The World of Dentistry

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The Bartlett pear (called Williams pear in England) is one of the tastiest and juiciest fruit in North American supermarkets. It’s hard to believe that by chewing on this soft delicacy, much to my dismay, I managed to break the filling on one of my lower molars.

Dental problems started to appear about 10,000 years ago, when humans stopped roaming the land to settle in villages and towns. At that time, mankind’s eating habits changed as our ancestors began eating more sugar, a leading cause for cavities.

Could it be that toothaches are God’s curse on the children of Cain for adopting their father’s sedentary living?

Cain was a farmer and his brother Abel was a nomad. Abel sacrificed the firstborns of his cattle to God who seemed to enjoy it. However, the zucchini, carrots and celery Cain offered up weren’t to the Almighty’s taste, maybe because Cain neglected to serve them with ranch dressing.

It took a long time for people to understand tooth decay. In olden times, cavities were thought to be caused by worms. In ancient Egypt, dental malformation in children was treated by feeding skinned and cooked mice to toddlers. In China, cavities were filled with bat dung. In Spain, frequent mouthwash with urine was key to good oral hygiene.

In the Middle Ages, tooth pullers began exercising their trade in public squares, promising their clients painless relief. Of course they were lying through their teeth but it provided great entertainment for crowds who had neither TV nor Internet to kill time. Tooth pullers also removed calluses.

In those days, dentistry and pedicure drank at the same well.

When Renaissance arrived, hairdressers joined the dental trade bandwagon. Noble ladies of Florence could thus have tartar removed from their teeth while getting a perm or having their hair styled.

In the 18th century, Pierre Fauchard, the “father of modern dentistry,” published The Surgeon Dentist in which he recommended the use of heavy metals for tooth fillings. He also endorsed regular mouthwash with urine.

A man collected his own urine in a bottle to use as mouthwash. Beware of unproven personal hygiene advice: it might just be a fad... especially if it’s gross.

Progress cannot be stopped but it sometimes takes a while to occur.

You can understand why I have always had mixed impressions about dental medicine. Should it be considered a science? An art? A technical trade?

With this in mind I began looking for a dentist. I chose a new dental office that had just opened in a strip mall close to where I lived, tucked between a video rental store, a pizza parlor and a realtor’s office.

Doctor Nguyen’s office was new, tidy, tastefully decorated and equipped with the latest technology. The good doctor was a pretty 30 year-old woman who had recently graduated from a Las Vegas dental school, a city that does not readily come to mind when you seek higher education.

I was told however that its dental schools have an excellent reputation.

After her examination, Doctor Nguyen told me that my decayed molar needed a crown but first I had to see a dental surgeon who would lower my gum, raise my jaw and perform root canal surgery. She would make the necessary arrangements for me.

Root canal surgery is a procedure in which the pulp of a damaged tooth is removed with files, reamers, drills and other precision instruments. Although this treatment sounds painful, the Polish surgeon I went to see possessed undeniable skills.

He first gave me a solid local anesthetic and then put on a blaring Johnny Cash CD to distract me from the abominations he was performing in my mouth using sharp objects.

I did not feel a thing.

When I saw Doctor Nguyen again, she worked for several minutes on my molar before saying: “This won’t do.”

She led me to her office. My mouth was numb from the anesthetic and I was still wearing the necessary bib that dentists tie around the neck of their patients while they intervene.

Doctor Nguyen turned on a giant screen on which I could see the digitized x-ray image of my mouth.

“You see, I can’t install a crown because your teeth are out of alignment, specifically here, here and here as well as on all this side of your mouth,” she said pointing at teeth with her laser pen.

“This is what I suggest: I will make a set of braces to adjust your teeth. You will wear it in your mouth for six to twelve months, long enough for your teeth to be redressed. This treatment will cost about $1,800. Your parents would have done well to take you to a dentist when you were a child.”

I refrained from telling her about my grandfather who lived the last 30 years of his life with only three teeth in his mouth and who saw a blacksmith when he had a toothache.

“Then I will install crowns on the teeth of your lower jaw which will no longer be aligned with those of the upper jaw. It’s about twelve crowns and it will cost $15,000 to $18,000. We can start the treatment next week.”

I asked Doctor Nguyen for a few days to think about it.

“You know, many people would not hesitate one moment to mortgage their house to receive such a treatment,” she said.

“Oh! I believe you!” I replied. “However, just to satisfy my curiosity, how much would it cost to have all my teeth pulled out to replace them with dentures?”

“About $10,000 but I wouldn’t recommend it,” she answered.

I thanked her, paid for the treatment I already had received and left her office, dizzy from novocaine and the astronomical amounts that she had quoted me for fixing my teeth.

A friend suggested I seek a second opinion and recommended a Swedish dentist for whom her sister worked as a dental assistant.

So I went to see Doctor Svensson, a middle-aged lady who looked in my mouth mumbling “I see, I see...”

Then she asked me:

“Is your dentist young? Her office and equipment, are they all computerized?”

“Yes! How did you know?”

“Dear sir, I think I can fit you with a crown. Would you prefer gold or porcelain? I believe a gold crown would look good on you. A gold crown costs $900, a porcelain crown, $1,200.”

“Gold would be nice,” I replied sheepishly promising myself to light a candle to Saint John Maynard Keynes who suggested the gold standard be replaced with the porcelain standard at the Bretton-Woods Conference in 1944.

John Maynard Keynes was a British economist who played a key role in the signing of the Bretton Woods Agreement in New Hampshire. As a result of this agreement, the gold standard was dropped. The porcelain standard is my invention. If you exchange your money for porcelain, you will be disappointed.

Two weeks later I was proudly wearing my new gold crown. It felt good and I was relieved that I did not have to rinse my mouth with urine.

