Monday
May282012

16. Hospital Stay

Following the radical cystectomy, I moved to the surgical recovery wing of Loudoun Hospital. It took a few days to get there, due to breathing problems that had landed me in the ICU. But once in recovery, the scene reminded me of the tv show, MASH. Lots of patients in pain. Lots of nurses mending bandages. Lots of medical carts flying through the hallways. The environment was much nicer than the show, of course. We had access to television and telephones, for instance. And I shared a room with just one other patient. But suffering is suffering. And there's just no way getting around that.

One of the first things I noticed was the bizarre bed I was put in. It had a deep, plastic lining -- for good reason, I later found out -- and rotated automatically. Constantly. Bottom right would move, then top left. Top right swayed, then bottom left. And it just kept going. So much so that I assumed motion sickness drugs were part of my daily regimen. Why the constant movement? To keep your muscles and blood flowing -- avoiding cramps, spams and worse -- and to massage all the parts that were cut into. All I know is that the movement made it impossible to sleep. Of course, I hadn't slept since I began chemotherapy. So what was the difference? I now was in severe pain. That was the difference.

The next thing I noticed: I had lots of tubes emanating from my pelvic area. Let's see, I thought, there's a plain, old catheter, coming out of you know what, connected to a big bag on the side of my bed. I remember that from my original surgery. Okay, I know what that one does. But I also remember how painful it can be when movement causes the tube to...ouch! It's called a Foley catheter. Gee, if I were Foley, I'd hate for that to be my enduring memory.

Then I looked down and saw another tube, called a suprapubic tube, on my left side, also connected to a bag, although somewhat smaller. What's that for? Just above that tube was another one, called a JP drain, connected to an grenade-like container. Hadn't seen anything like that before. On my right side, yet another tube, connected to yet another bag. A simple stent. To make things worse, all but the traditional catheter were leaking bodily fluids. Oh, joy. Wonder if that grenade really works?

I continued to look down at myself. There it was. A surgical incision, about eight inches long. It began above my belly-button, skipped a small section, then resumed on a line down to my privates. (Of course, my privates hadn't been private since that initial scope with Dr. Gaynor.) Other smaller incisions were on either side of the big line. And they hurt like hell. So, this is what recovery feels like. It sucks.

Then I began to feel another, sharp pain in my lower abdomen. What is this? The nurse came in, and told me that my pain was being caused by a build up of mucus in one of my drains. So she irrigated the drains until the mucus came out, pushing in and retracting saline water through a syringe. Looked hard. And it often took several attempts. But when the mucus finally came out, I had immediate relief. That's when I learned that my drains would have be irrigated every few hours. Problem was not many nurses knew how to do this. They had to resort to instructions Dr. Schenk had written down. So, much of my days were spent helping nurses clean up leaking drains and then having my drains irrigated. Like I said, recovery sucks.

Finally, Dr. Schenk showed up. Ah, I remember that guy. The cutter. He showed Kate and me how to take care of a lot of things, from irrigating drains to keeping tubes in place. But he was firm. Ultimately, I had to do this work myself, and use Kate only as a back-up. He even told Kate to go back to work a week after I got home. If I didn't agree with all this, he wouldn't teach us. Sensing I didn't really have a choice, I agreed. Next, later that day I should get up, take a shower, and walk around. Say what? I could barely move without triggering pain. Okay, he said, but push myself. Meaning soon. Real soon. He wouldn't discharge me from the hospital until I walked, pooped and showered. That's Schenk: tough but fair.

Then the big news: pathology tests showed no evidence of live cancer in the lymph nodes he had removed. That meant what, exactly? No need for further chemotherapy or surgery. I was done. Done? Really? So...from diagnosis through chemotherapy and surgery, I had gone from Stage IV cancer to no evidence of disease, or N.E.D. in cancer lingo. Sweet Jesus, who would've predicted that? What a relief! I just had to recover from surgery, adjust to a new plumbing system, and the rest of my life would be in front of me.

