Adventures And Thoughts As Recovery Wears On

Today recovery continues.  I have some blood passing at least once a day for the last few days, now 4 I think.  Usually but not always at the end of the stream I think it is a sign that the catheter in for a week beat the crap out of my bladder and related piping, not that I cared, I had an epidural through all accept the removal of it, which was done in fits and starts by a student under the supervision of a teaching Nurse.  Wow, just talking about it still makes by butt pucker a little. 

My left side is still markedly weak and I am very tired which I attribute to my body putting all available resources into the healing process. I talked at length with my Brothers in the morning and partied with Jared, Jocelyn and Maggie, the Hays family, in the afternoon and our beloved Colts won.  Vanessa was at a sorority function but called for a game update and had Jocelyn text the final score to her, hokey smokes, what a fan. 

It made me sad when they had to leave, but they have full weeks ahead and I understood.  I got to take a long walk for my present state, about a city block, this afternoon.  I have pulled a small section of my incision, the product of sneezing hard yesterday so I am taking yet another day very slowly and taking a minimal pain medication regimen. 

Now Monday Morning, and I am losing track.  Three weeks since the surgery?  I wake up to much improvement but I am still very delicate and prone to pulling in the same areas so I must continue with sitting, short walking and sitting.  Oh I am so tired of this regimen.  I am thinking that just about now I would be getting the catheter out if I my surgery had been successful and resulted in a new bladder.  The pain pills distort time and perspective and I hope the effects of what I took over the weekend in the interest of mobility wear off before I have to take any more.   

Skype is now second nature as I regularly visit with Rex and Dan.  For me this alone makes the computer worthwhile and would shorten Bill Gates sentence.  Video calls, what technology.  Just imagine, the telephone was invented around the same time as the gasoline engine.  Today the telephone in it’s infinite variations bears no resemblance to it’s original form, yet the gasoline engine is easily recognizable, having it’s last core improvement, hydraulic valve lifters, introduced in 1939.  While manufacturing techniques and materials of construction have changed, it’s still the same old technology.  Imagine if all technology was put on hold to support one industry, in this case oil.  Imagine if every generation we never said what if and every attempt to change was met with overwhelming resistance.  Many would feel very comfortable in such a world, saying we have all we need today and it will sustain us forever.  They will hold to this even as the world crumbles around them.  I wish I could experience such security by turning away from all but selected inputs. 

Video calls, what’s next, a wrist watch TV?  Holy Dick Tracy. 

4:30 AM and I am grateful for the morning.  I did not sleep fitfully.  I am continuing to pass blood sporadically in very light form or small clots.  Not sure what that means but will continue to monitor.  I still feel it is related to the catheter worn for a week while in the hospital.  Snickers demanded cuddle time so I set the computer aside and allowed her up.  I will be starting work early today as I have a lot to get out and several follow up calls to make.  Great to be busy.  Again today I can feel improvement in my incision but I am still not there yet.  Man I am ready to get back into walking normally, wearing real pants and going back to the gym.  Next week is my goal but I am fearful I might not make it.  Vanessa says probably two more weeks at least.  Perhaps they will come up with nanobots today to inject in me and go after my cancers like scrubbing bubbles, leaving me cured and able to once again drink 2 beers and write my name in the snow from the motel balcony.  Miracles happen every day. 

Two Weeks After Surgery

SnickersWatchcat and Danderbomb

Now the darkness settles in.  Deep shadows, cat on the TV tray, alert and eyes dilated.  Black holes now, ears perked, off the tray onto the table, the reassuring picture of Vanessa at rest with her cat standing guard.  What does she see?  I see nothing there, yet her eyes follow and track, left to right and back again.  The cat, only one paw from the wild I think returns to the tray, her self appointed station a couple of times a day.  Sometimes animals save us from ourselves.  I shall rest easy knowing the walking dander bomb is on guard and protecting me from the unseen.

Now Thursday in the dark of the early morning, watching pundits interview pundits on PBS discussing the economy I find myself disappointed with the length of time it has taken me to come back.  Perhaps it’s the flair of carpel tunnel in my left hand sending excruciating pain up the arm and persisting long after.  I just registered where my brace is in general terms.  Not enough energy to get up and get it.  Not enough energy has been my hallmark this week, now down to a pain pill every 12 hours or so I hope to be done with them. 

