Sometimes healthcare can really hurt!

Rachel and I just returned from two weeks in Costa Rica. We visited three small, beach communities on the Pacific Ocean and celebrated our wedding anniversary at the Ylang Ylang Beach Resort. We had exchanged vows on this secluded beach, ten years ago.

One leg of our Costa Rica travel was taking a car ferry from the town of Paquera, across the Gulf of Nicoya to the town of Puntarenas. We arrived at the ferry about an hour before the scheduled departure. I paid 300 colones to use the primitive restroom. Rachel purchased a Coca Cola Light for our voyage. While we were seated at a picnic table, waiting for the ferry to arrive, we watched an ambulance pull up to the docking area. The rear door was opened and we could see a patient on a stretcher. Seated next to him was a young woman in white, who we guessed was a nurse. A woman who looked like the patient’s wife, was also in the back of the vehicle. I could see an IV attached to his arm and another monitor attached to his index finger.

The nurse and wife stepped out of the ambulance, and the driver walked to the rear to join them. She was wearing some sort of uniform. Several men came out of the ferry’s staging area to assist. They looked like unskilled workers, not medical assistants. Rachel and I looked around and noticed a modest-sized motor boat tied up to the side of the main dock. It had a canvas tarp to protect passengers from the weather. The logos and lights on the boat made it look like a medical transport boat. A two hour boat ride appeared to be the preferred way to continue the journey to get to more sophisticated medical care in San Jose, the national capital.

The ambulance personnel and their assistants pulled the patient out of the vehicle. The gurney unfolded as they pulled it out, so that it could be rolled down to the waiting ambulance boat. Rachel and I wanted to satisfy our curiosity and watch the drama, but also felt like the patient and family probably wanted some privacy. I suggested that we move a little further away. We had just turned away from the procession when we heard a crash and a loud scream. We turned and saw that the gurney had collapsed suddenly, dropping the patient onto the sidewalk. Everyone was talking loudly at once. It was a chaotic scene. The patient continued to moan loudly. The wife was holding his face in her hands and trying to comfort him. Several other people were in action, some giving instructions and others just trying to right the discombobulated gurney. I noticed that the patient had been strapped to a back board. A several foot fall onto the hard concrete was very scary.

After a few minutes, the patient was gently lifted back onto the gurney and the gurney was slowly carried, not rolled down to the waiting boat. As soon as he was strapped in, the boat pulled away, and started the trip across the Gulf of Nicoya. At least the weather was sunny and the winds calm.

Afterwards, Rachel commented that it was fortunate that no one had their fingers caught and cut off in the collapsing gurney. What a disaster that would have been. We wondered what the incident reporting process was like in Costa Rica and who would be held responsible, if the patient’s injuries had been aggravated as the result of the fall. We talked about how we take for granted the easy access to our primary care doctors, specialists, hospitals, urgent care centers, and outpatient surgery centers. All can be found right in our neighborhood.

Our hopes and prayers went out to the patient, his wife, and the men and women trying to care for him.

Travel Tales: Beale Street Boogie

Rachel and I traveled to Memphis for Thanksgiving weekend to meet up with my son, Dan and his fiancé, Susie. Susie was originally from Memphis, and their wedding was going to be held there in eleven months. It was a chance for us to meet some of Susie’s family for the first time, and to help with a little of the wedding planning.

We arranged to eat Thanksgiving dinner at the beautiful Peabody Hotel. The Peabody is famous for its resident ducks, who spend their days swimming in a fountain in the lobby, and then every evening, waddle across the lobby to an elevator, to be transported upstairs to their lodging for the night. I kid you not. We also visited the Stax Museum of American Soul and learned a lot about the important role Memphis played in the evolution of “soul” music. We recognized many of the names of the original musicians, including Otis Redding, Isaac Hayes, Booker T. and the MG’s, and Wilson Pickett. Being movie buffs, we recognized many of the songs from movies like The Blues Brothers and The Commitments.

One of the surprises of our visit to Memphis was walking down Beale Street on a quiet Thanksgiving afternoon. This street, in the heart of downtown, is usually bustling with people. Tourists come to shop, eat, drink, and listen to live music. We were staying at a hotel just a few blocks away, and on Thanksgiving day, Beale Street was unusually quiet. Most businesses were closed, even the restaurants and bars. As we strolled up and down the sidewalks on a pleasant afternoon, we passed a few other couples and singles. Some were dressed to the nines, and looked like they were going out somewhere fancy. Almost everyone was African American. Everyone smiled, greeted us and wished us a Happy Thanksgiving. Rachel and I had commented on the friendliness of Memphis people during previous visits.

