Mediports and Football: Thursday's Procedures, Part II

The other procedure today was the installation of my mediport. This is a device that’s meant to ease the delivery of chemotherapy, which I’m probably going to start on the week of the 11^th. When my doctor mentioned a port, I pictured something like this:  

Ten years ago I did not have a port; back then, they were bulky and external and prone to fun things like infection, leakage, and clogging. Also, it had to stay dry. So I took the second option—an IV stick for every chemo session, which amounted to needles upon needles until I developed a needlephobia that persists to this day. When my oncologist told me that port technology had advanced in the last ten years, and I should really consider getting one, I was skeptical. But then I found out that now, ports look like this:

And once it’s installed, it looks something like this:

The picture above is not my chest or port. Mine is still under wraps until next week, but I’m hoping that it will look something like the above picture when it’s revealed. Right now, it looks like this:

When they installed my port, they lifted me off the table in the biopsy room, wheeled me down the hall, lifted me onto another table in another room, wrapped me up like a mummy with an inflatable, heated pad (very comfortable), and put a tent over my head. Then a nurse named Linda shaved the area and cleaned it with some prep fluid that she told me was orange. “For Halloween,” she said. Once the procedure started, the doctor gave me a series of sharp injections to numb me up so that I wouldn’t feel the incisions. What I would feel—but not be hurt by—was the tugging and rubbing that he had to do in order to work the port in under my skin and get it into place. Hearing this, I was thankful for the tent they set up that shielded my vision.

Once the tugging and rubbing started, the anxiety that had been building over the course of the morning felt ready to let loose, when apropos of nothing the doctor asked me, "Do you like football?”

“Uh, yeah.”

“Chargers?”

“Bears, actually.”

Several of the attending nurses let out a low, ominous “Oooooooo…”

“What?”

“Your doctor is a Lions fan,” a voice in the room said.

At which point I told him that I was, too, after last week’s game against the Cowboys, when Matthew Stafford—who happens to be the starting quarterback on my fantasy football team—pretty much assured me victory with his ballsy call to fake a spike and run the ball in for a touchdown as time expired.

This led to a longer conversation about fantasy football—my number one non-work related, non-family related obsession—and before I knew it, the procedure was over and I was on my way to the recovery room.

And what was I thinking about there? The folder of instructions for what to do today after having two invasive procedures? The biopsy results, due back next week? My impending chemotherapy?

No. I couldn’t wait to get home to obsess about my fantasy lineup for this week.

Never underestimate the value of a good distraction.

Put Your Hand in the Hand: Thursday's Procedures, Part I

One of my favorite short stories is Raymond Carver’s “Cathedral,” and no matter what class I’m teaching, I’ll almost always find an excuse to use it. The story is told from the perspective of an unnamed narrator who’s anxious because a blind man—a friend of his wife’s from before he knew her—is coming to visit them. Our narrator isn’t a bad guy, but he doesn’t get out much, either, and he’s uncomfortable (to say the least) with anything that exists outside of his own narrowly-defined boundaries. Anyway, this changes over the course of the story in the unlikeliest of ways. After the narrator’s wife has gone to bed, our narrator and the blind man, Robert, are smoking pot in front of a television documentary on cathedrals. The narrator, in the first of a series of small but significant moves outside of his comfort zone, asks Robert if he knows what a cathedral is. He doesn’t, so the two of them decide to draw one together. Or rather, the narrator will draw it while Robert goes along for the ride. Whenever I talk about the story, I always spend a lot of time on two lines that Carver writes to capture this moment:

“He found my hand, the hand with the pen. He closed his hand over my hand.”

I love these lines and how their repetition of the word “hand” shows how much this moment of connection means to the narrator.

I thought of this story and scene today. I was back in the hospital for two procedures—having a mediport installed (which I'll cover in another post) and getting a biopsy done of the growths in my abdominal cavity. We did the biopsy first. This involved me climbing onto a narrow table, lying face down (while protecting my still-tender incision from Monday’s surgery), and remaining as still as possible while they ran CT scans, inserted biopsy needles in my back (thankfully, I couldn’t see this), ran more CT scans to check their position, repositioned the needles, and took samples. I was sedated for this, but I could still feel movement back there. It wasn’t painful, exactly, but it was uncomfortably noticeable, and I started to visualize a long, sharp needle poking organs and arteries and other tender pieces of my insides.

