How To Become A Cancer Doctor

Start with one excellent childhood experience—a loved one who is cured.

Add a generous helping of baseline optimism, a cup at least.  More is better.

Mix in well a half cup of ability to suspend disbelief.  And then, maybe a pinch more.

Add a teaspoon or two or even three of denial.  Pollyanna had it right.

 

Remember to include an ounce of prevention—

Worth a pound of cure, so they say.  Suspend a quart of judgement, or two.

Make sure the oven is preheated with family.  Children help sweeten the mix.

Add three pets, or more.  A dog to welcome you home.  Two cats to curl up with.

 

Believe, truly believe in the best of all outcomes.

“Everything is for the best in this best of all possible worlds.”  Voltaire knew.

A gallon of forgetfulness goes a long way to wash the silt of failure away.

When there is nothing else, pray. Or wish.  Or hope.  Or desire.

 

Ice the cake of sadness with a sweet coating of self-forgiveness.

And when that recipe fails, start again.  Be kind.  Your patients are waiting.

Gone With The Wind

I have forgot much, Cynara! gone with the wind,
Flung roses, roses riotously with the throng,
Dancing, to put thy pale, lost lilies out of mind,
But I was desolate and sick of an old passion,
Yea, all the time, because the dance was long:
I have been faithful to thee, Cynara! in my fashion.

Ernest Dowson

Having no artistic talent whatsoever myself, nonetheless I am fascinated by art, and especially by artists themselves.  My father has been both an artist and an avid collector since the ship he served on as a Navy dentist docked in Sicily, and the local artists were allowed to come aboard to sell their wares.  He still has paintings he bought in 1945 hanging on his walls.  As a teenager in Depression era Chicago, he took classes on Saturdays at the Chicago Art Institute and wanted to become a portrait artist when he grew up.   His father, my grandfather, told him to get real and learn a trade.  He chose dentistry, and only later, after going to medical school, discovered that as a plastic surgeon, he could both be a portrait artist and earn a living.

Many of my artist friends do not take commissions.  When asked why, they say that it is often very difficult, if not impossible, to reconcile their own interpretation of a subject with that of the person commissioning the work.  Fortunately for me however, some do, and I have been the appreciative beneficiary of portrait work by artists such as Stephanie Snell, Paul Doyle and Marilyn Terry.  What do these artists paint?  They paint my dogs of course.  My children and I would never be able to focus and sit still for our own portraits to be painted and besides, despite this age of “selfies”, we are far too self conscious.

A few years ago, a young man’s wife developed breast cancer at age 25.  He is a well-known video artist known as Daarken and he and his wife needed money to meet their medical expenses.  An on-line fund raising auction was conceived, with the theme stated as “Beautiful Grim.”  Beautiful, because despite his young wife’s diagnosis and treatment, she was and always will be beautiful– yet for some young women with breast cancer, the prognosis can be grim indeed.  His friends and fellow artists rallied to the cause, and many contributed original works to the auction.  I am a friend of Daarken’s sister, and I followed the auction with interest.  In particular there was one painting that I kept coming back to, that no one was bidding on.  It was a portrait of an African American woman, beautiful and naked, except for her long stockings which were peppermint striped, red and white. Her hair was a tangled wild mass of curls against her beautiful skin. When no one else bid, the portrait was mine.

Over the years I have become very friendly with the artist and his wife, who shall be unnamed because of the personal nature of this anecdote.   They visited our home this past summer, and we commissioned a work of art.  The assignment was intentionally vague—“just paint something you see in New Mexico that inspires you.”  A few weeks ago the painting arrived, a full 4’ X 4’ landscape entitled “Sombrillo Vista.”  It is as beautiful as I had hoped, and emblematic of the New Mexico I have come to love.

When I called to offer my sincere gratitude, the artist’s wife said, “You know, just after he finished your painting he received another commission—a most unusual one!  A man called and said he wanted a portrait painted of his ex-wife. He is still in love with her and wants an oil painting to remember her by.”  Apparently he had sent a few snapshots of his ex along with his request.  Always a romantic at heart, this struck me as both somewhat insane, but also a true romantic gesture.   I said, “Send me a phone pic of the work in progress.  I want to see the woman who inspired this act of unrequited love.”  She did.  The woman was indeed beautiful, and playful, and mysterious all at the same time.  I said, “Well if the ex-husband doesn’t like the portrait, let me know because I will buy it.”

