My Night At the Opera

“Was that a high C or vitamin D?”  Groucho Marx as Otis P. Driftwood

Okay, I admit it.  I am a Philistine when it comes to opera.  I can’t help it.  I grew up in Houston, Texas when the acquisition of central air conditioning was a cultural zenith.  Houston, back then anyway, didn’t have opera.  It had swamp coolers and mosquitos.  It wasn’t until I got to college, and had a boyfriend from New York City, that I was invited to go to an opera—a real and very famous opera, “La Boheme”– in a famous place, The Metropolitan Opera House.   My boyfriend was well versed in the genre but neglected to give me one important piece of information—the fact that the opera would be sung in Italian.  For three hours I watched fabulously costumed singers with enormous voices waft slowly around the stage, living their Bohemian lives, building towards the climactic scene when Mimi, stricken with tuberculosis, gives her final aria, and final cough (complete with fake blood) and dies right there on stage.  I was premed and into medical realism.  She was far too fat to die of consumption and I said so.  End of boyfriend and operatic opportunity.

Fast forward forty plus years, and here I am in Santa Fe, New Mexico which boasts of having one of the finest opera houses, and opera seasons in the world.  My husband had never been to an opera, and so when he noticed an ad in our local paper for tickets forty per cent off for newcomers to New Mexico and the opera, he said, “Let’s go!”  We chose a night—last night—and an opera, “Rigoletto”, dressed up and headed out to what is surely one of the most beautiful outdoor venues in the Southwest.  We settled into our $150 per ticket Row Y seats just as the overture was starting.  After I snapped a quick phone shot of the opera house from inside, what looked like a teleprompter on the back of the seat in front of me warned me to turn off my phone, and I was thrilled to see that by pressing a button, I could read the libretto in English.  The only thing missing was the forgotten set of antique opera glasses I bought years ago on Ebay—you know—just in case I ever needed them.

Thirty minutes into the first act, Rigoletto comes home, and is fussed over by his daughter Gilda who undresses him, and helps him into a limp white garment that resembles a bib while both are singing loudly in perfect harmony.  Just as Gilda hit her high note, I heard a single muffled cough from the woman behind me, and suddenly there was a sensation of wetness on the outer aspect of my left ankle. Momentarily distracted, I glanced down my leg, thinking, “I hope that isn’t blood she coughed up,” but it was dark and the music was loud and the air was dry and caught up in the passion of the song, I quickly forgot about it.  That is, until the curtain went down and the lights went on, and the woman sitting to my left said, “Are you alright?”

I said, “Thank you but of course I’m alright—that was the lady behind me who was coughing.” Undeterred, she looked at my silk clad pants leg, and my purse sitting on the ground beside it and with a quick motion, gestured to the now empty seat and floor behind me, which was covered in vomit that had been slowly dripping down the concrete stadium wall to engulf my purse and my left shoe.  Abruptly standing, I announced to my husband that “we have to go NOW!” and once in the lobby, holding my purse delicately in front of me as exhibit A, I barreled past thirty or forty well dressed women waiting in line for the bathroom, shouting, “I don’t have to use the toilet—someone threw up on me and I need that sink RIGHT THIS MINUTE.”  The line in front of me parted like the Red Sea.

Now I am a doctor with three kids, and trust me, that was not the first time I have had a close encounter with throw up.  But winding my way back to the lobby to find hubby, I realized that I was not going back to my expensive seat at the sold out performance.  In fact, I probably was not going back to the opera at all, ever.  My husband who generally adores music was relieved.  He said, “I have discovered tonight that I really don’t like opera.”  Like I said—I am a Philistine.  You can have your Boheme and your Puccini and your high soprano operatic notes amidst shouts of “Bravo!  Brava!  Bravissimo!”   But for me—just give me the down dirty raw and emotional Broadway production of “Rent.” Without side effects.  Sorry, opera fans!

Past Lives

It’s been a tough year for me and my animals–we lost Magic, the elderly deerhound in January, and just last week, our thirty year old Quarter Horse Dash, the last of the red horses at our old place in California, Rancho del Caballo Rojo.  I am no poet, but tonight I came upon something I wrote out longhand over ten years ago after losing another red horse, and another gray dog.   I called it “Past Lives.”

