Playing Doctor

Initial Visit?

Tuesday, May 31

Nashville by Josh Rouse

When I decided how much I really loved Josh Rouse’s new album, Nashville—and I do love it: it’s the kind of album that the CD repeat function is designed for, you fall for one song and listen to it over and over, then fall for another and listen to it until you fall for the next—I thought about writing a review.

I was going to tell you that it’s as good as last year’s 1972, every bit as catchy, with melodious hooks and occasional blue notes and plaintive lyrics intentionally undercutting its beauty. But I thought how dry that would be; how I’ve read those reviews before, and how they might make me want to hear the album, but only because I liked the person who liked the album.

So I was trying to figure out how to convey how good this album is, and Susan Sontag’s 1964 essay ‘Against Interpretation’ came to mind. In it, she argues that ‘in place of a hermeneutics we need an erotics of art.’

Well, that was 40 years ago and her idea didn’t really catch on. But I thought I would give it a try with this album. So the preceding posts have been memories, sentiments and images that the ten songs evoked for me. Some are probably direct and obvious after the connection is made, some less so.

Anyway, listen to the album. It’s stunningly gorgeous.

Part one of Nashville:

it’s the nighttime

Friday, May 27

That’s Just Life

My day begins talking to Dr. Pasteur on the wards, when a nurse comes out of a room calling a code. We are the only doctors on the floor, so we go into the room.

‘You get the airway, I’ll run the code,’ he says, as I make my way to the head of the bed, grabbing the blue patient by his armpits and lifting him as the nurse slides the CPR board beneath him.

The crash cart is being brought in the room and the respiratory therapist is connecting the ambu-bag to the oxygen. I pull the man’s dentures out of his mouth. We begin ambu-bagging the patient to ventilate his lungs. There is no pulse, so a nurse begins compressions.

I’m looking down the man’s throat to place the endotrachial tube. His throat is full of spit and I can’t see anything. I call for suction, but they don’t have it yet. So I manipulate the blade and get the glottis to fall, his saliva bubbles and pops and I see the cords. I place the endotrachial tube and inflate the cuff. We connect the ambu-bag and begin ventilations, the nurse listens to his left chest, then his right, then his stomach.

‘Breath sounds bilaterally, not in the abdomen.’

But the CO2 monitor attached to the bag has remained purple. When it’s exposed to CO2 from an exhaling lung—as opposed to an air filled stomach—it turns yellow.

I’m in his trachea, I know I am. But the damn thing stays purple. I deflate the cuff, withdraw the tube. The suction is now ready and I clear the saliva. I am now looking down his windpipe. I’m surprised to see his vocal cords fully retracted. I can see all the way down to his corina. That’s not typical, and it strikes me that it’s a bad sign for the patient, but it does makes placing the tube easier.

We repeat the listen here, here and there. We repeat the CO2 monitor. It stays purple again.

‘I need another CO2 monitor,’ I call. ‘Now.’

The only venus access we have is a small line in his right hand, and I called for a triple lumen catheter when we walked into the room. While I was securing his airway, Dr Pasteur was getting central access via his right femoral vein.

I am watching the pulse ox. In a well oxygenated patient it reads in the nineties. It was reading in the seventies when we got into the room, it’s now in the fifties.

The new CO2 monitor stays purple.

The code team shows up at this point, a little confused to see the patient already intubated and with central access. Dr Pasteur has called for a round of epinephrine, and it’s being administered. I ask for a senior attending to check my tube placement. He confirms that it’s in the correct position.

There are a lot of people milling in the room and Dr. Pasteur tells everyone not involved in the code to get out. Most people stop talking and look at everyone else to leave.

‘If you are not on the code team: Get Out,’ He shouts, and everyone starts to make for the door. I see a medical student leaving.

‘Except the med student.’ I bark. ‘Stay in that corner, watch and don’t say anything.’

Eventually, I bring the med student out to do the chest compressions.

‘I can feel his ribs snapping,’ she says.

‘That just lets you know you’re doing it right,’ I say. ‘If the ribs aren’t breaking, you aren’t pushing hard enough.’

