After a while of talking about everything on social media, I decided to take a break and live my life in the real world. I focused on working hard during my last year of residency. Over the past year I’ve been working as an attending, which is substantially more rewarding than being a resident (particularly, I think, for radiologists since we have such little autonomy as residents). And my wife and I are expecting our first child in a few months, so I'll get to be a dad, even if it's just for a little while. Honestly, if it weren't for my fungating cancer, my life would be great!
For those of you who never saw my original post, I was diagnosed with peritoneal mesothelioma in February of 2016. I had extensive disease (my PCI was 31/39) so we decided to do a two-stage resection from the onset. The first surgery was in March 2016 and we did an extended right hemicolectomy, a cholecystectomy, splenectomy, omentectomy, and overall tumor debulking. We also did HIPEC with cisplatin, which unfortunately resulted in severe AKI. I was on dialysis for 3 months, and my kidney function has only recovered to around CKD 3b levels. There were other moderately serious complications that we addressed as they arose, but none of them were as significant as the kidney injury.
Between surgeries, we did intraperitoneal chemo with doxorubicin and carboplatin (alternating every other treatment) for about 8 cycles. The second surgery (November 2016) involved primarily a distal duodenal reconstruction (luckily the biliary tree wasn’t involved), another hemicolectomy, more debulking, and a second HIPEC. The second recovery went much more smoothly. However, we got a PET/CT a few months later, and there was some hypermetabolic activity associated with some soft tissue masses, so we started IV chemo with carboplatin, Alimta, and Avastin (early 2017).
We did something like 10-12 cycles of that. The abdominal disease was stable during chemo, but two mediastinal nodules near the apex of my heart enlarged, so CT surgery took them out with a robotic assisted thoracotomy (August 2017). We continued on chemo until the side effects became too much to handle (March 2018). Things had been stable so we decided to take a break from full treatment and just do maintenance Avastin. The "masses" we were treating might not have been anything, either. They haven’t really changed to this day and are probably just granulation and/or scar tissue.
After the second surgery but while I was on chemo, I went back to work and finished my last year of residency. In July 2018 we moved so I could start my real job and to be close to my family. A group where my parents live was willing to hire me without doing a fellowship, and after everything that had happened, I didn’t want to spend another year of my life in training. Anyway, I continued Avastin down here every 3 weeks, but around November of 2018 new lesions showed up in my pancreas. It took a while to coordinate the surgery, but in February of 2019, I had a third ex-lap to try to do a distal pancreatectomy. It was unsuccessful due to the degree of adhesions from the other surgeries and HIPECs, and also complicated by two EC fistulas that took 4-5 months to fully heal. I was on TPN for 2-3 months after that, but they’ve finally healed and I’m eating and drinking normally again.
Unfortunately, the pancreatic masses continue to grow, so now it’s time to start looking into clinical trials. There are a couple up at the NIH that I’m looking into, and if those fall through there’s something starting at Ohio State soon that I’m hopeful I can get into. The one at NIH that I’m most interested in is a T-cell trial. It would be the first time trying it out on humans, from what I understand, but they’ve had good success with it in mice models of ovarian cancer. It targets mesothelin, which is over-expressed in both ovarian cancer and mesothelioma (among others), so there’s a good chance it might work. I’m already running into pushback from them because of my kidney function, but I’m hopeful we can figure something out and that they’ll let me into their trial.
Before you (or I) go feeling a bit too sorry for me (or myself), I want to tell you a little story to put things into perspective. A few weeks ago, the wife of one of the younger partners in my group – someone who was only in her early 30s – randomly had a heart attack and subsequently passed away a few days later. She had been totally healthy, right up until the point that she wasn’t. She and her husband have multiple young children. So, getting a cancer diagnosis isn’t the worst thing you might have to deal with.
There’s basically no circumstance in life that can’t be made infinitely worse by some other horrible tragedy. Whenever you start feeling too sorry for yourself because you’re dealing with some shit, just remember that you should be grateful for the blessings you do have. It could be worse. It can always be worse.
Feeling sorry for yourself is the road to despair. The situation in which you find yourself might be out of your control, but the attitude you take while dealing with that situation is entirely up to you. The only thing you can actually control in this plane of existence is yourself. Horrible, terrible things will eventually happen to you in your life, and they’ll cause you misery and anguish, but they can only destroy you if you let them. There’s a big difference between dying and being destroyed. I’m choosing not to be destroyed by this, even if it ends up killing me.
There is an indomitable – dare I say Holy – spirit that resides within all of us, but you have to call it forth. You do so by accepting forthrightly the challenges that life has given you, with as much acquiescence to the facts of the matter as you can manage. I’m not saying that you’re magically going to get whatever you want in life. Far from it. But I am saying that you have the capability to withstand any challenge this world can throw at you. If you’ve never had to face some sort of awful tragedy in your life, just wait a while. You’ll eventually be facing the same kind of choice that I am, and you too will have a decision to make.
What kind of person do you want to be?
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