Full Table of Contents
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Abbreviated
Table of Contents

Home Page
Patient Safety
Silence vs
    Safety
Silenced
White wall
    of Silence
Silencing
Conflict Of
    Interest
Psychology of
    Providers
Subjectivity
Blacklisting  
Nurse survey
Loyalty
Mobbing and
    bullying
Trust Us
Defensive
    documenting
Report Rate
Risk
    managemnt
SOAP
Management
Hospitals
Crime in
    medicine
Sexual Abuse
Liability
    Limitations
Free Speech
    for Patients
Exploitation

OSMB Medical
    Boards
Mammography
solutions
Medical errors
Medical
    Complaints

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Injured patients who want to help and be heard, click here.

 

Thomas Jefferson said that given the choice between government without newspapers and newspapers without government, he would choose to have newspapers.

In medicine we have government without newspapers. Patients cannot find out what they need to know to make informed choices. No one in medicine records or reports the information patients need to know the most. So patients will have to.

Karen

Rough Draft / Under Construction

There was no doorbell yet. There was no knocker yet. She heard a power tool being operated inside. Thinking he would not hear her knock on the door anyway, she opened it and walked in. "Hello?" No answer. He must have hearing protection on.

There was no furniture in the living room yet, only sawhorses and building supplies. She knew there was a counter in the bathroom where she could set down her purse. "Hello?" No answer. The power tool started up again. Her footsteps crossing the hardwood living room floor were loud. When she turned the corner into the bathroom, the ferret darted halfway across it toward her and stopped. She stopped too. Since it did not come closer, she took one more step into the bathroom, just far enough to set her purse on the vanity, and the ferret attacked her biting her on the ankle. She shrieked as she kicked flicking the ferret across the bathroom. When it landed, it got back on it's feet, turned to face her again, and charged. She backed out of the room closing the door so it could not pursue her.

Aaron heard the shriek and took off his hearing protectors. He shouted, "Hello?" She shouted back, "You're ferret bit me."
"What did you do? Go in the bathroom?"

Later when he recounted this story to Paul, Paul laughed. Fortunately, Karen had a sense of humor too. It was a different kind of sense of humor. It had taken him most of a year to adjust to it. But it was what got him through moments like this. It would only carry him so far thought. The main issue now was her wanting to get married. When that discussion had been going on for only a short time, perhaps a year earlier, they had been lying in each other's arms when she had said, "You do think you are going to get married someday, don't you?" His reply had been, "If I do, I hope it's to a girl just like you." Very few women would see the humor in that. No other woman he ever had known would. In fact, later, when she laughed as she recounted that exchange to other women, they were horrified. His social capital declined precipitously in her hands. Which was ironic since she was not one of those women who tried to make that happen. She tried to do the reverse.

For instance, when her family learned she was dating someone new and asked what he did. She had tried explaining his work, but finally said, "He doesn't really have to work." That stopped everyone. If any of their children had been going to find someone from a zip code like that, they knew she was the one who would. Friends, relatives and family members generally expected that of her, but a man who doesn't even have to work?

Aaron hadn't known how much she knew about him. He had been as discreet as he could. He had a job, even though an intermittent one. And he had created a half true description of it that he could back up and discuss in detail, but she saw through it. Even though he was frugal and sensible with money, his attitude toward it was not like other people's. In the grocery he never looked at prices. In a restaurant once when they overheard a waitress gasp that the people at the next table had not left a tip and she had bills to pay, he doubled his own tip to help out the hardworking waitress. Who does that?

They had reached the point in their relationship where, when he was out of town, she checked on his house. The mail was piled on the floor inside the door. He had said she didn't need to worry about the bills, but she opened them. He had paid the power company and the phone company three times more than he owed so there would be credit balances for a few months so there would be no need to worry about those bills. The same for his credit cards. Who pays a credit card company more than is owed?

There never was a mortgage statement from a bank. She kept waiting for one to arrive. Slowly it dawned on her that there wasn't a mortgage. He had paid cash for the house. That gave her pause. She could find no evidence of debt of any kind.

And besides, she had spoken to Richard.

When Aaron told his parents that he had bumped into and had lunch with Richard Hidelbrook that first time, they had asked how the Hidelbrooks were doing. Aaron had not found out that much about them. His parents told Aaron to be careful. Politics with that family were delicate. Richard's grandfather had fallen on hard times and Aaron's grandfather had helped him out. The Hidelbrook's had never been able to pay him back. Grandpa didn't care. He just didn't want it to get in the way of their friendship. Which, of course, it did. So much pride is involved in these things. Then Richard's father had struggled financially his whole life too. They were self conscious about it. Aaron's parents told him to be careful about what he said around Richard.

Aaron knew what his parents meant. In high school he had dated a woman from the west side of Cincinnati a few times. There is a cliché about Cincinnati's being divided into two halves - the west side and the east side. They say that people on the west side watch baseball and drink beer while the people on the east side watch football and sip wine. This woman took him to a party on the west side where one of the first people who had spoken to him was a guy who was telling a story about having just flown through Chicago. When he talked about what a huge airport it was, Aaron contributed that the last time he had changed planes at O'Hare he had been carrying a sewing machine. A big, heavy, old sewing machine. And he had to carry it from one end of that airport to the other. What for? A girl in his class was going out to visit her grandmother who had a sewing machine to give her if she could get it home. So they flew out together so that he could "help" her carry it back. "You flew out just to get a sewing machine?" No. They were looking at colleges. Her grandmother lives out east where they were looking at colleges. So they went together so that she would have someone to fly with and he would have people to stay with and he could carry her sewing machine for her on the way back.

It took only moments for Aaron to figure out that he had stolen the guy's thunder. The two of them were the only two in the room who ever had been on an airplane. It was the only time the other guy ever had. Most of the parents of the people at that party never had flown. The guy had a story to tell, about what flying is like, and had expected to get a lot of mileage out of it that evening. Aaron had not just stolen his thunder, but had made his adventure seem insignificant. Within an hour Aaron figured out that it was worse than that. In his story he had said he was looking at colleges. And the flight was to out east no less. Most of the people in that room were not looking at colleges anywhere. Most of them were proud to be graduating from high school and were going to be looking for jobs soon. He had established himself as the biggest jerk at the party.

His date could not have been more happy to be with the guy who had so established his presence among her friends, but Aaron was mortified. He never saw any of those people again, but he knew that if he did, there would be no fixing it. To prevent doing that with Richard, who knew three generations of his family, would require an almost superhuman vigilance. He worried more about it when Richard and his brother Ted hit off and began doing things together. Ted was less of a people person. How was that not going to turn into a problem? But the situation kept being so weird. It was confusing.

Like one time when Richard telephoned him from a payphone asking if Aaron wanted to join him and some friends that evening. Aaron could not because he was flat on his back again. Richard said he was going to call him back in a moment. A couple of minutes later Karen called. He knew her by reputation. Richard had mentioned her a few times. She said that Richard was out of quarters and could not make another call, but had asked her to call Aaron and tell him that they were coming over to see how he was. Aaron said he was fine. He just had to lie still for a couple of weeks. He said they didn't need to come over. She said it was too late. Richard was on his way and she was to meet him there. Then she said, "So I'm really going to get to meet the Aaron Roark I have heard so much about?" So much? "Richard talks about you all the time." He does? "To hear him tell it, history will remember this century because of Einstein, Ghandi, and Aaron Raork."

Aaron laughed and said, "Right."
"Those were his words."
"Noooo."
"I'm not kidding."
"Why would he say that?"
"You make an impression. He talks about you and your brother - how creative, talented, smart, well-meaning you both are. He doesn't understand half of what you say about politics or your brother says about design and archetecture, but you have your sights set on the United Nations, don't you?"
"I did, but healthcare can take your sites off everything but getting up off the floor."

He didn't know it at the time, but having Richard for a friend was like having a publicist working the grapevine. Eventually he would figure out that there were perhaps a dozen women in Richard's circle like Karen. Any of them probably not only would have gone out on any kind of date he asked, but could have been talked into marrying him shortly thereafter. Most guys compete in that arena. Why was Richard doing this?

One of the things Aaron liked about Richard was his freedom from that competitiveness that is virtually ever-present among males. He didn't one-up Aaron or worry about being one-upped by him. Managing the pitfalls Aaron's parents had warned him about was possible because of the kind of person Richard was. But Aaron had no idea Richard what motivated Richard to say these kinds of things about him.

When Karen told him about it, Aaron believed that the information she had received about him was fragile and unsupportable. Just how fragile interested him. He was thinking about Solomon Asch, someone important in some circles of social science, along with Milgram and such people. Asch had shown that seeing isn't believing, but rather that seeing is believing what the group tells you to believe. Richard was feeding information to people that altered the way they saw him. Would they continue to see him that way if they had actual contact with him? Could experience overcome the beliefs of their group?

Asch had put groups of people in rooms and asked them simple questions that any child could answer correctly, such as which of three lines drawn on a piece of paper was the longest. The answer is obvious, unless other people answer it incorrectly first. All of the people in the room were plants except one. The plants would agree on an incorrect answer. After witnessing that agreement, other people usually agreed with it too. Things that obviously could be seen to be wrong by an independent observer, were not seen as wrong because of the suggestion of others. So would they change their minds when left in the room without the plants?

He was going to meet Karen in person. She had said his name in the same sentence with Ghandi and Einstein. How quickly would illusions be shattered by practical experience? He was interested to see now that they were going to meet.

Richard arrived first and was sitting on the bed talking to Aaron, who was not moving from the floor for anything, when Karen knocked on the door. Richard shouted, "It's unlocked." She came in and followed their voices to the bedroom. Aaron thought it curious that Richard didn't run to meet her at the door.

Karen entered wondering if it was safe to leave the door unlocked in that part of town. Aaron explained that he didn't have much choice. When his back was out, he could not get up to let people in, and people had to be able to come to help him. She asked who was taking care of him. "Oh, sometimes Mom drops in. Sometimes my brother. My friend Paul stops by on one weekend evening each week. In between, if I need someone, sometimes I summon a neighbor." Richard picked up one of the foam tubes lying on the floor beside Aaron. He said, "Look at these. See this recessed button? If he pushes this, it rings a neighbor. He bought wireless doorbells and gave a different one to each of three neighbors. In an emergency, he can buzz someone to come down."

Aaron said, "The door has to be unlocked if they are going to be able to get in, so. . ." Richard said, "See. In his family this is normal. They just go to the hardware and buy doorbells and find foam someplace and put this together. To think of things like this is just normal for them."

Karen asked how often neighbors come down. Almost never, he told her. Just for emergencies. She said, "So who is taking care of you?"

The phone rang. It was Ted. Aaron said, "Guess who is here?" Upon hearing that Richard was there, Ted said, "I'm coming down." Ted and Richard spent a while in the living room talking before they decided there was something they wanted to see and left Karen and Aaron in his bedroom. Aaron said, "He's not a jealous person, is he?" She thought it might be a sign of how much he trusts Aaron. Aaron asked, "How much trust is involved with a guy who can't even get up off the floor?"

Karen said that Richard talks to her on the phone as though he misses her and wants her to come back to Cincinnati. But when she gets here, he runs off with Ted on a Friday night.

Karen was at the school of Public Health in Wisconsin studying to be an epidemiologist. In high school when she was thinking about college, she had decided she wanted to be either a teacher or a nurse. Her father said to her that women don't always have to be teachers or nurses. He said that you could go into education without being a teacher and that you could go into healthcare without being a nurse. She thought about being a principal, but they have to go to every play and sporting event at the school. She had looked into being a doctor but did not want to be telephoned in the middle of the night and did not want to go to school that long. She also said she liked the security of the public sector for the retirement and healthcare plans, and so settled into studying to being an epidemiologist planning to work for the CDC, the Centers for Disease Control, where usually you would work a normal nine to five shift with weekends off.

As he listened to her he was struck with how much more practical and down to earth she had been in her goals. He wanted to save the world and create peace on earth for all nations. She wanted a retirement plan. He liked the reasonableness and attainability of it. He believed he was learning something from her.

"You know," she said. "If you are going to leave your door unlocked, you really should live in a better neighborhood."

Years later he would wonder if that's why he moved. He often said that one way or other other he always did everything she said.

She did not have it in her to leave him there alone. For the rest of the time she was in town, she kept calling. She kept coming over. Sometimes she arrived with groceries and cooked. Almost always she sat next to him on the floor just to be company for hours. After a while she said, "If you have any secrets in this place, I don't know where you've got them. I've been into everything."

