Dr. Marvin

At the very moment countless thousands cross busy intersections; as men vie for parking spaces; flight and dinner reservations are made; couples marry; families picnic; and, as children are born and elders die, a momentous event will unfold for our family which represents the capstone on years of hard work as well as a moment certain to inalterably affect a destiny. So, while the rest of the world goes about the business of their daily lives this Saturday, my family will be in Washington DC standing witness as a green velvet-trimmed hood is placed around our youngest brother's neck, a tassel is moved to the left facement of a motarboard, and an ancient oath recited, thus marking Blake's graduation from Medical School.

It gives me pause.

Can this grown man possibly have been the same baby who once brought renewed life to our aging parents; the ever-smiling boy in footed pajamas, pacifier askance, who led a ritual family march to bed at night; the little boy who worshiped his “Dimmy” and “Dott;” the little boy in a red apron who ran to greet Dad after school; the disengaged “Rudy Kazooty" of T-ball games; the young boy who sat on the shoulders of my medical school classmates; as well as the all-too-young man who eventually eulogized his own father?

Is it really possible?

Thousands of memories are swirling through my head; it is admittedly difficult to grasp the reality that Blake’s life to this point has passed by with the proverbial “blink of an eye.”

When Blake graduated from high school in 2001, I gifted him a copy of the "blessedly brief graduation speech" written by Dr. Seuss, "Oh, The Places You'll Go." As I struggled to come up with words which could adequately speak to my feelings now as he prepares to graduate from Medical School, I couldn't help but reflect on the same little book. After re-reading the inimitable text, I decided it remains a perfect sendoff as he moves forward with the "Great Balancing Act" that will be his life; "Oh, The Places You'll Go" succeeds where I would have surely failed, imparting upon Blake a "lifetime of wisdom."

Congratulations!
Today is your day.
You’re off to Great Places!
You’re off and away!

You have brains in your head.
You have feet in your shoes.
You can steer yourself any direction you choose.
You’re on your own. And you know what you know.
And YOU are the guy who’ll decide where to go.

You’ll look up and down streets. Look’em over with care.
About some you will say, “I don’t choose to go there.”
With your head full of brains and your shoes full of feet,
you’re too smart to go down a not-so-good street.

And you may not find any
you’ll want to go down.
In that case, of course,
you’ll head straight out of town.

It’s opener there in the wide open air.

Out there things can happen
and frequently do
to people as brainy
and footsy as you.

And when things start to happen,
don’t worry. Don’t stew.
Just go right along.
You’ll start happening too.

OH! THE PLACES YOU'LL GO!

You’ll be on your way up!
You’ll be seeing great sights!
You’ll join the high fliers
who soar to high heights.

You won’t lag behind, because you’ll have the speed.
You’ll pass the whole gang and you’ll soon take the lead.
Wherever you fly, you’ll be best of the best.
Wherever you go, you will top all the rest.

     Except when you don’t.
     Because, sometimes, you won’t.

     I’m sorry to say so
     but, sadly, it’s true
     that Bang-ups and Hang-ups
     can happen to you.

     You can get all hung up
     in a prickle-ly perch.
     And your gang will fly on.
     You’ll be left in a Lurch.

     You’ll come down from the Lurch
     with an unpleasant bump.
     And the chances are, then,
     that you’ll be in a Slump.

     And when you’re in a Slump,
     you’re not in for much fun.
     Un-slumping yourself
     is not easily done.

     You will come to a place where the streets are not marked.
     Some windows are lighted. But mostly they’re darked.
     A place you could sprain both your elbow and chin!
     Do you dare to stay out? Do you dare to go in?
     How much can you lose? How much can you win?

     And IF you go in, should you turn left or right …
     or right-and-three-quarters? Or, maybe, not quite?
     Or go around back and sneak in from behind?
     Simple it’s not, I’m afraid you will find,
     for a mind-maker-upper to make up his mind.

     You can get so confused
     that you’ll start in to race
     down long wiggled roads at a break-necking pace
     and grind on for miles across weirdish wild space,
     headed, I fear, toward a most useless place.
        The Waiting Place…
          ... for people just waiting.
          Waiting for a train to go
          or a bus to come, or a plane to go
          or the mail to come, or the rain to go
          or the phone to ring, or the snow to snow
          or waiting around for a Yes or No
          or waiting for their hair to grow.
          Everyone is just waiting.

