Moving Day

Two of my favorite people moved today. Well, actually one of them is a horse who thinks he is a person, and the other, my father. The horse, Norman, is a twenty five year old Lipizzaner who has been a family member for nearly seventeen years. Bred at Disneyland and born in May of 1988, Norman’s “fancy name” is Siglavy Deborah II, and he was raised and trained in a small but elite band of Lipizzaners stabled in Anaheim, California, their sole purpose in life to pull Cinderella’s carriage. When Norm was five or six, being a very smart horse, he figured out that if he leaned back in his traces, the other horses would do his work, and if he nipped at a guest, he didn’t have to go to work at all. And thus he was sold. He came to San Diego where he was retrained under saddle, which he evidently preferred. At her dressage trainer’s on a fine spring day, my daughter took one look at him with his pure white countenance and flowing mane and tail, and fell in love. What little girl wouldn’t want to be Cinderella? We’re still waiting on that prince.

 

My daughter grew up, and went to college, and then to medical school, and now is starting her internship in Internal Medicine in Boston. When she went away to college, we sold Norman with an iron clad buy back agreement to another young girl just starting her dressage career. When SHE went to college, we bought him back. At the time, having lost the paperwork, I couldn’t remember the price I sold him for. As it turned out, I paid more to buy him back than the girl’s parents paid for him. That joke was on me—but he was worth every penny. For the last several years, this highly trained dressage horse has been out to pasture in my back yard. He may be twenty five, but like my Corvette, he’s got low mileage.

 

A month ago my daughter finally agreed that his talents were being wasted, and we started to look for a person to be Norman’s person—to ride him, love him, groom him and fuss over him the way he deserves. She called her old dressage trainer, Tina Caldwell. Tina came over and rode him and despite his long vacation from saddle and bridle, he performed like the good little horse he has always been. Over the weekend, Tina called and said she had the perfect client who had just moved to town, and wanted to take some dressage lessons and have a nice horse to ride on the trails. She knew just the horse. Norman left today in an eight horse trailer, all alone in the big rig. He whinnied a few times for his buddy Dash, but loaded like a pro. He will never be sold again—he’s out “on lease”, but if he can make another person happy trotting down the trails and doing his rocking horse canter in the arena, he will honor all the years of his training, and after all, it’s not every day a girl, or a woman, gets to feel like Cinderella!

 

Coincidentally, today was the day my father had arranged for his movers to come. He has lived with me for the last six months, since my mother died and since he had an aortic valve replacement at the ripe old age of eighty seven. His condominium in Snowmass, Colorado is under agreement, and he has arranged to live at a lovely senior community very near where I work, called La Costa Glen. I am happy because he will be nearby, and given his recent health set-backs, this is a good thing. In horse years, my Dad is only a little bit older than Norman. Like Norman, Dad is far too young at heart to be put out to pasture yet. He is going to go where he can play a little bridge, a few holes of golf, and just possibly, take up painting again—a boyhood love put aside by the demands of an intense career in plastic surgery. Tonight I looked at the membership roster at La Costa Glen. It included four retired Admirals, and twenty five retired physicians and I pointed this out to my father, who decided immediately that it would be fun to do a weekly doctor’s lunch.

 

Though I will miss having them both at home, there’s life in these old boys yet!

All Creatures Great and Small

 

“He prayeth best who loveth best, all things great and small.

For the dear God who loveth us, He made and loveth all.”   Samuel Taylor Coleridge

 

A guest blog, tonight, from my friend Jackie Widen.

 

I find I really don’t like people who don’t love animals.  There, I said it.

 

I find it very odd and strange that the bonds we share with animals; whether they be furry or feathered, do not far out-weigh all the inconveniences (and yes, destruction) that our pets bring to our lives.

 

When I moved to Northern California in 2001 my fiancée was flabbergasted that I was spending $2,300 to ship my 12 year old mutt Lady, our 8 year old orange tabby cat Leo, and a calico-stray-who-adopted-us kitty we named Amigo until we found out that Amigo was really an Amiga, but Amigo still stuck.  The thrifty accountant such as he was proclaimed that we could have bought “all new” pets for that price.  I looked at him in amazement:  you have never truly loved a pet have you?  He admitted that despite owning many pets he had never loved one of them.  Well, I said, that is going to change.

