http://www.blogtalkradio.com/doctoranonymous

http://www.blogtalkradio.com/doctoranonymous

Feel free to check a good friend of mine, "Dr. Anonymous", and myself on his radio show Thursday (4-16) at 9:00PM. We will be discussing Palliative Medicine, Hospice Care, passions of the heart and probably sharing a few tales (some true) about our days in Medical School together.
Hope you can join us!!!
Dr M

Raymond and Eloise
~A Lesson of Love~

Today is February 14th, Valentines Day. I awoke early, unable to stay away from my writing…for I have a Valentines Day story to tell.

A true love story that quietly unraveled before my eyes.

Eloise appeared even smaller in stature than the last time I saw her. This was difficult to imagine for I have never met a tinier lady. She weighed 85 lbs and was well under 5 foot tall. Her advanced osteoporosis caused a posture to be stooped forward and stiff in her movements. This is the posture that is so common in the elderly but now physicians attempt to prevent. Her walk was more swift than expected and mostly steady. Despite this, I still found myself walking close to her in case she stumbled and offering a hand to help her on and off the exam table. She dressed neatly in older but well cared for slacks with a matching pastel sweater that had been worn many times before but still appeared new. Her hair was clean silver, short and well groomed. She later told me that she made herself get out to the hair dresser regularly.
Eloise had been coming to my office now for about 4 years. Today was different than all the previous times.

Today, Eloise was alone.

For the past 4 years, they presented to my office together…Raymond and Eloise. I list his name first for this was how one would see them.

Raymond was a large man even in his advanced age. He was well over 6’ 4” and carried himself even taller. He wore a barrel chest and carried strong, square shoulders that were relaxed like old mountains. His build was stocky with a slight relaxed belly but not considered overweight by any standard. His arms were longer than expected until you noticed the length of his legs. Then you realized that this was just Raymond. He had thick hands with long meaty fingers that made yours feel inadequately small when you shook his hand. He possessed a man’s grip reaffirming his size.
Echoing his physical attributes was his baritone voice. He was loud and assuming. When Raymond spoke, you couldn’t help but listen for it was impossible to talk over him. Everything about Raymond was that way….not to be ignored.
Early on, during our initial office visits, I received the impression that he was feeling me out. He would study me as I entered the exam room as a father would a suitor calling on his only daughter. He monitored the way I held myself and studied my movements looking for any sign of insecurity.
He would, of course, dominate the interview with questions that deserved answers and then sit tall and await my response. He asked many questions. Sometimes the questions were very direct requiring direct answers while other times he would lead me into a conversation just to listen to what substance “The Doctor” possessed. No matter how he was doing it…he was looking to see if I possessed the qualities that he expected from his new doctor. I must have passed.

