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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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    Friday, July 01, 2022
     

    "I Need You to Take This Fish," 


    ...said my brother as we drove to the Pittsburgh airport. It was early November and we had traveled to our father's home town in Pennsylvania to give him the funeral he wanted. His ashes (to be precise, half of them; we still have the other half) had been interred in his parents' grave. The trip gave us a chance to spend time with my father's older sister and our cousins. Our aunt is the only one of the three siblings still alive; thankfully she is still completely alert and was very happy to see us. One of our cousins, a real outdoors type, gave John some frozen fish he had caught for the trip back across the country.

    "It'll be fine!" he had said cheerily. "I have an insulated bag for it, just pack it in your suitcase." Not without misgivings, my brother had accepted the gift. But now we were running late and my brother had just remembered, first, that he only had a carry-on bag with him; and second, that he wasn't going directly home but to a sports function for his son.

    So guess who got stuck with a bag of frozen fish in her suitcase? But time was short and we had no choice, so into my luggage it went. I had visions of ruined clothing all the way back to Los Angeles. But luck was with me; the early morning Pittsburgh temperatures were below freezing and I changed planes in Denver (pretty cold there as well). When I landed at LAX it was a cool, foggy day. As I stood in the rideshare line, my brother texted me: "How's the fish?"

    "Not home yet," I responded tersely. As soon as I made it home I hauled my bag into the dining room, put it up on the table and began digging through it. To my relief it was still frozen solid. I don't know who manufactures that insulated bag, but I need to get one. 

    The fish was stored in my freezer for a few weeks, at which point it resumed its journey to my parents' house for Thanksgiving. My brother and his family took it home with them after the holiday. 

    And that is my epic fish story. 

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    Tuesday, June 07, 2022
     

    Testing, Testing

    Today while going through Twitter I ran across a tweet written by a woman mourning a friend who died of colon cancer at age 39. Her post states the friend's father died "young" (she does not say how young) of colon cancer, and therefore the friend requested a colonoscopy. According to the post, the screening was denied; insurance wouldn't pay for it. The friend was not diagnosed until her cancer had metastasized. The tweet has attracted thousands of retweets and hundreds of comments, many of which give other examples of friends and family members dying early of colon and other cancers. The responders' chorus: "Why wouldn't insurance pay for this? Why! This could have been avoided!" as well as the mandatory curses thrown at the US health system and insurance companies.

    Make no mistake, this is a tragedy. Unfortunately there isn't enough information given in the tweet to fully critique what happened. My first question, however, was: was this person offered a FIT test? FIT is an abbreviation for fecal immunochemical test and is a test to check for blood in the stool. More recently, a more sensitive test called Cologuard has become available (it checks for DNA markers in the stool which are compatible with colon cancer or certain types of polyps). It is more expensive than the FIT test and many insurances do not cover it; however, it is still a lot cheaper than a colonoscopy. Either of these tests could have helped diagnose the woman at an earlier stage. If these tests came back positive, it would definitely have influenced the decision to proceed with colonoscopy.

    Second: the current standards for colonoscopy in the US are that you begin screening at age 45 or, if there is a family history of colon cancer in a near relative, when the patient's age is ten years younger than the relative's at time of diagnosis - whichever is sooner. "Screening" here refers to colonoscopy, although many people decline them, in which case they can choose to be screened annually with a FIT test or with Cologuard every three years. The US screening recommendations have evolved over the years to become more aggressive, as I will discuss further.

    As always, the benefits of the UK health system are being talked up. For comparison I will present the NHS testing policy for colon cancer, as follows: FIT screening every other year, not annually, and screening is recommended between the ages of 60 and 74 (it can be extended beyond age 74 upon request by the patient). The NHS is considering extending screening back to age 50 but this has not yet taken place. Colonoscopy is not part of routine screening. 

