Don't count your chickens before they're hatched. Or your chemo before it's given.
"Don't count your chickens before they're hatched."
Growing up, a lot of life's little lessons were distilled down into cute little catchphrases that maybe still had some everyday meaning to people. But as America and Russia fought a Cold War for global supremacy and ran a Space Race for supremacy in the heavens, fewer and fewer people had any firsthand knowledge of poultry husbandry and so the saying rapidly lost its direct meaning and became more of a catchall to espouse a philosophy than a direct metaphor to an experience that most individuals had shared. But as a pre-teen, my family did keep a small flock of chickens so the saying actually does have some direct meaning to me. Still, if you have never seen a chicken lay an egg or seen an egg hatch into a - let's face it - totally ugly and disgusting-looking chick (they don't get to be cute until their fluffy feathers dry several hours after hatching), you probably know what this saying means.
Don't get too attached to a potential outcome. Stuff happens and things don't always work out.
With chickens, eggs may appear to be fertilized but they stop developing for unknown reasons, or one egg gets just a little too cold on one side and the chick growing inside becomes deformed, or practically a million other things can go wrong so that any particular egg laid might not hatch into a chick. Even then, chicks are relatively fragile little things and disease or small predators can easily pick them off so that all chicks hatched do not necessarily become fully-grown chickens that can either produce eggs or meat, both of which are very tasty and nutritious. And that is really just a 10,000 foot view of the fact that if you have a dozen hens and they are sitting on five eggs each, that doesn't mean that you will wind up with sixty full-grown chickens in six months. You might, but don't bet on it.
Great... what does this have to do with my cancer blog? Or am I suddenly shifting focus and am turning this into an urban agriculture/animal husbandry blog? Fortunately for both me and anyone who reads this, I am not doing the latter. But that doesn't mean that the 'counting chickens' metaphor isn't valid.
You see, I have been counting on this coming Friday as being my last cycle of chemo. Like, really counting on it.
My last cycle of chemo means a lot of things to me. First off, it means that I've made it. There are literally no more therapeutic options to prevent cancer from rearing its ugly head other than the heightened surveillance I will be subject to. I have crossed the proverbial finish line and can eat my celebratory roast dinner because I will no longer be poisoned on a biweekly basis. It also means that I can jump to a lilypad closer to the far shore, one where I can even see the banks of normalcy ahead of me. I can get back to the gym - maybe not right away, but soon - and start to rebuild my deconditioned body. Without the fluorouracil actively attacking the mucous membranes in my body, I can start to advance my diet back to a more normal one - for me, at least - meaning that I can add more fibre and spices gradually until I am able to eat what I used to. And, probably most of all, getting my last cycle of chemo means that I can say sayonara to my PICC, my frenemy for the past almost five months. That aspect alone was enough to bring joy to my heart as Friday loomed large on my horizon.
Getting my PICC removed means, more than anything else, that I could shower any way I want, any time I want. I wouldn't need to wrap it in cling wrap, pull on a cloth tube to absorb errant moisture, then cover the whole apparatus in a bag with the bottom cut out and secure that with two elastic bands at the top and bottom of the tube and still keep my right arm out of the main stream of the shower. I could just turn on the shower, wait for it to get nice and toasty-warm, and climb in and let the water splash where it wanted. I wouldn't have to limit my shower to a few quick minutes just in case water got under all the protective layers (trust me, it happens); I could stay in there until the hot water tank ran out if I wanted.
Glorious. Heaven, even. Fantasies of unfettered showers have been in my dreams for the past few weeks as Friday loomed.
Of course, my life would not return to normal once I woke up on the Saturday immediately after this Friday. For one thing, my fluoruracil infusion that is part of my protocol would continue until Sunday morning, and then it will take a couple of weeks before the majority of both it and the oxaliplatin that I have been receiving to clear my body. I will still need to be cautious about my body fluids and the people that matter that live with me or are physically close to me so that I don't expose them to potentially dangerous chemotherapy. And of course, I will still be feeling the side effects of the chemo during this time, and possibly even for a long time afterward. Still, for the first time in almost five months, I will know that I will soon be past all of these considerations because I'm not adding more poisonous fuel to the proverbial fire.
