tag:blogger.com,1999:blog-81875222547573541462024-02-02T11:30:20.293-08:00Mark vs CancerMarkhttp://www.blogger.com/profile/17710337880486481120noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-8187522254757354146.post-47211341465452562042012-02-01T13:41:00.000-08:002012-02-01T13:46:20.310-08:00Gun ShyWith my last entry, I think I jinxed myself. Makes me a little gun shy about saying anything else. <br />
<br />
Two weeks ago, I spoke about my bladder obstruction and catheter trauma as if it were all in the past. At that point, it was.<br />
<br />
But the next day, I had a recurrence. A much worse recurrence. I wound up in the hospital with a 10 cm blood clot in my bladder. It was discovered that I had a bleeding vessel in my kidney at the surgical site. I had another high tech intervention, an arterial embolization of a branch of the renal artery to stop the bleeding, then a second procedure to remove the clot. More anesthesia. More catheters. My worst nightmares revisited.<br />
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiz_4vlAuqMigrKOipm5ZQxy9dklR7vFCWQDpISM6zL9zd6_-Y6U8fQLoOeGcnhqBoJ52FYWtX8YngrvdJ5l_Qq_70yylSd82l5QanrLxAUVhyphenhyphen-DNsOdRYuv3QPzywouVbbQdEpv2tlniw/s1600/Snuffaluffagus.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiz_4vlAuqMigrKOipm5ZQxy9dklR7vFCWQDpISM6zL9zd6_-Y6U8fQLoOeGcnhqBoJ52FYWtX8YngrvdJ5l_Qq_70yylSd82l5QanrLxAUVhyphenhyphen-DNsOdRYuv3QPzywouVbbQdEpv2tlniw/s1600/Snuffaluffagus.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">(What would Snuffaluffagus say?)</td></tr>
</tbody></table>I had lost a lot of blood and wound up moderately anemic. I also had no appetite, and I lost 10 pounds which skinny old me couldn't really afford to lose. I felt weak and tired. I stayed in the hospital two nights, and I <br />
left with a temporary stent in my ureter in order to prevent more clotting. This was better than a catether, but still very uncomfortable. If felt like I had a splinter in my abdomen. Three days later, I went back and, hopefully for the last time in my life, had a cystoscopy where the stent was removed. Instant relief. What a blessing to be able to urinate without pain.<br />
<br />
That was a week ago. Ever since, I've been feeling great. My surgical scars are looking good, my appetite is in full force. It's so tough for me to feel this well, and yet not be able to go right back to doing the things I love to do: exercise, basketball, yoga, wrestling with the boys, hiking, skiing, jogging with the dog. I'm thirty-seven, I've survived cancer, and I guess I still haven't internalized the lesson that I'm not indestructible.<br />
<br />
Part of the problem is that I've discovered that I'm just not very in tune with my body. I mean, I had no conscious sense that I had cancer prior to the diagnosis. I had such minimal post-operative pain afterward. (When they asked me after the surgery to rate my pain, I sat there and pondered and thought, I don't really have any pain, so maybe a one? And that was without any narcotics.) <br />
<br />
It's like I either have devastating, exquisite, acute pain, like an obstructed bladder and a catheter, or a bad ankle sprain, or I have a sense that something is not right with my body, like a ureteral stent, and then I feel lousy, no energy, no appetite, depressed spirits. Or, much more commonly, thankfully, I have no exquisite pain, no sense of fatigue or foreign body sensation, and I feel great. It's like if I can't locate a conscious problem in my body, then my expectation for myself is to feel well, and therefore to do all the things that I need and want to do, like work and play. Why shouldn't I? I feel great.<br />
<br />
This sort of attitude probably makes me a lousy patient. <br />
<br />
However, I don't believe that my post-operative complications were related to me overdoing anything. They were probably going to happen one way or another.<br />
<br />
But nevertheless, now I'm gun shy. I never want to go through that ordeal again. So I'm taking my time, heading back to work slowly over the next two weeks, holding off of the exercise, even though every cell in my body is aching to go put on my running shoes and take advantage of this sunny winter day in Denver.<br />
<br />
But I shall refrain. No more pain. No more regrets. No more catheters. If it takes waiting another two weeks to ensure that . . . well, then I'm not taking any chances.Markhttp://www.blogger.com/profile/17710337880486481120noreply@blogger.com0tag:blogger.com,1999:blog-8187522254757354146.post-88563510690172207202012-01-19T20:48:00.000-08:002012-01-19T20:53:59.681-08:00Temporary ObstructionTwo weeks since I left the hospital, and I'm feeling great, even worked half a day. The robotic precision of my surgery seems to have minimized tissue disruption and helped hasten my recovery, not to mention sparing most of my kidney. Although I've sworn to my surgeon and my wife that I won't do any exercise for another two weeks, I'm pretty certain that I could start jogging tomorrow--gently, of course--and do just fine. This is very enticing to me, as I've been going a little stir crazy at home. But best not to tempt fate, so I'll have to content myself with long walks for now. Luckily, the weather in Denver has been spectacular recently--65 degrees and blue skies today, so long walks in the sunshine have been the perfect antidote for my <a href="http://catchingyourbreath.blogspot.com/2007/02/let-there-be-light.html">winter blues that always seem to set in in mid-January</a>.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0O3t9fcMYIqkVTuoDfJFG0DQJdNeYr_x6Cg7IqHHe3i3-Z_pf-ht1A22XLCaEdLBlemMqYRYDBXUc9XvuA9uwWkSCzFHALJ0IYNr-UOA2345IClE3DGidXV5uhxHH4bYKL2SST-1NdfU/s1600/pain.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0O3t9fcMYIqkVTuoDfJFG0DQJdNeYr_x6Cg7IqHHe3i3-Z_pf-ht1A22XLCaEdLBlemMqYRYDBXUc9XvuA9uwWkSCzFHALJ0IYNr-UOA2345IClE3DGidXV5uhxHH4bYKL2SST-1NdfU/s320/pain.jpg" width="240" /></a>My recovery has gone perfectly smoothly . . . except for one absolutely horrific event, an incident this Monday that was, without a doubt, the worst experience of my life, or at least the worst experience that I've had compressed into an afternoon.<br />
<br />
I can't do this story justice on a PG-rated blog. Nobody wants to hear the gory details anyways. But suffice it to say that it involved a post-operative sludge of old blood and necrotic debris in my bladder that caused a urinary obstruction, and an intervention involving a catheter, a catheter which I had to remove myself at home when it became dislodged. Blood and urine everywhere. I have never experienced such pain. My surgeon, who was gracious enough to listen to me howling in pain on the phone, said he's never really seen this complication before. Lucky me to be the first. In some small way, I think I now have empathy for women going through childbirth--sensitive areas, tight spaces, tearing tissues, and uncontrollable waves of excruciating pain. No, I'm not foolish enough to claim it is the same as childbirth, but it's hopefully the closest I'll ever get. I can tell you this: if that is what childbirth is like, then my child-bearing would have been one and done. <br />
<br />
