Dear Doctor, Thank You.

My son is celebrating his 7th birthday on Monday. He loves swimming, listens to the Phillies every night at bedtime, plays the piano, and is obsessed with Beyblades (the appeal of which is totally lost on me. They’re battling ninja tops that have names. I don’t get it. Moving on…) He is a perfectly healthy little boy. He almost wasn’t.

My wife will celebrate her 30ish birthday in December (she might read this, you never know.) She is a professional violist, outstanding cook, community activist, maniacally busy, love of my life. She  is completely healthy in every way. She almost wasn’t.

On a warm sunny September day 7 years ago, we found out that my wife Renee was pregnant with our first child…and that she had a brain tumor. Not a great day.

Renee was diagnosed with a meningioma in her optic canal. The growing tumor was causing vision issues, but they could not operate on her until she had cleared her first trimester. So we waited and hoped the tumor wouldn’t cause permanent damage in the interim. She finally had surgery in early November. I sat with her in the OR prep room, listened to the strong heartbeat of my unborn son, kissed my wife, and watched them wheel her way for a craniotomy, having no idea what to expect when the surgery over. Worst moment of my life.

As you no doubt deduced from the opening two paragraphs, this story has a happy ending. Everything turned out fine. Completely and totally fine. Renee’s recovery was hard and took time, but she has absolutely no side effects from the whole ordeal, save a scar above her hairline that you can sometimes see when her hair hangs a certain way. She had no issues giving birth and my son had no ill effects either. We now only have memories.

I, of course, thanked Renee’s doctors for the tremendous care they provided her, but it never seemed sufficient. So every year around this time, I do something to try and show my appreciation. It’s silly probably, but every year I share a piece I wrote back around the time of Renee’s surgery, on some social media outlet. It’s been posted on a website I created to update people on Renee’s condition, on MySpace, Facebook, and now on this blog. It shares the experience we went through on that day we found out about the tumor and pregnancy and how bleak the situation looked at that time. For me, it serves a dual purpose: it reminds me of the tremendous service provided by all of the health care professionals involved in Renee’s care, but also reminds me of the importance of the work we do in the the CME community. The same physicians I helped educate as a member of the CME department were the same physicians who cared for my wife.

After the jump is the narrative piece I wrote called Bad Day. I admit that it’s a bit long and I now cringe at how some of the things are written, but considering the shape I was in at the time it was written (I wrote most of it at 2 AM the night before the surgery with half a bottle of wine at my side), it’s not too bad.

And to all the doctors involved in this story, let me say one more time: thank you.

Bad Day

 There are all types of bad days, some worse than others. You might stub a toe or break a nail – that could be a bad day. You might lose your job or divorce your spouse – that would be worse. I had a particularly bad day a while back; it was worse for my wife Renee.

Prelude to a Bad Day

Renee had been complaining about her right eye for a while.

“It’s kind of like a floater.” she complained to me.

“Well, then it probably is a floater.” I remarked.

“It’s kind of like a floater.” she complained to our friend Anson, a resident at Wills Eye Hospital.

“It probably is a floater,” he agreed.

“It’s kind of like a floater” she complained to her mom.

“You should see an eye doctor” her mom replied.

She went to see an eye doctor.

Ophthalmologist Visit – Take 1

It’s a beautiful early fall day in the City of Brotherly Love. Center City is bustling as another business day gets into full swing. On the corner of 8th and Chestnut, an attractive 20-something woman with a Julia Roberts smile enters the 5th floor office of Dr. Stephen Lee, ophthalmologist.

Renee: “Hi, my name’s Renee Warnick and I’m here to see Dr. Lee.”

Receptionist: “Please fill out these papers and we’ll be right with you.”

A few minutes pass.

Receptionist: “Ms. Warnick, do you have your insurance card with you?”

Renee: “Absolutely, here you go.”

A few more minutes pass.

Receptionist: “I’m sorry, Ms. Warnick, but you’ve already had one ophthalmology visit this year and Keystone will not cover another visit until next year. You’ll have to pay out-of-pocket for this visit.”

Renee: “Thank you. Have a nice day.”

Ophthalmologist Visit – Take 2

It’s a beautiful late winter day in the City That Loves You Back. Center City is slowly waking up under a fresh layer of freezing rain. On the corner of 8th and Chestnut, a young raven-haired woman with sparkling chameleon eyes enters the 5th floor office of Dr. Stephen Lee, ophthalmologist.

Renee: “Hi, my name’s Renee Warnick and I’m here to see Dr. Lee.”

Receptionist: “Please fill out these papers and we’ll be right with you.”

A few minutes pass.

Receptionist: “Ms. Warnick, do you have your insurance card with you?”

Renee: “Absolutely, here you go.”

A few more minutes pass.

Receptionist: “I’m sorry, Ms. Warnick, but your insurance coverage doesn’t cover another ophthalmologist visit until June. You’ll have to pay out-of-pocket for this visit.”

Renee: “Thank you. Have a nice day.”

