My Days In Dermatology

I’ve always been good at pattern recognition and my visual/spatial orientation is excellent. Photography is my hobby, so it was only natural that as a medical student and internal medicine resident, I loved my dermatology electives.  Each day yielded up a new parade of interesting skin lesions and rashes, and by the end of my rotations I was confident in my diagnoses and recommendations—contact dermatitis?—steroids!  Eczema?—steroids!  Psoriasis—yep, you got it—steroids again!  Pimples?  Well that was a diagnosis that required antibiotics.  But sometimes, when it was really bad—yes, STEROIDS!  These were the days before Botox, and Restylane, and non-invasive mini-lifts, and lasers.  Occasionally there was the excitement of a skin cancer, or a truly serious life threatening dermatologic crisis, but as much as I enjoyed saying the words “pemphigus”, or even “bullous pemphigoid” (try it—they roll right off the tongue)—I didn’t want to spend my career looking at it.  I chose radiation oncology after my internal medicine residency, and never looked back.  I wanted to take care of sick people.

When I announced my retirement in February, the calls started coming in immediately.  Having moved several times since I graduated from medical school, I hold medical licenses in three states which makes me a prime candidate for companies who supply locum tenens or “hired hands”– doctors who cover practices while the regular doctor goes on vacation, takes maternity leave, or just needs a break.   I was vaguely interested, but not enough to commit to spending weeks away from home living in a hotel.  But then a call came in from my old group, a Los Angeles based practice that had just set up a skin cancer treatment unit in a San Diego dermatologist’s office.  The hours were reasonable, and the job was only two days a week, covering while the regular radiation oncologists took their summer vacations.  This type of radiation machine, called the Xoft, is fairly new and uses a miniaturized high dose rate X-ray source to apply radiation directly to the skin cancer, while minimizing the dose to surrounding tissues.  For basal cell and squamous cell skin cancers, the results are extremely good, with excellent cosmetic results providing a great alternative to the Moh’s procedure which can leave patients with a significant “divot” in their faces, sometimes requiring skin grafts.  Dermatologists can buy these machines, however they are not legally allowed to operate them, having no training or background in radiation therapy.  That’s where I come in.

For the last two weeks, I’ve spent Mondays and Wednesdays in the dermatologist’s office.  It is a remarkably busy office with seven exam rooms going at all times, an operating suite and numerous medical assistants scurrying around with headsets on to communicate with Central Command.  The atmosphere is similar to what I would imagine the air traffic control room is like at JFK.  No one ever goes to the bathroom or takes a lunch break. There are flat screen TV sets in every exam room, to entertain the patients while they wait (try explaining skin cancer treatment with radiation to an 86 year old with bilateral hearing aids watching an episode of “24”—challenging to say the least!) As the physician in charge of radiation, I must set up each patient to make sure the applicator is placed correctly.  This involves a brisk walk down a long hallway from my makeshift office to the radiation room many times a day.

In the middle of that hallway, mounted on the ceiling, there is a television which runs a continuous infomercial about the joys of cosmetic dermatology.  It took me a few passes to notice it, but once I did, I was mesmerized.  The pulsatile blue light of the laser erasing wrinkles, the miniscule needles injecting the varicose veins, the tightening of the dewlap under the chin and the apparent dissolution of fatty deposits in the wrong places and their magical reappearance to plump the cheeks and add youth to the lips were hypnotic.  A head-setted medical assistant colliding with my ample in-need-of-liposuction derriere brought me back to reality and the skin cancer patient waiting.

I am beginning to see some advantages in my current part time job.  I smile brightly at the dermatologist in his scrubs.  He is an MD-PhD and very smart to have hired radiation oncologists to treat his skin cancer patients.  I have a new admiration for the tools of his trade.  I think that if I am really diligent, I might just get a free consultation and who knows—with a little buffing and polishing and injecting—a whole new face!

