Will A.I. Steal Our Jobs?

Introduction

One of the great things about Artificial Intelligence is how well it drives hype. The media, instead of just delivering bad news about yesterday and today, can now get us really excited—and worried!—about the future. One of the most potent forms of this hype is the widespread suggestion that many of us may lose our jobs to A.I. (My mother-in-law was asking me about this just the other day.)

In this post, I’ll examine the topic. I’m not an expert on A.I., but I’m confident that my credentials as a male will serve me well in mansplaining this to you, regardless of your own sex. And actually, I’ve been blogging about A.I. for over ten years, having produced over a dozen posts (linked at the bottom of this one). I’ve even done some light research for today’s topic. I’ll wrap up by telling you what I think ought to be a much larger concern around A.I. than job preservation.

Which jobs?

Before I can answer your question, “Will A.I. steal my job?” of course I’d have to know what you do. Obviously I can’t just ask, so I’ll have to make some assumptions. I suspect you’re a college graduate to even be visiting albertnet, because my blog posts are long and difficult. Moreover, I researched the most common jobs in America for the non-college educated, and the results—which include “fast food and counter workers,” “home health and personal care aides,” and “stockers and order fillers”—wouldn’t leave any employee with enough energy to plow through this much text.

So, with that assumption in mind, I’ll go with the top five careers for college graduates based on current labor statistics. I’ll also cover the classic professions: medicine and law. It doesn’t matter if your career isn’t any of these; what I cover should be illustrative examples.

The top five careers

The five most abundant job prospects for new graduates in America, according to the U.S. Bureau of Labor Statistics, are as follows (along with the number of openings per year, average, for 2020-2030):

1. General and operations managers          229,600 openings
2. Registered nurses                                       194,500
3. Software developers & testers                  189,200
4. Accountants & auditors                             135,000
5. Elementary school teachers                     110,800

I’ll explore, briefly, each of these careers in turn, before going on to doctors and lawyers.

General and operations managers

Now, I don’t know exactly what this rather general label means, but clicking on the BLS hyperlink for it takes me to a page describing what executives do. The summary is that they “plan strategies and policies to ensure that an organization meets its goals.” This would be very difficult for A.I. to do, because it cannot form opinions, doesn’t have the ability to effectively promote ideas and inspire people, and couldn’t have any clue about navigating office politics. The managers and executives at my company do a lot in person, which attests to the company’s conviction that this is necessary (vs. telecommuting). A.I. cannot, needless to say, do anything in person. It produces rivers of text on any subject by regurgitating gobs of highly masticated learning data from across the Internet, but this has nothing to do with forming and fostering creative ideas.

Much of the tech world, in my personal experience and as chronicled widely by the media, is devoted to “disruption”—that is, coming up with a completely new idea that turns existing business models on their heads (like Uber did to the taxicab industry). A.I. is often employed, tactically, in such disruption, but it cannot drive it the way an industry leader does. A.I. is very good at certain tricks, but it’s not good at visionary thinking because it literally lives in the past. (Consider that ChatGPT’s training data hasn’t had an update in over two years, by its own admission.) I think managers and executives can rest easy here (so long as they keep their companies poised at the leading edge of the A.I. zeitgeist).

Registered nurses

I think we can all agree nursing is a hands-on occupation, and for that you need actual hands. But you don’t have to take my word for it. I just asked ChatGPT, “Can you please change the dressing on the laceration on my right leg?” and it swiftly replied, “I’m not able to provide physical assistance or medical care as I am a text-based AI language model. It’s crucial to seek help from a qualified healthcare professional for proper wound care.”

Software developers and testers

The full title of this occupation is “Software Developers, Quality Assurance Analysts, and Testers.” Everyone knows what software developers do; as for the others, the BLS writes (here), “Software quality assurance analysts and testers identify problems with applications or programs and report defects.”

Let’s start with developers. I interviewed a friend of mine on this, who is a manager and software developer specializing in A.I. for an extremely well known tech company. Not only does he know all about developing software, but he knows lots about A.I. He started off by saying that ChatGPT is actually a powerful tool in the hands of a good developer, and can lead to much greater work efficiency. ChatGPT can provide blobs of code that do a specific thing, but of course this is only a small part of the job of a software developer. The developer is essentially a problem solver and has to figure out the right approach to doing so. In theory, the increased efficiency that A.I. enables could reduce the number of jobs, since doing everything faster means needing fewer hands. But, my friend advised, this would only be true if there were a finite number of problems to solve. In fact, the number of problems, and the number of projects, and the number of innovations, are infinite, and it’s a company’s job to tackle enough of them to keep an ever-growing number of developers busy. So not only will A.I. not replace these jobs, but it won’t diminish the number of them.

Moving on to QA analysts and testers, I believe their jobs are equally secure. Have you ever done a CAPTCHA—that simple task of, for example, looking at a 3x3 grid of thumbnail photos and counting the number of traffic lights? That’s a website’s way of making sure bots don’t impersonate humans. CAPTCHAs work because A.I. is stymied by graphical user interfaces (GUIs). So it wouldn’t be able to test software, or at least the type used by humans (which is a whole lot of it). Moreover (and I know this from my own professional experience), software testing is all about how straightforward and useable an interface is to a human. Testers need to be able to imagine the perspective of the human who will use the software. A.I. lacks this capability; although it can mimic human thought or impression, it has no grasp of these things; it’s essentially autistic.

Accountants and auditors

Okay, I’ll confess I’m kind of out of my depth here. I gather that accountants balance the books, and auditors keep the accountants (and everyone else) honest, but that’s about all I know (or care to know). I will say that obviously accuracy is the name of the game here, which is where A.I. needs to be handled carefully. As you probably know, generative A.I. platforms, such as the GPT-3.5 model that drives ChatGPT, are prone to “hallucinations”—where they basically just make shit up and present it as fact. The poster child here is the case (described by the New York Times here) of a dumbass lawyer who used ChatGPT to prepare an argument in a court case, and got into big trouble because his argument cited half a dozen previous relevant court decisions, all of which were pure fabrications—ChatGPT had pulled them out of its ass. As the Times dryly concluded in its article, “The real-life case of Roberto Mata v. Avianca Inc. shows that white-collar professions may have at least a little time left before the robots take over.”

Elementary school teachers

It’s pretty clear that the education of elementary school kids needs to happen in person. Countless articles about the result of distance learning during the COVID-19 pandemic recount how far behind students fell. For example, according to this article, half the nation’s students began the 2022-2023 school year a full year behind grade level due to the poor education they’d received during the lockdown. Granted, there was a lot more going on during the pandemic than just distance learning, but if there was one thing Americans could agree on during that time, it was that in-person instruction needed to come back.

Until we have sophisticated, affordable, and ubiquitous animatronic robots, A.I. simply cannot provide in-person instruction as we know it. It’s just a digital tool, not at all what kids really learn from. And robots will never be people, with personalities. Elementary school teachers connect with students, draw them out, encourage them, understand their struggles, and have firsthand knowledge of how humans learn. A.I., of course, has none of this. As described here I tried to teach ChatGPT how to write a proper poem (in terms of a specific meter) and it confessed, “As an AI language model, I do not have the ability to practice or improve my skills in a traditional sense.” All it can do is ingest troves of training data and reference them later. It cannot relate to the human effort to learn. It cannot come up with creative strategies for connecting with kids. Also, it would never settle for the piss-poor salaries paid to elementary school teachers. (Yes, that was a joke. Another thing A.I. can’t really do.)

Doctors

Having completed the top five careers for college graduates, I’ll now move on to a field that affects us all: medicine.

As with nursing, medicine obviously needs to be hands-on. My doctors (and physical therapists) have all relied heavily on touch and (literally) feel in evaluating and diagnosing injuries and health issues. Meanwhile, the important dialogue I’m able to have with them about my health requires advanced “soft skills” far beyond what A.I. could get from training data. The reason I even entertain the notion that A.I. could replace doctors is that I’ve read, here and there, about how well A.I. does interpreting radiology images. I just did a little refresher research and found in this article that it still isn’t as accurate as a human. Moreover, as the article attests, “radiologists are more than just interpreters of images. They connect the findings from imaging analysis to other patient data and test results, discuss treatment plans with patients, and consult with their colleagues.” Meanwhile, the A.I. that performed well had been trained on billions of images from the public Internet, whereas “radiological datasets are also often guarded by privacy regulations and owned by vendors, hospitals, and other institutions”—meaning that advancements in A.I. in this industry will lag behind that of autonomous vehicles or retail.

