Cardiac Snuffleupagus and LUNG FREAK SHOW!

It has been a weird week.

1. Side effects? What side effects? Me no have got sidefects!

First, to prosaic matters, such as the giant invasive fungal infection in my head, and the unpleasant side effects of the drug used to treat it.

My life has fallen into a strange routine. I get up each morning wondering which kind of day I will have. On some days, I feel really terrible. I am cold, stupid, dizzy, tired, and overly emotional. Even a deodorant commercial might make me cry. On other days, like today, I feel almost normal. But to be safe, even on the good days, I'm not driving, calculating Pi out to 100 digits, or practicing my new trapeze act.

If I have a long string of consistently normal days, maybe it might be safe for me to try to go back to work sometime in the not-too-distant future. I really hope so. I miss my patients.  

Now on to the weird stuff.


2. Like the beat beat ------ beat of the Tom Tom...

Sometimes, especially when I lie down at night, I hear the rhythmic whooshing of my blood.* A few days ago, though, I began to notice some skipped beats. Whoosh, whoosh, whoosh ------- whoosh, whoosh ------ whoosh. I checked my pulse and it had the same irregularity. We were staying with my parents on Cape Hagfish, and they detected it too. It was an arrhythmia. That can be nothing to worry about, or it could be a sign of something very bad. Worrying about this kept me up at night.

So when we came back home the next day, I got an appointment at the local hospital for an EKG in the cardiology department. In the waiting room, I noticed the arrhythmia was gone. Damn. I got several EKGs and it just wasn't there. But, but, but! I felt like Big Bird trying to persuade everyone that Mr. Snuffleupagus had just been here but left before they could see him.**

It turns out that the afternoon was not the best time to catch it. But with his usual excellent timing, Snuffy showed up again after midnight.

Like the superhero she is, K/BWE leapt out of bed quicker than the human eye, ready to save the day! In seconds, we were in the emergency room. This time, they did find it on EKG: Beep ------ beep, beep.*** It was premature atrial contractions (PAC's)--generally pretty harmless, and maybe completely so.****

One of my medical mottos is "when in doubt, blame the drug."*****  I was taking meloxicam for my headaches, a long-acting drug related to ibuprofen and naproxen. I did a little research, and, very rarely, meloxicam may cause PAC's. I gambled that the meloxicam was unnecessary, since my headaches had been almost all better after the recent botox injection in my jaw muscles. So I stopped taking it. Bingo. No more PAC's, and headache is still practically gone.

After all my crazy health history, this was my first cardiac issue! I hear they are turning it into a cool new kid's toy: My First Arrhythmia, by Kenner. 

And for my next trick: my first pulmonary issue!


3. Stupid PET tricks

I had my PET scan last week.****** 

The good news is, desperate as they were, the Oncology Team could not find cancer. Yay!!!

But there is some unexplained inflammatory weirdness in my lungs. Boooo!!!

No one has yet suggested any explanation beyond "inflammatory," which is a description, not a diagnosis. And I don't see any articles about this being associated with any of my meds. What the truck???

Oh well, time for a lung specialist. Just what I wanted, another doctor on my case! Oy.

Stay tuned!

Tom





*I have had several patients complain of similar symptoms. It's not a big deal.  It can even be fun.  You can dance to it. (You can, not me - dancing really isn't my thing.)

**The old Sesame Street had an edge. At some point, someone decided that it was unhealthy to try to make kids with invisible friends feel normal, so Snuffleupagas became visible to everyone. Feh.

I, on the other hand, had invisible enemies.  Still do.

***Like road runner with a traumatic brain injury.

****PAC:  Unless you're a lizard, your heart is made up of four chambers called Larry, Moe, Curly, and Shemp. Not really. They are called the left and right atria (plural of atrium) above and the left and right ventricles below.

The normal heartbeat is started by a signal from the sinoatrial node--a gang of cells that hang out in the wall of the right atrium--that travels to the rest of the heart, causing it to beat. A premature atrial contraction is set off when some other idiotic cell or group of cells decide they want to send off their own signal. That causes a premature atrial contraction. Sends the whole thing out of whack for a beat.

