Daniel Menaker

Onconversations VI

Monday, July 25, 2011

SUPERB DOCTOR (on phone): So the CT scan results from Monday were, good.
ME: You don’t sound convinced. There was a little hitch in there.
DOCTOR: No, they’re good.
ME: Can you be more detailed?
DOCTOR: Well, with lesions this small, measurements are difficult. You can do two CT scans one hour apart, and they may well appear to measure things differently.
ME: And in my case?
DOCTOR: One of the nodules appears to be slightly larger–
ME: That doesn’t sound good–
DOCTOR: But that change is so small as to be well within the range of variability I just mentioned.
ME: Well, OK.
DOCTOR: And then two of the smaller nodules appear to have gotten even smaller.
ME: Now we’re talking!
DOCTOR: Overall, things really do look good, and that means we can proceed with the next session of chemotherapy.
ME: Oh, boy–can’t wait! No, I’m really glad about that, and grateful.
DOCTOR: But because of the slight numbness and tingling you’ve let me know about in your big toes and a couple of fingers, we’re going to change from cisplatin to carboplatin–it has fewer side effects in general, is just as effective, and causes less neuropathy in the extremities.
ME: So why did I start on cisplatin?
DOCTOR: Because the downside of carboplatin is that it suppresses the immune system a little more–the platelet count tends to go down more–and that means a slightly greater risk of a serious infection of some kind.
ME: OK, now I see.
DOCTOR: So if you develop a fever of more than 100.4, you must call the hotline right away.
ME: Aptly named hotline.
DOCTOR: Yes. And if it seems at all indicated, we’d admit you to the hospital and administer antibiotics. And we don’t want that to happen. So be careful about exposure.
ME: You think you-all don’t want to happen! I don’t either.
DOCTOR: Well, I actually sort of meant you and I.
ME: Of course–I’m sorry. Just a little anxious over here.
DOCTOR: Of course–I understand.

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Onconversations V

Wednesday, July 13, 2011

ME (In windowless examination room, with the lovely amenity of its own bathroom): You disagreed with your colleague when he said I should have surgery first and then chemotherapy–why?
ONCOLOGIST: Because I thought giving you chemotherapy first would minimize the chance of recurrence.
ME: And he thought?
ONCOLOGIST: He thought it was best to just whack it out of there as soon as possible, to eliminate any chance of spread.
ME: OK. Well, what if there’s no evidence of disease–I think you-all acronym it to NED–after chemotherapy.
ONCOLOGIST: Well, I know this sounds strange, but we hope there will be a little something left.
ME: Yikes! Really? Why?
ONCOLOGIST: So that we can study the tumor and be more exact about what it is and how to treat it if it comes back.
ME: Well, pardon me, but I hope there’s nothing left of any kind anywhere except my regular allotment of insides.
ONCOLOGIST: That’s understandable.
ME: Well, but you haven’t answered my question–what if we meet NED at the end of chemotherapy?
ONCOLOGIST: What if we do?
ME: I mean, what if there’s NED and I don’t want to have surgery?
ONCOLOGIST: That wouldn’t be … prudent.
ME: Why not? I actually know why not, but I have to fight surgery all the way to the end. I don’t like the idea of being a one-lung Charlie.
ONCOLOGIST: It’s exceedingly rare to have a full, long remission from chemotherapy alone. This is the second time you’ve had disease in that lung. It just makes sense to remove the rest of it.
ME: Aha! I knew it. You were cleverly semi-provisional about the prospect of surgery–that’s why I chose to be treated here–but actually, you’ve been intending to urge it all along.
ONCOLOGIST [smiling] ________.
ME: So do you have a gurney with my name on it ready for the OR?
ONCOLOGIST: We’re working on the embroidery.

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Onconversations IV

Wednesday, July 06, 2011

SUPERB YOUNG CHEMOTHERAPY NURSE (I refuse to use the term “chemo”–if anything doesn’t deserve to have a pet name, it’s chemotherapy): So if it’s working well, it will be six sessions, not four.
ME: That’s counterintuitive.
NURSE (juggling IV bags like Beanie Babies): Yeah–everyone thinks the opposite. But if there’s not enough effect after four, they switch to something else–or the surgery comes sooner, if that’s what’s in store.
ME: That’s what’s in store, I’m sure. I can almost hear the knives and saws being sharpened.
NURSE: So six would be the full course and would mean that it was working well. See?
ME: Yes. Makes sense now.
NURSE: _______
ME: So, how long have you been doing this?
NURSE: Here, at ______?
ME: Yes.
NURSE: Four years.
ME: Do you like the work?
NURSE: I love it.
ME: Do you have other goals in mind?
NURSE: You mean, like a Master’s?
ME: Yes–I mean, I guess so,
NURSE: Not right now. I have a one-year-old baby right now, so with the commute and everything I like the stability.
ME: Congrats! What flavor?
NURSE: Flavor? (Smiles) Oh–a boy.
ME: And the commute?
NURSE: It’s about an hour.
(Pause during truck-backing-up-and-kneeling-bus beeps from the monitor on the IV pole. NURSE murmurs, “From now on just the saline”)
ME: Not so bad. I used to think of commuting to work as a kind of military challenge.
NURSE: _______.
ME: Speaking of which, what do you think of military language for cancer–the “war on cancer,” patients “battling cancer,” and so on?
NURSE: I hate it. Most of us really object to that kind of terminology.
ME: It seems to be getting like the medical version of politically incorrect.
NURSE: Yes, but not as silly, I think.

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