When Cancer Comes To Call

A patient story tonight, from Jackie:


It was one of those days.  I had been to the gynecologist the week prior because I somehow knew the sporadic bleeding which I had experienced was NOT a simple Urinary Tract Infection for which I had been treated three times.  My doctor did the scrapings and biopsies and had me run down the hall for an ultrasound.  I’d had lots of ultrasounds during my pregnancies – especially with my twins -  but this one wasn’t fun.  There was no cute baby to smile at.  This time it was a transvaginal ultrasound which involved the insertion of a rather large tube into “that place” to look at the uterus.  “My what a big wand you have” I joked with the sonographer.  She didn’t smile.  That’s when I got a bit nervous.

Of course my doctor put a positive spin on everything – prior to the biopsy results.  He said it was probably just an over thickening of the uterus, Hyperplasia.  So I decided to wait until there was something solid to review and went on about my life.  I had a dental appointment a few days later.  My dentist announced I needed a root canal immediately and sent me to a nearby Oral Surgeon.  As I was pulling up to the Oral Surgeon’s office my cell phone rang.  It was my gynecologist.  “Well, there is a malignancy….”.  The words hung in the air.  We had a brief conversation – darn, I thought – I had researched  Hyperplasia thoroughly and knew all the right questions to ask.  I felt like I had studied for a test and then the test changed.   He said I needed to contact a special Gynecological Oncology surgeon and that his office would tell me what’s next.  So I called and left a message with that doctor but said I couldn’t talk for a couple of hours because I was just about to go in to have a root canal.  One thing I will say about those specialists’ offices; they run like a well oiled machine.  As I walked back to my car 2 hours later there was a message on my cell phone.  It was Jay, the Office Manager for the Gynecological surgeon I needed to see.  He was calling to schedule my appointment.  He paused and said “Good luck with the root canal. Sounds like you are having a great day”.   And so it went.

My life was forever changed.  May brought the diagnosis.   June brought the scheduling of the hysterectomy.  July 1 was the surgery.  July 10 came the pathology report.  Not what we had hoped for– the “once and done” hysterectomy revealed some naughty cells lurking within the uterus that have a tendency to “jump” into other areas.  Chemo or Radiation? My case was submitted to the Austin Gynecological Oncology Tumor Board for review as recommended by my Surgeon.  I was overwhelmed.  I didn’t know what I didn’t know.  As is often the case when you do get the “C” diagnosis; you are thrown into a blender of emotions but when the dust settles the appetite for knowledge takes over.  And so it was decided that radiation was the protocol. After I healed from surgery, radiation began.

So here’s the thing:  it wasn’t that horrible.  For anyone who has been through tough times, worked hard and experienced inconvenience or sadness – you are mentally strong and prepared for this challenge.  It is definitely a Mind Game.  I decided to fight and endure and not to whine and whimper.  For 6 weeks my life revolved around daily visits to the Oncology Center.  The treatment wasn’t bad.  The hardest part was drinking 40 ounces of water prior to treatment.  The side effects clicked in about 3 weeks in; lower GI issues.  But oh well, diarrhea is not the end of the world.  My pubic hair fell out which I found fascinating. I met wonderful friends in the waiting room.  The therapists and nurses and doctors were wonderful.  My neighbors and family rallied and emotions ran high.  Food and flowers poured in.   My sweet neighbor who had just finished two years of breast cancer diagnosis, surgery, chemo, radiation, reconstruction – I was at her door daily for her battle.  Now, she was at mine.  Life sifts down to the basics of priorities: Faith and Family and Friends.

I finished my radiation on September 15 and got to Ring the Bell which is special to all cancer patients because it means YOU ARE DONE.   My sweet family and a few friends showed up.  Tears flowed.  My husband pushed through the group to shake the hand of my Radiation Oncologist and choked “Thank you for helping my wife”.  I was ready to start my new healthy life.

Check-ups will continue for a few years and I will see both my Surgeon and Radiation Oncologist often. That’s okay.  My Surgeon is cute (I think he is almost the same age as my oldest son) and my Radiation Oncologist is an incredible mother of four who never seems hurried or distracted and makes me feel like I am THE most important patient in her practice.  I feel so blessed to have been in such capable hands.

I feel wonderful.   Celebrating my December birthday was more special this year.  Welcoming the New Year signaled almost a palpable relief to make a fresh start.  I take nothing for granted and try hard to live in the moment.  Ever the planner, this has been my most challenging goal.

