Reflections in a Head Mirror

In the fields of observation chance favors only the prepared mind.
-Louis Pasteur    


“Do you drink much alcohol, wine, or beer?” He was a patient with a newly diagnosed mouth cancer. I was working through my checklist while we became acquainted.    

“I have a beer most nights before dinner. Maybe I’ll have a couple more on weekends.”    

The questions continued. The patient’s teenage granddaughter was clearly taken by my young, handsome resident. “How long does it take to be a doctor?” she asked him. He went through the litany of four years each of college and medical school, followed by five years of otolaryngology residency. She counted the years up in her head. “You’ll be 30-years-old when you finish! Why does it take so long?” she exclaimed.    

He smiled and shook his head. “It takes a long time to learn everything you need to know to be a safe surgeon.” he replied. “Dr. Campbell even added two more years onto his training after residency.”    

She looked at me in disbelief. “Slow learner,” I explained.    

The focus returned to her grandfather and we completed the other questions about his health. The examination and scans confirmed what we already knew. His cancer was treatable but he would need an operation. He appeared to be in good shape and, before he left the office, we arranged a surgical date.    

A few days later, he was asleep on the operating table. I made the incision. As the resident and I lifted the skin off the underlying neck fat and lymph nodes, a familiar feeling washed over me. “Look at these tissues,” I said. “What do you notice?”    

The resident examined the fat intently.

“Why, the tissues are too flimsy, too soft, too yellow, don’t you agree? They don’t handle the way you would expect. Why is that?”    

“I have seen tissues look like this in alcoholic patients. He didn’t tell us about any problems, but we will have to watch him carefully after surgery.”    

I have never found a textbook that describes the subtle phenomenon we identified that day during surgery — the boggy, yellow fat that some alcoholics hide in their neck tissues — but this rare, subjective finding is something that I have noticed several times during my career. I spend time pointing out and discussing the condition whenever I see it. On top of everything else that our residents are expected to learn, we spend a lot of time sharing the non-textbook lessons. It is a long process.    

Indeed, two days later, we were ready when our patient started spiraling into the alcohol withdrawal his tissues had predicted. Later that week, his family discovered a stash of liquor bottles in the basement. 

Happily, my patient made a full recovery. In the process, though, he had helped prepare one more resident for the next patient who thought he had something to hide.

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The following is feedback received for this blog: Dr Campbell, You recently were involved with treatment for my brother who has tongue cancer. Now that I have seen your comments in this blog I feel he more than likely received some good, direct and caring advice from you. Myself and other of his siblings have been with him 24 hr's/day for the last 9 days. And he has finally agreed to Hospice care. But we allowed him to make all his own decisions, as hard as it was for himself and for us. After 46 young years, his death is coming soon. He too was an alcoholic and a smoker.. Some people refer to the previous bad habits he had as the reasons for this cancer. I prefer to look at what is occurring today and forgive and forget his past. Even a person who did not lead a good life in lifestyle and/or relationships does not deserve to suffer in the manner in which cancer imposes. I look forward to his death for peace for himself but will relish many memories. Previous family deaths have taught me that the intense pain does diminish but it never diminishes the love for your loved one. As time progresses, memories will come in stages as painful, then bittersweet, then as soothing and delightful. Thank you for all the caring and humanity given by yourself by all the staff at Froedtert. - Lori C. Dear Ms. C., Thank you for your comments. It has been an honor to be involved in your brother's medical care. One of your statements struck me. I agree that people tend to "blame" patients for the things that happen. We know that people who smoke and drink are more likely to get these cancers, and that knowledge can be very difficult for both the patients and their family members. Still, developing cancer was not his fault. In light of that, your understanding words are so important. I truly hope that your spirit that focuses forgiveness and love on him can bring healing both to your brother and to your entire family. Thanks again for writing. Sincerely, Bruce H. Campbell, MD

The capacity to give one's attention to a sufferer is a very rare and difficult thing; it is almost a miracle; it is a miracle.
-Simone Weil

I walked numbly down the steps of the funeral home, squinting as I reached the bright afternoon sun. People moved all around me, pushing strollers, walking dogs, searching pockets for car keys, talking on cell phones, looking into store windows, laughing. They were completely oblivious.

My mother and I had just spent the past hour at the mortuary, making arrangements for my father’s remains. The funeral director had worked steadily though his list: What should be in the obituary? Should the paper run the listing for two days or three? Here are several forms we need to complete. Could you please sign here? And here? Would you like to pick up the ashes or should we deliver them to the church? Do you want the clothes he was wearing? Because he was a veteran, he is eligible for a flag. We are so sorry for your loss! Will you be paying with a check or credit card?

