Do You Suppose Thyroid Cancer Has A Sense Of Irony?
Today, July 29th 2010, I got "the call" from my surgeon.
The call that has had my stomach churning the previous seven days every time the phone rang. The call that would quite possibly decide at the very least, the next several months of my life. In keeping with the ways of today's online existence, I received an email notification that a message had been left on our home digital voicemail. Noting that it was only 14 seconds long , I immediately thought " Oh its just the robo-call reminding me of my apppointment Monday AM." I will check it tonight. Then I decided to retrieve it and give it a listen. To my surprise , instead of an annoying computerized robot, I heard the sound of my doctor's voice.
"Hello Roger, this Dr. Randolph calling to chat about your path report. " Shit. Heart leaps immediately into my throat. Hands shaking, I called the number he left , and found myself speaking with his assistant, and not him. She seemed surprised that I had a message from him as she thought he had" left for the day some time ago," but she would check and see if he was still "up in his office". The next thing I heard was the dead air of a music-free hold.
Moments later the doctor picked up .
"Roger, this is Doctor Randolph. How are you? You got my message. Good. I'm happy to..."
Tell me that everything is fine?
"chat with you about your path report over the phone, or wait until the followup and we can chat in person"
He sure likes the word 'chat'.
"No I'm ok talking on the phone" I heard myself reply,with a voice still slightly altered in timbre and strength from my surgical event two weeks prior.
Dr. Randolph began, with his usual calm, almost upbeat way of speaking. (Had he not become a World Famous Thyroid Surgeon, he certainly could have had a future in recording self-help audio books. Not quite a Stewart Smalley, but you get my point.)
"Well as you know you had a lesion that was 16mm..."
Yup. Have to say I know it pretty well at this point. Pretty intimate with "the lesion" , doc. I have found myself in a longterm dysfunctional relationship these past 6 years with this so-called "lesion", discovered incidentally in the summer of '04,same year my daughter was born. You only just met it face-to-face two weeks ago. Dysfunctional to the point that hundreds, check that, thousands of subsequent hours of my life have been irrevocably lost. Ever since my "atypical" biopsy result in the fall of 2004, I have lived with weeks of anxiety,insomnia, unexplained weight loss,abdominal pain, an endoscopy, an abdominal CT-scan, and too many panic attacks to name in the last year alone because "the lesion" decided this past February to "change slightly in size and complexity". Not to mention I apparently gave myself a hernia this winter trying to get myself out of the funk, courtesy of "the lesion"( which will have me back under the knife at some point in the not-too-distant future). Yeah quite a relationship this one,ultimately ending in antidepressants and a mid-summer's thyroid surgery. Yeah, I am pretty familiar with "the lesion".
"...well the pathology on that turned out to be 'benign'. It was caused by -insert medical jargon here-thyroiditis" . Then he paused.
Somehow, I knew what was coming on the other side of the pause.
" however..."
No. Absolutely not. No "howevers".
Benign you say? Works for me. I'll see you Monday for my stitch removal/post-op checkup. In fact I will come see you every Monday to pay you tribute with the breakfast treat of your choice for a benign pathology, and a clear-cut end to this saga. "Howevers" are not welcome in this conversation, thank-you very much. In fact , maybe you did not notice the big " NO HOWEVERS" sign hanging up behind me. Did I mention my son turns 10 on the 3rd. Also my Dad's birthday. Big birthday, turning ten. He is so excited. All he talks about these days. His father's surgery is a distant memory at this point. Be nice to have the stitches out on the 2nd. Surprising him with a trip to the Fenway that night so...Good Day Sir.I said, " Good Day!"
"the report did show a 4 mm cancer underneath the benign lesion".
"what?" I heard my response , stunned to hear the C-word so soon after hearing what I thought was an "all-clear". Who's report? My report?
It's this damned tee-shirt, I immediately thought. What? What the hell does the tee-shirt have to do with ANYTHING? "Well you see, "crazy Rog" started to explain to "sane Rog", Remember the ' cancer' dream a few years ago? You were wearing the same exact shirt you have on at the moment, the HP Government IT one with the orange outline of the US Capitol when you took the call" Fucking HP. You suck. In fact when I took the shirt out of the drawer this morning, I almost put it back , in a move my overly superstitious mother would be proud of. But I told myself, c'mon, they haven't called by now they aren't going to call . Besides , it was a friggin' dream. Means nothing.
