Letting It Sink In
Today I had my first-ever, post-op, follow-up. (that has to rank as one of the most hyphenated sentences I have ever written.)
Throughout this process ,all the appointments were made for me by the doctor's office month's in advance, completely wrestling from me the ability to delay something I very much wanted to delay, if not avoid completely. These dates seemed so far off that they may as well not even have existed. I received my "packet" three months ago that laid out the pre-op consult , the pre-op physical exam, and the post-op follow-up, along with lots of documentation, needing lots of my closely guarded personal information. It was then I began to realize how much control over "self" you give up as soon as you decide to enter the mechanism known as the "Finest Medical Care In The World". I had just seen Gran Torino when the package arrived and unlike Mr. Kowalski(or is that kwaski?) I filled out all my forms, and kept all my appointments.
It has been a bit longer than two weeks since my surgery, and I am still adhering to the restrictions imposed on me as best I can. One such item was 'no driving'. I probably can drive now, but I figured rush hour in Boston was not the time to get behind the wheel for the first time in weeks. So Michelle drove me in to Mass Eye and Ear. My appointment was for 10:45, and we made it in with enough time to spare to hit the cafeteria on the seventh floor for some of their pancakes . For some reason they did not seem as good as they were two weeks ago when they were my first breakfast in forty-eight hours. Go figure.
When we got to the office , it became apparent that today the doctor was on a tight schedule. "He wants to keep things moving" one of his assistants explained to me as she escorted me back as soon as I walked in the door.
After showing us to the exam room, she immediately began her role in this process: removal of the steri-strips. She bustled about the cramped exam room, her extremely generous physical attributes only adding to the claustrophobic feeling I had as my personal space was invaded yet again, and began draping me with a gauze bib.
" I'm a-gonna put some unsticker lotion on you, and this will keep you dry"
Did she say 'a-gonna?'What the hell is 'unsticker' " I thought to myself as she started to squirt a cold fragrant gel all over my neck.
"Apparently the gel is mainly witch hazel," she informed us. By the smell of it, I had no reason to doubt her. After I was good and saturated with it, from Adam's apple to navel, and the room full of its aroma,she began pulling off the last surgical remnants of my summer ordeal. "Ohh look at that! He sure does good work" she crowed as she got the first looks at my nineteen day old incision. "Here come see for yourself" she prompted , showing me where the mirror was. "Oh. Yeah." I concurred, not so much agreeing as placating. I still had a six inch long scar on my neck. I still had the disturbing "path" report. I still had to "have a conversation" with the surgeon, and the endocrinologist. The only things I didn't have anymore were the nasty,yellowed, curling steri-strips, and half of my thyroid.
"The doctor will be with you shortly" she said abruptly exiting the room.
Michelle and I barely had time to make the usual, sarcastic wise-ass comments about the medieval-looking instruments laying about the room, before there was a light rap on the door and one of the "fellows" entered the room and introduced himself. I remembered seeing him several times when I was in the hospital, but Michelle was meeting him for the first time.
"Hello, I am Dr. P. Nice to see you again."
He took a deep breath before speaking. " So, I am going to talk with you first and then Dr. R will be in . I see he called you last week with your report, and informed you that the large lesion was benign..." he began with thickly accented English. My years spent in food service told me when I first met him, even in my narcotic-induced post-op haze, " he's Brazilian" . I wanted to say "Fala !" but restrained myself .
"...but we also found a small papillary carcinoma. This happens all the time and you have nothing to worry about" Now do you mind if I feel your neck..."
While he was speaking, I had become aware of a presence hovering outside the half-opened door to the exam room. Dr. R suddenly opened the door fully, said "hello" to both Michelle and I, then curtly asked the fellow, "Dr. P, Can I speak with you for a moment in the other room."
Michelle and I just looked at each other with a "wtf is going on?" expression as we awaited the fellow's return.
It never came.
Instead it was Dr. R who returned to the room. We exchanged pleasantries, and he flipped open the red folder with my name on it, and took a moment to look at the papers therein.
"As I discussed with you over the phone last week the path report showed the lesion we were concerned with, the large 16 mm one, was benign. So that is good news. But it also did show a small follicular carcinoma, of about 4 mm in size..."
I did not really hear the remainder of that sentence .
I heard the word "follicular" and my mind was off to the races.
The fellow had used the word "papillary" to describe the cancer. Papillary is the most common , and most indolent form of thryoid cancer. If it spreads at all, it mainly is confined to the lymph nodes of the neck. Very easy to keep an eye on. Follicular on the other hand spreads through the blood , bypassing the lymph system altogether. Immediately my mind began to think of the worst case possibilities. That my body was at that very moment being seeded with microscopic cancerous cells floating throughout my bloodstream, like bits of garbage swept away in a mid-summer's flash flood. That the garbage contained cancer-like maggots that would then infiltrate the organs of my body, devouring from the inside out. That what he was going to say next would include the words "six weeks" or " six months" or "to live". And "radiation." And "chemotherapy".
