After reading Cutting For Stone, I was hungry for more from author Abraham Verghese. Wow, was this a great book. Like some of my other all-time favorite reads, it took me a while to get into this one, but once I did, I was so well rewarded. I felt a little bereft when it ended, another sign of a great book. The characters were so richly drawn, they truly seemed like real people, and I was sad to think I wouldn’t know what happened to them for the rest of their “lives.”
I’m not crazy; this happens with good books, and I’ve heard other people say the same thing so I know I’m not crazy. At least not in this case.
I searched in vain for more books by Abraham Verghese and although he’s written prolifically for such esteemed magazines as The New Yorker and The Atlantic Monthly, he doesn’t have dozens of novels at the ready for voracious readers. He has written a book called The Tennis Partner, however, which I quickly scooped up on amazon.com.
Verghese is an infectious disease doctor and has been a professor of medicine at Harvard and Stanford, in addition to being a bestselling author. The Tennis Partner tells the story of Verghese’s friendship in El Paso, TX, with David, a medical student who is a recovering drug addict. Their friendship grows amid a shared love for tennis, and they both find the game to be “an island of order in the midst of personal chaos;” in Verghese’s case, his crumbling marriage, and in David’s case, his drug addiction.
One of the things I love so much about Verghese’s writing is his innate ability to describe a scene in such a way that makes it familiar and easy to visualize. For instance, when writing about moving to El Paso, Verghese says “This is the great promise of moving: that if you fold your life into a U-Haul truck and put it on the road, you will be given a clean plate with which to approach the buffet.”
Beautiful prose. Simple and clean, yet so on-the-money descriptive.
It’s a great story, not just because of the tennis. Both men were struggling with different things in their lives, yet tennis became the equalizer. Verghese says, ”In the way we controlled the movement of a yellow ball in space, we were imposing order on a world that was fickle and capricious. Each ball that we put into play, for as long as it went back and forth between us, felt like a charm to be added to a necklace full of spells, talismans, and fetishes, which one day add up to an Aaron’s rod, an Aladdin’s lamp, a magic carpet. Each time we played, this feeling of restoring order, of mastery, was awakened.”
I get that. Wow, do I get that. One of the reasons I wanted to get back to playing tennis as soon as I could post-mastectomy was to impose order on a disorderly life. And guess what? 9 days post-reconstruction, I already can’t wait to get out on the court and put this mess in order.
One line in the book has really stuck with me, and I carry it with me in my game. David and Abraham are battling it out on the court, David being the more experienced and younger (read: more spry, less creaky, and speedier) player. He always manages to best Abraham, and after yet another victory explained his winning strategy. It’s very simple. “Remember, the one with the fewest errors wins.”
True, so true, and not just in tennis.
I love tennis, and I’m fascinated by how the human body works. I’ve written about this before, and now that my latest surgery is in the rear-view window, I’m again impressed with and amazed by how our bodies react and heal.
I’m also fascinated by doctors. Surgeons, especially. Not in the “reverence for the white coat” aspect of previous generations, nor because of the fact that they perform a very difficult job. There are lots of hard jobs out there, and I’m sure there are plenty of things other professions require that docs wouldn’t handle well.
It’s more a fascination with what makes them tick and how their minds work. I always want to ask my specialists, why did you choose oncology? why did you choose plastic surgery? I’m overly curious (some would say nosey) about the minutia of their jobs: how many patients call them after-hours? how long does it take to repay med school loans? what do you do to unwind and feel like a regular person? I mean, after say, a 7-hour surgery in which they restore order to a hellacious mess of a chest wall, do they wash up, drive home in traffic, pop a beer and veg out? Or do they refrain from drinking, even after a long day, because they can be called into surgery at any moment?
Verghese writes quite eloquently about the physician as a regular person and of medical humanism. He’s an old-fashioned doctor in a modern world, and he teaches new-fangled doctors his ritualistic bedside observations. He believes medicine is a passionate and romantic pursuit, not just a science.
Kinda reminds me of my own infectious disease doc telling me that in my case, because of the post-surgery infection, he was practicing the art more than the science of medicine. A lovely thought after months of exams, tests, and hospitalizations that had left me feeling like a piece of meat. Not Grade A meat, either.
