There's No Place Like Home

I figured that with my appointment coming up this morning, Dr. Singer wouldn't bother giving me a preview of my biopsy results over the phone yesterday.

So my phone was turned off last evening and I was unaware of his call until I woke up today and saw that he'd left voicemail, with staggering news. The pathologist reported that my tumor is a benign schwannoma.

We rushed to our iPads and learned that a schwannoma originates in tissue that sheaths the nerves, grows slowly, is nearly always non-malignant, but can invade and destroy bone. It is often misdiagnosed as a soft-tissue sarcoma.

A benign schwannoma is best treated by surgically removing it, though if the surgeon doesn't get the whole tumor it may grow back. I even found a report on a Brazilian case much like mine, in which the intruder lounged in its victim's belly while gnawing away at the lumbar spine.

Surgeons in that case braced the weakened vertebrae with titanium mesh and a couple of long screws. In the X-ray illustrations the hardware looked like a kit you could buy at Home Depot.

Dr. Singer ended his brief recorded message by saying that the pathology report was "good news." It certainly felt that way to us, although you know you've accepted a new normal when learning that you need five hours of highly invasive abdominal surgery to remove a grapefruit-size tumor and reconstruct your damaged spine feels like good news.

What made it look good to us was not only that a benign tumor would not spread cancer throughout my body but also that treatment generally doesn't seem to include radiation or chemotherapy. It seemed I might be able to have my surgery and perhaps go home a few weeks later. No need for costly and uncomfortable months in New York.

We headed downtown for my 11 a.m. appointment with Dr. Singer in a state of cautious optimism. It all seemed too good to be true.

And then, suddenly, it looked as if perhaps that's exactly what it was.

I had promised Dr. Gerald Rosen at NYU that in exchange for his courtesy in seeing me informally and evaluating my scans, I would let him know what my biopsy results were. I called him from a Starbucks as we paused to caffeinate before seeing Dr. Singer.

"Hold on. Hold on," Dr. Rosen said. "I think we may have what we call a sampling error. What kind of biopsy was it?"

When I told him the biopsy was a needle or "core" procedure, he said the amount of tissue removed from the tumor was too small for a reliable conclusion on its malignancy.

"That tumor is just too big and its invasion of the spine is too aggressive for it to be benign," he said. "I think we need to get you in for a PETscan and then biopsy any area that shows rapid metabolism."

We ditched our lattes and trudged to my appointment like the rainy day parade we had just turned into. Neither of us had much appetite for further weeks of scans, tests and conflicting opinions before actually starting any treatment.

Dr. Singer began badly when we asked him to comment on Dr. Rosen's concerns. He rolled his eyes slightly and suggested that Dr. Rosen's view should be discounted since it came from "a medical oncologist," meaning, I suppose, that he's neither a surgeon nor a pathologist.

Maybe Dr. Singer guessed from something in my expression that I didn't appreciate his intramural scorn any more than I had Dr. Rosen's on Tuesday. In any event, he quickly came up with some actual responsive arguments:

1.    The pathologist says the tumor appears homogenous and it's highly unlikely that it contains any malignancy.

2.    If there is a malignant segment, neither a PETscan nor additional biopsies would have any better chance of picking it up than the first one did.

3.    A malignant nerve sheath tumor that large would almost certainly have revealed itself with chemical traces in my bloodstream which have not appeared.

4.    Even if we knew the tumor contained malignancy, nerve sheath tumors respond poorly to efforts to shrink them with radiation or chemo before operating. Surgery might still be the best option.

We wanted to be persuaded, and we were.

So the plan is that Dr. Singer will remove my little suicide bomber on July 15, stopping where it enters my backbone. At his side will be Dr. Mark Bilsky, a neurosurgeon, whose job will be to scoop out the rest and repair my damaged vertebrae with cement.

We won't be borrowing our friends' apartment into which we had planned to move tomorrow, nor will we be renting our other friend's apartment next month for the summer and fall. Instead we'll fly gratefully back to New Mexico next week to regroup, then return by car for the surgery. A post-op week in hospital. Another in a hotel room before I can travel.

If things go smoothly, I could be convalescing in the comfort and safety of my own home by the first week of August.

Of course, many a good monster movie ends with a chilling scene that leaves you wondering if the beast really died.

In this story, that would be my surgeon carrying the loathsome contents of his operating room waste bin through the door to pathology for a cell-by-cell examination.