DAY 058 -- "Alas, Poor Elwin!"

I couldn’t make this up, but if I could, I would do it like this:

There I was in the examination room counting ceiling tiles and not scratching an itch, when my radiation oncologist walks in lugging what struck me as the most infamous cranium in all of literature under his arm. He smiled, sat down, and my first thought was:

Uh-oh … any second he’s going to tell me that because he moonlights at the local community theater where he’s the understudy for Hamlet, and he’s just received an emergency casting call at the last minute to perform tonight, would I mind if he used the time to practice his soliloquy from the graveyard scene?

“Alas, poor Elwin! I knew him, Horatio: a fellow of infinite jest, of most excellent fancy!”

The truth, which is often much less entertaining, was that he’d brought in his cancer patient show n’ tell anatomically-correct demo skull, complete with detailed facsimile rubber brain innards, all sectionalized, to show me, if I wanted to know, exactly where my right cerebellum tumor was.

Right about there, I turned my excellent fancy and infinite jesting back to reality and we had a stress-relieving laugh (my stress, anyway). Then on to the main event:

Without wallowing in a bog of filler material, it looks like we’re going to proceed with, yes, a course of stereotactic radiosurgery. Sounds rather like a military operation, eh? “Alright, drop your meat, grab some heat and saddle-up, sergeant! It’s time for Operation Stereotactic Radiosurgery!”

(I think Operation Hot Bot would’ve been mas macho, but I can’t compete with my own imagination.)

Cool! This means next week it’s back in the terrible tube and I get a repeat MRI, this time emphasizing more sagittal versus axial planes. Ahem, at least I think that’s what he said. As you know from our history here, whenever I’m distracted in the grip of an Alas, Poor Elwin! mode, I will often mis-hear things. He might’ve said chewy caramel versus chocolate centers, but I did get the gist of it:

New Plan: lung tumor in the back seat for now. Brain metastasis takes the wheel. And, they'll give me nifty new treatment anchor headgear that I’ll get to keep and bring out later at parties and airports and Halloweens.

But, this means a re-routing of things: different scheduling, applications, side effects, and a new drug that acts more systemically than locally on my Candyland blood-borne gumdrops (oops … you see … I’m drifting again).

I left there today feeling like I was torn between two elevators: one for the brain, one for the body. So, screw it; I took the stairs.

And, as if you needed more comic relief (I always do), while waiting for the doc I spotted a jar on a shelf across the room. From my vantage point, the label looked like it read: “Feces.”

My logical brain (now suspect, but still mostly intact) and my decades of nursing savvy knew that the jar did NOT contain out-in-the-open poops, even though all the evidence, including the jar’s chunky contents, sure looked like it did.

Can you blame me for having a moment of fearful umbrage flirting with confused panic?

It lasted until I went over for a closer look: The entire label read “Earpieces.”

More as we go, El

DAY 057 -- "Into The Brain"

This week, I’ll be back at Rad Chemo Central, where you and I spent a few weeks darkening in the light a ways back.

Now that the recent MRI of my head found a new cancer (see Day 56), we have to shift from lung to head for the moment, hoping that the new affected lymph node in the lung treads water, or at least doesn’t sink further, as we get into the brain.

Yes, yes, yes ... we all know how surgical resections, stereotactic radiosurgeries and fractionated radiations work (if we don’t, not to worry, we didn’t know either until we checked), but we also can’t help getting clobbered with answers like the following, if we’re bold enough and curious enough to stand and deliver the questions into their line of fire:

“Unfortunately, in most cancers, once a person develops brain metastases, the tumor is not curable. With current treatments, patients can live from mont---"

Right about there is where the mind stops processing the spoken word into sensical sounds and written text into understandable language, and everything coming at us looks like flaming spears and sounds like screaming meemies.

(Yes, I had to look it up, too, just to sidetrack my brain long enough to stop vibrating and come back to front and center. A screaming meemie was originally a WWI artillery shell that sounded like … well … a meemie screaming. You’re welcome.)

The point is: our imaginations, when driven by anxiety and worry, are capable of so much more than simple reality. In literature, this is what makes great fiction.

In real life, this is the stuff of non-fiction nightmares.

Still, the editors and publishers of hope and optimism also have their sub-stations in our thoughts, so if we’re lucky, we can at least tread water (remember that dog-paddling tumor up there?) until everything gets to dry land.

Sigh. Here I’ve gone again, abusing my writer’s license and bracing against a pre-whirlwind of metaphor enroute to the calm before my pending brain-storm, unable to even get out of this sentence without mixing one. I’m not apologizing.

