I Coulda Been a Contender

It happened again today.  A youngish man, age 59 (youth being relative these days) comes in for a consultation.  His history began eighteen months ago when he started to notice hoarseness.  Thinking he had laryngitis, he saw his primary care doctor.  He was indeed diagnosed with laryngitis despite the fact that he had not been shouting for his grandson at the local soccer playoffs, nor had he had upper respiratory symptoms such as a snotty nose or a cough or a fever. He was treated with antibiotics, and did not improve.  Three weeks later, he saw his doctor with the same complaint and was again given another course of antibiotics.  Again, he had no relief, but since he was feeling fine and had no other symptoms, he waited.  And waited.  Until July when he suddenly became short of breath, especially when lying down.  He heard himself wheezing in that position.  He was finally referred to an ear, nose and throat specialist who recognized the signs and symptoms of advanced laryngeal cancer and performed a tracheostomy to save his airway, and his life.

When we are young, and in medical school, we are taught an old saying:  “When you hear hoofbeats, don’t think of zebras.”  In other words, when a patient comes in with a cough, your first line in the differential diagnosis is infection or asthma, not lung cancer. Most breast lumps in young women are cysts, or fibroadenomas, not breast cancer.  And when a patient comes in with hoarseness, it’s likely laryngitis, not cancer of the vocal cords, causing airway obstruction and requiring an emergency trach.  As a radiation oncologist, I see things a little differently, as in “through a glass, darkly.”  When I hear hoofbeats, it’s nearly always a zebra, not a horse.  When a patient shows up in my office for a consultation, they’ve already been diagnosed with cancer, many times after being misdiagnosed for months or years with bronchitis, or laryngitis, or cysts, or hemorrhoids.  Today my patient was the fourth patient I have seen in as many years whose laryngeal cancer was misdiagnosed as a benign process, ultimately resulting in the need for an emergency tracheostomy.  This is because you cannot see laryngeal cancer with a wooden tongue depressor and a flashlight.  The Norman Rockwell image of the doctor with the bright light above the exam table, shining into the mirror strapped on to his head, which in turn reflects light on the tiny mirror held to the back of the throat—those are images from the past.  Primary care doctors simply do not have the fiberoptic equipment necessary to do a good laryngeal exam today.  It’s expensive, and used infrequently.  But there is no excuse for not referring a patient with persistent hoarseness to a qualified ENT doctor.  It could mean the difference between life and death, or life without a voice, which is no small disability.

As I was completing my internal medicine residency, before I decided to become a radiation oncologist, I had a brief notion to take the LSAT’s and apply to Harvard Law School.  Back in those days there were only five or so MD-JD’s in the country, and there was definitely a need for people who had a foot in both corners.  In the end, I decided that I didn’t want to give up patient care, as interesting as I found the law, due process, presumed innocence—the whole lot. I opted out and continued my pursuit of medicine.  Thirty years later, it occurs to me that I didn’t have the experience or the knowledge back then to have made a good attorney.  But now, knowing what I know about the consequences of missing a diagnosis of cancer, I’d make a helluva good malpractice lawyer for the plaintiff.  In the words of Marlon Brando, “I coulda been a contender.”

Road Tripping

ROAD TRIPPING

Road trippin’ with my two favorite allies
Fully loaded we got snacks and supplies
It’s time to leave this town
It’s time to steal away
Let’s go get lost
Anywhere in the U.S.A.
Let’s go get lost
Let’s go get lost
Blue you sit so pretty
West of the one
Sparkles light with yellow icing
Just a mirror for the sun
Just a mirror for the sun

 

It’s been awhile since I hit the road with my two current favorite allies, the Q’s—Queen and Quicksilver.  Now that I’ve figured out how to solve the carsickness problem which had me out of the driver’s seat, into the back of the van on my hands and knees with my Lysol, paper towels and those green plastic bags, usually within 20 minutes of starting out, I’m eager to go again. Two years of that and all it took was a little bit of Bonine—who knew?  My last big road trip with the girls was to Oregon eighteen months ago, for the Scottish Deerhound National Specialty.  Time was short, and we did not get to take the scenic route up the coast.

