01 Feb My Cancer Diary, Volume V
Dear Friends and Family,
Relentless torments of snow and ice have battered Brooklyn in recent weeks, leaving the streets and sidewalks a chalky, salty mess and our creative ways of keeping kids occupied while indoors tapped out long ago. But even as winter slogs toward its halfway mark, if you look outside in the late afternoons, you can begin to detect that the light lasts a little longer, hinting that relief is on the way.
There are very few days in one’s life that you know, in advance, are going to be momentous. December 23rd was one of those days for me. I awoke before dawn and arrived at the hospital at 5:45 AM for the beginning of what would be a fifteen-hour surgery to salvage my left leg. An orthopedic fellow arrived to sign my thigh and at 7:30 AM I was wheeled down the longest hallway I had ever seen. (I later determined that the world’s longest hallways are probably all outside surgery rooms, and I learned that this hallway, long even by hospital standards, has been nicknamed “The Green Mile.”)
Inside, the OR was a mix of high-tech television screens; a swarm of nurses and attendants; a man with a large, astronaut-like glass bubble around his head; and a 12-foot long table overflowing with knives, scalpels, and prongs. There was enough equipment to cook a state dinner, though in this case the only thing being carved was me. In the last minutes before the anesthesia kicked in, my surgeon, Dr. John Healey, appeared over my table to tell me that the latest scans of my leg suggested that the tumor had been wiped out by the chemotherapy. “It’s dead,” he said. As he later told my family, “I wanted Bruce to go to sleep with a smile.”
As I drifted into sleep, Dr. Healey went to work, while Linda, my mom, and my brother waited anxiously outside. At 12:15 PM a nurse let them know that Dr. Healey was still resecting the cancerous material from my femur and thigh. At 2:50 PM they got a similar report, and at 4:50 PM another. At 6:10 PM, Linda, Andrew, and my mother were escorted into a room where Dr. Healey joined them five minutes later. “He’s doing fine,” Dr. Healey said. “I’m fine. That says it all.”
In his patient, arresting manner, Dr. Healey spent the next forty-five minutes outlining what he had done. First he removed twenty-two centimeters of my left femur (just shy of nine inches), as well as about a third of my quadricep. The amount of muscle resected was less than he had anticipated, and he was especially pleased that he was able to save a key artery he had expected to remove. “Bruce is going to love this,” Dr. Healey said. “The artery is called the profunda.”
Dr. Healey then installed the specially crafted titanium prosthesis into the gap in my femur, attached the device to the remaining bone, and screwed the entire contraption into place. Though we had expected this prosthesis to mimic the shape of the femur, it’s actually a series of tubes, cubes, rods, and rings that appears more akin to a shock absorber, though without the ability to expand and contract. (My brother thinks it looks more like the handle of a light saber from Star Wars.) Dr. Healey was encouraged that the prosthesis fit snugly into the good parts of my femur and likened the gap to that between a boat and a dock: the closer one is to the other, the easier it is for the healthy bone to make the leap and grow into the prosthesis. Overall, Dr. Healey said he felt emboldened by the positive developments and pushed himself to take even more chances and be even more courageous. Asked if there were any surprises, Dr. Healey said, “Bruce has a very big leg!”
Though Dr. Healey’s work was mostly done, mine was not. While Dr. Healey was briefing my family, the plastic surgeon, Dr. Mehrara, went to work on my lower leg. Dr. Mehrara removed a little more than nine inches of my left fibula, grafted it to my remaining femur, then screwed the fibula into the prosthesis. In order to keep the fibula alive, Dr. Mehrara removed four blood vessels from my calf and relocated them to my thigh. When he told my family about all this at 11:30 PM, he, too, was upbeat. “Good bone; good vessels; no problem,” Dr. Mehrara said. Dr. Healey returned near midnight to provide an exclamation point to this magnum day. “Believe it or not, I’m ecstatic,” he said. As promised, Dr. Healey was the last man standing; as foretold, he was the hero of this war.
And then: The recovery. I woke up the next morning in a fog of narcotics, tubes, drains, and incoherence. I had thirty-one inches of stitches up the side of my left leg and no clue what had happened. Even more confusing, during the time I was on the operating table the doctors had forcibly shut my eyes with what must have been duct tape, and I woke up with a scratched cornea. No one could explain why such a high-tech operation had been marred by this low-tech methodology. An eye doctor arrived that evening – Christmas Eve – to test my sight; he stuck a miniature eye chart about six inches in front of my face. In my state, the whole thing appeared to bounce up and down like a trampoline. “I think you need glasses,” the doctor said, and thrust a monocle in front of my eyes. “I don’t need glasses,” I said desperately, “I don’t need this test.” Then I promptly threw up on him. Unflustered, he declared my scratched cornea the worst he had ever seen and ordered me not to open my right eye for three days!
Within days my sight had improved, I weaned myself off the morphine drip and began to take stock of my body. In effect, I had two different wounds. The first was the thigh, which was grossly swollen, had two drains to reduce the swelling and seventy-five stitches that stretched more than a foot and a half from my hip to my knee. The second was the calf, which had its own drain, was wrapped in a splint to prevent movement, and had thirteen inches of dissolvable stitches. The ortho team was responsible for the upper wound; the plastics team for the lower; and each side strenuously avoided commenting, inspecting, or even looking at the other wound. But they did continuously blame the other team for keeping me in bed. For a time it seemed as if my leg had become the United States before the Civil War – with my thigh the North; my calf the Confederacy; and my knee was the Mason-Dixon line. The frustrating standoff needed Lincoln to restore the Union.