I would meet with Raymond and Eloise every few months and help them as they navigated through old age. Oftentimes they would present for check ups to monitor their blood pressure, heart rate. Weight, etc. It never ceases to amaze me the therapeutic effects of having your vitals checked by the nurse and hearing from the doctor that everything looks to be going along as expected. These visits are indeed…a strong medicine.
Sometimes Raymond and Eloise would come in between their scheduled office visits with various questions or ailments that were plaguing them. Thankfully the questions weren’t too difficult and the ailments not so serious…just valid concerns that arise from a slowly failing body. I counseled on hurt knees, rashes, backs that were stiff and the never ending insurance questions that my wife, Sandi, was capable of answering in more detail than myself. We adjusted “non-generic” medication to “generic” to allow a shared retirement pension to stretch just a little bit further. The generic meds were always less expensive by an oftentimes significant amount. We tweaked Raymond’s blood pressure medication, mostly under his guidance instead of mine, to where he was only taking one sixth of a the smallest milligram tablet available twice a day. This amount was difficult to imagine but he assured me that his measures were accurate. He stated that he was overly sensitive to all medication and anymore would make him dizzy. Every appointment, every treatment was a compromise…a compromise between my recommendations and his willingness to listen to them…or not to.
Please do not get me wrong. It wasn’t that I didn’t try. Early on I would become frustrated with Raymond’s visits and insist that he heed my advise for after all…I was his doctor. He would give me the floor, allow me to give him my spiel of why I think that he should do this and shouldn’t do that. He then would acknowledge that he knew that I was the doctor and that he certainly was not. He then would, in a polite, very “matter of fact” manner, would educate me on what he was willing to do and what he wasn’t willing to do. He certainly was a challenge. It would have been much easier to just dismiss him as a cantankerous old man who was stubborn and set in his ways…but to do this I realized that he would leave and not follow up with any other physician. What good would that do for him? At least he was coming in and listening to me though be it only sometimes. It wasn’t until much later that we found common ground that we could together stand upon.
But common ground we found. All in all, his blood pressure was controlled and his aches and pains responded adequately to the fragments of medications that he would allow me to supply him. Despite the fact that he challenged me in about everyway possible, I truly began enjoying his visits and found myself especially respectful even with his desire to supersede my advice and direct his own care. After all…I could see myself being the same way. Maybe he knew that of me and that’s why I “passed”.
Raymond disliked testing and hospitals more than he disliked medications. It was here that was another area we would find ourselves butting heads. He often complained of chest pain and difficulty breathing with physical activity on more than one occasion. This is what upset me the most for I knew that symptoms such as these denoted serious heart problems until proven otherwise. That’s just what he wouldn’t let me do…prove them otherwise.
On every visit after he mentioned these symptoms I would question him and his willingness to allow me to run some tests and if positive send him for treatment. I offered many different levels of attention from going to the ER enabling us to receive diagnosis and treatment almost immediately to working this up as an outpatient by getting some bloodwork, stress test, etc. full knowing that if I could get him to set foot in an emergency room, he would be admitted secondary to his complaints and immediate attention, treatment provided.
I know now that he trusted and respected me, for after months of pleading with him, he finally gave in…at least in part. Raymond agreed to see a cardiologist. He met with a respected local cardiologist and listened to what he had to say. I don’t know what the exact interaction was like that took place in the cardiologist’s office but could imagine that Raymond wasn‘t at all impressed. Sure he was polite and respectful but sure he wasn’t going to do much of what the cardiologist had to say. Bloodwork and an EKG was agreed upon but the Stress Test was definitely out of the question. I even met with Raymond and reviewed and concurred with the doctor’s recommendations. In perfect Raymond fashion, he respectfully declined a further work-up despite the knowledge of further heart damage and even death.
Over the next few years our office visits continued. Physician continued to navigate patient through the aging process. Like a path of fallen leaves, old age continued to reveal to them a direction they were destined to follow but with often uncertain footing.

It is here the story takes an expected and tragic twist.

Like many mornings, I arrived at my office and was greeted by our staff with an update of what labs and tests are back for my approval as well as who was seen in the emergency room and who of them were admitted. The news of Raymond’s heart attack was part of this morning’s report.

Apparently they were in Columbus at his daughters, and he became lightheaded with increasing shortness of breath. These symptoms must have been worse than previous or his daughters were better “doctors” than myself for they transferred him to the local emergency room where he was admitted.

The only other details that were given to me that day was that it was here that Raymond died.

Eloise appeared even smaller in stature than the last time I saw her. This was difficult to imagine for I have never met a tinier lady. She weighed 85 lbs and was well under 5 foot tall. Her advanced osteoporosis caused a posture to be stooped forward and stiff in her movements. This is the posture that is so common in the elderly but now physicians attempt to prevent. Her walk was more swift than expected and mostly steady. Despite this, I still found myself walking close to her in case she stumbled and offering a hand to help her on and off the exam table. She dressed neatly in older but well cared for slacks with a matching pastel sweater that had been worn many times before but still appeared new. Her hair was clean silver, short and well groomed. She later told me that she made herself get out to the hair dresser regularly.
Eloise had been coming to my office now for about 4 years. Today was different than all the previous times.

Today, Eloise was alone.

An excerpt from "The Journey Learned" copyright 2009

To be continued...soon.

The Party's Over...