Ophthalmologist Visit – Take 3

It’s a miserable late summer day in the 5th largest city in the nation. Center City is steaming in a soupy sauna that passes for weather this time of year. On the corner of 8th and Chestnut, a stylishly dressed woman with hour-glass curves enters the 5th floor office of Dr. Stephen Lee, ophthalmologist.

Renee: “Hi, my name’s Renee Warnick and I’m here to see Dr. Lee.”

Receptionist: “Please fill out these papers and we’ll be right with you.”

A few minutes pass.

Receptionist: “Ms. Warnick, do you have your insurance card with you?”

Renee: “Absolutely, here you go.”

A few more minutes pass.

Receptionist: “Ms. Warnick, the doctor will see you now.”

Renee: “Thank God.”

Renee was thrilled to be seeing Dr. Lee.

“He’s really an excellent ophthalmologist; I’ve been told he has a great bedside manner”

Several jokes quickly surfaced that referenced my own “bedside manner”, but I decided it best to keep these to myself. She normally finds my crude jokes funny, but sometimes I sacrifice common sense in favor of an ill-advised attempt at humor and end up slinking back to the doghouse with tail firmly tucked between legs.

The first sign that something was a little odd was when Dr. Lee was doing the “1 or 2” test. You know, the one where they flip the first lens in front of your eyes and say,

“Which is better…1”

Pause

“…or 2?”

And flip down a second lens. They do this about a hundred times and then magically come up with your prescription.

The normal pattern of conversation for the “1 or 2” test is this:

“Which is better…1…or 2?”

“1”

“Which is better…1…or 2?”

“2”

“Which is better…1…or 2?”

“2”

And so on.

Renee’s test went like this:

“Which is better…1…or 2?”

“Neither.”

“Which is better…1…or 2?”

“Neither”

“Which is better…1…or 2?”

“Neither”

And so on.

After the “1 or 2” test, Dr. Lee asked Renee to describe exactly what she was seeing during the test and exactly why she scheduled an appointment with him in the first place. She told him her vision had been blurry for a while, continued to be blurry, and was getting worse. Dr. Lee responded with an amazing statement.

“I believe you.”

I guess it’s pure naiveté that leads us to think our doctors believe every blessed word that utters forth from our mouths. So when a doctor tells you that, yes indeed, I believe what you say is true, it’s a bit of a surprise that this needs to be verbalized. Having been trained in the field of physical therapy, I probably should have known better. I’ve seen enough gold-digging workers comp patients and trumped up fibromyalgia/chronic fatigue cases to know that believability has to be taken into account when doing a patient exam and plotting a course of treatment. Thankfully, Renee had either an innocent enough face or a convincing enough story, that Dr. Lee decided further investigation was warranted. She received a referral to see Dr. Robert Sergott, a neuro-ophthamologist, and the next week we left for a week’s vacation in Maine.

The coast of Maine is one of our favorite places in the world and is a fascinating mix of high culture, lobster fishing villages, incredible natural beauty, and roadside signs exclaiming “Bush is a terrorist!” I won’t go into great detail about our Maine vacation, as it really doesn’t apply to the main (pun intended) focus of this narrative. Suffice it to say it was the type of vacation where an afternoon walk and dinner out made for an action-packed day. It was also during this vacation that we decided that, well, maybe it’s time to have a family and we could at least start trying to have a baby. Right. Good thinking. Start trying, because sperm need a bunch of practice runs before they’re really ready to roll. They’re like baseball players who need a couple weeks of spring training before they get their timing down. We were following the Bud Selig guide to procreation.

Renee’s neuro-ophtho appointment was scheduled for two weeks after our return from Maine. The Sunday before the appointment, she put in a prayer request at church. I thought this was slightly unnecessary, but then I’m the kind of person who tends to roll his eyes when someone stands up and requests prayer for their sister’s co-worker’s niece’s boyfriend who is going through a traumatic experience with a hangnail. That probably makes me an awful person, so I said nothing about her prayer request, even though I knew that there was no cause for concern about the doctor’s visit.

Anatomy of a Bad Day

6:00 AM: Crap. I forgot to reset the alarm since I’m not going into work until later. 610-WIP sports-talk radio blares loudly. The Phillies somehow managed to extend their winning streak to six by beating the hated Mets 5 – 4. Too tired to change the alarm time, I hit snooze instead.

6:09 AM: 610-WIP back on. Why is the snooze time only 9 minutes? The Eagles play their first game of the season tonight against Tampa Bay on Monday Night Football. Someone asks if I’m ready for some football. Being unsure, I hit snooze.

6:18 AM: “E-A-G-L-E-S…Eagles!” Snooze.

6:27 AM: “E-A-G-L-E-S…Eagles!” Snooze.

6:36 AM: No Eagles chant this time, just an extremely awkward hair-replacement commercial. I give up on the snooze and just lower the volume to a tolerable level (read: a level at which I can still fall asleep.) Renee stirs for the first time and asks if I’m going to the doctor with her. I thought this had been settled earlier, but I say it’s up to her. She says I don’t need to. I see my hopes of sleeping in until 7:30 fading. Barkley gives an exploratory whine from beside the bed. I fake sleep and ignore him.

