On The Road Again

On the road again
Goin’ places that I’ve never been
Seein’ things that I may never see again,
And I can’t wait to get on the road again.  Willie Nelson

 

If someone had told me even ten years ago that I would retire young and become an itinerant radiation oncologist I would have thought he had lost his mind.  As the career medical director of community based cancer centers, I was used to running the show.  And as the saying goes, I ran a “tight ship.”  Consultations were performed and documented in a timely fashion, day of the request if the situation was urgent, or within a few days if not.  The patients were given time to think about their treatment, but simulations could be done the same day as the consultation, or as soon as the patient agreed to treatment, and the new start times were never more than a week away. Patients were seen every week, or more frequently if needed.  I had the best team of radiation therapists, physicists, nurses and front office people that anyone could ever ask for.  But in early 2014, I like to say I retired.  But the truth is, I quit.

Articles about physician burnout are legion, and I have avoided adding to that literature in this blog. The truth of the matter is that we, as radiation oncologists, are a very privileged group.  We are privy to the most intimate details of our patients’ lives; we practice in a highly technical and ever changing environment which challenges us to be constant and consistent learners; our hours are regular and we are very well paid as a medical specialty.  And most importantly, we cure cancer.  What could be better?  But after thirty years in the field, I was tired.  2013 was a terrible year for me—in December of 2012 I lost a close friend, Catherine, and then my little dog Jack, and then in January my mother, and shortly after that my work partner Dr. William Spanos, the best colleague and friend a physician could ever hope for.  And in between, some very beloved patients who I had followed and treated for years.  I was done.

But a calling is a calling, and somehow, between the enchanted mountains of New Mexico and the healing hours spent on horseback and with my dogs, and the otherworldly sunsets and the pleasures of growing a vegetable garden, I needed to get back to doing what I do best—helping cancer patients.  So here I am, a “locum tenens” radiation oncologist, working for an agency, going where I am needed, for a few days, or a few weeks at a time.  On Sunday night I “saddled up” the old Suburban and headed to Las Cruces, NM to provide a little relief to the solo practitioner stationed there.

Today I saw an elderly woman who had just been diagnosed with locally advanced and metastatic lung cancer.  Despite the effects of her disease—weight loss, shortness of breath and pain—I could see that she had been and still is a beautiful woman.  I can’t cure her—no one can.  But I could promise her that I could make her breathing a little easier, and relieve the painful metastases in her lumbar spine. As I sat with the patient and her husband, I knew with certainty that I no longer had to be “in charge” or command my own practice.  I knew that I could help her.  And I knew, beyond question, that I had begun to love my profession again. For that I am very grateful.

It’s Been Awhile

Back in late September, my friends asked me if I was worried about the upcoming move to New Mexico.  I replied, no, it would be a piece of cake compared to my earlier cross country move from Boston to California.  After all, in 1993, I said goodbye to our babysitter of nine years and packed up three kids, a dog and a cat to move to a city where I did not know a single soul.  I will never forget walking into the principal’s office at our new elementary school, filling out the registration forms, and realizing that for the first time ever in my life, I had not a single name to fill in the blank space which said “Who to contact in case of an emergency.”  I was starting from scratch.

As it happens, I had seriously underestimated the effort required to detach from a home I lived in for seventeen years, from my accumulated belongings and from my youngest son and my elderly father, neither of whom desired to join me on my journey.  As sentimental as I am, it was impossible to merely throw things away—old photographs had to be examined and scanned, stuffed animals and dolls needed to be hugged one last time, old movie ticket stubs and playbills needed to reawaken memories before being tossed.  Each time I carried a large green trash bag out of the house, the closets, nooks and crannies seemed to refill themselves.  In the end, I ran out of time, and the movers packed what was left, which amounted to an entire moving van filled with our furniture, and over 300 boxes.  My culling was not very successful.

My biggest concern about the move itself was how my four dogs, especially elderly Magic in congestive heart failure, would handle the displacement, the two day 1,000 mile road trip and climb to 7000 feet in altitude, and the uncertainties of new territory.  As it turned out, the one that I worried about most surprised me with what appeared to be a new lease on life—clearly the cooler crisper mountain air seemed to rejuvenate him.  It was the little guy, Yoda, my tiny rescued Chihuahua-terrier mix that had some unexpected issues.

Yoda was picked up as a stray in Oakland, CA two years ago at Christmas time.  Starving and loaded with tapeworm, he jumped into the arms of a good Samaritan who stopped traffic on Fremont Avenue to pick him up. My veterinarian friend there made a search for an owner, but when none came forth she neutered him, wormed him and sent him down to me.  He quickly adjusted to life with the three jolly grey giants.  Playful and loving, he never met a soul he didn’t like and never caused us a moment of trouble–until the move.

For the first time ever, on arriving in New Mexico, Yoda suffered from severe separation anxiety.  When either my husband or I would leave the house, he would cry piteously and endlessly, despite the fact that the other of us was still there, along with his Scottish deerhound buddies. He was inconsolable. Amidst the doggy distress, fear and consternation, one thing became clear to me—at some point in his short life, he had been left behind.  And he did not want it to happen again.

Yoda has settled down now and he knows that if we leave the house we are coming back.  But his little trauma has left me with a New Year’s wish for us all:   Be brave!  Make a change.  Take a short trip, or a long journey, with your best friends and your family.  Yoda wants what we all want in our own way–to live, love and laugh—and never, ever to be left behind.   Happy New Year everyone!

Lighting Out For The Territory

“But I reckon I better light out for the Territory ahead of the rest, because Aunt Sally she’s going to adopt me and sivilize me and I can’t stand it.  I been there before.”