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The Biggest Swimming Pool in the World

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Superlatives are words used to qualify the absolute top or bottom in quality or quantity. How we enjoy talking about the wealthiest man in the world, the thinnest tablet or the most crooked political leader!

I guess these words were invented to make us forget how common our ordinary lives can be.

As I was discussing superlatives with colleagues, it made me think of something that happened while I was still married.

My wife was born to drive a car. She just loved to take to the road. She used any excuse to jump into the car and travel aimlessly looking for something new to see.

On a nice sunny Sunday afternoon my wife and I decided to take a ride in the countryside.

My wife was at the wheel. Fields, groves and cattle were going by the left and right of the car. I was daydreaming, thinking how great life was and how wonderful it was to be alive.

We came to a village famous for its cheese curds factory and decided to stop and sample the local delicacy.

Cheese curds were invented in Canada in the early 1960s by dairy farmers trying to bypass quota regulations. Easy to make, this fat, salty, slightly processed cheddar cheese quickly became popular and gave birth to the infamous “poutine,” a meal made of cheese and french fries topped with hot gravy.

We bought our cheese and as my wife was admiring the quaint shop, I read a story in the local newspaper about one of the area attractions, “the biggest natural swimming pool in the world.”

As soon as I mentioned it to my wife, she wanted to see it since it was only a few miles away.

We found the “swimming pool” at the end of an unnamed dirt road. The pool was made of three communicating stone basins at the foot of a large rock where a trickle of cold water was flowing from a spring. The bottom of each basin had been painted aquamarine to give the impression of an artificial swimming pool. All in all, the lagoon was much smaller in size than an olympic swimming pool.

It had been a hot summer with less than average rainfall. The stream was not a bubbly jet of water, just a slow dribble. The smallest basin was empty and the deepest contained nothing more than three feet of sticky water, green with algae proliferating under the warm sun.

This did not seem to bother the numerous children who were noisily splashing about in the water while their parents, slumped into lounging chairs around the pool, distractedly kept an eye on their progeny.

I told my wife this seemed to be the perfect place to catch a dermatosis that would make these poor kids’ skin tougher than the hide of Big Joe, the largest alligator of Florida that we had seen near Fort Myers.

With more than one million American Alligators (Alligator mississippiensis) in the world this species is far from being endangered as it haunts the southeastern United States. The word “alligator” is derived from el lagarto (the lizard), the name given to the reptile by the first Spanish explorers.

“You always see the bad side of things! Look at how much fun they’re having!” she said smiling and waving at the children.

At that moment, a man with a worn-out Elvis Presley T-shirt and sporting a dirty pair of khaki shorts with a dangerously open fly came to meet us.

— Welcome to our little paradise on Earth! Are you looking for a place to park your camping trailer?

— Erm... No, we just came to see the biggest swimming pool in the world, I said before being interrupted by my wife.

— Oh! There’s a campground? Can we see it?

— Yes, behind those trees, answered the man pointing towards a thinly-wooded area. I can give you a tour if you want.

— Oh! That would be delightful! Shall we go my darling? said my wife to me as she took the arm of our improvised guide.

Against my will I followed them through an underbrush planted with birch and aspen trees.

A lacing road was forming a loop of the campground. Trailers were parked along the road close to each other, most of them permanently. Some seemed to have been there for decades.

At the centre of the loop, a large porcelain urinal decorated with lights and plastic flowers was acting as a grotto for a statue of the Virgin Mary. The saint was standing in this makeshift shrine with her open arms, looking discouraged as if she declined any responsibility for the compound she found herself in.

Our guide was explaining the intricacies of camping to my wife as she obediently listened and asked questions from time to time. The man was so happy to have found an audience that he was rocking on his heels, a nervous tick that, to my dismay, was causing the broken fly of his shorts to open even more.

He then invited us for coffee in his trailer. My wife accepted although I was not keen on the invitation and we walked towards the fellow’s mobile home.

The trailer looked like our guide: common and unkempt. As the guy started to fight to open the jammed door, the broken fly zipper of his shorts gaped even more and, to my disgust, I saw “Elvis” leaving the building.

I had had enough. I took my wife by the arm, thanked our host and, pretending we had a long ride home we left this place where I had seen everything I wished I had never seen.

Swimming pools have been popular since antiquity, the oldest one was found in Sindh, Pakistan. In England, public swimming pools appeared in the mid-19th century. However, nobody has ever boasted of having the emptiest swimming pool in the world.

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Hospital Diaries VII: The Sweet-Smelling Ward

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This is part of a series. You can begin at Part I and follow the link at the end of each installment to read the next. 

Paralysis is a terrible impediment to autonomy. Not only are you not able to move but also you cannot get dressed, wash or go to the bathroom by yourself.

In the Gurney Hall I had to let go of my shirt and pants and I felt humiliated wearing nothing but briefs under the ridiculous patient smock with the wide opening in the back.

You see, clothes not only serve to keep you warm and decent, they also symbolize your social status. In a hospital this hierarchy is quite obvious: doctors wear white smocks and a tie, nurses and orderlies wear pastel-coloured scrubs, and patients lie half-naked at the bottom of the social ladder.

The social ladder is nowhere ever more present than in a fire brigade. Here a firefighter is climbing the social ladder in an attempt to become lead firefighter, a dangerous position with more responsibilities. Exactly why is a mystery to me.

I was sharing my embarrassment with my friend Lucide as she was pushing me in my wheelchair back to my room at the Emergency Overflow.

“You know, when you’re in a hospital, you have to give up your pride,” she said.

Unfortunately, my vanity prevented me from appreciating her wisdom.

The next day, I squirmed for an hour in my stretcher, finally managing to put on a pair of jeans. I could not button them because of my swollen and numb hands but I did zip them up.

As I was basking in this accomplishment, I looked up and saw a tall blonde woman who had been observing me for awhile, standing at the foot of my gurney.