7:00 AM: Jerk awake. Barkley’s whines have intensified with an added sense of urgency. Crap. I reach down and pet his head. Whining stops.

7:20 AM: Jerk awake. Whining is back and I’m also being jabbed in the back by a fire-poker. Turns out to just be Renee lovingly tapping me with her finger to tell me the dog needs to go out. I tell her she can take him out. No response. Barkley is now sitting with his chin resting on the bed, looking pitiful.

7:30 AM: Standing outside with Barkley and my little plastic baggies, my mind slowly creaks into gear. If I go with Renee to the doctor, I can probably get away with a half day at work. If I don’t, I have to go in now. This really is not a tough decision. Barkley finishes his duty (ha ha) and we go inside.

8:30 AM: I am seated in my normal position when Renee and I are traveling together – on the sofa, casually mentioning the time every 5 minutes as she scurries around trying to get ready. She had seemed happy when I told her I was going to the doctor with her, but that goodwill is rapidly draining away with my time announcements and the occasional (ok, frequent) “Let’s go!” My plan is to act like we’re late approximately 10 minutes before I want to leave and fake her into leaving on time. Barkley is seated beside my feet, looking a little miffed at having been swatted twice in the nose by the cat, who seems particularly grouchy this morning.

8:40 AM: We’re off! I am quite pleased that my plan has worked so well, although Renee seems slightly annoyed. Oh well, someday she’ll thank me and my underappreciated genius.

8:45 AM: We’re back! Renee forgot her insurance card. Dang! Forgot to factor that in. (Note to self: allow extra 10 minutes in travel time for the inevitable “I forgot my…”)

9:15 AM: Drop Renee off in front of Wills Eye Hospital, 15 minutes late. Could be worse. I circle around the block and enter the parking garage. Yes! Someone’s backing out of a space on the first level. That never happens! Hopefully it’s a good omen for the rest of the day.

9:20 AM: Sitting in the waiting room, Renee appears to be a little jittery.

“How you doing?”

“Well…I’m all right. A little nervous.”

“You’ll be fine.”

I’m a real wordsmith. We talk a little more and she takes my hand. As usual, she’s dropped her annoyance with me and now seems genuinely appreciative that I’m with her.

9:25 AM: Renee is called back to the examination room and I trail along behind. For some reason, I feel a little silly. It’s like I’m announcing to everyone that I don’t trust my poor helpless wife to handle this visit alone and I, the big strong husband, must be there to handle matters. This, of course, is ridiculous and I tell myself that as I take a seat beside the exam table. The nurse checks Renee’s vitals and then leaves us alone in the room.

“Are you still nervous?”

“Eh, not really.”

“I’m sure it’s just optic neuritis or something minor.”

“Probably.”

“…”

“…”

“Are we really going to try and have a kid?”

“I guess…I mean…we’re not doing anything to stop it right now, so we better be.”

“Good point. How long do you think it will take?”

“I don’t know. Look at Jason and Julie. She got pregnant right away.”

9:35 AM: A youngish woman of Middle Eastern descent, obviously not Robert Sergott, enters the exam room. I don’t catch her name, and just barely catch the hand she extends to be shaken. It’s kind of like shaking hands with a Kleenex. She mentions that she is a neuro-ophthamology fellow and I barely contain myself from blurting out, “You don’t look like a fella to me!” Why do I even think that’s funny? Thwarting my best attempts to make an ass of myself, I remain silent.

The female fellow begins Renee’s eye exam, and it doesn’t take me long to notice something odd. As she reads the eye chart from left-to-right, Renee has no trouble with the first three letters, in fact, doing better than I would. The fourth letter causes her to hesitate; it is blurry, but she can still make it out. She completely ignores the fifth letter. When Dr. Kleenex Hand questions her about it, Renee looks surprised.

“Oh. I didn’t know there was a fifth letter.”

“It’s ok to squint or move your head. Can you see it now?”

Renee is now obviously tilting her head, almost giving the chart a sideways glance. In this position, she is able to read the last letter. The same pattern is repeated as she moves down the chart to smaller letters; she stops after the first four letters and then tilts her head in order to see the fifth. Dr. Kleenex Hand scribbles a few notes in the chart and moves on to another exam. I start to get nervous.

9:50 AM: Nothing else remarkable happens during the rest of the eye exam. Dr. Kleenex Hand informs Renee that they want to do a visual field test to confirm what Dr. Lee, he of the great bedside manner, had found. We were prepared for this, as our friend Anson had mentioned this would probably happen, along with an MRI. Renee is escorted down the hall by Reggie the technician and I am pointed towards the waiting room.

10:00 AM: Why do all doctors’ offices have Golf Digest in the waiting room? Does anyone really read this? I like golf and watch the occasional Major on TV, but do I really want to read a detailed analysis of Fred Funk’s backswing? Every waiting room should be required to have a subscription to Mental_Floss. Now THAT’S a great magazine.

