Monday, October 26, 2009

Double whammy?

Here's one thing you never want to hear a doctor say to you in a solemn tone during an examination:

"I wish we didn't have to have this conversation."

When my radiation oncologist Dr. Chen uttered those words to me on Monday, I crossed my fingers and hoped that his next words would be something like "But we've been hearing complaints about a patient with uncontrolled flatulence in our waiting room and we think that you're the problem, Mr. Serchia."

Instead, I heard the very words from Dr. Chen I hoped never to hear again for the rest of my life:

"It appears that your cancer may have returned."

What? I thought. Back for a rematch —already? Well, that was a short honeymoon.

It was less than three months ago when Dr. B1, my head and neck surgeon, reviewed the results of my last biopsy and declared that the procedure showed no evidence of malignancy.

"That means at this point," Dr. B1 wrote, "we cannot see any more active cancer cells."

Dr. Chen's appraisal of my situation today is based on several factors. One, the nuttiness going on with my face that is rapidly making me unrecognizable to myself is occurring in parts of my mug that were not exposed to radiation during my 33 sessions in winter and spring. Two, the results of the CT scan that was performed on me earlier this month look "suspicious" to Dr. Chen and to another doctor who looked at it today. And three, it is unusual to see symptoms such as I am presenting so many months following the conclusion of radiation therapy.

Dr. Chen's assessment does not necessarily reflect what is truly going on with me. Even he said so. The next step, Dr. Chen explained, is another biopsy, which I hope can be performed during an already-scheduled appointment with Dr. B1 on Wednesday.

That biopsy could support what Dr. Chen said to me today, or it could contradict him.

If the biopsy shows malignancy, however, Dr. Chen says that he is not sure anything more can be done.

Certainly no more radiation, at this point. And my chemo treatments were halted earlier than expected this year after my blood counts dropped, so I imagine that also might limit my treatment options.

I didn't know quite how to respond to Dr. Chen's news so I reacted honestly: I cried.

But my afternoon at Kaiser was not over yet. Next up was a visit with Dr. Y, my maxillofacial specialist, just down the block from the building that houses the radiation and oncology department.

It's possible that osteonecrosis is causing the problems in my jaw and face, but Dr. Y doesn't think that's likely, after looking at my CT scan and two thorough inspections of the tissue in my mouth. If I had osteonecrosis, Dr. Y explained, there would be evidence of exposed bone, and he can't find any.

And believe me, he looked. Today he and an assistant inserted tongue depressors in my mouth to force it open and then Dr. Y ran his finger along the interior of my mouth.

They weren't messing around. The tongue depressors were used as if they were the Jaws of Life, to the point that my mouth began to bleed. The bleeding didn't appear to faze Dr. Y but it scared the crap out of me, reader, and I wasn't thrilled about being sent on my way following the exam with a paper bag filled with gauze.

I didn't shake Dr. Y's hand at the end of the visit because I had blood on my fingers. But I know I must have come across to Dr. Y as grumpy and he probably is hoping that Kaiser doesn't mail an anonymous survey to me to complete about today's visit in Maxillofacial Surgery.

On Wednesday, I'll get a biopsy and then can decide what my next steps are.

Wednesday is also the day that Alice Cooper is bringing his Theatre of Death show to the Nokia Theatre. I had a killer seat in the sixth row of the pit in front of the stage, but I'm letting a friend use the ticket instead.

There's way too many creepy theatrics in my life now to expose myself to whatever fantasies Alice may have cooked up.


  1. Paul,
    We've been out of touch to long. Your blog is at once frightening and uplifting. Such strength you have. As long as I've known you, you've always been a rock of a human being. I very much admire you. Should there be ANYTHING Peter and I can do, please, please, ask. We'll do anything we can to help you out. In the meantime, you go back on both of our healing prayer lists. Eric

  2. Our love and prayers are with you, Paul.
    Hugs, Peter Carlson

  3. Paul, as always, I am in awe of your grace and courage. I will keep you in my thoughts and prayers. Please take care of yourself. Kim

  4. Eric, Peter and Kim: thanks for your support. It means the world to me.

  5. Paul,
    You are in my thoughts - this is just another bump in the road and I trust you will be just fine. I miss you and hope to see you very soon. Keep me posted and if you need anything at all - just drop me a line or a text. I love and admire you so much. Always Shirley

  6. You are an inspiration ... wishing you all the best.

  7. Dude, would it be inappropriate to say something about silver-tongues. Well, anyway, I am saddened by your sadness. Isn't this like cycling, though; you climb that hill, race down on the opposite slope, only to be met around the bend by a nasty wall named innocuously enough: Easy Street.
    Well, you seem to have this gift of seeing things as they are, not as you wish them to be. Perhaps this is your coping tool...reality and all. It does not suit me at all. No siree! I will climb into a fantasy and cry "The plane! The plane!" for no one to hear but my own fearing heart.
    I will pray for you. I will mention that you are a my friend with an incredible spirit and a wicked pair of calves. You gift is your strength, and in that I hope that find peace, and serenity. By your example of seemingly patience and thoughtfulness, your notepad could not tell me more than you grace does every time I see you.
    Take care my friend! Mark Botello

  8. Mark Botello said "you seem to have this gift of seeing things as they are, not as you wish them to be"
    He really hit it with that comment. It is one of the most impressive things I've come to know about you after knowing you all these years.
    I love you and I will be there for you as much as possible. I also had the same reaction when reading this (I cried), but that doesn't mean I have given up hope that everything will be OK. And then we can go to the House of Pancakes.

  9. A few years ago, I was at a talk at UCLA led by a panel of writers. Someone in the audience asked the panel members if they blogged, and most of them said they didn't. They reasoned that it's foolish for a writer to give words away with no compensation.

    Well, the comments readers post here are generous compensation for blogging. I'm lucky to have you all as friends, and as readers. Thank you so much!