjecting an objection.

Then he corrects himself with a chuckle. Points to his head. “This thing just doesn’t work anymore! It’s peaches. Canned peaches!”

I assure him we have canned peaches and that he can write those in his menus for each meal. Diabetic or not, counting carbs or not, at times the nutritional goal is to just get calories and protein into the patient. Any way that that is possible.

And somehow the conversation pivoted.

Weather, peach trees, he lived in Washington State once, snow in Washington State today, fruit growers worried about a killing frost. Then their living in Oklahoma, how Oklahoma is a good place to be from, that Oklahoma pan-handle, the characters that live there.

And Annie Proulx’s book “That Old Ace in the Hole” jumped right into my mind.

Annie Proulx. That gifted, awesome story teller that brought us “Brokeback Mountain.”

I was now aware that the two of them were avid readers of historical stuff. His wife had already remarked that they had read every one of the Zane Grey novels.

He had already told me about the “101 Ranch” up in the pan-handle of Oklahoma, and some character that he had met there. Where he had once ridden a buffalo. And where this old rancher would go out into his pasture, cross his arms, put his fingers on his opposing shoulders, snooker up his lips in baby-talk and call out “Come here my baby. Come baby. Come here baby.”

And that old buffalo cow would mosey over in front of him. Rear up on her haunches. Place her fore-hooves on his shoulders. And they touched noses.

I knew they had to read Annie Proulx. I made a promise I would find the listing on Amazon.com, print it off for them, so they could find it at the library or a bookstore.

I knew they would thoroughly enjoy the story “That Old Ace in the Hole.” For it is one colorful history of that part of Oklahoma.

But I wanted to tell them so much more about the skill and craft of Annie Proulx. Of her sensitive treatment of the roughest of characters. Of her ability to tear hearts out of straight people with her story of two tragic cowboys. Of her association with, and writing an afterlog for, Thomas Savage’s novel “The Power of the Dog.” A ripping narrative tracing the tense relationship between two bachelor brothers on a Montana ranch in the 1920’s. When one brother marries a widow, the other brother, in his horribly repressed homosexuality, terrorizes his sister-in-law and her teenage son.

But I dare not.

I dare not let on that anything about Annie Proulx has any association with that gay thing.

For this is northern Texas. And gay things remain repressed.

But I hope they will discover on their own. And will understand. And will accept.

Perhaps they already do. And how awesome that would be.

I am trying to bring our conversation to a close. A couple more nutrition-related things I need to discus with him.

But he wants to talk. To tell stories.

And he laughs, and starts to tell of the cows on another ranch up near the Kansas border. A ranch leased from the Indians. Where a special grass would grow. And he separated his crippled, arthritically deformed fingers about 6 inches. “It grows just like this.”

“And you should see those cows. The sun just glistens off their backs! That grass is so nutritious! Just put a skinny old cow in there and see what happens!”

And I laugh. He makes a point, but doesn’t realize it yet.

“Now we just have to get you to be an old cow and get you into that grass!”

And he laughs and laughs. And his wife snorts!

And I promise him I will come and see him again.

The Refectory Manager