As I prepared for my most recent surgery, I remembered a lengthy but compelling passage from The Tennis Partner. Even though my pre-surgery to-do list was a mile long, I found myself flipping through the book to find this passage. I wanted to re-read it, as if absorbing these words into my brain would somehow transfer into the surgeons’ hands as they cut me open and tried to repair the damage that had been done. It took a few minutes, but I found it.
Verghese was treating a young woman in El Paso with mysterious symptoms and no clear diagnosis. He writes about how as he entered her hospital room, he was looking for more than just physical manifestations of an illness:
“I was attentive to the aura of the room, vigilant for her icons — a doll, rabbit-ear slippers, a prayer card, her own nightgown. I inhaled discreetly so that her scents, all the eructations and effluvia that were hers, the redolence that night spell the name of the disease lurking below, could land on the free nerve endings of my olfactory nerve. Smells registered in a primitive part of the brain, the ancient limbic system. I liked to think that from there they echoed and led me to think “typhoid” or “rheumatic fever” without ever being able to explain why. If the diagnosis eluded us in the first few days, her chart would thicken as pages of computer printouts bearing witness to the blood urea, the serum creatinine, the liver enzymes, and other soundings accumulated. But no computer could make the mind-pictures I could form if given the right clues: a liver hobnailed by cirrhosis; a spleen swollen like a giant and angry thumb from mononucleosis; a smooth-walled cavity in the lung apex within which a fungus ball clatters like a bead in a baby’s rattle.”
I love the “eructations and effluvia” especially. That’s some good alliteration.
I also really identify with the patient, and know that I too have a chart that has thickened with computer print-outs and such. Not that it’s a contest, but I bet my chart is thicker than hers.
I was out cold in the OR, having unspeakably nasty things done to my body to restore the damage wreaked by the post-mastectomy infection. Whew!
The first couple of days of week 1 are pretty hazy, thanks to my BFF morphine. Love that stuff. But my BFF knows its proper place, and we have short but infrequent get-togethers. This time around, my BFF gave me a terrible headache, which was quite rude, so I bid adieu to the pain pump as fast as I could.
Let’s start from the beginning. Or as much of it as I can remember. Readers, feel free to chime in when you notice I’ve left something out. We got to the Medical Center on time (6 a.m.) and I got right into my pre-surgery room. My beautiful gown and compression stockings were waiting for me, but I waited until the very last minute to don them. After some precursory steps, like accessing my port for the administration of the really gooood drugs, a gaggle of white coats entered the room.
Dr Spiegel led the way, with her PA Jenn next, followed by their resident, Dr McNight, then my favorite plastic surgeon. He was the only guy in the room. Yahoo, girl power! He had a cool wooden box in his hand and when I asked if it was a present for me he gave me one of his looks. Someday he’ll appreciate my humor. Inside the box was not a present, but his loupes, which sadly he didn’t offer to model. I’d love to see him in a pair of goofy glasses.
Dr Spiegel and Jenn started marking my belly and I’m so mad I didn’t think to take a photo because it was cool. They used a blue sharpie for arteries, a red sharpie for blood vessels, and a black sharpie for incision lines. Lots of arrows and lines later, there was a roadmap of sorts. Very cool. At one point, Dr Spiegel wasn’t happy with an incision mark so she had Dr McNight scrub it off my belly with alcohol and re-do it with the black marker.
After that it was time to head to the OR, and they must have given me a cocktail in the pre-surgery room, because I don’t recall anything after the sharpie party. When I woke up, some 8 hours later, I felt pretty good…but it was because I was wrapped in the loving embrace of some big-time anesthesia. Dr Ashmore, my hand-picked anesthesiologist, did a fantastic job of putting me to sleep, and more importantly, waking me back up. It was good and restful.
I’m not too sure about whether I was in a recovery room or went straight to the ICU, but once I got to ICU I recall that it was HOT. And I’m a Texas girl, so I know about some heat. The docs had warned me that the room would be warm, to help my newly transplanted blood vessels learn to regulate themselves in their new northern home. But wow, was it hot. Between the high temp, the two heaters, and the squeezing of the compression hose, I was roasting. I tried to be nice about it, and I think I only lost it once, when I begged one of the ICU nurses, probably Carol, to please please please just crack the door and let some AC in. Just for a second. She declined my request.
