by WD Clarke
‘To impact’ had even slipped (if this admission is not too too much of a strain on credibility) into Dr. Ed’s own usage. At meetings with the heads of other, less well-endowed departments, he would hear himself employing the verb as part of a strategy of empathetic truth-evasion, uttering such harmless little fibs as: ‘Make no mistake: these funding claw-backs have impacted the functionality of everyone in this room; we’re all in this together, here’. Similarly, ‘Your dosage has been ratcheted skywards in the past two months—how has this impacted your self-esteem?’ was something he might slip into standard doctor/patient chitchat, just to keep things up-close & ‘personal’. And just the other day in the staff lunchroom, he had tried ‘the Bengalis really impacted the Bears big-time, eh?’ (followed by ‘What was the final score? I had to dash to the can….’), albeit unsuccessfully, on ‘the Guys’ from Emerg.
‘Do-able’ (or—naturalizing it by dropping the hyphenation—‘doable’), however, was different. Whereas to his discriminating ears ‘to impact’ sounded ‘classy’, ‘do-able’ sounded … well, ‘brassy’. While ‘to impact’ communicated a certain, no-bull***t intelligence, ‘do-able’ smacked of philistinism = bad taste + new money, a nasal, leather-look arrogance, & etc. However, so far as Dr. Ed knew (which, admittedly, was not all that far, and extended only to a few members of his social circle, which was admittedly a small one) he was one of the first Canadians to document this neologism’s infestation of the continent.
Like so many other pesky nuisances (e.g. fire ants, killer bees, the career of George W. Bush), it had first arisen in Texas. He had first spotted it, again, at a conference, this one on the psychopharmacology of erectile dysfunction at Texas Christian University (home of the Horned Frogs). He’d linked up with a colleague from Med School days, who’d suggested a quick side-trip east to Tyler in his rented Cadillac Eldorado. The colleague was a running fanatic, and was entering the annual Tyler Rose Festival 10 kilometre footrace. He advised Dr. Ed to position himself at about ¼ mile from the finish line, so as to be ideally situated for the final sprint. This Dr. Ed did. The winner, from Kenya, took quite a bit less than half an hour to complete the course and claim his prizes ($5000 cash and a year’s supply of chicken-fried steak at Fat Man & Little Boy restaurants state-wide). His colleague had told Dr. Ed to look out for him ‘on or before the 40-minute mark’, which would be for him a ‘PB’, or a ‘Personal Best’. He made good on this prediction, and went by Dr. Ed at 38:12 by Dr. Ed’s watch, looking, in Dr. Ed’s estimation, fairly strong. Moments later, however, a tall, spindly-looking Texan in a headband and a 1970s Adidas t-shirt (next to a bubba in a t-shirt that sported a marijuana leaf above a slogan which read: ‘Your TexAss is Grass’) struggled apoplectically by, and someone in the crowd shouted out at him: ‘40 minutes, Hal! Do-able, bud, do-able!’ One year later, Dr. Ed first heard its use back home, at University Hospital, in an elevator. It was sprinkled into a conversation between two gastroenterologists regarding a breakfast cereal company-sponsored study on the development of colo-rectal polyps. The plague had arrived.
Damnitall, something was surely up. Max, out with his wife, back later? The only do-able hypothesis was that his wife had taken Max with her out of some kind of sense of duty, on some kind of charity mission; and that Max had gone along for the ride, had gone along with her because he’d had to. The only possible reason for his Max and his wife to spend any time together was … an emergency! Something had to be wrong with Max! G-ddammit, his wife had taken Max to the vet’s, he knew it, he just knew it! Jesus Christ, why didn’t she call and tell him?
9
2 Chocolate Freak-outs
The Clichés hit him hard, where it counted—below the belt—like a ton of bricks. Insult super-positioned itself atop, as it were, injury, leaving Dr. Ed in a state: leaving him in such a state that, he now realized, he was quite beside himself. And though it had been years since he had ‘felt’ that any such stock phrases could possibly apply to him, by his own admission he had to admit that any and/or all of them did, now, tonight. And how. And more. He was, he recognized in a bad way. The long and the short of it was that in the process of falling apart, he had gone to the dogs. If he’d seen it once in his practice, he’d seen it a thousand times. But not as regards himself, no, of course not, at least not since … why, since 1967.
