Category: Human Spirit

Kids baseball game

Seeing Red

Joanne Dragun, M.D.

The crack of the bat. The roar of the crowd. It is baseball season and the formerly tiny faces in the big caps and over sized gloves who dreamed of this day await their destiny. The baseball draft will change lives forever and few will be called to greatness. When you are an all star athlete with profound skill, your eyes are on the hopes of a big and glorious future. When you are sidelined from your college team to be treated for cancer, the world tilts. What brings you back on course is a family devoted and your own internal fortitude.

The path of baseball star pitcher Dylan Simmons is close to my heart. While managing juvenile diabetes, Dylan was top in the sport and while recruited from high school, chose to succeed on all levels in life. College came first and so he excelled at a finance degree. During his Florida State journey, the lymphoma diagnosis hit. Hard. Nothing mattered now but getting well. Can you imagine being parents, both with careers in cancer treatment, finding your own child will battle a disease and right at the prime of his college journey? Scott and Tracey his parents sat the bleachers, traveled the journeys, supported the dream for years, then find themselves navigating a familiar terrain, but now for their own beloved son. The star baseball career sidelined with the hushed words and devastating diagnosis.

Dylan made his way successfully through a tough program of treatment and ultimately transferred to University of Pittsburgh where his star continued to shine at every level. The self proclaimed, …“diligent student with a passion for pursuing excellence in everything I do” with aspirations on and off the diamond, saw them come to reality when he was drafted by the Cincinnati Reds.

Dylan’s journey to professional baseball (and sure to follow more greatness, records and success) could be the culmination of this truly inspirational story. His brave and courageous parents and supportive and successful brothers could now see their aspirations for him come to fruition. But I do not believe that this draft, to a wonderful national team, with vision to recruit his talent, is his true life’s work. In his own words, “believing that with hard work and surrounded by good people, nothing is impossible”.

Dylan will inspire every little face of a juvenile diabetic with assurance that a lifelong disease is not limiting. How you stand up to it is what matters. That the children in cancer wards, like the one in home town Jacksonville where Dylan was treated, will envision their own success. That parents will have hope, as Tracey and Scott did, and siblings will converge to lift when another is challenged. Dylan Simmons’ greatness will be legend because he is an outstanding and talented athlete and Cincinnati does not even know yet how fortunate they are. It is his determination, leadership and courage in the face of adversity and power with God’s blessing on him that will reach heights never imagined.

We wish you all the success you so richly deserve. Your journey gives parents the strength to see power and courage in their own children- never victims always victorious. God bless you, Dylan, and your wonderful family. We will follow your career with anticipation and we will celebrate your every achievement, but mostly we will be grateful that you were given the gift to inspire others to reach for their own greatness within.

Pain in the Neck

Joanne Dragun, M.D.

On a scale of one to ten rate your pain. What a ridiculous evaluation yet we ask it every single time a patient presents. If you have pain anywhere from anything it is all consuming. You don’t think,”well its just a five”. You want it gone and now! Even a toothache is worse than some post op or cancer pain.

In radiation we treat patients often for palliation, hopeful that as the tumor shrinks, it releases the nerve and clears the sensation- doesn’t always. For years I have prescribed opioids and now with the epidemic of abuse, cancer patients are made to suffer and find alternatives. I have never been a fan of the use of morphine, oxycodone, fentinyl, oxycontin etc. because they work centrally on the brain’s perception of pain. I believe managing it locally at the source is less toxic and addictive.

The pain clinic (not pill mills) are a good place to find experienced anesthesiologists who can inject a site for relief. Medical marijuana is legal in Florida if you can jump thru the hoops and can spare the cost.

Bessie came with her son. He is desperate to find her relief for the spinal fractures from multiple myeloma. She is now a full 2 inches shorter and bravely uses a walker. “Doc, my son wants me to smoke dope!” says the eighty year old. I advise, “That won’t be necessary. Lets get you set up with a Doc who can help”. A month later, Bessie returns. She is using the medical marijuana oil drops under the tongue and the pain is manageable. The relief on her son’s face is evident as well. She has less confusion, sleepiness and constipation as the narcotics are weaned down. “Doc, who knew at my age I would be on marijuana!”

It doesn’t work for everyone. There are regulations still strangling and since the federal government has it listed as illegal you cannot visit your grandchildren across state lines with it. I expect changes are on horizon as a bill recently passed the house. The poor grandmother arrested pre-pandemic in Disney for carrying her legal medical “stash” is one reason the law needs to change.

