Monthly Archives: June 2015

Oh, the indignity! (An update from Steve Safran)

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I smell awful. There’s a sickly, syrupy-sweet smell I give off during these intense weeks of chemo that, perhaps, might be nice coming from a pancake kitchen. But coming off my skin, and combined with its other scents, the smell is terrible. My bodily emanations are mini-violations of the Geneva Convention. Three sets of sheets aren’t enough changes a week to keep up with my ability to insult the very loom that created them.

Or maybe I don’t smell awful at all, and it’s just that my nose has been so wrecked by chemo that I can’t tell the difference anymore. Who brought that wonderful, fresh spring bouquet in here? Get it out!

Smell, taste, sensitivity to sound and light– it’s all different now. I’m two cycles deep in the course of treatment for testicular cancer, diagnosed in May. The hope is that three cycles will cure me, but four cycles is a real possibility. A cycle is three weeks: Week One is chemo Monday through Friday. Weeks Two and Three are chemo just on Monday. So if you can follow that, please call me and tell me which days I have chemo. I’m a writer, not an air-traffic controller.

Last week was the worst. I was scheduled for just two hours. Instead, I got the deluxe package stay at the Newton Wellesley Hospital, spending four of the five weekdays there. The room was spacious and parking was ample, but the pancakes brought my Yelp review down by a full star.

Staying in the hospital means visitors. The downside to having hospital visitors is that you are poorly dressed for the occasion. You aren’t “business casual” so much as “hospital humiliated.” Much has been made of the indignity of the “Johnny” that cruelly ties in the back, except that it doesn’t. People, come on— Velcro! However, you don’t have to worry about doing your hair as it has abandoned you, and since your only method of cleaning your body now comes in the form of a giant baby wipe, you don’t need any time in the shower.

Everything about chemo turns your intestines into the Keystone pipeline project. It’s part of Big Pharma’s plan to sell laxatives, stool softeners, and other meds to let loose the dogs of war. And you will smell like said dogs once these things let everything loose. So there you are, visitors in the room, dressed like an extra from “The Walking Dead,” and suddenly the Senekot, well, works. I won’t go on, except to say I cranked the TV on my way to the bathroom.

About the smell, little could be done.

Just me and my hospital pals, heading to the nurse’s station…

I get it.

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Most of my social media feeds are full of kindness. Really, y’all are a sweet bunch of voting, do-gooding, funny, and freethinking protectors of the planet and champions of the less privileged. Some get gussied up for countless events requiring large donations to noble causes; others give your time to help an elderly neighbor, staff the local food pantry, create art, and redesign all of our public spaces to be accessible and fun for everyone. A disturbing number of you have a near pathological savior complex for condemned animals and strays. And my how progressive we’ve all become! Two years ago I attended my first gay wedding with a boatload of Republicans shedding happy tears of love and support. Locally, my affluent town has voted to pay higher taxes to fund programs to bolster our vulnerable citizens. And 97% of you didn’t balk–even cheered– when our most iconic Olympic athlete transformed from the man we grew up with into the woman she was all along.

Most of you.

Some of you “will still call him Bruce,” or feel squeamish, or will compare him to a delusional white girl whose tangled web of lies included an impressive, unearned portrayal of a black woman. Indeed, there are few medical, scientific experts who study and treat these exceptional people who are at odds with the gender of their bodies. And unless you are a member of a thriving gay community, or live in New York or LA, or are Anne, you probably don’t have a single transgendered friend in your social media feeds. But armed with only un-peer-reviewed studies, a Wikipedia base of knowledge, and with no first hand experience, I think the only dissenting opinion anyone should launch onto social media regarding Caitlyn is this:

“I don’t get it.”

Of course, mainstream media wants you on board. The liberal masses don’t want your bystander nonchalance; they want full-throttle endorsement! And I suppose those who “will still call him Bruce” cannot stomach the cheers and accolades and awards for this flagrant display against God’s creation or nature or decency. The world has gone loony tunes! It’s OK. Take a beat. Remember our own parents’ opinions about homosexuals in a pre Will and Grace world? Well, regarding the transgendered, we’re still a few must-see-TV moments away. And no one will fault you for not understanding this brave new future of women-becoming-men and vice versa. But fabricating arguments in denial of something scary and true for thousands is unkind. Tying those opinions to religion makes Jesus facepalm.

