Taking time off

I'm doing it. I'm taking time off. I thought returning  to work would serve as salvation,  rebirth.  Redux, as  John Updike would say.
I may have been wrong

 I never understood Kafka's blather  about  the crucial skill of sitting tranquilly  in ones' room  amid books and papers. I need to be busy, obsessed, absorbed . I have experienced rich reward in work.  Much of what I do has no parallel in  the real world of Salaryman.

I've known many of my patients for decades. We have grown  old together,  developed diabetes and cancer , my patients and I . Part  of the miracle of my job is that my patients  understand  I am frail and mortal just like them,   We are  flawed, but we have each other.

My   support group  has protected me from the war roiling around us at work   Docs are leaving the group, and I cant  blame them. We work long hours and we are understaffed. If we cat work on a Saturday we must arrange our own coverage.  I suspect the   administration's  response to revenue shortfalls is to  make us work harder,  for longer hours . Reminds me of the  joke

 The beatings Will Continue Until Morale improves

 Why don't I leave? A cynic   would point out  the administration's  has me by the shorts.  The docs who regard their  patients as family will never leave.   The docs who view their job as an upper middle-class-carrer that could earn  big bucks if one gave Botox in the backroom  will eventually leave, anyway.
I remember when I returned to work  my mantra was  "I'd do this for free"  And I would. And, on some level, I do,  I am one phone call away from telling Solvy at Prudential the grand experiment of my retuning to  work did not work out.  I ca watch and re watch The Wire three times, I can re-watch  Arrested Development ,  pretend to  finish  A team of Rivals" again  which should bring us to 2019.

Which brings us  to today's  blog.  Pain.  Pain. Pain.   So much pain.  Comical,  out sized,  sarcastic.  Pain to make the tears flow freely  while I examine a patient and ask about an ill conceived ta too.  Its creepy.
  I can't work like this. the GVHD is back, a blind dentist  flaying around in the mouth  leaving  wreckage in its place.


Dilemma. Can't work in pain,  Cant work with  narcotics coursing in one's veins.  That sort of behavior ends on the first page of the Hartford Courant pic of me with  my  white coat  over my head,  reporters asking , in my estimation, how many died because I was taking medication. Dreamt last night I never went to med school,  I decided to be a lawyer ( or an Indian chief, the dream was unclear. Who  wears the   bird feather  headdress? ) I feel real fear in the dream content,  I may never work again.   The impaired physician is a cliche,  a pathetic  caricature. Me.

Shit shit shit.  This is the sort of blog  I never want to write, yet often seem to do so.   The blog  contains all the earmarks of post modern literature,  the inside  jokes,  pointless, self-serving, self pity

Funny story: I'm at the pharmacy  today picking up my meds. All my  scripts are stamped  DANA FARBER HEMATOLOGICAL  Malignancies  Department.  Its a free pass. No one 's gonna question my need for  drugs since I have the  big C. I feel as if I could buy a copy of  JUGGS magazine without a hint of embarrassment  "He's buying a titty magazine? Let him. he has cancer. poor guy, I hope the distraction helps"

I do a horrible thing: I open the  pills in the parking lot, junkie style.

Yikes. I should have 20  tablets of Ichor, I have 16.  Furious dazed, aching.  Some lab tech is having his own private party in some stairwell celebrating with my little white rounds of  tranquility and peace.

I am  not able to count to twenty, let alone remember the 8 diagnostic  features of  polycythemia vera . I storm into the pharmacy "You shorted me!"  I howl in righteous indignation, The  other  customers  swivel  to get a better look, some guy is going berserk.

Not the pharmacy's fault.

 For some reason, they distributed the pills  in various bottles. Why?  More to the point, I'm now that creepy guy, the guy you stare and and then slowly edge away from, the  stoned geezer  who pays cash for his narcotics to avoid the DEA.  After I apologize profusely, the pharmacist asks,  "Is it the heat?"  implying  the major side effect of sun exposure is a sense of being under dosed.

I return home .I can stop  wandering the house scaring the cats and kids,  mumbling "why doesn't god kill me now?"  This must be a key phrase one  learns at marriage counseling to avoid   I suspect "God Kill me now" is up there with  "I'm sleeping with your  sister" as what they call red-button expressions that have no place in life but enhance every  Coen brother movie .