If you want more details, ask me some time. It's quite a story.<br />
<br />
But here's the amazing thing. Once the catheter was out, the debris passed on its own, and my pain was immediately relieved. Three days later, and it's like there was never a problem, my recovery unhindered other than one lost day.<br />
<br />
And as miserable as it was, I don't regret it, because the outcome was good, because it resolved quickly and completely, and because, if that's the worst post-operative complication I had to deal with--the price for having my tumor removed and my life spared--then it was a small price to pay, and one I'd gladly pay again.<br />
<br />
Except I'd make sure to get an epidural next time.Markhttp://www.blogger.com/profile/17710337880486481120noreply@blogger.com0tag:blogger.com,1999:blog-8187522254757354146.post-26547074628982612112012-01-11T14:04:00.000-08:002012-01-19T21:09:20.706-08:00Healing ScarsI know that nobody wants to see this photo again. But few are going to see it anyway, so here you go.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyofcu3hjWKOMTcddoSiOqW5_pafYsQ40gPSYqykFKokZDoeG7Hh9oDm7ZN74CuZthECrRj7en3PtXFuH-wURhLYjDTs51IKBcQfWcQraGOgGD7RiC1W6Vbgz6GgD4oYtYUS5M7Zz-WyI/s1600/photo.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyofcu3hjWKOMTcddoSiOqW5_pafYsQ40gPSYqykFKokZDoeG7Hh9oDm7ZN74CuZthECrRj7en3PtXFuH-wURhLYjDTs51IKBcQfWcQraGOgGD7RiC1W6Vbgz6GgD4oYtYUS5M7Zz-WyI/s320/photo.JPG" width="320" /></a></div>I'm proud of my surgical scars, seen here in a nice montage of pinks, greens, yellows and purples. It's amazing to me that eight days ago I was strapped to a table with four robotic spears plunged through my abdominal wall, and already the wounds are sealed and healing. I'm feeling great, chomping at the bit to get back to work and exercise. A lot of things have been in my favor for a quick recovery: relatively young age, in good pre-surgery fitness, no risk factors for poor wound healing like smoking or diabetes, and mostly the decreased invasiveness of the surgery due to the precision of the Da Vinci robot--and of course the skill of the surgeon.<br />
<br />
There is another respect in which I feel my scars are healing. To explain, I first have to go back to Steve Jobs for a second. Steve Jobs felt that his pancreatic cancer had been incurred between 1997 and 1999, the two years after his triumphant return to Apple. For those two years, he worked hard past exhaustion, under conditions of maximal stress. He felt that his body's defenses were lower then than at any other point in his life.<br />
<br />
Whether this is true is doubtful. His cancer probably started sometime after that, and not due to physical and emotional stress. But who knows?<br />
<br />
My cancer, a renal cell carcinoma, was 4 cm at the time of resection. A typical growth rate for these cancers is about 0.5 cm/yr. Of course, we'll never know for sure, but doing the math would place the oncogenesis of my tumor at about 8 years ago, 2003-2004 range, which correlates precisely with the worst year of my life: medical internship.<br />
<br />
I have undying admiration for most everyone I knew in internship and residency, and a sense of pride at having survived and received excellent training in the process. But no doubt about it, that gauntlet wasn't fun to run. It was an awful year. We had moved from Phoenix to Greeley with nary a penny to our name. (A favorite memory of mine and Elizabeth's is that when we went to open a bank account in Greeley, we didn't even have the requisite $100 minimum deposit. We had to file a special application and meet with the branch manager: "Yes, sir, I really AM a doctor. Please believe me.")<br />
<br />
Then I was thrust immediately into the ultra high stress environment of residency. 100 hr weeks, 30 hour death marches on call nights, month after merciless month, uber-stress at every juncture: difficult patients, demanding attendings, life or death decisions, no sleep, no emotional or physical reserves. I've told people often that if I had to do it over again, not only wouldn't I, but I couldn't. I don't think I am capable of physically or emotionally submitting myself to those rigors again without spontaneous combustion.<br />
<br />
The final ingredient of this stressed-to-the-max stew was the fact the Elizabeth was expecting our second child right in the middle of that year. The pregnancy was a challenge, and then we had a fussy baby, late night feedings, and decreased emotional reserves for us both. If there were ever a time in my life with my physical and emotional defenses were utterly depleted, it was then. Plus the fact that I was in the hospital more than I was out of it, exposed to different chemicals, germs, and x-ray radiation that at any other time. A pretty toxic brew.<br />
<br />
Was there a moment, within that carcinogenic milieu, that I had a renal cell go rogue? That my body's defenses, which would have normally gotten medieval on any mutated cell, instead permitted it to survive, after which it began to replicate, over and over, building it's own little castle right there in the medulla of my left kidney?<br />
<br />
We'll never know. But that's my suspicion.<br />
<br />
I'm actually quite proud that my body, in spite of the stress I put on it, in spite of it having allowed the cell to mutate and survive and replicate in the first place, that at least it walled it off, put boundaries on its spread. "This far, and no farther," said my healthy kidney cells.<br />
<br />
Is it coincidence that I herniated my left cervical disc at a time when my tumor had entered a phase of rapid growth? (I say rapid growth, because at the time of resection the tumor had a gargantuan blood supply, indicating it was growing fast.) Was this disc problem my body's way of alerting me to a problem that otherwise would have gone unnoticed until it was too late?<br />
<br />
That's how I choose to think of it. Everything is connected, you know. My kidneys. My disc. My past, present and future. The scars in my belly. The scars in my soul. All healing with time, with select interventions, with improved lifestyle and perspective.<br />
<br />
To hurt is human. So is to heal.<br />
<br />
Hallelujah!<br />
<br />
<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"></div>Markhttp://www.blogger.com/profile/17710337880486481120noreply@blogger.com0tag:blogger.com,1999:blog-8187522254757354146.post-5479760594665388252012-01-09T22:47:00.000-08:002012-01-10T08:04:14.808-08:00Walking with Steve Jobs: the FlowMany harmonic convergences on my road to a cancer diagnosis and recovery. It's a journey that, as fate would have it, I've traveled with Steve Jobs, thanks to Walter Isaacson's timely biography. (Though I had to bid Steve a fond farewell at the end when our paths diverged.)<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuaF4YHWYxYyi01umXcBxb2VE2zHGIG7EMcMlVtIX_n3SnTP1dT8uOg31LcUoeTG50dQHnKdkxwdvbgO4JWdbMv8tLNWins7bN23gDQ5Ugx7Iry3TcAJiMrGNDZ76Qi4ZFP9YMKBvz8Qo/s1600/Steve-Jobs-by-Walter-Isaacson.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuaF4YHWYxYyi01umXcBxb2VE2zHGIG7EMcMlVtIX_n3SnTP1dT8uOg31LcUoeTG50dQHnKdkxwdvbgO4JWdbMv8tLNWins7bN23gDQ5Ugx7Iry3TcAJiMrGNDZ76Qi4ZFP9YMKBvz8Qo/s320/Steve-Jobs-by-Walter-Isaacson.jpg" width="320" /></a></div><br />
