This Could be Serious

Until this very early morning, I’d done only a little research into lung cancer and its treatment. Now, after having explored the matter a bit, I wish I hadn’t done my investigation. Ignorance, they say, is bliss.

Unless the doctors have been utterly wrong, my prognosis involves the potential for some truly unhappy experiences. Surgery for lung cancer is invasive, dangerous, and involves an extraordinarily unpleasant set of circumstances. It’s not simply “cut into the chest and remove a tumor.” It’s far more involved than that. Typically, a patient spends five to seven days in the hospital following surgery, with a tube (or tubes) coming out of his chest and attached to a special canister to allow excess fluid and air to drain out. I remember the chest drain after my open heart surgery fourteen years ago; it’s ugly and unpleasant. At least that was a temporary situation that led to a more positive outcome.

Lung cancer surgery is messy stuff. It’s painful from the start and the pain and discomfort lasts for quite a while, from what I’ve read.  According to material I found online at cancer.org, the complications of surgery can include “reactions to anesthesia, excess bleeding, blood clots in the legs or lungs, wound infections, and pneumonia.” The site goes on to say, “While it is rare, some people may not survive the surgery.” The site doesn’t explore options. Such as “what if the patient opts against surgery?” I am thinking about that now. I just realized it’s only a few minutes past 2:30 a.m. I thought I woke up a bit before 5:30 a.m., but I fooled myself. And I’ve just about finished my first cup of coffee.

Here’s what I found on a website of the National Institutes of Health:

In fact, many patients with NSCLC (non-small-cell lung cancer) have been cured by surgery. However, there are also many cases that fail to achieve a cure following surgery. In fact, 30% to 55% of patients with NSCLC develop recurrence and die of their disease despite curative resection. Therefore, many patients eventually die of their disease due to recurrence after surgery. Furthermore, surgery itself possesses a certain amount of risk. Although treatment-related death is relatively uncommon, there is still a significant risk of mortality, and most patients experience a decrease in lung function after surgery. Thus, despite the advances in surgery, treatment by surgical resection is less than perfect, even when a complete resection is possible.

“Most patients experience a decrease in lung function…” Is that something I’m willing to live with? Until I began looking into the realities of the disease, I had been under the impression that I was facing something uncomfortable and deeply troublesome but not truly deadly. “This is 2018,” I said to myself. “Lung cancer killed my father, but that was many years ago. Advances since that time must have made the disease less deadly.”

That’s what I told myself. But the more I explored it, the more I came to realize I had been deluding myself. Lung cancer hasn’t become any less deadly. It’s just as lethal today as it was when my father died. Maybe it takes more time to do its dirty work today, but it still does its dirty work.

So, as I contemplate this new information, I have to ask myself: Is it worth going through the misery of a fight whose outcome is not subject to any positive guarantee? Would I have more time to experience life more fully by simply rejecting treatment altogether than by spending time in a hospital and at home as a wounded invalid than by subjecting myself to treatment? I suppose I need to listen to doctors and surgeons, rather than depend on a Google search to inform me about life or death matters, but I don’t want to delude myself into thinking “oh, they’ll just do surgery and my problem will be solved.”

I realize, of course, that I’m exploring life and death decisions in the middle of the night, relying only on Google for my facts. And I realize that’s stupid and the information upon which I’m relying is probably not the most trustworthy. I know I need to talk to oncologists and surgeons and others who really know the topic. I know that. But I know, too, their jobs are to give patients hope, even when hope is a candle whose wick is short and unlikely to last very long. I want to know what’s real, not what’s possible in a fairy-tale world.

I realize, too, that I’m making a lot of assumptions. I haven’t even had the biopsy yet. But the oncologist’s matter-of-fact suggestion that surgery is the likely first step in treatment led me to bypassing a bunch of possibilities and wishes and hopes. Though I have no desire to ignore real “what if” scenarios, I have no interest in escapism for the sake of delaying the onset of reality. The fact that the medical professionals have found what appears to be a 2.6 cm mass in my right lung is serious. The likelihood that it’s malignant, borne out by the PET scan “brightness” scale, is more serious, still. The oncologist’s comments that essentially dismissed radiation and chemo as first lines of defense/treatment suggests the tumor is, indeed, a serious matter. All the “stuff” I’ve read that presents lung cancer as a damn serious and often fatal disease makes me think, again, that “this could be serious.” Could be, hell. Is. And that’s scary.

I’ve not “given up.” There’s more to learn, of course. It’s possible that I might live a perfectly happy and reasonably healthy life for years to come after surgery to remove a piece of my lung. But I don’t want to fool myself into thinking such surgery is likely to leave me “well.” One isn’t “well” if one is missing a significant piece of one’s lung, methinks.

All of this thought of  what it might be like to be me after surgery suggests I’m being very, very selfish. What about my wife? What does she think? Good question. She’s not apt to share what she thinks. She’s never been one to open up that way. I guess she might open up if she were to think my thinking runs counter to hers. Absent knowing, though, I can only base my thinking on what I think and what I know and what information flows my way.

My father’s death from lung cancer was horrible. He was in constant pain for at least the last few days. Morphine did little to relieve his agony. I don’t plan on suffering through what he went through. I’m just not willing to do that. On the other hand, I don’t want to cut things too short too early. I know. It’s very early to be thinking such stuff. But that’s what one does in the wee hours when one has nothing else to occupy the emptiness.