Waiting for my surgery date to finally roll around was like waiting for Christmas day as a five-year-old. It took FOREVER. The difference was that instead of unknown gifts that would be unveiled when the day finally arrived, the unknown in my current circumstance was tied to my survival. We would “unwrap”, so to say, how far the cancer had gotten and if more would need to be done to destroy the stinker.
To pass the time, I would pester the other moles on my body. I would look at a mole on my forearm for instance and say, “Hey you, if you act up I will kill you. I will cut you off and burn you to nothing. Don’t act up like your brother did…” Sounds childish, I know, but it seemed to help.
For chapter one, read: A CANCER DIAGNOSIS DURING MEDICAL SCHOOL: BECOMING THE PATIENT
Chapter two, read: A CANCER DIAGNOSIS DURING MEDICAL SCHOOL: CHAPTER 2
Chapter three, read: A CANCER DIAGNOSIS DURING MEDICAL SCHOOL: CHAPTER 3
A MENTAL GAME
I also returned to my clinical rotation for a week to keep my mind going and off of myself. I realized how easy it was to get caught up in the “I’m dying” thoughts when I was left to my own devices. Returning to the clinic had a much different flair for the week I was back though. At that time, I didn’t know if I was actually ever going to be a real doctor. I had no idea if I would see my graduation. It may seem melodramatic, but melanoma kills. Pure and simple. I had no idea if what I was learning was actually going to mean anything in the long run to anyone.
What good is a doctor that is six feet under?
I also learned for the first time what the feeling of getting “triggered” is like. Patients that came to the doctor seemed to all have cancer now. The C word was uttered EVERY SINGLE DAY, multiple times a day at that. And, to make matters even worse, half of the cancers I saw in clinic the week after my official diagnosis were skin cancers, the majority of which were melanomas.
Figures. You would think that this would be comforting, seeing so many patients that had survived their cancers, but patients would haphazardly share with me how theirs had metastasized to their brain or lungs and all the surgeries they had. All I could think about was me eventually telling the same stories bald, in a wheel chair, more dead than alive.
I started to realize three different things leading up to my surgery…
- I had no control on the outcome at this point in my journey.
- My mental health was under assault, and I wasn’t sure what to do with that as I had never struggled in that realm before.
- Trust and faith was going to be what saw me through, whatever the outcome.
LACK OF CONTROL
You have to realize, all my life my health has been a bit on the edge of crazy. From asthma as a toddler, to Type 1 diabetes at six, to thyroiditis, etc., I never was particularly healthy but also never particularly not.
I could do what I wanted when I wanted, but I also was limited in comparison to other 28-year-olds. My kidneys act more like they are 50 instead of 28. My healing potential is a bit slower than it should be. You see, my body is a 94 Civic, not flashy in the least bit, maybe with three different colored panels and mismatched rims, but functional, with a good motor that should last for years beyond what would reasonably be expected. My body gets the job done. It’s just a little dumb.
With my health always a little out of my control, I became an ultra-controller over what I could control in my life to compensate. This mainly took the form of academics. I really excelled in the classroom and took absolute control of my education. When I worked super hard, things always seemed to pan out. I got a 4.0 in high school and again in college. As such, I was able to go to the medical school of my dreams. I could control my destiny in the classroom.
As a patient in the clinic, I never had that feeling, ever.
With this new diagnosis, that reality and fear came rearing back into the limelight. I had ABSOLUTELY zero control over the end result, at least until my surgery. It wasn’t fun.
WOULD HAVE BEEN PLANNING YOUR FUNERAL
So, since the classroom couldn’t make up for my lack of control, I started reaching out to people to help me get insight. I reached out to family friends that knew me and had had medical scares of their own. I also reached out to teachers at my medical school, my local church members, and lots of friends.
One of the individuals I reached out to was Dr. G, a medical pathologist and teacher at my medical school. I brought him up to date on my medical diagnosis and asked if he would walk through the path report I had from the dermatopathologist and help me understand what they saw from the initial biopsy. This was different from the surgical biopsy they would be doing on May 4th. This was the report that had told the dermatologist that I had cancer.