The evidence we have so far shows no excess risk from these. Treatment with a medication is a matter of taste. But there is speculation that they may carry a tiny risk of stroke. How nice.

***** You should talk to your doctor before drawing such a conclusion, of course. But it is always worth asking if one of your medications could be causing a symptom.

******Willow and Katie stared at me so intently! Not really. In a PET (Positron Emission Tomography, of course!) scan, you fast overnight. Then in the morning, they inject you with radioactive sugar, and you become the Incredible Hulk. Meanwhile, greedy spots in the body, such as cancerous tumors and inflamed areas, eat up a lot of the sugar, so they glow when you got through a CT scan (a souped up X-ray), showing the docs where they are.

*                    *                    *

 Preparing for PET Scan

 

The Okapi Rides Again!*

From time to time I have shared my story with a colleague and said, "I don't understand why I am not dead yet."  They always respond, "oh, don't be ridiculous."  They know bupkis** of which they speak.  This time, I have a giant tumor all around the inside of my skull.  Why the swell am I not dead yet?  Even the experts don't know. 

However, things are kind of looking up.  Because even as those miserable antifungals didn't seem to be working, proving to me it was untreatable cancer or an aggressive benign tumor that would choke me; even as I got my affairs in order; even as I shopped outrageously humorous gravestones, the story took another wild turn.

Basically, the infectious diseases team in my area and Ski Buddy at Wicked Famous Cancer Center told me I was being an idiot, a shmegege, a dura'k, a pendejo, an idiote, a shagua.***  The antifungal drugs take months to kick in.  

Then the oncologist told me that the pathologists at the Johns who saw "cancer cells" may have pressured by the mafia. There is a serious likelihoood that what they called cancer cells were some weird-looking cells that would clearly have been cancer had they been clustered together, but, as they were spread here and there, they could be just my usual irradiated weirdness. There is just not enough evidence to decide there is cancer there. We have to assume fungus until proven otherwise.

So, am I going to live, or am I going to pop my clogs, s--- the bed, join the choir eternal?  No one is even guessing on the odds, but I am feeling pretty good about another hair-raising escape.****  (I could always die of the regular stuff-- falling off a cliff, bungee jumping with a loose cord, playing in traffic, etc.*****  But the same is true of you, dear reader.)

Assuming an antifungal works, it will take at least six months to clear out this giant mass of yeast and mold (kind of like beer and blue cheese put in a blender together).  The next month will be the hardest.  They will either have to figure out how to reduce or eliminate the really exciting side effects of posaconazole, or possibly try yet another drug in hopes of allowing me to resume my 'normal' life.

But things are looking up.

Be well,

Tom

P.S. This still counts as Tumor 5 no matter what.  That which grows uncontrollably from whatever cause is a tumor, as evidenced by the Three Stooges of the Infectious Apocalypse, Rubor (redness), Dolor (pain), and Tumor (technically, swelling or uncontrolled growth of inflammatory tissue like I have).   I continue to get more Tumoriffic!

*Common diseases happen commonly.  Unusual symptoms are most often due to common diseases.  So there is a saying in medicine: "when you hear hoofbeats, think horse, not zebra." With me, though, they have to think okapi.  

**Yiddish: nothing

***Yiddish: idiot, Russian: idiot, Spanish: pubic hair, French: idiot; Chinese: stupid melon.

****No, I do not mean that my hair will fall out.  I mean that it is sticking up like I just stuck my tongue in a light socket.  So is K/BWE's, my parents', my aunts', my uncles', my friends', and my dogs'.  The Professor and the cat, are just sittin' there like, "whatever.  Seen this opera before.  We knew that was gonna happen."

*****I actually don't plan to bungee jump ever again.  That time in 1993 was enough.

*                    *                    *

Awaiting appointment with one of the great heroes of 2005, The Coach.

