Rx: Stop Crushing Hope

October light

The following is a heavily revised version of a letter I sent the palliative care physician with whom I met a few weeks ago, who kindly shared an article from JAMA, “Holding Hope for Patients With Serious Illness.”

Dr. S.,

“Holding Hope for Patients With Serious Illness” is outstanding, and I’m thankful that you shared it with me.

I appreciate the authors’ readiness to allow patients[1] to control our own narrative, given the basic data that medicine can provide about any serious condition. It’s trite at this point to note that the condition does not define the person, but as one currently on the patient side of the relationship, I can tell you that’s still how it feels in 2021. I appreciate that doctors have a massive challenge when it comes to what the article calls “serious illness”; they’re trained to help, to cure, to heal. And in many cases, healing, at least in the sense of a cure, is not within the reach of medicine. That has to be nearly as hard for doctors as it is for patients. I also appreciate the legal and ethical dimensions of medical care, in part thanks to my graduate training in ethics, which focused quite a bit on medical ethics. But there is so much more to healing than what conventional medicine provides.

A feeling of agency is all-important, yet despite many medical institutions’ claims to value patient engagement, hopefulness itself, as a form of agency, does not appear to be appreciated – at least, by the doctors with whom I have been working. When you have my diagnosis of Stage IV pancreatic cancer (or one similarly “serious,” as the title puts it), mustering and maintaining any kind of hope requires enormous effort. We are brought up to consider various kinds of cancer a death sentence. Then we find ourselves diagnosed with one of these cancers, and cared for by doctors who repeatedly make clear – in diverse ways, only some of them verbal – that they firmly expect us to die in short order. Believe me when I tell you that the overwhelming message is: “Of course there is no hope, and if you feel so much as a glimmer of it, you are sadly delusional.” No wonder the stats for survival of pancreatic cancer and glioblastoma are so low. What do you think this palpable “certainty” does to people? Again, I respect the statistics etc. regarding the lethality of this disease, and I am not afraid to die. (I won’t elaborate why here, as this is already long enough.) But people do literally incredible stuff every day. People break records every day. None of that happens without those people at least being able to conceive of the possibility. In many other areas of human endeavor, the importance of outlook is not in dispute. So why is this widely recognized fact not being applied in the case of the most challenging cancers? I realize this may sound idiotic, but it’s not. Ask Naomi Osaka and Simone Biles, to name just a couple of curve breakers who have publicly addressed the critical importance of conviction to physiological achievements.

It is impossible for me not to ascribe this denial of hope to (a) a desire to avoid lawsuits, (b) a desire to get high scores in expectation management, and (c) a cost:benefit algorithm devised in collaboration with the insurance industry. It really is an active denial of hope; in my case, it has manifested itself in different ways. Let me cite three: (i) No oncologist suggested that I try the alternate chemotherapy regimen; I had to request it of my own accord. (ii) No doctor has even mentioned that a small number of people diagnosed with pancreatic cancer at Stage IV survive for years. I have only heard about this from relatives, friends, Marisa Harris, who has survived pancreatic cancer diagnosed at Stage IV for 21 years (without a Whipple or pancreatectomy), and complete strangers commenting on blog posts, Instagram posts, and the like. (iii) Not once have I even heard mention of the actual survival statistics with Stage IV pancreatic cancer, which offer some justification for hope.

A little digging and a few conversations with survivors of pancreatic adenocarcinoma diagnosed at Stage IV are enough to at least spark hope, which also happens to affect behavior, and behavior in turn affects how we feel, and at least to some degree how our bodies function. I know that my body created the cancerous mass in or on my pancreas that now threatens my life, and I am actively doing everything I can to help my body send the cancerous cells packing, because they have served their purpose as an urgent call for change. (Excuse the dichotomies in my language; I don’t subscribe to a mind-body dichotomy but am using “body,” “mind,” and “cancer” somewhat metaphorically to identify aspects of a whole. I know enough to appreciate that “my body” would like to be rid of the cancer.)

