Joseph F. Clark, Ph.D.

The next thing I knew, Holly was standing in front of us with a smile on her face. She and I hugged briefly and she invited us in.

With only Jim there, the two of us were able to catch up on each other’s comings and goings over the past few years. Holly worked part time as a waitress in a small coffee shop. She was majoring in social work at school, and after she graduated she hoped to eventually work with family services helping to keep families together. Her mother’s alcoholism had largely pulled her family apart and Holly wanted to make sure others did not suffer a similar fate.

Holly’s mother was an alcoholic who was often relapsing and binging, which made home life unpredictable. A binge drinker can convince themselves that they are fine and normal for days or weeks at a time, then suddenly go on a bender and be a complete monster. Often the alcoholic will not remember the episode later, or black out, and seem surprised at the hurt or angry behavior of their family afterward. The reason is that during the binge the binger can be violent and aggressive to the people around them but have no recollection of the altercations later. Her family will, however, remember those things and be emotionally scarred when the binge is over. Thus for a sense of stability Holly lived away from home and only visited her mother when she was sure a binge was not in progress. Holly wanted to help people and had found an avenue where her life’s experiences could be an aid to making that happen. I’m not really sure what I expected, but we were able to connect more effectively this time. On this visit, she also seemed more interested in what I was doing. Perhaps she saw parallels with her career plans in social work and my plans to help people via a career in sports medicine.

“So you work with all the jocks in the university?” she asked.

“Yes.”

“I was in the University Recreation Center and rode up the elevator with two huge guys who must have been on the football team. They seemed scary to me. Do they scare you? What do you do with them?” she asked.

“No, they don’t scare me—sometimes I am their best friend. I take care of their injuries, strap their ankles or knees if they need it, and try to make sure they can keep playing if not play better.”

“Strap their ankles? Ha Ha, you’re a ‘jock strapper’” she laughed.

Jim thoroughly enjoyed that. Joe the Jock Strapper quickly became the theme of the conversation. It is actually a friendly nickname that my closest friends and colleagues use to this day. I briefed Holly on the anatomy class I’d just finished. Her days as a nursing student gave her a clinical insight, so she was not grossed out by the concept of cutting up a body, but interested in hearing more about it. Something we couldn’t do when her roommate Jane was there. Both Jim and Holly were quiet and attentive as I explained how we would cut into the skin and expose the muscles and nerves. I told them how complicated the anatomy of the head and neck was, and how much time it took to dissect the face, eyes and skull.

“Was it hard to cut up someone’s face?” she asked.

“Well, that was done after we had some experience doing dissection, and by that time we’d gotten used to working on the cadaver. But it did end up having a dehumanizing effect, because she no longer resembled a human when we were done. She really looked alien after that.” I said.

Jim and Holly nodded, seeming to understand the ramifications. For me it was truly a learning experience and even somewhat visceral to cut into the face, mouth and eyes of Clare the Cadaver. We had discovered that Clare had no teeth and a cleft palate in the process of our dissection. She likely was missing several teeth from birth, and lost all her teeth long before she became a cadaver. Despite her advanced age, her lips and her face looked relatively well formed. But the roof of her mouth was largely absent. Modern medicine will often fix the roof of the mouth when repairing a case of cleft palate, but when Clare was younger the goal was probably just to have her face look relatively normal, which was a success because she was a normal-looking 90-year-old cadaver, with gray, pasty skin and shrunken muscles from years of sedate living. Again, the lessons I learned from Clare during that one class taught me just as much if not more than any college professor ever could. All medical personnel are deeply indebted to those who in life donate their bodies to research and teaching so that they can benefit society even in death.

The three of us talked for hours. The subject of food eventually came up, and who was hungry and what was there to eat? Holly didn’t want to go out to dinner, not only because it was expensive, but since she worked in a restaurant like place she didn’t really enjoy eating out. She suggested rummaging through the kitchen to see what we could find. My mother would often mix miscellaneous salvaged leftovers into a soup she called garbage soup. Hopefully we could come up with something better-sounding than that. Holly’s kitchen was well equipped and well stocked with fresh and dried foods, all sensible and healthy choices.

There were lots of choices, but based on personal preferences and supplies on hand, we settled on chili con carne. All three of us knew how to cook and we worked well as a team. Jim and I had both learned how to cook from Mom and I had worked for a while after school in high school at a catering deli. So I felt comfortable cooking. Our jobs seemed to assign themselves; I took to chopping the onions and green and chili peppers while Holly started pan-frying the ground beef. Jim opened cans of tomato sauce, got that cooking in an aluminum pot, and then started spicing it up. Between Holly and her roommates they had a great selection of spices and Jim had fun mixing flavors. With three of us working together we were able to get a nice pot of chili done in less than an hour. We served it over some instant rice, with steamed carrots on the side.

While I was chopping up the fresh chili peppers Holly had, I found a small one that I put in the mix intact. This was a little trick I’d learned in college and we called it “bingo chili” because if you were lucky enough to get the whole chili, you got to wash the dishes. I wasn’t sure if the rules would apply here because it was Holly’s home.

Dinner was a pleasant repast with good food and even better conversation. Jim doesn’t drink but I had a couple of beers, which Jim and I had brought along for the long trip home. Holly had some of her favorite red wine that came in a box she kept in the refrigerator. She liked chilled red wine.

Holly won at bingo chili. She absentmindedly commented on an unchopped chili she found in her bowl and I yelled, “Bingo, you win.”

Holly was nonplussed and Jim disinterested as I explained the rules of bingo chili. Holly said she didn’t mind doing the dishes but would accept help. Jim immediately volunteered and said the easiest way to do dishes was in the toilet because the flush is the ultimate rinse! Jim didn’t do the dishes; Holly and I did.

 Chapter 4. Reverse Road Trip

The anatomy class was a lot of work and ground on uneventfully after the trip to Holly’s. My mugging adventure was quickly forgotten in all the class work. I concentrated on keeping up with the material and passing the class. I got into a routine of class, lab, study and recreation. My main recreation was skateboarding, so I could see the city and get some exercise.

My final exam was scheduled for Thursday and I wanted to take Friday to clean up and then get moved out on Saturday, just a little over 4 weeks from when I saw Holly. We decided that Jim would arrive on Friday and head out with me on Saturday. We scheduled a stop in Des Moines into our trip home so that I could see Holly again. Holly and I had set up a meeting on Saturday, and I was bolstered by the thought of having Jim with me without Holly’s roommates.

The anatomy final exam was brutal. By the time a final exam is done on a human cadaver, the body has been dissected and examined in detail over the several weeks of the class. So the cadaver begins to look like a bizarre three-dimensional road map with strings and fibers running in seemingly random directions. Clare’s body had been instrumental in educating several health care professionals, and in the process the skin had been completely peeled off of her, every muscle and nerve dissected and isolated, all of her organs removed and analyzed, her ribs cut and heart cut open and even her skull was cut in half with a band saw to expose her brain.

Interestingly, one of the other cadavers had apparently died of a massive brain hemorrhage. When her skull was cut open, the blood must have still been under some pressure, because it sprayed all over the technician and student doing the cutting. Both had brownish-black splatters all over their clean lab coats. They washed the blood and sinew from their skin and clothes and went back to work. The dissection of this cadaver’s brain was made more unusual by seeing the pathology of the hemorrhage. There was so much brain damage from the hemorrhage that it was easy to see why the person had died. After the hemorrhage the brain swelled, and there was not enough space within the confined space of the skull for both blood and swelled brain. All of this pressure caused the brain to stop functioning.

The final exam was a test to identify anatomical structures in a pile of flesh and bones that had been poked and prodded to an almost unrecognizable state. Nonetheless, I appreciated the learning experience and had come to respect that pile of flesh as the proverbial icon of my learning experience in Omaha, Nebraska. I was familiar with Clare’s body inside and out, so to me she was an educational tool I will always remember and could never have done without.

My final exam was successful and I got a B in the class, which I was very happy with and was equally happy at having learned a tremendous amount of anatomy. Jim arrived the next day as I was returning all the class and library materials I had borrowed during the course. It is amazing how much additional stuff one can accumulate in a short time, and I needed to return all of that equipment. Jim helped load up the car while I closed out my class account and library loans.

