One thing about living with so pervasive and persistent a thing as lifelong paralysis…you tell yourself, nothing more. This thing that you have and is already bad enough, will do. You don’t want another malady. In fact, you won’t put up with another malady. In reality, you know you may have to endure something else, but still the magical thinking bends in the direction of this is it. I have had my measure of bad karma. No more will come my way.

Wrong.

Because what you forget is time’s winged chariot. That sucker is flying on. And on and on.

Which brings me to my bladder. Life has been bringing me to my bladder for many years. Regularly bringing me to my urinary senses, vis-à-vis limited control and therefore limited capacity. Don’t mess with me, my bladder says. And don’t forget me either.

It was very much out of character two years ago, just after our triumphant return from the North country, vis-à-vis Humboldt, that Messrs. Kaiser announced my bladder infection. I hadn’t had one of these since I was catheterized in a hospital 55 years before. Nonetheless, it seemed, things happen. So I took the antibiotics and thought nothing of it. Except that the bladder pain didn’t go away. Answer? Pelvic floor spasms. And what does one do for such a thing? Well because such a thing is a thing, one sees a Kaiser pelvic floor physical therapist. Which I did. Once. And I was given all sorts of exercises, including the redoubtable Kegel. And I thought very little of all that, mixed with occasional complaints to Kaiser that this thing absolutely still wasn’t going away. And my assurance from them: be patient.

All right, I know this account of things would bore any sensible reader. For which I apologize profusely. But please don’t shoot the messenger (someone else having gotten their first). Besides this is the unvarnished biometric truth. Honest. Real physiology. Inside story. Now it can be told.

And so it went, on and on, until this other thing happened. My three-year bladder cancer sonogram. Why do I have one of these? Because when peeing is difficult, people avoid it. Particularly people in wheelchairs. And when they avoid it, their urine concentrates…which over the years isn’t exactly a good idea. That’s why. And this time well, bad news. My bladder was getting distended. Plus I had a bladder infection. Or someone thought I did. Except that I didn’t. I mean, I was already well into a prescribed dose of antibiotics when someone at Kaiser decided no. But not before someone else in Kaiser decided I was in danger of damaging my kidneys and sent me a communiqué to that effect.

And reading all this, noting my saga as it unfolded, damned if it doesn’t sound alarming. It is, or was, or is and still was or something like that…alarming. And that, Gentle Reader, is where we stand. Or fall. Which is forcing me into a most unpleasant area…being my own medical director. No, I can’t trust these guys. Don’t hand over healthcare to a bunch of doctors, I always say. Which at age 76 one should have learned. But one hasn’t. And it’s just that simple. A simplicity somewhat complicated by having a doctor father and a mother nurse. But there you have it. I have cast off from the Kaiser dock, and I am charting my own course. Which as far as I can see, leads south. And what is south? Downey, California, of course. Home of Rancho los Amigos Hospital. Yes it is really called that. And, no, the place is not exactly one big happy Hacienda. But I was there for a medical reason, the hospital being the regional center for spinal cord injury. Which it remains.

While a few other things have changed. Principally, the nature of traumatic injuries to the spinal cord. In 1968, I spent almost half a year on a ward with 60 other spinal-cord-injured patients. Almost all had been injured in car wrecks. Oh, there were a couple of diving accidents. One stabbing. But bullets in the spinal cord? Are you kidding? Incredibly, in those days, seatbelts were not yet mandatory. The CEO of General Motors had actually gone in front of Congress and insisted that installing the belts would bankrupt his company. Truly. A straight face. No visible sign of cracking up. Just raised his hand, swore to the God of mammon, that the expense would kill him. Or his company. About 10 years later all the Detroit CEOs did exactly the same thing again. This time, over air bags.

Fortunately, good sense and certain balance of societal power, prevailed. So the car injuries have waned, but don’t worry. Where there’s a malevolent will, there’s a way. Shootings have filled the gap. No, this is not a joke. From a ward that contained no shootings to a ward that is all shootings. That’s right, gun violence, much of it in Los Angeles, has kept the trauma medicine world going. Good to know that a market can replenish itself. And on that bitter note, stay tuned.