April 1, 2013

birthday present

    Usually, it begins with a phone call.  But this time it started with a voice mail.  From my dad, he had some questions about his recent CT scan.  One of the quirks at MDACC is that the patient will oftentimes have the reports to various tests - CT scans, biopsies, blood draws, whatever - posted to their online account before they've met with their oncologist.  And though my dad's bone marrow biopsy, his molecular assessment and all that it entails (I'm not going into the details), and his blood work showed that he was 100% engrafted and 100% in remission, there were two little sentences in his thoracic CT which were reason for pausing.  Not even full sentences, really.  Just two measly statements out of multiple boring ones:
There is a new 0.7 x 0.5 cm poorly marginated nodular opacity in the right lower lobe posteriorly (image 95 of series 4). This may be a postinflammatory focus and recommend short-term followup (sic) to ensure stability or resolution.
 Just simply uttering the word "new" to a cancer patient is reason enough cause them to hold their breath in worried anticipation.  And "poorly marginated" are buzzwords to clinicians.  They normally do not imply benign findings.  And so my dad asked me what the report meant. 
     "It could be a lot of things.  Seeing as how you recently had a respiratory infection, it's likely that it's just a hold over from that bug you had," I said. 
     "What else could it be?  The radiologist wouldn't be recommending follow up unless there were other possibilities."  I could see my dad's mental faculties were still intact.
     Taking a pause while remembering a similar conversation I had with my dad about two years ago when he was first being diagnosed, I asked him, "do you really want to go down that road just yet?"  He did.  So we had the conversation about the possibility of another malignancy.  Thoughts of more testing, more chemotherapy, more fighting.....It's more than one person would care to endure. 
     It's likely the finding is the remnants of his recent infection.  It's less likely to be cancer.  But not improbable.  The price of surviving cancer is eternal vigilance. 

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