Jack

The instant when physician and patient first meet is critical to the future clinical and personal relationship between the two. We do judge one another by action and appearance so that first impression or judgement is important. Eyes are to the spirit as hands are to the art. Jack's bright piercing eyes projected his biting humor, voracious curiosity, and incisive intellect. Jack's hands were thickened and calloused by a lifetime of heavy work, the skin as well as the nails discolored and roughened by hard use and abuse.

A handshake can be far more than a polite formality, for in that simple gesture gigabytes of information are on line; is it limp, firm, warm, cold, dry, wet, hurried, lingering, with or without eye contact, smile, body language. What is the feel of the hand itself. How many hands will a working doc touch in a lifetime, how many minds will touch eye to eye? When my soft physician’s hand was folded in Jack's leathery grip, I got a message, anyone would. His rough but carefully chosen apparel also made a statement. It included a cap with only a big Y on it. You had to ask, "Y?" The subject of his visit was a particularly hypertrophic and twisted nail, a result of an old nail bed injury. I immediately remembered that we had met before, at Circulo Hispano, a social organization for Spanish speakers, or would-be speakers. He was a member of NAOM, and I was a member of NAOCh so we had some common interests.

Jack took the learning of Spanish seriously and was also active in Spanish Toastmasters. He loved the music and poetry of Latin America and maintained a huge library of tapes and literature. His broad accented Spanish was delightful to native speakers, conveying a warmth and enthusiasm which was captivating. In retirement he and his wife lived modestly but traveled much in an old cab-over camper which he had rebuilt. And he used his Spanish lavishly. Typical of his wide-ranging activities was a trip to Nicaragua for Violeta Chamorro's inauguration, where he also met and left Humberto Ortega with an earful of advice. (And I'm sure Humberto wasn't the only one to be so counseled.) He and his wife lived their ideals and they believed in the potential of people, their power to grow and change. Their house was always home to those they adopted during times of trouble.

Jack was a conservative "working man" who rejected that label because he felt the term was too often used to divide productive people into different political parties, when the truth is most people who work at all, work hard. He preferred to divide people simplistically into those who worked and those who didn't work, rather than poor or rich, bad or good. He had the ability to express strong disagreement with others, without offending them. The sincerity and intensity with which he expressed his views, in juxtaposition with his earthy persona, made people listen even when they disagreed. For a time Jack was active in the John Birch Society, but withdrew when he felt the current leadership was racist. Still he believed that the Soviets, (not to say the Russians), were the evil empire of his day, which in retrospect can now be accepted more readily especially by environmentalists. I was, of course, the recipient of many lectures from my patient, and surely got more advice from him than I gave to him!

Jack was a lifelong smoker, although reclusive in his later years. He had worked in the Kaiser shipyards during WWII and was exposed to asbestos as well as welding fumes and flux. A barrel chest and a chronic wheezy bronchitic cough resulted from this, and ultimately a degree of cor pulmonale. Rich food had also contributed to peripheral arterial disease. When he had a seizure-like episode, a head scan revealed a tumor which proved to be metastatic from the lung, inoperable because of chronic lung disease, as well as large vessel atherosclerosis, including an abdominal aortic aneurysm. After a round of radiation, however, he recovered for nearly two years, with only his usual respiratory insufficiency.

My wife had been honorary consul for Chile in Sacramento for some years, and had spoken of that country at Circulo Hispano. Jack had always wanted to visit, and particularly wished to attend the Chilean Military Parade, having seen a video of that three hour long annual extravaganza. After recovery from radiation, with admission to the reviewing stand for dignitaries in hand, he went to his parade. Later, in an episode typical of the man, he went by metro alone at night to a rough area of Santiago. Police, concerned about his "facha de Norte Americano," as well as his 77 years of age and innocent unheeding behavior, placed him under protective custody and took him home. Naturally he had been debating politics, and naturally he considered the whole evening great fun.

While he made some occult preparations for dying, like finishing work about the house which had been incomplete for years, he would never speak of the possibility of death nor his thoughts about his own. At last his aneurysm began to dissect, and he was hospitalized for pain control during which he developed renal failure. Hours before he died, groggy from uremia and sedation to control the painful aneurysmal dissection, a nurse who was unfamiliar with his case asked the old question once again before giving him some IV medication.

"Are you allergic to anything?" Jack opened his piercing eyes and transfixed his nurse with a solid jolt of pure soul, and said, "Only Democrats."

In death I suspect there is no Time, so that an instant is no different from eternity. If that is so, Jack is there in that infinite nanosecond, debating and charming some liberal angel or devil as the case may be, just as he did to us here. If that being shakes Jack's hand and looks into his eyes, he will never escape Jack's counsel. Often, with chart in hand, as I prepare to meet a patient for the first time, I consciously remind myself of the significance of that first exchange. I attempt to shrug off the preconceptions I may have picked up from other patients or from staff, or the chart, and focus on the significance of the moment at hand. I could, after all, meet another Jack; but I doubt it.