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Closing Up Shop

Every physician eventually faces the decision to hang up one’s spurs and walk into the sunset to a life of less stress, less money and more time to aggravate one’s spouse by getting underfoot.  Sometimes, because of physical infirmity or loss of mental capabilities, that decision is out of one’s hands. An old surgeon under whom I trained who was nearing retirement said, “I’d rather be missed than dismissed.” Others have either amassed a considerable personal fortune or, as a classmate who worked for a state medical school for 30 years and retired at 54, a comfortable public sector pension. But some of us wake up one day, decide “this isn’t fun anymore” and just quit.

I started thinking about getting out a couple of years ago after I overheard a nurse say, “Anyone who does an abdominal hysterectomy these days should be sued for malpractice.” I trained long before the era of the laparoscopic approach to everything and I’m comfortable with the abdominal approach. I’ve never liked vaginal hysterectomies; it’s like operating in a tunnel. I haven’t done major gynecologic surgery in almost ten years and I don’t miss it.

While I love obstetrics, it is a physically demanding specialty. Staying up all night becomes more difficult as one ages and near impossible by the time one reaches mid-fifties. My back doesn’t tolerate 8-hour surgery marathons like I did when I was in my thirties.

It can also be emotionally draining. I’ve had to tell more than one mother her baby has died, and I’ve cried with her and the nurses after the delivery. Our receptionist and her unborn son were killed when she was 38 weeks pregnant. An elderly man ran a stop sign and broadsided her car in a rainstorm. A colleague’s 18-year-old patient died from Group A streptococcal sepsis two days after delivering her baby. We’ve lived long enough that we know all the bad things that can happen and the prospect fills us with dread.

I’ve also known physicians who’ve gone through their entire careers with a clean record only to find themselves being sued when they are within a few months of retiring. That alone scares me more than anything else; like waiting for the walk down the Green Mile.

Medical practice has changed since I started and often not for the better. New physicians are likely to be corporate drones working 9 to 5 for large health care groups, potentially succumbing to a shift mentality, something I saw during my days working for a staff-model HMO. “It’s five o’clock and time for me to go home. You’re now someone else’s problem.” I always stayed until the last patient was seen, worked in emergencies and sometimes met patients after hours because it was more expedient than sending them to the emergency room, which would call me several hours later anyway. Now they call it “old school.”

Many physicians no longer take call or see patients in the hospital. They’ve been replaced by hospitalists who work 24-hour in-house shifts and go home. This arrangement might be preferable to having an overworked, sleep-deprived physician trying to juggle office and inpatients, but that personal connection many of us felt with our patients has been lost.

Smaller hospitals are not immune. As costs continue to rise and competition increases, they become “affiliated” with tertiary centers, if not bought outright, and the bean counters want a sizeable return on investment. One physician confessed, “I have men in three-piece suits telling me what to do—and I do it.” The hospital in which I worked in the early 1970s as an orderly closed recently, having held out too long against the regional behemoth’s advances.

Technology and guidelines derived from academic studies are making us obsolete. Seeing women every year for a pelvic and breast exam, Pap smear and a mammogram for older used to be the bulk of an Ob/Gyn’s office practice. Now, if a woman has a negative Pap and negative HPV testing the guidelines recommend another Pap in five years, even though I’ve seen women go from a negative Pap smear to invasive cervical cancer in a year. We no longer need to do an internal examination on a woman coming for birth control pills if she has no symptoms.  The National Breast and Cervical Cancer Early Detection Program told us our clinical breast exams only “modestly improved” early detection of breast cancer. The United States Preventive Services Task Force (USPSTF) says we should teach women “breast self-awareness” rather than breast self-exam, because “the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.”

A nurse practitioner can do eighty percent of what I do. A Certified Nurse Midwife can do ninety percent. So why the hell do you need me?

I can rise to the occasion when circumstances require expedient action, such as a woman with a liter of blood in her abdomen from an ectopic pregnancy or a baby needing to be delivered immediately to avoid certain death, even though it often leaves a knot in my gut. I probably have a few useful years left but that evening stroll along a beach looks more inviting every day.

Image (C) CanStockPhoto

Sounds of summer

To everything there is a season and to every season there is music. Memorial Day Weekend kicks off the summer season. Here’s my list of tunes for the hottest time of the year. Be sure to check out the L.A. Woman video.

