Saturday, May 23, 2009

The Journey I Took

I haven't put a post up here for awhile, mostly because I've been trying to figure out whether or not I want to write something about my recent experiences, and if so, how I want to write about them.

Ultimately, though, I don't think I can get back to blogging without saying something about this, so here goes...

This winter I was scrambling to find something in the way of employment. The academic job market is bad, and I hadn't heard anything but rejections from the faculty positions I had applied for. I had always been interested in joining Peace Corps, so I figured I might as well fill out the application.

To make a long story short, the Peace Corps needs English teachers and they quickly accepted me and nominated me to serve in a position in Central Asia.

That is not the journey I ended up taking.

Peace Corps requires a health evaluation for all incoming candidates. As part of mine, I had to have some lumps, or nodules, on my Thyroid gland I had been aware of for the past few years re-evaluated. I wasn't too concerned, the prior workup had indicated the nodules were benign.

I went in to have the nodules re-biopsied just before Easter. The Monday after Easter the doctor called, the biopsy had returned "suspicious" results. There was only a 20 percent chance it was cancer, he said, but I would have to have at least part of my Thyroid surgically removed to rule out it out.

Thyroid Cancer, I should note here, is a disease with a generally positive prognosis, for cancer at least. 15 year survival rates for the more common varieties run upwards of 95%. Most patients diagnosed under the age of 40 live out normal lifespans. Those of you who know how I deal with disease will know this comforted me not at all. I already knew a great deal about the rarer and more deadly forms of Thyroid cancer from the last time my nodules had been evaluated, and now I learned a great deal more about the possible complications that could render the less aggressive forms deadly. Every sensation in my body became a harbinger of doom. A back ache was a sign of a bone metastasis, a head ache of one in the brain.

After two weeks of waiting for a surgical consult (um, yeah, no matter what a health insurance company shill tells you, there ARE wait times for care under our precious market based health care system, at least if you are not a millionaire) I met with the surgeon. Who told me that, based on his reading of the history, he felt I was actually looking at a 70% or better chance of having cancer, and that he wanted to completely remove my Thyroid gland. Terrified, I consented to the surgery and drove myself home feeling slightly unreal.

The week between the consult and surgery was surreal. I was in some ways less afraid than I had been before the consult, in some ways more. Foremost in my mind was the risk of damage to my voice. Thyroid surgery requires the surgeon to work close to what are called the recurrent laryngeal nerves, any injury to these can paralyze a vocal cord and leave you permanently hoarse. As someone who relies on the presence of his booming voice as an important part of his teaching repertoire, this possibility terrified me. And of course there was the fact that I had been told I was very probably facing a cancer diagnosis. It was a long week.

My mother came out to help me through the surgery and recovery. The night before the operation was scheduled I wrote letters to friends and family, to be opened if anything should happen to me, and slept a few fitful hours. We drove in to the hospital before dawn, since my appointment was for surgery at 7:00am. The surgical prep area played a recorded loop of the sound of ocean waves. The pre-op nurses were chipper, joking with me to try to keep my spirits up as I sat through a long progression of anesthesiologists and doctors all asking the same questions about my medical history, and describing my procedures to me, not knowing I had already read every scrap of information on them the internet would bring my way. I had IV lines inserted into both hands. I wondered if these would be my last moments with my voice, and found it ironic that there was so little to say. My mother came in to sit with my for awhile, and then they wheeled me into the operating room. The sedative they gave me made me giddy. All my anxiety melted before the brunt of chemistry, and then there was blankness.

I came to confused, and in a fair amount of pain. I think my first words were "I hurt" though by then I knew enough to realize that it was a good thing that I could say that without too much trouble. My mother told me that the doctors were saying they thought my Nodules had been benign after all, based on what they had seen during the surgery, though I knew we would have to wait until later in the week when the full pathology report was finished to be sure. At the very least the rarer and more lethal forms of cancer had been ruled out.

