Tuesday, June 18, 2013

So Many Docs, So Little Time

In her 15 years of selling Manhattan apartments to wealthy clients, Pam met a lot of smart, successful people. Some of them became good friends, and a few of those were doctors.

That's how I found myself on the phone a couple of nights ago with Glenn Agoliati, an oncologist who retired several years ago but still likes thinking about tough cancer cases. That would include mine, judging from his eager questions about what my doctors and radiology reports have told me so far.

"Could be a lymphoma," he said, echoing speculation we first heard in our second opinion, from Dr. Singer. "But it sounds to me like it might also be a plasmacytoma. That would be my first guess."

I had no idea what to make of that. In my anxiety and ignorance, I hear the bell tolling for me in any word that ends in "oma." Glenn hadn't even seen my scans, and I had no real idea how brightly his star had shone in the medical firmament. So I googled plasmacytoma to see if it looked like a death sentence, and when it didn't I put it out of my mind.

But it came back to me this morning as I sat in the small office of Dr. Gerald Rosen, professor and director of the medical oncology sarcoma program at NYU. I got his name from Elizabeth's cousin Jennifer, an NYU researcher herself.

I'm starting to understand why the author of Talking With Doctors kept trolling so obsessively for medical consultations on his brain tumor. The pace of cancer diagnosis is glacial, so you have a lot of time on your hands. Anything beats staring helplessly at the abyss.

I was only going to drop off my CD's today and ask Dr. Rosen's assistant for an appointment next week, but I got very lucky and caught the doctor himself with a few minutes to spare.  He stuck my disc in his drive and began thinking out loud about what he was seeing as he scrolled through the images.

A sarcoma? Maybe, but soft tissue sarcomas don't generally attack bone. Could the tumor have started in the bone and pushed out? Probably not, judging from its size and the way it appears to be invading the vertebrae. Lymphoma? Highly plausible, because my spleen is enlarged, often a calling card of lymphoma.

"Any pain? No? See how it's right next to that nerve? What about numbness or swelling in your legs?"

He had me stand up and come around his desk so he could look at my ankles and give my abdomen a couple of speculative pokes. "That hurt? No?"

Like me, Dr. Rosen was now very interested in seeing the pathology report and slides from my biopsy. He had his assistant call a friend in the radiology office at Sloan-Kettering to try to spring them. When that didn't work, I tried Dr. Singer's office. No luck there either, not till Thursday when Singer discusses the results with us himself.

On one point, Dr. Rosen lined up squarely with Dr. Singer. Surgery right now would be nuts and in the end might not even be necessary at all, depending on what kind of tumor I'm hosting.

"I guess they're finally starting to learn something over there," he said with a wry little grin. I smiled uncomfortably at the insider humor, not wanting to think of my Sloan-Kettering team as a bunch of quick-knife guys who only just got house trained.

"A friend of ours is a retired oncologist," I said. "He told me he thought it could be a plasmacytoma."

Dr. Rosen went silent for several long moments.

"That's a very interesting idea," he finally said. "I hadn't thought of that, but it very well could be. We really need that pathology report."

Would plasmacytoma be good news? It might be, according to Dr. Rosen, since it's often associated with cancers that can sometimes be treated with relatively mild drugs.

Glenn's star was burning quite a bit brighter in my personal firmament as I walked out the door. We're planning dinner with him and his wife this weekend. I will beat him to the check.


  1. the scariest part of this story, to me, might be this line,

    "I hadn't thought of that..."

  2. Not bad for a "cold call," Dave. And more doctors "interested" in your case. Keep pitching and with any luck, you'll close the deal on your terms. Staying positive is the best option.

  3. It is that old miracle thing that is beginning to show it's beautiful light. YES! Have a wonderful dinner