my dance with cancer

not dead yet

2011-08-22T03:21:00.000-07:00

Someone pointed out that I have a responsibility to update this blog regularly. Because I have cancer, when things go silent for months on end, a reasonable assumption is that I've died. That hadn't occurred to me, so I apoligize to all of you who mourned my demise.

To be honest, I don't have much news in the cancer realm: no new tumours, no dramatic treatment decisions, no enlightening information from my stable of superstar doctors. I think they're bored with my case because it's not immediately life-threatening, and so they can't rationalize trying more surgery or chemo. For statistical purposes, they've done all they can do until something particularly nasty pops up.

In February 2011, I have the three-month follow-up for my surgery of June 2010. I know, I know, that's seven months, but we all appreciate the insanely busy, hectic schedule of a dedicated and hardworkng medical professional.

I am convinced that I have another tumour growing in my lung because of these ominous, periodic but regular symptoms: a stabbing pain in my chest, joint and bone aches, pain when I move and pain when I stay still, night sweats, insomnia, weakness, brutal headaches, fatigue, an annoying little cough, shortness of breath, nausea, and some days I simply can't get out of bed. Yep, it's gotta be the return of lung cancer.

Never being one to sit back and do nothing, I start smoking again. Ahhh, bliss! In the months of daily jonesing, obsessing and tweaking for a smoke, I develop a tremendous respect for those who quit for good. I respect accountants, too, for the work they do, but I know myself well enough to accept the fact that accounting is not a realistic goal for me. Same thing with spotless housekeeping, telephone sales, a life dedicated to Christ and non-smoking.

On a roll, I start drinking wine every day. Then comes smoking pot. Next, my diet goes all to hell with juicy steaks pan-fried in butter, greasy pizza and Kraft Dinner. Worst of all, I start playing Dragons of Atlantis, a fantasy role-playing war game online. As you can clearly see, I am in a bad way.

Oddly, this degenerate, unhealthy lifestyle doesn't make me feel any worse. The daily discomforts are still here, but at least now I enjoy a nice dinner with wine and a cigarette afterwards, then a joint and a couple of hours lost in the cyber-realms of Atlantis, slaughtering the enemy's battle dragons and raiding their outposts while the dirty laundry and dishes wait for tomorrow. Or the next day.

So, off to meet with Dr. Wadge for, I am certain, the dire news that lung cancer is still with me. Dr. Wadge is an internal medicine specialist in Sechelt here on the Sunshine Coast (the BC Cancer Agency wanted me to travel to Vancouver for followup appointments, but I declined).

It's a grey and drizzly morning, the weather in solemn harmony with my morbid outlook. Hank Williams Sr. sings the saddest song I've ever heard while I make the half-hour drive south on Hwy. 101 and smoke cigarettes.

In the peaceful waiting room, I pick up a local newspaper and choose one of the uncomfortable little chairs, the one furthest from the reception window and the other patiently waiting patients. I try to read but don't comprehend a word. Classical music plays at a low volume from tiny grey speakers bolted unobtrusively in the corners. I contemplate a long, black hair on the polished floor and wonder if it fell from from someone undergoing chemotherapy. I sneak a look at the person sitting across from me-- she knits something from a skein or ball of bile-green wool hidden in her black purse-- and wonder if she has cancer. I imagine a prisoner facing the guillotine, innocent of the crime he's accused of, feeling this same dreadful finality.

"Mizz... Winchester?" Now it's hurry down the hallway and into the little consult room with the doctor, with the test results already up and shimmering on her monitor...

Not a trace of lung cancer, no tumours visible, so the January 2010 wedge resection was a success. Too bad they took out all that perfectly healthy lung six months later but, oh well, I guess it's always best to take precautionary measures. Better safe than sorry. Perhaps I'll request a leg amputation. You just never know when something could go amiss with a leg, and if the leg is gone, well, then it won't cause any problems.

The CT scan shows two enlarged lymph nodes, but a size of 1.5 cm is not alarming given that the normal size is 50 mm. My missing oncologist (she took maternity leave in May 2010 and I haven't heard from her since) assumes it's an inoldent lymphoma, cancer, but the type and stage is unknown because a biopsy has not been taken. Apparently it's a deep and difficult surgery, removing either of these nodes, so I'm okay with keeping them for now. I've had quite enough, thank you, of having bits of me cut out this past year or so.

Dr. Wadge asks how I'm feeling, so I tell her.

"Well," she says with no small degree of resignation, "look what you've been through," and summarizes my last surgery with the disturbingly vivid phrase, "flayed open," which fails to reassure me. In other words, this is your life, so suck it up buttercup.

I tell her I've started smoking again and she replies that I can always quit again.

I express concern about the reoccuring nausea and abdominal pain, and she heads for the rubber gloves and jelly for a rectal examination, so I quickly change the subject before she can get me out of my pants.

I ask for something to help me sleep, and she orders a cousin of the tricyclic anti-depressant, amitriptyline. It puts me to sleep but the nightmares are so horror-show frightening that I'd much rather spend the night tossing, turning, aching and sweating than screaming silently in absolute terror, immobilized with fear, unable to wake up. Sometimes a little perspective is all that's needed to solve a problem.

I will have regular blood tests looking for anemia (common with lymphoma) and elevated white blood counts, and I will have a CT scan every three months, still looking for the return of lung cancer in my lung and other organs to which it likes to travel (the brain and liver are particular favourites).

When I exit Dr. Wadge's office, the rain has stopped, the sun is shining and the day looks much cheerier now that I don't have lung cancer again, and it's the Proclaimers in the CD player for the drive home.

I know some of you are wondering if I quit smoking again. Don't be silly.

The reactions to my smoking range from shock to horror to a deeply personal disappointment in my weakness, recklessness and willingness to, apparently, kill myself. Only my closest friends accept, and understand, my decision. Or at least they tell me they do, but I believe them because they too are Evil Smokers.

Honestly, my decision to start smoking (or quit quitting) isn't as impulsive as you think. I researched smoking and lung cancer, and learned that the lung cancer patient who quits smoking upon diagnosis will increase his lifespan. So far so good, but by the end of the lengthy study, you learn that the lifespan increase is three weeks. Three measly weeks? I guess you know what I decided they could do with those three weeks.

I quit smoking in mid-January of 2010, just before my first surgery. The first days were the easiest, but that likely had something to do with the initial trauma of the cancer diagnosis, lung surgery and the generous amounts of narcotics I was fed to keep the pain at bay. I was also physically unable to get out of bed to walk the four blocks to get off hospital property, the only place a patient is allowed to smoke.

At any rate, it didn't get easier, it got harder. The craving would hit, and although I knew how to distract myself from it, and although it worked for a few minutes, it was right back again a few minutes later. I became aware that there are a lot of minutes in a day.

Besides, I'm not convinced that cigarettes are the highly-toxic, guaranteed-deadly little items that health organizations and the government tell us they are.

When I pick up a pack of cigarettes and read, SMOKING CAUSES CANCER, I wonder why milk cartons don't say MILK CAUSES ALLERGIC REACTIONS (because it does, in some people) or, on a bag of Planter's Mixed Nuts, EATING NUTS KILLS PEOPLE (because nuts can kill some people).

I wonder why automobiles don't have big red stickers saying, DRIVING KILLS (because, indirectly, it can) or DRIVING CAUSES CANCER, because automobile emissions are far more carcinogenic than cigarette smoke.

I wonder why airports aren't targeted by the environmentally conscious, because the amount of fuel burned and dumped (regularly, to reduce weight) should be a much greater concern than a farmer and driving his Ford F-250 pickup truck around the pasture. And let's not even think of the fuel burned by the air force hotshots in their training exercises and shows to impress the public.

I don't understand why cigarettes are targeted so strongly, and I'm not enough of a conspiracy theorist to believe it's a backroom deal by the government and tobacco companies to charge a ridiculously high price for a pack of smokes.

I know that smoking is not a "healthy" habit, and I know that, these days, it's not socially acceptable in most situations. I suspect that a number of well-meaning, righteous people on various volunteer boards and in low-level government offices have simply allowed their enthusiasm to get out of control in a caring, heartfelt desire to do good for everyone. I'm sure they all use the word "proactive" at every opportunity and have no idea that there's a deep and wide, gaping chasm between statistical probability and scientific fact.

The problem is, I cannot find any reliable science to back up claims that smoking will kill you. There's a strong link between smoking and some types of cancer, but there's an even stronger link between drinking milk as a child and becoming a heroin addict as an adult. It suggests a connection, but it's misleading. One in three people will get cancer but fewer than one in three people smoke, and not all smokers get cancer.

There's more to the cancer story than smoking, and we don't know yet what it is. Even though we hate to be haters, we love to be blamers and we've been conditioned to blame cigarettes for the fact that we can't live forever and we're likely going to die of cancer or heart disease.

It surely wouldn't be a good idea to publicize the inconvenient truth that living in a high-density urban area exposes a non-smoker to more carcinogens than a pack-a-day smoker living in a rural area with minimal pollution.

Here's what has been proven: to maybe but not definitely get cancer, one needs a specific genetic marker that allows uncontrolled cell growth, plus regular, long-term exposure to a carcinogen. One without the other means no cancer; both must be present and it's still no sure thing.

If one could live in a carcinogen-free environment, cancer would not be a problem, but we swallow, breathe and touch carcinogenic materials every day of our lives. Food additives, air pollution, water pollution and natural carcinogens (arsenic in water) all contribute, and we can't escape them.

Bottom line, I smoked for over 40 years before I got lung cancer (ironically, the kind that non-smokers get). Whether or not my cancer was caused by smoking, the damage is done and I'm not really interested in quitting so I can prolong my life three more weeks.

notes from the ward

2010-12-17T14:28:00.000-08:00

I just found a little notebook I forgot I had with me in the hospital on a few occasions, and I'd like to share with you my narcotic-addled observations at both Vancouver General Hospital and St. Mary's in Sechelt. Unfortunately, a lot of it is illegible, but I was able to understand a few bits.

Roomie From Hell

Random comments from a middle-aged woman with whom I was sharing a room. I can't remember what she was being treated for, but heavier sedation would have been a blessing.

My tuna sandwich was just tuna and mayo. Tuna and mayo, tuna and mayo, can you imagine?
I got tea. I don't drink tea. This tea is awful.
Those nurses spend all their time reading and gossiping. They should have raised kids, they don't know what a hard day's work is.
Would you sleep in this bed? Would you?
He won't come and see me because he knows he'll get the what-for, the lazy old goat.
I know food, I cook. This coleslaw tastes like curry. If I wanted curry I'd go to Pakistan.

Dumb Questions from Medical Professionals

And the replies I prevented by biting my tongue.

Is your pain good?Oh yes, thank you, the my pain today is absolutely lovely. And don't worry, if it starts to subside, I can always poke myself in the eye with this pencil.
Are you having a good day?Yes, yes thanks, one of the best I can remember. I'll really miss all of this when I go home.
Can I get a blood sample?Obviously you're going to drive a needle into my vein to draw something out. Do you think there's a possibility it might be something other than blood? Are you really a nurse, or are you an actor from "Just For Laughs: Gags?"

Dumb Questions from Me

Why do you call what you do "practice?"
If you're going to ram a camera up my arse, why bother leaving the room while I undress?

Staff Analysis

There are three categories of staff, regardless of title, skill, experience or duties.

Acers seem to know what they're doing, enjoy their work and make an effort to improve the patient's comfort. They all deserve raises. And flowers.
Divas, too, are competent, but they want you to know it and want to make sure what a generous act it is for them to change a dressing or bring a glass of water. I feel sorry for their spouses and children.
Culls simply shouldn't have been hired, for any job, but they show up at all levels, moving slowly and frequently changing direction for no apparent reason. Culls are especially disappointing when they attempt to insert a needle into your arm.

Voices from the Hallway

Scraps of conversation overheard from Culls loitering in the hallway outside my room:

USA lost the cup. What can you do though? Yeah, it's just a game, eh?
I've had it with him. As soon as we get back from Mexico, pfffft, he's history. But he owes me a nice trip.
Auntie has a boy 32 and a girl 20. They're getting a little more mature, they're not teenagers anymore. They were good teenagers though.

The Valley Girls

I have no idea who these two are, or what they look like, but I'll bet they consult those cheesy "entertainment" magazines for paparazzi shots of Paris Hilton for fashion inspiration. I'm sure they both have little dogs that fit in their oversized Louis Vuitton cheap-knockoff bags.

They are indistingushable by voice. Same volume and pitch (a little on the high side), same breathless and perky delivery in the classic Valley Girl dialect (So I'm all like, you know, and so I go--" and the reply is invariably, "Shut up!").

I also think of them as The Giggle Girls because every conversation byte is ended with a near-hysterical, but thankfully brief, giggle. It is a good fit with most of their conversation, with subject matter such as What I Did on My Summer Vacation, Shopping, My Father is Soooo Old-Fashioned and the wildly popular Dumping My Lame Boyfriend.

When they discuss patient care, the giggles are somewhat horrifying.

So, like, she wants to go home with her catheter, teeheeheehee!
Shut up! She wants to go hoome with her catheter? Teeheeheehee!
Yeah, like really! Teeheeheehee!
Maybe I'll try that, teeheeheehee!
It could be kinda good when you're watching TV and don't, like, you know, wanna get up, teeheeheehee!
I'm always self-medicating too but I'm, like, well I'm a nurse so it's okay, teeheeheehee!
Teeheeheehee!

Patient Communication 101

I'm convinced that every doctor learned these communication strategies at medical school. Thankfully, not all of them (most, but not all) choose not to use them:

Avoid eye contact.
Maintain a complete lack of facial expression.
When patient explains their symptoms and medical history, acknowledge with no more than an ambiguous, disinterested, vague and very quiet, "uh hum."
Strive to leave the patient wondering:
   1) If you have heard them;
   2) If you have understood them;
   3) If you even care what they said.
Answer all direct questions with, "Everyone is different."

bucket list

2010-11-24T02:22:00.000-08:00

November is Lung Cancer Awareness Month, and here's the whole calendar, if you're interested:

November ~ Lung Cancer, Pancreatic Cancer;
October ~ Breast Cancer;
September ~ Prostate Cancer, Childhood Cancer, Ovarian Cancer, Gynecologic Cancer, Leukemia and Lymphoma;
June ~ Men's Cancer;
May ~ Women’s Cancer, Skin Cancer;
March ~ Colorectal Cancer.

May is Cancer Research Month, April is Cancer Control Month, January is Cervical Cancer Screening Month, and we have a number of holidays of less than a month:

Coaches vs. Cancer Awareness Weekend (January);
World Cancer Day (February);
Daffodil Days (March);
Minority Cancer Awareness Week (April 18-24);
Melanoma Monday (May);
Women’s Cancer Awareness Day (Mother’s Day);
National Cancer Survivors Day (June);
Men’s Cancer Awareness Day (Father’s Day);
Mammography Day (October);
Coaches vs. Cancer Classic (November).

Hold on, is this a disease or a spectator sport? This cancer is just one great big celebration of wonderfulness, all year long.

You may know that it's not politically correct to refer to a cancer patients as cancer patients. Instead, they're cancer survivors. Well, that's what I thought too, but now we're no longer survivors either. The latest buzzwords have turned us into "champions" or "warriors."

We warrior-champions are supposed to maintain a hysterically positive outlook, to believe that we are going to beat our cancer and never, never ever, let a shred of doubt enter our consciousness. Bring on the cheerleaders!

We're supposed to live every minute of every day to the fullest, to spend quality time with our loved ones, to tour Europe, to go skydiving, sign up for ballroom dancing lessons and take up mountain-climbing.

It's expected that we all have a bucket list of things we want to do before we "kick the bucket" (die), and that we spending every day working on the list, doing all those adventureous things we always wanted to do but never got around to.

I don't know who came up with these rules for living with a terminal illness, but it sure wasn't the guy puking up his guts after yet another chemo treatment, or the woman nearly comatose from painkillers while she recovers from yet another surgery.

First of all, when you have cancer, you're not normally a happy ball of energy and enthusiasm every day. Sometimes you're sick, sometimes you're tired. And most of the time you're sick and tired of being sick and tired.

Then there's the inconvenient little truth that cancer devastates you not only physically but financially. Even if you have fabulous medical insurance that covers all your treatment expenses (many don't), you're likely missing a lot of work and not getting paid for it. You may find yourself unemployed. You may find yourself on welfare. Yet, you're supposed to be booking that Carribbean cruise.

Never mind all that. Let's pretend that you feel healthy and you're independently wealthy. Off to climb Everest then? Afraid not. Cancer is a time-consuming disease, with an endless schedule of appointments for bloodwork, x-rays, examinations, CT Scans and follow-ups. Unless you live in a major centre, travel is involved.

