What I did for love

Last week a very special patient came to see me. I'll call her Angela (all names are changed for obvious reasons). Angela is 33 years old and 36 weeks pregnant with her first baby--a boy that she's named Michael. Two weeks ago she discovered a lump in each of her breasts. As she's pregnant, no x-rays or mammograms were done to protect unborn Baby Michael from radiation. She did however have an ultrasound and a biopsy of these breast lumps and was found to have breast cancer in each breast. She showed up for her appointment with her distraught husband, sister, and parents. We talked for over an hour and a half about her breast cancer and her treatment options. She had already decided to have a double mastectomy given the size of the tumors. She would also need several CT scans and radiologic tests to see if the cancer had spread beyond her breasts. But first, Baby Michael would have to be delivered to avoid exposure to anesthesia or radiation. Angela was calm and decisive through the entire meeting, but her husband and family were clearly fretful and anxious. So before the appointment ended, I told them about my friend Laurel.


I met Laurel in my first year out of residency. I was a young surgeon eager to apply my technical skills in the OR. The long hours and years spent in residency is very much focused on management of surgical diseases and honing of surgical proficiency. Laurel showed up one afternoon during a busy clinic with a red rash on and a 20 cm mass in her right breast. Her family doctor had prescribed an antifungal cream for the rash that didn't make it go away. She had something far worse than fungal skin infection. I did a biopsy of the mass and of the skin on her breast with the rash and scheduled her to come back to see me in 2 days for a discussion of the biopsy results. I told her to bring her family with her to that appointment as I thought that the results might reveal a cancer. I'll never forget how I squirmed in my chair as I told her these things, how I stumbled over my own clumsy words, how I hoped she couldn't tell how badly I was sweating. She seemed like such a nice person; and I simply didn't want to ruin her day with the spectre of breast cancer. And when the hell during residency were we taught how to compassionately deliver bad news?


Two days later I sat with Laurel, her husband, and 22 year old daughter in my office. The breast biopsy indeed showed a breast cancer. The skin biopsy revealed breast cancer cells in dermal lymph channels. She had inflammatory breast cancer, a rare but extremely aggressive type of breast cancer. Compared to non-inflammatory breast cancers, the survival rates are quite lower--in fact, they are dismal. She would start chemotherapy and radiation first. If she survived and the cancer shrunk, she would proceed with mastectomy.


Laurel's daughter was the first to cry. She didn't hold back any of her sadness. Soon everyone in the room was in tears including me. I cried for their grief, fear, and anguish. I cried because I wanted so much to help them, take away her cancer with one swift and dexterous operation but I couldn't. Before they left, Laurel asked if she could give me a hug. I thought, "Who hugs a surgeon? Do I look that pathetic crying that I need a hug even though she's the one with cancer?" I said, "Of course." She hugged me with her whole heart.

Over the next few months as she was getting chemotherapy then radiation, Laurel would stop by my office to see me. She insisted that she give a hug at the start and end of every visit. She also insisted that we address each other by our first names. Against everything I was taught to believe about being a medical professional, I found that to be comfortable and comforting. She told me about a book, "Love, Medicine, and Miracles" by a surgeon, Bernie Siegel. I read it and have re-read it several times. She told me how she changed her job--quit listening to people complain all day. She told me how she would visualize her immune system attacking and defeating her cancer. Rubbing her breast mass, she would say, "Laurel's white cells, do your thing!"

When her chemotherapy and radiation was finished, she came to my office for an "official " appointment. Though our meeting was scheduled, we still started with a hug and greeted each other by our first names. On examination, her breast mass had shrunk to a quarter of its original size. At 5 cm, it was still large but small enough to make a mastectomy possible. We talked about the operation including the dissection of her lymph nodes in her armpit. I wanted so badly for her to do well, but didn't want give her false hope because the prognosis of inflammatory breast cancer was so poor. She hugged me before heading off to do her pre-operative testing.

