Man in his late seventies comes in with his wife,
weak, lost twenty-five pounds, can't eat, hard to talk,
seeing double off and on past eighteen months,
been to a family doctor and two specialists.
They don't know, I've got some ideas. It's
beyond my scope here in the rural north country.
I get him tucked away in the Medical Center
by the following morning. He's out in five days
with a diagnosis, I was right for once. He's
eighty percent better on treatment, says
he's two hundred percent. Gives me the credit
for once. The gray hair helps. Man comes in
to emergency with loss of vision in one eye,
works full-time, in his sixties. It goes away
and he wants to go home. Internist and eye doctor
find nothing. I find something and say, no.
Family says I'm overreacting but they all agree,
reluctantly. Urgent angiogram—surgery on the
neck arteries is booked for the following morning.
That night his opposite side becomes paralyzed.
Emergency surgery cleans out a nearly
blocked vessel. They don't appreciate the
postoperative pain. They don't appreciate my
style or anything about me. He walks out
saved from almost certain permanent
disability. Woman comes in with a headache,
high blood pressure, in her fifties. I do a spinal,
few red cells, radiologist gets me on the phone.
He says the CAT scan's negative, I'm not
so sure and send her down country for an
angiogram. Radiologist was right and I was
wrong—no aneurysm in her brain. Young
mother of two comes in with seizures hard to
control all her life, and paralyzed on the right side
from birth. I consider a CAT scan a waste of money:
the gray hair stands for experience, remember?
She gets slowly worse over the years. Her family
doctor does a CAT scan, finds a malformation
of the brain. "We just ain't so smart," my old
teacher used to say when I was an intern. A man
comes in, in his sixties, can't work, losing weight,
muscles are twitching, hard to swallow, hard
to talk. Do some tests, tell his wife and him
he's got Lou Gehrig's disease, it will affect
his breathing, he's going to die, it will be
tough, we'll try some things. We do, he gets
worse, can't walk, can't feed himself.
I visit the house: a small cape with a screened
porch behind a variety store in a small town in
New Hampshire. He gets worse, I
visit some more, talk some to him,
to his wife and son, he dies.