We continue coding the patient for a full twenty-five minutes. We figure out the likely cause of the CO2 monitor not changing, the same thing that caused the patient to code. We attempt to fix it emergently, but it does not work. Dr Pasteur pronounces the patient dead.

I begin to thank everyone for their efforts when the med student approaches me.

‘Thanks for letting me participate,’ she says.

I meet my intern to do a paracentesis—removing free fluid from the abdominal cavity. When someone has a cirrhotic liver, fluid can build up in the abdomen. Eventually, this fluid will press up on his lungs and make it difficult to breathe. It will become so taunt that he will feel a constant stretch pain that can be quite agonizing.

We drain off one liter from this man and his abdominal pain goes away and he begins breathing comfortably again. The relief on his face is obvious. I write my procedure note, and on my way off the floor look in on him. He is eating his lunch.

‘How’s the pudding?’ I ask.


‘Your lunch.’ I point at his tray. ‘How’s the pudding?’

‘Oh! The banana pudding!’ he says, smiling. ‘It’s good!’

‘I love the banana pudding here,’ I say and begin to walk out.

‘Thanks, doc,’ he says.

I have eaten more banana pudding in the two years of my residency than I have in all the years that preceded it. It seems to be the municipal dish of most southern towns.

In the afternoon, I tell a woman that her breast cancer is a particularly aggressive form and has spread throughout her body. I tell her that she likely only has three months to live. I tell her that her main complaint would require major surgery to address, followed by radiation to fix. And that surgery would likely require her to be in the hospital for another month, a week or two of it on a vent in an ICU. And that’s if things went really well. And that would only be preamble to the joys of radiation.

‘Asking you to decide if we should attempt the surgery is not fair,’ I tell her, calmly. ‘It’s asking you to make decisions as if you were a doctor. So let me tell you what I would tell you if you were my sister… I’d tell you not to do it.’

‘If she only had three months,’ I continue, ‘I’d want to spend them chatting, and remembering, and laughing as much as we could. I wouldn’t want her to spend a month laid up in a hospital, with half of that time in an ICU on a vent.’

I begin to leave the room to give her some time to think. She had asked me to tell her alone. She asks me to now tell her family.

So I walk into the quiet room and tell her sister, her husband, her twelve year-old son, and her fourteen year-old daughter that their sister, wife, mother is likely to only be around for a few more months.

‘Hope for a miracle.’ I say. ‘We’re giving her the best that medicine has to offer. But the cancer is aggressive and it’s spread throughout her body.’

One of the nurses on the floor has gotten a promotion, and all the nurses are going out to celebrate. They invite me to join them and I accept. As I am leaving the hospital, I walk by the patient’s room and glace in to see her talking and laughing with her family.

On my way to the celebration, I’m listening to an old Rod Stewart song. The thought suddenly strikes me that life can be kind of like an old Rod Stewart song. It’s kind of annoying and you feel like if you changed the station there would likely be something better out there. But if you let go of that cynicism, it can be quite beautiful.

I roll down my windows and begin to sing along.

When I get to the Red Lobster, I drink my beer, walking around the table of nurses, chatting and laughing with them. One of them has brought her baby, and someone at the other end of the table is holding him when he begins to cry. Since I’m standing, I offer to walk the baby to his mom. I pick him up and his wail quiets. I walk toward mom, bouncing him a bit and he begins to hum a little song.

‘You’re doing a fine job,’ his mom says, putting a towel over the shoulder of my guayabera. ‘You should have been a pediatrician.’

My day ends holding a five month-old baby. I wrap my hand around the back of his head, rolling my thumb up to feel the soft spot. He cradles his head into my neck and I kiss his tiny ear and whisper to him, ‘You have so very much to look forward to.’

Nashville Epilogue:


Thursday, May 26

Why Won’t You Tell Me Why

When I was younger, I was covertly sleeping with the girl that my best friend loved.

