Sorry folks…

After much thought, because I am currently on vacation with my family followed by a visit to my sister in California, I do not want to spend any of the time writing. I’d rather spend the time with my family, thus there will be no new posts until Monday October 13th. I may try to repost some older posts that I think would serve as good reminders. As always, thanks to you all for coming to the site!

Patience

One question that I been asked over and over since the diagnosis and surgery is what have you learned from all this? To be honest, I have not discovered a sweeping lesson here (at least not yet), but as the title of this post suggests, one virtue that I have always found especially important, and even more so since the surgery is patience.

I’ve always been called a ‘laid back’ guy. In the past I didn’t give this comment much thought but was flattered by the observation. What is actually meant when someone is deemed ‘laid back’? Webster defines it as someone “having a relaxed style or character.”[1] I’ve always interpreted it as a compliment, but I’m sure to some, it’s actually a veiled insult, with the comment “you’re so laid back” meaning “unlike you I pay attention to and care about details .”[2] Regardless of the intent, I’ve always thought it to mean: someone who can roll with the punches. But the more I think about it, a ‘laid back’ person is a patient one, someone who can stay calm in the face of adversity.

It’s true, only a laid back person could let 18 years of vertigo and one year of leg weakness go unaddressed. My attitude may in fact have delayed my diagnosis, but this is the only instance that I found it detrimental. Since the surgery I can think of countless numbers of times that patience has been crucial to my recovery.

image

——- Patience in…Recovery ———–

The number one place that patience has been paramount is my recovery. This was less difficult in the beginning phases of my recovery as my gains were more noticeable. Now the gains are there but less pronounced. I would liken it to watching grass grow: if you spent every second of every day watching the grass and measuring it, you wouldn’t notice it getting longer. But if you were to leave it for a week (and tend to something else) you would undoubtedly notice the increase in length. This has been the case with my recovery. Early in my recovery, I would wake up and be able to perform a task I couldn’t the previous day. Now, a part of me thinks that my recovery is done and over with, and what I have now is what I will be left with. But luckily those who are not with me on a day to day basis, tell me that I look better than when they saw me last, and that I am making improvement.

For me there are definite moments of frustration: every loss of balance, every “what?” that I often hear in conversation because of my delayed speech, every fumbled object in my hands (revealing my poor motor skills) is accompanied by moments of frustration. Fortunately, I recognize this frustration, and try to quell it. I take several deep breaths and remind myself where I was immediately after the surgery—confined to an ICU bed, unable to care for myself, let alone walk. I remember to appreciate where I am today and the progress that I have made. Patience, and a sense of calm then takes over. When I was in the hospital on the Rehabilitation Floor, my Family Doctor would often remind me “Chris, you’re going to get better, but it will take time. Remember, this is not a sprint, it’s a marathon.”

image

—– Return to Residency—–

I do not want to go into the exhaustive details of my attempts to return to residency, as the process is still ongoing, but what I will say is that the process has been an exercise in patience. Patience from me, patience from the Family Medicine program, and patience from Sparrow. From my perspective I cannot wait to return to seeing patients, and would love nothing more than returning to the clinic. But I know that my return has to be done the right way; I have to be ready and all the necessary documents must be signed and reviewed .

I mentioned that I have seen a Vocational Rehabilitation specialist. I initially thought that she would advise me on my options after residency (i.e. other career options besides clinical practice) but she has taken it upon herself to spearhead my return to residency. She is constantly in touch with both Sparrow and me. She has been wonderful, and I cannot imagine where I’d be in this process without her. In our last meeting, she implored that I sign and send in all the provided paperwork to expedite the process. My response to her was that I wanted to review all these documents first. While errantly signing a form could hasten my return, it could also have long term unforeseen negative effects. Patience here, I told her, is key.

—- Patience—-

Benjamin Franklin once said, “He that can have patience can have what he will.”[3] Even though my ‘patience’ might have delayed my diagnosis, I hope that as Benjamin Franklin surmised, that it will result in a full recovery.

Good ol' Benny
Good ol’ Benny

[1] http://www.merriam-webster.com/dictionary/laid-back

[2] I remember in college, I was in the midst of stringing a tennis racquet when the string broke- forcing me to start over. There was another tennis player in the room who said, “Wow, you’re so laid back- I would have gone crazy.”   Thinking about it more, while she could have meant this as a compliment, she could have indirectly been telling me what a bad stringer I was, and that something like that would never happen to her.

image

[3] http://www.goodreads.com/quotes/tag/patience

[AA1] don’t quite understand this. Could you clarify?

[AA2]For legal reasons I really don’t think you should say that you might put a patient’s health at risk. In a court of law, they can use anything they find from you on the internet and use it against you. God forbid anything should happen, you do not want these kind of words floating out there in cyberspace. Moreover you are not putting anyone at risk any more than any other resident. You are fully mentally capable.

Physical Medicine and Rehabilitation

In attempting to return to normalcy, everyone I spoke to had the same advice: Get a good neuropsychologist and get a good PM&R (Physical Medicine and Rehabilitation) doctor. I was lucky in that not only were my neuropsychologist and PM&R clinicians considered top notch, but they were also wonderful to work with during my recovery. I decided that this post should be dedicated to the field of PM&R. I also asked my PM&R physician to write a short blurb surrounding his care for me and his thoughts on my situation.

