Wednesday, January 28, 2009

The Most Noble Profession

Medicine, I consider, a very noble profession. At its core is the commitment to both extend and improve the lives of others. But, it is the endeavour to fill those lives with meaning that I reserve the designation of the most noble profession, to be a teacher. I have always seen myself as a teacher first. I absolutely love to teach. When I was in sixth grade I went to the third grade classes to assist with reading. I continued with 'peer' teaching through junior high and high school. At church, I began teaching the Priests at age sixteen (the age that we become Priests), and have continued as a teacher at church since that time.
I had the privilege of dedicating two years of my life teaching the Gospel of Jesus Christ in Argentina, and the lessons that I learned there still serve me today. Argentina es lo mejor lugar para ser misionero.
When I returned to college, I had a professor named Dr. Bradshaw. He taught Cellular and Developmental Biology. He had a unique style of teaching. Rather than present to us a laundry list of facts that we would regurgitate onto the test and then summarily forget, he taught us how to analyze data. The test would consist of an experiment that we had not previously seen. He had given us the tools to understand the process and would then ask, "These are the data, what do they mean?" What a concept, asking a student to think.
In his first lecture, he likened all of us to a sponge. He even had a slide showing a sponge with head, feet and arms. "All of us are students and teachers throughout our lives", he said. "As we learn we are filling the sponge, and when we teach, we are wringing it out". How that rang true. I will always be both a student and a teacher.
When it came time to choose my path in medicine, I was influenced by an observation of one my professors during my residency at UC Davis. I was a little disillusioned about academic medicine as it seemed so focused on publishing and getting grants. Dr Stone reminded me, "Kevin, academics is about teaching." I had the great privilege of being on the faculty at Yale University, School of Medicine for 11 years and had specific lectures in all four years in the medical school curriculum. The greatest 'rush' that I would get as a teacher was when, half way through a lecture, such as male infertility, the hands would start to go up and the questions would begin. Then I knew that I had made a connection and they were thinking. I can't tell you how much I miss that.
Teaching did not stop when I came to Kaiser. I still get to work with residents, and of course, I teach my patients; but that also in now temporarily gone. However, I can still teach.

Becoming a patient has taught me some truly valuable lessons. I will be able to share these experiences with others. Today, while getting my chemotherapy, I was sitting next to an elderly woman. As she heard me banter with the nurse, she commented, "How do you stay so positive?" She is fighting a tough battle with brain cancer. I asked her, "What are your goals?" She responded that she recently became a grandmother and wanted to have time with her grandchild. I reminded her that her goal can keep her focused on winning those extra days.

Friday I will meet with the Bone Marrow team at Stanford. Stem cell transplant for amyloidosis in heart transplant patients is rare. So rare that Dr Lacy at the Mayo Clinic suggested that I return there to Minnesota for the treatment. It is trickier after a heart transplant because the anti-rejection drugs can make the infection risk even higher. Stanford, however, has begun a new multidisciplinary Amylodosis treatment center and they need to build a program that will also give them the expertise to treat patients like me. I will be their first BMT after heart transplant. I figured that as they treat me I can be their teacher. They will learn from their communications with the Mayo Clinic; they will learn from my bad days, they will learn from my complications; and hopefully they will learn from my successful completion of the treatment.
And thus, I can still be a teacher.

I have been given so much in my life. I can never fully recompense, no matter how much I serve in return, but I am always happy to try.


Wednesday, January 21, 2009

Cakes - not of our choosing.

It has been a while since I last wrote. I guess that even I, the eternal optimist, can feel discouraged sometimes. It has been a difficult two weeks; for many reasons. As I mentioned, I was hoping to go back to work part time in February. Because of the impending stem-cell transplant, this probably won't happen. In fact, it might be quite a while before I get back. People have somewhat incredulously asked me, "Why are you in such a hurry to get back to the 'stress' of work". Who I am has always been defined by my responsibilities to others, my partners, my patients, my friends and my family. Part of feeling 'whole' again has it's foundation in how I might serve others. I was really looking forward to that, as it will be both emotionally and psychologically healing. Even now, when I do a little administrative work in my role as Chief of the department, I feel immensely normal. I hope for this as much as I hope to be successfully treated of my disease.

