Tomorrow I’m going in for surgery. The expectation is that the last of any residual cancer will be removed, creating a margin around it to ensure I’m “clean”. The only thing is that I’ll never “really” feel clean again; as one doctor told me, “You’re a marked man.” (He did not mean to indicate that I’m certainly going to die from this, only that for the rest of my life, this will be something for which to watch and with which to contend.)

It’s been an interesting road getting here.

First, there was the diagnosis. Then there was the whirlwind of doctor visits; first, the oncologist, then a surgeon and a plastic surgeon. The plastic surgeon — no doubt normally a nice person — created another psychological dip when he turned out to be — well, here’s how it went:

[The plastic surgeon enters the room]

Doctor: “I can’t make any kind of guarantee whatsoever. If that bothers you, you might as well get up and walk out of here right now.”

Me: “Hi. I’m Rick. I guess you must be my plastic surgeon.”

Doctor: “I’m Dr. _______.”

Then there was a discussion of my history and the proposed plan. He did an examination and took a couple of pictures of the site.

At one point during the examination, he went off on a little tirade about how lawyers had ruined America. I tried to be polite about it — after all, this was a guy who was going to be cutting on me in a few days.

Me: “Well, I’m not an attorney, of course. But I think it’s important to remember that lawyers are tools. If you want to be angry at someone, it might be better to focus on the people who hire the attorneys and tell them what they want to have happen.

Doctor: “I suppose you’re right…but still….”

We then continued on with the interview until, at one point, he states “If I’d known you were a law student, I would have refused to see you.”

I responded by noting that, among other things, not all lawyers are the same. I pointed out that firstly, I’m a law student and not a lawyer; thus, I could not have done anything to him yet. On top of that, I said, I’ve no intention of doing medical malpractice law and, if I did, I’d probably come down on the side of the health care provider, since I spent about 20 years working as an orderly, hospital corpsman (aboard a ship without a doctor, the USS Anchorage), emergency medical technician and then, finally, owned a medical transcription service for several years.

That night, I told my wife what had happened and she insisted that he had to be taken off the case. The next morning, I called my primary care doctor — whose husband, coincidentally, is an attorney and graduated from the same law school I’m currently attending.

Another doctor, who I like very much, had previously removed himself from the case because he thought he could not do the surgery. But, as it turns out, there are two parts to my surgery: 1) Wider excision with potential skin grafting from the original melanoma site and 2) lymph node staging. It turns out the part that the plastic surgeon was going to handle can be handled by the original nice surgeon that I liked very much.

So my primary doctor arranged to have him back on the case for that part.

And so, tomorrow, I will go into the hospital first thing in the morning. After checking the room again for spiders (it’s a superhero thing), they’ll inject me, again, with a radioactive substance. Some time later, I’ll be wheeled into surgery, where the doctors will use a geiger counter to find the radioactivity in my lymph nodes. The “sentinel” lymph nodes will be removed for biopsy. A widening of the original excision area will be done. And then I’ll be home, laid up, in bed, for about a week.

We are, of course, hoping that the sentinel lymph nodes will not have any cancer in them. If they do, then it’s more surgery some time down the road and, possibly, some kind of treatment like chemotherapy, Interferon, or one of numerous experimental things like a vaccine. If they are clean — and the oncologist gives a 4 out of 5 chance that they will be given the size of the original melanoma and the results of various tests — then I’ll be sewn up and it’s just “observation” for the rest of my life with scans every few months for the first couple of years.

Today, I’m going out for one last pre-surgical game of golf (I won’t be able to play again for several weeks) with friends. Tonight, I’m going to make one last posting about a new toy I just got. And then I think I might not be able to post anything for some days.

Please think good thoughts for me and my wife. We need them.

And thank you for reading my blog. I hope to return to my regular blogging — and less of this not-so-useful personal journaling! — by sometime late next week.

Oh, one last thing: You’re all welcome to post comments here, as you know. My wife will read them to me if I’m not out of bed yet when they come in.

On December 31, 2003, at 7:52 a.m., a surgeon called to let me know that an innocuous mole of which I’d grown tired had turned out not to be so innocuous after all.

For those who don’t know, malignant melanoma is the most serious form of skin cancer. Depending upon the point at which you find a melanoma, your odds of survival range from really good to it-was-nice-knowing-you.

I’ve been conversing with various friends — some in the idiosyncratically-named RL (“real life”; as if there were parts of our lives that were not real), like my best friends, Dale & Sandy Winn and Mark King; others I’ve known online only, most notably Martin and Abi Sutherland from Sunpig — over the 8 or 9 days since I found out. This has been tremendously helpful.

