Raise Your Hand: A Memoir

By Patti Nemeth

Eight-year-old Patti is caught reading in her bedroom by her mother who warns her not to be a “bookworm” because no one will marry her. From such an early start, she faces the enormity of her educational disadvantage with parents who are unschooled, ignorant of the importance of education, and therefore unable to offer nurturing or guidance. She finds a different source of validation by competing with her classmates academically. Despite good grades her parents forbid her from attending college and disown her. Banished, and without money, she finds her way to college. There, she cautiously takes her path by emulating those she admires and rejecting negative influences. Eventually, she receives her PhD in Anatomy from UCLA Medical School.

Her scientific career takes her on an adventure of learning and discovery, with fieldwork in Africa and to Europe where she immerses herself in bold new academic and cultural experiences. On return to the USA, she joins the faculty at Washington University School of Medicine. Her career in science becomes permeated with disappointments from frequent encounters with misogyny.

Confident that her medical science background would serve her, Patti changes her career to clinical medicine and receives an MD from Washington University. She discovers life as a physician to be her true calling, one that calls on expertise as both a healer and teacher. As revealed through patients’ stories, she gains empathy, compassion, and understanding of the importance of personal dignity. During the learning process, she meets her true love and finds everlasting richness in a balanced life of family and career.

• Language: English
• Publisher: Xlibris US
• Release date: Apr 10, 2023
• ISBN: 9781669872474

Patti Nemeth

The author, born in Tulsa, Oklahoma in 1946, spent most of her childhood in Phoenix. Despite educational disadvantages, she received a Ph.D. in anatomy at UCLA Medical School and won an Alexander von Humboldt fellowship to do post-doctoral studies in Germany. Returning to the USA she served on the faculty at Washington University in St. Louis and established a laboratory for biochemical research on muscle metabolism. She was awarded numerous NIH grants, and published many research papers and book chapters. Her love of science and a need for helping others prompted her to further her education by going to medical school. She received her M.D. from Washington University Medical School followed by residency in Neurology. Her prior research interests in muscle led her to a fellowship in Neuromuscular Disease. She practiced neurology at St. Luke’s Hospital for many years, then found further rewards in semi-retirement treating underserved communities in New Mexico. She and her husband are fully retired in New Mexico.

Book preview

Copyright © 2023 by Patti Nemeth.

All rights reserved. No part of this book may be reproduced or transmitted

in any form or by any means, electronic or mechanical, including photocopying,

recording, or by any information storage and retrieval system,

without permission in writing from the copyright owner.

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.

Rev. date: 04/05/2023

Xlibris

844-714-8691

www.Xlibris.com

848729

CONTENTS

PART 1

Crashing

Clueless

Seeking Attention

Family Secrets

Don’t Let Schooling Interfere with Your Education

Reform School

Blooming

Nearly Losing My Way

The Glass is Shattered

PART 2

Vegetable Cellar

A Doctor’s Prophecy

First Love

Getting Serious

Dark and Light Meat

The Nunnery

PART 3

Cadaver

Dr. Naked

El Dopa

Castrating Female

PART 4

Alexander Von Humboldt

The Motor Unit

Baader Meinhof Gang

Nobel Laureates

Around the World

PART 5

Home

Ollie

Outer Space

Bodily Fluids

Bliss

Motherhood and Science

Double Football Clutch

PART 6

Back to School

Confidence

Road to Empathy

Compassion

Family and Career

Lessons from Women in My Life

Disillusion

PART 7

Getting a Job

Living My Dream

Fear of the Unknown

A Few Goodbyes

Balancing

Nerd in a Jock’s Body

PART 8

The Noticer

Solace

Smell the Penstemons

Nobody Knows Your Name

Find Hurt and Heal It

Yet Another Lesson

Acknowledgments

For Tessa, Ryan, and Rebecca

PART 1

CRASHING

Easing myself down into my plush office chair, I angled to stretch my back, and exhaled. It had been a busy day with patients in the neurology clinic, and as usual, I returned to my office to finish up the paperwork. Now 7 p.m., quiet, the staff had all gone home. I lingered a moment, swiveling around to briefly indulge in my bookshelves filled with epic neurology textbooks and treasured photos of my children and family. I smiled at the lace bookmark tatted into the shaped of a caduceus and a foam stress ball molded into the form of a brain, a couple of my most useful mementos from patients.