PM&R journal
PM&R journal

———- The Field ———-

Like many fields in medicine, the definition of PM&R medicine is broad. In essence, the aim of this branch of medicine is to restore function and improve the standard of living in those with either physical impairments or disabilities (or both). Many people (residents included) think that ‘PM&R’ stands for ‘Pain Medicine and Rehabilitation’[1]. While it is true that part of what a PM&R physician deals with is pain, the field involves much more—the scope of the field is much broader. In attempting to restore function in those with impairments or disabilities, a PM&R physician may see a patient who suffers from carpal tunnel syndrome in the morning, then a stroke patient in the afternoon. The field is a relatively new one, gaining notoriety after World War II, with the treatment of many injured soldiers.

Funny comic about the field.
Funny comic about the field.

——- Traumatic Brain Injury ——–

One of the patients these physicians treat, are patients with Traumatic Brain Injury (TBI for short). This fit my case perfectly, as the mass and the removal of it had resulted in the symptoms I have today. Technically, stroke patients also fall into this category. The role of the PM&R physician in these patients is to help them regain any functional ability that may have been impaired due to the injury. Depending on the specific deficit, a PM&R physician may refer the patient to a speech therapist (many stroke patients have speech deficits after the injury) and to a neuropsychologist (to aid with the evaluation of any possible cognitive delays). Every case is different, and requires specific tailoring and management for the optimal care of the patient. My case was easy and difficult at the same time: easy in that I required every kind of therapy, and little to no thinking (hopefully) was involved in this aspect of my care.[2] My case was difficult in that this occurred during my medical residency, creating many intricacies in my care.[3]

——- Dr. Michael Andary ———-

Dr. Michael Andary
Dr. Michael Andary

My first experience with Dr. Michael Andary actually came prior to my surgery and diagnosis. I was working on the inpatient service at the time (seeing patients in the hospital). On one of our patients there was a question of who the admitting physician was to be.[4] I remember it clearly, the residents (not wanting to do all the extra paperwork) had our supervising physician and then Program Director (a legend at Sparrow) directly telephone Dr. Andary in an attempt to clarify the situation (in reality we hoped that Dr. Andary would say, “sure thing! We’ll do the admission and all the paperwork that goes with it.”) Unfortunately, the result of this conversation was that we were to ‘admit’ the patient. It wasn’t this end result that sticks out in my mind however. I had never seen our supervising physician, I’ll call him Dr. Bond back down as he did. I could not hear the other end of the conversation, but from Dr. Bond’s responses I could tell what was being said between them:

Dr. Bond: “Say Mike, that patient in room 525? We are under the impression that we don’t’ have to admit her. Since you guys are managing her care shouldn’t you admit her?”

Dr. Andary: Inaudible.

Dr. Bond: “No I understand Mike that that’s how it’s always been, but we’d gladly see her as a consult[5] but seeing as you’re the main managing physicians it seems to me that you should admit.”

Dr. Andary: Inaudible.

Dr. Bond: “Ok Mike, I understand, we’ll go ahead and admit the patient.”

I was taken aback. Dr. Bond was well known and respected around the hospital and community. Who was this Dr. Andary who had ‘fought back’ and won? My curiosity was piqued. It was around then that I began to hear much of Dr. Andary and his own legend. He was well known around the PM&R community as one of the top physicians in his field. When I told the PM&R physician in Ann Arbor of my plans to become a patient at Sparrow Hospital his first response was that “Oh great, you’ll be in good hands with Dr. Andary.”

My first encounter with Dr. Andary as a patient came during his rounds. He was blunt, but honest. He had me perform a series of cerebellar tests, one of the tests having me run my heel up and down the opposite shin. “C’mon faster!” he implored. Of all the clinicians I have seen he remains the only one to tell me and my wife that he does not expect me to return to 100%. I see several possibilities with this: either the other clinicians think the same thing but do not want to tell me this, or Dr. Andary is truly the only one who believes this. While I hope that Dr. Andary is wrong and that the second alternative is the case, the rational side of me tells me that when it comes to medicine Dr. Andary is rarely ever wrong.

After my discharge, one of my many clinic visits included a trip to the Sparrow PM&R clinic. Here I would be seen as an outpatient, in the controlled setting of their clinic. Dr. Andary knew of my desire to return to residency and patient care, he entered the room and immediately said, “Chris, I know you want to come back. I believe that you can and will. I am on your side and will fight for you till the end.” Ever since this visit he has been deeply involved in my return to residency.

—– Blog ——–

Dr. Michael Andary
Dr. Michael Andary

A few months ago I asked him if he would write something for the blog. I asked that he focus on the aspects of my care that centered around my return to residency. This is what he wrote:

Dr. Chiou has worked hard to improve his motor control, cognition and ability to integrate information. It is now time to see if he can perform work specific tasks and finalize the skills, and neurophysiological connections to return as an effective physician. Much like a golfer learns to golf by practicing that specific sport, it is now time for Dr. Chiou to practice his specific job and see if he can return as an effective physician. If he can psychologically adjust to the slower pace, and adjustments, I believe he has an excellent chance to return to work as a physician. Michael Andary M.D. M.S.

 

[1] Actually, the joke about PM&R in medical circles is that it stands for ‘Plenty of Money and Relaxation’.

[2] Thus far, I have been seen by a Neuropsychologist, Family Doctor, Neurosurgeon, Neurologist, Ophthalmologist, Physical, Occupational, Speech, and Vocational Rehabilitation Therapists.

[3] In fact in a meeting with both of my PM&R physicians they (both very experienced physicians) stated that while they’ve aided in the return of many physicians back to work, this was the first case of a medical resident attempting to return to work that they had encountered.