Although she was smartly dressed and not wearing a white smock, I knew she was a doctor simply because she appeared out of nowhere like all the other doctors who came to see me in the hospital.

“Good morning sir. I am Doctor Sveta Tiplova,” she said with a strong Russian accent. “How are you feeling today?”

“Quite well thank you. Are you a neurologist?”

“No, I’m a physiatrist and I’m here to assess your condition.”

I thought I heard “psychiatrist” and for a moment I had a vision of the Soviet Gulag and the snowy Siberian steppes. I feared this new doctor was sent by the “Seagull,” the doctor who thought I was faking my illness, as a first step to having me committed.

Seeing my distress, Doctor Tiplova explained that she was a specialist of the musculoskeletal system. She then proceeded to thoroughly examine my hands, my arms, my shoulders, my neck and my knees.

Physiatry, a medical discipline that became popular during WWII, is about restoring the bones and muscles connexion after an injury otherwise than through a silly Bible camp song.

She seemed puzzled but I could see that she was carefully considering my ailment. She finally said:

“Listen, for what it’s worth I am going to submit your case to the Internal Medicine Department. They might be able to recommend some tests to establish a proper diagnosis.”

After she left I realized that medical science was as much in the dark about the nature of my illness as I was, although it did not have to cope with the pain and paralysis.

For the time being however, Doctor Tiplova’s visit had an instant benefit for me. For her examination, an orderly had moved me to my wheelchair and I was no longer lying down on my stretcher.

I had not been to the bathroom since I arrived at the hospital several days before. My friend Lucide had brought me prunes when she came to visit and I was beginning to feel their effect on my bowels.

Plums (prunus domestica) were introduced to the western world during the Crusades and offered as a perk to crusaders (whence the expression “plum reward”) who left their family and possessions behind to massacre Moors in the Holy Land. Once dried, they are called prunes and can be preserved for a long time. Their laxative properties are legend.

I rolled my wheelchair to the toilet, put the brakes on and painstakingly lifted myself up by leaning on the chair’s armrests. With great effort I advanced the three steps to the bowl and collapsed on its seat.

At once my intestines began to void. Oh! The joy I felt when I realized that at least this part of my body was fully functional! My hands, my arms, my legs and my neck may have given up on me but at this time I swear I was in Paradise!

However, after I was done and had wiped away the traces of my deed I was faced with another challenge. How was I to get up from the toilet? There were holding bars on the wall but my arms did not have the strength to lift me up.

I realized I would have to ask an orderly to help me get up from this awkward position.

There was a chain on the wall with a sign that said “EMERGENCY” in red letters. Humbly I pulled on it and after ten minutes an orderly showed up.

“Oh! Poor sir! You shouldn’t have tried to go to the bathroom by yourself! We could have brought you a commode chair!”

Commode chairs, such as this padded specimen, were popular in the 18 and 19 centuries before the advent of sewers. To each his own, using a commode chair is not a pleasant experience yet it is better than relieving yourself in a diaper.

He tried to pull me up but the bathroom was too narrow. He left to get another orderly and together they managed to make me stand up. The second orderly pulled up my trousers, buttoned them and zipped them up.

Nothing can wound your pride as much as having several people witnessing the embarrassing situation you are in.

As a consolation, I thought of Dante’s Divine Comedy where the author, while travelling through Hell, met an acquaintance who had been condemned to swim for eternity in a sea of excrements because of his pride.

Dante Alighieri is the Italian poet who established the Tuscan dialect as the standard Italian language. The Divine Comedy recalls his climbing the social ladder through the nine circles of Hell, the nine rings of Purgatory and the nine celestial bodies of Paradise. The journey is the reward indeed. Illustration by Gustave Doré, Public Domain

Once I was sitting in my wheelchair, I asked if I could go outside to have a smoke.

“That will not be possible sir,” said the orderly. “We have to put you back on your gurney. We found a permanent room for you in another ward and somebody will take you there shortly.”

As the gurney attendant was rolling my stretcher towards the elevator I was rejoicing because I believed that being transferred to a permanent room meant I was now a legitimate patient. Doctors would soon find the nature of my ailment, prescribe the appropriate treatment and I could go back home.

Alas! When the attendant pushed open the doors of the general medicine ward where I was to stay for the next several weeks a poignant stench of excrements assailed my nostrils.

I thought I was being taken to Dante’s first circle of Hell to be punished for my pride.

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To be continued in Hospital Diaries VIII: Lying in the bed I made

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Hospital Diaries VI: The Overflow

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This is part of a series. You can begin at Part I and follow the link at the end of each installment to read the next. 

I had been in the gurney hall for two days. Every move I made was painful and I still did not know what I was suffering from. It had all started with a gout attack but then I was told I had twisted my knee and had torn some ligaments. After being admitted to the hospital, doctors talked about arthrosis, spinal stenosis and a neurologist I nicknamed “the Seagull” insisted I needed back surgery.

Lying on my gurney I was pondering about how difficult it is to establish an accurate diagnosis. In all fairness I could not blame doctors for failing so far to identify the cause of my handicap. In a way, I felt it was like an evil genius, some kind of Keyzer Söze from the movie The Usual Suspects, was living inside my body, wreaking havoc at the expense of doctors/detectives who were completely baffled.

Only in literature and movies the issue is finding the “true” culprits. In real life, detectives and doctors are content to find a convenient suspect – all the best if it’s the real guilty party – to lay charges on, close the case and move on.

Those were my thoughts as I watched the hospital chaplain offer his sympathies to the family of a dying patient to whom he had just administered the last rites in one of the private rooms of the gurney hall.

At that moment an attendant showed up and began to place my personal belongings under my gurney. I was terrified she was going to take me against my will to the operating room for spinal surgery. I nervously asked her where we were going.

“I am taking you to your room sir.”

