It Helps to be Famous

Boston is a mighty fine place to visit, if you don’t mind the weather–my trip to the Harvard Writer’s Conference this week started out with four straight days of freezing rain punctuated only by gusts of wind.  But cold feet and wet shoes could not deter me and my daughter from our appointed rounds of Newbury Street and the Mall at Copley Place. Lugging my suitcase through Logan Airport last night reminded me that I bought more than books at the conference book fair.  In fact, I had already made a pit stop at Fed Ex to mail the books home—no room in the baggage.  I finally arrived back in San Diego at 11 pm, after seven hours on a JetBlue plane, where no matter how much they brag about the snacks being free, there’s only so long you can hold out on two bags of blue potato chips and a roll of Mentos.  The hastily bought tuna salad sandwich from Dunkin Donuts at the gate proved to be far too suspect to actually eat, and if you know me, you know that I am NOT a picky eater.

But back to the main subject at hand, the annual Harvard Writers conference (www.harvardwriters.com) was a welcome respite from the medical meetings I usually attend. The three days of talks by noted medical authors, publishers and literary agents were outstanding, but the best part of the conference was getting to meet other writers, some well published and some aspiring, to share ideas and stories.  I met specialists of every variety, including child neurologists (“How to Develop Your Baby’s SUPERPOWERS!”), sex therapists (“and let me tell you, I hear about a lot of BAD sex!”) and a surgeon who wrote a memoir of his internship called “The Year They Tried To Kill Me: Surviving a Surgical Internship Even if the Patients Don’t!”)  Who knew that the practice of medicine could be so exciting?  The fact that I have not ever actually WRITTEN a book did not deter me in the slightest—I signed up for every lecture, every work shop, every interactive demonstration to be had.  And I learned a tremendous amount.  Next year I’ll come prepared:  I will try to write a book.

Kudos to the course organizer, Dr. Julie Silver (www.juliesilvermd.com) , a breast cancer survivor, mother and Harvard physical medicine and rehabilitation specialist for putting together a stellar faculty.  She spoke about a subject familiar to many of the readers of this blog—she found that while she was able to survive her cancer, the aftermath of the treatments nearly killed her, which inspired her to write her book “After Cancer Treatment: Heal Faster, Better, Stronger,” a book which will help not only breast cancer patients but all cancer survivors recover from the side effects of therapy.  The prize for the most entertaining lectures had to be shared by Dr. Salvatore Iaquinta and Mr. Rusty Shelton. Dr. Iaquinta, the surgeon who self-published his memoir mentioned above created his book, soup to nuts, on Amazon’s vehicle “Create Space” (www.createspace.com) and highly recommended the process.  Definitely worth looking into.

Mr. Shelton, of Shelton Interactive (www.sheltoninteractive.com) gave two very enlightening lectures on the use of social media in publishing and marketing.  As it turns out, a lot of attention in the book publishing world is paid to something called “platform.”  In my hitherto world of swimming and diving, when someone said “platform,” they meant five meter or ten. But in the publishing world, the “platform” is the influence and following a would-be author has already built, not only through their professional associations and media appearances but also through the social media of a self-named website, a Facebook page, and especially a Twitter account.  The somewhat obvious conclusion here is that if you want to get a book published, it is exceedingly helpful to be famous already!

So grab your domain name now, and don’t forget Facebook and LinkedIn.  On your mark…get set…and START TWEETING!

Taking Back The Cat

 

Boston can be a cruel city, and not just because of the weather, although it is forty degrees, windy and raining right now.  It is an expensive place to live and eat, the drivers are daunting, and everyone always seems to be in a hurry.  A year ago I spend three anxious days here with my daughter, a newly minted MD, desperately trying to find a place that was reasonably close to the hospital she is training in, affordable, and cat friendly.  As they say, “two out of three ain’t bad.”  We found a boxy one bedroom in a high rise a short distance from the Longwood area, and for a mere two hundred dollars extra deposit, she was allowed to bring her cat.  But affordable, this place is not.