Mark Twain, Huckleberry Finn

 

While I wasn’t looking, someone snuck up behind me and bought my house.  Well, not exactly “bought” yet, but all contingencies are removed and the closing date is set for October 3.  This wasn’t supposed to happen.  My realtor told me that our place is “special”, a euphemism for “old run down house with wonderful horse facilities.” She said it might take a year to sell, and that the right buyer would come along—someone who wasn’t too house proud, but who wanted to “live the dream,” as I did seventeen years ago.  Someone who had always wanted a horse of her own and had waited a very long time to get one—or two or three or maybe even four.  Someone, in short, just like me.  And let’s face it folks—how many people are out there who are just like me?  Apparently quite a few.  The house sold in ten weeks for close to the asking price. And there are back up buyers, who just didn’t get back to see it for a second showing in time.

For seventeen years, I put off having friends and family visit. I had no dinner parties because we were embarrassed.  The house was a mess.  The carpet was old, and pet worn and smelly, the roof leaked, the kitchen was hideous, the “powder room” was a disgrace with orange and brown tiles left over from the 1970’s. But my children, my dogs and my horses were blissfully happy with the place.  It was home. When my friend Catherine passed away in late 2012, she left me a little bit of money, which I used wisely for a new paint job, new carpet and curtains, a stunning garage renovation (after all, it belongs to my dogs!), a bathroom facelift and some nice hardware for the newly painted cabinets in the kitchen.  Friends began to visit.  They said, “We love your place.”  As I walked around the vacuumed soft carpet and outside among the newly trimmed hedges, pruned eucalyptus, reseeded pastures and freshly dragged arena, I said to myself, “They are right.  I love this place.”

But there was sadness here for me as well—the tack room with photos of children long grown and horses long passed lining the walls, the empty bedrooms, and the dogs dearly departing, one by one.  And the cost of maintenance in drought stricken energy gridlocked southern California was a daily reminder of the fact that in March of this year, I retired from my full time job so that I could experience a little more life, and a little less death.  It was a good decision, and one I don’t regret, but a reduction in cost of living was a necessary corollary.  So the house went on the market, and here we are.  I need to find a place to live and I don’t have much time.  My youngest son, and eighty nine year old father are still here in San Diego, but I yearn for the open spaces and big skies of the west.  New Mexico, with its spectacular sunsets and mix of cultures has indeed been the Land of Enchantment for me.

It’s not clear yet, but I may, like Huck, be soon lighting out for the territories.  I hope you will all come and visit.  Wish me good luck!

Love, Loss and All That Remains

“Don’t ever tell anybody anything—if you do you start missing everybody.”  Holden Caulfield

From The Catcher In The Rye, by J.D. Salinger

I don’t know whether it’s fitting, or selfish that on this anniversary of the 9/11 terrorist attacks I was remembering my friend Catherine Doyle, who died last December 18.  I had gone into the local branch of Wells Fargo, to finally close out a couple of accounts we held jointly—as Catherine said, “In case you have to pay for my funeral.”  I don’t know why it took me so long—after the cremation, and the payment of the legal fees of the estate, there were only a few dollars left and it seemed like a lot of bother until the service fees started coming in.  As it turned out, I owed the bank $6.95.  Perhaps I expected that with time, I would not mind the finality of it.  Instead I found myself telling the bank teller the story of Catherine’s life, and much to her dismay, crying while I did it.  Some things just don’t get easier, and presenting a death certificate is one of them.

The annual Western Regional Scottish Deerhound Specialty was dedicated to Catherine this past July.  She had been a longstanding member of both the National and Regional deerhound clubs and it was important that we honor her service to the breed.  I gave a eulogy, and others spoke as well, and our comments are too lengthy and at this point, too foggy to reproduce here. But there is one thing that lingers in my head, and so, with apologies to those of you who were there, I will repeat myself here.

After Catherine died, her jeweler Barbara called me and said, “I have something of Catherine’s that you will want.”  She mailed me a plain gold wedding band, worn thin from use, that she thought had belonged to Catherine’s mother.  As it turned out, that was not the case.  Inside the old band was inscribed “F. J. Malone to Clara, 1917.” As I turned over the ring and read the inscription, it seemed as if I was suddenly flooded with images and snippets of conversation from the past, across two continents and two World Wars:  Franklin J. Malone, a young Irish soldier presenting this ring to his betrothed, Clara, in a hurried ceremony just before departing for the Continent to fight and perish in the trenches of World War I.  Clara Malone, pregnant with her only child Alice, poor, bereft and with no means of support, booking steerage to come to America to find work as a seamstress and a better life.  Alice Malone, growing up fatherless, marrying a military man, Pierce Doyle, whose blue eyes and strong jawline reminded her of the only photograph she had of her father.  Alice, alone and in labor at a military hospital stateside, giving birth to Catherine while her husband served his country until the bombs we dropped on Hiroshima and Nagasaki brought him home to his wife and only child.  Alice, Pierce and Catherine moving to New Mexico so that Pierce, now a high ranking Army officer, could oversee the nuclear test sites in the southern part of the state.  Catherine, smart, multilingual and witty going off to Barnard before a taxi cab hit her on the streets of New York, shattering her legs, and her dreams.  Catherine, coming home to New Mexico to live out her life in a place they had all grown to love.  And finally, Catherine in a photograph, imposing in her cape and tartans, holding a leash of deerhounds against a mountainous landscape of endless sky.

Sometimes, an act of war or terror changes the entire history of an individual, or a family, as it did for my friend Catherine’s grandmother Clara, and for the survivors of 9/11, and Iraq, and Afghanistan. I have nothing but the deepest respect for those who fought, those who rescued, and those who were left behind.  Someday, I hope that I hold that gold ring, and the fleeting images and fragmented conversations take the shape and form of a real story played out over the last hundred years.  And then, I will write that novel.