So now we know.
So now we know more than enough.
So now we know too much.
So now we know that we don’t know enough.

My surgeon actually does seem to be on top of things… and does seem to give a damn about what’s going on.

Sunday afternoon, October 28, 2007, while I was hanging about at the local mall, waiting for Gail to finish her purchase of some mysterious Lancome product (mostly so she could get the free gift), Dr. Williams called on my cell phone. Respecting the fact that I was in a public place, he offered to call me back later in the afternoon, or that evening after he’d finished a emergency surgery that was on his agenda. I pushed for one bit of information before I let him go; the location of the tumour.

The primary tumour is in, or actually is my right tonsil, with probable contamination of the surrounding tissue. This changes the diagnosis to Oropharyngeal from Nasopharyngeal. Its not any easier. In fact, on some levels, this is tougher. This is THROAT CANCER. Dammit.

The Doctor called back about 8 pm, after the emergency surgery, to discuss the details. (He started the conversation with a statement about how the violence in our lives is beginning to wear him down; he’d just done a neck reconstruction on some guy who’s wife had trashed his neck with a candle stick! And all I could think about was ‘Miss Scarlett, in the dining room, with the candlestick’…)

When Doctor Williams called back we talked at some length about the options for treatment. While there are nuances that will be discussed with the Team on Friday morning, there are two basic options:

Option One: Conservative/Traditional Approach.
This is the one that I’ve begun referring to as the Melonballer Approach. What it involves is Seven Weeks of Radiation Therapy, plus three courses of Chemotherapy, followed up by basic tonsillectomy type surgery to get the tumour (and some of the surrounding tissue) and a neck dissection to get the lymph node. I’ve been describing the removal of the tumour by suggesting that the surgeon essentially will reach into my throat and scoop out the tonsil and some of the surrounding tissue, not unlike using a melonballer tool. Of course this is a gross simplification. Really gross, actually.

Option Two: Radical Surgery Approach.
This strategy scares me, repulses me, confuses me somewhat, but, also is beginning to make the most sense. There aren’t a lot of stats on this approach, mostly anecdotal evidence from the practitioners and proponents, as well as a couple of patients. The gist of the approach is that it is a surgical option with less radiation, little to no chemo (or at least we didn’t hear the Doc say chemo…wishful thinking on my part?)
So, as we heard it (which is not necessarily how it was described…trauma filters were fully engaged during our chat) what they would do is start off with a ‘mandibular swing’, which essentially involves breaking my jaw and ‘swinging’ it out of the way so that they can see what’s really going on in the throat and on the back of the tongue. The image that almost immediately came to mind was the way the lower jaw on the movie/comic character “Predator” works when the beast is mad. In any event, the jaw is moved out of the way, leaving unrestricted access to the area in question. The tonsil would be taken, and, I assume, so would the second tonsil. A bigger portion of the tissue around the tumour would be taken. To make up this sudden deficit in material, a flap of tissue from one of my arms would be used to rebuild. And then, they put it all back together again, with the aid of a dental oncologist, and a plastics/reconstructist guy. The surgery is a 12 to 15 hour marathon, which, as a good friend pointed out, isn’t really that important to me ’cause I’d be asleep, followed by 2 to 3 days in ICU and then 2 to 3 weeks in hospital.

The timeline that I posited to the Doctor, which he didn’t dissuade me from, was that the surgery would be in the first week of December. That would put me home for the holidays, recuperating into January and early February… so I may able to slip into work for a couple of days a week starting in February, or a couple of hours a day… and, hopefully, still attend the Pink Elephant conference in Vegas the week of February 18th…

Oh well, so much for my boyish good looks. Is it possible that I can get them to give me a classic Kirk Douglas cleft in my chin when they rebuild? Or at least do something about that hint of a double chin?

I also am not entirely sure how I will deal with an extended hospital stay. Dammit, I would want a private room… I don’t need the traffic from someone else’s family. I don’t want to have to be considerate if I’m in pain. I don’t want to have to respect someone else’s pain. I don’t want someone else hearing me beg for meds, or ask for help to evacuate my bladder and bowels. And, if things go badly and I end up having to be fed through a tube into my stomach, I want to learn to do that one without an audience.

And besides, I might cry. I want to do my crying in private, dammit.

I spoke with friends last night, basically telling them that I don’t want anyone to see me while the jaw is in the first stages of healing; it’ll be swollen, ugly, and as my healing technique is keyloid (gotta check the spelling on that one!) there will be prominent scars until my beard grows back. They were quite surprised, and distressed… so I offered them a compromise. If someone can make me up a veil/bandit ‘kerchief/face mask that says “Under Construction” to cover the lower half of my face, I will welcome visitors. And they agreed! Heh, heh, heh… this could be fun, actually. If I can plan my recuperation to incorporate a few little fun things like the “under construction” mask, I and those close to me may find it a bit less traumatic, and we can all approach it with less stress.

Am I good to go? Nah, not quite. Friday AM we have the meeting with the Team… that will decide things for me. So far, Mom and Dad know the rough outline, the older brother and sister-in-law have a really good understanding, the little sister is aware, though without all the gruesome details, and Gord and JoAnn have the details. I still need to connect to with the local Aunt and Uncle, the Vancouver connection, and a couple of other local friends.

And, this morning the Speech Therapist/Pathologist called to set up an appointment so she can baseline my voice, speech patterns and swallowing.

So now we know.
So now we know more than enough.
So now we know too much.
So now we know that we don’t know enough.