Archive for October, 2019

An Icon Tried to Avoid Being an Icon

October 13, 2019

The thyroid, that excellent gland

Got removed via scalpel in hand

The rumor was tumor

The answer was cancer

A cure, we think, would be grand.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia.  I am currently taking some time off.   Any identifiable patient information, including that of my wife, has been used with permission.

Three weeks after her thyroid surgery, Bethany is recovering well and doing OK with an adjusted thyroid replacement dose.

In this country, anything removed from a patient gets sent to a pathologist.  Bethany’s thyroid had definitively turned against her.  The cancer was fully contained on the left but had come to edges (perhaps further) on the right.

Aside from minor fluid accumulation at the site of the surgery requiring drainage 3 times, her recovery has gone according to plan.

Sioux City has been through a sequence of endocrinologists, subspecialists caring for people with hormonal problems.  Sometime during one of my absences a very good one moved away.

Friday morning we set out for Sioux Falls.  While the dark and the chill reminded us of our fishing trips from Soldotna to Homer (Alaska) last spring, the experience had a decidedly different mood.  Wind whipped the car, we drove on divided highway with traffic, and we didn’t play at counting roadside moose.  In Alaska, we stayed close to the 60 MPH speed limit, but South Dakota lets Interstate traffic go 80; with a 35 MPH headwind we had noise we hadn’t dealt with last spring.

We’ve known the endocrinologist, Dr. Oppenheimer, socially, for decades.  He has an independent practice close to an I-229 exit.

The visit proceeded as expected: history, physical, then education.

Bethany will go off her levothyroxine, a generic T4, and onto Cytomel, a brand name T3.  (There are two active thyroid hormones.  T4 has 4 iodines and lasts for weeks; T3 has 3 iodines, is 6 times more potent, and lasts for hours.)  After a month, she’ll be off thyroid supplements completely for two weeks.  When her tsh (thyroid stimulating hormone) rise reflects an adequate loss of thyroid hormone, she’ll get radioactive iodine, I-131.  And then she’ll need to be isolated for several days.

Dr. Oppenheimer showed us around his clinic.  He has a room dedicated to ultrasound, and another for telemedicine.  He has a good deal of artwork in which he takes justifiable pride.

But I stopped and my jaw dropped at a framed letter.

The letter, addressed to Dr. Oppenheimer’s father (also an endocrinologist), dated 1947, entirely in German, bore the signature of Albert Einstein.  The iconic physicist declined to give the elder Dr. Oppenheimer an interview because he did not want to become an icon.