Long Beach Island part 2…

———— Contact ————
During the third day of our seven day stay I received word from another resident that one of my patients had delivered her first baby. According to this resident both the mother and the baby were doing well. During our residency we follow at least ten pregnant patients, from their first OB visit to the delivery of their baby. This could prove tough, as mothers-to-be can deliver anywhere from 37 – 41 weeks gestation; this is a 4 week window for which we’re to keep our pagers on and ready in the event the patient goes in to labor.[1] For example I’ve been called on Tuesday morning at 3am because my patient was in labor. This can prove difficult on someone’s lifestyle and it is for this reason that one of the first questions of a new Family Physician is whether or not they practice OB. Typically, the answer is no. We call these pregnant patients ‘continuity OBs’. I hate to use the cliché, ‘going through the motions’ but there are just some patients with whom this is the mindset. To us, these patients represent a number out of ten that bring us closer to our requirement. Like I said, however, this is only with a select few of the patients. For most of them, I feel honored to be a part of their journey that ultimately results in new life. This particular patient, I’ll call her Debra (in order to protect her identity), I had felt a strong connection with. I saw her for one of her first OB visits and I remember walking into the room and thinking, she’s really scared. She was only 18 and this was to be her first. When I was put out of commission by this mass I thought of her and hoped to be able to recover in time for her delivery (my time line for my recovery was and has always been overly optimistic). My speech was still significantly affected but I still had to call her to congratulate her and to see how she was doing. This was significant for me in that this was my first contact with a patient since the surgery. Because I was on electronic medical record (EMR) I looked up the progress of her stay.[2] It read (among other things),”mother and baby doing well.” I was relieved as childbirth can sometimes (luckily rarely) have bad outcomes. I found her number on the EMR (it was a cell phone number as I had called her before for another pregnancy related issue), took a deep breath, and dialed. I had to dial ‘*67’ before dialing so that the call would reveal an ‘unknown’ number on her phone, a habit I have picked up in all my contact with patients(my wife once mistakenly did not do this and unknowingly gave her cell phone number to a patient. The patient unfortunately had extreme anxiety and called her every few hours, including late at night. She eventually had to change her number. I realize that giving out your number does not necessarily have to end with a change in telephone numbers, but all it takes is one person for this to occur. It is for this reason that I have made it a habit not to give out my number).

Epic- our new EMR
Epic- our new EMR

“Hello? Who is this?” a male voice answered.

“Hi, is Debra there?”

“Who is this?” the voice again asked.

I had gathered from the defensive voice that this was probably her overprotective boyfriend. I had met him once in the clinic (he didn’t come across this way at all during the visit) and his voice was distinct. But for a first time father who was receiving a call from an unknown number this was understandable. “You can tell her this is her doctor, Dr. Chiou.”

“Oh, okay. Hold on, one second.”

I could hear in the background, “Debra? He says he’s your doctor?”

I could hear the phone being handed over, “hello?” she answered. From my visits with her in the clinic and my other encounters with her on the telephone, I knew it was her.

“Hey Debra, it’s Chris.”(I always introduce myself as ‘Chris’ to my patients to the chagrin of many of my superiors. The counter-argument against using first names is that it may lead to a crossing of some imaginary boundary, making the relationship less professional. This argument may be right, but I have always been uncomfortable with someone addressing me as either Mr. or Dr. Chiou).

“Hey Chris! I heard the news. How are you doing?” By then word has spread to my patients that my hiatus was health-related. I found this response interesting, as I had called her to inquire how she was doing, yet she was the one asking me how I was.

“I’m doing okay. “ I then quickly attempt to divert the attention back to her as I hate having any attention on me. “Listen, I’m sorry I wasn’t able to be there for your delivery. I have had some health issues. But luckily it sounds like everything went smoothly. How’re you and baby doing?”

“I’m doing well, baby’s also doing well. Her name is Athena, after the Greek Goddess.”

“Okay Debra, I just wanted to check in. I’ll be keeping tabs of you from my computer here and through the other residents. Good to hear from you. Talk to you soon. Bye.”

One of my biggest obstacles
One of my biggest obstacles

My initial reaction after that encounter was one of puzzlement. I didn’t know Debra had such a contentious boyfriend, were my first thoughts. My next thoughts had more to do with the reaction of both Debra and the initial responder to my call, more specifically my voice. I have always been a very self-conscious person, it is for this reason that I do not like to eat in front of people and the reason why I don’t haven’t had much contact with my patients. Both my sister and her husband were in the room and heard the call. “Wow Chris. I don’t think she could tell,” my sister said to me. Even though I figured that most or all of my patients had heard about my surgery I still had hoped that eventually one day I could speak without a trace of the speech delay and that my patients wouldn’t know. I was worried that my speech impediment might hamper my ability to get through to my patients. I saw it as akin to an overweight and out of shape fitness instructor. But according to both my sister and brother in law the speech difficulties were not evident in this phone call. Furthermore, the reaction to my call seemed to indicate that Debra could not tell. Maybe she could tell, I have not talked to her since that call.

————– Death —————-

The last day of my stay there involved a bottle of red wine and a conversation with both my sister and brother in law. At one point during the conversation the surgery was brought up. I told my brother in-law that one of my biggest fears during this ordeal was not recovering. “Wait a minute, wasn’t dying during the surgery your biggest fear?” he asked.

My sister and her family in LBI
My sister and her family in LBI

I had to think about this, he was an Emergency Room physician, someone who dealt with death every shift, asking me this. “No, I guess not,” I finally said, “even though I knew death was a possibility it is not what scared me most when I underwent surgery.” This was true I knew that there was a chance of death, but to me this would have been the easy way out. In fact, when I first experienced the double vision, I was convinced that it was a manifestation of a disease called Multiple Sclerosis. This a condition that can be very debilitating. It is a diagnosis that immediately arises to a clinician’s head once there are unexplained neurological symptoms. This is a disease without a cure, there is no surgery can make this ‘go away’, and medication only slows the disease process. I would have taken death over this diagnosis.

http://www.nationalmssociety.org/

A link to the National Multiple Sclerosis Society webpage.

