Two year anniversary

All of a sudden, as I sat in bed reading, my wife of two-and-a-half weeks jumped up and gasped. "What day is it?" I lowered a guidebook to the Big Island of Hawaii to my lap. "The 18th, why?" Her eyes were alive with excitement. "When is the anniversary of your surgery?" It slowly dawned on me. "The 17th." And as our hearts collectively jumped into our throats, maniacal grins tore across our faces. "We were zip-lining through the rainforest!"

From a honeymoon suite on the northern coast of Hawaii, with soft air carrying the sound of the waves and the scent of countless night-blossoming flowers through the windows, it requires a major effort to conjure up the memory of what this day felt like just two years ago.

I was in a grey twilight of consciousness. My pain was uncontrolled, and would not be for three more weeks. My lungs were beginning to incubate a hospital-acquired pneumonia. The gash down the center of my abdomen was being held together by staples, but an infection was brewing just under the surface.

I was full of morphine and antibiotics and hope. Hope that the surgeons really had gotten it all, and that I and all of my family and friends were finally coming to the end of a three-plus year saga. Hope that whatever the surgeons had done had not left me permanently incapacitated. Hope that my dream of leading a normal life of normal trials and tribulations was not a fantasy. I am not sure that I had the imagination to hope that at some point, my illness would not be the central defining aspect of my personality.

I am stunned when I think about how amazing my life is right now. I have been cancer-free for two years, and remarkably healthy in all other respects. The neuropathy in my feet has essentially resolved, and even my hearing is significantly improved. I am about to start my final year of medical school (only three years behind schedule). I know what I want to do professionally, and am proud of the progress I have already made. And I am married to a person more lovely than I ever knew existed.

These days, I find myself appreciating the moment, and planning for the future. I spend very little time reopening wounds of the past. I've got far too much life ahead of me for that.

In case you missed it, below is a link to our wedding announcement in the New York Times:

http://www.nytimes.com/2011/06/05/fashion/weddings/alia-creasey-and-joshua-lilienstein-vows.html

The Halo

He was hit from behind. He was only driving about 45mph, and being 91, I guess we should forgive him that. I don't know any of the rest of the details about what happened to him that day, and I don't want to. From the looks of him now, it was the horrible beginning of a horrible end.

He is hooked up to a ventilator, strapped down to the bed, his swollen and disfigured head rigidly fixed in place by a collar designed to prevent him from moving his broken neck. It's been days since his accident, but he is still crusted with blood and dirt. We want to get him off the ventilator, because he has developed pneumonia, as many on ventilators eventually do. But if we lift his sedation enough for him to breathe on his own, he will be in excruciating pain because of his many fractured ribs, so we called Pain Control to come and place an epidural. I came back from lunch to find four strapping Anesthesia residents standing outside of his room, shaking their heads. Neurosurgery had nixed that idea, they said. They had been told that the patient's neck was too unstable, and that he could not be rolled onto his side for the epidural placement in his spine. Instead, Neurosurgery would come (when?) and put screws into his skull to attach him to a rigid armature that should stabilize his neck enough to place the epidural. The apparatus is called a Halo. Once we're done with this poor man, it won't be the last one he wears.

In case you missed it...

An article about me appeared on the front page of the LA Times. Click here for a link to the article, and here for a link to the photos.

One year anniversary

I had totally forgotten, until my mother called in a celebratory mood: today I have been cancer-free for one year! It is the anniversary of my "heroic" surgery, so named because the best doctors in the country agreed that it was the only thing that could cure me, even if they weren't sure that it would work. We had a wonderful conversation, talking about all the things that have happened since then, and how amazing it is that I am not only alive, but doing so spectacularly well. I feel altogether unreasonably healthy, and perhaps not coincidentally, the CT and blood work done earlier this week show no evidence of disease!

A three year long torrential flood of events has carved new channels and created new beaches on the riverbanks of my psyche. And while the flood has abated, the previously glassy flow of events is now swirled aside into unexpected eddies of doubt, and thunders up against new boulders of understanding, and spreads out onto fresh floodplains of reflection. And while I would not wish my disease on anyone, my life has been made so much richer by riding these waves. Every day, many times a day, I encounter situations that resonate with me differently because of my illness. Life has been and continues to be wild, and drenching, and scary, and exhilarating. What more could I ask for? Dayenu!

I have been busier than ever before. Yesterday was the last day of my Surgery rotation, which is famous among medical students for the absurdly long hours spent at the hospital, kowtowing to the established sado-masochistic hierarchy, all the while having stunning opportunities to engage with countless people during the most critical moments of their lives. There is so much to write about, but it must wait: I have an exam to study for!

In the Vascular Surgery Angiography OR: The number of pagers carried is inversely proportional to one's importance.

