Reflections in a Head Mirror

[Music] makes practically everyone fonder of life than he or she would be without it.”
-Kurt Vonnegut      

Had I possessed any musical talent at all, my life probably would have gone in a different direction.  

Not that my parents didn’t try to make me a musician. They transported me to piano lessons, percussion lessons and voice lessons. They bought me a guitar. They pushed me to work hard in the middle school orchestra and the high school choir. They encouraged me to sign up for ensembles and high school musicals. In retrospect, each opportunity enhanced my appreciation for music but none of them made me into a musician.  

My new patient, a talented jazz artist, agreed that he has known lots of kids like me — eager but musically inept — during his decades-long teaching and playing career. Now that he had retired, he still enjoyed performing regularly with a remarkable local big band. Playing his horn was as natural to him as breathing. Music was still a big part of his life.  

When he had developed throat cancer, I silently worried that whatever treatment we proposed would finish his playing days. Surgery would change the shape of the pharyngeal cavity. Radiation would cause severe dryness. I shared my concerns with him and he shook his head. “Do what you have to do,” he told me. “I’ll be OK.”  

We decided on a course of treatment. It was not easy. His mouth was changed. Each visit showed that the tissues were healing, but it was a slow process.  

After a few weeks, he asked, “When can I start playing again?”    

“Go ahead and see what happens,” I replied. He smiled in a way that betrayed the fact that he had already been practicing.  

At each visit, he would announce, “I can play! I need to drink more water, but my chops are returning!” Before long, he was back performing with his friends. Without actively thinking about the process, he had not only recovered from our treatment but had learned to compensate for his new physical challenges in ways that no one could ever have predicted.    

As I sat in the audience one night, I realized that he was playing much better after all that we had thrown at him than I would ever have played even if I had spent a lifetime practicing. Everyone was happy.

Still, I will always try to imagine what it is like to pick up an instrument and improvise as effortlessly as some of my naturally gifted friends. I guess my parents were correct when they stopped pushing me to take music lessons and suggested that I pursue a different line of work.

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The following is feedback received for this blog: Somehow I would guess your musician friend/patient finds you "gifted". I never had the chance to learn a musical instrument as a youngster, but am trying now. Maybe someday, I'll feel like I can play in front of someone. Not yet. - rl bates http://rlbatesmd.blogspot.com/ Bruce, you actually played guitar quite well, as I remember, but as always, you remain modest. However, your deep compassion for people and the skills you have acquired and shared to enhance the quality of life for those in need is a rare and blessed gift. - Sue As someone who practices medicine but also has musical longings - I've been playing the oboe for just a year now - this post meant a great deal to me. Thank you for sharing your patient's story, courage, and gifts with us - and your own. -T. http://anesthesioboist.blogspot.com

“When we honestly ask ourselves which persons in our lives mean the most to us, we often find that it is those who, instead of giving much advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a gentle and tender hand.”  
-Henri Nouwen      


I have learned so much from this patient.    

I have learned that, in some people, cancer can be a chronic disease. This particular woman first developed cancer symptoms 50 years ago and she still carries some of the same malignant cells to this day.  

I have learned that small acts of kindness readily distinguish a decent person from an exceptional one; a lesson re-learned each year at Valentine’s Day when she drops off a bag of chocolate kisses wrapped in small bits of cloth.  

I have learned that hearing a patient tell the story of her journey with cancer enhances my understanding of how others might face similar challenges.  

I have learned that facial scars can affect how people might view a patient but they don’t have to affect how the patient views herself.  

I have learned that a person can remain in control of her health care and her life despite two dozen operations, multiple courses of radiation, a myriad of medical conditions, and a steady stream of hospital visits.  

I have learned that a life filled with community volunteering, raising children, being a friend, and staying active can co-exist with chronic illness and cancer.  

I have learned that there are people who, when I give them bad news, have the gift of always making me feel better.    

And today, as she smiled and told me that she is making plans to be admitted to an in-patient hospice unit, I learned that the terms “patient” and “friend” are sometimes inseparable.

