Category: Being human

Reflections that focus on life in general and more specifically on what it means to be a human being!

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Being human Medicine Reflections on Life, Being Human, and Medicine Updates on my health

Green Bananas, Two Years Negative and Keep Going On With Life

Two years ago I had a kidney stone. That brought me to the ER. Late that night, an ER doc that I have known for many years came in with a very somber expression. He opened my CT scan on the screen and showed me my 10 cm left adrenal mass. That was followed by another CT scan, labs, then surgical resection, radiation and the chemotherapy mitotane. Adrenocortical carcinoma (ACC) was the pathological diagnosis. ACC is a rare cancer with only about 300-500 cases per year in the United States.  ACC can recur despite the best efforts to get rid of it. The protocol then is to do CT scans every 3 months so that if it comes back, we could respond and treat it.

In May 2020 I had some enlarged lymph nodes in my chest. Just when I was regaining confidence that this was going to be behind me, the reality of it all came home. We spent some tense days and weeks of wondering if it was back. My August scans showed the lymph nodes as being smaller. On November 1, 2020 I had my two year scans. Those scans now show the same trend (lymph nodes getting smaller) and thus provide clear reassurance that those are not likely cancer.

Good news.

It does have implications, however. It means it is ok to buy new shoes. I sometimes reassure my patients by joking that they can buy “green bananas.” The idea is that they will be around long enough to have them ripen and enjoy them. New shoes also implies that you will be around long enough to wear them enough to justify the expense. 

What it really means is figuring out how to go on with life.

I joke with my patients about this but it is not a joke. It is an important part of their treatment. They have to change their thinking. They have to start thinking about how to go on living. They have to do this even if they have ongoing symptoms.

We all have to do this even if the world is not behaving how we want it to.

We all have had to deal with this in 2020. In late March we locked ourselves in our homes to get through the storm of COVID 19. We treated it just like we do a blizzard. We made sure we had supplies. We found books to read or shows to watch. We set up a card table and started doing puzzles together. We could stop life because it was a crisis. We were excused from a lot of what normally makes up our lives.

I can remember in late April when I saw the COVID projections extending into 2021. A pit formed in my stomach. This whole thing was losing its novelty. We were going to be stuck dealing with this for far longer than any of us would like. We had to come up with different strategies. For my part, I wrote our governor. I pleaded with her to consider pulling together experts to consider sustainable models for social distancing and control of COVID 19. It was time to move beyond shutting down everything and holding our breath. It was time to think about how we could live with new patterns for 1-2 years.

All of us have had to come to some sense of understanding of how to live in an era with COVID 19. It is not what we want. We want to be together. We want to hug our friends and have big get togethers with our family and friends. We want to go and linger at our favorite restaurants and sit in coffee shops for hours on end. 

On top of this, 2019 and 2020 have brought really hard things for many of our family and friends. I find my prayer list growing and growing and growing. Life is hard. There are things that cannot be fixed.

For me, my CT scan result means accepting my current symptoms and learning how to live in the body that I have. I have been left with adrenal insufficiency. With this comes a variety of unexpected issues and limitations. It means that I am not normal. I have another blog that I have written about this and will share it soon. That will go into more details. 

In brief however, in June I started to feel crummy again. I worried it was a cancer recurrence draining my energy. I was waiting for the other shoe to drop. I would somehow just muddle along with fatigue, muscle aches, and dizziness until I had to go through the next wave of treatments for cancer.

It isn’t cancer. 

That means that it is not something that will get a lot worse. It also means that there is not necessarily a clear path through it to get better. It means that it is something that I am going to have to figure out how to live within. Some days I come home, and I just want to collapse. I think by and large I do a good job of hiding it. My wife can immediately see it. I don’t want to distress her by it. She is just too perceptive. 

I am now on more hydrocortisone. I have learned to push fluids and to have a high sodium (salt) diet. I have learned also to understand my limitations. I am also experimenting with exercise. All of that seems to be helping. I am doing better than I was in June.

