Saturday
Feb112012

3. The Whirlwind

After Dr. Schenk told me that my condition was very serious, there was not much time to think about the implications. Kate and I spent a great deal of time together -- and those moments were heart-breaking -- discussing what all this meant. Our first order of business was to inform our children, Stephen (19), Michael (17) and Jack (14). Kate took the lead. She told them that I had a very bad disease, but that I would survive. Of course, I was far from sure about the survival thing. But we did not want to scare our kids.

Each child reacted differently. Just a few weeks before, Stephen's best friend had lost his mom to cancer, and so Stephen was rightly concerned. But as the oldest, he also was able to know that my cancer was not like hers. All Jack needed to know was that my illness was not terminal. Michael probably took the news the hardest. For starters, he found out about my cancer in an e-mail that my sister, Chris, had intended for Kate. And he struggled with his emotions over the next several months. Of course, we all struggled with our emotions. But I did not have time to dwell on them.

Instead, I felt thrust into an incredible whirlwind of activity. During April 2011, I had more than a dozen medical appointments, tests and procedures. I was exposed to doctors and test results that were totally foreign to me. All I could do was seek perspective through a second opinion. I reached out to my brother, Bob, a neurologist who practices in Northern Virginia. He is plugged into the medical community more than anything else I know. More to the point, he is the only person I could trust.

Bob and I are a couple years apart, and we live within 20 miles of each other. As a medical doctor and father of four, his life is incredibly busy. So we mostly catch up at family dinners -- in addition to Bob, two of my sisters live in the immediate area, as do my parents -- which are held every month or so.

Once I was diagnosed, Bob and I talked almost everyday. He told me that the treatments and surgeries would be devastatingly diffiicult, and so I had to get my body as strong as possible. He gave me a list of several vitamins and other supplements. I worked out everyday. And for that much needed second opiinion, we visited Dr. Dave Heyer, an oncologist Bob knew well.

Dr. Heyer made a few important points. First, the cancer is bad but treatable. Second, the approach of getting chemotherapy before bladder-removal surgery made sense. This is a relatively new process, which improves a patient's overall odds. Traditionally, chemotherapy followed surgery. Having gone through both, I cannot imagine how anyone would have the physical strength to do it that way.

Why lose the bladder? I asked. His reponse: bladder cancer has a high rate of recurrence. Yeah, I knew that by now. Also, the more successful the chemotherapy, the greater the case for bladder-removal surgery, he added. Huh? That sounds counter-intutitive. It is, he replied. But if chemotherapy can address the cancer outside the bladder, and the surgery removes the source element, then my odds of long-term survival jump significantly.

Okay then. Those were encouraging words. And they were followed by more. If I were your patient, who would you send me to? One of two places, and they are both great, he said. One is Johns Hopkins, which has an elite cancer center. The other? Exactly the same guy I was seeing, Dr. Schenk. Wow, what a relief! I had lucked into access to one of the best surgeons in the field, it turned out. Bob and I left the meeting with a better feeling than when we went in.

I chose to stay with Dr. Schenk. Hopkins is two hours from my home, and Dr. Schenk is just 10 minutes away. Moreover, even though he scared me to pieces, I saw how much time and energy he already had put into my case. He was the guy for me. In effect, I had turned over my life to one Gregory Schenk.

Dr. Schenk lost no time in moving forward. To know for sure whether my lynph nodes were infected, he sent me to get a PET scan. It is similar to an MRI, but one that takes a few hours to perform. I went to Reston Hospital for the procedure, but oddly a technican walked me outside to a trailer sitting in the parking lot. A mechnical lift elevated us to door level, beyond which was an MRI-looking tube, a technician's board, and a waiting area. So, let me get this straight: my diagnosis depends on a trucking rig in a parking lot? Could my situation get any more bizarre?

The test results: likely spread of cancer to the lymph nodes. Definitive? No. But the metabiolitic activity was such that it "walks like a duck and quacks like a duck," Dr. Schenk said in perhaps the only medical jargon I understood. The condition of my lymph nodes was important because it made preventing the cancer from spreading the paramount concern. "The danger to you is what is going on outside your bladder," he said, explaining that the cancer was on the move to other vital organs. And then, in words that stuck in my heads for weeks, if the cancer spread, "you know what we're talking about." Death. Yeah, I get it. What's next?

Next was the oncologist, Dr. Manoel Moreas. A tall, slim, dark man, Dr. Moreas has wonderfully sympathetic eyes and an accent-laden speaking style that is calming. He described my condition as "locally advanced." Local, because the tumor was centered in the bladder area. Advanced, because the lymph nodes were involved and the cancer was likely on the march. The goal of chemotherapy: stop the spread of cancer to other vital organs. The clock was ticking, and I needed to start chemo immediately. If cancer spread to another vital organ, my survival chances become basically zilch. If the treatments worked, chemo would forestall any spread and shrink the tumor's size, making it possible for bladder-removal-and-replacement surgery. He described the treatments I would recieve over the next few months. Two powerful drugs, Cisplatin and Gemzar, would be administered once a week for the next 12 weeks. And he covered the possible side effects, none of which were any good.

Next up was Dana, an oncology nurse who I would lean on for medical and moral support. Dana is as wonderful a human being as there can be. She sat down with Kate and me, and walked us through everything we could expect from chemotherapy. Chemotherapy attacks all fast-growing cellls, not just cancer cells. So my body would be put through the ringer. But she, too, underscored the urgency of getting started with treatments. I had to start treatments ASAP. For everything, though, she and the other nurses would be there for me. No other words would ring more true.

I also got practical advice. Don't use cash; it's dirty. Don't touch ATM or gas station keypads; viruses can live there temporarily. Open doors with your hand inside your shirt. Why was this important? Because chemo drugs would weaken my immune system such that my body couldn't fight infections. In fact, in some cases infections could be lethal. Also, chemo would make it more difficult for my blood to clot in case I was cut. So shave only with an electric razor and avoid using sharp knives.

Dana also told Kate and me that my treatments would test our relationship. Indeed, I had heard stories about how cancer can bring couples closer together or drive them apart. Fortunately, we grew closer than ever before. In fact, I fell in love with Kate all over again. Kate is number one. But during chemotherapy, Dana and the other oncology nurses were a close number two. During chemotherapy, you have sporadic interaction with doctors. But you live with the nurses. They are the ones who nurture you through every treatment, talk with you on the phone when problems arise, and give you the biggest hugs.

Then it was back to Dr. Schenk. He performed an initial surgery on me on Thursday, April 28, sort of a big biopsy that removed part of the tumor which he later confirmed as malignant through pathology. The following Monday, May 2, I had another minor surgery to insert a medical port into my chest. Mediports make it easier to receive chemo treatments because they replace the need for an IV for every treatment. That Friday, May 6, I began chemotherapy treatments. May 6 is Bob's birthday. But this was to be unlike any other birthday. The whirlwind I had found myself in was just beginning.

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