WIFE'S BROKEN WRIST FORCES SURGERY CANCELLATION. NEW ONCOLOGIST QUESTIONS PROCEDURE

If you are a regular reader of Mind Check, then you think I have now had the surgery I’ve been talking about in this space for awhile and am now ready to report on the results. Wrong! Two days before my date in the operating room at Wake Forest University Baptist Hospital in Winston-Salem, North Carolina, my wife took a fall in one of our bedrooms on a bedspread dangling on the floor and broke a wrist.

Suddenly she was faced with having to keep appointments with orthopedic surgeons to deal with the injured wrist, and she couldn‘t drive. How could I go forward with surgery that was a diagnostic procedure and no life or death matter when she was dealing with something more urgent and needed me? I canceled the surgery.

Additional CAT Scan

I then attempted to get a new date for the surgery, but a week passed and I did not hear from the surgeon’s office. More than a little dismayed by the lack of response, I then discussed with my oncologist whether some alternate approach might be a good way to proceed while we waited for the surgeon to forgive me for missing my appointment and rescheduling me. I raised this possibility with the oncologist because I thought that it might be a good way to gain more information on just how fast growing or slow growing my “olive-size” lymph node might be. My hope , of course, was that the node might have decreased in size or might even have disappeared.

The oncologist agreed that the additional CAT Scan was a good idea, and she acknowledged that the interval between scans was of sufficient length not to jeopardize my health due to excessive radiation exposure. I then went to Baptist Hospital and had the new CAT Scan. Two days later, feeling apprehensive over what the results might be, I called the oncologist. I was told that she was not in. This surprised me and left me a little upset since I was calling on a day when I had been informed the oncologist was always in. When I hung up I was wondering if I would ever get my results and, of course, what they might be.

Unexpected Call Back

My uncomfortable feelings were not to last. Ten minutes later I received a call back, but the caller was not who I had expected it to be. The caller announced to me that she was another oncologist with the same organization, and as she talked I learned that she had a very different approach than the oncologist with whom I had been dealing. First, she told me that the other oncologist was no longer with the practice, and she asked if I knew that. “No,” I responded, “I had no idea. That subject never came up in any of our conversations.”

She then proceeded to give me the test results. The lymph node was still there, she informed me. I was not happy at that news. However, while it was still there, she was quick to add, it had changed in size. It could not be said to have gotten any smaller, but it wasn’t larger either. In fact, what had happened is that the dimensions had simply changed with one dimension larger than before and one dimension smaller.

Called Quite Stable

Having said that, she then asserted, “I consider this lymph node to be quite stable.” She also said that she felt the data from the PET Scan, cited in a previous posting, did not reveal unusually high activity, a different interpretation than I had gotten from the previous oncologist.

She then volunteered that she did not feel that surgery was very helpful in cases like mine. She said, “I prefer a wait and see approach using procedures that are non invasive. For one thing, you should have CAT Scans every two to three months.

Bone Marrow Test Preferred

“Before subjecting my patients to invasive surgery,” she added, “I’d sooner see them have the bone marrow test. I know my patients don’t like them, but I think they would all agree that they are preferable to anything invasive.”

A word about the bone marrow test, to which the doctor was referring. The bone marrow test involves drilling into the hip bone to take a blood sample from the marrow area. If that description makes the test sound unusually painful, that’s fine because it is in my opinion a test somewhat akin to torture. How would I know? I know because I’ve had 10 of the bone marrow tests. They were all awful, but I would have to agree with the doctor. They were all preferable to having surgery.

Specialist in Lymphoma and Leukemia

Finally we talked about where I go from here given the fact that the oncologist I had been seeing had departed for a new endeavor in another part of the state. The doctor told me about the remaining physicians in her oncology practice, and she let me know that of those physicians she and another were the two specialists in lymphoma and leukemia. I wouldn’t have to choose any of the physicians in the practice if I didn’t want to, she told me, but she implied that she would be happy to have me if I chose her.

Easy decision. Given her specialization in my disease and given that I liked what she had to say, anyway most of it and especially what she had to say about surgery, I felt I had an easy decision. “I’d like you to be my oncologist,” I told her.