Saturday morning Jim and I were on the road headed east to Des Moines. About halfway to Holly’s, Jim found a set of hemostats in the Ford. Hemostats are surgical instruments that I used during the dissection of Clare, something I had borrowed from the anatomy lab and should have returned. They look like scissors, but are more like clips that snap shut. I figured I could mail them back when I got home, so I asked Jim to clip them on the tassels hanging from the rear view mirror. If they were hanging in plain view, I’d be less likely to forget them.

Saturday afternoon Jim and I found Holly’s no problem and I parked in my “usual” spot. I stood outside the door for a few moments before knocking. When I visited alone a month ago, I was too tired and annoyed at my car to be nervous, but I was definitely nervous now.

Would she be there, were her roommates really gone and what would we talk about? All this ran through my mind like a rumbling freight train. Jim, frustrated by my hesitation, knocked forcefully on the door to bring me back to the present.

Below is a series of e-communications between myself and a long time friend. The exchange is concerning this woman’s dying father and she wanted some information to help her understand what was happening. Unfortunately the local physicians seemed to not be providing information and the family and loved ones were feeling somewhat abandoned by the local medical system.

I’m reproducing this here with permission to show that the whole health care community can and should be engaged in educating families about what is happening to their loved ones. Following the exchange of letters below I summarize a few things and explain some of my thinking in what I said to her.

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Hi Joe

Please pardon my question to you about this as I’m sure you get many off the cuff type of neurology questions ……. but my father is dying so I was curious…

Last night my mother found him ‘shaking’ on the bed seemingly having a seizure. 911 was called and EMTs came (5 of them!) they were not able to resuscitate him on the bed (no pulse/breathing) so moved him to the ambulance to do further compressions/CPR. He was then brought to the hospital where they did more CPR. He was ‘stabilized” but his BP was VERY low until lots of meds given (do not know what kinds). Pulse was low as well.

Today he is on a vent, totally unresponsive except for some slight reaction to pain stimuli as the day wore on. BP doesn’t seem to maintain itself on its own and continues to drop unless on meds.

CT scan revealed no evidence of a stroke or embolism, no swelling or brain shifting – just normal aging signs and signs of Alzheimer’s.

We’ve not gotten a good picture from a doctor about what happened. Cardiac enzymes are up but indicated that could have been from all of the resuscitation work.

Could a heart attack cause a seizure? Can the brain NOT show any signs of stroke/embolism but still be damaged?

We have discussed and feel we’ll take him off life support tomorrow but I’m still left with the what happened question.

Might you have any thoughts?

Thanks so much!
T.

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Hi T.,
My sincerest sympathies to you and your family at this difficult time. I do not at all mind friends asking me questions. My life’s work is to try to help people and families during such difficult times so any small help I can be I’m glad to offer.

It is absolutely possible to be unable to see on imaging ischemic stroke or damage post seizure event such as you describe. It is also possible for a heart attack to cause a seizure. Even low blood pressure could cause a seizure especially with a brain that has pre-existing pathology such as Alzheimer’s.

I personally would not dismiss the low blood pressure or heart attack scenario especially with low blood pressure persisting. So without all the medical data please let me speculate. If his heart went through an episode of low blood pressure with or without low heart rate the brain might reach a point where not enough blood was getting to the brain. The brain, being fragile from other pathology, loses homeostasis which leads to the seizure. The shaking makes the heart work harder, but maybe it can’t. The seizure also makes the brain need more blood flow. Yes, it is complicated, but the result is a battle between the brain and heart, sadly both end up losing.

The cause of the original episode (heart attack, low blood pressure) could be hard to determine but might be a brief period of low blood glucose, a sneeze or several things that a person with normal control systems is able to respond to but a person with pre-existing pathology cannot respond to normally and a series of runaway events occur.

Everything you said above says to me that your father’s body is losing or has lost the ability to respond to cardiovascular changes that a normal healthy person is ready to deal with. I do not think anyone will be able to predict if that is something that could be changed or treated but (excuse me for being indelicate) the human body cannot live long without the control systems working.

I know what I am saying may be hard to take considering what you, your father and family are experiencing. The human body has many back up systems but as we age they begin to fail and other’s take over. We (patients, family and physicians) may not know that control systems are becoming less effective until an event such as you describe above occurs. Now, we are left with trying to preserve life and hoping that the control systems (control of blood pressure, heart rate, heart work, blood flow etc) can get back on line.

If you have any other questions, feel free to ask. All I have done, and all I am able to do, is speculated on some things that might have happened to your father.

Best wishes.

Joe

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HI Joe

Thank you SO much for your explanation. It does make very good sense to me and helps me understand a bit better about some of the events that have led up to the state he is currently in. I just couldn’t grasp the seizure activity with the lack of findings from the CT.

We’ll be having conversations with the Neurologist and Cardiologist today about his current state in order to make ‘the’ decision. But we all know what we’ll do. Sadly if he did suffer brain damage and could recover from the heart ‘issues’ he currently has – we don’t think he’d function well between that and the Alzheimer’s – he was already really struggling with the Alz.

My mom is his caretaker and has advanced COPD (Oxygen 24/7 etc) so her capabilities are limited. The cost for a GOOD nursing home is ridiculous and ‘they’ wont pay for the cost via Medicare unless you are pretty much broke – which would leave my mom without anything to live on (she is very independent and won’t do a nursing home herself)

Anyways….. I ramble.

All of us know what today will bring. There is a lot of dread and anxiety over it and in some ways a desire to have ‘it’ be over. But all in all – he is 80+ years old and has led a great life, and the practical side of me understand that this is life. Death is a part of life. Hard part is going thru it.

Thank you for helping me understand some of the physical aspects of what may have happened – we can all only speculate but I’d guess that you are very accurate in what could have occurred.

I’m grateful for your expertise and willingness to help me understand.

T.

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Please note, I waited a respectable period of time before asking T. for permission to post this exchange to my blog. Obviously I have taken out personal and patient identifiers. She was happy to allow me to share this on my blog because I think she understood the goal was to help patients and clinicians see how some information, even speculative is important to share. T. and I exchanged a few additional communications, which I will keep private.

 T.’s father died less than 48 hours after the episode above. The family made what they considered informed decisions concerning pain management and resuscitation choices and in their eyes he died peacefully with dignity.

I understand that physicians often are hesitant to speculate on events that have transpired with failing patients. Especially when it may never be known what happened as is the case with T.’s father. This hesitance may come from a fear of being sued or fear of being wrong, but the goal for all of us is to help patients and their families. This family, T. especially, needed information. I understand that it may be easier for her to ask an old friend some of these questions, but many people do not have that option. The physicians are the only source of information or comfort.

I also acknowledge that what I said may be wrong but what I tried to do in my answer was to not artificially raise her hopes but provide her with some relevant information that she and her family might need should they choose to withdraw care or make him D.N.R (do not resuscitate). Please look closely at the last two paragraphs in her response to my information; her goal was to try to “understand” what was happening. Clinically, we may NOT KNOW what is happening, but there is an understanding of multi-organ-failure that needs to be conveyed to the patients and their families.

I loaded up on coffee and tried very hard to pay attention to the lecture. Lab was a little easier because we were standing around Clare and all had to work together. The lab’s usual small talk ensued while we were cutting up Clare’s chest and abdomen. Sherry was telling the group that she took the evening off and had a few drinks to relax and that it was great to take a break. I was pretty quiet.

 “What did you do last night, Joe?”

 “I got mugged and spent the night in the police station looking at mug shots.”

Everyone laughed, thinking it was a joke.

 “Actually, I’m not kidding, I lost my watch in a mugging and will be going out later today to get a new one.”

 “I don’t care about your watch, are you OK?”

 “Yeah, I am fine.”

 “Well? What happened?” Kim asked. “Tell me everything. I can’t believe this.”

I told them the story, including the threat of a gun and me saying no.

 “Only a New Yorker would say no to three muggers with guns.” Dave said.

 “What guns? There were no guns and only one creep got out of the car,” I insisted. But by the end of the afternoon the story was that I had been attacked by a horde of drunken rabble with weapons and refused to surrender my property to them. I never did get the watch back, but I did go to the pawnshop and find a nice replacement.

