Category: Medical Life

In The Wild

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Part I

The speed with which medical conventions can domesticate the most outlandish requests, or re-frame even grotesquely violent behaviors, is an under-appreciated marvel of modern social life. In virtually every other setting—for instance, at your workplace—, it remains inappropriate for me to approach you, hand you a Dixie cup, and request that you fill it with your excrement. Work conventions rightly disallow this behavior, which would appear out of place, out of bounds, and downright weird.

However, if I approached you in my hospital office, handed you a paper cup with a wooden spatula, and there asked you to fill it with a stool sample, the request would be rendered perfectly normal because the conventions in that setting make it okay to require unacceptable things of you. In the right context, one of my colleagues might insert his finger into your anus, peer wisely into your vagina, thread a camera up into your colon to take pictures–or even cut you open from your collarbone to your pubic mound, slice out your heart, and put it in an ice chest. Only temporarily, mind you, because the promise is that someone will put it back when the time comes.

Although hospitals do their best to disguise the fact by building routinized, institutional facades (look at the architecture of the hospital pictured with this article), they are nonetheless the wildest places I can think of—far crazier than prisons, science laboratories, or military compounds, though they may share aspects of each of these establishments. Hospitals are the licensed institutions in which we hide the uncanny things of the world, chiefly by erecting conventions that suspend our incredulity. Hospitals assert the commonplace, affirm routines, profess the customary, declare humane incentives: just mundane practice going on in here, another ordinary day of saving lives, move along, nothing to look at. And in fact, you will not be allowed to look behind the closed doors.

But let me tell you, if at some point in your life, you discover that you need to be frightened–that you want to challenge your complacencies in ways you do not control beforehand–then hospitals are where you want to be. Nowhere else have I routinely touched people, circumstances, fates that otherwise I never would have imagined.

I never would have thought, for example, if left on my own—never thought to step behind the Senator showing me and my friends around the White House, and try to give him a bear hug. I am just too inhibited that way, and I don’t like Republicans. But Andrew, an adolescent high school student from one of the blue New England states, was comfortable with open displays of good feeling, and felt obliged to make a public declaration of his patriotism by embracing the natty senator addressing the New England Debate Club.

Naturally, Andrew called down upon himself the hordes of Secret Servicemen positioned throughout the building. The event I am writing about happened years ago at this point, well before 911, but even then the Secret Servicemen didn’t take chances–and given the initial urgency, it is to their credit that they pretty quickly recognized this was not a criminal assault, there were no bombs involved, and that everybody was safe, after a fashion. They had no idea what was really going on, but their expertise was with threats and violence, which they were trained to recognize when they saw them, and Andrew’s behaviors fit neither category.

For one thing, he was pretty disorganized in his attempt–not hesitant so much as uncoordinated in a weird way. He was also spouting a sort of ‘word salad’ that might have been mistaken at first for an unknown foreign language–except recognizable, though misused, words in English were mixed in. He wasn’t hard to deter from his intended purpose, the teacher-chaperones intervened with the government men, and eventually one of them took him back to his hotel room.

By report, he seemed to improve over the course of the afternoon, though his parents were called nonetheless, and arrangements were made to whisk him back home–in the course of which, however, he suffered another, more severe and persisting disturbance to his language production and his mental organization. He never made it home per se, but was taken directly to my Medical Center and admitted through the ER, where he was taken for a CAT scan. He had an aneurism in his left middle cerebral artery, which had begun to leak, causing disturbances in his language and motor control over parts of his right bodily extremities.

If he had been 75 years old, I think the symptoms would have been recognized more quickly than his were, because mid-adolescence is not typically an age at which to develop strokes. Though no one said anything, my sense at the time was that the adults around him all were assuming he had been taking some recreational drug, and his goofiness was the result. In truth, he would have been better off if he had simply been wasted on something fun, the effects of which were temporary. But instead of merely needing de-tox, he was awaiting brain surgery to clip the artery.

