Medicine

I was recently asked a question regarding current medical literature.[1] I knew the general accepted answer but also knew that ‘general accepted knowledge’ in medicine is always changing and is not constant. It was only in the late 19th century that bloodletting with leeches was a common and accepted practice.[2] In the 1940s arsenic and mercury were used to treat syphilis.[3] We view these practices as barbaric now, but there was a time when it was accepted as proper medicine. I mention these examples, not to make you question your medical care, but to highlight the fact that medicine is a dynamic field that is ever-changing. This made me think about my care and management.

—- A (Very) Brief History of Medicine —-

Let me first say that there are entire books devoted to the topic of the history of medicine, thus I hope my brevity in this section does not diminish from the field or its extensive history. In fact, I even considered leaving this section out, but then I realized that to even think about the present and future, the past must first be rehashed. Hence, a discussion of the current and future of medicine must start with its past.

As I mentioned, the history of medicine is an extensive one. In his book, “A Brief History of Medicine”, Paul Strathern starts the book by stating, “The practice of medicine is as ancient as humanity itself.”[4] Medicine was born when humans first came into existence. Even cavemen used plants in hopes of curing various ailments.[5] Any history of medicine would be incomplete without the mention of Leonardo Da Vinci; his study of human anatomy was light years ahead of his time. In 1928 Alexander Fleming (accidentally) discovered penicillin revolutionizing the treatment of infection.[6] In 1952 Jonas Salk invented the polio vaccine, not only preventing this debilitating condition in future generations, but also changing the way vaccines were viewed and used.[7] On July 3, 1977 the first MRI scan was performed, transforming the way disease was diagnosed and found. Although there were many significant milestones in the history of medicine, in my view, these five events seemed most important. But the question still remains, how does this impact current thinking and more specifically my care?

Sir Alexander Fleming - the father of penicillin
Sir Alexander Fleming – the father of penicillin

—- Medicine Today and Epidermoid Tumors —-

Medicine is an ever-changing field, in which accepted practices change as frequently as the seasons. Thus when I was asked about the current views on a topic, I could provide the current literature and knowledge but knew that this information would likely be obsolete in the future. Does this mean that it is useless to study medicine? Of course not, every treatment, every discovery, every invention, serve as a step toward the ultimate goal in medicine: to cure disease and to alleviate pain. The only purpose of giving examples of how the practice of medicine has changed is to point out that medicine is dynamic. I often think that if I suffered from this tumor only 30 (or so) years ago, the response by a physician would have been, “Your exam and symptoms indicate that there might be a tumor in your brain. Unfortunately, there’s no way to take it out. So let’s see how time treats it. If it grows, I’m sorry to say that there is no option.” I could have suffered an unwanted fate. Thus the question must be raised: is death a worse outcome than permanent disability? I mentioned in an earlier post that I have deliberately stayed away from scientifically researching my tumor in order to avoid bringing up any unwanted memories, but I have a hunch that the diagnosis and management of epidermoid tumors are drastically different than it was in the past. Even though this knowledge might have an impact on my diagnosis, the implications on my recovery are undeniable. It was once generally accepted that while peripheral nerves can regenerate central nerves cannot. I was taught this in medical school, but my recent conversations with a neurologist show my learned insights to be untrue- as both peripheral and central nerves are capable of regrowth. This comes as good news to me as many of my deficits are due to damage to central nerves (ie cranial nerves). So in a sense I am lucky to have had the tumor when I did. But this comes with a caveat. Maybe in 30 years my grandchildren will balk at the way I was managed as the idea of bloodletting with leeches makes us cringe today.

[1] Starting in January I will be writing a weekly column for the Epidermoid Brain Tumor Society, the question was actually posed by one of their board members.image

[2] Bloodletting”. British Science Museum. 2009. Retrieved 2009-07-12.

