Verifying the Pathology

Rad note » today's entry is part of a continuing saga that began on October 1st, 2014 .. see here » The Existential No Man's Land Between Biopsy & Diagnosis. The entry that precedes today's post is here » The Moores Cancer Center in La Jolla (Oct 28, 2014).

Seaworld San Diego Journey to Atlantis Roller CoasterLet me tell you what has been happening lately.

Better buckle up. And maybe even put on a raincoat. Here we go.

» The Radiation Oncologist called yesterday.

To say that our previous conversation about perhaps forgo'ing radiation & chemo

would probably be revised.

(Uh, to include both radiation & chemo.)

So naturally I was bummed to see my dreams evaporate .. my dreams of getting this thing cut out and finally being done with this 4-month 'adventure' ..

.. even if it meant somebody cutting open my neck.

My emotional rollercoaster took another sudden, steep plunge. "Look out below." Big splash.

"You guys are the experts," I said, trying not to sound dejected. "Whatever you feel is the best route to proceed, I'm totally with you."

"My colleague, the head-n-neck surgeon who you are seeing tomorrow," he added, "he will probably want to want to » verify the pathology."

San Diego Area MapAnd yes, today I again went down to Moores .. this time to see the "Surgical Oncologist".

And yes, he did indeed want to » verify the pathology.

Dude, let me tell you what "verify the pathology" means.

It means that they are going to re-biopsy the tumor (swollen lymph node in your neck) ..

.. by sticking needles into it (repeatedly) and sucking out the juicy-juice that you are growing in there.

No, they do not call it 'juice' .. but you catch my drift. Your own special sauce. Home grown carcinoma.

So I am warning you .. that I am feeling a little spaced out. Not as bad as after the chunks-of-flesh biopsy, no .. but I can definitely feel myself nicely whacked.

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••• today's entry continues here below •••

You catch yourself forgetting things that are normally second nature. Telltale indications that you are operating mentally at a level well below where you normally operate.

Such as, you will go to another room to get something and then forget what you came for when you get there .. "What am I doing here?" .. only to remember what it was after you return. "Oh, I remember now."

UCSD School of Medicine» The UCSD Med School Student

But first a Med school student from the UCSD School of Medicine there came into the room.

She introduced herself and asked if it was okay if she asked some questions and accompanied the doctor (the surgeon) for the biopsy.

Until she said that, I was not sure that they were definitely going to re-biopsy the node.

"They're definitely gonna re-biopsy?" I asked, sensing my anxiety level rise. (The anxiety that comes from the idea of needles being jabbed into your neck, repeatedly.)

"That looks like the plan," she said.

A biopsy is really not such a big deal .. except the last time I had this done, they hit a vein and I passed out. Woke up on the floor, wondering what the doctor was doing in my bedroom, who said, "You stopped breathing for fifteen seconds."

[ I am no physician, but I know that it is not good when you stop breathing, unintentionally. Because that is what dead people do. ]

She said that she had read my entire big file. I forget the exact word that she used .. but I remember being surprised that she indicated my file was big .. seeing that it was only two weeks ago when I first visited Moores.

"They've obviously been talking about you a lot," she said, shaking the fat stack of papers in her hand. And I thought, "Wow, that's a lot of pages for only one visit two weeks ago."

I told her the story of how it all began. And how things have been going lately. And how mom and gramps both died of cancer. And other things.

For example, I have been sweating at night around my collar-bone area. Not every night, but probably 2 out of three nights. I wake around 2 or 3AM, change my tee-shirt and go back to bed. No more sweating. I always wake with a dry tee-shirt.

But two nights ago, I woke to find my entire LEFT arm sweating .. shoulder-to-wrist. Nothng else. That has never happened before.

When I woke, my sweaty left arm was OUT OF the covers (where it was cool) and NOT UNDER the covers (where it was nice-n-warm), which seemed even more weird to me.