First of all, he’d gotten all hot under the collar, had worked himself up into a sweat until he was in quite a substantial lather. He’d then ran his motor, flipped his lid and blown his cool, subsequently blowing several fuses and at least one gasket, which in turn induced him to blow his stack as well as his top. Finally, he cracked, came apart, went to pieces and just plain blew up. He hit the ceiling. He hit the roof.
At this point, his nerves were so bad, he was unnerved. Unnerved, unmanned, unstrung; unstuck, unglued, undone—something, some thing had got a tenacious hold on his nerves and twanged, frayed, frazzled, jangled them. It had shattered them. But then came the jarring, shaking, stretching and rending, which continued unabated—relentless, unappeasable—until he was fairly stricken, shaken even, his hopes both dashed and crushed. In the end, he found that he was completely shot, shot to pieces actually, yet somehow still very much perturbed, and continued to boil over into a flustered swivet of a tizzy. He was in a state, a state of being quite, quite beside himself.
He and Max had been through a lot together, by gosh and by golly, and to lose him now, after only 11 years was … it was un-‘think’-able. Maybe he was wrong, maybe his wife had some other reason for taking Max with her. There could surely have been some other destination than that one?
No, no, no. No, the vet’s was the only doable possibility. His wife had suffered to take Max in the car exactly twice in the past nine years, and both times it had been to the vet’s. Both times Dr. Ed had been away, attending some conference or other, and on both occasions a depressed and lonely Max had tunnelled his way out from under their backyard fence, situations whose very nearly disastrous outcomes had forced his wife to act decisively on Max’s behalf.
The first time, Max had run across the road and collided sidelong with the Dickie Dee ice cream boy, who was pedalling his wares down the sidewalk opposite their house. Max had succeeded in catapulting the lad over his handlebars and into a telephone pole, giving him a severe concussion and 3 broken ribs, one of which came perilously close to puncturing his left lung. Max had himself been knocked out cold, leaving Dr. Ed’s wife to suspect and hope that the collision had been fatal. However, Max had subsequently regained consciousness at the vet’s a half-hour later, coming through the trauma like a trooper, completely uninjured.
The second incident had involved an intimate encounter with a porcupine. Max was in no immediate danger, the vet had told her over the phone, but he advised her against waiting until her husband’s return to deal with nearly two-dozen barbed quills lodged in the poor dog’s nose. The dog was, he said, most likely in a considerable amount of pain, and the wounds could easily become infected.
Accordingly as well as somewhat reluctantly, Dr. Ed’s wife had put Max in the rear of her Suburban, and had proceeded to drive him the mile or so to the animal hospital. Just before the parking lot, Max, who had been staring intently out of the left side rear window, spotted a Yorkshire Terrier being led to the vet’s front door from its owner’s car on one of those retractable 20-foot leashes. Max had then abruptly jumped into the front seat and onto Dr. Ed’s wife’s lap, causing her to veer off the road, over the curb and onto the vet’s front lawn.
Afterwards, a plethora of orthopaedic specialists had each, in succession, given Dr. Ed’s wife a clean bill of health. She insisted, however (and continued to insist, to the present day), on unspecific, shifting, intermittent and yet very real neck pain, and stepped up her number of weekly chiropractic visits from one to three. The Yorkshire Terrier was quite a bit less fortunate, having been killed instantly by the Suburban’s oversized 17˝ right front tire. Upon his return, Dr. Ed hastened t
o offer its owner a replacement Yorkshire puppy as well as $5,000 for her ‘emotional trauma’. He paid for the replacement of the vet’s lawn sign and for his wife’s front bumper and left front fender out of pocket, to avoid the inevitable hit to his insurance premiums.