[3] http://www.webmd.com/a-to-z-guides/features/look-back-old-time-medicines

[4] Page 1

[5] “Traditional Medicine”. World Health Organization. Retrieved 2009-02-18.

[6] http://www.wisegeek.org/how-was-penicillin-discovered-and-developed.htm

[7] http://www.american-inventor.com/dr-jonas-salk.aspx

Pain

Many times through my recovery process I think back to when I first emerged from the surgery and stayed in the Pediatric ICU[1]. Unfortunately (or fortunately) much of my memory from there is hazy. My only clear memory was that of pain. I was having dinner with my family recently and the topic of pain arose. My wife said, “Do you realize that you only received 1 mg of morphine? That’s a pediatric dose.” The usual dose of morphine is 0.1 mg per kg every 4-6 hours. I was about 210 lbs (~ 95 kg) at the time of the surgery, which means my dose of morphine should have been 9.5 mg of morphine.

—- Quantifying Pain —-

In medicine, pain is a topic that is poorly understood. We have long used the 0-10 Numeric Pain Intensity Scale. [2] This is our way of trying to make a subjective finding an objective one. The problem is that there is no way to measure how much pain someone is in. Unlike metrics such as blood pressure and heart rate, there is no set number for pain. Thus the question becomes how do we treat pain? If someone is found to have an elevated blood pressure, bringing down this number is easy, but with pain, even though there are medications to alleviate it, there is no tangible number to target for treatment. The Numeric Scale attempts to do this but in reality, clinicians rely on ‘gut feeling’ when it comes to assessing pain. This method lends itself to wide variation and often missteps.

Pain scale
Pain scale

—- Two Sides —-

As with everything, there are two sides to this debate. Someone in pain would assert: When they asked me to rate my pain, I told them it was a ‘7’. But they still refused to give me any medications for it. All I want is something to dull this pain so I can get back to my life. They have the medicine I need for this, so why don’t they give it to me? If you spoke to this patient’s clinician they might say: I have never encountered this patient before and I’m afraid he/she is a drug seeker—only wanting to get a high from certain pain medications. More importantly, these medications have potential serious negative effects—they can stop breathing for one. Also look at his/her heart rate, does that look like a ‘7’ to you?[3] 

There is no right or wrong side here, but what usually happens is that this hypothetical patient would not receive any pain medication, and would not be given an explanation. Both parties have valid arguments. The problem is not the patient or the clinician; the problem is with the system itself as there is no acceptable way to quantify pain. In an ideal world there would be a machine that measures pain. That way, the clinician could see a number in front of him/her: it says here that your pain was measured at 26.55 ounces. That’s high! Let’s go ahead and give you some pain medication and bring that down. Unfortunately, no such machine exists.

—- Chronic Pain —-

image

In a recent study it was found that ~ 30% of all Americans suffer from chronic pain.[4] This could range from daily headaches to unrelenting lower back pain. To put this number in perspective, it has been estimated that less than 1% of the population had a case of pneumonia in 2010.[5] The question that must be answered is are these people getting proper treatment?

—- No Answer —-

Short of a wild, unforeseen advancement in medical technology there is no all-encompassing solution to this question of pain. For now we must deal with the situation as it is. The one aspect that can be improved upon is communication. In the case described above the clinician must make it clear to the patient of his/her reservations while the onus of describing the symptoms falls on the shoulders of the patient. My sister often pokes fun at me as I would often be asked in the hospital to rate my pain– I’m not sure if I was trying to be (what I thought was) tough or I simply didn’t want to think about the pain I was suffering, but my set answer was ‘3’. She knew I was in more pain than that. As I think back to my experience of the small dose of pain medication I received, yes some of the fault lies with the clinicians taking care of me, but it was also due to my poor communication with them.

[1] I mention in an earlier post that due to the complexity of my tumor, my surgery was performed by a Pediatric Neurosurgeon in a pediatric operating room. Thus, after the surgery I was placed in a Pediatric ICU.

