A horse named Blue, a dog named Boo and a Judge named Cheryl

So life went on at the river house for a few years or months or whatever it was with its ups and downs. We had our adventures in the woods and fields riding horses, breaking into the old Kroger estate and trying to sell the rancid tulip bulbs in front of the post office. Fights broke out; nights where spent in pick up beds under stars and around fire pits. Siblings getting lost in the woods for hours and hours; an aresole can explosion popping open my brother’s hand, nothing a little rubbing alcohol and a popsicle won’t take care of. There was the occasional horse bite or kick, a cow’s birth and always the permeating smell of horse shit. Still, my favorite of favorites of smells, right up there with bacon cooking. It’s said they aromas can take you back into time quicker and more intensely than any others senses and my experience that this is a true fact. It’s not scientific but based on the number of times I’ve driven passed a horse pasture and smelling that slightly sickly sweet odor has taken me back into time to a muggy July day around the horses of my childhood.

A lot happened in the big world too, Nixon got re-elected, my uncle got elected mayor, folks started coming back from Viet Nam, Fisher beat Spassky, Watergate broke and the Supreme Court legalized abortion and I’m pretty sure something happened on, near or around the moon. The Exorcist came out and I snuck into a showing at Hyde Park Square, shit my pants and ran out of the theatre. George Carlin was arrested for seven deadly words and my family discovered the beauty of light beers.  Yep, from where I was sitting it was a good year.

Weekend life out on the camp was just right for me, one day I’d be playing cowboys and Indians with real horses, hatchets (tomahawks) and b.b. guns, riding wildly bare back and bare chested, we would find ourselves building forts and river rafts, hiking in the woods, breaking into abandoned houses and building the occasional fire that’d grow out of control as we dashed off. The next day I’d be playing burned out hippy kid, trying to memorize the words to Harrison’s Bangladesh Album while eating spam sandwiches and drinking the remains of canned beers and watered down cocktails from the night before. I was mesmerized by the picture of that little kid on the front of the Album cover, I wanted to reach in and pull him out and share my canned meat and egg sandy on rye. I dreamt of getting a team of recon specialists and ex Viet Nam do gooders, going to Bangladesh and rescuing that little fucker, teaching him the ways of the west and capitalism. Dressing him in Chuck T’s, Levi’s and a cool ass oversized army jacket.    Idealism came easy to a kid that was nearly always stoned.

One grey day I found myself and Dad walking across the railroad trestle from Miamiville. We’d went over to get some bologna and a few scratch tickets and we stopped into the tavern to knock back a couple of beers while we were there. Oddly though, my dad seemed pensive and broodish as we crossed over the river. He was obviously engrossed in his own thoughts as he took the trestle tracks one by one and I tight-rope walked along one of the rails, arms out for balance, sea-saw occasionally on purpose to make it feel a wee bit more dangerous. It rained recently and misted a bit so the river was running faster and higher than usual but I was always okay as long as I didn’t look down to the running water 40 feet below me. The nerves of steel kid.

Once we reached the safety of the other side, he seemed to loosen up a bit and asked if I wanted to continue walking the track rather than work our way down the scree of the embankment and on to the river house. Of course I want to continue walking, it’s not often I have my dad all to myself. We chatted about how much he loved me and how he came back from California to be with us kids; about love in general and how sometime it’s a beautiful thing and how sometimes it isn’t so great and things just don’t work out. We talked about Cat Steven’s, why Jonathon Livingston Seagull had such a long name for a bird where chili came from and we decided that Colby Cheddar was the best cheese and not Limburger.

We shivered and talked as we meandered down those tracks towards the School House restaurant; it was a happy moment, a moment frozen in time because we shared so few of those moments. Sort of a Pearl Harbor moment, I knew exactly where I was, the shade of my flimsy red wind breaker, how soggy my Convers had gotten, the color of the shrubs and which direction the rain was occasionally spitting. It was a misty and grey walk, but a happy walk, we’d push each other off the iron rails and laugh as we fake wind milled our arms. An overgrown pasture was on our right separated by a rusted wire fence, barbed wire and small locust trees and over grown shrubs that haven’t been manicured since the Kroger family moved on and out... Suddenly two horses galloped up and stuck there heads through a break in the thicket, one was a huge white appaloosa with blue grey spot that seemed as if his groom forgot him. His hair was tangled and matted, burrs where stuck in his tail and the remnants of his winter coat. His name was Blue and his was a beautiful horse, well cut, well defined and real spirited son of a bitch. I also knew for a fact that he liked to drink beer. Blues companion was a well-kept, well trained Palomino of no distinction as far as I was concerned. Too much of a lady for me, I liked Blue. We stopped and petted and put our arms around the necks, sort of hugging the animals and I just sort of wished that all our times together could be more like this.