Stuart Scott’s Acceptance Speech

Sometimes I feel like what I have to say isn’t very important and after watching a video clip of Stuart Scott accepting the Jimmy V Award for Perseverance tonight on ESPN, I think you might prefer to hear from him.  Background:  Stuart Scott was diagnosed with cancer of the appendix in 2007 and has been battling the disease for seven years.  Jimmy V, or Jimmy Valvano was the head basketball coach at North Carolina State, who died in 1993 of cancer but was known both in sports and his personal life for his slogan “Don’t give up, don’t ever give up.”  According to Wikipedia, Jimmy V’s tombstone reads, “Take time every day to laugh, to think, to cry.”

If you have time, continue to watch this video to see the clip about Scott’s enrollment in a clinical trial at Johns Hopkins, and then just as amazing, Michael Sam’s emotional speech about tolerance, acceptance and growing up “different” as he accepts the Arthur Ashe Courage Award.  These two guys say it all, so please watch:  http://espn.go.com/video/clip?id=11225895

More about my experiences in Dermatology tomorrow.

The Things We Save, The Things We Give Away

Since I just spent the last several months sorting through my own lifetime accumulation of “stuff” in order to get my house ready for sale, it was only fitting that I volunteered to chair the auction and raffle at the Scottish Deerhound Club of America’s annual National Specialty show, held in Richland, Washington last week. After my fall, winter, spring and summer cleaning, I had plenty that I myself could donate, so why not go on vacation just to have the opportunity to sort through someone else’s stuff?  After all, I’ve gotten good at it.  My intrepid road trip companion and auction co-chair Rachel and I rented an SUV a week ago Monday in order to haul the deerhound related treasures 1300 miles, set them beautifully arranged on a table, label and describe them enticingly just so they could, in short order, become part of another deerhounder’s collection of stuff.  George Carlin famously said, “A house is just a place to keep your stuff while you go out and get more stuff.” This time I vowed that I was NOT getting more stuff.

But while we were there…well, the stuff just kept on coming.  Prior to the event, I had fretted because my email entreaties to bring donations for the auction and raffle went largely unanswered, but apparently not unheeded.  The knocks on our hotel room door started as we were unpacking our own suitcases, and the donors came indeed, bearing gifts of cardboard boxes filled to the brim.  By Wednesday evening we could have built a cardboard city, although a bonfire might have been more appropriate.  There were treasures there which were hard to resist—an 1883 edition of William Scrope’s Deerstalking in the Scottish Highlands—clearly a necessary reference book for my life in Southern California, and a handmade deerhound topped casserole dish, oven safe and dishwasher proof, for my imaginary culinary creations.  Some of the items were brand new—a brocade collar fit for the Royal Dog of Scotland, and some were a little more than gently used, with a fluffy patina of dog hair and dust.   We slowly worked our way to the bottom of each box, sorting as we went, until we got to the last one, where I found two old picture frames, face down, and picked them up.

The dog in the picture looks at me, head slightly cocked, ears askew.  His eyes are brown, and questioning. His coat is clean, and not matted, and his head is covered in the soft hair called for by our standard.  He is in a cheap frame, as is his companion, in a matching frame.  Why are they here, buried in the bottom of a cardboard box? I imagine they are dead, and that the photographs are now too painful to look at because they remind the owner of times past, happier times, and I burst into tears.  I hope that I am wrong, that the person who brought these to my room in a cardboard box was just tidying up—that he or she had scanned the photos into his computer as “wallpaper” and had no need for the actual photographs anymore.  But that is not what those pictures said to me.  I put them back in the box.

Bring me your old leashes, your dirty collars, your worn T shirts and sweatshirts.  We will recycle them for the next generation to carry on the “long grey line.” Bring me your antique bronzes lovingly crafted by the Animaliers of France and England in the 19th century, and your tales of stalking the red stag over the heather and the drink of Scotch from the quaich at the end of the hunt.  Bring me your handcrafted jewelry adorned with Celtic knots of silver and gold, and your art work and your crafts.  But please, don’t bring me pictures of your own dogs, buried and perhaps painfully remembered, perhaps forgotten.  Keep them, and the memories you have of them running through the fields, healthy and young again.

We turned in the SUV at the Portland airport, and flew home.  The auction was a huge success, and we came home to our families and dogs—the only things that really truly matter.

