Sylvia's Walker Balls

Thank you. Thank you very much. Great to see you all here. Thank you. Thank you very much. Thank you so much. A center of excellence. It was a slate gray day with the temperatures hovering at five degrees as I finished my Thursday patient list. Sitting at my desk, cutting and pasting from our newly purchased electronic medical record, I heard in the distance the unmistakable shrub, shrub, shrub of Sylvia Kropopnik's tennis balls on the clinic corridor floor. Those balls, fixed with so much care by Bernie in her assisted living facility, had an unmistakable rustic tonality. It was rumored that Bernie applied a light patina of extra virgin olive oil to those balls. This was a secret of immense value to the retirement community. Sylvia's balls were the envy of all other members of the shady country assisted living facility. Now none of the residents could figure out how those balls never shifted from the ends her walker. It was rumored that Sylvia and Bernie had more than a professional relationship, but when it came to walker balls, there was no room for rumor or innuendo.

It had been a long day for me at the Rhoda and Sidney Feldman Empathicalistic Geriatric Center. I was exhausted, but that sound approached. How could I fail to see Sylvia? I had been been her physician for over 20 years. Sylvia Kropopnik had an EMR problem list as long as the Bronx Telephone Directory. She had advanced kyphosis, Charcot-Marie-Tooth disease, an ill-defined bipolar disorder, and most intriguing of all, a set of schmall's nodes that were the envy of every radiology resident in the Midwest. Busloads of medical students regularly appeared at my clinic to observe Sylvia's nodes. As she slid into my waiting room, I noticed the characteristic sparkle in her eyes that made her the darling of my office staff.

Because, as she constantly reminded us, she used to be, quote, big in her native country before coming to America. Of course, the nature of that bigness was never fully explained despite innumerable interviews, including occupations and hobbies, by years of third-year medical students from the neighboring university. The conventional Kropotnik wisdom was that her past had something to do with show business since there were references to stage managers and scripts, but there were also occasional references to fans, a three-piece band, and cat calls from an inebriated audience. This caused many of us in the clinic to think that Sylvia may have dwelled on the darker side of performance art.

I entered the examining room just as the sun was setting over Lake Michigan. A shaft of light, much like Goudy crystals in a Von Stein-Schuler flocculation test, had broken through the gray clouds. That shaft of light hit Sylvia across her face, causing her to hold her hand over her eyes.

Sylvia's hands. What had those hands touched? Where had they been? Wrinkled with age, discolored by the seppigenous paths of prominent veins, bent by arthritis, what did those hands say to me as a physician? Her yellowed fingernails comported with her smoking history.

Her splinter hemorrhages indicated a history of endocarditis. Their fragility spoke of her well-described onycholysis. But my eyes settled on a bluish discoloration of the fifth digit on her left hand. I'm turning blue, she announced. Sylvia, I said, you look fine.

is turning blue. My fingernail is turning blue, she stated. Did you hurt yourself? I asked. No, it just appeared. Now examining the fifth digit of her left hand, I noted a stellate dark blue discoloration under the fingernail. The lesion was faintly reminiscent of a photo on page fifteen thousand six hundred and eighty-nine in Tessin Rue's classic quote, inextricably difficult problems in medicine that only professors can solve. I had recently received a copy of this remarkable book from a grateful resident who had rotated through our office. That resident was headed for a career in dermatology. Although I had used the book mainly as a doorstop, I had read inextricably difficult problems and I had learned that it had received an excellent review in the recent weekly edition of Acta Academica Insignifica, my favorite medical journal. There it was on that page, a perfect photograph of the very abnormality that Sylvia had pointed out to me.

Sylvia, I said, I'm concerned about this. I'm going to refer you to Professor Tricia Nödlinger-Schlaufmann at the university. Professor Nödlinger has recently been hired to leave the Center of Excellence for subungual hematomas. She's big in her field. I'm sure you have seen her in the center's ads in local newspapers and on television. I don't want a professor, Sylvia said. I want you. Well Sylvia, I responded, I appreciate that, but medicine today has become very specialized. You need a sub-ungual professor at a center of excellence to deal with this. This happened to my cousin Meyer, she said. All he did was put an ice cube on his finger, heat up a paperclip, touch the area, it was gone in a week. Cousin Meyer. How could I have forgotten that Sylvia Kropopnik's cousin Meyer was the Schmata king of the Midwest. He had arrived here penniless and had built up a giant clothing empire. Except for some nasty litigation regarding the patenting of the Velcro fly, Meyer had a wonderful reputation in the community.

Was this a simple, sun-lung bolt hematoma, or was something more sinister lurking under Sylvia Kropopnik's nail bed? Only a center of excellence could solve this problem. The sun was now gone. A gloomy winter pall fell over my clinic. Tell me about Meyer, I said, resigning myself to another half-hour with Sylvager. Meyer was in the factory one day inspecting the machinery, she said. The stumpleforcer, you know, the machine that presses the belt line onto the trousers. Well, it was accidentally aggravated and it smooshed his finger. The finger turned blue. He went to see that goniff Dr. Wilson over on McDougald Street. Wilson said it was nothing, and it was nothing. So why do you think this is serious? Wilson is a goniff, but a good doctor. He knows his fingernails." Well, Sylvia, I said, this has a distinctly different coloration.

It could be a type of cancer, I said. A concerned look came over Sylvia's face. She stood up and said, thank you, doctor. I must leave. The van is waiting.

Rising with the aid of her walker, Sylvia left my office. the sound of her walker balls receded into furthermost recesses of my clinic. Several weeks later, I received a letter from the Saba Unwilhim Atonement Center of Excellence, thanking me for my referral of Ms. Sylvia Kripopnik. A pathology report was attached to the letter. It read, received from OR number seven, a specimen labeled, quote, Kripopnik, digit five, left hand. The final pathology conclusion was, quote, normal finger with associated subungual hematoma. No evidence of malignancy. I immediately called Sylvia to ask her how she was doing. Now the front desk of the shady country assisted living facility would not disclose any health related information. They said that Miss Kropopnik was no longer a resident at their facility.

called her cousin Meyer. Meyer, this is Dr. Frampton. I'm trying to get in touch with Sylvia, where is she? Meyer said, Doctor, some professor over at the university chopped off her finger. Sylvia's greatest joy was to play the piano. She couldn't do that anymore. I told her it was the same for cuck the thing I had in the factory and that it would heal on its own, just like Doc Wilson said it would. But she said you wanted her to go to that, what the hell is it? The center of excellence for jungle rungalomas or something like that. So she went and now she's gone and I might add so is her finger. Do you have any idea where she might have gone I asked. Well Meyer said the word at the home is that she ran away with that guy Bernie. You know the guy who always fixed her walker balls. But they're both in their 90s I said. Where could they have gone? Well said Meyer, Sylvia was a restless sort. I'm sure she She and Bernie just took off.

Look, at that age, what's left? No one ever heard again of Sylvia Kropopnik. No one ever heard of Bernie. About a year later, on a late February afternoon, all the patients had gone. I thought again of Sylvia Kropopnik, the nine-fingered nonagenarian.

I thought of her finger with the blue discoloration under the fingernail, a finger now floating in a jar at the university. And of course, I thought of her walker balls. I see Sylvia and Bernie in some far off place, enjoying each other's company, an aging Butch and Sundance side by side, heading towards the horizon. What a sight. 19 fingers, two walker balls, and a jar of virgin olive oil, most assuredly headed to another center of excellence.

Thank you very much.

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