The great hound sits on his small patch of lawn

Staring at the vertical lines of the white picket fence—his eyes go suddenly vacant

The small confines of his yard are gone

Instead he sees the rolling hills of a vast estate

The heather and the mountains lie beyond

 

The young ones sleep by the dying fire

Bodies and legs intertwined

An ember flashes—the spark illuminates a twitching foot, a wrinkled nose

The white stag beckons at the dark edge of the forest

In the morning the ashes smell of roasting meat

 

The old red horse looks up suddenly

His crooked white blaze a lightning bolt

His notched right ear flicks to and fro

He screams: the buffalo horses are leaving

His ghost white companion shies away in terror

 

There may be no heaven for these

The hart, the hound, the horse, the hunt

Yet they live on in the drums, in the horn, in the fire

And yet they live on in the chase.

 

A few closing notes here:

On the Deerhound:  Affectionately known as the “Royal Dog of Scotland,” it is not difficult to imagine how this breed, with its athletic, well-muscled build, came by the title. The Scottish Deerhound has a romantic past, a noble bearing, and a loving nature, so much so that Sir Walter Scott — himself the owner of deerhound named Maida — described the breed as “the most perfect creature of Heaven.

On the White Stag:  from Wikipedia–White deer hold a place in the mythology of many cultures. The Celtic people considered them to be messengers from the otherworld; they also played an important role in otherpre-Indo-European cultures, especially in the north.[1][2] The Celts believed that the white stag would appear when one was transgressing a taboo, such as when Pwyll trespassed into Arawn‘s hunting grounds.[2] Arthurian legend states that the creature has a perennial ability to evade capture, and that the pursuit of the animal represents mankind’s spiritual quest.[3] It also signalled that the time was nigh for the knights of the kingdom to pursue a quest

On the Buffalo Horse–from Mystic Warriors of The Plain, by Thomas Mail:  ” Each warrior had to have at least one horse which was trained to a fine point for buffalo hunts and warfare. It became his best and favorite, and was usually too valuable to sell or trade. He guarded it like a treasure and picketed it just outside his tipi at night. After all, his existence and future depended upon it to an amazing degree. A buffalo and war horse was trained to stop instantly at a nudge of the knees or a tug from the rawhide thong, called a “war bridle,” which was tied to the animal’s lower jaw. But more than that thong was necessary, since racing through thundering herds over rough ground that was riddled with bushes, rocks, and hidden burrows portended frequent collisions and spills for the rider, so during battles and hunts a fifteen- to twenty-foot rope was often tied around the horse’s neck so that its free end would drag behind the horse. When a falling rider seized the rope, his horse came to a sharp stop, and in a moment the man was on his feet and mounted again. Often one who had an especially valuable buffalo horse cut V-shaped notches in his ears.” My old Quarter horse Lucky came to me with a notched ear, so I always called him “my buffalo horse”.

Father’s Day

My father finds it hard to believe that he has a sixty one year old daughter.  I find it hard to believe I have a nearly ninety year old father.  I almost didn’t, which is story behind the scarcity of Crab Diaries blogs in the last two months.  If cats have nine lives, Dad must have ten or eleven.  The ninth life flashed before my eyes on April twentieth.

I have a “spiel” for the side effects and late effects of radiation therapy for every disease site. One of the late effects of radiation for abdominal malignancies is the risk of a small bowel obstruction months to years after the treatment.  My little speech goes something like this:  “Every patient who has ever had abdominal surgery, even for benign disease, is at risk for a bowel obstruction at some point later in their lives.  Scar tissue forms adhesions which restrict the bowel—if you’ve had cancer surgery, or an appendectomy, or even, like me, a C-section or two or three—you are at risk.  Radiation increases that risk, but if you recognize the symptoms early, and get treatment, there is a high likelihood that you can avoid surgery.  So if you ever have a period where you are experiencing abdominal distention, and realize that you are not passing gas, and start to feel nauseated, get thee to an emergency room for quick diagnosis and treatment.”

Apparently Dad didn’t get the memo.  In 2004, my mother called me late one evening to report that Dad had been in a car accident.  After running a red light, he was broadsided and found himself in the passenger seat when he should have been driving.  No, he was not wearing a seat belt.  He was taken to the emergency room of the hospital where he practiced, and was found to have a pelvic fracture, but he was “fine” and not to worry.  At his insistence, his colleague, the Chief of Plastic Surgery was called in and pronounced him fit to leave the hospital.  At four am, I got a second call from Mom, asking me “What does it mean that he got up to leave to go home and promptly fainted.”  It meant a ruptured spleen and I told her so.  A few hours and a splenectomy later, all was well– until April.

