A T-Shirt and a Bible Verse

Cancer update April 3, 2017

The flight out of Minot on March 29 was delayed. After everyone boarded the plane the captain came on the intercom and said that there was a “dent” in the side of the plane. This occurred somehow on the flight in.  An “Inspector” needed to examine the issue to determine if this was a serious problem. The inspector was on his way , but his arrival and inspection would take some time, so the pilot invited us to disembark. We all did.  We waited long enough to enjoy a great burger at the Trestle Tap House.  Meanwhile the inspector arrived, performed his duties, completed the necessary FAA paperwork, and the aircraft was cleared for flight. We re-boarded, and the rest of the flight was uneventful, which is just the way you like your flights. I was happy about the delay.

I sat next to a lawyer on a flight once. That particular flight was also experiencing a delay. It was a long delay and passengers were getting visibly and audibly agitated. 

He turned to me and said very calmly, “I was part of a legal team for the plaintiff concerning the crash of a small plane shortly after takeoff in Montana. People died in that plane crash. This was a long tough case, but I learned a lot about aviation. After that case, I will never again be upset about a delay caused by a mechanical. Delays mean that someone is on the ball. Someone has noticed a problem, and they are either investigating it, fixing it or both.”  Iv’e never forgotten that conversation.

As usual, upon our arrival in Minneapolis, Deb and I rented a car and drove to Rochester after the obligatory stop at REI to check out thousands of items designed to keep you safe, happy and mobile in the outdoors. Need an ice axe? REI!  Need some bomber mountaineering clothing? REI! Need a mountain bike? REI!  Need a tent that will handle 60mph winds at 20,000 feet, or a sun canopy for the beach, yep REI…. you get the picture. I don’t know why I go there and look. I have at least one of everything, and doubles and triples of a number of things. 

I had a CT scan on Thursday morning March 30. A highly competent nurse skillfully inserted an IV needle into my left hand on the first try. I gave her a “Whoa, Excellent!” She handed me a bottle of water to drink in preparation for the CT scan with contrast. After I drank it I had to wait for my body to assimilate the water. I sat for about  40 minutes or so. It takes 30 minutes for water to empty from your stomach. That’s a good thing to remember when you’re riding your bike for several hours on a hot day. Drink before you get thirsty. Otherwise, it’s too late. When the time was up, a bubbly young nurse came to get me. I wish I could remember her name, but I’ll call her Sherie. She was happy, spunky and had a playful spirit. “Hi, I’m Sherie”, she boldly announced. “I’ll be your CT guide today!” (big smile, animated, fun tour-guide attitude). “Let’s go!!”.  After we got into the hallway, she wanted me to lead, and of course, I had no idea where to go to. She was laughing. She took over and led me into a room with a new machine. Bonus! This one had carnival lights on it’s inside that changed colors!  Oooooh Aaaaaah, pretty, yellow, purple!  I hope it worked as great as it looked.

 “Lay down here”, she directed me. 

Then she threw a warm blanket over me and said, “OK, pull down your pants.” As I did so under the blanket she said, “Isn’t it amazing? I actually get paid to tell people to do that!”  It could have come across as crude, but it was so non-serious that it was just plain funny. I replied, “I bet your mom is thrilled that she paid for your school so you could learn how to say that that!”. She laughed, so did the other nurse in the room. However, when they injected the contrast into my hand to get a good picture of the cancer on my pancreas, it was not fun. It was painful, but it only lasted a minute or so. Apparently if you’re going to inject contrast into someone for a CT scan, the hand is a pretty sensitive place. For me however, the hand is a great place for an IV. So, you win some, and you lose a little, but it’s worth it. 

Friday morning was the third EUS RF ablation procedure. I woke up a little nervous, mostly because I had the urinary retention issue the time before and was afraid it would happen again. Also, there’s always a little,  ‘i don’t like it when they can’t get the IV in right’ thing going on in my head. I got up, and started to get dressed. I reached into my suitcase and pulled out a clean T-shirt. It was a “The North Face” T-shirt I got from my cousins Cindy and Dennis last July for my birthday. Strangely, this was going to make a difference in my morning and my day. “The North Face” has as a motto, “Never Stop Exploring”.  My shirt said, “Tested and Proven”. I put the shirt on and looked at myself in the mirror.   The notion that I should view this situation as an exploration and as an adventure came to mind and comfortably settled in. That and the thought that while I’ve been on a number of successful adventures I’ve also been weighed, measured, and found wanting on many more occasions, but God has not. He’s been tested and proven. He’s in control. He knows the outcome. A bible verse came to mind. Deuteronomy 31:8 The LORD himself goes before you and will be with you; he will never leave you nor forsake you. Do not be afraid; do not be discouraged. 

