Vignettes of a Writing Doctor

CHAPTER 1

Yukon Rx

Quackery

Exposure

Having Babies

Locums

Home Clinic

Family Medicine

Vertigo

Sleep

Nocturia

CPR et cetera

CHAPTER 2

Anniversary

Steelox

Turnupstuffers

The Cleaning Man

Batching Again

Bike Repairs

Fitting Out

Coiffeuse

Weddings

The Shed

Schmucked

Cats

Rabbit

Kilvert

CHAPTER 3

Teens

Hair, etc.

Mannequin

Rad

Adam in Victoria

Neckties

CHAPTER 4

Tree House Therapy

I, Judith Steele

Knackers

Props

Chow Mein

Habits

Form

CHAPTER 5

Tibetan Lessons

Jigme Taring

Tenzing and Hillary

In a Tibetan Tent

CHAPTER 6

Writing for the Editor

Foreign Correspondent

Becoming a Writer

CHAPTER 7

Fish Camp

Joe Martin

Bear Mauling

Jim Dawson

Sourtoe Cocktail

Yama

Brian

Fanbelt and Tyres

Old Crow

CHAPTER 8

Spring

Solstice

Cottonwood

Summer

Mayo and Dawson

CHAPTER 9

Winter

Winter Exercise

Winter Journeys

Loppets

Vladimir

CHAPTER 10

Atlin Cabin

The Biffy

Gerry Andrews

Nature’s Garden

Russel Crowe

Dick Bond

Doug Hike

Atlin Lake Sail

Christmas in Atlin

About the Author

INTRODUCTION

‘Vignette’ in the Oxford English Dictionary = ‘A short descriptive essay or character sketch.’

These vignettes were mostly written over the years I have lived in the Yukon, and some of them even earlier when I lived in Bristol, UK.

Mostly they were written for a medical audience, hence the evident leanings, but I trust they may entertain other people as well. Often they concern my family whom I have tried to disguise. They were frequently in medical periodicals and sometimes reprinted in local newspapers.

I am now retired and these pieces reflect the many happy days when I was still in practice in Whitehorse, Yukon.

CHAPTER ONE

YUKON Rx.

I’m lost since the old Pharmacopoeia was retired along with its tinctures, elixirs, and unguents and a goodly sprinkling of strychnine, arsenic, and ipecacuana. I was once accused by a respected professor of being a therapeutic nihilist because I suggested that most of the medicines one needs for our daily practice can be found in the cupboard of either the kitchen or the bathroom. But in these days of pills, capsules, and tablets there’s still nothing like a good bottle of medicine, the fouler tasting the better.

An old country general practitioner I worked for would use as his panacea for malingerers a bottle of water heavily tinted with methylene blue, one tablespoon to be taken three times a day after meals. When the bottle was half full, or half empty depending on the patients’ choler, they were instructed to fill it up with water and to keep doing so until all colour disappeared. Only then should they return to see the doctor.

One needs a few therapeutic tricks up one’s sleeve when dealing with the calibre of patient, like that of a Glasgow physician I knew, who asked in a high state of turmoil, Doctorrr; boss says I’m a moron. Is it trrrue? And that’s where the Pharmacopoeia used to come into its own. But with it gone we have to fall back on the kitchen and bathroom cupboard. I’ll consider the body systems roughly in order, starting with the largest organ and working inwards, top to bottom.

Soap and water cannot be bettered for skin cleansing, be it for wounds, infections, or scrofulous lesions. Follow with soaks of table, or Epsom, salts and let it dry in sunshine. The fizzy bubbles of hydrogen peroxide dislodge particles of dirt. Gentian violet is spectacular as well as antiseptic, so is a weak solution of iodine. Cow-pats are used to great effect on wounds in Nepal, especially for the newborn umbilicus, but one must pray there are no horses around harbouring tetanus.

For carbuncles, furuncles, and plain old boils, try ‘cupping.’ Take a jam jar, pop the oxygen with a flame, and slap the mouth of the ‘cup’ over the lesion to draw out pus. The same effect is achieved with a poultice of bread and honey, or balsam pine resin. Itchy skin is soothed by calamine lotion, starch paste, or a poultice of oatmeal. For bee stings use baking soda or weak ammonia; for wasps, vinegar, or lemon juice. Leeches drop off with the touch of a burning cigarette. Counter-irritants can divert attention from deep-seated ills so use heat to the skin, mustard plasters, or a kaolin poultice.

