Thursday, October 2, 2014

The Truly Unusual Little Episode in which Hoda Kotb, Cyndi Lauper, and Sara Bareilles Unwittingly Conspired to Save my Life

Sorry about the convoluted nature of this post…but there’s a payoff when threads tie together that challenges some of the most tightly written Seinfeld episodes…promise!

Cyndi

Anybody who really knows me knows that I have been a huge Cyndi Lauper fan since her emergence in the early days of MTV. Yes, I did my share of head-banging with Def Leppard and Quiet Riot back in those days, new-waving with Duran Duran, arena-rocking with Journey, et. al. But this 15-year old boy had a ridiculously oversized “She’s So Unusual” poster on his bedroom wall and played that LP along with Cyndi’s previous rockabilly band outing “Blue Angel” until, as they used to say, the needle wore out the records. There was something special about her voice, talent, and quirky passion that appealed to me much more than the otherwise often banal music landscape of the early 80s. I was lucky enough to see her in concert on the original “Fun Tour” at Cleveland’s Blossom Music Center in 1984 and to have recorded the “Live at the Houston Summit” (of all foreshadowy places) concert off the radio that year, a cassette tape I still have. I've always kept up with her discography through multiple format changes over the decades, LPs to CDs to digital. “True Colors” came out in college, “A Night To Remember” in medical school, "Hat Full of Stars" alternating with "Nevermind" as I moved from Cleveland to Galveston in '93; each subsequent album takes me to a specific time and place. 

In the summer of 2013, barely a month before the seizure that started The Sickness, Charlotte and I saw Cyndi live in Houston at the House of Blues on the “She’s So Unusual” 30th Anniversary Tour. Nothing like seeing a true talent live on stage to create a 2nd Generation fan for life. We both loved the show and I was thrilled to share this time with my daughter.

The Rainbow Connection

Now as a pediatrician in Galveston, Texas, I have worked closely with our local children’s oncology camp, The Rainbow Connection, both as a member of the Board of Directors doing year-round fundraising to keep the organization going, as well as serving as the Camp Physician every summer for the past 10 years so the kids can just be kids and enjoy camp, forgetting about their diagnosis and illness for a week…but with a doctor on standby “just in case.” Another part of my involvement in The Rainbow Connection is maintaining the websiteFacebook page, and planning some of the multimedia used at camp each year. I’m always listening for the latest and greatest inspirational tune to add to our extensive camp soundtrack that gets the kids pumped up and encouraged to be brave and try new things.

Sara

Sara Bareilles hit my radar so solidly into the digital age of music, that like many I owned her first hit single around 2007, the infectious “Love Song,” as an iTunes/Starbuck’s Free Song of the Week. How amusing when returning to iTunes to buy the whole album to find it titled “Little Voice.” Like Cyndi’s, Sara's is hardly a “little” voice and similarly captured my attention with her passion and talent. iTunes has certainly been Sara's friend, seeming to always push any of her new material to the front page, where with such simplicity I’ve clicked each of her subsequent releases into my collection, no needle on the record necessary.

The Sickness

Of course this entire series of blog posts or facebook notes was inspired by my own cancer diagnosis in August 2013. I had surgery and treatment for a brain tumor in September 2013, and had been recovering wonderfully in every way while under very close medical surveillance for complications or recurrence. Last spring, anticipating attending the upcoming 2014 Rainbow Connection 30th Anniversary Camp not just as the Camp Physician, but also as a patient myself, who needed and wanted to be able to forget about my diagnosis and “just be a kid” for a week, Sara’s 2013 song “Brave” was, for me, clearly the Camp Song of the Year. I’d already been playing this song on endless loop as motivation for myself…and I knew it had to be the song at the top of the rock wall for the kids to show us how big their brave is as they leapt down the zip line. Indeed, the song became part of Rainbow Connection musical canon and also punctuated the camp's 30th Birthday Week-in-Review Slide Show.

Unfortunately the sickness continued, requiring an additional surgery just a month after camp, in August 2014. For the second time, I had been recovering from brain surgery quickly and fully, until very abruptly on a mid-September day I became critically ill with an infection-related complication and was hospitalized in the ICU at MD Anderson in Houston. I recall virtually nothing about those first few days, as my brain-infected, sedation-infused mind operated wholly outside normal boundaries. I’ve been told I was confused, combative, at times seeming not to even recognize my closest family and friends who had dropped everything and mobilized to visit me from all over the country. This was some serious shit and I was drowning in it quickly. Nothing was reaching in and I was barely reaching out. Then…

The Song ("Truly Brave")

In honor of National Childhood Cancer Awareness Month (September), Hoda Kotb of the Today Show, a cancer survivor herself, had created an amazing music video with some kids from Children's Hospital of Philadelphia and some very talented musical artists. While visiting me in the hospital, my sister clicked a link posted by our Camp Director on the Rainbow Connection facebook page to the Today Show video and it started playing in my room. Somewhere, from the darkest depths of my illness, during its deepest inescapable, surreal cave of disoriented hypnagogic state, something that should have made virtually no sense whatsoever made perfect sense at just the perfect time, to just the exact person who could understand and need it most of all. Me.

