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?

My First Day Off

I’ve rarely been a real risk taker when it comes to physical activity.   I’ve never jumped out of an airplane, rappelled down a mountainside, or skied in fresh powder after being dropped from a helicopter.  When I swim, I like my pool water warm, and when I ride, I like my horses elderly and as they say, “bombproof.”  I like my skin and bones, well-padded as they are, intact.   Do I dare to eat a peach?  Yes, but you won’t find me scuttling across the “the floor of silent seas.”  I keep to the surface.  And the older I get, the more my apprehensions and hesitations apply to those around me as well, including but not limited to my dogs.

Today was my first day of retirement, and incidentally, the first day in four that it hasn’t rained here in Southern California.  Ellen DeGeneres joked at the Oscars last night that we’ve had a tough few days–“it’s been raining, but we’re okay.” Although the Scottish deerhound’s ancestral home is in the highlands where it never stops raining, or snowing, the SoCal brand of deerhound does not like to get its feet wet, and so the dogs have had very little exercise these last few days.  Today the sun broke through and all hell broke loose.  In my younger days, when my deerhounds would run full tilt and chase each other through the tall grasses of Sherborn Massachusetts, the ground would rattle and I would experience a thrill quite unlike any other—the thrill of the chase, the hunt.  I could almost see that red stag bounding up a hill, ever elusive, the dogs nipping at his heels.  Now, I see dollar signs.  Anterior cruciate tear?  Five thousand dollars.  Fractured radius?  Five thousand dollars.  Collision with a tree?  We won’t go there.

I had been outside with them for maybe ten minutes when the wild rumpus began.  Queen, the smallest of the three, and the fastest, is always the instigator.  She took off through hedges and around corners with her sister, Quicksilver in hot pursuit.  Magic, the old man at 9 and a half, has slowed down quite a bit.  He was never the brightest, yet over the years he has learned to use his bulk to “head them off at the pass.”  As I was hauling slightly mildewed dog beds out onto the patio, he intercepted one of Queen’s speedy zoom arounds and the next thing I knew, she was yelping in pain.  Rushing to her side, I saw the damage, a four inch tear in her skin, just at the groin fold.  Suddenly, my “to do” list for the day was narrowed to only one task.  I took her to the vet.

As always, I should have known better than to let close to three hundred pounds of aggregate dog loose simultaneously after being in the house for three consecutive days.  And I have a sneaking suspicion that the accident wouldn’t have happened if I’d been, say, at work, the way I normally am on Monday mornings, with Queen and Quicksilver ensconced in their separate yard, and Magic and the little dog Yoda in the house.  After a brief anesthetic and fifteen or sixteen sutures, Queen is home and will be fine.  My “to do” list will wait until tomorrow to be done—I guess that’s the nice thing about being retired.  No bones were shattered, no ligaments torn– we’re all still standing.  And my veterinarian’s children will be able to attend college.

As I’ve said before, when you run with the big dogs, it’s always something!

How to Save a Life

And I would have stayed up with you all night–Had I known how to save a life.

The Fray, “How to Save a Life”

The tenth season of Grey’s Anatomy premieres tomorrow night.   For the cognoscenti, this means we will find out what happened after the cliff hanger of last season:  Will April really leave Matthew at the altar, for her first love plastic surgeon Jackson?  Or will the handsome paramedic who loves the doctor unconditionally and quite unbelievably without ego issues, win his lovely bride?  After all, he organized a flash mob for his proposal to her.  He deserves his beautiful red headed pig farming sweetheart.  And why do I watch these things?  Is it because the women wear makeup and heels and do their hair and the men are so very handsome and no one looks tired, and lives are saved quickly, with great valor. As Hemingway’s Jake says at the end of The Sun Also Rises, “Isn’t it pretty to think so?”

The song, “How to Save a Life” by the Fray, was used in an episode of Grey’s second season, and afterwards became an anthem for the show itself.  My favorite rendition is a home video with a hand held camera, of the actual cast singing the song at a benefit—you can view it here:  http://www.youtube.com/watch?v=KX3AjiqFA1s   Yes, I know they aren’t “real” doctors. But I suspect that if you act like a doctor for ten years of your life, it might be hard in the end to tell the difference.  The emotions are all right out there, in the video and in the show.  And that’s the real answer to why I watch Grey’s Anatomy—I get it all out in front of my own television set so I don’t have to do it in front of my patients.   I don’t think it’s helpful to have your doctor cry while she is giving you bad news.