 

The animals were picked up by a courier at my home in Houston in their brand new carriers, flown at night to San Francisco (this was summertime and it was deemed too hot to fly during the day) and then transported by a hired driver from the Cargo area at SFO to our home 60 miles North.  I admit, the last part involving a hired driver was a bit excessive – but for $100 it sounded cheap compared to the other costs of my move; and besides, the 4+ hour drive round trip to San Francisco was not appealing.

 

So the trio arrived safe and sound and settled in.  The dog and orange tabby immediately claimed the new couch.  Amigo claimed my soon-to-be husband.  He was a goner as soon as the routine was established every night when he arrived home from work.  Amigo would meet him in the kitchen, and lead him to his chair where he would sit down and she would curl up in his lap.  He was enchanted.  And he “thought” he didn’t like cats.  I explained that the only people who didn’t like cats were those who hadn’t fallen in love with one yet.

 

Once we had some dinner guests; the wife was preoccupied during the evening playing with our two kitties.  Oh I love cats, she declared.  Really? I said, do you have any?  Oh no, she said, I couldn’t own one.  Why not? I was puzzled.  Because, she explained, if I owned one and it died I would not be able to handle the grief, so I have never wanted to have one of my own.   That conversation has bothered me and comforted me over the years since because there were certain truths behind it – logical reasoning – but the variable in that conclusion is that the love you feel for that animal sustains you after they are gone.

 

These three pets eventually came to the end of their days.  To that Rainbow Bridge as some call it.   For Lady, she had a series of old age maladies — she was 17 - and she struggled to do ordinary things.   I felt hollow as I sat there in the vet’s office when they gave her that final “pink” shot.  But what a good life she’d had; what fun times we enjoyed and what milestones she marked while my 4 children grew up.  More hound than Lab which the Pound had described, she was nevertheless a part of our family until the end.

 

Amigo would love and love until the cancer she fought was just too much to bear.   My husband was the most torn apart by her decline as her need to curl up on his lap was more to keep warm as she had lost most of her weight fighting the disease and it must have felt nice to be snuggled every evening.  When I called him from the Vet to let him know the “pink” shot  had been our only alternative he wept on the phone.   As devastated as I felt there was a piece of joy within because he finally understood the bond of a beloved animal.

 

Leo had the best cat life, ever.  In 2008 he rode in our car back to Texas.   What an experience!  After living 8 years in Sonoma County, roaming in our vineyard and laying in the vines, he was back to where he started.  He did have a couple of good years.  But then he too reached the end of his rich life and became very sick.  I took him into our Vet who was a very nice young woman, fresh out of Vet School.  She babbled on and on about maybe doing exploratory ultra-sounds to examine the mass in his abdomen that had prompted his weight loss and lack of activity.  Maybe we could do this, or maybe we could have a consult with a Cancer specialist.  I looked at this woman with tears in my eyes and asked “This cat is 16 years old, he has cancer, and he is sick.  If this cat was your cat, what would YOU do?”  She paused and answered “I would put him down”.  I told her that honestly that is the answer most pet owners want to hear – the truth – because making that decision is so hard, and it would be nice to hear the Truth.  She agreed.

 

Later the next year when I brought in some foster kittens that we had found, I talked to her again.  She admitted that she remembered our conversation quite well and it helped her to counsel her pet-owners better.  False hope is useless – and expensive.

 

About a year after Leo passed away I was ready for a new animal.  It was time.  On a cold Sunday in December, my birthday actually, I dragged my husband to an Adoption Event.  I had decided I wanted a Lab.  What God picked for me, instead, was a black Belgian Shepherd who was christened Zoey.  She is the love of our lives.  It is a remarkable thing,  this loving animals.  The colors of life seem richer.