More as we go, El

DAY 056 -- "One Incomplete Sentence?"

MRI (Magnetic Resonance Imaging) today of my brain (or what’s left of it after surviving decades of sex, drugs, rock n’ roll, Hula Hoops, Richard Nixon, Silly Putty and lots of eldercare, hospice and other bedside nursing care disciplines.)

Speaking of humor, my Docs ordered the MRI after finding those cancerous cells (See Day 055) active in my world-premiering lung lymph node --- cells that weren’t there three months prior.

I’d been through the MRI tube o’ terror before, so I was ready going in: pre-medicated with a hefty dose of benzodiazepines, comfy sweatplay pants, a pair of xxx-large hospital Pillow Paws booties and a johnnie gown Baby Huey could swim in.

The MRI tech/nurses were built for comfort and speed but also slow-going when needed, and with me today, I appreciated the crawling pace they used helping me to get my mind right for that crawling space they knew I dreaded.

If you’ve had one of these tests, you know the drill and you can skip along until the text starts to feel new again.

If you haven’t … well … hmmm … how to best describe getting an MRI of the brain in one incomplete sentence?

Supine on a hard table, head in a mold, arms pillow-propped and positioned, legs/knees blanket-gatched, heated blankets applied, earplugs and headphones placed (one for songs, one for silencing) IV for contrast medium inserted, and all fine until the Hannibal the Cannibal hockey mask is clamped down over your face.

But, luckily, because I’d already experienced the hostile arms of the horizontal Iron Maiden once before, I’d insisted on getting my mind right ahead of the procedure (per Dr.’s Rx, of course). I’d wanted and demanded to be stupefied with tranquilizers. If they’d slipped me inside that raucous, vibrating squeegee sleeve chamber without my pharmaceutical friendly fire, I would’ve freaked out.

Another fast forward (I’m assuming this is a recreational read for you, so I’m trying to keep it moving): Forty minutes later, after a couple of ins and outs for logistical tweaks, and several slam-banging mechanical interval audioblasts, tolerable (doped or not) only because they were somewhat muffled by the headphones, I was sucked out of the big plastic donut hole of death intact.

  

Later, in his office for the preliminary review of the results, my oncologist, to his great credit, managed to not suppress a laugh when I told him my best doctor joke.

I told him right after he told me that yes, he’d just consulted with the radiologist, and yes … I did indeed now have cancer in my brain.

So, I caught him flat-footed and responded by asking him before he knew how not to react, if he’d ever heard the one about the difference between doctors & lawyers?

“No?” He said, unsure of where it was going, and with me knowing that he’d never heard that old chestnut.

“Lawyers rob you,” I said, “but doctors rob you and kill you, too.”

He laughed frowning, then laughed grinning. My mission accomplished. It’s my goal to be an exemplary patient.

So, today, anti-heroes that we are, we went looking for any renegade cancer cells which may have scaled those cellular walls, broken out of the host prison on their own, and headed out on the lam for who knows where.

Trouble is, we found ‘em, right where we’d hoped we wouldn’t: in one of my head’s hideouts. Yes, we’d hoped to find nothing in my head, but hope springs. Best leave the rest of it there.

Now, I’d sure like to know who provided the getaway car.

When we thought the cancer was only in my chest, the course to healing was clear. Now that we’re faced with outliers, all the treatment options must be revisited.

Surgery, radiation and chemo now will be shuffled into spaghetti strand degrees of optimums, maximums and minimums, tossed against the wall, and we’ll see which stick.

Of course, there’ll be a bit more applied science than that, but I can’t resist a juicy metaphor.

Then, as we’ve gone thus far, there’ll be more as we go, El

DAY 055 -- "Where's Baby Doll?"

No kidding, there I was, coming back around to consciousness from general anesthesia after today’s post-op EBUS (Endobronchial Ultrasound) biopsy. I am a sucker for images like this. Raw as it gets, there’s no hiding in manipulation, and one picture is worth a thousand pictures.

The thing itself was “uneventful,” as we’re fond of saying in nursing. That means that the operating room wasn’t rocked by an earthquake as the flexible tube went down my windpipe, I didn’t roll off the table, and the procedure was successful, securing the biopsy needed to determine the nature and nasty factor of an outlaw lymph node.

The results … well … here we are.

