I'm sitting in a restaurant with a business associate and over his shoulder I notice a large, round table with a number of people glancing in my direction: I recognize some of the diners at that table, some I don't. The faces that are familiar to me are from past associations; all people I have good memories about. As I continued my conversation with my business associate I was sub-consciously thinking I needed to go over to the other table to say hello to all these old friends. My business conversation seemed to take longer than I would have liked and when I finally extricated myself to greet these old friends they were no longer seated at the table. I hurried out to the parking lot quickly enough to see the departing figures - all walking away from where I was standing. One old friend turned to face me and wordlessly conveyed the message with her eyes that seemed to say "we waited as long as we could". I awoke and found it impossible to go back to sleep.
I made a trip to the Hill Country in Texas in May to spend my Mother's 80th birthday with her and my Dad. The weather was glorious, unusual by comparison to most May's when it has been known to be hot and sticky in this part of the world. On the Saturday I played 18 holes of golf with my Mom and my 2 brothers, Bob and David at the golf course we affectionately refer to as "Rock and Root Country Club" but known as QuickSand at Woodcreek by everyone else. Sunday afternoon saw a family dinner at brother David's home in the same community where my parents have lived for these past 20 plus years. David and his wife, Suzanne, bought the home near my parents just this last fall. I had buried some of Geoff's ashes deep in the 9th hole sandtrap that is just yards away from their new back yard when I was in the same little town for my Father's 80th birthday celebration in December. Suzanne says she tries her best to keep an eye out for Geoff, there, in what used to be a favorite playground. Brothers and sisters, wives and husbands, granddaughters and grandsons, nieces and nephews, sons and daughters gathered in my brother's home to eat the rib eye steaks so deftly grilled by David and enjoy the cake my sister, Barbara, provided from a special Austin baker. We sang "Happy Birthday" to Mom and we meant every word.
Earlier that Sunday I accompanied my Mother and Father to St. Mary's Catholic Church in Wimberley, Texas for Mass on what was the actual 80th anniversary of my Mother's birth . It did not escape me that the last time I had been in a church was Geoff's service at Our Lady of Fatima in Kingsgrove. The familiarity of all the details of this country building for public worship in which I had never set foot before caused me to draw parallels with the parish facility in New South Wales, albeit on a smaller scale, where I said goodbye to my son. The sameness is striking, if not in detail but in the general layout of the building, but I suppose that could be said of most Catholic Churches. My watery eyes were immediately drawn to the baptismal font and its obvious symbolism combined with the memories of Geoff's baptism and the still fresh details of the ceremony on 13 October, 2010. My mind wandered through most of the service, fixated on memories of that still unbelievable day but, of course, that's a now familiar path for my thoughts.
Robin and I made a number of trips to visit my parents in Wimberley beginning in the early 80's with just Geoff until Melissa was born and then the two. Candi and Carri would come along but not every time. We would commandeer the "golf cottage" adjacent to the 9th tee box that was used mostly as a rental after my parents had moved full time into their retirement home above the 4th green and were trying to decide what to do with the house that was previously their weekender. Geoff had a talent for striking round objects with long sticks and his favorite adventure involving golf clubs was to dump as many balls as he could locate into the sand trap adjacent to the 9th green and attempt to extricate them with the sawed off golf club my Dad had fashioned. Once the well used balls were all freed from the gritty bunker he would gather them up and return them to the sand and repeat the process more than once. I have a memory of Geoff beginning this routine at an age when he was hardly 2 years; there he was, taking mighty whacks at the shag balls, with his diaper hanging quite low. As with most things, he had a talent for becoming particularly accomplished at the task before he was willing to give it a rest. I've probably played that 9th hole at least 100 times and every time I approach the tee box I've thought of that little blond boy deftly knocking ball after ball out of the greenside bunker. I assumed we would compete on that hole one day, Father and Son, just as my Dad and I had many times before, and perhaps a still younger version of Geoff beginning the cycle anew. How naive I was.
Monday morning found my Mother and me taking a hike along a newly built footpath from just outside the community in which they live to the "Blue Hole" located some 3 miles away. 20 odd years ago the Blue Hole was a quintessential deep in the woods swimming hole complete with well worn tires hanging from large trees by ropes in such a manner as to provide a swinging entry into the cool water from various heights and degrees of safety. The local emergency medical facilities made a good business out of patching up those swimmers who mistimed their jumps or hung on a little too long. Geoff and I made a few pilgrimages on the well worn path to the Blue Hole with his Mother, Aunts and Uncles and had great fun avoiding any serious injuries. In those days the Blue Hole was open to all who dared; some years later what was thought to be the landowner started charging a small fee for admission and now the city has acquired the facility and is "improving" the area with plenty of parking lots, concrete, asphalt, lighting and picnic benches. You can't improve perfect.
Thursday, June 2, 2011
Wednesday, May 4, 2011
Facebook Friend
"Geoffrey is Unavailable" so says his Facebook page when I hover the mouse over his name and the circular"chat" icon there. No shit, I think to myself. But then there is his photo where he is slouched on the sofa in the living room, staring right at me, daring me to make the message pop up one more time, right next to his name and the icon.
These technological tools can be cruel. I don't have a clue how to take down his page, not that I really want to since it lets me connect with vague vestiges of my son whenever I want. Occasionally I am called to check his page, by whom or what I cannot know and it makes all the memories and emotions flood back into my consciousness. Can this be a good thing? I wonder in self-interrogation.
Through my laptop I can connect to pieces of Geoff. His house music mixes are still out there in the ether, waiting for anyone to listen. Old emails, mostly trivial stuff, can be reviewed. I'm sure if I wanted, I could send him a new one, but I know I won't get a response and not because he is too preoccupied. He no longer tweets, although most of those escaped my understanding and always seemed a bit rude.