    When I began my training, screening for colon cancer consisted of sigmoidoscopies rather than full colonoscopies and screening began at age 50. The sigmoid colon is the last 40 cm of the colon, about 25 percent of the entire colon. Initially it was thought that the majority of colon cancers originated in the sigmoid colon, but we now know this is no longer true. Full colonoscopies became the norm after the well-publicized death of Jay Monahan in 1998. He was the husband of a journalist named Katie Couric, and had been screened with sigmoidoscopy but not full colonoscopy; Ms. Couric made it her cause to urge more aggressive screening techniques and this was changed. More recently, the age to begin colon cancer screening has been pushed back to age 45, as noted above. This is due to colon cancers trending at a younger age. 

    "Why not sooner?" - in general, colon cancer is not a young person's illness. There are very specific exceptions to this, involving genetic syndromes such as familial adenomatous polyposis, but they are rare. These syndromes have been closely studied and in many cases early colectomy, such as by age 30 or 35, is recommended to prevent onset of colon cancer. Now, screening recommendations can always be changed as I have outlined above; they are not set in stone. But there is always a balance between risks and benefits of screening. Colonoscopy involves anesthesia as well as the risks of perforation of the colon and bleeding. (These complications are rare, but they can happen.) The less invasive forms of screening, FIT and Cologuard, can give false negative and false positive results. This means that someone could wind up getting an unnecessary colonoscopy due to a false positive result, or that a cancer can be missed. Going on a snipe hunt to check a questionable result leads to increased risk and expense. In a very low risk population (such as below age 45), the risks and expense will outweigh the benefits. For every cancer found in this age group there are a lot of useless procedures. It's all about statistics, and this is why doctors as well as insurance companies - and the US preventive services task force, come to that - are generally reluctant to recommend screening at a very early age. 

    Symptoms of colon cancer at an early stage are very nonspecific. Constipation, bloating and abdominal pain can all be symptoms; unfortunately the majority of the time, they are not. Functional bowel symptoms are incredibly common, meaning that the patient has symptoms but no disease can be found even with radiologic testing or colonoscopy. It is simply not possible to work up everyone who presents with these symptoms. Of course, trying to point this out to someone who has lost a relative or close friend to cancer is a loser's game. What I try to do is listen, do a good exam, run a blood count to check for anemia and encourage the patient to follow up or email me if the symptoms continue or change. Screening has done a lot to extend lifespan by catching problems early, but it is not perfect. 

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    Sunday, June 05, 2022
     

     You Can Sell Your Soul and Still Lose

    One of my longtime goals has been to write mysteries (I do write fan fiction but would like to write something I can sell to the public). In pursuit of this goal, I have started to follow several blogs about writing including According to Hoyt, Mad Genius Club, Robert KroeseMonster Hunter Nation and Celia Hayes

    These blogs and their authors have some things in common. They tend to work in the scifi/fantasy genres, though not all of them do; they publish independently, usually via Amazon (some of them also have conventional publishers but do at least some independent publishing); and they trend to the conservative/libertarian side of the aisle, or at the very least they keep politics out of their writing. As a result they have met more setbacks in the course of their careers than one might expect (and Lord knows, most writers face enough of those). They don't whine about it but they do discuss it. Most publishers strongly prefer "diversity" in the works they publish these days, as defined by issues related to race, sexuality or gender. If the author's work checks more than one of those boxes it's even better. That is not to say that the writers I follow limit themselves to tales about strong, silent white men who conquer new worlds and exploit their resources when they are not killing dragons and marrying princesses. Their works are far more interesting than that, often irreverent and tweak quite a few sacred cows. This, of course, is why they keep running into roadblocks. Publishers expect novels to meet certain criteria (see my recent post on Charles Stross and his Laundry Files series, which has turned into a labored metaphor for global warming). The rule for books, I feel, is that the work should be fun and interesting rather than grim and judgemental.

    But... denizens of the scifi universe now appear to be turning on even the most rigorously diverse writers. The most recent example is an author named Stephanie Burke. She was a guest presenter at the scifi convention Balticon last month and her bio reads, in part, as follows: 

    Stephanie Burke is a USA Today best selling multi-published, multi-award-winning author, master costumer, handicapped, wife and mother of two. From sex-shifting, shape-shifting dragons to undersea worlds, up to sexually confused elemental fey and homoerotic mysteries, all the way to pastel challenged urban sprites, Stephanie has done it all and hopes to do more.

