Posts Tagged ‘change’

CHANGES: AN ESSAY

Monday, March 20th, 2017

As he had for more years than he cared to count, the elderly gentleman dressed in a three-pieced, dark-grey suit with white shirt; striped, grey-and-red tie; and black, wing-tipped shoes pushed through the revolving door to the old-style drugstore at the corner of Main and Grove. He removed a light-grey fedora from a head still covered with once-blonde, now silver-white hair parted neatly on the left. Clear, blue eyes surveyed a scene from generations before, a scene in which he had participated since opening his medical practice, a scene refusing to die.

The hour still was early. Slivers of first light were appearing. The soon-to-be bright Sun barely illuminated the dark nighttime sky.

Being a widower, Doctor Rufus Jenkins preferred not to breakfast alone. Years before, youthful passion had overcome prudence waiting to mature. Still a student, he could not afford to marry his sweetheart from high school.

Passion, however, screamed, Yes!”

Prudence murmured, “No.”

Passion ruled. Three months later, Emma fell ill. Acute leukemia. Weeks later, she died. In those days, effective treatments remained hidden beyond the medical horizon.

Grief never departed. Romance never returned. Marriage died with Emma.

Instead, he dedicated his life to his chosen calling, medicine. Medicine, not a job. Medicine, not an occupation. Medicine, not even a profession. For “Doc” Jenkins, medicine represented a calling like the clergy.

In an age of “healthcare” instead of medicine, “healthcare-plans” instead of insurance, and “providers” instead of physicians, such a man had become an historical relic.

Another historical relic was Parson’s Drug Store & Luncheonette. It clung to life, a symbol of a previous era, alone in a modern smorgasbord of homogenized, self-service “fast food” from cookie-cutter outlets filled with uncomfortable seating limiting long stays — factory-food served in an atmosphere of depersonalizing anonymity by human robots with empty minds expecting you, the unthinking customer, to fill their jars labelled “TIPS”. Reminder: Don’t forget to bus your own table, leaving your droppings for the next customer as the previous one did for you — droppings that rarely are cleaned. The sign on the trash will thank you for feeding it.

The town itself still existed only as a consequence of a former native-son’s having returned to buy a building left vacant by its previous owner, a manufacturing firm that had fled to China then to Viet Nam with headquarters relocated to Ireland. Revolutionary robotics of today instead of traditional textiles of yesterday. With the change, the once dismal future of the town suddenly seemed secure, at least for the moment. Chance and change would tell the tale.

As for the pharmacy, Abraham Parson had opened his apothecary in an age of bromides and enemas. His son, Ben, succeeded him. His grandson, Adam, maintained the now-profitless pharmacy still closed on Sundays with its luncheonette still open for breakfast and lunch. An old-fashion “phosphate”? Still available at Parson’s!

Yes, “chain-stores” selling everything from medicines to motor-oils had challenged the old-time pharmaceutical tradition. They offered longer hours and lower prices with the ubiquitous depersonalizing anonymity and sense of isolation increasingly prevalent in a society firmly ensnared electro-magnetically in a man-made web of radio-waves.

Alas, the independent pharmacy was receding into the past as was the traditional practice of medicine. Even the local supermarket offered not only a pharmacy but a “walk-in clinic” staffed by “Dr. Nurse”. Why should anyone want a physician in a medical office, anyway, when he can have a nurse in a supermarket? Quicker? Yes. Cheaper? Yes. Better?

Fortunately for those few customers who still preferred amiable social intercourse with a knowledgeable staff that knows you by name, Adam Parson had made a tidy sum trading foreign currencies via the Internet. Had he not done so, Parson’s Drug Store & Luncheonette would have become a distant memory among only the elderly losing theirs. Even so, many of his long-standing, loyal customers were departing for their final voyage. Destination? Unknown.

PART TWO

As usual, “Doc” Jenkins was the first customer of the morning. As usual, he strolled the same route to the counter. As usual, he selected the same stool that he always selected.

Yes, the elderly physician had become partial to small rituals. Continual change with its often spurious sense of novelty seemed more suited for the young. Familiar routines with their spurious sense of comfort seemed more suited for the old.