Because I spent a regrettable amount of time murdering rats with a guillotine in order to study their still fresh brains, I have a small and gruesome credibility to dissuade you from comparing Caitlyn Jenner to Rachel Dolezal. Though it pains my heart to read these articles, my arguments derive quite literally from the noggin. Some of you might be able to dredge up this long forgotten fact about human development: we’re all designed to be girls. The human default setting is Lady. If people had a browser that popped up automatically, it would be called Chyx. Without the effects of boy hormones (androgens) on our brains and bodies at key moments, we’re all going to need training bras and develop a complicated relationship with our bangs.

Testicular feminization syndrome is a remarkable example of the strength of our ontologic destiny– where chromosomally male fetuses whose receptors cannot respond to dude hormones can develop into completely physical girls. Luckily for some of them, their teeny growing brains are bathing in the same girly milieu, and so develop into women, too. They are able to lead less complicated lives as their brains and bodies respond to hormones in harmony. But for others, this:

Another case is instructive. An [XY] individual who is now living as a woman had been assigned as a girl at birth but was switched by a physician to live as a boy at the age of 3 months when testes were discovered. At the age of 13, her physician recommended that “he” have a mastectomy for his breast development. The surgery was performed and this individual continued to live as a boy although she had felt from early childhood that she would be more comfortable living as a girl. At the age of 22, she felt that she could not continue to live as a man and switched to living as a woman when she learned that she could obtain breast implants to regain what had been removed.1

For the transgendered, this sort of mismatch happens. Somehow the endocrine soup around the brain doesn’t gel with how the body is shaping up. It’s not a choice or a delusion; it’s biology. It’s also devastating, confusing, scary, and rare. For those who want more scientific proof than my watered-down biology lecture, I can point you to any number of rat labs with guillotines. There are also peer-reviewed research studies revealing structural differences in the transgendered human brain.

But despite more credible, kinder arguments, some of you will “still call him Bruce.” Otherwise thoughtful, smart people will keep citing the one doctor who doesn’t approve of gender reassignment surgery, or will make false comparisons to body dysmorphic syndrome, or worse, liken Caitlyn to a white girl using an enviable twist-out to be something she can never be. Caitlyn is a woman because her brain was always female. Rachel was never black because, well… she was never black.

I have another, more personal reaction to those who champion a fierce attachment to The Body the Lord Gave Us. Mine is no longer whole, but I am no less womanly for having amputated my breasts. Also, I’m alive. Like Caitlyn, I removed the parts that were endangering me, forcing me to be something I didn’t choose at all: a person with cancer. When your queasy disapproval of corrective surgery fetishizes a holy beauty of our native bodies, elevating the importance of our God-given bits and pieces over everything, how do you suppose your breast-cancered sisters feel? Well, this one stands with Caitlyn.

I get it.

Hello, Caitlyn

Hello, Caitlyn

1. Gottlieb B, Pinsky L, Beitel LK, Trifiro M. Androgen insensitivity. Am J Med Genet 1999; 89(4):210-7

It Was an Honor and a Privilege to Write This

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In the next two weeks, we’re going to six graduation ceremonies and parties. During a dozen years on Bernie’s arm attending black tie dinners honoring future surgeons, I have listened to 192 speeches. I counted. The amount of time these residents donate to difficult training– and what they sacrifice to do it–allows them the honor and privilege of saying whatever the hell they want up at the podium. But that doesn’t mean I might not poke fun of them. Just a little. Congratulations, graduates.

Graduation season is upon us, friends. And it’s all an honor and a privilege! It would have been impossible without your support on the road less traveled. It’s also a lot like swimming with sharks, but Mark Twain probably said something about it best. As a kid I dissected woodland creatures and took apart the toaster! Everyone or no one in my family is a doctor, but most of us have inspiring, dead relatives. I’m from far away (NOT a Red Sox fan, hahahahaha!) or from right here (Whoo hoo! Go, Sawx!) and when I started training something embarrassing or horrible happened. And then incredible and wonderful things happened. And it was all an honor and a privilege to have worked with you, the best people I have ever known, though the sum total of our future friendships will be Facebook “likes.”

