Marengo County, deeper cuts

Time is short for Nathaniel Evans.

How could it be otherwise? A lot of muddy water flowed into the TomBigbee under those bridges of Marengo County since '24, when he first arrived on the scene.

He came in a puker, lost 30 pounds this summer.

He still cuts the grass, so he expected to sweat off a little winter paunch in that Black Belt humidity. And nobody really tucks in in that heat.

But as it kept falling off, his church family grew concerned, nudged him toward me and mine.

We rotate, so it took a while for me to meet him, by then in the hospital for 10 days- an eternity in this insurance climate. His stomach seems obstructed, but it is hard to move the ball downfield from there.

Three partners each scoped him. Each says there is a lot of swelling in his stomach, some shallow ulcers, but the biopsies don’t show much. They ask if I’d put a PEG in to decompress him, sign him out as a 90 year old guy, not much left of him.

Just him in that quiet room, shades drawn, feels like a visitation already. I brace for an empty vessel, sit to see if I can get a consent signed. He can’t really talk- too weak, but he whispers

Just sit with me a while, and I’ll feel better.

Whoa. Expected one thing, got another. Lean a little closer, strain very hard to hear those dry chords. We talk about the PEG, he is alert, sensible. Normal. Just hard to catch.

Can I eat with it?

Maybe just liquids til we sort this out, it’s mainly for suction.

Is a popsicle a liquid?

Yes sir, it is.

Well you see to me a popsicle, and I’ll answer your questions. You can learn a lot, just listening to somebody.

Grape was what I found.

Marengo County was mostly unincorporated back then, mostly cotton farmers eking it out on the share. When cotton prices bottomed in the oughts, Henry Ford beckoned, but Nathaniel’s Daddy stayed put. It didn’t do him much good. There was a big split back then in the black community, between the ones who went North and the ones who didn’t. Maybe they were a lot different from the get go, or maybe they got that way after a few Detroit winters. Over time, rounded vowels were all they shared.

The Irish talked about this variance in the hungry 1840s- who went, who stayed, how it played out for each, what they missed. Maybe Sanjay’s cousins talk about it now, counting their losses and gains. We always measure, wonder if we choose right. I think about it often, and I only came down from Philly- in a Cirrus, home for supper.

The whole state was stuck, the war didn’t really even seem in the past. Jim Crow rules, and the Klan held sway in the counties. Birmingham, too. Hugo Black was only just then trying to distance himself, and only just a little, from ER Stephenson and the Klan for his first senate run. What he cost FDR in '36, and what Thurgood Marshall would demand of him- these were abstractions, still way beyond his ken. Not that he gave a rip- just raw ambition, that one.

That’s the world Nathaniel Evans entered, Leonard and Fannie’s second son. He chopped cotton from early, him and his older brother Earle, it’s hard on your hands, and they went to school in Sweetwater…but not that Sweetwater school- this one, and not for long. The '30s were a cannibal, the farm required all. They endured.

By and by a new war was on, and he wound up in Germany, carrying a rifle for the 41st engineers. He walked over from France, there must be more to say, but I won’t get it from him. It was all over but the shouting, the way he tells it. He didn’t like army life, came home as soon as he could. Earle stayed in the Navy for 30 years, went everyhwere.

Nathaniel came to Bessemer hunting work, hired on at Zeigler’s Meats. With a job, he caught the eye of a few girls, then latched on to one for 65 years. He put in 35 years at the Zeigler packing plant, first with a broom. He rose. Eventually, he cleaned up, cut, ground and wrapped sweet sausages, ultimately put them in a truck and delivered the product. Here his eyes lit- “I was GOOD at it, all of it!”

Retired, but didn’t like that. He worked security at a local hospital for another twenty years, walked some of those rounds in parallel with me.

Things were happening all around. Evans was a church man, and churches were central. He knew my fiercest patient, Rev Fred Shuttlesworth, but couldn’t bear to stay in a room with him with so much anger.

