Another Thanksgiving

Every year when the time changes and the days get shorter and the nights longer, I start to feel it.   By the time that the halls are decked with boughs of holly, now shortly before Thanksgiving, the season of airport delays, of frantic last minute shopping, of eating and drinking too much and then doing it again has begun, and with it, for many, the season of sadness.  At a time when festivities and noise are ramping up in the outside world, the Cancer Center becomes curiously still and quiet.

No one wants to get chemotherapy and radiation for Christmas.  It is far easier to ignore that lump or bump or missed mammogram than it is to schedule one more thing—a doctor’s appointment—when there are trips to take, family to visit and cookies to bake. And for those who have been recently diagnosed, it is rare that the treatment can’t wait a few weeks, just until “after the holidays.”  Although the “C” word strikes terror into our hearts, most of the time cancer truly is not an emergency.  This time of year, lunch breaks actually appear on my schedule, and the therapists cheerfully ring me up promptly at five to check the localization films for the day.

It isn’t hard to squeeze a new patient in this time of year, but when I get asked to do so, there is a very good chance that that patient is a little bit sicker, a little bit more symptomatic, a little bit more urgent and oftentimes a little bit younger than the average patient that I see though out the rest of the year.  Especially if that patient is hospitalized. Every year, there is someone—a husband, a wife, a child, a brother—who won’t be home for the holidays.

And so tomorrow, when you raise your glass around the Thanksgiving table, and give thanks for all of the blessings you have, do not forget to give thanks for your good health and that of your family, if you are lucky enough to have it.  And send out a prayer, or a positive thought, or an email or card to those who have not been so lucky.   It will mean the world to them.   Nobody wants cancer for Christmas.

Just Trying To Keep The Customer Satisfied

The institution that employs me is very bullish on customer satisfaction.  Having come from a fourteen year stint in private practice before I came back into the University fold six years ago, the little things that make a practice run smoothly come naturally to me. Patients are typically seen within a week of the consultation request—same day if they are in an emergency situation.  My front office staff actually answer their phones and my nurses and I return phone calls from patients, even if we have to do it after regular business hours.  The physicist and dosimetrist make sure that the radiation plans are optimal and that each plan undergoes intense scrutiny and quality assurance before the patient ever lies down on the table. The therapy staff work hard to make sure that the patients are treated with dignity and on time, at an hour which is convenient to their schedules. Despite my natural inclination towards dawdling and chatting, I try to keep to my schedule.  At the end of a patient’s treatment course, I personally ask him or her to fill out our patient satisfaction survey because the University bases my staff’s bonuses on the results. So far, I have never been disappointed.

Recently we treated a patient who had some significant physical challenges.  He was extremely overweight, with severe arthritis in his hips and knees.  In order to get to the “vault” to be treated, he had to be wheeled in a wheelchair, which required the coordination of several people since our doors lock for security.  Each day, a therapist would come up the elevator to get the patient, and our receptionist would hold open the door so that it would not close and bang into the wheelchair.  Time changes were made in his schedule to accommodate his other numerous appointments.  His wife partook of our Halloween potluck party and shared tidbits about her day with our front office staff.  His handicapped parking space was never occupied, and he never waited for treatment.  To all outward appearances he and his wife were treated like members of our family.  At the end of his treatment, the results of their patient satisfaction survey were eagerly awaited.  We knew it was going to be spectacular.  And it was.  On a scale of 1 to 5, with 5 being the best, each question was answered successively with a 5.  Was it easy to get a convenient appointment?  5.   Were you welcomed in a friendly manner? 5. Was the center comfortable and clean?  5.  Did the physician clearly explain the treatment objectives to you?  Again, 5, of course.  And so it went.  Until we came to the “Comments” section at the end.

Dated 11/15/13, the comments were written with perfect penmanship and read as follows:  “We thought your pink wall might be better if it was more of a rust color, to match the chairs and vases.  The color that it is just didn’t seem to go with the room.”

I’ll probably run out and pick up the paint chips at Home Depot this weekend.  We’ll get right on it!

