Update from Dr Jenkins

In the last year, I’ve seen nighttime overhead highway signs cautioning drivers not to stop due to high crime risk, and overhead highway signs cautioning drivers to be aware of moose. And I don’t feel like I’ve done much travel either. I did, however, take my first trip to South Africa. I lost a friend, attended a wedding, helped a friend celebrate his first birthday, and gained a cat. I built cat shelters and traps at Toronto Street Cat, attended a series of Graphic Medicine reading workshops, and went to the first Canadian Writers’ Summit and Taste of Little Italy with my long-time friend and fellow writer, Kathy Mac.  I went to Shaw Fest where the 2015 highlight was Peter and the Starcatcher, and this year’s highlight was Engaged. I went to Stratford for the first time in years, where I saw an amazing production of Shakespeare in Love. I attended a lot of concerts, with tickets both bought and shared by friends. I caught up on a lot of quality TV and some movies I’ve missed on DVDs from the Toronto Public Library. I enjoyed some non-academic reading for a change.

I taught a lot (and I mean a lot) of students, did a lot of grading, and had the joy of watching a few of my students gain awards or entry into grad school. I presented papers at conferences in Kingston (Queens) and North Bay (Nippising). I submitted a few things to peer-reviewed journals. I defend my PhD dissertation and convocated, so now it’s official and school truly is out.

This last year I breathed out, I walked, I observed, I took photos, I pondered, I cottaged. This fall, I’ve signed up for a wine course and an Italian course, because I finally can. I’m back to working out and I’m decluttering my apartment. I’m writing inventive academic work and applying to conferences in more exotic locales. And I’ve got six non-academic book projects to pick up again, now that I actually have the time and energy and focus. Stay tuned…

Meditation from a Hammock

This is my favourite place in the whole world. When I feel stressed, this is where I picture myself to relax and calm: lying in the hammock, gently rocking. It’s slung between two oaks, trees that I remember my older siblings jumping over, so these trees must be about my age. And as I lie resting, relaxing, I feel myself suspended between twin sisters, gently rocking me. I look up through their entwined branches, and realize that these trees’ roots must be similarly entwined, extending into the earth to similar depths though soil and past stone, that their branches extend into the air. And here am I, nestled in the hollow, between their branches and roots, caught in the air between. This is a safe place, a quiet and nurturing place. A place where I can relax, rest, read, a gentle smile on my lips. Where the day is timeless.

View from my Hammock

View from my Hammock

From here I can watch Loons and King Fishers, territorial Blue Herons quibbling over shoreline, and an Osprey with a clearly silhouetted fish caught in his talons. Nuthatches explore the ample branches and trunks seeking bugs; finding none, they move on.

Bluebottle casts a long shadow

Bluebottle casts a long shadow

Bluebottles sometimes alight on the canvas, soaking up the sun and casting long shadows. These trees are part of the Red Squirrel highway between the lakeshore trees and the trees in the woods. Sometimes, a Red Squirrel stops, puzzled by my presence, and stays a while looking down at me trying to figure me out.

When I was a kid, we didn’t have a hammock, so I’d go over the hill to my uncle’s cottage and lie in his. It had a yellow floral pattern with a fringe on the edge, and was strung between two trees near the lake. At some point in early adulthood, it occurred to me that I could have a hammock of my own. I purchased one for $8 at a local surplus store. It was a string affair, barely big enough for me, and required ample rope to suspend it between trees. Nothing fancy, but it worked.

A few years ago, a friend donated her canvas hammock to the cottage after an essential tree in her Toronto backyard collapsed quite spectacularly. This is the hammock I’m lying in now; it’s much nicer and bigger and firmer than my previous hammock. The yellow twine I used to tie up the old hammock has given way to tree-friendly webbed ties that offer support without damage. The new hammock is big enough to hold a whole day’s worth of reading, and has spurred me to master the fine art of sipping wine while suspended.