"Alas, poor Yoric.  I knew him, Horatio.  A man of infinite jest and excellent fancy--one of my inspirations for this blog.
-->

Autobiographical Flashback to Tumor 1 - in Memoriam of a Rescuer

She would be the most important helper he had outside of his family and medical team.  But Sherma had no warning of this on the first morning of her first job since before her children were born.*  She was to be the administrative assistant in a strange new home business. 

When she walked in, she greeted her new boss and his wife and met a gaunt, bald, 11-year-old boy under treatment for cancer.  The boy's bedroom was directly across the hallway from the office. His parents had a medical practice in addition to his father's new consulting business; they were going to the practice office that day.

 Before she walked out the door, his mother handed Sherma a syringe loaded with orange liquid.**  "Please give this to Tommy at 2 o'clock."  The weight in the pit of her stomach lightened somewhat when she realized it was not an injection, but a drink.  But still, she was left alone in a large house with a pile of her boss's chicken scratch to type up, a dog, a puppy, a cat, and a very sick child.  It was a strange beginning, but there she dropped her anchor.

For the next two years, the boy would be on chemotherapy.  He was in the house much of the time, sometimes with a parent or two, but sometimes with no one but Sherma to care for him.  In the mornings, upon arrival, she would always sit in the breakfast room with the boy, and they would play gin rummy and talk.  Then she would get to her regular work.  Sometimes the boy would build his models in the basement; sometimes he would come up and paint his D&D figures on the floor next to where she sat.  At other times, the boy would be in his bed across the hall, vomiting.  Sherma was there then, too.

After the boy finished his chemotherapy, she continued to work for this quirky business and to take care of these eccentric people with her steadfast love and graceful competence.  For years, she was the only employee. She sat at a desk that faced and abutted the desk where his father sat.

Then one day, over 25 years later, a little tremor heralded the onset of Parkinson's Disease.  She had to retire as she gradually began to freeze into a statue of herself.

Sherma was dearly beloved by her family, and they kept her at home as long as they could, though her last three years were spent in a nursing home.  But to that boy, she will always be the kind, strong, dignified woman who had helped carry him and his family through those terrible years and beyond.

I didn't visit her enough after she retired.***



*She actually had one prior job after her children were born and before this one.  However, it was so unpleasant that she resigned so quickly, no one counts it.  It is remarkable that she stayed with this home business long enough to become accustomed to and even to love its eccentricities.  My guess is she was stuck the very first hour, because Sherma could never leave a child who was in such need.

**This was a 'leukovorin rescue.'  Leukovorin is a highly concentrated form of folate that is used to reverse the toxic effects of methotrexate chemotherapy after it has had time to attack the tumor but before it has had time to kill the patient.

***I was the boy, of course.

 Portrait of Sherma Summers at the World Trade Center, acrylic on linen (2016) by Suzanne Summers LaPierre, based on photo (1980s) by Robert Summers (two of Sherma's three children, all loving and talented).

How Best to Help a Friend in Hard Times.

I am inspired to write this by the offers of so many friends and relatives of "anything I can do to help."  There are big and little ways to help, and ways not to help.


A couple of caveats before I begin:

- This post is definitely not intended as a request that anyone do anything for me.  I am amazing lucky with the warmth and support of so many friends and relatives.  It also helps that I have run up a great big red flag with this blog.  I get all I need.

- I cannot speak for all sick or bereaved people.  Some people don't want to talk about their problems with anyone, so you really have to know your audience.*  But I think most people who are going through serious difficulties have them at the top of their minds nearly all the time and feel lonely when everyone else tiptoes around them.  So ask (most of the time).

1. Ask "How are you doing?"

This question can fall flat sometimes, like the time I asked the question of the terminally ill mother of a friend.  But, mostly, I think, people are happy to be asked.**

I would qualify this, though.  If you are not family or a close friend, asking by e-mail or social media may actually be an imposition, because the sick or bereaved person may feel obliged to respond with energy and time that they don't really have. Asking in person is good though.

2.  Condolences

It's hard to go wrong with this one.  It's really easy to do in the age of e-mail and social media.  Just that little gesture brightens the gloom.  The more, the better.

