One in the Hand is Worth Three in the Arm

July 2018 CANCER CHECK-UP .. .Report

Four months, or one hundred and twenty days, or two thousand, eight hundred, eighty hours. No matter how you measure this particular length of time, it is the maximum length of time, determined by those with medical expertise, between reassessments of the state of the stage 4 clear cell renal carcinoma that occupies, or has occupied my body. In this capacity, my doctor functions as a sort of parole officer. I have a four month leash. A four month leash functions a bit like a work week. Except most days are like weekends. When Sunday late afternoon rolls around however, and Monday’s challenges flood my mind, I get a bit nervous for the next day’s agenda.

In my case,  the day starts with people who poke holes in my body in order to to extract blood for analysis, and other holes through which they inject a dye that lights up when subjected to a specific type of electromagnetic radiation. In case you’re wondering, this radiation has a wavelength ranging from 0.01 to 10 nanometers. This kind of radiation was named  X-ray because Rotgen, who discovered it, knew that it was an unknown type of radiation (versus UV rays, and gamma rays, and if you don’t know what it is, you put an ‘X’ in front of the name.) You’ve got to love science because it’s impossible to make this stuff up and well, that’s modern medicine for you.

So, I’m a hard poke. Now, being a hard poke is not at all like being a slow poke, and it’s light years (more science) away from being a cow poke, but it’s not too far away from being an old bloke. Being a hard poke means that I usually ‘get’ to be attended to by as many as three nurses. And by ‘attended to’ I mean poked with a 20 gauge IV needle. They had a particularly difficult time finding a vein into which they could insert a needle. First one tried several times, then another. They tried hot packs. They tried flicking the veins. They tried rubbing, massages, the works. Finally, they gave up. Seriously. One said, well, you’ve got a nice vein in your hand that looks decent. I think we can make that work.” “OK”, said the second nurse. ”I agree. That’s going to have to do.”  

“Make work”? “Have to do”? Gotta love that medical lingo. Sure enough, it went in. Next, she gave me a bottle of water to drink. Now, because I’m an old bloke, hard poke, I had been drinking a fair amount of water all morning to avoid the pin cushion effect, obviously to no avail. But when she handed me the water I said,

“I’m going to have to pee right after I drink this,” You see, I’ve acquired on my own, a certain fluency in using medical speak, and there’s no sense being shy in the presence of these professionals.

“Oh, no problem”, the nurse replied. “Go down the hall, take a right at the corner, and straight down that hall on the right is the restroom.” She continued, “When you come back you are in room....” The rooms are alphabetical, and there are a number of prep rooms. She stepped just slightly into the hallway and looked up at the top of the doorway.

“Oh!” she exclaimed. “You are in room P. Ha ha ha,!” she laughs. “Well, that’s appropriate! You won’t forget that number.” It was funny. I liked this nurse.

Once in the CT room, two other nurses, or techs, noticed the IV in my hand. One took charge.

“I heard you’re a hard poke.” she commented. Apparently news travels fast around here.

“Sometimes” I said.

“Well,” she continued while examining my arms with her own personal x-ray vision, “You’ve been poked enough, but I see a vein on the bottom of your arm that looks interesting.” She sounded much too curious.

“Go for it”, I said. But after rubbing, flicking, massaging, and other tricks to the ‘stick the patient trade’, she too settled for the IV in the hand method of dye injection. But just to be sure, she asked the other nurse in the room to ‘flush’ the IV. She did, and as she did she looked at my face, which wrinkled ever so slightly.

“Did that sting.” she asked?

“A tiny bit,” I answered.

“Well, let’s flush it again just to make sure, because there’s a bit of pressure behind this injection, which is needed in order to get a good picture, and we don’t want the IV to blow out, or for you to have to re-do this whole thing. “

“Excellent logic. Sound medical judgement. I fully concur. I couldn’t have said it better myself. Textbook!” I thought, hoping she got good grades in nursing school. Thankfully the second injection seemed better.

“We will have to go slower than we normally do,” she continued. “As the hand isn’t the best place for the injection, and also because it tends to ‘sting’, but we will go as fast as we can.” She took my impaled hand and positioned it just so, in order that the injection flowed through the veins in as unrestricted manner as possible. Satisfied that my contorted hand was in the best position possible for the least amount of pain and the greatest amount of dye, she asked if I was ready, and then as she exited the room offered up one final but very valuable patient tip.

“You’ll just have breathe through it,” she advised cooly.

WHAT?  I imagined myself huffing, childbirth style, in order to get through the pain. Instantly, memories of a dentist visit 52 years ago flooded my mind. I clearly remember him saying to me,

“I expect my patients to be able to deal with ‘some’ pain.” I think he had to replace the armrests on his dentist chair after that visit. While it is true that unfriendly peers would sometimes mock me by calling me ‘captain skinny bones’, It’s surprising how much strength is contained in the white knuckle death grip of an extra slim teenage boy of 13.

The door closed. The scans began. Yes, it did ‘sting’. I tried to think happy thoughts. That didn’t work. Instead I thought of a recent hard bicycle ride that only became fun following a visit to the dairy queen an hour after the ride was over. I survived that. I survived the dentist, and I survived this. The nurses apologized. The scan was successful. The pictures were good. There would be no more bleeding, poking, or ‘stinging’ today. The Dr would reveal the results the following day.

I have a Dr that is from the middle east. He’s a great guy. And he has a slight accent but it isn’t too distracting. He’s young. The word on the street is that while younger oncologists lack the experience of a seasoned doctor, they often have crisp and fresh knowledge of newer medicines, drugs and treatments. And, in my case, that could be a good thing.

After getting a few vitals from the assistant on the way into the Dr’s office; weight 192, BP 125/77, pulse 50, etc., we waited only a few minutes before he came in with a smile, a handshake, and a question.

“How have you been doing?” he asked.

“Great” I said.

“Well, let’s check you out.” I laid on the little exam table while he poked, prodded, checked the lymph glands, and listened to my lungs.

“Any pain anywhere?” he asked.

“Nope”, I replied.

Then he said,

“OK, everything looks good to me. I don’t know if I’ve told you this before, but as far as your situation is concerned, it's very odd. You are the exception. You are the outlier. We typically don't see this with similar patients. Nothing shows up on the scans. You continue to be clear. There is still no evidence of disease.  See you in four months."

Two thousand, eight hundred, eighty hours. The clock starts over. My situation is not odd. It’s God. While I may be an outlier medically, I do not lie outside the boundaries of God’s grace no matter what comes after those hours count back to zero one more time. Pray that we use those hours wisely.

Thanks for your partnership on this journey. Thanks for your prayers.

Love,

Mike and Deb