And then last Saturday happened.
The day started out beautifully and I felt pretty good. My wife and I took our miniature dachshund to a dog park and walked for about 3 km - the longest walk and most physical activity I have undertaken in over a month. We connected emotionally and intellectually in a way that my diagnosis has made difficult over the past nine months and wound up even more in love than we have ever been before (it's a constant progression for us, although I'd be lying if I said every day was a positive one). We went to bed and snuggled and everything was looking absolutely freaking rosy for my last cycle of chemo. Until I was awoken just after midnight by severe cramping and pain in my left side.
During the colonoscopy that definitively diagnosed my cancer, I was also diagnosed with diverticular disease. At the time it was evident but under excellent control in the estimation of my gastroenterologist, likely due to the fact that I was physically active and my diet up to that point included high fibre and relatively low animal fat - three of the things that really help diverticular disease not progress from the stable chronic diverticulosis to the more painful and acute diverticulitis. And in the very first hour of Sunday morning, my diverticulosis dashed headlong into a severe, almost blinding attack of diverticulitis.
I will spare you the details, but it's probably enough to know that within an hour I went through almost the worst pain I have ever experienced, passed out and fell, bruising my forehead, and suffered various other personal indignities. And then the attack passed. I got cleaned up and made notes of the event to report to my care team and got eight good solid hours of sleep. I woke up late Sunday morning feeling a million times better than I had when Sunday first announced itself and ate my breakfast with enthusiasm.
Except, when I went to the bathroom after breakfast there was a small amount of blood in my stool. That hadn't happened since just after my surgery. When I went again a few hours later, there was about half blood and half soft to watery stool. I passed frank blood three more times on Sunday and then a small amount of clots on Monday morning before it stopped. Aside from the blood - which should always be seen as a pretty serious warning sign - I felt pretty darned good.
In my professional life I help manage the care of patients with the most severe forms of diverticular disease. As such, I knew that bleeding, while rare, does occur. The symptoms that I had in the opening hours of Sunday all matched a bout of diverticulitis, and given that the fluorouracil I am being given causes inflammation of the mucous membranes that line the diverticula in my colon it made sense that they might ooze or even have a blood vessel rupture giving me the not-totally-unexpected diverticular bleeding I was experiencing. I had checked my temperature regularly from Saturday night through to Tuesday night - it never went above 37C - so I knew that I had not perforated my bowel as can sometimes happen. And because the volume of blood lost was small - my estimates were no more than 150 mL across all the losses - and they were decreasing I decided not to go to emergency and sit in a festering petri dish of other sick people while I waited for them to do an abdominal exam and send me home. Besides, I was seeing a Nurse Practitioner at the cancer treatment centre on Tuesday morning and I was getting progressively better, so there really wasn't any reason to panic. I told her everything that had happened, in all the detail that I am sparing you here, in the interests of full disclosure.
The nurse practitioner, however, was a little more concerned about my medical status.
To be fair to her, she didn't panic nor did she suggest at any point that I had mismanaged my own care. She also had the benefit of doing an abdominal examination that showed my lower left quadrant - where my diverticulosis exist - was dull and slightly tender. This indicates inflammation of the bowel which concerned her in light of the fact that I was about to get more fluorouracil on Friday and that it might aggravate my healing diverticulitis. She spoke with my medical oncologist who reviewed my symptoms and agreed that my event was probably diverticulitis, but given the possible risks of making it worse he wanted to hold my chemotherapy for Friday and give it next week. In the meantime and out of an abundance of caution, he ordered more bloodwork on my and would arrange for a semi-urgent CT scan to ensure that my diverticulitis was mild and resolving. He even suggested that I consider dropping the last cycle of chemotherapy because I had already derived most of the benefit from my therapy and the risk of making me sicker was probably not worth it.
From there, my day went rapidly downhill.