For Christmas this year my daughter gave me a beautiful silver charm.  On the front it says “Faith”.  She told me to turn it over.  On the back was engraved 9-15-2014.  My final day of radiation.  It has been the most horrible of years, but it has been the most wonderful of years.  When Cancer comes to call you rise up and fight the good fight.  And then, you go on.

Siskel and Ebert

I have always loved the movies.  Like every grade school kid watching reruns, I cried when Bambi’s mother died, and when starry eyed Judy Garland clicked her heels and said, “There’s no place like home!”  But when the big budget films hit the screen in my early pre-teen years—Ben Hur, Camelot and Lawrence of Arabia, I was irretrievably hooked.  Sitting in a dark theater, I could escape from actual or imagined troubles.  Some people prefer live theater, but for me it was always the big screen, where I could pretend to be Guinevere as Lancelot leaned in for a kiss, or Holly Golightly, or Cleopatra, up close, more real than in real life.  By high school I was reading the film critic’s reviews in our local paper, and by college I had my favorites.  Pauline Kael was far too esoteric for me—my “go to guys” were Gene Siskel and Roger Ebert with their trademark “thumbs up” or “thumbs down.”

I was channel surfing last night and I just happened upon CNN which was airing a documentary film about Roger Ebert, his career and his struggle with cancer called “Life Itself” from his memoir of the same title.  I had been aware that Ebert had been battling head and neck cancer for years before his death but I was not well versed in the details of his illness.  Roger Ebert was diagnosed with papillary carcinoma of the thyroid in 2002, typically a rather low grade cancer treated primarily with surgery. Unfortunately he was unlucky and the cancer recurred, ultimately necessitating removal of his lower jaw with subsequent loss of his larynx, and his ability to speak and swallow.  What was unique about Mr. Ebert was that unlike many public figures, especially those in the visual media whose jobs sometimes depend on facial appearances, he chose not only to go public with his illness, but to ENGAGE his many fans and followers in his day to day struggles via his website, his blog, and his Twitter account.  He allowed Steve James, the documentary filmmaker, to film him not only on his best days, but also on his worst.  He smiled and joked for the camera nearly immediately after his radical mandibulectomy and neck dissections, even as he was being suctioned for the secretions which if left untended would choke him.  His wife Chaz, his stepchildren and grandchildren were equally generous, at a time when the family was undergoing much pain and hardship.  He clearly had his demons and his days where he wanted to quit, but ultimately he was buoyed by the support he received from not only his fans, but from directors and actors he had at times panned.  To see Martin Scorcese pause to wipe a tear on camera when discussing his friend was a window into what this person meant to his friends and peers.

What I had forgotten, and was reminded of while watching the documentary, was that Ebert was not the only member of the Siskel and Ebert team who suffered from cancer.   Gene Siskel was operated on for glioblastoma, a malignant brain tumor, in the spring of 1998.  Only his wife knew of the diagnosis—he chose not to even tell his children.  He was back at work nearly immediately, and only when he became symptomatic again in early 2009, did he request a leave of absence from his show.  He died of complications of a second surgery to deal with recurrence in February 1999.  His friend and colleague Roger Ebert only learned the truth about the disease on a Friday, just days before he died, and had planned to see him on Monday.  Siskel died that weekend.  Ebert and his wife were devastated that they had not known, and had not been able to convey the love that was in their hearts.  I can only imagine how his other friends and family felt.

In my career, I have seen it both ways.   I have had patients who have their entire families with them for each treatment, who have written books about their illness, who have blogged about it, who have made public appearances and who have been pillars of support groups.   I have also had patients who were absolutely adamant that no one, sometimes not even spouses or children, should know about their cancer and treatment.  The reasons have been many—fear of unemployment, fear of upsetting loved ones, fear of being seen as weak or ill, and in one case, a minister who feared that his congregation would see his illness as punishment for prior sins.  But the common denominator was always one thing:  fear.

My patients generally have made up their own minds about what to reveal and to whom.  I respect their decisions and support them in whatever way that I can.  But when they do ask me, I always tell them that it is better not to take this particular journey alone.  Not every movie has a well-executed plot or a happy ending.  But as Siskel and Ebert would always say, there is joy in the characters you meet and love along the way.

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.

