One last Weekend in March

Holly and I enjoyed the last w-e of March in Asheville, doing some gardening in the rain, some running on the trail, and visiting with old and new friends. Friday we arrived around 7pm just in time to enjoy dinner with the rest of the world at the Asheville Pizza Co. They were all there to see Benjamin Button for $3. We were there to unwind from the drive and grab an easy dinner. Saturday it rained most of the day, so we caught up on basketball. We met up with Donna Z at the French Broad brewery to listen to music as one of our new favorite bands was playing. The Leigh Glass Band does mostly blues and americana music with a twist. We heard her at the French Broad on Valentine's Day, and she was a hoot. Fun to share her and the band over a Rye Hopper. Sunday we headed back out to the Blue Ridge Parkway to run the trail near Mt Pisgah, where we will launch the big trail trek on April 18th to celebrate good health. We ran about 80 minutes this time and covered the steepest, most difficult section of the trail. It promises to be a hilly Trek even though we are doing the trail to take advantage of the general downward slope. Late afternoon on Sunday we headed out to the Sourwood Inn off the Parkway to take advantage of their local special with rooms half off. Kacia, the chef, cooked for us and one other (local) couple who were also there for the special.

They were a young married couple who work in the music business. He owns a music marketing company (Ani Difranco, Catie Curtis, etc), and she is a disc jockey and music writer. They told us they too had had a commuter relationship early on (Boston-him, Aville-her) until he decided to move down and start his own company in NC. Like so many others, they are making it work though they have both worked remotely now and in the past. She told us the funniest story about doing the DJ thing for a radio station in Wilmington while she jiggled her son on her knee hoping he wouldn't make too much noise for her microphone. On his part, he told us about a woman who owned a clothing store in the same building as his office and how he accidentally learned that she actually does sound for Hollywood movies when she borrowed a fancy sound cable from him once. Amazing what people in Asheville are really doing while we watch basketball or plant camelias and rhododendrons.

I had my monthly blood work this past week and everything was great!

Photos: Holly with the Pisgah mtns in the background. Our weeping cherry tree and Susan's Aunt Janice redbud tree in the background.

A Week Away

I had one day this week in the clinic and then I spent Wed, Thur, and Fri at a medical education meeting in Chapel Hill. My pal Shannon who worked with me at the Buncombe Co Health Dept several years ago came down from Asheville to attend the meeting too. It was great to have her in our home and to attend the meeting with her. She is so funny and irreverent with her comments about getting rid of her "crackberry" since she was constantly checking email or calling people in every spare moment. I still smile thinking of her telling me about it. Crazy girl. I thought the meeting was a little weak compared to years past, but maybe I am a bit jaded and expect to be dazzled, entertained. and astounded by the learning from "on high" (mostly UNC Internal Medicine Faculty). I do so much reading now that I expect more meaty educational sessions than I did previously.

I did finish a terrific book this week by my guy Abraham Verghese, the Infectious Disease doctor who is also an author. This one was " Cutting for Stone" a story about 3 doctors in Ethiopia and how they got to be the parents of twin boys who grow up to be surgeons with their own interesting histories and stories. That author is so bright and resourceful with medical info that he fashioned bits and pieces of medical lore and cases into a fascinating book about love amongst friends, colleagues, and family. I'm on to "The Marcy Papers" about one women's grief at losing her mother to cancer. It was really well reviewed in the NY Times so I had the Hillsborough library order it for me. They had not even heard of it but ordered it for the system on my recommendation. Wish I could earmark ALL of my taxes to go to them. They really add a lot to my life, always having exactly the book I am looking for or willing to order it for me like this one.