The next several minutes of the phone call was what I can only imagine an out-of-body experience feels like. My mind began to race as it tried to process what it was hearing. I had imagined over and over again in the time leading up to this moment:how would I react if the news was cancer? Would I totally freak out? Would I start crying? Would I faint?. Hollywood has given us all kinds of scenarios for this moment. Which one would I choose?
In reality I did nothing. I just listened. Almost semi-hypnotic. I heard the calm, soothing voice of my surgeon, droning on with the expertise of a well-rehearsed bass, explaining numbers and statistics, and my voice accenting his explanations with the carefully placed snare beats of my response.
"now this occurrence is a fairly common one, when dealing with lobectomies. In fact it happens one in ten" Bahh-dumm dee dumm.
"I see." Snap.
"And this week, counting yours, I have 2 of these phone calls to make " Dee-dumm dee-dumm.
"I see" Snap.
"Now four millimeters is very small , but that being said ,it is a focus of cancer. The standard protocol for thyroid cancer is complete removal of the remaining thyroid tissue, and radioactive iodine treatment. However..."
There is that word again. Jesus, can't this bastard read my sign?
"as I was saying..."
He continued to do the "As I was saying" thing for another couple of minutes, while I climbed higher and higher up the precipice. But then he began talking me down off the ledge. Damn this guy is good.
"given its size , and the fact we removed the entire lobe containing it, I feel the risk of additional surgery outweighs the risk that this tumor poses going forward. So that is very reassuring".
"uh huh". Reassuring you say. Easy enough for you . It's not your neck. It's not your thyroid. It's not your cancer. It's not your son's tenth birthday. Holy Shit. This can't be happening. When I turned 10 , the most traumatic thing in my life was my parents decision to up and leave the town I was born in, and move across the bridge to Salem, changing schools, friends, quality of neighborhood, changing everything. Donovan gets this. Variation on a theme,I guess.
"So we need to have a conversation about this, and an Endocrinologist that focuses on thyroid cancer has to be a part of that conversation. I work with an excellent one at Mass General, and have already been in touch with him. I discussed your report with him and we are in agreement about how to proceed in the short term. I like to involve him in these cases as he does not automatically just agree with me as to what is best for the patient. So that is very reassuring also...."
"Dr. Barbarino?" I asked. I was fixated on the name, not really paying attention to what followed. In keeping with the way fucked up things tend to follow me around, earlier this week I was working on a computer owned by a "Cotter". Go figure.
"Barba-See-no" he corrected. "As I was saying..."
It is cancer, but it may not be one of the more aggressive forms, which necessitate additional surgeries and chemo , at this time. According to Randolph lots of people have undetected thyroid cancer. Some autopsy results often show it in as much as 36% of certain populations. But in many cases it is happy to sit and stew in its own "cancerousness" if you will, growing so slowly , one ultimately dies from something completely unrelated. Right now I am hoping that is the case with me.
"and right now it in your case it is totally, and completely unplugged."
His words, not mine.
Is that an all-clear? I am not really sure at this point, and am still processing. I guess it comes down to being optimistic and trusting enough to put my life in the hands of the doctor(s) advising me. Unfortunately my faith in the medical establishment has been shaken by the fact that for the previous six years we were just "watching and waiting" my thyroid, assuming all was ok. But after meeting Dr. Randolph we learned that "atypical really means "suspicious" , and from the get-go it should have come out soon after it's discovery. Not treated as if it was benign, per the advice of the endocrinologist I was seeing. Was. Won't be darkening his doorstep anytime soon. The kicker is I only saw him in the first place because the ENT surgeon who originally discovered our friend "the lesion" in 2004, whether because of inexperience or plain stupidity, deferred to the endo quack.
What faith I have left in those who swear to Hippocrates also has to withstand my innate predilection to always assume the worst-case scenario when it comes to my own health status.
