The Clean Slate

12 Jul
July 12, 2013

chalkThomas Richard Delancey was born in Portland Oregon on a July morning in 1945, the only child of two physicians. Although his parents had always hoped he would attend medical school, Tom would travel a different road. Shortly after graduating with his Bachelor’s Degree in 1966, he was drafted into the Army as a Second Lieutenant, and three days before his 22nd birthday, boarded an Army transport for the 10,000 mile flight that would formally introduce him to jungles of Vietnam.

Eleven days later, on a rainy Saturday afternoon, Tom’s parents received word that he had been killed during a mortar attack on his base compound. His father, Richard, badly shaken by the death of his only child, took a leave of absence from his medical practice and for the next eight years rarely left his home, anesthetized within a cocoon of despair and alcohol. He divorced his wife in 1970.

In 1976 Richard was hospitalized with prostate cancer. The night before his surgery was scheduled he had a visit from the surgeon. David Cohen, a former colleague and one of his closest friends. “As you know, Richard,” David said, “the pathology report was good. Your biopsy revealed a small, encapsulated tumor with no evidence of metastasis. And normal circumstances both the surgery and recovery would be uneventful.”

Then David leaned over and looked into Richard’s eyes. “But these are not normal circumstances,” he said. “Personally, I don’t think you’ll make it off the table.”

Richard was stunned. “Why on earth would you say such a thing?” he shouted angrily. If this is your idea of humor, I think it is ill timed and in very poor taste. “What exactly do you call this macabre bedside manner?” he snarled.

David slowly stood up and said, “I call it the truth, Richard. You have squandered the last decade on self pity and anger, and in the process, turned your back on everything that gave your life meaning: your wife, your practice, and your Creator, to name only three,” In short, ” he continued. “you didn’t lose your will to live – you simply gave it away.” Then he carefully reviewed the entries in Tom’s medical chart and prepared to leave. “The good news,” he said, as he walked towards the door, “is that you have 14 hours to reclaim it.”

That night, Richard confronted his demons, but after a decade of self hatred and despair, he was unable to find the forgiveness and self compassion he needed to release them – as hard as he tried, he could not surrender the pain of his past. At 3:00 AM, a tired and beaten man, he closed his eyes and began to weep. It was during these lonely hours that he suddenly felt a hand on his shoulder. He looked up to find David standing over his bed.

“What time is it?” asked Richard. “4:14 AM,” David replied, “and yes, I realize how late it is, but I wanted to share something with you.” David then placed a small chalkboard, two pieces of colored chalk and an eraser on Richard’s bedside table.

“My father gave me this chalkboard when I was eight years old,” David said quietly. “Each night, after saying my bedtime prayers, my father would bring the chalkboard into my room. He would then ask me to write the most important things that happened to me that day on the slate.” “He told me it didn’t matter if the events were ‘good’ or ‘bad’ and then sat patiently while I wrote them down. Then he would hand me an eraser, and I would erase everything I had just written.”

“Now son, when you wake up in the morning,’ he would say, ‘you start the day with a clean slate. No past or future concerns, just the miracle of the next 24 hours.”

“But what should I do with it?” asked Richard. David said nothing. He just gave Richard a hug, quietly closed the door to his room, and headed to the nurse’s station to review his charts.

Later that morning, after successfully removing his tumor, David helped the post-op team bring Richard back to his room.. While the team was transferring the patient back into his bed, David noticed his chalkboard sitting on the night stand. But the two six inch pieces of chalk that he had left earlier that morning were now only small nubs, and the eraser was caked with chalk.

The chalkboard had proved to be the turning point in Richard’s life. Eight months later he fell in love and married one of the nurses who had cared for him in the hospital. He also returned to medicine. No, not to his gastroenterology practice, the specialty he had trained for. Instead he decided he would pursue psychiatry.

Today, Richard is a board-certified psychiatrist – a prominent therapist with one of the longest patient waiting lists in San Francisco. He and his wife are also the proud parents of a new daughter.

If you ask Richard why he is one of the most sought-after psychiatrists in the Bay Area, and what is so unique about his psychotherapeutic technique, you will discover that he is actually quite modest about his success.

There’s nothing very mysterious about what I do, ” he will tell you, “I simply start each session by handing my patient a chalkboard.”

copyright (c) 2001

Martin Bayne

 

Never,NEVER Give up.

