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The solid thud of a Cadillac’s door slamming shut awakened Richard. He heard his dad yell to the driver as he sped off, “See you tomorrow, Skinny Flint, don’t be late. Tomorrow is payday and we don’t want to be docked any beer money.”
As he lay on the bed trying to rouse himself from post-nap lethargy, Richard wondered how the evening would go before he left for the train station. He hoped there wouldn’t be any real squabbles among the cast of characters in the family. It was getting near the weekend, so his dad might be in a reasonably good mood, knowing that he was headed to the beer joint the next night. His Mom would make a good last supper, too. He was sure it would be one of his favorites—certainly not Spam. She’d be home soon to talk over the day’s events before she got changed from her work clothes and started her home duties. It was almost like she had two jobs, but she never complained. Tonight, she had to stay up late to take them to the train station. Dad wouldn’t do it. He’d rather watch TV than deal with his mother-in-law. They hated each other.
“Richard, run up to Guy’s and get me a can of Key Snuff,” was his father’s greeting when Richard approached him in the kitchen as he set down his lunch pail. It wasn’t a request, but a demand. His father placed twenty-five cents in Richard’s palm—not even an extra ten cents for a bottle of Coke and two licorice on the two-cent deposit. Beer and snuff seemed to be about the only things that mattered to his old man. But a trip to the drugstore was OK, especially when Richard might run across some of his neighborhood buddies. Besides, he still had a dime in his pocket that was aching to be spent for a cold Coke. He was thirsty from his nap, sweating buckets in his hot bedroom with the afternoon sun peeking through the slats of the blinds.
“What if they don’t have Key like last time?” asked Richard.
“Ah, Judas Priest, get me Copenhagen then, and tell old man Guy to order up some Key. He knows that’s my brand. Don’t be hangin’ around the fire station either. I’m about out of snuff, and those lazy, sonsabitchin’ firemen don’t need to be entertaining some kid doin’ an errand for his father. You can play outside after you get back. I woulda had your useless brother do it, but as usual, he’s nowhere in sight. He probably thinks he’s too old to do this stuff for me now. He’d rather get in trouble than help me out. If ya take Clipper with ya, make sure ya keep him on the leash. I don’t want anything to happen to the dog. He’s the only loyal one in the family.”
“Yeh, Dad,” Richard responded as he took the money and went out the screen door, not letting it slam. He didn’t want to aggravate his dad. He thought his dad probably liked animals more than people, especially the family dog. He liked the dog better than he liked his sons, but, then, Richard guessed he probably liked Clipper better than his old man, too.
The dog certainly seemed happy to go on the errand. He already had found his leash and was holding it in his mouth, expecting to go.
It seemed that nothing Richard or his brother did pleased his father. It wasn’t as if they didn’t get into trouble, especially Robert, but they never did really bad stuff. Robert just seemed to take the verbal abuse as a matter of fact.
When Richard complained to him about it, Robert just said that’s the way most fathers in the neighborhood treated their kids.

“I bet it’s hard bein’ married sometimes—kind of stuck with the same person. Most people probably change too. I can’t see why my mother married my dad, for instance,” Richard said, getting to the point rather bluntly.
“Oh, I can. Why, ya wouldn’t be here yourself if she hadn’t! And that woulda been a cryin’ shame, don’t ya see. I wouldn’t be havin’ this grand conversation with ya otherwise.”
Bud paused to reflect, then continued.
“Ya woulda really liked your dad back then. I was just a kid about your age when my older sister started datin’ him. He was quite a dandy. He’d come over from St. Paul in his Model T all shined up to pick up your mom for the dances down in Dannebrog or wherever they had a good band playin’. I think he caught your mother’s eye ‘cause he was such a good dancer—she always liked the ones that could dance a lick. Anyway, he’d always come a little early to talk to me about farming like he knew that was what God intended us to be. He’d always give me a candy bar or something sweet. We both had a sweet tooth too. We’d go out on the dirt roads around the home place talking about the crops and livestock—how much he loved his horses he drove plowing before we all had tractors. Real farming stuff. Heck, he let me drive most of the time—somethin’ my mother wouldn’t let me do. I looked up to him, then, like a big brother I never had.”
“What do ya think made him into the man I got to deal with?” Richard asked, surprised at his uncle’s description of his father as a young man.
“That’s a tough one. Don’t know as anyone can tell ya why people change, but sometimes they just do. He always was into usin’ alcohol to have a good time when he was young. I think it’s finally catchin’ up with him now. It’s kinda like the egg before the chicken or the chicken before the egg in my way of thinkin’. Did the alcohol change him, or did he change first and just gets liquored up to forget about his disappointments in life? Like I said, he was a born farmer like me. When he and my sister were just startin’ out, tryin’ to make a go of it farming with his parents, they couldn’t make it because the bad years come. The dust storms just kinda blew them off the farm and into the city.”
Bud paused a moment, then continued. “Them was some hard times, let me tell ya—watchin’ your corn crop wither away in the drought in a couple of days—the dust in everything in the house even if ya tried to put wet cloths on all the cracks in the house and the doors. I think it took away all his hopes and dreams. When a man don’t have that, he gives up on the good things in life and gets bitter sometimes.”
“It doesn’t give anyone an excuse to be mean, though,” Richard said.