    So far, so diverse. I wish to point out here that I have not read any of her works and do not intend to analyze or criticize her writing, as I am unable to do so. My point is that today I learned from Twitter that midway through Balticon she was accused of making "offensive statements" (details unspecified) and was asked to leave. Her presentations were canceled even though the accusation was apparently unsubstantiated. Link is here. Ms. Burke was extremely upset by this incident, and rightfully so.

    Example Number Two: right around that same time, author Mercedes Lackey was speaking on a panel for the Science Fiction and Fantasy Writers of America (SFWA) and used the term "colored" when speaking about an author and critic named Samuel Delany. He is well known, well-respected and, yes, African-American. Mr. Delany specifically said that he was not offended by the term or by Ms. Lackey, who was praising his work at the time. Not only was she kicked out of the convention after this incident, but so was her husband. 

    Per Wikipedia, [Ms. Lackey] has... published several novels re-working well-known fairy tales set in a mid-19th to early 20th century setting in which magic is real, although hidden from the mundane world. These novels explore issues of ecology, social class, and gender roles.

    I'm beginning to discern a pattern here. Are you? It doesn't matter how much diversity street cred you have, if you don't toe the political line your readers and publishers can turn on you in a heartbeat. If you need another example, look at the one everybody knows: J.K. Rowling. Her adoration ratings, already quite high, jumped after she stated that Dumbledore was gay and had been in love with his nemesis Grindelwald - until she stepped up to the plate to support the rights of cis women. Since that time she has been pilloried on social media. (Incidentally, I think this explanation of Dumbledore's motivations is consistent with everything we learn about him in the series. But it was not touched upon because it was a children's book series, and because as a product of the nineteenth century, Dumbledore would have had very good reasons to conceal his sexuality for his entire life.)

    So my takeaway from these developments is as follows. Write what you want to write, but don't join the diversity conga line in a misguided hope for success. All it takes is one wrong turn of phrase, or even (as we have seen above) one wrong word. Your career will be instantly trashed. 

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    Saturday, June 04, 2022
     

     Mission Accomplished


    My move is over, thank goodness. Furniture was moved in an all-day marathon (twelve hours!) on May 31; since then I have made a couple trips back to the house to pick up a few forgotten items and to take my tenant to the airport. She is currently staying in Hawaii with family. She is finally out, which has justified this entire ordeal. I volunteered to take her to the airport to make sure she would leave. A nice enough woman, but she wasn't paying rent for several years and it was like pulling teeth even to get her to pay utilities. I had discussed this with her and we had come to an agreement that she would move in February of 2020... you know what happened then. 

    Now the work begins of cleaning, arranging and organizing and that will indeed be a long process. Fortunately my siblings have more or less given me carte blanche to sell, give away or trash nearly everything (the funds will be divided among us). So of course I sat down to blog instead. There are a lot of stairs in this house!

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    Thursday, May 26, 2022
     

    Book Review: Quantum of Nightmares

    Today I took some time off packing for my upcoming move to finish a book. (Should not have, but did.) The book in question was "Quantum of Nightmares," by Charles Stross. It's the most recent installment in his "Tales of the New Management" series; briefly, back in 2000 Mr. Stross began writing a book called "The Atrocity Archive," set in the UK in a universe where magic exists. Not Harry Potter type magic, but mathematical magic. This book was well received and led to a series known as "The Laundry Files." 

    The setting is modern-day UK and, at least at the start of the series, the public at large is unaware of magic; the Laundry is a government organization tasked with protecting the world against Cthulhu-type monsters from beyond the stars. As a government organization, it is also subject to workplace mandates and paperwork that would drive anyone mad. Stross loves to satirize management and the series as a whole is quite fun. It's a mix of horror and satire. 

