Heisenberg and Your Prostate

Uncertainty Principle:  A principle in quantum mechanics holding that increasing the accuracy of measurement of one observable quantity increases the uncertainty with which another conjugate quantity may be known.

Perhaps it is because I just got back from Albuquerque, a city which has become like a second home to me, that I have Heisenberg on my mind. For the one or two of you out there who are not “Breaking Bad” fans, “Heisenberg” is the name that mild mannered chemistry teacher Walter White assumes when he decides to manufacture pharmaceutical quality methamphetamine after being diagnosed with Stage III lung cancer. His motivation is to be able to leave his pregnant wife and son affected by cerebral palsy a little cash when he dies.  The evolution of Walter from upstanding high school teacher to ruthless drug lord unfolds over six seasons where moral ambiguity is the coin of the realm—in uncertainty principle terms, the more single mindedly he pursues his meth business, the fuzzier his personal ethics become.

Recently I have begun to think of the dilemma of PSA testing and the diagnosis and progression of prostate cancer in terms of the Heisenberg uncertainty principle.  Nowhere is this more apparent than in the case of men who have a rising PSA level post prostatectomy.  For many men faced with the choice of surgery versus radiation therapy, the selection revolves around the perception of certainty.  In medical school we are given the mantra, “To cut is to cure!”   Many patients choose surgery because of that perception—the ability of the surgeon after the procedure to say, “We got it all” and the satisfying thud of that post op PSA falling to zero.  Life is as it should be, the offending organ is gone, and the PSA is the definitive proof of cure.  In my own career I have pointed out countless times that if a man wants it black and white, cut and dried as it were, he may be more satisfied with the surgical option, since the slow fall in the PSA level post radiation therapy, with its attendant subtle blips and variations can be maddening to the patient, his family, and of course the attending physician.

But what of the patient whose PSA post prostatectomy does not fall to an undetectable level?  Or the patient whose PSA becomes unmeasurable, but months or years later starts to rise again?  On the one hand, our ability to measure serum PSA levels as a proxy for prostate cancer still lurking in the body has improved to the point of being able to measure values as small as hundredths of a nanogram per milliliter of blood.  We call this the supersensitive PSA assay and we accept this as proof that the cancer is there, somewhere, waiting to recur.  But what this supersensitive test cannot tell us is exactly WHERE those cancer cells are.  Neither bone scan, nor CAT scan, nor Prostascint imaging nor ultrasound is likely to give us the answer.  So what do we do?  As radiation oncologists we offer the patient the best we have, treatment to the “prostate bed”—the area where the prostate used to be—and sometimes the adjacent lymph nodes.  We know statistically that over a period of years, large groups of patients who were treated for their rising PSA with radiation do better than those who were not, but sadly this tells us nothing about the individual patient.  And the individual must decide for himself whether to take the leap of faith, and the side effects of one treatment compounded with another, that the cancer cells are still localized and that the radiation will kill them.

As a clinician treating patients with rising PSA’s post prostatectomy, I wait with bated breath for the first PSA after radiation to the prostate bed.  The patient is equally anxious—that stark simple but highly precise number is the measure by which we judge success or failure of the treatment.  But in focusing on the PSA, we often forget the obvious—that a number, even a highly precise number, is just that and nothing more.  What the patient will die from, and when, remains uncertain.  If I can help my patients remember that, and go and live their life with zest and satisfaction, then I have done them a real service.

Make Yourself At Home

I try not to sweat the small stuff.  Really I do.  But when I leave home, and leave my menagerie in the care of a house sitter, I am nothing if not explicit.  The directions for the care and feeding of my four dogs and two horses (the cat got a reprieve from his Boston eviction until May 9th) come to a total of four printed pages, small font, single spaced with nice paragraph indentations and bold headers like EMERGENCY!!   A walk through prior to the departure date is mandatory, to demonstrate the intricacies of the garage door and the cable TV.  The house sitter is equipped for every possible natural disaster. The keys to the van, already loaded with dog crates, are left on the kitchen counter and the van itself has enough water, canned goods, leashes and dog food to last a good month. Thermal blankets are located behind the driver’s seat, just in case hell freezes over here in sunny Southern California.  Flashlights are industrial quality, and batteries are included.  You could say that I am a “Be Prepared” kind of person.