[4] Often in the hospital there is much ambiguity surrounding this question. The bottom line is that being the ‘admitting physician’ requires more ‘paperwork’ including all the admission documents.

[5] In the hospital the order ‘consult XXXX’ is often written (or typed). This simply means that the managing physician is requesting the expertise of another physician. For example, if a patient under your care suddenly develops chest pain, a cardiologist might be consulted.

What it is

For today’s post, I wanted to repost my first post.  This is for a couple of reasons: 1.  I’m afraid that the post got lost in the website and that no one would see it.  Given the whole reason for the blog revolves around this tumor, I thought it was appropriate to rerelease it.  2. I want my story heard and think reposting the first article is a step towards doing it.  If you’ve already read this, I hope you’ll read it again.  If you have not yet read this post I hope you find it enlightening:

“It was tough, but I got you in to see Dr. Smith tomorrow morning”

I was sitting in the waiting room of the Neuro-ophthalmology office, waiting to hear the results of the MRI I had just undergone. Unfortunately I received the bad news through the scheduler. I knew who Dr. Smith was, I knew he was a neurosurgeon and I also knew that in order to see a neurosurgeon there had to be something to take out. Moreover, the fact that I was seeing one the next morning meant that it was something relatively urgent.

Let me explain what brought me to that moment: It was Monday March 18th,, 2013 that I awoke with double vision. I frequently get asked about the double vision- thinking back to that time the only way I can describe it is that there were two side by side images of everything I looked at. It wasn’t bad at first; in fact I was able to work for two days with the vision changes. I work as a resident physician in a clinic in Lansing, Michigan. The double vision was mild enough that I could trudge through Monday and Tuesday of my clinic, only complaining to the medical student once or twice about the double vision and resulting headaches. (I’m one of the lucky few who has never had a headache before but I have to admit that this was causing me to finally realize what nearly 75% of individuals have felt). [1] The visual disturbance kept progressing until finally on Wednesday of that same week I pulled my Family Doctor aside and told him about my symptoms. I told him that I had originally thought that this was some form of a complex migraine, but I thought that he should know. I had seen many Complex Migraines during my training and they had often manifested with visual complaints (that is one of the few downsides to having an MD after your name, you’re taught not to first think of rare conditions, i.e.: a brain tumor. I can picture one of my medical school professors telling me, “Always think of common conditions first!”). Fortunately in his experienced eyes this was no complex migraine. “You need to be seen by a neurologist right away, let me give Dave a call.” I could not hear this neurologist on the other line but Dr. Pearson’s responses told me all I needed to know (Dr. Randy Pearson, my family doctor). “You can see him right now? Ok, I’ll put that in.” He hung up the phone and turned to me “Chris, Dr. Kaufman will see you right away, he wants to get an MRI of your brain first.”

————————- The Neurologist’s Office ———————–

That brings me to that visit with me sitting in the waiting room, getting news through their scheduler. “Christopher? Dr. Kaufman will see you now” a medical assistant told me before she took me back to an exam room. I was nervous, I knew it was bad news but I didn’t know exactly what the news was. My wife arrived, my heart rate went down. I’d never admit this to her but she has a calming effect on me. I hated to worry her but I needed her there so I finally called her to tell her of the upcoming MRI and appointment. She is also a Family Medicine Resident, in the same year of training as me. I could hear the concern in her voice when I called her- she is much smarter than me, so I’m sure she knew something was wrong from the get-go.

My family: From left to right: Christian, Zoe(my dog), Fleur, me
My family: From left to right: Christian, Zoe(my dog), Fleur, me

Dr. Kaufman walks in and breaks the news to me. “Chris, let’s talk about your MRI. Why don’t you have a seat?” He tells me as he shakes my hand. “Fleur? Good to see you. Are you comfortable?” I’m used to this question as she’s 8 months pregnant. “Chris. They found something on your MRI,” he went on, “the good news is that it looks benign, but there is no way to absolutely know unless it is taken out.” He was good, there are whole courses in medical school designed to teach students how to deliver bad news, I’m sure if he had been graded on our encounter he would have received perfect marks. The rest of the visit seemed like a blur to me, but I do remember him saying that the appearance on MRI led him to believe it as an Epidermoid Cyst. The reason I remember him saying that is that my little sister had a similar growth in one of her ovaries. “Was this genetic?” I thought to myself. “I’ve scheduled you to see the neuro-surgeon right away tomorrow morning”

Dr. David Kaufman, MSU Neurology
Dr. David Kaufman, MSU Neurology
A schematic of the brain- my tumor was in the posterior fossa next to the cerebellum
A schematic of the brain- my tumor was in the posterior fossa next to the cerebellum

——————————- Telephone Calls ——————————–

Once I stepped out of the office I turned on my phone and called my mother. Whenever I meet someone else from either Taiwan or China, the topic of our mothers inevitably comes up. The words “she’s a tiger mom’ ultimately comes out of both of our mouths. But as I say this to others I know I’m selling her short. It’s a gross understatement. This is a mother of three, who devoted her career to Emergency Medicine, working 24 hour shifts in the Emergency Department as the lone physician. Her eldest daughter, my older sister Amy, was so talented in her violin skills that she was accepted to Julliard. However to mention her talent seems to detract from her hours and hours of hard work, pushed by my mother. She declined Julliard in favor of pursuing a career in medicine, at the prestigious Yale University. To her, Yale did not cut it, so she pushed me to excel in both my tennis and my academics so I could attend Harvard University, and also eventually into medicine. My youngest sister, probably the smartest of the bunch, rebelled and went into finance. This was all accomplished because my mother pushed us in every aspect of our lives. This, though, was out of her control: a brain tumor could not be outworked. That is why her reaction to my news was so memorable, “’I’m going to call your sisters. When is the neuro-surgery appointment? I’m on my way there.” (She has the habit of throwing questions in between statements. I attribute it to the millions of thoughts that must be racing through her head).

