"Love A Goat, For All I Care!"

As everyone knows, Vice President Biden let loose with another (seemingly) unsanctioned comment this past weekend on NBC's Sunday morning talk show,"Meet the Press," when he replied that he was "absolutely comfortable" with the thorny topic of same-sex marriages as well as supporting parity with rights accorded to those in "traditional" marriages.

Within minutes, the offices of both the President and Vice President went into hyperdrive in an attempt to walk back his off-the-cuff comment by releasing statements hoping to assuage various potentially untenable voting blocks.

In the two days since the Biden interview, Press Secretary Carney has been inundated with question after question from the press hoping to elicit salacious information for columns purporting potential rifts within the administration.

His steadfast reply, despite the single-minded stream of consciousness of the reporters, is "the President's stance on same-sex marriage is evolving."

This is one of the facets of politics that drives me bonkers.

Vice President Biden, in my opinion, may have answered the question honestly ~ as average citizen Biden might have done if asked. But during a crucial election year, no White House can afford having one of the President's minions going off the reservation by making rogue, unsanctioned comments. Once the wheels of a Presidential campaign are in full motion, every syllable and turn of phrase is vetted and tested by pollsters before any candidate or spokesperson utters a word. Modern Presidential candidates don't enjoy the luxury of being spontaneous or brutally honest with the end result being that their true beliefs are often intentionally blurred so as not to offend an essential voting demographic.

Rest assured that President Obama and former Governor Romney, like Mr. Biden, each has a definitive view of same-sex marriage; I suspect the public will not be privy to an airing of the victor's unvarnished opinion until after the election in November ~ unless the comments by Biden quickly followed by those of Secretary Duncan (Education) were intentionally fed to the media as part of an overall strategy by the Obama campaign.

Being neither the President nor a candidate running for office, I am free to offer my view on the subject.

When it comes to matters of privacy, my general credo is this:

When the day comes that the affairs of my house are completely in order; when I have no pressing problems or indebtedness; when there remains no single task which demands my attention, then and only then will I allow myself the luxury of even considering if I should involve myself in the private lives of others.

I have often told friends that when it comes to matters of the heart, my personal opinion is that a person can "love a goat for all I care!" There is "an edge of truth to my jest." It has never been nor will it ever be my prerogative to involve myself in the matter of whom others should or should not love; the choices people make for the sake of their personal happiness and in the name of love is not for anyone to judge.

Can I say I have never harbored concerns about an individual a friend might be dating. Yes. Have I always agreed with the ultimate choice a friend or family member has made in a life partner. Absolutely not! However, when push comes shove, it has never been left to me to determine who is best suited for whom when choosing a spouse.  Thank God.

As for this business of same-sex marriages, people are entitled to their fundamental disagreements and concerns. One might be justifiably opposed to same-sex marriage on the basis of a strongly held religious belief or even a personal sense of morality. Or, one might simply be homophobic, bigoted or wholly ignorant about the actual world that ~ like it or not ~ exists outside of every closed mind and door; even these individuals, sadly, have the right to their opinion. I will never hold someone's opinion against them so long as their views are expressed respectfully and intelligently without vitriol or malice.

At this writing, some thirty states have enacted laws that prohibit same-sex marriages. And the state of North Carolina, just moments ago, passed a statewide ballot initiative which has resulted in ratification of a State Constitutional Amendment to protect a ban already in place from being usurped by the judgement of a lower court in the future.

Despite these significant efforts as well as hundreds of newspaper articles and op-ed pieces I have read over the years, for the life of me I have yet, to my satisfaction, been given one sound explanation as to how a private decision between two adults of the same sex who decide to marry one another somehow adversely affects society.

As best I can tell, there hasn't been a demonstrable uptick in petty or violent crimes committed by these couples in states which have sanctioned the marriages. And unless I am grossly misinformed, malevolents like Richard Nixon, Bernie Madoff and Osama bin laden were never married to men.

I would honestly welcome reading a well-articulated, reasoned social justification for banning same-sex marriages (that doesn't invoke the tired arguments of old).