But something was up, something was wrong, wrong with Max; Dr. Ed could ‘feel’ it in his bones. Of course that was just a metaphor, but that’s just what it ‘felt’ like: he could ‘feel’ it in his bones, and as a consequence he could ‘feel’ the adrenaline entering into his blood, doing its thing to both body and ‘mind’. He knew, intellectually, the pathways and reactions involved, but intellectual awareness was of little use here, just now.
Dr. Ed panicked. And then Dr. Ed did what he always did whenever panic had him (which was hardly ever) in its ratcheted grip: he went on a doughnut run.
It was still early evening, and he had at least a couple of hours to kill; he knew that his wife—and Max, of course—would not be back until well after nine, until well after the mall’s doors had been locked behind her. She’d have taken Max to that new VetPlex out by the Auto Ranch on her way to the Town Centre (which was neither in the town, proper, nor at the centre of anything, at all), he was sure. She would’ve gotten Max in&out of the vet’s, and would have left him in the Suburban so that—he knew her routine—she could maximise the time available to do her thing, with Dr. Ed’s money. To save time she’d have eaten in the food court, he predicted, at Wok Fo Yu, perhaps, at Git ‘R’ India, or at The Meating Place—or, if she was back on her diet, at Frumpy’s (‘in motion with fresh food notions’). Not that he cared, not that he was missing dinner: Dr. Ed made all his own meals, anyhow.
Dr. Ed pulled into The Donut Hole, ordered a milk (extra-large, plain) and a half-dozen doughnuts: 1 Double Chocolate Iced, 1 Chocolate Sour Creme, 1 Chocolate Filled, 1 Chocolate Glazed, and 2 Chocolate Freak-Outs (a limited-time-only premium item, costing 10¢ extra apiece, it was a Chocolate Sour Creme Cruller that was Filled, Iced, and then Glazed). He ordered it all ‘to go’, but sat down and ate them in the store, shrewdly leaving the 2 Chocolate Freak-Outs, as well as most of the milk, for last.
He was just about to tuck into the first of these when the call came through on his pager. Table-talk in his vicinity (to his right, a boyfriend/girlfriend spat concerning whose body was more juicin’—today’s Sun’s page 3 girl or page 63 boy; to his left, a pensioner performing a dramatic monologue concerning his late wife’s manifold shortcomings; to his front, 3 teenaged males exchanging the derisory snorts and valedictory grunts of caveman sportspeak; to his rear, a mute husband-and-wife pair, staring with complacent inertia into their double-doubles) stopped abruptly, all eyes turning toward Dr. Ed.
Historically, doctors used to be able to rely on their pagers to successfully broadcast their privileged social stature to the world, for, not so very long ago, it was only doctors who carried them. No More. Nowadays, the presence of a pager suggested that a man like Dr. Ed could easily be taken for any number of things: a plumber, a drug pusher, a real estate agent, a delivery boy….
This drizzle of mildly curious attention hardly fazed Dr. Ed, who lifted up his pager to squint at its tiny liquid crystal display. It read:
CALL DR. PETE LA
FRAMBOISE EMER
G 776-2323
—Huh, Dr. Ed ‘thought’ with mild surprise, for this had happened before, though not frequently. One of my patients.
10
Re: Mrs. Missy Plumtree
Background
Missy Plumtree (née Watt), D.O.B. 06-06-68, had been first admitted into care on 08 December 1992. At that time she was a doctoral candidate in English Literature at the university, and had no prior history of clinical depression—or of any other psychiatric disorder. Her husband of six months, Mark Plumtree, an electrical engineer and major in the Royal Canadian Signals Regiment, currently describes her as ‘bright, mercurial, vivacious’. Her mother, Mrs. Harriet Watt, recounts that Missy, an only child, had been ‘cheery and outgoing’ as a young girl, but became ‘bookish and introverted’ and ‘given to moods’ in her teens. These periods of emotional volatility usually persisted from 12 to 24 (and, occasionally, to 36) hours ‘or so’. Mrs. Watt’s term for these episodes was ‘the Grumps’, an affliction apparently shared by her father, the late Francis Watt. Mrs. Watt maintains that Missy had been (and currently remains) unaware of the circumstances surrounding her father’s death, and that her daughter believes that her father died of heart failure.
