A Killer Within
A killer within
Times staffer Barry Bradley can't see the enemy, but he knows it's there; in fact, he found it.
By BARRY BRADLEY
Published May 15, 2005
The doctor's call came the Tuesday after Christmas.
"I'm afraid it's bad news," he said. "You definitely have lung cancer. You need to come back in as soon as possible. We need to schedule surgery."
I was expecting the news. It may seem morbid, but I was almost relieved that the doctors had finally found the cause of my lengthy and worsening illness. But actually hearing the words "lung cancer" had no real meaning at that moment. The full weight of those words, and the ordeal that lay ahead, would become evident soon enough.
My first questions, of course, were the same ones everyone asks: Is it treatable? How? With what? What happens next? And, finally, how long do I have to live?
This is a story about my lung cancer, and how I found it. Yes, you read that correctly - how I found it.
My only reason for writing this personal narrative is the hope that somebody will read it and realize that a clean X-ray is not a passport to health, a license to live. An X-ray is a marvelous diagnostic tool. But it's far from perfect. If I had trusted my tests and all the X-rays and gone home thinking I was healthy, I might well have been dead in a few months.
As it is now, my prognosis is better - not a whole lot better, but better. My weapons are faith, hope, courage and determination. As for how much time I have left, the doctors say I have a good chance of survival, mainly because of early detection, but only God knows.
Many have suffered and died from this disease. Others have survived, but we all experience similar emotions.
No matter where we are on the path of treatment, remission or recovery, no matter how much time we have left, no matter the quality of our day-to-day lives, we know too well there is a hateful, inexorable killer that follows us, invisible but always there, a mere foul whisper away.
The months that led to this diagnosis were a maelstrom of tests and procedures, often without me - the patient - being fully aware of the reason for the tests, or the significance of their results.
I felt like a rat in a maze, searching for the chunk of cheese that would provide an explanation, a cause for the symptoms that would not go away. Was this all in my mind? Was I going crazy? No. Something was there. And it wanted to kill me.
Every test was negative, but I knew something was wrong. My doctors had exhausted nearly every possibility. But I was still sick. I'd lost 30 pounds in three weeks, so the obvious early diagnosis was cancer. And since my father had died of colon cancer in 1980, that's where we started.
Besides, this wasn't my first encounter with cancer. In 1979, I developed a baseball-sized malignant tumor on my left kidney that doctors found quickly. They took out the kidney, spleen and adrenal gland, and that was it. Sure, I had to get chest X-rays every six months for the next several years, but I was back at work in six weeks. I was home free.
This time was different. To start the tests, a gastroenterologist performed a colonoscopy. It was clear. Next was the endoscopy, the tube down the esophagus. Again, nothing. CT scan. Zip. Chest X-rays. Nada. More blood tests than I can remember. All clear - except for a single indicator on one particular blood test that suggested there was cancer somewhere in my body. But where?
The human organism can sense when something is wrong. We can't always point to a spot and say, "This is where it hurts," but somehow we feel something is malfunctioning in our bodies. Call it intuition, a sixth sense, a prehistoric survival mechanism left over from when we first set a webbed foot on dry land.
The breakthrough for me came when I read something - I can't remember where - about some new tests for early detection of cancer, especially lung cancer.
My pulmonologist seemed genuinely surprised that I knew about these tests and that I wanted them. He agreed, though I think he had reservations about whether they'd find anything.
The tests were a pair of computerized tomography, or CT, scans, one using a contrasting solution injected into one of my veins and another without the injection. That was followed by a positron emission tomography, or PET, scan and yet another noncontrast CT scan. All these scans were then sandwiched together to form a three-dimensional image of the body's interior.
The tests, and the order in which they are given, may be different for everyone, and might even be unnecessary, but I had a strong feeling that I was doing something that would peel back a layer of the mystery.
When the results came back, the pulmonologist readily acknowledged his astonishment. There on the film was a small, kidney-shaped formation, slightly smaller than a dime, in the lower lobe of my left lung, glowing like a headlight in the dark.
He told me straight out that I was responsible for finding my own cancer. And it was a bad one. It was a malignant carcinoma, and it would have to come out - now.
The surgeon came highly recommended. At first we discussed a needle biopsy, but there were serious drawbacks. Because of the early detection, and the small size of the suspicious area, a needle penetrating the chest wall could miss the spot entirely.
