A Moral Dilemma Appears and Is Resolved

I raced to the Center for Bloodletting in
a taxi from a meeting at the job it was
now even more critically important for
me to keep as it provided my health
insurance, and when I paid the driver (of
note: I am not a habitual taxi-taker) I
opened the cab door and cracked
someone's taillight. To compound
matters, there was a small group of
teenagers hanging around that particular
car, spitting on it and goofing around and
smearing each other's hands in the spit.
What a blast that must have been, to be
like 14 and goofing around on one of the
first nice spring days in New York City.
I was about to write a note and the kids
all said, NAH, don't bother, you don't
need to, all cracking up like crazy, and I
started to walk away and then thought,
god, that is just the kind of thing that
god will kill me for if he sees me lying on
that operating table just two weeks from
now. So I went back, and I left a note on
the car with my phone number, the kids
all cracking up and pushing each other
and I thought, well, I've done the right
thing and with any luck they know the
car's owner and hate him (evidenced by
the spitting and smearing campaign) and
they will destroy the note and I will have
done the right thing but not have to add
more money to the burning pile.
Inside the Blood Center there was a
reception room with no receptionist.
Thinking I had hit a new low---I've
gotten used to waiting for hours, used to
spelling my name multiple times for one
person, used to waiting rooms both
luxurious and crummy, but now I was in
some kind of self-serve operation.
Maybe I'd eventually see a needle and a
plastic bag and stick myself and
draw my own blood to give to my own self
later, after performing my own
hip replacement.
But no. Eventually someone showed up
and I filled out the forms and then went
into a tiny room and got my finger
pricked for a tiny droplet and thought,
wow, what if somehow they could make a
whole pint out of that? But no such luck.


That was just to check the HMG or
whatever level which is the IRON level,
which had to be a fat and healthy 11 in
order for me to donate to myself and it
was 13.0! I was bursting with iron. Which
would explain the earlier cab door
incident---I just don't know my own
strength.
I swaggered into the "Donor Room" and
settled into a pink chaise-lounge outfit,
whereupon the world's tiniest, oldest
woman approached. She juggled around
papers and tubes and kept misplacing
things and I kept a close eye on her to
make sure she stuck the right little label
onto my papers and my blood-pouch. And
then she had a sneezing fit, which didn't
stop her diligent misplacing of things, and
then she approached again all ready to
wipe my arm and stick me and I had to
say "Um, would you mind changing your
gloves" and she said, “oh, okay, but it's
just my allergies,” and I didn't say “but I
don't want your mucuous in my veins,
lady, even if you do not at the moment
have a cold and have managed to outlive
everyone else of your generation.” And
then, after more scatterings of paper
and tubes and ripping open of sterile
things and letting them drag on the floor
(apparently unfamiliar with the concept
of sterility) she poked the world's hugest
metal needle into my arm and set me on
drip.

When I staggered out of there, lightheaded,
bloodless, the car I’d struck and
noted was gone, and so were its
tormenting teens.

A Childhood Song is Remembered

But meantime, I called the blood bank, to find out about making a
deposit for myself, to withdraw at a later date, on the day of the
surgery.

The very nice person—a nurse? A receptionist? A person with
medical knowledge, or not? --- told me to start taking my iron, so that
I could enrich my blood and therefore have the best possible blood in
case, God forbid, the surgeon needed it. This was another detail I
didn’t like to think about: lying on the operating table, needing blood,
because someone had just made a huge incision in
my once-lovely nearly unmarked body and was cutting through my bone!
But instead of thinking about the big picture of what all this was for, it
was much better to focus on just taking the necessary steps.

“The iron
can cause constipation,” the nurse/receptionist/janitor said, “but don’t
worry, your doctor can prescribe you a stool softener.”

Great. And then what? Then something to take care of the diarrhea
caused by the stool softener? And then? Didn’t we learn about this in
kindergarten: wasn’t there an old lady who swallowed a fly, and then
swallowed a bird (“that’s absurd! She swallowed a bird!” this was back
when children learned words like “absurd” and had vocabularies that
reached beyond “amazing.”) She swallows one creature after another,
each with the intent to cure the previous one, and ends up swallowing
a horse. “She died, of course.”

I took the iron. I ate spinach, and anchovies, and figs. I drew the line
at cockles and sweetbreads, and then it was time for the bloodletting.

Sometimes You CAN Judge a Dentist By His Office

Soon I found myself limping down East 34th Street, into a big, nondescript
building, and down a few steps from the ground level into a
grim, grimy waiting room, looking around in alarm at the other
patients, all of whom seemed in terrible states of distress/pain/terror.
It was brightly and fluorescently lit, so there was no avoiding how bad
everyone looking, including myself. It was like a car of the A train very
late on a Sunday night. What fresh hell is this? I didn’t say to the
receptionist, but instead told her I was there for a two o’clock
appointment.

“Name?” she said, looking vaguely around on her desk for something.
Maybe for a shiv to stick in my neck so she could put me out of my
suffering. I gave her my name, spelled it, spelled it again. My heart
sank when she finally found it, and I took one of the few remaining
empty seats.