Before this lymph node swelled, I rarely sweat at night. Almost never. Except if I had the flu or something like that .. and then I would sweat profusely (stinky sweat), my whole body, but feel great afterwards. Maybe once every few years.

There is nothing wrong with my arm. It feels fine. Feels great. Works great. And this arm is opposite the tumor side. So the sweating there makes no sense to me.

Making You Feel Like They » Honest-to-God Give-a-Shit

I really liked talking to her. To this Med school student who had read my file. Some people are easier to talk to than others .. about such deeply-felt things.

You know what I mean. They make you feel heard. They make you feel understood. You can see in their eyes that solemn sense of recognition that signals they are following you. That they 'get' you.

They make you feel like they are not afraid to go to the scary, uncomfortable place that life has taken you. They make you feel like they Honest-to-God give a shit.

Baloo and Mogli | Jungle BookPerhaps this is why I felt comfortable enough to tell her the story ..

.. about when I told the Bug » "I won't let anything happen to me."

Because that is an emotional thing for me.

I think this was my way of saying to her » "Please dont let anything happen to me. Dont let me be a liar."

My son is the same age that Lance was when his dad died. (Of cancer.)

So dont think I dont see the similarities.

Anyway, this interview with the Med school student felt good .. especially since I had been dealing recently with people dont care whether you live or die. (They care only about the money. Or so it would seem.)

» The Room Filled Up Fast

Then the nurse came into the room and shit started happening. Fast. They put me in "the chair" in the center of the room and laid it back. Recline would be the term.

They point you toward the far corner, so that your feet are near the corner and your head is near the center of the room.

Then the doctor came in. The surgeon. An older man. Not old, but older than the Radiation Oncologist, who is younger. You could feel the wisdom-of-the-ages oozing off of him .. especially as he taught the student.

Very low-key. Calm. Not at all excitable. He has obviously done this before. Many times. A routine thing for him. He can probably do this in his sleep. His voice has a soothing quality. Almost avuncular.

And the room, which is not very big, began to fill up with people. I mean, not even counting me, you have the surgeon, and the Med student, and the nurse, and some administrative lady, and two other young people sitting in the back next to a laptop on the counter. I think they were there to receive the biopsy samples.

Plus, they had also wheeled in the ultrasound equipment. So there was not much room in there.

This was very different compared to the first time they biopsied the node .. when it was just me and the surgeon. And I was sitting upright. (Uh, until I passed the fuck out, that is.)

Frankenstein» Being the Object of Fascination

It really is a fascinating thing to see / witness / behold this stuff, watching the surgeon work ..

.. if only I were not the object of this fascination ..

.. with multiple needles being stuck into my neck.

I mean, the surgeon is NARRATING as he goes ..

.. explaining everything he does .. to the student there beside him.

And he has the ultrasound probe pressing there on my tumor, and he's saying to the student » "See the structures? That's a vessel there. There's another. We want to avoid those areas."

As he inserts the needle into my neck, he says, "There's the needle entering the node. Now I am going to insert it further in order to sample the other side of the tumor."

And I am thinking, "Lovely." They are both watchng the ultrasound screen that I cannot see. And that I dont really care to see, either.

I could feel myself starting to sweat. It was more the IDEA of needles being stuck into your neck that freaks you out .. than the actual pain itself, which is actually easy to manage.

I took particular note when he said you dont want to inject the numbing solution into the tumor itself, but rather around it. And also when he said that you dont want any blood in your biopsy sample. To stop when you see a "flash of pink". Again, I found this all fascinating.

I did not say anything, but thought » "Since you're already sticking needles into my neck, and sucking out the juicy-juice .. why dont you just suck out ALL the bad shit? ALL the squamous-cell carcinoma nasty shit. Or at least as much as you can."

Sounds reasonable, no? 

It wasnt long until they said » "You're done. You can go."

They had what they needed. The room emptied as quickly as it had filled. Maybe quicker.