Reading and relaxing

Reading and relaxing

Catherine Jenkins 2015 all rights reserved

Travel, Ethnocentrism, and Civility

When we travel, inevitably we bring our domestic notions of correctness with us. We all have our prejudices; whether we care to admit them or not is another question. My most profound moment of ethnocentrism occurred when I was standing naked in a B&B bathroom in rural England, trying to figure out how to coax hot water from yet still another unique shower system. I caught myself thinking, “Why can’t the Brits do this right? At home, or anywhere in North America, I can simply turn on a tap and, hey presto, hot water! What’s wrong with these people?” Most British bathrooms use on-demand hot water systems, which are considered a more frugal use of resources; however, no two systems operate quite the same way. And most British homes are not well enough heated to want to stand around naked figuring it out. The moment passed quickly, and I found myself smiling at its triviality.

When one travels, if one is open, one also sees and experiences things that are unfamiliar, but actually much more civilized than one is used to at home. The hotel signs in Bergen, for instance, were much more entertaining than those I’ve encountered anywhere else.

Hotel room signage, Bergen, Norway, 2015

Hotel room signage, Bergen, Norway, 2015

Ladies Room sign, Bergen, Norway, 2015

Ladies Room sign, Bergen, Norway, 2015

Men's Room sign, Bergen, Norway, 2015

Men’s Room sign, Bergen, Norway, 2015

Similarly, many Bergen public washrooms signs exhibit a humour one does not usually associate with public washrooms. The Norwegian sense of humour is apparent in such gentle touches.

 

 

Traffic in Lisbon was truly scary. Both vehicles and pedestrians view traffic lights as vague suggestions for maintaining order. In the main tourist area, traffic lights were often out, and people unfamiliar with the city skittered across many lanes at speed, trying to avoid injury. Lisbon, however, also featured the most civilized public washroom I have ever encountered. Not only was it immaculately clean, but as well as the requisite toilet, it also featured a bidet. A bidet in a public washroom.

Most civilized public washroom ever, Calouste Gulbenkian, Lisbon, Portugal, 2015

Most civilized public washroom ever, Calouste Gulbenkian, Lisbon, Portugal, 2015

In other places, sanctioned attempts at formality may be tempered by members of the public. This is notable in graffiti, which I often photograph when travelling. One of the most striking examples I’ve seen was this bust in a Paris park which had been augmented, perhaps as a political statement.

Formality Disrupted, Paris, France 2012

Formality Disrupted, Paris, France 2012

Venice is, without doubt, one of the loveliest cities I’ve travelled. A city with a rich pharmacological history, it still features many drugstores, both modern and vintage. In case you can’t find one open, 24-hour vending machines can fulfill your needs. These appear, inset into ancient walls, throughout the island. The contents include feminine hygiene products, but are generally heavy on condoms.

Twenty-four hour pharmacy, Venice, Italy, 2010

Twenty-four hour pharmacy, Venice, Italy, 2010

Travel seeds new ideas by challenging one’s “normal” comfort levels and reference points. And that’s a good thing. On return, new, perhaps unique, possibilities open for consideration.

 

Catherine Jenkins 2015 all rights reserved

Whirlwind Tour of Lisbon and Sintra, Portugal

I left Toronto with a full yellow-orange moon rising on the horizon. Descending into London  at daybreak, I saw either a sun-dog or a moon-dog, but couldn’t tell which. Time travel, i.e., travel between time zones, creates that kind of confusion. The Thames wound into the distance of an intense peach skyline, as an armada of lights escaped Heathrow one after another. After a brief stopover at the airport, I was on to Lisbon.

My introduction to Lisbon was the man on the subway playing accordion with a Chihuahua perched on his shoulder, a little basket made of a pop bottle bottom and string dangling from the dog’s tiny mouth eager for donations. Lisbon is rich in history, but its present is pretty threadbare.

Tiled building with fire hydrant

Tiled building with fire hydrant

The conference papers were strong and in tune with my work, but sitting outside drinking Linden tea under a green canopy in the scent of White Jasmine and blinding sunshine (after the rough winter we’ve had), that was glorious! I stuck with the conference, but took advantage of Saturday afternoon-evening and Sunday to explore.

