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Part II


The One That Goes 'Kaboom'


Chapter 1: I Got a Feelin'


Sent: March 17, 2005

Subject: The Luck of the Irish

Life has just been a little too boring since last summer.   I just had to do something to spice things up.   So, last week, I got a little numbness on the right side of my face.   I didnít want to wait until my next scheduled MRI and CT to find out what it was, so today (March 17), I had them done early (sort of like opening your presents on Christmas Eve).   What should I find hiding under my right eye but a brand new baby tumor!   Or if not, itís that mucoepidermoid thing coming back to punish me for those patronizing comments I made about it last summer.

Well, I could look on the bright sideósecondary gain*, yippee!   Also, like its predecessors, it is quite small.   Thank God for small tumors!   Or I can bemoan my fate.   What have I done to deserve this?   Have I failed to make the proper sacrifice to some god or other?   Say, thatís easy to fix!   Anybody have a spare goat?   Or thereís that live and ĎFresh Killedí chicken shop a few blocks from the hospital.   Hmm.

Oh, what I must go through for my comedy!


P.S. Bizarre as it seems, Iím not kidding about the tumor (You gotta have the tumor for this kind of humor!).   It appears that I have my third tumor in the space of one year within the radiation field of my cancer treatment in the 80s.   Why now?   Why all together?   No clue, but this must be some kind of record.   Tune in next week for a thrilling biopsy followed by prognosis and treatment plan.   Now this is entertainment!

P.P.S.   Sorry fans, but this definitely means that I will not be able to do my long-awaited tribute to Josephine Bakerís Banana Dance at this yearís Auscultations** show.

* For all you non-medical people out there, secondary gain is the rewards you get when you are sick: sympathy, attention, money, (hint, hint).

** For all you non-Hippie General people out there, Auscultations is the hospitalís literature and arts magazine, and it holds an annual variety show.



Retrospective (April 12, 2007)


Surprising though it may be, the above e-mail describes a thoroughly un-fun time.  In early March of '05, I was nearing the end of my third and final year of residency.  I was on night-float.  An intern and I were responsible for the patients on the medical unit of Hippie General as well as admissions for the entire night.  It's a surreal experience to begin with. 


Then, one night, I noticed a numb/tingling area on my right upper lip--the sign of a damaged nerve.  I got a sinking feeling and fervently hoped that it was the onset of a herpes sore.  A medical geek, I pulled out my 'Netter's Anatomy' as soon as I got home and figured out exactly which nerve was involved.  Sure enough, it was smack in the middle of my old radiation field and prime cancer territory.  Oh, joy.


After my night-float rotation, I moved on, appropriately enough, to an oncology rotation.  This gave me a flexible schedule, so I arranged for an MRI at the earliest possible date (see below)s.  I hopped on my bike and rode to Ben and Jerry's Hospital for my scan.  Then I Shanghai'ed the first neuroradiologist and told him my sob story.  I'm a doctor, I had cancer as a kid and two new tumors in my radiation field last year, now I have this creepy feeling, yaddah, yaddah, yaddah.  The poor guy was cornered, so he read my film for me on the spot.


I rode back home on my bike.  I figured I was going to die in the next few months.  Probably not the best attitude when you're biking in Boston traffic.


On the plus side, I think the attending on my oncology rotation gave me an extra-good evaluation.



