Monthly Archives: July 2013

We’re Going to a Dog Party!

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When my kids were small, one of their favorite books was by P.D. Eastman.  Written in 1961 and entitled, “Go Dogs Go”, it was the story of a great migration of dogs, some in cars, some in buses, some on foot, some wearing pretty hats, and some not.  Where were all those dogs going?  You don’t find out until the end, when the secret is revealed.  They were going to a DOG PARTY!  A BIG DOG PARTY!  And when they got there, they were going to have a lot of fun.

And so, last Thursday, I loaded my van and headed off to Lompoc, California, home of Vandenberg Air Force Base, flower fields that supply most of the florist shops in California, and for Scottish Deerhound enthusiasts, the biggest annual dog party on the West Coast. I’ve gone every year to this big dog party since 1995, and most years I show my dogs there.  This year, however was different—this year I left my dogs at home.  My oldest deerhound is nearly nine years old—old for a giant breed dog– and the stress of leaving home, being groomed for show, living for a few days in a hotel room with only short leash walks for exercise was an experience he did not want or need.  My two younger hounds, the Q sisters Queen and Quicksilver, completed their AKC championships and Grand championships long ago.  They’ve won their trophies, and certificates, and the right to rest on their laurels.  Besides, all I have to do is wave the nail clippers in their faces and they go into full on Heart of Darkness mode—“The horror!  The HORROR!”  I thought about taking my tiny rescue Chihuahua mix, just for company, but remembering that he is a screamer when I am out of his immediate sight and earshot, I decided to do everyone at the hotel and show grounds a favor, and left him home too.  So off I went, camera in hand, to a dog show.

When the Christopher Guest movie, “Best in Show” came out a few years ago, I thought it was one of the funniest satires of the dog show world I could ever imagine.  Not so, said my dog showing friends.  They were appalled.  They said, “We’re NOT like THAT!”  They were wrong—we’re just like that, only more so. To this day, I enjoy quoting bloodhound man Harlan Pepper’s monologue about how he drove his mother crazy reciting a litany of nuts:  “Pine nuts….macadamia nuts…walnuts…pistachio nuts….RED pistachio nuts…”  If you haven’t seen the movie, please do, because I promise you will be entertained, even if you don’t particularly like dogs.  God may love a terrier, with its cute little derriere, but don’t ever think that’s the whole story behind why we go to dog shows.

At our annual deerhound dinner on Friday night, my table companions were a military software tester who is also licensed to drive 18 wheeled tractor-trailers, an architect who builds airports, a former Oklahoma City cop who spent the last several years in Iraq training bomb sniffing dogs, a saxophonist who doubles as a librarian during the day, a former lead singer in a punk rock band who now teaches school in inner city Los Angeles, and his wife, a well-known photographer of rock stars.  I don’t meet people like that in my regular life as a radiation oncologist.  But better yet, on Friday afternoon as I was sitting in the deerhound booth selling raffle tickets to raise money for next year’s trophies, I was approached by a reader of this blog, who said, “Can you direct me to the doctor from San Diego who blogs about dogs and treating cancer?”  That would be me, I said.

When real life intersects with my sometimes feeble attempts to explain what it is that I do, and how I feel about it, there’s the reward.  As P.D. Eastman said, “The red dog is in.  The blue dog is out.”  It doesn’t matter.  We all love our dogs.  It’s the people I’ve met through the dog show world, and now, through this blog, that make it all worthwhile.

I Am Gullible

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When we bought it fifteen years ago, the realtor kindly referred to our home as having a lot of “deferred maintenance.”  In Southern California speak, this meant, “Honey, it’s a tear down.”  We didn’t care.  The house is on three acres of land, ten minutes from the beach—absolutely perfect for three rambunctious children, the four Scottish deerhounds we had at the time, a couple of cats and other assorted critters.  Most importantly, it was a place where we could keep our horses at home, and from our own driveway access the miles and miles of horse trails in our little town.  The boys, sometimes in play and sometimes in anger punched holes in the cheap hollow construction doors; the new puppy chewed right through the drywall in the garage; the roof leaked constantly during our brief winter rainy season and any hint of dampness caused the eau de long gone cat and dog to rise aromatically from the worn carpet.  It was our little piece of paradise.

