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Mary – On Saying Goodbye

January 26, 2009 in Physician's Thoughts by rick

I mustered up the courage to visit Mary today.

Pulling into her driveway, I was greeted with the majesty of autumnal brilliance—golds, rusts, and crimsons set against a brilliant azure sky. A bold display of nature’s defiance against the upcoming long winter’s sleep. Not to be ignored, those leaves that had flamed out early chattered against my every step as I slowly ambled toward the doorway. Read the rest of this entry →

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January 26, 2009 in Physician's Thoughts by rick

January 26, 2009

‚”Ellen, your cancer is in remission and you are feeling good‚Äù, I restated. ‚”Why don’t you do something nice for yourself? How ’bout a vacation? Is there any place that you’d like to see?‚Äù

‚”But who will look after Mother?‚Äù she shot back, more as a challenge than a question. In a long pause that followed, Ellen’s steely blue watery eyes looked deep inside me for the answer to the question that had evaded her for the last 50 of her 71 years.

She sat bolt upright, with a nice straight back, on the examination table awaiting my response. Her long salt and pepper hair was pulled neatly into a very tight bun which was enwrapped by a very tight thin braid. This architectural feat was held together by multiple bobbie pins jutting out at various angles. A starched lace bonnet was perched atop her neatly arranged hair, as if to catch any rogue nonconformist locks which would dare contemplate escaping. Equally severe and anachronistic was her manner of dress. She sported a fitted white shirt with a high-necked lace collar and long sleeves buttoned tightly at the hand. Whatever femininity was gained from her long lavender miniature floral print skirt was immediately lost by opaque orange tinted knee high nylons and black sensible shoes. I believe that this whole ensemble can be only purchased through the American Gothic Catalogue of 1872 for a sawbuck and three bits.

The only skin showing, aside from her long fingers that had clearly worked for living, was her face. Her pale skin, unwrinkled and unblemished, appeared almost as starched and tailored as rest of her. Between her long thin nose and prominent jaw line and chin pursed thin linear lips which struggle to contain of boastfulness of naturally straight large white teeth. Her intense blue eyes continuously shifted, never gazing, always seeking. And with a glower that would make any school librarian green with envy, Ellen sat opposite me, alone in the office at end of a difficult day, looking like I had just lost a hand of ‚”Old Maid.‚Äù

‚”Mother is 92 years old,‚Äù Ellen reminded me in her strong Pennsylvania Dutch accent, often emphasizing syllables and words in a manner different from conventional spoken English. ‚”She has a schedule that I have to keep.‚Äù

‚”What about placing her in a nursing facility for a short time?‚Äù I offered. No answer, just a glare. ‚”Have you considered a friend or relative to come in for a while or how about hiring a nurse for a few days?‚Äù

‚”There’s nobody else, and I am not made of money, you know.‚Äù

‚”I am sure there are others out there.‚Äù Why don’t you ask around? In the meantime, take this prescription.‚Äù I quickly scrawled, ‚”Have some fun‚Äù on the pad and handed her the top copy. Ellen strained to smile briefly.

Duty—that strong sense of commitment focuses our energy and skills towards completion of a goal. That goal may be caring for an aging parent, young child, sick spouse, or perhaps job related with evening meetings, weekend conferences, or holiday hours. In either case, duty is often tainted with a certain degree of self-denial. To complete our tasks, we freely give up our time and energy leaving little room for more seemingly pleasurable personal pursuits. And to what end? Why do we keep giving when there seems like there is nothing less to give?

Because, there is inherent value and worth in a job well done. Just the sense of being needed and contributing to something or someone is enough to keep us in the game. I cannot tell you the number of my own birthday parties I have missed due to being called to the emergency department or operating room to care for someone acutely sick to care for someone that I am uniquely qualified to help at that moment in time. A heart-felt thank you from the patient and her family overcomes my loss of personal time and hundred fold. It lightens my steps, elevates my mood, and fills my heart. After pulling into the garage at midnight, kissing my sleeping children and wife, I am filled with a deep sense of pride and accomplishment which is too great to describe.

I have thought about that office visit with Ellen many times and have since regretted giving her that prescription. My effort to lighten the mood and get Ellen to consider something for herself may have undervalued her strong sense of duty towards her mother. I am sure she experiences tremendous pleasure and reward from caring for her mother the woman who selflessly raised her for all those years. It is nice to be needed.