3. Visits

These have to be done carefully.  Sometimes, someone feels so tired and ill that they just want to sleep.  It is safest to ask first.  Be careful not overstay your welcome.

Sometimes, for the right person, a surprise visit may work.  For instance, one of my best friends, G, whose sense of humor is very much like mine, was in the hospital after a major abdominal surgery for bowel perforation.  A day or two after the operation was her birthday.  So, I recruited 10 of her friends, and showed up in her hospital room (along with a couple of medical residents who tagged along at the last minute) and sang her 'Happy Birthday.'  She cracked hard, but when she watched us start eating the cake, she wanted to vomit, so she kicked us out.  So, if you do this, leave the cake at home.

4. Offers to help

Abstract offers to help are fine, but let's be honest, usually they are kind gestures, but just that.

On the other hand, noticing what is actually needed (rather that expecting that the sick person will tell you what they need) and offering to help in a concrete way can be really great.  People in crisis are tired and stressed.  When you are ill or distraught, sometimes the basics of everyday life can be burdensome.

For instance, Cousin MK, and family friend MA drove me back and forth to my radiation treatments in 2005.  SB*** and ND brought me and my family delicious food.  Our upstairs neighbors, L and J took care of Little Lord Chaos (now known as the Professor) on those several occasions when K/BWE had to whisk me to the emergency room for some dumb infection or ridiculous stroke.  My excellent guitar teacher, S, visited me and gave me guitar lessons in the hospital during chemotherapy.  Just recently, when I was recovering from my recent surgery, JR and ND let me sleep on their couch while my maniac dog, Willow, got to tear around their yard. 

You don't need to make a grand gesture.  Just an errand taken off check list or a moment to rest is appreciated.

5. It's not over when it's over.

For me, the most difficult times have been after the crises have passed.  During a crisis, one has a clear mission to get treated, and everyone rallies around them.  But life is not back to normal even when the obvious drama is over.  Physical and/or emotional healing is hard.  It's like coming home from a war.  Be there for them.

*                 *                 * 

All of these things are a comfort.  You should never feel bad if you don't have the time to go above and beyond.  You do what you can.

Be well,

Tom.



P.S. I have had more helpers than I can count.  To name a few, I thank:

My parents and extended family (one of whom, DW, has been a surrogate parent and is helping me turn this blog into a book), K/BWE's family, the Professor, and, of course (and the comic relief he provided as Little Lord Chaos), and K/BWE, my wife, my caregiver, and champion.  She is always there for me, always asks the doctors the questions I forget to ask, and pushes me to go to the hospital when I stubbornly insist there is nothing wrong.

And HBW, TD, KD, ND, AR, MS, EJ, DR, BF, JR, ND and JG just for for being there for me.

And childhood friend and massage therapist TK who has given me free massages in 2016 after I was erroneously told I was going to die within 2 years**** and in the current crisis.  It's very consoling when you think you may die soon, and that's all you can think about.

And friends GK, RW, and HW, who have given me refuges (the latter two overnight many, many times) in the Big Fruit.

And I will always be grateful to my school for accommodating my first cancer and the two years of rigorous treatments I had between 1981 and 1983.  And to my medical residency director R and, later, my infectious diseases fellowship director H.  And to the managers and chiefs at my medical practice who have accommodated me, and the many colleagues who have stood in for me over and over again.

And H, who came all the way back from Germany to help care for a sick boy.

And geology teacher T and classmates BB and AP (am I remembering everybody?) for helping me out of the Appalachian wilderness when I got a fever with a white count of zero on the middle school camping trip.  I probably would have died if you hadn't done that.

And EM, who is helping me realize a long-deferred aspiration.

And many more than I can name.

And to all who read and who respond to this blog.  I am a ham.  Part of the way I make illness tolerable is to turn it into performance art and get attention to preen my ego.  So, thanks to everybody who is reading this, anyone commenting here or commenting or liking on Facebook.  You are a helper too.  And I lied a little.  I would like you to spread this blog.  More is more.

Be well,

Tom





* Of course, I'm kind of easy to read on this.  I am quite flamboyant with my bad news.