I’ve loved cars and driving for as long as I can remember.  Growing up in the flatlands of coastal Texas, having a car was an essential rather than a luxury.  During my early teenage years the driving age in Texas was 14, and I felt stunned and cheated when the legislature changed the legal driving age to 16, four months before my late December fourteenth birthday, and well after most of my classmates had earned their freedom.  My own liberation came soon enough, in the form of a 1963 white Chevy Impala, owned by my late grandfather, who literally only drove it to the corner grocery store and back. When I inherited that big engined beauty, with its turquoise Naugahide upholstery and plastic steering wheel with the little depressions for my fingers, the year was 1969 and the car had 7,000 miles on it.  I was in heaven.

By the time I graduated from medical school my love of the V8 surrounded by lots of “heavy metal” was fixed and for the last twenty years my vehicle of choice has been a Chevy Suburban, three in succession with the last one, Big Red, now 12 years old and about to roll over 200,000 miles.  I am somewhat pathologically attached to that car—I say that it’s because two years after I bought it in 2001, Chevy had the bad idea to turn it into a “soccer mom” car by pulling out the standard second bench seat and replacing it with two “captain’s chairs”, thus effectively removing 18 inches of rear cargo space, just enough to ensure that I could no longer get two 700 size giant breed airline crates in the back.  In the early years I spent hours on hold with Chevy’s customer service reps, likely somewhere in India, waiting to explain what a bad idea those captains seats were, not to mention the hydraulic lift that replaced the rear “barn” doors.  Imagine having 400 pounds of dog trying to exit the vehicle all at the same time.  But the real reason that I am hanging on to Big Red is the memories of many wonderful, and some not so wonderful road trips with kids and dogs.

The one my kids will likely never let me forget is the trip to Palm Springs when they were eleven, eight and five respectively and in a fit of sheer stubbornness (my husband was working in Rhode Island but there was no way THAT was going to stop me), I hauled the three of them along with three deerhounds to the dog show in January.  By the time we had come down the mountain into the valley, all six of them had thrown up. After the unloading at the hotel and the clean-up, we were back in the car where they commenced a fistfight over what kind of food and where we were going to eat for dinner.  I mistakenly turned down a blind alley and in one of the worst “Mommy moments” ever, briefly accelerated towards the adobe brick wall at the end.  Finally, there was silence in the car.

The ones I will always remember are the road trips taken separately with each child.  With my daughter, the ritual was always the same—peanut M and M’s, Cheetos, and Cokes for snacks, and turkey sandwiches with potato salad and dill pickles for dinner on the road.  With my older son, it was my turn for music education—he always made a CD of “his” music so he wouldn’t have to listen to mine. The content never failed to raise eyebrows the next time I would forget to turn off the player while ferrying a colleague around.  I took the longest trips with my youngest boy.  In 2007, when he was sixteen, we drove through southern Utah on our way to Colorado.  As he looked out the window, he exclaimed, “I never realized how beautiful this country was until we went on this trip.  Now I understand why people want to fight for it.”  Definitely worth every penny of the price of gas.

I’ve been feeling the wanderlust again lately—I dream of no agenda, no AAA prerouted trip, no reservations, no timetables, and no deadlines—just the open road, and of course, a couple of my favorite allies.  Want to come?

Sara Beth Closes Her Eyes

Just when I think that I have escaped my work world for the day, here I am lying on my couch weeping while watching Dancing With The Stars.  Apolo Anton Ono, Olympic speed skater and his partner Karina Smirnoff have just danced to the Rascal Flatts song “Sara Beth”.  For those of you who don’t know the song, here’s a little sample for you:

“Six chances in ten it won’t come back again
But with the therapy we’re gonna try
It’s just been approved it’s the strongest there is
But I think we caught it in time
Sara Beth closes her eyes

And she dreams she’s dancin’ around and around
Without any cares
And her very first love
Is holding her close
And the soft wind is blowing her hair.”

The dance starts with Karina on the floor, her gauzy blue gown puddled around her on a dimly lit stage.  Apolo lifts her up and they begin a slow waltz.  As I watch, I am overcome with sadness as this thin slip of a girl dances away her cancer, her long hair about to be lost. And then, the lights go on and the crowd cheers and I am reminded of a conversation that I heard on Saturday night.