10:15 AM: I glance at my watch. I’m still on track to be back at the office by 1:00 PM: and put in a good four hours. Well…I’ll put in four hours anyway.

10:20 AM: Renee comes into the waiting room and I stand-up to follow. She sits down beside me and I sit back down.

“We have to wait while they analyze the exam.”

“Oh.”

“…”

“…”

“I don’t think I did very well.”

“What do you mean?”

“I don’t think I did very well. On the test, the visual field test. I got all flustered and couldn’t concentrate.”

“So. It’s not like a test you have to study for or write an essay. They can’t fail you.”

“I know…I think my vision’s worse. I just couldn’t see right.”

This time, I take her hand. We both sit and wait.

10:30 AM: There are now six of us crowded into the small examining room – me, Renee, Dr. Kleenex Hand, Dr. Sergott, and two medical students (the short lab coats give them away.) Dr. Sergott is holding the analysis of Renee’s visual field test and is explaining that her vision has worsened in the left lower quadrant of her right eye. He clearly has taken over the examination of this patient. Whenever he points to the visual field chart, the two med students crane their necks in unison to get a better look. The female fellow looks bored and is startled when Dr. Sergott asks her a probing question about the findings of the test. Her answer satisfies him and he returns his focus to Renee. He wants her to get an MRI, within the next 1-2 days if possible. Ruthie is looking into it. Someone knocks on the door and pops-in her head. It’s Ruthie.

“Doctor, they can take her right now if she hurries.”

Ruthie is good.

“Ruthie, you’re the best.”

Ruthie smiles.

10:40 AM: Renee needs a referral from our primary care doctor before she can get the MRI (God bless HMO’s – I mean that literally and sarcastically.) Fortunately, the office is only two blocks away at 8th & Chestnut and I head there to pick up the referral while Renee starts the paperwork at the imaging center. As I walk, I call my mom and then Renee’s mom to give them updates on our progress. They both seem concerned and want me to call back after the MRI.

10:50 AM: Here’s a big surprise…Jefferson Family Medicine Associates has Golf Digest in the waiting room. Fred Funk remains frozen in a permanent backswing. My cell phone rings.

“Hello?”

“Did you get the referral yet?”

“No, I’m still waiting.”

“Make sure you get it. I have to sign a waiver that says I’ll pay for the MRI myself if a referral is not brought over.”

“How much?”

“$4000”

“Hey, no problem. I’ll get my wallet from the car.”

“Funny. Just get the referral.”

“I’ll get the referral.”

11:00 AM: I jog over to the imaging center which is in the basement of the same building as Dr. Sergott’s office. Just as I’m sitting down in the waiting room beside Renee, she gets called back. She hands in the referral at the front desk and then disappears into a maze of white halls. I grab another copy of Golf Digest and get back to the Funk.

11:30 AM: Did you know that Tiger Woods is really just a regular guy like you and me? He likes to play video games, watch movies, and talk on the phone. Riveting.

Noon: MRI films in hand, we head back up the elevator to Dr. Sergott’s office.

“How was it?”

“Not bad. They had to give me a shot – that hurt. It had some kind of dye in it and when
they injected it into my arm, it made me feel cold. The guy said that was normal.”

“Did they stick your whole body in the tube?”

“No, just my head. They gave me headphones to wear – that was nice. I asked the guy if he could put on a different station, but he said the country music station was the only one they could get in the basement. At least I had something to listen to.”

How ironic, I thought country music caused blurry vision.

We meet Ruthie at the reception desk. She tells us it will take a little time to read the MRI’s, so we can go grab lunch and then come back around 1:00. Shoot…now I’m going to have to work late tonight. I call my boss and tell her I won’t be in until after 1:00.

12:10 PM: Neither of us feels like stretching our brains to come up with an original place for lunch, so we go to the first place we think of – Santa Fe Burrito on 11th Street. I have a love/hate relationship with this place. I love their burritos, but I hate that it’s located immediately across the street from my office window. When it gets to be lunchtime and they start cooking and I have my window open – it’s really not fair.

I order my usual – a California Chicken without sprouts (Like a birds nest, they are!) and Renee shows her creative flair by ordering a California Chicken with sprouts. We take a booth and begin munching in silence. I like the fact that are marriage has evolved to the point where we can sit in a restaurant, eat without talking, and it’s a comfortable silence. I’m not trying to impress her with my wittiness; she’s not trying to impress me with her lively conversation. It’s enjoyment enough to be in each others company.

Eventually, silence gives way to small talk. I am convinced that the MRI will show swelling around the optic nerve, she’ll get a prescription, and we’ll all let out a big sigh of relief and go home. Renee seems to agree with this, but she still feels pretty nervous. It affects her appetite and I polish off the second half of her burrito, rendering moot my decision to get the Diet Coke.

1:00 PM: Why didn’t I use the bathroom in the restaurant? I refilled my drink three times.

IshouldhavegonetheremanIgottagoIgottagoIgottagoIgottagowhyisthiselevatortakingsolong!IgottagoIgottagoIgottagothere’sthemensroomReneeI’llmeetyouinthewaitingroom!