Friday, February 28 will be my last day at work.  I am officially retiring, at age sixty. My staff and my patients have been asking me why for several weeks now.  They make very complimentary proclamations like, “But you look so young!” and “But you’re so GOOD at what you do” and “How can we replace you?”  The answers to these questions are “thank you,” “thank you,” and “No one is irreplaceable.”  The truth is that I feel like time is running out.  I have had some extremely joyful experiences over my last thirty two years in Radiation Oncology and I have witnessed some incredible success stories, many of which I have told here.  I know that miracles DO happen.  But I have also seen some terrible things, and there is not a doctor alive who would say that we don’t take our failures personally.  We do.  What I have come to realize, at least for me, is that the sad times are not getting easier as I am getting older.  Facing the deaths of loved ones this past year–patients, relatives, friends and pets—has left me with an acute sense that the clock ticking in the belly of the crocodile is ticking for me, and  I am no Peter Pan.

So I will leave my practice in the best of hands, and I will read and I will write and I will travel and see more of my children and all the other people I care about.  There is a line in “How to Save a Life” which goes, “And you’ll begin to wonder why you came.”  There is one thing that I am certain of, when it comes to my career.  I will never ever wonder why I came.

A Different Kind of Mask

“I want them to live again to the point where pain becomes art.”

Lawrence Durrell,  “Justine”

I have always loved masks.  Near sighted likely from birth, a fact which was discovered significantly later, I never minded stumbling around our neighborhood on Halloween, my already deficient depth perception further stunted by my Bugs Bunny mask.  To don a mask was a chance to become someone else,  and as I grew older my disguises became more exotic—a gypsy fortune teller with gold hoop earrings in high school, a Turkish harem girl in college.  My imagination, fueled by the old stories of the Venetian Carnivale dating back to 1162, knew no bounds, and I secretly dreamed of a masked ball where I would glide gracefully and soundlessly, recognizing and being recognized by a handsome prince, by touch and scent alone.

 

In 2002 I took the occasion of my daughter’s graduation from high school as an opportunity for us to visit Venice, and more specifically, the mask shop known as La Bottega dei Mascareri at the base of the famous Rialto Bridge where a lively market persists to this day.  Elizabeth Barrett Browning may have been speaking metaphorically when she said, “the soul’s Rialto hath its merchandise,” but I was subject to a more literal interpretation.  I wanted to buy a mask from the famous brothers Sergio and Massimo Boldrin, who fashion papier mache masks in the old Venetian tradition.  I picked out a good one, made by Massimo himself, and given the history it depicts—perfect for a doctor.

 

The mask is larger than my face and flat, hand painted with a crackle glaze to look very old, and it pictures a man in medieval clothing dancing around a bonfire,  wearing the peculiar bird beaked mask known to physicians of the plague years.  The beaks were stuffed with medicinal herbs thought to ward off the dread disease.  In just one scene, the mask depicts the horror of bubonic plague—the bird beaked man, the fire to burn the contaminated bodies and clothing, the “ring around the rosie” cheeks of the afflicted.  With some difficulty, I brought my prize home in a suitcase, only to find that it gave me nightmares.  Today it sits on a bookshelf in the study off our garage.   I can’t have it in the house.

 

My patients with head and neck cancer are all too familiar with the concept of the mask, but for them the mask has a different significance.  Fashioned of a material called Aquaplast, the mask starts as a thick sheet of perforated plastic.  Warmed in a hot water bath, the material becomes soft and pliable, and is stretched over the cancer patient’s head and shoulders where it shape shifts to appear like a woman’s fish net stocking, but without the softness.  The mask hardens to become a rigid immobilization device which is bolted to the treatment table.  In my field, precision is everything and the mask, custom made for each patient, allows the radiation oncologist to accurately target the cancer while sparing critical structures such as the spinal cord and the eyes.  Not for the claustrophobic, the mask is a temporary prison for seven weeks of daily treatment.  At the end of treatment, each patient is offered the opportunity to take his or her own mask home.  Most actually do.

 

Today at the biannual Multidisciplinary Head and Neck Cancer Symposium in Scottsdale, AZ, I saw something quite extraordinary.  In order to assist patients financially with these cancers, an organization out of Washington DC called 911 4 HNC mounted an exhibition called “Courage Unmasked”  (www.courageunmasked.org).  Cookie Kerxton, an artist who was treated for head and neck cancer herself enlisted other artists to transform radiation masks into works of art.  The results, several of which are on exhibit at the meeting, are objects of exceptional beauty, turning human suffering into inspiration and hope for others.