I must have winced or had some kind of a distressed look on my face, because one of the nurses, a woman named Julie, came over and bent down by where my head and arms were sticking out of the CT machine, and as the doctor fooled with the needles in my back, she took both of my hands into hers. She didn’t say anything; she just held my hands through the rest of the procedure.

For these last few days, I’ve been moved at whiplash-inducing speed through doctors’ visits and tests and hospitals, so when someone reaches out—in Julie’s case, literally—to slow me down, I’m grateful beyond words.

Post Op Blues

So, I'm a little over twenty-four hours removed from my surgery, and here's where I stand:

I'm not supposed to lift more than ten to fifteen pounds for the next four weeks. I'm not sure how this is going to go; I mean, I've filled plates of food that weigh more than ten to fifteen pounds--just ask anyone who's seen me at a cookout. Of course, my appetite's due to take a nosedive in the upcoming weeks, so maybe it's just as well...

I completely lack the flexibility (without screaming, that is) to put on my socks.

I found out last night that I have a total of three positions for sleeping: Hurts, Also Hurts, and Yep, Still Hurts. Now you may rightly ask, "Didn't they give you any pain medication?" to which I would reply, "Yes. But here's the thing..."

At this point we're about to venture, possibly, into TMI territory, so if you're of delicate temperament, you might want to stop reading here. I suppose I could stop, too, but when you've got cancer, you're pretty much allowed to say whatever the hell is on your mind. People are forgiving that way.

So, the pain pills. They have a pesky side effect. They can constipate.

And in my current state, that would be...well, it would not be a good thing.

Basically I'm dreading going to the bathroom if I have to exert any kind of force. I've tried a couple of times already, and when gravity hasn't kicked in, I've lacked the fortitude to help it out a little. It basically hurts like hell, even with a pillow pressed against the incision on my lower pelvis.

But really, to even get to that point of chickening out is pretty draining. That is, I first need to execute the once-simple act of sitting down on the toilet. To do this, I have to grip the sink with my left hand, grip the handle on the shower door with my right, and s-l-o-w-l-y lower myself until I'm about six inches off the toilet. Then I move first one hand and then the other to the toilet seat and complete the lowering process. Oh yeah, the whole time I'm wincing and sweating. It's only been a day, but I've already forgotten what it's like to get on a toilet without thinking about it.

So please, if you're reading this, the next time you sit down on the can with relative ease, whisper a little thank you. Because it might not always be so easy.

Adios, Sundance

"Count backward from one hundred."

I'm lying on a thin blanket and staring at three powerful-looking lights mounted to the ceiling. People in blue gowns and white masks move all around me; I know this not only because I can hear them but also because they keep popping up above me in my field of vision.

"One hundred..." I say.

My left arm lies against my side, an IV needle sticking out of a soft patch of innner elbow and trailing a long skinny tube that snakes somewhere behind and above me. I've got wires attached to various points on my chest and legs. My calves are wrapped in massage sleeves that are supposed to prevent blood clots. Something is beeping.

"Ninety-nine..."

The last time I was in a place like this, I was fourteen years old and about to have my appendix out.

"Ninety-eight..."

Now I'm having an orchiectomy, a word that I saw for the first time on Friday and that I've had to ask three different medical professionals how to pronounce.

"Ninety-seven..."

I've heard stories--probably bullshit--about anesthesia not working, about people being immobile yet able to feel every clamp, every retraction, every suction, every scissor snip, every scalpel slice. Again, probably bullshit, but when you're on the table, bullshit becomes a living, breathing thing.

"Ninety--"

And then it's over. I can see faces again--nurses', my doctor's--as they're moving my rolling bed back into place in the recovery room.

"How do you feel?" my doctor asks me.

She's a young woman who didn't in any way fit my expectations of what a urologist should look like when we had our first appointment last Friday. She didn't fit my girlfriend Shannon's expectations, either, when she met her for the first time that morning. I knew this from her narrowed eyes and the whispered, "We'll talk about this later..."

"Are you feeling okay?" my doctor asks again.

"Yeah," I say. "Big changes for Butch and Sundance."

"Who?" she asks.

I gesture vaguely at my crotch. "Butch Cassidy and the Sundance Kid. They just became the Lone Ranger."

The Condition of My Condition

I’ve fallen lots of times on my bike, and it’s always the same. My tire catches on the lip of a curb or slides on some loose gravel, and there’s a sudden shift of weight and space. My body tightens and I imagine my face registers something like shocked surprise. The world as I know it—a carefully balanced ride from here to there—has radically and swiftly rearranged itself, and I’m struggling to catch up.

