Boston, we have a problem.
These have been strange, awful, wonderful times. I think of the Hebrew word “Norah”
which means both terrible and
terrific, although I’d translate it as “awesome.” The closest english translation would be from the Rhode Island " awful awful" which is a milkshake that's "Awful good." Been an awful awful year.
I just can’t
believe it’s so
Though it
seems strange to say
I’ve never
been laid so low
In such a
mysterious way
And the
course of a lifetime runs
Over and over again
I
was in Boston this week and met
with a doctor for the first time
in 5 years. Oncologists aren’t physicians. Shaman, one who
heals through magic, more
accurately describes the healers I’ve met over the past few years. A Physician assesses one’s health
status, reviews accepted forms of care, and acts accordingly. Physicians have road maps; Oncologists
are like Felix the Cat:
Whenever
he gets in a fix
He
reaches into his bag of tricks
Less facetiously, an oncologist is
a soldier, a warrior assigned to one specific battle with one goal: victory at
any cost before the enemy invades.
I
remember my days as an oncologist. Patients would ask about their rashes, diet
or the best form of exercise.
“Oh,” I’d say. “You’d
better ask a real doctor about that.”
My duty was clear, win the war against the Hodgkins or the Ewings, and let others have the luxury
of fighting non-lethal opponents.
I
always relished my role as oncologist, because every rare victory was a real
cause for celebration. I was a hero if I cured 20% of my patients. I have to do
better when I treat pneumonia.
I’ve attended parties held in my honor to celebrate a 20-year olders’ victory over lymphoma, I am rarely
invited to parties to celebrate a newly normal cholesterol.
If
cancer is a war, then I was Colonel
Robert Gould Shaw, the white Bostonian whose African American troops were massacred at the battle of Fort
Wagner. Despite that fact the union troops died horribly at the
hands of the confederates, Gould is a celebrated hero. Because he tried.
I
mention this because I thought of
my past life as an oncologist when I visited the Farber this week. Ted’s demeanor had changed, he was a different
person than the oncologist I have known three years. He was a physician, not an oncologist.
I
cannot describe the dread one feels when meeting one’s cancer doctor. Any given appointment can end with a
frown, a sad shrug, and the phrase “ I wish I had better news for you,” which was what Bob told me when my disease progressed. To visit an
oncologist is a leap of faith, an exercise in breath
holding and Xanax popping, the knowledge that, in an hour or so, your entire future
might have changed.
This
is how I have felt when I have
visited Ted in the past. I sit in
the exam room, holding my breath, waiting to be told, “ the disease is back,
there is nothing left to do” I
remember visiting Boston a few
years ago, when Dr Freeman said “ You
have no choice, your disease
is progressing and you need a transplant.” I remember wandering the MFA grounds in a daze, examining the Bronze sculptures and wondering if I’d
ever visit the Museum of Fine arts again.
The
past is prologue. I met with Ted
this week, and he had transformed
into a physician He asked about my blood pressure, my
cholesterol, and whether I should be taking aspirin. The Shaman who could have said, at any time, “The battle is over, sorry,” was now chatting about getting my
diastolic under 90 and my LDL under 100.
I remember my experience giving general medical advice to my cancer patients. I was usually
wrong. I smiled and told him I’d
run his ideas past my cardiologist,
Jim, my doctor.
I
wandered from the Farber, euphoric. I even walked to the MFA to take a victory lap among the sculptures.
The
news was waiting for me at home.
I
always wondered about last years’ blood clots. Hematologists love blood clots, they are usually caused by some disruption in the
coagulation/ anti coagulation cascade. The cascade is
a finely honed balancing act,
bleed too freely and you’ll bleed to death. Clot too freely and you’ll end up with
thromboses in the legs, Pulmonary Emboli, and strokes
So, why did I throw clots from leg
to lung? None of my physicians had
done a work up, so I took it upon myself to run an anticoagulation panel, see where the trouble lay,
wondering why none of the 20 or so
physicians I worked with had sent out these tests.
Leiden,
with its canals, museums and open-
air markets is a lovely city. Leiden is also home to the University of
Leiden, where, in 1993, scientists
discovered a new syndrome, Leiden
V ( Leiden 5). Briefly, patients
so afflicted suffer blood clots because
Protein C, an anti clotting factor, does not bind with Factor V, a pro clotting factor.
I
have Leiden V. I will always have Leiden V. Add it to my J date profile when
Cyn leaves me:
bald fat
leukemic, diabetic Tay sachs carrier
who also has Leiden V,
seeks woman with fewer genetic defects.
Clashing,
confusing, dizzying emotions.
Sorrow. I thought I was freed from the endless cycle of confronting chronic disease. I was tapering my meds, awaiting the
day when I’d pop a Flintstone’s chewable
and call it a day. I will
end every day popping Coumadin, until the day I die, and checking my Coumadin
level.
Amazing Grace
how sweet
the sound
to save a
wretch like me
I once was
cured
but now I’m
bound
To take Coumadin
through eternity
And then, welling up, Anger. The folks
in Boston could have tested me for
Leiden BEFORE I developed my clots. Even without the
disease, I was a set-up for thromboses. I have a blood cancer. I have chronic Graft versus host disease.
I spent weeks in hospital
beds. Several of my medications
provoke clot.
Shouldn’t someone have checked Leiden V BEFORE the clot hit the fan? It’s not a rare disease, 5% of American Caucasians have the gene, most never know.
The
Farber tests me regularly for HIV,
my likelihood of developing that
viral illness is about one in a million.
What
to do? The Boston folk have become
family. Ted answers his phone
24/7, and has been reassuring in times of stress. I cannot forget the time Cyn called him in tears. “Tell
me,” she sobbed, “Is Steven dying?”
Ted told her something I’ve never heard an oncologist say. “I guarantee 100% he will be alright. “ Oncologists never never NEVER issue blanket guarantees. And yet, his soothing words, true or not, were the perfect anodyne.
So why the fuck didn’t he order a Leiden V when I first contracted GVHD, knowing I was at risk for potentially lethal blood clots?
How
can I turn against my Boston family? Melissa and Melissa, my two nurses, have become sisters, we chat about
Melissa’s young child, I talk to the other Melissa about her orthopedic
issues. What about Franz? I love the guy,
an angel, a vast teddy bear of a man, he who arranges CT scans and Bone marrow
biopsies, who magically finds time
for my CT scan on an otherwise
packed day. I walked with him triumphantly through the streets of Boston, people cheering my fight against what was, 10 years ago, a uniformly fatal disease.
But, But, But.
But, But, But.
I
should have been started on couamdin before my clots. I should have known I was
Leiden (+) before I collapsed on the Killington ski slope, a tight metal band wrapped around my
chest, a pain I dismissed at Bronchitis but actually was a blood clot breaking
off from my leg and travelling to
my lung. Let me say this: No one survives that. Why do I live?
I have that odd, horrible feeling one experiences
at five or ten or 20 when one suddenly realizes ones parents aren’t omnipotent. I
placed my life in the hands of the Farber assuming they were also all knowing
and all wise. That was clearly a mistake. They’re no smarter than I.
I
sit in our living room awaiting 24
visitors for Thanksgiving. Our 90 pound turkey bakes in the
oven. We have had a tough year ,
there has been squabbling among family members. I try to remember they’re family, for better or worse. We have disagreements, moments of
unpleasantness, but I vow to move on, get past our petty issues. Thus it is
with my Boston family, people I
will know until I die, Hopefully decades from now.
Happy
Thanksgiving!