“Any port for an old ship in a storm,” he told himself.

While unfolding his daily, printed newspaper, he heard a familiar female voice calling from the other end of counter, “Morning, Doc! The usual?”

Without moving his gaze from the printed page, he replied, “The usual please, Lulu.”

Hearing approaching footsteps, he looked her way. The years had transformed a young, pretty, curvaceous and vivacious cheerleader with long, straight, naturally chestnut-red hair into an old, wrinkled, tired waitress with hair now short, frizzy, and reddish-orange. He watched her now-dumpy body with fleshy arms and swollen ankles carry freshly brewed, hot coffee his way. Her sad eyes belied her forced smile.

“Doc” Jenkins mused, “No wonder the young feel aversion towards the elderly. Someday, thereto go they. Scares the Hell out of them and rightly so. Little gold to be found in the Golden Years.”

Moments later, Sam, the short-order cook, handed Lulu the usual plate of two eggs over-easy accompanied by crisp bacon and well-buttered wholewheat toast. With a sigh but no smile, the aged waitress delivered the traditional, satisfying, American breakfast decried loudly and widely as “unhealthy” when they who made the claim, ignorant of their native tongue, meant unhealthful.

Lulu mused, “If I had a buck for each of these, I’d be a millionairess. Well . . . close.”

About to take his first bite, “Doc” Jenkins sensed a new presence. A young man, almost still a boy, took the stool on his left.

The youth was handsome with his black hair and eyes as grey as a wolf. Hair shaved on both sides left a wide swath slick from pomade combed back from a perfectly formed forehead atop an unshaven face. His arms were littered with tattoos, the most prominent reading “Born to die!” and “Mom” inside a heart. Some claim that tattoos are windows to the soul.

Glancing at the lad, the physician continued his previous line of thought. “Seniors! The Media call us ‘seniors’. A sick joke. What does it make the younger generation, ‘juniors’? Seniors! A pathetic euphemism straining to mitigate the specter of ageing.”

In that which sounded like a whisper, the young man said, “What luck! Am I glad to find you here, Doc.”

The elderly physician nodded and replied, “If you’re going to whisper, move to my right. My hearing is better on that side.”

Switching stools, the young man said, “Hey, no problem. I didn’t think I was whispering.”

The words caused the physician to cringe. “Oh God, my hearing must be getting worse. Another joy of old age.”

Truly, for all but a lucky few, entering old age heralds a continuing series of losses with few gains, fewer head-colds being one of the gains. A poor bargain, indeed. Little wonder that depression and the elderly become frequent companions.

Lulu approached the young man. “What can I get you, Hon?”

“Coca-Cola.”

“Coca-Cola? For breakfast?” With a shrug, she turned and headed for the soda-fountain.

With a glass of colored, fizzy water sweetened with syrup from corn not sugar before him, the young man almost shouted, “Like I said, Doc. Dumb luck finding you here.”

“Pipe down! I can hear you without your shouting. Why so glad?”

The young man placed his unshaven upper lip next to the physician’s freshly shaven ear and whispered loudly, “I’ve got a problem.”

“Medical?”

“Yeah.”

“Come see me at my office. Make an appointment.”

PART THREE

(Silence.)

“Did you hear me, son, or you going deaf, too?”

“Deaf? Me? Going deaf? No, way! No problem there.”

“In that case, do you want to tell me what is your problem, or shall I guess?”

(Silence.)

“All right, son, I’ll guess. Your problem is sexual.”

“How’d you know, Doc? Who told you?”

“You did but not in words. Supposedly, b fsy chance, you spied me here. You came in because you don’t want to come to my office, right?”

“Yeah, right.”

“Why? Because you don’t want a medical record.”

(Silence.)

“Right.”

The young man’s concern was justified. Like all his medical colleagues, Dr. Rufus Jenkins employed a computerized medical record offered by a local hospital, one of a large chain of hospitals all using the same inter-connected system. The old-style physician had resisted. Reality, however, has its way. Had he been willing to forego payment for most of his services, he could have continued using ink on paper stored in folders.