I procrastinated a couple of days before telling Mom and Dad that I had been mugged. The whole incident was just an inconvenience for me, but I knew that it would be a major melodrama for them. So on my weekly phone call home I resolved to tell my brother Jim first and gauge his response before telling my parents. Jim thought the abbreviated story was hysterical and could hardly wait to watch Mom and Dad’s expressions as I told them one by one on the phone. Dad seemed to take it pretty well and gave the phone to Mom. Mom hit me with a series of questions about my health and welfare thereafter, not quite realizing that her angst was causing me more distress than the mugging itself. Interestingly, when Mom finally seemed to calm down she said Jim wanted to talk to me. I figured Jim wanted to debrief somewhat, but I was wrong.

 “Dad wants me to come out and get you when you’re done there,” Jim blurted out over the phone.

 “I see, you are going to be my hired gun,” I said.

 “Yeah, but it could be a fun road trip.”

 “I understand. You have my schedule here; let me know when you’re coming.”

 “Yep. Later.”

 “Bye.”

He hadn’t said much, but Dad was obviously concerned enough to quickly convince my brother to bring me home safely. Well, as Jim said, it could be a fun road trip.

While I was looking forward to doing the road trip home with my brother, I had planned on stopping by to see Holly. I did want to get some alone time with her and that might be hard with Jim there. Anatomy class was a substantial workload that left me little to no free time. Nonetheless, I scheduled a weekend where I could go to see Holly alone. The week before it, I worked doubly hard to make sure I was caught up on all the class work and planned to leave on Friday night for Des Moines. Holly’s roommates were in town, but she said that they would love to meet me. So, the date was set for a weekend getaway.

On Friday after class ended, I packed up the van and headed east on Route 80. I was about an hour outside of Omaha and the sun was setting behind me when my van started to sputter and stalled. I coasted to the edge of the road/to the road shoulder and tried the engine again. It started up with some protest, and I was back on the road in seconds. When I reached 40 miles an hour, however, I heard the same sputtering again. I let up on the gas and the sputtering went away. I accelerated again, but if I went faster than 35 mph the engine would sputter and die. Even doing 35 miles per hour, it would suddenly die for no apparent reason. With my warning flashers on I limped to an exit and tried to get help. No mechanics were working at the gas stations I stopped at. Strangely, when idling the engine sounded fine. I got back on the highway and kept my speed between 35 and 40, with occasional stalling, from Omaha to Des Moines. I tried calling Holly’s but the line was busy. One of her roommates must have been on the phone. It took forever to get to Holly’s. I got there after midnight completely exhausted and mad at myself and my van.

I knocked on Holly’s door and she answered immediately – concerned by my lateness and happy that I had made it. I explained to her the fiasco with my trip and apologized for being so late, assuring her I had tried to call multiple times. She understood. It was nice to see her and her presence made me calm down. I quickly realized how tired I was, which she noticed and ushered me off to bed.

The next morning, Holly referred me to her mechanic who did not work Saturdays, as it turned out. I finally found a mechanic who would look at my problem. He was the quintessential grease monkey, in blue coveralls, stained from what looked like years of crawling under cars. His name was Emmet and his lower lip protruded from a large wad of chewing tobacco. Emmet “reckoned” that water or “summit” was in the fuel line, although he couldn’t figure out why it was only causing problems at highway speed. While I was trying to show him what was wrong I revved the engine, and it ran perfectly. He suggested some gas additive and told me to run the van out of gas and then add more gas additive during the next couple of fill ups. I purchased some bottles based on Emmet’s recommendations, paid him for his time and went back to Holly’s.  Now it was nearly 3:00 P.M.

I had been on the road for over 22 hours and only shared about 3 sentences with Holly. All the rest of the time I was dealing with car issues, except for the couple of hours I slept on Holly’s couch.

When I got back to Holly’s she was not there. She was grocery shopping, so I introduced myself to her roommates properly. Last night I met one: Jane, and this morning I met Carol, but those meetings had been harried. Now that my van had a clean bill of health, we could have a real conversation.

I briefed Carol and Jane, who were sorority sisters of Holly’s, on who I was and what I was doing in Omaha. Carol was a business major and heavily involved in the sorority. Jane was undecided as to her major, but was not going to do anything medical. Jane was also an avid runner; often participating in marathons. I took the “not medical” comment as a gentle warning to stay away from talking about the gore I was immersed in Anatomy class.

 When Holly got home I helped the three of them unpack the groceries. We were going to have dinner at their place tonight. I asked if I could help and I was assigned chopping. Holly suggested that. Jane seemed to be directing the cooking and she was making a vegetarian casserole, with steamed broccoli and cauliflower on the side along with a salad with choice of dressings. The casserole had noodles, nuts, a mixture of vegetables and a cream sauce. It was very tasty.

Over dinner we talked about college classes, trying to live and pay for classes and the unrealistic expectations of college professors. Carol was advocating the sorority system, which helped sisters struggling in a society that did not value education. She made it clear that the “sisterhood” was a lifelong network to bring cohesiveness to all those smart enough to be in the Greek system. I was not in a fraternity and might have felt like an outcast if it had not been for Holly.

“Joe works as a student athletic trainer in college for the woman’s basketball team.” Holly said.

 “Really?” enquired Jane. “Do you know much about shin splints?”

Jane and I chatted about the causes and treatments of shin splints. It turned out that she was training for her upcoming runs by doing the stadium stairs. This had Jane running up and down every set of stairs in the college stadium. It was great aerobic training and for leg strength. But since she was running down the stairs, too, it put too much strain on her shins. I suggested flat training for a while or using a stair master. If she wanted to do the stadium stairs, I strongly advised walking down them gently. Jane also agreed to ice her shins after every training session and would look into some wraps as well. The two of us kind of got on a roll in the whole sports scene and dominated the conversation for a while.

Dinner wound down, and I offered to help with the dishes. I proffered my opinion that the cooks cook, so the eaters should clean up.

 “Next time, I’ll cook and you can clean up.” I said.

Jane and Carol happily agreed and Holly and I cleared the table and did the dishes. We engaged in small talk as we washed and dried them by hand. As we finished, Carol announced that we were all going to their local hangout for the evening. My eyes met Holly’s but I could not read her expression. My thoughts were; did she want to socialize as a group or did she want us to catch up? Without a clear signal from Holly, I followed the three of them out to a dimly lit pub, called the Rat’s Cellar, that was in the basement of a bicycle repair shop.

It was smoky and full of local college students, all of whom seemed to know one of the three women I was with. Again, Carol took the lead and chose a booth big enough for eight people that the four of for us sat in. I sat next to Holly with Jane across from me. A steady stream of guys stopped by the table to talk and Carol always introduced me as Holly’s friend from back east. I did not say much nor did Holly. We had some drinks and talked with many people as the evening wore on.

Eventually it was time to go. I am not a drinker but had three beers that night. Carol was in training for a marathon, so she was the designated driver. At the apartment, I sat down on the couch hoping to talk quietly with Holly. But, between the stress of class, the agonizingly slow drive here, and the drinks, I fell asleep.

I woke up the next morning feeling no worse for the wear from the drinks, but deeply disappointed that Holly and I had not been able to talk or really catch up. It was Sunday morning and I needed to leave by noon to get back to Omaha in time to do what I needed for Monday’s class. I showered and packed up the van; hoping to have some time just to be with Holly.

As it turned out, the only time Holly and I had alone was standing in the parking lot of her apartment complex leaning against my van. The whole weekend seemed surreal and unsatisfying. I clung to the hope that a second visit with my brother Jim might provide more evidence of the spark that once was there, but this weekend did nothing to reinforce a bond between Holly and myself.

I kissed Holly goodbye and hugged her. It was not entirely clear to me whether she was hugging back. As we separated, I looked deeply into her brown eyes and could not get a sense of what she was feeling. I knew what I was feeling, which was a feeling of loss and loneliness. I felt completely alone standing there with Holly in my arms.

I climbed into the van and drove off. Looking at back at Holly, I convinced myself that she looked sad, but I couldn’t really tell. About an hour outside of Des Moines, my car sputtered and died. I was doing 35 miles an hour with my hazard lights flashing. As I drove, I kept going back and forth between thinking there was a hope for a relationship with her, and then back to feeling that there was no hope. Even a long-distance relationship can be considered a relationship, I told myself. Maybe with on my second visit, even with Jim there, I might be able to sense a spark. Holly had told me that when my brother and I returned to see her on our way East, her roommates would be out of town. So maybe, I thought, without her roommates Holly and I could rekindle something. All these thoughts coursed through my brain at 100 miles an hour as my van and I drove under 40 miles per hour all the way back to Omaha. It was late when I got back to my room and I had a ton of work to do before Monday’s class.