Shortly after our conversation, a photo of the unfinished work was sent to the hopeful ex-husband.  He liked it a lot, but he felt that it was not quite there yet.  He had some advice for the artist– he said, “Just think—complex and Mona Lisa eyes with a dash of mischief and you’ll nail it!”  I laughed and said, “Now that should be simple.  You know, just be Leonardo da Vinci.” The finished portrait was unveiled to the good patron last week who promptly proclaimed, “It gave me goosebumps!”   The man likely needs a good therapist instead of a portrait of his ex.   But let us be clear:  he has been faithful to her, in his fashion.  And my artist friend, well—clearly, he NAILED it!

The View From Here

For Mrs. Shirley Wiley

 

Last Saturday I suddenly found myself flat on my back on our gravel driveway.   The events leading up to this are all too familiar to my fellow deerhound owners—sometimes even walking with bent knees doesn’t work if you don’t see it coming—“it” in this instance being an 85 pound seven month old deerhound puppy who has absolutely no sense of personal space.  At least not MY personal space.  He came around the corner of the garage at a hard gallop, his six month old borzoi “brother” in hot pursuit.  And quite literally knocked me off my feet.  As I gazed up at the sky, I thought to myself, “What the HELL was I thinking?”  When I went to shower Saturday night, I caught a glimpse of a bruise the size of Texas on my derriere.

When good old Magic died a year ago in January, I was down to only three dogs.  Practically “dogless”—at least for me.  The girls, Queen and Quicksilver, were aging themselves and little Yoda has never really caused any trouble.  There was a time when my household contained (well, contained is hardly the right word, but you know what I mean) three kids, eight horses, five Scottish deerhounds, a toy dog, two cats and a couple of guinea pigs.  I drew the line at birds. They required far too much attention.   My friends say I thrive on chaos.  But that has been true only at home.  Work has always been a quiet haven, a place of order and even relaxation.  It’s all relative.

People have been wondering where I’ve been, and why I haven’t been writing.  The reason is two-fold and can be summed up by two names:  Pibb and Cole. Pibb is the six month old borzoi–his “fancy” show name is Russian and unpronounceable.  Cole is the seven month old Scottish deerhound, registered as Jaraluv Unforgettable.  They are very busy boys, and even under constant supervision the casualty count is rising—a favorite antique trunk…the inlaid veneered Italian cabinet, the coffee table books, the lawn, the television remote control, and various and sundry shredded dog beds.  And judging from past experience, they’ve only just begun.

When I was a senior in high school, I had an English teacher, Mrs. Wiley, who changed my life by teaching me how to paint a picture with words.  When I started this blog, I decided after much deliberation–because I love photographs and photography–that it would be words only and no pictures—that I would force myself to be descriptive enough so that my readers wouldn’t need the photographs to accompany the stories.  So picture this:  two nights ago I left the kitchen/family room area to go to the study to find a calculator so I could run some numbers. I was gone maybe 20 seconds when I heard a loud THUMP!  I ran back into the kitchen to discover the source of the noise—Pibb, standing on his hind legs, had shredded a 4 pound FROZEN and wrapped package of hamburger meat meant for a lasagna. Whole Foods free range grass fed expensive hamburger meat. The sound came when he inadvertently pushed the now gnawed and bloody meat into the sink from the countertop. The lasagna never happened.

Years of experience tell me that this too shall pass. I am working with an excellent trainer. Someday people will admire my elegant and well behaved hounds as we walk across the Plaza.  Children will stop to pet them and I daresay they will both have a few titles to add to their names.  In the meantime, I’m going back to work where it’s quiet and the patients are well behaved and none of them knock me down or steal my dinner.  You’ll be hearing from me more often now!

An Extraordinary Life

“Death, be not proud, though some have called thee

Mighty and dreadful, for thou art not so”—John Donne

On a Sunday in January, 2014, I opened the New York Times Opinion section and stumbled upon one of the most unusual essays I had ever read.  It was written by Dr. Paul Kalanithi, who at the time was a 36 year old neurosurgery resident at Stanford who had been battling metastatic lung cancer for eight months.  Here is a link to the essay, entitled “How Long Have I Got Left?”– http://www.nytimes.com/2014/01/25/opinion/sunday/how-long-have-i-got-left.html?_r=0    The author’s point was one well understood by cancer patients everywhere—if the doctors could not tell him whether he had a month, or a year, or ten years, how could he possibly determine what his priorities should be and how best to live his life?  Should he finish his residency?  Should he write a book?  Should he have a child?  In his worst moments he wrote that he fell back on his first love—literature.  In the last sentence of Samuel Beckett’s The Unnamable, Kalanithi found a mantra to live by: “I can’t go on.  I’ll go on.”