His name was Mark and at night, there’d be a group of us in the dorms, watching Letterman or Apocalypse Now or Italian porn, and around midnight I would head out of the room, out the back parking lot, over the stream, and into the darkened golf course. I figured they’d assume I went back to my room and went to sleep. I figured no one would really pick up that I was not getting back until around dawn.

When the guys started referring to me as The Boy Wonder, I figured it was because I had a Robin figure on my desk and did not really question it.

It turned out that I had gotten the nickname because my roommate thought that I was sleeping with my best friend, and that’s why I wasn’t getting in until dawn.

He questioned Mark about it, and after Mark told him that we weren’t sleeping together, they started to wonder where I was spending the night. If not in Mark’s room, and not in my room, then where?

‘I wonder about that boy,’ my roommate said.

‘He’s The Boy Wonder,’ Mark said.

Even after all the other cats were out of the bag, that nickname stuck.

Part ten of Nashville:


Wednesday, May 25

Sad Eyes

My friend was unhappy for most of her twenties. She had dated a gymnast in college and missed him terribly since he moved to Utah

Her and her best friend were both sexy looking girls and were particularly close, so people sometimes talked, if you know what I mean. It became a little joke between them, but one night they were drinking and her friend got all serious and said, ‘I was thinking last night and I’ve decided that I’m a lesbian and that I’m in love with you.’

My friend started laughing and continued cackling for a very long five to ten seconds before she saw that she was not kidding.

She apologized for laughing, but how do you really apologies for such a thing? She ended up moving to Utah with the gymnast where they had an odd relationship. I never met him, so I never really understood their dynamics, but my friend confessed to a number of crazy things.

She put salt in his potted plants, killing them.

When his ex-girlfriend moved back into town, the gymnast let her keep some boxes in their home. My friend used incense to burn small holes in the backs of some of her shirts and skirts. ‘Small enough that you wouldn’t notice them until you were out and someone else might see them.’

When they had a fight, she would open up the capsules of his antihistamines, empty out the medicine and then put them back together. He couldn’t figure out why his allergies flared so badly after they had a fight.

Eventually, sense took hold of one of them, and they split up. She moved to Vegas, and the gymnast married his ex-girlfriend.

I hope she is happier now.

Part nine of Nashville:

why won’t you tell me what

Tuesday, May 24

Saturday Afternoons

I moved around a tremendous amount during my teens and twenties, so I was happy to think I had settled in Miami back in ’96. Moving to this southern town for my residency was not part of my plan. I feel far from home here. I miss needing to wear sunglasses when I go outside, and—more than that—I miss my sister.
I would swim across the ocean
I would lay down on a bed of nails
But I’ll spare you all the bullshit
I will spare you all the desperate details

The thing about missing people, for me anyway, isn’t the conversations or the activities. We pretend to be rational animals, but really we are animals with the capacity to rationalize. It’s someone’s quiet presence that can feel so sacred.

When I know I’m going to be around my sister, that area along the costochodral margin relaxes in an impossible manner and my breath is easier.
I will treasure every moment
I will lay down on the couch and watch TV

Part eight of Nashville:

sad eyes

Monday, May 23

When You Come Around

When I was twenty-three I dated a guy for the first time.

He was a DJ at a club in Iowa City. When I told my dad I was dating a guy, he drove me to Target and bought me every type of condom on the market. He must have spent two hundred dollars on them. I was humiliated as we went through the checkout lane and filled two full-sized paper grocery bags overflowing with boxes of condoms and lubricants.

‘Just because one isn’t comfortable, doesn’t mean you shouldn’t wear them. Keep trying them till you find one you like.’

Gertrude Stein once wrote, ‘Before the flowers of friendship faded, friendship faded.’

Something similar could be said about that bag of condoms and my new boyfriend.

For a few years he would call me every six or seven months and we would try going out again, but it never really rekindled. It always made me kind of sad when it did not.

Relationships are all about timing and trajectory, aren’t they?

Part seven of Nashville:


Friday, May 20

i go invisible

When I was twelve, I was hanging out with a group of about seven guys from my school. I grew up on an island near Miami—so we all lived within ten blocks of each other. One of them was my second cousin, who everyone considered a bit off, but I thought he was kind of cool.