Tempering my enthusiasm: my current condition. I looked like hell. I felt worse. And every hour was a struggle. My family had come to see me. I had mixed feelings about this. I was glad to see them, of course. But I didn't want to scare my boys with how poorly I looked. Apparently, I failed, they later said. My parents were there. Dr. Bob checked in on the patient. Joan and Phil had a wedding to get ready for -- their oldest son and my newphew, Matt -- but drove two hours to the hospital, spent time with me, and then drove back. Kerri, Chris, Cathy and Steve helped take my mind off what I was feeling. Cathy and Steve, in particular, spent a lot of time at the hospital. When I was in the ICU, I remember waking up briefly one night and thinking I had seen Cathy sitting next to my bed. I thought it was a dream. But it was real.

In the recovery ward, I ran into another problem. My veins had collapsed from so many blood draws being done that pain medication couldn't make its way into my body. One night, an escalating series of nurses came in, trying to establish a new blood line, with one nurse in particular -- and I'm bummed I don't remember her name -- being wonderfully comforting. "We've got to get medicine into this darling," she said, finally getting the needle in the right place. The wound nurses, David and Mary, tried a variety of solutions to keep one of my drains from leaking. And Laura, another nurse, helped me finally get out of bed, make my way to the shower, and take a walk -- if you can call it that -- around the ward.

After a week or so, things were slowly improving. Schenk removed one of my drains, a tube so long I wondered where it was housed inside me. With Laura's help, I could take two laps around the ward in a single walk. I cleaned and showered myself. And I otherwise met Schenk's conditions for discharge. So it was to be. Time to go home. I wasn't in a great shape, to be sure. My drains still leaked. My pain was still omnipresent. I was weak. And I didn't exactly look like I was ready for the dance hall.

But I was going home. Ah, what a feeling! Home. I'm home. That's when I almost died.

Monday
May212012

15. Surgery

Let me save you some time. Good news: I was asleep from 8 a.m. on Monday until 4 p.m. Tuesday, totally obvious to events in the meantime. Bad news: when I did wake up, I had to deal with the after effects of said events. They were not pleasant. Skip to the next blog post.

Now, for those who want to know the gory details -- and who are we kidding? you wouldn't be reading this blog unless you wanted to know the details -- my unpleasantness began the day before. Since the surgery involved my bowels, I had to make sure they were empty going into the hospital. Basically the same prep as if you were about to have a colonoscopy. A drink that is totally disgusting. Tablets you place in areas where you don't normally place tablets. And then the emptying began.

I could handle all that pretty well, actually. But what got me were the antibiotics I had to take at the same time. The logic being that I would be at risk for infections coming out of surgery, so prime the body beforehand. Okay, I get that. But these were really powerful antibiotics. And since I couldn't eat or drink, there was nothing in my body to absorb them. The result? Intense nausea. So much so I found myself laying on the bathroom floor much of the time, just waiting for the inevitable to happen.

At this point, fear set in. What am I about to do? How can I put my body through another severe trauma? God, tell me I don't have to do this. "You have no other choice," Kate said in a quivering then assertive voice. "You've got to do this surgery." Somehow, I made it to bed, shaking, clammy, frightened. Sleep. God, help me sleep.

Kate and I arrived at the hospital at sunrise the following morning, September 19, 2011. I felt just awful. Nausea and anxiety make for a nasty combination. To cope, I laid down on a couple chairs in the waiting room. A comfortable position, it was not. After a while, I saw my parents, who had travelled 25 miles from their home to see me off to the operating room. What amazing dedication they had.

Once in the pre-surgical carrel, the nurses prepped me for surgery. I was bummed that they couldn't use my mediport and, instead, had to open new veins to get the drugs flowing. Anesthesiologist arrived. As did the OR nurse and her cold hands. Finally, my man Schenk. "Are you ready?" he asked. Hell, no! But I wasn't here to go shoppng! I said my goodbyes to my parents. Kate gave me a big hug and kiss. Our eyes welled up with tears. And I was off. I don't remember anything after that.