I was enlisted to evaluate him to establish a portrait of his current level of cognitive performance, which would provide a baseline for his post-surgical therapies. Accordingly, I visited over two afternoons as arrangements were made for his surgery. There were the formal portions of the evaluation, which mapped out memory, attention span, visual-spatial organization, executive planning, and of course his linguistic functioning, which looked pretty decent even with the aneurism. There were also the informal parts of our interaction that let him tell me, off and on, that he liked political science, that he was an only child, and that his favorite band was Tool or Nirvana, depending. I preferred Alice in Chains to either one of them–which no way could he believe, man, because Cobain was such a great guitarist, and the best writer. And besides, Courtney Love was hot.

This could be a fun job. For two days we definitely had the best music going on the floor.

Part II

Other days, on other units, were less musical. On Thursdays we had neuropathology rounds at 7 a.m. in a group of inter-connecting rooms in the basement sub-floor near the morgue. There the neurosurgeons, the radiologists and the neuropsychologists (i.e. me and two others) would assemble among the pathologists to engage in Brain Cuttings: an instructive event during which the brains of persons who had died would be sliced in coronal sections to allow the group of us to examine the gross pathologies, before the sections would be given to other pathologists in other rooms to stain and photograph. Often there would be two or sometimes three brains trussed up in a vat of formalin, where they had been immersed in order to solidify and preserve them for the cutting.

In themselves, brains are remarkably fragile–which is the reason they each float in the cerebrospinal fluid inside each of our respective skulls. Suspended in that salty fluid, they weigh about one fifty-sixth of what they would on land, so to speak. The brain’s own weight would be lethal otherwise; it would collapse fatally on itself simply by the pull of gravity, squashing the life out. So it is a delicate thing to remove the brain from the braincase, and slide it into the fixative that will solidify it enough to allow manipulation. It takes a sensitive and dexterous hand–governed by the attentive mind of a sociopath. Here we’d be standing by this large butcher’s block, on which the pathologist would set the brain he just fished out of the formalin tank, and in the adjoining room, separated by a kind of shower curtain, we could hear the whirr of the diamond saw as the other pathologist was cutting off the top of a recently-deceased-person’s head. It took some getting used to. Hannibal Lecter might have trained in a place like this.

There were two pathologists: a male and female team. The man–call him Dr. Taft–always chose to cut the brains; the woman–call her Dr. Adler–had the knack of extricating the slippery cerebral mass from its protective layers of skin, bone and meninges without brutalizing it, and getting it into the formalin with minimal damage. I don’t know if she ever knew whose forehead it was into which she pressed that whirling saw blade, but the rest of us had to know. Otherwise we could not relate whatever pathologies we saw in the fixed brains to the particular medical histories that proved so fatal to our patients. That meant that each brain, which was labeled by the kind of tag you might find dangling on an appliance in Sears, could be connected to a clinical history, which one of us would read to the group while Dr. Taft prepared to start cutting slices.

You cannot believe some of the stories. One brain I remember looked as if it had been shot with a spray of ice. This had been a young pregnant woman who, some time during her third trimester, had been engaged in love-making with her husband. Given the size of her huge gravid womb, the couple had chosen to have oral sex. Unbeknown to either of them, as the poor guy was going down on his wife, his excited heavy breathing was introducing air into her vagina, up the birth canal, through the dilating cervix, and into the placenta, where it was absorbed through the immense plexus of blood vessels there. Their sexual excitement, in other words, fed multiple air bubbles into her blood stream, which abruptly killed her when her pumping heart shot all those emboli into her brain. She never knew what hit her.

You can imagine what it must have been like. For one second or so he thought he had brought his wife to climax, only to realize that, no, something was stunningly wrong. By the time he had called 911, she was already dead, and by the time the EMT’s arrived, they had lost the baby too. The group of us stood there in numbed silence, not making eye contact, and waiting just to get the session over with.

I never went to neuropathology rounds without preparing for them. The fundamental premise was, of course, that someone had died–which, naturally enough, occurs with some frequency in hospitals. But it nonetheless required a sort of steeliness, a resolve to take it all on, to walk into that room and slice up someone’s brain. It wasn’t for everyone. We strolled down unadorned corridors toward restricted rooms where, like it or not, our Thursday exercises assumed religious proportions. After all, our rituals required human sacrifice. With the permission of the deceased, whose organs we were using, we called up the gods of science, and retrieved truths as we found them in the literal world of the dead. We had mortality itself on the cutting block, and took the opportunity to dissect the accidents of disease and infirmity, tease out vital membranes, and prepare as best we could against the onslaughts waiting for every last one of us.