The rotation where I was finally treated with a modicum of respect, performed with reasonable proficiency, or the one with the least amount of call inspired me get a job doing that. Or, I’m really excited about my cardiothoracic surgery fellowship and the next paragraph is testimony to the man-crushable cowboy heroes of the operating room. I bet none of us will miss these horrible winters, huh? Hahahahahahaha!

Props to my current/future husband/wife/partner. We made it, honey, but we’re still broke. After a near decade of training there’s only, like, a few more years on the futon. I might get a little teary thanking you–maybe I’ll grab the baby for this part– as inspiration to the junior residents, and to prove I’m not always a condescending, work-dumping asshole. Look guys, they can’t stop the clock!

Michael Ellis DeBakey–or maybe Twain again– said something apt to this moment. I’ll never forget my training here at the World’s Best Hospital with the most Talented Surgeons in the Universe, unless my fellowship institution is a trade up and then you’ll only see me in their caps and sweatshirts. But I can’t wait to reconnect with you again as collaborators on research projects in this exciting field. Until I go into private practice… then please “like” my Facebook page.

As the person who wrote all of my recommendations always says, “blah blah hard work blah blah fun!” Thanks to grandma-on-oxygen or cousin-from-Hawaii for making the trip… and for this awesome chicken-or-fish dinner. It’s all been an honor and a privilege!

Is anyone validating the parking?

It’s your moment… tell us a great story.

Steve Gets Cancer… by Steve Safran

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Britt’s blog gave me cancer. OK, maybe it didn’t– the science is still out on the matter. But the facts are this: I am now being treated for Stage 2C Testicular Cancer. I’m not acutely familiar with the shades of the term “irony,” but surely this is somewhere in the vicinity.

Testicular cancer is “a young man’s disease,” and for this, I am repeatedly told, I should be grateful. It is nearly 100% curable. “If you had to pick a cancer, this is the one to get,” an oncologist told me. That’s fine and all, but that’s like saying “If you had to be sat on by an elephant, you picked a nice, small elephant. Look – he balances a ball on his trunk!”

There is one question everyone wants the answer to when surgeons are removing your testicle, so I will answer it right now:

They do not replace your testicle with an artificial one.

I have been getting treatment for this since the beginning of May, and this is the first public notice I’ve given. This is a little strange for someone who can’t wait to post whatever ailment he has that day. On this one, however, I decided to go the old-fashioned route. I didn’t take to social media. I called my friends. It’s intimate when something attacks you from inside, and I needed to talk or, at the very least, privately email them. (So, maybe not so old-fashioned.)

Word gets out, anyway, and that’s fine. It’s not a secret. I have tons of great support. I’ve even given Britt permission to enlist her prayer warriors. That’s a first for this Atheist Jew, whose usual reaction to “We will pray for you” is “Please, don’t.” It’s not because I found religion, but because I realize that the faithful truly believe they are helping. I am not going to ask my friends not to do that which they believe helps. I am not going to ask my friends not to turn to that which comforts them when someone they love is sick.

Two weeks into treatment, I was struck with a pulmonary embolism. This is a blood clot that finds its tiny, sticky way into your lungs. The key sign you have an embolism is that you feel as though someone chose to put up a skyscraper on your chest and neglected to get a permit from you. That morning I took a shower and ran out of breath. That afternoon, I was back in the hospital.

As a result, I now get to stick myself with a needle twice a day with blood thinners. This is the fifth drug I have started taking since chemo began to ward off the side effects of cancer and chemo. My medicine cabinet looks like a Jenga tower.

I have many more dates with needles and chemicals. What you’re reading is a cutdown of a much longer rambling at least six times as long. For now, I’m out of breath. Britt’s blog is exhausting.

Me and Stevie: Cancer-card-carrying pals.

Me and Stevie: Cancer-card-carrying pals.