In the meantime, each of us has enough on our private plates to last a lifetime; tend to your home, your loved ones, your problems … or even your goat if that makes you happy.

Everyone else, in my opinion, should just mind their own business! 

Blame The Fat Guy

I had heard too many horror stories and finally decided to take the collective advice to heart. As a result, with few exceptions, I made the decision to no longer open email that has been forwarded to a thousand other recipients before arriving in my virtual mailbox. Despite CAPITALIZED, exclamation mark-laden subject line warnings of dire consequences if erased, I now make it a habit to delete questionable emails without a second thought, assured (hopefully) I don't miss out on much.

There are a few individuals, however, who qualify for a summary exemption from this rule. I have no hesitation opening email with (somewhat) juvenile humor (to most) that makes me laugh out loud in the otherwise quiet of this room ~ all from a few friends who never fail to deliver.

A Urologist from Florida (why that is important I don’t know) recently sent this picture which reflexively propelled a slug of Diet Coke out of my nose:

GIRL SCOUTS - Maybe Next Time You'll Buy The F****** Cookies

I haven't seen a look like that since, "Children of the Corn."

This picture – or any mention of Girl Scout cookies for that matter – never fails to make me smile and often laugh; it takes me back to the waning days of my Residency, and to memories of Lemon Cream Girl Scout Cookies.

~~~~~~~~~~~~~~~~~~~~

I enjoy a cookie as much as the next guy, but for the life of me, I don’t understand the sway Girl Scout cookies hold over most people.

Every year, countless Mother’s herd pre-pubescent daughters to grocery stores with folding tables and boxes of addictive cookies in tow. The first take home lesson for a Girl Scout newbie is the art of “lying in wait” for any food-starved, grocery shopping unfortunate who makes the fatal mistake of inadvertently crossing her path. Every year, I vow to keep all four eyes open to avoid these all-too-cute, juvenile ponzi-schemers, but as sure as an unopened roll of Thin-Mints lies frozen in my freezer, I always fail.

What happened to the old days when these uniformed, fresh faced purveyors of saturated fat were forced marched door to door hawking their heart-clogging wares? Perhaps, the change of tactics was borne out of an abundance of caution; there are, after all, crazy people about? If even a glimmer of realism exists in the picture my buddy sent, we would all be wise to rethink the notion of who should actually be afraid of whom?

~~~~~~~~~~~~~~~~~~

My Girl Scout story occurred during the season of "The Cookies" which comprised those last few months of my Residency.

I finished my first case of the day, had seen the patient settled into the CVICU, and then headed to the OR office to take a short break before another patient arrived. As is the case in most offices this time of year, there happened to be several boxes of the damned (not-even-very-good) cookies strewn about one of the tables. This was Clarice’s evil way of foisting her intention on all of us to, “eat them before I do!”

Being a lowly, underpaid Resident, who was I to argue with free food?

I began by eating a single Lemon Cream cookie. While it tasted pretty good – certainly better than most – I only intended to eat the one. I also have a vague recollection of an unexpected delay to my next case, so – of this I am almost certain – I probably did go on to eat at least one more Lemon Cream. Beyond this my memory is a blur.

Anyone who has come through the (formerly) rigorous, long hours of clinical training both in Med School and Residency would agree the crazy lifestyle inculcates a manner of eating which surely would disgust most of our parents. The mere sight of a Drug-Rep (at feeding time) still has a pavlovian effect of begetting, in me, the appetite of a vulture on carrion. During those long days and nights of training, once food was secured (preferably free), all interns and residents learned to shovel it down  ~ all the while trying to remember to breathe between bites.

So, in fairness to me, considering many years of this frenzied, mindless feeding, I would concede only to a remote plausibility to one of the eventual rumors that had me finishing off an entire row of Lemon Creams. But, an entire box? Are you kidding me? The thought actually disgusts me.