The mother (Carol Glenn) of my son-in-law, Shawn Duke, died on the first day of April this year at 65 years of age. She had been waiting for months for a new liver, even got to #1 on the transplant list at UCLA but never got the chance to see if that operation could save her life. Shawn related so clearly at her touching memorial service what it meant to lose someone you love so much, that you cared so much about that in spite of whatever difficulties there were in the relationship, whatever upset there may have been in the too short of a lifetime spent together that he would gladly go through all of those challenges again to be able to experience one more day with his mother. That's a bargain I would make in a second, to have one more day with my son. Maybe I should post it on his wall?
These technological tools can be cruel. I don't have a clue how to take down his page, not that I really want to since it lets me connect with vague vestiges of my son whenever I want. Occasionally I am called to check his page, by whom or what I cannot know and it makes all the memories and emotions flood back into my consciousness. Can this be a good thing? I wonder in self-interrogation.
Through my laptop I can connect to pieces of Geoff. His house music mixes are still out there in the ether, waiting for anyone to listen. Old emails, mostly trivial stuff, can be reviewed. I'm sure if I wanted, I could send him a new one, but I know I won't get a response and not because he is too preoccupied. He no longer tweets, although most of those escaped my understanding and always seemed a bit rude.
The mother (Carol Glenn) of my son-in-law, Shawn Duke, died on the first day of April this year at 65 years of age. She had been waiting for months for a new liver, even got to #1 on the transplant list at UCLA but never got the chance to see if that operation could save her life. Shawn related so clearly at her touching memorial service what it meant to lose someone you love so much, that you cared so much about that in spite of whatever difficulties there were in the relationship, whatever upset there may have been in the too short of a lifetime spent together that he would gladly go through all of those challenges again to be able to experience one more day with his mother. That's a bargain I would make in a second, to have one more day with my son. Maybe I should post it on his wall?
Wednesday, April 6, 2011
Six Months Gone
Does it get any easier? In most every way, no. Having had these past 6 months to reflect on the what might have beens and the why didn't I questions I find myself feeling awfully inadequate and foolish. Before 6 October, 2010 I had all the answers; now I have none.
182 days have passed since that fateful phone call. 175 since the service at Our Lady of Fatima. Not one minute, though, without the memory of my son burning in my brain. Yet, I know I am not alone with these thoughts and feelings. His mother, sisters, girlfriend, grandparents, uncles and aunts, nieces, nephews and cousins along with Geoff's many friends and co-workers have expressed similar feelings. It wasn't supposed to be this way. There was going to be a long lifetime of visits and get togethers, accomplishments, events and milestones. I saw it in my mind's eye. I had no doubt. I was wrong.
I've read and re-read the autopsy report. I've requested and been provided additional opinions on the information and conclusions of the examiners. I've scoured the internet and spoken with doctors in Australia and California performing my amateur freelance medical investigation and found no reward for my effort. There is no answer as to the why. There's no comfort in hearing that the doctors didn't know Geoff had been stricken with Lymphoma for a second time; that their years of training and practice didn't provide them with the knowledge to anticipate this recurrence of the cancer or the ability to arrest the malignancy even if they had found it.
For every thing we know it's now obvious to me there is a huge imbalance with that which we do not. I've spent my life gathering facts, devouring printed words, listening to other's opinions and can only now conclude that maybe I wasn't really paying attention as well as I might have believed. The lessons I thought I learned were perhaps not those that were being taught. Many things I used to think important seem trivial in retrospect. I want my son back. I want another chance to be a better father to him. But that will never be. It's a lesson I've only learned too well.
182 days have passed since that fateful phone call. 175 since the service at Our Lady of Fatima. Not one minute, though, without the memory of my son burning in my brain. Yet, I know I am not alone with these thoughts and feelings. His mother, sisters, girlfriend, grandparents, uncles and aunts, nieces, nephews and cousins along with Geoff's many friends and co-workers have expressed similar feelings. It wasn't supposed to be this way. There was going to be a long lifetime of visits and get togethers, accomplishments, events and milestones. I saw it in my mind's eye. I had no doubt. I was wrong.
I've read and re-read the autopsy report. I've requested and been provided additional opinions on the information and conclusions of the examiners. I've scoured the internet and spoken with doctors in Australia and California performing my amateur freelance medical investigation and found no reward for my effort. There is no answer as to the why. There's no comfort in hearing that the doctors didn't know Geoff had been stricken with Lymphoma for a second time; that their years of training and practice didn't provide them with the knowledge to anticipate this recurrence of the cancer or the ability to arrest the malignancy even if they had found it.
For every thing we know it's now obvious to me there is a huge imbalance with that which we do not. I've spent my life gathering facts, devouring printed words, listening to other's opinions and can only now conclude that maybe I wasn't really paying attention as well as I might have believed. The lessons I thought I learned were perhaps not those that were being taught. Many things I used to think important seem trivial in retrospect. I want my son back. I want another chance to be a better father to him. But that will never be. It's a lesson I've only learned too well.
Monday, April 4, 2011
Lucky
I know when most people think of being lucky they think of something good they didn't expect. Probably for the same reason most gamblers play the "pass" line in craps and most stock investors don't "short" the stock market, luck is something the majority chooses to believe only happens in a good way. In fact, Webster's defines the word "lucky" as "having good luck". But there is another kind of luck and it gets doled out in equal amounts, I presume. We are taught that in our universe, for every action there is an opposite and equal reaction, according to Sir Isaac Newton and his law of motion. How this translates into the application of luck for any given person may not be so definable or applied in the same way but sometimes I wonder. Do good and bad luck accrue in equal amounts to everyone? Or, does the totality of bad luck get offset by good luck in balancing the universe without respect to any individual?
You can't measure luck; at least I don't think you can. If it's my bad luck that my TV blew up and cost me $500 to be repaired does that get offset by a single $2 winning lotto ticket? After all, its one bad luck event and then one good. Or could I expect to have an equal amount of winning lottery tickets over my lifetime to offset the cost of the TV repair? It's a ridiculous concept, I agree, trying to balance a TV repair with winning lotto tickets but we make these kinds of bargains with ourselves continuously.
