Good News, Bad News

A couple of days ago I returned from a scheduled visit to the Mayo Clinic for a consultation. Following the principle of lemons-lemonade, I had elected to drive there, rather than fly, because I greatly enjoy road trips, and because I had never seen that part of the country before from ground level.

The journey began rather inauspiciously. Which should have been a clue. There I was, hauling along about 80 or so, northbound on I35 a few miles south of Waxahachie, when suddenly there was a “bang,” followed by a sharp drop in speed and a loud, rhythmic popping sound at a rapid tempo, which dropped from prestissimo to andante as I decelerated. Instantly, multiple warning lights flashed red alert.

My first coherent thought after a moment of total confusion was: “Blown-out spark plug.” I eased to a stop in the grass a good distance off the shoulder to test this hypothesis. A quick visual exam of the engine showed all plugs to be in their proper places. But a plume of smoke was rising from the exhaust header, the result of a rivulet of oil dripping from cylinder number 4. This could be a blown head gasket. Lovely.

State Farm dispatched a wrecker with an ETA of 120 minutes, a minor eternity when you are dead in the water on a really hot day by the side of a busy freeway.

There was no getting around it; this was a pretty bad fix. I floundered about for a solution, trying not to panic. I really, REALLY did not want to miss this appointment, a golden opportunity that might not come again. Fortunately, I had had the foresight to leave a day earlier than I otherwise might have, to allow for unanticipated delays. This gave some wiggle room. A small consolation but a consolation nonetheless.

It was already over 100 outside, and probably 20 degrees more than that inside the car. My fingers were sweating so heavily that it interfered with the touch function of the phone, causing random malfunctions and making every action an exercise in patience. With effort, I queried Google for “rental cars near me” which produced a disappointingly short list of businesses, all of which were closed for the weekend. I thought: This cannot possibly be right.

I needed reinforcements. I called Carolyn, who went right to work. After a few minutes she found Thrifty Car Rental at Love Field in Dallas, about 40 miles away. The phone continued useless for all online activity, so I was going to have to do this the old-fashioned way, by dealing with actual live humans. The contact number Carolyn provided connected to a call center somewhere on the other side of the globe, staffed by people with English-language skills ranging between sort-of and barely. Between my lousy hearing, the overpowering road noise, the thick accents, and the language barrier, it just wasn’t happening. So I gave up and asked Carolyn to set it up for me from her end. A few minutes later there was a rental car reserved in my name at a facility across the boulevard from Love Field, available until midnight. All I had to do was get there sometime before then.

In due time the wrecker driver showed up. I told him what I thought the problem was and invited him to take a listen. His initial reaction was exactly the same as mine had been: blown-out spark plug. Hmmm. Perhaps I needed to take another look, maybe lay hands on the plugs to see if one was loose in its socket. I zeroed in on number 4, and sure enough, when I tugged on the plug wire, the plug came with it. Well, well, well. There’s your problem right there.

This discovery also explained the worrisome oil leak. Subaru uses an uncommon boxer-style engine, with horizontally opposed cylinder banks. Their valve-train covers always leak a little after a few years, and the oil collects in the spark plug wells, which are canted slightly upward for better access, and therefore do not drain. The fuel/air mix blasting out the spark plug hole had apparently pushed the collected oil out of the plug well and onto the valve cover, where it had drained onto the exhaust pipe.

OK, maybe this wasn’t so bad after all. If luck was with me then maybe the threads hadn’t stripped during the forced expulsion, and maybe the plug could be twisted back into place without a problem.

I had no tools, though, and the Firestone shop where they towed the car had no availability that afternoon. Neither could they promise to be able to fix the thing if, as was realistically pretty likely, the threads of the spark plug hole had, in fact, stripped. Time was of the essence, so I had to keep moving. Rent car it is. The rest could be dealt with later.