But here's what happened. My body was put at a sharp angle, with my head closest to the ground. Gravity would make it easier to remove and insert all that needed to be removed and inserted. Dr. Schenk then spent a fair amount of time aligning the robots to my body. He would use robots to do the removing, and he would manually do the inserting. Why robots? Besides making the surgery less physically taxing on Dr. Schenk, his associate and nurses -- and it's a taxing surgery, to be sure -- robots cut more precisely and thus result in less nerve damage than manually cutting. Sounds good to me. All this took several hours.

On the coming out list: my bladder, prostate and a dozen or so surrounding lymph nodes. Also on the cutting list: my small intestine, which lost a couple sections. On the going in list: one small intestine part, now formulated as a new bladder connected to parts below, and another piece of intestine formulated as a chute above the new bladder to receive fluid from kidneys, all of which would kinda, sorta function as the bladder system it replaced. All pretty straightforward, yet dramatic, stuff. But a problem complicated the entire surgery. Dr. Schenk noticed atypical cells on one of my ureters, the tubes that connect kidneys to the bladder chute. Atypical cells are generally pre-cancerous. So Schenk whittled away at the ureter in question until he was confident that all the bad cells were cut out.

That was great, obviously. But it left him with another problem. One of my ureters was now much shorter than the other. And that made connecting my neobladder difficult. To make the neobladder function, it has to be connected to the ureter coming from each kidney and then to the urethra coming from below. The problem? Nothing fit. Argh. Schenk told me afterwards that mine was one of the most difficult surgeries he had performed on a neobladder candidate. "I was trying every trick in the book."

Finally, by moving my neobladder closest to the short ureter, Schenk was able to stretch the long one just enough to connect the top of the neobladder chute. But it was on a more horizontal plane, rather than an angled one, so the neobladder couldn't connect to the urethra below. His solution? Pull up the urethra and its connecting parts (ouch!) until contact was made with the neobladder. And the whole thing fit, just barely. Whew! All this took several additional hours to perform.

A neobladder typically hangs tension free from the kidneys. Mine doesn't. A neobladder is supposed to be centered in the body. Mine is off to the side. As long as it works, I'm okay with that. From here, the surgical team inserted four catheters and drains into my pelvic area. They were designed to redirect urine away from the neobladder and connecting parts until they could heal from the surgery. The entire surgery took about 12 hours. Off to the intensive care unit.

All this waiting made Kate a nervous wreck. Twelve hours is a long, long time. My parents kept her company. My sisters Cathy and Chris sat with her for a while. As did Kerri, her sister. As did Michael, our son. Other family members texted her to see how the surgery was going. From time to time, Schenk would come out to the waiting area to stretch and update her on the surgery. But the hours felt like days. She went back and forth between wanting company and wanting to be alone. Unfortunately, there would be no escape from the fear and anxiety she felt. Even having dinner with our boys provided little respite.

As a cancer patient, it's easy to dwell on your own problems. But the impact on loved ones is incredibly severe. There were times during my treatments when Kate would break down in tears, overwhelmed by the impossible tasks of caring for me, dealing with work, managing our household, and being a mom for the boys. I tried to lessen the impact by urging her to go out for drinks with the girls. While those outings helped, their effect was short-lived. They were a bandaid on a deep, deep wound. Cancer became an endurance contest for both of us.

Back at the hospital, Dr. Schenk emerged and announced that the surgery was complete. It was a difficult one. But he was able to install the neobladder. He would put the material he removed through pathology tests to see if cancer was present in any of these areas. The lymph nodes, in particular, would be a focus on his. If cancer was still present in them, more chemotherapy treatments and surgery were quite possible. With that news, the nurses were ready to take Kate to see me. But just a moment. They warned her in advance. I would look nothing like I did before surgery.

When she arrived at the ICU, Kate saw that my head had swollen to the size, color and dimensions of a basketball. This was due to the pressure of my body being put at an angle for so long, My head was wrapped in bandages. My eyes covered. A breathing tube still inserted. Several additional tubes emanating from my pelvic area. Seeing this, she broke down. "The night before, I told you that you had to go through with the surgery; after seeing you I felt so, so guilty."