The new system actually proved less efficient than the old and certainly more public. Instead of dictating the findings of an initial History & Physical or jotting in ink from a pen a quick Progress Note onto paper, he endured the cumbersome, sometimes confusing task of searching for the correct box in the correct image projected onto the screen of an electronic monitor. Worse, the “techies’ continually were “updating” the system with changes initially befuddling even for users much younger and more savvy.

“O brave new world that has such people in ’t!” -from The Tempest by William Shakespeare (1564-1616)

Worse yet, when taking a medical history from a new patient or listening to a chief complaint from a current one, his focus was on a screen and keyboard — not on the patient’s face and body. More than once, he had complained to medical colleagues, “It’s an evil change . . . evil in the name of progress. Worst of the worst is patients’ loss of privacy. Change? Yes. Progress? If so, it’s progress without a conscience. Who would design such perfidy with no thought to consequence?”

Admittedly, loss of privacy can create an adversarial system between physician and patient; whereby, the patient withholds vital information, not wanting the rest of the world to gain access to it. Truly, the sanctity of the physician-patient relationship has been violated. Is the sanctity of the lawyer-client relationship next? Apparently.

The new electronic context had put into a bind the elderly physician bound to tradition. If he even listened to his potential patient without creating an official record, be there a lawsuit, he would have no written documentation for his defense. Contemporary legal contingencies demanded that, to be true to his malpractice-insurance, he create a record. Traditional medical contingencies demanded that, to be true to his calling, he render service. What to do?

PART FOUR

Pondering his dilemma, the elderly physician noted tears in the eyes of his young companion. Youthful tears dissolved elderly caution.

“Doc” Jenkins recognized that he was leaving himself totally vulnerable. An unfounded, vexatious lawsuit filed by an avaricious lawyer of whom no shortage existed likely would become the final insult among so many others to his remaining in practice.

“All right, son, I’ll tell you what I can do for you. Accompany me to my office. I’ll see you before we open. There’ll be no electronic record. There, however, will be one on paper kept privately by me. Also, there’ll be no charge.”

“No charge?”

“No charge! No financial charge . . . no financial record.”

With a smile revealing neglected teeth, the youth exclaimed, “Hey, Doc, you’re a cool dude.”

“Cool dude, eh? Tell me, son, why do you find the need for such secrecy about a malady so common? Today, young people carry venereal disease almost like a badge of honor. It’s a sign of . . . what do you people call it, ‘hooking up’? In my era, a first date more likely ended with kissing not copulating. Anyway, why the secrecy?”

His question seemed rhetorical. He already had noted the wedding ring to which the young man pointed.

“One night. One girl. One mistake, Doc.”

“One ugly consequence. Behavior has its consequences, you know. Bad consequences usually follow bad behaviors.”

“Yeah, that’s it. Consequences. My wife . . . I really love her, you know. She might not divorce me but knowing would break her heart.”

Later, while walking in silence to his office, “Doc” Jenkins considered some of the ramifications of human sexuality. He recalled the famous quip attributed to the long-dead Englishman, Philip Stanhope (1694-1773), “Sex:— the pleasure is momentary; the position ridiculous; and the expense damnable.” He himself added, “The expense can be more than money. Some things never change. Yet, who today remembers the scourge of syphilis in the fifteenth century, killing more than a million Europeans covered head to foot with pustules?”

Especially in the Western world, invidious forces had been undermining the age-old, worldwide concept of female chastity and male fidelity as virtues. Promoters of those forces proclaimed newly-coined “rights” based upon nothing but abstract and idiosyncratic, ideological proclamations. The undermining became wholesale with the introduction of pills to prevent conception. A pill a day keeps a baby away, allowing women to go astray. There always is a man handy willing to oblige a willing woman.

With “the pill” had come the bill — diseases. Not just syphilis. The so-called Sexual Revolution brought diseases previously unknown. Fully one-quarter of young American women now carry a venereal disease. The portals to pleasure have become the portals to pathology.

