The Unexpected Losses of Autumn


It’s been a melancholy morning: Cloudy sky, falling leaves, flowers in the pots on their very last legs, snoozing beagle perhaps on her last legs, me with the flu.

But now the sun is out and life is brighter. The leaves are falling golden now. The beagle’s slumber is a healing sleep. The herbs, perhaps, are making her well. The Father’s loving-kindness abounds.

I’ve been thinking lately about unexpected losses. Things that come up in your fifties that are not on your radar in your twenties, thirties or forties.

Things like losing a trusted doctor.

I’ve encountered three really good doctors in my life. By really good I mean really caring. I’m sure many have been really smart, but only three showed they really cared.

Dr. Morris

In college I dated a wrestler. He came to Michigan State University from a suburb of Cleveland to wrestle under the coaching of Grady Peninger.

I became sick one summer weekend while visiting the wrestler at his home in Ohio. The wrestler called his doctor, the doctor opened up his office in downtown Cleveland just to see me.

He drew blood and looked at it under a microscope. He called me over, had me look and explained what I was seeing.

He asked me what I wanted to do with my life. I fibbed and gave him the money-making type of answer that I thought adults who asked that question expected.

And then I told him I what I really wanted to do.

“Do what you love and the money will come,” he said.

I’ve quoted him often since then.

After quite a long visit he said he better get going before his wife started calling, they were due at his granddaughter’s birthday party.

He was clearly doing what he loved.

That one and only meeting was enough to induct Dr. Morris into my Hall of Fame.

Dr. Ferguson

I went to Dr. Ferguson because I had a respiratory infection, his office was close and he took the insurance I had back then. I didn’t know, when I made the appointment, that he was an internist who specialized in gastroenterology.

I could barely keep my head up in his waiting room, even started to doze off. When the nurse called me in I felt guilty for exposing her to my germs.  “That’s what we’re here for,” she said with reassuring kindness.

Dr. Ferguson looked at my blood, too. Then he sat next to me on the sofa in his office and explained what he saw.  He prescribed an antibiotic and then sent me to the hospital for an x-ray just in case…

When I went back for the follow up (yep, a doc who actually followed up) I mentioned a pain in my abdomen. He asked if I’d ever had a colonoscopy and that’s when I realized he had a specialty.

I only saw him twice after that – both times for a colonoscopy – but the way he took time to explain things and draw diagrams, the way the nurses at the hospital raved about him and said he used the really good anesthesia, they way he seemed to really care about my health made him my second inductee.

Dr. Migdal

Up until a few weeks ago Dr. Migdal was my gynecologist. It’s not TMI, it’s a fact.

I didn’t see him much more than once a year but I loved him.

I became his patient 15 years ago. I knew Dr. Migdal cared, not so much by the things he said to me as by the things he said about others. He didn’t name names or give any identifying information, he just shared general concern about patients who needed specific tests yet their insurance companies wouldn’t approve them. I often wished, listening to him, that I had a lot of dough, so I could start a fund for the patients he seemed to care so much about.

Once he expressed concern for a young woman who went into very early menopause, another time for a woman who discovered she was pregnant at 50.  He never violated confidentiality, he just showed his heart. He lamented that when he was a young obstetrician he would get called in the middle of the night informing him that a patient was in labor. He counted it a privilege to get out of bed and go immediately to the hospital.  Now, he said, obstetricians are not allowed to go to the hospital in the middle of the night, even those who want to. Regulations. He was grieved by all the new regulations.

Medicine is no longer an art. It’s no longer a science. It’s big business.

And Hall of Fame docs are becoming rare.

The last time I was in his office I asked Dr. Migdal his age. I didn’t say so, but I was hoping he was younger than me.  Because I had often thought that if I ever got cancer like my sister did, I would want him to be the one to walk me through it.

He happily answered. Turns out he is a few years older than me.

“You’re not planning to retire any time soon, are you?”

He assured me he wasn’t. But he would be having hip surgery.

It was an unexpected, yet dreaded, loss.

I read the letter and cried. Dr. Migdal’s recovery from hip surgery was not going as well as he had hoped. He was retiring, effective immediately.

I’ve never been one to cry over change. In my twenties, thirties and forties, I would have taken the letter in stride. Oh well, I would have shrugged, there are plenty of docs in the sea.

But in autumn, when leaves are falling all around you, you begin to feel vulnerable. You begin to not only appreciate a good doctor, you feel the need for one.

Since I received his letter 3 weeks ago, I’ve been meaning to send him a note. I want to tell him that he is inductee three in my Hall of Fame, that he’s up there with the greats. I guess this post is the rough draft.