We were in Mac’s bedroom and he had bunk beds. While we were talking, I climbed up on the top bunk, and I guess I didn’t say anything for a while, and the horrible wish came true.

In The Chronicles of Narnia, about the third or fourth book, either The Silver Chair or Prince Caspian, one of the children wishes she could see what her friends were doing at that moment. It turned out they were talking about her…

‘Where’s Erik?’ one of them said. They all looked around at the group sitting on the floor and saw that I was not there. If I had an ounce of sense, I would have said something. But I thought it was a fun trick and remained quiet, though my head hung over the edge of the bunk bed, peering down at them.

‘I guess he left without saying anything,’ Mac said.

‘That kid’s weird,’ someone said.

And so it started.

‘I don’t really like him much.’

‘I only hang out with him because he’s related to me.’

‘He goes to the gifted program with me,’ another one said, ‘but he goes to a special section for the people with problems. We call them the Mad Scientists.’

Someone told another story that confirmed my oddity.

I was so traumatized that I cannot even remember how I made it out of that room. I have a vague recollection of waiting until everyone left and then sneaking out, and I have a vague recollection of saying something and all of them pretending that they knew I was there and were only joking. I have no idea which one of the two is true.

Anyway, that was years ago, and I’m completely over it. And for the record, I only went to that special section because I had some weird speech problem, fuck-tard. I didn’t want to be in your Robot dance performance of ‘Kilroy Was Here’ anyway.

Part six of Nashville:

my love has gone

Thursday, May 19

Proximity to the Stars

In Chicago, I was poor.

I lived in a basement apartment and played so much solitaire I had sheets of paper tracking my wins and losses using different strategies. I had magazine cut-outs decorating the walls. It was the early nineties, so there were a lot of Winona and Johnny, John Malkovich, Wendy and Lisa, Gary Oldman, Chuck D, Sandra Bernhard, and Colin Firth. There was a larger still of Christian Bale from Empire of the Sun. He was on his knees, screaming, with a large explosion behind him. I had sharpied the word ‘potato’ at the photos edge.

Sometimes I’d hang out with this girl named Mary. We’d meet near Wrigley Field to play pool after class, then we’d go to the place where she cocktailed and get some free food. The owner would sometimes ask her to pitch in and help if they were busy. If she was too tired to work, he would ply her with coke.

So one afternoon turned into one long night and I was sitting at her bar and began talking to her friend, who was a magician from New Orleans. He was a nice enough guy, and we were watching them get the food ready for Lenny Kravitz, who was getting ready to perform next door. His balding drummer came in to pick up the food, and I remember thinking it odd that he was bald and that the drummer had to pick up the food.

Late into the night, Mary, the magician and I ended up back at my basement apartment.

‘All of these pictures on your walls,’ the magician said, ‘and yet, none of anyone you actually know. No one that you actually care about.’

Part five of Nashville:

middle school frown

Wednesday, May 18

We can talk about the streetlights

In the September of the year I turned twenty-one, I moved to Charlottesville, Virginia. I had decided to take a semester off college, to clear my head.

I got a job in a gourmet bakery as their delivery driver. I would bring the cakes and rolls and confections to the local restaurants. On alternate Thursdays, I would drive to Richmond, delivering specialty cakes to a few restaurants.

It was also my job to make the dinner rolls. After I finished my deliveries, I made the dough for the next day. It would just be me and one other person in the bakery. We would also make any random dish that needed to be prepared—lemon squares, brioche, brownies, sesame noodles, vegetable lasagna or whatever.

It would usually be Betsy or Demi that I worked with. Both of whom were older than me—late twenties—and both of whom appeared wildly romantic to me.

Betsy was house-sitting for a couple who spent their winters in Africa. Their home was filled with the stuffed heads of all manner of animals. When I say filled, I don’t mean one room. Most of the rooms had five to ten heads. And I don’t mean deer and deer and more deer. There were Lions and Rhinos and Croc’s and little strange animals whose names I didn’t even know. Betsy and I would hang out and watch movies like Easy Rider and Dr. Strangelove.