** I scored some serious points with my future wife before we knew each other very well.  I had heard that her father had passed away.  Even though we barely knew each other then, when I saw her next, I expressed my condolences and asked her how she was doing.  It definitely counted as a point in my favor a couple of years later when we started dating.

*** At the time, I didn't know that mason jars aren't supposed to be thrown out after you use them.  Sorry SB.

**** It's been almost 3 years, suckers!

 *                      *                      *

Coda to Previous: The Greatest Insult Language of All Time

This only makes sense if you read yesterday's post.

Still trying to deal with headache.  Took gabapentin and posaconazole after dinner hoping that the gabapentin could knock off the jaw-clenching while the posaconazole could keep killing the (increasingly unlikely) fungus without making me a zombie the next day.  Nope.  I'm not sleeping, but I send this update from outer space.  Luckily, it is not illegal to blog under the influence (BUI).

Enough!  I will stop kvetching!

But, to the more interesting point that I left out yesterday.  When I had the colonoscopy for my iron deficiency anemia a few months ago, the gastroenterologist/endoscopist came to me in the recovery room and told me it was normal.  Since I have referred many an iron deficiency anemic patient for workups myself, I said, "the next step is an upper endoscopy, then a capsule if that's negative, right?"

"Yes," he affirmed.

Then, when K/BWE called to make an appointment* for the upper endoscopy, his office refused.  This is NOT standard of care.  She messaged my primary care doc and told her this.  My primary care doc then called the gastroenterologist, and he denied ever agreeing to do the upper endoscopy. Huh???  He shall forever be known to me as Dr. Sphincter.  A different gastroenterologist went on to do the upper endoscopy.

That is all.




*I am ashamed to say this, but I am a typical male schlump** in that my wife makes many of my appointments.

**I am annoyed to say this, but Blogger's spell-checker does not recognize "schlump," a word from Yiddish (among other things, the greatest insult tongue ever spoken).  What shlemiels!

*                      *                      *

 This dog is disappointed in Dr. Sphincter

 and thinks he is a Schlub.

I'll Laugh About All This Someday.

Actually, no.  I'd better get to laughing about it now.  As a genius once said, "laugh while you can, monkey boy!"*  Besides, that last post was way too serious.

I have had some adventures over the last couple of days that deserve a good belly laugh.  Why am I writing/laughing at 2 in the morning?  Find out below as I describe health problems I have never before revealed in a Tumoriffic post!

First of all, there is something I am ashamed of.  I have had mild iron deficiency for years.  Iron deficiency is not usually shameful, but I never got around to getting it worked up, and that makes me a hypocrite.  (Patients, do as I say, not as I do!)  Iron is the most important part of the compound called heme which carries oxygen in your red blood cells (mine too, actually).  If you do not have enough iron, your body will not bother to make as any red blood cells (causing anemia) or be able to absorb as much oxygen from the air.  This can kill you, it's really bad, but you can actually get away with a pretty low number, and mine is only moderately low.  However, the kicker is, where is the iron going to?

There are three reasons as to why one's iron might be chronically low.  One might not be able to absorb iron efficiently (as in celiac sprue, or after gastric bypass surgery), one might not be getting enough iron in the diet (vanishingly rare), or one might be losing blood.  Assume bleeding until proven otherwise. 

Menstruation is the most common cause of blood loss-related iron deficiency.  I have never been able to menstruate, though, hard as I've tried. Blood loss through the gut is the second most likely cause.  You can actually bleed to death inside your gut and never know it.  Blood loss through the gut is scary.  Think of spooky stuff like gastric ulcers, stomach cancer, and colon cancer.  If you don't know where the blood is going, you really shouldn't wait around before getting a work-up, so I am duly ashamed.

So, I had a colonoscopy, which was the usual joy ride, but it did turn out that all was well in the end.**  There ain't no colon cancer in Tumoriffic, and I hope to keep it that way!  Unfortunately, that was months ago, and with all this fun  going on, I didn't rush to the next step, an esophagogastroduodenoscopy (known to the in-crowd as EGD) to look for a bleed in my esophagus, stomach, or the first couple of inches of my small intestine (aka, the duodenum).  Now that I am on sick leave, I figured I'd make the best of my free time and get an EGD. 

