I am a rookie forensic pathologist blooging my way through the first year on the cutting room floor. It's graphic in here-- there's blood and worse. Look away or read on: it's up to you.

Wednesday, May 31, 2006

A sample workout regimen for the novice boxer

Today's workout:

Stretching
Ten minutes of jumprope
Shadow-boxing, six rounds
Hope to get coach's attention for session on mitts
Fail to get coach's attention for session on mitts
Shadow boxing, three more rounds
Loose a dollar in the sport drink machine in front of bemused weighlifters
Shadow boxing, three more rounds
Chat with that girl who's really, really good
Realize that the gym's gonna close in half an hour
Double end bag for two rounds
(Coach is really involved in this deep conversation with someone you've never seen before)
Heavy bag for three rounds
The radio has stopped playing; wonder when that happened
Pack up
Notice that the conversation is taking place over an open Bible
Wave from the door and leave

Tuesday, May 30, 2006

How to be a cancer patient

I am of the opinion that chemo is hard enough; don't be a hero. If there is anything you can think of to make it easier on yourself, by all means do it. Here are some things that worked for me:

*** Very important caveat: Everyone's chemo is different. I have no idea what yours feels like, I only know what mine felt like and, believe me, it felt different every single time. Consider this a starting point***

1) First, you will need something to do. I like to read, but if you like crossword puzzles or sudoku, use those. Under no circumstances allow yourself to be separated from your book. Seriously, I put mine on my belly as they were wheeling me into the OR; don't worry, when people need it out of the way they'll move it and get it back to you the moment they're done.

2) Second: wear layers. I don't know about you, but my veins hide when I'm cold-- bring a sweater or a jacket or something and stay warm until they're done with your veins. I don't care if you're not expecting to get bled or get an IV, things happen, so stay warm.

3) Third, popsicles! Be careful with this one; some people's chemo makes them cold sensitive (I know cisplatin can make your hands very sensitive to cold) but, for me, popsicles were great for getting that horrible taste out of your mouth. Boy, as soon as they injected some of those drugs I could taste them welling up in my mouth and, believe me, I just didn't want any more of that ever, ever, ever. Also helpful is candied ginger (available in your friendly neighborhood supermarket) and little hard candies. Stuff tasted really funny for the first day or so, so strong flavors (sweet, sour, salty) worked best for me.

4) Assignments! People around me were always saying things like "I just wish there were something I could do..." So I started giving them assignments and it really, really worked. Generally, I'd start with ice water (which I contantly craved like you would just never believe.) People who were good at getting and refilling ice water might also be persuaded to fetch a thermometer (for my many fevers) or a bucket (I am a champion vomitter-- really, I'm very, very good at it [more later])

5) This might sound like a long way off, but you have got to celebrate your last day of chemo. I got my mom to bring some sparkling cider (also goes very well with chemo!) and we brought along a basket of leis from the party store. I spent my whole last treatment passing out leis to and pouring sparkling cider for the nurses, the oncologists, the patients, the family members. Now, one of my drugs hurt like crazy going into the vein and took forever to run in. Many are the hours I spent staring balefully at that @#$!! bag waiting for it to be over but that day-- that wonderful day!-- I looked up and it was already gone! I was done! And all my chemo buddies were hugging me and counting down their own treatments (just two more!) Really, you've just got to celebrate that last time...

6) Links:

Prognosis:
The National Cancer Institute (http://www.cancer.gov) posts a collection of reguarly updated information on each type of cancer. When you're ready, look yours up. They've got parallel pages for patients and for doctors. The patient pages will tell you what treatments to expect, the doctor pages will give you pull-no-punches survival statistics (these can be a little, well, real, so make sure you're in the right mood for them.)

Coping:
The Lance Armstrong Foundation (http://www.laf.org) I love the Lance Armstrong Foundation. When you're up for it, go to their website and check out the survivor tools. You'll probably find exactly what you're hoping to find.

Also, other cancer survivors in general. For example, my Aunt Julia (who lives across the country from me) sent me a get well card every single week while I was on chemo. I will love her forever for this and many other reasons.

Side effects:
I had a great chemo pharmacist who handed me the MicroMedEx pages for each of my drugs. MicroMedEx has patient information print-outs that list your side effects. This is great for when you have weird ones (like jaw pain!) and want to know if this means anything (or if it's just more crap you have to put up with.) See if you can get yourself some for your drugs.

