The Thundershirt

“Thunder and lightning, very very frightening–me”  Queen

When I woke up this morning, they were already at it, and I walked into the kitchen and immediately slipped in a large pool of saliva that had apparently been dripping from the mouth of big Magic, my 125 pound scaredy cat Scottish deerhound.  When I say “they”, I mean the tree workers who are up in the giant eucalyptus trees which blanket our property—I would call them arborists but I know better—they’re just very brave guys willing to climb up 100 feet with a chainsaw in hand to hack off the large branches hanging over the house, the horse pastures and our driveway.  Tree work is expensive, and the eucalyptus grow like weeds.  They need to be trimmed every three to five years minimum, and since there have been many other things I needed to spend money on in the last ten, namely, putting children through college, those gargantuan trees had had a bit of “deferred maintenance.”  Sometimes I need to be smacked in the face to pay attention to what is right in front of me, and this is exactly what happened the weekend before I left for Jamaica.  We had what is known around here as “Santa Ana conditions”, where a hot wind blows off the desert from the east, instead of our usual cool ocean breeze from the west.  As leaves and debris flurried like snow, I went out to check on the horses, and heard a crack.  I put my hand up to shield my face from the falling branch, and received the force of the limb with my hand and arm, which were nicely black and blue by the time I arrived in Kingston.  Three weeks later, the chain saws are still singing.

Magic has been afraid of fireworks and thunder since he was a puppy.  The first Fourth of July celebration came when he was eight months old.  As I heard the sound of fireworks, I went outside to call the dogs.  Magic was nowhere in sight, and a thorough search of the property found him shivering and wet, hiding under the bridge over a small creek that flows through the back of the property.  We brought him inside, dried him off and tried to comfort him as best we could.  As he aged, his fears escalated and translated into terror of every large repetitive or continuous noise, to the point where we just stayed home any time we knew there would be fireworks. Fortunately thunderstorms are rare in our neck of the woods, but holidays were problematic, and the usual solutions—closing the windows, playing music loudly to drown the sound, Bach’s Rescue Remedy—were only partially effective. Two years ago when we had a new roof put on the house, the constant hammering and banging overhead put old Magic over the edge.  His fears became uncontrollable to the point where we thought he would hurt himself so in desperation I called my veterinarian for tranquilizers.  She said, “Have you tried the Thundershirt?”

If you are familiar with Temple Grandin’s work, you will know that she is autistic, but with a unique gift which allows her to empathize with the way frightened animals feel and think.  Her designs for humane slaughter of cattle have revolutionized the traditional way that our food animals are led to certain death.  When she was young, she used to comfort herself by enclosing herself in a homemade device which literally held and squeezed her between two walls.  The sense of enclosure, and pressure calmed her panic, and allowed her to function in college and subsequently in society.  The inventors capitalized on the same concept—that perhaps being wrapped tightly in a stretch jersey fabric fastened with Velcro would calm a panicked dog.  We bought one for Magic, just before a scheduled visit to the East Coast and left my adult son in charge of our household with instructions to put it on the dog if he became anxious with the roofers.  A couple of days later, I called to ask how things were going at home.  Brandon replied, “Mom, he comes to me and begs for his ‘special shirt.’”

I arrived in Jamaica to find the rainy season in full swing.  Unlike San Diego, when it rains there the lightning flashes brilliantly across the darkened horizon and the rolling thunder cracks are bone shaking. My host Dr. Spence has four adult Catahoula Leopard dogs, and the dominant male Ludie was like Magic on a very bad thunder day, whining, trembling and salivating.  I told her about the special shirt, and she wrapped him tightly in a blanket, which seemed to help a little bit.  Today as I cleaned off the slimy floor, and pulled out the gray jersey Thundershirt and wrapped up my dog, it occurred to me that maybe this is not such a novel concept after all.  Maybe when we are faced with scary things beyond our control, all that any of us need most is a tight hug from someone who cares.

The Face Of Hope

With special thanks to Dr. Dingle Spence.

Thirty three years ago my husband and I went to Jamaica for a belated honeymoon.  We got married on the last weekend of my internship year, and immediately flew back to Boston for me to start my second year of internal medicine training.  Seven months later in the dead of winter, we flew to Jamaica to a lux resort in Ocho Rios where I spent a blissful week drinking sweet rum laced drinks and sleeping them off on a white sandy beach where the water was warm and turquoise, a far cry from the sodden gray snow banks of Massachusetts. We managed to get into the town once, long enough for me to buy a wood carving of two lovers kissing, made from Lignum Vitae, the national tree of Jamaica.  The sculpture still sits in the window by my front door.

