“Positive. No dry mouth, doctor.”
After a couple of years of unsuccessfully battling this mysterious affliction I finally said uncle and referred her to a newly launched dry-eye specialty clinic at a teaching hospital in Toronto. A few weeks later the consultant’s letter arrived. The opening lines read: “This pleasant 80-year-old woman presents complaining of a two-year history of dry eyes and dry mouth. She says she has to suck on hard candy almost continuously in order to relieve the mouth dryness.” What the hell? The consultant went on to conclude: “…a fairly obvious case of Sjögren’s syndrome.” I was gobsmacked. I requested my patient be called in for an appointment pronto.
When she arrived she was grinning from ear to ear. She happily displayed the bottle of Salagen the specialist had prescribed for her.
“This works great! Those doctors in Toronto, they sure know what they’re doing,” she remarked ever so thoughtfully.
I got straight to the point.
“Mrs. Kareishū, how come you always told me your mouth wasn’t dry?”
“Well, my mouth feels moist when I suck on a hard candy, so since I’m just about always sucking on one, it never really gets dry!”
My eyes rolled up with such force I was nearly knocked out.
Beginner’s Luck
Recently Jan and I accompanied a group of friends from our town to a Supertramp concert in a nearby city. When the show ended, someone suggested we check out the local casino. I had never been to a casino before. My mind conjured up Hollywood-inspired images of beautiful people, laughter and glittering roulette wheels. Hey, that sounded like fun! We hopped into our vehicles and headed out to The Slots.
The lot was jam-packed, so it took us a while to find parking spots. When we finally got into the lobby the first thing I noticed was a sign stating any patrons found leaving their children unattended in the parking lot would be banned from the premises for five years. There were also several posters for Gamblers Anonymous and Ontario Addiction Services on the walls. Hmm… .
We decided to go watch the horse races. There were a few hundred spectators at the downs. A huge scoreboard above the racetrack updated the odds continuously. One of our friends had a little gambling experience, so he gave us a crash course on how to bet on horses. Perhaps I misunderstood him, but it sounded to me like I could either bet on the favourite and win a pittance, or bet on one of the long shots and lose my shirt. It seemed like an expensive way to have a good time.
After watching pint-sized jockeys whip their tired steeds around the track for half an hour we lost interest and returned to the main building. By then I was getting pretty hungry, so I asked one of the employees where the restaurant was. He advised me the cafeteria was the only place where food could be purchased. I went in and looked around. They had every species of Cheezies, Pringles and Doritos known to man, but no hot meals or sandwiches. Oh, well. It was time to get the show on the road. We hurried down the main hallway, past a knot of beefy security guards and into the casino.
It was like stepping into The Twilight Zone. Hundreds of slot machines filled the room, and nearly all of them were occupied. The glassy-eyed zombies playing the slots were pushing buttons and pulling levers like well-trained lab rats. Whenever the credit on their machines ran out, most people automatically pulled out a fresh bill and carried on playing. Some of them were using $100 bills. Every other player had a cigarette in hand. Once in a while they’d stop pushing buttons long enough to take a drag. The air was blue with smoke.
I took a stroll around the room. Most people looked as though they didn’t have a lot of disposable income. There were markedly few conversations taking place, and no one was laughing. Everyone seemed to be grimly fixated on their slot machine. I noticed several players wearing necklaces with a credit card-type device attached to them. The cards were inserted into a special groove located on the front of each machine. I asked a waitress what they were for.
“Oh, those are frequent player cards. It works kind of like Air Miles. The card keeps track of how much you play. The more you play, the more points you get. When you accumulate enough points you can trade them in for things like food or free lottery tickets. Would you like me to get you one?”
“No, thank you,” I replied. I backed away from her warily.
There were no seats for non-players in the room. Your options were to play, stand around and get lung cancer, or leave. I decided to play.
I found a vacant one-armed bandit, sat down and fed it $20. My cash was instantly converted into 80 credits. It reminded me of something I once read in a psychology textbook: Converting money into more abstract things like poker chips or “credits” tends to make people less inhibited about spending it. Someone showed me how to work the device. Essentially, all I had to do was press one button to specify the quantity of money I wanted to bet, then either press a second button or pull down the lever to make the icons spin. If a winning combination lined up I’d be awarded credits; otherwise credits would be deducted. I could cash out at any time. It seemed straightforward enough. I started pressing buttons.
