Chapel Hill: Opinion

Learning the Thunder

Reflecting on the milepost of my 25 consecutive years as a licensed N.C. physician assistant, the last 20 at Duke, I recalled my black leather medical bag which was a graduation gift.

As I’ve been 100 percent hospital-based for the past 22 years, it hasn’t gotten much use. So I’ve had it lovingly stored, as it will someday pass to my nephew, also a physician assistant. But impetuously on this day, I wanted to get it out and go through its contents.

On a ladder from a top shelf, I carefully brought it down, opened the box and lifted it out by its sturdy handles. It seemed to emanate powerful purpose, and I brought it forth with liturgical solemnity.

The “physician’s bag” has long been a symbol of the medical profession. The first detailed description of a medical bag, including guidelines for its contents of equipment and drugs, is found in Hippocrates’ writings (460-370 BCE)

My medical bag is to me a symbol of my “calling.” No, I didn’t have messianic zeal to save the world; I was embarrassingly innocent and without guile. I simply knew that I was able to read the thunder.

I didn’t even see myself as “healing the sick”; I only wanted to relieve suffering. To this day, my purpose has remained: “first do no harm,” then relieve suffering – mental or physical – as I am able.

Come, look inside my medical bag which includes many relics of medical “tools.” Here is a tuning fork used with the Weber test which assesses for conductive or neurosensory hearing loss.

Another is a small caliber, yellow rubber tubing with a tiny mouthpiece affixed to my otoscope, called an insufflator. The physician “sipped” negative pressure in order to move the eardrum, assessing for fluid in the middle ear space. Later, instead of the mouthpiece, we used insufflators which had a small squeeze bulb, also in my bag, as sipping on the mouth piece was recognized to be in violation of the “germ theory”

A tool resembling needle-nosed pliers is actually a nasal speculum allowing the examiner to peer deeply into the nasal cavity.

My favorite is a sturdy metal vaginal speculum with two different adjustment mechanisms. These and other metal tools were “autoclaved” at each day’s end. Nowadays cheap, flimsy, disposable speculums are used.

By age 5, I’d witnessed more grand mal seizures than a seasoned neurologist might ever. My father had epilepsy. His young primigravid mother died of eclampsia and uremic poisoning while prematurely giving birth to him. He weighed 4 pounds; in 1929 this was a precarious state for an infant. His seizures were said to have been caused by birth anoxia and his mother’s toxemia.

My father could never get a drivers’ license so we traveled everywhere together using Chicago public transportation. As I was the eldest and my mentally ill mother was unable, I was his constant travel partner. Even then, I knew that I was brought along, and relied upon, to look after him when he had one of his frequent seizures. This marks my earliest sense of calling.

One day, coming home late on the CTA bus, he had a particularly bad one. We were tired and had been riding quietly in the bus bumping along. The other passengers were similarly quiet, resigned to the bus ride, idly watching the night lights flash by through the windows.

I could tell when a seizure was coming on. He looked at me with his typical prodromal expression on his face, eyes wide with terror. He had a look of embarrassment, as though he was trying to be nonchalant about the seizure that we both knew was whipping up its fury.

His periorbital muscles contracted, twisting his face into grotesque contortions. It seemed as though he was trying with all his might to keep his mouth from flying open, and as I imagined, screaming out the terror that was apparent all over his face. His efforts caused obscene sounding lip-smacking, which as the electrical storm thundered across his brain, eventually gave way to grunting, groaning and snorting.

Eventually his whole body was wildly convulsing until he ended up on the floor of the lurching bus. The passengers stared at us. I did as I knew to do: loosen his collar, not stick anything into his mouth, and most difficult of all – just watch the thunder and wait until it passed.

I knew that after the seizure had thrashed him, he’d be incapacitated with confusion, so I made sure we got off at the right stop. I was terrified at seeing my father in such agony, to see him so whipped and weak.

I am still learning it, still learning to read the thunder. But there have been times I’ve wished I didn’t know anything about it at all.

You can reach Blaine Paxton Hall at blaine@carolina.net

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