The elephant in the room.
April came, Joanie was getting exercise, eating well, and wanting to get back to work, and by the middle of the month she had her first outing when she met some people she worked with for lunch. I could see she was getting ready to go back to work, if only on a limited basis. Before long, she was back full time.
What we hadn’t thought about, or talked about, was the elephant in the room. This whole series of events had been brought on by the return of cancer. While all of her energy was devoted to healing from the surgery that was supposed to be “curative,” we hadn’t even thought about cancer that much, let alone talked about it. After all, she was supposed to be cancer free now.
For the most part it worked. However, a couple of days before our next visit to see Dr. Carson, it would not longer be ignored. Joanie, as she had before, would become a little short with me, and sit quietly for longer periods, and I knew it was because of the pending visit and examination. With cancer, we were never sure what an exam might show.
Her appointment was for Tuesday, so we left on Monday, and that night had dinner at the Village Wok, across the street from the Radisson with Ryan and Kim, and the subject was still being ignored.
The anxiety and uncertainty that accompanied every clinic trip was unwarranted this time. Joanie was given a clean bill, and there was no evidence of disease, and she wasn’t scheduled for another visit until mid-June. Joanie and I walked over to Sally’s after the appointment and had a glass of wine to celebrate. That night we went to dinner with Ginny and Ed at the Lexington in St. Paul, all of us feeling rather good about the day.
This dynamic was part of the process when we were issued a ticket to ride on the roller coaster that is cancer treatment, and we were getting used to it, even if we didn’t look forward to it. It takes a toll, and does test the coping mechanism of both the individual and the caregiver, but you do your best.
The June appointment was the same, and Joanie came out with a clean bill of health. She was scheduled for another visit in mid-July to have a colonoscopy as part of the preparation for what we hoped would be the next phase of this treatment, and that was taking the ileostomy down and hooking her bowel back up. Carson had ordered the colonoscopy because of a rectovaginal fistula that was probably the result of the radiation she had had. The fistula is an abnormal connection between the vagina and the rectum which could allow for feces or gas to pass through the vagina, which of course would present a whole host of other problems. The colonoscopy would give them a more definitive view of what was involved, and give them a better idea of how they might handle it from a surgical perspective.
I already knew there was only an outside chance now, so that subject was never talked about much. She would mention it from time to time, and all I could do was nod in agreement, still feeling somewhat disturbed I hadn’t told her what I knew.
In the interim, we did our best to get on with life, and as we discussed in the hospital, not let this disease control our lives any more than it already did. That approach worked for the most part, and we did get back to doing normal things, like going out with friends, having parties in our backyard, and enjoying our Sunday mornings with bagels, bacon and cream cheese. Your mind allows you to sometimes forget that you are in the midst of dealing with a deadly disease, and I think it helps to keep you sane.
On July 13th, we were back in Minneapolis, and Joanie met with a doctor from Colon and Rectal Surgery for the colonoscopy. Dr. Julio Garcia Aguilar conducted the procedure, and was only able to go so far due to “significant discomfort” on Joanie’s part, but he had gone far enough to be able to tell Carson what he had found.
We wouldn’t know this right away, but Aguilar’s note to Carson said:
“Given the size of the fistula and the radiation changes in the rectum, I do not think that a local procedure such as an endorectal advancement flap will solve this fistula. Repair would require removal of the rectum and bringing down some normal colon to perform a coloanal anastomosis. However, given her previous surgeries, this will be a technically difficult option, if at all feasible. Mrs. Wigen has demonstrated interest in having this fistula closed and ileostomy takedown. I have told her I would discuss different options with you and then we will make a final recommendation.”
Now, I am not a professional medical person, and I won’t even attempt to explain what and endorectal advancement flap is, or what a coloanal anastomosis is, but even I could read that to mean that it was going to be extremely difficult, if not impossible, to fix this situation, and it would result in a permanent colostomy for Joanie. By the way, I did look both terms up, and what he said all made sense.
We weren’t told right then what Aguilar had found, or what he had reported to Carson, and we headed back to Bismarck the next day, not knowing anything more than we did when we came down. I assumed we would be finding out in the coming days what Dr. Carson was planning on doing, and we would just have to wait with that cloud hanging over us. Joanie was still hoping it would turn out as she wanted it to.
It had been a tough winter and early spring, and the summer wasn’t giving us much of a break either.
She needed some good news for a change.