    Early in the series, the reader was introduced to the looming problem of CASE NIGHTMARE GREEN (it's always capitalized in the books), when the Stars Come Right, everyone will be able to practice magic in some form and the world will come apart at the seams. As time went on it became more and more obvious that NIGHTMARE GREEN was a metaphor for global warming, the author's bully pulpit became more obvious, and the series as a whole became less fun. I stuck with it until "Tales of the New Management," an extension of the original series, became the, ah, new normal. This series is set after the Laundry is dissolved, and Nyarlahotep has become the Prime Minister of the UK (trust me, things could be worse than having him in charge). 

    Suffice to say that after purchasing Q of N on Kindle, I sent it back within 24 hours and wrote a blistering review on Amazon. Finally, I tracked it down at the library and checked it out in the interest of giving it one more try.

    And my review is: nope. Reluctantly.

    Mr. Stross has a real talent for juggling multiple plotlines, and this is my weakness. Be it Charles Dickens or Tom Clancy, give me multiple plotlines and I am a happy camper. Q of N has lots o' plot, but... it's hard to explain... the transition from plot thread to plot thread is just too obvious. Sort of along the lines of "OK, here's Character A's viewpoint." Then "Character B, C... etc." with no lead-in. Each section of the book is just plunked down with no attempt at connection. 

    But far more important is the fact that not one of the characters in this book is likeable. None of them are nice people. To a certain extent you can empathize with them, but not nearly as much as one would think. This, also, is a habit of Stross. Even in the early days of the Laundry series, he took pleasure in pointing out that the (somewhat more likeable) characters were, in his words, "serial killers" and "unreliable narrators." The characters do kill bad guys in the course of the series, but their reasons are well explained. You can't have it both ways, Stross. Stick a sock in it.  

    The book has a great slam-bang finish in which all of the plot threads are brought together successfully, but the overlying anti-capitalist approach, about as subtle as a sledgehammer, takes all the fun out of it. Suffice to say that the meat department of a supermarket chain is the center of the action and the plot recalls Upton Sinclair and Jonathan Swift. They both wrote it better. 

    I do recommend the Laundry Files, at least the first five or six books. But as I said in my review, I think Mr. Stross needs a nice benzodiazepine cocktail before going back to his word processor. And the "Tales of the New Management" has had all the fun sucked out of it. 

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    Friday, May 20, 2022
     

     The Big Slog


    My mother's memorial service went really well. Of course, the day after everyone scattered back to their homes. My brother had to fly to Texas for work and I drove him to the airport; my SIL and the kids left separately. My sister and her family left back to their home in Colorado. Then I had to make arrangements for the party tables, chairs and linens to be picked up and for the tree trimmers to come this week (my parents' home got cited by the city due to tree overgrowth to the point that the street signs were obscured). 

    That much is done. Since then I have been packing, in a halfhearted fashion. This coming week a friend of mine is hiring a van, for the second time in a month, and we will ship more of my stuff out there. I have so many pictures - too many! - and in the coming year I need to look into selling or donating a lot of my things. 

    Yesterday as I was cleaning out desk drawers I found one of the last birthday cards from my parents. My mother's handwriting was so shaky that it was almost unreadable. Poor mom, I used to admire the elegance of her handwriting. Mine is rather esoteric by contrast. I recall once on vacation writing up a list of requests for a takeout burger place and watching my niece and nephews squint at it. 

    Old playbills I kept for years, now gone. So many things I just don't need to keep. I have a large rubber stamp collection that I'm contemplating throwing out, but have not been able to bring myself to do it. Maybe I'll hold a garage sale next year. With the threatened shortages for nearly everything I think I could do rather well. 

    Back to work...

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    Friday, May 13, 2022
     

     The Family Gathers


    My brother and sister arrive today with their families for my mother's service, which takes place tomorrow. They all have to leave on Sunday; unfortunately we all are too busy for this to be an extended stay. The place looks nice, with flowers in bloom (courtesy of the local nursery; they probably won't last a week after the service) and windows freshly washed. 

    This is a large house, and I'm going to be the only one living here. I'm getting used to the little pops and clicks you hear in any house; when the icemaker goes off I no longer assume that there's a serial killer standing behind me, making ice. And I now have a coyote that visits in the early morning. He just ghosted across the patio and up the brick stairs toward the street. I'm going to be living here full-time starting in June, assuming I survive the next two weeks before the move. 