Where do I go from here? Like the lady said, we wait and see. That means at least four CAT Scans a year and maybe an occasional bone marrow drilling (ouch!!!), that is, if I continue to be “very stable.” That’s a pretty good deal, especially given what almost happened to me.

A friend of ours aware of how my wife’s broken wrist saved me from surgery asked us what I was going to do for her in recompense. Harriet answered, “His not having to have surgery is good enough for me, broken wrist and all.” That’s my wife!

SUBSTITUTION, HOW A RED WAGON HELPED ME TO GET TO SLEEP AT NIGHT

My current health crisis has helped me to learn more about how my mind works. I have learned, for example, that I carry in my mind at least one protection mechanism (and probably more). Some might demean this protection mechanism by calling it a form of denial. Others, however, might be kinder and see it as a legitimate even laudatory means to cope with unhappy prospects. When fears start building up, this mechanism allows me, indeed forces me, to think about something else. I call this mechanism my substitution system.

Substitution goes back to my earliest childhood. I remember learning how to use mental or thought substitution as a child of three to four years of age. As a young child I was filled with fears. Witches, demons, and ghosts populated my mind and became especially troublesome at bedtime. Some of these demons may have originated inside my young head (and may be attributable to defects in my family life), but some of them were introduced in the stories read to me and by the movies I was taken to.

The Problem of Snow White

Movies were a special problem, and nothing scared me more than “Snow White and the Seven Dwarfs.” The wicked stepmother-queen in this Walt Disney production, based on a Grimm Brothers fairy tale and completed in 1937, caused me much terror, and night after night I found myself fixating on this example of jealousy and vanity carried to the extreme. I couldn’t sleep. Something had to be done about it, but what? Well, I could force myself to think about something else.

I’d seen a kid in my neighborhood in Philadelphia with a wagon, and I thought I’d like to have one too. Did I want one just like his? No, I wanted a better one. I began to visualize the kind of wagon I wanted. I began to build it in my head. It would be bright red and shine like crystal. The wheels would be large, as large as possible, and the tires would have jet black tread. Rising up from the body for the protection of its precious cargo would be side extensions made of polished wooden slates.

The Boats Fixation

By forcing myself to think about the red wagon I pushed the wicked stepmother queen out of my head, and I was able to get to sleep. I have been practicing wagon substitution ever since except that the object visualized ceased to be a wagon decades ago. Long ago boats became my fixation. I started becoming interested in boats when I first moved to Margate, a suburb of Atlantic City, in 1953.

Like Atlantic City, Margate along with Ventnor and Longport, are parts of Absecon Island. One is never very far away from water anywhere on Absecon Island including, of course, the beach and the ocean. One is also never too far from boats.

Building a Barge in Margate

In 1953 I started building a barge-like structure on the shores of the bay that runs the length of the island about two to three blocks from my house. I was building it with a friend I’d recently made, and we were designing it as we went along. We were both fourteen at the time, I think. Barges are not exactly major challenges in naval architecture, but I suspect we would have had more of a challenge on our hands had we ever gotten to the house that was to sit on top of the barge platform.

Our barge building came to an abrupt halt when the police arrested us. My friend and I had been using house lumber taken from the house construction site of a local builder. No, we hadn’t paid for the lumber, but as part of the resolution of the case the judge decreed that we pay the builder an amount that far exceeded what we would have paid had we gone to lumber yard and purchased our wood directly.

Avoided Reform School

We had to pay through the nose, as the saying goes, and we ended up with nothing to show for our efforts. The builder sent a crew to our construction site, dismantled what we had built, and took the wood back to be used on one of his houses. Hence he profitted many times over from our misfortune. But at least my friend and I didn’t end up being sent to reform school for our misdeeds.

I recount this small episode drawn from the annals of juvenile justice not only as an example of how I learned at a young age that crime didn’t pay, but to place a date on when my efforts in mental substitution switched to the use of boats. For many years hence, designing and building boats within my head (I would frequently commit my designs to paper, but never attempted to build any of them) was a method I used to escape the everyday worries of keeping a job and supporting a family and the stresses from the political realities of the day, namely the cold war and the possibility of missiles raining down multiple nuclear warheads.

