I am Dorothy

A Visit with Dr. Vladimir

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A Conversation with Dr. Vladimir

“A neurologist will measure the electricity conducted across your wrist to determine if you have Carpel Tunnel Syndrome. I will send you to Dr. Vladimir. I must warn you, however, some of my patients refuse to visit him twice. He is not very communicative, but he’s a good doctor. If it is Carpel Tunnel Syndrome, we will operate. Your thumb could go lame.”
In an office just inside the entrance to the old villa, Dr. Vladimir stands before a desk studying a stack of papers. He glances up when I enter, then back down before speaking. “Madame Michaud?”
“Take a seat in the next room.”
Neurologist. Add that to cardiologist and psychiatrist and I will have seen every doctor a healthy, perimenopausal woman must see. In the empty waiting room, which is really an elegant living room, I sit beneath tall windows overlooking a splendid garden. Sunlight warms my back. A cello and bow hang on one wall. I peruse a heavy book of Paul Klee drawings. It feels like I have stumbled into a Jane Austin novel. Dr. Vladimir appears in the doorway. I follow him to an office at the end of the hall.
“De quelle payee est-ce que vous est venir?” he asks.
He switches to English. “And how do you survive, living in this little country?” His heavy accent reveals that he, too, comes from someplace else. He indicates the chair beside a table with tray and computer monitor. I sit down. He sits across from me.
He is pleasant-looking, of medium build with gray-white hair. His skin has a healthy pink caste. Brown irises appear exceptionally large behind his glasses, and gentle when he dares to look at me, which is not often.
“Now to determine if what you have is in the realm of disease.”
“Disease?” I imagine fevers, sweats, chills, an insidious illness creeping through my body to cripple or eventually kill me.
“Which hand is worse?”
“The left, I think.”
“We will measure the conductivity from wrist to fingertips.”
“Will it hurt?”
“Not much.” He secures a velcro band to my pointing finger, another to the middle finger, then connects wires to a band around my wrist. He dips the disk at the end of one wire into a dish of water and presses it against my skin, then rotates a knob on the monitor. Electricity flows through my hand. I wince. A blip appears on the screen. “You see that?” He points. “Now we will make it bigger.” The next impulse is stronger. He repeats the procedure, diminishing the power. My thumb twitches like it did the morning I woke up with a herniated neck disk.
“You get used to it,” I say.
“It dies down. Now we will do it differently.” He initiates another series. “Do you have numbness? Pins and needles? Pain?”
“Numbness. I don’t think I have pins and needles, and there is no pain. I don’t feel anything. When I move my fingers, the feeling comes back.”
“Does it wake you up?”
“I don’t think so.”
“It seems unlikely that it is disease, or Carpel Tunnel Syndrome.”
“Could it be coming from my neck? I had a herniated neck disk. The feeling never came back completely in these fingers.”
“Only on the left hand?”
“Nearly everybody has a herniated disk. Most don’t even notice it.”
“Is that true?!”
“Yes. Who did you see for yours?”
“Dr. Lafitte.”
“Did he operate?”
“No. He said, ‘No reason to operate’.”
“I’m surprised. Dr. Lafitte likes to operate.”
“He does?!”
“Oh, yes. Very much. Was it pressing on the nerve?”
“If it were, he would have operated.”
“It really hurt! More than anything I have ever experienced.”
“I believe you. We neurologists think differently from the rest of them.”
“How? Like scientists? Do you think about numbers and things?”
“We are interested in the way things work. We are getting older. We have these little things. The best is to ignore them. It is not good to operate. If the patient is not in pain, or if their sleep has not been disturbed, they will never be satisfied because certainly, after an operation, they will have pain. In the bible, we doctors are... what do you call it? Punissment.”
“Yes. I give you a little advice: stay away from the doctors. They like to operate. It’s how we make money in our business.” He rearranges the wires.
“When the doctors get hold of you, they don’t let you go. I found that out in the hospital.”
“For what did you go to the hospital?”