We have had a terrific w-e in Asheville with pizza and microbrew beer at our favorite place around the corner on friday, a run in the woods and NCAA basketball on saturday, and brunch with friends on sunday. We are trying to cover all of the route of the celebratory hike we are doing April 18th here. So each w-e we try to cover a portion of it by foot, scouting out spots for parking cars to access the route along the Parkway. The entire trail is almost 18 miles, and we plan to do most of it that Saturday if the weather cooperates. It's our celebration for my good health and an attempt to push ourselves to do something physically challenging. I have been toying with the idea of running another marathon this year. Holly doesn't want to do a race that long, so we may just find a shorter run we can do together. A half-marathon somewhere we've never been together would be fun too (e.g Chicago). Anyway, I hope many friends will join us on April 18th for hike along the Shut-In trail and a potluck afterwards.

Today's photo: a group of pelicans flying over Emerald Isle.

A Rare Site Indeed

We spent the w-e in Emerald Isle watching basketball with a gang of friends, most of whom were disappointed when UNC lost in the semi-final round of the ACC men's basketball tournament on Saturday. Pam and Cindy have a wonderful house they remodeled so that they can live at the beach full-time and work from home. Though they aren't on the beach front, they can see the ocean from their deck and several of the big windows on the front of the house. We kept watching a group of cedar waxwings that were quite taken with their juniper trees and a powerline nearby. I managed to get a photo of the flock in one of their calm moments, all perched on the pole and powerline in an orderly row watching the ocean. It struck me today how rare it is to see the cedar waxwings so close to people and the ocean. Then it hit me that they had settled upon an ideal spot to share with friends with whom they could fly, hang out, eat, and enjoy the scenery. We enjoyed that rare sight/site too.

Beach bound for the ACC Tournament

Holly and I have just finished watching NC State, her alma mater for Vet School, lose to Maryland in the first round of the ACC men's basketball tournament. Sadly, they are probably done for the year as their record has been only so-so. Tomorrow after I get off work, we'll drive down to Emerald Isle where our friends are hosting a w-e of fun, fellowship and basketball. Tomorrow there are 4 games with both UNC and Duke playing in the afternoon or evening. Now that NC State is out of the running, Holly will pull for UNC, and I will be left the sole, lonely Duke fan FOR THE ENTIRE WEEKEND. It's a tough job, and I'll need the proper balance of humility and school spirit to pull things off in that den of Carolina blue. Wish me (and my team) luck.

I was really happy seeing my patients yesterday in the clinic. Things have been going smoothly now that I seem to have all of my wits about me again. I mean that my memory is back to normal, and the last remnants of my chemo brain seem to have cleared. It is much easier to move through my day if I can remember the encyclopedia's worth of knowledge that I acquired over the last 10 yrs or so (okay it isn't really that much, but I have to at least know where to look to find the info if I can't remember it all). I was pretty worried in November and December about how spotty my memory was. I had some real word and fact retrieval issues. I didn't want to hurt anyone with my feeble chemo brain and I know from experience that one of the worst things is not knowing what you don't know. But the rashes and lab tests and treatment protocols are all streaming back into place just as I'd hoped, and I feel safe again.

I had an interesting encounter yesterday with a 50 yr old hispanic woman who I was seeing for her yearly physical exam. We were going over Lillian's social history-issues like do you smoke, drink alcohol, work, have a partner or husband etc...
She told me that she was now divorced (for 2 yrs) which made her initially very depressed and sad. (I couldn't help remembering Liz Gilbert's analogy in "Eat, Pray, Love" about divorce being like a car accident everyday for 2 years straight..) Anyway, Lilliana now has a new partner. She had this big, sly smile as she relayed this news in spanish and added that he is much younger than she is. When I asked how old he is, she grinned and told me that he is only 28 yo, younger even than the oldest of her 4 boys. She said that he makes her happy, takes care of her, and showers her with attention. Well who wouldn't like that??? I asked her if she is working, and she told me that she now works in an Italian restaurant in Fuquay-Varina. My spanish is not so great so I was sure I had misunderstood her since Fuquay is south of Raleigh-Durham and pretty far from Burlington where our clinic is located. I asked for clarification, and sure enough, I understood right. She is now living in Angier, at least an hour from our clinic in Burlington. She had tried getting her care at another office closer to where she now works and lives, but hadn't liked the experience. "You are my doctor so I am here again. It's only an hour," she said. What a compliment. I kept thinking about that and how fun it was to see her delighted by her younger man. You go girl. If men can do it, why can't we?

