Another Thanksgiving

Every year when the time changes and the days get shorter and the nights longer, I start to feel it.   By the time that the halls are decked with boughs of holly, now shortly before Thanksgiving, the season of airport delays, of frantic last minute shopping, of eating and drinking too much and then doing it again has begun, and with it, for many, the season of sadness.  At a time when festivities and noise are ramping up in the outside world, the Cancer Center becomes curiously still and quiet.

No one wants to get chemotherapy and radiation for Christmas.  It is far easier to ignore that lump or bump or missed mammogram than it is to schedule one more thing—a doctor’s appointment—when there are trips to take, family to visit and cookies to bake. And for those who have been recently diagnosed, it is rare that the treatment can’t wait a few weeks, just until “after the holidays.”  Although the “C” word strikes terror into our hearts, most of the time cancer truly is not an emergency.  This time of year, lunch breaks actually appear on my schedule, and the therapists cheerfully ring me up promptly at five to check the localization films for the day.

It isn’t hard to squeeze a new patient in this time of year, but when I get asked to do so, there is a very good chance that that patient is a little bit sicker, a little bit more symptomatic, a little bit more urgent and oftentimes a little bit younger than the average patient that I see though out the rest of the year.  Especially if that patient is hospitalized. Every year, there is someone—a husband, a wife, a child, a brother—who won’t be home for the holidays.

And so tomorrow, when you raise your glass around the Thanksgiving table, and give thanks for all of the blessings you have, do not forget to give thanks for your good health and that of your family, if you are lucky enough to have it.  And send out a prayer, or a positive thought, or an email or card to those who have not been so lucky.   It will mean the world to them.   Nobody wants cancer for Christmas.

Finding Your Way Home, Again

But all great voyagers return 

Home like the hunter, like the hare

To its burrow; below, earth’s axle turns

To speed their coming, the following fair

Winds bless their voyage, blow their safe return.

 Barbara Howes

Today I saw an 80 year old patient with skin cancer—not a melanoma—the dangerous one, but a routine garden variety basal cell cancer sitting right on the edge of his nose, where the nose meets the skin of the cheek. His surgeon told him that he could cut it out, but that there might have to be a flap rotation or a skin graft to fill the gap, and the patient declined surgery.  As a result he was referred to me.  After hearing about radiation, this nice man decided to go ahead with treatment, but he had one question—could he wait until after the holidays?  The reason was that all thirteen of his grandchildren were coming to visit him, and bringing his first great grandchild.  I reassured him and told him that of course he could wait—the treatment of skin cancer is never an emergency, and while he might sing “Rudolph the Red Nosed Reindeer” to his grandkids, we didn’t want him to look like that famous deer!

My daughter arrived back in Texas yesterday after travelling since Thanksgiving on the residency interview circuit.  She has covered both coasts and eight different cities since showing up on in San Diego just before the holiday. She said it was good to be home, even though she misses her cat, who remains here with me during her travels.  I sense a grown up transition in the transference of “home” from being here with her parents, to “home” being her own condominium in Houston.  Although I miss having her around, I am happy that she has found her own ground, and her own friends, and made a life for herself there. Her biggest job in the next few months will be to figure out just where her next home will be, for the next three to six years. The best advice I can give her is to choose her next move based on her comfort with the people she has met along the way.  Not only will they be her peers and her mentors, but they will most likely resemble her “family” in the coming years—she will spend more time with them in the hospital where she lands than she will with any of her real family members.  For newly minted doctors, the hospital where they do their training becomes home.

I am glad that Christmas Eve and Christmas Day fall on a Monday and Tuesday this year.  My department will be closed both days, which will give my patients a four day weekend.  For some, this means they will get to take a trip home, wherever that may be.  For others, the four day rest will give them some relief from the side effects of treatment.  For those of us not undergoing treatment, may the fair winds blow your friends and families to you, or you to them, and safely bring you home.

Just Call Me The Grinch

I don’t get it.  Today as I was getting off the freeway, I passed a local farm stand that had just put up a big sign:  “Get Your Christmas Trees Here!”   And there they were, lined up like little soldiers, the beautiful Scotch pines, and Douglas firs, and balsams. How will they even last the five weeks until Christmas?  We haven’t yet had the food orgy we call Thanksgiving, but television ads for “Black Friday” already abound.  Does anyone else besides me want their holidays one at a time?  I’m still basking in a sugar coated candy corn stupor from Halloween.  Please let me enjoy my family, all gathered for Thanksgiving, before I have to think about braving the malls for glad tidings and gift buying.

The root of my problem– my crabbiness– (and after all, this IS the Crab Diaries) here is not Thanksgiving, or Christmas, or the shopping days in between.  It is my patients.  As the holiday season approaches, the pain and suffering of my patients seems to increase. This is a phenomenon that I have observed year after year.  At a time of year when a radiation therapy department, or an oncology chemotherapy infusion center would be—ideally—empty, we are bursting at the seams.  Why?  Because only the sickest of the sick will forego the holidays with their families and come in to the emergency room, the surgery center, the radiation therapy department or the infusion center for treatment.  The rest, the less acutely ill, will put off their biopsies, surgeries, chemotherapy and radiation until “after the holidays”.  As well they should.  Very little in cancer management is actually an emergency.