Last week the rare occasion occurred where my husband and I had different trips planned at the same time.  He was going to Japan on business, and I had plans to meet a friend in Albuquerque for a three day getaway.  I tried to round up the usual suspects for housesitting, but all were previously booked. So rather than cancel my trip, I took the plunge and hired someone new.  She came over a week before the trip, loved the animals, memorized their names quickly, and took notes on top of my printed instructions.  She said she would leave her own dogs at home with her daughter and that she had no prior commitments during the time that I was to be gone.  I left home with a sense of relief that finally, I had found the right person for the job, and my parting words were, “Use the latches on the doors leading to the living room and please do NOT let those dogs pee on my brand new living room carpet!”

As I pulled through the gate onto my own driveway on Saturday night, the first thing I noticed was the horse trailer sitting inside.  A horse trailer?  My horses haven’t traveled in years.  I briefly considered peeking inside the trailer, but I could see my own horses down at the barn, and decided to go inside.  My dogs were lying down, relaxed, fed and happy–no worse for the wear.  So far so good.  My house sitter was seated at the kitchen table.  She beamed at me and said, “I enjoyed staying at your house SO much!  It was like having a vacation.  I should be paying YOU to stay here!”  She then elaborated, “I hope you don’t mind that I brought my horse over.  He didn’t get along with the white one so much, but he was fine with the chestnut!”  Seeing my look of surprise, she said, “I only wanted to take a little ride up the street to see the neighborhood.  I hope that was okay.”  I nodded numbly, wondering how far behind my horses were on their vaccinations.  She then went on cheerfully, “The dogs all got along great—my Great Pyrenees managed to go swimming in the muddy stream, so my daughter and I had to hose him down with the garden hose but we got him clean, and washed all the towels.”  I resisted the urge to run look at the certain hairballs in the washer and dryer.  She stood up and said, “I’ll come back ANYTIME!”  As she walked out she grabbed a large blue accordion that I had somehow missed on the way in.  She smiled and declared, “The dogs loved my music!”

As the horse trailer crunched out the driveway, I decided to have a look in the living room.  The stampede of pawprints were unmistakable, as were the large yellow spots on the white carpet that kept me occupied until around nine pm, when the sound of geysers through my open kitchen window led me outside. A trail of broken sprinkler heads crushed by the wheels of the swaying horse trailer created a fountain effect not entirely dissimilar to the fountains at Bellagio.  Unfortunately the water was not falling on the grass.

Multiple applications of pet odor and stain remover plus one brand new Bissell vacuum later, along with a hefty repair bill for the sprinkler system, parts and labor, all is well with the world.  My traveling companion said, “Did you call her?  Did you yell at her? What did you say??”  I shook my head.  As I said, I try not to sweat the small stuff.  After all, the “kids” are all right.  Anybody know a good house sitter?

Love in the Time of Cancer

I used to be able to paint my own toenails but that was before age and arthritis caught up with me and these days I can’t SEE my toes, much less paint them.  Here in the land of perpetual sunshine and flip flops one is not allowed to have ugly feet, so off I went today to see a lovely woman who takes care of such things.  Today she was very sad over the end of what had been a promising love affair. He had seemed to have all the “right ingredients”—handsome, slightly older than her but boyish still, owned his own business, long divorced with no pesky baggage such as alimony—for a while she thought he just might be “the one.”  I asked her what happened and she said simply, “Anger issues.”

A couple of months ago, writer and radiation oncologist Dr. Robin Schoenthaler shared with me an essay she wrote in 2009, which I had somehow missed when it went viral over the internet back then.  It is simply titled, “Will He Hold Your Purse?” and here is the link because it is a must-read for any woman seeking a man:  http://www.boston.com/bostonglobe/magazine/articles/2009/10/04/will_he_hold_your_purse/  I thought about that article today as my manicurist, age forty-five and gorgeous but still single described walking away from a relationship that she recognized could be harmful.  And I remembered some of my own stories from the cancer clinic, and I told her one of them.