Two weeks ago I finally had a chance to go back to Jamaica, as the invited guest of Dr. Dingle Spence, radiation oncologist and palliative care/oncology specialist at the Hope Institute, a small cancer hospital run by the Jamaican Ministry of Health.  I was there for two working days, spending the first at the large urban Kingston Public Hospital, a 500 bed hospital which houses the only government funded radiation oncology unit on that side of the island.  In the morning we did teaching rounds with the ear, nose and throat surgical team, along with the residents and medical students.  Patients and their families waited outside our conference area and were brought in one at a time, to be examined and questioned by the team such that each had our full attention. Several patients had advanced disease, and I learned that one major problem is that the pathology department is overwhelmed with cases from all over the Caribbean, and that oftentimes it takes two to three months to get a pathologic diagnosis.  By that time, many cases have progressed so far as to be incurable with the resources at hand.  Still, the dedication of the team, and in particular that of the head surgeon Dr. Natalie Whylie was very apparent and heartfelt.

That afternoon, I had the opportunity to see several patients with Dr. Spence—all with various forms of advanced lung cancer requiring radiation to palliate symptoms of shortness of breath, and hemoptysis—coughing up blood. Simulation at Kingston Public Hospital is done the old fashioned way—by taking an X-Ray with markers on the skin in the approximate area of the tumor, then shifting the “field” to match the tumor accurately. On that day, all of the X-ray machines in Radiology were in disrepair, and non- functional.  We escorted the patients to the Emergency Ward, where the radiology tech told us that the ER was too busy, and that we would have to come back later.  All three men, quite ill from their cancers, took a seat in the waiting room without food, water or complaint.  Three hours later, when we were called back to do the simulations, they were still there.  We simulated each in turn, then escorted them back to the radiation department, where they waited some more until it was their turn to be treated on the Cobalt machine later in the evening.  The therapists work 12 hour days on that machine, and we left before those patients had their turn.  After a short visit to the private radiation oncology facility in Kingston, where cash paying patients can be treated on a linear accelerator, we returned to Dr. Spence’s home high up on Jacks Hill.

The second day was spent at the Hope Institute.  Founded in 1963 by the Jamaica Cancer Society, the hospital has grown to 45 beds, for patients receiving chemotherapy and radiation and for end-of-life hospice care.  Since patients frequently travel long distances for cancer care in Jamaica, beds are often used to house patients for prolonged courses of treatment.  The wards had clean crisp linens, and the smells of fresh cooked meals in the large recently modernized kitchen wafted through the rooms.  The nurses had an air of easy familiarity with their charges and the atmosphere was upbeat, despite the fact that many of the patients were gravely ill.  I was asked to lecture on several subjects, and given an air conditioned auditorium and three hours which I doubted seriously that I could fill.  As it turned out, the nurses, therapists, residents and students who attended felt comfortable enough to ask questions, and a home cooked midday meal helped pass the time quickly.  My old Resident’s Manual, given to me at Massachusetts General Hospital in 1982 and carried with me for over thirty years as a souvenir, was a major source of interest, because it contained information pertinent to the treatment of patients with the equipment that is available to cancer patients in the public sector of Jamaica, equipment that has long been abandoned or replaced in our own country.

The thing that struck me the most about my experience in Kingston was the fact that despite the human suffering that I saw, in a country short on both technology and morphine, the patients remained hopeful and even cheerful in the face of extreme adversity.  I asked my host, Dr. Spence, how this could be, coming from the land of complainers, myself chief amongst them. She replied, “Most people in Jamaica have a deep faith.  They truly feel that they are in God’s hands, and what will be, will be and only God knows best.”  As I watched her move from bed to bed, giving comfort to the dying with only her soft voice and her cool touch upon their feverish foreheads, I realized something that sometimes I have forgotten in my excitement over the technology that I have available every day, without even thinking about it.  In the end it’s not about the technology at all.  For the most desperate among us, it’s about faith, and about love and human kindness.  For this reminder, I will be forever grateful.

It’s Always Something

When you are owned by a Scottish deerhound, or two or three, you get the pleasure of their company on your couch, the soulful gaze of their soft brown eyes as they gently interfere with your reading and typing, and occasionally the crunching sound of the prime rib that was marinating on the countertop before your dinner guests were to arrive.  Sometimes you also get hurt.  These dogs may lounge around your home looking like gray shaggy throw rugs, but trust me, they do move, rapidly and with great force.  Children in a deerhound home learn to walk with their knees bent, because a speeding hound colliding with a locked knee pays college tuition for many an orthopedic surgeon’s kid.  The Deerhound discussion list abounds with hilarious takes on how many ways an unsuspecting owner can suddenly find herself in harm’s way—sprained wrists from leashes getting tangled, broken noses from an exuberant hound kiss, road rash from that time your canines spotted a feral cat at a truck stop on the way to the National Specialty and the occasional broken ankle because your dog decided spontaneously to cross in front of you to exit the show ring.  We tell each other stories and have a little laugh—most of the time.

