Dan You Have Cancer - The Oncologist and the Hospital

The time between December 28^th and January 8^th when I could get in to visit the oncologist seemed like an eternity. Cancer was confirmed but the extent and severity of it was yet to be told. On that first visit I got to meet my very own oncologist. Now I had been told that I was to see Dr. Sarah Panini or was it Dr. Sara Panini. In either case it did not matter. That day I learned that it was Dr. Rajesh Surapaneni. Not a Sarah, a Sara or even a female but one heck of a good doctor and a better person.

Dr. Surapaneni was unable to perform the total physical exam he wanted to because my back and ribs were so sore I was unable to lay on the exam table. In the Bible when scripture begins with ‘verily’ it means that the words to follow are very important and deserve your total attention. If the verse begins with ‘verily, verily’ what follows is darned important and worth of your total attention, sitting up straight and anything else that prepares you to become enlightened. If the verse begins with ‘verily, verily, verily’, well I cannot imagine to importance to the words that would follow. Thinking back I do not remember if my oncologist began with ‘verily’, or ‘verily, verily’, but Ann and I treated it as if he began ‘verily, verily, verily.’ We were told that what I had was serious, extremely aggressive and needed to be treated post haste. Without treatment life expectancy would be several weeks or months at best. Happy New Years, Ann and Dan! We were then introduced to staff that was to schedule my forth coming chemo regime. Home I went to prepare for the fight of my life. Off to work Ann went to try and achieve some sense of normalcy.

I was barely home fifteen minutes and my phone was ringing. Caller ID said it was Andrews and Patel, my oncology practice. Surely there was a scheduling conflict or I had inadvertently left something behind. But nooooo! It was the man himself, the newly discovered, the lead dog, the man in charge, Dr. Rajesh Surapaneni on the other end of the line. Using his man-in-charge leader voice, the voice that left no doubt that what he said should be identified with ‘verily, verily, verily, I say unto you’ told me the get myself to the Emergency Room at Community General ASAP, STAT or any other combination of letters that meant N-O-W! They would be expecting me. He explained that my lab results from the morning bloodletting showed the calcium levels in my blood were in the red, critical range. This was a first for me. I have had reserved seats for the theatre, many baseball games and reservations at restaurants throughout the years but never have had reservations at the hospital ER. Cancer certainly can change your world quickly.

A quick call to Ann to come home and get me was followed by the short trip to the ER. The ER waiting room was packed. I gave them my name then took a seat among the masses. After a very, very short wait (not to be confused with verily, verily) a triage nurse sat down at an unoccupied service window and called my name. I did not look because I knew it wasn’t necessary. I could feel them. Hundreds of eyeballs were watching me as I stood up, transversed the crowded room, went to the desk, gave the nurse my name and was promptly without hesitation greeted by yet another nurse who escorted me out of the line of fire, into the inner sanctum of the hospital ER.

Striped, gowned, placed gingerly into a bed, I was quickly surrounded by a bevy of nurses, LPN, RN and whatever other types there are. A bevy of nurses is probably a misnomer in that they were all caring angels to me so let’s change that to a host of nurses. When they discovered I had tremendous back pain they provided some magic pills that caused me to float about six to nine inches above my bed. Nothing hurt, heck nothing even mattered at that time. For the next four to five hours I was asked questions, poked, stuck and sent for several scans. Details of all this somehow escape me at this time. I do know it was the best I had felt in a very long time. Sometime after nine o’clock or was it ten, I left the ER and was placed into a regular room. I was staying the night. As the high of the magic pills wore off I began to spend one terrible night trying to sleep in a hospital bed. Remember I had been sleeping in a recliner for two months straight at this point in my life. Other ‘magic pills’ were provided but none had the same effect as those in the ER.

Wednesday I was told that I had cancer in the following places; jaw, skull, ribs, sternum, hips, spine, liver and brain. Not a problem. It is better to know one’s enemy than it is trying to fight something that doesn’t fully expose itself. Before that battle could start however, the seriousness of the calcium levels needed to be addressed and diminished.