          Waiting for the fish to bite
          or waiting for wind to fly a kite
          or waiting around for Friday night
          or waiting, perhaps, for their Uncle Jake
          or a pot to boil, or a Better Break
          or a string of pearls, or a pair of pants
          or a wig with curls, or Another Chance.
          Everyone is just waiting.

NO!
That’s not for you!

Somehow you’ll escape
all that waiting and staying.
You’ll find the bright places
where Boom Bands are playing.

With banner flip-flapping,
once more you’ll ride high!
Ready for anything under the sky.
Ready because you’re that kind of a guy!

Oh, the places you’ll go! There is fun to be done!
There are points to be scored. There are games to be won.
And the magical things you can do with that ball
will make you the winning-est winner of all.
Fame! You’ll be famous as famous can be,
with the whole wide world watching you win on TV.

     Except when they don’t.
     Because, sometimes, they won’t.

     I’m afraid that some times
     you’ll play lonely games too.
     Games you can’t win
     ‘cause you’ll play against you.

     All Alone!
     Whether you like it or not,
     Alone will be something
     you’ll be quite a lot.

     And when you’re alone, there’s a very good chance
     you’ll meet things that scare you right out of your pants.
     There are some, down the road between hither and yon,
     that can scare you so much you won’t want to go on.

But on you will go
though the weather be foul.
On you will go
though your enemies prowl.
On you will go
though the Hakken-Kraks howl.
Onward up many
a frightening creek,
though your arms may get sore
and your sneakers may leak.

On and on you will hike.
And I know you’ll hike far
and face up to your problems
whatever they are.

You’ll get mixed up, of course,
as you already know.
You’ll get mixed up
with many strange birds as you go.
So be sure when you step.
Step with care and great tact
and remember that Life’s a Great Balancing Act.
Just never forget to be dexterous and deft.
And never mix up your right foot with your left.

And will you succeed?
Yes! You will, indeed!
(98 and ¾ percent guaranteed.)

KID, YOU'LL MOVE MOUNTAINS!

So…
be your name Buxbaum or Bixby or Bray
or Mordecai Ale Van Allen O’Shea,
you’re off to Great Places!
Today is your day!
Your mountain is waiting.
So…get on your way!

I hope no one will accuse me of being presumptuous when assuring you of how proud Dad would have been to be present in the DAR Constitution Hall as you take that walk across the stage to accept your diploma this Saturday afternoon, Blake.

Both he and your Mother would surely

Want you to always follow your most noble instincts,
Want you to always be a force for right and good,
Want you to defend the weak as they taught you,
Want you to always be brave,
Want you to know that whatever you do, or wherever you go,
     you walk with their blessing and love,
Want to you keep your faith in God, your humility and sense of humor,
Want you to allow nothing to deter you
     from getting what you want from this life,
Want you to know that while they may have had regrets or sadness in their lives,

     they have always been grateful to have you as their son.

Congratulations, Blake.

Let's Pretend

I don't know what to believe anymore.

I am also apparently too stupid to understand what is actually going on up on Captiol Hill in Washington, DC.

But mainly, I am in sensory overload.

"Deem and pass;" Reconciliation Bill; CBO Scoring; Deficit Reduction; Double-Counting Medicare Cuts; New Entitlements based on taxes already pledged to other programs; Cornhusker Kickback; trolling for votes.

One fact I know for certain is that the pharmaceutical giant, Walgreens, moments ago announced they will no longer accept new Medicaid patients come June.

The decision by Walgreens takes this process well beyond politics; the reality of the proposed Health Care legislation has officially landed at our doorsteps.

The Slaughter Solution

Otherwise known as "Deem and Pass," this is the proposed unconventional method expected to be used so as to enact the tenuous Health Care package. Essentially, it would allow the House to "deem the previously approved Senate bill passed" even with amendments and without a conventional vote -- none of which is proscribed by Article I, Section 7 of the Constitution.

So, what?