Those who know me will hopefully attest to the fact that I am not the “preachy” type.  But when I see the holiday excesses already beginning, in the form of a big sign advertising Christmas trees before the turkey is stuffed and the gravy is set on the table, I have to step up for those who will not be sitting at the table, or around the Christmas tree this holiday season.  If you know someone who has battled cancer this year, send extra thoughts, prayers and cards their way. Visit them, call them, text them—just let them know that you care.  And if you and your family are in good health, give extra thanks and may it always be so.

My birthday is in December.  I hate it—having a birthday five days before Christmas.  Those of you with December birthdays know exactly what I am talking about.  But every year since 1984, the year my daughter was born, I do see those candles on my cake as an opportunity, the magical opportunity for a birthday wish as I blow out the candles on December twentieth.  Every year, I wish for the same thing—I wish for the good health of the people I love.  I hope you all wish for the same thing for Christmas this year—truly, there is no greater gift.

If Wishes Were Horses

For Missy

Is there any woman alive who can’t recite the old nursery rhyme “If wishes were horses,then beggars would ride”?  The line is etched into the memory of every little girl who ever wanted a pony, but its true lineage dates back to James Carmichael’s Proverbs of Scots circa 1628 when the original read  “and if wishes were horses, then pure (poor) men wald ride.”  In my post entitled “Nana”, I recounted my short though blissful riding career at age 10, ended prematurely by the illness of my grandmother.  During a brief college fling with a polo player (yes, he had a string of polo ponies and yes, his name was Julian, and yes, his family were Hungarian emigres of questionable political  heritage), I was treated to a ride at breakneck speed that started with an innocent giddyup and very nearly ended in my demise.  Ultimately I decided that I would prefer life and limbs intact and gave up on Julian and his horses that handled like Ferraris, but without brakes.

Twenty years went by– medical school, two residencies and three children later—I found myself as the Radiation Oncology director of a community cancer center equidistant between Cape Cod and Providence RI.  One day, I saw a young woman in her early thirties who had been diagnosed with breast cancer.  She had elected to have a  lumpectomy and radiation, and when I saw her for the first time she had just completed her adjuvant chemotherapy.  I noticed two things about her immediately—the first was that despite her hair loss and other effects of her chemotherapy, she was beautiful, athletic, confident and in control of her body, her life and her situation.  The second thing I noticed was her bracelet.  It was perfect—a golden circle made of beautifully worked horses heads, eyes alert, nostrils flared, ears forward, manes flying, the horses of my dreams .  There was no way that I was going to ignore that bracelet. But first things first—the cancer.  We spoke about radiation, the risks, the benefits, the course of treatment, the side effects.  She told me her biggest concern was her little girl who was only three years old—she wanted to make absolutely SURE that I knew that she was going to make it, because she could not bear the thought of her daughter growing up without her.  I told her I understood perfectly, and I did.

At the end of our session, I could restrain my curiosity no longer.  I asked her about the bracelet.  She told me she had always loved horses, and that she had grown up riding on the Cape. The bracelet was a gift from her husband, as was her horse, Percy.  She told me she rode that horse every day, rain or shine, stopping only briefly for her breast cancer surgery, and continuing on right through her chemotherapy.  She said, “He keeps me sane”.  She asked me if I rode horses.   I said, “No, but I always wanted to—I just never had the money when I was a teenager, and as I got older, with career and kids, I just never had the time.”  She looked me in the eye—and said to me, “Well the time is now.  You never know what is going to happen.  You could end up like me, with breast cancer or something worse, when you least expect it.  If you’re ever going to do it, you should start NOW.”

That was it—my wake up call from a patient who was smart enough to see what I had missed and game enough to point it out to her physician—that the only time and the best time one is ever guaranteed is right now, right here.  The following weekend, I got my 8 year old daughter out of bed, made a beeline to the girls boarding school riding stable near our suburban home, and signed us both up for riding lessons. My 5 year old son followed in breeches, knee straps and short stirrups, and my 2 year old– ever the cowboy—well, when he turned three and got his helmet, he loped Old Ellie around Far West Farm much to the shock and dismay of the other boarders, to see such a small boy piloting such a huge animal, completely on his own.

Twenty one years have passed since I saw and treated that patient.  I left the practice to move out west in 1993.  But every year, at Christmas, I get a card from her wishing me well, and thanking me.  Always included in the card are photographs of her, usually on her horse, though Percy is long gone, and also photographs of her daughter, now grown and a beautiful young woman in her own right.  And there is always a gift, a little something “horsey” chosen specially for me– a picture frame, a Christmas ornament, a beautiful box of stationery, a silk scarf—with ” clouds of white stallions with bright fiery eyes”. Every year, without fail, there is that renewal of our friendship, and a reminder of what is important in life.

As for the horses themselves– Rosie, Lucky, Veronica, Harmony, Sissy, Romeo, Truffles, Oscar, Shorty, Besty, Norman and good old Dash—they’ve served my family well over a period of twenty years, carrying us over miles of trails, and through both adolescent and midlife crises. They are the best therapists—they listen without comment or criticism, and they never mind when you cry into their thick strong necks. Winston Churchill said  “No hour of life is wasted that is spent in the saddle.”  But I still think that J.D.Salinger said it best in The Catcher in the Rye:

“I’d rather have a goddam horse.  A horse is at least HUMAN, for God’s sake.”