It turned out Emmet was right in that “summit” was in the fuel. But it wasn’t water. Some kind of chalky grit had somehow gotten into the gas and it only clogged the fuel lines if the fuel flow was fast for a while. In other words, driving at 60 mph would lead to this gunk stalling the car. The entire fuel line and gas tank had to be flushed to fix the problem, and if that had not fixed it, I might have needed to replace that whole system. Fortunately just flushing worked.

Very shortly after leaving Des Moines, one hits the Mississippi River and crosses the river into Nebraska. Omaha is a small but very modern and complete city on the banks of the Missouri River. My destination was Creighton University. Thanks to the maps that came with the registration material, I quickly found both the school and the dorm I needed to get to. The dorms were actually medium-sized, semi-furnished apartments. My “room” had two bunk beds, a couch, TV, dining room with table and 4 chairs, and a pretty well equipped kitchen with fridge, freezer, oven and stove. I was going to have a roommate – a pre-med student named Jim. Jim was also from New York.

Registration for classes had ended for the day and would continue tomorrow. Although I was registered for my class, I needed to pick up a temporary ID to be on campus and in the library, etc. Orientation was tomorrow afternoon and classes would start the day after tomorrow, so I had nothing much to do today. I was very tired and looking forward to trying out one of those bunks.

Anatomy class would be traditional didactic class work, which means the professor talking at the students and the students listening, in the morning and lab in the afternoon, 5 days a week. There were two main instructors and a bunch of assistants. There would be three exams based on anatomical sections: chest and abdomen, then head and neck, followed by extremities. The class was made up of a wide range of people from all over the US and Canada. Some were pre-med, some were medical students who needed to make up an anatomy class, and some were dental students who would only take the part of the class relevant to dental medicine, which is chest and abdomen plus the head and neck anatomy. So they would be with us for about 2/3 of the course.

The class would be all together for the classroom instruction and in groups of 4 for the lab. Each group of 4 would receive a human cadaver to dissect, and each group would include 1 or 2 dental students. The dental students were spread out this way to ensure that the cadavers were all used consistently and fairly by each of the groups.

There were very strict rules and protocol for the use of human cadavers. We had to avoid ever referring to the body as “it.” We were instructed to say, “the cadaver,” “he,” “she,” or use the cadaver’s name in life. My group’s cadaver was called Clare in life and we called her Clare. My group consisted of myself, Sherry—a dental student, Dave— a medical student, and Kim — a graduate student. Sherry was from Texas and was actually retaking the class because she was unable to complete it at her home university. Dave was from a student in Creighton and from Nebraska and had failed the class the previous year and Kim was taking it for credit in his degree program.

Class was long, hard and a great learning experience. There were 60 people in the class with about 15 cadavers. I had purchased the books and a lot of the dissection tools but I didn’t have everything I needed, so I bought some more. Each student was loaned a “bone box,” which was a toolbox with a complete disassembled skeleton. This I left at home and would work with it to learn the anatomy as needed. I would skateboard to and from class and sometimes home for lunch. My roommate Jim was re-taking a chemistry class, so his schedule was not as hectic as mine. I tried to help him a bit with his chemistry.

An interesting thing happened about a week after class started as I was skateboarding back from the cadaver lab. I had been working on Clare, trying to get the conduction system of the heart straight in my head. The subject is fairly complicated and it was quite late – about 2 A.M. I was halfway home when a Lincoln Continental passed me and pulled over in front of me while I was going under a bridge. It was the only secluded part of the road between the lab and the dorm. There were three people in the car and my New York instincts kicked in immediately. I got off the skateboard and held it in my right hand. I stood where I was, not approaching the car that was blocking my way. A single black male got out of the passenger side, and with a blustery swagger he came up to me and said, “Give me your wallet!” I was gripping the skateboard tightly and ready to use it to defend myself.

 “No!” I said.

 “What the f*ck. Listen, give me your money now.” He then hid his right hand behind him and said, “I got a gun—give me your money.”

 “No.”

 “Listen, give me that watch or my friends and I are going to beat the shit out of you.”

I took off the watch and gently tossed it to him.

 “Turn around,” he ordered.

 “No,” I said as I tightened the grip on my skateboard and with my other hand started to write the license plate down on my hand.

 “Don’t you be writing down no number.”

No response.

 “Fuck,” he said and trotted back to the car.

I got back on the board and went in the other direction. I found a campus security officer and told him what happened.

 “What—you were mugged?” he exclaimed. “And you said ‘no’ to a mugger with a gun?”

 “He did not have a gun,” I said.

 “How do you know? You said he claimed to have one.”

 “True, but he was just using that line to intimidate me.”

 “You really should do what a mugger says or you could get hurt,” he replied.

The security guard, named Benny, called the other campus security and the local police to report the robbery. I was brought to the campus security office to fill out the report and wait for the local PD. A uniformed officer came and got a description of the car and the license plate. The car turned out to be stolen, but he would go out and look for it. The police would also issue a BOLO (be on the look out) alert for the car. A short time later a detective named Rodgers came to take a statement from me. It was around 3:00 A.M. now. He asked me questions and took notes along with a description of the mugging and made the same musings about not saying no to a mugger. I shrugged and assured him there was no gun, just a threat.

He then asked how I could be contacted locally and how long I would be in town, as well as asking for ID. I gave it to him and he said, “It figures, only a guy from New York would say no to a mugger. Have you been mugged before?”

 “No, this is a first.”

 “Well, you are lucky.”

I didn’t tell Detective Rodgers that I was ready to smash the skateboard across the guy’s face if necessary. Rodgers asked me if I would recognize the mugger again and I said yes. His face was a vivid memory. After finishing the info for the university police, Detective Rogers took me to police headquarters. He got me a bunch of mug shot books to look at. There were hundreds of black males of a similar age in those books.

I gently pointed out to Detective Rodgers that there was a female in the lineup. He looked at the picture and said, no, that is a guy who dresses in drag to mug people.

 “Wow! and I thought she was cute.” I said and the detective laughed.

A large, burly, uniformed sergeant now came in and asked me, “Are you the one who refused to turn over your wallet to three armed muggers?”

 “Well, sort of,” I said. “There were three, but only one got out of the car, and he didn’t really have a gun, so I figured none of them had a gun.”

The sergeant stared at me in astonishment until Detective Rodgers broke the silence, “He’s from New York.”

 “So living in New York makes you an expert on mugging?”

 “No, but I have seen a lot of mugging victims because I worked on the ambulance and I was not going to be one of those victims. Plus, I’ve heard enough scenarios of experienced muggers and joy riding idiots who were seeing what they could get away with. I haven’t seen any muggers as cute as yours, however,” I said, pointing to the picture in the mug shot book. They all laughed.

I briefed them on my stint on the ambulance and what I was doing in Omaha. I assured them that I was not permanently traumatized by this and would help them if needed to ID the guys. Truthfully, my feelings were that my family would be more traumatized when I told them. The sergeant asked me if I would lose my street cred for getting mugged and losing my watch in the hick city of Omaha. Again, we laughed. I also agreed to not say no to any muggers in their city again and to give them a call if I saw the guys hanging out around the university. We all seemed to agree that the university was a good place for muggers because it tended to be full of non-street wise people.

Detective Rodgers gave me a ride back to the dorm. Before I got out of the car he handed me his business card and said, “If there is anything you need while you are here, give me a call.”

 “Actually, there is something you could help me with,” I said. “Do you know where I could get a watch?”

Detective Rodgers laughed at that and I smiled.

 “Actually, I do.” He went on, “You could go to Tony Contey’s pawn shop. It’s one of the places I was going to check to see if it shows up there. You should check there for your watch as well as for a new-used watch.”

Detective Rodgers had just given me the name and address of a fence.

 “Thanks.”

 “Bye.”

I looked toward the dorm and could see the sunrise reflecting off the windows. I looked at my wrist where my watch should be to see what time it was and shrugged. I really didn’t need the watch to know that I had just pulled an all-nighter and needed to take a shower and get ready for class.

