I have mentioned that in the past, often at times of great duress in my life, often in the midst of cacophony, some window in time and space opens, if only for a moment, but the moment becomes a moment of grace, and, in that moment, an extraordinary medical feat has been granted to me. I have no explanation for any of this, I admit freely that I “hear voices”, voices that others do not hear. I cannot complain about a gift, this gift, weird as it may sound to others
This year, while sick as a dog from the cancer chemotherapy I was receiving for the metastatic cancer that I had discovered in December, my wife having already bought advanced reservation tickets to the “Capital Steps” political spoof performance at the Portsmouth Music Hall, I went to the Music Hall.
I sat all the way back, next to the door, at the very back of the Hall, out of fear that my chemotherapy induced nausea and sudden overwhelming tendency to vomit, on little or no notice, might present, and that I would be able to bolt out the door ,make it to the nearest trash can, and barf there, rather than make a mess in the theater.
I had already scoped out the target trash can and it was about six good steps away from the seat I was in.
I could have stayed home, but, cheap bastard that I am, I was not going to let an expensive Music Hall ticket to go to waste, and besides the whole family, wife, daughter, and I, are all political junkies, we watch political TV addictively.
Finally, this is an annual event, and, given my diagnosis and prognosis, who would want to bet I will be here next year, to see the next year’s version? ( Not I)
So, while sitting at the very back of the hall, and debating with myself whether I would barf or not, whether I would have to get up and run out the door to do so, precisely then, I had another impossible to ignore “moment of clarity”, just like those that have presented themselves in the past.
I have learned to wake up and pay attention, no matter what else is going on. It seems inescapable, inexorable. There is something medical, something badly out of kilter in my nearby, something that is badly wrong with someone in my immediate area, something that will kill or harm them, whoever they may be, and my job appears to be to find it, and sort it out, here and now, “or else”….It is the “or else’ that so drives me. The “what if you miss it, then what?”
I have never let the “or else” happen, at least not so far as I am aware…
I can give no clear reason for any of this. It is some kind of “Intuition” or “Premonition” or I do not know exactly what. A window opens , information streams through, and the window closes again. Other doctors that I have mentioned this to look at me somewhat askance. This is crazy talk.
This time, while I am sitting and feeling deeply sorry for myself, all of this because I’m so ill, a small clear voice says; “what’s wrong with that Guy on the stage who is talking about this presentation?
“Man! I am so sick, I’m not sure I am not gonna barf all over myself”, is my first response, but the little voice won’t shut up..
“What’s wrong with that Guy?” , “ Man! I am so sick”. “Shut the hell up, what’s wrong with that Guy?”
This internal debate continues, until, despite how crappy I feel, I take a good look at the tall gent who is telling us what a wonderful job his Not for profit “do good” Housing Partnership organization is doing, at providing housing for the poor and struggling of Portsmouth, and how pleased he is to see a large audience here for a few laughs at the (mis)representation of the Washington DC political travesty that the Capital Steps entourage will produce, using the true facts of the political scene in Washington.
The Capital Steps skits are a benefit performance, for his organization. We here have all paid for a few apartments to be renovated, nothing wrong with any of that. Still, I can’t figure out why the little voice is bugging me. At first glance there doesn’t seem to be too much going on. Big man, talking persuasively, on his game, in his space, amongst friends.
Finally, I stop feeling sorry for myself, and really take a good look at the gent on the stage. He seems sincere, and quite well spoken, and although I look some more, it takes me a moment or two to really examine him at this distance, and even then I’m not quite sure what it is that has caught my attention. I look and look and whatever has set off my alarms is fairly subtle .. When all is said and done, it really isn’t very much.
His jaw is a bit too heavy for the rest of his face, and his hands are somewhat larger, somewhat more huge, and more thickened than I might expect, even for a big guy like this one, and his feet, in his shoes, are the size of small rowboats. But, a lot of big guys are heavy in the face, and have big hands and big feet. Those are the only relative abnormalities I can detect, and they are not earthshattering
Keep in mind, that I am about 300 feet away from this Guy.
Keep in mind, also, what it is like ( you are probably not so troubled)to have small but disturbing voices in your head, not all the time, but often enough, and keep in mind that you have already learned never never to ignore them
Then the rest of the message is upon me—The little voice says;
“Hey Dimwit, this Guy has Acromegaly”. “He has a tumor in his pituitary gland”, that is what enters my consiciousness, what crosses my mind, once I have had a good look at him.