To prevent frostbite, trappers in this neck of the woods sprinkle inside their socks red cayenne pepper that brings blood flooding to the cold extremity by irritation of the skin. Rubbing the feet with onion may help. But the universal treatment of skin problems when nothing else will do is Bag Balm made by the Dairy Assn Co Inc.

In Nepal, for treating coughs, I used to paint the chests of inveterate bidi-smoking coolies with solutions of brilliant green, gentian violet, or yellow mercurocrome. Word got around that this was a powerful virility rejuvenator and my clinics were flooded. Magenta paint and purple potassium permanganate are fungicidal and astringent.

Those baneful lesions of eczema and psoriasis, not helped by a holiday in the sun, may respond to coal tar and salicylic acid in paraffin, and coconut oil. The sun may help acne, but the opposite will be the case with skin cancer and herpes, when kissing is a no-no, and medicinal alcohol is applied to dry up blisters.

Warts cause universal grief. In the suggestible (ideally between the ages of six and twelve) I have had remarkable success with charming – my record is forty-seven verrucas on a single pair of feet gone within the week. Mother takes the child to the bank and they draw out one new penny for every wart. Then they go to the Yukon River Bridge and throw the pennies over one by one while reciting the magic word, learned aforehand: Tikkitikkitembonaseremboberi beribushkidankerwallamannapannakofernascoshotz. Should this fail, your quack may then resort to salicylic acid plasters, silver nitrate sticks, liquid nitrogen, or – God forbid – surgery.

Under the skin lie muscles that warrant gentle kneading to relieve spasm and ease tension. Magical is ten minutes icing with a packet of frozen peas wrapped in a damp facecloth followed by a hot shower, hot packs, and then a massage with one of the derivatives of methyl salicylate in arachis oil – Deep Heat, A535, Analgesic Balm or, if you are in Hong Kong, that universal panacea, Tiger Balm.

The nether parts, though not strictly integument, are skin. The itchy anus, which can drive the sufferer to madness, may be soothed with baking soda baths. Nothing beats cornstarch for babies with diaper rash. Ladies may find ease with a douche of vinegar and warm water, and yeast doesn’t like the lactobacillus of yogurt, though it is messy to apply. Sores are healed with gentian violet or boric acid.

Let us now enter the head, and we find the kitchen and bathroom cupboards still have plenty to offer, except with pain. Old aspirin is still the mainstay until we need the heavies; then nothing can beat the Brompton Cocktail – elixir of heroin, cocaine, and gin. Hot milk and Horlicks usually lull the patient to sleep.

Here’s tea in your eye! Numerous sore, red eyes are made worse by the chemical irritation of the preservative in commercial drops. Tannic acid squeezed direct from a tea bag (Tetley’s or Nabob’s) is astringent and soothes many red eyes. Boric acid works too. Rubbing a wedding ring on a stye is as good as Golden Eye Ointment of yore, but no better than a compress of cloth wrapped round a wooden cooking spoon and dipped in boiling water. For blepharitis rub the lids strongly with a Q-tip, and apply baby shampoo or hydrogen peroxide.

Waxy ears – olive oil; itchy ears – alcohol and vinegar, half’n half. And for cleaning junk, hydrogen peroxide can’t be beat. If the vestibular apparatus plays up, an acupressure bracelet may steady the nausea without the dry mouth and poppy eyes of scopolamine patches.

For sore throat gargle with salty water or crushed soluble aspirin. Ulcers on the lip mucosa may melt away with gentian violet paint that spreads round the mouth so the bright purple lips are contraceptive and prophylactic against herpes.

For cough pour a kettle of boiling water on a splash of Friar’s Balsam or a pinch of menthol crystals, make a little tent with a towel, and inhale the steam deeply. It liquefies snot, shrinks swollen passages, and encourages spit. Then go early to bed with a potion of honey, whisky, and lemon. Laying a mustard plaster on the chest and chewing a clove of garlic will ensure you have to stay home next day for social reasons.