 

Medical school can be a difficult and alienating experience, and if you’ve lived your whole life with warm fuzzy creatures all around, as my daughter had, there is only a brief period of excitement about a new city and a new endeavor before you begin to miss the cat curled on your lap when you study, the dog whining for attention and giving you an excuse to give up your books and go for a walk.  Despite the uncertainty of her future, my daughter found herself at the Houston Humane Society, staring into the cage of a ten month old kitten too old to be particularly cute and too plain to attract the attention of the numerous seekers dotting the rows of cages filled with sadness and longing.  A few hours later, she brought the malnourished and worm ridden little gray-brown tabby home, and christened him “Bitty Kitty.”  Several vet visits later, the worms were gone, but the effects of early starvation were not, and he has remained, as an adult, a very tiny cat.

 

A year later, with every month just a little bit more money going out than coming in, my daughter realized that if she stays where she is, her life savings will be completely gone before she finishes her residency.  She looked long and hard, in every spare hour she had, for a less expensive place, still close to the hospital, where she could still keep her cat.  Again, she achieved two out of three goals.  She found the perfect place, much less expensive than where she is living now, within walking distance.   But the cat is verboten.  No cat, no way, not even a tiny one that doesn’t cause any trouble.  She called me weeping, for advice.  I said, “I’ll take the cat.”

 

History has a way of repeating itself.  Thirty-five years ago I was accepted into a residency program at the same teaching hospital she is training at now.   I had a dog, the very first dog I bought, raised and trained all by myself.  Shandy was a collie in the old tradition of Lassie, and he was beautiful, and intelligent and my constant companion.   When I heard on Match Day that I was going to Boston, my only thought was to find a place where I could keep my dog—a large dog at that.  I came and I looked and looked and trust me, there was NO apartment within 20 miles of the city that would let me keep a large dog, or any dog, locked behind closed doors all day, and sometimes all night, because interns keep terrible hours.  I came to my senses when I realized that I knew no one in the city, and that it would be unfair to my dog to keep him.  Heartbroken, I did my best to find him a good home, with a surgeon who later moved to Ohio.  He did not keep in touch.

 

It’s been awhile since we lost old Timmy Tom at nearly eighteen years of age.  Although I have missed having a cat, I have not missed cleaning up kitty litter.  Still, I felt myself weakening recently when I spied a large male orange tabby being offered by a local cat rescue group. He stared at me and purred. But something made me hesitate, and now I know why.  On Wednesday I will depart Boston for San Diego with Bitty Kitty in hand.  He may be small, but he is mighty.  Those deerhounds better watch out.  The cat is back.

A Culture of Tenacity

It occurred to me yesterday evening as I walked off my flight from San Diego into Terminal C at Boston’s Logan Airport that I have done this before—landed at an East Coast hub two weeks after a major terrorist attack.  On September 20, 2001, my daughter and I, not without some hesitation, boarded a flight to Boston to look at colleges.  That was a long time ago but the mood there at Logan was strangely similar.  I ducked into Hudson’s Books for a late night snack, since I was waiting for her flight from Houston, and a woman in line next to me said, “Do you have any of those Boston Strong buttons?”  I had been thinking the same thing, just as she said it.

 

Bostonians have a long history of resilience and tenacity.  When I was a horse loving kid I read a story about Paul Revere’s horse, told from the point of view of the horse (of course!)  Apparently Paul did not spare the spur in his midnight ride on Brown Beauty, a mare borrowed from Samuel Larkin—nothing would deter him from his mission, and the good people of Boston, their roots steeped in hardship and persecution and war and famine, have followed suit for centuries.   The blood shed on the cobblestones of Boylston Street two weeks ago was not the first, nor will it likely be the last.

 

What I loved about my training in Boston thirty years ago was that same unflinching and uncompromising commitment to patient care demonstrated by the forefathers in their commitment to freedom.  Yes, the hospitals where I trained had some of the best teachers and most dedicated researchers in the business.  They wore their old school bow ties like badges of honor, and they still do.  Doctors wore white coats, and medical students did not inquire if it was okay to wear shorts to clinic, as they sometimes will in Southern California.   There was a certain formality, which translated into respect—for their peers, for their students, and for their patients.  Especially for their patients.  We laughed about them, we cried about them, we read and lived “The House of God”, and in the end we gave our all for them. I have missed that these last twenty years.

 

It’s good to be back.

