The Character

One of the immense joys of the practice of medicine is the opportunity to meet a great variety of interesting and unique people. I especially enjoy the ones that do not fit the mold, the true characters of our society. The prototype of this sort of individual was Ed Wilinski. You all have had patients like Ed. Not the same health problems, of course, but the same charismatic appeal, the same special charm. Ed would have throttled me if he could hear me describe him as charming.

I was on a roll with unique and special patients when I first met Ed. Our inpatient service had just discharged Donna, a young woman with pneumonia. She had told the junior medical student that her occupation was that of an “ecdysiast.” The student thought she worked in a dermatology clinic until he was told that this was a euphemism for exotic dancer or “stripper” (“one who sheds the outer lining”). Upon auscultation of her chest, I could not help but notice that she likely was very popular with her audience. At the time of her discharge from the hospital, she issued an invitation to our team to view her next performance. I do not often visit patients in their workplace, but I must admit I was sorely tempted. I think the medical students on our team followed up on her offer.

In my clinic, I had previously evaluated a young woman with Turner’s syndrome (gonadal dysgenesis). Since her ovaries were not making estrogen, she appeared as a tiny, attractive prepubertal girl, rather than the twenty-one-year-old woman she was in reality. She was started on estrogen and developed the standard secondary sexual characteristics (read that as larger breasts) within several months. At her most recent visit, she asked for a refill of her estrogen and also thanked me for helping her get employment. When I inquired about the nature of her job, I was taken aback somewhat to learn that she too was an exotic dancer. Seemed like my patients were handling most of the adult entertainment in the area.

Ed was not an exotic dancer, but he clearly was the type who would have been in the crowd, hooting and howling at their performances. I first met him about twenty years ago in our Emergency Room, when he presented with severe hyperthyroidism. He almost seemed to be a caricature of the classic manifestations of Graves’ disease with his bulging eyes, a goiter reminiscent of a turkey’s wattle, heart thumping away at a hundred miles an hour and a labile mood that ranged from the frenetic to sobbing depression over the course of seconds. His heart rhythm was abnormal and he sported a sizable blood clot in his left leg. I insisted that he needed to be in the hospital. He reluctantly agreed. Thirty minutes after admission he was pacing the floors and insisted that he would stay only if he didn’t have to eat the hospital food. We agreed he could get his meals in the cafeteria. One hour later he said he would stay, only if he didn’t have to sleep there. His metabolic mania was such that I felt he would never sleep anywhere. After a short time he signed out against medical advice.

Ed did follow up in my clinic and after three or more radioactive iodine treatments, his thyroid status finally came under control and his mania mellowed, but never quite disappeared. He had grown up in a blue collar neighborhood on our city’s south side, and had dropped out of school after the tenth grade (“Hell, I flunked out!” he bragged). He worked to support his mother who was “crippled by arthur-itis” in his words. Ed tried to enlist during the Second World War, but the Army refused him because of the “god damn hernia.” His work was in construction, factories, maintenance and a host of other jobs, but he was always the first to be laid off, perhaps because of mild alcohol abuse or his carefree attitude about work of any sort. He finally landed a job as a bartender shortly after I became involved in his care. He kept urging me to come to his workplace. “Hell, I come out to see you all the time at your job. How about returning the compliment?”

His tavern was across the street from a large factory. At 7 am, when the night shift got off duty, hordes of workers would pour into the pub. Ed tended bar from six in the morning till just after noon. Late one Saturday morning I visited his workplace. The night shift had gone home to bed and the tavern was filled with what appeared to be the neighborhood regulars, grizzled codgers whose major interest seemed to be their alcohol. The place was dimly lit and the dank atmosphere made me shiver. One stool was unoccupied, almost as if it had been reserved for me. All the patrons had a partially filled schooner of beer in front of them. These glasses were about the size of a large fish tank. A majority of the denizens also had whiskey glasses near their right hand. "Doc, how the hell are you?" bellowed Ed as I walked into the establishment. “It’s about time you showed up.”

No sooner had I eased myself onto the stool, than a schooner of beer appeared in front of me, along with a two ounce jigger of bourbon. Ed announced that the house was buying, and an immediate shout of joy arose from the crowd. Toasts ranging from Prosit to Skol to a Polish word I could not decipher filled the air. With some trepidation, I sipped at the bourbon. No hesitation on the part of my new compatriots. I marveled at their ability to curl their lower lips under the bottom rim of the glass and snap their heads back with such speed, literally hurling the alcohol down their gullets without losing a single drop. After several minutes it became apparent that I should buy the next round. And so it went. By the time there were four full glasses of whiskey plus the one I had been sipping in front of me, it became obvious that I was either going to have to make a premature exit or be directly admitted to a detoxification unit.

Ed showed up faithfully for his follow-up visits. He always had a few humorous and slightly ribald stories for me, but he specialized in truly corny jokes and groan-evoking puns. His atrial fibrillation required anticoagulation and he reveled in referring to his Coumadin as his “condom pill.” When he retired, he spent his time mowing his neighbor’s lawns, griping about politics and boy-sitting his two-year-old- grandnephew. For reasons that are hard to explain, I really loved this man. What did he represent to me? A variety of feelings and sentiments, such as an absence of pretentiousness and an abundant dose of reality, accepting ourselves as we are. He was uneducated and felt it was too late to change so, he had no qualms or regrets, or perhaps it was just that he had a stubborn macho pride in his faults and deficiencies. Maybe I saw in him a reminder of my own family’s background and origins. Whatever the reasons, I certainly looked forward to his clinic visits and tried to schedule him as my last patient so we could spend more time together.

He missed three consecutive clinic appointments some years ago. I called his home but received no answer There was no response to my letters. His pharmacy had been calling me for refills so I at least knew he was alive. When he finally did return, he looked disheveled and unkempt. He had lost weight and appeared haggard and exhausted. “I’m having problems, Doc. I am not sure I want to live.” It took some time for the story to evolve. His grandnephew had been crushed to death by an automatic garage door at a neighbor’s house. It clearly wasn’t Ed’s fault, but he felt that it had happened on his watch. He was inconsolable. All the humor, the enthusiasm and the joy of life had been sapped from this man. He sobbed as he told me the story, which only subsided when I held him in my arms and hugged him.

Time really does not heal all wounds. But as the years went by Ed slowly came to life again. Using the vernacular, he would tell me about politics, health care, television and the various elderly women he had been dating. He loved to dance and would polka and waltz for hours, stopping only when his exertional dyspnea flared. Then came the rectal bleeding. It wasn’t hemorrhoids as we had hoped, but an especially virulent form of colon cancer. The surgery and chemotherapy slowed this dynamo down considerably.

He was hospitalized in late December with nausea, vomiting and more weight loss. “I feel like crap!” he growled as I entered his room. His language was improving, I thought. He spent thirty minutes describing the dance he had been at the prior week till he got to the point he really wanted to discuss.

I know I’m dying Doc, but I have one more wish. I want to go fishing when the season opens next May. I’ll be too sick to drive, and all my old fishing buddies are gone. Will you take me fishing?” I quickly agreed as I held back my tears. I’ve never been more flattered by a request.

Ed Wilinske died a week later.

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.