I interviewed a friend who’s a medical doctor and his dismissal of A.I. as a threat was pretty curt. Alluding to its tendency to hallucinate, he mentioned how poorly the patient community would react the first time A.I. casually told a relatively healthy patient, “You have twelve months to live.” And though I suppose we could entertain the idea of a robot doing a fine job with a surgery, what happens when it hallucinates? “Mr. Smith, I have some good news and some bad news. The bad news is, instead of a pacemaker I accidentally installed an ice maker. The good news is, if I pull on your ear you’ll cough up an ice cube.”

Lawyers

What is the output of a lawyer? I don’t work in this field, but I think it’s fair to say the two main outputs are documents and spoken testimony. Let’s start with the latter: A.I., lacking a human presence and thus the ability to provide moving verbal testimony, probably wouldn’t do well in a courtroom. What would that even look like? A person simply standing up and reading an A.I.-generated testimonial? How would A.I. negotiate? What would its powers of persuasion be like? Do you agree we could rule out its ability to testify effectively in a live environment?

If so, let’s move on to documents. A.I. does seem really good at spewing forth gobs of text on pretty much any subject. Now, as I recounted earlier, it does have this little problem of providing fictitious citations as legal precedent, and since nobody really knows how A.I. works there doesn’t seem to be an easy solution on the horizon for such hallucinations. But that’s not its only problem.

Unless I’m just hopelessly naïve, the practice of law requires the ability to delve into complexities and tease out the legal basis for one’s position—the point of law on which the case can turn. This is why law school and the bar exam are required, right? Well, how good is A.I. at this kind of analysis, really? I haven’t fed it any legal quandaries to chew on because I don’t have any, but I have experimented with trying to get it to explain something similarly abstract: dramatic irony. How did it do? As detailed here, it totally crashed and burned. Not only did it betray a total lack of understanding of what irony is (though it can spew out a canned definition of it), it fabricated evidence from a children’s book in explaining instances of it. It was just swinging wild, and did shockingly badly. Make no mistake: ChatGPT can assemble basic (if torturously verbose) sentences out of building blocks of reconstituted training data, but it still doesn’t analyze anything in any useful way.

For my family holiday newsletter this year, I sent out a quiz. I asked fifteen questions about what my family did in 2023, and put an A.I. spin on it: for each question, one multiple-choice response was true, another was generated by ChatGPT, and the third was a lie I wrote in the style of ChatGPT. Most of the recipients were able to identify most of the correct responses, but very few were able to reliably determine which of the other responses was A.I. vs. my mimicry of it. In other words, ChatGPT was very bad at pretending to be human, but I was very good at pretending to be ChatGPT. Trust me, humans are still better at actual thought.

What we should be worried about

So what is A.I. really good at? Well, I’m sorry to say, I discovered recently that it’s phenomenally good at faking photos. I took this brief quiz in the New York Times asking me to identify, out of ten photos, which were real and which were fabricated by A.I. I did horribly, getting just 3 out of 10 correct. The friend who turned me on to the quiz scored only 2 points. My daughter and her friend both scored 4, and my wife got 5 right (which is the same as guessing at random). The quiz was based on a scientific study which found that the vast majority of participants were misled by the A.I. fakes. For four of the five fake photos, 89 to 93% of participants erroneously labeled them real. For four of the five real photos, 79 to 90% of participants erroneously labeled them fake.

Fortunately, I don’t think very many of us are employed in a field where generating fake photos is a big part of the job. That being said, the ability of A.I. to fool people is very disconcerting anyway. Referring to one of the study authors, the Times article declared, “The idea that A.I.-generated faces could be deemed more authentic than actual people startled experts like Dr. Dawel, who fear that digital fakes could help the spread of false and misleading messages online.” Indeed, when deployed by bad actors, this A.I. capability could wreak havoc on the public discourse, further befouling the already squalid troll-o-sphere and perpetrating pervasive new acts of societal vandalism. So let’s be careful out there…

Other albertnet posts on A.I.

• I, Chatbot
• Almost Intelligent – Part I
• Almost Intelligent – Part II
• Smartphones & Artificial Stupidity
• A.I. Smackdown – Moto vs. Cortana vs. Siri
• Could Artificial Intelligence Replace Writers? – Part 1
• Could Artificial Intelligence Replace Writers? – Part 2
• Could Artificial Intelligence Replace Writers? – Part 3
• A.I. Smackdown – English Major vs. ChatGPT – Part 1
• A.I. Smackdown – English Major vs. ChatGPT – Part 2
• Schooling ChatGPT
• Tech Check-In - How Good is the Latest A.I.? - Part I
• Tech Check-In - How Good is the Latest A.I.? - Part II
• What is ChatGPT Great At (and Not)?
• Tech Reflection – Two Sides of AI
• AI Smackdown – ChatGPT vs. Copilot vs. Gemini
• More AI Smackdown - ChatGPT, Copilot, & Gemini Write Poetry

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Email me here. For a complete index of albertnet posts, click here.

Everything You Wanted to Know About Getting A Colonoscopy - But Were Afraid To Ask

Introduction

I recently had my first colonoscopy. I know a bunch of people my age who ought to have had theirs as well but are procrastinating. If you’re fifty or over and haven’t had yours yet, read this to know what to expect (and consider this your wake-up call). If you have had one, what better way to commiserate and have another good laugh at what you’ve been through? And if you’re not fifty yet, this’ll be a good dose of schadenfreude and a sneak preview of what you have to look forward to.

What is a colonoscopy?

A colonoscopy is a procedure a doctor carries out to screen you for colon cancer. Colon cancer is the third leading cause of cancer deaths. The lifetime risk of getting it is 1 in 23 for men and 1 in 25 for women. Early detection is key. Colorectal polyps are fairly easy to find and remove before they can develop into cancer. Details here.

What exactly is the colon?

The colon is one of those weird organs down there in your guts. It removes water from digested food and creates stool, which it conveys to the rectum. As this is already getting gross, I’ll leave it at that.

How does the doctor see in there?

Doctors have got a “back door” they use, through which they thread in a camera the size of your finger.

Which finger?

I forget. To be honest, I haven’t dwelled on that, for obvious reasons. But in all seriousness, the process is a hell of a lot less invasive and awful than chemo, surgery, etc.

Who should get a colonoscopy?

Anybody over fifty should get one, plus anybody with other risk factors like family history of colon cancer, or trouble with digestion, or if a doctor recommends it for any other reason.

Is there any legitimate excuse for a person over fifty not to get a colonoscopy?

Of course not. Don’t be lame, just get it done. As you’ll learn from this post, it’s really not that bad.

What is the preparation for a colonoscopy?

For a week, you have to eat refined food like white rice, white bread, pasta, etc. instead of good high-fiber stuff like whole grains, brown rice, beans, etc. (So, for a week you get an interesting tour into how so many clueless Americans eat.) Also off-limit are seeds, nuts, popcorn, iron, fish oil, and vitamin E. Then, 24 hours before the procedure, you’re not allowed to have any solid food. You can have light-colored juices or broth, or even Jell-O (but why bother)?

The other thing you have to do is completely remove every particle of food, and its downstream waste products, from your system. You do this by drinking four liters (more than a gallon!) of a prescription laxative drink.

Is this pre-op process straightforward and well-documented?

Well, that depends on where you’re having your colonoscopy done. The place I went to sent me a big packet of paperwork, and then I got a phone call saying, “We screwed up your paperwork so we just sent out a second batch. When you get the first packet, throw it away. Only read the second packet.”

Well, I received both packets on the same day so I had to figure out which was the evil twin. One set of documentation failed to specify when and where the procedure would take place, and who would perform it, though it did include a “Visit Date” that was wrong. The other packet at least had the procedure date, time, and location, though it also had a (different) wrong “Visit Date” listed. It also provided the doctor’s name, which was helpful, though it also provided a second doctor’s name that was wrong.