We're caught up in a machine, and it's a machine built to raise money for cancer research. Yes, funding for cancer research is a good thing, but let's cut the cancer patient some slack. Opps, I mean cancer champion. Let's not use the person as a success story to support the fundraising cause, because odds are he won't be a success story.

Cancer treatments, and thus the prognosis, are improving, but cancer has been the top killer in Canada since 2007, and one of three people gets cancer. Let's look at some more statistics:

The five-year survival rate for "cancer warriors" diagnosed in 2004-2006 is 62% of people not diagnosed with cancer. A diagnosis in 1998-2000 was 60%, so an improvement is being shown.

Let's look at the five-year survival rate for individual cancers. The percentage figure is the number of people out of one hundred who will survive for five years:

Thyroid cancer ~ 98%
Testicular cancer ~ 95%
Prostrate cancer ~ 96%
Skin melanoma ~ 90%
Breast cancer ~ 87%.
Bladder cancer ~ 73%
Non-Hodgkin's lymphoma ~ 63%
Colorectal cancer ~ 63%
Brain cancer, ages 15-44 ~ 58%
Leukemia ~ 54%
Ovarian cancer ~ 42%
Stomach cancer ~ 24%
Liver cancer ~ 17%
Lung cancer ~ 16%
Esophageal cancer ~ 13%
Brain cancer, ages 65-74 ~ 9%
Pancreatic cancer ~ 6%

These figures are for early-stage diagnosis, and unfortunately not everyone is diagnosed quickly enough to meet the five-year survival percentage. For example, of 100 people diagnosed with lung cancer that has spread, only three will survive for five years. The average survival for someone diagnosed with Stage 4 prostate cancer is 1-3 years and, if they refuse treatment, only 6-9 months.

This year, over 76,000 people in Canada will die of cancer (over a quarter of them from lung cancer) and almost 174,000 new cases will be diagnosed.

But we're not patients and we're not survivors, we're fucking warriors and champions, and we're not going to think about dying of cancer, and we're going to put together a bucket list of adventures and other fun things to do.

But, if you can, please donate to cancer research. It's not going nearly as well for them as they'd like us to think, in spite of all the cheerleaders.

anticipation

2010-10-22T02:11:00.000-07:00

Tomorrow is a big day, my first visit with a doctor since my surgery June 21, four months ago.

About a month ago I phone the Cancer Agency in Vancouver, a huge facility that tracks and manages treatment of every cancer patient in British Columbia. I tell a secretary my oncologist, Dr. Ho, won't be back to work for about ten months, off on a year's maternity leave, and I'm wondering about a follow-up for my thoracic lobectomy.

The next day, I get a call back from Dr. Ho's replacement, who came out of retirement to help with the abandoned caseload. He tells me he will send a letter to my doctor here in Pender Harbour. My doctor, unfortunately for me, buggered off on a year's sabbatical a couple of months ago, but his replacement will get the letter recommending an x-ray and blood tests.

I will meet him tomorrow, his first shift at the Pender Harbour Clinic. I have some anxiety about this meeting. I don't seem to have good luck with doctors, and the ones who work out well for me soon abandon their practice for long periods of time. For some unknown reason, most doctors are unable to properly diagnose whatever health problem I happen to have. I've had a few serious health incidents in my life, and every one of them was screwed up. For example, nearly 20 years ago...

After a lovely moonlight swim in Garden Bay Lake, I'm climbing back up the bank to the road where my truck is parked. I'm holding my jeans and shirt above my head, to keep them from dragging in the dirt. It's dark. I'm wearing "stupid shoes," those useless thong things that are really just a slab of flat rubber held on to your foot with a thin strap across your toes.

I lose my footing in the loose gravel, and you know how these things happen so quickly but seem to go in slow motion. I know I'm falling, but I'm determined to keep my clothes off the ground, so I keep my arm held high over my head. CRACK! That was my arm and, damn it, my clothes are sitting on the ground.

So is my arm, and it won't move. I can pick it up with my other hand, but it won't move on its own, no matter how much I concentrate. I admire the large rock that my arm, with the weight of most of my body behind it, landed on rather abruptly. It occurs to me that this might be a reason why people are warned not to go swimming alone. A servant to carry my clothing and this might not have happened.

So, the arm is broken. No big deal, it doesn't hurt and my truck is right here. I fashion a makeshift sling from my jeans, and off I go to St. Mary's Hospital in Sechelt, about a half-hour drive. Dr. Estey is on duty in the Emergency Room.

"What happened?" he asks.
"I fell, and I think I broke my arm," I reply.

He lifts my arm off the counter, pushes into the flesh here and there, then announces, "Yes, it's broken, but it's a nice, clean break so we'll put it in a cast and you can come back in the morning for an x-ray."

So, before long, I'm sent on my way with a cast, a proper sling and four Tylenol-with-codeine for the pain I'm not yet experiencing. Just as well, it's not a drive I want to make while high on painkillers.

It's been a long night, so I'm asleep soon after my head hits the pillow. But not for long. About 4 a.m. I wake up with excruiating pain in my arm. I gobble two of the T3s but it's even worse an hour later. Down go the other two.

Now, between the pain and the drugs, there's no way I can drive back to the hospital, so I call Jane. She's one of those really good friends who always is available when I really need help, even though she would much rather be sleeping at this ungodly early hour of the morning.

Anyway, back to St. Mary's and into the x-ray room where I'm told to lift my arm up, vertically, against a metal plate. Problem is, it's really painful to move the damned thing, and lifting it in that position is not going well at all. I'm not happy because I don't like whining in public, and the x-ray technician is frustrated because she can't take her x-ray.

"Just grit your teeth and do it!" she orders. So, I grit my teeth and...

... wake up in the back of an ambulance, on my way to Lion's Gate Hospital in North Vancouver, high as a kite on morphine (apparently I passed out in the x-ray room when I tried to lift up my arm).

I ask the ambulance attendant if I can sit up front. I ask the driver to turn up the radio, and turn it up some more. I happily wave at people in their cars behind the ambulance. I generally make a complete idiot of myself, but decide that I like morphine.

I'm wheeled into Lion's Gate, into the operating room and, next thing I know, I'm waking up after surgery. Dr. Estey's diagnosis of a nice clean break was a little off. Turns out the arm was dislocated at the elbow and the bone was shattered. I now have a stainless steel shaft running from my elbow to my wrist, and the surgeon quips that I will never break that arm again. "You might bend it," he says, "but you will never break it."

So far, he's been right.

cancer chatter

2010-09-16T20:36:00.000-07:00

Yikes, I haven't blogged since July and we're now halfway through September. I think about it, almost daily, and I even sit down here at the keyboard a couple of times and start an entry. Doesn't work, though, the flow is dry as an attic cobweb.

For me, writing is like sex. If you're not in the mood, you're not very good at it. Unless, of course the writing is of a technical sort, in which case it's more like a jigsaw puzzle; somewhat challenging, mildly entertaining but devoid of passion.

I have to figure out why my cancer blogging fountain of words dried up, and it finally comes to me: I'm thoroughly sick of cancer conversations. Not the back-and-forth, information-sharing, what-if exchanges that I love, but the inevetible tales of woe or faith that so many casual acquaintances subject me to. They knew someone who had cancer so they're an expert, or they're traumatized or they feel that they can forsee the future to tell me I will be cured.

I'm horrified that so many people know so little about this bastardly disease that attacks one of every three people on the planet. Some have cancer, are being treated for it, and they don't know what kind it is. They do not know what kind of cancer they have. Not a clue, and this floors me. Aren't they the least bit curious?

Jesus tapdancing Christ, this cancer may kill them, don't they have any interest at all? Apparently not but, in spite of this, they're eager to tell you all about it. I always listen politely and wish them luck. Sometimes, if I'm in an evil mood, I grin like an idiot and say, "Oh, you'll be just fine!"

I've already talked about the plethora of secret, miracle cures people let me in on. Oddly, everyone learned about them from a friend of a friend of a friend, on the Ophra show or read it in a magazine (I'm guessing an ad in a magazine). Anyway, I don't even bother argueing anymore.

I learned my lesson after responding, "Oh, that's reaaally wonderful, I had no idea I could cure my cancer just by taking some kind of hemp oil preparation. Guess I'd better run right down to the health food store and buy up a whole bunch of it, eh? Gee, you're so clever! You should be a doctor!"

And I may have gone on a bit longer, my voice dripping with sarcasm. Anyway, Miracle Cure Dude finally gets it, looks me right in the eye and snarls, "Fuck you, douche bag!" as he turns on his heel and stalks off down the Italy aisle in the wine section of the liquor store, heading for Kokanee. I smile, because I imagine yelling at him, "Hey buddy, you should quit drinkin' yer beer out of aluminum cans, it's killing brain cells."

Finally, there are those who lost a loved one of cancer and, believe me, I have great sympathy for anyone who has lost a loved one because we all do and it's always rough.

My sympathy dwindles when, on my first solo trip shopping after my lobectomy, a woman about my age but a bundle of energy and the picture of health, runs up to me to to say, "How ARE you!" I reply, "Not bad, thanks," and she launches into the saga of her mother who died of "female parts" cancer.

Really, that's what she called it, and I wonder if, at her age, she still does not know the names of female reproductive organs. Maybe she thinks these are bad words not to be uttered in public or, most likely, she doesn't really know much about what killed her mother and doesn't much care because it's really all about her.

I'm in pain, exhausted and stupid from Dilaudid, hanging on to the grocery cart to keep from collapsing on the floor of the IGA and struggling to get some air in my lung.

She prattles on about her mother who died ten years ago and she went to stay with her and she cooked for her and she cleaned for her and she shopped for her and she loved those little butter tarts and it was so hard and her mother ended up in the hospital but she stayed on with her sister to look after Dad because he was just beside himself because she had looked after him all these years, blah, blah, blah, blah, blah, blah.

There was something in there about getting a flat tire on Granville Street in Vancouver, but I missed a lot of the details. At one point, when she paused for a breath, just for fun, I said, "My mom was murdered by a rhinocerous with AIDS," but she never batted an eye, just kept right on about what a dedicated daughter and selfless person she was when her mother was dying of cancer of her female parts.

Next time I'm gonna turn around, yank up my shirt and show her my scar!

So for the most part I try to avoid cancer chats, but a few of them put an honest, happy smile on my face for most of the rest of the day. They are the ones who are honest and direct, the ones who say "cancer" instead of looking at their toes and mumbling, "the C word," the ones who don't treat me like an invalid or a freak, the ones who know they won't catch cancer by standing too close to me.

I think it was Scientific American Mind that ran an article recently that explained this peculiar behaviour in otherwise sane and intelligent people, tracing it back to early evolution when there was safety and strength in numbers. Be it fighting off predators or an invading tribe, a sickly individual is of little use so they weren't desirable as fellow citizens. We're getting better though, it's 2010 and today we rarely send our Stage 4 cancer patients off on ice floes.