Today is see the Ologists and get the staples out day.  More importantly it is Vanessa’s Birthday.  I hate the cancer for keeping me from my appointed rounds on her birthday.  I cannot imagine a gift worthy of her love and sacrifice for me during this past year of hardship.  I shall try to make her day a jolly one, despite the hospital meetings this morning.  We will have Jocelyn with us for these consultations, our secret weapon. I cannot tell where my Women are on my condition.  I find in my readings in such publications as the Journal of Urology that various studies have been done on post chemo therapy different from the what I have recieved.  Dr. K felt I might be a candidate for radiation which will put me in the care of the team Radiation Oncologist. After all if I can add a couple of years without it killing me it seems to him I should.  Now from Oncologist to Urologist to Radiation Oncologist my graduation to being a possible candidate for radiation takes me to a new ologist and a new fat file to be created.  Dr. Hahn was not so enthused about radiation so today we meet with them and get the skinny.  No sense second guessing what’s next I think I will just let the day unfold as it will, remembering all day first and foremost it is Van’s day. As I sit here and the PBS news hour takes time to show me the pictures of the most recent killed in our ill fated military forays.  Ten children, ten sons, ten friends gone and all the lineage that may have come from them.  Ironic I should see this at this time, but I am glad I did.  One more Vicodin this morning, I hope it’s the last one I have to take.    

It Hurts To Laugh

Look at the fun in…feeling terminal, la da da da da da da da, feelin’ terminal to parody Simon and Garfunkle.  I noted in Van’s notes she made note of my breakdown after my visit with Dr. H.  She had asked me what he said about chemo and I broke down in tears for a moment.  Every time I do that the absurdity of it all seems to overwhelm the tears.  If ever their was a font of humor at a funeral it is I (I have done some of my best work at them as Family will testify), so the disease and the visits with the doctors and the acronyms and the terms and the questions by the Women are intrinsically part of the process that Dr. E talked about in the beginning. 

I wondered if the ologists were reading the same Google stuff that I had been reading.  I remember saying boy I hope I don’t get to that point when I was doing my initial research, and here I am.  I never had pain from the cancer, just from the treatments and unintended consequences.  I asked the surgeon where the pain would come from when it did..  ‘Left leg’ he replied, ‘of course we will give you what ever you need.’  ‘Of course’ I replied.  Sometimes the weight of it hits bottom and comes back up.  Of course I do not want to leave, although I am not afraid for my family, for their strength and bond would see them through my passing and they will all continue to thrive.  I just don’t want to miss out on the show as it goes. Since all of my Women reached adulthood I am surrounded by very beautiful and gracious Ladies.  It is every Father and Husband’s dream.  Who wouldn’t want to hang around as long as possible to be part of it. 

Feeling sorry for me is a luxury I cannot afford and feeling terminal equates to that so I put those feelings aside.  I am staying on the job, keeping my calendar full and taking advantage of my good health and increasing mobility.  Now 10 days since my surgery and I am healing pretty much on schedule I think.  Most of the time I am like an old dog, laying around here and there all day long every day, eating and doing that other thing.  I am still taking the generic vicodin so I do not have to worry about overwhelming ambition to do anything. I am content to just sit in my drug induced haze and heal.    

Freedom of flagellation is a totally unique experience for me.  Mostly gas passing is frowned upon in my life.  Beyond sitting around with the boys there is no appropriate venue for cutting loose.  A delightful unintended consequence to that recovery from surgery was the amazing level of support and encouragement given me to let em’ rip, so to speak.  Farting was a coveted sign of recovery in the hospital, and encouraged by Family and Staff I did my best to work one up and once started proudly ripped whenever I could.  So now these days later we still celebrate the gas although I sense Vanessa’s enthusiasm is waning in this regard.  It is impossible to minimize the miracle of medicine and that we are so advanced that I can have my colon cut in two and reattached and be near normal only a few days later.  I know it won’t last.  Already there are hints that I will have to return to civilization, where farts and belches are socially unacceptable sooner rather than later.  No matter, I shall toot proudly and hopefully often for the time I have to do so. 

Sunday and the clocks are turned back in that peculiar Hoosier ritual whereby we reset our clocks.  Long after Vanessa retired I found her standing at the foot of the bed with that self satisfied look of accomplishment.  ‘There’ she declared, ‘I think I have reset every clock in the house except this hall one (it’s atomic and will)'.  I checked my solar powered atomic wrist watch and it had reset as well.  No small feat resetting the clocks since we are surrounded by them.  As I write I see one lower right, a phone with one next to me, a small decorative thing on Vanessa’s side table, and very large and intimidating round one on the wall behind me, time. 