What I DO know with certainty is that, at some point, the surgical delay was overcome and I headed over to the holding room to greet our next patient.

~~~~~~~~~~~~~~~~~~~~

An hour or two later, a fellow Resident and friend, Pat Cooney, DDS MD, entered my operating room in a pique of pseudo-anger barking,

“Hey, Marvin. Did YOU eat all of Dr. Nelson’s Lemon Cream Cookies?”

I do recall laughing at the thought of what he had asked; not knowing (remembering) if there was any proof substantiating the allegation, I obviously replied, “No.”

Cooney followed with a definitive,

“Well, it sure as hell wasn’t me!”

Only later, once free of the Operating Room, did I finally learn what had transpired before his interrogation:

(Dr. Nelson, Alan Alda look-alike, mentor and boss, walks into the OR-side departmental office intending to eat one of his precious Lemon Cream Girl Scout Cookies. Allegedly finding only an empty box, he directs his inquiry to Clarice, his trusted aide-de-camp/Girl Friday/brains of the operation):

Dr. N: “Clarice, do you know who ate all of my Lemon Cream Cookies?”

Clarice: “No; the only person I have seen lately is Cooney.”

(Cooney Enters)

Dr. C: “What’s hangin’?”

Dr. N: “Cooney, I came in here expecting to enjoy a Lemon Cream Cookie but it appears you beat me to it! Hell, you beat me to all of them!”

Dr. C: (Indignant) “Sure, ........... BLAME THE FAT GUY!”

Pat has an entirely different take on the story (which probably speaks more to years of exposure to inadequately salvaged Nitrous Oxide while a dentist):

"You (as in me) and I were coming back from pre-op-ing patients, around 18:00 hours. We ran into one of the perfusionists who told us about the Girl Scout cookies in the office. Then as YOU were in the process of eating ALL of the Lemon Cream cookies, I told you to ease up because, in the end, when Nelson finally realized all of his precious Lemon Creams had gone missing, everyone would blame the Fat Guy!

The next morning, I got in to the office before you had a chance to tell Clarice your biased, sanitized version -- because I KNEW what you would try to do and was determined to beat you to the punch.

When you walked into the office trying to frame ME for YOUR gluttony, the cat was already out of the bag!"

(And, I am CERTAIN everyone believed the FAT GUY had nothing to do with the disappearance of all those cookies, Pat!)

~~~~~~~~~~~~~~~~~~~~

A few months later as the academic year drew to a close, Dr. Nelson et al presented both Pat and I with two very large, gift-wrapped boxes. Having expected a golden laryngoscope, I was truly excited at the prospect of what could possibly come in such large packages!

As it turns out, Dr. Nelson found himself passing through Chicago O’Hare airport in the weeks that followed the drama that became known as the "Day of the Missing Lemon Creams." While waiting for a flight, he fortuitously happened onto yet another prostituted Girl Scout who was desperate to sell the last of her cookies ~ she desperately wanted to get home to play her Grand Theft Auto video game.

He wasn’t the least bit interested in her Tagalongs, Thin Mints, Do-Si-Dos, Somoas, or Shortbread.

He had but one request on his mind. Actually, two.