Now I'd like to share with you a couple of Facebook posts I made while holed up at home in Kleindale, avoiding the stupider cancer chatter. Each was given the title...

~~~ A D V I C E F O R T H E D A Y ~~~

August 20

When the raisins in your cereal taste really bitter, consider that the milk you poured on it might have been sour. Do not ignore the bad taste while eating 3/4 of the bowlful before pouring milk in your coffee to see it curdle.

September 2

When softening butter in the microwave, do not set it for two minutes on High, and don't put a quarter pound in one of those tiny little souvenir plates. Coming soon... how to clean a quarter-pound of liquid butter out of your microwave!

September 8

After removing the screen from the kitchen window, do not leave said window open wide enough for a Stellar's jay to fly through after you have, like an idiot, placed peanuts on the windowsill. Note to self: buy more Fantastik Orange Action just in case you have another morning of cleaning up birdshit in the kitchen.

to a friend i haven't met yet

2010-07-31T02:05:00.000-07:00

A couple of days ago, a friend told me that her sister was just diagnosed with lung cancer, and that she's going in for a lobectomy the end of August, the same surgery I had about a month ago.

I don't know this woman. I know nothing about her except that we both have the same type of cancer, us and tens of thousands of other people. Still, I feel a connection with her because of our shared... um, let's call it a challenge because anything else sounds fatalistic and self-pitying.

Maybe it's like the connection made by men (okay, women too) who go to war. I know a few Viet Nam vets and they are brothers because of shared experience. They speak the same language. They know things about each other because of where they have been and what they have been through. Their experience changed them, and no one else gets it, unless they've been in Nam.

Cancer is like that, like finding yourself in the middle of a war that you never signed up to fight (hell, you never even got a chance to dodge the draft). There is this bond among cancer survivors. We know stuff that no one else knows unless they've faced cancer. So, this woman is where I was six months ago, newly diagnosed and facing surgery, and in my head I'm talking to her like she's someone I've known all my life. Carrie isn't her name, but let's say it is.

Carrie, you lucked out getting Dr. Ken Evans as a surgeon. He's a wizard with the scalpel and you'll be so pleased when you discover that your incision doesn't have any staples, or even stitches, just a taped-on dressing that may be abandoned after just a couple of days because it heals so quickly. It heals smoothly, without the bumps and puckers that are typical of stitched and stapled incisions.

Carrie, I'd like to tell you about mistakes I made so you can avoid them. You'll probably make a few of your own, but at least I can give you a heads-up on a few that you don't need to subject yourself to:

1. Do not log on to YouTube and watch the videos of lobectomies. They are graphic, gory and absolutely terrifying. They are meant for medical students, not sensitive human beings like you and I. No one needs to see, in full colour, what the inside of their lung looks like.

2. Do not try to be a hero by scrimping on your pain medication. Narcotics are your friend, and there is no danger of addiction when you're taking them for legitimate pain. Further, by not taking them, you risk slowing down your recovery.

3. On the subject of narcotics, be sure to ask for medication to counteract the constipation they will cause. Don't wait until it's a problem because, if you do, then... well, it's a problem. Drink lots of water and don't eat the cheddar cheese you'll find on your lunch tray every day.

4. You'll wake up to find a little clip on your finger (it measures the oxygen saturation in your blood). Do not remove it. If you do, your computer monitor will immediately begin sounding all kinds of alarms and this will just annoy your neighbour patients and the nurse who must rush over to see if you've died.

5. Your visitors may try to make you feel better by telling you a funny story or a joke. They mean well, of course, but this is a mean thing to do to you. Laughing hurts. Tell them to talk only about serious topics, maybe the price of gas or forest fires in the Interior.

6. Your visitors may get bored so, to help them pass the time in a more interesting way, send them out to get coffee for you at Starbucks and one of those delicious sandwiches at the little shop across the street. There's also a Subway at the corner if you're really hungry. They'll appreciate the Vancouver scenery and you'll get a break from hospital food.

7. Be sure to bring your own pyjamas and slippers. You just can't say enough about how bad hospital gowns are for one's morale.

Carrie, that's the really important stuff you need to know to get through this as comfortably as possible. They say a lobectomy is a major surgery, right up there with open-heart, but in fact you'll not find it that hard. Why? Because you'll be so stoned you won't know and won't care what you've been through.

You'll go home with prescriptions for pain medication, and at least for the first week, you'll want to take them regularly. This is fine, but you'll forget what you came into the kitchen for, you'll forget the first chapter of the book you're reading by the time you get to the second chapter, and you'll forget just about everything that anyone's said to you. Make sure you explain to your friends and family that you're not really suddenly stupid, you're just under the influence of some high-powered drugs.

After you stop taking the pain medication, you'll forget that you're recovering from surgery, and you'll absent-mindedly reach for something you dropped on the floor or stretch to get something from a top shelf in a cupboard... and then you'll scream in pain. After a few times of doing this to yourself, you'll pay more attention.

Plan to sleep either in a recliner chair or propped up with lots of pillows in bed. At first, lying flat in bed is not only painful but it's damned near impossible to get back up. Under no circumstances should you get in the bath tub; you risk being stuck there for a couple of weeks at least.

You will likely develop an annoying little cough. They never mentioned this in the hospital, but I've since learned that it's quite normal and it does go away. This little cough isn't painful, but sneezing certainly is, much like it would be if you had broken ribs. It's an excellent excuse to avoid all dusting and vacuuming.

For me, the hardest part is the slowness of the recovery. Three weeks would have been a piece of cake, but supposedly it will be three months until I'm back to some semblance of normal. The best part is looking back and realizing that, every day, I'm getting better. And you will too.

the lobectomy papers: part 4

2010-07-10T12:47:00.000-07:00

Ghost in the Machine

In spite of the high technology and professional staff, things do not always run smoothly in Stepdown.

Let's look at the computer monitoring system for patients. Each patient's computer can sound an alarm to warn nursing staff of any abnormal readings.

This is an excellent tool to provide a timely heads-up if a patient happens to be having a cardiac event or if they've, um, died, causing the signals to stop altogether.

An excellent tool, providing it functions as it should. But, we all know computers are prone to little glitches, ghosts in the machine so to speak. The one connected to the patient on my immediate left is not an exception.

The patient's heart rate, pulse or whatever reading jumps from 117 to 124, then dives back to 117, setting off the alarm because of the rapid change.

Nurses rush over, determine that the patient (who somehow sleeps through the whole performance) is not having a cardiac event, and reset the machine to shut off the incessant, high-pitched beep-beep-beeping alarm.

Within minutes, the alarm sounds again. Same drill. This goes on all day, all night, the next day and night and the day and night after that. Various nurses coming and going on their particular shift try to fix the problem. They all fail.

The obvious solution is to turn the damned thing off altogether, but that would defeat its purpose and certainly cause some embarrassment if the patient died and nobody noticed his heart stopped beating because the alarm didn't sound.

With the malfunctioning computer just inches from the head of my bed, I'm all for turning it off. By the time I reach 48 hours without more than a few minutes' sleep at a time, I fantasize about strangling the patient in the bed beside me.

I know it's not his fault. I know his computer monitor is to blame. Yet I so badly crave uninterrupted sleep that I cannot think of a good reason to spare this person's life, especially because he sleeps like a baby through the whole thing. Lucky for him, I couldn't get out of bed to save my life.

Nurses work a 12-hour shift for three days, then get four days off, so today there's a new face in Stepdown, Dan, a male nurse who responds, like all the others have, when the alarm sounds next to me for the millionth time.

"Good luck," I grumble, with no attempt to conceal my sarcasm.

"It's fixed," he replies after playing around for a bit in the menu level of the system.

"Yeah, right," I say.

I wait for the alarm to sound. It should happen in a few minutes. All is silent. Can it be? Could this guy have figured out so effortlessly what no one else could manage? I think, Nurse Dan is da man! I think, maybe there is a God. I begin to relax. I feel myself drifting, falling into the arms of Morpheus.

BEEP-BEEP-BEEP-BEEP-BEEP ...

Jesus H. tap-dancing Christ, here we go again. I'm so thoroughly exhausted and angry that I am near tears.

... BEEP-BEEP-BEEP-BEEP-BEEP ...

I'm going to ask to be moved. No, demand that I be moved, away from this instrument of torture. I'll ask to see a supervisor. I'll threaten to go to the media. I'll call my Member of Parliament, my Member of the Legislative Assembly, I'll write to the Hospital Authority, I'll e-mail the freakin' Premier of the Province, I'll throw my food on the floor.

... BEEP-BEEP-BEEP-BEEP-BEEP ...

And here comes Dan, the smartass who thought he fixed the problem. Oh yeah, he's gonna get a piece of my mind.

"Here we are," he says cheerfully, picking up a little clippy-thingy he sees beside me, on my bed. It's an infrared device to monitor my oxygen saturation, it has a cord leading into my computer, and it's supposed to be clipped to my finger.

Dan replaces it on my finger, resets the computer and all is silent.

"Um, I guess it musta fell off," I say in a small voice. A very small voice. Inwardly, I cringe.

If you don't yet know what trance music is, or even if you do, listen to Ghost in the Machine by Xerox & Illumination, Moshe Keinan and Amir Dvir from Israel. It's the real deal.

the lobectomy papers: part 3

2010-07-09T17:46:00.000-07:00

Highs and Lows

This recovery is ever so much more enjoyable than the one in February because my pain is considerably less. Between the epidural-delivered narcotics and Dilaudid pills, I live in a relatively happy, if not befuddled, place. But sadly, as they say, all good things must come to an end.

My blood pressure drops to 78. I explain that I normally have low blood pressure but that doesn't impress anyone. My beloved epidural is blamed for the crash, and the best way to get my blood pressure back to a living, breathing human level is to turn off the narcotic feed for a half hour, then cautiously creep it back up to 3. It was 7 when I was pain-free; talk about separation anxiety.

It doesn't take long for the epidural magic to wear off, and I am not at all appreciating this latest torment, a charlie-horse-like pain, a horrible, seizure-like cramp, that drives like a freight train right through my chest, freezing me in position with a hand pressed to my upper rib cage to hold together what's left of my lungs.

It hits just about every time I try to move, and a few times when I don't. My beloved Dilaudids, 4 mg every three hours, don't even come close to dealing with it. There are groans, there are screams, there are gasps, there are curses. I frighten the visitors.

The most amazing part of this experience is the admission by a doctor that a lobectomy is, "... an extremely painful type of surgery." Wow. I've never heard a doctor say "pain" before. They might mention slight pressure, some discomfort, a bit of irritation and other innocuous sensations, but never the P word. Fine. It's painful. I get that, now please do something about it!

But no, we must run blood tests and a cardiogram because the pain I try to describe sounds to someone like a cardiac event, otherwise known as a heart attack. A cardiac event? That's like calling excrutiating pain "slight discomfort." Oh, wait, they already do that. Perhaps the kinder, gentler term for heart attack was crafted to calm the patient's family, or to reassure his employer that he really can handle that promotion. But, "serious as a cardiac event" just doesn't have the same impact.

I've never had a heart attack, but I know this isn't one. I know that heart attacks don't occur over and over, that they aren't caused by some insignificant movement. I know that, if I was indeed having heart attacks, I would have been stone cold dead hours ago. To add to my frustration, no one is familiar with the term charlie-horse. And no one is going to turn my epidural back on until they've thoroughly checked out my heart.

The Pain Doctor is consulted, and he finally comes up with a drug he thinks is worthy of a try: Gabapentim. It's an interesting drug, used to treat epilectic seizures, bipolar disorder and pain from migrane headaches to degenerative disc disease of the back. It's also interesting that, like love or the economy, no one really understands how it works. We start with 200 mg every three hours.

A perk of living in Stepdown is that everything is brought to you, even the X-ray Dept.

A pleasant technician quietly rolls in a darling, mini, wheeled x-ray machine, lays a lead blanket over the parts of me she's not interested in, steps back behind the machine, calls out, "X-ray!" like you'd call out "Four!" on the golf course, and pushes the button to take a picture.

I'm sure it costs more than my home, my truck, all my computer equipment and all my camera gear but, here it is, another service included in a $165-a-night room. Today I'm finding it difficult to be critical of the Canadian healthcare system.

My cardiogram and blood test results are returned with the verdict that I've not had a heart attack, I mean cardiac event. Gee... ya think?

With the dosage upped to 300 mg every three hours, the Gabapentim is working. The chest charlie-horses lessen until they're gone and my epidural is gradually turned back up to a conservative but civilized 3. Along with 2 mg of Dilaudid every four hours, I'm back to a tolerable level of pain.

My blood pressure never did reach normal range but then, as far as I know, it's never been normal. I doubt that it ever will be, and that's just fine by me. Life wouldn't be nearly as interesting if everything was Normal.

As much as I love Dilaudid, because it's a narcotic, it has certain disadvantages. Narcotics cause constipation. Serious constipation and, unless you've suffered serious constipation, you have no idea of how painful it can be. Now I'm certain why junkies are so skinny. I used to think it was their unhealthy lifestyle, but now I'm convinced it's simply because they don't eat. They're scared to. Scared shitless, you might say, and that's no laughing matter.

Someone in the kitchen has a sense of humour though. Every day, on my dinner tray, appears a small, factory-wrapped package of Black Diamond cheddar cheese. Black Diamond produces a lovely cheddar (I sometimes buy it at home) but, unfortunately, cheddar causes constipation.

It takes every iota of my willpower to stash the package in my drawer rather than rip it open to enjoy right now. That's how bad narcotic-induced constipation is.

"And the doctor said, 'Give him jug band music, it seems to make him feel just fine.'" John Sebastian (Lovin' Spoonful).

the lobectomy papers: part 2

2010-07-09T14:38:00.000-07:00

July 22 - Stepdown Unit

The deed is done, the lobe is gone, the sutures tied and the tubes in place. Seemingly only seconds after the general anasthetic knocks me out, I wake up in the Stepdown Unit. The internet said I'd wake up in the Intensive Care Unit (ICU), but there doesn't seem to be one here on the 12th floor Lung Dept. Turns out that a Stepdown Unit is like an ICU, but not quite so intensively caring. This is a good thing. If I don't need intensive care, then I can't be in intensively bad shape.

The Stepdown Unit is a ward of up to ten patients with their own stable of on-site nurses and a variety of frequently visiting doctors and other medical professionals dealing with their particular case.

Today I have six roomies in Stepdown, and they've all undergone some type of major lung surgery. In bed, they're wheeled in, groggy and barely conscious, after their surgery and, when they're improved enough to join the general population, they're wheeled back out the door, bed and all.

Each Stepdown Unit patient is connected to a computer via an assortment of equipment to monitor pulse, blood pressure, heart rate and oxygen saturation. The blood pressure cuff is a permanent fixture, strapped to one's bicep to inflate every hour on the hour for yet another reading. So much for the healing properties of uninterrupted sleep.

At 10:30 a.m. on my second day at the Stepdown Unit, I am bestowed a visit by the Pain Service Doctor. Really, a Pain Service Doctor. Is he going to evaluate my worthiness to be in Stepdown, my worthiness to be served more of that kickass pain medication? Or is he going to order up some new kind of pain for me?

Next, the Social Worker makes her rounds. I think it's interesting that she spends most of her time with patients who already have a solid support network of friends and family, and those of a "spiritual" bent. I suppose this makes it easier for her to apply the basic counselling technique of paraphrasing the patient's words in a positive slant, getting the patient to agree to the new way of looking at their situation.

Social Worker: "Do you have someone to help you with routine household tasks when you go home?"
Patient: "Um, maybe I could ask the neighbour to bring my garbage out to the curb on Thursdays, and my other neighbour might be able to go shopping for me sometimes."
Social Worker: "So I'm hearing you say that you have a reliable and competent support system in place when you go home?"
Patient, visibly perplexed: "Um, well... I guess, if you say so..."
Social Worker, happily checking off a box on her clipboard form: "Great! Now, would you like to talk to a sister from the church?"

Sometime during the flurry of visits from doctors, nurses and others in the helping professions, I find time to take inventory of my condition.

Last time I was here, I was horrified to discover a drainage tube coming from my lung and leading to some unknown recepticle below my field of vision at the edge of my bed. Well, it's baaa-aaack, and it's every bit as Stephen King as the first time. The transparent, half-inch diameter tube regularly gushes bright red blood and gore from somewhere inside my chest. This is something I do not want my visitors to see, and I appreciate that none of them mention it.

Even more disgusting than the drainage tube is the urine catheter tube. Yup, there goes my last shred of dignity, zoom, right out the window, and I didn't even know I had any left. This transparent tube leads to a collection bag that sits at the bottom of my five-footed "Christmas tree," which also holds a collection jar for the other drainage tube and, at top, whatever drugs happen to be dripping into my i.v. at any given time. The urine catheter tube is a frightening half inch in diameter but, on closer inspection and with great relief, I see that the size is greatly reduced before it's taped to my leg and headed into my bladder. Again, thanks to my visitors for not mentioning this.

The third tube is a happy tube. I have a vague idea that an epidural is a procedure specifically for pregnant women, maybe an injection of some kind. I'm in the ballpark but pretty far out in the field.

The epidural is a small catether tube leading into the layer of fatty tissue surrounding the spinal cord. It feeds a regular, pre-measured dose of high-octane narcotic directly into the sweet spot of the nervous system, effectively numbing a large area. Ahhhhhhhh. If I handed out Nobel prizes, the inventor of the epidural would be at the top of my list.

