Up until this time, I had enjoyed a cordial relationship with the surgical oncologist, but I began to be dissatisfied when his June 21st Office Visit Note included some statements I found to be, at best, misleading; namely

• "He did not do well after his distal pancreatectomy in 2021 and had to spend long times in rehab in addition to needing a G-tube for enteral nutrition.
  
  "He had heart attacks and he is now on Plavix."

so on June 23rd I sent an email expressing my concerns.

• "I think some statements in the Visit Notes might give one the wrong impression.
  
  
• - "First, it might be assumed from the first statement that my misfortunes occurred as a result of the surgery and began immediately afterward.
  
  
• "Actually, I recovered remarkably well after the surgery, until – three months later – a still unexplained violent reaction to chemotherapy landed me in the hospital, when a G-tube was implanted. The rehab began closer to my discharge seven weeks later and continued for some time at home. Details are provided here.
  
  
• - "The second statement might lead one to assume that there were recent heart attacks – not that one was 32 years ago – and even that there could have been more than two!"

During our July 9th Office Visit, I again brought up those issues:

• - That I had completely recovered from the original surgery and three months later, a violent reaction to chemotherapy resulted in the problems described.
  
  
• - As for the heart attacks, I expanded on my description: There had been two heart attacks involving different arteries and whose symptoms were so minor that they might have been ignored. Both were corrected with balloon angioplasties that didn't include stents.
  
  
• The first one – 32 years ago – was followed over the years by 21 treadmill stress echo tests and 10 echo tests, all of which were normal. After the second, in April 2024, a cardiologist cleared me to leave the hospital 12 hours after I was admitted, and since then I had completed a course of 33 days of cardio rehab. Also, by the time of this visit, three months after the heart attack, my cardiologist had stopped the Plavix requirement.

I also mentioned that as a writer I make changes or include addenda as new facts come to light. In fact, I've made multiple changes to the pancreas saga on my website since I first posted it. He then said he never makes changes! Betty Lou interjected at this point, "I'm a writing teacher; of course you revise your drafts!"

I pressed the situation several times, but he was adamant, with a variety of explanations for the seeming contradictions. The first was that it is written for other doctors who expect that anything that happens after a surgery – evidently with no end date – must be caused by it!

The second was that other doctors will "read between the lines" and know what is really meant! Betty Lou pointed out that the insinuation was "There, there, mere laymen can't be expected to understand what doctors do."

In any case, I have no idea how another doctor would determine "between the lines" what actually happened.

He also brought up that any surgery is risky; that if my blood pressure suddenly dropped, which sometimes happens, it could be all over! I was becoming less and less confident of another operation at his hands. And the later 5½-hour operation by another surgeon occurred without incident.

I also said that if I had happened to decline chemo, the ensuing disaster wouldn't have occurred (the only connection to the surgery was that it resulted in the recommendation for the procedure that eventually caused my undoing) – his response: "How do you know?"

He also said the chemo is the reason no cancer had returned. I said that I hadn't yet even been able to complete the first course – of six – when it landed me in the hospital, so it seems unlikely that is the reason (after all there was no sign of cancer beforehand, and if less than one course of treatment was adequate, why would six have been scheduled?) – his response: "How do you know?"

While it's true that such hypothetical results are unknowable, based on the circumstances, I don't think either of my suppositions is unreasonable.

In any case, his continued refusal to modify an obviously incorrect narrative, supported by flimsy rationales, unsettled me. There may be a legitimate reason for such a stance, but I haven't heard one.

Unfortunately, what remains is that the purpose of the phrasing is to provide a preemptive justification in case the next operation didn't go well. In my previous life, this was known as CYA.