Quick Update

So...after a week of some big tests, I don't have much news to report.  I promise I will soon.  Apparently lymphoma is one of the most difficult cancers to diagnose.  There are many, many different types of lymphoma (beyond Hodgkin's and non-Hodgkin's), and particular types are divided into subtypes.  The original pathology report (created just based on the core samples that were taken on July 23, before the bar exam) was able to confirm that I have non-Hodgkin's B-cell lymphoma, but there are 3-4 subtypes of this particular lymphoma, and treatment depends on what type I have.  Plus the cancer needs to be "staged."  So that's what these tests will figure out.

At the moment here's where things stand:

There are three things the doctors will be looking at: 1) the pathology report from the work done on my tumor that was removed last week, 2) the PET scan report, and 3) the results of the bone marrow biopsy.  The pathology report will determine what particular type of lymphoma I have.  The PET scan will determine if and where the cancer has spread in my body, and the bone marrow biopsy will determine if the cancer has spread to my bone marrow.  The latter two tests will be the most important for staging the disease.

Once all the tests are completed and the reports are produced, everything is presented to a "tumor board."  There, doctors from various related fields and specialties (lymphoma, leukemia, other blood cancers) discuss the results of all the tests and recommend a course of treatment.  Once the recommendation is made and all tests are completed, treatment can begin.

Artist's rendering of the Tumor Board

So, depending on when reports are completed, we will know a lot more about the actual diagnosis and treatment.  That could be happening within the next several days.  I'll keep you posted

My second two-day test in the past three weeks

The bar exam taught me that I crave two-day tests with major life implications.  So I decided to do another one this week.

First up was the PET Scan. This was sort of cool.  The entire "test" takes about two hours, but an hour and a half of it consists of blood work, letting radioactive stuff drip into you through an IV, and drinking cups of barium.

First you get a blood glucose test.  I had been on a 24-hour, no-carb fast along with a 6-hour, water-only fast, so my blood sugar was in check.  This was going much better than day one of the Maryland bar exam.  Step two is to set up the IV so they can pump radioactive stuff through my body.  I've had a ton of blood work done, all on my right arm (since my left arm has been banged-up from the surgery), so some of the nurses have started commenting on the number of injection sites on my arm.  I told them I just like heroin.  Gotta amuse myself somehow.

Then it's on to drinking cups of barium.  Having thrived on kegs of Natty Light for years in college (which probably caused this), this wasn't very difficult.  But it wasn't fun.  It was about on par with the time we mixed Wild Turkey with Old Crow to make "Wild Crow."

So the deal is (I'm paraphrasing in layman's terms) that this radioactive solution travels through your body and bonds to/reacts with the cancer cells.  The barium concoction enhances the image and allows various vessels and organs to show up during the scan.

Once everything has had time to get situated in your body, you are forced to take a leak (I'm not sure about the purpose of this - presumably so you don't soil the PET scan machine), and then placed in a tube which apparently makes other people freak out, but has never bothered me.  They run thee separate scans.  During scan two, they inject some sort of substance into your body.  I'm not sure what it was, but I think it was LSD.  My mouth immediately went dry and I tasted metal.  Then a burning sensation slowly moves from your upper chest down through your abdomen and thighs until it feels like you have to shit fire.  All the while, the machine is making weird noises and spinning around you. 

Fortunately (or unfortunately), that only lasts for about a minute, and then it's on to scan three, which takes about 25 minutes.  The whole thing is relatively painless, but what doctors are left with is a 3D image of your entire body that will show if and where the cancer has spread.  Obviously, I hope I look less like a Christmas tree and more like North Korea at night.  And yes, I just juxtaposed those two similes in the same sentence.  Tenth grade English FTW!

Day two was the bone marrow biopsy.  I promise I'll stop with the bar exam references at some point.  But if the bar exam were a medical test, it would be a bone marrow biopsy.

First, a friendly-looking nurse walks into a room with an ominous-looking cart.  Then she has a nice chat with you, but all the while she is pulling things out of the cart.  Things that Jack Bauer uses to interrogate terrorists.  And you try to maintain the conversation when all you are doing is looking at these objects and wondering, What on earth is that used for? and Where is that going?

It is actually more difficult to describe the process than it was to actually undergo the biopsy.  The biopsy is taken from your pelvis.  Point of entry: upper left asscheek.  The goal: drill into the bone, remove some marrow, remove some of the bone itself, and then walk around like Edward Norton in American History X for a couple days.

They numb the area with lidocaine, which helps a ton.  The experience is less "painful" then it is "horrifically unpleasant."  After numbing the area, a small incision is made, and the process of burrowing down to the bone begins.  The process for actually getting into the bone is actually a holdover from Civil War-era medical practice.  The nurse reaches the pelvis with the needle and then proceeds to jam the needle in with repeated short thrusts (ha ha ha grow up).  This is the only time in my life I wish I had osteoporosis.  "Your bones are too hard.  Most of the time our patients are old and have softer bones," the nurse said during halftime of the needle-jamming process. 

After drying the sweat on her brow and having a cigarette or something, the nurse went back at it.  Progress was being made.  "We're about 75% there," the nurse told me.  Less than a minute later, we struck oil.  It was time to extract the marrow. "You're going to feel some negative pressure," I was warned.  And holy hell did I feel that "negative pressure."  It felt like everything from my balls to my abdomen was being vacuumed into a vortex.  I guess that was the negative pressure.

Apparently it worked, though, and the marrow was extracted.  But that was the easy part.  Now it was time to get a piece of bone.

