Archive for November 2007

Mandolins and Kidney Stones

November 24, 2007

        I became a mandolin player by default.  I understand Bill Monroe picked it up the same way, when his brothers had already laid claim to the fiddle and the guitar.  (He got better than me, though.) 

        When I first came to town, I was a banjo player, but as soon as I heard the Moose pick the five, I switched to guitar.  Moose told me they were short on mandolin players in town, and I’d see more work if I learned how to play it, so I took his advice.  

        The first gig I ever played was a Halloween party at a local church, and it was a baptism by fire.  I only had my mandolin three weeks, and protested when the Moose called, but he was insistent- his regular man had run away from home with a French accordion player he met at Galax.  He knew a good man over in Raleigh, but he was out on the road with his regular band.

        As they say in bluegrass, it was rough style.  I hung back from the mic, and tried to chop along on the three chords I knew the best I could, and did one short solo on an easy piece Moose assigned.  We left the stage, and I complained it wasn’t very good.

        Moose said, “You’ve only had the thing three weeks- what didja expect- David Grisman?”  Still, I was his regular mandolin player from then on.  For the first ten years I guess he felt sorry for me, or maybe it was there was no one else in town who could play, but I never got fired.  (We knew of one band where the lead singer fired his mama, the bass player, on a regular basis.)  Maybe it was because I was reliable, never missed a gig, and was always on time and sober.  Come to think of it, maybe it was in spite of that.

        The day I knew I had the mandolin job permanently, though, was when the Moose missed his only gig.  We figured no one would know it was bluegrass without a banjo, and I was the only one in the group with some skill on the instrument, so I left the mandolin in the case.  It wasn’t very good. 

        More important though, was the fact Moose didn’t make the show due to a kidney stone.  I met him in the E.R. an hour before the gig.  As he told the rest of the guys later, “I knew Dr. B was a good friend, but I didn’t know how good till he showed up in the E.R. with that morphine.”  A kidney stone is everything it is cracked up to be.  After I passed mine, I called up several patients and apologized for my insufficient empathy.

        We are now another decade down the bluegrass road (the Nitty Gritty Dirt Band longevity record has been eclipsed) and I believe my spot is relatively secure.  Bluegrass bands are like baseball teams; everyone brings a different skill to the table- the trick is blend it into a team.  The Good Lord didn’t give me the pipes to sing lead, but I have worked hard to be a serviceable baritone (some say monotone) part singer, and I’m a decent but not spectacular utility mandolin guy.   As far as I know, though, we are the only semi-professional band in the area with medical benefits.

        As the boys always say, I play good for a doctor, and a fellow who can treat a kidney stone comes in handy every once in a while.

Dr. B

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Privacy

November 24, 2007

        Did it every occur to you that the folks who push HIPAA to protect your privacy are the same crowd that came up with the Social Security Number?

        I don’t know about you, but that worries me.

Dr. B

Money, Medicine, and Music

November 24, 2007

        I guess I am old, nostalgic, or both, but sometimes I do miss the “good old days.”  Not that I want to turn my back on technology.  In fact, I am a most willing participant in high tech, as my 20/20 vision after modern retinal detachment surgery will attest.

     I do wish we could somehow partake of all the fine advances but not have turned medicine into a business.  There was more satisfaction in it being a healing art.

        I used to go out on house calls with my Dad, and have made a few myself.  Folks who believe they know a patient by the paper they keep are so naive.  The impact of sitting at someone’s kitchen table and sifting through the array of pills from different Docs the patient “thinks” they might be taking is powerful.  Everyone trying so mightily to pass rules to govern human behavior needs to make a few house calls before they get so dadburn high and mighty as to their perceived importance. 

        I didn’t make this house call with Dad, but once he went up in the country to check on a woman who had a belly ache for a few days, and ended up doing a STAT delivery.  A few years later, when the child went to school, they realized in the confusion there had been no birth certificate filed, so they did a little paper work and life went on.  (I can’t even begin to explain what a bureaucratic crime that would be nowadays.)  I assure you, though, none of that paperwork made that child one ounce better off in this world.  It fascinates me how importance the folks in charge attach to their paper trail rules, though.

        The other thing Dad realized was the family had forgotten to pay for the house call, but they were most willing to settle up- the charge was five dollars!