“You’re right about that, Richard. Don’t give no man an excuse to be mean to his family just ‘cause he had a few hard knocks in his life. Think there was other problems too, though. Still no reason to be the way he is. Just got wore down. He almost died when he was in the Marines from a dental abscess. Think he had a ruptured appendix once that almost got him too. Now, how often does that happen?”
“Still no excuse,” Richard said flatly.
“You’re a hard case yourself,” Bud observed, seemingly more sympathetic to his father than Richard.
“I suppose next you’re gonna tell me that havin’ to work in a crummy factory with a bunch of morons is another excuse,” Richard interjected before his uncle could get to that one.
“As a matter of fact, yeh, I think that’s another reason. You’re the one askin’ why. I’m just tellin’ ya some things. You can take ‘em or leave ’em. I never worked in no factory myself, but I toured one of those tractor works in Illinois once right across the Mississippi River from you in Iowa. It just seemed like the men lost some of their dignity in those places, especially if they was used to bein’ their own boss on the farm. That grinds ya down, ya know—but maybe ya don’t. And I hope ya don’t have to learn some day.”

Richard and Ganny crossed the gravel street that separated Ganny’s semi-treed property from Uncle Jack’s acreage, which consisted primarily of a large garden surrounding a stately, two-story house. At times obscured by the extended runners of the tomato, watermelon, and pumpkin plants, a well-worn dirt path meandered through the rows of crops and over dams bridging the irrigation ditches. It reminded Richard of Bud’s cornfields on a small scale. It could be manipulated easily with a few shovels of earth strategically placed here or there. Being a city boy, he didn’t know what many of the plants were, but he certainly recognized the tomatoes in various stages of ripening and the melons nearing maturity.
Even though he was a city boy, Richard could appreciate the value of this fine, well-managed garden plot. He bet that his other grandma would have been envious, although she would never admit it. But then, she had to put up with a bunch of hooligans tramping around in her garden looking for foul balls from the whiffle-ball games.
“Some garden, huh, boy,” Ganny commented to herself as much to Richard.
“I’ll say. Uncle Jack must spend a lot of time out here takin’ care of his crops.”
“Yeh, he does. Gots lots of patience and a farmer’s touch. Not like me. I’d be out here robbin’ the patch all the time instead of tendin’ to the growin’ like ya should. It’s good therapy for him though, since he couldn’t manage the runnin’ of the farm no more with his condition and all. This is just the right size for him. He ain’t no people-person. Never was, but since the war, he’d just as soon be by himself out in the field all day. Don’t have to deal with anyone. It’s even worse now with the nerve damage he got in the Great War when he got gassed. Now he shakes so bad that he’s got to hold his coffee cup with both hands just to get it to his mouth. Then he still spills some on himself and the floor. He’s gotten so self-conscious about bein’ around anyone when he eats that he won’t go out anymore where there’s any eatin’ to be done. Shame, really, to cut himself off so much from the world.”
Hearing all this, Richard wondered whether it was such a good idea to meet him.
“Do ya think it’s all right for me to bother him? Maybe he won’t want to see me, since I never met him before.”
“Aw, shucks, he’s been lookin’ forward to your visit as much as me. He’s heard so much about ya and what a good kid y’are. Besides, it’s adults he don’t like much. He hates ‘em lookin’ at him when he shakes. Thinks they’re makin’ fun of him. And I know you won’t be starin’ at him or makin’ fun of him. You got a lot of respect for your elders. I can tell your mom taught ya that, and I hope maybe your dad had somethin’ to do with it too.”
“Well, I’d only think it was the right thing to do considerin’ him bein’ a war hero and all. What exactly happened to him to get so messed up? Did he kill lots of Germans?”
“Don’t know about the Germans. Think he was so sick of the war when he come home, there wasn’t much to tell. He once told me that a man shouldn’t be proud of killing another livin’ bein’. He couldn’t even bleed out a hog when he finally recovered after the war and got back to farmin’. Said it reminded him too much of the fightin’ in the Ardennes where he got machine-gunned by the Germans. He only told me once about it right after he got shipped home from the hospital. Guess it was always like a nightmare relivin’ it anytime he thought about it, let alone talkin’ about it.”
“Where was he shot?” Richard wanted to get the details. He never knew anyone who got shot.
“Got shot in the legs, the right one real bad. Shattered his thigh bone. They wanted to take it off when he finally got to the hospital from the Front, but he wouldn’t let ‘em. Said he would die from gangrene, ‘specially after layin’ in a muddy bomb crater with a dead German for two days in between the lines gettin’ mustard-gassed to boot. He told him he’d just as soon die if he didn’t have his leg for farmin’. I didn’t mention how stubborn he can be too. I guess they just had him lay in the bed for months until it healed finally. He told me once that bone splinters still poke through his skin on occasion. Anyway, he’s still alive and kickin’, but he’s got a bad limp instead of a peg leg. His tremor from the gassin’ is gettin’ worse as he gets older. Don’t think he’ll stop shakin’ ‘till they lay him down.”

With equally solid strokes, Ganny cut slices and placed them on the plates. The watermelon was indeed a beauty. Reddish liquid seeped from its almost auburn innards, quickly filling the plate’s surface. Some of it splashed out on the ground as they hurried outside to some old patio chairs on the rough lawn. Richard noticed that they were the same kind that his other grandmother made him sand down and paint each year back home. Ganny’s, he had to admit, didn’t fare so well. The metal chairs were dotted with chips of various colors that revealed the previous paint jobs.