But back to the article. More than anything, I appreciate the authors’ willingness to dwell in the grey zone instead of maintaining the stance so common among physicians – at least, in many of their interactions with patients – that things are black and white, and that numbers (whether statistics or results of blood tests) define what is real and possible, in effect to the point of predicting what is or is not going to happen. If I didn’t have a solid will, a curious mind, some well-informed woodworking friends (among them a brain surgeon and a research oncologist), and a stubborn streak, I would still be accepting the inevitability of my death in a short time as a result of this condition. It may happen, and if so, I will make my peace with that, something I have been actively working on since childhood. On the other hand, I may live for years. That’s my goal, because I want to be here for people I love, and there’s a lot more work I want to do.

Doctors cannot predict the future any better than most people, but if you were standing in my shoes, you would find it easy to imagine that some of them believe they can, because that is the message conveyed by the majority of my interactions with oncologists to date. The calculation of odds is retrospective, not forward looking – i.e., it is based on what has happened to date. But where members of the general public are concerned, this qualification about statistics not being the same as odds of future outcomes is more often assumed to be understood than it actually is. As a result, many cancer patients interpret the statistics as the odds of their own survival. The actual odds of our survival are likely to be higher if patients are encouraged to believe that we at least have a chance. I understand that this retrospection is consistent with the scientific method, but it is not the only way to look at serious illness such as cancer, and it is certainly not in the patient’s best interest. Even the financial services industry is legally required to post disclaimers that past performance is not a guarantee of future performance.

Now to the question of “facing reality,” as distinct from living in “denial.” While staying hopeful, I have no problem acknowledging the diminishing likelihood of surviving for more than the next few months as I get farther from the date of my diagnosis. It is affirming to see the doctors who authored this article refuting the paternalistic nonsense about patients needing to be brutalized (my word; that is how it feels) with routine reminders of “what is coming” in order to take their situation as seriously as it warrants. I would, though, like to see scare quotes around the word “false” in the following quote:

“Another report presumed that hope, especially when unrealistically optimistic or false, was potentially harmful because it could lead to noninformed decision-making and overly aggressive treatment. These presumptions are not supported by the literature. Existing data suggest that patients with false hope report better psychological outcomes than those who have lower or absent hope. Indeed, patient-endorsed hopes rarely equate to true delusion or misunderstanding.”

Hope is hope, regardless of how “well founded.” And here I am using scare quotes because again, the foundation that doctors are considering is based on past performance and doesn’t appear to take account of factors that defy quantifiable measurement.

These authors argue convincingly that most patients have the existential wherewithal to maintain hopefulness while putting our affairs in order, etc. in case we die sooner than we would prefer. Most adults are not simple-minded, but too many doctors treat us as though we were. I daresay most of us are able to live with complexity. Life is never as black and white as the experience of being a patient in this medical system might suggest. I am lucky to have woodworker friends whose day jobs are in medicine to help me appreciate this perspective. Those of us who can see the disconnects between our everyday experience of life and the extraordinary experience of oncology-world must constantly remind ourselves that life itself exists in the grey, not the black and white. Even high-school biology students are aware that our own cells are continually dying (or being killed by other cells) and being replaced. Physiologically speaking, much of what makes me “me” is not the same material that comprised me 15 years ago.

During this experience I have repeatedly had doctors “endeavor to convince [me] to give up [my] hopes and accept the clinician’s projected reality.” To me, at least, such attempts do feel brutal; they also seem wrong on principle, not to mention when viewed from a consequentialist perspective. Do my oncologists recognize that their approach implicitly discourages hope? I want to give them the benefit of the doubt, because I believe they are good, caring people. But when Dr. #1 starts a new chemo regimen with the statement “No one is going to live forever” and immediately refers me to a palliative care specialist, she might as well be forecasting the failure of the treatment; that is how such a statement, given the timing, comes across. I realize that she was trying to make it possible for me to a palliative care specialist sooner than I would have if she hadn’t brought it up that day. But still. Words and their timing matter. I am conveying to you, fully and honestly, the effect on me of those words and their timing. This psychological effect is so relevant to healing that statements such as this (and others I mentioned during our conversation in your office) could be seen to constitute a violation of the Hippocratic Oath.

