Friday, 18 December 2015

When staring down cancer, you'll want the prick

You ask the average person when death comes knocking at their door whether they want a prick on their side or some kindergarten teacher who is going to kiss their ass. When that day comes, I want the prick!

Philip Seymour Hoffman in Patch Adams

"How exactly are you going to take the cancer out?" my friend asked the two surgeons who had just violated her, through her nose, with a scope.

They both looked at each other, blanched, and looked back at her.

"We have our methods," the female doctor said softly.

It was a good question, which deserved an honest answer, but it left the doctors squirming and clearly running for cover. It was a question that my friend could have had answered if she had been a little more Internet savvy. I knew the answer; I had Googled it hours before.

My friend has oral cancer, a tumor just below her tongue. Two days before Christmas, doctors will drive a backhoe through her mouth. That's what the Internet says.

But on a day a few weeks ago, the surgeons were keeping their cards very close to their lab coats.

They didn't answer the question directly, but they needed to. My friend may be a hundred pounds soaking wet, she may have looked fragile and shaky, and much like the ancient granny of these two thirty something surgeons, but she has the heart of a lion. She needed to be told the truth that day but she left even more nervous and uncertain.

A few days later, she punted her surgery by fainting in the bathroom.

The surgery was cancelled.

Yesterday, she had a do-over with another surgeon, a man about a decade older, a pleasant looking fellow with kind eyes. Yesterday, he told her the truth.

You want the truth?
You can't handle the truth!

The surgeon sat beside my friend and patted her on the arm.

"You have the right to be scared," he said, looking her in the eye. "There would be something wrong with you if you weren't scared. This is a big surgery, and a lot can go wrong."

He took her through the procedure in fine detail, explained that there needed to be two doctors in the OR because the surgery was going to take eight hours, and needed a fresh surgeon especially at the end when things could go sideways. He explained that he would be taking a graft from her arm, along with the veins to plug into her mouth to keep the blood flowing. There was a chance the graft wouldn't take, a one in twenty chance, but he said those were pretty good odds.

It's not a new surgery; docs have been doing it for ten years, and have been doing transplants for more than forty years.

"I do about 70 of these a year," he explained. "I think I've done 500 in total. I'm not going to say it's routine, because nothing about cancer surgery is routine. But it's done all the time."

Then he looked at her gravely.

"But it has to be done. Trust me, there is no worse way to die on the planet than to die with a head and neck cancer. It's an excruciating death."

And then the talk turned to cigarettes the culprit that got her into this mess. A pre-op nurse had told us it was ok for her to smoke right to the end.

"Give them up today," said the doctor. "If you keep smoking, you'll dilate the blood vessels and there's a good chance the transplant won't take. And then we'll be standing there and you'll have a big hole in your mouth."

Holy shit, I thought. Well that's telling it like it is.

"I'll put on the patch when I get home," she said, knocking me to the ground.  My friend had been resisting tossing her smokes. She was determined to smoke til the end. But it took this doctor to get her to give it up, cold turkey.

After I'd picked myself off the floor, I heard the doctor take my friend on a tour of her Christmas future. On December 23rd, she'll wake up in terrible pain, the worst of her life, but there are drugs that will kill it, and she'll be merely uncomfortable. She'll probably wake up in a panic, fighting for air, railing against the tracheotomy that is needed to help her breath while the swelling in her tongue goes down.

"How will I keep my throat from getting dry?" my friend asked him.

He smiled.

"You'll learn to live with it," he said. "You'll learn to live with a lot of things. The first week will be awful, I won't lie to you. The second week, you'll feel more like yourself. By the third week, you'll be eating and doing things normally. It won't be long before you can order a pizza and get the pepperoni you asked for and not the mushroom."

The surgeon asked if we had any more questions. We didn't so we shook his hand and made a date for next Wednesday at a time and place we know all too well. My head was spinning a little. I wanted to pee myself, if I am to be honest.  I looked at my friend and she shrugged, and picked up her gear to head off for more blood tests.

"Somebody told me the other day that I'm a tough old bird," she said.

It was at that moment she became my personal hero.

For the first time, she seemed strong, ready. She had all the information she needed.

As I look back on this terrible journey, I realize that it was the fear of the unknown that had gripped my friend like a bear trap. She didn't want to be coddled, she wanted to be told the cold truth.

As she stood at death's door, she didn't want the kindergarten teacher, she wanted the prick.

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