Gumbo Lagniappe (You’Ve Got to Be Kidding): (A Collection of New Plays, a New Translation of Tartuffe and Recent Medical Essays)

By David J. Holcombe

GUMBO LAGNIAPPE (You’ve Got to Be Kidding) contains original plays, many with public health themes, but others dealing with our fascinating current political and social climate. Several plays were written for this year’s Spectral Sisters Productions Ten-Minute Play Festival for which the theme was “You’ve Got to Be Kidding,” thus the second part of the title. A collection of selected recent medical essays, some of which complement the plays, also add to this literary gumbo, as does a new translation by the author of Moliere’s classic, “Tartuffe.”

Together, these new plays, an old classic and some assorted medical essays, offer “lagniappe,” a little extra, to the body of world literature. This small town, Alexandria, stuck in the middle of Louisiana and two hours’ drive (at least) from any larger city, has the advantage of being like a tramp steamer isolated in the immensity of the Indian Ocean. We have learned to entertain ourselves on the trip and this unlikely location has produced a host of plays from many other talented, but unrecognized playwrights. May creative energy continue to bubble forth from this curious location, as far off-Broadway as you can get, but perhaps a bit closer to heaven. My thanks to those who want to explore something new while supporting an undiscovered author from Central Louisiana.

• Language: English
• Publisher: AuthorHouse
• Release date: Feb 17, 2020
• ISBN: 9781728347202

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© 2020 David J. Holcombe. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 02/17/2020

ISBN: 978-1-7283-4719-6 (sc)

ISBN: 978-1-7283-4720-2 (e)

Any people depicted in stock imagery provided by Getty Images are models,

and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

Cover design, Renaud and the Golden Llama by David J. Holcombe, 2019

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Contents

INTRODUCTION

ACKNOWLEDGEMENT AND DISCLAIMER

NEW PLAYS

EVERY SYSTEM

THE SCHOOL SHOOTING

PUBLIC HEALTH TRANSFORMATION

GOING TO MOLOKAI

FRENCH IMMERSION SCHOOL

HUNGARIAN IMMIGRANT

THE ICE FACILITY

UNFAIR ADVANTAGE

THE WINE TASTING

FEAR

WEST SIDE GRILL

A BEER AT THE MUNICH CAFÉ

THE HOUSE ON SAVA STREET

TROIKA

MARUSA AND THE TWELVE MONTHS

TARTUFFE BY MOLIÈRE (NEW TRANSLATION BY DAVID J.HOLCOMBE)

RECENT MEDICAL ESSAYS

INFECTIOUS DISEASES

FOODBORNE DISEASES FROM 2015-2018

HEPATITIS A: ON THE UPSWING

HEPATITIS C: BOOMERS BEWARE!

HEPATITIS C: CURE WITH THE NETFLIX MODEL

CANDIDA AURIS: A NEW FUNGUS AMONG US

INSECT-BORNE DISEASES ON THE RISE IN THE U.S.

BRUCELLOSIS: HOG HUNTERS BEWARE!

STD’S IN LOUISIANA: FINALLY SOME GOOD NEWS

PREP (PRE-EXPOSURE PROPHYLAXIS): A PILL TO PREVENT HIV

CHRONIC DISEASES

PROSTATE SPECIFIC ANTIGEN (PSA), PROSTATE CANCER AND LONGEVITY

OBESITY AND CANCER: A DANGEROUS ASSOCIATION

FINANCIAL TOXICITY AND HEALTH CARE COSTS FOR CANCER

ARTHRITIS: ANALYZING SEVERE JOINT PAIN AND INACTIVITY IN THE U.S.

HEALTH STATISTICS

COUNTY (PARISH) HEALTH RANKINGS FOR 2019

THE WELL-BEING OF YOUNG WOMEN IN THE U.S.