Soon fortified, I focused my attention on the task at hand. The newly imposed electronic medical record system, purported to add accuracy and efficiency to medical reports, inevitably and needlessly extended my day. Most annoying were the unforced errors of the voice-recognition software that resulted in dictation mistakes like the department of itching for aging, the patient had a temper for tremor, and my personal favorite, lover function for liver function.

These random errors compelled me to carefully proofread each of my medical notes before signing them into the patient’s permanent medical record. As I concentrated on my work, a tapping on the frame of my open door startled me. There mid-doorway stood a handsome young man with exquisite posture wearing a fine black suit and a yarmulke. Oh yes, of course, Dr. Todd Silverman, a neurologist whom our medical group was actively trying to recruit had an appointment with me. Both of us weary from our day, warmly and gamely assumed enthusiasm for the interview.

We soon became engaged in a conversation about some of the important challenges of patient care when my pager rang out, torching our thoughts. In a frantic tone, a nurse in the outpatient surgical recovery room pleaded, Dr. Nemeth, can you come quickly? We have a patient who’s crashing!

I stood, excused myself from the interview, and grabbed my lab coat, as the nurse told me more. The patient’s not waking as he should from a routine surgical procedure. He’s shaking all over, and his blood pressure is rising fast.

Dr. Silverman jumped up. May I join you? We snagged a colleague’s lab coat for him and ran together down the concrete steps of the stairwell.

The surgical recovery room itself was dimly lit in austere contrast to the bright florescent lights directed onto individual patients stationed around the room. Nurses crowded the bay of the distressed patient. Several tried to secure the young man’s arms and legs as he thrashed wildly while others attempted to draw blood samples. His breathing was shallow and rapid. Sweat spread over his face and chest, and he wailed inconsolably, despite our attempts to soothe him.

His vital signs were critical with very high body temperature, pulse rate, and blood pressure. Dodging his unintended blows, I could barely complete my neurological exam. I found that his pupils were dilated, his eyes darted in random directions, his mouth contorted itself, and his legs and arms continued to flail. A gentle tendon tap below the knee produced hyperactive patellar reflexes and terrifying rhythmic whole-body jerking.

While I had never seen a case of serotonin toxicity, I recognized the signs. I instructed the nurses to give an intravenous sedative and hypertension-lowering medication, and to call the pharmacy for emergent delivery of cyproheptadine, a drug that counteracts serotonin. Todd, never having seen this condition either, looked up the appropriate intravenous dosage of cyproheptadine on his Blackberry, and it was quickly administered. To support the patient, we pushed fluids, gave him supplemental oxygen, and reduced his fever directly with ice packs.

Profoundly aware that if this was indeed serotonin toxicity it could be fatal, we searched his medical history and operative notes to establish the source of an excess of serotonin in the patient’s system.

Serotonin is a neural chemical messenger that controls appetite and gut function, and is involved in a variety of complex functions in the brain related to mood, sleep, memory, and sexual behavior. The body itself produces serotonin and regulates it internally to maintain these activities in a normal way. So what was the source of all this excess serotonin?

Ingestible forms of serotonin are found in many common medications, including those for depression, anxiety, migraine, cough, and nausea. It is also found in some dietary and herbal substances. Prior to surgery, the patient had taken his regular medications, including Prozac for depression, Topamax for migraine, and, as we soon learned, St. John’s Wort herbal supplement for anxiety. All three of these can increase serotonin levels in the brain. Yes, those were a lot of sources, but were they sufficient to cause such a violent reaction? We continued to investigate.

We learned that the anesthesiologist used fentanyl to put the patient under sedation, and he gave Zofran after surgery to alleviate nausea. Both of these medications also increase serotonin. Now we had a more complete answer. The additive combination of the four medications and the one herbal supplement led to his critical serotonin level.

