Another new doctor and another new reality.
The initial news was a stunner. We were now again faced with a sea of uncertainty and confusion, and it would be sometime before it would cleared up.
Dr. Hughes’ notes, said after the bronchoscopy, “This lesion has the appearance of a primary non-small-cell lung carcinoma.” Lung cancer.
The day after was a Saturday, and Joanie didn’t have to go to work. We talked, and she was wondering what she should tell people. There were those who knew she was going in for the procedure, and I told her, she should call John and Mikey and tell them there was a potential problem, but we wouldn’t know any more about it until after we meet with Dr. Carson in Minneapolis, and after that she could tell anyone she thought needed to know, or who she wanted to tell. The fact was, at that time, we didn’t know much.
We had a dinner club scheduled with three other couples for that night, and we changed those plans. One of the other couples graciously took our turn.
That day I went to the computer, and plugged in non-small-cell lung cancer, and proceeded to find out more than I could ever understand about it, but I kept looking to see if I could get an idea of what it was, and what kind of treatment there was for it, and what the odds were.
This was a time when I, as caregiver, began to look for the answers to those questions that would give us the most positive options.
I had grasped onto Hughes’ impression that it had the appearance of lung cancer. Using my limited medical education, I had found a branch to cling to, and that was, depending on the stage, surgery might be curative. That meant, losing part of a lung might be the answer. This is when you learn, as a caregiver, about the triumph of hope over reason. I found that I was so bent on finding something that made sense to me that in spite of my medical ignorance, I wanted badly to find an answer that made sense.
All I wanted was to find an answer that would make Joanie feel better, and give her something positive to hang onto. Our world had all of a sudden been disrupted.
The thing I missed altogether, as I was to focused on the lung cancer part, was that this was, in all probability, metastatic squamous cell cancer of the cervix. Here again, hope over reason. What I had read a long time ago, but had forgot, was that if cervical cancer metastasizes, the lungs are one of the popular places for it to show up. I had paid little attention to that, due mainly to our holding on to the fact that the exenteration could be “curative.”
It was a ten day wait from the time of the bronchoscopy until we met with Dr. Carson in Minneapolis, and it was ten days full of uncertainty and on my part, confusion. Joanie, kept busy. Her calendar was full, and as far as she was concerned, she would worry about this when we next met with Carson. She had work to do, and nothing was going to get in the way.
Come the 21st of April, we meet with Dr. Carson in the clinic, and we find out she is recommending Joanie see a Dr. Michael Maddaus, one of the top thoracic surgeons at the University of Minnesota Hospital to discuss what the next step will be in dealing with the suspect mass in her right bronchial tube. We still didn’t have an idea of what exactly what it was, but I’m not sure they knew exactly either, even though they probably thought it was metastatic disease. Carson order a CT scan, so at around six that evening we found ourselves over in radiation to get that done. We would see Maddaus the next day.
The next afternoon, we met with Dr. Maddaus at the Masonic Cancer Center which is located between the Phillips-Wangensteen Building and the hospital. He came in to the room, relaxed, shirt collar open, followed by a nurse who was taking notes. Maddaus struck me as one of those surgeons who could have been on M.A.S.H. with Hawkeye or Trapper John. It wasn’t that he was brash, but it was that he exuded confidence and about two minutes after meeting him for the first time you felt he could do this. Joanie took a liking to him immediately.
I was really pleased with how he dealt with her. He made her feel comfortable, in what was a very comfortable situation. He was telling her they were probably going to have to take out part of her right lung. He spent about 45 minutes talking to her about how this might be done, and told her they might be able to do it laproscopically, meaning they wouldn’t have to open her chest. That would be the best news we could hear. He did caution her that they might not know that until they got a better look at what they were dealing with. Joanie seemed okay with everything he was telling her. I remember thinking, “This guy is one helluva surgeon, and probably could be one helluva salesman.”
Nobody, not Carson nor Maddaus, had told us for sure they thought we were dealing with non-small-cell lung cancer, or if they were dealing with metastatic cervical cancer. All we knew right then, was that he was going to be her surgeon for the next time she went into an operating room.
Before he left, he told us he wanted a PET scan, which was a new one on us. We had never heard of this one before. PET stands for Positron Emission Tomography.
What it amounts to is a scan they do after the patient has been injected with radioactive glucose, and since cancer cells metabolize glucose at a higher rate than normal cells, the cancer cells light up on the scan, and it gives doctors a more precise picture of what and where the problem areas might be. Think of the cancer cells as sort of a perverted PacMan that gobbles the juiced up sugar, and lights up the screen. This diagnostic tool was fairly new when Joanie had her first one. It was so new, that the scans were done in a trailor parked next to the hospital. This tractor-trailer operation would make rounds of hospitals in our area where it wasn’t available on a full- time basis in house.
Since it involved nuclear medicine, I wasn’t able to accompany her any further than the door to where they give her the shot. With the PET, they could compare the results to the CT scan of the abdomen and the chest they had made a few days earlier.
The result of the PET showed, “Impression: There is a single focus of concerning uptake corresponding to CT abnormality in the right lung, consistent with malignancy.”
When they use the word uptake in connection with a PET scan, it means something lit up. In Joanie’s case, the scan agreed with the CT there was something terribly wrong going on in her right lung.
We had been in Minneapolis for about three days now, and it was beginning to tell on Joanie. We headed for home, not caring if we got home early or not, she just wanted to be home.
We didn’t talk at all about what we had been told by either Carson or Maddaus, and all we really knew was we had about fifteen days until we were back down there for lung surgery with Maddaus.
By the time a couple of hundred miles were behind us, I began to reflect on how unfair I thought this whole deal was. She had been so close to the five year survival threshold, and it was snatched away unceremoniously from her, starting with a cough.
Not that other people don’t have bad experiences, or suffer medical setbacks, but this was my Joanie, and I didn’t care if anyone agreed with me or not, she was getting a bum deal. It wasn’t fair, and the future was in doubt again.
When we got back to Bismarck, and she found the couch, and Muffin found her lap, I looked at them sitting there, and couldn’t help but think that if Muffin had a voice, she would agree with me too.