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.

Gone With The Wind

I have forgot much, Cynara! gone with the wind,
Flung roses, roses riotously with the throng,
Dancing, to put thy pale, lost lilies out of mind,
But I was desolate and sick of an old passion,
Yea, all the time, because the dance was long:
I have been faithful to thee, Cynara! in my fashion.

Ernest Dowson

Having no artistic talent whatsoever myself, nonetheless I am fascinated by art, and especially by artists themselves.  My father has been both an artist and an avid collector since the ship he served on as a Navy dentist docked in Sicily, and the local artists were allowed to come aboard to sell their wares.  He still has paintings he bought in 1945 hanging on his walls.  As a teenager in Depression era Chicago, he took classes on Saturdays at the Chicago Art Institute and wanted to become a portrait artist when he grew up.   His father, my grandfather, told him to get real and learn a trade.  He chose dentistry, and only later, after going to medical school, discovered that as a plastic surgeon, he could both be a portrait artist and earn a living.

Many of my artist friends do not take commissions.  When asked why, they say that it is often very difficult, if not impossible, to reconcile their own interpretation of a subject with that of the person commissioning the work.  Fortunately for me however, some do, and I have been the appreciative beneficiary of portrait work by artists such as Stephanie Snell, Paul Doyle and Marilyn Terry.  What do these artists paint?  They paint my dogs of course.  My children and I would never be able to focus and sit still for our own portraits to be painted and besides, despite this age of “selfies”, we are far too self conscious.

A few years ago, a young man’s wife developed breast cancer at age 25.  He is a well-known video artist known as Daarken and he and his wife needed money to meet their medical expenses.  An on-line fund raising auction was conceived, with the theme stated as “Beautiful Grim.”  Beautiful, because despite his young wife’s diagnosis and treatment, she was and always will be beautiful– yet for some young women with breast cancer, the prognosis can be grim indeed.  His friends and fellow artists rallied to the cause, and many contributed original works to the auction.  I am a friend of Daarken’s sister, and I followed the auction with interest.  In particular there was one painting that I kept coming back to, that no one was bidding on.  It was a portrait of an African American woman, beautiful and naked, except for her long stockings which were peppermint striped, red and white. Her hair was a tangled wild mass of curls against her beautiful skin. When no one else bid, the portrait was mine.

Over the years I have become very friendly with the artist and his wife, who shall be unnamed because of the personal nature of this anecdote.   They visited our home this past summer, and we commissioned a work of art.  The assignment was intentionally vague—“just paint something you see in New Mexico that inspires you.”  A few weeks ago the painting arrived, a full 4’ X 4’ landscape entitled “Sombrillo Vista.”  It is as beautiful as I had hoped, and emblematic of the New Mexico I have come to love.

When I called to offer my sincere gratitude, the artist’s wife said, “You know, just after he finished your painting he received another commission—a most unusual one!  A man called and said he wanted a portrait painted of his ex-wife. He is still in love with her and wants an oil painting to remember her by.”  Apparently he had sent a few snapshots of his ex along with his request.  Always a romantic at heart, this struck me as both somewhat insane, but also a true romantic gesture.   I said, “Send me a phone pic of the work in progress.  I want to see the woman who inspired this act of unrequited love.”  She did.  The woman was indeed beautiful, and playful, and mysterious all at the same time.  I said, “Well if the ex-husband doesn’t like the portrait, let me know because I will buy it.”

Shortly after our conversation, a photo of the unfinished work was sent to the hopeful ex-husband.  He liked it a lot, but he felt that it was not quite there yet.  He had some advice for the artist– he said, “Just think—complex and Mona Lisa eyes with a dash of mischief and you’ll nail it!”  I laughed and said, “Now that should be simple.  You know, just be Leonardo da Vinci.” The finished portrait was unveiled to the good patron last week who promptly proclaimed, “It gave me goosebumps!”   The man likely needs a good therapist instead of a portrait of his ex.   But let us be clear:  he has been faithful to her, in his fashion.  And my artist friend, well—clearly, he NAILED it!

