Sunday, May 27, 2012

It’s that time of year again. As I write it is the official start of summer. It’s been a rainy week and that is predicted to continue however the thunderstorms are indeed the hallmark of summer. Summer for so many here in the northeast is a time of joyful awakening. It’s been cold or dreary, then cloudy and wet, and then summer brings a time of renewal. Many cancer patients watch this from afar. Their time away is no summer vacation.

I met Mark many years ago in the bone marrow transplant unit. A nasty form of leukemia had flattened this vibrant and powerful man. He lay in a darkened room as his wife paced the hallway. She shared much about their lives and also about their adult children. She had done her own statistical research about survival rates and was terrified. I thought to myself as he navigated his treatments that he always seemed FLAT in his bed. After his treatment and discharge I saw him a few months later walking in the hallway of the hospital. He had grown his hair back into a ponytail and also had grown a beard. He remarked how he was only visiting a friend who was having a heart procedure. I reflected and thought of the flat affect I had remembered and now he was once again vibrant man before me.

Although I did my training in all areas of medicine, working in oncology for over 10 years I have come to my own non-scientific hypotheses, conclusions, or antidotal findings. One finding is that there is a rhythm that patients and families develop while coping over a long treatment period. Unlike a trauma or limited illness, the intensity during those times cannot be sustained.

A part of my new patient discussion can be a discussion about coping skills. Let me use the examples I use in my discussion:

If you have a injury, the flu, or time limiting event often people cope in this progression.

“Ugh oh.. I think I am coming down with the flu”, or “I fell and sprained my ankle”, or like scenario.

Regardless of the event, most often the progression of disability is a slow or sudden decline and then a linear progression to what I call the best recovery potential. An example in the case of an orthopedic injury the person may never be as strong as before that injury.

My experience with people in treatment for cancer is that their journey to wellness isn’t EVER linear. Symptoms from treatments, removal from their daily routine for months at a time, etc. all can cause a jagged up-down-up-down-up-down roller coaster of emotion even within a day. The coping skills that we normally develop cause emotional exhaustion. What I often see then is that the person become FLAT in the bed. Hopefully this doesn’t last over a long period of time as a new rhythm develops.

Several years ago I was watching the news when a story came on the TV about a school project for elementary students during the summer. They were to color a gingerbread man style cut out, put him into an envelope and send him on a summer vacation. If he were to visit the beach he could be photographed with a sand pail and write about how the sunscreen stung his eyes. He may have been sent to his grandmother’s house where he got to stay up late and eat ice cream for dinner. At the end of the summer he returned home with a journal of his travels. Stanley was flat yet his adventures allowed him to take on the vibrancy of a human child.

When I look at my patients who have come to the end of their normal push to cope and now lay flat in their bed I think of that flat character. My patients are indeed going on a journey and it is no summer vacation. They may be flat for now however I wait for the day when we all may celebrate they are once again going home.

Authors note: Patients name is not his real name

Wednesday, May 16, 2012

Distractions vs. Focus

Taking time to notice Cora’s light:

  It’s been several weeks since I blogged. I have missed the discipline of writing and have been told by my readers they have missed reading as well. Thank you to “you”! for saying so!

This can be such a frenetic time of year for many people. Weddings, Baptisms, graduations, moving, vacations etc. are on the rise as the summer months come more near.

Last weekend I participated in a multi-family yard sale for the first time. It was so awakening as to how many things I had kept over my years that had grown idle in my life. I sold a beloved table that even my son said he would miss but I am no longer hosting the overflowing family gatherings. I sold many children’s items as well. It was heartwarming to see items that had served many of us going on to continue in another home. The man who bought the table paced anxiously attempting to reach his wife. “I still am in the dog house for buying something before asking her. I can’t do it again.” He said.  He later took that chance and emptied his wallet 12.00 short of my FIRM price. That table was to be placed in his sunroom and serve making space for his family dinners. It made all of us smile as he loaded it into his truck.

I have been thinning out my belongings using a series of criteria:

1.     Have I used it in the 10 years I have been in my current space ?
2.     If I still like what it is, why is it in a storage container not being used?
3.     If I were to move to a smaller place, what would I be willing to leave behind.
4.     How many bread pans do I need if I am gluten free now? [laughing]

As I spoke to others about my yard sale adventure the reactions were all envy to have thinned out belongings or those who were overwhelmed by the idea of beginning a daunting task.

My own mother is moving. As she began to sort and pack I began to look at my own space and really LOOK using my sorting criteria above.

Indeed, everyone believes they are healthy until a doctor gives them news to the contrary and their innocence of health is forever lost. Weeks ago I made a comment to a friend that working in a trauma center and also seeing many oncology patients every day I am mindful that my life could be altered or taken in an instant. I said I wanted to lighten my life-load and not burden my family if accident or disease were to strike. That said I would also enjoy the minimalism vs. clutter.

Little did I know that my seemingly innocent comment almost became true.

Two weeks ago on a drizzling early evening I was driving to nearby town to go to a “big-box’ store for a particular item. It was after a long day at work and I was tired and thinking about all the TO-DO’s on my list for the yard sale, the wedding I am performing, the baptism and and and and.. etc. As I drove slowly up a hill and turned around the curve my thinking immediately changed. Coming at me was a jack-knifed tractor-trailer who had locked up his brakes as he was careening down the hill towards me. As many have said, these situations are remembered in slow motion. I was on a small country road without a shoulder, lucky there were neither telephone poles nor mailboxes as I first steered around the tractor part. Relief was for only seconds as I then saw the trailer swinging into my lane. Indeed, I stopped unscathed. The truck then hit a pole and spun around as if he were coming UP the hill not down. The truck driver was not hurt either. It took me a few days to shake off how unscathed I was and how close to being airlifted to a trauma center I had come.

In those days afterwards, and even now I have a renewed sense of the goodness and blessings in my life. As I lighten my load of “stuff” I am finding I have more awareness of the items that trigger memories, and usefulness of things I do keep.

I also have a renewed awareness to take time to notice the small stuff because in retrospect it may not be small after all.