He kindly walked through the report with me and gave me insight. He is a bit goofy and has a unique view and vernacular. At one point he said something like, “Blade, if you would have waited any longer, we wouldn’t be planning your graduation…we would be planning your funeral.” He said the report showed a very aggressive cancer, but it seemed to not get beyond the initial site all that much. There was no evidence of growth into the vessels around the tumor and the biopsy had a complete margin around it.
Thirty minutes of his time gave me hope.
I may not have felt like I had any sense of control, but I was starting to better understand what was going on in my body. Ignorance may be bliss, but knowledge is power. Dr. G helped me tap into that knowledge and understanding just a bit, and it seemed to help. Especially going into surgery within the week.
FRIENDS IN OUR CORNER
A final group of people I will mention reaching out to early in the game was a few of the couples in our church that Kristi and I had met in Rochester. Kristi had gotten to know a few gals from our church that were all married with young kiddos. She would get together with them for weekly breakfasts and other activities when the husbands were at work, all of which was at the Mayo, albeit in different capacities. I had become pretty close with the husbands of Kristi’s breakfast club. One was a resident and two were in different areas in nursing. All were and are stellar individuals.
When cancer became my reality, these families were some of the first to know. Kristi needed support just as much as I did. It came rushing in with these couples. In months of workup at doctor appointments and surgeries, these people were always there, watching our kiddos, bringing us meals, getting together to forget about cancer and make memories. They were and still are some of our greatest blessings.
With my surgery looming right around the corner, I reached out to the husbands of the families and asked if they wouldn’t mind offering me a blessing. For those not familiar with blessings, it is simply a special prayer given in a time of need and facilitated by those that have the priesthood. If you want to know more about the priesthood, I would be happy to chat, but to shorten the story, I asked them if they would be willing to give me a blessing before surgery. This brought great peace. It was instructive and hopeful. It was exactly what I needed. I got the blessing the day before surgery. The next morning was D-day.
D-DAY
Surgery was outpatient, meaning I would get the wide excision of the site where my mole had been, then off I would go back home to await the results. My report time was 5:30am as the surgeon, Dr. H, wanted me on the table first due to being diabetic and having to fast for surgery. With two kiddos it made it hard to figure out how I would get there. One of my classmates and good friends named A offered to drop me off and make sure I was all checked in ready to go.
I felt like I was some sort of movie star getting picked up in a Tesla at 5am to get transported to my surgery. She walked me in, helped me get checked in, and even stayed with me in my room while I awaited the nurses to take me off to pre-surgery imaging. They hadn’t determined if they would take out any lymph nodes to check so they were going to do a special scan called a lymphoscintigraphy to see if and where they would need to take them if needed.
Right before they took me and A left, not to her home, but to her rotation for the day (meaning she got up extra early to take care of me when she totally should have been sleeping), the nurse dropped off a special wash they wanted me to use head to foot before my scan. Now, this was particularly challenging as I couldn’t scrub my back. A offered to help do my back, upping the ante on me feeling like a rock star. Not only did she drop me off, but now she was going to bathe me.
There were some laughs. I told her if she ever needed a vote for president, she definitely had mine. As awkward as this situation could have potentially been, her seeing me without a shirt on solely to scrub my back, she was kind, gentle, matter of fact, and cared for me better than most. Not awkward in the least bit. It was humanity and kindness at its finest.
Spoiler alert: This is not the only point in my journey that A shows up and helps when I can’t help myself.
SURGERY
A left after I was squeaky clean and off to the scan I went. They injected a special dye that mapped which lymph nodes they would go after. Two nodes lit up in my groin, so two was what they were going to take.
The rest was as I had experienced in my medical training, albeit, as the provider/student and not the patient. It was strange being on this side of the knife for surgery.
My leg and groin were site marked as I was consented. They wheeled me to the OR. I fell asleep before I could do anything and the next thing I knew, I was waking up in my room.
I remember immediately rubbing my butt. Weird, I know, but there was purpose to it.