On the seventh day, Dr. Healey (after protesting that he was not as tall as Lincoln) finally broke the stalemate and provided a surprising diagnosis. I had eased past the possible complications of surgery more hastily than they expected and my leg was simply not ready to begin rehabilitation. “I’m afraid you recovered too quickly,” he joked.
Finally on Day Eleven, I was allowed to sit up for the first time. “Your leg will swell; it will fill with blood; and it will turn purple,” Dr. Healey warned. “Your head will throb; you’ll get dizzy; and you’ll faint.” He was right! Over the next 24 hours I slowly made it out of bed, into a wheelchair, and into my new life. On Saturday, January 3rd, twelve days after I arrived, I was finally sent home. It took an ambulance, a fire truck, two crews, a stretcher, and a near overdose of pain killers to get me out of Manhattan, into Brooklyn, up a flight of stairs, and into my bed. The girls came upstairs and swarmed around me. We had reached the end of phase two of our year-long war.
And we did so on a high of positive news. The day before releasing me, Dr. Healey paid an unannounced visit to my hospital room. Linda and I were eating a mushroom and anchovy pizza she had smuggled onto the seventh floor. Dr. Healey had just come from the Tumor Review Board, he said, and had some news. The pathology showed that the chemo had been astonishingly successful, and the kill rate for my tumor was 100 percent. This result substantially increases the chances that the chemo killed the invisible cancers in my blood that have been our primary concern since July and likely improves my overall prospects. The normally reserved Dr. Healey could not contain his enthusiasm. “This is not a small skirmish,” he said. “This is victory in a major battle.” He then reached out and shook my hand.
Even with this burst of momentum, the following weeks proved extremely challenging. Back at home, the pain was intense, the inconvenience enormous, and the progress of regaining my strength and mobility far more tedious than I had feared. My days became consumed with drug regimens, bed pans, sponge baths, physical therapists, and my pitiful attempt at exercises designed to regain even nominal movement in my left leg. The simple act of turning over in bed would often leave me howling; going outside to visit the doctor required three people to assist me, including someone elevating my leg as I bumped down the stairs on my rear end like a toddler, out the door, and down the icy stoop. My orders call for no weight at all on my leg until Valentine’s Day, followed by six weeks of fifty percent weight on my leg, then months of physical rehab to help me learn to walk again.
And to make our lives significantly more complex, ten days after being discharged from the hospital, I began three months of post-operative chemo. Suddenly I layered all the miseries of last fall – nausea, weight loss, low blood counts, and mental anguish – on top of the pain in my leg. I’ve been hospitalized once since that time and on more than one occasion found myself just crying out unexpectedly, “I don’t want to have cancer anymore!”
But, of course, I don’t have cancer anymore. We must live with the threat that it returns at any time, but for now, at least, I am cancer free. The one strategic decision we made last summer was to delay the surgery for half a year in part to tell if my body would respond to the chemo. Boy did that decision pay off. The news from phase one was as good as we could have hoped; phase two, the surgery, also appears to have been a remarkable success. We are now well into phase three, and we do so with momentum and firmly focused on the future.
So how did everyone else bear up? Linda braved this unimaginable ordeal with more grace and good cheer than almost anyone else I can imagine. Our families rallied in extraordinary ways, kept the girls occupied, and spent all hours of the day and night, first at the hospital then at home, moving necessities to within arm’s reach. My mother even sacrificed a few afternoons of vigil to beat me in every single game of gin rummy we played.
On one memorable afternoon five days after the surgery, we brought the girls to the hospital for a visit. I had worried about this occasion for months, eager not to traumatize them. I persuaded the nurses to unhook me from my IV’s, ditched my gown for civilian clothes, covered up my wounds and all the scary equipment with sheets, and welcomed the girls into my bed. We had scripted the event down to the nanosecond. The girls gave me a gift, I gave them one, I read through Curious George Goes to the Hospital, then we whisked them away before they could take in too much information. Tybee was especially excited to meet Dr. Healey near the elevator, and when everyone got outside, Eden announced, “Thank you for taking us to the hospital, Mommy.” Upstairs, I wept like a baby and proud father all at the same time.
With the passage of time, our lives have once more settled into a routine. With such a long lag since my pre-Thanksgiving chemo, my eyebrows and eyelashes returned in force, along with my military buzz cut, and the unwelcome addition of my first-ever five-o’clock shadow. The girls excitedly tracked my leg’s evolution from stitches to scar and have come to relish their late-afternoon ballet performances in our bedroom. (The one mandatory note: tossing pretend flowers for the “grand finale” and pretend candy for the “encore.”) Our little family once more is a unit – hobbled but moving forward.
We fully expect February and March to be challenging months. Linda is headed first to California then later to India; I am surely heading back into the hospital. But I have promised the girls I will begin to walk about more freely by their birthday in mid-April and that my hair will grow back by this summer. On some days, these landmarks even seem close.
Until then, we take comfort that so many of you are taking this journey alongside us and know that even in the face of your own setbacks, standoffs, snowstorms, and heartaches, you’ll take an afternoon with someone you love, think of the many blessings you’ve sent our way, and use our struggles to help you persevere a little more easily through this season of challenges.
And, of course, please take a walk for me.