Happiness is a Warm Puppy

I had promised my friend Rachel two months ago that when it came time to let her current litter of Scottish deerhound puppies go to their new homes, I would come to Arizona for the big send off. I bought my ticket to Tucson cheap but life has been hectic lately, between the pressures of work and the constant buzzing of the chainsaws at home—we’re five weeks into major tree trimming and repairs of a seriously neglected irrigation system.  By the end of last week, I had serious qualms about leaving for the weekend, and I expressed them to my good friend and traveling companion Robin who had also had some second thoughts.  In the end, we both concluded that it might be good to get away, and so with promises to one another that NEITHER of us was taking a puppy home, we embarked.  Some promises are harder to keep than others.

Rachel lives in the far southeastern corner of Arizona, where a triangle of towns including Sierra Vista, Bisbee and Tombstone serve up a little piece of the old West.  Fort Huachuca, anchoring the western end of the triangle, is a living history museum.  There, General Nelson Miles fought off Geronimo in 1886.  In 1913, the fort became the base for the famous “Buffalo Soldiers” of the tenth Cavalry Unit, comprised entirely of African Americans.  Later, and to this day, the base has become a center of strategic command and military intelligence.  Needless to say, the area is not easy to get to, which makes it remarkable that prospective puppy owners made the long trek by car from Colorado, New Mexico, and California to claim their prizes.  Some of us, including Robin and me, were there just to visit,  to help educate new owners on the ins and outs of this rather quirky breed, and let’s face it—to smell the puppy breath.

What is it about a puppy that can melt the heart of a full grown man?  Is it the remembrance of boyhood hours spent in the company of a scruffy dog, walking back roads while kicking a can, and trailing a stick behind?  Is it the potential fulfillment of a primordial urge to hunt—to “bring home the bacon” by partnering with a sentient being who is fleeter of foot and keener of eye and nose and ear? Is it that need to nurture which is largely suppressed in our culture where it is not “manly” to be kind, and sensitive?  I forgot to take my camera last weekend, but my cell phone is now full of pictures of happy new owners, their faces shining wet with kisses, and arms filled with awkward deerhound pups whose feet were nearly as big as their heads—puppies who will indeed make their owners feel like “The Laird of the Manor.”  After they are through destroying the living room couch and shredding the oriental carpets.

Despite my insistence that I am not in the market for another dog, I found myself under the spell of the runt of the litter, a little girl with a blue collar and a kinked tail.  She was feisty, that one—seeking attention from and bestowing kisses upon the gathered humans, yet fierce in mock battle with her brothers—a future Queen for sure.  I was happy to be flying home, because if I had driven the temptation to put her in the car might have overwhelmed my good judgment.  Still, I could not help feel a twinge of regret when Rachel called me today to say that the couple from New Mexico were so pleased with their male puppy that they were coming back for Little Blue Girl.  Good choice on their part—I am quite certain that despite the tail she will knock ‘em dead in the ring and on the field.  For me, there will be another puppy, another day.  Count on it.

“Buy a pup and your money will buy love, unflinching.”  Rudyard Kipling

For Michael

Writing a novel is like
following a recipe for
rhinoceros stew that begins:

1) Find a Rhino

-Michael S. Palmer

I was saddened earlier this week to read, first on Facebook as posted by his son Daniel, that Michael Palmer had passed away after suffering a heart attack and then a stroke, while going through customs in New York on the way back from a trip to Africa.  Many of you know Dr. Palmer as the bestselling author who wrote medical mystery thrillers like “The Sisterhood” in 1982, “Extreme Measures” in 1991 which was made into a movie with Gene Hackman and Hugh Grant, and more recently “The Fifth Vial” and “The Last Surgeon.”  I knew him as something else.

