I want to post a bit about my history of symptoms, my initial trip to the hospital and the treatment plan going forward.
So we were out for supper Friday September 5th (the night before our fifth wedding anniversary!) at Scott and Kim's. I was feeling fine the whole night but after we got home and before we went to bed I had several BMs that were purely blood and lots of it. Because its hard to judge the volume I didn't think anything of the first one, but by the time I had had three in the space of three hours I was getting worried. I told Penny and she suggested I phone the health link to get their opinion and suggestions for a course of action (it being Friday night, I wanted to avoid the ER if at all possible as wait times are particularly bad then). The health link nurse asked me a bunch of questions but it all came down to how much blood did think I passed? Less than half a cup, or more than half a cup? I had no idea but figured it could be more than half a cup. So, off to the hospital I went. I got to the triage desk at exactly midnight and checked in. They told me it was busy and it would be "a few hours" before I would be seen. So I settled in with my book and blackberry with all the other Friday night invalids. I finally got to see a doctor at about 5 am but was stuck in a room with 6 or 7 other people. We were all seated in chairs with one bed that we shared when the doctors came for exams. At this point I began to measure the volume of blood I was passing. While I was in the ER I passed about 1.3 LITRES (!) of blood. We guessed that my total blood loss for the night could have been 2 litres or more!
Once I saw the doctor he deduced that I didn't have any obvious hemorrhoids and I should probably have a sigmoidoscopy to investigate further. So on Saturday afternoon I was moved up in to the internal medicine ward and was sent for the sigmoidoscopy. A sigmoidoscopy differs from a colonoscopy in that it only investigates the lower portion of the large bowel and does not involve a full 'cleanse', whereas a colonoscopy investigates the entire large bowel and requires a full GI cleans. The doctor who performed the test was my age and seemed to enjoy his work (!?). But alas there was too much blood for him to see anything clearly so he suggested I come back tomorrow (Sunday) for a full colonoscopy. So away I went back to my ward for my second night in the hospital. Once I got back to my room I was met by a Nurse who told me I was "NPO" which is some Latin acronym for "don't eat or drink anything until after you've had 5 feet of fiber optic camera cable crammed up your arse". So, my last meal was Friday night. It was now Saturday afternoon and I hadn't had anything to eat or drink all day. My colonoscopy was scheduled for Sunday afternoon so I was looking at about 48 hours plus of not eating or drinking a single thing. Oh that doesn't include the FOUR LITRES of peach flavoured salty water I had to drink to clean out my system. Good times. I managed to drink my entire 4 litres in the required 4 hours and retired to my bed in an attempt to sleep.
Sunday morning I hung out not eating or drinking and thinking that this trip to the hospital was a lot more invasive and time consuming than what I was expecting. Little did I know it would get worse. Before my colonoscopy Sunday afternoon I met with the doctor (another young guy) in the hallway to discuss the procedure. He was in a great mood (I'd like to see what kind of mood those guys are in when the roles are reversed!) and proceeded to explain that in a guy my age they were not really looking for or expecting to find anything nasty (like cancer). He said the most likely cause of the bleed was from undiagnosed Crohns disease, ulcerative colitis, or perhaps just a burst blood vessel that wouldn't stop bleeding. So we headed into the room to do the test. I was chatting about my kids with the nurse and asking about her family (she had 2 grand kids almost the same age as Carly and Andrew). We joked around and then she loaded me up with happy juice and sat back to enjoy the show. As soon as they got under way, the mood in the room changed. I was drugged and couldn't hear what they were saying but I could tell something was wrong. As soon as I was out in the hall after the test, the doctor came out to talk about what he found. He apologized profusely for leading me down the wrong path and explained that they found something that looked like cancer but they wouldn't know for sure what it was until the biopsy came back in 2 days. He was very professional and apologetic so I was still in high spirits until the nurse I had been talking with came out to say goodbye. I could tell she was shaken by my diagnosis and by the time we parted ways we both had tears running down our cheeks.