On the other hand, it wouldn’t be a federal crime if either one of us went to a neighborhood pub, knocked back a couple, and shot a game of pool.

She’d probably kick my butt.

Dr. Rick Boulay


Richard M. Boulay, MD, practices medicine in Allentown, Pennsylvania. He hopes practicing will someday pay off.

Damn Weeds

January 26, 2009 in Home Page, Keeping Up Your Spirits, Physician's Thoughts by Laurie McCarthy

January 26, 2009

“Look at all those beautiful little white flowers,” I said to my wife. “I don’t remember seeing them there before.”

In the neglected ten-by-thirty foot corner of our garden, a crop of white flowers began to emerge toward the end of the summer.

“You never saw them because they are weeds,” my wife said.

“What do you mean…weeds?” I asked. “They are beautiful!”

“Weeds aren’t always ugly, but even the pretty ones grow fast enough to choke out the other flowers,” my wife reminded me.

“But they are growing so well there.”

“That’s what weeds do—they get in while you are not looking and take over everything.”

“Don’t you even think about going out and pulling those weeds,” I growled. “I will do it myself…damn weeds.”

My wife’s recently diagnosed leukemia had weakened her immune system. She spent most of the summer in bed—recovering from the fatigue of the disease and the nausea of the treatment.

And somehow, while I was taking care of everybody’s cancer, leukemia had crept into my home and attacked my wife’s body. For months, I had missed the telltale signs of fatigue and malaise, chalking them up to day-to-day stresses of motherhood. When the diagnosis came, she crumbled; and I went into survival mode. I watched as my wife struggled to climb the stairs like a sick person, stopping halfway to a landing. I saw as they started an IV and observed the red blood cell transfusion dripping into her veins easing her fatigue. I rubbed her back when she threw up the life sustaining pills that were just too big to get down. And I put her to bed and cuddled her, like I did with the children, to ease her fear. I couldn’t do anything real except simply be there. And just when things seem to improve, a simple walk in the yard led to a simple scrape on the shin which led to a complicated skin infection (cellulitis to those of us in the know) which led to several doctor visits, and threats of hospitalization.

“I wasn’t planning to do any work in the garden. I’ve learned my lesson. But what am I supposed to do? Sit in the house all day?” she asked.

“No, but you must protect yourself, wears gloves, and long pants when you go out for this sort of thing. Life has changed for us, and I can’t afford to have you in the hospital because you are too selfish to give up gardening or too stubborn to wear gloves!” I grumbled.

“Well I don’t need to have you hollering at me in my own back garden.” She turned and headed for the house.

I remained…and looked at this impenetrable hedge of pretty little white flowers which grew as tall as me. And I began to pull. And I tore at the earth ripping out every lost opportunity. And I reaped a harvest of the pain of the possibility of my daughters’ weddings without a mother-of-the-bride. And I clawed at the anger of the chance of going to my girls’ graduations alone. And I scratched and groveled at the ground pulling and tearing weeds half crazed with a mission to reclaim this little corner of the garden. Dirt flew into my hair and clothes and mouth. And sweat stained my clothes and streaked my face. My eyes burned with salt and dirt and my flesh tore from unseen pickers. And my quiet whimpers grew into audible sobs and heaves until I was startled by my 10-year old.

“Are you okay dad?” she asked.

“Yeah. I‘m fine.I lied.

“Are you crying?”

“No,” I cried.

“It looks like you are crying.”

“Allergies…damn weeds.”

“It sounded like you are crying.”

“Dads don’t cry. They get allergies.”

“Do you need a hug?”

She always knew when I needed a hug. “I think I do.”

My tiny little 10-year old jumped into my arms and hugged me closely to her.

“Ouch, my neck,” I hollered.

“Love hurts, Dad.” She giggled as she ran back to her tree house vanishing as quickly as she had appeared.

When I looked up, I had thrashed through the entire bank of weeds. My wife’s accounting background allowed us to quantify gardening performed by the number of green trash bags filled. I had 16. It was more than that though. The irony had not escaped me. I had managed to protect and preserve just a little corner of my life which had been taken over by some outside uninvited monster. A once impenetrable scourge of weeds were untimely ripped and tossed away in a neat row of bulging green trash bags.

And when I was done, the once beautiful white flowered hedge was barren and desolate. It looked far better before I had taken out my anger on it. Now a wasteland plowed under at the end of the growing season, the little corner held the promise of a better next year without god damned weeds choking everything out.

