This is the unedited version of a chapter in my manuscript, Dillie the Deer, about the return of my cancer.
“I think my cancer is back.”
Dr. R didn’t believe me, but I knew in my heart it was.
“No, no,” he reassured me with a laugh. “You just finished radiation a month ago. You had thirty-eight treatments. That means you had thirty-eight CT scans as well. If it were back, we would have seen it.”
This was my radiation oncologist, the doctor in charge of the radiation treatment. My surgical oncologist had retired the day I had my sutures out. The very last thing he did was refer me for radiation treatment, a move I had originally protested.
“Why do I need radiation treatment if the cancer is gone?” I had asked him.
He hemmed and hawed and basically gave me the medical equivalent of the parents’ quintessential explanation “because I said so.”
What he hadn’t explained to me, but the radiation doctor had, was that my cancer cell type was a uniquely aggressive one, and nearly always showed back up angrier than before. By irradiating the sites where the original cancer had been, they could lessen the risk that it would grow back.
I was learning. One of my more recent lessons was that physicians are exquisitely bad at telling bad news to their patients. My original doctor had let the surgeon tell me that the cancer that he described as “slow growing” and “no big deal” was anything but, and the surgeon had let the radiation doctor tell me that the cancer was highly likely to come back with a vengeance.
One of my Ohio State professors used to always tell his captive audience of budding veterinarians that “Life is a learning experience.” Indeed it was, and cancer was the SAT’s.
Once I understood that my cancer was a bad one, I stopped complaining about the inconvenience of having to go up to the hospital every day when I should have been working, and the considerable embarrassment the treatments caused. On the day I received my diagnosis but had not yet told anyone, my practice associate Stacy had informed me she was pregnant and was quitting. She was kind enough to stay on duty until I was back to work after my original surgery, but as soon as I came back she had left. This meant that during radiation treatments my office could not see morning patients. It also meant that by day 38, when the side effects and fatigue the treatments cause were hitting me the hardest, I was working a ten hour day alone.
Really, though, the hardest part about the radiation treatment in the beginning was not the side effects at all, but the indignity. Despite all I had been through as a patient, I still had not learned to toss aside vestiges of human dignity.
I remember the stunned face of an ultrasound technician early in my cancer journey when I refused her request to let a male medical student be present during a very unpleasant procedure. She told me in a huff: “He is a medical student!”
I turned right to the barely-old-enough to shave future doctor in his fresh, pristine, not-yet-baptised-with-patient-blood virginal white coat, and told him firmly: “Here’s your first lesson. Your patients aren’t a piece of meat. We have feelings. We get embarrassed. And we don’t want men around when we do.”
That was before I had surgeons, anesthesiologists, nurses, and even a DaVinci robot poking and prodding all over me. Even after all that, I still clung to the silly notion that my dignity was essential.
Radiation treatment beat that right out of me. By the time I was done with that little learning experience, I had been tattooed in places a biker chick would not allow, had a plastic mold of myself made so I could be affixed to a table like Hannibal Lechter, and had an entire cast of unknown male technicians moving me around a table like I indeed was USDA prime. I learned quickly that dignity during times like these only made it harder to endure. By the end of the treatments, the doctor started to say: “Now I am going to insert this ....”
“Don’t tell me,” I said. “Just throw a towel over my head and do it.”
Had that same ultrasound technician asked me at the end of radiation treatment if a male medical student could be present, a different person would have answered her. “Sure,” this new person would have said. “Tell him to bring his friends. And some chips. And a camera. The more the merrier!”
Once I had given up the silly quest for dignity, the hardest part of the radiation treatment was laying still for thirty minutes every day. I had a million things to do. I had patients I was working on, bloodwork to review, clients to talk to, employees to manage, bills to pay. I had all this hubbub going on with Dillie. I was teaching a night class and had lectures to prepare. I was designing a database for lost and found pets in the area and revamping the database I had created for the emergency clinic. I was a very, very busy person, yet every day I started my day by being strapped to a table and having to lay perfectly still.