You Know You’re at a Plastic Surgery Meeting When…

My friend Dawn and I recently attended an evening meeting of the Houston Society of Plastic Surgeons.  Since we were invited guests, and not plastic surgeons, we didn’t stop on the way into the lovely formal dining room to pick up our name badges because the organizers had not made them for us.  On the way out, however, we both noticed clear plastic perfectly formed oval objects sitting on the table, looking for all the world like crystal paper weights.  I picked one up and it slithered out of my hand, slippery as a water balloon.  It was then that I realized that the beautiful paper weight was indeed, a silicone breast implant made by the company that sponsored the dinner.  After all, what do you expect when you attend a gathering of the plastic surgery clan?

I have learned in medicine to expect the unexpected.  The reason that I got in my car and drove 970 miles from Santa Fe to Houston was that my father, now nearly 91 years old and an emeritus Professor of Plastic Surgery at Baylor College of Medicine, had been asked to give several lectures as a visiting Professor for the residents and fellows in training.  Several is a bit of an understatement.  He was actually asked to give five separate talks, including three on consecutive days at 6:30 am, because as we know, surgeons start their days early.  After assuring Dad that I would not be getting up to attend ANY 6:30 am lectures, I set out for Houston in the midst of some of the worst rainstorms and flooding seen in that town in over thirty years.  Dad has had to curtail his practice over the last few years due to significant health issues, and when he came down with a bad cold days before the trip, I tried to no avail to convince him to stay home.  He of course wouldn’t hear of it.

His assignment for the evening lecture last Thursday night was to talk about his surgical missions overseas to repair cleft lips and palates, other birth defects, and contractures due to severe burns and other injuries. Especially since he retired from active practice, he has participated in several trips a year with Surgicorps International, traveling to Guatamala, India, Bhutan, Viet Nam, Zambia and other countries to attempt to give a normal appearance, and thus a normal life, to those unfortunate enough to require his services.  Devoted parents travel great distances to wait all day for their children to be evaluated, and once the schedule is set, surgeries proceed for the next 7 to 10 days, twelve hours a day, until the work is done.  Dad methodically showed the construction of each trip, from soliciting donations, to transporting equipment, to evaluating prospective patients, to post-operative care. At the end of his talk, he showed a blurry photograph of a 43 year old man who had lived his entire life with a severe facial deformity.  He told us that when the patient woke up in the recovery room, the first thing he asked for was a mirror.  When he saw his own face, swollen from surgery, but yet distinguishable as a normal human face, this patient burst into tears.  As my father told the story, everyone in the room did the same.

Plastic surgeons often get a bad rap.  In our youth driven, appearance conscious world, it is all too easy to make jokes about their bread and butter cosmetic work—the breast implants, the face-lifts, the nose jobs, and the botox.  At dinner last Thursday night, my friend and I, and the residents in the room, were privileged to catch a glimpse of what these talented surgeons can do to change the life of a child, and that child’s family and future.  The residents in the room are lucky—in a few years they too will have the skills to give the gift of a normal appearance and normal function.  As for me, well, I think it’s time to get back to work treating cancer patients.

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.

Love Letters

Another guest post tonight, from my friend Jackie Widen:

I miss letters.  Rather, I miss sending AND receiving letters in the mail, real letters on stationery.  Our cultural communication has been reduced to tweets, posts, texts, emails and Facebook messages. Another part of growing older is remembering and cherishing this simpler method of communication. I guess I am old.