It is a subtle add all the not-too-obvious facts together diagnosis, if diagnosis it is.
Acromegaly is insidious, and develops slowly enough for most patients, so that neither they nor their families, nor often even their doctors usually notice.
So, sometimes, it takes some very sick and slightly possessed clown, at 300 feet, to notice and add up the meaning of what he is seeing. That is what is going on, now, in real time. The 300 feet distant sick clown has voices in his head, and something magical is underway
Clown or no, magic or no , Acromegaly is not light-duty stuff, not at all. It is a result of an adenoma (the tumor is usually “benign”, but dangerous anyway) because it is growing within the boney surround which contains the pituitary gland of the patient There is no room for expansion, it is a finite space with a growing mass within, and two very bad things happen, fairly soon,if such tumors are left unaddressed; unabated growth continues, in the hands, feet, jaw, and other not yet closed growth centers of the patient, and b) the tumor itself grows, crushing the pituitary gland into the bony walls of the space below the brain that anatomists call the Sella Turcica. The Pituitary is referred to as the ”Master Gland”, since it secretes the stimulating hormones that subsequently control all the other important glands in our bodies, the thyroid, the gonads, the adrenals, all the other glands which produce the hormones that balance our lives
If the pituitary crushes itself accidentally because of a tumor within, you may see the excess growth hormone outcome, as I am seeing here, but the patient becomes Sterile and/or “Hypothyroid”, “Addisonian”, or “Prematurely Menopausal” and they may simply die.
Those are the well documented sequelae of the tumor I think I have diagnosed at 300 feet. Whoops! Now what?
I watch the show, escape barfing for the entirety of it, and when it is over, I try to find the tall guy with the unbeknowst–to-him problem.
No Luck; too many people, too far from a barf can, I am sick and tired, so I go home.
The following Monday, I set about to find him , and after going through a couple of switchboards worth of “How May I be of Service?”, I get him on the phone.
“This is Dr Terry Bennett” I say to him and “you do not know me, but I butt into people’s lives and I am about to butt into yours, ok?”
“Do you have a family doctor?”
“OK, I would like you to call him or her, when I hang up, and ask your doc to get your skull either CAT scanned, or order an MRI with contrast” “Do it today, it is urgent”
“ It really is dead important, or I would not be disturbing you, and I hope I am wrong”
“I may be mistaken but I think you have a tumor in your pituitary gland, and, if I am right, you will need surgery pretty soon” I murmur a few other platitudes to this total stranger, and hang up.
Two days later I get on an airplane for what I believe is my last holiday, in the sun, in the British Virgin Islands.
Upon my return from that trip, somewhat surprised to be still vertical, and still at work in my medical office, I am going through my telephone messages at my office, and find a note that says “Mr M called and asked that you return his call”
I do not recognize either the name or the number, but dial it anyway.
A voice answers, and asks “is this Dr Bennett?”
I say “yes”
There is a short pause, and then the voice says
‘Thank you for my life”
Here is the other side:
November 13, 2013
Dear Dr. Bennett,
I am writing because I thought it might interest you that I recently marked one-and-a-half years since undergoing surgery to remove a tumor from my pituitary gland that you originally suspected was present. The tumor, it turned out, though benign, was secreting human growth hormone into my system at ten times normal levels, causing a group of insidious and not obviously related symptoms over a period of ten years or more. As I’m sure you know, left untreated for long periods of time, acromegaly, as the condition is known, can lead to serious health problems or death. Your reaching out to me – a stranger with subtle indications of illness whom you’d observed from the back of theatre – to suggest that I be clinically evaluated, lead to my diagnosis and treatment. Since surgery, my hormone levels have returned to normal and my overall health is excellent.
I tell the story often of how I took a slightly awkward but well-meaning phone call from you the morning after introducing a benefit performance for the non-profit organization that I run in Portsmouth, NH. The call, though momentarily terrifying, was like an epiphany to me. You, alone, among my many medical providers, family members and, of course, myself, were able to give a name to the thing that had hold of me, but which I had never found the words to describe.
To say that you may have saved my life is, in this case, nothing more or less than a fact. It was my good fortune that your medical expertise is not something you leave at the clinic but carry around like an offering as you walk through life. My family and I will be forever grateful.
With deep gratitude,
Terry Bennett is a primary care physician. He lives in Portsmouth, New Hampshire. Diagnosed with stage IV cancer in 2010 he remains alive today.