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.


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.