The doctors tried to wake me up. But I gasped for air. Again. Another gasp. Again. Gasp. No oxygen. The doctors determined that I could not breath on my own. So back went in the breathing tube, and I was rendered unconscious again. Which made Kate feel only worse.

I finally woke up. I asked the nurse what time it was. She said four o'clock. Okay, I thought, not a long surgery. That's good. Then she added, "Four o'clock, Tuesday afternoon." Oh. I had missed 32 hours in time. "After surgery, you couldn't breath on your own..." Oh, Lord. This sounds bad.

For the next few hours, I'm told that doctors and family members talked with me. But I don't remember any of that. What I do remember: seeing Kate's eyes, tears streaming down her face, but with that pretty smile of hers. She kissed my cheek. We held hands. She said the surgery was a success. I smiled. Exhausted, I soon drifted off to sleep.

Another set of adventures awaited me.

Monday
May072012

14. The Decision

The greater the distance from chemo treatments, the better I felt. Not that the side effects were gone. After all, I was pale as a sheet from spending so much time out of the sun. My muscles were weak. And tingling and insomnia were still with me. But my mind began to clear up. My appetite began to return. My energy level increased. And, fresh off the PET scan report that showed a "complete response," I could finally envision looking beyond the next day. The more normal I felt, the less inclined I was to put my body through hell again.

So....did I really need the surgery known as a radical cystecomy? It sounded pretty yucky. Remove the bladder. Remove the prostate. Remove all those lymph nodes. Cut into my small intestine. Tear out a section. Stitch my intestine back together. Formulate the prized part as a pseudo bladder. Hook it up. With the caveat that it wouldn't work like a normal bladder. The new bladder would simply be a receptacle for urine, with no muscle structure to void the fluid. Thus, I'd have to use my abdominal muscles to do the trick.

That's not all. The neobladder would continue to share a characteristic with its former parts in the small intestine: it would produce mucus. In the small intestine, mucus helps break down food so it can pass through your body. In the neobladder, however, mucus blocks the sphincter through which urine must pass to leave your body. It's unclear how long the neobladder would continue to produce mucus; it might lessen over time, it might not. So, besides the physical trauma of recovering from major surgery, I'd have months and perhaps longer of adjusting to a new bladder that would be difficult to use a certain amount of time. How would I void my bladder in these cases? Welcome to the world of catheters. Other side effects, like incontinence, were a possibility, too.

In other words, my decision on whether to have surgery was more than one of avoiding a recurrence of bladder cancer. It also was a decision to accept and cope with a total lifestyle change for the rest of my days. Hmm. Let's just say, I wasn't exactly rushing to make up my mind.

And it's not like the alternatives were any better. For instance, I could have gone with an intestine-turned-internal receptacle as well, but with an access port built on my abdominal wall where I would void the bladder by inserting a catheter. This is known as an Ileal conduit urinary diversion. Another choice was an external pouch, called an Indiana Pouch reservoir, which would sit on my side and be voided there. Not having at least the possibility of going to the bathroom normally ruled these out for me. Also, if the neobladder proved too problematic, I always could switch to one of these systems. But I couldn't go from one of these to a neobladder. So the choice to go with a neobladder is really a choice to give your body a chance, however big or small, to void your bladder somewhat normally. Still, what a shitty set of options.

Dr. Schenk was leaning on me to get the surgery, of course. No dummy, he. And I understood his perspective. But I needed to make this decision on my own. For guidance, I turned to the stats. By now, I knew that bladder cancer had a high rate of recurrence. But just how high? Pretty darn high, it turns out. The low end of estimates said 50 percent for lower-staged cancer. Yes, that was the low end, and for stages I had esclipsed. The high end? 85 percent and up. In fact, bladder cancer has one of highest recurrence rates of any form of cancer. Geez! Therefore, my decision had to assume that cancer would return if I did not have my bladder removed. And what if the cancer does return? I asked Dr. Moreas. Well, he said, it can come back in the bladder or another vital organ, with a greater vengeance, spread more quickly and aggressively, with no assurance that treatments will be as effective as the ones I just went through. Gee, thanks for that ray of joy.

