Bert’s reprieve

Burt called on Tuesday evening to say the biopsy of the tumor in his lung had gone well, that he was home and feeling okay. He had an appointment with his primary care doctor on Friday by which time he expected to have the results of the biopsy. I was to go with him  to help him remember what the doctor said. I told him Jerry and I would be there in the evening of the next day.

We set out Wednesday morning, taking the North Cascades Highway through the mountains. That road is closed in the winter because it is snowy and steep so it’s a marvelous drive through a changing landscape and climate. It begins in the placid Skagit River valley where the water flows evenly through fertile farm land. The climb into mountains is abrupt; the winding road rises steeply through fir forests and sudden overlooks of deep blue lakes and aqua-green glacial rivers and streams. The western side of the mountains is thickly forested. This year was so rainy that waterfalls are still crashing down the sides of the mountains,

As we drove east the mountains became more craggy, with sharp knife like peaks and sparser trees.

Cascade peaks

On the east side of the mountains are the two towns of Winthrop, a self invented “western theme” town, and Twisp which tries not to be like Winthrop. Then the two lane road winds through apple orchard country in lower hills, with the land becoming progressively drier. After we passed the Grand Coulee Dam there we were on an elevated plateau, at first mostly sage and scrub and finally gently undulating field after field of wheat, many still green. We could see where the widely scattered towns are by the huge silos silhouetted against the open sky.

Silo in Davenport

We stopped at a Mexican restaurant in Davenport and arrived at Bert’s place just before  dark. When we came into Bert’s small round hay-bale house his lanky figure was motionless in a chair with his long legs stretched out limply. I was shocked at how terrible he looked — thin and haggard. Later I realized that was partly because he didn’t have his teeth in. I asked how he felt and he replied, not too good.

Bert's house

The walls were covered with pictures Bert had painted, many landscapes and some views from an airplane. He said he had been feeling too ill to paint in the last week.

Bert's painting of the view from an airplane

The three of us talked for about an hour. Bert assumed that he had cancer, as apparently the pulmonologist who ordered the second biopsy did. He talked of dying. I told him he could come to Lummi and stay in our apartment, but he said firmly, “I’m going to die here. When I can’t take care of myself any longer I’ll take my own life.”

Then we spoke of the Washington laws on suicide, of the Hemlock Society, of ways of killing oneself. The conversation shifted to a discussion of his financial and real estate assets, bank accounts and various vehicles including some airplanes and old farm equipment. Jerry is his executor and the next day was to be spent touring banks and signing papers. There was no call from the doctor with the biopsy results.

Jerry and I spent the night in a little travel trailer of Bert’s. It was not a comfortable night. The trailer had the same disadvantage as our camper; in order to get up to pee in the night one of us had to climb over the other because the bed is against one wall.

Bert seemed somewhat better the next day and we spent most of the day driving through  wheat farming country around Davenport as Jerry and Bert did their banking.

Wheat field and sky

I enjoyed the drive and Bert told us a lot about wheat farming. He said with modern equipment one man can farm 10,000 acres, and in the future GPS automated equipment will make it possible for one man to operate 4 or 5 combines at the same time, so even fewer people will be needed to work the land. He said this country opened up for wheat growing because of genetically modified wheat that matures in 90 days. Before that the growing season was too short and the land was used for grazing cattle.

While Jerry and Bert were banking I looked for a few items in the Davenport Pharmacy. It turned out to have only a small stock of drug store merchandise; it had a large section of gift items (chicken theme prevailed), flags and patriotic bunting, candy and a soda fountain and greeting cards with Christian inspirational messages. There was a liquor store in the back.

Bert’s place is in a hilly area that has sudden rocky outcroppings, not wheat growing land. He raises a few cattle each year. His “bone yard” is filled with derelict vehicles, boats, farm equipment and airplane parts. I found some wild life to photograph.

A frog at Bert's door

A butterfly on Bert's weeds

After a nap and a walk Jerry and Bert and I had a glass of wine together and discussed Bert’s never-ending dispute with the Noxious Weed Board.  They sprayed weed killer on his land without his permission, and he is keeping a Davenport lawyer busy suing them. He wants Jerry to carry on the case after he dies.There was no word on the biopsy.

That night Jerry and I checked into a motel with a real bed. The Black Bear Motel carries out the western motif that seems popular in eastern Washington. There was lots of cowboy stuff and flags; the bird houses were shaped like guns. All the rooms had names. Ours was the “Prospectors” and had gold mining décor.