I could not believe my ears! Finally I was leaving the noisy gurney hall with its blaring bells and alarms! As I was profusely babbling my thanks to the attendant, she curtly said:

“I’m just doing my job sir.”

After I was wheeled into my new room, an orderly slid my body to a wider gurney with a thicker mattress. From the conversation the orderly and the gurney attendant were having, I understood that I was now in a place called the Emergency Overflow, a somewhat “underground” department set up for patients who had been residing in the emergency ward for at least 48 hours. This was the way the hospital had found to avoid the heavy fines that were imposed if the ministry of health’s performance goals were not met.

Mankind is obsessed with order, yet lusts for chaos. Maybe that’s why bureaucracy was invented. Bureaucracy is a form of labour organization purposedly designed to effectively achieve a cost-efficient use of resources in a rational way. However tremendous effort and considerable ingenuity are needed to get around bureaucracy’s cumbersome rules.

I owed my escape from the gurney hall to this paradox.

I was now in a no man’s land of a sort, some temporary quarters run by a minimal staff. From time to time a nurse would come by to take my vital signs and ask me to rate my pain on a scale from zero to ten and an orderly brought me my meals.

In Canada, hospital menus are designed by dieticians. Low-salt, low-fat and low-sugar meals usually taste like cardboard. If the food is not particularly tasty, it is however very healthy.

Everyday I had a visit from “the seagull,” the neurologist who was convinced I was faking my illness since I would not agree to have back surgery.

“Come on! Show me what you can do! Get up on your feet and walk!” the seagull would mock me.

I was nearing rock bottom. Having been confined to a stretcher for almost a week, I still did not know what I was sick from, my doctor was treating me as if I was imagining my ailment and I was taking painkillers that had no effect on my pain.

When my friend Lucide came to see me, she brought a bottle of Ibuprofen. I quickly took two tablets and hid the bottle in my bedside table hoping no overly conscious nurse would steal it away from me again.

While I was waiting for the medication to take effect, I told Lucide about my frustration and despair.

“Hmm… I saw three empty wheelchairs in the hall as I was coming to your room” said Lucide. “Maybe if we could borrow one and go to the cafeteria it would lift your spirits a bit.”

US president Franklin Delano Roosevelt (1882-1945) was confined to a wheelchair for the rest of his life after being struck with paralysis during a vacation at Campobello Island in New Brunswick. Still today doctors disagree about whether FDR suffered from poliomyelitis or Guillain–Barré syndrome.

My friend is a genius. I rang the nurse right away. After about 15 minutes of waiting, an orderly arrived and I asked her if I could have a wheelchair to go for a stroll with my friend.

“I’ll ask your nurse,” she replied.

Lucide and I continued our conversation for about 20 minutes and having no news from my nurse, I rang again. When the orderly returned, I asked her if the wheelchair I requested was coming.

“I’m sorry sir, your nurse is taking a break and I haven’t been authorized to give you a wheelchair yet.”

That was too much. The frustration that had been building up in me for the last week overflowed.

“Listen miss: are you telling me there is only one person in this ward who can allow me to go down to the cafeteria in a wheelchair to have coffee with my friend? This is a simple request! I’m not asking for a liver transplant! All I want is a wheelchair! This is not the third world, is it?”

My outburst took the orderly by surprise. She began to cry. Her sobs alerted her supervisor who rushed into my room.

“What have you done to my employee?” he enquired uneasily.

Ashamed, I told him what happened while a nurse was taking the orderly to the hallway to comfort her. Five minutes later, the supervisor came back with a wheelchair in which he helped me sit. Lucide wheeled me to the elevator to go to the cafeteria.

Still astounded by the drama that just happened I was nevertheless ecstatic to be sitting, moving away from the confines of my room.

Lucide and I got some coffee and I asked her to take me outside to smoke. It was a cold January night and at minus 20 degrees I was shivering. It was the first cigarette I had had in six days. It felt like I finally had found relief for my pain.

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To be continued in Hospital Diaries VII: The Sweet-Smelling Ward

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Hospital Diaries V: The Seagull

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This is part of a series. You can begin at Part I and follow the link at the end of each installment to read the next.

When everybody around you is suffering, your own pain becomes less important. I quickly realized that my complaining and moaning weren’t providing any relief. I was only contributing to the overall noise in the gurney hall.

A nurse had taken away my bottle of ibuprofen and the painkillers that they had given me were totally ineffective. I was too stiff to move and the thin blanket covering me was not keeping me warm. I was in constant pain and felt helpless.

When another nurse came to check my vital signs, he noticed my distress and asked:

“How are you sir? Are you in pain? Can you rate your pain?”

I could not understand why nurses insisted on wanting me to rate my pain on a scale from zero to ten. I felt it was impossible to draw meaningful conclusions from such subjective impressions.

“It hurts a lot,” I answered.

“You were given a painkiller two hours ago,” said the nurse after looking at my chart. “Maybe it’s not pain you’re feeling but only discomfort.”

I was not in the mood to discuss semantics and I gave the nurse a spiteful glance.

Pain is a reaction to an unpleasant stimulus. Tolerance to pain can vary deeply between individuals. The most common tool used to measure pain is a standard scale graded from zero to ten. The accuracy of this tool is questionable.

“You’re probably right,” I said with sarcasm, “and I’m also very cold.”

“In that case I can help you.”

The nurse went away and came back with a warm blanket to wrap me in. I dozed off almost immediately.

During this first night in the gurney hall, my neighbour who had broken her back was transferred to an actual hospital room and I now had a new roommate who was retching loudly behind the thin curtain separating us.

When I woke up in the morning a tall slim man in a white smock was standing by my stretcher.

“I looked at your MRI results and saw that you have light arthrosis on two of your lower back vertebrae. That would explain your spinal stenosis and could be the cause of your paralysis.”

The hospital staff spoke in a strange language that I could barely understand. They also tended to show up unexpectedly and never introduced themselves. I found this extremely annoying.

