A Brief History of Cancer

This is an attempt to make the longest blog post ever. But also, so many people from so many directions have asked for background and updates. This is an attempt to get the full story out. Good luck :)

It all started with an infected abscess on my shoulder blade.

I won't go into that, because it's a little disgusting. I'll just say it ended with a trip to the emergency room and surgery so minor it was barely more intense than a haircut. That set off a reminder that I hadn't had a physical in just over a year and a half, and Maria was going to hound me about it until I did.

Doctor #1 - Early December 2008

The first doctor involved is Susan Boyle, my primary physician. I love this woman. She is friendly and funny and thorough. (ETA: When I wrote this, it was long before the Other Susan Boyle had made her appearance. I haven't seen my doctor since then, but I bet she feels like Michael Bolton from Office Space. -4/20/09)

She said "do you drink, smoke cigarettes, smoke marijuana, or buy your crystal meth out of the back of an El Camino from a smelly man in a hoodie known only as 'Doug'? Sorry, I'm required to ask." She also calls me personally at home, after hours, with my results from the bloodwork -- everything is fine, but she is there to answer questions for about 15 minutes. Hard to think of good questions when my results are all normal, so it was things like "using the blood you took from my arm, are you going to be growing an army of cloned Super Soldiers that look like me? When will they be ready, and can I have one to walk my dogs?"

But during the exam, she finds a lump just under my throat. She says she could take a look at it, but it is too close to my thyroid gland for comfort, so she refers me to North Atlanta Endocrinology and Diabetes (or "NAED," which is the sound made when a Southerner calls to someone named Ned).

Doctor #2 - Just before Christmas, 2008

So I get an appointment with the first NAED doctor who could see me, a man named David Shore. A friendly, plain-spoken man with a hint of a New Jersey/New York accent. Hey, I grew up in Alabama -- like I can tell a friggin' difference between the two. The conversation went like this:

Dr Shore: "So your PCP found a lump on your thyroid."

Me: "Yup."

Dr Shore: [Feeling my neck] "Yeah, that's a lump! Come back next month and we'll stick a needle in it."

At no point in all this am I particularly stressed. You hear "lump" and you think "cancer," but it could be a host of other things. My dogs even get them, and they always turn out to be little fat deposits. And remember: this all started because of an abscess on my back, so I know from lumps.

January 15, 2009

Biopsy Day!

I'm back at Dr. Shore's office, lying on an inclined table with my feet about two feet higher than my head. The nurses are passing needles and swabs and bandages back and forth across my field of vision, and I keep having to sit up because the blood rushes to my head. Finally, Dr. Shore comes in, and they spray what they claim is topical anesthesia, but which might be cooking spray for all the numbing properties it had. Needles go in six or seven times, hurting way more than giving blood at the Red Cross.

They tell me I'll get the results back in a week to 10 days, although it turns out to be both. I'm sent on my way.

January 23, 2009

At about 3:00pm on Friday the 23rd, I get a call from Judy, Dr. Shore's medical assistant. She says Dr. Shore wants me to come in next week to talk about my results.

Me: "Okay, I can come in any time. Can you tell me what my results are?"

Judy: "Your biopsy came back abnormal."

Me: "What does that mean? They just got weird results, or are we talking cancer?"

Judy: "Dr. Shore will have to give you the details next week. I'll have the appointment desk call you before the end of the day to make an appointment as soon as we can next week."

Me: "Can I talk to Dr. Shore now?"

Judy: "I'm afraid he's not available the rest of the day. Someone will call you soon. Have a nice day!"

Have a nice day. Hilarious.

By 4:45 I still haven't heard from the appointment desk, so I call them and get the "gone home" message. I leave a mildly snarky voicemail and call Judy back. She's gone too, and my voicemail this time is more of an emotional plea for mercy, in case she checks her voicemail over the weekend. She doesn't.

The Dark Weekend of the Soul

Maria flies out Saturday morning to New York. She was in Boston when I got my abcess removed, too. Next time she flies to New England, I better come along.

I keep myself entertained as best I can over the weekend, but I'm basically stewing about Judy and getting nervous about my biopsy report.

January 26, 2009

I get into my office at about 8, and immediately I call Judy (voicemail) and the appointment desk (voicemail). I don't know why people feel that medical treatment in America has become so cold and impersonal -- the answering machines I spoke with struck me as very tender and caring.

A little after 9, the appointment desk calls. Whomever is on the other end has a perky, upbeat voice that seems more appropriate for telling me about a new offer from my cable company. She chirps that Dr. Shore wants to see me at 3pm.

Of course I'm there early. At about 3:45, someone comes to the waiting room and shouts that Dr. Shore got held up by a medical emergency, and if we wanted to reschedule, go to the desk. The only way I'm leaving there without talking to Dr. Shore is in handcuffs while being read my rights. But you have to wonder: a medical emergency? He's an ENDOCRINOLOGIST. What sort of medical emergency are we talking about? Did someone's pancreas become explosive? This will be a mystery as long as I live...

I finally get back there about 20 minutes later, and he comes in. I think he could sense that I was a little on edge.

Dr. Shore: "I'm surprised your wife didn't come with you."

Me: "She's out of town on a business trip."

Dr. Shore: "Oh, that's too bad. I know she'd want to hear this immediately."

Me: "She was still in town on Friday."

Dr. Shore: "... so about your biopsy..."