1:10 PM: Much relieved, I walk into Dr. Sergott’s waiting room to find Renee, appropriately enough, waiting for me. She is much more nervous.

“Um, I saw Dr. Sergott when I first walked in and he waved me back. When he saw you weren’t with me, he said I should wait for you before he talks to me.”

“Did he say anything about the MRI results?”

“No, he just said to wait for you.”

That’s not good.

“He probably just wanted to make sure I could find you.”

I don’t sound very convincing and Renee doesn’t look very convinced. A nurse shows us back to the exam room and Dr. Sergott arrives immediately. He’s alone. I’m beginning to think that optic neuritis is a long shot.

“Well, I have some good news and some bad news.”

That’s not a great start.

“The good news is that we know what’s causing the problem and we know how to treat it.”

That IS good news.

“The bad news is that you have…”

Optic neuritis! Optic neuritis!

“…a meningioma, which is…”

Okay. Okay. What’s that?

“…a benign brain tumor on the lining of the brain.”

Everything stops.

A brain tumor? Did he just say my wife has a brain tumor? Did he just say my wife has a brain tumor? Did he just say my wife has a brain tumor? A brain tumor? A meningioma? A meningioma. A brain tumor.

Dr. Sergott is still talking; I’m not listening. I look at Renee. She’s listening intently, her expression unchanged. This worries me. Renee displays her emotions verbally and is always quick with a comment and matching facial expression after something happens. One of the things I love most about her is her ability to spontaneously express true joy, and happiness in an undeniable manner. To hear her say “Oh, I love it!” is to believe it. To hear her now say nothing is heartbreaking.

I tune back in to Dr. Sergott. He’s explaining the surgery – a craniotomy. This at least gets a response from Renee – she giggles! If I wasn’t so busy fighting off disbelief, I might laugh, too. It sounds so absurd! The giggling stops with his mention of her need to get her head shaved. This one really hits home. I can read it in the dimming of her eyes and faltering attempt to smile. The only thing I would say Renee is vain about, and she would openly admit to this, is her hair. A craniotomy sounds ridiculous enough to laugh off; a shaved head is very real and very personal.

Dr. Sergott is in the unenviable position of trying to reassure us that everything is going to be all right, yet keeping us aware that the surgery Renee faces is very serious. When we told Anson that Renee was going to be seeing Dr. Sergott, he did an impression of him where he runs his hand through his hair while talking and makes it stick up everywhere. His impression was dead-on because that is exactly what Dr. Sergott is doing while he explains the surgery. I realize I’m doing it as well.

1:30 PM: Dr. Sergott steps out into the hall to grab the MRI’s. When he returns, Dr. Kleenex Hand and three med students are trailing behind. With a magicians flourish he snaps a film up to the lighted x-ray viewer and points out the tumor. He doesn’t need to point. The tumor is as obvious as if it was wearing a “Hi, my name is…Meningioma” name badge. The big white bully has rudely snuggled up beside the right optic nerve and is pressing against it, looking for a little action. The more aggressive it gets, the worse Renee’s vision will get.

I try to listen to Dr. Sergott talk and sort out my thoughts at the same time and end up doing a poor job of both. The drop in Renee’s expression at the mention of head shaving was only temporary and she is back to listening intently with a matter-of-fact expression on her face. I can only imagine what she must be feeling inside as Dr. Sergott continues to describe the evil growing in her head. 2 to 3 cm…normally benign… located on the planum sphenoidale…4 to 6 hour surgery…one month recovery time. He wants her to see Dr. Stephen Dante, a highly regarded neurosurgeon who has just joined on at Jefferson. Renee asks if this is going to mess up our plans for our trip to Italy in four days. He gives her a look of compassion, and a bit of skepticism, and pawns off responsibility for the decision to Dr. Dante. I try to make a joke playing off the “Rome wasn’t built in a day.” quote, but my effort is half-hearted and it falls flat.

2:00 PM: Ruthie is trying to reach Dr. Dante to schedule an appointment, but when Dr. Sergott said he just came to Jefferson, he just came to Jefferson. He doesn’t even have an office phone number yet.

Things are coming to a close with Dr. Sergott and crew and little is left to say. As an afterthought, Renee throws out that there is a small possibility that she could be pregnant. Very small. Dr. Sergott blinks and seems to stumble on his words a bit. He glances at the chart and then glances at Dr. Kleenex Hand. He doesn’t look happy. Thinking back on the initial patient interview, I don’t remember the pregnancy question being asked and I know Renee didn’t bring it up. Dr. Sergott’s expression tells me there will be a lecture coming when we finally leave. He looks back at Renee and his face softens, slightly.

“You need to find this out immediately. If you’re pregnant, it throws a whole new set of circumstances into the situation. Some research has shown that increased hormones from pregnancy can cause meningiomas to grow at a faster rate. Along with that, you’ll also have to consider the effects of anesthesia from surgery on a fetus in the first trimester. It could lead to a real ethical dilemma for you.”