10 Jul
July 10, 2013 YouTube Preview Image

FRIENDS

07 Jul
July 7, 2013

friend

Whenever I’m asked how I measure friendship, I recount the following story:

Roughly ten years ago, there was a Nor’easter that dumped seven feet of snow on the upstate New York town where I lived. The storm was a particularly powerful one – officials closed most of the NY State Thruway at midnight and drivers in the path of the storm were warned to seek shelter and stay off the roads!

I awoke at 3:00 that morning in acute intestinal and colonic distress. In short, I couldn’t move my bowels and the pain was increasing exponentially—I was doubled over when, as a last resort, I decided to call Bobbie Bowden, a colleague and friend.

Despite the weather and the hour, she answered the phone as she usually did—pleasantly upbeat . . .and said when she heard my strained voice, ”Marty, what’s wrong?”

After describing the problem she said, “Sounds to me like you need an enema. I’ll be right over.”

She then quickly shoveled an ungodly amount of snow from her driveway, grabbed her black Labrador and crossed her fingers while turning the starter on her ancient Volkswagen van. It started!

The fifteen-mile journey itself was uneventful and she arrived and returned home unscathed.

*** The rest of the story has been redacted due to HIPAA restrictions. Suffice it to say, everything came out just fine.

FRIENDS II

I am a fortunate man, blessed by the gods. I recently met a woman, Jackie Pinkowitz. Her capacity to love is greater than any human being I’ve ever met on my 63-year-old journey. To know her is to experience a dynamic that is life affirming far beyond what most of us are used to or settle for.

She and her husband, Lon (an amazing man in his own right). lived through the paralysis of grief when their young son was killed in a freak accident. Yet, with indefatigable determination, they transformed the unthinkable pain of their son’s death into a symphony of activism,compassion and joy now experienced by every life she and Lon touch.  Jackie and Lon — I love you  both.

More on Jackie later. I am exhausted. The therapy sessions at the new skilled nursing center I live at can be very tiring.

A day in the life of Jackie Pinkowitz

Jackie Pinkowitz,M.Ed.

Chair, CCAL-Advancing Person-Centered Living

Vice-Chair, Center for Excellence in Assisted Living

Leadership Team – National Dementia Initiative

Instructor, Prof. Cont. Ed., Rutgers University School of Social Work, Gerontology Program

jpinkowitz@gmail.com

 

“All She Wants Is Your Blood”

27 Jun
June 27, 2013

ad

“”At first, the soliloquy  was muted, almost a whisper. As 11:00 pm came and went, and the wall clock’s small hand pushed its cohort toward midnight with the determination of Sisyphus, the speaker picked up the pace . . .his  larynx now pounding out the words like a finely-tuned Formula-One engine.

Soon he was shouting a litany of female names, peppered with the occasional “Bill” and “Serg.”

As time grinded forward with the speed of growing mushrooms, the timbre and urgency of the voice became demanding and cruel. “GINA!” he yelled, “Why did you run away?”

**********

Last night, from 9:00 pm to 6:00 am, I experienced what I imagine a nine-hour rollercoaster ride in hell would be like, performed simultaneously with an exorcism.

In other words, I had my first, formal introduction to Alzheimer’s–no, not as a patient, not even as a caregiver, just as an observer/onlooker.

As some of you already know, I was recently admitted to a skilled nursing facility for an indeterminate period of rehabilitation. (A combination of Parkinson’s meds, sporadic bouts of depression, confinement to a wheel chair and myriad other factors, had created a long-standing battle with morbid obesity; and I was losing.)

I will freely admit the prospect of leaving the simple, private comfort of my 400 sq. feet of assisted living and trading down to the roommate mentality of skilled nursing, invoked sheer terror in this writer’s soul. Thus I was pleasantly surprised when I checked into my new digs three days ago: no roommate, air conditioning 24/7 and the worst food since Soylent Green.(Which was great for me! Even the thought of a complete meal was enough to induce nausea.)

AND THEN, LAST NIGHT, A PATIENT CHECKED INTO MY ROOM.

A mistake? An unfortunate Act of God? A practical joke? (No, none of these, but I can assure you this is where this fairy tale becomes Grimm).

You see, my new long-term care combatant is a 90+ retired auto body detailer with a broken hip and (lest I say the “A Word?”) Alzheimer’s.