Dad woke up feeling a little queasy on a Friday after a lovely trip to Phoenix a few days earlier.  The feeling persisted and overnight the symptoms progressed, but being the stoic and ever in denial physician that he is, he knew that the food poisoning or virus would soon be over and he would be back to normal.  But when he described his symptoms to his primary care doctor nearly 30 hours later, she sent him to the nearest emergency room.  By the time I was able to get back to San Diego, he had perforated his obstructed bowel and was headed into surgery, two years after his second open heart surgery and one year after hip replacement, two months shy of his ninetieth birthday.  Surgeons are different from normal people.  At a time when I would have had my arm out for a shot of morphine and hospice, he said simply, “Let’s go for it.”   Six and a half hours later, minus eighteen inches of small bowel, he was brought to the ICU where I was asked, as his next of kin and medical power of attorney, what his code status was.  You know the answer. Despite all of my previous prejudices against family members who refused to acknowledge the obvious—that 90 year olds have to die sometime, he was a “full code.”

Dad is back home now in his own apartment, feeling a bit tired but generally speaking no worse for the wear.  Despite the fact that my sister and I were at his bedside continuously for a month, when he returned home, he sent a long email to all of his friends describing his ordeal and thanking his girlfriend Evelyne for her devotion to his care.  His daughters were cc’d on the email.  After a serious bout of righteous indignation, I reminded myself that patients NEVER remember their time in the intensive care unit, and that is a VERY good thing.  The entire family will be headed to California in ten days for his big 90 birthday, and we couldn’t be more thrilled.

Happy Father’s Day, Dad, and we sincerely hope there will be many more.  Your loving daughter—M.

In Praise of Angelina

I have always been one of Angelina Jolie’s biggest fans.  The Academy of Motion Picture Arts and Sciences saw fit to reward her 1999 performance in “Girl Interrupted” with an Oscar, but I wasn’t well and truly smitten until the second Lara Croft Tombraider movie was released in 2003.  In that film, Jolie, who performs her own stunts, is seen galloping on a dark horse while spinning a heavy shotgun from side to side to shoot alternating targets.  And she is riding SIDESADDLE.  If you don’t believe this, have a look here:  https://www.youtube.com/watch?v=tz1lCcs9tac  In the Lara Croft movies, she is the epitome of a strong, athletic, intelligent and self assured woman.  It may not seem like much, but I granted Miss Jolie a high honor indeed—in 2004 I named a dark, agile and fast deerhound puppy after her, the soon to be champion Caerwicce’s Lady Croft, aka “Angelina”.

 

In the years that followed the Lara Croft movies, Angelina Jolie went on to surprise her public in more ways than one.  The girl who initially achieved notoriety for wearing a vial of her second husband Billy Bob Thornton’s blood gained a different type of fame when she adopted a Cambodian child, and subsequently became a respected ambassador for the United Nations.  She has become well known for her humanitarian efforts, devoting as much time to improving the lives of refugee children as she does to her own career.  Recently, she has added the titles of author, director, and Mrs. Brad Pitt to an already impressive resume.

 

But perhaps the biggest surprise of all came two years ago, when she went public in the New York Times with the revelation that she is positive for the breast cancer gene BRCA1. In a moving statement, she wrote of her difficult decision, at age 37, to undergo bilateral prophylactic mastectomies and reconstructive surgeries in the hope of staving off the cancers that took her mother, her grandmother and her aunt.  She was clear and concise, reasonable and dispassionate in her account.   Not only did she raise awareness of the heritable form of breast cancer, she gave courage to all women facing the challenge of a mastectomy.  If one of the worlds most beautiful and sexy women could undergo such surgery in the glare of the celebrity spotlight and come out looking stronger and even more beautiful, so could some of the rest of us.

