A Country Doctor Writes:

Ted Hall was in for a blood pressure check and flu shot today. He is a secure, big-boned man with a hint of a southern drawl. A retired military man with a son who is a decorated war hero, he has seen a lot, and seems to take everything in stride.

Wrapping up his visit, I looked at his “Problem list”, the cover sheet on the left hand side of the chart that lists his allergies, chronic medical problems, social and family history. A couple of words under “Family History” caught my eye and rekindled my memory. I asked:

“How is Brittany doing?”

He beamed. Brittany was his youngest daughter. I had seen her only once, but I have carried the memory of that June afternoon in my heart for the last 23 years.

It was a stifling hot Thursday afternoon. I was relatively new in town and Brittany Hall was a High School senior, who usually saw a colleague of mine who was off that day. She had a rash on her legs, graduation was the next day, and I agreed to see her as a “double book”.

Entering Room 11, the same room where I saw her father today, I met a pretty, blonde girl with a flowery summer dress. She didn’t look like most girls from around here, and she carried herself differently. She seemed older and more mature than most eighteen year olds.

Brittany felt fine, and was just concerned about an unsightly bright red rash on both legs. It had been there for a couple of days. She wanted it gone, or at least less noticeable by graduation the next day.

The rash that covered both calves of her fair-skinned legs was petechial and didn’t fade when compressed. The rest of her exam was normal.

“These are broken blood vessels,” I explained to her. “We need to run some blood tests.”

Fifteen minutes later I knew for certain what I had already feared. Her white blood cell count was 28,000, all the same kind of cells – she had acute leukemia, and within twenty more minutes I had arranged for her to meet with the oncologist on call at the hospital twenty miles up the road.

As she left the office with Ted, who came to pick up his daughter, she said:

“And I thought I would just get a cream to put on my legs.” 

I never saw her again, but the reports from the Cancer Clinic kept trickling in. She went through chemotherapy, delayed long enough so she could attend her graduation, and then she left for college. Ted was my colleague’s patient, and I would see him occasionally. Dr. Walls left the area, and Ted became my patient a couple of years ago.

I know I had asked him once before about Brittany, and he had told me she was well, but that time we had not pursued the subject more. Today we lingered more with the story we shared.

“She’s 42 now, you know, a beautiful woman” he said, “and she is married and has two gorgeous, healthy children. The cancer doctors had warned her she might never had children, but she had no problems.”

“I’ll never forget that day she came in with the rash on her legs,” I said.

“Me neither,” he choked.

It warmed my heart to see Albert T. McCall the other day. Nobody knows what his real middle name is, but his nickname is “Twinkle”.

When he greeted me, I instantly saw his deep-set small blue eyes sparkle against his pale complexion, and I knew “Twinkle” was back!

It had been a long haul. Ethel, the love of his life, had died about a year and a half ago. They were high school sweethearts and always did everything together. When her health failed, he took over all the household duties and kept her comfortable at home into the end. At age 83 he lost her, and he became a different man.

Years ago the two of them were the square dance royal couple of our area, and for a decade they ran a dance hall in a retirement community in Florida every winter. He was the caller, and she took care of the business.

“Twinkle” had a thick New England accent, and a wicked sense of humor. Over the years he had developed another persona, “Uncle Al”, with an even thicker accent, wide suspenders, an oversized plad shirt and a silly hat. He told stories about growing up poor and mischievous in the thirties, and he wrote hilarious poetry, which he would always bring samples of to his office visits.

Before Medicare D came about, with rising medication expenses for himself and Ethel, he self-published a book of stories and poems. This endeavor brought in enough money to cover one or two years’ worth of medications. The following year, his children helped him produce a CD based on his book. At 83, he was on a roll, making public appearances to promote “Uncle Al”, always joking in his quiet, soft-spoken way. His deep-set baby-blue eyes did justice to his nickname, squinting and twinkling in his kind, pasty-white, round-cheeked face.