Now, I'm not a petulant prima dona founder and CEO of the world's most valuable corporation, neither do I claim to be an iconoclastic techno-artiste, nor a visionary genius who has changed the very fabric of modern society and how we engage with technology. But I do have a cancer diagnosis, I do like to take long walks to clear my head, I am enchanted by Eastern mysticism, and I love my iPhone 4 like nothing else I've ever owned, so this is how our journey together began.<br />
<br />
I had followed Steve Jobs with casual devotion ever since I got my first iPod. Anybody who could design such a slick, intuitive device allowing me to hold a thousand songs in my pocket--well, that's somebody that deserved my respect and admiration.<br />
<br />
I enjoyed reading about the flourishes of his product launches, and I felt sad when he revealed he had cancer. When he died on October 5, 2011 of metastatic cancer, I, like most everybody else in the world, felt a sense of both loss and gratitude. This was 2+ months before I became aware (consciously or empirically, at least) of my own tumor. I was surprised by the depth and intensity of my feelings. I actually cried thinking about it one night--well, more of a moistening of the eyes. His face was on the cover of every magazine, all over TV and the internet, and I couldn't seem to get enough of reading about him. I viewed his graceful, poignant Stanford speech on YouTube time after time.<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/UF8uR6Z6KLc?feature=player_embedded' frameborder='0'></iframe></div><br />
When Isaacson's biography came out in late October, I went to a bookstore and thumbed through a copy for an hour. My wife, picking up on my interest, bought me a copy, intending to give it to me for Christmas. But she worried I might buy it myself before then, so she gave it to me early, just before Thanksgiving.<br />
<br />
I read the last chapter first, and then dove right into the start: humble origins, given up for adoption, raised by working class parents. Eventual reunion with his literary-gifted biological sister. Spiritual wanderlust that took him to India and Buddhism. Love for Dylan and the Beatles. Iconic origins as a teenage tech wizard, building the first commercial PC in his garage. Then as the chapters progressed, I was appalled by his callousness, cruelty, and caprice. He was derisive, arrogant, fickle, and impetuous. I mean, there's no way around it, the guy was a total jerk to most of the people he knew. Was this the same guy who gave that deeply humane Stanford address?<br />
<br />
Yes. All part of the package known as Steve Jobs: genius and jerk, bundled.<br />
<br />
Everyone who knew him talked about his "reality distortion field," his ability to convince otherwise talented and autonomous people that they could do impossible things beneath his imperious eye, unheard of things, all according to some script in his head that told him the way things ought to be. It was like he could see the future. In the early 80s, he was talking about building notebook sized computers that you controlled with a touch screen, which sounds an awful lot like an iPad two decades before the technology existed to create such a thing. An intemperate prophet, he was frustrated by all the idiot mortals who couldn't bring to fruition the images of products future that he saw in his head.<br />
<br />
In spite of all of his negative traits, he was intense, bold, tenacious, and charismatic, and these traits were enough to snare people in his distortion field. He could focus with laser-like precision on a goal or product, total disregard for others' feelings or well-being. And more often than not, he pulled it off. For all his flair and drama, his primary aesthetic was simplicity, in his products and in his life.<br />
<br />
He was fired by Apple. As he said, "How can you be fired from a company you started?" This is one area where I feel a little solidarity with Steve. It's easy to see now that being fired was the best thing that could have happened to him. Dissed by Apple, he threw his energies in different directions, including starting a little company called Pixar. When he came back to Apple in 1997, he hadn't been softened, rather seasoned, now scary-focused.<br />
<br />
At this point in the book, my ability to read was thrown off by my neck injury. When the acute pain died down, I blazed through his early successes back at Apple: the iMac and then the iPod.<br />
<br />
Then I was diagnosed with cancer myself. A whirlwind of worry ensued, no appetite to read. Mercifully distracting holidays, then a week of working and more worry. A few days before the surgery, I launched back into reading, determined to finish the book before the end of the year.<br />
<br />
But I didn't make it that far, and then the day of surgery was upon me. I optimistically packed my bag full of books to read while marooned in a hospital bed.<br />
<br />
I woke up from surgery in a fog, visited with my wife and brother for a few groggy minutes, and then fell asleep again. Waking up later that night, I felt more alert, in remarkably little pain, and like reading, so I reached for my book. The bookmark was at Chapter 35: Round One. October 2003. Steve Jobs felt fine physically. He had had kidney stones, and got a follow up CT scan which showed normal kidneys, but a spot on his pancreas. Probably nothing, they said. But it needs to be imaged further.<br />
<br />
Further evaluation showed that it was indeed a pancreatic cancer, a very rare kind, treatable by resection. But this is where Steve Job's reality distortion field let him down. He acted as though he could will it away. He ignored it, tried alternative treatments, to no avail. (Now, I'm all for using effective alternative methods for many ailments, especially mental health. But it's sad to think that he had a deadly disease in his body, caught early enough to eradicate, and yet he refused decisive therapy. Oncology is a scary bugger, and not one to mess around with.)<br />
<br />
His denial took him past the point of metastasis, and so when he did have surgery, it was major, insufficient, and accompanied by debilitating chemotherapy. Eventually he had to have a liver transplant (which he received in expedited fashion by what sure sounds like manipulation of the donor system with money). Then more chemo. But the cow was out of the barn and it was too late. He was going to die.<br />
<br />
His ambition remained relentless. He still kept churning out world changing products like the iPhone, iPad and iCloud. He remained as irascible as ever, an indomitable genius/jerk to the end.<br />
<br />
These were the chapters I read over my two days of recovery in the hospital. His self-exacerbated travails heightened my sense of gratitude that I had discovered my cancer early enough to permit decisive, definitive treatment.<br />
<br />
In a dying moment, Steve shared these insights:<br />
<br />