“That’s interesting,” I said snidely. “Who are you sir and what do you do?”

“My name is Dr. Sharp and I’m a neurosurgeon. I doubt surgery on your spine would be beneficial. You don’t have severe arthrosis and I do not recommend this operation”.

Surgery is too often viewed casually by patients and doctors alike in the Western world. However there is something creepy in having masked strangers performing mysterious acts with sharp objects on sleeping people, don’t you think?

“Dr. Sharp, are you telling me I have arthritis?” I said confused.

“No. I said arthrosis. Arthrosis is a degenerative disease of the bone cartilage. Arthritis is a swelling of the joints. Arthrosis is a wearing down of the bone cartilage that often occurs with age.”

“And what is spinal stenosis?” I asked.

“Spinal stenosis is a narrowing of the spinal canal where the spinal cord is located. In your case, arthrosis may be the cause of that narrowing but as I just said I don’t think surgery will be helpful.”

“I’m relieved,” I replied. “Spinal surgery sounds risky.”

Unimpressed by my comment, the doctor gave me a blank look and added:

“In any case, I will discuss this with my colleagues and we’ll talk about it later.”

I was never to see Dr. Sharp again. I often wondered if that hospital didn’t hide some kind of “Bermuda Triangle” that mysteriously swallowed up doctors.

The Bermuda Triangle is an area of the Atlantic Ocean between Florida, Puerto Rico and Bermuda where many ships and aircraft have vanished. Some people believe that the Earth’s magnetic field is to blame for these incidents. This might also explain the shortage of doctors in hospitals.

That morning my friend Lucide called me on my cellphone to see how I was and to find out if I had been given a room. I took the opportunity to ask her to bring me some ibuprofen to relieve my aching body.

While I was on the phone a man with dark hair and bushy eyebrows rushed in.

“So, are you ready for your surgery?”

“What surgery?” I said, startled.

“Well, the operation on your spine to get rid of your nasty arthrosis, of course!”

“I thought this procedure wouldn’t be necessary! But first of all, who are you sir?”

“My name is Dr. Backridge and I am a neurologist. Who told you this operation would be unnecessary?”

“Erm... It was doctor... Huh... I can’t recall his name but he was some kind of brain surgeon who came to visit me this morning,” I said, befuddled. “You’ll probably find his name in my file.”

“I never read patients’ files, they’re totally unreliable,” the doctor said with a twitch. “So? Do you agree? Can I book the operating room?”

I felt cornered. I am not impulsive by nature and, right at that moment, I did not have all the information to make such a serious decision and weigh its consequences objectively.

The doctor was rocking nervously on his heels while tapping with a pen on a clipboard.

“Dr. Backridge, can you guarantee arthrosis is the cause of my illness?”

“A 100% guarantee? No, I can’t say that for sure but it’s a possible cause.”

“Doctor, I hope you can understand how I feel. Right now I can’t walk and I’m afraid that if I get this operation I will never be able to walk again.”

The doctor gave me a fierce look.

“Listen sir, don’t waste my time. If you don’t agree to this surgery, I can see only one explanation...”

“Which is?”

“You’re putting on an act! You’re faking!” he snapped.
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He then turned and left abruptly, his white smock flapping behind him like the wings of a giant bird. He made me think of a seagull that comes out of nowhere, making a lot of noise, shits everywhere and leaves as he had come without ever accomplishing anything.

“I would not mind if this doctor got lost in the Bermuda Triangle,” I thought.

Seagulls have existed for at least 30 million years. This bird with the obnoxious squawking can be found anywhere there is a lot of water. It will eat anything but seems to enjoy feeding on human garbage.

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To be continued in: Hospital Diaries VI: The Overflow

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Hospital Diaries IV: The Gurney Hall

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This is part of a series. You can begin at Part I and follow the link at the end of each installment to read the next.

A hospital is a strange world filled with machines and enigmatic people speaking unintelligible languages. For example, after only a few hours at the hospital, my vital signs had already been checked several times (I guess to make sure I was still alive), I had been incubated and rolled away on a stretcher through a maze of hallways to a “gurney hall.”

The gurney hall was actually a large square room of the emergency ward where patients waited either for a diagnosis or for a bed to become available. Along the outer walls, about 20 cubicles could accommodate two gurneys each, separated by a thin curtain. In addition, five glassed-in rooms were used to isolate contagious patients and the dying.

My cubicle neighbour was an unfortunate victim of a sporting accident, a 42 year-old woman who broke her back hitting a mogul while tobogganing with her children.

A toboggan is a runnerless sled used to travel over snow in Canada. It was designed by Natives to haul supplies and young children. Nowadays tobogganing is popular among Canadian children and their parents who have forgotten they are not as flexible as in their youth. Illustration: Dog-sledges of the Mandans by Johann Carl Bodmer. Source: Beinecke Rare Book and Manuscript Library, Yale University, public domain

A nurse showed up at my bedside bringing with her the usual equipment for taking blood pressure and temperature as well as a clipboard to scribble notes.

“Good morning sir, my name is Florence and I will be your nurse today. Are you in pain? Can you give me an estimate of your pain?”

Maybe I was confused because of my sufferings but I didn’t understand the question: for a moment I thought I was supposed to estimate my pain in Canadian or US dollars.

“On a scale from 0 to 10 could you rate your pain?” explained the nurse.

“It hurts a lot,” I muttered.

“Very well. Let’s describe your pain as an 8 then. I will bring you some painkillers. If you need anything, just ring,” she said showing me an alarm button tied by its wire to my gurney’s railing. She then disappeared with her machines.

The pain was excruciating. With every move I made I moaned. Soon my cries were joined by my neighbour’s whimpers and the wailings of other patients in the gurney hall, cascading into a tormented concerto accentuated by the bells and alarms of monitoring machines.

