Closer to the Cut

Yesterday, two calls from the hospital in Little Rock emphasized that this lung cancer surgery thing is really going to happen. First, a call from someone representing the anaesthesia team called to ask a lot of questions about my medical history, experience under anaesthesia, allergies, etc., etc., etc. I wanted desperately to ask the woman who called whether her accent was South African (because it sounded like a South African accent to me), but I stuck to the issues she raised. I think her name was Clare. If I can remember on Monday morning, I’ll ask someone whether Clare from the anaesthesia team is originally from South Africa. And, if the answer is “yes,” I’ll ask to speak to Clare after I’m well along in recovery so I can inquire about her life story and her experience, pro or con, with peri-peri sauce, one of many South African flavors I find quite appealing.  The second call wasn’t as interesting, but it was slightly more jolting. I had been expecting, based on my interactions with the surgeon, Jason Muesse, that I would be his second procedure of the day; a morning procedure, but not the earliest. But the caller told me I should plan to be at the hospital at 5:00 a.m. on Monday morning in preparation for a 7:00 a.m. surgery. Even for me, 5:00 a.m. is early. For my wife, it’s early to the second power, multiplied many times over. Needless to say, our decision to drive to Little Rock on Sunday afternoon, rather than heading over early Monday, was confirmed in spades. We’ll get a room in a nearby hotel or motel. My wife will plan to stay there for at least another two or three days. I think she’s already made reservations with a place that offers complimentary 24/7 transportation to and from the main hospitals in the area, UAMS and CHI St. Vincent.

I opted for the November 19 surgery date, even though Dr. Muesse intends to be away on holiday/vacation for the remainder of Thanksgiving week. His colleague, Dr. Steliga, will take on responsibility for aftercare until my release from the hospital. Dr. Muesse recommended I get the surgery done ASAP after my meeting with him and, in fact, we set the surgery for November 14 (last Wednesday). After the meeting, though, I had cold feet. I wanted to participate in our little wine/appetizer group’s gathering (this month, it was an Italian theme), which would have been impossible with a November 14 surgery. Methinks I simply got scared and used that as one of a couple dozen convenient excuses. When I opted against November 19, I suggested December 4. Dr. Muesse had suggested I not wait any longer than that, for fear of allowing the tumor to metastasize. We don’t know for certain it hasn’t already, but I certainly didn’t want to give it more time, regardless, so we picked Monday.  I’ve probably already written this. I feel like my writing must seem a little like the words of elderly people who tell the same story over and over and over again.

Despite fears and misgivings, I’ve come to grips with the fact that I’m having lung cancer surgery and that I’ll have chemotherapy afterward. Those facts conspire to force me to admit that it’s more than I’m having surgery for a malignant tumor and subsequent treatment; I have to admit “I have lung cancer.” That is harder to say than I expected it might be. For whatever reason, it’s easier to talk about the matter in a certain way—that a tumor is growing inside of me that, if left untreated, will eventually kill me—than in another—that I have lung cancer. The latter seems more sinister and more deadly for some reason. “You have lung cancer.” None of the doctors thus far have stated it in that way. “The tumor is malignant.” That’s closer to what they’ve said. I wonder whether their choice of words is quite intentional? I wonder whether they explicitly avoid saying “you have lung cancer” because that statement sounds to the patient like a death sentence? Hmm.  I wonder if, in my own mind, I’m better off telling myself that a malignant tumor is growing inside my lung as opposed to informing my already fragile sense of security that I have lung cancer? I’m sure there are resources to answer than question, perhaps people who have explored it more deeply than I can or will, but I’m not planning to spend my time today looking for them. Instead, I’ll spend a couple of hours at the Unitarian Universalist Village Church working on a new long-range plan. I have mixed feelings about that at the moment, but I will do it, nonetheless.

I have the sense that a lot of people don’t want to talk in any depth or detail about my diagnosis. And I can understand that. It’s uncomfortable talking with someone about a diagnosis that carries with it the prospect of that person’s earlier-than-anticipated death. Yet, as the person with the condition, I feel like talking about it. Not to elicit statements of concern and good wishes but to talk about more practical matters like pain management and when I’ll be able to drive after surgery and the number of follow-up visits I’ll have to make to the surgeon and oncologist and other aspects of how this surgery will impact my life and for how long. I can answer the question of “how long?” The rest of my life. But I’m looking not for the long-term minuscule impacts; I’m curious about ongoing dislocations to my quality of life and their impact on both me and my wife. I suppose lung cancer support groups can help answer some of those questions. After I return home from surgery, I’ll plan on seeking information about them. I suspect there are groups locally, perhaps even in Hot Springs Village. The unfortunate fact of life, though is that people in the Village who might have experienced what I’m about to go through are apt to be considerably older than I and may have had surgery and recovery before current techniques were in use. WAIT. Now THAT is the equivalent to the attitude that “we’ve already tried that and it didn’t work.” I hate that! I’ll not go down that road, by god!

Tomorrow, at church, we’re having the annual Thanksgiving Dinner. We’ve participated in the event each of the past two years. It’s not a huge affair, just a luncheon with turkey supplied by the church (purchased from a local vendor that smokes them) and side dishes supplied by church members and friends who sign up to provide specific dishes. We’ll be among several to bring green bean casseroles. If I were on the committee responsible for organizing the event, I’d lobby for something different. Perhaps an Indian-inspired turkey dinner. I just did a quick search and found a Tandoori turkey and chutney dinner on the epicurious website. The accompaniments include rice pilaf with almonds and raisins, caramelized cumin-roasted carrots, scalloped potatoes with coconut milk and chiles, and raita. Now THAT is a dinner I’d get excited about. But the excitement might fizzle when I realize only a half-dozen others in the congregation would share our excitement. And we’d have to cook the turkeys, rather than have someone else do it. Ah, well, I can dream. Perhaps next year my wife and I can offer a supplemental Thanksgiving dinner for adventurous diners, both inside and outside our church.

This food fixation presumes I’ll be able to eat what I want after surgery and that my attention won’t be focused primarily on pain management as opposed to the promotion of pleasure (I’m still alliterative, even when I’m shivering in fear). I read last night that fifty percent of lung cancer patients deal with severe chronic pain after surgery. That ups the ante for me, a man who readily admits to being allergic to pain. I’m banking on being in the fifty percent of patients who do NOT experience severe chronic pain after surgery. But even if I am in that fortunate fifty percent, I already feel empathy for those people who do suffer it. It’s an awful choice; between dying—and, in the process, suffering severe pain for a relatively short amount of time—and living for an unknown length of time while suffering from chronic severe pain. I sometimes wonder whether the focus of medicine should be regularly revisited with an examination of the philosophy that pain reduction should be given priority over life extension. Or, perhaps, we ought to openly discuss ways in which, on an individual-specific basis, we can measure that precise point at which, on one side, quality of life outweighs the price in pain paid to live it and, on the other side, the pain one would have to endure to continue to live one’s life is too great a price to pay to live. Just suggesting the discussion of such an equation may reveal how selfish and self-centered I am. The impact on others’ lives—wives, husbands, sons, daughters, parents, friends, et al—should figure into the equation. And, ultimately, we would probably decide that there is no equation sufficiently elegant and complex to determine that point at which life with pain is preferable to death. It’s an interesting problem to think about. But I’d rather think of it in the abstract that be forced to consider it as an immediately practical matter.

I do hope, when I come out of surgery, I’m able to talk with Clare about South African food. Assuming, of course, she was reared in South Africa. Even if she wasn’t, I hope I’m able after surgery to talk her about South African food. Or anything, really. Anything at all.