These were perilous ceremonies, requiring perhaps a sort of ancient Mayan sensibility. Mercy wasn’t in it. Dr. Taft accidentally inflicted a vicious wound in his hand with the knife he was using to transect one of those brains, and though he survived the resulting systemic infection, it was a very near thing. He was ill for a prolonged time, and he wound up losing some of the function in that hand.

My own changes came some months before Taft’s injury, and had a different provenance all together. As we gathered around the ceremonial block that Thursday, and as Taft prepared to make his first cut at the frontal pole of a male brain, I heard someone–one of the interns, probably–begin reading the clinical history of the specimen we were about to study: The patient was a 17-year-old adolescent male named Andrew, the voice intoned,  a neurosurgery patient with an aneurism, who post-surgically bled out in the recovery room. Oh man. Oh man. I could see the extensive, black irregular pool of blood that had guttered into the left parietal lobe, the left anterior temporal lobe. I didn’t want to see the rest of the ugly stuff in the lateral ventricles, once Taft cut back to them.

I was looking instead for the place where Andrew kept Kurt Cobain’s music, the place where he knew the words to Lithium, Aneurysm, Heart-Shaped Box–the secret area where he stored his version of Nirvana. Everyone would have, if they had known him.

Handguns

Technology has evolved considerably since my first years in the Medical Center and, as we all know, the speed of that evolution is itself increasing. Today any reasonable 10-year-old can remember a time before the first iPhone. I can myself recall an even worse epoch when there were no cell phones at all, not even flip phones. In those days, I knew the location of every single telephone booth there was along the corridor between my house and the hospital—and along both sides of the road–because when my beeper went off, I had to find a pay phone in a big hurry to call in. This made for skittish driving when I was on call. And not just me: I know of accidents–one of them grimly fatal–that occurred when a colleague’s beeper went off on the drive home, or on the drive into work, and good road safety was challenged by the programmed, urgent need to find a telephone. Continue reading “Handguns”

I Remember It Well

Most of us in our post-industrial world spend a remarkable fraction of our mental powers just trying to stay organized. I wake up in the morning, and before I throw the covers off I’m already starting to reconstruct my schedule. Who am I supposed to see today? What am I doing for lunch? Where did I put my beeper? What are my afternoon meetings? Do I have time to get gas in the car? What is the name of the security guard who buzzes me onto the in-patient unit?  What is my password to the ATM? What was I supposed to tell the Volvo mechanic about that leak? What’s my password to my work computer? Wait, do I have change for the tolls? What’s my iTunes password? What’s my email password? None of this stuff is particularly fun to remember–just required learning that has to be exercised a hundred times a day to allow access to what we actually do for work.

That sort of instrumental retrieval is different than those unpredicted events of recall–like when the name abruptly pops into my mind of that song I woke up hearing in my head this morning: “A Good Woman’s Love.” I haven’t thought of that song in two decades until this morning, and who knows why I thought of it then. I can randomly pull other things out of my memory–for instance, where we buried our dog Amos in the back yard. I recall breakfast with my father, who always ate two runny poached eggs, with black pepper,  and two pieces of toast that my mother made for him. I can still smell that pepper. He would be wearing his khaki Marine uniform, and a brown tie with a Windsor knot. At the dinner table, once in a while, something would prompt him, and he would start reciting the first 100 lines or so from the Prologue to the Canterbury Tales–in Middle English–because that was the sort of thing he was asked in high school to learn. That was his memory task in his day, which–given who my father was–provided him with about as much intrinsic satisfaction as I am provided by recalling my computer passwords: just stuff he put into his head that stayed there.

My beautiful picture

I also remember how he enjoyed watching John Wayne westerns–‘Oat Operas’–, which later was another thing that popped into my head that morning as I strolled into a nursing home I consulted to. I was there to evaluate the mental status of an elderly man–let’s name him Paul– who had fallen down his basement stairs. His wife had found him unconscious at the bottom of the steps, called Emergency Services, and he was taken to the Medical Center to be evaluated for fractures and bleeds. Once he was cleared, and determined to be medically stable, he was then discharged to a sub-acute setting to provide some supervision and careful medical attention before he was sent home again.  I was part of that careful medical attention. We wanted to be sure that the confusion he displayed upon regaining consciousness did indeed resolve as anticipated before we let him go.