Many memories remain from that afternoon. Most of all, as I left the funeral home, I wondered how all of these people could be going about their business as though nothing had happened. Doesn’t everyone feel this numbness – this incredible weight – just as I do? How can they be rushing about at such a time?

There is value, writers tell us, in these intense, shared experiences. Eventually, each of us is temporarily overwhelmed, however briefly, by personal or shared loss. Like most people, I slowly returned to “normal,” shaking loose the shroud that had pressed down on me. Occasionally, the sensation revisits me, stopping me in my tracks for just a moment.

Not long ago, I was walking down the hallway on one of our hospital inpatient units when I felt the old twinge.

Behind some of these doors, I realized, there are people having cataclysmic experiences. It is possible that the man in this room has been given terrible news. A woman in that room might suddenly have realized that her husband is never coming home. Just down the hall, a young family could be coming to terms with a series of difficult and life-altering treatments. Next to the nursing station, a young child is being led to a bedside, perhaps to say goodbye.

At the same moment, out in the hallway, I am having a trivial conversation with a colleague, smiling as I hear laughter around the corner. I plan out the rest of my day, trying to save enough time to grab lunch and complete my operative notes before I head to clinic. Later, I will head home after I have finally checked everything off my list.

On this day, I am one of the oblivious ones.

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The following is feedback received for this blog: This post reminded me of when I lost my father just two years ago. It seemed the whole world was asleep as we left the ICU at St. Luke's in Milwaukee at about 3:20 a.m. Only a couple of stoic nurses were stationed at computers and everything was dark, with the exception of blinking lights and monitors. Heads down, we were a sobbing mass of humanity making our way through the abandoned hallways. When we emerged outside after so many hours at vigil with him, it seemed the rest of the world was completely oblivious to our loss. (Call the funeral home, contact a priest, do this, do that.) My father was a very sensitive guy. I recall him admonishing us kids when we visited him in the hospital many years ago, for making way too much noise. "Quiet," he said. "The people in the next room just got some bad news." We all experience the highs and lows of life, but a little empathy goes a long way. - Steve B. Fabulous post. Thank you. I'm so sorry for your loss. My grandmother slipped away in February. When I got that phone call to tell me, I simply said thank you. I asked when they wanted me to clear her room. They said there was no rush. I called my husband. I told my children their Great-Nan had gone. I called my father in South Africa (I'm in UK) to tell him. I called my other grandmother and several other family members.I called her lawyer who held her Power of Attorney. He told me to clear the room the next day! I remember looking back and thinking I worked through a process, step-by-step. You see, for me, the death had been coming on for 10 years as slowly as the Alzheimer's had been consuming her. I'd had to say goodbye to her 5 years earlier when she forgot who I was. In the remaining 5 years, she basically fell apart ending up bed-ridden and a mess. So when I did get the call, I was so relieved that she'd finally been released from all that misery and anguish. But then the processes begin. There's a certain groove you slot into to deal with phone calls, funeral directors, ministers, catering arrangements, florists, etc. etc. And once the whole shabang is over, then you realise that you did all that in a kind of haze. And gradually the numbness wears off and life resumes. It's a very strange experience. - Jabulani Beautiful post. I could complete relate when you said: Most of all, as I left the funeral home, I wondered how all of these people could be going about their business as though nothing had happened. Doesn't everyone feel this numbness - this incredible weight - just as I do? How can they be rushing about at such a time? I felt the same way at the loss of a loved one a few years ago. I always think I'm the only one thinking or feeling a certain way and it's nice to see that I'm not alone. Thank you for sharing! - Jen I am sorry about the loss of your Dad. I know you are a man of faith and so have the hope/expectation of seeing him again... but it hurts on this side because we miss them. My mother died back in April and I am still in disbelief sometimes... even though elderly and declining in health. You said you feel the sensation of losing him and I think of it as it comes in waves. I have lost and cried over people I love... but nothing prepared me for losing my mother. Oh sure..intellectually you know it will hurt... but it is a profound sense of loss. I consider myself empathetic and have been supportive of friends who've lost parents... but now having gone through it... I really know how much it hurts and think I should've done even more. That 1st week was like I was in a timeless tunnel. now a thought will hit me out of the blue... and the pain of it washes over me like a wave and falls back again. I understand your feelings. Those moments are surreal. - SeaSpray seaspray-itsawonderfullife.blogspot.com So very true. Strangely enough,we as human beings [social creatures] must still grieve at a very personal level,and all the rituals and procedures that follow may lessen the loss of a loved one,BUT amidst the deafening roar of life,we must grieve in equally deafening silence and in isolation. - shantu patel