[2] With 10 being the worst pain of your life and 0 being no pain at all.

[3] The heart rate is often used to aid in assessing pain. The theory is that someone who rates their pain as high should have an elevated heart rate.

[4] Institute of Medicine of the National Academies Report (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington DC: The National Academies Press.

[5] http://www.answers.com/Q/What_percent_of_people_get_pneumonia_every_year

3 Things

My step father, whom I consider very wise, once told me, “Chris, you need three things in life to be happy: something to do, someone to love, and something to hope for.” I was curious about this saying and felt compelled to look up its origins. My research and investigating led me to Tom Bodett, an author and radio personality.[1] I have thought much about this saying and believe it to be true. I then wondered do I have these three things in my life?”

Tom Bodett
Tom Bodett

——-Something to do———-

This tumor has been a mixed blessing in that it has stripped me of some activities (i.e. walking and talking normally and communication) but has also pushed me to take part in things I had never before tried. Before being confined to my house I did not spend as I wanted with my family. Even though I did much reading for medical school, I had not read a book other than a scientific text. Furthermore, writing is something I used to dread; I remember hating anytime I had to write an essay in college. In fact, one of the aspects I liked about medical school was the lack of essay style writing assignments. This tumor has given me the opportunity to partake in all of these activities: I have spent more time with my family than I ever have, I have read more (nonmedical) books in the past year than in my entire life, and I cannot wait until the time comes for me to write a piece for this blog. So when I made a mental checklist to see if I had those ‘3 things’ my stepfather spoke of, ‘something to do’ was the easiest category to address.

—-Someone to Love—-

I am often asked if this tumor has put a strain on my marriage. On the contrary, if anything this ordeal has brought my wife and I closer. She often jokes that before all this, I never used to hold her hand (now if we go anywhere together I always hold her hand for physical support). I am a strong believer that pressure reveals our true nature. Something as beautiful as a diamond needs pressure to be formed; the same idea applies to us as humans. Pressure, or stress when translated to homo sapien terms, can create something as beautiful and strong as the bond between my wife and I, or expose the cracks in the foundation between two loved ones. Even though there are many in my life that I love, the love I have for my wife first came to my mind when considering this quote.

—–Something to Hope for—–

This recovery process has been one filled with hope: hope for a full recovery, hope that my story is heard, and hope to inspire those facing any adversity in life to overcome any challenge in front of them. This saying has been repeated over and over and no doubt changed countless numbers of times; one of the versions claimed that you needed ‘something to look forward to’ as opposed to ‘something to hope for.’ These can be very different sayings as one could look forward to something while not hoping for it[2](and vice versa). Luckily for me, I look forward to waking up every morning to see my family and I also hope for some recovery that day.

Have you heard this quote before? Is the idea of achieving happiness, something we have strived for for centuries, as simple as having these three ‘things?’ When you think of this quote, what three responses do you come up with?

[1] http://www.bodett.com/bio/

[2] For example, you could look forward to your payday, but not necessarily hope for it.

Holding on…

I recently watched a fascinating documentary by Ken Burns on the life of former President Franklin Delano Roosevelt (FDR). In it Burns details the life of both FDR and his wife Eleanor in the backdrop of The Great Depression. I found one specific part especially enlightening and thought-provoking. We are all now aware that FDR was confined to a wheelchair, however this was not public knowledge during his presidency. In fact, FDR would try to hide any trace of his disability. In photos in which he was standing, there was always something or someone holding him up. I had to see for myself, and sure enough when I googled “FDR photos standing”—the first 10 images (like this one) showed him either leaning against something or him holding on to someone else.[1] What’s more mind boggling is the fact that Americans and some world leaders did not know of FDR’s need for a wheelchair.[2]

 

FDR- notice that he is leaning against the wall
FDR- notice that he is leaning against the wall
FDR- it's subtle but he is holding on to the gentleman next to him
FDR- it’s subtle but he is holding on to the gentleman next to him

The reason I bring this up is that I often find myself holding on to anything nearby when I stand in any public situation. This could be something as discreet as a nearby chair to something more obvious like a wall. You may wonder do you hold on when not in public? The answer to this has two-fold: 1. When I am at home with family, I rarely stand for a prolonged period of time, and 2. A loss of balance or fall in front of people outside of my family would be embarrassing, thus I do try and prevent this in any social situation.