Local injectables, kyphoplasty (rebuilding collapsed vertebrae) nerve calming meds like gabapentin and lyrica, antidepressants are all alternatives to narcotics. Most pain specialists are anesthesiologists and will explore multiple options. Perhaps even medical marijuana. You do not need to suffer. If you or a loved one is in chronic pain for any reason, see a pain specialist. It is high time to breathe a sigh of relief.

Gifting

Joanne Dragun, M.D.

A lovely patient has been busy through chemo and radiation sewing beautiful masks. The fabrics are fun and fanciful yet keep toxic inhalations at bay. She even included some college teams. Her gift of love is extended not only to our staff and fellow patients, but she is mailing to Texas, Ohio and other cities in Florida. It is a great way to share the “we’re in this the together” time. Another patient is making meals she shares with an elderly neighbor. He helped her through her drama of diagnosis with his own strength with cancer history. Mrs. Charles gifts a large pack of precious toilet paper to another patient, Mrs. Evans who is in a wheelchair and unable to go anywhere except this therapy. The gifting and kindnesses go on and on (as is usual with cancer patients anyway) but more so now. This lifts everyone’s spirits.”Doc, its never about me- everything I do, even this therapy is for my family” Hank says. Malinda is a substitute teacher, unemployed. She is “manning up” accepting the risk  helping at the church to make food bags for children- her heart is breaking for them more than her need to feel safe.

What is it with these cancer patients? They are such a fierce group. “Doc, you concern yourself with my treatment but let me live how I need to”. Maybe these gifts from the heart are what is keeping them going- being needed, which is a prime motivator for life. So these feisty cancer patients and survivors are changing my own dialogue. I want to say “be safe, stay home until there is a better way to manage this disease, don’t put yourself at risk (there are patients who have lost the battle not from cancer but the virus). But instead they teach me everyday. I now think: Be strong, don’t cower, push back, remain tough as you had to for treatment, don’t be bullied, spread love which boosts the immune system like nothing else can.

So a new message is evolving: Continue to gift your spirit- even  with a phone call. There is so much rescuing to do. The pain will only heal with human kindness- not a vaccine or drug.

There will be a time when our formerly self-centered lives return to a new normal. But the break in our focus is so dramatic, devastating and gut wrenching that we will all be changed. People are waiting hours in line for food (“Doc, I’ve worked everyday since I was 14 now I can’t afford gas to come for treatment”.) There is no way this won’t have a lasting impact.

If you feel compelled and are able to help, I will not direct that you cower to the threat. Of course I want you to stay safe which may mean staying home. But we know that you are fearless and unlikely to listen to caution after these past months of peeking through the blinds.  Instead I encourage you to live that life of sacrifice and strength that helps you to fight this cancer battle and continue to be unafraid. You are needed. (Just wash your hands and wear a mask).

Kaleidoscope

Joanne Dragun, M.D.

Turn the dial, just a few millimeters. Change the direction: a green tree, a blue sky. Marvel at the prisms, colors, dimensions and complexity.

The simple toy is able to capture our imagination reminding us how each point of view is influenced by minor movements. In medicine as in life, each of us have unique perspectives and they change daily. It is helpful to recognize how a slight change in thought, knowledge, or circumstance will influence our choices. Since “the only thing certain in life is change” we should be open to all possibilities.

Just a few aging and healthcare examples: Many seniors have said, “I am never going into a home”. But now three cooked meals, socialization, care and attentiveness look better then loneliness and rigidly holding onto an outlived house. Patients often present with cancer and say, “never chemo!” But when the grandchild climbs onto their lap and holds their face in their chubby hands, their heart melts and they nod, “Do everything possible”. A newly diagnosed patient enters the center, looks around and sees others getting on with life not terrified or broken and now their spirit lifts with hope.

Doctors are taught to view every decision through a patient’s point of view but we bring our own prejudices and need for rescuing into the mix. This week Dolly is so frightened of side effects she almost says no to any treatment and her family are adding their own concerns to her fear. She doesn’t see a way out, but we implore Dolly to to trust in her own courage and a new prism of hope takes hold.

Even more complicated is recognizing that within your own circle of friends and relatives, even spouses, their viewpoint will not coincide with yours. I have had to tap into this awareness often in my career. Every single time I sit across from the person scared or suffering or questioning and open my own mind to their viewpoint. It takes practice and patience and we don’t always get it right. What I think I understood today will change for them tomorrow.

I offer to you this week just that wisdom. Realize the frame of reference for yourself and others regarding any situation is almost fleeting. Don’t get stuck. Know that you can change a view swiftly and without any effort. It is always available to you. Nothing is firm or fixed and options are everywhere. You are the one holding the viewer. Turn the dial and prepare to experience a new and wondrous change in life. Allow the magic to unfold for you.