But even in paradise, you can only put off repairs for so long and eighteen months ago, when traces of mold began ominously to appear between the rafters of the vaulted ceiling in the living room, we knew it was time.  We hired professionals to get rid of the offending black stuff, then we hired roofers, then a painter and then one thing led to another.  After listening year after year to contractors who insisted that there was NO money worth putting into the old place, and that we should tear it down and rebuild on our lot—never mind the fact that we were putting three children through college by then—I took matters into my own hands and hired a handyman, recommended by a disappointed contractor who insisted that the $65,000 that he was asking to redo the kitchen was a bargain we should be grateful for.

Buoyed up by what a fresh coat of paint and some decent hardware did for my old kitchen cabinets, I decided to attack the hallway bathroom next.  For those of you who have been here, this is the 1960’s bathroom covered in orange and yellow flowered tiles on a brown background. Despite the overwhelming urge that I felt to sing the chorus of “Let the Sunshine In” from the musical “Hair” every time I sat on the toilet, I literally took the plunge and hired Bath Planet.  The salesman was good, very good. He convinced me that all I had to do was pick out a fake marble pattern from his handy notebook computer, and he would take measurements, and my new bathtub and surround and new countertop would be fabricated custom, just for me, in a factory somewhere outside of Chicago and when it arrived, all in one piece, the installers would drop by and just pop it in right over the old tub and ugly tiles.  He said it would take about three weeks to receive my new bathroom, and just a few hours to install it.

That was nearly six weeks ago.  The installers came Wednesday, two hours late, with what looked like large sheets of plastic.  It took them the first three hours just to “prep the bathtub.”  The prefab liner fit, but when they went to install the side and back wall of the shower, they discovered that the back piece was cut two inches too narrow.  Apparently the salesman was not good with a tape measure.  The orange flower tiles peeked out hopefully from behind the fake marble.  We stared incredulously and it was not a pretty sight.  The plastic pieces were shipped back to the factory today and there are gaping holes in the walls where the tub faucet and shower head are due to be installed.  No one can tell me when they will arrive and whether they will fit when they do.  And, oh and don’t you know, the shower doors have to be fabricated separately, by a shower door guy, but that can’t happen until the surround is in.  It looks like we’re in for a long haul.

My mother used to say, “You get what you pay for.”  My husband says, “The nicest thing about our house is our beautiful pre-fab barn.”  They both always told me, “You are SO gullible.”  Right on all counts!

There’s Hope For The Rest of Us

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This morning I had the opportunity to speak about radiation oncology before a group of high school girls in a program called BeWISE, which stands for Be a Woman In Science and Engineering.  The organizer of this morning’s seminar had purposely chosen an all- woman faculty, so that the students would get an opportunity to mingle with and question those of us who had chosen the pathways of scientific research and medicine.  During a break in the program, these two conversations were overheard.

From an accomplished female radiologist who is married to one of the country’s greatest gastrointestinal cancer surgeons—“I was picking up my husband downtown at a conference with the kids in the car and as my husband hopped in, another speaker at the conference leaned into the car window and asked my daughter if she wanted to be just like her dad when she grew up.  She said, “No, he’s just a SURGEON!  I want to be a Doctor, like Mommy”.”

From a female gynecologic cancer surgeon, also married to a physician—“I took my daughter to work on Take Your Daughter To Work Day.  We were in the OR, all scrubbed and ready to go, and my scrub nurse said, “Do you want to be a doctor like your Mommy or like your Daddy.”  She said, “I want to be a MOMMY, like my Mommy.”

Whether we identify our busy lives with respect to our children as “benign neglect,” or whether we prefer to think of ourselves as allowing—no– EXPECTING our children to “step up” and take more responsibility for their schoolwork, their pets, their siblings and the household chores, we must be doing something right, ladies!

The Adventures of Dad, Continued

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If you’ve been following this blog for a while, you’ve probably figured out that my father is one tough old bird.  He was my grandmother’s first born son, and was yanked forcibly from his mother’s womb a month prematurely via a forceps delivery after her water broke.  As a result, his left brachial plexus was damaged, leaving his left arm paralyzed.  By good luck and sheer determination, the paralysis was not permanent and he went on to graduate from high school at 16, attend college and dental school, join the Navy, decide he didn’t like being a dentist, go to medical school, and ultimately become a world renowned plastic surgeon. It’s been a tough act to follow, that’s for sure.  There are two things I remember vividly from my childhood—the first is that wherever we went he was always on the lookout for imperfection in the faces of strangers, and never hesitated to let us kids know how he would fix such imperfections.  The second is that he was an artist, in real life and not just in the operating room.  In this age of computer modeling, it is hard to remember that there was a time when my father would see a new patient in an exam room, study her profile, sketch it on the white exam table paper, and proclaim, “This is how you look now.”  He would then draw an idealized portrait next to the first sketch and state triumphantly, “And THIS is how I will make you look!”  If you think there was a single patient who could resist that kind of sales pitch, think again.

