"One's destination is never a place, but a new way of seeing things." - Henry Miller - The late American writer
Where is one’s destination? Where is mine? Where is yours? The answer to these questions is simple. It is not a discussion needed to be had by great minds, great philosophers, great theologians. It does not require a great amount of pontification. The answer is simply “here and now“.
My name is Rudy Yanuck. I am a 48 year old retired pathologist, the 2010 Gateway Area Chapter of the National Multiple Sclerosis Society’s Father of the Year, and a 21 year survivor of multiple sclerosis. Though my life with MS is full of opportunities to live in the here and now, MS presents challenges each day. My family shares these struggles with me. I know it is not easy for them and I am truly grateful.
So many people, myself included, focus their time and energy searching for, agonizing over, what their destiny in the future may hold. Where they feel they should be in five, 10, 15 years. They fret over what could be, should be, might be, hope to be. They forget about what is, the NOW. They forget to appreciate, cherish, love what is right HERE in front of them. The NOW. Or worse yet, they only focus on the bad, and forget about the good. I wish I could say I've always lived in the here and now, but it wouldn't be true.Today I’d like to share with you some of those moments.
In the spring of my surgery internship at the Naval Hospital San Diego, in 1994, I felt as though I was on top of the world. Life could not get any better. About to finish the professionally most challenging, physically taxing year of which over twenty years later I am still most proud, followed by three years of flight surgery, then orthopedic surgery residency and career as an orthopod. This was my destiny!
Then one day, “Lieutenant, tomorrow at O-800 you WILL report to staff sick call. You WILL obtain your medical record and you WILL report to the ophthalmology clinic. You have an O-830 appointment with the neuro-ophthalmologist. You WILL receive an MRI.” the Chief of the Department of Urology, sternly ordered me. Immediately, I stiffened in fear.
I wasn’t to concerned about the ophthalmology appointment. I had been evaluated by The neuro-ophthalmologist two months previously as part of my flight surgery application. I had been selected and would not have had the orders in hand to report for flight surgery training that summer had I had not passed the eye exam. It was the MRI I feared. That test had the potential to discover, uncover, reveal, ruin… and save me.
During my internship I was generally referred to as doctor. So when a captain referred to me as lieutenant, I knew the only reply was “Yes Sir”.
From July 1, 1993 to July 1, 1994 I did a basic surgery internship at the Naval Hospital in San Diego. Early in July 1993 on my trauma service rotation, I began having some difficulties with touch sensation. Feeling pulses in order to get blood for an arterial blood gas measurement was difficult for me, sometimes impossible. It became the running joke of one of the staff surgeons. At times I felt the tears wanting to erupt but I refused to show my true emotions, laughing along with him.
As the year progressed, I started noticing other difficulties. I had more trouble than most with fine, and even some gross motor tasks. As the rest of my team would glide rapidly down the staircases, their feet seemingly not even making contact, I would be left slogging behind. On call nights when I stayed overnight in the hospital and was awakened, summoned to assess a patient, I found it difficult to begin the long trek from my call room to the patient wards, spending the first 20 yards or so bouncing off the walls for balance. One day I asked a fellow surgery intern if he was tired. He emphatically replied “HECK YEAH I’M TIRED! I’VE BEEN UP FOR THE LAST 36 HOURS!” So I tried to convince myself that it was just a hazard of the job. But deep down I knew there was something more.
I had been a surgical intern on the urology service for the month of April 1994. The interns rotated Fridays, performing minor surgeries with the department chairman. The previous Friday was my turn. Apparently he had noticed something in my surgical technique that caused him enough concern to lead to our Monday morning meeting in his office, and warrant a mandatory ophthalmologic evaluation and MRI.
At the appointment, The neuro-ophthalmologist performed essentially the same exam he had performed two months previously. This time he asked more directed questions focusing on my peripheral vision. He was looking for signs of bitemporal hemianopsia, the classic symptoms of a pituitary Adenoma. A brain tumor that affects peripheral vision. Untreated it could cause blindness, endocrine disturbances, and potentially death.
My responses to all of his questions where “No”. “Your exam is unchanged from the last time I examined you. I don’t see a justification for an MRI.” “Whew.” I thought, finally releasing the breath I was holding. “Well”, he said, “actually I do. If the captain wants an MRI, the captain gets an MRI.
The month of May, I spent assigned to the pediatric surgery service at a private hospital in San Diego. As an unlicensed physician, as most interns are, I had a very limited role in actual patient care at this hospital for liability reasons. I primarily observed, not being allowed to write notes and orders in patient charts, cover inpatient call, not even allowed to “scrub in” on surgeries. The relaxed pace was sometimes boring but a welcome reprieve from the frenetic pace of the rest of the year.