Leaving the horses behind, my dad gestured that it was time to start heading back home for dinner. Unexpectedly my dad’s conversation turned from light hearted and silly to a more serious note. He abruptly, out of the blue said “You’re mother is trying to put me in jail.” I stopped dead in my tracks. I lost my breath; I had visions of going to the Norwood Jail to see him, separated by bars, how long would he be in jail? Days, months, years, was a life sentence looming? First things first I thought as I composed myself.

“Why?! I said.

“I’m not sure son, money. She’s looking for money and I don’t have none.”

After such a special moment this news hit especially hard. My throat started to burn; close up, my eyes started to water as I struggled to fight back the tears at the thought of not seeing my dad for who knows how long. No more walks, bologna sandwiches, no more motorcycles, driving the car by myself, no more sitting on the bar stool at the Miamiville Tavern drinking straight grenadine and mowing down Vienna sausages. No more nothing. I was getting pissed and as I struggled to rationalize what could possibly happen ‘I figured my Step Dad must somehow be behind this. But there was nothing I could do, he was grown up and I was just a little kid.

My dad continued “I’m supposed to send her money every week and I just don’t have it, we had to go see a judge and your mother pulled this out to show him.” It was my dad and step mom’s Christmas card. They were standing in front of a royal blue slat fence with a bunch of dogs, cats and horses around them. I knew that card very well; I would sometimes pretend that I was in that picture too. Sometimes I would include my brother and sister but mostly it as just me. And I actually remember looking for that photo once and it being gone from where I kept my copy. That must have been the one that made its way in front of the judge. I knew the names of every one of the animals; Jeanne, Sunfire, Bullet, Diane, Eli, Boo, Jason, Chelsea, Spencer, Levon, Geronimo, Spike the cow and her calf Flipper. . “She told the judge I had enough to keep these animals but not enough money to take care of my kids, so I might be going to jail.”

I cried and wailed and hugged my dad’s waste as we stumbled along. I think maybe he cried a little bit too.

“You know, there might be one thing….” his voice trailed off a little.

I shrugged and tried to catch my breath. “What’s that?” as I wiped my eyes on an already drenched red windbreaker.

“Your twelfth birthday is coming up and the judge will let you decide who you want to live with, all the kids get to decide. You could come with me and the animals or your Mom and B. Then, I wouldn’t have to pay as much money because we’d be taking care of you here and I could probably catch up on what I owe and wouldn’t have to go to jail.”

Brilliance! And I realized I had a big decision to make.  And it was a big decision that merited a lot of thought, mulling over and scrutinizing Unfortunately I didn’t possess the necessary capacity for reason and logic to pull this one off. I didn’t consider asking a priest, grown up, older kid or someone with more life experience. I just wanted to go where the party was, a theme that would follow me later in life.

The Therapist, Pin Cushion & Igor (pronounced EYEgor)

Today I had three important appointments:
Uno: With social worker to discuss goals on how to deal with the stress and changes that may come with a transplant. No big deal. A meet and greet.
Number Two: Blood work drawn to define my MELD score, a number used to determine how sick I am and how desperately I need a new liver. I'll find out the results on Monday or Tuesday. I'm dehydrated so Lillie Phan had a hard time hitting a vein; it took her and two other philbotamist about 8 hits before they found what they were looking for.  Success was found after about an hour in the chair, making me late for my future appointments.
C: Vaccine from Nurse Ratchet and a talking to about tardiness. Odd lady, I guess she had every right to be bitter and what a better target than me to take it out on. She was well into her 60's, page boy haircut, the skin and complexion of curdling milk and she had a wondering eye and was hunched over like Marty Feldman in Young Frankenstein. She came at me like a rabid dog with a lecture on how I had no right to reschedule and that I was throwing her whole system off. I relayed to her my earlier experience at the blood lab but she wasn't having it, our voices rising slightly as we talked over each other and her North Shore Boston accent turning into something more reminiscent of a Charlie Brown Adult meets the AFLAC duck. Eventually after I accused her of having attitude and wasn't sure if I was she was going to poke me with a syringe full of malaria, typhoid fever and a case of the willy's she calmed down. By the time I left, it felt like we were old chums as she schooled me on the best tattoo artist (her nephew) ever to come out of Revere was. I can’t wait for my next two visits with her and gave her a wink to her good eye as I walked away.