I have always had trouble with IVs in that my veins are deep and are of the shakers and movers type. Even if you are lucky enough to find them the challenge becomes hitting them and making a solid connection. I expressed my concern about be confused with a pin cushion one morning when one particular ‘blood sucker’ tried six times to draw blood. Even though I tried to be as kind as I could, I knew she understood where I was coming from when I mentioned the pin cushion analogy.

Several very positive things happened the rest of the week. First, I only spent one night not-sleeping in the hospital bed. I moved to a recliner next to my bed from then on. Two, I became friends with the dietitian who then became very helpful in providing me what I wanted for each meal. Momma didn’t raise no fool. Third, I was able to witness to the clergy that came in to encourage me. I don’t think he ever heard someone in my condition say the things I said. At least that was what the expression on his face said. Fourth, they sent me home on Friday as my calcium levels fell back inside the acceptable range, not good but acceptable. One last positive was that the nurse practitioner assigned to me by Andrews and Patel came in special to see me and explain that I did not have cancer in the brain. Small victories were realized but victories big or small are non-the-less victories. 

Prayer works! Praise the Lord! 

Dan, you have cancer: The Beginning

Stephen’s idea was to participate in a 5K while he was home from Florida during the Thanksgiving weekend. Since Ann and I had been walking faithfully all summer I felt that I was in good enough shape to include myself in the grand event. Several phone calls and emails later both Nathan and Seth were enlisted in the event also. We would be walking a Turkey Day event starting and ending on Harrisburg’s City Island on Thanksgiving morning.

We were greeted with 14^o temperatures that morning as we departed for the race’s starting line. Layers upon layers of clothes made us look like those poppin’ fresh biscuits that swell as they bake and can then have the layers striped away as you eat them. Stephen and Nate ran their 5K. Seth and I walked ours. My goal was to complete the course across the Susquehanna River to the East shore and back in something under an hour.  I attained that goal as my time was just over 54 minutes, good enough for a third place finish in my age group. A quick trip home followed by final meal preparations followed by the packing of the meal into the car followed by the trip to Nate and Jen’s where we were to consume the food of our gratefulness.

Before the turkey, mashed potatoes, baked corn and gravy had a chance to settle in and begin the digestive process, it was decided another walk around the neighborhood was in order. Off we went. Before we had added an addition mile of steps to our fit bits I felt the pain of a day of activity that seemed to stretch my boundaries a little too far.  By bedtime Thanksgiving night I was sore from one side of my ribs to the other. The night’s restless sleep did little to relieve the discomfort. If anything it was a little worse.

At the same time this was happening, I had been watching a bump form and grow on my right mandible. It started small. It gradually increased in size. It never caused any pain or discomfort. It was just there. I noticed it as I shaved. I felt it as I watched TV in the evenings. At first I thought that I had an infection in the glands found there. As it grew in shape and size I knew what it was. God was slowly preparing me for the inevitable show down that I had on December 28, 2018 with reality.

I did not always recognize it, but God does prepare us for the reception of bad news. This does just happen prior to “The Big Event” but gradually over a lifetime of experiences. When I handed in school work that I knew didn’t receive my best effort I had days or weeks to prepare for the ultimate bad news. When I saw events falling into place at my place of employment that would alter my future plans I had time to think and prepare different scenarios in how to react to the eventual outcome. When I saw my children doing things that were not in their best interests, I could see in many cases the end from the beginning. I was given time to prepare for the eventuality and to have a reaction plan I place. The same thing happened to me in regards to my “bump”. Somehow I knew it was cancer or at best not good. I was given two months to think, plan and pray for what was about to happen.

I shared my lump and subdued concern with Ann. She wanted me to go and have it checked out immediately. That didn’t happen as I put it off until after my colonoscopy of December 7^th. I received a glowing report from the doctor immediately after the colonoscopy. I believe the medical term he used to explain my situation was, “Clean as a whistle!” He in fact led me to believe that event though I should return for another exam in five years, a wait of a longer time would not be unreasonable. That report came on a Friday. The following Monday I called my family doctor to look at my lump. If it seems that I was on a linear approach to health care, I was. My family doctor was unable to see me quickly so I was passed off to a new-to-the-practice doctor the following week. If you can imagine Harpo Marx as someone born and raised in India, with hair that melted from fire red on top to orange to yellow around the nape of the neck,  with an ego the size of Texas, this is who I saw. At the time I was quite disturbed by the interaction with this medicine man however in retrospect I believe he was put there that day to jump start to action not only me but others in my healthcare chain.