I wanted to take a road trip while in college. It is the college thing to do. So the questions became; where do I go, and with whom? I quickly decided I was going alone, because I wanted to go see Holly. Holly was a former girlfriend who had moved from New York to Omaha, Nebraska, a few years earlier. I was less than diligent in writing to her, but I did still want to see her again. A lack of letter writing on my part did not mean a lack of interest. Holly had headed to Omaha, and that was where I wanted to go. Even though Holly and I didn’t really have a chance to get too serious in our relationship, there were enough sparks and emotion there to make a road trip to Omaha pretty compelling. Holly had been a huge crush of mine for a long time. It seemed like we were just beginning to click when she and her family moved suddenly. Now, I just needed to find a second reason or justification to go to Omaha.
Like any university, Susquehanna University had a system of partner universities and programs. There was a bulletin board with notices of opportunities from a year abroad to classes to prepare you for the various entrance exams. I found a notice for a specialized class for athletic trainers studying human anatomy in…yes, Omaha, Nebraska! I could take the class, do a road trip, and try to hook up with Holly all at once. Having a class there would give me time to reconnect with her. The timing of the class matched up with my class schedule at Susquehanna. All I needed to do was make sure I could afford the trip and that the anatomy credits would transfer to Susquehanna. I also needed to check with some friends on the most recent address for Holly. I could do that over the upcoming Christmas holiday, while convincing my parents that the trip was a good idea.
“I’m a New York boy—what can happen to me in Omaha, Ma? Why are you so worried about this?”
“I’m your mother; it’s my job to worry.”
Looking at Dad I asked, “Are you telling me I can’t go?”
“We’re not saying that at all, Son. We just want to make sure that it is the right thing to do and that you’re going to be ok.”
My thoughts were I was glad I didn’t tell them everything I’d been doing on the ambulance at all hours of the day, night, weekend and whenever. I was grateful I never told them about the knives being pulled on us or hearing gunshots down the road when I worked on the ambulance. Maybe if I did tell them all of that stuff, they might not be so worried about this road trip. My brother Jim understood pretty well that the Holly connection was a big part of my motivation, but not the only part.
After much debate and assurances that it was needed for my career, I got permission to go to Omaha for Anatomy class. My parents even offered to kick in some of the expenses, which was immediately accepted and much appreciated.
I was able to track down some good information on Holly. I discovered that she was in Des Moines, Iowa, just a short trip from Omaha, and I got a phone number. Holly was a full-time undergraduate college student attending Drake University and I was going to try to find her at school. That was probably a good thing, because it took her family out of the equation. Her family had drinking problems and this had contributed to her move from New York to the Great Plains.
After convincing myself that my main reason for going was the class, I registered for it as soon as I got back from break. That is, I registered before trying to contact Holly. So even if she didn’t want to see me, I was still going, and I was going to see her anyway because I would only be a short drive away, or at least driving by where she was. I was traveling over 1200 miles to be less than 130 miles away from her. The chances of catching up with her were greatly increased, especially now that I had a phone number and address.
I purchased all the books needed for the anatomy class and even tried to look at them before I departed for Omaha.
At the end of classes at Susquehanna, I went home to New York to say good-bye to Mom and Dad. I also got the car tuned up and some extra parent cash before heading west. A few hours before getting in the car, I tried the number I had for Holly. It rang, and when a female voice answered it I asked for Holly.
I could hear muffled shouts for Holly.
“Hello,” a soft, familiar voice said.
“Hi, Holly?”
“Yes, who is this?”
“Um, it’s Joe Clark, from New York.”
“Joe! Hi! You didn’t need to add the New York part. How are you?” she asked.
“Uh, I’m fine. You see, the reason for my call is that I am going to be in Omaha the day after tomorrow and um, I wanted to call and see if it would be ok to stop by and say hi.”
“Of course, if you are anywhere near here you must stop by!”
We did not engage in small talk. I told her about the athletic training, about the class in Omaha and gossip about old friends. I also made sure that this was a good number to call her on. I told her about the class and that I would be in touch so we could make plans to hook up. The timing of the class start was such that I couldn’t stop by on the way out, despite the fact that I would be driving through Des Moines on Route 80 to get to Omaha.
I got up at 4:00 A.M. to leave for Omaha. Much to my surprise the whole family was up to say good-bye—Mom, Dad, Jim, Kathy, two dogs and two cats were all lined up to see me off. Why was this such a big deal for the family? The trip was a long distance but not a long time. I’d been away from home for much longer periods of time, so the effusive farewell was a surprise. I’d packed my van the night before and was showered and ready to go. I kissed everybody, including Mom who was crying, got in the van, and left.
My car was a Ford 150 panel van, large and safe. The inside was fixed up quite well thanks to a lot of work by Dad. He’d put in a bench with custom cushions in the back and carpeting throughout. This vehicle was also a civilian version of a lot of the ambulances I used to drive. Those were often Ford 350s, with a long back and a cap on top. So, I felt very comfortable in it. A little over 20 hrs from now, I would be in Omaha unpacking and getting ready for Anatomy class.
A few hours down the road I checked what Mom had packed for “lunch” and found enough food and supplies for a small army. There were multiple sandwiches and multiple bags of chips, a half-dozen apples, an assortment of candies, bags of ice and some healthy alternatives of carrots and celery. She’d included some carbonated and caffeinated soft drinks as well, plus napkins and utensils.
I quickly got into a routine during the drive. I would fill up with gas, use the toilet, and then drive. I’d drive until I had about a quarter of a tank of gas and then I would start drinking and nibbling. I would stop to pee and fill up with gas only when it was an emergency (urgent pee or gas urgently needed), and the cycle would repeat itself. I might eat some salted snacks of some kind after a pee or fill-up because those did not interfere with the cycle. I worked my way through several cycles well this way and this little schedule seemed to help the drive. I spent most of the drive listening to the radio to keep up on traffic and weather, and for the tunes. Route 80 is a highway that goes for nearly 3000 miles, from New Jersey to California. I got on it in New Jersey and went through Pennsylvania, Ohio, Indiana, Illinois, Iowa and Nebraska. Pennsylvania is a very long state. I had never been to the western border of Pennsylvania because I normally got off Route 80 at the exit for Susquehanna University. About 4 hours after passing the exit for Susquehanna, I hit Ohio.
Ohio is not as long as Pennsylvania, but it is the beginning of the Great Plains and as such is pretty flat. Route 80 stays near the northern tip of Ohio near Lake Erie. After Ohio it goes through Indiana and Illinois and starts to head south. Route 80 is somewhat diagonal, going from northeast to southwest.
Most US interstates that go east and west have even numbers and the numbering starts with small numbers at the bottom of the country and moves north. Odd number interstates go north and south and start with the small numbers on the West Coast. So, Interstate 95 travels from Florida to Maine
I reached Des Moines, Iowa, and looked around. Was I looking at sights that Holly had seen? Were these familiar surroundings for her? They were not for me. I found an excuse to stop in Des Moines so I could pee, get some gas, and pick up some food, although I still had tons from Mom. Maybe Holly had filled up at the same station.