Luck has been defined by some as "when preparedness meets opportunity" in trying to describe what it's like when you, perhaps, make your own luck. Now that's not really luck based on that definition, is it? But luck is defined in the eye of the beholder. Consider a baseball game where one father's son is pitching and different father's son is the batter. Both players are among the best on their respective teams. In the last inning, the batter strikes out looking at the game's final pitch. The father of the batter that struck out could rationalize that the pitcher got "lucky" sneaking a fastball by his accomplished son but I doubt the pitcher's father would see it the same way; he would perceive that the strikeout was the product of years of playing catch with his son in the backyard, thousands of dollars of private pitching lessons and hard work and dedication on the part of his offspring.
Is it luck that is in play when a young person dedicates himself to their studies and then gets a scholarship to a prestigious university? Some may perceive it to be so but I doubt the young student would see it that way. I suppose luck is one of the terms we use to attempt to explain that which is unexplainable, in the mind of the individual. Certain events take place in our lives and since we are unable to conjure the reason we can only rationalize that they are the result of good luck or perhaps bad.
My own challenges these last few years, as the readers of these pages can understand, find me debating the relative lucky quotient in my life. Foremost on my luck scorecard: I developed Lymphoma in 1998 (bad luck) but I was cured (good luck). My son, Geoff, developed Hodgkin Disease in 2007 (bad luck) but was thought to be cured in 2008 (good luck). In 2010 Geoff died from a rapidly developing Lymphoma that was undiagnosed (really, really bad luck). Later that same year I was diagnosed with Squamous Cell Carcinoma in my tongue (bad luck) but I have been pronounced "cured" after major surgery and an uneventful recovery (good luck). Try as I might, I am unable to find or understand the reason these things have occurred so they must be attributable to luck; It would be a relief to be able to think so but, alas, it's not the way my brain works. I'm going to have to figure it all out.
You can't measure luck; at least I don't think you can. If it's my bad luck that my TV blew up and cost me $500 to be repaired does that get offset by a single $2 winning lotto ticket? After all, its one bad luck event and then one good. Or could I expect to have an equal amount of winning lottery tickets over my lifetime to offset the cost of the TV repair? It's a ridiculous concept, I agree, trying to balance a TV repair with winning lotto tickets but we make these kinds of bargains with ourselves continuously.
Luck has been defined by some as "when preparedness meets opportunity" in trying to describe what it's like when you, perhaps, make your own luck. Now that's not really luck based on that definition, is it? But luck is defined in the eye of the beholder. Consider a baseball game where one father's son is pitching and different father's son is the batter. Both players are among the best on their respective teams. In the last inning, the batter strikes out looking at the game's final pitch. The father of the batter that struck out could rationalize that the pitcher got "lucky" sneaking a fastball by his accomplished son but I doubt the pitcher's father would see it the same way; he would perceive that the strikeout was the product of years of playing catch with his son in the backyard, thousands of dollars of private pitching lessons and hard work and dedication on the part of his offspring.
Is it luck that is in play when a young person dedicates himself to their studies and then gets a scholarship to a prestigious university? Some may perceive it to be so but I doubt the young student would see it that way. I suppose luck is one of the terms we use to attempt to explain that which is unexplainable, in the mind of the individual. Certain events take place in our lives and since we are unable to conjure the reason we can only rationalize that they are the result of good luck or perhaps bad.
My own challenges these last few years, as the readers of these pages can understand, find me debating the relative lucky quotient in my life. Foremost on my luck scorecard: I developed Lymphoma in 1998 (bad luck) but I was cured (good luck). My son, Geoff, developed Hodgkin Disease in 2007 (bad luck) but was thought to be cured in 2008 (good luck). In 2010 Geoff died from a rapidly developing Lymphoma that was undiagnosed (really, really bad luck). Later that same year I was diagnosed with Squamous Cell Carcinoma in my tongue (bad luck) but I have been pronounced "cured" after major surgery and an uneventful recovery (good luck). Try as I might, I am unable to find or understand the reason these things have occurred so they must be attributable to luck; It would be a relief to be able to think so but, alas, it's not the way my brain works. I'm going to have to figure it all out.
Thursday, February 24, 2011
Recovery And A Report
Upon parking the car in the garage Mitzi guided me into our family room and had me sit on the dual recliner love seat, which was to become my base of operation for the next few weeks. Carri had followed us in her own vehicle and when she arrived Carri and Mitzi made a plan for picking up the prescriptions and other supplies we might need and Mitzi subsequently left to pick up those items. I was happy to be in my familiar surroundings. I had a small challenge trying to find an appropriate shirt to wear around the house because the incision in my neck was just painful enough that I couldn't tolerate anything rubbing against it. We solved that problem by taking an old T Shirt and cutting it straight up the middle then using a safety pin to fasten it about half way between my waist and neckline which worked out perfectly until Mitzi was able to find me a pair of pajamas at Kohl's later in the week that provided the same comfort.
Carri spent the night sleeping on the sofa in the adjacent living room; not because we didn't have a bed for her but to satisfy her concern that she wanted to be available if something "happened" and the living room was much closer to where I was located than was the spare bedroom. It was a very sweet gesture on her part. Mitzi slept in the Master bedroom and I spent that first night (as well as the next 6 or 7) on the recliner, semi-sitting. Because of the 2 drains in my neck and still tender wound I couldn't lay down but fully reclining in the chair was akin to the sleeping arrangement I had in the hospital but with far less noise. Nothing "happened" that night (or any other). Carri spent the next day working on her computer and keeping track of me so that Mitzi was able to run errands and try to get our home in order. Toward the late afternoon Carri packed up and headed back to her home in San Diego and her husband and two children after confirming we would be able to get along just fine on our own.