My husband and I had gone downtown to see a play at the San Diego Repertory Theater about the protest music of the 1960’s.  We went early because there was a lecture and discussion between the director of the play, Todd Salovey, and his brother Peter Salovey, who just before Thanksgiving had been named the new President of Yale University.  Professor Peter Salovey had given the opening address to my daughter’s incoming freshman class at Yale in September of 2002.  The talk was quite memorable because he had just described and written a book about a concept called “emotional intelligence”, roughly defined as the ability to recognize, empathize with and respond correctly to emotions exhibited by others.   In the world of psychology, this was BIG, because it explained that IQ, or intelligence quotient, is only one ingredient to successfully navigating life, career and relationships.  Emotional intelligence, or EQ is the other essential.  If you lack it, you are in trouble.

In the discussion Saturday night, Professor Salovey was asked two questions:  first, is it possible to quantitatively measure emotional intelligence.  The answer was “yes, it is.” The measurement device is a validated 45 minute test called the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), administered to persons over 17 years old.  The second question was even more important, and relevant to the practice of medicine:  is it possible to IMPROVE one’s emotional intelligence, and if so, how?  The answer was surprising.  One way, and perhaps the best way, to improve emotional intelligence is to practice “feeling” through art.  Listening to music, going to plays, watching a comedy on television, seeing an exhibit—all of these things are designed to elicit powerful emotions.  Apparently, the older we become (unlike the IQ test where sadly, we peak out in our early twenties), the more life experience we have, and the more just plain practice we get, the better we become at expressing and interpreting emotion.

Our cancer center takes a very holistic approach to curing cancer and I can take no credit for that—the medical oncologists who started the practice there have long been committed to offering complementary therapies such as massage therapy, acupuncture and art therapy.  One of my patients told me on Monday just how much she is enjoying these ancillary services, especially the art classes.  She told me that they help her deal with the emotional trauma of being diagnosed with cancer.  As it turns out, if you want your children to be empathetic and able to read the signals of others, you might want to hand them paint, brushes and an empty canvas, or a camera, or clay to model or a musical instrument or a pencil and a blank book to write in. And of course, get them a puppy to love.  As for me, I got a good dose of emotion tonight on DWTS.  And if I find myself lacking, there’s always “Grey’s Anatomy” on Thursday!

Cold Roast Beef

Just when you thought I had finished talking about Thanksgiving, here it is again. A few weeks ago, between patients, I was catching up with other physicians’ blogs. Yes, readers, I have discovered that I am not the only one, nor am I the most articulate or humorous or erudite MD to put fingers to keyboard. Some of my fellow writers are very very good, and when I can figure out to get a blog roll going on the sidelines of my page, I will share their sites with you. Anyway, I came across an essay by a medical student where she thanked her cadaver for allowing her to learn by his donation of his body “to science.” For those of you who don’t know what happens when one donates one’s body to science, I can tell you that most of the time the final resting place is the medical school anatomy lab. Here the alpha of gross anatomy is the human upper arm, where the ropey bundle of nerves which makes up the brachial plexus is dissected free in order for the student to understand the complexity of how we use that delicate instrument, the human hand. The omega, or the last body part dissected, is the brain.

 
So the thing about her essay which really struck me, besides her sincerity, was one sentence, paraphrased here—“I don’t think I’ll ever eat roast beef again.” That one line took me right back to medical school and my own gross anatomy lab where I too dissected a human being, thirty seven years ago. Back in those days, before the Health Information Privacy laws of 1996 gave us the right to keep sensitive health issues anonymous and long before we willingly gave up that right by broadcasting every sniffle and sneeze on Facebook, cadavers were actually sent to the anatomy lab still wearing their hospital bracelets. My man’s last name shall remain with me, but his first name was Herman and I even knew his birthday. Before you exclaim, “How AWFUL!” think about it. To me and the preceptor and the three other members of my team, this man was not just a body to be dissected—he had been a living breathing human named Herman who had thought enough of the process of training young doctors to give us himself—all of him. It was personal.