Supplement:

How to vomit

(This is my favorite method; feel free to customize...)

Assemble the following in front of the TV:


a trash can/bucket/similar appropriately-sized receptacle
Air freshener
spray (this is key)
Large glass of water
and the remote control



Tune the TV to a documentary (or something else talky and interesting)

Vomit.

Spray air freshener.
Swish and spit water.
Attempt to maintain focus on the documentary.
Periodically inspect vomit to gain insight into what, say, candied ginger looks like after a brief trip to the stomach.

Repeat.

and remember, I made it (twelve treatments!), so can you...

The view from here

It's hard to be sure, because I didn't know it would be an event at the time, but we're probably around end of my first month boxing. So far:

1) Both coaches and pretty much all the boxers who show up every day know my name; people who show up a few times a week wave.
2) I can name both coaches and pretty much all the boxers who show up every day.
3) Equipment:

Mexican hand wraps
Ringside bag gloves
Pro Boxing speed bag
Mouth guard and turtle shells
Very cool plastic jump rope with nice handles
Bag to put all this in
with lots of zippers and pockets
Lots and lots of sports drinks from the
vending machine right outside the gym


4) Training regimen:

Wrap hands
Stretch
Jumprope: 10-15 minutes
Shadow boxing: I lose count after about 6 but I think I'm doing about 8-10
rounds
Mitts: 2-3 rounds if I can catch the coach's eye, but that doesn't
routinely happen
Double end bag: 2-3 rounds
Heavy bag: 2-5 rounds (getting better but sometimes I'm just pooped out by
this point)


5) Stuff I'm kind of figuring out at this point:
  • They all say you're supposed to breathe out when you're punching and they're all right. You can do it quietly if you're afraid that your opponent will pick up on it, but if you aren't disciplined about this you'll find yourself all worn out with roughly nine hundred years until the bell goes off.
  • The particulars of hand wrapping are very, very important. Get someone to do it for you until you are 100% sure you are doing it right.
  • It doesn't really look like it but you're kind of punching with your feet, your hips, your back: it all has to work together. Arms alone just aren't going to do it.
  • People who are really good are also really fast.
  • It doesn't look like it but three minutes is a really, really long time
  • There is no way in the world to make it all the way to the water fountain and back in thirty seconds. No way.

Monday, May 29, 2006

Version 2.0

There's a picture of my mom, circa 1963. She's got a pixie cut, cigarette pants, and a mock turtleneck with a pair of slingback flats. She's dancing in front of a low table and a hip little danish-looking sofa, laughing.

I have never met this woman.

My mother is the sixth of eleven children and seemed, to me at least, to recede into whatever space she occupied. Her social life consisted entirely of Saturday morning telephone conversations: two to be exact. One to one of her siblings, rotating so that each recieved as many calls as the others. The other was to Bea.

Bea lived with my mother for ten years in a modest yet apparently chic apartment in Washington, D.C. and it was a small town scandal.

The moment my mom graduated high school, she ran off to the biggest city she could think of and began her new, glamourous city life as a soda jerk in D.C. (Mom still makes a mean milkshake...) She met Bea at the boarding house: two working girls with big city dreams. It was Bea's idea to apply to the FBI in the first place. They marched up those imposing steps arm in arm, were hired on the spot, and moved in together shortly thereafter.

At this point, the narrative always goes blank.

Blinking like a little strobe light through this ten year gap is the annual FBI dinner dance. Mom needed a date, dad needed a date, and, via a bit of coworker matchmaking, they agreed to be one another's date for this event.

Don't think romance: think prom-- think dateless and prom. Think prom that happens every year and every year you have to go. Think about being the kind of person who will always be dateless for prom. Now imagine that you have met another such person and, out of necessity, gratefully, you band together. Every year, dad would ask; every year, mom would go. And in between, they saw one another not at all.

There are artifacts from this time, but only a few. Aside from the photograph, there is a surprisingly extensive collection of silver tableware that mom split with Bea when she moved out: salt and pepper shakers, ashtrays, serving boats and the like. It sits, carefully wrapped in a series of high cupboards in the kitchen. I've seen it exactly once.

The clouds part on the tenth year. Mom wants to have kids and she isn't getting any younger. It's hard to say what dad wanted, but my parents' marriage really makes most sense when seen as an extension of the FBI dinner dance.

There is a picture of Bea helping my mother on with her garter belt at the wedding: they both grin nervously at the camera. It was soon after this that Bea met Maggie and they became Bea-and-Maggie.