I am not sure why Hoosiers feel compelled to force themselves by law to give or take an hour.  The entire concept of any typical Hoosier to have such power is a downright scary.

Vanessa makes a fun ritual of the rite twice a year, and I must say I look forward to it as well.  This is not the first time she worked through a part of her process with this ritual in the middle of the night.  I went out for a paper this morning, still pretty sore.  Gerald stopped by yesterday.  When I met him at the door I just felt relief, he and Joe are family now, if you define it as the ability to sync up upon meeting each other and mutual love and respect as you do.  Seeing him for the first time since surgery helped me sense the magnitude of the accomplishment.  Under the knife and back again, as they say, or maybe just I said that, not sure.  I enjoy his stories and projects and we often brainstorm in the classic sense through some homeowner hell issue and the like.  Sometimes he patiently allows me to ramble as I do and more often than not we laugh until the tears flow in our meetings. 

It hurts to laugh, literally, but I just can’t help it. 

Surgery Day

Surgery day at last.  I sleep pretty good and arise around 6AM.

I pack my man bag (it’s not a purse) with the personal material, a book, I pod, camera, pad, pens, advocacy cards etc.  I took the laptop down and packed it in it’s case with necessary accessories to set up in the hospital.  Some things that I packed are the direct result for my previous hospital stay.  Certainly going to the hospital is not a goal for most of us and avoided generally, having the experience in the first place makes subsequent  visits easier to prepare for.  At the hospital a quick trip through registration and down to preop.  I stopped at the men’s room on the way down, the last time I would drain this way no matter what I thought as I stood at the urinal and then set on the stool because my nerves were clearly irritating my pee machine.  We met a special nurse who would report on me every 2 hours or so to family.  The room included a chemo recliner, extra chair and sink etc.  All the stuff you find in exam rooms.  It was very small, with 3 people packing the place.  After getting in my gown and getting seated Vanessa came in and rotated with my Daughters, Sisters and Brother in Law.  It was great to have the support of Family.  Early in the process I would feel guilty about imposing on loved ones but the disease and difficulty of doing anything without a lot of support made me forget the guilt long ago.  I never appreciated how important it was.  I am never too long alone in my room accept at night.  Pre op is 3 hours to sit and get asked the same questions repeatedly.  The questions posed by the pre-op nurse, resident surgeon and pain management team were to confirm that I did as instructed verbally, by e mail, by phone and by the duplicate instruction copies previously received. 

The time in pre-op went quickly.  Dr. K the surgeon came in one last time to confirm my surgery with me and discuss first and second urinary diversion options.  Renee gave us a Babtist prayer (it went on a while) and with hugs for the Sisters, a firm handshake and see you later for Jack and hugs and kisses for Daughters and Wife I took the long walk to operating room 14.  As we turned down the hallway for the final steps I wished I had lingered longer with my girls.  We entered an area with shiny aluminum like doors on both sides.  We walked to room 14 and as she opened the door I entered an operating room.  My previous surgery was done in a hospital basement room that shared space with surgical supply closet.  This room was equipped for surgery.  It was large, with big digital monitors on the north wall.  The table was at an angle in the room making working around it spacious.  I felt a calm and comfort level with the staff.  The last thing I remember was having the epidural set, which was painless.

In recovery I popped back quickly.  Dr. K came in to advise the surgery was a failure.  The cancer is extensive making bladder removal impossible.  He found a small quarter size tumor on the outside of the colon and removed that small section.  It was hidden in the folds.  He asked about going back to the oncologist and I approved.  By 8p or so I was in my room, a double shared with a young man much more stressed than I.

Days Before Surgery

A hard guttural feeling.  A sick feeling.  It runs down and makes you feel weak in the knees.  Sometimes you can taste a little vomit in the back of the throat.  Only 60 years old.  Thinking about losing your bladder and prostate.  Oh sure lots of things could go wrong with me, heart attack, stroke, car accident.  Never the less thinking about it makes me a little sick. 

But then I am reminded again of all the hidden blessings, a flood of memories into my mind, Sisters, Daughters, Neighbors, Friends and Co Workers.  Concerts, games, visits, dining and the lost goes on.  Of course the experience I am about to go through will present a entirely new set of blessings for me to take joy in. 

