NO NO (Norah)

I got the idea for this blog from a book that I have almost finished. "The Help" by Kathryn Stockett, could almost be a biography of my early years. Some of you know that I was born and grew up in the South (Tennessee). Hitler invaded Poland when I was 6 months old. The Civil War had been over for 75 years, but there were remnants of segregation all over the USA (not limited to the South). Because of that, black people were at the bottom of the job chain. A lot of black women found work as maids. Maids came in two categories, day and full time. Full time meant that they lived on site. Full time maids wore white uniforms, as a rule, at least out in public. A white uniform on a black woman with a white child in tow would get her into a lot of places that she would not ordinarily go.

Exactly when NO NO came to live with us is beyond my memory, but I expect it was while I was still a baby in arms. Our house was separated by about 10 yards from "the little house", a two room affair attached to our single garage. The small house was fitted with gas heat and electricity. It was NO NO's home. During the day, she took care of our house, and mostly she was my nanny. I was her full time charge, but my mother took care of a lot of the household duties. I never recall NO NO cooking or serving meals. She did wash and iron clothes, but I think she had me as her main duty. The rest was secondary.

Why NO NO? It was all I could get out of my mouth in early talking efforts, and it stuck. In effect, I renamed Norah. I know that she had at least a sister, but I recall no history of a marriage or children for NO NO. She had a family name, but I have forgotten this and likely never heard it more than once or twice. She was such a great part of my daily life that I always considered her as family. Unlike some in "The Help", my parents treated her as a valuable member of the household. I have no clue as to her salary, but she had a place to live, which I learned later was a nicer spot than a lot of her friend's. She had at least a Sunday off, and her schedule could be flexible. She worked only nights when my parents were gone. I learned a lot about many things from NO NO. Early on, she taught me about race. The "N" word was not used in our household. She was called by her name, and others were called "colored". I remember being in a car somewhere with my mother and NO NO, and for some reason race came up. NO NO explained me that God made all people but some were different colors. She always preferred to think of her self as a Negro. That was a lot for a 3 or so year old to soak up, but it was the first word that I learned to spell. I knew that her skin was black but she was still NO NO to me.

On occasion, we would travel down into Alabama or to Memphis to see grandparents. NO NO was always with us. I wish that I could know where she slept, bathed, or went to the bathroom at those places. My grandmothers both had maids but not full time. I can only imagine that NO NO stayed with these women. Once, in Memphis, NO NO took me to the municipal swimming pool not far from my grandmother's house. I strolled off and jumped into the deep end of the pool. NO NO began to scream for help, as I sunk. Not being happy with the response from onlookers, she jumped into the pool, white uniform and all, to fish me out. Now, a black woman in Memphis, Tennessee in the 1940s, jumping into a whites only public pool was out of the ordinary. Years later, she would pull up her skirt to show her knees. "See them white scars on my black skin? That is from pulling you out of that water". Regardless, I am here to tell the tale. My first nickname was also a thing from NO NO. While in Alabama at my other grandmother's house, I came out the back door one morning crunching on something. NO NO was already in the yard and thought I had a piece of toast in there. UNTIL, she saw two legs slip through my lips. She fished out a June bug, and for her, I always answered to "June Bug".

As I mentioned, NO NO had at least one sister. The first time that I remember her was in her house which was also some sort of black woman's beauty parlor. For a small child, the view of a black woman having her hair done with a curling iron heated to sizzling over a coal stove was impressive. NO NO's sister had a boy my age named Robert. Sometimes, Robert would come to see her, and we would explore the small world of our back yard and vacant lot. When it came time for Robert and I to go to school, our ways parted. That was the way it was then. I wonder what happened to Robert? In later years, NO NO went to live in retirement with her sister. Even when in college, it was a Christmas time visit yearly that we took NO NO her gift there. Usually, a 10$ bill. Often that would buy her a ton of coal for her winter. One of those years, my mom told me that this year we would not go. NO NO had died. How old? I do not know, but I remember her gray hair. My mother never had across word to or about NO NO.They were partners more than employer-employee.

Random memories: I can remember that it was a joke in our house that NO NO would rock me to sleep even after I was almost tall enough to drag the floor with my feet. I remember NO NO as a snuff user. Did you know that a finger in her mouth with it applied to a bee sting is curative? As in the book, there was a network of maids who cared for children together. I remember my sandpile sweetheart from down the street had a nanny named Jessie. NO NO taught me by listening to speak in "Dialy" (dialect). This stood me well when in the 5th grade, my teacher (whose father had been in the KKK) praised my recitation of an Uncle Remus story in class

There is no doubt in my mind that NO NO loved me, as if I was her own. Our skins were different, but I don't think for a minute that we thought about that. Times change. Sometimes for the best. I do think that I had something that others will never have. Right or wrong, it was good for me, and I think it was good for NO NO.