        We used to have an old Doc in town who had an interesting take on all this.  At Hospital Staff meetings, regardless of what problem was being addressed, he always said, “I don’t exactly what’s wrong here, but it’s got something to do with money.” 

        Now that we have all these political and executive types making millions of dollars for mis-micromanaging the most complex details of another human being’s life, I have to agree. 

        Maybe all those type folks should do house calls for a few years before we put them in charge.  But, I know that will never happen.  As old Doc said years ago, what is wrong here has something to do with money.

        I am off today, and going to play a gig at the nursing home.  Don’t tell anyone I am doing it, though, or someone will dream up a bluegrass music nursing home acquisition and validation form (BGMNHAVF) that must be completed in triplicate before commencing to play.  It would ruin the whole experience, and I would hate to be out of compliance- they might not let me go again until I took some kind of course on  the variety of musical tastes of the nursing home population as defined by some obscure government study.

        I promise you too, that the cat wanting the form filled out can’t play a note.

                                              -Dr. B

Golf Course Wisdom

November 23, 2007

        I played golf with my boy over the holidays.  The times they are a changing, ’cause he used to gloat when he outdrove me ten yards, but now that it is forty, he apologizes and asks if my last check-up was O.K.

        I tell him it’s alright.  He might be able to outrun and out jump me, and hit a golf ball longer, but he’ll never catch up with me on one thing- wisdom.

        I think he knows it ain’t true, but is smart enough to realize he’s got to concede something, and not to take away the only thing an old man can lay claim to.

        He’s such a good kid I don’t care if he can drub me on the golf course.

                                                        -Dr. B

  

       

Bomb Shelter Loyalty

November 23, 2007

        Several folks wanted to know what the Bomb Shelter is like.  Others wanted some insight into the lifestyle of a country doc.  I decided to tell you an old Bomb Shelter story that might satisfy both requests.  Except for the fictional parts, it is a true story, but the names have been changed to protect both the innocent and the guilty.