She had lived in Italy for years, but had come back to be close to her sister who had given birth to twins with identical birth defects and required constant medical care. She told wonderful stories of life in Tuscany among artists whose names I recognized.

Demi was funny, a single parent, and came from a family whose name I also recognized. She lived in a nineteenth-century farm house, next to a church and behind a cemetery. I would come over and she would feed me tomato chutney that she had made. She would say things like, ‘The Dali Lama was sitting in that chair last week, and ate this same chutney. He was very nice.’

I would look down at my chair and then at her, remembering that the Dali Lama had been in town the previous week, and that she had taken a few days off, and I wondered why she was working at any bakery, gourmet or otherwise.

In December, I left to resume school, this time in Chicago. I left Charlottesville, left with unfinished business and on bad terms with almost everyone there. Everyone I cared about, anyway.

Part four of Nashville:


Tuesday, May 17

Snow on the Sand

For me, one of the most potent images from the movie Eternal Sunshine of the Spotless Mind, a film filled with potent images, was the simple image of the beach in winter.

Enjoying something so much that you stay far after it’s reasonable to do so; the frostbite only reminds you of the sunshine.

Part three of Nashville:


Monday, May 16

It’s the nighttime, Baby.
Don’t let go of my love tonight.

When I was nineteen, I fell into my first real relationship. Unfortunately, it was with the girl my best friend was in love with.

She and I were both a bit younger than he was and we both idolized his coolness. Neither one of us wanted to jeopardize our friendship with him by letting him know what was going on between us. So during the daytime the three of us would hang out at the cafeteria, the Art Building, or in the dorm lobby. (It was a Christian college, and the opposite sex was not allowed in the dorms except during weekend visiting hours—and even then the door had to be open at least six inches and a light had to be on in the room.)

In the nighttime, the two of us would meet out on the golf course behind the dorm. We’d meet at the green of the seventh hole and lay out, watching the stars, talking, and what-have-you. That was the first time in my life I understood how superfluous sleep was. We would be out there until five or six in the morning, until just before sun up, watching the stars streak and spin across the sky.

Of course, he eventually found out. She told someone who told someone, as all things tend to happen. He forgave us, which was generous, and she eventually started sleeping with someone else.

She broke up with me while we were perusing magazine titles in the library. I picked up a copy of Art Forum and Rolling Stone and told her not to worry about it.

‘It’s cool.’ I lied, and went to sit with my friend, who was reading Fear and Loathing in Las Vegas.

Part two of Nashville:

winter in the hamptons

Friday, May 13

L'odeur de la mort
Those Other Scents

Again, I am not a fan of warnings, but today's post may be a bit much for some people.

‘Focus on the bone saw,’ I thought, while mouth breathing. ‘You are no longer an animal. You are no longer human. Focus on the bone saw, follow the markings he’s made for you. Right there. That’s it. Two centimeters above the ear and across the forehead.’

‘Look at the size of this heart,’ the Medical Examiner said, holding up the enlarged heart in his hand. With the other hand he took the bread knife and made a series of cuts like a loaf of bread into the heart, revealing a thickened left ventricle. ‘Long standing hypertension.’

‘Nice,’ I said.

He came around to the head, where I stood, and made a few corrections of my saw work and removed the top of the man’s skull.

Now brains are fragile things. Two days rotting in the heat is a rather insurmountable task for them. When we were kids, we used cold spaghetti and paste for haunted house brains. I thought it was a pretty good illusion at the time.

I had no idea.

This man’s head became a homeless drunk spewing forth unimaginable scents, vomiting up bilious oatmeal, creamy gray colored chunks with flecks and strings of green-black bits.

‘Steady. Steady,’ I thought as his putrid brains slopped around the bucket and down my leg onto my shoes. I swallowed hard and focused on recognizing anatomy. I imagined a deluge of histologic images to distract me from the deluge on my hazmat suit.

But then, the pearl.