 

Today she has done it again.  In a New York Times article entitled “Diary of a Surgery” (http://www.nytimes.com/2015/03/24/opinion/angelina-jolie-pitt-diary-of-a-surgery.html?ref=opinion&_r=0 ), she reveals that she has recently undergone removal of her ovaries and fallopian tubes to prevent ovarian cancer, the disease that killed her mother.  She describes precisely the terror she felt when informed that some recent blood tests were equivocal, the dreadful anticipation of the results of a PET/CT scan and the realization that now, at age 39, she has entered menopause.  But she also describes the relief she felt once she had made a decision to go ahead with the preventive surgery: “I know my children will never have to say, ‘Mom died of ovarian cancer’.”

There’s bravery and then there’s true courage and grit.  It’s one thing to perform gymnastics while swinging from the rafters of the Croft estate, or to shoot a rifle off the back of a galloping horse.  It’s quite another to write clearly and objectively the story of being diagnosed with a genetic mutation, and of the careful informed decisions she made to minimize her risks, while at the same time admitting that her decisions were not necessarily the right ones for everyone.  As Angelina says, “Knowledge is power.”  We owe her thanks for sharing hers with us.

 

Live Long and Prosper

I was sitting at lunch with a friend today when she leaned over to check her phone messages and discovered the sad news that Mr. Spock, sometimes also known as Leonard Nimoy, had passed away due to complications of chronic obstructive pulmonary disease.  She looked up at me and said wistfully, “He was my first girlhood crush.”  To which I replied, “Mine too.”  In 1966, while my thirteen year old contemporaries swooned over the mop headed Beatles, I was madly in love with a guy with chiseled features, a low pitched but perfectly modulated voice, and above all, pointy ears.  I found him irresistible.

Some girls want a boy who will bring them candy hearts on Valentine’s Day and flowers for their birthday. Others prefer a tougher nut to crack.  To Spock’s adoring fan girls, he represented the latter, the “strong silent type” whose deep human emotions lurked well behind that cool Vulcan exterior. Secretly we all believed that we were the one, and of course the only one, who could penetrate Spock’s personal deflector shields to get to that emotional reactor core.  The challenges would be great, but so would be the rewards. Since Spock was significantly older, and entirely unavailable, we turned our attentions to the dark quiet boy in the back row of math class who sat scowling at his paper, pressing his pencil lead so hard into the paper that it snapped off.   He was no Spock, but he would have to do.

My girlfriends and I have hopefully long outgrown our attraction to emotionally unavailable men–candy hearts and flowers are most welcome these days.  Leonard Nimoy tried for a time to outgrow his identification as Mr. Spock, even titling his first autobiography “I Am Not Spock.”  He became a writer, a director, a poet, a photographer, and even at times a very bad singer, but despite his many accomplishments his admiring Trekkies continued to flock to Star Trek conventions to get a glimpse of the man with the pointed ears.  In later life, Nimoy embraced the character that made him famous—when you have become a cultural icon, resistance, as they say, is futile.

What is it now, nearly fifty years later,  that still draws us to the Vulcan mindset, where war, and rage, and yes, even passion were considered “highly illogical?”  Perhaps it is a longing for a simpler world and an earlier time, where each one hour television episode had a story with a beginning, an ending, and a moral and no one had any trouble figuring out who the good guys were.  Spock stood at Captain Kirk’s shoulder as a moral compass, a conscious reminder to put thought before action and to behave ethically towards all species.  We could all use a little Spock these days.  Leonard Nimoy, you will be deeply missed.

This Rough Magic

Have I given fire and rifted Jove’s stout oak
With his own bolt; the strong-based promontory
Have I made shake and by the spurs pluck’d up
The pine and cedar: graves at my command
Have waked their sleepers, oped, and let ‘em forth
By my so potent art. But this rough magic
I here abjure

Prospero, The Tempest, Wm. Shakespeare

Two weeks ago today, we lost our big male deerhound Magic.  It should not have been any surprise—he had been diagnosed with cardiomyopathy in August and from the looks of his echocardiogram August 8th, his days were numbered.  He was with us for over ten years, a long life for a giant hound.  But the finality of death is always a surprise, isn’t it?

