The Light At The End Of Your Tunnel

Torpedo tube on a submarine.
The floodgates open

Murky waters flow

In preparation 

For an invasion 

Down below

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In case you didn’t know, March is Colon Cancer Awareness Month and it’s fast approaching! Routine colonoscopies can reduce your risk of colon cancer by 70-90%. Book your loved one’s colonoscopy now! It makes a great Valentine’s Day present… After all, nothing says, “I love you,” like a good colon cleanout. 

The Lump

“How long has this been here?”

“I don’t know. Maybe six months.”

“Why didn’t you tell me? You have been in for a head cold and a sprained ankle in the past several months. Why didn’t you bring it up?”

Truthfully, I don’t know why we ask these questions. 

What does it matter in the grand scheme of things, the why? It could be one or several of over a dozen things but knowing why does not change the what or the now. Asking why only makes the patient feel… worse. 

Actually, I do know why we ask. 

It is our way of saying, “Look, if you die, remember it isn’t my fault,” because we feel guilty, somehow. Responsible. It is our way of conveying that we are hurt that you didn’t trust us without saying those exact words out loud. And to be honest, we are in shock, scared, terrified of what this might mean for you. We know the fear and the pain and the hair loss and depression and everything else that may come your way because of this little lump in your breast.

I have been on both sides. 

I can tell you that as the patient I understand the not bringing it up thing. I consciously chose to ignore it myself. Not because I was depressed or was in denial that it was there. It was certainly there. Nor was I lazy. Or ignorant. I knew full well the implications of a slow growing mass in my breast. I simply did not want to know. If it was breast cancer, fine. So be it. It wasn’t going anywhere. Death didn’t scare me. In some ways, I was probably playing chicken with death, with the mass.

Who was going to flinch first, I wondered.

Then one day my own doctor was saying those words to me… “What the hell were you thinking?!?!??!”

And the truth is, I don’t know. 

Please note, that I do not have breast cancer. I’m not dying from anything, not yet anyway. My breast is just fine, thank you! I was just reflecting on this whole phenomenon last night, the ignoring of things we shouldn’t really ignore. 

Flawed 

There are a surprising number of physicians who blog. I loved this post from Deconstructing Doctor about how it feels to potentially miss something, how it can eat you up, how isolating the medical profession can be. Check her out!

deconstructingdoctor.com

broken-saint-1422381-639x573I don’t always do the right thing.  I don’t always figure it out.  That’s the worst part of this job.  The not being perfect part because not being perfect means I’m flawed and flawed people make mistakes and my mistakes can hurt people.

One time I almost missed a lung cancer.  Oh God, the gut-wrenching weekend that I spent after that one.  I must have lost 5 pounds just from the nausea that I felt.  How could I eat?  How could I breathe?  My mind ground the details of the entire chart into a fine powder and then I sifted through that.  Trying to account for every dust particle.  How could I have failed so miserably?  I could have just died.  Truly.  What a miserable wretch I was.

The crazy part is it couldn’t have been helped.

She had lung cancer a decade before.  It came back.  My angst came…

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Comparing 

zinnia in black amd white

Life is made of joys and sadness. Ignoring the sad, painful times neutralizes the joyful ones.

One of my office managers keeps insisting that we not talk at all about the negatives of our job. He would prefer that the staff and physicians only project happiness, sunshine, and roses at all times. I am not sure that is entirely healthy.

This is the way of life lately. No one wants to hear or even acknowledge the negative. Sadness makes us uncomfortable. It is painful. It is a natural thing to want to avoid it.

Why can’t you just be happy?

The problem is that completely ignoring it promotes isolation. It keeps us from recognizing who is suffering, who is at risk, who needs help. This is a tough job for all involved. What is wrong with acknowledging that so we can all work through it together? 

Am I the only one who feels this way? What is wrong with me?

And it takes away the drive to get better. 

If everyone is happy, why do I have to do it right?

The worst part is that it takes away the celebration of the real triumphs. 