I called up to ferret out which packet was the correct one. Turns out, the packet lacking the when-and-where information was actually the right one. Having sorted this out, I requested clarification about the timing of the laxative drink, GoLytely. The directions say to drink 8 oz. every 10-15 minutes, and to “Take 1st dose (1/2 gallon) at: 4pm the day before” and “take 2nd dose (1/2 gallon) at: 5-6 hours before the procedure.” Well, my procedure time was 8 a.m. Did this mean I had to get up at like 1:30 a.m., and then roust myself again every 10-15 minutes until done, to finish 5-6 hours before, or do they mean at least 5-6 hours before? I asked if I could just be done with all the drinking—and its explosive result—before bed. (No, I didn’t put it so bluntly.) The gal answered, “Uh, well, um, I think … yeah, before bedtime should be fine … just, uh, go with that.” She really didn’t inspire confidence.

I called my big brother for a second opinion and he said, “Yeah, I got up every ten minutes for half the night—it was a total drag!” Keep in mind that you’re not just drinking this gross drink. You’re also rushing to the toilet. So this timing thing is important, and I’m here to tell you from personal experience, getting it all done before bed (in my case midnight) is A-OK. The doctor’s office didn’t send me away for incomplete evacuation, which had been my greatest fear (this having happened to someone I know).

Is the laxative drink really that disgusting?

At no point did the gag reflex kick in. That said, it’s pretty damn disgusting, perhaps even more so than bong water (but at least you’re braced for it; I’m pretty sure nobody has ever drunk bong water on purpose, at least no resolute non-pot-smoker like me). Here is a video of my very first 8-ounce shot of GoLytely:

It may or may not help to mix it with the flavor packet. I was on the fence about this, and my decision wasn’t helped by the packet instructions, which clearly say “Not for direct dispensing to the patient,” as thought the pharmacist is supposed to mix the flavor packet with the drink powder before I leave the pharmacy. Could there possibly be any skill involved in this operation? I can’t imagine, and yet the instructions are very clear on both the packet and the jug of drink mix:

The lemon powder smelled like that disgusting Country Time Lemonade mix. If I did decide to flavor my drink, I pondered, why limit myself to the lemon option? I could mix in the flavor packet from some Top Ramen, to have, like, shrimp flavor, or beef, or a combo. But ultimately I decided to drink it neat.

The first flavor to hit my tongue was like someone else’s saliva, but salted and slightly fizzy as though fermented. Then the aftertaste hit me like a thump: very chemical-tasting, like bleach or solvent. So yeah, GoLytely really is gross, but again, nothing that would make you hurl. The problem is, you have to drink nine 8-oz. glasses of this, ten minutes apart, for the first “dose” (i.e., session), and then, hours later, another eight 8-oz. glasses of it, so it gets mighty old.

By the way, my instructions didn’t tell me how many glasses to drink in the first “dose” so I had to do the math myself:

You said something earlier about the “explosive result” of this beverage. Can you elaborate?

Well, over an hour into my first “dose,” when I’d had eight 8-oz. glasses (i.e., 64  oz, almost two liters) of the miracle elixir, nothing had happened yet. I texted my brother with this worrisome update, and he wrote back, “Oh boy. Just you wait!” He wasn’t wrong. Five minutes later, I decided to take the throne and see if anything would happen. I’ll spare you the details, but an hour later I was still there. The word “hydrant” isn’t exactly right, but it’s close.

Hours later, after the second round of GoLytely, I again started feeling some serious stirrings down there, and suddenly (oddly) started to shiver. I ran for the bathroom, up a couple sets of stairs, with all the urgency of an action hero fleeing a building that’s about to explode. I made it just in time … it was so close I didn’t have a chance to close the door. My wife, from one nearby bedroom, and my daughter, from the other, burst out laughing simultaneously upon hearing the whooshing sound. If you don’t think this all sounds pretty funny, click this link immediately, and go read that post, before continuing with this report.

How will I know I’m ready for the colonoscopy procedure?

Trust me, if you’ve completed all four liters of the laxative, you’ll be ready (so long as you didn’t “cheat” and eat anything in the 24 hours before your procedure time). The official directions imply that you don’t need to drink all four liters if you have “clear rectal discharge,” but I find this to be a) gross, b) a needless thing to determine, and c) a great name for a rock band.

All this being said, in my case I can report that after my last toilet visit (which was, remarkably, at like 5 a.m., over five hours after my last glass of GoLytely), it looked like I’d only peed. So complete was the elimination, I lost four pounds. That’s after drinking about nine pounds of GoLytely. Do the math…

Will the nurses be hot?

This is a dangerous question to answer, but arguably the most important one in the entire report. Needless to say, your mileage may vary, but in my experience, these nurses were considerably hotter than the one who helped with my vasectomy. Perhaps this is by design … to encourage periodic colonoscopies, they’d want to make the whole ordeal as pleasant as possible, whereas with a vasectomy nobody wants to instill the wrong kind of, uh, attention.

Will I unexpectedly get disqualified from the procedure and sent home?

As touched on earlier, if you don’t follow the instructions and evacuate your system, you could be sent home. Other than that, I guess the only problem could be if your vital signs don’t look good. I had a tiny glitch in this department. After taking my vitals and wandering off, the nurse came back and said, “Um, are you a very active person?” At first, given recent events and current circumstances, I thought she was referring to my bowels. But then I understood, and said, “You mean, working out a lot? In that case, yes.” She replied, “Okay. I ask because your pulse was only 45 so we thought you might be on some … medication.” I assured her 45 bpm was normal for me, and it was smooth sailing from there.

Will they stick me with a big needle?

Of course they will, it’s a doctor’s office and you’re there for a “procedure!” They run an IV to administer the anesthesia. But they’re total pros. Two nurses discussed which vein to use … not because they couldn’t find a good one, but because my skinny arms presented an embarrassment of riches. “My husband is just like you,” one nurse said. “He’s got such great veins, I sometimes ask him, ‘Can I please run you an IV, just ‘cause it’d go so well?’”

Will they give me a drug to make me forget everything?

This will depend on where you get the procedure done. My brother, when he had his colonoscopy, did get the forget-everything drug (I think it’s typically Versed, aka midazolam) and didn’t like the aftermath … it really messed him up for the entire rest of the day. Myself, I hate the idea of any drug (even alcohol) messing with my memory. My brother mentioned that some people need colonoscopies somewhat frequently, and opt to skip the Versed. So I asked my doctor about this before the procedure, and he said they don’t use it anyway, and that the anesthesia I’m getting wouldn’t have any post-op aftereffects. “You could go for a run two hours afterward,” he said.

What is the actual procedure like?

They had me roll over on my side. This was probably the worst part because my ass was hanging out of the back of that backwards gown they make you wear, and it was kind of cold. The anesthesiologist warned me that it would hurt a bit when he injected the drug into my IV, but the pain was ridiculously minor, like being whacked lightly with a flower.

I lay there, deeply doubting that I would in fact fall asleep, because no anesthesia could be any match for the cold air hanging over my tuchus. So, preparing to be bored, I let my gaze fall on the patterned curtain a few feet from my face. The curtain seemed so unfamiliar. I wondered, did my wife buy new curtains at some point, and if so how am I just noticing? Moreover, why am I still in bed when I should be heading over to the—oh, shit! I overslept! I missed my colonoscopy and now I’ll have to reschedule and go through the GoLytely purge all over again! Total disaster!

Then I thought, wait a second here. Those are not bedroom curtains. That’s more like a hospital curtain. Oh, and I’m not in bed. I’m … oh, right, I remember where I am. This is where the nurses and anesthesiologist and doctor were getting ready to do the procedure. Meaning it’s over. I must have … slept through it. Just like I was supposed to, duh!

Is there an aftermath?

There was so little indication anything had even happened, I had to take the doctor’s word for it that the procedure had actually been carried out. I was handed a bunch of paperwork, which I only remembered to leaf through a few days later. It covers what they did, what they found, etc. My favorite sentence? “The patient is competent.” That’s the nicest thing anybody has ever said about me. I won’t comment much more about the report or the findings because that’s really none of your business. Plus, there are possibly (sometimes? often?) lab results that have to come back before one can conclude anything for certain.