“I was worried about him dying,” my sister chimed in, “especially when it was past midnight and the surgery was not finished yet.”

To me death from this was not my fear, the protagonist often dies in movies, however it is rarer to see the hero’s life permanently change for the worse once a movie is through and the credits roll. Don’t get me wrong, dying and the death process is something that upsets me, especially when I think about it. But it is the thought of the aftermath (my family, the funeral, financial difficulties) that upsets me, not the actual process (unless I am to die a slow and painful death). The next question naturally is,”why didn’t this ‘aftermath’ scare you then?” I have no good response to this; perhaps my lack of fear of death was an act of selfishness or complete ignorance.

 

 

 

 
[1] Pregnant patients who go in to labor before 37 weeks gestation are considered higher risk and are deferred to our OB colleagues.

[2] In December of 2012 Sparrow went from all written records to all electronic. This was a daunting undertaking for the hospital, but I feel a necessary one. Due to the change, long gone are the days of illegible consultations and missing notes. Now accessing someone’s medical record is easier.

Long Beach Island…part 1

———————-Discharge ———————–

My discharge from Sparrow was based on the condition that I was with my mother for at least a week. The caregivers at the hospital had seen my mother care for me, and feared the worst (a fall) if I was discharged without her looking after me. They thought that my wife would be too distracted by and have her hands full with our newborn son to be able to take care of me. The only problem with their discharge plan was that my mother was supposed to be helping my older sister and her husband care for their two little children while they worked in their shifts at the Emergency Department. My sister had just lost their second nanny, and did not trust anyone but family to care for her one and two and half year-old daughters. My mother had been helping them out about every other month (my brother-in-law’s parents take over the reins of childcare during the other months, but were out of the country during this month). I desperately wanted to leave the hospital. We pleaded with the discharge physician to let me go home with my wife, but he was steadfast in his stance, “ No way,” he responded, “Either Chris goes home with his mom, or else he has to stay here.” We did not know what to do. On the one hand I definitely did not want to be in the hospital, yet I could only be discharged under the care of my mother, who was set to leave for a trip to the east coast to help my sister. We came up with a variety of solutions to this: one being for me to stay in the hospital, another for my mother to take a flight (she normally drove there) to Long Beach Island (LBI) which would make her departure later and her return sooner. None of these solutions seemed right, however. It was then that my mother came up with the idea to bring me to LBI. This satisfied my need to leave the hospital while allowing my mother to take care of her grandchildren in LBI. The only downside to this idea was that it would take me from my wife and children for the week. The discharging physician thought that this was a brilliant idea, “I think [Chris] needs a break from Lansing, a trip would be good for him.” Thus I was discharged from Sparrow on Friday and we left for LBI on Monday.

http://www.longbeachtownship.com/

I mentioned earlier that my parents are divorced. My father has since remarried and has children, while my mother is living in South Chicago in Hyde Park with her new husband. He, Bill Nichols, has been my stepfather since he moved into our home in 2000. During my hospitalization Bill was great, not only helping my wife and children at home, but helping me with my rehabilitation in the hospital as well. Bill’s role and dynamic in the family is an interesting one: his main focus is the happiness of my mother. Fortunately for me, my mother’s happiness is tied to mine, thus, his pursuit to make her happy has helped me. He is extremely opinionated but has tried to stay out of any of our discussions regarding my health during this ordeal. This was no different as he did not chime in, and I’m sure he was itching to do so, during my discharge situation. When I did ask for his opinion, his only response was, “just do whatever makes your mom happy.” His looking after my mother’s happiness occasionally creates friction between himself and the Chiou children. An example of this came during their recent move to Chicago. Amy and her husband were pleading with my mother to move to Philadelphia (a town only a 45 minute drive from their home in LBI) where she could spend more time with them, and also help with childcare. Amy has always tried to move us all close to each other, to no avail. (It doesn’t help that she is always moving herself, but the sentiment is there nonetheless). Bill, sensing my mother’s desire not to spend her retirement solely caring for her grandchildren, decided not to move to Philadelphia but to Chicago instead. This was extremely disappointing to Amy and her husband, with the blame falling on Bill’s shoulders.

Bill and my mom
Bill and my mom

———— Home —————-

I distinctly remember the feeling of leaving the hospital. It was a Friday. I remember that it was a sunny spring day. Pulling up to the driveway and seeing my wife with our newborn son in her hands is an image I will never forget. I was able to spend the weekend with my family. What a glorious weekend; a weekend without any activities (to my wife’s dismay), just me with my family. Those are my favorite types of weekends. Unfortunately, the weekend came to an end as we left for LBI on Monday morning at 6 am.

Christian, Cormac, and Fleur
Christian, Cormac, and Fleur

————- Car Ride ————-

At the hospital I was accustomed to awaking at 7am in preparation for my breakfast and occupational therapy, so waking up at 530am was very tough for me. It was for this reason the first hour of the 12-hour drive I was in the backseat sleeping. I remember waking up, looking out the window and seeing countryside. I was used to this growing up in Nebraska, but this seemed different. Maybe being in the hospital for 4 weeks made me appreciate the view differently but to me everything seemed in place: the cows, grass, clouds, hills, they were all where they were supposed to be. I had spent over a month confined to a hospital bed, appreciating cows and grass was a result of this stay. My parents were committed to giving me their own therapy sessions throughout the trip. My mother’s Emergency Medicine background has made her efficient and quick at all tasks she performs, and these sessions were no different. Thus all breaks (bathroom, food, gas, etc.) had to be combined with therapy sessions. Our first break was a combined bathroom/breakfast/therapy break. We took a total of three breaks on the way there. When we finally arrived it was about 8pm, I was exhausted, more than I would normally be for a long car trip. When we told the PM and R physician about the upcoming trip, he warned that riding in the car itself was a workout. According to him, being a passenger in a car ride is filled with micro-adjustments made mostly with our abdominal muscles and the part of our nervous system that tells us where we are in space. Then again, most of my long car rides aren’t broken up by physical therapy sessions.