<i>"What drove me? I think most creative people want to express appreciation for being able to take advantage of the work that's been done by others before us. I didn't invent the language or mathematics I use. Everything I do depends on other members of our species and the shoulders that we stand on. And a lot of us want to contribute something back to our species and to add something to the flow. It's about trying to express something in the only way that most of us know how--because we can't write Dylan songs or Stoppard plays. We try to use the talents we do have to express our deepest feeling, to show our appreciation of all the contributions that came before us, and to add something to that flow. That's what has driven me."</i><br />
<br />
The Flow. This evokes Buddhist ideas of Fields of Mind, Interconnectedness, the Way, the Tao. He had premonitions his whole life that he would suffer an early death, which he did. But not before he had left an earth-shaking legacy.<br />
<br />
I've hopefully been spared the early death part. I'm not going to shake the earth or revolutionize industries. But what will my contributions be? I've already been envisioning a hand-held teleportation device. The second generation model will also have a time travel app. But until the engineering catches up with my vision, I'm going to have to stick with other passions. My beautiful wife. My adorable, brilliant children. Mental health reform. Direct patient care. Writing. Dog-sledding--I've just picked this up.<br />
<br />
So this is all to say, thank you, Steve Jobs. For Pixar, iTunes, iPhones, Angry Birds, and my future Macintosh furnished office, which I'll get once I can afford your justifiably high-priced creations.<br />
<br />
You and Tim McGraw have taught me to Live Like You Were Dyin'. Time to go ride a bull named Fu Man Chu, to do some rocky mountain climbin' this summer, to watch an eagle flyin'. Short of that, I'll chase my own dreams.<br />
<br />
Life: fragile, short, precious. "The powerful play goes on, and you may contribute a verse." I will myself to believe that we're all put here for a reason. The challenge is to figure out why before we croak, before we're swept away by the relentless tide, to contribute in some way, large or small, to that endless, incomprehensible Flow.Markhttp://www.blogger.com/profile/17710337880486481120noreply@blogger.com0tag:blogger.com,1999:blog-8187522254757354146.post-24707788739983597562012-01-08T12:01:00.000-08:002012-01-08T12:09:41.239-08:00Entering Recovery ModePost-operative day 5, and I'm feeling like Tebowing:<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl45Ir-7tcKaiXbThdh3IbeT24ftrr3GMBOdhzo2ocHcj_phJrCRCIXGzkoNAxVLRQhkWM5jb9K9tD08MCZQXH6hRQnUoqYWsQcM1RLVZ3SN0d1A8LZN3R2BhB9aRZ43kpVXGWyILxeBk/s1600/photo%252819%2529.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl45Ir-7tcKaiXbThdh3IbeT24ftrr3GMBOdhzo2ocHcj_phJrCRCIXGzkoNAxVLRQhkWM5jb9K9tD08MCZQXH6hRQnUoqYWsQcM1RLVZ3SN0d1A8LZN3R2BhB9aRZ43kpVXGWyILxeBk/s320/photo%252819%2529.JPG" width="239" /></a></div>The surgery is over, the cancer is removed, the Foley--thank heaven--is out. I'm home, walking, eating, off all pain meds, and I have a long and purposeful life to look forward to.<br />
<br />
Here is the dynamic duo that saved my bacon:<br />
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie3t87bJ4Ax0g64R-MEOglev5BufEd4ryJm_XmLF49tkEc2uT4ItoE_bNPRyIttnX3QvlCRi8z81kMuQ1CDsMRANoe0V1VULkMS9VTPF1QRn8gwqQ-eVVl9gLw2P2Z3AmU9X0v6TxL4sg/s1600/da+vinci.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEie3t87bJ4Ax0g64R-MEOglev5BufEd4ryJm_XmLF49tkEc2uT4ItoE_bNPRyIttnX3QvlCRi8z81kMuQ1CDsMRANoe0V1VULkMS9VTPF1QRn8gwqQ-eVVl9gLw2P2Z3AmU9X0v6TxL4sg/s200/da+vinci.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr. Dave Inchy</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhii-0bVdXsS8A65vgExAQpGhIU5Bc9rspc9d3F9TZtJwbuvEeB_YnIopm4vOwzreKB_O1eQ3KOEhekKVGUHMu5TqM-ytxJXqK_TcB54eeNhH0KwAIAO5IuHe7DPt1DcuQzDsk2L3ZqcTA/s1600/dr_jones_1.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhii-0bVdXsS8A65vgExAQpGhIU5Bc9rspc9d3F9TZtJwbuvEeB_YnIopm4vOwzreKB_O1eQ3KOEhekKVGUHMu5TqM-ytxJXqK_TcB54eeNhH0KwAIAO5IuHe7DPt1DcuQzDsk2L3ZqcTA/s1600/dr_jones_1.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr. Mark Jones, MD</td></tr>
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Here is the path report (abridged):<br />
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<ul><li><i>4.7 cm left kidney mass, renal cell carcinoma, clear cell type, Stage 1B, Furhman grade 2, excellent margins. </i></li>
<li><i>(This translates to: it was cancer, which is bad, but everything else was as good as could be hoped for. It was early, it hadn't spread, and it is now gone, no chemo or radiation required.)</i></li>
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Here are my incisions:<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhneX2T2tpXct_o5fZgBkzA2pv_kt5WSasdzdW-THuNVxPmg6rSmjPI8k3Y6r4qnMlILZxbNNZITvxJEf5aTO7ukB7HDY1rF-MQSFrLgTokvpxDpuhkrS6nYE2J8ppcZC05uErEn_W-0EE/s1600/photo%252818%2529.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhneX2T2tpXct_o5fZgBkzA2pv_kt5WSasdzdW-THuNVxPmg6rSmjPI8k3Y6r4qnMlILZxbNNZITvxJEf5aTO7ukB7HDY1rF-MQSFrLgTokvpxDpuhkrS6nYE2J8ppcZC05uErEn_W-0EE/s320/photo%252818%2529.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Not so bad!</td></tr>
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Lastly, here is a picture of the future, where we live and die at the whim and mercy of machines: <br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicVNklmboVrgvOPxvUO9Dp0Yq2h59UrTKRWR5EN7_VOEqwh0JMMf7ngaTHkQdr3MwW-3oo0iN6CRdcmAG0AkV-ppHZItlnOI8MLoxbXwY1HRgQBAqRwuvUhwFVbOujNGWG2eJxit0UgxM/s1600/da+vinci+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicVNklmboVrgvOPxvUO9Dp0Yq2h59UrTKRWR5EN7_VOEqwh0JMMf7ngaTHkQdr3MwW-3oo0iN6CRdcmAG0AkV-ppHZItlnOI8MLoxbXwY1HRgQBAqRwuvUhwFVbOujNGWG2eJxit0UgxM/s640/da+vinci+2.jpg" width="640" /></a></div><br />
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More thoughts tomorrow when I plug back into the Matrix.Markhttp://www.blogger.com/profile/17710337880486481120noreply@blogger.com1tag:blogger.com,1999:blog-8187522254757354146.post-50043685696290006842012-01-03T07:39:00.000-08:002012-01-03T07:39:59.164-08:00Cheers!T minus three hours. Heading out the door in a minute for the hospital.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdWFmbtcb3WNEdOcRX2BF0XMxNeTmIeOFpoEuIDVUf3h-NeEOeWBCVKWdemE_xR4B1MfkGu1qkHMPvr_xxyUGgAUaQq2WZSJlwsyk3KP6oWtCxNCpsABjZBjiuD6vNQ1Y1_bD_YFNgWsE/s1600/photo%252817%2529.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdWFmbtcb3WNEdOcRX2BF0XMxNeTmIeOFpoEuIDVUf3h-NeEOeWBCVKWdemE_xR4B1MfkGu1qkHMPvr_xxyUGgAUaQq2WZSJlwsyk3KP6oWtCxNCpsABjZBjiuD6vNQ1Y1_bD_YFNgWsE/s320/photo%252817%2529.JPG" width="239" /></a>Had a fun night. Two observations: one, jello tastes great, but it gets old quickly; two, magnesium citrate is nasty stuff. All these years I've been prescribing it for patients and never knew what it tasted like. Pleasing lemony taste? I don't think so.<br />
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So I didn't get much sleep last night, but I feel invigorated right now. It's so weird to feel so well as I'm heading into something so serious. My back hasn't felt this well in weeks. I've gotten a great outpouring of support and positive energy from friends on facebook and through email and through phone calls from my family.<br />