I then call my sisters to tell them of the news. Somehow my mother has managed to call them first. My older sister answers the phone in tears, telling me that everything will be alright, that a good friend of hers is now a neurosurgery attending physician at The Massachusetts General Hospital. She tells me that she is going to call him right away. My younger sister, also in tears, tells me that she has already booked airline tickets to get in the next day.

My family: From left to right: Amy, Pearl (my mom), me, Alice
My family: From left to right: Amy, Pearl (my mom), me, Alice

————————Neurosurgeon(s)———————

The next morning, Thursday, I go to see Dr. Smith, the local neurosurgeon. He tells me not to worry and that this is a benign tumor, with the only true ‘cure’ being to take the mass out via surgery.

“What will you do in the surgery?” My wife asked him

“I’ll literally go in and suction out the mass.”

“What’s the recovery process like?”

“Pretty quick. You’ll be in the Neuro- Intensive Care Unit for a couple of days, then I’ll have you moved to the [General Medical] floor for approximately 3-4 days.”

“How long will the recovery take?”

“Should only take 2 weeks.”

He scheduled the surgery to be done the next Tuesday.

We still thought that we ought to get a 2nd opinion, so we went to the neighboring University of Michigan, with a world renowned neurosurgery department. We were lucky in that we got in quickly with an appointment with one of their top neurosurgeon’s Dr. Stephen Sullivan. He walked into the room and warmly greeted us. He went over the MRI with us (this seemed like the 50th time I had seen it) and ultimately said, “Chris, I’m a very experienced neurosurgeon but if it were my son I’d want the best possible surgeon performing this particular surgery. That’s why I’ve called Dr. [Cormac] Maher, one of our best pediatric neurosurgeons to come see you. He does these types of surgeries way more than me, albeit on younger patients.”

I was completely blown away. In the span of two days I had seen two different neurosurgeons. As a practitioner I have acted as both the physician giving the second opinion and been told that after seeing me the patient wishes for a 2nd opinion. My assumption was that both scenarios ended the same: the physician giving the second opinion says the same thing as the first one. I assume this for a few reasons- 1. Even though we may go to different medical schools, or get our residency training at different places we still learn from the same textbooks; thus our a medical opinions will be the similar. And 2. Medicine is a very algorithmic profession. There are countless numbers of papers and ‘decision rules’ that serve to guide physicians. (For example if a 63 year old male smoker, with type 2 diabetes comes to the Emergency Department complaining of chest pain there is an algorithm that tells the physician exactly what to do[2]). Thus I deduce that most of our decisions are the same. But here were two physicians in the same field with two very different responses.

Dr. Maher walked in, smiling warmly with one of the first things he said to us being an apology. “I’m sorry for making you wait, my name’s Dr. Maher, I’m one of the pediatric neurosurgeons here,” he went on, “Chris what we know is that you have a mass in your brain, unfortunately we don’t know what exactly the mass is. It looks benign on the MRI but until we get it out and look at it under the microscope we won’t know if it’s a malignant tumor or not.” The rest of the visit was a blur to me. Up until now I had assumed that this was a benign, harmless tumor (If there is such a thing). Even the chance that this could be an invasive, malignant tumor scared me.

“I’d like to operate sooner rather than later, how does next Thursday sound?”

I don’t even remember saying ‘yes’ or even signing a consent (which I must have done) because my mind was spinning. A malignant tumor could mean chemo- or radiotherapy . It would also mean that my lifespan was significantly shortened. This was the first time during this ordeal that I as faced with the prospect of death. Even after first hearing of this mass in my brain, because the words ‘probably benign’ were always connected to it, it had not crossed my mind that this could end my life. What was strange was I did not fear death for myself I feared it because the effects it could have on my family.

Dr. Cormac Maher University of Michigan Neurosurgery
Dr. Cormac Maher University of Michigan Neurosurgery

According to the Center for Disease Control (CDC) approximately 40,000 people took their own lives in 2010.[3] I’ve often told people that I believe suicide to be the most selfish act that someone can commit (yes, more than theft, adultery, or even murder). I’ve had to deal with suicide many times (before a career in Family Medicine I trained in the Emergency Department for a year where suicide attempts are a daily occurrence), and my thoughts always immediately go to the suicide victim’s family. They are left to deal with the aftermath. Thus the thought of my own death made me think of my family.

On the drive home my phone was flooded with texts as news of my tumor had spread throughout my program. One of these texts was from one of my phone was flooded with texts as news of my tumor had spread throughout my program. One of these texts was from one of my closest friends in the program, Megha Tewari saying “I’ve looked up this Epidermoid tumor, and it looks pretty rare. What did the surgeon say?” I did not and have not done any research on the tumor, which goes against my normally inquisitive nature, but I figured the less I knew the better. I did not want to read about the prognosis of the tumor, or even the surgery itself (which I found ironic, I always tell my patients to try and gain as much knowledge as they can about their medical conditions). The double vision was getting worse, the surgery day could not come soon enough.
[1]World Health Organization, http://www.who.int/mediacentre/factsheets/fs277/en/
[2] Gerber, Thomas, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848418/
[3] CDC, http://www.cdc.gov/nchs/fastats/suicide.htm

Suicide

In lieu of the recent Robin Williams suicide I wanted to create a post today devoted to that topic.