I loved "The Help". The author's web site is informative also.

Pathology Reports

For the few that will get prostatic cancer, a word on reports.

I think that reports need to be addressed, both biopsy and surgical pathology reports. As a medical student, I was fortunate to spend a 3 month lay-out quarter working in a hospital pathology department. Since it was in the nation's largest privately owned hospital with about 1200 beds, we had plenty to do back in the 60s. I was also lucky to work with four very nice pathologists who were interested in teaching. Other than a dozen autopsies (also very instructive), I spent all my days cutting surgicals. For whatever reason, surgical pathology was not stressed in our general pathology courses, so my mind was a fertile field to plow.

Each day, I was given specimens removed at surgery to describe grossly into a dictaphone, cut sections (I was taught where to cut on a given specimen), and then read with a double microscope the microscopic slides from those that I had cut two days before. The pathologist was on the other side of the double scope to teach me. It was one of the most rewarding periods in my medical education. With this lengthy preamble, I will now try to get to the point.

We saw a lot of prostate specimens, both whole and chips from trans-urethral resections (TUR). I would guess maybe 20-30 specimens per week. Most of these specimens were sent to us because men had prostatism (BPH) and not cancer. In those days, there was no PSA test, and a man with PC usually came to surgery because of a nodule on DRE. The TURs were the majority unless a man with a so-called "median bar" required open prostatectomy, which was treated with complete removal rather than a TUR.

When examined microscopically, often the chips or the sections of the whole prostate would reveal malignant cell structures. These were usually considered as incidental findings and reported to the surgeon. CT scans were unknown, bone scans were so primitive as to be nearly worthless, and the urologist had to watch for new evidence of recurrence. If bone metastasis showed up on x-rays, then an orchiectomy (testicle removal) was done. Biopsies may have been done back then, but I recall seeing none.

OK. Now to the REAL point of this message, When a pathologist looks at sections of prostate tissue with cancer evident, there is not a little sign there down in the tissue that says "Gleason 4+3, 4+4, or some such". This determination is an ESTIMATE, not an absolute, and it is based on cell appearance. Give the same slides to another pathologist and, you may get a different grading, up or down. The same goes with estimates of per cent of the prostate involved. Of course this is a good reason for multiple readings of slides. I suppose one could send slides to a hundred pathologists, and then take the majority opinion as gospel, but that is ridiculous. In our department, it was standard procedure for more than one doc to look at anything questionable. Disputes were judged by the head man. Gleason was yet to set out his system, so the grades were I-IV, with IV being what is now a Gleason 10.

If you are disturbed by your Gleason score or other micro findings remember the doc is looking at a tiny portion of your prostate on biopsy. In a whole specimen, as a rule, the look is not a lot greater (sometimes our guys would tell us to make more slides of other areas to see further cells). Those scores are not written in stone by any means.

The New American Football, Page Two

Some weeks ago, I wrote some observations about how American college football had changed in my perception over the years that I have seen it infrequently. Well, now the season is over. I had a lot of fun watching various teams from all over the USA play season and bowl games. The ESPN-360 was well worth it.

I like ESPN, but I wonder if they realize that their announcers and "color commentators" are often afflicted with the terminal "blathertosis". These guys are constantly yapping about something and not always about football either. I really do not care about which restaurant at which they ate last night. They often digress, and frequently sound like pitchmen for a given player or coach to the NFL. I wonder if they get a commission? Another thing; what is the deal with all these girls(mostly) running around on the sidelines with green bottles like cocktail waitresses? I understand the need for good hydration, but what happened to the table with cups of liquids on it? These players are big boys who ought to be able to get their own drinks. On another note,each broadcast team seems to have at least one female member who is on the sidelines. Now, I am all for equality in the workplace, but if I was a coach in a tight game, I would likely be unkind when one of these babes stuck a microphone in my face to ask an asinine question about how I felt.

I guess the modern locker room looks like a hospital now with x-ray machines, CT scanners, etc. Won't be long before there will an OR in it, so that arthroscopy can be done on shoulders and knees. Sometimes, the coaches look like they are going to stroke out also, so CT scans might be helpful for them.

Just a few last thoughts for this year....