When Professor Alan Morrison of GWU Law School was asked to define the word "Deem" as it relates to this process, he replied, "In class, I always say it means 'Let's Pretend.' "Deem" means, it's 'not true.'" He went further to advise anyone considering use of the procedural maneuver in passing this landmark legislation "not to do it;" the Slaughter Solution would certainly raise Constitutional issues sufficiently credible for intervention by the Supreme Court -- as it has done in the past.

The high Court has ruled at least twice in the past twenty-five years holding there is but one way to enact laws under the Constitution -- identical Bills (same text) must be passed by both Houses of Congress and then signed into Law by the President.

And curiously, the 1998 Supreme Court decision which struck down the "Line-Item Veto" specifically spoke to this "same text" voting requirement; interestingly, two "friends of the court" briefs in favor the "same text" language were written by both Reps. Nancy Pelosi and Louise Slaughter.

Now, the self-same Rep. Slaughter, currently the House Rules Committee chairperson, has proposed using this "self-executing" procedure to craft a rule 'deeming' the Senate Bill -- even with the different (amended) language -- enacted without the need for a direct vote.

Our congressmen/women would be wise to remember the classic rebuke by the high Court in past rulings which warns "repetition of an un-Constitutional process does NOT make it Constitutional."

I absolutely have a vested interest in the pending legislation as a medical professional; at this time, absent the specifics of the reconciliation bill, however, all of us are left to simply speculate as to what will emerge with the passage of this legislation. And while I don't know what specifically prompted the decision by Walgreens, I am fearful that passage of this Bill -- especially with the stench of procedural wrangling -- will lead to further erosion in our collective confidence in elected officials and the democratic process, as well as the evolution of a potential avalanche of adverse effects for countless thousands in the months and years ahead. Walgreens may only be the beginning.

More important than my role as a physician, or even consumer, is my position as citizen.

Personally, I see this desperately flawed process, put into action so as to finagle passage of the Health Care Legislation, as an affront to the intent of our Founding Father's and as disrespectful to each of us as citizens. Let me be clear, if there is truly an urgent need to craft legislation that assures every citizen adequate medical coverage while maintaining fiscal responsibility, I am completely in favor of our elected Representatives and Senators working tirelessly toward that end. But I write this remonstration out of disappointment for the shameless move proposed by the House; circumventing the Constitution by enacting this massive Bill through the use of a clever -- if not un-Constitutional -- procedural maneuver is both reprehensible and ill-advised. The old adage reminds all to "be careful what you wish for;" rest assured, this debacle will morph into a never-ending and contentious battle for years to come.

This is not about Red or Blue. To my mind, this is simply about right and wrong. We can do better and deserve more from our Representatives.

Regardless of your point of view, I agree with even the most strident voices asserting each of us has a responsibility to make our opinion heard. The legislation will be enacted this coming Sunday; I implore everyone to take the time (and considerable patience) to make your views known to your Representatives.

Toll Free: 877-762-8762. Otherwise: 202-224-3121

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.

Trained Monkeys

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 ... Undergrad (Part II)

I am sure most everyone has experienced the feeling before.

I refer to the sense people often relate when arriving at some new destination or environment – and immediately feel at home. It makes one believe, “This is meant to be.” It could be an apartment, a home, a far flung college campus, or even a potential workplace.

From the moment I stepped into the frigid, sterile confines of a suite of operating rooms, I knew I had arrived.

My first wakeful exposure to an operating room came while a summer student at the Texas Heart Institute in Houston, Texas. Neither Marcus Welby nor any other television drama could have adequately prepared me for the excitement, tedium, and routine choreography of operating rooms that were to eventually become an integral part of my life’s work.

To my way of thinking, one unfortunate aspect of the "I want to get into Medical School" circus comes with a ridiculous mandate for pre-med students to work in some health-care related capacity prior to actually applying to medical school. While the notion is laudable, the requirement should actually come under the heading of “resume padding.” Many of my peers shadowed a beloved family physician or toiled at local hospitals drawing blood or carrying out other grunt work. I was always hard pressed to understand the degree to which most of us would actually form any valid conclusion about a future in medicine based on the experience of drawing blood or pushing patients around winding corridors. Regardless of my opinion, admissions committees at every medical school insisted on this vacuous demonstration of a serious intent to practice medicine from every applicant.