Robin Williams
Robin Williams

The numbers are staggering, according to the CDC in 2010 over 38,000 people committed suicide.[1] Almost 500,000 people with self-inflicted injuries were seen in the Emergency Department. The medical cost of the self-inflicted injuries and suicides was an estimated $41.2 billion dollars.[2] This means something we already know: suicide is a major health issue. For the ec

A great illustration depicting suicide
A great illustration depicting suicide

onomists, preventing, or creating a solution to this problem could result in significant money saved. For everyone: the problem is so prevalent that we all know someone, who at the very least attempted suicide. Are there some warning signs that an event like this is going to occur? The resounding answer to this question is ‘yes’. Nearly 90% of those who take their own life have an underlying psychiatric condition—this could range from depression to schizophrenia. What’s more jaw dropping is that about 75% of those who commit suicide exhibit signs (signs such as substance abuse, withdrawal from family, or acting recklessly).[3] This begs the question: if there are both warning conditions and warning signs, why does it still occur with such frequency? I believe that the answer to this question has many branches of answers: I think that proper education of the general public could decrease this number. This education not only includes teaching people about the warning signs of suicide but also resources at their disposal if they suspect anything.[4] Now you may wonder what this topic has to do with me and my recovery.

 

——— How Does This Relate? ——–

Like I mentioned in a previous post, one worry for my recovery was my emotional state. Many people if put into my situation (handicapped overnight by a brain tumor) would fall into a depressed state, and may contemplate suicide. I am lucky in that my psyche is filled with hope following this ordeal: hope for a full recovery, and hope that my story is told and heard.[5] I consider myself simply lucky to have this outlook—I would not find fault with someone falling into depression under some circumstances. Like I said in an earlier post: there are varying schools of thought when it comes to depression—one extreme (these are clinicians: physicians, psychologists, mid-level providers, nurses, etc.) feels that depression exposes a weakness of the mind; that ‘mentally tough’ people could and would not become depressed. On the other end of the spectrum some view it as a physiologic phenomenon, caused by an imbalance of neurotransmitters in the body.[6] I find myself in the middle of these two extremes: I believe that our whole body is always in a state of delicate balance, with the ratio of neurotransmitters very finely tuned, and the number of receptors on our cells always very important. I believe depression occurs when someone under duress is nudged in the direction of a depressed state, having the balance of the neurotransmitters thrown in the direction of depression. There are unfortunate people who suffer from depression as no result of any situation. In my case, the optimism and hope I have felt since the surgery has probably counterbalanced the adverse effects this ordeal has caused.

Could the almost 40,000 people’s lives be saved with further education and increased awareness? It might be a little farfetched to expect this, but even if one life is saved by any actions I feel it’s worth the effort. It’s sad that it takes the suicide of a public figure to bring this issue to light, but I am glad it has been brought to the public eye, by whatever means necessary.

A fantastic book on suicide.
A fantastic book on suicide.

[1] http://www.cdc.gov/ViolencePrevention/pdf/Suicide_FactSheet_2012-a.pdf

[2] Besides the medical care cost, this figure includes the cost of work loss.

[3] http://www.suicide.org/suicide-warning-signs.html

[4] There are several numbers one can contact if they feel someone is in trouble: the easy number to remember is ‘911’. The police are trained to handle these situations. Another number to remember is 1-800-SUICIDE. This number can also provide help to anyone in need.

[5] I mentioned in the last post that I have taken up reading since my surgery. One of the first books I read is a book by Jerome Groupman titled, “The Anatomy of Hope”.

[6] This is the reason I try to avoid medications: I find that medications are an attempt to correct this imbalance; I worry that medications may result in detriment to this balance.

Music, Movies, Reading, & Cooking

I have always enjoyed music, movies, reading, and cooking, even before the surgery. Afterwards, I have begun to appreciate and love these activities even more. Before, medical school, residency, marriage, and parenthood occupied my time; I could not spend as much time with my hobbies as I had wished. Just as this tumor has allowed me to spend more time with my children it has also given me more time to enjoy these activities.

—– Music ——-

I have always loved music. As a teenager, I loved hip-hop. I have memories of listening to The Wu-Tang Clan and DMX before big tennis matches to get me fired up. While I still enjoy hip-hop[1], my taste in music has diversified; I also like musicians such as The Killers, James Brown, and Leon Russell. The only genre of music that I do not listen to happens to be the most popular type of music in the USA: country music.

Now I constantly listen to music whenever I can—while working out in the gym, cooking, and writing. Each time I listen to music it serves a purpose—while in the gym I use music to motivate me to work harder and push myself.[2] While cooking, music inspires me to be more creative in the dishes I make. With writing, music puts me in the right frame of mind to write about my experience with this tumor.

The Wu-Tang Clan in their 'tough' pose.
The Wu-Tang Clan in their ‘tough’ pose.

As with movies, music is a form of art that has the ability to move our souls, and transport us to different places. I cannot imagine a life without music and know that my recovery would be seriously hindered without the aid of music.

—– Movies —–

Movies provide me with an escape from reality. In movies, feats that aren’t possible in real life become commonplace on film. Conversely movies can be biographical in nature, and can detail the life or events surrounding a person’s life.

