By the time 2008 ended, my practice was moving along the tracks under a full head of steam. 2009 glimmered before me, promising to evolve into the best financial year of my professional life. As I reviewed the firm's Business Plan, I was able to anticipate growth that would eclipse the bitter, lean years just past, when we struggled so hard to stay underway, to just maintain the hope of forward momentum.
Business was very good, revenue receipts were unprecedented, we were opening more quality files than ever and some of the 7-digit cases I had ardently pursued for 2 or 3 years were starting to resolve, which changed the financial statement considerably. Amidst a flush of optimism and success, all in my professional life seemed to be coming together and running like a Tag Hauer.
Then, as if the Universe needed to balance its books, I received a malignant cancer diagnosis.
And life sort of stuttered and paused.
The journey from normal to "diagnosed" began with a simple presence on my right shoulder blade during the summer of 2008 -- a dark mole which started to catch my eye as I stripped after a workout or toweled off after a shower. At first, the observation of the dark spot didn't really register in any conscious way. After all, it was only the size of a dull pencil point when it first floated into view. Slowly, though, I started to hear myself say: "Hmmm....what the hell IS that thing? I don't remember that mole."
Then, I would shrug, dress and go on with life. There were battles to fight and dragons to slay.
The presence on my shoulder did the same thing. It marched forward too, with its own agenda. It grew.
By December of last year it was the size of a small pencil eraser -- still floating into view every now and then and still buffeting me with an awareness that prompted the unspoken query: "What IS that thing?" Up until that point, my contemplation of the presence amounted only to idle, fleeting curiosity. Nothing more.
My friend, Lee, who is in Med School, saw it over the holidays and was the first person to stop me, catch my attention and state unequivocally that the presence on my shoulder was new, apparently growing and potentially deadly. "You are going to have that looked at," he said to me. " Not in a month, Jim. Now."
And so, to mollify Lee, I made an appointment with a skin mechanic. In due course, therefore, I found myself standing in my dermatologist's office during early January checking out the charts on the walls showing what can happen to unaddressed skin cancers. Trust me. It ain't pretty. What happened to the nice, soothing art doctors used to have on their walls, anyway?
As soon as I peeled my t-shirt off and Dr. Mary Dobson saw the mole, she moaned.
I was pretty sure that was probably not a good thing.
"Oooo...." she said. "I do NOT like the looks of THAT thing, Jim."
She removed it in 90 seconds and sent it off to the pathologists, who reported their findings back promptly: It was a malignant melanoma, Dr. Dobson explained when she called me at work 4 days later to discuss the results. "OK," I said. "Well, so? That's only a skin cancer, right? You scraped it off, right? We're done, right? I'll drop by every couple of years and you can make sure we don't have anymore of those popping up......right?"
Not exactly.
As opposed to the simple, neat resolution cultivated in my head, I was instead trundled off to the surgeon, who explained what would occur: First, they would do a nuclear bone scan -- just to make sure there was no "activity" in the bones. That's what they call it -- "activity." What they mean by "activity" is metastasized cancer. If they find THAT type of "activity" in the bones, you will then have to "weigh your treatment options." That's how they explain it, but what they mean is you are a fucked duck -- mainly because there are no real radiation or chemotherapy options for melanoma. There are immunotherapy options but nothing real promising. Anyway, after the bone scan, they'll do CT scans of the abdomen and chest w/ contrast, Dr. Benton Dupont relates casually, which is how they search for irregular masses or tumors, he explains further. If they find any of those, you get to "weigh your treatment options" again, although--in truth--you are a screwed pooch. Dr. Dupont's explanation is a bit more professional, of course. Once all that's done, they then intend to inject the melanoma site with radioactive isotopes. In that way, they can "light up" the lymph nodes through which that portion of the rear right shoulder drains inside my bod.
At that point in the narrative, blinking stupidly, I ask: "Why do you want to light up my lymph nodes?"
"So we'll know which ones to remove."
"Remove my lymph nodes? Don't I need those? I mean....after all....this 1955 model CAME with those as standard equipment. Won't I pull to the right or something if we yank 'em out?"
