When Cancer Comes To Call

A patient story tonight, from Jackie:


It was one of those days.  I had been to the gynecologist the week prior because I somehow knew the sporadic bleeding which I had experienced was NOT a simple Urinary Tract Infection for which I had been treated three times.  My doctor did the scrapings and biopsies and had me run down the hall for an ultrasound.  I’d had lots of ultrasounds during my pregnancies – especially with my twins -  but this one wasn’t fun.  There was no cute baby to smile at.  This time it was a transvaginal ultrasound which involved the insertion of a rather large tube into “that place” to look at the uterus.  “My what a big wand you have” I joked with the sonographer.  She didn’t smile.  That’s when I got a bit nervous.

Of course my doctor put a positive spin on everything – prior to the biopsy results.  He said it was probably just an over thickening of the uterus, Hyperplasia.  So I decided to wait until there was something solid to review and went on about my life.  I had a dental appointment a few days later.  My dentist announced I needed a root canal immediately and sent me to a nearby Oral Surgeon.  As I was pulling up to the Oral Surgeon’s office my cell phone rang.  It was my gynecologist.  “Well, there is a malignancy….”.  The words hung in the air.  We had a brief conversation – darn, I thought – I had researched  Hyperplasia thoroughly and knew all the right questions to ask.  I felt like I had studied for a test and then the test changed.   He said I needed to contact a special Gynecological Oncology surgeon and that his office would tell me what’s next.  So I called and left a message with that doctor but said I couldn’t talk for a couple of hours because I was just about to go in to have a root canal.  One thing I will say about those specialists’ offices; they run like a well oiled machine.  As I walked back to my car 2 hours later there was a message on my cell phone.  It was Jay, the Office Manager for the Gynecological surgeon I needed to see.  He was calling to schedule my appointment.  He paused and said “Good luck with the root canal. Sounds like you are having a great day”.   And so it went.

My life was forever changed.  May brought the diagnosis.   June brought the scheduling of the hysterectomy.  July 1 was the surgery.  July 10 came the pathology report.  Not what we had hoped for– the “once and done” hysterectomy revealed some naughty cells lurking within the uterus that have a tendency to “jump” into other areas.  Chemo or Radiation? My case was submitted to the Austin Gynecological Oncology Tumor Board for review as recommended by my Surgeon.  I was overwhelmed.  I didn’t know what I didn’t know.  As is often the case when you do get the “C” diagnosis; you are thrown into a blender of emotions but when the dust settles the appetite for knowledge takes over.  And so it was decided that radiation was the protocol. After I healed from surgery, radiation began.

So here’s the thing:  it wasn’t that horrible.  For anyone who has been through tough times, worked hard and experienced inconvenience or sadness – you are mentally strong and prepared for this challenge.  It is definitely a Mind Game.  I decided to fight and endure and not to whine and whimper.  For 6 weeks my life revolved around daily visits to the Oncology Center.  The treatment wasn’t bad.  The hardest part was drinking 40 ounces of water prior to treatment.  The side effects clicked in about 3 weeks in; lower GI issues.  But oh well, diarrhea is not the end of the world.  My pubic hair fell out which I found fascinating. I met wonderful friends in the waiting room.  The therapists and nurses and doctors were wonderful.  My neighbors and family rallied and emotions ran high.  Food and flowers poured in.   My sweet neighbor who had just finished two years of breast cancer diagnosis, surgery, chemo, radiation, reconstruction – I was at her door daily for her battle.  Now, she was at mine.  Life sifts down to the basics of priorities: Faith and Family and Friends.

I finished my radiation on September 15 and got to Ring the Bell which is special to all cancer patients because it means YOU ARE DONE.   My sweet family and a few friends showed up.  Tears flowed.  My husband pushed through the group to shake the hand of my Radiation Oncologist and choked “Thank you for helping my wife”.  I was ready to start my new healthy life.