I’m glad Renee’s not pregnant because he really seems concerned, almost like he’s mad at us for even considering it. He debates about giving her a home pregnancy test and then decides to just write out a script for her to have blood work done. As we prepare to leave the examination room, he has a few parting words for us.

“Pray that you’re not pregnant. You don’t want that right now.”

2:10 PM: Renee has been amazing so far. She has remained totally composed, asked intelligent questions and even chuckled a time or two. I feel like someone tried to kick me in the stomach but aimed too low. We walk over to Ruthie’s desk, where she is still trying to get hold of Dr. Dante, and sit down to wait. Renee looks at me and I can see her eyes reddening, brimming with tears.

“I’m going to have to shave my head.”

She opens her mouth to say more, but starts sobbing instead. I put my arm around her and she leans against my chest and lets the trauma of the day come pouring out. Biting on my tongue, I barely manage to regain control of a losing battle with my own emotions. I want the tumor! I want to open up her head, take out the meningioma, and shove it in my head – I can deal with that. I can deal with things that happen to me. Not Renee…please not Renee. Don’t you dare let anything happen to her. Do you hear me! DON’T YOU DARE LET ANYTHING HAPPEN TO HER!

Ruthie glances over with a compassionate look and murmurs a few words of sympathy. The shuddering from Renee’s body has stopped and I hand her a tissue. She manages a weak smile and we sit together in silence, both listening to the growing agitation in Ruthie’s voice as she continues the futile hunt for Dr. Dante.

2:30 PM: Success! Ruthie has managed to track down the phone impaired Dr. Dante and schedule an appointment for the day before our trip to Italy. Whatever she is being paid, it’s not nearly enough. All of the tears are gone now and we both just want to go home. But before that can happen, we still have a few more things to do first.

2:32 PM: As we walk to 8th and Chestnut to get Renee’s blood work done, I call my boss to tell her I’m not coming in.

“Hello, this is Jeanne.”

“Yeah, hi Jeanne, it’s Derek. I’m going to need to take off the rest of the day.”

“Is everything all right?”

“Well…”

Man, how do you put something like this lightly?

“…Renee has a benign brain tumor.”

I guess you don’t.

“Oh…wow…um…of course you don’t have to come in. You know that.”

“Thanks. I’ll tell you more tomorrow.”

2:45 PM: We’re back in another waiting room. I don’t bother to look for Golf Digest this time. The woman at the registration desk calls Renee up to ask her a few questions. One of the questions is why does she need the blood test. Renee tells her she needs to find out if she’s pregnant because she was just diagnosed with a brain tumor. The woman visibly flinches and looks at Renee sadly.

3:00 PM: Minus a few cc’s of blood, but plus one sore arm (they always have trouble finding her veins), Renee returns to the waiting room and we head off to pick-up her referral for the upcoming neurosurgery appointment.

3:15 PM: Thankfully the line is short and Renee is able to reach the referral desk fairly quickly. Again she is asked about her medical problem. Again she says a brain tumor. Again the woman at the desk flinches. And again she looks at Renee sadly. This time though, the exchange makes me smile. Renee is already starting to accept the meningioma as hers and the tone she uses projects a “Yeah, I gotta brain tumor. So what?” attitude. It’s a remarkable turnaround from sobbing on my shoulder less than an hour before.

3:30 PM: Finally, we leave Jefferson. Being in the car together is the first time we have been alone since the meningioma diagnosis and it is surprisingly unemotional. Renee has already had her moment, I refuse to have a moment, and we both feel pretty drained from the day’s events. Mostly we just rehash everything we’ve learned today and compare notes on what we remember. I try to give Renee a quick Brain Anatomy 101 review, but it’s been over five years since I had Neurology in school and I struggle just to come up with the names of all the lobes.

Renee wants to stop and pick-up a home pregnancy test and I can’t blame her. As dire a situation as Dr. Sergott made pregnancy seem, I don’t want to wait until tomorrow to find out the results of the blood work.

“We could just stop at Davis Pharmacy off of Baltimore Ave.”

“OK.”

“I thought you were going to stop somewhere and get one yesterday. Remember, my mom said I should take one before seeing the doctor.”

“I did stop somewhere yesterday…they didn’t have any pregnancy tests.”

“You did? Where?”

“7-11.”

“7-11! Of course they don’t have home pregnancy tests at 7-11. Did you really think they would?”

“Well, it was the only place I pass coming home from basketball.”

“There’s a CVS on the same road.”

“OK! I was thirsty and wanted a Big Gulp.”

“Oh, brother.”

“I know.”

3:45 PM: Who knew there were so many different types of home pregnancy tests? At least 8 or 10 varieties, most of which look exactly the same to me. What’s the difference between an early pregnancy test and a regular pregnancy test? If you’re taking a home pregnancy test, aren’t the odds pretty high that it’s early in the pregnancy? Renee is studying each box like she actually knows what she’s doing…maybe she does. I quickly lose interest and become much more fascinated with a box labeled “Men’s Shaving Powder”. Do people still use this? Renee decides on a pregnancy test, buys three, and we head home.