As it turned out, he did not have long.  Despite the optimistic and sometimes humorous tone of the essay, Dr. Paul Kalanithi died of his lung cancer 14 months later.  But not without first doing ALL of the things he mentioned in the essay.  He finished his neurosurgery residency as chief resident. He repaired a fractured marriage.  He had a child.  And to our great benefit, he wrote a book called “When Breath Becomes Air” published posthumously in January of this year—a book which despite my oft stated incredible reluctance to read anything I know will make me cry, I grabbed off the shelf the minute I spotted it in a local bookstore.   I was not disappointed, and yes, I cried.

The courage of cancer patients, and of all patients facing life threatening disease astounds and inspires me.  Many go through grueling and exhausting treatments and manage to put one foot in front of the other—they “can’t go on…they go on.”   Paul Kalanithi not only went on…he wrote about his experience in a book that will stand not only as a cancer memoir, but as a profound piece of writing.  When faced with dying, he chose life by completing his training, by having a child, by believing every day that he still had much to offer.  In an essay for Stanford Medicine he wrote words for his infant daughter which were included in his book: “When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.”

I hope you get a chance to read his book.  Even if it makes you cry.

You Know You’re at a Plastic Surgery Meeting When…

My friend Dawn and I recently attended an evening meeting of the Houston Society of Plastic Surgeons.  Since we were invited guests, and not plastic surgeons, we didn’t stop on the way into the lovely formal dining room to pick up our name badges because the organizers had not made them for us.  On the way out, however, we both noticed clear plastic perfectly formed oval objects sitting on the table, looking for all the world like crystal paper weights.  I picked one up and it slithered out of my hand, slippery as a water balloon.  It was then that I realized that the beautiful paper weight was indeed, a silicone breast implant made by the company that sponsored the dinner.  After all, what do you expect when you attend a gathering of the plastic surgery clan?

I have learned in medicine to expect the unexpected.  The reason that I got in my car and drove 970 miles from Santa Fe to Houston was that my father, now nearly 91 years old and an emeritus Professor of Plastic Surgery at Baylor College of Medicine, had been asked to give several lectures as a visiting Professor for the residents and fellows in training.  Several is a bit of an understatement.  He was actually asked to give five separate talks, including three on consecutive days at 6:30 am, because as we know, surgeons start their days early.  After assuring Dad that I would not be getting up to attend ANY 6:30 am lectures, I set out for Houston in the midst of some of the worst rainstorms and flooding seen in that town in over thirty years.  Dad has had to curtail his practice over the last few years due to significant health issues, and when he came down with a bad cold days before the trip, I tried to no avail to convince him to stay home.  He of course wouldn’t hear of it.

His assignment for the evening lecture last Thursday night was to talk about his surgical missions overseas to repair cleft lips and palates, other birth defects, and contractures due to severe burns and other injuries. Especially since he retired from active practice, he has participated in several trips a year with Surgicorps International, traveling to Guatamala, India, Bhutan, Viet Nam, Zambia and other countries to attempt to give a normal appearance, and thus a normal life, to those unfortunate enough to require his services.  Devoted parents travel great distances to wait all day for their children to be evaluated, and once the schedule is set, surgeries proceed for the next 7 to 10 days, twelve hours a day, until the work is done.  Dad methodically showed the construction of each trip, from soliciting donations, to transporting equipment, to evaluating prospective patients, to post-operative care. At the end of his talk, he showed a blurry photograph of a 43 year old man who had lived his entire life with a severe facial deformity.  He told us that when the patient woke up in the recovery room, the first thing he asked for was a mirror.  When he saw his own face, swollen from surgery, but yet distinguishable as a normal human face, this patient burst into tears.  As my father told the story, everyone in the room did the same.