I recall one couple distinctly, from 2003.  They were both in their eighties, and she had breast cancer. One reason they were so memorable as a long married couple was that he was African American, and she was Caucasian, and back in the 1940’s when they married, two schoolteachers in love, they must have faced nearly insurmountable prejudices and racism.  He was an attractive soft spoken gentleman, with a sweet smile and wiry close cropped gray hair.  She must have never been a great beauty, but time had thinned her hair, and added on pounds, and osteoporosis had twisted her spine. When I saw her after her surgery, she had had a wound infection, and her breast had become misshapen as a result.  He held her hand tightly though out the consultation, and when I left the room so that she could get dressed, he followed me out into the hall and grasped my own hand in both of his. With tears in his eyes, he asked, “Will she be alright?”  I replied, “Yes, she will.  Her cancer was caught at an early stage, and I think she will be fine.”  He sighed with relief, and still holding my hand, he said of his wife, “She is my princess and my queen and my better half and my best friend.  I could never go on without her.  Thank you, Doctor, thank you.”   We walked back into the exam room and he beamed at her.  She blushed as she met his gaze.

I don’t wish for any couple to have to undergo the litmus test of a cancer clinic.  But when my manicurist said to me today, “I don’t think I even believe in love anymore,” I sure wish we had a proxy for that partner who, in Dr. Schoenthaler’s words, “will sit in a cancer clinic waiting room and hold hard onto the purse in his lap.”  That’s the one we want.

It Helps to be Famous

Boston is a mighty fine place to visit, if you don’t mind the weather–my trip to the Harvard Writer’s Conference this week started out with four straight days of freezing rain punctuated only by gusts of wind.  But cold feet and wet shoes could not deter me and my daughter from our appointed rounds of Newbury Street and the Mall at Copley Place. Lugging my suitcase through Logan Airport last night reminded me that I bought more than books at the conference book fair.  In fact, I had already made a pit stop at Fed Ex to mail the books home—no room in the baggage.  I finally arrived back in San Diego at 11 pm, after seven hours on a JetBlue plane, where no matter how much they brag about the snacks being free, there’s only so long you can hold out on two bags of blue potato chips and a roll of Mentos.  The hastily bought tuna salad sandwich from Dunkin Donuts at the gate proved to be far too suspect to actually eat, and if you know me, you know that I am NOT a picky eater.

But back to the main subject at hand, the annual Harvard Writers conference (www.harvardwriters.com) was a welcome respite from the medical meetings I usually attend. The three days of talks by noted medical authors, publishers and literary agents were outstanding, but the best part of the conference was getting to meet other writers, some well published and some aspiring, to share ideas and stories.  I met specialists of every variety, including child neurologists (“How to Develop Your Baby’s SUPERPOWERS!”), sex therapists (“and let me tell you, I hear about a lot of BAD sex!”) and a surgeon who wrote a memoir of his internship called “The Year They Tried To Kill Me: Surviving a Surgical Internship Even if the Patients Don’t!”)  Who knew that the practice of medicine could be so exciting?  The fact that I have not ever actually WRITTEN a book did not deter me in the slightest—I signed up for every lecture, every work shop, every interactive demonstration to be had.  And I learned a tremendous amount.  Next year I’ll come prepared:  I will try to write a book.

Kudos to the course organizer, Dr. Julie Silver (www.juliesilvermd.com) , a breast cancer survivor, mother and Harvard physical medicine and rehabilitation specialist for putting together a stellar faculty.  She spoke about a subject familiar to many of the readers of this blog—she found that while she was able to survive her cancer, the aftermath of the treatments nearly killed her, which inspired her to write her book “After Cancer Treatment: Heal Faster, Better, Stronger,” a book which will help not only breast cancer patients but all cancer survivors recover from the side effects of therapy.  The prize for the most entertaining lectures had to be shared by Dr. Salvatore Iaquinta and Mr. Rusty Shelton. Dr. Iaquinta, the surgeon who self-published his memoir mentioned above created his book, soup to nuts, on Amazon’s vehicle “Create Space” (www.createspace.com) and highly recommended the process.  Definitely worth looking into.

Mr. Shelton, of Shelton Interactive (www.sheltoninteractive.com) gave two very enlightening lectures on the use of social media in publishing and marketing.  As it turns out, a lot of attention in the book publishing world is paid to something called “platform.”  In my hitherto world of swimming and diving, when someone said “platform,” they meant five meter or ten. But in the publishing world, the “platform” is the influence and following a would-be author has already built, not only through their professional associations and media appearances but also through the social media of a self-named website, a Facebook page, and especially a Twitter account.  The somewhat obvious conclusion here is that if you want to get a book published, it is exceedingly helpful to be famous already!

So grab your domain name now, and don’t forget Facebook and LinkedIn.  On your mark…get set…and START TWEETING!