Love and Loyalty From the Souls of Dogs

“Such sadness and endearing and abiding love…”  Fran

I am by nature a “right brain” person—despite my training in science and medicine, I prefer paintings and photographs to words and mathematical constructs.  Over the past two years of writing this blog, I have resisted on many occasions the urge to add pictures to this website, despite the fact that I possess wonderful photographs of the things that I write about—my family, my dogs, my horses and my patients.  I am constantly taking pictures—I have chronicled my entire life in photographs from my first Kodak Brownie and I will continue to do so.  But I started writing again, thirty eight years after graduating from college with an English degree, to see if I could “describe” rather than “illustrate” the events in my life which have had an impact.  I want to write stories that leave a little bit to the imagination, to my readers’ right brains—stories that can be read out loud.

For the past few months I have been following the saga of Roo on Facebook.  Roo is an Ibizan hound owned by the artist Nan Kilgore Little. Affectionately known by their owners as “beezers”, this breed’s history dates back 5,000 years to the times of the Egyptian pharaohs.  The erect ears and tall lean bodies of these hounds are depicted in hieroglyphs in the tombs of Ptolemy, Nefermat, Mereku and Tutankhamen.  Think of the god Anubis, Protector of the Dead, and you will have a good visual image of the head of this hound.  Brought to the Balearic Islands off the coast of Spain by the Phoenicians in 800 B.C., these dogs have hunted to put food on the table of their masters for centuries.

Roo turned sixteen years old a few weeks ago, an extraordinary old age for a large sighthound. You can see it in the pictures—the eyes, once keen are now cloudy and the strongly muscled hindquarters have wasted.  The bone structure appears more prominent, and yet more delicate at the same time. The ears are nearly transparent, and beautifully veined.  Nan started to post pictures of him on his daily walks, interacting with the other dogs in the household, and resting on his favorite pillow—pictures which have inspired a legion of Facebook followers who clearly feel privileged to watch the “old man” in his waning days and to take that last journey with him and his loving family.

The last forty-eight hours have been tough. Old Roo, with his brightly colored bandanna and his watchful countenance has stopped eating and has taken to his bed, his head resting on his favorite pillow.  He is not in pain, but he is very tired.  No more walking in the Wild Yard and no more jumping over the Big Tree.  His best friend, an Australian cattle dog named Barkool, has taken up watch and rarely leaves his side.  Barkool is neither elegant, nor particularly beautiful and his squat body is a contrast to the lean and classical Ibizan.  He is Sancho Panza to Roo’s Don Quixote.  He is the friend we wish we all had.

My Facebook friends love dogs as do Nan’s and as a result, we frequently feel compelled to put up photographs of abused, starving and abandoned canines in need of rescue, or dogs beaten and bloodied in the service of man’s cruelest whims.  But rarely, in these hastily posted pictures, we see a glimpse of life as it can and should be.  Yesterday Nan posted a photograph of Roo and Barkool.  Roo is wearing his blue bandana and is wrapped the cocoon of his softest blanket, one covered by multicolored hearts.  Barkool’s head is tucked under Roo’s chin as a pillow and his stocky body is still as can be.  His eyes show apprehension, and resignation at the same time.  He is, above all, present for his buddy.

Sometimes friends and families of my patients are uncomfortable visiting their loved ones after a diagnosis of cancer, or even more so at the end of life.  They ask me, “What should I say?” or “What can I do?” The answer is revealed in Nan’s picture of Roo and Barkool:  without fanfare, without words, without tears, just be there.

