Hey All!
Thank you, thank you, thank you...to Medgadget, to Epocrates, and to Lenovo, for uniting our community by offering a glimpse of the numerous, amazing medical blogs "out there" through your annual contest. Like last year, my eyes are a little brighter to such infinite talent in the medical writing world. Thank you for your energy brought to this endeavor. To my fellow nominees and winners, my heartiest congratulations on your recognition. Well-deserved and well-placed, each and every one of you. To my fellow nominees and finalists in the Best Literary category, it is truly my honor and pleasure to be listed beside each of you. A reward in and of itself. Thank you for your passionate words and eloquent insights.
Finally, to my readers--my amazing, faithful, insightful, intelligent, and devoted readers--I thank you always for your support, for embracing my words, and for making this such a thrilling personal experience. Your friendships and kindnesses outweigh any awards or votes I may ever receive. Thank you...
There are times when I simply cannot believe that I have been blogging for over a year. November, 2009, in fact, was the official start of this endeavor and now, with the blink of an eye, we sit in the year 2011 with anticipation for another spring and summer to roll around.
When I had first started out, I was diligent and adamant about posting three stories a week, aiming for Monday, Wednesday, and Friday. Although it was extremely hard work and, at times, exhausting, the rewards were worth it. I remember being in Hilton Head, last March, and staying up until 3 am to finish a post for that Wednesday. Of course, the next day I was a mess on the tennis courts, but I reasoned it was a small price to pay.
As some of you may have noticed, then, I've slacked off a bit since those days of three posts a week. It was late fall/early winter when I finally was able to breath out and not carry around too much guilt if I didn't get several postings done in one week. Sure, I think about writing a story here and a story there, but it was also nice to focus a little more on work, on family, and, especially, on my kids. Something had to give and, unfortunately, it was my blogging.
That said, I am going to try harder to pick up the pace again. Some weeks may entail only one posting, some weeks two. I think the days of three postings a week, though, may be behind us. I thank you, though, for sticking this out with me. The only reason I am still going, of course, is because you, the reader, have been so committed. For that, I thank you.
Finally, I have been asked repeatedly over the past year if there are any posts that are my absolute favorites. It's a question that I can't answer. I view my posts, my stories, as works of literature (in a feeble sort of way), and I don't know if I can pick out a batch of favorites. I do know that the majority of my stories focus on compassion and kindness and those little, obscure moments of humanity that many might miss. When I finish another posting, if I am smiling, then I know I have done some good.
Intrigued by the question, though, I did review my library of postings and was able to pull out several that really hit home with me. And my readers. If you are a new reader to my blog, this might be a great way to catch up on some of my perspective. If you are a tried and true steady reader, these old stories might be a fun read (again). I thank you for visiting some of my older works. So, onward...
If you want to learn a bit more about me;
Against The Norm
The Quivering Finger
Blogging & Me
More about my family;
My Buddy, For Always
Dear Australia
The Fringe Benefits
The Beaten Path
Sad;
A Mother's Cry
Grandpa's Grandkids
Heroes Among Us--Gigi
A Love Story
The Emaciated Shoulder
No Second Chances
This Father's Daughter
Talk-worthy;
The Damaged Eyes of Alcoholism
The Appreciative Cashier
No Love For A Father
The Pit Stop
The Witness
Please Make Her Comfortable
Funny;
Ssshhh
The Half-Load Predicament
All Bound Up
My John Deere Cap
Double Crack
It Wasn't Me!
How's that for a start? Looking at the list myself, I keep wanting to add to it...it's hard for me to pick one "baby" over another. Some of the funnies, even, have gotten me into trouble. Can you do me a favor, though? I would love to hear from you--to know what previous postings or stories may have hit home with you, hit that raw nerve or made you smile or burst out laughing. Even from ones I haven't mentioned.
Again, big thanks and kudos for all of your support over the past year. I am a lucky and fortunate guy. Happy (and sad) reading...and have a great weekend. See you next week...