 

At the meeting, volunteers were handing out free posters depicting forty two of these beautiful masks.  When I get home, I will have my poster framed and I will hang it in the room where I examine my head and neck cancer patients.  I am hoping that the bright colors of the beautiful masks will lessen their fear, and transform their pain.  There is indeed great progress in the treatment of their cancers.

The Glass Is Half Full

A couple of weeks ago my nurse came to me with a request for a consultation.  Since our schedule has been packed full lately, she’s been asking me where I can squeeze patients in.  She said, “I’m not sure about this one—he says you treated him twenty years ago and he wants to see you.  But there is no new pathology so I don’t know how urgent it is.”  I looked at the consult request and did not remember the patient but there were several handwritten jottings on the cover sheet from the referring physician that listed phone numbers and beside them, “no answer at this number X 3,” and “Dr. Fielding hasn’t worked here since 2004.”  Apparently some effort was made to track me down, since I have changed jobs a few times in the last twenty years. I said, “Well get the latest information on the patient and put him in the open emergency slot a week from Friday.”

So Friday came yesterday and this patient was scheduled at one o’clock.  I like to review the charts before I see new patients, so I picked up the chart during a hurried lunch and read through it with a growing sense of recognition, and no small amount of dread. The man had been treated for advanced head and neck cancer back in 1994.  He had presented with cancer on the lateral aspect of his tongue, which was excised by his surgeon.  Six months later, he recurred both on the tongue, on the soft palate, and in his neck, with a large tumor wrapped around his jugular vein.  His surgeon tried, even sacrificing the large vein, but he could not resect all of the cancer and the patient was referred to me for post-operative radiation therapy.  Given that the man was only fifty one years old, his medical oncologist made the decision to give him chemotherapy along with the radiation, a decision which was considered quite radical at the time.  Treatments for head and neck cancer back then were crude by today’s standards, and fraught with complications, and this man had had all of them.

By 2000, he could no longer swallow, and his esophagus had to be dilated.  This happened again in 2008, and another procedure provided relief.  His saliva never fully returned after treatment, and so in 2012, plagued with tooth decay, he began a series of extractions, augmented by hyperbaric oxygen therapy to prevent osteoradionecrosis of his mandible.  Unfortunately this did not work, and he ended up having a portion of his jawbone removed.  A year ago, he began to have a new issue—when he tried to swallow the food was going down “the wrong way” and causing him to choke, resulting in several episodes of aspiration pneumonia.  It was becoming hard for him to go out socially, and enjoy a meal with friends and family. His carotid and vertebral arteries were narrowed, putting him at risk for stroke. Multiple recent studies showed no evidence of recurrence of his cancer, but there was scar tissue in the back of the throat which prevented the epiglottis from closing over the trachea when he swallowed.  These were the things I read in his chart before I saw him, and I anticipated that our session together would be an angry one.

Tall, older and thinner than I had last seen him, the patient greeted me with a huge hug.  His wife smiled warmly.  As we sat and talked in our sunny consultation room, he described his current difficulties and told me that his surgeon had referred him back to me for electrical stimulation therapy of the throat muscles, which might help his aspiration.  Our institution has an entire department for the rehabilitation of head and neck cancer patients.  I groped for the right words to say to this man who had suffered through complications which are rare by today’s standards of care.  I apologized profusely, and explained that now we have better ways of shielding normal tissues to spare patients the terrible late effects of treatment.  I told him I would be happy to put in a referral to our swallowing and speech rehabilitation specialists.  He looked at me in surprise, and said, “Doc, I didn’t come here for that.  Dr. M (the surgeon) already put in the referral. When I found out you work here, I came to say thank you.  I was fifty one when I was told that my chances of survival were 10 per cent.  Now I’m seventy one years old.”  He squeezed his wife’s hand and said, “We’ve traveled the world together.  We’ve seen our grandkids graduate high school.  We’re going on a cruise to San Francisco next week.  Yeah, I’ve had my problems but we’re still having fun!”

Some folks are just “the glass is half full” kind of people.  Having always thought of myself as one of them, I’m surprised it took me a whole consultation to recognize that in my patient. Taking care of cancer patients has always been a good way to remind myself that my own life is not so bad.  Lesson learned, again.

Facebook Flicks

Fourteen years ago, writer/actor/director Christopher Guest made a little movie called “Best in Show”, supposedly a movie about dog shows, but more accurately a very funny movie about people who show dogs.  The film was eagerly anticipated in the dog show world, since many of us knew which dogs of each breed had been chosen to represent their kind at the penultimate show, a spoof of the upcoming Westminster Kennel Club extravaganza happening in New York City next week.  When the film premiered, murmurs of disappointment echoed through the hallowed halls of the AKC and crescendoed into harrumphs of “We’re not like THAT!”  Ever the klutzy owner-handler, I stood on the sidelines thinking, “Oh yes you ARE!”