Yesterday I began my surgical prep with the first step, ending my Sea Aloe.  It is a nutritional supplement that promotes healing and generally makes me feel pretty good.  Vanessa reminded me I had to stop and I did not argue.  So no Sea Aloe, continuing to exercise, continuing regular diet, oreos left, ice cream left, lunch meat left, a good dinner or two.  No time to do so many things I wanted to do before the surgery.  Got my Granddog for the week end while the kids go to see his Mom in MO. 

Rex advises he did some research on my surgery and the only long term problem I will have is learning how to handle the large brass spigot that will be used for my main drain.  Oh, I love humor. 

Saturday before surgery.  The SBS day.  It starts with a very rambunctious Granddog, dog breakfast, dog biscuit and dog tug and drag Grandpa in and out of the quicksand (a game we play on the laminate floor with her indestructible squeaker.  Tonight I travel to Purdue to with other husbands to join Vanessa at a black tie event for her sorority.  This is an important deal for her that she has busted her buns to prepare for.  I am very proud of her ability to network and advance in any organization she is involved in becoming a key contributor and player without a lot of feather waving.  More than that is the value she places in every acquaintance and friend along the way.  Quite remarkable. 

I have not seen Inger since Van left.  I was not aware she was also a Beta Sigma Phi member but it is a very large organization and it would not surprise me if she was, as it seems to fit her as well I think.  Oh what luck I have had to have Inger come into my life.  

Deciding On The Surgery

Monday and back at work.  Gave the office the word today on my surgery date and plans.  No questions just appreciation on being kept in the loop was the universal response.  I continue to wonder at the people that actually care about me.  A marvelous miracle and blessing each and every one is.  Through my life I have employee and employer but not so much a coworker.  Mostly alone, the majority of time getting to or coming from interrupted by brief encounters with clients and fellow employees the job leaves me on my own for the most part.  How wonderful now at my age to discover the caring and concern the team has for me.  

My cousin now undergoing prep for a stem cell transplant noted she is just now realizing how sick she is.  I understand her sentiment.  Although I have had a surgery, hospitalization, intense physical therapy, allergic reactions to meds, a full round of chemo and now have a permanent handicap from the cancer preparing for surgery is still a hard reality to face.  It means I really am sick.  Frankly I never thought I would be a candidate or have even a remote chance of a cure, yet here I am, the answer to all the prayers said for me. 

Surgery means urinary diversion, but it also means a 20-30% chance of getting the cancer out of me, the only chance I have.  I have decided that my first choice is the neobladder.  This is the most complex and difficult surgery choice I have.  It means I am banking on the 20 year goal for remaining life, not the 5.  I confirmed this morning in another hard step forward.  I did a lot of soul searching on this and found much help and solace in the journals posted on the BCAN web site.  I am looking forward to getting it behind me and hope to be back in good order on or about Christmas.  Like a runaway train, there is no stopping me now. 

The Nitty Gritty Of Hard Choices

Tumor Is An Ugly Thing

Monday morning long before sunrise and I find myself in the same frame.  Time to suck it up.  Autumn is now here in force.

OK, let’s think this through.  Clue one is the reality of it, as shown in the photos taken in February.  Clue two as so eloquently delivered on the BCAN site;

‘If bladder cancer is found to have spread to other sites, systemic chemotherapy is recommended. It is very difficult to permanently cure metastatic bladder cancer in most people. In most cases, the goal of treatment is to slow the spread of cancer, achieving shrinkage of tumor (temporary remission), relieving symptoms, and extending life as long as possible. With advances in treatment, most patients with advanced bladder cancer can expect to live longer than they could just a few years ago.’  ‘Longer than they could’  the operant phrase to consider. ‘Bladder cancers are chemosensitive…’, ‘if the tumors do not respond to an initial course of chemotherapy and radiation, it may be reasonable to perform, if medically possible, a cystectomy.’ Again quoting the BCAN site, here they explain in other terms what the surgeon described as ‘same as pouring water on it’.  In my case the chemo had an effect on the tumor making the surgery reasonable.  The Cleveland Clinic offers these insights on surgery;

‘It takes one to two months on average to feel well again and to regain your strength. Also, it is not unusual to feel a little depressed or discouraged after surgery. Discussing your feeling with friends, family, and even other members of a support group (ask your health care team member about support groups in your area) can help you deal with your emotions. As with any life change, an adjustment period is normal. Don't hesitate to call your doctor or other health care team members for assistance or if you have questions. Their goal for you is to get you back to your lifestyle as soon as possible.’