Jim
Friday, February 18, 2011
Tuesday, February 8, 2011
Future Hopes
Vote for StorytellERdoc for Best Literary Blog at the Medgadget Medical Blog Awards! Thanks for your support...
After another recent shift with a predominance of patients suffering from lingering flu symptoms, I decided to swing by our local Walmart to stock up on our home supply of pediatric medications, just in case. Some acetaminophen, ibuprofen, decongestant, and cough suppressant would hopefully get us through the rest of this winter season. And, of course, what a great variety of favorite flavors--orange, bubble gum, berry, and grape. Heck, some of them taste so good that faking the flu for the little cups of "candy" might be to my kids' benefit.
Unfortunately, on the way to the pharmacy area, one of the first aisles I always encounter is the candy and gum aisle. Not a good thing for me, since I have quite a recent fascination and taste for Gobstoppers, a Wonka jawbreaker product (don't tell my dentist). The yellow psychodelic boxes scream at me from their shelf, "Jim, come and put a couple of us in your cart," and regardless how much I fight it, the pull is too strong.
Needless to say, my kids love going to Walmart with me.
On this particular day, then, I walked to the mid-aisle to grab a few boxes of the candy. I wasn't alone in the aisle, though. To the right of the Gobstoppers, two parents stood looking at the shelf of big Hershey chocolate bars, immersed in a conversation (yes, I listened) of milk chocolate versus dark chocolate. To my left, a grocery cart with a makeshift, rigged-up kiddy car, driver seats and steering wheels included, on its handle-end. Two kids sat in those seats--an approximate four-year old girl and a three-year old boy. The Gobstoppers sat waiting for me between the parents and kids.
As I approached the family, I was caught off-guard with the screaming and fighting going on with the young kids. In fact, at one point, as I was kneeling down to grab the boxes of candy, I was appalled to find the little boy trying to punch his sister in the face, her hands rapidly moving to block each of his thrown punches, protecting herself. Still on my knees, I looked toward the parents, who must have completely tuned-out their kids. I was just about to say something when the little boy stopped, but not before his sister screamed out, "Get the hell off me, God damn it!" Still no reaction from the parents.
After this, I stayed kneeling, observing these peculiar parenting skills (or lack of) while looking at a box of Junior mints. While I was debating getting the mints, the little girl and boy started to talk to one another. About me! I actually wrote the conversation down in the pharmacy because it had shocked me much. It went like this.
Little girl: "Who the hell is that guy?" I looked at them looking at me.
Little boy: "I don't know, but if he gets close enough, I'm going to kick the shit out of him."
Little girl: "That will be fun. Try to knock him out." For good measure, she added, "God damn it." Again.
I was disheartened. I was shocked. I was annoyed with the parents for not addressing such obnoxiousness from their young kids. I looked from the kids to the parents, who had quickly glanced our way before figuring their conversation about chocolate was more important. I looked back to the kids again, before standing up and walking away with my Gobstoppers. I was upset and figured this was the best option for me, at that time. I knew it wasn't the kids' faults, but rather their parents. Their role models. But I wondered to myself, "What kind of adults are these kids going to become?"
This happening got me to thinking about our society. For the most part, we all know great kids in our lives, from our own to our friends' and families'. To raise respectful, kind, compassionate and loving kids and guide them appropriately into adulthood, when we choose this road of parenthood, should be the primary goal in each of our lives. We may not always succeed, darn it, but we have to try our best and throw our energy into the effort. Because that effort translates into the brilliance of the future generation coming up to govern our world.
These parents demonstrated no effort. And, unfortunately, they are not alone.
How many of us see the changing pattern with our society's kids. Talking back to well-meaning adults. Not respecting our elders (at least hold the door open for them and smile!). Tolerating vulgar language and meaningless violence via computer games and TV. Not respecting one another's uniqueness. Forgetting manners. Immersing oneself into texting instead of holding actual conversation. Avoiding volunteerism and chores. Placing more importance on material possessions rather than relationships.
Although I see both ends of the spectrum every day in the ER, I can only imagine the stories a teacher can tell.
