Complicated

Constant Reader: I write this from a hospital bed, under the influence of a variety of medications. One happens to be Vicodin. I apologize in advance, should this post all-too-accurately reflect my clouded mind.

It started so simply, but I learned what my doctor meant when he said "complicated" on Thursday.

"Needle biopsy." Two words. Both understandible. The first is the pointy thing from which you cringe. The second thing is the thing that means "answers".

At this point, I'm far beyond my fear of needles, and I want answers, so "needle biopsy" isn't threatening, it's hopeful. I was looking forward to it. That's not a typo.

It was a long day. No food or water after midnight the night before, and I had stopped eating at 9:00. I expected to be taken for the procedure early in the morning. But—in the way of hospitals—early morning flowed into late morning, which eased into early afternoon in a glaze that mirrored the late-summer haze I could see over the East River as I gazed from my room's window.

The clock told me it had been a long wait, but the time passed without angst. I was where I was, ready to do what needed to be done, and it would happen when it would happen. I was surprised by my calm. Then, I wasn't. I realized I needed my energy for other things.

I got word that they would come to get me around 2:00. I didn't need to do anything to get ready, I was already 14 hours without water and 17 hours without food. I was in my hospital gown, with my ample arse hanging out the back. I was tubed to my IV—feeling fluids flow into my vein, keeping me leashed and hydrated. Let's roll, already.

Be Careful What You Ask For...

Transport came, and I was wheeled through the labyrinth. The paths familiar, but unknown.

You know the experience. You return after many years to a place where you've had a significant experience. You recognize the feel—the vibe—the aromas, or the sounds. The corridors look familiar, but you can't recall the directions. You can predict the turns, but you don't know why. Everything has the familiarity of a dream you once had, without the context. It's weird, but not unsettling. Yet it's not comforting. It's...something else.

The next 45 minutes crawled. For all the waiting I had done, this last little bit was the part that enhanced my white hair count.

It's like the final mile of a long roadtrip. You've been in the car for hours, and you've had to go to the bathroom for the past who-knows-how-long, but you held it, knowing that you're almost home. That last mile always takes forever, and every Sunday-driving, one-eyed-octogenerian tractor driver is in front of you—looking at the map and talking on the phone with one foot on the brake and one foot on the decelerator. You know, that mile.

That's what my 45-minute wait in the prep room was like.

Eons after arriving, the radiologist introduced himself. I never caught his name. It didn't matter. He's a young Tony Shaloub (circa "Big Night"). I had a maniac for a radiologist. Perfect!

He detailed the plan—what there was of it.

I would be laying on the gurney/bed/tray/slidy-thing and they would take a scan (CT). He would be looking for a clear path to the tumor/abscess/growth/alien. If he didn't find one, mission aborted and we would regroup. If he found one, I would be sedated. The then would take a long needle and insert it into my abdomen. Using frequent CT scans as guidance, he would work millimeter by millimeter to pierce the tumor/abscess/growth/alien. Once pierced, he would extract some fluid and take some samples of the tissue.

Finally, he would remove the needle, I would be revived, and we would all skip hand-in-hand down the yellow brick road. Please sign here.

Sounded good. I signed.

Yep, It's Complicated

Nurses made final preparations, and I was wheeled onto the bridge of the Starship Enterprise (the J.J . Abrams version).

Seriously, these rooms are unreal. They're lit with the light of the heavens, everything is white or metal, and Motown plays in the background. It's a Daft Punk video, and I'm the star.

I'm introduced to the team, I crack jokes, we all laugh, good times.

I'm placed on the gurney/bed/tray/slidy-thing, and I'm inserted into the tube. Thank the Gods that I'd already emptied my bladder...

Constant Reader: I'm claustrophobic. MRI machines are my personal hell. Some other time I will share those experiences. For now, suffice it to say that my palms are sweating as I type—just thinking about it.

Out. Breathe. Chat with nurse (cute!). And Dr. Shaloub comes out, thumbs down.

No path.

The Conversation

We needed to talk.

No clear path meant...what?

One option would be to go through my intestine.

Imagine an inflated, plastic grocery bag. Now imagine laying a fire hose across the top of it. The option at hand was to insert the needle through my skin and surface muscles, then through the fire hose (the small intestine) and into the grocery bag (the tumor/abscess/growth/alien). Take the samples. Get out, go away.

He said he needed to consult with his colleagues; I encouraged him—have fun!

While he returned to the control room behind the window, I flirted with my soon-to-be-married-and-moving-to-SanFran nurse.

Flirting works. It passes the time, releases pleasant brain chemicals, and—this it important!—gets the nurse to do  you favors, like turn you around so that if we go on with the procedure, my feet would enter the machine first, not my head.

I could have kissed her.

Meanwhile, a parade of scrubs-clad, unshaven radiologists of all shapes and sizes paraded through the control room. From our position on the Enterprise bridge, not only could we watch the parade, we could watch them navigate the CT image. They were playing with contrast, zooming in and out, and scrolling up and down my abdomen image. We were watching this on the giant, ceiling-mount monitors all around us. Cool. Creepy.

Then, it got surreal.

My dear soon-to-be-married-and-moving-to-SanFran nurse went to a wall control, and kicked up the volume.

"Respect" pumped through the speakers, and she began to sing along—all five-foot-nothing of her, belting Aretha.

I looked at the control room window, and I see several heads nodding to the beat. She sang. They nodded.