When I first found out I had melanoma the-week-before-this-week-that’s-seemed-like-an-eternity, I’m not sure I really understood. The call came in just as I was going out the door for work; another 30 seconds or so and I would have missed it. Whether that means Dale and Sandy’s New Year Party that night would have been more enjoyable, or the doctor would have just reached me at work, I don’t know. Either way, it was a shock.

A couple of weeks before that, I had gone to have a mole removed. Some people think they’re beauty marks. And they can be cute, but I’d grown tired of this one. It wasn’t that it was any trouble. But like an old t-shirt, I’d finally decided I was ready to part with it; it was time for a new look. So with minimal ceremony fit for such things — which is to say a scrub with Betadine and a small Lidocaine injection — I had it carved from my body.

Well, most of it. A PET scan reveals that it left some friends behind. But I’m jumping ahead of myself.

So on January 6, I was back in the surgeon’s office, discussing “the meaning of all this.” Without going into a lot of detail — I’m not going to get too personal online! — he told me that he had surveyed nine or so other doctors and none of them had seen anything like this before. He recommended a visit to an oncologist, to get a more informed opinion.

And so I found myself at the Fresno Cancer Center, where I met one of many of the nicest people I’ve had the privilege of meeting in my life, my oncologist. After a thorough interview and examination, he informed me that I have a Stage II, T3aN0M0, malignant melanoma. There was no recognizable spread to lymph nodes; no known metastasis. However, as it turned out none of the doctors at the cancer center had ever seen anything like this before…

The plan was to perform all the usual tests for a stage II melanoma. I was scheduled for a PET scan the next day at Fresno’s first and only dedicated PET Imaging Center, Valley Metabolic Imaging, home to more of the world’s nicest people. After checking the room for spiders, I was injected with radioactive sugar. (If you don’t get that one, you just don’t know enough about superheroes.) A one-hour quiet period ensued — no talking, no moving around in the recliner, no getting up and no blogging — to allow the most active cells in the body to absorb the sugar. The idea is that by complete relaxation, the muscles are prevented from gobbling up the radioactive sugar (no doubt another reason they resist the superhero effect), leaving it for the hyperactive cancer cells. And I’m told that one of the “good things” — although I fail to see this as good — about melanoma is that it’s a “hot” cancer; it’s highly metabolic and gobbles that sugar for all it’s worth. Or maybe I should say that it gobbles it for more than it’s worth, because, frankly, melanoma is worth squat for anything except killing you.

Talking, by the way, would result in the vocal chords taking up the radioactivity. Blogging is difficult due to the lack of Internet connections in the quiet room and also would cause your fingers to glow, which ruins the “quiet room” atmosphere created when the lights are shut off after the injection.

Melanoma cells can “break off” from the original tumor, drifting aimlessly through the body in search of another home. Beachfront estate (the bladder), cultural sites (the brain), airy vistas (lungs), or, for the gutsy thrill-seeker melanomas, a 25-foot slippery slide (intestines), and even the distal (fingers and toes) reaches of the body or a room with a view (the eyes) are considered good sites in which to build a new colony. Consequently, the scan for patients with melanoma takes a total of about four-five hours (including quiet time) and runs from the top of the head to the tip of the toes. A specialist reads the images and generates a more-or-less (medical) English translation.

In my case, I found out yesterday (January 8, 2004) afternoon that the scan revealed I had not swallowed a single pet. The only activity of any abnormality was around the site of the original excision. But we had already anticipated this; I’d been told I would have to go for a widening of the excision to take more healthy tissue and create a larger “clean” border.

This isn’t the end of the story. Next Wednesday, I’ll go for the surgical consultation with a new surgeon — the wonderful and friendly surgeon who removed the original mole is unable to handle all the requirements of the next type of surgery — who will widen the resection and perform a “staging” of the lymph nodes. As I understand it, the area around the original melanoma will be injected (with another radioactive substance, I think, so I’ve another shot at superherodom), the “dye” will be traced to see which lymph node catches it first. This is called a “sentinel” node. I don’t think it’s a specific type of node; I think it’s called “sentinel” because it’s the first lymph node that drains that area. If I’m right about this, any node should be a candidate for “sentinel.” This lymph node will be removed, analyzed and, if clean, I’ll be closed up. The treatment from that point on will be to just watch me for the rest of my life, with periodic scans — I still don’t have all this worked out. If the sentinel contains cancer, the surgeon will do a “clean-out” procedure, removing more lymph nodes. Then, like Sam Donaldson, I might have to wear a tight stocking to control swelling, but should otherwise be able to live normally. If this happens, I’ll probably also have Interferon or some other treatment, in addition.

Anyway, that pretty much covers where we are today. Don’t forget that you can read this blog regularly or actually subscribe on the main page (left-hand column) to receive occasional notices of updates. If you do that, note that I don’t send out updates with every post, only the ones I decide really need to be “advertised.”