Pre-med students who could spend summers in the Houston area certainly had many options available to them which afforded the potential for truly eye opening experiences; some of these summer positions successfully offered more than a tangential sampling of the reality of medicine for medical wannabes.

The Texas Medical Center must surely be one of the largest in the world; from a distance, it appears to be a city unto itself. At last estimate, the complex employs well over 100,000, is home to two medical schools, a dental school, various nursing and allied health programs, world - renowned cancer and pediatric centers, one of the largest VA hospitals, multiple private hospitals as well as two world-class heart programs built by Dr. Cooley, and the late, Dr. DeBakey.

During the spring semester preceding my senior year of college, I learned that both of the heart programs in Houston offered highly competitive summer programs for prospective medical students. (A belated "Thank You" to Sally McDonald, (now) MD.) Having spent the majority of my college years immersed in Chemical Engineering studies, I was pretty much out of the pre-med loop and had no foreknowledge of either of the prized programs. I was beside myself with disbelief at my lack of prior initiative or insight; with the late date, I was clearly behind the eight ball and had to move quickly in order to realize any hope of securing one of these positions.

In a fortunate twist of fate, my parents “knew someone” who also happened to be a lifelong friend of Dr. Denton Cooley of the Texas Heart Institute. While a personal appeal to Dr. Cooley in support of my application was certainly helpful, my academic record would have to stand alone in order to support an appointment to the program.

Ask any friend who knew me during the interregnum after applying and each would probably cringe at the thought of my crazed anxiety as I awaited the decision. Like so many prospective medical students, I had somehow latched onto a notion that failing to secure this job could be a death blow to any future in medicine. (FACT: pre-med students are a breed apart.)

I was pleased and much relieved when a letter eventually arrived inviting me to be one of ten students who would spend the summer with Dr. Cooley and his associates. I would have liked to think my academic credentials propelled me across the finish line in good stead; when finally meeting my fellow summer students, however, I quickly learned many of them were the scions of referring cardiologists and other medical attending physicians, as well as family and business friends. For all my hard work in college, it had apparently mattered more that my parent’s physician/friend played college ball with Dr. Cooley. Beyond a moment of reflection, I doubt I gave it another thought.

It was very difficult as I bided my time through the completion of the term and finals, and then anxiously awaited a starting date of June 1st.

Following two days of orientation as well as an education in operating room decorum and hygiene, we were finally led down a winding staircase to the ten operating rooms which made up the heart of Dr. Cooley’s domain of old. Every day we were to consult a master OR schedule then make our way to an assigned room; we would remain in that operating room until all the work for the day was complete.

Imagine.

Dr. C and the Trained Monkey

It is 7:30 am. You walk into one of the ten operating rooms all of which are bustling with activity and a disarming ambient temperature of 55 degrees. All ten patients simultaneously have IV’s, central and arterial lines placed followed by the induction of anesthesia and intubation; the patients are then shaved, prepped and draped but only after foley catheters and rectal temp probes have been inserted; the activity reaches a pitched climax as a chorus of pneumatic saws in the hands of ten surgeons carry out midline sternotomies – throughout the oval of the suite, all ten chests are “cracked” in unison. The movements are fluid, precise and surprisingly absent any of the anticipated drama. As quickly as it began, the rooms palpably settle into the routine - even mundane - practice of open-heart surgery. To these seasoned professionals, this performance is a well-worn ballet of sorts, but to the myriad visiting medical professionals it is instantly a heady and memorable experience. Each of the fledgling summer students was immediately awestruck by the good fortune that had landed at our feet.

The ten surgeries were completed and, following fifteen or twenty minutes of turn-around time, the dance began anew. The cycle was repeated multiple times throughout the very long days until all of the scheduled cases were complete. As an example, within the Institute museum each of our names is permanently immortalized on the framed, faded surgical schedule from a day in July of that year when the Texas Heart Institute carried out a personal record of 52 open heart cases in a twenty-four hour period.

What were the duties of the summer students? Surely, we were instructed to stand out of the way of the professionals and observe?

Not a chance.

From the start, all of the students in their assigned rooms, scrubbed and gowned, were placed either at a patient’s chest or legs to assist the surgeons as they went about their work.

And we were quickly taught how to sew.