But that only lasts a split second. The thing to do then is understand that you’re falling and nothing is going to change that. Just ride out the fall and wait to land. Then pick yourself up.

When I heard from my doctor the afternoon of the sonogram and he told me that I had a mass on my right testicle, a weird calm came over me. I took a deep breath, heard the word Okay in my mind, and understood that I had given in to the fall and was waiting to land. Got it. A growth. So what do we do now?

My schedule immediately filled. Appointment with a urologist. Biopsy of the growths that the CT scan turned up. Insertion of a port for chemotherapy. Surgery on the morning of the 28^th.

Okay.

The big news was that this was almost definitely not a recurrence of my germ cell cancer from ten years ago; it was a new one—testicular. I’ve never so much as won a fruit basket in a raffle, but apparently I’d hit the cancer lottery twice.

But I’ll take that bad luck because it’s more than balanced out—not even close, really—by my good luck at having the friends I have, and who have leapt into action with a swiftness and focus that makes Seal Team Six look about as efficient as the DMV.

So with all of this in mind, I’m shifting the focus of this “Queasy Writer” blog (a title that is probably going to become more literal than metaphor). I’m going to do my best to update daily or near-daily in order to chart this new journey and the people who help me along the way. It will be a way for people to stay updated on my progress, and I’ll try to make the details of my particular cancer, its treatment, and (fingers crossed) my recovery as lively as possible.

Please Lie Still While I Crush Your Balls

When most people hear the word “sonogram,” they probably conjure up pleasing images of a young man and woman holding hands and expectantly watching a screen while a nurse gently slides the wand-like apparatus over a smooth round belly.

Sadly, this isn’t exactly what happens in a testicular ultrasound.

I’d been dreading this test from the moment my doctor said I needed one to find out if this was in fact a recurrence or something new. I had one ten years ago, and even though it came out negative, it was still pretty much the worst part of that cancer experience. Would a normal person think this? Probably not.

I went in early. The waiting room was empty except for a woman sleeping under the television and an older couple who was having an animated conversation in what I thought might be Hawaiian. I tried to focus on the TV—some morning talk show was on—but I couldn’t follow the interview.

“Verasky?”

I turned to see an attractive woman with glasses who looked like she was about seventeen.

“Versaci?” I tried.

“Oh, okay. Sorry. Come with me, please.”

She introduced herself as Hailey and told me that she was a sonogram technician and would be doing the procedure today.

“That’s perfect,” I said.

As we walked down the hall, I asked, “Have you done a lot of these?”

“You’ll be my second.”

In the small, dimly-lit room, she walked me over to a bed and pulled a curtain around. I felt like I had to come clean.

“Okay,” I said. “A couple of things. First, I’m a little tender down there right now. And second, I’m a huge baby when it comes to my balls.”

She just looked at me.

“I mean, I’m definitely going to be your worst patient of the day.”

She laughed nervously. “I’m sure you’ll be fine.”

“I’m sure I won’t,” I said. “But listen. If I pass out, I want you to just go ahead and do the procedure while I’m out.”

She stared at me. “Can you please take off everything below your waist and sit on the bed? I’ll be right back.”

I stripped and waited. I heard footsteps before the curtain pulled back and there was another woman standing there. Also attractive.

“I’m Natalie, and I’ll be doing your sonogram today.”

“Did I freak out Hailey?”

“A little bit, yeah.”

I gave Natalie the same spiel, all in the interests of full disclosure.

“Well, you just relax, and we’ll go slow.”

“Okay, but I want to apologize in advance for the undignified behavior that you’re about to witness.”

She snorted, then arranged me on the bed, a towel over my thighs just below my scrotum, and a towel over my penis just above my scrotum. She spread some gel on the edge of the sonogram wand, which looked like a little vacuum cleaner attachment.

“This might be a little cold,” she said, and moved the wand down to my balls.

At the moment I sensed contact, my entire body tightened up and I clutched the top towel in my hands. The force pressing down on the most sensitive part of my body was more than I could bear. This was worse than I remembered, worse than I could have imagined.

“I haven’t touched you yet,” Natalie said.

It didn’t get much better. She told me to just breathe normally, and I thought I did, but then she warned me not to hyperventilate. She also mentioned at least twice that it was taking a little longer because she was going so slow.

When it was over, I said, “You’ve been doing this for a while.”

“About thirteen years.”

“So, I know a radiologist has to read this, but can you tell me what you think?”