I am not blind to the irony of all this. Most 55 year olders are  frolicking with grandchildren, wintering in  Boca and  reading John Grisholm's word.  But I cant  stop working  Who is going to tell  Ms Z that her cancer is back but to do it with such  affection and concern she honestly thanks me for the news.

I flash on Bonnie Franklin, One day at a time who died of pancreatic cancer last year


So while you’re here enjoy the view
Keep on doing what you do
So hold on tight we’ll muddle through
One day at a time, One day at a time.

Feh, less significance  than I remember    Nonetheless,  The enemy  is the doubt, The  not knowing. I called  the office , not coming tomorrow. Maybe not Friday.  Have to be off the pain meds.  This is obvious , too. There appears to be no answer.  Except to get better.  More doubt.    

Col Chamberlin

Josuah Chamberlin

It's 2:30 AM and I contemplate lieutenant Josuah Chamberlin, a personal hero.  He was ordered  to defend little round top during the battle of Gettysburgh.  He struggled to halt General Robert Lee's attempt to  cut the Union forces in two.
" Defend your position at all costs"

  His superiors never knew he  was  out of ammunition.  He would defend against the  confederates armed only with fixed  bayonets.

 Chamblerlin stopped the Grayback   advance. He   halted the enemy attack and kept the Union whole.

  This part of the  story is  remarkable, but doesn't explain my admioration for this union  officer.  He was repeatedly wounded during the War, and  lived with a pelvis filled with  Confederate lead until the day he died at the dawn of world war I

 I have done nothing so bold, so grand, so life affrimning. After the Civil War, Chamberlin became the Governor of Maine and then the  president of Bowdoin college.  He  lived a daily existance of  constant  pain.

  Daylight is three hours off. I gulp   the same morphine derivatives Chamberlin used 150 years ago.  We share one similarity    Neother of us is terminally ill, our dangerous pasts  replaced by the  merely nettlesome present.  The pain won't kill us and the question becomes: How to remain useful,  productive, happy  in a world of discomfort?
I am thankful,   grateful.  My  situation is not unique.  Many of us struggle with pain.  Cyn's back throbs, I have friends with trigeminal neuralgia  that feels like an electronic probe  surging pain into a jaw.

 How to remain  productive in pain -cloged days? Meditation? Medication?   I stuggled to  extricate myself from the prednisone and pain medictaion,   my  once and future constant companions To be useful. Beit Shamai argues in the  old testiment  that it would have been better never to have been born. He may be right.

My dear parents, I suspect , would have been much much happier  had they been childless.   I don't doubt their love for us, but still, makes you wonder.    Mom is an intellectual, she would have been happy  teaching,  reading, thriving in a  childless life with my dad. My dad is an engineer. His slice of heaven included his slide rule,  his  engineering journals and  his graph paper.  Children are messy, random and demanding. Had we never been born, my brother and I would have been spared much grief.
So why be born, how to explain existence without becoming facile, glib or  fatalistic? In my 2 AM persopetive, I will always be in pain,   I will go through my  remaining days with a fixed expression stretched to my face,  my patients will ask why  I am crying at work.  What to tell them?
 I am here for two reasons. I feel a real obligation to  Mark Heller, my  late father in law. He would have  said we are all soldiers " Come home on your  shield or with it," he'd say.


I'm finsihing Donna tart's The Secret history

She writes

πληθὺν ταρβήσας: τὸ δὲ ῥίγιον αἴ κεν ἁλώω
μοῦνος: τοὺς δ᾽ ἄλλους Δαναοὺς ἐφόβησε Κρονίων.
ἀλλὰ τί ἤ μοι ταῦτα φίλος διελέξατο θυμός;
οἶδα γὰρ ὅττι κακοὶ μὲν ἀποίχονται πολέμοιο,
ὃς δέ κ᾽ ἀριστεύῃσι μάχῃ ἔνι τὸν δὲ μάλα χρεὼ
ἑστάμεναι κρατερῶς, ἤ τ᾽ ἔβλητ᾽ ἤ τ᾽ ἔβαλ᾽ ἄλλον.

or, in the Samuel Butler translation:

"Alas," said he to himself in his dismay, "what will become of me? It is ill if I turn and fly before these odds, but it will be worse if I am left alone and taken prisoner, for the son of Saturn has struck the rest of the Danaans with panic. But why talk to myself in this way? Well do I know that though cowards quit the field, a hero, whether he wound or be wounded, must stand firm and hold his own.”

