the next day at 7:45, so Josh said yes. After I completed Round 6 of chemo, he and I walked over to the MRI facility on First Avenue. Josh went home to relieve our nanny and see the girls before they went to bed. The MRI took about forty-five minutes and involved lying in a tube that made me think of coffins and being buried in the ground—more so than the PET scan, because the MRI machine is even narrower, and more confining. The only thing that was not tomblike was the constant banging and clanging of the machine, which sometimes made my entire body vibrate on the table. It also involved lots of inhaling and exhaling and holding my breath for significant periods of time. I got done a little after 9:00, took the subway, and didn’t get home until after 10:00. It was a long, exhausting day.
I got the MRI results the next afternoon. The psoas muscle spot, the one that the surgeon and the oncologist had thought was probably nothing, is in fact something. There are two cancerous lymph nodes in that spot—one is necrotic (i.e., dead cancer), and the other is alive. Now you see why I don’t put too much stock in doctors’ prognostications.
I forwarded the MRI report to Josh. Upon review, he is “rationally optimistic.” The fact is that my organs are clean, which is a good thing, and for there to be two lymph nodes involved seems like not a big deal. But you can begin to understand how absurd all this sleuthing and surmising can be. In a strange role reversal, I am not so optimistic. First of all, PET scans and MRIs cannot reliably detect growths on the peritoneum. The one tumor found (and removed) outside my colon during surgery was a drop metastasis on the peritoneum above the bladder. These recently discovered cancerous nodes are likely there.
From the beginning there has been talk about me being a good candidate for something called HIPEC surgery—shorthand for hyperthermic intraperitoneal chemotherapy—a grueling procedure that involves making a massive incision and bathing my abdominal cavity in heated chemo for ninety minutes. If it sounds equal parts sadistic and desperate, that’s because it is. The procedure is also known among the cancerati as the “shake and bake.” The cut is ugly, and the recovery is hard. I feel like these MRI results put me that much closer to HIPEC, and I’m not happy about it.
I’ve told Josh that the risk has to be sufficiently high for me to undergo HIPEC. In any event, it seems like a diagnostic laparoscopic surgery, in which a surgeon would go in to just look around, is an inevitability given the limitations of scans for detecting peritoneal growth. I also felt like I was diagnosed as Stage IV because of a technicality, due to a tiny drop metastasis to the peritoneum—a drop signifying noncirculatory invasion because it’s a literal drop off the primary tumor and not cancer spreading through the lymphatic system. I felt like I was more a Stage IIIC than a Stage IV. Now these MRI results confirm that I was rightly categorized as a Stage IV, and that I have metastatic disease. All just numbers, I know, but numbers matter to some degree, no matter how much I want to deny their importance.
Because metastatic disease is almost never curable.
8
The Bliss in Making the Journey Alone
I went through the infusion of Round 5 of chemo on a Monday in October mostly alone, with a dear friend coming at the tail end to take me home. Usually, Josh meets me at the cancer center sometime before the infusion starts, but this past Monday he had a $100+ million deal signing and he couldn’t leave the office. I told him not to worry about it. I come from the world of big corporate law, so I understand how it is. $100 million isn’t that much money in that world, but it’s significant enough that clients have expectations. In response to his self-inflicted guilt, I reminded Josh that work, and more importantly bringing in an income to pay for health insurance and the complementary treatments not covered by health insurance, is more important than ever now. Besides, this was just one of twelve chemo treatments; it wasn’t surgery; it was no big deal. Even with the cloud of cancer hanging over us, life (as distorted as life will be from now on) must go on—the children must go to school,