Dr. H had said if the wide excision was too big to close up, they would take a skin graft from my butt. If my butt was wrapped, then they had to take more than they had planned, possibly meaning worse results, both from an infection standpoint and from a prognosis standpoint. No tape. My butt was uninvaded. Thank goodness.
My groin was puffy and tender from the nodal excision, and my leg was wrapped pretty good. If there is anything I have learned during my training, it is that getting up and walking is one of the best things to do post-surgery if you are able. So, with my butt in check, I asked to go on a walk. The nurse walked with me, but it was good overall.
RECOVERY
I had made up my mind that whether there was a fight on the horizon or not, I wasn’t going to go down easy. I was going to walk if I needed to, run if I needed to, go through surgery again, do chemo if it meant me being there for my kiddos to grow and my wife to not be widowed. After all, I was at the world-famous Mayo Clinic being cared for by the best of the best. I was 28 with decades of life to live. I was a physician in training and I’d be damned if I wasn’t going to put all that training to good use and make the world a better place.
Cancer may have reared its ugly head, but it was gonna die, not me.
Recovery consisted of sitting in on the couch, leg raised above my heart, and not moving all that much…FOR 10 DAYS! I’d lie if I didn’t go a little crazy. I now sported a shark like bite on my calf. Cool scars are one of the perks of cancer I guess.
Pain control was pretty good with Tylenol and IB. Hazel would come and rub my back and took great interest in my care. Kristi was my rock and reminder. She kept me honest with my recovery overall and course corrected me when I pushed my body too much. I was starting to hobble around more when Dr. H called. A surgeon never calls as early as she was that particular Monday morning, so I was nervous picking up.
“Hello?” Dr. H shot back in her sassy tone without a Hi or a How are you.
“I am mad.” That can’t be good.
“What are you mad about Dr. H?” She proceeded to tell me she was angry because the path report hadn’t gotten back to her before the weekend. This was unacceptable. So, in her go-get-em attitude, she called the pathologist at 5am and told them ever so politely that they needed to do their job. Period. She told me I would know by that evening what the results of the nodal dissection were.
But, the call never came. 5pm rolled around, and still no report.
THE PATH REPORT AND A DEDICATED ONCOLOGIST
I was a bit down. Last time path took forever to come back it was cancer. Long time = bad outcome. We decided to go to our friends’ home for their son’s birthday party, who my daughter has pretty much grown up with here in Rochester.
It was a fun night with spectacular cake pops and lots of conversation while the kids bounced around. It helped keep my mind off the lack of results. Everything was going great that evening until I got a path report notice at 8pm. Again, an unusual hour, so my nerves were sky high. I quickly opened it up and read.
Wide local excision – negative margins for residual melanoma. Clean margins deep to the lesion. No evidence of metastasis or residual melanoma.
Perfect! Great news. Then the nodes.
Node 1 – Positive for melanin staining cell. No extranodal extension. 0.02 mm at greatest diameter.
Node 2 – Negative for melanin staining cells.
Diagnosis – microscopic metastatic melanoma.
My heart sank. Not only had the cancer shown up but it had gotten out. Supposedly it only got to one node, but it was there, not where it should be, lying in wait.
My cancer had decided to play a little hardball. We would need a bit more than surgery. Little did it know though, Dr. M was not only on top of everything melanoma wise, but he was just as tenacious as I was in beating this sucker.
To prove my point, he talked with me that night at 8:30pm and again the next morning at 5:45am. When my phone rang that early, I looked with blurry eyes to see who it was and saw it was Dr. M. I quickly answered. My groggy hello was met with energy equivalent to the purest of caffeine.
“Blade, I was up all night thinking about you and about your official diagnosis. I want to meet with you today or tomorrow, whichever is most convenient. There are a couple therapies I have up my sleeves that we are going to get you on stat. I think we need to be more aggressive. Buy us more insurance. No dancing around. We are going to take good care of you.”
Tenacious and kind. The type of physician I want to be.
Connect with me on Instagram or Facebook for the daily fun (and grind) between posts. To connect with Blade check out his Instagram – @dr.bladeinprogress
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All the best to you guys! It’s so important not to deviate from the chosen path, whatever happens. Admire your courage and strength.