4 January 2007
Thursday, 11:20 PM
High-Level Journal Summary: A poem which shows the human side of being a doctor. While doctors do their best to help people who have critical medical conditions, there is no way for doctors to directly control outcomes. This poem shows the very human things that a single doctor must live with by being so brave as to help people in critical health situations.
Such doctors have to live with the reality that they can't always win. That is a tough burden to bear, and I respect them for being willing to go into such places in life. It takes special people to help others in the face of such uncertainty.
Countdowns:
1.) Day 11 of 28 in my 16th 5/23 Temodar chemotherapy cycle.
2.) Bi-weekly hematology report on 1/6/07 to see how my blood levels are doing.
3.) Inova Brain Tumor Support Group Meeting on 1/9/07.
4.) Quarterly meeting with my local neurologist, Dr. Amy Stone, on 1/9/07. The purpose of this meeting will be to review the results of my 11/29/06 meeting with my primary neurologist and epileptologist, Dr. Steven Pacia.
2007 Seizure Activity:
1.) Last Simple Partial Seizure, or SPS, was 8 days ago.
2.) In 2007, I have had no SPS's.
Actual Journal: Having the name of "David," I always look up when someone says that name across the room, however faint the volume of their voice. It's just a reaction to a familiar word. It's almost like a reflex. I'm guessing that most people have the same "reflex" when it comes to their own name.
Parallel to the above, an interesting thing has developed regarding words related to the brain. I can be in a coffee shop, deep into something else, and all of a sudden the word "brain" is mentioned and I perk up and tune into that conversation automatically. This new reflex happened this morning when I was having my grape-nuts cereal at 6:30 AM.
I was tuned into The Writer's Almanac on WETA, 90.9 FM. Garrison Keillor was narrating a poem, as he does every weekday morning at 6:30 AM. Having just woken, I was half alert. All of a sudden, I realized that the poem for the day mentioned the word "brain." I tuned in very quickly to listen more closely.
Cases
Man in his late seventies comes in with his wife,
weak, lost twenty-five pounds, can't eat, hard to talk,
seeing double off and on past eighteen months,
been to a family doctor and two specialists.
They don't know, I've got some ideas. It's
beyond my scope, here in the rural north country.
I get him tucked away in the medical center
by the following morning. He's out in five days
with a diagnosis, I was right for once. He's
eighty percent better on treatment, says
he's two hundred percent. Gives me the credit
for once. The gray hair helps. Man comes in
to emergency with loss of vision in one eye.
works full-time, in his sixties. It goes away
and he wants to go home. Internist and eye doctor
find nothing. I find something and say, No.
Family says I'm overreacting but they all agree,
reluctantly. Urgent angiogram-surgery on the
neck arteries is booked for the following morning.
That night his opposite side becomes paralyzed.
Emergency surgery cleans out a nearly
blocked vessel. They don't appreciate the
postoperative pain. They don't appreciate my
style or anything about me. He walks out
saved from an almost certain permanent
disability. Woman comes in with a headache,
high blood pressure, in her fifties. I do a spinal,
few red cells, radiologist gets me on the phone.
He says the CAT scan's negative, I'm not
so sure and send her down country for an
angiogram. Radiologist was right and I was
wrong — no aneurysm in her brain. Young
mother of two comes in with seizures hard to
control all her life, and paralyzed on the right side
from birth. I consider a CAT scan a waste of money:
the gray hair stands for experience, remember?
She gets slowly worse over the years. Her family
doctor does a CAT scan, finds a malformation
of the brain. We just ain't so smart, my old
teacher used to say when I was an intern. A man
comes in, in his sixties, can't work, losing weight,
muscles are twitching, hard to swallow, hard
to talk. Do some tests, tell his wife and him
he's got Lou Gehrig's Disease, it will affect
his breathing, he's going to die, it will be
tough, we'll try some things. We do, he gets
worse, can't walk, can't feed himself.
I visit the house: a small cape with a screened
Porch behind a variety store in a small town in
New Hampshire. He gets worse, I
visit some more, talk some to him,
to his wife and son, the man dies.
Poem: "Cases" by Parker Towle, from Body Language. © The Library of America.
What this made me think of
This poem does a beautiful job of showing the successes and failures of a single doctor. He strikes me as a man whose heart and intentions are in one place, but the reality is that this is no guarantee of a positive outcome. There are medical successes along the way, and there are medical failures along the way, too.
This is a poem that resonates with me. It reminds me that my medical team is doing all they are able to do to help, but at the end of the day, they are human beings who can only go so far. And that is okay. I am totally okay with that.
In the above poem, it shows the very human things that a single doctor must live with by being so brave as to help people in critical health situations. Such doctors have to live with the reality that they can't always win. That is a tough burden to bear, and I respect them for being willing to go into such places in life. It takes special people to help others in the face of such uncertainty.