I enjoy movies that can bring me to another place and enlighten me. This includes big budget action films, comedies, and ‘biopics’. I absolutely refuse to see any movies that are ‘emotionally draining’; these are movies where you leave the theater more emotionally spent than when you entered: films like Hotel Rwanda and The Hours come to mind.

In relation to my recovery I especially enjoy ‘comeback’ movies. These are movies where the protagonist, typically a sports figure, suffers a major setback in the beginning of the film and spends the rest of the time building him or herself up to become stronger. Movies like Rocky or The Dark Knight Rises are like this. One common theme that runs through all these movies is that at the end of the movie, the hero’s life is changed and somehow through all their tribulations they become stronger. I hope that like Rocky or Batman that I will emerge from this ordeal both more evolved and stronger.

The 'comeback' movies of all comeback movies.
The ‘comeback’ movies of all comeback movies.

In terms of my recovery, going to movies provides me an opportunity to see friends and socialize. My friends often go out of their way to offer to take me to a movie. With two young children at home, it is nearly impossible for my wife and I to go the movies together.[4] However, when I go with friends it provides us an opportunity to catch up.

—– Reading ——–

Since leaving Sparrow Hospital I have taken up reading and have read about 30 books.[5] I prefer nonfiction ranging from books about Einstein to memoirs about famous leaders. Like with movies, a good book has the ability to take the reader to a faraway place. I don’t have favorite authors, but only have one prerequisite: it is important that I learn something from the book, and not just be entertained.

I often get asked, “What have you learned from your reading?” There isn’t one underlying lesson that ties all of these books together—each book teaches me something different: one book may encourage me to think ‘outside of the box’, while another book might present certain views of happiness.[6]

The latest book I have been reading by the Dalai Lama and Howard Cutler.
The latest book I have been reading by the Dalai Lama and Howard Cutler.

Besides helping to improve my writing skills, reading also gives me a part of the day devoted to me. I typically set aside some time every day and put on some soft music to read. There are some days that are too busy which I don’t read, but I try to read at least a little every day.

—- Cooking ——

When I was interviewing for residencies I received advice from many people. One piece of advice was to be truthful on all of your application. The example this physician used was that someone put ‘cooking’ down as an interest. Unfortunately for this applicant, the interviewer was an avid cook, and was offended that the applicant would include ‘cooking’ as an interest while not knowing the intricacies of it (i.e.: what could you use to balance out the acidity of oysters?)[7] I think if I were to fill out a resume now I would include ‘cooking’ as an interest. I by no means am a master chef[8], but I thoroughly enjoy it.

In terms of my recovery, I enjoy the control cooking gives me. One aspect of my life that this tumor has stripped from me is control. Literal physical control over my own body (i.e.: titubation and ataxia), and control over returning to residency, and over my schedule. Any aspect of my life that I have control over I have clung to.[9] Also, as an added bonus, at the end, if you have done it right, you are left with an enjoyable dish.

My latest cooking obsession- homemade hummus.
My latest cooking obsession- homemade hummus.

——- Activities ——–

Like with all the books that I’ve read there is not one underlying theme to all these different aspects to my life. They all in their own way have helped me to recover: Music helps to motivate and center me. Movies provide me with a temporary escape and also serves as a medium with which I can see friends. Books also give me an escape but also serve to enlighten me. Cooking provides me with at least a semblance of control. While all of these are separate without each and every one in my life my recovery wouldn’t be where it is today.

[1] As far as I know DMX is no longer releasing albums, and The Wu-Tang Clan are set to release their first album after a many year hiatus.

[2] My wife, a psychology major in college, completed a study that showed that subjects exercising to certain types of music worked out harder when compared to no music.

[3] I have a ritual of playing The Lumineers station on Pandora when I sit down to write.

[4] Going to a movie with my wife entails us getting babysitters, finding a movie that we can both enjoy at a time we can both make.

[5] The book industry is estimated to be a $132 billion dollar industry.

[6] There is a fantastic book I read titled, Moonwalking with Einstein by Joshua Foer. Besides being incredibly written, it is also very informative; telling of the benefits of memorization.

Great book about the power of our memories.
Great book about the power of our memories.

[7] Residency interviews are notorious for strange questions—someone was once asked “why are manholes round?” The interviewer is not looking for a correct answer but wants a peek into the thought process of the applicant. Manholes are round to prevent the cover from falling in by the way.

[8] For example, I had no idea that oysters are acidic.

[9] This includes cooking, diet, and exercise.

[AA1]Can you explain about the frame of mind? Not sure what you mean by this

Fatherhood

In life we are in constant pursuit of happiness. Everything we do, whether it be working to earn money, or even watching a scary movie, is done so we can attempt to achieve happiness.[1] Philosopher John Stuart Mill attempted to quantify happiness by calling it ‘utility’.[2] Even with this in mind, the sheer joy and happiness that my sons have brought me is unquantifiable. There are two parts of my day that I always look forward to: 1. When my older son, Christian, returns from school, and 2. When I pick up my younger son, Cormac, from daycare. My experience raising each has been completely different.

——— Christian ———–

On Christmas night of 2006, my first son, Christian William Chiou[3], was born. From that night on, Christian barely ever left the side of my wife. There is a slang term: “mama’s boy”; while this is usually in reference to an older boy, because Christian did not leave the side of my wife for the first three years of his life, I would have labeled him a mama’s boy then. In fact I do not remember most of the first few years of his life. He breast-fed until he was 2, thus most nights I did not wake up until morning.[4] I paid lip service to other new fathers who complained of their loss of sleep. Before my tumor I would call the relationship with my son ‘playful’. My stepfather, from whom Christian received his middle name, observed our relationship and told me it was a ‘best friend’ type of relationship. At first, I scoffed at this, recounting the many times I disciplined him. But the more I thought about it, never having a brother growing up probably made me treat him more like a younger brother than a son.