I carried this Walmart story with me for a few weeks, bummed at the behavior of those children, constantly on vigil to find a hopeful story to balance out this disappointment. And then, the other day during an ER shift, I found it.
I walked into Room 17 to see my next patient, a nine-year old girl who had sustained minor anterior chest burns after bumping into her mother, who had been holding a pot of boiled water. Because the room was quiet and calm, I was quite surprised to find five people in total in the room, four kids and their mother. The mother was standing to the patient's right, beside the cot, while the oldest and youngest children, girls, shared a corner seat and their brother sat to their left on a stool.
Despite a TV in the room, it was not on, and the children all sat with an opened book before them, reading. Mom was whispering to her daughter with the burns, consoling her with her words and touch, gently stroking the back of her hand and her ribboned braids.
I walked up to Mom and the patient and introduced myself. "Hello, Doctor," the patient said, bravely trying to smile over her discomfort. She melted my heart, trying to be respectful while a three inch patch of skin lay peeled from her body between her clavicles. The mother turned to the other children. "Say 'hello' to Sissy's doctor," she said, and I was greeted with three more genuine smiles and greetings. They spoke with a bashful confidence that I fully appreciated.
We talked, the mother and patient and I, for quite a bit about what happened that brought them to our ER. After a stable exam, the nurse came in to clean the burn and show Mom how to care for it the next few days at home.
While finishing with this patient, I felt compelled to share with Mom how impressed I was by her kids. Not once did they talk without calling me 'sir' or the nurse 'maam'." They took turns, one at a time, to step up to their sister's cot to be supportive of her. No arguing or fighting, only kind words were uttered. No scowls, only warm smiles were worn. They were unabashed with their hugs and physical contact, sharing their seats and coats with one another. The mood and energy of the room was lighthearted and fantastic.
"Your kids," I shared with Mom before discharge, "are absolutely wonderful. It has been such a pleasure to see how well-behaved and loving they are with one another and with you. Even most of our staff has commented on their excellent behavior. Well done, Mom."
Mom was somewhat embarrassed by my compliment. "Trust me," I assured her, "I mean my words. What a wonderful job you are doing raising such fine young kids." As I spoke, the kids all grinned, bumping into one another with their elbows and bodies. I looked at all of them and smiled.
Mom thanked me, shyly, before explaining that she was a single parent. "Although I get tired by the end of the day, things seem to be going quite well with the kids." How could they not? This was an amazing woman, a role model for all, well aware of the importance of raising good children. And she was accomplishing, on her own, what two parents with less children weren't.
A hero.
After complimenting the children on their behavior and their impeccable church clothing, I ran to the freezer and grabbed four Italian ices. Grape. And lots of stickers from the nursing station. Just some small gestures to acknowledge their good behavior.
My hopes for our future have been restored. It took a few weeks, but I'm back to focusing on the good of our children. Thanks to the brilliant unselfishness of a great mother...
As always, big thanks for reading. Well done job to the mother of these four children! Also, thanks for your support in the recent Medgadget Medical Blog Awards voting. It continues until Sunday at midnight. If you enjoy my blog and posts, I would greatly appreciate your support and vote.
After another recent shift with a predominance of patients suffering from lingering flu symptoms, I decided to swing by our local Walmart to stock up on our home supply of pediatric medications, just in case. Some acetaminophen, ibuprofen, decongestant, and cough suppressant would hopefully get us through the rest of this winter season. And, of course, what a great variety of favorite flavors--orange, bubble gum, berry, and grape. Heck, some of them taste so good that faking the flu for the little cups of "candy" might be to my kids' benefit.
Unfortunately, on the way to the pharmacy area, one of the first aisles I always encounter is the candy and gum aisle. Not a good thing for me, since I have quite a recent fascination and taste for Gobstoppers, a Wonka jawbreaker product (don't tell my dentist). The yellow psychodelic boxes scream at me from their shelf, "Jim, come and put a couple of us in your cart," and regardless how much I fight it, the pull is too strong.