[Now, we interrupt this narrative to describe the other problem that played so large a role in yesterday's events.]

Since early 2006, I have had trismus,** more commonly known as lock-jaw.  It's not because my mother is a W.A.S.P.****  It's because my face was char-broiled in x-ray radiation in 1981 and then proton beam radiation in 2005.  In early 2006, after I finished chemotherapy, my jaw clamped down permanently.   I am unable to open my mouth more than a little finger width.  It's a bit inconvenient.  I have to cut up food in small bits, so it takes a long time to eat.  However, it would be much more disabling if I were a zombie from the Walking Dead, or a vampire.*****

The trismus has become much worse lately as my main jaw muscle (the masseter) has started clenching up, causing severe right-sided headaches.  I initially thought this was the tumor inside my cranium squashing my brain, but I noticed that my teeth were crushing together, and my cheek was sore.  Maybe it has been stress, but I can't imagine what I might be stressed about.

The day before the EGD, my go-to neurologist, Dr. Brain, gave me gabapentin to stop my masseter from spasming and giving me a headache.  I started that night, and it worked like a charm.  But, by morning, when K/BWE drove me to my old hangout, Ben and Jerry's Hospital, I was zonked out.  I faded in and out and could barely sign the consent forms.

I was wheeled into the operating room, and there, the challenge began.  There were two scopes on a table.  One was the size of a horsewhip or a colonoscope,****** and that's apparently the usual one. Everybody could see that one was hopeless.  The other was a bit bigger than a cocktail straw or spaghetti--about the size of a cystoscope.  (They use that to look inside your bladder.  Imagine how they get that in!)  That was better, but they still had to make sure I didn't bite down on the thing.  That was the real puzzle.

I perked up, since this seemed a fun game, and the endoscopy team and I brainstormed into how to do this.  Usually the patient has something like a binky with a big hole in the middle between their teeth.  That was really made for the larger endoscope, though, so no matter how hard I pulled on my lower jaw, and how much lidocaine they smeared on my masseter, there was just no way of getting it in my mouth without knocking my teeth out.  I like my teeth, so that was not an option.

What to do, what to do?  I had an idea.  Why did we have to use a binky-like object?  Wouldn't any object that I could put between my teeth that was larger than the little scope do?  So, they cast about for one, finally settling on a biteguard--what they use to keep you from biting off your tongue during shock therapy, just like in One Flew Over the Cuckoo's Nest. ******* I pulled off a stellar Jack Nicholson impression, and it worked!  For some reason, they did not want to sedate me much, so I got the unusual experience of seeing on live video my own stomach, and my very own duodenum (bonus!).********

They found nothing to explain the iron loss or the anemia.  What did they say?  Go ask a hematologist!*********  That's very convenient since oncology and hematology are the same field (although many subspecialize), and I'm going to an oncologist for that other reason.

Anyhow, after the procedure, Kathleen drove me home, and I crashed on the bed and slept until dinner cuddled up to Willow.  So that is why I started writing this at 2 in the morning.  (I don't know what I'm going to do about the jaw.  It's not worth going around feeling like a zombie all day, especially if I can't eat like one!  Mmm. Brains!)


Be well!

Tom








*John Lithgow as mad scientist, Dr. Emilio Lizardo in Buckaroo Bonzai, Across the Eighth Dimension

** For your next colonoscopy, instead of clearing your bowels by guzzling the rabid skunk vomit that is magnesium citrate, use polyethylene glycol (Miralax).  It doesn't make the bowel clearing part any more fun, but the other end of the process will be much more tolerable.  Ask your gastroenterologist why there are not letting you use polyethylene glycol instead of skunk vomit.

***I am not talking about Emperor Trismus, a little-known Roman emperor who directly preceded Aurelian during the crisis of the third century.  Actually, there is no such emperor.  Trismus was a poet in Ancient Rome who invented the predecessor to the modern dirty limerick.  (That too is a lie.)

