Biopsy results

It might have made for more interesting writing if I had cancer, but I don’t. The doctors don’t know what I have. They suggested that I have a follow-up CAT scan in three months to learn if C-5 has done anything else weird. Peggy thinks it is a space alien; it does look other-worldly.

My surgery was at the huge new hospital, and the operating room was also right out of science fiction. For one thing, I counted five large screen, flat panel televisions from where I lay with my throat exposed and my head in a plastic doughnut. On each of those screens was an inside view of my neck, and everything in my neck was in some shade of gray; everything that is except for C-5, which was a brilliant white. It was weird, I tell you, to lie there with these enormous C-5s staring down at me from every angle, and me knowing that a team of strangers in masks was about to stand in the glare of two huge round spotlights; press a razor-sharp knife to my throat; and cause my blood to flow up my neck, down either side, and even into my ears and hair (Peggy did wash blood from my hair).

Yesterday, the surgeon went ahead and sent me to the scheduling clerk to set a date for my next operation, one to unpinch the nerve that makes my right arm tingle. She said she doesn’t think I need shoulder surgery, that this neck surgery will eliminate my shoulder pain. My last neurologist and my orthopedist think differently, but it’s hard to argue with a woman who just cut from the front of my throat all the way to my backbone and made it almost as painless as opening a bag of tortilla chips.

Her assistant walked to the desk with me, and I happened to say something on the way about the pain in my left shoulder. He disappeared and a moment later reappeared with the surgeon. “You have pain in both shoulders?” “Yes, the pain is in both shoulders, but the tingling is only on the right.” I didn’t remind her that she already knew this. “Then that’s a whole other and more drastic surgery, so I want to try a series of steroid shots first. They give some people relief for years.” Okay. Cancel second surgery. Schedule first steroid shot. This is the kind of weirdness that I run into all the time with doctors. They spend almost no time with you, don’t listen to half of what you say, and then send you off for risky tests and procedures.

I back the van out of the garage for Peggy when she goes to work. I do this because it is almost wider than the garage door and scary for her to back out. Today (Friday) was her first day back at work. The van’s CD player took up where it left off on Monday when she brought me home from the hospital. I was puking IV fluids at the time, so the relaxing New Age music struck a different chord this morning.

Peggy and I felt pretty good when we left the doctor’s office on our bikes. Then she remembered a paper she had meant to bring (a form she needed the doctor to sign regarding the days she took off from work). I could tell she was really mad at herself for forgetting it. “Peggy, we just found out that I don’t have cancer. Why are you so bummed about a damn form?” A short while later, my own exhilaration wore off, and all I felt was enormously tired and even a little empty. Once we got home, we had all these phone calls to make to people who were awaiting my biopsy results, and I simply wasn’t going to make them, because I knew everyone would be happy and relieved, and that they would expect me to be happy and relieved too. It wasn’t that I didn’t feel these things; it was just that I was drained of all energy. Within minutes, I had gone from planning a celebratory meal out to wondering if I could stay awake long enough to eat a salmon burger at home.

I can best explain my feelings this way. Imagine that you’re crossing the street a little distracted—listening to your iPod maybe—when all of a sudden an 18-wheeler comes barreling down on you with its air horn blowing, its brakes screaming, and misses you by six inches, the turbulence alone almost knocking you to the ground. Would you feel like going out to celebrate the fact that you were almost, but not quite, killed?

I was surprised by my ennui because I had been relaxed at the surgeon’s office. I had two really distressing events this week, both of which I had known about and dreaded for days. The first was having my throat cut, and the second was getting my biopsy results. Yet, I went to both of these events relaxed. I’ll try to explain. A stressful event is made such by the nature of the event itself, but also by our emotional resistance to the event. In the case of my two events; I knew that they were going to happen, that there was no rational way I could stop them from happening, and that I might as well surrender myself to them, thereby giving them permission to happen. I transformed myself into clay, into water, into a complete pacifist; and this enabled me to approach these formerly dreaded experiences with disinterested curiosity.

So why then, when I had felt relaxed at the surgeon’s, did I feel so tired afterwards? Had I not really been relaxed after all, but had only fooled myself into thinking I was relaxed? These were unsettling questions, and I simply didn’t have the emotional energy to entertain them. Instead, I reminded myself that I had survived a very hard week that had come on the heels of many very hard months; that I had behaved bravely; and that I have earned the right to forgive myself for not being a perfect human being. Being human is a devastating proposition because it also means being flawed. My doctors are flawed; my nurses at Sacred Heart were flawed; I too am flawed; and I forgive us all. May God help us all, and may God save us all because we most certainly cannot save ourselves.

Awaiting a possible death sentence

Twenty-three hours and ten minutes from now, I will be told whether I have metastatic cancer. That moment will either be the beginning of a new life (a life that will include an early death) or it will be, more or less, a continuation of my old life.