Every interaction with oncologists leaves me deflated. After each one, I have to make a supreme effort to regain a sense of hope. I loved the conversation with you, and then I made the mistake of reading your notes. I shouldn’t have, because I saw yet again the relentless banging of the death drum in the statement about six months from now being the mean survival time in my case.[2] What is the point of even bringing this up in your notes? Is it some kind of assurance to the insurance industry that yes, the patient understands that she probably has just a few months to live, and so will probably not continue to expect you to keep paying for her medical care? Is it a way of assuring the doctor’s hospital system that the patient is unlikely to sue if she does not recover her health? I understand that the latter is a reasonable concern, but why does this belong in a doctor’s notes? Maybe I am missing a benign explanation, but by the time most of us have been referred to a palliative care professional, we have almost certainly been apprised, more times than we can remember, of our prognosis based on statistics.

As for those particular numbers, I am not one of those glibly-cited Americans who, based on statistics published by PANCAN, conflate a 3% chance of surviving three years to a 50% chance. And (not “but”) I still regard 3% as fairly generous odds, based on my life experience; I have encountered worse odds on multiple occasions. As the article acknowledges, cultivating hopefulness, even in the face of daunting odds (not to mention doctors who themselves in effect conflate 3% to zero — and that is damning) can also be beneficial. And I can tell you, as one in a pointed existential position, that hopefulness makes every minute of my life far richer than it might otherwise be.

The article does contain a few condescending statements. In the final paragraph of page 2, the authors suggest that “[p]atients could then be asked, ‘Given what is coming, what are you hoping for?’” Again, notwithstanding that we will in fact all die, this “given what is coming” seems condescending and too close to predictive. The following paragraph also starts with condescension; I recognize that doctors today are expected to be more humane than was deemed acceptable decades in the past, but I don’t see how it is the responsibility of medical doctors to “prioritize conflicting hopes.” Is that your job, at least insofar as hopes extend beyond decisions regarding healthcare and the legal machinery surrounding death? I don’t want my doctors even trying to cover that stuff, because none of them is qualified to do so.

I would have loved to see, in the penultimate paragraph, an acknowledgement that “[Holding hope]…demands…willingness to both change directions and move forward without knowing what is coming” is something that applies to everyone, regardless of health status. That is an objective aspect of the human condition, at least among those of us who care to hope and have the inner resources to do so. Perhaps such a note would have exceeded the word limit, but if not, it should be there.

With gratitude,

Nancy Hiller

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[1] I have always disliked that word, with its connotations of passivity and suffering (from the Latin, for “to bear,” “to be afflicted,” or “to carry from underneath”), and wish there were a substitute for those of us in any state other than deeply sedated, under general anesthetic, or comatose.

[2] Let’s also acknowledge that these numbers are just a guide to what is happening and what is likely to happen. Addendum: Jenifer Van Winkle, a friend who is a registered nurse, pointed out to me that my doctor’s note about “six months” was a way to make sure that I would be able to sign up for hospice care, should I need it — i.e., not an unnecessary reminder to the patient but a heads-up to the medical industry regarding my case. I wish that doctors could explain such details to patients. Doing so would strengthen trust, instead of eroding it.

We’ll let you know when we’re done

Almost there. I’ll return next week to tweak the fit of the doors, add a coat of paint to the upper sections, and install door pulls. One of the customers is a musician; he needed space to store scores, sheet music, cds and books.

Yesterday Mark* and I installed a set of built-in cabinets and open shelves for some customers of mine. The customers, who are 100% on board with pandemic safety protocols, turned down the heating, opened windows, and left the house for the day. Mark and I wore masks the whole time we were inside their house. As we leveled the base cabinets, fitted the 8-foot-long walnut counter carefully between the alcove’s walls, and scribed outlying parts to irregular surfaces — all of it painstaking work involving large, heavy parts, ever mindful of the baby grand piano just feet away — it occurred to me that the job bore many similarities to the endoscopic procedure I’d had two days earlier.