With a patient in such distress, a half hour seemed like an eternity as we attended to him in expectant fear. Finally, the most horrific of the symptoms begin to ease, affirming to us that our diagnosis and treatment were correct. Once confident that we had this under control, I slipped away to inform the patient’s wife of what had happened. She gasped, and I sat holding her forearm as I gave her assurance that he should make full recovery. With her now at his side, he soon regained consciousness and his symptoms continued to abate. Crisis averted, we admitted him to the neurology floor of the hospital for further observation, where I would look in on him first thing in the morning.

It was now well after 9 p.m., and Todd and I had witnessed each other in action. An interview by fire. Having decided we worked well together, I extended him an invitation to join our group and he accepted.

Driving home, I felt exhilarated, a combination of being energized, peaceful, and satisfied. A familiar feeling of gratification that I have experienced many times over the years. At home, my husband gave me a long knowing hug, and we talked, not about the patient or medicine, but about how fortunate I was to experience such fulfillment through my work. Work that given my background, culture, and family dynamics, should have been impossible for me to achieve.

CLUELESS

No, no, no! I screamed, beating on the rickety chain-link fence that rattled like a can of nails and repelled me backward. No, I don’t wanna go home! I wanna go to school.

Through the fence, I saw little girls that looked like me, my size, except they wore bright dresses and saddle oxford shoes and were running around laughing and playing together. They shrieked as they jumped from the swings to the monkey bars of the jungle gym, to the merry-go-round, and then off to the teeter-totter. A school bell rang loudly, followed by the shrill tweeting of whistles that hustled the children into the schoolhouse. Mom and I had walked Randy to his first day of school, but I didn’t know it was just for him.

Let’s go, Patti, she nudged.

No! I don’t wanna go home, I yelled, holding fast to the metal wire squares of the fence. Why can’t I go to school? Why does Randy get to? Mom grabbed my arm, wrenched my fingers loose, and spanked me firmly. I continued to stomp my feet, pounding my moccasins into the sandy dirt. Frowning, I twisted my body to look back as she pulled me away, practically lifting me off the ground.

There on the other side of the fence was my terrified brother, standing alone, holding on to his suspenders and sobbing, I want to go home! I want to go home. The corrugated steel merry-go-round was grinding loudly, empty now and spinning slowly, as the teacher kindly led Randy into the school. Mom walked me home in silence.

Randy was two years old and I was one when we first came to Phoenix. We traveled a thousand miles from Tulsa by passenger train with our mom, who at age twenty-four had left her husband, our dad, and never looked back. Carrying a few possessions and her two babies, she came to Phoenix to start a new life. Mom’s sister, my Aunt Mollie, and Uncle Pat met us at the train station. They had arranged for us to rent a house on McKinley Street in downtown Phoenix, kitty-corner from theirs.

I do not remember the inside of the house, but the outside was wonderful. The house sat up on an exposed foundation of cement pillars. Behind the house, these pillars revealed a shallow earthen cave of mud, rocks, and spider webs forming a musty cool grotto where I could hide from my brother when we played cowboys and Indians. Always the bandit or a nasty Indian, I stashed my loot of bottle caps, small stones, feathers, and nails there. I rode yelling giddy-up all around the front yard, stirring up dirt as I dragged my heavy wooden horse. The horse was really just a rough four-by-four timber post that I had found which could deliver some wicked splinters. I was glad though because these kept Randy from stealing my horse.

Shortly after arriving in Phoenix, I am told, Mom got a job as a waitress at a diner across from Stevens Motors in midtown. There in the noonday rush, she met a car salesman, Hoyt Elliott. They married, she stopped working, and we moved to a two-bedroom house on Cheery Lynn. The house seemed fine, but without air-conditioning or even a swamp cooler, it was hard to get to sleep in the Phoenix summer heat. So Mom would wet my face and chest with a washcloth, set me in front of an electric fan, and I would fall asleep on the hall floor. Later, somehow, she would get me into bed.

Mom was thin and pale, and seemingly very tall as she towered over me. As early as I can remember, she wore bright red lipstick and left little squares of toilet paper around the house with her perfect lip prints. This puzzled me. Why put it on and take it right off? There were photographs of her with balls of yarn wrapped with her own hair, elevating her coiffure in the front to accentuate her forehead. Aunt Mollie said that Mom was proud of her forehead. In those photos, Mom smiled and was quite pretty. But at home, she rarely smiled or laughed, and always seemed sad or distant. She did not talk much to me or explain things like why I couldn’t go to school with Randy. I wondered what truths were held in silence behind those unhappy eyes?