Cruising the Chesapeake

Boats were my escape, but they were not all fantasy. For a while, I lived in Maine and was paid to write and edit articles about the sea. Throughout my life, I have been privileged to own and operate boats of significant size. During the 1990s, the Chesapeake Bay became my cruising ground, and my wife and I spent many hours traveling to and getting to know its many very interesting water towns. And now my substitution object has switched to unusual varieties of aircraft and spacecraft, about which I may write in the future.

As I indicated at the beginning of this essay, some members of the psychiatric community might look at my use of substitution and accuse me of living too much in a state of denial. At the age of three, had I analyzed what it was that scared me about the wicked stepmother queen of “Snow White and the Seven Dwarfs” and then somehow risen above it instead of spending mental time with imaginary red wagons, perhaps I would be better off today.

Developing the Imagination

Possibly, but then something has to be said on behalf of exercising the imagination, especially if one is a creative person. My red wagon was one way I discovered and developed the power of the imagination as a means to overcome fear.

I am now actively involved with the program of the Blue Mountain School of Meditation, as I have previously indicated. Some of the reasons I am pursing this practice are to get control of my mind and keep it focused as much as possible on the positive, to enhance the moral center of my life, and to minimize the role of fear in my outlook. In addition to daily meditation itself, this practice calls for the daily use of a mantram, that is, the use of a saying of a religious nature repeated over and over again to oneself to substitute for the negative thoughts during times of anxiety.

Not So Benign Substitution

Yes, another form of substitution. Let us acknowledge the value of substitution then, despite what some mental health care professionals might say, but let us quickly bring the importance of good judgment into the discussion. There is benign substitution and not so benign. When we use addictive substances and fall prey to risky attitudes and behaviors to substitute for the fears that plague us, we are doing ourselves and those around us no good. We cannot eat our way to a sound mind, for example.

At the same time, we must assert the principle of moderation even with benign substitutes. If we are spending a preponderant amount of our time in our head designing red wagons or boats or whatever and not accomplishing other things that need to be done in our lives, that may be our clue that a rigorous re-examination of what is going on in our lives and the need for intervention are necessary.

Yes, but no one should have to spend his every waking moment thinking about health problems. We all need a break from that kind of fixation, as steeped in reality as it may be.

ABOUT MIND CHECK

Thank you for tuning into Mind Check, a biweekly effort to prove that we are what we think and that clear thinking leads to effective action and to a better world. Mind Check is intended to serve as a bridge between the realm of the human spirit, that center of our energy, mental and physical, and our rationality or reason, of which the scientific method is an excellent example. Mind Check is also intended to prove that the ideas of right and wrong are innate, not exclusively inherent in the situation or the whim of the moment.

To communicate with the author of Mind Check, please write to stephen.saft@gmail.com. For examples of the writer’s other writings, see the website http://www.iwillmeanpoetry.com. The author is also preparing to launch a site of podcasts consisting of spoken poetry, essays and short stories. Be on the look out for it.

Copyright © 2007 by Stephen Alan Saft

FINDING THE OLIVE IN THE HAY STACK

So what’s happening? I would love to launch into a brand new subject in Mind Check, but I have unfinished business to attend to, and I feel I owe you, the visitor-reader-viewer, an explanation of what’s been happening since my last posting.

My big news is that since that posting I met with the surgeon and his assistant. This visit was strictly a consultation, not the procedure itself, as I originally expected it to be. The visit also included a disappointment. According to the surgeon, the laparoscopic approach may not be able to do the job, that is, it may not be able to find the very small object it is supposed to remove—an object measuring 2.4 cm by 1.4 cm.

Searching Less Familiar Territory

Performing such a task is a challenge just a little less daunting than finding a needle in a haystack—for several reasons. First, the surgeon and his team are looking for an object that is very small. In our meeting, the surgeon described it as “the size of an olive.” Second, the surgeon and his team are dealing with less familiar territory than what they are normally used to as a laparoscopic team where known parts of the anatomy such as the gall bladder or appendix or spleen are the usual targets of a laparoscopic search. What they have to go on are the images from the CAT and PET scans. And that’s all!

Finally, even if found relatively easily, this “olive,” which is an enlarged lymph node, may turn out to be behind something important like a blood vessel that can’t be moved aside too easily, anyway not by something as small as a laparoscope.

