The Mating Game

When I was a kid, we lived in the Braeswood apartment complex in Houston, TX, right next to the A & P grocery store.  There were no leash laws back then, and everyone in the complex let their dogs run loose.  I have one distinct memory of dog breeding from “back in the day”—I went outside to play in the central courtyard and saw a beautifully groomed white standard poodle who appeared to be stuck to a large black and tan shepherd mix breed male.  They were back to back, and neither seemed to be able to get away.  All I could think of was the “pushmi—pullyu” in the Doctor Dolittle books.  I asked my mother, “Why are those dogs stuck together like that?”  I was eight and she did not care to elaborate.  The strange conjoined creature finally broke apart, and approximately two months later we heard the poodle owner crying pitifully as her beautiful girl gave birth to eight brown nondescript puppies down in the laundry room.  And that was all I knew for the next forty or so years.

Although I’ve had dogs since I was ten, in 1994 I got my first “show dog,” a Scottish deerhound bitch (yes folks, get used to it—that’s what dog people call them!)  I took handling classes, learned to “stack” and “gait” her, and with the help of some very patient friends, she attained her AKC championship by the time she was two years old, and I decided to become a “breeder”.  I followed advice, bred “the best to the best” by sending her all the way back to New York to breed to a proven sire of champions, and managed to get only four puppies, two of which had short tails which did not conform to the “standard.”  At that point I came to my senses and realized that it is much easier to BUY a well-bred, healthy, beautiful dog than it is to breed one.  I returned to my regular dual careers of raising three children and working as a full time radiation oncologist and was never again tempted to breed another litter until….recently.

Many of you have read stories on this blog of my two Q’s, Scottish deerhound sisters, now AKC Grand Champions Jaraluv Queen and Jaraluv Quicksilver. They are both characters—Queen for her trick of “going through”—when she is extremely happy she celebrates by dashing between my legs, first from the front, then from the back, laughing at me all the while.  Quicksilver has different tricks—she adores her food, and when she hears her dinner being prepared, she dashes into her crate where she is fed, then pops her head in and out until the meal appears.  Queen is probably best remembered for her interview with local news after the famous deerhound Hickory Wind won Best in Show at Westminster—as the newscaster interviewed me, Queen sat like a human being on my couch, calmly picking her toenails while her sister hid behind the stereo speakers.  As I said, they are characters.

Since there were no genetically or phenotypically compatible gentlemen callers within a thousand mile radius, we decided to go with frozen semen/artificial insemination. And I will give a shout out to Carol Bardwick at www.caninecryobank.com for trying her very best. A visit to her place deserves a separate blog all on its own—later, for sure.  We tested progesterone levels, we made sure the “stuff” was shipped in from out of state on time, we made sure to dim the lights and we did our best to create a romantic mood for the “installation.”  Our timing was perfect and once released from their cryogenically sealed containers, those little swimmers were SWIMMING!  I saw them under the microscope with my own eyes.

So convinced I was that the girls were pregnant, that I failed to recognize their typical signs of post season depression.  It was morning sickness—I knew it.  I fed them Wheat Thins with cream cheese to stimulate their appetites.  I made omelets with Havarti cheese and heavy cream.  I cooked filet mignon and wild salmon.   I gained seven pounds in four weeks.  Finally, the suspense was too much.  Favoring expense over stress, I arranged for a board certified veterinary radiologist to come to my home with her ultrasound machine (after nearly buying a used veterinary ultrasound unit myself, thinking that whether they were pregnant or not, I could always check myself for gallstones!)   I watched with dismay as we went from cervix, to body of uterus, to uterine horns, to ovaries—both sides, both girls.  And saw nothing.  Nada.  Not a single puppy.

If I ever try this again, I’ll go with what a fellow deerhounder called YPF, which stands for “young, proven and fertile.”  In other words, a dog that can do what that old shepherd mix did to that poodle back in 1963—climb on and get the job done.  In the meantime, I’ll open my home to another rescue, preferably an old dog that no one else wants, to keep my ten year old Magic and 2 year old tiny Chihuahua mix rescue Yoda company.  After all, a little good karma goes a long way, and who cares about that new white carpet anyway?