    Going back to my mother, her death was both expected and unexpected. She had Covid at Christmas in 2020 and was never really the same afterward, although she did not have to be hospitalized. She developed a terrible, racking cough which improved for a while and then worsened again in the last few months of her life. When she was in the hospital, the respiratory technician looking at her blood gases  kept asking, "Are you sure she didn't smoke?" Finally I explained about the Covid and he immediately said, "Oh, that explains it." This despite her chest X-ray not showing any significant abnormalities.

    Then my aunt (her sister) died, followed by my father six weeks later. I have written extensively about my aunt's illness, but not my father's. He had vascular dementia related to strokes and hypertension. The week after my aunt died, with the distraction of her illness gone, I was able to really look at him for the first time in weeks and realized how much weight he had lost due to his dwindling appetite. After a quick family discussion, I put him on hospice and he passed away in his sleep a month later. Mom never really recovered from those twin losses. She was very depressed, but when we held my father's celebration of life in August and she was able to see many of her friends, she did surprisingly well. It was the last real social event she attended. 

    Many of her friends offered to take her out for lunch and the caregivers did take her out once or twice, but more and more she slipped into isolation. In December she was hospitalized, twice in January, and then she became more confused and died at the beginning of February when her oxygen level suddenly dropped and she began coughing up blood. It was shocking and sudden; none of the imaging or tests she had indicated that something like this was going to happen. When asked what had happened, my stock answer was "I could give you half a dozen possible explanations, but I don't know exactly what it was." I am sure there was some sort of pulmonary cause, but none of us in the family saw any reason to do an autopsy.

    When she died, I had left her just a few hours before to drive back to my house and run errands. I do so wish I had been there when she passed away, but I did get to spend the previous evening with her, and I take some comfort in that. 

    I hope to write more about her later, but I can't face it just yet, and there is much to be done before my siblings arrive. Must go.


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    Wednesday, May 11, 2022
     

     

    Journal Post #1

    I’m going to try something different here, cross posting pieces from my journal on this blog. At least doing this will ensure that I will be producing more posts to entertain any wandering reader who happens by. Briefly, several months ago I decided to start keeping a personal journal to document my decisions for the coming year. I had retired, or semi-retired, in January of 2020 to take care of my ill aunt and parents. As it turned out this was just in time for Covid to come along. My aunt passed away one year ago, followed by my father six weeks later, followed by my mother three months ago. Now I am in the process of selling my home and moving back to my parents’ to try and get the house on the market. Come along with me, won’t you? It’ll be fun. Hopefully at least engaging, in the way of a train wreck.

    Yesterday I was able to get the mirror on my car fixed, and I feel much safer driving now. Did some more packing and moving. My mother’s celebration of life service is in three days, and the other fam members will arrive in two days. So I’m just trying to get the place pulled together, bedrooms ready, food in the fridge. I do wish they could stay longer, but everyone has to get back to school/jobs.

    Last night, to distract myself, I wound up looking at housing prices and other facts about Provo, Utah as part of my research for my long-term plan to move out of California (why Provo? Only because I’m thinking of attending a conference there next year). But Utah, like California and much of the western US, is suffering from drought. This has reinforced my vague plan to move to the East Coast. I don’t like floods or hurricanes either, but it would be nice not to have to worry about water.

    I also spent some time with my tenant, reading lines with her. She is an actress and currently is auditioning for a Netflix show called “Obliterated.” As far as I can tell it’s about a bunch of Navy SEALS who spend their time cursing, having sex and taking drugs when they aren’t saving the world. Good Lord, I’m glad I’m not an actor; I cannot fathom having to take roles like that.

    More later.

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    It's Time, It's Time, It's Time

    I am in the process of moving. About a month after my mother passed away, the property behind me began construction on a new building which will likely be a condominium. All the trees that shielded my house from the Eastern sun are gone. There is construction noise every day. Despite that, the house is in a desirable area and it sold quickly. So now I am packing and moving. The traffic and crime in Los Angeles continue to worsen, and I just don't want to live here any more; it's time. 