Plastic surgeons often get a bad rap.  In our youth driven, appearance conscious world, it is all too easy to make jokes about their bread and butter cosmetic work—the breast implants, the face-lifts, the nose jobs, and the botox.  At dinner last Thursday night, my friend and I, and the residents in the room, were privileged to catch a glimpse of what these talented surgeons can do to change the life of a child, and that child’s family and future.  The residents in the room are lucky—in a few years they too will have the skills to give the gift of a normal appearance and normal function.  As for me, well, I think it’s time to get back to work treating cancer patients.

Eddie, A Horse Story

In the horse rescue business, there is a euphemism for when a horse at auction is sold to a kill buyer, who gets dollars for pounds for transporting horses to Mexico or Canada for slaughter.  We call it “getting on the wrong trailer.” In the United States last year alone, over 100,000 horses climbed on that trailer, many of them after successful careers as racehorses, ranch horses, dressage horses, jumpers or just plain family pets.  The old and the infirm are particularly at risk, since a horse who cannot be ridden is an expense many owners cannot afford.  Often these horses are transported over long distances without food or water, to be further injured en route to meet a terrifying end.

On Saturday night, one such old horse showed up at Mike’s Auction in Mira Loma, California.  He didn’t have a name, just a number—hip #245.  He was blind in one eye due to an old injury, and his other eye was cloudy.  The buzz floating around was that he had been a trained dressage horse, but no one knew for sure.  All of the familiar Southern California rescues were there, as they are the second Saturday night of every month, steeling themselves for that inevitable point in the auction where they run out of money or space, and the elderly, the lame, the unbroken and unwanted run out of time.

The morning after the auction, Forgotten Horses Rescue posted on Facebook that it had been able to save five equines from slaughter, one of which sold for the astoundingly low price of $40.  A supporter wrote in, “What happened to hip #245?  A quiet retirement home or the wrong trailer?”  Trish Geltner, who runs Forgotten Horses replied, “Sadly we were out of funds by the time his number came up.”  Denise Tracy, who owns Tracy Acres, a sanctuary for retired and otherwise unadoptable horses up in Vacaville, had worried about him all night after seeing his picture on the auction list.  When she learned what happened, she wrote, “On my way to church, tears streaming down my face.” Denise has had some trauma in her own life, and has a soft spot for blind old horses.  She offered him a permanent forever home at her sanctuary, if he could be found and retrieved.

Trish sprang into action.   She located the horse, frightened and already bloodied and bruised from being thrown into a pen with younger stronger horses.  She put out a call to Forgotten Horses’ Facebook supporters and within minutes funds had been raised to pay his “bail,” to transport him to a temporary foster and obtain veterinary care, and to pay his way to Vacaville and Denise’s welcoming arms.  At the time that I am writing this, he is on his way north.

It turns out, this horse’s name is Eddie.  He is 24 years old, an Irish thoroughbred, and was indeed a dressage horse.  The woman who brought him to auction cried when she left him, saying that he was a good horse and that she had tried in vain to find him a retirement home when she could no longer keep him.  A kind hearted person is always an optimist—surely she hoped that someone, someone with means, would step up and save him from certain death in a Mexican slaughterhouse.  In the end, just in the nick of time, a small village of horse lovers reached into their pockets while Denise Tracy reached into her heart.

At Tracy Acres, one of Denise’s horses has a sign hanging outside her stall.  The sign says, “A True Love Story Never Ends.”  Eddie is going home, and the rest of us are the better for having made it happen.

My Night At the Opera

“Was that a high C or vitamin D?”  Groucho Marx as Otis P. Driftwood

Okay, I admit it.  I am a Philistine when it comes to opera.  I can’t help it.  I grew up in Houston, Texas when the acquisition of central air conditioning was a cultural zenith.  Houston, back then anyway, didn’t have opera.  It had swamp coolers and mosquitos.  It wasn’t until I got to college, and had a boyfriend from New York City, that I was invited to go to an opera—a real and very famous opera, “La Boheme”– in a famous place, The Metropolitan Opera House.   My boyfriend was well versed in the genre but neglected to give me one important piece of information—the fact that the opera would be sung in Italian.  For three hours I watched fabulously costumed singers with enormous voices waft slowly around the stage, living their Bohemian lives, building towards the climactic scene when Mimi, stricken with tuberculosis, gives her final aria, and final cough (complete with fake blood) and dies right there on stage.  I was premed and into medical realism.  She was far too fat to die of consumption and I said so.  End of boyfriend and operatic opportunity.