Time acted strangely during my stay in the hospital. Probably a side effect of the morphine. The day wasn't too bad, other than some pain and weakness from the lingering effects of the surgery and anesthesia. I vomited up my first clear liquid meal, which was more embarrassing than anything else. My voice came up to nearly full strength fairly quickly (it had suffered some temporary damage from my intubation during the procedure), and that was encouraging. I managed to send some email and other messages from my mother's laptop. I slept on and off.

My room mate, it became apparent from the discussions I could hear his doctors having with him through the thin curtain dividing our room, was in the hospital to have a surgery related to complications stemming from chemotherapy he was undergoing for lung cancer. It is terrible to say, but the realization of how lucky I was in comparison to him relaxed me tremendously.

Oh, and somewhere in there I regained the ability to pee, which was nice. The day after surgery was all about regaining things I had never really considered losing.

Then evening rolled around, and my mother left, and my room mate was discharged, and things got weird. I wasn't with it enough to concentrate on even so much as a television show. I drifted in and out of consciousness. Time passed incredibly slowly. I woke up thinking it was the middle of the night, only to realize it was 8pm.

Morning came after what seemed endless night. After a long day of waiting, testing to see if my stomach was ready to tolerate food (by feeding it deplorable hospital cuisine, who can screw up grilled cheese and tomato soup? seriously) I was discharged.

I lay on my futon watching TV, trying not to move my stiff and tender neck too much, while my mother spent her time (I am somewhat ashamed to say) cleaning my apartment, which she found unacceptably dirty.

On Friday, the surgeon called. The pathology showed my nodules to be benign. My mother, who had been stoic until then - trying to keep me from falling further in to my constant near panic - cried with joy.

And I slowly got stronger. I stopped needing vicodin for pain after a few days. My father came out to relieve my mother, and she returned to work. My surgical drain (which was gross) came out after a week, my stitches a few days later.

But my thyroid was gone for good. Since you need thyroid hormone to live, I'm now dependent on synthetic thyroid hormone for life. Taking the synthetic hormone is no trouble, just a small tablet every morning. Looks sort of like a birth control pill, actually... maybe pills delivering artificial human hormones lend themselves to a certain form factor?

I read a variety of accounts of what it is like to be on Thyroid hormone replacement drugs before my surgery. Many patients report no major side effects. Others report a wide variety of problems, weight issues, depression, anxiety, memory issues, cognitive difficulties. So far, I feel fairly normal, though I have only been on the drugs for a few weeks, and the lingering remnants of my natural thyroid hormone have not fully left my system. It is wait and see, but I'm hopeful I will be able to get on with my life on the drugs without any real difficulty.

In any event, I am starkly aware of how lucky I am not to be facing a cancer diagnosis. Oncologists like to tell thyroid cancer patients that they have a "good" diagnosis, but they still face the challenges of constant monitoring for recurrence of their disease, radioactive Iodine scans and treatments that require them to be withdrawn from their thyroid replacement drugs (which causes them to become ill as their metabolism runs down without the necessary hormone), and life on a "suppression dose" of synthetic hormone - essentially a very slight intentional overdose of the hormone that helps prevent their cancer from coming back. Even if I do end up facing some challenges because of my hormone replacement, they will pale in comparison to all that. I'm ready to face them.

Still, my pill every morning can't help but remind me that my life hangs on a slender thread. In effect, I now am permanently facing a death sentence one month away, on indefinite reprieve. Every month I will go to the drug store and pick up another month of life.

Really though, this was always true. Our lives are never as certain as we pretend them to be. In a sense, all this has simply forced me to see life the way it is, without guarantees.

So, that is the journey I ended up taking, when I tried to join the Peace Corps. Frankly, now that I've written this, I want to put it behind me, and blog about silly things and TV shows and politics and digital culture.

Except, of course, that I hope I don't lose this sense of how good it is to be alive.

I just want to take this chance to thank all my friends and family that stood by me as I took this trip. You really can't know how much your support has meant to me, unless you have been through something like this yourself, in which case you understand what the support of friends and family means in the deep way that I only now have come to comprehend.

So yeah, thanks everybody. Life is good. Back to your regularly scheduled programming.

1 comment:

Emily said...

woo! we are now even more fucked up for life. sweet!