I was already disappointed that my last course of chemo was being delayed, but a faint glimmer of hope arose when he suggested that maybe I didn't need it at all. That meant not only no more poison, it meant that I could get my PICC removed now, allowing me to rejoin the normal world even sooner than I had hoped. Still, in the back of my mind I was thinking about how, all along, my decision making on chemo was based on the assumption that I did have metastases that were too small to detect, otherwise treating with these poisons made no logical sense. I cast my mind forward five years to imagine finding out that I did have a secondary tumour and that the seven cycles of chemotherapy had not killed it. Unfortunately, the mortality for these secondary tumours is shockingly high. At least if I had received my last cycle of chemo I would feel like I had done everything possible; if I cut it short 7/8 of the way there... who knows?
I didn't really feel enthusiastic about taking that chance. But I still had my bloodwork to do. I walked over to the adjoining hospital and had the helpful lab phlebotomists draw out more of my blood for testing, then started to drive home.
I was called by my oncologist's office assistant when I was halfway home. He had received my bloodwork and talked to some colleagues and they all felt that getting a CT was really important given my bleeding. I was asked to ensure my phone was with me at all times because I might get a call to come in for a CT right away.
Okay. That was a little scary.
I was called by his booking assistant just after I got home. The bowl of cereal I had eaten four hours earlier was wearing thin and I wanted to make a sandwich to satisfy my hunger. She asked me a few questions and then dropped some more bad news on me. "Okay: based on the criteria you qualify for an immediate walk-in CT scan. I will call the medical imaging department at the hospital closest to you and arrange it. Don't eat anything, but drink a full 750 mL of water before you arrive there. Can you leave now?"
"Sure," I said, putting the unbuttered bread - and more of my hopes and comfort - back in the bag I had just taken it out of. I put on my shoes and got in the car to drive to the hospital for the CT.
I've had several CTs already. I am not claustrophobic and I know the drill so I was not at all scared of getting the scan. That didn't mean I wasn't scared. The bleeding that had stopped over twenty-four hours earlier seemed to be a much bigger issue than I had thought, and now there was a definite tone of urgency about me getting detailed investigations done.
The staff at Medical Imaging were great and I was done being scanned within 45 minutes of my arrival. That's pretty good considering they were fitting me in in between the people with strokes and various other acute imaging needs as well as the people who had booked appointments during the time I was there. Having my PICC - something that I have become accustomed to but still don't like - made it much easier for them to give me the contrast agent to enhance my CT. Like I said, they were awesome, and as the scan was finished I was all ready to head out for home and await the results like I had on all my previous CT scans. But this CT was not like all the others - it was needed urgently.
"So... we're going to have a radiologist read the scan as soon as possible. It will probably take half an hour. Have a seat in the waiting room and we'll come get you to tell you to go home or to tell you what step B - or steps B and C and possibly D - are," the helpful technologist told me.
"Oh. Okay," I said. She was great, but my level of fear rose at the implication that there was more to be done on me. I sat in the waiting room and looked at news stories on my phone for thirty-one minutes before another technologist called me into the hallway to talk.
"The radiologist has read your scan and is calling your doctor with the results. Based on his report, you are strongly advised to go check in at Emergency right now."
Cue the icy grip of fear as it wraps around my innards.
"Oh. Sure," I said. My voice sounded unreasonably calm, even in my own head.
I went and sat in the overcrowded ER waiting room waiting to see the triage nurse. He was very busy and doing his best, but it still took over half an hour before he even acknowledged that I was there and came to take my details. He had perhaps ten seconds he could spare to have me tell him why I was there so I kept it brief - I was sent for an urgent CT, they said to come here, I've been having some rectal bleeding - and sat and waited for him to call me up. He called several other patients up, mostly children with sprains or asthma attacks, and half an hour after he talked to me he called me up.
"So... tell me more about this bleeding," he said.
"Sure. I was seeing my oncologist this morning and he sent me for an urgent CT because..."
"Wait. Oncologist? You're a cancer patient?"
"Yes."
"Are you actually receiving chemotherapy right now or are you going to start soon?"
