Today we are the ladies who lunch.  I went to make rounds this morning before I picked her up, but I felt like a lady of leisure.  My charge is a delightful  61/2 year old little girl, who lost her mother to colon cancer three years ago.

This little girl is growing up without a mother.  One day, she told her father and me that she planned to "marry two people,"  a boy and a girl, so that "the girl could be [her] children's grandma." 

M struggled through the first half of the first grade.  She was distracted, unprepared.  Her father did not expect the sudden appearance of homework in their finely tuned schedule.  His work keeps him out of the house until 7 pm most days, and she is barely awake past 8:30.  Early on, M's teacher suggested that she would need to repeat the first grade.  Her father refused let that happen.  They both worked very hard to find solutions.  Over the course of the year, her work improved steadily to the point where she achieved a final report card that would make any parent proud.

As a special treat, I invite M and a friend (who could not make it today) for a girls' day.  Manicures and pedicures with lots of fussing over my small friend.  Until now, M had not experienced the nail salon world.  She re-named the pumice stone "the tickle brush."  She asked if the nail polish would come off when she took a bath.  Pink on her toes with stars and glitter.  Purple on her fingers with a yellow flower painted on one nail from each hand. 

After our pampering appointment, we dined al fresco  on pizza (she ate the cheese off of hers and left the crust).  Dessert for her was pineapple sorbet in a pineapple shell, which fascinated her.  She had not seen anything like it!  During lunch, she slipped off her sandals several times in order to admire her shiny toes.

Our next stop was the movie theater.  We watched the remake of Willy Wonka, which was a bit dark for my young friend.  I was unsure if this was an adaptation of Dahl's original work or an unofficial Michael Jackson documentary.  At least M enjoyed her box of jelly beans. 

I could have stayed out all day with her.  I saw that she enjoyed herself.  But it was my own happiness that I did not want to end.   I have no children of my own.  But if seeing them succeed and be happy is anything like this, I can't wait.

There were an awful lot of fava beans. Each of the three of us had picked two pounds, at least.  We shelled them on the deck, outside, by the dunes.  A perfect Amagansett morning.

We worked quickly, each of us with his own style.  I used my knife to slice along the seams of the pods, opening them like little green books with velvety insides .  One half of the couple I was with used thumbs to break them open, scattering beans on the table.  The other half cut across the pods, delivering beans as if popping them out of a toaster.  It was clear there was a little competition going on.  I think everybody won in the end, since we had a huge bowl of scrumptious beans when we were done.

They are one of those couples who people turn to stare at.  A gorgeous brown-eyed brunette and a striking blue-eyed blonde, both in terrific shape.  An outstanding doctor and a talented advertising executive.  Church every Sunday.  Dinner parties at their beautifully appointed Brooklyn townhouse.  They are such good people.  Their families turn to them for advice and assistance in many matters.  And clearly so in love with each other.  They will often steal glances at each other when they think nobody is looking.

I think I've learned more about what makes a solid relationship from the two of them than I have from any other couple I've known.  Steve and Stephen are terrific role models for what makes a marriage work.  Trust.  Attraction.  Compromise.  Devotion to higher purpose.  They've got it and it emanates from them and from their relationship. 

They live in a neighborhood in Brooklyn which is mostly "straight."  Couples, families, singles.  Their home is the center of their neighborhood.   Not coincidentally, neighbors happen to drop by at about dinner time, since they know that the best meal in NYC is being cooked in that kitchen.   About one month ago, one set of their neighbors was blessed with a healthy baby girl.  Since her mom describes herself as 'not much of a cook,' her parents joke that when she asks "what's for dinner?" she'll be sent over to her uncles Steves'.

When we go out to Amagansett, the kitchen is again the center of attraction.  After prep work is done, we visit the beach or the pool and have a serious workout in anticipation of the meal to come.

However, our dinner guests are now mostly gay couples.  Our menu includes -- not surprisingly--  many fava-centered dishes.  But also a homemade pasta; a dish made with eggplant, mint and garlic, layered so thin the flavors are barely (but most certainly) there; and a jalapeno-infused ceviche to awaken sleepy taste buds.  It's the best meal in the Hamptons that night, we agree.

I am the fifth wheel.  Our host, an incredibly talented and caring man,  is the sixth.  What a stroke of luck it would be if we weren't both searching for the same thing;  A great guy, about my age. 