Check-ups will continue for a few years and I will see both my Surgeon and Radiation Oncologist often. That’s okay.  My Surgeon is cute (I think he is almost the same age as my oldest son) and my Radiation Oncologist is an incredible mother of four who never seems hurried or distracted and makes me feel like I am THE most important patient in her practice.  I feel so blessed to have been in such capable hands.

I feel wonderful.   Celebrating my December birthday was more special this year.  Welcoming the New Year signaled almost a palpable relief to make a fresh start.  I take nothing for granted and try hard to live in the moment.  Ever the planner, this has been my most challenging goal.

For Christmas this year my daughter gave me a beautiful silver charm.  On the front it says “Faith”.  She told me to turn it over.  On the back was engraved 9-15-2014.  My final day of radiation.  It has been the most horrible of years, but it has been the most wonderful of years.  When Cancer comes to call you rise up and fight the good fight.  And then, you go on.

Rethinking heroism

For Elly

I have mentioned in previous essays here that I do not treat pediatric patients–that I learned that I don’t have the temperament for it–but I never said why.  The meeting in Boston brought back a flood of memories from the early days of my career, and it is time to revisit some of them.   Every year my professional organization honors one or two or three of its own, for exceptional lifelong service.  This year, Dr. Robert Cassady was one of the honorees.  During my residency, he was the Chairman of the Department of Radiation Oncology at Boston Children’s Hospital and I had the good fortune to rotate on his service.  He taught me a lot about compassion, and how to approach difficult problems.  But one lesson I failed to learn was how to mask my feelings for the good of the patient, and the family.

In 1985, I was asked to see a two year old boy with Stage IV neuroblastoma.  This is a malignant tumor which develops from nerve tissue, occurring in infants and children.  Most neuroblastomas begin in the abdomen, in the adrenal glands or next to the spinal cord, or in the chest.  The disease is most commonly diagnosed before age 5, and the incidence is 1 in 100,000.  In most cases, the tumor has already spread when it is first diagnosed.  The little boy that I was asked to see had failed numerous rounds of chemotherapy and radiation.  There was nothing more that we could do.  Somehow, I found myself in the uncomfortable position of telling his young mother that her firstborn child was going to die.  She started to cry.  And then I started to cry and I could not stop.  When Dr. Cassady offered me a job at Boston Children’s a few months later, I declined.

At the meeting, I had time to reconnect with an old friend who had been one of my very first residents.  She is an exceptional physician who has had more than her share of tragedies in her own life.  Her husband, who was a prominent child psychiatrist, died young leaving her as a single parent with three children including a fifteen month old boy who will never know or remember his father.  She has spent her career in New Orleans, and after getting through the nightmare of losing her husband, she had to deal with Hurricane Katrina in 2005, which flooded her department, depriving her of a job, and which completely unhinged her eldest daughter  during the formative years of high school. The family was displaced to Florida, their futures uncertain.  My friend recovered from these challenges and losses with incredible courage and dignity.

I sat with my friend at dinner last Monday night, as the winds and rain of Hurricane Sandy raged outside our hotel.  Her family is doing well now, and to my complete surprise, since she made her own career treating gynecological cancers, she told me that she has become the pre-eminent pediatric radiation oncologist in the great rebuilt and revitalized city of New Orleans.  She told me that she loves it—taking care of kids with cancer. I was incredulous—I asked her how she could stand it.  She told me that with what she herself has been through, she feels that she can truly help other mothers and children in crisis.  The triumphs, in her mind, significantly outweigh the tragedies.  She is a “glass half full” kind of person.  She is my new hero.

After spending a few days in her company, I have been rethinking pediatric radiation oncology.  Maybe, it just takes a little bit of life’s hard knocks to be able to be helpful when the unthinkable occurs.  Maybe you just have to be older, to learn that it is indeed possible to “ride on through it .”  And maybe, just maybe, we are ALL capable of a lot more than we think we are.