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"You aren't ill; it is just that you are made of second-rate
materials."
--- Nataliea Ginzburg (1916-1991),
Italian novelist. Alberto, in Family Sayings, to his wife,
Miranda.
One day, a few years back, I got a call from my mom. Nothing urgent; she was just checking in. Normally, we would have talked for a while, but I wasn't feeling well, and I cut the conversation short with a lame excuse. I could have just been honest, but since I was planning on seeing a doctor shortly, I didn't want to cause her any premature worry, so I decided to be a bit discreet and wait till I knew more before apprising her of my condition. In retrospect, telling her Sue was going into labor probably wasn't the best way to end the phone call.
The
actual problem was that I had a very sore left foot.
It started out on a Thursday feeling like I had sprained it, or
banged it up in some way that I couldn’t recall.
This isn’t as far-fetched as it sounds; I’m at that point in my
life where my absent-mindedness has progressed beyond just misplacing
items, or forgetting why I walked into a room, or requiring my sons to
wear name-tags. I’m
constantly discovering bruises, scrapes, cuts, and third-degree burns
whose origins I can’t recall.
When my foot started aching, my first assumption was that I
couldn’t remember some recent attempt to drop kick an anvil or try on
one of Sue’s shoes.
By
Friday morning, I was in some serious pain.
By “serious pain” I mean agony; I mean nausea-inducing,
to-the-point-of-fainting type pain; it was, I think, the maximum amount
of pain that any grown man could be expected to bear, which is to say it
was about one tenth the pain of childbirth.
My
feet are not pretty under the best of circumstances (although I've
always thought the toes on my right foot have a mischievous twinkle).
But now my left foot was swollen and inflamed, mutated into a
monstrous throbbing parody of a lower extremity.
If I could have applied enough pressure with it to generate a
footprint, I’m sure I could have convinced the tabloid press that
Sasquatch had settled in the Santa Clarita suburbs.
I
made a doctor’s appointment for that afternoon.
Sue drove me to the clinic in our van while I lay in the back
seat, moaning softly (but not too softly; I had to adjust my
volume so Sue could hear me over the radio).
To my dismay, we had to park a good distance away from the clinic
entrance; apparently motor vehicles seriously disrupt the exterior
aesthetics that the architects had in mind when planning this structure,
so the nearest parking spaces have been discreetly placed in the next
county. To be fair, there
is a circular drive running past the entrance doors, so that drivers can
dump their ailing passengers at the entrance without losing too much
vehicular momentum. But my
pride dictated that I hobble from the parking lot to the second story
doctor’s office at a rate that can only be described as the exact
opposite of light speed.
The
small relief I gained when I was finally able to take a seat in the
waiting room was offset by the added discomfort of my need to visit the
restroom. I felt like my
bladder had entered a competition with my left foot to see who could
attain a more radical degree of distension.
I had passed a restroom on the way to the waiting room, but I had
intentionally held off a visit for three reasons: 1) My journey across
the parking lot and to the second floor was excruciating enough without
the added mileage of a side-trip to the facilities; 2) Considering the
state of my foot and my bladder, both the trip to the restroom,
and the business therein conducted, would probably make me late for my
appointment; 3) If, by chance, I was asked for a specimen, I didn’t want
to come up dry, so to speak.
So
instead, I sat in the waiting room chair, as the pain caused me to break
out into a cold sweat, making me thankful that at least some
liquid was leaving my body.
Of
course, there were all sorts of preliminaries to go through before the
doctor would see me… taking my blood pressure, checking my temperature,
recording my weight… all measurements which I’m sure would be very
important to any coroner who might want to know what condition I was in
right before my foot exploded.
I won’t bore you with all the details.
Instead, I’ll bore you with the doctor’s diagnosis after he examined my
foot and listened to my tearful description of the symptoms.
The doctor looked me straight in the foot and told me I had a
textbook case of gout.
At
this bit of news, my mind raced in several directions at once.
For one thing, I didn’t know they had courses on gout,
much less a textbook. I
figured I’d better hobble on over to the library straightaway and check
it out, since I realized I didn’t have a clear impression of what gout
was. Of course I’d heard
of gout, but I only had a vague notion that it was the exclusive
malady of fat and loutish members of royalty who sloppily guzzled great
flagons of ale, ate huge cuts of meat with their bare hands, and threw
the bones over their shoulders.