 

So for all of those folks who have avoided the expense, the inconvenience, the mess, the destruction, the fur on the baseboards and poop and puk on the carpets, for all of those awful things that come along with the joy of owning a beloved animal, I say too bad for you.  I’ll take the chaos anytime.  How lucky for us.

Mama’s Gonna Sing You a Lullaby

I have had patients and their families do strange things during a consultation.   Patients taking notes and recording what the doctor says are pretty commonplace these days, as are answering a cell phone and arguing with a spouse over what really happened while giving a history.  Some patients go to great lengths to disconnect from the process, filing their nails, or flipping through a magazine.   I’ve watched babies’ diapers being changed, snacks being eaten and business conducted by text messaging.  I have probably encouraged this informality—I have a consultation room furnished with a comfortable couch and chairs, with soft lighting.  I think it’s nice for patients to meet their doctor and nurse for the first time with their clothes on, as if they were home in the family room.  I thought I had seen everything, but I learned yesterday that I had not, because yesterday, for the first time in my career, a patient fell asleep during our initial consultation.

 

Now I am not saying that I give the most interesting speeches on the planet about the risks, benefits, alternatives to and side effects of radiation therapy.  In fact—a little confession here—I have given the spiels about the various treatments of prostate cancer and breast cancer so many times, that occasionally, just rarely, after an afternoon meal during the dog days of summer I have found myself drifting off mid-sentence and righting myself with a jerk.  Not very subtle, I know, but forgivable, especially during the early sleepless nights of motherhood combined with career.  No one has ever actually complained that I fell asleep during the consultation, so I suspect that my heavy nodding head and half closed eyes were taken as  Yoda like signs of wisdom and empathy rather than tactless boredom.  At least I hope so!

 

So yesterday was a watershed moment in my lifetime of treating cancer patients.  A middle aged woman, otherwise in excellent health, had been given the diagnosis of breast cancer after a routine screening mammogram.  She underwent a lumpectomy and was found to have ductal carcinoma in situ, the earliest detectable form of breast cancer, Stage 0.  She was referred to me for consideration of postoperative radiation therapy, and was seeing me for the first time with her husband accompanying her.  She was lucky—her cancer was detected so early that the likelihood of relapse was low, no matter what treatment she chose.  As I launched into my time worn discussion of her good prognosis, and the finer points of radiation therapy, she suddenly interrupted me, saying, “I just got back in the pool and swam for the first time since my surgery.  I love to swim.  It’s great exercise, but now I am really tired. Do you mind if I lie down on the couch here?”  There are many reasons why I am not a psychiatrist (see three previous essays on the subject for reference!) but generally speaking, I am okay with couches.  I said, “Sure!” and continued to talk.  As I neared the topic of CAT scan based treatment planning, to avoid treating her heart and left lung, I noticed that her eyes were closed.  A few minutes later, a slight snore escaped her lips. Her husband sat at rapt attention, but my patient was out like a light!

 

I am choosing to take this as a sign that she was very, very comfortable with me.  But in the meantime, I think it might be time to spruce up my dog and pony show, for sure!

Other People’s Money

I love to shop with other people’s money.  My father and I spent the weekend shopping to outfit his new apartment.  After living with me since January, when he was hit with the double whammy of my mother’s death and his own need for open heart surgery, he is ready both physically and emotionally, to strike out on his own again.  During our trip back to Colorado last week, we realized that there was very little, apart from his collection of Western art, acquired slowly over a lifetime in a labor of love,  that he could use.  Everything in their home there was exactly to my mother’s specifications, that is, feminine in tone and color, and scaled to the vast vaulted ceilings of a ski chalet.  It is all staying behind for the new owner.

My sister had tried to help with the outfitting of the new place.  She lives in close proximity to the Short Hills, New Jersey mall, where you can buy just about anything, including, last time I was there, a DaVinci Robot for robotic surgery.  Well maybe you couldn’t actually buy it, but you could play with it.  Hoards of teenaged boys stood in line to work the controls while their mothers vied for the latest Louis Vuitton.  I felt certain that between Crate and Barrel, Pottery Barn, and Restoration Hardware, they could buy what he needed in the air conditioned comfort of the mall, and have it delivered via the stores’ California warehouses.  But alas, the couches and chairs at these furniture stores, were all “special order”, meaning a six to eight week wait for delivery.  My father is a surgeon:  it goes without saying that he is not very good at waiting for anything. Just ask his scrub nurses.