At that time, balloon angioplasty was still in its naissance and, as a result, formal bypass grafting was the norm – even for single vessel heart disease. Every patient who underwent a “bypass” had at least one of his legs splayed open and a segment of vein removed which was then used as the bypass conduit. After the vein "harvesting" was complete, the incisions were left for the summer students to close.

While there was certainly a learning curve for each of us, it gradually became the clear but unspoken goal of every summer student to outdo the next when it came to craftsmanship. It would not be an exaggeration to state that most of the surgeons, by the end of our stay, truly came to appreciate - often prefering the work of the students on loan for the summer. This notoriety became a source of great pride - as well as a few swollen egos.

As with other friends who also worked that same summer across the parking lot with Dr. DeBakey's team, each of us at the Texas Heart Institute was truly blessed with the opportunity to work with Dr. Denton Cooley and his associates. It is a real tribute to these surgeons that the medical community remains truly awed by their abilities; each of them somehow managed to make their work appear effortless – whether they were bypassing blocked coronary arteries, retooling or replacing valves, implanting mechanical left ventricles, or transplanting hearts.

In the years following medical school, I went on to complete a fellowship at the Texas Heart Institute. At our graduation service, Dr. Cooley introduced me to the audience as the, "summer student who never left." "Dr. Marvin was personally responsible for bankrupting our summer program; after he clocked in on June 1st, he never clocked out!"

Afterward, I reminded him of the axiom he taught us as our summer at THI came to a close; as we prepared to return to college, I believe he wanted to temper the naive assumption of many a student who may have somehow mistaken the ease with which the surgeons work and our new-found abilities, as he asserted,

“Any monkey can be trained to perform surgery. We spent the summer teaching a bunch of college educated monkeys how to close legs, hold hearts, and assist at the chest. The difference between you and me is that I have the knowledge and experience to know when surgery should be carried out.”

In four sentences he had aptly reined in my youthful enthusiam but also reduced my glorious (and lucrative) experience into the mockery that was, “How I Spent My Summer as a Trained Monkey.”

He laughed out loud and in a few minutes ended our conversation by offering up a true revelation:

If given the opportunity, what would Dr. Cooley choose as a surgical specialty today?

Without hesitation came a Graduate reply,

“Plastics.” Chuckling, he added, “Where is Mrs. Robinson when you need her?"

Medicine -- Undergrad (Part 1)

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 ... Undergrad (Part 1)

I walked out of Moore Hill that first day to a brisk, sunny January morning not at all certain what the future would hold. By the time I had walked a mere fifty yards or so past Gregory, I began to feel at home.

I made my way along strange sidewalks to register for classes. Every corner and turn took me one step closer to familiarity with the campus that would prove beneficial in the months and years ahead. I had arrived at The University.

Given it was my declared intention to eventually be accepted into medical school, one might assume I would first make my way to the Pre-Med office to get the run down of classes required for admission. Not I.

No, I had decided to go in an entirely different direction; instead, I made my way to the Robert Lee Moore Building and the Department of Chemical Engineering.

I still wonder how it is most undergrads come to decide on a major when entering college. Some choices seem obvious: the artist might decide on architecture; a talented French horn player may elect to teach high school music. And I am forever in awe of those who simply seem to "know" what life has in store for them. I am writing about the rest of us; what happens along the way which helps to devine our future?

High School anatomy had granted me an education from Mrs. Whipple and the "cat." This practicum eventually bestowed an arrogant, ignorant notion that simply because I had successfully endured the stench of phenol as well as commendably memorizing copious details, I must surely be suited for a career in medicine.

But, was that enough?

Well, I had also grown to love Chemistry and gained a better than average facility with Math.

Good. It turns out these skills are also prerequisites for success in being accepted into medical school. So why didn't I just make a left turn past the Welch Chemistry building and walk up the hill to the Pre-med office that January morning?

Because I had been warned to avoid registering for classes as a "Pre-Med" student.

I am guessing Pre-Med students had been much-maligned for years; while only an assumption, I honestly didn't know for certain if it was a well-earned generalization or not. However respectful friends may have been of my career choice, many wasted little time advising me to, "grow an extra set of eyes in the back of my head," when dealing with "Pre-Med people."

