Saturday, March 28, 2009

The little girl and Natasha Richardson

Everyone has heard by now about little Morgan McCracken from Mentor, Ohio (my neck of the woods) who was hit on the head by a batted baseball and had a delayed presentation of an epidural hematoma that required an emergency craniectomy. She's now well and is expected to make a full recovery.

Little Morgan was the darling of the internet news cycle primarily because of the temporal relationship of her injury to the unfortunate case of Natasha Richardson. According to the McCracken family, after watching a news report on the Richardson tragedy, they became concerned about a headache Morgan developed and took her to the ER. The consensus of the mainstream media and blogosphere is that the intensive coverage of the Richardson saga is what saved the life of Morgan McCracken.

A story like this, with all its post modern overtones, is highly appealing to me. Obviously, real human beings are involved. Natasha Richardson died tragically. A little girl almost succumbed to a seemingly minor injury. But the idea that our celebrity driven media culture can be a primary source of life-saving knowledge is something that ought to astound all of us. If Jane Doe falls on that bunny hill and dies two days later, no one ever hears about it. But Natasha Richardson is a Tony Award-winning actress. She's a celebrity. So her story gets the full cluster bomb treatment from the MSM and the internet for a couple of news cycles until all the fuss dies down (usually give or take 72 hours). Her mere celebrity is what enabled her to become a hero to the McCracken family. For most Americans, "Natasha Richardson" is a brand rather than an actual human being. The name has been disembodied from the actual person for the sake of celebrity. And our culture can't get enough of it. What if the McCracken family were atypical Americans who didn't watch TV, didn't mindlessly surf the internet, but instead spent quiet evenings at home reading the classics with Mozart on softly in the background? Would Morgan still be with us? Have we come to a point where mass marketed, superficial pop culture is so pervasive that we cannot live safely without it? Is it so ingrained in our national psyche that we now actually rely on it, to some extent? A little girl was struck on the skull by a batted hardball and subsequently developed severe headaches. Do parents really need the story of Natasha Richardson hammering away at their visual/auditory cortexes to decide that, hey, maybe we ought to get our little girl to the hospital? The whole thing strikes me as being demoralizingly sad commentary on our culture...

Wednesday, March 25, 2009

Transplant Chains

Interesting story from Medpage Today about an extended donor kidney chain involving now 10 recipients across the USA. What we're talking about is the following: Person A donates a kidney to Person B. Person B has a family member who decides to donate a kidney to unknown Person C. Person C's brother then donates a kidney to unknown Person D. And ad infinitum. The particular streak cited in the article has reached ten. There's even an acronym for the practice (of course there is) of non-simultaneous, extended altruistic donor chains--NEAD.

A cursory reading of this sort of practice is unavoidably heartwarming; the idea of a string of people, unknown to one another, perpetuating the ultimate Gift over the course of many years. Personally, I think it's one of those stories that affirms the inherent potential goodness of human beings. But writing about it, publicizing it has the effect of almost denigrating it to some extent. Like most acts of charity, perhaps it's better left private and unspoken.

And what about hypothetical Person M down the line? What if Person M is a perfect match for a kidney from the brother-in-law of Person L and Person M is overjoyed and filled with thankful relief that finally those long, monotonous, soul-sapping days of dialysis are maybe at an end and then, once the initial excitement abates, Person M's nephrologist slides in the fact that this kidney (Person M's) is a donor kidney from someone in a long NEAD chain and, well, you know, it would be nice if potentially we could continue that chain in the future, once yours is in and functional and you're off dialysis and all.

And Person M sits there numbly contemplating this information, knowing her Mom is dead and her Da drives a bus, smokes like a fiend and has a baseline creatinine of 2.5 and she's estranged from her son in California and her sister is a highly successful real estate agent in New Haven, Connecticut with four kids but she hasn't spoken to her in nearly ten years for reasons too complicated to get into. And there's no one else. No close friends she would ever dare to ask. And she's sitting there in that office trying to reconcile the wonderful news of impending transplantation with the scenario that she will in all likelihood be the one who "breaks the streak" of non-spontaneous altrustic kidney donation.