As we passed a small park, sandwiched between two buildings, two older gentlemen were setting up an amplifier and microphone on a small cement stage. The man with the microphone pointed at us, smiled, and waved us over. Rachel observed that the small audience, seated on a few park benches, all looked like homeless people. It was a nice afternoon and we had time to kill. We decided to join them. We took a seat on a bench at the rear of the seating area. The group of men and women in front of us all had white grocery bags that looked like they contained leftovers from a Thanksgiving dinner. They also each had a large can of beer. When I was in college, my friends called the large sixteen ounce cans, pounders.

After a few minutes of waiting, the duo was ready to play. They placed a Kentucky Fried Chicken box in front of the stage for tips. The older gentleman at the microphone welcomed us and wished us a happy Thanksgiving. The other fellow, carrying an old electric bass guitar, approached the mic and just said, “gobble, gobble.” Then they began to play. They were great! They played a wide variety of soul songs. We recognized most of them. I especially enjoyed their rendition of Sitting on the Dock of the Bay. They played a raucus version of Mustang Sally and succeeded in getting the growing audience to sing the chorus with them. Rachel and I did our best to add our voices to the homeless choir. The singer tried to get Rachel to join him onstage to show her dance moves on a song called, Walk the Dog. Rachel politely declined.

About forty-five minutes into the set, a homeless women set down her can of beer, got up from her bench, approached the stage, and began dancing. Many people in the crowd clapped and the singer was encouraging. She was Caucasian, middle-aged and dressed in jeans and a large grey hoodie. Her dirty hair and the lines around her face gave the impression that life had probably been somewhat hard for her. But she was an uninhibited dancer, and she was fun to watch. The musicians got quite a few tips during that song.

A bit later, Rachel and I dropped a few dollars in the Kentucky Fried Chicken box, waved to the musicians, and continued on our way. It was time to get ready for dinner at the Peabody. When we got back to our room that night after dinner, I powered up my laptop and glanced at the news headlines on my homepage. One caught my eye. It read, “Naked woman arrested on Beale Street”. I clicked on the article and the first thing I saw was a mug shot of the woman we had watched dancing a few hours earlier. Her photo had already made the national news wire. The accompanying article said that she had been arrested for disorderly conduct for dancing naked. At first we laughed a little, and then we felt more sad. We were sure that the fun of the afternoon had taken a downward turn.

There was a place for people to write comments about the news article. The first person who responded posed the question of what constituted disorderly conduct and what her real crime had been. He suggested that if she had been dancing with clothes on that she likely would not have been arrested. Her real crime was nudity. Was nudity really the same as disorderly conduct? Was being naked a crime? His comments made me think of Time Square in New York City. There had been many articles in the news about women posing in just body paint, on the streets around Time Square. Some were painted as super heroes and some as American flags. For ten or fifteen dollars you could have your picture taken with them. While creating some controversy, the nudity was legal in the city and the naked photo business was “taking off”.

Rachel and I talked about her several times during the weekend. Our experience with the Beale Street dancer added both a wacky and somewhat melancholy vibe to our otherwise, great trip to Memphis.


I had a dream last night…

Found Stories can come from a wide variety of sources. All of us have had the experience of waking up after a vivid dream, and wondering where the images or actions came from. Sometimes we think that we should write down a description of the dream, before we forget it. Here is one such dream that I had several months ago. I was so moved by the feelings I experienced that I took the time to write down the parts that I could remember. Enjoy this Found Story.

The first thing I remembered in the dream was walking around Bethesda West, a nursing home in West St. Louis County where I consulted in the 1990’s. The name of the facility was changed a few years ago. In the dream, I did not work there, but as I wandered around, some of the staff recognized me. As I was trying to leave the property, I found myself confused. I wandered around the property, and was unable to find the correct parking lot and my car. I knew that my thinking was off and I was anxious. What was wrong with me?

In the next scene I was in my car and was driving. The road was terrible, with dangerous giant ruts, ice, and treacherous sections. At times I lost control of the steering. I swerved into the parking lot of some kind of motorcycle repair shop. The people standing outside of the shop were sort of rough-looking. I was still having trouble steering my car and I drove into a motorcycle and knocked it down. The rough-looking guys looked angry and were walking toward me as I tried to speed away.

