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Dartmouth Medical School Dartmouth-Hitchcock Medical Center

Grand Rounds

Taking inventory

By O. Ross McIntyre, M.D.

Snake Rapid on Quebec's Dumoine River is a nice stretch of moderately difficult water that goes right, then left, and then right again. By the time my late wife, Jean, and I ran it for the first time in 1986, we had done enough paddling to know that we would be able to make it down the rapid, but not enough to read water well or to have really perfected our technique. We hit a rock, leaned the wrong way, failed in our brace, and then swamped on the downstream side.

The canoe rolled over as we plunged under the foam, our loose-fitting life jackets riding up under our chins. Surfacing, we located each other and the canoe. As we bumped along over boulders, taking repeated hits to our butts and legs, we did a few things right (such as getting to the upstream side of the canoe and holding onto our paddles) and some other things wrong (such as holding onto the canoe rather than onto the ropes tied to each end of the craft).

The canoe, still upside down and buoyed by the gear tied inside it, suddenly got hung up on a ledge, while Jean and I were jerked free by the current. A hundred feet downstream, we dropped into a large pool at the end of the rapid. I looked upstream as our canoe slid off the ledge and floated down toward us. Soon the canoe was in our control, and several friends arrived to help us ashore.

The Grand Rounds essay offers insight or opinion from a member of the Dartmouth medical faculty. McIntyre, a member of the Dartmouth College Class of '53 and the Dartmouth Medical School Class of '55, served on the DMS faculty from 1964 until his retirement in 1998. An oncologist, he was the director of Dartmouth's Norris Cotton Cancer Center for 17 years, as well as the chair of the prestigious national Cancer and Leukemia Group B research consortium; in addition, he is a 20-year cancer survivor. Also an avid canoeist since boyhood, McIntyre and his wife of 48 years, the late Jean Geary McIntyre, spent as much time as they could paddling and camping for weeks at a time. This essay is adapted from a recent book he wrote—Paddle Beads, published by Gray Books—and is reprinted here with permission from the author and the publisher.

Crack: Water gushed from the canoe, our packs, and a previously undetected hairline crack in our plastic camera bag. Photography was canceled for the rest of the trip.

We started off again, running the next rapids easily, and the next ones after that. When we finally reached a portage at a waterfall, I found out just how heavy our water-soaked packs were. My bruised thigh cramped as I limped over the easy trail. But the rapids below the falls offered an easy run, and as the evening light poured between ominous rain clouds, it illuminated a shining path of safe water leading to the lake below. I wouldn't have missed that sight for a compound fracture.

We camped that night on top of an esker, a narrow, rocky ridge left behind by a subglacial river of some long-ago ice age. Perched about 25 feet above the water, we crammed our tent stakes into the cracks between the esker's plum-sized pebbles. It was raining before we finished putting up our tents.

The gussets in our pack liner had blown out, and most of the things in the pack were wet. Inside our dripping tent, we mopped off the sleeping pads with a dry piece of clothing, spread out our one dry sleeping bag as a quilt, and got under it. The heavy rain continued through the night.

By morning, the rain had stopped, and we set off again down the river. The mist was heavy on the water at first, but by the time we stopped on a sandbar for lunch, we were in the full heat of the sun. Within minutes, we had emptied our packs and spread out our wet belongings. Soon the sandbar was covered with steaming raingear, tents, clothing, and sleeping bags. We plunged into the river for a welcome swim and cleanup.

Strewn: As I climbed out of the river refreshed, I looked over our gear strewn across the pebbles and baking dry in the sun: bandanas, socks, a ball of twine, boots, a paperback book, shirts, maps.

Everything there was an old friend, a familiar sight. But how much of it had we really used? Though we had carried the gear for miles, paddling it down the river and hauling it over rough portages, we did not need most of it. In fact, with only a few essentials we could still have canoed to the end of the river in comfort and safety, leaving our excess baggage on the sandbar to surprise the next canoeists coming around the bend.

That view remained with me over the years, returning each time I spoke with patients or the public about how a diagnosis of cancer affects a person. This inventory, deciding what is essential and what is not, is something that a cancer patient does early in the illness. Whether cured or not, the patient looks at his or her life and its accompanying baggage and decides what is important.

This inventory, deciding what is essential and what is not, is something that a cancer patient does early in the illness.

For most, life itself is the first thing to be seized. Otherwise, the rest of the trip is canceled. In fact, as long as there is life, everything else can be left on the sandbar. Next in importance are family and friends, who offer a gentle haven of sometimes tearful embraces, awkward words, and shuffling feet.

Journey: So some of us who have been given a cancer diagnosis set out again on our journey, our belongings now secure and dry, but our souls a bit different as a result of having taken inventory. And the country passing by looks different, too: the hills friendlier, the water gentler, the daybreak more precious.

Our dunking was accidental but came out well—resulting in only a bruise or two. But it left us thinking of those whose inventory is reduced to a life clutched in desperation with all else discarded, those who have abandoned their possessions on a sandbar, leaving them to be found by the next party when it canoes around the bend.

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