If ever I was going to doubt my father’s resilience, it was this year.  When my mother passed away in January after a long struggle with dementia, he promptly went into congestive heart failure from a stenotic aortic valve.  Ten years after his coronary bypass surgery, he had a second open heart surgery to replace the valve.  When we all realized that he could no longer tolerate the altitude of his retirement home in Snowmass, Colorado, he decided to move to San Diego, living with me while we sorted out his health issues.  After the heart surgery, he began to chafe for his independence, but was also not confident of his ability to meet new people, make new friends and start over at the age of 88.  We urged him to at least try, and so, two weeks ago he moved into the lovely retirement community of La Costa Glen in nearby Carlsbad, California.  The first week was a bit rocky—at one point the community lost electricity, and I had forgotten to supply him with simple safety gear—a flashlight, some candles.  He worried that he could not remember the name of every new person he met, until I reminded him that the reason La Costa asks its residents to wear their name tags is that no one ELSE could remember HIS name, either.  Sometimes I can’t even remember my own, these days.

Yesterday however I knew he had turned the corner.  He spoke excitedly about a dinner party he attended on Friday night, and about the bridge games he was playing, and about the Great Ideas sessions that the community holds where residents who are retired from all walks of life can discuss the nation’s problems, and potential solutions.  But the truth was revealed when he whispered conspiratorially over the phone, “And a lady has already asked me to partner up!”  I said, “Partner up?  What does that mean?”  He said, “You know—each person has their own living space, but you do EVERYTHING together, meals, activities, and ….you know!”  I said, “Dad, you’ve only been there two weeks.  You are going to have to beat those ladies off with a stick!  You need to play the field for a little while before you partner up!”   He laughed.  It’s good to know that life begins at eighty eight!

The Ninth Life

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They say that cats have nine lives.  If ever that saying was true, it applies to our Timmy Tom who started his ninth today.  Thomas will be eighteen years old in September, and a week ago I thought he was a goner. In truth, when I look back, his eighth life started about a year and a half ago, when he began to make peculiar noises, particularly at night.  My daughter was housesitting with her boyfriend while we were in Africa, and she emailed me to say, “What’s with Timmy Tom?  He walks around yowling all night.  I think he is possessed.  My boyfriend calls him Devil Cat.  Should we call an exorcist?”  Indeed, his cries at night were enough to wake the dead.  But he was eating and drinking well, and producing copious amounts of excrement as befitting a 20 pound yellow tabby, deposited in the proper place—his litter box.  After careful inspection and palpation of various body parts finding no particular tender areas, we gave it no more thought.

In August of last year we were visited by two friends who happen to be veterinarians, here in San Diego for the big veterinary society meetings.  They too were treated to the loud vocalizations emanating from our cat, at which point Margaret said, “He must be hyperthyroid.  It’s one of the symptoms of hyperthyroidism in elderly cats—they make a lot of noise.”  She examined him and listened to his heart and pronounced it normal, without the loud galloping rhythm associated with an overactive thyroid. He was sleek and fit (and maybe just a little bit fat!)  We got used to the noise—after all, in a house full of animals a few extra vocalizations at night were nothing to lose sleep over.  It wasn’t until this spring that the cat began to lose weight—just a little at first, nothing too alarming.  But the weight loss combined with an obsession with the dogs’ enormous water bowl (not to mention my toilet) led me to conclude that perhaps he was diabetic.  I took him to the vet, who drew blood and pronounced that he was not diabetic, however his thyroid level was sky high.  Never mind—there’s medication for that, as long as you can catch your cat to administer it.  Cats are smarter than dogs—there’s no such thing as concealing a pill in a chunk of cheddar cheese.  Thank goodness for methamizole cream, administered on a gloved finger inside the ear.