My hotel was near the conference site, outside the downtown core, on a street not shown on any map. Lisbon defies mapping, and even the locals seem confused by its layout. It’s a medieval city, and apart from the Baixa, a district that was razed and rebuilt, it has maintained its labyrinthine illogic of narrow laneways. Adding to this is its hilly terrain, and a tendency to build upwards rather than outwards. I like to explore on foot, but Lisbon is not optimal.

I set out in search of the Castelo de São Jorge, but never succeeded in entering its grounds. How can you lose a castle? Especially one that size, perched high on a rock, right downtown? You’d be amazed. I caught a few glimpses, but by the time I found the entrance, it was closed for the day. Undeterred, I continued my exploration.

Castelo de São Jorge, Lisbon

Castelo de São Jorge, Lisbon

I found my way to the Tagus riverfront at the edge of the Alfama district, and then continued into the Baixa, the tourist quarter. Most cities keep their active seaports away from tourists, but not so in Lisbon; here, they overlap. In the Praça do Comércio, an enormous open square and former site of the royal palace, signs abound warning tourists to beware of pickpockets. In the square’s centre, a statue of King José I rides, and an enormous arcade and triumphal arch open into the city’s streets. This area, rebuilt in 1755 after the earthquake levelled much of the city, is on a grid pattern, making it much easier to navigate.

Igreja do Carmo, Lisbon

Igreja do Carmo, Lisbon

The Elevador de Santa Justa is located between the Baixa and Chiado districts. It was built by Raoul Mesnier du Ponsard, a student of Alexandre Gustave Eiffel, and opened in 1901. The elevator’s wood and brass interior speaks of its provenance. From the Elevador’s high viewing platform, I was finally able to see the castle; the Igreja do Carmo, a ruined church that reminds Lisbon of its tragic past; and much of Rossio and the Baxia.

Brasileira, Lisbon (exterior)

Brasileira, Lisbon (exterior)

Continuing into the Chiado quarter, I ate a light supper at the Brasileira, an Art Deco café once favoured by artists and intellectuals. After the main course, I had my first pastéis, a small custard tart made with phyllo-like pastry, its top burnt like crème brûlée. It was good, but the one I had later in Belém was better.

Brasileira, Lisbon (interior)

Brasileira, Lisbon (interior)

A life-sized bronze statue of Portuguese poet Fernando Pessoa sits at a table outside, still haunting the café where he once wrote while enjoying a smoke, bica (Portuguese coffee) and absinthe.

I took a cab back to the hotel—the best way to get around Lisbon. The cab’s radio played Canadian Bryan Adams’ “(Everything I Do) I Do It for You, making me feel like it is a very small world indeed.

Sunday marked my excursion to Sintra, a brief train ride beyond Lisbon. Similarly to Toronto, in Lisbon the subway doesn’t open until 9 a.m. on Sunday, but I was still able to catch the 9:40 train to Sintra. Lisbon sprawls, with miles and miles of apartment blocks in varying shades of white with varying shades of red tiled roofs, occasionally broken up by fields, cows, and quarries. There’s no sense of leaving the city and entering the countryside.

Once in Sintra, I had to choose which of the many castles to explore. I caught the bus up to the elaborate Palácio da Pena, its style and colours reminding me of Portmeirion, Wales. The site originated as a fifteenth-century monastery, then was rebuilt in the nineteenth century as a royal palace, and has been a museum since 1910.

Palácio da Pena, Sintra

Palácio da Pena, Sintra

I revelled in the fantasy of the place, and spent a very long time wandering its many rooms. From the parapet, I could see the ramparts of the Castelo dos Mouros, the eighth-century Moorish Castle down the slope. On the descent back into Sintra, the bold chimneys of the Palácio Nacional de Sintra are hard to miss. On the train back to Lisbon, I kept catching glimpses of the Roman aqueduct spanning the landscape.