Today, thanks to Facebook, I experienced a deja-vu of that moment when I watched my very own Facebook movie.  For the few holdouts reading this who eschew the “social media”, Facebook describes itself as “a social utility that connects people with friends and others who live, study and work around them.”  For many people, “around them” today literally means the whole world, and folks with interests in common, say, Scottish Deerhounds or thimble collecting, find themselves as fast Facebook friends with likeminded ladies and gents around the globe.  In honor of Facebook’s tenth anniversary, the shadow minions of Mark Zuckerberg decided to celebrate by making a movie of each of our very own lives.

The movies starting rolling in on my news feed late last night, and finally this morning, I could stand it no longer—I hit the little arrow indicating the start of my personal Facebook Odyssey.  Exactly one minute and two seconds later, I had to greet the contractor working on my house with tears streaming down my face.  My life was before me–so “poignant”, so “in the moment”, so “true.”  Or so my Facebook friends said.  It was only after the second or third viewing that I began to realize that my movie was all about three things, in descending order of frequency:  my dogs, my Dad, and my youngest son.  But especially about my dogs.  By the end of the day, I noticed more and more comments from my Deerhound friends that their own movies were dominated by their dogs.  “Where are all my people?” one friend asked.  “Maybe the little computer elves making the movies just happen to LOVE Scottish Deerhounds,” I joked.

At last viewing, I found myself asking the same question.  Where are all my people—my husband and my two older children?  Where are the horses?  Where are my colleagues?  Where is my belated and much missed cat Timmy Tom, and where the heck is my red Corvette?  It was then that I had my Best in Show moment.  If my Facebook flick says it’s all about the dogs and Dad, then maybe it is…perhaps just a little bit too much.   Maybe I need a psychiatrist.  But maybe, just maybe, I need to spend a little less time on Facebook and a little more time on what matters most—living life.  I’d best get on with it.

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.

When Age is a Relative Thing

I remember when I was a medical student and an elderly patient would be admitted to the surgical service through the emergency room with a bowel obstruction, or a lung cancer, or blockage in the coronary arteries so severe that only a coronary bypass could save him.   The students and residents would gather around the attending, and debate the merits of operating on the patient, or “keeping him comfortable”, ensuring certain death.  One of the things I remember hearing, typically from the mouths of those advocating for aggressive management was always, “But he’s a GOOD ninety!”  Meaning, the patient may have been ninety years old, but he looked younger, and had no competing medical problems, and had been living independently and enjoying life.  As I grew in my radiation oncology career, and medical students and residents would debate the same with me, one of the things I always try to remind them is, “There’s nothing like radiation and chemotherapy to turn a GOOD ninety into a BAD ninety really fast.”  It’s the truth.

So when I returned from my mini-vacation at the dog show in Palm Springs at the beginning of last week, the first thing I did was check my schedule to see if any of the patients who were seen in my absence were on the simulation list for treatment planning so I could review their history and physical exams.  I found one unfamiliar name, so I picked up his chart.  It turns out, this man is an 86 year old retired figure skater, still active as an international figure skating judge, who had recently been diagnosed with an early stage intermediate risk prostate cancer, Gleason grade of 3+4=7, PSA of 9.  He had come in under duress to see one of my partners because, you see, he didn’t WANT radiation therapy.  He wanted a prostatectomy.  Now, in my world, and in the world of my referring urologists, 86 year old men do not get prostatectomies, robotic or otherwise.  There is too much risk of fluctuation of blood pressure and bleeding, and consequently heart attack and stroke. Dr. Donald Skinner, retired Chairman of Urology at the University of Southern California used to say, “I won’t even operate on a 70 year old man, unless he brings his 90 year old father to the consultation with him.”  This patient’s choices were watchful waiting, now known as “active surveillance”, hormonal therapy, or radiation.  After a long discussion with my partner, he chose radiation therapy.