Once in the chairs, they commenced to attack the watermelon. Richard was used to eating watermelon with a fork at a table, but he followed his grandmother’s lead by biting off a chunk, chewing the sweet meat carefully to avoid the seeds, swallowing the juices, and spitting out the seeds until he got to the rind.
“This’s gotta be the best watermelon I ever had,” Richard announced in between bites and spits.
“Didn’t I tell ya that your Uncle Jack is one champion melon grower?”
“Ya did, for sure, Ganny.”
“Well, I wasn’t just whistlin’ Dixie, I meant it. Now, if we’re braggin’ about knowin’ champions when it comes to watermelons—your ol’ Ganny was a champion too at spittin’ seeds. When I was about your age, I was the champion watermelon seed spitter of the Howard County Fair. Bet I can still put one of ‘em out there better than you can, Richey.”
That was a challenge that Richard couldn’t refuse even if it was from his grandmother.
“Bet ya can’t,” he replied. With that answer, he took a bite out of the next slice, searched with his tongue for a good specimen, swallowed the rest, and readied his mouth for a mighty attempt. Using the springy chair as a catapult, he reared back initially, then lurched forward while spitting out the seed into the Nebraska air. It was a good effort that landed on the grass about thirty feet away.
“Beat that, Ganny,” Richard said, his youthful dander challenged by an old woman, even if it was his grandma.
“Well, I gotta admit that I reckon that was one good effort, and I don’t know if I can match it, bein’ kinda old and outta practice and all, but let me give a shot.”
She took her bite of watermelon, searched for just the right seed with her tongue, swallowed the rest, and readied her mouth for the attempt.
With the experience of a professional watermelon seed spitter, she launched the seed with a fluid motion of her upper body, neck, and head. The seed flew into the air and landed fifty feet away.
“Wow, Ganny, you are a champion seed spitter!” Richard exclaimed, duly amazed by his grandmother’s effort.
“Just goes t’ show ya—don’t ever underestimate your competition.”
“You’re right about that,” Richard answered humbly.
“Me and watermelon seeds go way back. Ya know, it’s good to get humbled now and then. Just when ya think you’re all special and all, somebody comes around to put your feet back on the ground. Keeps your mind in the right place so ya don’t get all big-headed. There’s always somebody smarter or faster or whatever than you are. Don’t forget it. Appreciate what ya got, but don’t forget where ya come from is what I say. Somebody will knock ya down eventually off your high-horse. Just like Grover Cleveland.” She paused, not wishing to go further with her thoughts, and hoping that her grandson did not pick up on the finale.
Fortunately, Richard was still enthralled with the seed-spitting demonstration. He had not yet developed insight into the nuances of adult thought. His was still the world of today, never imagining that older people had a life filled with passions of their own.
Instead of acting joyful about her victory, Ganny was suddenly sorrowful, fighting back tears and sniffling as quietly as she could to hide her change of mood from Richard.
The awkward silence made Richard uncomfortable.
Finally, she said, “Richey, it’s nothin’ you did. The seed spittin’ just seemed t’ bring up old times and what coulda been. Turned out OK in the end, though. Otherwise I wouldn’t have you sittin’ next to me so I could out-spit ya.”
“Guess it must be about time t’ go inside. The mosquitoes are startin’ t’ bite,” Richard said, giving his grandmother a chance to gather her thoughts. Even though he was perplexed by the change in her, he perceived that it was best to move on with the evening and not pursue her emotions.
“Sun is settin’. Another day is gone. Time for this old farmer’s wife t’ hit the hay.”
“Me too. It was a big day. Sure enjoyed it, though. About the best day of my life, even if I lost the seed-spittin’ contest. Met two great men and got t’ spend the evening with the best grandma in the world.”
Now Ganny’s tears really started to flow. She turned toward her grandson and hugged him the best she could considering the instability of the chairs and the plates in their laps.
“Richey, that was worth more t’ me than you or anybody will ever realize. It pays to stick to your principles, ‘cause you’re always rewarded in the end. You’re my reward. Let’s clean up those dishes and get to bed.”
Richard carried the plates to the sink. Ganny only commented on the specifics as she washed the plates and Richard dried them. What was unsaid didn’t matter. Ganny’s other life was hers, and she didn’t need to explain it to anyone, including her grandson, who didn’t need to know. She could live what could have been over and over in her mind until she died. It would be safe in the grave. She was just glad for what she had.
After finishing the clean-up and quick trips to the outhouse, they slipped off to their respective bedrooms. Richard heard little of the chorus of the insects as he slipped off to his dreams of baseball heroics, a sheet loosely covering him to the level of his underpants. Despite her fatigue, Ganny lay restlessly in her nightgown thinking of what could and couldn’t have been un

“Doc, do ya think I can race the downhill in four days?… it may be my last chance to win the world championship,” the gnarly mountainbiker asked as he limped into my makeshift medical clinic and plopped down on my examination and operating table, a rickety single bed in a Spartan hotel room in Sierra Nevada, Spain where The 2000 World Mountainbike Championship was being held. Through my connections with USA Cycling and being a volunteer physician at the Olympic Training Center while having been a competitor myself in World Championship in past appearances as a member of the USA Masters Mountainbike Team, I had been selected as the team physician for the USA Moutainbike Team. Ready for business, I had just arrived to the mountainous ski area above Grenada and had just finished setting up my mini MASH unit with medical supplies from my golf traveling case sans golf clubs.