The moving pad and dropcloth visible at left are protecting the highly-polished, flawless piano.

The previous procedure, a pancreatic ultrasound and needle biopsy two weeks before, yielded a tissue sample with no trace of cancer cells. The first academic article I found on pancreatic cancer noted the difficulty of obtaining reliable pancreatic tissue to biopsy, so the inconclusive biopsy was not a surprise. And while it meant investing another day in fasting, driving to Indianapolis, etc., I was glad to have it done in the interest of getting the most accurate picture of what’s going on.

Those facing this kind of endoscopic procedure have reason to feel anxious. It’s freaky to imagine having a tube run from your mouth, down your esophagus, through your stomach, and into the upper part of your duodenum. The point of this post is to put your mind at rest by sharing my experience; when it comes to medical procedures of any kind, I am the Dr. Seuss character in Green Eggs and Ham: “I do not like them, Sam-I-Am.”

The hardest part is not being able to take anything by mouth after midnight until your procedure is over. Food is one thing, but not drinking water for up to 12 hours is a challenge. I prepared both times by staying up until midnight the night before, drinking as much water as I could that day and evening, to ensure I was hydrated. After checking in and waiting, you change into a hospital gown and have your vitals checked. A nurse sets you up with an IV and saline. You meet the doctor and the anesthesiologist (my experiences over the years have convinced me that a weird sense of humor is a job requirement for a career in anesthesiology), so you have a chance to ask questions.

Then a nurse wheels you into the exam room where the anesthesiologist and doctor are waiting. There’s someone to keep an eye on your vitals and a tech to get you ready. Everyone I’ve dealt with has been kind. You’re covered in taped-on monitors, with a blood pressure cuff on one arm and the IV in the other. They set you up with oxygen in your nostrils, stuff a nice pillow behind your back to keep you on your side, and ask you to bite down on a plastic tube about 1″ in diameter that keeps your mouth open while the endoscopy tube is inserted. Just as you’re thinking “how the hell am I going to avoid getting a cramp in my shoulder?” you’ve left the house on a worry-free propofol excursion. Bring in the cabinets and the tools. Set everything up. Transform the alcove (or bathroom, or kitchen) into something you hope will delight the customers — they’re out of the picture, just as you are, with a group of highly trained medical pros watching your every heartbeat while the doctor makes his passes back and forth with an ultrasound “camera,” then inserts a fine needle through the wall of your stomach to get a sample of tissue.

All being well, the next thing you’ll be aware of is a kind nurse saying hi as you return to your senses, a moment echoed two days later, when I texted one of my clients to let her know we were done for the day and her family could come home. I waited until her husband arrived, to make sure nothing went wrong while the front door was unlocked.

Two days earlier, in Indianapolis, I awoke with a vague awareness that I’d been drooling; the nurse mentioned it was bile (lovely); the doctor had also examined a spot on my liver this time. As with the first endoscopy, I had no pain at all, not even the sore throat that is the most commonly cited after-effect. I washed the bile out of my hair when we got home, with plenty of time before I had to give a long-scheduled Zoom presentation for the annual meeting of the San Diego Fine Woodworkers Association.

Ordinarily I would remove any adjacent baseboard and shoe molding, then cut it to fit after installing the cabinets. In this case, the baseboard on this wall ran behind a bookcase loaded with books, so after determining the precise location of the scribe stile’s front face, Mark cut the baseboard and shoe with an oscillating multitool.

The preliminary diagnosis is still adenocarcinoma of the pancreas. We should learn more after the pathologist examines the tissue sample. I continue to feel fine and am thankful for that.

*My husband, Mark, and I each run our own business, but we’ve significantly reduced our contact with others since March in view of the pandemic. As a general contractor whose work is hands-on (as distinct from those GCs who spend most of their time running their business and supervising others), Mark would ordinarily be spending his days in close contact with fellow tradespeople and customers, much of the time inside their homes. A while back we decided that the most responsible way forward during the pandemic would be help each other on jobs that take more than a single pair of hands, instead of working with others.