I ended the day with a tram ride out to Belém to watch the sunset behind the Torre. This is the site from which countless ships ventured during Portugal’s historic past. Exiting the tram, I saw what I thought was the royal palace, but turned out to be the extraordinary sixteenth-century Santa Maria de Belém, a monastery. Aiming towards the tower, I strode past the Centro Cultural de Belém, a recently constructed monumental box of a building. Nearby is the Monument to the Discoveries, an oversized statue built in 1960 depicting the lineage of Portuguese explorers. While not to my taste, it’s clear that much has been invested to attract cultural and tourist dollars to Belém.

I made it to the Torre de Belém at precisely sunset. Built just offshore in the Tagus River in the sixteenth century, the tower marked the starting point for numerous expeditions out from Portugal. Because of its maritime importance, the Tower was declared a UNESCO World Heritage Site in 1983. No one had mentioned the wide amphitheatre-like steps facing the Tower on shore. I watched the tide change like a symphony, the Tower itself beautiful in its wading stance, resting ankle deep like a moored chess piece.

I trudged back into central Belém and had an amazingly good veggie burger on a patio, while watching the line-up at the famous Pastéis de Belém slowly dwindle. I’d been keeping an eye on the mob since my arrival. About half an hour before closing, the line-up was finally manageable. I only waited a few minutes before being handed a Pastéis de Belém, larger, firmer, fresher and warmer than the one I’d had at the Brasileira. It was the right taste to take me back into Lisbon to pack for too-early a flight home the next morning.

Catherine Jenkins 2015 all rights reserved

Biopsy: Rhetoric and Intimate Pain

Who ever thought up the word “mammogram”? Every time I hear it, I think I’m supposed to put my breast in an envelope and send it to someone. Jan King

The anomaly in my left breast was located and first imaged in 2008, with a mammogram and then an ultrasound. It was determined to be a benign adenopathy; in other words, nothing to worry about. This finding was confirmed in 2010 with a second mammogram.

This year, I made the mistake of changing imaging clinics, which means changing radiologists. The new clinic is housed in a hospital, so they’re used to seeing the worst, trained to look for the worst. After the mammogram, the technician said, “Oh, there’s something in your left breast. Nothing to worry about, but don’t be surprised if they call you back for an ultrasound.” I respond that I’m already aware of the anomaly in my left breast. I’m not worried.

The call came the next week. I booked the ultrasound. More imaging. More radiological inspection.

The follow-up call came the following week. “We’d like to do a biopsy.” Umm…wait a minute. The anomaly had already been examined and dismissed twice. I respond, “If I can get the images from the other clinic, can we nix the biopsy?” “Oh, that’d be great! Probably, yes.”

The day before I leave for Norway, in the midst of conference prep, travel prep, cat-sitting prep, absent-from-class prep, I’m flying through the city trying to relocate the other clinic, get copies of previous images, and drop them off at the hospital. I tell them I’ll be unavailable, out of the country, for the next several days. They nod and smile understanding.

I return home to a phone message. “We’d still like to do a biopsy.” Okay, now I’m getting a bit anxious. I’m still 96% certain that there’s nothing to worry about, but the medicos, those authorities on my health, are concerned enough to make this request, so it’s only natural that I begin to feel a little less certain that everything’s okay.

I’m really not looking forward to this. There are no opportunities to ask questions until I’m lying supine, half-naked, vulnerable on the examination table. Ultrasound guides the procedure. While the tech is relocating the anomaly, I ask the two questions I’ve been formulating. “What are the chances that this is nothing to worry about?” “Oh, well, the radiologist reported it as ‘undefined,’ so it’s nothing that we look at and say, oh, that’s a cancer.” Okay, so that’s good news. “How big is this thing we’re talking about? The size of a pea? A marble?” “Oh, not even the size of a pea. The size of a really small pea.”

So, umm, what are we doing here?

Somewhere in here it’s explained that the “mass” is close to the chest wall, so they’ll have to be careful not to catch a nerve or the muscle.

