Foyle’s War’s Teeth

Perhaps it was by design, or perhaps not, but the attention to period detail in the crime series Foyle’s War is remarkable and rare in a seemingly simple way: it gets teeth right.

Foyle’s War is a police drama featuring Detective Superintendent Christopher Foyle (Michael Kitchens). Many of the crimes he investigates in Hastings, Sussex during WWII are related to the conditions on the homefront including profiteering and sabotage, but jealousy and madness also provoke ordinary people to behave wickedly. The show premiered in 2002 and ended in 2015 after 28 90-minute episodes. The last episodes following the war find Foyle in London, working for MI5.

Foyle is a quiet, highly principled man. He is compassionate, but he does not suffer fools. He’s a widower with one son, Andrew, serving in the RAF. From the first episode onwards he is accompanied by Samantha Stewart (Sam) as his driver, and in the first five seasons he works with Sgt. Milner, a policeman who lost part of a leg in the war.

There are perhaps a half dozen other characters who appear in more than one episode, but for the most part, the cast is fluid.

Its creator, Anthony Horowitz, has attributed Foyle’s War appeal to the tone of the show. It defies the sentimental nostalgia for the war years, and Horowitz based many of the situations Foyle investigates on historical events. The New York Times acknowledges that Foyle’s War is typically “celebrated for the ‘historical accuracy’ (those are the words always used) achieved by its creator and writer, Anthony Horowitz. . . . The better word is probably scrupulousness — the special texture of the show owes to the faith we feel in Mr. Horowitz’s depiction of the clamped-down, suspicious yet doughty atmosphere of 1940s Britain, and to the trouble and expense to which the production has gone to recreate those times.”

In contrast, consider the criticism of Downton Abbey, which historian A. N. Wilson called a “sanitized fantasy.” Downton may get the place settings right, but “the servants in the program are far too clean,” according to historian Jennifer Newby: “The reality would have been a lot more grubby, I don’t think people realize that the servants stank.”

All I think you need to do to understand why Downton is fantastical and Foyle’s War is not, is to look at the teeth.

Foyle’s teeth

Christopher Foyle (Michael Kitchen) has acceptable, ordinary teeth. There are no obvious flaws, other than a little yellowing. Foyle smiles easily – he has a very expressive face – but his smiles are usually closed.

Samantha (Sam) Stewart (Honeysuckle Weeks). Sam’s mouth seems to change from the start of the series to its final episodes. In the opening episodes, Sam’s teeth seem to be a bit small for her mouth and there appear to be spaces between her teeth.

In the last series, her teeth seem capped and bonded.

Foyle's War
Sam Stewart (driver)

Sgt. Milner has good teeth, as does Foyle’s son, Andrew. The actors who portray them, Anthony Howell and Julian Mark Ovenden, were stage actors. I expect it would have been hard to find experienced actors to play young men in their twenties who have not had good dentistry.

What’s interesting is that the characters who have obvious problems with their teeth represent all social classes. A fisherman, a police commissioner, doctors, army brass, industrialists – all are at risk. Not everyone has bad teeth: a daughter of a wealthy family in Series 1, episode 1, has perfect teeth, as does a burn victim.

Let’s see some examples:

Foyles War
Fisherman in “White Feather”
Foyle's War
Hilda Pierce, MI5. Yellowed teeth.
Not bad teeth — but not perfect, either
Foyle's War
A doctor’s teeth
"The Funk Hole"
Overlapping teeth
Police Commissioner’s mouth
Series 5, epsiode 2
The brass in “Casualties of War”
Serie 4, episode 2. Guard in “Bad Blood”
The Hide; season 7. episode 3
A nanny missing a tooth
An industrialist’s functional but not dazzling teeth

Some do have good teeth:


I don’t know if in the between-the-wars period imperfect teeth could be fixed to look like what is considered normal today, but the family of Downton Abbey would have had the resources for cosmetic dentistry if needed and available. So it isn’t too surprising that Lady Mary, Mrs. Crawley, and the rest of the Granthams have 21st century American teeth.

But it would be very surprising if the servants of the house also have perfect smiles. And they do. This is a huge oversight for a series that claims to be true to its historical period.