Holding onto something provides me more mental security than actual physical support. I wouldn’t fall if that chair weren’t there to hang onto. This is akin to the concept of insurance. Most of us will purchase insurance but never use it. But in the rare case of the catastrophic event, we are comforted that we have it. Insurance plays to one of our strongest emotions: fear. Fear, that we will fall ill suddenly and critically, fear that a collision will destroy our car, or perhaps fear that someone will steal our valuable belongings. Holding on, like insurance, provides me with the peace of mind that something is there if I were to fall.

We all have our random objects that we hold onto, for me this just happens to be a literal object: for you this could be the $20 knee brace you bought because it was on TV or the $1500 electric generator you have in case there is a power outage. I hold onto a literal object for insurance: a chair, a table, or a wall. I imagine and hope that as the days and months pass, I’ll find myself holding on with less frequency, and free to let go.

[1] There is one photo from his early days before he was stricken with polio.

[2] Gunther, John (1950). Roosevelt in Retrospect. Harper & Brothers.

Another Special Thank You to Ben Austen…

Ben Austen
Ben Austen

I would like to thank Ben Austen again for taking the time to read my blog and contribute to it as an editor for this post. When my mother and stepfather Bill moved to Chicago they loved to recount Bill’s tennis experiences and talk about his various students. One of Bill’s hitting partners was a man they called Ben. My mom would tell me that Ben reminded her of me, citing his tall figure and modesty. When I began the blog I thought of Ben, as I would often read his pieces in the New York Times and Harper’s Magazine, and I very much admired him as a writer.[1] My mom suggested that Ben edit a piece for the blog. I thought this to be a great idea and immediately e-mailed him. Even amidst his hectic schedule, he responded without delay, stating that he would be happy to edit a post. Although unfortunate circumstances led to my current condition, luck brought Ben to me. Well, luck and Bill’s tennis prowess. In any case, I feel very grateful and honored to have his involvement and support.

Blame part 2 of 2 (as edited by NY Times contributor Ben Austen)

—- One in a Million ——

During one of my visits to Chicago, Bill had a tennis lesson, at which time I met the Chinese mother of a child he was coaching. Even though the courts were located close to my parents’ residence, the walk seemed particularly long on that morning. Maybe it was because it was so chilly or because it was so early. The mother of Bill’s student noticed my awkward gait and slow speech in our conversation and asked my mother in Mandarin what had happened to me. My mom’s answer was very concise yet powerful.[1] “He was unlucky and had a brain tumor.” This brought me back to the topic of blame. Until then I had coughed up my condition to bad luck. But I found myself wondering, “Is there someone to blame?”

Coincidentally, this conversation occurred at the time I was reading the ‘Blame’ section in the “Art of Happiness.” It made me reflect on how I had been searching for someone to blame for my condition: At first I blamed myself for ignoring subtle clues of a possible medical issue. Before the discovery of the tumor I would often go for jogs around the block. I began to notice during these runs that my right leg was not as easy to lift as my left. I blamed my prior back problems and continued to be in denial of my symptoms. Similarly, I rarely ever had headaches, but during medical school after staying up all night, I experienced a shooting pain from behind my right ear to my temple. Unfortunately, I began suffering the same headaches during residency. They happened to coincide in time with when we installed a new air-conditioning unit, prompting me to have my blood checked for carbon monoxide poisoning. Again, I was trying to assign blame for my headaches, but was simultaneously searching for a reason to continue to be in denial about my condition. It turns out the installation of the air-conditioner was a red herring. It does not take 4 years of medical school to realize that my symptoms might have portended a more ominous condition.