Okay, okay. I guess I'm going to have to do this, I thought. Softening the blow were Dr. Heyer's words from way back when: remove the source element, and my odds for long-term survival jump considerably. Okay. I see the logic here. But, God, I wish it was in the direction of no surgery.

What did I do? I escaped. I did anything and everything to fill my days with activities that didn't remind me of cancer. I went to work for a few hours here and there. Great to see people. I went to ballgames, and caught up with friends there. I took Kate and the kids to restaurants. A trip to Thomas Jefferson's home, Monticello, proved to be too much -- I suffered dehydration -- but even that was okay. I went to gatherings with my broader family. My sister Betty travelled from Denver to visit me. I spent time on personal finances and a business plan for work. Escapism gets a bad rap, but it definitely has a role in the life of cancer patients.

My worlds started to collide, however. During mall walks with Kate, I began to notice all those posters in the walkways, posters I had previously ignored. What were they about? Cancer awareness. Oh. Wanting further escape, we went to the movies to see a romantic comedy called "Crazy, Stupid, Love" (which turned out to be bad, boring, dumb). The purist form of escapism. The movie trailers began. First up: "50-50," a film about a guy who learns he has cancer and portrays his struggle to survive. Umm, God, are you trying to send me a message here?

His message: there was no escape from cancer. It was everywhere. And I had to adjust to that reality. After a while, I began to realize that the name of the cancer support network at the hospital, Life with Cancer, was called that for a reason. It really is life WITH cancer, even for those in remission. No matter how hard I tried to escape, cancer was now a part of my life, part of who I had become. Accepting this truism didn't mean that I was giving in to cancer. No, no, no. But it did mean that I couldn't ignore my condition. My battle with cancer was not over. I still had work to do. The surgery, as awful as it seemed, became a must-do. There simply was no avoding it. Which, of course, brought my mind back to my mortality, all the hardship I would have to endure in the meantime, and the impact on Kate and the boys.

My mind was made up. The surgery was a go. I hated the decision. I absolutely hated it. But for me, there could be no other way. No going back. No second guessing. Instead, much like before I began chemotherapy treatments, I had to get my mind and body prepared. I had until Sept. 19, 2011, to get ready. Strengthen myself physically. Get tough mentally. Support my family. What I didn't know? For what I was about to experience, no level of preparation could have sufficed.

Saturday
Apr282012

13. Home Economics

Dealing with cancer takes a heavy toll on you physically, emotionally and spirtually. But it's a financial battle as well. From medical costs to the loss of income, dollars play a big, big role. Going into my experience, I wasn't sure how things would play out moneywise. Would my health insurance cover my scans, tests, chemotherapy drugs, surgeries, ER visits, hospital stays, rehabitation, in-home care, and physical therapy? And if so, how much of the costs? At the same time, I wondered what would happen to my income. After all, I wasn't exactly logging hours at work.

Everyone who has cancer faces these same questions. That's why I did a lot of research and fact-finding, often with the help of Kate, to better understand my situation. Since I knew my salary would go down and medical costs go up, my first action was to turn off some of my automatic savings. For instance, I pay down my mortgage every month. So I turned that off. I also reduced my 401(k) contributions. Both actions boosted my cash flow.

Still, my primary concern wasn't preserving cash in my checking account. It was health insurance. If I lost my entire salary for several months, I knew I had savings to back me up. But if my health insurance wasn't good enough, then I would be exposed to more medical costs, which soared into the hundreds of thousands of dollars.

Fortunately, I was lucky. Boy, was I lucky. All my doctors were on my health insurance plan from Aetna. The chemo drugs, which cost thousands of dollars per session, were covered. My surgeries were covered. Even a large portion of other medical treatments. I ended up paying a few thousand dollars for the surgeries. PET scans were not covered because they were seen as experimental. And Walgreens drugs and doctors' visit co-pays certainly added up. But all told, I got off easy.