The RA means resident assistant and they are students who have certain responsibilities in the dorms outside of regular business hours. Some cynical students say that the RAs are responsible for staying sober during the weekend. Nonetheless they are the ones who need to know if there has been an injury in the dorm. I found the RA, Dave, and asked if he had heard about a woman falling down the steps and possibly being injured. He said no.
“I see,” I said, “I need to report a broken door between the common room and Aikens north.’’
“That I know about,”
“How? — it just happened a second ago.”
“I reported that the spring on it was broken a couple of days ago.”
“Sorry, we are not on the same wavelength here,” I said, probably still having the Schrödeinger wave equation on my mind. “I came running over here because Dingle told me of an injured woman and I broke the glass on the fire door as I ran through it.”
Greg, the RA, and I went to the door and he now understood. He thanked me for reporting it, taped it up, jammed it open, and said that this was indeed the door whose broken spring he had already reported.
We never did find anyone hurt from a fall so I went back to Shrödinger and Dave went back to his room. RA’s are supposed to be in their room or in some other clearly identified place in the dorm when they are on duty, and Dave was always in his room. Therefore he was always available when needed but did not always know what was going on in the dorm.
The door’s window and spring were fixed on the following Monday. A few weeks later I received a bill for $140. The university was billing me for the damage to the door. I talked to Dave and he said that he only reported that I was involved in the window break; he didn’t know who broke the spring beforehand. I called facilities management to try to find out what was going on but they said I had to make an appointment with a manager. So I went to see an administrator in the university’s power plant to appeal the charge.
The administrator, Nelson Porter, was a tall, lanky man with extreme male baldness that left him with a horseshoe of salt and pepper hair around the back and sides of his head. He was known throughout the campus as the guy with the keys. He had keys to every door on campus and he always carried them dangling loudly on several large key rings. He wore the same white shirt, narrow dark tie and green work pants every day, regardless of the weather.
I stood in front of Nelson’s desk and pleaded my case. I emphasized that the door was already broken, and had been reported earlier. I had reported the broken glass to the RA immediately and felt that I should not have to pay for it.
He shook his head and said, “You think I should pay for it?”
“Well, yes. If the door’s spring was not broken the glass would not have broken.”
“You know that for sure?” He said smugly, not trying to hide his contempt for me.
“Yes.”
“Ok,” he said shaking his head doubtfully, “I’ll subtract the spring repair and labor costs and just charge you the cost of the window.”
“I should not have to pay anything. The door was broken and it was the lack of a properly functioning door that resulted in the broken window.”
It might or might not have been beneficial for me to try to point out that not only was the door was broken, it had no warning signs about the defective spring and it was lucky that I or someone else had not been injured as a result. But I did not have a chance to pursue that argument before I was interrupted by Nelson.
“Listen,” Nelson said, obviously annoyed with me and his voice rising in anger, “I am billing you for $69 in parts. If you refuse to pay it, you do not graduate. If you appeal it, your account with the university may be put on hold and you may not be eligible to register for next term. Your account for this incident stands at $69.00. What you do about it is up to you.”
The man’s arrogance was infuriating. He knew he had absolute power and that I was in a position of complete weakness. There was no way I could force him to do the right thing, so he would get his money. I paid the bill. For me at that time this was a substantial amount of money. Every penny I had needed to go to tuition or living expenses. Nothing was extra and nothing was being saved. There was no choice, however.
I have used this episode as a learning experience for my own dealings with students. I am currently a Professor of Neurology and am fortunate to work with many bright and talented students. Remembering the demeaning treatment I received from Nelson Porter, I try to treat all my students as if they are potential peers. Nelson felt that I was a small fry with no recourse or significance. He made me feel small. So I always make sure that my own subordinates never feel small. Even though I did gain in the end from my experience with Nelson, I have not let that change my mind on what I resolved to do when I walked out of his office. I do appreciate the lesson, however.

Susquehanna University is a small liberal arts university of about 2000 students, in Selinsgrove, Pennsylvania, on 220 acres of reclaimed farmland. It has fields and farms on several sides of it and is a short walk from the Susquehanna River. During the fall, the smell of the harvest wafts in from the fields anywhere on campus. The university was founded as a Lutheran Missionary College in 1858. One of its claims to fame is that the famous football coach Amos Alanzo Stagg coached there during his run as one of the winningest coaches in history. The football field is called Stagg Field. It also has a wonderful college of music and business. The dorms are spread throughout the campus while the main classroom buildings are in the center.
Dorm life in any university builds a bizarre closeness that is hard to describe if you have not lived it. You learn the bathroom habits of your roommate and many of the other people in the dorm. In all-female dorms, the women’s menstrual cycles will synchronize and a dorm of hundreds of women will all be reaching for the sanitary supplies at the same time.
In a men’s dorm some incredibly immature forms of entertainment can crop up. For example in the men’s dorm I lived in, called Aikens, we invented unit check wrestling. It was basically wrestling, except the goal was not to pin your opponent to the mat but to grab his testicles and force surrender. So this was a homoerotic exercise and entertainment. There were usually jokes about wanting to get checked and the frequent participants would be accused of enjoying it too much. I did not participate, although I would be summoned to attend to injuries that had occurred. I took to keeping a combination first aid kit and training kit in my dorm room because everyone seemed to come to me with illness or injury.
After one interesting unit check match the “winner” was a guy named Myron Briggs who had survived a fairly brutal unit check without surrendering. He ended up winning because his opponent was so focused on inflicting what he thought was an intolerable unit check that he left his own unit unprotected. Seeing an opening, Myron seized the moment (and a very painful unit check) to win when his opponent quickly submitted defeat. After the celebrations, however, Myron came to see me for a quiet word. He had read, he said, that sumo wrestlers would push their testicles back up into them during competition. What he was talking about is that a man’s testicles are connected to the inside of the abdomen. They actually form inside the abdomen near the intestine and descend into the scrotum after birth. The canal that they travel down, called the inguinal canal, is where the sumo wrestlers push their testicles. Myron figured that if he could do that he could win at unit checking. The problem is that if you do not keep the canal open from birth as sumos do, it gets too small for the testicles to travel up and down within. Nonetheless, Myron had forced them back up into himself and when he beat the unit check, they were pushed so far up into him that they hurt a lot and did not want to come back down again.
In sports it is possible for a man to be hit in the groin and the testicles pushed up into the canal a little. Since this is known to occur, there is a treatment for it that athletic trainers all learn. I told Myron I would try to treat him but it might not work. I made it clear that if he wanted my help, he had to promise, should that happen, to go to the ER WITH me immediately—no argument. My concern was that for human testicles to function normally they must be kept cool. This is why they are suspended outside of the body, where they are actually about 4 degrees cooler than the rest of the body. If they stayed in the abdomen, as they were now in Myron, he might be rendered sterile and I did not want that happening to him. In any case, Myron agreed to my terms.
I had Myron sit on a hard floor and gently hold his knees to his chest. Grabbing him under his shoulders as I would an ambulance patient to lift them up off the floor, I told Myron to cough repeatedly. As he continued to cough, I would pick him up a couple of inches and let him fall to the floor on his butt. The goal was to force the testicles out via the pressure of the coughs and the force of the fall. After a couple of coughs and falls Myron announced that one had popped out. Realizing now what we were trying to do, Myron would time his coughs to coincide with the drops. After a couple of well-timed simultaneous drops and coughs Myron announced, “they’re back!” with great joy. Then he swore me to secrecy and I have kept that secret until now.
Greg Barry was a chemistry major in my class when I began my studies at Susquehanna. He had started as a chemistry major with the professed goal of being able to make drugs when he grew up. He claimed he absolutely adored Timothy Leary and wanted to be like him and make the best drugs. Greg had a nickname that he seemed to revel in —“Dingle”— thus he was known as Dingle Barry.
Greg dropped out of chemistry in sophomore year and he was still looking for a major by his junior year, which is a pretty sure sign of someone on the five-year college plan or no-degree plan. Greg’s family paid for his college, so as long as he did not fail out he had a gravy train. Junior year Greg was experimenting with majors and different drugs. He got a hold of some magic mushrooms and was having a pretty bad trip one weekend. He told me he had done some cocaine along with the ‘shrooms. Greg was hallucinating, but was coherent enough to be scared. He asked me what to do. I knew the traditional treatment for ‘shrooms was to induce vomiting, but with cocaine the blood pressure can be increased and vomiting can exacerbate this to dangerous levels. So inducing vomiting was not what I wanted to do now. I was in the process of advising Greg to find a colleague to stay with him to ride out the trip when the school nurse arrived. Someone had called her.
I briefed nurse Mary Peterson on Greg’s status. She proudly said to me, “I have the ipecac.” Ipecac is a liquid that induces vomiting.
“But that might spike his BP (blood pressure). He is already coming down and he did the ‘shrooms and coke nearly 4 hours ago,” I said to her, trying to convince her not to make Greg vomit.
“The treatment is ipecac and he has earned it,” she said.
I fully understood that concept of teaching someone a lesson, which is what she meant by saying he earned the ipecac. I vividly recalled when I worked in the ER in years past “pumping the stomach” of teenagers who got drunk. We would have a tube down their nose and one in their rectum to completely purge their whole system of the alcohol. The truth was that the alcohol was almost never in the intestine at this point and already in the bloodstream, but the stomach-pumping treatment was a punishment to teach them a lesson.
However, I truly believed that cocaine and vomiting could produce a deadly increase in blood pressure and pleaded with Mary not to do it. But I was just a dumb student and she knew better. Greg got the ipecac. He vomited in the dorm toilet and I stayed with him, hoping that his blood pressure would not cause some weak spot in his arteries to rupture. Greg vomited hard and long. There was a lot of fluid because we made him drink a lot to help give his stomach something to flush.
Greg and I both seemed to know when he was done vomiting. I gave him some towels to wipe his face and he looked at me as if he were asking me, why did I do that to him? I looked at him closely and there were multiple little hemorrhages in his cheeks, nose and even the whites of his eyes. The term for multiple little hemorrhages is petechial hemorrhaging, and it can occur with high blood pressures such as while vomiting under the influence of cocaine. I was glad that many small non-lethal hemorrhages had occurred as opposed one big bad bleed that could kill.
I tried to get Mary to acknowledge that the petechial hemorrhaging was indicative of the blood pressure elevation I had talked about, but she dismissed it as unimportant.
Greg’s roommate Paige agreed to monitor him during the night to ensure no more vomiting, drugging, or drinking, and a continuous presence of breathing. I was mildly concerned that Greg might vomit again and inhale the vomit. Aspirated vomit is lethal and has killed the likes of Jim Morrison, Curt Kobain and Jimi Hendrix. I checked on Greg first thing the next morning and he was happily breathing and snoring away.
The next afternoon I discovered that Mary Peterson had complained to my bosses in the athletic training staff that I had undermined her authority in front of “her patient.” I pleaded my case, explaining my coke and blood pressure concerns about Greg, but was duly reprimanded.
Greg became a kind of fan of mine after that. Anytime there was a medical anything at school he wanted to tell me about it. He would brief me on any drug overdoses that occurred on campus and what the other people did about them and did I think it was right? While Greg did not do less drugs after his little episode, he did restrict his experimentation to one thing at a time. He seemed to be very proud of his decision to only do one drug at a time like it was a step towards being a grownup. (This, of course, assumes that alcohol is not a drug, again Greg logic.) Greg reminded me of many of the people I had to deal with on the ambulance in some ways, because of this rationalization of destructive behavior.
It was interesting how my college studies, athletic training and paramedical experiences sometimes collided. This was demonstrated to me late one Saturday night I was studying physical chemistry. I was learning the Schrödinger equations that are used to characterize wave mechanics. This is a fundamental principle in all of physics and chemistry because it mathematically describes all waves. The Schrödinger equation can be used to describe ocean waves, the colors of the rainbow, radio waves talking to satellites, cell phones, magnetism, and how to tune a piano. However, just because it is useful and widespread does not mean it is easy. Understanding it is actually pretty hard. So I was diligently studying with headphones on to drown out the drunken noise of the dorm when Greg Dingle Barry came running in.
“Somebody just fell down the stairs on the north side of Aikens and they’re not moving.”
I was out the door like a shot. Aikens was a two-story dorm with four sets of stairs but only one main set of north side steps that I headed to from my dorm room on the south side. Aikens north was the female wing and Aikens south was the male wing. The wings were about the same size and shape, separated by a common room. So to get from my room to the Aikens north stairs, I had to go through the common room, which was unusually empty for a Saturday night. As I ran through the common room it seemed quieter than my dorm room. How strange, I thought, perhaps I should be studying here. I ran up to the fire door that separated the common room from the north wing, a door I had passed through a hundred times. Because it was a fire door it was always shut. The door had a large glass window with wire mesh in the glass. I pushed on the door and much to my surprise it flew open at great speed. It swung wide and smashed against the opposite wall with a tremendous crash, spider-webbing the glass on the door. As I paused to make sure there was no glass on the floor, I noticed that the spring that closed the door was broken, leaving the door open.
I continued to the steps and found no one. Greg, who was following behind me, pointed to a spot on the floor and said, ‘‘She was right there.’’
‘‘I understand. Ok, we need to go get the RA on duty.’’