        The Bomb Shelter, owned by Jack Barber, is a longstanding N.C. watering hole for bluegrass musicians.  It is an authentic 1950s prewar (cold war) bomb shelter converted to a bluegrass haunt when the standoff with the Russians wound down.  I can not divulge its whereabouts, as that is a highly guarded secret in the eastern N.C. bluegrass community. 
        The crowd is a tight circle of players, mostly good amateurs, with the occasional professional sitting in. Everyone knows everyone in the bluegrass world.  As one of my patients used to say,  “All you bluegrass boys is thick as thieves.”  John Hartford said bluegrass was the last American small town, where we were an extended family, and no one locked their doors.  Treachery is rare in our world.  Expensive instruments can be left out without fear of theft.  Oh, of course, there are times when someone will break the rules.  When it happens, an all out search is launched.  The national trade magazines, like BGU, (Bluegrass Unlimited) will run an ad until the piece is recovered, as they did years ago when a well-known banjo finally turned up in a Brooklyn pizza parlor.  The perpetrator is seldom criminally punished, but their fate is much worse than that, as they are permanently ostracized from the bluegrass music community, becoming as well known as a PGA pro that would try to make his living moving the ball in the rough when unobserved.    
        All that being said, though, newcomers are always welcome into the circle, as long as they understand bluegrass etiquette. 
        One night a new man showed up at the Bomb Shelter.  He played a decent flat pick guitar, and had a passable voice.  We were glad to get to know him, as you often needed a man to fill in, and I entered his data into my Wizard filed under music, guitar, and lead singing.  (The Wizard was the predecessor of the Palm Pilot.)  I was one of the first in town with one of these gizmos, and it came in quite handy.  Mine was filled with a quite wide variety of contacts, everything from bass players to neurosurgeons.  The session was going along great, and someone called for “Catfish John,” a standard made famous by the Country Gentlemen, and popularized in this area by a gentleman named Floyd Freeman, who had played in a number of bands, and toured with Monroe for a few years as one his countless Bluegrass Boys.
        Floyd was one of my favorite patients.  We first became acquainted one night in a bluegrass emergency.  He had a show booked, and his mandolin player had cancelled out on him.  Seems the boy wanted to stay home and watch rasslin’ on T.V. with his mama, and would not budge.  With only two hours till showtime, Floyd was desperate.  I was off duty and agreed to fill in. 
        Freeman was a powerful singer; we blended well, and cut the gig without incident.  The true emergency came up after the show.  Backstage, Floyd rolled up one of his pant legs for me to inspect.  He had an obvious D.V.T. (blood clot.) After an urgent admission and some heparin he was cured up, and much appreciative.
        After that I was his Doc for a number of years, and also did a few shows with him every year.  We became fast friends.
        He had several medical problems, but in fairness to him, I don’t feel is would be right to outline them on the net, so I will leave it simple.  One day when I was out of town he died unexpectedly.  When I found out, I went home and cried.  As it turned out, there wasn’t anything anyone could have done, but it still hurt, and hurt bad. 
        We all went to the funeral.  As always, these are sad events, but there was some levity when folks were called on to recall some of the humorous anecdotal road stories he had accumulated over the years.  A number of musicians were there, and several impromptu performances reminded us Floyd wouldn’t want us to linger in sadness too long.  The preacher commented that the Docs didn’t know exactly what was wrong, and I wanted to TESTIFY, but held my peace.  I figured the minister’s job was to try to comfort the family, not me, and of course didn’t say anything to the contrary. 
        Some Doc avoid funerals, because they can be volatile.  One went to a service for one of his patients, and was spotted by a young man who pointed at him and shouted out, “There’s the S.O.B. what killed my grandma!”
        Darrell was only nineteen at the time, but in the wisdom of a kid who hit the road as a teenager, he understood.  He came by the office the next day, and strummed through a few bars of Catfish John on my office Martin.  “You know Tommy, I knew Free real good.  I went on road trips with him when I was only fourteen, and we had a lot of time to talk.  I don’t really think he wanted to go on like things were getting.  He was too short of breath to sing anymore.  I believe he knew he was going to die before too long.  There warn’t nothing you coulda’ done about it, and you don’t need to go blaming yourself.  I am sure he ain’t blaming you from heaven.
        Darrell broke into another chorus of  Catfish John.  “Mama said, don’t go near that river…. No one did that one as good as Floyd Freeman, huh doc?”  Darrell always could call for the right tune.  I guess he was right about Floyd too, but it took a long time to get over his death.
        Getting back to the Bomb Shelter, when someone called for “Catfish John” that night the new man was in town, I’m sure you now understand how that would bring back significant reminiscence for all of us.  Jack Barber still owned Floyd’s old Herringbone guitar, and though it was several years after his death, Floyd Freeman’s memory was still fresh.  The new man had heard him sing somewhere along the way, and commented how much he liked his style. After a moment, he looked at me in a peculiar way, and paused to study my features.