What does this all mean?

  1. I don’t have any evidence of residual or recurrent cancer.
  2. I do have symptoms that are not magically going to go away. 
  3. I am going to have to learn how to manage my symptoms, live within them, and live for all the good things that I can do.

What does it mean for you?

  1. I am sorry for all the pain that 2020 has brought. COVID 19 and its limitations and implications have brought pain for everyone. On top of this it has been a year of enormous grief, pain, and loss for more friends than I can ever remember. 
  2. We do not have a magical cure. I cannot make COVID 19 go away quickly. I cannot also take away the pain from my friends, no matter how much I want to and no matter how earnestly I pray for them. 
  3. We go on. We live. We do what we have to do. We try to make the best choices and decisions we can but mostly we just have to go on with life.

This morning my body ached all over. I got up because it was at least as good to be up as it would be to be aching in bed. I took my hydrocortisone and plopped in a chair with my computer and my coffee. I waited for my body to warm up and get ready for the day. I would love to have a magical cure. Maybe I even secretly hoped that the scans would show cancer or something that would be a way to explain my symptoms in a way that could be fixed. I didn’t really want that, however. I am very pleased with my results. It just means that I need to get up, keep moving, and keep living.

This is what all of you have had to do. In spite of COVID-19, in spite of elections and election results (whatever they may be), and in spite of horrendous losses that can make both of those look trivial, you just get up and decide to live. Go ahead. Buy some green bananas. Treat yourself to a new pair of shoes.

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Being human Reflections on Life, Being Human, and Medicine Reflections on the Christian Life

The Ice Cream Cone, Stretching My Mind, and Enjoying My World

It was a hot day. We were standing on the sidewalk outside of an ice cream shop when I saw her. Her clothes were a little bit askew and unkempt. In her hand she had an ice cream cone. 

In the heat the ice cream was melting and running over the side of the cone, down her hand and streaming down her arm. She would only slowly take licks. She wasn’t distressed by the rapidly melting cone. She wasn’t trying to madly clean up the leaks of ice cream running down. She was enjoying her ice cream cone. She was intent on doing so. She would not let anything get in the way of her enjoyment of the cone. She was not going to bite or rush through the ice cream. She was going to slowly lick and enjoy it, even if it meant that much of the ice cream melted and made a mess on her and the ground around her.

I didn’t mean to be staring. But I was transfixed by the image. My eyes were pulled to it as I tried to understand.

I must have been really staring for the woman walked over to me with a big smile. “It is so good! Do you want a lick?” she asked me.

“No. No, thank you, but it does look really good. Thanks for asking! Enjoy it!” I responded. I forced myself to look away.

That was probably 20 years ago. I still have the vision in my mind. In the moment that I saw her, I had my gaze pulled to her and I struggled to understand. Even now in my mind I am trying to understand.

Understand what?

When I get an ice cream cone I am always sure to take a couple of napkins. I strategically watch for any areas that are melting and am careful to lick them. I don’t want the sides of the cone, let alone my hands or arms to get dripped on by the melting ice cream. If it is really hot I may have to speed things up and start taking bites of the ice cream. 

I must keep things in control. They must be neat and tidy. Eating an ice cream cone is serious business. You would hate to make a mess on your hands or arms and especially not on your clothes. You have to be proactive. You have to anticipate what is going to melt and lick or eat before it becomes a problem. If it is a high-risk day (hot outside), it might be better to get the ice cream in a bowl or at least have a bowl with you to catch the melting ice cream if things get out of control.

She thinks and experiences life differently than me.

I think that is the first lesson and one that pulled me to looking at her that day. I couldn’t imagine being calm and slowly licking the ice cream cone while the ice cream ran a steady stream down my arm. It was beyond my comprehension. In that it made me realize that not all of us think the same. I know that is obvious, but I don’t think we operate that way in our understanding of the world and how we relate to each other. Generally, I assume that people think just like I do. Whatever actions they take or words they say I judge within the bounds of what I would do or say. If they deviate from that, they must be wrong.