DISPARITIES IN HEALTH OUTCOMES

MENTAL HEALTH ISSUES

BIPOLAR DISORDER AND SUICIDE: A DOUBLE TRAGEDY

SUICIDE AMONG THE ELDERLY

ACES (ADVERSE CHILDHOOD EXPERIENCES): PREDICTORS OF FUTURE HEALTH OUTCOMES

TOXIC CO-WORKERS: AN OMNIPRESENT CHALLENGE

PREVENTION

DYING ON THE ROADS IN LOUISIANA

MOTOR VEHICLE CRASH INJURIES AND THE SUDDEN IMPACT PROGAM

ROUNDABOUTS: A GOOD SOLUTION

SHELTERING AT THE MEGASHELTER DURING HURRICANE HARVEY

TIME TO TRAVEL, BUT DO IT SAFELY

ADULT VACCINATIONS: NEVER TOO LATE TO VACCINATE

PARTICIPATE IN THE ARTS AND LIVE LONGER

VAPING: INDISPUTABLY DANGEROUS

HEALTH POLICY

THE ONGOING HEALTHCARE DEBATE

MEDICAL COSTS AND POSSIBLE SOLUTIONS

ON DRUGS, PROFITS AND THE PUBLIC GOOD

THE EVOLUTION OF PUBLIC HEALTH AND ITS FUTURE IN CENTRAL LOUISIANA

MASS SHOOTINGS: A PUBLIC HEALTH MENACE

HATCHING TROUBLE: THE DIETARY SUPPLEMENT HEALTH AND EDUCATION ACT OF 1994

SYRINGE SERVICE PROGRAMS: COMING TO CENTRAL LOUISIANA SOON

OPIOID HARM REDUCTION: A COMPREHENSIVE APPROACH

REPRODUCTIVE HEALTH

TEEN PREGNANCY IN THE UNITED STATES: A WORK IN PROGRESS

PREGNANCY-RELATED MATERNAL DEATHS

IMMIGRATION ISSUES

IMMIGRATION AND HEALTH OUTCOMES

THE IMMIGRATION PRISON INDUSTRY IN LOUISIANA

CIVIL SURGEONS, IMMIGRATION AND COMMUNITY HEALTH WORX

ABOUT THE AUTHOR

INTRODUCTION

GUMBO LAGNIAPPE derives from a couple of typically Louisiana expressions: gumbo and lagniappe. Gumbo refers to the ubiquitous Louisiana roux-based stew made with just about anything edible. Lagniappe is a Creole term for a little extra. Merchants in French-speaking New Orleans used to add a little extra to a customer’s order as a token of friendship and respect, and a hope of continued patronage. GUMBO LAGNIAPPE, represents a gumbo of several genres (plays, medical essays and even an original translations of Molière’s Tartuffe) that all come as a little extra to previous publications by the author.

This volume contains some original plays, many with public health themes, but others dealing with our fascinating current political and social climate. A collection of selected recent medical essays, some of which complement the plays, also add to this literary gumbo. Several of the plays were written for this year’s Spectral Sisters Productions Ten-Minute Play Festival for which the theme was You’ve Got to Be Kidding, thus the other portion of the title.

These plays, much like the many that have preceded them, have gotten very little critical acclaim. Although a few have appeared on stage at the Kress Theatre in Alexandria, Louisiana, most have never been performed and hardly ever read. Since they have all been self-published, however, they have attracted a host of marketing services, all promising to introduce an unknown genius to the eager outside world. Such rubbish, directed to the vain and foolish with extra cash, only represents modern day sirens coaxing the unwary onto the rocks of bankruptcy.

To add to this gumbo, there is also a new translation by the author of Molière’s classic, Tartuffe. Denouncing hypocrisy never seems to go out of style and I wanted to do a translation from an English speaking Francophile playwright’s perspective. Changing poetry into prose while untwisting the language, sometimes archaic, into contemporary English prose proved an interesting task. Perhaps this new translation brings nothing to world literature, but it kept me engaged and enhanced my appreciation for a wonderful work that has stood the test of time. I hope Monsieur Molière will forgive me.

Together, these new plays, an old classic and some assorted medical essays, really do offer some lagniappe, a little extra, to the body of world literature. My thanks to those who want to explore something new while supporting an undiscovered author from Central Louisiana. This town, stuck in the middle of Louisiana and two hours’ drive (at least) from any larger city, has the advantage of being like a tramp steamer isolated in the immensity of the Indian Ocean. We have learned to entertain ourselves on the trip and this unlikely town has produced a host of plays from many other unrecognized playwrights. May creative energy continue to bubble forth from this curious location, as far off-Broadway as you can get, but perhaps a bit closer to heaven.