Where have the last 2 months gone??? The Christmas Tree was up one minute, down the next....the Christmas ornaments await their 11 month slumber.
Much good has occurred in our lives over the past months. We were blessed to have our "German Son" with us over the Holidays, witness the miracle of life as we watch our daughter's belly grow awaiting the birth of our first grandchild and prepare for the "Big Move" into our lake house. There is something to be said about the phrase, "We haven't used that in years...let's get rid of it!".
Hope I find you and your's happy, healthy and anticipating a 2009 full of life and laughter.
Dr. M

The Carpenter's Gift

From an unexpected craftsman, was created a gift for a person so deserving.

I first met Stanley shortly after I opened my Family Practice office. Like many, he presented with a story of tragedy much too lengthy for his years. I met him soon after he had suffered a stroke, in his early 30’s. My first thoughts revolved around this young age and this awful event that left him a shell of who he once was. It wasn’t until a few years later that I really got to know him.
Like usual, Stanley would present every so many months to allow me to monitor his progress. At first, Stanley’s wife would come back to the exam room with him…similar to a mother with her child. She would answer for him and direct his portion of the interview, expecting me to be impatient with her husband who was now relegated to a childlike existence. After a few visits, he would venture back to the exam room alone as she would wait in the waiting room. It was during these visits that I was able to witness the full extent of the damage that the stroke had caused.
Thankfully the stroke did not effect him physically. Stanley wore a medium build, 70’s style, longer than average, neatly combed brown hair parted on the side. For a thought he reminded me of the Eagles’ Glenn Fry. He walked normally and retained full use of all of his physical attributes. To look at him briefly, like we too often do, you might not notice that something was wrong with Stanley. But when you truly watched him move, you could see a hint of something definitely missing. Stanley had the stature of a grown man but possessed the assurance of a child. He walked with unsure steps and looked with uncertain eyes. I couldn’t help but feel bad for him. How difficult to be functioning at the level of a child trapped in a man’s body.
Talking and listening to Stanley revealed the greatest level of damage. He listened painfully trying to comprehend even the simplest of sentences. He responded even slower. When I would ask him how had he been feeling since we last talked, he struggled with a response. His answers were forced and his vocabulary was limited to short, quick, one word answers. Nothing more. He never smiled and his voice was always monotone devoid of the normal influx that we all possess. Not to be unkind….Stanley had an unhappy animated voice….a voice without joy.
Stanley would seldom make eye contact. It was though he was ashamed. He would often look down at his feet when he did speak and infrequently glance out of the corner of his eye to read your expression. He would sit with a teenagers slumped posture and often sit on his hands while on the exam table. Certainly he realized something was wrong with the way he felt. Certainly he knew something was wrong with Stanley.
It pained me to see him struggle. A simple question and answer session seemed a cruel reminder to both of us…that he was a shell of the man who he once was. After a few office visits I realized that he wasn’t going to get better. This was as good as it was going to get. Stanley was relegated to what I envisioned as an awful existence.

One day he presented a little differently. I can’t say that it was a positive change. It wasn’t. I couldn’t have imagined him looking any more lost that he usually did but….lost he did look. I found myself hanging even more on every forced word. His gait was pressured and his mannerisms suspicious. For the first time, I saw terror in his eyes.
Stanley was experiencing panic attacks. It wasn’t bad enough that he was a prisoner in his own thoughts. Now the clouded visions he lived with, brought with them…uncertainty.
Slowly and painfully he painted the scenes with trembling one word palates. Where, in the past, he found comfort in being alone, he now found fear. He always was uncomfortable around large groups of people. Now this discomfort turned to panic. He found himself trembling with thoughts of the future but haunted with visions of the past. He continued to paint me his picture. I continued to feel uneasy. His voice quivered as if a child describing nightmare after nightmare. Unfortunately, this without the promise of the morning.
I prescribed for him 2 medications. One to take daily that would eventually after several weeks allow the demons to go away. The other medication was to take on a “as needed” basis to hopefully do the same while the other, much less sedating, medicine took effect.
I explained my plan several times to make sure that he understood. I think that he did and assured him that I was just a phone call away. I escorted him into the waiting room hoping to find his wife, but she wasn’t with him. A neighbor had brought him that day. I reached out and shook Stanley’s hand, longer than I had before just to get his attention. I made him promise to call me if he needed me and to come back in 4 weeks. He gave me his one word promise without making eye contact and out the door he went. I swallowed hard and remembered my children’s first day of school.