But we are all so different. We grow up in different families with different standards and customs and norms. We have different things that have molded and shaped us throughout our lives. Each of those prior events influences our reactions to what happens around us and how we behave. What she was doing that day was natural for her. In that I was alerted to the fact that I need to let my mind be stretched. I need to seek out new or different knowledge if I truly hope to understand my world and people who are around me.

I read once a list of books that every Christian should read. I cannot find it now. It was not the usual list of devotional or books on faith or theology. There are indeed wonderful such books that I have read and cherish. Many of us could pull together such a list of books. But this was a list of novels that would take me into worlds that I do not understand. I have heard that it is in stories that we truly learn and change. I try to seek out such stories. By living the experiences of people so different from me in the stories, I hope it helps me to better understand the people around me. Our world seems so divided. Perhaps we should try to read stories that don’t make sense to us. In that maybe we would find wisdom. Maybe it would help me understand how it would be possible to eat an ice cream cone very slowly, even if the ice cream was melting and running in streams down my arm.

She really was enjoying her ice cone.

I think that is the other big thing I took away from the image. I remember trying to come up with a word for what I saw. Passion? Or better, perhaps, “sensuality.” Sensuality = “the enjoyment, expression or pursuit of physical pleasure.” Often this is used in a negative sense and in regard to people who destroy their lives in pursuit of sexual or other pleasures. People can sometimes sacrifice what good is in their lives to satisfy their immediate desires. 

But, yet, there is a positive side to sensuality. The woman with the ice cream was not a sexual image. It was just pure enjoyment for the sake of enjoyment. That is what I was trying to understand when I found myself staring at her on that hot summer evening.

God has created all things. He created us to experience good in this world. He is the one who created the sensual pleasures of this world. In that moment, with that creature of His, was one who could purely enjoy the pleasures of a cold ice cream cone on a hot and sticky day. In each lick, she was enjoying the wonders of the world which God has given us.

Imagine that you give me a present. I tear off the wrapping paper and only say a halfhearted, “Thanks,” before I set it aside. You would be deflated. 

But imagine if even on the first glimpse of the present, as I pulled the paper back, you saw excitement and delight in my eyes. Imagine how you would feel if you saw me holding on to the present and savoring it. Imagine if hours later you saw me still sitting and holding the present you gave me. It would be a wonderful thing.

God’s creature was showing Him a wonderful enjoyment of one of the simple pleasures He has created for us. That is what I was seeing. That is what my eyes were drawn to on that day. I was getting a glimpse into a wonderful gift giving scenario. 

Which brings me to the question that was in my mind that evening and ever since. Do I know how to really appreciate the gifts that I have been given? Am I capable of so enjoying them that I will not be concerned about the conventions and other things that might limit my behavior? Will I love my wife and my daughters so much that I don’t care if it makes me look silly? Will I appreciate the wonder of a sunset with such intensity that people might laugh at me? Will I let myself appreciate and savor the joys of my work so that people might want to laugh at me?

Could I eat an ice cream cone slowly, enjoying each and every lick?

It was beyond my understanding that day to do so. But in that moment, a slightly unkempt and unconventional woman was able to teach me a lesson. 

Maybe I should go and hug my wife and hold on a really really long time. Or perhaps go sit with one of my daughters and really listen and hear what is going on in their lives. Or now as I go to work look at each patient as a gift or an opportunity to use my skills for good. Should I welcome each decision, even hard decisions, as something that might help someone else? 

My next sip of coffee will be my most enjoyable. My next bite of breakfast will be so good. My next look out the window will appreciate the beauty as much as I ever have.

God has given me so many good things. Today can I really and truly let myself enjoy them?