Make Yourself At Home

I try not to sweat the small stuff.  Really I do.  But when I leave home, and leave my menagerie in the care of a house sitter, I am nothing if not explicit.  The directions for the care and feeding of my four dogs and two horses (the cat got a reprieve from his Boston eviction until May 9th) come to a total of four printed pages, small font, single spaced with nice paragraph indentations and bold headers like EMERGENCY!!   A walk through prior to the departure date is mandatory, to demonstrate the intricacies of the garage door and the cable TV.  The house sitter is equipped for every possible natural disaster. The keys to the van, already loaded with dog crates, are left on the kitchen counter and the van itself has enough water, canned goods, leashes and dog food to last a good month. Thermal blankets are located behind the driver’s seat, just in case hell freezes over here in sunny Southern California.  Flashlights are industrial quality, and batteries are included.  You could say that I am a “Be Prepared” kind of person.

Last week the rare occasion occurred where my husband and I had different trips planned at the same time.  He was going to Japan on business, and I had plans to meet a friend in Albuquerque for a three day getaway.  I tried to round up the usual suspects for housesitting, but all were previously booked. So rather than cancel my trip, I took the plunge and hired someone new.  She came over a week before the trip, loved the animals, memorized their names quickly, and took notes on top of my printed instructions.  She said she would leave her own dogs at home with her daughter and that she had no prior commitments during the time that I was to be gone.  I left home with a sense of relief that finally, I had found the right person for the job, and my parting words were, “Use the latches on the doors leading to the living room and please do NOT let those dogs pee on my brand new living room carpet!”

As I pulled through the gate onto my own driveway on Saturday night, the first thing I noticed was the horse trailer sitting inside.  A horse trailer?  My horses haven’t traveled in years.  I briefly considered peeking inside the trailer, but I could see my own horses down at the barn, and decided to go inside.  My dogs were lying down, relaxed, fed and happy–no worse for the wear.  So far so good.  My house sitter was seated at the kitchen table.  She beamed at me and said, “I enjoyed staying at your house SO much!  It was like having a vacation.  I should be paying YOU to stay here!”  She then elaborated, “I hope you don’t mind that I brought my horse over.  He didn’t get along with the white one so much, but he was fine with the chestnut!”  Seeing my look of surprise, she said, “I only wanted to take a little ride up the street to see the neighborhood.  I hope that was okay.”  I nodded numbly, wondering how far behind my horses were on their vaccinations.  She then went on cheerfully, “The dogs all got along great—my Great Pyrenees managed to go swimming in the muddy stream, so my daughter and I had to hose him down with the garden hose but we got him clean, and washed all the towels.”  I resisted the urge to run look at the certain hairballs in the washer and dryer.  She stood up and said, “I’ll come back ANYTIME!”  As she walked out she grabbed a large blue accordion that I had somehow missed on the way in.  She smiled and declared, “The dogs loved my music!”

As the horse trailer crunched out the driveway, I decided to have a look in the living room.  The stampede of pawprints were unmistakable, as were the large yellow spots on the white carpet that kept me occupied until around nine pm, when the sound of geysers through my open kitchen window led me outside. A trail of broken sprinkler heads crushed by the wheels of the swaying horse trailer created a fountain effect not entirely dissimilar to the fountains at Bellagio.  Unfortunately the water was not falling on the grass.

Multiple applications of pet odor and stain remover plus one brand new Bissell vacuum later, along with a hefty repair bill for the sprinkler system, parts and labor, all is well with the world.  My traveling companion said, “Did you call her?  Did you yell at her? What did you say??”  I shook my head.  As I said, I try not to sweat the small stuff.  After all, the “kids” are all right.  Anybody know a good house sitter?

Two Hundred and Nine Short Essays Later


Here I am in Boston, on the eve of my very first writer’s conference, feeling a bit like an imposter.  After all, the extent of my writing so far has been this blog, apart from thousands of histories, physical exams and treatment plans over the last thirty-nine years since starting medical school.  It occurred to me that someone might actually want to know what it is that I write about.  And then it occurred to me that I had never actually thought about it.  So I did, and this is what I came up with.