In baseball, when your team has a rally going and you've strung together a bunch of hits, no one wants to be the last out. Eventually, these NEAD chains will have to end; it's naive to think one would continue interminably. Presumably, recipients won't be required to perpetuate the chain in order to be considered for the kidney (too much of a moral slippery slope). But the longer the chains continue, the more moral pressure is transferred to the next recipient. (Joe DiMaggio certainly felt more pressure to get a hit in game #52 vs. game #9 of the streak). How will they process that pressure? Will it create stress and disharmony amongst their own circle of loved ones, this unspoken obligation to continue a process that very few humans are up to fulfilling? It makes me unconfortable, the publication of something like this. If it happens spontaneously, randomly, then it's a wonderful story. If it continues because of a desire to Continue the Streak, then we've compromised ourselves to some extent.

Monday, March 23, 2009

Waiting Room

Recently, I had to operate on a frail, elderly male on a Sunday morning for an incarcerated inguinal hernia. He had a bazillion medical problems, including stage IV lung cancer, and he had been deteriorating health-wise for the past several months. He'd lost weight, didn't go out much, couldn't golf anymore, but he seemed happy enough, accompanied by his wife at 4am in the ER. He really did. You can tell those kinds of things about people without asking. An incarcerated inguinal hernia, however, is a mechanical problem and there isn't much to offer someone suffering from the pain of one other than an operation. We went through the risks. He'd had a heart attack just two months ago. His lung cancer compromised his ability to tolerate general anesthesia and obviously increased his risks of post-op pulmonary morbidity. He was bad protoplasm, as we say.

The operation went fairly well. It was a recurrent hernia, had been fixed in the 1970's via one of the old "tissue repair" techniques (i.e Bassini, McVay, etc), so there was distorted anatomy, obscured landmarks, and a generalized snarled tangle of scar tissue. A knuckle of purplish bowel was trapped in the defect and I had to do a limited resection. It came together nice though. He did well. He went to the ICU extubated, stable, you couldn't ask for more.

After surgeries, I write orders, I dictate, and then I go talk to the family. I try to do it the same way every time so I don't forget anything. After the paper work, I found myself mindlessly ambling down a long, hushed hallway like an automaton, formulating in my mind things yet to be done, a consult to see, stuff to do around the house when I got home. The waiting area is off to the right at the end of this hall through a wide archway. Just before my physical body loomed in the middle of said archway, I stopped suddenly, catching something undefined in my peripheral vision. I stopped just short of the archway, but close enough so that I could still scan the waiting room. In a chair by the window was the little old wife, sitting quiet and motionless in the sunlight. She was waiting. There was no one else in the expansive room and it was quiet. The TV was off. She didn't move she seemed swallowed up almost in one of those cushiony, ridiculously large waiting room chairs, shoulders slumped, not moving, staring off through the window without giving the impression she was looking at anything in particular. She was a small woman, compact and contained. She wasn't frail. She was just small. She wore oversized glasses and her head barely cleared the back of the chair. Her shoulders sloped like a gentle backyard declivity. The light of the room made shadows pool in the crannies of her clavicles. She looked engulfed by the chair. Her hands were folded together in front of her like she was making a little cabin or a teepee, her fingers bent and crooked like weather-warped lumber. She didn't move. She wasn't talking on the cell phone or reading the paper or checking her watch or watching television or chewing on a pencil while trying to figure some crossword puzzle or the Jumble. Who knows what she thought about. She just kept looking out the window, without moving, with this almost beatific smile, one of those slight, subtle smiles that you don't really notice unless you stare at someone for a time. It was that time of the year when winter was starting to break and it was warmer out and the sun was starting to acquire a real presence, shedding that meek, gauzy glow of winter and the sun was out in force that Sunday morning and the rays beamed in through the windows with a golden linearity and caught the silvery strands of her hair and the creased wrinkles of her exhausted-looking, wan face and I simply couldn't move for a minute or so, staring unseen from my voyeuristic perch, watching this silent old woman abiding in patient repose. Patiently waiting for word of her husband.

I finally went in and sat down beside her. I told her everything was fine. She smiled at me and said, I'm so happy. Her hands were still folded. Her eyebrows arched and she said it again, I'm so happy, and nodded her head, the first movement I'd seen her make since I'd decided to gawk at her. I sat there for a while longer than I usually do. I asked her things about their life together, where they'd been, what they did for work, their children and grandchildren, etc., and she told me things about herself that I didn't know and would probably soon forget. But it was nice.