An IV dripping…a hospital monitor beeping…Cyndi singing “True Colors”…no wait, that’s Sara singing “Brave”….kids giggling at the top of the zip line showing how big their brave is…there was nothing that could have spoken louder or clearer to me at that moment. I needed to be truly brave. I needed to wake up. Get better. I’ve got kids to raise. I’ve got a wife to love. I’ve got patients to care for. I’ve got camp next year. I’ve got stuff to do. I am not finished. I am smiling ear to ear and crying in my obtunded unresponsive sleep. 

WAKE UP!!!


YouTube link if video not playing inline above:

So I did, and here I am.




Tuesday, August 12, 2014

(Almost) One Orbit


We are fascinating creatures. We possess an inherent and intuitive desire to count, organize, and sequence virtually everything. Before humans even understood exactly how or why the Earth orbits the sun, the planet's annual trip around its central star became the benchmark measurement for all significant events of history, as well as those of each individual lifetime.

That the 365 rotations of the Earth on its axis correlates with a single trip around the sun is arbitrary and unique to this particular rock circling this particular ball of fire. Yet the "year," subdivided into "months" (patterned on the Earth's own orbiting rock), further divided into "days" by the illusory rising and setting of the sun, is how we measure, collate, and define our lives, accomplishments, and memories. That a person remained alive, married, employed, or remembered for yet another trip around the sun, is routinely celebrated. This is especially true for a first anniversary, and also for those at 5 or 10 year intervals. This is an arbitrary cultural manifestation of biologic natural selection favoring our ancestors who more frequently survived their primitive environments with 5 digits on each hand, and eventually developed a base10 numerical system.



The first date many of us learn and commit to instant recall memory is our own birthday. For me, November 18, 1967. Kids can reflexively report how old they are and instantly flash the right number of fingers. Kindergarteners finally put their naturally selected thumbs to good use, proudly spreading all 5 digits in response to "So how old are you?" At some point, maybe late 20s or mid 30s, the birth year suddenly becomes very important as a pause for quick calculation becomes necessary to determine age. Hmmm...it's 2014, I was born in '67...guess I'll be...uuhhhh...47 in November so I must be 46. Yeah, I'm 46. Really? I'm gonna be 47 this year? Sheesh.

Life progresses and other important dates are impressed upon memory, like the birthdays of parents and siblings (cake!!), and important recurring holidays like Valentine's Day (candy!! February 14th!), Halloween (candy!! October 31!), and Easter (candy!! um..when is Easter, exactly?). Only the naiveté of a child could foster contemplation of how cool it must have been for Jesus to have a birthday (December 25, 0000) on Christmas Day. Double presents!

The dates of historic events that occurred before we were born become part of our shared experience and could sometimes be contextualized by parents or grandparents. Certain dates have always carried great weight and gravitas as far back as I can remember. July 4, 1776...December 7, 1941...November 22, 1963...May 4, 1970 (my Dad was a student at Kent State and we were all there). I lived through many, many April 19ths before I knew that would be my wife's birthday. August 4th came and went a couple dozen times before it became my wedding day on August 4, 1995, our 1st anniversary in 1996, and will be our 20th in 2015. Those dates are now enshrined in my personal Calendar Date Hall of Fame (and damn well better not be forgotten!). The births of kids on September 2, 1997; June 19, 2000; and January 9, 2002 are among the most special of dates. I succeeded in flawlessly rattling them off rapid-fire in a pre-op urology clinic interview, an amusing quiz to make certain that I was indeed satisfied with the kids I already had and was ready for a vasectomy. 

I can distinctly recall how September 11th, 2001 changed from a simple quiet morning in the ER, where I had already written that meaningless date on half-a-dozen charts, to a day that everybody knew, even as it had barely unfolded, would be "one of those dates." September 13th, 2008 drew a line in the sand that everybody here in Galveston knows distinctly marks the "pre-Ike" and "post-Ike" periods of our lives. It was with wistful sadness and moist-eyed joy that recent commemorations reminded me that my entire life and generation are encompassed within and profoundly influenced by the 50 year-long shadow of JFK in Dallas (November 22, 1963) and the Beatles on Ed Sullivan (February 9, 1964).

As you grow older, you don't expect or hope to add more landmark dates to the list. Maybe a grandchild's birthday (in many, many, MANY years!!!). One year ago, at age 45 (um wait I was born in '67...about to make reference to summer of 2013...so yeah, 45) I added a new one: The day-I-had-a-seizure-while-giving-a-lecture-to-the-medical-students-on-their-first-day-of-school and got-diagnosed-with-a-brain-tumor. My own personal Pearl Harbor Day. I'll always remember exactly where I was and exactly what I was doing when that happened. I hope the events of that day not only made for a unique and memorable first-day-of-medical-school story for that auditorium full of future physicians, but impressed upon them the way an ordinary August 26th can abruptly, and with only subtle warning, become August 26th, 2013, a date dramatically altering a person's health, hopes, and identity from that day forward...or possibly even that final bookend date to be chiseled on their tombstone. 

