Pass the Butter Please

 

With gratitude to Doctors Rafael Espada and Michael Madani, for fixing my father’s heart, twice.

 

When Michael Phelps was interviewed during the Beijing Olympics, the world first learned about the extraordinary amount of food needed to fuel the swimmer with the wingspan of a pterodactyl. He said that he ate 12,000 calories a day, and no one believed him except for me. I believed him because I too was a swimmer in my youth, and a distance swimmer at that. Breakfast consisted of two scrambled eggs with cheddar cheese, a few slices of bacon, buttered toast, and a half grapefruit or cantaloupe. Lunch was a sandwich and chips followed by a whole package of Hostess cupcakes or snowballs—I particularly liked the snowballs because I would peel the pink marshmallow and coconut topping off the chocolate cupcake and eat that separately “for dessert.” Dinner was typically a slab of beef, potatoes au gratin or baked with butter, cheese and sour cream on top. Oh, and there was always a vegetable—to this day I can eat two heads of broccoli all by myself. After dinner, an entire bag of Chips Ahoy cookies usually kept me company while I did my homework. And this being Texas, barbecued beef or ribs, or both, fried chicken and biscuits slathered with butter and honey were Sunday treats. I swam four to five hours a day, and I was skinny, and I never gave heart disease a single thought, not even when my granddad dropped dead of a massive heart attack at age 75.

When my father turned seventy five, the same age we lost Grandpa, he thought that maybe he should have a stress test. He never had any symptoms—he was just a tiny bit superstitious about the fact that seventy five seemed like a good age to have a heart attack, or perhaps to avoid one. His internist obliged, somewhat begrudgingly since there was no history of chest pain or palpitations. His stress test was floridly positive, and before he could say “Boo” he was in the cath lab having a coronary angiogram. As the dye flowed, the images showed triple vessel disease, with greater than 90 per cent occlusion of the left main coronary artery. They call that lesion “The Widowmaker”, and that’s what it had done to my Grandma. As the interventional cardiologist tried to pass a stent, my father experienced a run of ventricular tachycardia—an arrhythmia which is basically “pre-death.” The next thing he knew, he was waking up from triple bypass surgery and he was madder than hell at all of us, his family, because he knew all along that there was nothing really wrong with him and we made him go through with surgery.

 

A week ago at age 87 my father had his second open heart surgery, to replace a worn out stiff old aortic valve. He’s a pretty tough old bird, and he made it through, although his post-operative course has been a little rocky. About a month ago, before the surgery we went out to dinner with some new friends that Dad had made in San Diego, a couple that live across the street from me. They warned us ahead of time that they were a little bit “fanatic” about their diets. I did not know what they meant. He, like Dad, is a retired plastic surgeon, handsome and fit. She is a realtor, elegantly dressed, thin and very persuasive. We went to an Italian restaurant, and as drinks were served, the waiter brought out warm freshly baked bread and butter. As is our habit, my father and I reached immediately for the bread and butter. Our hostess eyed the butter Dad had placed on the little bread plate, and then proceeded to snatch both butter and plate, depositing them on the other, unoccupied side of the table. She said authoritatively, “Mel, you can NOT go on eating butter. Not with your heart being the way that it is.” I was astonished. I had never seen anyone do that to a virtual stranger in a restaurant. Not to mention the fact that it was a tiny bit late to be taking the butter away from my father. He was not happy about it either.

 

This got me to thinking. I haven’t been particularly good about restricting my calories, watching my fat intake or about exercise as I have gotten older. The pounding of my hip joints repeatedly against the cement walls of the pool during endless flip turns, coupled with another 30 plus years of jogging on asphalt roads, taken up when my swimming years were over, have taken their toll on my joints. I adore butter and ice cream and red meat. I’ve gained 20 pounds over my “fighting weight” and love comfort food in the truest sense—I use it for comfort in times of stress. But it seems now, as I sit by my father in his hospital bed, that there is a choice to be made, since my genes have declared themselves as least as far as heart disease is concerned.