I soon come to realize the containers of red stuff from my lung and yellow stuff from my bladder must be periodically emptied. And measured; the volume of liquid leaving my body apparently indicates something important.

The red stuff is disposed of discreetly, but not so the urine. It's poured into a clear, graduated container for measuring, then carried boldly down to the far end of the ward, to the bathroom. I don't know why the nurses hold this beer-glass sized contained up so high (picture the Statue of Liberty with her torch), but they look for all the world like staff in a busy pub, carrying a glass of Canadian draft to a thirsty patron.

There are certain benefits involved with the nasty catheter. For example, one can drink limitless amounts of fluid without the inconvienience of having to get up to stumble to the bathroom for a pee at 2 a.m. This afternoon I drank several large glasses of ice water, a cup of tea and a container of apple juice with lunch, and finally, later in the afternoon, a large cup of Starbucks coffee. One-point-seven litres of urine is produced while I have not the slightest sensation of a full bladder.

Yesterday, before sending me into Lala Land at the OR, Dr. Evans asked if there was anyone I'd like him to call to report on the surgery. I gave him Gerald's phone number in Port Coquitalm, and I had already instructed Gerald to, at their request, call Jane, Judy, Pat, Billy and Steve.

Today, Dr. Evans tells me that he repeatedly tried the number but was unable to get through. No answer, no answering machine. This is concerning. Gerald does not have an answering machine, but he certainly would have waited for word on my surgery before heading our anywhere. In fact, I remember that he was going to take the day off work to wait for a call.

A nurse was kind enough to try the number for me, again and again, on the Stepdown cell phone, but to no avail. By 3 p.m. I arranged to have a phone by my bed. By 4 p.m. I was wondering who I might call to find out if something has gone wrong. Gerald, if nothing else, is reliable. If he says he'll wait for a call, he'll damn well wait for the call. Understandably, I'm worried.

Then, Gerald strolls into the ward and up to my bed with a cheerful hello, to which I replied, "Where the hell were you!'

"I just got off work."
"Where were you yesterday, when Dr. Evans was calling to let you know how my surgery went?"
In a patient voice, not quite with his eyes rolled up to the ceiling, but close, Gerald says, "You called me yesterday. You told me the surgery went fine. Remember?"

Times like this, I want someplace to hide, someplace dark, quiet and completely out of sight, until everyone forgets my latest faux pas. At least there was a reason for this one: the epidural.

the lobectomy papers: part 1

2010-07-09T08:40:00.000-07:00

June 21: Vancouver General Hospital

I'm running late, completing last-minute preparations for a couple of weeks away from home and not expecting to be able to do much when I return home... automatic fish feeder installed in the tank (thanks, Shelley), plants watered, laundry done, recliner chair installed in the bedroom, bills paid (well, mostly), toiletries packed, pyjamas packed, notebook (oldschool type; not the laptop) packed, books and magazines packed.

Twenty minutes behind schedule, we head out the door with Gerald predicting we'll miss the ferry. Not critical, but it would result in a two-hour sit in the Langdale parking lot. Fortune shines upon me though, because the ferry is even later than we are, so we board with no wait. Damn. Although I remembered to wash the laundry, I forgot to throw it in the dryer.

At the VHG Admissions desk, I'm processed and dispatched to my room on the 12th floor of the Jimmy Pattison Pavillion, where all the serious lung cases are kept. I'm an old hand at this, having been here just in February, for wedge resection surgery.

I'm the kid who already has a season of summer camp under her belt, the old con returning for another bit in jail; cocky and comfortable, already looking to claim the best bunk and the best view, looking for a game of cards to pass the time.

My room, shared with Ingrid, is spacious for hospital accommodations by any standards, with a spectacular view of downtown Vancouver with its picturesque, bustling harbour and a backdrop of the moody North Shore mountains. Overhead cranes zig and zag above construction sites, lines of vehicles stop and start at traffic lights, tiny ferries travel back and forth through the waterways.

It looks like a child's playset of miniature cars, busses, buildings, boats and Mechano toy cranes. A tiny helicopter appears over the North Shore, heading south, getting bigger as it gets closer. Now it's a full-sized, for-real chopper thwap-thwap-thwaps its way almost right up to my window. It hovers a moment, then descends to make a perfect landing on a white cross-marked landing pad below. Cool.

My room is in a clean and modern tower in the heart of what's argueably the most beautiful city in the world. It has extraordinary room service and in-house amenitites. How many hotels do you know of that have an operating theatre? The food isn't great, but it's delivered three times a day, while juice, water and snacks are available on demand.

The view? Well, I've told you about the view. This semi-private room is billed, regardless if the patient or their health insurance carrier is paying, at $165 a night. A private room is $195. The Sutton Place is one of the nicest Vancouver Hotels I've stayed in, but I doubt you can get a room under $200 a night. Granted, they have parking, but you have to pay for your own meals. And surgery.

If I'm still here July 1, I'll have a million-dollar view of the city's Canada Day fireworks display over Burrard Inlet.

Vancouver is best known for its Celebration of Light international fireworks show, changed it from Symphony of Fire, presumably to spin attention from the polluting aspect of the days-long pyrotechnical orgy, not to mention the fire hazard in the hottest, driest time of year.

But, we love our fireworks. Even a smug, vegan, tree-hugging and hybrid-driving citizen of the planet and champion of Mother Earth looks the other way at the expense, the noise and chemical fallout of their beloved fireworks.

Admiring the view is interrupted by a visit from my first cousins, Russell and Brian Doyle, and Brian's wife, Pam. It's okay, paramedics have already transported the patient from the helicopter into the bowels of Vancouver General and the chopper has thwap-thwapped up, up and away, over the harbour and North Shore mountains, looking like it's headed to the Sunshine Coast, maybe even my home of Pender Harbour. I fantasize about being onboard, not facing surgery in the morning.

I'd never met Russell before; in fact, I didn't even know he existed. Such is the nature of my family. We don't waste a lot of time keeping in touch, so visits like this are really appreciated. Rusell contacted me a few weeks ago because an uncle died without a wife, family or will, and so all the family members had to be notified for Kimble's estate to be distributed amongst the children of his siblings, according to Canadian estate law. Kimble and his siblings numbered 12, not unusual for a Roman Catholic family in northern New Brunswick not long after the turn of the 20th century, so I doubt I'll get enough to pay off my Master Card.

Russell is in Vancouver on a brief layover, heading to the Land of the Midnight Sun to take part in the Whitehorse 24 Hours of Light mountain bike festival. He also runs, so I know he's not a smoker. Genetics is interesting. Most of the Doyles drink alcohol in that good old Irish tradition, but not all of them in my generation are stupid enough to still be smoking. Russell and Brian are my cousins though, there's a peculiar sense of familiarity when I talk to them, like looking into my mother's dark brown eyes.

Russel leaves, off to catch his plane to the Yukon, Brian and Pam leave, and Gerald leaves. I'm left with my books and thoughts, trying not to recall those lobectomy images and descriptions I found on the internet.

stress mess

2010-06-18T14:21:00.000-07:00

"Stress is nothing more than a socially acceptable form of mental illness."

Richard Carlson

I had an appointment to see Dr. Ingrey today, to get results of my CT Scan last Friday, but I cancelled. Today is not a good day. I've got the killer headache and fatigue that's been with me for over a month now, I'm queasy, lightheaded, dizzy and my ears are ringing. Perhaps not wise to head out to hurtle down the highway at 80 kph, wondering if I'm going to pass out before reaching my destination and maybe driving a bit faster so I don't before I do.

Dr. Ingrey phoned to say that no brain tumours showed up on the scan (dizzy or not, I did a little happy dance in my head over this news). He explained that the headache is likely caused by stress from having cancer and anticipation of my next surgery. My headache is all in my head.

This is good news, but puzzling. I've had my share of stressful jobs, relationships and situations, but I thrive on stress and always have. I embrace it and glory in it, love the challenge and excitement of it. In fact, I can remember times when I probably went looking for it.

As publisher and editor of the Harbour Spiel for 15 years, I was regularly faced with deadlines and responsibility for material that might get me sued, or at least result in half the people in town pissed at me. I get a thrill out of taking risks. I've never had headaches, unless self-inflicted by lack of sleep along with excessive sauvignon blanc, cigarettes and joints the night before.

There is no reason for headaches today. Several years ago I sold the Spiel and toned down my consumption of unhealthy substances to the occasional glass of fine wine with dinner. I'm not stressed by work because I have almost none, just making minor updates to information and uploading the occasional banner ad for Pender Harbour Online.

I've had a comfortable, stable relationship with the same man for nearly 20 years, and he will stay with me after surgery until I tell him to go back to his apartment in Port Coquitlam, back to work at the shipyard. No stress there.

Fraser, my old cat, disappeared last month and I think he became a meal for a litter of coyote cubs, as has been the fate of so many cats in the area. I worried how he would make out while I was in hospital for a couple of weeks with only a friend stopping by once a day to fill his dishes on the kitchen floor. I miss him terribly, but now I don't worry about him. Even less stress in my life.

Maybe I'm stressed out because I don't have any stress? Oh, wait. The cancer. Almost forgot about that. And the upper left lung lobectomy on Tuesday morning. Hmmmm. Being sick and tired of being sick and tired for well over a year now. Still not having a clear diagnosis of the cancer in my bone marrow, spleen and lymph nodes. Still not knowing the stage of my lung cancer. Well, maybe.

Okay, I'm stressed out.

I'm stressed out because I have cancer and my expectations of the Cancer Agency have crashed. I don't know if this surgery on Tuesday is the right decision, and I never will. So, let's look at it rationally. What's the worst thing that could happen? I'll die. And why is that a bad thing?

It will be sad for the people who care for me, but it won't be a bad thing for me. It will likely be a good thing, because that will be the end of any "discomfort" as the doctors like to say, and diminished quality of life.

Oh, and the stress will certainly be relieved. I'll be dead, so I won't need anything, want anything, miss anything, regret anything or ever again get annoyed at a telephone solicitor. Happily I'm an atheist, so I won't be faced with eternity burning in hell for my sins. It's all good.

But, I'm still stressed. I suppose I'm a tad anxious about the "discomfort" of having my ribs pulled apart to rip out most of the rest of my lung, that ghastly drainage tube and a lifetime of lessened breathing capacity and physical activity. But, I'm psyched to have it done.

After all, I thrive on stress.

giving thanks

2010-06-11T19:46:00.000-07:00

St. Mary's Hospital has a CAT Scanner. Big deal, you say. It is, I say back. The hospital serves a population of only 2,500 people spread across the Sunshine Coast, and the scanner was bought largely by donations from local residents and businesses. We done good.

Back in the day of the Back the CAT campaign, it was impossible not to throw money at it. It seemed like a portion of every dollar you spent on the Sunshine Coast went to the campaign.

Plus there were profits from fundraising raffles, concerts, garage sales and pancake breakfasts, and then there were those collection tins. They were everywhere, and the glares of the nearby public demanded that you drop in a few loonies and twonies. (If you're reading from outside Canada, that's what we call our money. Really. No, we don't call our banks "loonie bins.")

I wondered if a CAT Scanner was the best use for all that money raised, if it might not be better spent upgrading the operating room, or making the parking lot spaces a bit wider for those of us who don't drive a Smart car.

In those days, people were sent to Vancouver for their CAT Scans. This involved several hours' driving and a ferry trip, blowing the whole day for a ten-minute procedure. I've had at least half a dozen CAT Scans at St. Mary's Hospital, and I'm thankful that I didn't have to make that trip to Vancouver for each of them. I'm also thankful that I never once needed a CAT Scan before the machine was installed at St. Mary's.

One of these scans turned up cancer, even though Dr. Cairns thought the "wee spot" was scar tissue from the bronchitis, pneumonia or t.b. that I couldn't recall having. I'm thankful that I moved on to Dr. Ingrey, who refused to dismiss the wee spot, and I'm thankful for that CAT Scan at St. Mary's Hospital.

It's a cool machine that wouldn't look out of place aboard the starship Enterprise. The "Computerized Axial Tomography" procedure is typically fast and painless. This morning I enjoyed breakfast and coffee, verboten in so many of the tests I've been subjected to, and there was no inconvenient prep such as three days of fasting or a high-octane laxitive the day before.

All I had to do was drink water, more water, and more water after that. St. Mary's Hospital is half an hour's drive away, on a road that needs an election to get rid of its bumps, wows and potholes. Once there, I sprinted to the automatic doors of the hospital, squirmed while they opened enough for me to squeeze through, then bolted down the hall and around the corner, nearly coliding with a patient being pushed in a wheelchair. I was thankful, very thankful, that the single washroom in that wing of the hospital was not occupied.

The water is required to flush one's kidneys of the somewhat toxic contrast medium used for the scan, and it's best to drink too much than not enough. So, $3.50 for two more bottles of water, sign in, sit and wait. Must keep drinking water. A good half-hour later, I'm summoned to the room housing the CAT Scanner and directed to lie down on a sheet-covered slab. My knees are raised on a triangular piece of foam and my head is strapped down.

I don't know why these rooms are kept so freakin' cold; it feels like about 60 degrees Fahrenheit (15-16 Celsius), but the technician kindly drapes a soft, pre-warmed blanket over me, on top of the lead blanket covering the areas they don't want to see. I feel like a dish of lasagna, prepared in layers.

Now I'm lined into an i.v. drip of salt water, and I'm so wishing I hadn't drank all that water. I'm told not to move an inch, and the technician leaves the room, unaware of the heroic effort I'm making not to jump up and dash to the washroom.

The CAT Scanner fires up, sounding like an SR-71 Blackbird's jet engine warming up for takeoff, only not that loud. With a series of clicks, the slab creeps horizonatlly into the maw of the machine, carrying me into a white tunnel. I realize that life must be hell for claustrophobics. There is a pause, then I'm slid back out of the tunnel. Part One is complete.

Part Two involves waiting, unmoving, for several hours. Okay, it's only five minutes, but I'm dying to go to the toilet and ever second drags on forever.

Finally, the technician ditches the salt water i.v. solution and replaces it with contrast medium, which is really radioactive dye but "contrast medium" sounds so much healthier for something thats going straight into your vein. I've had so many CAT Scans, PET Scans, MRIs and X-rays in the past year that I do not understand why I don't glow in the dark.

As the technician begins the dye feed, she says in a perky voice, "You'll feel like you peed yourself but you haven't!" It's been over half a century since I've peed myself and I can't remember what it feels like. It feels very warm in the area of my crotch. I think with horror, maybe I really have peed myself, all that water and all that waiting has my poor bladder screaming for relief.

Now I'm surprised by a sharp, strong, metallic taste in the back of my throat, which wasn't mentioned. Gah! Apparently only some people get this. Lucky me. The bad taste and the crotch warmth subside quickly and I'm thankful to learn that I've not peed myself after all.

Now the turbines fire up again, the clicking starts, and I'm moving into the snug white tunnel for a second time. I wonder if a Freudian psychologist with a sense of humour might call the CAT Scan a "Pussy Scan," given their fondness for back-to-the-womb symbolism. I wonder how they perform a CAT Scan on a really big person. They certainly wouldn't fit into the tunnel. Maybe they have super-size CAT Scanners. Then, the slab kicks into reverse and I'm back in the room, unhooked from the i.v., unwrapped and sent on my way.

I am most thankful to finally get out of that teeth-chatteringly cold room and back to the bathroom, not a second too soon!

latex, leather and chains

2010-06-09T19:07:00.000-07:00

Today I had blood taken, nothing unusual for a cancer patient.

I've had it done a hundred times before, at least. Sometimes it's a disaster, sometimes I don't even notice. Today it was way up there on the scale of Simple Procedure Done Well. A little jab, hardly pain, and that was it. The way it should be.

Why, I've wondered, do some medical professionals butcher such a simple procedure? I've had them repeatedly try to hit the vein, and miss (I have good veins). I've been left with bruises up and down my arm like a downtown eastside junkie. I've had shockingly painful experiences when the needle was inserted. It's not rocket science, why aren't all of them competent?

At one memorable St. Mary's Hospital fiasco where a nervous nurse repeatedly and painfully injected a large needle under the skin on the back of my hand, but couldn't manage to hit the vein, I suggested she go out on the street and bring back a junkie to do the job right.

Okay, I know that wasn't very nice, but I wasn't feeling well and that sometimes deteriorates my usually patient and kind disposition. She left, not to find a junkie, but to send back another nurse who slid the needle into the vein, first time, no pain.

Maybe nurses who can do the deed well should have a little badge on their uniform pocket. Like a Boy Scout badge, maybe with a brightly embroidered drop of blood or a syringe. I think they deserve recognition for their skill. Plus, it would warn unsuspecting patients, when they encountered a badgeless blood-taker or injection-giver, to grit their teeth because it's gonna not be nice.

One nurse told me that she was never trained to give an injection. What the fuck? How can you not be trained in this frequently performed procedure? Anyway, that was her excuse. She blamed the current Liberal government for their "heartless" cutbacks in medical funding.

I wished that the union would back off on their Poor Underpaid Nurses rhetoric. Nurses have no choice about belonging to the union, and paying the substantial union dues, so it's not like they're in danger of losing members.

Sorry, I digress. Back to the blood sample.

Today, I noticed that the nurse did not wear the ubiquitous latex gloves, and I asked her why. She explained that she was trained decades ago, when frequent handwashing was as automatic as breathing, and that she relied on a sense of feel that was compromised by the latex. Certainly, I barely felt the needle going in and she nailed the vein, so maybe that was a factor.

Nurses, like all front-line medical workers, are at a higher risk than an accountant for needle-stick injuries, which could result in infection with AIDS or hepatitis. We talked about how ridiculous it was to wear latex gloves as a safety precaution. Think about it: is a thin layer of latex going to prevent a needle-stick injury? Not.

