Read An Excerpt
The
Hankins Sisters
When
my mother suddenly became ill with a heart problem,
I was drafted as a temporary replacement for
her in my father’s rural medical practice
near the Smoky Mountains in East Tennessee.
I didn’t relish the idea of taking any
leave from my glamorous job as a U.S. Senate
lawyer, but it was an emergency and I was assured
it would only be for a couple of days.
How
could I say no? So I rushed home from Washington
to fill in as his receptionist.
When I unlocked the front door of my father’s
office at 7:30 the first morning, the phone
was already ringing. I hurried inside and stretched
across the reception desk to answer it.
“Dr.
Jourdan’s office,” I said, out of
breath.
“Do
y’all wash out feet?” a woman shouted
in a raucous voice.
I
considered her question. Although I spoke the
local dialect fluently, I had no idea what she
meant. I said, “Excuse me?” and
quickly moved the earpiece a safe distance away
from my head before she had time to respond.
“Wash
out feet! Do y’all wash out feet?”
she screamed.
“I
. . . I don’t know.” I sent up a
silent prayer that we did not.
“Well
she needs her foot washed out! How much do y’all
charge for that?”
If
I was unsure if we even did such a thing, how
could I know how much it would cost?
“I
don’t know,” I said.
In
the ensuing silence I managed to add, “I’d
ask the doctor, but he’s not here yet.
I’ll find out when he comes in and call
you back and tell you what he says. Okay?”
I fumbled through the piles of paper on Momma’s
desk until I located a pencil and a blank scrap
of notepaper, jotted down the woman’s
name and number, and then hung up. I stared
at the phone warily. Working as a temp for Daddy
might be a little harder than I’d anticipated.
I hurried around to the other side of the reception
desk in an attempt to put a bit of formica between
myself and the medical world. But before I’d
even gotten seated atop the wooden stool that
was the main feature of my new domain, I heard
the front door open and then the unmistakable
sound of elderly ladies, their voices worn out
from too many years of use.
One squeaked like
a rusty hinge and the other crackled in an unpredictable
jumble of soft and then suddenly loud sounds,
like a radio with bad reception. The ladies
were advising and encouraging each other in
an effort to negotiate a small step at the front
door. I turned and saw that it was the Hankins
sisters, Herma and Helma, and their friend who
lived with them, Miss Viola Burkhart.
I’d
known them all my life. They were in their nineties.
The Hankins sisters had never been married.
Miss Viola was a widow who had come to live
with them after her husband died. She was ninety-eight,
weighed about seventy pounds, and had an advanced
case of what the sisters called “old-timers.”
Somewhere along the way she’d lost the
ability or inclination to speak and now she
wore a perpetual vacant smile.
Helma
was ninety-five and also weighed less than a
hundred pounds. She was extremely stooped, bent
almost double from osteoporosis, and her eyesight
wasn’t good. Herma was the baby at ninety-one
and probably weighed more than both the other
ladies combined. She was still sturdy but deaf
as a post. So there was one who could hear and
see, but not think or talk; one who could think,
hear, and talk, but not see; and one who could
think, see, and talk, but not hear.
The
ladies were inseparable. Helma did the cooking
and talking on the phone and Herma did the heavy
work and the driving. Both of them took care
of Viola.
Helma
wore a faded green polyester leisure suit with
an oddly intriguing assortment of safety pins
arrayed along the edge of one lapel, while Herma
had on baggy sweatpants and a misshapen sweater.
Miss Viola was wearing a demure flowered dress.
All three ladies wore shiny brown naugahyde
coats that had been fashionable in the sixties.
When
they moved, they shuffled along together, holding
onto each other for support and navigational
assistance. They made their way carefully to
the reception desk and Helma said that it was
Miss Viola who needed to see the doctor today.
Herma said, “Hey there, girl,” and
smiled. “We was sorry to hear about your
ma. How’s she doing?”
“Pretty
good. She’ll be back Monday.”
Herma
looked at me in confusion and said, “I
thought she had a heart attack.”
“She
did.”
“Ain’t
she in the hospital?”
“Yeah,
but she told me she’d be out by Monday.”
I
was relieved when Herma decided to leave it
at that. The story sounded a little thin, even
to me, but I desperately needed to believe it.
Then,
without even a hint of foreboding, I made my
first executive decision in the health care
arena. “You ladies can come right on back
to the examining room,” I said. I figured
it would be easier to get all of them up and
down just once instead of twice; and waiting
in the back would protect them from exposure
to whatever germs the other patients might bring
in. It seemed like a good idea at the time.
As
I helped them through the door that divided
the waiting room from the rest of the office
I said to Helma, “You ladies are lucky
to have each other.”