When I pushed back at this doctor’s suggestion of actions, he got my regular family doctor involved. It was he that took control with a calming presence and a more patient friendly course of action. It was my family doctor that got me into see the otolaryngologist two days later.

While all this was going on my torso had become very, very pain filled. I hurt from side to side. I even expressed to Ann that I felt my shingles were returning. I had a difficult time lying down. Getting in and out of bed was next to impossible. I tried to relieve the pain by lying down on my stomach. While trying to get in bed face down I caused a terrible burning pain in my sternum. Now I hurt worse than ever. I believed that I had torn cartilage in my chest.  Sleeping in bed was now out of the question. From the end of November until February 13, I slept each night in a recliner. Not easy to do night after night and not very restful. I did prepare me for what was about to happen in early January when I’d begin intense chemotherapy. It was just all part of the process. It was all part of the “New Normal”. All part of God’s plan for me.

Dan, you have cancer.

As strange as it might seem my life was full of the very things need for me to face the news delivered to me on December 28, 2018 and again in a more lethal dose on January 7, 2019. I was unaware of it and the particulars in those moments but in retrospect I am able to see the providential hand of God on many things in my life leading up to that time. The preparation He unwittingly had me go through was foresightful and exactly what I needed.

The otolaryngologist my family doctor sent me to see, biopsied a lump, soon to change names to tumor, on my right jaw on December 21. When he entered the patient room on the 28^th where Ann and I were waiting, we experienced the same nonverbal communication that the stocking-capped father did in Clement Moore’s “A Visit from Saint Nicolas”. “A wink of his eye and a twist of his head; soon gave to know I had nothing to dread”. In this case there was no wink, no head twisting, just a friendly smile and some sobering words about the result of the biopsy. You have cancer. “Under the microscope (this way of explaining things is used to absolve any humans from blame of the findings) the cells harvested from your lump are seen as small-cell squamous cell carcinoma”. Say it in English doc, say it in English. My onboard Google translate heard, “You got cancer Dan and it ain’t good”!

The merry-go-round I was now on seemed to momentarily spin out of control. The golden ring not only passed my thoughts at the speed of light, it also seemed to be getting further away from my reach.  “Dear Jesus, take control!” Everything stopped. I could now focus on what the doctor was telling us. He did a much more thorough exam going down my throat, up my nasal passages, into my sinuses. I became thankful that he was an otolaryngologist and not a proctologist. I had just had a colonoscopy on December 7^th, how appropriate is that, and am glad another one was not in order.

The doctor found nothing, nothing at all. The only manifestation of squamous cell carcinoma was in the tumor on my jaw. This is good. That is what the doctor said. That is how I felt.  It was sometime immediately after my surrendering the situation to Jesus that a peace, a peace that passes all understanding came over me. I decided right then and there to set a course of action. I could not control if I did or did not have cancer but I sure could control how I manage my life having cancer.

I decided to never hide the truth from anyone. If someone asked how I was feeling, I am going to tell you. Feeling bad, you will know. Feeling good, you will know. Don’t want to be bothered right now, I’ll tell you that too. I adopted this attitude because I need to be strong not weak. I need prayer and lots of it. My experiences have shown me that if someone is praying for you it is always helpful and more meaningful to them if they know the specifics of the need.

Before leaving the office that Friday my otolaryngologist discussed the next steps we needed to take. He offered several ways to proceed.  To this time in our lives Ann and I had only ever dealt with pediatricians, cardiologists and nursing homes. We are experts in all three. God has chosen me, my health and our immediate future to broaden our horizons and earn additional medical school credits in oncology. The doctor never flinched when I told him I could not make a choice. I told him I was putting my faith in him and God to be sent to where I needed to be to begin the battle of our lives. After some more conversation and reckoning on his part, he set up an appointment with the practice of Andrews and Patel which happened to be only minutes from our home. The hand of God at work once again.