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I had to rouse my kids early today so that we could shuttle them off to babysitters. I blasted "Dynamite" and "Just A Dream" and "Baby" from the stereo and put on a dance show. I've got to admit, I've got some pretty nice moves for an old white guy. They just stared at me sleepily from under the covers. My daughter was entertained, but said, "Didn't they tell you you shouldn't be dancing before your surgery?" <br />
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No way, darling. Now is the perfect time to dance.<br />
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I'm going to have surgery, and I'm going to survive, and we have a lot to look forward to. That's a perfect reason to dance. Uh huh, that's right, move it now, uh huh.<br />
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Tumor? Meet Dr. Jones, his robot, and a man who's got so much rhythm he's just got to MOVE it. It's an unbeatable combo, so say your prayers, buddy. Your days are numbered. Hours, actually. Less than three, to be precise . . .Markhttp://www.blogger.com/profile/17710337880486481120noreply@blogger.com1tag:blogger.com,1999:blog-8187522254757354146.post-19717744406487338532012-01-01T11:06:00.000-08:002014-09-20T19:15:51.223-07:00Incidentally<div class="separator" style="clear: both; text-align: center;">
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How I discovered I have a kidney tumor . . .<br />
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Short answer: incidentally.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_p9AMBwJgnc7uOk_vViH2jpk_4Q7SEWjSYypBcKUf7jJ9tf_hj4ZQbFzMQGu4LPEK4LRkQJyOMJgEy85RZuCSpRd8poGyOwji5eZniKDAFYG6w9ZjqX1bmMSpPmvlS2qK5aK9PdqAJYY/s1600/Kidney+Tumor2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_p9AMBwJgnc7uOk_vViH2jpk_4Q7SEWjSYypBcKUf7jJ9tf_hj4ZQbFzMQGu4LPEK4LRkQJyOMJgEy85RZuCSpRd8poGyOwji5eZniKDAFYG6w9ZjqX1bmMSpPmvlS2qK5aK9PdqAJYY/s1600/Kidney+Tumor2.jpg" height="237" width="400" /></a></div>
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Slightly longer answer: a 4 cm kidney mass was found incidentally when I had an MRI of my spine for a herniated disc in my neck. <br />
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Really, really long answer: on December 1st, 2011, all of Denver woke up to the first big snowfall of the year. I bundled up and went out to shovel the snow, and in a flourish of holiday good will, I also shoveled my next door neighbor's driveway. Somewhere in that forty-five minutes, I slipped and twisted my upper back awkwardly. It wasn't a severe injury, but I started having a sharp pain behind my left shoulder blade. It felt like I had pulled a rib out of place, like it just needed to be popped back in. The pain worsened through the afternoon. That night, I was stretched out on the floor, trying to get some pain relief. My young four-year old monkey--er, son--saw his daddy stretched on the floor and thought it was time to wrestle. He jumped on my back and bam, it felt like somebody had stabbed me with an icepick right behind my shoulder blade. <br />
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Nothing could give me relief. Every position was painful. I had a miserable night. The next morning, I needed to drop something off at a doctor's office downtown, and like an idiot I decided to drive down myself, never mind the fact that I couldn't even turn my neck. I was going to tough this one out. I could only check my mirrors by awkwardly twisting my entire torso. I made it to the doctor's office, dropped off my item, and then while stooping back into my truck, the pain suddenly extended down my left arm, then to my chest. Sharp electrical jolts of pain. I became short of breath and dizzy from the intensity of the pain. I got out of the truck and started pacing around the parking lot of the clinic, clutching my chest. What a sight. Chest pain radiating down my left arm associated with shortness of breath and dizziness. Great, I thought, I'm going to be one of those idiot doctors who ignored his own heart attack for days before he dropped dead in a parking lot. I checked my pulse. Normal. I thought back to the onset of this pain, reassured myself that this was musculoskeletal, most likely a herniated disc in my cervical spine. I breathed deeply and tried to rise above my pain and anxiety. I found a semi-happy place for a few seconds, dug deep, and stooped back into the car--more jolting pain--and was able to torturously drive back home.<br />
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When I stumbled back home, I told my surprised wife that I needed to see a physical therapist that I knew. Once there, the therapist instantly surmised it was a herniated disc and put me in cervical traction, and that mercifully relieved my pain. While laying flat on the therapy table, I called my brother who is a doctor, who called in a steroid medication and some pain relievers. Then I went home to nurse my wounds. The combination of remedies and a home traction unit gave me partial relief. I was able to rest.<br />
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I was loathe to even consider neck surgery, so I determined to try PT for at least a few weeks. I was slowly getting better, but then I found out that my insurance policy (an accident rider) required that I get an MRI within two weeks of the injury if it was to be reimbursed. On day thirteen, I called around, looking for the cheapest place for a cervical MRI. To my great gratitude, the receptionist at Health Images in South Park recognized my name as one of their referring physicians, and told me that they had a policy to offer courtesy MRIs to referring docs. Fantastic, I thought. It made the insurance situation a moot point, but now I was curious. Did I have a herniated disc in my neck? I made an appointment for the next day.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjquwCl3k2oca_gjpDi0t3dutAeCi3k0EOLfP_sGBu2ovlBe74RRs0a1J45OMQpTRgGo-EJ0lAuWYpz0j-yQn17WP7zkiDGgQI8wpxgoqnsc8lIDbRFphZYIyLwQB2W698N_lXNu_5739Y/s1600/Herniated+Disc.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjquwCl3k2oca_gjpDi0t3dutAeCi3k0EOLfP_sGBu2ovlBe74RRs0a1J45OMQpTRgGo-EJ0lAuWYpz0j-yQn17WP7zkiDGgQI8wpxgoqnsc8lIDbRFphZYIyLwQB2W698N_lXNu_5739Y/s1600/Herniated+Disc.jpg" height="237" width="400" /></a>When I arrived, they asked what I wanted done. I said a cervical MRI, and then as an afterthought <br />
asked them if they would do the thoracic spine as well. After all, the pain was in my upper back. Sure, they said. So then I went and endured forty-five minutes of loud buzzing and banging (why so loud?), and then went to talk to Dr. C., the radiologist who was working late. It was about 5 pm by this time. We looked at the films together, and it was not hard to see my C6-7 disc protruding into my spinal canal. You should see a neurosurgeon, he said. It's contacting the cord and you may need surgery. Great, I thought. A herniated disc in my neck. Maybe surgery. I was processing this information as I pulled out of the parking lot and headed home.<br />