And Then There Was One

This is a guest blog, tonight from my friend Jackie, who has shared wedding stories, dogs stories, friendship stories and love stories here.  She wrote this piece a year ago, and wrote the postscript last week.  This is for anyone who has ever experienced the loss of a loved on in the most painful way possible.  It’s long, so bear with us.          From Jackie:

I think a part of me will always be angry with my sister, my only sibling.  The anger sometimes morphs into fury, but then I feel guilty.  And then the guilt makes me sad, and the sadness overwhelms me with a depth of despair that only a few might understand.  When I got the call last January that my sister had committed suicide a part of me died, too.  The part of me that always hoped and dreamed that the estrangement my sister and I had experienced over the past several years could be overcome and we could renew the wonderful sister bond that we’d had shared for over 50 years.  How did things go so terribly awry?

 

I would say our childhood was unremarkable except in hindsight it was very remarkable.  My dad worked hard as an accountant for a large oil company and my mom stayed home to be a wife and mother.   We had everything we needed but few luxuries and I guess there was so much love in our family that I never really thought we were missing anything.  We lived in a new freshly minted suburban home and could walk safely to our elementary school.    Our house was always clean and tidy, we sat down to dinner every night together, and watching Lassie on Sunday night was a ritual. To save money my mother sewed all of our clothes; not always our preferred styles, but now I appreciate how hard she worked and how many hours she devoted to keeping our home life running smoothly.   It seemed totally normal to get up, have breakfast with my family, go off to school, make good grades, come home to a clean and organized home, and know Dad would be home for dinner at 5:30.   We followed the rules, respected our parents, made good grades, and both of us completed college in less than 4 years.  Our college educations were paid for by my parents so we never worried about loans or working through school.  My sister and I were close; we played and argued and shared secrets ~ and a bedroom too since my grandmother frequently came to visit.  We were loved and we knew it.

 

My sister and I had unique differences in our personalities and talents.  I swam competitively after giving up hope of having a horse of my own – when I was little I took riding lessons and loved being around them.   My sister swam a bit too, but never gave up on that dream to have her own horse.  When I was in college and she was still in high school my parents gifted her with her first horse.  He wasn’t much to look at, but moved well and she was ecstatic.   My sister was a bit of a slob in life; messy, but her riding tack was immaculate.  She would spend hours cleaning bridles and saddles and organizing them in precision-like order. She avoided cleaning her room but would happily muck out a stall.  I was more organized and enjoyed keeping things  clean, and that was a sort of joke between us – she had no problem ignoring her domestic chores to spend endless hours with her horses.   She just didn’t care.  And I loved that about her.

 

In our adult years, when we were married, we lived about 1 mile away from each other in Houston. She was a fun Auntie to my kids, and I did my best to help her with her  boys, who each had some unique learning challenges.  Her motherhood days were not easy.  But we enjoyed those years and were together constantly.  We talked on the phone everyday – long before there were cell phones.  Caller ID had just come into vogue and I would see her number and just pick up the phone and say “hey” and we would start in.  We endured the tragic and sudden loss of our father in 1995 and helped our mom get through some very tough years.  Sometimes we would just sit together and drink wine and cry.  She and her husband decided to move out to the country so she would have more room for her horse passion and perhaps find other schools to better manage her boy’s learning issues, and I moved to the West Coast in 2001.  That is when our bond would start to crumble.

 

Around 2005 my phone calls were not returned; I left messages, and my mother who lived close to my sister would ask me if I had spoken with her as her calls were ignored too.  Finally the ugliness was revealed.  My sister had decided to leave her marriage and children and run off with a pseudo-psychologist who practiced polygamy and had a prison record and had promised her a life of ease and loveliness.  She was trancelike in her devotion to him.  Her children and (now) ex-husband would call me in disbelief over her behaviors.  She managed to chase away all of the “wives”, handed over ALL of her divorce settlement, and very quickly discovered that he was nothing more than a con-artist who abused and beat her into submission.  I had told her from the start I did not support this decision, from the research I had done I felt he was a dangerous man and her decision was ill-advised.   I begged her to reconsider.  She turned on me with a vengeance, cutting me out of her life and insisting I owed her an apology for “judging” her choices.  And so it went.  I would follow her discreetly from afar and learn that she would run away from the violence more times than I could count; she would marry him and then leave him immediately afterwards because of the abuse.  She divorced him and then remarried him.  Her ex-husband would help hide her but always, always, she would go back.  My attempts to contact her were refused.  Her only calls to our mother were for money.  Mother’s Day, Christmas, Birthdays were ignored.  The years went by and I kept hoping she would come home.  Meanwhile her ex-husband moved on with his life and remarried and moved away.  Her boys grew up. I came back to Texas in 2008 but still no connection.  I told her ex-husband to please ask her to call me, I was here with any help she needed – but her pride was too high and the rift too deep.  She would not ask for help.  The torment continued. She had trapped herself into the endless cycle of abuse.  A few more bizarre business ventures would keep her with him, and give her temporary hope,  but they would fail and the misery would continue.  Early on she ran away from him and he threatened to cut her horses’ throats from ear to ear if she did not return.  She returned.

