Short Order Medicine:
Short Stories for People With Short Attention Spans

Chapter Three: Murdock

I’m a weary, weary traveler
travelin’ through a world of pain
I got to make it through this journey
so my travelin’ won’t be in vain

Chris Cain

Murdock went by the abbreviated handle, "Doc". Whether he anointed himself with this badge of skill and competence, or whether his cohorts gave it to him, I will never know. I was never to know much detail about his younger years other than that he spent most of his time in and out of prison. In his own words, "I never killed anyone who didn't have it comin’." I found this reassuring, as his physician. I sensed that his active years of burgling, smuggling, and fencing were long over. This man in his sixties was trying to live out his years in the peace and solitude of 'the country', while attempting to grow enough marijuana to buy his daughter a piece of land. The problem was, he was now an old man, doing young man's work growing dope is neither physically easy nor safe from the animal and human predators that roam our hills in the late growing and harvest seasons. Living with deer, feral pigs, wood rats, mountain lions, bear, and thieves, the grower is under constant stress.

I first met Murdock in the early 1980’s when he came to the hospital with chest pain. His mind was sharp as a tack, despite his inclination to consume pints of whiskey in an evening, but his body was wracked from a lifetime of trauma, tobacco abuse, the above mentioned organic solvent, and a diet which at best might be termed irregular. His diagnosis was angina (heart pain from coronary artery disease), he was observed in the ICU to rule out heart attack, and he became my patient. This was in the days of my family practice, before I left to pursue full time emergency work. Upright, Doc was a big man, once tall, but now hunched over, walking with a cane. One leg was bowed, not from rickets or horseback riding, but from the angle in his femur from an old gunshot wound. It was long enough ago and he was tough enough that I suspected his cane was a 'just in case' stick. One never knows when a big stick might be needed in this dangerous world. He spoke with forthrightness, candor, humor, and a twinkle in his eye. His mouth had more gaps than teeth so his smile, wide and unselfconscious, was disarming. He gave me the sense that he had lived by the outlaw's code of honesty. You keep your word and only harm those that seek to harm you. You steal from those who can afford the loss, and you love your children. You provide for your family as best you can, and you slip through life with stealth. You rely on no one but yourself, you trust no one. Not exactly the baseball and apple pie version of American life, but more honorable than much of what passes for respectable these days. His caricature is revered by the movie going public that loves the strong, handsome sociopath who lives by his wits, carrying the undocumented secrets of a troubled childhood. Murdock was a warrior, a fearless, self-reliant survivor in a decaying society. I’m sure he wasn’t always so self-reliant as the criminal does take without asking and the incarcerated are hardly independent creatures but at this point in his life, he sat upright in the saddle and never looked back. He knew his death was over his shoulder, patiently waiting. The only thing he really took seriously was the need to leave behind something of value for his daughter.

Murdock knew he had coronary disease but didn't want to stop smoking to reduce his risk of dying before his time. He cared very little about death other than wanting to live for one or two successful growing seasons to provide for his daughter. She didn't have any knowledge of his commitment to her. She lived hundreds of miles away and rarely saw her father. This was to be his surprise gift in departure from this life.

His hospitalization for anginal chest pain was uneventful and he was discharged with a plan for follow up in my office. Seeing Murdock in the office would make my day. Contrasted with the often-depressed chronically ill or terminally fearful neurotics, Murdock sparkled with strength and humor in the face of a collapsing body. Though he would downplay his symptoms of circulatory insufficiency (weakness, chest pain, leg cramps, difficulty breathing), he would take whatever I would prescribe and attempt to follow instructions as best as he could. He never missed appointments and would tell a little story about life in the hills, or about characters he had known during his colorful career. He always asked about my family and would often slip me a five-dollar bill and instruct me to give it to one of the kids. He gave me a hundred-dollar bill at Christmas. I told him I couldn't take it, but he not only insisted, but convinced me that my caring for him made him want to give this to me and if I wouldn't take it, I would be denying him the pleasure of giving something back. I could see that accepting this gift would make him happy and so I gave in. He beamed and his eyes got wet. So did mine.

The winters were hard on Murdock. He lived in a small trailer on some rugged land several miles out of town, at about twenty two hundred feet of elevation. In between growing seasons, the ground was slippery with mud and there was very little level ground. It was always a challenge keeping warm, but what the wood burner and kerosene heater couldn't provide, Johnny Walker and thick steaks would supplement. Doc liked his meat. Whiskey, hand rolled Bugler smokes, and steaks were his pleasures. None of them did his aorta much good, though, so when he came to the ER with severe back pain, I thought it was unlikely that he was whining about a muscular strain. He never whined. He had lost the pulses in his right leg and was sweating profusely in a cool room. He was near death. We transferred him just in time to get his aortic aneurysm repaired, no complications. The old warrior approached his mount for the next trail, the next journey into the unknown.

