DOUBLE TROUBLE
(A Medical Short Story)

Cousin Asa reached bony fingers over his cup of coffee, plucked a blob of chocolate-covered peanuts from the candy dish, and winked. Ignoring the unspoken protest of his wife, he munched away contentedly while adjusting his lean frame to the dining-room chair.

"My doctor has me on this low cholesterol diet," he said. "Looked in my eye-grounds a while back and told me my arteries was in top shape for a man my age. But he took me off fats anyway. Made me stop eatin' chocolates. Peanuts, too."

"Oh my! Daddy used to eat peanuts by the handful," observed Cousin Flora with resignation.

"Used to eat 'em all day," said Cousin Asa. He winked again. "I been readin' up on this cholesterol. Seems as you doctors don't really know what to think. Not all cut and dried like you first come out on it."

I had to agree with him.

At seventy-eight, Cousin Asa seems indestructible. Alert and wiry still, he's proud of his thick, iron gray hair and his slim, athletic figure. Without urging be will often demonstrate a full set of unusually white teeth - all his own. (The secret of dental health, according to Asa, is brushing four times daily with precipitated chalk and lemon juice - the same mixture his mother once used on ivory piano keys.) Uncertainty is not one of his failings, and when he talks - which he does at length - it is in the positive, unshakeable manner of a man who has long since met and conquered all of life's problems.

Cousin Asa and my wife, Jane, are from the same New England township, where he was a contemporary of her parents. Although the family tie is a once-removed affair between grandfathers, Asa has lived away long enough to adopt a southern viewpoint about kinship. He retired and moved to Florida more than twenty years ago. He has had no trouble staying busy there. When he's not bowling ("the oldest, active, sanctioned league-bowler in Pensacola") or in his woodworking shop ("over two thousand tools - you name it, I'll make it") he pursues a long-standing interest in medicine.

Asa admits he would have made a good doctor. In fact, he started out to be one, but got sidetracked in college and ended in insurance. He reads the medical columns in all the papers and magazines that come his way, and seldom misses a medical show on television. He has his own syringe and needle and gives himself a daily vitamin shot. An impressive number of illnesses and operations, his own and Cousin Flora's, have by now supplied him with a staggering background of medical intelligence. He has associated with and advised enough other senior citizens, all in various stages of progressive physical decay, to give him the confidence of an expert in diagnosing and treating most ailments. His qualifications in the field were strengthened recently when one of his granddaughters married the physician son of a medical school classmate of mine.

Each year on the trip north with Cousin Flora to visit their children, he spends the first night on the road with us. He may talk woodworking in Carolina or bowling in Massachusetts, but at our house in Georgia it's always medicine.

Cousin Flora, a buxom woman of cow-like placidity, smiled helplessly as Asa poured more coffee and lit an unfiltered cigarette. "Caffein keeps Daddy awake. And I tell him he smokes too much, but he never listens."

"Been naggin' me on it over fifty years. I keep tellin' her it's too late to worry now - at my age somethin' else'll get me first. Besides, my chest X-ray last month was perfect. Looked like an eighteen-year-old's. That's a gospel fact."

We were sitting around the uncleared table after a late supper. I could tell from the way Cousin Asa fidgeted restlessly in his chair he was about to begin one of his detailed medical stories. He sipped his coffee, drew deeply on the cigarette, and blew a deliberate cloud of smoke at the ceiling.

"How do you doctors feel," he asked, fixing me with the smug look of a man who knows the answer, "about a patient who comes in and diagnoses his own case for you?"

I hedged. I said it depended on what kind of approach the patient used. "Now, if he comes in and says…", I began. But there was no stopping Asa now.

"Y'see, I was havin' this pain in my arm." He indicated the muscles of his left upper arm, "Matter of fact, woke up with it one mornin'. So I go right down to see my internist, Dr. Sanders. He couldn't make too much out of it. Said it couldn't be the old ticker - my electrocardiogram just the week before was A-1 for a man my age. But, by golly, I knew it was hurtin'. Sore as a boil when I touched it here." He demonstrated, squeezing. "I could move it some, but when I squeezed it! Boy!" And his face mirrored the excruciating pain it once caused.

"Was it bursitis?" I asked.

He grinned and shook his head. "Nope. We X-rayed everythin'. No calcium or anythin' like that. Anyways, Doc gives me some pills and I take them for four days, but the arm gets worse. Next day I'm back to the office. 'Doc' I say, 'the arm's worse. The pills you give me aren't doin' the trick.' 'Well,' says he, 'try some of these for the pain and we'll give you some penicillin injections.' And I say, 'Anythin', Doc, just give me a little relief.' So I take the penicillin a shot a day for five days, but they don't help either. Meanwhile, see, the old arm is just athrobbin'. Still hurtin' like all get out."