"Actually, Friday was supposed to be my last chemo. I received cycle seven of eight ten days ago."
"Put a mask on right now please," he said urgently, pointing to the box of surgical masks that were hidden from sight until i had sat down. "If you have to come here again, the first thing you should always say is that you are a cancer patient getting chemo; we don't want to have you sitting here with other people for too long."
"Okay. Sure," I said, biting my tongue to prevent me from asking how I was supposed to somehow know that. I had to bite my tongue even further when I was asked to go back to the same overcrowded waiting room and wait for another hour and a half amongst all the same people I had been around for the past hour. I guess I was wearing my magic mask this time so now it was okay.
From the waiting room I was taken in to an exam room deep in the large ER. A very young, very sweet nurse took my vitals and asked me more details about my bleeding episode. It was the fourth time I had told the same story to people in the same building and the third time I had told someone in the same department where she worked, but that wasn't her fault. I answered her questions and asked what my CT results showed.
"The doctor will explain that to you He's the next person you'll see."
And he was. Nearly four hours later.
By this time I had not eaten for twelve hours. I didn't even have any water left in my water bottle to drink - that was long gone before my CT scan was done six hours earlier. And while I was glad to see the ER doctor walk through the door, I had to really bite my tongue at the first question he asked me.
Yep, you guessed it. "So... tell me more about this bleeding episode you had..."
Eventually, after telling my story for the sixth time since I walked through the doors of the hospital, he told me what my CT showed.
"There is definite signs that you have diverticulitis but the radiologist says that it is relatively minor and appears to be resolving. That matches with the symptoms you described and how you are feeling now, and frankly we wouldn't treat what we are seeing here from a clinical perspective. But the CT also showed something completely unrelated but more sever - you have a portal vein thrombosis, a large one, in fact."
Oddly, this severe and unexpected outcome was a relief.
You see, for the previous six hours I had been fairly certain that my CT had actually shown a more serious tear or partial rupture of my bowel, one that would require surgical intervention. I see patients on my ward not infrequently for whom this is the case, and while I have every faith in the surgeons who would have been called upon to fix my damaged gut, that didn't mean I wanted to undergo another surgery, at least not an emergency one. But portal vein thrombosis is treated medically, with anticoagulants like rivaroxaban, and I could go home not too long after receiving the news. So, in an odd way, this bad news was actually one of the better pieces of news that it could have been.
I left the emergency room seven hours after I first got to it. I had not eaten anything since my bowl of cereal in the morning, but I was happy as my wife and I drove home to scarf down whatever leftovers we had in the fridge. I was not going to need to be admitted, was not going to need to undergo another surgery. And I could eat!
But I was still not going to get my last cycle of chemotherapy until at least next Friday. So all my anticipated joy of being done my chemo was delayed by at least seven days.
Don't count your chemo until it's given.
****
UPDATE:
In keeping with the whole 'don't count your chickens theme', I just got a call from the Nurse Practitioner I saw yesterday.
"Hi John. I was talking to your oncologist and he thinks you are safe to go ahead with your chemotherapy on Friday like we originally planned. What do you think of that?"
"Um..."
It took my still-chemo-ravaged brain a few moments to work through the details. The NP was wonderful and patient and answered the few questions I had, mostly about whether the portal vein thrombosis was a concern (it wasn't, at least from a chemotherapy perspective) and whether the fluorouracil would put me at a greater risk of another attack of diverticulits (it might, but if that happened I should report to ER right away and be treated with antibiotics even if I'm not running a temperature). She told me that I could take some time to decide and let her know later today or even tomorrow.
I didn't need more time though.
"Let's go for it," I told her. "I want the maximum benefit from my therapy, so I do want this last cycle. And waiting a week won't change anything other than delaying my return to normal by another week. So let's go for it."
"Okay. Great. See you Friday then," she said.
Until this call, I had sullenly accepted that I might or might not get another cycle of chemo, and that if I did, it would be delayed by at least a week. Now, everything had changed... which brings to mind another little saying that sums a whole philosophy nicely.
