"...think for a moment of the long chain of iron or gold, of thorns or flowers, that would never have bound you..."

“That was a memorable day to me, for it made great changes in me. But, it is the same with any life. Imagine one selected day struck out of it, and think how different its course would have been. Pause you who read this, and think for a moment of the long chain of iron or gold, of thorns or flowers, that would never have bound you, but for the formation of the first link on one memorable day.”

----Charles Dickens, Great Expectations, last para chapter 9

I have been reading a lot during these SARS-CoV-2 times and Great Expectations was always one of my favorites. The above paragraph particularly strikes a chord with me as do other recalled images in those first few chapters, such as the lanterns in the protagonist's cottage, the darkness of the marsh, the torches of the pursuers and the convict's leg irons. 70+ years of life have now passed, and many would say that is a lot of “time”; but each segment of those many decades was not parceled out equally…certainly not all had the same impact. Each bit of time…minutes, hours, days, etc., cannot be recalled as particularly eventful, but over 70 years of events have now passed, regardless. I like the way James Taylor put it: “The thing about time is that time isn’t really real; it’s just your point of view or how does it feel for you.” I have written about one such day when I was 13 (https://www.dhirubhai.net/…/nothing-your-past-holds-you-bac…/) that also follows that theme in Dicken's classic, but this is about another day, much earlier in my life, the day I became bound to a calling that has consumed most of my life in education, training, and practice, simultaneously robbing and enriching me. But just like the conjunctions of iron or gold, thorns or flowers, it is not the only antithesis in my years lived.

It was the early fall of 1956 or the late spring of 1957; no memory of a specific date exists. It occurred while we were still living in Owensville IN where my father had returned to general practice in 1956 after his second military tour, this time with the US Army, having been in the US Navy during WWII. It was not a school night. Maybe a Friday or Saturday night? I was in the first grade that year and I would not have been able to go if the next day had been a school day. It was a warm night (I was in shirtsleeves) and quite dark. Dad had finally asked me if I wanted to go with him on a house call. My brother was two years older but never did have any interest in Dad's profession even as a youngster. It was to be my first house call with my dad. I was so excited! I remember riding in our huge navy blue 4-door Buick Roadmaster. I had to literally climb into the front seat. I then sat up on my knees to look out of the front windshield, no seat belts or car seats then. The sound of the car's huge whitewalls coursing over the gravel that made up the roadway to that farmhouse was a particularly memorable part of that trip. It is now like accompanying music to the memory of the time that passed between us on our way to and from; it is as easily recalled as are the dancing headlight beams. I could only see what the headlights revealed as I looked out over that huge dashboard upon which I balanced myself with my arms outstretched as far as they could go. I bounced in that seat as we drove over the uneven and unseen roadbed. I bounced as the headlights danced to the tune of the crunching gravel, but I could see little. As I said, it was quite dark.

Dad eventually turned into a yard without a driveway and the headlights lit up the front porch of a small wooden farmhouse. It appeared initially dark and empty; then there was a light moving through the house and bobbing through the front window. The front door opened and a man with a lantern waved it toward the car and Dad extinguished the headlights. Now only the dim lantern guided us up to the porch. I walked beside Dad to his left, opposite the side he carried his large black bag. The man saw me and said, "Oh, I see you have Little Doc with you, tonight." Dad smiled and I knew that what the man had said pleased him. Dad put his hand behind me to help me up the steps and I was ushered through that door and into a small living room that opened to a kitchen where the man lit a second lantern on the kitchen table. He asked me if I would like a piece of pie as he looked at Dad and winked. And when that was cut and put onto a plate he wondered aloud if some homemade ice cream would not also be in order. I watched as he opened the ice box (I remember the large block of ice in the top cabinet). He scooped out two big heaping spoonful of ice cream from a bowl in the bottom of the icebox onto that plate and put it before me. I thanked him and Dad nodded. I was seated on a wooden bench that made up one side of the kitchen table. I remember Dad washing his hands at the kitchen sink using a small black handled pump noted as the only fixture. Dad, his bag, and the man then went through a door off the kitchen, and I could see the edge of a bed briefly from the light of the lantern and heard a woman's voice greeting Dad. Then the door was shut. I heard nothing more while I ate my pie and ice cream. Dad was in that room "doctoring"...that is what he did. He was a doctor and every day he "doctored". That was a fact, to me an absolute truth. I was aware of many absolute truths at that stage of my life when all beliefs and actions were simply right or wrong, good or bad and you were always expected to know one from the other. I was completely unaware that what was about to happen to me in the next few minutes would, over the course of the remainder of my life, transform such concepts.

