Father’s Day

My father finds it hard to believe that he has a sixty one year old daughter.  I find it hard to believe I have a nearly ninety year old father.  I almost didn’t, which is story behind the scarcity of Crab Diaries blogs in the last two months.  If cats have nine lives, Dad must have ten or eleven.  The ninth life flashed before my eyes on April twentieth.

I have a “spiel” for the side effects and late effects of radiation therapy for every disease site. One of the late effects of radiation for abdominal malignancies is the risk of a small bowel obstruction months to years after the treatment.  My little speech goes something like this:  “Every patient who has ever had abdominal surgery, even for benign disease, is at risk for a bowel obstruction at some point later in their lives.  Scar tissue forms adhesions which restrict the bowel—if you’ve had cancer surgery, or an appendectomy, or even, like me, a C-section or two or three—you are at risk.  Radiation increases that risk, but if you recognize the symptoms early, and get treatment, there is a high likelihood that you can avoid surgery.  So if you ever have a period where you are experiencing abdominal distention, and realize that you are not passing gas, and start to feel nauseated, get thee to an emergency room for quick diagnosis and treatment.”

Apparently Dad didn’t get the memo.  In 2004, my mother called me late one evening to report that Dad had been in a car accident.  After running a red light, he was broadsided and found himself in the passenger seat when he should have been driving.  No, he was not wearing a seat belt.  He was taken to the emergency room of the hospital where he practiced, and was found to have a pelvic fracture, but he was “fine” and not to worry.  At his insistence, his colleague, the Chief of Plastic Surgery was called in and pronounced him fit to leave the hospital.  At four am, I got a second call from Mom, asking me “What does it mean that he got up to leave to go home and promptly fainted.”  It meant a ruptured spleen and I told her so.  A few hours and a splenectomy later, all was well– until April.

Dad woke up feeling a little queasy on a Friday after a lovely trip to Phoenix a few days earlier.  The feeling persisted and overnight the symptoms progressed, but being the stoic and ever in denial physician that he is, he knew that the food poisoning or virus would soon be over and he would be back to normal.  But when he described his symptoms to his primary care doctor nearly 30 hours later, she sent him to the nearest emergency room.  By the time I was able to get back to San Diego, he had perforated his obstructed bowel and was headed into surgery, two years after his second open heart surgery and one year after hip replacement, two months shy of his ninetieth birthday.  Surgeons are different from normal people.  At a time when I would have had my arm out for a shot of morphine and hospice, he said simply, “Let’s go for it.”   Six and a half hours later, minus eighteen inches of small bowel, he was brought to the ICU where I was asked, as his next of kin and medical power of attorney, what his code status was.  You know the answer. Despite all of my previous prejudices against family members who refused to acknowledge the obvious—that 90 year olds have to die sometime, he was a “full code.”

Dad is back home now in his own apartment, feeling a bit tired but generally speaking no worse for the wear.  Despite the fact that my sister and I were at his bedside continuously for a month, when he returned home, he sent a long email to all of his friends describing his ordeal and thanking his girlfriend Evelyne for her devotion to his care.  His daughters were cc’d on the email.  After a serious bout of righteous indignation, I reminded myself that patients NEVER remember their time in the intensive care unit, and that is a VERY good thing.  The entire family will be headed to California in ten days for his big 90 birthday, and we couldn’t be more thrilled.

Happy Father’s Day, Dad, and we sincerely hope there will be many more.  Your loving daughter—M.

For Once, Then, Something

As I was leaving for Boston, I asked if anyone would care to contribute to this blog.  I am still processing the wonderful things that friends and family have sent me.  This one is from my husband.

One drop fell from a fern, and lo, a ripple
Shook whatever it was lay there at bottom,
Blurred it, blotted it out. What was that whiteness?
Truth? A pebble of quartz? For once, then, something.    Robert Frost

Our daughter is in the last year of medical school and is having a hard time deciding what career path to take. She has applied for a residency program in internal medicine, but a recent experience with her grandfather in Africa where she was able to assist in the surgical repair of a variety of physical deformities has made her wonder if a career in surgery might be a better fit.

Choosing a career is a really big deal. Since most of us have to live with the choice – good or bad – for much of our adult lives, it’s a decision not to be taken lightly. This is particularly true in medicine, where the training is long and arduous, and by its very nature is not something you want to repeat again should your first career choice not work out. Yet, there aren’t many “how to” books written on the subject, and few of us feel comfortable directing someone else along a career path that might not work out for them. So, what advice – if any – might I give my daughter?

Based mostly on personal experience and some library research I performed as an undergraduate, I suspect that many of us choose a career based on a “gut” feel. Sometimes a career just feels right. Perhaps it’s the intangibles or maybe just good fortune. I know in my case it was a little of both.

My daughter recently asked me how it was that I ended up being a pulmonary physician. The question brought to mind how many different career paths I actually explored along the way. Once, I wanted to be a psychiatrist. This was at the beginning of medical school when I was fresh from spending endless hours listening to the sometimes neurotic musing of my college friends. Hey, this was interesting and could be fun, particularly if you’re getting paid for it. So, I picked psychiatry for my first elective rotation in med school, and saw what real mental illness is like. One of my patients was a teenage girl, who seemed outwardly normal, but confided in me that she had had an immaculate conception and was going to deliver the Lord’s baby. When I asked the attending psychiatrist if there was a pill for this, he looked at me like I was the crazy one. Psychiatry was definitely not my cup of tea.

Then, I looked into neurosurgery. As an undergraduate, I did an essay on a famous neurosurgeon named Harvey Cushing. An amazingly gifted physician whose written descriptions of his patients – complete with very accurate sketches – can be found to this day on display at Mass General Hospital. It would be great to have a career like Cushing, so I signed up for a neurosurgery rotation. But, this didn’t appeal to me either. The patients didn’t improve very often, and perhaps equally as important, I just couldn’t identify with the attending neurosurgeons who didn’t appear to be as interesting as I imagined Harvey Cushing to be.

So, like my daughter I applied for an internship in internal medicine. From an intellectual point of view, this seemed like a good fit, and I did identify with the attending physicians who seemed smart and articulate. But, there are so many specialties of internal medicine; I really wasn’t sure which to choose. Then, something happened. I was reading up on a patient with an unusual lung infection when I came across an article called “In Defense of the Lung” by a physician named Gareth Green. It described the complex interplay of factors that protect the lungs from infection, and how someday it might be possible to modify lung defenses to help susceptible people actually resist pneumonia. Something about this notion resonated with me, and for the next two decades the interface of infectious disease and pulmonary medicine was my career focus.

Some people find themselves in the career they always imagined for themselves, but I wonder if this is a good thing or not. Did they get a chance to explore how other career paths might have worked out? Were they willing to experiment and take a few chances along the way? As I say, I don’t know if this is a good thing or not. It may be much easier to pick something and stick to it, like my wife has. And in her case, it has been a remarkably rewarding approach. But, I can’t help wishing that my daughter would keep an open mind about opportunities that might come along in medicine or in surgery or in some other branch of medicine. Once this happens, then it could well be that something unexpected and great will be in store for her. I hope so.