Rescue

Joanne Dragun, M.D.

More threatening than covid, more dramatic than hurricanes, the scariest this week are the weather channel meteorologists. Not satisfied with the quick moving Isaias, they pile on that 89% of hurricanes are yet to arrive in the US in a very active year. Look, we have no more room for any more toilet paper or water so stop threatening us. From Florida to New England, we prepared and alerted. Then we get a reminder of just how life can change in an instant last week.

Following death and destruction in North Carolina, further inland the storm traveled as far as West of Philadelphia. Dr. Brian Lally, a good friend and radiation oncologist in Doylestown Pa with U Penn tells me, “The sky darkened, something hit my window, the power went off and I went to the vault to help the patient off the table. As the accessory power went on, there was crashing as a tornado blew the wall of glass into the lobby. The cars upended in the parking lot and everyone was escorted into the vault.” The roaring was terrific he tells me as the storm swirled. He made his way out to find the hospital daycare in the adjacent building had its roof caved in.

Dr. Lally, staff and teachers formed a human chain with tiny figures, some small enough to be in arms, and evacuated to his department. The concrete and lead lined vault filled with small frightened faces. Fourteen were missing in the head count! A tech working there knows the daycare well and went to investigate. They found them all huddled into a small room/closet where the tree had fallen through the roof. EMT’s arrived and everyone was triaged with only minor injuries.

There were no masks, there was no hand washing, there was surely no distancing. There was massive surge of loving care and in an instant, heroes were born. The tiny faces with big eyes break  your heart. Privacy keeps me from sharing the photo but babies, toddlers all crunched under the large intimidating radiation machine in the concrete vault bring awe and tears. 140 children saved.

Thank you, Dr. Brian and staff for reminding us all how in a moment of crisis, care for each other is the only matter. Diving in to rescue with no thought of personal safety. The  “managing” for months this new reality in our homes and work, the threat of more hurricane drama ahead, the grieving for suffering and loss that many have and will face, all disappear in an instant. When we rescue someone, we are saved.

In the Service of Others

Joanne Dragun, M.D.

There are many we need to thank for their sacrifices these past months. Grandparents who learned to help with home schooling, essential workers, many not in healthcare who put their big boy and girl pants on and headed out- some for minimum wage to keep our needs met. Stores and restaurants fiercely trying to provide safety and give us all a break from sheltering- while they struggle as well to survive and stay open. Families working from home, but driving their loved ones to the center for treatments, waiting in the car, not permitted inside. Demonstrations of sacrifice move me daily. When you avoid encountering the virus by dunning masks, sanitizing and distancing, you also are protecting others and being of service to the greater good, and maybe that person right next to you.

A small example happened this week. We have been out of sanitary wipes for this clinic for a month. I headed to Walmart at 7AM to purchase some of a handful of supplies that will be gone by 7:15. A woman at the next self-service checkout heard me ask the clerk if I could purchase two. But the limit was one so the shopper quickly took them, wrung them up and put them in my cart! She was completely unselfish and happy to help.

Walking to the lot I expressed my gratitude and told the shopper that at the center this will help my staff avoid hours of breathing in the spray to disinfect continuously. She stopped, got tears above her mask and said, “I am due to be there next week for chemo! The fun multicolored dreadlocks were a wig. We almost hugged then stopped and giggled. These simple acts of kindness are occurring daily. Millions of essential workers have their own stories.

Teachers as we know are truly essential and are getting ready to be brave for the children. They will mask, shield and sanitize and engage our children who need them so very much. In this crazy time we are all acting in the service of others. We have never been more interdependent in our lives.  Structure and processes are being put in place. Fear is not an option. We need to try, but with caution and care. The cashier, stocker, delivery driver, waitress, clerk and most healthcare workers did not sign up for this either. They do not have the luxury of working from home- there is no pay without showing up. We can be smart and careful to remain engaged. This virus has taken so much from us and our children, but it has also added opportunities. Service to others empowers and enriches us all. Thank you.

 

Super Spreaders

Joanne Dragun, M.D.

Hands washed. Check. Wipes in the car. Check. Sanitizer in the small purse. Check. Keys and credits card handy so no routing around. Check. MASK ON. CHECK! Heading out the door today for any endeavor takes some planning that has now become habit. With numbers increasing in Jacksonville, it remains wise to continue precautions. (Even the RNC canceled. The President’s need for adoring fans is like a need for air- just not this air!)