The Library

“Books are a uniquely portable magic.”  Stephen King

If books are a uniquely portable magic, the same cannot be said for hundreds and hundreds if not thousands of books, but port them we did.  The first thing that my husband and I noticed about the house we ended up buying was the library—a room completely lined from top to bottom with built in bookcases.  I have lived in many places, and set up makeshift bookshelves from salvaged boards and cinder blocks, and later, the do it yourself–put them together to watch them fall apart IKEA models—but I have never had a library.  Say it with an affected British accent if you will—the “lye-brahr-ry”, or feign embarrassment and call it the “TV room”, this library has become the focal point of our home.

I consider myself fortunate—my family has always revered books.  I have two volumes from my mother’s childhood, Mary Poppins and Mary Poppins Comes Back, reprinted in August 1941.  You don’t remember Mary Poppins?  Let me jog your memory of a far more innocent time: “If you want to find Cherry-Tree Lane, all you have to do is ask the Policeman at the crossroads.”  At the end of the second chapter, the children Jane and Michael ask Mary where she’s been on her day off.  She replies, “In Fairyland.”  They are baffled when she tells them that she did not see Cinderella or Robinson Crusoe.  They proclaim that she could not have been in THEIR Fairyland.  Mary Poppins gives a superior sniff and replies, “Don’t you know, that everybody’s got a Fairyland of their own?”

My own Fairyland was created by Walter Farley, and Marguerite Henry and Albert Payson Terhune.  Farley wrote the famous Black Stallion and Island Stallion series of stories about Alec and The Black, an Arabian washed ashore with the young boy who tames him after a shipwreck, and Steve Duncan and Flame, the chestnut stallion he discovers on the mythical Caribbean island of Azul. Henry wrote Misty of Chincoteague, and Stormy, Misty’s Foal, inspiring little girls of my generation to long for their very own ponies.  Terhune wrote Lad, a Dog which I read when I was ten.  Twelve years later, while in medical school, the first puppy I ever bought on my own was a collie.  The dreams and myths inspired by a childhood of reading never really go away.

And so, when my children were young, I bought books upon books, and since I worked during the day, we read them together late into the night, before Harry Potter, which they were old enough to read on their own, and before video games, and computers and Facebook. The kids had their favorites—one was The Ox-Cart Man, describing the rhythmic seasons of life in colonial New England, by Donald Hall who later became poet laureate of the United States.  They also loved Wilfred Gordon McDonald Partridge, about a young boy who helps an elderly lady in a nursing home regain her memory by bringing her objects from the past, and of course The Giving Tree, by Shel Silverstein about selflessness and unconditional love.

When the kids grew up, and graduated to their own taste in reading material, I put away the children’s books—packed them lovingly into boxes and put them out in the shed by the barn.  And there they sat, quiet and safe, until the movers from Allied Van Lines retrieved them and brought them here, to the library.  As I unpacked all the boxes, the memories of childhood—my mother’s, my own, and my children’s came back full force as I indulged myself by opening and rereading nearly all of them, until I came to my own favorite, written and illustrated by Barbara Cooney in 1982, two years before my daughter was born.  It’s called Miss Rumphius, about a little girl named Alice who grows up and travels far and wide, but comes home to a city by the sea, where she plants lupines and becomes known as The Lupine Lady.  As a little old lady, she tells stories of her adventures to her great niece, also named Alice.  Little Alice says, “When I grow up, I too will go to faraway places and come home to live by the sea.”  The Lupine Lady says, “That is all very well little Alice, but there is a third thing you must do.”  “What is that?” asks little Alice.  Her great aunt replies, “You must do something to make the world more beautiful.”  “All right” says little Alice, who then reflects, “But I do not know yet what that can be.”

If books can inspire our children to make the world a more beautiful place, then they are indeed magic. I am so glad I kept all of ours.

It’s Been Awhile

Back in late September, my friends asked me if I was worried about the upcoming move to New Mexico.  I replied, no, it would be a piece of cake compared to my earlier cross country move from Boston to California.  After all, in 1993, I said goodbye to our babysitter of nine years and packed up three kids, a dog and a cat to move to a city where I did not know a single soul.  I will never forget walking into the principal’s office at our new elementary school, filling out the registration forms, and realizing that for the first time ever in my life, I had not a single name to fill in the blank space which said “Who to contact in case of an emergency.”  I was starting from scratch.