Laurel's operation went perfectly. She recovered quickly without complications. 3 days later her pathology report came back: Lymph nodes clear of cancer---excellent! No cancer found in the 5 cm breast mass---Wah! It couldn't be!! I called up the pathologist and made him review my biopsy result and do more sections of the mass. How could he miss a cancer in a mass the size of a small orange? How can there once be cancer and now none? He did more sections THREE more times (because I pestered him incessantly about it)...there was NO CANCER to be found. When I finally told Laurel of her results, I knew I had witness a miracle. The chemo docs high fived each other and claimed victory with their drugs. The radiation folks patted themselves on the back and marveled at the power of their radiation. I believe with my whole heart and the entire fund of my medical knowledge that Laurel cured her own cancer.

That was 8 years ago. Laurel is alive, happy, and cancer-free today. We send each other Christmas cards every year with updates on our lives. She told me I could tell anyone who had cancer about her story. I think about her alot and am so thankful to have the priviledge and honor to know her and have her friendship. She taught me that the most important part of my job was to give people hope and empower them to take control of their health. She taught me that the best part about my job was how much I could love and care for my patients.

So with her story, I hope that I passed on Laurel's hope and courage to Angela and her family. She has so much to live for: a new marriage, a new family, Baby Michael.

In a few days, I will go to court as a defendant in my first malpractice trial. It seems like business as usual for the lawyers and an opportunity to collect on more money for the plaintiff. I'm the only one who is taking it all so personally. I could've settled and walked away, but I felt that I had to fight for myself. I did nothing wrong and would defend myself in an imperfect judiciary system with the distinct chance of losing. I've thought about what I'm fighting for: my innocence? Justice? I'm fighting for the doctor I became after I met Laurel. I didn't want to become embittered by law suits. I didn't want to continue to be a doctor and be devoid of hope, caring, and love because I was so paranoid and hateful from this litigious environment.

Perhaps I'm being naive or overly idealistic about it, but I don't want to lose the person I was before this suit. That person is worth fighting for.

Fight

In 10 days I will be fighting for my life. Sheesh, that sounds a bit melodramatic! No, I don't have a terminal illness. Murderous barbarians are not hunting me down. The Fashion & Hygiene Nazi's don't have a warrant on me (why CAN'T I wear technical clothes all the time and not shower between workouts?!). No, I won't literally be fighting for my life, but I will have to be in that mindset for an upcoming ordeal where the outcome is someone wins and the other loses. I need to win and must fight to do so. And NO, it's not Eagleman! Natasha Badman's gonna win and I can't wait to marvel at her victory.

It's a Buddhist belief that within every person there is the capacity for great compassion and kindness as well as great self-preservation and aggression. Certain situations make for almost irresistable acts of generosity (who wouldn't help a cute abandoned puppy?) or cruelty (who didn't join in when the whole cafeteria was making fun of the nerdy, fat kid?). Other situations call for us to make decisions about our behavior where our morals, our nature, and our emotions are at odds.

I've figured out that it's not in my nature to fight. I'm certainly very competitive about all of things and relish in the thrill of victory--but scoring the highest on a test, making the best pot roast EVER, getting a PR at a race, or even winning my age group is not really about fighting. It's about doing the best that I can relative to others. It's not about throwing them under the bus or beating the crap out of them to win. I just don't think I could do harm someone else for the sake of winning. I would really suck at boxing, wouldn't I?

Then again, what kind of person would harm another for the sake of winning? Well, if we were at war that'd be a no brainer. If we grew up like male children in the Spartan culture and wanted to make it to puberty...there's another no brainer. [Spartan mothers would say to their sons as they went off to battle: "Return behind the shield or on it."] But for godsakes, I'm not presently in a combat situation; and DragonLady that my mom is, she would have kinder words than that to say to me.

I don't feel that I lack courage--I'm not afraid. I don't feel that I lack motivation--I want to win. I do feel that if it comes to figuratively delivering the victory blow I may hesitate. So somewhere in the depths of my zen-rific, "It's all good", Primum non nocere self I must find some fight and throw altruism out the window.

So what does this have to do with triathlon except that my trial is going to occur just before my "A" race? Alot of people talk about how triathlon, Ironman made them aware of something about/inside themselves that they didn't think they could do/know they had. I'm going to step completely outside of my comfort zone, act completely outside of my nature, and come out the other side muddy, bloody, and battered regardless if I win or lose--all before Eagleman. I'd be deceiving myself if I thought my performance at Eagleman won't be affected. What remains to be seen will be what that effect is.