I religiously wear latex gloves when making wine because even one rogue yeast particle can ruin an entire batch. Making wine, your hands are moving over a large, open primary fermenter, and a tiny particle that might have been hiding under a fingernail might find its way into the mix. It's the only time I wear them, and I don't like it. They decrease my sensory input, and make it difficult to do manual tasks such as ripping open a tiny yeast package. I certainly wouldn't want to put a needle into a vein while wearing them.

But are the gloves really necessary? Do they do any good at all?

The latex-glove craze started in the 1980s when AIDS was new and no one was certain how it was transmitted. Hepatitis C was yet to be identified as a disease transmitted exclusively by blood-to-blood contact. Someone came up with the latex gloves idea and I wonder if it was to protect medical professionals or to give a (false) sense of security to patients?

I remember a nurse coming into my hospital room with that wheeled cart holding numerous vials of blood samples, and she was heading for my arm to get my sample. She was wearing latex gloves.

She took my blood and moved to the next bed to take that patient's blood. Still wearing the same latex gloves that she wore when she came into the room.

So, it seems the gloves are to protect the medical professional rather than the patient. But, think about it. We already established that the flimsy gloves aren't going to stop a needle-stick injury, so that leaves open wounds on the medical professional's hands. Wouldn't they put a freakin' Band-Aid on it? Problem solved.

But, everyone working in a clinic or hospital or ambulance or first-aid shack, touching a patient, wears the latex gloves. Environmental awareness aside (how long does it take for a pair of latex gloves to decompose in a landfill?), just what is the point of wearing these gloves?

They decrease one's manual dexterity, don't offer much protection, and very well may instill a false sense of security that results in sloppy hygiene. I would much rather have the nurse or other medical professional be obsessive about handwashing with antibacterial soap.

Sorry, I don't really want to talk about leather and chains. Maybe another day.
.

rebooked and unquit

2010-05-27T16:18:00.000-07:00

My original surgery date was May 3, but I cancelled that in a state of uncertainy and occasional bouts of panic. We're talking about cutting out most of my left lung, so it's not a casual decision, not like whether to have salad or fries with that sandwich.

I still don't know whether it's the right decision but, on May 12, I agreed to sign up again, and this time I'm determined to go through with it. After all, if I died becaue I didn't have it, I'd feel pretty silly, now wouldn't I? Dr. Ingrey sent the request to my surgeon, Dr. Evans, and the first word on the page was URGENT!

Ever since, the sound of the telephone leaves me cold. Is it my summons to a Vancouver General Hospital operating room? Is it the beginning of a lot of pain and downright inconvenience for the rest of the summer, at least? Total strangers, even telemarketers must wonder why I seem so happy to hear from them. My phone rings about a dozen times a day, so it's lots of little rollercoaster rides.

This morning I decided it best to follow up on the referral. Just in case. You never know, sometimes these things get misplaced. Plus, there was the fury of Dr. Evans' secretary when I cancelled last month. I didn't really expect that she was mad at me enough to lose the referral, thinking it best that I die as quickly as possible but, still, every day without a phone call made me wonder.

"Dr. Evans' office."
"Hi, this is Myrtle Winchester. I'd like to follow up on a surgery request from Dr. Ingrey in Pender Harbour a couple of weeks ago."
"You want your surgery date." No, this was not a question.
"Um, yes!"
"June twenty-second. Admit on the twenty-first between one-thirty and three-thirty."

After a pregnant pause long enough to make it clear that she had nothing more to say to me, I asked, as politely as I could manage, "When was the surgery scheduled?"
"A few weeks ago."
"Why wasn't I notified?"
"Because I was on holidays."
"When did you get back?"

This wasn't a pregnant pause but an angry one. Then...
"I got back Tuesday morning."
"Okay..."
"Good. Bye." Click.

Right. Not making any new friends today, are we Myrtle? Oh well, June 21, so I have a bit of breathing room. No pun intended, but it works. June 21, the first day of summer, the Summer Solstice. I'm sure this will be one to remember.

Did I mention that I unquit smoking?

The day I un-cancelled the surgery, I decided that a few weeks of cigarettes wouldn't make a big difference in my lifespan, and a few weeks of smoking again would certainly improve the quality. I like smoking and, although I quit nearly four months ago, it wasn't going well. Not going well at all.

There were times when I almost could have chewed off my arm for a cigarette. You know how they say it's so much easier after three days, three weeks, three months? They lie. The gum took the edge off but I couldn't quit the gum. I guess methadone addicts feel like this when they trade heroin for a more socially acceptable but equally addictive drug.

The first drag of that first cigarette tasted... well, strange, but not unpleasantly so. You know how they say it will taste so bad you'll feel like puking? They lie. By the end of that first smoke, I was enjoying the flavour as much as a fat slice of Billy's strawberry cheesecake. Home made with real whipped cream and fresh strawberries.

You know how they say the first one puts you right back to smoking as much or more than you ever did? They lie. Well, maybe not an outright lie, but an exaggeration for sure. The first couple of weeks I was smoking no more than half a dozen a day, and not really wanting more. A cigarette killed the craving like the gum never did, so after a smoke I forgot about smoking for hours. The gum didn't work quite like that.

And, yes, you're right. I'm rationalizing. I'm an addict and a spineless one at that. I'm also the reason lung cancer doesn't fare so well in the cancer family of national fundraising events, even though it's the cancer which kills more people than any other. Fundraising is all about marketing, so it's not hard to figure out why lung cancer isn't so popular a cause.

First and foremost, it's the cancer associated with smokers. Dirty, nasty, evil smokers. They deserve to get sick and die, they are 100% responsible for their cancer and they deserve what they get. Of course this is wrong, many non-smokers die of lung cancer, but who cares when you're deciding which disease to give your money to.

Next, lung cancer rarely occurs in children. Children are the best prop in any fundraising campaign. Where do you think the term "poster child" came from? Almost everyone loves babies and puppies, so huge dollars go to children's cancer research. And the SPCA.

Finally, there's breast cancer, which is the most common type of cancer but far from the deadliest. But, more people support breast cancer research than any other. Hmmm. Could it be the breast thing? Breasts are motherhood, breasts are sexy, breasts provide nourishment and fill out clothing nicely. And men love breasts. Breasts can make an otherwise rational man throw away his money, and we've all seen it happen. I'm not saying it isn't a good cause, but we can see why it's so successful.

But, lung cancer, well it's just not got a good hook. I also feel badly for the rectal cancer fundraising teams, because they've got their marketing work cut out for them too.

Some years ago, when I ran a store in downtown Madeira Park, I was accosted by fundraisers on an almost daily basis. The Cancer Society, Stroke Foundation, SPCA, Volunteer Firemen, Girl Guides, Music Society, Coast Guard Auxiliary, Seniors Housing Association, Legion, Lions, Rotary, community clubs, various environmental groups, school classes wanting to go on field trips and on and on and on. I simply couldn't give money to everyone, so I had to identify criteria for who got my donations.

Say you have $100 to give away. Who deserves it most? Where will it do the most good? Is it better to give 100 groups a dollar each or give it all to one? Is it more important to support people trying to cure a fatal disease or those providing shelter for unwanted pets? Underprivelidged children going to summer camp or volunteer firefighters saving lives? A new piano for free music lessons or affordable housing for seniors on a fixed income?

Well, of course they're all deserving and all the causes are good ones. So you can't decide, you can't give more to one and less to another and you can't afford to support them all. Ultimately it gets down to the person in your face with their hand out for a handout. If it's someone you know, it's a lot harder to refuse. And that's how irresponsible we are in deciding whether to help find a cure for a fatal disease or help buy a gleaming new baby grand.

undead like me

2010-05-15T22:55:00.000-07:00

"Rumours of my death have been greatly exaggerated."

Mark Twain.

I used to publish the local paper. In fact, I started the Harbour Spiel and ran it for 15 years before selling it to my friend Brian Lee in 2006.

The Spiel was, and remains, pretty much a one-man show, which is about the only way a small-town publication can survive.

The publisher is also the editor, reporter, photographer, ad designer, layout artist, bookkeeper, salesperson, janitor and bill collector. You can see how the line blurs between the person and the paper.

Brian and I agree that the Spiel is a big part of Pender Harbour, and for a long while now he's wanted to do a story on its early history. Last month we got together in my living room for The Interview, conducted with the tape recorder rolling while we ate pizza and drank wine. It was fun, as a visit with Brian always is.

He titled the story, "The Myrtle Years," and made it the main feature of this month's issue. I have to admit I'm pleased with the story. Like the photographer who never has their picture taken, I've never had anything written about me before. Well, there was that item in the Police Report a few years ago, but we don't need to bring that up.

Brian concluded the article with a mercifully unsentimental mention that I have cancer an am documenting the experience in (this) blog.

Today I met a woman I'd not seen in some months, and the first thing she said was how great I looked. I thanked her.
"But you look so good, you look so healthy!"
I thanked her again.
"I thought you were dead," she said, somewhat accusingly.

That would most surely explain why I looked healthy to her. Few corpses have any colour in their face (okay, I was wearing makeup), never mind drinking coffee and bopping around Madeira Park in the sunshine. We all know The Vampire Diaries is fiction.

"I read the article about you in the Harbour Spiel," she said.
I expected her to say that's how she knew I had cancer, and maybe someone had mistakenly thought they heard, and repeated, that I'd died. You know how small-town gossip goes, like the Chinese whisper game.

But, no, she wasn't going to let herself off that easily.
"I thought it was your obituary. It said 'The Myrtle Years'."

Right. Well, the whole exchange really was quite comical, and I know how it is with writing. No matter how hard you try to second-guess how someone might misinterpret something, there will always be one reader who will entirely miss the point or come to a seriously incorrect conclusion. No big deal, and it's a funny story to tell at the pub.

Which I did, later this evening, sitting with a few people I know. Everyone laughed. Everyone except for one woman (I'd known her for years) who looked me straight in the eye, directly across the table, unsmiling.

"I read the title and put it down. I couldn't read the rest. I thought you were dead."
Her chilly tone made it clear that I had quite some nerve to be sitting there in front of her, breathing and talking, eating nachos and drinking wine and, well... being alive, after my obituary was published in the Harbour Spiel.

I won't be telling the funny story, any more, of how someone assumed the early history of the Harbour Spiel was my obituary. At least not to anyone who reads the Harbour Spiel.

If you're wondering about that article, you can download the .pdf file to read the May edition of the Harbour Spiel. "The Myrtle Years" starts on Page 14. And, no, I'm not dead.

should I stay or should I go

2010-05-09T19:36:00.000-07:00

Should I stay or should I go? The Clash, from their 1982 album, Combat Rock. I saw them at the Commodore Ballroom in Vancouver around that time, and they're still one of my favourite bands. Lately the song fits this current number in my dance with cancer. My lung, singing, "Should I stay or should I go?"

It's always tease, tease, tease

You're happy when I'm on my knees

One day is fine, next day is black

So if you want me off your back

Well come on and let me know

Should I stay or should I go?

With so many unknowns about an upper left lung lobectomy and my cancer in general, I went looking for answers beyond the offices of my oncologist and surgeon.

Opinions from a handful of unrelated medical professionals including two surgeons and an oncologist agreed that a lobectomy would be radical, given all the unanswered questions about my cancer. They leaned towards testing to confirm whether or not the other cancer is lymphoma and a PET Scan in a few months to see what was happening in my lung.

So, I cancelled my surgery, which was supposed to happen last Monday. The real reason, truth be told, is that I was terrified about being cut open and having most of my lung hacked out. Scared of the pain that I would suffer in the months-long recovery. Scared that I might be left dragging around an oxygen tank. Scared of not being able to look after myself, physically and financially. Scared of loss of dignity and loss of independence. But mostly, scared of the pain.

I've had enough, and I have always believed that quality is much more important than quantity, especially in life. There's no guarantee that surgery will cure me, and I think I'd feel pretty silly if I had the lobectomy and a few months down the road, the cancer's back. So, I cancelled the surgery.

Should I stay or should I go now?

If I go there will be trouble

An’ if I stay it will be double

So come on and let me know!

My surgeon, Dr. Evans, like most other surgeons, has a receptionist/secretary, office worker type of person, and she took the call. I met her once, at my first and only visit to Dr. Evans' Vancouver highrise office. She was sitting behind a big, dark oak desk in the office with "Dr. Evans, Thoracic Surgeon" on the door in a tastefully understated nameplate.

I had no reason to assume she wasn't Dr. Evans, especially when I said, "It's nice to meet you, Dr. Evans," and she didn't correct me. When she sent me to an examination room and a man entered, I assumed he was an assistant. I was surprised when he introduced himself as Dr. Evans. Husband and wife team? Nope. Anyway, that never did sit well with me, and I'm still not sure what her name is.

It was her I spoke with when I called to cancel my surgery.

"You want to cancel the surgery?" Given her how-dare-you tone of voice, she might have been asking if I was going to travel to Haiti to have the evil spirits voodooed out of me by a witch doctor.

"Yes, I want to cancel." Just in case she didn't hear me correctly the first time.

Her response shocked me. She laughed, but it wasn't a happy, warm sound. It was that forced and phony, deliberately exaggerated laugh you hear when someone is doing their best to convey that you are an idiot whose opinion is so patently stupid that you're not even worth talking to. The kind of disrespectful response that, had I been in the office rather than on the other end of the telephone, might have earned her an enthusiastic backhander.

Instead, in the calmest tone I could muster, I said, "I'm glad you can see the humour in the situation."

"Well!" she sputtered, "It's a lot of work to set these things up," and heaved out a theatrically loud sigh of exasperation before hanging up. Perhaps she's overworked, underpaid, unappreciated, or maybe she suffers from PMS From Hell and I got her on a bad day. I'll give her the benefit of the doubt. No one, especially in her field, could be that lacking in compassion without a good reason.

Anyway, I cancelled my surgery. I'd rather have a couple of good years than a decade of agony.

This indecision’s bugging me

If you don’t want me, set me free

Exactly who I’m supposed to be

Don’t you know which clothes even fit me?

Come on and let me know

Should I cool it or should I blow?

Dr. Evans called me that same day. He was understanding, patient and disappointed. He believes that I am taking a great risk by hanging on to that lung tissue that may be harbouring microscopic cancer cells eagerly waiting to run rampant and metastacize in my brain and liver.

The surgery could cure me, not having it could kill me. On the other hand, February's wedge resection surgery could have cured me and the lobectomy could kill me. I'm seeing that lobectomy as the equivalent of treating gangerine in the end of a toe by amputating the whole freakin' leg.

On Wednesday, I got a call from Leanne, my general practioner`s receptionist. I like Leanne. She`s professional and efficient, but always friendly. Dr. Ingrey wanted to see me, and we set up an appointment for Friday. Oops, busted.

When you walk into a doctor`s office, they always ask how you are, and people automatically respond, "Fine thanks," or the equivalent. It`s become a meaningless question with a meaningless answer, but the doctor really does want to know how you are, unlike the acquaintance at the grocery store. Presumably you're there with a problem that he may be able to help, but if you tell him you're fine, he hasn't got much to go on.

Just imagine, if people at the grocery store answered honestly:

"How are you?"

"I have cancer."

"Well that's nice, good to see you, you have a great day."

That's almost as bad as the people who ask the question and get the "I'm fine," but that's not good enough for them on a sunny day in front of the Post Office. "No," they say, grabbing your arm and looking soulfully into your eyes, "How are you."

These are never close friends who know how you are and care, but casual acquaintances who for some unknown reason, in front of the Post Office on a sunny afternoon, want you to bare your soul to them. I applaud them for an attempt at reaching out, but that's really not the best way to do it. Maybe an invitation for a drink or a coffee somewhere with chairs would be more appropriate.

So, when Dr. Ingrey asked me how I was, I said I felt like I'd been summoned to the principal's office for getting caught smoking in the washroom.

Dr. Ingrey's pretty much on the bottom of the food chain in the pack of surgeons, oncologists and pathologists I've been dealing with; he's just a lowly general practioner. But, he somehow dialed in to my concerns and offered individual assurances that they would be taken care of as well as possible. Really good drugs, home care, more drugs and a few other perks are available to make life of a recovering lobectomy patient tolerable.

The appointment ended with a letter sent to Dr. Evans, headlined URGENT, requesting a rescheduling of my lobectomy.

Once Dr. Evans is back from his holiday, I'll be hearing from his secretary. It will be interesting to see if her mood improves any when she gives me a new surgery date. I'm sure it will; it certainly couldn't be any worse than the last time I had the pleasure of a conversation with her.

Should I stay or should I go now?

If I go there will be trouble

An’ if I stay it will be double

So come on and let me know!

After the new appointment is set, I think I'll wait a couple of days and call her back to say, "I want to cancel the surgery." Then, when she says, "You want to cancel the surgery?" in a hysterically incredulous, how-dare-you voice, I can say, "Nah, just kidding this time."

Listen to Should I Stay or Should I Go by The Clash.

to lobectomize or not to lobectomize, that is the question

2010-04-19T22:52:00.000-07:00

Last Thursday's conference of cancer experts decided that my situation was not straightforward. I am learning that, in the world of cancer, nothing is straightforward.

Pathology determined that three distinct masses were removed from my lung on Feb. 5, but odds are that microscopic cancer cells remain, waiting to grow and spread. Cancer has a lot in common with the dandelions in my garden.

PET Scan images show additional cancer as "hot spots" in my lymph nodes, bone marrow and spleen, but the bone marrow biopsy, blood tests, x-rays, CT Scans and ultrasound aren't conclusive.