Mitzi left a stack of mail for me that came in while I was in the hospital. I started to sort through the pile the first morning I was home and among the golf magazines and catalogs was a large white envelope with the return address "New South Wales Government - Justice and Attorney - State Coroner's Court". I knew exactly what the envelope contained but I couldn't bring myself to open it. "Tomorrow" I found myself thinking "I'll be up to opening it tomorrow". There hadn't been a minute since Geoffrey died in October that he wasn't with me. The night stand next to my bed has a candle from his service and a lock of his hair in a red velveteen pouch is tied around the candle. His photos are all over our home interspersed with photos of all of our children and grandchildren. Far more often than when he was alive I find myself wondering what he would have thought about something or how would have reacted to a situation. My self talk includes regular unilateral dialogue with Geoff. Mostly I find myself being sad about my sense of loss and the grim reality that I will never see his incredible smile or hug him hello or goodbye or hear his voice again. But I'm also pissed off mad that all of these interactions have been taken away from me, his mother, Melissa, Joanne and the countless other family members and friends that knew him and loved him so much. My expectation was that the envelope would provide some answers but most likely even more questions. I wasn't ready for either so I didn't look at the documents.
Over the next few days I progressed from a purely liquid diet (protein drinks, ensure, fruit juice) to some soft foods like pudding and generous amounts of ice cream. My speaking gradually improved and the incision seemed to be healing up nicely but was begining to become obscured by my new full beard as I was unable to shave. I had very little pain but occasionally my swollen tongue or the neck wound would be uncomfortable. My first few days at home were spent watching various golf tournaments or other sporting events on television between frequent naps. Mitzi was able to take care of the drain in my neck without much challenge and save for a visit from a home health nurse on the first Saturday we had virtually no interaction with any other healthcare professionals as we never felt the need.
I don't remember exactly when it was but after a few days of having that big white envelope staring at me I finally tore it open and removed the contents. There was a cover letter with all the expected platitudes and invitations for questions followed by a thick stack of paper, comprised of a 16 page document entitled "POSTMORTEM EXAMINATION REPORT FOR THE CORONER" along with 4 additional pages of forensic and patholigical information.
On page 2 of the examination report under the heading of "OPINION" was the statement "Geoffrey Loe died on 6 October 2010 at St. George Hospital and that the cause of death was as follows:
1. DIRECT CAUSE: Disease or condition directly leading to death:
(a) DISSEMINATED DIFFUSE LARGE B-CELL NON-HODGKIN'S LYMPHOMA
ANTECEDENT CAUSES: Morbid conditions, if any, giving rise to the above cause, stating the underlying conditions last:
(b)
(c)
2. Other significant conditions contributing to the death but not relating to the disease or condition causing it:"
There is no misprint in the above or typographical errors. The Antecedent causes were blank in the coroner's report as was the the area for "other significant causes". I started flipping through the other pages but my concentration had been intercepted. What happened to the Glandular Fever theory? Why isn't that at least mentioned as an underlying condition or a signficant contributing condition? We had been told that the likelihood that the Lymphoma had returned was very low or that even if it had, that it was the primary cause of death was a remote possibility by Geoff's doctors (see "Meeting the Doctor" posted to this blog December 3, 2010). Why does the report reference Large B-Cell Non-Hodgkins Lymphoma when Geoff had previously been treated for Hodgkin Lymphoma? As I leafed through the rest of the documents and quickly put the report back into the envelope I found myself with feelings of disbelief and betrayal. I knew I would need an opportunity to pursue my questions about the report and the treatment he received. I also knew I didn't yet have the energy to pursue those questions right away.
Carri spent the night sleeping on the sofa in the adjacent living room; not because we didn't have a bed for her but to satisfy her concern that she wanted to be available if something "happened" and the living room was much closer to where I was located than was the spare bedroom. It was a very sweet gesture on her part. Mitzi slept in the Master bedroom and I spent that first night (as well as the next 6 or 7) on the recliner, semi-sitting. Because of the 2 drains in my neck and still tender wound I couldn't lay down but fully reclining in the chair was akin to the sleeping arrangement I had in the hospital but with far less noise. Nothing "happened" that night (or any other). Carri spent the next day working on her computer and keeping track of me so that Mitzi was able to run errands and try to get our home in order. Toward the late afternoon Carri packed up and headed back to her home in San Diego and her husband and two children after confirming we would be able to get along just fine on our own.
Mitzi left a stack of mail for me that came in while I was in the hospital. I started to sort through the pile the first morning I was home and among the golf magazines and catalogs was a large white envelope with the return address "New South Wales Government - Justice and Attorney - State Coroner's Court". I knew exactly what the envelope contained but I couldn't bring myself to open it. "Tomorrow" I found myself thinking "I'll be up to opening it tomorrow". There hadn't been a minute since Geoffrey died in October that he wasn't with me. The night stand next to my bed has a candle from his service and a lock of his hair in a red velveteen pouch is tied around the candle. His photos are all over our home interspersed with photos of all of our children and grandchildren. Far more often than when he was alive I find myself wondering what he would have thought about something or how would have reacted to a situation. My self talk includes regular unilateral dialogue with Geoff. Mostly I find myself being sad about my sense of loss and the grim reality that I will never see his incredible smile or hug him hello or goodbye or hear his voice again. But I'm also pissed off mad that all of these interactions have been taken away from me, his mother, Melissa, Joanne and the countless other family members and friends that knew him and loved him so much. My expectation was that the envelope would provide some answers but most likely even more questions. I wasn't ready for either so I didn't look at the documents.
Over the next few days I progressed from a purely liquid diet (protein drinks, ensure, fruit juice) to some soft foods like pudding and generous amounts of ice cream. My speaking gradually improved and the incision seemed to be healing up nicely but was begining to become obscured by my new full beard as I was unable to shave. I had very little pain but occasionally my swollen tongue or the neck wound would be uncomfortable. My first few days at home were spent watching various golf tournaments or other sporting events on television between frequent naps. Mitzi was able to take care of the drain in my neck without much challenge and save for a visit from a home health nurse on the first Saturday we had virtually no interaction with any other healthcare professionals as we never felt the need.
