Uploaded: July 10, 2007 (Regarding the events of August, 2006)
Subject: Retrospective--Dr. Sprite
and the Nutcracker Surgical Suite
In the spring of 2005, before I was distracted by that annoying
osteosarcoma, I had been in the final month of my internal medicine
training and all set to start a fellowship in infectious disease
medicine in the summer. (This branch of medicine concerns any
disease caused by an agent that is passed from one creature to another and
is dependent on its victim for sustenance. This includes herpes, strep throat, mad cow
disease, and tapeworms.
When the osteosarcoma popped up, my future employer graciously held
my place. After I finished chemo, I rested for a few months, then I
in the spring, I finished my internal medicine training by
apprenticing myself to a
Hippie General infectious diseases
consultant. My schedule was gentle, but he was an excellent mentor,
so I got a lot out of it. In July, I left the nest of little
Hippie
General play in the big leagues and do my fellowship at the
prestigious
Balding Medical Medical Center.
Everything looked great. There were six other starting fellows, and
we became friends immediately. The more senior fellows and faculty
were very congenial as well. I had found, as they say of subspecialties
in medicine, my 'tribe.'
I was to rotate monthly through various outlying hospitals
affiliated with the Balding Medical Center as well as the Center itself. I
had a great first month at St. Elsewhere (thank you, Samuel Shem),
and they were happy with my performance, but for life to be a true
comedy, things like that can't last for long.
Near the end of the month, things began to fall apart-starting with
my face. The metal clip holding together my surgically recreated
right maxilla (cheek bone) eroded through the radiation-damaged skin
that covered it. I scurried back to
F'in' Famous Cancer Hospital
for a repair (see e-mail from
July 12, 2006). Being a doctor and therefore
physically invincible, I took only two days off and was back to
work.
Meanwhile, I had long been looking forward to a completely unrelated
and long-scheduled surgery that turned out to fall on the very next
week and the day before I started at Hospital Number 2.
This next procedure was for a much happier purpose than the
face-hole patch-up. K and I had decided that
LLC ought to have a
protégé. This was going to be complicated. I had just been through
the second big course of chemotherapy in my life. Chemo kills little
Tomlets, and there were almost none left. However, Dr.
Nutcracker, a
specialist at a famous fertility center, would attempt to salvage a
few, brave survivors by cutting directly into the bunker where they
hid. Ouch.
The planned surgery was a scouting expedition. If Dr.
Nutcracker
found any viable Tomlets, K would have to take horrible hormones for
two months to get lots of eggs ready for the Tomlets. (Given that I
was the source of the problem, it really wasn't fair for
K to be
subjected to such a nasty regimen. It involves the best mood effects
of menstruation multiplied by ten and embellished with all kinds of
needles in all kinds of uncomfortable places.) The plan was that
once K's eggs were ready for harvest, Dr.
Nutcracker would go back
in and scoop out a few more Tomlets and send them to a test tube for
hot dates with the eggs.
Dr. Nutcracker said the incisions would be tiny and the pain
minimal. Eager to get back to work as soon as possible, I went for
spinal anesthesia and sedatives instead of general.
Naturally, I went back to work the next day.
That morning, despite my surgeon's reassurances, there was plenty of
pain. (Actually, he had told the truth. The pain was minimal-for
him.) True to the Doctors'
Code of Masochism, I didn't mention the surgery to my colleagues. With every step I felt as if a vengeful ex-girlfriend were
stabbing a voodoo doll in the worst place. I rounded on my patients
bowlegged. By afternoon rounds, I was exhausted and chapped.
The attending physician that day was an energetic sprite of a man. I
met him after lunch, and off he skipped through the hospital, med
student at his heals. I dragged. At one point, we needed to go up a
few floors. The elevator beckoned me, a rest from the endless
walking. But the attending chirped, "We're taking the stairs. Come
on, it's good exercise, and elevators waste energy."
Indignation, embarrassment, and rye amusement vied with each other
in my head, but the exhaustion of the morning's work and my two
surgeries had left my brain even more sluggish than my feet. I
wanted to say. "When my balls aren't bleeding, I almost always take
the stairs, but today, I would prefer the elevator." But I was too
slow. Off the others went up the stairs, and I waddled painfully
after them.
I reached our destination a bit late, winning a stern look from
Dr.
Sprite. Dull-eyed, I began to present a patient in the usual
ritualized way. Chief complaint, history of present illness, past
medical history, medications-here, I made an inexcusable mistake. I
used a trade name instead of a generic name for a drug. Every time
this happens, a baby seal is clubbed to death and Tinkerbell's
herpes erupts again. At least this attending seemed to think so. He
launched into a diatribe on the lures and deceptions of
pharmaceutical marketing and how overpriced originals are prescribed
instead of cheaper generic alternatives because doctors don't know
generic names.
I wanted to say, "Wait, wait! My brain is malfunctioning! I
practically always use generic names. I was the guy who arranged a
talk at my medical school on drug marketers by their nemesis, Bob
Goodman, founder of 'No Free Lunch,' and I have worn his signature
buttons. Detailers have never gotten me to come out for a dinner.
All my pens were purchased at CVS or stolen from other doctors or
patients too weak to fight me for them." *
Dr. Sprite preached to
the choir, but the choir had lost its voice.
I had been judged and found guilty of ignorance, collusion with Big
Pharma, laziness and energy profligacy. Would it have been impolitic
at this point to mention that over the course of that day, he
himself had caused the deaths of several baby seals, and Tinkerbell
had already cancelled her hot date because of him? Even if it had
been appropriate, my mind could not make the words. My punishment
for the duration was disapproving looks and a litany of dry comments
that smelled vaguely of insults.
Post-script:
A few days later, Dr. Nutcracker called us with sad news. He had
found almost no Tomlets, and those few he found looked like the
Frankenstein Monster's Sperm. They were deemed useless and thrown
away without even a lab report.
A few months later, a well-informed friend referred us to the most
eminent male infertility doc in the world. We told him our story. He
was very professional, and clearly worked very hard to tell us what
he thought without openly dissing a colleague. Apparently,
Dr.
Nutcracker had led us astray. He had used an old and potentially
harmful technique that jeopardized what fertility I had left and
precluded any effective Tomlet retrieval for at least 6 months. (He
would have tried in just 2 months if he had found the Tomlets
sufficient.) Worse, the Tomlet factories would have been in better
condition had we waited longer for the effects of my chemotherapy to
fade.
But most tragically, Nutcracker had led us astray. Those happy few Tomlets that he found, misshapen as they were, were actually a
potential band of brothers (or sisters) for LLC. Unlike in dating,
with the Tomlets, what was important was what was on the inside.
Now, with the Tomlet factories many months away from full recovery
due to chemo and the Nutcracker's intrusions, with
K's odds for a
successful fertilization, uncomplicated pregnancy and safe delivery
diminishing daily due to her age, and with my continuing medical
problems, we just didn't have it in us to try again.
The final indignity? The state-of-the-art tool for Tomlet retrieval
is not the scalpel that Dr. Nutcracker wielded, but a tiny needle.
That was truly below the belt.
* Doctors receiving 'gifts' from drug company representatives constantly. Doctors
. . . and now, back to the e-mails.
All comments, suggestions, compliments, insults, and hate-mail should be directed to Tom@tumoriffic.org.