Even scullery maid Daisy has a dazzling smile.
Downton Abbey
Housekeeper Mrs. Hughes’ perfect smile
Downton Abbey
Tenant farmer’s and cook’s healthy mouths. 
Lady's maid Anna's perfect smile
Maid Anna’s teeth are every bit as good as Lady Mary’s.

Let’s face it: imperfect teeth are taboo. There can be no glamour when there’s a crooked tooth.

But there can be no pretense of historical accuracy when the scullery maid has a smile that rivals an aristocrat’s.


Have Hoodie, Will Die

“His hoodie killed Trayvon Martin as surely as George Zimmerman.”

“You have to recognize that this whole stylizing yourself as a gangster, you’re gonna be a gangsta wannabe? Well, people are gonna perceive you as a menace.”

“I am urging the parents of black and Latino youngsters particularly not to let their children go out wearing hoodies.”

Geraldo Rivera, Fox News 

Who would have thought it? Racism in America can end, liberty and justice for all can prevail, if only parents would take a pair of scissors and cut the hoods off their kids’ sweatshirts.

While you’re at it, make sure you get rid of those drawstrings. I expect Geraldo will be telling us any day now that they are a leading cause of suicide among American youth.

Continue reading “Have Hoodie, Will Die”

Two Families, Two Pets, Two Trips

Here’s one of many summaries of a despicable deed, an illustration of callousness and poor judgment, heartlessness and cruelty, by the GOP presidential frontrunner with a net worth of $220 million, Willard “Mitt” Romney. See Dogs Against Romney if you need more details. Watch this interview and you will see Romney still doesn’t get it, thinks what he did was no biggie, but he wouldn’t have done it if he had known he was breaking Massachusetts’ animal cruelty laws, and besides, it was a long time ago.

…you may not be familiar with the 1983 story where Romney crammed his five children, wife and luggage into the family station wagon for a 12-hour drive to the family cottage at Beach O’Pines from Boston to Ontario. The family dog, an Irish Setter named Seamus was placed in a dog carrier and fastened to the station wagon’s roof rack….

Now brace yourself for the ugly part of the story when one of Romney’s sons yells out the word ‘gross’ as he sees a brown watery discharge running down the back window. Poor Seamus’ bowels let loose from the extreme distress of being on top of the car roof.

So what did our potential presidential candidate do? Romney pulled into a service station, hosed down Seamus, the cage and the car, and then put Seamus back on top of the car in his crate and continued on with the journey to Ontario.

Romney’s excuse for putting Seamus on the roof was that with five kids and all their stuff, there just wasn’t room in their station wagon for the dog.

I know a little something about road trips with animals.

In 1970, my mother, father, two brothers, and I loaded into a station wagon along with a toy fox terrier and a Siamese cat and made the 2,148-mile trip to Laramie, Wyoming. It took a lot more than 12 hours, I assure you. And since we were going for 8 weeks, we too had a lot of stuff, even though we were renting a furnished house. On the way back, we rescued a kitten from a motel keeper; the mother cat had been run over. So we were traveling home with 3 kids, a dog, a cat, a kitten, and two adults.  All sentient beings shared the same pleasures and discomforts.

The next year, the only four-legged family member was Tobias, the Siamese cat, who joined the five humans in the station wagon for the 3,086-mile journey (that’s 6,172 roundtrip) to Stanford University in Palo Alto, California. This time we were renting an unfurnished trailer for two months, so even more stuff was involved — pots, pans, linens, towels, etc. The stuff went on the top of the car. The howling (and occasionally vomiting) Siamese went inside the car. That was a long time ago, too.

Summer, 1971: the author and Tobias. I believe this was taken in the Mojave desert, when we all got out to stretch our legs and let the engine cool down. If you look closely, you can see Tobias is wearing his harness.

Why did we make such onerous journeys? My father was not a $220 million mouth. He was a public school teacher, and in the sixties and early seventies the Federal government supported science education by providing institutes for high school science teachers. The teachers received a stipend, probably about what they would have earned teaching summer school. Travel and housing expenses were not included, so as a family we would have done better financially staying home. But education — for all of us (imagine being 12, living on the Stanford campus in 1971) — mattered more than money.

I’m sure the Romney boys learned a lot on their lakeside vacations at the family “cottage.” I just hope none of them has a dog or cat.