I began the second half of 1980, my junior residency year in Internal Medicine, as a happy newlywed.  My best friend from medical school, who had followed me to Boston from Philadelphia after a difficult internship year there, was not so lucky.  She had finished medical school with a divorce and a significant amount of debt, and what had started as drinks with friends in bars to blow off steam after a tough exam had turned into a habit of daily heavy drinking to cope with the pressures of internship and the loneliness of living in a strange city far from friends and home.  By the time she arrived in Boston for our second year of residency, she was a functioning alcoholic, dutifully coming to work every day and falling apart when she got home at night.  Until she couldn’t hold it together anymore.  After a few false starts at AA meetings, where she met the man who would save her life, she became increasingly abrasive and combative when inebriated.  Black outs and an arrest followed, and finally on the night of my twenty seventh birthday, our friendship nearly ended when she had to be escorted from the restaurant where we had gone to celebrate.  I withdrew to my work and my newly purchased suburban home, and I distanced myself from my friend.  I was done.

It could not have been more than two weeks later that I got a call from a man who identified himself as Michael Palmer, an emergency room physician at Falmouth Hospital.  He wanted me to know that he had met my friend at an AA meeting in Boston.  He said that she had been so good about coming to meetings regularly at first, so that when she stopped coming, he became concerned.  I don’t know what made him go to her apartment the night she nearly killed herself, but he did, and found her crumpled on the floor, unconscious from an alcohol overdose.  He literally picked her up, got her in the car, and drove her to Newport, Rhode Island to a detox and rehab facility, where she voluntarily agreed to be admitted and treated. To this day, I believe he was her guardian angel where I had failed her.  Today she is a practicing anesthesiologist/critical care specialist who has been sober for more than thirty years.

The first announcements of Michael Palmer’s death bore no mention of his work with alcoholic and drug addicted physicians, of which there are sadly far too many.  I remarked on this to my husband, who said, “You should write something about it.”  I said, “Perhaps Michael did not want that part of his career to be known to the public—perhaps that’s why they call it Alcoholics Anonymous.” Fortunately, the obituaries in the Boston Globe and the New York Times gave credit where credit was due.  Knowing Michael, I suspect that he was as proud of his work with impaired physicians as he was of his writing.  In fact, even more proud.  My husband still remembers the business card that Michael gave him when we had dinner with him and his significant other out on the Cape.  It read, “Michael Palmer, MD– Minor Author.”  He was a doctor first, in the truest sense of the word.   He cared.

Back In The Saddle

An email from a reader early this morning reminded me that I have not given my Crab Diaries an update on the adventures of my eighty-eight year old Dad.  The story left off on our trip back from Aspen, Colorado where we held a memorial service for my mother on September 29.  The thin mountain air had proven too much for him, necessitating a mad dash to Denver to get him down from the altitude.  He was mighty tired after that journey, and cancelled a trip which was to have taken place the following weekend for a reunion of his old “travel club”, a group of plastic surgeons, most of whom are quite elderly now, who have been getting together once a year for at least the last forty years to teach one another while having fun in remote locations. The destinations have grown decidedly less remote in the twilight years, and while I was sad for him, I agreed that a trip to Chapel Hill, NC was not in the cards.

So you can all imagine my surprise when he announced, a week after the cancelled travel club excursion, that he was “still going to Viet Nam.”  Say what?  I knew that Surgicorps– the volunteer group of plastic surgeons, nurses, physical and occupational therapists and lay support team that he has travelled with for years– had a return visit planned to Ho Chi Minh City from November 1 through 12, but I was unaware that he had bought tickets.  His seven hour open heart surgery to replace a stenotic aortic valve was only this past March.  He swore that his cardiologists had given him the “ok” and I realized in short order that there was nothing that my sister or I could do or say to keep the man at home. I committed to an early morning wakeup last Friday to drive him to the airport.  As he walked with his suitcase to the car, I noticed that he seemed short of breath, and I said, “Dad, you really don’t have to do this—you have nothing to prove anymore.”  He insisted that he was “fine” and that “this is a test—to see if I can still do this.” For Dad, life is just a series of unending “tests” and he hasn’t failed one yet, unless you count hypoxemia at altitude!