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My phone rang. The radiology tech spoke. "Dr.Foster, are you still close by? Dr. C. would like you to come back for some more imaging." Why? I asked. "He sees something on your left kidney, probably just an artifact, but he'd like to take a closer look."<br />
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This was the moment of cliche, when time stands still. But that's not the exact metaphor. It seemed more like deja vu. "Sure, I'll come right back," I said as I flipped a U on the deserted, darkened street. I said out loud to myself, "I have a kidney cancer." This moment is hard to describe, but it wasn't like I was processing a revelation of new knowledge. It was more like a new awareness of something that I already knew, like I had already lived this moment and was now simply remembering something previously experienced.<br />
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I drove back, they put me in the MRI, gave me contrast, and imaged my abdomen and pelvis. The radiology tech was kind, purposefully vague, but I've been around the block enough to know that whatever they had seen was of significant concern. This time, I was able to listen to music while in the machine. They asked what I'd like to listen to, and I said Coldplay. Every Teardrop Is A Waterfall came on the playlist. I tried to forget about my concerns. There was nothing I could do, so why worry? Whatever was there was there, and nothing was going to change that.<br />
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When the MRI was over, I slowly dressed, and then walked back down the hall to the darkened reading room. Dr. C. was there, my images pulled up on his bank of computer screens. Even from the back of the room, I could see a large mass above my left kidney. He swiveled in his chair, ran his hands through his hair, and said, "I think you're going to be lucky here." Luck--this is what I wanted to hear. That must mean it's something benign! But he continued, pointing through the ceiling, "Someone must be looking out for you. I think we just caught a cancer early, when it can still be treated."<br />
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What? Cancer? Did he really say cancer? Of course he did. But I already knew it. My eyes were fixed on the screen, by the large white tennis ball sitting on top of my kidney. There it is, I thought. I have kidney cancer. I clenched my fist. I felt a rush of tears come to my eyes. I turned away. Dr. C. turned back to his screen, began describing the tumor in technical terms, one doctor to another. I wasn't listening. I had cancer. I was only 37, healthy as a horse. I couldn't feel a mass, not one symptom, no risk factors, but I had cancer. He showed me the MRI of my spine, over 120 images, and in the final 3, I could see the very top of my left kidney, along with a large mass that shouldn't be there just coming into view. If they had positioned me a half centimeter higher in the machine, or if he hadn't finished reading the whole film, it would have been missed. <br />
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I left in a daze about ten minutes later, clutching the CD in my hand, the CD that carried the damning evidence. I thought about it: nobody knows about this me and Dr. C. and two radiology techs. What if I just don't tell anybody? What if I go toss this disc in the river, make it swim with the fishes? Nobody would be the wiser, at least not until I died two years later with metastatic renal cell carcinoma. But my kids. How was I going to tell my kids? How was I going to tell my wife?<br />
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Driving away in a vacuum of sound, I headed towards the middle school where my son's team had a basketball game. I was the assistant coach, and I was late. My wife was already there. I walked into the packed gym, bouncing off parents and kids, the squeak of high-tops, the thumb of dribbling balls, shrill whistles. Everyone seemed perfectly healthy and happy, no care in the world except for the games going on right in front of them. I found my wife crammed in along a sideline. My youngest son saw me, squealed and ran across the court towards me. I bent to pick him up before my neck reminded me that wasn't a good idea. My wife saw me, instantly read the concern on my face. Through the din of the gym, I beckoned her to follow me back outside. <br />
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"What's wrong?" she asked. "Is something wrong?"<br />
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"Let's go to the car, so we can talk," I replied.<br />
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Once in the hermetically sealed confines of the car, my youngest tumbling around the back seat, I cut to the chase, "Sweetheart, I--I have a tumor on my kidney."<br />
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"What?"<br />
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"They did the MRI, and found I have a herniated disc in my neck. But they also found that I have a tumor the size of a lemon on my left kidney."<br />
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"You mean a cancer?"<br />
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"Yeah. Most likely. Maybe not. But if it is, it looks like it's early enough to remove it with a surgery, no chemo or radiation required."<br />
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She stared at me. "Are you being serious?"<br />
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"Yes."<br />
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"Whoa. This is weird. I feel like this isn't happening. This doesn't seem real."<br />
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I knew the feeling.<br />
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We walked back into the gym. I helped finish coaching the game, distracted. Then we headed home. What were we going to do?<br />
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I had a hard time getting to sleep that night. I woke in the morning, my back and arm hurting. I turned and sat on the side of my bed, stretching. I thought about getting up to use the bathroom, about things I needed to do. And then I thought, Wait, what just happened yesterday? Then I remembered. I had a tumor on my kidney.<br />
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Really? I mean, seriously?<br />
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Yeah. Seriously. A tumor the size of a lemon on my left kidney. I had cancer.<br />
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I turned my torso stiffly to look at my wife. Her eyes were open, watching me.<br />
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"Are you going to be alright?" she asked.<br />
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"Yeah," I said. "Well, I think so." But I realized, for one of the first times in my life, I didn't know the answer to that question..<br />