I met the activist much later, of course, came to my own conclusion, all that future of theirs now long past. I figured much of his rage- so palpable it burned me, made me squirm- was directed at the movement that slighted him after he’d suffered so many calamities for it.

Now I believe I got it at least partly wrong. There was just a volcano at the center of him, from before the SCLC days, it was there from the first. It wasn’t easy to be him.

Regardless, for Nathaniel, there was work to be done, children to raise, a boy and a girl. That quotidian challenge was sufficent.

They grew up and left, his wife and he grew old together. With her gone, these last years are just one foot in front of the other, the treads lonely. He takes a little comfort in the path’s long familiarity… or says so, at any rate.

An ordinary life, well lived.

I had my time, enjoyed it, too, right up to here now with you. I got no regrets. Now, what’s it going to be?

I look at a lot of pathology slides lately. We always looked at them during the training years, but once that’s over, time presses.

Steve O’Sheal, the pathologist at our little hospital, is a good friend to my Haitian pals, and me. Steve looks at our path, slide after slide, month after month, for years now, never gets paid for it. Always gracious, always helpful.

Tis the season- may Steve’s name be written in the book of life.

I go down and look at slides with him more than I used to, my only thanks.

Different stains yield spectacular colors. Glands, crypts, mucosa, submucosa, adventitia- the music of my spheres. The interplay of individual cells and tissue architecture makes a tiny universe, fascinating, occasionally decisive, critical. Steve leads me through it, and I leave feeling smarter. That’s a pleasant delusion, harmless.

This time, it’s helpful. It reminds me of our old trick.

Steve, can you make deeper cuts on the blocks from the biopsies Murat sent you last week?


…Mac, he has signet rings.

So that’s it, linitis plastica. Middle of the picture, just right of center. A purple ring with a red stone.

Leather bottle stomach, the gastric cancer encases the stomach and gut, squeezing like a tight sleeve. It will never let go.

Yes! An answer! Then…ugh!

I tell him. Straight down from here, not long.

He has the grace to not ask exactly how long, saves me a lie, some heartfelt fiction.

Can I eat?

Maybe popsicles are going to be the limit.

Y’all got orange?

We do.

There is so much history to be gleaned our older patients. Sometimes a tattoo on an arm from an Evil time, scars from a war, or sometimes scars that can’t be seen with the eye.

Sometimes the Social history is the most interesting thing in the History and Physical. Thanks for sharing. C

Thank you for sharing Doc!

Dick, thanks for sharing this with us. Other physicians may (or may not) have your intellect, but I suggest few have your empathy.

Well done.

You go, Brother Abraham!

One of the members of my tight little Vistage CEO development group in Vegas is a young, smart guy who, along with his Mom and his Brother, founded a successful and growing hospice care company. Mostly outpatient, but they’ve also built a beautiful new inpatient facility.

I’ll never forget one time Brian was talking to us about the work they do. He wasn’t trying to be profound or anything when he stated very simply, in the middle of a longer sentence, “I’ve found that most people die pretty much they way they lived . . .”.

I stopped him, made him repeat that and then we talked about it. Sure made me think about how I live every day.

Nathaniel is dying the way he lived: with quiet dignity.

Thanks once again for sharing Doc.


You have a gift.

There is enough publishable material on this site alone for “The Collected Works of Dr McG”.

If I could listen to Morgan Freeman read the telephone book, I would be entertained.

If I could read a story about one person in that book written by McG, I would feel as though I had done my daily devotional.

Given my current bent toward religion, it is no small accomplishment when I say that Old Thomas could have used a Doc McG story. There would have been no doubts after that.

Thank you!

Godspeed Nathaniel

Godspeed, Mr. Evans.


Wow. I have a good friend who says we all lead lives of quiet desperation. I’ve told him I prefer to see it as quiet dignity. Sometimes it looks the same. I need to send him this. Thanks for sharing.

A fine and worthy post Doc. You are a good man, and he is lucky to have you by his side on this journey. Keep us informed.