Friday, July 3, 2009

2 - Diagnosis

WARNING: The following narrative contains much material that is not suitable for younger viewers. Nor the generally squeamish. Nor even most adults, who, if they are like me, prefer to live in denial and avoid unpleasant subjects.

Here's the long version. This is a tale of cancer diagnosis, treatment, and survival. Anal cancer, a relative of colorectal, which is a major killer of males in this country, due largely I think to late diagnosis. The story has that as its moral, just so you don't have to wonder until the end: early detection saves lives.

Let me state right up front that I was lucky. I was damned lucky. I got off easy, I think.
Relatively speaking, I had the simplest, lightest, least invasive, least debilitating cancer treatment ever. I am thankful that it was easy. No, I am thrilled that it was easy. I wish that everyone who has the misfortune to cross cancer's path could have it as easy as I did, or even easier. I am trying not to whine here, but to inform. This is what happened to me. This is what I should have expected had I been well-informed. And will expect the next time. (Quick! Find me some wood to knock on!) Maybe being informed -- forewarned -- is a good thing.


Last fall, I had some symptoms, bleeding. Irregular, slight. There for a day, gone for a week. I set up a colonoscopy in January; he didn't find anything but internal hemorrhoids, no big deal. Whether the tumor was not there at the time, or was too small to see, or whether the guy missed it, we'll never know. Six months later the symptoms are back. Off to the gastroenterologist, Ms T's doctor this time, not the guy I went to earlier. He looks at the bloody glove after the examination, says, That's not right. We have to do a real examination, a flexible sigmoidoscopy. I waited, in retrospect foolishly, a couple weeks.


This sigmoidoscopy itself is easy, one of those procedures where you get really good drugs to go bye-bye and you can't remember anything afterwards. One minute you're on the table, the nurse is sticking a needle into the IV saying that this will make you very sleepy. The next minute it's late that night or tomorrow morning. Whoa. You're not unconscious all that time, just brain on autopilot with no conscious memory afterward.

Bad News

The examination was on Friday. He might have mentioned on Friday that he had biopsied something, but through the drugs I don't remember. Tuesday I get a message on my voicemail at work. From the doctor, not from the nurse. That's unusual in itself, enough to get my attention. "You must come to see me today, without fail." Yikes. That scares me half to death. So I call Ms T and we go to see the doctor that hour.

He looks grave. Yes, it's cancer. He shows me a picture taken by retroflexing the sigmoidoscope. Looks irregular. He had biopsied it, and the report is not good. Squamous cell carcinoma. Oh, sh*t. But, he says, it looks to be very early. The treatment will be minor, not major, not that bad. See a surgeon. No, not disfiguring surgery, not that bad. Maybe we can get the whole thing with surgery and skip the radiation and chemo, not that bad.

He gives me referrals to surgeon, chemo, and radiation oncologists. I spend the rest of the day arranging appointments. Actually get in to see the surgeon the last thing that same day. He thinks we can probably remove the whole thing. Small and early. How's the day after tomorrow?

In the meantime we see a chemo doctor, who is called the "medical oncologist," a nice young guy. And he refers us to a radiation guy, right across the street. Turns out to be a wonderfully convenient location, full-service treatment center within a hundred yards.

All the doctors have the same vocabulary: malignant, lethal, fatal, deadly. Malignant, lethal, fatal, deadly. Malignant, lethal, fatal, deadly. It's horrifying, numbing. I think it's done to get my attention, to make sure I take this seriously and immediately. I can imagine that a lot of patients go into instant denial when given such a diagnosis. This is the type of cancer that kills a lot of men, because they ignore it, because they let it go too long before taking it seriously, because they fail to go into treatment immediately, because they're too embarrassed to deal with it. These doctors schedule procedures as quickly as possible, I guess not to give me time to reflect. First exam; sigmoidoscopy two days later. Surgery a week later. A week after the new pathology report, schedule the chemo and radiation, boom just like that.

We see so many new doctors, fill out so many histories, that we eventually write a list of answers to the standard history questions: all the drugs I take, names and dosages; all the diseases I've ever had; what my parents died from, etc. It helps us not forget anything.

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