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I had cancer.Markhttp://www.blogger.com/profile/17710337880486481120noreply@blogger.com0tag:blogger.com,1999:blog-8187522254757354146.post-77913993282565799652011-12-26T17:05:00.000-08:002011-12-31T18:15:15.368-08:00Christmas PresentWe had a sublime Christmas here in Colorado, tumor and all.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAMAsKXU9UfMrvQHL8xlgtgZnOYOUqY9kVtkqXWqjbFDtcOVBbAYArbhk4bQX9eqh1Mhb2tk-rCg1cp3PuSR6EVubYp0NxddSUMuXdyq7v9LAdSY2ETqDSI36CottSEwmQTAMeFPUPfnU/s1600/DSC01948.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAMAsKXU9UfMrvQHL8xlgtgZnOYOUqY9kVtkqXWqjbFDtcOVBbAYArbhk4bQX9eqh1Mhb2tk-rCg1cp3PuSR6EVubYp0NxddSUMuXdyq7v9LAdSY2ETqDSI36CottSEwmQTAMeFPUPfnU/s320/DSC01948.JPG" width="213" /></a></div>My kids don't know about the cancer yet, and they are at perfect ages to enjoy fully the magic of the season. My ten-old daughter is no longer a believer in Santa Claus--I confessed to her the truth when she knowingly confronted me a few weeks ago. Yet she remains innocent and hopeful enough, permitting herself to be swept away by the allure of things that she now knows to be fables. She is a wise beyond her years, observant, intuitive. She seems to sense that she has a lifetime of adult skepticism to look forward to--no fun!--not to mention the encroachment of teenage angst, so she's making this season of innocence last. I look forward to watching her grow, to see what amazing things she's going to do with her life.<br />
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My two younger sons are still true believers. My eight-year old is super-smart, and asks incisive questions for which there are no satisfying answers. "How can Santa carry all those toys on one sleigh? How can reindeer fly, anyway? What makes Rudolph's nose glow?" But his trust in the absolute reality of Santa as presented to him by his parents and by society is still strong enough that he has not yet confronted head-on the obvious conclusions of his questions. His cognitive dissonance is still buried deep in his subconscious, soon enough to be set free. I downplay Santa for him big time, don't actively perpetuate the deceit. I stay mute and let him ask the questions and ponder my non-answers. Soon enough he will put the pieces together on his own, and I'll share the truth with him when he asks about it.<br />
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My youngest son, four years old, is now self-aware enough to recognize the traditions, to see how he fits into this grand picture, this season that seems to have been built to maximize his delight: candy, cookies, songs, surprise and presents. He is fully on board the Christmas train, pure sparkly-eyed wonder that is a joy to behold.<br />
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Their ages, still within the perfect, recursive, inexhaustible nebulae of childhood, have aligned at the same moment that their dad is confronting his own vulnerability, the fading of my own star. I think this year, Christmas 2011, may stand out as the high-water mark of Christmases for our still young family, the timeless benchmark against which all other Christmases are measured.<br />
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I think back to my own childhood. There is maybe a eight year window, between age four and twelve, in which I believed and partook fully of Christmas. So few, so endless. It seems like there were ten thousand Christmases woven through my childhood, persisting to this day within the matrix of my mind and memory. Where exactly are those Christmases located? How did they ever end? Did they? Will they always be there? Or here? Or will they fade away, too, once I'm gone . . .<br />
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Those are questions for today, December 26th, 2011. I didn't think about them much over the past few days. The thrill of watching my children experience Christmas kept me entirely occupied. But now that is over. I have a week of waiting. Waiting. Waiting for a surgery that will spare me a premature death, that will afford me scores of more Christmases to come to share with my children and grandchildren, this season of hope and love, recurring annually and endlessly within this beautiful, fragile dream of life.Markhttp://www.blogger.com/profile/17710337880486481120noreply@blogger.com0tag:blogger.com,1999:blog-8187522254757354146.post-82314487447197687282011-12-23T06:25:00.000-08:002012-01-02T10:34:43.180-08:00Living: the DreamThese nights, I am taking pride in doing the dishes. I rinse, I load, I wipe off the formica counters, sweeping the dinner debris into my cupped hand. All done with precision, economy of motion, no wasted energy, a man at home in the kitchen, decades of practice, at the top of my game as a husband and father and domesticated human male. When I was fourteen and first had the inkling that I might someday be a family man, this is the sort of thing I envisioned myself magnanimously doing someday. "Take it easy, honey. I've got the dishes tonight." Now I'm living that dream.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGSa9xHh-9As9PuZ_G7WcXSIcKcbxkUyuy8gCwof9buaVuTFRSkJGd5qu7PVcbweuBlR7sp37YDJzj1y8F6sgdUdiYJjmUERAlSjpbVKRtGvPe-5OE3MfV7PCsEXFch5tI2YAi5mHkQR8/s1600/photo-1.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGSa9xHh-9As9PuZ_G7WcXSIcKcbxkUyuy8gCwof9buaVuTFRSkJGd5qu7PVcbweuBlR7sp37YDJzj1y8F6sgdUdiYJjmUERAlSjpbVKRtGvPe-5OE3MfV7PCsEXFch5tI2YAi5mHkQR8/s320/photo-1.JPG" width="239" /></a>I start the washer, listen to it gurgle and rattle. I sneak past the kids playing video games, put on my coat and hat and walk out to the backyard into a heavy snowfall. Six inches on the ground and building. I look at the neighbor's back yard with its lone miniature pine tree lit up, an island of electric cheer muted beneath the falling snow. An ambient orange glow permeates the air, streetlamps and Christmas lights reflecting off clouds, filtering back down through heavy flakes. No wind, no sound, only silent snowfall. My house radiates behind me. I put my hands in my pockets. Snow is melting on my face, my breath frosting in the air. I look past the tree burning its festive bulbs defiantly into the blanketing swarm, colored shadows cast across featureless snow, and I think how strange it is to know that I have cancer.<br />
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I know it, but I'm not sure I believe it. I don't feel like I have cancer. I'm only thirty seven. I have no symptoms of it. I have no risk factors. I have never had a serious medical problem in my life. I'm a doctor, darn it, not a patient.<br />
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I've spent a week now looking at MRIs and ultrasounds, reading articles and talking to specialists. The lemon-sized tumor on my left kidney, found incidentally during an MRI for my back pain, exists to me only within the medium of a computer screen, and when I shut that off, only on the compact disc stuffed into my coat pocket, my name and date of birth scrawled across it with permanent marker that may outlast me. I've been toting this disc around, showing it to smart people, hoping someone will tell me it's not what it so obviously appears to be. It could be benign, right? Of course it could be. Cancer is a tissue diagnosis. Rinse. Repeat.<br />