Let’s start with what we know about Alzheimer’s — in a nutshell we know what we don’t know is infinitely greater than what we do know.

Look, I hate to be the bearer of bad news, but as an MIT scholar and former cell biologist, let me level with you, the news about Alzheimer’s ain’t good.

It is axiomatic of most human disease that “…within the cause lies the cure.” Thus, I’ve listed the latest causes of AD

The cause for most Alzheimer’s cases is still essentially unknown[34] (except for 1% to 5% of cases where genetic differences have been identified). Several competing hypotheses exist trying to explain the cause of the disease:

Cholinergic hypothesis

The oldest, on which most currently available drug therapies are based, is the cholinergic hypothesis,[35] which proposes that AD is caused by reduced synthesis of the neurotransmitteracetylcholine. The cholinergic hypothesis has not maintained widespread support, largely because medications intended to treat acetylcholine deficiency have not been very effective. Other cholinergic effects have also been proposed, for example, initiation of large-scale aggregation of amyloid,[36] leading to generalised neuroinflammation.[37]

 

Amyloid hypothesis

In 1991, the amyloid hypothesis postulated that beta-amyloid (βA) deposits are the fundamental cause of the disease.[38][39] Support for this postulate comes from the location of the gene for the amyloid precursor protein (APP) on chromosome 21, together with the fact that people with trisomy 21 (Down Syndrome) who have an extra gene copy almost universally exhibit AD by 40 years of age.[40][41] Also, a specific isoform of apolipoprotein, APOE4, is a major genetic risk factor for AD. Whilst apolipoproteins enhance the breakdown of beta amyloid, some isoforms are not very effective at this task (such as APOE4), leading to excess amyloid buildup in the brain.[42] Further evidence comes from the finding that transgenic mice that express a mutant form of the human APP gene develop fibrillar amyloid plaques and Alzheimer’s-like brain pathology with spatial learning deficits.[43]

An experimental vaccine was found to clear the amyloid plaques in early human trials, but it did not have any significant effect on dementia.[44] Researchers have been led to suspect non-plaque βA oligomers (aggregates of many monomers) as the primary pathogenic form of βA. These toxic oligomers, also referred to as amyloid-derived diffusible ligands (ADDLs), bind to a surface receptor on neurons and change the structure of the synapse, thereby disrupting neuronal communication.[45] One receptor for βA oligomers may be the prion protein, the same protein that has been linked to mad cow disease and the related human condition, Creutzfeldt–Jakob disease, thus potentially linking the underlying mechanism of these neurodegenerative disorders with that of Alzheimer’s disease.[46]

In 2009, this theory was updated, suggesting that a close relative of the beta-amyloid protein, and not necessarily the beta-amyloid itself, may be a major culprit in the disease. The theory holds that an amyloid-related mechanism that prunes neuronal connections in the brain in the fast-growth phase of early life may be triggered by ageing-related processes in later life to cause the neuronal withering of Alzheimer’s disease.[47] N-APP, a fragment of APP from the peptide’s N-terminus, is adjacent to beta-amyloid and is cleaved from APP by one of the same enzymes. N-APP triggers the self-destruct pathway by binding to a neuronal receptor called death receptor 6 (DR6, also known asTNFRSF21).[47] DR6 is highly expressed in the human brain regions most affected by Alzheimer’s, so it is possible that the N-APP/DR6 pathway might be hijacked in the ageing brain to cause damage. In this model, beta-amyloid plays a complementary role, by depressing synaptic function.

 

Tau hypothesis

The tau hypothesis is the idea that tau protein abnormalities initiate the disease cascade.[39] In this model, hyperphosphorylated tau begins to pair with other threads of tau. Eventually, they form neurofibrillary tangles inside nerve cell bodies.[48] When this occurs, the microtubules disintegrate, collapsing the neuron’s transport system.[49] This may result first in malfunctions in biochemical communication between neurons and later in the death of the cells.[50]

 

Other hypotheses

 

Herpes simplex virus type 1 has also been proposed to play a causative role in people carrying the susceptible versions of the apoE gene.[51]

 

Another hypothesis asserts that the disease may be caused by age-related myelin breakdown in the brain. Iron released during myelin breakdown is hypothesised to cause further damage. Homeostatic myelin repair processes contribute to the development of proteinaceous deposits such as beta-amyloid and tau.[52][53][54]