 

When we lived in Boston thirty years ago, we used to like to eat at two restaurants in Somerville. There was a barbecue place right next to a health food restaurant. I can’t quite remember the name of the barbecue place but I think it might have been Sam’s. The health food restaurant was called Jaye’s. Each of them had a big sign out in front—they were competitors of course. The health food restaurant sign said, “Eat at Jaye’s, Live Forever!” The barbecue restaurant sign said, “Eat at Sam’s, Die Happy!” The question for me, and in fact for all of us is, “What’s it going to be?”

The Golden Rules of Cancer

Rule # 1:   I didn’t give you your cancer so be nice to me.

And the corollary:

Rule # 2:   You didn’t give you your cancer so be nice to yourself.

I believe that in dealing with cancer, it helps to play by the rules.  The first rule means that as angry as you are about being diagnosed with cancer (or in fact, any other life threatening or life changing disease), try not to exhibit that anger towards your doctor.  It’s counterproductive for the patient (you don’t really want the entire staff calling you names behind your back and doing quick about faces when they see you in the hall, do you?  And don’t imagine for a minute that we don’t!)   And it’s disheartening for the physician who has dedicated his or her life to taking care of people just like you.  There will always be the occasions where the doctor and the patient just don’t “connect”.  If that is the case, and there is no rapport, please try to find another doctor who better fits your needs and personality.  It is absolutely your right to demand your doctor’s time and attention.  It is not your right to verbally abuse the doctor.  Early in my career, I had a lung cancer patient who was absolutely vicious—he answered every honest question with a snarl.  One day, I had had enough  (another one of those epiphanies!).  I said, “Mr. M, I know you are angry that you have cancer, but I didn’t give it to you and I am only trying to help you so please be nice to me.”  We got along famously after that and  I have had more than one occasion to say those words since.

As for Rule # 2, I cannot say how many patients come in blaming themselves for their cancer.  Trust me, I have heard it all.  They say, “if only I had had a better diet….”.  Or  “if only I had exercised more….”.  Or, “I didn’t handle stress well and it gave me cancer….”.  And their friends and neighbors can be ever so unhelpful—”If only you had eaten the Andrew Weil  way….”.  Or, “if only you had done Tai Chi which is more spiritual than that yoga YOU do….”.  Or “if only you had never lived 100 miles from a nuclear power plant…..”.  (Interestingly enough, no one EVER blames it on the cigarettes or the alcohol,  but that’s another whole story.)    Let’s face it folks—cancer, like many other life threatening diseases, is in most cases multifactorial and not at all related to one’s personality or one’s diet if one is not obese, or one’s spirituality, or whether one even does one’s laundry and which detergent one does it in. And (sadly for most of us!)  you can’t choose your parents and grandparents for the good genes. Whether it’s a virus, a bacteria, a bad gene, an environmental toxin, an evil substance you voluntarily smoke or ingest, genetic or whatever—in many to most cases we’ll never know.  It’s just shitty rotten luck, most of the time.  So stop blaming yourself and get with the program, which means quit smoking (smokers have a higher relapse rate for nearly all types of cancer than nonsmokers), start exercising (the Harvard Nurses Study showed that embarking on an exercise program after the diagnosis of breast cancer reduces the risk of relapse and it’s likely true for other cancers as well), and get to your ideal body weight because fat people get more cancer (and yes, trust me, I DO know how hard that is!).  Got that?

And finally, Rule # 3:  Unashamedly stolen from that great book of my youth, The House of God, by Samuel Shem:

The Patient is the one with the Disease!

Which means, I have to hold up my end of the bargain. Come what may, I need to walk into that consultation with a warm smile and a handshake.  I can’t come to work with all the baggage I bring from home—what aggravations and grievances my dogs,cats, horses, kids and husband have caused.  I can’t whine about my own problems  to my patients. (I do maintain the right to whine to my friends and family, however.)   And finally, I can’t blame my patients when they lash out in anger, or take it personally when they refuse treatment or don’t follow my advice.  It’s their right:  the patient is INDEED the one with the disease.

I think the cancer business would be a little bit more pleasant, a little bit more tolerable, if we all played by the rules.  Don’t you?