What? Can we BE more happy?

It is OK to feel fear, doubt, sadness, frustration. It is what we do with those emotions that is the key. How do we respond and use them constructively?

I see this in patients, too. So many believe they should not have to feel any negative feelings, that such feelings should be avoided at all costs. 

I know I should still be happy. I am going bankrupt, my wife left me, and my son is in jail, but I should be happy. Everyone tells me I should just be happy. Make me feel happy.

Doc, I am really, really trying to stay positive. I have metastatic cancer and I am in pain all the time and chemo is kicking my butt. Everyone tells me I should stay positive or I won’t beat this but I really just want to cry. I need to cry.

You know what? Being sick sucks. Having cancer sucks. Sometimes life just sucks.

And it should be OK to say it sucks. It should be OK to grieve and be sad and to cry if need be, even if it makes others uncomfortable. 

What we need is balance. Not a cult of happiness.

Yellowed

yellow painted industrial lights on the Eiffel Tower.

He was rude and ugly and had been since the day I met him for the first time… three days prior. I listened to his symptoms and looked at his jaundiced face and I knew. 

I knew.

The whole visit he was antagonistic, questioning my every move, downright insulting me at times, telling me that I did not know what I was doing. I wanted to yell at him to shut up and be nice, to just let me help him, but I knew that he knew that I knew he was dying. 

Bullying me made him feel as if he still had power. 

“I have your results, sir. They confirm what I suspected.”

“You are a stupid bitch.”

I am so very afraid.

“I know this is not something you want to hear and for that I am sorry. Let me set you up with an oncologist and they will take it from here…”

A Doc-ument

A few weeks ago I met an intriguing physician, an oncologist with an unusual story. She had told that story to Craig S. Boyack and his newest novel, The Playground, was born. I invited her here while I am traveling to let you all get to know her…

Thanks for having me over Victo. My name is Dr. Gina Greybill. At the beginning of this story, I really am a broken person. Who expects an oncologist to get cancer herself? It hit me hard, and took a family member from me too. So I left oncology. My heart was just not in it any longer. 

Instead, I started working in end-of-life care at a wage somewhat lower than I was used to. These people need someone who understands, and I understand more than most. I travelled from one place to the next living with and helping hospice patients as they died. My next assignment took me into a world I never knew existed.

There are some interesting medical issues in this story, not the least of which is my encounter with a parasite. This parasite enhances my abilities and let’s me see into a world nobody else has access too. Angels, Devils, fairies, and monsters are all out there. This is a big part of my journey.

I even have a struggle with my medical oath, but desperate times do call for desperate measures…

As far as other interesting tidbits, your readers might be interested in the old medical cane. Nearly everyone knows what a sword cane is, but very few know that canes were made for other uses too. In the days of house-calls, a doctor might travel with a hollowed out cane that contained a few professional items. There might be a tincture or two, some paper envelopes of powders, maybe even a lancet depending on the era.

There is a very special ear trumpet in the story. It looks so absurd that everyone would post pictures of me on Twitter. We found an interesting way of using it that keeps it from being a magnet to the social media crowd.

A deadly infection makes an appearance. It’s marks a major turning point for one character. There is also a brutal thug who has an alternate use for tampons. Another interesting situation uses the topical application of opium as a pain killer.

If this sounds like an intriguing story, your fans might like to pick up a copy of The Playground here.

There are some interesting medical bits in this book, but Craig wants me to tell everyone that he’s an author, not a doctor. His job is to do enough research to make it believable within the context of the story. I think he’s done a good job of that, but the readers will be the ultimate judge.

Victo, thank you for having me over today.

***
Truthfully, I don’t know what genre to classify this book. There are historical fiction elements, the paranormal, good bits of violence, medicine, technology, horror, suspense, and plenty of death. I guarantee it will make you think.

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Timeless

Golden, ornate museum clock.

It was noon on Christmas Eve. 

He had asked me to call him as soon as I had the results.