I I also blamed an MRI technician who told me that I could not have an MRI performed due to my vertigo that was brought on by lying flat. I was 18 at the time and sitting on the MRI table. Due to my vertigo (the reason I was having the study) I was told I could not have it done. Since I was so young I was not well read on the various presentations of vertigo or Benign Paroxysmal Vertigo(BPV). I did know, however, that it was usually a self-limiting disease[2]that sometimes followed a viral illness, and that the Epley Maneuver[3] was successful at resolving the symptoms about 75-80% of the time. During that period, its effect on my life was limited: with my tennis, I could not look up quickly for my serve or overheads, thus I had to make sure my service toss was neither too jerky, or behind my head; hitting an overhead was not an issue as long as I had time to look at the ball.[4] It also dictated the way I slept—I could not sleep while lying flat and had to sleep with at least two pillows under my head. At the urging of my mom, I saw an ENT specialist, who told me it was probably a condition called ‘Benign Paroxysmal Vertigo’ but wanted an MRI to be sure. Both the neurosurgeon and neurologist later told me that the vertigo symptoms I experienced were likely due to the tumor.  Thinking back, I probably would have handled the situation just as my ENT had. Many people are claustrophobic and cannot undergo an MRI without pharmacologic aids; typically we know this prior to ordering the study and can prescribe some proper medications before the MRI. There are some instances where this is either not mentioned or overlooked. Typically in such instances, the patient arrives for the MRI, attempts to complete it and cannot, and tells the technician that he/she cannot complete the study due to their symptoms. After the patient makes a big enough deal of it, the physician is called, and the proper medications are ordered. I made no such stink, leaving immediately after being told that I could not complete the MRI if I could not lie flat. My brother in-law often says, “The squeaky wheel gets the grease!” He says this when a patient who complains gets their way. In this case I suppose I wasn’t ‘squeaky’ enough. The clinicians who saw me later all questioned my diagnosis, as BPV typically resolves in three months. I remember a world renowned ophthalmologist saying openly to me “You know, Benign Paroxysmal Vertigo shouldn’t last this long.” I ignored everyone who told me that this might be something more serious, and I justified my denial by focusing on the fact that the vertigo was not getting worse.

MRI machine
MRI machine

I even blamed my neurosurgeon, thinking that a sub-total resection (a less aggressive surgery where part of the tumor is purposely left in) could have averted all these after-effects.[5] The thought here is that with a sub-total resection there would be less manipulation of the area and vital structures such as the cerebellum and its surrounding nerves would be unaffected.

I then realized that I was falling into the trap of the blame game. My condition is NO ONE’S fault. I just happened to win the lottery for getting a congenital brain mass—because the mass and its location are so rare, I have had difficulty coming up with studies or articles that cite the chance of having this type of mass (with the ensuing symptoms), but according to my calculations, less than one in a million people will have this mass in their posterior fossa with subsequent Posterior Fossa Syndrome. I can either search for someone or something to blame this on, or just cough it up to luck (good or bad). After much thought, I’ve realized it really doesn’t matter whose fault it is. After a tragedy, our thoughts should not be, “Who’s to blame?” It ought to be, “How can this be prevented in the future? How can others avoid the same mishap?” Instead of looking for someone or something to blame, would it not be more productive to find the source of the problem? I admit to the same human tendencies, as my first reaction to the tumor was to find out whom or what was responsible; however, this experience and introspection has motivated me to resist this urge and instead to ponder more productive thoughts. As Cutler and the Dalai Lama point out, “We tend to look for one single cause, and then try to exonerate ourselves from responsibility.”[6] I now refuse to look backwards in an attempt to place blame on someone. This type of practice is a fruitless endeavor. I invite you to join me in this way of thinking.