As it happens, I had seriously underestimated the effort required to detach from a home I lived in for seventeen years, from my accumulated belongings and from my youngest son and my elderly father, neither of whom desired to join me on my journey.  As sentimental as I am, it was impossible to merely throw things away—old photographs had to be examined and scanned, stuffed animals and dolls needed to be hugged one last time, old movie ticket stubs and playbills needed to reawaken memories before being tossed.  Each time I carried a large green trash bag out of the house, the closets, nooks and crannies seemed to refill themselves.  In the end, I ran out of time, and the movers packed what was left, which amounted to an entire moving van filled with our furniture, and over 300 boxes.  My culling was not very successful.

My biggest concern about the move itself was how my four dogs, especially elderly Magic in congestive heart failure, would handle the displacement, the two day 1,000 mile road trip and climb to 7000 feet in altitude, and the uncertainties of new territory.  As it turned out, the one that I worried about most surprised me with what appeared to be a new lease on life—clearly the cooler crisper mountain air seemed to rejuvenate him.  It was the little guy, Yoda, my tiny rescued Chihuahua-terrier mix that had some unexpected issues.

Yoda was picked up as a stray in Oakland, CA two years ago at Christmas time.  Starving and loaded with tapeworm, he jumped into the arms of a good Samaritan who stopped traffic on Fremont Avenue to pick him up. My veterinarian friend there made a search for an owner, but when none came forth she neutered him, wormed him and sent him down to me.  He quickly adjusted to life with the three jolly grey giants.  Playful and loving, he never met a soul he didn’t like and never caused us a moment of trouble–until the move.

For the first time ever, on arriving in New Mexico, Yoda suffered from severe separation anxiety.  When either my husband or I would leave the house, he would cry piteously and endlessly, despite the fact that the other of us was still there, along with his Scottish deerhound buddies. He was inconsolable. Amidst the doggy distress, fear and consternation, one thing became clear to me—at some point in his short life, he had been left behind.  And he did not want it to happen again.

Yoda has settled down now and he knows that if we leave the house we are coming back.  But his little trauma has left me with a New Year’s wish for us all:   Be brave!  Make a change.  Take a short trip, or a long journey, with your best friends and your family.  Yoda wants what we all want in our own way–to live, love and laugh—and never, ever to be left behind.   Happy New Year everyone!

A Not Quite Requiem for Big Red

Some of us think of the automobile as a means of transportation and nothing more.   Others, like me, see the car as something else entirely—an extension of ourselves, and an expression of identity.  Growing up I was influenced by my dear old Dad—our childhood was marked by a succession of American made muscle cars from the 1966 Ford Thunderbird convertible which met its sad end on the 610 freeway in the rain, to the Pontiac Firebird Formula 400 I drove out to Big Bend National Park, reaching its top speed of 160mph on a lonely stretch of interstate 10 before my new husband cried “Uncle!”  The first car I ever bought myself was a 1975 Chevy Camaro, V8 engine, bright red with white vinyl upholstery.  I was 21, and I was GOING PLACES.  I enjoyed that car for seven years until one too many spin-outs on Route 9 in the snow after I moved to Boston convinced me that it was time for something more practical.  The day I drove my brand new front wheel drive bronze Nissan Stanza out of the lot was the day I knew I had made a big mistake.  I was born for red cars with big engines.  I like people to see me coming.

Sometimes, however, we have to be practical.  By 1991 I had three children and a growing menagerie of pets.  I got my first Chevy Suburban, known then and probably now as the “National Car of Texas” on a company lease, and from then on I was hooked.  That car was indeed “like a rock.”  I drove it until the lease was up and then got another, this time the heavy duty three quarter ton with enough power to tow my house.  The menagerie had grown to include horses by then, and I wanted a car that I could both  live in and drive with three kids, 2 horses and an assortment of dogs.  There was nothing comparable to the trusty Suburban in the automotive world. A bemused trucker watched me struggle into a parking space at a truck stop and actually taught me how to park my behemoth.  By 2001 I realized that the horses were safer with professional drivers and big rigs, and I “traded down” to my current Suburban, affectionately known as “Big Red.”  That was in the spring of 2001, and I was in love—with a big red car.

I’ve had Big Red for nearly 14 years and 230,000 miles.  Shortly after the model year 2001, Chevrolet in its infinite wisdom decided to turn the historic first true sport utility vehicle into a soccer mom-grocery shopping car.  Gone was the bench middle seat, replaced by “captain’s chairs” for easier access to the third row.  Gone were the “barn doors” which opened from the middle out, one at a time, replaced by the hydraulically lifted single back window-door, which may have provided better grocery access, but was entirely impractical for those of us carrying three to four hundred pounds of dog, all wanting to exit the vehicle at the same time. Gone was the middle seat that folded entirely flat, allowing the entry of two 700 size dog crates, the only passenger vehicle to this day which had that much cargo space.  In my distress over the changes to my beloved Suburban, I spent an hour on the phone with a Chevy customer service representative from India, who duly noted my concerns, but had no idea what I was talking about.