One month went by. I walked into Stanley’s room nervous. He looked better….not completely better like I always wanted him to be…but better. I sat down on my stool and asked him how he had been. I waited patiently for his answer. So did he. He finally relayed to me that he was feeling better and for this I was glad. He then began telling me about one episode occurred about a week prior. I listened. He described waking up in the middle of the night. It was dark in his room. He felt a wave of panic come over him and immediately began shaking. He began crying. I envisioned a child afraid of the dark staring at the closet door waiting for it to open. I listened more. He stopped talking as if he didn’t know what else to say. I asked him what did he do to make the feeling go away. He thought for a while, looked down at his feet then back to me and paused for what appeared longer than usual even for Stanley.

“I said Jesus.” He told me.
“That’s all….I said Jesus.”

I just sat there waiting for him to say more…but he didn’t. He seemed a little more like himself. He seemed…..lighter. I acknowledged that I was glad that he was able to make the panic go away and then turned the conversation back over to him. He seemed that he wanted to say more but wasn’t. Maybe he couldn’t. We exchanged some small talk and advised him that I was glad that he was feeling better and that he should call me if any of these symptoms came back. I stood up off my stool and reached for the door.

“I make churches.” Stanley said to me.
Not thinking that I heard him correctly I asked what he had said.
“I make churches.”
“Out of wood….I make churches.”

I sat back down to listen to exactly what he had to say. He, in very few words, described how he cuts plywood into pieces, paints each and every part and then nails the pieces together. He fashioned his hands to show me the general height and width and even slowly described the steeple that he cuts to put on the roof. I couldn’t believe what he was telling me. I faintly imagined a smile growing from the corner of his mouth. But as quickly as it occurred….it faded. I asked Stanley if I could one day see one of his churches and he, quicker than usual, said, “Yes!”

A few weeks went by and I can honestly say that I forgot about Stanley’s little churches….that is, until he came back to my office.

I opened the exam room door and saw Stanley nervously sitting on the exam table. His eyes were dancing between me and the counter on the opposite side of the room. I initially thought that someone else was in the room until I looked in that direction. On the counter sat one of Stanley’s churches. It was taller and narrower than I had expected. The height was about 16” and more narrow than I would have made it. I picked the little church up and Stanley nervously watched as I inspected his creation.

The front of the little church consisted of a tall, narrow archway door with similar style windows mirrored on each side of the door. In each window was a chrome wire running vertically the tall windows’ length. The wire’s ends were bent at 90 degree angles and stuck into drilled holes on the inside surface of the plywood to secure them. On the back wall of the church was a larger hole, approximately 1” in diameter that housed a small light bulb protruding into the church’s interior. The wire and plug were stark white and stood out from the antiqued overall appearance. The walls and roof were all nailed together by what appeared to be small chrome finishing nails and the little church’s external walls were painted a faded green, the roof a faded brown and the inside walls were left unpainted exposing the plywood’s grain. The heads of the nails were not completely straight and the paint failed to stick to them leaving them noticeably exposed and sad to say unnatural looking.

Stanley looked nervously as if I was quietly inspecting his report card for the first 9 weeks of the grading period. He awaited my response. After I cleared out a perfect spot for it on the counter, I sat the little church down. I looked back at Stanley just to see him look away. I knew that this meant the world to him and he was afraid that I might be like all the rest….impatient and uncaring.

I praised the little church…..not artificially…it was genuinely beautiful. I ran my fingers over the edge of the roof and commented on the craftsmanship. I showed him how it sat perfectly on a flat surface without rocking and then envisioned him testing the same multiple times just to assure perfection. And perfection it was!
I almost failed to realize the importance of this moment and thanked him for bringing it in and handed it back to him. But more was required I could tell. I asked him how long it took him to make it and did he make many of the little churches. He slowly shared with me that it takes him about 5 hours to make one church and that he doesn’t want to make too many because then he would be too busy. I chuckled at this comment and surprisingly…so did he. This was the first true outward emotion that I witnessed from all the years of getting to know Stanley. It was great to watch him laugh and I didn’t want him to stop.
I asked him if the little church was for sale and his body language completely changed. He sat upright and I swear I saw him stick his chest out with pride. He nodded yes and said,
”Thirty Dollars.”
I echoed his bounty and pointed out that he spent 5 hours making his little church and that he should ask more. I told him that I was interested and that I would be right back. I exited the room and imagined him jumping off the exam table, dancing to celebrate a sale. A wishful thought. I reentered the room and handed him $40.00. He looked up at me after counting the money and smiled the prideful smile that I had long yearned for. He never said the words, Thank You. He didn’t have to.

