Tamoxifen

The data from the ATLAS study have me in a funk. I've been in a horrendous black cloud of depression all day. The results suggest that premenopausal women with ER positive tumors who take 10 years of tamoxifen rather than standard 5 years of therapy decrease their mortality and disease free interval, especially after the 10th year of medication. Tamoxifen hasn't really bothered me and I don't mind taking it for another 5 years if that is what is suggested by my oncologist. I'd stand on my head and chew gum while reciting the Declaration of Independence if she told me it was good for me. But some of the statistics are a real buzz kill, like: the cumulative risk of breast cancer recurrence is 21.4% in women who stay on tamoxifen for 10 years (versus 25.1% in women who only take it for 5 years) and breast cancer mortality (meaning death due to breast cancer) 5-14 years after diagnosis is 12.2% in the 10 year group versus 15.0% in the 5 year group.

I went running on the bayou today to try to clear my mind. I always go back to my same spot where I gave all of this mess to God 6 years ago. I was silently praying with my head bowed at my favorite tree and when I looked up, there was a butterfly (could have been a moth, but I'm fairly certain it was a butterfly) almost exactly where I had left my pink, plastic breast cancer awareness bracelet offering 6 years ago. Butterflies are reminders of my cousin Rebeca who died 11 years ago. I think I've written about this somewhere before, but at her funeral, her younger brother, my cousin David, relayed an incident that had occurred at their house the morning of Rebeca's funeral. When her immediate family went out into their backyard that morning there were thousands of monarch butterflies in the woods behind their house on their southward migration and David took those butterflies as a sign from Rebeca that everything was going to be okay and every time any of us, her siblings and cousins and parents and aunts and uncles, saw a butterfly, everything was going to be okay and she was right there with us watching over us. I'm not making this up and it couldn't be any more perfect. Literally, the moment I lifted my head from that prayer, in the exact same spot that I had left my offering 6 years earlier just days after my diagnosis when I was so scared and my future seemed do uncertain, there it was - a perfect butterfly. And it just sat there and flapped its wings and didn't move for several minutes. I thought it might have been a moth, because it was kind of old looking and a little battered, but I'm fairly certain it was a butterfly. I even reached out and placed a little kiss on it, transferred from the tip of my finger to its wing and it didn't even move. It just sat there and fluttered its wings. I was about to take a picture of it with my cell phone and it finally flew away. At that moment, I knew everything was going to be okay. It was the exact same spot 6 years ago that God had promised me everything would be okay. If people don't believe in God or don't believe that he speaks to you, then slap me silly and call me a fool because I couldn't have made the situation up and it couldn't have been any more significant. And I think the fact that the butterfly was a little old and part of it's wing was missing was just God's way of emphasizing not only am I gonna be okay, but I'll probably be around for a long time and I'll be a bit tattered, with parts missing and out of place and not so pretty when it's finally time for me to go. And just like that butterfly, when it's time for me to fly away, it will be on His terms, not mine and I'll fly right on out of here before anyone can even stop to take a picture.

So numbers or not, I'm going to be okay and Rebeca, I love you and thanks God.

Water Polo and the ER

Currently I am sitting in an aquatic center located 266 miles from my home. I got up at 4 am and drove 4 hours this morning so my 12 year old could come to an all day water polo training. Of all people least likely to care enough about athletics to drive this far for practice, I am probably it. I love my kid. That is the only reason I'm happy to be here and already calculating the volume of 5 hour energy drinks I'll need to consume to make it back home tonight.


My kid isn't the best but he loves the sport and I think this will be good for his ego/self-confidence. Who could have ever explained to us the things we would be willing to do because we love our kids so much, the sacrifices we'd be willing to make. As I mentioned, he's 12 and the youngest one in his grouping here so he wants me to stay-8 hours on the bleachers watching him practice. But he's my baby, so even though I'd love to sneak away for a couple of hours, each time he steals a glance up here and smiles, it's worth it.


I worked in the ER a couple of days ago. I was called over to help out in the shock rooms towards the end of my shift. During my residency, fellowship and early days of practice I didn't mind taking care of the critically ill patients that were brought into the emergency room. But, it's been about 7 years since I've done that sort of thing so I wasn't quite sure what to expect. And I've never taken care of trauma patients, just patients with heart attacks, strokes and altered mental status. A large volume trauma was coming in and they needed all hands on deck. Lucky for me and the patients, I only had to triage minor injuries. However, the whole experience left me rattled. It reminded me just how fragile life really is. One minute you are going over the grocery list in your head and the next minute you are gone. You could tell a lot of the younger doctors and trainees relished the thrill of it all and the rush of adrenaline. Maybe they went home later that night and contemplated the sanctity of life, but mostly it seemed like a thrill ride for them. That's not bad, just shows you what a few years and a few life experiences will do for you. The experience affected me for days afterwards. I couldn't stop thinking about the fragility of our existence and how, as a health care provider, I'm entrusted with so much.


That night when I got home my 9 year old daughter was still awake. She had been waiting for me and it had been a rough nite for her, arguing with her brothers and subsequently getting in trouble with her father. While she was in the shower with me, letting the hot water carry all our burdens away, she detailed her list of offenses. Mostly, she was to blame and she knew it. She realizes she incites her brothers to anger and can incur the wrath of her father with just a look. Actually, she seemed quite pleased with the control she possesses but at the same time was saddened by its frequent negative outcomes. I decided to tell her about my evening in the shock rooms. At first she was flippant, but as I continued to talk she soaked it all in and for the moment she understood that most squabbles don't matter because life is precious.


That night was God's display of Newton's Third Law of Motion. In one part of the world one family was trying to make sense of the incomprehensible and elsewhere that life, though unknown to her, was being honored by a little girl through her realization that you can't take the people you love for granted. God bless hurting people everywhere and let us be mindful of the precious little time we are gifted.
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