The Black Bear Motel

The next morning we were up early and, after walking the poodles, searched for breakfast. All we could find open was the Submarine Sandwich shop. We were surprised when we walked in to see 13 guys ranging in age from 50’s to 70’s, wearing work clothes and baseball caps, sitting together throwing dice for coffee. We chatted with some of them while we ate as they continued to throw dice. A couple of them were crop duster pilots and Jerry enjoyed himself talking about airplanes.

Then I went with Bert to see his doctor. The doctor was fairly young — 40’s or early 50’s — jolly and extremely obese. He asked his nurse to try to reach the pathologist who had processed the biopsy. We talked about Bert’s illness, and Bert complained about the number of tests he had had. He asked what the next step was. The doctor said probably  seeing an oncologist. I said there was an immediate problem of Bert’s feeling so ill. The doctor said: “Immediate problem! Wait a minute, Bert, I wanted you to stay in the hospital and you said you were going home.” They argued a bit about who said what and the nurse knocked saying the pathologist was on the phone.

After a few minutes the doctor came back looking puzzled. He said it was sort of good news — there was no cancer in the tumor. I expressed great relief. Bert just seemed stunned.

But what was it? And what was making Bert sick? The pathologist had suggested a fungal lung infection. He didn’t think it was tuberculosis.

We left the office knowing that there was nothing more to be done until next week. Then Bert will go back to the pulmonologist. Jerry and I had a coffee with Bert before we started for home. There was no more talk of dying. I promised to do some research on the internet about fungal lung infections. Bert remarked that the thing had started with a dry cough at his place in Arizona last January.

Here’s the email I sent Bert yesterday after I had studied up a bit.

Dear Bert, I have been doing some research on the web about fungal diseases of the lung. There seem to be 3 possibilities: coccidiomycosis, blastomycosis, and histoplasmosis. The most likely is coccidiomycosis because it is specifically found in places like Arizona and Mexico. The spores of this disease are found in the soil and dust and during dry periods are dormant but when it rains they become active and can infect people or animals that breath the spores. The disease starts with an unproductive cough and flu like symptoms. It can become chronic and can be confused with cancer in the lungs by medical people who are unfamiliar with it. It is not hard to diagnose if it is suspected. The treatment is with anitfungal drugs all of which have a lot of side effects and I don’t think they should use those drugs on you without putting you in the hospital. If you want to read about these things look up the 3 diseases listed above. I think the Wikipedia entries are very good. I hope you are feeling okay. I think we will try to call you later today (Saturday). Anne

Jerry talked to Bert later. He had read the email, printed it, wrote his own comments on it and drove into Davenport to deliver it to his doctor! This was not a result I expected and I hope it doesn’t start trouble. But Bert is always ready for a scrap. He told Jerry he is feeling pretty bad. I worry about him. The disease that he probably has is better than cancer, but it isn’t good. He is elderly and not in good health anyhow.

It seems to me that the pulmonologist should have considered the possibility of an infection, at least after the first biopsy was negative. Some non invasive tests might have avoided the second biopsy. He is supposed to be an expert on diseases of the lung, so even if coccidiomycosis is rare (I had no trouble finding it on the internet) he should know about it, and if he had taken a careful history and learned that Bert had been in Arizona for the winter he might have suspected it.

This story is not over yet.

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15 Responses to Bert’s reprieve

  1. Aaaargh. What a journey, emotional and medical, for you all. Hopefully Bert will now start to get the treatment he needs or can agree to. Loved his painting. And his house. And the pictures of your physical journey to get to him.

    Not fond of medicos. They often seem to jump to conclusions and resent having their pronouncements questioned. Good luck to you all.

  2. Marja-Leena says:

    Oh, good news but as you say, it’s not over. I agree with Elephant’s Child and only wish that the regular medical profession would be more open to working along with alternative health practitioners. That drugstore sounds horrible. Best of luck to you all.

  3. Annie says:

    Wow that’s quite something! Interesting diagnosis, Dr. Anne!

    The doctor sounded like he was so sure he had the right diagnosis that he was unable to consider anything else. Maybe if one is sure one knows what the problem is, one just doesn’t look any further. And certainly from your previous description it is rather surprising to find out that the tumor has little to do with Bert’s symptoms.

    I hope Bert is able to get to the bottom of all this and get treated properly. He sounds like an interesting guy.

