The Disconnect

On Tuesday I did what I said I would never do.  Three years ago, as I was buying an iPhone 5, the Verizon guy was intent on selling me a $70 case called “Lifeproof,” which was guaranteed to be exactly what it sounds like—you can drop it on concrete from five feet up, a horse can step on it, no harm done, and most importantly it is waterproof.  I looked at the salesman and said, “I’m not an idiot, I wouldn’t put the phone in water!”  He smiled knowingly and said, “Women drop their phones into the toilet ALL the time.  They wear tight jeans and put the phone in their back pocket and forget about it and when they stand up, it pops right into the toilet.”  I said, “I don’t wear tight jeans and I don’t take my phone to the bathroom, so THAT will never happen–but a horse stepping on the phone is a distinct possibility!”   Thirty minutes later I walked out with my new iPhone and a $70 case.

I was so very pleased with my Lifeproof case that last summer, when Verizon informed me that I was “due for an upgrade,” I hurried into the nearest Verizon store and got my new iPhone 6, a trimmer sexier model which required—you guessed it—a new $70 Lifeproof case.  As someone who now drives her fourth Chevy Suburban, product loyalty is a big thing with me.  If I like something, the only way to pry me away from it is to give me a new one, same model, perhaps with an upgrade or two.  The last Suburban is fifteen years old and going strong at 250,000 miles.  The upgraded new one cannot hold two 700 size dog crates the way the old one can, which in my opinion is a major design flaw.  This prompted a two hour phone call to a Chevy customer service rep in India, to no avail.  No such problems with the iPhone 6 or my new Lifeproof case.  They function perfectly—no glitches.

So on Tuesday I loaded up the Suburban and headed north to Pagosa Springs, CO, a beautiful town in the Rockies which boasts some of the best trail riding around.  I was going to meet some girlfriends for a 4 day ride.  When I got to my cabin, I put my cell phone in the back pocket of my jeans while I unloaded the car.  And promptly forgot about it.  So imagine my surprise, sometime later, when I noticed a strange blue light emanating from the—well, you guessed it—the toilet.  As I fished it out, the screen gave a last little flutter of activity and then, suddenly and irredeemably, went black.  Lifeproof, as it turns out, is only waterproof if one closes the charging port, which one did not.  Twenty four hours and one bag of white rice later, I ordered my new phone.

If I was going to be disconnected, I only wish there had been a little more excitement—my horse sailed over a rocky cliff, the phone went flying into the air, and landed in the West Fork River but we survived the tumble a la “The Man From Snowy River.”  Next time, that’ll be my story and I’ll be sticking to it!

On The Road Again

On the road again
Goin’ places that I’ve never been
Seein’ things that I may never see again,
And I can’t wait to get on the road again.  Willie Nelson

 

If someone had told me even ten years ago that I would retire young and become an itinerant radiation oncologist I would have thought he had lost his mind.  As the career medical director of community based cancer centers, I was used to running the show.  And as the saying goes, I ran a “tight ship.”  Consultations were performed and documented in a timely fashion, day of the request if the situation was urgent, or within a few days if not.  The patients were given time to think about their treatment, but simulations could be done the same day as the consultation, or as soon as the patient agreed to treatment, and the new start times were never more than a week away. Patients were seen every week, or more frequently if needed.  I had the best team of radiation therapists, physicists, nurses and front office people that anyone could ever ask for.  But in early 2014, I like to say I retired.  But the truth is, I quit.

Articles about physician burnout are legion, and I have avoided adding to that literature in this blog. The truth of the matter is that we, as radiation oncologists, are a very privileged group.  We are privy to the most intimate details of our patients’ lives; we practice in a highly technical and ever changing environment which challenges us to be constant and consistent learners; our hours are regular and we are very well paid as a medical specialty.  And most importantly, we cure cancer.  What could be better?  But after thirty years in the field, I was tired.  2013 was a terrible year for me—in December of 2012 I lost a close friend, Catherine, and then my little dog Jack, and then in January my mother, and shortly after that my work partner Dr. William Spanos, the best colleague and friend a physician could ever hope for.  And in between, some very beloved patients who I had followed and treated for years.  I was done.

But a calling is a calling, and somehow, between the enchanted mountains of New Mexico and the healing hours spent on horseback and with my dogs, and the otherworldly sunsets and the pleasures of growing a vegetable garden, I needed to get back to doing what I do best—helping cancer patients.  So here I am, a “locum tenens” radiation oncologist, working for an agency, going where I am needed, for a few days, or a few weeks at a time.  On Sunday night I “saddled up” the old Suburban and headed to Las Cruces, NM to provide a little relief to the solo practitioner stationed there.

