Thursday, January 10, 2013

"Even in this nicke of time, this very, very instant."

I'm probably the only person in the northern climes running the air conditioner.  My initial excuse was that the air needed dehumidifying.  When that got the bald eyeball, I admitted to being hot.  Now it's getting a bit cool but I'm safely ensconced in comfy bedding, hoping someone else will discover how to use the thermostat.

Life with fevers!  Hot, cold, sweaty.  I want frozen fruit, no, wait, I want hot soup, with many spices and several of TW's dried jalapeños, for good measure.  Wait, hold the soup, and gimme an ice pack!

But it's been kind of a nice day.  Pain sitting at a mere 6 out of 10 (whatever the heck that means) and Buddy has discovered all my old cashmere leg warmers.

Cashmere leg warmers, when sprinkled with catnip and then rolled into a ball, are objects of drooling adoration for Mr. Buddy.  And they're perfect for me -- I throw like a girl, so what better thing for me to be tossing about but bright red or sexy black cashmere leggings?  I am achieving amazing distances and Buddy is uprooting all the haphazardly strewn about area rugs in our chichi wing of Marlinspike Hall.

I have quarantined myself in our cozy little wing because the staff is coughing and sneezing and generally making any gross respiratory-related, gravelly noise possible.  Roughly 80% of the staff has the flu and the other 20% are apparent mimics.  I'm not letting those walking microbes across my line in the sand... not for nothing.

Every year, my MDVIP Go-To-Guy and I have the same conversation about the flu vaccine.

Oh, I probably haven't mentioned that I had the Grand Pooh-Bah of MDVIP Appointments last week, last Thursday to be exact.  I dread these annual affairs, and they always turn out... fine.
More on that later.

Back to the recurring flu vaccine conversation.  Back in 2005, I was an advocate of the vaccine, thought nothing of it, was very grateful for it, even though I'd had the flu a few times after getting it -- either getting a variant not covered by the flu-guessers or bad timing.  That year, I'd just had my right shoulder replaced by none other than our beloved ShoulderMan -- it was our first meeting, back when things seemed much more straightforward!  I had a few problems afterward, weird stuff, of course -- a necrotic lymph node right next to the surgical site, and a pretty severe anemia, despite having had a top-off at the hospital prior to discharge.

This was before Go-To-Guy went all MDVIP on everyone, back when he was one of the founding docs of a pretty large, very busy practice.  I came in because I was inexplicably getting weaker, and  blahblahblah we discovered I was just anemic.

"While you're here, why don't we give you your flu shot?  I know you're a little run down, but what could happen?"

Please pay attention to that phrase: "what could happen?"

Informed consent, wham, bam, thank you super nurse, I got my shot and we headed home.

Two hours later, I was deathly ill.  Fred, not always quick to pick up trouble, being a cheerful and positive kind of guy, went and bought the Mucinex that Go-To-Guy recommended.  And that's the last thing I remember until I woke up about five days later on a respirator, overwhelmed by the sensation that I had missed something.

Anyway, "what could happen?" became a catchphrase that reduces me and Fred to tearful hysteria.  It just cracks us up.

And Go-To-Guy wipes the story from his memory every year.  Psychic trauma does that to people.
Last Thursday, as he talked me into taking the pneumonia vaccine, he opened his mouth, which then sort of flapped around aimlessly, because you *know* what he was about to say!  It was almost the same situation as the phrase's début iteration -- we were dealing with being rundown from my stomach bleed, with a low hemoglobin (but so much better, thankyouverymuch!).

I about fell on the floor laughing.  (No, I didn't.  That would have been... rude.)

There's been nary a hint of a problem from the vaccine.  But think carefully the next time you're tempted to gloss over potential pitfalls with a blithe "what could happen?"!

So... part of these annual MDVIP "physicals" is a prompt summary letter afterward to remind you of what you just talked about the week before.

The happy experience of discovering that my desire to be on "Do Not Resuscitate" status was not going to cause me or my treating physicians a boatload of upset or the need for reinventing the wheel -- well, I had not had the chance to even run it by my MDVIP Go-To-Guy Treasure of a Physician.  We had exchanged emails, but I was always in a snit over something, over-the-top, and he's a born optimist.  So I was never sure if we were talking about the same thing.

That my last hospitalization went so well, that this potentially thorny issue proved thornless, had nothing to do with him -- turns out, he didn't even know I had stayed as long as I had.