A Boston Story

Despite the recent hurricane, Boston is a city with many charms. If I had forgotten, a walk through Beacon Hill on Halloween was a great reminder—little ghosts and goblins everywhere and old brownstones decorated to the hilt. As I looked up at something protruding from a large bay window on Mt. Vernon Street, I realized that what I was seeing was two legs with old fashioned striped stockings and buckled boots hanging out as if crushed by a falling house. Ding Dong, the wicked witch was dead. Taking a shuttle bus to the Convention Center daily triggered memories of my medical school “away” rotation at Boston University Medical Center, and years later, dinners with my husband at St.Botolph’s restaurant in South Boston and First Nights celebrated with the kids downtown. But there was one sight I was unprepared for. On my last day at the meeting, I happened to glance up at just the right time to look to my right and see the Cary Akins Pavilion at the Boston Health Care for the Homeless Program, at the corner of Massachusetts Avenue and Albany Street. Since my old Blackberry is nearly worthless for “surfing the net”, I quickly emailed my husband and said, “Google this!” because Cary Akins was the name of my heart surgeon neighbor in Dover MA twenty five years ago. I wanted to know if he had died and left a lot of money for a good cause.
Within minutes, he had emailed me back. Here is the story, from the Boston Globe, 2006.

A Wealth Of Goodness
By Brian McGrory, Globe Columnist | February 7, 2006

<<Rich people are getting a bad name, maybe deservedly so. If it’s not Jeffrey Skilling and Enron in the news, then it’s Bernie Ebbers or everyone’s favorite money pig, Dennis Kozlowski of Tyco.How bad is bad? Big oil executives are reaping huge bonuses simply because the cost of oil soared in the wake of Hurricane Katrina, according to a New York Times report. What a country!

Then along come a few guys in our own little hamlet who might make you feel a bit different about rich people, if only for a moment. One is Jack Welch, perhaps the most legendary chief executive officer of the last 50 years. Critics will point out that he’s been well compensated by General Electric, even in retirement. But there’s a world of difference between Welch and the slugs mentioned above. Welch built up a company, rather than tore it down; he helped enrich everyday investors, not fleece them; he put people to work, instead of sending them to the unemployment lines.About ten years ago, he showed up at Massachusetts General Hospital for major heart surgery, which is when he met his surgeon, Dr. Cary W. Akins. Akins, by his own account, doesn’t normally befriend his patients, ”because it could cloud my judgment.” But Welch, he added, ”wasn’t going to let it be any other way.”
The surgery was a success. Soon, Welch and Akins were talking regularly and socializing, along with their wives. One night last summer at the restaurant of The Wauwinet on Nantucket, Welch leaned in and made a proposal.As Welch tells it: ”I said, ‘What’s your favorite cause? I’d like to give them a million bucks, whatever they are.’ ”
As Akins recalls, ”He told me what he wanted to give, and I almost fell off my chair.”
Fortunately, Akins kept his composure long enough to call Dr. Jim O’Connell, probably the closest thing Boston has to a fully functioning saint. He runs an organization called Boston Health Care for the Homeless, and as part of that rides around the city in a van several nights a week, giving medicine, food, and a few moments of comfort to the men and women who live on the streets.
To most passersby, these street dwellers are nameless, faceless nuisances. To O’Connell, they are people in dire need. He’s learned not only their names, but their ailments and quirks. He persuades them to visit his two clinics. He opened a convalescence home for those recovering from illness or racked by disease.
”He is,” Akins said, ”Boston’s equivalent of Albert Schweitzer and Mother Teresa.”
Akins had met O’Connell a few years before at a medical presentation, and, as soon as Welch made his offer, Akins picked up the phone and called O’Connell about the million dollars. By coincidence, Boston Health Care for the Homeless was raising funds in hope of renovating the old city morgue on Massachusetts Avenue and turning it into a comprehensive, one-stop clinic and shelter for those without anywhere else to go. O’Connell needed about $13 million in contributions to do it. Some local foundations wanted to give money, but were waiting to gauge community support.
One thing turned to another. O’Connell and Akins visited Welch. Welch was floored. ”This guy is unreal,” he said of O’Connell. Welch made one demand: The entry pavilion would be named for Akins. Akins, in turn, was overwhelmed and embarrassed, two qualities not typically associated with cardiac surgeons. ”I had some pointed words with Jack,” he said. ”I don’t deserve to have my name on the building. Words really fail me.”
Last week, Welch handed over the $1 million. ”We’re just trying to kick things off,” he said.
Yesterday, John Harrington, the head of the Yawkey Foundation, raved about O’Connell and strongly hinted of a multimillion dollar grant to come. ”We’re going to be one of their major givers,” he said.This is how it’s supposed to work, but in the era of greed and ego, it rarely does.>>