This morning, we worked for more than three hours to remove something which took less than two hours to put in a few months ago.

Not subtle, the things that we do at work.  Replacing a knee joint requires several large trays of equipment, power tools, measurements, xrays, special cement and a lot of good luck.  Most patients do quite well.  They go back to work.  They chase their grandchildren around again.  Some go skiing or play tennis.  Most patients are very happy after their recovery from surgery, which takes anywhere from three months to one year.

When difficulties occur, they are not subtle either.   Infections are one of the scarier things that can happen to a patient with a joint replacement.  Today we had to deal with such a patient. 

Our patient is a large woman. 

Wherever one is trained, there is a tongue-in-cheek term for each 200 pounds of a patient's weight. Where I trained in Southeastern Minnesota, they were called "Iowa units." 

Obese people are tough to operate on.  Obese people have more complications.  Unfortunately, obese people also need joint replacements younger than do non-obese people.  So they are in trouble from the start.  This particular patient is 5'8" tall and weighs about two Iowa Units.  Her belly covers her genitals completely.  We needed two people in order to insert the urine catheter.  One of those people was responsible only for holding her gut out of the way.

She is in her late 50's and had her knee replaced for the first time six years ago.  That implant became infected, since her weight bred many opportunities for bacteria to hide and to seed her blood, and subsequently the metal and plastic which made up her knee replacement.   When bacteria land on metal and plastic, it's party time for them.  Metal and plastic don't have immune systems.  They are breeding grounds;  free lunch. 

The only way to get rid of an infection in a joint replacement is to take everything out.   The patient is left without a moveable joint for a period of time (usually six weeks).  A combination of intravenous antibiotics (targeted to the bacteria grown in cultures of the area) and a "spacer" consisting of bone cement laced with more antibiotics are used to eradicate what is left of the infection.  Only when blood tests and other measures are normal can a new joint replacement be implanted.  And the second time is much harder than the first, since more bone has been lost and the knee is scarred and stiff.   The implants are bigger and have long stems up and down the bones, which require more cement to hold them in place. We had no choice but to go ahead.  We know she will have a hard time.  She may lose her leg in the end if the infection does not remit.

Take everything out.  When she came to the hospital, there was a hole in her knee larger than my fist.   We could see metal, along with the soupy sewer of infection inside.  I felt the need to take a shower after looking at it. 

One hour.  Tick tick tick.  Saw, chip, cut. Tricky to chip out the cement but save the bone.  Too much force and the bone shatters.  Too little and we get nowhere.  The thing would not budge.  Some swear words.

Two hours.  A tease.  Some cement chunks come loose.  Each time we try to free the metal pieces from the bone, they hold fast.

Forty-five minutes more.  During one yoga practice, we were taught to tackle something difficult by thinking of the opposite.  We wanted to pull this implant out.  We were hammering and sawing and pulling.  Why not push?  Just once?  Tap tap tap.

Then...  a wiggle!  A slide!  Exhausted, arms sore, we've freed it, and all the bacteria along for the ride. We irrigate the knee with several liters of sterile solution.  Then, carefully, close the wound and place a padded splint on the leg.

Six weeks from now, we will know if she will have another chance.  We will know if our chipping and our tugging will make a difference for this person.  This mother of two, grandmother of five.  This two Iowa Unit bacterial hostess.

Lessons?

Lesson #1:  Sometimes we will need to chip away for a long time before we know if we will gain anything from it.  We may, however,  learn a lot from the chipping. 

Lesson #2:  Answers will present themselves in strange ways.  Keep your eyes open.

His name was on our list. An uncommon name. I knew he had lived in New York at one point, ten years ago. We moved here from Philadelphia at about the same time in 1994. He came for grad school; I came to do HIV research and then to attend medical school.  I had not seen him for more than ten years. Yet, there he was, on our list.

I was not slated to assist with his surgery, so I waited in the recovery room to see if it was, indeed, my friend from long ago.  We recognized each other immediately, even though he was still in an anesthesia haze.  I've learned that men develop crushes on their female doctors under the influence of such things.  I have been trying , without success, to apply the anesthesia effect to my everyday life. 