Because it was a home game, we had a fairly standard procedure for such things; I called the head trainer and briefed him. It was decided that I was taking her to the hospital for x-rays and the emergency physician would call the team physician for orders after the injury had been assessed. Meanwhile the team physician called the emergency room to tell them we were coming in. Casey did not want any family or friends called until more was known about the injury.
The emergency room was completely empty when we arrived. From my days on the ambulance I recognized the expressions on the faces of the ER staff, who were mildly glad to have some business, but still cautious in their joy because a first patient can be quickly followed by many. I didn’t know any of the ER nurses, but gave them a report on my patient as I would have if she were an ambulance patient. Before I knew it, I heard myself saying, “ Nineteen-year-old female with a witnessed traumatic event to the medial aspect of the right knee approximately 1.5 hrs ago. No prior dizziness, no LOC, no KON, vitals stable and good throughout. Patient was iced immediately and treated with I.C.E. Exam shows instability of the medial collaterals, guarding and localized pain.” They knew that LOC meant loss of consciousness, KON meant knock on noggin and I.C.E. meant ice, compression and elevation for treating the injury. Casey looked at me with a mixture of confusion and fear.
The nurse tending to Casey asked me, ‘‘Are you the boyfriend?’’
‘‘No, I’m the student trainer for the team. I tended to her injury in the acute phase.’’
She nodded and went on, paying no attention to what I had said. While it annoyed me that they were not using the info I provided, I understood it. In the emergency care situation, bystanders and helpful friends were not reliable witnesses and often would embellish the truth. To the ER staff I was not “on the job,” so my information could not be trusted. I needed to form a relationship with them to build trust. That was not going to happen today, but it was going to start today.
The ER visit went fairly predictably from my perspective, so I spent a lot of my time keeping Casey apprised of what was happening and translating the ER jargon for her. I even explained my mini report to the ED staff to her. She kept asking me what had happened and what was wrong with her leg, and I had to tell her, “I am not a doctor, so I cannot do a diagnosis.”
“OK, so what do you think MIGHT have happened when I twisted my knee?” she said sarcastically.
“Casey, I think you MIGHT have torn some ligaments in your knee,” I said.
She looked at me and got very flushed in the face. Tears started to well up in her eyes and she stared at her knee angrily as if it had done some terrible wrong to her.
“I’ll probably lose my ride,” she said, referring to her basketball scholarship.
Right now, more than anything in the world, I wanted to help Casey, but I couldn’t. Not until the x-rays were back and a diagnosis made. Once we trainers had a diagnosis, we could start on treatment and rehab. Even if the diagnosis meant surgery, we could do lots of pre-surgery conditioning to help speed her recovery afterward. If an athlete is scheduled for surgery, the advice we usually give is to NOT take it easy. Strengthen that limb and work that joint as much as the surgeon will let you. Often the surgeons will say, “Do what you want—if you injure it more, I can fix it when I’m in there.” While this statement may seem a bit cavalier, it is somewhat true. If a ligament is torn in half, exercise will not tear it more. But all of these things needed to wait for the diagnosis. For now, my job was to keep Casey entertained and make sure that when we got her marching orders they were followed, which they would be.
The x-rays came back with no bone damage. The team physician would see Casey first thing tomorrow morning. Casey was prescribed some mild painkillers and RICE (rest-ice-compression-elevate) treatment for tonight. Tomorrow we would be doing a more complete exam. Although I was not scheduled to work tomorrow, I would be there because Casey was on my team. Even though I couldn’t play with them on the court, I felt like I was a member of the team and she was part of my responsibility as a teammate.
The head trainer, Scott Patt, and the team physician, Charles Bowen, did the exam on Casey. She no longer had any obvious ligament supporting the inside of her knee. This was clear because her right knee could be bent out to the right with very little pain or resistance on her part. I had done this same test last night, but not to the extent that Dr. Bowen now did, making her knee look like it had a hinge enabling it to move from side to side like a pendulum. Her ACL was then tested by seeing if the knee would slide forward or backwards. This was done by having Casey sit on the training room table with her feet on the table and the knee bent about 45 degrees. Dr. Bowen then pushed and pulled on Casey’s knee. It slid back and forth by what seemed like inches, making her knee joint look like a dresser drawer being pulled out and pushed back in again. This was all indicating that the ACL was damaged, but maybe not as severely as the MCL. Finally, to see if Casey had the terrible triad, Dr. Bowen palpated the inside of Casey’s right knee while moving it in different directions. He soon declared that the cartilage in the medial meniscus was damaged too. The medial meniscus is a large piece of cartilage that acts as a buffer between the femur or thighbone and the tibia or shinbone. The medial meniscus is also attached to the MCL, so the two are often injured together. Casey indeed had the terrible triad and would need surgery. Casey only wanted to know WHEN she would be able to play. Shaking his head, Dr. Bowen said not this season.
Casey was inconsolable. Her parents came to pick her up from the university later that day to get a second and third opinion. All the opinions were the same. She had the triad and needed surgery. I promised Casey I would work with her to get ready for the surgery and help her rehab the knee for next season. She decided to take the rest of the term off, so I could not work with her on rehab. She assured me she would do some “stuff” at home. Her surgery was not very successful and she did not return to the university. Casey lost her ride. Despite my best intentions and all of my efforts to be encouraging, I could not help Casey.
I missed Casey and so did the team. We still had a great season, only losing 7 games out of 30. I had a few more trips to the ER during the season, but fortunately nothing as serious as Casey. I did, however, build a rapport with the ER staff and they began to trust my clinical reports. They would report my vitals in their charts, which was a big vote of confidence on their part.

