“When she was in early this week, I could smell the bacterial overgrowth coming from her lungs. She carries bacteria, but this time the stench was pretty powerful.”
“How’s that proboscis performing?”
“Perfectly…too perfectly. It frightens me sometimes. By the way, your mother was here yesterday. Sometime in the afternoon.”
“You’re in enough trouble with Nora. Don’t compound the felony by sharing your talent for recognizing people by their smell with her. She won’t understand. Moreover, she’ll be mortified if she thinks you can recognize her that way.”
“So mortified that she won’t come back?”
“No such luck, sweetie. She’d only shower and drench herself in perfume.”
“I have a lot more olfactory data to share with your mom. It could be entertaining.”
“The laughs won’t be worth it. Trust me.” Lois hesitated a moment. “Has Jack come up with anything about evaluating your newfound talent?”
“He’s talked with the Chemosensory Perception Lab at the University of Utah in Salt Lake City. Jack’s setting up an appointment for me. I think it’s a total waste of time.”
I read extensively and learned a lot about the unheralded world of smell, a universe described with the limitations of a preschool vocabulary. Perfumes, foods, and the rich aromas of nature won public acclaim, while the rest, 90 percent of the molecules that fill the air, are either unknown or a source of embarrassment and disdain.
“Smell is different from the other senses, Lois. What we see, touch, or hear passes through the thalamus, the back part of the forebrain. Then it goes to the cerebral cortex where we experience those senses. In contrast, smell takes a nonstop path to the cortex. That explains why aromas we know speed to specific brain memory sites and fills our minds with lucid and detailed recollections.”
“Every time I smell maple syrup,” Lois said, “I find myself back in my Mom’s kitchen eating a stack of buttermilk pancakes.”
“With my nose, the same aroma often leads to a different memory. The new aromas, the ones that only animals and I can appreciate, fill my world. They’re new to me, and elicit no memories. I try to characterize each new aroma by linking it to a known scent or combinations of scents: lemon-skunk, acrid-vanilla, moldy corpse, etc. I add each new aroma to my unending lexicon of smells. Trees, plants, animals of all kinds, industrial byproducts, and a thousand others form a trail of molecules sometimes leading to its origin, while mostly they dissipate rapidly into the atmosphere or are swept away on a passing breeze and remain a mystery.”
I drove directly to Brier Hospital, parked, and walked to the Respiratory Care Unit (RCU). As the door to the unit swung open, I gagged on the glut of ghastly odors. I leaned on the wall trying to escape, and then grabbed three pieces of Altoids Peppermint Chewing Gum and rammed them into my mouth. The heavy mint flavor gave me temporary respite by overwhelming the offenders.
When I walked to Pam Davis’s bedside, the strong stench of bacterial degradation hit me full force. My mind flashed to my first student rotation in the RCU under the guidance of Harold Haft, a jovial lung specialist. Patients coughed into clear plastic cups and filled them with foul sputum showing nurses and physicians how the lung infection was responding to treatment.
“That’s disgusting,” I said the first time I saw these collections.
Harold went on to gross me out as he laughed at his own favorite clinical aphorism, “Phlegm, it’s my bread and butter.”
I popped more Altoids as myriad aromas tried to overwhelm the gum’s defensive positions. Soon, they too were expended, and I stood naked and unprotected in a universe reeking of sickening molecules.
I walked up to Barbara Howard, the charge nurse. “What’s wrong with the ventilation system?”
She looked at me as if I were crazy. “There’s not a thing wrong, Dr. Roth. We went through this yesterday. I had the engineers check the HVAC system. They said that it was functioning perfectly.”
“I don’t give a damn what they say, this place reeks…it’s disgusting. How do they expect anyone to work in a place that smells worse than a morgue?”
Barbara studied me carefully. I knew I had upset her, again. I was upsetting many people lately. My pulse bounded and my hands trembled as I scribbled my orders as quickly as possible, and rushed to escape from this pulmonary purgatory.
