Hopper and the Trains

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Lionel Hopper is famous.

According to him anyway.

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When I first entered the exam room, I was greeted by the musty, unmistakable smell of abandoned hygiene. On the exam table sat a new patient named Hopper. He was the doppelganger of Doc on Back to the Future, except Hopper's carefree hair wasn't white, but the color of a faded tangerine and he had thick sideburns flanking a face that looked like it housed a lot of stories.

Hopper got straight to the point. He wanted Dilaudid, a narcotic pain medicine for his back pain of 30 years.

Our conversation went a little something like this:

Me: It is our policy that we do not prescribe narcotics for long-term pain.

Hopper: So what am I supposed to do?

Me: What have you been doing?

Hopper: Drinking beer.

Me: How much beer you drinking?

Hopper: Sometimes 1 or 2 beers a day, or sometimes 20-30 cases of beer a day.

Me: 20 or 30 CASES?? (placing huge emphasis on the word cases)

Hopper: You bet....whatever it takes. I've been all over and can't get a doctor to give me some of that medicine.

Me: You've been all over this city?

Hopper: All over this country. I'm FAMOUS!

Me: Really...what are you famous for?

Hopper: Hoppin' trains. I'm a train hopper!!

He said this with a mix of disgust (that I didn't recognize his fame) and pride (as if train hopping were the equivalent of winning the Nobel Prize).

Hopper: I've been surviving on the streets for 30 years.

Me: I could prescribe you some Naproxen.

Hopper: I can't afford that.

Me: But you can afford Dilaudid?

Hopper: Yep. It's the only thing I can afford.

(Along with 20 cases of beer, I thought....)

Me: Would you like a Toradol shot right now to help with the pain?

Hopper: No way. I'm allergic to needles.

Me: You are allergic to needles? (placing emphasis on needles....)

Hopper: Yep, one time they gave me a TB shot and my arm swelled up to here (spreading his fingers about 5" high from his arm).

Me: That means you were having a reaction to the medicine, which means you could have tuberculosis.

Hopper: Nope. It's those damn needles.

After we finished the visit, the nurse walked by as Hopper was walking down the hallway toward the exit. She heard him muffle under his breath,

"I'm never coming to this clinic again...."

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You win some. You lose some.

RIPPLES

I love lakes. And the beach--- the smell, endless sky, birds, soft sand. And mostly, I love the hypnotic waves that ripple on and on and on and on.

And yet... here I am living in a desert.

But I realized the other day, that there are waves (of sorts) to appreciate right here in my arid inland life.

My story begins with R, a 50 year female who tripped and landed on her elbow. She didn't show any visible trauma initially, but then large purplish bruises arrived to the party several days late, which caused R to worry and so she came to see me for the first time. With a normal x-ray and exam to back me up, I gave her reassurance that the bruising was a normal response and, "no, you are not crazy to be so worried."

One week later, R  brought in her best friend, I, who had not seen a doctor in several years. The two ladies giggled and carried on in the exam room, like a pair of teenage cheerleaders talking about the football team. I had a boatload of concerns, her health spiraling downward from years of neglect. Over time, we have tackled the problems one by one.

One day, I came in with her husband P, a diabetic who stopped taking his medication several years ago. His diabetes was out of control, bringing with it several other problems along for the ride. Among the first things I did was give him some cream for a bothersome rash. After getting almost immediate relief, he told his daughter to come see me for a rash that she was fighting. The 24 year old daughter, P2, bopped into the office with miserable sores and bobbed out with a prescription for relief.

So..R brought I. And I brought P. And P brought little P up the coconut tree. (Haha...10 points if you can name that book....).

Then there is L. She is an 82 year old firecracker, tough as leather, who was recently diagnosed with breast cancer and underwent a mastectomy. Her two daughters brought her in to see me as a new patient because she was having a reaction to the antibiotic given after surgery.

A week later, I walked into the exam room and saw a familiar face. "Well hello," I said. "Welcome back." One of L's daughters, E, had a few problems of her own she wanted to discuss.. Since then, E has returned several times, and I look forward to her visits.

A couple of weeks ago, as I was taking a history on a new patient named S, she blurted out, "my mother told me to come see you." Turns out, S is just as delightful as her mother and 82 year old grandmother (E and L).

And wouldn't you know it? S has a teenage daughter. And yes, now I have seen her also. Four generations. L+E+S.

Throughout my schooling I heard various providers boast about this sort of thing. "That's what I love about family medicine," they would taunt, "being able to care for the whole family."  Honestly, I didn't understand that appeal.

Until now.

I see they  were right. This privilege brings a certain pleasantness, a kind of soothing rhythm, as I move in and out of their days and observe the ebb and flow of their lives.

Waves.

Oh sure, it isn't a substitute for the beach. But this RIPPLE effect (of seeing friends, families, generations, one bringing another and another) echoes a tiny hint of the ocean and brings a small wave of joy, right here in the desert.

And I don't even have to clean sand from my car.