Chapter 1. My Career as an Athletic Trainer.

As a child I always wanted to be a medical professional when I grew up. Some of my earliest memories are of being fascinated by biology and medicine. I wanted to be Einstein or a physician. I took my first first-aid course at the age of 13 in a class full of adults and was their equal in the book work and practical work. I was an expert on bandaging and splinting. My mother tells me that when I was 11 my Christmas wish list contained two things; Legos™ and medical books. I was trained as an emergency medical technician by the time I was 18, and fantasized about being a paramedic, athletic trainer, researcher or physician. While I bounced around between career choices, I had a general sense of where I was going.
I wanted to get an advanced degree to increase my chances of “helping people” someday. I had decided upon that general direction but was not too sure what discipline to choose. So during my first four years of college I needed to start making choices and decisions as to what type of graduate degree to pursue. That is true for all college students; there are many choices regarding graduate school that need to be made as an undergraduate. So in effect everyone’s graduate education starts as an undergraduate.
I kind of fell into the world of athletic training when I went to college. The university knew I was an experienced ambulance person and they needed that skill set in the training room.
Athletic training is a para-profession that combines sports medicine, exercise, fitness and athletic competition. Athletic trainers are highly trained paraprofessionals who must manage injuries and help athletes improve their performance. Thus a breadth and depth of theoretical and applied knowledge is needed to be effective. I had worked on ambulances to help pay my way through college, was interested in medicine and science, and had an interest in helping people, so becoming an athletic trainer seemed like a logical extension of these interests. It seemed that a great way to help people would be to work with people who wanted to be helped, wanted to improve themselves, and were looking for help from people like me. Working with athletes to help them stay healthy, recover after injury, and to improve their performance seemed ideal. The athletes appreciated the help and the athletic trainers I worked with were smart people who also wanted to “help people.”
I easily got a job as a student athletic trainer and took some classes in athletic training as a complement to my Chemistry major and Biology minor. A student athletic trainer assisted the university’s full-time athletic trainer and got a stipend. I already knew a lot about anatomy and physiology, so the training classes were relatively easy. Learning how to tape an ankle was pretty easy for me, too, because it was so much like bandaging. When I worked on the ambulance I could bandage anything and do it fast to stop the most serious bleeding, so now I was taping an ankle to keep it from twisting during play. I was indeed helping people. These people just wanted to play a game as opposed to many of the people I tended to on the ambulance, who wanted to drive recklessly, do drugs or engage in bar fights. The career change for me was not away from helping people but towards helping a different kind of person: the competitive athlete.
Athletic trainers got know most of the athletes we worked with very well, and fortunately we rarely if ever had to deal with life-threatening injuries or death. Serious injuries could end a sports career or end a season, but it was mercifully rare to find an athletic trainer having to deal with a cardiac arrest.
Don’t get me wrong, however, athletes can sometimes die of heat stroke or have undiagnosed congenital heart disease that can cause sudden death. Then you would find the athletic trainer doing CPR and every single Certified Athletic Trainer must be trained in CPR and have regular re-certification. I often would be asked to instruct the athletic trainers in CPR because I was one of the few people to have actually done it – a lot. But that was when I was working on the ambulance, which was a life I did not want to go back to. I never wanted to be thumping on someone’s chest again, but was glad to impart knowledge and experience to those who might need to do CPR someday.
The skills needed for an athletic trainer are actually quite similar to those of an ambulance person. You need to be well trained, ready for anything, and calm under pressure. An ambulance person might be under pressure because a couple of family members are watching as you try to help a loved one during some emergency. There is the pressure from the medical emergency itself plus the pressure of the family members watching the events unfold. An athletic trainer, likewise, might be called upon to tend to an injured athlete during a major sporting event in front of thousands of people. Some of my athletic trainer colleagues have been on the field during nationally televised games, which means millions of people watching. So, calmness under pressure is an especially good thing for the athletic trainer.
Within a few weeks of joining the athletic training staff I was put in charge of the woman’s basketball team. I had a student trainer supervisor and the full-time trainer to use as resources when needed. I quickly learned the injuries that female basketball players were likely to get and learned how to help with stretching, warm up, and rehab. For athletic trainers a substantial part of the job is preventative taping for joint support. Taping ankles is what many people think of when the subject of supportive taping is discussed, but an adept athletic trainer can tape many joints to give a little extra support. With a good knowledge of anatomy and tons of experience in bandaging all sorts of limbs, I quickly mastered the art of supportive taping of all the major joints prone to injury in the female basketball player.
The woman’s basketball team was a lot of fun and they were consummate competitors. The women also were very conscious of their performance and their physical characteristics. They constantly wanted to improve their game and themselves. So, if I gave them recommendations to do some stretching exercises or strength training advice, they took it. Often they would do more than required to be better. While this was not always the best thing to do, it showed that they were listening and wanted to be helped. What a joy it was to work with these people, and I got to go to all the games and sit on the team bench, which is the best place from which to see a game.
Every once in a while a serious injury would occur. In my first season as the women’s basketball trainer, the lead point guard, the star of the team at the time, injured her knee during a game. I ran onto the court to tend to her. She described a twisting sensation in her right knee followed by a popping sound or unstable sensation on the inside of the knee. She suddenly felt intense pain and at the same time the knee felt “all loose,” she said. That is a fairly typical description of a tear in the knee ligaments (likely the medial collateral ligament or MCL), the cartilage, or the anterior cruciate ligament (ACL). It could be all three at the same time as well, a combination injury known as ”the terrible triad,” which could be a career-ending injury.
The woman’s name was Casey and she was a criminal justice major. The basketball scholarship she had was her way of getting an education to become a state trooper and eventually a detective. Right now, Casey was not thinking about her scholarship; she was thinking about the pain in her knee and whether she could play the rest of the game. Without doing an exam, I knew that she was not playing again tonight and her future was in doubt. I did a quick evaluation on the court, and much of what I was doing was trying to calm her down and get her to focus on me rather than her quickly swelling knee. With help from the assistant coach, I got her to the end of the bench where the injured players and myself would sit. I put some ice on her knee and told her to rest it a bit for now and we would do more of an exam at half time. As the adrenaline that had kept her pumped on the court started to subside, the tears started to flow. She was upset about the injury and concerned about the ramifications of it all.
At half time she said it didn’t hurt much anymore and she really wanted to try to get back into play. I unwrapped the bandages holding the ice bags in place and examined the knee again. There was a substantial amount of swelling on the inside of her knee. I did not try to evaluate for tenderness, but I did want to see how stable the knee was. To test her knee’s stability I had her get on the training room table and asked her to sit back and relax. I picked up her uninjured leg and to show her what I was going to do, I put one hand under her ankle and held up her leg. With her good leg straight, I gently pushed on the outside of the knee and she just looked at me. I told her that pushing like that should not hurt and that the knee should not move. I went then to her injured leg and gently picked it up by cradling the ankle. She would not let the knee straighten but showed no sign of pain. I asked her if it hurt to straighten it, and she said it just felt better this way. With the knee slightly bent, I again very gently pushed from the outside in, looking for any sign of pain. She did not wince at all. But she did look very surprised because her knee now bent sideways in a way it was not supposed to. I had hardly pushed it at all, and I had the information I needed. She had a serious knee injury and was not going to be playing for a while. There were other tests I could do, but they were not needed now. I told her that she was not playing again and put the ice back on her knee.

To be continued.