Christian showing off his soccer accolades
Christian showing off his soccer accolades

I mentioned in an earlier post that I feared his reaction to my condition. During my initial recovery I asked my wife not to bring him to the hospital as I did not want him to see me in such a state. I was scared that he wouldn’t understand, or worse, think that this was somehow his fault.[5] Mostly, I did not want to lose my friend. Luckily, it was as if nothing had changed. From the beginning he treated me as he always had. I can count the instances on one hand where he even acknowledged my disability. He is extremely athletic and intelligent and has made many friends at school. I’m not sure if it’s their age, or maybe their innocent outlook on life, but none of his friends have ever said anything about my condition. I have yet to experience an episode of titubation in front of them, but have no doubt that after their initial reaction of “what is wrong with your dad’s head?” they would carry on as if nothing was happening.

Sure, there are a bevy of logistical issues (traversing his school, explaining my condition to his teachers, managing both him and my younger son at soccer practice) but seeing him return from school every afternoon makes it all worth it.

——– Cormac ————

Cormac with our dog Zoe
Cormac with our dog Zoe

On April 19th, 2014 I became a father for the second time. The conditions surrounding his birth were a bit different than for Christian: For Christian we were just getting ready for medical school, now we were both about to enter the last year of our residency. Most notably, for Christian’s birth, I was not a patient in the same hospital two floors up, recovering from brain surgery. Unfortunately, for Cormac’s birth, this was the case.

I mentioned above that I don’t remember most of Christian’s early years; this is not true for Cormac. Every word he has spoken, his first steps, and all the meals he threw on the floor, I remember. He is now in daycare[6], but there was a time that he was not in daycare and spent the days with me. This is in stark contrast from Christian, who barely left his mother’s side.

When I tell people of my condition and of the birth of Cormac, I inevitably get an ‘oh jeez’ or ‘oh brother’ reaction—“not only do you have to deal with a brain tumor but a newborn as well?”. Yes, I won’t deny that at times it is tough- the sleepless nights, crying fits, and poopy diapers are not the glamorous parts of child rearing, but I think I was extremely lucky to have Cormac when we did. Instead of bad luck, I see it as good fortune to be able to be home as much as I have. If I were to give you the choice between a. being able to be at home with your two sons or b. working so much you’d rarely ever see them—you’d pick ‘a’. Sure ‘a’ comes with the kicker that you’re at home because of a brain tumor, but even with this, the choice is clear.

—— My Two Boys ——

Being the age that I am (31) many of my friends are considering parenthood. “We’re just not ready” is the most common reason people give not to have children. My response and stance has always been the same, “no one is ever ready to become parents. You’re tricking yourself if you think there’s some point in your life where you feel ‘ready’ for children. It just happens, and you do everything possible for your child.” In this constant pursuit of happiness, the joy and ‘utility’ that my sons bring me has been ineffable.

image

[1] In the case of the money earning, most are under the impression that more money equals more happiness—if I were to ask you “who do you think is happier? A homeless beggar, or the CEO of a major company?” Most answers would no doubt be the CEO—the real question is not who is happier, but why do we assume the CEO is happier? For the scary movie, someone who enjoys scary films sees them to fulfill their desires in an attempt to attain, yes, happiness.

[2] My college roommate used to joke and say he was “trying to get utiles” (his tangible transformation of utility).

[3] His middle name is in honor of my stepfather, Bill ‘William’ Nichols.

[4] We let him sleep in our bed, something we always advise patients against. So, when he would wake up in the middle of the night, my wife would feed him without waking up herself.

[5] As physicians we’re taught that children of parents with chronic, debilitating illnesses are at risk for a variety of conditions including, depression, oppositional defiant disorder, and conduct disorder. Thus it is important, we’re taught, from the onset that the parent is open about the condition with their child and reinforces that the condition is in no way their fault. This is does not prevent 100% of those conditions developing, but it can help.

[6] Besides providing me with time to complete therapy and respite we have also found that it has been fantastic for his socializing skills.

Happy Labor Day! Today’s post: Dani & Aimee

For today’s post I wanted to put forth pieces written by two of my fellow colleagues, who were elected as co-chiefs.  Aimee Tegtmeier was selected to be chief with me while Dani Watkins was elected to fill the role in my absence.  I felt they had a unique perspective not only because we were in the same class of residency, but also they were asked to fill the position of co-chiefs.  While Greg and Megha[1] were forced to deal with all the initial logistical hurdles my condition presented, it was Aimee and Dani who handled the repercussions of my absence from July of 2013 to the present.[2]  More importantly, I consider them both very close friends.  It goes without saying that they have been extremely kind to me since the surgery.  Even though I know they easily handled the chief position[3], they both went out of their way to try to include me in all ‘chief decisions’.  We would often have meetings where we would discuss various topics, such as scheduling, changes to our protocol, and issues that our fellow residents brought up.  I knew they did not need my help or input on these issues, but was honored they chose to include me in this process.