Can dogs perceive tragedy in their lives?  Do they grieve as we do?  If so, Magic had grief aplenty.  Acquired as a four month old puppy with his half-sister Angelina, he was fine until at six months, he fractured a metatarsal bone taking a corner too fast, and after surgery to pin the shattered bone he spent six weeks in a cast.  He recovered just fine, well enough to finish his championship at 18 months without a trace of a limp to suggest his prior injury.  From the time he was a puppy, we called him The Dog Who Never Did Anything Wrong.  He never got sick, never barked, never growled, and never EVER had an accident in the house.  Following the example of our older male Izzy, he was a friend to all—humans, dogs and cats.  Well maybe once he chased a horse, but after the embarrassment of being chastised, he never did it again.  He was a homebody, afraid of fireworks and thunder and lightning, but as long as he had his family about him, he bore no complaint.  When his sister and constant companion Angelina passed, he clearly had a period of sadness, but bounced back quickly.  But when we lost Izzy and in rapid succession the little dog Jack to old age, Magic lay down on the carpet in the family room between the coffee table and the chairs, head between forelegs, and there he stayed.  He ate his meals, and went out twice a day to do his business (“whether he needed to or not!” we joked).  But the exuberance and sense of humor that characterizes the deerhound personality was gone.

When we sold our home in San Diego in October, and decided to move to New Mexico, Magic was the dog we worried about the most.  Given his heart condition, we weren’t sure that he could make the transition to altitude and cold weather.  We worried and fretted and even considered putting him to sleep, but in the end, since he wasn’t in any pain, we loaded him, the two girl deerhounds and the little rescue Yoda into the van and off we went.  Our biggest fear was that we would have to find a veterinarian somewhere along Interstate 40 to do what we hadn’t been able to bring ourselves to do before we left.  But the big dog surprised us.  Here in Santa Fe, he seemed to take a new lease on life.  Suddenly he was interested in his surroundings—he ran, he played, and he discovered where the bunnies were hiding in the culvert.  He patrolled the fence line at sunset, watching for coyotes.  He assumed the role of pack leader for the first time in his life.  His two female consorts adored him, and he was The Man.  And, like a family member of any patient diagnosed with a terminal illness, I began to have magical thinking:  first, let’s see if he makes his tenth birthday!  He did.  Then, let’s see if he makes Thanksgiving, when the kids come home!  He did.  And then, jeepers, maybe he’ll see Christmas, and even another New Years!  He did.  So then I began thinking about his eleventh birthday, next October.  As I said, death is always a surprise.

As we get older, each loss hits harder.  I’ve done a lot of thinking about this these last two weeks.  When we are children, the family dog seems to live forever.  He’s there when we start kindergarten, then junior high, then high school.  He comforts us when we’re sad.  Our lives, and his life, while not equivalent, are at least proportionate.  But as we age, the lifespans of our pets seem to shrink.  Now that I am 61, Magic’s life seems to mine a mere blink of the eye.  He was there, beside my bed, every night for ten years.  And now he is gone, and I’ll never again curse under my breath as I trip over him in the dark, and my life is much the worse for that.

Rest in peace, Ch. Caerwicce’s This Rough Magic, October 15, 2004—January 25, 2015.

“When you are sorrowful look again in your heart and you shall see that, in truth, you are weeping for that which has been your delight.”  Kahlil Gibran

Medicine at the Crossroads

 

        “When you look for the bad in mankind expecting to find it, you surely will.”    Pollyanna

 

I try not to spend too much time on Facebook, but it’s always been a good way to keep up with “friends” in the Scottish Deerhound world.  The deerhound, being a rare breed, tends to link people across the country, and indeed the world, who have similar interests.  Lately though, the deerhound people haven’t been discussing dogs much.  Instead, they’ve been discussing their terrible experiences with the world of medicine.  One owner described being admitted through the emergency room of her local hospital for stroke-like symptoms.  By the evening of her second day of admission, she complained that she had not yet been seen by a physician.  Another complained that a family member had just been diagnosed with Type I diabetes, but was initially given an appointment with an endocrinologist in six weeks—completely unacceptable in this situation by any standard of care.  I am of course compelled by pride to speak up and defend my profession, but not without an increasing sense of embarrassment for what used to be considered a noble calling.