A week later, I got this brief email:   “Hi…….everything is good. We have four long operating days…many cases…incredible variety.  I’m enjoying myself immensely but my hip is a big problem.  Definitely plan to have surgery when I return.  Cannot sightsee because of the need to walk long distances. That’s OK as I’ve already seen most everything.  Food is incredible…hospital puts out a feast for lunch!!! Hope all are happy and well. I am upgrading my return air ticket. Off to happy hour!!! Love….Dad”

According to the Surgicorps Facebook page, the team has now completed fifty eight surgeries in five days.  On Monday they will do their all day follow up clinic and then the plan is to depart for home.  In the meantime, Typhoon Haiyan has decimated the Phillipines, and is headed straight for Viet Nam.  There will be widespread flooding in the low lying areas of Southeast Asia.  I hope that the team will be safe, and that the populace has ample time to prepare.  Knowing my father, ever the optimist, I can only imagine that he is congratulating himself for his recent swimming workouts and thinking, “At least I don’t have to worry about altitude sickness!”   I guess hip replacement surgery is next on the agenda.  You can’t keep a good man down.

The Future is Now

Two days after I returned from Jamaica, my husband surprised me by throwing a dinner party for his business associates and their wives, most of whom I had not met.  Knowing that my first few days back at work would be hectic, he decided that he would not burden me with the planning and execution of this party, so he asked everyone to bring a dish. After I got over my incredulity and had a glass of wine– “WHAT??? You invited 10 people I’ve never met for dinner and you made it a POTLUCK???”–it turned out to be a pretty good party.  At one point, one of the guests, a visionary in his own company, stood in our family room perusing the shelving holding my prized DVD collection, hundreds amassed over the last fifteen years and neatly alphabetized, and said, “Oh, DVD’s!  How very twentieth century!”

For the last eight months, I have had an ATM machine in my garage.  Not just any ATM machine—this one was purchased by my youngest son, the twenty two year old entrepreneur.  Having soured a bit on gold and silver investing as the stock market surged and gold prices fell, he decided it was time to research a new form of paperless currency called bitcoin. As always, he did his homework and began to “mine” bitcoins via his home computer and then bought some more when he realized that the computing power to mine the bitcoin would cost an arm and a leg in electric bills.  He thought that perhaps the next big thing would be to have ATM machines where one could exchange dollars for bitcoin.  So he bought himself an ATM machine, along with the domain name www.bitcoinatm.com and sat in the garage for weeks, programming the machine to do just that.  Apparently a Canadian company called Robocoin beat him to market, doing $100,000 worth of business in just eight days (http://www.washingtonpost.com/blogs/the-switch/wp/2013/11/06/people-have-bought-or-sold-100000-in-bitcoins-from-a-vancouver-atm-firm-says/).  My son is now shopping his creation and the domain name to the Winklevoss twins formerly of Facebook fame, collectively known as the Winklevii and currently the largest American stakeholders in bitcoin (http://money.cnn.com/2013/09/17/investing/bitcoin-winklevoss-twins/). On September 17, bitcoins were trading at $140.  Today they are worth over $300.  If the Winklevii aren’t interested, there are always the Chinese.

What does this all mean for medicine?  Tonight my son had dinner at the house and we were talking about the upsurge in interest in bitcoin.  I joked, “Pretty soon they’ll be paying for doctors’ visits in bitcoin.”  He said, “Mom, it’s already happening!” and passed on two links to medical services paid for by bitcoin at a plastic surgery clinic and an in vitro fertilization clinic. You’ll find the info on reddit—try “Boobs for Bitcoin” and “Meet the World’s first Bitcoin Baby” at respectively, clinics in Miami and Los Angeles. He also pointed me in the direction of a website called www.coinmd.org where patients can ask questions and doctors can answer, and get paid in bitcoin.  I don’t think I am quite ready for this brave new world.  I still like the jangle of change in my pocket, and am thrilled when I can use my extra pennies to pay a bill of $20.07.  Call me old fashioned.

Still, when one of the guys working hard to trim my overgrown eucalyptus trees stopped me yesterday to ask “Why do you have an ATM machine in your garage?” I replied, “It’s a bitcoin ATM.  It’s the FUTURE.”  For the sake of my son who will likely be supporting me in my old age, I sure hope so!