As I waited, I thought I heard a muffled scream from the next room.
The minutes ticked by: ten, twenty, thirty. Why did I come on time to
these appointments? Why couldn’t I learn to just add an hour to
whatever time they give you? and then a woman came out from the
door that presumably led into the torture rooms, with an ice pack
pressed tightly to her jaw, and sank into one of the chairs. Maybe she
had to wait before leaving to make sure her head didn’t explode. And
then a man, disheveled, smelling quite strongly of something bad (his
rotting tooth?) came in and sat next to me.

I pulled out my cell phone, shook my head, made a clucking sound
with my tongue against what was left of my teeth. Why I bothered with
this little performance I don’t know, because all the other patients
were preoccupied with their own distress/exhaustion/terror.
I walked up to the receptionist’s desk. “Yeah?” she said in the same
laconic tone with which she’d greeted me.

“Sorry,” I said, affecting a British accent for some reason, as if this
would absolve or at least disguise me, “I’ve just gotten a call from
work, I have to go back into the office.” I thought I sounded
convincingly like I worked at the U.N. or in some important
international office of commerce.

“I’ll call to reschedule,” I called over my shoulder as I pushed open the
door, thinking the receptionist must have been on to me, and anyway,
why did I care? Why bother with this ruse? to the street, and then
hobbled as fast as I could to the subway, pulling out my phone to call
Robin, one of my pickiest friends, and get her recommendation for a
dental surgeon.

Now, here is a little known fact about medical care: sometimes the
prices really don’t vary much. Granted, a high-powered, in-demand
surgeon on Park Avenue will likely charge more per office visit than a
down-on-his-luck guy with a brand new degree from Kutzupistan. But
for some things, sometimes you can find a great medical professional
that charges about the same as the guy with the crummy office and the
twitchy hand and the receptionist who can’t spell.

Gary Ruth’s office is on Central Park South, a good sign right there. I
flew up in the pretty, glass-enclosed elevator, then stepped into the
hushed office. Right away I noticed the kind, muted lighting --- the
last you want when your face is a mask of distress/pain/terror is for
people to actually see what you look like.

I went to the receptionist’s desk and said, “I’m here for doctor Ruth,”
thinking as I did that I was not the first patient to want to make a joke
about this.

The receptionist looked at me and said “Miss Van Arsdale?” Had my
standards really gotten so low that a having a receptionist expect me
and pronounce my name with an approximation of what it should be,
being seen within fifteen minutes of the appointed hour, having a
pleasant place to wait and a coat rack for my jacket sent a shiver of
thrill through me and made me want to stay there forever?

I wanted to stay in that waiting room forever, but very soon a nurse
appeared and led me down a nicely-carpeted hallway to the exam
room, another room I never wanted to leave as the dental chair faced
a big, square window looking out on treetops of Central Park. A paneless
window, I thought, and then laughed at my own joke.

Dr. Ruth came in, youthful and bouncy, and told me the infection risk
with hip replacements is, indeed, in getting invasive work done, like
implants. It would be quick and easy for him to do this, he said, and I
should get it done. In fact, he said, he should get it done, he had lost
the same tooth, and furthermore, his hip was starting to bother him
when he ran.

Running. The wind in my hair, wheeling around the reservoir in the
autumn afternoon light.

I gave him a few tips on physical therapy exercises, and the next thing
I knew I was limping back there the next day. I laid back in the chair,
and Dr. Ruth put a big rubber thing in my mouth, “a little pillow to
keep your mouth open,” he said, and the nurse slipped a mask over my
face, and slipped, so gently I didn’t notice it, an IV into my arm.

And then I woke up, looking out at those great treetops in Central
Park, which seemed to have gotten a little greener while I slept.
Dr. Ruth, in his kindness and wisdom, prescribed not only the
antibiotic but also a pain killer, Tylenol with codeine. “You’ll probably
only need one of these,” he said as I left, still in my sedated haze.

Little did he know how many of those pills I’d need, but not for my
tooth (or metal rod) pain). I’d need them, desperately, for my hip pain,
because by now, a month before surgery, it was hurting like hell. Gone
were the halcyon days of pain after walking more than ten minutes;
now it hurt if I walked across the living room. Or even if I didn’t. Gone
was the Nirvana of using only Aleve for the pain. Gone were the
halcyon days of walking out of the Active Release Therapy with a
spring in my step. The thing is, now the pain started in the morning,
roughly around the time I got out of bed and walked into the
bathroom, and lasted until night, when I took a pill. Or twoThus began
what I thought of as The Narcotic Period.

It’s actually a good thing that the pain kicks in a month before the
surgery. This, I figured, is the body’s (god’s?) way of showing the
patient that the surgery is indeed Desperately Needed. One
chiropractor suggested that once you decide to have the surgery, you
give up your defenses against the pain; there’s no more fighting it.
Whatever the reason, the pain quickly became the ruling factor in my
life. And hard on its heels, the pain medication.