Needless to say, my kids love going to Walmart with me.
On this particular day, then, I walked to the mid-aisle to grab a few boxes of the candy. I wasn't alone in the aisle, though. To the right of the Gobstoppers, two parents stood looking at the shelf of big Hershey chocolate bars, immersed in a conversation (yes, I listened) of milk chocolate versus dark chocolate. To my left, a grocery cart with a makeshift, rigged-up kiddy car, driver seats and steering wheels included, on its handle-end. Two kids sat in those seats--an approximate four-year old girl and a three-year old boy. The Gobstoppers sat waiting for me between the parents and kids.
As I approached the family, I was caught off-guard with the screaming and fighting going on with the young kids. In fact, at one point, as I was kneeling down to grab the boxes of candy, I was appalled to find the little boy trying to punch his sister in the face, her hands rapidly moving to block each of his thrown punches, protecting herself. Still on my knees, I looked toward the parents, who must have completely tuned-out their kids. I was just about to say something when the little boy stopped, but not before his sister screamed out, "Get the hell off me, God damn it!" Still no reaction from the parents.
After this, I stayed kneeling, observing these peculiar parenting skills (or lack of) while looking at a box of Junior mints. While I was debating getting the mints, the little girl and boy started to talk to one another. About me! I actually wrote the conversation down in the pharmacy because it had shocked me much. It went like this.
Little girl: "Who the hell is that guy?" I looked at them looking at me.
Little boy: "I don't know, but if he gets close enough, I'm going to kick the shit out of him."
Little girl: "That will be fun. Try to knock him out." For good measure, she added, "God damn it." Again.
I was disheartened. I was shocked. I was annoyed with the parents for not addressing such obnoxiousness from their young kids. I looked from the kids to the parents, who had quickly glanced our way before figuring their conversation about chocolate was more important. I looked back to the kids again, before standing up and walking away with my Gobstoppers. I was upset and figured this was the best option for me, at that time. I knew it wasn't the kids' faults, but rather their parents. Their role models. But I wondered to myself, "What kind of adults are these kids going to become?"
This happening got me to thinking about our society. For the most part, we all know great kids in our lives, from our own to our friends' and families'. To raise respectful, kind, compassionate and loving kids and guide them appropriately into adulthood, when we choose this road of parenthood, should be the primary goal in each of our lives. We may not always succeed, darn it, but we have to try our best and throw our energy into the effort. Because that effort translates into the brilliance of the future generation coming up to govern our world.
These parents demonstrated no effort. And, unfortunately, they are not alone.
How many of us see the changing pattern with our society's kids. Talking back to well-meaning adults. Not respecting our elders (at least hold the door open for them and smile!). Tolerating vulgar language and meaningless violence via computer games and TV. Not respecting one another's uniqueness. Forgetting manners. Immersing oneself into texting instead of holding actual conversation. Avoiding volunteerism and chores. Placing more importance on material possessions rather than relationships.
Although I see both ends of the spectrum every day in the ER, I can only imagine the stories a teacher can tell.
I carried this Walmart story with me for a few weeks, bummed at the behavior of those children, constantly on vigil to find a hopeful story to balance out this disappointment. And then, the other day during an ER shift, I found it.
I walked into Room 17 to see my next patient, a nine-year old girl who had sustained minor anterior chest burns after bumping into her mother, who had been holding a pot of boiled water. Because the room was quiet and calm, I was quite surprised to find five people in total in the room, four kids and their mother. The mother was standing to the patient's right, beside the cot, while the oldest and youngest children, girls, shared a corner seat and their brother sat to their left on a stool.
Despite a TV in the room, it was not on, and the children all sat with an opened book before them, reading. Mom was whispering to her daughter with the burns, consoling her with her words and touch, gently stroking the back of her hand and her ribboned braids.
I walked up to Mom and the patient and introduced myself. "Hello, Doctor," the patient said, bravely trying to smile over her discomfort. She melted my heart, trying to be respectful while a three inch patch of skin lay peeled from her body between her clavicles. The mother turned to the other children. "Say 'hello' to Sissy's doctor," she said, and I was greeted with three more genuine smiles and greetings. They spoke with a bashful confidence that I fully appreciated.