I’ve heard of power ties before. I wore them on occasion when I wore a suit as a principal. I’ve never heard of a power t-shirt before though. It’s funny how your mind works, or what triggers a thought or brings a bible verse to mind ….. or is it? Many of you have been praying for me, and I feel as though this is simply a result of your earnest prayers and support, and the power of God’s Word. Fortified, I relaxed and was ready to take on the day.

We arrived at the reception desk at the Gonda building, floor two ,south wing, just in time, and checked in. They gave me a buzzer and we sat down. My buzzer went off within a minute or two. This time, Jessica stood at the door to the pre/post Op area.  Deb and I walked up to her with a smile.

I said, “I bet you’ve been waiting JUST for me!” She laughed, and told me she’d take me back but that Martin would be my nurse. I walked back with her and I sat on the bed. She measured my neck. Martin came in. If Martin would have had a white beard, and a red suit, he’d be a perfect “jolly ol elf”. 

He said, “You’re going to have fun in here today.” You know what? He was right. He and Jessica went back and forth with some inside jokes, and complained about each other a little bit, but included Deb and I in on the fun. 

Finally he asked, “What do you do Mike?” 

I said, “I’m retired now, but I was an elementary school principal for many years,” 

“Oh! That explains the vibe I was getting from you” he exclaimed! Then we had more laughs when he told us about his time as a student at a catholic school with the nuns. Yes, he ended up in the principal’s office, and I’m sure the nuns there still remember him. I’ve never had fun, and certainly not this much fun in pre-op before!

Jessica hooked me up to the monitoring equipment, and Martin nailed the IV insertion, all the while chatting and laughing . Then the anesthesiologist came in. He introduced himself. Dr John Abenstein was from Velva and knew of my brother’s wife, Wanda. She graduated a class or two behind him. He asked how the last procedure went. I told him about the urinary retention issue I had last time and he mentioned that he was talking to another Dr about that very thing this morning. He said he’d use a different med this time, instead of the one that caused the problem. He was very personable, friendly, your good friend, next door neighbor kind of guy, and just down right caring. 

The doctor came in. There’s the usual greeting, and ‘how have you been doing’ kind of conversation that takes place initially. Then he got into what was really on his mind. 

“Mr Fogarty, I’ve been looking at your scans and I’m sorry to have to tell you that we don’t see any change in the tumors at all. They all essentially look the same as they did at the beginning. Of course we’ll do another scan in April after today’s procedure but if the scan continues to look as it does now, it doesn’t make any sense to spend the time and the money to do more of these procedures. If they are not working, why continue? I must tell you that I feel bad about this. We’ve had success with this technique for your type of situation. But sometimes, thats’ just how it goes. I wish I could tell you differently. I’m sorry.”  I could tell he really was.

Pre-Op was no longer fun. Deb thanked him for being forthright and upfront as my ability to comprehend and respond suddenly diminished. It’s funny what a series of common ordinary words; looks, the, same, no, change, spoken in a specific context, can do to your mental capacities. I did my best to regain focus.

“I also have to tell you,” he went on, “that I’ve been on the phone this morning to perhaps the world’s most preeminent expert on this technique.” I perked up. Dr. Levy wasn’t giving up yet.

He continued, “We had quite a lengthy conversation. (This guy is in Europe) He’s given me several tips, and I plan to employ them today. In summary, we are going to turn up the power, we’re going to go longer, and after we are done with that, we are going to go back in and inject alcohol right into the tumors to try and kill them that way. Of course if this works, we won’t know if it was the intensity, duration, or alcohol that did the job, but we are going to go after it. To do all this, we are going to need to keep you very still, and I need to tell you that you will be at increased risk for pancreatitis, more than before. Are you OK with that? Any questions?”

“No”, I replied. I was on an adventure. God obviously had gone before me, and he was with me now. I signed permission. 

“OK, great”, he said. “I’ll see you in a couple minutes.” 

