How to Save a Life

And I would have stayed up with you all night–Had I known how to save a life.

The Fray, “How to Save a Life”

The tenth season of Grey’s Anatomy premieres tomorrow night.   For the cognoscenti, this means we will find out what happened after the cliff hanger of last season:  Will April really leave Matthew at the altar, for her first love plastic surgeon Jackson?  Or will the handsome paramedic who loves the doctor unconditionally and quite unbelievably without ego issues, win his lovely bride?  After all, he organized a flash mob for his proposal to her.  He deserves his beautiful red headed pig farming sweetheart.  And why do I watch these things?  Is it because the women wear makeup and heels and do their hair and the men are so very handsome and no one looks tired, and lives are saved quickly, with great valor. As Hemingway’s Jake says at the end of The Sun Also Rises, “Isn’t it pretty to think so?”

The song, “How to Save a Life” by the Fray, was used in an episode of Grey’s second season, and afterwards became an anthem for the show itself.  My favorite rendition is a home video with a hand held camera, of the actual cast singing the song at a benefit—you can view it here:  http://www.youtube.com/watch?v=KX3AjiqFA1s   Yes, I know they aren’t “real” doctors. But I suspect that if you act like a doctor for ten years of your life, it might be hard in the end to tell the difference.  The emotions are all right out there, in the video and in the show.  And that’s the real answer to why I watch Grey’s Anatomy—I get it all out in front of my own television set so I don’t have to do it in front of my patients.   I don’t think it’s helpful to have your doctor cry while she is giving you bad news.

Friday, February 28 will be my last day at work.  I am officially retiring, at age sixty. My staff and my patients have been asking me why for several weeks now.  They make very complimentary proclamations like, “But you look so young!” and “But you’re so GOOD at what you do” and “How can we replace you?”  The answers to these questions are “thank you,” “thank you,” and “No one is irreplaceable.”  The truth is that I feel like time is running out.  I have had some extremely joyful experiences over my last thirty two years in Radiation Oncology and I have witnessed some incredible success stories, many of which I have told here.  I know that miracles DO happen.  But I have also seen some terrible things, and there is not a doctor alive who would say that we don’t take our failures personally.  We do.  What I have come to realize, at least for me, is that the sad times are not getting easier as I am getting older.  Facing the deaths of loved ones this past year–patients, relatives, friends and pets—has left me with an acute sense that the clock ticking in the belly of the crocodile is ticking for me, and  I am no Peter Pan.

So I will leave my practice in the best of hands, and I will read and I will write and I will travel and see more of my children and all the other people I care about.  There is a line in “How to Save a Life” which goes, “And you’ll begin to wonder why you came.”  There is one thing that I am certain of, when it comes to my career.  I will never ever wonder why I came.

Happy Place

“Think of a place that’s really perfect.

Your own happy place.

Go there, and all your anger will just disappear.

Then putt.”        Happy Gilmore, 1996

I don’t know if I have ever heard my radiation therapists say this to a patient, anxious on the treatment table, “Go to your happy place.”  I think I may have imagined that they say this, because I remember thinking it might help, and also remember thinking to myself, at various times in the past, “I don’t have a happy place.”  And I didn’t, until a year ago when I finally took the trip to Africa that I had wanted to take my whole life.

I was a child obsessed with animals—all animals, but especially elephants and lions. I learned in school that elephants were like us–they lived long, they loved, and they mourned their dead.  By the time I was ten I had seen the movie HATARI! (Swahili for “DANGER!”) five times, and the only song I ever learned on the piano that I can still play, besides the ubiquitous Fur Elise stamped in the far recesses of my brain, is the Baby Elephant Walk. Born Free came a few years later, and I wept with joy over the story of Elsa. By the time I got to college, I had read Beryl Markham’s biography, West With The Wind, George Schaller’s The Serengeti Lion and after that came Isak Dinesen’s Out of Africa, and all of Hemingway.  In 1984 I was swept off my feet by the Robert Redford/Meryl Streep movie version of Dinesen’s book, and in 1993, imagining myself to be a latter day Beryl Markham, I gave myself a flying lesson for my fortieth birthday.  Unfortunately I chose to do this in gusty winds in Aspen Colorado in the middle of the winter—needless to say it was my first and last attempt at becoming an aviatrix.