I wake up lying on a bed. My eyes are closed and both of my legs are elevated in front of me. I smell plastic and feel something covering my nose and mouth. It feels like some sort of oxygen mask. I try to open my eyes, but only the right eye opens. I look at myself. I’m in a hospital gown. Both legs are in traction and are being slowly raised and lowered by a machine. The machine does the same thing with my feet and toes, gently moving them around. I noticed lots of abrasions, stiches and bruising on my legs and feet. Some toes were bent in an awkward way.

My thoughts and my pulse were racing. Where was I? What had happened? Was I badly hurt? Was I paralyzed? Did I have a traumatic brain injury? Had I been in a coma? How long had I been here? I had worked in the field of brain injury rehabilitation for more than 30 years. Was this what it felt like to be a patient who had been in a bad accident?

Looking around, I saw that I was in a large hospital room. It looked like a small ward, with six other patients, all in beds like mine. It reminded me of the ICU at Sarasota Memorial Hospital, where I had worked as a therapist in the 1980’s. All of the patients looked like they were badly injured, but most were awake. I had not spent a night in a hospital since I had my tonsils removed when I was four years old. I turned my head and could look out of a window. The building that I could see looked like DePaul Hospital. I had been there for doctor’s appointments many times in the past ten years. I thought for a minute. I must be at the Rehabilitation Hospital on the DePaul campus. Yikes! I am a TBI patient. I was terrified!

It was time to see how bad my injuries were. I tried to move my arms. They both moved a little. I could feel the tubes attached to both arms and something pinching my right index finger. I tried to move my legs and wiggle my toes. The machine made that difficult, but I sensed some movement was under my control. I lay still. My skin felt irritated in many locations, but I was not in severe pain. I hadn’t tried to talk yet. I tried and succeeded in vocalizing a little. Yes! At least I could make some sounds. So far, so good. Now the hard part. What was my mind like? I sat quietly and just “thought”. I didn’t notice anything unusual. Maybe I’d lucked out.

I looked around the room again. I could see staff tending to other patients. Had anyone noticed that I had woken up? Is this like in the movies when the coma patient wakes up and amazes everyone with their normal speech and cognition? Where is Rachel? She should be here at my bedside. Is she okay? Was she in the accident? Was she injured? I decided to try to get someone’s attention. I vocalized again and a nurse or nurses aide approached me. She didn’t look particularly surprised that I was awake. She looked down at me and smiled. She told me that I’m really lucky and that I was pretty banged up. I began asking my questions, out loud, this time. How long had I been there? Was I unconscious for long? Where was I hurt? What happened to me? Where was Rachel? The nurse just smiled, shook her head and told me that we would talk about all of that later. She patted my forehead and walked away. I wanted to scream!

I looked down at my legs and feet. The machine continued to gently move them. My legs were moving up and down. The joints of my feet and toes were being gently stretched. Without warning, my toes curled and my feet tried to break the motion dictated by the machine. They seemed to have a mind of their own. I couldn’t feel them. I was not controlling them. They were moving without my conscious effort. Something was wrong. My brain must be damaged. I screamed.

The dream fades to black. I awoke with my pulse racing. I was drenched with sweat.

I thought, so that’s what it’s like.



A Message in a Bottle

Rachel’s week had been a challenging one and I surprised her by inviting her on a weekend “stay-cation” at the Chase Park Plaza Hotel in St. Louis. We had done this once or twice a year, for a few years. It didn’t require much planning and always was fun. Our plan was to visit the opening of a new exhibit at the Contemporary Art Museum, go to a movie at the independent theatre at the Chase, and have an elegant dinner at Café Eau, our favorite restaurant inside the hotel. We reserved a room for Saturday night and were all set.

We arrived at the Contemporary Art Museum in the early afternoon. There were two new exhibits that had opened earlier in the week. One was called “Laurie Simmons: Two Boys and the Love Doll”. The exhibit consisted of two series of photographs of life-size inanimate figures. One series focused on two male CPR dummies, each posed in front of a computer. According to the printed descriptions, the characters were in some sort of a cyber-relationship and the message was about human interactions in a world filled with technology. The second series of photographs was of a life-size, latex, female love doll from Japan. The attractive and realistic doll was posed in a variety of scenes and dressed in various outfits. Some were sensual and some were not. There was only a little nudity.