"The more things change, the more they stay the same."
Growing up, a lot of life's little lessons were distilled down into cute little catchphrases that maybe still had some everyday meaning to people. But as America and Russia fought a Cold War for global supremacy and ran a Space Race for supremacy in the heavens, fewer and fewer people had any firsthand knowledge of poultry husbandry and so the saying rapidly lost its direct meaning and became more of a catchall to espouse a philosophy than a direct metaphor to an experience that most individuals had shared. But as a pre-teen, my family did keep a small flock of chickens so the saying actually does have some direct meaning to me. Still, if you have never seen a chicken lay an egg or seen an egg hatch into a - let's face it - totally ugly and disgusting-looking chick (they don't get to be cute until their fluffy feathers dry several hours after hatching), you probably know what this saying means.
Don't get too attached to a potential outcome. Stuff happens and things don't always work out.
With chickens, eggs may appear to be fertilized but they stop developing for unknown reasons, or one egg gets just a little too cold on one side and the chick growing inside becomes deformed, or practically a million other things can go wrong so that any particular egg laid might not hatch into a chick. Even then, chicks are relatively fragile little things and disease or small predators can easily pick them off so that all chicks hatched do not necessarily become fully-grown chickens that can either produce eggs or meat, both of which are very tasty and nutritious. And that is really just a 10,000 foot view of the fact that if you have a dozen hens and they are sitting on five eggs each, that doesn't mean that you will wind up with sixty full-grown chickens in six months. You might, but don't bet on it.
Great... what does this have to do with my cancer blog? Or am I suddenly shifting focus and am turning this into an urban agriculture/animal husbandry blog? Fortunately for both me and anyone who reads this, I am not doing the latter. But that doesn't mean that the 'counting chickens' metaphor isn't valid.
You see, I have been counting on this coming Friday as being my last cycle of chemo. Like, really counting on it.
My last cycle of chemo means a lot of things to me. First off, it means that I've made it. There are literally no more therapeutic options to prevent cancer from rearing its ugly head other than the heightened surveillance I will be subject to. I have crossed the proverbial finish line and can eat my celebratory roast dinner because I will no longer be poisoned on a biweekly basis. It also means that I can jump to a lilypad closer to the far shore, one where I can even see the banks of normalcy ahead of me. I can get back to the gym - maybe not right away, but soon - and start to rebuild my deconditioned body. Without the fluorouracil actively attacking the mucous membranes in my body, I can start to advance my diet back to a more normal one - for me, at least - meaning that I can add more fibre and spices gradually until I am able to eat what I used to. And, probably most of all, getting my last cycle of chemo means that I can say sayonara to my PICC, my frenemy for the past almost five months. That aspect alone was enough to bring joy to my heart as Friday loomed large on my horizon.
Getting my PICC removed means, more than anything else, that I could shower any way I want, any time I want. I wouldn't need to wrap it in cling wrap, pull on a cloth tube to absorb errant moisture, then cover the whole apparatus in a bag with the bottom cut out and secure that with two elastic bands at the top and bottom of the tube and still keep my right arm out of the main stream of the shower. I could just turn on the shower, wait for it to get nice and toasty-warm, and climb in and let the water splash where it wanted. I wouldn't have to limit my shower to a few quick minutes just in case water got under all the protective layers (trust me, it happens); I could stay in there until the hot water tank ran out if I wanted.
Glorious. Heaven, even. Fantasies of unfettered showers have been in my dreams for the past few weeks as Friday loomed.
Of course, my life would not return to normal once I woke up on the Saturday immediately after this Friday. For one thing, my fluoruracil infusion that is part of my protocol would continue until Sunday morning, and then it will take a couple of weeks before the majority of both it and the oxaliplatin that I have been receiving to clear my body. I will still need to be cautious about my body fluids and the people that matter that live with me or are physically close to me so that I don't expose them to potentially dangerous chemotherapy. And of course, I will still be feeling the side effects of the chemo during this time, and possibly even for a long time afterward. Still, for the first time in almost five months, I will know that I will soon be past all of these considerations because I'm not adding more poisonous fuel to the proverbial fire.