Amtrak Absurdities. And David Bowie.

I’m not going to make an argument for train travel in the US. Even a contrarian like me knows that’s a hopeless case. But I’ve been reading about trains lately and have amassed a bunch of fragments that I’ll stuff into this virtual cabinet of curiosities in case someone else can use them.

Train travel is 30-40 percent more fuel efficient per passenger mile than air or auto

Let’s go from Atlanta to Chicago. Here are our choices:

  1. We could drive. It’s 718 miles and would take  12 hours. Fuel costs for a 2008 Corolla: $52.
  2. We could fly. Here’s a fare for $167. Flight time: 1  hr, 43 min.
  3. Or we could take Amtrak.  Cost is $245 one way, and we’d be there in only 37 hours, 41 minutes. I am not kidding.

Major Population Centers (# ranked) in the US not served by any passenger trains.

  • # 6 Phoenix, AZ
  • # 15 Columbus, OH
  • # 25 Nashville, TN
  • # 27 Louisville, KY
  • # 30 Las Vegas, NV

As car ownership and the Interstates grew, passenger rail travel options decreased.

  • 85% fewer passenger cars operated in 1965 than in 1929. When Amtrak was established in May 1971, all but 182 of the 364 passenger trains that operated on April 30, 1971 were discontinued. Now it operates 44 routes.

Total km of Track (from CIA Factbook):

  • European Union: 228,710 km (2010). The land area of the EU is less than one-half the size of the US
  • US: 224,792 km
  • Russia:  117,157 km
  • Germany:  41,981 km. World rank #6. Germany is slightly smaller than Montana with the fifth largest economy in the world
  • France: 29,640 km. World rank #9. France is slightly less than the size of Texas
  • Japan: 26,435 km
  • of Roadways: United States: 6,506,204 km. European Union: 5,814,080 km
  • Oil Consumption: United States 18,690,000 barrels per day. European Union 13,630,000 barrels per day
  • Natural Gas Consumption: 1 United States 646,600,000,000 cubic m. European Union 487,900,000,000 cubic m
  • Oil Imports: United States 11,310,000 barrels per day. European Union 8,613,000 barrels per day


  • The first gas shortage in 1977 could have seen a return to passenger rail. Instead, the number of routes continued its decline. So much for energy conservation political posturing then — or now.
  • Having roadways doesn’t mean you can’t also have passenger trains.
  • The rails are in place in the US: why aren’t they used for people as well as freight?
  • If Americans don’t want to use public transportation, why do they fly? If supporting a national rail system is socialism, wouldn’t the same be true of supporting an interstate highway system (arguably the largest Big Government Federal social engineering event in US history).

Amtrak’s Greatest Missed Opportunity?

”]Between 1972 and 1976, David Bowie toured the US five times. He didn’t fly a single mile, and in fact, took ocean liners across the Atlantic. In the US, he used buses — and Amtrak. He made multiple trips on the Super Chief (aka Southwest Limited) between LA and Chicago. He rode the Floridian, which ran from Chicago through Louisville KY, Nashville TN, Birmingham AL, Jacksonville FL, and down to Miami (and points in between), which was shut down in October 1979. He took the Coast Starlight from Seattle to LA, and the Sunset Limited for Phoenix. This is a trip he couldn’t take today. And others.

Too bad no one was paying attention. Would passenger train travel be different today if someone had?

Homeland Security Doesn’t Extend to Evacuation Plans

Here we are in hurricane season. It has been a year of extreme weather, so I thought I’d have a look at what plans FEMA, an agency of  the Department of Homeland Security, has made to evacuate large metropolitan areas like Miami and Houston, since I was also looking into evacuating for nuclear power plant disasters. As I noted yesterday, all I could find on FEMA’s site was the suggestion to keep your gas tanks full and limit your family to taking just one of its cars.

