It Might Get Messy

The funniest single moment in cinema is when the shit actually hits the fan in “Airplane”. The shit is going to hit my fan on Monday, 0530 hrs. I’m sure it’ll have its funny moments. Mostly it’s going to be painful and uncomfortable. 

And when I say “painful and uncomfortable”, I mean something along the lines of horrific. I’m not clear on the details, but here’s what I do know. They have the operating room reserved for the day—12 hours. There are two distinct phases of the surgery—removing the tumor, and replacing the crater where the tumor was. 

Phase 1 starts, I believe, with them punching a hole into the front of my trachea and then sealing it from my oral cavity so I’ll be able to breathe while they deconstruct and then reconstruct my throat. One of the decisions they’ll make at that point is whether they need to simply remove my entire trachea and, in another more drastic (and hopefully remote) scenario, my voice box. Hopefully we can put that one off until I’m cogent and relatively free of the morphine derivatives. But it may not be possible. There’s at least a chance I’m gonna wake up without a trachea, or worse.

THAT would piss me off. But I think my physicians are aware of the fact that I would FREAK OUT if they hacked out my trachea without a good reason. So I presume they’ll have a good reason, should they have to go there. We may have to make that decision later, but at least I’ll be able to participate then. We will also decide if my throat is sufficiently functional to remove the tracheotomy, or if I have to live with THAT for the rest of my life. Oy.

Now, where were we? Oh yeah. Procedure. First, Dr. H opens my throat and cuts out the tumor. There is apparently a good deal of art involved in this. He says he feels the tumor, decides how big it is and how big it might get, then overcuts the trench in the back of tongue so there’s limited chance of leaving any malignant tissue. This is largely because we’re out of treatment options—I’m past my lifetime dose of radiation, so the next step up would be to excise my entire tongue top to bottom and any other tissues it might have spread to. We’re trying to avoid that at the moment. Unfortunately, the massive trough this is going to leave in my throat is going to destroy what’s left of my ability to eat solid(ish) food, drink without drowning, and not suffocate in my own saliva when I’m asleep. Ouch, if I may say so.

Now, at this point Dr. G takes over. He is a plastic surgeon, and his part in this physiological play is, believe it or not, almost entirely improvisational. Apparently, he looks at what Dr. H has done, and then decides whether it’s best to a) strip off a long strip of skin from my forearm with associated blood vessels, fold said skin into a shape approximating the chasm in my tongue, and painstakingly hooking up as many blood vessels from my arm to the ones now exposed in my tongue as he can, b) strip off a thicker and smaller chunk of skin and underlying muscle, fold it into said shape, and stuff it into the hole in my tongue, or c) scrape a big handful of functional epi- and sub-dermal material from the skin of my arms and paste this…uh…paste into the trough in my tongue. I asked him to work on my right arm. My left will have to handle my pitiful abilities to play guitar instrumentals, since singing, even singing painfully out of key as I generally do, is no longer going to be an option. 

Meanwhile, I will be deep in the throes of morphine-induced unconsciousness, catheterized, and just sort of awaiting the moment the docs finish up, the nurses get me into ICU or recovery, depending on how massive the post-surgical trauma is, and I wake up more or less in serious discomfort and pain.

At that point, if there were justice, irony and humor in the universe, “Airplane” would just be coming on the TV suspended over my bed. And I’d probably rip out several rows of stitches laughing. And it would be worth it!

It Might Get Messy

My throat is becoming noticeably less functional. And pain is more permanent. Meaning it’s time to deal with this baby. That’s “baby” in the sense of the tumor that grows on the shoulder of the guy at the end of “Canticle for Leibowitz” by Walter M. Miller Jr. Except I don’t expect mine to transform into the second coming of Christ, several thousand years and two global nuclear conflagrations after he was due. Of course, neither did the guy in the book, now that I think of it.

Anyway. Where were we? Oh yeah. A week ago Wednesday. A day that began as prima facie proof that, with massive assistance and tolerance of my professional colleagues, I was just about back to functioning at full form. First, an email from the guy running the short courses at the toxicology conference in Scotland this spring. Turns out he got two identical course proposals, one from me and my five-co-instructor posse, and one from an old acquaintance with a competing company. Short course guy wants us to merge our two full day proposals into a half day each. Kicking off a round of call-and-response among my team, the conference guy, and the guy from the other company. Of course, with a deadline for getting the entire act together by Friday. 

Meanwhile, the course we teach at the university had its second class meeting the night prior. Had two students who needed to added to the roster and caught up on the work-to-date, a third on the fence about dropping who needed lots of information, and the administration at the U which needed a ton of paperwork completed. With everything, including Thursday’s class, two stops at the campus personnel office, roster finalized and everybody caught up by…Friday, of course. 

Meanwhile, the projects that my friends and betters have been working me onto are coming to crisis points. One needs sample sites identified and mapped in the eastern swamplands of Louisiana, another needs toxicology thresholds for fish in Montana rivers, another has to have—immediately—a plan and budget to start natural resource damage assessment this year, and then there’s the one that…well, then my cell phone rings.

It’s Dr. H. Explaining to me what’s about to happen. Which is that I am going to be operated on sometime in the next two or three weeks, will spend seven to ten days (and if my experience is useful as a basis for temporal projection, it’ll be at least the latter) in hospital, then will have a period of weeks when it will be touch-and-go between survival, recovery, and drowning in my own oral secretions, then decisions will be made regarding whether to remove the tracheotomy or alternatively my trachea itself depending on how things go. THAT’S not a decision I’m looking forward to. And then there’s months more of recovery.