I spent the night in ICU, but thankfully the flaps, aka former belly skin & fat that were magically transformed into breasts, behaved and there was no drama (other than me begging Carol to crack the door, turn down one heater, turn up the thermostat or bring me a gallon-sized frozen margarita). The flaps had to be checked every hour, yes every hour, with a hand-held doppler. There were (until yesterday) some wires stitched on top of my chest that somehow transmitted audible sound of the blood rushing through my newly transplanted blood vessels through the doppler. It sounded a lot like a fetal heart monitor. And we heard it a lot. My flaps were cooperative, and the nurses were able to hear the blood rushing almost instantly after putting the doppler onto my chest. One nurse told me that sometimes it took 20 minutes to find the sound. I started to panic after a few seconds of not hearing it, so can’t imagine the size margarita I would need if it took 20 minutes to register.
The ICU room had a wall of windows with mini blinds, and the nurse was right outside the door at a desk looking into my room if not attending to her one other patient. Some people might think that would make you feel very safe and catered to, but it made it hard to sneak anything by her because she was always watching. If she wasn’t watching, somebody else was walking by. It was a constant parade of doctors, residents, nurses, PCAs and other people peeping into my room.
I got released from ICU after some really delicious jello and a contraband peanut butter & jelly sandwich (liquid diet…pffft) into a regular room on the 8th floor of Dunn Tower. Lovely view out the window of the heart of the Texas Medical Center, and more importantly, no heaters. It wasn’t exactly chilly in the new room, but so much better than the ICU room. Nevertheless, I did beg to have the tight, scratchy, hot compression stockings removed. Those nurses were not swayed by my shameless begging.
Apparently the docs were pretty pleased with their handiwork, and if you missed Trevor’s and Amy’s guest blogs while I was too loopy to post, go back and take a peek. Long story short, the flaps were cooperating, the morphine headache abated, some regular food arrived, and life rolled on. At some point they moved the flap checks to every two hours instead of hourly, which was mighty nice. It’s amazing how your perspective changes in a situation like that. After umpteen hours with no food, a simple PB&J was a delicacy. After being awake most of the night, a short cat-nap seemed a decadent luxury.
I’m sure I said some goofy stuff and probably offended someone at some point with my off-color humor. Apparently I channeled my mom, too, telling my friend Laura who works at Methodist and who visited me several times a day, “Thanks for dropping by.” Every time she came by. I was just being mannerly and didn’t realize I’d seen her a few hours previous.
There are conflicting reports on how the turf war between the Drs S played out. All parties are being quite cagey on the details of who did what part of the surgery, and like a good murder mystery, we may never know who real killer was. I have my suspicion, but even asking point-blank hasn’t garnered an answer, so we may have to label that information “permanently classified.”
I did get to skate out of the hospital a few days ahead of schedule, and even though I received impeccable care, I couldn’t wait to get out of there. Coming home is always sweet, but never as sweet as when I’m leaving a hospital room.
I have more mobility than I did after the mastectomy, but not as much as I’d like. The first few times I had to get up without using my arms but relying on my legs and abs, the hip-to-hip incision on my tummy protested mightily. But it got better every time, and now I do it almost without thinking about it. Almost. I still can’t walk completely upright because the incision is still very tight, but I’m not quite the Quasimodo I was in the hospital. I get a bit straighter every day.
I came home with 6 JP drains this time, and had to upgrade my VB sling bag to a bigger VB bag that could accommodate the drain party. I knew from last time around that 4 drains fit nicely, with a little extra room for my Blistex, some folding money, and a teeny ziplock bag of pills, should they be necessary. Six drains would have burst my handy little bag right open. Wonder how many drains this lady is toting in her VB bags?
I had my first real shower today, not counting the seated variety the hospital offers. Again, it’s the little things we take for granted. I’m down to just 2 drains and back to my sling bag, thanks to Jenn removing the 4 drains up top yesterday. She gave me a good report; everything looks good and is healing nicely.
While I feel a whole lot better and am ready to get back to normal, my handlers think one week post-op is a bit premature to jump right back into the day-in, day-out routine. I am trying to take it easy. I’m resigned to the fact that I’m back to one outing a day for a while, and sadly, a doctor’s appointment counts as an outing. Yesterday I had a small entourage escort me to see Jenn, and we had a bite of lunch (sans margaritas) beforehand. The handlers insisted on snapping a photo of this maiden voyage, and there was some talk of me earning a margarita for every device I had removed at the subsequent appointment. Between the two doppler wires and the 4 JP drains, somebody owes me 6 margaritas. No salt.