Last week I covered a practice in El Centro, about 140 miles east of my home in Rancho Santa Fe.  I felt Big Red shudder and heave going over the Laguna Mountains.  For the first time ever, cars were passing me to the left as I struggled to maintain 55 mph. My good friends at Quality Chevrolet have been patching the air conditioning compressor together for years, but this was something entirely new.  Fearing the worst, I took the car back to the dealer today, with clear “Do Not Resuscitate” orders.  All day I waited, and finally around 4 pm I got a call from service.  Bill said, “Ma’am, I think your engine and transmission are okay.  We found a faulty oxygen sensor. We’ll replace it tomorrow.  You’ll be good to go.”

Good to go to New Mexico?  I sure hope so.  I don’t want a new car.  I love Big Red.  I am loyal and I persevere. The Chevy Suburban no longer comes in red.  My family thinks I’m nuts.

Lighting Out For The Territory

“But I reckon I better light out for the Territory ahead of the rest, because Aunt Sally she’s going to adopt me and sivilize me and I can’t stand it.  I been there before.”

Mark Twain, Huckleberry Finn


While I wasn’t looking, someone snuck up behind me and bought my house.  Well, not exactly “bought” yet, but all contingencies are removed and the closing date is set for October 3.  This wasn’t supposed to happen.  My realtor told me that our place is “special”, a euphemism for “old run down house with wonderful horse facilities.” She said it might take a year to sell, and that the right buyer would come along—someone who wasn’t too house proud, but who wanted to “live the dream,” as I did seventeen years ago.  Someone who had always wanted a horse of her own and had waited a very long time to get one—or two or three or maybe even four.  Someone, in short, just like me.  And let’s face it folks—how many people are out there who are just like me?  Apparently quite a few.  The house sold in ten weeks for close to the asking price. And there are back up buyers, who just didn’t get back to see it for a second showing in time.

For seventeen years, I put off having friends and family visit. I had no dinner parties because we were embarrassed.  The house was a mess.  The carpet was old, and pet worn and smelly, the roof leaked, the kitchen was hideous, the “powder room” was a disgrace with orange and brown tiles left over from the 1970’s. But my children, my dogs and my horses were blissfully happy with the place.  It was home. When my friend Catherine passed away in late 2012, she left me a little bit of money, which I used wisely for a new paint job, new carpet and curtains, a stunning garage renovation (after all, it belongs to my dogs!), a bathroom facelift and some nice hardware for the newly painted cabinets in the kitchen.  Friends began to visit.  They said, “We love your place.”  As I walked around the vacuumed soft carpet and outside among the newly trimmed hedges, pruned eucalyptus, reseeded pastures and freshly dragged arena, I said to myself, “They are right.  I love this place.”

But there was sadness here for me as well—the tack room with photos of children long grown and horses long passed lining the walls, the empty bedrooms, and the dogs dearly departing, one by one.  And the cost of maintenance in drought stricken energy gridlocked southern California was a daily reminder of the fact that in March of this year, I retired from my full time job so that I could experience a little more life, and a little less death.  It was a good decision, and one I don’t regret, but a reduction in cost of living was a necessary corollary.  So the house went on the market, and here we are.  I need to find a place to live and I don’t have much time.  My youngest son, and eighty nine year old father are still here in San Diego, but I yearn for the open spaces and big skies of the west.  New Mexico, with its spectacular sunsets and mix of cultures has indeed been the Land of Enchantment for me.

It’s not clear yet, but I may, like Huck, be soon lighting out for the territories.  I hope you will all come and visit.  Wish me good luck!

In Sickness and in Health: Seven Things to Know about Healthcare These Days

My 23 year old son says my blog posts are too long.  He says that his generation believes that if you can’t say what you mean in 350 words or less, you’re not worth reading. At the writer’s conference I attended last spring, I learned that books sell best if there are odd numbers in the titles (never mind the commercial success of “Ten Things I Hate About You”).   It has to be 5 or 7, because 6 and 8 just don’t cut it, and those of us old enough to remember know that Bo Derek is the only 10.  So here is my attempt at listing important things to know about how medicine works these days, in no particular order.