Miranda, again.  I didn’t know Cary and Barbara Akins well, despite the fact that they lived next door to me for six years.  He was a very busy surgeon, and I was an overwhelmed young mother with three kids and a career just getting started.  We worked at different hospitals, and I am sure that he spent many long nights and weekends dealing with acute coronary events.  But I am so happy that I happened to glance up from my emails and my Blackberry at just the right time on Wednesday to see what Jack Welch and Cary Akins have done.

When my kids were little, one of their favorite books was a beautifully illustrated childrens book by Barbara Cooney called Miss Rumphius, published in 1982.  In it, Miss Alice Rumphius travels the world as a young girl, but comes home to coastal New England as an old woman to plant lupine seeds which bloom on the road sides every spring.  She tells the small children of the town, “You must do something to make the world a more beautiful place.”   I still do not know yet what that will be.

When I Was Young

I am in Boston, on the twenty sixth floor of the Copley Marriott Hotel, waiting out the storm. I have not been to ASTRO, my professional society meeting in three years.  I passed when the meeting was in San Diego two years ago, and Miami last year so that I could come to Boston, because I did my residency training here, started my career and my family here, and lived here for fifteen years.  And besides, New England is so lovely in the fall.  I chose my hotel carefully—not too far from the Convention Center, and very close to the restaurants and shopping in Back Bay.  I had it all planned.  All except for Hurricane Sandy.  I arrived here with my office manager on Saturday night, and managed to get in a half day at the meeting yesterday.  Today they “called it” at noon, and here I am back in my hotel room.  Tonight’s parties have all been cancelled but there seems to be a lively crew at the hotel bar.  I’m sure I will be joining them shortly.

We all say that we attend these meetings to learn what’s new in our field of radiation oncology, but the truth is that it’s very hard to learn anything when you run into an old teacher, or resident, or medical student between each lecture and it is ever so much more fun to sit and talk.  I bumped into one of my very first residents yesterday afternoon.  I mentioned that I had been writing down some of my old stories, and she piped in, “I have one for you—it’s about you!  I’ve never forgotten it.”  I said, “Oh, do tell me.”  I was a first year attending, and being responsible for a resident was a frightening prospect, although I tried very hard not to show it.

She said, “It was during my very first few weeks of residency.  I was called up to the ICU to consult on a 91 year old woman who was at the end of her life, on a ventilator.  The situation was dire, but they called us to ask about treating a large skin cancer on her face with radiation.   I knew that there was no way we could get her downstairs to treat her, but I didn’t know what to say on her chart.  So I came and asked you!”    I said, “What did I say?”   She said, “You told me to go up there and write on her chart: SURELY YOU JEST!”

Apparently my sarcastic sense of humor hasn’t changed much in the twenty seven years since that day. It’s how we oncology folk get through it all

Six Pounds of Hamburger

Six pounds of lean hamburger, two roasted chickens stripped to the bone, two pounds of green beans, a large steamed pot of brown rice, a couple of pounds of hard grated cheddar cheese and I am ready to go.  You might think that I am laying in provisions for a trip to the wilds of Alaska, but no, I am going to Boston for a meeting. They have restaurants there.  The food that I have carefully prepared is for my dogs and cat.   I will be gone for six days, and even though my husband assures me that he can take care of the four dogs, one cat and two horses still at home, it is important to me that it be done right. You may translate that to “it must be done MY way.”

I don’t know when it happened that I stopped feeding cheap store bought kibble and started to actually cook for the dogs. It may have been gradual—a sprinkling of cheese and a bit of hamburger here or there for a dog gone off its feed due to illness or injury.  I suspect that this little guilty pleasure surfaced at about the same time that my kids grew up and left the house and we all know that a mother needs to feed her children.  I measure out tablespoons of flax seed (keeps ‘em regular!) like I am doling out cod liver oil and vitamin E as my mother used to do when I was a competitive swimmer.  My husband gets into the act too—he tops off their dinners with Nilla vanilla wafers for dessert—a treat that the “laird” administers. Guests who are not dog people stare in wonder at the evening ritual, and no one more so than my houseguest from Kenya, a physician who absolutely REFUSED to believe that the creature I was carving up was a chicken—apparently they do not grow chickens that big in Africa.  Nor do they feed their dogs better than they feed their children.  I had the decency to be slightly ashamed, but not enough to go back to the cheap kibble.