Asa stopped to sip more coffee. His look was challenging. "Sounds like a puzzling case," I said.

"A real puzzler. Yes, sir!"

I didn't risk another diagnosis, and Asa didn't seem disappointed.

"Well," he continued, "I guess me and Doc must have tried a dozen different medicines. Even took another round of penicillin shots. We didn't get anywheres. Nothin' touched it. Now, by this time I'm figurin' Doc don't know what's wrong any more'n me. And all this time the old flipper is still hurtin'. Sore as the dickens. So, do you know what I did?"

Cousin Asa didn't wait for an answer. "Well - I say to myself - what the heck. I'm not gettin' any better, so I figure why not go down the street and give this here chiropractor feller a chance?"

Anticipating disapproval, Asa held up a restraining palm. "Oh, I know you doctors don't think much of these guys. I don't either. After all, I've got medical doctors in my own family. But when you're hurtin', it pays to be broadminded."

"Did he find some pinched nerves?" I asked.

"Three of 'em. He even showed me on the X-rays where the vertebrae was out of line. Said he could cure it with eight treatments."

"Did you take them?" asked Jane.

"Sure did. All eight of 'em. Like to got my neck twisted off. But they don't do a bit of good. He wants to give me eight more, but I don't go back."

Cousin Asa snuffed his cigarette and shifted position. "Well, believe me, this business is goin' on over three weeks now, and I'm not gettin' any better. Course, I'm lucky it isn't my bowlin' arm. But when a man gets my age, he needs to feel comfortable. And every mornin' here I am with this durn sore arm. Some days it's six, seven hours before I can work some of the achin' out." He paused, "Got any ideas?"

I couldn't come up with any and offered him a chocolate instead. He took it, poured more coffee and cocked his head like a professional owl. He was edging forward now in his chair. "Now, this is the payoff. Remember when I asked how you doctors felt about a patient telling you your diagnosis?"

I said I remembered.

"Well, I got to figurin' back on the case - all on my own, now - and it come to me all of a sudden. Just like that. Simple as all get out. So, the next day I'm back to see Doc Sanders. 'Doc,' I say, 'the arm's not gettin' any better. And he says, 'Mr. Whitney, I don't know what else to try. It's probably somethin' that'll just have to wear itself out in time.' 'Now wait, Doc,' I say, 'I been doin' a little research on my own about this condition, and I think I've hit on the answer. Now,' I say, 'I don't claim to be a doctor, and I don't want to make your diagnosis for you, but just listen and see what you think.' 'Fine,' he says.

"'Well,' I say, 'what I figure is, I get this here infection which settles in these arm muscles. You follow me so far?' And he says, 'Yes.' 'Next we try all these medicines and none of 'em touch it. Right?' 'Right,' he says, 'We even try a couple of courses of penicillin. Right?' 'Correct,' says he. 'Now,' I tell him, 'what I figure the trouble is, is that while this here first infection, this primary infection, is settin' in - Whammo! - here comes a brand new secondary infection and sets in right smack on top of the first one! Just like the old double pneumonia! And all we need to do to cure it, Doc, is to give me some double doses of penicillin to take care of both of 'em!''

Cousin Asa leaned back to watch my reaction. He lit another cigarette, but couldn't contain his triumph. "A doggoned secondary infection! And right on top of a primary! How do you like that?"

"What did Dr. Sanders say?"

"Say? Well, I guess I took him by surprise, but I got to hand it to him. He didn't twitch a muscle. He looked me square in the eye, slapped his hand on the desk and said. 'Mr., Whitney, I believe you're right!'"

"Did the double shot cure you, Asa?" asked Jane,

Cousin Asa beamed. He lifted his left hand high above his head and snapped his fingers three times. "In three days! In three days the old flipper was good as new. In three days, mind you - and all that time we never even thought of it!"

We all fell silent for a while. The ladies started to get up to clear the supper dishes. But Cousin Asa, eyes narrowing, pointed his cigarette at Cousin Flora. "There was another time. I had to make the diagnosis in her case."

"Now, Daddy," scolded Cousin Flora, "don't go and tell about that, It's late now and these people need to get to bed. Besides, I know the doctor must get tired talking about medicine. He's got to listen to it all day long,"

"Doctors always like to hear about interestin' cases," said Cousin Asa.

"Has Cousin Flora been sick lately?" asked Jane before I could stop her.

"Well, it wasn't all that much," said Asa catching Cousin Flora's frown. He hesitated. "I guess it is gettin' on toward your bed time. I forget it's an hour later here. Anyways, I'll just cut it short and give you the diagnosis first."

"What was it?" I asked.

"Too much acid in the system."

(c) "The Doctor's Lounge", The Bulletin of the Muscogee County (Georgia) Medical Society, Sep 1972, Vol. XIX No.9, p.16

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