One of the oldest stories in the world is the attraction between nurses and their patients. Caring for someone and being cared for by someone clicks on some primordial level. It is not as though anything particularly romantic could happen. There was Richard. And there was Aaron's inability even to turn his head.

She went back to Wisconsin. He bought a ranch house (bad knee - no stairs) in the suburbs. Not a big one. But he had so many downtimes, either because of health problems or contracts ending at work, that he thought he should have a project that was lucrative that had no deadlines and could be picked up and abandoned at will. He knew that one of the most lucrative things that a small investor can do in real estate is to fix up a rundown house and sell it. So he bought a rundown house in the worst part of one of the best suburbs and created a plan for sprucing it up and turning it over in his spare time. His brother came to see it and said, "You know, if you tore out this wall . . . " and then talked for half an hour about how great that house could be. It was the wrong kind of thinking for turning a profit. It was the kind of thinking that created wonderful spaces, but not profit. But Aaron found parts of the plan attractive and set to work on a project that instead of taking a few months now would take a couple of years. He was inexperienced at assessing the time it would take and was too easily influenced by Ted and ideas that sparkled.

In order to speed things along, he decided to contract out part of it. He got quotes from a couple of contractors on a portion of the work. He gave a 30% deposit to the cheapest quote and never saw that contractor at his house again. When he finally figured out the guy never was coming back, he called a lawyer. The lawyer told him that the cost of pursuing the contractor would exceed the amount he'd be likely to collect and so it wasn't worth pursuing. He called several lawyers. Each said a different thing, but none of them were of any help. He even called the police. They told him he could file a report if he wanted. He went to the station and did. A detective there spent forty-five minutes asking him questions about the contractor and the contract and the work and what Aaron had done to find a solution. Aaron was supposed to find some additional information about the contractor and call back. Three days later when Aaron called back with the information, the detective had no remembrance of the case or Aaron and could find no file relating to it. As time went on, he would learn more about how little people in trouble can depend on the police to be energetic and interested in doing what many would consider to be their duty in such matters.

No one even told him that when a contractor takes a deposit and disappears without driving a single nail, it is theft. Aaron could have told the police to put the contractor in jail for it. The police did not explain the applicable law to him. In the future he would find that often the police do not know the law. In this matter, the contractor's facing the prospect prison might have squeezed the return of some of Aaron's money out of him, and might have made the contractor less likely to continue to do such things to other people. The contractor was an expert at bilking people. His victims were not experts and needed some help from someone who was, like perhaps the police. But neither the lawyers nor the police told him what he needed to know, let alone did anything to help.

Aaron tracked the guy down and figured out where he lived. A neighbor said he was installing carpet for Dalton Georgia Carpet Outlet, but advised him not to pursue it. "He's a hill jack. He has a gun. He knows where you live." Calling someone from Appalachia a hill jack was the same as using the "N" word to refer to someone of African descent. The neighbor himself appeared to be Appalachian and so perhaps might be excused for using the term. He looked at Aaron's appearance and asked where his house was. When he heard "Blue Ash," he felt he should explain a thing or two about the world that someone from the east side might not understand. He said that in a black neighborhood someone like Aaron could become a crime victim at anytime by anyone because he looked like he might have something worth stealing. But here in this "hill billy" neighborhood, no one would bother Aaron unless he bothered one of them. If someone bothers a hill jack, every friend, cousin and in-law would be looking for Aaron. The Hatfields and McCoys are no myth, he explained, although in more colorful language that included the "N" word.

Cincinnati is the location of the largest in-country migration in the history of North America. It was the migration of people from Appalachia to the city. They comprised a quarter of the population of the city and often had no use for people of African descent. Aaron had sat with educated, successful people listening to them condescendingly disparage racism in Cincinnati as though the people who were racists were evil and should be carted off to pens and forgotten. They did not see their own attitude as possibly being the equivalent of racism for speaking so disparagingly about people from a culture from the hills where few finished high school and few had jobs and family was everything. Part of hill tradition was that it was an insult to your parents to show them up by doing better than they did. If you father quit school in the fifth grade, out of respect for him you did too. Racism was part of their heritage. What do you do to influence the heritage of a group that does not read newspapers or magazines, that does not finish high school, and that often even is illiterate? Self righteously disparaging them as a group is a sort of racism too, isn't it?

Aaron had friends in both camps. The man who cut his hair was Appalachian and owned three hair salons, drove a Mercedes Benz and flew to Florida to play golf one week out of five in the winter. One time while getting his hair cut, a mixed group of black and white men, some of whom appeared to be Appalachian, came into the hair salon. The man at the head of the pack, a wiry, old black guy with bloodshot eyes, asked a question. Aaron's haircut was stopped for a bit while the hair stylist had a discussion about work they were doing on one of his apartment buildings. When they left he said, "Sorry for the interruption. That man has been working for me for seven years. If he brought that crew in here, it was because he wanted them to hear for themselves what I wanted them to do. It can be hard to get people who have their own way of doing things . .  you know when you are used to doing things a certain way?"

Aaron had been warned not to pursue the contractor, but he didn't stop. In a brown shirt and brown tie and brown slacks, he walked into the particular carpet outlet the contractor was working for and said that the sheriff wanted to verify the employment of the man, which in fact they had said they did, but no one asked who Aaron was. What Aaron wanted was to find some way to garnish the contractor's wages. The attractive, young woman behind the desk opened her books to Aaron. Aaron saw that the contractor had given them a social security number that was one digit off from his real one. They hadn't seen him in a while, but they owed him money and told Aaron on what day he most likely would come back to get it. Aaron could come wait to see if the contractor showed up. When Aaron asked more about the contractor, they remembered that when applying for the job, he said he had installed carpets for Buddy's Carpet Barn.

Aaron called Buddy's and had trouble getting cooperation. They were defensive of their contractors. Aaron kept a light and friendly conversation going with them and learned that when the contractor had applied for work, he hadn't had the necessary tools. Sub contractors are supposed to supply their own. But this contractor had told them a hard luck story and persuaded them to provide tools to him that he would work to pay off. He would pay them off out of the work they provided to him. Aaron said, "Well, rather than work for you to pay for the tools, he's using your tools to install carpet for Dalton Georgia." Their toned changed completely. They realized they had been had. They answered everything Aaron asked and told him to let them know if he learned anything additional.

His weekly evenings of discussion with Peter were less funny and less lofty during this period as the questions on his mind were about how to survive in a world in which people cannot be trusted.

Karen asked if was worth putting this much effort into this. He supposed she had a point. He spent one more day on it. He sat in the parking lot at Dalton Georgia on pay day and waited all day. The attractive woman from behind the desk walked past him several times in the parking lot. Each time she smiled and waved. One time she came out and asked if she could get him coffee or anything and they chatted for a bit, but he declined. He gave up at about six-thirty that evening. She called him later and said that the contractor arrived about five minutes after Aaron left. Does the contractor know what kind of car Aaron drives? Does he know Aaron is following him? Aaron gave up.

Part of why he had pursued this is he had made several bad decisions and was trying to arrest the downward spiral. For one thing, when purchasing the house he had not put in the sales contract any contingency about financing, because he was going to sell stock to pay for it. He signed the contract on a Friday but decided not to bother his broker until Monday. On Monday when he called his broker to sell the stocks his broker said, "Well, you don't want to sell it today. We just had one of the largest drops in history today." The stock market continued to drop and drop. The house ended up costing thirty percent more than it would have cost if he had sold the stock on the Friday he bought the house.

After he signed the contract to purchase the house, but before he finally gave in and sold his depreciating stock, the real estate agent showed up on his doorstep with papers that needed to be signed and said, "Oh, by the way, I also am one of the owners of the house I sold to you. That's not a problem, is it?"

"Um. I guess not."

But it was. He had ended up agreeing to a purchase price for the house that was too high, which he chalked up to his own ineptitude. He knew so much about real estate. He had read a book on negotiating. But it was his first house purchase, so he chalked it up as an expensive learning experience. Now he learned that the agent with whom he had negotiated also was the owner.

His training as an investigator of brokers had touched on this, but he called his stock broker to clarify it and said, "If a stock broker sold you a stock without disclosing the he is one of the principles in the company, that would be wrong, wouldn't it?" Yes. Very wrong. There are regulations about that. "What if a real estate agent negotiates the sale of house without disclosing that he is one of the owners?" His broker did not know a lot about real estate, but it seemed to him that would be putting the buyer at an unfair disadvantage in the negotiation. He suggested calling the board of realtors.

When Aaron called the board of realtors, they did not answer the question. They did not say whether it was right or wrong. They told him how he could file a complaint if he wanted. So he did that. A couple of months later he and the agent were called to appear before the board to tell their stories. The real estate agent pointed a finger at Aaron saying, "I said to you, when I came to deliver those papers, that I was one of the owners."

"That was after the fact. We'd already signed the contract."
"So why didn't you complain right then at that moment?"
"Because I'm just a normal person. I'm not experienced with this. I'm not an expert in this. It seemed to me that something about this wasn't right. But I wasn't sure."
"You said it wouldn't be a problem."
"No. You said, 'That's not a problem, is it?' shaking your head "no" with a good salesperson's technique for evoking agreement. I said, 'I guess not'."
"You could have called me up. You could have complained."
"We were going to end up here anyway. Why get into a shouting match?"

The realtor had come with a lawyer who repeatedly impugned Aaron's motives. He asked question after question that implied Aaron was out to get the realtor because of his own sick motivations. One of the board members finally asked the lawyer to stop persisting in impugning Aaron's motives and discuss the facts. Another board member asked Aaron if there had been a For Sale sign in front of the house and what he remembered about it, then asked the realtor if that sign had identified him as a licensed real estate agent.

The agent was reprimanded and put on probation.

That did nothing to make Aaron whole. This did nothing to make up for the negotiating disadvantage at which he had been and how that appeared to have added to the amount he paid for the house. But he thought it was the right thing to do. This agent might have pulled this same stunt many times in the past and easily could have continued to do the same thing many more times in the future if no one stood up to say something about it. Like a plumber no one ever complains to about 250 dishwashers. A normal person does not know enough to be sure such behavior from a realtor is wrong. A normal person does not understand how exploitative it is. A normal person is too busy managing the demands of his or her life to go to the trouble to do something about a situation like this. Aaron felt a duty to do it even though he there was no benefit to him in doing it. He felt it was his duty to do what he could to protect the next person and said that to the board of realtors during the meeting.

Putting that big, expensive mistake behind him, and putting the theft by the contractor behind him, he embarked on the remodeling plan Ted had suggested, rather than the more practical one he originally had come up with himself. Aaron had checked with a real estate agent they knew about whether or not it made sense as an investment. Real estate agents are the wrong people to ask such questions. The agent told him to do it.

When his father heard about his experience with the reprimanded agent and his experience with the contractor and the drop in the stock market, he said to Aaron's mother, "How can one person make so many mistakes?" She repeated that to Aaron. Aaron knew the answer. In college he had been affluent enough not to have to stay in a punishing dorm situation. He moved off campus and then became sick. Between those two things he had missed the social lessons and the network building that people normally get when they are freshmen in college.

Then his back problems continued to separate him from a potential community. He did not grow socially as he should have. Then he got a job that did not require that he go to an office or become part of a community. And now he was working on an additional task that isolated him in another way. If he had been working to become an investment counselor or an executive, his family's community could be of some support. But he was rehabbing a house - a world the community of his parents knew little about. He was naive and alone, except for Ted who was not practical. And Paul with whom weekly discussions over dinner were not about real estate and building products. He was having to figure out solutions in isolation, which meant he spent a lot of time at the builder's supply reading instruction labels on products to figure out what to buy and how to use it.

One problem he had was with the plumbing. When he was in the crawl space sweating pipes, it took forever to heat the pipe enough to boil the moisture out of it enough to get the solder to hold. And even then it did not work well. Driving down the road one day while listening to public radio, an announcer on a children's show happened to mention, during the course of a story, that his uncle had been a plumber and had taught him to get a slice of white bread and shove it in the pipe to hold back the moisture from the joint being sweated. Then, when you are finished, turn on the water and the water pressure will push the white bread out of faucet. After that Aaron had no more problems installing plumbing (as well as even more reason to continuing to listen to and contribute to public radio), but he could not help but shake his head at how hit and miss his ability to learn these things was.

This situation was only worse in medicine. After his experience with his back and his knee, he wanted to find a doctor to whom he could go for second opinions. He had a wart that Karen had said he should get rid of, so he decided to use it as a way to explore for other doctors. He went back to Colorado.