Once is how many times I have seen the surgeon who will carry the news (the second time I was unconscious). How might I prepare for hearing my death sentence from the lips of a stranger, a woman stranger? Getting through that moment seems, in this moment, like the hardest thing I will ever have to endure. Mostly, I don’t want to cry. Silly at this might seem, I am, after all, a man, and I possess a man’s vanity.

Along with terror, I feel a strange exhilaration, as if I had bet my life savings on the roll of a roulette wheel. Sure, I could lose big, but I could also win big, and what bigger prize to win than my life?

Post surgical adventures

I don’t have biopsy results. The surgeon said she would replace the bone while I was on the table if the lab could tell right away that it was malignant, but the lab couldn’ tell right away. No news is good news, I suppose—or at least it’s not bad news (I’m too tired and drugged to know which). I am to learn if I have cancer at 3:00 Thursday.

I feel much better than expected, but that could be because of the Percocet. I observed after past surgeries that I would feel good enough that I would think I didn’t need painkillers, only to have the pain return with a vengeance when I stopped them. It’s definitely harder to beat pain back down than it is to keep it down in the first place. Still, I will replace my next Percocet with a Vicodin and see what happens.

I was in excruciating and ever worsening pain yesterday after being intubated, and I got no relief even after being given the highest dosages allowed of at least a half dozen painkillers. One of the funny things about painkillers is that they can knock-you-on-your-ass if your pain level is within their ability to handle, but if it’s beyond what they can handle, you can’t even tell you’ve taken anything.

The nurses were at a loss to understand my pain since it was well beyond what most people experience. They just knew that my oxygen level was below ninety, and that I was reporting intolerable pain even after having taken everything they had to give. They wouldn’t discharge me, yet they couldn’t help me, and they wouldn’t let me use the one device with which I thought I could help myself—my CPAP. They didn’t appear to know much about the machine, but their main objection was that they would have to call the hospital electrician to inspect it, and that this was too much of a bother for something they had no confidence in anyway. When I degenerated to the point of no longer being able to speak (due to the pain and lack of oxygen), they called the electrician.

He arrived in five minutes; picked up the unplugged CPAP; examined it for five seconds; said, “Looks okay to me;” and put an orange sticker on it. Ah, the security that comes from a professional safety inspection. With my first breath, I felt significant relief, and my oxygen saturation soon jumped from eighty-eight to ninety-nine. My theory is that a swollen trachea caused the pain. By opening my trachea with positive air pressure, the CPAP both relieved the pain and allowed the passage of air. Since a CPAP’s normal use is for sleep apnea, I can understand why the nurses didn’t believe it would help a patient who was awake, yet they could have spared me hours of misery if only they had called the electrician sooner.

The morning of surgery

The time is 4:20 a.m. I have to be at the hospital at 5:45. I am calm. What will be, will be, and I am prepared to face it with dignity.

People with their throats cut generally look dead; my first death

I never saw anyone with their throat cut but what they looked the worse for wear; in fact, they looked dead and they didn’t die smiling either. Judy (that would be Doctor Judy) says not to worry, that she cuts two and three throats a week sometimes. What I want to know is how she finds that many people who (a) need their throats cut and (b) are willing to let someone do it.

I had my first serious surgery about eight years ago. It was such a new and unusual procedure that I had to drive 110 miles to the Oregon Health Sciences University to see the one doctor in Oregon who knew how to do it. Dr. Hwang was so young, and little, and smart, and cute—not to mention caring—that I would have adopted him in a heartbeat. He suggested that I have the surgery in two parts to minimize the risk, but I wanted it ASAP, and I had no qualms about trusting him to do it up right. The morning he was to operate, the anesthesiologist came in first (as they always do), and offered to give me a little something for anxiety. I told him I wasn’t the least bit anxious—I was just enthusiastic. He thought I was putting him on, and we got into an argument about whether I was anxious. When he saw that he couldn’t win that one, he left. I thought he might hold it against me, but he and Hwang both did bang up jobs in surgery and, what with being awake but stoned out of my gourd, I enthused all over the place about what great doctors they were.

God, but I miss those days when trust was a given and surrender came easily. By now I know the routine well—the pre-dawn drive to the hospital, the forms to sign, the wrist-bracelet, the humiliating gown, the hasty “vitals,” the endless questions from the endless procession of nurses about why I am there and when I last ate, Peggy’s attempt at casualness, the anesthesiologist’s visit, the trip to the bathroom with a nurse carrying my IV, the stretcher ride to the holding area with the lights passing overhead and the curious strangers looking down at me, the inevitable crashes at corners, and finally into surgery. There, the many people in masks and gowns, the perfunctory courtesy, the move from the stretcher to the operating table, my diseased fingers turning white from the cold, my arms being stretched to either side like the crucified Jesus, the additional warm blankets that are never enough, feeling helpless and exposed, waiting eagerly for an injection of happy juice. Then recovery. I will have stayed awake for surgery if possible, so I pass the time listening to other patients moan and puke, and trying to recollect everything that happened. If the surgeon gives a shit, he comes by to tell me how it went.