Hard to resolve  this.  Self  destruction or , more accurately, non  existance, would be cowarly, selfish.  We are here for others. If  Chamberlin had stayed at Bowden, the South might have won the war and Michelle Obama would be a slave.

   I have an obligation to raise the family, to set an example for my kids, his grandchildren. I have patients who need me.  Despite the pain, the battle rages on.  

We are not here  to  to enjoy  great meals, see great sights,  read great books, We are here because in the endless wash of eternity, we have  sentience  for a  precious scond of time,  before the draft ends  and we return to stable state,  our eternity as a wisp of silica dust spinning in some faceless corner of the sky.   Carl Sagan  wrote  we are Star Stuff.  In this perspective, all martter waits its turn to turn sentient, every atom gets its chance  to gaze through   conscience's   telescope, observe the   universe and contemplate our role in an indifferent  heaven.  

Whats a little splash of pain in an eternity of unconsciousness?  Don't worry the dentist warns,  this will only for a moment.

I come from the land of ice and snow. Idiot.

On the plus side, it appeared we had another 2 weeks of daylight. Alternatively   my immediate survival was in serious doubt.  I remember cold. Wet, damp. People talking at me, their faces etched with sudden strange concern.  They were speaking in swedish.  Maybe it was the wind.

The dreaded death spiral.

Could they land a helicopetr up here to airlift me out? Would I ask dear friend Allen to  fireman carry me down the 1000 foot lava field to safety?  Are there donkeys up here? I know there are asses.

Embarrassment.  I was about to force ten lovely  eco tourists  to change their plans from "a  sprightly  romp across the  boiling mud fields"  to "A scene from the Buthan death march  transporting some idiot who should not have  attempted  apline hiking while  gobbing prednisone and percocet  to fight the GVHD fire in his mouth."

Iceland’s summers are cold.  The air holds a vague Nantucket trace,  cool fog condenses on the fishing fleet bobbing in the bay. We had planned this trip last year as a lark, a hoot, a race among the runes. Four  hours from Boston.
We were standing at the exact spot Led Zeplin had wrtitten the immigant song  40 years ago

 I come from the land of ice and snow
 from the midnight sun
where the hot springs flow.

 I am stupid man, Stupid stupid man.  I think my IQ was clocked in at 150 something, but  I lack  the   sense that god gave geese.

On the plus side I rely on a near death experiences to  trigger   strange new blogs.

  I want to prove  I am intact, bold, rough, a AARP card carrying eccotourist  decked out in a 1000 dollers worth of high tech,  drip dry  synthetic, colorful  fabrics.
Eccotourist . A new word that  refers to anyone willing to use a staddle toilet and risk Hep A while on vacation.

The guide looks concerned " Do you have any health issues?" he asks. I laugh.

The vacation has been wonderful.  We biked the streets of Reykjavik, biked past Bjorn’s sea side house,  feasted on  cod tongue and swam the silicated  viscous waters of the blue lagoon.  Reykavyk has a  ski town feel, slightly tacky and shabby,  but a town with heart, soul,  people with ideas. Glad to be here.

Who can avoid dangerous drama?  It's wonderfully distracting. More to the point, If your only goal in life is not to lose consciousness and continence,    you can elegantly avoid life's real issues: A daughter who is one phone call from  joining an Amsterdam  boyfriend to open a vegan restaurant in the Hague.  She's running a YMCA camp this  summer,  exposed to  Bob cats and deer ticks.

As I  struggled with  losing consciousness  I feel  relief  I am suddenly spared obsessing over my parents' heath,  the  gun epidmeic in the US and the inexorable  fact  we are sliding  into  war with Russia.

  You can't hide from danger, no matter how  carefuly you try. Jeffrey is  spending his summer in Guatamala city,  learning  spanish and treating the local populace for parasites.  Guatamala city. Death squads, 45, 000 people dissapeared in the 1980s.  When his body goes missing  will our friends roll their eyes?   they'd NEVER let their  son work in a war Zone.  The  central American  tragedies were 30 years ago,  but Jeff walks on ground staurated with human  bone meal.

