[Johnson] imagining that the dropsical collection of water which oppressed him might be drawn off by making incisions in his body, he, with his usual resolute defiance of pain, cut deep, when he thought that his surgeon had done it too tenderly — Boswell, A.D. 1784, Life of Johnson, 2:598
Dear friends and readers,
Often in life there are no good alternatives, but before I can explain this I realize I have not reported the good news — because paradoxically it has brought the operation upon us: Dr Fortes will operate on the Admiral on June 3rd. It will take 8 hours and he will have an assistant surgeon with him.
The good news last Tuesday was that the Admiral is in Stage T2, N0, M0. That means there has been no spread of the cancer anywhere (it remains localized in his lower throat), the nodes as far as can be told are unaffected, and he’s in Stage 2. Now the lump could have been T1A or T1B; that would have meant had not penetrated the wall and was Stage 1, but after all it is too big for that. It has penetrated, so Dr [Ali] Fazel recommended chemotherapy and radiation first. It is stage 2 a little on.
Then when we arrived at Dr [Daniel] Fortes (the thoracic surgeon) office this past Friday I expected, I hoped he would say we’ll start radiation and chemotherapy next week and when the weeks have gone by and the admiral recovers, then the operation. In my mind the more we put that operation off the better. Instead Dr Fortes said he was prepared to go ahead to do the operation as soon as possible. And the Admiral said yes. And suddenly we were doing it. He signed papers and we agreed to do preparatory work next week. Dr Fortes said that he felt he could cut out the cancer entirely, it’s in early enough stage. Then (said he) perhaps only some chemotherapy and radiation. I felt the Admiral liked this. When Dr Fazal said Stage 2 (T2) meant chemo first the Admiral immediately said we had to leave that up to Dr Fortes and maybe Fortes would say the NO MO (no nodes involved, no spread) part of the staging warranted operating right away, at which Fazal said nothing.
I felt worry and shock when we left the office, at the same time a sort of confidence that now the Admiral might recover and live. He began to talk — self-consciously — of the coming year. Look there’s that path they’re improving so we can get to the opera next year; that sort of thing. Next year you see suddenly is available. What is not to be forgotten is this operation puts him in a compromised state for the rest of his life. While death rate from the operation is said to be low, complications rate is high (40%): one has to watch out not only for pneumonia, but something called leakage. He must spend 3 days in the ICU, at least a week (more probably) in hospital, and then at least a month on a feeding tube. Dr Fortes said Kaiser would provide Home Health care with a nurse to teach us how to feed him through a tube and to monitor and check up what’s happening.
What roused my worry and anxiety was a phone call from someone who meant very well and told me of his sister who had esophageal cancer stage 4 (!) and did not have the drastic operation, though the chemotherapy and radiation she had was very harsh; she is now in remission — for 3 years. He gave me the phone number of the prestigious Boston doctor who cared for her. The admiral read this doctor’s biography, a description of his history on the Net and said it was just like Dr Fortes; both do minimally invasive esophageal surgery; both trained in well-respected places. We don’t know the full circumstances of this other case. We would have to stop all that Kaiser is doing so quickly for us; we have no idea what the other hospital’s costs or criteria are; it’s so far from home.
I began to realize why so many people who have cancer go for quack (non-scientific) remedies, as these are all much less invasive. I remembered the Admiral’s mother: she would say once she decided to buy this particular product she would not look back at other selections even if new ones came her way. It was just too stressful and useless too.
The crux of this bad cancer is that the cancer is in a bad place, the center of the chest and to eat without most of your esophagus is going to be hard for the body to adjust to. But not to do anything is far worse (trust me, if you are still reading, gentle reader, you don’t want to know what this evil esophageal cancer proceeds to do to nearby organs if you do nothing). We have been told by the 4 doctors what there must be an operation. If the staging had been T0 then Dr Fortes could have tried to scoop the lump out and cut very little but this is not the case here. By sheer happenstance we actually came across a YouTube of Dr Fortes lecturing to other doctors about esophageal cancer around noon today. Among other things, he talked of the T0 case where they don’t operate; said they have not been able to get enough people to participate in trials to say if the outcome is better if you have chemotherapy and radiation first and then operate or vice versa. Gave some grim statistics.
He does say there is not near enough research on Acid Reflux Disease (GIRD). That people are not taking it seriously enough. If we would (and we could) get better medicines to stop the damage, then people would not develop esophageal cancer in any where near the numbers.
I couldn’t agree more!!
I did go over and look at lots of statistics and told myself the Admiral is in the second most favorable category, reminded myself of the 2 people we’ve been told about who had the surgery, one living for 20 years now and the other for far more than 5.
We have now cancelled our trip to New York City this coming week so he can do the preparatory work. Today Caroline came over and we bought an adjustable inclining bed, latex foam mattress and it’ll be here on Thursday. We are fortunate that we have the money for such things, that we have an insurance policy where the sums asked are small co-pays. We were lucky that Dr [Jonas] Wiltz was alert to the Admiral saying now more than 2 months ago he was having trouble swallowing.
Caroline has offered to keep me company during the 8 hour vigil. Her friend, Michelle, may visit us. I’ll keep Yvette informed through the phone.
So there’s where we are tonight. Before he went to bed, the Admiral reminded me he retired from his full-time job as Chief Engineer at DISSA on June 3rd, 9 years ago.