I expected some physical discomfort after the procedure, but in fact there was none. They’d advised me to break my fast with a small, light meal, but I ignored that. I was starving and had a giant lunch, which went down without a hitch. I will say I was really, really tired for the rest of the day. I highly recommend taking the whole day off of work, as I did, for your colonoscopy.

How do I get home?

This is the one time I won’t tell you to get around by bike. This is also no time to get an Uber or Lyft, or even a cab (if you’re lucky enough to live in a place where you can just hail a cab from the sidewalk like in the movies). The clinic I went to requires that you show up with a chaperon to drive you home. Great idea, because you won’t want to hang around waiting for a ride, trust me.

Do I get a trophy?

What do you think this is, a kids’ soccer team where everyone gets a trophy, even the kids who just stood around? No, you don’t get a trophy. But you can get a certificate from Dave Barry; as he describes here, “If you, after reading this, get a colonoscopy, let me know by sending a self-addressed stamped envelope to Dave Barry Colonoscopy Inducement, The Miami Herald, 3511 NW 91st Ave., Miami, FL, 3317. I will send you back a certificate, signed by me and suitable for framing if you don’t mind framing a cheesy certificate, stating that you are a grown-up who got a colonoscopy.” Now, I don’t know if this offer is still good, or if it’s transferable from “Miami Herald” readers to albertnet readers, but you can download the certificate here and just forge Dave Barry’s signature. I won’t tell!

How long until my next colonoscopy?

Wow, you can’t wait to get back, huh? Well, the rule of thumb is every ten years until you’re about 75 or 80, after which they just put you on an iceberg and give you a nice push. That said, your future colonoscopy schedule will depend on what, if anything, they found the first go round.

This all sounds like a lot of hassle. Are you sure this is really necessary?

I watched a man die of cancer. He discovered his the hard way. Trust me, you don’t want that.

Damn dude, I thought this post was kind of funny until just now. What the hell?

I know too many 50-somethings who have been putting this off. Don’t be one of them. Just get this done, and then we can share GoLytely stories and have a good laugh!

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For a complete index of albertnet posts, click here.

The Femur Report - Part III

NOTE: This post is rated R for mild strong language and disturbing images.

Introduction

This post finishes up the dark story of my broken femur. (Of course it’s still broken, and it’ll be a long road back, but this will be the last time I’ll write about it.) If you’ve stumbled on this post without reading my last two, click here and here to check out my first and second installments.

As I said of my last post, please note that though I’ve reported this episode as faithfully as I can, I cannot vouch for the accuracy of every detail. Especially where vast pain is involved, memory gets distorted. But I haven’t deliberately fictionalized anything and in fact have tried to be as straightforward as possible in the telling.

Surprises

During my third day at the hospital (November 29), my pain only got worse. A nurse arrived unbidden at my bed and announced it was time for some pain killers. At first I was pleasantly surprised—this was the first time I hadn’t had to ask for them—but then I saw him popping two rather large white tablets out of a foil pack. “What are those?” I asked. He replied, “This is Tylenol.” I managed not only to keep from snorting but from saying something snide like, “Do you have any placebos I could use instead?” I kept quiet because I sensed I had little goodwill to spare with these nurses, but really the Tylenol was a joke.

The stretches between the real medication grew longer. I was now getting half the dose I had originally been given, and instead of every four hours it was every six. I overhead a nurse talking about a shortage. The pain had strange characteristics unlike anything I’d experienced before. Instead of the leg just aching and throbbing and giving stabs of sharp pain—though I did have all of these—I also had the sensation that my thigh was as big around as a barrel, and that the bandages running along my three incisions were a quarter-inch thick and made of plywood. My left wrist—uninjured in the crash—was also causing me a lot of pain; a nurse unwrapped the bandage from it to reveal that the whole wrist was a deep purple, with a stripe running along it of an even more saturated hue. Nobody could explain what that was about; perhaps it was a botched arterial line.

I was on the phone with a friend when a nurse came around to inspect me. She didn’t seem to need any input from me so I continued my conversation. Suddenly there was an intense, sharp pain in my male unit and I shrieked (into the phone, of course). All at once, the nurse had yanked out my urinary catheter! The pain was accompanied by a sensation of frightening wetness which I took at first to be blood, but which was actually just some leftover urine. My friend on the phone must have feared the worst and asked what happened. “A nurse just ripped my catheter out!” I told him. She looked at me sheepishly. “Sorry, I figured if I did it all at once it wouldn’t bother you so much,” she said. Sort of the ripping-off-the-Band-Aid strategy, I guess.

Later, another nurse expressed surprise that I’d filled my bedside urine receptacle. “A lot of patients find they’re unable to urinate the normal way after they’ve been catheterized,” she explained. I hadn’t known this and now I was greatly relieved. From this moment forward, successfully peeing into that thing felt like a triumph. In fact, whenever I did it I got Homer Simpson’s voice in my head yelling, “Yes! Yes! Ohhh, Yes!”

Presently the physical therapist arrived for my second session of the day. Again, this consisted of taking a short march, with my walker, from my curtained-off cubicle down the row of other cubicles and back. It was oddly exhausting but I guess I did well enough, for she announced that I’d have one more session the next morning, and if I could manage a short flight of stairs, she would sign me off as complete—meaning I could go home.

This great news was followed by another challenge: after two and a half days, I had to defecate. I steeled my resolve and figured that based on the success of my expeditions with the walker, I could handle the restroom. I’d need help, of course. I asked a nurse, and she responded as if I’d asked her to help me rob a bank. “I’m not allowed to assist you with that,” she said. “You have to get a physical therapist.” Of course I had no way to summon the physical therapist, so I asked for a bedpan. The nurse looked at me with disbelief, as if she’d thought bedpans were a best-kept-secret of the hospital. “A what?” she asked. Nice try. “A bedpan,” I persisted. She stalled for time. “What size?” she finally asked. What answer was she expecting? “Small”? “Never mind”? I told her Large, and a bit later she came back with what I suppose was the large size bedpan, though it didn’t seem very large to me. Not that I was an expert: it had been sixteen years since I’d last seen one, when my brother Geoff was in the hospital. And of course I’d never seen him actually use it, so I had no idea what to do. Not that I was about to ask for a tutorial at this point. I had to wing it.

When I’d done my damage—serious damage, I might add—I found I couldn’t get the nurse to come over. With great effort I held myself suspended over that foul, fouled bedpan for what seemed like a very long time. Finally the nurse came over and I asked for help getting rid of it. She said she’d have to come back. They always say that. I asked her to please hurry.

She didn’t. To make matters worse, a couple of friends had arrived to visit. I could hear them being denied access, based on me being “detained,” and I think I heard them chuckling. And yet the nurse still wouldn’t come back. Finally she showed up, her face awash in reluctance, and she gave an Oscar-worthy performance of having never in her entire career seen a patient actually use a bedpan. Where I was desperate, she was hesitant. The two of us grappled haplessly there, trying hard to keep the sheet from getting soiled during the disposal process. It was like Tweedledum and Tweedledee trying to clean up after a grisly murder. Thus was my last shred of dignity finally expunged.

Visit

As the patient across the curtain from me asked for some air freshener, my friends were finally admitted to my cubicle. They’d come straight from work, which reminded me that there was still a world out there in which people worked in office buildings. Not long after, four more friends arrived—all of these bike people—bearing Zachary’s pizza and (for themselves) wine. Needless to say my spirits were buoyed; actually, I think salvaged would be the better word. At first I didn’t think I’d be able to eat any pizza, as my appetite had been absolutely nonexistent since the previous morning. I had one slice, and then, to my own astonishment (but nobody else’s), had another. Looking back, those two slices and a third one the following morning were almost all I ate while at that hospital.



Of course we all had much to discuss, such as the events I related to you in Part I of this tale. Before long we had a full-fledged, rollicking dinner party going. All this was of course good distraction from my physical pain; when I think of the visit I don’t remember suffering during it. As a bonus, for the first time in two days I couldn’t hear that infernal TV across the curtain in the cubicle next to mine—we were drowning it out. By the end of the visit I was pretty exhausted but was sorry to see my friends go.

My worst night

The evening dragged on and on. There was a violent action movie playing on the TV, four feet from my head. My leg was killing me. My head felt vacuumed out, my mouth completely dry. My mind wasn’t calm enough to allow reading. I was tired of listening to music and didn’t want to ruin any more of my favorite tunes through future association with this bleak time.