 

In 2011 I attempted to contact her via text.  She was rude and abrasive and would have no part of a conversation until I apologized, again, for the “choices” she had made.  My last words to her were that I wanted to resolve our differences, that I loved her, and would not fight with her.  No response.  I later learned that he tracked her phone, emails and texts.  There was never really a chance for her to be honest with anyone.

 

So in January when I got “the” call, a part of me was not shocked.  Still the tragedy of the whole messy thing crashed down around us all.  She had driven 9 hours to an out-of-state locale, hidden from all.  She poured a glass of wine and poisoned herself with barbiturates.   She was discovered through her car’s GPS.  When the kind detective contacted me he was solemn and sad.  In a level voice he asked if I wanted to hear her Note.  I listened quietly as he read me her last words, how she was so very sorry to leave everyone but she could not take the physical and emotional abuse any longer.  The final straw was that he was having an affair with a woman she worked with.  The disgrace was complete.

 

When I especially missed her during our years apart, I would fantasize about coming together over a favorite bottle of wine – sitting together, face to face, and thrashing through everything so we could begin again.  I think about the glass of wine that she poured herself to wash down the pills, the glass that should have been our glass of wine ~ our fresh start, our new beginning.  When she left forever that cold day in January she destroyed all of the hope.  And that’s when the anger/guilt/sad cycle begins again.   Why could she have not called me one last time to ask for help?  Why didn’t she remember the goodness about us?  Why why why…

 

My sister would have been 58 on June 30, 2013.  She was fun and smart and beautiful, and I loved her very much.  I will miss her forever.

 

A Healing Postscript:

Dr. Miranda thought it might be a good idea to wait to post this piece about my sister’s death until I had spent more time grieving.  It was a good idea.    I originally wrote this almost a year ago.  She suggested I write a follow-up on how things are going, how the healing process has gone.  It’s taken me longer to write this postscript than it did to write the essay.   I have struggled with this all week.

 

The passage of time is an amazing thing; it softens the rugged edges of grief and lifts the darkness.  But when the death of a loved one is a result of suicide, there is always a cloud that hovers ever near.  It is a difficult process to experience and it has given me deeper compassion for others who have gone through this horror.  A few days after my sister died my mother still had not called her friends or Pastor.  I contacted him myself.  He was shocked to hear the news – he knew our family well – and wondered why no one had notified him.  I explained that she could not bring herself to tell anyone; she was ashamed.  He told me that was not unusual.  He went on to comfort me with his opinion that Suicide was the single most selfish act a human being can commit; that it leaves those left behind wrecked and ruined, the ripples run far and wide.  He was right about that.  Even now when I mention my sister passed away I am always asked “Oh that’s terrible.  Was it an illness?”  And then I have to figure out just how much of the story I need to tell.

 

I have such a wonderful family and amazing friends and a great life.  I just wish my sister was here to share it with.  When I packed up my mother’s house recently and went through all the “stuff” I would literally talk out loud to her “…here is that plate that we agreed would go to you….or……  hey look at these pictures of you in grade school, what a hoot…..or…..remember this horse trophy that you were so proud of….”  and on and on.  I have decided I will never completely come to terms with her death, so I choose to remember the happy times of her life.  It’s the best I can manage.

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.

Deconstructing the House

Photographer’s notes:

Please have the home prepared before the photographer arrives.
1. Turn on every conceivable light.
2. Open window coverings.
3. Remove pool hose, pool supplies and backyard toys.
4. Open patio umbrellas.
5. Remove BBQ cover.
6. Remove cars and trash cans from driveway.
7. Remove laundry, toys and cleaning supplies, brochure stands, etc.
8. Hide the dogs (and yucky evidence of dogs), if any.

My house is for sale and yesterday was the day for taking photographs.  I read the instructions carefully—I like to be prepared.  Numbers one through seven were easy, although removing two very conspicuous red cars, a Suburban and a Corvette, took a bit of doing.  And fortunately I have no brochure stands in my family room, or magazine stands in the bathroom (who has time?) But number eight—“Hide the dogs (and yucky evidence of dogs), if any”— say WHAT?  That was going to take some serious planning.  It doesn’t take much imagination to realize that not everyone loves large gray hairy dogs as much as I do.  It is interesting that horses add ambience because you can’t smell manure in the photographs, and even more interesting that there were no comments about hiding the yucky children.  The horses are pretty and the kids are grown and gone anyway.  But dogs, well, dogs are just yucky.