I don't remember exactly when it was but after a few days of having that big white envelope staring at me I finally tore it open and removed the contents. There was a cover letter with all the expected platitudes and invitations for questions followed by a thick stack of paper, comprised of a 16 page document entitled "POSTMORTEM EXAMINATION REPORT FOR THE CORONER" along with 4 additional pages of forensic and patholigical information.
On page 2 of the examination report under the heading of "OPINION" was the statement "Geoffrey Loe died on 6 October 2010 at St. George Hospital and that the cause of death was as follows:
1. DIRECT CAUSE: Disease or condition directly leading to death:
(a) DISSEMINATED DIFFUSE LARGE B-CELL NON-HODGKIN'S LYMPHOMA
ANTECEDENT CAUSES: Morbid conditions, if any, giving rise to the above cause, stating the underlying conditions last:
(b)
(c)
2. Other significant conditions contributing to the death but not relating to the disease or condition causing it:"
There is no misprint in the above or typographical errors. The Antecedent causes were blank in the coroner's report as was the the area for "other significant causes". I started flipping through the other pages but my concentration had been intercepted. What happened to the Glandular Fever theory? Why isn't that at least mentioned as an underlying condition or a signficant contributing condition? We had been told that the likelihood that the Lymphoma had returned was very low or that even if it had, that it was the primary cause of death was a remote possibility by Geoff's doctors (see "Meeting the Doctor" posted to this blog December 3, 2010). Why does the report reference Large B-Cell Non-Hodgkins Lymphoma when Geoff had previously been treated for Hodgkin Lymphoma? As I leafed through the rest of the documents and quickly put the report back into the envelope I found myself with feelings of disbelief and betrayal. I knew I would need an opportunity to pursue my questions about the report and the treatment he received. I also knew I didn't yet have the energy to pursue those questions right away.
Wednesday, February 23, 2011
Surgery
35 days ago I wrote about my upcoming surgery for Tongue Cancer. I checked into Loma Linda University Hospital with the assistance of my wife, Mitzi, shortly before 5 a.m. on January 21, 2011 after spending the previous day in various pre-op examinations and consultations at the hospital and then the night at the Loma Linda Inn. The Loma Linda Inn is located directly adjacent to the hospital, was definitely no frills, but proved to be a good spot to hang out before my surgery as well as a place for Mitzi and a number of other family members to retreat and at least attempt sleep or rest for a few days after my surgery was completed. After a last meal of a double double (my choice) at the nearby In and Out Burger we made a round trip to our home in the Palm Springs area to do some last minute packing and returned to the motel in the late evening of January 20. Surprisingly, I was able to get a few hours of sleep before our appointed arrival time at the hospital but certainly didn't need an alarm clock to wake up.
Once at the hospital we were escorted to the pre-op staging area in military like fashion with 4 or 5 other families that had similar appointments but no doubt for other reasons. After the march through the hallways and an elevator ride to an upper floor of the hospital we were assigned to a particular area of the facility, separated from the other occupants by only haphazardly drawn curtains. I was required to exchange my clothing for the requisite hospital gown, open to the back, just like in the movies. The uncomfortableness I felt donning the gown was the last vestige of any sort of personal dignity or modesty I would feel for the next number of days. Once appropriately attired I climbed into the bed to which I was assigned and patiently waited for the procedures to begin. We knew that Carri and Candi were on their way to Loma Linda at this early hour and could only hope they would make it so that I could see them before I was wheeled away to the Operating Room. Between blood pressure, temperature and heart rate checks it was discovered that within the voluminous paperwork that made up my "chart" a specific consent form that was to be signed by my surgeon and me was missing. The nurses seemed a little agitated about the missing document and paged my surgeon. While waiting for the surgeon to respond I noticed most of the other folks involved in similar pre-op routines were being wheeled out of the staging area. The delay, although short, proved to be fortuitous because Candi and Carri arrived within minutes of the time I was to be taken since the missing paperwork snafu had been corrected and I was able to visit for a short amount of time with them before the real fun began. Had the missing document never been I would have been removed from this area of the hospital without having the opportunity to see them before the surgery. It was comforting being able to spend those last few minutes with my wife and 2 oldest daughters and it kept my mind off what was to quickly be my reality.
An orderly was summoned to wheel me from the staging area to a more official pre-op facility that didn't allow for visitors. There was then a process that included the starting of various IV lines and other preparatory requirements that typically involved needles during which I was asked no less than 5 times if I knew where I was and why I was there. Apparently I answered all the questions correctly. I was visited by my surgeon, Dr. Paul Kim, a head and neck surgeon and a professor at the Loma Linda University Medical School along with his assistant. He reviewed the impending surgery with me and drew lines on my neck to indicate the pattern of incision. I was then introduced to the anesthesiologist who described his process and involvement and had his own battery of questions for me. He then told me he was going to inject something to relax me into one of the various lines of fluid that were routed into the back of my wrist. I vaguely remember being wheeled into the operating room that was abuzz with activity and having a number of people introduce themselves to me in my waning consciousness.