For years, we would visit relatives "back East" in the Summertime and Bea-and-Maggie were always on the itenerary. You could tell how favored relatives were by the amount of time allotted to them per visit. Bea-and-Maggie were always heavily weighted, coming in second only to my Aunt Peggy, who had horses.

I always loved Bea-and-Maggie's place. They didn't know quite how to relate to kids and, so, treated my sister and me like miniature adults. My sister could take or leave it but for a bookish little girl like me, this was love at first sight! Finally someone to talk to! They'd bitch about work and I'd bitch about school and my mom would slowly thaw at the kitchen table into this woman that I'd never met before, the kind who just might dance around the coffee table, laughing.

Sunday, May 28, 2006

Nerd anthem

Pathology means "the study of suffering" (so I'm told) but what it really means is that you are a nerd with a microscope.

I like to explain pathologists as the hospital laboratory: everything you send to the lab you're sending to us-- blood samples, urine samples, tissue samples. Other doctors usually see us at conferences, waggling lazer pointers and babbling on and on about cells. (This involves looking smart in front of a bunch of people, which is always nice.) If they think of us at all, they picture us sitting behind microscopes in some cubicle or other, scanning, dictating, and scanning again... shuffling flats of slides from one pile to another until *bing* 5 o'clock, at which point we disappear (poof!) into a fleet of Lexuses (Lexi?) leaving a fading trail of perfume andVivaldi.

But what we're probably most famous for is autopsy.

Autopsy, I am told, means "to see for oneself" but I tend to think of it as the part of pathology that tends to get its own TV show.

My experience of autopsy takes place largely at the coroner's office. The first thing I want you to know about the coroner's office is that the walls of the service floor are painted just a baffling, gut-wrenching, nearly criminal shade of grey. I honestly cannot begin to imagine what possessed anyone to even make this color of paint. It's like they took a focus group and tried to think of a wall color that was even more depressing than black. Black, they said to themselves, has been done. Let's be creative!

The second thing I want you to do is this: I want you to go to thislife.org and click on "our favorites." There's an episode called something like "the house by loon lake" that feels pretty similar.

Here it is:
You drag all that schooling and all your smarty-pants studying and all those books you so laboriously crammed into your head to the table and you meet this stranger and you have an hour and a half or so to find something, a fulcrum, an edge, a nugget, just something that puts the story together. For an hour or so, you are immersed in this other person-- you walk into this person's world, follow them around for a while, poke yourself into their secret places-- you enter them, dissect them, measure them, peer at them intently, set aside little pieces of them in a jar, pause thoughtfully, scribble down a mass of little notes, and sew them shut.

I'm still a little unsettled by the idea of turning myself into a medical examiner. There is no way around how gruesome it is. No matter how tender you feel toward your patient, you are still covered in their gore; that horrible sucking sound is you-- carefully,precisely, professionally-- tearing their liver from their body. But I can't deny the attraction, the exhilaration of solving the puzzle, of finding the thread that unravels the tangle, of putting the sequence in line: abdonimal pain, gallstones, pancreatitis, death. So, when you picture me, it is in a vapor-lock mask, a disposable operating room gown, paper boots and a face shield, holding a (verycool!) huge curved knife and peering intently at the carefully cut surface of...-

The amazing adventures of cancergirl!

I didn't always have superpowers. At least, I didn't always know I had superpowers.. I remember the first time I realized I was, well, different...

So I'm sitting in one of those little phlebotomy chairs in this little anteroom in the nuclear medicine department and oscar, the tech, comes back from wherever he just was carrying a little yellow fishing tackle box. He sets it down, opens it up, and inside it there's this syringe with a tiny lead jacket on it and as he's injecting this stuff into my vein, I notice his radiation safety badge-- you know, that little clip-on thing you put on your jacket?-- and I start to wonder where's my little radiation safety badge? Oh, to @#$! with that, where's my little lead shield?

That's when it dawned on me.

It used to be that vegetables and jogging were good for me. Now chemo and radiation are good for me. Sure, mere mortals like oscar have to be protected by fishing tackle boxes and tiny lead syringe jackets. Me, you can just shoot that right into me!