She
smiled. “Oh yeah, we got enough spare
parts between the three of us to make one whole
person!”
I
took them back to Room 3 because it was the
only room with enough places for all of them
to sit down. Room 3 was used for surgery and
contained Daddy’s pride and joy –
the hydraulic surgical table.
Thirty-five
years ago, when he couldn’t really afford
it, Daddy had bought the special motorized table
that would raise and lower, so he could lift
patients to a comfortable height while doing
surgery. Even now the table still occupied a
special place in his heart, like his Leitz microscope.
No one was allowed to touch either piece of
equipment but him.
The
table was controlled by four pedals that lay
flat on the floor. The entire table could be
either raised or lowered; or it could be tilted
by raising or lowering either the head or foot.
I
seated Miss Viola in the middle of the table
and told the ladies that the doctor would be
in in a few minutes. Then I returned to my post
at the reception desk. While I waited, I retrieved
my phone messages from voice mail in Washington.
My boss, Senator Hayworth, was conducting a
series of hearings on corruption in the nuclear
power industry, and I expected most of the calls
would be related to that.
There
were eleven messages. I sorted them with respect
to time zone and then numbered them to indicate
the order in which they should be returned.
First came the calls to people on Eastern time:
government affairs representatives for the University
of Tennessee and Tennessee Valley Authority.
The call to a huge nuclear power conglomerate
in Chicago could be made after 10:00, to a colleague
in Sedona an hour after that, and then after
noon I could reach the Los Angeles offices of
the lobbyists for the electric power industry.
Tokyo Power Company would come last, after 8:00
tonight. No problem.
As
I dialed the Director of Federal Relations for
the University of Tennessee, Daddy came in carrying
a cardboard tray with a styrofoam cup of coffee
and a McDonald’s bag. He set his breakfast
on the counter and I told him about the ladies
waiting in Room 3. He nodded, fished his sausage
biscuit out of the bag, and began to unwrap
it.
Then
he looked at me with his head tilted. “What’s
that sound,” he said.
“I don’t hear anything,” I
said, trying to stay focused on the opening
pleasantries of my business conversation.
He
laid his biscuit down next to his cup of coffee
and walked down the hall toward the back. I
heard him pause at the doorway of Room 3 and
say, “Good morn . . .” Then he shouted,
“What the hell’s going on in here?”
“Gotta
go,” I said, hanging up on the Director
while she was talking. Then I bolted for the
back.
Things
were not the way I’d left them. The surgical
table’s motor, normally a low-pitched,
almost inaudible hum, had changed to an angry
whine. The head of the table was tilted as high
as it would go, over five feet in the air, and
the foot was down, almost touching the floor.
Miss Viola had slid into a little wad at the
lower end. Herma and Helma were frantically
struggling to keep her from falling onto the
floor, but she was oblivious. She smiled serenely
as Herma tugged on her arms and Helma hoisted
her ankles.
I
couldn’t understand why this was happening.
It sounded like someone was standing on a cat’s
tail. I looked down reflexively and noticed
that Herma had somehow come to be standing on
the floor pedal that raised the head end of
the table. She clearly didn’t realize
what she was doing, nor could she hear the table
motor running.
Daddy
shouted a one-word accusation, “Carolyn!”
and leapt forward to snatch up Miss Viola. As
she slipped off the end of the table, her dress
peeled up over her head. He tried to set her
on her feet, but she was so dizzy she couldn’t
stand by herself. He told Herma to get her foot
off the control pedal, but she couldn’t
hear well enough to understand what he was saying.
He
made a series of shuffling hops sideways, crushing
Viola tightly against his side, and startled
Herma by lifting her bodily off the pedal with
his other arm. He held one lady under each arm
while he stomped on the “Head Down”
control.
All
of this confusion and man-handling sent the
sisters into a tizzy. And Daddy was incensed
that anyone would dare touch the controls of
his table, much less put such a terrible strain
on it.
“What’d
you do that for?” Daddy shouted at Herma
in a voice so thunderous that she finally heard
him.
“Do
what? I didn’t do anything! Your table
there is broken!”
“It
better not be!” he said.
When
the table was level again, he plopped Miss Viola
back down in the center and flipped her dress
down over her legs. She seemed neither startled
nor embarrassed. In fact, she seemed to have
missed the whole ordeal.
Under
the circumstances Daddy decided to go ahead
and tend to Miss Viola’s medical problems
before normal office hours. He patiently listened
to all three ladies’ health concerns and
wrote prescriptions all round.
As
the ladies drove away, Daddy went back to his
sausage biscuit. He stared at me while he chewed
and then said, “Don’t ever do that
again.”