Sent: March 24, 2005

Subject: When it Absolutely Must be There on Time


Can you believe it? This is fifth Tumoriffic e-mail! Itís like Police Academy. The sequels never stop. 
Well, nothing really exciting has happened since my last installment, but thereís so much material, I figured I needed to write it down before I forgot or had brain damage. First, tidbits I didnít include in my last e-mail: 
1. Flashback: How to make your doctor work hard for you. 
So last week, LLC was home sick with upper and lower GI symptoms, upper respiratory symptoms, and malaise, and on Tuesday, he was feeling so lousy, he simply refused to be put down. I had decided to see my primary care doc for this facial numbness I was having so I could get my next MRI and CT a month early.  I brought LLC along.  My doctor was out, but there was a very nice resident who saw me.  Now, picture this.  You are a young doctor, and another young doctor who has been sprouting tumors like mushrooms for the past year presents with a rather ominous symptom. Meanwhile, lying Pieta-style in his lap is this adorable little boy who looks like he is on the verge of death. Man did that resident move fast! 
2. The weekend from Heck 
Can I tell you about our weekend? We found out about the tumor on Thursday afternoon, On Friday, my oncologist said he was worried that it was so wrapped up in the nerves of the face that it might be unresectable. 
My parents (the Medical Mafia), leapt into action, calling my old surgeon at Johnsons Hospital from 20 years ago, Dr. Wyatt Earp. Dr. Earp, aside from bearing a striking resemblance to one of the Mario brothers, is way up there with the Jedi Master in the pantheon of surgeons.  If you need a tumor scraped off a nerve in the ear/nose/throat region, he is God. He agreed to take my case. 
The next problem was getting the MRI and CT to him. I was working on Friday, so K went to Wicked Famous Cancer Hospital and got them on CD-ROM and, with the help of a friend sent them via Fed-Ex to arrive at his house the next day. Anxiously, she tracked the package on the internet. It went to Johnsonstown (Bingo!), but then it somehow took off for Tennessee (Huh?) then disappeared altogether. Meanwhile, K and I had caught LLCís virus and felt terrible, and just to add to the Gothic atmosphere of the whole weekend, LLCís diarrhea had gone turbo. He was expelling yellow liquid stool with such force that it would spray out the leg-holes of his diaper onto the rug. 
The Fed-Ex people apparently considered K a hysteric, telling her repeatedly that they would call her back in ďan hour,Ē and never doing so. After all, itís just cancer. Whatís the big deal? Finally, K put on her lawyer voice (similar to the stern mom voice) and insisted that they pick up another copy and deliver it same day free of charge. They did. 
Fast-Forward to Wednesday 
Now weíre on a flight to Baltimore to see Dr. Earp. The dense fog and pouring rain are a nice touch. We booked a flight on American Airlines to Johnsonstown at 10:22am. We arrived at the airport, and it was cancelled due to a mechanical problem. The American Airlines employee was clearly a graduate of the same charm school as the Fed-Ex folks and was unimpressed by our story. So we caught the next flight on Air Tran. Whatís another couple of hundred bucks down the toilet?


Retrospective (April 13, 2007)


A Little Redemption


At this point in March of 2005, my distraught parents were frantically calling every physician on the east coast.  Nearly everyone assumed that the new tumor was probably a recurrence or metastasis of the mucoepidermoid tumor taken from my soft palate a year earlier.  If it breaches its original boundaries, chemo and radiation are pretty useless, and people tend to die even with radical surgery.  What a hardcore Tumoriffic Saga that would have been.


Dr. Communication of "You've got a brain tumor.  You should get a neurosurgeon." fame was actually a voice of comfort and sanity.  Salivary gland tumors like the mucoepidermoid were his specialty.  He pointed out that those tumors almost never cross from one side of the body to the other in the early stages.  That implied that the tumor I now had was something else.  Almost anything else would be better.  Maybe the world was not about to end.



Sent: March 31, 2005

Subject: Band of Tumors


I'm sitting in my parents' home after an excellent dinner at the Ol' Dangler's Inn.  It's has excellent food with great ambience, and, if you're lucky, you can catch a glimpse of local notables trying no to be seen with their mistresses.  Tomorrow, I'm off to Johnson's Hospital, and the wild rumpus begins.  The esteemed Doc Earp will perform a fiberoptic biopsy and (hopefully) full resection.  Preliminary diagnosis will be in.  I wait with baited breath.  (I've always wondered what that means.  Does my breath attract fish?)


I'm hoping that tomorrow, I'll find this was all a tasteless April Fools' Day prank: It's not a tumor.  It's just the world's largest booger.  You know those neuroradiologists.  Anything for a laugh.


Oh, and here's another good one.  Today, the Pushme-Pullyou Insurance Company claims nurse called and told me that their doctor had refused to certify my out-of-network referral for surgery.  After I finished laughing, I asked her whether the good doctor was stoned.  Then I regained my manners.  Luckily, my extremely helpful primary care doctor called them immediately and set them straight. 


So wish me luck!


P.S. Friends in the old hometown: I would have loved to have had a chance to visit.  Life is mildly loco right now.  If you feel like making the trek to Johnson's Hospital on Saturday (do not feel obliged!), call K first.  I will probably be very happy to have visitors.  Just don't expect much in the way of stamina.  Also, if you make the trip, it's worth talking to a guy who hangs out next to the main hospital entrance.  He can hook you up with some top quality Colombian at a great price!



Sent: April 4, 2005

Subject: One mean April Fool's Joke


Day 18 of my full-immersion oncology independent study.  I sure hope there are a lot of radiation-induced head-and-neck tumor questions on the internal medicine boards in August.  I'll be so ready!


As scheduled, I had surgery on Friday, April 1 (joke's on me).  What fun!  Unfortunately, we're only a little bit closer to a concrete diagnosis.  It's not a fungus ball, and it's clearly not a booger.  Bummer about that.  I was looking forward to showing that one off.  Stay tuned for the final pathology within about a week.  Special prize for anyone who guesses correctly!


K and I came back home on Sunday.  We missed the weather.  I feel like Hilary Swank punched me in the face, but otherwise, I'm recovering nicely.  A little more R&R and I'll be ready for the next round.