Press, press, look.
Press, press, look.
Not exactly the most intellectual game going, but frighteningly enough there was an undeniable appeal to it. It was sort of like participating in a lottery – even though you were fully aware the odds of winning big were almost zero, each time you pressed that second button you felt like this could be the time you won the jackpot.
I must have been having a bit of beginner’s luck, because 15 minutes later I was up to 120 credits. The Vulcan in me spoke up: Now would be a logical time for you to quit and cash out a winner.
“Are you kidding? I’m on a roll! Nothing can stop me now!”
But the odds are stacked against you, so if you play long enough, you’ll be guaranteed to lose.
“No way, killjoy - I’m red hot! I’m going all the way!”
Suit yourself.
I continued playing.
Five minutes later I was down to 30 credits. A waitress came by.
“Would you like a drink, sir?”
I hesitated. Drinking and gambling are two activities that probably should not be combined.
“No, thank you.”
“Coffee and pop are free,” she added.
“Do you have decaf?”
“No.”
I knew if I had a cup of regular coffee this late at night I’d be up for hours. I’m sure there’s nothing a casino likes better than an insomniac playing one of their slot machines.
“No thanks.” As she turned to go I asked, “Any idea what time it is?”
“Sorry, I don’t have a watch.”
I caught a glimpse of the wrist of another casino employee who happened to be passing by. No watch. I scanned the walls. There wasn’t a single clock in the entire room. There were no windows, either – all the lighting came from artificial sources. Background music was curiously absent. The only sound was the trance-like drone of the slot machines. It was almost hypnotic. No clocks, no windows, perpetual light and continuous white noise. Whoever designed this room obviously wanted to make its occupants as oblivious to the passage of time as possible. The Room That Time Forgot. Talk about the ultimate gambling environment. I returned to my game.
A short while later my credits ran out. Without even thinking, I fished out another bill. I was about to slide it in when my inner Vulcan murmured: Are you sure you want to go down this road?
I thought about it for a spell, then stood up.
The player to my right squinted at me dully. I noted with some disquiet that we bore a passing resemblance. In addition to looking like he was half in the bag, he was tethered to his machine by one of those creepy Frequent Gambler umbilical cords. I wondered if somewhere out there a family was waiting for him to come home. Hoping and waiting. Night after night.
“Ya done already?” he slurred.
“Yep.”
“Well, dat’s how it goes, eh? Ya put yer money in da @$#% machine, ya
press da button and it eats yer @$#% money!” He leaned over to my freshly vacated slot machine, dropped a couple of tokens in and pulled down the lever. Three different icons tumbled into place. He shrugged, turned back to his own unit and resumed playing.
Out-bluffing the Kids
Our friend Gord is an ER doc in a nearby city. Last winter we invited him to visit us in our small town. One of the things he and his two sons mentioned they wanted to do during their stay with us was go sledding. A few hours before they arrived, Jan inspected our sliding paraphernalia. The crazy carpets were fine, but our sleds were in woeful condition. She drove to Canadian Tire and returned with two new GT racing sleds. They cost $50 apiece.
Assembling things like GTs greatly exceeds my virtually non-existent mechanical capabilities. Luckily for me, when Gord got to our house he offered to help. We sat on the kitchen floor and surrounded ourselves with a slew of sled parts. After 30 minutes of head-scratching and tinkering we managed to put together a pair of GTs that looked more or less like the ones on the covers of the boxes. We both felt that applying the decals would take more time than it was worth, so we skipped that step.
The last thing we needed to do was fasten a slender tow-rope to the front of each sled. The instruction sheets didn’t offer any helpful hints as to what type of knot to tie. The company probably figured if you couldn’t come up with an effective knot, either you still drank from a sippy cup or you were just too damn stupid to own one of their sleds. Unfortunately, Gord and I both happen to be severely knot-challenged. We can intubate, throw in chest tubes and do spinal taps, but knots? Fuggedaboutit. What do we look like, sailors?