So off we went to my own personal idea of shopping heaven, the Cedros Design District in Solana Beach, a place where I have had so much success in my own decorating efforts that not one, but THREE stores give me a decorator’s discount, though anyone who knows me will attest to the fact that I am no interior designer.  I just know what I like.  My eclectic repertoire ranges from simple Shaker wooden furniture to faux lux upholstered pieces that need only a Scottish deerhound draped elegantly as an accent.  Dad was game and had the high limit platinum credit card, which he jokingly explained to a baffled salesgirl that it was “just a little something I found on the sidewalk outside.”

One gorgeous distressed leather couch, a free form coffee table cut from a single slab of acacia wood, a leather covered burnished walnut desk and console fit for a Fortune 500 executive, a new queen sized bed with a padded taupe linen headboard, outfitted in high thread count linens in a cool beige, accented by a silk burgundy prayer rug on the floor later, Dad is nearly ready to move in.  The art collection will arrive in August, courtesy of an artist friend who is willing to make the drive from Colorado to San Diego and who will actually take CARE of the art.  I made the new bed in the new apartment today, stepped back and with my Dad, took a look at our work.  He said, “My new place is beautiful. Do you think it might attract any of the ladies in this place?”   He’s baaack!

I Want To Be Daenerys Targaryen

I used to want to be Lara Croft, of Lara Croft Tomb Raider fame. The sight of Angelina Jolie swinging from the rafters of the Croft Mansion in a black catsuit, and capturing the heart of Gerard Butler was more than I could stand. I even named a deerhound in her honor, Caerwicce’s Lady Croft, also known affectionately as “Angelina.” But that was before Daenerys, and Game of Thrones.

 

For those of you who lack the addictive form of television entertainment known as HBO, here is a quick synopsis. Long ago and far away there were seven kingdoms ruled by four main dynasties–the Starks, the Baratheons, the Lannisters and the vanquished Targaryens who ruled from the Iron Throne with the help of dragons. But now the world is dark, and the dragons have died long ago, and the ruling clans are at war, and as they say on the show, “Winter is coming.”

 

Into the fray steps a beautiful young woman, Daenerys Targaryen, the last survivor of her clan, sold into marriage by her greedy brother, and gifted by her new barbarian husband with a set of ancient petrified dragon eggs, pretty to look at but everyone knows that the dragons are extinct. She learns to ride a horse, learns to speak his language Dothraki, and learns to love her centaur-like husband. Upon his untimely death, she walks through the flames of his funeral pyre and emerges unscathed, with newly hatched baby dragons on her arms.

 

In short order, with an evergrowing retinue of devoted followers, and in a flowing blue silk chiffon gown accented by over the knee beautifully distressed brown leather riding boots, she begins her long march home, doing good and championing the oppressed as she goes. At the end of the third season, after winning a battle to free an enslaved city, she stands on the parapet and declares, “I am Daenerys Stormborn, Mother of Dragons, The Unburnt, and the True Queen of the Seven Kingdoms!”

 

Mother of Dragons, indeed! Here’s to heroic female figures in art, literature and film. Long may you reign!

What Is It With Kitchens?

The original title of this blog piece was CLEANING OUT THE KITCHEN.  I started it before I went to Colorado to clean out my mother’s house, and specifically her kitchen.  It began: You know those old circus acts where a tiny car pulls up on the stage and then people and dogs start coming out and they just keep coming and coming and you keep thinking, “There is NO way all of those dogs and people could have fit in that tiny car!”   Apparently that is my kitchen.  And my mother’s kitchen, and probably the kitchens of a whole lot of other people I know.  As it turns out, there seems to be a universal appeal of kitchenware and gadgets acquired, but not truly needed.

