Tuesday, June 4, 2013

First Opinion

I recognized Dr. Martin Karpeh from his online profile picture as soon as I spotted him. We were both entering the lobby of the Beth-Israel Medical Center on Union Square Park yesterday morning.

His experience as an oncology surgeon was as impressive as you'd expect for the surgical chairman of a big New York hospital. He sees a lot of soft tissue sarcomas.

But for some reason what amazed me about his profile was that it said he spoke not one but two foreign languages. I introduced myself and told him I was a new patient on the way to his office.

"Wow," I said as we got on the elevator together. "Where did you learn your Chinese?"

He looked confused. "I don't speak Chinese," he said.

"Oh," I said, wondering if I should doubt his cancer fighting credentials too. "Your profile said you speak Chinese. And Russian."

"Well, I know enough to ask a patient if he's in pain and where it hurts," he said. "But that's about it."

I used to be pretty good at elevator conversations, but this one was heading for a dead end. However, I saved it with a flourish as the doors opened on the 4th floor.

"We should be okay," I said. "My English is very good."

I can't say I got the laugh I was hoping for, but he did give me a pleasant look of tolerant amusement as he escaped into his office and I picked up my new patient forms at the reception desk.

We probably won't be entirely pleased when the brave new world arrives in which we all have our continuously updated medical histories on chips embedded in our necks. But honestly, how many times am I going to have to write that I have a mild allergy to aspirin and underwent rotator cuff surgery in 2008?

Never mind. Less than an hour later with my forms completed, my vitals measured, and my general condition appraised by a smart nurse practitioner, Dr. Karpeh came into the examining room and gave the best presentation I ever heard on a sensitive and complex subject.

In a nutshell, my sarcoma isn't just squatting in unoccupied real estate. It's invading one of the vertebrae in my lower back and starting in on a second. About a third of the bone in that first vertebra is now fully colonized, no longer mine. The bad chunk needs to come out with the tumor.

There was some good news. The sarcoma still has some distance to go before it reaches my spinal cord and the nerves that control my legs and other crucial lower body functions that need not be named at this time but you know what they are.

But there's not a lot of time to wait. Once an MRI confirms his initial appraisal of the state of play, Dr. Karpeh proposed that he organize a surgical team consisting of himself, a radiation specialist and possibly a neurosurgeon. Within three weeks they would cut me open, remove as much of the tumor as possible, and nuke the rest before sewing me back up.

Care would need to be taken during this hair-raising procedure not to harm the aforementioned nerve trunks or the major arteries and veins that also pass through the war zone. Otherwise, loss of function and potentially lethal blood clots could result.

The doctor laid it all out like a man who has seen this elephant before and dealt with it, which he is and has. But although he projected optimism, he didn't give me odds on my surviving the whole thing intact without a recurrence, and I think I know why.

Soft tissue sarcomas are relatively rare, only 6,000 or so new cases diagnosed each year, less than 2 percent of all cancers. Sarcomas of my type are a small subset of that. So there isn't a statistically significant cohort of people in my situation on which a reliable handicap could be based.

From what I've read, an educated guess at the odds might be about the same as Russian roulette with a six shooter, not so bad but who would play if they didn't have to?

We're hoping to get a second opinion by week's end from one of the sarcoma specialists at Sloan Kettering. Not that we imagine it will paint a rosier picture. But the strategy might seem more likely to succeed, and everybody's telling us there's no better place than Sloan Kettering for this kind of fight. 


  1. Odds, schmodds--you're gonna make it through this thing, long and arduous as it may be. I predict you'll be back in the rooftop pool on schedule this Fall. Love, W&V

    1. Your AP colleagues are confident your wisdom, wit and wiliness will see you through this. Hang in there and know that we're thinking of you.

  2. I agree with Walter again...poolside as scheduled for sure.

  3. Dave, you are very clear-eyed. I would hope to be the same under similar circumstances. Glad your sense of humor is also intact, though; I think that will also come in handy.

    Was just talking with Sue yesterday--we are all following along with concern and thinking of you.