Photo: me at the Sourwood Inn on a recent trip to our favorite B and B in Asheville.

Swamp Chicks

Today a group of my pals from Asheville are headed down south to spend 3 or 4 days in the Okefenokee Swamp. I've never been, but I have the T shirt, as they say. Actually, I don't have the T shirt, but my good friend Susan, the photographer, has given me a number of her cards and reprinted pictures from past trips. I really wanted to go this time, but I just couldn't see asking for the time off after recently starting back to work after my cancer. Though it feels like I've been back for a while now, it's really only been a little over 2 months. I'll be thinking of them this week though as they paddle around, taking in the mossy environs. Hope to get another good picture or card out of it at least.

I was going through my Duke Medical School alumni magazine last week, and I noted their article on liquid tumors. That is what they call leukemia, lymphoma and multiple myeloma since they are all tumors of blood products and/or the immune system. The article was talking about all of the headway that is being made in these cancers, especially now that more immune system research is paying dividends and stem cell transplants are more common. A few of my doctors commented on their research and work with patients, which is always good to see.

At the back of the magazine, they have a section that announces new faculty members, profiling them with a photo and their educational background. I noticed that one of the guys from my gross anatomy dissection group was just hired by the surgery department. Eric took a detour from our class to get a PhD in genetics and then finished medical school in 2003. After that, he did the interminable Duke surgery residency and just got his first non-training job. He and I started medical school in 1993 so getting your first real job in 2009 is quite a long time to delay gratification, if you know what I mean (only in medicine can you train and train and train like this). I had to smile a little when I read about his appointment to the surgery department because he was rather squeemish about cutting our cadaver when we were in class together. At one point, we had to do a "Bobbitt" cut of the penis, named after the woman who cut off the penis of her husband way back. He couldn't watch while I did the maneuver and seemed pretty queasy about dissecting the organ after I had removed it from the cadaver. Imagine my surprise to see him smiling up at me from the magazine, having completed his surgery residency & training. It just goes to show you, you never know about people. We can all be whatever we want. It's a good thing too.

Today's photo: an interesting sculpture in the Wedge brewery taproom on a recent visit with Susan and Donna.

Spring Arrested

I just got back from our great little library in town (Hillsborough), having returned the Abraham Verghese book I finished earlier today. "The Tennis Partner" is the author's story of his friendship with an Australian born tennis player turned medical student who studied Internal Medicine under his tutelage at Texas Tech. I'd read the positive review of the book when it came out and recently noted a review of his new novel in the NY Times, which made me want to order both of the books. "The Tennis Partner" had a very poignant ending when his friend, the medical student relapsed back into his cocaine addiction after working so hard in AA and in school to (re)set his life under Abraham and others. I couldn't even imagine trying to do medical school with a drug addiction problem; just managing the school part was stressful enough.

I'm still on the reading kick I started months ago during my leukemia treatment, though lately I've been particularly interested in books by doctors. I've adjusted my lunch schedule at work so that I have a little time to read each day, and I can often sneak in some more reading while Holly is driving to or from Asheville. It's been a real joy to keep up the reading, and I find the books by doctors to be more helpful to me now than in the past. I've always enjoyed thinking about the social side of medicine-how it is different from any other job in its explicit openness. I read recently that there is an impending shortage of primary care doctors, especially those willing to see medicare patients or the elderly. It makes me wonder who is going to take care of all of us baby boomers when we get to be that age. Hopefully there will still be people training who enjoy medicine.