Milk or baking soda may quieten temporarily the rumbling of upwards gas. Medicinal charcoal absorbs obnoxious farts. Of course, liquorice is the basic ingredient of all the newer ulcer drugs. Woodward’s gripe water (‘Granny told Mother, and Mother told me’) can be poured direct down the throat of a mewling infant. Neat sherry stays colic and ensures parents a good night’s sleep.

When the bowels are runny peeled apple turned brown, or some kaolin should firm them up. For stopped up bowels, Granny used to give me raisin water, prune juice, or syrup of figs. The gurus now preach bran. An infusion of senna pods drunk as tea or, as a last resort, emulsion of liquid paraffin or cascara will shift concrete.

I’ve missed lots of things I could have used from my kitchen or bathroom cupboards – a copper bracelet to ward off arthritis, goitres shrunk by chewing seaweed, or iodine rubbed on the neck. I favour bitters and tonics from the old Pharmacopoeia because they have healing powers unrecognized by the ignoramus who wrote of a difficult field where faith and hope are not supported by scientific evidence, their value depending on suggestion.

As residents we used to prescribe Stout beer or Guinness to perk up post-operative patients, and sherry to stimulate appetite. When a child I had to take cod liver oil and malt three times a day when I was truly peelly-wally.

This all reminds me of the doctor who was on the mat before the medical disciplinary body because he put all his drug samples in a bucket on the waiting room table with a label reading Help yourself and don’t bother me. His defence – hard to refute – was that his treatment was no more random than most of his colleagues.

QUACKERY

Often patients have tried several brands of unconventional medicine before they come to see their doctor. It rankles to discover a patient who returns from a visit to a fringe practitioner and tells you s/he is cured from the chronic complaint that you have been unsuccessful in treating for the past several years. Where does humility start and honesty end? If I cannot help my patient, why not let someone else have a go, even though I may not be able to rationalise the scientific basis for their treatment? I have been confused by these questions and have not come up with an easy answer.

Paramedicine is freely available on this side of the ocean. It can be difficult to know the qualifications of the person with whom you are dealing because chiropractors, veterinarians, and a host of allied workers refer to themselves as Doctor. On a recent visit to California I was made a priest in a newly formed religion of mountain worshippers and now can legally call myself Reverend.

Because there is no list of GP’s patients, it is easy for them to try this doctor and then that one. To see a doctor the patient need only register with a health insurance card, although s/he may have visited two other clinics in town the same day, shopping around for opinions. This freedom has the advantage of allowing patients to change easily from a doctor in whom they have lost confidence, but it undermines the loyalty that is usually a healthy bond between family doctor and patient.

I have under my care patients who keep coming to me for psychological support, but who have all been outside the profession for cure. An apparently hopeless schizophrenic who had seen at least three reputable psychiatrists, and was admitted for six weeks to a large centre for evaluation, got into the hands of a proponent of multivitamin therapy – a Fellow of a Royal College, no less. The man recovered miraculously within a few weeks and has remained well, apart from a month of diarrhoea and vomiting that ceased on reducing the toxic dose of niacin vitamin he was taking.

Many people suffering from bad backs go first to a chiropractor, who may also be a vet. They describe graphically the relief that came when the displaced vertebra was put back with a report like a rifle shot. After an enthusiastic manipulation one of my patients suffered a nerve palsy that took a year to resolve. I am not cynical about manipulation, having fallen head first while skiing, heard a loud crack, and found my neck newly mobile once the tingling in both my hands had worn off.

Offbeat medicine recently surged in popularity with an epidemic of visits to the Philippines for psychosurgery. Several charter flights left the Yukon for Manila and patients returned with legion miraculous cures after as many as twenty-three operations performed on one person in as many minutes – and without sign of a scar or spillage of a drop of blood, discounting the red dye released from the healer’s palm.

In the wake of the Philippines a local practitioner branched into holistic medicine. I went to an expository meeting and endured two hours of naive explanation about holus meaning the whole person. I concluded that what was being sold in euphemism as a revolutionary approach to medical practice was exactly what I understand by good general practice with a few frills added.

