Ring Out The Old

Ring out, wild bells, to the wild sky,

The flying cloud, the frosty light:

The year is dying in the night;

Ring out, wild bells, and let him die.

Ring out the old, ring in the new,

Ring, happy bells, across the snow:

The year is going, let him go;

Ring out the false, ring in the true.

Ring out the grief that saps the mind

For those that here we see no more;

Ring out the feud of rich and poor,

Ring in redress to all mankind.

Ring out a slowly dying cause,

And ancient forms of party strife;

Ring in the nobler modes of life,

With sweeter manners, purer laws.

Ring out the want, the care, the sin,

The faithless coldness of the times;

Ring out, ring out my mournful rhymes

But ring the fuller minstrel in.

Ring out false pride in place and blood,

The civic slander and the spite;

Ring in the love of truth and right,

Ring in the common love of good.

Ring out old shapes of foul disease;

Ring out the narrowing lust of gold;

Ring out the thousand wars of old,

Ring in the thousand years of peace.

Ring in the valiant man and free,

The larger heart, the kindlier hand;

Ring out the darkness of the land,

Ring in the Christ that is to be.

Alfred Lord Tennyson, In Memoriam



As an aficionado off all things Scottish, it is ever so tempting to quote Robert Burns’ “Auld Lang Syne” tonight, especially when I remember that poignant scene from “Out of Africa” where Baroness Blixen, aka Isak Dinesen, realizes on a fateful New Year’s Eve that she is no longer in love with her husband, but with the handsome and unattainable Denys Finch Hatton.  But as always, I tend to wander from the main theme of tonight, which is a theme of thankfulness.

To all of my friends and family who kept me somewhat sane during this difficult past year, much of which I have shared with you on this blog, I say “Thank you.”  To all of the readers whom I’ve never met but who put up with my quirky musings on cancer, family, dogs, cats, horses and life in general, I am ever so grateful for your encouragement.  Next year I hope to continue to inform you, to make you laugh and cry and above all, to make you wish that you, like Baroness Blixen, had a Scottish Deerhound, or two, or perhaps even three.

As a radiation oncologist, it’s been a very long time since I took call on New Year’s Eve. I am at home tonight, with a nice glass of wine in hand, getting ready to cook dinner and watch the last few episodes of “Breaking Bad” on Netflix—a little sadly because I don’t think everything is going to turn out all right in the end, and I for one thrive on happy endings.  But before I sign off on 2013, I want to thank the good people who are out there “in the field” tonight, taking care of the rest of us across the country and abroad—the ER doctors and trauma surgeons, the nurses in the emergency rooms and in the ICUs, the firefighters and paramedics and police officers who are all vigilant and on high alert tonight, and of course, our armed forces at home and far away.  I wish you all a Happy, Healthy New Year.  Live long and prosper, and stay safe out there!  With gratitude, Miranda.

The Leaky Roof

In this dry Southwestern part of the United States, there are only two seasons:  fire season and rainy season.  Fire season will end in another month, hopefully without further casualties or homes lost. The rainy season will start, such as it is.  Here we average 9 inches of rain a year, and we are perpetually unprepared.  The roads, slick with oil from a summer of busy vacationers’ rental cars, become virtual “Slip ‘N Slide” games for unsuspecting drivers who, not used to navigating in “weather”, hit their brakes hard and the famous freeway pile ups begin.

My small radiation therapy department was designed to give patients a sense of quietude and peace.  From the laminate flooring which absorbs sound, to the Japanese vases on the hall tables, to the landscape photographs which line the walls, each element was chosen to calm the anxious spirit of the newly diagnosed cancer patient.  Most of the department’s day to day functions take place on the second floor of the building, where offices and exam rooms and our consultation area are simple, functional and comfortable.   To get treatment however, the patients must descend down a floor to the “vault”, since the shielding of a linear accelerator cannot be retrofitted easily to an existing space.  Even the elevator down is “Zen”, wood paneled and carpeted, moving slowly and unjarringly to the lower level where the patient receives the radiation.  When the patients exit the elevator, they enter a sun filled anteroom, then walk down a ramp into a large well lit room with a state of the art linear accelerator.  The walls of the anteroom and the ramp are furnished with spectacular photographs of Bryce National Park, taken by a well known landscape photographer, who also happens to be a radiation oncologist, who is still working as such despite his beloved avocation of landscape photography because he is still paying the legal bills of his daughter, who famously refused to dry clean a certain blue dress, lest she be called a liar by those who sought to protect a President.

Our “vault” was an “add-on” to the building in 2008.  As such, there is a junction between the vault structure and the building itself.  Shortly after we opened in October of 2008, we realized that the roof was leaking precisely at that junction.  By November, mornings after a big rainstorm, we would exit the elevator into a large puddle.  By January, the puddle had become a river, flowing down the ramp towards $2.5 million worth of equipment.  This was not good.  We complained, and the builders of the “vault” did their best to seal the leak, to no avail.  The university got involved—after all, it was THEIR building.  A lawsuit ensued.  Meanwhile, we solved the problem by stationing a large gray rubber garbage can directly outside the elevator, lined with sheets of plastic which ascend to the ceiling and disappear behind the ceiling tiles.  Now, when it rains, the garbage can fills up.  It is the duty of the maintenance man to empty the garbage can every morning during our season of rain.

Somehow, our garbage can and plastic sheeting do not fit with the “esthetic” of our very Zen-like department.  But like anything else in a landscape viewed daily, they have become mundane, ordinary and invisible to our therapists, and even our patients once they’ve had those first few treatments, when the whole process is new and very frightening.  Four rainy seasons have come and gone, and at last report, the litigation has been “continued” until next spring.  Meanwhile, I fantasize that my department is an anchored antediluvian world where wickedness will soon be washed away by the great flood of floods.  I imagine myself as Noah, and reluctantly consider an ark (while replaying in my mind the great Bill Cosby routine where God asks a recalcitrant Noah, “NOAH….How long can YOU tread water?”).  If the waters breach the top of that garbage can, millions of dollars of equipment will be ruined, and our department will close until the damage is repaired and a new linac installed and commissioned.

How many University bureaucrats does it take to fix a leaky roof?  You tell me!