Chapter Forty-Four
It was subtle at first, but I noticed the change in people’s reactions to me. My staff and others familiar with my talent, suddenly took extraordinary care with their dress and personal hygiene—how could that be bad? Perfumes, scented powders, deodorants, and aftershaves blended in the office milieu. It pleased me at first, but then I understood that my ability became problematic for others—my smeller made them self-conscious. Being with me was like sitting naked or with a mind reader; who could be comfortable with that? We function better in a society where our small secrets remained classified. We were still entitled to private thoughts, weren’t we?
As a child, I remembered my mother’s allergies. The nasal congestion had her shoving the milk carton or the wrapped leftovers under my father’s nose. “Smell this. Is it okay to eat?”
People, especially my office staff, weren’t putting things under my nose, but my talent had become the equivalent of installing surveillance cameras in the office. They approached me expectantly, as if I were about to perform an armpit check.
I couldn’t do much about my perceptions. I never commented on the scents that flowed over me, except on occasion to compliment a woman on a particularly delightful perfume. In public places, I found myself moving to another location to escape the repulsive stench of those who refused to bathe or change clothes. My sensitive snoot made me aware of my patients’ aromas. Some, only I appreciated, while others with medical or dental problem, or a portion of Korean bok choy could offend anybody. Every tactful approach to informing a patient about their smell worked well until they became aware of my true meaning, then it became shock, denial, and aspersions against my manners. It reflected our culture and its sensitivity to issues of smell.
Jack Byrnes and I shared in the care of Sherrie Brown, a dialysis patient.
Sherrie became one of the most intractable patients Jack had seen in the dialysis program. An attractive young woman, Sherrie found clever excuses to skip her treatments and ignore crucial dietary restrictions.
Jack shook his head. “I’ve tried everything. I’ve spent too much time, as did nurses and our dietitian, trying to explain to Sherrie that her behavior is compromising her health, if not her life. Nothing worked so far. You give it a shot, Arnie.”
I had my office call and set up an appointment.
I didn’t know what I could offer, but when I entered the examining room to evaluate her, it reeked of urinous waste chemicals she couldn’t eliminate on her own. It had been accumulating in her body and now emanated from her skin and breath.
“I’m always happy to see you, Arnie,” she said coyly, smiling in her usual seductive way. She wore a short skirt, a satin tank top, and three-inch heeled sandals. She’d painted her toes pink.
“We need to talk…”
“Don’t be mad at me Arnie,” she pouted. “This dialysis thing is killing me. I need a kidney transplant yesterday…”
“There’s not much I can do about that, except to keep you in good shape until one comes along. That brings me to the reason I’ve asked you to come today.”
“Jack ratted me out, didn’t he?”
“Let’s not make this thing a father/daughter or teacher/student relationship, Sherrie. I respect you too much for that.”
She smiled at that, and then fixed her large brown eyes on me.
Subtlety had no place in this conversation.
“When I came into this room, it smelled like urine. You smell like urine, Sherrie. It’s from the wastes you’ve been accumulating in your body because you’re skipping dialysis treatments and not following your diet.”
She took a large step backwards, her eyes widened in shock. She covered her mouth and nose with her hands.
I felt like a shit. “I’m sorry, Sherrie, but it’s true, and if you continue this way, you may not make it to a transplant.”
“Nobody ever told me! Why? I’m mortified! Look at me, Arnie. I’m a pretty woman, I dress well and take time with my hair and makeup…and I smell like urine. People can smell me that way. My God! It’s embarrassing…humiliating.”
When she cried, I placed my hand on her shoulder. “You’re a beautiful woman and it’s because I care about you, Sherrie, that I want you to do well. I know that for someone your age, dialysis is a pain in the ass, but we’ll get you a transplant as soon as possible. Meanwhile, we can fix this problem with a little extra dialysis. If you make it to your treatments and stick to the diet, this problem will go away in a few days.”
Afterward, Sherrie followed her diet and never again missed a dialysis treatment.