The second exhibit was titled, “Occupational Therapy”. The exhibition featured the work of 20 different artists. The part of this exhibit that captured our attention the most was a piece of performance art by an artist named, Pedro Reyes. His piece was titled, “Sanatorium”. Two volunteers wearing white lab coats, manned a table to greet visitors and sign in people who wanted to actually participate in the mock therapy experiences. Once you provided your name and signature granting permission to participate, you filled out a short questionnaire describing how you were feeling: stressed or relaxed, happy or sad, focused or distracted. One of the white-coated young women then provided a tour of four therapy rooms. The first had a large white maze set up on a table in the center of the room. On shelves across one wall were hundreds of common objects. Participants were asked to retrieve objects from the shelves that represented their life and to arrange them however they wanted to in the maze.

The next therapy room had a table filled with several buckets and several wine bottles. Both buckets and wine bottles had rolled-up scrolls of paper placed in them, one in the neck of each bottle and lots of the scrolls in each bucket. The clinician explained that in this session, participants would write down a personal secret, roll it up and tie it with twine. Participants would place their secret in one of the buckets and select any secret they would like from one of the bottles on the table. One would trade their personal secret for the opportunity to read a secret submitted by someone else. We assumed that the secret that we would write would be shared with future participants.

The third room contained another large wooden table and several chairs like you would find in a school. On one side of the table were paper and colored markers. On the other side of the table were two typewriters. The clinician explained that in this session the participant would tell the clinician a story about their life. The clinician would then draw a picture, depicting the story as the participant typed out their story.

The final room also had a large wooden table and chairs. On the table were tools to print a message with alphabet stamps. Participants were asked to think of the epitaph that they would like printed on their tombstone and to use the tools and alphabet stamps to print out the message. The finished project would be attached to the wall for others to view.

At the end of the visit to each of the four rooms, Rachel and I were asked to choose one session to participate in. Rachel chose to let me be the subject and I chose the room with the “secrets”. The clinician escorted me into the room and we both took a seat. She handed me a slip of white paper and pen to write down my secret. I thought for a few minutes and then wrote down my secret. “My wife and I ran in a nude 5K race at a clothing optional resort in Florida”. I thought that would be unexpected and pretty funny too, for someone who would trade for my secret. I carefully rolled up my secret and tied a length of twine around it. The clinician did not read it and instructed me which bucket to place it in. The bucket looked like it held fifteen or twenty other secrets. I was then invited to select one secret from the mouth of one of the wine bottles. I didn’t really have a strategy. I just picked one that called out to me. I hoped it would be funny, like mine.

I slid the twine off of the rolled up slip of paper to reveal the secret. It was written with a ballpoint pen. The first thing that struck me was the poor spelling and penmanship. The message was printed and was very sloppy. Some words had been crossed out so that the author could start the word over. The line of printing was not straight and sort of meandered down as it crossed the paper. My guess was that it was written by an adult, not a child, and the author was not very skilled at writing. This is what the secret said: “I hav always been a disgrase to my family”.

After reading the secret and staring at it for a minute or two, the clinician instructed me to roll it back up, secure the twine around it, and place it back in the bottle. She then gave me the sheet of paper with the before and after questions. I was again asked to rate how I was feeling. I was surprised to write down ratings that indicated that I was less happy and a bit more stressed than before my session with the clinician. The secret that I had selected and read had made me both sad and curious.

Who had written the secret message? Why did the writer think that their family viewed them as a disgrace? Had they done something terrible? Was the writer a man or a woman? Perhaps it was something about the handwriting that made me imagine that the writer was a man. What was his relationship with his family like now? Did they spend time together or were they estranged from each other. Who were the family members that were referred to in the secret? Were they parents, siblings, a spouse, or maybe his children?

I told Rachel about the “therapy session” and about both the secret that I had written and the secret that I had selected. She laughed when she heard that I had written about our funny running experience. As we talked about the message about the man and his family, an idea began to form in my mind. Perhaps this was not all that it appeared. Maybe the desired outcome for viewers of this piece of performance art was to create a genuine emotion. The secret that I had read had accomplished that outcome. I had felt saddened, concerned and anxious. Were the secrets rolled up and placed in the necks of the bottles written by real visitors like me, or were they carefully written by the artist to elicit a variety of emotions? I wished that I could read a sampling of the secrets to find out.

Rachel and I decided that it was more interesting to imagine that the secrets were authentic and that the authors were real people. Rachel reminded me that the subject matter for my first novel, Painted Wings, had been a “found story”. A found story is an idea for a story that you sort of bump into during your daily life, that piques your interest and curiosity. Who knows? Maybe this story about a message in a bottle will turn into a future book. Stranger things have happened.