Anxiety

Nearly two years ago, I sat with my younger sister at the airport in Houston, Texas waiting for our respective flights.  She was going back home to New Jersey, and I was headed back to California.  While waiting, she passed the time browsing SAT prep sites on her iPad.  Her oldest child, my nephew, was starting his junior year of high school that fall, and she wanted to make sure his summer was well spent, and that he had the opportunity to prepare for the exam which would determine his future college options.  As she talked about the merits of one approach over another—classroom instruction versus private tutoring– I felt my anxiety level rising like an uncomfortable expanding bubble in my chest, gradually cutting off my air supply.  The pressure was palpable.  After listening for a few minutes, I said to her, “Please stop talking about this—you’re making me very nervous and I’m not even TAKING the exam.”  She looked at me in surprise, and we moved to other topics.

 

On Sunday evening on our way out to dinner, I went with my daughter to take sign out from the intern who was leaving the ward service the next day, and turning the very sick patients over to my daughter’s care.  I tried to position myself unobtrusively, in the far corner of the residents dictating room, sinking as deep into the shelter of my wrinkled hooded raincoat as I could, but even from my self made cocoon I could hear them discussing in hushed tones the low platelet counts, the mucosal bleeding, the fevers unresponsive to antibiotics in these acute leukemic patients.   It was seven pm after a long weekend on call, and the interns and residents looked exhausted.  The white cubicles and the scuffed linoleum on the floor reflected the fluorescent ceiling lights overhead. The faint smell of stale fried food and sweat combined to form a vaguely nauseating aura.  Suddenly I was transported back thirty-five years to my own internship, and to my first night on the cancer service and in that instant, I felt every bit of anxiety that I felt so many years ago.  For anyone who has done an intensive medicine or surgery residency, these feelings form the impetus to learn and become competent—the overwhelming sense that a human being’s life is in your hands, and this night, and every night, you must be vigilant; you must perform and do your very best.  The end of shift can never come soon enough.

 

It’s been many years since I taught a class of high school students, or staffed an inpatient service run by interns and residents.  But if I ever do either again my recent “flashbacks” will serve me well.  It’s good to remember the fear and tension associated with being a learner in a stressful situation.  Teaching has always been a passion for me, and those are the memories and feelings which will make me a better teacher.

Two Hundred and Nine Short Essays Later

 

Here I am in Boston, on the eve of my very first writer’s conference, feeling a bit like an imposter.  After all, the extent of my writing so far has been this blog, apart from thousands of histories, physical exams and treatment plans over the last thirty-nine years since starting medical school.  It occurred to me that someone might actually want to know what it is that I write about.  And then it occurred to me that I had never actually thought about it.  So I did, and this is what I came up with.

 

WHAT I WRITE ABOUT:

Cancer                                                                                                                           Radiation Therapy                                                                                                                 Dogs                                                                                                                                   Cats                                                                                                                                     Horses                                                                                                                                   Being a mother                                                                                                                         My kids                                                                                                                                 Travel                                                                                                                                    My father                                                                                                                               My mother                                                                                                                             Being a doctor                                                                                                                         Life

WHAT I AM TRYING TO SAY ABOUT LIFE

Cancer patients inspire me and motivate me                                                                       I’d like to explain a few things about cancer                                                                         I’d like to explain a few things about radiation therapy                                                     Cancer is evil and is not selective and makes me sad                                                 Cancer patients can be funny and they also make me laugh                                   Sometimes people do really stupid things when it comes to cancer treatment         Sometimes simple people can be heroes                                                                         Dogs are good therapy for me, my cancer patients, and my kids                                     Ditto on cats                                                                                                                       Horses are beautiful, liberating, dangerous and always expensive                                     You can be a mother AND a doctor and it’s going to be very hard                                     Your kids will forgive your shortcomings                                                                            Your kids will make fun of you                                                                                           Your kids will be successful if you EXPECT them to be and don’t harass them              Travel is enlightening and sometimes difficult and sometimes funny                                    My surgeon father is both an inspiration and a source of extreme annoyance                       My mother had a hard life and a hard death, despite appearances                               There’s always someone worse off than you                                                                   There’s always something to hope for

 

WHAT I AM TRYING TO SAY ABOUT BEING A DOCTOR AND ABOUT MEDICINE

Examine your patients—it’s important                                                                               Think for yourself and follow your gut instinct                                                                Beware of templates.  They tempt us to cheat                                                                     The Rules of the House of God still apply                                                                      Doctors make mistakes.                                                                                                       Be very selective about who you hire and set a good example for them                             Be the captain of the ship                                                                                                     Try not to whine, even if you fail                                                                             Communicate with your referring doctors and with your patients                                     Take the time and make the time                                                                                         Learn to speak slowly and clearly in layman’s terms                                                           Try not to say no, and never say “never”                                                                             DO NOT DROP THE BALL when dealing with cancer patients                                           And finally, answer your goddamned phone calls

Did I leave anything out?