It was such a relief to see my sister, her husband, and two children. They live in a place called Long Beach Island, a town in the eastern part of the New Jersey Shore, a place that becomes less populated in the winter and comes alive in the summer months. It is a quiet beach town that I always enjoyed visiting, but Amy and her husband, Amir, weren’t enjoying their time there and were constantly talking about relocating. They both suffer from an affliction my father in law has coined “chronic dissatisfaction” with their current locale. I haven’t figured out if this is because they both work in the Emergency Department[1] and their dislike of the city or town they’re in is a result of the patients they see, or if their personalities simply made them unhappy with wherever they live. They are both in constant motion, always looking for the ‘better’ deal. Like with most things in life, the answer was probably a combination of the two, rather than exclusively answered by one explanation. My wife and I have the opposite problem, we generally like where we are even when everyone around us seem dissatisfied.

Amir and Amy
Amir and Amy

Being out of the hospital and with my family, even though physically taxing, was different from being with them while confined to a bed with occasional nurse checks. Emotionally not being with my wife and sons was rough on me, but being able to be with others that I loved brought me much joy. It is tough to pinpoint an exact tangible difference, but in the hospital every visitor I had, family or not, was there to see me, while here I was there to see them. Perhaps this little change was all that was needed to make such a big difference. Being away from my wife and sons was tough, to say the least, so I made sure to either phone them or Skype them often; I had some episodes of frustration, that manifested itself on to my parents. These episodes stemmed from my inability to be with my wife and sons that unfortunately were felt by my parents. They are human and were growing frustrated with my shows of unhappiness there. I often wonder if they realize the root of my frustration there- I do not talk about that trip with them anymore, not because of some unwritten underlying disease with the topic, but more so because we feel there are better things to discuss. I made it clear to them and anyone that would listen that I missed my family. At that time, I had two things on my mind: 1. My wife and sons, and 2. A pregnant patient who had just delivered her first child.[2] I decided to call her to see how she and her newborn were doing.
[1] A place not known for attracting the all-stars of the community.

[2] I will discuss this in my next post, but as a physician you often worry about your patients. When my last patient is seen for the day, my mind cannot turn off and stop thinking of patients. In this particular case, I had the privilege of seeing this patient for her regularly scheduled OB pregnancy visits, and had heard word that she had delivered while I was in LBI.

April 19th

April 19, 2013

———— It Begins —————-

On a Thursday afternoon my 38 week pregnant wife told me that she’d be spending the night in the hospital with me. My mother reluctantly agreed to leave the hospital for the night so I could spend time with my wife.[1] After walking into the room and eating yet another Sparrow provided meal, she turned to me and said, “Babe, I think I’m starting to have contractions.” She began to time them- 8 minutes apart. With us both working quite a bit in Obstetrics, we knew we had time. The advice I typically give to patients is to wait until the contractions are somewhere between 3-5 minutes apart and regular. She called her Obstetrician though to warn him of her impending delivery. She then turned to me, “Should I call your mom yet?” She knew once she called my mother she would leave immediately and come to the hospital. She was right. When we told my mother of Fleur’s contractions, despite their being so far apart, and despite my mother’s experience as a past Ob-Gyn physician, her first response was, “I’ll be right there!” From our house on a good day (no traffic, all green lights) it takes somewhere between 15-20 minutes to get to the hospital. After getting off the phone with Fleur, my mother somehow got to the hospital and into the room in 10 minutes. To this day I don’t know how she did it. I’m still waiting for a police officer to show up at my door with a speeding ticket in hand for travelling at 300 miles per hour. The first words out of her mouth as she burst in to the room was, “You should go to the Labor and Delivery Unit.”

Thinking of my mom's drive to the hospital makes me think of this.
Thinking of my mom’s drive to the hospital makes me think of this.

“The contractions are still too far apart, I’ll go in a couple of hours.”(It was about 8pm then) my wife replied.

Even though my mother is strong willed and opinionated, when it came to my wife she’d often bite her tongue. I think she knows it upsets me if they argue. I knew that this was one of those times that she had to hold back. I could see it in her face, she was thinking “No! You should go now!” Instead what came out was, “Okay, sounds good.”

————- We Go ————

Finally at around 930pm the contractions were close enough to warrant a trip to the Labor and Delivery Unit (L and D)[2]. I’m not sure what it is about that unit but once she was roomed, her contractions suddenly increased in intensity. This was to be our second child. Our first one, now 7, was born in Omaha, Nebraska naturally. She was able to give birth without the aid of pain or labor augmenting medication. That was the plan for this one, but as I had learned, plans change. The pain was too great and her cervix was not progressing so she decided to receive epidural analgesia.[3]

At that point in my hospitalization I was still dependent on a wheelchair for my mobility. When Fleur first went to L and D, my mother accompanied her there, leaving me in the bed. “I’m going with her,” she told our nurse, “please watch him until I get back.” When the nurse came into the room to check my vital signs, she found me sitting up in bed looking as if I was getting ready to leave. “Chris, where do you think you’re going?” She asked me. She was right, I wanted to regain the ability to walk so I could go to see how my wife was doing. I knew, however, that a fall could set back my recovery for months, or even kill me. The nurse checked my vital signs, and it was not a surprise: my heart rate and blood pressure were high.[4] Finally my mother walked in. “She’s doing okay. Have they given you your therapy schedule for tomorrow? They put her into room 5.” We then went down to see her.