Fast forward forty plus years, and here I am in Santa Fe, New Mexico which boasts of having one of the finest opera houses, and opera seasons in the world.  My husband had never been to an opera, and so when he noticed an ad in our local paper for tickets forty per cent off for newcomers to New Mexico and the opera, he said, “Let’s go!”  We chose a night—last night—and an opera, “Rigoletto”, dressed up and headed out to what is surely one of the most beautiful outdoor venues in the Southwest.  We settled into our $150 per ticket Row Y seats just as the overture was starting.  After I snapped a quick phone shot of the opera house from inside, what looked like a teleprompter on the back of the seat in front of me warned me to turn off my phone, and I was thrilled to see that by pressing a button, I could read the libretto in English.  The only thing missing was the forgotten set of antique opera glasses I bought years ago on Ebay—you know—just in case I ever needed them.

Thirty minutes into the first act, Rigoletto comes home, and is fussed over by his daughter Gilda who undresses him, and helps him into a limp white garment that resembles a bib while both are singing loudly in perfect harmony.  Just as Gilda hit her high note, I heard a single muffled cough from the woman behind me, and suddenly there was a sensation of wetness on the outer aspect of my left ankle. Momentarily distracted, I glanced down my leg, thinking, “I hope that isn’t blood she coughed up,” but it was dark and the music was loud and the air was dry and caught up in the passion of the song, I quickly forgot about it.  That is, until the curtain went down and the lights went on, and the woman sitting to my left said, “Are you alright?”

I said, “Thank you but of course I’m alright—that was the lady behind me who was coughing.” Undeterred, she looked at my silk clad pants leg, and my purse sitting on the ground beside it and with a quick motion, gestured to the now empty seat and floor behind me, which was covered in vomit that had been slowly dripping down the concrete stadium wall to engulf my purse and my left shoe.  Abruptly standing, I announced to my husband that “we have to go NOW!” and once in the lobby, holding my purse delicately in front of me as exhibit A, I barreled past thirty or forty well dressed women waiting in line for the bathroom, shouting, “I don’t have to use the toilet—someone threw up on me and I need that sink RIGHT THIS MINUTE.”  The line in front of me parted like the Red Sea.

Now I am a doctor with three kids, and trust me, that was not the first time I have had a close encounter with throw up.  But winding my way back to the lobby to find hubby, I realized that I was not going back to my expensive seat at the sold out performance.  In fact, I probably was not going back to the opera at all, ever.  My husband who generally adores music was relieved.  He said, “I have discovered tonight that I really don’t like opera.”  Like I said—I am a Philistine.  You can have your Boheme and your Puccini and your high soprano operatic notes amidst shouts of “Bravo!  Brava!  Bravissimo!”   But for me—just give me the down dirty raw and emotional Broadway production of “Rent.” Without side effects.  Sorry, opera fans!

Past Lives

It’s been a tough year for me and my animals–we lost Magic, the elderly deerhound in January, and just last week, our thirty year old Quarter Horse Dash, the last of the red horses at our old place in California, Rancho del Caballo Rojo.  I am no poet, but tonight I came upon something I wrote out longhand over ten years ago after losing another red horse, and another gray dog.   I called it “Past Lives.”

The great hound sits on his small patch of lawn

Staring at the vertical lines of the white picket fence—his eyes go suddenly vacant

The small confines of his yard are gone

Instead he sees the rolling hills of a vast estate

The heather and the mountains lie beyond

 

The young ones sleep by the dying fire

Bodies and legs intertwined

An ember flashes—the spark illuminates a twitching foot, a wrinkled nose

The white stag beckons at the dark edge of the forest

In the morning the ashes smell of roasting meat

 

The old red horse looks up suddenly

His crooked white blaze a lightning bolt

His notched right ear flicks to and fro

He screams: the buffalo horses are leaving

His ghost white companion shies away in terror

 

There may be no heaven for these

The hart, the hound, the horse, the hunt

Yet they live on in the drums, in the horn, in the fire

And yet they live on in the chase.