That was when I knew I had something really bad.
The wait for the biopsy results seemed to take forever but in the mean time there was no shortage of tests to do, doctors and nurses to talk to and halls to walk with my noisy IV pole. On Monday I went for an abdominal CT, a chest CT, and a chest X-ray. On the abdominal CT they could see what they thought was a tumor in the colon, as well as 2 spots in the liver that were likely metastases (cancer that had spread to the liver from the colon). The other tests confirmed no sign of cancer in the lungs, lymph nodes, prostate or anywhere else. I figured that was good.
On Monday afternoon as I was still waiting on biopsy results, I had an alarming experience. A young female oriental doctor with a poor command of English came to my bed. With the flurry of activity in my room (I was sharing with 4 other people) and the language barrier, I missed part of the introductions. She proceeded to tell me that my biopsy results were back. She said they were not conclusive but it looked like I had an adenocarcinoma in my esophagus and I would have to have another esophageal biopsy done to confirm the first pathology report. I was initially scared shitless. So this is how you find out you have cancer? A doctor just walks in and pukes out your diagnosis in broken English? No way! Then I told her that I had never had a biopsy taken from my esophagus and she looked confused. Then she looked at her chart, said that she must have the wrong patient, and vowed to look into my plight. Then she turned around and gave the same speech to the guy across the room whose biopsy results they were. Funny thing is he was 70 and I'm 31. All she would have to do is look at the age in the chart and she would have known she was talking to the wrong person.
In the end she came back and told me that my biopsy results were in fact not yet in and that she was very sorry for the miscommunication. She was very polite about the whole thing BUT when you're giving a diagnosis like that maybe double check that you're giving it to the right person.
On Monday evening Penny was there when the doctors came by to give me the results of my biopsy. It was an emotional experience to hear the words "unfortunately it IS cancer". But they were very professional and helpful in explaining the likely course of treatment and the team of doctors that would provide it. We convinced the nurses to let Penny stay with me in the hospital all that night. Unfortunately, as the most stable and youngest patient in the ward I had been moved to what used to be the patient lounge. There were only 2 patients in the room but it was right outside the nurses break room so all night there were people going in and out. Needless to say Penny and I didn't sleep a wink that night.
The remainder of the week in hospital (Tuesday to the following Monday) was spent learning about cancer, undergoing more tests (Rectal Ultrasound is NOT a Pink Floyd album), having a port-a-cath installed in my chest and meeting with doctors. From my admission on Saturday morning to my discharge on Monday I had 7 different teams of doctors: An ER doctor, an internal medicine doctor, a gastro-intestinal doctor, a colorectal surgeon, a hepatobilliary (liver) surgeon, a medical oncologist (chemo doctor), and a radiation oncologist. I say teams of doctors because that's exactly what they are. Each attending doctor has fellows, senior residents, junior residents, and students that work underneath them. So when you meet with, say the internal medicine doctor, you could be meeting with the attending physician or you could be meeting with a student. It makes communication difficult. It made me wonder how anything ever got done. Oh and if you think you can page a doctor and they'll call you back you're wrong. The pager is purely a device that beeps in order to signal the end of a clinical visit.
So, after 10 days in the hospital, a crash course in Medical school here's what else I learned:
- I have stage 4, grade 2 colon cancer (Adenocarcinoma)
- Stage 4 means it has spread from it's place of origin
- Grade 2 means it is moderately differentiated (1 is slow, 3 is fast)
- The main colon tumor is 8cm from the back door
- Both the colon tumor and the spots in the liver are totally operable (good news!)
- I will have to undergo more than half a year of chemotherapy, a cycle of radiation, and at least 2 major surgeries in the quest for a cure
- This all could have been prevented by early screening (they usually don't even think about screening for colon cancer until age 40 with family history, which I have).
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