Hopefully my follow-up August 2nd will resolve some of this.
The call that has had my stomach churning the previous seven days every time the phone rang. The call that would quite possibly decide at the very least, the next several months of my life. In keeping with the ways of today's online existence, I received an email notification that a message had been left on our home digital voicemail. Noting that it was only 14 seconds long , I immediately thought " Oh its just the robo-call reminding me of my apppointment Monday AM." I will check it tonight. Then I decided to retrieve it and give it a listen. To my surprise , instead of an annoying computerized robot, I heard the sound of my doctor's voice.
"Hello Roger, this Dr. Randolph calling to chat about your path report. " Shit. Heart leaps immediately into my throat. Hands shaking, I called the number he left , and found myself speaking with his assistant, and not him. She seemed surprised that I had a message from him as she thought he had" left for the day some time ago," but she would check and see if he was still "up in his office". The next thing I heard was the dead air of a music-free hold.
Moments later the doctor picked up .
"Roger, this is Doctor Randolph. How are you? You got my message. Good. I'm happy to..."
Tell me that everything is fine?
"chat with you about your path report over the phone, or wait until the followup and we can chat in person"
He sure likes the word 'chat'.
"No I'm ok talking on the phone" I heard myself reply,with a voice still slightly altered in timbre and strength from my surgical event two weeks prior.
Dr. Randolph began, with his usual calm, almost upbeat way of speaking. (Had he not become a World Famous Thyroid Surgeon, he certainly could have had a future in recording self-help audio books. Not quite a Stewart Smalley, but you get my point.)
"Well as you know you had a lesion that was 16mm..."
Yup. Have to say I know it pretty well at this point. Pretty intimate with "the lesion" , doc. I have found myself in a longterm dysfunctional relationship these past 6 years with this so-called "lesion", discovered incidentally in the summer of '04,same year my daughter was born. You only just met it face-to-face two weeks ago. Dysfunctional to the point that hundreds, check that, thousands of subsequent hours of my life have been irrevocably lost. Ever since my "atypical" biopsy result in the fall of 2004, I have lived with weeks of anxiety,insomnia, unexplained weight loss,abdominal pain, an endoscopy, an abdominal CT-scan, and too many panic attacks to name in the last year alone because "the lesion" decided this past February to "change slightly in size and complexity". Not to mention I apparently gave myself a hernia this winter trying to get myself out of the funk, courtesy of "the lesion"( which will have me back under the knife at some point in the not-too-distant future). Yeah quite a relationship this one,ultimately ending in antidepressants and a mid-summer's thyroid surgery. Yeah, I am pretty familiar with "the lesion".
"...well the pathology on that turned out to be 'benign'. It was caused by -insert medical jargon here-thyroiditis" . Then he paused.
Somehow, I knew what was coming on the other side of the pause.
" however..."
No. Absolutely not. No "howevers".
Benign you say? Works for me. I'll see you Monday for my stitch removal/post-op checkup. In fact I will come see you every Monday to pay you tribute with the breakfast treat of your choice for a benign pathology, and a clear-cut end to this saga. "Howevers" are not welcome in this conversation, thank-you very much. In fact , maybe you did not notice the big " NO HOWEVERS" sign hanging up behind me. Did I mention my son turns 10 on the 3rd. Also my Dad's birthday. Big birthday, turning ten. He is so excited. All he talks about these days. His father's surgery is a distant memory at this point. Be nice to have the stitches out on the 2nd. Surprising him with a trip to the Fenway that night so...Good Day Sir.I said, " Good Day!"
"the report did show a 4 mm cancer underneath the benign lesion".
"what?" I heard my response , stunned to hear the C-word so soon after hearing what I thought was an "all-clear". Who's report? My report?
It's this damned tee-shirt, I immediately thought. What? What the hell does the tee-shirt have to do with ANYTHING? "Well you see, "crazy Rog" started to explain to "sane Rog", Remember the ' cancer' dream a few years ago? You were wearing the same exact shirt you have on at the moment, the HP Government IT one with the orange outline of the US Capitol when you took the call" Fucking HP. You suck. In fact when I took the shirt out of the drawer this morning, I almost put it back , in a move my overly superstitious mother would be proud of. But I told myself, c'mon, they haven't called by now they aren't going to call . Besides , it was a friggin' dream. Means nothing.