We talked, the mother and patient and I, for quite a bit about what happened that brought them to our ER. After a stable exam, the nurse came in to clean the burn and show Mom how to care for it the next few days at home.
While finishing with this patient, I felt compelled to share with Mom how impressed I was by her kids. Not once did they talk without calling me 'sir' or the nurse 'maam'." They took turns, one at a time, to step up to their sister's cot to be supportive of her. No arguing or fighting, only kind words were uttered. No scowls, only warm smiles were worn. They were unabashed with their hugs and physical contact, sharing their seats and coats with one another. The mood and energy of the room was lighthearted and fantastic.
"Your kids," I shared with Mom before discharge, "are absolutely wonderful. It has been such a pleasure to see how well-behaved and loving they are with one another and with you. Even most of our staff has commented on their excellent behavior. Well done, Mom."
Mom was somewhat embarrassed by my compliment. "Trust me," I assured her, "I mean my words. What a wonderful job you are doing raising such fine young kids." As I spoke, the kids all grinned, bumping into one another with their elbows and bodies. I looked at all of them and smiled.
Mom thanked me, shyly, before explaining that she was a single parent. "Although I get tired by the end of the day, things seem to be going quite well with the kids." How could they not? This was an amazing woman, a role model for all, well aware of the importance of raising good children. And she was accomplishing, on her own, what two parents with less children weren't.
A hero.
After complimenting the children on their behavior and their impeccable church clothing, I ran to the freezer and grabbed four Italian ices. Grape. And lots of stickers from the nursing station. Just some small gestures to acknowledge their good behavior.
My hopes for our future have been restored. It took a few weeks, but I'm back to focusing on the good of our children. Thanks to the brilliant unselfishness of a great mother...
As always, big thanks for reading. Well done job to the mother of these four children! Also, thanks for your support in the recent Medgadget Medical Blog Awards voting. It continues until Sunday at midnight. If you enjoy my blog and posts, I would greatly appreciate your support and vote.
Friday, February 4, 2011
Sister, Sister
Good day, everyone. Briefly, it is that time of year when the prestigious Medgadget Medical Blog Awards are upon us, and I have humbly been chosen as a finalist in the Best Literary Medical Weblog category for 2010. If you enjoy my blog and posts, especially from 2010, I would greatly appreciate your support for this award. Simply click on the highlight above and go vote for StorytellERdoc! As always, thanks for reading and especially for your support! Now, on to the post...
I rolled open the sliding glass door of Room 33, pushing aside the privacy curtain as I entered into the treatment room to see my next patient. By the nurse's triage note, she was a woman in her mid-thirties who presented to our emergency department with a history of leukemia and a recent complaint of bruising.
Running through my mental checklist prior to entering, I was hopeful that this patient was actively undergoing chemotherapy, which would be the best explanation for her bruising (low platelets as a result of her medications). If she was in remission and not actively receiving chemotherapy, however, the bruising could signify, among other things, a return of her leukemia. The bruising might just be letting us know that her bone marrow was ill and not able to produce healthy, viable cells.
Sigh. I thought back to Christmas Day a few years back when my mother, in remission from her leukemia, nicked her fingertip while cutting a dinner roll at the kitchen sink. A little nick of bleeding that we struggled to control. "It's back, Jim," Mom had said, knowing the truth, sadness creeping into her eyes as she watched me dress her cut. I, playing the dutiful son, reassured her that all would be okay when, in truth, it turned out not to be.
Stepping into this patient's room, then, I was prepared for the worst but hoping for the best.
Two women greeted me as I walked into the room--the patient, sitting upright on her cot, wearing a flimsy hospital gown and loose-fitting pajama bottoms, and a woman of similar age sitting beside the cot in a hospital chair. They were obvious sisters, resembling each other quite strongly. Especially when they smiled their warm smiles.