Tomorrow I head out on JetBlue for ASTRO, the American Society of Therapeutic Radiology and Oncology annual meeting.  Apparently I am heading right into the “Perfect Storm”, although I thought they already made that movie.  Hurricane Sandy is due to make landfall soon, and I may be floating down Newbury Street and the Boston Common on my way to the convention center.  I don’t mind as long as I can get reservations at No.9 Park for dinner.  I will see old friends, do a little shopping, and maybe attend just a few of the educational sessions. If there is anything really new in the world of cancer treatment, I promise to write all about it.

In the meantime, my animals will be well fed, and my husband will survive—he always does.  But my writing may be a bit sparse for the next week.  Here is an open invitation to you all:  Please send your guest blogs to mfielding@crabdiaries.com   I know that my readers are nurses, doctors, front and back office staff,  psychologists,  veterinarians, dog people, horse people and of course my best friends and family.  Please write your own stories and share them with the rest of us.  I want to hear your voices, NOW!

You Can’t Tell a Book

 

Apparently I am not the only one who has learned a few things from my patients.  My husband surprised me and wrote this over the weekend, and I thought you might like to read it.

“ I was a pulmonary physician at a Boston hospital when I first met Martin, a patient with advanced emphysema that I was particularly fond of.  Martin lived in a poor neighborhood with his wife who worked as a sales clerk at Filene’s Basement, a discount department store.   He showed up for clinic visits wearing a white undershirt with wrinkled jeans, and carried a dusty backpack where he kept his breathing medicines.   His appearance stood out at this hospital, which typically served the more affluent people of Boston.  Perhaps because of his disheveled looks, other patients and staff seemed to steer clear.  Not surprisingly, I would usually find Martin sitting alone in the corner of the waiting room, often reading an old book.

Over the years I cared for him, I realized that we both shared a love of literature, since I had majored in English in college. Not only did Martin like to read literature, but he was also something of a poet.  He published short poems in a community newspaper and liked to show these to me in a kind of off-hand way saying, “thought you might be interested”.  I remember that I was often too busy in clinic to take the time to read these poems, but I did appreciate the effort that went into them.

One year Martin had several hospitalizations related to his lung disease.  Somehow he became convinced that my care was the only reason he survived these episodes.  Out of gratitude he started to present me with an old book on each clinic visit.    The dusty books piled up in a corner of my office, and I always thanked him but I never had the time to read them. Eventually they were put in a box, and I thought made their way home.

When Martin finally succumbed to his emphysema, I made a point of attending the funeral.  It was the only time in my career that I ever did this.  The funeral was in a large church with several hundred people in attendance. Some stood up and remarked on the positive contributions he had made to the community despite his breathing impairment. When they expressed the love they felt for him, it actually brought me to tears.

A few years later, Martin’s wife showed up in my office to say hello.  It was winter, and to my astonishment, she was dressed to the nines in a mink coat and had a large diamond pendant adorning her neck. “You look great!” I said and then added, “I see you must  have re-married”. She quickly corrected me, “No, I didn’t get another husband.  You see Martin was a good man in more ways than I knew.  After he died, I called up a local book dealer to cart out the stacks and stacks of old books Martin kept in our apartment.    Fortunately for me, this man was honest.  See these books Martin had collected over the years were really valuable.  Most were first editions, and some were signed by famous authors.   Funny thing, I took care of Martin all those years, and now he’s taking care of me after he’s gone.”

That night I rushed home. We had moved since Martin started giving me those books. My wife and I ransacked our house looking for the books but we never did find them. Like their owner, the tattered bindings and dusty covers yielded no clue as to what was inside.”

When I read this story the other night, my husband had an introductory line.  I’ve saved it for the end.  He said “Patients have a way of teaching us some of life’s great lessons, when we are able to see things for what they really are, rather than what they appear to be.”  I say it a little differently.  My patients teach me something every day, about themselves, and about me.  I only have to remember to take the time to look, and to listen.