 
In death, the body gives up all of its secrets. Herman gave me my first experience of seeing cancer from the inside out. He died of lung cancer, and his lungs were full of tumors, as were his liver, his bones and even the soft tissues of the muscles of his body. We dissected and discussed our findings during the long days, reeking of formaldehyde. Gradually through the course of a semester, I discovered the evil and relentless nature of his disease. One night after anatomy lab I dreamed that I took him home with me. I laid him down on my living room couch. He did not talk; he did not move. He was just there, with flesh the color of old roast beef. The dream was very real and I woke up half expecting to walk into my living room and see him there on the couch. It was years before I could eat roast beef again.

 
Three years ago at Thanksgiving, I decided that I would cook a whole beef tenderloin, in addition to having the traditional turkey. After all, I’m a carnivorous Texan and red meat is not that bad for you if you don’t eat it all the time. This year, with a twenty five pound turkey, a four pound beef tenderloin and only nine people to feed, we had lots of leftovers. As I loaded a plate with sliced beef, done to a perfect medium rare, I had a transient moment of discomfort, a slight sensation of nausea, and a very brief flashback to Herman and anatomy lab. Next year, perhaps I will do a lasagna, or a nice fettucine alfredo instead!

Monday Monday

I wonder if I will still hate Sunday nights when I retire.  I’m quite sure that I am not the only one who feels this way.  Sundays used to be a day of rest—perhaps for some it still is.  But for me, it’s panic day.  So very much to do, so little time to do it.  I just came in from grooming and feeding the horses, brushing three deerhounds, clipping forty-eight dog toenails and then cleaning the results off the garage floor, it’s almost 7 and I haven’t showered or washed my hair or paid the bills.  Damn it, the leftover turkey is gone and I have nothing in the house to take for lunch tomorrow. Run to the store. Oh, no gas in the car?  Damn it. Most Sunday nights I stay up til 1 or 2 am, because that’s what it takes to get ready for Monday.

This particular Sunday night panic is even worse than usual, because it is coming after I have had an entire week off work.  I briefly check the list of things that I had promised myself I would do during my week off, most importantly, as I mentioned in a previous post, get rid of many of the superfluous belongings I have accumulated in the last 15 years.  In this task I failed, despite my father presenting me with the gift of one of his favorite books, entitled “Clutter’s Last Stand”, likely destined in my hands to become another piece of clutter. I had even planned to take a picture of my three now adult children for a Christmas card (wishful thinking, I know) since they were all home and actually in one place at the same time—well that idea was roundly vetoed with painful choruses of  “you gotta be kidding me!”  Which prompted me to remind my daughter of her childhood girlfriend’s family, the parents and six children, still dressing up each year in matching outfits with a theme—I’ll never forget the eight matching red and white Ducati motorcycles, with matching leather outfits, and their matching long blond hair flowing as they simultaneously shook their ringlets out of their helmets, but I digress.  Some things you just can’t compete with.  At least the white table cloth and napkins that were hiding out in the rarely used dining room are finally washed and put away.

Re-entry is always tough—take it from NASA.  I’ve learned over the years to try not to think too much about my patients and my staff when I am off, otherwise it’s not a true break from the routine.  But being away from cancer patients for a week is a double edged sword.  Oncologists tend over time to become, in the words of that old Pink Floyd song, “comfortably numb.”  Coming back to work after a week or two off is like reentering a world where the colors of panic and pain and sorrow are suddenly more vivid, and more deeply felt. It takes a few hours, or even a day to get back into the rhythm of the cancer center, and then suddenly, it’s like I never left— “just another manic Monday.” Thirty times tomorrow, I will open an electronic chart on my desktop, walk into an exam room, and say, “How are you feeling today, and how was your Thanksgiving?”  I hope they had a nice holiday.  I know that I did.

My Little Dog Jack

The table was cleared last night and all the leftovers were put away– today they are nearly gone.  Three loads of dishes were done, and the last of the fancy glasses were put back on the shelf, upside down so they won’t collect dust until the next time they are used, next November.  The white linen table cloth and napkins are still on the dining room table—out of sight, out of mind.  I’ll get to those tomorrow, I promise.  Someone fed the cat pumpkin pie, and I awoke this morning to view the results of that indiscretion on my fluffy white bath mat.  All in all, Thanksgiving was business as usual.  Except for one thing—and everyone who came remarked upon this fact—Jack did not bark.  Not even once.