After an hour of waiting for the painkillers that Florence promised me, I remembered I had some ibuprofen in my shoulder bag. I swallowed two capsules and drifted into a restless sleep.

“Wake up sir! I brought your medicine!”

It was Florence who was handing me two caplets of acetaminophen and a glass of water.

As I was about to take the pills from my nurse, she noticed the bottle of ibuprofen on my bed.

“What’s that? Who gave you this medication?” she enquired as she picked up the muscle relaxant.

“Nobody, I answered, it’s the medicine I was taking at home to ease the pain and the swelling.”

“Did your doctor prescribe this?”

“Not at all, it’s available over the counter in any drugstore and it provides me with some relief,” I replied.

“Sir, you are not to take medication that is not prescribed by a doctor. I must report this right away.”

And she left taking with her my valuable remedy and the painkillers she was supposed to give me.

Stunned to see my medication confiscated, I uneasily managed to doze off.

When I woke up, a smiling bearded little man who looked like a leprechaun was sitting at the foot of my stretcher, tapping on my leg.

“Good day, how are you today?” he said.

Still in a daze, I felt like I had magically awakened in Middle-earth and that anytime Gandalf the Grey and Frodo Baggins would come to take me on some outlandish journey.

“Not very well, but who are you?” I replied.

“My name is doctor Ogham and I am a neurologist. Please tell me how you ended up in my hospital.”

One more time I explained the unbelievable story of a gout attack that turned into a sprained knee degenerating into overall paralysis. While I was talking, the practitioner was feeling my knees, my wrists and my hands, taking notes in the process and asking me to flex my limbs.

“I see, I see,” said the doctor. “But I could see better with a CAT-scan, an MRI, an EMG, some X-Rays... I’ll make the necessary arrangements.”

He then left as I was struggling to make sense of what he had just said.

One hour later, an orderly came to wheel my gurney to the nuclear medicine department to be irradiated with a scanner.

CAT-scans are 3-D images of the inside of a human body produced with an X-ray machine that looks like a giant bagel. In the last 25 years, medical imagery has become so common that the number of people exposed to radiation has been on the rise. This could explain the colour of the skin of the patient in the above photograph.

Several times in the next few hours I was to be rolled in and out of the gurney hall for tests.

Finally, I was taken to a room where Doctor Ogham hooked me up to an electromyograph, or EMG, that sent electric shocks to my nerves to see if my muscles would react.

Laying down as the neurologist was poking me with needles, I felt like a voodoo doll being subjected to some arcane ritual.

Voodoo is a complex religion which origins can be traced to the African slave trade. The voodoo doll, an amulet used to cast spells, became well known following the release of the 1932 Hollywood movie White Zombie. Fortunately, modern neurologists have little in common with voodoo witch doctors.

“This is strange, very strange,” said the good doctor, “Your muscles are reacting perfectly well. This does not look like a neurological problem, everything is working normally.”

Back to the gurney hall, I became acquainted with my neighbour who told me she was waiting for a brace to be made in order to stabilize her spine so she could sit up and move without risking any further injuries.

“Anyway, she said, they can’t keep me more than 48 hours in the emergency ward.”

“Why is that?” I enquired.

“That’s the maximum time allowed by the Ministry of Health. The hospital will be heavily fined if it goes over it. They better find me a bed quickly.”

Night had come. Lying shivering on my stretcher, I could feel the pain creeping back to my joints. How I wished the nurse had not stolen my ibuprofen!

I achingly reached for the alarm tied to my gurney’s railing. Bells were ringing and patients were crying in the gurney hall. Exhausted, I fell into a restless sleep waiting for a nurse to bring me drugs to ease away my pain.

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To be continued in Hospital Diaries V: The Seagull

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Hospital Diaries III: Incubation

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This is part of a series. You can begin at Part I and follow the link at the end of each installment to read the next.

Parked in a wheelchair at the hospital’s emergency ward, I soon understood why sick people are called “patients.” Patience is the ability to wait in silence while surrendering to calamity.

Unfortunately, the young lady sitting in front of me did not grasp that concept. With her cell phone glued to her ear, she was ranting over the senselessness of the health care system.

“I’ve been waiting for five hours! I’ve had a splitting headache ever since I got vaccinated last week and I’m leaving for Thailand in two days! Why is nobody taking care of me? Don’t they realize this is an emergency?”

Many people think that all emergencies require immediate action. This is not so. There are different levels. Some emergencies need to be addressed without delay, others can wait a little while. Few are a priority.

While driving me to the hospital, my friend Lucide tried to reassure me about my stay at the hospital by telling me the difference between private and public healthcare systems.

“A private healthcare system sees patients as a source of revenues whereas a public system – such as the one we have in Canada – views them as expenditures. A public system aims at getting you well enough to send you home as quickly as possible in order to minimize costs. You’ll see: in a snap you‘ll be back in your apartment, happily cleaning it up.”

I was not as optimistic as my friend. I believed that the waiting time at the emergency ward could be long. That’s why I asked Lucide to prepare some supplies for me before leaving my place.

In a shoulder bag I had a sandwich, some apples, an orange, a few biscuits, a water bottle, two packs of cigarettes and a small jar of Ibuprofen, the muscle relaxant I was using as a pain reliever.

Ibuprofen is an anti-inflammatory drug used to alleviate fever, pain and swelling. One can say it is basically a “super Aspirin.” Ibuprofen is included in the core model list of essential medicines published by the World Health Organization and should be part of everyone’s medicine cabinet.

The enraged Thailand traveller was furiously pacing when I was called on the intercom.

Clumsily I wheeled my chair to an office where a nurse was waiting for me to check my “vital signs.” It took me a minute to understand she wanted to take my blood pressure and my temperature.

The nurse tightened an armband on my upper arm and stuck a thermometer in my mouth under my tongue.

