October 6, 2015Joint National Commissions Galore
I like the new cholesterol guidelines
better than the old guidelines: no room for confusion,
like the warning at the edge of a flat world.
But with or without guidelines time marches on,
arteries harden and narrow, sooner or later
somewhere inside each of us the blood will make
a whoosh whoosh sound while getting to where it is going.
In med school Professor Lub Dub Smith taught us how
to listen to hearts that for classroom purposes
made the namesake sounds as valves close in sequence.
He would stand at the podium and imitate the heart,
adding clicks, murmurs, rumbles, gallops, and snaps
according to where the heart was troubled.
We loved him standing up there and sounding
like an exotic male bird showing off for the ladies.
I offer my stethoscope to the patient who whooshes
and he acts as if he wishes I hadn’t assumed
my inner ears are clean enough to touch by proxy.
But a little too close for comfort is how we learn,
that’s how we know exactly where to listen.
If one day I look in one ear and out the other
I’ll never make that joke again. I’d issue the standard warning
against going too far with Q-tips and leave it at that.
People don’t need to know everything, all the details
that don’t matter. Why the chloride is high
is like asking why normal is normal and then you need
to go statistic and draw the normal distribution in the air,
taking the audience out there on one tail or the other
of the bell-shaped curve, at which point they take my hand
from whatever horizon it’s pointing at and say it’s ok,
it’s going to be ok. Not normal isn’t so bad,
after all each result on the chem 20 panel has a 5% chance
of being too high or low, and the chance of a normal person
being normal for everything is about 50%, lower than you’d guess.
I used to give that lecture and the students compared me
and the subject to watching grass grow or paint dry.
No one mentioned my dry wit. Later in life they will recount
eternity in an hour and return to the difference
between paint drying and grass growing, apply that wisdom
to their daily yoga practice, not only apply it but rub it in
to achieve a carefree finish. People don’t know carefree
until an asteroid out of nowhere blots it and the horizon out
then crashes through the ceiling so there’s no place to sit
except on the edge of a speck of the big bang.
In that gloomy light what looks like a mixed metaphor
turns out is an elephant hogging the sofa.
Best not to talk too much about something like that,
best to reframe that experience, after all
it was only a small asteroid, maybe just a meteor,
a shooting star, someone’s wish wishing to come true.
The doctors say maybe we can help a little
and the patient decides a little chemo sounds better
than nothing. It’s easier to hear what we want to hear,
and not just because of ear wax or the vacuum
that used to be memory or good old reliable denial—
which may be dumb but is not stupid—
but because of Charles Darwin and natural selection.
Counting on happy endings helps us reproduce,
impose sanctions, plan for retirement, trust sunscreen,
overcome modesty, fall in love and stay in love
like that lively couple French kissing on the beach.
The French also invented the stethoscope. Whoosh
you want to hear him whisper in her ear.
Their private joke. Shush her private answer.
His cholesterol looks high, sugar and blood pressure too,
the kind of more than chunky more than middle-aged guy
who drops dead more often than chance would allow.
Is laughter his best medicine?
Not according to the Joint National Commission.
With electronic medical records it’s easy to rank patients
with diabetes and learn the higher numbers are people
who like to thank the staff with home baked cookies.
It’s a sweet gesture. Sharing makes them happy.
We let them be happy but we can’t make them,
not that there are guidelines. You can make
an old friend happy just by bumping into him
on the sidewalk. He’ll say how happy he is to see you.
Then say it again to make it stick. You smile back.
You stop slouching. You know that feeling when you finally
get around to changing the light bulb in the garage
and can go out there and actually see? That’s how light it feels:
two old friends in the daylight savings delayed dawn
waiting for the indoor pool to open. Cholesterol doesn’t come up,
but staying alive is implied by context. Why else be up early
swimming laps and asking existential questions?
Why does the water feel cold even though it isn’t?
Why keep the locker room so cold? Why do goggles
fit perfect one day and leak the next?
Same head, same beady little Kafka eyes that are overdue,
according to the postcard, for a check-up.
There’s a moment during that exam when the reflection
of the optic nerve is visible to its owner,
just a glimpse is all you get, it seeing you seeing it,
hardly counts as introspection but what could be more meta?
Halls of mirrors for one thing. Guidelines for another.
Thousands of randomized patients and after a while
they look so much like you or me that escape is impossible.
While standing in line getting guidelined to death,
while explaining to the nurse your pressure is always high
at the doctor’s office, while saying aah then saying aah
an octave higher, while trying as instructed twice
to please don’t blink the eye drops out—
staring as hard as you can to be a good patient—
think about how hard it is to outwit a reflex.
They never listen. Think about all those basic circuits
lined up end to end, how they can take us to the moon
and back if only we would let them.
Last night there was a full lunar eclipse,
the kind that looks like cream of tomato soup,
all the sunrises and sunsets on the planet
bent in the moon’s direction. But it was raining hard,
cats and dogs, too wet for shadows, and the rain
was an excuse to stay in bed and listen
to three points form a straight line
while heading in different directions.
The night, pleased to have an audience,
purred as it settled into place.
from #49 - Fall 2015