Trip to see Dr. A & the Infectious Disease Doc

Spent half the day at MGH today, what fun. Had a ten o'clock appointment with an infectious disease doc, nice lady. Seeing her is one of the hoops I have to jump through to get a new liver. There are lots and lots of hoops of different sizes, angles and heights. Some of them are even doused with kerosene and lit on fire; that would be called the heart stress test. Today's was easy, except for a small moment of anxiety where I thought I might pass out; apparently I haven't had enough fluids today so I was a wee bit dehydrated. Nothing three cans of cranberry juice, some unsalted crackers and a mini Butterfinger and musketeer bar didn't cure. Thanks nurse Brad, the ambigiously gay dude wearing a plaid shirt and wranglers. Odd for hospital garb.

They wanted to put me into a wheel chair to get me over to Doctor A, my Hepatologist; I politely declined and proved that I could make it over on my own accord by demonstrating the Hokey Pokey, Limbo and the Macarena. I have to go back Thursday to start getting vaccinated for Hep B. Lucky me, three move visits.

Dr. A's visit was good, she's 5 months pregnant which is pretty awesome, she lost her parents this year and her husband’s father passed away. Being well into her 40's she called it a miracle. I myself am hoping for a miracle of another kind. I guess.  We talked names for a few minutes, I myself told her I was partial to Elvis, she said she like Robert, Robert Chung. Her husband is Korean and a famous liver surgeon.  I let her know Robert Chung wouldn’t be bad, just don’t name him Wang, Wang Chung. Everybody Wang Chung Tonight!

We talked about symptoms, fatigue, swelling, ascites and interferon. A lot of my test results are down, which is a good thing, but the fatigue is rearing its ugly head. She's trying to get me something called provigil, the name I'm sure was developed by a focus group to sound, well, professional and vigilant? Let’s take a prefix and a suffix that have two different meanings that sort of sound like what we want this medicine to accomplish, mush them together, come up with an vague marketing campaign and make a million trillion dollars. Oh, and while where at it, let’s hire a firm and consultants to help us figure out how and why we should deny this drug to prospective patients. Provigil was developed for folks with narcolepsy, so that’s cool.

So basically, Dr. A just had a catch up meeting; I have an interferon injection class on the 26th and more hoops to jump though for the liver.

(A new installment of life on the river will be posted shortly)

Life on the roller coaster

Addendum

Dear Mr. X,

I am writing to you in reference to the liver transplant evaluation you recently initiated at the blah, blah, blah….

The Multidisciplinary Liver Transplant Committee met on July, 6, 2011 and it was the recommendation of the Committee that your listing with the United Network for Organ Sharing be deferred. The Committee’s recommends are that you should have a consultation with Dr. C. from pulmonary, which has been scheduled.

In the meantime, we will continue to monitor your liver function as you remain under the care of Dr. A and Dr. T.

Blah… blah… blah… blah… blah… blaahhhh……

Blah?!

Either Ellen was a little over zealous in what she was saying or I was I little over zealous in what I was hearing? Fingers crossed and wait to begin the wait.

A quivah in me livah

Liver disease can live in your body for years and years before any of the symptoms decide to materialize. oOnce they do they can come at you full force like a locomotive or a smack in the face, a real hard smack, one that really hurts and stings. One of the more fun symptoms is the constant fatigue. I’m not saying the exhaustion I and other Hep C victims experience is any more difficult to deal with then anyone else’s, but it is nearly impossible for me to put the level of exhaustion into words.

Waking in the morning, with the thought of having to swing my legs off the bed walk to the bathroom and start my day is daunting. I feel like gravity has affected me differently than other folks, like I’m always being pulled to the ground, it takes every fiber and all the will power in my body just to move from point a to point b. I’m walking through sludge or wet sand. The mere task of driving to the drug store, getting gas, walking to the mail box, mowing the lawn or carrying a laundry basket takes on the same magnitude as a Shackleton expedition. The absolute worst is not having the energy to run around with my kids, it wrenches my heart into two. Hunched over and drained of any pep or vigor, my head sinking down from its own weight between my shoulders, belly expanding with fluid, ankles and legs swollen. Tired. Would the same choices have been made had I known what I know now? Hind sight is 20/20 which none of us is blessed with.