Thank you for caring, Dr. Migdal. I’ll always have The Great Physician, but I wanted you for the duration, too.







Negative Nellie

I had an appointment to see a specialist on Tuesday.  It was originally scheduled for September 3rd, but his office called Monday afternoon and said they had a cancellation and would I like to come tomorrow instead?

So I drove across town Tuesday morning and limped through a large medical building to get the records they wanted me to bring.  I thought they’d be grateful that I took their cancellation and made the effort.

But when I checked in Tuesday afternoon, I was greeted by Negative Nellie.  Her name was actually Amanda, but she was definitely a Nellie.  She was young and pretty and ugly.  And her professional personality was off to a snarly start.

I handed her my license and my insurance card.  She looked at it for a minute and then screwed up her face.

“We don’t take this insurance,”  she firmly asserted in a sort of accusing, punishing voice.

“Look at the back of the card,” I suggested,  “I’m pretty sure you do.”

She flipped it over and then handed it to the woman next to her.  That woman looked it up in a binder and said, “Yes, as long as [insurance name 1] and [insurance name 2] are both on the card, we take it.”

[Insurance name 1] is on the front of the card and [insurance name 2] is on the back of the card, so Nellie said, “It doesn’t say [insurance name 2] on the front.”

The nice lady next to her said, “I don’t think it matters as long as both names are on the card.”

I could see in Nellie’s set face that she wasn’t about to concede.

So I spoke up.  I shouldn’t have, but I did.  “I’ve been through this confusion before,” I said with a smile, trying to blame the confusing card and not her, “and I can assure you that the second name does not have to be on the front.  If it makes you feel better, I gave my insurance information over the phone when I initially made the appointment and it was checked then.”

Uh oh.  Now she was determined to prove me wrong.

The nice lady suggested she ask the insurance specialist in the back if she needed additional confirmation.

So off she huffed.

Yep, they take it.

And Nellie was not happy.  She was rude a few minutes later when she handed back my license and card.  She was rude when I handed in my questionnaire.  And she was rude when I said goodbye.

She looked about 21.  Unless she switches professions (I vote for that), her work life is going to be miserable – for her and for countless patients.  How much nicer and more gratifying her days would be if instead she were to cheerfully say things like, “I haven’t seen this type of insurance before (It’s a pretty common one), let me double check with our insurance expert for you.”

For you, not against you, is the operative attitude.

I thought of Nellie this morning when I read John 5.

A man who had been an invalid for 38 years was lying next to a healing pool.

Jesus approached him and asked, “Do you want to get well?”

(Apparently not everyone does.  In fact, I’ve known people like that, you probably have, too.  People who counter every helpful suggestion with an excuse or reason why what you are suggesting is impossible;  people who seem to enjoy wallowing in misery.)

The man did want to get well, but no one would help him into the water when the pool was stirred, and, since he was so slow others would push ahead of him.

Jesus bypassed the pool altogether and said,  “Pick up your mat and walk.”

So he did.

And it was the Sabbath.

So his fellow Jews, rather than being THRILLED that this cripple of 38 years could suddenly walk, jumped right in and said the equivalent of “Awwww, you’re in trouble.”

No rejoicing over the sudden wellness of a fellow human being.  Just, “It’s the Sabbath, the law forbids you to carry your mat.”

What makes punishing people focus in on the infraction and completely ignore the miracle?

‘We don’t take your insurance.”

What makes Negative Nellies so punishing?  What makes them see everyone who comes their way as an adversary to be squashed?  A cheater to be caught? And WHY ON EARTH would they enter a  healing, helping profession?


Public Service Announcement: It Ought to Come with a Warning

Last I heard, six partners or more is considered medically promiscuous. That’s six total partners – consecutive and/or concurrent.

I grew up with a girl who became sexually involved with a man from the neighborhood. She was sixteen, he was thirty-two and married – he said his wife was a bitch. She was too young and naive to know that the wife is always a bitch, and never that he is simply a cheating bastard. So she gave him her virginity and he gave her HPV (human papillomavirus) – the gift that keeps on giving. He gifted her with one of the strains that causes recurrent genital warts.

She was not promiscuous, medically speaking, and yet she still contracted a disease. Because it only takes one rogue partner.

I remember how much pain she was in when the doctor burned them off, how she couldn’t sit down.

After all that, the warts came back.

She is married now and avoids intercourse with her husband when she has an outbreak, which is good, I suppose, but HPV is contagious even when there are no lesions present.