Pre-operatively, there were nurses and doctors and techies reviewing my history and prepping me for the morning’s events: inserting IV’s, electrode stickies stuck, assuring themselves that they knew that I knew what they were about to do, getting me down to underwear/flapping johnny and those one-size-fits-all ribbed slippers, on with my nursing bouffant cap, dentures out, jewelry off.

Diane sat next to me, and as usual, filled in the blanks where my mind drew them. There were many, as I was having trouble processing it all. (The brain has a wonderful capacity for performing a magician’s sleight-of-head under stress.)

The oncologist explained everything expertly, using a great metaphor/analogy of a tree and how its encircling bark mimicked the big doings in my chest interior. He did this while again showing us the offending lymph node on the computer screen, scrolling through the scan slices for a compelling trip around my heart’s descending aortic arch, and a bunch of other cool et ceteras.

The anesthesiologist, when she wasn’t distracting me with the facts of what would happen under her applications, talked about her winter power walking adventures with a like-minded Diane.

I felt quite pampered and reassured by it all.

Then, off we went through the maze of hallways to the operating room (everything’s a maze when you’re being wheeled around on your back).

Fast-forward: someone hovering behind me said “Here we go,” and the next thing I remember is where I am in that picture up there, emerging into a muddle head.

The nurse later told me that when I was returning to wakefulness, I kept asking “Where’s Baby Doll?” and everyone in post-op was hoping that I meant Diane. Ba-da-bing.

Another post-op nurse, in sworn secrecy, also said that the first thing I slurred/blurted in my anesthetized fog was “I told you God was a woman!” I vaguely remember a chorus of laughing female voices, but I could be wrong.

It’s why I became a nurse decades ago, just to embrace humor like that.

As for the the results? Well … preliminarily, not the best.

“Abnormal” cells found, and after my “tumor board” meets in the next couple days and fully evaluates the results, we’ll discuss options: revisiting chemo, radiation, possibly surgery.

I know what you’re thinking: should I buy season tickets to Fenway?

(See what I did there?)

More as we go, El

  

DAY 054 -- "Those Certain Uncertain Biggies"

I've now had my last immunotherapy infusion of the calendar year. Useless and meaningless trivia, but that’s just fine with me for now, because I’ve had enough profound, life-altering, on-your-mark-get-ready-set essential bulletins in the last few months to last me another lifetime, which it may well have to do.

(That’s an inside cancer joke.)

Today’s treatment was uneventful: the nurses know me and my rolling veins well enough now to never miss the puncture, and they always give me the right chair. I must have my back against the wall if I’m going to be sitting in public for a while. It’s the Wild Bill Hickock Syndrome.

Maybe that will change in this new year, as I’m more concerned with the killer in front of me than the one coming up on me from behind. Plus, I'm playing crossword solitaire, not poker.

(Another cancer joke, truly awful, but my license).

And, just incidentally, in my nursing career I’ve always given my patients the needle on “two” during a called three-count. “Ready? Okay, on three, ready? Now … One … TWO!” This way, the patient is in pre-flinch mode. Less tension, less pain, less chance of missing the mark. (You won’t find that method in any of the manuals.)

My oncology Doc checked in as usual during treatment, reviewing the latest labs, checking vitals, doing Doc stuff. At my request, he also brought up my new mystery lymph node image (see Day 052) on the computer to show Diane, who came along today to help hold up my fuzzy-saggy head. I again asked the Doc, as I always do, all the doomsday and V-Day hypotheticals.

Diane asked him, in her best fellow research biologist-speak, “When you do the biopsy, will the analysis be similar to the staging that was done on the subclavicular scan?”

She is my pearl. My sheet music. My lava flow. My sticky note. I love her. The Doc said great question, and gave her an answer that blew by me like a comet brushes by the earth, as my eyes shut down my ears. I’m okay with just watching the burst and receding flash of light and letting it go.

Much as I want to know everything about everything, I don’t have to.

Yes, yes, I know the Doc would rather not talk about what would happen if this happened when that happened, should the other thing happen while the first thing is happening … but that’s because he’s a good doctor.

Still, he also knows my mindset, and allows my always wanting to know the “best- and worst-cases,” obliging me the best he can. Yes, he’s concerned about the image, which is why he and his fellow consulting Docs want to get the biopsy next week, so we can rule in or out the goods and evils based on hard evidence.

Meanwhile, not knowing where things stand plays absolute hell with my imagination, but isn’t that common in all of us? Don’t we all let our minds run wild when it comes to those certain uncertain biggies in our lives?

Yes, we can and do conjure up most anything when we labor over what might be coming next in love, sex, death and where the fuck are the car keys.

More as we go, El