My "other life,"  in Philadelphia, the one before medicine,  was one of insurance underwriting, beach volleyball and an enviable group of friends.   The Summer months transformed us into children who would break out of our workplaces, shoes and clothes flung aside to reveal our tanned bellies in bathing suits and our sand-worn feet.  Greedy for every minute of play, we bumped, set, spiked until the last hint of daylight was gone.    The local bar was our dinner place, where we held the postmortem on our just-finished matches.  The bartenders at this particular place were all in our volleyball crowd.  They would lean hungrily over the bar to learn the latest unofficial "standings." 

We had our own community:  An  insurance executive; a trust fund baby;  a nurse; a house painter; a film editor; a journalist; a saxophonist; two Ph.D. students; an actor; a graphic designer; bartenders; medical students.  Everyone was welcome.  We were black-white-brown-orange-yellow and hit a white ball with our hands and talked about hitting that ball, drank together, ate together, travelled together to tournaments.  Nothing mattered except for the game and the friendship borne from it.  Our differences were obscured by the kicking up of sand.

Too bad my old friend needed to have surgery today, since he won't play any volleyball or softball now for six months.  But I am so grateful to him for being on that list.  He gave me the gift of reminiscence.

Not a believer.  Star sign?  Who cares?  But this week has been under the influence of something.  Over the past seven days, I've lost 370 pounds!  Two of the men who have been in and out of my life for the past two years are now--finally--out.  Not only has all that weight come off (where is Kirstie Alley to pitch this plan?), but I've learned a few things.  Wanted to share them:

Lesson #1:  I can't make someone a better person just because I want them to be better for me.  Must have been something about medical training that makes me think I can fix anything.  How liberating to admit I can't.  Even better to admit that I won't.  During the Dvorak concert in Central Park last week, I realized the man sitting next to me had not changed his behavior in all the time I'd known him, despite our having dated, broken up, become friends, evolved into friends-laden-with-dating-innuendo, the death of his mother, the death of my mother, his losing his job, his introducing me to his family members....    No amount of hoping or action or patience on my part was going to make him a better match for me.  And this thunderbolt hit me just as there were some sprinklings of rain during the concert.  So, after we packed up and found a taxi, I told him that this would be the last time he saw me.   I felt lighter immediately.

Lesson #2:  Water seeks its own level.  As women, we are taught to blame ourselves for others' behavior towards us.  "This would not have happened to me if I were better in some way," we think/believe.  The worse we are treated, the more we blame ourselves.  Take man #2.  We had ten dates in two weeks.   Intense, physically and emotionally exciting.   Then, my  wonderful mother is admitted to the hospital for the last time of her two year battle with Pancreatic Cancer, and he neatly disappears.  I do receive some text messages from him, but essentially he is gone.  No time to brood over it, since there are more important things happening for me right then.  But I wondered:  what had I done?

Two months after my mother's death, he contacts me again and we "date" again.  He invites me to friends' parties.  He confides in me about certain health concerns he has.   After another month or so, and after the first time we are intimate, the disappearing act is replayed.  I don't understand it; am angry and confused.  But I leave it alone.... let him go.   Again, this is somehow my fault.  But just this week, I hear from him again, since a colleague of his has a medical problem and wants my advice.  He invites me to a sporting event with him this weekend.  Before we leave for the stadium, he announces to me (actually, he waggles the Sunday Times in my face and brags to me) that I was "let go" since he wants to date a woman who is famous for her narcissistic, grade-school diary meets "sex in the city" account of her life on the internet!  Despite my urge to roll up that paper and whack him in the face with it, and my opinions on this particular woman aside (they are irrelevant; she has never met me,) I understand so much better what drives him. If this sort of  woman is what he wants, then it makes so much sense that he does not want to date me.   There goes another 170 lbs. 

Lesson #3:  Furious activity is no substitute for understanding.  I am learning to conserve my energy.  There are things that matter so much more than wasting my time with inappropriate men.  Here are some of them:

•  Making a difference in the life of a child; (see Big brothers-big sisters , Boys and girls clubs of america)
• Reading a political essay and looking up each thing I do not understand;
• Holding the hand of a patient who is anxious about being put under anesthesia while she is put to sleep;
• Making sure to call people by name;
• Taking the time to write a thank-you note to someone who has had you to their home for a dinner or a party.

...To name a few.

Until the next time.