In any case, I spend the rest of Wednesday cleaning up the various professional messes engendered by the fact that I’m about to drop into the Seventh Circle of health care Hell. Cancel the short course. Transfer the university course. Disengage from active project work. Now I need to get my office clean enough to function without me taking up room at the center of the mess.

In any case, the internet is encouraging, as is the experience of the mom of one of Molly’s friends who’s had the same procedure. I think things are open to conjecture. We’re talking about nastily radical surgery here. In preparation, this coming Tuesday morning I go to meet with the plastic surgeon about the reconstruction. It is perhaps a measure of the time-critical nature of things that he returns from a conference in Europe today, is in surgery all day tomorrow, and sees me first thing Tuesday. I expect he’s gonna look like jet-lagged hell. But he is sure as hell going to have to explain this pot roast theory of tongue replacement to me. In detail. More on that next week, my friends. Hang in there, everyone. Things should get VERY interesting going forward from here!

It Might Get Messy

Or it might come apart in a spectacular fractal decomposition of parts, subparts, fragments of parts, interstitial dust and liquids of varied textures, colors and origins. Which, I suppose in an existential and pointlessly metaphoric way pretty much defines “messy”. 

Maybe better to say it’s gonna get ugly. Inevitably and inarguably ugly. Here’s the deal.

Dr. H studied the PET/CAT scan output. Found several things he didn’t like. A couple spots in my left lung that had grown measurably since my last scans. First evidence of remote expression of malignancy otherwise confined to my throat and tongue. On its face, this is bad. However.

The spot on my tongue where the original tumor was has re-sprouted cancer cells. And is growing rapidly. And is pretty damned big. Big enough so that today, I can feel it, and it is starting to hurt like hell 24/7. It has to go, and it has to go soon.

And that’s the start of how things are going to degrade. Treatment options for this revived tongue tumor are limited. I’ve pretty much run through my lifetime dose of radiation, so there’s no play there. Chemotherapy is possible, but can only slow, not stop or reverse, the malignancy. I’m afraid this baby requires surgery. On the plus side, the tumor appears to be coherent and amenable to successful removal. Absent the backup of radiation, though, Dr. H says he needs to overcut to minimize chances of future recurrence. This means drastic things for my future. The surgery will damage what’s left of the functional abilities of my throat complex. I may lose my ability to keep liquids from running into my respiratory tract. Simultaneously losing my ability to swallow. Leaving me…where? Dr. H wasn’t completely clear. I’ll have a tracheotomy through surgery and after. We’ll have to make a decision whether to keep it or lose it later. That decision may depend on whether I’d rather be able to talk or swallow.

Both functions, BTW, will be compromised by the replacement of a large proportion of my tongue mass with thigh muscle. In other words, if I’m going to be able to talk at all, I’m going to have to do so after teaching a frickin’ piece of bottom round roast to produce the sounds needed for human speech! As I inquired of Dr. H: “Are you shittin’ me?!” 

Dr. H reported that he was not, unfortunately, shitting me. In fact, he said he thinks, but is not completely certain, that he will not have to remove my voicebox itself. Depends on that balance between swallowing and speaking. Which depends on the thoughts of the reconstructive surgeon who will spend the day in the operating room with Dr. H when they work me over. 

More on that momentarily. Let’s go back to those lung spots. They’re small. One is 2 mm in diameter, the other 6 mm (I need to talk to the doc about this. I thought the resolution on the PET/CAT scan was on the order of cm. So I must be missing something). Anyway. This wouldn’t ordinarily be an issue, particularly since neither of them is “PET positive”—i.e., they didn’t take up the radiolabeled sugar. But they have grown. Dr. H consulted his “thoracic guy”, and they agree that the lung spots are in places where it would require massive and serious surgery to get viable biopsies. This would necessitate delay in treating the tongue tumor, mitigated as much as possible by chemo. Together, the docs think the risks of putting off dealing with the tongue tumor exceed the risks of waiting to see if the lung spots actually manifest as malignancies. Basically, they think I’ll be recovered enough from the throat surgery and reconstruction to deal with lung surgery if and when needed.

So, at the moment, we’re simply awaiting Dr. H getting an operating room he can schedule for a whole day’s work. Part of that depends on consulting with his “reconstruction guy”. Dr. H says he “has to find his reconstruction guy” to finalize the plan for surgery. This phrasing makes me think of a bad episode of The Wire, where Dr. H is desperately searching the bars and clubs in the northern residential barrens of Baltimore for an oral reconstruction surgeon. 

The bottom line? I’m about to make a sudden transition from recovering and marginally functional middle aged guy to crippled and pathetic old man. It’s only gonna take a few weeks from now for the whole deal to go down. 

Oh, don’t worry about me going down easy. I expect to be—promise to be—sharp and sarcastic through the process, out the back side, and onto the rest of the road. Next week, absent any more real news (which I don’t expect, even if Dr. H DOES manage to find his reconstruction guy) I’ll give you the hilarious story of last Wednesday, or as I call it, The Day the Diagnosis Went Down.

Thanks for being here, everybody. Hopefully I’ll have photos from surgery, which should be in a couple weeks. Love you all!