At the Colorado Medical Facility they had him see Dr. White, the man who had grown up behind him and next to AhEeeAh. Dr. White showed no recognition of his and Aaron's having been neighbors. He did not really look at Aaron and appeared completely disinterested in his existence. So this was not going to be a new physician on his list. Dr. White used a chemical treatment to attempt to remove the wart and explained that they did it this way so that they did not have to go to the expense of storing liquid nitrogen. It did not work. Aaron returned three times. Each time it did not work. Each time he was charged full price for the visit. Part of his discussion that week with Paul was about how many other industries repeatedly would charge the customer for work that did not accomplish its goal.

He remembered the initial explanation of why they did not use liquid nitrogen and decided to seek help elsewhere to see if someone else did. He went to the dermatology department at University Hospital. A new man had just taken charge of that department and they gave Aaron an appointment with him.

Dr. Sullivan was almost as tall as Aaron, was in his forties, was fairly fit physically, and had thick, dark, well groomed hair. He asked Aaron many questions about himself, including quite a few about any other potential skin problems he could have, and including something about any potential girlfriend he might have. Then he said that they would use liquid nitrogen and they would remove the wart on the first try. Aaron was not aware that dermatologists see a lot of people who have sexually transmitted diseases and that often such patients are reluctant to talk about all of their symptoms or behavior or other health problems that might be involved. So some dermatologists are good at putting patients at ease and getting doctors to let them examine them. He also was unaware of other reasons that some physicians have for wanting to examine patients, but in half an hour he was on his back in his jockey shorts with the physician nearly touching them as he asked Aaron to hold his testicles out of the way while he checked something. From a very private area he scrapped some skin and handed it to a student who was shadowing him and asked him to get it checked. After that he used liquid nitrogen to remove the wart. 

He had just come from Louisiana to run the dermatology department here. His dream was to live in the country in North Carolina where he owned a house that he was planning to retire to someday. Currently he was renting the house to his retired father. "Why don't you just live there?" This is what he does, so he was here. He asked Aaron a third question about his girlfriend. Aaron did not know what to say to any of these. He was not sure he could call Karen his girlfriend yet. So he was evasive about those questions and made answers that he thought provided the requested information without having to commit to having a girlfriend. Dr. Sullivan had his own interpretation of that. After the student reported the results of the test of the skin scraping and then left again, Dr. Sullivan said he was new in town and did not know anyone and asked Aaron if he would like to come over to dinner Saturday night.

Aaron was so shocked he said, "Okay," and then felt like an idiot for not having made an excuse and declined. Dr. Sullivan said, "Would you like to bring your girlfriend?" Aaron said, "Could I? Yes. I would. Thanks." Dr. Sullivan did not hide feeling deflated and said, "It won't be much. It will be simple."

In high school he would have been smart enough to handle this better. But he had been isolated too long. It did not occur to him to call the doctor and say something had come up and he was sorry but could they do it another time, with both of them knowing they never would. Instead he called Karen to ask what the chances were that she would be in town that weekend. They were nonexistent, but she said just to call one of his friends. So he called Beth.

Beth was one of the twelve or so women that Richard had propagandized about him. She had very strong opinions, seemed to be angry at people a lot, but had a body that men never forgot. Narrow set eyes that peered at you intently during conversations and then closed when her large mouth opened in laughter. She was pretty. She said she was getting married in two weeks. He congratulated her and asked about her future husband. She asked why he had called and he told her and she laughed and said she would love to come. "But you're getting married in two weeks." Her husband was going off with college friends that weekend. She would be alone. He would understand if she went off with an old college friend too.

At dinner with Dr. Sullivan, he watched the way the two of them spoke and finally asked if this was a long term relationship. They said they had known each other a long time, but Aaron could see that he didn't believe it. That made Aaron aware of how Beth and he were interacting, like two flirtatious kids who were interested in something that was not part of their relationship, but he did not know what to do about that and did not think it mattered anyway. This would get them through the evening.

Dr. Sullivan had asked Aaron several times about his job. Aaron had given up using the ruse he used when he was an investigator, because he no longer was an investigator. Now he said that he was renovating a house for sale. The doctor did not appear to be satisfied with the answer. Aaron did not look like someone who renovated houses. He asked more questions about just what Aaron was doing to the house at that moment. At that moment Aaron was laying brick pavers into wide, angled steps leading up to the front door. He said it was something that was better in concept than in practice because it involved cutting so many pavers at exact angles to make it work. Beth asked how he did that. She said she always wanted to know how to do that. She asked if he would teach her. Dr. Sullivan asked, "Haven't you been over there while he's doing this?" Aaron said that he just had begun that particular project two days ago and that No, his house was such a dusty mess of building materials that they did not spend much time at his house. Right there in front of Dr. Sullivan they set a date for the next afternoon for her to come to his house to learn how to cut pavers and set them in sand to make steps bordered by timbers. Dr. Sullivan leaned back in his chair watching two attractive young people flirt with each other.

And she was attractive. The next day he was covered with dust and sweat in his driveway holding a circular saw in his hand when Beth pulled in his driveway. He ran to her window to tell her that her car would get covered with dust there and that she should park in the street. As he leaned by her window to tell her that, he saw that she was wearing the shortest blue jean cutoffs a person can wear without getting arrested. She smiled up at him and backed out of the driveway. When she got out of the car, she tightened the knot in her tee shirt that looped the bottom hem of it through its neckline leaving her waist uncovered. As she did that, he looked away lest she catch him noticing that she was not wearing anything under that white tee shirt. Later this would lead to a discussion with Paul about Socrates and Plato and temptation and restraint - temperance being the virtue that produces self-control, and self-control being the ability to resist the temptation to act violently in order to satisfy desires, and isn't sex like an act of violence in certain ways? In the giving in to becoming physical in a moment of passion. Those words used so often in the same sentence. Sex and violence.

As she walked up the driveway, she said, "Looks like you're getting something done."
"Making dust more than anything, I think."
She saw the steps and said, "This is great. I mean it. This is going to be great. Really great. I like this." No words of response came to his mind. All of his mental gears were struggling to produce enough restraint to keep his hands off of her body.

There was no wind on that hot day. Dust hung in the air when he cut the pavers. He had a hose with a nozzle on it set to mist. At times he had sprayed that into the air to clear the dust out of it so he could breathe without the mask. The driveway was wet with water that did not shine because it was laden with the masonry dust. He worried that the muck would hurt her sandals and she said not to worry as she had brought worse ones with her in case she needed them. She went to her car and shed the cute leather sandals. She returned wearing foam rubber flip flops.

He showed her how to mark the angle on which a paver needed to be cut by holding it over the place into which it was to be set and laying a straight edge across it parallel to the timber, and then scribing a line on it. He had her stand back with her fingers in her ears and watch one time as lowered the circular saw's abrasive blade onto the scribed line. Dust billowed. It shot into his stomach and rolled up and down his body and around his head, nearly blinding him, as he held the saw steady and gently worked it back and forth along the line cutting his way through the brick. It took a lot longer than she had expected. She said that she was worried she was going to destroy a brick trying it. He said he had extras.

The scribed another paver. He adjusted the goggles and hearing protection to fit her and put them on her. He stood off to the side with his fingers in his ears as she tried lowering the saw onto the paver. She did not quite understand it and the saw jerked toward her and cut a curved line in the wrong place on the paver. He showed her again about how to set the front edge of the saw down to steady it, and then lower the rest of it slowly. She never got comfortable with it, and never got really straight cuts, but ones that were serviceable and that he used. Half way through the first paver her brunette hair had changed color with the dust. So had her skin and her clothes. The dust was on and in everything. It even got inside the goggles as they did not conform to her smaller head as tightly as they did to Aaron's. When dust got in her eyes and she pulled the goggles off, she took off the work gloves he had given her and reached to wipe her eyes with her hands when he stopped her. Instead, he had her bend over at ninety degrees to face the driveway while he put the hose in her hand. He took the nozzle off of it and set it for a gentle trickle. She let that run across her face to remove the abrasive dust without rubbing it into her eyes. She said, "That feels good. Cold water on the face in this heat and dust feels good. Can we do this after every paver?" She let it flow on her chin and cheeks almost to her ears. He gave her paper towels to dry her face, but water ran down her front into her tee shirt where it made it clingy and less opaque. He dropped the running hose on the driveway wondering what Plato would do.

After the next brick, and after the next hosing of her face, he put the nozzle back on it and sprayed it around to clear the air. She thought the mist felt good and took the hose and sprayed it straight up above her so that the mist would drop on her. Her tee shirt became less opaque after every paver. And when she bent over to run the saw, the extra weight the moisture gave to her shirt caused it to fall open further. He was speechless.

After an hour and a half of cutting pavers and setting them in place, she said that she had known it was going to be dusty and sweaty, but she had not idea it was going to be this dusty and sweaty. This was the most dusty and sweaty she ever had been in her life. Lifting open her cleavage and looking down it herself said she had dust in everywhere. She picked up the hose and pointed it inside her tee shirt as she washed dust out from inside of it. Aaron wondered, "Am I supposed to look? Am I not supposed to look? She is facing me and talking to me. Do I turn my back?" She leaned her head back and let the water run through her hair to get the dust out of it. The tee shirt became transparent. He said, "Should I increase the flow?" She thought he should, but then said, "You have a shower in there, right? Why don't I just go stand under that?"

As she climbed over the partially completed front steps to go into the house, he asked her if she would like something to drink. While he was in the kitchen putting ice in glasses listening to the shower run, she called out, "And so that hole in the roof is going to be a skylight?" With the water running she could not hear his response, but after she turned off the water she continued. "This is so great. I never saw a shower with a skylight before. It is so great to shower in the sunlight like this." She came out of the bathroom wrapped in a towel. "I hope you don't mind. Once I was in there, I thought, 'What the heck?' How often do you get to take an indoor shower in the sunlight with fresh air blowing through. So I took a real shower in the sunlight. Do you have a washing machine in which I could spin these clothes dry?" He didn't. Not yet. The renovation was not that far along yet. Taking her drink from his hand she said, "Oh, well. I can wring them out in the sink."

Had she been present that time in the cafeteria when Franny had said, "Christ, Aaron. What's a woman have to do? Hit you in the head?" He said, "If you weren't getting married in a week . . . "  She said, "I'm not married yet." He thought, "Holy crap" and had to review exactly where his relationship with Karen was. They had not slept together. They had not spoken of having a relationship. Couldn't he be forgiven if he wasn't completely clear about that? Would anyone ever find out anyway? Somewhere in the back of his mind was a question about why Beth was presenting this temptation a week before getting married. Was this her bachelorette blowout? Had Richard's propagandizing her made her want to have a child with him? Was she in love with her finance but seeing this as an opportunity to have Aaron's child without cheating during her marriage? It was all confusing and speculative and difficult to think about with nothing but a towel wrapped around Beth in his kitchen as she leaned over the sink wringing out her tee shirt.

He finally said out loud, "Holy crap."
She asked, "What?"
"You in that towel. When you lean over the sink, it gets shorter. If you weren't getting married in a week . . . "
She said, "I'm not married yet."
He thought, "Holy crap," again.

When he told Paul that he had managed to get through the afternoon without taking that towel off of her, Paul shook his head saying that he should have gone for it. But they discussed fidelity and integrity and building relationships free of guilt or complications caused by momentary passions. Paul said, "So the passion was momentary and is gone?" "No," Aaron said. "It sticks to every part of me like hose water wet dust. I think somehow it got in my brain." Paul laughed.

For the rest of his life Aaron would have moments when, mentally, he was in that driveway or in that kitchen with her as though it was happening right then. Eventually, he would think that his restraint that afternoon was one of the greatest mistakes of his life.

A few days after Beth had been there, he was asleep one night when he heard a noise. His living room was open to the sky. He had torn out the ceiling to make it a cathedral ceiling. The hole in the roof under which Beth had showered let light shine into both the living and the bathroom and even spill some light into the kitchen. Had something crawled in through that hole in his roof? He opened his eyes and listened. In a single story house with a gapping hole in the roof, anyone or anything could get in. No part of his brain suspected it might be Beth at his door wanting to ask why he had resisted her, but a little part of his brain wished it was. After a moment he heard the noise again. He rolled out of bed quietly. Since it was a wood floor over a crawl space, he had to move carefully so it would not creak. He tiptoed into the living room and stood looking up into the moonlight coming through the roof. He saw nothing. He heard nothing. After a long moment the sound came again. It was from under the floor. He knelt down and put his ear on the floor. After another pause there it was again. A gnawing sound. What was in the crawlspace eating his house? He stomped on the floor and the gnawing stopped. He went back to sleep.