Francis Watt had been deceased for 6 years when Missy was first referred to University Hospital by her family physician. Mrs. Watt described her late husband as a ‘strict but loving’ father, and his relationship with his daughter as ‘normal’. Mr. Watt had been a high school science teacher, and encouraged his daughter’s precocity, facilitating the acceleration of her studies to the extent that she graduated from secondary school at 16 years of age. Missy enrolled in computer science at the University of Waterloo, but upon the death of her father in the fall of 1986, abruptly terminated her studies. After a 6 month hiatus she transferred to English Literature, in which she received an honours degree with first class standing. She moved to her present address in 1989 in order to commence graduate studies in that subject, was awarded an MA in 1990, and continued on with her doctorate on a SSHRC federal research grant.
She had celebrated her marriage to Major Plumtree in May of 1990, just prior to completing her comprehensive exams. Thereafter, she was commencing work on her dissertation when, according to her husband, her alternating periods of depression and elation began to become somewhat exacerbated. She was admitted to the psychiatric unit at University Hospital in December of 1992 by Major Plumtree, who had found her at the municipal airport attempting to book a ticket to northern Ontario. When Major Plumtree suggested that Missy accompany him to the hospital Missy replied that she would kill herself if she were forced to do so, but eventually relented.
The admitting physician, Dr. Michael Tannenbaum, described her in his notes as ‘uncommunicative but clearly agitated’, and that her only statement during the initial interview was a muttered complaint of ‘being controlled and manipulated by her husband’. Dr. Tannenbaum suggested a 72-hour stay in the hospital, to which Missy assented, and she was immediately prescribed 900 mg of lithium daily (note: creatinine satisfactory as serum concentrations reached 0.9-1.1 mmol/L in subsequent blood work) as well as given a course of lorazapam—8mg (2mg bds + 4mg hs) for manifest agitation and anxiety. Missy continued with Dr. Tannenbaum for 9 months thereafter as an outpatient, during which time she had ceased all work on her dissertation and had clearly slipped into a state of clinical depression. Dr. Tannenbaum then referred her to the Alba Phase 1b trial.
Preliminary Interview 27-09-93
Missy Plumtree is briefed on the randomized, blind dosage allotment process [Missy = 3rd quartile], as well as on the anticipated therapeutic benefits and possible side effects of Alba. She agrees to the terms and conditions of this study, and certifies that she is not currently taking any other medications. She agrees to a weekly monitoring of blood levels as well as a bi-weekly interview with a member of the clinical trial team. She is not currently pursuing any form of psychotherapy or counselling outside of the clinical trial and agrees to refrain from doing so until the completion of the trial. She signs the patient contract and waiver stating that the terms and conditions have been explained to her in full and that she agrees to abide by them. She is then given appointment dates for 27 blood level tests and 13 interviews for the following 27 weeks, to end on March 31, 1994. She is taciturn and somewhat distrustful in manner, but complies with requests readily, and appears somewhat optimistic that Alba will produce a salutary effect on her mood. Prescription is written for 30mg 1x/day, renewable bi-weekly.
Clinical Interview #1 12-10-93
Missy’s blood levels appear to have stabilized at 58 and 60 μg/ml, within estimated normal range. She does not appear to be suffering from any side
effects at this time, nor has she experienced any improvement in perceived outlook. She is informed that while side effects usually appear within 48 hours, improvements in mood are to be expected within 2–4 weeks. She is encouraged to discuss her situation whenever it feels appropriate to her. She assents to this suggestion, but does not engage in dialogue.
Clinical Interview #2 27-10-93
Blood levels remain stable, at 58 and 61 μg/ml. Still no change in perceived outlook, but Missy is reminded that this is statistically normal, and that there is a projected 70% probability that she will see an improvement inside of 6–8 weeks. Missy relates that she has been fighting with her husband, but declines to elaborate. Mildly probing questions receive no response.