I have always been a letter writer.  I remember as a child writing to both of my grandmothers who lived in California.  Both were widowed and led quiet lives, and at the time I just thought it normal to correspond regularly with them.  Now I realize how much they must have enjoyed receiving my crudely crafted letters.  The news to share was probably silly in hindsight; what grades I got on my spelling test (yes they actually tested for spelling back in the day) or what our pets were doing or how pretty was the dress my mother had recently sewn for me.   The postal rates were regular mail and air mail, and of course air mail was preferred. There were “air mail” stickers to plaster across the envelopes and to keep postage down we wrote on flimsy air mail stationery so that long letters were lightweight and could pass under a single unit of postage. Of course we used fountain pens.  Oh and don’t forget the sealing wax.  For my 8th birthday I received a set of stamps and sealing wax candles.  I can still smell the wax as it dripped onto the point of the envelope seal, and then I would select (quickly) the stamp of choice and stamp firmly, leaving a distinct initial or fleur de lis.

My father dutifully wrote each week to his mother, as did my mother to hers, but somehow I remember my father’s efforts more.  Phoning long distance to California was a luxury – forget unlimited talk or cell phone freedom – and so perhaps I observed his habit and incorporated it into my own routine.  When I left for college in 1970 my father wrote to me every week, and I loved opening my mail box in the Student Center and seeing his distinctive script scrawled across an envelope.  The letters were short, scratched out on tablet paper that I recognized from his work, and he always enclosed a few dollars for a treat. Usually our correspondence revolved around how the Dallas Cowboys had fared recently, or how his golf game was or just stuff about the family.  I saved every one of his letters and gathered them with ribbon.  Thank heavens in all the purging my parents did during retirement they didn’t throw out my special box of college mementos.  While cleaning out my mother’s house last spring I found all of MY letters that I had written to him.  He had saved them all too.

Preparing my 90 year old mothers’ house for sale was a tough project.  But there were treats along the way.  Packed carefully away in an old trunk were three sets of letters, bound up in aged ribbon and yellowed with time.  The first set were letters written to my grandmother from her then fiancée, the grandfather I never knew as he died when my mother was 12.  The paper was filmy onion skin, the script exquisite in its fluid loops and dips.  Why did we stop teaching penmanship in schools?  His cursive was amazingly beautiful, from a different era – I was dropped back in time into 1918.   I felt almost guilty reading about the anticipation about their upcoming nuptials.  The letters were sweet and innocent and filled with fervent passion about their future together.  The next set were the letters my grandfather had written to his daughter (my mother) while she was at camp – the summer she was 12.  A smaller stack, but the poignant part of that keepsake was the final letter written just before he was scheduled for surgery from which he did not survive.  The letter arrived after he passed away.  My mother put that final letter on top and bundled them up.  I am pretty sure she never revisited that correspondence.  She confided years ago that her childhood ended that day; that she felt old and heavy at the young age of 12 as she was an only child and felt enormous responsibility to care for her mother, a 42 year old widow who had never worked a day in her life or finished high school.  She was her mother’s caregiver until my grandmother passed away at age 98.

The final set were letters my father wrote to my mother during their courtship.  I recognized my father’s scrawl immediately.  It was more legible back then; hard to believe he had already served during World War II, gone to college on the GI bill and was just starting out at Shell Oil at the ripe old age of 30. He and my mother were engaged and he had been transferred out of town; so writing letters was the way they kept in touch.  Again I felt like a voyeur, but it was a wonderful piece of our family history that was indescribably beautiful.

As I ponder the New Year, I think about the ways I would like to make my life more meaningful.  I can lose a few pounds and exercise more, play more and worry less – but it occurred to me that I would like to write more and spend more time with pen to paper.  My calligraphy lessons have infused me with a new passion for the beauty of the printed word, but I know also the simple act of writing a letter to someone will give them more pleasure than it gives me.  So for my lovely mother-in-law and the elderly lady in California who we enjoy helping out – there is a fresh stack of note cards ready to be filled.  All I need is the sealing wax.  Amazon Prime is taking care of that.

