Tuesday, November 29, 2011

Home Remedies



We live in an age when you see enough ads on television to prescribe your own medicine.  Never have so many known so much about medicine, illness and their own bodies. We know what's new for our medicine cabinet before we even get to a doctor's office.

While your wife seeks out Bath and Body Works for a magic bottle of aromatic peppermint body lotion that promises calm nerves, you can get a full body scan and walk away knowing your body is full of potential land mines. The Life meter says you have 22 months and one week. Quickly, mortgage your house and head for a Total Health and Happiness Clinic somewhere in Florida.

Off to an army of smiling white coats, garden hoses, pliers and a long thin thing that looks like a vacuum hose. Don’t worry, all equipment, made in China by high school dropouts, are stainless steel—and guaranteed to hurt like hell.

Your own your way to the now mythical 82, where, bleary-eyed from your third cataract operation, leaning on your third new knee you can watch your 600th game of T-Ball game. Batter up!

Such cynicism. I am sorry. I intrude on personal, sacred stewardships. And I am dangerously light minded when I speak so flippantly of our sacred journey Home. Take your time, dear friends. Back to something less heavy. I want to make you laugh. It’s often my lonely way of embracing you, my friends and family. If I make you laugh in a good way, I show you I love you.

Medicine and illness in the 50s? Very different. What about a lower middle class kid? The son of two well-meaning high school grads whose medicine cabinet was bursting with, oh, your great grandfather can guess: hydrogen peroxide, baking soda [stored in five different locations], an army-green bottle of Listerine [marketed I guess by the CIA], a half gallon canister of Vick's VapoRub, wood alcohol, and assorted bandages.

The rest of the medical supplies were in the kitchen, or, in the case of excessive bleeding, a handy cobweb in the far ceiling corner little Dollie could never reach. No thoughts of a broom with a cleaning cloth on the end. I had to wait for Lonesome Dove to teach me that. And then watch. But I loved being watched. She was our champion "watcher," her green eyes smiling, happy someone else was making progress on spiderwebs and dirty dishes. This morning I would gladly both wash and de-spider web the house to have those green eyes following my every adroit and stallion-like moves.

You laugh about spiderwebs?  It’s a fact. The day of  my little accident, a Piute woman was visiting Mom. She knew everyone in town, so it was not unusual to follow her into Black's Market and end up in a level 2 conversation with a logger or a miner from a place we called the Venadium. She was always reaching out and the greater the need, the longer and stronger her reach.

Anyway, I cut my arm open, as, kids often do such things. Maybe I picked up the wrong end of Mom’s Bowie knife that served as potato peeler and carving knife. The Piute lady, round, sweet but unsmiling, who for some reason, only looked at Mom in the eyes, grabbed a chair and reached for Nature’s Blood Clot. Her soft brown hand swathed my bleeding arm in, yeah, you guessed it, a spider web. The blood stopped immediately, allowing me to scamper into the Bishop summer—to play cowboys and "Indians." This time I chose to be an “Indian” and suffered the immediate consequences. Down I went with 16 Winchester 76 bullets fired by the “good guys,” those ever-ready boys in blue.

Allow me a slight shift for a second here. My sister-in-law, Jennifer once said my parents “worshipped sleep.” I do know that the kitchen closed at 6 [for Dad and Mom, that is] and the yawning started halfway through Frosty Frolics or Lawrence Walk. By 7:30 you’d better find a place to be—to be very quiet. The phone hung free, the line dead. We were officially cut off from the outside world--until 4:30 in the morning, when Dad was up and ready to go. Strangely enough, no phone calls ever came quite that early.

The television separated my folk’s room by 2 inches of either plasterboard or cardboard. “Turn that thing down!” Time for Big Brother, Larry, to issue commands: “Scatter guns,” a line, I think I picked up from an old Lash Larue movie. Or was it that mechanical toy, Bob Steel? The most important thing was to clear the decks by 7:30 at home. As Gene and I moved into adolescence, Dad solved this obvious conflict of circadian rhythms by giving us each a trailer of our own. "There are your new bedrooms, boys," he said.

Gene, fearing imminent war with both China and Russia, stocked his domicile with enough aspirin and bandages to cover Gettysburg. “Quit going out to the store for medical supplies," Mom said.  Senor Boflis [a name which endless research has not uncovered] has started his own Botica.


