Monday, January 23, 2017

we got no chance of recovery

Two weeks ago, the microcosm of safety in which I live was invaded. My cousin, who is supposed to get married in a few months, had a seizure. The day is a blur. It started with receipt of a frantic text message, then a phone call to a dumbstruck fiance, followed by throwing a bunch of things into a backpack and driving to the hospital with my stomach churning. I didn't want to be a physician at that moment. I didn't want to know the things I knew. A woman so young, with the symptoms she had, and the timing of it, there were very few things that could be the cause. So when I heard there was a mass in her head, I was unfortunately not surprised.

There were conflicting impulses when I got to the hospital. I wanted to hug her and burst into tears. I wanted to take her hand and tell her everything was going to be okay. I wanted to see the MRI with my own two eyes, wanted to speak to another physician, wanted to review her labs. I wanted to be everything all at once, her cousin, her protector, her physician. I'm not sure I succeeded at being any of those things.

In some ways, she turns out to be lucky. When the neurologist did show me the scan, I exhaled an involuntary expletive. The mass was large enough that it had caused swelling in her brain, and shifted one side into the other, likely in part the cause of those seizures. The part of me who was a physician checked out in that moment, and it was just about this woman who was as close to a sister as I'll ever get having a tumor, how her life was about to unexpectedly change in this instant. The neurologist had to get my attention to point out that the mass looked like a meningioma, one of the few tumors you can have in your brain that is not malignant.

She needs surgery but it will be complicated because the mass is so close to blood vessels. And she was stable and not having seizures, so by the next day, there was no reason for her to stay in the hospital. She's getting surgery in a week. I am racking up the miles driving back and forth to see her, mostly to keep her distracted from the uncertainty that lies ahead. We haven't been able to talk about her wedding and its feasibility because it brings up possibilities to do with her recovery that she does not want to face right now, and I can't blame her for that.

I wanted to be at the Women's March. I spent the day instead with the near antithesis of a feminist- much as I love my cousin, much as she is the closest thing I have to a sister, she and I hold wildly different beliefs about most things. But I was thinking of the march and thinking of the power shift in this country, and thinking of the uncertainty to do with my cousin's surgery. There are patients out there, who, when ACA is repealed, will have a diagnosis such as hers, will be diagnosed with a mass in their head, and because their seizures are under control, they won't have the luxury of arranging a complicated surgery. They'll be told they're not covered to get elective surgery, they'll be told this doesn't qualify as an emergent surgery, and they'll be stuck with a tumor lodged in their head for an undefined amount of time. My cousin is very worried about whether this surgery will go well, whether it will leave her with neurologic deficits, how long it will take her to recover from the surgery. But to imagine the added stress and turmoil that would come with not even knowing if she could have the surgery? It's appalling.

Friday, January 20, 2017

it is my day to live a simple life

Not great art, sure. Although, actually, I will say that if someone acts well, they can elevate even the silliest of movies, and I think that is what Donna Murphy does in this scene.

It's also, insane though it may sound, a scene I think about all the time on days like these. What she says, I believe in deeply. I always go back to the work, and it is always what I need. To justify my existence, to prove to myself who I am, to chase away all the doubts. Always, the work.

The last couple of months have been concentrated turmoil, and the election only slightly contributes to it. I think there is more turmoil ahead. But it is a Friday, and I am going to do what I always do on most Fridays. I am going to work. My colleagues and I will talk about science for an hour. I will work on a research project. I will write some more of a manuscript. I will see patients.

One of my patients will be photographed. She told me about her granddaughter, who at 10 years old, decided on her own to grow out her hair, then have it cut to donate to cancer patients who are in need of wigs. When I asked her if I could share her story, her eyes lit up; she beamed. I realized that in the end, this is what we all crave. To have our stories told, to be heard as we tell them ourselves, to be told our stories have value, to be remembered. My story is my work, among other things. Today, I am grateful to have that work. Others are not so fortunate, and I feel how much harder this day is for them.