We all have our romantic notions of where and who and what we want to be when we grow up, but life gets in the way.  In my case, “life” was three kids and a highly specialized career which did not lend itself to the African bush. But just over a year ago, fortune smiled on me and the constellation of circumstances necessary to make a trip to Tanzania suddenly came together—the time off work, the housesitter (my daughter) for my dogs, cat and horses, and the delusion that I could sell my Corvette, purchased by me for my own fiftieth birthday nine years prior, in the middle of a recession to make the trip affordable.  Armed with binoculars, a new camera, sun proof clothing, DEET 30% and malaria pills, off we went.

I think that it is a rare thing in life when one’s expectations are not only met, but exceeded.  This was my experience in Tanzania, from New Year’s Eve spent looking out over the Great Rift Valley, to seeing the famous “tree lions” in Lake Manyara National Park, to the early morning game drives as the sun rose over the Serengeti plain, to the old bull elephant, long tusks still intact and unharmed for over sixty years, lumbering across the floor of the Ngorongoro Crater.  We had a full moon rising over Mt. Kilimanjaro on our last night in Arusha, temporarily blotting out the light from the Southern Cross.  The air was clear and smelled of hibiscus and I knew, unequivocally, that this was my happy place.

I am pretty certain that with my family history, one day I will find myself lying on the treatment table awaiting my radiation, nervous despite my years of experience on the giving and not the receiving end of this specialty.  If my therapist smiles and says, “Relax, go to your happy place—this will be over in just a few minutes”, I will know exactly where to spend the next 15 minutes, among the zebra and the wildebeest kneeling beside the crater lake, the song of a thousand flamingos softly taking wing ringing in my ear. And if that fails me, there is still a shiny red Corvette to drive home.  Happy places, indeed.

No I Could Not Write a Book

Since I’ve been writing this blog, quite a few people have said to me, “You should write a book!”  Let me be clear in my self-assessment—first of all, I don’t have the attention span these days to write a book.  A novel has a plot, well developed characters, a beginning, a middle and an ending.  I’m not sure but I have a feeling that most good fiction writers have a clear idea of the story they want to tell before they start writing.  “But wait”, you say. “You should write a nonfictional account of your work—a true cancer doctor story.” This territory has been covered, most famously by Jerome Groopman who wrote The Measure of our Days, which became the inspiration for the television show Gideon’s Crossing.  How about a history of cancer itself?  Again, already taken in the most definitive way imaginable—I give you The Emperor of All Maladies by Siddhartha Mukherjee.  Of course, the books that scare me the most are the ones by cancer doctors who actually GET cancer and there are several of those out there too—consider I Signed as a Doctor by Laura Liberman whose title refers to the fact that when she had to sign consent for her own cancer treatment, she signed on the wrong line—the doctor’s space.  Call me superstitious but I don’t want to tempt fate.

Why do so many physicians feel compelled to write?  Ethan Canin (Carry Me Across the Water, America America) graduated from Harvard Medical School and actually practiced medicine for several years until the publication of his third novel allowed him to write full time.  He now teaches on the faculty of the Iowa Writer’s Workshop, and has been quoted as saying that “everyone has an expressive urge, but it’s particularly pronounced among those who practice medicine.”  He goes on to say, “It’s like being a soldier—you’ve seen great and terrible things.”  I don’t think being a doctor is like being a soldier because our lives are not typically in danger (although ER doctors in inner city hospitals might argue that point!)  I think of it more as a compulsion to “bear witness,” Ancient Mariner-style.  We spend much of our days writing down histories, and many of those histories give a small glimpse into the essence of what makes us human, and what gives us courage and hope.  There is nothing like a serious illness to separate the wheat from the chaff of life.

I was an English major in college, and though I will never be a John Keats or a William Carlos Williams-two of my physician-poet idols, I will never regret the time I spent reading their works, or the great works of Shakespeare and Milton and Hemingway and all the others. I may have been a bit behind in the basic sciences but that path of study gave me the tools to actually listen to my patients, to interpret what they are saying, and in turn, to be able to write down their stories.  I don’t have a major new novel swirling around in the back of my head, so for now I’ll just continue with these little vignettes.  And I would really appreciate it if my friends and readers would send me some of their own stories.  Who knows—there might be a blockbuster movie in there somewhere.  If not, there’s always law school!