‘Look at that,’ the M.E. said. He reached in to the base of the skull, and there, right where the internal carotid artery branches into the anterior and middle cerebral arteries was a blood clot. It was enormous: Nearly the size of a giant gumball. ‘You are witnessing a rare and beautiful thing: a clearly identifiable cause of death. This clot is what killed our friend here.’

There was a sense of glee in the room, but we finished our work and left as quickly as we could.

Despite the excitement, and the thing that started this story in the first place, for nearly a year afterwards, my stomach turned and I had to close my eyes and concentrate on not heaving whenever I got close to duck meat, most cheeses or anything cooked with fennel.

Even today, particular blue cheeses will bring it all back, and I’ll have to actively prevent my brain from putting me back in that cramped putrid room.

Thursday, May 12

L'odeur de la mort
The Decomp Room

I went into the Decomp room to see an enormous blue-black man who was repulsively swollen. But though I say repulsively swollen, nothing about his appearance could even begin to compare with the stench. The room is small and the stench hits you with one hundred million years of evolution commanding you to get the fuck out.

Turn around. Vomit. Run.

Rid yourself of anything to do with this putrid stench.

Your nose begins to run and your eyes tear up.

Get out. Vomit. Just get the fuck out, now.

‘Well, look who’s joining us,’ the Medical Examiner said.

My hood and mask hid that my eyes were tearing. Staring through the tears, I steadied my voice and asked, ‘What’s the story?’

‘Sixty-two year-old Anglo garbageman found in his bathtub after not reporting to work for three days.’

‘That’s three days worth of decay?’ I asked.

‘Don’t take long in South Florida.’

‘Any idea what killed him?’ I asked, my voice is steady, but all I am thinking is: Don't Vomit. Don't Vomit.

I’m sealed in a hazmat suit. If I vomit, it will smear the front of my mask. It will pour down and soak my clothes.

‘No, and we’re not likely to either,’ he said. ‘Finding a definite cause of death is truly rare. But when they show up like this, it is damn near impossible.’

I am breathing through my mouth, trying to think of only the case. I am forcing myself to ignore that I am taking particles of this dead man into my mouth. I am not thinking that. I am not thinking that. I am not thinking that I am eating this rotting corpse.

Tomorrow: Those Other Scents

Wednesday, May 11

L'odeur de la mort:
Dealing, Not Dealing, and Preparing

Halfway through the day, I saw the Medical Examiner putting on far more than the simple protective gowns that we wore; he was putting on a C13 Neoprene Hazmat suit.

‘Where are you going with that?’ I asked.

‘A place that you don’t want to follow,’ he said.

‘Where’s he going?’ I asked the Diener.

‘The Decomp room.’

The Decomposition Room, or Decomp room, is where they perform the autopsies on the dead who have been found in—logically enough—various states of decomposition.

Now, I am by no means a gunner, but that was obviously a taunt. And I wasn’t about to back down from that.

I put on a Hazmat suit that looked like it would fit me. I imagined myself the Red Duke’s son, Paul, putting on a stillsuit for the first time, but I ended flailing around and having the Diener help me with the zippers and hood attachments.

In order to get to the room, you have to essentially go through an air lock. You go through the cooler with all the body bags, through the back door of the cooler, through a weighing area, and into a small—tiny—room with an enormous fan that constantly recirculates the air in the room with fresh air from the outside, this is supposed to minimize the odor, but in the reality of a South Florida summer, it simply makes the room hot. Very hot.

Let me address for a moment, if you will again indulge me, how movies portray the stench of death. Obviously, scent is not really visible. Cartoonists can draw squiggly lines emanating from noxious substances. Movies will occasionally use a yellow smoke, but often that won’t work in a given movie or scene, so they will resort to signifiers. In Silence of the Lambs, they show the agents putting Vicks VapoRub below their nostrils as they approach the body drug out of the river.

This is a rookie mistake. The idea is that the smell of the Vicks will mask the odor, but as any mother will tell you, the menthol and camphor open the nasal passages. This allows more of your olfactory epithelium to be exposed to all the odors you breathe in. It makes the odors stronger and linger in your nose longer. And when I say longer, I mean for days longer.