“Blah,blah,blah!!!!” I hear it across the store aisles. A woman is tossing things into a cart while on the phone- no mask. Not even tucked like so many under her chin as if she had a chin lift (you do realize there is no point of entry there). She is shattering my peace. It is smart to get in and out or buy online and when you can’t, then make your trips quick, efficient, and distanced. The reason I was appalled is that she didn’t distance, talking like that spreads,  and she seems insistent on avoiding responsibility. If someone has a medical condition enough to avoid a mask, stay home please. Like a bee you cannot avoid (well, more like a murder hornet)  she kept following me, so eventually I overheard her conversation.

It was a tirade of complaints from one thing to the next. Her “chi” was very disruptive and brought to mind Peanuts’ “Pig Pen”. I wondered who cared enough to let her whine. It dawned on me that she is a super spreader of hot mess. People who complain constantly, or just want to hear their own voices and not listen, are infectious too. It was noxious stimuli for me.

I rushed out to the safety of my calm, peaceful clinic. I thanked God that demoralizing and aggressive chatter does not happen in my sheltered space. Here, people have every right to be disenchanted with their circumstances. They may be too ill to care for themselves and need to move from home, concerned for the children who may lose a parent, fearful of cancer and it’s treatment now adding to COVID job loss and money woes, so many issues surrounding this insult that vary with each individual and family.

Patients are sitting in front of me daily who have every right to cry, kick and scream their shock, fear, and anger. Instead what I do see is a serenity that is ethereal. It’s not all acceptance; they are here to fight or at least learn. At every turn there is hope and always the love and concern for others come through loud and clear. Above their masks, the eyes tell me all I need to know. Wide eyes, a crinkle of smile, a soft tear- all at the same time in this sacred space.

You will encounter thoughtless people like that shopper many times now. I hope we all remember that many many more of us are being brave in the face of challenge, far beyond a capability we thought was within us. Positive, uplifting words are necessary now more than ever. Gentleness, a loving spirit, and show of courage are also contagious. Let us all be super-spreaders of the very best kind.

Big

Joanne Dragun, M.D.

We all recall the wonder-filled upbeat movie “Big” with Tom Hanks. The title reflected transforming into his grown-up body while still a child. The concept of living big with a child-like wonder can inspire us all. Dancing on the keyboard, falling for the pretty girl, though shy, making bold and wild ideas come to life in toys… living big! Lately, we’ve been doing the opposite. I listened to a meditation recently. The guide had many suggestions to keep things simple and contemplate small, taking time instead of just barreling through life. I am not having any of it. We are done living a scared, tight, small existence. We only get one life and while a virus has upended our peace, we can still be bold.

When Norman came to see me this week, the tattooed motorcycle rider was used to living in a big, gregarious way. The new diagnosis of cancer at only 45 years knocked him over. His whole perspective on life changed with one scan. There is a disconnect between his activities, travels, work, family, and friends, and this new threat. “Shoot me now, Doc! I guess I am dying. How’d you like that for a kick in the head??” This lifestyle change is more than he bargained for so early in life.

 I remind Norman that he didn’t ride his Harley cross country until he practiced around the block. Ramping up to “big” takes effort. “Norman I want that life for you as well. You can still live large, unafraid, fearless. Right now we need to manage the confusion and terror. You can’t get out of the rain until you build a roof, so let’s get started on therapy to protect you”. No one, regardless how tough is not afraid of cancer- double negatives for emphasis. During therapy, Norman needs hope for the future. Eventually, he will improve and there will come changes but he will have time to acclimate to them.

Lives have changed everywhere this year. Every one is not getting back to normal with covid either- there are jobs, businesses, and health changes for many- even psychological stress. Our child-like wonder has vanished. So its time to think of new normals and give ourselves the chance to be fierce and excited about our futures again. We are not here to live small, mousy insignificant lives. No matter the stressors- you are in this life to make a difference, love your family and friends, engage with passion and deliberateness.

The next day Norman came for the simulation to start the planning for radiation. He rode his Harley, walked in the door as if he owned the place. Gone was the downward cast eyes and quiet frightened demeanor. He was big, bold and brash and I loved it. “Bring it on,” his attitude said. That power will give him strength for the battle and surely impact his immune system. If he succeeds it will be all him and he will go on to live and love a big life.

Thanks Norman. You were just the shot in the arm we all need now. You will inspire others and we will all embrace a full future without timidness or fear. It’s important for us to live big lives in honor of those who miss having those years. Let’s all make the most of rejuvenation after the recent months of fear, and engage big and expect bigger.

Mothers

Joanne Dragun, M.D.

You may expect a warm and glowing blog post about Mother’s Day.  We all love our mothers and many of us miss them. This post however, is in honor of Mothers for a different reason. It’s to give homage to the “I told you so” thought that every mother on earth and above is thinking right now.