“And lead us not into temptation but deliver us from evil.” -Matthew 6:13

PART FIVE

With medical history taken and physical examination completed, “Doc” Jenkins sent his young patient to a nearby laboratory for medical tests including a smear of exudate from the male member for purposes of microscopic examination as well as culture and sensitivity. The diagnosis, however, appeared obvious — gonorrhea! He hoped the infection would prove treatable.

[Note: In 1943 with the advent of penicillin, treatment of gonorrhea had become simple and speedy. Previously, as for Emma’s leukemia, no effective treatment existed.

Prior to penicillin, men usually had cleared the infection themselves. Untreated, the infection may resolve but with urethral scaring. Scars contract. Contracting causes strictures. Strictures cause urinary retention. Treatment? Passing a metal sound through the urethra. Painful? Excruciating!

Women contracting the infection often had suffered its transformation into pelvic inflammatory disease. Untreated, “PID” can localize into an abscess then explode into widespread abdominal infection. Widespread infection can cause death. Consequence of surgical treatment? For those who survived, infertility.

“The future isn’t what it used to be.” -Paul Valéry (1871-1945)

Penicillin and other antibiotics had changed that terrifying scenario. That change, however, was yesterday. Today, a new change — actually, more of an old one. Some strains of the bacterium, Neisseria gonorrhoeae, have acquired resistance to all known antibiotics. Welcome to the past! In the case of gonorrhea, Monsieur Valery was wrong; the future is that which it used to be.]

Before the young man departed, “Doc” Jenkins announced, “I need the name of the girl. Even more than you, she needs treatment. I’ll do for her what I’m doing for you . . . if she wishes.”

“No, I’ll tell her, Doc.”

“Nothing doing! I need to inform her myself and document . . . privately . . . having done so as well as getting the names of her other sexual contacts.”

“Other contacts?”

“Come now! You don’t fancy yourself her only stud, do you?” He thought that, perhaps, he should regret having used the pejorative term. He did not.

(Silence.)

“No, I guess not. Okay, you can tell her.”

After his patient had departed, not waiting for diagnostic confirmation from the laboratory, “Doc” Jenkins telephoned the contact. If he waited, he could not predict how many sexual contacts she might have during the interval.

The young woman answered immediately. The elderly physician explained as gently as he could the situation.

Her reply was swift and not gentle. “No way, Doctor! That’s not how it happened. I was a virgin until that . . . that . . . until he almost raped me.”

The physician thought, “A virgin? At her age? Rarer than a real silver-dollar.”

“Raped you? Serious allegation.”

As any prosecuting attorney can testify, rape is the easiest crime to allege — the hardest to prove. In an age of radical feminism, men become presumed guilty until they prove themselves innocent; a challenging task, at best.

This young woman proved to be other than a radical feminist. “All right, maybe it wasn’t real rape. I suppose that I didn’t say, ‘No!’ Anyway, I also didn’t give him ‘the clap’. He gave it to me. I’ve seen my ‘Gyn’, and I’ve been tested.”

“Doc” Jenkins took a moment to collect his thoughts. Surprise — a frequent companion of sex.

Then, he asked, “Do you know from whom he contracted the disease?”

In a softened tone, she answered, “Look, I’ve known the guy for a long time . . . pretty close. We work together. I admit it. I might’ve been partially at fault. He’s good looking. I liked flirting with him . . . nothing serious . . . just joking, or so I thought until that one time.”

“So, if he didn’t contract the disease from you, from whom?”

“Good question! He told me he’d never fooled around before . . . never cheated on his wife. Personally, I believe him. He’s not only good looking and real nice. He’s a straight-arrow.”

“So, from whom?”

“His wife. Who else? There’s been talk. The husband is the last to know, right?”

Even after all his years of medical practice, her answer made the old gentleman feel slightly sick. He silently recalled a line from Shakespeare’s Hamlet, “Frailty, thy name is woman.” He added, “And just as often, men.”

“Two more questions, Miss. Have the results of your diagnostic tests returned?”

(Silence.)

“Yes. Gonorrhea.”

“Antibiotics. Is your case sensitive to antibiotics . . . any antibiotic?”

(Silence then sobbing.)

“No.”

© Gene Richard Moss (2017)

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