Although I complain about going to the med center, there’s always something interesting to see along the way. Getting out of the suburbs is a good thing, and there’s a whole ‘nother way of life in this big city of ours. Last time I was at the med center for some testing, I saw this car and had to take a picture, to show Macy. I knew this car would appeal to her:
and had to snap a picture. Yes, it is a zebra car, complete with a long tail. Gotta love the big city.
And that doesn’t happen very often.
As you lovely readers know, I usually have a lot to say, about a variety of topics, and one of my favorite things about blogging is being able to blab away about whatever tickles my fancy at the moment. Sometimes silly, sometimes ticked off royally, sometimes serious, but rarely speechless.
When I saw yet another envelope from the Methodist Hospital, I didn’t think much about it because I get a lot of mail from that fine place. Between the bilateral mastectomy and the post-mastectomy infection, I’ve spent a lot of time at Methodist, both in Sugar Land and at the Medical Center. Getting mail from Methodist is nothing unusual. (If you click on the Sugar Land link above, you’ll see a pic of several doctors on the Methodist SL home page. The dark-headed one on the far right is my oncologist, Doogie Howser. Yes, he is that young, and yes he is that cute in real life.)
But this letter is definitely unusual.
Now I’m not dogging Methodist. I’ve had most excellent care there on all of my visits, and I don’t for one second take for granted the supreme luxury of having such esteemed medical care right around the corner (Sugar Land) and a short hop down the toll road (Med Center). I know that people come from far and wide to seek care at the places that are easy drives for me. So let’s be clear that I’m not dogging Methodist.
One of my favorite things about Methodist SL is this:
Love that. Hell yes, I should get special parking, right up front, at the breast center. Even though until just a few days ago I had no breasts, I still liked the special treatment that Methodist SL affords its breast care patients. Wish the grocery stores and Target would follow suit.
But back to the letter.
I know, I know it’s a terrible picture. The iPhone camera stinks, but it’s convenient, and let’s remember, people, that I am 5 days post-op here, with 6 JP drains sprouting from my body, and today was my first day without any pain pills, so keep your comments about the shoddy photography to yourself. This is not a photography blog, after all. I probably shouldn’t even be typing yet, but I’m dedicated to bringing severe belly laughs to you, my lovely readers, so you’re welcome.
Since it’s such a shoddy photograph, let me reiterate the juicy parts: The Methodist Sugar Land Hospital Breast Center’s records indicate that based on my US mammo f/U uni performed on March 22, 2010, it is time to schedule a routine screening mammogram.
Oh, you mean the mammogram last March that set off the chain of events, preceded by my annual well-woman exam, that led to me being diagnosed with breast cancer at age 40? That mammogram?
The letter goes on to tell me that I need to be aware that many breast cancers do not produce symptoms. That “early detection requires a combination of monthly breast self-exams, yearly physical exams, and periodic mammography according to your age and physician’s recommendations.”
And that I should contact Methodist Sugar Land Hospital Breast Center at 1-800-HOW-STUPID-IS-THIS to make an appointment, and they thank me for my cooperation.
The irony is stifling.
On one hand, it’s nice that the MSLHBC is so on top of things as to remind its patients that it’s time to come in for the good old smoosh & squeeze. Lots of women need reminders, and the hospital certainly should not be tasked with knowing I don’t happen to be one of those women.
On the other hand, it’s pretty hilarious and utterly ridiculous. And scary, too; don’t forget scary: the idea of anyone touching my newly sculpted chest, much less putting it through the greatest flat iron ever, makes me very, very afraid.
Thank you, Methodist, for the reminder. I will get right on it.
The body is a miracle, the way it heals. A factory of survival and self-repair. As soon as flesh is cut, cells spontaneously begin to divide and knit themselves into a protective scar. A million new organic bonds bridge the broken space, with no judgment passed on the method of injury.
Wow. That’s pretty prose. I wish I had written it.
I’d love to claim it as my own, but that would be wrong, and Lord knows I need the great karma wheel to turn my way. I can’t afford to tempt the gods of fate, as they seem to like toying with me.