Best guess, official guess, is the adenocarcinoma (which was first diagnosed as squamous cell) hasn't spread beyond the left lung, and that the other hot spots are probably lymphoma. Drs. Ho and Evans, backed up by the rest of the conference members at the BC Cancer Agency, want to watch the lymphoma but do no treatment.

What they
want to do is
a lobectomy
(not a lobotomy,
a lobectomy!).

The "lobe" is the upper or superior lobe, and that's most of what's left of my left lung. "Ectomy" means cut the damned thing out and throw it in the incinerator.

Easy for them to say. I say, I'd rather have a bottle in front of me than a frontal lobotomy, a comment attributed to Tom Waites, Dorothy Parker and WC Fields. All three seem likely candidates.

I'd like to know why the wedge resection was the first recommendation. Surely they knew then that there would be a possibility that microscopic cancer cells would be left behind. Why not just do the damned lobectomy in the first place, get it over with and not put me through two surgeries?

Dr. Ingrey says I'm making myself crazy with my "morbid curiosity" about my cancer. It's not an exact science, he admits, and there aren't definitive answers to all my questions. No point in looking for second opinions, because the conference provided numerous second opinions, which all agree.

Say buh-bye to lung lobe. Plan on 10-14 days in hospital followed by three months of recovery. Forget about being a marathon runner, an opera star or a long-distance swimmer.

"Doctor, after the surgery, will I be able to play the guitar?"
"Of course."
"Great! I've never been able to before!"

To be honest, I'm most concerned about the pain. I've never been a wuss, but this past year of procedures, topped off with that agonizing bone marrow aspiration, have left me with an almost desperate resolve to avoid any more. No so desparate that I'll refuse the lobectomy, but I'm not looking forward to it.

Besides, Dr. Ho is pregnant, due to have a baby any day now. I'm reluctant to whine about the discomfort of surgery to a woman who is about to give birth, which is sometimes described as passing a kidney stone as big as a pea. No sympathy there.

I should be happy, honoured perhaps, that some local Christians are praying for me. Two have told me that their prayers will cure my cancer. They are certain of this. Several others tell me that I've been put on a "prayer list," whatever that is. I picture a sheet of lined paper with a list of names and problems:

Sam - lost his job;
Debbie - lost her dog;
Joe - alcoholic crackhead hoarder;
Mary - house burned down;
Pete - allergic to Viagra;
Myrtle - cancer;
And so on.

I tell these people that it's a waste of time to pray for an atheist, but they will not be deterred.

Some flatly refuse to believe I'm an atheist. Of course, they insist, I believe in God and the Hereafter, I just haven't admitted it to myself yet. Im in denial, but I will see the light, yes I will. Louise Berg surprised me with the information that it's easier to pray for an atheist than an agnostic. The mind boggles.

What frustrates me about all this Christian intervention is the absolute, blind faith that God will cure me because of third-party prayers, even though I'm convinced that God does not exist.

Let's pretend that there is a God. He would be the one who created my cancer, everyone's cancer in fact, because He creates everything. So now a few of His children are saying, "Hey, Big Dude, we think you screwed up on that one, so cure the cancer, willya."

They expect God will say, "Oh, okay, I made a mistake so I'll just change it." The God I learned about in Catechism did not make mistakes, and questioning His wisdom was a guaranteed one-way ticket to Hell. God has His reasons for everything He does.

Or maybe God is like a big, mean kid who pulls the wings off flies to watch them struggle helplessly, earthbound until some insect-eating creature comes along to gobble them up for a quick snack, or until they're crushed by the random stomp of a Size 12, black Dayton boot.

Many people survive cancer, but I strongly suspect that God has nothing to do with it. It's likely the type of cancer, the individual's genetic makeup and overall health, medical treatment or a combination of the three. I'm certain it's not the work of a few of the flock at Christ the Redeemer Church in Pender Harbour.

Think of it another way. Consider all the people who die of cancer, each and every day, throughout the world. Odds are, some of them are really nice folks, they have friends who are Christians, and those Christians pray for the cancer to be cured.

Why does God not listen to them? Is God pissed at them for some Holy indescretion? Maybe they took His Name in vain (GODDAMMIT!) when they hit their thumb with a hammer? And so He's getting payback by letting their baby girl with leukemia die as punishment? God the drama queen.

In a small way, I envy these devout, God-fearing believers. Imagine the feeling of accomplishment, of joy, of power, when a lymphomectomy is successful and all sign of cancer are removed! Imagine how good it must feel to believe it was your prayers that saved the life of that person! Maybe a bit of an ego problem here? Ya think?

I'm certain of this: An eternity in God's company (heaven) is not a comforting thought. With the least bit of logical consideration, God appears to be a total whacko, and death without an afterlife sounds like a far more peaceful alternative.

scans, gowns and things that go bump in the night

2010-04-11T17:44:00.000-07:00

I had a telephone chat the other day with Dr. Cheryl Ho (pictured at right) who works out of the BC Cancer Agency in the Big Smoke, aka downtown Vancouver BC. She's a highly qualified, busy and well respected oncologist, and she talks to me on the phone.

How cool is that? I think of the many hours of traveling I've wasted here on the Sunshine Coast to see some specialist in Sechelt or Gibsons to disclose my birthday and medical insurance number, or to be told, "Your test results were fine."

I'm the one with cancer, but their time is more precious than mine, and the Sunshine Coast is hardly known as a hotbed of medical superstars. But, Dr. Ho talks to me on the phone.

Dr. Ho already has results from the flurry of tests I've undergone these past few weeks: CT Scan, bone marrow biopsy, blood tests and ultrasound, and she's not found anything new or conclusive. In fact, on Thursday, she's presenting it at "conference," a brainstorming session with a radiologist, surgeon and other medical experts, who will focus their talents on my perplexing case.

The blood tests didn't reveal any surprises, the bone marrow biopsy showed nothing startling and the ultrasound didn't identify any lymph nodes that looked as though they would be enlightening in a biopsy.

So, she's thinking that a low-grade lymphoma is likely. Low-grade lymphoma is a non-Hodgkin's (NHL) cancer of the lymphocytes or white blood cells, also known as indolent lymphoma. If low-grade NHL was an animal, it would be a sloth. Very slow-moving and, as cancers go, downright lazy. Some people with low-grade lymphoma live for years, decades even, without treatment. We like lymphoma.

Dr. Ho sees a "spot" in my lung on the CT Scan, likely one or two tumors that weren't removed in my February surgery, although a radiologist will make the call, and the call may be a biopsy to confirm either cancer or some evidence of the surgery. It's a little early for scar tissue, so I'm guessing it's a tumor that got off lucky in Round One.

If it is, I'll be saying goodbye to the upper portion of my left lung (most of it) in a pulmonary lobectomy, followed by a few days in ICU (Intensive Care) and a total of 7-10 days in hospital, presumably Vancouver General. The surgery doesn't kill most people and the recovery period is up to three months. As you no doubt imagine, I can hardly wait.

But enough of that, I want to tell you about the CT Scan...

I've lost count, but I think I've had no less than ten CT Scans so far in 2010, along with numerous X-rays and a PET Scan. A geiger counter would likely register me at the Toxic Waste Dump mark on the scale.

"Take everything off except your panties, socks and shoes, here's a gown, put your clothes there, come out when you're done."

Something needs to be said about hospital gowns. You haven't lived until you've been ordered into one, then forced to parade through a waiting area of other patients, with either your body bizarrely contorted to hold the thing closed at the back, or with your bare arse hanging out.

Brilliant. A sick person, or one with certain injuries (think broken arm) would find it challenging to tie up the front, so, let's really make their day by putting the ties in the back.

In the past few months I've had the opportunity to model gowns at St. Mary's, Lions Gate, Vancouver General Hospital, and the BC Cancer Agency. Everyone has a different style of gown. Sometimes the gown styles vary between departments of the same institution.

They're all slightly different, they're all blue (why blue?) and they all should be supplied with little instruction booklets, with diagrams, to show you how to put the damned thing on.

Most are made of thin, chilly cotton, but I encountered one made of some kind of light, stiff paper. Can't remember where, so the supplied drugs must have been of better quality than the wardrobe.

Some have three arm holes, which results in two backs and one front, or two fronts and one back. You can only be sure that it has three sides, but that's harldy helpful when your body only has two. Some varieties of the Alien Gown (it has three arm holes-- what would you call it?) have ties, and some don't.

The tieless style is guaranteed to shrug off one of its shoulders, leaving the arm hole at your elbow. Remember the guy with the broken arm? Now he's really buggered because that was his good arm, and now he can't lift it to adjust the gown which has effectively become a strait jacket.

No matter how you put it on, you may feel as if you're being gently but firmly garrotted. Although the designer went crazy with arm holes, he forgot all about room for the neck. A little scoop would have made the garment so much more comfortable, but (do you remember platform shoes?) sometimes one must forsake comfort in favour of high fashion.

If you're wondering about the title, there's nothing in this post about things that goes bump in the night. I had been thinking of my room-mate at VGH, but I rather liked him and telling the story would be a little bit mean. Hope you're not disappointed.

like a mushroom

2010-04-02T01:23:00.000-07:00

I'm liking this cancer thing. I feel better than I have in a year, everyone is really nice to me and telling me how great I look, and I'm getting away with murder. Sometimes I feel like I could chew off my arm for a cigarette, but that's another story.

The only thing I can complain about at the moment is best expressed with that old saying...

A bone marrow aspiration (a teaspoon of marrow was sucked out of my hip bone) was done on St. Patrick's Day, but a sample of the bone itself was not taken. This was likely due to my screaming and cursing, and I may have threatened someone's life but I can't remember.

Last week I had an ultrasound of my neck, a close look at lymph nodes to choose one for removal. No results from that yet, but I hope to hear soon.

Yesterday I saw my general practioner, Dr. Ingray, who suggested that both procedures (removal of a lymph node and a piece of my hip bone) could be done at the same time, while I'm out cold in la-la land, and this sounds like an efficient and sensible idea. It's also the only way that anyone is getting that bone sample, because I refuse to have it done without general anesthesia.

My oncologist hasn't scheduled either procedure yet, so hopefully we can intercept her before I'm set up for biopsies on two different days in two different hospitals.

Being an impatient person, I'm frustrated that this is dragging on so long. I was diagnosed Jan. 12, two and a half months ago. That's about ten weeks or 80 days ago. I know the lung cancer is adenocarcinoma, but don't know if it's Stage 1, 2, 3, or 4. I don't know what kind of cancer I have in my lymph nodes, my spleen and my bone marrow. I don't know if the lung wedge resection surgery I had Feb. 5 was successful in removing one, two or all three tumors. I don't know if I'll be having more surgery, chemotherapy, radiation therapy or nothing at all. I don't know whether or not to renew a one-year subscription to Digital Photo magazine.

But, on the up side, people are sending me all kinds of information on how to cure cancer.

For example, eating asparagus cures cancer. Who knew? Ironically, I love asparagus and eat it at least several times a week. Have been for years. Very odd that I have cancer.

There are many secret cures for cancer, and they've been around since cancer was identified and given a name. It's usually a pill or a potion, but there are a few really nasty ones out there that involve enemas.

Long lists of testimonials are written by people like Agnes in New Jersey, whose loving husband was on his death bed with only weeks left to live, wasted away to nothing and in terrible pain. The doctors said there was no hope, the cancer was inoperable, untreatable and just go buy the damn casket. Then... the secret formula was administered and, in just a few short weeks, Loving Husband is the picture of health, completely recovered. Secret formula that's been around for decades. Secret formula that's been successful in hundreds of cases, maybe thousands. And, for only $49.95 plus shipping and handling, you can buy the secret formula.

Another popular cure is the one that the big, evil pharmaceutical companies got wind of as soon as it was accidentally discovered by some kindly doctor or maybe even a housewife. So, the story goes, the Big Pharma obtained the formula by some nefarious means for the sole purpose of locking it away where no one could benefit from it. They did this, of course, because a cure for cancer would cost them billions of dollars. Apparently it's much more profitable to let a customer die than to prolong their life for another few decades of spending money on the usual prescriptions that people without cancer buy anyway.

These cures, in the form of medicine, a book or a cd, are usually sold by Dr. McGillicuddy or some such name. A doctor, sometimes, but Google may reveal that he's a doctor of dentistry or veterinary medicine. Or that his diploma was issued by a university that never existed, his scientific research was done in a hospital that never existed and his articles were published in a medical journal that never existed.

One of my favourites is the doctor (a vet) who claimed his knowledge of curing cancer was largely developed from performing autopsies. Somebody did the math and discovered that, in addition to working full-time as a veterinarian, he would have had to have performed autopsies five days a week, six hours a day, for 12 years! Never mind that it's illegal to carve up a corpse without a license to practice medicine (on humans).

Although I do appreciate the thought, I have a hard time listening to an otherwise intelligent person tell me how I can cure my cancer by buying a book of secret knowledge or drinking essiac tea. I will, however, continue to eat asparagus, but that's just because I love it.

feeling pressure

2010-03-18T23:15:00.000-07:00

I really like that people send e-mails and even stop me on the street to tell me they enjoy this blog. I like knowing it makes people laugh as well as shows them what it's like to be a cancer patient.

I really like my oncologist, Dr. Ho, but I'm thinking she has another, terrifying and intimidating side because of the breakneck speed at which she arranges tests for me.

Last week I had blood tests and an ultrasound of my neck, and when the experts have a look at that they will select a lymph node (at least I think one will be enough) to remove for biopsy.

The PET Scan showed cancer in these nodes, but oddly the ones in my chest, closest to my lung, weren't looking malignant. This could mean that the cancer in my lymph nodes is not secondary lung cancer, but perhaps lymphoma. This would be a good thing.

The next test, on St. Patrick's Day (I wore a green sweater) was a bone marrow biopsy, to be taken from my hip. Via a needle. A big needle. Dr. Ho and a handful of reputable medical websites assured me the procedure would be almost painless.

A local anasthetic would be used, the same type as a dentist uses. I would feel some pressure, some discomfort, but I would be surprised that the procedure was far easier than I had expected.

I admit that I was surprised, and I did feel some pressure, but that's where the resemblance to what I believed and what occurred came to a screeching, grinding halt.

I was led into a little room off the chemotherapy ward of Lion's Gate Hospital in North Vancouver, looking out at a row of mostly elderly patients lounging in reclining chairs, covered with quilts while their treatment was delivered intraveinously. It was a peaceful scene.

I was asked to scoot on my side as close as I could to the edge of the bed, and the metal-barred side was raised. I should have been suspicious when a nurse said, "Some patients like to hold on to the bars." That little comment should have been a dead giveaway that I was not in a happy place.

The doctor was positioned behind me, beside her table of instruments which I chose not to examine. I should have been even more suspicious that there were two other people, one at my hip and one at my legs (well positioned to restrain me). The doctor said that she would explain everything she was doing, and that started off pretty good. I may have imagined that she had a German accent.

"You vill feel cold, from cleaning of zee area." And cold it was, as my exposed hip was wiped down with some antiseptic liquid. Then once more, then a third time.

"Now I vill freeze zee area and you vill feel a little prick." This was the local anasthetic and, yes, there was a little prick as the needle was inserted. This was followed by a feeling of numbness. All good.

"Now I vill freeze zee bone," and she did with another needle and another little prick.

"Now I begin zee procedure," she continued, "and you vill feel some pushing." Although my hip was frozen, I did feel pressure as the needle was inserted into my flesh and pushed right into the core of my hip bone.

Suddenly the play-by-play description ended and the nurse standing in front of me leaned over, looked into my eyes and asked, rather urgently, "How long was your ferry ride?"

The timing was perfect. She asked the question at the exact moment I was overwhelmed by the most intense, white-hot pain I'd ever felt. I did not answer her question.

I let loose with a scream and a litany of profanity that made no sense whatsoever but certainly conveyed the message that I was feeling more than a bit of pressure. I sincerely hope that all those elderly chemo patients were stone deaf.

The door to the room was quickly closed, no doubt so the chemo patients would not be unduly frightened. I found myself gripping the rail on the bed with all my strength. Had I been able to let go, I would have punched out all three co-conspirators in that chamber of torture, but I was frozen in agony. Tears were running down my face. It seemed to go on for at least several minutes, and those were excruiatingly long minutes.

It finally ended, and the pain receeded. I composed myself somewhat and stupidly apologized for my foul language. The doctor allowed that it may have been more painful than normal because my bone marrow was diseased, and I suppose that was meant to make me feel better.

A towel was rolled up and I was directed to lean back against it, to stop the bleeding, and not move. I was told a nurse would be back to check on me in 15 minutes and, if all was well, I could then go. I waited. And waited. And waited some more. I was sure that far longer than 15 minutes had passed. It seemed like hours. I contemplated getting up and leaving, but decided that it would be best to wait until I was checked out.

Jane and I had arrived at the hospital at 11:20 a.m. and the procedure was slated to take a half-hour to 45 minutes. Jane would be back at noon to meet me at the entrance. When I still hadn't emerged by 2 p.m. she decided to go looking for me. She was told I had been released at 11:30, that I might be in the cafeteria, that my procedure was completed and I was gone.

I'm lucky to have a friend who doesn't hesitate to question authority. She insisted that I wouldn't leave because I had nowhere to go and no way to get there, and persisted until someone finally had an Aha! moment and remembered the little room in the chemotherapy ward. That's where they found me.

With my bone marrow biopsy behind me (no pun intended), I've been hearing from a number of people who had the same procedure and experienced the same, intense pain as I did. When the hip bone biopsy was being explained to them, the words "discomfort" and "pressure" were used, but none were told that it would be painful.