I don't know exactly how this feat was performed.  The only thing I knew is that I felt it.  That was the worst part of this entire process.  Although the pain was greatly reduced by the numbing, you could feel every single thing and it felt like they were doing exactly what they said they were doing. Piercing the bone felt like you would imagine piercing a bone would feel like.  Extracting marrow felt exactly like that.  And snipping off a piece of the bone felt just like you could imagine.  And I was a milk-drinking asshole who had to go and make things difficult for everybody.

Finally, mercifully, the bone was cut.  "Got it!" announced the nurse, handing the sample to the tech. I relaxed.  My mind relaxed.  And then I heard the worst words I've heard since "I have bad news": "There's no bone here."

I'm not a medical professional, so I don't know how this happened.  I'm not sure how you think you have a piece of bone and then it turns out to be not a piece of bone.  Who knows.  Maybe somebody who knows more than me can enlighten us.  But they had no bone.  And they needed to get some bone.  And it had to be from me.  So they were going to have to try again

"Will you be patient with us?", the person with the needle jammed in my pelvis asked me.  "I don't have many options, do I?", I responded. 


So they went at it again, pushing and prodding and poking my stubborn pelvis.  I wondered if my pelvis was like a car window - if you put enough pressure on a single point, would it shatter into a thousand pieces?  I  guess they would be able to get their bone then.  But the pelvis wouldn't concede.  The needle did.  The thing actually slipped off my pelvis, jamming into whatever other tissue is hanging out down there. 

Do you know what it feels like when somebody tries to jam a needle into your pelvis and it slips off?  It feels like SOMEBODY TRIED TO JAM A NEEDLE INTO YOUR PELVIS AND IT SLIPPED OFF.

Finally, my superpelvis relinquished its bone.  The nurse extracted the bone and showed it to me for good measure.  It looked funny.  After keeping some pressure on my wound, the nurses taped me up like Forrest Gump and I was good to go.

And for the second time in three weeks, two days of life-altering tests left me with a sore ass.

Interlude

It's been a little over a week since my diagnosis, and each day has been a little better. It doesn't take you long to get used to the new reality. Of course I asked "Why me?" and "What did I do to deserve this?" in the aftermath of my diagnosis. But there aren't any good answers to those questions. As Christopher Hitchens wrote, in the midst of his own struggle with cancer, "To the dumb question 'Why me?' the cosmos barely bothers to return the reply: Why not?"

Physically, I feel fine. I don't feel like I have cancer. I'm not even sure what that is supposed to feel like. I have some residual pain from the surgery in my left arm, and my right arm is sore from all the shots, pokes, and IV's that have meant to spare my left arm from further damage. So I can't really lift heavy things. That's the physical impact of lymphoma so far.

Mentally, I'm fine. And not just saying that. There is certainly the initial shock of learning about your diagnosis. But I got over that rather quickly. I actually think it has been more difficult for the people around me. They don't know how they would react to such a diagnosis, so it's hard for others to gauge how I feel. But I have a better idea of how I would react...because I'm doing it right now.

Besides, what can I do? One of the most difficult things to cope with is the utter sense of helplessness. You wait to be told your diagnosis. Wait for more tests to come back. Wait to be told what treatment you'll have to endure. I asked my doctor what I could do - diet, vitamins, exercise, whatever - he responded, "Surprisingly little." With virtually any other challenge in life, you have some degree of control. You can study harder, work longer, prepare better. With this, you sit and pray and hope and wait, all at the mercy of whatever it is that has decided to set up shop in your body.

What I can control is my attitude. I know this is the part where I'm supposed to tell you that I think positive and I only focus on the good things and I stay optimistic. But you're all nice people. I don't want to lie to you. I think about negative stuff all the time. It's freaking cancer. If it was a positive thing, it would be called vacation or something. You all didn't read "I have lymphoma" and high-five your cat. You sat there in stunned silence. Or felt terrible. Or sad. Or maybe indifferent. But it's ok. It's human nature. You can't deny those feelings or put your bad thoughts in the closet and pretend they don't exist. Here's a quick drill: Think about anything except an elephant. What are you thinking about right now? I'll guess: An elephant. See. Nick 1. Your mind 0.

Nonetheless, I am pretty much completely and legitimately at peace. There are many objectively positive things that I can focus on: I'm young, healthy, in good shape, have access to great doctors. Sure, I think about the negative stuff. But it doesn't really bother me. There's nothing I can do about it, and the worst case scenarios just aren't that likely. So instead of ignoring certain thoughts, I just deal with them.

More importantly, the support I have received has been overwhelming. It was pretty difficult to keep my diagnosis from almost everybody I knew for nearly a week. Since I announced the news on Thursday, I have been stunned by the response. Yes, I know I have great friends and yes, I know people care. But rarely does anybody have an opportunity to experience this firsthand. It's Monday now and I'm still buried in messages.

So that's where I am right now, before I begin a big week of tests. We'll know a lot more in a few days.

A Note

After my previous post turned out pretty dark, I felt I should clarify some things I mentioned in my first post.

I'm just going to write whatever I feel like, whenever I feel like writing it. You'll certainly get updates, and I'll try to be as diligent as possible with those. But you'll also get whatever emotions or rants I feel like yapping about at any given time (I'll try to stay on topic). A number of people, my doctor included, told me to keep a journal throughout this ordeal. I have no problem with anybody knowing what I'm going through, so I'll just keep my journal right here on the internet.

More importantly, it's always difficult for the people who care for somebody who is battling cancer. I cannot count the number of messages I've received about those of you have watched or are watching a loved go through this experience. If my words can help people understand and cope with an incredibly difficult process, then at least I can contribute something positive because of this.