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

On Writing: Marking the Anniversary of a Blog

“I admire anyone who has the guts to write anything at all.” – E. B. White

“All you have to do is write one true sentence. Write the truest sentence that you know.” – Ernest Hemingway

“Writing is easy. All you have to do is cross out the wrong words.” – Mark Twain

“There is no greater agony than bearing an untold story inside you.” – Maya Angelou

“There is nothing to writing. All you do is sit down at a typewriter and bleed.” – Ernest Hemingway

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Dr. Kathy Hughes, Behind the Mask

This is the anniversary of my very first blog post, that day a year ago when I summoned up my courage, took a deep breath and clicked on the “publish” button that first time. I crossed a threshold of sorts in that moment, the start of my transformation into a writer.

A great deal has happened since with my writing and blogging, and my world has changed as a result. I have many people to thank for the support and encouragement, the help and the teaching. When I am asked about blogging and writing I have focused on the who — who helped me, challenged me, inspired me.  I have also spoken about the how — how to do it, getting started, learning the platform or the medium. In my focus on the who, what, where, when, and how, I neglected the why. The why is the most interesting and important part, both the easiest and hardest story to tell.

I was talking with Chris Porter from On Surg a couple of months ago. At the end of an interview, he asked me about blogging and how I got into it. The camera was still on, and I launched in to my usual description of the how and the who. Later I realized that the question was really about the why. That prompted an email, which I expanded for this post. The anniversary of the blog seems the perfect time to share what that conversation inspired.

The truth is, I have always wanted to write. In 6th grade my class was given an assignment, to imagine what we would do/be when we were older.  My answer was, “a veterinarian, or writer, or lawyer” (thinking that lawyers wrote a lot and were masters of language and debate). I remember my Yiayia (Greek Grandmother) in Sacramento, Calif., going out and getting me a T-shirt from University of California, Davis, home of the state’s veterinary school. That shirt became my favorite, the coolest shirt I owned (even cooler than the Peter Frampton one), especially for a kid in the DC suburbs. I wore it out.  I ultimately veered just a little from those goals, ending up in (human) medicine and surgery.

I admire people who write and write well. I love to read, and to read what good writers have written. To me, writing carries importance and immortality. We still read and discuss the works and the writers who are long gone. Writing to me is the Biggest Most Amazing Thing Ever. To aspire to be a writer, to actually be a writer, is a long-cherished dream.

I started writing daily for myself.  I took a creative writing workshop (interestingly, taught/directed by a surgeon) through the Massachusetts Medical Society. The workshop showed me I could create something that moved others, that they responded to favorably. I found that the workshop also broadened my narrow view of what “creative writing” really means. The experience motivated me to keep up with my writing, and to think about writing more than just for myself, planting a seed. When I started this blog, that seed germinated, and has grown.

In considering writing, I didn’t think I had a voice. I wasn’t sure what I could or would or should say, or who would really care what I had to say. After all, I am a surgeon who has spent the majority of her career in private practice in mid-to-small sized hospitals, serving communities of modest (even challenged) means. The prominent and predominant voices and writers around me were big important surgeons from big important academic centers and their large urban hospitals. I was not sure where I fit in. It felt important for me to write exactly because I could not find another voice like mine.

I blog because I do have a voice, and I do have something to say. Sometimes it is fresh, even unique, sometimes I wish it were more original. But no matter what, in this blog I am adding to the discussion. I am sharing my thoughts and stories, sharing a piece of who I am. Yet there is a paradox in this writing approach. I crave to write that perfectly crystallized, novel piece that will capture and immortalize a nugget of truth. But it turns out that writing about the commonly shared experiences is the most gratifying. The revelation that my experiences, struggles, and observations are mirrored in others brings a wonderful sense of belonging. This blog helped identify for me not just other physician writers, but a community who can share in these stories and experiences. I am able to express these thoughts and stories, and to give voice to all of us. I thought I was speaking for myself, but soon felt the rush of realizing that I am speaking for others, too. I felt the rush of the power those words, my words, could convey.