The doctor doing the biopsy arrives. Somewhere in here it’s revealed that they’re not doing a needle biopsy, but a core biopsy. And not a single core biopsy, but three samples—from something less than the size of a pea. This ensures an adequate diagnostic sample. Maybe it’s just my interpretation, but I get the feeling that both the tech and the doc are also wondering why we’re doing this.

The doctor explains that she will sterilize and freeze the area, then make a tiny incision through which to insert the core biopsy gun. “This is what it sounds like,” she says, pulling the trigger. I jump. She says, “It sounds like an automatic stapler. I’ll tell you before I take a sample.”

Core Biopsy Gun

Core Biopsy Gun

She proceeds with her plan slowly, gently, carefully. This is the best one can hope for. When everything is correctly positioned, she says, “Okay, 1, 2, 3” and fires. The mechanism reverberates through my ribcage like a nail gun. I jump and tense automatically. Eyes wince shut, waiting for the recoil. My reaction surprises her and she waits for me to relax slightly before removing the gun that cradles a small piece of my flesh. I think that this is what a tree feels when a dendrologist removes a core sample, except my flesh has nerves and blood.

Satisfied with the first sample, she returns for the next, carefully reinserting the gun’s muzzle into the three-millimetre incision. I feel the tool move and tug inside my breast, against the freezing. Once everything’s lined up, she says, “Okay, 1, 2, 3” and fires again. A nail gun goes off inside my chest. Instant stabbing pain in my left pectoral muscle  writhing on the table  mouth open in surprise  and shock  and nausea  and eyes squeezed shut  and it’s not stopping  it’s not stopping  it’s not stopping  it’s not

Carefully, she removes her precious sample. I say, “I have to put my arm down.” Not waiting for permission, I follow this announcement with this action. “Okay, just don’t touch anything.” I’m still writhing  pain  not stopping  not stopping  not

She’s checking, checking with the ultrasound wand. I’m imagining leaving. Getting up and walking out. Then I’m imagining returning if the sample is inadequate. Better stick with it. But it hurts  it hurts

“I’d be really glad about now if you could tell me that you don’t need the third sample,” I say. “That’s what I’m checking for,” she says. With the tech’s help, they take one last picture as evidence that they have a through-and-through of the “mass,” like a lucky bullet wound. She says, “We’ve got everything we need. You can go now,” or words to that effect. My memory is hazed by pain. I apologize. Apologize for not being a compliant patient. For being betrayed by my sensitive body. She turns from the door, says, “I should be apologizing to you,” and leaves.

It is only then that the tech gives me the after-care instruction sheet, and I realize the extent to which I have been intentionally injured. Apply ice to reduce swelling. Take Tylenol (not Advil or Aspirin which might induce further bleeding). Keep site clean and dry for at least 24 hours. Keep dressing in place for at least three days. Be on guard for signs of infection. Expect bruising for up to three weeks. Avoid heavy lifting for at least 24 hours. This is the number for emergency follow-up. Ensure that you have an appointment for regular follow-up in 10 days.

I leave in a mild state of shock. My left pec is screaming. For days, my left arm and hand are weak, with reduced sensation and movement. Bruising is still apparent on my breast during the follow-up appointment.

The follow-up doctor is someone I’ve never met. To her credit, she begins with, “You’re fine. Everything’s okay.” She later acknowledges, “You weren’t worried, were you, but we made you anxious, didn’t we?” That’s right. I say, “I wonder if I had to go through this simply to indulge a radiologist’s curiosity.” She responds, “Probably, yeah.” The ultimate determination? It’s a benign adenopathy.

Now, don’t get me wrong. I understand that statistically there are some advantages to mammograms and early cancer detection. But that’s not what this was about. Some people have since suggested to me that this was to improve biopsy numbers, which in turn ensure continued funding. While I can’t attest to that, I do know that this wasn’t optimal patient care.

 

© Catherine Jenkins 2015 all rights reserved