When I wheeled into the room, Fleur was in the middle of a strong contraction. When a patient calls me to tell me they’re in labor, I always ask the same questions as the ultimate decision point for me is whether or not she should come to the hospital yet. “Have you lost any fluid? (a ‘yes‘ warrants an automatic trip to L and D) Is baby still moving okay? (a ‘no’ response means they should be immediately evaluated in L and D). How far apart are the contractions?” Finally if the patient answers all those questions with a non-alarming response and if she tells me that she is experiencing a contraction as we speak, I know we have time. Labor can be a multi-day event, and being able to speak during a contraction is a tell-tale sign that the patient is in early labor. When I entered my wife’s room in the middle of a contraction she could not speak. In fact, she couldn’t even acknowledge that I was in the room.

When she finally saw me she managed a forced smile, said hello, then said, “They’re too strong. I think I need an epidural.” I could see the pain permeating her whole body. Some people equate child birth to passing a kidney stone for a male. I’ve never suffered from a kidney stone but I bet it pales in comparison to childbirth. I’m guessing there’s no male equivalent to the birth of a child (sorry to anyone who’s had to pass a stone). The kidney stone analogy was probably thought up by a male who got tired of being told how painful child birth can be. Anyhow, I immediately said, “Sure thing, you do whatever you want hon.” I was still in disbelief that she didn’t have any medication with our first. I didn’t care about having a natural delivery. I just wanted my wife to be as pain-free as possible, and our child safe. Since her labor was not progressing and the pain was unbearable, she finally decided to get the epidural, which was placed with little difficulty. “Ok, we should go rest,” my mother chimed in, “it’s 1230. You need to be rested for your therapy tomorrow.” Leave it to my mother to always think of me, no matter what the situation. I resisted and she persisted. My resistance only bought me 30 minutes of time with my laboring wife. At that time my wife turned to me and said, “Chris, this medication’s kicking in, I’m going to fall asleep. You should go to your room with your mom so you can rest.” I reluctantly agreed. By the time I was laying down in the bed it was probably 130. The next thing I remember was being awoken at 3 by my mother “She’s ready to push. Let’s go!” I had never gotten up from my bed so quickly. When I arrived in her room, she was indeed pushing.[5] Her OB was in the room, along with the nurse yelling words of encouragement, “You’re doing great! Just like that! You’re almost there!” I had met our OB through my work in the hospital and loved the way he thought of and dealt with patients (it’s for this reason that we decided to go with him). When he saw my condition in his clinic he told us of his son: sadly at age 30 his son was at work when he suffered a seizure. It was discovered that a brain tumor was the cause of his seizure. He was not as fortunate as I in that the tumor was malignant and even though he underwent surgery to remove it, he passed away 1 month later. This saddened me, just hearing this story and the hardship this man endured made me think of how it would have affected me as a father. I then thought of the similarity of his son’s situation to mine, with us being the same age and both diagnosed with brain masses. Luckily for me the tumor was found to be benign, and my life span was not shortened. I was also fortunate in that I did not suffer seizures prior to or after the surgery. Regardless, hearing the story of his son brought me through a wide range of emotions.

————— Birth and After —————

Finally at 349 AM on April 19 2013 my second son was born at a whopping 9lb 2.6 oz. Unfortunately because of my double vision and stiff neck I was unable to witness the miracle. My head had to stay locked on the floor, as this was the position of least discomfort for me. I could occasionally try to lift either my head or my eyes but this caused me too much pain, and also seemed to make my double vision worse, which in turn made me nauseous. Thus, my mother who was also present for the birth, was able to witness the delivery and also cut the umbilical cord. My wife was understandably exhausted and our newborn son was crying which, at the time, was music to my ears. My wife suffered from a vaginal tear (not too uncommon during child-birth) which required suture repair; she seemed to not even notice the physician at work after they put our son in her arms.

Cormac Robert Chiou
Cormac Robert Chiou

I was wheeled back to my room after the birth, separate from my wife and newborn son. My daily routine went from awaken -> breakfast -> therapy ->nurse and/or doctor -> nap -> lunch -> therapy ->smoothie -> therapy with my mother ->sleep, to now awaken -> breakfast -> therapy ->nurse and/or doctor -> see my wife and son -> lunch -> therapy ->see my wife and son -> smoothie -> therapy with my mother ->see my wife and son -> sleep. I normally give 100% effort to my therapy. Giving 100% also requires 100% attention. In the days following my son’s birth I know that I was unable to give my full attention to my therapy. I often wonder if the therapists noticed a change in my performance.

Our family
Our family

The topic of a name had come up but was not discussed at length between us. Unlike for our first, for whom we didn’t find out the sex until birth, we figured knowing the sex of the baby beforehand would aid us in our preparation. Thus we knew we were having a boy but had not thought of a name. My wife, who had been transferred to the Mother-Baby Unit (a Unit designated for recovering mothers), turned to me one day and asked, “How do you like the name Cormac?” I liked it. Cormac is the name of the neurosurgeon who operated on me; I liked the sound of it: Cormac Robert Chiou.[6] As you can imagine there are not too many names that go well with ‘Chiou’.[7] Our oldest son, Christian, now had a new brother, and insisted that his first name start with a ‘c’ to be like him, thus he loved the name. When we tell people his name, we often have to explain its significance to us. It is not exactly a traditional Taiwanese name, in fact it is a traditional Irish name meaning ‘charioteer’.[8] I often tell people that the name is subject to change depending on how my recovery goes. His name remains Cormac today.

