Another Thanksgiving

Every year when the time changes and the days get shorter and the nights longer, I start to feel it.   By the time that the halls are decked with boughs of holly, now shortly before Thanksgiving, the season of airport delays, of frantic last minute shopping, of eating and drinking too much and then doing it again has begun, and with it, for many, the season of sadness.  At a time when festivities and noise are ramping up in the outside world, the Cancer Center becomes curiously still and quiet.

No one wants to get chemotherapy and radiation for Christmas.  It is far easier to ignore that lump or bump or missed mammogram than it is to schedule one more thing—a doctor’s appointment—when there are trips to take, family to visit and cookies to bake. And for those who have been recently diagnosed, it is rare that the treatment can’t wait a few weeks, just until “after the holidays.”  Although the “C” word strikes terror into our hearts, most of the time cancer truly is not an emergency.  This time of year, lunch breaks actually appear on my schedule, and the therapists cheerfully ring me up promptly at five to check the localization films for the day.

It isn’t hard to squeeze a new patient in this time of year, but when I get asked to do so, there is a very good chance that that patient is a little bit sicker, a little bit more symptomatic, a little bit more urgent and oftentimes a little bit younger than the average patient that I see though out the rest of the year.  Especially if that patient is hospitalized. Every year, there is someone—a husband, a wife, a child, a brother—who won’t be home for the holidays.

And so tomorrow, when you raise your glass around the Thanksgiving table, and give thanks for all of the blessings you have, do not forget to give thanks for your good health and that of your family, if you are lucky enough to have it.  And send out a prayer, or a positive thought, or an email or card to those who have not been so lucky.   It will mean the world to them.   Nobody wants cancer for Christmas.

Cold Roast Beef

Just when you thought I had finished talking about Thanksgiving, here it is again. A few weeks ago, between patients, I was catching up with other physicians’ blogs. Yes, readers, I have discovered that I am not the only one, nor am I the most articulate or humorous or erudite MD to put fingers to keyboard. Some of my fellow writers are very very good, and when I can figure out to get a blog roll going on the sidelines of my page, I will share their sites with you. Anyway, I came across an essay by a medical student where she thanked her cadaver for allowing her to learn by his donation of his body “to science.” For those of you who don’t know what happens when one donates one’s body to science, I can tell you that most of the time the final resting place is the medical school anatomy lab. Here the alpha of gross anatomy is the human upper arm, where the ropey bundle of nerves which makes up the brachial plexus is dissected free in order for the student to understand the complexity of how we use that delicate instrument, the human hand. The omega, or the last body part dissected, is the brain.

 
So the thing about her essay which really struck me, besides her sincerity, was one sentence, paraphrased here—“I don’t think I’ll ever eat roast beef again.” That one line took me right back to medical school and my own gross anatomy lab where I too dissected a human being, thirty seven years ago. Back in those days, before the Health Information Privacy laws of 1996 gave us the right to keep sensitive health issues anonymous and long before we willingly gave up that right by broadcasting every sniffle and sneeze on Facebook, cadavers were actually sent to the anatomy lab still wearing their hospital bracelets. My man’s last name shall remain with me, but his first name was Herman and I even knew his birthday. Before you exclaim, “How AWFUL!” think about it. To me and the preceptor and the three other members of my team, this man was not just a body to be dissected—he had been a living breathing human named Herman who had thought enough of the process of training young doctors to give us himself—all of him. It was personal.

 
In death, the body gives up all of its secrets. Herman gave me my first experience of seeing cancer from the inside out. He died of lung cancer, and his lungs were full of tumors, as were his liver, his bones and even the soft tissues of the muscles of his body. We dissected and discussed our findings during the long days, reeking of formaldehyde. Gradually through the course of a semester, I discovered the evil and relentless nature of his disease. One night after anatomy lab I dreamed that I took him home with me. I laid him down on my living room couch. He did not talk; he did not move. He was just there, with flesh the color of old roast beef. The dream was very real and I woke up half expecting to walk into my living room and see him there on the couch. It was years before I could eat roast beef again.

 
Three years ago at Thanksgiving, I decided that I would cook a whole beef tenderloin, in addition to having the traditional turkey. After all, I’m a carnivorous Texan and red meat is not that bad for you if you don’t eat it all the time. This year, with a twenty five pound turkey, a four pound beef tenderloin and only nine people to feed, we had lots of leftovers. As I loaded a plate with sliced beef, done to a perfect medium rare, I had a transient moment of discomfort, a slight sensation of nausea, and a very brief flashback to Herman and anatomy lab. Next year, perhaps I will do a lasagna, or a nice fettucine alfredo instead!

Thanksgiving

Thirty two years ago, I had something to prove.  I was recently married, and so, in fact, I had a lot to prove.  First of all, that I could actually cook a turkey.  I had never cooked a turkey, but I was good at following directions.  I got advice from my “Nana”, Grandma Jenny Silver.  She said, “First you have to wash the turkey inside and out.  Then use a knife to scrape the skin—those guys who butcher the turkey—they know NOTHING!  They always leave some feathers and quills and you have to get them out.  Then cut an onion in half and put the onion, and a few peeled carrots, a few celery sticks and a clove of garlic inside the turkey.  Rub salt, pepper, and a little bit of paprika on the skin.  Refrigerate overnight.  And THEN you will have a very tasty turkey.”  The turkey was perfect.