 

Oxidative stress and dys-homeostasis of biometal (biology) metabolism may be significant in the formation of the pathology.[55][56]

 

AD individuals show 70% loss of locus coeruleus cells that provide norepinephrine (in addition to its neurotransmitter role) that locally diffuses from “varicosities” as an endogenous anti-inflammatory agent in the microenvironment around the neurons, glial cells, and blood vessels in the neocortex and hippocampus.[57] It has been shown that norepinephrine stimulates mouse microglia to suppress βA-induced production of cytokines and their phagocytosis of βA.[57] This suggests that degeneration of the locus ceruleus might be responsible for increased βA deposition in AD brains.[57]

 

THE END

 

Well, I managed to complete this blog post on one hour of sleep. (Good for me!)

 

PS The title refers to a comment made by a personal care attendant to my new neighbor about a phlebotomist who wanted to draw a specimen.

 

 

 

 

 

 

 

From The Front Lines, a Fight for Aging Boomers

23 Jun
June 23, 2013

ccc

Martin Bayne, 63, in long-term care, is still trying to wake up his cohort: There is no solid system to care for elderly.

MICHAEL VITEZ, INQUIRER STAFF WRITER

POSTED: Sunday, June 23, 2013, 3:01 AM

 

Martin Bayne doesn’t so much sit in his wheelchair as he sprawls in it. He looks like he might slip out at any moment. He is obese – a consequence of so many diseases, medications, and limitations.

His world is so small now, a room and occasionally the hallways of a personal-care home near Allentown.

It is from this isolated existence that Bayne, 63, has reached out to an enormous audience in the last year. He has had an essay published in Health Affairs, a leading health-care journal, and has been interviewed by the New York Times and by Terry Gross on her NPR radio show, Fresh Air.

Bayne sees himself as a “clarion” for aging baby boomers. For 11 years, since early-onset Parkinson’s disease left him unable to care for himself, he has been living in a world that primarily elderly people inhabit – institutional long-term care.

He has made many discoveries about this life, about its limitations and indignities, and he’s trying to wake up his generation. He borrows an analogy from Jimmy Carter: Boomers are on an elegant train, in the dining car, feasting on foie gras and steak, but only a few miles ahead, the track is out.

“A lot of people are going to get hurt,” he says. “Lose their dignity. Lose their way of life.”

Bayne recently got out of the hospital after weeks of pneumonia. Doctors also found a mass the size of a grapefruit on his thyroid. This is all on top of congestive heart failure, two pulmonary embolisms, and more.

Every word he spoke  during a visit last week was a struggle, but his wit was intact. Asked how he was doing, he said, “I’ll make it through the interview.”

Bayne excelled early on as a salesman of long-term-care insurance. The more he sold it, the more he saw its limitations, and the more he realized America needed to develop a new attitude about growing old and a comprehensive system to care for people as they declined.

Bayne realized that millions of Americans were suffering from chronic illness, but that there was no comprehensive system to help pay staggering bills or to provide care in acceptable settings. He became such an expert in long-term care and an advocate for reform that he earned the moniker “Mr. Long-Term Care” and once ran a popular website.

He tilted at the biggest windmills. In an interview with The Inquirer 13 years ago, he said: “The culture doesn’t know what to do with people who are old and frail. We hide them away. We have such a pathological view of aging. They want us kept young forever, having face-lifts. Until we deal with how we turn away from aging, long-term care will always take a second seat.”

As his Parkinson’s progressed, he became an enormous consumer of long-term care, first at home with aides, then for the last 11 years in two different facilities.

He had foresight to buy a long-term-care policy at age 40, for a $1,000 annual premium, which would pay up to $231 a day for life. His policy, he said, has paid about 80 percent of his $750,000 in long-term-care costs.

Bayne has now lost hope that America will develop a system to provide for the long-term care needs of its citizens. Neither the people nor the politicians have the will. His blunt solution: “Children should be tasked with taking care of their parents.”

Alas, Bayne, divorced, has no wife, no children. As his world has shrunk, so have his goals. He now just tries to improve the life of residents in his community. His descriptions are so powerful they have carried his voice far beyond his isolation.