    I am still working with my medical group off and on, but I see no reason to continue staying on the hospital staff; it's expensive and membership needs to be renewed every two years. I just got word that I have been transferred to a new committee (every staff member needs to belong to at least one, and I liked my old one a lot). Certainly this isn't the end of the world, but it's one more change that has influenced my decision: When my membership comes due in January I will let it expire. It's time. 

    I am moving into my parents' house in the hope of getting it ready for market. This will take over a year (it is stuffed full of everything from my father's office equipment to model trains) but it is will be a relief for all of us in the family to divest ourselves of all this stuff! Then I plan to move out of state, though I am not sure where yet. It is definitely the right time to move out of California.

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    Tuesday, May 03, 2022
     

    Personal Update 

    I am settled in here in my mother's hospital room for her third admission in a month. 


    At least, that's what I wrote back on the 22nd of January. My mother passed away on February 4; my father on June 19 of last year. My aunt died May 8 of last year. 

    It's been a difficult time. I have been writing, just not on the blog. I started keeping a journal last December with the intention of using it to clarify what I want to do both for myself and for my mother. But my mother never really recovered from the twin blows of losing her only sister and her husband six weeks apart. My siblings and I are planning a celebration of life for her which will take place in about ten days; I am in the process of selling my house and moving to my parents' home so that I can get it into shape to sell. 

    I'm not going back to work, at least not full time; I am considering working virtual sessions to keep myself busy when I'm not throwing out junk or battling spiders. (I sometimes think my parent's house is one solid cobweb.) But right now I am packing and sorting, and I hope to put together an estate sale at some point. And I hope to document the process here (at least the interesting part). 

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    Friday, May 07, 2021
     

    The New Normal


    The process of dying, I have come to realize, is a procession of "new normals"; much like aging, but at an accelerated pace. It's frightening to look back at what my aunt could do three months ago and where she is now: bedbound and unconscious. It happens in stages.

    - She went from needing assistance to walk, to a walker, to a wheelchair.

    - When she first came to stay she was able to go upstairs and to shower by herself. First she lost the ability to climb stairs. We cleaned out a room used as an office on the ground floor and she moved in there. Hospice provided an aide to help her shower; that came next. 

    - The bathroom. One morning she was standing brushing her teeth, turned around, lost her balance and fell (I was standing nearby and was able to catch her; no harm was done). After that I insisted that she have an escort to the bathroom. Then she needed full support. One morning as I was holding her she could not take one more step. After that it was the bedside commode. 

    - Being able to stand. For a long time she insisted on eating breakfast in the kitchen and going to her chair in the living room, but in the past two weeks she has been restricted to her room. Using diapers was the last taboo; she required three people to get her out of bed and on/off the commode and to dress/undress her as she could not support herself.

    - for the past week she has been minimally responsive, gradually becoming unconscious. The medications (morphine, lorazepam) have helped a lot. She fought their use for a while, as she had been a very successful member of a twelve step program for decades; but we kept explaining patiently that there was no reason for her not to use the medications. The pain finally convinced her to agree to their use.

    Now we wait. I believe she has only hours left. Helping someone to die at home is incredibly difficult but also rewarding (especially given that, had she been placed in a facility, she would have had no visitors or independence; I think she would have died much sooner). 

    I'm too tired to say anything else right now.

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    Wednesday, April 28, 2021
     

     Roses


    My aunt loves roses and grew them in her backyard in the desert. (There are heat resistant roses available; a neighbor of hers once insisted on growing English roses, spent a fair amount of money on them and then watched them die in the heat and relentless sun.) Her friends who have come to visit have cut and brought the blooms with them. The living room smells of roses. 

    Yesterday she developed chest pain, likely due to the tumor infiltrating into her chest wall. She is now on regular doses of morphine and benzodiazepine (for the anxiety and agitation). Hospice is coming daily. She is taking liquids by mouth but very little food. 

    We vacillate between long hours of nothing as she sleeps punctuated by a concerted effort to get her to the toilet, calm her, change her clothing. I pass the downtime by cleaning the kitchen and clicking from Facebook, to Twitter, to email. The house is hushed. It is a waiting game now. 