Cancer                                                                                                                           Radiation Therapy                                                                                                                 Dogs                                                                                                                                   Cats                                                                                                                                     Horses                                                                                                                                   Being a mother                                                                                                                         My kids                                                                                                                                 Travel                                                                                                                                    My father                                                                                                                               My mother                                                                                                                             Being a doctor                                                                                                                         Life


Cancer patients inspire me and motivate me                                                                       I’d like to explain a few things about cancer                                                                         I’d like to explain a few things about radiation therapy                                                     Cancer is evil and is not selective and makes me sad                                                 Cancer patients can be funny and they also make me laugh                                   Sometimes people do really stupid things when it comes to cancer treatment         Sometimes simple people can be heroes                                                                         Dogs are good therapy for me, my cancer patients, and my kids                                     Ditto on cats                                                                                                                       Horses are beautiful, liberating, dangerous and always expensive                                     You can be a mother AND a doctor and it’s going to be very hard                                     Your kids will forgive your shortcomings                                                                            Your kids will make fun of you                                                                                           Your kids will be successful if you EXPECT them to be and don’t harass them              Travel is enlightening and sometimes difficult and sometimes funny                                    My surgeon father is both an inspiration and a source of extreme annoyance                       My mother had a hard life and a hard death, despite appearances                               There’s always someone worse off than you                                                                   There’s always something to hope for



Examine your patients—it’s important                                                                               Think for yourself and follow your gut instinct                                                                Beware of templates.  They tempt us to cheat                                                                     The Rules of the House of God still apply                                                                      Doctors make mistakes.                                                                                                       Be very selective about who you hire and set a good example for them                             Be the captain of the ship                                                                                                     Try not to whine, even if you fail                                                                             Communicate with your referring doctors and with your patients                                     Take the time and make the time                                                                                         Learn to speak slowly and clearly in layman’s terms                                                           Try not to say no, and never say “never”                                                                             DO NOT DROP THE BALL when dealing with cancer patients                                           And finally, answer your goddamned phone calls

Did I leave anything out?

A Brief News Update From the Animal House

If you’ve been reading this blog for a while, you know that I have quite a little menagerie here.  In my animal loving prime, when I had a lot more energy than I do now, we had 5 Scottish deerhounds, one Brussels Griffon, two cats, two guinea pigs and eight horses, at least one of which I kept a secret from my husband who I feared would think that perhaps things were getting a little bit out of hand.  One day at the barn, he spotted a horse that he just KNEW I would love, and he inquired of the trainer whether the horse was for sale.  She didn’t quite know how to tell him that I already owned that particular animal.

The zoo has been winding down a bit here, mainly because the kids are gone and I am less prone to temptation without their little voices clamoring for that kitten for sale in the parking lot at the grocery store.  The cat with nine lives, eighteen year old Timmy Tom, was put to sleep in August when we could not control his thyroid disease, weight loss and vomiting.  Many of the horses have moved on to greener pastures elsewhere, where new children could learn to ride from the safety of their well-trained backs, and some of the best have passed on to that great green pasture in the sky.  Stormin’ Norman, the little Lipizzaner who carried my daughter through many a dressage test, left in late June to be leased by a beginning dressage rider.  In August she called to say she wanted to extend the lease to six months.

So I was surprised yesterday to get a call from the trainer to say that they would like to send twenty four year old Norman home.  She said that no matter how much she fed him, she couldn’t keep weight on him, and besides, an old stifle problem was recurring.  Fearing the worst, I went over to the boarding/training facility last night to have a look at him.  Now, mind you, this is a horse who has lived in my back yard for the better part of twelve or thirteen years.  Always a personable animal, with a beautiful expressive face and eyes, he knew me as well as any horse can know a person.  So I was surprised last night when I approached him with a bag of carrots and I heard no welcoming whinny.  His head shot up, and if horses can glare, this one positively glared at me.  His expression, plain as day, said, “Where the heck have YOU been, and when are you getting me OUT OF HERE?!”  And then he munched on his carrots.  He looked a little thin, but otherwise fine.