I tried my best.  I had the carpet, nearly new but already showing the telltale signs, cleaned professionally on Tuesday.  By 8:30 am, the dog beds were all dragged outside and piled on the patio outside the master bedroom, hidden from every conceivable camera angle.  The dog bowls were emptied and neatly stacked in the pantry.  The crates in the garage had new clean pads installed, and smoothed wrinkle free.  The grooming table was stashed behind the crates, out of sight.  The morning “deposits” were scooped and emptied into a heavy duty, heavily scented drawstring bag which was in turn, placed in the small shed where the garbage cans are duly hidden.  The footprints from the previous evening’s wandering through the freshly watered grass were wiped from the kitchen floor.  The three deerhounds themselves were fed early, and were napping in their kennel runs.  The only trace of dog impossible to erase was my vocal little rescued terrier/Chihuahua mix Yoda.  I resigned myself to the fact that the only way to keep HIM quiet was to carry him around with me.  Four hours and one aching left arm later, mission accomplished.  I sent the photos to my kids with the note: “Look ye upon these photographs and know ye, that ne’er before has this house looked so perfect, and ne’er again will it.”  I didn’t want them to miss that one brief moment where we could pretend that we had no muss, no fuss, no chaos, no life, and no love.

Last night I dragged the dog beds back in, and then for good measure–because one girl just finished her heat season, and as sisters often do, the other just started hers—I took throws accumulated from 20 per cent off discount coupons from Bed Bath and Beyond and completely covered the master bedroom floor in a patchwork of riotous color.  I refilled all the water bowls and made sure that the pillows on the couch were fluffed and arranged just the way Queen and Yoda like them.  I made sure that the house, so ordered and neat and perfect for the photographer, was once again, perfect for the dogs.  After all, they are the ones who live here now with me and my husband.  I took new photographs of life as it really is—messy, chaotic, sometimes downright dirty.  I wouldn’t have it any other way.

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.

For Ellen

“to live in this world

you must be able
to do three things
to love what is mortal;
to hold it

against your bones knowing
your own life depends on it;
and, when the time comes to let it go,
to let it go”
Mary Oliver, New and Selected Poems, Vol. 1

As a parent, you are not supposed to have a favorite child, and since some of us physicians feel a strange but kindred protectiveness for our patients, likewise we feel guilty about having favorites.  But we always do. My favorite patient died last night.  On my last day of work, I gave her my email address and my cell phone number, so we could keep in touch.  She gave me a bright red stuffed teddy bear, so that I would always remember my “wild red headed woman from Texas.”  Except that she had no hair–she had grown and lost it so many times over the six years I treated her that even I lost count.  When I retired, I made sure that she had a follow up with one of my colleagues, who I trusted would give her his best opinion and effort in managing her care.  When he saw her in March, he told her there was nothing more he could do.  She signed on to hospice the following week.

She was diagnosed with a rare form of cancer of the uterus nine and a half years ago.  By the time I met her, in 2008, she had already developed lung metastases and had undergone several courses of chemotherapy, none of which had kept the metastases in check for very long.  After a trial of radiofrequency ablation which resulted in a pneumothorax and chest tube, she was referred to me for consideration of stereotactic radiosurgery.  We treated her lung lesions one by one, and one by one they faded into scar tissue.  She was happy and relatively without symptoms until eighteen months ago, when she began to recur in the lung, and brain, and soft tissues of her muscles.  She remained upbeat, larger than life, encouraging the radiation therapists to treat each new lesion as it occurred.  My entire staff looked forward to treating her every time she returned to the department.  We joked about awarding her “frequent flyer miles” and she laughed and her blue eyes sparkled. Her chocolate chip cookies were legendary, and she gave us the recipe, but they never turned out the way they did when she baked them.  We accused her of leaving out a secret ingredient and she protested vigorously.  She said she would never do that.

She traveled a lot in the last year of her life—to visit her children, to see a new grandchild being born.  Her last trip was to New Orleans with her husband, where she looked forward to eating beignets and listening to Dixieland jazz, even though her trip was interrupted by an emergency room visit for shortness of breath. When we parted at the end of February, we promised to keep in touch and get together for lunch or dinner but she had complications from her last course of therapy, or from the cancer itself, and when I heard from her by text and by email, the news was not good.  In her last email, she told me she had joined a gym, determined to try to regain some of her strength. She promised to call when she was feeling better.