Jack is my little dog, a ten pound Brussels griffon, that I bought as a puppy fourteen years ago on a whim after seeing the Jack Nicholson movie “As Good as It Gets.”  Those of you who have seen the movie know that the misanthropic author protagonist, Melvin Udall, played by Nicholson, gets stuck taking care of a very cute but rather obnoxious little dog after the dog’s gay owner is attacked and hospitalized.  Gradually, Udall learns to love the dog, and to tolerate human beings.  I was smitten by the little movie dog, had to have one, and did NOT do my homework.  As a result I have had fourteen years of a yappy tiny tyrant who rules us, the deerhounds and the cat, and who has never been successfully housebroken. There were years when I am sure that my Jack, like that old Gary Larson comic strip (“my name is No No Bad Dog”) thought his own name was “Shut the F-ck Up Jack!”  But Jack is blind, deaf and crippled by arthritis now, and no longer hearing, he no longer barks.

My eighty seven year old father flew out to spend Thanksgiving with us, since my mother has advanced dementia and no longer speaks or recognizes him from her nursing home bed.  He had not been to California in more than six months, and he was shocked at how much the little dog had aged in that short period of time.  My dad spent most of the day on Wednesday and part of the day yesterday organizing his papers and the stories he calls his “vignettes”, tales from his youth in Chicago, his time in the Navy, his many years as a practicing plastic surgeon.  He read one of his stories at dinner last night—as a child during the Great Depression in Chicago he had thrown his vegetables on the floor in a temper tantrum and his father, my grandfather, had dragged him downtown to see the lines of men waiting outside in back of the cafeteria, to receive the garbage to take home to feed their families.  It was a reminder to us all to be thankful for what we have.

As my father sat working at the kitchen table, my little dog Jack lay silent at his feet, sleeping in a patch of bright sunlight that shone in from the sliding glass doors leading outside.  They’ve both slowed down a bit, and they’ve both lost their hearing, and some of their footing, but there’s life in those two little old men yet. I know one thing for sure, and that is that there will never be another like either of them.

Thanksgiving

Thirty two years ago, I had something to prove.  I was recently married, and so, in fact, I had a lot to prove.  First of all, that I could actually cook a turkey.  I had never cooked a turkey, but I was good at following directions.  I got advice from my “Nana”, Grandma Jenny Silver.  She said, “First you have to wash the turkey inside and out.  Then use a knife to scrape the skin—those guys who butcher the turkey—they know NOTHING!  They always leave some feathers and quills and you have to get them out.  Then cut an onion in half and put the onion, and a few peeled carrots, a few celery sticks and a clove of garlic inside the turkey.  Rub salt, pepper, and a little bit of paprika on the skin.  Refrigerate overnight.  And THEN you will have a very tasty turkey.”  The turkey was perfect.

I had something else to prove—that I could make a family out of my disjointed, dysfunctional relatives.  I was the second wife, and my husband’s first marriage had failed.  My new in-laws were not convinced that I could make a go of it.  My parents lived 2,000 miles away.  My grandparents were in their eighties and in failing health.  It did not look promising, but I was determined.  In my 1200 square foot house in Sherborn Massachusetts, with its tiny dining room that could seat six comfortably, eight under duress, I cooked that turkey and assembled the relatives.  The dinner was a success. Everyone got along, and I masqueraded as a gracious hostess, aided and abetted by a bottle of Wild Turkey mixed with Coca Cola, a gift from my somewhat anxious husband.  I considered it a prelude to having a real family, a house full of kids and laughter and dogs that I could call my own.