After I published my piece on the fatal shooting of Dr. Michael Davidson, I was contacted by Carey Goldberg, reporter and co/host of CommonHealth (http://commonhealth.wbur.org/) and asked what struck me the most about the nearly 200 comments left on the essay when it was picked up by KevinMD.com.  Here is what I replied, “There were several reasons that Dr. Davidson’s death hit me particularly hard, even though I never met him.  One reason was that I trained at the Harvard teaching hospitals, Beth Israel for Internal Medicine and MGH for Radiation Oncology, so this hit close to “home” especially with my daughter being there.  But more importantly, I come from a medical family–grandfather was a dentist, father (now 89 years old) is a world renowned plastic surgeon–and in my lifetime of 61 years, I have seen the sad decline of public affection and respect for physicians.  When I was a child, people would stop me on the street to tell me how wonderful my father was.  Now, when I sit in on conversations among people who do not know I am an MD, I hear nothing but derision if not outright hatred.  There are many, many more people, as evidenced by the response to my blog piece, who feel slighted not only by “the system” but also by their physicians.”

And why not?  Articles such as this, http://www.nytimes.com/2015/01/30/business/medicare-payments-surge-for-stents-to-unblock-blood-vessels-in-limbs.html on the front page of the New York Times continue to erode patients’ faith in their physicians to “do the right thing.”  Patients despair when they cannot get appointments to see their doctors in a timely fashion and when they are seen, that their doctors don’t spend enough time with them or explain things to them.  They despair over the cost of care in increasingly difficult economic times. But doctors are in despair also, at the ever increasing bureaucracy of medicine, the insurance conglomerate which makes documentation, authorization and billing a nightmare, the takeover of large segments of medicine by for profit corporations and the heightened expectations for positive outcomes fueled in part by misleading advertising by those same corporations.  Many have come to feel that the sacrifices, both personal and economic, that they made in order to go to medical school were just not worth it.

I do not pretend to have any answers to the multiple crises that contributed to the death of Dr. Davidson, or the current climate in which doctors and patients must function.  I wish I did. But I do have a request for both my patients and others, and my physician colleagues, as well as my Facebook friends and the media.  Let us try once again to see the good in one another again, and not just the bad.  We’re all human, and at some point we are all going to get sick.  For better or for worse, we depend on one another.

In Memoriam–Dr. Michael Davidson

In 1994, I was working at my first radiation oncology job in San Diego at Grossmont Hospital when I came into work to hear disturbing news.  One of my colleagues in medical oncology, a compassionate man known for his gentle nature, had stayed late at the Cancer Center the evening before to finish up paperwork.  With his back to his ever open door, he sat at his desk never once considering that he was in danger.  A disgruntled relative of a former patient surprised him from behind, and beat him viciously over the head and body causing broken bones and contusions, and leaving him for dead.  He managed to call for help, and he survived after spending two weeks in the hospital.  He returned to his practice of treating cancer patients after a long convalescence—after all, it was his calling in life.  He died many years later, suddenly at age 69.  I do not know if that beating years earlier contributed to his early death but the knowledge of it certainly changed my life.  I worked late, and was alone in many offices at night after that, but I remained cautious and vigilant about security, never again taking safety for granted.

Yesterday I got a hasty text message from my daughter, who is a second year internal medicine resident at Boston’s Beth Israel Deaconess Medical Center.  She told me that a doctor at Brigham and Women’s Hospital, a fellow Harvard teaching hospital, had been shot at work and that the hospital was on lock down.  She didn’t know how much was in the news yet, but wanted to let me know since I had trained and worked at these hospitals.  I was as shocked as she was, but I should not have been.  The doctor, Michael Davidson, was a highly respected young cardiovascular surgeon—a rising star in his career, and a husband with three children at home.  The gunman, having sought out Dr. Davidson, fired two shots at close range before retreating to an exam room and taking his own life.  Dr. Davidson was given immediate medical attention by his colleagues at his own hospital, one of the top trauma centers in Boston.  He died of his injuries late last night.  As it turns out, the shooter, Stephen Pasceri, had no history of violence and his gun was licensed.  But he did have a history of dissatisfaction with the “medical system” and sadly his mother had been a patient of Dr. Davidson’s, and had passed away two months ago.  Not much has been said in the news about her, but such is the nature of cardiovascular surgery—these doctors do not operate on healthy patients and not every outcome is successful.