ACKNOWLEDGEMENT AND DISCLAIMER

I would like to thank all those who inspired either the plays or medical essays. The real world offers an endless source of inspiration for the interested author. As such, it is impossible not to pick aspects of reality to introduce into the fiction of contemporary plays. Some people may find topics or characters familiar, but any resemblance to the living or the dead is strictly fortuitous.

Dr. John Hill and Jeff Goelz assisted with proofreading and editing. Jeff Anglicized my translation of Tartuffe, line by line, while updating some language. Both gentlemen deserve my heartfelt thanks.

Spectral Sisters Productions continues to inspire by encouraging developmental theater in Central Louisiana, an unlikely location for such activity. Both CenLA Focus and Visible Horizon (regional publications) continue to print my articles on medical themes, despite the occasional controversial subjects.

EVERY SYSTEM

By David J. Holcombe and Renaud Lenart Holcombe (in his own words)

CHARACTERS

LENARD: Young man in his mid-thirties, intense, severe and articulate

MOTHER: Lenard’s mother. Mid-sixties, sincere, pragmatic, casually dressed and unpretentious

DOCTOR: Late-sixties, a bit pompous. Speaks with an East Coast accent

SETTING

There is table with two chairs and a third chair off to the side with a small desk for a laptop. Lenard sits on the solitary chair. He is typing on a laptop and reading the text to the audience as he writes. (Memorization is not necessary since the text can be read. His texts are emails sent to a close friend.) The Doctor and Mother use the other two chairs. They are speaking to one another and often get up and walk around. The Doctor and Mother cannot hear Lenard and vice versa and do not address him directly.

DOCTOR: (To MOTHER) My sincerest condolences for your loss. There’s nothing more terrible for a parent than losing a child, especially by suicide.

MOTHER: (To DOCTOR) No parent ever recovers from this sort of trauma. I saw it many times as a social worker. It’s so unnatural, so devastating. No one ever gets over the loss of a child and you know it as well as I do.

DOCTOR: Yes, you’re right. I’m so sorry for you and your family.

LENARD: I’m thinking pretty hard about Electro-Convulsive Therapy. It flat out scares the shit out of me. I don’t even know if outpatient is a possibility. After every treatment I’d need a ride home as well as someone to watch me for six or so hours. But I told my psychiatrist I’d think about it and a few minutes ago sent a list of questions from important: Is outpatient ECT even possible? How long would I need to be out of work? To inconsequential: Would I need to take out my facial and ear piercings?

MOTHER: Among our son’s papers, we found a medical report from an expert clinical psychologist ordered by the psychiatric nurse practitioner. (Pauses) It was detailed, very professional and appalling. Did you read it?

DOCTOR: Yes, I read it.

MOTHER: Given the length, depth and severity of our son’s bipolar disease and his use of nicotine and methamphetamine, was it appropriate that he was being cared for by a psychiatric nurse practitioner rather than by a psychiatrist?

LENARD: You used a phrase a while back, saying that I was experiencing a mental health crisis. That pretty much hits it on the head. I’m going through a serious relapse of my bipolar disorder symptoms. Over the last few weeks, they’ve become as bad as when I was at my worst in college. This last week I’ve been losing the ability to pretend things are okay at work and have been approached by a few folks noticing my irritability or looking exhausted and run down. I’m having trouble taking care of myself at home; half my refrigerator is full of dirty dishes from weeks ago and I’m forgetting to eat regularly or shower on the weekends. I’m struggling with more frequent suicidal ideation and intrusive thoughts.

DOCTOR: Mrs. X is among our best psychiatric nurse practitioners. (Pauses) All of our nurse practitioners have weekly meetings with their collaborating physician, a clinical pharmacologist and a psychiatric social worker. (Pauses) They’re not practicing independently, far from it! It’s a collaborative team approach and usually works very well.

LENARD: It’s overwhelming, but I’ve got help from my psychiatrist and therapist. They’ve been going above and beyond to figure out options, things to try and checking in to make sure I’m okay. Some of that gets lost in my dispatches; I focus on the latest failure or roadblock and discount the work they’re putting in to help me. I haven’t put them in a great position; I’m a shitty patient to have: Highly treatment resistant across the board with deep-seated trauma and an inability to prioritize my own health over things like work. I’m increasing doses of the blood pressure medication, increasing one of the other meds and I’m going to try and get a consultation with an Electro-Convulsive Therapy specialist.