Stanley left our office with more purpose in his walk and I realized that at least for a few minutes, I was introduced to the Stanley that I had never known before.
The girls in the office commented on the pretty little church and I proudly cleared a space for it on my bookshelf in the hallway of our office. Everyone could see Stanley’s little church. He was proud of his hard work and I was proud for realizing the opportunity that was placed before me to make a big difference in a young man‘s life with a tiny gesture of kindness.

The story doesn’t end here.

Elizabeth’s chart has taken up residence on my desk.

She walked into my office looking finally her age. She was 61 but up until the radiation and chemotherapy for her breast cancer, she looked to be at least 15 years younger. Her Irish skin revealed what appeared to be sun burnt areas especially on her arms. She wore long sleeves this warm spring day. She adorned a scarf that would have been more fashionable when she was a young girl than today. I dared not to look beneath it. She always took pride in a full head of thick hair. Her eyes were still “sky-bright-Irish-blue”. They did look a little more fatigued than usual though.
Needless to say…I wanted to pick her up and run far away…..far away from the CT scans, the PET scans, the myriad of tests and procedures that aged her to this state….away from the radioactive beams of energy that crash through her body in an attempt to kill the cancer causing a path of destruction of both good and bad….away from the poison that was delivered into a port hanging out of her chest. I desired to possess the healing touch of GOD and deliver her from this evil….but no matter how I tried… the disease progressed.
Along with the physical changes, I noticed obvious emotional changes as well. She smiled less. She looked through weary eyes. Through reports from her husband, she often found herself in bed, sheltered from the outside world anticipating the future….tearful and afraid. She complained of severe fatigue for several days after her treatments, both mental and physical. As the fatigue would wane over the following days, it would then be time for another round of chemo or radiation. Nausea, vomiting, flu-like symptoms, abdominal pain…the entire cycle would then repeat…sore burned skin, mouth ulcers, diarrhea, body aches. The symptoms of the worse case of the flu….over and over again.

What I said earlier…I meant. I often dream of the day that I could shelter my patients from harms way. I would imagine the laughter when we would meet when the cancer was cured. I would pick her up, cradle her in my arms and run far away. I would leap over adversaries, stiff arm potential tacklers and arrive in the land of sunshine…from the land of the storms. There I would allow her to gain back her strength…renew the tattered body and replace it with new. She would feel youth again.

Our office visit this day was typical. She and her husband updated me on the current events since our last meeting and I reviewed the new reports in her chart. I would answer her questions and concerns that were voiced. We both would concentrate on the obvious and hang on every “positive” news obtained…..I would accentuate anything that I could. I would praise her for not losing too much weight. I would seem satisfied with the fact that her most recent imaging scans look promising that the cancer hasn’t spread to new areas. I was glad that the pain was tolerable and that the nausea only lasted a few days after her treatments. I would search for anything positive amidst the destruction.
This might have superficially helped a small amount but the obvious could not be overlooked….Elizabeth had “Stage IV Breast Cancer”. A cure wasn’t impossible but also wasn’t likely.

As I sat on my stool in front of her my thoughts wondered, not in an uncaring way, but in a “how can I help her through this way”. Then I knew exactly what I was to do. I excused myself from the room telling her that I needed to get something.
I blew the dust off of the little church not even looking to see if any was on it. I held it in one hand as I opened the door with the other. I proudly placed Stanley’s church on the counter now in Elizabeth’s room. They both looked at me smiling as I sat back onto my stool and told of the church’s little story.