Of course I'll continue to count my total trips around the sun from '67. Almost as meaningful is the nearly complete orbit I've made since August 26, 2013 and those yet to come (the math is soooooo much easier). I've now got an additional line in the sand separating "pre-tumor" from "post-tumor" life. Counting the years since a cancer diagnosis may seem inspiring yet still a bit ghoulish. In a field of medicine where doctors tally their treatment successes in 5-year survival times, I'm fortunate to have taken my first steps. 

Almost a year ago, I went to work on August 26th blissfully unaware of the 3.5cm time bomb ticking in my right temporal lobe, which was removed on September 25, 2013. This coming August 26th I'll already be recovered from a second procedure to remove a 1cm recurrence discovered just this week. I'm moving on to the terrible twos with hopeful plans to make it to kindergarten and beyond. 

Put away the chisel for now.


- kpb 8/12/14
#negu

Tuesday, June 17, 2014

How Are You Doing?

This is probably the most Frequently Asked Question to which most people in most circumstances don’t truly care to hear the real answer. “How Are You Doing?” is often the slurred appendage to “Hey,” as in “heyhowurdoon?” Often, “How Are You Doing?” is more a friendly informal salutation than a genuine question. All anyone really expects in return is a “fine” as we pass quickly in the supermarket or arrive to a meeting. The last thing anyone actually wants to hear is the long drawn out story of How You Are Doing. For the past several months, I have commonly been the recipient of a heretofore unfamiliar variation on the “How Are You Doing?” question: the one where the questioner really does want to know How I Am Doing.

Yes, I still get the everyday obligatory “heyhowurdoon?” and the dude-ified abbreviation “sup?” with attendant head bob. Frequently I’m now approached with “Heyyyyy, How Are YOU Doing?” with the extended cheery “ay” in “hey,” clearly enunciated capitalized words with the vocal emphasis on the all-caps and audibly italicized “YOU,” ending with the full-on, g-included, rare-in-Texas, two-syllable version of “Doing?” There’s often a simultaneous tip of the head, scrunch of the brow, and pat on my shoulder or hand. In this format, the question is sweetly sincere, but demands more than just a cursory “fine” from me. Kind people genuinely want to know How I Am Doing, and the truth is “It’s complicated.” Caught at any given moment, however, I am indeed “fine.”

Here’s How I Am Doing:

Radiation therapy has left me with a conductive hearing loss in my right ear. I can’t hear your voice over the world’s rumbling ambient noise unless you are to my left. My own voice, chewing, swallowing, stomach grumbling, as well as louder environmental noises bounce around and echo in my head incessantly. The space between my ears can easily become a racquetball court of clatter. It occasionally mimics some of the scary “am I the only one hearing that?” phenomenon that started this whole thing last August. Of course there are worse things than being deaf in one ear, and I'm grateful I've had no real pain, nausea, or other debilitating physical symptoms. This deafness and accompanying auditory weirdness would not be nearly as unsettling if it were not a 24/7 proxy for the tumor, a constant reminder of why I have the doggone deafness in the first place. Just when I have almost forgotten about all this for one hot second, I’m immediately reminded by the ocean in my right ear, even when alone in a silent room.

I’m tired. All the time. I’m adjusting to this as a “new normal” and hoping it goes away. My oncologist tells me this can be a lingering effect of radiation that can last for months, sometimes “forever.” It’s been months, but I’m still tired. I wake up in the morning bright eyed and bushy-tailed, but the sack of fatigue hits me by mid-morning like a paint can in the face of a Home Alone burglar. By the time I get home from work, I’m often ready to crash for the night. If we run around and do some evening stuff I can keep going, but 5 minutes on the couch or the La-Z-Boy and I’m out. I purposely rest all afternoon on the days I have an evening clinic shift and I do fine. Hey look, I’ve had a malignant brain tumor. I've had surgery. I’ve had radiation, I’m on several medications. I work more than a full-time job and have 3 kids. I deserve to be tired. I feel that if I’m falling asleep that readily that my body must need the rest. But I don’t want to sleep my life away at this point.

I’ve had a series of MRIs every 2 months since surgery in September that progressed from “expected post-surgical inflammation/changes” to “radiation induced changes around the surgical cavity” to “concerning area for recurrence near the surgical site” to “previously noted concerning area has decreased, but warrants continued follow-up.” Blood work and a week of oral chemotherapy every month has barely fazed me, but lately it’s been fazing my platelets. Please don’t pat my shoulder or hand too hard when you ask How I Am Doing. Living blood test to blood test, MRI to MRI, appointment to appointment is stressful. The 1-2 day wait between the MRI and the neuro-oncology appointment where I get the results is the worst of all. A good friend has dubbed this unique brand of stress “scanxiety.”