Taking Back The Cat

 

Boston can be a cruel city, and not just because of the weather, although it is forty degrees, windy and raining right now.  It is an expensive place to live and eat, the drivers are daunting, and everyone always seems to be in a hurry.  A year ago I spend three anxious days here with my daughter, a newly minted MD, desperately trying to find a place that was reasonably close to the hospital she is training in, affordable, and cat friendly.  As they say, “two out of three ain’t bad.”  We found a boxy one bedroom in a high rise a short distance from the Longwood area, and for a mere two hundred dollars extra deposit, she was allowed to bring her cat.  But affordable, this place is not.

 

Medical school can be a difficult and alienating experience, and if you’ve lived your whole life with warm fuzzy creatures all around, as my daughter had, there is only a brief period of excitement about a new city and a new endeavor before you begin to miss the cat curled on your lap when you study, the dog whining for attention and giving you an excuse to give up your books and go for a walk.  Despite the uncertainty of her future, my daughter found herself at the Houston Humane Society, staring into the cage of a ten month old kitten too old to be particularly cute and too plain to attract the attention of the numerous seekers dotting the rows of cages filled with sadness and longing.  A few hours later, she brought the malnourished and worm ridden little gray-brown tabby home, and christened him “Bitty Kitty.”  Several vet visits later, the worms were gone, but the effects of early starvation were not, and he has remained, as an adult, a very tiny cat.

 

A year later, with every month just a little bit more money going out than coming in, my daughter realized that if she stays where she is, her life savings will be completely gone before she finishes her residency.  She looked long and hard, in every spare hour she had, for a less expensive place, still close to the hospital, where she could still keep her cat.  Again, she achieved two out of three goals.  She found the perfect place, much less expensive than where she is living now, within walking distance.   But the cat is verboten.  No cat, no way, not even a tiny one that doesn’t cause any trouble.  She called me weeping, for advice.  I said, “I’ll take the cat.”

 

History has a way of repeating itself.  Thirty-five years ago I was accepted into a residency program at the same teaching hospital she is training at now.   I had a dog, the very first dog I bought, raised and trained all by myself.  Shandy was a collie in the old tradition of Lassie, and he was beautiful, and intelligent and my constant companion.   When I heard on Match Day that I was going to Boston, my only thought was to find a place where I could keep my dog—a large dog at that.  I came and I looked and looked and trust me, there was NO apartment within 20 miles of the city that would let me keep a large dog, or any dog, locked behind closed doors all day, and sometimes all night, because interns keep terrible hours.  I came to my senses when I realized that I knew no one in the city, and that it would be unfair to my dog to keep him.  Heartbroken, I did my best to find him a good home, with a surgeon who later moved to Ohio.  He did not keep in touch.

 

It’s been awhile since we lost old Timmy Tom at nearly eighteen years of age.  Although I have missed having a cat, I have not missed cleaning up kitty litter.  Still, I felt myself weakening recently when I spied a large male orange tabby being offered by a local cat rescue group. He stared at me and purred. But something made me hesitate, and now I know why.  On Wednesday I will depart Boston for San Diego with Bitty Kitty in hand.  He may be small, but he is mighty.  Those deerhounds better watch out.  The cat is back.

An American Safari

I’ve always secretly envied families who served as hosts for AFS, the American Field Service, which promotes cultural exchange by bringing high school students from foreign countries here for a year, and by sending our own students around the world.  As a doctor-mom busy with the balancing act of raising her own three children while pursuing a full time career, I could not imagine coping with an extra teenager around the house, especially where homesickness and language barriers were involved.  I was having enough trouble dealing with my own.  Consequently, I’ve never had the pleasure of being a tourist in my own country—seeing our world through the eyes of a stranger in a strange land—at least not until last week when I hosted my Tanzanian safari guide, Martin, as part of his whirlwind tour of the United States.