A couple of nights later he heard the gnawing, got up, stomped on the floor and went back to sleep. This escalated until it took slamming a two by four against the floor to make enough noise to discourage the creature. Finally it got to where slamming a two by four only caused a twenty second pause in the gnawing before it resumed. He had been down there during the day to drag wires and pipes as he remodeled, but never saw anything but gnaw marks. So far he had been disinclined to crawl on his stomach at night to confront the animal.

He went to the hardware and bought a mouse trap. The next morning it had been set off, but apparently whatever had triggered it had been angered by being trapped because it took a bite out of it. Not a bite like gnaw marks. A bite like a person would take out of a sandwich. He went back to the hardware and got a rat traps - bigger platform, thicker wood. The next morning there was a rat in the trap. Not including the tail its body was about seven inches long. He removed it and reset the trap. During the next several nights there still was gnawing, but nothing else got caught in the traps. This time the hardware sold him glue traps. The next morning he had caught another rat identical to the first one, but during the ensuing nights there continued to be gnawing without anything else getting caught in the traps.

Finally he called an exterminator who explained to him that adult rats send the baby rats out to investigate anything new that enters their environment. When a baby gets caught in a trap, they know not to go near traps. So Aaron had trained the community about traps and traps would no longer be effective there. "Community?" Aaron asked? "Oh, yes," said the exterminator. He estimated that Aaron had a community of forty or fifty rats in his crawl space. But he said that it would not be a problem. He had a poison, a white powder, that he could puff into the crawlspace. It would settle everywhere so wherever the rats went they would walk through it and die. It was not something that Aaron could purchase himself. You had to have a license to get it and you had to have a license to apply it, but it would kill the rats.

The problem Aaron saw was that he himself crawled through that crawl space in order to work on the house. The exterminator did not think that would be a problem, but Aaron did. He also worried because the seal between crawlspaces and houses is not air tight. Dust moves back and forth. He would be living with poison. He called several other exterminators, but each had the same solution.

Aaron knew that two hundred and fifty years ago people got rid of rats before they had poisons like these. He wondered how they did it. He drove to the library to research it. This, of course, was in the days before there was an Internet and you had to get in a car and go to a library and get a book to learn about such things. He found books that were so old that it was hard to distinguish between and "f" and an "s." He read about using ferrets to get rid of rats. According to the books, ferrets attack rats on instinct and they are fearless and relentless. If a ferret sees a cat or a dog, it runs straight at it, but not in attack mode. It just wants to play. Dogs and cats run away from ferrets. Ferrets are smaller than squirrels, but squirrels have eyes on the sides of their heads, like prey, and run away like prey. Ferrets eyes look straight ahead, like a predator, and they act like predators. That frightens other animals.

The books said that even though ferrets attack rats by instinct, they have to be taught to kill. To train them to do that, it is necessary to give them a small mouse to play with. When they attack it, inadvertently their bite will kill it and it will get the taste of blood and death in its mouth and when it sees a large rat, it will understand the goal. "Perfect," Aaron thought. "I don't want a crawlspace full of dead rats. I want gone rats. I just won't train it to kill."

He bought a Tradin' Post, a newspaper composed exclusively of classified advertisements, and looked under Pets For Sale. One of the ferrets that was for sale was full grown and was being sold because it was too aggressive and kept biting people. Aaron thought, "That's my ferret," and bought it. He had build a cage for it and put the cage in his pantry with a pipe leading down into the crawlspace. When he set the ferret in the cage, the ferret took one look at that pipe and dove into it. Aaron soon learned he had created ferret nirvana.

Ferrets sleep twenty-three hours a day. When they wake up they are hyper active for an hour and then go back to sleep. Everyday the ferret woke up and spent an hour in the crawlspace. Most days Aaron could hear the confrontation between the rats and the ferret. He could hear their claws on the plastic sheeting cover the gravel down there as they fought. After a couple of weeks the sound changed. It sounded as though the big guns had come out. Perhaps the adult ferrets had tired of watching their babies get run around. Now instead of hearing claws on plastic, he heard gravel flying. But every time the ferret came back up to its cage, it did not even look dirty, let alone injured. Ferrets are not fast or strong or agile and they weight almost nothing. How this ferret was holding its down against rats that were five times as large, maybe even larger than that, was something Aaron wished he could see. After about six weeks, there were no more rats.

One day the ferret woke up, ran down the pipe, and in five minutes was back looking at Aaron as though to say, "Okay. What now? There's nothing left for me down there. You're in charge. What have you got for me now?" He began letting it out into the house for an hour each day.

Since he was renovating, there were no covers on the ductwork for the heating and air-conditioning in the floors. So one of the things that the ferret did was investigate every inch of them. It loved coming up in the bathroom from other parts of the house. In fact, after a while, it began to protect the bathroom as though that was its territory. It appeared only to be playing when it did this, but it play aggressively. So when Karen wandered into it one day, the ferret bit her on the ankle. Aaron was in the attic at the back of the house opening up a gable vent.

When looking at the house before purchasing it, looking through the windows he saw moisture on the inside of the glass of every window. When getting bids from contractors he mentioned it and each of them had solutions, but none that made sense to him. One suggested installing dehumidifying equipment. After giving up on contractors, a couple of times he had carpenters stop by to discuss how they could help him. One of the things he wanted was for them to open up the gable vents. When the previous owners had had aluminum siding installed, the contractors who did that had covered over the gable vents with siding. Aaron believed that the unvented attic might be the problem. None of the contractors or carpenters thought that would make any difference. And they thought that the people who installed the aluminum siding would not have installed it that way if it was not the right way to do it.

Aaron had not wanted to climb ladders with his knee more than necessary, but he gave up and did. The day he cut the siding away from two of the gable vents, the moisture cleared and never came back. That is why houses are dry inside. The moisture wicks away through attics that are ventilated. Contractors and carpenters often know the correct way to build without knowing why. When something has been built incorrectly, they might see that it was not done in the usual way, but not understand the problem.

There was a third vent at the back of the house he had not gotten to yet. He had saved it until his knee was having a good day. He was working on it when Karen shrieked. It was so difficult to climb through the truss work to get to where he was working that he wanted to stay where he was until it was finished, but he heard her shriek and dropped what he was doing to hurry to where he could see down into the livingroom.

"Yes. I went in the bathroom. You make it sound like a normal person would know better."
"The ferret has declared that as its personal territory. Didn't you know that?"
"How would I know that?"
"Did it bite you?"
"Yes. It bit me."
"It misses its rats." She didn't have a come back. That was unusual. He stopped joking. "Are you okay?"
"I guess so."
The way she said that caused him to pull off his goggles and let them hang around his neck. "I'll be right down."
"No. It's okay. Finish what you are doing."
Climbing back through the rafters he said, "What I'm doing is going to take a while. I'm coming down."
"No. Finish it. I've got the door closed on the bathroom."

When he got to her part of the house, he climbed down the step ladder using only his left leg, protecting his right leg, working in sandals as usual. She was sitting on a sawhorse in the living room. She said she had been thinking. He already knew what she had been thinking. Two years ago her oldest sister had gotten married, started teaching, and now had a baby. Last year her next oldest sister had gotten married, started teaching, and now was pregnant. This year her younger sister had gotten married. Next year her youngest sister was getting married.

Karen was in town on an internship at the Centers for Disease Control and Prevention. Next year she would become a fulltime epidemiologist there. Aaron already was employed, even if only intermittently. She did not want to be forty when she was having her third child. She wanted to get married before Christmas. By the time she got her degree next spring, she wanted to be pregnant.

Previously she had mentioned that the financial strain on her father of paying for four weddings in four years already meant that she would have to wait at least another two years before she could ask for a fifth wedding from him. She didn't want to wait two years. She had adjusted her thoughts about what size wedding she had to have. She cared more about the life that would follow than the event itself.

Aaron said, "Do you want to get married now?"
"What do you mean?"
"Go to the courthouse and do it."
"When?"
"Tomorrow."
"Seriously?"
"What the hell."
"Just the words every woman longs to hear. 'What the hell'."

He pictured them telling their children years from now about how Daddy proposed to Mommy standing between sawhorses, looking like a raccoon with the lines left around his eyes by the goggles, a tool belt around his waist, hearing protectors hanging around his neck, sweat, sawdust, grime. "What the hell."

She asked, "Who will we invite?"
"How big do you want this to get?"
"Hmmmmmm."
"How long do you want it to get delayed?"
"Right. Between your mom and my mom. . . "
"There could be a hundred and fifty people at a ten thousand dollar wedding in two weeks."
"I'm leaving in two weeks."
"There would be no time for a honeymoon."
"A honeymoon? Where are you taking me?"
"Wherever a plane is going the day we get married."
"We shouldn't tell anyone, should we? It will balloon out of control. Really? Tomorrow? We could just do it?"

It turned out that there was a waiting period in Ohio, but in Kentucky there was not. He spent the day on the phone making arrangements and did no more work on the house. That evening, after she left, he found a lawyer who worked evenings and rode his bicycle to his office to ask some questions. He leveled with the lawyer and told him that he was in an investigative business in which he investigated educated, connected people. If one of his investigations ever caused someone to lose a career, and then perhaps his family, and the perhaps become alcoholic, and then some time in the future figure out who Aaron was and blame it on him, Aaron thought it possible that he could be sued. His parents had arranged their assets so that if anyone sued his father, the family would not be destitute. The lawyer told him how to do that. Keep separate checking accounts. Keep investments in their own names. Since Aaron had assets, they should divide assets by putting the house in her name. He had to be careful not to pay for repairs or upkeep. She had to pay to have it painted. She had to pay the utility bills to make sure it was clear that she was the exclusive owner of it.

The attorney brought up the subject of divorce and said that if he had any concerns about that, he should not let himself be pressured into marriage. He said that after you get divorced the state enters your life and things never are the same again. He said that after a divorce you have to pay for two of everything and life styles take a sharp decline. It was clear to Aaron that the lawyer had been divorced and spoke from the heart and was giving advice like a concerned uncle. He would come back to this lawyer to change his will later. Currently his will left all his money to his brother.

In the courthouse in Kentucky there were two lines they had to wait in. One was to get the license. The other was to answer questions the state had to ask before sending you to a justice of the peace. While Aaron got the license, Karen answered the questions. When she was an undergraduate, she had a roommate who was from Kentucky who used to joke that back home the only thing you had to prove to get married was that you were not related. When the person on the other side of the counter asked if she was related in anyway to her fiancé, Karen laughed. It was true. She tried to get Aaron's attention. She wanted him to hear this.

Aaron was chatting with the lovely young woman who issued the licenses. She laughed at something he said. Then she giggled. Her eyes sparkled. They were having the best time talking. There can be a natural progression to such conversations between people who are attracted to each other, as there was in this one. The flow of the conversation brought them around to where, just as she was sliding the marriage license across the desk to him, the most natural thing for Aaron to say at that moment would have been, "So what time do you get off work?" This was so funny he wanted Karen had to hear this. He was turning to get her attention to come here this, when he saw her laughing and motioning for him to come to her so that she could tell her story to him. So he did that.

This would be the story they would repeat in the future when telling people how they got married. That and, to close friends, a brief description of the living room of the cheap house of the justice of the peace where an immense woman in sweat pants hobbled over from next door to be the witness. Two hours later he heard her lie for the first time.

They were at the airport. They had just gotten their tickets to Cancun. It was time to tell their parents. They found a payphone. He told her to go first. "No. You go first."
"Why would I go first?"
"It's okay. You can call first."
"You're the bride. Your mother should know first."
"It's okay."
"No. It's not. You're mother is going to care about this."
"No. She won't."
"Of course she will."
"She'll never know."
"Why create a situation in which there's something we don't want her to know."
"It'll be okay."

She could not be persuaded so he called his mother and told her. He could tell she felt badly, as though pressure from her had put him in a position where the only way he could marry this woman was to sneak away and do it without telling her. There was a lot of truth in that, but she congratulated him and told him to have a wonderful time in Cancun.

Then Karen called her parents. She said, "Mom. I got married. And you're the first person we've called. No one else knows yet. You're the first." For Aaron this moment was like waking up from a coma and wondering, "Where am I?" Why lie? Her mother must know it's a lie. She had to know her daughter well enough to hear that it is. Especially with the way it was brought up and repeated. A stranger listening probably know this was a lie. And why had Karen not just called her mother first if it was so important that she had to lie?

