Cancer

I have a patient who is very close to my heart. She started seeing me when I was first able to have patients on my panel as an intern. She hadn’t seen a doctor in quite a few years and was working hard to get her health straightened out. She was in a healthy relationship with her significant other; had four children with whom she had an excellent relationship; and had an overall positive outlook on life.

I enjoy working with adolescents and young adults who are in treatment for addiction because, despite their vulnerability, they are at an age where interventions have a reasonably high chance of being successful. Their genetic risk for addiction is something they cannot change, but they can modify their overall risk by changing their environment and carefully choosing their friends.

It was his first visit to a hospital–any hospital–since his birth in this one eighty years earlier, and the trip to the emergency department for blood in the urine soon escalated into a workup for bladder cancer. He became one of the most memorable patients of my medical school experience and, for that matter, my entire career.

Though so crotchety that some of the staff avoided him whenever possible, he and I always got along well.

I grew up on a farm in Connecticut, went to college in Rhode Island, and have lived my entire adult life in small-town Vermont, so the mores of rural New England are deeply engrained in me.

That means Robert Frost’s poetry is part of my vernacular. (I own two hardcover copies of You Come Too, a collection of his most popular poems: one copy was printed the year I turned ten and bears my name on the flyleaf in childish script;

In late fall of 2020, rumors were buzzing around the hospital where I worked about a possible retirement buyout package. My supervisor and I sat in our large conference room discussing what we had heard. I said, “If the offer is decent, I will probably accept the package. I don’t want to work until I’m carried off the unit on a stretcher.” Then, with my usual humor, I chuckled and added, “I tried that once and it didn’t turn out so good.”

Years ago, on my first rotation as a third-year medical student, I received a dreaded phone call. My father had arrived home late one night after work. As he entered the house, he tumbled down the stairs. His physician, worried that my dad had suffered a mini-stroke, ordered an ultrasound of the carotid arteries in the neck.

Most people aren’t aware of a cancer that is ruthless above the rest. This cancer lasts a lifetime and never fully remits.

I first became aware that I was susceptible as a child. I was on an examining table and our pediatrician asked my mother to step outside the room. I then heard him berating her: “This child is sunburned! How could you! You know you have genetic skin cancer!”

She was my head nurse on a treatment unit for psychiatric patients. In the course of our work we became as close as sisters. When she developed breast cancer with heavy spread into the lymph nodes, I was devastated but not surprised. She lit one cigarette from the last one throughout those days before smoking was banned.

I knew it was coming.

After my morning walk, I sat down and ran my fingers through my hair, and ended up with a handful. Right on schedule, Day 14 following my first chemo treatment for stage lll inflammatory breast cancer.

Taking what remained of my shoulder-length hair and cutting off what I could with a pair of scissors, I noticed how much I looked like my dad, now that my features, rather than my hair, took center stage. Then my husband shaved off what remained as I sat on an overturned Home Depot bucket in our backyard.

Every second Wednesday of the month we met on Zoom, five of my medical colleagues and I, for more than a year. We started off sharing fun facts. She spoke of her bike rides—how fast she could go, how beautiful the fall leaves were, how fresh the forest air smelled, how spring brought a veil of green.

We also discussed the differences between a doctor’s approach and a scientist’s approach to teaching students and residents in a hospital setting. We provoked each other. We enjoyed the intellectual challenge that faced us—the puzzle of creating a sound medical education research design.

Her breath rasped, heavy, traveling all the way from an ICU in India to my ear pressed to the phone in Yonkers, New York. My mom’s best friend, her cousin, was dying far away from me. She had been like a mom to me.

Her sister had put the phone to her ear so that I could speak to her. She was unconscious for the most part, her body ravaged with cancer, her systems shutting down, one by one.

Keep a green tree in your heart and a singing bird will come. –Chinese Proverb

Spring folds into summer like origami. My vegetable garden thrives. Potted flowers stretch toward the sun. Wildflowers, I seeded in March, burst forth in a colorful display that attracts bees. The yard hums with activity.

All this appreciation for the beauty of the natural world is tempered by my health. I have a blood cancer, multiple myeloma. The disease environment in which I live comes with complications. Some days I am awkward and self conscious as an adolescent. My skin mottles in ugly blotches, my GI tract turns somersaults, or worse, freezes solid. My body cannot be trusted. I sulk and just want to be alone.

I receive treatments aimed at reducing the damage caused by this incurable malignancy. Each month a six-hour infusion of a monoclonal antibody and immunoglobulins tamp down the damage. At home, I take low dose oral chemo along with steroids. I am alive and I am healthy… after a fashion.

I’ve come to accept my illness as part of the overall order. It is not an anomaly, a mistake, or a bad break. It is here to stay. For me,