And then last Saturday happened.
The day started out beautifully and I felt pretty good. My wife and I took our miniature dachshund to a dog park and walked for about 3 km - the longest walk and most physical activity I have undertaken in over a month. We connected emotionally and intellectually in a way that my diagnosis has made difficult over the past nine months and wound up even more in love than we have ever been before (it's a constant progression for us, although I'd be lying if I said every day was a positive one). We went to bed and snuggled and everything was looking absolutely freaking rosy for my last cycle of chemo. Until I was awoken just after midnight by severe cramping and pain in my left side.
During the colonoscopy that definitively diagnosed my cancer, I was also diagnosed with diverticular disease. At the time it was evident but under excellent control in the estimation of my gastroenterologist, likely due to the fact that I was physically active and my diet up to that point included high fibre and relatively low animal fat - three of the things that really help diverticular disease not progress from the stable chronic diverticulosis to the more painful and acute diverticulitis. And in the very first hour of Sunday morning, my diverticulosis dashed headlong into a severe, almost blinding attack of diverticulitis.
I will spare you the details, but it's probably enough to know that within an hour I went through almost the worst pain I have ever experienced, passed out and fell, bruising my forehead, and suffered various other personal indignities. And then the attack passed. I got cleaned up and made notes of the event to report to my care team and got eight good solid hours of sleep. I woke up late Sunday morning feeling a million times better than I had when Sunday first announced itself and ate my breakfast with enthusiasm.
Except, when I went to the bathroom after breakfast there was a small amount of blood in my stool. That hadn't happened since just after my surgery. When I went again a few hours later, there was about half blood and half soft to watery stool. I passed frank blood three more times on Sunday and then a small amount of clots on Monday morning before it stopped. Aside from the blood - which should always be seen as a pretty serious warning sign - I felt pretty darned good.
In my professional life I help manage the care of patients with the most severe forms of diverticular disease. As such, I knew that bleeding, while rare, does occur. The symptoms that I had in the opening hours of Sunday all matched a bout of diverticulitis, and given that the fluorouracil I am being given causes inflammation of the mucous membranes that line the diverticula in my colon it made sense that they might ooze or even have a blood vessel rupture giving me the not-totally-unexpected diverticular bleeding I was experiencing. I had checked my temperature regularly from Saturday night through to Tuesday night - it never went above 37C - so I knew that I had not perforated my bowel as can sometimes happen. And because the volume of blood lost was small - my estimates were no more than 150 mL across all the losses - and they were decreasing I decided not to go to emergency and sit in a festering petri dish of other sick people while I waited for them to do an abdominal exam and send me home. Besides, I was seeing a Nurse Practitioner at the cancer treatment centre on Tuesday morning and I was getting progressively better, so there really wasn't any reason to panic. I told her everything that had happened, in all the detail that I am sparing you here, in the interests of full disclosure.
The nurse practitioner, however, was a little more concerned about my medical status.
To be fair to her, she didn't panic nor did she suggest at any point that I had mismanaged my own care. She also had the benefit of doing an abdominal examination that showed my lower left quadrant - where my diverticulosis exist - was dull and slightly tender. This indicates inflammation of the bowel which concerned her in light of the fact that I was about to get more fluorouracil on Friday and that it might aggravate my healing diverticulitis. She spoke with my medical oncologist who reviewed my symptoms and agreed that my event was probably diverticulitis, but given the possible risks of making it worse he wanted to hold my chemotherapy for Friday and give it next week. In the meantime and out of an abundance of caution, he ordered more bloodwork on my and would arrange for a semi-urgent CT scan to ensure that my diverticulitis was mild and resolving. He even suggested that I consider dropping the last cycle of chemotherapy because I had already derived most of the benefit from my therapy and the risk of making me sicker was probably not worth it.
From there, my day went rapidly downhill.