Conventional Surgery An Option

If the surgical team cannot find or reach the object, then right on the spot they will enlarge the initial incision and perform a conventional surgical procedure. First, however, they will be using the laparoscope.

Laparoscopic surgery, what is it? Laparoscopic surgery is usually what people in medicine mean when they talk about “minimally invasive surgery.” Because it is minimally invasive, recovery time is normally much quicker than with conventional surgery. Hence my disappointment when the surgeon told me that he might not be able to complete my procedure laparoscopically.

Cavity Inflated

Here is how the online encyclopedia Wikipedia defines laparoscopic surgery (www.wikipedia.org/wiki/laparoscopic_surgery): “The key element in laparoscopic surgery is the use of a laparoscope: telescopic rod lens system that is usually connected to a video camera… Also attached is a fiber optic cable system connected to a cold light source …to illuminate the operative field, inserted through a 5mm or 10mm cannula [hollow tube] to view the operative field. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space.”

The target of this tiny gizmo is, as the surgeon described it to me, “a thing the size of an olive.” Not only must this olive be found, but it must be cut away from the surrounding mass and then extracted. Once out of me, it will then be sliced and put under a microscope by a pathologist (an expert in the causes of disease) and a report prepared.

Lymphatic System Defined

The olive is an enlarged lymph node, a part of the body’s lymphatic system. What is the lymphatic system? Every cell in the body needs to be fed to stay alive. Every cell in the body also needs to be cleaned to remove the byproducts of metabolism or feeding. The feeding is accomplished by the body’s tissue fluid, which is part of the body’s blood system. The cleaning is the role of the lymphatic system, which is also responsible for defending the body against disease. Tissue fluid and lymphatic systems are linked.

On the web site http://www.lymphnotes.com, one of many that deals with lymphatic issues, tissue fluid and lymph are compared and contrasted. “The role of tissue fluid is to deliver the groceries to the cell. The role of lymph is to take out the trash [the byproducts of metabolism] that is left behind and to dispose of it.”

Known As Lymphoma

Lymph nodes play a central role in the production of antibodies, which the body produces to fight disease including cancer. Sometimes the nodes are cancerous themselves. That may be the case with “the olive” inside of me, found by both CAT and PET scans and shown to exhibit higher than normal metabolic activity by the PET scan. Cancer originating in the lymph nodes is known as lymphoma.

If the “olive” is found to be evidence of lymphoma, then my oncologist (cancer specialist) is likely to recommend chemotherapy as the treatment. Chemotherapy primarily involves the transfusion of chemicals into the blood stream. Sometimes chemicals are also taken by mouth.

Chemicals Are Killers

Most of these chemicals are killers. That in fact is why they are taken. Their job is to attack and kill fast growing parts of the body such as cancer cells. Unfortunately, there is no way to stop them from also killing other fast growing cells in the body such as hair follicles and parts of the stomach lining. Hence the sudden baldness we see in cancer patients. Hence the bouts of nausea they frequently experience.

By talking about chemotherapy at this stage, I am getting ahead of myself, and that is not a very good idea when dealing with anything as momentous as the possibility of a cancer reoccurrence. In fact, it is not a very good idea in any case. I am learning from my meditation practice to live in the present, and never has such a skill been more important.

It is the now that is important. It is learning to make the most of the present that is essential. That is the best path to getting the most out of every moment of life.

ABOUT MIND CHECK

Thank you for tuning into Mind Check, a biweekly effort to prove that we are what we think and that clear thinking leads to effective action and to a better world. Mind Check is intended to serve as a bridge between the realm of the human spirit, that center of our energy, mental and physical, and our rationality or reason, of which the scientific method is an excellent example. Mind Check is also intended to prove that the ideas of right and wrong are innate, not exclusively inherent in the situation or the whim of the moment.

To communicate with the author of Mind Check, please write to stephen.saft@gmail.com. For examples of the writer’s other writings, see the website http://www.iwillmeanpoetry.com. The author is also preparing to launch a site of podcasts consisting of spoken poetry, essays and short stories. Be on the look out for it.

Copyright © 2007 by Stephen Alan Saft