But Gene's pharmacy houses roughly the same medicine in the house. For Dad, everything came down to baking soda, that Oakie panacea for bunions, sunburn, even “boils.”  The list of ailments rendered harmless by the muscle man holding a hammer was endless. 


Now we were set for the atomic bomb. We knew how to "duck and cover." Gene's Botica was stacked to the ceiling with aspirin, and Dad had a 10-year supply of baking soda.  Seldom sick, he resorted to this Oakie panacea  for "tired feet" [from golfing?] and brushing his teeth.  He didn't even have to borrow a tube of Colgate from Senor Boflis.  

Remember that playing Man [homo ludens] was also Repairing Man.  He loved the notion of saving 22 cents on the toothpaste. "The beauty of this, boys," he would say, while folding a towel deliberately, even the Marine corps. way that made us proud, "is that you are getting better cleaning for practically nothing." Take a cheap shortcut, beat the “system,” emerge triumphant and free of The Man.  Did he ever add up Senor Boflis' inventory?  Or those gallons of orange juice?  Or all those Snickers "for weight gain"and strength?

And now Dollie. Her first-aid kit was about the size of an old-fashioned cigar box. In the 40s and 50s they built those little containers out of real wood. Three of them were large enough to hold 900 marbles I won at the height of my marble powers, in the 8th grade. Then one day, Gene shot them into space, hoping to kill a bird or two, slung into oblivion by his new Whamo slingshot. 


If Uncle Roy had been around, he could have come up with some form of Mafiosa torture yet unknown to civilization. And I might have used it. I can still see those gems, made for variety and class. Such marbles disappeared, along with the game, around the mid-fifties. Nibs, anyone? Remember: "shooters go."

But real sickness called for her little boxes of her cure-all medicine: Vick's VapoRub. A simple sleep-disturbing cough was worse than, say, Malaria, or what Dollie called  a “bark,” a dress rehearsal for a firing squad because it took so long. Lying in bed, tracking the ceiling cracks, you knew she was coming. You piled into bed at, say, 6, and then buried your face risking a Desdemona-like death. If you slipped, lost focus and surfaced for air, you were doomed. Mom’s bare feet hit the well-worn linoleum floor---kkkkkaaaaaathmpppp. Then the fast-paced—no, the near running to your bedside.  You want me to say, “so she would climb in next to me, hold me to her breast and hum one of her half-finished Spanish ballads.” Sweet.

However, not true. She brought with her Ponce de Leon’s elixir. “Here, put a finger full in each nostril and then . . .swallow a finger-full.” In spite of the label, we could have been ahead of our time, though it’s been quite awhile since I've seen someone eating Vick's VapoRub. Shhhhhhhh. Perhaps word on the street already precedes me.  It could be some kind of “upper” or "downer." But it worked, and you knew it, as you drifted into a vapo-fog--swaddled in VVR.

The Vick's water boarding was only to be outdone by a torture invented by the Kiowa Indians, back before the ever-ready US cavalry was even invented. Yes, the infamous onion poultice. Once again, the philosophy of medicine in those days was "what doesn't kill you, makes you stronger." Sounds like chemo to me.

The sound of angry, sleep-interrupted bare feet hitting the floor was easily outdone by the sound of surgical instruments in The Kitchen. Out came the heirloom frying pan, the Bowie knife cutting and peeling the onions.  I can still hear the paper-like crackle of onion skins flying around the counter, The top burner explodes into action; soon it warms the onions into a 50s version of Amoxicillin or a  Z-Pack. Then came the swaddling cloth: a worn, faded, paper-thin cotton diaper. No babies anymore, but they played a backup role as “rags”--an all-purpose piece—cotton for all seasons.  Dollie rolls the onions onto the waiting cotton diaper, then, smack! down on your chest, close to your mouth, nearly on your nose. “Now lie there—and sleep!” Oh yes, sleep. Breathing onions. Today onions may abound in Lora’s salads but never, oh never [sounds like a hymn I know], have I touched a fried onion.


In moments of turmoil and self-pity my nose can conjure up the reek of leeks.

