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

Rolling Thunder

‘Tis a night of rolling thunder and pounding rain in northern Texas. The kind of thunder that brings back memories of a time when I was 14 or 15 years of age. It was up in Canada, in the foothills southwest of Calgary. A place and time far removed from this thunderous Texas night.

My Dad was always on the lookout for uranium. He bought a Geiger Counter and on Sunday’s we would head up into them thar hills and he would scout around with that thing and with the earphones on his head. Always thought he was going to get rich with some miraculous prospecting discovery.

One Sunday, it started raining up there. And the rolling thunder. Thunder that echoed and re-echoed off the foothills and mountains, one continuous sensation of rumble.

We drove into this meadow where an old, dilapidated, clapboard cabin with a whiff of smoke coming out of the chimney was nestled under a stand of fir trees. A couple of out-buildings were nearby and we could see horses in a corral which had a little lean-too of a shelter for them.

We got out of the car and went up to the cabin and pounded on the door. My father’s intent was to find out if anybody in there knew anything about uranium in the area.

Inside, were three boys, a little older than me.

Uranium was the last thing on their minds.

But my heart, pounding in my throat, with wonderment.

Talk of the romance of cowboys in the wild . . .

Kids supposed to be herding cattle. I suppose a plausible prequel of Brokeback Mountain.

But here they were, sitting at a cluttered kitchen table, playing cards.

Scruffy denim shirts and pants. Socked feet with glimpses of naked, peeking, toes and heels. Denim jackets piled up in the corner. Rifles stacked on a rack..

I was overwhelmed with the smell of roasting meat in the wood burning cook stove. There was a large stone hearth on the far wall with flickering flames, lots of red-hot coals. The kitchen area was littered with opened boxes, cans with sprung open lids. Chipped enamel pots. A tea kettle sizzling on the hot stove surface.

Guys. Roughin’ it. Lovin’ it. Coziness in the ambience of rolling thunder.

And the bed. A old coil spring bed.

It was a one-room abode, so the bed was protruding from the wall opposite the “kitchen” area.

One old, dilapidated bed. Rumpled up blankets. A black-bear hide crumpled up on top.

Seemed pretty obvious that all three of them slept together in that one lumpy old bed.

And it was then that I realized a reality before me that I could only vaguely imagine.

What would it be like to snuggle and cuddle for hours on end, for night after night, in that big old nest of a bed?

With the sound of the rolling thunder masking the intimate guttural rumbling. The noise of pounding rain obliterating the sighs and groans of passion. With a real bear hide to hide bare naked beneath.

And which one slept in the middle? And which ones slept on each side? And did they take turns? And who cuddled? And who was cuddled? And did they kiss? And did they let their legs intertwine? Wrap each other in their arms? Let faces press into necks?

And it was beyond my rational thought there might be anything else. I knew of nothing else. I was simply incapable of the knowing of anything else.

And who was the first to say “I’m tired. I’m goin’ to bed.”

And what did it take for them to eventually fall asleep?

And what was the morning like?

I have never forgotten that scene. That experience. That picture blazed into my nascent psych.

I knew nothing of being “gay.”

I did know the furry within in me to want to experience the experience of cuddling with a boy that I loved.

And so the sound of rolling thunder brings it all back with fury each time I hear it.

I have this terrific longing to be in an old cabin in the mountainous foothills, the foothills west of Calgary, in places like where Brokeback Mountain was filmed. In places like Priddis, a little town southwest of Calgary where my Dad did actually have a little farm when I was about 4 years old. And the memories of that winter (1949/1050) spent in Priddis.

So the rolling thunder re-ignites this longing to be in that kind of cabin again. With a fire in the hearth. With savory, aromatic victuals in the oven. With a bed with exquisite linens and things. With a man who cuddles and snuggles. With a feeling of fulfillment and contentment and sharing and receiving and giving and relishing in the glow of reciprocal love.