Her mother telephoned all of her children and all of her siblings as though she were bringing them the news, but really trying to find out who knew before she did. For months she was convinced that everyone but her knew about it ahead of time. She sobbed about that. She harangued people about that.

Aaron looked at condos for sale in Cancun. During dark, wet winters in Cincinnati, while paying high utility bills, he had wondered if he could not get a place in Mexico and commute from there winters. They took a bus out of Cancun to see what Mexico was like away from the tourist areas. The bus wasn't for tourists. It was the bus that was taken by Mexicans commuting to the hotels to their jobs. Karen and Aaron spoke no Spanish. Someone in the hotel had told them how to find the bus stop. They had gotten in line with other people waiting for the bus. Now that they were on it, they wondered on how to get off. They finally saw that whenever someone slammed a hand against the sheet metal interior of the bus, it stopped and let them off.

Everything about finding their way around Mexico was fascinating. They liked the food. They liked the people. They believed they could learn Spanish. Before they left Aaron said he considered this weekend trip to have been a scouting mission. Previously he had said that if they liked what they saw, later they would go back for a week to the pacific coast. And then after that two weeks. They would travel from city to city getting a feel for where they wanted to spend time. It would be some years before her job would give her enough vacation time to take advantage of it, but he wanted to buy a house or condo or something and begin laying the foundation for this being part of their lives.

The next morning they were eating the buffet breakfast in Cancun when Aaron poured what he thought was syrup over pancakes that just had been handed to him by the man at the griddle. From the look on the man's face, Aaron knew he had done something wrong. In spite of the language barrier, Aaron figured out that the cook had set his cooking oil up on the counter with the food the tourists were supposed to take, and that was what Aaron just had poured on his pancakes. The man took Aaron's plate, poured the oil off of it, and handed it back to him. Tourists know to be careful of the water. There are no notices posted to tell them that cooking oil in Mexico can be an uncooked animal product.

When they got back to Cincinnati, they beamed as their told how much they had liked Mexico. For three days life was beautiful. Being married was great. The future looked great. Karen wanted to start trying to get pregnant by Christmas. Aaron said he would finish the house by spring and then sell it so they could buy a bigger one together. He did not want to follow the normal path of buying progressively bigger houses as life went on. He wanted to get their final house now and never move again. He told her all the reasons for that, some of which were financial. But warmer and more personal ones were more numerous.

Karen's father told her that relatives already were planning a baby shower for her. "Huh?" she said. He told her that everyone thinks she must already be pregnant for her to have slipped away and gotten married so quietly. "Well," she said. "In time they would see that wasn't true." Her father said he just wanted her to be aware of what everyone was thinking. She and Aaron talked about how to handle that. And they talked about how to handle her mother's making life hell for everyone by haranguing them with suspicions of being the only one left out of the loop as to Karen's wedding plans. But life still was great for those first three days before Aaron got sick.

They assumed it was just normal travelers' diarrhea. They had read about it before they left. According to the literature, forty percent of visitors to Mexico get it and it usually resolves itself in a few days.

Karen's mother was planning a reception dinner. Since their families had not met and there had been no ceremony, Karen's family wanted to have a dinner for everyone in their home. Karen's sister had been married in their home just last year. It had worked out fine. The first thing Aaron thought about was their living room. His parents had original oil paintings in their living room. The only piece of artwork in the living room of his new parents-in-law was a print of a charcoal drawing of a bleeding Jesus in agony on a cross.

There is a day in the lives of many Protestant children when, for the first time, they enter the gymnasium of a parochial school and see hanging high on the wall an instrument of torture with a huge, three dimensional Jesus bleeding in color with thorns driven into his head and agony on his face. When Aaron saw his first one, he wondered what parental guidance at movies could be shielding children from when this is what they played volley ball under. He also wondered if they kept the same commandments. His King James Bible forbade making graven images.

Once in college at a party on the west side of town, listening to Catholics sounding as though it was presidential election politics as they lobbied and argued for who should be made a saint, Aaron finally turned to the woman next to him and said, "Do you mean that there is an election and men here on earth vote to determine what is going to happen up there in heaven?" The woman just smiled.

When one falls in love with someone while an invalid being nursed, it happens outside of a normal context. You don't get to see her among your friends. You don't get to see her with your family. You don't get to sit with her in a quiet restaurant and learn the things about her you normally would, like whether she knows how to use a knife and fork. The nurse and patient falling in love with each other is one of the oldest stories there is. Something about that relationship moves something that feels "right" in a primordial way.

Because he could not move for so long, there was no question of anything physical happening between them, but it went on for so long. And then when he was moving around again, he wasn't able to get in a car for a long time still. Finger food in his apartment brought in by her was what they ate. By the time she had to return to Wisconsin, he believed there was something between them deserving of fidelity. When his life was returning to normal, she suggested he come up to visit. After that, there was no turning back. He had no inclination to turn back, but it was after that that he discovered that she did not know how to let him open a door for her. She did not know how to let him help her put her coat on. She did not know how to let him hold her chair for him. He wondered what they taught people in parochial schools.

He knew he had a hard time getting a word in edgewise with her, but when he finally met her family he learned why. They interrupted each other and everyone else. Isn't the first manner that children are taught is not to interrupt? One of the surest ways to alienate people is to interrupt them. He was in a committed relationship with her by the time he witnessed her doing that to people they met. All he could do by then was adjust to how that was going to hamper their lives.

He also learned that neither she nor anyone in her family knew how to eat. They ate baked potatoes by crushing them with their fingers until they were mashed inside the skins, then breaking open the top and using their fingers for a dam to hold the mashed potato still as they pushed a fork into it. They ate chicken breasts in a similar way, by putting fingers on it to hold it down while tearing strings of meat off of it with a fork. His parents were about experience this at her parents house.

They also were about to see the shrine in the backyard. They might also see her mother outside smoking next to it, crossing herself and puffing. Two of Karen's siblings smoked as well.

The first time he brought Karen home to meet his parents, on their way up the walk to the front door, as his mother came out to greet them, the moment his mother looked at her, he could see that she didn't like Karen. At first glance, the first moment she saw her, his mom was not happy. This was not the first woman he had brought home, but it was the first time he had experienced this reaction. Inside the house, Karen interrupted his mother. His mother, without the slightest change of expression, dropped her own thought and picked up Karen's. It was like watching a Samurai step out of the way of a child with scissors.

Weeks later they were at Aaron's house again with friends of his family's at dinner when one of them asked Karen about what she was studying and then peppered her with questions designed to allow Karen to say impressive things about herself - her degree, her planned career. Aaron could hear the subtext, that this guest had been told by his mom that they were waiting and hoping for him to see the light and move on to a more appropriate girlfriend. Aaron heard these questions as an argument in Karen's favor being staged by one of his mom's friends for his mom's benefit. But any positive feelings he might have felt from finding this ally were overshadowed by finding out how much he needed one.

He did not ask her to marry him spontaneously. It had been discussed. It had been thought about. He would have missed her if she were not there. He could not imagine someone who would be better to stay home with. He had never gone out with anyone who would have been less attractive in terms of the things that occur outside of home, society, sports, business, name it. But the way his life was turning out, he wasn't getting to be part of all that anyway. What was more important than home? And he truly was in love with her.

There had been one moment when she had come to his house and sat him down because she wanted to talk about something. The way she spoke for the first several minutes had the tone of someone whose heart was breaking after having decided that this is never going to work and, painful as it might be, was going to leave. For him it was one of those moments when you know what they mean when they say "every fiber of you being." He felt every sinew in every muscle in his body letting go. When it turned out her tone was from the fear that he was the one who might leave after this discussion, he interrupted her to put his arms around her and say, "No. Never. How could I ever want to be anywhere but with you?" He meant it. And not just at that moment. He had known it for a while. He had thought about it in context with all the rest he had learned about her and her family. He did not make statements like that off the cuff. She knew that about him as much as she knew anything about him. She knew that when he said something like that, it would be true tomorrow and the next day and the next. The discussion she had come to have with him did not last nearly as long as she had thought and had a much better ending than she had been prepared for.

Standing, sweaty between the sawhorses with goggles around his neck had not been planned. But everything that followed from that moment had been thought about and discussed. Between the sawhorses she clarified only one of the factors, and one they had been in the middle of discussing lately - the timeline. She put in perspective that in a short time they would have moved beyond ever being able to meet some deadlines that she wanted to meet for her own life's plan. The time was now. When he said "Tomorrow" he was thinking it would be the beginning of a discussion that could lead to something a little more well planned a little further in the future perhaps preceded by a formal "will you marry me" on bended knee at some planned location. When she said "Really?" it was clear that she was excited by "Tomorrow." He believed brides should get their way and if "tomorrow" was what would make her happy, then it was the thing to do. Immediately he regretted having said "What the hell" and began trying to think of a way to make up for it. He still was trying to think of how to make up for it, but now that it was the day after "tomorrow" and they were back from Mexico, he was sick. He would have to work on making up for saying "What the hell" when he was better.

Karen wanted him to see a doctor. So he did. Dr. Ober assumed it was Giardia and gave him an antibiotic and something to coat his stomach. He had not eaten in ten days. Now he could eat some, although not much. He was able to resume light work on the house, but only fifteen or twenty minutes at a stretch. When the prescription ran out, the sickness returned worse than before. He went back to the doctor and was put on Flagyl Tab, which if the doctor had checked, is contra indicated for people with Charcot Marie Tooth. In the days before the Internet, information was so much harder to get that what he knew about Charcot Marie Tooth was only what his doctor had told him.

Karen went back to school. Aaron's boss asked if he could go to Seattle in a month and he said he thought he could. He thought he would be over this Mexican thing by then. But when the prescription ran out in a few weeks, he had to cancel. Dr. Ober gave him a prescription for a higher dosage of the same drug. It seemed to work a little better. But when it ran out the sickness returned to where it had been before and Aaron had to decline more work out of town. Over Thanksgiving he barely was able to go to the requisite dinners with Karen. Dr. Ober put him on even higher dosages. That got him through a few more weeks, then it was like falling off a wagon again. He barely was functional over Christmas. By spring break when Karen came to visit he weighed only 146 pounds. The last time he had weighed that little was when he was fourteen years old and he had not been as tall then.

"I had no idea how thin you had gotten. Does your doctor know what you look like? What does he say you've got?" Dr. Ober did not believe in testing. He believed in experimenting to see what drugs worked. Flagyl Tab seemed to have an effect. So he kept increasing the dosage. He was taking handfuls of the prescription three times a day, an amount that alarmed her. She said drugs have side effects. She had never seen anyone taking such large quantities of any prescription and said that no one should be swallowing that much of chemical. She told him to see other doctors. Aaron had done that with his back and his knee and his Epstein Bar to no avail. Ober had given him lectures about wandering from doctor to doctor and about how patients who do that often are just looking for someone who will tell them what they want to hear, etc. Besides, when you were as sick as he was, how could you make that effort?

Karen telephoned friends at Cincinnati's Centers for Disease Control who put her in touch with someone at the CDC in Atlanta who looked things up and answered questions. Karen wrote down the name of a test they said that Aaron should be given. She and Aaron went to Ober together for his next appointment. Ober appeared to think he was wasting the insurance company's money, but to appease Karen would get the test done. She said, "He's lost 53 pounds and he did not have weight to lose. He was an athlete. Now he's a skeleton." The parasite was identified. The CDC in Atlanta shipped overnight a drug called Yodoxin that killed the parasite. If he had not had family, Karen, with connections in healthcare, would this have turned out like his back, never correctly diagnosed, incorrectly treated resulting in permanent disability?

With Karen back in Wisconsin, he began trying to exercise and gain weight. According to the charts left from the last time he had been able to workout, he had lost 45% of his strength. As the months went on he was able to gain weight, but no strength. Karen did researched Charcot Marie Tooth and found out why. Flagyl Tab is a neurtoxin. It is contraindicated for people with Charcot Marie Tooth. People with that condition do not have adequate insulation around their nerves. Drugs that are safe for other people are not safe for people with Charcot Marie Tooth. Ober had mega dosed Aaron for six months on a drug that Aaron never should have taken even for one day. Every day that he was on it damaged his nerves further. They were less able to conduct messages from his brain to his muscles. He now was less coordinated and weaker because of it.