P.S. I really appreciate your e-mails.  While I was in the hospital, K printed them out so I could read them.




Sent: April 9, 2005

Subj: Tumor of the Month Club!  We have a winner!


. . .and the winner is:


Osteogenic sarcoma!  This peppy little tumor, known to acquaintances as osteosarcoma, is the second most common bone tumor in adults and can be found in association with past history of radiation to the head and neck.  It also looks great in a bikini.


And the victor in last bulletinís tumor-picking contest is none other than my own father, who guessed it in one.  He will be taking a no-expense-paid trip to Wicked Famous Cancer Hospital with me in a couple of weeks. 


Oddly, I am relieved.  This is no fungus ball, but it could have been a high grade carcinoma, and thereís just nothing funny about a high grade carcinoma coming back.  Osteosarcomas, on the other hand, have a reasonable cure rate.  Theyíre a laugh riot.


I saw Dr. Jedi Master, my old neurosurgeon, today.  Someone from the staff came in and said cheerfully, ďYour scan looks fine!Ē  Of course, she was looking for a meningioma recurrence, and really, thank goodness there isnít one.  But you should have seen the look on her face when I (gently, trying not to laugh) told her why it wasnít fine.


Shortly after my appointment with Dr. Jedi Master, I visited his colleague, Dr. Kenobi.  Back before there was even a diagnosis, everyone else was shaking their heads in futility, but he said he could cure me.  Now, he told me his plan.  He is part of a brand new skull base team with a plastic surgeon, and an ENT surgeon, all very eminent.  I can be the team's very first patient!  Yippee!*  The bad news came when Dr. Kenobi explainedóhow to put this delicatelyóthat I should prepare for the possibility that he might need to remove my right eye. . .



. . .and not put it back.


Good thing Iím going into infectious disease, a field where I wonít need depth perception.  On the downside, I may never learn skeet shooting, and all my Viewmaster slides would be useless to me.   Of course, Iím going consult every expert I can find as to whether they can spare my eye.  And Iím all out of jokes on this one.



* If you have a complex problem that needs multiple surgeons, consider signing on as a team's first patient.  I figure it's like wedding night for an old-fashioned couple.  There's excitement in the air because none of them have, you know, done it with each other before.  That might sound a little scary, but hey, isn't excitement what cancer is all about?  Besides, if you choose a team that's been working together for a long time, they might be so sick of each other that they bicker constantly and take out your hypothalamus because they're not paying attention.




Sent: April 17, 2005

Subject: Clash of the Surgeons, or The Eyes Have It!


Well, cancer is a roller coaster.  Thatís what makes it fun.  Last week was slightly less grim than the one before, but Monday was a prize-winner.  The neurosurgeon at Wicked Famous Cancer Hospital told me that he could save my life, but he was almost certain that he would have to remove my right eye and some other important stuff Iím rather attached to.  Can you say enucleation, boys and girls?  (Enucleation is a fun SAT word that means getting an eye removed.)  I was not thrilled, although what he proposed was certainly preferable to a prophylactic craniectomy.


Eager for a second opinion, on Thursday, I flew down to F'in' Famous Cancer Hospital.  There, I met Dr. Coach, an ENT surgeon and Dr. Mister Rogers, a neurosurgeon.  They take out head and neck osteosarcomas for breakfast.  (No, not a date.  A resection!)  They think they can probably take out the tumor and leave the eye along with several other of my favorite things.  This has put me in a much better mood.  I lost my heart in San Francisco, but I may keep my eye here.


On Monday, I also met Dr. Zap, Chief of Radiation Oncology at Manís Best Hospital, and Dr. Xena, who will be my cruise director and medical oncologist for this magical mystery tour.  Iím looking at 29 weeks of chemotherapy (usually two days every three weeks) with some pretty heavy duty stuff.  (Note: I sent an e-mail to some people saying it would be 18 weeks, but after some deliberation, the team is offering me a longer, stronger cocktail with a better cure rate but nastier side effects.)  After the ninth week of chemo, hopefully, the tumor will be easier to resect, and I will go down to NYC for surgery.  A couple of weeks down there, then the last 20 weeks of chemo.  Whether I get radiation depends on how completely they resect the tumor.  If all goes well, life should get pretty boring by 2006.  Kickoff is this coming Tuesday at Wicked Famous.


Wish me luck!



P.S.  There should be a Monty Python sketch with dueling surgeons:

Surgeon 1: Alright, so Iíll have to take out your eye,  BUT, can he do this?  Iíll sweeten the deal by performing the surgery while suspended by my ankles from the Leonard P. Zakim Bridge!


Surgeon 2: Ha!  He thinks thatís good?  Well listen to this!  Not only will I leave your eye in, Iíll put in a third one at no extra charge!  And I can do it blindfolded and using only my feet!



Next, Chapter 2:  'The Drug War'



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