 

On Monday night after a grueling day traveling home from Colorado, I pulled into the driveway at 10 pm.  Immediately the dogs were out of the house and all over me, and as I picked up my purse from the driveway where it had fallen, I managed to look up just in time to see a giant paw on a collision course with my right eye.  A searing pain and blurred vision followed, and in a moment of hysteria to rival Gene Wilder’s in “The Producers” I screamed at my husband, “I am BLINDED and it’s YOUR FAULT! I have to go to WORK in the morning, and I DO NOT HAVE TIME FOR THIS!!”  I cupped my hand over my right eye for dramatic effect, moaning softly. Eventually, I calmed down and went inside to inspect the damage, which consisted of a scratch across my lower eyelid.  The blurred vision was due to the fact that a large deerhound toenail had dislodged my contact lens, and the searing pain was the result of said contact being firmly lodged in the inner corner of my eye.  I was quite relieved that I could still see out of the eye as well as I ever could, which isn’t saying much.

 

Last night I had to attend a faculty dinner meeting.  Midway through the meal, I spotted what appeared to be a gnat or a small fly whizzing around my food.  I batted at it, and then remarked to the physicist sitting beside me that there was a bug bothering me and my dinner.  He looked at me quizzically.  He didn’t see any bugs.  I continued to smack away at thin air until I came to the embarrassed realization that what I was seeing, was in my EYE, not on my plate.  My right eye, which had been home to a dirty deerhound claw two nights prior.  When the bug was still there this morning, I made an appointment with the eye doctor who was kind enough to see me during his lunch hour.  Thirty minutes later, I emerged with a right pupil the size of a stealth flying saucer and a diagnosis of a vitreous “floater”, dislodged by trauma, annoying but not anywhere near annoying as a retinal detachment would have been.  My afternoon patients were kind enough not to notice that their doctor appeared to be hallucinating bugs.

 

When you run with the big dogs, trust me, it’s always something!

The Adventures of Dad, Yes, Again

You can ask anyone—I have absolutely NO sense of direction whatsoever, and am completely geographically challenged.  In fifth grade, just like everyone else, I learned all of the states and their capitals.  Today, if you put a map in front of me, I can still name the states of the West Coast, the Deep South, the East Coast, and I can always find Texas, but ask me about anything in between and I am flummoxed.  The names of the capitals are long gone, with a few exceptions.  So I accept full blame for what happens in this story.

 

On Saturday I left San Diego for Aspen, for my mother’s memorial service.  When she died, at age 81 last January, my father was hospitalized, too ill to even come to her simple graveside service.  So we decided to have the “unveiling” on Sunday, a Jewish ceremony where the engraved headstone is placed on the grave.  Traditionally this is done on the one year anniversary of the death, but one year will be January 7, and the prospects of flying in and out of Aspen in winter, not to mention the possibility of having a ceremony in a snowstorm seemed bleak. After the ceremony graveside, my father planned a luncheon for his friends at the Snowmass Club where my parents spent many happy years in their retirement.  Dad, ever the professor, had prepared a PowerPoint presentation of his life with Mom, and nothing, not even the fact that he is oxygen dependent at altitude and the protestations of his two daughters at being featured in the PowerPoint could dissuade him.  It was going to happen, and it did, without a hitch.  Fortunately, as the offspring with the most technical experience, I was chosen to advance the PowerPoint, which I did with great speed, finessing the most embarrassing parts.

 

All was well until yesterday, when Dad awoke with nausea and a headache.  Fearing altitude sickness, I made the executive decision to cut short the trip, and get an earlier flight out of Denver so that I could get him down a few thousand feet, rather than spend the rest of the day in Aspen at 8,500 feet to take the 7 pm flight we had booked.  After a brief discussion with American Express, I learned that I had about six hours to make it to Denver, return the rental car to the wrong airport, rush an 88 year old man through a very large airport and board the plane.  Remembering that last June, when we drove his car from Aspen to San Diego, his oxygen saturation was fine by the time we got to Glenwood Springs at 5,761 feet, I ditched the oxygen tanks and hit the road like the proverbial bat out of hell.  But there was just one little fact that I forgot, which is that Denver is east of Aspen, and to get there we had to go across the Continental Divide through Vail Pass and the Eisenhower tunnel, which is, at 11,158 feet, the highest point on the entire Interstate Highway system.

 

I told Dad to put on the pulse oximeter, and I watched with some dismay that as we climbed in altitude, his oxygen saturation fell in inverse proportion.  Somewhere just beyond Vail Pass, when his saturation hit an extremely low 77 %, he said, “I am going to take a nap now.”  Promptly his head rolled forward, and he was motionless.  My immediate thought was, “Oh my God–I’ve killed him.” Panicked, I scanned the shoulder of the road for a place to pull off where I could perform CPR. I had no cell reception. I could not call 911. There were no ambulances anywhere in sight. Beads of cold sweat formed on my brow.  I had a vision of myself, a lonely figure by the side of the road pumping my father’s recently operated on chest.  And then, all of a sudden, I realized that there would be no chest pumping.  If my father died with a spectacular view of the Continental Divide, having just honored my mother and seen all of his old friends, by falling easily into an eternal slumber, who was I to argue with that?  Fortunately, in that very moment of my epiphany, he took a nice deep breath and woke up.  I said, “Did you have a nice nap?”

 

Dad, I know you’re reading this.  I hope you’re not mad.  But if you want me to perform CPR roadside at the top of the world, you better let me know!