Worse yet, if you take away the royalty part, and substitute Dr.
Pepper for ale, I fit the profile pretty well.
I
asked the doctor how I had ended up with a disease that was supposed to
be the province of obese English royalty from the Middle Ages; he
laughed condescendingly and told me that I labored under a huge
misconception. Gout is
not, he told me, a disease of decadent royalty, nor is it a malady
confined to the era of moats, maces, and banquets with no utensils.
To combat my ignorance and preconceptions, he plucked from a
handy rack of informational literature a pamphlet entitled All About
Your Bout With Gout. On
its cover was a medieval portrait of a gentleman with a striking
resemblance to Charles Laughton, wearing a crown and holding a huge
pewter goblet of wine in one hand, and a half-chewed ham hock in the
other. (The rack was filled
with other weapons for the war on stereotypes, titles like:
Malpractice Suits: More Trouble Than They’re Worth; Bedpans Are
Your Friends; Doctors And The Two-Porsche Minimum; The
Importance Of Hospital Gown Ventilation; and Your
Physician And God: Is There A Difference?)
From
this pamphlet, I learned that gout is a disease that affects more than
one million Americans.
Pamphlets like these are always eager to let the reader know how many
other people are likewise suffering.
Being provided with this information did nothing to improve my
attitude; knowing that there are at least 999,999 other gimpy gouty
individuals in our great country didn’t make me feel any better,
probably because I knew none of them were hurting as much as I was.
According to the literature, gout causes inflammation, swelling, and
severe pain in joints. The
big toe is a common target of gout, which, in spite of the pain it was
causing me, really lowered my opinion of gout as a respectable disease.
All the really heavy-hitters in the disease kingdom go after
vital areas like the heart, liver, lungs, and digestive system.
What kind of disease launches an all-out attack on the soft
underbelly of the big toe?
At
any rate, the pamphlet went on to give me a better picture of gout,
which is most commonly caused by a condition called hyperuricemia,
which is a high level of uric acid in the blood.
But what is uric acid, I wondered, and did it have anything to do
with why my bladder control-valve needle was in the red?
Well, the obliging pamphlet answered, uric acid is a substance
formed when the body breaks down a waste product called purines,
and is normally dissolved in the blood, sent through your kidneys, and
ultimately passes out of the body in the urine.
So, uric acid is actually a waste product that’s formed when your
body is dealing with some other waste product, which seems a little
inefficient to me; sort of like putting your trash can out on the curb
and discovering a couple of hours later that you have to scoop up little
piles of trash it’s deposited on the sidewalk.
With
gout, the uric acid level is so high that uric acids crystals are
formed. These crystals, being of low moral character, want to hang out
in joints, where they congregate and cause inflammation, swelling, and
loud music on Saturday nights.
Eventually, uric acid crystals can form kidney stones, a
condition that, I’m told, makes one nostalgic for gout.
…
where they took a blood sample.
It seems that modern medicine wasn’t interested in how much uric
acid was in my urine. They
wanted to know how much was in my blood.
This was, I thought, another example of terribly inaccurate
medical terminology, and I lodged an earnest complaint with the lab
nurse. In retrospect, it probably isn’t the wisest move to cop an
attitude with a person who is, in the next few seconds, going to stick a
sharp object into your body, especially when she can claim that it
always takes 10 to 15 attempts to find a vein.
After having my blood taken and solidly confirming with the personnel
that voluntary urine sample submissions were not a part of clinic
policy, I stopped by the restroom, then went by the pharmacy to pick up
a couple of prescriptions the doctor had written.
One was for some little green pills that were supposed to act as
a super anti-inflammatory to relieve the symptoms that were forcing me
to do the Igor shuffle. I was told to be sure to eat something before
taking these. Maybe it’s
just me, but every prescription I’ve ever been given came with the
instructions to “avoid taking on an empty stomach”--- even
suppositories. Not that
it’s a problem; I can’t remember ever having an empty stomach. But it
seems to be the default instruction for any prescription medication.
I think it’s just a pre-emptive defense strategy that
pharmaceutical companies have cooked up.
If they’re faced with a lawsuit involving some poor schnook who
took one of their little green pills and broke out in a broccoli-like
rash, they want to be able to look the plaintiff in the eye and say,
“Maybe it was something you ate.”