In real life Paul had been a high school teacher, and I was anticipating a relatively benign interview with an educated, articulate adult who had spent his professional life trying to instill in others a respect, if not a regard, for the intellectual qualities of mental life. My kind of guy. As I stepped into his room, where I expected to find him, several things happened at once. I was startled to see that he was in fact not laying in his bed at all, but was crouching down behind it, sandwiched between the bed and the wall. This was unique in my experience. I have had people try to elope from hospital rooms, and even a few who have fought with whoever tried to come in, but I had not ever–either then or later–walked in and found someone who was trying to hide. And then I heard him start hissing at me, “Get down! Get down!” 

Well, I’m no fool, there was space enough beside him behind the bed, so I bent down and scurried over to join him. He was still in his pajamas, and was sporting a huge bruise that engulfed his right eye and cheekbone, and extended to his forehead and toward his temple. I could see why he had been evaluated for a skull fracture: he had evidently hit his head really hard. When he saw me coming, he made room for me, so I squeezed down beside him, the two of us peering cautiously over the bedspread, and back out into the room. This could have been awfully silly, if anyone happened to see us. But he was so obviously terrified. You have to respect that sort of terror.

Or at least I do. I spent the next few heartbeats getting comfortable–I mean, I didn’t know how long we were going to be hiding behind the bed–, and also trying to get oriented to my new friend.  I had elected instinctively to join him in his universe: I did not take him to be assaultive, or in any way dangerous.  He was organized in his behavior,  and inhabiting a legible, consensual world–even if I could not yet identify it. After all, he invited me into his place, and fully expected me to grasp what was at stake. He was also openly concerned for my safety–which prompted all that frantic hissing when I entered the room. He wanted to convey a sense of urgency without giving his position away. But I still didn’t know what was going on his mind. Was he psychotic? I didn’t really think so, but I also didn’t know what could have instilled such fear in this peaceful nursing home, full of old people in wheel chairs.

The bed was meant to protect us from someone or something that was roaming just  outside our line of sight. So I quietly asked, “Where did they go?” Seemed like a logic thing to want to know.

He thought so too. “Indians,” he told me as he scanned the horizon with his one good eye. They woke him up, he told me, and had been shooting at him. 

I have to admit that I was surprised by his answer–non-plussed, in fact, and almost speechless. I think partly because I’d joined him in his place of terror, I was just naturally expecting something closer to the sources of my own nightmares than Indians–like some creature out of Predator or Alien, some hideous being that would tear my arms off at the shoulder, and then start eating them in front of me. But I mean, Indians are just people, like all the rest of us. I can deal with people.

But his answer also meant that I had a glimmer of where he was, not only what planet he was hiding on, but which landscape on that planet. I was settling in.

“Where are the arrows?” I asked, pretending to look around us. My aim was to see if Paul could be redirected to his literal surroundings, enticed by the observable things around him into a physical environment other than, and in competition with, the mental place he was hiding in. As he glanced around to find them, his expression changed from fear to a puzzled, suspended look as he noticed the dresser, the tray table with the pills and magazines on it, and so on. As he saw these things, he also recognized that they were incongruous with the landscape he thought he was inhabiting.  It began to feel like that scene in The Matrix, when Neo is given the red pill, and is then sucked out of the world he truly thought was real, into a world he definitely did not expect to exist. I was sitting right beside this guy, watching as he was swept from a Southwestern desert landscape in the 19th Century, and into a 21st Century New England nursing home.

As he sat there, holding his breath and trying to figure out what was going on, a nurse walked down the hallway outside the room, clearly visible from where we were behind the bed.

Should we warn the nurses? I asked–but by that time I was aware he had come with me all the way back into the material world of the nursing home, and that he, too, was aware of the remarkable discrepancy between what had been so persuasively real–all those arrows whistling by his head, the  burning Conestoga wagons, the horses and the sounds of war–and the here-and-now noises of the nursing home with the chair alarms going off as an ancient person tried to stand up, who wasn’t supposed to because of the risk of falling.