You Can’t Keep A Good Man Down

It’s been awhile since I got my readers up to speed on the adventures of Dad.  For those of you who are new to this blog, my father is a plastic surgeon who retired from full time practice about 15 years ago after a very successful academic career.  He turned 89 years old in July and the last couple of years have not been kind to him:  my mother passed away in January of 2013, and shortly after that Dad had an aortic valve replacement followed eight months later by a hip replacement.  These surgeries were in addition to coronary bypass surgery ten years ago, a splenectomy a few years later necessitated by his penchant for running red lights, and a badly fractured collarbone after taking an expert ski run a little too fast at age 85.  Despite all of this, I was not surprised when he told me a few months ago that he planned to go to Guatemala last week with Surgicorps International, a group that performs plastic and reconstructive surgery in developing countries.  What DID surprise me however was his announcement that he was taking his 84 year old girlfriend Evelyne with him.  He was positively gleeful—he proclaimed over dinner that he was going to teach her to clean instruments and prepare the OR between cases. I did not think this was a good idea, and my opinion was backed up by my sister who has never been a big fan of medicine in general, blood and guts in particular.

A week after the big “reveal”, I took Dad aside and told him that while I had no objections to Evelyne accompanying him on the trip, I thought it was a TERRIBLE idea for him to consider taking her into the operating room.  I said, “Dad, Evelyne was a piano teacher, not a nurse!  And don’t you remember what happened the first time you took ME into your operating room?”  He remembered.  I was seventeen years old, a high school student mildly interested in medicine, at least to the degree that I was volunteering at a local hospital as a candy striper (do they even have those anymore?). He invited me to watch a face lift, being performed under local anesthesia.  I was fine for the first 30 minutes or so—the slice of the scalpel, the smell of the Bovie, the careful undermining of tissue between the skin and the soft tissues of the face.  But when he then peeled back the loose skin to reveal those sinewy muscles below—well, the last thing I remember hearing was—“QUICK!!  Somebody catch her!”  I fainted dead away.  I could only imagine poor Evelyne doing the same, and cracking her head on the instrument cart.  Dad smiled and nodded.  A week later he announced that they had driven to San Marcos so that she could pick out scrubs.

Dad and Evelyne returned home from Guatemala on Saturday night.  On Sunday afternoon, I went over to their senior community to return their cat, whom I had been keeping during their trip.  Well, actually it’s my daughter’s cat, but that’s another story.  I loaded kitty into his carrier, and the litter box, the unused kitty litter, the big bag of food, the two stainless steel bowls, and numerous cat toys into the back of my car.  I called and gave Dad the 15 minute warning:  “Meet me downstairs because there is too much for me to carry.”  He dutifully met me in the parking lot, but there was still too much paraphernalia.  I said, “I’ll just run the cat up to Evelyne’s place.”  So I did.  I knocked on the door, cat in hand.  No answer.  I rang the doorbell.  No answer.  I knocked again, louder.  Still, no answer.  I dropped the cat carrier and ran back downstairs.  I said, fearing the worst, “Dad, when was the last time you SAW Evelyne??”  He said, “Last night—why?”  I said, “She’s not answering the door.”  He said, “Well, I think she’s been on the phone for a long time.  I keep calling her but the line is busy.”  At this point, I am completely unhinged.  I said, “DAD—SOMETHING COULD HAVE HAPPENED TO HER!!!!  WHAT IF SHE IS UNCONCIOUS AND DROPPED THE PHONE??”   At this point, even he is looking a little scared.

I ran back upstairs.  The cat is meowing in his carrier.  I knock, no, I BANG on the door shouting, “Evelyne, it’s me, come to the door!”  I ring the bell again and again.  And finally, I hear stirring and a small voice inside the apartment.  Evelyne appears at the door, a little bewildered that I have made such a fuss.  She says, “I’m sorry.  I didn’t hear the door.  I’ve been on the phone all day, telling EVERYONE about my adventure!”  As I sighed with relief, I said, “Oh, you enjoyed yourself?”  She said, “It was the greatest experience of my whole life.  I even got to see a gall bladder being removed.  And when they cut open the gall bladder, I got to see REAL gallstones!  I had to call everyone I know and tell them ALL about it.”  She looked exhausted, and utterly triumphant.

