The Perfect Ten

"Sixty-six year old female, chest pain."

The roads are rimed with ice, thick in places, bumpy, dangerous. Cable chains, coupled with tremendous weight, give our aid car traction and mobility. It's two in the morning, and we are hurrying on the treacherous streets, closing distance with the medics. The address is at a mobile home park, "The Estates", a manicured ersatz village brimming with retirees, trailers lined up in tidy, landscaped, aluminum rows. We go there often.

At the station, Rich had stared sleepily at the map on the wall, pulling on his bunker pants. "I don't know where we're going."

"It's by the freeway." It had sounded so helpful in my head, before I said it. I try to coax my groggy mind into showing off with turn-by-turn directions. "Follow the medics. They know where they're going."

We lose sight of their flashing red and white lights. A dispatch to "chest pain" is urgent in itself, but a slow start and an icy night make me anxious. The medics have made the only possible turn, and when we come around the corner, we can see them again, two blocks ahead. I'm in the officer's seat, pulling on nitrile gloves, Rich is focused on navigating the slippery route - slow on the corners, faster on the straights. He closes the gap between the two vehicles, and I relax a little.

We arrive seconds behind Medic forty-six, parking behind them, and uphill on the glazed asphalt lane. A narrow set of stairs leads up to the door under the carport. I wait at the bottom, until the medics are inside. Last week, I was bringing a gurney into a similar mobile home, and my foot went through a rotten plywood step. I bounce experimentally on the treads, assessing their strength, should we need to carry a patient out this door - no cracking or creaking under my weight.

I enter the home, and a woman is flitting about at the front door. "I was hoping they'd send some handsome firefighters!"

"Nope," I deadpan, "They sent us, instead."

I expect her to usher us to our patient, but one of the medics, Eric, asks her to take a seat and launches into interview mode. I've got a report and clipboard in my hand, and it's my role to record patient demographics (name, age, address), medical history and chief complaint. I'm still groggy, and I strain to make sense of the conversation, recording pertinent facts. No one asks her name, so I scan the counter for medications. I pluck a bottle, empty of oxycodone, from the window sill. I squint at the label.

"Are you Peggy?"

She is and she has a host of medical issues, none of them cardiac related. But because she uttered the magic words to dispatch, the medics are chasing down the chest pain path. They hook up the cardiac monitor, sticky little blue patches connected to wires at her shoulders and hips, under her robe. Nothing remarkable.

"The pain is right here." She thumps her belly with a closed fist, below her ribcage. "It goes to my stomach, and chest. And my back."

Roger leans her forward and palpates her back in several places. She jumps a little when he presses her flank, in the middle of her back.

"Oooh, right there."

"Well, Ma'am, I don't think this has anything to do with your heart. But, these boys will be happy to take you up to the hospital... -if you want." Boys. Rich and I are both over forty. But it sounds down-homey. I let it slide.

She wants. Happily, she can walk just fine, and no one is too concerned if she does, but we would be for a patient in cardiac distress. Rich and I each take an arm, and steer her toward the door of the aid car, mincing our steps on the packed ice. She has some difficulty climbing in, due to her bum knee, but I don't want to lift her on the gurney, on this icy hill, if I don't have to. We take our time and soon she's belted into our bed in the back of the aid car. The heater barely maintains 68 degrees F, against the bitter cold outside, but I shake off the chill, and call the nurse, while Rich starts us in the general direction of the two hospitals.

I flesh out the report in the back of the rig, while we bounce along. The document constitutes a legal and medical record of the event, and different types of calls require specific information. She was never asked her to rate her pain during the interview.

"Ma'am? On a scale of one to ten, how would you rate your pain? With one being no pain, and ten being..."

"Ten."

"...being the worst possible pain imaginable?" Like losing a leg in a meat grinder, like getting impaled on a fencepost, like giving birth to quintuplets - simultaneously?

"Oh, it's a ten." She smiles at me, nodding. Her hands are folded across her generous lap.

"Okey-doke. Ten out of ten. Got it. Thanks." I bend to the paperwork, making a note of her statement, but I frame it in quotation marks, in the subjective section of the report.

I reckon I've experienced 7/10 pain, and it made me sob. But I've seen 10/10 pain. I've heard the wailing, the moaning, the pleading for it to stop. The desperate writhing. The gnashed teeth, enamel squeaking, the clenched knuckles, squeezed bloodless, white. Ten out of ten? Balderdash. Hooey. Confabulation. Steaming bullshit.

There's no traffic, and despite the ice, we arrive at the hospital shortly. After a short wait, we are sent to a room at the emergency department. Peggy wriggles from our gurney to the hospital bed, after we raise the latter to the same level. There hangs a new flat screen monitor on the wall which monitors and displays vital signs. I like technology, and I comment on the addition to the room.

"Oh. I thought that was a TV. Isn't there a TV in here? I am so thirsty." She is sitting up, gazing about the room. "I thought there'd be TV..."

The admitting nurse has followed us into the room. "Nope. Sorry." She doesn't sound very apologetic.

I give her my short report, epigastric pain, radiating to the chest, abdomen, and back. I high-light the ten out of ten rating with animated fingers.