“Most residents in assisted-living facilities, by necessity, live secret lives,” he wrote last year in Health Affairs. “On the outside, there might be a calm, even peaceful, veneer. But beneath the surface, all of us are susceptible to the ambient despair that is a permanent component of life in this type of facility.

“It’s the result of months or years of loneliness and isolation and of a lack of true social interaction among residents. It’s also the result of burying our feelings and emotions about the exceptionally high numbers of demented and disabled neighbors around us and being surrounded by frequent death.”

Bayne recounted a story about an elderly resident who interacted with no one. Bayne tried repeatedly, day after day, just to shake the man’s hand. He cut the man off with his wheelchair after dinner, blocking his exit, and still the man refused. Finally, one day, the man accepted Bayne’s extended hand.

“After that day, something happened to him deep down inside,” Bayne said. “Every meal after that, I would shake his hand.”

One day, the man, who always dressed in shabby clothes, came down in a fresh, pink oxford shirt. Bayne knew what it meant. “I started crying,” Bayne recalled. “My friend said, ‘Don’t worry. Everything is going to be just fine.’ He died that night.”

“Residents all feel enriched by their relationships with Marty,” said Suzanne Panick, the administrator at Sacred Heart Senior Living in Center Valley. Bayne routinely now sits with residents when they’re dying. A woman said to him, “There’s no place like home,” before drifting off and dying days later.

Bayne has changed in these last years. As he has grown more dependent, he has become more giving. “I learned how to reach in and touch a person’s heart,” he says. “Not in a manipulative way. But in a powerful way, in a way that gives the person being touched great power.”

 

Unexpected upset

This story takes a sharp turn.

On Tuesday, the day after our first interview, Bayne went by ambulance to a hospital in Bethlehem.

He had fallen out of his wheelchair. A personal-care home is not prepared to care for someone of his size, with his needs, said Panick, the administrator.

From the hospital, he will go to a nursing home. Panick says she worked hard to find a nursing home that would take someone of Bayne’s size. It will have equipment to lift him when he falls. And a therapist who can work with him to lose weight.

Bayne vehemently didn’t want to go. He wanted to stay in his assisted-living facility, his home. But in his eyes, what he wanted didn’t matter.

From his hospital bed, by cellphone, struggling for breath and words, Bayne said Wednesday: “I’ve spent most of my adult life being an advocate for other people. And when it’s my turn, I don’t have anyone to step up to the plate for me and no one to turn to.”

Panick, the administrator, visited Bayne in the hospital Thursday. She is fond of Bayne, and he knows that. She explained that Sacred Heart just didn’t have the facilities to help him. He needed rehabilitation to get stronger, lose weight, and return.

“I’m not upset,” Bayne said, barely audible on the phone. “It’s all changed again. But that’s the way it is. I look at it as a challenge. And that challenge might be good for me. So I’ll make the best of it.”

 


Contact Michael Vitez at 215-854-5639, mvitez@phillynews.com, or follow on Twitter @michaelvitez.


 

 

GOOSE IN A VASE

13 Jun
June 13, 2013

waratah-flambe-vase-large

I was a second-year Soto Zen Buddhist monastic novitiate when I heard this little jewel for the first time.

Just keep in mind, memory like everything else, is impermanent.

So, forgive me if, after forty years, if it was a bottle, not a vase; or a duck, not a goose.

I assure you, when this sliver of heaven fully opens itself to you, any animal and container will do just fine.

“I own the most valuable vase in the world.”
“You don’t say?”

“Yes, but I also have a terrible problem.”
“Is that so?”

“There’s a goose inside the vase, and the goose and I long ago became friends.

And that’s your problem– a friendly goose?

Of course not, but like us, geese need to breathe. Well then, remember the vase?

                                                  It’s nearly depleted of Oxygen.

                                                          PLEASE! Save the goose and preserve the vase. Can you do that?

                                                [clapping hands] “There, it’s out.”

PRESS RELEASE

07 Jun
June 7, 2013

ahcha

 American College of Health Care Administrators 1321 Duke St, Suite 400 | Alexandria, VA 22314

Ph: (202) 536-5120 | www.achca.org

PRESS RELEASE

FOR IMMEDIATE RELEASE

MartiBayne Receives ACHCA Public Service Award

 

 

Alexandria, VA April 15, 2013 The American College of Health Care Administrators (ACHCA) is proud to announce Martin Bayne as the 2013 recipient of the ACHCA Public Service Award. The award was presented during the Awards Luncheon at ACHCA’s 47thAnnual Convocation and Exposition in Orlando, Florida on Saturday, April 13, 2013. The coveted Public Service Award recognizes an individual who has promoted positive public awareness related to the field of long-term care.