That's when he tells me I have thyroid cancer. Or, more specifically, he says the results came back as "suspicious," but we need to proceed as if it is cancer, and from that point on, he talks as thought it's definitely cancer.

He is the first to hit me with two cliches that I have since grown impatient with:

1. "This is the best type of cancer to get." (A brazen lie. The best type of cancer to get is one located in someone else's body. Preferably someone you don't like. Schadenfreude Carcinoma.)


2. "A year from now, we'll be laughing about this." (I don't think so. Even if I set a new record for recovery speed, I'm not seeing a Gigglepalooza at the end of the road. A huge sigh of relief and a fanatical devotion to regular exams, sure. But I'll miss out on the Chucklefest.)

His prescription:

• An ultrasound to see if it's spread to the surrounding lymph nodes or anything
• More cowbell
• Surgery to remove the whole thyroid gland
• Radiation treatment
• Synthroid pills every day forever and ever
• Regular scans to see if the cancer comes back

He gives me a copy of my biopsy report, some additional reading material, and the business card of a surgeon he recommends. Funny thing about that biopsy report - it's fairly detailed, including a document history. The pathologist who did it sent it back to them on Monday the 19th, four days after I got the biopsy, and four days before the late Friday call that ruined my weekend. I am not happy.

Intermission

It is at this point where I start telling friends and family what's going on. To this point it had only been Maria. This is about when most of you reading this probably heard about it first. I am flooded and overwhelmed with supportive notes and emails and phone calls and tweets and Facebook postings, and I am quite moved by all of it. And sorry if I didn't get back to you in a very timely manner -- my head hasn't been where it should be.

My friend Stephen had gone through thyroid cancer a few years ago, and he gives me a lot of helpful information, including the name of his endocrinologist, with whom he has been pleased. I call Dr. Beasley's office, and they can't see me until Feb 3, which is about a week away. I also call to make an appointment for the ultrasound, which they can't schedule until Feb 12. So I spend the next week alternating between feeling sorry for myself and feeling stupid when I hear from old friends fighting with much more impressive and scary types of cancer.

Doctor #3

They always call you into the back rooms right as you're at the Moment of Truth while playing Risk on the iPhone.

The first thing that strikes me about Dr. Beasley's setup is the form they give me, asking how I prefer to be contacted, and can they leave detailed information on voicemail? I tell them they can leave information in as many places as they possibly can -- I don't care who else knows what's going on with my thyroid, as long as I know as soon as possible.

Dr. Beasley comes in. He's an older, very friendly man who laughs a lot. He reminds me a little of my late grandfather, except Dr. Beasley doesn't appear to be drunk. He asks a lot of standard questions about my history and habits ("You know Crystal Meth Doug? How's he doing? I bought moonshine and illicit powdered tiger penis from his grandfather when I was in med school.")

Then he says something interesting: "It might not be cancer." And he draws a little diagram like this:

See, the thing about a needle biopsy is that it gets very little material. My results were "suspicious," which means they spotted some cells that are commonly associated with a type of thyroid cancer. This is only a little more certain than the "indeterminable" result, which is when the pathologist looks through a microscope and goes "WTF?" and starts dreaming about naming rights for a new neck disease.

Dr. Beasley said we could do another needle biopsy, but what would be the point? The only way to be sure is with an open surgery biopsy. Dr. Beasley said that's likely what Dr. Shore was suggesting, but didn't give all the background information. I'm not so sure, but I'll get a proper vent about that experience up later.

From my perspective, not much would change. It would go like this:

1. I go under the knife.
2. The surgeon removes the affected half of the thyroid. (The thyroid is sort of butterfly-shaped, and has two distinct lobes. My little growth is on the left lobe.)
3. The diseased lobe goes off to a pathologist on site to do whatever they do to test for cancer. This takes 20-30 minutes.
4. While this is going on, the surgeon pokes around the area to see if anything looks odd. Enlarged lymph nodes, funny colors, whatever. If anything looks wrong, the surgeon will remove it.
5. The pathologist comes back with either a "yes, cancer" or "no, not cancer" verdict.
6. If it's cancer, the other half of the thyroid comes out, I get sown back up, get the radiation treatment and Synthroid pills, and come back every few months for a scan.
7. If it's not cancer, I get sown back up, skip the radiation, and probably still need the Synthroid but at a much lower dose.
8. I wake up and learn the verdict.

I understand everything a lot better now. Dr. Beasley spends more than 30 minutes with me, giving me a full neck physical (feeling my throat when I swallow, things like that), swapping jokes, and anticipating and answering questions. Then he has to go, and a nurse comes in and sits with me for another 10 minutes and she tells me what the radiation treatment is like, if it comes to that. (I have to board my dogs while I'm doing it and Maria and I have to sleep in separate rooms, since I'll be "hot." No point in giving them radiation sickness.)

So we decide:

• I'll meet with the surgeon, Dr. Schmitt. I'll let him talk through the procedure, and if I'm comfortable with him, I'll move forward with scheduling the surgery.
• If I'm not comfortable -- if he seems hell bent on cutting out my entire thyroid based on the needle biopsy results alone, for example -- I'll get a recommendation from Dr. Beasley.

That's where we stand now. If you have made it this far, you know everything about what's going on with me that I know. I'm much calmer now after talking to Dr. Beasley. After all this, I might not have cancer at all. (Still -- assume I do. Prep for the worst and all.)

Thanks again to all of you for your concern and support. I'm told that a positive attitude is important, and I don't think I could have one without you guys.