Norman’s coming home to join twenty eight old Dash on Wednesday, and I must say I’m glad.  The two old souls deserve a nice retirement, despite the fact that they really don’t like each other. And Labor Day weekend I visited a friend in Albuquerque who had a litter of eight week old deerhound puppies– it was hard to leave without one but they were all spoken for.  One day soon, I might be hearing the pitter patter of new little feet around these parts. After all, what’s a new carpet for?

Get A Cat

I have to admit it—I never liked cats.  Actually, to be more accurate, they never liked me.  Where dogs would always drool and fawn, the cats I knew as a child were reserved and aloof, and heaven forbid you should touch them in the wrong place.  The reward could be bite marks and a row of painful scratches down the back of your hand.  When I was thirteen, I found an abandoned kitten.  She was tiny and jet black and I smuggled her into our house inside my coat, thinking that I had found the answer to the mystery of cats—one of my own, who could teach me how to be a proper cat owner.  She snuggled against me as we fell asleep that night.  Sometime later, I was awakened in the dark by a tiny monster gnawing at my earlobe. My screams of terror woke my parents, and likely the dead too, and by morning my little secret had been deposited at the local animal shelter.

When I was pregnant with my daughter, our old dog passed away, and we were amazingly without pets for three years. While I realized that with a toddler and a full time job, a large breed puppy would likely be the proverbial “straw” to break my back, I was still longing for a dog.  My best friend in Boston said, “Why don’t you get a kitten? They are SO much easier than dogs.”  I said, “I don’t like cats.”  She said, “That’s because you’ve never owned one.”  Couldn’t argue with that!  The next weekend we were at the Animal Rescue League, picking out a six month old plain gray tabby who approached us through the bars of his cage.  That boy must have known he needed to behave like a dog to win my heart, and so he did.  He came when he was called, enjoyed having his belly scratched, begged for food, and greeted me at the door every night.  His name was Max, and he taught me to love cats.  He also taught me that a cat that goes outdoors when you live next to a hundred acre nature preserve is a short lived cat.

Fast forward to 1995.  I met a woman who was a breeder of Bengal cats.  She had a litter of three kittens and she invited me over to see them.  The dam of the litter was stunning, a golden yellow with beautiful rosettes decorating her entire body.  She had three kittens, all yellow and striped.  I said, “Where are their spots?” She said, “Oh, they get them when they get older.”  Four hundred dollars later, I took home my Bengal kitten and christened him Timmy Tom.  When I took him to the vet for his shots, the receptionist took my information, the cat’s name and birthday, and wrote down “Domestic Shorthair” under breed.  I said, “Excuse me, he is a Bengal.”  Twenty minutes later, the vet pronounced my kitten healthy.  I said, “Do you know when the spots come out?”  He looked at me, smiled, and said, “How much did you pay for your yellow tabby?”  When I told him, I am sure that his guffaw could be heard at the front desk.  The receptionist giggled as I left.

Timmy Tom is a huge cat, now seventeen years old.  In his prime he was a hefty twenty one pounds, an apt illustration of hybrid vigor.  His coat has lost a bit of its shine, and he may have dropped a pound or two, but he has his eyesight, his hearing and all of his teeth.  He is the undisputed king of the household, and the giant hounds shrink back if he bares his teeth and hisses at them.  He screams at me if I am slow to slice the chicken breast he eats for breakfast every morning, and he likes his shrimp without cocktail sauce.  He never learned to cover his business in the litter box, and he does not care one iota if my bathroom smells because of it.  I exist to please him and not vice versa.  After all, he is a cat.  I am still waiting for his spots to come out.

A year ago my daughter the medical student cried and said she was lonely and missed her dogs.  I nodded sagely and gave her my best advice:  “Get a cat.  They’re easier than dogs.”  And so she did.

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   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!

