Daniel Menaker

Onconversations XLI

Monday, November 26, 2012

(In the CT place for my third follow-up scan after Star Wars radiation treatment a year or so ago. )

TECHNICIAN: Please take off your sweater and shirt.
ME: I’m getting to know the drill.
TECH: You don’t have anything around your neck, right?
ME: Nope. Well, nothing physical.
TECH  (laughs, half-heartedly, but then says): Yeah, I asked a guy the same question earlier this week and he said, “Nah–I left my wife at home.”

(I climb on the slab, extend my arms over my head, getting ready to ride the ferry into the doughnut hole of the CT machine.  “Don’t breathe,” the mechanical voice says, sternly, and a green, Pac-Man-esque face appears on the narrow display over my head with his mouth closed, as whatever it is whirls around me. “Breathe”–just as sternly, and the little round face appears with its mouth open, looking very cheerful. The ceiling of this room has a kind of trellis of leaves and flowers painted on it.  It’s less cheerful than bizarre.

Then, I have to go to  another building to meet the radiologist and get the test results. I am not wildly anxious, but I melt a couple mgs. of Valium in my mouth, just to take the edge off the one-hour interval. My wife joins me in the second waiting room. After a while a nurse comes in to fetch us into the examination room.)

NURSE: How do you feel?
ME: Good. Except for this pain and skin sensitivity on my back and lower chest.
NURSE: That’s the radiation. How about your weight?
ME: I’ve put on a few pounds, if anything.
NURSE: Good.
ME: A rale or two from time to time.
NURSE: The radiation. Any difficulty swallowing?
ME: A little from time to time, but no more than I’ve had for some years–a side-effect of blood-pressure medication, I’ve been told.
NURSE: Right. Heartburn?
ME: As a matter of fact. yes, a little.
NURSE: That’s the radiation.  Your last bowel movement?
ME: This morning.
NURSE: OK. Please get up on the scale.
(I do.)
ME: Take six pounds off–I have a lot of junk in my pockets.
NURSE: _______
NURSE: OK, it will just be a few minutes and Dr. ______ will be in to see you to discuss the scan.
(Discuss the scan? I don’t like the sound of that. A few minutes pass.)

DR (enters and says immediately, as he bustles into the room, and with out really looking at me): The scan is good.  (So much for discussion.)
DR: Now about this pain …
ME: It just went away.
DR: What?
ME: It’s really strange, but the pain just disappeared.
DR (getting it, although in fact the pain really did suddenly subside): Ah, the psyche is an extremely powerful organ. But seriously, tell me about the pain.
ME: It’s not a big deal. It’s right below my ribs on the left side, and you can feel a little swelling there. The only time it really bothers me is at night.
DR: Would you lift up your T-shirt?
(I do. Doctor examines my chest and stomach.)
DR: I don’t see or feel anything.
ME: It’s there– it really is. (I try to show him.)
DR (palpating the left and right sides of my lower chest): I can’t feel anything different.
ME: It doesn’t matter to me, now that I know the scan results. Nothing matters except that. But there is swelling there. But really, never mind.
(My wife suggests some possible remedies–a pillow like the one she uses for her back and some medication that she takes. Dr. ________ is skeptical.)
DR: What we can do is try some Lidocaine patches.  I’ll give you a prescription.
ME: If I keep feeling this way, I won’t need anything.
DR: Yes–I’m very pleased too.

(I keep hoping for a truly funny or otherwise bloggable moment, but it doesn’t happen.  Unless you count the fact that on the way home, the crowded crosstown bus–creeping along 66th Street toward Central Park and then Lincoln Center, this bus which would usually drive me nuts with New Yorker-type impatience [the wheelchairs, the walkers, the cell-phone conversations, the sanitation trucks blocking the way, the bulky clothes too early for the season, and so on]–this bus seems to me all jollity and energy and, well, life.)

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Onconversations XL

Tuesday, November 13, 2012

(With a couple of weeks to go before my next follow-up CT scan, I notice a slight swelling at the bottom of my rib cage on the left, and I have continuing pain in the middle of my back–both are sites where the stereotactic body radiation therapy beams were zapped through eight or nine months ago. The swelling is sore. I am on about four Advil/day, so this pain–which is expected and normal (if anything is normal in the cancer world)– is not severe, but the swelling is new, and I don’t like it. It feels like there’s a little cylindrical sponge under there. So I write an email about this development to my thoracic oncologist. He usually responds to emails, and I use this courtesy as sparingly as I can. I realize that it might be better to call my radiology oncologist, but sometimes when I call his number and the lovely-voiced assistant isn’t there to answer, the phone rings four or five times and then this voice comes on the phone and practically shouts out “Radiology!” The first two or maybe even three times I called that number, I thought it was a real if somewhat impatient human being. But it was Radiology’s version of an answering-machine message, and it left me a bit flummoxed. But guess what: My thoracic guy is out of the office, it seems, because I get no reply. So I call the Radiation number.)

PHONE (after four rings): Radiology!
ME: Um, hello? Oh. Yeah. Message. Well this message is for Dr. ________ This is Robert Menaker calling, You know, Dan Menaker. Robert Daniel Menaker. Well, Menaker is all I need to say, probably. Anyway, I have this sore swelling right under my rib cage and I wanted to ask Dr. ________ about it. Maybe he could call me back. (I give phone number.) Thank you.

