Thursday, June 28, 2012

The HBO Miniseries Continues

It has been a while since I have written in the present tense and updated readers on what's going on today. A long slog of daily hyperbaric treatments just does not inspire in the same way as strokes and false alarms of clivus cancer do.

Here's what's up:

1. First, the surgeons have come to consensus. Dr. Treebeard, Famous ENT, agrees with everyone else that surgery is not a good idea in the absence of a doomsday head infection, which I do not have. You may recall that he had been discussing possible surgery for late this month. It is not as though things have changed that much, so why is he singing a new tune?

Reading him charitably (which I should), last time I saw him, he was responding to me. I was terrified after a small stroke and with an infection, and I had an open bone next to my brain that I wanted covered right away. He did not say that surgery was inevitable. He just said that he could do surgery if conservative treatments (meaning hyperbaric oxygen and nasal antibiotics) do not work. I wanted surgery, because I was afraid of what would happen without it. In any case. . .

2. Second, the HBO, the antibiotics, or the combo, is working. My formerly-naked clivus has become far more modest. After  less than three out of six weeks of treatment, the area was mostly covered. Through the pharyngoscope, the area that had been bare bone has now taken on the appearance of Kobe beef. The red granulation tissue (or scar) is growing over healthy bone with no sign of infection. Hygeia, the Greco-Roman goddess of Otolaryngology, has promised that the next time she looks at it, she'll take a picture I can hang on my fridge.

3. I have nine more hyperbaric treatments to go followed by one more week of nasal antibiotics. Thus, the crisis that began with everyone thinking I was in for the battle of my life will resolve with the healing of a deep wound I didn't even know was there.

Tuesday, June 19, 2012

Childhood Flashback 2. The Catch

The long, sleek, black pharyngoscope lay coiled in gray foam inside a steel shell case. "I'm going to numb your nose with a spray and put this tube into your nostril so I can see what's there," said Dr. Feldman to the boy. "It shouldn't hurt, but tell me if it does, and I'll spray some more. It will definitely feel strange." And it did.

Then, he saw the thing, the mass, the tumor. He saw its underside when he put the dental mirror in the boy's throat. It was an ugly, irregular, scabby, crusted thing that had no right to be in a child's face. Dr. Feldman's heart beat quickly with horror and pride.

Later, they sat in his office. "I see a mass in the nasopharynx. (Tom, that's the area behind your nose.) It's blocking the right inner ear and causing the earache. It's also blocking the right nostril." The boy smiled nervously, the parents, ashen.

That very afternoon, the boy lay down in on a stretcher that pulled him through the great ring of hardware spinning behind glass and plastic--the CAT scanner--a new and miraculous invention. His father informed him that the CAT scanner's development was partly funded by investment from Capital Records, the company that had produced the early Beatles in America. Later, his friends asked if there was a thank-you to the Beatles on it. There was not.

The tumor glowed in the pictures, a crab confined behind his face. The parents' dread weighed in their throats. Afterwards, inexplicably, they took him to a horror movie--An American Werewolf in London. Twenty-five years later, when the boy saw a poster for the sequel, he felt as if someone had walked on his grave.

What sort of mass was it? Was it the kind that bled uncontrollably when cut? That had to be known first.

So the boy learned what an angiogram was. A few days later, he lay very still as the tube was inserted into an artery in his right groin and threaded all the way to his face. Then he felt the burning of the contrast dye as the doctors took x-rays. He would remember it as the most painful, frightening procedure of his life--the cut in that terrible place, the pain of the dye, the imperative stillness. But they discovered that the mass was not a bleeder.

Then came the pediatric hospital of plate glass windows and carpets and walls of deep blue. As the resident closed the boy's surgical wound, Dr. Feldman stepped out. The parents and the father's mother stood up. "Tom, Carol, can you come with me to the Family Room?"

The grandmother's fury erupted when they returned and told her what he had told them. Before her jabbing finger, the tall, broad-shouldered surgeon folded on himself. "How DARE you leave me out of that room! How DARE you tell them first that MY GRANDSON HAS CANCER!"

Saturday, June 16, 2012

Childhood Flashback 1. The Earache

Someone might have found it earlier. Might have prevented a lot of grief. One year before, he was playing 'maul ball,' where the object of the game is to tackle whomever has the ball. The concussion sent him to the emergency room and got him the skull x-ray. There it had been, waiting for a brilliant catch by some genius radiologist who never was.

But one year later, it demanded attention. On a hot summer night, the boy and his friend put on a play for the parents. After the boy slept under an air conditioner's frigid wind that night, the morning's earache seemed natural.

But the earache did not go away. It bored into his head. It grew worse over weeks and months. Soon, the right side of his nose could not breathe. It bled. Infection? Allergy? Try this pill. Or that. This pill did nothing. That pill caused a rash. Neither made it better.

Running laps, breathing hard, the boy felt something flopping in and out of his throat. The awkward young history teacher saw him falter. The teacher had probably been compelled to coach 6th grade football. His voice cracked as he yelled at the boy to try harder.

The parents were not long out of medical training. They could imagine. The dread grew. What is wrong with the boy? The only. The one child.

Saturday, June 9, 2012

Childhood Flashback (#?): Unlucky Me?

