7-19-11 Tuesday  + 9 months

Status:  Improving and feeling better after the GVH flare up.  Still with some resolving mouth issues, but they too are improving. 

Events: At Hopkins yesterday for #5 of 6 prophylactic injections of chemotherapy into the spinal canal, and a visit to the GVH docs.  Lab numbers looked good.  Got a prescription of oral swish and spit steroids, a swish and swallow anti-fungal, and some viscous lidocaine (syrupy novocaine) to coat and numb my tongue (add 3 more to my list).

  I went down to the radiology suite for my lumbar puncture (suite isn’t quite the right word for the universally dim basement radiology corridors that look like they are discarded sets from old Harry Potter movies) and met the doctor who was going to perform the procedure.

 Realizing this was July when interns, residents, and fellows turn over (everybody is new), I asked who he was and where he was along the path.  He said he was a 1st year fellow, meaning he had just completed his residency and was just learning neuro-radiology.  I asked him how many of these procedures he had done.  He was silent for a moment and then said, “I’ve done some.”  I kept looking at him, and he said, “A few.”  I was looking for a ballpark figure … a dozen, 20, 50?  Then he says nervously, “I really haven’t kept count.”

 This was not the answer I was looking for.  Better would to have said, “Well, not as many as I will have done at the end of the year, but you’ll have no problem, and Dr. _____ is here (the attending physician) who’s done more than you can count.”

 As it turned out, I was glad the attending was in fact in attendance.  I re-iterated that he should put the needle in at the L2-L3 interspace and just tell as he went along what he was about to do.  Well, that worked for about a minute.  He did say that I’d feel a sting a bite from the numbing skin injection, but barely a hint thereafter.  Was that him marking a spot with his pin or was the LP needle going in.  Since you are lying face down on your stomach, the only inputs you have are sensations from your back and the conversation between those doing the procedure.

  After 45 minutes of continual coaching from his senior, it was obvious he was having a difficult time.  And at last the attending said, “Let me try.”  Those were welcome words.  Within a few moments the needle was in the right spot and collecting spinal fluid.  One of my nurse practitioners came in and expertly infused the chemotherapy, and off I went on a gurney to lie flat for 2 hours (helps prevent post-LP headache).

Comments: One of the hardest things to say in any endeavor is, “I don’t know.”  To be comfortable with feeling that you don’t have all the answers, and to realize that the best response is not to substitute some b.s. to try to smooth things over, but to search for the answers.  One of my heroes, Nobel laureate Richard Feynman said,   “The first principle is that you must not fool yourself, and you are the easiest person to fool.”

  An ancient Zen Monk named Zuigan used to start every day looking into a mirror and saying to himself out loud: “Master, are you there?”  And he would answer himself, “Yes sir, I am!”  Then he would say, “Better sober up!”  Again he would answer, “Yes sir! I’ll do that!”  Then he would say, “Look out now; don’t let them fool you!”  And he would answer, “Oh no, sir, I won’t!  I won’t!”                                                                         

 I’m doing well enough that my next scheduled checkup is next month, but I’ll keep you up to date every week until then.

Love,

-Bruce

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9 Responses to “”

  1. Mitzi Krockover Says:

    You really are my hero–I wouldn’t have lasted 10 minutes with the fellow, let alone 45! I’m sure you were extremely gracious and understanding–and you have furthered medical education in a way you probably never thought you would.
    Glad you are feeling a bit better. We all send our love.
    Mitzi

  2. Margot Says:

    Wonderful life lessons. Passing them along to the next generation. What a day you had and how great that you came away with something positive for all. Hope your intern is reading this. Thank you. Love to you, Lisa, Rachel and Ethan.

  3. Blaine Says:

    Hi Bruce,

    Wise words regarding, “I don’t know”. I used them in a teaching moment with our interns today, although they certainly apply to all.

    Take care and love to all.
    Blaine

  4. Barbara McKee Says:

    Bruce,

    I haven’t sent a greeting in a long while – but have kept you in my thoughts and still thoroughly enjoying your blog and admiring everything about you and all of the love that your family and friends share with you. I enjoyed my first trip to Israel which was an awesome experience for me.
    Keep on improving and keep on teaching all of your friends as well as all of the residents who can only improve by having had you as a patient.

    Barbara

  5. Debbie Blum Says:

    Dear Bruce,

    I have been quietly keeping up with your progress while dealing with elderly-parent health issues and school work. I am glad that you continue to improve, albeit more slowly than I know you would like. I love hearing about all the teachable moments. I continue to keep you in my thoughts and wish you ever smoother sailing as you get closer and closer to the next big milestone–the one year mark–on your road to recovery.

    Love,
    Debbie

  6. wendy Says:

    Your blog is a reminder that many of us are anesthesized and never know who is actually doing the work, the doctor we trusted or someone in their learning curve. I have been known to draw on myself “X marks the spot.” Perhaps you can do the same for the next procedure, it’s hard to ignore. They either laugh or think you’re crazy, but meanwhile you do get their attention. Or perhaps your friend Art Urlene can come show them how, I think he volunteered months ago. 🙂 When I tell patients any psycho educational/ dialysis information I start by saying I’ve been doing this for 10 years, intentionally to earn their trust. I can’t wait to see the course you design from this learning curve for future medical students

  7. Laurie Samuels Says:

    Your good spirit lifts me. I hope that you continue to feel better and better.

    Thanks for sharing your journey with us… it has indeed taught us all so much about medicine, patience, and strength.
    Love to you. Laurie

  8. Judie Says:

    I just read a few of your posts from one year ago. Except for the posts, I would imagine the experiences become blurred. And for good reason. Please know that I continue to keep up with your blog and send best wishes to you, Lisa, Rachael, and Ethan.
    Judie

  9. Carolyn Hyde Says:

    Bruce,
    Amazing, but not surprising, that as you continue down the road as a patient, you are always the teacher. Although the new doc was probably nervous as heck to have you as his patient initially, it quickly moved into a wonderful chance for him to learn and ultimately become a better doctor fromt he experience. Keep on keepin’ on!
    Fondly,
    Carolyn

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