By the time Martin arrived in San Diego, I had a tough act to follow. A somewhat arduous journey had taken him from Arusha, Tanzania, to Dar Es Salaam, and from there to Doha International Airport in Qatar.  From Doha, there was a flight to London’s Heathrow Airport, and finally he touched down on American soil in Miami, Florida.  Before he left Tanzania he had written to ask what he could bring me from Tanzania and of course I said, “Nothing, just yourself.”  Apparently he felt that my answer was unacceptable, and he had loaded his suitcase with gifts for all of his American hosts—Maasai clubs for the men, beautiful hand beaded Maasai necklaces for the ladies.  Although Martin made it to Miami where his first hostess, Donna greeted him, his suitcase did not.  After being told initially that it was stuck at customs in Heathrow, the news was delivered much later that the bag was irretrievably lost.   Someone has made a killing selling Maasai artifacts in the London Tube, I suspect.

Martin is an avid amateur photographer and to my delight he chronicled his journey across America on Facebook.  His Florida entries included his introduction to MacDonald’s, gated communities,  gardeners wielding leaf blowers, drive through banking, an RV dealership, and Harley Davidson motorcycles.  From Florida he traveled to Washington, DC where he posed in front of the White House in what appeared to be a blizzard.  He was hunched over, smiling and shivering.  After a brief stop in New Jersey to visit relatives, he moved on to San Antonio, Texas where his host there, a wealthy rancher, had been so grateful for his own safari to Tanzania he went back and built two wells in Martin’s mother’s hometown.  This African man who faced down Cape buffalo at home was pictured gingerly reaching out to pet a longhorn steer on the ranch, with the caption reading, “I am afraid of these cows!” A field trip to the Alamo was followed by an evening of San Antonio Spurs basketball.  From Texas he ventured to Colorado, hitting Denver, Colorado Springs and Breckenridge in the course of 48 hours–“I took the gondola up the mountain, but no, I did not ski!”  And finally, two weeks after arriving in America he stepped off the plane at Lindbergh Field.

Before Martin came to Southern California, I asked him what he most wanted to see.  His answers were immediate and definitive—he wanted to see Hollywood, and he wanted to go to the World Famous San Diego Zoo.  Hollywood I could understand, but the zoo was more problematic.  I said, “Martin, you see these animals every day in the wild.  Why would you want to go to a zoo?”  He replied, “Because I want to see how Americans learn about the animals of Africa, and I want to see animals that I have never seen in Africa.”  A day later I was on a Hollywood Home of the Stars tour bus, snapping pictures with my iPhone and oohing and aahing like all the rest—“Look, the Playboy Mansion!  Tom Cruise’s house!  Madonna’s house!  KATY PERRY’S HOUSE!!!!” To which Martin replied, “Did he say MacDonald’s house?”  As I took his picture with an ersatz Charlie Chaplin on the Walk of Stars, the actor turned to me and asked me for a tip.   Martin said, “Just like Maasai!”

Martin’s last stop in San Diego was indeed the San Diego Zoo. As we walked through the exhibits, he marveled at how much effort was made to recreate the animals’ natural habitats. A friend of a friend is a panda keeper there, and we were treated to a behind the scenes tour of the panda facility which houses the most successful captive breeding program of these rare creatures in the world.  (Thank you, Kathy Hawk!) A viewing of the bamboo storage locker was followed by a special viewing of the recently weaned baby panda, Xiao Liwu.  After the pandas, the Polar Bear Plunge followed, and all was well until we got to the elephant enclosure.

In 2009, one of my patients wrote the ad copy for the San Diego Zoo’s new elephant enclosure, dubbed The Elephant Odyssey. She urged me to go and visit this state of the art facility, and finally in 2011, I did.   As much as the zoo tried, there is only so much it could do with 2.5 acres.   The steel “baobab” trees, and the girders and the electric fencing were reminiscent of “Jurassic Park.”  Despite the various enrichment activities and “no touch” training, this was not the Serengeti.  Martin gazed upon the elephant enclosure with dismay.  He said, “The elephants are sad.”  As we walked out of the zoo, he said to me, “Why don’t Americans come to Tanzania to see these animals?  They are so much happier when they are free.”  I explained to him that to me, and to most Americans, a trip to Africa is an expensive dream, and nothing more.  He said, “I wish that were not so.”