Apparently, they have [still] forgotten that trains run in the US. After Katrina,

“Amtrak ran an evacuation train from Avondale Yard in New Orleans to Lafayette on September 3. New Orleans Regional Transit Administration buses transported passengers from the city to the yard. Once aboard the trains, meals-ready-to-eat, water, and medical and security personnel were available. The train had capacity for 600 evacuees, but only carried 97, who were then bussed by Houston Metro Transit to Texas. The same afternoon, federal officials called off further Amtrak evacuation train operations, as Texas shelters were at capacity and officials were unable to utilize Amtrak to send evacuees elsewhere. Amtrak has kept two trainsets (one Superliner, one Horizon) in Lafayette to be used on an as-needed basis, while bus and aircraft evacuations of New Orleans continue. Sen. Mary Landrieu (D-LA) criticized the Federal Emergency Management Agency for being slow to accept Amtrak’s initial offer of assistance last week. ‘When Amtrak offered trains to evacuate significant numbers of victims – far more efficiently than buses – FEMA dragged its feet,’ she said.”

This story by from the September 2, 2005 Clarion Ledger (Jackson, MS) by Sylvian Metz suggests that trains could have been better used:

“Amtrak will begin evacuating stranded New Orleans residents tonight. If all goes accordingly, the first train should pull out of New Orleans about midnight. . .

The train will run around the clock, with a second train to join the operation in the next couple of days. . . . Amtrak will use freight lines owned and operated by Union Pacific Railroad, Burlington Northern Santa Fe Railway and Canadian National/Illinois Central Railroad. . . .

Amtrak President David Gunn came up with the idea two days ago, according to Meridian Mayor John Robert Smith, former chairman of Amtrak. Smith then presented that plan to U.S. Sen. Mary Landrieu, D-La., and Bill Gotshall, chief of staff for U.S. Sen. Trent Lott, R-Miss.”

Let’s look at the progress of the idea into action. Was using trains FEMA’s idea? No. It came from Amtrak to the mayor of Meridian, MS, to a US senator, to the chief of staff for another senator. This does not seem very efficient.

And why on earth would they use the train to take people only as far as Lafayette, LA, 145 miles out of New Orleans, and then bus them an additional 220 miles to Houston? Why were officials “unable to utilize Amtrak to send evacuees elsewhere”?

Worse still,

“A challenge was faced with staging evacuees for passenger rail services offered by Amtrak, due to the lack of communication, coordination, and prior planning among local, State, and Federal officials. Assistance offered by Amtrak prior to the landfall of Hurricane Katrina was not accepted and resulted in a train with 900 seats (7 locomotives and 20 cars) leaving prior to the storm.”

Does any of this make any sense?

One of the recommendations made during the Congressional hearings following Katrina by the Director of Homeland Security for New Orleans was to

task AMTRAK to develop and maintain the capability to evacuate 5,000 special needs citizens from any metropolitan area in the case of a declared National Emergency.

Sounds reasonable, but was this idea acted upon? Well it was, when the topic was hot, and on September 1, 2008, prior to Hurricane Gustav 2,022 people were transported by train from New Orleans to Memphis. But by 2010, things had changed. On June 10, 2010, in testimony to Congress regarding the BP oil spill, Mark A. Cooper, Director of Louisiana’s Homeland Security and Emergency Preparedness Office asked that

FEMA . . . re-initiate its contract with Amtrak to provide a means of evacuation for at-risk populations from the New Orleans metropolitan area. FEMA informed the state, literally mere weeks ago, that it had determined to cancel this contract. In light of the current oil spill, it is glaringly apparent that all modes of evacuation will be needed should a storm threaten the coast.

I haven’t found yet whether FEMA is working again with Amtrak, or if a Houston Feasibility Study by Innovative Emergency Management (IEM) that showed that with 72 hours notice, 3,600 people could be taken out of that city to Dallas or 6,300 to a transfer point has prompted any action.

Of course, these numbers are tiny compared to the number of people that would need to be evacuated. Amtrak only runs 34 trains nationwide. Still, because trains can’t solve the whole of the problem doesn’t mean it makes sense not to utilize them at all, especially for those who would be most stressed by long bus trips in bumper to bumper traffic.

There’s a lot more to having a secure homeland than keeping terrorists off planes. That is, after all, a theoretical risk that would affect far fewer people than would the next major natural disaster and the sooner-or-later major manmade one.