After Ethel passed away, “Twinkle” lost his nerve. He developed heart palpitations, spells of wheezing and hyperventilation, indigestion and poor sleep. Nothing I did seemed to work, and he was always leery of new medications. He even ended up in the Emergency Room a couple of times with no firm diagnosis.

Finally he agreed to an almost homeopathic dose of an antidepressant – the same one his wife had taken for a while.

I knew the instant I saw him that the medication had helped; the twinkle was back in his eyes, there was a faint grin across his round face. His shoulders were raised high instead of drooping, and I could almost imagine the hat and suspenders from the cover of his CD.

“Jeez, I feel good”, he exclaimed, his little eyes squinting at me.

“I’m glad the stuff worked”, I said.

“I don’t know what’s in it, but I feel like myself again!” he beamed.

After many unproductive visits with Albert T. McCall, I again enjoyed the company of “Twinkle” and “Uncle Al”.

I need to find that CD and put it in the car; it will make great listening when I go on house calls this fall.

Between 4 and 5 pm is a time when many people start to wind down, even at work. In our clinic it is usually a mad dash for the finish. We often begin the last hour of the day with all bases loaded – a patient in every exam room.

This is also a time when some of the strangest phone calls come in. Today we heard from Beulah Betts.

Beulah Betts is a remarkable 94-year-old woman. She is almost blind, and lives by herself on Yellow Brick Road, which is a trailer park from the late sixties or early seventies. Her home is neat as a pin, even though she doesn’t see well enough to watch television, read the paper or even see where she put the vacuum cleaner. Her refrigerator door is full of pictures of relatives’ children, even though she cannot see them.

I did a house call there a week or two ago. Her two younger sisters were there, obviously a bit concerned about Beulah’s failing memory. Soon after I arrived, Beulah told me something important about her medications:

“I didn’t know what all these pills were for, so I stopped them.”

I was humbled. Other than her macular degeneration and her memory, she seemed to be in great shape. The trailer was as neat as ever, and she looked good, with normal vital signs despite her noncompliance.

I quickly proposed a compromise. Her cholesterol pill and her eye vitamins seemed more important than the rest of them:

“Why don’t you take these two kinds of pills and we’ll put the rest of them away.”

She was O.K. with that, and we finished the home visit.

Today, shortly after 4 pm, Autumn got the call from Beulah as she suddenly missed all her other pills. I paused for a moment. Was this her usual, mild confusion, or had she had a little too much of that orange soda-looking concoction she once admitted to keeping in her refrigerator? Should I call her sisters, or maybe Adult Protective Services? I decided against it; she was probably safe. Autumn was able to confirm with Beulah that she still had the cholesterol pills and the eye vitamins.

At 4:45 Beulah called again. I was still up to my ears in messages and had two more patient visits to wrap up. This time, she talked to my appointment secretary, Gwen.

Gwen was clearly concerned. Beulah claimed she had been at our clinic this afternoon and we wouldn’t give her any medication.

My heart sank. Was Beulah really that confused? Was she drinking? What was going on?

I called Beulah’s sister, Beverly. That’s how the story finally came together:

Beulah had an appointment with the eye doctor today, long overdue. I had actually asked Autumn to call the eye doctor to facilitate this. Beulah has now developed glaucoma, and had been given a prescription for eye drops. When Beulah and Beverly found out how much the drug store was going to charge for the eye drops, they had come to our clinic. Someone at the front desk had taken the prescription and forwarded it to the staff member who helps patients apply to the pharmaceutical companies for free medications. Because of how wild things tend to be here between 4 and 5 pm, nobody had told me yet or had had an opportunity to document their conversations.

So, during our Bewitching Hour, I had myself worrying that poor Beulah was hallucinating about coming to the doctor’s office while sipping too much of her yellow concoction during her Happy Hour.

As it turned out, she was no more confused than our clinic or I was!