Pretty in Pink (Rethinking Pink)

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

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October 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.

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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.

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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.

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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.

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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!