[1] She answered in English. I am able to understand some Mandarin and speak even less.

[2] Meaning it usually resolves on its own, without intervention

[3] This is a technique where the patient’s head is manipulated to fix the problem.

[4] If for some reason my opponent hit a quick lob, surprising me, I’d have to it go over my head.

[5] When I met with Dr. Janet Osuch her first question to me was, “Did the surgeon warn you that this might happen with your recovery?” He did warn me of all the typical surgical risks: infection, excessive blood loss, death, etc, and some complications more specific to my surgery such as cerebellar mutism (many times, 10% of patients who have a surgery in a similar location to mine, patients will emerge from the surgery with the inability to speak—cerebellar mutism), and he even warned me of the possibility of the presence of an intracranial shunt (essentially a tube from your brain that serves to release any excess pressure buildup in the head). Luckily neither occurred. But the answer to her question was “no” he did not mention the possibility of developing these specific symptoms.

[6] i.d p158

Special Thank You to Ben Austen

Ben Austen
Ben Austen

I would like to thank Ben Austen for taking the time to read my blog and contribute to it as an editor for this post. When my mother and stepfather Bill moved to Chicago they loved to recount Bill’s tennis experiences and talk about his various students. One of Bill’s hitting partners was a man they called Ben. My mom would tell me that Ben reminded her of me, citing his tall figure and modesty. When I began the blog I thought of Ben, as I would often read his pieces in the New York Times and Harper’s Magazine, and I very much admired him as a writer.[1] My mom suggested that Ben edit a piece for the blog. I thought this to be a great idea and immediately e-mailed him. Even amidst his hectic schedule, he responded without delay, stating that he would be happy to edit a post. Although unfortunate circumstances led to my current condition, luck brought Ben to me. Well, luck and Bill’s tennis prowess. In any case, I feel very grateful and honored to have his involvement and support.

Blame part 1 of 2 (as edited by NY Times contributor Ben Austen)

——Whose Fault is it? ——

image

I am in the midst of reading the book “The Art of Happiness” written by Howard Cutler, detailing his conversations with the Dalai Lama. In it, Cutler ponders many different questions about life that he asks the Dalai Lama to give his thoughts on—these topics range from dealing with faith to his thoughts on virtues such as compassion. Cutler uses his many patient interactions in the questions he poses. For example, he cites his interaction with a severely depressed patient and uses this experience as a springboard to question the Dalai Lama on his thoughts on the value of empathy. While the book highlights the Dalai Lama’s social intelligence, this was brought to the forefront by Cutler’s thought provoking and intelligent questions. While the Dalai Lama is clearly almost all-knowing, in my opinion there is no book without Cutler. For me, the most salient and relevant of the ideas posed in this book is the human inclination to find blame: “Often our normal tendency is to try and blame our problems on others, on external factors… It seems that whenever there are intense emotions involved, there tends to be a disparity between how things appear and how they really are.”[1] Reading this struck a chord with me. I found myself thinking about the role of blame in my ordeal. I agreed with him—if a horrible act is committed, like a rape or murder, our first thoughts are who did it, and did they catch him/her? My son has a classmate in school whose parents are divorced—the first question that sprung to my head was “Why? They are both so nice, was one of them adulterous?” My parents are both fanatics of the stock market, having the television tuned to CNBC for what seems like 24 hours a day. I’ve noticed that when the DOW or NASDAQ falls, CNBC’s anchors look for someone or something to pin this decline on: economic indices were down or the market was reacting to a policy enacted by politicians. No matter what the stated cause is, the underlying principle is the same: blame. We, as a society, often look to blame something or someone instead of trying to be more constructive. For example, the disaster that hurricane Katrina left in New Orleans was blamed on the shortcomings of FEMA and President Bush, and the universal healthcare website issues were decried as problems with the Obama Administration itself. As a physician, I have to admit that assigning blame or finding the cause is a theme across many medical school courses. We live in such a litigious society and physicians are often caught in the middle. This has forced many physicians to practice ‘defensive medicine’. This is when a test or procedure is performed in solely for the purpose of protecting the physician’s behind.[2] The U.S. is often criticized for its low ranking in healthcare (in part due to high medical care costs)—I am by no way saying the fix for our health care system is less defensive medicine but it would definitely help. Perhaps  my interest in this topic was piqued because it was hammered into my head throughout my life in medicine.