 
[1] My wife was there much of the time for my therapy, however my room was not big enough to room me and two other people for the night.
[2] For Labor and Delivery.
[3] This is a form of delivery of pain medication during labor. A catheter is placed in the spinal canal (via a needle) which delivers strong pain killing medication, typically something like Fentanyl.
[4] Stress and anxiety can elevate your heart rate and blood pressure. In fact, I was taught in medical school that a way to determine if someone was ‘faking’ pain was to look at their heart rate. A normal heart rate in someone complaining of excruciating pain should raise eye brows.
[5] Labor is classically divided in to stages: 1. Dilation -> 2. fetal expulsion -> 3. Delivery of the placenta
[6] We had already come up with a middle name, after her father Robert Broughton.
[7] Pronounced like ‘Chew’ it was suggested to us (obviously by someone who had not thought it through) that we name our first-born Hugh, making him Hugh Chiou.
[8] It also means ‘son of defilement’ apparently, but I’ll stick with ‘charioteer’.

The Surgery and Hospital Recovery Part 2

———————- Sparrow Hospital ——————

Sparrow Hospital
Sparrow Hospital

Sparrow Hospital sits in the heart of Lansing, the capitol city of Michigan. It is a large hospital with many different sections: a general ICU, a cardiac ICU, a neurology ICU, a neurology step- down unit, a Cardiac floor, Surgical floor, General floors, Orthopedic floor, Hematology and Oncology floor, a pediatric wing with pediatric ICU, an Obstetrics wing, and finally a Rehabilitation floor.

My transfer to Sparrow was to the Rehabilitation floor under the care of Family Medicine and the Physical Medicine and Rehabilitation teams. I arrived on April 3rd and was immediately seen by the floor technician, my nurse, the Family Medicine physician, and the PM&R resident and attending physicians. My first night there I was placed in a room with three other patients. The night was a rough one; unfortunately the other patients suffered from dementia and they spent the night moaning. I also was unable to complete my activities of daily living (or ADLs as they are referred to in the health profession) as I was unable to walk or stand. Thus besides not being able to sleep due to the constant moaning, I was also unable to urinate in a toilet. My only option was to urinate in a handheld plastic urinal container. The problem was that I lacked the strength and the coordination to do this. I had the option of calling in the technician to help me. I had to try myself though; what a mistake. My pants needed to be changed. At that point I finally pushed my ‘Call Button’ for help at which point I was given scrub bottoms by the floor technician. It was then it finally dawned on me- this was going to be a long recovery.

As at the University of Michigan days at Sparrow were also very regimented. I would wake up at 7 and have breakfast at 8. I would then be seen by an Occupational Therapist first who would help me with my ADLs(ie: brushing my teeth, shaving, and showering). I would then go to the basement of the hospital where I would complete both my physical and speech therapy. Because I was at my base hospital I would frequently have visitors. It’s interesting, I told my wife that I could categorize the visitors into two categories: 1. Those who wanted to see me because they were worried I was getting bored in the hospital and wanted to keep me company, and see if they could help in any way and 2. Those who wanted to see me as if I were an exhibit. I have myself visited friends in the hospital, and part of me wanted to visit because it made me feel better about myself. I hate to cast any aspersions on any one of my visitors but the lead-ins to these visits was always the same. I’d be taking a nap or getting ready for bed when I’d hear a knock at the door. Sometimes I’d be getting ready to eat; I did not like to eat in front of people before my surgery, now when I eat it would be akin to watching a toddler eat, with food all over their mouth, and their ‘eating space’ littered with food. I now hated to eat in front of anyone and avoided it at all costs. If this comes across at all negative towards hospital visitors I don’t mean it to. It got to the point that my wife made a sign that read, “I’m sleeping, please me rest”. Then there are those close to me that did not visit but sent me kind gifts, cards, and messages. I know that this was not a slight, but an attempt to give me some semblance of peace in the hectic hospital. Looking back, I do not know which method I preferred. This does not and should not serve as a Thank You card to everyone, you do not need to waste your time reading a blog of Thank Yous; the reason I say this is if you for some unfortunate reason have a close friend in the hospital really think about how you want this person to know that you’re thinking of them. The immediate knee jerk reaction is to rush to the hospital and find their room. For some, a face to face visit is warranted, but for others it’s not necessary. You have to realize that this visit is for them, while a ‘Thinking of You’ card might suffice, if you do this out of a desire not to go to the hospital then you risk alienating a friend in need.

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On the subject of visitors I feel as if there are a few I should mention. During the second of my four week stay in Sparrow a college roommate of mine, a very dear friend, came to visit me from New York City. His name is Jesse Oberst. Before the surgery there were two regrets that always popped in to my mind: 1. Not being able or learning to speak mandarin (I still get new patients who recently immigrated from China, whose English is deficient, who see my last name and expect me to carry on the visit in Mandarin. I can picture the disappointment in their faces when I tell them that I only speak English). And 2. Jesse’s father passed away unexpectedly 5 years ago from metastatic kidney cancer. My regret was not going to be with him. Now Jesse was coming to see me. I’ve known Jesse since our times at Harvard. I met him during one of my first nights there. Besides being extremely smart and quick witted (he’s probably one of the smartest people I know), he also has one of the biggest hearts of anyone I’ve met; which would be hard to find in his 5’9 small frame of his. I gave him the nickname ‘tweaker’ after meeting him because of his predilection to leave/flee from any and all gatherings(he hated the nickname so much that I had to stop using it). He was diagnosed with Attention Deficit Hyperactivity Disorder(ADHD) in his younger years that required medication. He proceeded to go on to coxswain the national championship boat at Harvard. He graduated with a degree in Economics and now works as a consultant to a large company in Connecticut making himself and the company large sums of money. Seeing him was a reminder of the importance of friends. During his visit we did not have long deep talks, just seeing him was enough to lift my spirits. I did tell him that I deeply regretted not having been there for him as he was for me. His big heart would not let me divert any of the attention away from my current state.