I confess a sense of pride that I can express myself in writing, that people enjoy and appreciate my words, that I am a good writer. I am still learning though, very much. I have many teachers all around me, in the writers I read, the friends who help scan for typos and grammatical faux pas, the mentors who help me hone the skills of the craft itself. Writing mirrors medicine in that regard, in the concept and experience of lifelong learning. We practice medicine. Writers constantly evolve too, and the best would assert that they are still trying attain mastery themselves (there is another Hemingway quote about that somewhere…).

For me, the act of turning thoughts into something tangible is both healing and sustaining. The world of medicine and surgery is exhausting physically and emotionally. We know the calling to care for others is and has always been special and all-consuming. More recently it has become increasingly frustrating as the pace of change accelerates and sometimes overwhelms. Change, both positive and negative, is stressful. Sometimes the negative seems to accelerate faster than the positive. Turning to writing, and the connection and community this has nurtured, has helped me navigate and mitigate these effects. Writing feeds a part of me I hadn’t realized was starving, exercising skills I had let atrophy. I am healing as I am writing.

I want to thank you who are reading this, whether new to my writing or along for the ride over the past year (or more). I don’t think you are really a writer or a blogger until and unless your words are read. So thank you for reading, for sharing, and making me a writer.

“Let me live, love, and say it well in good sentences.” – Sylvia Plath

“A word after a word after a word is power.” – Margaret Atwood

“One day I will find the right words, and they will be simple.” – Jack Kerouac

“Either write something worth reading or do something worth writing.” – Benjamin Franklin

“I was a late bloomer. But anyone who blooms at all, ever, is very lucky.” – Sharon Olds

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Dr. Kathy Hughes, out from behind the mask

Addendum:  It has been a tradition in this blog to start each entry with a quote (from a song/song title, saying, famous person) — or two or three. I went overboard today, because each of these quotes spoke to me and my writing, and in some way reinforce my story and feelings in this piece. And I couldn’t find a good rock-n-roll song to quote. Thank you for indulging me, this time.

Little Miracles

“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” Albert Einstein

“Miracles happen everyday; change your perception of what a miracle is, and you’ll see them all around you.” — Jon Bon Jovi

“The miracle is this: The more we share the more we have.” — Leonard Nimoy

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Sand and Sky, Summer, Ocean Park Beach, Maine

It is amazing when things in medicine work just the way they are supposed to —  it’s like a miracle.

When I take an antihistamine, I can breathe, and all the itching and sneezing stops. When I get an injection of local anesthetic, I can touch and poke and pinch to test that it is working — and it is. When I had an operation on my knee, an ACL repair, my knee stability was noticeably restored almost immediately, despite the post-op pain and swelling. I know these things work on patients, because books, observations, and experiences have shown me so. As a surgeon I get a kick out of operating on acute appendicitis, where often even in the recovery room immediately after surgery, the patient already feels better.

Yet I still marvel when I notice that this stuff is working on me.

I used to worry that as I entered the world of science, and then medicine, I would lose the ability to see beauty, to appreciate and be amazed and awed by the world around me. I worried that the more I knew about the details of how things worked, that I would not be able to see the glorious whole, the big picture, whatever that big picture might be.  Would the biology and chemistry and biochemistry and physics become like a filter on a camera lens, changing the way I would see these things? As I got deeper into this world of science and medicine, and then surgery, I was concerned that the experiences around me might overwhelm or blunt my humanity,  become mundane. Would I  become callous, detached, dispassionate? Would I still feel? Would I lose my faith, whether in people and humanity, or even more? Continue reading

Embracing Eternity

Eonia I Mnimi (Eternal Memory) – Greek Orthodox Funeral Blessing

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Sunset approaching after the storm, Falmouth, MA

“Have you ever seen anyone die before?” my cousin asked me, from across the bed.

