When I woke up from the inadvertent nap on Robin's sofa Melissa let me know they had dropped the program off at the printers and they would have the booklets printed and stapled by the next morning (Tuesday). She also had a printer's proof that she showed me and I thought it looked wonderful given the short amount of time they had to prepare and the obvious challenge with compiling a handout for your brother's funeral. I then walked out to the front yard and phoned Mitzi to get a report on Tanner's birthday party. She was happy to tell me they had a great time at the amusement park and that Shawn had done an incredible job arranging everything. She said that Candi's home was spotless, that Shawn had filled it with balloons, ordered a very nice cake which he personally assisted the cake maker with decorating and that in addition to the trip to Boomers they had the cake and ice cream at a Farrell's ice cream parlor. In spite of his mother being 8000 miles away Tanner had a memorable birthday with his dad, sister, grandmother, aunt, uncle and cousins. I was happy to hear the report.
I made and received phone calls and emails from a number of family members in America keeping everyone as up to date as I could with the details. Candi and I tried our best to keep Geoff's sister, Carri, who lives with her husband and 2 children in San Diego as current as possible. Carri appreciated our effort. I found that most everyone had no words that could explain their true emotion about the situation. The conversations were typically awkward exchanges when trying to communicate with my parents or siblings or daughter about what we were dealing with in Sydney. They wanted to say words that would take away my pain and show their love and support and I wanted badly to be able to express to them my appreciation for that love and support. It's said there are nearly 1 million words in the English language but among those apparently the correct ones to convey the feelings of having your son, grandson, nephew, brother stolen from your grasp have not been coined.
Sister Mary from St. Ursula's school came calling soon after Melissa returned from the printer. She spent some time with Robin and Melissa discussing the expectations for Wednesday and the mechanics of the audio system at the church. She assured us that she would be present at the service and available for any unexpected challenges that may arise. Sister Mary has the gift of making everyone around her feel a little calmer, a little more at peace and a little more confident about the journey we were all about to embark upon. For that I was most grateful.
After we walked Sister Mary to her car Robin advised me that it was time for us to head over to St. George Medical Center for our meeting with Dr. Choi. She grabbed her purse and keys from the house and we headed over to the hospital in Kogarah in her still damaged sedan with the vibration noise as loud as ever. It was late afternoon and parking, as everywhere in Sydney, was at a premium. After locating a relatively close by spot on the street, then walking to the clinic of Dr. Harvey I discussed with Robin what I thought our goal for this meeting ought to be. We were there to gather information; I didn't want to come across as accusatory or attempting to fix blame; I wanted the physician to be as open and honest about what he thought happened to Geoff as possible.
We walked up to the reception area for the clinic and identified ourselves. The receptionist apparently had been anticipating our arrival as she immediately ushered us into an office just off the lobby. Within minutes Dr. Choi entered the office and introduced himself. He appeared to be in his 30's or perhaps early 40's. His name would indicate that he was Asian as would his appearance but if you spoke with him only by telephone you would assume he was a blue eyed blond Australian based on his speech patterns and diction. I concluded he was born and raised in Australia. He first explained to us that Dr. Harvey, the staff specialist in hematology for St. George Hospital, was out of the country attending a symposium; that he had left on 2 October. Dr. Choi explained that he was a hematology fellow currently assigned to Dr. Harvey, that he could be reassigned at any time but that we should feel free to follow up with he or Dr. Harvey for any future issues, either of them would be happy to help us. Dr. Harvey had been primarily responsible for Geoff's treatment for Hodgkin Lymphoma since he was diagnosed in the last part of 2007.