Carol Cassella wrote that prose. If you’re a fiction fan and don’t know her work, I encourage you to get her books sooner rather than later. Whether you run to the bookstore or download onto your e-reader, get on it. You won’t be sorry. She’s an anesthesiologist-turned-author whose first book, Oxygen, is one of my all-time favorites. Her second book, Healer, wasn’t quite as good but I gobbled it up in hopes that it would be. I liked her right off the bat, because she’s a Texas native and a Duke graduate. A girl after my own heart. She’s also the mother of two sets of twins (!) and how she got anything done, much less wrote 2 bestsellers, is a mystery to me.
I read Healer this summer, while I was trying to heal. I was struck by the passage above, and loved how dramatically it introduces the book. From the very first sentence, I was hooked. While I certainly didn’t set out to turn this blog into a space for book reviews, sometimes things happen that way, and I’m an equal-opportunity blogger, so there we are.
As a physician, Cassella understands the intricacies and magic of the human body. As an author, she’s able to capture that and express it so that someone like me, an impatient patient, can read it and say, yeah, that’s right–the body is a miracle!
I needed that reminder. I was so focused on wanting my healing to occur faster, I didn’t realize that the fact that it was happening at all was amazing.
Equally amazing is the education this experience (e.g., the “cancer journey”) has provided. I’ve learned a bunch of lessons I never wanted to learn, such as how utterly unfair life can be. I’ve acquired skills I never thought I could and hope to never have to use again. Anything involving packing a wound or administering IV drugs at home falls into that category.
I’ve certainly learned a new vocabulary. Not just the new definition of “normal,” either. Things like nosocomial (originating in a hospital, as in a nosocomial infection). Like debridement (removal of foreign material or dead tissue from a wound in order to promote healing). Like aromatase inhibitors (drugs like Tamoxifen that lower estrogen levels in the body by blocking aromatase, an enzyme that converts other hormones into estrogen). Like oophorectomy (surgical removal of the ovaries).
I’ve learned how to get a good night’s sleep in a noisy hospital. I’ve learned the difference between DCIS (ductal carcinoma in situ) and invasive breast cancer, and that they’re both plenty scary. I’ve learned that an injection can leave a bruise for close to 3 months. I’ve learned that the practice of medicine is both a science and an art. And I’ve completely forgotten what it feels like to wear a bra.
Those of you fortunate enough to know my daughter Macy know she has a love for animals that’s as big as Texas. She’s said from her earliest days that she wants to be a vet and a zookeeper. I can think of no other vocations more suited to her, and despite the fact that she may end up at Texas A&M (oh, the horror!) for vet school, I support her.
Getting a little ahead of myself, again.
Keep in mind that we already have two dogs and three fish in our house, and that on any given day I’m meeting myself coming & going just keeping up with the necessities of getting through the busy day. So when Macy asks for another animal for Christmas, I heave a big sigh and think, what’s the best way to change the subject?
This isn’t the first time she’s asked for another animal. In fact, every time we go to the pet store she lobbies hard, and that girl is persuasive. Factor in my own love of animals, and we’re lucky we don’t have more of a menagerie around here.
I knew we were in trouble this time, though, because the only thing on her Christmas list was an animal. Uh oh.
A note about this child: from the moment we saw the sonogram image of her in utero we knew she was different. Different, good, that is. That first image showed a beautiful profile with her tiny wrist laid flat against her forehead in classic Scarlet O’Hara pose, as if from the very beginning she was thinking up some form of drama to unleash on the world.
Macy has never been like other girls. She never liked the Disney princesses, and to this day can be heard muttering under her breath when she comes across one of them on TV, “That Belle is so stupid.” When all the other little girls were having a Tinkerbell-themed birthday party, Macy wanted a barnyard theme. When all her little preschool classmates were tottering off to ballet class, she was in the backyard, digging for worms and filling the birdfeeder.
So it should come as no surprise that this fiercely independent girl not only goes her own way (despite the crowd), but has stayed true to herself for all of her 8 years. Her love of all creatures is here to stay.