At dinner that night, I told Lois, “I’m not looking forward to this trip to Salt Lake City. I have a hard time being a patient, and worse, being a freak of nature.”
“We’re being overly dramatic today, don’t you think, Arnie?”
“Maybe a little, but I doubt that the University of Utah’s Chemosensory Laboratory has ever seen the likes of me. I don’t see how they can help.”
“If we’re going to find an accommodation for that spectacular smeller of yours, it’s more likely to come from people who do this for a living. It’ll cost you a day, no big deal.”
I was in a good mood until I picked up the first chart of the day, Missy Cabot. When I turned to Beverly, she gave me her what-can-I-do, look.
In all my years of practice, I’d discharged only two patients: one who falsified a prescription and another who challenged every recommendation and fought with me on each visit. Now, when I considered that Missy might be the third, the thought disturbed me. It was one thing to discharge a hostile patient, it was another to discharge someone so dependant and appreciative, when I was doing so out of frustration. Perhaps someone else can help her, I rationalized.
I opened the examining room door with a “Hi, Missy,” and skipped the loaded ‘how are you?’
“You’ve got to help me, Doctor. I can’t stand this anymore.”
Suddenly, my mind became alert. Something was different with Missy…or was it me? When I placed the blood pressure cuff on her right arm, I sensed it at once, a tangy, orangey aroma. I listened to her slightly irregular pulse beat as I measured her blood pressure and studied her. Her left hand had a fine tremor and her neck showed the linear, elevated red marks of fingernails…a hive-like reaction.
What if, I thought?
“What medications are you taking, Missy?”
“Only what you gave me,” she said, bringing out her list. “Cholesterol pills, Xanax at bedtime, estrogen every day, and progesterone five days a month.”
“Anything else?”
“Nothing.”
“What about vitamins or supplements.”
“One-a-Day Women’s Vitamins.”
“Any unusual coffees, teas, or broths?”
“No. I used to drink Mormon Tea, but they took it off the market. It made me nervous…you remember…it had something in it that the government didn’t like.”
“Yes. Ephedra. It caused too many problems and the FDA banned it. Did you change teas?”
“Sure. I drink bitter orange tea. It’s delicious.”
“How much do you drink?”
“Five or six cups a day, but not after four in the afternoon or it keeps me awake.”
I excused myself and went to my office computer. The search on bitter orange revealed that it contained synephrine, a close cousin to ephedrine and pseudoephedrine, the active ingredients from the ephedra plant. I shook my head; could her symptoms relate to this tea?
When I returned to the examining room, I turned to Missy. “I want you to stop the bitter orange tea. It may be making you sick.”
“Okay, doctor. I’ll try.”
The next six days brought repeated calls—pleas from Missy that she was so tired, she could barely stay awake. I encouraged her to keep off the tea and her calls gradually abated.
Today was her visit, three weeks later.
Missy smiled when I entered the examining room. I barely recognized her as she looked fifteen years younger. Her voice was strong, she’d changed the bright lipstick to a muted gloss, and her hands were steady.
“You look wonderful, Missy. How are you feeling?”
“The first week was rough. I think I know what addicts go through…what they call withdrawal. The craving I could deal with, but the fatigue and lack of energy, that was a killer. I almost drank some tea when I got tired and needed to do some work.”
“Don’t you dare, Missy.”
“I know, Doctor. I’m a new me and haven’t had any chest pain or irregular heartbeats. I knew you would help me, and you did.”
I recalled her visits and my conviction that her symptoms were psychiatric and knew that I’d done her a disservice. “I owe you an apology, Missy.”
“Whatever for?”
“For not paying enough attention to you. The first lesson you learn in medical school is to listen. I didn’t do a good job at that. Moreover, I dismissed your symptoms. You deserved better and I apologize.”
Missy smiled. “Aren’t you sweet.”
I blushed.
“You paid more attention to me than friends, family, and even my husband. I’m not easy, Doctor. I’ve never been easy. I’m neurotic…that’s the word they’ve used on me. I know that and I’m the one who should be thanking you and your staff.”