I used a little magic now and again; I knew I told the occasional white lie. Part of my time at work was spent listening to prosaic complaints and throwing in a word of advice and reassurance. During the other part of my time I earned fully what I am paid for in my supposed ability to spot the dangerous from the dross and the unusual from the mundane that should separate me from the purveyors of quackery whom I have berated. I should be humble enough not to mind if my patients are spilling expensive vitamins into the lavatory, if they get better after the first relaxing holiday they’ve had in years across the Pacific, if their backs are pain-free after having their vertebrae shuffled around, or if they have their eyeballs taken out, turned round and put back in again to restore their failing vision.

I do not wish to deny the healers their successes when they can cure someone on whom I have had no luck, but I resent their dishonesty in claiming to falsehoods. As usual, the last laugh is on me. A respected British physician friend, having had months of raised liver function tests after an attack of infectious hepatitis, visited an acupuncturist who had done marvels for several of his patients. Within days of having the needles, his biochemistry returned to normal and he was able to enjoy a good life.

EXPOSURE

Sheep Mountain overlooks the south end of Kluane Lake. In winter when plastered with snow it looks Himalayan, but in summer its barren scree is like any of the other rocky hills that bar the way to the inner sanctuary of the St Elias Range. The brief halcyon season of alpine flowers makes the dry semi-desert Yukon soil spring alive with blooms that are painful to trample under your boots.

On a sun-blest day in June I trudged up one of the rotten ridges of Sheep Mountain to gain a spectacular southerly view of some of the largest glaciers in the world that extend away to the Gulf of Alaska. On top I rested and watched a flock of white Dall sheep, related to the Rocky Mountain Bighorn, peering over the crest of a ridge above Bullion Creek that drains the back of the range. After a brief sojourn on the summit I set off down the mountain as I was booked to chair a symposium that evening at the Arctic Institute of North America whose white huts I could see clearly nestling opposite the foot of Kluane Lake.

Descending a grassy alp to the north brought me to a knoll where the ridge split. To the right a fine scree chute fell steeply to the woods nearly five hundred metres below. I bounded onto the slope, and the stones bore me downhill like a moving staircase, small round pebbles rolling under my boots and the whole hillside sliding gently towards the distant lake. Few sensations in the mountains are so ecstatic as the effortless descent of good scree.

Within minutes I was down among the large boulders at the end of the chute. But my momentum, the sheer physical pleasure of exertion, and the hot sunny day, kept me running. I paced through the woods and galloped down the grassy bank towards my parked car. I was thoroughly overheated from the work of the climb, and sweat poured off me. Deep azure Kluane Lake beckoned.

I threw my rucksack on the hood of the car, dashed across the highway, and down a bank on the far side towards an old jetty that lay among some lakeside bushes. This was no time for contemplation; I had to act before the icy water could chill my enthusiasm. I stripped off all my climbing clothes, took a couple of strides along the jetty and dived in. I gasped as the freezing water caught just under my ribs and stabbed like a knife. I submerged for a few seconds and surfaced to admire the unique beauty of the place and to reflect on the joy of being able to swim naked in such a spectacular and desolate spot.

Out of the corner of my eye a cloud of billowing dust reminded me of the propinquity of the Alaska Highway – man’s only imprint on the barren scene. I climbed out of the water and stood on a rock to pull on my pants. Over my left shoulder I caught sight of something blue moving towards me. Then through a pall of dust a circular red light flashed. A big blue pick-up truck drew up beside me and a uniformed man climbed out, the broad yellow band down the side of his trousers leaving no doubt who he was – an officer of the Royal Canadian Mounted Police, no less. The noise I heard was not the sound of his spurs jangling but rather the warning bells of my conscience; it seemed ridiculous to feel guilty about skinny-dipping in such a secluded spot. The officer ambled towards me, his hands thrust into a smart leather holster belt.

And what do you think you’re doing? he asked.

I thought it looked pretty obvious, and said so. After all you don’t find a man naked beside a lake on a sweltering day clutching himself for no good purpose.

Where do you come from? he said curtly.

Whitehorse, I replied.