A word of advice: if you need a bone marrow biopsy, demand to be sedated. Maybe it's true that most people find the procedure causes only "some discomfort" but if you're not one of them, trust me, you do not want to experience it clear-headed and wide awake.

Next test to come, a CT Scan to discover if my surgery of Feb. 5 was successful in removing one, two or all three tumors in my lung. If there are any left, I'll be having more surgery, but that will be a piece of cake compared to the bone marrow biopsy.

Although surgeons have a fondness for cutting human flesh, they do their best to minimize the human's pain; they aren't nearly so stingy with the good drugs!

curiouser and curiouser

2010-03-10T12:45:00.000-08:00

I spent most of yesterday afternoon chatting with two oncologists, Drs. Cheryl Ho and Robyn MacFarlane, at the BC Cancer Research Agency in Vancouver.

You may remember that I have squamous cell carcinoma. Scratch that; there's an updated diagnosis. Now I have adenocarcinoma. Like squamous cell, adenocarcinoma is a type of NSCLC (non-small cell lung cancer). I asked my oncologists if this new diagnosis was an upgrade or a downgrade. They agreed that I should think of it as a lateral transfer.

You may remember that I had three tumors removed from my left lung in a wedge resecetion procedure. Scratch that, or at least put a question mark by it.

The pathology report implies that only one tumor was removed, thus leaving the other two little darlings behind. The tumor referred to in the report was 2 cm in size, and the wedge resection was 8 cm.

The other tumors were both adjacent to and smaller than the first, so I can't imagine how an 8 cm chunk of lung, presumably with the larger tumor in the centre, would miss them. The oncologists will clarify this with the surgeons and let me know.

You may remember that I also have cancer in my lymph nodes, spleen and bone marrow, and that we don't yet know what type of cancer is present there. This hasn't changed, but it is getting curiousier and curiouser.

In my PET scan, the lymph nodes in my chest didn't show any activity (cancer), as they would be expected to if the lung cancer had spread. Lung cancer very often spreads to the liver, and my liver is fine. So, it appears that the other cancers are some other kind of cancer, likely lymphoma. But (and there's always a but), it's highly unusual for two separate, unrelated cancers to pop up at the same time in the same patient.

A bone marrow biopsy and a lymph node biopsy will reveal the identity of every last scrap of cancer in my body, and I'm hoping for lymphoma. If not curable, it's certainly treatable. If it's not metastacized lung cancer, my prognosis for being alive in five years soars from 1% to maybe 60%. Yeah, I want lymphoma!

the beginning

How did it all come to this?

About a year ago, I got very sick. Nauseous, terrible pain in my right side, dizzy, weak and generally debilitated by the symptoms. Over several months I lost over 40 pounds and was mostly unable to get out of bed. Some days, I thought I was dying and other days I hoped that I would.

I had blood tests, urine tests, ultrasounds, x-rays, CT scans, a bronchoscopy and a colonoscopy, and then another colonscopy because Dr. Piers screwed up the first one. Then more blood tests, scans and now occasional trips to the emergency room to be rehydrated and have my electrolytes tuned up.

Dr. Cairns insisted it was IBS (irritable bowel syndrome). Dr. Wadge suspected my appendix. Dr. Goddard considered exploratory surgery to look for scar tissue buildup from an old gallbladder surgery. No one could figure out what was wrong with me, and I was living on Jell-O and morphine.

Then, a CT scan revealed a wee spot on my lung. Dr. Ingrey insisted that this be dealt with before spending any more time on my gut complaints, so the next thing I knew I had a cancer diagnosis and was on my way home from surgery at Vancouver General Hospital in early February, 2010.

Now, you're thinking, back to trying to figure out the gut problem. Nope. The gut problem is gone. Vanished. I have no symptoms whatsoever. I'm eating anything I want and lots of it. I've gained 15 pounds since surgery and am recovering very well from that too. But, it makes no sense.

My surgery was in my upper left lung, not in my lower right abdomen which seemed to be the source of the problem. Bronchial system, digestive system. No connection. No cancer in my lower right side. No rhyme, no reason.

Dr. MacFarlaine nailed it. It's called paraneoplastic syndrome and it occurs, not often but sometimes, in cancer patients, particularly lung cancer patients. Some unrelated, unconnected thing happens somewhere else in the body, somewhere away from the cancer. Sometimes this happens, as it did in my case, before the cancer is diagnosed and can even lead to cancer diagnosis.

never assume anything

So, I assumed that I'd be scheduled for chemotherapy or radiation therapy as a followup to my surgery. Most people have their hair fall out from chemo/radiation, and I didn't expect to be any different. Not a biggie for me. Hair is hair, it grows back and it doesn't hurt when it falls out. I can't imagine having an identity crisis because of temporarty hair loss. At worse, I'll have to wear a hat to keep warm or prevent sunburn.

Hair is hair, but there's no reason not to have a bit of fun with it. My hair is white/grey and hasn't been cut in quite a while so, confident that it was all going to be falling out in a month or so anyway, I cut it.

With kitchen scissors, without paying too much attention to evenness or style. Then, with a ten-year-old package of henna, I transformed it to a peculiar pinkish orange colour. Fun. And it's going to fall out anyway. Right? Wrong.

I may not be doing chemo, or radiation, or more surgery. I may be undergoing nothing more than monitoring, a test or two every six months. This is the best-case scenario, and I'm happy to know it's a possibility but, holy henna, Batman!

Now my hair is the colour of a faded pumpkin and it looks like it was cut by a visually impaired person with a bad case of the shakes.

Never, never ever, assume anything. But, if you must, leave your hair alone.

stitch mystery

2010-03-05T12:52:00.000-08:00

WARNING
This blog entry includes graphic descriptions of medical procedures. It is not appropriate bedtime-story material for small children and may be offensive to some readers.

In my defense, I was completely unconscious. I’m sure you understand why, after surgery, I didn’t want to be poking and prodding the raw areas of recent scalpel activity. And, having eyesight about on par with a mole, I certainly couldn't see anything in the bathroom mirror. Not that I wanted to. If it was someone else's sutures and incisions, blood and pain, then I'd be right in there to have a look, but not when it's my body. I'd just rather not look or feel or even think about it, thank you, until it heals up.

So, two weeks after surgery, while doing some tentative exploration of my left side, I was surprised to discover a stitch in an area previously covered by a bandage. You may remember how pleased I was to discover that my wedge resection surgery required only one stitch (which was removed a week ago). Oh well, not the first time I’ve been wrong.

Back to the “new” stitch, one of an almost transparent thread rather than the heavy black of the other one. It looked, and felt, like lightweight fishing line. I was easily able to unravel several running stitches until I came to a dead stop. I couldn’t find the end of the thread. It went in but didn’t come back out. Perhaps, I thought, pulling the thread would cause a nearby dimple in my flesh that would indicate the other end.

No dimple, just the opposite, and enough “discomfort” that I soon stopped testing my theory. I was faced with the perplexing situation of a single thread coming out of my chest, seemingly from somewhere deep inside. I told myself, “You can’t get there from here,” and made an appointment at the Pender Harbour Health Clinic.

The nurse appeared with her suture-removal instruments, laid me out on the examination cot and flipped on an startlingly bright overhead light as I explained my little adventure. Using the location of the stitch (immediately below my left breast) as an excuse for my incompetence in both locating and removing it, I pointed out my age (55) and the nature of gravity (it sucks). A couple of years ago (okay, decades), a perkier boob would not have concealed the stitch nor would it have required an extra hand to hold it out of the way while said stitch was located and removed.

This reminds me of a guaranteed side-effect of any serious illness… it destroys every last shred of one’s modesty, often before diagnosis, while various tests are being performed.

I am certain that a substantial number of men die of prostate cancer diagnosed too late because they refused to let another man (the doctor) insert a finger into their rectum. Likewise, I believe that women die because they delayed or outright refused both pap tests and mammograms. And, I totally understand their decision. I allowed myself to be subjected to a pap test every ten years, but I swore that my last one was indeed my last one.

I couldn’t imagine how having an additional person in the room would lessen my embarrassment, so I waived my right to have a female nurse present at the procedure. When you find yourself naked from the waist down, flat on your back with both knees in the air and both feet in chrome “stirrups” designed and positioned to spread your legs apart in a most indecorous manner, you can’t really do much more than grit your teeth.

Enter the doctor, an elderly, bespectacled man prone to unintelligible muttering, carrying a plastic-wrapped, plastic speculum.

I think it was blue and I think the packaging was made by the company that makes those potato chip bags which are impossible to open without scissors.

Dr. Cairns didn’t have scissors, so he did what we all do with a potato chip bag, he pulled it apart. We all know what happens to the chips in those bags; when the bag gives, the contents fly everywhere.

The plastic packaging finally gave, and the speculum went zooming across the little examination room, hit the wall and bounced several times across the floor to come to rest under my cot. I was mortified, but Dr. Cairns retained his composure. A quick study, he used scissors to open the second speculum package.

The next step is insertion of the speculum into the vagina. Then, the instrument of torture is ratcheted open to allow a tissue sample to be removed from the cervix. This is where embarrassment is overcome by physical discomfort. One wonders why the damned thing must be spread open so wide.

The tissue sample is small, the instrument to remove the sample is small, but one feels like room is being made to drive a full-sized pickup truck up one’s vagina. Yes, one wonders. And one grits their teeth even harder while they lie there, reminded of a butterfly impaled on a pin, repeating the mantra, "It’s almost over, it's almost over, it's almost over."

But it wasn’t over yet. Dr. Cairns, with one hand gripping the speculum and the other holding the instrument to take the tissue sample, developed a sheen of perspiration on his face. Then his cokebottle-thick glasses slid down his nose and fell off. I can’t say that he panicked, but he was certainly agitated, one hand still gripping the speculum, as he fumbled around for his glasses, which had landed on the cot between my legs.

Seconds were hours, it seemed, but he finally retrieved his glasses, got them back on his face and completed the procedure. He quickly left the room, without a word, and I vowed that I would rather die of cervical cancer than be subjected to that kind of humiliation again.

The punch line? Several months ago, at St. Mary’s Hospital, a female doctor performed a pap test. It was quick, painless and without incident. However, it’s still highly unpleasant and I do not intend to have another one. Happily, I have lung cancer, something that can be monitored with non-invasive imaging tests involving high doses of radioactive dye.

Okay, back to the cot in the examination room of the Pender Harbour Health Clinic, wondering what’s become of the other end of that suture thread. The nurse did a close examination and some cursory, gentle pulling. She concluded, “Hmmm. Isn’t that odd.”

I agreed. She did more looking and discovered a small knot, a couple of inches away. Aha! But no, this knot turned out to be yet another stitch, and another with no visible source. Very odd. Then, she found a third, also unrelated, stitch with no visible source. Very odd indeed. She decided to call in the doctor to have a look.

Dr. McDowell solved the mystery instantly. “Those are dissolvable stitches,” he said. It turns out that a dissolvable stitch, when exposed to air, becomes hard and appears to be a normal stitch. I silently wondered if dissolvable stitches were made of the same material as biodegradable garbage bags, which are fine until they get wet.

Dr. McDowell told us that the stitches would eventually drop off, after they had dissolved from beneath the surface of the skin, or they could be cut off in a way that would cause them to retract into the flesh, facilitating their disappearance. This latter procedure involved more tugging and pulling, so I told the nurse that, because it sounded like so much fun, I would go home to do it myself.

And, one of these days I probably will. If they don’t fall off before I get to them.

onward ho!

2010-02-20T18:44:00.000-08:00

I finally got a call from the BC Cancer Agency, and I have an appointment for March 9, when I'll meet with oncologist Dr. Cheryl Ho and presumably be scheduled for further testing before a treatment strategy is decided.

Although my lung tumors proved to be squamous cell carcinoma, it's unknown what type/s lurk in my lymph nodes, spleen and bone marrow. I'm hoping for lymphoma.

Seriously, I want lymphoma (the easily-treatable kind with the great odds for success) to be the yet-unidentified cancer in my body. That would mean that the lung cancer isn't Stage IV, which would give me a much brighter prognosis. I've been looking for a t-shirt, "I want lymphoma," but haven't had any luck finding one.

The BC Cancer Agency is a superstore for cancer patients. Consults, testing and treatment, counseling for patients and their families, a resource library and even a lodge for affordable overnight stays (meals included!) for out-of-town patients. That's me, an out-of-town patient, but I'll be driving back home to my own bed if I can manage it.

I had my PET Scan (positron emission tomography) at the Cancer Agency, and it was all good until the very nice assistant decided to assist me with a firm, supportive arm around my waist.

I really wish someone had told her that my side was terribly sensitive, downright painful in fact, so she wouldn't have been subjected to my thoughtless but swift reaction of pulling back a fist and yelling, "Getyer fuckin hands offa me right now!" Intense pain does not improve my usually sunny disposition, and I'll be feeling badly about that one for a long time.

It was less than a month from the PET Scan that set off the alarm, "CANCER!" followed by surgery, and the subsequent biopsy results of squamous cell carcinoma. Pretty darn quick, and I was liking the pace. Now's is going to be almost another month between the biopsy results and a consult with an oncologist. Sigh. Hurry up and wait.

But, you may ask, why so long? Because the BC Cancer Agency's procedure includes "triage" on referrals, and it takes weeks. Triage? On referrals? If you're like me and know the definition of the word, you picture a stack of bleeding, gasping sheets of paper that have just been dragged in from a horrible accident out on the street.

Oncologists rush in to study these sheets of paper, deciding which ones get their attention (earlier appointments) and which are left for later appointments. Be glad that oncologists don't work in the ER.

The posters and t.v. ads always stress the importance of early detection in cancer. Silly me; I thought early detection implied early treatment, but it might mean that late detection results in no treatment at all... because the patient dies of old age before getting to see an oncologist.

Seriously though, I am impressed with the response of my general practitioner, Dr. Ingrey, and all medical professionals who have dealt with me in Vancouver since I've become a cancer patient. At no time in the process did I feel like a widget on the assembly line, no small feat because, in 2007, there were over 21,000 new cases of cancer diagnosed in the province of British Columbia alone.

the wrong bus

2010-02-18T02:23:00.000-08:00

Jan. 12 - Diagnosed with cancer.
Feb. 5 - Wedge resection lung surgery, three tumors removed.
Feb. 7 - Drainage tube removed from said lung.
Feb. 8 - Home from Vancouver General Hospital.
Feb. 12 - Biopsy result: squamous cell carcinoma.
Feb. 17 - One and only stitch removed.

That starfishy thing at the right? It's a piece of lung with cancer. It's interesting, how things change after you've been diagnosed with cancer and start to enjoy new experiences brought about by the disease.

For example, my doctor said, "Your incisions look good," as he removed a stitch this afternoon. Sigh. I remember being told that my hair looked good, my clothes looked good and even my ass looked good. Today, my incisions look good and my doctor looks too young to be practicing medicine. I'm obviously on the wrong bus, but I don't know how to get off.

The stitch hadn't been bothering me but, now that it's gone, I'm missing a pinching feeling when I turn or move a certain way. I'm also missing an occasional jab from the end of the heavy, stiff thread (they don't really use catgut), and a pull when it got caught in a seam of my shirt. I assume you know I don't mean "missing" in a gee-I-can't-live-without-you kinda way.

Still some sharp twinges in my chest but nothing serious. My breathing is improving daily, and I can almost accomplish a full yawn. It's really nice to be able to sleep on my side again, and I look forward to being able to sleep on the other side too. Still to come, being able to sneeze without feeling like I've been tasered by an overzealous RCMP officer at YVR.

I left the hospital with instructions for a number of exercises, including deep breathing and coughing. Yes and, coughing exercises and, no, I wouldn't have imagined that one either. I guess it's good for expanding the lungs or toning their muscles or something. I have no idea. I just do my exercises and don't question the experts, but I have to say my coughing has improved tremendously. At first, it was a pathetic little, "huh!" but now it's sounding like an almost-respectable smoker's cough.

I have instructions not to lift anything over ten pounds for 6-8 weeks. Ten pounds is nothing. My cat weighs ten pounds, my camera bag weighs ten pounds. This is the most difficult part of the whole recovery, not being able to pick up my cat. Poor Fraser, he probably wonders what he did wrong. Not only am I not picking him up but, in bed, when he heads for his usual snuggle spot across my shoulder, he gets shoved to the floor. He is adapting though. Now he avoids walking across my chest by walking across my face. This is especially charming at 3 a.m. when I'm sound asleep. Imagine ten pounds of weight distributed to four relatively small paws. Then imagine one of those paws stepping on your closed eyeball, pressing down with most of that ten pounds. Charming.

I've been taking red reishi mushroom capsules since I've been home from hospital. Okay, I see your eyebrows go up and your eyes get big, but let me explain. Ganoderma lucidum has been the subject of a number of legitimate, reputable medical studies, and it not only shrinks tumors in lab rats but, in people, alleviates the side-effects of chemo and radiation treatment for cancer. I am a skeptic, but I do believe in science, so we'll give this stuff a fair trial.

Not having had cancer before, or a piece of lung removed, I have no idea how I should be feeling, but I suspect I'm doing pretty well considering that for several months before surgery I was pretty much bed-ridden and unable to eat anything but the blandest diet (I'd lost over 40 pounds, but I'm pretty sure that was from not eating rather than the cancer). In the past week, in spite of the surgery, my appetite's improving, pain and nausea have vanished, my energy level is increasing and my strength is returning. Is it the mushroom? I don't know, but I'm going to keep taking it.