Further, it could easily precipitate the collapse of my left lung, which would lead to a new array of serious problems. The biopsy could also come back negative, but the surgeon said he probably wouldn't believe the results of the test and would want to operate anyway, just to be sure. We decided to skip the dicey biopsy. The risk-reward arithmetic just didn't add up.
He told me and my wife exactly what would happen in surgery: the incision, the breaking of the ribs to get the lung out, the removal of the cancerous tissue, the two chest tubes after surgery and the expected length of recovery.
I love it when they say you're going to experience "a little discomfort." That's like saying Lizzie Borden was a little eccentric. The pain was exquisite, even through the acrid, cotton-mouthed haze of morphine.
I especially enjoyed the "mild discomfort" when the surgeon's assistant came into ICU on the third day and removed the two garden hose-sized chest tubes. Just breathe normally, she said, as she pulled the tubes from my incision. Yeah, okay, I thought. And just let me get my hands around your throat.
As I drifted in and out of consciousness the first few days in ICU, I was under the impression that all was well. I had cancer in my left lung, the doctors had removed it and that would be the end of it. In my mind I was cured.
The postsurgical biopsy said otherwise. Outside my hospital room, my surgeon was explaining to my wife that I had small cell carcinoma, one of the most virulent and aggressive killers in the cancer arsenal.
And though the surgery went fine, small cell carcinomas usually dispatch hundreds or even thousands of seeds throughout the body, looking for a place to settle and grow. Even more frightening, it takes only a single seed to start a new cancer at a new site. He also explained that it was a fast killer, so I needed to start chemotherapy as soon as possible.
To my wife, Jean, these were just words. She took them all in with a certain numbness, even though as a home health aide with the Hospice of the Florida Suncoast, she knew exactly what lay ahead for both of us.
All her adult career has been spent caring for the terminally ill. She has witnessed thousands of deaths, fully a third of them from cancer. She has seen the reality of a cancerous death, how it eats away the life of a patient. It is not a death in which one goes peacefully into that good night.
And now she was married to a cancer patient.
With hospice work, Jean sees patients only when they are close to death. They may have a few months, weeks or days when she is called in. Now she would witness the entire process from the beginning. When she called my mother with the news, she wept.
Together, the doctors, Jean and my mom decided to wait and tell me about the biospy after I had emerged from the drug-induced la-la-land, when I could fully comprehend what they were saying.
Prognosis percentages, guesswork and just plain coin tosses are the only tools doctors have to offer their patients. Some people respond to chemo and radiation, some don't. Some survive months or even years. Some don't.
Where did I stand? The doctors were hopeful because of the extraordinarily early detection and the surgical removal of the primary cancer site. Still, small cell carcinoma, even if caught early, is fatal about 60 percent of the time. Put in a brighter light, at best I have a 40 percent chance of beating this.
The trick is killing all of the seeds that now are racing through my body before they latch on someplace and begin growing again. They are prone to settle in the liver, the bones and the brain.
Once again, I seemed to get lucky. A test revealed the cancer had not eaten its way into my brain. Had it done so, I simply would have gone home to die.
Chemo is the best hope for killing the rest of the nasty little small cell devils. But chemo also kills other fast-duplicating cells, like those for your hair, nails and brain.
The aim - and the hope - is to kill all the bad cells before killing too many of the good ones.
In my case, the oncologists decided I also should get radiation after I finish the chemo. So I'll be getting the full monty, the slash, poison and burn smorgasbord of cancer treatment.
But somehow, my spirits remain high. My faith in God is strong, so my bags are packed - whichever way the train goes when it leaves the station.
Before I go further, let me explain something about my life. I am not one of those unfortunate, innocent people who got this loathsome disease through no fault of their own. I have been a two-pack-a-day smoker for more than 40 of my 57 years, even though I knew better. I have broken all but one of the Ten Commandments, and even invented a few of my own.
I've gone through life at 7,000 rpm, thinking I was bulletproof. I did all the booze and the drugs (and, yes, I inhaled). In truth, I should have been dead years ago. No one deserves cancer, or any illness, but if there is one person who does, it's probably me.
On the other hand, I have tried to be a friend and mentor to my comrades and colleagues, as well as a loving husband to my wife. I have sought to have a positive effect on those I have touched over the years. I believe I have an inner kindness, a nurturing spirit that brings out the better things in others. In the end, though, deserving has nothing to do with it.
Since my diagnosis, I have seen subtle changes in the way I think and react. It's almost as if every sense is elevated. I find myself being more patient and kind.
