Tuesday, July 14, 2009

A real head case

My appointment on Tuesday with Dr. B1 was shaping up as a biggie, so I was thrilled when my best buddy offered to leave work early and join me.

I sometimes feel guilty when I'm with my doctors and they have to wait on me to write my questions to them in longhand. I feel even worse when my doctors struggle to read my handwriting. It's helpful having a someone with me who can speak directly to my doctors, and it's even better when that person is someone who usually can tell what's on my mind just by reading my expression.

Just minutes after we took our seats in the waiting room for Kaiser's head and neck department, a nurse manager told us that Dr. B1 had been called to the hospital on an emergency. Dr. Rhonda Lubka, another physician in the head and neck clinic, would see me instead, the nurse explained.

My heart sank. But I also knew that if I was that guy in the hospital with an emergency need, I would want Dr. B1 there.

The wait for the appointment was long. I filled up two sheets in my legal pad chit-chatting with my buddy, and I ran out of conversation. So I tried something new: singing.

When I had a voice, my singing could bring prisoners of war to their knees begging for mercy, but gimme a pen and some paper and I can be a regular Enrico Caruso. To pass the time before my appointment began, I decided to croon tunes from a CD that has been playing in my car for weeks.

"I am a lineman for the counteeeeeee," I wrote, adding musical notes and squiggly lines around the lettering.

My buddy stared quizzically at my pad. "Are you serenading me?" he asked.

"Like a rhinestone cowboy," I warbled in script.

My buddy grabbed the pen and pad from my hands. Continuing the Glen Campbell theme, he wrote "Southern nights." His musical notes looked more authentic than mine.

By the time I got to "By the Time I Get to Phoenix," our hootenanny was over. The nurse called my name and led us into Dr. Lubka's examination room.

Once I sat in the chair to wait for the doctor, I jotted down the topics that I hoped would be covered in the visit.

First, I wanted to find out if Dr. B1 had reviewed my June 25 PET scan, and what his take on it was. Next, I wanted to find out what Dr. B1 thought about doing a biopsy. I hoped to hear Dr. Lubka say that my airway was clear enough to consider having my trach removed sometime soon, and I wanted to find out what I should be doing to treat all of the pain I've been feeling in my mouth, jaw, gums, chin and head.

From the moment Dr. Lubka extended her hand to greet me, it was clear that I was not dealing with a mere understudy, or a substitute teacher unfamiliar with the lesson plan.

Dr. Lubka said that she had talked with Dr. B1 about me before he left to go to the hospital, and she called up my medical records on her computer. She looked at my MRIs, CT scans and the recent PET scan and she dropped a laryngoscope down my nostril to try to get a look at the suspicious tissue revealed in the most recent scan.

I may be oversimplifying Dr. Lubka's comments, but she seems to think what most of the oncologists believe is cancer may in fact be dead scar tissue, or "eschar."

No conclusions were reached today about the next steps in my treatment. Getting a biopsy in the affected region of mouth is complicated by the immobility of my jaw. Under anesthesia, my muscles may relax but forcing my mouth open could break my jaw.

Entering the problem area through my neck with a knife is risky because I might not heal properly. (How do you think Frankenstein's monster got those rivets?)

Instead, Dr. Lubka promised that she would talk to Dr. B1 and said that I would hear from him very soon.

I wrote "thank you" in my pad and then we left.

On the way home, I heard "Wichita Lineman" the way it was meant to be sung. Maybe someday I'll get to sing along.

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