Ten days ago I thought the jig was up.  Each morning I was presented with a gift—I won’t bore you with the details but suffice it to say that my bathmat will never be the same.  The emergency vet last Saturday concluded that the intra-aural administration of medication was unreliable and that Tom’s thyroid needed better regulation.  He got fluids and we switched to the pills.  He did not get better.  On Wednesday, I took him to his regular vet, who examined him and found an abscessed tooth.  She drew blood work too, but it was too late in the day to send it off for analysis, and I had to wait until after the July 4 holiday to get the results.  The covering vet called me yesterday to say that his white count was 20,000.  Twenty thousand?  Yikes!  My own white count wasn’t that high when I was hospitalized with MRSA.  My husband and I swung into action.  We gave the cat antibiotics.  Which antibiotics?  The ones leftover from the little dog who passed in December.  We are nothing if not economical.  Antibiotics in this household are never wasted.

Timmy Tom woke up today a new cat.  He sauntered into the kitchen and demanded his chicken breast for breakfast.  He got that and more—some grilled ahi tuna left over from our holiday barbecue.  He drank deeply from the dogs’ giant water bowl and from the toilet.  And my bleached and laundered bath mat remained unbesmirched.  Cue a distant chorus of “Memory” from the musical CATS—“Daylight, I must wait for the sunrise, I must think of a new life. And I musn’t give in. When the dawn comes–Tonight will be a memory too.  And a new day will begin.”  For Timmy Tom, the ninth life has started.

Why Doctors Should Be English Majors

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In early May, I was lucky enough to receive an invitation to see a production of “The Tempest”, by the Hobart Shakespeareans, a fifth grade class led by renowned elementary school teacher Rafe Esquith.  The production was scored, lit, set and acted by inner city ten year olds who, lacking funds for elaborate Elizabethan garb, all wore the same T-shirt emblazoned by an image of William Shakespeare, with the simple slogan “Will Power.”  I wrote about my experience in the blog piece “Such Stuff as Dreams Are Made On.”  Two weeks ago, an op-ed piece by Verlyn Klinkenborg in the New York Times decried “The Decline and Fall of the English Major: http://www.nytimes.com/2013/06/23/opinion/sunday/the-decline-and-fall-of-the-english-major.html?ref=opinionHYPERLINK   As I read it, I reflected on my own experience in medical school and beyond, and I think that Mr. Klinkenborg’s message is one that medical school admissions committees should be hearing loud and clear.

Despite the fact that doctors are faced with increasing mounds of paperwork and decreasing autonomy, medical school admissions are as competitive as ever. All handwringing about the state of the profession aside, young people still desperately want to be doctors.  Students who would vie for a coveted slot in medical school must start their resume building early in their college careers, and must complete with flying colors a standard premedical curriculum which with rare exception has not changed one iota since I applied to medical school in the fall of 1974. Students who major in the basic sciences—biology, chemistry and physics—have an advantage in the race for med school admission because they typically outperform other majors in their MCAT scores and because their majors allow them to get a leg up in scientific research.  In many cases, college students who are science majors apply for medical school with first author publications listed on their curriculum vitae.  And at the end of medical school, students who have taken the time to obtain a dual MD-PhD degree are the ones who are most competitive for those coveted specialties of dermatology, plastic surgery, orthopedic surgery and radiation oncology where the prize at the end of the road is a controllable “lifestyle” combined with high reimbursement.

But even in the rarified world of first author scientific publications in peer reviewed journals, there is that moment of truth, when push comes to shove, and a group of editors must decide whether to publish the paper of one author, or someone else’s.  No matter how brilliant the tables and graphs, in the end that decision will be made on how well the author EXPLAINED the data, how compelling was the argument, and how explicitly the new data informs both the reader and the greater body of work on the subject.  In the end, this is where those former English, and history, and philosophy majors shine, and surpass their basic science background colleagues.  Just ask Dr. Harold Varmus, the current director of the National Cancer Institute, Nobel Laureate, and possessor of both undergraduate and graduate degrees in English from Harvard.

This week I worked with an excellent medical student.  He was bright, personable, and thorough and the patients truly enjoyed speaking with him.  We saw six or seven new patients together, and here is an example of the narrative on the physical exam on one: “ABD: SFT, sMS, NTDR, NABS, NHSM.” Say what?  For the non-MD readers out there, that means that the abdomen was soft and non-tender with no masses, abnormal bowel sounds and no enlargement of the liver or spleen. In this fast paced world of texting messaging and abbreviation, this old English major would like to see her own life history and physical exam written in English, please!   Why does this matter?  Colum McCann said it well in Let the Great World Spin:  “Literature can remind us that not all life is already written down: there are still so many stories to be told.”  Very few doctors will ever win a Nobel Prize.  But all of us should be able to tell a patient’s story, tell it well, and make sure it’s worth listening to.  After all, it could mean the difference between life and death.