No more Dilaudid, morphine, Ativan, Gravol and a few other prescription medications for nausea, and no more "puffer" shots of whatever that stuff is that allows you to get enough oxygen not to pass out. My drug consumption has been reduced to chewing a half dozen pieces of nicotine gum throughout the day (it's Day 14 as a non-smoker).

Throughout the day, I do think of having a cigarette, or rather of enjoying a cigarette, but the thought passes quickly and it's taking longer and longer to return. However, I firmly believe that everyone needs at least one bad habit, so I'm drinking a glass of wine before dinner, or just to be sociable if someone drops over. Or, if the sun is shining and I'm in the garden.

the five stages of stupid

2010-02-16T23:00:00.000-08:00

A cancer diagnosis will, at least, get your attention, not unlike like a smack upside the head with a brick. If you could visualize the feeling, you'd see yourself as one of those cartoon characters who gets run over by a steamroller, flattened to a quarter-inch thick on the blacktop. But, toons have an easier time peeling themselves back up to carry on with the show.

People normally react with denial, bargaining, anger, sadness and, finally, acceptance. These are the classic five stages of grief, coined in 1969 by Elisabeth Kubler-Ross in her book, On Death and Dying. They occur in any loss.

You grieve at the death of a loved one, the end of a relationship and the loss of physical possessions, such as having your house destroyed by fire or your Harley Davidson stolen. And, the stages of grief are set in motion with the diagnosis of a potentially fatal disease.

I was lucky, I immediately went into shock and remained that way (with no small amount of help from Ativan and morphine), until I could work through the five stages of grief in a calm and reasonable manner. Here's how it went:

Denial - Oh, but I can't have cancer, not me. Okay, that's just inane. You have cancer and you know it, so move on to the next stage.

Bargaining - If I survive this, if I can only get better, I promise I will...
Promise what? Give up eating chocolate? Give up wearing wool socks? Dance around a fire naked while howling at the moon? Don't be silly. Nobody cares. Nobody wants to make a deal. Nobody can make a deal. You have cancer.

Anger - I'm mad that I have cancer, that it wasn't diagnosed sooner, that I've been unable to work, that I may have to have surgery and chemo, that I may be sick for a long time, that I may die. I'm mad at the medical profession, mad at everyone who doesn't have cancer, mad at myself and mad at the world. I'm mad at cigarettes, mad at the pollution in the mill-town where I grew up, mad at the Vancouver smog that I breathed for ten years and mad at the additives in food. There now, doesn't that feel better? No? Well, sorry, it's one of the stages and you have to go through it. Don't get mad at me, I didn't write the damned book!

Sadness - This is the one that I got stuck at for about two weeks, until I realized that I had absolutely nothing to be sad about. Worst-case scenario, I die. Well, I was going to die anyway, and everyone has to die of something. Would I be happier if I was to be murdered by a crazed psychopath? How 'bout being killed in a horrible car crash, is that cheerier? Struck dead by a piece of falling space debris? There really doesn't seem to be a happy way to die. There's not an app for that.

Acceptance - I have cancer, but cancer isn't the problem. The problem is the realization that I'm not going to live forever, that I may not be here next year, or the year after, or ten years from now. I'm hardly worried about burning in hell after death, or worried about being subjected to harp music and dead relatives for eternity (although some of those dudes in the Philadelphia Cream Cheese commercials are kinda hot). I know that some people will miss me, and that I'll be missing out on life but, really, I'll be dead. I will have no perception of sorrow. I simply won't be here.

So, let's move on, shall we? I feel reasonably well and there's no reason why I can't get as much pleasure from the things I enjoy as I did a year ago. Later this week, I need to get my truck insured so I can go for coffee at the Java Docks, head out on a sunny day to take pictures and go for lunch with a friend at Garden Bay Pub. Spring is just about here, so I can start planning my garden. My Pender Harbour website needs updating, and I'm itching to go back to work at the Village Vintner-- I seriously need to make some money.

And, as weird as it sounds, cancer is my new hobby, a damned interesting one. I look forward to spending time on it, learning as much about it as I can.

red cup, black cup

2010-02-13T18:50:00.000-08:00

I spent five days in St. Mary's Hospital in Sechelt last month and five days at VGH (Vancouver General Hospital) more recently.

The food service at both hospitals is contracted by Sodexo, and I thought it would be fun to compare the two from a patient-experience perspective.

Jell-O is typical hospital fare, so let's start with that. Pretty hard to screw up Jell-O, right? Jell-O at St. Mary's is kind of, well, slimy. It's almost tasteless and slithers rather than jiggles. It has an odd smell, but that could have been the plastic container it came in. It may have been better if not served warm. VGH? Real Jell-O, or something that looked and tasted like real Jell-O, served chilled, in a plastic bowl that didn't stink.

St. Mary's Sodexo soup is probably edible if you like oregano. A lot of oregano. It seemed to be the only vegetation in the bowl of muddy, brown, scummy liquid. The other primary ingredient was salt, and lots of it. It was served cool, but I understand that chilled soups are all the rage in trendy Yaletown restaurants. The cooks obviously weren't on the ball at VGH, serving hot soups with identifiable veggies like carrots in a flavourful broth that wouldn't be life-threatening to a cardiac patient.

Perhaps it's a simple matter of the dishes. In both places they're designed with identical, disposable plastic lids, but the cups, plates and bowls themselves are made of a different type of material. While VGH has a hard plastic, St. Mary's has opted for a softer, almost rubbery material. I'm guessing this is a safety factor. A rubber cup would do far less damage than a hard plastic one if flung at another patient, or a food-service worker, in a fit of rage.

Every day I tried to send my trays back, but I had to keep them for at least an hour. Why so long?

"So They know I delivered it," I was impatiently told by a food-service worker who pushed my gardening magazine on the floor with the tray.

"I can't eat this food, it's awful. Please don't bring me any more because it seems a terrible waste."

"We must deliver the trays, ma'am," she said with barely-concealed outrage.

Conspiracy theorists might think the kitchen at St. Mary's is on the take from MacDonalds, Mr. Submarine and other local eateries because of the many meals from them brought in by visitors. But no, patients are allowed to keep their own food in a kitchenette on the floor.

At both VGH and St. Mary's, juice came in little packages like you'd get from a vending machine. Of course, both were supplied by Sodexo. The odd thing is, VGH juice was juice and St. Mary's "juice" was some kind of flavoured drink that tasted like over-sweetened, watered-down Kool-Aid. Room temperature at St. Mary's, chilled at VGH.

At home, I make both oatmeal and Cream of Wheat. They aren't difficult to make, but require a bit of attention or you end up with something lumpy, either too watery or too gluey. Guess who wasn't paying attention to their porridge? Yup, and it was even better at VGH than my own.

At St. Mary's, I finally asked, "Why is the food here so terrible?"
A Sodexo employee snapped, "We cook for many, many people, and the food has to be put on trays and brought up from the kitchen. What do you expect!" Sorry, but unless the food is being sent from Vancouver by pack mule, that's not a good enough excuse. At VGH, far more meals are served and there are far more floors, patients and real estate. On my wing of the 12th floor, my meals were just fine.

Hospitals are boring, so patients make up little games. On the first floor at St. Mary's, we played What's in the Cup. Is it tea? Is it coffee? Why doesn't it look, taste or smell like either? We'd have a sniff, a sip and guess, but we were never sure. I decided to ask the experts, the Sodexo employees who served the dark and nasty brew.

"What's in the cup?"

"Coffee," she said, obviously not interested in chit-chat.

"How can you tell?"

"It's morning," she replied, in that same tone you'd use if someone asked a really, really stupid question.

Later, with a different food-service person:

"What's in the cup?

"It's tea," she cheerfully told me.

"How can you tell?" I asked. "Everything that comes in a cup looks, smells and tastes the same."
She laughed, and let me in on a secret.
"You know how we tell? It's simple... coffee's in the red cup, tea's in the black cup."

cancer cures smoking

2010-02-12T00:44:00.000-08:00

On Feb. 4, the day the 2010 Winter Olympic Torch burned through the Sunshine Coast, I burned through nearly a pack of Export "A" Ultra Smooth cigarettes on my way to have surgery on my lung to remove three tumors. Cancerous tumors.

Why quit now? I smoked my first cigarette at 12 and, by 14, I was an accomplished, regular smoker. This was the 1960s. My mother smoked, most of my teachers smoked in the classroom, my doctor smoked in his examination room and, of course, all the cool boys smoked.

The only reasons for me not to smoke? "It isn't ladylike" and "it will stunt your growth." A towering (for largely Francophone northern New Brunswick) 5'9", I had no interest in being taller or being ladylike.

My mother dismissed the health concerns of smoking by pointing to her mother's grave: Elizabeth Doyle died of lung cancer in her early 60s, never having smoked a cigarette. Grandpa Joe always had a pipe in his mouth, but secondhand smoke wasn't to blame because he never lit the thing.

It may have been smoke inhalation damage from the night their Atholville home caught fire while they slept, but my mother was of the opinion that your birth and death were preordained so it didn't much matter what you did in between.

She got breast cancer in her 40s, in the mid-1960s. They lopped off her breast, gave her a few radiation treatments and she was fine, for a few years. It came back, in her lymph nodes. Surgery under her arm, more radiation and she was again fine. The third time it was in her throat, and now we're into the early 1970s. Same routine, surgery and radiation, and she was fine.

That last time, she quit smoking. Or so we thought. Next spring, as ten feet of snow melted behind the house, under a little window just big enough to stick your head out, a pyramid of weathered DuMaurier (her brand) cigarette butts was revealed. My father and I didn't mention it, he cleaned up the butts and my mother immediately took up smoking in front of us. As our family did with this kind of thing, we just pretended it never happened.

I walked up to the Vancouver General Hospital (VGH) admissions desk with a brand-new pack of Export A Ultra Smooth cigarettes in my pocket, along with a purple Bic lighter, ready for me as soon as I could get back to them. I'd been smoking for over 40 years and, cancer or not, I knew that the damage was done, so what would be the point of quitting now? I was a hardcore addict, I knew I couldn't quit, and I accepted that.

After surgery on Friday, my focus was on staying comfortable (comfortable = avoiding pain) and not messing up the drainage tube obscenely coming out of my lung, through my ribs and snaking over the side of the bed to some invisible receptacle for blood and gore. I made the mistake of having a peek and, believe me, they should not make those tubes transparent. It was unsettling, to say the least.

The pain was fine, unless I moved. I guess I shouldn't have been surprised; they did pull a chunk of my lung out between my ribs, along with the tumors in it, so those ribs and surrounding muscles were a bit tender. The nurses were wonderful, cheerfully pushing another dose of hydromorphone (Dialaudid) into my i.v. tube every four hours and sooner if I whined, which I did. Never occurred to me to crave a cigarette. I don't know if it was the pain, the narcotics or the unpleasantness of the situation, but I think I just forgot I was a smoker.

On Sunday, the drainage tube was pulled out (a disturbing sensation to say the least), the hole was closed with one stitch and the pain subsided considerably. I was now steady enough to walk to the bathroom without hanging on to a nurse, and even explore a bit beyond my room. Breakfast, lunch and dinner were all delicious. It occurred to me that I should be craving a cigarette, but I wasn't.

The next morning, Feb. 8, I was released, less my wee tumors, from the 12th floor of VGH after a checkup x-ray and visits from my surgeon, his residents and a few nurses to make sure everything was okay and I was clear on what I should be doing, or not doing, at home.

Before leaving my room, in a fit of melodrama, I pulled the pack of Export A Ultra Smooth from my jacket pocket and disdainfully flung it into the garbage bag taped to my bedside table. It was like they were someone else's bad habit, and I didn't feel like wasting space in my pocket for it. I did, however, keep the purple Bic lighter.

The first few mornings at home, waking up, I visualized my immediate routine. Open eyes, stretch, reach for the cigarettes, light up, go to the bathroom, then to the kitchen for tea and cereal. I'd normally chain-smoke through that first cup. But wait, there are no cigarettes here. That's not the addiction talking, but my brain; still groggy with sleep, it hasn't forgotten the habit. Awake now, I don't want a cigarette.

It's been a week since surgery and I've still not smoked, nor have I had that berserk craving that's impossible to out-will or ignore. I'm down to only one or two 4-mg Dilaudid tablets a day, so I can't give that any credit. I'm feeling very little pain and getting my energy back quickly, so I should be wanting to smoke. But, I'm not. My jones has left the building.

Cancer cures smoking.

hurry up and wait

2010-02-11T13:48:00.000-08:00

One in three people will get cancer, and there are about 200 types of cancer. Everyone, at some time in their life, is affected by cancer. Although not the most common cancer, lung cancer is the most deadly. Of those diagnosed with lung cancer, 60% will be dead in a year and 70-80% will be dead in two years.

Lung cancer is divided into two categories, Small Cell Lung Cancer (SMLC) and Non-Small Cell Lung Cancer (NSCLC), based on differences in the onset and in treatment. I have NSCLC, which was revealed in a tumor biopsy. There are four types of NSCLC, all considered incurable:

adenocarcinoma;
bronchioloalveolar carcinoma;
large cell carcinoma;
squamous cell carcinoma.

About 30% of all NSCLC is squamous cell. It commonly metastasizes or spreads to the brain, liver, bone and other parts of the body. A PET Scan (positron emission tomography) showed that my squamous cell carcinoma may have set up shop in my spleen, various lymph nodes and bone marrow. Or not; the other locations may be lymphoma or some other type of cancer.

Lung cancer is usually treated, with or without surgery, by chemo and/or radiation therapy. Treatment strategy depends on staging or identifying the development progress of the cancer. Because it looks like mine has spread beyond my chest, I'm guessing it will be classified at Stage IV (advanced) but hoping it's a different type, which would mean that the lung cancer is less than Stage IV.

Although squamous cell lung cancer patients don't respond well to chemotherapy, they respond better to radiotherapy than patients with any other type of lung cancer. Chemotherapy is typically used only for symptom relief and, because I don't have much in the way of symptoms, I'm guessing radiation therapy will be recommended.

My thoracic surgeon, Dr. Ken Evans, referred me to the BC Cancer Agency for staging, tests to determine if my other cancer/s are NSCLC or something else, and what my future holds in the realm of treatment.

I'll be dealing with an oncologist and other cancer specialists or, rather, they'll be dealing with me. Today they told me it usually takes two or three weeks for a referral to be processed. Yeah, yeah, hurry up and wait.

out, damned spots

2010-02-10T01:34:00.000-08:00

Alan J. Cairns at the Pender Harbour Health Clinic was my general practitioner because, when I needed to see a doctor, he was unfailingly the first available appointment.

Go back a few months, and I'm looking for results of a CT/CAT Scan done at St. Mary's Hospital, looking for a reason for nausea and pain in my gut, which I'd been trying to get sorted out since May '09.

"Well," said the good doctor in his rolling Scottish brogue and with a whiff of tobacco smoke on his breath, "You have a bit of emphysema but that will show up in anyone who's smoked for a long time. And," he continued, peering over the top of his glasses at the computer screen, "There's a wee spot on your lung. Likely scar tissue from pneumonia or bronchitis, or maybe TB."

"But, I've never had any of those..."

"Lots of people have them and don't realize it, or you could have been exposed to TB and never got sick. If you're concerned about it, I can set up an appointment with a specialist." This doctor had already assured me, several times in the previous months, that I did not have cancer.

Whatever. I left with a morphine prescription refill and a new one for yet another medication for IBS (irritable bowel syndrome), which the good doctor was convinced was my problem in spite of my protests that I didn't have any IBS symptoms. I was pretty much bed-ridden these days and hadn't worked since June.

Long story short, I dropped Cairns to sign up with Dr. Ingrey, the new kid on the block who seemed to have a brain and didn't seem to have a drinking problem. Ingrey was concerned about the wee spot on my lung, and he got me in to see a thoracic surgeon in Vancouver in less than a month. This in itself is a bit of a medical miracle; in British Columbia, it's normally at least three months until one gets to see a specialist.

Dr. Ken Evans gently explained that my wee spot could be cancer, and got me a PET Scan (positron emission tomography) tout suite at the BC Cancer Agency. I didn't get the feeling, as one often does in a doctor's office, that I was wasting his valuable time. He understood that a visit to his Vancouver office was an all-day trip for me, so he volunteered to fax results to Dr. Ingrey, home on the Sunshine Coast. Yes, I think he's a sweetie.

A PET Scan shows wee spots, tumors and suspicious areas as "hot spots" or "cold spots." Hot spots are cancer, cold spots are a sigh of relief, all revealed without a biopsy or other invasive testing. Big needle through my chest to rip out a piece of my lung, or a relaxing lie-down on a cushioned table and the soft hum of high technology? No contest. I want the PET scan, and I don't care if I glow in the dark for a month!

PET Scans involve an injection of radioactive dye, then imaging in a machine not unlike the CAT Scan. I think of it like a high-performance CAT scan, one on steroids. The worst part of the procedure was having to lie perfectly still for the duration of the scan, about an hour in my case (it's often longer). As soon as you're positioned and begin entering the scan tunnel, of course, your nose itches. You cannot scratch your nose. You must lie perfectly still.

My good friend Jane drove me to Dr. Ingrey's Sechelt office on January 12 for the results. They weren't so good. Hot spots indicated cancer in my left lung (three tumors), lymph nodes at my left collarbone and right abdomen, in my spleen and in my bone marrow. Cancer.

I felt sorry for Dr. Ingrey. He was careful in delivering the information, and I could tell he knew it was tough to take. I succeeded in not breaking down. I told him I was in a state of controlled panic and needed a prescription for a strong sedative so I wouldn't fall apart completely. He wrote one for Ativan (lorazepam), a fast-acting little sublingual pill in the benzodiazepam (Valium) family.

Jane got the news first, then my prescription, Master Card and an order for a carton of Export A Ultra Smooth. No, this wasn't reckless. With possibly only a few weeks to live, what was the point of quitting?

Reckless was asking my friend to fraudulently use my credit card and forge my signature. I didn't think that one through. I would have been stuck in Sechelt, a half-hour's drive from home, with no drugs and no cigarettes, while she was taken to jail. No, this was not at all a good situation.

But, the day was not to be all bad: Jane got away with her crime of credit card fraud and so I got to have Ativan and cigarettes, and a ride back to Pender Harbour.