Dr. Choi then took a seat and began by expressing his personal sorrow and dismay at Geoffrey's passing and that he had been in contact with Dr. Harvey by telephone and email and that Dr. Harvey was equally distressed. He then spent the next 15 minutes or so relating the details of Geoff's case from his perspective without referring to any notes, files or computers. I took notice of this because it was obvious to me that he had spent a good amount of time preparing for our visit and his presentation came across as honest and open. Perhaps my expectation was that he would be guarded in his comments so as not to accept any responsibility for events that led to Geoff's death but the reality was the opposite. He explained that when he saw Geoff on 29 October along with Dr. Harvey and reviewed the results of his blood test they didn't believe anything particularly troubling was occurring. Although they suspected, based on his symptoms, that Geoff had been struck with Glandular Fever (Infectious Mononucleosis) the blood test did not support a positive exposure to the EBV virus that would necessarily be present so they decided to repeat the test the following day. At the same time, they noticed that Geoff had a "presenting" lymph node under one side of his jaw. Swollen lymph nodes are consistent with Glandular Fever, he explained, but that they tend to be symmetrical or mirrored on opposite sides of the body and this singular enlarged lymph node was somewhat troubling as it did not match the typical Glandular Fever symptoms. Although it was somewhat premature in the normal Hodgkin Lymphoma follow up they ordered a CT scan for the following day as well. He went on to explain that there was some reluctance to have Geoff undergo the CT scan due to the extreme amount of radiation he had been exposed to over the last 3 years from previous scans and therapy. Nonetheless, they ordered the CT and Geoff showed up the following day for the 2 tests.
The follow up blood test performed on 30 October revealed a positive exposure to EBV in contrast with the test from the previous day. Dr. Choi explained this was not uncommon and was consistent with a recent infection, that the test was focused on the anti-bodies that one's system produces and that is takes some time for those anti-bodies to develop in a measurable volume. The results of the CT Scan revealed some more interesting findings: Geoff had enlarged lymph nodes throughout the scanned areas, from his groin to his sinuses. Dr. Choi explained that this was still consistent with Glandular Fever and that the size of the lymph nodes affected were not overly large and save for the one presenting node in his neck seemed to be symmetrical. In spite of Geoff's history of Hodgkin Lymphoma the decision was made that they were most likely dealing with Glandular Fever and the protocol for treatment was bed rest, fluids and over the counter medication to treat fever.
Dr. Choi continued by explaining that the responsibility for determining the the causation for Geoff's death now lay with the Coroner. He also said he and Dr. Harvey did not believe that the initial findings, the conclusion that the primary reason for Geoff's demise was Lymphoma was incorrect and that after all of the analysis and reviews were completed they were more of the belief that we would find that Geoff died from an overwhelming infection that his compromised immune system was unable to defend against. He further explained that he had an acquaintance in the coroner's office and was hoping to use that relationship to obtain information more quickly than the protracted time period we were told of 8 to 12 months for the results of the examinations. He did acknowledge that it was probable, in retrospect, the Lymphoma had returned but that it had not reached a stage where the enlarged lymph nodes, in and of themselves, were life threatening.
Because I had my own challenge with Lymphoma I had some questions that I needed to ask. I knew that one of the markers for determining the severity of lymphoma involvement is the size of the largest affected nodes I specifically asked Dr. Choi to explain what the retrospective review of the CT scan indicated. He quickly responded by stating that Geoff had no enlarged lymph nodes that measured over 2 cm, not particularly large depending upon the location of those involved nodes. I then asked Dr. Choi what he would have done differently given that he knew then what he knows now. Without hesitation he responded that he doesn't believe they would have done anything differently, that EBV infection does not react well to antibiotics and that in many cases the antibiotics exacerbate the symptoms. He restated how shocked both he and Dr. Harvey were that Geoff's illness escalated so quickly.
Before we left the office Dr. Choi took my yellow legal pad on which I had been taking notes and wrote his contact information, including his personal mobile telephone number and email address. He then told us he would communicate with us whenever there was meaningful information to report and at a minimum every 30 days until the coroner issued his report. He welcomed us to contact him at any time we had questions or a need to discuss any of the information we had previously been provided.
Robin and I exited the office in silence and walked toward her car absorbing all the information we had been provided. As she engaged the starter she looked over at me and asked if I would like to go for a walk. She suggested we go to a place where she and Geoff used to walk while he was undergoing his treatment in 2008. I welcomed the idea and she guided her vehicle into the late afternoon traffic.
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