Potpourri

On Writing: Marking the Anniversary of a Blog

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“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.

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A Matter of Faith

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“Have a little Faith in Me” – Have a Little Faith in Me, John Hiatt

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Russian painted wooden Easter eggs

Spring ushers in major holidays in many faiths and religions. Western Easter has just passed, we are in the midst of Passover, and coming to the close of Holy Week with Good Friday for Eastern Orthodox Christians, making final preparations for their own Easter celebration.

The rites of spring and the vernal equinox, new life and rebirth are springtime themes and touchstones across many cultures. Faith is important to many people and across many cultures and religions. I would assert faith is even important to atheists and agnostics, and those without a formal religious tradition.

Faith is important in medicine, too. Continue reading →

Embracing Eternity

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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.

*****

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 →

Snow Day

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“When I no longer thrill to the first snow of the season, I’ll know I’m growing old.” – Lady Bird Johnson

“The snow doesn’t give a soft white damn whom it touches.” – e. e. cummings

“Come in, she said, I’ll give you shelter from the storm.” – Bob Dylan

Snowy Day, Winter 2014

Snowy Day, Winter 2014

 I am not that different now than I was as a kid, with the prospect of a snow storm looming in the future. As the storm approaches and the forecast comes in to focus, I feel the spark of excitement building in my core. I can’t help but feel this quickening, the magnitude paralleling the magnitude of the anticipated storm.

Here in New England, we are bracing for a storm of “historic magnitude”, “Top 5” , whatever that means. A nor’easter predicted to blow in and lay down between 2 and 3 feet of snow where I am. What a thrill!

Things are different now, of course, than in childhood. Instead of the delicious prospect of a bonus day off from school, spent “helping” dig out, playing in snow, and getting Mom or Dad to make up some hot chocolate or a warm nourishing comfort-food meal, more practical preparations and planning take precedence.

The planning is ever present. As a doctor, and especially an on-call general surgeon, it is critical that I be able to get to the hospital regardless of the weather. 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!

Remembering a Friend, Forever Young

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“May you stay forever young…” –Forever Young, Bob Dylan

“Eonia i Mnimi (Eternal Memory)” -Greek Orthodox Funeral Chant/Hymn

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Maine coast, morning fog

In the holiday season and as the year is drawing to a close, a paradoxical melancholy creeps in amidst the celebrations and holiday cheer. We take even a brief moment to pause and reflect on the past year and on past holidays. It is a good time to dwell a little while with those memories.

At this time of year, social media is rife with posts and alerts reminding us all to be kind and gentle, sensitive to those around us who are in pain. There are many for whom the holidays bring no joy, no cheer, and symbolize stress and loss. We are asked to be on alert for those who may be in crisis instead of celebration.

In health care, it seems as if this time of year ushers in a spike of tragedy. More stress over more severe illness, more sadness over profound losses. It seems more acute, more raw, more shocking, as these sad events play out in stark contrast to the festivities celebrating the joy and cheer of the holidays around us. Even if the numbers don’t bear this out (though they might), it is this sharp contrast between joy and grief that etch these memories more deeply in our minds.

These memories color our reflections of the holidays. They are good reminders to be aware and sensitive to those around us.

Today’s musings are more personal than medical.

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

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“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 →

Changing the Clocks – Timely Observations

“Let’s do the Time Warp again!”  – The Time Warp, The Rocky Horror Picture Show

 

IMG_1911I am always a little out of sorts in the days that follow the time change every fall and spring.  I find it easier to get up in the morning when it is light out. In the fall, that is only temporary, and the light continues to slip away and fade as we pass into winter, when the days – or at least the daylight hours – are shorter. So changing the clocks only provides transient respite from the coming dark mornings.

I think people might like the idea of adding an extra hour to their day, as we change the clocks in the fall and despite the annoyance of resetting clocks, as much as they dislike losing that hour in the spring. We all imagine a luxurious extra hour of sleep, though that fantasy is usually thwarted by the reality of our schedules and our internal clocks (especially if you have pets or small children, even if your own internal clock can be ignored). Those internal clocks take frustratingly longer to adjust, so you end up simply waking an hour or so early. When we lose that hour in the spring, we almost invariably sacrifice an hour of sleep, as our busy schedules end up  overriding both lost hour and internal clock. We can be out of sorts with a side of zombie as we tackle those first few days.

The view of the time change is a little bit different for doctors, and anyone who must be on call for their job, though much of what I have just observed still holds. I can speak best to my experience of this as a doctor, though, so it is that perspective I will use. I view the time change, and much of my world in fact, through the prisms of being on call and the on call schedule.   Continue reading →

What’s in a Name

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A rose, by any other name, would smell as sweet.  Wm. Shakespeare, Romeo and Juliette
A rose is a rose is a rose.  Gertrude Stein

IMG_1551“This is Dr. Hughes” or “Hello, I’m Dr. Kathy Hughes” — This is how I answer the phone, or introduce myself as I walk in to a room.

I think it matters what I am called, how I am addressed. It also matters what I call you, as my patient, and how I address you.

Any Tom, Dick, or Kathy  can be Tom, or Dick, or Kathy. But it conveys a special role and relationship to use one’s title or formal name. Not everyone can be Doctor to you, and especially not Your Doctor. It is a special and particular relationship that I have with you. I’m your Doctor, I’m your Surgeon, I’m Dr. Hughes.

And in addressing my patients as Mr., Mrs., Ms., or Dr. (perhaps only with the exception of the very young and the very old, where stage of development or dementia interfere) I also convey and acknowledge the special relationship they have with me.

I admit, I still call my parents Mom and Dad; my aunts and uncles have likewise retained those titles. And even to their chagrin, I use the formal titles to address my parents’ friends, and my old teachers and professors. It’s not just a reflection of how I was raised, but an acknowledgment of the special bonds and relationships in this part of my life, too.

It is important to acknowledge these relationships and bonds. How you address someone, what you call them, does that. It is like a shorthand, a shortcut, spelling it out. It honors them–the relationship, the bond, the person.

I remember a lot of eye-rolling and joking at the expense of the early feminists in the Sixties and Seventies, when they objected to what they felt were sexist titles and names. So work titles like “Mailman” evolved to “Mailperson” to “Letter Carrier”; first year college classes changed from “Freshmen” to “Freshpersons or Freshwomen” to “Firsties” (at least at some Womens’ Colleges). But as silly as some of this seemed and seems, the feminists had it right–there is power and identity in what you call something or someone, or how you refer to them; power in naming. Likewise, the kind of naming, or failure to name, can do the opposite, diminishing power and instead offering disrespect, even contempt.

I confess that I bristle when I am called by my first name by a patient or their family member if I have not invited them to do so. Continue reading →