Needless to say, they are already planning to go with Surgicorps to Viet Nam in October.  At age 89, he has found a soul mate.  And at 84, she has found a new calling in life.  There’s hope for the rest of us, for sure.  We’re planning one heckuva ninetieth birthday party for him in July.  That is, if his schedule permits.

Get Your Kicks on Route 66

No one would ever call me a drama queen–at least, not in the figurative sense.  Not in the literal sense either, since never once in my sixty years have I ever tried out for the elementary school play, the high school musical, the college a capella groups or the fourth year medical student end of the year shebang.  I may do a good dog and pony show by tripping over a dog and flying through the air, or falling off a horse (and, again, flying through the air), but I am no song and dance man.  Inspired by a high school sweetheart who sang and played guitar, I bought a used Gibson J50 acoustic in 1970 only to have my music teacher (who had guaranteed she could teach ANYONE to sing) pronounce me hopeless.  The boyfriend is long gone, but forty four years later I still have that guitar as a souvenir of my high school longings and failings.  And I still can’t sing.

Today, however, I had the pleasure of attending the annual musical revue at La Costa Glen, the senior community where my father now lives. A few months ago, Dad told me that he was dating a “young lady.”  With some trepidation and with visions of the said “young lady” seeing the retired plastic surgeon as a meal ticket, I asked “How young, Dad?”  He smiled and said, “She’s eighty three.” A few weeks later, I had the opportunity to meet his new “friend” Evelyne, who is by any definition what we oldsters would call a “hot ticket.”  Petite, and beautiful and French Canadian with a charming accent, Evelyne has travelled the world, had her own music school where she taught piano lessons, and when her first husband had a major heart attack and wanted to sell his beloved airplane, Evelyne decided to learn to fly it herself.   And fly she did, all the way from San Diego to Montreal and back.  When the movers and shakers at La Costa Glen decided that the annual play would be a musical entitled, Get Your Kicks On Route 66, Evelyne decided to learn to tap dance.  My husband and I had tickets for today’s matinee.

For an hour and a half today we got to see a very talented group of octogenarians light up the stage, telling the story of a group of seniors who decide to take a bus trip down the old Route 66, and gracing each stop along the way with song and dance routines and some wickedly funny storytelling, mostly poking fun at themselves– their restaurant ordering habits, their need for frequent “pit stops” and their own memory lapses.  A retired physician gave a Broadway worthy rendition of “Old Man River” and a retired professional songstress hit the boards again with “My Kind of Town.”  Evelyne sang and square danced her way through “Cotton Eyed Joe” and tap danced her heart out to “One” during the last bus stop in New York City.  By the time they headed for home with “California Here We Come”, the whole audience was clapping and singing along—even tone deaf yours truly.

Which brings me to the idea that perhaps it’s never too late to try out for the school play.  One of my birthday presents this year was a ukulele, which I have sworn to master.  I just won’t sing. And I hear there’s a North County dance studio that offers tap classes.  Bill Robinson, Fred Astaire, Eleanor Powell—step aside!  I figure I’ve got about twenty years to practice before I audition at La Costa Glen. Anyone care to join me in a little soft shoe?

The Good Books

Where I come from, when most people refer to The Good Book, they are referring to the Bible.  This is not true for my father, because to him, the Good Books are something else entirely.  He describes a scene early in his career as a plastic surgeon, when he had taken his doting mother to see his new office. Coincidentally, a lovely thank you note had just arrived from one of his patients.  He read it appreciatively and passed it on to my grandmother, so that she could “kvell” over her son the doctor even more, as if that were possible. His secretary, having a penchant for scrapbooking and noticing the mutual positive reinforcement going on, decided that from that day on, when Dad received a thank you note or letter of appreciation, she would put it in a scrapbook, which he anointed as his “Good Book.”  By the time he retired from full time practice at age 75, he had accumulated a series of five very thick Good Books.  And he advised me to do the same.  He said that when he felt tired or depressed, he would read his Good Books and feel revived.