This training in do-it-yourself medicine was not lost on me, I assure you. Ask my brother Gene. Isaiah Berlin, in his study of Tolstoy, says the "fox knows many things; the hedgehog knows only one thing." I was a hedgehog.

Somehow Dad and Mom were gone—probably visiting Uncle Gene, searching for another dream. Dad, who was a financial prophet for everyone but himself, wanted his brother to buy 40 acres of vineyard next to us for $40,000.  No deal.  Do you know what 40 acres of ground is worth in Escondido today?

Parents gone, Larry takes over. And there is trouble; there was always trouble. The Guardian Angels swing into action. Gene first drops a glass bottle of milk and then steps on it. This is no flesh wound from a Randolph Scott matinee. We have blood everywhere. Sissy hides in the corner; Michael keenly observes my first real ER experience. Curious fellow. Gene screams loud enough to even wake up Jimmy Lail, the hapless victim of earlier ambuscades at the hands of my brothers become Katzen-Jammer Boys. The Terrors of the Trailer Park.  He shudders and stays down low in his trailer, waiting for an ambulance.

I have to work fast before Gene passes out watching his own blood pooling on the linoleum floor. I put him on the sofa, call for reinforcements. Michael is not strong enough to hold his hands down. He sits on Genet’s flailing arms [Gene became French Canadian the last time the folks left; it soothes him--he finds his roots[?].  Carol sits on his legs, her face turned. I grab the round carton of salt; you know, the one with the little girl carrying an umbrella.

It Rains Salt. We're into something from Gone with the Wind.  I can hear that shattered Confederate in butternut, crying, "Don’t cut; Don’t cut!" We don't even have a saw.  Later in college I would learn about Okham's Razor, which translated into Texan means, "keep it simple, stupid." We settle for salt.

Carol heroically offers to stuff a recycled diaper into Gene’s mouth. Equally heroic and disgusted, he turns aside—and continues to scream. The salt, now starts taking the shape of a miniature Mt. Saint Helens. It does its work. We save his foot, and he proudly bears the battle scars today.  He tells people it was Cold Harbor. Or was it The Battle of the Wilderness?


So here we have a living, albeit painful example, of Yankee Ingenuity, the roots of our courageous pride as Americans.  The spirit of Ben Franklin and our own forefathers lingers here. "Home Remedies." Do our grandchildren even believe that there is any kind of remedy at home?  Our home?  Don't we need a professional?  A clinic?  A Workshop?  Counseling? Sylvan Learning Center?  More name brands in our closets?  Yet another "App" for a screen?


A courageous pride. Our roots. You, my grandchildren, who will read and understand this only when you are in your late 30s.  You will realize you need to dig deep and find that gutsy and for the most part happy past your great grandparents knew.  And we found the remedies . . . because we had to.

Your legacy and . . . mine.  



6 comments:

  1. I’m going to take ET’s toothpaste formula more seriously. Stannous Fluoride is beginning to make me gag. I do use a concoction Nita found through Young Living Natural Oils that’s been pretty good, but I lace it often with baking soda or salt already, so the switch should be easy.

    Nita uses mentholatum instead of vaporub, but the principle’s the same. As kids we used merthiolate. Not only did it disinfect the wound, but you could wear your red badge of courage a few days before it would wash off.

    Great blog, all 2,161 words of it. But who’s counting?

    donny

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  2. Who would have known that to cure/treat anything one needs sufficient alkaline, the same solution the stomach employs to protect itself from its own disinfectant? Sodium bicarbonate was probably the cheapest and most available 'therapy' at the time. It has become an end unto itself, the result of excess supply and semi-constant demand... one of many remnants of the pre-sulfa zeitgeist under which I continue to labor. What will be the next medical apocrypha, Windex? hCG? magnetic armlets?

    I saw someone in clinic today who takes Vit. C for her anxiety, a therapy that certainly relies on 'epiphenomena' for its verification. I keep NEJM on speed dial for moments like these, but they haven't been returning my calls.

    At some point we (those who bear whitened coats and perma-grins) look for mental respite and these are perfect moments to 'get to know' the patient. Ours is an Aristotelian career with Goldman-Sachs performance requirements, a cognitive marathon of 50 years duration. Our water stations are staffed by family, callings, loans, and patients; some of them insist that they can do the thinking and the results are more academic than therapeutic. I'm happy to participate. It's a fine symbiosis when both parties are allowed their liberties, however when one side becomes the aggressor there seems to be more beneficial outcomes, your coronary vessels are fine examples. May they remain patent, dear professor.