I have had general anesthesia more than once before this surgery and it always strikes me that, unlike sleep, you cannot account for the time. There is no dreaming, no sense of what is taking place, just a large black hole in one's reality that begins when the anesthesia takes hold of your awareness and ending in some recovery room at a future point in time. The time that had passed could have been 20 minutes or a month, you have no way of knowing without someone else telling you. I remember awakening on Saturday, January 22 at approximately 9:00 a.m. (or so I was told) and immediately set upon by 2 male anesthesiologists who, after quickly ascertaining my level of consciousness, rudely removed the nasotracheal intubation equipment (breathing tubes inserted in my nose) apologizing all the way but explaining that it was necessary to perform this procedure while I was awake so that I would begin breathing on my own. If I wasn't fully awake before I was then. Mitzi arrived soon after in the Intensive Care Unit (ICU) and told me that I was doing well and that I had an incision that ran from my right ear to the left side of my mouth, roughly along my jaw line, that I was missing approximately 1/3 of what was my tongue and 40 lymph nodes, more or less, from the right side of my neck. She went on to tell me that Dr. Kim had told her that he was very happy with the results of the surgery and felt he had achieved some very clean margins on the tumor and saw nothing unusual in the lymph nodes he had removed. As part of the surgery I had a portion of the tissue directly beneath my chin removed (submental island flap) that was utilized in the reconstruction of my tongue. I came to learn later the official nomenclature for the surgery "Hemiglossectomy with submental island flap and selective neck dissection". I had a nasal gastric tube inserted and sutured in for feeding and various IV lines running in and out of both wrists and one ankle. There were 2 drains emanating from either side of my neck. Mitzi told me over and over how worried she had been and how happy she was to see me awake and I understood her relief and tried as best I could to reassure her of my own sense of well being now that I was fully awake, even though I was unable to speak, through eye contact and head nods. She had plenty of company during my surgery and the following hours; her father, George and his wife, Cheryl, Carri, Candi and Mitzi's daughter, Katie. Katie and Carri had spent the night with her at the Loma Linda Inn and Mitzi expressed how grateful she was for the support. Carri had gone home to San Diego earlier that morning and Katie was going to stay with Mitzi at the hospital for the balance of the day.
I spent the next 3 days in the ICU and was moved to a regular room on Monday evening, January 24. A number of people came by for visits, including Candi and her husband, Shawn and my neighbors, Jacques and Matilde. Mitzi also related a funny (in retrospect) story about my business partner, Art Alvarez, who decided to come by the hospital on Friday evening. Not knowing that I was still under the anesthesia and would be for another 12 hours he was allowed into my room in the ICU around 8:00 p.m. on the night of my surgery. Apparently I was laid out, head fully tilted back with the new incision in full view. He later wrote in an email to Mitzi describing his visit "...not for the squeamish!". I had a few challenges with choking, primarily related to the nasal gastric (NG) feeding tube and a reaction to morphine that caused me to reject additional offers of the pain killer.
On Tuesday morning, January 25 I was told by the doctor that visited me during his rounds (an associate of my surgeon) that I could go home as soon as I demonstrated the ability to swallow. Further, that they felt my progress had been so good that they were willing to remove the NG before releasing me as long as they thought I could get sufficient nutrition by way of my mouth. By then I was able to croak out a few words around my very swollen tongue but let the doctor know in a most adamant way that I was prepared to demonstrate my ability to swallow as soon as they would allow me having no idea if, in fact, I actually could pull it off. Around noon time I was brought a tray with some vegetable based broth, a small container of green jello and a cup of cold decaf coffee. I managed to slurp down enough of the substances that were pawned off as food to convince the nurse I had the ability to swallow and she communicated my accomplishment to the doctors' office. While awaiting my discharge order I was visited by the physical therapist who made a few laps around the floor where my room was located with me. Earlier that day I had been allowed to sit in a chair in my room which was the first time I had been out of bed for more than a few minutes. In the late afternoon I was visited by an associate of my surgeon who confirmed I was to be released that evening, wrote me a couple of prescriptions for antibiotics and hydrocodone and gave Mitzi instructions for the drain that was still sutured into my neck. The doctor told us to make an appointment with Dr. Kim for the following Tuesday (February 1) and when I inquired if the pathology results from the tissue and lymph nodes that had been removed were available was told that information would be provided at our appointment the following week. The doctor then roughly removed the NG tube upon which happening gave me instant relief and pleased me greatly in spite of the discomfort associated with its extrication.
I chose to walk out of the hospital after getting dressed rather than use the offered wheel chair and while Carri (she was going to spend the night at our house to help out) and I rode the elevator down, Mitzi had gone ahead to pull the car around to the front door. I climbed into the passenger seat on what was a cool night and exhaled the sigh of relief one experiences when knowing that a challenge has been successfully met. Mitzi piloted the car to the San Bernardino freeway and began the drive back to our home.
Once at the hospital we were escorted to the pre-op staging area in military like fashion with 4 or 5 other families that had similar appointments but no doubt for other reasons. After the march through the hallways and an elevator ride to an upper floor of the hospital we were assigned to a particular area of the facility, separated from the other occupants by only haphazardly drawn curtains. I was required to exchange my clothing for the requisite hospital gown, open to the back, just like in the movies. The uncomfortableness I felt donning the gown was the last vestige of any sort of personal dignity or modesty I would feel for the next number of days. Once appropriately attired I climbed into the bed to which I was assigned and patiently waited for the procedures to begin. We knew that Carri and Candi were on their way to Loma Linda at this early hour and could only hope they would make it so that I could see them before I was wheeled away to the Operating Room. Between blood pressure, temperature and heart rate checks it was discovered that within the voluminous paperwork that made up my "chart" a specific consent form that was to be signed by my surgeon and me was missing. The nurses seemed a little agitated about the missing document and paged my surgeon. While waiting for the surgeon to respond I noticed most of the other folks involved in similar pre-op routines were being wheeled out of the staging area. The delay, although short, proved to be fortuitous because Candi and Carri arrived within minutes of the time I was to be taken since the missing paperwork snafu had been corrected and I was able to visit for a short amount of time with them before the real fun began. Had the missing document never been I would have been removed from this area of the hospital without having the opportunity to see them before the surgery. It was comforting being able to spend those last few minutes with my wife and 2 oldest daughters and it kept my mind off what was to quickly be my reality.