About Browns Ferry Nuclear Plant, Tornadoes, Evacuation Plans — and Car Pooling

Here’s a what-if for you. What if there had been an accident at Browns Ferry in North Alabama when it lost power after its power sources were knocked out during the F5 April 27, 2011 tornado? That could have happened. Initially, the Tennessee Valley Authority “indicated everything functioned as it should”; however, Pam Sohn reported in the Chattanooga Times Free Press that

“documents the utility is required to submit to the Nuclear Regulatory Commission show reactor operators became distracted while manually operating cooling water flow to the Unit 1 reactor and water began boiling off faster than it was being replaced.

“Additionally, a valve failed, a diesel-driven fire pump failed, the diesel-driven generator for the security station failed, the warning sirens were lost, power to the chemical lab was lost, and an emergency diesel generator keeping cool water flowing to one of three reactors shut down because of voltage fluctuations caused by a fluid leak after a brass fitting broke.”

The Storm Prediction Center in Norman, Okla., now ranks Alabama first in the nation for severe tornadoes. In other words, what happened April 27 at Browns Ferry could happen again.

A tornado doesn’t even have to be involved, of course. No natural disaster was involved when Browns Ferry came close to being the site of the first ever meltdown:

“Because of a fire that rendered most of the safety systems useless the TVA-owned plant came very close to being the site of the first major nuclear accident in 1974. Ultimately catastrophe was avoided by the tiny Athens Fire Department using common sense and dousing the first with water, even as the nuclear specialists at the plant rebuffed the local firefighters for six hours as they attempted to put the fire out with various chemicals.” [Tommy Stevenson, Tuscaloosa News]

You should have a look at Browns Ferry 2011. Really, you should; it has such lovely pictures of autumn leaves and lilies and butterflies. This is a calendar/brochure for people who live within a 10-mile radius of the plant. It has an evacuation map and driving directions. People with special needs aren’t forgotten: they can return a postage-paid card and their names will be placed on a list!  The problem is, these instructions wouldn’t have been much use on April 27, 2011. Consider this:

How will people be alerted of an accident? Use of the Prompt Notification System sirens, radio, and television. On April 27 there were dozens of tornadoes in North Alabama. By the time the late afternoon wave came through, electricity was off, and siren towers blown down.

If somehow the alert gets through — enough sirens are still functional and people have battery radios on — and the call is to evacuate, what are they supposed to do? “Use your own transportation, or, if possible, ride with a neighbor.” Carpooling is the evacuation strategy for a meltdown! And what if you don’t have a car? I guess this is the scenario anticipated here: “If you have unique needs or experience problems, call 211 for assistance.”

Now then, after the tornadoes, there would have been some problems with these instructions. Gas pumps wouldn’t be working, telephones wouldn’t be working, traffic lights would be out, and roads would be blocked by live wires, fallen trees, and other debris.

Let’s face it. With a car you might get out; without one, you don’t stand a chance. And this seems to be FEMA policy in general. These are its instructions for preparing for evacuations:

“Keep a full tank of gas in your car if an evacuation seems likely. Gas stations may be closed during emergencies and unable to pump gas during power outages. Plan to take one car per family to reduce congestion and delay. Gather your disaster supplies kit. Make transportation arrangements with friends or your local government if you do not own a car.”

There is, in other words, no Federal evacuation plan. You are on your own. And that worked out so well for so many before and after Hurricane Katrina, and for Texans during 2005’s Hurricane Rita:

“Evacuees fought traffic Wednesday afternoon through mid-day Friday, moving only a fraction of the normal distance expected.[14] Average travel times to Dallas were 24–36 hours, travel times to Austin were 12–18 hours and travel times to San Antonio were 10–16 hours, depending on the point of departure in Houston. [29] Many motorists ran out of gas or experienced breakdowns in temperatures that neared 100 °F (38 °C). Traffic volumes did not ease for nearly 48 hours as more than three million residents evacuated the area in advance of the storm.[14] This was the largest evacuation in U.S. history.”

Glad to know we’ve learned from experience. And remember to keep your gas tank full at all times since once “an evacuation seems likely” it will be too late. And if you don’t have a car, well, why don’t you? Maybe someone will give you a ride. Yeah, right.

Yes, It’s the 21st Century. No, That Doesn’t Mean All Teachers Accept Left-handedness

It’s National Lefties Day. I wasn’t planning to write about left-handedness today. I wasn’t planning to write about it ever. But yesterday my daughter discovered she was left-handed.