  4. LindaSalem says:

    Valley Fever which is coccidiomycosis. It’s VERY common in Arizona and California as well although I haven’t heard as much about it lately as I used to. I think because people don’t usually live near agriculture in these states as they uses to. Plowing helps to release the spores into the air. When I was living on Arizona, it was believed that everyone had at least a minor dose of Valley Fever bit some people get very sick and theist never return to Arizona. On the 1970’s when my son had his tonsils put, I met a woman there with her husband. He’d had VF and he’s had a part of a lung removed. I too am surprised the doctor didn’t think of it. Also, it’s very like TB in symptoms and it’s not uncommon for people who have lived in AZ or CA to have false positive readings for TB.

    It’s wonderful Bert doesn’t have cancer but if he does have VF, I think it’s going to be a while before he’s feeling better. Hopefully they have better drugs for treating it than they did in the 1970’s. However, as you say, they can have wicked side effects.

    I always enjoy your writing. It reminds me of letters from home and your photography is incredibly beautiful. Thank you for sharing.

  5. Marie says:

    Bert is very lucky to have you.

  6. wisewebwoman says:

    Bert is extraordinarily lucky to have you and Jerry by his side. he sounds like a very interesting man indeed, though scrappy!!
    A friend of mind had a very similar experience Anne. They actually cut her wide open to peer into the lungs and discovered the fungal issue. They were convinced it was lung cancer as she is a heavy smoker.
    This all puts me in mind of a New Yorker article several years ago about the preconceived diagnoses of doctors who can’t be convinced it’s otherwise. Wish I could remember what it was called and could see if I could trace it.
    They are far from infallible.

  7. Ernestine says:

    When you share
    I always feel as though
    I am right there with you.
    Loved the pictures.
    So sorry he had to go through
    all of this….
    maybe it was not necessary
    you are all lucky to have
    one another.
    Continue to keep healing thoughts
    in my mind
    going your way….

  8. Deborah says:

    Anne, your posts are peopled with the most interesting characters and you write of them so well. I enjoyed being along with you on this trip and could even properly relate to some of the drive, having been through Winthrop (the Western one) last summer for the first time. It’s a beautiful part of the country amd was, for me, surprisingly different from that part of BC that borders Washington State and Idaho.

    You’re good friends to Bert – very kind of you to do all that you did, and also to intervene with his doctor, who sounds less than stellar. I wish Bert a full recovery and hope he feels like he has a new lease on life, rather than being disappointed that he has to carry on.

  9. I hate doctors. I hope it ends up being less serious than it seems to be right now.

  10. IslandCAT2u says:

    Anne, my mother had Valley Fever many years ago. She lived in Arizona. She ended up having most of one of her lungs removed. She lived for about 20 more years after that surgery. She was probably about my age when she had the surgery (60 something.) Anyhow, I hope that they can figure out Bert’s illness and help him to be more comfortable ASAP! And again, wonderful pictures! Thanks!

  11. Pauline says:

    I start reading your pieces and hate it when I have to “put the book down,” so to speak. Reading here is like reading a continued story.

    WWW touches on a good point – often when we have preconceived ideas, we are unable to change our minds. Doctors are prey to this, too apparently. Hope Bert finds some relief from his symptoms.

  12. Hattie says:

    I wouldn’t blame the doc too much in this situation. These fungal diseases are tricky to diagnose.
    You have such a good eye for the people and places of the Northwest. I’m always a little adrift here, not in my element. We’re headed east tomorrow along some of the territory you just covered. I can’t believe it’s still green out there this time of year. My neice says it “never” rains there this time of year, but it was raining yesterday.

  13. Darlene says:

    I had Valley Fever about 40 years ago. I was hospitalized with pneumonia and my first test to VF was negative, although I tested positive for diabetes. That turned out to be a false positive. After returning home I was so exhausted I could hardly get out of bed. Then I developed blister like bumps on my knees. At that point my doctor ordered a second VF test and it was positive this time. It is hard to diagnose even though you know what you are looking for.

    I am glad the the biopsy was negative. VF is the lesser of two evils.

  14. Natalie says:

    Anne, this is such an interesting report in so many ways. All my sympathy goes out to Bert, and to you and Jerry for being such caring and helpful friends. I do hope Bert will get the treatment he needs without much side-effect trouble. What an interesting character he is, and his painting is excellent! Could an exhibition of his work be organised somewhere, the proceed of sales to go towards getting the best medical treatment possible? From that one painting you’ve shown, I would think that a serious gallery in a major city would be interested in his work (and in his undoubtedly interesting life that gave rise to it).

  15. Freda says:

    It all sounds horrible and traumatic, but hopefully your research will end up with a clearer diagnosis being made.

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