Second, I have finally admitted to myself that a stem-cell transplant will not be a 'piece of cake' unless that cake has liver pate for frosting and sardines for candles. I know this will make me sick beyond what I have previously experienced. I know I will get through it; I don't worry about it, but it will be hard.

Third is the fact that I feel weaker than I did after my heart transplant. The drugs have taken their toll, (or the amyloidosis has). I feel fatigued all of the time and fight past it to function. I am dizzy all of the time, especially when I get up from sitting for more that 15 minutes. I feel bad for Barbie, because I am not always fun to be around, even though I try as hard as I can. I remember before my Dad died of multiple myeloma, he was on the same drugs that I take and he was often 'grouchy', which annoyed us. But now I understand; it wasn't his fault.

Every patient who is chronically ill just wants to feel normal again. Often we must accept a new normal and come to terms with who we are, not who we were. Then again, I would rather feel a little bit ill half of the time than be a little bit dead all of the time. Ah yes, perspective.

How I feel does not diminish my gratitude by one iota. Nor has my hope waned. It is just that, on some days, the effort to self-motivation is the heaviest weight that I lift. I see six months from now a retrospective view that does not daily remember these difficult days, because they remain in the past. The more I can focus on others, the sooner that will come to pass. Until then, I have my fork ready to dig into liverwurst cake.


Thursday, January 8, 2009

Phase II

Recently, I finished my first course of chemotherapy with Dexamethasone (Decadron) and Velcade. Overall it went well, as I have mentioned, but as expected, 3 days of the week fatigue prevented me from accomplishing much. I kept wondering if this would need to go on in perpetuity. Should one trade occasional days of discomfort for a month of really feeling sick with the stem-cell transplant. And yet, I have always felt that the stem-cell transplant was inevitable, so why delay it. One reason for delay would be to give Velcade chance to lower my kappa light chain levels; yet none could tell me for how long I would need to be on these drugs. Forever?? Much of the treatment is not based on strong data from the literature, but rather, results based, such as is it working or how bad are the side-effects. Therefore, it is difficult to know when to abandon one therapy and change to another.

Tuesday I had my routine heart biopsy (it is sad when a heart biopsy is seen as routine). Which showed a good result with minimal rejection present. I also saw Dr Schrier and Witteles at Stanford and he was concerned that my kappa light chains significantly increased, despite the Velcade. Since my six month anniversary from my heart transplant will be next month, he suggested that I go ahead and schedule the stem-cell transplant. That was actually what I wanted to hear. I would like to move forward with this. However, I had asked Dr Weisshaar, my cardiologist if I could return to work in February thinking that the stem-cell transplant would be far in the future. She reluctantly agreed, but wanted me to take a gradual approach, with Barbie as the judge that I wouldn't overexert myself. But now I realize that I may have to delay my return until after the stem-cell transplant. I am a little sad about this, not just because I still feel a sense of responsibility to my patients and my colleagues, but in addition, psychologically I need to work to add some normality back to my life. However, my priorities are well placed and I will follow the counsel of my doctors. It is better to sacrifice now for something better in the future.

Barbie is going to start classes next week at Sierra College. She is taking organic chemistry and nutrition as prerequisites of dental hygiene school. So we will have a busy Winter and Spring this year. We remain constant in our hope.


Sunday, January 4, 2009

New Year in Tahoe

We had a fantastic time as a family on New Years Day in Lake Tahoe. Our annual tradition is to go snowmobiling. This began when we lived in a rental in Rocklin 4 years ago, and it was our first Christmas away from Connecticut, so we were sad and had to get out of the house. Being in the snow covered mountains with a beautiful view of Lake Tahoe will lift any one's spirit. Doing it at 40 mph is even better.

The weather was perfect; crisp, clear but not too cold. We were all together with the exception of Jeremy and Alexandria. The one glitch was that we thought Caitlin could drive her own snowmobile at age 15. She had been anticipating this all year only to be told when we got there that the minimum age was 16. She was devastated. However, the tour guide had her ride on the back of his vehicle and then let her drive quite a bit. She was then all smiles. We spent two hours racing through snow covered pine trees with blue skies above and a blue lake below. This has become a great family tradition.


Caitlin after being told that she couldn't drive the snowmobile

Caitlin after driving with the tour guide in back, holding on for dear life.

Corey and Rebecca

Samuel and Michelle