Blame the Tuna

Note: This is the first in a series of posts related to the tales in Making Things Work. The posts are new material, not excerpted from the book. Each will be tied to one of the book’s chapters, in this case, “It’s All Problems.”

Some people are so convinced of their powers that they seem to feel invincible. They’re too good at what they do–too rock-star “together” in general–to make mistakes. (Or perhaps they’re too deeply invested in this conceit to acknowledge that they make them.)

My attitude is closer to that of the majestic tuna I once saw in a BBC documentary about oceans. The most striking part of the film was the vision of the fish as David Attenborough calmly observed that the killer whale (clearly visible in the frame) was taking its first bite. The fish’s eyes were as steady as if it was contemplating a leaf of kelp floating by on a peaceful current. “OK,” it seemed to be saying. “So this is happening.”

It’s not that I’m defeatist about s**t happening, or that I don’t do everything in my power to avoid it. It’s that experience has liberated me from the burden of believing that when you really know what you’re doing, things just go smoothly. I’ve found that the more I know, the vaster I simply recognize my ignorance to be.*

***

The other day I was finalizing the installation of doors on a set of built-in cabinets. They hang in pairs, with one fixed by a catch and the other opened by a surface-mounted latch. Traditionally, the fixed door would have been held shut by an elbow latch, but I used a pair of rare earth magnets instead, for convenience. I’ve been using these magnets as catches for years. They’re strong, simple, and inconspicuous.

As I worked, one of the customers walked through the room and remarked that the doors looked great. He was heading toward one as though he might close it to see how it looked shut. I had just glued the magnet on the door in place with quick-setting epoxy a few minutes before, so I asked him not to shut the door, to keep the magnet from being pulled back out of its socket. Being a physicist, this customer knows all about rare earth magnets. He started telling me about them and mentioned their repulsive force, a feature that had somehow never even occurred to me. How had I been oblivious to something so important? I wondered. How had I managed never to set a magnet the wrong way? He grabbed a pair of magnets and held their negative faces toward each other, showing me how it was impossible to force them together, explaining “they’ll just flip around if you let go of one.” From now on I would certainly make a point of checking the polarity before gluing a magnet in place.

As I prepared to set the final magnet, I let it click into place and marked the back to make sure I applied the glue to the correct face. I pressed it into its socket and went back to work on the other cabinet while the epoxy hardened.

About a half-hour later, I was ready to install the keeper for the last latch. I gave the left-hand door a push so the magnets would pull the door closed and align the closing stile with that of its mate. The door popped right back at me.

How many of these magnets had I used over the years, without incident, only to screw up the polarity of the first one I’d ever checked? Classic. My mind went straight to the tuna.

I tried to pry the magnet out with the tip of my utility knife, but the epoxy had set too hard. When you’re on a job site you don’t have access to the tools and materials of a shop. You have to improvise. I needed to get this latch installed. There had to be an elegant way to fix my mistake. I unscrewed the door stop (of course I’d glued it in place for extra strength, so I had to break it free with a stout chisel and mallet), gave the surface a quick scrape, and turned it around with the back facing out.

Ugly but eminently salvageable

I screwed it into place, marked the position of the magnet on the door, and drilled a hole for the magnet in the stop. I grabbed a magnet and checked the polarity—twice, just to make sure—then glued it in place. This time I got it right.

Once I cleaned up the stray epoxy, it looked as good as new. The little gap at the top between the face frame and the cabinet top will be concealed by cove moulding, a detail I like to add in some cases for subtle relief.

Some may be scandalized that I find it acceptable to reverse a stop this way, leaving this imperfection on a piece of finished work. As one whose career has taken her into countless old houses, where I have seen (and learned from) all kinds of ingenious solutions made by earlier craftspersons to comparable problems in their work, I take pleasure in anticipating that some future craftsperson will come across the back of this door stop and enjoy a moment of solidarity as he or she recognizes why the magnet’s there.

*I am using the word “ignorance” according to its lexical definition, i.e. not-knowing–not in the looser sense of stupidity or uninformed bias.

