Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Sunday, February 28, 2021


    Not much new to report here. I have signed up to work in the clinic on Saturdays in March (after talking about it for more than a decade, The Firm has finally opened on Saturdays - another instance of the pandemic changing work patterns). My aunt clinically is about the same, but I don't know how long that is going to last - so I did not want to commit to more than one day per week.

    It's been stressful having her here, even though I know it's the right thing for her (and she knows it too). I know she feels isolated and depressed, though at least she is not in a nursing home but with her family. It is just too difficult to talk to my parents for any length of time, given my father's dementia and my mother's severe hearing loss. My aunt and my parents spend their days at opposite ends of the house. I have not been able to come up with a solution, as my parents claim a large part of my time and to be quite frank about it I do need some time to myself if I am not to implode. She has had many visitors, cards and letters and I think that is helpful but it doesn't make up for the fact that she is facing the end of her life. My aunt has asked for a television to be installed in the living room, where she sits; so we are going to be doing that next week. She loves to watch the news, so maybe this will make her feel better. 

    My study review materials for the Medical Boards have arrived, so that is something else I need to start working on. I have to recertify every ten years to keep my Internal Medicine certification. It's a couple of years early, but I would like to get it over with and this seems as good a time as any. Formerly the test was given twice a year, but (again due to the pandemic) it has been cut back to once. This will be the last time I have to take the test - but then again I promised myself eight years ago that I would not be doing this again, so there you are. 

    I had my colonoscopy done, but unfortunately I have to do it again! I followed instructions exactly but apparently the prep was not sufficient. That mixture you have to drink is the absolute worst. The archaic term for it was "saline laxative" and it works by pulling additional fluid into the intestine. This rinses everything out, so to speak. It contains magnesium, potassium, citrate and other lovely things. You also have to drink a lot of water with it so as not to induce dehydration. 

    Lately I have been pondering what to do when I am free to travel again. I would love to go back to Australia, to see the Netherlands and Scotland; but first of all I think I would like to travel Route 66. I'd bring along my camera and seek out some of the old buildings and locations to photograph. The route was decommissioned in 1985, with the completion of the Interstate Highway System, but has refused to die. It has a stature in American lore that I don't think will ever be replaced, partly due to the song, of course, but it is even mentioned in works like "Fear and Loathing in Las Vegas" and, of course, "The Grapes of Wrath."  A sadder bit of travel history associated with it: "The Green Book," a travel manual specifically for Black motorists, listing places that were safe - and unsafe - for them to stay. There were plenty of  "sundown towns" along the route where African Americans were not allowed after dark.

    And now I have to figure out my schedule for the week. More later. 

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    Friday, February 19, 2021

     Ash Wednesday 

    I started Lent this year with a more introspective mindset than usual, what with my aunt on hospice and my elderly parents being themselves. (Deaf, stubborn, won't wear their hearing aids, a little confused.)  On Wednesday I had to go into the city in the hope of getting my first COVID vaccine at the hospital - most of my co-workers have completed it already but I was delayed due to contracting COVID in early January, though I feel fine now. 

    It was indeed a fine and appropriate Ash Wednesday. The humbling process started early, as my staff ID was rejected when I tried to pull into the hospital parking lot (I had not been there in months, so it had been deactivated). The ID problem duly fixed, I wandered into the building and found the walk-in line for the vaccination. I was issued a ticket and a sticker marked 2/17 (for that day's batch of vaccine), answered questions regarding symptoms (none, thank you) and while in line passed a table stacked with envelopes of ashes for application. I helped myself to one, curious to see how the do-it-yourself penance kit would work. Stood in line for a while and eventually made it to the front, handed in my ticket and sat down with a friendly nurse to answer more questions and read through the information provided (we are using the Pfizer vaccine). The injection was painless; I sat and read my Kindle for the required 15 minute observation period and then left. My next injection is in three weeks and I have an appointment. It's a relief to finally get this done. 

    Later that day at home I sat in my room and opened the envelope. It contained a cotton swab with a dab of ashes on it and a slip of paper with a two-sentence reading. I focused on "Dust you are, and to dust you shall return" - thinking of my aunt - and applied the ashes. 

    Hopefully this year I will be more focused on Lent than I have been the last few years. As for Easter... we don't know whether my aunt will still be with us then or not. The good news is that the outreach of love and support from her friends has been nothing short of uplifting; come what may, I know I will hold these memories on Easter Sunday.

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    Saturday, February 13, 2021

     Caboose Potato Soup

    One of my parents' caregivers recently bought us what looked like a job lot of zucchini, as it was on sale cheap. I happen to like oven-roasted zucchini, but my parents and aunt find it somewhat less appealing. So it was off to the Internet, the world's biggest cookbook, for soup recipes. 