Deb kissed me goodby, I was wheeled down the hall, introduced to the OR room staff, and placed on the operating table. All of this was very pleasant. I was given oxygen. Then I ceased to exist, once more, without any warning this time.

I struggled to climb out of the deep, heavy gravitational pull, from the bottomless black hole of non existence. The post OP room lights barely flickered into view for a brief moment, but only partially, then my eyelids slammed shut again. I began coughing, sputtering. I wondered if I was going to puke. The thought drifted around in my mind fading in and out of focus for a while. A sliver of light slipped between my nearly closed eyelids again. 

A nurse said, “Would you like something for nausea?” Someone answered. It wasn’t me. (Deb did, she and Martin thought I just had some phlegm in my throat)  She asked again. I said yes but don’t remember saying it. Moments later, the thought that I might puke drifted away (again, unaware, she used the IV port to inject the meds). My brain was reeling from the heavy darkness, knowing, finally, that I was in recovery and that my job was to wake up. The dark hand of gravity reached up from below, grabbed my brain, and pulled me back down again. This cycle repeated itself over and over. With each grasp for lucidity, the light stayed on just a tiny bit longer, and the involuntary plunges back down into the black hole were not quite as deep, nor for as long. I remember taking deep breaths, to raise the oxygen level in my blood, hoping that would revive my brain. Deb said the oxygen saturation level on the monitoring equipment would shoot up to 100% when I did that.  Martin, my main nurse, asked me if I’d like something to drink. I told him I needed something to help wake up my mind. I thought perhaps the caffeine in a Coke would help. He brought me one. The brain fog reminded me of some really intense training rides I’d been on, where you crawl way back into your brain to hide from the pain, where the only things that are working are your lungs taking in air, and your legs turning the pedals around. Lungs and legs. Nothing else functioned. Nothing else mattered. I tried again to clear the fog. 

This was not like the last time. Last time I woke up and sat up in a very short amount of time. This time, I struggled hard and long. It was a quite a while before I felt as though I could sit up. And even longer before they would dismiss me. Even then, when they did, Deb wheeled me around Mayo Clinic and downtown Rochester (connected by tunnels and covered sky bridges) for about an hour in a wheel chair before I felt as though I could stand and walk to the car without stumbling. She shopped. I sat in the chair concentrating on reality and muscle control.

Before Deb wheeled me out of post-op however, the Dr came back in and had some important things to say. Because he was cranking up the intensity, and the duration, they had to make sure that I was totally incapable of any involuntary movement what-so-ever. So, yes, I was under deeper and longer than before. Secondly, he was seeing changes in the tumors through the ultrasound monitor he used to guide him during the procedure. Ultra Sound doesn’t provide a very high resolution picture, but he was certain about what he saw. Definite changes. But were these changes the right changes? While very capable radiologists read the scans and provide a thorough report, these renal tumors are very vascular in nature (full of blood vessels). This characteristic makes them prone to ‘light up’ with the contrast on a CT scan as does living cancer. He was going to have ‘his’ radiologists read the scans next time, because they know more specifically what he is looking for. The tumors will be there, he said, dead or alive. They aren’t going anywhere. So interpreting their condition is the challenge. But he reminded us again, if there are no changes, there will be no fourth treatment. Hopefully, he said, we will want to do a fourth.

How do I feel now? My stomach is a bit messed up, and eating is somewhat uncomfortable, but what else would you expect? Other than that, I’m happy, life is grand, and God is amazing.

We go back in a month.

—  SHORT VERSION —

We did at CT scan on Thursday March 30, and had the EUS RF Ablation procedure on Friday, March 31. 

Right before the EUS procedure:  We talked with the doctor. He said the CT scan showed no change so these procedures may not have made a difference. We will come back in a month for another CT scan and then either do another procedure or cancel it. He said if it's not doing anything it's useless to do more of them. So, we wait and see I guess. It was NOT the news we wanted to hear but we appreciate his honesty. We told him that and he said that is what he would want if he was the patient.  Deb says, “Personally I am hoping we find out later that things ARE working.”

Immediately following the procedure: The dr was just in. He treated things way more aggressively this time and actually thinks more is happening than the CT scan shows. He said the CT scan will always show the mass because even if it dies, it will still show up on the scan. He said he has a couple radiologists that know what he is looking for and he plans to have one of them look things over. So, we may hear better news next time!