But it didn't. Instead the conversation contained phrases like " "minimally invasive", and "near zero","discussions" , "conversations" and "we will make sure we follow you".
But I couldn't let the slip-up by the fellow go.
"Dr. P told me it was 'papillary'. Follicular can spread through the blood" I blurted out, interrupting the doctor in mid-sentence.
"yes, Dr. P made a mistake. He is still very new, and does not always get the language right."
No shit ,he is new, I thought. Would it totally blow this guys mind if he knew with my advanced research tool , "The Google" , I found out on "the Google" that Dr. P was so new that his medical license, a "limited " one in fact, had only been issued to him on July 7th. Exactly one week before he was in the O.R. assisting you as you sliced open my neck? But I refrained.
" Yes, about that. I will be addressing that with him shortly. Forget what he said. You need to listen to what I am saying", Dr. R replied. I began picturing what will happen later, after we leave. I imagined this intern, fellow, whatever he is called being beat about the head by my enraged surgeon with tubes of witchhazel,clipboards, his "Limited License", and whatever else he could grab,amid screams of " Papillary? Papillary?!! I'll show you Papillary!!!!" Then, summarily being dragged by his ear to the cabinet where the wax for the Maserati is kept," I want two coats this time , dammit, you hear me? TWO COATS!"
Needless to say,henceforth our verbally challenged fellow has now become known as "Dr. Maserati" between Michelle and I.
Basically the long and short of my follow-up is my doc feels they got all of the cancer during the surgery. Yes it was follicular , a more aggressive variant, but the fact that it was minimally invasive in pathology means he feels ,aside from more frequent check-ups on the remaining part of my thyroid, "we can put this to bed at this time". The likelihood that it metastasized is in his words "close to zero". But that also means that the ability to have the certainty I need for my own peace of mind will be "close to zero" as well. I realize the chances at getting a doctor to speak in absolutes, or guarantees is also "close to zero".
So I surrender to my new reality. That of "lucky bastard post-op cancer patient" . I will be followed more closely. That means more frequent blood tests, checkups, ultrasounds, more invasion of my personal space, and whatever else they deem necessary, for the rest of my life. As a sufferer of "white coat syndrome" I am not thrilled at the prospect, but it certainly is much better than what the alternative could have been. As cancer diagnoses go, this is about as good as it gets.
The doctor began the visit "wrap-up" by summarizing what he had said previously, and telling me he understood "this was a lot to process " and I need to "let it all sink in." No kidding.
So I have begun the sinking-in process. If this is my only brush with the Big C , I will take it, but this year so far has been enough to make me old.
I sure as hell hope so.
Throughout this process ,all the appointments were made for me by the doctor's office month's in advance, completely wrestling from me the ability to delay something I very much wanted to delay, if not avoid completely. These dates seemed so far off that they may as well not even have existed. I received my "packet" three months ago that laid out the pre-op consult , the pre-op physical exam, and the post-op follow-up, along with lots of documentation, needing lots of my closely guarded personal information. It was then I began to realize how much control over "self" you give up as soon as you decide to enter the mechanism known as the "Finest Medical Care In The World". I had just seen Gran Torino when the package arrived and unlike Mr. Kowalski(or is that kwaski?) I filled out all my forms, and kept all my appointments.
It has been a bit longer than two weeks since my surgery, and I am still adhering to the restrictions imposed on me as best I can. One such item was 'no driving'. I probably can drive now, but I figured rush hour in Boston was not the time to get behind the wheel for the first time in weeks. So Michelle drove me in to Mass Eye and Ear. My appointment was for 10:45, and we made it in with enough time to spare to hit the cafeteria on the seventh floor for some of their pancakes . For some reason they did not seem as good as they were two weeks ago when they were my first breakfast in forty-eight hours. Go figure.
When we got to the office , it became apparent that today the doctor was on a tight schedule. "He wants to keep things moving" one of his assistants explained to me as she escorted me back as soon as I walked in the door.
After showing us to the exam room, she immediately began her role in this process: removal of the steri-strips. She bustled about the cramped exam room, her extremely generous physical attributes only adding to the claustrophobic feeling I had as my personal space was invaded yet again, and began draping me with a gauze bib.
" I'm a-gonna put some unsticker lotion on you, and this will keep you dry"
Did she say 'a-gonna?'What the hell is 'unsticker' " I thought to myself as she started to squirt a cold fragrant gel all over my neck.
"Apparently the gel is mainly witch hazel," she informed us. By the smell of it, I had no reason to doubt her. After I was good and saturated with it, from Adam's apple to navel, and the room full of its aroma,she began pulling off the last surgical remnants of my summer ordeal. "Ohh look at that! He sure does good work" she crowed as she got the first looks at my nineteen day old incision. "Here come see for yourself" she prompted , showing me where the mirror was. "Oh. Yeah." I concurred, not so much agreeing as placating. I still had a six inch long scar on my neck. I still had the disturbing "path" report. I still had to "have a conversation" with the surgeon, and the endocrinologist. The only things I didn't have anymore were the nasty,yellowed, curling steri-strips, and half of my thyroid.