I’ve never been as organized as my father, who keeps meticulous files on everything that interests him, to this day.  Nor, as a young female physician just starting practice in the early 1980’s, did I ever have a secretary that I would DREAM of asking to “scrapbook” for me, much less bring me a cup of coffee.  But I had many appreciative notes from patients, and I read and treasured each one.  I put them in the top drawer of my desk, and would reread them when I came upon them while searching for a highlighter, or a directory of local doctors.  And when I left that particular job, or that particular city, or that particular office, I would read them one more time, remember the patients who wrote, and let them slip into the recycle bin.  There’s only so much you can take with you, apart from the memories.

Exactly two weeks ago, I received a letter at my office addressed to me personally.  The letter originated in Bradenton, FL where I know no one. I did not immediately recognize the name or the return address, but I opened it and read:

“Dear Dr. Fielding:

It has been 25 years since I completed treatment by you for Stage 4 Hodgkin’s Lymphoma.  I came to the Leonard Morse Hospital from Turkey with a tumor in my chest.  I was treated by Dr. Jao and referred to you for radiation therapy.  My treatment included radiation therapy and chemotherapy from November 1987 to October 1988.

I will always remember that when I would meet with you during my radiation therapy I usually felt “lousy.”  You would come into the exam room and tell me I looked great.  Your positive and caring manner always lifted my spirits and renewed my confidence that I would overcome Hodgkins.

I retired in 1995 and have enjoyed good health and my retirement in Florida.  Your caring and medical expertise saved my life and I am forever grateful.  I thank you and wish you a Happy New Year.    Sincerely,  RB.”

The letter was accompanied by a photograph of my patient and his wife, riding gilded carousel horses on a merry-go-round, hands held high to reach for the golden ring.  They appear to be very happy.

I have been thinking a lot lately about retirement myself.   There are places I want to go, people I want to see, and things that I want to do while I am still healthy enough to do them.  When I got home the evening I received that letter, I showed it to my husband who said, “I bet you won’t want to retire now!”  I thought about it for a minute and said, “No, you are very wrong about that. That letter made me cry, but not because I want to continue to do radiation therapy forever.  It made me cry because it made me feel that what I have done since I graduated from medical school in 1978 was worthwhile.  That it MEANT something. That I have not wasted my time.”

To my patients who have taken the time to write over the years—you have no idea how much that means to us doctors.  To my daughter, struggling through a tough internship year in Boston, and to my medical students—stick with it.  Thirty years from now you will be very happy you did, with or without some Good Books of your own.

Superstition, Karma and Faith

I have always been a mildly superstitious person.  With a casual air, I will walk around rather than under an open ladder and I never wear opals since they are not my birthstone.  I will happily pet a purring black cat then shiver when it runs across my path, and when I break a mirror my heart sinks.  I remember watching the Rachel Ray show one day and saw her toss a pinch of salt over her left shoulder after spilling some of it—and I thought, “I am not alone.” I tend to look at everyday occurrences as omens, good or bad.  And in my effort to impose some sense of justice in this crazy world, I believe in karma.  I try to stock up on the good stuff.

Today my 88 year old father had a left total hip replacement.  I had tried to talk him out of it for months, since he had only just had his aortic valve replaced in March.  He has been living independently again, and has actually been seeing a wonderful woman at the senior community where he lives.  With my mother’s dementia, he had not realized how much he had missed having someone to talk to, to confide in.  My sister and I were against him going in for elective surgery.  But as the months rolled on, he became more limited, and for the last month it has been obvious that he was in constant pain, and that surgery was inevitable.  My husband drove him to the hospital this morning, and stayed there while I worked today.  He called me at 3:30 to say that the surgery had gone very well, and had been done via an anterior approach under epidural anesthesia. Ninety minutes, start to finish, and Dad was awake, oriented and moving all four extremities.