Medical costs depleted part of my bank account, but only part. What about monies coming in? Here, I lucked out again, working for an employer, Freddie Mac, with a great disability program. For the first 90 days of my leave, I was covered by short-term disability and paid my full salary. After 90 days, which occurred right after my chemo treatments ended, I was placed on long-term disability. Here, my pay would be reduced to 60 percent of my salary. But each year, my benefits program allowed me to buy an additional 10 percent for a few bucks a pay period. And each year, I said why not? So my pay declined to just 70 percent of my normal salary.

I also got something else: a savvy case worker, Jasmine. When I talked with her after my post-chemo PET scan, and that I would have roughly a two-month wait until surgery, Jasmine came up with a plan. When I felt up to it, she asked, why not do some work from home, even for just a week or so? Why was this significant? Because returning to work and then leaving again would trigger a second short-term disability period, where my salary would return to 100 percent for another 90 days. And that's what I did. I have great people that I work with, and I was able to work on an external relations business plan for my division head, Hollis. It took portions of a few weeks to develop the plan, almost all the work performed at home.

My experience taught me a few things. I was incredibly fortunate. Fortunate to have great health insurance. Fortunate to have great benefit programs at work. Fortunate that loss of income and large medical costs did not devastate my family's financial condition. Of all these, the most important is the absolute need for quality health insurance. You simply don't want people to forgo medical treatments or procedures due to inadequate insurance. As a society, we're not there yet. And that's a sin. Also, now that I have a pre-existing medical condition, I fear that the political process will back away from the protection I have due to President Obama's health care reform. As if I didn't have enough to be scared about.

But one event gave me encouragement. Kate and I were on a walk one day, talking about the uncertainty we were facing, including our financial situation. I told her that there were so many unknowns in my medical condition, and so many procedures still to go through, it was difficult to fully understand them, much less take action. But on finances, I felt oddly calm. When all is said and done, I said, finances are just a bunch of numbers. Whether they are high or whether they are low isn't the most important thing. What is is that we would be together to figure them out. Kate smiled. We hugged. And I knew God was watching over me.

Monday
Apr232012

12. The Waiting

Tom Petty isn't kidding. The waiting really is the hardest part. After meeting with Dr. Schenk on July 22, I had to wait until August 10 to get a PET scan. Why so long? As long as I was still feeling the side effects of chemotherapy, my body could not lay still long enough for the protracted scan. I couldn't take my mind off what the scan might find. But I was able to do new things. Kate took me out on a greater variety of outings. And I began to appreciate life even more.

For instance, while Kate logged case files in a work computer, I waited in a school's administration office. There, a father and son new to the area were trying to find out which school they could attend in the fall. The son's case was more complicated than usual because he needed access to a specific academic program not offered in all schools. I watched one of the administrators work the phones and call several people before coming up with the correct answer. We don't often think about the staff in schools. But they can be just as important, and dedicated, as those that teach students. When Kate showed up, I walked away with a smile on my face. What a good memory for my nighttime ritual of trying to get to sleep.

We also went shopping at the local furniture store and a wine store, both family-owned businesses in the heart of Ashburn. Both stores had owners willing to talk with you about all matters and help you buy the right items. We ended up buying two small tables and a couple bottles of wine. Before my diagnosis, I hardly noticed these stores, much less their owners. But now, as a cancer patient at home during the day, I was able to experience how more people live and work outside a traditional office environment. And it enlightened my mind and lightened my mood. Another great memory to store.

Slowly, my appetite began to return. So Kate and I, sometimes with Jack, would go out to lunch at local restaurants. I loved these events because I got to spend one-on-one time with Kate in a non-medical situation. Again, I got to observe the life of others at home during the day. Retired people. Moms meeting up with each other. Kids home for the summer. Workers in the neighborhood taking a break. God, what a great environment. Later, Kate and I went to The Birchmere club in Arlington to see one of our favorite bands, Fountains of Wayne. I was amazed that I had enough strength to stay out so long. And I got home with a horse voice from all the singing we did that night.