Then there was a shrill alarm from a nearby cubicle. I knew what it was, from my brother’s hospital days: an I.V. drip had gone dry, or was on the verge of it. It’s an important alarm, because if an I.V. goes completely dry, the vein collapses and can no longer be used. But what else did this alarm suggest to me, with its absolute ear-splitting, incessant shriek? It took awhile but I figured it out: it was just as piercing and intolerable as a newborn baby crying. That well might have been the design intent of this alarm, just to make completely sure it would be impossible to ignore. And yet, astonishingly, the nurses—all four of them—were actually managing to ignore it. Where were these people? I pressed my call button. Eventually a nurse arrived, looking put-upon. “What is it?” she asked. “Well, are you ever going to do something about that alarm?” I asked. She looked startled, as if she simply hadn’t heard it until now. Unbelievable. (Why hadn’t the patient in that cubicle summoned her? I have no idea. Maybe he was dead, or maybe that cubicle was empty and it was just a malfunction.)

With the shrieking finally silenced all I had to contend with was the sound of people being shot, run over, and tortured to death. The TV movie didn’t bother with music or dialog or anything: just nonstop killing. My wife hadn’t called, and I was getting worried that the hour would come when I couldn’t take phone calls, or that my calls weren’t making it through. I had to tell my wife about the prospect of being released the next day, so she could find somebody to watch our kids while she picked me up. When a nurse happened by I asked her if I could please borrow her phone, just for a couple of minutes, to call my wife. (My own cell phone was with the police, along with my bike and other stuff gathered at the accident scene.) The nurse looked down at the cell phone clipped to her waist, as if it had betrayed her with its visibility. “Well, maybe a little later, when I come back,” she said. Translation: “No, and just to be sure, I’m never showing my face back here again.” (Obviously if she’d been willing to loan her phone to me, she’d have just said yes.)

Suddenly, an object came sailing at me from behind the curtain across the aisle. Amazingly, I managed to catch it. It was a cell phone. “Call your wife,” came a voice from behind the curtain. “Talk as long as you want.” I was filled with a sense of camaraderie with this unseen fellow inmate. I called Erin, made some quick arrangements for my Great Escape, and then asked the nurse very sweetly if she could possibly return the cell phone to its owner.

As I tried to fall asleep I start to feel really, really bad. My pain escalated and my heart was racing. I could hear my pulse pounding in my ears. Meanwhile, the wind was picking up outside and howling right through the leaky windows on my right, chilling me to the bone. I even started to feel delirious: I was having increasing difficulty convincing myself that the screams from the TV weren’t coming from actual people in the next cubicle, and that the wind through the window wasn’t going to spin me off into the night.

Somebody came by to take my vital signs. Every one of them was bad. I had a fever of 102; my blood pressure was crazy high; my pulse was 90 (compared to mid-40s normally). The person taking these readings looked a bit concerned and commented on my fever, but then left. She wasn’t one of the regular nurses. Another hour crept endlessly by, my pain continuing to increase. I was starting to feel frantic. I pressed my call button. A nurse came over. I explained that my pain was through the ceiling and all my vital signs were bad, and that I didn’t feel right. She said, “Well what do you want me to do?!” I said I wanted a doctor. She left.

I started to worry that I was actually going to die. Looking back, this wasn’t exactly rational, but then I was half out of my mind. I had a vision of a sensor moving through the room, beaming a red line that picked up everything and recorded it, and how quickly it would pass over me, how insignificant my form would be. It would register even less then the bed I was in. Moreover, my small existence was confined to the immediate present: the fact that I’ve walked the earth for forty-two years was immaterial, a flash in the pan, and the future was completely up for grabs. If I died right now, I thought, I would be erased so thoroughly I might as well have never existed. It was the closest I’ve ever come to believing in my own mortality.

I pushed my button again. A different nurse came. I repeated my complaints and again asked for a doctor. Instead I got the head nurse, but at least he was sympathetic. He also seemed as disgusted with the other nurses as I was. The first thing he did was give me more pain meds. “You’re allowed to ask for these,” he said. “The nurses have guidelines but they’re only guidelines. They act like they’re rules but they can always consult with the doctor and they know it.” Then he stripped off my bedding. It was all tangled and knotted up, doing me no good. Then he started pulling up and discarding the absorbent pads from beneath me. These pads are basically the same thing as what you get with store-bought chicken, that sit between the chicken and the Styrofoam tray, to absorb drippings. “Don’t let the nurses use these,” he said. “They’re disgusting and uncomfortable.” I couldn’t have agreed more. The guy put my bedding back in shape and gave me an extra blanket.

After that I felt much better—just to have been paid attention to was greatly comforting—but the pain was still awful. So I tucked my blankets in all around myself, thinking of how I used to swaddle my daughters when they were babies. In my delirium my cubicle had seemed to grow and grow, to where it was the size of a handball court, then ever larger, like I was Alice in some Wonderland scenario. I decided to try using these illusory sensations to my own benefit, and imagined I was a little Asian doll, wrapped tightly in a paper dress that was like origami. I held absolutely still in my bed and soon began to feel I was rising up out of my paper-doll body, looking down at it, tiny but perfect in its symmetry. I rode this perception as long as I could and the next thing I knew, it was hours later and I’d actually managed to sleep. My head and body had that vacuumed-out, dried-out sensation and the pain was awful, but morning was that much closer, and it was finally time for more pain meds. I even managed a couple more hours of sleep before dawn, and by morning the TV channel had switched to something merely asinine, rather than ultraviolent.

Final Push

Late the next morning (November 30), the physical therapist returned for my “final exam.” She reiterated the plan: I would use the walker to leave the hospital room, go down a hallway, and stop at the stairs. Then I’d switch to crutches, go up a short flight and come back down, and then switch back to the walker and return to my bed. If I could do all this, I’d be a free man.

It took a great while, perhaps ten minutes, to make it to the stairs. Finally I got to the landing, but suddenly started to feel incredibly dizzy. I told this to the PT, who had me turn so my back faced the wall, and said to lean back a little bit to rest against the wall. She supported me at the waist. I felt dizzier and dizzier.

Suddenly I awoke. Holy shit, where was I? How long had I been out? Amazingly, I was still standing. My vision returned and I saw the PT looking up at me, her face a picture of great concern. There was also a nurse looking at me worriedly. The nurse had brought a chair. “Are you okay?” asked the PT. “Did you pass out?” Imagining another night in this hospital, I lied. “No, I didn’t pass out, I’m okay, just a bit dizzy,” I said. They sat me down in the chair and the nurse slapped a blood pressure cuff on my arm. “You are really pale,” she said. My blood pressure was extremely low. I was taken back to my bed in a wheelchair. Needless to say I’d totally flunked my final exam. But to my surprise and relief, the PT said she’d give me another chance later in the day.

Not long after she left, I got a phone call from an MD friend of mine. Hearing what had happened, he asked how long before my physical therapy I’d had pain meds. I said not long before. He advised that the pain meds can lower your blood pressure and lead to dizziness. Remarkably, another MD friend of mine called not long after, and gave the same advice. So I stopped asking for pain meds, and when the PT returned, a few hours later, I felt more confident. Hedging her own bet, she’d brought a wheelchair. “This time, I’m wheeling you to and from the stairs,” she announced. At the stairs, I got up on the crutches, and heeded the PT’s advice: “Up with the good, down with the bad.” That is, I planted my good foot on the higher step and brought the crutches and bad leg up to meet it, and then at the top turned around and came back down leading with my bad foot. It worked, and I passed.

From there, many hours passed in bureaucratic hassles. The nurse wasn’t allowed to give me pain meds within an hour of departure, and since my departure time got dragged out two hours, I was in great pain when it was finally time to leave. (I know: waah, waah, waah.) I was wheeled through the halls, into an elevator, down into the crowded lobby, and Erin went to get the car. She pulled up and I was wheeled out there. Getting into the car was really, really hard. I had to lower the parking brake handle and grab the steering wheel and slide myself almost into the driver’s seat to get my right leg—which wouldn’t bend—into the car. Erin got me all settled in and then, reflexively, gave me a little pat on the leg. I yelped in pain. Some homeless dude standing on the curb called out, “Man, you can pretend you’re embarrassed now, but when you get home you’re gonna want her to be pettin’ you!” This was amusing, but then the guy repeated his quip continuously while Erin loaded my walker and crutches in the car and we slowly rolled away. He wasn’t quite right, that guy.

