Saturday, May 31, 2008

Chicken Run

For the last nine months, we've been amateur chicken farmers. But due to our imminent summer vacation and upcoming move, we gave our eleven chickens away today. It's a rather poignant moment: the end of the Chicken Era.

Last fall, we joined ranks with another family in caring for eleven hens that were housed in a chicken coop on a ranch outside of town. It was a great opportunity for our city family to get involved in some real-life agri-culture (farm work, chores, getting down and dirty), not to mention to get some delicious farm fresh eggs.

Jim, one of the dentists in town, had a spare chicken coop sitting on his beautiful ranch, and he was gracious enough to lend it for our chicken endeavors, and so twice a week we headed out to his coop nestled in the cottonwoods by a pond to feed our frenzied feathered friends.

There were four Rhode Island Red hens, four salt-and-pepper Plymouth Rock hens, and four plain old white hens, prolific egg layers all, putting out sixty to seventy eggs a week between them. Due to the egg surplus, Joy and Grant got to start their own little business, "Foster's Farm Fresh Eggs." If they collected the eggs and took care of the chickens, they got to sell them and keep the profits. Quite a business, I must say. The kids are rolling in the dough. Even Justin grew to love going out to feed the ever-bustling, ever-interesting (to a one year old at least) chickens.

Eventually, we took over sole ownership of the chickens, and finally today we bequeathed them to another young family. The whole chicken business was quite a bit of hassle, especially in the winter when it was 28 below zero, but I must say that I feel rather sad at the close of this chapter. It started out on a whim, and ended up becoming an integral, earthy part of our Worland life, a vignette of what our future might have held should we have chosen to stay in Worland longer.

But hey, they still need eggs in Colorado, right? Do you think our new suburban neighbors would mind if we erected a chicken coop in the back yard? Would eleven clucking, stinky chickens be a problem?

Come on, Colorado. Time to put that "Locally Grown Food" movement to the test!

But in seriousness, I know there is a vestigial farmer in me. I feel him clamoring to be released whenever I've been tangentially involved in farming or ranching. We hope to own our own small ranch someday: some acreage, some horses, and--gosh durn it--some chickens!

Tuesday, May 20, 2008

Spontaneous Wipeouts

A young child is ambling on without a care in the world. Suddenly, through a mixture on incoordination, head-size disproportion, and just plain bad luck, they collapse in a heap.

Cue the crying.

Elizabeth and I refer to this sudden, catastrophic collapsing malady of childhood as the "spontaneous wipeout." Our children are masters of the art.

Joy may be routinely brushing her teeth, and suddenly she has fallen violently, wedging herself between the toilet and the trashcan.

Grant may be eating his breakfast cereal, sitting flat on his bottom, and suddenly, without any obvious impetus, he has toppled head first onto the hardwood floor, scattering soggy cheerios to the four corners of the kitchen and sustaining a large goose egg on his forehead.

Justin, being only a year old, can be forgiven his frequent falls, but I have no doubt he will soon be following--or should I say falling?--in his siblings footsteps.

New light was shed onto the origins of this phenomenon last week. Joy was standing still in the kitchen, not moving in the least, when suddenly she crashed through the screen door, ripping the screen out of its frame, scraping her foot and bruising her arm in the process. In my ultra-calm but deadly serious voice, I questioned from the couch, "So, Joy. What happened there?" She whimpered plaintively from the porch, "I don't know, Dad. I just went out of balance."

Ahhh. So that explains it. Going in and out of balance without a moment's notice.

In medicine, there is a condition known as Benign Paroxysmal Positional Vertigo, or BPPV. But this is not that, for this may be paroxysmal, but it is by no means benign.

This is the Spontaneous Wipeout. Who knew gravity could be so malevolent?

Sunday, May 11, 2008

Breaking the Bad News

I don't have to diagnose patients with cancer very often, thankfully. But the last few weeks have brought a grim procession of cases where I've been the one that's had to break the news.

Two of these patients have been very elderly, very frail, and while a cancer diagnosis is always devastating, they and their families have met the news with a sense of resignation mellowed by dementia.

But two of these patients have been fairly young (in their fifties), otherwise healthy and brought into the doctor's office by fairly minimal symptoms. In both cases, I initially pursued a conservative work-up, but through a mixture of clinical intuition, defensive medical practices, and plain old blind luck, I ended up ordering special imaging studies. Both patients ended up having particularly large and aggressive tumors; both now face a horrifying gauntlet of major surgeries, radiation and chemotherapy, all of which appear unlikely to prolong their lives.

Ugh. It's enough to make me want to do an MRI of my whole body, just to be sure there isn't something sinister simmering in my tissues.

It's a little bit like hearing about a plane crash: when you see something so horrific, you suddenly feel vulnerable, even though your odds of suffering the same fate are exceptionally small. (Unless, of course, you fly on Great Lakes Airlines.) Compound that by paranoia by witnessing first hand the disaster several times in a short span.

When I'm faced with an x-ray report that reveals a likely cancer diagnosis, I feel devastated for my patients as well. I dread having to be the messenger, though I do appreciate the importance of my role in reliably and empathically conveying the information. Knowing I will have to answer a deluge of panicked questions once I break the awful news, I go do as much research as possible to try and educate myself and be prepared. But oncology is such a specialized field now with such specific diagnoses, treatments and prognostications, that whatever meager information I impart will be utterly insufficient. This is especially true when I am breaking the news of an as yet unconfirmed cancer, as you never diagnose cancer off of an x-ray, but rather under a microscope once you get a tissue biopsy. It's all a very hopeless feeling for me; usually the best thing I can do is convey the information, offer compassionate solace, extend an invitation to hope for the best, and then expedite a referral to an oncology center. It's not like treating an ear infection: easy diagnosis, excellent prognosis, concrete remedy.

It's more like dredging a lake for drowning victim: emotional paralysis until the awful discovery confirms your worst fears.

I guess that's why I've had a Tim McGraw song humming in my head all week:

He said, "I was in my early forties, with a lot of life before me
When a moment came that stopped me on a dime.
I spent most of the next days, looking at the x-rays
Talking 'bout the options and talking 'bout sweet time."
I asked him when it sank in, that this might really be the real end.
How's it hit you when you get that kind of news?
Man, what'd you do?

He said,
"I went skydiving
I went rocky mountain climbing
I went two point seven seconds on a bull named Fu Man Chu
And I loved deeper
And I spoke sweeter
And I gave forgiveness I'd been denying
And he said, some day I hope you get the chance
To live like you were dying."