The
second prescription (the white pills) was to be taken on a long-term
basis to reduce my uric acid level, which was probably the underlying
cause of my gout. So the green pills were the soldiers, hitting the
beach at Normandy, while the white pills were the elite strike-force,
slipping behind enemy lines to take out Hitler in his sleep.
However, the doctor warned me: don’t take the white pills until
my present case of gout had entirely cleared up.
If I took them any sooner, I would turn into a pillar of salt.
Worse yet, I would relapse into an acute gout attack.
In other words, the cowardly white pills only agree to do their
job after the green pills have sounded the all-clear.
I
started taking the green pills, and they worked great.
By the next day, the swelling, inflammation and pain had
decreased a good 90 percent, and I was feeling pretty smug that I lived
in an age where a little pill could do in 12 hours what it used to take
a bottle of leeches a week to accomplish.
To
play it safe, I finished off the green pills. At the prescribed dosage
rate, it took about 5 days.
I carefully assessed the condition of my foot: well, maybe a little
pain, but nothing that couldn’t be attributed to any foot with around 5
decades of mileage on it.
So I started taking the white pills.
The
next day I was in agony.
Apparently my gout had only appeared to be dead, and had waited
till the final reel to pop up from the grave and wreak more mayhem.
I had the Jason of gout, and I cursed the little white pills that
had resurrected it. In my
World War II metaphor, the white pills were the pharmaceutical
equivalent of the French.
I
called my doctor. He refilled my green pill prescription, then took the
battle to the next level: a five-day dosage of hormones. I was routinely
cautioned to avoid taking these on an empty stomach, ignore any minor
side-effects like massive hair-loss or breasts, and come back to see him
in a week.
In a
week’s time, my symptoms were neither acute nor benign.
My foot was sore and swollen, but I could walk on it in a way
that both got me where I was going and elicited a satisfactory level of
sympathy. Putting on a shoe
was possible, but not desirable, since the pain increased in direct
proportion to the amount of footwear (with lady’s hosiery at one end of
the scale and wingtips at the other).
I was in pain, but it was a pain I could live with and remind
others of constantly.
At
the next visit, the doctor shook his head.
The hormones hadn’t done their job (I assumed he was talking
about the ones he had prescribed).
I still had gout, so I still couldn’t take the white pills that
were designed to prevent gout.
“I’m going to try one more medication,” he said.
“If this prescription doesn’t address the condition, a referral
to a rheumatologist will be the following treatment stage.” I whipped
out my Doctor/English – English/Doctor dictionary and translated this
to: “Beats me. If this
doesn’t work, you’ll have to go to someone knows what he’s doing.”
These pills of last resort were very tiny, so a lot of them fit in a
small container, which was just as well, since I was supposed to take
one of them every two hours.
I hadn’t liked the way the doctor’s hand shook when he wrote the
prescription. I was a even
more uneasy when I gave the pharmacist the prescription and watched the
color drain from his face.
The last straw was when I paid for the prescription and, instead of the
expected “Have a nice day,” the clerk said, “May God go with you.”
The
label told the story. It
read: “Take one pill every two hours until symptoms cease, or vomiting
or diarrhea occur.” I had to admit, it was a novel treatment plan,
prescribing a medication that would either cure my condition, or focus
my attention on more pressing concerns.
I stared at that label for quite some time, trying to decide the
relative value between my toe and my digestive tract.
I finally decided to go for it.
I told myself that the pills might very well work before any
unpleasant side-effects occurred. And, if not, at least they’d keep me
off my foot.
Eighteen pills later, I had very profound regrets about my decision.
I won’t go into how hard the pills hit me. Suffice it to say that
I wasn’t vomiting. You can
figure out the rest by process of elimination (get it?).
After 24 hours suffering the side-effects of those tiny tablets
of evil, I felt like I had jettisoned everything in my body that wasn’t
securely fastened. I was
now a shell that consisted only of blood and bone… and gout.
I
had Sue call the doctor and arrange for the referral to the
rheumatologist. It’s not that I couldn’t use the telephone; I had the
strength (barely), and the handset cord reaches all the way to the
bathroom. But I like to feel I have enough personal integrity not to
pretend to be cordial to someone once I’ve made the decision to arrange
his or her assassination.
All material copyright 2009 Chuck Thornton