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.