The Ginseng Man

THE GINSENG MAN JOHN W. BURNSIDE* He was somewhere in his seventies when I first met him. His age was often a question of mine but of no concern of his. That first visit to the office started a 6-year sparring match in which we both took pleasure. "Good afternoon, Mr. Clemens, my name is Dr. Burnside." "Otis," he said. "Beg your pardon?" "Most folks just call me Otis," he replied. He was short, solid and smelled musty. He had gray crewcut hair, and there were defiant tufts from his ears and nostrils. He wore khaki slacks, well-worn high-topped shoes, checked flannel shirt, and a string tie with an Indian clasp. His "dress up tie" I was later to learn. "What's the problem?" I inquired. "For you to find out, innit?" he said, looking at me sideways. Terrific! Six more patients to see, I'm already behind, and this crusty devil wants to play games. Not a very emphathetic response but there it was. A labored drill of "yeps" and "nopes" led to the diagnosis of diabetes as his major problem. I took a long time to get there so that I could hardly pursue much else. My exam was abbreviated but enough to confirm the absence of any significant retinopathy or neuropathy, a grade one aortic stenosis murmur, moderately enlarged prostate, and one absent foot pulse. Not too shabby for seventy plus and carbohydrate intolerance. I told him of some lab tests that I wanted, talked a bit about diabetes, arranged for him to see the dietitian, and set up another appointment. As he was leaving, hand on the door, he turned and with a shy grin said, "You're better'n the last, I may be back." Over the next 2 weeks, I found Otis popping into my mind at odd moments. I had missed something—no, I had missed a lot. I hoped that ?Paper written at Milton S. Hershey Medical Center. Address: University of Texas, Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, Texas 75235.© 1988 by The University of Chicago. All rights reserved. 003 1-5982/88/3 1 04-0596$0 1 .00 586 I John W. Burnside ¦ The Ginseng Man he would keep the next appointment. I wondered if I really had passed his secret test. He came. Over time, he gave me little glimpses of who he was. I was never quite sure ifhe was teasing me or wasjust afraid to reveal too much too soon. I discovered a man who had little patience with civilization. Not angry,just self-sufficient and happy to be alone. ". . . live in a cabin on Blue mountain. Built it myself." ". . . wife died long time ago." ". . . gotta son. Lives in Texas. Writes once in a while." ". . . gotta dog. Good dog." ". . . Hoffer's a good read." ". . . naw, pay ya cash. Don't have Medicare, don't draw security." I found myself responding in kind, telling him little bits of myself. Our conversations were less and less questions and answers and more and more simple declaratives. He was comfortable with silence and taught me to be the same. He would remember these little confidences and bring me things. Once a small meteorite for my sons, a couple of small mountain laurel for my garden, a good book. We began to have fun, but his diabetes was no better. Time and again his blood sugars pushed 300. I was certain he was getting up every couple of hours at night to go to his one-holer. "Can't piss off the porch. Draws the porcupines. They like the sweet salt." Talking diet was talking nonsense. He ate when he felt like it and what he felt like—game, fruit, or whatever took his fancy during his infrequent trips to a grocery store. We started oral hypoglycemics—pushed to maximum dose and still no real response. I really did not like the idea of going to insulin. One episode of low sugar on the mountain and that would be the end of Otis. Coming into the hospital for regulation was hard to contemplate as well. For Otis, personal control was everything and would not tolerate much tinkering...