Be careful, I want to warn him.  Be careful.  Dont accept rides from  men in  military fatigues.

These warnings are useless.   What if you are a 19 year old American in love, who wants to visit a girlfriend in Kuala Lampur?    Does  flying 33,000 over a war zone count as  risky business? Was he a moron?

Can't run can't hide.  Last month a Danish tourist stepped off the path up here  and was instrantly parboiled. Really.  As he's lying there  frozen,  scalded and dying, did his tour  leader think  

heimskulegt Dane, þú ekki vara hann við að villast úr t leið?

 Stupid Dane didnt I warn him to stray from the path?


So many of my stories involve  near death experiences. I count my cherished freinds as people who have actively  intervened  to save my life.  God bless Allan, you saved my life in the  lava flows.  Thanks Tony, thanks Martha, I wouldnt be here if not for you.

Let's leave the sickening scene. I'm in my high tech rain gear, in the rain,  fog and steam.  I am hallucinating, frozen and  spiraling  toward the big sleep.  I can't stop shaking. It's 52 degrees.  Cyn  steps over,  embraces me and I start to feel the earliest trickle of warmth filtering back into my core. The Swedish mom has given me an extra sweater and a chocolate bar.  The hallucinations  fade. I will live.  I will be OK, even if it's not. We have no choice.

GVHD for you and me but mostly me

I'm back

Distant memories provoked Proust's creative juices  it appears my muse is the queen of pain

Pain focuses the brain,  creates barriers to  resist the  endless tide of  electrical fire racing through one;s mouth

Makes us whiny. Needy, unpleasant.
Welcome to my world. Again.

 I should not complain,  I have reached the season some of you have reached with me, the season of sick parents and friends of  failing organs and  children no longer children who insist on making  dangerous, destructive choices you had hoped they'd out grow by the time they could buy liquor or rent a car.

I planned long a illustrious decline.  I would  see patients, I would  cut back my hours, spend more time with Cyn and the  kids, slowly defusing across the  country, vital  life forces I am no longer able to control or regulate.

Let me tell you what's going on.

I was told to stop blogging.  I was warned it could hurt my practice.  Too bad. My old boss is gone.  I have things to say and life is just too short to cower.  We'll let the lawyers sort this out, that's what they are paid for.

Life was swell.  I had renounced  narcotics and steroids. My  skin stopped blossoming in a livid riverscape every time I bumped a gym locker.
The lack of stress was quickly replaced by the stresses all of us go through: An alarming birthday ( 55? No shit, I'll be dead soon) My parents' friends, whom, I remember as young sparking adults are now dropping like, well, like the  oldsters they are. My parents are holding up ( ptooo ptoo) but their lives and bodies are  sand castles along a stormy shore. What did Bob Dylan say?

It's an endless ocean,but it stops at the shore.


And so the distractions returns. Am I living ouy a useful decline?  Are my parents suffering?  Do I have to attend yet another Shiva   and speak fondly of a man I knew in 1972?

And then. The pain. Or rather, THE PAIN
  My mouth exploded in fire,  the sensation of sucking on  a  polishing  drill bit.  GVHD, GVHD GHVD

 I though I out grew this shit.  Cyn likes it, on some level, calls it my insurance . She likes the thought the German have re armed are are once again patrolling my mouth, searching for spies stragglers and invaders

And I have returned to, shall we say, medical management. The meds suppress the pain for 6 hours or so and then the red tide returns.
Its not all bad.  I have lost a lot of weight. I am re notching my belt. My facial skin is tightening up,  my million dollar face lift. Yay.
There must be a  market for Graft Versus host disease. I have patients who underwent surgical mutilation to lose weight.  They  had their  stomachs air lifted out  so their diabetes would abate, their clothing would fit. Their  misery strikes me as much worse than a little GVHD . Throw in a  face lift, we are golden. doesn't Jennifer Gardner  talk about her new  skin cream, the one that contains stem cells? Or am I confusing this with  Cameron Diaz wiping  Ben Stiller's DNA on her hair. Whatever.
Whatever.
Problem :Can't see patients with involuntary tears running down my face. Cant see patients  hopped up on a magical medical cocktail. Cant stay home and watch reruns of Modern Family
Cant Cant Cant. The daily Cant.
Cyn says it will get better. The prednisone will work, Ill feel better, I'll return to work.
Welcome back