        “Ain’t you a doctor?”  He asked me in the wary way people often do in the beginning. 
        “Yep.  Bibey.  Tom Bibey.  Pleased to meet ya’.”  I extended my hand to shake and howdy. 
        He took a longer look.  “Ain’t you the doctor that killed Floyd Freeman?”  Usually the Bomb Shelter rocked.  Now it was the quietest moment there we had ever experienced.
        I broke the silence.  “Sir, doctors can’t say much about cases due to confidentiality.  However, I can tell you with absolute certainty that I did not kill Mr. Freeman.  If you are not prepared to retract your statement, then we’ll have to go outside and settle this.”  I never had quite gotten over losing Floyd- he was a good’un. 
        I looked at the boy and immediately wondered what possessed me to issue such a challenge.  Usually, I let reason outvote a flash of anger.  He was at least twenty years younger than me, and the veins on his tree trunk neck were popping out like ropes.  
        At least I had the sense to choose good friends.  To my right was Moose Dooley.  He had some flecks of gray in his beard, and was twenty pounds over his rasslin’ weight, but he was still formidable.  Once we played a festival in Lillington, and we had dared him to enter a tough man contest over at the gym, where he had finished second.  We had ragged him unmercifully, until one night he proclaimed there were some guys around tougher than him, but none were in the room.  He seemed to have lost his humor regarding the subject, and I noticed no one ever brought it up again.
        Stroker, our flatpick man, was lean and quiet.  Sometimes he’d go three days without eating, a habit he acquired while in the army special forces. He grew up in the country just north of Winston, and they say he once stayed in the cage with the King County orangutang for five minutes.  He’d seen a lot worse foxholes in his time than this one, and moved in to cover my left flank.
        Barry Graylord was the tenor man that night.  Barry had been an all star linebacker for the Harnett High Mad Hornets, and had a baseball tryout pending with the Braves one spring, until he broke his femur in football season his senior year.  His meathook paw on my shoulder was significant reassurance.
        As for me, well, I ll have to admit my first concern was whether or not the boy would dislodge my cataract implant if he hit me in the left eye.  I’d grown up myopic and my only decent sport was golf.  I’d spent my formative years reading books and taking bubble tests, and my physical abilities had been significantly eroded through years of practicing medicine.  My standard position was to never call a vote until certain of the outcome, and in my resentment had rushed to judgment.  I just had to hope the crowd didn’t start chanting,  “Fight, Fight, Fight…”  The logs in the woodstove sizzled.  It was very quiet.
        Darrell edged over and glared at the man, but I waved him off as best I could.  Those hands and fingers were his livelihood, and besides, he had a gig with the Gentlemen at Oakboro that weekend, and I didn’t want to wreck the show.  Simpkins stood by Darrell.  With his two hundred fifty pounds, the scales were starting to look significantly out of balance to the newcomer. 
        I must tell you that new history transpired that night at the Bomb Shelter.  And no, a fight did not break out.  First, let me tell you the Bomb Shelter is a peaceable place.  There are very few absolute rules. It is as laid back as it gets, an atmosphere of hot dogs left over from the V.F.W. cookout, Co-Colas, and Nehi grape drinks.  Other than cigarettes and occasional white liquor whiskey, vices are to be left at home so as not to disturb the picking.  Except for one time two years ago when Wild Bill was placed on six weeks probation after wrecking his wino cycle into the retaining wall, and letting out a string of cuss words in front of Jack’s grand kids, no one has ever been banned. 
        Jack is the law in the Bomb Shelter and he quickly moved in to enforce the house rules. “Son, I’m going to have to ask you to leave.  Dr. Tommy here takes care of most of us, and we don’t allow any disrespect here.  Also, you and your people are no longer welcome in this establishment.”  Jack was always polite, but firm, and besides, the boy was significantly outnumbered.
        He put away his Martin and headed for the door.
        The Moose stopped him before he was gone.  “Boy, that’s a nice Martin you have there.  Do you like it pretty good?”
        “Yeah, it’s a good guitar.  Why do you ask?”
        “Well, if you ever come back here you might as well give it to me, because I’ll break your knuckles and twist your fingers into pretzels, and you’ll never be able to play it again.”  When the Moose got his blood up, it was a scary sight.  I knew Moose well enough to know that he wasn’t serious, but that boy didn’t, and he immediately disappeared never to grace the door again.
        We resumed playing without any further discussion.  I was glad the newcomer wasn’t much of a player, as we wouldn’t miss him as badly as if he’d been a hot picker.
        I was thankful for Moose Dooley and all my buddies, too.  That boy woulda flattened old Doc faster than the King County Rangatang if I’d had to tangle with him alone.