    I hope her passing is peaceful. 

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    Thursday, April 22, 2021
     

     The Dying Patient


    They don't tell you what it's like to be with someone who's dying. As in, being there all the time, day in and day out. Sometimes I wonder if even the hospice doctors and staff know. It isn't that they are not kind. But the nurse, who currently is coming twice per week, checks vitals and asks about bowel movements - "Do you have any questions?" and then she is out the door within 15 minutes. I do not say this to criticize, as I have done my share of such visits. But after a while it is hard to know what to do or say, how to pass the time when not focused on such minutia. 

    My aunt is suffering. Not to say that she is in pain, but she is a very social person and has always been someone who likes to stay active and do things. At holiday dinners, rather than sitting around with a cup of coffee she was always the one cleaning the kitchen or getting the meat off the turkey carcass. Now she is too weak to walk and too confused to focus. She cannot get much enjoyment from reading; cannot remember which of her friends has called her from hour to hour. Her sole consolation is conversation and I am not the best source of that. I have tried to think of entertaining topics but have long since run dry. My father is too demented to talk to her and my mother is too hard of hearing; plus my aunt has suffered vocal cord paralysis due to the tumor and can barely make herself heard.

    Two days ago she told me she wanted to pursue assisted suicide (I think the preferred term is "assisted euthanasia" these days). Her first discussion with the hospice doctor is scheduled for tomorrow. I don't see how she could not qualify, I just don't know whether she will be able to last the next two-plus weeks until all the criteria are met. We should perhaps have discussed this sooner, and I feel badly about that now. I told her that once again she was a groundbreaker, as she has been so often in her life. 

    She was raised in a small Southern town and went on to teach as a career - not much else was open to women in those days. Her first marriage, the product of elopement, failed shortly after she moved to Alaska (her husband was transferred there). She went on to marry again, and eventually left her second husband for a female partner. That relationship lasted 25 years. She successfully fought cancer once and then developed lung cancer more than ten years later. She has traveled, volunteered, has made many friends and excelled at entertaining them. 

    Religion is not a consolation for her, she puts her trust in friends and enjoying life. She has outlived her prognosis by nearly three weeks, but I don't know how much longer this is going to go on. All I can do is to be here, and it is humbling. 


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    Monday, April 19, 2021
     

    Therapy Session

    Back I am at the blog, in search of counseling. Did I mention that this blog serves as my makeshift therapist? I visualize it as female, of no particular appearance, leaning forward, professionally caring but geared to forcing the truth out of me. 

    Then we sit and look at whatever this truth is. 

    Well, (I brace myself,) the past month has been a little tough. It's indisputable that my father's dementia is getting worse. His sister called last week to speak with him and then asked to talk to me; she wanted to know how he's doing. He can't really carry on a conversation any more, though he is always glad to hear from her. I think he had another stroke about a month ago; he has to be coaxed to eat, and often falls asleep during breakfast or dinner. He can't tell us when he has to go to the bathroom any more and is often incontinent without being aware of it. In addition to that my aunt, the one with metastatic lung cancer - remember? She's on hospice now - is becoming weaker and weaker. She is eating less and her weight loss is accelerating. A few weeks ago I made the decision to move in with them, and I've been staying there more or less full time. 

    This means I won't be seeing patients for now. Not that I was seeing many, just one four hour shift per week, but it was something. It made me feel like a doctor again and not just an overloaded daughter, gave me a chance to dust off my skills rather than letting them atrophy. Even virtual visits are not an option, as it has become impossible to spend four uninterrupted hours online due to the needs of my parents and aunt.

    My aunt is my main responsibility right now. She is becoming increasingly confused as well as having major memory loss (probably due to the chemo and radiation). She isn't able to keep herself occupied with much - she does read but I don't know how much of the book she retains day to day. In an effort to give her variety, I tried to show her how to use my Kindle but she simply could not fathom it, even after I set up a book for her with a large font. She could not remember how to tap it to turn the pages. Physically, she is wheelchair bound and requires oxygen at all times. Even taking her to the bathroom has become a significant journey.