“Tachycardias. I had a new kind; irregular. It scared me. I went to the hospital. They kept me for two weeks; did all kinds of awful things. They let me believe I might die. I asked to see a psychologist to help me deal with my fears. My doctor said I didn’t need one.”
“What did the psychologist say?”
“I never saw one.”
“Actually, I did, months later.”
“What did he say?”
“She said, ‘Isn’t it nice our bodies have these harmless little ways to get rid of stress?’”
“I guess that’s a good thing to say. Your tachycardias, you still have them?”
“What do you do about them?”
“Ignore them?” I ask, sheepishly. “I have developed a technique which works most of the time to stop them.”
“What is that?”
“I find some place to sit down, loosen my belt, unzip my pants, lean forward from the hips, expand my chest, and press.”
“You can submerge your head in water. It’s called ‘the diving reflex.’ It stops the tachycardia. They don’t know why it works. It puts a break on the heart. One lives with these things. My father had them. He lived to be seventy-six. They started when he was eighteen.”
“I was twenty.”
“Magnesium works, sometimes, or digitalis. That’s an herb. When my father broke his hip and went to the hospital, his doctor told him, ‘You should be taking digitalis,’ so he started. His tachycardias never came back. My son has them, too. He plays chess. I offered to give him something against them, but he didn’t want anything. When there is a difficult move on the board, he gets a tachycardia, and that stops the play.”
“Ah, causes them to pause and gives him time to think?”
“No, it ends the game.”
“That’s good!” I smile.
Every now and then, Dr. Vladimir gathers his courage, inhales, and looks me straight in the eye. I like his eyes, so large, deep brown, like a doe’s. He does not look away immediately, but once he has, he doesn’t look again until he has gathered his courage.
As we talk, he moves the wires to my right hand. “Now we’ll do the other side.” He dips the disk in water and presses it to my wrist.
When the repeated shocks come, I ask, “Is this the pins and needles feeling?”
“Yes.” He points to the screen. “You are borderline. If you have a four, they call it ‘normal.’ If it were 4.1, it would be abnormal.”
“What is average?”
“3.6. These numbers practically rule out Carpel Tunnel Syndrome.”
“Does that mean the falling asleep comes from my neck?”
“That could be.”
“I can stand pain. I wouldn’t operate just because of pain. I would only operate if I might go lame. I type at the computer.” I hold up my hands. “My hands are perhaps the most important part of me.”
“You are not going lame.” He hits my wrists and elbows with a small rubber hammer. “What do you type?”
“Stories and poems.”
“Poetry. That is good. Stories and poetry? You write books?”
“No. I’m not published.”
“What kind of stories do you write?”
“I try to write the truth.”
“What is the truth?”
“My Aunt Janet says, ‘Art is a search for the truth.’ I try to find the truth; to see what it is.”
“And why do you write?”
“So that I won’t forget. When my father-in-law died of cancer, I wrote about him, his wife, my husband, myself, so I wouldn’t forget. Also, I am living in a foreign country. I write to go home.”
“I knew a woman composer in Russia. She said the same thing. When she had an experience, she said she had to compose music for it.”
“And when she played the music, she would remember the experience, the feelings that accompanied it, maybe see the scene where it took place? Depending on how her brain works. Mine works visually. I see things. When I write, I am seeing the event. I write the words to try to capture it.”
“And imagination? It is good to use your imagination.”
“I recently tried fiction.”
“Imagination is a bad thing for doctors.”
“I can see how that might be. Patients can imagine all sorts of things wrong with them from a doctor’s innocent remark.”
“Patients can go home and write all sorts of things about their doctors! In five years, it won’t be necessary to type with your fingers. Already, you can buy programs. You speak to the computer. The computer understands, but you have to train it to recognize your voice? It takes about an hour. I can’t use it for medical things. If I say ‘Alpha this’ and ‘Beta that,’ it doesn’t understand me. So I prefer to type, which I do fairly quickly.”
“Me too!” I grin.
“The computer is best for simple sentences; simple words.”