I found enough material in my mother’s kitchen to completely outfit at least three kitchens.  There were two sets of everyday china, two sets of stainless steel utensils, two sets of pots and pans, and multiples of nearly every baking dish and tray known to man.  There were two Cuisinarts, a large old one and a small new one, entirely unused. An ancient and lonely MixMaster was tucked into a corner cabinet and extra bowls for it were curiously stored in the guest bedroom.  Two Osterizer blenders stood ready for service and there were hors d’oeurvres trays of every size and shape, Tupperware beyond reason, and a lovely set of glasses emblazoned with ground glass butterflies that I had never seen before, tucked in a cabinet above the cook range.  There were two sets of fine china, both of which I remember from Thanksgivings as a child, and an additional set, a curious sky blue patterned with tiny gold stars that I had never seen.  Good knives were in conspicuously short supply, lending credence to the idea that my mother did not actually COOK, at least not in recent memory, confirmed by a new rolling pin sheathed in its original cardboard wrapper. My grandmother’s silver, monogrammed and polished, resided next to my mother’s Grand Baroque service for twelve, including ice tea spoons.  Who actually uses ice tea spoons?  The silver tea service perched on the buffet was a relic from a bygone era, more genteel, more civilized, when folks actually had sit down dinner parties, and real conversations while seated uncomfortably next to someone other than their spouse.

Before I left for Colorado, I had the entire interior of my house painted for the first time in fifteen years.  I decided to paint the old stained and worn oak kitchen cabinets a light cream color, which necessitated removing all of the kitchenware from them.  In cleaning out my own cabinets, I gave away a brand new Crock Pot, never used, a juicer, also never used since I can buy fresh squeezed orange juice at my local market, a Quesadilla maker (yes, they exist), a George Foreman grill, a toaster abandoned in favor of the panini maker, and what was left of the cracked and chipped everyday dishes I’ve used since getting married over thirty years ago.  Everything else was loaded into boxes, to be lovingly replaced in an organized fashion upon my return.  Tonight we grilled salmon and steak and served them up on a set of my mother’s old china.  The boxes are still packed and seem likely to remain so.  Four boxes were mailed from Colorado to my son and his girlfriend setting up house in Washington DC.

I am continuously amazed at truly, how little we actually need of all of the things that we have accumulated.

The Road Warrior

Those who know me know that I am no stranger to traffic school.  My last session, in January, had to do with a disagreement with a camera perched on top of a traffic signal on my way home from work.  I said, “The light was yellow.”  Unfortunately the camera disagreed.  Bad news, good news—that self same camera, while capturing an image of me in my big red Suburban perfectly, did not capture the cell phone held up to my left ear.  I paid my dues and did my time, and I did not cheat on the test.

 

And so it was no surprise today, after only three hours on the road out of Cedar City, Utah headed towards Las Vegas, when I saw the flashing blue and white lights behind me, signaling me to pull over.   I was six hundred miles into a nine hundred and seventy mile road trip transporting my father, and his Volvo, back from Colorado to San Diego.  The officer said, “Ma’am, do you know how fast you were going?”  I said, “I don’t know Officer, I think about 80?”  He replied, “No ma’am.  I clocked you at ninety miles an hour.”  My father, in the passenger seat, piped up helpfully, “I thought you were going a little fast when you passed him.”  When I passed him? Thanks, Dad.  The officer looked at him, still a bit pale three months after open heart surgery at nearly 88, then at the heat shimmering up from the road and sighed.  He said, “The speed limit in Nevada is 75.  But I’m not going to give you a ticket today.”  Since he had K9 Corps emblazoned on his uniform, I felt compelled to chat him up about his dog.  He waved me on my way.

 

Between helping my daughter drive from Texas to Boston Memorial Day weekend, and now traveling from Colorado back to California, I figure I will have passed through seventeen states in three weeks—not bad for an old road warrior.  It’s hard to stop and smell the flowers when you’re driving 500 miles a day.  But last night, at a truck stop near Moab, Utah, I captured a perfect western sunset through the lens of an iPhone, the twin rain shelters over the pumps framing the darkened silhouette of the convenience store behind them.  I was reminded of taking this same route nearly seven years ago with my then sixteen-year-old son.  As we headed east from St. George on his first trip through the West, my son said to me, “Mom, now I see why this country is worth fighting for.”   He was right.  I think I’ll just slow down.