When I visited the Hope Institute in Jamaica in 2013, I saw many patients dying of cancer, without the benefits of affordable chemotherapy, state of the art radiation therapy and even without a readily available supply of morphine.  But I did not see anger, in the patients or their relatives, who were cared for under the loving guidance of Dr. Dingle Spence.   Here in America, quite the opposite is true: we have come to believe that every disease is curable, that every outcome should be positive, and that death, in the words of Dylan Thomas, shall have no dominion.  Most of us, however do not take to the wards fully armed, looking for our doctors. Today I am in despair for his wife, for his children, for the surgical residents he would have taught, and for the thousands of patients that Dr. Davidson could have helped if his life had not been taken.

When we graduate from medical school, we take the Hippocratic Oath, which in the modern version not only exhorts us to heal the sick but to exhibit warmth, sympathy and understanding.  Let our patients and their families extend those same traits to us as we complete our daily rounds.  Let our clinics and hospitals be places of healing, and not of killing.  Please, please let us do our jobs.

Addendum January 22, 2015.  This was submitted by a colleague in the Comments section but I want to bring it forward to the actual page.  Please take the time to read and consider signing.

Dear colleagues,

The violent death in Boston of Dr. Michael J. Davidson, an inspiring cardiac surgeon who devoted his career to saving lives and improving the quality of life of every patient he cared for, is a senseless and horrible tragedy.

There was an incident in the past where a patient at a VA hospital made a threat to shoot a physician.

VA physicians are federal employees. Federal employees have enhanced legal protection against violence. The threat of violence toward a federal employee by itself is illegal. Police officers were able to conduct an investigation and speak with the patient. Once the patient understood that the threats could lead to prison, the volatile situation was defused.

Laws protecting federal employees against violence provide an additional tool to help direct an individual away from violence. Unfortunately, this protection does not extend universally to all healthcare providers.

The White House has a “crowd-sourcing” system where the executive office reviews proposals with at least 100,000 signatures obtained within a 30 day period.

http://wh.gov/i220E asks that the legal protections against violence currently provided to federal employees be extended to all healthcare providers.

While no law reduces risks to zero, our effort would be well worth the energy if it could prevent even one senseless death.

Please take a moment to sign this petition, and consider spreading the word. Everyone can sign this petition including your friends and family.

Thanks.

The Curbside Consultation

Recently a friend of my husband’s in San Diego had a mammogram which showed some suspicious microcalcifications in her right breast.  She underwent a stereotactic biopsy which revealed ductal carcinoma in situ, the earliest form of breast cancer also known as Stage 0 breast cancer.  This type of cancer is non-invasive and does not metastasize, however, if untreated it can progress or recur as a more serious type of breast cancer, so at the very least excision of the abnormal area is indicated, and in some cases radiation and/or mastectomy are necessary.  My husband asked if I would speak to her regarding her breast cancer, and somewhat reluctantly I said yes.

 

Why reluctantly, you might ask.  Isn’t that the nice thing to do?  I said to my husband, “I think it’s a mistake to do consultations over the phone.  I have no access to the mammograms or pathology report, and I cannot examine her.  These things are important to have and do to give someone an informed opinion about her case.”  He said, “But can’t you just talk to her a little bit and recommend a surgeon, and maybe give her a bit of information about radiation therapy?”  I agreed to do it.  A few days later we connected by phone.

 

Having practiced in San Diego for twenty one years, and having a major interest in breast cancer, I know every surgeon in San Diego and Riverside counties who specializes in breast cancer.  Likewise, every radiation oncologist and medical oncologist.  I am a virtual referral encyclopedia—tell me where you live and I will tell you where to go.   In this case I recommended the surgeon whom I would choose to operate on ME, if I had breast cancer.  Same thing for radiation oncology.  I did this for my husband’s friend, and we discussed her case at length.  Because of her relatively young age, excision alone was a bad choice, so we discussed the pros and cons of excision plus radiation versus simple mastectomy with or without reconstruction.  At the end of the conversation she thanked me, and then mentioned that there were actually TWO areas in the breast that were biopsied and were positive, and they were not particularly close together.

 

That little fact, which I would have known if I had had her pathology report and her mammograms in front of me, changes everything.  If a woman has multifocal disease, there is a good probability that she may be better off removing the breast.   I backtracked and covered that point, but I worried that I had made an anxiety provoking situation much worse by confusing a new breast cancer patient.  In the end, she sought the care of an excellent breast cancer surgeon, and I know she will be fine.  But I have the lingering feeling that in trying to do the nice thing, I did the wrong thing.