I told of the carpenter. I told of the carpenter’s craft. I told of the pride that followed when a small gesture of kindness reaped great rewards when I offered to purchase the church. And I then told that I knew that I wanted Stanley’s little church to belong to her.
She smiled and turned her head to admire the little church and appeared honored to be acceptant of such a precious gift. Acceptant she was! She got off of the exam table with a slightly guarded gait and walked over to the counter. She bent down to look into the little churches windows. She looked over the exterior and finally picked it up carefully in her weathered hands.

Everyone in the room, me included, leaned forward just incase she dropped it…but she did not. She ran her hands across the point of the roof and admired every angle. She would look between her husband and I as she would compliment the craftsmanship. I think at exactly that moment….I knew how Stanley felt. As he watched me….I watched her. I felt proud.

She smiled widely a smile that was worth much more than $40.00.

She thanked me for my kindness and said that every time that the little church would light her path, she would pray for Stanley. That surprised me. I was so caught up in thinking of what I could do for Elizabeth that I couldn’t imagine her doing something for someone else.

She and her husband left my office carrying The Carpenter’s Gift.

I realized then, the true gift.

I realized then…the true carpenter.

Stanley, alone, in the black darkness of his night called the name of “Jesus”.
Elizabeth, alone, in the darkness of her night will do the same.

And the gift of “THE CARPENTER” heals all wounds.

I met with Elizabeth today in my office.
Her last PET scan revealed “The CARPENTER’S Gift”…

“There are no signs of cancer“.

***

An excerpt from: "The Journey Learned" copyright 2008

Have Truck will Travel

Thought everyone would enjoy a pic of my sons. Like us humans...they enjoy frequent rides to fun places like the park, Petsmart, the "woods", etc. "Sparky" the Boston Terrier "assumes the position" within about 32.8 seconds and usually is sound asleep...he must be an infant by heart. Watson...the one with "the skin for two" will not relax until he has received looks from the car next to him, barked at every auto, child, squirrel or anything else that might be threatening in site. His other duty of course is to slobber all over HIS window. This...is his favorite!!!
Safe travels and Happy Thanksgiving to all!!!
Dr M

Life's Chapters.

A book is divided into many chapters. Pick up any book and what is one of the first things that you do(other than read the last page)? If you are like me, you go to the index and peruse the titles of the chapters. The chapter titles often reveal the "flavor"of the book. The chapters are always distinct and though they build on the previous sections, they often are capable of standing on their own and announce...a piece of the story.
Our lives are no different....filled with chapters. Though there is one subtle difference. Let me explain.
Stop for a moment. (Please do this) Take a piece of paper and look back at your life. Look frontwards or backwards...makes no difference. Write down key turning points in your life...marriage, kids, careers, etc. Write down "Your Chapters".
If you are like me, you can list quite a few in a short period of time. It was easy for me to think of 10 chapters. Then, I thought of another one to insert between the third and fourth. Now I have 11 chapters. But wait. Another exists, and then another. Every chapter tells a piece of who you are.
Now look through your chapters. Were your chapters announced? Were you capable of fingering through the index of your life to see what the next section was to bring. Probably not. Unlike a book, life's chapters often come...unannounced. It isn't until we have lived the chapter, that we then realized, it was one.
Wouldn't it be awesome to know when a new "life chapter" was beginning? Could you then have an effect on it's content? A little tweak here...a little tweak there...take this road and avoid the other...smile, laugh and love from the first page to the last.

Throughout my life I have witnessed GOD's direction and experienced HIS miracles...unfortunately it took me years to listen. Yesterday was no different. I am GOD's eager student and HE has been teaching me to look for each chapter's beginning. Yesterday was one such beginning. As I stood at the top of the staircase I was reminded of this.
We finalized the purchase of our "Lake House"...yet another chapter. Sandi and I feel that this chapter will be full of promise...full of laughter...full of love and the fulfillment to share treasured moments with our friends and family.
I can't wait to see you in our newest chapter.
"See you at the lake!!!"
Dr M

An excerpt from: "The Journey Learned" copyright 2008

Toasty Toes.

'Tis the time of the year. Here's to all of you out there that, like myself, allow the time to slow down, get warm and hover around something other than the television.

If you haven't a fireplace, find someone who does and invite yourself over. Take some mulled wine and your favorite PJs...an evening to forever remember will follow...especially if they don't know who you are. :)