But I'm also sitting on a volcano of anger. It's not the "why me" thing, it's the idiot who does something stupid. It's the pharmacist who grills me over my pain medication like I'm a drug addict. My first response is to lash out and say: "Look at my head, you simple-minded moron. Do you think I chose this bald head? Do you think I'm enjoying chemotherapy and the pain of all the shots of this drug or that concoction? Just fill the freaking medication and shut your pie hole."
The next day, I drag myself back to the drugstore and apologize.
Perhaps unconsciously, I feel that people should know how badly I feel. But that really isn't fair, is it?
Now, on to something else that's stupid. Obviously I didn't smoke while in the hospital, and I made it smoke-free several days after my release, but the pressure, the uncertainty, the occasional fear of what I was up against overpowered my will not to smoke. So, yes, I'm smoking again, though only about a quarter as much as before.
Go ahead, call me stupid. That's okay. And, yes, I'm still trying to quit. I'm using the patch, the gum, the little nicotine inhaler. I'm considering hypnosis, acupuncture. If I thought it would work, I'd probably snort used kitty litter in my quest to give up cigarettes. But I swear it's the toughest addiction out there.
Of course, the darker side of me says, "What possible difference could it make now?" But I won't let myself go there.
Jean and I have been married a little over 21/2 years. We met through a mutual friend. When I got sick last October - and stayed sick through Christmas - she was just about at wit's end.
I'll let her tell it in her own words:
For the past six months, Barry had been tired most of the time and not his usual happy self. As each test proved negative, I wondered if he was clinically depressed. I also feared there was something wrong with our very young marriage.
My first husband died eight years ago from a sudden heart attack, and I have always felt God sent me Barry to grow old with.
As strange as it may sound, I was actually elated when they finally found his cancer. This was something we could fix. Just remove a piece of his lung and all would be well, and life would return to normal.
What I didn't realize was that surgery was only the beginning of our long fight against this disease.
I have gone through many emotions: fear, depression, worry, denial, anger - especially anger. I think that subconsciously I thought if I could be angry at my husband, I wouldn't feel the pain of possibly losing another soul mate. I was livid when Barry started smoking again. Without the loving support of my family and co-workers at hospice, I would not have the spiritual inner strength to help my husband fight this cancer. I am also seeing a counselor, who is reminding me how to find beauty in every day. We have a long, twisting road ahead of us. But I know we will get through this together, holding hands.
Thankfully, for both of us, Jean has moved past her anger, just as we are both moving through the phases of loss, as put forth years ago by Elisabeth Kubler-Ross in her book On Death and Dying. It's not that either of us feels that I'm certain to die, but the process helps put things in perspective. And if I live, I'm sure I'll be a better person every day for the effort. Now Jean and I both are seeing a counselor to help us with this process. We are feeling strong, and in many ways are closer than ever before.
Now I feel compelled to bring up what may be a sensitive issue: sexual intimacy. Doctors say lung cancer, even chemo, should not prevent sex. But in our case, there is none. It's not that I don't love my wife or find her attractive (great legs), it's that my mind never drifts very far from my disease. I try, believe me, to put it aside, but it's impossible.
I feel as if I have to exercise a mean strength and arm myself for battle every day, because every day that damnable beast is inside me. I've never backed away from any kind of fight, and I've developed this flint-eyed, steely determination to kill it with my own willpower. I have a body full of poison, and an attitude to match. I simply must kill it before it kills me.
So, instead of sex, we decided to buy a new house. I have always been a saver. I have aggressively saved and invested and put away money for retirement.
But now, retirement doesn't seem all that important. Our current house, which suits me fine, will be paid off in about four years, and I wanted to be totally debt-free by age 62 so we could retire early and have fun spending our savings.
But Jean isn't that fond of our current house. She wants something a little bigger, a little nicer, with a great big fireplace and a formal dining room. Given my change of attitude about my long-term survival chances, I agreed. We found the perfect house and bought it on the spot.
Our next adventure is a trip out West. The Grand Canyon has been there for millions of years, and Jean has always had a longing to visit this masterpiece of nature. Now we're checking out travel packages on the Internet.
I'm certainly no pessimist, and I'm sure I can beat this thing. I keep telling my friends not to worry; I'm tougher than a two-dollar steak. But something tells me we should make that trip sooner rather than later.
- Barry Bradley is an editor for the St. Petersburg Times' metro news department. He can be reached at email@example.com He will be writing another story after he finishes his chemo and radiation therapy.
[Last modified July 7, 2005, 12:28:04]
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