Back In The Saddle

An email from a reader early this morning reminded me that I have not given my Crab Diaries an update on the adventures of my eighty-eight year old Dad.  The story left off on our trip back from Aspen, Colorado where we held a memorial service for my mother on September 29.  The thin mountain air had proven too much for him, necessitating a mad dash to Denver to get him down from the altitude.  He was mighty tired after that journey, and cancelled a trip which was to have taken place the following weekend for a reunion of his old “travel club”, a group of plastic surgeons, most of whom are quite elderly now, who have been getting together once a year for at least the last forty years to teach one another while having fun in remote locations. The destinations have grown decidedly less remote in the twilight years, and while I was sad for him, I agreed that a trip to Chapel Hill, NC was not in the cards.

So you can all imagine my surprise when he announced, a week after the cancelled travel club excursion, that he was “still going to Viet Nam.”  Say what?  I knew that Surgicorps– the volunteer group of plastic surgeons, nurses, physical and occupational therapists and lay support team that he has travelled with for years– had a return visit planned to Ho Chi Minh City from November 1 through 12, but I was unaware that he had bought tickets.  His seven hour open heart surgery to replace a stenotic aortic valve was only this past March.  He swore that his cardiologists had given him the “ok” and I realized in short order that there was nothing that my sister or I could do or say to keep the man at home. I committed to an early morning wakeup last Friday to drive him to the airport.  As he walked with his suitcase to the car, I noticed that he seemed short of breath, and I said, “Dad, you really don’t have to do this—you have nothing to prove anymore.”  He insisted that he was “fine” and that “this is a test—to see if I can still do this.” For Dad, life is just a series of unending “tests” and he hasn’t failed one yet, unless you count hypoxemia at altitude!

A week later, I got this brief email:   “Hi…….everything is good. We have four long operating days…many cases…incredible variety.  I’m enjoying myself immensely but my hip is a big problem.  Definitely plan to have surgery when I return.  Cannot sightsee because of the need to walk long distances. That’s OK as I’ve already seen most everything.  Food is incredible…hospital puts out a feast for lunch!!! Hope all are happy and well. I am upgrading my return air ticket. Off to happy hour!!! Love….Dad”

According to the Surgicorps Facebook page, the team has now completed fifty eight surgeries in five days.  On Monday they will do their all day follow up clinic and then the plan is to depart for home.  In the meantime, Typhoon Haiyan has decimated the Phillipines, and is headed straight for Viet Nam.  There will be widespread flooding in the low lying areas of Southeast Asia.  I hope that the team will be safe, and that the populace has ample time to prepare.  Knowing my father, ever the optimist, I can only imagine that he is congratulating himself for his recent swimming workouts and thinking, “At least I don’t have to worry about altitude sickness!”   I guess hip replacement surgery is next on the agenda.  You can’t keep a good man down.

Denial Is Not a River in Egypt

If you desire healing,
let yourself fall ill
let yourself fall ill.”

Yesterday I saw a patient—an 80 year old woman with metastatic cancer involving her bones.  She had near complete replacement of her twelfth thoracic vertebra by tumor, and also significant destruction of her fourth and fifth lumbar vertebrae, demonstrated by PET-CT scan and bone scan.  She had so much pain in her legs that it was difficult to walk.  In attempting to discertain whether her pain was coming from her thoracic or her lumbar spine, I asked her a series of questions.  The only answers I got were that she had slipped while getting into the bathtub a few weeks ago and that her pain was in her left ankle and her right thigh, both of which had been X-rayed and were normal.  Questioning her about her bowel and bladder function was also unrevealing—sure, she had problems with both, but that was because of the radiation she received in 2009.  It would seem as though her cancer was causing her no pain at all, yet that was why her medical oncologist had asked for a stat referral.  After 30 minutes of discussing her bathtub mishap, her daughter had had enough.  She nudged her mother and said, “Mom, you KNOW that is not why we are here.”

My eighty seven year old father has been similarly reluctant to attribute his recent symptoms to his failing aortic valve.  Despite being told last summer that he had aortic stenosis, he asserted to his cardiologist that he had no chest pain, only a little shortness of breath with exertion.  He was able to walk downhill the eight tenths of a mile to his tennis club, but walking back up had become more difficult.  In December, he was still playing doubles tennis despite the fact that he had squeezing chest pressure which occurred with exercise, and was relieved by rest.  His cardiologist believed him—that his symptoms were pulmonary rather than cardiac.  The pulmonary doctor from Denver was summoned, and the lung consultation was exhaustive.  The conclusion was that my father had nothing wrong with his lungs.  My father, who by the way is a physician himself, could not admit that his symptoms were classic angina pectoris, and were worsening to the point where he was having them with minimal exertion. For the last two months he has insisted to every doctor who has interviewed him, “I have no chest PAIN, only a little squeezing pressure when I exercise.”  The result has been undiagnosed congestive heart failure which would have killed him, if he had not contracted an upper respiratory infection which landed him in the hospital and led to the real diagnosis.

I admire the stoics, the non-complainers.  I am not one of them.  When I have an ache or a pain, the entire world knows about it.  But there should be a limit to stoicism and that limit should be where the patient who is in denial is doing himself harm.  On Monday, my patient will undergo a CT simulation for radiation treatment of her thoracic and lumbar vertebrae before she suffers from a spinal cord compression and paralysis from her cancer.  On Tuesday my father will have his aortic valve replaced.  May they both emerge from their ordeals physically and mentally intact.  And may their doctors, including myself, learn to diagnose and treat these patients before they do themselves irreversible damage.