  1.  No news is NOT good news anymore.  The days of doctors calling you with your test results are, for the most part, over.  Do not assume that because you did not get a call, everything is fine.
  2. If we are treating you, please report your side effects so we can help you.  You don’t get brownie points for being a “good patient” by keeping quiet—you just get sicker.
  3. Please do not bring samples of bodily excretions in to the office on toilet paper in plastic bags.  You might make someone sick.  That someone might be the doctor. Brief quantitative and qualitative descriptions work well.
  4. If you need to get your doctor’s attention, one phone call may not be enough even though it should be. Go ahead, be a pain in the ass.  If the person up front gets tired enough of hearing from you, Facebook might be closed out and a message conveyed.
  5. Insurance companies are not your friends.  They will NOT call you back.  If you call and get a phone tree, press “zero” until a human being comes on, and then demand to speak to a supervisor. Your life and  bank account depend on it.
  6. Know the names of your medications and their doses, and if you can’t remember, write them down and put them in your wallet. Please don’t say, “A little yellow pill.”  UNDERSTAND what the pill does. Not knowing can kill you.
  7. Don’t say “I have the flu” when you have a cold or a little upset stomach.  Get your flu shot this fall or you will figure out what the real flu is when you really have it.

I could go on but I won’t.  As they say in obedience training, “Exercise finished!”

And Speaking of Plastic Surgery

I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights.   The show stars Clive Owen as the charismatic cocaine addicted Chief of Surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop.  The tagline is, as they say, priceless– “Modern medicine had to start somewhere.”  On the third episode, last Friday night, Dr. Thackery performs a pedicle skin graft from the upper arm to cover a gaping hole in a woman’s face where her nose used to be, before she got syphilis.   Back in those days, this was a marvelous feat.  Real progress in what we now know as reconstructive surgery didn’t come until the end of World War I, when Sir Harold Gillies, a New Zealand otolaryngologist later known as the “father of plastic surgery,” established the first hospital ward for the facially wounded in Queen Mary’s Hospital in Kent.

For over fifty years, I have been a bystander to the evolution of plastic surgery.  As a teenager I remember the heady early days of microvascular surgery—my father, Dr. Melvin Spira reattaching the scalp of a man whose hair got caught in machinery, then the tales of sewing back severed fingers and ultimately entire limbs with gradually improving functional results.  In the 1970’s the great French surgeon Dr. Paul Tessier, pioneer in techniques for cranio-facial surgery to correct birth defects came to the United States to teach, and I remember a Saturday morning clinic at my father’s office, where mothers whose children’s facial deformities were so severe that these kids had, literally, never seen the light of day waited in line to be seen by the great surgeon who could give them back a normal appearance, and thus a life.

Plastic surgery, like my own specialty of Radiation Oncology, has become one of the “lifestyle” specialties to which medical students aspire, particularly those with an artistic bent and good hands, and for good reason.  Cosmetic procedures are highly reimbursed, and are done during “regular” working hours. Walking around here in San Diego and Los Angeles, surely two of the plastic surgery capitals of the world, it’s easy to spot who has had “a little work” done.  Having one face lift might be a good thing (I wouldn’t know because, as I’ve covered in previous blog pieces, my imagination runs wild with the possibilities of complications and I am far too chicken for elective surgery), but have three and you become one of “Our Ladies of Perpetual Surprise”, eyebrows at the hairline.  Same goes for breasts—it is not normal for the “girls” to be rigidly immobile as their owner pounds away at the Stairmaster.

Last year I mentored a medical student who had started his medical education thinking that he wanted to become a plastic surgeon.  After a beloved aunt developed breast cancer and needed radiation, he started to think that perhaps he would rather become a radiation oncologist because he enjoyed dealing with cancer patients.  He was an outstanding student, and I was quite sure that he would be accepted, and do well in either specialty.  I assured him that with his gifts, and his compassion, he could combine his interest in helping cancer patients with his interest in reconstructive and restorative surgery. Residency interviewers for plastic surgery residencies have a difficult job these days: all of the applicants SAY they want to do reconstructive surgery, but most end up doing cosmetic work.  Apparently my student was convincing when he said he wanted to do plastic surgery to help cancer patients.  He started his plastic surgery residency at Stanford last month.  Dr. John Thackery of “The Knick” may be fictional, but I hope that my student leads the way in new innovations in reconstructive surgery.  My cancer patients may depend on it.

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.