I Am Easily Charmed

There has been some confusion around the office due to the fact that my partner became suddenly ill, and it was important that the patients on treatment be seen once a week.  In addition to my own patients, I had seen all of his three weeks ago while he was on vacation, so I had a working knowledge of most of them, their cancers and the problems they were having during treatment.  Still, there were new patients to be seen, simulated and treated and it seemed that the most logical division of labor was for me to see the new patients, and the substitute doctor to see the old patients, many of whom were close to the end of their treatments.  It seemed that way anyway.

So when my partner’s nurse asked me to see a prostate cancer patient belonging to my partner this morning, I asked, “Didn’t Dr. Substitute see him yesterday, as she was supposed to?”  Our nurse answered, “She tried, but he wanted to see you.  He remembered you from three weeks ago. He is at the end of treatment.”  I said, “Okay, just this one time, but I will NOT see him in follow up.  He can return to his urologist for follow up as long as his PSA normalizes.”  A moment later, I was in with the patient, a kindly elderly man who described not his side effects and symptoms, but the fact that yesterday he went to the San Diego Fair with his two daughters, and what a delight it was that he got to spend time with his adult daughters alone without his wife.  Apparently this is a yearly ritual. We spoke about the art exhibits, the rose growing competition, and of course, the fried food.  I thought to myself, “Maybe Dad would like to go to the Fair.” I exited the room twenty minutes later, proclaiming to the nurse, “Okay, I will see him ONE time in follow up.  Just ONE TIME!”  She smiled.

At the end of the day there was another.  Just started on treatment, this prostate cancer patient had missed his on treatment visit yesterday because Dr. Substitute had to leave.  The nurse warned, “He’s a bit chatty.”  I entered the room, whereupon he declared, “No cancer patient is truly cured.  I just hope I outlive my cancer.”  This was a challenge indeed.  Despite the fact that I was quite certain my partner had already had this conversation with the patient, I felt the urge—no, the COMPULSION—to tell this patient of the multitude who indeed I had cured over a thirty year career.  It was a long conversation.  We both enjoyed it, heartily.  I added another patient to my roster.

What is it with these prostate cancer patients?  We have a mutual admiration society.  And I hear that the word on the golf course is, I give the best “finger wave” in the business.  Just sayin’…..

I Had a Brother

Sometimes it’s the little things that trigger the memories.  A few weeks ago, when those young women who had been abducted in Cleveland were found, almost by accident, my father said to me, “I don’t believe this story.  It’s impossible that these women could be locked up for all those years and no one ever heard them, or saw them.”  I lashed out in anger, “Dad, there are BAD people in this world, whether you want to believe it or not!”  I went on, “Don’t you remember when Joel and I were little and you and Mom would be getting ready to go out on a Saturday night, and you sent us across the grocery store parking lot to the drugstore soda fountain to get dinner?”  My father was a plastic surgery resident then, and we lived, the five of us, in a two bedroom apartment in a complex next door to the A & P.  I was seven and Joel was five and I had a job–no, a DUTY to make sure that the server did not put mayonnaise on his hamburger.  He wanted it PLAIN and that was that.  I said, “Something TERRIBLE could have happened to us and you and Mom didn’t care.  You just wanted us out of the way so you could get ready.”  My father had no recollection of this whatsoever, and it occurred to me that perhaps he wasn’t even there.  Perhaps he was still at work, sewing up lacerations and dog bites and victims of car accidents.  There were no actual memories of him, only of my mother, sitting in front of her vanity, applying her make-up.  She was beautiful, my mother. While she put on her make-up, my little brother stole candy from the drugstore.