I had something else to prove—that I could make a family out of my disjointed, dysfunctional relatives.  I was the second wife, and my husband’s first marriage had failed.  My new in-laws were not convinced that I could make a go of it.  My parents lived 2,000 miles away.  My grandparents were in their eighties and in failing health.  It did not look promising, but I was determined.  In my 1200 square foot house in Sherborn Massachusetts, with its tiny dining room that could seat six comfortably, eight under duress, I cooked that turkey and assembled the relatives.  The dinner was a success. Everyone got along, and I masqueraded as a gracious hostess, aided and abetted by a bottle of Wild Turkey mixed with Coca Cola, a gift from my somewhat anxious husband.  I considered it a prelude to having a real family, a house full of kids and laughter and dogs that I could call my own.

I cooked those turkeys for the next 30 years, and amazingly, most of the time, everyone showed up—kids, dogs, girlfriends, boyfriends, cousins, aunts, uncles and inlaws.  But somewhere around the thirtieth Thanksgiving, I started to get tired.  The huge turkey, the stuffing cooked ahead of time, the endless pulling of a heavy bird out of the oven to baste, and assess, and replace—the awful green bean casserole and the gooey marshmallows on top of the pureed sweet potatoes—over the years it became less a labor of love, than just– a labor.  Driving home from work one evening three years ago, I saw a sign in the big picture window at Brett’s Bar B Que—“GET YOUR THANKSGIVING TURKEY HERE”.  I thought, “Hmmmmm, maybe next year.”   Two years ago, I ordered a cooked turkey from Brett’s ahead of time.  It was perfect.  Last year I did the same.  I had nearly twenty people at my house.  For the first time ever, we couldn’t all sit at the same table.  And my dining table is huge— it seats 14 people easily.  I cooked everything else, including a perfect beef tenderloin.  I am a meat eater, and while everyone lapsed into a turkey stupor, I was happy with my roast beef.  I ate standing up, and vowed never to do it again.

My fantasy last year was “next year in Santa Fe.”  I had visions of Thanksgiving dinner prepared for me at the Inn of the Anasazi, eaten leisurely in front of a pinon wood fire, dishes cleared and washed by someone else, well aged Scotch after dinner followed by a deep sleep under a down duvet in front of the kiva fireplace, Navajo rugs on the floor, a dream catcher hanging in the doorway.  I would get hotel rooms for the kids and their respective significant others, and for my closest friends and relatives, should they choose to join us.  A reliable house sitter would be at home, caring for my dogs, cats and horses.  Friday would be spent leisurely visiting the pueblos, touring the old churches and the quaint shops filled with scented candles and silver and turquoise.  Yes, that would be just the thing for Thanksgiving.  It would be perfect.

Tonight my daughter baked brownies and carrot cake. In the morning, I’ll start my side dishes and marinate the beef tenderloin.  I’ll roast beets for the salad, and cook bacon to go with the sautéed brussel sprouts that I’ll top with bread crumbs and parmesan cheese.  The turkey, cooked by Brett, will be tender and tasty.  My family is all here, and my best friends are coming to dinner.  I will set the table, worry about the china and silver and the wine, and end the day exhausted.  And I will be very very thankful for all that I have.  Santa Fe is a fantasy, but right here, right now is just fine.

But have I mentioned that I want to spend my sixtieth birthday, in thirteen months, December 2013, at the Ngorongoro Crater Lodge in Tanzania?  One can always dream…..

Just Call Me The Grinch

I don’t get it.  Today as I was getting off the freeway, I passed a local farm stand that had just put up a big sign:  “Get Your Christmas Trees Here!”   And there they were, lined up like little soldiers, the beautiful Scotch pines, and Douglas firs, and balsams. How will they even last the five weeks until Christmas?  We haven’t yet had the food orgy we call Thanksgiving, but television ads for “Black Friday” already abound.  Does anyone else besides me want their holidays one at a time?  I’m still basking in a sugar coated candy corn stupor from Halloween.  Please let me enjoy my family, all gathered for Thanksgiving, before I have to think about braving the malls for glad tidings and gift buying.

The root of my problem– my crabbiness– (and after all, this IS the Crab Diaries) here is not Thanksgiving, or Christmas, or the shopping days in between.  It is my patients.  As the holiday season approaches, the pain and suffering of my patients seems to increase. This is a phenomenon that I have observed year after year.  At a time of year when a radiation therapy department, or an oncology chemotherapy infusion center would be—ideally—empty, we are bursting at the seams.  Why?  Because only the sickest of the sick will forego the holidays with their families and come in to the emergency room, the surgery center, the radiation therapy department or the infusion center for treatment.  The rest, the less acutely ill, will put off their biopsies, surgeries, chemotherapy and radiation until “after the holidays”.  As well they should.  Very little in cancer management is actually an emergency.