I know, I know, it sounds hokey as all hell. I can anticipate the sniggers and arch-ironic dismissal of yet another corny "doctor as healer" story. I get that. And it's fine. I usually get annoyed with that kind of a schmaltz-fest. But this was real. It was one random Sunday morning in the nascent Ohio spring. The old couple eventually left the hospital together. I may see them again at the two week follow up appointment, but I rather hope they skip it, off doing something unstructured and fun, something that doesn't require any more patience....

Friday, March 20, 2009

Monday, March 16, 2009


This is a request from a humble, lowly general surgeon in Ohio to all the talented ER docs across the country: When a patient presents with an incarcerated inguinal hernia, it's ok to gently try to reduce it in the ER. If, however, it doesn't reduce easily with some moderate pressure then you're probably better off just letting a sleeping dog lie. Don't force it. Forget the steep Trendelenburg and the IV sedation; call the surgeon and make him get his sleepy behind out of bed so the hernia can be addressed properly. Reducing a strangulated or ischemic hernia doesn't do anyone any favors.

I've had two patients over the past few years referred to me the day after having a hernia "reduced" in the ER in the middle of the night who showed up in my office with generalized peritonitis and/or sepsis on exam. A hernia is a mechanical problem; the goal isn't merely to reduce it, but to repair it and evaluate for evidence of bowel ischemia. Just a friendly public service announcement....

Saturday, March 14, 2009

The Little Man Fights the Power

From the WSJ is a story about Jonathan Leo, a professor of neuroanatomy at a small college in Tennessee, who had the outrageous gall to criticize the conclusions of a paper published in JAMA last spring (how dare he!) regarding the efficacy of the anti-depressant Lexapro in treating post-stroke depression.

Dr Leo wrote an on-line piece for the British Medical Journal (worth a read) in which he points out that behavioral therapy was just as efficacious as Lexapro when compared to placebo but that this was downplayed in the original article leading many in the mainstream media to conclude that SSRI's ought to be routinely prescribed for post-stroke patients. A follow-up letter to the editor last year from Dr. Leo resulted in an acknowledgement in JAMA of his point but by that time, the story had run its course and received little notice outside the esoteric circles of psychiatry.

So Dr. Leo proceeded to write this piece in BMJ where he also highlights past financial ties between the lead author of the Lexapro paper and Forest Laboratories (coincidentally, the maker of Lexapro) which was not noted in the publication last spring. JAMA recently printed an apology letter from the lead author citing "errors of memory" as the reason for the initial lack of transparency.

Now I'm a sucker for stories of the little man fighting the power. I love this kind of thing. Miracle on Ice. Georgetown vs. Villanova. Ohio State vs. Miami in the 2003 title game. David vs. Goliath. And now Jonathan Leo vs. the JAMA ivory tower. Here's JAMA editor-in-chief Catherine DeAngelis on Leo:
“This guy is a nobody and a nothing” she said of Leo. “He is trying to make a name for himself. Please call me about something important.” She added that Leo “should be spending time with his students instead of doing this.”

Leo also received a phone call from JAMA executive deputy editor Phil Fontanarosa (I'm sure he's the kind of dude who probably introduces himself at conferences as 'Hi, I'm Executive Deputy Editor Phil Fontanarosa, how about getting me another coffee, hey?') who allegedly had this exchange on the phone with Leo:
“He said, ‘Who do you think you are,’ ” says Leo. “He then said, ‘You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry.”

Well, isn't that nice. The lesson, as always: don't question what the smart guys at large academic centers are doing. Conflicts of interest and manipulations of data will be handled behind closed doors, don't you worry. We'll take care of everything, they say.

The insidious aspect of this is, as we move into an inevitable era of comparative effectiveness research (CER) as a way to control costs and streamline clinical decision making, it's papers like this with all their hard data and pure science (ostensibly) which will serve as the foundation of those very algorithmic decision trees that physicians will be expected to follow (lest they be labeled a 'bad doctor'). Good for Dr Leo at tiny Lincoln Memorial University. Corruption and financial incentives are not just temptations of our representatives in Washington DC....

Thursday, March 12, 2009

Breast Cancer and MRI

Finally some news on the use (or overuse) or MRI in breast cancer. The COMICE trial was a large, multicenter, randomized controlled trial from the UK that assessed the utility of MRI in the pre-operative work-up of breast cancer. The results basically demonstrated no significant benefit in terms of survival nor did it lead to a reduced need for re-operation in breast conservation therapy.