The Newborn Nursery

In 1979, some variation of the following probably occurred.

A medical student, his hands quivering, placed his hands behind my shoulders and picked me up from a rolling basinet. He gasped as my unsupported head rocked back, seemingly threatening to roll right off my neck. He was quite relieved when it didn't. He placed me under a heat lamp, and then fuddled with the dial, trying to figure out how to turn the thing on. He measured my head with a paper tape measure, picked up his pen to record the data, and then wondered to himself for the first of many times if he was supposed to take off and change his gloves between doing this and doing that. He decided no. He searched a poorly mimeographed form for the right box in which to write this number. There were hundreds of boxes on the page. While searching, he forgot the number, and went back to re-measure. He sweated under the heat lamp. He did not even try to contain his surprise when I grasped his latex-covered finger and jammed it into my mouth, WAY in there, and began sucking on it. He had never felt anything quite like that before. He didn't imagine it tasted all that good, but I apparently didn't seem to mind, so he let me - at least it had gotten me to stop crying. He scratched my foot and made my toes fan, he flipped me over on my stomach and made me wag side to side by tapping up my back, he pulled my arms down and watched as they sprung back up. He gently squished my testicles between his fingers. I didn't like that at all. He decided that now would probably be a good time for a glove change, before picking up his pen again.

That head would grow curly blonde ringlets, then straight brown hair, then curly brown corkscrews, then fall out. Those lips would go on to speak French and kiss girls. Those reflexes would be incorporated into innumerable layers of recurrent neural subroutines, and be orchestrated to throw curveballs and fill out forms. Those testes would grow cancer. He documented what he could, but he had only the faintest idea what might happen to it all.

It's over! Let it begin!

I've been studying 12h a day for three months. No listening to music in the car, only audio reviews. There are post-its all over my apartment: the brachial plexus on the bathroom mirror, the Circle of Willis above the toilet paper, and the basal ganglia next to the coffee maker. I have a whiteboard covered with ridiculous mnemonics for memorizing inane but testable details. I ended up making 6800 virtual flashcards at last count - far too many to use for their ostensible purpose, of course, but the act of making them was valuable in and of itself. I subsisted largely on coffee and chocolate, occasionally defrosting treasures from my mother's kitchen.

The United States Medical Licensing Examination Step 1 is a big deal: 6h of trick multiple choice questions determine more than any other measure whether or not one gets interviewed at a residency program. Doing well means a much greater chance at getting to go somewhere I want to go for residency, and doing something that I want to do; doing poorly means that I could conceivably just get put somewhere, to become a kind of doctor I didn't really want to be. This exam has been intimidating me for over three and a half years now, and I am overjoyed at being healthy enough to have taken it on. I won't know for six weeks how well I did, but for the moment, it doesn't matter: it's over!

And now the real work begins! If the experience of my friends is to be believed, starting in January I get to pay $50k a year for the chance to be scolded for being inefficient, dangerous, and in the way. The next three years (at least) will largely be spent in sleep deficit. It will also be a period of relative social isolation. Most of the people I used to know in LA have graduated and left town. I will be on rotations with a small subset of an already small and isolated social network, and everybody is going to be stressed out in the exact same way, with nothing else to talk about. For the past few years, I've been the center of an incredibly deep and wide spring of love and support, and I have gotten used to being told by everyone around me how great I am. This coming period will be a test of my ability to maintain motivation and self-respect without the constant pats on the back that I have become so used to.

I spent today walking around the hospital with one of the Medical Student Educators, getting an orientation to clinical rotations. I have to say that despite the above, I'm pretty excited about all of this. Even though I am more dangerous now than I ever have been or ever will be, my badge opens doors with big scary signs reading "Authorized Personnel Only", I get waved to the side and told to walk around instead of through the metal detector, and I get handed tiny babies straight out of the oven. These are but insignificant indications of the humbling amount of responsibility and trust that is being placed in me. However painful the process, I realize that I am about to get an incredibly valuable education.

What I've been doing since surgery

Rest assured, no news has been Very Good News. It was a very slow recovery... until it wasn't. At a certain point I started to feel exponentially better each day, and pretty soon it became clear that I was feeling so fantastic that it was time to get back to work!

I am currently studying 12+ hours a day for the national board exam, which I take in a month. It's a big deal, and I need to focus more than I ever have before. Because of the way the timing has worked out, I have a little more time to prepare for this test than if I had not gotten sick again, which is a very good thing. My education has been quite fragmented, and I have even more loose ends and gaping holes in my knowledge than your average medical student, so I am happy to have more time to review. I have also been taking advantage of the flexibility my schedule has offered, enjoying this time of health and freedom as much as I can, considering I have to be studying full time. Here's what it has looked like! (now back to it...kidneys!)