Those who know me will hopefully attest to the fact that I am not the “preachy” type.  But when I see the holiday excesses already beginning, in the form of a big sign advertising Christmas trees before the turkey is stuffed and the gravy is set on the table, I have to step up for those who will not be sitting at the table, or around the Christmas tree this holiday season.  If you know someone who has battled cancer this year, send extra thoughts, prayers and cards their way. Visit them, call them, text them—just let them know that you care.  And if you and your family are in good health, give extra thanks and may it always be so.

My birthday is in December.  I hate it—having a birthday five days before Christmas.  Those of you with December birthdays know exactly what I am talking about.  But every year since 1984, the year my daughter was born, I do see those candles on my cake as an opportunity, the magical opportunity for a birthday wish as I blow out the candles on December twentieth.  Every year, I wish for the same thing—I wish for the good health of the people I love.  I hope you all wish for the same thing for Christmas this year—truly, there is no greater gift.

A Dog Story

I am not in the habit of writing obituaries for dogs.  But some things you just can’t let go of.  Maybe it is because Thanksgiving is approaching, and Thanksgiving four years ago was the start of all this dog’s troubles, or maybe it’s just that the shorter days and longer nights give cause for contemplation, but today I am going to tell you a dog story.

In May of 2002, we lost our big male deerhound Timber quite suddenly.  He was found to have a rare cancer, a hemangiosarcoma, that arose from the left atrium of his heart, and his demise was swift and completely unexpected.  Although we had three other deerhounds at the time, I’ve never liked odd numbers and so I contacted a breeder/friend in Oregon and two months later we brought home Izzy, a four month old fuzzy gray puppy, who looked, with his proportionately small head, dark eyes, black nose and huge legs and feet, like nothing more than a gray lamb. The three adult deerhound females of the house, not to mention me and my teenaged daughter, doted on him.  Izzy grew up as the “man” of the dog yard and took his responsibilities seriously.  He kept everyone in line, and helped raise six puppies over the subsequent 10 years—two for his breeder back in Oregon when he went back there to be shown, and two more sibling pairs for me.  You don’t need to do a lot of obedience work when you’ve got a smart older dog showing the “young ‘uns” what to do.  He finished his championship easily at age two, got a beginning lure coursing title (although speed was not his forte) and then retired to do what he did best, guard the house, watch out for the kids, and keep the rest of us in line.  I’ll never forget how, one night on our “evening patrol”, he frightened a peeping Tom who was staring into my daughter’s bathroom window.  My screaming and his furious barking roused my teenaged son, who ran outside with his huge hunting knife ready to defend us.  He needn’t have bothered—one look at a giant hairy dog weighing well over 100 pounds was enough to ensure a quick flight over the fence for our unwanted guest.

Thanksgiving being what it is, we all overindulged four years ago and so when Izzy appeared to be having difficulty moving his bowels after the holiday, I chalked it up to dietary indiscretions until it became clear that something was dreadfully wrong.  Off he went to the vet, where sedation was administered and an enema was performed, revealing that the dog had developed perineal hernias which had weakened the pelvic floor to the extent that he could not perform his usual “duty.”  As the vet techs were getting him off the table, however, an accident occurred and they managed to dislocate this dog’s heretofore perfectly normal left hip.  Four anesthesias–a CT scan, two closed reductions and one open reduction/internal fixation which took six hours– later, I brought my big crippled dog home, still with the unsolved problem I brought him in with.  Twelve weeks after that, he had recovered from his hip repair sufficiently to undergo repairs of the perineal hernias, another complicated and painful surgery.  In between, I contemplated putting the big guy to sleep, but he was only six years old.  My veterinary surgeon came to the house and said, “This dog wants to LIVE.”

And live he did, quite happily, for another four and a half years, until we finally “did the deed” due to recurrent hernias.  Although he never fully regained his mobility, he loved to play with the new puppies I bought three months after his surgery, bounding after them with his awkward gait and lying belly up in the horse pasture while the puppies “attacked” him.  He never showed us how much pain he felt and he never met a stranger he didn’t like (as long as they came through the door, and not over the fence!) On the day we killed him he greeted his veterinarian with a wagging tail, to the point where my husband nearly backed out of the planned euthanasia.  This dog enjoyed life to the fullest, despite his significant and many disabilities.  This dog wanted to live.

I think often about my friends and colleagues who will not allow their children to have a dog—I’ve heard all the excuses—allergies, too much work, not enough space, too limiting in terms of travel.  I think they are wrong, and I am obnoxiously vocal in my judgment of them.  I think that our dogs teach us so much about cheerfulness, stoicism, willingness to play–even as adults, acceptance, love, loyalty and compassion.  I hope that when I am old and infirm I will bear the burdens of age and disability with as much dignity as my Izzy did.  But I sincerely doubt that it is “humanly” possible. We love all our animals, but some take a giant piece of our heart when they go.  Happy Thanksgiving Izzy.  We miss you.