Things Are Good, Even if I Am Nuts

OK, a couple of updates:

• My partner had a wide excision of her original melanoma site and a sentinel node mapping on 12/2/08.
• The excision margins were negative for satellite lesions. Profound relief and rejoicing.
• A sentinel node and a portion of the wide excision have been sent to Stanford's pathology lab for immunohistochemical testing, which is going to take another week or so to be completed. This is high-tech stuff.
• Her 10x5cm wound now has a vacuum dressing in place. This is taking some adjustment, because the device has to be carried around in a fanny pack all the time. We call it Cousin Albert. The machine emits intermittent bubbly sounds, which we refer to as Albert's flatulence.
• In the middle of all of this, I did three night hospitalist shifts and one prenatal clinic.

I've definitely had better weeks, but I've also had worse. A few years ago, on a particularly rainy night, our dog was about to enjoy a snack of free-range frog in the backyard. My partner, a vegetarian, objected to this and chased after her, and promptly fell off our porch. This resulted in a massive, comminuted tibial plateau fracture which has required four surgeries over the past three years and has kept her in a wheelchair most of the time. This has been truly awful for her, an active person, a former triathelete. For me, it has also been terrible but for different reasons. The accident occurred when I was still a new doctor in town and I didn't feel I could let the momentum of work slow down to accommodate her injury. So I ran around like a flea on a dog for two years, working more than full time at three jobs and also serving as chief cook and bottle washer at home. I still do most of the work around the house, so the end of my work day often involves taking out the garbage, folding laundry, vacuuming, grocery shopping and cooking.

I'm not complaining. There are working parents who do their own version of this double-shift and you all know what the pace of such of life feels like. I do have a little bit of help, a woman who comes in a couple times of week to walk the dog and run to the store, but I still do most of the household management, and I'm not very good at it. 

My partner's fracture occurred a month after we'd moved into our house, and with the chaos of the surgeries, my work schedule and the reduction of our housekeeping force, the result was a household in chaos. We've never completely unpacked from our initial move to Rural, which involved the merger of two households worth of furniture, knick-knacks, linen, and white elephants. I had to have a shed built as a kind of holding pen for our stuff, the original idea being that we'd comb through the excess and gradually deaccession our redundant possessions. Well, this hasn't happened. In fact, many of the boxes I moved into the house have been serving as end tables and ottomans. This is a style of decoration I call Nouvelle Pathetique.

I moved around a lot when I was growing up, and unlike a lot of people who had similar experiences who go on to enjoy a nomadic, out-of-a-suitcase kind of existence, I find myself yearning for a place where I feel at home, the kind of place which is immediately familiar and reassuring, from the color on the walls to the cool, irregular surface of the bathroom tiles. One thing my partner's illness has made clear is how little our house lives up to this dream. The unresolved mess and the on-the-fly relationship I have with the place makes me feel anxious and guilty when I am in this house, rather than happy and rested.

This must change. Even though the initial diagnostic workup of the melanoma is reassuring, the fact remains that this disease will have an impact on the rest of her life, and might even end it before either of us is ready to loosen the grip on her life. There is a nineteen year age discrepancy between us, so the likelihood of my outliving her has always been a fact to be reckoned with in our relationship, but the melanoma has brought the possibility into high relief. The epiphany of the past week has been this:  If these are the last few years we have together, I want them to count.

Now, I'm not being pessimistic. I'm very hopeful about the future and that this melanoma has been handled in enough time to limit its harm. But I'm a physician, and I know how the malevolent jester we call cancer can behave. So I'm looking at every day as a gift. I don't want to waste any time.

Because it is likely we'll spend a lot of time at home, especially if she elects to get adjuvant therapies for melanoma, it seems critically important for this home to feel like--home. 

So I've been decluttering and cleaning and planning a palette of bright and harmonious hues to paint the dining rooms. I've been dreaming of airy dupioni silk curtains and witty upholstery slipcovers, and a beautiful edible landscape in the backyard, whose progress we can watch from a place that feels like home. Don't be surprised if paint chips, fabric swatches, and the adventures of home renovation begin to seep into the corners of these narratives.

Comments

[Bianca Castafiore]

I am glad the initial results were good but also understand your desire to "seize the day" -- we all should do it. I had to smile at myself while I read this entry. I'm having surgery Monday and yet am only obsessed with the de-clutterization and cleanliness of our house... because I want to come home to a beautiful, peaceful place where I can heal. It does matter... so go for it!

[Daphne]

I'm a recently graduated junior doctor and I'm such a big fan of your blog. 2 months ago I had to go through a laparotomy after an incidental finding of a large ovarian cyst (~16cm). I lost my ovary in after the surgery. I wouldn't say I know what it's like for you, but I guess I can understand how difficult things can be when something like this punctuates the everyday routine, it made me stop and re-evaluate things in life. I admire your writing, definitely a great inspiration to me. Hope everything goes well on your side.

[katy]

Hi. I'm also a family physician, just discovered your blog about 6 months ago and have really learned a lot from you. I admire your thoughtful ability to translate your experiences into words.

Just wanted to say I'm pulling for you and your partner. This is difficult stuff. Being a doc, I know we obsess on the medical literature--just remember that a)the statistics are just that...averages... and don't reflect how any one person's life is going to turn out. A friend's dad was diagnosed with stage IV colon ca (metastasized) at the beginning of residency. The stats say negligible 5yr survival but 8 years later, he's doing very well. b)the survival stats, by definition, are based on old treatments. Someone who survives 10 years started a whole different type of treatment than is available today. There have been tremendous improvements in melanoma therapy in the last decade as you know, and we can't possibly know what outcomes will be like for people starting treatments today.

I recognize you're trying to balance realism and optimism, but remember we physicians have a tendency to err on the side of doom and gloom b/c of what we see in the hospital. But that can be like seeing the coin land "tails" 3x in a row and assuming it doesn't have a "heads" side. We may be pragmatists, but our sense of statistics are generally way off!

Best wishes; we're all thinking of you, Katy

[Leslie]

delurking to say how glad I am to read about the margins!. I hope the pathology comes back as good as is possible.

I'm with everyone else - if I was local I'd come help. Having gone through most of a year coping with a non-healing broken ankle and surgery you both have my sympathy. That's hard to cope with without the follow-on illness.

[Jane]

Two of my favorite sites for decluttering (a newfound passion of mine!) are unclutterer.com and zenhabits.net (I think it's .net). I really do feel so much better having a spare, orderly home. I also picked up the book "Does this Clutter Make my Butt Look Fat?" at the library and skimmed through it, and it helped kick-start me into my decluttering process.

[rlbates]

Too bad we all live too far away to have an old-fashioned type "house-warming". Kitt and I and others would surely help you get things unpacked, painted, etc. Take care. :)

[Vijay]

Great to have you back in action, Theresa. I see that the 'restlessly creative' nature is going to be put to maximal use. Good luck, both for your partner & your home improvement scheme. Like Kitt above, I would help if I could, but you probably wouldn't appreciate my style which is best described as 'old-fashioned pig sty.' My wife would probably side with you :)

[dragonfly]

So glad to hear about the margins. Hoping and praying about the immunohistochemistry.

[Kitt]

If I were not in Denmark, I would come over and help out! Seeing as I just discovered your blog a week ago and have since burned through the entire archive... I'm a pretty big fan. If I had the money I would fly over to Rural during my January break and put your house in order for the sole benefit of being in the presence of your amazingness.