 

[1] The Art of Happiness, Riverhead Books, New York, 2009 p158

[2] For example, maybe a CAT Scan is ordered when the suspicion for something to be found on this scan is low.

Hi all!

So my next post is a complicated one with a special guest editor. Because I want to make it a good read I am rewriting it and it is not ready yet for release. I hope to release it on Monday and Friday of next week.

Hope

What is hope? Merriam’s definition is to want something to happen or be true or think that it could happen or be true.[1]  I think there’s one key aspect of that definition that needs to be included: the desire needs to be realistic or possible. I could want to have no residual effects of this brain surgery, but that wouldn’t be realistic. I could want pigs to fly but it just won’t happen. This is not hope, it’s a delusion. I mentioned in one of previous posts that I have taken up reading since my surgery. The first book I read was a gift from Megha called The Anatomy of Hope by Jerome Groopman. In it he masterfully deconstructs hope and its role in his experience in medicine. In a chapter titled “False Hope, True Hope” he describes encounters with a cancer patient he took care of as a medical student until he was an attending physician. He tells poignantly of a patient named Frances Walker, who had been diagnosed with cancer of the colon. He and his partner indicate to her that chemotherapy can induce remission in her case. While he acknowledges that this is technically true, he later calls it a “sin of omission.”[2] He states that “the evasions, the elliptical answers, the parsed phrases were all supposed to be in the service of sustaining hope. But that was hollow. It was false, a seductive yet only temporarily satisfying illusion.”[3] The truth is that there is not set definition of hope in this situation. I like to define it as a desire or wish of an outcome that is obtainable. In each of the guest posts hope shined through. I realize that it might be unrealistic (thus not a hope) to envision a day for myself where none of the effects of this ordeal could be detected and life returns to the way it was before the surgery; even the scars on my head will forever serve as reminders. But my hope has evolved. In the hospital after the surgery I had clinicians constantly telling me that they expected a full recovery, bolstering my expectations; my younger sister was trying to schedule a trip to Lansing over Memorial Day Weekend of 2013; I was still confined to my hospital bed then, but remember saying to her, “I’ll be fine then Al[4]. You don’t need to visit.” I had envisioned myself playing the same Memorial Day tennis tournament. Now, over a year and a half later, I know that playing competitive tennis is out of the question; but when I think back to where I started this journey, confined to an ICU bed with my only capable movement being slight shifts in the hospital bed, I realize that I am incredibly fortunate to be where I am today. When a stranger sees me hobbling to the grocery store, they think what an unfortunate, handicapped man. If I could only show them how much hard work, how many hours at the gym, how many speech exercises it took to get me there, then they’d understand. If they knew where I was a year and a half ago, heck, a few months ago, then they’d be impressed with my progress. This is why I still have hope for my continued recovery. I still believe that more progress lies in the horizon, and that this is not an unrealistic desire.

trim.690C337E-15BD-4913-B857-072FB4982F12

 

 

[1] http://www.merriam-webster.com/dictionary/hopehouse, New York, 2004, p 53

[2] The Anatomy of Hope, Jerome Groopman, Random

image

[3] i.d p 53, Groopman also authored another book titled “How Doctors Think”. For a great interview with Katie Couric check out https://www.youtube.com/watch?v=j3XxS-p31qY

[4] Ever since childhood I’ve called her ‘Al’. A mutual friend later told me that she does not let anyone else call her that.