Making it through work feels like running a marathon, I could sleep for days after a decent shift. Unfortantely, my mind won’t turn off. Fatigue and sleepiness are two different things, yeah, they often run hand in hand, but you can be fatigued and your mind still races a mile a minute. To help me get though a day at work I generally sneak away mid-afternoons, months ago I was going for walks and grabbing coffees to help maintain my stamina. Not any longer, those days are long gone. Lately, I’ve been crawling into my car, driving the five minutes to the waterfront, turning the AC to high, putting the seat back and covering my face with a sweat shirt as Itry to get a 20 minute nap in.

My sanctuary is right out in open, across the harbor from Logan airport, planes fly directly overhead. I sit next to an abandoned warehouse that looks like it could house an aircraft carrier, jersey barriers blocking the way; you sort of have to weave in and out of the pointless security Massport has put up. Regrettably the area is policed by Massport, Boston’s finest and the State Troopers driving by and either telling me to screw or making sure I’m still alive and not slumped over because of an overdose. Eventually all but the most of the men in blue began to recognize my car and begin to leave me alone.

So, I was on one of these short sabbaticals from work, sleeping in the front seat of my car when my cell phone rings. I’d normally ignore it unless it was my wife.  Transplant Center. “Hello?” it was Ellen my transplant coordinator; she’s the RN who pulls all my exams, tests and appointments together. It’s also her job to be very positive and hopeful which she does wonderfully. Financial aid question, Ellen; infectious disease appointment, Ellen; helping me get a prescription filled that my insurance provider has declined, Ellen; sending my paperwork to the evaluation board, (made up of Hepatologists, psychiatrists, surgeons, social workers, gastrointestinologist, anesthesiologist and probably some other ologists of one sort or another) for a new liver and acting as my advocate, Ellen.

That why she was calling, it was Wednesday the 6th of July, she presented my case to the board that day and they okayed me for a new liver. I’d be listed nearly immediately. I thanked her, sat back in my chair, turned up the AC and silently cried a little before I called my wife and my mother.

I smoked but didn't inhale.

So Dad And I were sitting at the kitchen table in the river house, the weapon lies between us, on a slightly overused plastic tablecloth, it always felt greasy and slick,  it had a morning glory design disrupted by a few cigarette burns and the thing probably should have been discarded a year ago. On the table sat some nearly empty bottles of Stroh’s, an ashtray with dead butts, a tin of Hormel’s deviled ham on a plastic plate surrounded by saltines. There was a half eat’n pot of clams cooked in beer and a loaf of dark bread from Findley Market, the room had sort of a sweet bar room aroma. There were a lot of windows in that room, two of the walls where all windows from the waste up. Generally they looked out onto the back yard, a beaten up green shed covered in tar paper and the house barn that our horses called home, currently they were fogged up dripping with condensation from all the body heat and cooking that was taking place in the room. It was winter but we must off just come off a warm spell because a moth repeatedly kept flying into the back window, struggling to get at a light source. I thought it odd that a moth was out there this time of year. It’s tapping against the glass pane kept getting slower as the temperature dropped and it tired, I had to fight the urge to open the door and let it in.

We sat there, just kind of looking across the table at one another; I’d look at him, the weapon, the moth, fidget a little and look back at my dad. He had lamb chop side burns, darkish hair and a small comb over where he was slightly balding. He was sweating a bit, it was hot in that room and the oven door was open warming it up even more. It was kind of like a western show down, one of us waiting for the other to break the silence that was only interrupted by the occasional tapping from the moth. My dad picked up a pack of smokes, soft pack Viceroy’s, lit a cigarette and inhaled deeply. He looked over at the moth, picked up a newspaper, walked to the back door and opened it, with one quick sideways motion he smashed the moth into a greasy crumpled smear against the window of the back door. It stuck there, smashed body and crumpled legs; he threw the paper on the table, sat down and looked at me.

Gently he said “Son, you look like you have something on your mind¸ you have something you want to ask me.”

I squirmed a bit, and nodded.

“Well, what is it?”

“What’s it feel like when you smoke marijuana?”

I could see my Dad thinking about how he wanted to formulate his response. How could he make a nine year boy know what it felt like to smoke marijuana? It seemed like a lot of time passed before he decided to answer; I could hear voices, laughter and music coming from the other room. I started to wish I hadn’t asked that question and that I was sitting on the floor in front of the stereo, head phones on, forgetting things while listening to American Pie.