He discovered that for the first time since he was 15, he was less coordinated and weaker than his father. Eventually it became clear that a prescription that had no positive effects had aged him thirty years. He never again was able to get stronger than he was right then. He had expected to start a family shortly after getting married. He had expected to be working earning money to pay for having a family, and to finish renovating the house. Instead, a misdiagnosis, a flawed medical philosophy, and a certain amount of inattention on the part of his doctor caused him to lose work, money, time and to have aged 30 years in important ways. A simple test six months earlier would have healed Aaron with no side effects. There is no record anywhere of any of this. No one culls such information from patients. No one allows the public to review and rate physicians. Aaron had no way to find out if some other doctor might be more attentive or have a different philosophy. And no way to warn other patients about what to watch out for with Ober. Since he did not have that kind of information about other doctors, he felt no confidence that going to another doctor would be any better. It only would be hit and miss. So he went back to Ober within weeks after finishing the Yodoxin because he was in so much pain. It felt like his back again.

Ober wrote a prescription for Naprosyn, a drug used to reduce inflammation. He took it that evening and it made things in his knee and shoulders and back feel better than they had felt in a long time. The next morning the Mexican illness hit again. He called Ober's office. They had him come in immediately. Ober made an appointment for him to go to a hospital for a colonoscopy in a week. Ober did not ask or say anything about the Naprosyn, so Aaron kept taking it and continued was miserable and incapacitated for the whole week.

In the hospital, lying on his back waiting for the procedure, he chatted with the extremely good looking blonde woman, about his age, who was an intern training for her future career. He wanted to ask what it is that motivates someone to choose a career in which they will be shoving things up people's butts all day, but he was trying to find that out without putting it that way. She could not have been more pleasant. When they put an IV line in him they told him that what they were giving him would put him in a twilight. He would be able to hear them and take directions from them, but probably would not remember anything after the insertion of the IV. When they began the procedure, he was aware of the physician coaching/teaching the intern. There was one point when he told her to put her hand somewhere to feel the scope moving through Aaron so that she would have a sense of where it was. She hesitated to do it. The physician barked at her not to be shy and just do it. Aaron felt the most tender palm he ever had felt on his lower abdomen and realized that she had been shy. He was as skinny as a skeleton, but he still had a six pack. And she had been shy to place her hand in so personal a place. They said he probably would not remember much, but he would never forget that.

When they finished and he was in recovery, they told him they had found nothing. They asked him if he had been taking any medications. He said, "Just Naprosyn." The doctor said, "Naprosyn? That's the problem. That's the problem. Stop taking that. Didn't you doctor ask you if you were taking anything?"

"My doctor gave it to me." The physician just shook his head.

So Aaron had an expensive and unnecessary test and a week of sickness that could have been avoided just by stopping the Naprosyn. On the phone from Wisconsin Karen told him to find a new doctor. "How? Who? Your family's doctor who gives people lobotomies?" He said there was no way Ober could have known that suddenly Naprosyn was going to become a problem. She said, "In the first place, if you could take Naprosyn before but you can't now it's because the lining of your stomach and intestines have been rotted out by the prescription he mega dosed you on for six months. I'm studying public health. I've learned about that. In the second place, every doctor knows how harsh Naprosyn is on stomachs. He put you on Naprosyn and the next thing that happened was you had a stomach problem. If that connection isn't the first thing he thought of, he wasn't paying any attention to you. He didn't remember what he had you on and he didn't check your chart and he didn't ask you. Instead he left you on the drug that was tearing you up for a week longer while you waited for an appointment for an expensive test for nothing. And that from a doctor who caused all this in the first place because he doesn't believe in testing. And now your insides are torn up more from the Naprosyn."

He had used all of the connections and resources he had to find this doctor and look how this one turned out. How was he going to find another? Throw a dart at the phonebook? He began working on it, but he could not help but be unhappy about the fact that patients constantly are told to be active participants in their own care while not having access to the most important information necessary to do that, including the information necessary to make an intelligent choice about where to get care in the first place. He could find more information about kitchen gadgets than about doctors. But he began doing what he could to find someone else.

He wanted to drive to Wisconsin and spend time with his wife, but they were offering him work in Phoenix. His back was bothering him a lot, but he took the work. He was moving more slowly now. He wasn't breaking speed records in his work anymore. And he was having trouble staying on top of all the information. One day as he walked down the sidewalk to a bank, he was going over his pocket sized cheat sheet on which he had written down his fake income and fake neighborhood and fake job description and where his fake wife worked and what school his fake kids went to, as usual. When he entered the bank he was directed to an office near the back. As he entered the office the man behind the desk stepped out from behind it extending his hand and saying, "Hi. I'm Howard Kestle." Aaron shook the man's hand and said, "Hi. I'm . . . " and he could not remember his fake name. He could not make up a new one because he had an appointment. Aaron said, ". . . I'm . . . you're noon appointment." Kestle leaned over his desk, looked on his calendar and said, "Tom Barenthaus?" Aaron said, "Yes," and got through the appointment.

They offered him another job after this one. He thought he could finish this one in time to have a couple of weeks to go to Wisconsin, but it took him all the time available. He just was not as fast as before. He had to go straight to the next city. Karen and he talked on the phone every night and for brief moments throughout the day. It was prohibitively expensive in those days before cell phones and she said that they should not spend so much money on phone calls, but he said that he could not get through the days if he did not talk to her. Their phone bills were more than her rent.

It was getting harder and harder to carry off being indistinguishable when he did his job. He limped with the pain in his knee. His back increasingly was a problem. He slept on the floor. He rented vans with relatively straight seats. He spent the better part of each evening stretching as he had been instructed for both his back and his knee. He stretched first thing in the morning, last thing at night, and repeatedly throughout the day since he had a van in which he could do it. But he still could not slump naturally into the chairs in people's offices. He had to sit up unnaturally straight. That made him stand out from other people. And his back continued to hurt anyway.

He wanted to go see Karen. They were offering him another job after this one. He didn't know how to make the decision. And he was in pain.

*    *    *

Manny Donatella's desk was a mess. It was situated immediately next to people standing in line to see a teller so the people in line overheard any financial information that might be discussed with him. The floor needed cleaning. The trash baskets needed to be emptied. These all were things he was supposed to note. Including Mr. Donatella's wearing clothes that no longer fit since he had gotten even heavier. The vice presidents at this banking chain hired Aaron to advise them of things like this. They would want to know that their salesperson and investment counselor's collar was too small for his neck and could not be buttoned and that his tie hung loosely below it.

They were discussing investments in general and what that meant for Aaron's fake portfolio. Manny leaned across the desk and said, "The stock market is going to double."

"Double?"
"At least."
"Are you sure?"
"You can count on it. Some think it is going to quadruple. So here is what you want to do. . ."

Manny had just promised an investor two things: that he could not lose his money and that in addition it was going to double. This was the most important thing Aaron was supposed to watch for. The literature provided to him to help him understand how to do this job had carefully laid out what kinds of sentences and what kinds of words constituted promises. It was important that brokers make sure that investors understand that they can lose. And it was important that brokers never promise financial gains.

Aaron knew that if he were unscrupulous he could get a friend to come to this bank with most of Aaron's money and let Manny do whatever he wanted with it. If his money quadrupled, no problem. If it did not, they could just sue. Manny was why Aaron was hired - to make sure none of the bank's employees were making promises like this. Manny became the standard by which all other securities brokers were measured at Aaron's firm. Within hours a vice president in a distant city had gone to work to clean up this mess.

Typically, Aaron's firm was hired by banks to investigate their own brokers. If ten or fifteen years from now some investor filed suit saying that one of their brokers had led them to believe they could not lose or promised them gains that they did not get, the bank could have Aaron's firm testify in court to protect them. In court they could show that an independent firm had surreptiously investigated that broker three times in a five year period without finding any evidence of that broker making such promises. But more important than that, his firm would identify for them anyone who was to make sure there never would be a such a lawsuit. Aaron was looking out for the "little guy," for the unsophisticated investor who too easily could be taken advantage of, or just not well taken care of.

But then, over the next several years, Aaron watched the stock market double. And then quadruple. But that was just the average price of stocks. If Aaron had followed Manny's advice, his money would have done much, much more than that and he would have been rich.

When the Dow Jones Industrial Average had climbed above 1500 Aaron had told people he was thinking of holding out until it hit 3000 and then selling. His father's friends laughed. They were moving out of growth stocks right then while it was still above the peak of 1500.

Following investing was difficult while not being in the swim with other investors with whom to discuss it. His isolation caused him to think that perhaps he should just put his money into an index fund. At least then all he would have to do to follow his investments would be to pay attention to the Dow Jones Average. But people laughed at him when he suggested that and he left his money in utilities and bonds and other overly conservative investments for someone his age.

The stock market was close to 2500 when he investigated Manny. His investments maintained their secure value while the rest of the market climbed and climbed and climbed. Inflation and illness and bad decisions ate up his capital.

*    *    *

When he was in the next city working on the next contract, his back hurt so much he did not know how to carry on. There was no rhyme or reason to it. None of the things he had learned to do or not do made any difference. It came and went inexplicably.

He called Dr. Ober who prescribed something that he could pick up at a Walgreen's out of town where he was. It would loosen the tightness in his legs and perhaps that would help his back. One of Aaron's standard questions at times like that was whether this prescription would effect his mind at all. He was sensitive to such things and told Ober that his work required a completely clear mind or he could get in a lot of trouble. Ober assured him it would not effect his thinking. But Ober was wrong again.

Aaron was on the job, sitting across from Fred, another investment counselor, when he got confused. He could not remember all of his information. He tried making up some information. It did not fit with the other information he already had made up. Fred looked at him quizzically and began grilling him, asking him questions he already had been over before. Aaron believed he had been caught. If you got busted once, you never could work in that field again. This was important. He made it through the appointment, but called his boss and explained what happened. His boss said not to worry about it and complete the contract. Aaron wanted them to get someone else to complete it and let him get out of there before things got worse, but his boss wanted it completed sooner than that At an appointment the next day, Ernest, the next broker, smiled and stared at Aaron while delivering a letter perfect presentation without making any attempt to sell him anything. It covered all of the points that the Securities and Exchange Commission mandated be covered, but included no attempt to sell him anything. The only time that had happened before was when some investment advisor heard his life story and concluded that someone in Aaron's position should not invest quite yet. Never before had a broker simply covered all the legal bases and smiled and sent him on his way. Aaron was sure word was out on the grapevine.

A couple of days later he was in the office of a broker named Geraldo when Geraldo, who was doing a very good job, stopped and looked at him. Aaron had done his best to change his appearance. And he had taken the unusual step of making up a career that would be distracting. Usually you wanted your fake career to be so uninteresting that no one would give it a thought. But Ernest had figured out who he was. So Aaron changed tactics.

Just for such an eventuality, Aaron had gone to a theatrical supply house long ago and learned how to dye hair, how to put weaves into it to make it longer, how to apply a mustache that looks real. He even had purchased contacts to change his eye color. On occasion, just for practice, he had employed one or another of these techniques from time to time. Now he was using all of them. And he was claiming to be a bar tender in a country club. Country clubs were something he could talk about at length, which was one of the reasons he chose this fake career just now. But something he said caused Geraldo to stop and looked at him and ask, "What did you say your name is again?" Aaron repeated his fake name. Geraldo looked at him for a pause and then asked, "In the country club, people tip?" A barrage of questions ensued about that country club, where it was, who the members were, the hours Aaron worked, etc. Geraldo was looking for holes in his story. As Aaron answered the questions, Geraldo got a couple of brochures out of a drawer, walked out from behind his desk, and sat down next to Aaron peering closely at his face and his hair and his mustache.

Geraldo handed him a brochure and told him to read through it for a few minutes while he made a phone call. As Aaron looked at it Geraldo dialed a number and asked to speak to Fred. When they told him Fred was not in, he asked them to have Fred call him the minute he came in. The Geraldo dialed another number and asked to speak to Ernst. Ernst was in a meeting. Geraldo said it was important. They said they would have Ernst call him back as soon as they could. Then Geraldo got up from behind his desk and sat down next to Aaron again. Aaron turned to face him. "No. No, " Geraldo said. "Keep reading the brochure for a while." Aaron turned back to the brochure as Geraldo looked him up and down studying the profile of his face. "Tell me more about where you live," he said.

This was why Aaron did so much homework for each job. He was able to have an in depth discussion about his fake neighborhood. After a while Aaron said that he was running out of time and they would have to finish this another day and left.