The other visitor I wanted to mention was my father Dr. Rei-Kwen Chiou. For a week during my third week in Sparrow Hospital he flew in from Oregon, where he currently practices as a urologist, to visit me. My relationship with my father was and is a strange one. When I was 12 years old my parents filed for divorce for several reasons. I was old enough at the time to make decisions, and I made up my mind that would stay loyal to my mother. The divorce was not on good terms, hence any communication with my father was looked down upon. My father is an extremely cerebral and intelligent human being, which explains his success in his profession. Seeing him in the hospital and seeing him interact with my mother is something I will never forget. I had not seen my parents together since they split up 18 years ago. Like I mentioned earlier, the divorce was contentious, so I expected sparks to fly when he visited. I think that they had both independently decided to put aside their qualms for me. He also described to me his current health issues which includes high blood pressure and arthritis. He also described a scary experience he went through: he awoke one morning with numbness in his hand. After a series of brain tests it was determined that he had suffered from something called a Transient Ischemic Attack (TIA, or ‘mini-stroke’). This again faced me with my mortality. This was my father, someone who I had always pictured as invincible; here he was in the hospital seeing his son who had just undergone brain surgery, telling him that he had had a mini-stroke. My thought, as selfish as it sounds was,” if he could have this going on, then was I next? Was this brain tumor just the tip of the iceberg?” Even though part of the visit instilled fear in me, it was just nice to see him. If Jesse made me realize the importance of friends in the hospital, my father highlighted how important it was to have family around.

Nowhere was this more apparent than my mother’s presence as a permanent fixture at my bedside. If I had to summarize my ordeal in the hospital, it would go something like this: 3/28- brain surgery at the University of Michigan followed by a two day stay in their ICU. 3/31-4/3 general medical floor at University of Michigan, ended by a transfer to the Rehabilitation floor at Sparrow Hospital. 4/3-5/3- inpatient stay on the Rehabilitation floor at Sparrow Hospital. 5/3- discharge from Sparrow Hospital. Every day and night my mother was there with me. She spent a month sleeping on a hospital pull out seat, which converted to a place for, at most, ½ a person to sleep. Their Rehabilitation Floor held 22 patients, 21 of whom relied on the nurses, technicians, and hospital transporters for tasks such as eating, toileting, bathing, and transport to various places in the hospital. My mother did all of those tasks plus monitored for any negative medical signs[1] (I did mention her medical background didn’t I?). Her presence there with me went far beyond any logistical aspects that she handled. Having her there kept me sane. Even at 30, the time I spent with my mother during my hospitalization was the most time I had spent with her. We were laughing so much together that some clinicians worried that I might have had some brain damage from the surgery.[2] I could not have made it through the stay without her. Sure there were times of frustration, when the ‘Tiger Mom’ in her would come out (I can even now picture yelling at me to, “Get up! We have to do the practice speech exercises!”), but for every frustrating moment there were countless numbers of times I was grateful that she was there. I hate to bring in a war analogy, but now I understand why veterans who served together had an unspeakable bond. My mother and I had been through this together and an unbreakable bond that was already present as mother-son was fortified.

Me and my mom at Sparrow
Me and my mom at Sparrow

Because I am on the topic of family, I would be remiss if I didn’t mention my sisters. As I alluded to earlier, my younger sister, Alice, currently living in Boston, works for a financial firm, gets most of her traits from my mother in that her personality in a nutshell would be described as ‘aggressive’. I’ve always thought that she is the type of person you’d turn to when you want something done. If you were in a bind and turned to her, “Alice, NASA is asking me to build a Space Shuttle. They said they wanted it in two days. Can you help?” Without a doubt, two days later she would tell me, “Ok Chris, the space shuttle’s in your backyard, anything else?” There are just some people that have a trait to get things done; she is one of these people. Along with this, she is also great at telling others what to do. I think like my mother, she needs at least the semblance of control. She had absolutely no problems questioning my caregivers or demanding something I may have mentioned in passing.[3] I was lucky to have her with me.

Me and my sister, Alice
Me and my sister, Alice

My older sister, Amy, is a completely different animal. If a potential criminal was being interrogated, and my sisters were in charge of the interrogation, Amy would be the ‘good cop’, somehow finding and appealing to the criminal’s soft side (Alice would be the one causing bodily harm until a confession was elicited). Besides having two children (and one on the way), Amy works as an Emergency Department physician, like my mother. She also shares my mother’s propensity to, well, mother. That’s where their similarities end.[4] I’ve never met anyone with her compassion for others. I often wish I could have one drop of her compassion so I could be a better person and physician. During my last week at Sparrow she, her husband[5], and two daughters came to visit me. She was there for my surgery and saw me immediately after, so her being able to see my progress (and tell me) helped.[6] Having her visit brightened my day and kept my spirits up. Even to this day, in the midst of her hectic schedule, I still get a daily ‘check-in’ telephone call or text.

My sisters’ presence kept my spirits high and my hopes for recovery even higher. Even though they are so markedly different, they both, in their own way, helped me through this ordeal. With my younger sister’s aggressiveness and older sister’s compassion, they shared a common denominator in my recovery: simply seeing them pushed me towards getting better, however, more importantly, it helped me rediscover my love for them.