She is lucky, though, because the strains that manifest as warts are usually not the strains that cause cervical cancer.  Those strains have no visible signs.

I learned about the connection between HPV and cervical dysplasia/cervical cancer years ago at a conference on the epidemic of STDs among adolescents. I also learned from one of the speakers – a doctor specializing in adolescent health with a practice in the Boston area – that the AMA (American Medical Association) made a decision to NOT share that connection with patients.

My head reeled, sitting there in the audience, as my stomach and my naive trust absorbed the blow: Doctors withhold information at the direction of the AMA?

I raised my hand, “How can they not tell?”

“There’s nothing doctors can do about it, there’s no cure for HPV, so why get patients upset?”

“Well there is something patients can do about it,” I countered, “they can choose to be less promiscuous, they can make informed decisions about their sexual behavior.”

“There are people who don’t want them to be less promiscuous,” he shrugged. “Sex is a huge money-making industry.”

Don’t get me wrong, the speaker is a good guy who takes time away from his practice to travel around the country speaking to kids about the risks casual sex poses to their health. He was just telling it like it is.

As I drove home from the conference I thought about friends who had cervical dysplasia and who had no idea they were at risk of developing cervical cancer; who had no idea of its connection to HPV. I thought of the “medically promiscuous” teens and young adults who came to the center for free pregnancy tests. I thought of the young client I had seen recently, the one who had already had seven different partners and she was only seventeen.

I started to sob those I-need-windshield-wipers-for-my-eyeballs kind of sobs.  “Lord, you have to warn them,” I begged.

I shared what I learned at the conference with the volunteers back at the pregnancy center. One of them, a nurse, confided that she was diagnosed with cervical dysplasia – a pre-cancerous condition – and she had to really press and insist before her doctor would tell her the cause of her condition – HPV.

She was a virgin when she married her husband and her husband had had only one previous sex partner – his first wife. So how did she contract HPV? His first wife was unfaithful, hence their divorce.

A few years later I traveled to Houston for a conference on adolescent sexual health. The main speaker told the story of a man whose wife – her patient – died of cervical cancer at Scott and White. He remarried. His second wife also became a patient at Scott and White and she also died of cervical cancer. The man became angry, blamed the hospital. The hospital pointed out that they were not the common denominator, he was.

Testing showed that HPV had made a comfy home for itself just under the surface of his skin. No warts, no visible signs on his body. He had lost two wives to a virus he did not know he carried.

One of the aims of that conference in Houston – though it was not advertised as such – was to introduce a new vaccine that was about to hit the market, a vaccine that would protect against six of the over one hundred strains of HPV. The keynote speaker was on the team that developed the vaccine.

Not too long afterward, I received a postcard in the mail urging me to “Tell Someone.” It was from the maker of the vaccine.

This is the postcard I received in the mail, to which I added some of the facts I learned at the medial conference.

This is the postcard I received in the mail, perhaps you received one, too, minus the facts, which I added based on the information I was given at the medial conference.

Oh yeah, now you want me to tell someone, now that there is money to be made.

I’m not even going to go into the pros and considerable cons of the vaccine. Not today anyway.

Here’s the bottom line: You can be a sixteen year old virgin, have sex with one rogue guy and get HPV. You can save yourself for marriage and marry someone who had only been with his (cheating) wife, and end up with HPV. So how the heck do the “medically promiscuous” think they are going to escape disease?

The American Lung Association (or maybe it’s the American Cancer Society) has been running frequent ads featuring people who were filmed speaking with voices distorted by tracheostomies and showing torsos maimed by surgeries and painful lung drainage tube removals, who have since died, in an effort to convince smokers to quit smoking. Though I hate to watch the ads, I am glad they are being shown so frequently and I pray the campaign will be highly successful.

If it is, then I pray it will be followed by a similar campaign featuring infertile couples (last I heard, infertility rates were up 300% – much of which is due to scarring from pelvic inflammatory disease caused by chlamydia and other sexually transmitted bacterial infections); featuring women fighting cervical cancer, men suffering from epididymitis; men and women battling virulent oral cancers caused by HPV, etc.  Show young and old what can come of the fun, cool, casual sex they see on tv. Perhaps urge them to do what God told them to do in the first place:  Keep their (future) marriage beds pure.  Without mentioning God, of course, so people will listen. Keep it purely scientific, without giving props to the One behind the science.

Sex ought to come with a warning – a parental warning, a medical warning, a societal warning, like it used to – before infertility rates were sky high and STDs were epidemic.