I am a Dog Person

If it’s true that in this world there are cat people and dog people, I am most definitely a dog person.  I cannot remember a time when I have had fewer than four dogs.  Most of my like-minded friends think that this is normal.  My chosen breed is the Scottish Deerhound.  This is a very old breed, used in Scotland to hunt the red deer even before the advent of firearms.  These powerful hounds were able to keep pace with the fleetest of foot, and are pictured in old etchings going for the neck and throat, or for the hamstrings of the unfortunate deer. It has been said that the deerhound is the “Royal Dog of Scotland”, that no one ranked lower than an earl could own them, and that a “leash” of deerhounds was the price whereby a convicted murderer could buy back his life.  My friend Richard, historian of the breed, says that these stories are likely apocryphal, but they please me nonetheless.  Lately, my husband has taken to calling himself “The Laird”, while three or four of them lounge about his feet as he watches Monday night football on the giant screen tv.  Sir Walter Scott’s monument sits in the heart of Edinburgh, his deerhound Maida at his side, whom he called “the most perfect creature of heaven.”  I couldn’t agree more.

And so it was only natural, that when the veterinary specialty clinic in our area was looking to partner with human radiation oncologists for the purpose of delivering stereotactic radiosurgery to dogs with brain tumors, I was chosen to forge ahead with the alliance.  As part of the bonding process, I was invited to tour the veterinary cancer center with my staff.  The facility was clean, bright and airy, the staff cheerful and obviously skilled, and the linear accelerator used to treat the animals was state of the art. Stationed outside the linac was a white board schedule with the names and treatment times of the dogs under treatment. I was surprised to see that the schedule was full, morning to evening. Both the medical oncologist and the radiation oncologist greeted us, and we discussed ways in which we could collaborate to improve the lives of both dogs and humans affected by cancer.   As we were leaving, a sad eyed basset hound, held tightly in the arms of a vet tech, gave a low whimper as his IV was started for his chemotherapy.  To my amazement, my office manager, who has seen EVERYTHING in the human spectrum of suffering over a 15 year career working in cancer centers, burst into tears and exclaimed, “It’s just so SAD!”.  And she is not a dog person.

What is it that drives human beings to spend thousands of dollars treating their pets for cancer?  People who swear that they would never under ANY circumstances themselves undergo chemotherapy or radiation change their minds abruptly when it comes to their beloved pet.  People who become apoplectic when faced with 20% co-pays on their own insurance will cheerfully re-mortage their homes to give their 11 year old dog a chance of cure.  What is it about the human-animal bond that compels us to never give up, to fight the good fight for our cat with lymphoma?  Especially since that animal cannot tell us that yes, they want that amputation and they want that chemotherapy and radiation.  Scottish deerhounds are particularly susceptible to osteosarcoma, a nearly always fatal bone cancer very common in large to giant breed dogs.  I asked the veterinary oncologist, who has since become a good friend, “Why do people amputate the leg of a giant running hound, and give intense chemotherapy, when on average the dog lives only a year?”  I tried not to sound judgmental but he knew what I meant.  He said, “Miranda, you must stop thinking of the dog as a human being.  The dog doesn’t look in the mirror and say, where did my leg go?  Look at how deformed I am!  The dog says, I am so grateful that the horrible pain is gone.”

I have been very fortunate.  I have never had to make the decision to amputate the leg of a dog who lives to run.  But I have corresponded for years with a British couple, Marc and Bev Doyle, who made that decision for their deerhound Darcy, who lived happily as a “tripod” for four more years before dying of other causes.  Marc and Bev have used Darcy’s example to raise a huge amount of money for osteosarcoma research and have likely benefited countless other Darcys in the process.  Marc is a photographer, and one of my favorite images of his was taken out on the moors, when Darcy ventured out for a walk for the very first time after her amputation.  It is a purposely grainy black and white photograph, taken from behind as the day is waning.  Darcy has become tired on her walk and pauses for a few minutes to lean on her deerhound brother Duffy, who stands very still to support her while she rests.  There is a gentle breeze reflected in the dogs coats. They are both looking ahead to the horizon.  I call this picture “Lean on Me”.   Marc calls it simply, “Hero.”

The odds are that one day, perhaps soon, my luck will run out and I too will face the decision of whether to pursue aggressive cancer care for one of my dogs. When that time comes, I don’t know what I will do.   Do you?