"Hello," I said, walking up to the patient and taking her hand in my gloved ones as I absorbed her appearance, "I'm Dr. Jim. A pleasure to meet you, maam." She was fatigued-appearing, trying to smile the listlessness from her face. Despite her attempts, she looked so very tired. Her eyes were hazel and apprehensive, closely watching me study her. Her skin was smooth, maybe a touch pale, and her cheekbones gaunt. Her lips were slightly dry. The hospital gown loosely hung from her shoulders.
I turned to her sister, introducing myself to her as well. As it turns out, she was the older of the two. She, like her ill sister, had hazel eyes that, perhaps, sparkled a bit more, reflecting her bigger reservoir of energy. Her skin was creamy rather than pale. Where her sister was gaunt, this woman's face was healthy, lacking her sick sister's bony jawline and cheekbones. Her smile, the obvious family trait, was as genuine as her sister's. Looking at her sister, it was easy to imagine what the patient might look like on a typically healthy day.
For all the similarities, though, there existed two glaring differences between these siblings. Whereas the healthy sister had beautiful, coarse chestnut hair, the patient wore a black and yellow bandanna to her eyebrows, obviously covering her hair loss. The other thing? The patient's arms and upper chest were covered by varying stages of bruises--older, yellowish-brown ones to younger angry, purplish ones. The ravages of battling a malignancy.
"Maam," I said to Lisa, the patient, "are you actively on chemotherapy for your leukemia or are you currently in remission?" I held my breath in anticipation of her answer.
Lisa hesitated before answering. "I guess both, Doctor Jim," she said. "I am currently in remission but still take maintenance chemotherapy." In many cancer therapies, there is both an "induction" phase and "consolidation" phase of chemotherapy. Induction therapy is the aggressive initial round(s) of chemotherapy, whereas consolidation (think of maintenance) typically is started after the cancer has been halted or significantly "beaten back" by the induction round.
"Do you know which chemotherapy regiment you are on, Lisa?" I asked, relieved and happy with both of her answers to my questions. Her bruising, I suspected, was most likely due to low platelets from her medicines.
She nodded her head no. "I can never remember the long names of them."
"Let me try," I said, "are you on ara-C and idarubicin?"
Lisa and her sister both looked at me with surprise. "Yes," Lisa said, "those are it. How did you know?" I briefly explained that I had some familiarity with leukemia and the agents used to fight it.
After interviewing Lisa as her sister sat bedside, holding her hand and contributing to Lisa's history, I learned that she had done beautifully with her induction phase of chemotherapy and had quickly entered remission after a few months. Thus far, she had only received one round of maintenance chemotherapy, the week prior.
The amazing thing? Lisa didn't even live in our hometown. She grew up here but was currently living in the South, having returned, with her doctor's permission, to visit her family for an extended weekend. She had no family to help her battle her leukemia in Tennessee and her coming home was the first time she got to see her immediate family since she was diagnosed. "That's alright, though," she said, "I know everybody's prayers are with me."
The supportive sister, sitting beside the bed stroking her ill sister's hand, suddenly burst into sobs. Gasping for air, she tried to talk. "I...wanted...to...come...down, Leeessaaa, but...couldn't..."
What a pivotal moment. Obviously, the healthy sister carried a lot of guilt and pain around for not being physically closer to help her ill sister through her torments. Whether it be kids, a job, or other responsibilities, though, I can only imagine the heaviness the healthy sister endured with each mile she was separated from her sister.
Lisa reached over to her sister and rubbed her hand through her sister's thick hair. "Oh, sister, sister," Lisa said quietly, reflectively, "I know you want to be with me. Trust me, I do. But I'm okay--really, I am. Between my friends, I am well-taken care of."
"But," the healthy sister continued, her face now looking as listless as her sister's, "I want to be there, by your side. It's not fair."
"It never is," Lisa said, "but your daily phone calls and cards and endless prayers have been felt. I promise." Lisa lifted her sister's chin up so that she could gaze into her sister's eyes and slowly, before me, her sister's face gained back its strength and tranquility.