So you may wonder, “meals, therapy, doctor’s and nurse’s encounters, and visitors. That doesn’t take up a whole day. What else did you do?” That is a very good question, with my only response being: smoothies! Every day after my therapy was complete I would ask whoever was wheeling me to go to the hospital Lobby Café so we could get smoothies. These cost around $5.00. My wife and I calculated that we probably spent around $300 on smoothies alone.[7] Charles Dudhigg writes in his book The Power of Habit that personal habits are engrained in us.[8] Thinking back, my daily smoothie ritual was my form of controlling the situation. Throughout all these recent events I had given up control. Everything from my therapy schedule to my meals[9] was laid out for me. The only control I had over my day was what flavor of smoothie I would get. I was in the hospital recently and was asked if being there caused any bad flashbacks on the contrary I asked for a smoothie. My wife had our second child in the Obstetrics unit at Sparrow. Her experience was perfectly pleasant(as pleasant child birth can be), however recently she did an overnight shift at the hospital which required her to go to the Obstetrics Unit and she told me that she had trouble even being near there due to flashbacks. For some reason unknown to me, the thought of being in that setting does not create anxiety in me. I might think it’s strange if on my first day back, I treat a 30 year old for a brain tumor but I do not anticipate any anxiousness. Was it because my outlook on my stay there was one filled with optimism and hope? Who knows maybe on my first shift back if and when I return to the Rehabilitation Floor, I’ll have a full blown panic attack and be unable to function.

Finally after a month long stay in the hospital, on Friday May 3rd I was discharged. I remember it clearly because the night before my discharge my mother wanted to celebrate my departure with lots of food. She came in to my room wielding four large bags of take-out. She had gotten both Mexican and Japanese take out. My stomach either did not agree with the combination, and I spent the entire next day vomiting into a basin. This wasn’t enough to keep me hospitalized, but what a sendoff.

[1] There was one night during my stay that I suddenly developed chills with a temperature of 100.5 degrees F. She was convinced that I had an infection stemming from one of the surgical sites on my head where a clamp was put on to keep my head in place during the surgery (we later read that approximately 60lbs of force was used). My mother then insisted that I start a once daily intramuscular antibiotic (administered through injection). I thought that this was over-kill, and that I did not have an infection. After a long argument with her, the senior resident on call, Dr. Gregory Lawson, thought that we were both wrong and opted for oral antibiotics (pills) to control the infection and cover most of the possible offending organisms. After starting the antibiotics, my fever subsided.

[2] Frontal lobe damage- an area of the brain that when damaged could lead to inappropriate laughter.

[3] For example, if I mentioned that I was a little chilly, she’d immediately push my Call Button and demand a warmed blanket.

[4] With the exception of high intelligence. But that is a trait they all share

[5] Also an Emergency Department physician

[6] I doubt Shaquille O’Neal’s mother woke up one morning and thought, “he’s really tall!” When changes happen so gradually daily monitoring can be detrimental to viewing progress.

[7] $5 per smoothie and two smoothies each day (one for me and one for the person with me) for 30 days.

[8] Dudhigg, The Power of Habit

[9] There were choices on the menu but these choices were the same every day.

The Surgery and the Hospital Recovery part 1

 

————– The Surgery —————

I arrived to the University of Michigan Pediatric Surgery Department on the morning of Thursday March 28th. My surgery was scheduled for 8am. My wife, mother, sisters, and step dad accompanied me(our son who was six at the time went to school). I was warned beforehand that the surgery could take up to 12 hours. To me the surgery was the easy part- I would not be awake during the surgery. I would awaken after the procedure finished. What boggled my mind is that a surgeon could operate for that long.

After I checked in, I was escorted to the surgical preoperative room by the surgery nurse. “Are you comfortable?” she asked. Interesting question I thought, here I was about to get my skull opened to remove a tumor in my brain, and I was being questioned about my comfort level; although I knew she had to ask me this, “yes I am. No complaints,” I replied.

Then two Nurse Anesthetists walked in. “Dr. Chiou? We’re here to start your [intravenous line]. One of us, along with the Anesthesiologist, will be there during your entire surgery. Do you have any questions?”

“Yes,” my mother chimed in, “how long after the surgery will he be extubated?”[1]

“We hope to have him extubated before he goes to the Intensive Care Unit.”

“After the surgery he is going to be placed in the Pediatric Intensive Care Unit(PICU) right? Who will manage him in the PICU? Are there Intensivists that will be in charge of his care during his stay there?” She went on.[2]

“Yes, after the surgery he will be placed in the PICU. There he will be managed by our PICU team which includes a Pediatric Intensivist.”[3]

They then proceeded to put an IV in my arm along with some medication(Versed to be exact). Because I was medicated and essentially unconscious I do not remember anything after that. The next memory I can conjure is waking up in the Surgical Recovery Unit(SRU). However according to my family, I was not in the SRU until 1 am. The surgeon said that the surgery took over 16 hours!

Apparently during the surgery my family thought that getting some food for the surgeons was a good idea. The idea of ordering some pizzas came about. I only tell you this because it gives some insight into the personality of my little sister Alice. This was her telephone conversation with the Pizzeria:

“Hello? We’d like 3 large pizzas delivered to Mott Childrens’ Hospital-a cheese, a sausage, and a pepperoni please,” my sister said.

“Ok, that’ll be $49.75”

“How long does it take you to deliver?”

“Usually between 20-30 minutes.”

“Ok, can you guarantee 20?”

“Uhm…no?”

I’ve always pictured offspring to inherit traits from their parents. People who know my family say that I’m more like my father, my little sister is more like our mother, and my older sister, Amy, is a mix of the two (my parents are divorced, with my mother retired currently living in Chicago, and my father, practicing Urology in Oregon). My mother’s genes came out during that exchange.

Page 1/2 of the operative report.
Page 1/2 of the operative report.
Page 2/2
Page 2/2

————————– PICU ————————-

My next memory is waking up in agony. Simply saying that I was in an incredible amount of pain does not do the feeling justice. I will describe it as a mixture of several sensations: extreme discomfort, enormous pain, nausea and dizziness all bundled into one. The next two days I stayed in the Pediatric Intensive Care Unit on a steady dose of IV pain killers and anti-nausea medication. I had never taken any pain medication before (with the exception of some Tylenol).