Today I saw an elderly woman who had just been diagnosed with locally advanced and metastatic lung cancer.  Despite the effects of her disease—weight loss, shortness of breath and pain—I could see that she had been and still is a beautiful woman.  I can’t cure her—no one can.  But I could promise her that I could make her breathing a little easier, and relieve the painful metastases in her lumbar spine. As I sat with the patient and her husband, I knew with certainty that I no longer had to be “in charge” or command my own practice.  I knew that I could help her.  And I knew, beyond question, that I had begun to love my profession again. For that I am very grateful.

The Vigil

People always say, “You’ll know when it is time.”  Sometimes that is true.  But sometimes it’s hard to tell.  This has been one of those times.  Having lived through the horrendous experience of our old deerhound Magic fracturing his leg due to a previously undiagnosed osteosarcoma, I want very badly to spare Queen that awful demise.  But when is it time, actually?

With a horse, I think it’s easier.  Those that are spared the usual disasters which befall horses—the broken leg due to a fall, the perforated intestine due to colic—they simply get old.  When their arthritis can no longer be managed, when the tendons finally give way and the hooves can no longer bear the weight of their bodies, they lie down and cannot rise.  Or they stop eating and stand quietly in a corner of a green pasture.  And then you know its time.

Dogs are different.  They want to be with you.  They are willing to put up with pain and suffering beyond what a human thinks is possible, as long as you will lie down with them, pat their heads, give them a special treat while looking into their eyes on a sunny day.   Leaving must seem to them, after a life of protecting you, a betrayal.  They want to stay for as long as they can.

The vigil started this morning.  The dogs are smarter than I am.  I let the puppies in the house while the lawn was being mowed—the mower frightens them.  When Pibb was ten weeks old, he made the mistake of stepping on Queen who was asleep at the time.  She made sure that never again will he forget the maxim to “let sleeping dogs lie”.  When the kerfuffle ended, I was shocked to see that not a hair on his head had been harmed.

When Pibb came in today, he immediately lay down with Queen, head to head.  An hour later, I noticed her position had shifted.  Her front leg was touching his, paw to paw.  I think she was reassuring him.  This afternoon, she felt well enough to go out and bask in the sunshine.  Yoda, my little mixed breed rescue, has always been an empathetic little dog.  He cries when the girls have their nails trimmed.  Today he plopped down right beside her face.  And there he stayed, his little body shielding her eyes from the sun.

Saying goodbye has never been easy for me.  But I know that it’s time.  And if there is a heaven for dogs, Magic and Izzy and little Jack will be waiting for her.  We will be okay down here, knowing she is no longer in pain.

Rest in peace, GCh. Jaraluv Queen.  Forever our Queen of Hearts.

I Want to Live With Chip and Joanna

I’ve always been a fan of home improvement television shows.  Back in Boston, watching Bob Vila’s This Old House was an obsession, considering that there were few homes in the Boston area that WEREN’T “this old house.”  In 1980, we bought our first home—an 1860’s post and beam Victorian, complete with porch and pillars.   It was a wreck.   Bob taught me to sand the old hardwood floors to a polished sheen, to install an insulated window to protect against the frigid winds of winter, to update a kitchen from the days when no one had cabinets, and to make the most of a stone and earth cellar.  He was my idol, a man who could actually fix things (quite unlike my new husband) and take the tired bones of a once handsome Victorian and make a warm inviting space for a young family.

These days, there is a whole cable television network dedicated to the proposition that behind every dilapidated homestead there is a diamond in the rough, only waiting to be polished to highly marketable perfection.  I happened upon the Property Brothers one day while I was having my teeth cleaned at the dentist.  Nearly horizontal in the chair with a headset kindly provided to distract me, and trying to ignore the scraping and picking, I fell madly in love with Jonathan and Drew Scott. These twin Canadian brothers first disavow prospective homeowners of any delusions they might have about affording the house of their dreams, and then proceed to transform a cheap wreck with the right square footage into that very house.  Nothing less than miraculous, in my humble opinion.

From the Property Brothers, I graduated to Flip or Flop.  Tarek and Christina El Moussa are real estate agents who fell upon hard times during the 2008 recession.  So they decided that instead of selling real estate, they would buy foreclosed and other distressed properties, fix them up and resell them.  I’m no television critic, but a few seasons of Christina shrieking when the bargain house turns out to have (gasp!) cockroaches, and the renovated house has (gasp!) a subway tile backsplash and dark wood cabinets—well, I guess I’m easily bored.  Although I have to admit, when a viewer who happened to be a nurse diagnosed Tarek’s thyroid cancer from her home screen—yes, I was impressed.  I watch reruns just to see if I could have picked it up myself.

But when I happened upon “Fixer Upper”, I knew I had hit pay dirt.  Chip and Joanna Gaines, a lovely couple from Waco, Texas are the real deal.  Together they find houses that are sorely in need of TLC. Their typical clients are young, on limited budgets and are full of dreams.  These two make dreams come true and they do it with compassion, empathy, minimal fanfare and great taste and impeccable style. And they do this, of all places, in Waco, Texas.