I cooked those turkeys for the next 30 years, and amazingly, most of the time, everyone showed up—kids, dogs, girlfriends, boyfriends, cousins, aunts, uncles and inlaws.  But somewhere around the thirtieth Thanksgiving, I started to get tired.  The huge turkey, the stuffing cooked ahead of time, the endless pulling of a heavy bird out of the oven to baste, and assess, and replace—the awful green bean casserole and the gooey marshmallows on top of the pureed sweet potatoes—over the years it became less a labor of love, than just– a labor.  Driving home from work one evening three years ago, I saw a sign in the big picture window at Brett’s Bar B Que—“GET YOUR THANKSGIVING TURKEY HERE”.  I thought, “Hmmmmm, maybe next year.”   Two years ago, I ordered a cooked turkey from Brett’s ahead of time.  It was perfect.  Last year I did the same.  I had nearly twenty people at my house.  For the first time ever, we couldn’t all sit at the same table.  And my dining table is huge— it seats 14 people easily.  I cooked everything else, including a perfect beef tenderloin.  I am a meat eater, and while everyone lapsed into a turkey stupor, I was happy with my roast beef.  I ate standing up, and vowed never to do it again.

My fantasy last year was “next year in Santa Fe.”  I had visions of Thanksgiving dinner prepared for me at the Inn of the Anasazi, eaten leisurely in front of a pinon wood fire, dishes cleared and washed by someone else, well aged Scotch after dinner followed by a deep sleep under a down duvet in front of the kiva fireplace, Navajo rugs on the floor, a dream catcher hanging in the doorway.  I would get hotel rooms for the kids and their respective significant others, and for my closest friends and relatives, should they choose to join us.  A reliable house sitter would be at home, caring for my dogs, cats and horses.  Friday would be spent leisurely visiting the pueblos, touring the old churches and the quaint shops filled with scented candles and silver and turquoise.  Yes, that would be just the thing for Thanksgiving.  It would be perfect.

Tonight my daughter baked brownies and carrot cake. In the morning, I’ll start my side dishes and marinate the beef tenderloin.  I’ll roast beets for the salad, and cook bacon to go with the sautéed brussel sprouts that I’ll top with bread crumbs and parmesan cheese.  The turkey, cooked by Brett, will be tender and tasty.  My family is all here, and my best friends are coming to dinner.  I will set the table, worry about the china and silver and the wine, and end the day exhausted.  And I will be very very thankful for all that I have.  Santa Fe is a fantasy, but right here, right now is just fine.

But have I mentioned that I want to spend my sixtieth birthday, in thirteen months, December 2013, at the Ngorongoro Crater Lodge in Tanzania?  One can always dream…..

Just Call Me The Grinch

I don’t get it.  Today as I was getting off the freeway, I passed a local farm stand that had just put up a big sign:  “Get Your Christmas Trees Here!”   And there they were, lined up like little soldiers, the beautiful Scotch pines, and Douglas firs, and balsams. How will they even last the five weeks until Christmas?  We haven’t yet had the food orgy we call Thanksgiving, but television ads for “Black Friday” already abound.  Does anyone else besides me want their holidays one at a time?  I’m still basking in a sugar coated candy corn stupor from Halloween.  Please let me enjoy my family, all gathered for Thanksgiving, before I have to think about braving the malls for glad tidings and gift buying.

The root of my problem– my crabbiness– (and after all, this IS the Crab Diaries) here is not Thanksgiving, or Christmas, or the shopping days in between.  It is my patients.  As the holiday season approaches, the pain and suffering of my patients seems to increase. This is a phenomenon that I have observed year after year.  At a time of year when a radiation therapy department, or an oncology chemotherapy infusion center would be—ideally—empty, we are bursting at the seams.  Why?  Because only the sickest of the sick will forego the holidays with their families and come in to the emergency room, the surgery center, the radiation therapy department or the infusion center for treatment.  The rest, the less acutely ill, will put off their biopsies, surgeries, chemotherapy and radiation until “after the holidays”.  As well they should.  Very little in cancer management is actually an emergency.

Those who know me will hopefully attest to the fact that I am not the “preachy” type.  But when I see the holiday excesses already beginning, in the form of a big sign advertising Christmas trees before the turkey is stuffed and the gravy is set on the table, I have to step up for those who will not be sitting at the table, or around the Christmas tree this holiday season.  If you know someone who has battled cancer this year, send extra thoughts, prayers and cards their way. Visit them, call them, text them—just let them know that you care.  And if you and your family are in good health, give extra thanks and may it always be so.

