The Diagnosis

You have no idea how strong you are until you have to be. And, I believe, generally we are much stronger than we think. Throughout my life, I’ve seen people go through shitty situations and think “Man, I don’t know how they do it.” Well, I now understand. You just do.

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By the time we went to bed after what had been the longest day that I can ever remember, we were well versed in the Pericardial Window procedure that I would have in the morning. I had only been under anesthesia once before when, a few years prior, all four of my wisdom teeth came out. Overall, that whole ‘going under’ and waking up process was a pleasant experience, so I was kind of looking forward to that. And the actual operation sounded relatively simple – cut a hole in the sac, syphon out the juice, and close me up. Easy. The result would give my heart some much needed relief, they would be able to determine whether there were cancer cells in the fluid and, most importantly, determine the type of cancer. All that could be determined from testing the tiny piece of membrane from the window but since the surgery was on Saturday there was no pathologist to do the test and we would have to wait until Monday for preliminay results.

As I came to learn throughout my stay, hospitals come to life at 4am for routine blood work, chest x-rays, and on days when surgery is scheduled, to start an IV drip. So that’s also about what time I began to get nervous. Though I was mostly looking forward to a really good anesthesia-induced nap, it started to sink in that this was way more serious than pulling a few teeth and my nerves started to get to me. But soon after the nurses did their thing, and we were left alone in the room with our thoughts, the surgery team came in with Starbucks in hand to introduce themselves, review one more time what they would be doing, and put us at ease. Since I was only allowed to tee-tee into a jug, my nervous bladder and I were thankful to relax.

As it turns out, Baton Rouge is much smaller than it seems. And, when you’re old enough in a small town, the friends you made in college are the people that get to operate on you. That’s where I was. I was lucky as usual and a few members of the kick-ass, all-female surgical team were people I knew from college and friends of friends. Now I’m not going to say that I got special treatment because of this, but, from this point on, I’m pretty sure I got special treatment. It was, at the very least, nice to see familiar faces.

A little while after explaining the procedure to us but before being transported to the OR prep, the Nurse Practitioner came back in the room with some pep in her voice. “Change of plans. Instead of going in through your chest, we’re going to go in from the side. We can still do the window, but we can also get a sample of the tumor to biopsy.” This was part of the ‘let’s beat him up, he can take it’ mentality and they were seemingly excited about this route, which meant we were too. Never mind that we completely shaved my chest already for no reason – but hair grows back.

The person whose job it is to transport patients around in their hospital bed finally brought me down to the surgery prep room where at 7:00AM on a Saturday, everyone was truly awesome to be around. I’ve said it before, but I really can’t stress how well were treated at Baton Rouge General. But there we were – everyone was ready, they marked my left side with a sharpie and it was time to do this. I only remember a few things after the anesthesiologist pushed the prep cocktail, but it was fun. I instantly felt drunk - like a really fun drunk. The anesthesia drugs did not disappoint. I was in and out of consciousness after that, but I know I talked about drinking tequila with the nurses, I remember Meredith holding my hand while they rolled me down the hall and she made them stop to give me a kiss just before the OR. I remember being asked to roll onto the operating table and my arms spread out and strapped down and that’s about it. Meredith would have to update me on everything that happened after she sent her husband of eight weeks to the operating room with several (attractive) doctors wearing my wedding ring around her neck on the necklace I gave her on our wedding day. Her updates would be phoned in from an assigned nurse.

The first call was only to say that the procedure started and that I was doing well.

The second call, two hours later, was to let her know that I was done, everything went well, but was still sleeping.

Her next update came from the surgeon and nurse practitioner. In a private room, they sat down with her and laid out everything:

- Instead of taking a tissue sample they made the decision to do a wedge resection to remove the entire tumor. That is, basically taking a slice of pie from my left lung.

- They had a pathologist come in to do a frozen biopsy and confirmed it was indeed cancer. I’m guessing that was part of my special treatment and someone called in a favor to get that done on a Saturday morning.

- When they drained the pericardial sac, the fluid was bloody. This indicated that it was probably an advanced stage cancer.

- And, that I was doing fine.

This is one of times where I think the strength we pocess just comes through becuase it has to. She took the news as well as anyone, relayed it to family in the waiting room and waited for me to wake up.