According to Dr. Monica Morrow (the Tom Brady of breast oncology):
MRI finds two to three times more disease in observed rates of local recurrence in patients selected (for breast conserving surgery)without MRI. This results in increased mastectomy rate for questionable patient benefit. To date neither short term surgical outcomes nor long term local control or contralateral breast cancer rates are impoved with MRI.

Essentially, MRI does not improve surgical outcomes, leads to a higher rate of unnecessary mastectomy, and is extremely expensive (about $1600 a pop, out of pocket). Seems like a slam dunk---time to start getting away from routine pre-operative MRI's for breast cancer.

I had a patient recently who had had a mammogram which showed multiple concerning areas of pleomorphic calcifications diffusely throughout the breast. I sent her for stereotactic needle biopsy of all the spots but the radiologist called and said he wanted to get an MRI first. I was in the middle of something, so I hastily agreed, assuming he had a good enough reason. Well the MRI showed... multiple suspicious areas of pleomorphic calcifications. All the subsequent core biopsies were positive for DCIS. She ended up getting a mastectomy. In retrospect, the MRI added absolutely nothing to the case. We knew she had multicentric/multifocal disease based on mammography alone. The MRI simply (expensively) confirmed what we already knew. It was wasteful, delayed defintive surgery, and just added more stress and cost to an already charged situation.

There are situations where MRI could potentially be useful (to help resolve discordances betwen conventional imaging and physical exam, to assess response to neoadjuvant chemotherapy, inflammatory breast cancer, patients with positive axillary lymph nodes and occult primary breast cancers, some patients with hereditary breast cancer syndromes) but at this point in time there is not nearly enough evidence to support its routine use in most patients with breast cancer...

Monday, March 9, 2009


A nine year girl in Brazil who had been repeatedly raped by her stepfather for 3 years became pregnant with twins. Last week, doctors involved in her care performed an abortion at 15 weeks gestation with consent from the girl's mother. They were concerned that a full-term twin pregnancy would present an unnecessary risk to the life of the small-framed girl. Furthermore, there was concern that delivery might compromise the child's future ability to give birth, once she was of age.

That seems pretty reasonable, no?

But Brazilian Archbishop Jose Cardoso Sobrinho felt otherwise. He immediately excommunicated the doctors who performed the abortion and the mother who gave consent. Today, a Cardinal from the Vatican publicly defended the Archbishop's decision, saying:
"It is a sad case, but the real problem is that the twins conceived were two innocent persons, who had the right to live and could not be eliminated,'' Cardinal Giovanni Battista Re told the Italian daily La Stampa.

The stepfather, predictably, has not been excommunicated.

Saturday, March 7, 2009

Road Trip Euthanasia

Here's a link to an article about a British couple, both with terminal cancer, who traveled to Switzerland to die together at an assisted suicide clinic. The topic of euthanasia will always incite vigorous debate and as we move into this era where our ability to provide expensive, life sustaining care in cases of terminal cancer or the elderly patient in the ICU with multiple organ failure starts to overlap and conflict with our ability as a society to pay for such care, it is an issue that ought to be brought to the forefront of the entire health care debate rather than being shunted off into the realm of "provocative dinner party discussion topic amongst well to do people who have no stake in it either way".

I'll get my stance on euthanasia out of the way right now: It strikes me as absurd and almost fascist that the State holds the right to determine the terms of how an individual chooses to die in cases where death has become inevitable. Too often we see the poor, broken-down, emaciated, pellucid-skinned, dry mouthed, cracked lipped, hollow-eyed skeletal figures in the hospital, admitted for "dehydration" or "ileus" or "nausea/vomiting" or "abdominal pain" but what their real problem is is terminal cancer and they're dying and they look at you with weary beaten eyes when you walk into the room, hi I'm Dr Buckeye, a surgeon, and there's a slight shake of the head, shoulders sagging and whispering, you can barely hear them, have to lean in close, they say no surgery, I don't want any surgery I want to die, they say. It happens all the time. It's sad and horrifying and you can't imagine how helpless they feel, in a hospital again but they know the score, better than anyone else, but they're too tired, too worn out to fight it anymore as a son or a husband drags them into the ER yet again in the middle of the night.