 Mr. Bayne established a newsletter and website about long-term care in 1992, which became a trusted source of information with a large following. Mr. Bayne was CEO and co-founder of New York Long-Term Care Brokers, one of the largest in the United States. He is a prolific writer, advocate, and one of the foremost authorities on long-term care and the need for long-term care insurance. He has touched many lives with his wisdom and insight.

Founded in 1962, the American College of Health Care Administrators (ACHCA) is the only professional association devoted solely to meeting the professional needs of today’s long term care administrators and executives. Focusing on advancing leadership excellence, ACHCA provides professional education and certification to administrators from across the spectrum of long term care. For more information about ACHCA contact the national office at (202) 536-5120 or visit www.achca.org.

 ###

 

For more information contact:

Becky Reisinger

Manager, Business Development

American College of Health Care Administrators

breisinger@achca.org | (202)470-6446

NEW YORK ZEN CENTER FOR CONTEMPLATIVE CARE

05 Jun
June 5, 2013

Twenty-five hundred years ago the historical Buddha established a practice to address suffering, old age, sickness and death. In this tradition, Koshin Paley Ellison and Robert Chodo Campbell, Zen Buddhist priests & chaplains established the New York Zen Center for Contemplative Care, a registered 501 (c)(3) nonprofit corporation, in the heart of New York City in 2006.

Fully-accredited, Year-long Training Programs:

Recognized as true pioneers and leaders in the Buddhist Chaplaincy field, the New York Zen Center for Contemplative Care is creatively transforming pastoral care by being both the first and only Buddhist organization to be a fully-accredited, by the Association of Clinical Pastoral Education, as an CPE Clinical Chaplaincy Training Center in America. NYZCCC integrates Buddhist contemplative practices into the professional training, creating a dynamic program that is interfaith and experience-based, geared toward developing professionals and those seeking to deepen their spiritual, caregiving practice.

NYZCCC also offers a year-long Foundations in Contemplative Caregiving Training Program, which provides the groundwork for your contemplative care practice. Students fulfill the program requirements through class participation, 100 hours of contemplative care volunteering, rigorous reading and writing exercises and an end-of-year project.

“The Ideal and the Actual, Like a Box All With Its Lid”

02 Jun
June 2, 2013

buddha

I received the following letter yesterday:

Martin,

I came across your article in the Washington Post describing what it’s like to live in assisted living when you’re much younger than the average resident. My mother was diagnosed with Parkinson’s just over a year ago, and she has terrible fatigue and weakness. She is 68. Just a few years ago, she was my #1 helper for my newborn daughter, active, driving, taking the bus and train from the suburbs to my home in Chicago. She has recently decided that she probably cannot continue to live on her own. She feels too weak or afraid to venture out of her apartment, and she has some in-home help and meals-on-wheels during the week.

We don’t have the means to afford assisted living over the long term, but I want to commit to paying for a year at a facility to see whether eating good food and working with others toward the goal of being in the best shape possible will enable her to live independently again. Are you aware of any assisted living arrangement for folks with Parkinson’s’ where they actually try to improve your mobility, health, and independence, and not merely try to manage your decline safely? We experienced the ugly side of skilled nursing after a fall last summer, and I am determined to do my best to keep her away from that for as long as possible.

 Thanks so much for reading. And kudos to you for being out there and speaking the truth.

I was particularly struck by the author’s desire “to commit to paying for a year at a facility to see whether eating good food and working with others toward the goal of being in the best shape possible will enable her to live independently again.”

I replied, “Save your money. We’ve not yet evolved to the standards you desire and your mother desperately needs.”

It was then I remembered a line from a Zen Buddhist scripture I would chant each morning when I was in monastic training. “The ideal and the actual, like a box all with its lid.” Loosely translated it states that our innate desire to seek perfection – whether in a monastery or the secular world – is tempered with the reality of our own humanity. But that doesn’t mean we abandon our commitment to excellence.

Eldercare, in its current iteration, is fraught with traumatic challenges. And yet the Japanese Kanji character for “tragedy” also means “opportunity.”

