A Sign of the Times

My chemo doc is part of a very busy practice.  Something like six or seven MD's, a complete chemo lab, a blood lab, and so forth.  So the parking lot is quite busy. 

But the parking spots closest to the front door are posted with signs like this one -- saving those spots for cancer patients. 

When Deb and I first visited this facility, I thought it was very cool and very thoughtful -- these reserved parking spots.  Clearly it would make life a little easier for "them": the folks who were suffering either from their cancer or from their treatments to make the cancer go away.  And I felt a distance between me and "them."  After all, I wasn't suffering from either disease or treatment.  So we didn't park our car in these spots.     

After several visits, I felt it would be okay if we parked our car in one of these spots.  I still wasn't suffering,  but I had surgeries behind me and before me.  And radiation treatments.  And chemo.  And I certainly did have cancer.  So I felt I qualified. 

By ten weeks after our initial visit, I was deeply grateful for having these spots available when we had appointments.  I was so weak that the difference between walking 15 feet to the front door of the office or walking 50 feet to the same door was huge.  And the message on the signs now said much more to me than the words indicated.  They seemed to say: "We understand what you're going through -- because we've seen so much of it long before you started coming.   And all we can do for you is offer this small token: we want you to park here because we understand." 

And after every visit, I would forget about the signs.  But then as we pulled in to the parking lot for our next visit, there they were: the signs and their offering of understanding.  And it made life just a little more tolerable. 

Ever since then, I've parked in these spots without giving it serious thought.  Yes, I am a cancer patient.  And so I'm allowed this special parking privilege -- whether I need it or not. 

But something happened to me during my last visit -- a visit I made just to pick up a form.  I felt I no longer qualified to park in these special spaces.  Just because I had had cancer didn't mean that I was still a patient.  And more importantly, if I thought of myself as a cancer patient, I was holding myself within the confines of the disease.  Identifying myself with an illness I no longer had. 

If I'm declaring myself to be cancer-free (see the previous posting), then I could no longer take advantage of those parking spots set aside for cancer patients. 

So from now on, when I visit my chemo doc, I will park my car the extra 50 feet away from the front door -- no matter how many empty spots there are for cancer patients -- and joyfully walk the extra distance.  Walking which nowadays is no problem at all. 

Kind of a nice sign, don't you think?

A Long, Strange Trip -- with the Toll Booth Behind Us

I have in front of me the Final Report on the PET scan done on April 6th of this year.  The scan intended to determine the nature of the spot in my right lung.  For the report, the examining doc compared this scan with PET scans performed on me April of 2009 and October of that same year.  (In other words, a bit before my chemo and radiation treatements started and then again after they were completed.) 

And one might say there's nothing to report.  And that "nothing," my dear friend, would be a Good Thing.  But in truth, there are several important things to report, those things are a Very Good Things indeed. 

First, there is no sign of cancer anywhere.  (Here's a brief medical explanation of the PET process: The PET scan consists of being injected with a sugar solution which is radioactive.  The solution is given time to circulate throughout the body, where it will be preferentially taken up by cancer cells.  This is called "FDG," but I don't know why...  The sensing mechanism -- that is the great big metal doughnut -- then looks for spots in the body that "light up" due to higher concentrations of this radioactive sugar.  Any such spots are identified as tumors.  But nothing of that sort showed up on the scan.  YAY!)

Actrually, the scan was not "nose to toes," as I thought it might be.  It turned out to be "nose to knees," but that's okay.  Ain't nothing going on below my knees.

During a post-scan visit with my lung doc, he mentioned that there is a rare sort of cancer that doesn't "light up" on a PET scan, but there's no reason to expect that I've contracted that.

So Good Thing #1 -- no sign of cancer.

Second, the examining doc noted that the spot in the upper lobe of my right lung -- the spot that started this Long, Strange Trip -- shows up on the previous two PET scans.  It was there, and it hasn't changed since 2009.  And it may have been there for years for all we know.

So Good Thing #2 -- whatever's going on in my right lung seems to be inert.

(In Doc Speak, Good Thing #1 is: "No evidence of FDG avid malignancy."  And Good Thing #2 is: "Two-year stability of lingular opacity [is] in keeping with a benign etiology."  Pretty neat, eh?) 