And do you usually show your ass like this in Whitehorse?

No, actually, I said feebly, looking out over the wilderness, because there are a lot more people around Whitehorse.

Well, continued the officer, it’s indecent and it’s against the law. Think of the people who might see you.

I looked round this corner of one of the least populated parts of Canada that I had sullied with the glimpse of my bare backside. Retaining a nonchalant air in the presence of so awesome a law-keeper was difficult. Images flashed across my mind of possible headlines in the local paper: Physician charged with indecent exposure, and I wondered what sort of case my lawyer friend from next door could make on my behalf.

I’m very sorry, officer, I replied, I assure you I won’t do it again.

Okay, let this be a warning. But next time you’ll be charged. He hitched his smart pants out of the dust, fingered his handcuffs suggestively, and stared at me.

Excuse me, officer, I muttered apologetically, I must be getting along as I have a rather important speaking engagement at the Arctic Institute.

What are you talking to those guys about, anyway? he snapped.

Exposure, I said. He obviously thought I was being cheeky, and he didn’t seem amused.

Honestly, officer, it’s about hypothermia – cold, and all that stuff.

I pulled on my clothes and fled.

HAVING BABIES

At an obstetric refresher (or learner) course I’ve just attended, it was good to discover that babies still appear the same way they always did. Furthermore, just as many babies seemed to survive in the dark days before prospective mothers were hooked up to the television to detect heartbeat, sex, and every time the foetus turns over in bed – all failsafe procedures that have hardly reduced the Caesarean section rate. I am thankful I learned my obstetrics with an ear trumpet, a good midwife, lots of patience, and occasionally a pair of Wrigley’s forceps.

I was introduced to obstetrics as a student at St George’s Hospital, Hyde Park Corner, London, by two very different teachers. Larry Kirwan-Taylor, a debonair and foppish society gynaecologist, would stroke the hands of distressed pregnant Knightsbridge debutantes, and prescribe pessaries for the prolapses of their mothers. Silver hair was feathered over his ears, and his immaculate, hand-tailored suits always bore a carnation in the buttonhole. A monocle attached to a thin black silk ribbon hung round his neck, and would drop out of his eye as he bent his head to examine the patients lying in the Sim’s left lateral position. His examinations always ended with a pat on the patient’s bottom and a discreet puff of Johnson’s baby powder as he pulled up the draw-sheet – urbane gestures that might nowadays land one in the courts.

K-T’s lectures, especially those on family planning, though slim in academic content were popular with the students, ever hopeful of getting some tips for their amorous forays with the nurse probationers. If you invite a gal out for the evening, he would say, . . . better to make love before dinner than afterwards. He never did explain the rationale for this gratuitous advice, and most of us were so naive we wouldn’t have known what to do with it anyway. He would tell us the only important quality for success in medicine is always to be available.

George Gwillim, the other gynaecologist, was a rough, rude, tempestuous, short-statured Welshman, a qualified barrister as well as a brilliant technical surgeon. He disdained women, whom he treated offhandedly. During outpatient teaching clinics half a dozen students would crowd round the examination couch hanging on his every word while peering at some interesting condition. He would tetchily wrinkle his stubby nose to raise his glasses up his face as he pulled on rubber gloves while holding forth on the condition displayed before him. Meanwhile we students craned our necks and writhed in embarrassment for the poor patient at the other end of the speculum, whose head end was disregarded and often tearful. In the operating room George Gwillim was a pioneer and master of vaginal hysterectomy.

I did my obstetric internship in the heartland of rural Suffolk, a backwater in the bulge that is East Anglia south of The Wash where King Canute dipped his feet to quell the advancing tide. My boss, an eccentric Irishman named Paddy O’Meara, was a fanatical golfer and follower of racehorses. He ran the obstetric unit with me as the sole house surgeon mainly, I suspect, because he would brook no challenge to his outdated methods. The head nurse of the gynaecology ward was his doxy, and she would make me unwelcome if I did not clear off immediately after ward rounds so they could have a cozy tea party together in her office, the door firmly closed and the nurses well-trained not to disturb them.

Within two weeks of my starting the job Paddy took off on holiday