Daniel Menaker

Onconversations XXXVII

Thursday, August 16, 2012

(I talk to a friend a couple of weeks after a  CT scan showed good results six months after the completion of fancy radiation therapy)

FRIEND:  Well, that’s fantastic news!  I’m so glad to hear it. (With a little indignation) How come you didn’t tell me right away?
ME: I’m sorry. I tried to tell everyone who might care with a group email. I just went through the alphabet in the address bar and chose the names of people who I thought might not want to know.
FRIEND: What? “Might not want to know”?
ME: I mean, who I thought might want to know. Not “might not.” Sorry.
FRIEND: Interesting mistake.
ME: Oh, please.  Anyway, of course I should have included you. It’s not my fault if you have some weird email address that has nothing to do with your name.  Isn’t that for adolescents and stalkers and ranters and serial killers? I guess I just didn’t recognize it when it was autofilled.
FRIEND: It’s OK–I’m just having you on a little.  Now that you have good news, I feel like it’s easier to kid you. What’s next?
ME: Another scan in November. The guy says every three months for two years, then every six months.
FRIEND: Why?
ME: They must have some kind of statistical reason.
FRIEND:  I wonder. I mean, does it make sense that survival rates in a case like yours, say, would be significantly worse if it was like every four months?
ME: Hmm. That does seem pretty unlikely. Especially since my case is a little unusual, and since my guy put this second one off for almost three weeks because he was on vacation. It was nice to have a few  more weeks not to have to think about it, except insofar as you naturally have to think about it at least a little.
FRIEND: What does the guy think is going to happen?
ME: He hasn’t said. I haven’t asked. What’s the point?
FRIEND: Planning.
ME:  I’ll just go on trying to do what I want to do until I have to stop. Isn’t that what we all do anyway?
FRIEND: Not all of us have a life-threatening illness.  Well, except life itself.  I said that because I knew you were going to say it. Or something like it.
ME: Right– I would have.  It’s amazing how well the cliches serve you when you’re in situation that really calls for them. Make the most of every day. None of us get out of here alive. Stop and smell the roses.  They actually turn out to be useful and comforting.  And besides, I have actually done some planning–some financial
stuff–and I think it’s pretty much taken care of.
FRIEND: You mean, like your will.
ME: Among other things, yes. It’s interesting–in an earlier will I left a thousand dollars to a pretty random friend just to enjoy while I was alive thinking about the postmortem surprise he would experience.
FRIEND: That’s very weird.
ME: But this time everything was serious, befitting my age and condition, probably.
FRIEND: What are you leaving to me?
ME: A grown-up email address.

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Onconversations XXXVI

Wednesday, August 01, 2012

(Another follow-up CT scan, six months after the completion of two courses of stereotactic body radiation therapy–SBRT (http://radonc.ucla.edu/body.cfm?id=61).  Preceding the test, the usual nerves.  “Scan-to-scan anxiety is real,” my thoracic oncologist has written to me in an email. Thanks, Doc, I say to myself. The appointment for the scan is at 2:30 in the afternoon, for the consultation about the scan at 4.  Owing to amazing downtown-and-crosstown-bus luck, I get to the hospital at about 2. They take me in for the scan very quickly, and the scan itself is also very quick. The technician gives nothing away.  You try to read something into their “Have a good day”s and “Take care”s when the test is over, but they have become expert at hiding their knowledge of what the scan has or hasn’t shown. So I’m done with the scan before 3.  Will I have to wait until 4 to see the young radiation oncologist? No.  I’m taken into an exam room almost immediately.  There a nurse comes in with one of those rolling vitals poles and takes my vitals–white-coat effect pretty apparent.  Blood pressure 160/60 (weird!), pulse 110, but blood-oxygen level–the little clip they put on your finger; how does it know anything?–very good: 98%.  Weight 174 with clothes on–which is great because it means my weight is around 170.  It’s  great because I have spent the past week at the Southampton Writers Conference eating everything in sight and thought I must have put on five pounds but haven’t.  Then in comes a handsome young resident–they rotate through radiation oncology; this is the third one I’ve seen over the past year of chemotherapy and SBRT. [Don’t forget that my wife and I are still waiting for the results of a crucial CT scan all this while.]  He is thorough but very fast–heartstethosocopebreathingstethoscopechesttappingbacktappingunderarmlymphnodepalpitationnecklymphnodepalpitationmusclestrengthtestingreflextestingeyemovementtestingandsoforth, and as he’s being thorough and quick, we talk.  He says something about having lived in Boston for seven years.)

ME: You went to school there?
DR: Yes.
ME: Harvard? [What an idiot!]
DR: Boston University.
ME: Undergraduate and medical school?
DR:  Yes.
ME:  And you’re rotating through radiation oncology right now?
DR:  Yes. You’re in good shape.
ME: Thanks.
DR: Well, Dr. ________ is looking at the scan right now. I took a brief look before I came in to see you.
ME:  (Thinking, “And …?”)
DR:  He’ll be in to see you soon. We just have the preliminary report now.
ME:  (Thinking “AND …?”)
DR: Uh, he’ll tell you all about it. We won’t have the full report until a little later.
ME: OK.
DR: Do you work out?
ME: Yes–four or five times a week.
DR: What do you do?
ME: I do exercises for half an hour and then run for half an hour. Shuffle is more like it.  (A standard small joke. Very small.)
DR:  Very good.
ME: And do you work out?
DR: I wish.
ME: Your work here doesn’t allow it.
DR: Not usually.
ME: Well, that’s unfortunate.

(Here I make a comparison between the speed with which the resident went through the tests and the way our dog sort of does all his tricks in an efficient hurry in order to get his treats as soon as possible. The confession of this moronic and insulting comparison is bad enough–I wanted to bite my tongue in half even as I continued to slog through it.  But I can’t bear to set down the details.  The resident wore a look of indigestion while I went on.)

DR:  Hmm. Interesting. Well, good luck. It was good to meet you.

(A few minutes later the oncologist comes in to see me.)

DR: Well, the scan looks very good.
ME: Excellent!
DR: (seems very pleased with himself, more pleased than with the actual result–as he should be, since this whole course of treatment has been something of a gamble that we took together and he has been at least temporarily vindicated.) Yes—it’s just what we hoped.  The nodules appear to be gone. There are no new ones, and your lymph nodes show no evidence of spread.
ME: Excellent.
DR: This is just a preliminary finding. Someone else who is expert at reading scans will be looking the scan over very, very carefully soon, and we will let you know what he says.  Probably we’ll call you.
ME:  How annoying! Tell him not to bother.
DR: What?
ME: The expert–tell him he doesn’t need to look very carefully. I’m satisfied right now.
DR: (gravely)  I’m afraid I’m not at liberty to do that.
ME: I’m kidding. Just happy to hear this news.
DR: (faint smile) There is some scarring from the radiation, and it could be that the scarring is obscuring something, but I don’t think so.
ME: Well, this is great.
DR: I’d like to do another scan in another three months.
ME: Or four, maybe.
DR: (nods his head, not in agreement but in comprehension of my deranged mood)  Three months.

(At home, an hour later, the resident whose examination of me I compared to a dog doing tricks, calls.  “The final report confirms the good findings,” he says, hastily.  “Congratulations!” He gets off the phone as quickly as possible.)

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