I started to pass the time by imagining I was having a conversation with my dearly departed friends Pat and Dean. I missed them both terribly, and it was therapeutic for me to think of them and pretend Pat was telling me a joke or Dean was counseling me about a case. At first, I had to force myself to think about them, but by the end of the month, as soon as I got snapped into the table, they were right there, anxious to talk to me.
After that, any time I was on a CT table, they were immediately in my head.
This was no supernatural event. No ghost story. The Long Island psychic was not hanging about. I was conjuring them up in my head simply to pass the time. Yet, sometimes, my conjured friends took on a life of their own and said and did things I didn’t expect.
Pat reminded me one session about the last time we had all been together as a group. Steve and I had treated the staff to a night out, and rented a Hummer super-stretch limo to cart the whole gang up to see Larry the Cable Guy perform in Cleveland. Pat and her husband Dan, her daughter Sherry and husband Jim, Dean and Joan, Dean’s assistant Michelle and her husband, my nephew Matt and his girlfriend, some of the former employees from the ER, and Steve and I all climbed into the huge Hummer with a lighted dance floor in the center and went to see the raucous redneck comic.
“We were white trashing it style that night!” Pat told me unexpectedly as I lay on the radiation table. Her distinct gravelly laugh was as loud in my ear as if she were sitting right there.
Only a few weeks after that memorable staff outing, Pat took me aside and told me she needed to take some time off. She had been feeling run down and her chest hurt. She didn’t want to go to a doctor because she knew he would just tell her to quit smoking, and she didn’t want to hear that. She was just going to take it easy for a little while. By the time she went to the doctor, the cancer was inoperable. When she visited me on the radiation table, she was still wearing the pink bathrobe and big, fuzzy slippers she insisted on being buried in. “No fancy dresses for me,” she had said. “I am going to the afterlife in comfort.”
Then, just a few months after that, Dean was gone, too.
My own diagnosis came less than a year later. The past two years had been more of a learning experience than I ever wanted to have. Learning that people I loved that had so much life and energy could be taken away so quickly, as could I, was a lesson I had rather not had. I should have skipped class that day.
I began to actually look forward to my radiation treatment and that quiet thirty minutes where Pat and Dean came to me in my mind. By the end of the treatment, I didn’t have to try to force myself to think of them. They were there waiting for me. As soon as I laid on the table, I could hardly shut them up!
A month or so after I had completed the radiation protocol, the telltale dull but persistent pain reappeared. I knew it was the cancer. I knew it. I didn’t ignore the signs because I knew the pain meant the tumor was back.
The radiation doctor, though, was trying to convince me it was probably the gallstones they had seen on the scans, and sent me to a surgeon to have my gall bladder removed.
For the second time in a week, I began a conversation with a doctor, this time the surgeon, with the same phrase.
“I think my cancer is back.”
The surgeon was a tall, thin man with an easy smile and friendly manner. I was thankful he did not have the legendary surgeon’s arrogance that I had witnessed among the equine surgeons at Ohio State. But then, I wasn’t a ten million dollar racehorse with a broken canon bone. I was just a frumpy veterinarian with cancer paranoia, and gall stones.
Like my radiation doctor, the surgeon also laughed at my paranoia. He tried to reassure me that this was a very simple procedure, and they would go in with an endoscope, get the gall bladder out of there, and I would be home that after noon. Easy peazy. No big deal.
“When you’re in there with the scope,” I said, “Could you take a look around? I really think the cancer is back.”
The next time I saw the surgeon was on surgery day at the outpatient center. He had on his blues and I was getting my IV put in by the anesthesiology team. “Don’t worry,” he told me. “We do these all the time. I will see you when you are waking up.”
The very next thing I remember was him once again standing over me, but with a completely different tone. I was in the recovery area now. I must have been awake prior to that because I was sitting in a chair, but I do not remember one second before him standing over me and saying:
“You were right. It’s cancer.”
Then, he left the room.