"Nah. We'll only take a few....like 2 or 3. After we excise tissue from beneath the melanoma site, we need to take the nodes too. Gotta check both."
"Tissue? Your carving out tissue? Like....a hunk of meat?"
"Well, yes. Both the tissue and the nodes need to be removed and biopsied, Jim. That's the bad news. The good news is--if those come back clear--then you're all good. No problem. You just have to see your dermatologist every 6 months and make sure that we have no reoccurrence of the melanoma -- on the right shoulder or anywhere else."
After laying all this out matter-of-factly, Dr. Dupont hands me off to his nurse, who sets up all the testing, which I dutifully attend over the next 2 weeks.
All the tests come back normal -- no "activity." No masses or tumors. Nothing that makes the sawbones raise his eyebrows. All of this is lauded as good news by Dr. Dupont, who--being a surgeon--reminds me that SURGERY is NEXT.
Very quickly, surgery is scheduled, which I also dutifully attend, going under general anesthesia on Wednesday, February 25, 2009 so that Dr. Dupont can hack off some meat from my right shoulder and scoop out 3 lymph nodes under my right arm, which are (I blindly trust) the "lit up" nodes identified as "draining" the area of my melanoma site. After an early morning 90 minute surgery, I spend the day in the hospital, absolutely gassed on Lortab. My sobriety date is April 19, 1993 so I haven't been drunk in a long time, for which I am thankful. However, on this day, I am as shitfaced as a waltzin' pissant. I am wholly cognizant of my drug-induced debilitation --even through the ache of the surgery sites-- and hate it. I used to drink alcohol in order to feel this way, I reflect to myself, even while stumbling around in my disordered mind. What a moron I was. I'd rather slam my dick in the car door than feel the heavy loopiness which has me alternately slurring or nodding off.
OK, well....maybe that's an exaggeration.
Perhaps just a good country ass-whippin'.
In any event, during the late afternoon I am released in a wheelchair because actually trying to walk would be a joke. Tooled out into the light of a waning day by a chatty orderly, I am dumped from the wheelchair into my car to be driven home by my Dad and a friend, while everyone speaks about you as if you are not present. You think you'd like to say a few words and I may have even tried, however I believe I merely drooled.
Finally delivered home, I worked in a quick puke from the anesthesia, crashed and slept for 12 hours.
When I got up, still a little the worse for wear, I bathed, stretched a little like an old dog and hit the door for the office. I'm bouncing back from the surgery, although I can neither run nor hit the gym for a couple of weeks, which is drivin' me batshit. However, at night, I tussle with the dawning thought that I've just endured the first real "health alarm" of my life. I will get the results of my tests next week and we'll find out whether I'm "clear" or whether it's time to "weigh my treatment options."
We'll see.
Up til now I've pretty much assumed I was bulletproof. Apparently, I'm not.
The words of Billy Crystal's character (Mitch Robbins) from the 1991 movie "City Slickers" echos in my mind, a speech he gives to his son's elementary school class:
Value this time in your life kids, because this is the time in your life when you still have your choices, and it goes by so quickly. When you're a teenager you think you can do anything, and you do. Your twenties are a blur. Your thirties, you raise your family, you make a little money and you think to yourself, "What happened to my twenties?" Your forties, you grow a little pot belly you grow another chin. The music starts to get too loud and one of your old girlfriends from high school becomes a grandmother. Your fifties you have a minor surgery. You'll call it a procedure, but it's a surgery. Your sixties you have a major surgery, the music is still loud but it doesn't matter because you can't hear it anyway. Seventies, you and the wife retire to Fort Lauderdale, you start eating dinner at two, lunch around ten, breakfast the night before. And you spend most of your time wandering around malls looking for the ultimate in soft yogurt and muttering "how come the kids don't call?" By your eighties, you've had a major stroke, and you end up babbling to some Jamaican nurse who your wife can't stand but who you call mama. Any questions?
So, J.R. .... any questions?
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