But all this is not why I want to live with Chip and Joanna.  The real reason is that these two are the parents I never had.  Their home, Magnolia Farm, is where I would have given my eye teeth to grow up.  They have lots of kids.  And horses and cows.  And goats and chickens and kittens too.  Joanna knows how to jump rope and she can do cartwheels.  Chip knows how to make every construction project a playground and he is the consummate clown, juggling eggs to the delight of their children, even when one smashes on the floor.  Their farmhouse has just the right amount of shabby chic appeal, light and bright and cluttered with the best things—crayons, coloring books, and a stray hair barrette.  They are indeed the real deal.  They are Chip and Joanna.

Since I am doing locum tenens work, and since I have always kept my Texas license, I am going to request an assignment in Waco.  And I am going to go see Chip and Joanna. I want to see firsthand the magic that puts the heart where the home is.  Isn’t that what we all want—a place where deep and true love becomes manifest in the visible tangible everyday life?  Come with me.   It’s never too late.

Another Dog, Same Breed, As Soon as Possible

“Hark to Beaumont. Softly, Beaumont, mon amy. Oyez à Beaumont the valiant. Swef, le douce Beaumont, swef, swef.” Beaumont licked his hand but could not wag his tail.”  T.H. White, “The Once and Future King”.
               For the past couple of years, my life has been pretty easy.  I spent last summer putting in a vegetable garden, and making improvements in the landscaping around my home.  In September I went back to work after a somewhat abbreviated bout of retirement, but just part time covering other radiation oncologists’ practices.  My two Scottish Deerhound sisters, Queen and Quicksilver were then approaching 7 years old, and were long past the destructive behavior so characteristic of the giant breeds in their youth. My little mixed breed rescue Yoda had never been a problem.
             On December 19, 2015 I upended my quiet comfortable life by getting a new puppy, a ten week old borzoi named Pibb.  Two weeks later, I compounded the chaos by acquiring a “brother” for him to play with, an eighteen week old Scottish deerhound puppy named Cole.  Despite a few misgivings and knowing full well what I was getting myself into, I went ahead with what I knew deep in my heart was a preemptive strike. Queen had been limping off and on, and despite my denial I knew that the proverbial “other shoe” had dropped.  Her chronic lameness worsened suddenly a few weeks ago and like her dam before her, she was diagnosed with osteosarcoma, a bone cancer common in her breed.
                  As a radiation oncologist for adults with cancer, my day to day ethical challenges are few. I do my very best to be sure that my patients understand their diseases, and the side effects, risks and benefits of treatment. As a devastated dog owner, the decision making process is not so simple. The tell tale X-rays resulted in a consultation with a board certified veterinary oncologist, where my husband and I sat and listened to our options. Amputation and chemotherapy, the standard of care, would give Queen a median survival of 9 months.  Untreated the disease progresses rapidly, often times resulting in a pathologic fracture. Pain control is also a problem, and pain can often be ameliorated by radiation therapy–my own specialty. Except in the rarest of cases, the disease is incurable because metastases are present, whether they can be detected or not.  All treatment is palliative.
               As we sat with the veterinary oncologist two weeks ago, contemplating our options, I remembered my friend and vet oncologist Dr. Greg Ogilvie saying, “The dog doesn’t look in the mirror and say, ‘Oh, I only have three legs.’ The dog only knows that the pain is gone.”  And we were told that dogs tolerate chemotherapy exceptionally well, much better than human beings.  So we sat and nodded and thought that perhaps our initial instinct, which was to provide comfort care only, might be wrong.  Who knows better than a cancer doctor how important it is to provide and maintain hope?  And so we wavered.
                 In her incomparable essay “Oyez a Beaumont”, Vicki Hearne describes what it was like to lose her Airedale Gunner when he fractured his pelvis from prostate cancer.  As a dog trainer, her advice to clients has never wavered:  ”Another dog, same breed, as soon as possible.”  And then she admits to us, that it was ten years between the death of Gunner and the purchase of a new Airedale pup.  She says, with feigned indifference as our hearts break, “That was as soon as I could get to it,what with one thing or another.”  I got to it a little sooner.
               Deerhounds are homebodies, and our Queen particularly so.  Carsick since puppyhood, trips are stressful for her, and the risk of fracture even getting such a large dog in and out of the car is significant. Outside the veterinary specialty hospital, in the cold light of day, we lifted her into the car and she fell immediately into a sound sleep because she knew she was going home-home to her sister, her humans, and even those pesky puppies. We knew then that home is where she will be for what remains of her life.  We love her and this, more than anything, is what we owe her.