I do not remember most of my PICU stay. The only aspects of the PICU that I remember are the kind nurses(although there was one nurse that insisted that I needed to be moved constantly. I remember that with each attempt I would get so painful that I would vomit). I seemed in such discomfort to my family that the Intensivist was called for an explanation. My family never left my side. In the few moments in each day that I was able to open my eyes and be lucid I vividly remember seeing my wife, sisters, and mother. I also remember extreme discomfort with any movement due to my urinary catheter. According to my sisters I did not react to the pain-killing medication well, claiming to them that I was seeing ‘ghosts and dragons’. I do not recall any of this. I was seen frequently by Dr. Maher and his Nurse Practitioner Tara with both asking how I was doing. I slowly improved until it was deemed that I no longer needed to stay in the PICU.

This is the pathology report from my tumor.  I blacked out the names of some physicians.
This is the pathology report from my tumor. I blacked out the names of some physicians.

————————— The General Medical Floor ———————

Upon transfer to The Floor I was greeted by the floor nurse that was assigned to me. “Welcome to the floor Dr. Chiou, my name’s Laura I’ll be taking care of you until my shift ends tonight at 7. Let me have a look at your file,” she tells me as she looks at her computer (or C.O.W.S. as we call them, an acronym for computer on wheels), “it looks like here, you have IV pain medication per your request, along with some anti-nausea medication, and some anti-clot shots, twice a day. It says here that you still have an IV in place. How would you rate your pain now on a scale from 1-10?”[4]

This is a question I would be asked the most in the hospital during this whole ordeal. In medicine we are very poor at measuring pain. There is no machine, like for blood pressure, where a number appears that tells us what the level is. My answer was always, “no pain, 1.” There is one school of thought that hates the rating scale, citing that it is too subjective: one person’s perception of pain might be different from another’s. The other opinion is that because there is no way to objectively quantify pain, that the Pain Scale is the best way to accomplish this. Before this whole ordeal I found myself agreeing more with the former group, picturing what we call in medicine as ‘pain-seekers’.[5] However, now, after going through this, I find myself more in the middle; still weary of the subjectiveness of the current system, yet agreeing that there is no better way, currently, to measure pain.

My days on the floor were very regimented. The Neurosurgical team would see me in the morning, the resident or Tara, followed by Dr. Maher. I would then be seen by the day nurse assigned to me who would check my vital signs and administer medication. Hospitals, especially teaching hospitals are extremely regimented. The day typically starts very early, with the resident physician or mid-level provider(MLP)[6] seeing the patient (which includes asking how the night was, how they’re feeling, and completing an examination). The resident or MLP then writes the progress note, and waits for the attending (or supervising) physician to come. During this time typically the day nurse comes in to check the vital signs and administer any needed medications. After this, breakfast, is served. Usually as breakfast is nearly finished, the attending physician comes to the hospital and is ‘de-briefed’ on the patient by either the resident physician or mid-level provider. The attending physician then sees the patient to perform their own assessment. The rest of the day, at least for the patients, consists of lunch and dinner, and more nurse’s visits. My days in the hospital were no different, with the only break to this pattern being either being seen by a consulting physician[7] or conversations with my family.

Because of my persistent double vision and large influx of calls and texts, I decided to not look at my phone. Before the surgery I was glued to my phone, awaiting random text, calls, or emails (I have since begun to revert back to this habit). However, because my wife had a phone and everyone that knew me knew her as well, many people would try to keep tabs on me through her. One of my friends from Lansing, Kyle Snell (also a Family Medicine resident physician) came to visit me in Ann Arbor. I remember this well, mostly because a. I knew it was a long drive for him and he hated driving[8] and b. he was the first (of many) visitors. He was accompanied by his wife, Addy, a nurse on a cardiac floor. A physician and a nurse, who better suited to see me, a recovering surgical patient, I thought. But right from the start of the visit I noticed their discomfort in seeing me in my state. Their uneasiness was subtle, but I like to think that I am quite adept at reading body language and countenance. I imagined the thoughts racing through their heads: He looks terrible. Why is he speaking like that? How can anyone recover from this? These thoughts made me anxious, and this was one of my closest friends. I was set to become chief resident of the Family Medicine Department next year, which meant meeting new people all the time. I had never before felt anxious in meeting people, now apparently after my surgery talking in front of people made me very nervous. Even with these thoughts the visit was a welcome change to my monotonous day. Seeing Kyle made me realize that being closer to my family and friends was important. I then told my wife I wanted to return to my base hospital.

Addy and Kyle Snell
Addy and Kyle Snell

[1] During longer surgeries patients get put on a breathing machine to help control their airway. This involves putting a plastic tube down the patient’s throat. This process is called intubation.

[2] Because my surgery was to be completed by a pediatric surgeon, who was used to operating in a pediatric operating room, my surgery was to be completed in Mott Hospital, the University of Michigan Pediatric Hospital. I was there that I would also receive my care.

[3] There is now a branch of medicine solely devoted to care of patients in the Intensive Care setting, these physicians are called Intensivists.

[4] This way of rating pain is based on the Verbal Numerical Rating Scale (VRNS).

[5] I mentioned earlier that I trained in the Emergency Department many of the patients we saw we labeled as ‘pain-seekers’. Patients who we thought came to the Emergency Department only for pain medications.

[6] Mid-level providers are either Nurse Practitioners or Physician’s Assistants, essentially somewhere between a physician and a nurse.

[7] In my case, because of my double vision the Ophthalmologist was consulted. And due to the anticipated long recovery process, the Physical Medicine and Rehabilitation team was also consulted.

[8] He is obsessed with a phenomenon called Crossfit, a workout fad. Thus if he can bicycle somewhere, he does

What It Is

“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