Summer in the City – The Lovin’ Spoonful. This was one of the first songs I heard on AM radio after emerging from the cultural isolation of small-town Arizona. The minor chord was unsettling; the jackhammer and ‘60s car horns, unforgettable. The windows were open at night because we didn’t have air conditioning and I could hear the rumbling shock wave of railroad cars coupling in the big train yard by the glass factory. Those were good factory jobs – allowed a lot of people to buy homes. 

Chain of Fools – Aretha Franklin. A cloudy, sultry summer night. There’s lightning in the distance near Chicago. The static interrupts the Queen of Soul as she sings I ain’t nothin’ but your fool / You treated me mean / Oh you treated me cruel.Thunderstorm canstockphoto5305187

Pleasant Valley Sunday – The Monkees.Another Pleasant Valley Sunday / Charcoal burning everywhere.” Kids running around the grass barefoot; dogs and burgers on the grill; the grown-ups in lawn chair with cans of Falstaff. Things would go to shit within a year – ghettos exploding; the cops going berserk in Grant Park in ’68 and a war that would take 58,000 sons and daughters.

Sunshine Superman – Donovan. Midsummer. A 1930’s era bungalow with the windows wide open for a breeze. A mother in a black floral print pinafore apron, the kind with the frill around the arms, presses clothes with a heavy Sunbeam Ironmaster, the one with the black handle and the braided cord. She dampens the clothes with water from a glass pop bottle corked with an aluminum sprinkling head. That’s the image I see when I hear this song.

Bad Moon RisingCreedence Clearwater Revival. High school kids in our rural Illinois town made money during the summer break by detasseling corn.  This is one of the songs they listened to in the car on the way to the fields.20150725_194221

Twistin’ By the Pool – Dire Straits.  In 1963 our parents listened to Nat King Cole sing Those Lazy-Hazy-Crazy Days of Summer. Twenty years later we listened to this with our kids. Sunglasses, bathing suits and the Euro beat. Annette and Frankie would fit right in.

School’s Out – Alice Cooper. Back in 1969 our parents thought Alice Cooper was dangerous. I should have known something wasn’t right when The Jet Song from West Side Story showed up on the third track. This son of a preacher man is a Republican, lived in Phoenix next to Barry Goldwater and gave up booze for golf (he has a four handicap). He’s been faithfully married to the same woman since 1976.

L.A. Woman – The Doors. Drivin’ down your freeways / Midnight alleys roam / Cops in cars, the topless bars. The dark side of the City of Angels.

Hey Frederick – Jefferson Airplane. Nicky Hopkins’ emphatic piano, Jorma Kaukonen’s piercing guitar, and Grace Slick’s sultry voice and erotic lyrics caressed my adolescent anger. Nicky has been gone 22 years; Grace and Jorma are now in their mid-70s and I’m a grandfather.

Blows Against the Empire – Paul Kantner/Jefferson Starship. This Hugo Award nominated concept album featured David Crosby and Graham Nash, the Grateful Dead’s Jerry Garcia, Bill Kreutzmann and Mickey Hart, and David Freiberg from Quicksilver Messenger Service along with Grace Slick, Jack Casady and Jorma Kaukonen’s younger brother Peter. It was a story of counter-culture people hijacking a starship and traveling out of the solar system in search of Utopia. Almost half a century later it reminds me of Berniebots. One of my favorite pieces, “Let’s Go Together,” starts at 8:14. The You Tube single version is an alternate take and kinda sucks.

Spoonful – Cream. Some of us defected to the dark side, leaving Top 40 for music our parents thought was dangerous drug music. Wheels of Fire-Live at the Fillmore fell into that category, with that psychedelic gatefold sleeve and Eric Clapton’s searing guitar. I bought the cassette version and would drive dark country roads listening to it on my portable player that looked like Dr. McCoy’s tricorder.

In-A-Gadda-Da-Vida – “I. Ron” Butterfly. Four of us high school misfits would sit around our dining room table solving the world’s problems, listening to this with the record changer’s overarm extended so it would play over and over. It likely drove the parents nuts, but they never let on. (Click on “I.Ron” if you’ve never seen The Simpsons’ version.)

Lord Have Mercy On My Soul / When Electricity Came to Arkansas – Black Oak Arkansas. Way back when, before 24-hour news cycles and talk radio, most of the small AM stations shut down at 10pm. This allowed me to pick up “The Mighty 1090,” KAAY-AM from Little Rock, Arkansas, playing longer tracks from relatively unknown rock artists: It’s A Beautiful Day, Bloodrock, Spooky Tooth, The Flock, Love Sculpture, Sisyphus, Hawkwind, Jamie Brockett, and Black Oak Arkansas. Nothin’ like a little redneck raunch ‘n’ roll to get you goin’.