I walked out of the room, aware of the impact of what I had just witnessed. For all the tragic and heartbreaking illnesses that occur in the world, how many of the sufferers endure an unavoidable physical separation from their loved ones and must go at fighting their illness on their own? And can you imagine being a son, a daughter, a brother, a sister, a parent, or a best friend that has to sit on the sidelines, miles away, from someone you love who is suffering with a serious illness? It was obvious these two sisters would have preferred nothing less than to be geographically closer to one another to rely and lean on each other during Lisa's travails.
The magnified pain from both Lisa and her sister, as a result of their physical separation, was a reminder to me of how lucky my family was to be able to "circle the wagons" when one of us got ill. If only everybody could be so fortunate.
I wish that for you and your family if ever the time would come.
Lisa's platelets were low, just as we thought, and she was admitted overnight for several platelet transfusions. I promised her she would be discharged in the morning. She promised me she was going to talk to her sister, reassure her all was okay, and gingerly approach her about being her possible stem cell donor. "Lisa," I said, "that would be wonderful! You know your sister loves you and would be a donor in a heartbeat if your bone marrow matches. I'll keep you both in my thoughts."
And I do...especially for the lesson they taught me that day. Thank you, sister, sister.
As always, big thanks for reading...see you early next week. Jim
I rolled open the sliding glass door of Room 33, pushing aside the privacy curtain as I entered into the treatment room to see my next patient. By the nurse's triage note, she was a woman in her mid-thirties who presented to our emergency department with a history of leukemia and a recent complaint of bruising.
Running through my mental checklist prior to entering, I was hopeful that this patient was actively undergoing chemotherapy, which would be the best explanation for her bruising (low platelets as a result of her medications). If she was in remission and not actively receiving chemotherapy, however, the bruising could signify, among other things, a return of her leukemia. The bruising might just be letting us know that her bone marrow was ill and not able to produce healthy, viable cells.
Sigh. I thought back to Christmas Day a few years back when my mother, in remission from her leukemia, nicked her fingertip while cutting a dinner roll at the kitchen sink. A little nick of bleeding that we struggled to control. "It's back, Jim," Mom had said, knowing the truth, sadness creeping into her eyes as she watched me dress her cut. I, playing the dutiful son, reassured her that all would be okay when, in truth, it turned out not to be.
Stepping into this patient's room, then, I was prepared for the worst but hoping for the best.
Two women greeted me as I walked into the room--the patient, sitting upright on her cot, wearing a flimsy hospital gown and loose-fitting pajama bottoms, and a woman of similar age sitting beside the cot in a hospital chair. They were obvious sisters, resembling each other quite strongly. Especially when they smiled their warm smiles.
"Hello," I said, walking up to the patient and taking her hand in my gloved ones as I absorbed her appearance, "I'm Dr. Jim. A pleasure to meet you, maam." She was fatigued-appearing, trying to smile the listlessness from her face. Despite her attempts, she looked so very tired. Her eyes were hazel and apprehensive, closely watching me study her. Her skin was smooth, maybe a touch pale, and her cheekbones gaunt. Her lips were slightly dry. The hospital gown loosely hung from her shoulders.
I turned to her sister, introducing myself to her as well. As it turns out, she was the older of the two. She, like her ill sister, had hazel eyes that, perhaps, sparkled a bit more, reflecting her bigger reservoir of energy. Her skin was creamy rather than pale. Where her sister was gaunt, this woman's face was healthy, lacking her sick sister's bony jawline and cheekbones. Her smile, the obvious family trait, was as genuine as her sister's. Looking at her sister, it was easy to imagine what the patient might look like on a typically healthy day.
For all the similarities, though, there existed two glaring differences between these siblings. Whereas the healthy sister had beautiful, coarse chestnut hair, the patient wore a black and yellow bandanna to her eyebrows, obviously covering her hair loss. The other thing? The patient's arms and upper chest were covered by varying stages of bruises--older, yellowish-brown ones to younger angry, purplish ones. The ravages of battling a malignancy.