Chemo's even freakier. I was most of the way through chemo before I noticed the little sign on the cabinet over the chemo barcalounger that says "spill kit." I've been in the lab long enough to know what that means.: I know that means that whatever just spilled on the floor is so dangerous that you need special stuff to soak it up with while you flee the room in horror. The special yellow trash cans I noticed right away: chemo waste. Somehow, it's even worse than plain old "biohazard" hospital waste. (How bad do you have to be before you're even worse than plain old biohazard hospital waste?)

This is when I realized that haveing cancer is kind of like having a superpower. Okay, it isn't the superpower you'd pick, but who picks?

Behold!: you can just inject me with pretty much anything. I am... Cancergirl!

Full contact

So I walk into the rec center the other night and we're sparring and I've never sparred there but it's full contact and I have no idea what that means. Sparring for me means feeling stupid and crying in the parking lot after kung fu thinking "how come I suck?" over and over again. Full contact sparring, I come to understand, means that girl is going to break your nose if she can figure out how.

She is going to knock out your teeth if she can. She is going to hit you as hard as she can for as long as she can and you are going to have to stop her. Because she is the only other adult female fighter at the rec center and there is clearly something about her that's, well, feral.

Meanwhile, the game is afoot. Kids are squaring off with one another: getting their hands wrapped, donning the headgear, putting in their mouth guards, getting tied into the big sparring gloves. The first pair look to be about five or so. The next few are a little older, but only a little. None of these kids has a whole lot of experience boxing; everyone's very, very new and it looks like nothing on earth. I keep thinking up superhero names for them: the windmill versus the dogpaddle... the guy who just doesn't wanna get hit versus randomly exploding guy...

I'm standing there thinking that, actually, these kids have been doing this longer than I have when it's my turn. So I put on the gear, hop into the ring, skip out of the corner and notice rather suddenly that whatever my opponent is doing she is definitely not boxing. Her face is kind of scrunched up, her arms are swinging around her full-force and somebody, somewhere is laughing. She is fighting. She is street fighting. I have walked into a brawl and am halfway through realizing this when the second wild right hand connects with my neck.

Strategy comes to me pretty fast. Two punches in and I figure out that it's only the right hand that's connecting, so I thrown up my left hand to make a little wall for my face and start delivering crosses straight at her nose. Set up, push off the right foot, turn the hip, and bam! I know I should be jabbing, but I can't bring myself to part with my (Aha!) invincible shield. The left hand stays put, covering my face and I give her a few more.

Now she's on the ropes and the laughing has stopped. She's not hitting, her hands are down, and that look on her face is still there. I don't know what to make of it. I back up and wait. I scoot in a little and tap her with my right hook. I tap her again and she explodes off the ropes, arms swinging. Fine, I know the drill this time: left hand shield, right hand bam! (Not the most complex of strategies, but, hey!, I'm just happy to have one. Back to the ropes again, same thing: she's not hitting, she's not guarding, she's just leaning there with that look on her face. Maybe it's the mouth guard. Tap... Tap... Nothing. No more explosions. Then the bell rings and she's sitting on the canvass, out of breath. Turns out she really only had about two good berserker attacks in her. Also turns out that the laughing was her. (Spooky!)

She vows to quit smoking and we schedule a re-match for next time the rec center has this sparring day-- in five months or so.

I haven't seen her much since-- maybe once or twice after our sparring session-- but she told me she was going to quit smoking and start running. For a while, I would push myself through rounds on the heavy bag by imagining that she was out there somewhere, training. But there's a new adult female at the rec center and she's really, really good. (I mean really, really good.) And she is always training. (I mean always training.) So I don't have to imagine any more.

Million dollar baby

So I'm getting my @ss kicked in sparring on a very, very regular basis and it's starting to tick me off (you gotta put your waist into it, you gotta put your waist into it, poor ryan keeps saying, god bless him...) and whenever I drive to kung fu I pass this little boxing supply store and I'm thinking: focus mitts. What I need are focus mitts. (This is how my mind works: there is no problem that cannot be solved by shopping.)

So I get a pair and I get my (very patient) boyfriend to hold them up for me and I'm out in front of my house hitting them. (Alas, I have no backyard. Thus, if I wish to practice my martial arts, I am forced by circumstance to be the weirdo with the wooden sword out in the front yard.)

Let me preface this by saying that I live in not the best possible neighborhood, legally speaking. I used to count the number of people who got arrested in front of my house, but I lost count around seven and that was not very long after we moved here. (If it ain't dangerous, I can't afford it.) So there are always lots and lots of people walking up and down the street at all hours and lots and lots of people just kind of hanging around all day long, looking crafty and alert. (Dealers? How the @#$% would I know?) They sem friendly enough. When I jog past, sometimes they yell out helpful tips, like "keep those feet moving!" while I'm waiting at a light. I refer to them as my ad hoc coaching team.