In a weird sort of way, I enjoy my MDA appointments. There's a comforting unspoken solidarity in the elevator as it rises to the 7th floor full of us "head cases." Nobody asks How I Am Doing. Everybody smiles, nods, and knows "It's complicated." Sometimes I see this young lady sporting a scar matching mine being pushed in a wheelchair with a portable suction machine in her lap and a bag of liquid nutrition hanging from the pole. I smile at her while I cry a little inside; I can walk, swallow, and eat perfectly well. Like everyone, including my “previous” self, I get a headache now and then, slur a word here and there, become frustrated by simple problems, occasionally get a little off-balance when I stand up too fast, or get a song stuck in my head. Now all these little dopey everyday occurrences carry so much extra weight and meaning. Every. Single.Time.

I worry about what’s going to happen. Waiting for the next shoe to drop. Then I worry about how much I’m worrying about it. I can sometimes get thrown into a spiral of outright shaky panic over making the simplest decision (“What do you want for dinner?”). Yet when in my comfort zone of motor memory tasks, like solving a Rubik’s cube in a minute or (believe it or not) being a pediatrician, I fall right into a steady rhythm and don’t miss a beat. Again it’s a new normal. I must constantly remain self-aware and reflective about How I Am Doing. I have a trustworthy team of friends and co-workers to keep me in check, and my always supportive family to talk me off the ledge when I can’t decide between 3-bean soup or spaghetti.

Speaking of dinner, my appetite has changed considerably. I have lost about 20-25 pounds through all this, which I had been wanting to lose for years. Be careful what you wish for. I’m eating less, eating healthier, and trying to stay a little more active. These are all good things. Still it’s uncomfortable when people unfamiliar or even vaguely familiar with my situation say “Hey howurudoon? You look great! You’re so svelte. Have you been losing weight?” Cue Debbie Downer awkward brass wah-wah noise. “Yeah gee thanks I’ve lost 20 pounds! This MDA diet is the best ever!!”

So when you ask me How I Am Doing, please remember that I may not have heard you, I’m very tired, I may be getting my latest blood or MRI results tomorrow, I’m worried, I don’t know what I want for dinner, but I'm happy these pants fit again. “It’s complicated.”

I really do appreciate you asking. I know you care. Thank you.

-kpb 6/17/14


Wednesday, September 25, 2013

Don't Pray For Me Today

Today I go to the operating room. I have an excellent neurosurgeon who specializes in operating on precisely my type of brain tumor. Alongside him will be the best team of anesthesiologists, nurses, radiologists, pathologists, and other health professionals, taking care of me at the premier cancer treatment center in all the world. My family and friends are with me.

I will wake up later this afternoon still halfway under the groggy fog of anesthesia, move my left arm and leg, report to the nurse about my latest gas passings, futilely beg to have my foley removed, say a few inappropriately amusing things, then select items from the most exquisite menu of clear liquids offered anywhere. It seems that after almost a month of Listening to Your Prayers, Having a Reason for Everything, and Working in Mysterious Ways, the Answerer of Prayers has gotten me squared away perfectly today. He's Got the Whole World In His Hands and probably needs to move on to other things.

So don't pray for me today.

Pray for all the little kids with cancer, who haven't yet lived 5 or 15 years, let alone 45, and are experiencing much more misery and pain, or enduring more difficult treatments for more serious conditions than what I am undergoing, with little to no understanding of why.

Then pray for all the healthy kids that they never have to experience any of these things. The Answerer of Prayers will have a little extra time to take care of that, if you don't pray for me today.

Pray for all the kids who got hurt in accidents with cars and guns and hammers and lawnmowers and swimming pools and knives yesterday who are in hospitals all over the country today in pain and barely clinging to life.

Then pray for the millions of otherwise happy, healthy kids that they don't have accidents like that tomorrow, or the next day, or ever. The Answerer of Prayers can give some additional attention to that, if you don't pray for me today.

Pray for all the kids who are being beaten, molested, or neglected and have nobody to protect them, or whose protectors have become their daily living nightmares.

Then pray for all the happy kids in good homes, that they don't fall victim to such abuse or become enticed by trusted adults who are predators in sheep's clothing. The Answerer of Prayers will have more time to keep them all safe, if you don't pray for me today.

If you nonetheless feel compelled to pray for me today, then instead please pray for Amy, Cameron, Justin, and Charlotte, that they will have the strength to endure whatever inevitability the Answerer of Prayers has planned for me. I prefer the extra good juju be set aside for them, "just in case," rather than spent on operating room distractions.

I have already been placed in Good Hands, so don't pray for me today.
-kpb 9/25/13

Thursday, September 19, 2013

Going Bananas

I have not seen any patients since Sunday, August 25th. Combination of neurological dysfunction, pharmacological alteration, and psychological fear…there have been some days that I have felt like I probably could go to the clinic, but the fact remains that my colleagues have my shifts covered and I have not seen any patients in almost a month. I don’t think I’ve ever gone that long without seeing a patient since graduating medical school. I miss it.