He called his boss and said he had not even been able to finish the last job. His boss asked him how Geraldo had been doing up to the point at which things went wrong. Aaron told him about how compassionate Geraldo had been, how careful Geraldo had been to make sure that Aaron understood the downside and that these investments had to be made for the long term and that Geraldo did not want Aaron watching every stock price everyday and worrying about fluctuations. Even though he had not gotten through all of the information he normally would have, Geraldo had been so attentive and good that his boss said Aaron had gotten enough and told him to go ahead and do the last two jobs in the contract. Aaron tried as hard as he could to talk him out of having Aaron do the last two, but his boss told him to do it.

The second to last job was in a black neighborhood. The black man he was investigating looked as though he was being taken to the gallows. Aaron could see that the man was on to him. The man asked him how he happened to be living in a black neighborhood. Aaron said his wife was a bleeding heart liberal. The man almost laughed, but was so worried about his job being on the line that he completed a straight-from-the-book session and then, as Aaron walked away from the bank, stood at the window watching him go wondering if he was going to get to keep his job. Aaron felt so sorry for him and wanted to turn back and say, "Your job never was on the line. We're just protecting you from lawsuits. You did great." But he could not do that.

The last job was in a neighborhood that was exactly the kind of neighborhood where Aaron fit in. The bank was huge and immaculate. For the first time Aaron decided to use his real name and real investments. This time, to have the best cover anyone could, he wanted to move real money into that bank and actually purchase some security or other. He asked his boss to let him do it. He had a bond that had come due and he needed to reinvest the money. Rather than do it through his normal broker, why not do it through the one he was investigating. Nothing could be a better cover than that. He told his boss how much money he needed to reinvest and learned a lesson.

His boss choked and said, "I thought I was hiring a starving graduate student." Aaron now had first hand knowledge of the problems that can be caused by having more money than your employer. He believed he had hurt his chances of keeping this job. His boss could not imagine using real money in the course of this investigation and would not let him do it.

Most of the information Aaron used in this next investigation was true, but Paul, the broker, did not believe any of it. Paul was a savvy man turned away from his computer dismissing Aaron saying that it would not be in his interest to speak to Aaron any further. Aaron was not prepared for this. He never had been turned away before. How was he going to complete the contract? He knew he was not allowed to reveal anything so he could not say that it might be more in Paul's interest than Paul knew. Aaron wanted to insinuate that the Paul's boss's boss's boss's boss hired Aaron and that was the wrong person to make think you turned away a client so dismissively. Paul clearly was on to him. He wanted to speak in innuendos that would enable both of them to do their jobs. But it was not to be. Later a Vice President at Paul's bank was flabbergasted to learn that one of their brokers turned away a client like that.

That did turn out to be Aaron's last job. It was a while before he was realized that. No one said that it was over, but his phone didn't ring anymore. Finally he called his boss and asked point blank and was told that they could not hire him again now that he had been busted. Aaron was laying on his back in pain in Ohio wondering what he was going to do now when Karen called him to tell him her mother had been diagnosed with cancer.

***

Rough Draft / Under Construction

Life changes with that kind of news. Plans previously made are put on hold without discussion or thought. She came back from school for a few days. He hardly saw her as she spent all of her time either at the hospital with her mom or spending the night at her parents so that her Dad would not be alone. Siblings said, "What about Aaron?" She told them that if he did not understand her spending this time with her parents instead of him at this time, then he could leave. They were taken aback by the statement, but when she repeated it to him, he smiled. He also told her that she had enough siblings in town taking care of her mother and that she should go back to school. He told her that everyone but her mother would understand. Which made her smile.

Saying that they would understand was more diplomatic than accurate. They were not completely at peace with her being gone. For a family with two teachers among its children, they did not place as much importance on higher education as they did on being here with their mom at a time like this. No one in her family ever had gotten a graduate degree before, but they didn't really notice when she did. When she got her Masters of Public Health (MPH) Aaron was the only who attended her graduation. A couple of decades later when her brother had a child who was considering going to graduate school, the announcement was coupled with the statement, "The first one in the family to get a graduate degree."
Karen said, "What? The degrees of your sisters don't count?"
He said, "You have a graduate degree?" 
"I could not have gotten my job without one."

Aaron watched as a couple of siblings registered remembrance of her going to graduate school. The others hid their surprise. No one said to her brother, "Where were you? How can you not know? Don't you remember?" At the time of her graduation, their mother's health squeezed everything else out of the consciousness of the family.

When she moved back to Cincinnati and moved into the unfinished house with Aaron they had not yet started a family, but taking care of her mother was the chief thing on her mind too, even though she didn't officially have the degree yet because there were some problems with her dissertation. Repeatedly pain incapacitated Aaron. Progress on the house was fitful. Pain killers made him stupid and, he worried, would mask whatever he was doing that caused the pain. Dr. Ober had offered him a psycho pharmaceutical that would make him feel happy no matter what, something psychiatrists give to depressed people. Dr. Ober had said, "Why not?"

"Why not" was that Aaron wanted to be lucid and productive, figure out the problem, fix it, and get on with life. He had lost his career because of a prescription that was supposed to help reduce the pain in his back but that instead just altered his mind. It was not inspiring to be offered a prescription that did nothing but alter his mind in the wake of the other problems caused by prescriptions given to him by Dr. Ober. But he needed his mind. He needed to figure out what the problem was and heal it so he could finish his house and find a job and start a family. But that was all Ober offered. He returned home with no answers and no help.

Karen cared about his problem but, she needed him to help her as much as he needed her to help him. On top of everything else, her thesis had come back with a request for further work. For her thesis she had studied an obesity clinic. She needed data on the patients to measure outcomes after treatment, but such data was not collected by the clinic in an orderly fashion. The data that was collected was not clean and regular. There were major gaps in what could be learned about the outcomes for the patients. The evidence available suggested that the treatments were making a difference, even though not as large a difference the patients needed to have made, but because of the paucity of comparable data the only thing that could be said with real certainty was that the results were inconclusive.

No thesis. No degree. She had thought all that was behind her as she embarked on her career, but now it was hanging over her head in need of attention. Aaron suggested that what her study really showed was that people in healthcare are not interested in whether patients benefit from treatment, otherwise they would collect this data themselves in order to know the long-term consequences of their treatment on patients. He suggested that perhaps Karen should change the premise of her thesis and recount the difficulty of obtaining the data and the obliviousness of the workers and the institution to the outcomes for their patients.

When was she going to have time to think it all through? Karen became the person designated to spend nights with her father, and to spend nights with her father and mother when her mother was back from the hospital too. Legitimately, her siblings were not in as good of a position to do it between their children and the other demands of their careers and families. Aaron was used to being alone and spent so much of his time incapacitated anyway. Without being discussed starting a family was being postponed. They could not know that someone in healthcare was going to choose to make it so that they never could start one. It did not seem to be an issue. In her peer group, people were getting married later and having children later. Her own sisters were not. Her old friends from high school were not. Half of them had gotten married when they were eighteen or nineteen and had multiple children by now. But Karen had been in graduate school where classmates were getting an education and getting careers settled before starting families. Besides, her husband's health was problematic.

Was doing the physical labor necessary to finish the house causing the back pain? Was it something else he was doing? It got worse and worse. He hired people to do the work. In anticipation of finishing and selling this house, they began looking for bigger one to buy. They found one on the edge of a development called Chimney Hill in Blue Ash. Chimney Hill was a spectacular development. It was out of their price range, but there was a house on a piece of property that backed up to it. It and was not technically part of Chimney Hill, but it looked as though it could be. The driveway behind the house faced the street in Chimney Hill. Instantly Aaron saw that if that driveway connected to the street behind it rather than the street in front of it, and if its current backyard became its front yard, the value of the house would double. The realtor, a small, dark man from India named Sanjey, said that this already had been thought of and they already had the permits to do it.

In keeping with the advice Aaron had gotten from a lawyer before getting married, to keep from having all their eggs in one basket, the house was going to be purchased and paid for entirely by Karen. Careful people with assets protect them. His parents also had divided up their assets between them so that if something had happened to one of them they wouldn't lose everything. This also is among the reasons that people with assets transfer portions of them to their children. Like his parents, the first time Aaron purchased insurance, he purchased an additional one million dollar umbrella policy to cover any liability he might incur. Aaron was doing what careful people with assets do. Doing it from day one in the marriage made it a clear arrangement. Aaron would pay for food and clothes and cars and everything else, but not for any maintenance or improvements to their next house in order that it could not be claimed that he owned any portion of it. He bought her car from her and put it in his name so that she would have more cash that legitimately was hers. She saved one hundred percent of her salary to accumulate down payment money for the house she would buy for them.

The realtor had told them that a thirty year mortgage was the best plan for people in their position. Aaron had run the numbers and saw that a fifteen year mortgage was a much better plan for people in their position and arranged for that instead. Over the course of the loan they would come out several hundred thousand dollars ahead. She signed the contract to purchase the house and he looked for contractors to work on it. He wanted to get things rolling and have the work start the day they took possession. But within a week he figured out that not only had no one gotten the permits the realtor said they had gotten to make the alterations to the property, they never would be able to get such permits. Without them the house was not worth what they were paying for it. They called Sanjey and complained. He only argued. They called his boss who said his job was to keep the deal from falling apart.

The next six months were consumed with caring for her mother, Aaron's back pain, and an ugly battle caused by a dishonest real estate agent who had made false representations. Since the representations had not been in writing, no one believed Aaron and Karen, but Sanjey had been instructed by his boss never to speak to Karen and Aaron again because of how much dissention had been caused. The real estate agency wanted to smooth things out and finish the deal. But Sanjey turned out to be irrepressible and contacted them again and lied to them again. Aaron told Sanjey's boss about the new lies, Sanjey told his boss he had not contacted Aaron. Sanjey's boss believed his employee and proceeded to enforce the contract Karen had signed to purchase the house. But the irrepressible Sanjey contacted Aaron again and so infuriated Aaron with his lies that Aaron telephoned Sanjey's boss immediately and shouted at him, at length, recounting a history with that firm that had pushed him to the point that he did not care what it cost he was going to go to whatever trouble and expense necessary to end this contract. If he could not end it, he was going to make it so expensive and painful to enforce it that they would be sorry they did not tear up the contract the first time he complained about Sanjey's lies.

The tone in Aaron's voice, the depth of his conviction, the consistency of his story, and the sudden renewed vigor caused Sanjey's boss to stop for a moment. He called Sanjey and asked him  if he had contacted Aaron again. Sanjey, of course, denied it, but now his boss was having trouble believing the denial. Why would Aaron suddenly have flown off the handle at this moment without any provocation? Sanjey's boss tore up the contract and told Aaron they were sorry. It had kept them out of the house market for half a year and it had been so crushing, to have looming over them a huge potential debt for a house that would be nothing but a losing proposition, that it overwhelmed every aspect of their lives. Upon hearing the story Aaron's father asked his mother again how one person could make so many mistakes.

There was a birthday party for one of the new grandchildren in the **** family. The child was too young to blow out his own candles. By tradition, grandmother did it. She leaned forward from the hospital bed they had rented. It was in her living room. Someone put hands around the IV tubes to keep them from getting tangled. This lifelong smoker with lung cancer, who was on chemotherapy and having so much difficulty breathing on her own that sometimes she wore an oxygen mask, leaned forward as they held the cake in front of her. She did her best to blow out the tiny birthday candle. It took several tries.

On a Sunday morning they got a call from Richard asking if they still were looking for a house. He was at his uncle's in Buckeye Trails watching his uncle's neighbor put a "For Sale" sign in the front yard. It was a neighborhood in which houses sold quickly. Aaron was lying down in pain and could not think about going to look at the house, but he knew that street. Both he and Karen had been on that street. When she had been dating Richard they had visited his uncle a couple of times so she knew better than Aaron did. Aaron said they should call a realtor and make an appointment to see the house. She wanted to wait till Monday when Aaron might be feeling better. She thought she would call the listing agent of the house on Monday. Aaron said that calling a listing agent was how they got Sanjey. During the last six months he had spoken to a few realtors while trying to resolve that previous mess. He had a phone number for one he could call now.

"On a Sunday morning?"
"Real estate agents work on Sundays."
"Why make people rush?"
"Do you like the neighborhood? Do you want a house? Be the first one there."