After what felt like an eternity he said “We’ll, you know when you eat a piece of cheese, and you love the way that cheese tastes, when you smoke,” he gestured at the weapon “that piece of cheese tastes that much better. Or… when you have a piece of steak, pot makes steak taste better, or if you’re listening to music, it makes that music sound better.” It just makes everything better! I got it. “It’s a gift from the earth, natural; it grows in the soil, what could be wrong with that?”

That didn’t sound so bad or dangerous to me. “So, it’s not dangerous? You’re not going to go crazy?” My dad smiled, laughed a little and gave me a reassuring hug. “It’s just something people use to help them relax.” I felt better, safe comforted. My dad wasn’t going to go insane or get arrested from smoking marijuana, he was just going to relax, all good news.

Eventually, everyone at the river house slowly filtered back into the kitchen and I got nods and pats on the backs, from the long haired, goatee sporting pirates that were pretending the counter culture movement was still in full swing and the halter top, Daisy Duke hippie girl hangeroners. Cans of beer where opened, cigarettes lit and a bottle of wine was passed around. We worked our way back into the living room, played records, talked and everything was good. My dad must have given someone a secret okay because the weapon was picked up, packed with some dried out, dusty, herbal debris. I was entrhawed, on full alert, here I was, about to witness some great ceremony or secret rite, after all, the weapon did sort of look like a peace pipe. One of the gypsy’s put the weapon to their mouth, struck an oversized fireplace match and put it to the bowl, a couple of small flames danced out of the bowl as the match was extinguished and the pot ignited. A grey blue cloud of smoke floated through the air. It was drifter and mesmerizing. If you’ve never smoked or smelled marijuana burning it’s a very hard aroma to describe, it’s like trying to describe the smell of baking chocolate chipped cookies to someone that’s never smelled them before. It had a sickly sweet, slightly tropical and grassy fragrance. It smelled exotic and reminded me of the incense that was constantly burning in little cones on window sills. And I wanted to do more than smell it

Marcus, the man smoking inhaled deeply, held his breath, coughed a little bit. I studied his technique More smoke filled the room as the pipe was passed to the next man. I couldn’t take my eyes off Marcus, I waited for his head to explode or blood to start coming out of his ears, and disappointingly he only coughed, gently whacked his chest with a sideways fist, exhaled and smiled as his eyes started to look more glassy and bloodshot than usual.

I watched as everyone took a hit from the weapon, eventually it worked its way around to me. It was in my hand, hot and lit, I got the nod that it was okay, I was panicked and didn’t want to look like a novice. I held the pipe to my face leaving a little gap between the weapon and my mouth and took a small breath, I tried not to get anything into my lungs, I just held what was in my mouth quietly, took a couple of gasps and exhaled hard. Nothing came out, I was relieved, I’d smoked my first toke, but not smoked, I wasn’t ready to cross that bridge yet but I’d thought I fooled these old pros into believing I had. I sat back feeling cooler than I’d ever felt, spinning back and forth in a rattan hanging chair, Converses dragging the floor, I’m the bomb, yes, yes I am.

As I looked around through the haze I realized everyone was smiling and laughing, I started to laugh too, the more we laughed the louder and longer we laughed, hooted and hollered. Our eyes where watering and my sides was hurting from so much laughter, I didn’t know what we were laughing at and didn’t care, I assumed no one else did either. A shared happy ecstatic moment in time. If this is what marijuana does to people I thought it was pretty cool. Everyone was looking at me and gesturing, I could see some of them mimicking me, mocking my fake attempt at smoking. I realized that it was me and my feeble first attempt at smoking pot was the butt of the joke.

I could feel myself turning red with shame and embarrassment as the laughter continued. I was dreadfully humiliated and disgraced. I slammed down the weapon and stomped into the kitchen sulking, I could hear the laughter in the next room seemingly getting louder. I opened the cabinet under the sink, grabbed some 409, a paper towel, opened up the back door and wiped the dead moth off the window. I didn’t bother with the other grime, that wasn’t my problem. I threw everything into the trash barrel and stomped off into the night.