Good Thing #3 is not a direct part of the scan procedure or the analysis thereof. 

I've had this nagging concern for the last 18 months or so that, while my cancer had shown no signs of recurring at its original location, we hadn't done any scans to see if it had metasticized to somewhere else in my body.  My three main docs routinely examined my head and neck with gentle probing -- but we hadn't looked at my lungs or liver or anywhere else with a scan as sophisticated as the PET.  So I might still have a cancer, but it simply wasn't where we were looking.  And in this light, the original cancer that produced the bump on my neck was readily visible -- and that's how we caught it.  But a metastatic tumor in the lung...  or liver... 

But this latest PET scan had provided the best proof available that I was, in truth, cancer free.  And this awareness has helped me recognize now how much that nagging concern had been weighing on me.  And it's taking some serious time to adjust.  I have to see myself in this new light:  post-treatment and post-anxiety. 

I understand, by the way, that this anxiety is perfectly normal for folks whose cancer is in remission: (as in: "Sure, things look okay right now, but...")

So while my body will always have telltale signs of the cancer and its treatment,  I'm now giving myself permission to consider being cancer free for the rest of my life.  And I guess that should feel wonderful, and maybe it will sometime soon; but right now it just feels... well, unusual. 

So this Long, Strange Trip is at an end.  And the rest of my life awaits.  The concern about the spot on my lung proved to be unnecessary.  But the Trip itself has been immensely helpful:

I've come a long way 'round to wind up back where I started.  But I'm in a wonderfully different place.

A Long, Strange Trip -- on the Exit Ramp

We had a regularly scheduled visit to my radiation doc on Thursday the 14th.  One of those "every three (or six or whatever) months" visits that my chemo doc, my E/N/T doc, and my radiation doc have called for.  Normally, he probes gently around my neck area and looks into my mouth -- checking for a local recurrence of the cancer.  I really like this guy in any case, and it's quite likely that his design of radiation treatments is largely responsible for my continued cancer-free contition.  So it's perfunctory medicine, but a chance to reconnect with someone who was there for me at a critical time in my life. 

This time around, though, he was also the first medical person I was scheduled to see who was ready, willing, and able to take a look at the PET scan (done on the 6th).  Now you might well have thought that I would have been anxious to have a qualified person look at the scan results as soon as possible and tell me what they show about the spot on my lung -- which has turned into the principle reason for this Long, Strange Trip coming home from Baltimore. 

Well, I certainly would have guessed that I'd be anxious in such circumstances, but I felt remarkably at ease.  I had kept the PET scan disk sitting on the dining room table -- right next to the CT scan disk from Jennersville Hospital -- and so I felt that I had the answer in hand.  And I felt that it didn't matter what the result was, just that I had one. Kinda strange, but then that's the kind of trip it's been... 

Anyway, we showed up at the doc's office early to give him time to review both disks if he had a chance to do so.  Turns out he didn't.  That he was, in fact, backed up by other patient consultations.  But that was okay too.  It gave Deb and me a chance to sit in the examining room-- quietly -- and recall the times two years ago when such visits were fraught with anxiety.  And so it was a chance to be thankful for the restitution of peace in our lives. 

When he did show up -- with apologies for our being held up, because that's the kind of guy he is -- he had not only examined the PET scan, but had compared it to a CT scan of mine from two years ago.  One that I had completely forgotten about.  But I believe that it was taken before my treatments started -- kind of a base-line exam for future reference.  And what he told us about what he saw was wonderful:

He saw that the spot currently residing in my lung had been there for at least these two years, and may, of course, been there a lot longer.  And he listed for us several possible reasons for the spot being there -- all of which were non-cancerous. 

Now my doc is Asian and his face reflects that marvelous sense of tranquility that one sees so often in so many Asian faces.  But on that Thursday, you could see that he understood what this news would mean to us, and that he shared in the joy that the news brought with it.  He had, of course, been with us since the start of my treatments and has been for me such a source of strength and comfort for years now.  And so this day was a victory for the three of us (that is, him, Deb, and me):  the spot's been there for a long time and hasn't changed in years.  (Note: we still don't know what the spot is, and maybe never will, and maybe it doesn't matter now...)