My birthday is in December.  I hate it—having a birthday five days before Christmas.  Those of you with December birthdays know exactly what I am talking about.  But every year since 1984, the year my daughter was born, I do see those candles on my cake as an opportunity, the magical opportunity for a birthday wish as I blow out the candles on December twentieth.  Every year, I wish for the same thing—I wish for the good health of the people I love.  I hope you all wish for the same thing for Christmas this year—truly, there is no greater gift.

He Was Just Lucky

Maybe it was the half-starved little bay mare I saw on the San Diego Humane Society’s website today, or maybe it was the sight of my husband cleaning his saddle, the one he hasn’t used since old Veronica died back in 2005—I don’t know—but something’s got me thinking about horses again.  And remembering the first one I called my own.  His name was Lucky T Bonanza and he was foaled in 1977, a grandson of the Quarter Horse legend Coy’s Bonanza, but when I met him he didn’t look like much.  He was underweight, under-exercised, and had big sores on his withers from an ill-fitting blanket.  And he was sixteen years old, not exactly a spring chicken but “well-seasoned” for the rank beginners that we were, and of course the price was quite right.  We bought him for my husband, since I was able to ride my kid’s Quarter Horse mare, Rosie, barely bigger than a pony at 14.2 hands, but plenty big enough for me.  I like my dogs big, and my horses low to the ground for an easier landing when I fall off!

Although a local horse trainer brokered the deal, we met the old man who was selling his horse.  Stiff with arthritis, he had swung his bad leg over that horse’s back one too many times, and had accidentally kicked the horse, spooking him, resulting in the old man losing his balance on the mounting block and having a bad fall.  His doctor said, “No more.”  For a few weeks after he sold us the horse, I would see him slowly winding his way between the corrals with a large bag of carrots in his hands, feeding the horses one by one, until the bag was empty.  After a while, he just didn’t come any more.  My husband rode Lucky a few times, but then there was another incident where the horse bolted, literally BACKWARDS into a pipe corral, ejecting my unfortunate spouse.    Suddenly, Lucky was for sale again.  But there was one problem—nobody wanted to buy him.

Now I am not a brave person—far from it.  I’ve always been quite cautious in fact—managed to make it to adulthood without ever breaking a bone.  But I am stubborn, and I’d be damned if I was going to feed and house a horse that no one was going to ride and that no one wanted to buy.  Besides, that horse just had the kindest eye.  So about two weeks into Lucky’s second time around “for sale” in less than a month, I announced that if no one else was going to ride the horse, I was.  I won’t lie—I had the trainer hold him steady the first few times I got on, but after that, there was no stopping us.  That horse was my good companion, my therapy, my “go anywhere—do anything” horse, except that he didn’t like getting his feet wet and so I learned to jump in a Western saddle.  Oh, and every so often when we were out on the trail, he’d break into a dead gallop, completely unbidden.  As it turned out, that was where the old man would gallop him, and old habits die hard with old horses.  My heart pounding, I managed to stay on, at least most of the time.  After a while, I had to buy a new house because my old one didn’t have a place to keep horses, and of course Lucky deserved a grass pasture.  When we moved we got him a girlfriend, big Veronica, an 18 hand Dutch Warmblood mare, a retired dressage horse that my husband adored.  He always said she smelled good.  She towered a good foot above Lucky, but he thought she smelled good too.

Lucky died at nearly 28 years old in December of 2004; he was loved every minute of the last 12 years of his life. Veronica joined him two months later at age 26, a grand old age for a girl her size.  But what of the old man who sold me my first and favorite horse?  As I mentioned, we saw him daily for a short time after we bought Lucky, and then no more.  One day, I was sitting having my morning coffee, and reading the obituaries, and there it was—“Dr. Sol Roy Rosenthal, dead at 92.”  Ninety two?  I was in shock.  That man rode that horse and galloped the trails of the San Diego back country until he was ninety two years old.  As it turns out, Dr. Rosenthal was actually famous, not just for one thing, but for two.  He was one of the original developers of the BCG vaccine, used extensively in Europe to help prevent tuberculosis.  But the other thing that he became known for was even more interesting—he believed that high risk exercise makes you live longer. He published extensively on this theory, and he galloped every day, and he lived to be 92.

