We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
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Friday, April 24. 2009
Our shrink friend Nathan, who has completed Aliyah in Israel, sends this reminiscence of his days working for the Indian Health Service, doing general practice including surgery and obstetrics - and anything else that was needed. Old-timey medicine.
Before replacing the sloughed skin on Mrs. R's arm, I had to find out why her forearm was raw to the muscle. New here among the Sioux, I am surprised to learn that my colleagues (and one ancient Roman Catholic always fiddling with her rosary) hadn't checked this elderly, chunky widow's blood sugar: diabetic, sure enough, never diagnosed. So, first things first: stabilize her blood sugars, treat the diabetes, and give proper antibiotics (for anaerobes and aerobes -- they missed this too), then when you see the shiny, glimmer of healthy tissue margins, go for a skin flap transplant.
Before hitting the OR, I had done several days debriding of the sloughed wound: fresh it must be to transplant the sod of skin. In the OR, flipped on her side, I slid into the vertebral space between L4 and 5; a bit lordotic pull by the nurses and I had a clear tunnel in. Then, flapped on her back, Mrs R. was ready. The thigh well scrubbed, Betadined, aproned, an oval hole isolating the site. Instruments we had. The strange loopy-scalpel to slice just-thick-enough epidermis and a touch if dermis to both "take" to the new site, yet leaving some dermis to heal-over the thigh; something like a large cheese knife the instrument looked. Forearm next. Her arm flung up like some lop-sided angel wing, I probed left-handed with two gloved fingers, then slid the massively long needle --- like from the cartoons -- in between the stretch of skin. Wait. Wait. Numbness without paralysis in the arm. First, a touch on the skin (for sensitive fibers); then a pinch with a forceps (for the pain C-fibers) and success.
Laying the layers onto the site is much like laying sod; carefully, side by side, the edges trimmed to the wound shape. The "root" growing will take on its own, a pressure bandage holding the skin sod in place. A fine lawn it will hopefully be; like sodding around a putting hole -- it should look good and cover the ground. And after five or six days of brief peeks, it looks darn good.
It was the only time He has ever spoken around me.
Top photo: Sioux war party, 1870s?
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Everyone ought to read "Black Elk Speaks" at least once. Really quite a book.
There was a gentleman in his 90's who lived in my Dad's neighborhood a few years back whose father had fought in the Indian wars. Dad didn't know about the guy's family history until the guy got Alzheimer's. Apparently his father had told him some stories about the wars when he was younger and once he got Alzheimer's, paranoia got to him and much of his interaction with others involved asking if they had seen any Indians in the area. A very sad/tragic yet black-humorous story. I wish I could relate the details the way Dad had related them to me, but it was an interesting (for me) perspective on the "noble savage".
:e should write a book about it. Why did he become a shrink? It sounded (as do his posts from Israel) as if he really enjoyed the family doctor, physical, hands-on aspects of life. Nothing against shrinks.
I will write more for the blog about the Sioux.
Me thinks, yall are pagans but friendly ones.
Dad told me that he had an uncle killed by savages before white folks civilized them.