After several days of all this -- concert, eating out, school visit, wine and furniture shopping -- I felt like I was on an extended vacation. It had that same great, liberating feel. Then it dawned on me: I was beginning to heal emotionally. I was seeing the beauty of everyday life. Beauty that had been obscured by side effects while I was undergoing treatments. Beauty I was never aware of pre-diagnosis. Which of course made me cry.

I even carried my upbeat mood to oncology, where I had perhaps my first amusing experience. Now, amusing and oncology are words that rarely go together. But in this case, they did. When I returned for a port flush, the nurses noticed that my hair was, well, barely noticeable. And they felt sad for me. "It's okay, it happens to everyone." Except that's not what happened. In fact, my hair continued to grow during treatments, So much so that I asked Kate to cut my hair; I didn't want to risk getting cut by a barber. But she cut my hair so short that any remainder was difficult to see. Argh. Just when I was trying to move past treatments, I now had chemo hair to deal with!

In addition to hair, I parted with other things as well. For instance, I wore buttoned shirts to chemotherapy treatments. Those shirts made it easier than golf or t-shits for the nurses to access my Mediport. But now, I put those shirts in the back of my closet, not to be worn again anytime soon. My white iPhone reminded me too much of oncology, So I switched with Kate and got her black iPhone. These things sound kinda silly. But at the time, I was looking for any way to put bad memories behind me.

All this led to my big date: the PET scan. This time, I didn't think twice about walking out to a trailer for the latest in modern medicine. I knew the routine. My body still tingled, but I managed to stay still enough long enough for the diagnosticians to get a reading. What it was, I would have to wait. Sigh. This was Wednesday, and I would have to wait until the following Tuesday, August 16, when I would meet with Drs. Moreas and Schenk. Kate tried to distract me by taking me to an Orioles baseball game, the first one we had attended since treatments began. But my mind inevitably drifted to what the scan might show. What if the treatments didn't work? Would Moreas add more cycles for me to go through? Would the drugs be changed and I begin a whole new set of treatments? Would I even have any options?

Thursday. Friday. Saturday. Sunday. Monday. The longest five days of my life. My first break happened Monday night when I talked with my brother Bob, who I had included on the list of doctors to be given my test results. He had the results. He admitted that some of the technical jargon eluded him. So he was cautious about what he was about to tell me. There were two words on the report that he believed offered me hope: "complete response." Sounds encouraging. But what does that mean, Bob? He wasn't sure. But Moreas was. "Complete response" means that the scan found no cancer in my lymph nodes -- the area that initially indicated possible spread -- nor anywhere else. You're kidding, right? I said. No, it was not good news, he said, it was great news. In fact, he had seen only one other case like mine.

Okay, I began to feel a whole lot better. But I was still holding back. Why? I needed Schenk, who was straight and blunt with me all along, to tell me. "You've heard about your results?" he opened with. Yes, I had. But I said no. I needed to hear it from his mouth. What did they show? I asked. "Complete response." And that meant what? "It worked." Those were the best words I had heard from Schenk. My body just collapsed in joy and relief. It meant I wasn't going to die, at least not anytime soon. Schenk has told me so, and there was no greater authority. All those treatments, all that agony finally paid off. Thank you, Lord. Tears flowed.

After catching my breath, and hugging Kate, I asked, "What's next?" He said: "It means that you're a candidate for surgery." This is where I pushed back. Let me see if I got this right: chemotherapy killed my cancer cells, and you still want to remove my bladder? Yes, he said, "you remember what we talked about." Yeah, I did. Bladder cancer has a high rate of recurrence. Even scans are not definitive in identifying all possible cancer cells. Blah, blah, blah. Of course, I knew all this by heart by now. And I knew I would have to do the surgery. But mentally, I just wasn't in that space. I had just been given the greatest reprieve of my life, and I needed to enjoy the moment. What's more, my body was gradually building strength, chemotherapy side effects were gradually abating, and I wanted to keep this going instead of putting my body through another kind of hell.

Still, I left the meeting with Schenk agreeing to a surgical date, September 19. In the weeks ahead, though, I would ask myself one question over and over: Should I really go through with the surgery?

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