An orderly was summoned to wheel me from the staging area to a more official pre-op facility that didn't allow for visitors. There was then a process that included the starting of various IV lines and other preparatory requirements that typically involved needles during which I was asked no less than 5 times if I knew where I was and why I was there. Apparently I answered all the questions correctly. I was visited by my surgeon, Dr. Paul Kim, a head and neck surgeon and a professor at the Loma Linda University Medical School along with his assistant. He reviewed the impending surgery with me and drew lines on my neck to indicate the pattern of incision. I was then introduced to the anesthesiologist who described his process and involvement and had his own battery of questions for me. He then told me he was going to inject something to relax me into one of the various lines of fluid that were routed into the back of my wrist. I vaguely remember being wheeled into the operating room that was abuzz with activity and having a number of people introduce themselves to me in my waning consciousness.
I have had general anesthesia more than once before this surgery and it always strikes me that, unlike sleep, you cannot account for the time. There is no dreaming, no sense of what is taking place, just a large black hole in one's reality that begins when the anesthesia takes hold of your awareness and ending in some recovery room at a future point in time. The time that had passed could have been 20 minutes or a month, you have no way of knowing without someone else telling you. I remember awakening on Saturday, January 22 at approximately 9:00 a.m. (or so I was told) and immediately set upon by 2 male anesthesiologists who, after quickly ascertaining my level of consciousness, rudely removed the nasotracheal intubation equipment (breathing tubes inserted in my nose) apologizing all the way but explaining that it was necessary to perform this procedure while I was awake so that I would begin breathing on my own. If I wasn't fully awake before I was then. Mitzi arrived soon after in the Intensive Care Unit (ICU) and told me that I was doing well and that I had an incision that ran from my right ear to the left side of my mouth, roughly along my jaw line, that I was missing approximately 1/3 of what was my tongue and 40 lymph nodes, more or less, from the right side of my neck. She went on to tell me that Dr. Kim had told her that he was very happy with the results of the surgery and felt he had achieved some very clean margins on the tumor and saw nothing unusual in the lymph nodes he had removed. As part of the surgery I had a portion of the tissue directly beneath my chin removed (submental island flap) that was utilized in the reconstruction of my tongue. I came to learn later the official nomenclature for the surgery "Hemiglossectomy with submental island flap and selective neck dissection". I had a nasal gastric tube inserted and sutured in for feeding and various IV lines running in and out of both wrists and one ankle. There were 2 drains emanating from either side of my neck. Mitzi told me over and over how worried she had been and how happy she was to see me awake and I understood her relief and tried as best I could to reassure her of my own sense of well being now that I was fully awake, even though I was unable to speak, through eye contact and head nods. She had plenty of company during my surgery and the following hours; her father, George and his wife, Cheryl, Carri, Candi and Mitzi's daughter, Katie. Katie and Carri had spent the night with her at the Loma Linda Inn and Mitzi expressed how grateful she was for the support. Carri had gone home to San Diego earlier that morning and Katie was going to stay with Mitzi at the hospital for the balance of the day.
I spent the next 3 days in the ICU and was moved to a regular room on Monday evening, January 24. A number of people came by for visits, including Candi and her husband, Shawn and my neighbors, Jacques and Matilde. Mitzi also related a funny (in retrospect) story about my business partner, Art Alvarez, who decided to come by the hospital on Friday evening. Not knowing that I was still under the anesthesia and would be for another 12 hours he was allowed into my room in the ICU around 8:00 p.m. on the night of my surgery. Apparently I was laid out, head fully tilted back with the new incision in full view. He later wrote in an email to Mitzi describing his visit "...not for the squeamish!". I had a few challenges with choking, primarily related to the nasal gastric (NG) feeding tube and a reaction to morphine that caused me to reject additional offers of the pain killer.
On Tuesday morning, January 25 I was told by the doctor that visited me during his rounds (an associate of my surgeon) that I could go home as soon as I demonstrated the ability to swallow. Further, that they felt my progress had been so good that they were willing to remove the NG before releasing me as long as they thought I could get sufficient nutrition by way of my mouth. By then I was able to croak out a few words around my very swollen tongue but let the doctor know in a most adamant way that I was prepared to demonstrate my ability to swallow as soon as they would allow me having no idea if, in fact, I actually could pull it off. Around noon time I was brought a tray with some vegetable based broth, a small container of green jello and a cup of cold decaf coffee. I managed to slurp down enough of the substances that were pawned off as food to convince the nurse I had the ability to swallow and she communicated my accomplishment to the doctors' office. While awaiting my discharge order I was visited by the physical therapist who made a few laps around the floor where my room was located with me. Earlier that day I had been allowed to sit in a chair in my room which was the first time I had been out of bed for more than a few minutes. In the late afternoon I was visited by an associate of my surgeon who confirmed I was to be released that evening, wrote me a couple of prescriptions for antibiotics and hydrocodone and gave Mitzi instructions for the drain that was still sutured into my neck. The doctor told us to make an appointment with Dr. Kim for the following Tuesday (February 1) and when I inquired if the pathology results from the tissue and lymph nodes that had been removed were available was told that information would be provided at our appointment the following week. The doctor then roughly removed the NG tube upon which happening gave me instant relief and pleased me greatly in spite of the discomfort associated with its extrication.
I chose to walk out of the hospital after getting dressed rather than use the offered wheel chair and while Carri (she was going to spend the night at our house to help out) and I rode the elevator down, Mitzi had gone ahead to pull the car around to the front door. I climbed into the passenger seat on what was a cool night and exhaled the sigh of relief one experiences when knowing that a challenge has been successfully met. Mitzi piloted the car to the San Bernardino freeway and began the drive back to our home.
Wednesday, January 19, 2011
Personal Note To All Readers
You may have noticed that I have not been quite as prolific in my updates to this blog over the last few days and weeks. And, in the coming weeks there may be very few new posts. I have another challenge to deal with that needs my more immediate attention.