Since I had just started the transition to a more “8 to 5” administrative position as residency program director, I have been trying to at least go into my spiffy new office. While nervous about my ability to see patients, I figured any bonehead could sit at a desk answering emails, rubber stamping stuff, attending meetings, and moving the stapler from one side of the desk to the other. However I soon found that my malfunctioning acoustic processor and auditory filter could not handle the imaginary “Carol of the Bells”-ish clatter playing along with the constant chatter, questions, phones ringing, AC fan getting louder and LOUDER and LOUDER like an 18 WHEELER ENGINE IN MY HEAD.

I found myself becoming exhausted, disoriented, and frustrated earlier and earlier each day. I’m doing a little work from home but have not gone to the office at all for the past 2 days. Sublime silence in my Laz-E-Boy has indeed settled my mind as I contemplate surgery next week. But the clattering noises, metal mouth, and heavy tongue are readily summoned, especially when the kids arrive home from school each afternoon with their buckets full of chaos.

Early every Thursday morning Amy runs a charity food distribution give-away at a church just a few blocks from our house. I have never gone with her before, but decided I wanted to go help pass out the food today…you know, do something useful, helpful. When we pulled in, there were already hundreds of people waiting all around the parking lot perimeter. I overheard conversation that some had been there since 5:00am to stake out an early ticket number for the line. Many pushed rickety rusted shopping carts, but most clutched makeshift carriers such as those ubiquitous canvas Wal-Mart bags, milk crates, laundry baskets, or even trash cans.

I recognized some of the clientele as parents of kids I’d seen in the clinic. Most others were an assortment of people I was not at all surprised to see out there: Old guy with oxygen tank and walker, scrunch faced man in stocking cap muttering to himself and yelling at birds, toothless lady joyfully repeating “I got #2, I got #2, I got #2” to anybody that would listen (many were impressed or envious), young unshaven guy with homeless smell and strips of torn paper towels inexplicably wrapped around his shins and feet, old lady with thick glasses in her kelly green Sunday best including pillbox hat and corsage wandering around finger in the air non-stop praising-be. There were a few young families and a few fancier folks who were clearly providing their less fortunate neighbors with transportation to this weekly gathering. I was glad to be there and was very proud of Amy.

As the usual truck arrival time drew nearer, there was a growing excitement, anticipation, and rumbling. Wonder if they’ll have chicken today? Hope they have carrots! I got #2, I got #2, I got #2. Those potatoes last week were so good. Once the big rig arrived and the inventory assessed and unloaded, Amy put me in charge of passing out bananas on the shady side of the truck. Because there were tons of bananas this week, people would be able to have as many bananas as they wanted and wouldn’t fuss at me. I’ve got hundreds of bananas in front of me with dozens of boxes still on the truck, and I’m ready to pass them out. Bring it.

Clatter clatter clatter Carol of the Bells clatter chatter chatter why is there an 18 WHEELER ENGINE IN MY HEAD I got #2 I got #2 I got #2 BE QUIET BIRDS Bananas oooooh look at all those bananas how many bananas can we have AM Radio AM Radio AM Radio 1 banana #2 banana 3 banana 4 Do they have carrots today clatter clatter chatter chatter Carol of the Bells 18 WHEELER there really is an 18 WHEELER RIGHT NEXT TO ME DOESN”T ANYONE ELSE HEAR THAT those potatoes last week were so good IT'S SO LOUD BE QUIET BIRDS AM Radio I got #2 I got #2 I got #2 I GOT #2 I GOT #2

“Are you OK?” It’s Amy.

“No I can’t do this. I need to sit down.” Welling up with tears. Not helpful.

Back in the van, doors closed, AC running quietly, radio off, no bananas, no 18 wheeler, sublime silence settles my mind. I rested my head on the window and watched the reflection of the food line procession in the passenger side mirror, all the people with their shopping carts, grocery bags, milk crates, laundry baskets, trash cans. Amy is directing everybody: the volunteers, parents of my patients, old guy with oxygen tank and walker, scrunch faced man in stocking cap muttering to himself still yelling at the birds, homeless-smelling paper towel shin foot guy, kelly green Sunday best lady still praising-be, young families and fancier folks. It's all silent and very distant.

The lady who got #2 walked happily in my direction from the line, pulling her trash can now full of food, bunches of bananas balanced on top. Her reflection grew larger as she got nearer and I could see her joyful toothless smile. I noted the banal Toyota disclaimer with an unusually disconcerting neurological dysfunction, pharmacological alteration, and psychological fear:

Objects in mirror are closer than they appear.
-kpb 9/19/13




Friday, September 13, 2013

For Want of a Hammer

Because I was thought to be precociously smart, or perhaps smart-ass, I was tested for and sent to kindergarten at age 4. My birthday was in November. I was always the youngest and littlest kid in the class. When we lined up by height for school pictures I was always last in line.

Because I was young and little and smart I tended more towards science and math clubs than sports. I played baseball almost every summer from age 5 onwards but was terrible. My dad came to every game to watch me play right field and/or sit the bench.