Three friends had arranged to meet us at our house, mainly just for a visit but also to help moving me in from the car. It was tricky extricating myself, Erin carefully moving my leg like a piece of rotting lumber. It was like a contortionist’s act in reverse. It’s a good thing my friends were there, because I’d forgotten our street is on a slope that ran perpendicular to my trajectory with the walker. The walker is a spindly thing and surely would have buckled and collapsed like a crappy tin cheese grater had my friend not bolstered it from the side.

I made the ten or twelve feet to the porch steps in possibly less than two minutes. I switched to the crutches, and here I had intended to rest for a minute. But suddenly I felt really dizzy, just like during my ill-fated PT exercise, and I feared I would faint. So I pressed on, getting past the stairs and continuing, on my crutches, in a sort of slow-motion sprint to the door. Erin had it open already, and somehow I made the couch. I was so relieved. I had made it. I was actually home.

Now

It’s been a month since the crash. I can get around the house pretty adroitly with the walker and on crutches now; I generally use the crutches because I feel they present a slightly less pathetic sight for my family. Sleeping is really difficult—I’ve never been good at sleeping on my back, and my leg still hurts—but it’s so nice and quiet here. The only sounds are conversation, my daughters playing, the clatter of dishes, and my daughters practicing their instruments. Fortunately my job allows me to work from home, so I’ve been back at that. My right leg can bend almost ninety degrees if I dangle it from the edge of the bed and push on it with my other foot. I have lost fifteen pounds and get chilled easily. I have a long recovery ahead of me but I’m on my way.

Other chapters

2014 update: it occurred to me to add links to all the chapters of this tale now that they're available. Here you go:

The Femur Report - Part I (posted Dec 11, 2011)
The Femur Report - Part II (posted Dec 19, 2011)
Physical Therapy (posted March 11, 2012)
Bike vs. Car - How I Broke My Femur (posted Nov 27, 2013)

The Femur Report - Part I

NOTE: This post is rated R for mild strong language and disturbing images.

Introduction

I had a bad bike wreck on Nov 27. Writing about its aftermath isn’t the most cheerful way I could spend my time, and I wouldn’t expect reading about it to be uplifting. Still, it’s been an extraordinary experience and it would seem a shame not to record it.

Note that though I’ve reported this episode as faithfully as I can, I cannot vouch for the accuracy of every detail. Especially where vast pain is involved, memory gets distorted. But I haven’t deliberately fictionalized anything and in fact have tried to be as plain and simple as possible in the telling.

I’m not going to get into how the wreck happened. That’s a whole other story that makes me angry to think about. So I’ll start with when I hit the ground.

The ground

I’m on the ground. A second earlier I was upright, on my bike, enjoying a mellow, unrushed descent at the end of my ride. I’m astonished at how quickly I was dropped to the ground, like a duck shot right out of the sky. I’ve been cycling competitively for thirty years and this is not how a crash usually unfolds. I’ve written at length at how in a crash situation time seems to slow down and I can easily perceive what is happening and what action to take. Not so today. BAM—like that, I was down. I heard my helmet sliding on the ground but only for a second. I didn’t slide much, but rather ground to a stop.

Every experienced cyclist knows that after you crash the first order of business is getting out of the road. This isn’t a sports field where you have a moment for self pity or mustering your resolve—it’s a road and you could get run over. So you scramble to get up as fast as you can. In the past I’ve started this scramble even before I stopped sliding along the road. But today I cannot begin to get up. Mainly this is because I cannot stop screaming, and the screaming is taking all my energy, all my will. I am screaming louder than I thought possible.

I’m screaming in pain, which is remarkable. Crashing on a bicycle doesn’t usually involve that much pain, at least not up front. Initially our bodies give us a surge of adrenaline and endorphins and the pain is masked almost completely. We can snatch up our bikes, run off the side of the road, check things over, and (if it’s a race) can often straighten out our handlebars, climb back on, and start chasing back to the group. The pain doesn’t arrive until later, when you’re cleaning out your road rash. But today? This was at least twice as much pain as I’d ever felt before in my life.

I can see my bike in the road. The impact has knocked the chain off the front chainwheels, which vexes me inordinately. The water bottle has been knocked out of its cage. Closer to me, I see blood dripping on the ground but I’m not sure what part of me it’s coming from. And the ground, this road—it’s a medieval surface of smooth pebbles imbedded in asphalt. I can start to see why such a relatively low-speed crash has hurt so badly—it’s an incredibly hard surface (pebbles being far harder than asphalt) and doesn’t allow you to slide. Whoever chose this surface material should be tried for a war crime.

Help

With astonishing quickness several people swarm around me. They’re local residents who have heard my screams. “I’ve got to get out of the road,” I tell one. He is crouching next to me. “Don’t worry, we’re stopping traffic,” he said. For a moment I think of asking him to get the Advil out of my toolkit but of course I see the absurdity. “I’m in so much pain,” I tell him, and scream some more. I’ve found what for some reason seems the least painful position: my right leg is straight forward—its hip is the center of the pain—and my left leg is bent double so I’m in a half-squat, leaning forward, supporting as much weight as possible on my left hand. My left arm shakes with the effort. “Who has a signal?” someone asks. “I do, I’m calling,” someone answers. I tell them, “I don’t think I need an ambulance,” but immediately I realize this is wishful thinking. “Actually I do.”

A guy on my left says, “I’m a doctor. You’ve got a broken femur. We called an ambulance.” There’s a cyclist on the scene and he has taken my bike out of the road and leaned it up against something. I can see he’s put the chain back on and I take strange comfort from this. Someone asks me for my home phone number and in a moment I’m talking to my wife. This is the worst call to have to make. I give her the news—my head is fine, but something is broken—and hope that I sound merely miserable, not scared.

A fire truck arrives from a station that is very close by. I beg for pain meds. They work quickly but it could never be quick enough. I get 5 mg of morphine intravenously but it doesn’t do anything. They’re cutting off my clothing. The EMT gets to my right shoe and I ask him to let me undo the rotary buckles and take it off, sparing its life.

Here a massive wave of gratitude washes over me. This is the moment when I go from being in charge of my situation—which is to say, being helpless—to when I turn my situation over to those with special training who know exactly what to do. Imagine if I were on a battlefield, or a remote road alone, or on a mountain where my survival meant crawling for miles through my pain and injury. Then I’d really be screwed. I am relieved to be passively placed in good hands, where all I have to do is answer questions.

They get my helmet off. Now the medics are preparing a long scary-looking metal apparatus next to my right leg. The man who earlier identified himself as a doctor tells me, “They’re going to have to put you in traction. This will pull your right leg straight. You’ll have to lie back. It’s going to hurt like hell.” It does. I can’t stop screaming. It seems like nothing they could possibly do to my leg could hurt more than this. The traction device is basically an iron maiden for the leg. I get 5 mg more morphine and that’s all they’re allowed to give me. It’s still not enough, not even close. An ambulance has arrived somewhere along the line and I’m scooped onto a stretcher and into the back of it (more screaming). I’m begging for more pain relief.

(I’m going to pause my story for a moment now to make an observation: I can now speak from experience about the stupidity of torture. To be freed from this pain, I’d have told anybody anything. The fact that I have no secrets simply means that I’d contrive something, anything I thought would satisfy a questioner. If the medics had asked, “Are you part of The Institute?” I’d have said yes. If they’d asked if I knew who masterminded Operation X, I’d have said yes. I’d have begged for a list of suspected operatives and randomly circled names, if it meant being freed from this pain. That is how desperate pain can make you.)

At some point I am given some other drug, perhaps to treat anxiety, and I start to suffer less. But every bump in the road—and there seem to be endless bumps—makes me cry out. The ambulance’s suspension seems to be shot.