Rethinking The Hunger Games

When the movie The Hunger Games was released in the spring of 2012, it broke box office records during its opening weekend.  Not familiar with the books of the same name for young adults by author Suzanne Collins, I did not rush out to see it but I liked its young star Jennifer Lawrence, and was eager to learn more about the new film.  I asked my son, who had taken his girlfriend to see it in IMAX, what it was about.  He said, “You wouldn’t like it Mom.  It’s about children killing children.  It’s “Gladiator” for kids.”  Since “Gladiator” is the only movie I have ever paid, not once, but THREE times to see on the big screen, I beat a hasty path to “The Hunger Games” and I was not disappointed.  Yes, it is a movie about children killing children, but the shining presence of its young star Lawrence, as the fiercely determined and staunchly moral Katniss Everdeen–a name as evocative of lithe cat-like goodness, emerging sexuality, intelligence and of course nine lives as Humbert Humbert was of blunt force, dullness and downright evil… but I digress—diverts the viewer’s attention from the sad specter of death as mass media entertainment.

How strangely ironic it was then, today, to wake up to the news of the shootings at Isla Vista, the residential community that houses a large number of University of California at Santa Barbara students, and to find out that the perpetrator of this heinous crime—a child killing other children—was the son of the assistant director of the Hunger Games movies.  A nightmare come true—to see one’s son in videos detailing exactly what grievances would lead to this explosion of violence, and worse, to have called the police because of concerns over a son’s mental and physical health, and to have those concerns brushed aside when action could have possibly prevented the tragedy. The finger pointing and blame assignments have only just begun.  But the facts remain, whether we are speaking of Columbine, or Virginia Tech, or Sandy Hook or Aurora—alienated mentally ill teenagers and young adults with weapons destroying the hopes and dreams of many families’ futures.

Tonight I looked at the Facebook page of Elliot Rodger, the 22 year old assailant who died last night along with his victims in Santa Barbara.  Oddly enough, the page has not been taken down. There are pictures upon pictures—“selfies”—shot with a cell phone of the handsome young man and his black BMW and his Armani sunglasses and his expensive clothing.  It is telling that there are no other human beings in these pictures—just a young man and his fancy things—and yet there is a glimmer of talent there in the few photos taken from vantage points on solitary hikes in the Hollywood Hills—a moonrise, a view of the Los Angeles skyline in the evening.   But the rantings on video and even the captioning on his Facebook self-portraits speaks to a deeply disturbed, alienated and delusional youth, who is more than anything, alone and lonely.

The father of one of the victims has already cited that this tragedy is the fault of the NRA.  I do not believe that.  I believe that the problem lies in our society itself—a culture which creates a pressure cooker for high school students to succeed at any cost, a culture which glorifies violence while ignoring mental illness, a culture where movies about children killing children become major box office hits. It’s time to take pictures of our friends, and look at them and above all LISTEN to them instead of taking pictures of ourselves, our food, our sunglasses and our cars.  It is time, indeed, to rethink The Hunger Games.  My deepest sympathy goes out to all of those affected by this terrible event.

The Irony of It All, Part Two

The dogs are quiet today, sprawled out across their various rugs and beds in the family room.  After the panic and anxiety caused by the fires here in San Diego last week and the heat that generated them, it is pleasant to feel the cool breeze created by opposing windows in my kitchen.  I am waiting for delivery of a piece of furniture—an old Chinese grain storage bin which had been “repurposed” as a decorative cabinet long ago, and which is about to be “repurposed” anew to hold the television controller and cable box for my new flat screen wall mounted tv—the evolutionary equivalent of man’s preoccupation with necessity progressing towards his preoccupation with luxury.  I treasure the symbolism in my treasures, as it were.

The cabinet will put the finishing touches on the home improvement projects we started nearly a year ago.  My friends with giant dogs and horses will feel a pang of recognition when I say that by moving in here over sixteen years ago, we traded a beautiful home graced with a gourmet kitchen (with two dishwashers, no less!) for acreage with a tumble down ranch house that was a few years beyond “fixer upper” into true “tear down” geriatrics.  It all started with the cat, that self-same Bitty Kitty who visited a year ago while my daughter traveled for internship interviews.  He took a dust bath in the living room fireplace and carried the blackened ashes to the already worn couches and carpet stained by a myriad of prior pets.  When we replaced the couches and carpet, the owner of the furniture store oversaw delivery and remarked, “You’re too old to be living with three-day-blinds!  This is not an apartment!  Why don’t you get some real curtains?!” The new curtains gave the old paint job a dingy tint and the new paint job made the bathroom tiles look ever so dated, and well…you know how it goes.  Last week we actually epoxy’d the garage floor.  It is now perfect.

