Pretty in Pink (Rethinking Pink)

“Isn’t she…isn’t she pretty in pink?” – Psychedelic Furs, Pretty in Pink

IMG_1829October in New England. The sky is a brilliant blue, the leaves on the trees are turning impossible shades of orange, yellow, and red.

October is Breast Cancer Awareness Month, so in addition to the brilliant fall colors all around, people are wearing pink clothing and pink ribbons, and products on store shelves has been packaged in pink wrappers. Professional sports teams wear pink. Hospital, civic, and community organizations sponsor special Breast Cancer programs and often have pink treats and pink giveaways to reinforce the message.

One’s inner cynic can easily rise to the surface, and it’s easy to unleash a bit of snark at this pink-splashed world every October. From the little annoyances like markups and surcharges on items because they are repackaged in pink, to the big scandals and exposes on breast cancer organizations who support exorbitant CEO salaries or only spend pennies-on-the-dollar on research, support, prevention, or treatment. And really, who isn’t aware of breast cancer already? (Final person has been made aware of Breast Cancer, from this recent satiric post). I’m really not a “pink” kind of girl, studiously avoiding it for most of my life, so I appreciate those who find pink cringe-worthy.

Not that long ago as a young surgeon in-training and later as a young attending, when I wore my pink ribbon pin people would ask me what it meant. Specifically, doctors asked me about it, and more specifically, other surgeons asked about it.  Mostly male surgeons, but then, surgeons were and are still mostly men. Women patients, women physicians, and women surgeons had started to wear the ribbons to raise awareness and show support, but it was relatively small number of people. Breast Cancer was felt to be a women’s disease (although it affects men too), and there were not a lot of options or even challenges to the surgery or for the treatment. Surgeries were deforming, medications made patients quite ill, and outcomes could be depressing and disheartening.

How times have changed. Continue reading

In a Blink: ‘The Diagnosis Is Cancer’

“Life changes in the instant. The ordinary instant.” -Joan Didion

“Maybe that’s what life is…a wink of the eye and winking stars.” -Jack Kerouac

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Sunrise, Plum Island/Newbury, Massachusetts (November 2011)

Life changes in a blink. A misstep, an accident, being in the wrong place at the wrong time. The seconds and even microseconds seem an eternity. Nothing will ever be the same from that moment. Everything that happens in that instant, flash, blink,  changes the whole world, your whole world, and you can never go back.

A few weeks ago I was in an automobile accident, my friend was driving. It was on a highway, at speed, involving two other cars besides ours. Amazingly, no one was hurt (I assume this, since the culprit who caused the wreck kept right on going and never stopped). The cars were damaged, my friend’s car took the worst of it. It is in the shop so that it can be fixed up, as good as new. All of this happened in a blink, an instant. Too fast to even register what was happening. Our plans for the day were shattered. My friend will be dealing with this for months, by the time all the repairs are done, bills paid, insurance adjusted. But cars can be fixed, as good as new. This is what got me thinking.

Injury, accidents and trauma, illness represent a nearly universal experience. No one is spared, Continue reading

Lessons From Zachary: What a Physician Learns From the Death of a Dog

“You think that dogs will not be in heaven? I tell you, they will be there long before any of us.”Robert Louis Stevenson

 

My dog died three years ago today.  On this day I will remember him, and share a little bit of him with you. These are the lessons from Zachary that I learned during that fall three years ago, on the final leg of our journey together.

Zachary was the first dog of my very own. He was a flat-coated retriever, and a fairly typical example of his breed. Typical of the breed’s “Peter Pan” personality, never growing up. Smart and energetic and goofy and quirky and unique, all of which made him an absolutely typical flat-coat. I could write on and on about his qualities, both endearing and frustrating, and regale you with stories. We would have some good laughs. But let’s save that for another time. We will also hold off on discussing grief, or mourning pets, or the role of pets in our lives.

Let’s just say my dog was a very good dog, and that I still miss him.

He was diagnosed with cancer around September 17, 2011, and died on November 15 of that same year. I learned a lot in that eight weeks. He had malignant histiocytosis, a cancer for which flat-coated retrievers and Bernese mountain dogs share a genetic predisposition, as yet to be defined. It is an otherwise rare cancer, but it is also a rare and difficult-to-treat cancer in people. In fact, there is research at the NIH, as an offshoot of the Human Genome Project (the Canine Genome Project) which studies this cancer in hopes of unlocking the secrets to aid in testing, diagnosis, and cure –for both people and dogs. This research is in part funded by Flat-Coated Retriever and Bernese Mountain Dog breed groups. Zachary was able to contribute to this as a healthy youngster, and again later after he was diagnosed, in his final moments. My choosing to participate offered me some comfort at the time, and still does. Untreated, dogs usually have a life expectancy of 2-6 weeks; with treatment, that can extend up to 6 months, give or take. Zach did not respond to treatment, to put it mildly. He did not tolerate the chemotherapy. He made it 8 weeks from the time of diagnosis.

As a surgeon, I am no stranger to death and dying. I treat cancer patients nearly every day. I have cared for many patients and their families, from the initial biopsy on to the end. I thought I would be well equipped to handle this, given my background and experience. I understood the concepts and differences between treatment and cure, palliation, and hospice care. But I soon realized that I still had a lot to learn. I am still surprised at how much I had to learn, how different it was in dealing with my dog whose life was slowly and inevitably slipping away. Continue reading