So last week, I let him know the day before the big exam that I was hurting a lot and would appreciate it if we skipped most everything so I could get home and rest my nasty bones.  We always need to go over meds and that takes a long time -- it's very useful and helpful, and it actually serves well as a guide for what is going on in each "system." As we discuss a drug, we discuss the problem, we make adjustments, etc.  We review my blood work, which, frankly, depresses me.  There is no way to dress up those results.

I couldn't bring myself to look at this kind man, or at his super kind nurse, and even say "DNR." But I found words, and delivered them with what I hoped was good humor and appreciation.

Here's the relevant paragraph from the letter I got today:

"Unfortunately, you continue to have severe pain with your hips being the most prevalent at this time.  It is certainly possible you have an infection in one or both of your hips and it sounds like your left shoulder may have infection in it as well.  The elevated white blood cell count and the persistent low grade temperature support this fact but we really have not been able to eradicate this infection by the use of either oral of IV antibiotics.  As you said to me, I think right now the best approach is pain management and 'putting out any of the fires that we can.' Ideally, surgical resection of any hardware in your joints with heavy doses of IV antibiotics would be the only way to eradicate this ongoing infection but I am not sure you are willing to proceed with anymore surgery and frankly, I am not sure if your body could take much more than what you have been through."

He did hear me.  He always has.  I am really blessed.  Because I did not make it easy for my physician to hear me.  I flirted with the concept of "stopping," but then, when it got hard, I called for help.  Now comes the test.  At any given time, there are "fires," but which are the ones that threaten the foundation?  Which are just flare-ups, little grease fires that can be squashed with a cooking lid or stifled with a damp towel?  When do I just drop and roll -- with prayer or mute begging to the universe, or, if I am doing well, and have done my work, the hope of resolution?  And when, prayer, begging, and work done, but Death dallying, do I call for help, because it's just a straightforward blaze that a spritz or two will stop?

Were he not such a good guy, I'd ask MDVIP Go-To-Guy, but it's not his place to be asked, and it's not his place to answer.  It's not Fred's place, though it will be his to endure the results.

It's time for me to grow up -- it's the very nick of time.  I'm gonna have me a chat with Buddy.



The English language gives us the opportunity to be 'in' many things - the doldrumsthe offingthe pink; we can even be down in the dumps. With all of these expressions it is pretty easy to see what they refer to, but what or where is the 'nick of time'? It may not be immediately obvious what the nick of time is, but we do know what it means to be in it, i.e. arriving at the last propitious moment. Prior to the 16th century there was another expression used to convey that meaning - 'pudding time'. This relates to the fact that pudding was the dish served first at mediaeval mealtimes. To arrive at pudding time was to arrive at the start of the meal, just in time to eat. Pudding was then a savoury dish - a form of sausage or haggis (see also the proof is in the pudding). Pudding time is first referred to in print in John Heywood's invaluable glossary A dialogue conteinyng the nomber in effect of all the prouerbes in the Englishe tongue, 1546:
This geare comth euen in puddyng time ryghtly.
In the nick of timeThat seems a perfectly serviceable idiom, so why did the Tudors change it to 'the nick of time'? The motivation appears to be the desire to express a finer degree of timing than the vague 'around the beginning of the meal'. The nick that was being referred to was a notch or small cut and was synonymous with precision. Such notches were used on 'tally' sticks to measure or keep score. Also, during the 16th century, pudding began being used as the name of sweet dishes and they were usually served at the end of the meal. As this trend continued 'pudding time' being used to mean 'in good time' made less and less sense.
Note: the expressions 'keeping score' and 'keeping tally' derive from this and so do 'stocks' and 'shares', which refer to the splitting of such sticks (stocks) along their length and sharing the two matching halves as a record of a deal.
If someone is now said to be 'in the nick' the English would expect him to be found in prison, the Scots would picture him in the valley between two hills and Australians would imagine him to be naked. To Shakespeare and his contemporaries if someone were 'in (or at, or upon) the (very) nick' they were in the precise place at the precise time. Watches and the strings of musical instruments were adjusted to precise pre-marked nicks to keep them in proper order. Ben Jonson makes a reference to that in the play Pans Anniversary, circa 1637:
For to these, there is annexed a clock-keeper, a grave person, as Time himself, who is to see that they all keep time to a nick.
Arthur Golding gave what is likely to be the first example of the use of 'nick' in this context in his translation of Ovid's Metamorphosis, 1565:
Another thing cleane overthwart there commeth in the nicke:
The Ladie Semell great with childe by Jove as then was quicke.
The 'time' in 'the nick of time' is rather superfluous, as nick itself refers to time. The first example of the use of the phrase as we now know it comes in Arthur Day's Festivals, 1615:
Even in this nicke of time, this very, very instant.

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