Finally, after a long year of playing the lone bandit with Randy in school, and just before my sixth birthday, I entered first grade. I was proud of the new red squaw dress with black and silver trim that Mom made me for that special day. Most of my clothes were homemade, often squaw dresses because she believed that we were of Cherokee descent. My only pair of shoes were leather moccasins. I was careful not to let them slip off at school because they reeked from stale sweat.

Inside the schoolhouse was a menagerie of neatly stacked books and board games, and baskets of toys. Large colorful ABC plaques with words and matching pictures were high up on the walls around the classroom. School was a fantasy world, full of things that we did not have at home.

The teacher arranged our chairs in a half circle and read The Grasshopper and the Ant aloud to us. It was all so new! Without books at our house, no one ever read out loud to us. I had my brother’s discarded comic books, but since I couldn’t read them, I just made up my own stories.

After the teacher finished reading, she explained the moral of the story. Remember, work before play, and chores before fiddling time away.

The teacher asked us all to tell what our chores were at home. I timidly answered that I didn’t have any. She said I was lucky but that one day I would. Be like the ant. Don’t put off working hard, so when winter comes you can relax and enjoy the fruits of your labors.

I didn’t quite understand what she said, but I trusted this kind woman and I remembered.

The teacher held the book open for us to see the pictures and taught us the sounds of written words and how they matched the actions, and eventually, I could follow the storyline. My comic book pictures at home began to make sense. One day, later in the year, the teacher called my name to stand up and move to a new reading group. Ordinarily, I sat quietly and rarely spoke out, but this day when I advanced to the highest reading group, I jumped for joy. Oh boy! I exclaimed as I bounced up and down in my new chair. I could read! I hadn’t known at the time that most kids learned to read in kindergarten or at home before first grade.

One day the teacher brought out a storybook and a record player and played Peter and the Wolf. The story came alive to the music! What fun. Since there was never music at home, I had no idea what I was missing. After school, I ran home and begged Mom for a record player.

Absolutely not! If we buy a record player, then we’ll need to buy records. Money doesn’t grow on trees, you know.

I asked but she wouldn’t tell me what money grew on. I tried to tell her about the music and books I liked at school, but this seemed to make her angry. She didn’t like my kid questions, especially my persistent why questions. Confused and sad, I learned to be quiet.

Because Mom didn’t want to spend money on toys, I played with the insects and other wild critters that I found around the yard. This fascination came in handy during the grasshopper plagues in Phoenix in the 1950s. My stepfather, Hoyt, told me that because of the large number of grasshoppers devastating crops and private gardens, the local department of agriculture offered a bounty of ten cents a pound for their capture. For hours at a time, I chased down every grasshopper in sight, stuffing them into paper sacks. I skinned my knees and dirtied my dress scrambling after them but was up and after more. I loved to hear them skirmish and crackle in the sacks.

It was all fun and games until I realized something. No one actually told me what would become of them. Once their fate dawned on me, I felt bad, having learned the story of just how happy and gleeful grasshoppers were. I decided I would have to make amends and not harm another animal.

Walking to school one morning, I found a horned toad with a burnt-off foot. My chance to do good! I secretly held him in my hands and guarded him, thinking about his lost foot all through my reading, drawing, and singing classes. The teacher announced that we would all walk to the playground for our class photo. No problem. I gently held him on my lap. You could see him in my first-grade class photo. When the teacher discovered my secret, I reluctantly obeyed and let him go in the grass. She explained that holding him may hurt him more.

I saved the dimes I made capturing grasshoppers thinking it would eventually be enough to buy a record. Then a terrific opportunity arose. A boy in my class offered me a dollar if I let him kiss me. Boy, was I thrilled! Mom and Hoyt always talked about how poor we were. A whole dollar! I could really help the family! A kiss would be nothing. Like getting money for free.

Robert kissed my cheek, and I barely felt it. This was the first time I had ever held a dollar bill. Excited about the money, I raced home to proudly present it to my mom.

She examined the bill. Where’d you get this?

