Blind Date With Surgeon - August 30, 2012

AUGUST 30, 2012

Today Paul and I met with the surgeon I've been referred to, Dr. Y---. It went...okay.  On the plus side, she was extremely clear in her explanations of things.  On the minus side, there was some social awkwardness.

I should start (as we did in the appointment) with the scan results from the CT/PET. The good news--I guess--is that the scanners did not detect any cancer in the colon or chest or neck or anyplace other than the uterus and maybe one ovary.  I'm not jumping up and down, because it hadn't occurred to me that there would be cancer in any of those areas--but of course it happens:  Something is detected in one area, and then they find out that it has spread to their spine or their lungs or their lymph.   So, from that perspective--I should be--and am--very grateful that there weren't any bad surprises.

There were however, a couple of surprises which weren't exactly good.  The right ovary looked normal on the CT, but it "lit up intensely" on the PET, which shows metabolic activity.  Dr. Y--- said that this could be due to ovulation, and not cancer--but that she would recommend removing it in any case, to be on the safe side, so even if it turns out to be clear, I'll still be out an ovary.

We talked a lot about something called "standard of care," which Wikipedia defines as "appropriate treatment based on scientific evidence and collaboration between medical professionals involved in the treatment of a given condition."

Standard of care, I gathered, could also be interpreted as the amount of cautionary action required for the circumstances--so it depends not just on the general diagnosis, but the specifics of a particular case.  Like the STAGE and the GRADE of the cancer.

I was familiar with the idea of stage, which is the degree of spread of the cancer, but grade is a new vocabulary word.  It is a measurement of quality, not quantity.  The grade evaluates the behavior of the cancer--ranging from non-aggressive: Grade 1, to the most aggressive, Grade 3.  The second surprisish" thing is that my cancer, because the biopsy reports it to be a "clear cell" cancer, falls in the Grade 2 to 3 range.  Dr. Y-- referred to it as Grade 3 during the course of our discussion.

With a Grade 3 uterine cancer, the standard of care would be to take the uterus and both ovaries and some--or all of the lymph nodes in the area.

There's a point in first dates, job interviews, conversations at dinner parties, where you can sometimes suddenly feel things begin to go south.  I'm not exactly sure where that turn happened in this case.  I think maybe it started when Dr. Y was saying something about perhaps "preserving" the left ovary--which, I understood, was a departure from the strict standard of care, so probably, in her mind, a generous offer.  I asked--since the right ovarian activity might have been due to ovulation, if it might make sense to have another scan--perhaps at another time of the month?  I think there was surprise in her voice when she asked "Would that with a view to preserving both ovaries?" And maybe there was a slight edge there too, because I found myself saying, "Well, maybe?" With a question mark at the end.

Then it got a little worse when I mentioned that the last time I had cancer, I hadn't done the required chemo. 

"So you are telling me this to say, 'ha ha I didn't do what the doctors wanted but I am okay'?"

All the sudden I wasn't sure why I had told her.  I thought I was telling her to let her know we might not always want to take the conventional path, but maybe there was an element of truth.  "I want someone who wants to be on my team."

"It is my job to give you the information.  You can do what you want to with that information.  I had one woman who listened to everything I said, and then she told me she didn't want to do any of it, she was going to shoot green grass juice up her vagina."

"How's she doing?" That was Paul asking--not a question that went over very well.

"We didn't stay in touch."

The meeting wrapped up pretty quickly after that.  She seemed ready to be done, and I felt flustered. I forgot to ask for her email, and we never set anything up for a second scan for the ovary, so I sent an email through her coordinator asking about those things.  I am left with mixed feelings.  I guess it's just part of my "cancer personality" that I want everyone to like me.  But then again, wouldn't anyone want the person wielding the knife over their abdomen to like them?

I'm sure I'll feel better about the whole thing when she emails or calls back--it probably wasn't as bad as I feel about it right now.  In the meantime, I'm packing for Atlanta--Dragon Con.