Tuesday, August 15, 2006

Update on Mrs. The Old Man

Hi Friends:

Last Wednesday I accompanied Mrs. The Old Man (Susan) to her appointment with her oncologist to learn about her status as it relates to having completed four rounds of chemotherapy over the past three months, the results of the CAT scan from the day before, and the details pertaining to her anticipated surgery later this month to remove the tumor in her upper right lung.

The oncologist was very positive about the shrinkage of the tumor from the chemo and her general health, but he startled us pretty severely with his apprehension about whether or not she is, in fact, a candidate for the surgery. His comments over the past two months had inclined both of us to quite a bit of confidence about the direct line from the chemo to the surgery and the future.

At the very beginning of the chemotherapy, the oncologist had shown us on the PET scan that there was some possible involvement of lymph nodes in the cancer activity in her lung. But, both of us recollect that at the next appointment he kind of shrugged off the notion that the lymph nodes were really much of aconcern. Then, after two months without any reference to her lymph system, at last week’s appointment he brought this issue back on the table and expressed some concern about the involvement of three or four nodes. As to the surgery itself, he said very little other than to state that he is not a surgeon and that we would have to find out where we are in the appointment with her surgeon, which took place at 4:15pm Monday. Consequently, for the last five days,we’ve been rather “on edge” to say the least.

So, “4:15 Monday” finally arrived and we met with the surgeon. In consultation, he is a very sensitive and very direct professional. He walked us through a detailed analysis of last week’s CAT scan, a very thorough discussion of the factors and options, and a very candid assessment of her status at present. The good news is that Susan is, in fact, a viable candidate for surgery. This is huge. Her surgeon is very much the kind of physician who would have sat us down and told us, point blank, that this would not work and would not be worth attempting, if he did not truly believe that he can open her up and “get itall.” Can he guarantee us of this? No. Is he persuaded that he has a good enough shot to warrant putting Susan through extremely major surgery? Yes.

This is no simple decision. Next Thursday, August 24,at 7:15am, he will open up her right side under her arm, remove a rib, and then resection (remove) the upper lobe of her right lung along with the tumor therein, and he will remove two hillier lymph nodes inthe middle of her right lung. He does not see any other definitive evidence of cancer based on the scans and data he has at present. Of course, no one knows precisely what he may find once he is inside, but based on the data at hand, he believes the surgery is viable and that it will offer Susan her best chance of maximum survival.

She will be in surgery for about 4 hours, in the hospital for about 6 or 7 days, and at home in bed for a month, followed by limited activity and additional recovery for another one to two months. Also, during this recovery, she faces the prospect of additional rounds of chemotherapy. Obviously, if the surgeon did not think he has a very good chance of getting it out, he would not put her through an ordeal of this magnitude.

He was also very candid with us about her long term prospects. While he is confident that this surgery offers Susan her Best Chance, he does not think her chances of actually beating cancer are very good at all. It was pretty brutal hearing this assessment. He is very clinical, very well-researched, and very cognizant of the survival rates and research data on people who have this kind of cancer, and at what stage it is diagnosed, how it behaves, and what it all means in statistical terms for survival. While we are very encouraged in the short term by his momentous decision to proceed with the surgery, we are mightily challenged emotionally and psychologically by his candid assertion that, in his opinion, her long term situation is not promising.

What he does not fully factor into such an assessment are elements like 1.miracles, 2.faith, 3.just how extraordinary Susan is (and always has been,) 4.how strong and generally healthy she is, 5.how young she is, and 6.the fact that she has never smoked. It would be foolish and naïve to discount the data, the research, and the statistical facts of lung cancer survival. But is it not just as foolish and naïve to limit the discussion to only these aspects?

So, Monday night was a great big mix of emotions. She has blood tests and lung function tests to get done between now and next Thursday morning. We have lots of praying and trusting and staying focused to do in the next ten days. And we are profoundly grateful that the surgery affords her the very best medical chance on the table of possibly reaching a point where she is indeed “cancer-free.” Please continue to pray, it’s all pretty overwhelming. Thank you and bless you. Your faithful reporter,