Sunday, November 25, 2007


Years ago in college, I took an ethics class. We covered all sorts of difficult topics, and tho I recall enjoying the mental exercise, I remember little of it.

One essay stuck with me. I don't recall the author (perhaps a reader will), but the substance of the essay resonated. It described the journey of a boat as a metaphor for our journey through life. If a boat leaves on a long enough journey and encounters enough problems through the way, one could imagine needing to replace every last board, nail, and piece of machinery on it. If that boat returns to it's port of call without any piece of the original boat remaining, can you still call it the same boat?

Since that discussion, I have at some level pictured my inner self as a boat. It's not a fancy one, but wood with graceful lines, and likely evolved from some deep memories of childhood book illustrations of Noah's ark. I see my boat as starting out shiny, oiled, and polished, and by the end of my life to be weathered, splintered, and faltering.

Henry's illness has put a huge gash in my hull. I will contain the damage and continue my journey, but my boat will never be the same again. Somehow I find this comforting. His illness, no matter the outcome, will shape my future sailing.

Thursday, November 22, 2007


A friend once told me the story once of an elderly family member. He was 98 years old, and tho frail, was living at home independently, as healthy as one can expect to be at that age. Unfortunately, he fell and broke his hip. He underwent surgery, and rehab, and was set to be discharged back home when he had a massive PE and died.

Of course, she was saddened, as anyone would have been. But it was her comment, "It's just not fair" that caught my ear.

Obviously, I didn't argue with her. But I can think of little that is more fair than living to a ripe old age independently, healthy, and dying quickly and likely fairly painlessly. We're obviously all going to go, and it sounded like a pretty good ending to me.

I think there is a difference in outlook between people who are exposed to death and disease often, and people who aren't. If you spend your working hours talking to young people with chronic disease, or watching 45 year olds roll in to the ER in asystole, or even just follow a number of geriatric patients as they experience the illness that takes their lives, you take your health less for granted.

"It's not fair" used to pop into my head when I would see a 38 year old women with breast cancer, or hear about a 50 year old who dropped dead of a heart attack.

But when you have a three year old with a metastatic brain tumor, "fair" takes on a whole new perspective. When you see teenagers walking the halls bald, in a mask, with their IV pole and chemo hanging on it, your life starts to look a lot more fair. When you hear the child in the room next door vomiting all night, the fact that your back hurts from sleeping on a crappy fold-out hospital couch fades.

Let us all be more thankful for our health, and less demanding on life to be "fair".

Wednesday, November 21, 2007


I'm reading my son a book today, about a turtle who has to go to the hospital for surgery on his shell.

Through the book, I'm using the storyline to try to explore the emotions that he's having at being so sick and in the hospital. We talked about being mad, and being sad. I took the opportunity to point out the helicopter that was on the hospital TV and said "I'd be scared to ride in a helicopter. Do you ever get scared?"

He answers, "Don't worry, mommy. I will take care of you so that you won't be scared."

Sunday, November 18, 2007

A new do

We've been dreading my son's impending hair loss. I've been trying to talk about it alot, without actually saying that it was going to happen. We've looked at pictures of other chemo patients, and of course he see the other bald kids here. Even though he's only three, and not yet inducted into the world of vanity, I was very apprehensive about the loss. How would he react? Anger? Fear? Embarassment?

He started shedding 2 days ago. It was everywhere, and bothered him because it kept getting in his eyes and mouth. The solution was to put on a stocking cap, which he wore for about 12 hours. I was on the phone when I noticed him take the cap off, and start pulling handfuls of hair out of his head.

He was completely nonplussed. I brought over an emesis basin, and together we pulled all of the hair out of his head. He was quite relieved that it would no longer bother him.

Ok, so there's the first thing that I've worried about in this whole process that actually turned out not to be the big deal that I thought it might be.

Saturday, November 17, 2007

The gift of life

Chemotherapy has been hard on my son. As predicted, all of his blood counts have bottomed out. He has required both a blood (red cell) transfusion and a platelet transfusion, and will most certainly require more.

As the nurse hung the blood bag up and set it to infuse into his central line, she asked if I needed her to cover it with a bag, if it bothered me to see it hanging there. I said no, that it was fine.

I watched it going in, seeing the blood willingly given from someone somewhere, someone who has never met me or my son. Each drop that fell seemed like life being infused back into him, and I was profoundly grateful for this anonymous and selfless gift.

Thank you to each and everyone of you who has ever taken the time to lie on that plastic table and donate a unit of blood to the blood bank. I've done it before, and it never seemed like that big of a deal. Now that I'm on the receiving end of the gift, I can assure you that it is a huge deal. Next time you give blood imagine a human being on the other end of that tubing. You are truly saving a life.

Thank you.

Friday, November 2, 2007

The new Dr. Smak

This journey is certainly changing many people, in many ways, myself included. I'm wondering how it will alter my practice as a primary care doctor.

It seems to me that most primary care doctors have a baseline level of concern from which they operate. On one end of the spectrum are the docs who elect to err on the side of caution and do more 'ruling out' of dangerous conditions. On the other are those more laissez-faire docs, who assume health until proven otherwise, the "call me if it's not better in a month" docs. Both approaches have their advantages and disadvantages, and the wise doctor learns to find a flexible middle ground, depending on the condition.

On the whole, I have in the past leaned toward the laissez-faire side. Part of this is my baseline level of concern - my mom was certainly not a rush-the-kid-to-the-doctor type. Part of this is my population - I generally follow a younger, more healthy population.

I'm guessing my leaning is going to change, at least for a while. I'm not sure I'll be capable of NOT ordering a CT on every headache that walks in, especially in my young, healthy kids.

Everything seems more ominous now. Little things, rare things, stuff in the past that I didn't worry at all about. I know that it is in part a reaction to what I am going through. However, this is my first personal serious brush with mortality, and I know that part will not fade.