By the time I was coherent enough to feel the need to brag about getting married before one of the nurses, we were on our way to a fancy new room which we were told was more equipped to handle drain tubes. Since I now had two tubes coming out of me. Draining bodily fluid into briefcase sized containers on the floor. This was a little bit of a shock to me. Meredith gave me the updates from the surgeon, but I was more concerned about the four new holes in my side, two of which had tubes coming out of them. This wasn’t part of the simple cut-drain-close procedure that they told me about. I learned that one of them was for my lungs and went all the way up by my collarbone to drain any remaining fluid. The other one went around my heart for the same purpose. They were uncomfortable and truly made it difficult to do anything. But we were in the ‘special’ ward – it was the cancer ward – equipped for this and where the amazing nurses enter our story.

Up until this point, the nurses we had – as great as they were – were mainly to monitor me and make sure I took whatever medicine was needed. Now that I needed physical help, they were on top of their game. As soon as I was settled in my room, they laid out the rules, set goals and within hours of my surgery had me back on my feet. And with my lung and heart juice boxes in tote, we were walking around the halls in no time. We did this several times a day, each time increasing in distance until it became easy, evenutally venturing out to the gift shop and even outside. Our walks, along with the twice daily chest x-rays made the time go by quickly and after two days of this routine I became accustomed to the tubes. My situation made fun conversation with the frequent visitors and helped us take our mind off all the pending tests.

Before we knew it, though, it was time for the tubes to come out. It was a very strange feeling watching someone pull a meter of surgical tubing out of me. But once they were out, I quickly learned what their purpose was – I had juice steadily flowing out the pencil size hole that was left from my heart tube. The pink fluid running down my side was apparently normal, and of course they were prepared. There was a maxi pad on hand ready to be taped to my side. As strange as that was, it was an effective solution and proved useful over the next week when Meredith would have to change my 'bandages' (maxi pad) every few hours.

Now that I was no longer tied down by my juice boxes, they were ready to start scanning me again. Since my tumor was confirmed cancer, the likelihood and fear of it being in other parts of my body was high. The first place they checked was my abdomen and the unremarkable results we received from that CT scan was the first not-bad news we received – but that doesn’t mean it was good news. Since there were no other tumors below my chest this pointed toward the lung tumor as the primary. And if you remember what the pulmonologist said, that’s not good at all. The next scans they ordered were a brain MRI and full body PET, but we had to wait on those. So, with an unremarkable CT scan and chest x-rays showing my lungs healing well, I was cleared to go home.

There was no real reason for me to stay anymore but it was hard to fathom leaving my safety net of constant care. Over the course of our stay the nurses and staff kept some order and provided a constant variable in what was a very uncertain time for Meredith and me. I took great comfort knowing that the nurses, food servers, techs, doctors, residents, and even a Hanson alumi Chief Clinical Officer all had a genuine interest in my case. Of those, I should say the most interested was a resident who asked if I grew up next to a nuclear power plant or was ever exposed to agent orange. And while Franklin is its own little world, I don’t recall either of those being there. However random or small the role was, everyone was determined to help.

After taking a deep breath and unplugging from the hospital, it was nice to be home. Friends and family were cooking and taking care of us while we just kept the routine of changing maxi pads until I finally stopped leaking a week after the tube removal on Easter day. Meredith turned into a great nurse during that time even giving me blood thinner shots twice a day but I was glad to no longer be leaky. By that time, though, we already learned the full pathology results from the biopsy and it was hard to celebrate.

I don’t envy any person that has to tell someone what I was told. There is no easy way but it didn’t happen like on the movies or TV. There was no scheduled appointment to sit down with the doctor and be gently handed the diagnosis. It was a very quick and matter of fact phone call. I was lying in bed when the surgeon called and quickly told us that the tumor, pericardial sac, and fluid all had non-small cell adenocarcinoma cancer cells in them. It’s a common type of lung cancer but since it was present in organ tissue outside of the primary location it was Stage 4.

“Oh fuck!” -Me

She encouraged us not to Google anything and that no matter what we would read online, those statistics are averages that do not include many healthy 32 year-old non-smoking men and most information was already outdated.

The matter of fact part of the call was that we were going to fight this. Hard. She recommended a local Oncologist and said we should start chemotherapy as soon as possible.

Before all of this happened I knew the odds of getting cancer (you should too) and so I expected to get some variation at some point in my life, but I was hoping it would be in 50 years when there would be a magic pill. I know there's never really a good time for this but as bummed as I am about it being right now, from what I can tell, the doctors are enthusiastic that I'm young and healthy. The plan is to “beat me up." I can take it.

It didn’t take long after that for Meredith to also fill out a contact form at MD Anderson. We knew enough by this point to understand that what I had wasn’t good and it wasn’t by any means normal. But as much as we knew there was obviously still so much that we were waiting to learn. More scans, more tests, more doctors - and most of it would actually turn out to not be bad news.