I left work at 5:30 to go over to the hospital.  I stopped for gas before getting on the freeway, and as I stood at the pump, ready to disengage, I saw a tiny black dog dart across the busy street, collar and tags on with a six foot leash trailing behind him.  He ran quickly across the parking lot and I reflexively locked my car, glanced over my shoulder to see if there was an owner in pursuit, and seeing none, I took off after the dog, walking slowly, non-threatening, calling “Puppy, puppy, puppy” in my sweetest voice, the one I rarely use.  I was quickly joined by a man who had pulled into the station in an extended cab pick-up truck, his entire family in the car.  He jumped out of his car, said, “I saw the dog, I will help” and came with me.

The little dog, clearly terrified, ran to the far end of the lot where two teenaged girls saw what was going on and unfortunately, immediately gave chase down an alleyway between a garage and a guitar shop. A man covered in mechanic’s grease joined the rescue efforts, adding to the chaos of concern.  And then the tiny dog ran right into a side street, directly into the path of an oncoming car.  By the time we reached the lifeless body, the woman who had been driving the car was sitting in the middle of the road, sobbing uncontrollably, and putting herself in imminent danger. The man with me picked up the dog, a well-cared for black and tan Chihuahua, still sporting his collar and lead, and we checked him.  His eyes were open but he was gone. The small entourage carried him across the street to an open veterinary clinic, so that the owner could be notified, and would not have to search the empty streets tonight.  If you are a dog loving reader, and have never found yourself in that sad situation, you have been very fortunate.

I got to the hospital with a sense of impending doom, and was quite surprised to see Dad sitting up in bed, entertaining his nurse who was improbably named Evangeline.  She was catering to his every need; he was in fine spirits and his pain was well controlled.  I know he isn’t out of the woods yet, but I was relieved and grateful.  Instead of superstition, I should have had faith—faith in the doctors and nurses taking care of Dad, faith in the human beings who rushed to try to help that little black dog, and faith that there is a purpose and meaning in the events of the day. But somewhere a family is grieving tonight, and I am wondering why.

All I Want For Christmas Is You

Today, along with millions of other Americans, I made a last minute dash to the mall.  Since Hanukah fell most improbably on Thanksgiving this year, and since I was too busy burning the turkey and side dishes to burn candles, we decided to celebrate Christmas instead.  It will be a small celebration—my daughter is on call during her internship in Boston, and my older son works for the State Department in Washington, DC.  Apparently world crises do not stop for Christmas, or any other holidays for that matter. So it will be a small crowd around the table—just my youngest son, my 88 year old father, and my husband and me.  Who was it that said, “As we grow older, our Christmas list gets smaller as we realize the things we really want can’t be bought”?

I had already taken care of gifts for the rest of the family, but the motivation that drove me to the mall today was the question of what to get for Dad.  He’s been very generous with me lately, helping shoulder the bill for the massive relandscaping project, and helping my daughter pay off her medical school loans.  What does one give a (mostly) retired plastic surgeon who has already traveled to the far corners of the earth, who has driven fast cars (and instilled a love of them in me, his daughter), and who has spent the last year trying to pare DOWN his earthly possessions from the contents of two residences in Snowmass, CO and Houston, TX.   What he wants, I can’t give him—the ability to play tennis and golf and to ski again, the ability to live at altitude without oxygen, the ability to regain his hearing, lost after a car accident, and a loving companion to keep him company as the years wear on.  Unfortunately magic is not in my repertoire.

In the end, I spent a rather aimless two hours wandering through the maze of stores, rejecting fancy cufflinks, smelly colognes, silk ties, comfy slippers and expensive watches.  I hesitated at Brookstone—there was a mini projector and a tripod which would enable PowerPoint presentations and the exhibition of literally thousands of slides, now converted to digital, of patients whose physical imperfections had been corrected long ago but whose emotional scars might linger on. In the end, I rejected the set up as too complicated—another technology to learn and forget.  I bought a few small things, and got back in the car.  As I neared home, I stopped in the local liquor store and bought him a nice bottle of Tanqueray and a perfect lime—his favorites.  What do we all really want for Christmas? We want the health and happiness of our loved ones, and also, for me, my patients.

All I really want for Christmas is you—all of you.  I hope you all have a wonderful day.