One of Martin’s last Facebook photos of his trip was a panoramic view of the Las Vegas strip, which he subtitled “THIS is America!”  The tone of his remark was of childlike wonder, without a trace of sarcasm or irony.  Although many of us were quick to “correct” him—“No Martin, Las Vegas is NOT America”, the truth is that for many, America is still a place of fabulous riches and bright lights, a place where dreams come true.   Seeing my world through Martin’s eyes, from the sandy beaches of the coastal towns, to the glitz of Hollywood, the concerted conservation efforts of the San Diego Zoo and to my own backyard, convinced me that indeed, the grass is always greener. While he dreams of Hollywood, I dream of returning to Africa, summer of 2015.  Anyone care to join me?

Moving Mom

 

Another guest blog tonight from my friend Jackie–I can certainly relate and I know many of you can too!

 

My Mother turns 90 next month. She is selling her house of 28 years and moving in with us. It’s official: I am a grown-up.

Time is a funny thing. I remember I couldn’t wait to grow older when I was young. It seemed forever to reach that 16th milestone; then 21, then 30 and OMG I was 40. Officially OLD. My eldest son is 35 and honestly and I can actually remember being 35 and yet here I am at 61 taking on the role of care-giver and life-manager for my mother. I raised 4 kids with an alcoholic husband, got through a miserable divorce, survived the deaths of my father and sister, but I never felt like a grown-up until now. It’s a little scary.

In conversations with my peers I discovered we are all going through this challenge together; what to do when your parents are not capable of living independently but don’t want to go to “one of those places”. I researched a lovely retirement community near us a few years ago and told my mother all about it. She was quiet, and refused to come visit us for almost a year, fearful we would surprise her by leaving her there and abandoning her. Of course this was never our intention; we thought that living in a high rise condo community with chef-prepared meals everyday, an on site beauty shop and library, shuttle service for shopping ~and even a town car chauffeur on duty daily~ would be lovely! I wanted to go live there myself! But she shut down any conversations about this idea and insisted she was fine in her big two story home – alone – and lonely.

In a tough conversation three years ago I explained to her that I had given up on trying to re-locate her nearer to us. Although we are only a three hour drive away, that is a long stretch in an emergency. She agreed “in principle” that living so far away wasn’t a good thing, but she just couldn’t bring herself to part with her home and all her things. I explained to her that I wanted to help move her closer but without some cooperation on her part it was just too hard. She promised to try and at least start sorting through her house and throwing things away in preparation for the “someday move that she didn’t want to make”. I asked her to begin with the magazines. There were 500 magazines from 25 years of saving neatly stacked in piles in her family room cabinet. The next time I visited I checked and the magazines were still there. We had a long way to go.

Last year as we grieved the loss of my sister, her perspective shifted. She was ready to be closer to us; her being alone was becoming more difficult and she realized I couldn’t hop into a car and drive long distance just to help her to a doctor’s appointment. Oh – and she was still driving. Last year when she turned 89 her Driver’s License needed renewal. “AHA” I thought – when we go to the Department of Public Safety office they will surely make her take a test or maybe do a refresher driving exam. And then she couldn’t live alone and she would have to move. Nope. She filled out the one page form and checked “no” to all the pertinent boxes – she had not had a stroke, or was disabled, or had a chronic illness that made her unable to perform driving tasks. When I saw the box “Are you Hearing impaired?” I jumped up and asked the clerk if being deaf in one ear was an issue. Her response “Can she hear a officer if he stopped her vehicle and spoke to her?” Mom answered “Oh yes last year when I forgot my new Vehicle registration sticker a nice officer pulled me over to tell me and I heard every word.” She paid her $7 and got a new photo taken and we were finished. I asked the clerk when this license would expire and she answered “When she is 96.” I asked if there would be any tests or refresher driving exams and she nodded, sadly, “no”. Fast forward to now and we have all agreed that it’s time to turn in the keys. Whew.

The choices had become more complicated since a few years back when I thought the condo life was the answer; she was no longer a candidate for an active retirement community and certainly not ready for an assisted living situation. She still enjoys puttering outside in her garden and managing her meals and laundry – so what was the solution? As I thought about it I reflected back to 1986 when my parents built their dream home and included a suite so my then-90 year old grandmother could permanently live with them. I guess the cycle has come full circle as my husband and I are now planning our dream house but with one significant addition – a small cottage on the property so that she may live near us and with us as she needs and I will be close to help out when that time comes. She’ll have a bright and shiny new place to live just steps away from us, and if she needs care, there is an extra bedroom.