    Her friends have been very supportive and have made the drive from the Palm Springs area many times in the past two months to visit. Two came yesterday and two more are coming today; yesterday, two men (partners) and today two women (also partners). The women have a lovely long-haired dachshund that loves my aunt, and my aunt loves her right back. I will miss seeing her today as I had to go into town for an orthodontist's appointment (my treatments are over and I am graduating to a retainer, hooray!)

    My aunt has outlived her prognosis, I think due to force of will alone. Major props to her for this. Taking care of her has taught me a lot, as I have never seen major illness from the family point of view before - only as a physician. Eventually I will go back to work part time, and I hope I will take what I have learned with me.  

    I don't know whether all of this commentary adds up to anything or not. At least it is a relief to put it down.

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    Monday, March 08, 2021
     

     Daytime Television

    Spending more time with my parents as I have done recently, I have become familiar with the drone of television in the background. It haunts me on an almost daily basis, to the point that it has become "white noise." I have the weekday schedule of my father's favorite channel nearly memorized: Perry Mason, then Matlock, then In the Heat of the Night, then The Waltons... you get the idea. The afternoon is a parade of Westerns, one after the other: Bonanza, Gunsmoke, The Rifleman

    In a desperate grab to maintain my sanity I have started deconstructing these shows - at least, some of them. "Perry Mason" is still the king as far as I'm concerned. Yes, the general plot is the same episode after episode, but it has a great noir feel and the cast is just excellent. I can't get enough of Hamilton Burger and Paul Drake, not to mention Della Street - the perfect secretary and co-sleuth. But "Matlock"... ugh. The show was Andy Griffith's late-in-life meal ticket, and I can empathize with that, but it just isn't that good; from the Eighties hairstyles and power suits to the awful overacting, it is nothing short of cringeworthy.

    "In the Heat of the Night" was a favorite of mine back when I was a medical resident. Set in a small Southern town, the show featured location shooting which added lots of atmosphere and overall did a good job portraying the daily life of law enforcement. Plus, Carroll O'Connor anchored the whole production as the police chief struggling with the effects of racism on the town and trying to shake his personal racist past. Sadly, on re-viewing the show it is marred by overacting among the weekly characters/suspects and more bad Southern accents than you could shake a stick at. 

    "The Waltons" was a favorite of mine back in elementary school and junior high. A low-key drama, it showcased the trials and tribulations of a rural family growing up during the Depression and WWII. It was narrated at the beginning and end of each episode by the oldest son, the first in his family to go to college and who would go on to become a writer; it gave the show a retrospective and nostalgic feeling, sort of the "I remember the time Mama had to go off to the tuberculosis sanitarium" sort of thing. (Yes, that was an actual plot.) It's a comforting sort of show, but after a while it just became tiresome plus the child actors started aging out of the cast after a few years. Sometimes I like to imagine it's set in a postapocalyptic future, where Walton's Mountain is salted with booby traps and the family is living on squirrels and coffee... but it's hard to see that there would be much difference.

    On to the Westerns. Not much to say here, they're all alike really. I have realized over time that Westerns are just soap operas with the addition of gunfire. "Bonanza" seems to have more variety than the others, but it all comes down to Hoss being clueless, Little Joe getting framed for murder or Adam lecturing the townsfolk about the importance of being more openminded. "Big Valley" has it all over Bonanza as far as I'm concerned. 

    And then there's Adam-12. This was a Jack Webb production, similar to "Dragnet" in that it was a salute to police and their service to the public. The difference here was that the cast was younger and better looking, two earnest whiter-than-white guys in a patrol car driving around Los Angeles all day dealing with all sorts of stuff during their shift. The show is so dated that trying to imagine the patrolmen thrust into the reality of present day Los Angeles is impossible; the poor guys would get cut down by gunfire five minutes into their shift.

    After "Adam-12" it's time for the evening news, returning to the 21st century once again. Not much to be said here, except that when compared to today's news these dated old shows are much more tempting. 

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