Because I was smart and tended more towards science and math, I was enrolled in the Gifted and Talented program starting in 7th grade, which meant I went to Center Jr High across town instead of Albion like everyone else in my neighborhood. The special-ed kids also went to Center and we rode the same bus. Sometimes I would laugh at them or with them, but more often I sat and tried to talk to them or help them understand stuff.

Because I was enrolled in the Gifted and Talented program at Center Jr High I was among the first group of kids in Strongsville in 1979 to take a computer class. There was one Tandy TRS-80 and one Apple II in Mr. Daugherty's classroom. 

Because the Apple II had an intrinsic elegance that the TRS-80 did not possess, I did all my 7th grade computer work on the Apple II. Most of the other kids used the TRS-80. Both of them required writing programs in BASIC.

Because my Gifted and Talented trajectory carried me through to AP classes and science and math clubs in high school, I went on a field trip in 10th grade to Case Western Reserve University where we visited the Biomedical Engineering Department and saw scientists creating artificial vision and bionic arms.

Because I was smart and good at math and science and had seen the amazing things the scientists at Case Western Reserve University were doing in the Biomedical Engineering Department, I decided I was going to Case Western Reserve University to become a biomedical engineer.

Because we had a neighbor that lived behind us that did not know us very well but knew that I rode the short bus to school, she once told my mom how impressed she was to hear that I had been admitted to Case Western Reserve University to become a biomedical engineer. My mom simply said "Yes we're very proud of him."

Because I went to Case Western Reserve University to become a biomedical engineer I was assigned to a room in a suite in Glaser dormitory with 5 other guys who also wanted to become engineers. That first year my suitemates were Mike, Matt, Vern, Clark, and Lee. Because I had a serious girlfriend that first year, I didn't get to know these guys as well as I should have until the next year.

Because these guys wanted to become engineers they were also smart and good at math and science and also so clever and hilarious that I laugh even now thinking of some the things we did. Matt had an original Apple Macintosh 128K and used to get up early in the morning to do nothing but rearrange the file and folder icons around on the desktop. Because I appreciated the intrinsic elegance of the Apple Macintosh 128K, I used sit on Matt's bed and watch him do this. Sometimes he would open a file in MacPaint which was a 2-bit pixelated picture of a nude Japanese woman.

Because two of my suitemates were named Clark and Lee, and they were amusingly foreign, we would insert their names into songs which included the words "you and me," such as "It's only Clark and Lee and they just disagree" or "Say Clark, say Lee, say it together, that's the way it should be." Needless to say I still do this today and it makes me at least smirk, but often LOL.

Because I was smart and good at math and science, I performed very well academically in the first two years of prerequisite courses necessary to become a biomedical engineer at Case Western Reserve University, I was able to start taking biomedical engineering courses and was also required to select a humanities track at the beginning of my junior year. 

Because I was required to select a humanities track at the beginning of my junior year, and the director of the medical anthropology track had the amazingly cool name of Atwood Gaines, I chose to enroll in the medical anthropology track to fulfill my humanities obligation at Case Western Reserve University while becoming a biomedical engineer.

Because I found the introductory biomedical engineering courses at the beginning of my junior year so painfully dry, boring, and far removed from the artificial vision and bionic arms I had seen on my field trip to Case Western Reserve University as a sophomore in AP science classes when I was in 10th grade, and the world of medical anthropology that Atwood Gaines introduced was so rich, fascinating, and vibrant, I changed my major to medical anthropology.

Because Case Western Reserve University was not, as its name might imply, a military school, but rather a result of the 1967 merger of Case Institute of Technology and Western Reserve College, changing majors from engineering to anthropology was not at all a problem. This resulted in my changing from a "Casie" to a "Reservie" and experiencing some harsh razzing from nerds.

Because I changed from a "Casie" to a "Reservie" and changed my major to medical anthropology, I took an actual 9-week college course called "The Anthropology of Rock and Roll." This course existed solely so that Atwood Gaines could noodle on his guitar and explain in detail over a 9-week period how he believed Eric Clapton single-handedly transformed the blues to rock and roll. Tom Petty was not mentioned a single time in this course, much to the dismay of my friend Dave Sfeir. I received a grade of "C" in "The Anthropology of Rock and Roll." 

Because I had been dumped by my girlfriend, who incidentally was the winner of the Miss Korea Chicago Pageant 1986, and I am not making that up, I spent a large part of my sophomore and junior years making great friends with my dormies and "finding my path" via changing majors, taking courses such as "The Anthropology of Rock and Roll," drinking alcohol, being obsessed with One Life to Live, and endlessly watching a grainy VHS tape containing bootlegged copies of Sixteen CandlesFerris Bueller, and Rebel Without a Cause.

Because I spent a large part of my sophomore and junior years "finding my path" via changing majors, taking courses such as "The Anthropology of Rock and Roll," drinking alcohol, being obsessed with One Life to Live, and endlessly watching a grainy VHS tape containing bootlegged copies of Sixteen CandlesFerris Bueller, and Rebel Without a Cause, my GPA was suffering.

Because my GPA was suffering and I was about to graduate with a BA in anthropology, I realized I needed to stay in school.