And…you say.

And… she is nearly 15 years old.

I don’t know who I am more furious at — myself or the pre-school teacher. Why didn’t I catch this? I’ll tell you. I assumed that in the final years of the 20th century everyone knew that you don’t force a left-hander to become a right-hander. I guess I should have known better.

So my back-to-school advice to young parents in 2010: Watch your kid color before you put her in school. Take note of her preferred hand. If she shows any inclination to be a leftie, watch like a hawk that she is still using that same hand a month later. If not, give her a pencil and see how she holds it in each hand. If when using her right hand she does a weird contortionist’s grip painful even to observe, while with the left she holds the pencil in the usual way, it is past time to march down to her school and go ballistic. Your kid’s teacher is an idiot.

So how does a ninth grader discover she’s a leftie?  She goes to her second freshman art class. The class exercise is to use the hand you don’t favor to write with, then try writing with both hands at once, and then compare the output with your normal writing.

In presumably right-handed Daughter’s case, all were amazed to see that her left-handed writing was clearer than her right, and when writing with both hands at once, the words looked nearly the same.

A brilliant, curious public school art teacher (and for all but a year Daughter had always been in private schools) was intrigued and spent some time with Daughter. She noticed that Daughter did a weird grip of the pencil with her right hand, and held it naturally with her left. She asked if Daughter’s hand hurt when she wrote.

Now, a year or two ago I was flummoxed when Daughter appeared to have all the symptoms of carpal tunnel syndrome. Kids don’t get this, right? We went and got an Ace bandage or hand brace or something, more to avoid a fight on my part than for any other reason. That year she had some lengthy assignments that had to be hand-written. I considered her complaints about how her hand hurt if she had to write a lot to be either a Princess and the Pea affair or an unconvincing excuse for laziness. Maybe, I’d say, your hand wouldn’t hurt so much if you held your pencil normally.

I feel like joining the self-flagellants.

Then Brilliant Art Teacher did some exercises involving closing eyes and touching nose or something like that, probably like these,  to determine handedness. Once again, Daughter checked out as a leftie.

I know I probably shouldn’t start googling what happens when a leftie is forced into right-handedness. But of course I will.

Already I am wondering how this is going to revise the past. Like for several years when she was three, four, maybe even five, Daughter insisted on wearing her shoes on the wrong feet. I’d put them on correctly, she’d change them. She said they felt better that way. I said they couldn’t possibly and she was being contrary.

I feel really really rotten. Can’t go back, though.

But I can warn others.

Parents of young children, beware. You think you’ve imagined most of the way your child can be harmed when you send her out into the world. You are thankful that there are a few things you no longer have to fear, things like lefties being forced to become right-handed.

Think again.

“She became dizzy and came to the emergency room for further evaluation”

Remember my post before last, Melena, Hematemesis, Hypovolemic Shock — and A Lot of Love? You know, the one about vomiting up great tarry mounds of clotted blood, losing consciousness, and getting oxygen and IVs in the ambulance before it left my driveway?

Well, today I went to hospital to get my medical records from my latest stay.  And here is what my History & Physical report said:

Sunday night the patient found the blood in her stool. The patient had hematemesis this a.m. Patient came to the emergency room.

Now the Consultation Report. It has the same time inaccuracy: my melena [and if I can use the correct terminology, why can’t they?] didn’t occur Sunday night but just a few hours at most prior to my hematemesis. The report goes on to say:

She became dizzy and came to the emergency room for further evaluation.

And now the Discharge Summary, same misinformation regarding melena, then:

On the day of admission, she vomited coffee-ground materials, got dizzy, and came to the emergency room.

Three reports prepared by three different doctors, each wrong about the timeline, and not a whisper in any of the three about what happened before I arrived in the ER.

There are other annoying things, like under General Impressions in the History & Physical, there’s this observation:

 a  trace of blood around the mouth

but not a word about the globs of dried blood in my hair. Never mind.

The biggie, obviously, is where are the narrative and the record of my vitals for the 20 minutes prior to my arrival? Even if it is not the hospital’s responsibility to incorporate these into the record of my stay under their roof, shouldn’t there be some mention of my means of arrival? Isn’t it downright deceptive to write:

She became dizzy and came to the emergency room for further evaluation …

… got dizzy, and came to the emergency room.