 

Live and Learn

Some people have the vague notion that when you’ve been a woodworker for decades, you know how to do everything. If only. No one knows how to do everything. Experience in a variety of techniques may be transferable to new forms, but just because a technique will work does not mean it’s especially good in structural or aesthetic terms, let alone efficient to use in specific circumstances.

When faced with a woodworking mystery–say, a look I want for a finish, or some convincing 3-D effect I’d like to produce in an 1/8-inch-deep relief carving–I like to try to answer the question for myself before I seek the answer from others. The effort of thinking a problem through will often give me deeper insight into methods others recommend, and it’s especially satisfying when I find that “my” method is the one used by other woodworkers I respect.

I’ve enjoyed a few such moments while planning how to build a hayrake table for the book on English Arts & Crafts furniture I’m writing for Popular Woodworking.

My contact at Bridgeman Images provided a hi-res image of Gimson’s original drawing for the table, which we will purchase the rights to reproduce in the book.

I chose this particular table based on an original drawing by Ernest Gimson that I came across online. The artistry in the rendering is delightful, and the table fit the bill when I was looking for a furniture form distinct from the other two projects in the book, a chair and a sideboard. It wasn’t until I was at the lumberyard looking through stacks of sassafras that I got wind of the fun in store for me, thanks to a message from Frank Strazza. “The challenge is getting all 5 shoulders to meet perfectly, everything is scribed to fit,” he wrote in an Instagram post to which he referred me. My blood ran cold. Then I adjusted my perspective: This table is a puzzle.

In for a penny, in for a pound, as they say across the Atlantic. Here are a few of the thrills I’ve enjoyed on this journey to date.

The lamb’s tongue
I love the look of a lamb’s tongue, but in more than 30 years of work as a cabinetmaker, I had never before had occasion to make one. I devised my technique based on what made sense, starting with a saw kerf to make the clean transition from chamfer to carving. I made a sample; it worked well.

Yeah, it’s super rough. It was a quick experiment in a piece of discarded wood. But I figured out how to make a lamb’s tongue.

When you’re writing for publication, you want to be informed about these things. I was especially concerned that my use of the saw kerf might be way out in left field. So I did an online search. Up came a Lee Valley post written by Chris Schwarz, who starts with a saw kerf and follows through with a chisel, as I had.

Yes.

The joint between the stretcher and the legs
The hayrake table form I’ve seen published most often is based on one by Sidney Barnsley in which the stretcher meets the legs at a 90-degree angle. I’d seen the same leg-to-stretcher orientation in a gorgeous hayrake table made by Ernest Barnsley at The Wilson last spring. But the Gimson table’s stretcher rails meet the legs in a V—commonly known as a bird’s mouth in the realm of architectural moldings, which presents a challenge.

I could see the joint being an actual bird’s mouth (in molding terms, if not in ornithological terms), preferably with a tenon or spline to lock the stretcher mechanically in place. Not that I was sure about how I’d create that mechanical part. Alternatively, the stretcher could be notched into the leg.

This time I consulted Christopher Vickers, an English craftsman-designer who has built several variations on the Gimson hayrake theme; we met last spring when I interviewed him at his home in Somerset for this book. (Look out for a post on Vickers, coming soon. You’ll be blown away by his shop.) “Your first guess is almost correct,” he wrote back, “in that the legs are notched for the stretchers but with the addition of a short tenon on the end of the stretcher with a mortice (1/3rd width of the stretcher) into the leg.”

Cool again. It’s so fun to learn a new technique that builds on stuff you already know.

Mitered mortise and tenon joint
The hayrake stretchers meet the center stretcher rail at 45 degrees, and the drawing indicates a pegged mortise and tenon joint. This all seemed fine until I experimented with chopping the mortises. How would I get the point at the far end, I wondered—that is, make a mortise that ended in a pointed V?

A trial tenon for the hayrake-to-center-rail joint, placed next to the full-scale layout. I tried to cut that sharp far point of the mortise but wondered whether it was really necessary.

It seemed to me that it would make more sense to make that end of the tenon square, but I was worried that this might be cutting corners. (Ouch.) So I looked up Mike Pekovich’s article from 2012. Mike cut the far end of the tenon square.