Interferon, Interference, Interfere, Inner Fear

Interferon, Interference, Interfere, Inner Fear,

June 2011

Definition of AGUE

1: a fever (as malaria) marked by paroxysms of chills, fever, and sweating

    that recur at regular intervals

2: a fit of shivering

After a short wait of watching the comings and goings of other patients, my wife and I are finally called back to a small room by Nurse K. She has a bunch of letters behind her name and I don’t really know what mean or really care.  Apparently they have something to do with her specialty, hepatolgoy and specifically the treatment of Hep C.

Nurse  K’s office is not much more than a windowless cubicle, it has no personal belongs, no post cards from the Cape, no Red Sox, Bruins or Patriots bric-a-brac, no picture of a boyfriend or dog, no sloppily scrawled drawing from a niece or nephew. No diplomas or certifications adorn these walls, only a small poster demonstrating the different levels of pain with smiley to frown faces from the numbers one to ten. There are two chairs and a half-length examination table with a roll of schrunchy white paper over it, this of course is where I get to sit. Aptly, it is a very sterile environment - perhaps the reason I’m here is sucking the warmth out of the room, or perhaps it is intentional design.

Nurse K is very undemonstrative, with a slight automated smile and steel blue eyes, sort of pretty and cool. But not cool as in hip, cool as in chilly, like the nondescript examination room we’re in. We sit there as Nurse K talks about a new “protocol.” Protocol is a term medical folks like to use instead of saying, “Before we make you better we have to make you completely miserable.” It’s not their fault - sometimes before you bounce back, you have to hit rock bottom. Unfortunately it’s painful.

Nurse K talks about this new and improved treatment of interferon which is traditionally a combination of pegylated-interferon and ribavirin; two antiviral drugs; one releasing interferon proteins and the other interfering with viral replication. The new addition to the cocktail is called telaprevir, yet another antiviral drug which inhibits the hep c virus.  I don’t understand the medicine behind it; I just hope and pray it works.

It’s a balancing act, a multiple pronged attack. Two things need to happen, I need to get cured of Hep C and I need a new liver. One can happen without the other, but if both happen, that’d be super awesome. It is strange to me that I have two teams of docs, one pushing for the Hep C cure first and the other pushing for the transplant. It’s confusing and scary and having gone down that interferon road before, I’m not looking forward to another trip; it was blurry, painful and dreamlike. I didn’t feel like myself when I was on it. It is a hard pill to swallow, well; not literally -  it’s a pre-dosed syringe that you have to shoot into a muscle. They suggest your leg, but you need to move the shot around your body because one of the side effects is the development of rashes.

The first time I took my cocktail I locked myself in the employee bathroom inside the Lenox Hotel. It was a one person bathroom, so I had privacy. I pulled my gear out, sterilized the infection point, loaded the needle, stuck it in and pushed the plunger down. How reminiscent of another time, a long time ago, doing the same thing, only different, and possibly the cause of my illness. It is nearly a déjà vu experience, years and years apart. I wondered if I was the only Hep C patient who had ever had this sensation.

Nothing happens at first; the medicine needs time to get absorbed into your system. I’m able to go back into the kitchen, stand on the line and expedite, at least pretend to while a sous chef helps me stay focused. Tickets come in, orders get called, my head spins a little bit and the words on the paper fade in and out. I feel a wee bit nauseated.

I take a break and sit in my office, looking around at the collection of cook books, terrine molds, assorted knives and specialty tools. I feel at home among this stuff. A recipe for some magazine I’m working on looks at me from the computer screen. Partially used bottles of booze, wine, specialty oils and vinegars sit on the shelves along with a half used tin of saffron and a small sample box of bar snacks. A half-eaten dinner special one of my Sous Chefs wanted me to try sits on a plate. I love being a Chef and hope this treatment doesn’t affect my value to my team and restaurant. Shortly, my body starts to ache a little, my head pounds a little more, I get dizzy and my stomach starts to spasm and quiver. I can feel an eruption starting to brew in my belly. A couple of gags and I quickly reach down, pick up my unlined trash can and puke in it. I puke some more, I dry heave, I dry heave until my abs hurt and I can taste the bile and acids coming up from my stomach. The sounds coming from me are reminiscent of the sounds from a wildebeest dying on the African Savannah; I’m shocked no one has heard me.  My body lurches and rolls into the trash can as it climbs to a crescendo of jerking, coughing and gasping. In time the nausea subsides; my nose is bleeding a little - did I hit my head, is it part of the protocol? I gasp, catch my breath, wipe my mouth and think, okay, time to go home.

In the car I realize I only have to do this another 48 times, or so.