The nurse gave me her card and said she would call within a few days with results.

So this was my first biopsy where I stayed awake the whole time. That's progress for you. Cause for celebration.

World-Record for 3 Vials of Blood » Beautiful Technique

The Moores Cancer Center in La JollaTho I first needed to go to the lab and give them three vials of blood.

This guy who drew my blood, a Filipino with a German name ..

.. he was very good. The fastest ever. Twelve seconds maybe. Done. The needle is out.

Most blood-takers jab the needle in a little further when they change the vials. But not him. Beautiful technique. He obviously gets lots of practice. I noticed that he didnt tie the rubber band very tightly, either.

He asked me to make a fist and said, "Look at those muscles flex. You must work out a lot."

I knew this was total bull, but it made me smile anyway. It distracted me enough to take the edge off.

When he pulled out the needle and said, "Done," I shouted » "You *are* the man!"

"Have a nice day," he said with a proud smile. People know when they are proficient.

One of the more clever blood-takers I've had recently, asked me, right after she inserted the needle, "So what are you planning to do with the rest of your day?"

I doubt they are genuinely interested, but the mental process that you must engage in, in order to formulate a reasonably intelligent response, causes you to take your mind off the needle sticking in your arm JUST ENOUGH to distract from the pain. I found it a surpringingly effective ploy.

The LEAST painful needle was delivered by the girl who prep'ed me for the PET scan in Encinitas. But she did not draw blood. Rather she simply injected me with a radio-isotope marker.

I barely felt that. Just a little prick. (She was from Oregon. Oregon girls rock.) They may however, use a smaller needle for that.

But when they inject the needle to draw blood .. you know you have a rod of iron in your vein. Big pipe. Glug, glug .. out comes your blood.

I already have an appointment (at Moores) for next week to do a "simulation scan" .. where they map your head and neck (3-D style) in preparation for radiation.

This also involves an I-V (they tell me) for contrast .. just like they do for the CT scan. So more needles are coming soon .. to an arm near you.

For the PET scan, they remove the needle as soon as the radio-marker is in you. Just a few secs. Whereas, for the CT scan, they leave the I-V in your arm for the whole scan. Thirty minutes.

When 'Soon as Possible' is » Not Good Enough

While I was sitting in the waiting room at the lab, a guy behind the counter was talking on the phone to somebody about a problem with one of their computers. "I am going to let you talk to my manager," he says, and hands the phone to a lady.

She says, "No. 'Soon as possible' is not good enough. That could be tomorrow. This needs to be fixed today." Techno drama. Ten minutes later, a heavily tattoo'ed guy showed up to fix the computer.

That's about when they called for me. "Our next contestant .. come on down." They obviously do a lot of work at that lab. Lots of volume. Heavy volume.

» Cancer Can be Caused by a Virus?

I will follow-up tomorrow to tell you what they are specifically looking for in today's biopsy. They think this cancer might be caused by a » virus. Isnt that bizarre?

I said to him .. to the Radiation Oncologist who called yesterday » "But I havent been with a girl in years."

He said » "That has nothing to do with it. You can have this when you're a kid. It lies dormant for years."

[ I have never had an STD .. far as I know. One time, however ..

.. I had an old girlfriend call and say (something like) » "I'm having some girly problems. If you could get checked for this thing, that would be helpful."

And I said, "Hey, cool. No problem. What are friends for?"

And it was no problem .. until however, the doc stuck that q-tip thing up my pecker. Whoa, dude. That's gotta be up there with waterboarding .. far as unpleasant shit goes.

I mean, he just grabs your schlong and says, "Okay, take a deep breath."

If they stuck a wire bottle-brush up there, I dont think it could have hurt much worse. It felt like they first soaked the q-tip in Tabasco.

"Mother of God! If there were any bugs up there before, they're all dead now."