Severe drought in the West over the last few years and overly aggressive tree roots furtively seeking water had taken their toll on our landscaping, and the bulk of our meager water supply was emptying underground from broken pipes, so that too needed attention and correction and above all, money.  Six months after completing the irrigation work, our water bills are lower than they’ve ever been, and the rose bushes are blooming again.  San Diego may be a desert, but how green are my pastures!

So I am enjoying this brief period of “this old house” being “as good as it gets.” I am no Martha Stewart, nor was ever meant to be, and my husband is definitely not “handy”—he would rather hire someone than change a light bulb.  The kids are grown, the horses are ancient, and even the dogs have slowed down a bit.  The house is for sale, and rightly so.  But every so often, I sit in the kitchen and listen to the wind chimes and watch the mother bird nesting and chirping in the ceramic birdhouse outside the open window. And I wonder why it took me sixteen years to realize that my “tear down” is instead, a little piece of paradise.

# WeddingFail

From Twitter today–jimmy fallon ‏@jimmyfallon

Hashtag game! Tweet out something funny, weird, or embarrassing that happened at a wedding and tag with #WeddingFail. Could be on the show!

 

My friend Jackie just got back from a family wedding on the East Coast.  She probably had no idea that Jimmy was auditioning #WeddingFail tweets for his show.  Jackie, we’re going to need to work on getting this down to 140 characters.  In the meantime, enjoy her full length version.

 

A WEDDING STORY

 

My husband and I just returned from his nephew’s wedding which took place back East.  We were able to connect with a lot of family and old friends and we ate and drank our way through the three days of celebrating.  We flew home today and I had a lot of time to reflect back on the weekend, parts of which made me smile and parts of which were downright horrific.

The Rehearsal Dinner was to be a most wonderful event hosted by the Groom’s widowed mother.  She had worked for months making preparations and selecting the menu; there was an open bar and an ocean view terrace for enjoying the beautiful scenery.  After cocktails and dinner and toasts and love all around the Mother of the Groom slipped and fell on her slippery 4″ heels and landed face first on the floor.  Black eye, swollen chin, black and blue elbow and knee.  The make-up lady had her work cut out for her the following morning.

The Matron of Honor was Big Sister to Bride.  Used to being the center of attention she became Queen Bitch of the day, arguing and tormenting her little sister up until the Wedding Party marched down the aisle.   Adding to the drama was the 2 year old “flower girl” daughter of afore-mentioned Matron of Honor.  She squealed and wailed in defiance of walking down any aisle not to her liking – and she didn’t like that aisle – so at the last minute Father of the Flower Girl swept her away so the ceremony could be heard.  Her behavior might have been attributed to the fact that she had a watery and snotty cold.   But Father of the Flower Girl in a selfish urge brought child back to the ceremony in order to hear final vows and just in time for her to let out another wail as she flung her juice box at the Bridesmaids.  Mother-Matron of Honor found this very funny and giggled.

Parents of the Bride divorced nastily over 20 years ago and yet despite two decades apart managed to save ugly remnants of their dissolution for the Wedding Weekend.  The exes had to be seated across the Reception Ballroom from one another and separated for fear of an explosion.  At the Rehearsal the night prior to the wedding a fight erupted between them over who got to answer WHO GIVES THIS WOMAN IN MARRIAGE TO THIS MAN.  Seriously?  When the Officiate asked that question during the ceremony no one breathed.  Thankfully he answered “Her Mother and I do”.  Exhale.

Meanwhile I enjoyed people watching (one of my favorite sports) at the blend of Wedding guests.  Groom is bi-racial; father African American and Mother Caucasian.  Bride is half Jewish.  We had Groom’s Aunt Thelma with full wig and weaves and Bride’s Aunt Anita who was covered in bling and commented to all who would listen that since she just had her eyes done she wasn’t up to outdoor photography and shouted out Mazel Tov whenever a toast was made.  The Groom’s mother has been married four times and has three children with three different fathers and both daughters were Bridesmaids.  The beautiful young people were fun to watch on the dance floor; the older and chubbier ladies – not so much.  One couple had just completed dance lessons – we could hear them counting …”and one-two-three…” for hours, but they seemed to improve as the night wore on.  But who really cared; the music was loud and the DJ played requests.