Two cases of Lemon Cream Girl Scout Cookies.

~~~~~~~~~~~~~~~~~~~~

For the record, I don't eat Lemon Cream Girl Scout Cookies; the fact they are no longer sold is irrelevant.

Medicine -- High School Years

In addition to a general dislike for anything relating to physicians, there was little in my background that would have pointed to a career in medicine. As my youngest brother approaches his graduation from medical school, I started thinking of what led me to practice medicine.

This is my story ... the High School Years.

"Been there, done that." "No way in hell." These are the common answers people offer when asked,

"If given a chance, would you revisit your high school years?"

With one caveat, my response would be, "In a heartbeat."

I absolutely loved high school and never willingly missed a single day.

High school was an insular environment in many ways. We were all first segregated by age and class rank which afforded an inherent sense of belonging; twenty years down the road ~ popular or not ~ one would always be a "member of the class of ~ what have you." As a student you were further encouraged to integrate into the various social and athletic constructs. While I was a proud member of the Conference and District championship swimming teams, I doubt this qualified me for the revered "jock" status reserved for football and basketball. Regardless of where one ultimately settled into the mix, we were a "family" of sorts. This provided a good deal of comfort to me.

Education was the means to an end.

To be certain, each of us was enrolled in school to get an education. But studies often seemed to be more the price of admission we each had to pay in order to reap the benefits of an even greater wealth of fun and entertainment. The first bell at every hour would have everyone searching the halls for this friend or that. The final bell and simultaneous closing of all the doors would then have every student safely ensconced within a room of thirty different friends or acquaintances all of whom were fodder for another fifty minutes of mutual entertainment ~ and education.

Looking back, I still have difficulty imagining my friends being forward-thinking enough to actually plot a course of study for the next four years while a freshman. I had initially assumed all of us would take the same compulsory courses weaving our way through high school in goose-step fashion. I had no idea we were going to be asked to make choices. It was only after our freshman year was well underway that I realized just how poor my choices had been.

Erudition aside, words are a passion of mine.

Imagine, then, the horror ~ two to three weeks into the school term ~ when I suddenly found myself lost during conversations with friends as they discussed the esoterica of Biology and French ~ courses I had opted not to take. In short order, I had summarily exempted myself from participation, impotent as I sat listening to friends speaking in "languages" I didn't understand. For someone who thrives on conversation, this drove me to distraction.

I would guess there is nary a person who has endured high school who wouldn't admit to wanting to "belong" rather than setting themselves apart. Yet, through a lack of foresight or guidance, I had single-handedly managed to accomplish this by signing up for a less than prodigious workload. Not immune to the crazed need to fit in, in addition to an overarching drive to not be isolated from conversation with friends, I made the conscious decision to correct my mistake.

My best friend, Kevin, had taken Biology 1. I took Biology 1 the following year.

My good friend, Julie, had signed up for French 1. I took French 1 the following year.

Thus, the story of my high school academics became a game of "catch up." It was embarrassing.

As we eventually approached our senior year, all the "cool" guys were signing up to take a course called, "Bachelor Living." There was a concerted move afoot to assure that the men of tomorrow would at least know the rudiments of cooking and sewing. Whether or not I truly wore the imprimatur of "cool" is debatable, doubtful, OK, so I wasn't, but I signed up for the course nonetheless; I suppose I may have hoped it might wear off on me by association.

While I truly enjoyed the semester of cooking, I had absolutely no intention of spending five months sewing a shirt. I had other plans.

Having discovered a true passion for Biology in the three years since the embarrassment of my freshman year, I had ravenously consumed every course offered by Ms. Redden and Mrs. Whipple ~ the much revered and dread Biology teacher of lore. Still paying a price for that freshman mistake, the most coveted course she offered still seemed out of my reach. Senior Anatomy and Physiology was offered only to those students who had completed every prerequisite course -- I was currently enrolled in the one course which would have assured my admission.

There was also the little problem that this course was held during the same hour as my "sewing" class.

Don't ask how I managed; I honestly do not remember. But, with the inexplicable agreement of Mrs. Hoax, the easy going Bachelor Living teacher, I was allowed to "skip" the entire semester of sewing all the while (somehow) inserting myself into the Anatomy and Physiology class.

