Mythology Masquerading as Medicine. One P.A. at MD Anderson

 

I think the fact that there was a medical student in the room altered the outcome of my last appointment. The Physician's Assistant, who I had initially pegged as "more authoritative" than the nutty-nerdy Rad-Onc-Doc, was apparently very keen on being my authority figure before I met with my actual Doctor.

"So..are you eating a high-protein diet?" she asks in near sing-song, with that grating lilt which makes a question more than a question, "Six small meals a day?" 

The question

The presumption

The condescension

"Small meal" is a contradiction in terms.

I was having none of it.

"No...?" My faced twisted up.

"How much are you eating?"

"Three...?" If that. Like a normal person.

"Well, that's ok." I think she was deciding whether or not to get on my case. "But don't skip meals. What's your protein?"

This line of questioning--her reasoning that eating within my normal range was skimming acceptability standards, yet I was expected to have known that a diet overhaul was par-for-the-course of radiation treatment--was stalling out my neuro-processors. I couldn't recall what my sources of protein were.

"E-ggs...?" Yea, eggs. I like eggs.  Now I wish I told her I was vegan. Just for gigglesBut the brain was still on the fritz.

"Yeah, eggs are good. What else?" I felt like a sixth-grader getting a pop quiz. I couldn't remember what meat I regularly ate, because I don't regularly eat meat.

I grasped at straws. "Jello...?"

ERRR! WRONG ANSWER! I'm apparently not smarter than a sixth grader.

"Jello?!? Jello is nothing! You need protein!" I stared...that was the point of gelatin to me. It's rendered animal protein. That's why it goes straight to my hair and nails. That's why I eat it by the box-load. (Looked at the box. Says protein 0%, but that's beside the point. I know what feeds my body, dammit.)

I fought my brain to work for me while she failed to wait for an answer. "Yogurt doesn't count! Dairy protein doesn't count! Soy protein doesn't count! Meat, nuts, beans! Artificial protein doesn't count!"

"Huh?"

"Protein shakes."

"Okaaay..."

"Oh. And don't gain weight. With that Tamoxifen you'll be on, and because your tumor was estrogen positive, weight gain is an indicator, so you don't want to gain weight." Now she's talking about precautions that won't be a concern for another four weeks when presumably I'm seeing her weekly. She was not clear whether the gaining of weight is an indication of cancer reoccurrence or if it is a correlative indicator predicative of reoccurrence, although I think she meant the latter.

Translation: don't get fat, you'll get cancer.

To add a little dimension, you must know she speaks this as a string-bean of a woman in front of a female medical student who I can refer to as "cuddly". As a former wearer of the cuddliness, I was in an unusual spot of knowing an asshole in the moment of being an asshole when the asshole did not know I knew. It was a bit awkward and I wasn't sure what to do with my potential power to strike her down where she stood, so I instead decided to diffuse the situation.

"I don't see how that'll be an issue. I just can't wait until I can get back to running my half-marathons," with a half-enthusiastic arm swing for emphasis.

"Oh, you can do that now." Completely dismissive with a little hand wave, she didn't even look at me when she said it.

I felt the blood in my ears. "No." My words had bite to them now, "I can't."

"Oh.." getting her attention, finally. "I guess we're cutting into your workout time, huh?"

Speaking to the medical student, who is apparently under orders to remain completely silent. "I have a five year old. My training has to be planned."

"Well, get him on a bike! Say 'Follow Mommy!'" P.A. keeps trying to have all the answers, when she really should just shut up. Or apologize. I glared at her while I was trying to decide when or how I should correct her that I have a daughter and not a son. Never mind explaining how well our bike-riding lessons have turned out.

"Oh, um, I guess that's easier said than done, huh?"

I gave her one of those smiles reserved for when we don't have anything nice to say.

"So, um, about that irritation..."

I turned to Silent Student without letting P.A. finish,  "Yeah, I guess I'm just a little bit irritated."

I've got to hand it to her, Student keeps a good poker face. That was quite the zinger.

Back to the P.A., "...and impatient. I'm ready for this to be over."

"Uh, yeah, I guess it's easy for me to say 'Be patient'..."

"...cause you're not the patient." I was still enjoying my word play, but I hope the lesson got through to Silent Student. You are not the patient. You have no clue about my life outside of my chart. You don't live my life. I will continue to live my life because my life must continue to be lived. If I am lucky, you will not be a primary figure in my life. You sure as hell are not going to micromanage it.

 

 

So, let's review: I'm supposed to eat all-Paleo like a body builder, twice as often, on food I don't normally eat, and less accustomed to purchasing and/or portioning appropriately, while I have no exercise regimen to speak of -- but don't gain weight.

I'll get right on that, chief.

This diet is recommended because the radiation is damaging to the proteins of my body so I should consume protein to help repair it. Sounds logical. I had interpreted that part of the Radiation Therapy Information Packet as "enjoy that extra helping of pork chop or chicken." Or: "make a three-egg omelet or add two extra egg whites." Not: stock up on tuna and nuts and graze on animal flesh every two hours.

If I were to take P.A.'s advice seriously, then this is what she is saying:  Flesh begets flesh. That's the crux of the argument. Nuts and beans were secondary. I needed MEAT.

Now, I may have only had one class on Food and Nutrition for my college Biology requirement, but, last I checked, breast tissue, proportionally the largest section of tissue affected by the radiation, is FAT. Yes, protein is involved. but it's FAT.

And why exactly does dairy or soy protein not count? Can anyone guess how that t-bone steak comes into existence?

Calves become hulking piles of meat by eating grass. GRASS! Children GROW through most of their formative years, not by gnawing on pork loin or can after can of tuna, but mostly by consuming milk.

And chicken nuggets of course--which are mostly soy.

So what--biologically, cellularly, molecularly, in the protein-building sense--is the difference between bovine and human?

 

 

Flesh begets flesh?

If she brings it up again, I'll say I've gone vegan. Just to watch what happens.

 

Views: 115

Comment by Arthur James on October 19, 2013 at 1:44am

`

Enjoy with medical staff . . .

Bun Bo Hao - Stir Fried

or Grilled Lemmon Grass

On Steamed Rice with a

Ca Phe Sua Da - iced

coffee aulait - or

a ` Seasonal

Pumpkin

Siced

Ale

`

Never

Ever

Quit

Comment by JMac1949 Today on October 19, 2013 at 6:03am

Since you're in Texas you can sooth all concerns and deflect further questions with a white lie, just tell em you're eating BBQ... I hate hospitals and stupid questions... from stupid people who are reading a checklist!!  Still hoping you manage to come through all this free of cancer. Hang in there gurl! R&L

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