    I am not a fan of sliced zucchini cooked in vegetable soup; it gets really limp and unappetizing. I gave this some thought, inspired by memories of a trip to Ireland I took with my aunt a few years ago. The hotels there which cater to tour groups do the usual choice-of-three-entrees dinner menu, and the first course was always soup. Described as "vegetable soup," it was not the tomato- or broth-based type you might visualize. Rather it was a pale green puree, a cream-type soup, certainly with potatoes as a main ingredient. It was always tasty.

    So I found this recipe and made it, of course with a few alterations: no garlic as my aunt hates it, vegetable broth instead of chicken because that was what we had in the house. For herbs I used the thyme and a small amount of Italian blend seasoning. I did throw in some half and half at the end. It was very well received, and I will be making it again soon. You do cook the zucchini and potatoes until very soft, then puree it which solves the consistency issues you get with long-cooked sliced zucchini. 

    My father tasted it and said "My father called this caboose potato soup." Oh, really? I asked for more information and he gave me some family history I had not heard before: his grandfather was a railroad man, working the Pittsburgh-to-Chicago run. In those days of the early 20th century the crew member assigned to the caboose was the designated cook. The meal was almost always a stew or soup, due to limited kitchen facilities on board plus irregular eating hours - this could be kept hot and the crew could help themselves. Potatoes were plentiful and cheap, and make a fine soup base. So this is really more of a soup concept than an actual recipe:

    Saute some onions, add broth or water plus a cooked green vegetable (peas, green beans, celery, even lettuce could work here), add the sliced potatoes and simmer; then puree when everything is soft. Add some cream or cheese if you like.  It's difficult to screw this up and it is always good. As a bonus, it freezes well. 


    Tuesday, February 02, 2021

    "What's For Dinner?"

    As the chief cook and bottle washer for my parents and aunt I am constantly trying to figure out what to cook for dinner that they might like. I have limitations placed on me: my aunt can't tolerate garlic, my father hates vegetables, no one likes spicy food. I've been doing this for about a week and am perilously close to running out of options. Trying to feed people nourishing food on a nightly basis is not the easiest thing to do.

    Dinner last night was a success: everyone loved it. Also it was easy in that most of the preparation was done the night before.  It was roast chicken, but the ingredients and technique were specific: Mimi's Sticky Chicken. Check out the recipe. I can recommend it highly. I applied the spice rub the night before, leaving out the garlic powder and cayenne in deference to people's tastes, and chucked it in the oven the following afternoon. The chicken roasts at 250 degrees for five hours. Yes, that is correct - though I confess that I got nervous and turned it up to 275 for the final hour. It was moist, tender and delicious. 

    If you search for "sticky chicken" you will find several quite different recipes, so I appended a link above. We will definitely be making this again. I served it with sauteed spinach, which my father didn't eat; but then, you can't have everything.


    Monday, February 01, 2021
    "But I'm Feeling MUCH Better Now!"

    Those of you of a certain age may remember a sitcom called "Night Court" which aired back in the 1980s. It was set in New York City and starred Harry Anderson as an unconventional judge who presided over sessions of night court, John Larroquette as the district attorney and Markie Post as the public defender. It was truly hilarious, one of the great sitcoms which has sadly been forgotten. Various character actors kept turning up on the show in recurring roles, one of which was John Astin as Harry's long-lost father. He had a history of mental illness and had been institutionalized at some time in the past. Every time he told another character about his history of mental illness he'd end his story with the phrase "But I'm feeling MUCH better now!" accompanied by a truly frightening smile. (You may remember him as Gomez Addams from The Addams Family, which made the smile even more effective.)

    The reason I bring this up...

    I am now presiding over my family's Gilligan's Island-esque setup, consisting of my parents and my aunt. My parents continue to live in the house I and my siblings grew up in; it is now much too large for them, but they have consistently refused to move. My parents have some dementia and other health problems, as well as poor mobility, so they have caregivers 24 hours a day. About six weeks ago one of the caregivers came down with COVID, followed by all the others (and my parents and myself), but fortunately everyone has recovered. 

    My aunt has metastatic cancer and two weeks ago she underwent a procedure for treatment followed by five days of chemo. She has declined significantly since; her memory is now very poor and her balance is off. Her doctor strongly recommended hospice, but we are waiting until her next appointment in one week to make that decision. In the meantime she is staying with us. 

    I am monitoring meds, fixing dinner, running errands and scheduling doctors' appointments and palliative care visits. I am, in short, seeing medical care from the other side. The experience has convinced me that the US medical system needs far, far more social support than we currently have available. And we are the lucky ones; my parents can afford to pay for home help. This takes a huge amount of stress off me but it is still difficult. 

    So how does "Night Court" fit into this? Well, John Astin's catchphrase has become my new mantra: every time I feel exceptionally frustrated or at my wit's end, I tell myself "But I'm feeling MUCH better now!" 

    It seems to help. Give it a try the next time you're feeling stuck.

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