I had arrived during the vaunted semester of "the cat."

Over the years as people invariably come to ask how it is I decided to pursue a career in medicine, I generally begin by speaking of "the cat." While the sacrifice of that cat certainly played a role, there are many others who were also central to the decision.

Mrs. Hoax, Ms. Redden, Mrs. Whipple, Mr. & Mrs. Bucker, "Mimi" & George Stewart, Mr. Glidden, Mr. Earnhardt, Kevin, and Julie ~ they and countless others ~ played some integral role in paving the road to my future. It is a shame I have never before sat and pondered this until now. I am convinced people are generally unaware the impact they have on others in ways great and small. What I wouldn't give to have the opportunity to let each of them know how grateful I am simply for having had the opportunity to spend those four precious years alongside them. To let each of them know how they unwittingly helped to guide me to an uncertain future.

"If given the chance, would you revisit your high school years?"

In a heartbeat, but only if I was allowed to bring all the lessons I have learned along the way.

(Including Mrs. Hoax's tried and true method for a kick ass omelet!)

November Looms

Emma: I want you to tell them it ain't so tragic! People do get better!
Patsy: What do you want me to do?
Emma: Tell them it's OK to talk about the cancer!

from the book, "Terms of Endearment"

During the phone call, a family member was struck by the fact I had not informed everyone. She wanted to know how my complete circle of friends and acquaintances could not be told.

I had my reasons.

I was also free to change my mind.

For the past couple of years I have been under treatment for cancer.

It all began as a nagging point of tenderness in my chest ~ just where my sternum meets with one of my ribs. With one finger, I could isolate the pain and "rub" it away. It went on this way for another couple of months or more ~ no better and no worse. It was tolerable.

Until the night I was awakened by a breath-robbing pain elicited by simply turning onto my side. This was definitely not normal by any stretch. I chose to ignore it anyway.

It did not take long, however, for me to realize I could no longer fool myself into believing the pain might be inconsequential.

I enjoyed a momentary reprieve, however, after talking with some of my colleagues, all of whom were certain the totality of my symptoms pointed to a nerve root compression injury from working out. "We are tired of watching you rub your chest ~ go order a damned MRI and get the problem fixed."

It was not a nerve root compression injury.

The MRI isolated a golf ball-sized mass encroaching on the neurovascular bundle under one of my ribs.

Following an extensive evaluation, a diagnosis was returned: In oncology-speak, the mass represented a high-grade, 3BE Anaplastic Large Cell Lymphoma.

This past March I drove to the cancer center to undergo yet another round of RCHOP21; my second complete course of chemotherapy (due to failure of initial treatment or relapse). As I sat in the waiting room of the lab, I heard my name being called. The woman shouting my name was clearly not one of the lab technicians; she was either a physician or a nurse.

She came forward and introduced herself to me, asked a few probing questions and then left the room. She repeated this process another two or three times before finally explaining that, "the head of the BMT Department would like to speak with (me)." Huh?

I was then ushered into a nearby conference room where a physician (I had never met) was seated at a table reviewing my treatment records. What?

Without wasting a breath, the stranger proceeded to inform me that, as a specialist, he was not confident I would be able to, "see (my) way to a cure without a transplant."

I felt dizzy. "What kind of transplant?" (A stupid question but I was in shock.)

Seeming to appreciate my confused state, the physician hesitated and then smiled as he replied, "A bone marrow transplant, Dr. Marvin."

I am currently biding my time as I await another diagnostic biopsy this November. My transplant future will depend on the outcome of this test.

So, going back to my relative's initial concern. Why haven't I told everyone about the cancer?

Simply put: I enjoy normal conversations with family and friends.

"How are you doing?"

Sure, it is a simple question. But this most common of questions takes on considerable heft when tainted with the knowledge of someone's treatment for cancer. You soon realize every answer is incomplete until you have again addressed the "cancer."

Please don't misunderstand. I appreciate the care, concern, and compassion extended by all my family, friends, and strangers alike. The prayer groups and support I have enjoyed have been a source of great comfort.

After a period of time, however, this patient wanted to be asked that simple question from someone ~ anyone ~ who wasn't aware of my medical condition. I craved normal conversations with people who were only interested in knowing, "what kind of great stuff has been going on in your life?"

This begs another logical question: If this is truly how you feel, why write about the cancer now?

As much as I would like to believe I am living a normal life, I am not. At least for the time being.

