The One That Goes 'Kaboom'
Chapter 1: I Got a Feelin'
Sent: March 17, 2005
Subject: The Luck of the Irish
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.
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!
All comments, suggestions, compliments, insults, and hate-mail should be directed to Tom@tumoriffic.org.