Collective strength

Good news: I'm not writing about death or drooling like a dog on a bike ride.

Today's blathering is about the great Kings of Thailand. In alot of Thai movies when the hero faces certain doom, he/she, in that time of desparation and grasping for hope, usually evokes the memory of King Naresuan who defeated the Burmese in 1591 and freed the Thai capital from their occupation. The protagonist (a kicker boxer trying to save his family from the Vietnamese mafia, an undercover policeman investigating the illegal endangered animal trade, a cartoon elephant in search of his father) has been beaten and bloodied. The bad guys are getting the better of him and begin a premature victory cheer. Our hero closes his eyes and the scene unravels... On a battlefield in western Thailand, the Thai and Burmese army clash in a fury of swords, arrows, gunfire, and cannons. While foot soldiers and horseman battle man to man on the ground level, another confrontation takes place 12 feet in the air on elephants. King Naresuan fights the Burmese king with lances. Their elephants brawl with tusks. The Thai army and king are outnumbered and appear to be losing. The King summons the courage of his father and all the great kings of Thailand, summons his own courage, and delivers a lethal blow to the Burmese king...

Our hero returns to the reality of his dire situation and gathers the strength from this memory, this collective courage that he is part of because he is Thai and defeats his enemy.

Okay, so it's obvious that I watch alot of predictable, formulaic movies (in English too!). My point is that during times when we need help, hope, courage, strength we can tap into not just our own reserves but into a collective one. We all come from some kind of greatness. In our histories, there are those who possessed and demonstrated extraordinary acts of bravery, fortitude, and perseverence. I think alot about my parents' incredible work ethic and drive to succeed. I think about my grandmother's determination to pull herself out of poverty (she was orphaned at 4 year old and though she was illiterate, she owned a successful business by the time she was in her 20's).

When I'm feeling "up against it--and the breaks are beating the boys", I draw upon the stength of my family, my ancestors, and yes, the great Kings of Thailand. I think,"Remember who you are..."

Gosh, I've always wanted to quote Knute Rockne All-American and Lion King.

Recycling

Spring has hunkered down in grand fashion here in Upstate NY. We've been blessed with mild temps, only a few sprinkles, and breezes that won't knock over a bladed tri bike. Just about every ride has been outside for the last month; and the trainer butt sores have all but healed. I feel so damned happy to be outside riding my bike, pushing some big watts (for me), and having the sun warm my back. Then some SUV-- usually a monstrous Escalade or Navigator-- goes whooshing by me around 60 mph, it's side view mirror millimeters from my head. I ended last season with a healthy dose of fear for road riding. Local and national stories of cyclists vs. cars seemed so numerous and suddenly became personal. I fled to the trails with my mountain bike while my skinny-tired darlings gathered cobwebs in the garage.

This season I thought I'd try to get a new perspective on my lingering fear of death by a vehicle while on 2 wheels: Recycling. That's right...recycling in the form of organ donation. I figure if my brains are splattered within my pretty red helmet and the rest of me is okay I'd be very happy and proud to have someone reuse my healthy organs. With all this training my heart likely has very little or no coronary artery disease and a rocking stroke volume to boot. My kidneys are in great shape because I'm a hydration Nazi and don't take NSAID's. My liver has more than recovered from my college drinking days. Lastly, my cigarette-free lungs: I'd love for some person which cystic fibrosis to breathe easy with them.

I know it all sounds macabre (I think about death alot with my job), but I think it comforts me to know that all this training wouldn't go to waste, that all those swims, rides, and runs could help more than just me PR at some race.

I once saw a documentary about a village in the Himalayas where the people take their dead to a sacred place on a mountainside, have a memorial service, then the village "undertaker" takes the dead person, cuts them into portions for large vultures to take away. To the Western sensibility, it's gross and barbaric--but to me it's clean and practical. I like the idea of being taken away into the mountains by large birds when I die--it would be my one chance to really fly. I've floated this idea to my family and friends. They think the organ donation thing's the better way to go.