 

Think of this when you stop your doctor friend on the street to ask about a friend or relative who has recently been diagnosed with cancer.  Curbside consultations do no one any favors.  If you or a friend or relative need an opinion, get an INFORMED opinion—present to the consulting physician with your history, your radiology, your lab work, your pathology and your body to be examined.  Then, and only then, you will be assured that the recommendations that you receive are the ones you should truly follow.  It could save your life.

They Shoot Horses, Don’t They?

“I may not know a winner when I see one, but I sure as hell can spot a loser.”  Rocky

On Saturday night, thirteen horses were saved from kill buyers at Mike’s Auction in Mira Loma, California, by three rescue organizations—Forgotten Horses Rescue, Inc,  HiCaliber Horse Rescue and Joey’s Home Animal Rescue.  Here in the United States, we consider horses companion animals.  We don’t eat horses.  In other countries, that is not the case.  When a horse is used up—too many losses at the race track, or no longer fit for work, or too old, too lame or too tired to be useful, they go to auction.  Despite the withholding of federal inspection funds in 2007, when horse slaughter was essentially banned in the US–funds were restored in 2011, and three states including Missouri, Iowa and New Mexico have been trying to reinstate their slaughterhouses.  The result of the 2007 ban has been the unintended consequence that horses are now shipped to Mexico for slaughter, transported in crowded railway cars without food or water, and then, if they even survive the journey, they are bludgeoned to death with sledgehammers.  This is not death with dignity befitting a once beloved family pet, or a money winning race horse.  But it happens at Mike’s.  Once a month, on a Saturday night.   Do not blame the auction house—they, like all of us, are just doing business.  Blame the folks who treat animals as commodities instead of living sentient creatures.

My old horses, Dash and Norman, are now 30 and 27 years old.  They have lived a good life—one, Dash has been a children’s show horse since he was three years old.  He is lame as can be, but his old eyes still light up if you put a small child on his back and lead him around.  The other, Norman, was born and bred at Disneyland where a small breeding band of pure white Lipizzaners is kept to pull Cinderella’s carriage.   He didn’t take much to pulling a carriage, and was pulled off duty to be trained under saddle.  At age 14, the sorrel Quarter Horse Dash became my son Brandon’s show horse, competing in local western horse shows.  When he retired from the show ring, he became my trail horse, until finally by age 22 he could no longer be ridden without fear of stumbling.  Norman became my 12 year old daughter’s dream horse—trained to fourth level dressage, but plagued by a congenital bone lesion in his left stifle.  He too was retired a few years ago.  Both horses lived at home in my backyard as pampered pets until we moved to New Mexico in October.  They are now under the care of Dash’s former trainer in Del Mar, California, where they will remain at least through the winter.  I miss them terribly.

I never thought much about horse rescue until I got a letter in the mail five years ago from The Horses of Tir Na Nog, a San Diego horse rescue group.  Apparently, unbeknownst to me, my husband had given them some money.  He is not known for his charitable heart, so I figured he must have been on to something worthwhile and important.  So I kept giving them money, and then one day I saw a Facebook page that made me feel like I had been punched in the stomach—for Forgotten Horses Rescue, started by Trish Geltner when a starved horse named Spero came into her care.  Spero didn’t make it, but Trish vowed that he would never be forgotten, and she has kept her word.  Then I found HiCaliber, founded by Michelle Cochran, a formal San Diego Animal Control officer who got involved when she intercepted an auto accident involving a former racehorse.  Before that, she had “only” been involved in rescuing much maligned pit bulls.  It took me a long time, but I have finally realized that not every equine is treasured and treated to a loving life of retirement.  So I am doing my best to see that the old, the sick and the lame are spared a miserable death in a cattle car.   It is my small way of giving back, and being very thankful that I have the means to be the owner of 30 year old and 27 year old retired horses.

My heart breaks when I see starving, beaten and abused horses, dogs and other companion animals.  I know that yours breaks also.  So please, people—if you have a beloved animal companion warm and safe at home–a dog, a cat or if you’re very fortunate, a horse—find a local shelter or rescue and do what you can to support it.  It may not be much—a few dollars or a few hours of your time.  But trust me, it will mean the world to those you support.  Thank you.