I was seriously considering giving up when an ancient memory of a knot I learned in Cubs decades prior lumbered out from some forgotten corner of my brain. I hastily replicated it before the memory receded.
I looked over to see how Gord was making out. I guess he never attended Cubs. He had tied a hideous Spanish Inquisition-looking knot on his sled. He was staring down at the tangled mess despondently. I couldn’t resist: “Avast matey! That's quite the Frankenknot you've created there!”
“You can say that again,” he said. “Oh well, no one said it had to be pretty. Let’s go tobogganing!”
It was an ideal afternoon for sledding – only minus 10 degrees Celsius, a cobalt sky and tons of fresh powder. Best of all, we had the entire hill to ourselves! No hot-dogging snowboarders attempting death-defying grinds and shreds. No snowmobilers paying homage to Saint Knievel. No tinnitus poster boys with portable boom boxes blasting out their favourite speed-metal arias for our listening pleasure (Hey buddy, did it ever occur to you that maybe the rest of North America doesn’t want to hear Napalm Death at 10 billion decibels?). Just two middle-aged guys and their kids. We had a great time.
Two hours later one of my daughters announced she needed to go to the bathroom. It was about time for supper anyway, so I told Gord we were going to head back home. He said he and the boys would go down the hill one last time and then meet us at our house. I gathered up as many of the sliding accessories as I could handle and walked home with the girls.
Gord and his boys arrived not long afterwards. We washed up and had supper. After supper the kids played games until they were exhausted. At bedtime Gord read them all a story. When the last child finally drifted off to sleep, Gord, Jan and I went to the kitchen and raided the fridge for beer and snacks. We stayed up chatting until midnight.
After breakfast the next morning we asked the kids what they wanted to do. Their answer was unanimous: sledding. Gord was the first to get his snowsuit on. He went outside to round up the gear but returned shortly afterwards with a quizzical look on his face.
“I found all the crazy carpets, but there’s only one GT outside,” he said. “Where’s the other one?”
“Probably in the garage,” I replied.
“No, I already checked in there. Do you remember where you left them when you got home last night?”
“Them? I only brought one back. Didn’t you bring the second one? It was tied to that bench near the top of the hill.”
“I must have walked right by it. I guess I figured you had taken both of them with you.”
“Don’t worry about it,” I said. “It’ll still be there. This is a friendly little town. It’s not like anyone’s going to rip off a GT.”
The boys finished pulling on their boots and ran outside. My daughters weren’t quite ready yet, so I told Gord to go on ahead. Five minutes later the girls and I departed.
When we emerged from the path that opens onto the clearing at the top of the hill I spotted Gord right away. It wasn’t that difficult – at 6-foot-5 he was easily the tallest of the dozen or so people milling about. Even from a distance I could tell something was amiss. I waved at him and shouted, “Did you find it?”
Instead of answering, he loped over to me. Uh-oh.
“There was no GT tied to the bench,” he whispered, “but that kid over there has one that looks exactly like ours.” He jerked his thumb in the direction of the throng of people at the summit.
“Do you think it’s ours?” I asked.
“I’m pretty sure.”
“Did you talk to him?”
“Yeah.”
“What did he say?”
“He said he got it for Christmas.”
I went over to take a look.
The boy was facing the opposite direction as I approached. There was a GT immediately behind him. I scrutinized it closely. In addition to being brand spanking new and sticker-free, it was sporting the same abominable knot. How suspicious can you get? I tapped our suspect on the shoulder.
He twisted around lazily and appraised me. He was a gangly 12-year-old boy with saffron hair, an explosion of freckles and pale blue eyes. A hint of a smirk played about his mouth.
“Hi, I’m Dr. Gray,” I said. “What’s your name?”
“Josh.”
“Josh, this GT looks a lot like the one I accidentally left out here last night. Do you think it could be mine?”
He tilted his head back, looked me straight in the eyes and said, “Nope, it’s mine.”
“When did you get it?”
“At Christmas.”
“Are you sure, Josh?”