The lawn was like a tightly woven carpet around the palm trees. Joseph's black skin shone in the sun as he stood next to flowering bushes, sheers in hand. The pale boy's head was bald and shone as well.
He was thin and wore an Izod shirt and plaid shorts.

The boy lingered as his parents walked on with the porter to their cottage. "Hi, I'm Tom. What's your name. . ."

And as they talked, Joseph came to ask, and the boy told. The reason he was bald was that he had cancer. The treatment made all of his hair fall out. But he was going to LIVE.

"But I know a girl in town. She has breast cancer. She is only 14--just three years older than you. The doctors said they could not help her. She is waiting to die."

"But they must be wrong! They can cure cancer!"

"It is too expensive to go to America, so she stays here."

"No! This is wrong. I have to talk to her. There must be money somewhere for cases like hers. It's stupid that she should die."

*                        *                        *

The next day, they passed through the clean white gates and down the dirt road of houses surrounded by walls topped in shattered glass. A short walk farther were the concrete buildings of the harbor, gray with dust and with corrugated aluminum roofs.

Through a gate was a small dirt yard with a naked toddler and a sad mother. She smiled at the visitors. "Please, come in. Joseph told us about you."

The inside of the house was small and dim and cooled by the smooth concrete floor. The thin, shy girl sat on the tattered couch. Her hair was cornrowed.

The boy launched into his sermon of hope. When he was done, the mother smiled and sighed. "We took her to Miami. The hospital had a free program. She saw the best doctors, but she has a bad cancer. They did their best, but there is no more they can do. She is home now, so she can be with us."

"Oh. . . Oh. I'm sorry. I'm sorry."

Joseph took the boy back up the road and through the white gates to the manicured lawns and flowering bushes and palm trees and a beach of pink sand with warm, gentle waves.

Sunday, June 3, 2012

The Down Low on HBO

My kindergarten* best friend B asked me to explain to him in more detail what HBO was like. I wrote him several messages. Then, I realized I had a Tumoriffic update in the making.

My verdict on HBO? It could be worse. It is--if I think about it when it's happening.

It takes place, as I have described before, in a sealed, horizontal, clear acrylic cylinder. Lengthwise, I can just touch either end of the tube with my arms stretched up and my toes pointed. Width/height, I can sit at a 45 degree angle. Much more, and I would bump my head. However, the acrylic is clearer than glass, and, especially if there is a good movie on, I mostly don't notice.

I lie on a stretcher, which is annoying, because the mattress is plastic, and even through the sheet, it makes me sweaty. At the same time, I am often a little cold. They have increased the blankets I take in with me, though, and that helps. On my wrist, I have a bracelet that is wired to the chamber to prevent static buildup. If I wish, they will also send me in with a water bottle and, for urgent situations, a urinal. They do not have a stoolinal for the truly bad situations, which makes the plastic mattress worth the annoyance.

Because of the risk of fire, I must not bring anything in with me except my glasses, but including my clothing. I wear nothing but a johnny. I have to insist on getting a long one, or my butt hangs out.

Everything else is forbidden. My iPod or a book could light the 100% oxygen on fire, as could deodorant, hair gel, skin creams, earrings, nose rings, nipple rings, and mustache wax. I'm not kidding about that. There is a sign that lists all of these and more in the dressing room. I can imagine how each was discovered. For instance, at some point, some Salvador Dali look-alike got into an HBO chamber and spontaneously combusted. Or maybe that's how Dali died. I'm too lazy to look it up.

The stretcher is not great for sleep, but I can watch movies on a TV that is attached to rails on the outside of my chamber. I bring my own movie or watch one of theirs. They have a limited selection. I'm on episode 4 of my own copy of 'I, Claudius' right now. I suppose I should be a responsible doctor and watch continuing medical education videos, and maybe I will watch a few. Despite the potential for HBO puns, I don't think I will watch A Game of Thrones there. The every-other-scene nudity would be a bit awkward with the nurse sitting two feet away on the other side of the acrylic shell.

I do not get to use the remote. If I want the volume changed, or anything else, I have to wave frantically at the nurse. She can speak to me on an intercom with a speaker and microphone in the chamber. Incidentally, other than the TV and the intercom, the sound isolation is practically complete.

I am a little tired afterwards, but they say that gets better.

Frankly, I like most people, would gladly pay my lunch money just to be in an acrylic tube for 2+ hours watching movies every day, but the kicker is that I don't get to wear my bling. No, actually, that's not true. Aside from my wedding ring, I have no jewelry. I gave up the tiara last year. I find the nearly four hour time suck of driving there, waiting for preparation, being inside (a.k.a. diving), waiting to be cleared to leave, and driving to my next destination to be highly inconvenient.

I can imagine what my dear friend G** would say, so I will preclude her objection. It could be a lot worse. It's not hemodialysis after all, and, unlike hemodialysis, it will end in five more weeks. Best take it philosophically as yet another tourist ride into chronic illness where I get to return to something resembling home afterwards. Then, I will be able to tell my patients what it will be like for them--this is the value of involuntary experiential internal medicine.


* We were best friends in kindergarten. He is no longer a kindergartener. That would be weird no matter how you read it.

B is the only one of my close friends my own age who can give me a run for my money in medical adventures. He is currently recovering from a cardiac valve replacement, the latest of his many heart surgeries. (He's all heart, I'm all head.)

** G is not exactly my age, but can go toe-to-toe with me any day on premature health nightmares.