Giving him what I called my ER five second visual biopsy, my initial medical intuition was to get a sense of what and where his problem was, how bad was it, potential prognosis, and not so much about his character, but what kind of character he was. My response to his question was, “let’s take a look” although glancing at his swollen, red, inflamed knee, twice the size of his normal one, his competing was doubtful. He certainly looked the part of being an aging professional downhiller with long scraggly hair, a lined, rugged face, beefy muscular build, and grungy clothes. Nevertheless, despite his obvious pain, he had a warm, cocky smile exuding the laidback friendliness of a Western Slope Colorado mountainbiker who he was. Being a cross country mountainbike racer, I never had the nerve, skill, or death wish to downhill race. My family and friends thought I was pretty crazy to do what I did considering how rough and technical most of the cross country courses had become, often crashing and usually having a few healing dings on my body. But, the downhillers were a different breed, dressed more like gladiators than cyclists, they rode their mountainbikes over and through obstacles, drop-offs, and radical terrain that required as much skill as madness. Although our competitive careers had never crossed, his being a pro downhiller and my being a cross country amateur, I recognized his name as he had been one of the top male USA downhillers for several years.
Before I “laid hands on,” I asked him about the past and recent injuries he’s had. He chuckled, “too many to count, doc, tore it up bad several times. The last one was a year ago in Slovenia when I crashed and had a big dirty cut over my knee cap. I went to a crummy medical clinic where a nasty, grumpy doc cleaned it out without numbing it up and just stitched me up. It healed up ok, but over the past week it started getting red and swollen under the scar. Now, it hurts to bend my knee, and it looks like I got a big pimple in there about ready to burst.”
Actually, I thought that was a good history, and it addressed a lot of my concerns about the seriousness of the problem. First, I took his pulse, blood pressure, and temperature, vital sign clues to whether the suspected infection had extended into him systemically. His pulse was normal, not fast. His blood pressure was normal, not low. His temperature was normal, not high. They were all good signs that the infection had not affected him beyond his knee into his general circulation.
Next, I asked him to lay back on the bed to take a good look at his knee. I pulled up the lower edge of his droopy shorts to fully expose his knee and upper leg. I noted that there was around a 4 inch diameter of raised red swelling, erythema, over his knee cap, patella, with a tented 3 inch scar running across it. It looked like the swelling and redness was confined to the front of the kneecap, prepatellar, without evidence of its extension into the joint space behind it indicating fluid, an effusion, inside the joint, which would be an ominous finding. Nor, did he have evidence of “blood poisoning,” lymphangitis, with streaks of redness extending up his leg from his knee. If he had indications of either of these complications, my next step would have been to contact a hospital in Grenada to ready transport as soon as possible. Fortunately, he didn’t, so I proceeded with the exam to verify my initial assessment that the infection was localized outside the joint and was not extending into the rest of his body.
I put on exam gloves and lightly palpated his knee starting to the sides and back first, not wanting to influence my exam by stirring up the actual problem. He had no real discomfort doing that until I palpated the anterior of the knee which felt soft and doughy, fluctuant, indicating that there was most likely a collection of pus inside his giant pimple being an abscess. Just to confirm my judgment, I did a limited exam of his knee’s range of motion and stability of its ligaments. His range of motion was slightly limited on knee flexion due to the abscess’s overlying skin being stretched. However, if he had a real infected joint effusion, he wouldn’t have allowed me to barely bend it. What did surprise me was the laxity of his knee ligaments from all his crashes when I checked them making me wonder how he competed at all. But, that wasn’t the problem today although I feared it would become major issues for him a few years down the line.
My conclusion was much more optimistic than when I first saw him hobble into my clinic. It looked like he had an abscess outside the knee joint above the patella with no signs of systemic involvement probably from some retained small foreign body from his accident a year ago. It would require me to do an incision and drainage to drain the pus out. Whatever foreign body was still in there had to be small not to cause any problems for over a year, and I wondered whether I could identify it if it flowed out with the pus. Even so, he wasn’t out of the woods yet in being able to compete, especially at full capacity.
I explained it all to him, and he readily agreed to go under the knife. Fortunately, I had brought a few disposable suture sets with instruments, drapes, syringes, and lidocaine. I also had disposable scalpels. I cleansed and gently prepped his knee with betadine. And as I had done so many times in the ER when a nurse wasn’t available to assist, I used as much sterile technique as possible to open the suture kit, plop the knife blade on it, and put on my sterile gloves. Then, I draped his knee, drew up the lidocaine, and injected his knee over where I planned to make my incision. I gave it a few minutes to anesthetize the area as best I could considering that it is difficult at times to do with a large abscess when they need to be probed. I made the incision, and as with most abscess’s needing draining, the stinky, yellowish pus poured out under pressure spilling out over the drapes. Fortunately, for me, as sometimes happens, the pus didn’t squirt out landing on me. The incision was extending wide enough that I could open up the abscess to irrigate out any retained pus as well for me to peek inside for a foreign body. Sure enough, a tied black silk suture, no longer tied to anything, caught my attention, and I removed with my hemostat.