Preoccupation over my upcoming MRI towards the end of the month blurred my memory of that rotation. One event does, however, stand out. I had been informed of a little boy who had received a gastric tube for feeding because of a congenital abnormality. He was having difficulty breathing due to indigestion and bloating. Later that evening, the father called me with the same complaints. As instructed, I told him to “burp” the tube and go to the emergency room if his difficulties continued. I went to bed.
Early the next morning, around three am, the father called me back to inform me his son was dead. I froze in panic. “My God, what do I say? What do I do?” I thought. I had never been in a situation like this. Medical school only prepared me to take care of the living, never teaching how to deal with this inevitable scenario.
Previously, I had been a part of a team in these kind of situations. The more experienced attending physicians handled this stuff and I stayed in the background with the rest of the surgical entourage. This time I was alone having to talk with an acutely grieving parent. I expressed my condolences for his loss. I hung up the phone with the unsettling feeling that I handled it all terribly wrong. Eight months later, when my daughter died at 4 dAys old, I would learn that there was nothing I could have said to ease his pain, but to have said nothing would have been inexcusable.
The morning of Thursday, May 26 I went to the radiology clinic for my MRI. The machine looked like all the other CT scanners and MRI scanners I had seen previously. But this time, I was the patient lying on the table whose head the unseen magnets would rotate.
I lay supine on the table. A cage was placed over my head. I imagined I looked like a hockey goalie or baseball catcher. The table slid into the scanner, automatically positioning my head in the narrow opening. “!-!-!” went the scanner, then silence. Suddenly a loud “gnweuew”, followed by “dupt-dupt-dupt-dupt-dupt-dupt-dupt-dupt, blop-blop-blop-blop-blop-blop-blop-blop, doof-doof-doof-doof-doof-doof-doof-doof, rat-tat-tat-tat tat-tat-tat-tat. The sound would have been deafening had it not been for the headphones placed over my ears. Then silence. A few seconds later it started again. This pattern continued for the next two hours.
The following afternoon I called the radiology department to get the results. I spoke to the neuroradiology resident who was reluctant to discuss the preliminary results. Radiologists generally don’t discuss results with patients, only doctors. Dilemma, I was both. He nervously stressed the results were only preliminary, not yet reviewed by his attending radiologist, not yet finalized. he then delivered his preliminary findings, which were word for word of the eventual finalized report,with a shaky voice,not out of nervousness and insecurity in his interpretation, but out of concern for what his interpretation meant to the person on the other end of the phone line, me.
I listened, hung up the phone, and steadily, with heart pounding, throat closing, and eyes welling, walked to the men’s room. Once the latch clicked behind me, I collapsed to the floor against the corner, in a heap of wails and sobs. I wept like I never wept before, and only thrice since.
My pituitary gland was fine. The test uncovered severe bilateral demyelination of my periventricular white matter, ultimately resulting in a diagnosis of multiple sclerosis. Just like that, my professional hopes and dreams, my destiny, vanished. The Navy forced me into a field of medicine I had never enjoyed, never considered, and in fact, had felt not really a true clinical specialty, pathology.
I did my pathology residency at the University of California, Irvine, a prestigious program, with some prestigious names in the field of pathology. I could not see that then. I was too busy mourning the loss of what could’ve been, should’ve been. I was too busy being angry at multiple sclerosis for what it had taken from me professionally. I was too busy fighting accepting what was there in front of me, the here and now. I did not see nor appreciate the opportunities being given me.I wanted my destiny back!
Anger prevented me from accepting the what is and fully engaging myself in my training. Had I done so, it would not have taken me the many attempts to pass the pathology specialty boards as it did. Life would’ve been so much easier for me and my family had I embraced the opportunities.
Following my residency, I did hematopathology fellowship training at the Armed Forces Institute of Pathology in Washington DC, a very prestigious program, with many prestigious names in the field of pathology. It was during this training when I began to accept my destiny, embracing the here and now. I started seeing it in a new way. Interestingly I began to enjoy my job, finding it less difficult than it had been. I began having fun.
After a 20 year career in pathology, my multiple sclerosis had progressed to the point even the low physical demands were becoming physically taxing. After a three year battle to save my job, I took a forced federal disability retirement. Again, I failed to see the opportunities presented. I did not embrace my new destiny. Once I finally did, I began to enjoy my new life. I began having fun.
Today - my here and now - I am a full time at home dad to five kids, ages 4- 21, spending my days with my children and working on taking care of my health. These are the moments I cherish. Life could not get any better. THANK YOU
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