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I put my hand beneath my coat, underneath my shirt, feel my cold fingers on warm skin, press beneath my ribs, around to my flank. I feel nothing. There is no tumor. I reach back into my pocket. The disc. Here is the tumor. I will take this disc and I will crumble it in my hands like a sacrament wafer, blow the dust off my fingers, let it sift into the snow. Tumor be gone.<br />
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I'm really considering this possibility. Maybe this is some elaborate conspiracy to convince me I'm dying, to do what? Steal my life insurance money? Or maybe my entire life has been a play and this is the dramatic tension at the end of the third act. So what comes next? Let me preview the script, please. If I don't like it, may I rewrite it? Maybe the protagonist prefers not to die until he figures out what the hell is going on here.<br />
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I stand here for a good long while, flakes settling onto my shoulders, in the rimples of my sleeves, catching in my eyelashes, thinking, feeling, doubting, breathing, trying to discern if what I am thinking and feeling and doubting and breathing is even real. I can come to no conclusions.<br />
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I don't have enough information. This might be real, and it might not be. This might be one of an infinite number of eventualities that my life could have or will take. This just happens to be the one I'm experiencing now. Maybe in another eventuality I die of renal cell carcinoma that metastisizes to my liver and lungs and brain after I unwisely delay surgery for two measly weeks just so that I could save $10,000 on my deductible, and my children weep for me at my funeral then curse me in college when they learn that I deprived them of their father because I was such a tightwad. In another, the tumor ends up being benign after all and I go back and tell the earnest radiologist "I told you so" and spike my stethoscope on his desk. In another, I'm cured after six months of chemo and go on to write a bestselling, heart-wrenching memoir about my experiences as a doctor with cancer, making a YouTube video that gets ten million hits, appearing on Oprah, inspiring millions, flipping the coin at the Super Bowl. Oh, the humanity. In another, the tumor never existed. In another, I die rescuing a puppy from the river and the tumor is found on autopsy and adds an extra patina of poignancy to my selfless death. In another, I die on the table when the surgeon shows up drunk to the operating suite and lacerates my aorta with his robotic assistant, which isn't drunk yet obeys his every drunken whim. <br />
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But maybe none of those things ever actually happens because this reality in which I'm contemplating these futures is merely a mental construct itself. I'm actually hooked up to wires, bathed in a pink pseudo amniotic fluid, living a false life entirely encapsulated within the Matrix, doing nothing more useful or real than generating power as a slave for machines. Cancer diagnosis leads to emotional angst which equals more neuronal activity which results in a little extra juice for some soulless robot who's mining who knows what minerals to do what? Build more robots? Harvest more human slaves? <br />
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Or maybe this is all real, there is simply no purpose to it, and all efforts to divine a larger meaning will remain forever futile. It is whatever it is, and these dozen paragraphs are nothing more than my continued vain pretensions to significance, my echo-less scream into the abyss, my unrequited love for my own life, my precious moment of consciousness, my soul slipping away, like it or not, maybe decades sooner than expected because of this cancer, but what does it matter? Either way I'm destined to die, a fire burning up its fuel, a flame flickering away. It never meant anything other than what I experienced in my own mind.<br />
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But that can't be. It's got to mean something. I just can't figure out what yet. Maybe I can make it mean something. That's what I want to do. Could this be my faith? And if I still can't figure out what it means, then I'll just keep doing things while I'm still breathing. I'll keep busy. I've got to run this disc back up to University Hospital tomorrow. I'll have one more person look at it. Can't hurt to get a sixth opinion. If he says what the other five have said, then I'll get my blood drawn and my EKG and do all of my pre-op paperwork done and proceed with the surgery on January 3rd, hoping the doctor doesn't show up drunk, hoping his skill and his robot permit me to keep up this charade a little bit longer, this veneer of consciousness, this metaphor of life.<br />
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After a while I realize I'm getting cold. The little tree is getting deeper in snow, lights dimming. I head back inside. My wife is pulling sugar cookies out of the oven. The kids are wrestling on the ground, either laughing or crying. The dog sniffs my crotch. I swat him away, shrug off my coat and slump towards the kitchen table. My wife asks me what I was doing outside.<br />
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"I'm not sure," I respond. "Just thinking about things."<br />
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She gives me a look that is eighty percent compassion, twenty percent fear, and then asks if I feel alright. I see it flicker across her face. She wonders if I'm dying.<br />
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"I feel fine," I respond with a touch of bravado. She comes to give me a hug. She looks so good in her apron right now, flour on her face, the scent of sugar cookies in the air. I reach out and feel the litheness and warmth of her body, her slender waist. My hand strays to her back, to her flank, her kidneys. She kisses me.<br />
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"Thanks for doing the dishes," she coos.<br />
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"My pleasure," I say. And I mean it. It is a miracle to be alive, to be able to do something like the dishes tonight for my wife.<br />
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I wipe away wetness from my eyelashes. Melted snowflakes, probably. Tears, maybe. I've cried often the past few days, mostly when I'm alone. She thinks they're tears, and I don't dissuade her right now. I'm looking over her shoulder, through the frosted window, across the yard through the swirling storm to the little lit up pine. A technicolor torch. A lighthouse. A burning bush.<br />
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Please, God. Buddha. The Spirit of Man. The Divine Will. The Benign Indifference of the Universe. Whatever you are. Let this all mean something.Markhttp://www.blogger.com/profile/17710337880486481120noreply@blogger.com1