“Don’t
do what?” I said. “Don’t leave
any old ladies alone with any of your stuff?”
“Just
don’t do it again,” he snapped and
took his biscuit into the back to eat it in
peace.
We
were both under a lot of stress.
A
few minutes later, Alma, Daddy’s nurse,
confided that during her entire twelve years
with the doctor she’d never heard him
shout like that before.
“Well,
just stick with me,” I said, “I’ve
been with him for forty years and I’ve
been hearing it the whole time.”
Daddy
was fantastic at handling medical emergencies.
He was unbelievably cool under pressure if,
say, someone had cut off their arm or leg with
a chainsaw. But he simply wasn’t equipped
to handle the kind of emergencies that seemed
to crop up whenever I was around. He could cope
beautifully with every kind of chaos, except
the kind I created. And right now he was stuck.
He couldn’t work with me or without me.
I
felt for him. It was a good thing I was only
going to be subbing in this job for two days.
If I stayed a week, he’d end up sharing
a room with Momma in the cardiac ward.
Other Stories
Gifts for a Country Doctor
At
the pinnacle of what I used to think of as my
career, a family emergency forced me to abandon
my fast-lane Washington lifestyle and return
home to the Smoky Mountains of East Tennessee.
My
mother had fallen ill and the family needed
a temporary replacement for her as the receptionist
in my father’s rural medical office. I
was assured that I would only be needed for
a couple of days, so how could I say no?
I
could handle my mother’s job without too
much trouble because I was practically raised
in the office. For most of my life I’d
helped out, to extent I was able, during nights,
holidays, and weekends. But when I returned
after a decade living away in the big city,
I saw the place with new eyes.
It
was a dizzying transition. In the blink of an
eye, I traded forests of white marble columns
and vast domes of gold leaf for more than half
a million acres of colorful autumn foliage gilded
by the slanting yellow rays of the late afternoon
sun.
As
my two-day stint stretched into weeks, months,
and then years, I slowly shed my identity as
a U.S. Senate lawyer, or any kind of lawyer,
and became a not particularly noteworthy but
deeply satisfied participant in some genuine
public service, humble though it was.
No
more cross-country jaunts in Lear Jets or joyrides
on nuclear submarines. It was enough to take
the occasional bone-jarring sprint across the
cow pasture in an antique twelve cylinder convertible
Cadillac, trunk lid permanently removed so the
behemoth could be used to haul hay.
It’s
hard to overstate the difference between a world
like Washington where my colleagues and I would
frequently ask each other, “Is that with
a ‘b’ or an ‘m’?”
to clarify whether we were talking billions
or mere millions, and a world where the only
way some people had to get any cash at all was
by foraging in the woods for walnuts during
a short harvesting season.
Because
money was scarce, my father treated hundreds
of people for free, somedays everyone. But his
patients weren’t the kind to feel comfortable
accepting charity, so, when they could, they’d
drop by and leave off some token of thanks for
his kindness. The fact that this sort of exchange
has become a hackneyed stereotype doesn’t
take away from its charm. Sure, he got the traditional
food items like fresh fruits and vegetables,
whole-hog sausage and home-cured ham, beans
and cornbread, fudge and divinity. But more
often than not, he got paid with less predictable
sorts of things.
Sometimes
the gift was actually a burden, but, whatever
it was, Daddy always accepted it gracefully:
a tiny blue jay that had fallen out of its nest,
a cardboard box containing four deodorized baby
skunks, an orphaned raccoon in a boot.
He
got all sorts of things: a cutting of an admired
maple tree, a twig that grew into a magnificent
climbing yellow rose, a half stick of dynamite
probably stolen from the mines, a rusty Confederate
sword found in the woods, Indian arrowheads
turned up by a plow, a handful of bungee cords
scavenged from alongside the interstate, and
the back half of a 1934 Chevrolet pickup truck
that would “make a good trailer to haul
things in.”
During
the years I worked with him I got to share in
the pleasure of seeing these interactions. The
sweetest thing I ever saw him get was an offer
of friendship from an elderly retarded man who
stuttered out a shy invitation for Daddy to
visit his very rural cabin where he suggested
they could sit together on his porch and watch
the squirrels play. He generously added to the
bargain by telling Daddy, “You can sit
in the chair.”
No
amount of money in the world could ever outdo
a deal like that.
The
most unusual thing he ever got was the still-warm
body of a red fox that a patient had seen get
hit by a car. Daddy took the beautiful corpse
to a taxidermist and then displayed the magnificent
creature for decades until my mother could no
longer vacuum the dust out of its thick fur.