MOTHER: Usually works very well? (Pauses) Our other son, who lives in Belgium, had a nervous breakdown after Lenard’s suicide. (Pauses) He was hospitalized for 20 days where he was seen daily by a psychiatrist. That was followed by two weeks of outpatient clinic, also with a psychiatrist, and after that, weekly visits with the same doctor. (Pauses) He never saw a nurse practitioner. In fact, they don’t even have physician extenders in Belgium because they produce enough doctors for their needs.

DOCTOR: You know that’s not the reality here. We’re handicapped by a severe shortage of doctors in general and psychiatrists in specific. There’s no denying it. We must depend on physician extenders.

MOTHER: Even at your institution, one of the most prestigious medical Meccas in the United States? You don’t have enough psychiatrists to meet the needs?

DOCTOR: Yes, even at our world-class medical institution. There simply aren’t enough psychiatrists.

LENARD: Head-wise it’s been a strange week. I’m feeling better, but it’s not the right reasons. Rather than actually seeing any improvement, I’m just overwhelmed with the sense that it just doesn’t matter because I’ve been right about everything all along. I started self-medicating with meth because I didn’t believe that I would be treated through normal channels and now, nearly two years later, I was right. I held off on blood pressure medication for a long time because I knew that it would be a three to four month process; I was assured that it wouldn’t be the case, that it typically took a couple of weeks, and now, after six or so weeks, I’ve been right again. I suspect that my acupuncturist has quietly fired me as a patient because of the lack of any sort of improvement. Being right over and over that I can’t actually be helped at all feeds into a feeling that there aren’t any more consequences. I can stop trying and fighting to keep things together because at some point I’ll hit an inevitable breaking point and that’ll be it. The part of me that knows that none of this is actually the case is just getting smaller and smaller. Luckily, I’ve got the psychiatrist’s appointment today that I’ve got to leave for in a few minutes and also therapy later on, so there’s that.

MOTHER: The contrast between the national healthcare systems in Belgium and the U.S. and the outcomes for our two sons is stunning. One is still alive in Belgium while the U.S. Postal Service shipped Lenard’s cremated ashes to our doorstep. (Pauses) The box was marked Cremated Human Remains. Can you believe it?

DOCTOR: Yes, I believe it. And the difference in your sons’ treatments and outcomes is remarkable and tragic.

MOTHER: Our son in Belgium paid a couple of hundred Euros for the whole hospitalization and post treatment. That’s all. We’re still getting Lenard’s substantial medical bills for out-of-system providers and other non-reimbursed expenses. They just sent another bill for over a thousand dollars to us nine months after his death!

DOCTOR: I’ll make sure that bill’s written off.

MOTHER: Thank you.

LENARD: The appointments went fine, but we’re still in grasping-at-straws mode. The psychiatrist suggested Trans-Cranial Magnetic Stimulation, probably not covered by my insurance, and looking into genetic testing specifically geared towards figuring out what medications I’m most likely to respond to, also probably not covered by my insurance. We might also try replacing the anti-psychotic with something else in the same class, but…shocker…there might have to be some insurance wrangling for that as well. The acupuncturist eventually got back to me and I’ve got an appointment next week. In theory, we’ll be trying some techniques for getting me to not freak out about moving while the needles are in place, so we’ll see what shakes out there.

MOTHER: And our brilliant U.S. healthcare costs us over three trillion dollars a year or 18 percent of our gross domestic product. That’s over $9,000 per capita, twice as costly as in Europe. (Pauses) And all our astronomical expenditures only get us to 34th among developed countries for our health outcomes. Is that reasonable? Is that normal? Is that even acceptable?

DOCTOR: You’re very well informed. It’s all true. What more can I say?

MOTHER: You can say that we have a fantastically expensive and grossly dysfunctional health care delivery system that’s perfectly designed to produce the results it produces.

DOCTOR: I know you are distraught, but medical economics are outside the scope of the discussion of your son’s care.

MOTHER: Are medical economics really outside the scope of our discussion or at the very heart of the matter? (Pauses) Our national life expectancy is dropping and it’s due to drug overdoses and suicides, both psychiatric issues. Our son is a statistic now, nothing more than a number in a data sheet, another victim of diseases of despair.