Happy dance.

Hedge your bets by leaving parts over-length until you need them cut to size

It seemed like a good idea to leave the stretcher parts long, cutting each joint in a logical sequence called for by the structure. This way I wouldn’t cut the joint on one end of a part only to find I’d thereby made the part too short to allow for the joint on the other end. Leaving the parts long would also allow me enough material to redo a joint if I messed it up. If I was correct, the parts should come together like a puzzle. It was nice to see that Mike recommends just this approach in his article, although the joinery in that table has significant differences from that in the Gimson example.

And so it goes. We live and learn.–Nancy Hiller, author of Making Things Work

9 Lives for the Win

There’s nothing like a great hardware store staffed by people who know their stuff. In Bloomington we have two: Kleindorfer’s and Bloomington Hardware. When I needed something in a hurry to sand the inside radius of several arched brackets for a current job, Kleindorfer’s lifer Scott Cosby fixed me up with the parts to transform  a steel cat food can into a sanding drum of the perfect radius. (It was the perfect radius because I’d used the can to mark the curve.)

Drill a hole in the center of the can’s bottom

Insert fender washer and threaded bolt

Add outside fender washer and fasten with two nuts

Cut strips of self-adhesive abrasive paper and stick to can

See it in action

Why I have access to cat food cans

 

Cabinetry in Extremis: “handyman special” edition

This pack of sandpaper has been in my mother’s collection since the 1980s, when such items were still being manufactured in England

My mother and sister decided to do something about the space-hogging, impossible-to-keep-tidy storage shelves in my sister’s tiny bathroom when I was visiting them last weekend. I’d often wished that I could build a shallow cabinet for that bathroom–something more interesting, durable, and practical than they were likely to find at Target, Lowe’s, or IKEA–but living so far away and visiting by plane, not by truck, made it impractical.

As we discussed possibilities for the space I found myself increasingly determined to build something rather than have them buy it. There was just one small catch: they’d waited until the eleventh hour to get going on this project. I had a plane to catch the next day. So we dutifully checked the stores. They offered various ensembles in medium density fiberboard. All would have eaten up more floor space than necessary, and in every case the price was steep for something that would be a practical and aesthetic compromise.

Family friend and carpenter David Heeren had given my mother a pair of old doors he’d found at a garage sale. They were in great condition, the older-growth softwood aged to a lovely patina, rusty shadows of long-gone hinges adding character. If I planned a cabinet around them all we’d need would be a few 1-by-6 boards.

By now it was late afternoon. We were going for it.

Professional drawing and materials list

Fortunately my mother’s welding studio located next to my sister’s cottage had many of the tools I needed.

Sawhorses in the grass made for a workable bench

It wasn’t quite as simple as hanging a couple of old doors on the crudest of cabinet structures, a box. The cabinet sides had to be notched for the chair rail and baseboard (thanks for the use of your jigsaw, John Freeland), and the braces on the backs of the doors had to be trimmed. Limited time and less than ideal working conditions called for <choke> creative treatment in hanging the doors. I trimmed them to fit the available space, then notched the braces so  the doors could be hung full-overlay style* using steel butt hinges from the hardware store, screwed (shh) straight onto the cabinet parts without mortising. Dave generously let me rip an astragal molding of sorts on his table saw.

Brace marked for trimming

Since my mother’s chisels were nowhere to be found, a bit of screwdriver improv was called for

One benefit of using old stuff: precious signs of earlier makers. This carpenter’s elegant script still indicates that this brace goes “Top.”

When all eight adjustable shelves are in place they’ll hold a lot. The 5-1/2-inch depth is perfect for bathroom stuff; the minimal protrusion makes the room feel twice as big as it did before.

We decided to leave the area under the bottom open for additional storage.

Fine cabinetry it’s certainly not. But it’s a solid piece of built-in storage furniture that will last decades–assuming that the next person in the house doesn’t consider it junk and replace it with the aforementioned store-bought fare. It has the kind of character that comes with using old stuff. Most important, my sister and mother love it.

*covering the face edges of the carcase