"The doctor will be with you shortly" she said abruptly exiting the room.
Michelle and I barely had time to make the usual, sarcastic wise-ass comments about the medieval-looking instruments laying about the room, before there was a light rap on the door and one of the "fellows" entered the room and introduced himself. I remembered seeing him several times when I was in the hospital, but Michelle was meeting him for the first time.
"Hello, I am Dr. P. Nice to see you again."
He took a deep breath before speaking. " So, I am going to talk with you first and then Dr. R will be in . I see he called you last week with your report, and informed you that the large lesion was benign..." he began with thickly accented English. My years spent in food service told me when I first met him, even in my narcotic-induced post-op haze, " he's Brazilian" . I wanted to say "Fala !" but restrained myself .
"...but we also found a small papillary carcinoma. This happens all the time and you have nothing to worry about" Now do you mind if I feel your neck..."
While he was speaking, I had become aware of a presence hovering outside the half-opened door to the exam room. Dr. R suddenly opened the door fully, said "hello" to both Michelle and I, then curtly asked the fellow, "Dr. P, Can I speak with you for a moment in the other room."
Michelle and I just looked at each other with a "wtf is going on?" expression as we awaited the fellow's return.
It never came.
Instead it was Dr. R who returned to the room. We exchanged pleasantries, and he flipped open the red folder with my name on it, and took a moment to look at the papers therein.
"As I discussed with you over the phone last week the path report showed the lesion we were concerned with, the large 16 mm one, was benign. So that is good news. But it also did show a small follicular carcinoma, of about 4 mm in size..."
I did not really hear the remainder of that sentence .
I heard the word "follicular" and my mind was off to the races.
The fellow had used the word "papillary" to describe the cancer. Papillary is the most common , and most indolent form of thryoid cancer. If it spreads at all, it mainly is confined to the lymph nodes of the neck. Very easy to keep an eye on. Follicular on the other hand spreads through the blood , bypassing the lymph system altogether. Immediately my mind began to think of the worst case possibilities. That my body was at that very moment being seeded with microscopic cancerous cells floating throughout my bloodstream, like bits of garbage swept away in a mid-summer's flash flood. That the garbage contained cancer-like maggots that would then infiltrate the organs of my body, devouring from the inside out. That what he was going to say next would include the words "six weeks" or " six months" or "to live". And "radiation." And "chemotherapy".
But it didn't. Instead the conversation contained phrases like " "minimally invasive", and "near zero","discussions" , "conversations" and "we will make sure we follow you".
But I couldn't let the slip-up by the fellow go.
"Dr. P told me it was 'papillary'. Follicular can spread through the blood" I blurted out, interrupting the doctor in mid-sentence.
"yes, Dr. P made a mistake. He is still very new, and does not always get the language right."
No shit ,he is new, I thought. Would it totally blow this guys mind if he knew with my advanced research tool , "The Google" , I found out on "the Google" that Dr. P was so new that his medical license, a "limited " one in fact, had only been issued to him on July 7th. Exactly one week before he was in the O.R. assisting you as you sliced open my neck? But I refrained.
" Yes, about that. I will be addressing that with him shortly. Forget what he said. You need to listen to what I am saying", Dr. R replied. I began picturing what will happen later, after we leave. I imagined this intern, fellow, whatever he is called being beat about the head by my enraged surgeon with tubes of witchhazel,clipboards, his "Limited License", and whatever else he could grab,amid screams of " Papillary? Papillary?!! I'll show you Papillary!!!!" Then, summarily being dragged by his ear to the cabinet where the wax for the Maserati is kept," I want two coats this time , dammit, you hear me? TWO COATS!"
Needless to say,henceforth our verbally challenged fellow has now become known as "Dr. Maserati" between Michelle and I.
Basically the long and short of my follow-up is my doc feels they got all of the cancer during the surgery. Yes it was follicular , a more aggressive variant, but the fact that it was minimally invasive in pathology means he feels ,aside from more frequent check-ups on the remaining part of my thyroid, "we can put this to bed at this time". The likelihood that it metastasized is in his words "close to zero". But that also means that the ability to have the certainty I need for my own peace of mind will be "close to zero" as well. I realize the chances at getting a doctor to speak in absolutes, or guarantees is also "close to zero".
So I surrender to my new reality. That of "lucky bastard post-op cancer patient" . I will be followed more closely. That means more frequent blood tests, checkups, ultrasounds, more invasion of my personal space, and whatever else they deem necessary, for the rest of my life. As a sufferer of "white coat syndrome" I am not thrilled at the prospect, but it certainly is much better than what the alternative could have been. As cancer diagnoses go, this is about as good as it gets.
The doctor began the visit "wrap-up" by summarizing what he had said previously, and telling me he understood "this was a lot to process " and I need to "let it all sink in." No kidding.
So I have begun the sinking-in process. If this is my only brush with the Big C , I will take it, but this year so far has been enough to make me old.
I sure as hell hope so.
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