State Farm offered a $30 discount on a Lyft ride. So I downloaded and installed their app, and instantly went down a rabbit hole of serial glitches, culminating maybe forty minutes later with the dreaded “Your account has been locked” message. Another forty frustrating minutes followed with customer support, which probably ought to be in quotes, conducted at glacial speed, entirely by text. The last communication was: We have submitted your case for review. The end. No timetable for resolution. Well alrighty then. Guess it’s gonna be Uber after all. So I downloaded and installed their app, and was pleasantly surprised to be greeted with the message “Welcome back, Scott.” Some years prior I had apparently set up an account but never used it, and had therefore forgotten about it. But Uber had not. In ten minutes I had a ride. Thirty five minutes after that I was standing in front of the rental desk at Thrifty.

After a five-hour delay, I resumed my northward journey in a nearly new Toyota Corolla. Not the full-sized car I had been promised, and for which I had paid. But it was clean, had really comfy seats, the latest in driver-assist technology and, crucially, a good air conditioner. As an added bonus the car got seriously good mileage, averaging a consistent 42 miles per gallon at 80-plus miles per hour. Much better than my Subaru. At around $3.60 per gallon, the savings on gas would take a good chunk out of the cost of rental. Eager to make up for lost time, I drove until blurry vision set in around 1:30 am. I stopped for what was left of the night in a blink-and-you-miss-it burg a couple of miles off the Kansas turnpike.

The remainder of the trip was blessedly routine. The driver-assist features were quite sophisticated. With all features turned on the car steered itself, kept a steady distance from cars ahead of you, applied brakes and throttle as necessary, and warned you of any obstructions. Very little was required of the driver. Which was fine with me; that much more bandwidth for thinking and observing the passing landscape. The car was almost advanced enough to drive itself, at least on the highway, but it didn’t allow that option. If you took your hands off the wheel, fifteen seconds later you would get a warning. If you ignored the warning, the assist feature shut off, an alert sounded, and the cruise control was disconnected.

The Toyota also had some irritating nanny-ish features, a reminder of the general wussification of our society in recent years. For example, you couldn’t use cruise control without every single driver-assist feature being enabled. This took a minute to figure out. The car locked all doors with an emphatic, final-sounding clunk, like a cell door slamming closed, the instant you put it in gear, and kept it that way. And if you tried to drive even a hundred feet with your seatbelt off, say from the motel office to your room across the parking lot, an alarm would sound, impossible to ignore, which quit only when you put the DAMNED BELT ON already FOR GODSAKE or slid the gearshift into “park.”

Some people are bored to tears by road trips. They don’t know what they’re missing. For me it’s practically therapy. You have unlimited time to think, plus an endlessly changing view. What could be better? On this particular route, while there isn’t any scenery that you might describe as “grand,” there is plenty to keep you interested if you’re willing to adjust your expectations. There are the Arbuckle Mountains of southern Oklahoma, a geologically complex formation with a history dating deep into the pre-Cambrian, that incomprehensibly ancient, alien era when the land was barren, the sea and air were poisonous, and the most advanced life forms on the planet were primitive, single-celled prokaryotes. Next up are the Flint Hills of Kansas, with thirty-mile views across short-grass prairie; the last remaining stands of it, in fact, all others having been driven to extinction by grazing and the plow. At the far edge of the Sunflower State are the Missouri Breaks, a densely forested warren of scarps, canyons, and promontories flanking the broad Missouri, a natural refuge continuously occupied by aboriginal Americans for a thousand generations.

A little farther along are the glacial outwash plains of southern Iowa, laid down just fifteen thousand years ago by veritable Mississippis of meltwater spilling from the great continental glaciers as they retreated northward. Beyond these are the limitless cornfields of central Iowa, the world’s granary. Hundreds of thousands of precisely spaced rows, each containing hundreds of thousands of precisely spaced, virtually identical individuals, each individual an exemplar of precision botanical engineering, optimally designed for the conversion of sunlight, carbon dioxide, and water into high-grade sustenance with maximum efficiency.

Beyond the imaginary line separating the imaginary entities of Iowa and Minnesota lie the Big Woods, that primeval web of towering, old-growth, maples and red oaks and sweet gums, with a summer canopy so dense that even at high noon the forest floor is shrouded in permanent twilight. These give way after a time to the boreal forests of the far north, a thousand-mile deep expanse of spruce, birch, and pines, reaching all the way to the high arctic, unbroken but for a narrow, man-made, corridor marking the imaginary line that separates the Canadian and American political entities.