She did call me, last weekend, to see if I could have lunch with her and her husband on Thursday.  I missed her call, but I knew I was busy that day, so I called her back to reschedule but she did not pick up the cell phone.  And so I was not surprised when I received the news today that she had passed away last night.  Not surprised, and yet astounded, that such a vital life force had left us.  My entire staff is bereft.

In his email to me and I am sure, countless others who knew and cared about her, her husband included two photographs of her.  In the first one, they are cutting their wedding cake—she in her beautiful white dress with her long flowing red hair and he, handsome in his tuxedo and moustache.  Over thirty years must have passed between the first photo and the second, where she stands alone, healthy, beaming, and holding a yellow rose.  After all, she was from Texas. As I looked at the pictures again this evening, it occurred to me that I knew that the ingredient she poured into those chocolate chip cookies but forgot to write down for the rest of us was love.  Simply and purely, love.

I am Passionate About…

A few days ago I decided that since I have been officially retired for two months, it was time to change my profile on the LinkedIn social network.  After all, the purpose of that network is to link business and professional people to potential opportunities and ideas.  I needed to let contacts know that I am no longer with the University where I practiced for the last seven years, while at the same time, just labeling myself “retired” seemed far too final.  LinkedIn, as it turns out, has a “prompt” on each member’s profile page which encourages us to say succinctly what we’re all about.  The prompt is “I am passionate about…”  It took a few moments for my brain to dispel romantic visions of the great love stories of all time–Catherine and Heathcliff?  Zhivago and Lara? Scarlett and Rhett?  The realization dawned on me that what LinkedIn was alluding to was professional and not physical.

What I am passionate about, and remain so despite the significant burn out that led to early retirement, is community based cancer care.  Contrary to what I believed during my residency, when I referred to patients being admitted by LMD’s (local medical doctors) from St. Elsewhere, over the course of a long career I have come to believe that most cancer patients are served best by being treated in their own communities.  Certainly there will always be patients whose presentations, diseases and complications merit immediate referral to a tertiary care center, however most patients with typical presentations of common cancers are also people who have jobs, who have children and/or elderly parents to care for, who have concerns about the financial burdens of treatment, and for many elderly patients concerns about transportation to and from treatment.  Our job, as community based cancer specialists, is to make sure that the treatment being provided measures up to the standards of care and safety that we have learned from our colleagues in major academic practices.  In communities with limited resources, this can be challenging.

For physicians and community leaders interested in creating a community cancer center the key ingredients are simple. First, you need a mission.  Decide what the goals of your center will be and write them down.  Create a statement.  An example could be:  “Our mission is to deliver medically and technologically advanced cancer care to residents of this community in a supportive environment close to home.”  These goals will be your guiding light as you proceed.  Second, you need a building.  Although many of the functions of a tertiary cancer center can be spread out into the community, we are not yet at a point where we can deliver “virtual cancer treatment.” Many pre-existing buildings can be modified to accommodate chemotherapy and even radiation therapy, at a fraction of the cost of new construction. Third, you need equipment.  Specifically, in order to deliver radiation therapy you need a multipurpose linear accelerator, capable of delivering highly focused stereotactic radiation as well as standard of care intensity modulated radiation therapy and superficial electron therapy for skin cancers.  Although it makes a good PR campaign to have the latest “sexy” name in equipment, much of this highly specialized equipment is not designed for a general practice. You will need infusion equipment and likely some laboratory equipment.    Fourth, you need highly trained and certified personnel to administer chemotherapy and radiation therapy, and particularly in the case of radiation, to insure quality. Fifth, it is my opinion that community cancer centers benefit greatly from affiliation with university practices in terms of access to clinical trials, to tumor boards, to advanced pathological diagnosis and to the expertise of specialists in each disease site.  Finally, and perhaps most importantly, you need the support of the community. To paraphrase Hillary Rodham Clinton who said, “It takes a village to raise a child”, I would say that it takes the dedication of a community to create a successful cancer center.

The future of cancer treatment, indeed of medicine in general, is unclear however we must not lose sight of the fact that patients are more than their cancer diagnosis, their chemotherapy recipe or their radiation dose prescription.  We need to keep them in their jobs, with their families, functioning as normally as possible under difficult circumstances, throughout their treatment and afterwards.  My own experience has shown that this is achievable in a personalized setting in the patient’s community.  That is what I am passionate about.

This piece is condensed from a longer talk I gave in Jamaica in October 2013.  For the full transcript feel free to email me and I will send it on.

# 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!