When I walked in the exam room to get the patient to sign a consent before we started, I was fully prepared to try to convince him that at his age, it wasn’t likely to make a difference in his overall life span to be treated for this early stage prostate cancer.  What I wasn’t prepared for was a man who looked twenty years younger than his stated age, in great condition, holding hands with his equally attractive wife, also a retired skater.  My speech about the treatment being unnecessary “at your age” went unsaid.  Instead, I gawked and said, “Ice dancing or pairs?”  From then the discussion veered from the upcoming Winter Olympics, and then to the fact that he grew up in Seattle and came to San Diego on vacation, whereupon he discovered that there was a place where it didn’t rain every day and decided to stay. He was twenty when he met his fifteen year old bride to be at a skating rink in Orange County.  He was tall, with an elegant physique. She was petite and a beginner. He smiled at her as he told me the story of the “best pick up line EVER!”  He found himself next to her at the edge of the rink and said, “What are you doing there, standing in a HOLE?”

Perhaps it was not the best pick up line ever. But his vivacity, vitality and joie de vivre certainly bought him a definitive course of intensity modulated radiation therapy.  After all, he’s a GOOD eighty six.

Curmudgeonly Me

I didn’t like my flu shot very much this year.  Some years they hurt worse than others, and I haven’t yet figured out whether that depends on which nurse gives me the shot, or which strain I am being vaccinated against.  This year was a bad one—within 24 hours my arm was so sore that I couldn’t raise it above my head.  I received it on a Friday and with it, my little sticky badge to be placed on my hospital ID that proudly proclaims me duly vaccinated and safe to see patients. The next day I left on a Southwest flight to Albuquerque.  It is rare that I ever check luggage these days, after an unfortunate mishap in 2006 when my family ended up in New Haven, CT for my daughter’s college graduation, but our luggage went to Florida. As I hoisted my own suitcase into the overhead rack, I felt an acute twinge in my shoulder anteriorly in the region of the biceps tendon, same side as the flu shot.  By that evening, I couldn’t sleep because of the pain, and two months later, it still hurts. My husband says it was a coincidence.  I am not so sure, but I have no choice in the matter.  If I want to keep working, and seeing patients, an annual flu shot is mandatory.

This past Friday through Sunday I was in Palm Springs, CA for the Palm Springs Kennel Club dog show.  For those of us who show dogs, this is one of the biggest shows of the year, the “kick off” to the dog show season, and the prelude to the Westminster Kennel Club show in February.  If you win at Palm Springs, there is a very high likelihood that you will be winning at Madison Square Garden.  Or so they say, because I don’t travel in those rarified circles.  Still, many of my friends were slated to show their deerhounds, and even though I didn’t have any puppies to show, or adults who haven’t finished their championships, I had nothing else to do so I hopped in the car for the two hour drive on Thursday night, leaving my own dogs at home.  Dog shows are ever so much more fun when you don’t have to walk, feed, bathe or groom your own dogs.  I was there to have fun, and maybe do a little shopping at the big outlet mall at Cabazon.

My friend and oft traveling companion Rachel had delivered the last puppy from her recent litter to a woman in Texas who had just lost her own deerhound to osteosarcoma a few days before the Palm Springs show.  By Monday of the show week, Rachel complained of a sore throat and upper respiratory congestion.  She really should have skipped Palm Springs, but she’s a tough one, Rachel, so on Thursday early she loaded two dogs in her car and headed from Arizona to California.  By the time she arrived in Palm Springs, she had a severe cough, fevers, shaking chills, a headache and muscle aches so bad that she couldn’t stand for very long.  I arrived after she did and brought her four bottles of water, which she managed to keep down, but she couldn’t eat anything—the masseter muscles in her jaw hurt too bad.  I said, “Rachel, did you get a flu shot this year?”  I had just seen the television reports Thursday that H1N1 flu was at epidemic proportions in Texas.  She said “No, I never get flu shots.  They make me sick.” By Friday she was feeling faint, and barely managed to get around the ring with two dogs.  One of her puppy owners lives near the show site, and she insisted that I drive her to visit the nice man and his puppy.  Midway through the visit, she turned pale, broke into a sweat and I rushed her back to the motel to see if I could get her rehydrated and some food into her.  As she wiped her brow with her forearm, before making an emergency bathroom stop, she said, “I’ve never been this sick in my entire life.”

Bingo.  That’s the flu.  All these folks who go around with the sniffles saying, “I’ve got the flu” or when your co-worker says, “I spent the weekend goin’ and throwin’—I had the flu”—that’s not the flu.  That’s a cold, or a GI bug, or “I want to take a sick day.”  But when your friend who has served time in the Army and who has driven an 18 wheeler cross country professionally says to you, “I’ve never been this sick in my life”—now, THAT’s the flu, as in influenza.  Get your flu shots folks.  There’s still time if you’re not sick yet.  Don’t delay, because I won’t be around to nurse you through it.  I wear my “flu shot” badge proudly, and hope that my shoulder isn’t still hurting in the spring.