“Yep.” He turned away from me in a blatantly dismissive manner. I could feel my hackles rising.
“Hang on, Josh; I’m not quite finished yet. Like I said, I’m pretty sure this is my GT. What’s your mother going to tell me if I call her and ask if you got a GT for Christmas?”
He wasn’t expecting that. His smug look faltered.
“Um… .”
“What’s your last name, Josh?”
“Uh… .” He started to fidget.
“What’s your phone number? I’ve got a cell phone right here in my pocket.” Of course I was bluffing, but he didn’t know that. The last remnants of his cockiness vanished.
“I don’t know!” he bleated nervously.
“Do you seriously expect me to believe you don’t know your own phone number? Come on, Josh; give me a break. What’s your phone number? Maybe I’ll talk to your father, instead.”
His eyes widened in horror.
“I promise you, I don’t know!” he wailed.
By this time several curious snowboarders had coalesced around us. A few of them started snickering.
“I promise you, I don’t know!” someone trilled in a squeaky Josh-like voice. The rest of them guffawed loudly.
“Josh, this is my GT, isn’t it?”
“Y-yes,” he stammered at his boots.
“What’s it called when you say things that aren’t true?” Gord asked him pointedly.
“L-lying.”
I relieved him of his plunder and gave it to Kristen. She hopped on the sled and went rocketing down the hill. Josh slunk away guiltily.
An hour later I was sitting on the bench taking a breather when Josh approached me.
Aha, he’s come back to apologize. There’
s hope for him yet!
“Dr. Gray?” he ventured, eyes downcast.
“Yes?”
“Can I borrow your GT?”
Legerdemain (Sleight of Hand)
Most weekday mornings I do a couple of scheduled minor procedures in the emergency department. Patients used to have to sign a consent form prior to undergoing minor procedures, but a few years ago that antiquated ritual was laid to rest. If registering at the front desk, sitting in the waiting room for half an hour and then remaining perfectly still on an uncomfortable stretcher while being poked and prodded by sharp instruments isn’t proof enough that consent has been given, I don’t know what is.
Wart removals and cortisone injections are usually quick and predictable. Biopsies, on the other hand, are an entirely different kettle of fish. Minor biopsies involve removing only a tiny sliver of tissue, so sometimes the entire procedure lasts no longer than a few minutes. In those cases it probably takes more time to fill out the various forms that accompany the specimen to the laboratory than it does to remove the lesion itself. There are times, however, when much larger blocks of tissue need to be expunged. Sometimes this is because the lesion itself is bulky; other times it’s because the mole looks cancerous and we want to make sure all traces of it are eliminated. When it comes to lumps-and-bumps removal, there’s nothing more disconcerting than receiving a pathology report that states the lesion in question is an incompletely excised malignant melanoma.
When I enter the treatment room I always ask my patient to confirm the procedure they’re expecting me to perform. I find this is the best way to avoid injecting the wrong joint, removing the wrong mole, etc. Why make malpractice lawyers’ jobs any easier than they already are? After I’ve verified we’re both on the same wavelength I begin to gather the necessary hardware. If my patient has that familiar white-knuckled look I’ll chit-chat with them as I assemble the supplies. First I place my latex-free gloves on the counter behind me. I then open the biopsy tray and pile the scalpel, needles, syringes and suture material onto it. Next I pour chlorhexidine into the stainless steel bowl. After instructing the patient to lie down, I adjust the spotlight to ensure the lesion is optimally illuminated. When I’m satisfied with the lighting I put on my disposable blue facemask. Breathing with the facemask on always makes my glasses fog up, so after a few seconds of looking like a total loser I dispense with the glasses and deposit them on the counter. I snap on my gloves with dramatic flourish, draw up the local anaesthetic and whirl like Zorro to face the doomed lesion (okay, so maybe not quite like Zorro). I wash the skin with the antiseptic solution and drape clean towels around the area to maintain a sterile surgical field. I give fair warning that I’m about to start injecting, then infiltrate the vicinity with the anaesthetic. Once my target is fully frozen (does this hurt? – poke, poke) I’m ready to proceed.
Dude, Where's My Stethoscope? Page 15