Post op day 8
I met today with my oncologist. She is a very sweet doctor with a calming demeanor. I guess it is necessary to have such a calming demeanor when part of your job is to give bad news. She went over the pathology. Her voice was like a babbling creek running over the stones of my illness. My tumor was over three times the size that was estimated. While this is not uncommon for estimates to be off, it was my tumor and how common the underestimation didn’t matter. But yet it was hard to be upset as my oncologist lulled me with her voice. My lymph nodes were still clean but pathology identified the tumor invading into the wall of a lymph canal or blood vessel. The technical term is lymphovascular invasion (LVI). LVI prognosis is difficult to judge. It depends on if the cancer went through the entire wall of the vessel or not and if cancer cells broke off into the blood stream or the lymph. Lymphovascular invasion is a scary term. But it is treatable.
My oncologist discussed the new chemotherapy regimen with me and my husband. It needs to be a more aggressive treatment due to the possible breaking off of cancer cells into the blood stream or lymph. You can be lymphnode negative and LVI positive. The prognosis is slightly worse than LVI negative alone but it is important to know that chemotherapy medications are for precisely that possibility- the possibility that there are other cancer cells in your body that haven’t been picked up yet. Even though, as a doctor, my head tells me this, my emotions are in a free fall. So I go back to the ever soothing voice of my oncologist as she tells me about the new medications that will be used and the change in schedule for my chemo. There will be two additional medications added and the infusion will take a longer time both in hours for the infusion and weeks I will be getting this regimen of chemo.
My initial plan was to go to work in the morning on Fridays and go for chemo in the afternoon. My Fridays are pretty easy. I run a clinic until noon and have meetings and administrative work in the afternoon. My meetings could be changed to phone meetings and I could log into the hospital computer system since I will still be at the hospital. Easy to fit in chemo into my work. See patients in the morning and run over and get hooked up for chemo in the afternoon. Now this will change. My Friday clinics are a specialty clinic. I am the only doctor of my specialty that does these evaluations in my state. There are doctors of other specialties that will see patients, but if the question is more appropriate for my specialty, there is only me. As you might imagine, any decrease in my ability to see patients in this clinic is significant. I am not sure which I was more upset by- the worsening of my treatment and prognosis or the decline in my ability to see my patients. We all have responsibilities and the ability to adequately take care of our responsibilities is a part of what makes us tick. One of my responsibilities is this clinic. My cutting down on the amount of patients I can see is not only detrimental to the patients waiting to see me, but also to my finding ways to function as normal as possible with my looming illness. Looking for bright spots in an otherwise ominous cavern is essential for helping with coping. This change is difficult to swallow. I try now to replay the melodic sounds of my oncologist as I remember her words. Today, reality is creeping in too much. I am ill. I have cancer. My life will be different. This cancer is constantly changing my definition of me. I need to find a way to be happy with my new definition and a way to feel good. I should have recorded my oncologist and just play her voice on an endless loop. But for now, I write and hope to find solace in the expression of my thoughts. Tomorrow is a new day.