Some may say--Hey what about Palliative Care/Hospice? And that's certainly an option. But there's something inherently ghoulish about hospice if you think about it. And this isn't necessarily a criticism; the very nature of palliative care and hospice is based on a certain element of ghoulishness, no matter how much we'd like to think otherwise. It's like funeral parlors; no matter how nice they are or how well run or how expertly they apply the make-up to your loved one's face or how personable the owner of the parlor seems to be, you never want to spend a lot of time in one and you don't get all nostalgic about the previous parlors you've visited in the past. It's an industry based on death and dying. Our culture unfortunately is simply not ready to treat death as a normal aspect of the life cycle. That's the way it is.

The set-up for hospice is this--you have a condition whereby your life expectancy is less than six months. You get admitted to a lovely "facility" away from it all, often in the woods somewhere, often described in pamphlets as "rustic" or "pastoral". The floors are often lacquered wood and there's soothing music in the background and every room is spacious and clean and confortable and there's a wide window that's looks out into nature, pine trees, squirrels, tortuous creeks etc etc. It's all quite fine. But what if you're suffering from Stage IV colon cancer and your liver bulges with gnarled, fist-sized metastatic deposits and you're either in too much pain or too doped up on pain medications, too sedated to really care one way or the other about the pastorality of of your chosen stage for dying and really, as long as someone keeps pumping the morphine or dilaudid into you, it wouldn't matter to you if you were here or stranded in a shabby room in some Motel 6 on a barren stretch of Southwestern USA highway. It's sounds awful but I have to believe that a large percentage of the benefit of hospice care is not for the dying, but rather the living who will remain when the loved one passes on. You don't want to have to visit your dying grandma in some soul-withering nursing home or in an ICU with a million tubes sticking out of her; instead, think how soothing it would be to see her in a beautiful private room, with family pictures set up everywhere and the nurses are attentive and never make her wait for pain meds and she just seems so comfortable and driving home, a part of you thinks, well, maybe dying isn't that bad. And you go to sleep that night thinking "at least she's in a good place", an actual place not some euphemism for heaven, and it's powerfully comforting for some reason.

But what about those people who don't want it all dragged out in sedated tranquility and blissful narcotized beatitude? What about the man who's been through 3 rounds of experimental chemotherapy and he's made his peace and come to terms with his own mortality and he's tired and broken and just wants to exert a last bit of control over a life that has already careened so far out of his control compared to the existence he knew prior to being diagnosed with cancer? Why is this even a moral issue? Why is his best option to enter a "facility" that functions solely as final depot on his journey toward death, where everything exists and functions in such a way to make that process more comfortable, soothing, almost stream-lined? And every day waking up he knows it's all a thin veneer, perfume sprayed over a rotting corpse, the day of reckoning creeping ever closer but he doesn't know when, he just has to keep going, day after day, passively slogging through the rest of his existence with a docile resignation.

It's time to start having a legitimate conversation about euthanasia. Modern medicine now has the power to drag patients past previous lines of demarcation between life and death and sustain them artificially for a time. There's always another chemo regimen. Admit to the hospital for dehydration. Place a feeding tube. There's always something we can do to attenuate the long slow decline. But what about when we've exhausted all the weapons in our arsenal and the futility of the situation becomes undeniable? There are unforeseen consequences to modern medicine. Swept under the rug for far too long has been this effect of creating a population of patients who, in previous generations, would have died quietly at home, but now are re-animated so to speak, just enough to allow discharge, just enough to get them through another few months. We have a responsibility to these people. They've trusted us to bring them to this point of utter defeat. The "moral" thing, to me, would be to at least give them the option of quickly and painlessly ending it on their own terms.....

Thursday, March 5, 2009

Surgeon General

So apparently Dr. Sanjay Gupta has dropped out of the running to be President Obama's Surgeon General. I don't know whether to be sad or disappointed or excited or apoplectic or sanguine. (Actually I think I'll go with completely apathetic.) He's either the worst candidate imaginable or the perfect candidate for our times. He's young and well-spoken and has those perfect gleaming white teeth and the immovable movie star black hair and he's all over CNN corresponding and whatnot about various health matters, and wouldn't he just be the perfect guy to be the nation's official spokesperson on public health in this age of the Celebrity? Or not. Isn't the Surgeon General usually some grizzled old retired doc with a beard or variation of beard (Van Dyke or goatee or at least a wispy little stache), the kind who whacks your patella with one of those rubber hammers even if you just need a Cipro script for your sinusitis, and you're always just a little afraid when he ambles into your exam room in the starched white coat smelling of iodine and camphor with the glasses perched precariously on the bridge of his nose? Can't we get one of those guys again? Well, wait a second; that's old fashioned, stereotypical, and faintly misogynistic. Maybe it's time for someone with a little more media savvy, someone who knows his way around a powder room, who knows the exact concentration of hydrogen peroxide it takes to tranform your teeth from a row of dull yellow autumn corn kernels hanging down from your gums into the sparkling luminescent orbs of pure white delight, evidently the current standard for anyone who spends any amount of time in front of a camera these days (local on-location weather reporters included).