"Maam," I said to Lisa, the patient, "are you actively on chemotherapy for your leukemia or are you currently in remission?" I held my breath in anticipation of her answer.
Lisa hesitated before answering. "I guess both, Doctor Jim," she said. "I am currently in remission but still take maintenance chemotherapy." In many cancer therapies, there is both an "induction" phase and "consolidation" phase of chemotherapy. Induction therapy is the aggressive initial round(s) of chemotherapy, whereas consolidation (think of maintenance) typically is started after the cancer has been halted or significantly "beaten back" by the induction round.
"Do you know which chemotherapy regiment you are on, Lisa?" I asked, relieved and happy with both of her answers to my questions. Her bruising, I suspected, was most likely due to low platelets from her medicines.
She nodded her head no. "I can never remember the long names of them."
"Let me try," I said, "are you on ara-C and idarubicin?"
Lisa and her sister both looked at me with surprise. "Yes," Lisa said, "those are it. How did you know?" I briefly explained that I had some familiarity with leukemia and the agents used to fight it.
After interviewing Lisa as her sister sat bedside, holding her hand and contributing to Lisa's history, I learned that she had done beautifully with her induction phase of chemotherapy and had quickly entered remission after a few months. Thus far, she had only received one round of maintenance chemotherapy, the week prior.
The amazing thing? Lisa didn't even live in our hometown. She grew up here but was currently living in the South, having returned, with her doctor's permission, to visit her family for an extended weekend. She had no family to help her battle her leukemia in Tennessee and her coming home was the first time she got to see her immediate family since she was diagnosed. "That's alright, though," she said, "I know everybody's prayers are with me."
The supportive sister, sitting beside the bed stroking her ill sister's hand, suddenly burst into sobs. Gasping for air, she tried to talk. "I...wanted...to...come...down, Leeessaaa, but...couldn't..."
What a pivotal moment. Obviously, the healthy sister carried a lot of guilt and pain around for not being physically closer to help her ill sister through her torments. Whether it be kids, a job, or other responsibilities, though, I can only imagine the heaviness the healthy sister endured with each mile she was separated from her sister.
Lisa reached over to her sister and rubbed her hand through her sister's thick hair. "Oh, sister, sister," Lisa said quietly, reflectively, "I know you want to be with me. Trust me, I do. But I'm okay--really, I am. Between my friends, I am well-taken care of."
"But," the healthy sister continued, her face now looking as listless as her sister's, "I want to be there, by your side. It's not fair."
"It never is," Lisa said, "but your daily phone calls and cards and endless prayers have been felt. I promise." Lisa lifted her sister's chin up so that she could gaze into her sister's eyes and slowly, before me, her sister's face gained back its strength and tranquility.
I walked out of the room, aware of the impact of what I had just witnessed. For all the tragic and heartbreaking illnesses that occur in the world, how many of the sufferers endure an unavoidable physical separation from their loved ones and must go at fighting their illness on their own? And can you imagine being a son, a daughter, a brother, a sister, a parent, or a best friend that has to sit on the sidelines, miles away, from someone you love who is suffering with a serious illness? It was obvious these two sisters would have preferred nothing less than to be geographically closer to one another to rely and lean on each other during Lisa's travails.
The magnified pain from both Lisa and her sister, as a result of their physical separation, was a reminder to me of how lucky my family was to be able to "circle the wagons" when one of us got ill. If only everybody could be so fortunate.
I wish that for you and your family if ever the time would come.
Lisa's platelets were low, just as we thought, and she was admitted overnight for several platelet transfusions. I promised her she would be discharged in the morning. She promised me she was going to talk to her sister, reassure her all was okay, and gingerly approach her about being her possible stem cell donor. "Lisa," I said, "that would be wonderful! You know your sister loves you and would be a donor in a heartbeat if your bone marrow matches. I'll keep you both in my thoughts."
And I do...especially for the lesson they taught me that day. Thank you, sister, sister.
As always, big thanks for reading...see you early next week. Jim
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