China Grove – Doobie Brothers. The semester is over. All my earthly possessions are in the back of my 1973 Gremlin as I’m headed out of Champaign on I-74.Gremlin

Whipping Post – The Allman Brothers Band. Nothing says hot summer nights in the South like the Allmans’ music. The Fillmore recording segues into thirty-four minutes of Mountain Jam. It doesn’t get any better than this.Swamp sunset

Us and Them – Pink Floyd. Every so often a remarkable work appears. Dark Side of the Moon is unarguably one of the best rock albums of all time; this is one of the best tracks. So light one up and have a great summer.

Gremlin Photo (C) Paul Niedermeyer, Curbside Classic. Used with permission.
Thunderstorm and Bayou sunset (C) Canstock Photo
Cornfield – my photo

Waking the dead

My brother bought a black suit when he married at 45, remarking, “I’m going to be attending a lot of funerals,” a reasonable proposition at my age. We lost several people close to us last year, prompting me to reflect on my own mortality: how would I like to be remembered; what music I’d like at my memorial; whether to leave an estate or spend it all before I go.

I remember wakes more than funerals. It’s not the line of people waiting to comfort the bereaved and pay their last respects to the dearly departed. Rather, it’s the visual tribute and chronology of a life that leave more of an impression, particularly if one had been acquainted for a relatively short time. We used to assemble photo collages on poster board; now images can be digitally uploaded to a computer and played on a wall-mounted monitor, complete with soundtrack.

It usually starts with the square black and white glossy snapshots from the 1940s or 1950s, shot with a Brownie box camera. We were babies or little kids and death was an abstraction that never crossed our minds. I notice the backgrounds more often than the subject, recalling my own childhood. Living rooms with obnoxious floral wallpaper that was once trendy. The sturdy couch, armchair and ottoman, covered in a short-napped, rust-colored upholstery that felt like a fresh buzz-cut when you ran your hand over it. Sometimes there was a heavy mantle clock which required winding with a key. It was made with wood and the chime was real, not electronic.Mom and Me April 1955 cropped

Kitchens had refrigerators with rounded corners and latches, white gas stoves with pilot lights, and gleaming six-inch ceramic tiles (ours were yellow with black trim). Most average folk didn’t have a formal dining room like the Cleavers or Dr. Stone and his wife. More often a chrome and laminate dinette set with vinyl-covered chairs sat in the middle of the kitchen. At least one photo had a kid in a high chair, or, as with my sister, sitting ON the table while pouring out the sugar bowl. bday007 resizedOften a little one sat on the lap of a father or grandfather, dressed in a white T-shirt and dungarees, both of them smiling for the camera. Or the look was more subdued, suggesting Dad wasn’t quite used to having a squirming tax deduction. Grandmothers with short silver hair wore a severe, disapproving look behind those black, butterfly eyeglasses.  They always wore dresses; no jeans, slacks or pant suits. bday008 resized

Photographs evolved with the lives they recorded, becoming color prints or Kodachrome slides, which held up much better than the Instamatic pictures from the 1980s that would fade into various shades of red and brown. Siblings sat beaming in front of a real Christmas tree with those big clip-on light strings, surrounded by toys we’ve forgotten ever existed. There were snapshots of First Communion and Confirmation if you were Catholic, or the full-body dunk if you were Baptist. (I’ve never been to a Jewish funeral but I’m sure Bar Mitzvah pictures are prominent.) The years roll on with memories of family vacations; eight grade graduation; the first car if the parents had money or, more likely, a shot of the first driver’s license. High school prom if you were one of the cool kids. High school graduation and impending adulthood. Be careful what you wish for.Graduation 1975

The paths often diverged from here. Some went to college, then got married. A few married right out of high school and went to work. The bride and groom looked so young in those photos. Then they started having their own kids, assuming the mantle of parenthood from those now content to be grandparents. As one photographic cycle continued another one began. Before they knew it, those kids were grown with kids of their own and the roles shifted yet again.dar001For the most part everyone turned out OK. Occasionally a wayward child turned into a troubled adult despite the best efforts, something no one wants to talk about. Even more tragic was a child lost to illness, accident or war, a premature departure that remains painful and triggers tears.