Another season rolled by. Murdock was back home doing better than prior to his aneurysm, and he was able to tend to a large portion of his crop. He did need help, however, and this was a problem. The sort of people in Murdock's small circle of acquaintances who might be in a position to help him with a growing venture were small in number and short on personal aspiration. By cultural standards, they were the losers, the chemically dependent school dropouts who sought identity with biker accouterments, street language, and downward mobility. If Murdock had survived as an honest, hardworking criminal in the days before TV and speed, today's fringe survivor is an opportunist, regardless of personal integrity or interpersonal commitments. A word given is not necessarily a word kept, if an opportunity for advantage arises. And so, Murdock was taken advantage of. His whiskey was consumed, his crop was raided, and his helpers vanished, putting him back to square one. He would have to survive another year to start over growing enough pot to get enough cash to buy enough land to give to his daughter. Winter returned.

Murdock began having more angina (coronary chest pain) in spite of increasing use of nitrates (nitroglycerin is used to reduce heart pain by dilating coronary arteries) and aspirin. One stormy night, he made it to the ER, having driven his old Jeep through mud and torrential downpour, while having crushing chest pain. The cold wind didn't chill his body enough to stop the sweat from pouring off his face and upper body. His EKG showed ischemia (not enough blood flow in the coronary arteries) without injury changes (not a heart attack, yet). Pre-infarction angina. What a tough old bird. Anyone else would be in the throes of a major heart attack with permanent damage as a consequence. Murdock was lucky enough to be having this screaming, painful warning. We loaded him with intravenous nitroglycerin and heparin (blood thinner) and transferred him down the road, again, for his bypass operation. He did fine. The winter wore on and Murdock waited for the first chance to start some seedlings for the next attempt at a jackpot. Or, at least, a down payment. One spring day, Murdock came to the office with a new symptom. He had a sore in his mouth. Though fearless, he was not immune. The laws of physics and biology are impersonal and concrete. The body is soft and frail and easily harmed by chemicals, storms, and concrete.

I looked past the craggy pinnacles of cracked and worn dental enamel to the back corner of his tongue to see the grim finding. He had an ulcerating mass, about three fourths of a centimeter across, which I thought most certainly had to be cancer. This lesion in an older man who has spent his life drinking and smoking is cancer until proven otherwise. I took a little biopsy and had him come back the next week for results. As expected, this was a squamous cell carcinoma, malignant and invasive. A bad cancer. The only chance for cure would be a radical neck dissection - taking out half his tongue, jaw, and surrounding lymph nodes with other soft tissue. He would be disfigured and impaired, but he might survive. He twinkled, smiled, and thanked me but decided against this surgery. "If it's my time to go, then I'm gonna take my .38, lie down in a hole, and take care of business."

I told him that I would respect his decision, but dying of untreated oral cancer is a horrible way to go and I didn't want to see him going through the pain. He assured me that it would never get to that point. When enough was enough, he would dig his hole. I believed him. I didn't think that the statements of this man of strength might be just so much wind when all his strength was gone. I didn't want Murdock to suffer pointlessly. He had lived his life outside the rules of society. I didn't want to see him as a hopeless dependent in a nursing home, draining society's resources for a pointless end. That might be the way it's done around here, in this day and age, at this state of the evolution of civilization, but it is neither what I would have for myself, my loved ones, nor for Murdock. It is one thing to fall off one’s horse and quite another to be dragged for a few miles. We decided to try some radiation to slow things down. After all, the growing season was upon us and Murdock had work to do.

I began to see Murdock more regularly in the office. Though the radiation had slowed the growth and progression of his tumor, it had not stopped it and swallowing was becoming more painful. Murdock had never been a complainer but as the discomfort far exceeded that which would have brought the average person to plead for drugs, he finally asked for something that might be more helpful than whiskey. Though by any standards he was a chemically dependent abuser of alcohol and tobacco, he had never gravitated toward street drugs. I gave him liquid morphine, for ease of swallowing and in anticipation of major pain. Though he did not have a high drug tolerance from prior addiction, his alcoholism rendered him relatively resistant to usual doses of the drug. Within a month he was stabilized on a hefty dose of morphine and he was able to tend to his plants. Murdock was a man on a mission. He knew he probably wouldn't survive to another growing season so this was the one to pull off. If half of his plants were females and half of them made it to harvest, he could get his daughter a nice nest egg. As difficulty swallowing made it harder to maintain his body weight and strength, he was increasingly reliant on this season’s helpers. He started with two young men to help but soon there was only one. The other one vanished with half of Murdock's Social Security cash and all of a fresh bottle of morphine. Murdock was getting close to the point at which I expected him to vanish into the earth. There was no way to tell when his disease would overpower his mission. His speech was becoming difficult to understand due to the displacement of his tongue by tumor. It was now August, plants were getting tall, but there were at least two more months of growth necessary before he could cash in.