“Well, I appreciate that, Missy. From now on, I’ll pay more attention.”
She smiled. “Don’t make promises you might not be able to keep.”
What could I say?
Chapter Forty-Five
I understood that a major disadvantage of leaving familiar places was losing the one protective mechanism that mitigated against the overwhelming olfactory assaults, sensory exhaustion. People who live next to a pulp plant eventually became oblivious to the pungent stenches, the aromatic byproducts of the manufacturing processes. To a significant extent, I’d reached an uneasy truce with the molecular milieu of home, office, Brier Hospital, and all my familiar haunts. Today when I drove to the Oakland International Airport, I battled a new army of sensory saboteurs.
The hors d’oeuvres was the crowded airport parking lot that stunk of exhaust gases and the fumes from jets landing and taking off. They made me nauseated. The appetizer was the crowded terminal and its human byproducts, the restaurants, the fast food joints, and worst of all, the chemicals they used on the aircraft to obscure the pungent cabin odors. They overwhelmed me.
After we landed in Salt Lake City, I rushed outside to the leper colony of smokers. As an unusual act of courtesy (we were after all in the smoking area), the gentleman beside me lifted his unlit cigarette. “Do you mind if I smoke?”
“Not at all,” I said. “I don’t smoke, but I love the aroma.”
And its ability to crowd out all other smells.
I took a taxi to the clinic, a tan modern two-story building near University Hospital.
“We’re expecting you, Dr. Roth,” said the receptionist. She led me to a small office and a stack of forms a quarter-inch high. “If you’ll take a minute to fill these out, Dr. Whiffler will be right with you.”
Dr. Whiffler? I nearly broke out laughing. Some physicians must be fated to their jobs like Dr. Anger, the psychiatrist, Dr. Staggers, the alcohol rehab physician, Dr. Fieler, the gynecologist, and Dr. Frank G. Slaughter, the novelist
Twenty minutes later, after a soft knock on the door, a tall, thin, and balding man who looked about my age entered. He stuck out his hand. “Jerry Whiffler. Nice to meet you.”
I can’t help but smile again at the name. “Call me Arnie.”
He
smiled in return then laughed. “Yeah, it’s a perfect name for a doc in my business. I think my karma drove me to it.”
Jerry took a few minutes to review my history, and then looked up at me. “Tell me all about it.”
I went through it all in detail. I described the encephalitis, my awakening, the gradual onset of increased olfactory sensitivity, the aroma-memory associations, the pleasure of this skill, and at times, its repulsiveness.
He directed me into his examining room and performed a physical, emphasizing my nose and throat. “Everything looks fine to me. Let’s put your talented nose through its paces.”
His nurse brought a wooden box the size of an attaché case containing about fifty small vials. “You’ve heard of the University of Pennsylvania Smell Identification Test?”
“Yes, I read about it. It’s kind of crude for my problem, don’t you think?”
He looked at me strangely. “Let’s give it a try.”
He placed the first vial on the table, but before he could open it, I said, “Vanilla.”
“What?”
“That’s vanilla.”
He reached for a vial in the middle.
“Smoke.”
I continued the theatrical display of my talent four more times. He looked at me oddly. “This isn’t a prank is it?” He looked around the room for hidden cameras. “Sometimes my colleagues get carried away with their practical jokes.”
“No joke, Jerry.” To drive the point home, I punctuated my performance with, “This morning, you had an onion bagel with lox, cream cheese, and onions, Walla Walla onions, I think. You smoke Amphora Golden Blend Pipe tobacco, like my Dad, but I think you only do that at home. Your wife wears White Shoulders perfume, and your dog is in heat.”
“My God,” Jerry said. “This is incredible. When can you move to Salt Lake City?”
“Right,” I said. “Imagine all that information coming en masse, uncontrollable. I’m a schizophrenic or an autistic child overwhelmed with sensory information. I’m afraid it’s going to drive me crazy, and it nearly has on occasion.”
The Sixth Sense (Brier Hospital Series Book 3) Page 20