My wife returned as if on cue. “Look there,” I said proudly. “Sixteen bags.”

“What are you doing? I was going to have it bulldozed,” she said.

“But you loose the English ivy that away.”

“You do know that garden is loaded with poison ivy.”

“Great,” I muttered. “I’ll take a shower.”

“Damn poison ivy.”

Dr. Rick Boulay

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by joshua

A Question of Faith

August 11, 2008 in Physician's Thoughts, Physician's Thoughts on Faith, Role of Faith, The Role of Faith by joshua

August 11, 2008

I believe the role that God plays in our lives is often magnified during times of great suffering. How we perceive that role is a question of faith, often strong and steadfast in some, especially my patients, but sometimes unreliable and inconvenient to others, like myself, on a journey of understanding and acceptance.

During the terminal stages of my grandmother’s colon cancer, I recall her saying, “Je pense que le Bon Dieu ma oublier.” Despite high school and college French, I never was able to pick up my grandmother’s French Canadian dialect.

“She thinks God forgot her,” my dad translated.

I was puzzled. My grandmother was a pillar of the church. Educated in a rural convent, she left Quebec with my grandfather and together they helped build the new Catholic Church and school where my grandmother taught first graders and sang solos at Midnight Mass. She learned English predominantly through romance novels—the margins annotated with dictionary definitions of unfamiliar English words. I loved everything about her.

“So how could Grand Maman think God forgot her,” I wondered aloud.

“He didn’t,” my father reassured.“God’s just busy getting heaven ready for her. Your Grand Maman is very tired. She needs to rest.” I failed then to understand that she never felt abandoned by God, merely that He was tardy in calling her home.

Marie recovered from surgery beautifully. Preoperatively, she assured me (as well as herself) that Jesus would lead her through. And He did. But despite her strong belief that her large mass was benign, I extracted several pounds of cancer from her abdomen. Marie required no blood transfusion, and her enormous incision closed easily. Uncomplaining, she transcended the pain, indignity, and betrayal of unanticipated bodily functions. She was discharged the following Sunday, a day early.

During her hospitalization, Marie’s bible lay on her bedside table. Unlike most hospital bibles, this one was actually open—its pages somewhat tattered, with notes scattered in the margins. Marie’s bible was a “working” bible… for this was not Marie’s first bout with cancer.

Ten years earlier, at 32, she was treated for breast cancer—a difficult and protracted battle through chemotherapy, radiation and surgery, and countless days of nausea and fatigue. But others did unto Marie and her family. And God saw her through it. The notes in the margins bore witness to that.

This time Marie’s chemotherapy began well. Despite pumping powerful chemicals directly into her abdomen, she experienced none of the nausea that so debilitated her a decade earlier. But when the subsequent chemotherapy was abandoned because of an infection, she worried. “I remember last time how important it is to get your chemo on time,” she recalled. “Won’t this decrease my chances?”

Before I could reassure her, Marie smiled, “No matter, God will look after me.”

The role God plays in our lives can be powerful. Whether we pray to live completely or die comfortably, the supplications continue until our prayers are answered. Yet, how do we know if we’ve actually changed the outcome or coincidently selected destiny’s preplanned course? We can never know. Yet we continue to believe.

As an adult, I’ve had an on again/off again relationship with God. Describing myself as more spiritual than religious, I felt that introspection and “doing the right thing” somehow absolved me from the need to participate in organized religion.

A frequent witness to the power of faith, I am back at church, having relinquished Catholicism for the whitewashed simplicity of Presbyterianism. Unfortunately, my grandmother’s faith gene appears to be recessive, but her music gene has proven dominant and I, too, sing solos at church on Christmas Eve. Unlike Marie and Grand Maman, with decades of religious study and a faith that provides the very backbone of their existence, I still dabble and I have yet to crack a bible.

Suspended between healthy scientific agnosticism and unyielding faith, I’m selective with my prayers. I fix what I can myself and reserve my praying for the tough stuff—not day-to-day trivialities, least He become tired of my pettiness and turn a deaf ear to that one, last, really big need. When I pray, I pray for others, especially my patients. I’ve always had everything I needed and most of what I wanted…except for Marie’s and Grand Maman’s faith–the force strong enough to bring life or death…the force powerful enough to bring hope to the weary and peace to the anguished. Maybe I should pray for some of that.

Dr. Rick Boulay