"Right." She looks blankly at me. "Worried about TV and a drink?" She smiles sweetly, and shrugs a little. "A ten? I don't think so."

"I know..." I tear off the pink copy of my report and hand it to her.

"Thanks. You have a good morning."

"You too." I call over my shoulder, "Bye Peggy! Hope you feel better." Rich is waiting in the idling rig, the cab heater blasting.

"Let's go home, Cowboy. I'm sleepy - A ten out of ten."

Out Of Phase

Like the brains of dogs, and certainly cats, the human brain is a fragile organ, susceptible to damage and pernicious meddling. Conditioned to respond to a recurrent situation, the brain re-wires its behavior to handle the repeated and expected situation. Consider the adopted pet, having changed households, now displaying inexplicable and irksome behavior towards its new owners. Ring a bell, Puddles salivates. Stimulus, response.

It seems that a small part of my own brain has been perverted from its previous programming in new ways both inconvenient and devious. Like an "abductee", wandering around Terra Firma after the rumored anal probe, I scratch my head and wonder aloud, "How did I get here?" Or more accurately, "What day is it?"

Give me your hand, walk with me.

The pre-Colombian Mayans didn't use the wheel, but they measured the length of the solar year to a far higher precision than the Europeans who formulated the Gregorian calendar. Curiously, the über-precise Mayans preferred a whole number, 365, to the precise value they measured, and built their elaborate calendars around that figure, eschewing leap days. Even with that small error, and given a (long) life time, by the time you were eighty years old, spring would arrive just a few weeks earlier (by the calendar), than it had when you were a Mayan child, playing in the mud.

The word month is a cognate to the word Moon, meaning they have a common, or related origin. In a climate without appreciable seasons, or if the Moon figured more prominently in your mythology than did the sun, it might seem reasonable to mark the passage of time by the phases of our satellite. The observant and diligent shaman, however, might eventually eventually discover four other ways to define the Moon's orbit: the sidereal month, relative to the stars; the tropical month, relative to the vernal equinox; the anomalistic month, relative to the Moon's position nearest to (or farthest from) the Earth; and the draconic month, relative to the ecliptic plane. The lengths of these five periods vary by as much as two days.

Every great thinker wrestles with the issues of incorporating new information into the body of "knowledge" he already possesses. Aristotle, later Ptolemy, played with a mental model of spheres, each moving a particular celestial object relative to the other objects, with the Earth in the center. The periodicity of the Moon has no direct numerical relation to the annual revolution of the Sun, and it must have made the great thinkers, trying to correlate the two, crazy.

I can easily imagine a Lunar Interpretive Committee arguing the merits of the different months around a campfire, weighing common sense against spiritual belief, much like certain discussions around the firehouse dinner table. In the end, apparently, some wise figurehead threw out the whole notion of a month's duration being, in any way, tied to the Moon. Subsequently, we inherited a year of twelve months, of varying duration, correlated to the signs of the Zodiac. Call it executive prerogative.
The seven day week, depending upon whom you ask, came from the average weight of a baby camel, the number of fingers on the hand of a convicted pirate, or the alcoholic content of early beers. Actually, seven is a hallowed number, derived, by most accounts, from the number of naked-eye, visible stellar objects in the night sky: Moon - Monday; Mars - Tuesday; Mercury - Wednesday; Jupiter - Thursday; Venus - Friday; Saturn - Saturday; Sun - Sunday. The length of the week in the western world has been solidly established for at least two millenia, perhaps much longer.

As to the reprogramming of my neural equipment, I'd lived forty years, happily measuring my days with the accepted and understood year, month and week, negotiated oh so long ago. When I was hired by my Department, the damage began. We use an eight day rotation of shifts, working two twenty-four hour shifts (plus the occasional overtime) in that time. Our days off comprise a "two-off" and a "four-off", meaning a two and a four-day period between shifts.

We ask a bread-and-butter question of some of our patients, to assess their level of orientation: "What day is it?" It's a mediocre question, often irrelevant to the changeless world of an extended care facility, where one day blends into the next. I often must perform some mental calculations of my own, before I can process the answer. Curiously, I have no problem remembering how many days until I work next, but I seldom know what day of the week it is.

The biggest effect arises as the real world moves out of phase with my eight-day week. Take for instance, weekends. The odds of a real-world weekend completely lining up with my time off are 50%. If I include Friday or Monday as part of the weekend, the probability drops to 25%. I'm not complaining; I have abundant unstructured time off from work, but it can be difficult to coordinate weekend activities with friends and loved ones.

Particularly troubling is the complication created by my kids living out of state. Initially, I was overjoyed with the schedule when I was hired, and the prospect of all the time it would allow me to spend with them during the week. After they moved to California, repeatedly negotiating which weekend the kids are coming up each month became a huge pain in the ass. Three quarters of the year's three-day weekends necessitate a trade or a day off to maximize visitation. I have a very limited pool of possible trade partners, and I try to reserve those trades for the months without an open weekend.

Conversely, it's nice to go do something during the week, without the weekend crowds. Movies, museums, trails are much less crowded on a Tuesday. I have a lot of flexibility in my week for dentist or doctor appointments. I have to go to bed on time just eight days a months, but every work day is both a Monday and a Friday.

What day is it today?