Ball’s in our court.

“THERE’S A MASS ON YOUR THYROID . . .”

31 May
May 31, 2013

throid

The title constitutes six of the most frightening words in the English language.

A week and a half ago I am rushed by ambulance to the ER. It is 6:00 am and I’m having a great deal of difficulty catching my breath. At first, doctors think it is a flare-up of my CHF (Congestive Heart Failure). I am admitted late that morning.

St. Luke’s Hospital in Bethlehem, Pennsylvania is where people like me–who hate hospitals–go to be treated. The medical staff is consistently reassuring and dedicated and the Personal Care Attendants and CNAs are as good as you’ll find anywhere.

Day three: pulmonary specialists are called in for a consult and rule out CHF, based on a loud expiratory wheeze and other factors, and began to lean toward a COPD-Bronchitis-Asthma problem. To get a clearer look they order a CAT scan.

A radiologist says the scan reveals a grapefruit-sized “mass” on my thyroid gland that appears to be pushing against my trachea.

Could this mass be the culprit?

I meet with a team of pulmonary/thoracic surgeons. They opine that the mass should be removed in the OR, but first, they want a needle biopsy. In this procedure, a lump of cells are aspirated into a long needle that is placed into my chest with ultrasound guidance.

I have the ultrasound procedure, but the mass is too well-hidden inside my rib cage and scapula. The ultrasound image is essentially useless.

Twenty-four hours later, a new team of surgeons from the Radiation/Imaging Dept. tell me they will retry the biopsy, but this time using a CAT scan to guide the needle.

The first week is now “the past” and a thick porridge of melancholy sets in.

The next day is medically unremarkable and I am unprepared for the knock on my door as I fold the last of a Sloppy Joe bun into my mouth from the dinner tray.

A dark-skinned man of medium height introduces himself as an oncologist. Nice guy; Syrian. We talk about the world-as-it-is for a few minutes, then both settle into the business-at-hand. “I know you didn’t come here tonight to talk geopolitics. What’s up?”

“The original CAT scan revealed two lesions on your sternum.” he said.

A bead of cold sweat begins its journey from my left arm pit to my waist. “And you think it might be . . .” The sentence hangs in the air awkwardly.

“Myeloma,” he says, with just the slightest tinge of sadness in his eyes.

“What’s the next step?” I ask in a voice suddenly two octaves lower.

“A full-body panel of x-rays and blood work.”

I lay my head on the pillow and take a deep breath. “What does your gut tell you on this one?”

“You understand I have to rule it out,” he says, “but do I think you actually have myeloma?” Again, his eyes soften. “No,” he says, a smile accentuating a beneficence unusual in bedside consults..

Late that night I practice a technique I call “fall away,” in which I allow my body and mind to fall away in a total act of surrender. In the eye of the storm there is stillness and peace and I have my first good night’s sleep.

The next day I have the x-rays and blood work. It is negative.

In the interim, my lungs and their feeder tubes began to respond to the antibiotics, steroids and broncho-dilation breathing treatments. Although I still have a nasty cough, I am breathing easier, with less effort.

The next day seems to jump out at me. I shudder awake at 3:00 am, nervous and irritable about the CAT needle biopsy. The Transportation Unit parks a gurney outside my door precisely at 2:30 pm. and I’m wheeled down to Radiation/Imaging.

Twenty minutes later I am introduced to the physician who will perform the procedure and he explains in detail what will be expected of me. The thought of being inside a CAT machine for thirty minutes has very little appeal, but I have no choice.

At that precise moment, the Universe intervenes.

“I’m not so sure I want to subject you to this procedure today, before first obtaining the results of the PET scan of your neck five years ago in New York,” the physician says. (I had completely forgotten about the PET scan). “Once we have those records, we can chart its rate of the growth just by eye-balling the two radiographs. It looks to me like calcification is present to some degree, which means it’s likely been there for some time. Let’s get the records. I still may end up recommending the biopsy after I see the PET scan, but in the meantime, there’s not a whole lot we can do.

The next day couldn’t get here fast enough. After almost two weeks, I’m going home.

Suzanne and Carol, the two senior administrators of the assisted living community I live in, along with a handful of residents, are there to greet me.

By most standards, a modest Welcoming Committee, but to me it’s like a ticker tape parade. Martin Bayne