I left the wound open, squirted antibiotic ointment in it, and dressed it loosely. I didn’t tell him my concerns about how the wound was originally handled as I was not there. I probably wouldn’t have put in an interior suture, especially a non dissolvable silk suture, in a contaminated dirty wound. Fortunately, the wound didn’t get infected initially because of it, but most likely his body eventually identified the silk suture as a foreign body, thus, the delayed inflammatory response a year later. I might not even have put any sutures exteriorly if it was really dirty leaving it open to allow drainage, letting the wound heal by secondary intent from the bottom to top, not caring about scarring. In any case, that was how I was planning to manage him, now. I made it clear that he was not to practice, and he needed to keep his leg elevated. He was to have daily wound checks and dressing changes with me. I would decide when he could practice or compete. I gave him antibiotics from my supplies to take as well. He left thankful and optimistic with a firm handshake and good ol’ boy smile. I sighed with relief that the situation was manageable, glad that he had a better chance to race than I originally assumed.
I saw a couple of other cyclists after that, nothing serious, mainly questions about chronic injuries, medications, and physical preparation for competing. One got a B12 shot in a hardened butt that had had too many. Maybe not so necessary, but part of her major pre race routine affecting her confidence. Another pro cross country racer wanted to have a pre race liter of IV fluid as he was concerned about his ability to hydrate enough during the expected hot, dry race.
My wife and I had dinner with the team, and I was introduced to them. We sat with several of them and had surprisingly deep discussions. Their cocky exterior seemed to dissolve. Despite being at the top of their racing profession, many of them seemed emotionally vulnerable, deeply concerned about their performance and sponsorship which was tied to the continued ability to compete. Like all professions they had their worries, too, especially considering how fleeting, injury prone, and financially insecure theirs were.
About three am the next morning I was awakened by my room phone ringing. Still half asleep, I had difficulty understanding the anxious caller with a strong Australian accent. After asking him to repeat what he said more slowly, I learned that he was the head coach for the Australian Mountainbike Team, which was staying in the same hotel a floor above us. Their team did not have a physician with them, and he knew the USA Team did have one. He asked if I would come see one of his junior downhillers who was having a “seizure” as he was jerking, but awake and talking. It didn’t sound like a grand mal seizure which was reassuring, but it sounded serious. I quickly got dressed and rushed upstairs.
I was met at the top of the stairs by the frazzled coach who escorted me quickly down the hallway to the downhiller’s room. Walking into the room, there were four occupied beds with young, barely awake, tough looking Aussie kids. It wasn’t difficult to pick out the one who was having the “seizure” as he lay clutching a blanket to his neck, his exposed hands shaking on top of it, and his body writhing underneath it. His distressed eyes were widely open below his taunt forehead which was beaded with sweat forming rivulets at his temples soaking his hair and pillow as it descended. Indeed, he was having a seizure of sorts. It wasn’t the seizure of epilepsy, his was the rigor of sepsis, his body’s chills and fever response to infection. I took a thermometer from my medical bag and put it in his mouth as I quickly assessed him. It wasn’t difficult to find the source of his infection as I looked at his left lateral thigh where he had an inflamed, swollen, raised reddened four by eight inch abrasion which still had a few specks of dark particles deeply imbedded in it. His temperature was 103 F. This kid was really sick and septic. With a shaky voice and even thicker Aussie accent, he told me that he had fallen in a practice downhill run in training two days ago. He had cleansed the wound the best he could in the shower when he got back to his room. Their team trainer had put antibiotic ointment on it and a big dressing. He had practiced yesterday without much difficulty until late in the afternoon when the leg started to ache more, and he started feeling weak.
The diagnosis was obvious, sepsis from an infected wound. His heart rate was fast, tachycardic. His blood pressure was normal. Technically, he wasn’t in septic shock, but on his way. I explained to the coach and young man how serious this was, wanting to call an ambulance to get him transported to a hospital to get IV antibiotics as soon as possible. The problem was that we were on top of a mountain around thirty miles from the nearest hospital down a circuitous road to Grenada. Despite my dire diagnosis and “life and death” concerns, neither the coach or the young patient would agree to the immediate transport. They were hard headed Aussies after all, and I couldn’t convince them. Ethically, they were my responsibility, but not realistically, they were out of my control. So, I made a deal with them compromising my medical judgment for the greater good in taking care of the patient the best I could under the difficult circumstances.
When I looked at him more carefully, I noticed that he had a fine red rash over his body which I initially thought was flushing related to his fever and sweating. Putting the information together, I thought most likely he had a strep or staph infection. Fortunately, I had brought the appropriate antibiotic, Augmentin, for it, and he was not allergic to penicillin. I loaded him up on it before I anesthesized the wound with lidocaine. Then, I scrubbed the wound vigorously with betadine, and I removed all the dirt particles from it. I smeared it with antibiotic ointment and covered it with a nonadhering dressing. I encouraged him to drink lots of fluids and gave him a few Tylenol tablets for pain and fever.
Sleep did not come easily when I returned to bed being charged up by the interaction and worried about whether I was doing the right thing. Boy, I hadn’t expected so much business the first day, and I wondered what was in store for me the rest of the week. I got up late the next morning and related my medical experiences with the USA coach over breakfast. He was really thankful that I had brought all my supplies and equipment. So was I. I, then, went to the Aussie’s room to see how he was doing even though it had been only around six hours since I saw him.
