Day 6 in Baltimore (part 1 of 2, read first)

Short story: 2 scans today, the first was planned the second was not…it was the results of the first scan which required a 3 dimensional perspective of an area discovered in the first scan.

Results: There’s a newly discovered nodule in my upper chest and diffuse disease in my lungs. I still haven’t spoken to the attending physician yet about the plan, but there’s no doubt that there’s still thyroid cancer in my body.

Discussion: 5 years ago, a ton of bricks fell on me. I was told something that changed my life forever, my thyroid had papillary carcinoma and it had spread to many lymph nodes throughout my neck and mediastinum in addition to my lungs. During the time since, the experience of living with cancer has been a conduit through which, I have adapted something that my mom calls (she’s a shrink, so it must be legit) emotional resiliency.

With that in mind, I expected the news today to bounce a bit…no matter what the news, I would want to collect myself and make a plan and deal.

As I lay on the table for my second scan, I had already been on the table for a full hour. The large metal blocks rotated centimeters from my face and chest at a rate of a few inches per minute. It was a full hour of laying there thinking. First I thought about the differential diagnosis for mediastinal masses (the 4Ts, but you probably don’t care about that). Then I started thinking about the real question at hand: was the nodule mediastinal (between my lungs) or not (in my lung)? If not, then bad news bears. If so, then it is probably just a lymph node filled with cancer and could be plucked out surgically.

Then I started to get scared for the possibility of having a lung nodule. As a fellow in pathology this year, I have seen and helped participate in the diagnosis of many different sorts of cancer. Since 2005, when I was initially diagnosed I’ve always felt strangely alone going through this experience, even though many friends and family have been so close. Up until today, I had never really been able to connect the dots between myself and other people with cancer. I’ve known many people in the last few years, with whom I’ve connected but as the years have passed I wonder whether or not what I’d like to think of as resiliency, isn’t more of a numbing or hardening of my heart. During my first summer in the first few months, I was emotionally very raw and tender. I’ll never forget breaking down in tears as I was driving to work one hot summer morning when I heard the news that Peter Jennings had died from lung cancer. I hadn’t even watched the news and hardly knew anything about him.

Within those first two years I knew many people who dealt with cancer. During the second summer, my grandfather, rather suddenly got diagnosed then ultimately died from malignant melanoma. A few weeks later, my Mom’s partner/boyfriend died from prostate cancer. Later, I watched my buddy Tony, fresh back from Iraq, get diagnosed with leukemia and subsequently get treated ultimately to remission.

Then there was my friend Jason from high school. He was two years behind me in school and when he graduated from college in 2004 found out he had medulloblastoma (brain cancer). Over the following 4 years, he went in and out of remission a few times, then ultimately passed away during my second year of medical school in 2008. We had coffee together a few times and tried to call each other when we could. I hesitate to say whether or not we were close. In some ways, very much so but I’m not sure how good of a friend I was in the end. I couldn’t even bring myself to go to his funeral. It hurt so incredibly bad to see his repeated triumphs and subsequent returns to the hospital. I don’t know if I’ll ever forgive myself for not being there to honor him.

All of this starting flowing through me as I lay there on the table. These connections seemed to reach out to me reminding me of a common experience that I’m quick to overlook. Cancer is intrinsically an experience with uncertainty and everyone who has had cancer is confronted with that uncertainty. When I started this blog, I was 3 years into living with cancer and after a successful surgery in the summer of 2008, things seemed to be well, so it became a bicycle racing blog. During that time a ton has happened. Other, ultimately much more important events occurred, the bricks that were dropped began to be built and organized. I got into medical school, married an incredible woman, and despite being told that it would not be possible had our daughter.

This is all to say that I’m having a hard time seeing myself as resilient at the moment. Definitely more along the lines of freaked-out, insecure, neurotic, and emotional. The reality of the situation is that it is probably not a lung mass and that when I get off the plane I’m getting ready to board, there will be a voicemail from the attending physician telling me so.