****I once had a teacher so W.A.S.P.y that she actually spoke with teeth totally closed.  It's a thing.

*****That brings up a whole other weird thing about my face.  When my jaw first started clamping down, my surgeon gave a jaw-stretching device.  It's a machine with two plates that go under your teeth and a gizmo that you squeeze to separate them.  The trismus was all on the right side where the radiation had been, so I would put the device in that side.

One day, I noticed that the bottoms of my top teeth on the right did not exactly overlap the tops of the lower teeth.  Part of what was left of my poor, abused right maxillary bone (which carries the teeth of the upper jaw) had completely broken off from the rest of my face.  I didn't even feel it when it happened.  It's still there to this day, just floating in the tissues of my face with the teeth of my right upper jaw useless for chewing.  I am truly special!

******Maybe it was a colonoscope.  I do hope they rinse them in between procedures!

*******Luckily Nurse Ratched was off-duty that day.

********As the scope went down my esophagus, it made this sound like the one you would make if you scrubbed glass really hard with Windex, "REE-UH, REE-UH, REE-UH." I wondered if my esophagus was going pop.

*********Why not a third endoscopy?  Unlike the esophagus, stomach and duodenum, which, together might be 2 feet in length, unlike the 'large' intestine, which is about 5 feet in length, the 'small' intestine is 20 feet long.  No endoscope can go that far, so what they do instead is a capsule endoscopy.  A little camera is fit into a capsule.  You swallow the capsule, and it goes all through your system taking pictures, like some kind of sicko tourist.  BUT, they can't fit one of those through my teeth, and that might be a good thing, since I have a hard enough time swallowing some large pills that can fit through my teeth.

 This dragonfly has been avoiding getting her colonoscopy.  That doesn't mean you should!

On Luck, a Philosophical Interlude

There was a patient I once had; almost exactly my age.  He had never had money.  He had never gone to college or had a good job.  He married once and had a child but hadn't seen him for years.  He did something stupid but not violent that led to a short jail sentence.

During that sentence, his bad habits and bad genes caught up with him and sent him into severe liver failure. He was transferred to the prison ward of my hospital and became my patient.  He had weeks to live.  I contacted his judge, who allowed him to come off the prison ward to die on the regular ward. 

One clear spring day, I wheeled him outside.  He lit one of the cigarettes I had bought him.  He looked at the sky and out over the lovely park in front of us, and he said, "I guess it's been a good life."

Who is lucky?  A lot of people have commented on how unlucky I am.  It's true that I have had many absurdly serious health crises for someone my age.  But I don't think that's the same thing as being unlucky.  In my life as a cancer patient (for instance, Saving the Girl), and in my career as a doctor, I have seen a lot of unlucky people.

The unluckiest have been children.  When I did a pediatric oncology rotation in medical school, there was a teenage girl who had a brain tumor.  The surgery to remove it had left her terribly brain damaged and on a ventilator.  Her wrists were tied to the bed to keep her from tearing  her many tubes out, and she would frantically gesture with her hand as if she wanted a pen.  One day I gave her a pen, and I put a pad underneath it.  She scribbled violently and randomly.  And when I took them away, she continued the frantic gesturing as she did every day, trying to send some message that may not even have had words anymore.  She never made it off that ventilator.

As a doctor to adults, I see all sorts of misfortune.  Patients will open their hearts about their history of childhood abuse, or the spoiled marriages they can never leave because you need two incomes just to keep a roof over your head and the refrigerator full, especially if you are old.

Even if I die tomorrow, I am lucky.  I was born into a family and a place and a time which gave me protection in my crises.  No one important has ever made assumptions about me based on how I look.  I have a happy marriage with a thriving son, and I have wonderful relatives on both sides who are there for me.  I have dozens of close friends ready to help in crisis.  I have a good job.  There are people I have never met who read my updates and offer sympathy and support.

So, no, I am not unlucky.  Thank you to everyone who makes that so.