 

A few closing notes here:

On the Deerhound:  Affectionately known as the “Royal Dog of Scotland,” it is not difficult to imagine how this breed, with its athletic, well-muscled build, came by the title. The Scottish Deerhound has a romantic past, a noble bearing, and a loving nature, so much so that Sir Walter Scott — himself the owner of deerhound named Maida — described the breed as “the most perfect creature of Heaven.

On the White Stag:  from Wikipedia–White deer hold a place in the mythology of many cultures. The Celtic people considered them to be messengers from the otherworld; they also played an important role in otherpre-Indo-European cultures, especially in the north.[1][2] The Celts believed that the white stag would appear when one was transgressing a taboo, such as when Pwyll trespassed into Arawn‘s hunting grounds.[2] Arthurian legend states that the creature has a perennial ability to evade capture, and that the pursuit of the animal represents mankind’s spiritual quest.[3] It also signalled that the time was nigh for the knights of the kingdom to pursue a quest

On the Buffalo Horse–from Mystic Warriors of The Plain, by Thomas Mail:  ” Each warrior had to have at least one horse which was trained to a fine point for buffalo hunts and warfare. It became his best and favorite, and was usually too valuable to sell or trade. He guarded it like a treasure and picketed it just outside his tipi at night. After all, his existence and future depended upon it to an amazing degree. A buffalo and war horse was trained to stop instantly at a nudge of the knees or a tug from the rawhide thong, called a “war bridle,” which was tied to the animal’s lower jaw. But more than that thong was necessary, since racing through thundering herds over rough ground that was riddled with bushes, rocks, and hidden burrows portended frequent collisions and spills for the rider, so during battles and hunts a fifteen- to twenty-foot rope was often tied around the horse’s neck so that its free end would drag behind the horse. When a falling rider seized the rope, his horse came to a sharp stop, and in a moment the man was on his feet and mounted again. Often one who had an especially valuable buffalo horse cut V-shaped notches in his ears.” My old Quarter horse Lucky came to me with a notched ear, so I always called him “my buffalo horse”.

Father’s Day

My father finds it hard to believe that he has a sixty one year old daughter.  I find it hard to believe I have a nearly ninety year old father.  I almost didn’t, which is story behind the scarcity of Crab Diaries blogs in the last two months.  If cats have nine lives, Dad must have ten or eleven.  The ninth life flashed before my eyes on April twentieth.

I have a “spiel” for the side effects and late effects of radiation therapy for every disease site. One of the late effects of radiation for abdominal malignancies is the risk of a small bowel obstruction months to years after the treatment.  My little speech goes something like this:  “Every patient who has ever had abdominal surgery, even for benign disease, is at risk for a bowel obstruction at some point later in their lives.  Scar tissue forms adhesions which restrict the bowel—if you’ve had cancer surgery, or an appendectomy, or even, like me, a C-section or two or three—you are at risk.  Radiation increases that risk, but if you recognize the symptoms early, and get treatment, there is a high likelihood that you can avoid surgery.  So if you ever have a period where you are experiencing abdominal distention, and realize that you are not passing gas, and start to feel nauseated, get thee to an emergency room for quick diagnosis and treatment.”

Apparently Dad didn’t get the memo.  In 2004, my mother called me late one evening to report that Dad had been in a car accident.  After running a red light, he was broadsided and found himself in the passenger seat when he should have been driving.  No, he was not wearing a seat belt.  He was taken to the emergency room of the hospital where he practiced, and was found to have a pelvic fracture, but he was “fine” and not to worry.  At his insistence, his colleague, the Chief of Plastic Surgery was called in and pronounced him fit to leave the hospital.  At four am, I got a second call from Mom, asking me “What does it mean that he got up to leave to go home and promptly fainted.”  It meant a ruptured spleen and I told her so.  A few hours and a splenectomy later, all was well– until April.

Dad woke up feeling a little queasy on a Friday after a lovely trip to Phoenix a few days earlier.  The feeling persisted and overnight the symptoms progressed, but being the stoic and ever in denial physician that he is, he knew that the food poisoning or virus would soon be over and he would be back to normal.  But when he described his symptoms to his primary care doctor nearly 30 hours later, she sent him to the nearest emergency room.  By the time I was able to get back to San Diego, he had perforated his obstructed bowel and was headed into surgery, two years after his second open heart surgery and one year after hip replacement, two months shy of his ninetieth birthday.  Surgeons are different from normal people.  At a time when I would have had my arm out for a shot of morphine and hospice, he said simply, “Let’s go for it.”   Six and a half hours later, minus eighteen inches of small bowel, he was brought to the ICU where I was asked, as his next of kin and medical power of attorney, what his code status was.  You know the answer. Despite all of my previous prejudices against family members who refused to acknowledge the obvious—that 90 year olds have to die sometime, he was a “full code.”