“Sure I have, plenty of times,” I answered.

We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath.

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My uncle had been declining for several years with Lewy Body Dementia, and it had been accelerating over the past year or so. It was stealing him away, his mind anyway, though until lately his body remained strong. He wasn’t even on any medications, except the Exelon patch and Namenda to slow the dementia, remarkable for his 88 years. Last fall he had an “episode” for which he was hospitalized, and his doctors indicated that it was likely progression of his disease; so from then on, he had been cared for with hospice assistance. His death was certainly not imminent, within days or weeks, as one usually thinks with hospice involvement, but it was inevitable. There was not much to do from a palliative point-of-view, there simply wasn’t anything else to add to or to enhance his care. But as he declined, his family— especially my cousin — were going to face some hard choices about how best to care for him. The resources in the home, even with hospice and aides to help in his care, were rapidly becoming inadequate. As it turned out, they did not have to worry any more about breaking the promise they made to him.

*****

That afternoon I went to see my uncle, who had been living with my cousin for the past few years. I had been texting and emailing with her over the prior week, after he had another “episode”—this time more severe, like a seizure or even a stroke, from which he was not waking. He had not had anything to eat or drink for about a week, and had stopped voiding for the past day or so. He would rouse slightly, then drift back to sleep. She indicated that his breathing had started to become irregular at times, with long pauses. He had small doses of morphine and ativan sublingually to ease his breathing, though it is hard to say if those tiny doses did much, or how much was even absorbed.

When I walked in to the room with her, to sit for a while and keep him — and her — company, the breathing pattern was immediately recognizable to me. It was the classic, end-stage pattern of Cheyne-Stokes respirations, the crescendo-decrescendo pattern punctuated by apnea, pauses ranging from 10 seconds to nearly a minute, before the whole pattern repeated. He was not in any discomfort, there was no distress. It bothered us more than him. It also meant that the end was coming soon, some time in the next hours. Continue reading

Happy New Year! The Pause To Reflect

“Every new beginning comes from some other beginning’s end..” – Closing Time, Semisonic

Sunset, December 2014, Falmouth, MA looking towards Martha’s Vineyard

We come end of 2014, and to New Years’s Eve, the annual celebration of flipping the page to the next calendar year. This celebration has always seemed a little forced, a little arbitrary (especially as there are other calendars out there celebrating other new years). My brother, back when he was bartending his way through school, used to refer to it as one of the amateur nights. I enjoyed the parties, especially when I was younger and it was a chance for the old gang to reunite over the winter break.  As I have gotten older and friends have dispersed along their lives’ paths, I have preferred a quieter evening among family or close friends, if I am not working (and often I am). Some years I haven’t made it to midnight.

New Year’s Eve and New Year’s Day cap off the holiday season, and the completion of the calendar year. The last blast as we head in to the rest of a long winter, which has barely gotten under way, just past the solstice. It is a busy, hectic whirlwind time of year, full of lights and celebrations and family and friends and stress. Good stress and bad stress, but stresses all the same. It is also a time to reflect, take inventory. I think it is a good time to pause, and be still. Even if it is a brief island of peace in the sea of frenetic buzz and hubbub all around.

So as this holiday season and the year draw to a close, I am taking a moment of quiet, a deep breath, a pause, to be still. I invite you to do the same.

I reflect on this year as it comes to a close, and acknowledge the blessings and the people around me, who support me with their love, their affection, their friendship, their guidance. I can look back on the year just ending, its triumphs, its challenges, even its failures, with gratitude for the lessons learned from them all. Looking forward with hope and optimism, waiting to see what unfolds as I move into the new year. I know there are more challenges awaiting me; I must have faith that there will be successes, too, keeping eyes and heart and mind all open so that I recognize those opportunities as they present themselves.

Thank you for joining me on this journey Behind the Mask, as we continue forward together. Wishing health and happiness to all in the New Year!