Somewhere along the way, a friend calls me to ask how the journey is going. Fine for now, I say. But after we hang up, my inner hair-splitter gets hung up on the word “journey,” which seems evocative of something greater than a mere road trip. A proper journey, by definition, is long, serious of purpose, and transformative. You face a challenge or series of them, which if met lead to learning and growth. You encounter setbacks and false starts and wrong turns. But in successfully passing from origin to destination you are raised from a lower state of being to a higher one. Although I have described this excursion to others in casual terms, and in my own mind pretend that it is a little more than a diversion, in truth it is a dead-serious thing. It will not be pleasant. It’s outcome will almost certainly affect the rest of my life. So after some reflection, I concur that my friend’s categorization is accurate.

Yet despite its serious purpose, I thoroughly enjoy this voyage, and take a moment to wonder “why?” What is it about transiting from a known Point A to unknown Point B that appeals? Around this time my inner pedant chimes in with psychobabble explanations. Symbolic of our life journey blah blah blah, timeless quest for adventure blah blah blah central theme of our cultural yore blah blah blah blah blah blah blah. I shush it and start over. After a bit of reflection it occurs to me that at some deep level we instinctively equate changing our physical location with changing ourselves. Don’t like your particular status quo? Change it. Exchange a mundane and  problematic “here” for an exotic and idyllic “there.” Problem solved. Never mind that, as a wise man once observed, wherever you go there you are.

It further occurs to me that if you were to look at it as a business proposition, this “journey” thing would be a pretty hard sell. You leave Home, that place of comfort and safety, predictability and familiarity, where you well and truly belong, where everybody knows your name, to go god knows where and face god knows what. Hardship is pretty much a given, danger or injury or death a real possibility. It’s loaded with unknowns, especially unknown unknowns, the worst kind. What thinking creature in its right mind would ever willingly submit to such a thing?

Yet the urge to wander, to explore, to see what’s out there, to take a chance, is universal among our kind, and probably unique. It might be feature or it might be a bug. For every spectacular, celebrated success, there might be a thousand dismal, forgotten failures. But it’s what we do. And because of it, despite some very real downsides, at this moment in history we humans are pretty much rocking it.

Rochester is a lovely, well laid-out town in southern Minnesota that exists for the sole purpose of serving the Mayo Clinic. Of its 120,000 citizens, fully one-third work at the Clinic, and at least half the remaining serve it in some support capacity. Like many Midwestern cities, it uses the street-avenue, north-south-east-west system, so even without a map you know where you are just by looking at the nearest street sign.

Like a tourist town, Rochester is a Destination, only without the price-gouging. Food, drink, and lodging are more than reasonable, everywhere. Everyone is nice to you, everywhere. The vibe is overwhelmingly “Welcome. How can we help?”

For decades, the Mayo clinic has been the gold standard of healthcare. Almost every ranking of medical institutions places it first, ahead of such world-leading facilities as Cedars-Sinai, Johns Hopkins, Stanford Medical, and the Cleveland Clinic. The Mayo began modestly, when in 1878 a diminutive, energetic, English immigrant by the name of William Worral Mayo, described as “feisty” by contemporaries, settled in Rochester at the insistence of his wife, who had grown weary of the itinerant life of a traveling doctor.

The practice of medicine in the 19th century bore little resemblance to our modern version. At that time, doctoring was more of a trade than a profession, an art not a science. You needed no certification or formal training to practice medicine. There were no governing organizations. A would-be doctor typically apprenticed with an established one for a few years before going out on his own. Or not; some just hung out a shingle and took whomever showed up. You learned on the job, the hard way, and kept what you learned to yourself; trade secrets and all that. A visit to the doctor was as likely to kill or cripple as heal you.