Yeah. I do dream of that.

And as the rolling thunder moves to the hills of yonder, that dream always dissipates with the waning rain.

But on another day, that rolling thunder always returns.

And so the dream never dies.

And the rain won’t wash it away.

The Refectory Manager

I have never witnessed in my lifetime a politician quite like you.

I feel like John McCain and his campaign mantra: “My friends, I’m constipated and I’m ready to go.”

This stuff has been building up within me.

Another conjunction this weekend: The mutual agreement with a friend to read Emerson at respective picnic tables thousands of miles apart on Saturday, the Adult Education forum at church today, talking of the Transcendentalists with their utopian experiments, the responsive reading in church authored by Henry David Thoreau that included the quotation: “I did not wish to live what was not life, living is so dear,” the incessant political harangue which is beginning to infuriate me.

And so: “I gotta go!”

It is such a swirling cacophony in my mind, the events of the past few days and weeks.

The symbolisms. The words. The accusations. The shilling. The framing. The desperations. The handicapping of a horse-race. The jousting of political candidates, with their unutterable intent to inflict the killer political blow.

Bitter. Poverty. Jobs. Out-Sourcing to Overseas. Illegals. NAFTA. Columbia. Healthcare. The damning of America. Bosnia. Hope. Terror. Torture. Hate. Economy. Unemployment. Family Values. Traditional Values. Choice. Sanctity of Life. Gays Destroying Marriage. Amnesty. Corruption. Big government. Little people. The voters.

Yes. The voters. Voters who are bitter. Voters who cling to guns. To religion. To antipathy. Voters who want something better, something more. Present-day voters who Henry David Thoreau aptly described years ago as people “leading lives of quiet desperation.”

And to how many of us today does that describe?

For how many of us, do we have this primal, inner longing, for some transcendental utopian experience? Something. Anything. That transcends that life of “quiet desperation.”


Thoreau, in Walden, that chronicle of his solo utopian experience, remarked “I did not wish to live what was not life, living is so dear.”

Living is so dear . . .

He had to be thinking of his mentor, Ralph Waldo Emerson, and his words: “I had fancied that the value of life lay in its inscrutable possibilities … The results of life are uncalculated and uncalculable.” (Emerson, Experience.)

In today’s parlance, we hear concepts such as “The Audacity of Hope.”

In the course of our history, so many Americans have been drawn to the ideal of utopia—an ideal which may not be realistic or feasible or practical or even wise. The Shakers. Oneida. New Harmony. Brook Farm. Fruitlands. Utah. Battlecreek. And in recent history, Jonestown, Branch Davidians, YFZ Ranch near Eldorado, TX.

But for most of us, utopia is something more egalitarian. A simplicity and dignity to life and to our relationships within it.

And for some, it is a rationalization that “I am in this world, but not of this world.” And what happens doesn’t really matter, because my belief system says it will all end soon and this old world will be nothing but a smoldering moot point. And heaven will be my home. Utopia. For Ever.

But the likely reality is that it will “not end soon.”

And so politicians of today appeal to hope and to anti-bitterness. And to bitterness. And to religion. And to anti-religion. And to the status quo and to change. And to experience and the right kind of experience. And to double-speak. And to the flaunting of empty rhetoric and promise. And to the blatant falsity of hope.

And there is one politician who uses ideas and phrases and complex thoughts that sound 21st century transcendentalist to move this experiment called America into experiences that are “uncalculated and uncalculable.” He speaks of unspeakable things in political rhetoric.

And for that realization to take place, the process of the shattering of the status-quo will, by necessity, be filled with shock and awe. The goring of old political oxen will become a killing field And the old beast of politics-as-usual will not die . . gracefully or otherwise.

For the first time in generations, we have that kind of politician. It may be generations before one like this comes again.