4:00 PM: We no sooner get in the house and Renee makes a beeline for the bathroom. I feel like I should be doing something to prepare, like reading scripture or saying a prayer or something dramatic. Instead, I go into the bedroom and lie down, a more than appropriate response in my opinion.

4:01 PM: Renee yells at me from the bathroom to come in after two minutes have passed. I stare up at the ceiling.

4:03 PM: I walk into the bathroom to find Renee sitting on the commode and the pregnancy test lying upside down in the sink.

“Did you look at it?”

“No, you look at it. I turned it upside down so I wouldn’t see it.”

“How do I know if it’s positive?”

“You’ll see a plus sign if it’s positive, a minus sign if it’s negative.”

I grab the box from the trash can and look at the directions just to be sure. She’s right. However, I’m positive she’s not going to be pregnant. I mean really, we just started trying, like, two weeks ago. Two weeks ago!

I grab the indicator, say a quick prayer (something like “God help us all.”) and flip it over.

Plus sign.

I stare at the indicator for several seconds, trying to figure out exactly what it is trying to tell me. Renee asks what it says and I hand it to her. I look at the instructions again to find out when a plus sign actually means a negative reading. No mention is made of this phenomenon. The horizontal line of the cross looks faded to me, but again, no mention is made of this in the instructions. Renee is the first one to speak.

“I can’t believe I’m pregnant.”

“Well you know, those things aren’t always completely accurate.”

“Derek, they’re like, 95% accurate or close to that. I’m pregnant.

“But how is that possible? It would have had to have happened, like, on our first shot.”

“Well, then it probably happened on the first shot.”

“Let’s just wait and see what the blood work says.”

“Derek, I’m pregnant. But just to be sure, I’ll take another one.”

“All right.”

Plus sign, again.

4:30 PM: Renee calls her parents to let them know what’s going on. I don’t ask if she’s going to tell them about the pregnancy or not, I already know. Renee’s inability to keep a secret or withhold information is commonly joked about on both sides of the family. I’ve had countless conversations that begin with Renee saying:

“I’ve got a surprise for you.”

“What is it?”

“I’m not telling. You have to wait.”

“OK.”

5 minutes later.

“Aren’t you curious?”

“No, not really.”

5 minutes later.

“Should I tell you what it is?”

“Sure.”

And then she proceeds to tell me about the big surprise and/or secret. It’s a rare Christmas or birthday that I don’t know ahead of time what present she’s giving me. So I know there is no chance of her holding back on the pregnancy, especially not with her mom. I can only hear one side of the conversation, but Renee is doing most of the talking.

“Hi Mom, how are you?”

“I’m doing all right, I guess. We’re finally back from the doctor.”

“Well, there’s good news and there’s bad news. The good news is that I’m pregnant.”

I look at her when she says this. In my opinion, she’s giving the info in the wrong order. She should give them the bad news first and then cheer them up with the good news. Telling them about the pregnancy first is going to make the news about the tumor hit that much harder.

“Thanks! Yeah, I can hardly believe it either. I took two pregnancy tests and they were both positive. I did get blood work done, so I guess we’ll know for sure tomorrow.”

“The bad news is that they found a tumor on the lining of my brain.”

My ears prick up. She needs to tell them it’s benign.

“It’s called a meningio…meningie…meningo…Derek, what’s it called?”

“Meningioma. Renee, tell them it’s benign.”

“Meningioma. It’s pushing on my optic nerve and that’s why I’m having vision problems.”

“Tell them it’s benign.”

“Yeah, you could really see it on the MRI. It was this big white blob in the middle of my head.”

“Tell them it’s benign.”

“If you draw a straight line from the bridge of my nose through the back of my head, and then another line from one ear to the other, where they intersect is where the tumor is located.”

I’m going nuts. It’s been five minutes since she told them she has a brain tumor and as far as they know, it’s malignant. They must be freaking out.

“Mom…they’re going to do a craniotomy. They’re actually going to take out a piece of my skull, remove the tumor, and then put my skull back together.”

“Renee, please, please, PLEASE, tell them it’s benign!”

“Oh yeah, they said the tumor’s benign.”

Just a little detail we thought you should know.

5:00 PM: Next, Renee calls Anson and his wife Hannah. She tells them the whole story and Hannah, a resident at Jefferson’s Family Medicine department, invites us over for dinner to talk. They’re having ribs. We’re there!

6:00 PM: We leave for H&A’s later than expected, but this time it’s my fault. Barkley’s been ignored the whole day and I decide it’s better to take him for a walk now then worry about it later tonight.

I can tell Renee’s spirits have picked up as we are driving in to Center City. She’s happy to be going out and is anxious to show Anson her MRI’s and talk to Hannah about the pregnancy. Seeing her in a better mood cheers me up, as well. I don’t think either of us wanted to be alone tonight.

6:45 PM: Oh man, these ribs are good! I usually don’t think ribs are worth the effort to cook, for all the more meat they offer, but if someone else is doing them, that’s a different story! Conversation is obviously centered around the day’s events, but the tone isn’t too serious. I can feel some of the stress from the day begin to lift and seeing Renee laugh and smile helps tremendously.