                                                      -Dr. B     

Advertising in Medicine

November 22, 2007

        For the most part, I am against advertising in medicine, and find it a conflict of interest.  Before I get too sanctimonious though, I have to disclose I still have a pair of Tagamet socks from the early days- I know it for a fact ’cause I waxed my car with them last spring.  And too, I must admit one time I used some  samples of a forgotten topical steroid to clear up my dog’s peculiar dermatitis.  Before I forget, the hemorrhoid cream samples resolved my brother-in- law’s poison ivy quite nicely.  It worked great- if you read the labels it is all the same stuff.

        In recent years, though, the pharmaceutical and insurance industries have taken the hype to a whole new level.  I don’t have any idea what they spend for all those T.V. ads, but I am sure just a minimal percentage of it would sustain our little clinic in perpetuity (without ever bothering to charge our patients anything) if there was some way for us to put all that kind of money in the First County Bank and run the practice off pass book interest.

        As a doc, though, the advertisement thing never seemed the right way to go.  Besides, we hardly needed it.  I had one old fellow who lived till 107 or 109, depending on which of his two birth certificates you believed.  He told everyone he lived that long ’cause of Juicy Fruit chewing gum, young women (gotta admire the guy) and Dr. Tommy Bibey.  Truth was it was from the Good Lord, good genes, and a knack for choosing the right ancestors, but with word of mouth advertising like that, who needs a T.V. ad?

        Before I go get some coffee, I’d better tell you the cup has a drug name on it.  I’m a good Doc, though- the generic equivalent is just as good on this one, and I always write it anyway.

Dr. B

Thanksgiving at the Bomb Shelter

November 22, 2007

        Last night was the annual Thanksgiving jam session at the Bomb Shelter, and the boys were out in force.  My daughter was in from college, so they were on their best behavior.  As she says, when ladies are present the group straightens up a bit- they tend to hold their pinky right when turning up a beer and such as that.  I am certain many folks would question the wisdom of taking a young lady to such an establishment, but she is a straight “A” kid, and I don’t think it hurt her raising any.

        Some of our pickers are more famous than you might think.  For example, Cajun Mark, an affable chain smoker, once wrote a tune that was an early theme song for the Ladies Pro Rodeo circuit.  He did a fine rendition of the “Barbecue Blues” and of course someone called for “Mama’s Got the Know How.” 

        The Moose was away on business, so Darrell took over on the banjo, and I played the mandolin, except for covering the bass while the doghouse man went for a COHIBA cigar smoke break.

        I hadn’t seen Hudley Regan in a while, but he was off tour with his gospel band, and did much of the lead singing and the flat pick guitar.  Hud sings one called “The Boar Hawg Twist,” a crazy saga about being a hog farmer. 

       It reminded me of a favorite old patient who used to invite me to go hunt wild pigs with him.  The fellow had a terrible end-stage ischemic cardiomyopathy, (bluegrass translation: his heart had done gone bad from hardening of the arteries and it was too far gone to operate) so I declined- I was afraid he’d drop over eight miles from the blacktop and I wasn’t stout enough to drag him out of the woods- but I sorta wish I had gone once before he died.  I’ll bet it was quite an adventure.

        Someone requested “Your Love is Like a Flower.” It is an old Flatt and Scruggs number, a standard everyone has done for years, and we accommodated.  We used to have a cassette tape of the tune in the newborn nursery at the hospital, and I always played it when I was doing circumcisions, but I got to worrying it might turn those little fellows against our music, so I quit when we got a new administrator who was a touch more formal.

       That is entirely another topic, but I know one Doc who believed that circumcisions were a cultural phenomenon, and not a medical procedure.  He was so resolute in his conviction that he refused to accept payment, except for a bottle of wine.  He was a bluegrass guy, too.

         Wild Bill, so named for his appearance akin to a wild animal (the boys once finagled him onto the cover of an unsuspecting “Pet Care” magazine) was there in his usual seat by the wood-stove.  “BlackJack” was played at warp speed, and at the end of the tune Bill took a last sip off his shine, wiped his scraggly ‘stache with his shirt sleeve, and then  hollered for us to “Play something peppy!”  I think the slow ones make him cry.  More on Bill down the road.

        It was a good jam session.  I didn’t tell anyone that folks were reading about them- I was afraid it would make them self conscious- but I’m sure if they knew they would say to have a fine Thanksgiving, and would invite you to come next week. 

                                             -Dr. B

The Bomb Shelter- A Bluegrass Hangout

November 19, 2007

        The Bomb Shelter (pronounced “Bum Shelter”) is an authentic pre-war (cold war) fallout shelter converted into an Eastern N.C. bluegrass hangout.  It is frequented by the famous, the infamous, and the unknown.  The jam sessions are most often good amateurs, with the occasional professional drifting through town in between gigs. 

        Once some folks were here from England to attend a very famous East Coast eclectic and bluegrass festival in Western N.C.  After jamming with them, I invited them to the Bomb Shelter, and I believe they enjoyed it more than the festival proper.  It didn’t hurt that Charlie Waller and the Country Gentlemen were in that night.  It was a couple of years before Charlie’s death, but the man had the clearest voice right up till the end.  What a singer.

        I’ve been asked many times how you get to the Bomb Shelter, and the answer is you can’t get there from here.  If you do stumble upon it though, you have to sign your name to the wall, play a few tunes, and swear to secrecy.   