And so the clean-out of her home began. I started with ( guess what) those magazines. Mom kept trying to save them back – I kept throwing them in sacks. We finally agreed if we took them to the Library they could be enjoyed by many people and we didn’t have to move them. Over the past months several more trips to her home for clean out sessions followed and before long the house was show-ready. It sold in 8 days after 4 different offers. The sale will be final in early May and the serious packing has begun. Mom told me recently that she really can’t believe she is going to be 90 soon. She still feels in her mind that she is younger; where have the decades gone? Perhaps it’s a myth that you are supposed to feel your “real” age. Whatever the case, I am embracing this challenge and look forward to having Mom closer. I know it will not always be easy but that’s okay. It will be a privilege to make her final years happy and safe. On those really hard days I will remember what my daughter said to me recently “Ya know Mom, when you are old we will be taking care of you”. So perhaps the bigger lesson here is that family is family, and sometimes that’s all that matters. I can do this. And after all, I AM a grown-up now.

A True Story

As a child, I dreamed of going to Africa some day on safari.  Late at night I would drift to sleep hearing the imagined trumpeting of a bull elephant, and seeing visions of elegant giraffes moving like tall masted ships through the grasslands of the Serengeti behind my closed eyes.  I read voraciously—first children’s books about the animals, and later the autobiographies of brave colonial women—Beryl Markham’s West With the Night, and Isak Dinesen’s Out of Africa.  But I never went there until two years ago, when I received a flyer in the mail about a trip to Tanzania during the great wildebeest migration sponsored by my college alumni association.  I was fifty eight years old and had not been out of the country in ten years.  It was time, and throwing fiscal caution to the wind, I exercised my credit cards and signed up.

My guide on that trip was Martin Matei, who at that point had been employed as a safari guide for twenty five years.  Martin had an uncanny ability to see things the rest of us could not see, and hear things the rest of us could not hear, and upon doing so, would put his foot on the gas pedal of the old canopied Land Cruiser to get us right in the thick of whatever was happening.  As a result, I managed to get some extraordinary shots of elephants mating (“Happy Babar”) and an exhausted lioness rolling on her back after a similar session (“She’s Having a Cigarette”).  It didn’t take long for the six of us in Martin’s car to notice that wherever Martin went, the rest of the guides fell in behind. It was indeed the trip of a lifetime.

Martin and I have kept in touch over the last two years, and a few months ago, I received an email from a man named Beatus Mushi who identified himself as Martin’s nephew.  Beatus, who lives in Colorado Springs, had a list of Martin’s email contacts and had taken it upon himself to organize Martin’s first trip to the United States, hoping that some of his former clients in the US would help out to show him the country.  We were delighted.  Martin left San Diego for Las Vegas today after three days packed full of activities, including a Hollywood bus tour and trip to the World Famous San Diego Zoo.  More about Martin’s American safari later, but first a quick story.

In 2003 Martin was guiding a safari party that included Dr. James Doti, the president of Chapman University in Orange, California.  Dr. Doti had a wonderful time on safari, and wanted to do something to show his gratitude to Martin, so he asked if Martin had any children.  Martin had three, but at the time they were quite young.  Martin asked why, and was told that as president of the university, it was Dr. Doti’s right to bestow three full Presidential Scholarships to deserving students.  Martin said, “I have a nephew who is very deserving—smart, and a very hard worker.” Martin arranged for Beatus to meet Dr. Doti. Interviews and tests ensued, and a few months later, Beatus received a first class ticket from Arusha to Los Angeles.  A few years later, Beatus was in possession of a first class education from an American university.  And what did Beatus do?  He became a US citizen and joined the United States Army.  And in the process he supported his widowed mother and his six brothers and sisters so that they too, could rise out of poverty and get an education.

I think that from now on when I read the newspaper and feel despair over war, global warming and worldwide poverty, I’ll think of what Dr. Doti did by extending a hand to one, thus changing several lives.  Serendipitous meetings and small gestures can make a huge difference:  one does what one can.

For Dr. Doti’s account of running the Boston Marathon with the young man he came to call his African son, go here:  http://marathonandbeyond.com/choices/Doti.pdf