I am tired of keeping separate the mental lists of those, "who know," from those, "who don't know."

I am tired of circumventing questions and responding with "half-answers."

And, I am tired of hurting those who, once they have discovered my situation, are slighted by my apparent inability to trust them with the information.

This IS my life. For better or for worse.

I feel great at the moment. I am not now nor have I ever sought anyone's sympathy. I hope anyone who may feel slighted would accept my apology. Your understanding and support wouldn't hurt, either.

In a few months, I will know what my future holds; I remain an eternal optimist.

And, I honestly don't mind if family and friends continue to feel compelled to ask about the "cancer." But do me a favor ~ balance those concerns by also asking,

"What kind of craziness have you been up to lately?"

"You Been Goofing With The Bees?"

I hate -- that is a strong word -- "very much dislike" on-line "quizzes." For the life of me, I don't understand why anyone would want to know if I like "broccoli," or if I am a "birdwatcher?"

Regardless, a friend recently forwarded a multi-question interrogatory my way. Generally, I would have dismissed the quiz out of turn; had it been sent by almost anyone else, I surely would have relegated the test to its rightful place in the wastebasket of the Ethernet.

50 questions.

I began by answering with bored, monosyllables but soon found myself elaborating. Worse, I later "got to thinking."

Question 47: How many tattoos do you have? None. Unequivocally, NONE.

Not that I have anything against body art; I actually believe tattoos, in moderation, suit some personalities. (But seriously, why would you tell me on Sunday you have no money to pay bills, then proudly celebrate a brand new "tat" on Monday?)

My issue with tattoos is long-standing but has nothing to do with ink.

I am trypanophobic -- I am terrified of needles.

Question 26: "What did you want to be when you were little?"

When I was five, I wanted to be a firetruck. I had issues.

If alternatively asked, "what could I see myself doing as an adult?" I may have answered that I wanted to be funny -- like Dick Van Dyke. But, I most certainly also wanted to be a physician.

I somehow managed to accomplish both; although one of my patients is always quick to (re-)assure me that, "(funny) looks aren't everything."

Again, I very much dislike -- no, really hate -- needles. How did this needle-phobic kid become a physician?

Summers were spent outdoors; there were no computers or video games. There was also the dictum that children were "meant to be seen -- preferably outside." So long as a summer sun ruled over our street lights, we ran and ran and ran. This amount of time accorded me the opportunity to accumulate a great wealth of (dis-)information from "knowledgeable" siblings and friends.

One valuable lesson handed down -- and confirmed by the singer, Nilsson -- declared: "Don't be goofing with the bees." The rule, in my mind, logically extended to anything with a stinger. I had personally witnessed pain and suffering inflicted on countless friends by these flying marauders; while it wasn't a pure case of schadenfreude -- my general thinking was, "better them than me!" The take home lesson: anything with a stinger is bad.

So, given this construct, why would anyone believe I could somehow grant special sanction to man-made "stingers" attached to syringes filled with potentially life-saving vaccines or not?

My family eventually came to expect it. I suppose it may very well have been embarrassing for them; not for me.

As a result of my fear, I spent a great deal of time as a kid running and screaming through sundry doctor's offices in failed attempts to avoid moustached, pointy-hat wearing, syringe-wielding nurses in white. It was just too bad if you happened to get in my way; I was going through you, "come hell or high-water." In the end, unfortunately, the Cloris Leachman-esque nurses of my youth always had their way with me; they had help -- I clearly understood THAT tone in Mother's voice.

The logic escaped me. Why would anyone voluntarily sit still for the infliction of any pain? Seriously, which of us was truly smart? On one hand, you had an automaton of a child who unflinchingly sat "like a good boy" while under a parent-sanctioned assault. Or, as in my case, you had a boy who dared question -- strenuously -- the necessity of being needled by some stranger. My parents had always told me to use my head -- well, my mind, heart, and accumulated life-lessons called on me to rise up and "fight the man."

Perversely, I later opted for that career as a physician -- with a license authorized by the state to stick ridiculously large bore needles into the persons of my patients. The object of my dread as a boy has now become one of the tools of my trade. Ironic - perhaps even hypocritical. 

Question 22: Birdwatcher? I have never personally seen a tufted tit-mouse.

Question 42: Broccoli? I do like broccoli. Blanched with a squeeze of lemon. Have recently been told to try a broccoli garlic mache?

Question 47: How many tattoos do you have? None.

I DO hate on-line quizzes.

And, I recently had a tetanus shot.

I took it like a man; the bite marks on my hand were visible for at least a day.