My brother spent his life between drug rehab facilities and prison, with brief moments of hopeful sobriety in between.  We stopped speaking for a very long time after he cashed in the ticket my parents sent him so that he could be best man at my wedding.  He spent the weekend in Las Vegas gambling.  He didn’t bother to call.  When our grandmother died a few years later, we met in Chicago at her tiny apartment just before her funeral.  When my father asked if there was anything of hers that we wanted, he replied, “I checked the silver.  It’s under the bed.  It’s plate.”  My brother survived car accidents, a bad marriage and the AIDS epidemic.  He was handsome, smart and charming.  You just wanted to believe him when he said that things were better, that he was getting along  fine.  His eyes were cornflower blue, and my favorite picture of him was taken when he was eighteen.  He was sitting on a ferry boat on the way to Anacortes, wearing a blue shirt.  In the picture, the sky is gray, and he looks young, and sad.

In 2003 my brother died of an accidental heroin overdose in a flop house hotel in Portland, Oregon.  Apparently, he had been shooting up with a friend, who was recently released from prison and was on probation.  The story I got was that the friend knew that my brother had overdosed, but fled rather than call 911 and risk going back to prison himself.  It was a few days before they found my brother’s body. I don’t remember much about the funeral, except that it was late fall, and turning bitter cold.  I still miss him.

The other day I was rifling through drawers in my office, trying to find an article I had saved about melanoma.  I had to pull out some old framed family pictures that were taken off my desk top during some construction in the office, and put in the drawer for safe keeping.  I showed the medical student the pictures of my kids and we had chatted about my sister and he asked, “Do you have other siblings?”  I replied, “I had a brother.”

Weights and Measures

The sudden illness of a colleague is always a shocking surprise.  As physicians, we are trained from an early age to ignore our own infirmities in the service of others.  Apart from my three C-sections, I have been extremely fortunate in terms of my own health—I can count the number of sick days I’ve taken in the last thirty years on one hand and I am thankful every day for that blessing.  In my day to day world of caring for cancer patients, I know that in an instant, by accident or by sickness, everything can change.  I think that my colleague must have felt the same—that calling, that mission to care for the stricken that leads one to suppress the rising signs of illness in order to keep that black curtain of infirmity a little further to the edge of the window frame of life.

On Monday I learned that the man I have grown to respect for his insight, his dedication to his profession and his kindness would likely not be coming back to work, ever. My entire department was devastated, especially his nurse who has worked so closely with him for the eighteen months he has been with us, and also his patients, each of them with cancer,  who asked me one by one when they saw me for their weekly on treatment visit, “I am so sorry to hear that he is ill.  When is he coming back?”  As the realization of the gravity of his illness slowly came to all of us, since he had not shared the knowledge of his disease with any of us, the weight began to descend.  Our patient load is at its highest, our working hours are extended, there are patients waiting to be seen, planned and treated.  Who will step in to consult on these patients, to plan their radiation treatments, to oversee their side effects and work the extended hours?  Right now, we do not know.

I have always said that unlike my father, I do not want to “die with my boots on.”  I want to retire while I am still healthy enough to do the things that I’ve put off for so many years—to write, to paint, to take photographs, to teach English, to travel, to play with my dogs, and perhaps, just perhaps, get another horse—an older horse, a calm horse (we grow so brittle as we age that we break more easily!) who will carry me down the trails so that I can smell the orange and lemon blossoms on the trees, up close, as they bloom in late December here.  I said this to my husband last night, at the end of a very long week.  He said, “No one ever knows what they will do when faced with a terminal illness.”

This was a very busy week in the clinic, and I had a medical student rotating with me. In the chaos that surrounded us, I had to keep reminding myself, first things first. Yesterday, together we saw a man with a life threatening cancer.  I was running very late, and he was the last new patient of the week.  My student took the reins—he interviewed the patient, examined the patient, explained the treatment and seamlessly introduced me to the patient and his wife, who were quite pleased with the care and attention he had already received. We completed the consultation together, and as I left the room I suddenly felt a deep sense of satisfaction.

When the weight of illness suddenly descends on an individual, my colleague, and consequently, his patients, his co-workers and me, his partner, we can still take comfort in the small measures of success–the satisfaction that we, as a team, are doing things right.  Sometimes it’s the little things, the small gestures and kindnesses that count.  We dust ourselves off, and we go on.