My task at that point was, first, to cushion his panic, because he wasn’t all that sure he belonged in a nursing home any more than he belonged in a wagon train somewhere.  And then, as he assimilated his surroundings with what he was beginning to remember about his accident and his several days in the hospital, his fear changed into a grave anxiety regarding what was happening to him. It was no longer a matter of one outer world morphing into a different one, but rather a question of his own interior sanity. Because he was aware that his mind was playing tricks on him.

The nature of those tricks was precisely what I was there to determine, in which he was as invested as I was. He began telling me how he came to hit his head: he had been going into the basement to start the laundry, and slipped on his wife’s bra, which had been tossed down the stairs to be washed, but had landed on one of the steps. He hadn’t seen it, and his feet went out from under him. He recalled some of his time in the hospital, though many of the details remained discontinuous. He couldn’t account for all the days intervening between when he fell, and when he started to clear in his mind. He remembered the trip in the ambulance from the hospital to the nursing home, which was embarrassing, because he had been so self-conscious as the attendants strapped him onto the wheeled gurney, maneuvered him through the public hallways of the hospital, out of the double doors of the Emergency Room with everyone watching, and into the waiting ambulance–and then performed a similar task in reverse to get him into his present room. Everybody remembers that trip, if they have ever had to take it.

What he could not figure out, however, was why he thought he had been participating in the Indian Wars in the American Southwest. And he was terribly afraid he would have further instances of these intrusive experiences. So was I, for that matter, because I could not determine from the way the evaluation was proceeding why he should have had that experience. His intellect was sound: cogent and reasonable. He was fluent in his verbal production, and he readily devised strategies to organize novel information, both verbal and visual. His attention span was variable, but that was to be expected given the head injury

And then we tested his memory, which was remarkable in its presentation. The volume itself of what he could recall was a little bit low for his age, but still within normative limits. However, he was experiencing a startling number of intrusions. He could not tell the difference between what he was formally asked to learn, and these extraneous details that would insert themselves in his memory, so that he thought he was recalling information that in fact he was making up without knowing it.

Here’s the way it works. Read a list of words to a person: sixteen words selected from four categories, four words to each category. There are fruits, items of clothing, vehicles and tools. But you do not mention to the person that there are any categories–just read the words in a random order. During the third of five trials, Paul recognized that the words could be grouped into categories; he perceived conceptual relationships, in other words, that would allow him to group similar words, and exclude those that were dissimilar. He was appropriately using his intellect.

However, after a delay, I read him a recognition list of words–about 50 of them. All of the words on the original list were included, but so were other unrelated words (birds, household appliances), as well as words that could be in one of those four original categories, but in fact were not on that list. There simply were other fruits and tools—none of which could he have learned since they in fact were never presented to him. His task now was to say whether any given word on this second list was also one of the words he had learned on that first list of 16 words. If it wasn’t on that first list, he was to say so.

The trouble was that Paul ‘remembered’ everything. Anytime he encountered a word that was within a category on that first list, he believed that he remembered it being present. That is, even though I never mentioned the word ‘apple’, he thought he remembered me saying that word simply because I did say ‘watermelon.’ Both are fruits. This is a major problem. He wasn’t mixing up categories, but he could not keep straight the different sources of the information that he was newly learning: when I happened to say one thing, and when I said something different. This meant that any given detail of information in his mind could be combined with any other bit of mental information to make a new experience–entirely new, a completely made-up story of events that he had no idea he was fabricating, but which he absolutely believed to be accurate.  He was jumbling together information that he knew, regardless of the source from which he learned about it.

Just think about the implications here. If I cannot identify the source of my memory of velociraptors, then I’m going to be terrified to venture outside my house, because I do not want to be seen by roaming dinosaurs that will treat me as a slow-moving prey animal. I will know that I am in my own house, but also remember those velociraptors sprinting around outside, and so will keep indoors, and play it safe. In this way I change my behavior according to information that I have cobbled together from different sources of knowledge: my lived experience in my house, and my memories of dinosaurs that I have extracted from their fictional source (Jurassic Park), and inserted into a category of experiential information to which they do not belong.

In Paul’s case, just before he went to bed he had been shown a 1950’s movie about the Wild West, and when he woke the next morning, the events of the movie were mixed in among the compendium of his mental details, all assimilated into the particulars of his experience at large. He had vivid memories of the battle, the excited noises, people shooting and being shot, some of whom he now thought he knew. He remembered everything he saw–except the part about the source of what he was seeing: it was a movie, and not his lived experience.

