Tuesday, May 19, 2009

Cry me a river

When a top professional tells you your breasts are amazingly photogenic, you can rest assured you’re hearing it from someone who knows.

Of course when that professional is a medical imaging technician and the view she’s raving over is entirely internal, some of the pixie dust tends to dissipate. When you yourself get a gander at the captures and see nothing so much as a sort of fuzzy astronomical chart of the Milky Way, your confidence reverts to entirely pre-compliment status. But such was the opinion of the nice lady at Women’s College Hospital and such was all I was able to take away from my second mammogram.

Last time I endured the discomfort and indignity of a mammogram and breast ultrasound I took away a good deal more, from a personal insight, to an instant diagnosis, both of which I felt compelled to write about and gained the distinction of being the first writer ever to have the word “tits” published in the Globe and Mail. (Eulogy material! Score!)

There’s a PS to that story too (which I also wrote about; there was a time when I could hardly go to the bathroom without making, if you don’t mind me saying, a blog entry) whereby a woman who read the story contacted the Globe to get in touch with me. Seems she had also been moved by my experience… she had been reading my essay on the way to her own appointment with boobular destiny at the imaging clinic and took a special comfort in my personal happy ending. The surprise (even shock, she related) was that her name was Jane Wilson too. Imagine: it would be like coming across a secret letter from yourself to yourself, telling you everything was going to be alright.

But this time around I received no immediate answers – no publishable material – no distinctive anecdotes; just the remarkable experience of being treated like a human being in the often inhuman business of doctoring.

I’ve spent a lot of time in the medical world (I’ve always said that with a properly illustrated textbook and a sharp steak knife, I could take out an appendix. And really, I’m almost certain of this…) from volunteering at the Sick Kids, to supporting friends and loved ones unfortunately buried right up to their necks in it, for reasons less than desirable.

I suppose it began with my mother and her time(s) spent in hospital for treatment of, and then for dying of breast cancer, through my father and his time in hospital and in hospice before death, kindly at home, to my dear darling friend who has battled an absolute army of illness since I first met her more than 10 years ago. She’s had fully three different types of cancer, requiring surgery and chemotherapy and she battles on – with a few less bits and pieces (nothing she can’t live without) and a patience that’s starting to become just the faintest bit frayed around the edges as cancer has once again reared its hideous head to tease and taunt and terrify us all once more.

And in all those times and through all those experiences, I’m very sad to report that more often than not the treatments – and those who treated – were the worst part of the experience.

This is not in any way to suggest that overall, medical professionals are cold, emotionless automatons, bound and determined to make a bad time worse (or even like Laurence Olivier in Marathon Man, grim, determined, practiced sadists) just that in the most tender and terrifying moments, it is the rare professional who is able to make the worst moments better. Or even bearable. I am speaking of course of the highest ranks of medicine – the surgeons, internists and specialists – because with equally rare exception my experiences with nurses and GP’s have been nothing short of life-saving.

Is it their job, you ask? Their job to comfort and support and empathize with people in extremis? It’s not written down anywhere, so I guess the answer is no. But surely it is the fundamental job of humans to make the plight of other humans easier to bear – and no more importantly than at the moment of a devastating diagnosis.

I can take my father out of this equation almost entirely. With the exception of a few of the very highest placed specialists (who were the most unpleasant of all the medical people I’ve ever had the misfortune to meet) he was surrounded by the support and even love of his GP and the professionals she guided him toward, to help guide him through his last weeks and days. As far as I can tell, she went out of her way – the infamous above and beyond – to gently lead him down the painful path of acceptance and then readiness for death. When he died at home late at night, she was standing by and came over past midnight to sign his death certificate and kiss his forehead before he was taken away by the funeral people.

(As he was removed from his lovely home, zipped up in a big black bag and rolled away on a gurney, my brother was amazed that a) it could even happen to this man who had loomed so large in all our lives, for all our lives, and, b) that it was he who was leaving and we who were staying.
“I get the feeling we should just all clear out and he should be bricked in with all his books and clocks and paintings. Nail boards over the door, seal the place right up and leave him here like a pharaoh in a pyramid.” I agreed. But it was a condominium and I knew even then there was no way we could have gotten the condo board to go along. They were, to a jaded soul, next to medical specialists, the most unromantic folks you could ever care to meet.)