One of my colleagues and I were talking earlier this week about how to deal with a patient we have both seen who refuses to have his foot amputated despite a huge non-healing ulcer and bone infection that is not responding to antibiotics. He has been told that it won't heal without amputation and that eventually he might die of a bloodstream infection. Yet he declines anything except antibiotics which are, at best, a band-aid solution for now. My colleague is much more proactive than I am, trying everything to exhort the guy to have the surgery. My style is to tell him what can happen and let him decide. I can't imagine what it would be like to hear that you have to lose your foot to save your life, especially when you're hobbling along and making do as it is. But she and I debated the right way to handle these kinds of patient cases, not sure what is really best. How hard do you push or threaten or scare the patient versus letting them decide the course on their own? I don't know that there is a correct answer; I suspect we all adopt a style that meshes with our own values and what we can live with. It's challenging though.

Last night we had dinner with friends, and one of the other women there had not heard about my leukemia and 7 mos of treatment until last night. She lives in the Triangle area, but we don't see each other often. I summarized that whole experience in about ten sentences from diagnosis to treatment course to my thrill at being back at work now. I haven't had to do that this illness so it felt awkward to summarize all of that as if I were talking about another person in passing. But those ten sentences were 7 mos of my life-major death scare followed by hard scrabble effort. Thank goodness for repression and optimism; they helped me alot.

Today's photo: saw this guy on one of my long runs in Asheville; had to catch him before he ran off. Spring was arrested by the colder weather we had earlier this week. Now the forsythia can keep budding with the 70 F we have today.

Our March Snow

We are still in Asheville celebrating the snow. Miriam and Alex were here for most of the w-e too, but they left Sunday midday after Alex realized that she was coming down with a cold. It had been raining or rainy all w-e, but that didn't stop us from enjoying Brushfire Stankgrass at the Pisgah Brewery on Friday night as well as the Mast General Store, Salsas and the Hot Springs Hot Tubs on Saturday. It was a bit more drizzly on Sunday though, and it began changing into sleet and then snow around noon. It was so beautiful here all day yesterday, even though it was cloudy and gray most of the day. Despite the clouds, 4" of snow has a way of brightening things up-all clean, and white and pristine looking. Today it is clear and cold with blue skies to offset our white topped hills. It was 19 degrees and windy when I did my run around Beaver Lake (me and the guy with the Salukis) this morning. I almost fell a couple of times in the icy patches, but it was terrific to get out and play in the snow. I have been wanting to go somewhere to cross country ski before it gets too warm, but I'm not sure we will make it to Vermont or Colorado anytime soon. So I was imagining that I was skiing since the exercise, movement, and views are very similar. It sure was pretty going up and down Lookout Mtn (and up and down it again after running around Beaver Lake). I took a couple of pictures to include here.

Later we'll pack up our things, Quigley and the kitties and head back down the mountain to the Triangle. Holly's company announced a 10am start today, so I suspect we'll encounter snow or ice there as well. Next w-e is the start of daylight savings time so this is out last w-e here before we have more daylight evening time. Nice to get one real snow if this turns out to be the last one.

I had the cutest little boy in my clinic earlier this week, being seen for a cold and sore throat. He was about 5 yrs old, hispanic, with that short buzz cut that really accentuates their thick, black hair. He conversed with me easily in both english and spanish, hopping up on the exam table, saying "Ahhh," and breathing deeply when I told him what to do for me. After we were finished and I was telling his Mom what to do for his cold, he officiously pulled out his wallet, one of those hand tooled leather ones with lacing around the edges, and removed a crisp dollar bill to hand to me. I had to chuckle as I told him that he didn't pay me but instead the women at the front window. I told him that I only do the doctor part and someone else takes the money. That seemed to satisfy him, and he carefully placed his dollar bill back into his wallet. I felt honored, actually, that he wanted to pay me. I remember how precious a dollar is at his age.

Today's photos: Miriam and Alex plus one of the house in the snow.