I've got an appointment with my pulmonary doc next week on Tuesday the 19th -- and I expect him to give the PET scan disk a thorough going-over.  And I'm feeling that his analysis is somehow more "official," since he is the lung guy and he is the one who ordered the PET scan in the first place.  And for that reason, I feel that my Long, Strange Trip is still in progress. 

But I also feel that I'm on the exit ramp and slowing down. 

Anyone got change for a $10 bill?

A Long Strange Trip -- Is This My Exit?

So at the start of this LST, I stopped into an Emergency Room to check on a sharp pain in my chest. (Which was never really explained, but that's all right since it hasn't re-occurred.) And I get diagnosed with pneumonia. (Which I still don't totally believe, but I've stopped coughing, so that's all right too.) But the spot on my lungs that showed up on a CT scan kept this trip going. It wasn't all right...

So now on the next leg of the trip (and maybe the last one?), Deb and I have just come home from the PET scan facility with a CD copy of the scan results firmly in hand -- a scan of my lungs and everything else. A CD I hope to present to my radiation doc late next week for analysis. So that's as right as it can be at the moment.

If the scan proves to be negative, then I will feel comfortable in declaring this Long, Strange Trip -- that started driving home to West Chester from visiting my Dad in Baltimore over three weeks ago -- declaring that trip to be over.

A few recollections from today:

The scan itself:
The PET scan technician was great. A very upbeat, positive young man with a handful of useful euphemisms. Step one in the process of PET scanning is injecting a radioactive substance into the patient's arm and waiting for an hour or so until the solution travels throughout the body. Now he might have told me: "I'm going to inject you with a substance so dangerous that it gets delivered to the office and stored in a heavy lead container. It will react with cells throughout your anatomy, producing matter / anti-matter particles that will, in turn annihilate each other in a microburst of energy." Because that's what will happen. In fact, he told me, "I'm going to inject some sugar solution into your arm, then we wait until it circulates everywhere." Because that's what will happen.

And he might have told me: "Then we're going to strap you down to an uncomfortable table and run your body through a huge, ominous-looking plastic doughnut that is likely bring up any feelings of claustrophobia you've ever had. And the doughnut will catch the radiation particles as they are emitted from your body." But instead, he told me: "Then we're going to place you on the bed of the camera."

Pretty cool, eh?

(In fact, I've now become pretty much inured to getting scanned in giant plastic doughnuts, and have fallen asleep in the middle of the scan. In the middle of the doughnut. Truth.)

Breakfast at 11:30:
I was not supposed to eat anything after midnight before the scan, so by 11:30 or so, I was quite peckish. And there was a really nice diner (run by a Greek family, of course) close to the scan center. So Deb and I stopped for a bite. Actually quite a lot of bites... Great food, good service, and really nice coffee.

And one of the things that made the stop all the more special was the coffee mugs, which were quite heavy (as in sturdy) with the intriguing shape shown in the photo attached. Now, the shape of the mug won't mean anything to any of you -- until you read the name of the diner. And then it will only mean something to the folks here in the lower right-hand corner of Pennsylvania.

So let me fill in the rest of you. The restaurant is located in the town of Limerick. And the most notable feature in the town is the two gigantic cooling towers of the nuclear power plant which happens to be located in the town. And the shape of the coffee mugs (the gentle curve inwards on the lower half matched by a gentle curve outwards) closely mimics the shape of said cooling towers.

We did not ask the owner of the restaurant if the mugs were chosen for their similarity in shape to the key feature of the town's largest employer. We'd rather just keep the mystery going... (But we did buy a pair of the mugs. Kind of a memento.)

How I feel now:
I had not consciously felt any anxiety leading up to today's scan. As in, the scan will show what the scan will show and worrying about it is the worst thing I can possibly do.

I did, however, suggest to Deb that we have wine with dinner the last three nights in a row. Which is unusual for us... And I did finish my wine before she did, which is also unusual. So I guess there was some subliminal anxiety I wasn't aware of.

But!! On the drive home, I felt somehow ever-so-much lighter -- as if the seat belt in the car was holding me in place. That I might float away if I wasn't wearing it.

Which was a not-so-subtle reminder that what we tell ourselves is not always the total truth.

And I'm telling myself that I'm not really that anxious about the result. And I almost believe it.