Sang. Nodded.

At that moment, had dancers burst through the doors and started a movie-musical routine, I would have been completely unsurprised. I would have embraced the experience and played the role of "The Patient", as they cavorted about the room, swinging with the machine that goes "Ping!".

Alas, it did not happen. (I know I will forever regret that it didn't. If ever there was a time for my life to become a musical, that was it.)

There Can Be Only One...Decisions, Decisions

Reality shifted. Dr. Shaloub came back into the room with a skinny Dr. Kumar (why does every doctor in radiology come straight from central casting?). They had spoken with Elvis (my urologist), and they had an option.

Constant Reader, please note that I'm now 15 hours without water and 18 hours without food. I have a half-dose of Vicodin moderating the pain. I had four hours of sleep the night before.

Elvis was not happy with the intestine option. As the needle would pass through the intestine, it would then enter the tumor/abscess/growth/alien, carrying with it anything it had picked up along the way. In other words, any samples would be contaminated by the intestine.

They had a second option: a "venus" option. Venus, like the goddess? If Uma Thurman walks in, I officially give up on reality.

"What's that?", I dutifully asked.

Imagine an inflated, plastic grocery bag. Now imagine laying a garden hose across the top of it. The venous option means you insert the needle through my skin and surface muscles, then through the garden hose (a major vein near the psoas muscle) and into the grocery bag (the tumor/abscess/growth/alien). Take the samples. Get out, go away.

Hmmmmm.

This has its risks as well. First, they would be going though a vein. That, itself, is scary. Then, they would be returning through the vein with the needle, after it would be contaminated with the crap from the tumor/abscess/growth/alien.

So, option one makes Elvis nervous. Option two scares me. Do I have any other options?

I neglected to mention earlier that Elvis's resident, Dr. Neversleep, was part of the control room parade. I asked what the options were. Is surgery an option?

They had not talked with Elvis about it, they said. There was no immediate urgency, I could take my time and make the decision. I could go back to my room and sleep on it, they reassured.

But time wasn't what I needed. I needed data.

To make a decision, I needed to know my options and the risk/reward balance for each option.

I was remarkably lucid. I was calm. I was composed, and I had created a good relationship with them, as they created a good environment for me.

So I made a request: Please call Elvis, and please ask him what all of my options are. They did, and he wanted to speak with me.

So, we played telephone.

The radiologist held the wall cord aloft, half-way from the wall to the phone the resident held and dialed. My soon-to-be-married-and-moving-to-SanFran nurse held the spiral phone cord, half-ay between the phone and me as I spoke into the receiver...some twenty feet from the wall port.

So much for the Starship Enterprise.

Clarity and Decision

We talked. In five to ten minutes he outlined my choices, and we discussed risks and expectations.

You already know options one and two (intestine and vein). There are two more...

I asked about a surgical option. That, as it turned out, was the option he liked least. Not only was it abdominal surgery—always a risk for infection—but the tumor/abscess/growth/alien is in a particularly difficult place. The combination of difficulty and infection risk (from the tumor/abscess/growth/alien itself) made surgery an unattractive option.

The last option was to take a regimen of strong antibiotics, via IV for a day or two and then orally for two weeks. Attacking any infections, we would see if there would be any effect on my tumor/abscess/growth/alien. This was the least risky choice. If it got smaller, hooray! We could then deal with a smaller abscess and monitor the area over time (years). But we still would not know if it was cancer. And we would be waiting for several weeks for any answers.

Four options, one choice.

Complicated.

We talked more, as I calculated. I weighed what I knew and did not know, and I focused on facts. As much as I could. Tired, hungry, thirsty and medicated, I was not at my best, but I bit down, focused hard, and made my decision.

Venous.

In the end it was a decision between antibiotics and venous. While antibiotics represented the least immediate risk, it did not give me the information I needed to sleep at night. Venous had risks, but I thought all were reasonably mitigated by having the procedure done where I was (Sloan-Kettering). If there was any problem with the vein, they would whisk me of to surgery without second thought. And they had already started administrating some antibiotics in preparation for the procedure. Were any infection to spread, I felt it would be addressed by the planned antibiotic regime.

As to cancer exposure. This was the difficult one for me. But I realized something that swayed me. If there are cancer cells, I am headed for chemotherapy. I will not pass Go. I will not collect $200. I'll be ushered into a protocol without hesitation. So the relatively small risk of blood exposure was inconsequential. Cancer = chemo. Simple

So, venous it was.

In minutes, I was sedated. The next thing I knew, I was emerging. Open eyes. See soon-to-be-married-and-moving-to-SanFran nurse. Ask how it went. No problems, I think I heard.

No complications.

Blink. Recovery room. Everything OK? Yes? Rest. Sleep. Wake. OK? OK. Return to room, hungry.

I asked my lovely nurse if I was permitted to eat. She affirmed. I asked my lovely nurse if I was permitted to drink. She affirmed. I drank, and drank, and drank some more. I ordered dinner—basically the entire left side of the menu, and I drank some more. I waited for dinner, and I drank. Then I peed, so I drank some more. Then I peed AND drank, and I felt like the circle was complete.

Ravenous, I ate. Consommé, salad, rice, fish, vegetable roll, brownie. I ate it all. I lovingly cleaned my plates, and I drank some more.

And, finally sated, I slept.

Uncomplicated.