‘What restrictions will I face regarding work, activities, diet, or travel?

People with urinary diversions are usually able to return to the life, work, and hobbies they previously enjoyed.

• Work — Most people can return to their jobs in one or two months on average. If you have concerns about your line of work or other job hazards, be sure to ask your doctor.
• Activities — After the post-operative period, exercising and participation in sports and other activities is encouraged. Check with your doctor or health care team member.
• Diet — There are no eating restrictions, but if you have special dietary concerns, check with your doctor or health care team member.
• Travel — There are no travel restrictions. Just a word to the wise — travel fully prepared with necessary supplies, as you might not be able to purchase all supplies at your destination.’

So there it all is.  Most likely we aren’t talking decades living my alternative life style before this cancer takes me down and my only chance of extending any time I have lies in surgery so surgery it is.  And so we shall begin chapter two of this journey.

Facing The Radical

9/24/10 In the early morning on the BCAN web site (www.inspire.com) reading the comments in a men with neobladders discussion group I came across this one;

‘I have had my neo since 2/09.  I am incontinent and must wear pads and diapers.  …so far can only go 3 hours…use a condom cath to travel hooked up to a leg bag…have had diarrhea since my surgery.’  The he goes on to write ‘With all that I am still happy to have the neobladder, for me the bag would have really brought me down.  I have learned to live with this and try to just move on the best I can’.  Once again I feel puny in the shadow of giants in character.

Now Sunday and two days have gone in a flash.  My ever patient Son and Daughter took me to a golf course for a sound round of beers and 6 holes or so, 3 lost balls, 3 horrible gaffs.  But as it was approaching twilight there was no one ahead, a perfect scenario for a first timer.  ‘Natural golfers’ he said of our hitting, straight and true when mind is not overwhelming matter and ball contact issues do not prevail. Starting with a golfer was most important as I picked up many of the basic etiquette's involved in sharing the field with others.  I like the game and concept but suspect the economics will prevent me from venturing very far past the driving range for the foreseeable future.  Miracle I was out there at all I think as I look back on the what ifs and disjointed events that finally led me to discovery and a treatment path.

‘I would have done it a month ago’ the surgeon said.  I remembered that part of his dissertation, Vanessa’s protest that Dr. H said surgeons liked to wait two months after chemo.  The surgeon gave a mild defense; well there can be complications as he rattled off a few life threatening ones as if they were only incidental matters.  But now Sunday morning, in the clearer light of day I wonder if I should endure another TUR only to delay surgery until a later date and keep the risk, but I know in my heart with this kind of cancer it is proven that waiting is not an option.  I posted on BCAN and voices responded giving me a sense of hope, yet as the week end wears I find myself increasingly depressed.  Major surgery, a week in the hospital, 8 weeks to recover is beyond daunting to me. 

Waking Up After Surgery

I woke up, easy to focus, as when my conscious mind awoke from it’s trip to whoknowswhere I immediately hit the ceiling. I think literally. The pain was exquisite and excruciating. What the hell kind of pain is that anyway? Throbbing, burning, in waves, constant, debilitating, all of the above, ah yes, that’s it and more. With my toes and fingers dug deep in the ceiling a kind nurse came to my aid. Holy cow. We can give you something….delirium…..we are moving you to a room….please don’t touch me. Can anyone put the fire in my penis out? The tired old vet has been beatin’ like a junk yard dog. We have something, ok, let’s break it out and apply it.
‘Oh my’ she said, ‘that’s the biggest catheter I have ever seen!’ ‘Inspiring’ I panned. Positioned now in a room and in bed I put all my Lamaze training to the test, panting and blowing through waves of pain that now filled my mid section from tits to knees.
With his comforting tone, Dr. El let me know the pain was not in my head, it was real, and was caused by an infrequently encountered condition called catheter intolerance, or to put it another way, that garden hose I stuffed up your Business not only ripped the shit out of the upholstery, but was also rejected by all the related tissue of the body in the general area. The nurse stressed that I keep on top of the pain. If I needed anything just push the call button. I did, and it did not work. She said she called maintenance, and later they brought me a large box that plugged into a wall socket designed for it; giving me a call button and making the TV work. Maintenance showed up the next morning, but I sent them away. As I lay there passing the time I found the need to call for pain every 2 hours, regular as clockwork. My first response would come 45 minutes after my first energizing the call light. Medication would follow within the next 45 minutes.
Afraid to sleep, for fear of the pain and ever so sad for being such a burden but so thankful for My Women. With health care you need an advocate.
I got this catheter routine. Mom’s final days included maintenance I was somewhat adequate help with but mercifully Vanessa would take charge when we were on watch. I shall have one for two or three weeks they say.
If I end up in Heaven, I hope I get a house with high ceilings.