Is recovery where I’ll be told if I have cancer? Probably not. I’ll be put to sleep this time, so I’ll be among the moaners and pukers. Probably Peggy will know first, and probably Peggy will be alone. Then again, maybe no one will know. The surgeon said that calcification might make an early diagnosis impossible. If this is so, and if I have cancer, it will mean a second surgery to replace the bone. Or not. I’m not going balls-to-the-wall unless I have a decent chance of survival.

I used to wonder how a doctor tells a patient he has cancer. I thought they would have learned some special words in medical school. I’ve had four doctors this year (three in October and one in January when I had hernia surgery) throw out the possibility, and I was struck by their casualness. The neurologist who brought it up in October told me over the phone. Phone calls from a doctor usually mean bad news, but I wasn’t expecting anything like what I heard. “It might be cancer, and if it is, it would have spread from someplace else—possibly the prostate. You need to see your internist about what to do next. Good bye and good luck.”

If someone who didn’t know English had tried to judge the nature of the call from the tone of the caller, he might have thought that Blockbuster was telling me I had a movie overdue. I imagined that this doctor never gave me or my problem another thought after he hung up. And why should he?

I first watched a man die when I was a fourteen-year-old ambulance attendant. The call came at 7:30 on a Sunday night, right in the middle of Mission Impossible. We found the man alone and unconscious on his partially mopped kitchen floor, and he died as we lifted him into the white Ford station wagon that passed as a Mississippi ambulance. CPR hadn’t been invented, and when I started to apply an oxygen mask, the boss laughed and told me not to waste his money.

As we drove back through town, the streetlights were still burning, the man at the filling station was still pumping gas, and people were still leaving church. I had expected the world to stop, and it hadn’t even slowed down. That was forty-five years ago. My belief that my kind was the center of the universe and the pinnacle of God’s creation also died that day.

If only I have enough time to finish editing my journals, I will be grateful. If I don’t have cancer at all, maybe my other problems won’t seem quite as bad.

What good is God?

It takes about four hours to do the yard up right, and I don’t remember a time in my adult life—except once when I had the flu and twice when I had strep—that the job would have tired me out, yet I only lasted 45 minutes today before I had to slow down. After ninety minutes, I felt the need to take an extended break. This is how I am spending my break.

My fatigue made me remember my neighbor, John. Five years ago, he drove 120 miles over the Cascades, climbed a 10,358 foot peak, and drove home, all on the same day. Few people could do as much at any age, but John did it at 55. Instead of being pleased, he was upset that it drained all his energy. He went to the doctor the next week, and died of prostate cancer the next year. While I was working in the yard, I seriously entertained the thought that I really might be facing death.

It was this melancholy realization that made me think of Eugene Sledge, a World War II soldier who wrote about the battles on Pelieu and Guadalcanal. Sledge said that new soldiers typically think they’re too smart to get killed. When they observe that more experienced soldiers than themselves get killed all the time, they conclude that they could die, but that they probably won’t because they’re special to God, and God will protect them. Then they see their friends die—sometimes horribly—and they are forced to ask themselves what makes them more special than those people. When they can’t think of anything, they conclude that, not only might they die, they are almost certainly going to die.

Then I remembered Dana Reeve, the wife of Christopher Reeve, who died of lung cancer less than a year after his death. I saw her on a DVD about health care recently. She was well dressed and appropriately made-up, but her eyes were tired, and her pauses for air came too often and lasted too long. I admired the hell out of that woman because she radiated such incredible courage by trying to help other people live longer when she was so near death herself. I had the thought that a good death would go a long way toward making up for a life that, if not failed, is nothing to brag about either.

When I listen to Pachebel’s Canon in D, I often reflect that, if Johann Pachebel didn’t do another thing but to write that one piece of music, a piece that comes nearer to embodying the divine than anything else I’ve ever seen or heard, it would have justified his entire 53 years. What, then, have I done to justify my years?

The one thing that I just cannot see my way to bear is my knowledge that I will be leaving Peggy alone. If only I could have her hypnotized so that she would come home from the funeral wondering how she ever put up with me to begin with and glad that I was dead, I would prefer that a million times better than to think that she will experience a grief that is beyond anything I can imagine. I picture her here, in this house, crying alone in the wee hours. I picture her coming home at night without me to greet her and without her supper on the table. I picture her taking her bike out for a ride while my bike remains behind. I picture her sitting in this chair, at this computer, getting things all fouled up, and not knowing how to straighten them out, and not having me to call.

If I could imagine now everything she will feel then, she might feel less alone for knowing that I traveled the same road ahead of her, but I know I cannot. Writers from Job to Eugene Sledge were right; God’s favors are not bestowed according to merit. What then, is the good of God?