Still.

It was Merry frickin’ Christmas Eve.

I didn’t want to do this. Not to him. Not to his family. Not to anyone. Not on Christmas Eve.

But it was cancer. No doubt about it. The five centimeter tumor in his bladder had caused him to pee blood. 

I picked up the phone, hesitated, then put it back down. 

No. 

Not today.

I packed the laptop into my bright red leather bag and turned off the lights in the office as I walked out, the last one left in the clinic. My footsteps echoed down the hallway to the alarm code panel. I could feel the cold sneaking in around the glass door and I shivered involuntarily.

I stopped.

Sometimes you have to trust that there is a higher power at work, something beyond you. There was a reason he was supposed to learn about this diagnosis before the holiday. Maybe to help him reconcile with someone? Maybe so he could make this the best Christmas of his life, in case it was his last one?

I don’t get to decide. It is not my place.

He wanted to know.

I walked back to my office, picked up the phone again, and this time I actually dialed his number. 

He answered. 

I told him the news.

“Thank you, Doc.”

“Merry Christmas,” I said.

The Weight of Mass

IMG_5750

“You have a mass in this breast. A large one.” 4.5 centimeters. It felt hard, like a rock. I drew in a breath as my heart sank. Oh, God.

“Yeaaahhh… About that, Doc…”

“How long has it been there?” I asked sharply. 

“Oh, I don’t know. A year maybe?”

“You have been in here three times over the past year, twice for head colds and once for a bladder infection. Why didn’t you tell me? Why did you wait until your physical for me to discover it?” She had wanted to skip the breast exam but I had pushed a bit and she relented. 

On some level I felt hurt. Had she not felt comfortable enough with me to bring it up? What did I do wrong? 

Snap out of it! This isn’t about you.

“Because I know it’s cancer.”

“You are thirty-six. You have three kids. You are a single mom. Why would you wait if you thought it was cancer?”

“Because I am going to die anyway.”

“You don’t know that.”

“Yes I do.” She gave a lopsided smile. More like a grimace. 

She is still alive. It has been two years. Her hair isn’t really growing back well so she still wears wigs. Her fingers are numb. Every day she worries if it will come back.

And sometimes she wishes it had just killed her outright….

Missed

IMG_9408

“I was sent to cardiology. Then pulmonology. I had chest X-rays and even a heart catheterization. When those were all negative he said he didn’t know what to do next. So my daughter said I should come see you….”

I nodded.

“The thing is, doc, the pain was only in my lower chest. Now it is also in my upper abdomen and I have nausea. It’s getting worse. Much worse. And the cough has not gone away…”

She was young. She was scared. She had everything to lose.

“Did you have any blood work done?” She had not brought any records with her.

“No.”

“Any imaging of your abdomen? An ultrasound or a CT scan?”

“No.”

“Here is the plan: start on an acid reducing medication twice daily. Let’s get some lab work done, including an H. pylori test looking for a bacteria that can increase your risk of stomach ulcers. Back in two weeks. If you are not starting to feel better, we will do some imaging.”

When the labs came back the next day, they looked awful. I already knew what was wrong…

Cancer.

Imaging confirmed. 

“You are amazing, Doc. You figured out in two days what my previous primary care doctor could not figure out in six months….”

I thought for a second about basking in the dubious glory of delivering her death sentence. In fact, I almost hung up the phone, leaving it there. I wanted to be the best, the smart one. Brilliant. The hero.

“Truthfully, I am not special. Anyone would have picked it up at this point. All of the other work up was already done and your symptoms had progressed to the point that it could not be missed. The early stages are tough. The generic symptoms could be almost anything. Your other doctor did all of the right things.”

There was an uneasy silence.

She wanted someone to blame, someone to be at fault, someone to be angry with. I understood. I was taking that away.

“Well, like I said, I am going to make some calls to see if we can get you into one of the experimental studies. I am not sure it is much hope but it is something. I am here if you need anything at all in the meantime…”