Things will turn out
Plus: Whither the spring birds?
BIRDS
Not yet
SPRING NORMALLY BRINGS a variety of warblers and other migrating birds to our neighborhood and often to our little pond. Some years, beautiful Western tanagers come in numbers and stay for a couple months before moving on. Other groups, like the shorebirds on the coast, make only a short pit stop to refuel for the trip to their breeding grounds further north. But this spring I’ve not yet seen the usual migrants in our yard. I have been cheered by a pair of beautiful varied thrushes who I suspect are nesting in a neighbor’s tree.
Happily, Barbara went into regular sinus rhythm three days ago, her second and longest period of relief from a-fib since her surgery five weeks ago. She’s finally getting a little sleep, walking better, and retrieving juice and yogurt from the fridge without me. I’m told that in another two months, if things go well, she will have mostly recovered.
The aged apple tree in the yard has bloomed, usually a signal that the orange-crowned, yellow, Wilson’s, and yellow-rumped warblers may appear within days. I’ll fill the pond and wait, whenever they come.
TALES FROM THE CLINIC
The daughter
By Barbara Ramsey
ALTHOUGH HE FAILED to take the meds I prescribed or curtail his drinking and smoking, Bill memorably once told me not to give up on a guy like him. And I never did. When a chest x-ray revealed a tumor in his chest, I was committed to getting him a complete work-up. But there were obstacles.
Bill had been a longtime resident of East Oakland with many close friends and neighbors. Unfortunately, that neighborhood had become increasingly dangerous over the years. When the crack epidemic hit hard, older people like Bill became the targets of addicts desperate for even a little money. There were drive-by shootings just a block or two from our clinic—at noon, in broad daylight.
But Bill was a bright and resourceful guy. Six months before his cancer diagnosis, he found a small apartment in a subsidized housing development twenty-five miles away. The pleasant Bay Area suburb near a BART transit station was far safer than his old neighborhood, but he lived alone without a car and was now far away from his old friends. Though there were no drive-by shootings, there were also no neighbors he knew. And the hospital where he could get diagnostic studies and treatment was a forty-five-minute BART ride.
I was a family physician with limited expertise in lung cancer care. I gave him as much help as I could, but his work-up was mostly performed by other doctors. I did manage his referrals and kept track of his overall situation. And I anticipated the usual difficulties. He would need transportation, home care, and emotional support.
When I asked Bill who might go with him for this series of treatments, he said, “No one. I can do it by myself.” So, I decided to accompany him on his first visit with the radiation oncologist. Partly I wanted to go for selfish reasons. This doctor had a good reputation and I wanted to meet him and forge a connection, both for Bill’s sake and for future patients who might need cancer care.
The oncologist was cheerful and competent as he walked us through a description of the treatment plan, which involved a series of radiation treatments. These would require Bill to shuttle back and forth between his home and the hospital over many weeks. He seemed unconcerned. “That’ll be fine,” he said. “No problem. Things will turn out.”
After the visit was completed, I had a quick private conversation with the doctor. I explained the complexities of Bill’s situation, but he seemed as unconcerned as Bill. “Just call the cancer society” he said. “They have volunteers who can provide transportation, help with meals, all that.” His nurse gave me the phone number and I drove Bill home. On the way, I explained about the cancer society assistance that was available. He sounded dubious. Other people meddling in his business? He wasn’t sure he was interested.
Once we got back to Bill’s apartment, I asked if he would please show me around his new place. The apartment was small but tidy and clean. He invited me to sit down on a well-worn sofa. “Bill, this could be a difficult next few months,” I said. “You’re going to need other people’s help. You know that don’t you?”
He didn’t agree but was willing to discuss it. I asked him if he’d told any of his old friends back in Oakland about his diagnosis. “No,” he said. “They have problems of their own and don’t need to know about this.” His attitude didn’t surprise me. Several of my patients over the years felt a cancer diagnosis was the most private of subjects, occasionally even shameful. Simply to speak of it was to invite darkness. I had one patient who could never say the word except in a whisper.
I asked Bill if he had family he could talk to. No, his siblings were dead or in other states. I asked if there were any other family members. No, just his daughter.
His daughter! He’d never told me he had a daughter. She was the child of his first marriage and lived in Virginia. He said he talked to her over the phone sometimes but hadn’t told her about his cancer. He couldn’t be bothering her with his health situation. She had a husband and kids and an important job with the state government.
“How about if I call her?” I asked. “I can tell her about your cancer diagnosis and then you won’t have to.”
“Sure, if you want to,” he said quietly.
He gave me her number. It was about 6 pm on the east coast, so I figured I had a good chance of catching her at home. She answered on the third ring. I explained who I was and the reason for my call. After a few words of preparation, I explained her father’s situation.
“Daddy!” she said. “Oh my God!” She was flustered and confused. When she caught her breath, she asked all the pertinent questions, which I answered as best I could. Then I heard loud thud. “Oh, I’m sorry,” she said. “The suitcase just fell off the bed. I’m trying to pack as we talk.” Pack? “Yes, ma’am, because I’ll be taking the next plane. I’m coming to California to be with Daddy.”
I handed Bill the phone. “She needs to talk to you.”
She did come to California and handled everything expertly. It turned out that she had been calling and visiting Bill regularly over the past fifteen years. He hadn’t ever mentioned her because it had never occurred to him to do so. Doctors were doctors and family was family.
His daughter talked him into letting the cancer society people help out and she arranged for many details of his care. That first time she stayed long enough to take charge, then delegated appropriately. Bill only lasted another eight months, but his daughter and her kids returned several more times before he died. He’d been right all along. Things turned out.
Snippet of the week
ONE HAS TO WONDER how the American Academy of Pediatrics and other U.S. medical organizations will respond (or not) to a new blockbuster report on youth gender medicine written by pediatrician Hilary Cass and commissioned by the English National Health Service. As Helen Lewis describes in The Atlantic:
The crux of the report is that the ambitions of youth gender medicine outstripped the evidence—or, as Cass puts it, that doctors at the U.K. clinic whose practices she was examining, although well-meaning, “developed a fundamentally different philosophy and approach compared to other pediatric and mental health services.” How, she asks, did the medical pathway of puberty blockers and then cross-sex hormones—a treatment based on a single Dutch study in the 1990s—spread around the world so quickly and decisively? Why didn’t clinicians seek out more studies to confirm or disprove its safety and utility earlier? And what should child gender services look like now?
The answer to those first two questions is the same. Medicalized gender treatments for minors became wrapped up with a push for wider social acceptance for transgender people, something that was presented as the “next frontier in civil rights,” as Time magazine once described it. Any questions about such care were therefore read as stemming from transphobic hostility, full stop. And when those questions kept coming anyway, right-wing politicians and anti-woke comedians piled on, sensing an area where left-wing intellectuals were out of touch with popular opinion.
I woke up at 5:50 thinking, oh good, Wild Things went out twenty minutes ago. Second thought was: Did I call a Western tanager a yellow tanager? Perhaps a sign of my slightly addled brain these days.
I remember hearing you tell about Bill.
You also went with me to my cancer appointments and you sat on the exam table so you could be close enough to hold my hand at each one. Who does that???!!! I love you Dr. Ramsey.