His diet switched from steak to Ensure, a high nutrition milk based supplement often prescribed for the aged and chronically ill in an effort to maintain caloric and protein balance. Sort of old peoples 'formula'. Pretty much the same except no nipple. I knew that it would take a small miracle for Murdock to succeed in his venture but I hoped that he would not have to suffer excessively at the end. I hoped he would manage his affairs as planned. Imagining him lying helplessly in a hospital or nursing home bed with a feeding tube sticking out of his abdominal wall, unable to talk from a mouthful of cancer, was emotionally and spiritually repulsive. Of course, that could be said of any of the many that do rot away in nursing homes. Those dispositions are for the dependent masses, not the self-reliant warrior. He stops when it is time to stop - if he can.

Whether from the toll of morphine or devastation of mouth cancer, Murdock began to fall. Where there once had been a man, there was now a pain-wracked frame with hollowed eyes and slow movements. The spark was gone, the twinkle dead before the body, great intentions lost to the needs of the moment. His helper found him on the ground semicomatose and brought him to the hospital. He never went home. His dehydration was corrected with IV fluids but he never regained enough strength to do anything else. He wasn't strong enough to go home and his plan to stop his own life at the right time had been shelved and replaced by the instinctual drive to survive to the next moment, the next thought. He was visited regularly by his helper who had vowed to finish his project for his daughter. At that point in my career, I had left my practice to pursue full time emergency medicine so he had another doctor while in the hospital. The choices for Murdock evaporated. Murdock was transferred to the nursing home to die, without a feeding tube. He lasted another two weeks or so, mostly in narcotic sleep. He was never again in a position to say good bye. He just faded off and away until there was nothing left.

Was the whiskey and tobacco worth this death of slow suffocation of body and spirit? Alcohol and tobacco are well known precipitators of this ugly disease. If he could have seen the end, the inevitability of this disease, twenty years earlier, would anything have changed? Would his daughter ever be able to appreciate his depth of commitment to a nearly impossible task for an old man? For her? And if she could know, could she get emotional fulfillment from her father that a down payment could never bring about? Murdock touched me in a way hoped his daughter could have experienced even a little bit. I suspect that when she grew up, he was busy doing time, and she got short-changed. He was trying to make it up to her, running as if in a dream, agonizingly slowly towards an end that kept inching away, just out of reach.

Two years after Murdock’s death, now 14 years ago, a worried mother and father brought a little boy named Oren into the emergency department. Oren had stopped eating, had a fever, and was irritable. He was a one year old, a difficult age to make some diagnoses. But, he had the sign. I could put my hand under his head and lift his body off the gurney, angled up from his heels. His neck was the clinical definition of ‘stiff.’ I performed a spinal tap and found pus cells. He was treated for meningitis that was cultured and found to be caused by the Meningococcus bacterium. This was the famous Meningococcal meningitis, which at worse kills rapidly and at best, leaves a child deaf. Occasionally, early aggressive treatment works wonders and a total cure is achieved. Oren was blessed with the good fortune of total cure. To this day, the father thinks I saved his son’s life, in spite of my having simply followed the ‘cook book’ approach to basic medical care. I have told the father these facts repeatedly. It is not that I had to have Oren’s dad think less of me or to burst his bubble; it is just what comes out between friends. You see, years later Oren’s dad was to become my music partner and closest of friends. So many years later, I was to find out that Oren was named after Doc, Murdock Oren. Oren’s dad, Mark, was Murdock’s last true friend and one of the only people that knew how special this old toothless, sparkly eyed character was and so honored him with a godson, of sorts. I didn’t know any of this until after several gigs when, late one July night, after we pulled off a successful rendition of old blues, Hendrix, and Dylan, we sat out in my back yard in near total darkness and talked about friendship and honor and small children. Mark told me of his time with Murdock and I was amazed at the interleaving, overlapping, and relatedness of our community. Doc died before Oren was born but, instead of failing to leave his daughter a grubstake, he left a spiritual inheritance for a little boy who impresses everyone around him with goodness and sparkle and cleverness.

That night in my back yard was seven years ago. Oren is now 14. He is a gifted musician and brilliant boy, excelling in all that he does. I suspect that he’ll keep his teeth and straight legs….