Maybe he was just lucky.  But I think maybe he was right.

I am the Grocery Store Doctor

I hate supermarkets—those bright fluorescently lit mega-stores where you seem to walk for miles, filling your cart as you go while constantly rearranging the contents to avoid flattening of the perishable fruits and bread.  There was a time ten years ago when the presence of three rapidly growing teenagers  mandated the use of two carts for each shopping experience, not to mention an assistant, usually my daughter, since one cart could not hold enough food for a few days, let alone a week.  And forget Costco—who knew that I needed a five gallon jug of ketchup with a matching jug of mustard, ten bargain DVD’s and oh, look at the deal on those sheets!  Whoever said that the road to hell is paved with good intentions was describing me shopping at Costco, no doubt about it.

So now that the kids are grown and mostly gone, I do my shopping at the corner grocery store—a place I pass every day on my way home from work.  It’s the kind of place that has homemade macaroni and cheese at the deli counter, and fresh stuffed cabbage, and garlic mashed red potatoes with the skins blended in and plenty of butter and salt and cream. The owners employ their own butchers, and since we are a house of hungry carnivores, the men behind the meat counter are my special friends. I’ve been going there so long that all of the employees know my name, and most of them can recite my kids and dogs names as well.  So it’s only natural that when they have a medical problem, they come to me–in the grocery store. I guess you could say more accurately that I go to them.  I’ve diagnosed allergies, ulcers, psoriasis and migraines, and on a few occasions, a cancer.

Last Thursday night, my favorite butcher—the one who calls me (and all of his other female clients) “Princess” and gives me the $5.99 hamburger meat for $2.99 when he’s out of the cheap stuff—comes up to me as I am waiting at the deli counter.  He says to me, “Look at this!” while pointing to his jaw.  I see a large abrasion on his chin, dark with dried blood.  I say, “What happened to you?”  He says, “I got up in the middle of the night to go to the bathroom and I must have fainted, because I woke up at 5 am with my head on the floor and my jaw is killing me and I came to work but it’s gotten worse all day and now I can’t swallow.”  My eyes widen with alarm as the girl behind the counter goes, “Tell her about the ear—TELL HER ABOUT THE EAR!”  I say, “What about the ear?”  He says, “Well, when I woke up there was blood coming out of it.”  I said to him, “You need to go to the emergency room, TONIGHT!  You could have a skull fracture.  You need some X-rays and a CAT scan right away.”  I don’t say what I am really thinking, which is that this same man had lung cancer a couple of years ago, and I am worried not only about the possibility of a fracture, but also about the possibility that a brain metastasis caused him to have a seizure and black out, hitting his head and face.  He seems reluctant—he wants me to tell him that he is fine so that he can go home and self-medicate with beer and tequila shots.

I realize I must do something fast or I will lose him.  I say, “Let me call it in.”  He says, “What do you mean?”  I say, “If I call the emergency room doctor and tell them you are coming, they will take you right in. You won’t have to wait”. He says, “Well, okay, but I have to finish my shift.   I get off at 8.”  It’s 7:30 pm. I go out to my car and dial the hospital and ask to be connected to the ER.  When they pick up, I say, “This is Dr. Fielding calling in one of my patients.”  I tell the ER doc, “I have a patient with a history of lung cancer here, who experienced a syncopal episode early this morning and now has a mandibular abrasion, swelling on the right side of his face and blood coming out of his ear.  I am worried about a fracture but also about whether he may have brain metastases that caused him to have a seizure.  He needs skull films and a CAT scan ASAP.  He will be at the ER by 8:30 pm.”   The ER doctor says to me, “Where is the patient now?” I say, “In the grocery store, with me.”  He says, “What?” I say, “In the grocery store.  He is my butcher.”  Silence on the other end of the phone, and then, “Tell me you’re kidding.”  I summon up my best authoritative voice, and reply, “I am not kidding.  We are in the grocery store and I am calling this in NOW.  Call me after the CAT scan.”  He says, “Yes ma’am!”

As it turns out, the butcher has a fractured jaw.  No brain metastases—it could have been a lot worse.  He will be fine.  And I am now the Madonna of the Meat Counter.  I hope I at least get some free dog bones out of this!