I turned to the nurse in a panic. “What does he mean? Cancer of the gall bladder? The pancreas?”
Even in my sedation fog, I knew that those types of cancer would be infinitely worse than the endometrial cancer I had.
The surgeon reappeared and finished his explanation. They had gone in with the scope, and just to the right of the entry point, right where my pain was, there was a five centimeter mass. He showed me the photograph they had taken of the yellow blob of tissue with multiple blood vessels running to it that was attached to my abdominal wall.
“While we were in there, “ he continued, “we pulled up your CT scans from just a month ago, and this wasn’t there. This is a hot one.”
My immediate reaction, enhanced by the “Twilight” drugs, was juvenile and feeble: “But I did everything they told me to do,” I whimpered.
The surgeon unnecessarily explained that cancer just didn’t work that way.
I knew that. In my fog, though, I thought it should. Just like getting an “A” in the many hundreds of classes I had taken in my life, I put the work in, so I should get the reward. I endured the surgery and the radiation. I kept every appointment. I did every scan they ordered. I drank enough disgusting “EZ-Cat” barium-infused lemonades to make Andrew Zimmern wince. I did the work; where was my “A”?
Finished with futile explanations, the surgeon said he was going out to the waiting area to tell my family.
“No,” I said. “I will.”
I wanted to tell them. I didn’t want them to go through what they had during my first surgery. When I had had my original robotic surgery, Steve, my dad and his wife Reva, and Sherry had waited for ten hours before anyone even came out to talk to them. The procedure had taken that long. Finally, the doctor emerged. The first thing he said to them was: “Could she have been bitten by a cat?”
After ten worrisome hours, that was the very last thing they expected to hear.
“She’s a vet,” Sherry reminded the man who knew my insides unlike any person in the world but didn’t remember my life’s work.
“Oh, that explains it then,” said the surgeon. Then he left, leaving my family even more bewildered then before.
Finally, he came back and explained that although my lymph nodes did not look cancerous, they looked like at one time I might have had “Cat Scratch Fever,” an occupational hazard. Then, he proceeded to tell them that the procedure had taken so long because the cancer appeared terribly aggressive, and they had to dissect out all the lymph nodes in the area. I was going to need radiation, he told them, and very likely chemo.
“This is going to be bad,” he told them.
Devastated, Steve went home alone that night thinking my condition was terminal. Dillie and Lady climbed in bed with him, but he was inconsolable. All through my illness I had tried to reassure him that I was going to be fine. I just had some unpleasant work to do, but in the end, I would be fine. We would be fine. Sobbing into his pillow with Lady and Dillie trying to lick away his tears, he realized for the first time that I could die.
In my hospital room the next day, Sherry came in to see me before the doctor made his rounds.
Sherry had had her own cancer learning experience when her mother. She was Pat’s daughter. Sherry had tended to her through the chemo and through the cancer’s inexorable spread to the brain. Sherry was with her when she had taken her last painful breath. She had learned through her mother’s ordeal that doctors were not always completely candid with the patients. She knew I would want to know what the surgeon had said. She had taken notes, and showed me her little steno notebook.
Yet, later that morning, the surgeon told me a completely different story. “We got it all,” he said. “There was no cancer in the nodes. The abdominal washings were clear.” I needed to take a few weeks off from work, but then I was good to go. I could resume my life of being bitten by angry cats and untwisting Great Dane stomachs.
Now, here I was not even six months later, and a different surgeon had just shown me a photograph of the innocent-enough-looking blob of tissue that was trying to kill me. I wasn’t about to let him tell me one thing and tell something even worse to my family.
I wiped away my tears as he showed them back to the recovery area. Brave face forward, I thought. Be a good soldier. I did not want them to see I was upset.
How silly I was to think that I could hide anything from them. My heart broke to see Steve come bouncing back with a big smile on his face.
“That was quick!” he said.
My dad and his wife Reva came in next. Dad was still recovering from a double knee replacement surgery that had nearly cost him his life. The post-op complications had sent him to ICU for a month. He came back in baby steps, using his cane.
