Thursday, November 12, 2009
A nor'easter of bad news
Dr. B1 already let the cat out of the bag about my biopsy results a day earlier, so I didn't know what to expect when I showed up in Kaiser's Head and Neck Surgery Department on Wednesday for my post-op appointment.
Once Dr. B1 entered the exam room and placed a hand on my shoulder, however, I had a gut feeling about what he had to say.
He logged on to his computer and called up my chart and the pathologists' notes. Dr. B1 took six tissue samples in last Tuesday's biopsy, beginning at the base of my tongue, where cancer was first detected in January, and moving forward toward the front of my face. From my chin, he carved out a hole about the size of a dime.
His harvest of flesh struck the jackpot: Each of the samples Dr. B1 captured contained carcinoma. Six skulls and crossbones in a row.
What this means, Dr. B1 explained, is that the cancer did not respond to the radiation treatments and chemotherapy I had last winter, notwithstanding the midsummer biopsy that produced "no evidence of cancer."
"You must feel like you've had a load of bricks dropped on you," he said, then adding that it looks like I'm now "caught between a rock and a hard place."
If I could talk, I would have interjected, "That's two cliches in one sentence, Doc. I'm cutting you off."
He described what a surgical response to my cancer surge would look like. First, my tongue would be removed, and then my mandible. Bone grafts from my leg and arm could make up some of the loss, but whether they would work would be uncertain, and cancer could still return.
The whole thing made me queasy, so I was relieved when Dr. B1 said that surgery wasn't a viable option.
That left chemotherapy as the next option.
I really snapped to attention when Dr. B1 told me that the chemotherapy would not be "curative" but instead "palliative." In other words, he thinks that a cure is not possible. The best that I can hope for is controlling the symptoms of the cancer.
You see the term "palliative care" a lot in hospice brochures. I wasn't prepared to see these words introduced into my medical vocabulary.
Dr. B1 and I spent a long time not saying much of anything to one another. I quietly tried to absorb everything that Dr. B1 had said, and he sat beside me.
After several minutes, he passed me off to Dr. McNicoll, another surgeon in the Head and Neck Department.
I wasn't really clear why I was seeing a new Head and Neck physician after more than a year of office visits and three surgeries with Dr. B1, but I was certainly open to hearing another doctor's assessment of my situation.
Dr. McNicoll didn't pull any punches. He said that surgery would mean cutting off "half of my head," and his take on the chemo was that nothing can really cure me at this point.
So he took the discussion in a new and wholly unexpected direction. He urged me to think about how I wanted to spend my days: doing things I enjoy or running around seeing oncologists and sleeping in hospital beds tethered to an IV.
He added that I might want to see a social worker about an advance directive.
Both appointments were over inside of an hour. And after I checked out with the nurse at the front desk something happened for the very first time: I was leaving the Head and Neck Department without having a return visit set up.
My hub of my Kaiser experience is now drifting eastward, down to the oncology department at the complex on Vermont Avenue. I'll be seeing Dr. B2 there on Wednesday to discuss chemotherapy.
Where this is all going to lead is anyone's guess.
My dad reminded me on Wednesday that when faced with dicey odds, I have a history of proving doctors wrong. I'm counting on history repeating itself.