Wednesday, November 5, 2014

Catscan report: Death to the lackeys of carcinogenic imperialism!

Got the results of yesterday's catscan today. Cancer in the bladder itself has shrunk considerably, so much so that it is not unreasonable to expect subsequent treatments (four more cycles, blah) to eliminate it completely. The carcinogenic imperialists and their lackeys are on the run; I warned them not to mess with a topologist! The possibly cancerous lymph nodes scattered about my abdomen with one exception haven't shrunk at all, but they haven't grown either. This is considered a very positive result by the oncologist, who, by the way, was much amused by my promise to credit him in my next research paper.

As to what happens at the end of the chemo, here there is a divergence of opinion. The very standard practice suggested by the oncologist is that one then goes ahead with a cystectomy (bladder removal) to ensure all the cancer has been removed from the bladder, and at the same time excise any suspect lymph nodes. This I definitely will not do. He envisions a bladder returned essentially to we'll cut it out? That's nuts. It's all way off in the future still, but under those circumstances I wouldn't even consider it. You definitely have to push back on things like this.

As to the catscan, there was the usual comedy of miscommunication so disturbingly common in hospitals. I started off in the radiology waiting room at UW Med, which is like Central Station at rush hour, packed with all manner of humanity waiting to be scanned for this or that. A male nurse approaches me with a large bottle--I don't know, about five gallons--of liquid. "Mr. Mitchell, you need to drink this (contrast solution) over the next hour before the scan. But don't go to the bathroom because the doctor wants you to have a full bladder during the scan." With great difficulty a I keep a straight face, and attempt to reason with the fellow: "Sir, that is not going to happen. I have an empty stomach, per your request. I am here because of bladder cancer, although apparently you have not been informed of the fact. And even under the best of conditions, my bladder has about a fifth the capacity of that bottle. Does it seem likely to you that I will be able to comply with your instructions?" But nothing will sway him; these are, he insists, the doctor's orders.

Fine. I take the bottle and have a seat, with no intention of following the instructions because it would be physically impossible. After half an hour a trip to the bathroom is already unavoidable. No problem; the second half of the bottle will be more than enough to fill the old bladder. I'm thinking I can manage it if the catscan begins at 11:30 as scheduled.

But of course it does not. Still in the waiting room at 11:50, I inform the nearest nurse that time is fast running out on the full bladder theory. If they don't get me in soon, more than time will be running out and it will be all over their catscan. Just five more minutes, I am assured, and ushered into waiting room no. 2 where the next nurse takes the liberty of opening up my PiccLine and putting stuff into it. "And now," she says cheerily, "I need to take a little blood to check your kidney function." What?! I just had extensive bloodwork on Friday, which showed among other things that my hematocrit levels are starting to drop. I ain't giving up any more red blood cells! Really? says the nurse. Well yes, because I'm currently undergoing chemo for bladder cancer. Oh, says she, and goes off to check. "You're right, you do have a complete lab report. No need for the blood draw". Imagine that. But I really, really do need to get this done soon or I'm not going to be able to hold it. "You can go to the bathroom", says the nurse, "that's not a problem". No I can't, because the doctor wants a full bladder for the scan. "Oh," says she.

In my experience if you have ten people working on you in a hospital, the odds are only two of them will ever talk to each other, and even then it's probably about the Seahawks. Finally, a scan room is about to open up. Yet another nurse escorts me further into the inner sanctum of Radiology. But not to a scan room. "Wait here," she instructs me, pointing to waiting room no. 3 which is open to the hall. Five minutes go by. Ten minutes go by. Nurses walk by at a brisk pace. Probably running for the bathroom, damn them. Fellow travelers come and go. A nurse seats another older gentlemen in the chair opposite me. "You can all have a party" she suggests. "I'm not dancing with these guys" he mutters. Five minutes later muttering man is summoned for his scan. Hey! No fair! I was here first! Beginning to grasp the magnitude of my emergency, a nurse offers the possibility of going to a catscan in the ER, "but it's a long walk". Or I can "wait five more minutes".
Yeah, right.

At last we are on the way to the scanner. "You'll be getting an injection of dye that will make you feel like you have to go the bathroom" says the latest nurse. A born comedian, apparently. "But you won't really go". Ma'm, I would like to point out that I am 63 and know my own bladder exceptionally well. It is a mathematical certainty; we have missed our window of opportunity. And to the catscan operator: I really don't want to make a mess of your expensive machine. Can you just go halfway, and hold the rest? Okay. I'll try. Then into the machine. They take a few pictures, then inject the dye. Now we have to wait ten minutes before the last picture, says the operator. No way. I try bargaining: How about eight minutes? She takes pity on me. Even eight minutes are an eternity. I begin humming out loud "Stride la vampa" from Il trovatore, waving my arms, anything to distract. Now the last picture is taken, she's rolling back the scanner bed, I'm throwing off the blanket---wait, wait, she says, I'm still lowering the bed---but I jump off, bolt across the hall to the bathroom and barely, just barely, make it.

Today at the doctor's office a resident showed me the catscan pictures on the computer. "This is the bladder," he points out. "You can see that it's completely full."

1 comment:

  1. Very encouraging results--so glad to see this, Steve!

    And you could try -- although it sounds like it would be futile-- to explain to them about the remarkably small capacity of the Mitchell bladder...