Here's what the Surgeon General does:
"As head of the 6,000-member Public Health Service Commissioned Corps, the surgeon general acts as the government's chief spokesperson to educate the public on health issues, but has little direct role in policy-making."

That seems pretty....lame. You mean you're not like the "General of all the Surgeons" in some militaristic hierarchy? This is just a PR gig? Why not hire Mary Hart for the job? Or Scarlett Johansson? Don't you think the stop smoking campaign would have made a lot more headway in the eighties if Brooke Shields had been Surgeon General rather than that wily old C. Everette Koop? I'm not exactly surprised Doc Gupta turned this dealio down. Let's remember, between telling us on CNN about the unsubstantiated benefits of asparagus with regards to toenail cancer and how the weather can affect our health, the guy is in fact a practicing NEUROSURGEON. Which is nice.

So the bottom line on this breaking news: somewhere between who cares and the "oh really?" you get from your wife when you try to tell her about your favorite college football team's latest recruiting class.

Wednesday, March 4, 2009

Portal Venous Gas

What you see above are ominous CT findings from a recent patient who presented with sudden, severe abdominal pain. The first slice shows portal venous gas and the second one is illustrative of pneumotosis intestinalis. Portal venous gas is a rare finding most commonly associated with mesenteric ischemia and bowel necrosis. Historically, it has portended a grim prognosis (mortality rates 75-90%). The treatment is cold hard steel, ASAP.

This particular patient had infarcted his cecum for whatever reason. Fortunately the ischemic insult was isolated to the cecum and the bowel had not yet perforated. I did a right hemicolectomy. He did surprisingly well. The odds weren't good, but you figure somebody eventually has to survive this sort of insult right? I've had a few who didn't....

Tuesday, March 3, 2009

Waiting and Stress and Breast Biopsies

This article from Radiology highlights a common source of stress that many women face; the stomach-churning, mind-wracking interval while you wait for the final pathology to be determined from your breast biopsy. The cited article measured salivary cortisol levels in women throughout the waiting period after core needle breast biopsies. What they found was that stress hormone levels were just as high during the waiting period as levels determined in women who were told the biopsy was positive for cancer.

The science of the paper isn't great and the conclusions made regarding wound healing with mildly elevated cortisol levels is conjectural at best, but papers like this don't have to be great science. The point is that women experience a tremendous amount of emotional stress while waiting for breast biopsy results and we as physicians ought to do everything we can to get those results to them as soon as possible. For core or needle biospies, it ought not to take more than 24-48 hours. For lumpectomies or axillary dissections however, it could very well take several days but no woman should be waiting more than a week.

For obvious reasons I cannot imagine what it's like to go home with a bandaid on a wound after a breast biopsy to determine whether "something" seen on your mammogram is or is not a cancer and being forced to go through the subsequent days, taking care of your family and going to work and just trying to live your life, all the while in the back of your mind you're wondering, wondering. The stress often starts days prior to even seeing a surgeon. A woman will get a call randomly from her PCP or her Gyne about a "finding" on her last mammogram and that she needs to see a Surgeon (a surgeon?!??!) as soon as possible, here's the number. Then maybe the surgeon can't get you in until later in the week. Finally you meet him and he tells you that since the "lesion" (now it's a lesion????) can't be palpated, you'll have to go for a stereotactic core needle biopsy, to be set up in the department of radiology with a different doctor in a few days. And then the day of the biopsy arrives and it isn't so bad, the discomfort, but you go home again without answers. And you wait. And every time the phone rings your heart quivers and jumps just a bit knowing it could be your surgeon's voice; we need to talk, could you come into the office this afternoon.....

The whole process can sometimes get dragged out over several weeks. For me, it's good to be reminded every now and then that there is an actual person who has to endure the torment of the wait.....

Monday, March 2, 2009