These statements are not untrue: I was dizzy before I started vomiting blood and lost consciousness. And I did come to the ER for evaluation. Not untrue, but  nonetheless false.

When I told the Records Clerk something was wrong, she called in a person who I will call the Conciliator. She’s the one who says, oh I’m so sorry this happened dear, but I haven’t a clue why it did, who is responsible, or what can be done. By the way, why did you come to get copies of your records, anyway?

Because they are mine, I replied. Silence. Because they are mine and no one cares about my health more than I do. And I like to know what is going on.

We left it with the Concilitator promising to get back with me in a few days, when she learned something about anything.

We’ll see.

At Risk for Esophageal Varices and I Nearly Bleed Out from a Gastric Ulcer: How Weird Is That?

Update: The current (November 2014) hypothesis among my doctors is that whatever they were called in my past posts — Dieulafoy lesions, Cameron’s erosions, or bleeding ulcers — all these bleeds have their source in the portal hypertension which comes from cirrhosis which is caused by my auto immune system attacking my bile ducts, that is, my primary biliary cirrhosis.

If you’ve read any of my posts on primary biliary cirrhosis (PBC), you were probably surprised by yesterday’s post that there wasn’t some sort of medical muddle involved. Wonder no longer: there was. It’s just that my emphasis was different so I left it for today.

I’ve written about being at risk for esophageal varices as a result of having PBC. These are swollen veins (like varicose veins), caused by portal hypertension (itself caused by cirrhosis [in the case of PBC — there are others. Click through to a site devoted to patients’ experiences with it]) in the esophagus. Left untreated these could “burst and bleed into the gut.”

But I had an endoscopy just this past January that showed only a trace of varices, and in such cases, 96% of people are trouble-free for at least 1-2 years (then they do another scope).

Of course, that means 4% of people aren’t.

So as soon as I regained consciousness in the ambulance, I alerted the chief EMT to tell the folks in the emergency room about this. And when I got there, I told them myself.

I will refrain from elaborating on how it feels while being transfused to have to repeatedly explain primary biliary cirrhosis and spell Urso Forte [the drug I take for it] to the ER nurses, and later my floor nurse and abdominal ultrasound technician.

However, following the endoscopy performed there in the ER trauma room, the GI who did the procedure reported that I lost enough blood to require four transfusions not because any esophageal varices burst, but because of a “gastric ulcer spurting blood.” He repaired it with three hemostatic clips and put me on pantoprazole.

But how weird is that? To be at risk of burst esophageal varices and have a gastric ulcer burst instead?

I reviewed my endoscopy report (high marks to the GI, who actually gave me a copy of my own medical report!) and found the location of the ulcer to be the cardia. Googled that, and discovered it is right where the esophagus becomes the stomach, and, in fact, for many years there was debate as to which organ it belonged to.

Now then, there is a new kid on the block at the hospital: the hospitalist. This person is sort of in charge of patients who come in through the ER and whose regular doctor doesn’t admit or have any role in their care. Like me. It took me two days to get someone to tell me who was really in charge of my case: the GI who did the procedure, or the hospitalist.

When the hospitalist visited me, I explained about my surprise that my bleed was gastric and not related to portal hypertension [PBC]. I told him that I didn’t have a local GI, but that I was under the care of a hepatologist at the UAB med center.

So the next day he returns, and says, “Good news: you don’t have to have a liver transplant.” I thought yeah, duh, but let him continue. He told me he had set up an appointment with the hepatologist who would do another endoscopy. And I said that sounds great, but what about this report from the GI deeming the cause of the bleed to be a gastric ulcer? The poor guy looked confused. I suggested he go back and have another (an initial) read of  my endoscopy findings.

But the hepatologist’s office and I agree that I should be seen by him. I have so many questions: can a burst esophageal varice adjacent to the cardia be mistaken for a spurting gastric ulcer? Is it really possible to have such an awful gastric ulcer and no abdominal pain? Can portal hypertension cause a gastric ulcer? Will this happen again? And will I have no warning other than feeling steam-rollered before it does?

And just how weird is it, if it was a garden variety gastric ulcer, for this to happen to a person who has to worry about bursting varices?

Stay tuned.