        There will be much to follow re: Bomb Shelter jam sessions.  See you there one night.

 Dr. B

Thanksgiving- Mama’s Got The Know How

November 19, 2007

        I know it’s Thanksgiving week before I even get out of bed.  The wife has got the persimmon pudding and pumpkin pie simmering, and the unmistakable aroma has wafted up the stairs.  I didn’t even need to look at the calender.  An old Cajun song we used to do at the Bomb Shelter (that’s another story) called “Mama’s Got the Know How” comes to mind. 

        I sure am thankful for my wife, ’cause all I know how to do is write prescriptions and play the mandolin.  She’s got everything else figured out, and can play the bass and sing, too.

        Now that persimmon pudding is the best- if I can just figure out how to con my boy out of the corner piece this year….

                                                 -Dr. B

Doc Goes to the Courthouse

November 18, 2007

    “Dr. Bibey Goes To The Courthouse”

        For two days last year, I was on jury duty, and I thought folks might get some insight by hearing of my experience.  And no, I wasn’t in any trouble or a malpractice case- it was a jury selection for a criminal case. I ended up being released because the defense deemed my background and life experience as a physician might be prejudicial in this particular case, at least that was my interpretation.  We are supposed to be confidential about it, but the event was a year ago, and I fictionalized the experience anyway, so I can recap my thoughts without fear.  Here’s how my two days as a potential juror went.
         On Monday afternoon we went and watched a movie about the court system and filled out some paperwork.  My County is small town, U.S.A., and I knew almost everyone there.  I sat down beside the only dude I didn’t recognize, and it turns out he was an ex-con and convicted felon.  (Like me, he ended up being released, but for different reasons.)
        We put our hands on the Bible to swear in- me and the cocaine guy were together- and after a few hours we were released for the day and told to come back at 9:00am Tuesday.  I went to the office and somehow the first patient I saw knew all the details, even down to knowing I was to go back at 9:00am the next morning!
        The next morning we filled out some more paperwork, and were told we could go to the bathroom, but to be back in ten minutes.  Ten minutes turned into a hour.  I did not take anything to read.  Because of this error, I had to watch an infomercial for Victoria Principle’s skin care line.  That was bad enough, but the next program was a weight-loss/dance gig commercial pitch, and after five minutes of that I got up and told everyone that I was sorry, but I couldn’t take another minute of “Hip Hop Abs,” and had to stretch.  Half of the potential jurors were my patients and most of the rest of them knew me through music and asked the lady in charge if it was O.K. for me to bring my mandolin.
        When we went to jury selection, some of the  lawyers laughed at a couple of my answers.  I still can’t figure out why all these legal people find me so humorous, but it invariably happens every time.  One time I was in a deposition about a car wreck, and the attorney stopped dead in his tracks and said he felt like he was interviewing a medical Mark Twain, and hadn’t had so much fun in years.  I need to figure out why I am so amusing to all these legal guys before one of these things turns serious. 
        Of course, I knew of all the attorneys, clerks, recorders, bailiffs etc, etc, and perhaps I was excused on those grounds.  Those of us not selected went back to the jury room, and waited again. 
        Finally the lady in charge (I’m not positive of her title) came into the room and told us before we left she wanted the other potential jurors to know that I was Dr. Tommy Bibey, and was a fine doctor and the best musician in the County, (I’m glad she wasn’t under oath- far from true there- well I’m an O.K. Doc, but not worth two cents as a professional musician) and they needed to come out and hear me play!
        Then the three folks I wasn’t sure I knew came up to me and wondered if I would be their Doctor, and as did the ex-con, who now considered me his friend!  Dang-est thing I ever saw, and I wondered if somehow this was related to them worrying I might just say whatever came to mind- a dangerous thing for a man under oath.  I guess all that  had some bearing on why they didn’t keep me that day.
        All told, it was a peculiar foray into a world I had no bearings in, and I was glad to get back to the office and see some sick people.
        I went home and thought about it and figured I better be the best Doc I can, ’cause I had the strange revelation that here in the County I’m not sure I wanted to go over to the Courthouse for anything more than a look-see.
        After all that, I was glad I was in no trouble, and as Walter Hagen would say, decided to go home and smell the roses.

 Dr. B