She looked at me. “I really can’t.”

“I can’t help thinking that if I’d been a better patient, you’d tell me something.”

She smiled. “Go ahead and get dressed.”

Just before I left, I said to her, “You should be grateful. Now you’ve got a ‘this one guy.’”

“What do you mean?”

“Well, the next time someone gets anxious on the bed there, you can just say, ‘Listen, I had this one guy…’”

She laughed. “You take care, now.”

With that procedure out of my mind, I could focus on something else. Like my certainty that I had a growth.

The News

So, the tests.

My doctor sent me for another blood test that day, on October 11^th. Just to confirm the first results. Of course, they did.

Then a CT scan on the 17^th. Chest, abdomen, pelvis. I hadn’t had one in a while, but it’s amazing how fresh the details stay. Choking down almost a full liter of barium in the hour before the scan. I did have my choice of flavors—mint, bubblegum, or orange—but there’s no hiding the chalky texture. For the record, I picked orange, but it really should have been called “vaguely orangish.”

Another part of the CT is the iodine dye that they send through an IV. The technician, a young guy named Eric with a bone-grinding handshake, put the line in my arm and fastened it with what later felt—when he pulled it off—like duct tape. He began to tell me what the iodine would feel like, but I stopped him and said that I’d been here before.

“Okay,” he says. “I’m starting it now.”

A puddle of heat spreads across the back of my throat. I swallow reflexively, but it’s not going to go away. In fact, it grows. I can feel the warmth leak slowly down the length of my spine and pool in my crotch. It’s not pleasant. It’s made even less pleasant by the fact that those two big containers of barium are now pushing urgently against my sphincter.

“We’re almost done,” he says, as if sensing my discomfort.

And then we were.

The results came in the following Monday. I was sitting in my office, ready to bike home but waiting for my doctor to call with the results. Finally, the phone rang.

“How are you?” I asked him.

“I’m fine,” he said. “I wish I could say the same for you.”

He told me that I had “multiple growths” in roughly the same vicinity as last time. He said that he’d never heard of a ten-year recurrence of germ cell cancer. We made an appointment for the next day so that we could go over everything in more detail. I knew it was coming, but clearly a part of me still believed that the two blood tests had all been a giant mistake. And then, as if I needed another reminder that we’re all prisoners in our bodies and slaves to what they might do to us, I got cold, my hands—and, presumably, the rest of me—turned white, my head started to hum, and I felt like I was going to throw up.

The next thing I knew, I was standing in my kitchen and calling my son, whom I was supposed to pick up in twenty minutes. Somehow I had biked home, but I had no memory of the ride. It was gone, just like the fragile security I’d been living in.

Guy Walks into a Doctor's Office...

…and gets told that he has cancer again after ten years.

Sorry, pretty shitty punchline. But it’s the one that I’ve been dealing with since Friday, October 11.

When I finished my chemotherapy for germ cell cancer back in September of 2003, I’ve been going back for regular tests make sure I was still cancer-free. For the first year or two, these tests were intense—blood tests and chest, abdominal, and pelvic CT scans every three months. For a year after that, they dropped to every six months, and then annually. After five years, no more CTs; just blood tests.

My anxieties experienced a similar decline. I thought about my cancer constantly for the first few years, then occasionally, then pretty much not at all.

So this year—my ten year anniversary of being cancer-free—I almost didn’t make an appointment. I’d started to get the feeling that my doctor didn’t need or want to see me anymore. In fact, on my nine-year visit, he turned me over to a physician’s assistant. I figured I was in the clear.

The nurse had just taken my temperature and blood pressure, and I was waiting in the little room for someone—my doctor? another PA?—to come in. As I waited, I Googled “blood pressure charts” because the numbers the nurse recited to me seemed a little high. I was worried that I might have hypertension.

I’m trying to recreate that moment in my head. I’m hunched over in the stiff-backed chair, one hand holding my phone while the other one scrolls through Google hits and waits for them to load. While they do, I stare at my black Vans, which are starting to fade out to gray in the toes a little. One shoelace looks a little loose.

I want to savor this moment because it’s the last moment of peace that I remember. Funny thing is, it didn’t seem peaceful at the time (Do I have high blood pressure? Do I need to get a new pair of shoes?). I thought these were real worries. A few seconds later, they became laughable.

My doctor walked in. He was looking at an open folder in his hands.

“Your tumor markers are up,” he said.

Ba-da-BUM

Thanks, folks, you’ve been great. I’ll be here all week.