Aimee, Dani, and Megha
Aimee, Dani, and Megha

 Both Aimee and Dani have moved on: Aimee is set to finish residency in this month (normally residents finish in July, but Aimee’s completion was delayed as she took time off after the birth of her first child), and Dani is practicing medicine in Cleveland.  There is no doubt in my mind that they will be fantastic attending physicians: their combination of knowledge and compassion makes for an ideal clinician. My only fear is that they will move away and I will lose touch with them.  Luckily for me they both have ties to the area: Dani is from Michigan, so family is an excuse for her to return.  Aimee’s husband (also a very close friend of mine) is a resident in another program, and has will not finish until July of next year, thus, she is going to work in the area at least until he is finished.

I did not know either of them prior to residency but I have gotten to know both of them very well since our move here in 2011.  They are very different from each other: Dani is blunt, and has no problem telling you what she is thinking.  Aimee is always smiling, and is the type of person who makes you feel better simply by being there.  While they are almost night and day in their own personality, when it comes to patient care they both always put the patient first.[4] Another similarity is that they are both incredibly kind people.  Even though I have been out of the loop in the residency, I try to stay in constant touch with both of them; this can prove difficult for them, as Aimee is tending to a newborn while getting ready to become a working physician, and Dani is working as a clinician in Cleveland. Yet somehow they both find the time to check up on me.

I asked them to write a piece about what challenges my absence presented, and what it was like to see me in the hospital.  This is what they wrote:

 Dani Watkins:

Those of us lucky enough to be in the family medicine field know that priority number one is family. Our residency program is no different, we are all linked together as a part of a unique family unit, and when one of us is struggling it is very hard on all of us. The first feeling I had when we found out what was happening with Chris was fear. Fear for the surgery he would need, fear it was cancer, and fear for what this would mean for his recovery. The first feeling of relief was when Fleur told us it was not cancer and it appeared the surgeon had gotten all of it. Then my concern shifted to ‘how will his recovery go? How will Chris and Fleur handle a new baby and care for Christian?’ When I saw Chris at Sparrow after he was transferred, I will not sugarcoat it….. it was overwhelming to see such a strong, young, and active person be suddenly thrown into a state of complete dependence in such a short time when we had just worked together at the hospital a few short weeks prior. This threw all of us into protection mode at the program. Everyone worked together and we knew what we needed to do. Although we could not physically help Chris go through therapy, we could split up calls, take Fleur’s calls, bring food, and send well wishes of encouragement. When Chris asked if I would work with Aimee as co-chief resident, I could not turn this down. I had not initially wanted to be a co-chief, and also wasn’t sure if the program wanted me. Without question it was something I needed to do. Chris’ absence was difficult in the fact that our friend, our family member, was not by our side as before. What amazes me is the love the other residents showed, and their complete selflessness in covering any and all calls that needed to be covered. The office in baskets for Chris and Fleur were divvied up, and patient care continued on.

My wife and son, Dani, and Megha
My wife and son, Dani, and Megha

 

The sadness I believe we all felt when first seeing Chris after surgery has melted away, as now when I see him, his strength and physical ability has improved so much and the capacity for the human body to heal has proven to be simply miraculous. The sheer mental strength and love Chris and Fleur both possess is even more miraculous. We all wait with bated breath for his time to return, and although we are moving on as we have graduated I have no doubt Chris will return to finish residency and will be a better physician for having gone through the trials he has.

Aimee Tegtmeier:

Aimee with her baby son
Aimee with her baby son

Naturally it was very difficult for me to see Chris as a patient and not as a fellow physician. It was surreal what he and his family, and us as a residency family, were facing. Brain tumors happen to other people, not to people I know and care about. As scary as the diagnosis was, I was relieved to hear the word benign. However, we knew this wasn’t the end of the story. Chris would have a long road of recovery ahead. I tried to put myself in his shoes. Would I be angry, confused, in denial? Or perhaps just relieved to not be facing a malignant diagnosis?   I was amazed to watch Chris face his challenge with dignity and resolve. Though he was noticeably different on the outside (speech and visual changes, difficulty with walking, fatigue, etc) the same old Chris shown through from the inside. During the early stages of his surgical recovery despite his physical deficits, he always seemed to have a positive attitude. I never once heard him complain. In fact, whenever we would visit him he always seemed more interested in our goings-ons than he was with recounting his own difficulties. His wife (and my colleague) Fleur was also a pillar of strength during this time. The usual smile that graces her face never left. I admire the way she stood by Chris as his encourager.     Prior to the diagnosis and surgery, Chris had just been elected co-chief resident along with myself. In his absence, my colleague Dani volunteered to take over the bulk of Chris’s role. It was strange to plod ahead without him. He was always there in spirit and offered to spearhead several projects. But his recovery was no doubt a full time job, mentally, emotionally and physically; and I know he regretted missing the opportunity to his class in full force.    One thing that really stood out to me during this time was that Chris still viewed himself as a physician in pursuit of his end goals. Even though he was forced to take on the role of the patient, I felt like Chris didn’t let his physical handicaps limit his aspiration. He was not retreating or backing down. This must have taken an incredible amount of courage. Chris is still working hard pick up where he left off and we are eagerly awaiting his return.

 

[1] See an earlier post titled “Greg and Megha”.  They were the outgoing chiefs at the time of my diagnosis and surgery.

[2] The ‘medical’ calendar begins in July, meaning new residents and new chiefs.  It is often said that as new residents begin in July, the worst time to become ill is in this month.

[3] I’ve had many residents tell me of the great job they did.

[4] I would often hear from patients how much they loved having Dani and Aimee as their doctors.