Dad is back home now in his own apartment, feeling a bit tired but generally speaking no worse for the wear.  Despite the fact that my sister and I were at his bedside continuously for a month, when he returned home, he sent a long email to all of his friends describing his ordeal and thanking his girlfriend Evelyne for her devotion to his care.  His daughters were cc’d on the email.  After a serious bout of righteous indignation, I reminded myself that patients NEVER remember their time in the intensive care unit, and that is a VERY good thing.  The entire family will be headed to California in ten days for his big 90 birthday, and we couldn’t be more thrilled.

Happy Father’s Day, Dad, and we sincerely hope there will be many more.  Your loving daughter—M.

In Praise of Angelina

I have always been one of Angelina Jolie’s biggest fans.  The Academy of Motion Picture Arts and Sciences saw fit to reward her 1999 performance in “Girl Interrupted” with an Oscar, but I wasn’t well and truly smitten until the second Lara Croft Tombraider movie was released in 2003.  In that film, Jolie, who performs her own stunts, is seen galloping on a dark horse while spinning a heavy shotgun from side to side to shoot alternating targets.  And she is riding SIDESADDLE.  If you don’t believe this, have a look here:  https://www.youtube.com/watch?v=tz1lCcs9tac  In the Lara Croft movies, she is the epitome of a strong, athletic, intelligent and self assured woman.  It may not seem like much, but I granted Miss Jolie a high honor indeed—in 2004 I named a dark, agile and fast deerhound puppy after her, the soon to be champion Caerwicce’s Lady Croft, aka “Angelina”.

 

In the years that followed the Lara Croft movies, Angelina Jolie went on to surprise her public in more ways than one.  The girl who initially achieved notoriety for wearing a vial of her second husband Billy Bob Thornton’s blood gained a different type of fame when she adopted a Cambodian child, and subsequently became a respected ambassador for the United Nations.  She has become well known for her humanitarian efforts, devoting as much time to improving the lives of refugee children as she does to her own career.  Recently, she has added the titles of author, director, and Mrs. Brad Pitt to an already impressive resume.

 

But perhaps the biggest surprise of all came two years ago, when she went public in the New York Times with the revelation that she is positive for the breast cancer gene BRCA1. In a moving statement, she wrote of her difficult decision, at age 37, to undergo bilateral prophylactic mastectomies and reconstructive surgeries in the hope of staving off the cancers that took her mother, her grandmother and her aunt.  She was clear and concise, reasonable and dispassionate in her account.   Not only did she raise awareness of the heritable form of breast cancer, she gave courage to all women facing the challenge of a mastectomy.  If one of the worlds most beautiful and sexy women could undergo such surgery in the glare of the celebrity spotlight and come out looking stronger and even more beautiful, so could some of the rest of us.

 

Today she has done it again.  In a New York Times article entitled “Diary of a Surgery” (http://www.nytimes.com/2015/03/24/opinion/angelina-jolie-pitt-diary-of-a-surgery.html?ref=opinion&_r=0 ), she reveals that she has recently undergone removal of her ovaries and fallopian tubes to prevent ovarian cancer, the disease that killed her mother.  She describes precisely the terror she felt when informed that some recent blood tests were equivocal, the dreadful anticipation of the results of a PET/CT scan and the realization that now, at age 39, she has entered menopause.  But she also describes the relief she felt once she had made a decision to go ahead with the preventive surgery: “I know my children will never have to say, ‘Mom died of ovarian cancer’.”

There’s bravery and then there’s true courage and grit.  It’s one thing to perform gymnastics while swinging from the rafters of the Croft estate, or to shoot a rifle off the back of a galloping horse.  It’s quite another to write clearly and objectively the story of being diagnosed with a genetic mutation, and of the careful informed decisions she made to minimize her risks, while at the same time admitting that her decisions were not necessarily the right ones for everyone.  As Angelina says, “Knowledge is power.”  We owe her thanks for sharing hers with us.