I do not really know what Dad did in that room other than give this woman an injection...a "shot". I know this now because Dad's glass syringes with steel reusable needles that he attached were carefully cleaned, the needles were sharpened on a small grinding wheel; then all were sterilized in the office autoclave, reassembled, then packed into rubber-stoppered stainless-steel sleeves held upright by elastic bands against the interior walls of his large bag allowing ease of access when the bag was laid open. These steel sleeves were filled with a disinfectant after the syringes were placed inside, then tightly stoppered with those hard rubber caps. I learned all this later but that night, as the door of the bedroom opened and Dad came out while being thanked by the man previously noted, the entire house was suddenly filled with a highly volatile, but invisible, cloud of isopropyl alcohol. I can acutely recall it just with this retelling; it filled my every breath with its sweet, penetrating vapor. Any occasion I have ever had since to smell that compound, this event is instantly relived. I remember Dad still had his stethoscope on, the earpieces were behind his neck (he never slung his scope around his neck just pulled it down from his ears) and he was carrying his bag. He opened it and replaced the stethoscope into it. The man again said how grateful he was, and I heard the woman's voice calling out with her thanks, as well. It was the '50's and doctors had recently acquired powerful antibiotics able to cure deadly pneumonia and stop strep throat/scarlet fever from becoming rheumatic fever with its crippling arthritis and debilitating chronic valvular disease; even pyelonephritis and cellulitis could be successfully managed. IV papaverine could be given to stop a hypertensive stroke and IV calcium gluconate would relieve osteoarthritis. No more "cut to cure" as the only options. It was a Golden Age for physicians and their bag of injectable medicines. House calls were commonplace, and injections were the expected treatments. Country doctors always gave "shots", not pills. Too many frugal patients would hoard pills and never take a full dose rendering that therapy useless. Dad may well have been a city boy in his rearing but now he was a country doc. He knew his patients and they knew him; each met the other's expectations in those days. It was a different time. Yes, quite a different time; that is both a fact and an absolute truth, one of the most haunting of the very few I have remaining.

Dad told the man that he would be back to check on his patient the next day and motioned for me to come. He started for the door. The man looked down at me and said as I was leaving, "It will be good to have Little Doc growing up to take care of us with you, Doc." Isopropyl alcohol vapors still filled the room. I can, to this day, feel the exaggerated sense of pleasure in that moment. Pleasure that Dad was pleased with this statement and that he was pleased with what he had just accomplished in that house; the man and the female patient (never seen) were happy; I was happy with the pie and ice cream and the sense of respect and gratitude that was being bestowed upon my father for "doctoring" that night and, most of all, the pronouncement that I was to grow up to be just like him. It was all so overpowering and in retrospect, I cannot get over the part that the olfactory stimulation of that volatile alcohol and the effects on my developing forebrain and limbic system must have played that night.

And from thence, the thought came to me suddenly and without reservation; the answer to the question so often asked by hard-working adults to children, "What are you going to be when you grow up?" This was what I was going to be; what I was going to do with the rest of my life; all determined at the age of six. Without any understanding of the cost to me of the journey, I had decided that whatever it took, I wanted to have that happiness, respect, and sense of accomplishment. I wanted to feel as I felt then...always. My mu-receptors were hard at work building a compulsive desire in me even if that science was unknown to me or anyone else, for that matter, at the time. The salience of opportunity costs, the transience of the vigor of youth, or the value of leisure would remain unacknowledged by me for many decades.

The most powerful instruction anyone can receive is edification by those in a position of authority or trust, even more so if loved. My father was all three to me. He edified being a doctor that night and the accompanying endorphin stimulation to me was overwhelming. It was many years before I understood that I had met my father's mistress that night and was totally captivated; at first sight only dimly illuminated but instantly an object of desire, worthy of pursuit. And so, that night, in the dim lantern light, the first link of my "long chain" was forged. Medicine became and remains the longest-lived passion of my life. But just as the light, so also the darkness of that night's encounter would become a constant companion. That paradox continues; Dame Medicine with al Her illuminations can yet be quite a dark mistress.

The links of my chain continued to form over the many years of knowledge acquisition with only a few brief attempts to file the attached leg-irons off; once at the age of 9 to become a cowboy, at 18 to become a game warden and finally at 20 to become a high school teacher. They were brief interludes with their own joys and possible alternative lives lived but no match for that first isopropyl alcohol, mu-receptor stimulation that had created such an obsession in my childhood mind. That obsession, reinforced by years of continued paternal edification led to the development of a personal, chain-forging, internal reward system that brings me to my now. My now, where it no longer matters, that during my 25-year pursuit to become worthy of my father's mistress, she would so transform as to be barely recognizable vis-à-vis that first apparition. The irony is, She would ever be the same for Dad. I saw Her with him often; they appeared joyful to the very end of his conscious awareness. After all other memories were gone, siblings, parents, Mom, my stepmother, my siblings...after everyone was gone, She remained. Even during my last visit with him on the Alzheimer's unit in Evansville IN before I left for Afghanistan, when he did not know who I was; even then his head would turn to the name, "Doc", and he would smile, nod, and remember. He remained bound unto death by his long chain; a chain that gently tethered him by its last remnants of fragrant blossom. It comforts me to believe this to be an absolute truth: She loved him back.

It is of little matter now knowing that no pursuit, no journey, would ever bring me back to the pleasure of that first house call when I beheld Her with Dad. I would never really know the mistress Dame Medicine he showed to me to that night; I would only be allowed to covet and pursue Her. There has been no loosening by the knowledge that over the years the long chain that now binds me is not to Her, but to the more demanding and mercurial courtesan that had replaced her by the time I stepped out of medical school and residency training. That is the sad and now, particularly ironic fact regarding the nature of my personally forged long chain these many years later. In the recalled dim light of that house call, where that first chain link formed, I no longer see any absolute truth regarding its composition, be it iron or gold, thorns or flowers. Like the courtesan to which it attaches me, it too has a mercurial nature. Regardless, I am, and remain, bound. Like Dad, I believe ????? ???????? ???????? ??? (Song of Solomon 6:3)...and tell myself, truth or not: "She loves me back; She loves me back..."