The formal term for this sort of memory impairment is ‘confabulation,’ which at times can be very difficult to distinguish from psychosis. The most common problem with it, however, is to distinguish it at all. The person who is struggling with a confabulated memory does not know that he has a problem: he ‘feels’ his recall is clear and reliable, he relates his experience with notable confidence–indeed, with exactly the same confidence that your or I might tell about our time at work today, or who we met over lunch, and what we said. There is no intrinsic difference in the details of the memory; the difference lies in the various sources from which those details were extracted.

Paul recognized that he had a problem because the memories he had upon waking were so out of keeping with his room in the nursing home. And in this instance was he lucky. If he had been shown a different movie–say, a spy movie to keep him entertained that night–, then the presence of his fabrications would have been far less obvious, and perhaps impossible to trace. Who would ever know whether he had in fact worked under cover during World War II to aid escaping Jews? How would you test that out? You probably would want to interview family members, but that is not necessarily a reliable source. I know, for instance, that my own father was an officer in the European theater during WWII, but I don’t know much about what his actual duties were, or whether he also had unwritten orders he carried out under cover. He never told me his military secrets, and so I would be of no help to an inquisitive doctor asking me about the truth value of my father’s memories, if my father ever wound up in a nursing home with a head injury, which he never did.

In Paul’s instance, however, his memory complaints were evident, and so were the improvements he demonstrated over time, although truth requires me to admit he remained vulnerable to confusing combinations of memories for as long as I knew him. And indeed there were times when he again lapsed into his life in the great southwest, and regaled his grandchildren with tales of adventure. They spiced everyone’s life up, which isn’t always, you know, a bad thing.

My Life With Skunks

A friend of mine–Bruce–had a pet skunk that he kept in his apartment, where it was about as house-trained as a cat. It had its own kitty litter thing in the bathroom, and we would feed it raw hamburger and eggs, and it was relatively affectionate like cats sometimes are. Occasionally at night, though, it would get territorial with Bruce’s new friends coming over to visit, and at such times it would stamp its little feet in a cute way, then spray you in the face with this incredibly foul, noxious fluid that would burn your eyeballs out. Then we would all live on the beach for a couple of weeks until the apartment aired out. That’s how we rolled in Southern California in those days. We were pretty laid back.

I mention this as prologue to the afternoon years later, when my beeper went off, and I was paged to the ER to evaluate an adult who had just been brought in by ambulance. My office was in another part of the hospital, and while I was walking through the corridors I was reminded of my sunny adolescence as I met the unmistakable essence of skunk rolling like an awful fog up the hallway. Once I arrived in the ER, I didn’t need anyone to point out who I was supposed to be evaluating–which was a good thing, really, since the place was pretty much empty: patients, doctors, family members, nurses, social workers, orderlies, receptionists–everybody had cleared out.

Except two unhappy EMT’s from the ambulance, and this emaciated guy wearing a sort of breech clout and vest that he obviously made himself out of maybe a dozen skunk skins. He hadn’t tanned them, so of course they were rotting (this was September, the end of summer), which only added to the flavor of the encounter. It was memorable. The first thing I did was order the three of them outside into the courtyard, and tried to get up wind of him. I wasn’t worried that he would try to escape: there was no place on earth he could hide, and besides, you could see he was starving. It’s true he was also floridly psychotic and paranoid, but he was tamed by the lethargy induced from his long want of food. He was actually in a bad way.

He had spent months out in the woods, and the woody terrain bordering the farmland of a nearby town. It turned out that everybody knew he was out there: farmers spend a lot of time outside in the summer looking at their crops, the weeds, the weather, rain clouds and so on, and folks noticed this young man in various stages of nakedness roaming around in the miles and miles of forested countryside. He wasn’t harming anyone, and so in the egalitarian way of stoic New Englanders ever since Robert Frost, they let him do his thing. Also, they were really busy this time of year.