DOCTOR: Life expectance in this country is dropping. You’re very well informed and 100% correct. We have a long way to go in this country.

LENARD: Trans-Cranial Magnetic Stimulation is essentially Electro-Convulsive Therapy with magnets instead of electricity. It avoids the anesthesia, post-treatment monitoring and other side effects. That being said, it’s not entirely proven against bipolar disorder, which makes it a tough sell for insurance companies. I’m holding off on switching the anti-psychotic for a couple of days since apparently I’ve been taking it wrong. Turns out it needs to be taken with food in order to be absorbed; I usually take it right before bed since it’s supposed to make you sleepy, but since I haven’t been consistent about eating dinner it’s possible that’s been a factor. Now I’m supposed to take it with lunch at work since I’m better about eating when I’m there and hopefully I won’t pass out at my desk. If that doesn’t do anything, and I’m not holding my breath, then maybe next week we’ll swap out the medication. I might also be adjusting the blood pressure meds since after the fourth round of fiddling, there continues to be no improvement. I’m waiting to hear back from the primary care physician since apparently the workflow is that he sends a questionnaire, I fill it out and submit it, and then he ignores it for a few days until I pester him. It’s also been suggested that I think about doing an intensive outpatient program, but given my feelings toward group therapy, a major component, I’m not too wild about the idea.

MOTHER: Our son is dead, your state lost a good taxpaying citizen, his company lost a brilliant system analyst, and we had to scrap his dried blood off the parquet floor of his home and put it into a garbage bag. (Pauses) No parent should have to do such a thing! Ever! Anywhere! Anytime!

DOCTOR: This must be unbearable for you and your husband.

MOTHER: Unbearable for us, yes, but worse for Lenard. He’s dead! He’s done! His ashes are scattered over the rocks at Kisatchie Forest. Oh, God!

LENARD: I’m fucking tired of this! Tired of the diagnoses, tired of the medications, tired of the tests! Tired of being told that I’m doing something to get better only to get worse! Tired of not being able to get straight answers from doctors because I’m somehow impervious to medical science! It was hard enough when it was just my head that responded to treatment by worsening, now it’s my body, too.

MOTHER: (Shaking her head) Lenard’s death haunts me day and night. I wake up thinking about it in the morning. During the day, I start sobbing uncontrollably at some random word, some sound, or some sight the reminds me of him. His death keeps me from sleeping at night. (Pauses) Time may attenuate grief, but it doesn’t heal it.

LENARD: It’s been a pretty rough few weeks and it feels like every couple of days, the bottom is dropping out a bit further despite all efforts to the contrary. You’ve got your own struggles going on and I try to be mindful and provide any support I can, but it’s tough for me not to get swept up in whatever downward spiral I’m in and I’m sorry and thank you for listening.

DOCTOR: (To MOTHER) You must hang in there, if not for yourself, then for your spouse and your other children. (Pauses) Grief consumes time and time consumes grief.

MOTHER: Buddhist?

DOCTOR: No, Jewish.

LENARD: I was planning on going through the 400 or so work emails today, but I think I’m having too much trouble with coherent thinking to pull that off. This whole confusion thing is really problematic and I’m worried about it getting worse and worse.

MOTHER: It wouldn’t be so terrible, but Lenard just shut us out of his life. (Pauses) I could have helped him. His father could have helped him. But he shut us out completely. He even told his father to leave and never come back when he tried to bring up the subject of his bipolar disorder when we visited him. (Pauses) Can you imagine? Telling your own father to leave and never come back to your home?

DOCTOR: That’s harsh.

MOTHER: And when my husband asked Lenard, I’m old. I could die next week. Do you want the last words to your own father to be ‘leave and never come back’? Do you know what Lenard said?

DOCTOR: No.

MOTHER: He thought about it a moment and then he said, have a nice trip.

LENARD: I had an acupuncture appointment on Tuesday that I screwed up. She asked about some recent wounds on my leg from self-harm and clearly didn’t believe the pretty thin lie I came up with. Then she decided to put in fewer needles because I was so jumpy that I was wincing in pain when she was putting them in. I checked with my insurance company about my appeal and it got denied since apparently even though a hospital may be covered, individual doctors within it might not be, which I didn’t know. So I’m