Because I realized I needed to stay in school and I was a good writer, I was able to create a beautiful and compelling essay describing how my GPA suffered during my junior year due to the life-altering realization that engineering was not in fact my destiny, but that in fact I was meant to be a doctor who would approach patients with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which would in fact contribute to their healing.

Because Case Western Reserve University had a very progressive patient-centric School of Medicine with a unique curriculum based on the concept that doctors should approach patients with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which would in fact contribute to their healing, I was accepted to attend Medical School at Case Western Reserve University.

Because I was accepted to attend Medical School at Case Western Reserve University, my grandmother sent me money to buy a computer of my own, and I found a used Macintosh 512K for $1000. Because I appreciated the intrinsic elegance of the Macintosh I would get up early in the morning to do nothing but rearrange the file and folder icons around on the desktop. 

Because it would not fit onto a single 3.5" floppy disk, I did not have the MacPaint picture of the nude Japanese woman. Now that I've Googled her up I see she isn't as nude as I remember.

Because I attended Medical School at Case Western Reserve University I learned that it was actually true and critically important that doctors should approach patients with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which would in fact contribute to their healing.

Because my first clinical rotation in third year at Case Western Reserve University School of Medicine was Pediatrics, and I was very nervous about having any sort of credibility taking care of older children with serious illnesses, I chose to do my inpatient month on the NICU step-down floor at Rainbow Babies and Children's Hospital.

Because I chose to do my inpatient month on the NICU step-down floor at Rainbow Babies and Children's Hospital during my Pediatrics rotation at the start of my third year at Case Western Reserve University School of Medicine, I worked with a first year neonatology fellow named Dr. Brenda Hook who always talked about how they did things in Galveston, where she had done her pediatrics residency. I had never heard of Galveston before I met Dr. Brenda Hook.

Because you cannot avoid things indefinitely at Case Western Reserve University School of Medicine, I was eventually required to do pediatrics rotations with older children as well as all the other rotations in all the other specialties, and found that I did have a special knack and love for Pediatrics. And the kids actually seemed to find credibility in my Doogie Howserness. Sometimes I would laugh at them or with them, but more often I sat and tried to talk to them or help them understand stuff.

Because I came to have a special knack and love for Pediatrics, I did several more electives and an acting internship in various pediatric specialties. Throughout my 4th year I saw lots of different kids on lots of different inpatient and specialty service rotations including one 8 year-old boy named Michael.

Because Michael had recurrent prolonged fevers, joint pains, swollen lymph nodes, he was being seen in rheumatology clinic when I was on that elective. Because I was the student who did the original full history and physical in clinic and discovered through the workup that he actually had lymphoma, and because I had learned by attending Medical School at Case Western Reserve University that it was actually true and critically important that doctors should approach patients with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which would in fact contribute to their healing, and because I had credibility with this older child with a serious illness, my team trusted me to lead the conversation where this diagnosis was revealed to Michael and his family. Michael's mother was on hospice care for terminal cancer.

Because Michael was in the hospital a lot the following month when I did my acting internship on the heme-onc service, I played a lot of games and did a lot of puzzles with him, and often slept on a cot in his room at night instead of the call room because his mother was on hospice care for terminal cancer and could not be there.

Because I saw Michael all the way through from his diagnosis to his mother's death to his final chemo party, I decided I wanted to be a pediatric oncologist.

Because I wanted to be a pediatric oncologist I determined it essential that I find a smaller pediatric residency program that would give me a solid foundation in general pediatrics before I went on to fellowship training. 

Because I wanted to find a smaller pediatric residency program that would give me a solid foundation in general pediatrics before I went on to fellowship training, I requested application information from the Pediatric Residency Training Program at The University of Texas Medical Branch in Galveston, Texas.

Because I had heard Dr. Brenda Hook talk many times about how they did things in Galveston during my inpatient month on the NICU step-down floor at Rainbow Babies and Children's Hospital during my Pediatrics rotation at the start of my third year at Case Western Reserve University School of Medicine, I met with her and she assured me that the Pediatric Residency Training Program at The University of Texas Medical Branch in Galveston, Texas would suit my needs perfectly.

Because Dr. Brenda Hook assured me that the Pediatric Residency Training Program at The University of Texas Medical Branch in Galveston, Texas would suit my needs perfectly, I interviewed there and spent the day meeting amazing and wonderful people and spent the weekend falling in love with the little island city.

Because one of the amazing and wonderful people I met on my interview day, the Department Chair Dr. Pearay Ogra, had some sort of supernatural abilities, he said to me during my interview, "Well, pediatric oncology sounds like a nice idea, but you never know what will happen. You may come here, meet a nice Galveston girl, get married, have a few kids and decide to stay and have a career here in pediatrics."

Because it was 1993 I called my mother from a pay phone near the beach and said "This is going to be the place."

Because this was going to be the place, I ranked The University of Texas Medical Branch at Galveston, Texas #1 on my list. I was thrilled when I opened my envelope on Match Day and discovered that The University of Texas Medical Branch at Galveston, Texas was indeed going to be the smaller pediatric residency program that was going to give me a solid foundation in general pediatrics.