But by the close of that century, medicine had begun to change, and William Mayo figured large in that transformation. He was among the first to apply scientific principles to medicine. He accepted the Germ Theory of disease, and understood the importance of cleanliness. He was also dedicated to the idea of service: “The patient’s needs come first.” At one point he and his wife mortgaged their house to buy a cutting-edge microscope for their practice. He was among the first to cultivate an ethos of openness; whatever was learned was shared.

A breakthrough of sorts occurred when Mayo came to realize the importance of skilled care in speeding the recovery process. In the aftermath of a devastating tornado in 1883, the agnostic Mayo partnered with the sisters of Saint Francis, a nearby convent, to open Saint Mary’s Hospital. At that time, hospitals weren’t known as healing institutions; they were dismal places where you went to die. Saint Mary’s Hospital was among the first to be devoted to healing the sick, not comforting the dying. The intelligent and dedicated sisters of Saint Francis, accustomed to the discipline of convent life, took naturally to the new, science-based regimen, guided by the philosophy of treating every patient as one would treat Jesus.

The Mayos had four children. From the time they could walk and talk, Mayo’s sons William James and Charles Horace were a part of the Mayo medical practice. They accompanied their father on his rounds, swept the offices, helped in myriad small ways, gradually learning the healing craft from the ground up. They turned out to be naturals. By the time they were young adults, the Mayo brothers were widely known for their skill and innovation. Doctors from around the country, and eventually from around the world, flocked to the rapidly growing institution to learn from the masters. In 1921, the Mayo Clinic was officially founded as a non-profit center for healing and teaching.

Carolyn arrived by plane at about 1 pm on Monday at the Rochester airport, quite possibly the smallest jet-capable airport you will ever encounter. Virtually everyone who passes through it is connected somehow with the Clinic, either a patient or companion to one, a doctor, or some kind of Clinic official. You do not go to Rochester for the fun of it.

The Clinic itself is a paragon of order, it’s superb management evident in every detail. The online patient portal lays out your appointment schedule to the minute. Each appointment begins with a check-in at a service desk. Twenty seconds later, you are all set. Ten minutes after that, someone comes out a door and calls your name. At no point do you wait for more than a few minutes. Everything runs right on schedule. If you show up early, they can almost always fit you in. There are five or six clinical buildings at the downtown campus, where most cases are handled. All are interconnected by elevated “skyways” and underground “subways,” which spare you from having to endure the fierce chill of a Minnesota winter.

Everywhere are reminders of the Mayo’s long and distinguished history. Memorials, honoraria, and testaments line the corridors. There is a museum of the Clinic’s history near the public entrance of the main building, another in the Plummer Building right across the way. You cannot help but realize how very many great persons have come together over the years to make this place what it is.

Thoughtful touches abound. Volunteers linger all over the place, ready to answer any questions. Stand there for a second or two looking lost and someone is guaranteed to walk up to you and offer assistance. Numerous grand pianos are scattered about, open to anyone to play. If no one does, sooner or later some official volunteer will show up to play a few selections from her songbook, providing welcome diversion for anyone within earshot. Giant windows are everywhere, lined with comfy chairs that face outward so that you may enjoy the view. Signage is strategically placed and absolutely clear.

Each and every day Mayo serves thousands of patients. Some like me are ambulatory, with no obvious problems. You’ll see a couple and wonder which of them is the patient. Others require no such guesswork. As we waited for my first appointment, just across the narrow aisle, almost close enough to touch, was a woman somewhere in her forties, confined to a wheelchair, daughter by her side. To look at her was to witness torment. Pale and withdrawn, all but done with life, she wore the thousand-yard stare of someone who had lost all hope. It was gut-wrenching to behold, and we both breathed a sigh of guilty relief when her name was called and she was wheeled away.

Over two days there were to be an initial assessment, a blood draw, a CT scan, an EKG, a fluoroscopic X-ray, and finally an endoscopic exam followed by a consultation with my assigned surgeon, a fellow by the name of Robert Cima.

The moment Doctor Cima walked into the room, it was obvious that something was off. He waived the endoscopic exam, and after a brief intro got right to the point: I can do what you want but there’s not much to work with, and you would probably not be happy with the results. I cannot scope you because it would cause an infection. By nightfall you’d be sick to the point of needing hospitalization.