Photos became larger and sharper in the twilight years. Digital cameras eliminated the trip to the developer for prints. Smart phones then surpassed digital cameras and entire albums were a finger-swipe away. Many a parent converted a shoe box full of memories to a digital archive; but they would never be anything like the originals.Thugs02

By now our grandparents are long gone. Our parents are leaving us one by one, sometimes later than expected as they live into their eighties and nineties, instead of having the big one in their sixties like they did when we were kids. Ironically that’s where we find ourselves now. We’ve come full circle.

The final episode of the original Twilight Zone was “Passage on the Lady Anne.” A young couple boards an aging cruise ship only to discover the other passengers are all quite elderly and find their presence unsettling. The pair is eventually forced off the ship and into a lifeboat, because this trip is, for them, premature. The others are sailing towards the Final Destination

We’re all booked on the Lady Anne. Sooner or later we’ll find a ticket in our hand, waiting our turn to board.

 

Whales and Meisterbrau

Franklyn MacCormack hosted the “All Night Showcase” on Chicago’s WBBM and WGN radio stations between 1959 and 1971. This was back when the now-defunct Northwest Airlines was known as Northwest Orient. (“Northwest Orient *gong* Airlines”) He played “mood music:” the soft, sultry tunes Rock Hudson would have played while gently but relentlessly pursuing Doris Day in Pillow Talk. MacCormack also read poetry on the air, told stories and extolled the virtues of the show’s sponsor, Meisterbrau beer, in his comforting baritone.

You’re probably wondering why a rebellious teenager steeped in Jimi Hendrix and Led Zep would be familiar with the old fart’s genre, but my musical tastes had always been fairly broad. And that’s not the point of this tale.

I’d gotten my driver’s license in September 1970 and, after a few month of driving around town with a parental co-pilot, I was allowed to take the car by myself. There was no published list of rules for me to follow; no advice given before I took off.  I knew there would be hell to pay if I screwed up. Fear can be a great motivator.

One evening in January, 1971, some of my friends and I imagined we were adult enough to explore finer dining than the local burger drive-in offered, and do so without thoroughly embarrassing ourselves in the process.

So we met at The Red Door Inn, a restaurant about 30 miles away. It had subdued lighting, candles on the table and real cloth napkins. Our wallets were a bit light—part-time jobs for teenagers don’t pay that much—but we pretended we were adults out on the town. The highlight of the evening was watching small birthday cakes topped with a single sparkler being delivered to surprised diners, mercifully without having to suffer through a lame, off-key rendition of “Happy Birthday.”

Eventually we had our fill. We said our goodbyes in the parking lot and went our separate ways. A light snow started to fall as I pulled out of the parking lot.

This was a few decades before a new Interstate 39 would make the drive back to Route 18 a straight shot, cutting the time in half. For some inexplicable reason known only to God and my young self, I thought that taking the back roads along the hypotenuse of the triangle would get me home much faster. I’d done it on a bicycle with a couple of friends the summer before; how hard could it be in the middle of the winter in the dark? Pretty hard, actually.

The pavement ran out about ten minutes later. I was now on a rural dirt road in the family car, a big-ass Chrysler New Yorker with rear-wheel drive that was not known for stability on slick roads. The snowfall became a little thicker, muffling the sound of the gravel under my tires. The back end started to slide back and forth. I couldn’t see the shoulder anymore and worried about ending up in a ditch. If that happened a quick death would be preferable to the slow end that would inevitably reward my survival.

I slowed to a crawl and stopped sliding. I turned the radio on to WBBM for company. Franklin MacCormack introduced a tune my friends would have derided as more appropriate for an elevator full of old people, but it was preferable to the relative silence of my isolation. My grip on the steering wheel tightened. Will he live or will he die? Details at 10!

MacCormack’s soothing voice followed the song’s end, waxing poetic about nothing of substance. There was a brief moment of silence, then an ethereal sound drifted in, like a faint echo, rising and falling. The songs of humpbacked whales began to fill the darkness, not something one expected driving along barren cornfields in Illinois. One of the most beautiful voices God ever created started to sing:

Farewell to Tarwathie, Adieu Mormond Hill
And the dear land of Crimmond, I bid you farewell
I’m bound off for Greenland and ready to sail
In hopes to find riches, in hunting the whale

The snowfall seemed to soften as the voice swelled. The darkness outside became a comforting blanket, swaddling an infant in Mother’s arms. The gravel road turned to blacktop; the lights of home appeared in the distance. I don’t remember the rest, only that I knew I would be safe.