All in all it was a great weekend.   But I had to marvel at the drama and craziness and how unconventional most weddings have become these days with blended and re-blended families.  I think the best and the worst of family dynamics are on display at a wedding – and I know most couples, although excited to exchange vows, sometimes hold their breaths worrying that some dark secret or some inappropriate event will mar their joy.  I think the couple enjoyed their celebration; I know we enjoyed our trip.  But it was one wild ride.  Cheers, Mazel Tov and Halleluia!

Feet Don’t Fail Me Now

On Friday, once again, I cancelled my elective bilateral foot surgery, cheilectomies to ameliorate the effects of decades of running miles a day on hard pavement and wearing high heeled shoes to work. Like many other physicians faced with the dilemma of elective surgery, the “what-if’s” got the better of me—what if I get an infection, what if I have a poor result and am worse off than before, what if—god forbid—I end up with an amputation?  In the end, I opted out.  Six weeks after retiring from my job running a satellite radiation therapy facility for our local university practice, I am having far too much fun traveling, writing, gardening and culling the accumulated belongings of sixteen years in one house to undergo a forced “lay-up” for the summer.  The pain I know is preferable to that which my imagination can manufacture.  In short, I am a chicken.

Prior to becoming a chicken, I had always been an athlete.  At age seven, a swimming instructor announced to my mother, “She’s got talent!” and the next thing I knew I was trying out for the old Shamrock Hilton swim team in Houston, Texas.  To this day, the audition remains crystal clear in my mind—the coach asked me to swim the length of the fifty meter outdoor pool.  I had never seen a pool so enormous, but I resolved to try.  After all, what was the worst that could happen?  I jumped into the deep end reasoning that if I didn’t make the whole distance, at least by the time I tired, I would be able to stand up.  I reached the shallow end and touched the flagstone, gasping for air.  I stood up.  The coach said, “Okay, great, now SWIM BACK!”  I looked at my mother and began to cry.  She commanded, “DO IT!”  And so I did, despite the fact that the deep end loomed like a dark lagoon ahead.  I made the team.  Ultimately, my small stature and dogged nature suited me best for distance events—the 400 meter individual medley, the 1500 freestyle. The fact that I had once been daunted by swimming 100 meters seemed ludicrous a year later.

I graduated from high school one year before the passage of Title IX, the law that ultimately mandated athletic scholarships for women at every public university that offered the same for men.  With no incentive to continue a grueling five hour a day routine which produced green hair, bloodshot eyes and oversized shoulders, I turned to running for exercise.  And run, I did, for the next thirty five years—on the road, on the treadmill, in hot humid Houston and freezing snowy Boston—I ran away my fatigue, my stress, my disappointments and my sleep deprivation.  At age thirty one, after two residencies, I looked to be about eighteen years old, and so I wore heels, to make myself taller, more imposing, more apt to be taken seriously by patients and peers. Oddly enough, that strategy seemed to pay off, when my introduction of myself as “Doctor” no longer resulted in the question, “Really?”

The year before we left Boston in 1992, I watched the “Marathon Man” Johnny Kelley run his last full Boston Marathon at age 84.  Many years later, with these feet broken down from walking on tip toe when not running on asphalt, I am no Johnny Kelley. My running days are over for good, and even my walking days are fewer and farther between.  But as I contemplate the various ways in which our bodies fail us as we age—cancer, heart disease, stroke and dementia—I am thinking that arthritis and bone spurs aren’t all that bad.  I can always go back to the pool.  Or maybe get that little buckskin Quarter Horse I’ve always wanted.  There is no landscape, emotional or physical, that isn’t improved by the view from the back of a good horse.  I’ll get around to fixing those feet one of these days, sooner or later.  Probably later.

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!