And yes, results of the q-tip up pecker test were negative. But that was a long time ago. ]

A virus, I'm sure you know, is litle more than » code. And in this case » genetic code.

» The Power of a Virus

When I was 19, I came down with » the Kissing Disease. Infectious mononucleosis. "Mono." Which can be serious trouble for older people, they told me. Life-threatening, even.

Nuclear-powered ballistic missile submarineThis was while I was in the Navy.

"Looks like you're a sick boy," they told me after they came back with the results ..

.. after I had been sitting in the waiting room for an hour or two ..

.. waiting for the results of the blood test.

I knew I was sick. They didnt have to tell me.

It put me on my ass for two weeks. I had no energy. It took a concerted effort just to get up to go to the bathroom. You just want to lie down and sleep. Bed rest is what they prescribed. No drugs.

You are so tired that you could lie down and fall sleep on the sidewalk. I'm not exaggerating. Sitting up is exhausting.

It hit me so fast. Like you snapped your fingers. One minute I felt fine, the next, I needed to go lie down. An impressive virus that was.

I was stationed up in Maine, at the time, at a ship being overhauled at the Bath Iron Works.

Country road in autumnThe previous weekend I had driven down to Connecticut (a 4-hour drive) and hooked up with an old friend (Laura B).

An affectionate little thing. I remember how her body would become physically hot when she became passionate.

Her lips became fiery-hot. Noticeably so. More than any other girl.

Well .. there was one other girl ..

.. whose body-temperature became roasted-hot. But that's another story. The girl with the exotic emerald green eyes.

The photographer. From Lancaster, Pennsylvania. Who lived in one of those small surrounding towns .. like Blue Ball or Intercourse or Paradise. Nice people there. Very nice.

She lived in an old farm house .. out in the middle of nowhere. Cool place. A rare find. I met her at a church there. Those eyes enchanted me. Church girls .. they always look so pure and wholesome.

» Nurse Case Manager

New Rad DigsWhen I got home from Moores today, I took out the nurse's card from my shirt pocket and set it on the dresser ..

.. besides the cute, uplifting cards that Nana has been sending.

Where I couldnt help but notice all the letters listed there after her name. "Dang."

I knew what RN stood for. But I had to look up MSN (.. no, not her favorite web site) and also » AOCN.

Like I said, when she walked into the room, shit started happening. And fast. She provided you with all the fine details that showed she knew her shit down to the level of nuance.

I dont really know what a 'Nurse Case Manager' does, but I could definitely tell that they know their shit.

The surgeon may be seated at the center of the biopsy procedure, but it is the nurse who coordinates everything. At least, that is how it appeared from my (admittedly Frankenstein) perspective.

The nurse said that the numbing stuff that they shot into my neck would wear off "in 3 or 4 hours." And I'm starting to feel it now. So the pain seems right on time.

Yes, I definitely feel it. It feels like somebody jabbed a bunch of needles into the side of my neck. And like a vampire sucked out a few vials worth of blood.

I can see that I have a nice, little dark-colored bruise there .. about the size of one of your fingernails. Where did I put that Advil?

Update » it's not a bruise. It's a clear, mini band-aid .. with a blood spot .. toward the back of the neck, where I couldnt see so well. But it still hurts, anyway. Tho Advil seems to help.

Sometimes, during these past few months, when I would feel lousy, typically later in the day, I would take some Advil. But it never really seemed to help. So I stopped taking it and just lied down instead.

The end. ■

Rad note » today's entry is part of a continuing saga that began on October 1st, 2014 .. see here » The Existential No Man's Land Between Biopsy & Diagnosis. The entry that precedes today's post is here » The Moores Cancer Center in La Jolla (Oct 28, 2014).

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This page contains a single entry by Rad published on November 13, 2014 11:13 PM.

The Moores Cancer Center in La Jolla was the previous entry in this blog.

Simulation Scan, More Laughs & the Date is the next entry in this blog.

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