From his painful position in bed, he called an agent and made an appointment that would give Karen just enough time to change and drive there. Aaron could not get up. She went alone. When she arrived the agent was sitting in her car waiting. The agent's name was Carol. She was wearing riding boots. She had been about to go horseback riding, but went straight there to meet Karen. Within half an hour Karen was on the phone to Aaron. She liked the house. He told her to buy it. She signed the contract. It was a fair deal made with honest people and they moved into it a couple of months later.

The house was only eleven years old. It did not need renovating. It did not need permits. It needed only paint and wallpaper and some updating of the kitchen. They hired a painter to get it painted before they moved in. They picked out a new floor for the kitchen at a store that offered free installation. While the work was being done they got a call from the painter. The wallpaper in one of the bedrooms had not been sized when it was installed. When they tried to remove it, it tore the face paper off of the drywall. Building codes require sizing walls before putting wallpaper on them, but no one checks and this saved some contractor three dollars worth of paint and fifteen minutes of work. So the original contractor had skipped it. The painter said that the drywall would have to be torn out and replaced. Aaron asked why they didn't just skim coat it. The painter said that his nephew had been in charge of that room and had done more damage than that.

Aaron commented to Karen that he hoped that someday building codes would require that subcontractors leave their names and phone numbers for the future inhabitants of houses so that, at moments like this, someone like Aaron could telephone and complain, or maybe even report him to someone.

Like that plumber in California. There was a condo complex that his brother had lived in for a while in California. When Aaron visited, he noticed that his brothers dishes were not clean. Ted said the dishwasher would not get them clean. Everyone in the condo complex had the same problem. When Aaron heard that two hundred and fifty condos all had the same problem, it raised many questions. Was General Electric making a dishwasher that was no good? Was the water pressure in this area bad? Was there something in the water that did not work with dishwasher detergent? In the back of his mind for months the issue sat waiting for him to stumble on thoughts or information that might help solve the problem of two hundred and fifty people. It was a new condo complex. More than a few people in it had called plumbers. None had improved the problem. Some were considering replacing the dishwashers that came with their new condos.

Back in Cincinnati Aaron installed a dishwasher in the house he was renovating. He never had done that before and it gave him some understanding of the mechanics behind one of those. He kept thinking about the dried particles of food cemented on the plates and glasses in his brother's dishwasher. The next time he was visiting his brother, he pulled the dishwasher out from under the counter. The waste line was kinked. The dishwasher could not drain properly because the plumber who installed it saved a few cents on each dishwasher by cutting the rubber drain tube as short as possible, which caused it to kink. A trip to the hardware store for a piece of tube that was six inches longer solved the problem. Where was that plumber? He was a licensed and train professional who did his job and moved on without having to worry about recourse from customers. He did not have to worry about anyone making him understand how much trouble he caused for two hundred and fifty families. Why was there no mechanism to enable two hundred and fifty to say something to that plumber? That plumber probably would continue doing the same thing to people for his entire career.

As it turned out, the new floor that was installed with an adhesive that was water soluble. The vinyl tiles were eight inch squares. That meant the floor had seams everywhere. When they washed the floor, moisture seeped through seams and caused the new floor to begin peeling up. To prevent that, they had to avoid getting the floor wet. They could not give it normal washings. They could not strip and polish it. They could not wet mop it. They had to use rags that barely were moist and do the best they could on their hands and knees. They were too discouraged. It had cost too much money already. They lived with dirty floors for years. Where was that subcontractor? Why could they not say something to him? Why should he be allowed blissfully to continuing doing substandard work without ever hearing from the people he did it to? That kind of adhesive might be fine for other kinds of floors, but not for this kind of floor. But that contractor's income was not tied to the long-term outcome of his work so it was not something of which he needed to be aware for his own purposes. Only for his customer's.

*        *        *

When Dr. Ober came into the exam room, Aaron was lying on the table with his forearm across his forehead. Dr. Ober recognized agony. He used to work in an emergency room. He said they were going to take care of him and not to worry. Ober sent him to a hospital where a battery of tests were run. They said it appeared that he had an ulcer. The scheduled another colonoscopy. During that they took photographs of a duodenal ulcer and told him that the pain of a duodenal ulcer was indistinguishable from back pain. Ever since the Flagyl Tab and the Naprosyn, he had thought his back had been in pain. In fact, since then it had been this duodenal ulcer.

That explained so much. Previously back pain had been associated with lifting something wrong or sitting wrong or sleeping on a surface that was too soft. But after the six months on Flagyl Tab, back pain had been been unexplainable. It seemed random. Dr. Ober put him on a high dose of Zantac several times a day. Aaron asked if it would have any effect on his mind. Ober told him that Zantac had been around for decades and was as safe as drugs get and would not effect his mind.

It was amazing how quickly the pain left. Within hours Aaron felt better, but now he was supposed to watch his diet. Ober had told him to avoid fiber. "Think mushy. Like donuts." Donuts are good? "Yes. Eat donuts for a while." Aaron lived on donuts for a few weeks. Later he would learn that many fried foods, like donuts, are bad for ulcers. And that many mushy foods are full of fiber. So this was bad advice.

Eventually he also would learn that Zantac effects a person's mind at dosages as high as had been prescribed for him, although he did not understand that it was the Zantac effecting him. For the first time in his life he was driving in traffic when he could not process the information in front of him and did the wrong thing and caused an accident. One of the problems with being stupid is that being stupid makes it hard to figure out that you are stupid. For a long time he did not make the connection between the prescription and the accident and similar things that happened.

While on the Zantac, he showed his old house to a prospective buyer. Her name was Sally. She sold restaurant equipment for a living. She liked the house and asked how long it would take to finish it. He had a team of contractors working and it would be done in a month. She wondered if he could sell it with a lease with an option to buy. She needed a year to save the down payment. She had been in her present job for seven years and made a very good salary. He checked that out. She was single, although she had a child. But she had no pets and did not smoke and never threw parties and would take care of the house as though she owned it already because she was going to in a year. So he accepted the arrangement.

A few weeks after she moved in she called about a plumbing problem in the kitchen. He told her he would take care of it the next day. She might have thought he was going to have a plumber work on it, but he went there himself while she was at work. He had installed the plumbing in the kitchen. He knew it better than anyone else. When he arrived he spent fifteen minutes stretching in the living room It was going to be necessary to get down under cabinets to work on this plumbing and he was taking care of his back. The Zantac had cleared up the pains caused by the ulcer, but there still was the problem in his back. The back pains were more understandable now. They usually followed an event, like climbing under kitchen cabinets. He was working to avoid that.

The mix of aroma's in the living room was disturbing. He opened the door to get fresh air. When he was done stretching he followed the smell and discovered pets in cages and a kitty litter box, although no cat was present at the time. Sally had said she had no pets. When he went back out to his car to get his tools, the little girl who lived next door ran up to him and said that this wasn't his house anymore and he shouldn't be going there as though it was. He saw her father looking out the window next door and knew he was hearing words the little girl had been instructed to say to him. He told her to tell her father he had come to repair the plumbing. Later he would learn that the neighbors had been alerted to tell Sally if he ever came there when she was not home. No one wondered why she would care.

The kitchen was not clean. A dusting of flour still was on the butcher block counters he had installed. He set his tool bag top of it. The pipes were behind the lower cabinet. In order to look at them, he opened a drawer so that he could remove it and see better when he opened the cabinet below it. The drawer was filled with paper money. Thousands of dollars. He slammed the drawer shut. What was she doing with that kind of cash stuffed in a kitchen drawer? Then he realized that the powder on the counter was not flour. It was cocaine. And now it was on the bottom of his tool bag. He took the tool bag outside and dragged it across the lawn to clean any residue off.

Within a few months she stopped paying rent. He learned the steps necessary to evict a tenant. It wasn't easy. She now had fourteen pets and the house reeked of pet urine. The wall to wall carpets were stained and stinking. And she had a roommate, a large muscular woman nicknamed Gorilla, usually called "Grr" for short. Aaron got so that he could hear when Sally was lying, which she did frequently. Suddenly she had some cash and paid him a large portion of what she owed promising the rest soon. He stopped the eviction proceeding. Neighbors told him that the son of one of the people on the street had become an installer of cable television and that he had illegally installed free cable for his old friends in the neighborhood. Sally learned about that and kept track of the license numbers of people who visited his house. She then reported the license numbers and the neighbors to the cable company. The cable company gave a five hundred dollar reward for reporting someone with illegal cable. She made forty-five hundred dollars on the six neighbors and three friends with illegal cable. The man lost his job. She used some of the reward to pay some of the rent she owed. She spent the rest on cocaine.

Six weeks after that, she telephoned Aaron to tell him about a tragedy that she did not want him to learn about through the grapevine. From the first half of the first sentence he knew that she was lying about whatever it was she was about to tell him. What she told him was that "Grr" had killed herself. Neighbors already had told him that they were lesbian lovers. They also said that they wished that Aaron would hang curtains over the sliding glass door of the rear bedroom so that their children would not be reporting such things to them. He mentioned to Sally that she might consider doing that, but she did not do it. And she was adamant about not letting him in the house again. The story Sally told him now was that she had gone on vacation, and when she returned she went around back to check on something in the backyard (Aaron thought, "Who comes back from vacation and does not first open the front door, but tells a child to sit in the car while she goes in the backyard to check on something") when, through the very sliding glass door that still did not have curtains, she saw Grr on the bed with a rifle in her mouth. She had called the police who had come saying that Grr had been dead for about a week, the same amount of time Sally had been gone, and listed it as a suicide. The neighbors did not believe it was a suicide, but no one asked them. They had heard the fighting and arguing. They had seen the disputes tumble out into the yard. They had heard glass breaking and gone to knock on the door to see if everyone was all right and been met at the door by a disheveled, red faced, hyperventilating Sally who shoed them away and closed the door. Aaron could hear in Sally's own story that she was guilty. Why couldn't the police? In the future, when reporting to the police degenerate, life-ruining crimes committed against him in a hospital while he was tied down and helpless, he would find out. But at this moment he thought about something he had learned when studying political science. He had learned that there are counties in this country where they don't have a murder rate because in the history of the county no one ever had committed a murder. He now wondered about how many counties did not have a murder rate because the police did no better than this. He wondered if Blue Ash had a murder rate.

Sally did not resume paying rent again. She promised she would get money soon. He waited longer this time, but after a few months he began eviction proceedings again. In the middle of the night she disappeared. She took the wall to wall carpet. She took the free standing fireplace. She took the curtains Aaron had left in the front windows. She took the light bulbs out of the sockets and the screens out of windows. There was damage and destruction and stench everywhere. If his mind had been clearer would he have been able to handle this better? Would he have let her take it on a lease option in the first place? He wasn't wondering about the effects of Zantac yet. And he very well may have made all the same decisions without it. But he was wondering if there was anyplace on earth one could go to find people who were honest and decent and well-meaning.

In medicine he still was looking for a new doctor. Everywhere he had gone in medicine for quite a while, he had asked for recommendations for a new doctor. They were not willing to suggest anyone. It appeared to be considered a breech of some sort to lead a patient away from the doctor currently in charge. Sometimes they asked why Aaron wanted to switch. He did his best not to complain, but said different things to different ones of them while searching for an answer that would elicit the information he needed. Finally to one doctor he said that Ober was willing to treat only one condition at a time. If you had problem with an ulcer and a problem with a knee, you had to make two appointments that were weeks apart. And at the second one when talking about your ulcer, he would say that you really should be jogging for exercise, with no remembrance of the bad knee. The doctor to whom he said this smiled and said he did know of a physician who listened better than most. His name was Jeercurz. Aaron wrote it down.

Next Chapter

Medical Novel Table of Contents

Persons, places, events, and situations in this story are purely fictional.
Any resemblance to actual persons, living or dead, is coincidental.

Rough Draft / Under Construction

NOTES
Holes in shoes in snow

When Karen was three years old she walked around a room in her house with a crayon drawing on the wall at a three-year-old's height. Her mother brought

development and coordination of disease prevention strategies at the CDC.

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The real subject of all conversations became"
What does he know
What is he trying to find out
What do his questions reveal about what he is able to find out

The goal of discussion became the gathering of information that could help her. When his mood changed abruptly, as it unavoidably would when he realized where she had been, she plied him with questions about what had changed his mood. She wanted details in order to determine how he knew and how she could cover it up next time. Gone were the days when they could just love each other.

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Home | Table of Contents | It's a Path
Silence versus Patient Safety
Loyalty versus Patient Safety
The White Wall of Silence versus Patient Safety
Blacklisting Patients
Freedom of Speech for Patients
Medical Complaints - How to

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It's a path

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