“Didn’t I tell you not to touch your face? Don’t pick your nose. Stop rubbing your eyes. Don’t spit or farmers blow. Clean under your fingernails. Wash your hands!!! Cover your mouth when you cough. Use a tissue when you sneeze”. She was brilliant wasn’t she? She didn’t need Dr. Fauci- it was intuitive. She knew this pandemic was coming and tried to train our habits. AAH if we only listened. Was she dismayed when she looked in your room and closet? “Clean up! This place is a mess. You’ll get bugs or an infection” or something to that effect. How right she was. Now you pull out all your mother’s teachings to clean surfaces, disinfect and sanitize. As Jimmy Fallon said in his thank you notes “Thank you doorknobs for reminding me to clean you- which I never have”. Mom probably did.

How is it that Mom is always right? My Mom was compulsively neat and clean so we learned at an early age. Fastidious as Mom was, heaven forbid the “orderliness … you know ‘next to Godliness’ on the report card was not an “A”  She never used the word “data”. As annoying as it was, I respect this now. Have you found yourself looking up utube videos for how to clean various objects and surfaces? Trust me- bleach can make a mess.

So this Mother’s Day let’s salute the women who birthed us, raised us, taught us, or for the men, married us, are sisters and friends to us and remember they have a God-given mission in life- to love us and keep us safe. If you really want to give a gift forget the flowers and cards. If you are blessed to still have her, call and just say, “Mom, you were right.” She’ll know. Now go wash your hands. Thank you.

Happy Mother’s Day to all those who gift their wisdom and strength everyday. God Bless you.

 

 

Telemedicine

Joanne Dragun, M.D.1 Comment

Have you tried this yet? Telehealth has been around for about ten years and a quick service for minor issues.  We have never used this for radiation therapy cancer visits but engaging with patients who do not require an in– person exam reduces their risk during the pandemic. What I am finding is that sometimes it’s a hoot!

“Doctor! You don’t look sick! How come I gotta talk to you on the phone? They say I can’t come because I might catch a virus.”  I am sitting at a computer in an exam room. Dalia is in front of me on her phone with facetime.  At 83 she needs to be protected but doesn’t fully understand how staying away from the doctor is better for her health. Her face is covered with a mask. “Dalia, is anyone with you?” She assures me no one- “Dalia, I am far away from you on the computer so you don’t need to wear a mask. We both giggle. “Doc, this is the craziest thing! I just want to come in and see you- how are you gonna examine me?” We review the reports I have but I agree this is profoundly limited.  We  set a time in a month for a “real visit”.  

Larry was in this week for a check up. At 87 he is having none of it. “Doc, if I am gonna die, you gotta give me a hug. I might not make it next year.” He always brings a smile. “Larry, your mother lived til 101 and your cancer is controlled, so no hug today, stay home and we will see you next year!”

Ginny is newly diagnosed, has several procedures this week and is frankly terrified. “Doc, I just need your comfort and strength.” You don’t get that from a computer. Mickey came in for a followup. “We could have talked over the computer” I say. She shakes her head, “Doc I live with my 96 year old mother, I was dying to get out for the morning!”. Harvey is happy to call it in and escape the prostate exam. Olive tries to stick her foot in the camera so I can see the swelling. We laugh about her being a contortionist. Mike is shy but finally turns around to show me a rash on the buttock that looks like shingles and needs treatment immediately. Understanding that cancer patients are frequently immunocompromised keeping them safe at home is important but limited.

The laying on of hands is a revered part of doctoring. I recall the first time we examined each other as med students, the scientific learning took a real turn. I have always felt that the bond formed when a physician examines a patient is a force. I never take for granted no matter the years, that you have placed your trust in me to use my skill for your benefit. It is always an honor and a sacred trust. It is never haphazard or routine. Touching another person for an exam has healing properties and the impression that telemedicine can replace is a fallacy.

If your doctor’s visit is set up for telehealth, go in prepared before you hit face time or Zoom. Make a list of your concerns and questions. Since you are not physically examined, this visit is unlike most and involves talking with your doc and they can only help if you provide real information. They are there to help in spite of the circumstances- we all know it isn’t thorough but it can be efficient and safe.

 I will see anyone who refuses medical care over a computer. My patients have a fearless spirit. They know that the virus isn’t seeping under their doors, tracking them down. They have learned to avoid risky behavior.

You and the USA have seen tough situations and prevailed. We will again. I will hug my patients again, I will give up telemedicine for the hand to hold and the touch to calm. I will be there for you and you will be there for others. Let’s be unafraid together.