I was already disappointed that my last course of chemo was being delayed, but a faint glimmer of hope arose when he suggested that maybe I didn't need it at all. That meant not only no more poison, it meant that I could get my PICC removed now, allowing me to rejoin the normal world even sooner than I had hoped. Still, in the back of my mind I was thinking about how, all along, my decision making on chemo was based on the assumption that I did have metastases that were too small to detect, otherwise treating with these poisons made no logical sense. I cast my mind forward five years to imagine finding out that I did have a secondary tumour and that the seven cycles of chemotherapy had not killed it. Unfortunately, the mortality for these secondary tumours is shockingly high. At least if I had received my last cycle of chemo I would feel like I had done everything possible; if I cut it short 7/8 of the way there... who knows?
I didn't really feel enthusiastic about taking that chance. But I still had my bloodwork to do. I walked over to the adjoining hospital and had the helpful lab phlebotomists draw out more of my blood for testing, then started to drive home.
I was called by my oncologist's office assistant when I was halfway home. He had received my bloodwork and talked to some colleagues and they all felt that getting a CT was really important given my bleeding. I was asked to ensure my phone was with me at all times because I might get a call to come in for a CT right away.
Okay. That was a little scary.
I was called by his booking assistant just after I got home. The bowl of cereal I had eaten four hours earlier was wearing thin and I wanted to make a sandwich to satisfy my hunger. She asked me a few questions and then dropped some more bad news on me. "Okay: based on the criteria you qualify for an immediate walk-in CT scan. I will call the medical imaging department at the hospital closest to you and arrange it. Don't eat anything, but drink a full 750 mL of water before you arrive there. Can you leave now?"
"Sure," I said, putting the unbuttered bread - and more of my hopes and comfort - back in the bag I had just taken it out of. I put on my shoes and got in the car to drive to the hospital for the CT.
I've had several CTs already. I am not claustrophobic and I know the drill so I was not at all scared of getting the scan. That didn't mean I wasn't scared. The bleeding that had stopped over twenty-four hours earlier seemed to be a much bigger issue than I had thought, and now there was a definite tone of urgency about me getting detailed investigations done.
The staff at Medical Imaging were great and I was done being scanned within 45 minutes of my arrival. That's pretty good considering they were fitting me in in between the people with strokes and various other acute imaging needs as well as the people who had booked appointments during the time I was there. Having my PICC - something that I have become accustomed to but still don't like - made it much easier for them to give me the contrast agent to enhance my CT. Like I said, they were awesome, and as the scan was finished I was all ready to head out for home and await the results like I had on all my previous CT scans. But this CT was not like all the others - it was needed urgently.
"So... we're going to have a radiologist read the scan as soon as possible. It will probably take half an hour. Have a seat in the waiting room and we'll come get you to tell you to go home or to tell you what step B - or steps B and C and possibly D - are," the helpful technologist told me.
"Oh. Okay," I said. She was great, but my level of fear rose at the implication that there was more to be done on me. I sat in the waiting room and looked at news stories on my phone for thirty-one minutes before another technologist called me into the hallway to talk.
"The radiologist has read your scan and is calling your doctor with the results. Based on his report, you are strongly advised to go check in at Emergency right now."
Cue the icy grip of fear as it wraps around my innards.
"Oh. Sure," I said. My voice sounded unreasonably calm, even in my own head.
I went and sat in the overcrowded ER waiting room waiting to see the triage nurse. He was very busy and doing his best, but it still took over half an hour before he even acknowledged that I was there and came to take my details. He had perhaps ten seconds he could spare to have me tell him why I was there so I kept it brief - I was sent for an urgent CT, they said to come here, I've been having some rectal bleeding - and sat and waited for him to call me up. He called several other patients up, mostly children with sprains or asthma attacks, and half an hour after he talked to me he called me up.
"So... tell me more about this bleeding," he said.
"Sure. I was seeing my oncologist this morning and he sent me for an urgent CT because..."
"Wait. Oncologist? You're a cancer patient?"
"Yes."
"Are you actually receiving chemotherapy right now or are you going to start soon?"
"Actually, Friday was supposed to be my last chemo. I received cycle seven of eight ten days ago."