Whatever crazy, fearful thinking first led him out into the woods, after he was there a while the most important thing on his mind became food. It is hard for a person in a disorganized, disheveled mental state to find and capture enough edible materials–whether animal or vegetable–to keep his body sound for months on end. The only things that he could find to eat, and that would not try to run from him, were the skunks. They don’t run: they stand their ground and warn everything else to get away, fast. So he could kill and eat skunks–and then after his fashion, he made clothing from their hides once he lost whatever he was wearing when he first left his civilized mind in whatever place he once called home.

I suppose it’s true everywhere, when you think about it, but in the part of New England I’m talking about, skunks are in finite supply. There’s just not that many of them,
not enough to support a large and clumsy predator forever. So after he had killed and eaten all the skunks he could find, the only other thing that wouldn’t run away were the cows out in the pastures. It must have taken a while for him to figure out how to attack a cow, or to get hungry enough to try, but he eventually shot one with a bow and arrow he got somewhere, and that was too much for the area dairymen, who had a tough enough time trying to make a living without having people shoot their best milkers with toy arrows. One of them called the police, and that in the due course of events led to my chance to meet him. It was as natural as breathing: find someone in skins shooting arrows at cows, and bring him to the Emergency Room to see me. I’ll sort things out.

This time, however, I wasn’t given a chance. No community can afford to have its ER shut down, so while I was outside with him, a team of people with a large van came to collect him and bring him to New Haven, where there were facilities that could handle the particular challenges my guy presented. They bundled him up in some sort of cloaking fabrics, and off they went. I never saw him again.
POSTSCRIPT

Over dinner one night I mentioned the encounter to a friend of mine, Gary Young, who was as moved as I have been by the passions stirring my scared hunter. So Gary wrote a poem, which is published on page 225 of his book, Even So: New and Selected Poems. You can also read it here (It is a prose poem):

In Western Massachusetts, a man wandered into the woods to live alone. He tried hunting, but the only animals that stood their ground, the only animals he could catch were skunks. The man was sprayed, of course, but he caught them, ate them, and dressed in a cloak of rancid pelts. When he was found, the scent was on his breath, his skin, and when I heard his story, I thought, comrade.

Medical Life

The book that I am about to introduce arose out of one of those innocuous moments during a nondescript social gathering I was attending–an opening at an art gallery, actually–, when I offered an innocent observation that unexpectedly elicited a disproportionate, clamorous response. I probably should have known better, since this sort of thing used to catch me unawares when I was a graduate student in a neuroscience laboratory. The group of us in the lab were studying the role of a particular neuropeptide in different animal behaviors. We’d be sitting at lunch in the Blue Wall Cafe discussing the penis-licking response of male rats prior to intercourse, or the lordosis position of the females and how hard it was to identify the moment of penetration, and we’d abruptly realize that the room had gone quiet, and that the wait staff were treating us like scum.

Same thing in principle at that art gallery. I had meant to be supportive of a friend who was going through a divorce, when I happened to mention a detail or two about a man who had carnal relations with one of his farm animals. I didn’t mean anything by it, really, but for some time afterward I was asked by colleagues, with friendly but obvious disbelief, whether I have actually, really known a farmer who had sex with his cows. One person went so far as to question how the act could be done at all.

To address the last issue first, it was done–while the poor creature was secured by its head in its milking stanchion–by standing behind it on a milking stool. I have further, procedural details, too, like what to do about securing its tail, but under the heading “Way Too Much Information” I will keep such instruction to myself for now. You can ask about it later, if you want to.

To address the first question–whether I have ever known such a gentleman as I am describing–will necessarily introduce descriptions about what a neuropsychologist does all day. Or at least, what this neuropsychologist did while practicing at a large tertiary care Medical Center in New England: he, which is to say I saw a notable range of people–children, adults and elders–with neurological insult of one sort or another. This particular farmer was one of my patients, and had a frontal dementia that was wildly disregulating his behaviors. It was a fatal, degenerative disease–and from just about any position of empathy you can think of, his end couldn’t come soon enough.

As you might imagine, I also saw a large number of absolutely horrified family members, relations who were beside themselves with terror, anxiety and shame. And grief. Because this was not the man they had always known–not the father, not the husband, not the friend. And there was no telling what he might do next.

So I have many stories, and buried among them are probably the elements of why I couldn’t keep doing this anymore. Pretty much every day was a revelation, nothing I ever did was boring.

Let me tell you about my day.

 

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