7:15 PM: Renee whips out her MRI’s and hands them over to Anson. He seems slightly uneasy to be looking at the films of his friend’s brain, especially the ones with the tumor so obviously present, but he is a good sport and studies them intently before offering his analysis.

“It looks to me as though the viola playing part of the brain is very large, but the card playing part has atrophied quite significantly!”

Renee, a professional violist, finds this hysterical. We’ve had a running cards competition with the Miedels for several years, primarily in hearts. Renee has never lived down calling Anson a “little dork” after he gave her the queen on one particular hand. He claimed it wasn’t the “dork” part that bothered him, but rather the need to throw “little” in front of it.

We run through a laundry list of questions for them, and they answer all of them as best they can. Really, they don’t tell us anything different than we’ve already learned today, but there is something reassuring about having everything confirmed by a friend.

8:30 PM: We’re both quiet almost the entire trip home, a combination of fatigue and being lost in thought. I try to get a feel for how my own emotional state is, but I have too many things running through my head to really get a good focus. The dominant thought I have is that I can’t believe I just found out that my wife has a brain tumor and is pregnant on the same day. That’s overwhelming everything else in my head right now, and for good reason. Renee looks over and smiles at me.

“We’re going to have a baby.”

I sure hope so.

9:00 PM: Renee makes a pit stop in the bathroom and then heads straight to bed. The exhaustion of the day has finally won out over the stress and excitement. She stays awake long enough to say goodnight and is asleep before I crawl in beside her. My mind is racing like it used to after cramming all day for a final exam and I know that attempting sleep is going to be an exercise in futility.

9:10 PM: “…batting seventh and playing left field, Pat Burrell. Batting eighth, shortstop Jimmy Rollins. Batting 9th and warming up in the bullpen, pitcher Kevin Millwood.”

Reciting the Phillies line-up is usually a sure-fire way to put myself to sleep. Tonight, I breezed through all nine starters and am starting in on the middle relievers.

“Turk Wendell, Dan Plesac, Rheal Cormier…ah screw it I might as well just get up and watch the Eagles.”

10:00 PM: Watching Tampa Bay stomp all over an embarrassingly inept Eagles team has brought a level of clarity to my thinking. I’ve calmed down enough, or at least grown tired enough, that the activity level in my brain has died down and my thoughts are starting to line-up.

It appears to me that what we are facing is a choice between the health of Renee and the health of the fetus (I can’t bring myself to say baby. Fetus is a good sterile clinical term that keeps me from feeling too connected to it.) If what Dr. Sergott says is true, then the pregnancy may cause the tumor to grow faster and the longer we wait, the worse her symptoms will get. On the other hand, if we do the surgery too soon, we run the risk of damaging the fetus. So we have to decide…no not we…Renee will have to make her own decision and I’ll have to make mine. So I have to decide between potential blindness or worse for my wife and possible deformity or spontaneous abortion of my unborn child.

How am I supposed to do that?

The ultimate frustration is that there is nothing I can do about it. Nothing, nothing, nothing, nothing. Oh sure I can pray and be supportive and yadda yadda yadda, but I can’t do anything. I can’t protect Renee from the tumor. I can’t take it away from her. I can’t do anything.

At different points during the day my eyes have felt like dams bursting at the seams. I fought hard to keep back the tidal wave of tears and I’m fighting now.

10:01 PM: I continue fighting.

10:02 PM: Still fighting.

10:03 PM: I give up.

Advertisements

3 responses to “Dear Doctor, Thank You.

  1. Beth Brillinger

    Hey Derek, you and I have known each other for a long time and worked together. I am touched by this story. I am so affected by “life aligning” stories like this. So many people have had these kinds of situations where life hits you in the head with a baseball bat (SMASH). And often, the care of a team of doctors is so crucially involved. My baseball bat moment – I lost my brother to Stage IV Lymphoma almost 2 years ago. We had a 48 hour “notice” before we lost him. The surgeon who operated on my brother (my brother did not awake from the anesthesia, his bone marrow and blood cells were not working properly) stayed with us to the end and answered all of our questions, and shared his own experience of losing a brother. The healthcare team has so much influence on the devastating experiences we all have the potential to face, and I’m proud to be a small part by doing my best work in our CME profession. I am so happy when I hear stories like yours because I don’t wish my (and my family’s) experience upon anyone. So yes, Thank You, Doctor for taking care of all of us.

  2. Thanks for sharing, Beth, and my sympathies to you and your family on the passing of your brother. It’s easy to become numb to the content and value of what we as CME professionals do. Sometimes it takes stories like these to remind us.

  3. I’ve read your story I don’t even know how many times now. And each time, well, to say it’s touching is really understating it. So yes, thank you doctors. For my family, it’s the primary care doc my dad had and my mom still has. Two totally different situations that she handles with care, consideration, knowledge, and honesty. All I can ever ask of a doc who needs to know it all about complicated issues. I can only hope the myriad of GREAT CME out there aids her natural tendencies.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s