“That wasn’t so bad, was it?” he asked in his booming former DJ’s voice.
I discovered that despite my professional training, I was not any better at relaying bad news than the doctors were. I started to cry. “The cancer’s back.,” I blurted out.
The surgeon stepped in to finish the explanation, and showed them the photograph of my cytological nemesis. “I will order CT scans,” he told them, “and then we’ll know how many there are.”
On the way home, Steve was in denial mode. “They’re not really sure it’s cancer, “ he said. “They didn’t biopsy it. Maybe it’s just scar tissue.”
I had no time for denial. There was a fight to fight. Throughout this entire journey, I wasted no time hanging out in the denial station. I just got back on the train and continued on. Yet, at the same time I tried to feed him as much positive, flowery outcomes as I could. Now, despite seeing a photograph of the killer itself, he was hanging on to those flowery outcomes like a San Francisco hippie in the “Summer of Love.” I couldn’t bear to beat down his false hope with what I knew to be medically true: that any time cancer gets outside it’s original site, the patient was in trouble. I was in trouble.
I called the radiation doctor from the car, leaving a voicemail message with today’s bad news. In less than two minutes, he called me back. I told him the surgeon had ordered CT scans next week.
“No, no.” he said, in his melodic Indian accent. “We need those scans yesterday.“ He instructed me to report to the radiation department at seven the next morning.
More barium lemonade, I thought. Yum.
A week later, he called me with the results. “There’s three masses,” he told me, without sugarcoating. “There’s the five centimeter mass, right at the original incision site. Then there’s two smaller masses where the robotic arms went in and out of the abdomen.
Then, he spelled out the plan. He had scheduled me for a CT-guided biopsy in a week, on Christmas Eve. On New Year’s Eve, they would put in the indwelling IV port for chemo. On January 2, I would meet the chemo doctor, Dr. M, who, he reassured me, was one of the best in Akron. On January 5, I would begin chemo.
“It’s all about the chemo now,” he said.
The train was on track, and it was a bullet train.
I was extremely grateful how he had taken over my case. Pat had not been so lucky to have Dr. R on her side. She had taken herself to an emergency room once the cough had gotten bad enough. With just a chest film to go by, the ER clinician had told her she only had six months to live. He referred her to a pulmonologist, who couldn’t see her for weeks. Discovering she also had a mass in her small intestine, the lung doctor then referred her to a gastroenterologist, who couldn’t see her for more weeks. That doctor then referred her to an oncologist, that wouldn’t even schedule an appointment for her until the gastroenterologist had sent the chart over to his office in 2B of the medical building, from all the way at the other end of the Andromeda galaxy, 2A. After three more weeks of waiting for the gastro doc to complete the referral, she learned that he had left for a four week European vacation, leaving her unsent chart on his desk.
Meanwhile, the clock was ticking. Five months of the six that she was told she had left had already passed and she hadn’t even seen an oncologist. Sherry and I fervently urged her to go elsewhere, but she didn’t want to rock the boat. She was caught in a sticky web of denial, and the dangerous assumption that these doctors that didn’t even know her name cared if she lived or died. She finally got mad enough at the situation that she demanded her chart and drove herself, as sick as she was, an hour away to Cleveland Clinic. for a walk-in exam. That very day, they admitted her on emergency and moved her to the oncology service.
By then, though, it was too late. The chemo they started only served to make her remaining time harder to bear.
I had, thank God, a totally different experience. I was never once in a disastrous holding pattern as Pat had been. My course to a cure was charted immediately and definitively. Dr. R’s take-charge attitude reassured me. I now understood why when my original surgeon had told me he was retiring and I had gone all Scarlett O’hara on him “Where do I go? What will I do?,” he had told me with reverence: “Don’t worry. I referred you to Dr. R.”
I was confident I would be well again. My faith in my medical team and the power of chemo was steadfast and strong.
At least for a couple more days.