And like those utopian experiments of yore with their predestined failure, their seemingly inevitable inability to sustain themselves, I have this gut-wrenching fear this current politician is also destined to failure. For the shock and awe of the change he calls for cannot be enough. The killing fields of gored political oxen will experience resurrection after resurrection. His hope will be smothered and drowned and eviscerated by the tentacles of entrenched fascism, corporatism, the unaccountable and uncontrollable military industrial complex, the multi-nationals that answer to no one, and a media of blathering talking-heads fixated 24/7 on exploiting missing blonds and the private misery of celebrities.

And the bitterness of Pennsylvania will return with a vengeance.

And America will be forever changed.

And it will be a wilderness of guns. Of religion of hate. Of a desperation of antipathy..

Mr. Obama, I admire you. I have never witnessed in my lifetime a politician quite like you.

But I have this fear.

That America is not ready for you.

And this epiphany will be wasted.

And the history books that our children will write, will say: “Damn you, America, for what you didn’t become.”

The Refectory Manager

Who also sits alone at a picnic table . . .

[A part of a conversation with another who just experienced a lonely day shared only with the wind and roar of the ocean, the screaming of gulls, and the words from Henry David Thoreau.]

Hi
Just looked on the map and found [ ] State Park. I can very easily imagine the scene. I have been at a few locations on the Pacific Coast, and most of the places were characterized by a very short beach filled with driftwood and debris, then a high bluff of some kind. And the wind. And yes, most of the times it was cloudy or misty of some sort.

And the alone-with-the-stillness. Alone at a picnic table. The isolation of a mid-week, remote, picnic table exposed to the vastness of the emptiness of a foaming, turbulent ocean shore. Some people find that to be totally disorienting . . . they need chaos around them, but others revile in that stillness . . . and the alone part? Maybe physically, but hopefully not emotionally.

I have seen pictures on occasion that typically depict two men of more senior ages that sit side-by-side. The perspective of the camera is always from behind. You can see over their shoulders into the common horizon. In some pictures it looks to be a porch swing that they are sharing. Other pictures, it is just lawn chairs of some sort. And yes, I have seen pictures where it is a picnic table. Their backs resting against the old, weathered table top. They look out. And I suppose inward as well. And I often wonder of the content of their conversation. I often wonder of their hands . . . if they are clasped together in the security of mutual touch. I often wonder if their knurled old bodies find warmth and security cuddled together.

The hospital where I am currently assigned takes care of a lot of elderly people. It is rare for me to find a patient that is under 70 years of age. And their knurled bodies. And the disfigurement and deformities of aging and disease. The nutrition trigger of "wound" that necessitates a visit by the dietitian. The "wound" is so often a diabetic cellulitis in the lower extremities. Even worse, the decubitus ulcer . . . sometimes it has progressed to stage IV where tissue has degenerated even down into the bone itself. And their hands and arms can be so frail, just skin over bones with ridges for tendons. And their feet look so swollen, so red, so ulcerated, so black-splotched, so contorted. And I try to get them to smile, to agree with me that two bites are better than one, that three bites are better than two, that four bites are better than three . . . and yet they can't eat, or are two weak to eat, or hate the Dysphagia-I (pureed) diet with honey-thick liquids that their swallowing impairment demands to help prevent aspiration pneumonia or the cardiac diet that restricts the sodium that just makes it all the harder for their failing heart and lungs to work, or they simply just don't want to eat . . . and nobody has the guts to let them simply and unashamedly say "just let me die."

And then I remember the pictures of old men, sitting side by side. And imagine their laughter, their private little jokes, their contentment, their relishing the ambience of a precious moment . . . in the now . . . in the past. And their wonderment of a future.

And I think what it means to sit alone at a picnic table. For I do that often. And my only companions are the birds I hear but can't see and the images of words silently emerging from the pages of Henry David Thoreau or some other meaningful book.

And the realization that I too have a friend who also sits alone at a picnic table. Who knows, someday, we both may find and share another picnic table together.

The Refectory Manager