"Put a mask on right now please," he said urgently, pointing to the box of surgical masks that were hidden from sight until i had sat down. "If you have to come here again, the first thing you should always say is that you are a cancer patient getting chemo; we don't want to have you sitting here with other people for too long."
"Okay. Sure," I said, biting my tongue to prevent me from asking how I was supposed to somehow know that. I had to bite my tongue even further when I was asked to go back to the same overcrowded waiting room and wait for another hour and a half amongst all the same people I had been around for the past hour. I guess I was wearing my magic mask this time so now it was okay.
From the waiting room I was taken in to an exam room deep in the large ER. A very young, very sweet nurse took my vitals and asked me more details about my bleeding episode. It was the fourth time I had told the same story to people in the same building and the third time I had told someone in the same department where she worked, but that wasn't her fault. I answered her questions and asked what my CT results showed.
"The doctor will explain that to you He's the next person you'll see."
And he was. Nearly four hours later.
By this time I had not eaten for twelve hours. I didn't even have any water left in my water bottle to drink - that was long gone before my CT scan was done six hours earlier. And while I was glad to see the ER doctor walk through the door, I had to really bite my tongue at the first question he asked me.
Yep, you guessed it. "So... tell me more about this bleeding episode you had..."
Eventually, after telling my story for the sixth time since I walked through the doors of the hospital, he told me what my CT showed.
"There is definite signs that you have diverticulitis but the radiologist says that it is relatively minor and appears to be resolving. That matches with the symptoms you described and how you are feeling now, and frankly we wouldn't treat what we are seeing here from a clinical perspective. But the CT also showed something completely unrelated but more sever - you have a portal vein thrombosis, a large one, in fact."
Oddly, this severe and unexpected outcome was a relief.
You see, for the previous six hours I had been fairly certain that my CT had actually shown a more serious tear or partial rupture of my bowel, one that would require surgical intervention. I see patients on my ward not infrequently for whom this is the case, and while I have every faith in the surgeons who would have been called upon to fix my damaged gut, that didn't mean I wanted to undergo another surgery, at least not an emergency one. But portal vein thrombosis is treated medically, with anticoagulants like rivaroxaban, and I could go home not too long after receiving the news. So, in an odd way, this bad news was actually one of the better pieces of news that it could have been.
I left the emergency room seven hours after I first got to it. I had not eaten anything since my bowl of cereal in the morning, but I was happy as my wife and I drove home to scarf down whatever leftovers we had in the fridge. I was not going to need to be admitted, was not going to need to undergo another surgery. And I could eat!
But I was still not going to get my last cycle of chemotherapy until at least next Friday. So all my anticipated joy of being done my chemo was delayed by at least seven days.
Don't count your chemo until it's given.
****
UPDATE:
In keeping with the whole 'don't count your chickens theme', I just got a call from the Nurse Practitioner I saw yesterday.
"Hi John. I was talking to your oncologist and he thinks you are safe to go ahead with your chemotherapy on Friday like we originally planned. What do you think of that?"
"Um..."
It took my still-chemo-ravaged brain a few moments to work through the details. The NP was wonderful and patient and answered the few questions I had, mostly about whether the portal vein thrombosis was a concern (it wasn't, at least from a chemotherapy perspective) and whether the fluorouracil would put me at a greater risk of another attack of diverticulits (it might, but if that happened I should report to ER right away and be treated with antibiotics even if I'm not running a temperature). She told me that I could take some time to decide and let her know later today or even tomorrow.
I didn't need more time though.
"Let's go for it," I told her. "I want the maximum benefit from my therapy, so I do want this last cycle. And waiting a week won't change anything other than delaying my return to normal by another week. So let's go for it."
"Okay. Great. See you Friday then," she said.
Until this call, I had sullenly accepted that I might or might not get another cycle of chemo, and that if I did, it would be delayed by at least a week. Now, everything had changed... which brings to mind another little saying that sums a whole philosophy nicely.
"The more things change, the more they stay the same."
Comments
Post a Comment