So, it was that when considering the totality of (dis-)information I had gleaned, as well as an assessment of my academic strengths and weaknesses, I enrolled as a Chemical Engineering student who also intended to one day attend med school. While undoubtedly making the road more "interesting," my logic seemed sound: By earning a degree in Chemical Engineering, I would have an alternative career choice if med school never materialized.

Survey Classes, Gunners, and Grades

There is nothing quite like walking into a room ~ no, an auditorium ~ with 500 or so other students vying for top honors in a class like General Chemistry, notorious for being a "weed out" course. Chemistry marks the beginning of the end for many students; as a result, enrollment has the potential to bring out the best and worst in people.

I was soon introduced to the term "gunner." I came to hear the whispered phrase, "Oh, so and so is a gunner," and it certainly didn't strike me as praise. I don't recall if anyone ever sat down and explained its meaning to me; eventually everyone figured it out for themselves. To my way of thinking, a gunner was someone who would stoop to any level to get a good grade.

I initially felt many were being a bit hypocritical; after all, wasn't everyone then ~ at minimum ~ a "closet" gunner given we each had the same goal of doing our best while simultaneously outperforming fellow classmates? But I came to learn that to walk in the shoes of a gunner, one must be willing to visit a darker side of human nature; a gunner would screw a fellow student, step over the bloodied corpse and continue climbing the proverbial "food chain" with nary a moment's hesitation.

I unfortunately have distinct memories of a few of these students. They each seemed to be universally held in contempt as they really made no effort to conceal their intentions. On one occasion, I heard the brother of a now famous mogul intentionally mislead a fellow classmate regarding the date for a test. He then cavalierly admitted what he had done, all the while laughing hysterically. It was through my experiences with gunners that I came to better understand why many people held Pre-Med students in disfavor.

I soon learned there are other, less invidious, ways to find yourself in dutch with classmates enrolled in Pre-Med survey classes. I learned this lesson the hard way.

When eventually enrolling in Organic Chemistry, I was truly fortunate to land in the class taught by Taylor B. Jones, PhD, one of the rare professors who could teach anyone to love this touchy subject. But for all the praise I have for Dr. Jones and his acumen as a professor, his enthusiasm for students and their success held the potential for mildly adverse consequences.

I distinctly remember everyone nervously settling into seats the morning we were due to receive marks following our first exam. Dr. Jones entered the room, approached the podium and immediately asked if "Rob Marvin" was present. I hesitated then raised my hand with no small amount of trepidation; I had seen the "Paper Chase."

After acknowledging my attendance, he proceeded to go over the stats for the test and then went on to announce that I had earned the highest marks on the exam.

Was I happy? Of course. Dumbfounded is another word. Organic Chemistry may rank highest among those classes which destroy the hopes of many a potential physician.

I was also not blind. I quickly learned that singular notoriety has consequences especially among the ranks of gunners. With a few laudatory words of praise from Dr. Jones, the gunners turned and glared, telegraphing concern that this Marvin guy might actually inch his way past them and potentially stand in the way of them realizing their goal. Gunners are not in the habit of looking at the backside of anyone; they pride themselves in always having a clear path.

While a great moment for any college student, I understood my invisible position in the class had changed:

Not only was I now targeted by the gunners, I was also labeled one by others. It also marked the day I officially became engaged in Pre-Med warfare. By enrolling in an entirely different college, I had hoped to be beyond the scope of these dynamics; like it or not, however, I was now directly in competition for a valued seat in some distant med school class.

My perch at the top of that Organic Chemistry class didn't last ~ it seldom does for most of us. Thankful for my moment in the sun, I was equally grateful eventually having the onus placed on someone else's broad shoulders.

I eventually came to understand; up until that day in Dr. Jones' class I had not truly been engaged in the pursuit of my goal. Sure, I had gone through the motions: attended classes and labs; studied well into the night; had taken and passed exams. By calling me out, however, he forced me to come to terms with the fact that competition in college, and life, is an essential component to success. People who actively pursue a vaunted position must compete against great odds all the while potentially risking being vilified unfairly along the way.

Despite my enrollment in the College of Engineering, I officially became a Pre-Med student that day.

It isn't Pre-Med students people should hold in contempt.

No, I would say to keep your eyes open and on the lookout for the Gunners.

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?"