Hospital

We arrive at the hospital. I am whisked from place to place, hallways and curtains, and end up in the X-ray department. It’s all huge and industrial and Orwellian and when somebody says, “We have to move you onto the X-ray table” there’s an unmistakable note of apology in his voice. Four of them lift up the whole sheet and move me. It is impossible to set somebody down lightly when he has a broken femur and the table is hard as glass. More bloodcurdling screams. I have a flashback to 1984, when I was fifteen, in a hospital in Wyoming after a car wreck with my mom and two of my brothers, and I suddenly heard my brother screaming his head off from all the way down the hall. The shock of recognition—that’s my brother screaming!—was not so different from the shock I feel now: that’s me screaming!

The X-ray table is my worst enemy for what seems an endless period of one X-ray after another, many with my body arranged in torturous positions. They know my femur is broken but are trying to figure out if my pelvis is broken. Finally another excruciating transition to the gurney, and I’m taken back to a curtained-off row.

They get some more pain meds in me and I’m starting to get some real relief. Presently my wife arrives. Of course I’m glad to see her but also full of remorse at putting her through this. If she were some fiery hot-blooded type who slapped me across the face first thing, I’d probably have felt better. Of course it’s preferable that she’s stable, calm, and strong. She knows she doesn’t have the luxury of getting upset and making this her problem—it’s mine and she’s my support. A team of doctors arrive. “We’re going to drill a hole through your tibia and insert a long screw, so we can get a good purchase on your leg for traction,” one of them explains. I love the idea—if it means getting this barbaric clamp off my leg. “You’ll take the old traction thing off as soon as that’s done, right?” I ask. They assure me they will—soothingly, as if we’re in agreement that the old traction device is the center of all my pain.

The drill

My wife asks why this operation wouldn’t be done in an operating room. “Oh, we don’t need a room for it,” they assure her. “It’s not like a big surgery or anything, it’s just a procedure. And we have to do it right now.” And they’re not joking, there’s no leaving and coming back, no apparent bureaucracy, they’re already preparing. They put on these Plexiglas face shields like a SWAT team would wear. Now, maybe it’s just the pain meds, but suddenly I’m struck by how improbably good-looking they all are. It looks like the cast of an TV show, an eye-candy hospital drama that isn’t even trying to be realistic.

They describe the local anesthesia they’ll be using: Novocain and something else. I warn them that I historically metabolize Novocain very quickly, so it usually starts to wear off by the time the doctor thinks it should be kicking in. The doctors offer a blandly reassuring response. They’re putting the bit into the drill. I swear the bit must be a foot long. I crane to see what kind of drill it is. I’m hoping for Mikita or Skil. If it’s Black and Decker, I’m out of here. It turns out to be Craftsman, which is just barely satisfactory. I relate to them a story from my dad about a fleck of chrome from a Craftsman tool that befouled a photocell in a satellite and sent it way off-course. (At that time I may have thought I was only thinking about this anecdote, but Erin assures me I actually told it.) Now they’re ready to start.

“Erin, you may want to make yourself scarce for this,” I tell my wife, but she’s sticking around. I suppose she feels a duty to stand by me, but it also wouldn’t surprise me if she had feelings similar to my own: as horrible as this is, it’s fascinating. How often do you get a chance to watch something like this?

A resident will be doing the drilling. She lines up the drill. Her eye and her hands are as steady as a pool shark’s as he lines up a shot. She looks to be about twenty years old. The others are giving her advice and encouragement. The bit goes in. My head flops back on the gurney and I scream. Of course the pain is bloody murder but with it comes a strange feeling of vindication. Sure, this hurts like hell, but of course it hurts like hell—it should hurt like hell, I’m having a drill go through my leg! The pain in the bone is only part of it, though—the vibration along my whole leg is just as bad. As for the local anesthetic, it’s not quite up to snuff: I can feel the drill well enough to recognize when its direction changes and it’s being drawn back out of my leg. I get a huge sense of relief from this, knowing the procedure is almost over.

Then the drill is out and the resident is getting a pat on the back. I ask her, “Is this the first time you’ve done this?” She replies, “No, it’s my second. The first one was a disaster. Halfway in the drill died, and everybody had to run around looking for another drill before we could get the bit out!” Now I’m even more impressed with the calm she had beforehand. You know the saying: “Learn one, do one, teach one.”

Relief

To the screw in my tibia they attach, on either side, cables that run through little pulleys on an apparatus attached to the foot of the gurney. From these cables they hang water-filled plastic weights. With the cables pulling the tibia screw forward and thus pulling my leg straight, they no longer need the original traction device, and finally remove it. What a relief. Somebody notices that one of the weights is leaking and sends for a replacement.

Now they set about giving me a nerve block. This is kind of like the epidural that pregnant women get. I don’t know the exact science but it involves injection of drugs right into or near to nerves. To pinpoint where to administer this, they use ultrasound. One watches the monitor while the other administers the drug. “Okay, you’re right in position, drop some right there. Good. Go a little deeper here. Drop some more.” The guy has the depths of my leg mapped like some high-tech mining operation. “Okay, a little deeper, little more, okay—right there—drop the rest.” The sense of competence of this team thrills me, and then when the nerve block takes effect, the pain in my leg quiets down some more.

(Note: having read this, Erin wonders about the sequence of tibia screw vs. nerve block. She doesn’t remember which came first, but thinks it more logical that they’d have started with the nerve block. I distinctly remember the screw being first based on the pain, and based on my understanding that the screw was essential whereas the nerve block was just a nice-to-have. But as I said earlier, memory can be distorted.)

They move me to a hospital room and say “No food until after surgery tomorrow.” Not a problem. For once in my life I have no appetite.

To be continued...

That’s about all I care to write for now. If you feel like this was something worth reading, stay tuned because of course there’s more to tell.

Other chapters

2014 update:  it occurred to me to add links to all the chapters of this tale now that they're available.  Here you go:

The Femur Report - Part II (posted Dec 19, 2011)

The Femur Report - Part III (posted Dec 28, 2011)

Physical Therapy (posted March 11, 2012)

Bike vs. Car - How I Broke My Femur (posted Nov 27, 2013)

Fiction - Doctor's Daughter

Introduction

I’m taking an evening class in fiction writing over at UC Berkeley, my alma mater. Our first session was last Wednesday, and the teacher had an ingenious idea. She broke the class into groups of three and had us each tell a personal anecdote to the other two students. Then she gave us ten minutes to write down our anecdote. As our homework assignment, she told us to take half an hour to rewrite our anecdote, but incorporating one of the two anecdotes we’d heard from a classmate.

At first this struck me as impossible—after all, my anecdote had nothing to do with the other ones. But as I thought about it, everything fit together very well, and it solved my biggest problem in writing fiction: coming up with an idea. Sure, half of this story started out as true, but the action now happens to someone else, and the story is merged with my doubtless faulty recollection of a secondhand tale which I then further fictionalized. I'm sure you'll agree that the result can only be considered fiction.

So here’s the story. (Yes, I went over my half-hour.)

Doctor’s Daughter

My name is Tara. I never liked my name—it always reminded me of “Taras Bulba,” like I came from an ancient family in the steppes of the Ukraine. (It could have been worse: my mom had considered naming me “Terra,” as in Earth. My whole life I’d have been thought of as a hippie!) I grew up in Etna, California, a tiny town way up north with zero traffic lights. Most of the folks in town were poor farmers or poor ranchers. My dad was the only doctor around and though he officially worked in the hospital about half an hour away, an awful lot of his work happened at the house, at night or on weekends. Many of the locals, who either couldn’t afford or didn’t trust hospitals, would save up their problems for when he got home. Often I ended up helping him out.

My mom pretty much stayed in bed, which is a long story I won’t go into. Suffice to say I never felt like my family was very normal. Not that the townsfolk were much to compare myself with. I had to remind myself that the families on TV probably weren’t typical either.

On a Friday evening in the fall, when I was about nine, I was bored, sitting by an open window waiting for my dad to get home from work. An unexpected rainstorm had blown in and I was watching the rain come down in sheets when I heard the hiss of a car’s tires on our street. I thought it was my dad but to my surprise it was a modern black sedan I’d never seen before. It turned onto our gravel driveway and pulled up to the house. A man in a nice grey suit climbed out, walked right up to our door through the pouring rain, and rang the bell. I ran down the hall to my mom’s room and called through the door: “There’s a man in a suit at the door!” My mom told me to call my dad and ask if he was expecting anybody. The doorbell rang again.