So I'm out in the front lawn with the focus mitts and one of the hang-around-all-day guys who is hanging around nearby steps closer and says "Now, you gotta put your waist into it." [Slap forehead: of course the coaches know how to fight...]

So we start talking and he tells me that I really have to go to the rec center: they'll teach me how to box. Now, while we're talking, one of the other hang-around-all-day guys walks up to tell me that I really have to put my waist into it and have I considered training at the rec center? And so the two of them start chatting with each other :
"That's what I was telling her.."
"My enforcer trains there..."
"I used to be an enforcer and I trained there..."

[By this time, the tag line is running through my head: two out of two drug dealers surveyed recommend ____ Rec Center for their enforcers who box.]

I get directions.

Here is the rec center:

wood floor
portable stereo (hip hop, loud)
lots of boxing posters all
over the place
six heavy bags
a bag you can practice uppercuts on
three speed bag(all flat)
double end bag
a ring with a couple of
guys in it who are clearly very, very good
two coaches with focus mitts
a whole bunch of very sweaty, very fit guys
and me.


I love the coaches. Day one they're handing me a sign in sheet, telling me I'm perfectly welcome there over and over and over, and calling me into the ring for class, which consists of about ten to fifteen 9-year-olds and me, all holding up our hands and skipping back and forth across the ring. For the end of class, the coach calls us out, holds up his hands and calls out punches (one two! one two!) It's my turn and I'm sweating so hard and breathing so hard and I can feel the punches start to lose their force and coach starts calling out "million dollar baby! million dollar baby!" and I smile and the force comes back.

Be happy without robots

So jenny is my new hero.

It all started with a tee shirt-- it's got a little bat on it. So I ask her what's up with the bat and she says she's way into caving so I ask her to take me sometime and, literally years later, she does.

There's a cave in simi valley, but you're not technically supposed to be there. It sits back behind a bunch of houses and is literally somebody's back yard, so we bring these really durable trash bags to clean it up. "We" is jenny, one of her friends, one of his friends, and me. So I get there in my brand new headlamp and knee pads and there are these two guys I've never seen before hanging out in a parking lot in simi valley. Oh yeah, and a film crew. From bollywood.

Jenny shows up and off we go. It's a short, pleasant scramble up a hill to this pile of rocks with grafitti all over them and all of a sudden jenny declares "it's all about how small a space you can fit through" and slithers into a crack. We're sitting there looking at each other and her head pops back up-- "try not to step on the caterpillar."

It's amazing how fast you get used to things. The first step down was weird (RIP fuzzy little caterpillar; I swear he was like that when I found him), the first crack was murder-- all I could think of was don't think about the tons of rock about to smush you, don't think about the tons of rock about to smush you. You can barely fit yourself through these things, let alone two people so we can't really see each other. All I can see is jenny's foot or a little bit of pant leg from one of the guys and the swinging cool light of the headlamps. I can't for the life of me figure out where these so-called openings are, so I'm just following the foot. This goes on for an hour.

We reach a "room." At this point, anyplace where you can actually sit down feels huge and this place is massive-- you could've put a queen-size bed in there and still had room to get around it-- and there are beer cans and candle wax and graffitti everywhere, including an open invitation to a "cave party" spray painted on the wall. I'm about to think that it sounds pretty dangerous to go into this kind of place with a bunch of people you don't know when I realize that I can't remember which of the two guys is josh. (Ever have one of thos moments?)

Another hour and we're out, another half hour and we're at this C&W bar at the foot of the hill eating fried pickles and I can't shut up about when are we going again...

A couple weeks later, jenny's having a party at her house with a whole bunch of people I've never seen before and she pulls out a bunch of paper and pens and we're playing this game where you write a sentance, then hand the paper to the next person , who tries to draw what you wrote, folds the paper to hide the writing but not the drawing and hands the paper to the next person who writes what the sentance might be based on the drawing. We can't draw for @#$! so the sentances spiral out of control pretty fast. My favorite one starts out with "Open a bottle of wine to celebrate" and moves through "People fleeing carnivorous cookware" to "Be happy without robots."

So, like I say, jenny is my new hero.