Surgery

February 12, 2010 the disease has turned my world on end. Thursday I spent the better part of two hours trying to output 150cc of urine while retaining 20-40cc. If I failed this test it would be more days of a catheter, a prospect I would not accept. Never had the measure of 150cc been so important, and I splashed water down and held on as long as possible. Just before lunch, my forefinger in the hot water stream at the bathroom sink, I reached the magic mark.
We had a lunch to celebrate of chicken sticks, fish sandwich and all the trimmings. It was fabulous.
This is Sunday AM-beginning the week of decision and direction change. Resign the gym, put affairs in order, and consult with Dr. K, E, and Nurse E. Meet with the girls, assimilate the information, and plunge ahead. Surgery seems the only step to take, the excepted step in the US at this writing.
There are no cliffs in Indiana. No easy way out. Even as I struggle with the whatifs that sneak into my mind every day, causing my stomach to lurch, I face details and put one by one each behind me.
Tea with Vanessa in the morning, who would have thought it possible. Cranberry juice, more in the last few days than in the previous 58 years. Rethinking resigning the gym, going to take a leave of absence instead I think. Maybe I can get a new bladder and live out the remainder of my life with some normality, albeit a different reality from the past. If so a lot of walking will be required to recuperate.
Yet many unintended consequences continue to surface. Skype with my Brother, seen him more this week than the last 2 or 3 years at least.
And how strange that now I keep running into articles and TV that discuss my issue. Never noticed before. Like buying a car then seeing them everywhere I guess.
How long has it been since I slept all night long? Seems like an eternity. These past few days have been especially grueling. Yet I seem to be getting better as the days go on.
Working from home this week, still not back on the road. Hope to get around and see most everyone before I have my surgery.
Solid sleep did I ever! Pains sharp and out of the blue, from what? Itching means healing, or something else, who knows. Whatifs fill my mind sometimes without warning.
After the first surgery my need to pee was hourly, all 24. During the first 3 days I wore the dreaded catheter. It is worthy to relive that experience.
My surgery was a transurethral resection. Or to put it another way, straight up your business with tools, lights, packed lunch etc to scrape a tumor off a wall. Dr. Gasman came in just before they wheeled me into O R. ‘Can you tell me your name?’ Mike Courtney and I mumbled my birthdate. ‘Oh, you know the drill. Can you tell me why you are here?’ ‘Cancer’. ‘Very good Mr. Courtney.’ I waited for my biscuit or a pat on the head, but only got his continued dissertation. His delivery was somehow forced, like he wanted to project calm but underneath he was a ball of pent up frustrations at the verge of blowing out a wall. Yet he was sing song like, calming as he went on. He made me a cocktail of triple whammies that will put me to sleep, he will put a breathing tube in me a pump me full of breathing gas. Then he paused, I thought I saw his expression crack, just a little. Was that a grin coming on? ‘It’s the gas that keeps you asleep’ the good doctor said.
I had Googled this surgery and done some reading. Once in the OR, Gasman positioned over my head, people milling about I was in the money making part of this service business. He then quietly started talking. Mr. Courtney, I am now placing my special recipe into your IV, as you are helplessly laid out like some over fed mammal washed ashore and unable to grasp the situation for lack of thumbs. Then we will……………
Hospitals are after all job shops. Fundamentally their function and product cycle is the same as your heating and air conditioning supplier. Hospitals sell new equipment in the way of services and products. Hospitals repair and do maintenance work on existing equipment, humans. Profitability relies on maintaining the right ratios of product and service sales at the volume and margins required to make the nut. Here I was, an older unit, but in pretty good shape, going into the express service bay (same day surgery) for what I hoped would be a cure for my cancer. I looked at the mechanics, the team. The Star still not there, and I will not see him.
Where does the mind go when Dr. Gasman comes calling? When you wake up you will be groggy, disconnected.