Because it was a smaller pediatric residency program that was going to give me a solid foundation in general pediatrics, within the first few months of residency at The University of Texas Medical Branch at Galveston I met even more amazing and wonderful people, many of whom I am lucky enough to still count among my dearest friends, trusted colleagues, and sage mentors some 20 years later.

Because not everyone can be a dear friend or trusted colleague, one of my fellow interns in the Pediatric Residency Program at The University of Texas Medical Branch at Galveston was often unreliable and frequently called in sick. I had to cover her call for the inpatient service on December 9, 1993.

Because I was covering call for the inpatient service on December 9, 1993, I was summoned to the ER to evaluate a patient for admission and saw perhaps the most beautiful girl I had ever seen working as a tech. She had standard-issue blue scrubs on yet somehow she was literally glowing. Despite my Doogie Howserness and being nervous about having any sort of credibility with approaching such an amazingly beautiful girl, I rolled my chair right up next to her and struck up a conversation.

Because she was a nice Galveston girl she talked to me and said she was a GEMS Paramedic working overtime in the ER to make some extra money to buy a house of her own. She wrote her phone number, mom's phone number, work number, and pager number on the back of a prescription and told me I should come for a ride-along on the ambulance with her some time. As I walked back up to the inpatient floor with my upper level resident Rima Chamsedine, I said "I am going to marry her."

Because I married her, we had a few kids and I decided to stay and have a career here in pediatrics. 

Because I decided to stay and have a career here in pediatrics, I have taken care of thousands of children with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which I hope has in fact contributed to their healing.

Because I decided to stay and have a career here in Pediatrics, my first job out of residency was in the newly opened Pediatric ER at The University of Texas Medical Branch at Galveston. I came to know the pediatric residents very well through working with them on 12-hour long night shifts, where you can really get to know somebody. Sometimes I would laugh at them or with them, but more often I sat and tried to talk to them or help them understand stuff such as doctors should approach patients with an intrinsic empathy, humanity, and understanding of their unique personal and cultural perspective, which would in fact contribute to their healing

Because I worked in the Pediatric ER at The University of Texas Medical Branch at Galveston I worked side-by-side with Dr. Russell Miller who taught me more about medicine and life than anybody I have ever known. He had the uncanny ability to clearly frame any issue, any issue at all, into 3 simple bullet points. I wish I had somehow offered the same to him when he needed it, and even more selfishly wish he was here now to help me clearly frame my current issue.

Because I had credibility with the residents and knew them well, had an intrinsically elegant PowerBook, was the only person in the late 90s who knew how to use Powerpoint and Photoshop, and was a smart-ass, I became the de facto creator of the annual "Resident Roast" to be presented at their graduation from the Pediatric Residency Program at The University of Texas Medical Branch at Galveston each year.

Because I presented the annual "Resident Roast" each year, the Camp Director of the Rainbow Connection, who happened to also be the Child Life Specialist at the Children's Hospital at the University of Texas Medical Branch at Galveston, and the Assistant Camp Director of the Rainbow Connection, who happened to also be the Residency Program Coordinator for the Pediatric Residency Program at The University of Texas Medical Branch at Galveston, approached me about creating a 20th anniversary slide show to be presented at The Rainbow Connection Camp for Children with Cancer and Blood Disorders in the summer of 2003.

Because I created the 20th anniversary slide show which was presented at The Rainbow Connection Camp for Children with Cancer and Blood Disorders, and I still had a special interest in children's oncology because of patients like Michael who I saw all the way through from his diagnosis to his mother's death to his final chemo party, my whole family came to the Rainbow Connection 20th Anniversary party that year.

Because my whole family came to the 20th Anniversary party at The Rainbow Connection Camp for Children with Cancer and Blood Disorders, I joined the board of directors and became the camp physician and medical director for this organization and have attended camp along with my kids ever summer since.

Because I am the camp physician for The Rainbow Connection Camp for Children with Cancer and Blood Disorders I have become a part of a family of very special people. I have seen kids fight against, win against, and lose against cancer, but each with amazing courage, joy, and grace.

Because I have seen kids fight against, win against, and lose against cancer, but each with amazing courage, joy, and grace, I am determined to do the same myself. 

Because I still have credibility with the residents in the Pediatric Residency Program at The University of Texas Medical Branch at Galveston, sometimes laugh at them or with them, but more often sit and try to talk to them or help them understand stuff, I became the Program Director for the Pediatric Residency Program at The University of Texas Medical Branch at Galveston just a couple months ago. 

Because I see them every day and try to have an open-door policy as much as possible, even through the last few difficult weeks, the residents feel comfortable to laugh at me or with me, but more often sit and try to talk to me or help me understand stuff. This week one of the residents came to my office to tell me that the expression I was trying to use in morning report was not "For want of a hammer," but actually "For want of a nail."

Now I will make like a tree, and get out of here.

-kpb 9/13/13