A recent trip to La Push

We went for a drive to Forks in the pouring rain, all bundled up anticipating rain and cold. Turned out to be absolutely beautiful once we got a few miles west.Fun play on the beach with found objects.

How do I get through this maze to you??

Results finally

First thing I did this morning when I got to work was to check the biopsy results. No malignant cells seen. I am so very relieved.

more from the other side of the exam table

I had my thyroid biopsy today, technichally a fine needle aspiration (FNA). I have been anxious about this for the past week. Not so much for the actual procedure but more to have the results. Before the procedure, lidoaine is injected above the biopsy site to numb the tissue. Then to get the tissue they make multiple quick passes into the desired tissue with 3 different needles.

It was an interesting hour spent lying on the table. Most of the time spent waiting to see if they'd need to take more samples or if what they had was adequate and chatting with the ultrasound tech.

I was impressed with the bedside manner of the radiologist who did the biopsy. He had a good sense of humor and was very considerate. Radiologists don't deal with real patients much and so it was kind of novel to have one who was very personable.

This whole experience is just giving me more compassion for patients when they are in a vulnerable and scary situation, just trying to anticipate and validate their feelings as much as possible.

My neck is still hurting. It was a bit of long day. I had the biopsy at 9, then went to work at 11: 30 and was on call seeing patients until 6:30. I've only told one nurse at the clinic about my nodule and the ensuing workup. I don't like to make a big deal about things but it was nice to have her know today to get a little sympathy ...

Results back on Monday.

fearlessness

What would it be like to live completely free from fear?

I went to a yoga class for the first time in 8-9 months. I'm not sure why I haven't been going. Life just got in the way, I guess. As we were sitting in poses for awhile, the teacher was reading some from Light on Life by BKS Iyengar. Something in what she read triggered the above question.

Just asking the question brought some joy. What would it be like indeed. Not to be fearful of other's criticism, of doing things the wrong way, of my own anger, of being a bad person, of other's anger ...

What would it be like to awaken in the morning completely at one with myself, knowing from my heart that exactly who I am is okay. Knowing that the world is a good place, that what I choose to do and think is the right thing for me at that moment, irrespective of what anyone else might think. Of being comfortable in my own skin. Relaxing and slowing down the internal clock.

Sometimes I am taken aback at the fact that Mike and I are living in Port Angeles. How did this happen? I've been moving from one area of training to another over the last 11 years, always counting down until I'm done with one thing, being impatient to move onto the next phase. Well, the next phase is here. This is it. This is my life. Oh, there are little things that I count down. Such as how long until the answering service takes over for the evening when I'm on weekend call. But there are no long term countdowns like I've had over the last several years. It's an interesting change. I, and we, are settling into the community, making a life for ourselves here, together. I guess I am finally feeling a sense of calm that I haven't felt for awhile.

It is amazing that at certain points in the past, college for instance, I really thought I had life and myself figured out. Oh no. Theres is so much more to learn, so many changes. I guess in some ways it means that life isn't boring.

a new side of the exam table

The following is quite medical, bear with me.

On our next to last day in Ireland, I was standing in the bathroom drinking water, the bathroom being the only source of water in our hotel room. Not often one drinks standing next to a mirror with the capacity to watch oneself drink. I was doing just this as I noticed a lump in my neck rising and falling with each swallow. Hmm.

When I examine a patient's thyroid, I often will ask that they swallow in order to watch the gland rise out of the base of the neck. It is never an easy task to swallow without a swig of water, but I ask them to do this anyway.

So, I knew instantly that this lump I saw was a thyroid nodule. I went about to examine it with my fingers next (I can't put aside medical training for a minute): decent size, rubbery consistancy, freely mobile. I'd been feeling fine, no change in my usual state of affairs. Seemed like an incidental finding but disconcerting nonetheless since I'd never really had anything wrong besides occasional sports injuries and acute viral illnesses.

I had had a well woman exam a few weeks before we left for Ireland, establishing care with a physician in town, the wife of one of my partners. I called to make an appointment with her when we got back into town from our trip. Her first available, non-acute appointment was 3 weeks away. In the meantime I started to see an acupuncturist. Even though I am trained in allopathic (Western) medicine, I have a deep interest and respect for other modes of healing.

After 3 acupuncture visits, I finally had a visit with my doctor. I knew what should would order but needed her to order them. Even though I exam myself and self diagnose, I am still not my own physician.

The difference between the two offices - the acupuncture and family physician - was so stark. Such great ambience in the former, the sound of falling water, walls painted green, soft lighting, an hour appointment. And, in the latter, white walls, bright lighting, at most 10 minute appointment.

My thyroid function tests were normal, but the thyroid ultrasound showed a complex nodule with a solid and cystic component. A solid nodule is most likely indicative of multi-nodular goiter, which just means enlargement of the thyroid gland with several nodules that function as normal thyroid tissue, perhaps due to iodine deficiency or an autoimmune process. But a complex lesion has the potential of not being benign. Hence the fact that I have an appoinment for a ultrasound-guided biopsy this coming Friday.

Early on in my acupuncture treatments, someone mentioned that the Chinese medicine way of looking at thyroid nodules was blocked chi, or energy, in the neck. This lead me to start investigating chakras. The chakras are points of energy in the center of our bodies, leading from the base of the spine up to the crown of the head. The neck and thyroid are part of the 5th chakra, also called the throat chakra, among other names. This chakra deals with communication, listening and creativity. One of the books that I have mentions the following as descriptive of someone with a 5th chakra deficiency: fear of speaking, small, weak voice, difficulty putting feelings into words, introversion, shyness, tone deaf and poor rhythm. Although not perfect, this describes me pretty well. In addition, she describes people as looking like their neck is not connected to their body, throwing the neck out of alignment from the body. There are a few pictures of me during the wedding, when I am doing exactly this. I don't like seeing these pictures; I look so awkward. When I went to a month-long rotation in California at the end of medical school, we had to do a creative project to present to the group at the end of the month. I wrote a poem of sorts that I combined with movement/dance. My friend Ned read the first part as I moved, then I began to speak of finding my own voice. In addition, one of the lines of Mike and my vows promised that we would each speak our truth. It seems that I've been dealing with these issues for awhile. And if you want to look at it from an energetic perspective, these issues have manifested themselves as a thyroid nodule.

For the past several days, since getting over the initial shock of the ultrasound results, I am telling myself that I am healthy, happy and whole. I love myself. I speak my truth. I am not focusing on what I don't want to happen but filling my thoughts with positive intent instead.