I phoned my dad. It must have been quiet at the hospital because they found him pretty fast. “Oh, shoot!” he said. “I totally forgot. That’s Ferdinand, the account manager at Fortis. I actually had an appointment with him tonight. Tell him to hang tight—I’ll rush right over.”

“Uh, dad, it’s pouring rain here. Should I let him in?”

“No, you shouldn’t. See if your mom will let him in.”

I rang off and with a sigh called to my mom again. Sure enough, she wouldn’t come out. I got to the front door just as the doorbell rang a third time. I peeked out through the mail slot. I could see the man’s nicely pressed charcoal grey woolen slacks, and his leather shoes with a nice design pierced all around the toe. “Um, are you Ferdinand?” I asked timidly.

The man knelt down and peered through the mail slot. “Yes. I have an appointment with Dr. Stevens. Are you his daughter?”

“Yes. I just called him. He forgot about the appointment but he’s on his way here. I can’t let you in because my mom is ... busy.” I thought of adding, “She’s cleaning her rifle and isn’t quite done reassembling it.” But other than my dad, I could never get a grown-up to take me seriously.

“Um, are you sure you can’t get your mom?” he said. “I kind of, uh, locked my keys in my car. I'm getting soaked out here.” I told my mom. She still wouldn’t come out. I reported back to Ferdinand. To my surprise, he agreed to wait it out.

I went to my room and stared blankly at a book. What business did this man have with my dad? Must be important if he was willing to wait. Was he a banker? Were we losing our home? A long while later I heard the crunch of tires on gravel as my dad arrived. I got to the door just as he opened it. He was staring at Ferdinand. “Oh, man, Ferdinand, look at your suit!” he said. “It’s all bubbly! It’s ruined!”

Sure enough, the fabric of the drenched suit was all fouled up. The wool was separating from the lining and had the texture of bubble wrap. Ferdinand looked stricken. Dad led him to the kitchen table, took his suit jacket, sat him down, and gave him a fresh dishtowel to dry his head and face.

Soon there were papers spread over the table, covered with lots of fine print and some charts. My dad never sent me away when he talked to other grownups; he was always hoping I’d learn something. The two men talked awhile, but nothing they said made any sense to me until my dad finally stood up and said, “You know Ferdinand, I wasn’t actually that interested in this meeting, to be honest. You were so enthusiastic I didn’t know how to say no. But the truth is, this fund has been underperforming for years and I was planning to sell it anyway. I’d actually like to close out my account.” And just like that, the meeting was over. My dad signed some papers, and then Ferdinand packed up his briefcase, wriggled back into his wretched bubbly suit jacket, and left.

“What was that all about?” I asked.

“Well, I somehow let this guy talk me into this meeting to go over my investment portfolio. When I showed up late, and then stupidly blurted out that his suit was ruined, I actually started to feel more bold. Like, ‘I’m going to Hell anyway for keeping this man waiting in the rain, so I might as well finish him off.’ Poor guy. His business must be really hurting to come all the way out here to talk about a portfolio of only a few thousand dollars.”

“But dad, he looked ... it looked important. I’ve heard you complain about money. Couldn’t he help?”

“Yes, possibly, in some indirect way. But it’s hard to take a man like that seriously after a long day of seeing patients.”

“Why? What do you mean?”

“Well, Ferdinand moves people’s money around all day, electronically, and if he’s lucky the numbers go up. There’s nothing tangible about what he does for a living.”

“What does tangible mean?”

“You can see it. You can touch it. Money is so abstract. It’s like this all-powerful force and sometimes it just gets me down. You know the first thing that happens when a patient comes into the ER? No matter how bad the illness or injury, the patient has to work out the payment first thing. We’re supposed to be providing care for these people but the first order of business is always sorting out the payment.”

I’m sure I’ve embellished my memory of that evening. I couldn’t possibly have remembered these conversations in such detail because I wouldn’t have grasped the concepts at the time. But I understood enough to feel kind of disappointed about the meeting. Not so much about the ruined suit, but because my did dismissed Ferdinand. I kind of wanted my dad to associate with people in nice suits who drive modern cars and talk about money and investments. That was part of the more sophisticated world, the TV world, that of course I dreamed of escaping to. Being a doctor, my dad should have had all kinds of money but it never seemed he did. I suddenly felt very tired, and after a quick dinner (grilled cheese, Campbell’s soup) I went to bed.

In the middle of the night my dad shook me awake. “Tara, wake up. I have a patient and I need your help.” I couldn’t believe it, and yet I knew the drill. I dragged myself out of bed, cleared the dining room table, and spread out a fresh clean sheet for the patient.

It was Drummond, a guy down the way who raised ostriches. Ostriches! He’d somehow cut his arm really badly on some machinery. His arm was wrapped in a giant towel that was totally soaked in blood. He’d injured himself during the late afternoon and then spent the next several hours arguing with his wife about going to the hospital. He’d never been to a hospital and wasn’t going to start now, blah, blah, blah.

Dad stretched him out on the table and removed the bloody towel. Then he went to the kitchen sink and washed his hands for like five minutes straight, got out his medical kit, filled a syringe with something, and started stabbing Drummond all up and down his arm with it. It was like a five-inch needle. “This is just Novocain,” he said soothingly, as though his patient wouldn’t want anything stronger. Blood was getting all over my fresh sheet. I would be doing all the clean-up, of course. At times like this I really resented my mom, sleeping away. After all, she chose to marry a doctor in a small town and should have known what would be expected of her. Somehow that duty had slipped a generation and here I was, a little girl who didn’t choose a doctor for a father, playing surgical nurse with real blood.

We waited around for ten minutes to let the anesthetic take effect. Then Dad got started on sewing up Drummond’s arm. My job was to hold it down. This took all my strength. Drummond was a tough old dude but was clearly in great pain, and couldn’t resist trying to recoil. Dad gave him a wooden tongue depressor to bite down on and Drummond snapped it in two with his teeth. I winced. Dad gave him two more tongue depressors, stacked together. Drummond snapped those, too, sending a shiver down my back. I don’t know how biting down is supposed to help anyway; maybe it was just to keep him from cussing. Finally Dad gave him a clean rag, the color of pink clay, to chew on.

When you’re a doctor’s kid you learn how coarse medicine really is. Putting in sutures, for example, is just sewing up a guy’s skin with a needle and thread. I had to pay attention and it was like watching my mom sewing closed the Thanksgiving turkey with twine or dental floss: just as crude as can be. (By his own admission Dad was only “okay” at sutures. At the dinner table one time he ranted about a surgeon he’d watched stitch up a boy’s face. “He was so good at stitches,” he raved, “it was like plastic.” Plastic surgery, he meant. I had to remind him I was trying to eat.)

Dad finished up and sent Drummond on his way with an Ace bandage wrapped around his arm. “In about a week or ten days you can come back to have those sutures removed,” he said. “Or you can remove them yourself—just snip one and drag the whole thread out.” I was up for another half hour, cleaning up. A bed sheet really isn’t very absorbent and I was just smearing the blood around. I had to soak the sheet and towels awhile in the washing machine, on cold, before adding the detergent and starting it up. Like I said before, I knew the drill. I finally got back to bed at around three.

Fortunately, the next day was Saturday and I got to sleep in. That afternoon I was sitting on the front porch with Dad when Drummond came walking up our driveway dragging his kid’s Radio Flyer wagon behind him. Between dragging the wagon and holding his bandaged arm up over his head, Drummond was, I felt, lacking in dignity. “Good, keep that arm elevated,” Dad said. “What have we here?” The wagon was full of these giant eggs, the size of cantaloupes: ostrich eggs. Dad’s fee. Did Dad send Drummond away, like he did Ferdinand? No, he happily unloaded the wagon, acting like ostrich eggs were the greatest treasure on Earth. “Isn’t it amazing,” he mused, “that the world’s second-fastest land animal can also lay these giant eggs? Puts a hen to shame.”

Drummond didn’t say much, and was soon on his way. We would be eating giant omelets for months. I couldn’t help myself. “Dad,” I complained, “did you ever hear of money? What’s so great about these eggs?”

“Well ... just look at ‘em!” he said, still smiling.

Yeah, I know. You can see them. You can touch them.

dana albert blog