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The following is feedback received for this blog: (She) is my aunt. She IS an amazing woman, and this word is almost inadequate to describe her. Despite the occupation of her body by illness and cancer, she has continued to own her life, to move forward, to continue to LIVE. She is able somehow to see-and feel-the positive which most of us, given her lot, would have lost sight of long ago. She has been able to take in the best of living and also to give with the same fullness of heart. I am, and will remain, in constant awe of her spirit. I will always feel grateful and lucky that her life and mine have been connected for almost fifty years. I hope, and somehow know, that she will continue to find joy in her continuing journey. - Rebecca I am not sure how I found this blog but I did and I have read most of it. Although I have lymphoma I had a parotidectomy in Sept of 97. I had a wonderful doctor that has changed my life in so many ways. When I read you post *Learning* Its very true after being a long time patient there is friendship as well. Its amazing to me how I count on his opinion just as much as I do the rest of my doctors. But his friendship equally as much as well. You wrote so beautifully about a patients scars. I also think how my doctor handle my care was perfect. Yes I have scars but I walked outta of his office...with a confidence to handle whatever came my way. I always felt that he helped me every step of the way to get here. I agree others might view me differently be it the scars or the cancer. But your so right I don't view myself any differently. Didn't then and don't know. I just wanted to say thanks for writing on what you see as a Person and as a Doctor. Heres to life and living it to the fullest. Hope http://clubsammichcafe.spaces.live.com/

“The most effective form of birth control I know is spending the day with my kids.”
-Jill Bensley    


Cancer of the roof of the mouth rarely occurs in children. Several years ago, I took care of a young teenager whose orthodontist had noticed a slowly growing, painless mass on the hard palate. After determining that everything else was fine, we took her to the operating room and removed the tumor. Once she had healed up, she never had any more problems with her mouth. I saw her regularly for a while and then she stopped returning.  

Several years later, her mother brought her back to the office for a check up. The patient sat glumly in the chair occasionally glaring at her mother. As I updated her medical history, she was having some trouble with forming words.  

“I feel fine,” she said. “I’m only here ‘cause she made me come.”  

“Okay, open up,” I said.  

This was no longer the cute little kid I had cared for a few years before. As she leaned forward to let me examine her, I smelled tobacco smoke. When she opened her mouth, she clicked an enormous tongue stud against her teeth.  

Her mother rose from her seat. “There! Doctor! Tell her that that thing is bad for her!” The girl rolled her eyes.  

“When did you start smoking?” I asked. She shrugged and immediately delivered the same withering glance at me that she had just leveled at her mother.  

We reviewed what I knew about tongue studs: they are interesting, they don’t help during job interviews, but they are not dangerous.

We also talked about smoking. As a survivor of cancer, she might be at an increased risk of additional malignancies, especially if she engages in high-risk behaviors like smoking. For the first time during the visit, she was engaged and was clearly listening, although she did not give me the satisfaction of saying she wanted help with quitting.  

Mother and daughter left the office, both frustrated yet both vindicated, in a way. I'm pretty certain that the battle continued when they got home.  

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The following is feedback received for this blog: Thought of you as we recently enjoyed a weekend in SMOKE-FREE CHICAGO. Not only is it safer inside - it's safer outside too. The streets are now monitored by smokers. C'mon Milwaukee. - Lucia I read a cool article in the latest article about a chef in Chicago with tongue cancer..... thought it might be up your alley. http://www.newyorker.com/reporting/2008/05/12/080512fa_fact_max/?yrail - buckeye surgeon www.ohiosurgery.blogspot.com Great story! My experience with adolescents is that they don't get at all how risky smoking is (or maybe they like it for that), but your young patient at least knows what it is to have to have surgery for a tumor at least. And I bet she was more receptive because you okayed her tongue stud! Nice job! - Jane Geraci http://janemariemd.blogspot.com/

Bloggers often issue challenges to each other. This week I was "tagged" by Suture for a Living. The challenge was to create a six-word memoir. The other challenge is to tag other unsuspecting bloggers to do the same.

The challenge brings to mind a “Six Word Story” contest. To me, the best example of that genre is Hemmingway’s “For sale. Baby shoes. Never used.”   Another favorite (I can't find the author right now) is: ""I'm sorry.' 'For what?' 'Never mind.'"

So, my six word memoir reflects a continuing tongue-in-cheek battle that often surfaces in my office conversations with patients. I say it so often that it is a theme in my practice. When confronted with a cancer survivor who continues to smoke, I sometimes grin and say:  

“No problem. Smoking’s good for business.”  

Hmmm. Now that I have written that, is "smoking's" one word or two?

Anyone else want to try? Submit your Six-Word Memoir by hitting the "Feedback" button below.

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The following is feedback received for this blog: Sing. Ease burdens. Pass it on.   learned these things from my parents, Richard and Virginia and I am so grateful. Sing in happiness and sadness, proclaim the Word of God, lift spirits (including my own) of those wearied by what happens on the journey of life.   Ease burdens of the dying, brokenhearted, those who have lost hope. Pass it on - things, poems, food, skills, peace, anything that makes the world a better place. - Deborah Ruck Chronic disease. Shaped me. Bonsai tree - Annette