But the story was very different for my mother. When she received her second (and last) diagnosis, telling her the cancer had returned, complete with the intelligence that there was no treatment, there was no cure, there was no hope, she, rather understandably, began to cry. She was told, abruptly and with neither preamble nor sympathy, to pull herself together and get out of her doctor’s office.

I always told myself this was because it was so long ago – in the 80’s – when bedside manner wasn’t taught at school along with injecting oranges and memorizing what the hipbone and everything else is connected to.
But honestly? I really don't think anything has changed.
For my friend… well, with her the story is different yet again. I hadn’t met her during her first bout with cancer, but have stood by her for most everything else over the last decade or so. Because I’m a freelancer, I’ve been able to accompany her to most of her appointments. I’m there to play cards, make jokes, suggest diversions, gossip and giggle and basically get her through the waiting period, before going into the examination room with her and remembering the questions she wants to ask when fear and anxiety have got the best of her for a few moments. (She also has an appalling memory. Mine is slightly less so.)
With her, I’ve gotten to know all the receptionists and nurses; we see each other every six months for routine checkups between shocking diagnoses, and we are for the most part all happy to see each other. Her oncologist (a very important one) and his interns are amongst the exceptions; they’re thoughtful and nice and patient. And hopeful – a quality I cannot laude highly enough.
But there are always a few wormy apples you have to brace yourself against. Take the young bottom-of-the-barrel doctor-ette who was filling in for the oncologist’s own intern one stressful day when my friend asked her how much longer before she’d be seen.
We’d already waited hours for what was supposed to be a quick appointment before we needed to high-tail it over to the hospital next door to be prepped for an unrelated surgery; the one we were waiting for was for lymphoma, the one we were on our way to was for colon cancer. (Did I mention how brave my friend is?) Anyway, we had a rapidly narrowing window of opportunity; if we waited much longer the surgery would have to be re-scheduled – an agony almost worse than the impending operation. What I’m saying, is we weren’t moaning for fear we’d miss our pedicure appointments. This woman, this fill-in intern, this creature took one look at my friend (who it should be noted was simply one of about 40 people with cancer waiting to see a doctor that day) blew out her cheeks in exasperation, and told her she didn’t know.
“It’s just that I have to be at Mount Sinai in half an hour,” says my lovely friend.
Oh cry me a river,” said this Satan in scrubs, and blew past her on her way to heaven (or hell) knows where.
Cry me a river. Right up there with the oncologist who recently told a chemotherapy patient asking for help with the side-effects: We don’t care.

I’ve got more stories, each more inexplicably chilling than the last. The surgeon who wanted a piece of my friend’s liver so badly, she didn’t want to wait for biopsy. “I’ll take about 40%; we’ll follow up with chemo. Look at the time – must run.” She was wrong. At that point the cancer had not progressed and the prognosis was good. We made all sorts of Chianti and fava beans jokes after that. What else was there to do? Then there was the post-op technician in the recovery room who told her to stop whining about her pain, before discovering the morphine drip had been pulled out of her vein and was soaking into the mattress.

And I know that there are people who will be reading this who have had marvelous, exceptional, joyful, even transcendent experiences – exciting satisfying adventures in medicine. More likely, there have been those of you who have had wonderfully unremarkable experiences. Or who can relate stories of pleasant, even caring salutations with those who are about to help you stop dying. We all have our anecdotes – these are just mine.

The day after tomorrow is another biopsy day for my pal. We gird our loins (or rather, I do – hers need to be sort of un-girded for the procedure) call on our reserves of charm (you’d be amazed at how important sucking up is – it’s saved us a time or two) and convince ourselves once more that this is just another predictable discomfort on the way to confounding them all again by surviving.

And my tits by the way, are okay. My humane and human specialist went above and beyond, and even to some trouble, to secure my old films to make double sure in a compare-and-contrast sort of way that the photogenic pair are here to stay that way.

And I appreciate the kindness almost more than the prognosis.

P.S. Having said all the preceding, I am still grateful beyond all measure that I actually have a health care system to bash...
P.P.S. The girlfriend is great - she had the liver resection, but it looks as though they got it all and she won't require chemo. It is the best possible outcome and we are all thrilled.