Fareweel Tae Tarwathie is an early 19th century Scottish whaling song. Farewell to Tarwathie,  is from Judy Collins’ 1970 album Whales and Nightingales.

Great Covers

It’s a new year and I’m not feeling particularly eloquent yet.

Some well-known songwriters penned hits for other singers or groups. Carole King wrote Little Eva’s hit, “The Locomotion;” Carole King, in turn, did Aretha Franklin’s “(You Make Me Feel Like) A Natural Woman.” Other classics have more obscure roots. Blues singer Memphis Minnie wrote “When the Levee Breaks” in 1929; Led Zeppelin reworked it in 1971. The 1990s heralded the rise of tribute bands and albums, often as good as, or even better, than the originals.

So here are some of the most famous, or infamous, covers of tracks we all know.

WoodstockCrosby, Stills, Nash and Young. We all grew up with this song, but Joni Mitchell wrote it after talking with her then-lover, Graham Nash, about those three days of sex, drugs and rock ‘n’ roll. Her version, on Ladies of the Canyon, is rather dreary; CSNY made it rock!

Singin’ the BluesBlack Oak Arkansas. Originally made famous by Marty Robbins and Guy Williams in 1956, this incongruous version is on BOA’s 1971 debut album, between Hot and Nasty and Lord Have Mercy on My Soul. “Jim Dandy” Mangrum’s distinctive voice would make Axl Rose sound like Pavarotti.

GloriaJimi Hendrix.  Written by Van Morrison and a hit for The Shadows of Knight, Gloria has been reworked by many groups, including Patti Sm
ith’s punk version that begins, “Jesus died for somebody’s sins but not mine.” I heard this extended version driving home at 3 a.m.after delivering a baby. The censors weren’t around then….”even though she didn’t like homemade sin, and her breath smelled like wut pussy.”

Are You Experienced?Belly. From Stone Free, the 1993 Hendrix Tribute CD, this version of the title track from Jimi Hendrix’s debut album gets an alternative rock makeover by Tanya Donally. Play this sucka’ LOUD!

With A Little Help From My FriendsJoe Cocker. Cocker took Ringo Starr’s tepid little tune from the (IMHO)  over-rated Sgt. Pepper’s album and injected it with soul. It didn’t hurt to have Jimmy Page on guitar. John Belushi did an epileptic but dead on tribute to Joe Cocker in this unforgettable version on Saturday Night Live

Twist and ShoutThe Beatles. Recorded by the Top Notes in 1961 and the Isley Brothers in 1962, John Lennon goes all-out on this one.


Shout
Otis Day and the Knights. Even though DeWayne Jessie lip-synced Lloyd Williams’ vocals for this Animal House classic, he really could sing. His older brother Obediah, a.k.a. “Young Jessie,” sang with The Coasters before moving to jazz. Jessie went on to an almost 40-year career as Otis.

MiserlouDick Dale and the Deltones. An
obscure tune from Egypt or Asia Minor got a surf-rock makeover in 1962 and cinematic notoriety in Quentin Tarantino’s Pulp Fiction. Dick Dale was born Richard Anthony Monsour and heard his uncle playing Miserlou on the oud. Who said nothing good ever came out of the Middle East?

Heat WaveLinda Ronstadt. Just the memory of her in that Cub Scout uniform still gives me goosebumps.

Country RoadsToots and the Maytals. Welcome to Jamaica, mon; have a nice day! All the women I knew in high school who were John Denver fans thought this was sacrilege. I thought it was perfect!

Who Do You Love? I’m torn between this one,
George Thoroughgood and the Destroyers’ Sam Adams Beer commercial version, and the six-part live performance by Quicksilver Messenger Service, from the Happy Trails album.

Crimson and CloverJoan Jett and the
Blackhearts
. Leather and heavy metal turned this adolescent Shondell’s classic into a heavy-metal lesbian love ballad.

SpoonfulCream.  Written by Willie Dixon and
recorded by Howlin’ Wolf
, Eric Clapton and Co. turned this into a seventeen-minute jam session on the epic Wheels of Fire album.

Viva Las VegasZZ Top. Substitute Texas blues-rock for Elvis Presley’s samba and you get this. Thank ya, thank ya verramuch.

I Got You, BabeBeavis and Butthead. Cher’s voice only got better during the intervening three decades since she and “some dork” sang it in 1965. Why Cher would associate with two animated imbeciles defies all logic but I, for one, am grateful and amused.

Tracks (C) original performers.
Image (c) Can Stock Photo