The next several minutes of the phone call was what I can only imagine an out-of-body experience feels like. My mind began to race as it tried to process what it was hearing. I had imagined over and over again in the time leading up to this moment:how would I react if the news was cancer? Would I totally freak out? Would I start crying? Would I faint?. Hollywood has given us all kinds of scenarios for this moment. Which one would I choose?
In reality I did nothing. I just listened. Almost semi-hypnotic. I heard the calm, soothing voice of my surgeon, droning on with the expertise of a well-rehearsed bass, explaining numbers and statistics, and my voice accenting his explanations with the carefully placed snare beats of my response.
"now this occurrence is a fairly common one, when dealing with lobectomies. In fact it happens one in ten" Bahh-dumm dee dumm.
"I see." Snap.
"And this week, counting yours, I have 2 of these phone calls to make " Dee-dumm dee-dumm.
"I see" Snap.
"Now four millimeters is very small , but that being said ,it is a focus of cancer. The standard protocol for thyroid cancer is complete removal of the remaining thyroid tissue, and radioactive iodine treatment. However..."
There is that word again. Jesus, can't this bastard read my sign?
"as I was saying..."
He continued to do the "As I was saying" thing for another couple of minutes, while I climbed higher and higher up the precipice. But then he began talking me down off the ledge. Damn this guy is good.
"given its size , and the fact we removed the entire lobe containing it, I feel the risk of additional surgery outweighs the risk that this tumor poses going forward. So that is very reassuring".
"uh huh". Reassuring you say. Easy enough for you . It's not your neck. It's not your thyroid. It's not your cancer. It's not your son's tenth birthday. Holy Shit. This can't be happening. When I turned 10 , the most traumatic thing in my life was my parents decision to up and leave the town I was born in, and move across the bridge to Salem, changing schools, friends, quality of neighborhood, changing everything. Donovan gets this. Variation on a theme,I guess.
"So we need to have a conversation about this, and an Endocrinologist that focuses on thyroid cancer has to be a part of that conversation. I work with an excellent one at Mass General, and have already been in touch with him. I discussed your report with him and we are in agreement about how to proceed in the short term. I like to involve him in these cases as he does not automatically just agree with me as to what is best for the patient. So that is very reassuring also...."
"Dr. Barbarino?" I asked. I was fixated on the name, not really paying attention to what followed. In keeping with the way fucked up things tend to follow me around, earlier this week I was working on a computer owned by a "Cotter". Go figure.
"Barba-See-no" he corrected. "As I was saying..."
It is cancer, but it may not be one of the more aggressive forms, which necessitate additional surgeries and chemo , at this time. According to Randolph lots of people have undetected thyroid cancer. Some autopsy results often show it in as much as 36% of certain populations. But in many cases it is happy to sit and stew in its own "cancerousness" if you will, growing so slowly , one ultimately dies from something completely unrelated. Right now I am hoping that is the case with me.
"and right now it in your case it is totally, and completely unplugged."
His words, not mine.
Is that an all-clear? I am not really sure at this point, and am still processing. I guess it comes down to being optimistic and trusting enough to put my life in the hands of the doctor(s) advising me. Unfortunately my faith in the medical establishment has been shaken by the fact that for the previous six years we were just "watching and waiting" my thyroid, assuming all was ok. But after meeting Dr. Randolph we learned that "atypical really means "suspicious" , and from the get-go it should have come out soon after it's discovery. Not treated as if it was benign, per the advice of the endocrinologist I was seeing. Was. Won't be darkening his doorstep anytime soon. The kicker is I only saw him in the first place because the ENT surgeon who originally discovered our friend "the lesion" in 2004, whether because of inexperience or plain stupidity, deferred to the endo quack.
What faith I have left in those who swear to Hippocrates also has to withstand my innate predilection to always assume the worst-case scenario when it comes to my own health status.
Hopefully my follow-up August 2nd will resolve some of this.
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