The downhiller was sitting on the side of the bed munching on an energy bar and drinking electrolyte fluid while dressing in his biking clothes preparing to go out for a practice run. He was a tough, hard core, bullet proof kid with an Aussie attitude, for sure. Despite being elated to see him upright and alive, I wasn’t real happy about him being so irresponsible. He told me that his race was in two days, and he needed to practice. I found the coach and told him about my concerns. This time, I got the coach to nix the practice that day, but I agreed to allow the downhiller to practice the next day if he was recovering. I was surprised that his skin had already cleared, and the wound looked much better as well. Hurrah for the good doctor, modern medicine, and the resilience of youth!
Not so upset with the downhiller, I was more relieved that he had effervesced and seemed remarkably improved within so view hours as I went from there to my MASH clinic to meet with the other problem child. At least, when he wandered in later than the appointed hour, he wasn’t dressed to go to practice. Wow, he wasn’t a gangsta downhiller after all and took on some personal responsibility. His wound looked markedly improved as well with no more drainage with resolving swelling and inflammation. He wanted to know whether he could do a practice run later in the day. Considering he had no systemic involvement and the wound was well protected, I thought it would be ok. No more business, I took the afternoon off and rode the cross country course which had only a couple of technical sections that I walked not having a great mountainbike with me. Besides, I didn’t want to become my own patient.
Fortunately, there wasn’t much going on medically the next couple of days. Both downhillers were much improved the next day, and I allowed full participation for both. It didn’t matter, anyway, I couldn’t have stopped them. Before the pro men’s cross country race, I gave the requested liter of IV fluid to the racer after making sure it was ok with the coaches and legal for the regulations. After all, it wasn’t really illegal blood doping by improving the red blood count which had been done in the past. It didn’t seem to have much effect as the racer had a poor performance. I took one competitor to a local clinic for an x-ray for a wrist injury. It looked like a sprain to me with minimal swelling and tenderness, but sometimes wrist injuries can be tricky such as with navicular bone fractures, and these athletes lived by their hands on handlebars. The doctor at the clinic wanted to look at my patient’s wrist before ordering the x-ray. Fair enough, it was her x-ray, and I hadn’t been able to pack one in my golf bag. She didn’t think an x-ray was necessary making the arrogant comment that Americans order too many x-rays when they aren’t necessary. I cajoled her to get one, not having to get on my knees to plead my case. Of course, by my or her reading it was negative, and, no, a radiologist wasn’t needed to do an over read. The Spanish physician gave me a smirky smile as if to tell me, “ I told you so.” Sometimes, you have to be diplomatic to get what you want and suck in your pride…must be nice to practice medicine in Spain without malpractice lawyers. The patient didn’t have any snuffbox tenderness making me concerned about an occult navicular fracture which often does not show up until it starts to heal as it isn’t visible on the initial x-ray. If that had been the case, I would have treated the patient with splinting regardless what the x-ray showed. Considering her arrogance, the Spanish physician probably didn’t even know this.
Both my downhillers’ wounds looked great the next morning. The USA one went to practice, and the Aussie went to race. I didn’t go to his race as I was busy giving IV fluids to the USA cross country pro before his race. My obligation was first to his race. Unfortunately, he finished in the middle of the pack, which was disappointing for both of us. I did see the Aussie coach that evening, and he told me that the junior downhiller got second, which, if nothing else, was a remarkable medical victory as well as a tremendous personal achievement overcoming a potential life threatening illness. I got no further thank you’s from the kid or the coach, not even getting an Aussie team jersey which would have been nice. However, it really didn’t matter so much as I was relieved that it turned out as well as it did, and that was my own personal reward.
Although I was obligated as the team physician to attend the men’s pro downhiller race, I wouldn’t have missed it for the world having connected to my crazy pro downhiller. I stationed myself at the bottom of the downhill near the finish line and the throne chair where the finished racer with the fastest time to that point would sit until he was dethroned by a faster time. It was a raucous and unruly setting with beer flowing and spilling with a crowd barely protected behind a picket fence from the racers as after they blew through the finish line skidded in a cloud of dust to stop within a few feet from crashing into them. Racers had been seeded from the slowest qualifying runs to the fastest, and my guy was one of the last to go. There were several dethronings met with drunken celebration until my guy’s run. The top of the downhill was barely visible as he descended, and the only way to follow his run was by seeing the puffs of dust as he braked in the turns far above and the time splits that were announced at 1000 meter markers. As he descended the clouds of dust became larger, and the split times became better and better. He roared through the finish, skidded to a stop with style, and looked back at the dust obscured time clock. As the dust settled, he jumped with joy that his was the fastest time, and the crowd went nuts with jubilation as he was a character well liked even by the Spanish fans. His bike was quickly dispatched to the side line, and he was marched to his throne. As the last few racers descended, I watched as he sat tensely until the last one finished, unsuccessfully trying to dethrone him. He jumped out of the chair with a fist pump when he realized that he’d finally won. I felt that I’d won too.
He did gracefully thank me the next day despite, I’m sure, having a bad hangover and a serious night of downhiller partying. The Championship over, we left the next day. I rode my bike down the mountain and picked up a rental car in Grenada, drove it back up the mountain, and my wife and I drove to the Portugal Coast for a few days of R and R before flying back to the USA from Lisbon.