My
favorite thing he ever got paid with was given
to him when I was a teenager. It was made by
a ninety year old widow who was so crippled
with arthritis she lived confined to only a
single room of her house. Daddy made free house
calls on her for many years and, in return,
she sewed him a quilt. The night he brought
the quilt home he gave it to me with tears in
his eyes. He said he couldn’t bear to
look at it because of the hours of painful effort
he knew it had cost her.
Ever
since that night the lovely quilt has hung on
the wall beside my bed, wherever I lived. It’s
a giant pink star on a white background. I’ve
spent decades marveling at the thousands of
tiny stitches placed by her gnarled fingers.
Nowadays
the quilt reminds me of what a real career is
all about. It’s not about the direct deposit
of currency from one bank account to another
or getting on C-Span while you work. It’s
about the one-on-one exchange of time and attention,
warmth and concern.
The star quilt is a testament to a rural community,
an epic poem from an old lady to my father.
It says a lot about the blessings of really
noticing the people around us. It says everything
you’d ever need to know about love and
kindness, patience and courage, and Southern
lives, well lived.
An Opinion Editorial
Guillotine-Related Medicare Claims
Did you know that Medicare has a category for reimbursement of claims caused by “Legal Execution, Beheading, Decapitation (By Guillotine)”?Well, it does.
When I became aware of this fact, I felt compelled to ponder what sort of a person could perceive a need to put guillotine-related incidents into the Medicare coding manual.
Not just think about it, or joke about it, but actually do it. And skate it past all the editorial and medical reviewers.
Help me out here. Under what circumstances would a senior citizen (or their bereaved family) seek reimbursement from Medicare in connection with being guillotined?
Even if you could cook up a possible scenario, how often could this kind of thing be expected to happen? Couldn’t it be covered under a catch-all provision at the end of the coding manual called “Other”? Shouldn’t it be? Should I have to pass it coming and going several times a day while desperately trying to locate the code number for “sore throat”?
I think not.
This absurdity first came to my attention several years ago when a family emergency forced me to swap my cushy, inside-the beltway Washington lifestyle for answering the telephone, manning the reception desk, and filling out the insurance paperwork at my father’s medical office near the Smoky Mountains of East Tennessee.
I’m willing to admit that I didn’t make the most graceful of transitions. But the most painful aspect of my new down-sized life was not struggling with the precipitous loss of status and income, or trading Hermes for Wal-mart. The worst shock was learning that the insurance system which I had easily mastered during summer vacation at the age of fifteen, had been “streamlined” by the government to the point that it was now incomprehensible to me, a forty year old former U.S. Senate lawyer with an engineering degree.
I, who had aced my way through three years of calculus and who had been competent to draft our nation’s nuclear legislation, was utterly buffaloed by the challenge of filling out a Medicare form for a patient with a stomach ache.
Because I couldn’t cut and run, I had to try to slog my way through.
All day long I paged back and forth through the Medicare code book, searching, but rarely finding, the secret formula that would cajole the government into reimbursing the treatment for a ninety year old lady’s joint pain or a retired miner’s lung problems.
What I found instead was a section for “Accident Involving Spacecraft, Includes Launching Pad Accident, Excludes Effects of Weightlessness in Spacecraft”. So if an elderly citizen is crushed on the launching pad under a toppled rocket, they’re covered. But if they hit their head on the ceiling of the Space Shuttle once it has reached cruising altitude, they’d better not come crying to Medicare.
Although my former boss, the brave and beloved Astronaut and Senator John Glenn, went into space again at age seventy-seven, I’m willing to stick my neck out here and suggest that this is not really a sufficiently common occurrence to merit inclusion in the coding book that each physician’s office must consult for every single patient visit.
The nation debates how to bring health care costs under control and yet allows Medicare reimbursement for “Problem, Spoiled Child” and “Quarrelsomeness”.
And the entry for “Double Whammy”? I’ve certainly experienced the situation, but never dreamed anyone could get medical insurance coverage for it.
Recently I faced another painful revelation about the lack of common sense underlying our nation’s health care system as I watched my parents, both of whom have doctorates in Pharmacy (my father went on to get an M.D. as well) struggle with the new changes in the Medicare prescription drug benefit program.
It was frighteningly similar to a lottery or gambling. They had to sign up at a cost that was subject to change, for benefits that weren’t certain.
If a team of pharmacists, one of whom is a doctor, can’t figure out how to proceed, how is a more typical senior citizen supposed to navigate the labyrinth?
Are we a nation serious about addressing the health care needs of our citizens? Are we willing to get real about creating a humane, sensible, and efficient system to care for each other?
Apparently not.
Are prescription drug benefits available for seniors who have been guillotined?
Probably so.