Biopsy

From where I lay on the gurney this morning, the room looked more like a television studio control center than an operating room. Industrial lighting fixtures hung overhead, and the walls were festooned with flat panel video screens.

I recognized the images on display, multiple copies of the cross-section from my CT scan that shows most clearly what I'm up against, one of them nearly life size.

"That is an ugly picture," I told the nurse who was covering me with a blanket that must have been in some kind of warmer it was so toasty.

"It sure is," she cheerfully agreed. "That's why we have to hurry up and make you better."

I was about to have a needle biopsy, a procedure not much more intrusive or unpleasant than a colonoscopy but with much greater expectations riding on it for us.

Laboratory analysis over the next few days will produce a report which we hope will positively identify my tumor and suggest the best strategy for dealing with it -- chemotherapy, radiation, surgery, or most likely some combination of two or all three.

But it might only deepen our confusion over the tight spot we're in.

I spoke last week by phone with Dr. Robert Wise, a Chicago psychiatrist introduced to me by a former AP colleague, who helps people with complicated ailments navigate the health care delivery system.

Wise suggested that I read "Talking With Doctors" by David Newman, a psychotherapist and artist who learned at age 44 that a tumor was occupying cavities and breaking through walls inside his skull.

Like me, Newman consulted doctors at both Sloan-Kettering and Beth Israel, as well as several other hospitals, in and out of New York, and like me he heard starkly different views of what his treatment should be.

Newman's medical situation seems to have been far more dire than mine, and it wasn't hard to see why the top shelf talent he was consulting would come to shifting and opposing conclusions about how to deal with it.

By the time of his successful surgery in Boston, which several of his New York doctors told him could not be accomplished and should not be attempted, he had tried the patience of more than a dozen surgeons and medical oncologists with his challenging questions.

It was a hard story for me to read. Newman is clearly many times smarter, more energetic, more analytical, and more driven than I am. Even if my life depends on it, as it well could, I don't believe I have the capacity or stamina for a two-month ascent into the thin air of exotic tumor research and treatment such as Newman undertook.

It is daunting to think that my survival chances could be significantly reduced because somebody somewhere can cure what ails me, but I lack the endurance to find that needle in the haystack as Newman did.

Nevertheless on Wise's advice, I did not tell Dr. Karpeh at Beth Israel that I was taking my business to Sloan-Kettering, only that we have decided to delay any surgery until we have a biopsy and then review our options in light of the results.

Wise also advises making it clear at Sloan-Kettering that we will make our choices on how and where I am treated in stages without committing to any single doctor or institution.

This may be hard, since my natural tendency would be to invest absolute trust in a single caregiver and then strive to become his or her most compliant and likable patient ever. 

To avoid such internal conflict and to keep from forcing Pam into the impossible role of fighting advocate vis a vis both my medical providers and myself, I have my fingers crossed for biopsy results that point much less ambiguously toward a treatment protocol than Newman's diagnosis did.