A better technique is to breathe through your mouth and focus on the work you have to do. But again, I digress…

Tomorrow: The Decomp Room

Tuesday, May 10

L'odeur de la Mort

I am not a fan of warnings, but today’s post may be a bit much for some people. If you are of a delicate nature, come back tomorrow.

During my second year of med school, I spent a day at the Medical Examiner’s office, helping out with autopsies.

Have you ever opened the stomach of a woman who overdosed on sleeping pills, pain meds and chemotherapy? Would you be surprised to find Planters Dry Roasted Peanuts in her stomach with them? Do you suppose she really loved peanuts, or do you think she swallowed handfuls of them to hide the aftertaste of the pills? I spent weeks hoping she loved peanuts.

Or have you ever cut the anus out of a dead hooker to look for evidence of an anal rape by her murderer? Now, that’s an interesting story.

Some guy (or girl—girls can do anything guys can do) was killing hookers and putting their bodies in Samsonite Outline Jumbo Suiters and leaving them around town. I’d tell you some of the more interesting details, but I don’t know if they ever caught the guy (or girl—Girl Power!) and so I don’t want to screw up any Good Cop/Bad Cop interrogation routine that may take place in the future. I will say it was a bit tricky to get her into a position where we could dissect it out. I am glad the evidence photographer was focused on the body rather than me.

What a day that was!

But I digress…

Tomorrow: Dealing, Not Dealing, and Preparing

Monday, May 9

L'odeur de la mort

One of the disadvantages of being a doctor, if you will indulge me, is recognizing a number of scents that remind one of death and decay.

Recognizing scents can sometimes be an advantage. When walking by a patient’s bathroom, we can tell if someone has a rectal bleed by the smell. When someone sneezes, I can sometimes distinguish the type of bacteria causing their sinusitis.

Once, when I detached a chest tube from the collection cup so I could smell the lung's effluent purulence, a nurse looked at me horrified, saying ‘You are one hardcore doctor.’

‘Mildred!’ I said, smiling with my hands open and at my side, ‘Does that mean I can’t take your daughter to the movies on Friday night?’

‘Oh, you can take her, alright,’ she said, turning and walking out of the room. ‘Just don’t go sniffing anything you ain’t supposed to be sniffing around when you’re with her.’

But diagnostic scents are uncommon and don’t effect me much outside of work. A bit more intrusive are the scents of association. Two in particular are problems for me. The first is perhaps more curious than the second.

When I was in my first year of med school, I would go over the corpses in the gross anatomy lab for an hour or so and then study in the library for several hours after that. Because I was not excited about having the stench of preservatives and dead flesh on me for all of that time, I showered using what I thought would cover up the lingering fumes. It was Doc Bronner’s Lavender soap. A nice enough scent and it did the job.

However, ever since then, whenever someone smells of lavender, all I smell is a 93 year-old secretary who died of Alzheimer’s disease.

The other scent is a bit more direct. But the story turned out to be more complex than I anticipated, so welcome to...

The Smell of Death Week

...only here at Playing Doctor.

Tomorrow: Prelude

Friday, May 6

Do You Want to Touch My Monkey?

This Monkey Face is my favorite. In fact, it was her favorites experiment that caused me to go off on this curious diatribe:

‘What CD would you bring with you to a desert island’ is not asking ‘what’s your favorite?’ It’s asking ‘what do you love that you wish you could hate?’

Television, a bit differently, but similarly so, is not meant for such passion. Television is not ‘seeking a long term relationship.’ It's an aesthetic one night stand. No, not even that. It’s a hand-job in the front seat of a Chevy pick-up. It’s hastily thrown together, and hurled at the fourth wall. We get to see what sticks. Television is meant to be intangible; even TiVo asks ‘are you finished with this program?’

Yes, by all means, I am finished.

Dump it from memory.
Dump it from my memory, now.

DVD’s of television shows are abominations, making painfully obvious how transient the medium should be. Especially if they have a collector’s edition casing. It is like showing pictures of your whores to your grandchildren.