While her first choice for a new animal was a chinchilla, the $150 price tag turned me off, and Trevor has a strict “no rodents” rule, so she moved on to a turtle. I told her that, while fascinating, turtles stink and I’m not sure they like to be handled, so she may be disappointed with a hard-shelled creature. Next up was a bearded dragon. Considering they grow to be 3 feet long and eat live mice, the answer was not just no, but no way.
Cue the leopard gecko.
Macy has taken care of a friend’s leopard gecko, the beloved Rico, so she (and we) knew what they were all about. So I went to Petsmart last week to look into it, see what all we would need to make her Christmas dreams come true this year.
There was a sale on leopard geckos. I love a good sale. However, that also meant, as the reptile lady pointed out, that they were selling more of the geckos, so I might want to go ahead and get mine and avoid the risk of coming up empty-handed when I was ready to purchase. Tricky sales technique, and it worked.
I brought the little guy home and set up his tank, with the two lamps and fake plants, the cave and the water dish. I put the mealworms in the fridge and thought about the best place to hide him. I settled on the guest room closet and when the kids got home from school, told them to stay out of there.
All was well. Or so I thought. I snuck up to the guest room to feed him the mealworms twice a day and to switch the lamps from day to night light. I thought I was being pretty sneaky. But a few days ago, Macy came downstairs with a very long face and a worried countenance.
After some coaxing she finally came out with it: she’d been looking for her clipboard and found the tank in the guest room closet. She was afraid she’d be in trouble, but truth be told, I was relieved that I was no longer in charge of the gecko’s care. I didn’t realize how stressful it was to keep him under wraps and alive until Christmas.
So we moved him from the guest room to Macy’s room, and she was tickled pink to know that she was the proud owner of a leopard gecko. We were busy getting his lamps plugged in in her room and so it was a few minutes before she decided to lift the cave and lay eyes on her new creature.
Sorry it’s graphic, but that’s life, people. The new gecko had dropped his tail. Apparently it’s common as a defense mechanism (when they’re being hunted) or in times of stress. Guess this little guy was stressed about his new home.
But the little zookeeper wasn’t grossed out, she was worried. She was afraid he was going to die. Cue the tears. Merry Christmas, everyone.
After some quick Internet research, she was reassured that he was ok, this was something that just happens and that his tail would grow back in a month. We made another trip to Petsmart to treat him to some live crickets (gecko comfort food), and all was again right in our world.
Kinda creepy, if you ask me. But as the little zookeeper later explained, it’s all part of life, for a gecko.
I didn’t really think about the significance of it all because I was wrapped up in just getting there on time, but thanks to my bossy-pants partner and several others who’ve remarked upon this particular topic, I’ve now officially clued in.
It’s probably a good thing I didn’t have time to think about the significance of all of this, because I might not have enjoyed it as much. I would have over-thought it and put a bunch of undue pressure on myself and forgotten to savor the fact that I was there, upright & healthy and swinging my racquet. It seems like a long time ago that I went through everything I’ve been through, with the cancer and the surgery and the infection and blah blah blah. It seems like a long time ago but it really wasn’t.
It’s a good thing I was thinking more about the logistics: getting both kids off to school, having my costume ready, packing my tennis bag. If I had stopped at any point yesterday to think about the fact that just 2 months ago I was in the hospital, my mind might have been on something other than slamming that perfect volley at the net player’s feet. If I had remembered that 2 months ago, I was sporting a 5.5-cm-wide wound in my chest wall, I might have double-faulted every time I came up to serve. If I had pondered the fact that I had a raging infection, my passing shots may have lacked authority. If I had spent a moment recalling the 22 days I spent in the hospital this summer, that cross-court winner placed just inside the alley would have fizzled. If I wasn’t so captivated by the fun and spectacle of the event, I might have focused on the fact that everything that could have gone wrong after my surgery pretty much did, and that would have sent that lob sailing right over my opponents’ heads but just outside of the baseline.
So it’s a good thing I didn’t think about it, any of it, until after the fact.
Now that I have thought about it, (and thanks, partner, for reminding me of the very short timeline), I’m pretty well overcome with emotions, from thankfulness for my current good health to gratitude to my tennis friends for their incredibly warm welcome back and patience with me as I reacquainted myself with the game. It sounds so cheesy when people say to appreciate each day, each moment. But it’s really true, especially after you have some crazy medical drama in your life. Life is short, and it is precious. And we never know from one day to the next what’s ahead. So make the most of it.