Fever is measured by inserting a thermometer into the mouth, the rectum, the ear or under the armpit of a patient. It was only in the 19th century that doctors realized that fever was a symptom, not an ailment. Besides their taste, there is no difference between an oral and rectal thermometer.

While she was writing down the results I asked the nurse if she knew how soon I would see a doctor.

“Not right away. We’re very busy now. We will call you to let you know which cube you should go to.”

“A cube? What do you mean?” I asked, puzzled.

“That’s what we call our consultation rooms. Now if you could please return to the waiting room, I have other patients to see.”

I was not thrilled by the idea of being “incubated” at the hospital. I was also less than elated to wait for ten long hours until I was called to Cube 67. During this waiting time, several patients – including the traveller to Thailand – grew tired of waiting and left the ward without seeing a doctor.

I had been looking at the walls of Cube 67 for twenty minutes or so when a young doctor showed up. I told her why I had come to the hospital. I explained my gout attack, the torn ligaments in my twisted knee, the weeks spent in bed at home and my paralysis.

She wanted to examine me. To do so she had to call two orderlies to lift me up from the wheelchair and sit me down on a bed. I painfully took off my jacket and my shirt and put on an open-back smock that one of the orderlies tied at my neck with a lace.

After the doctor checked my knees, my hands, my wrists and my arms, she left the cube without a word.

I could hear her talking with a man on the other side of the door:

— “He’s well over 50, he can’t walk and he has trouble moving. I wonder if...” she said.

— “He’s got all the symptoms, said the man, it could very well be spinal stenosis.”

— “That’s exactly what I thought,” she concluded.

Those were the last word I heard from her and I was never to see her again.

After 30 minutes, a nurse came into the cube carrying a plastic basket filled with small glass bottles and stickers.

“I need to take some blood samples, she said. Please roll up your sleeve, sir.”

I obliged half-heartedly. The nurse filled 31 vials with my blood then left.

There I was, alone in my cube, sitting on a slippery leatherette and foam mattress. I was cold. My arms, my shoulders and my legs were sore. What would become of me? I did not know what “spinal stenosis” meant and I was afraid.

One of the most widespread myths of modern times is that medical officers specializing in nerves and the spinal cord are called “spin doctors.” Because of that belief, people think that spinal stenosis means these doctors write down their observations using shorthand. However, spinal stenosis is really about an abnormal narrowing of the spinal canal running through the backbone.

Shivering, I managed to stretch and pick up my jacket that the orderly had left on the wheelchair. Despite the pain, I put my coat on, lay down on the bed and dozed off.

When I woke up, a man dressed in tan scrubs was putting my clothes, my shoulder bag and my shoes under a gurney. He then proceeded to skillfully slide my body over to the stretcher.

The attendant opened the cube’s door and wheeled me out to the corridor. I asked him where he was taking me and he replied:

“Where am I taking you? Why, to the gurney hall, of course!”

A gurney is a wheeled stretcher used to take patients on a journey. It is often equipped with a hydraulic system for raising and lowering patients so the attendant does not injure his or her back and develop spinal stenosis.

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To be continued in Hospital Diaries IV: The Gurney Hall

Hospital Diaries II: The Firefly

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This is part of a series. You can begin at Part I and follow the link at the end of each installment to read the next.

Every time I see a doctor, it seems he ends up making recommendations that are totally unrelated to the purpose of my visit.

I have gotten used to the persistent advice to stop smoking but I just can’t stand it when I’m told to lose weight.

That’s exactly what the good doctor who diagnosed a sprain on my knee said to me. I left his office annoyed but resolved to follow his advice if only to stop receiving unwanted suggestions.

The road to slenderness is simple: follow a balanced diet. Forget about gyms and fitness centres. Sure they will tone your body and build muscles but you will really need to exercise a lot to lose weight. And the more you exercise, the more you risk getting injured.

According to a Canadian study, 40.2% of people aged 20 to 64 who were injured in Canada in 2009-2010 did so practising sports, exercising or walking. Only 16.5% suffered from work-related injuries. This may mean that Canadians are either smart workers or simply lazy.

In Canada, the key to balanced eating is found in Canada’s Food Guide published by Health Canada. This system is based on four essential food groups: fruits and vegetables, grain products, dairy products and alternatives, and meat and other sources of proteins.

The Food Guide explains what constitutes a typical serving for each food group and how many servings males and females need according to their age. If you keep a record of how much you eat, you will lose weight quickly without risking your health.

That’s what I did as my knee was failing me. I lost 40 pounds in three months. Now I only needed to lose another 15 pounds to reach a healthy weight and turn my doctor speechless.

However, I was not worrying about dieting the morning I woke up paralysed in bed.

I was in a bad predicament but I found out I had an unexpected advantage: I had a full bladder.

Despite the pain and because of the urge, after about 30 minutes I managed to move my head, then my fingers, my wrists, my elbows and my legs until I laboriously sat on the edge of the bed.

I relieved myself in my homemade bedpan and then assessed my situation. My twisted knee was not the issue anymore. I could no longer move easily because I was sore all over. It would take a miracle for me to get out of my apartment by myself. My fridge was getting emptier by the day but worse, I was almost out of cigarettes.

I found myself in the middle of the proverbial tunnel looking for a light.

As I was moping about my condition, the phone rang. It was my friend Lucide who, worried, was calling to enquire about me.

I told her about my disablement and that I was running out of supplies. Right away she offered to run some errands for me and said she would stop by that night after work.

In the darkness, a firefly was shining her light to help me find the way out.

The firefly or lightning bug is an insect of the lampyridæ family. There are more than 2,000 species of fireflies. Some females lightning bugs do not fly and look like their larvæ. They are called “glow worms.”

When Lucide arrived at my place carrying several bags of groceries she was struck with consternation, not because she was seeing her friend bedridden and disabled but because of the sorry condition of my apartment.