Reruns, however, are fine. Don’t ask me why. They just are.

I think of the back cover endorsement that says ‘All men should read Erasmus; All educated men should read Erasmus once a year.’

Nip/Tuck does not allow for such pretense.

Shame, really, because you’re right: Dr. Christian is H-O-T.

Anyway, go read Monkey Face, because she is H-O-T.

Wednesday, May 4

Uncynical Wednesdays

Tuesday, May 3

Call Me Wolverine.

Monday, May 2

Le Petit Chat. Il Est Mort.

Driving home, I found the thing that every cat owner dreads most; on the road in front of my house lay an unmoving furry object.

Luckily, I don’t own a cat.

I drove up next to it and pulled over. I wasn’t sure if it was dead or simply sleeping—this is The South, dogs and cats sleep on the road—so I called its name, ‘Kitty, Kitty.’

It didn’t move, so I got out of my car and crouched next to it; its eyes were closed and its tongue hung halfway out its mouth, neither one very helpful for figuring out if it was dead or just sleeping. It had not breathed since I started examining it, and then I noticed there was about a tablespoon of dark fluid seeping from its anus. That was a better indication that it was dead.

My neighbor has a fair number of cats, and though I did not recognize this as one of them, I figured there was a good chance it belonged to her. I was going to leave my car next to the cat, but was afraid someone would have to run over the cat to get around it, so I parked my car and went next door.

‘Hi, Erik, how are you?’
‘I’m doing pretty good, and you?’
‘Um, there’s a cat that got hit in front of my house. I didn’t recognize it, but was afraid it might be one of yours.’

We are not overly close neighbors. We are what I have heard a comedian refer to as Hey Neighbors. Every time you see a Hey Neighbor you say ‘Hey’ but that is as far as the conversation goes. We have spoken a few times, like when the peeping tom was terrorizing the neighborhood last year and when she put up a fence along our shared property line. When I leave town, I give her my contact numbers. When her kids wreck their skateboards in front of my house, I offer to get their mother or call an ambulance. But that is about as far as it goes.

But when we approached the cat and got close enough to start to recognize its markings, she took my arm.

There is something foreign about the familiar when they are dead. In a very peculiar way, the dead do not resemble the living. Maybe its denial, maybe its unquenchable hope, but there’s a furrowing of the brow as loved ones examine the deceased, unable to reconcile the living version that they know so intimately, with the lifeless object before them.

I saw that furrowing of her brow as we got closer, but when we were before it, crouching as she reached out to pet its furry belly, I heard the quiet inhalation of acceptance. I put my arm around her shoulders and she grabbed my hand.

The body was still warm. The dark fluid was now starting to spread out, covering a larger area behind it. I stared hard at its body, looking for any sign that it was still alive. But I didn’t know how to pronounce a cat.

With a human, the first thing I check for is the absence of peripheral pulses. Then listen for possible heart or breath sounds. Often I have an EKG strip to demonstrate that the heart has stopped conducting a rhythm. I then try and wake the patient up, usually rubbing their sternum while checking for any sort of reaction. I’ll then take a small piece of cotton and rub their eyes, looking for any sign of a corneal reflex.

I don’t know where to look for a pulse on a cat, and I wasn’t going to poke its eyeballs or do a sternal rub in front of its owner. So I went to my car to get my stethoscope. When I returned her son had joined her, he had brought a blanket from the house. The two of them crouched next to the body.

I listened to its chest. I heard nothing. I carefully picked it up and looked it over. No obvious signs of trauma. The spine felt loose, but this was the first time I had picked up a freshly dead cat, so I didn’t know if that was unusual. The important thing was, I was covertly pinching the front leg at the shoulder joint as I picked it up, trying to get any sort of reaction from it. I got no reaction.

‘She’s dead. I’m so sorry.’

I placed the body in the blanket and wrapped it, carefully placing it in her arms, but she was unsteady.

‘I’ll take her, Mom,’ her son said and took the cat, cradling it in his arms as they walked together into their home.

Medical Records

Season Three

Season Two

Season One