When I told her about the kiss her face turned red like she was angry. I couldn’t believe that she would be angry. Did she not understand that we could now afford to buy a record?

She crumpled up the bill and shoved it into my hand. Take this money and give it back!

Why? I tried to hand it back to her, but she wouldn’t take it.

Without explanation, she ordered me out of the house. Although embarrassed for reasons I didn’t understand, I knew I didn’t want Robert to see my shame. I walked in the general direction of his house, and when I was out of Mom’s sight, I covertly slipped the bill into a dry ditch.

We moved to another new home and soon I had baby half-sisters, Shelley and Cindy. They were of no importance to me at the time because I was not allowed to touch them. I was, however, excited that we lived near Monte Vista Elementary School, where I could walk myself to school. My mom told me that I graduated from first grade and would start the second. I jumped up and down with joy shouting, I graduated, I graduated! I sensed that she was surprised too.

The new house was nice with a view of Camelback Mountain, although as a kid I didn’t really appreciate the view. What I really loved though was the front yard with a berm around it that formed a flat low lying basin of grass. The basin would receive a massive gush of water when the irrigation man released the steel containment plate. And within a few minutes, the lawn turned into a shallow lake with water nearly to my knees.

If irrigation day occurred on a Saturday, as it often did, all the kids in the neighborhood got a full day of what we called swimming. We laughed and ran around while our heels splashed our clothes with water. Randy and I floated head down when the water was deep enough. Later we slid on our bottoms in the muddy grass, savoring the coolness. Mom looked at our dirty clothes dripping with rank-smelling water and frowned.

Randy and I each had our bedrooms, while our sisters shared. I especially adored my wooden dresser, painted white, rimmed in gold, with an enormous round mirror extending from my feet to the top of my head. However, with that, there was only room for a bed. No desk. I used the dresser drawers and vanity shelf for my school papers. I did my school assignments sitting on the floor in elementary school and even throughout high school. By then it had become particularly uncomfortable and disorderly.

I had to stand on my bed to reach my bookshelf where I stashed comic books—Archie and Jughead, Dagwood and Blondie, Road Runner and Wiley Coyote, Bugs Bunny, Donald Duck, Mickey Mouse, Superman, and Dennis the Menace. My first actual book was Black Beauty, which I still have. I re-read it recently to learn that it was a story about how horses perceive humans. While I certainly did not understand that concept at the time, I loved the beautiful horse illustrations. So I drew life-size horses on all my bedroom walls with crayons. Mom let them remain, which encouraged me to think that maybe I could be an artist.

My chance came one summer day as I walked barefoot to the five-and-dime store. My feet were calloused enough to withstand most of the sizzling heat of the asphalt pavement and concrete sidewalks, and the stickers in the burr clover. I stopped in the shade of a slender streetlamp pole to cool my feet. There I found a discarded empty matchbook cover with an ad for an art class on the inside. I ran home, gathering the courage to ask my mother if I could take the art class.

A neighbor lady was visiting and the two were sitting at the kitchen table complaining that the milkman was late again today, as I nearly exploded with excitement.

After I got Mom’s attention, I handed her the matchbook and asked, Will you apply for me?

She rolled her eyes and then looked at her friend. Not really looking at it, she gave it back to me and said, Sure, you can be an artist . . .

As my eyes lit up and I clutched the matchbook to my chest, she said, "You already draw flies."

Both women laughed and then went back to ignoring me. I slunk off to my room and stared at the crayon horses on the wall that had betrayed me.

Mom filled her days with cooking and household chores, with Randy, me, and the two babies underfoot. She did not work outside the home. In fact, other than pinning clothes on the umbrella clothesline she rarely even went outdoors. There we no flowers or vegetable gardens. Hoyt cut the grass and trimmed the pyracantha shrubs, and he climbed the apricot trees to prune them.

Mom always wore an apron and added, then blotted off, red lipstick when Hoyt called to say he was on his way home. Adult couples came over for occasional poker nights, which seemed mighty serious as there was no laughter or merriment. As best as I can remember, my parents did not have dinner parties, date nights, or dancing, nor did they attend concerts, art exhibitions, or sporting events.

Mom spent a lot of time in the kitchen and kept us well