I had been confined to my bed for several weeks and household cleaning was no longer a priority. Dirty dishes were piling up on the kitchen counter. The floor was covered with objects that I could not pick up because I was unable to bend over. A heap of dirty laundry gathered in a corner of my bedroom and dust was taking over my lodgings.

“What a pigsty! exclaimed Lucide while dropping her bags on my bed. How can you live in such a mess?”

« Erm... Did you bring me cigarettes?”

“They're in the bag,” she answered distractedly while inspecting the jumble in my apartment. “Do you have any garbage bags?”

“In the cupboard, underneath the sink,” I answered while looking for cigarettes in one of the grocery bags.

Lucide disappeared in the kitchen while I tried to unwrap a cigarette pack with my numb fingers. It seemed I had lost all the manual skills I once had.

Lucide came back to the room with a garbage bag and as she saw my shaky hands fighting with the cigarette pack, she cried out:

“What’s with your hands? Look at your knuckles! They’re all red and swollen! This is much worse than a twisted knee, you must see a doctor! Come on, I’ll take you to the hospital!”

With great difficulty I began to dress. I had lost a lot of weight and my clothes did not fit me anymore. I was in a bad shape and I felt weak and distressed.

It took me almost half an hour to manage to get up with Lucide’s help. When I took a first step leaning on my walking cane, it felt as though I had no kneecaps, like my thigh bones were resting directly on my shin bones. I almost passed out from the excruciating pain.

I live on the second floor of an apartment building. As I began to climb down the 14-step stairwell, AC/DC’s Highway to Hell was playing in my head and I had to sit down on the second step to gather my wits.

Highway to Hell is a song about the gruelling conditions of constant touring. Six months after its release, Bon Scott, who sang on the original recording, was found dead at 33 in the back of a Renault 5 after a night of heavy drinking. Show business is a mother who enjoys eating its young.

Finally, I was outside. I had been locked in my apartment for a month and winter had settled in. It was cold and the snow was cracking under my steps. In a last effort, I sat down in Lucide’s car as she started the engine.

I was on my way to the hospital, a harbour for the unfortunates of the world.

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To be continued in Hospital Diaries III: Incubation

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Hospital Diaries I : A Gout-Ridden Wretch

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Ouch! I was awoken by a shooting pain in the middle of the night.

For the fourth time in 30 years I was having a gout attack. By now I knew the story: the sharp pain in the joint at the base of my big toe would fade away after I applied ice packs and took muscle relaxants. This meant I would be lounging in bed for a few days while rereading the works of Guy de Maupassant.

After three days, the swelling had subsided but the pain in my foot remained and I was unable to walk without limping. It was not unbearable so I went back to work where a lengthy report on crystallizing the Canadian public health system through the infusion of additional government funds was waiting to be edited.

“Gout? What’s this? You think you’re Charles Dickens?” joked my friend Aaron when he saw me at the office.

I tried to explain that gout was not some outdated distemper and that its occurrence was on the rise in North America but my colleague was no longer listening: instead he was focusing on the coffee machine sputtering a reluctant espresso into his cup.

The espresso machine is believed to have been invented in 1884 by Angelo Moriondo, in Torino, Italy. The drink gained in popularity worldwide in the 1980’s so much that automatic dispensing machines such as this one are now common in North American public institutions.

Weeks went by, I was still hobbling and to make matters worse, one of my knees failed. I now had an even clumsier gait. I went to a doctor who told me upon quickly examining my swollen knee that it was sprained. He recommended two weeks of rest and to avoid putting weight on my leg.

So I took the last two weeks of annual leave I had left and went back to read Guy de Maupassant’s tales.

As this forced vacation was coming to an end and the time to return to work was approaching, my knee was still hurting. With the help of a walking cane, I went back to the clinic where the doctor summarily felt my puffy knee to immediately declare:

“This is a splendid case of a sprained knee with torn ligaments! You must get to bed my friend! Didn’t I tell you before to get some rest?”

“But I’ve been at home for the last two weeks!”

“In bed? No, no, my friend, stay in bed with your leg raised and apply ice packs four times a day. I am prescribing you some muscle relaxants to ease the pain.”

With the prescription in my hand, I called a cab to take me to the drugstore while realizing to my displeasure that, having used up all my annual vacations, I had to take unpaid leave to attend to my health.

The cab driver was talkative and seeing my cane asked me what happened to me.

“Oh, it’s nothing, I just twisted my knee” I said.

“You should stop smoking!” he replied.

Not impressed by the man’s popular wisdom I was stunned by the effectiveness of the advertising campaign put together by the Government, the health system and the pharmaceutical industry to blame all worldly problems on smoking.

So I went back to bed, determined to heal my costly lame knee. I would get up once a day to use the bathroom and prepare some food. My meals were simple: sandwiches, fresh fruits and vegetables, cereal, cheese, social tea biscuits and water.­­­ I ate lying down. With a razor blade, I cut up a two-litre soda bottle to use as a bedpan to avoid standing up.

The polyethylene terephthalate bottle was invented in 1973 by Nathaniel Wyeth, an American engineer, for pressurized liquids such as soda pop. Carbonation is weak in human urine. However it is surprising how many people use such bottles to relieve themselves when nature calls.

After a week this idleness was taking its toll. My back was aching so much that it was becoming a challenge to sit up in bed or to get up.

I could pull myself out of bed with a strap I tied to my bedroom door while I pushed myself up with my elbow resting on a stool. Every day walking from my bedroom to the bathroom and the kitchen became more difficult.

One morning I woke up laying on my back with my arms extended, completely paralysed.

I was sure this was the first time in the history of modern medical science that a gout attack turned into a sprained knee spreading to the upper body and limbs of an individual.

This is when I realized I needed some serious help.

To be continued in Hospital Diaries II : The Firefly.

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