The next year, the World Championships were in Vail. I wasn’t the team physician, but I did attend it with one of my Danish cousins. We stayed at the iconic Pepe’s in a nice room, watched the races, and rode some of the trails. One morning, my pro mountainbiker was having breakfast at our hotel, and he recognized me as I sat eating with my cousin. Being the gregarious character he was, he came over to our table, and I introduced him to my cousin telling him that he was meeting a world champion. My Danish relative was impressed. I asked him how he was doing, and he said that the season hadn’t gone well, and he didn’t expect to be able to defend his title. I wasn’t surprised considering how beat up he was from years on the circuit. He didn’t act sorry for himself though, nor did I give him any sympathy. He’d risen to the top which is more than most could say, and I felt pride in my own way that despite the lack of first place medals in medicine, I’d, at least, made the podium.

I knew I was headed for high seas when my new shipmate, a dentist originally from Brooklyn, said, “Ya gotta help me out, here, with my wife, you know, ‘cause I don’t know nothin’ about down there,” demonstrating with the sweep of his hand the pelvic region. Neither does the doc on the ship, so I’m countin’ on you to tell me what to do.” And what I wondered as he related his dilemma on the sleek vessel‘s deck was how I managed to be in the midst of this medical adventure while plying the Caribbean Blue? “Ya Mon, don’t worry, be happy,” was the order of the day for this sailor, not medical consultation. Only this time it was without a local license, valid consent, or malpractice insurance. I wasn’t even sure whether they had these things in “da islands,” and I wasn’t going to ask the dentist’s high-powered, lawyer wife her legal opinion if I had to delve “down below.” My inclination was to swear ignorance of the feminine area rather than my “Oath” to heal. My obligation as a physician to listen and facilitate the situation to a humane end won out. As I braced myself for the gale, I only hoped this Good Samaritan wouldn’t have to “walk the plank” if things didn’t go well.
Windstar Cruises’ brochures described voyages of “casual elegance” on their computerized sailing ships, large enough for all the usual cruise amenities while small enough to languor in exotic, small ports for intriguing adventures on land and sea. Having only one hundred pampered passengers per voyage, the well-appointed ship provided an atmosphere much to my wife’s and my tastes with as much socialization as we desired while avoiding the herding mentality of the behemoths of the sea . Our previous Windstar Cruises to Tahiti, Malaysia, Thailand, Greece, and Turkey had lived up to the billing, especially when we brokered affordable two for one specials which included airfare. Oo, La, La, the times we had, and the places we saw…c’etait tres magnifique! We had made a few casual friendships with other couples on these trips, but nothing as intimate as this one eventually became.
Rather than dining by ourselves, we decided…or should I say my wife, Mary, decided, she, being the nursing administrator enjoying socializing and me, being the aloof clinician preferring solitude at our own table…to spread our best boating cheer to other passengers on the second evening out. It’s not that I didn’t like to mix with other people in these situations. It’s that I found that anonymity was not necessarily a bad thing. As in this case, I usually wind up agreeing with her that having a little dinner party with others can spice up an evening. We sat with three other couples of our era from Southern California, each spinning stories about their various professions and interests. We especially hit it off with an academic dentist and his wife, a high powered feminist lawyer, both, originally from New York City. He recounted even better dental than ER stories that I could muster that evening with his sideline work at the LA Zoo. I mean, how many people extract teeth from lions and tigers and do root canals on elephants and hippopotami using a garden hose for irrigation? “See,” Mary said, while giving me a poke in the ribs on the way back to the cabin, “wasn’t that better than eating by ourselves all the time.” “Yes, Dear,” was, of course, the only answer.
Two days later I got up early to work out at the ship’s fitness center before docking in Martinique. After a good spin on the exercise bike, I cooled off on the forward deck hanging out over the railings, my sweat flying off in macro-drips to the sea as the ship approached the harbor. Transfixed by the azure sea as the waves whooshed under the bow, I didn’t hear the approach of my new, best friend.
“I’ve been lookin’ all over for ya’s,” he said, his Brooklyn accent crushing the moment. “Figured I find ya workin’ on yourself… tryin’ to be some kind of athlete,” he commented as if chastising me for my lack of availability, then, losing his harshness, he pleaded, “ ya gotta help me out, here. My wife’s got a problem down there, ya know,” illustrating the area he was meaning with a wide stroke of his hand pointing to his groin. Don’t know anything about that part of anatomy.”
My immediate thought was that I hoped he knew a little.
I had to admit, besides the medical issues, I did wonder what kind of help he needed “down there” with his wife. I was able to keep a poker face as I inquired to the problem. He explained that his wife had developed swelling and pain the past forty-eight hours over one of “lips,” a good dental term, of her external genitalia. She had seen the ship’s doctor the previous evening, who had given her Tylenol with Codeine and started her on ampicillin. Not feeling comfortable taking care of the problem further, the doctor had also called ahead to a medical clinic in Guadeloupe and had made an appointment for a gynecologist to see her that morning. They would be the first off the ship to take an hour taxi ride to the specialist for definitive treatment.
That sounded better than good to me, but the dentist didn’t seem too happy, grumbling that “ya never know what kind of creeps ya gunna find in these far-flung places in the boonies.” I sort of understood that although I wondered whether that included all the fly-over territory between New York City and Los Angeles for him. It only looked like I was off the hook as I watched her painfully shuffle down the gangplank with her husband’s support to an awaiting taxi on the wharf. She was definitely in trouble.