“I write simple sentences; use simple words. When I write, I don’t think about my body at all. Writing is a total escape. That’s good when you’re a hypochondriac.”
“When I was twenty-eight, I was in a research program. We used ourselves as guinea pigs. I tested my cholesterol and it was high. I thought, ‘I can spend the rest of my life worrying about my cholesterol.’ I decided never to do another test on myself, and I never have. With illness, if it’s going to kill you, that will show soon enough.”
“You mean, you will feel so bad that you will know in time that you are really ill?”
“If it’s going to kill you, it will kill you. There are certain problems; the people with these problems just drop dead. The rest of the things, these are not interesting. It is best to ignore them.”
“My brother just dropped dead last October.”
“They think he had a fixed ventricular seizure. He had a virus which damaged his heart. He told me it was pumping only 25% of its volume. He said most hearts pump 50 to 75%.”
“He was a very sick man.” Dr. Vladimir shakes his head, sadly.
“I wish they had told us! I would have called him more often. They were going to give him beta blockers. They told him if beta blockers didn’t work, they would put him on the list for a heart transplant.”
“Maybe it is for the best.” He speaks softly, as though talking to himself. “You can either worry about these things all the time, or you can ignore them.”
“I think ignoring them is better! I think people who ignore them are happier while they’re alive.”
“I do, too.”
“My brother refused to believe he was going to die. He kept going to his job right up until his last day. I think he was happy right to the end. A heart specialist wanted to fix my heart.”
“But then he would have to operate.”
“He was already inside with his electrodes and things.” Dr. Vladimir smiles. “He wanted to apply heat to the spot that causes the problem. He said three of the 272 patients he has done this to have an artificial pacemaker. One little slip – it is so close – and you destroy the heart’s natural pacemaker. You have to put in an artificial one right away.” I lean a little closer. “He says his three patients are all very happy with their artificial pacemakers.”
“Pacemakers are a big business. I have stock. They going to be used more and more. They have just given permission to use a new kind which can stop a heart from fibrillating. They bring back three out of four cases.”
“Three out of four who would have died? They think my brother’s heart was fibrillating. Why didn’t he have one of these?” My voice quavers.
“They are very, very new,” Dr. Vladimir replies, gently. “If I had something really bad, I would find the best specialist. Otherwise, it is best to ignore these things.” The examination is complete. Dr. Vladimir walks with me into his office. “You could try magnesium. If that doesn’t work, you could try digitalis.”
“Does it have side effects?”
“Everything has side effects.”
“If something has side effects, I’ll get them. That’s my imagination. Could you write that down for me?”
He writes: ‘Magnesium, Digitalis, Dr. Camembert,’ and ‘diving reflex.’ “For digitalis, you need a cardiologist. You could go to Dr. Camembert. He usually takes his patients off their medications. He doesn’t do too much.” He hands me the prescription slip. We walk down the hall. He stops and turns to me. “Do you know Oliver Sacks?”
“Oliver Sacks?”
“Yes. He is the man who took his wife for a hat.”
“Oh, he took his wife to buy a hat.”
“No. He had a patient who thought his wife was a hat. He’s a neurologist. He writes about his most quirky patients. He has written lots of books. The most famous is, ‘The Man Who Took His Wife for a Hat’.” He turns back to his office, takes a second prescription slip, and writes: ‘Oliver Sacks, ‘The Man Who Took His Wife for a Hat’.’ “He’s a little like Woody Allen.”
“Then I’ll like him. I’m a little like Woody Allen.”
As we re-enter the hallway, an attractive young woman, face gray with pain, emerges from the bathroom. I think, probably most of the patients who come here look like her.
Dr. Vladimir gazes thoughtfully at the sunshine streaming into the waiting room through the garden windows. “It’s not killing you,” he says, thoughtfully. Then he turns and looks straight at me. “Stick to writing, and stay away from the doctors!”
I shake his hand, warmly, and say, “It was a great pleasure to meet you!”
Walking away, he turns his head to one side. I hear him say, “It was the same for me.” I push open the front door and step outside into the sunshine.

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