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  3. Yes, Dear Dr. Z, may my "coronary vessels remain patent." Long enough, for example, to reread Thucydides and the remaining letters of Paul. "donny" and I took care of "Eyeless in Gaza," so we have that going for us. Are the "Goldman Sachs performance requirements" the profit motive in medicine? If I have that much right of what you've written, can I rejoice or despair in an article in the WSJ that promises fewer blood transfusions because, in the end, they didn't prove cost effective? Hurrah for less intervention. I wonder if my own "beneficial outcomes" with the clogged vessels is due to the very fact that I don't worry about Mr. Cancer [Krebs, i.e., the crab in German] or exotic neurological disorders. I think you would rightly say that it's more the Plavax and three other bottles that are doing their job. How will American medicine [I wander here, but you're used to this] keep up with cultural expectations about "longevity," a "longevity that is in turn driven by Goldman Sachs and the medical industrial complex itself? Or is it much simpler? Television adds make promises; patients ask doctors to make the same promises; and insurance companies comply--sort of. Won't the day come when those co-pays continue to go up? Right now DMBA charges a co-pay of 100 for as chemo treatment. What if it were 350.00? Does anyone have any idea just how much "life" without quality and filled with a hell of a lot of anxiety about dying, is actually impacted by the cost of medical procedures? Does anyone stop and figure out that the small print describing a "NEW" procedure promises all of 4-6 months more of a cancer-laced body? I read, for example, that a new prostrate medication [using one's own cells, I believe] would cost 70,000 and "promise" around a year of additional life. Where are we going from your perspective?

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  4. This comment has been removed by the author.

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  5. There has been considerable time and money spent to define how well medicine is meeting expectations and the effects of those interventions psychosocially. Most use a Quality-Adjusted Life Year (QALY) index as a way to communicate to others the extent to which some intervention will have an impact on the amount of 'quality' time lost. The Wikipedia entry about QALY has an excellent summary.

    There is always a danger in these efforts because statistical aggregates and 'polling data' are never adequate substitutes for the individual effects of some policy or mandate; I've found, anecdotally, that QALY standards tend to overestimate the quality time lost, therefore we are probably too cautious in the literature.

    Because we're wandering I'll mention: Hayek called this form of social engineering a "fatal conceit." He wrote: "The particulars of a spontaneous order cannot be just or unjust" because "the results are not intended or foreseen, and depend on a multitude of circumstances not known in their totality to anybody." This expresses one reason why I don't see anything particularly menacing about how the market is set up any more than I would find in a petri dish viewing the microbiota of a patient's lip abscess. I cannot evaluate the response of a market with moral or other similar terms because they are categorically inappropriate much like calling a dinning table foolhardy seems not suitable.

    The fact that prices have increased can be attributed to an ever-increasing expenditure by central authorities, both implicitly and explicitly. Implicitly because markets respond to increased demand by increasing prices and explicitly because insurance companies follow federal ICD codes for how they charge patients. The reasons why prices controls didn't work for the airlines, interstate commerce commission, and gasoline are the same for why they don't work in medicine. The results are the same. This is more ominous to me than how an investment bank naturally reacts to the incentives and constraints place before it.

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  6. Keep in mind: when a paper publishes "years of life saved" or "months of life saved," it is not doing so in a way that would be applicable to any individual considering that procedure/intervention. A new chemotherapy that promises an increase in 4 months of life saved compared to its competitor is not saying that any given patient will experience 4 more months of life if the therapy is pursued. The publication actually claims 4 months/100,000 patients, which means that a new chemotherapy could improve someone's life substantially and allow him/her to live many more years, assuming the competitor saves 2 months/100,000 patients. The years of life saved is merely a way for statisticians to communicate with one another, a convenience tool. There are publications that present those kinds of data in a "number needed to treat" or "attributable risk" format that can be applied to an individual patient. You'll usually find that those numbers are extremely generous compared to current standards of care for any given new drug that is approved. If you don't, that means Goldman didn't find the right lab :)

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