In contrast, our carefree day was spent living “da Caribbean life” at the beach and shops near the wharf. Back on board the ship in the early afternoon, we lunched royally on the rear deck with a grand view of the Island. A familiar looking taxi rumbled toward our dock and screeched to a halt. The dentist hoisted himself out of one of the rear doors, flung some cash at the driver’s window, stomped around the taxi to the other rear door, and with as much gentleness that he could muster helped his wife out of the car and led her back toward the ship. She looked worse. From my distance, I could not hear the moans that she uttered with each step, but I winced with them anyway. Sweat splashed off his face to his already soaked tropical shirt while his beefy arms supported her upper body as they approached the gangway. Alert crew came to their aid to help her up the gangway and to their cabin. Just before they disappeared from sight into the ship, he peered up and scanned the ship as if looking for someone. When our eyes locked, there was no doubt that it was me.
Not knowing what had transpired, I felt it best not to intervene. My hope was that she was still groggy and waking up to post-procedural pain. I figured that he would approach me if he needed me. Finished with lunch, Mary went below. I stayed put and available. It wasn’t long before he confronted me with “ya really got to do somethin’ down there, now.” Then, he told me their medical experience on shore in beautiful Martinique.
The taxi driver had taken them on a bumpy thirty mile ride to the capitol city where she was to be examined by the Island’s gynecologist. It turned out that he was a rather unkempt general surgeon of uncertain nationality and training. As the doctor examined her, ashes from the burned down cigarette that dangled from his mumbling lips had fallen on her exposed abdomen. “Yeh, and all he does is, just flicks ‘em off her without an apology,” my new best friend adds. “Then, he says that he won’t do any surgery unless she spends the night…like I’m goin’ to let this creep operate on her anyway. So, here we are back to square one, and I’m asking you to help us out.”
“Ok,” I said. “I’ll examine her in your cabin, but I think it would be a good idea to get my nurse wife to assist me.” Mary had gotten me into this mess, and for lots of reasons I thought it would be best to recruit her to be the new nurse on board the ship. If this boat sunk, I wasn’t going down alone. My first mate was going with me. “We’ll be down to your cabin in five minutes,” and I was off to get Mary for our mission.
Ready for action and being the good mate that she is, Mary required minimal encouragement…not even, a pretty please…to come with me. I updated her on their miserable day on the way down to their cabin. Their door swung open before I could finish my knock revealing a very pale, diaphoretic woman in obvious discomfort on their bed. Despite being an awkward situation, I sensed immediately that he was right, I had to do “somethin’.” He told me that she was very dizzy and had a temperature of 101. With as little socialization as was necessary, we got down to business putting on our appropriate caps and exposing the patient. My suspicions were right. Even though she was in her 50’s, she had an orange size, pointing Bartholin’s abscess of the labia, seen more commonly in 20 year old women in the ER. She was septic and needed an immediate incision and drainage.
It took me a few moments to think through the problem and how to resolve it. Here I was on cruise ship pulling out of a Caribbean port headed for another backwater island…who knows? Maybe 3000 miles from where I can legally practice medicine…examining a woman’s pelvis, who also happens to be some hotshot lawyer in LA per the request of her academic, doctor husband, who also happens to be really sick and in need of my Good-Samaritan care since the physician on board does not wish to embrace the issue. I excused myself, found the ship’s doctor in the dining room finishing his nice lunch, and explained to him how the two of us were going to take care of this lady’s illness.
“But, I’ve never I&D’d a Bartholin’s abscess before,” the retired internist protested when I informed him of what he needed to do to make this woman better, or even prevent from dying tragically by his lack of doing “the right thing.” “I’ve given her antibiotics and pain pills that should pull her through until we get to Barbados in three days where they have a real hospital.”
“No,” I commanded. “This is something we can easily do together. I will borrow your wheelchair from your dispensary, bring her to the dispensary, place her on your examination table in stirrups, help you prep and anesthetize her, and assist you with locating the proper place to make your incision to drain the abscess.”
Reluctant, he still had to ask, “are you sure that she can’t wait a few more days?”
Feeling sorry for the old guy, not wanting to be in unfamiliar territory like me, I gave him sympathetic, “no, believe me I don’t want to be in this position either. It’s not that difficult. I’ll show you what to do. And we have no other choice under the circumstances.”
“Ok,” he agreed reluctantly like a chastised urchin. “I’ll meet you in my medical dispensary in ten minutes,” he said trying to regain some of his self-respect.
By ten minutes Mary and I had whisked the patient to the dispensary and were readying her for her procedure. The overbearing dentist backed off and did a good job of being the concerned husband at the head of the table held his wife hand, looked at her affectionately, and spoke to her softly and reassuringly. The cruise physician arrived looking about as pale as the patient, but in control. I sat him down on the stool between her legs and handed him a syringe filled with lidocaine. I pointed to the spot where her prepped labia appeared to be most tented and suggested anesthetizing that area. His gloved hands trembled so badly that I took the syringe and slowly injected it myself. I gave it a few minutes to numb up. Then, I handed him the scalpel. His hand wavered back and forth several inches as he tried in vain to control his body by focusing his mind on the target. I could see that it wasn’t going to happen. I took his clenched hand holding the scalpel in mine, and we stabbed the abscess in just the right place. Under tremendous pressure, pus shot out of the wound giving her some immediate pain relief.