(Later that afternoon, the thoracic guy’s nurse calls me back.)

TG’S NURSE: This is ________ from Dr. ________’s office. You emailed earlier today?
ME: Yes–thanks for calling back.
TG’S NURSE: Dr. ________ is out of town. Maybe I can help you.
ME: Well, I have this swelling at the bottom of my rib cage, and then there’s the pain in my chest and back, which I understand is normal.
TG’S NURSE: Can you describe the swelling?
ME: Yes, it’s like a little skinny mole or vole under my skin–soft and rounded.
TG’S NURSE: A mole or a what?
ME: Let’s just stick with “mole.”
TG’SNURSE: When did you notice it?
ME: A week or so ago. I finished my radiation treatments about eight months ago, and was told then that there would probably be pain, though it’s a little worse now. But it’s the swelling that’s new.
TG’S NURSE: Eight months ago?
ME: Yes–I think that’s a normal time lapse for the pain part.
TG’S NURSE: Really?
ME: Yes.
TG’S NURSE: Have you thought about calling Radoiology?
ME: Yes, I called and left a message.
TG’S NURSE: Well I know Dr. ________ will want to talk to you when he gets back, but in the meantime, I’m sure Radiology will call you back.
ME: OK, well, I’ll just wait.  I probably shouldn’t have bothered you. It’s just that their answering-machine message is sort of like a drill sergeant–a little daunting.
ME: Nothing. I’ll just wait.

(No more than half an hour later, the Radiation Oncology nurse calls me.)

RO NURSE (briskly): Is this, er, Menaker?
ME: Yes–Robert Menaker. Daniel, you know–
RO NURSE: Date of birth?
(I give it)
RO NURSE: Dr. ________ asked me to call you. What seems to be the problem?
ME: I have this new swelling right at the bottom of my rib cage, and this pain.
RO NURSE: The pain is normal–do you need anything stronger than OTC meds?
ME (tinily but still ludicrously proud of knowing what “OTC” means): No–just taking three or four Advil a day.
RO NURSE: That’s not so bad, considering how close the nodules were to the chest wall.
ME: But the swelling is new–it seems like a little soft roll under–
RO NURSE: Normal also.
ME (relieved): Really?
ME: This late?
RO NURSE: Perfectly normal.
ME: Well, good. I mean, not good that I have the swelling, but–
RO NURSE: Yes, I know. Your next scan is on November __th.
ME: Right. Thank you.
RO NURSE: So don’t worry, OK?
ME: Easy for you to say.
RO NURSE (laughs): Right.

(The following Monday, the thoracic oncologist calls me.)

TO: So I hear you called about some swelling.
ME: Yes, but Dr. ________’s nurse got back to me and said it wasn’t anything to worry about.
TO: Right.
ME: I probably should have just called that office in the first place. But not to be a wuss or anything, but their answering-machine message is scary. Some autocrat yells out, “Radiology!”
TO (laughs hard): They’re more about protons than personality.
ME: You didn’t need to call back, but thank you.
TO: Don’t worry–I like to know what’s going on.
ME: I don’t want to be one of those patients who– Well, you know.
TO: You’re not. You’re an ideal patient.
ME (pleasantly taken aback): Really?
TO: Yes.
ME: Jeez, I’d like to put that in my blog, but how can I do it modestly?
TO: You can’t.

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Onconversations XXXIX

Sunday, November 04, 2012

FRIEND 1:  You know, my mother filled out all these DNR forms, but a lot of times in a hospital they don’t follow them.
ME: Doctors just take care of it all the time. They just do it.
1:  Not necessarily in hospitals. There are all these protocols and procedures.
ME: I think they just quietly usher the person out quite often.
FRIEND 2: It’s the nurses, a lot of times.  They’re the ones who make it harder. Especially if they’re very religious.
FRIEND 3:  My father died at home, and when he was going, the assistant nurse was new and she didn’t really know what she was doing. So somehow she gave him only ten percent of the morphine he should have been given.
ALL: (Groan, say “Oh, no,” then are silent, thinking of the unnecessary suffering.)
ME: I am determined to take care of this myself while I still can, or get the best, um, facilitator I can find.
2: Everybody says that, and most people end up having a harder time than they should.
3. I read somewhere–I think it was Philip Roth writing about his father–that dying is always hard work.
ME:  You know, you hear that about just about everything. Work is work, play often involves work, pets are work, kids are work, friendship is work, and you have to work on your marriage. It doesn’t seem fair that marriage is work.  Too much work. And now dying is work. Probably you have to work in Heaven too. Singing praise is probably work.  Hell might be better–you don’t really have to work on anything.
1 (looking at me, contritely): Oh, no, Dan. I hope we haven’t depressed you with all this talk.
ME: Why? Not at all. I like deathy conversations.
1: Well, you know–I was just thinking of your…situation…and I was thinking that this kind of talk might get you down, considering…you know. I’m sorry.
ME: Well, until this moment, it hadn’t occurred to me at all, but now I am depressed because you thought it would depress me.
1: Well, I’m sorry.
ME: I was joking. Sort of.

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