When I was in Australia dealing with the events surrounding Geoff's death I had a flare up of a "lesion" in my mouth that had occasionally been a nuisance to me over the last few years. In August, 2007 I had the lesion examined through a "loop biopsy" (at that time it was the size of a pencil eraser) and it was determined to be benign. Over the past few years I was treated primarily by a dentist under the assumption I was grinding my teeth in my sleep and had a "night guard" made, along with some other recommendations which I followed. During that period of time the lesion was stable and didn't seem to get any worse, nor did it get better. However, when I returned from Australia toward the end of October, 2010 it had grown approximately 4 fold in size and was causing me considerable pain. Over the course of the following 8 weeks I was seen by an Internist, Dentist, referred to an Oral Surgeon and subsequently referred to an Ear, Nose and Throat Specialist (ENT). The ENT was immediately alarmed by the size and appearance of the lesion and he ordered some tests that culminated in surgery on December 17 to determine if, in fact, the lesion was benign or perhaps had become malignant.
The ENT had told me before the surgery that there were two possible outcomes: He would take a portion of the lesion and have it processed as a "frozen section" immediately and if the lesion was determined to once again be benign he would remove the entire mass, stitch up my tongue (where it resides) and after a few days I would be as good as new; OR, the analysis of the frozen section would indicate a malignancy, in which case he would terminate the surgery and refer me out to a different type of physician for a more invasive procedure. I awoke in the recovery room of the surgery center after the procedure on December 17 and noticed by the clock that it was approximately 3 hours after the surgery had begun. Shortly thereafter, a nurse came into the room and asked me how I was feeling. I could barely speak but I managed to ask her "What happened?" she then asked me if I had spoken to the doctor, I shook my head to indicate NO and she then said I would have to wait until I spoke with him to find out the results of the surgery. I had somewhat convinced myself before the operation that I was going to awaken afterward and be told that everything was fine and after a few days of healing I would resume the normal course of my life. Given the way the nurse responded to my garbled question I knew I was absolutely wrong in that assumption. After a few minutes my wife, Mitzi, came into the recovery room and reluctantly shared with me her conversation with the doctor since he had to leave the hospital to attend to other patients before I awoke.
I was diagnosed with a well differentiated, diffuse, Squamous Cell Carcinoma (SCC) of the Tongue based on the results of the analysis of the frozen section. We were to meet with the ENT doctor a few days later, after I had some time to heal, to talk about the next steps.
When we met with the ENT doctor the following week he explained that I was going to be referred to a Head and Neck Surgical team at a teaching hospital about an hour away from my home in Southern California. This particular hospital is well respected for their head and neck surgery along with many other specialities. The appointment with the surgeon was scheduled for January 4 and I had healed up about 70% from the first surgery by the time we met with the new doctors. After examination by two different physicians I was counselled that the most appropriate treatment was further surgery, specifically, a partial glossectomy and a selective neck dissection. In simpler terms they were recommending removing a piece of my tongue, approximately 5cm in diameter from the right lateral side along with the lymph nodes on the right side of my neck. During the past few weeks the details have been arranged such that the surgery is going to be performed on Friday, January 21. The surgery will last from 4 - 7 hours and I will be in hospital for 5 - 7 days. I will have a tracheotomy performed as well as a feeding tube (for approximately 2 weeks). Any further treatment will be based on the analysis of the lymph nodes after they are removed.
So, naturally, I have been asking myself if or how this could relate to Geoff's challenge with Hodgkin Lymphoma and my amateur research indicates that it does not. I was diagnosed with Non-Hodgkin Lymphoma in 1998 and have had no recurrence after treatment with chemotherapy. Apparently that is also unrelated to Geoff's cancer, according to those that are supposed to know. I will undertake this journey with the SCC and its treatment with the support of all my family and friends and the confidence that is needed to prevail. I ask only for everyone's best thoughts and good feelings. Keeping the memory of my son alive in the hearts of those who knew him and now for many that never did is so important to me that I will focus on that commitment to help get me through these next challenging weeks. Knowing that I have 3 wonderful, strong, daughters, 4 fantastic grandchildren, a wife that loves me, 2 incredibly supportive step children and my own parents, siblings and in-laws that will be with me every step of the way mitigates the fear I imagine one would normally experience about this next period of time.
I will be communicating with all of you as soon as I am able. I have been in constant contact with Geoff's doctors in Kogarah at St. George Medical Center and I expect to have the official coroner's report within the next month, or so, and am anxious to try to come to some understanding of just what happened to take the life away from just a wonderfully happy and productive young man.
When I was in Australia dealing with the events surrounding Geoff's death I had a flare up of a "lesion" in my mouth that had occasionally been a nuisance to me over the last few years. In August, 2007 I had the lesion examined through a "loop biopsy" (at that time it was the size of a pencil eraser) and it was determined to be benign. Over the past few years I was treated primarily by a dentist under the assumption I was grinding my teeth in my sleep and had a "night guard" made, along with some other recommendations which I followed. During that period of time the lesion was stable and didn't seem to get any worse, nor did it get better. However, when I returned from Australia toward the end of October, 2010 it had grown approximately 4 fold in size and was causing me considerable pain. Over the course of the following 8 weeks I was seen by an Internist, Dentist, referred to an Oral Surgeon and subsequently referred to an Ear, Nose and Throat Specialist (ENT). The ENT was immediately alarmed by the size and appearance of the lesion and he ordered some tests that culminated in surgery on December 17 to determine if, in fact, the lesion was benign or perhaps had become malignant.
The ENT had told me before the surgery that there were two possible outcomes: He would take a portion of the lesion and have it processed as a "frozen section" immediately and if the lesion was determined to once again be benign he would remove the entire mass, stitch up my tongue (where it resides) and after a few days I would be as good as new; OR, the analysis of the frozen section would indicate a malignancy, in which case he would terminate the surgery and refer me out to a different type of physician for a more invasive procedure. I awoke in the recovery room of the surgery center after the procedure on December 17 and noticed by the clock that it was approximately 3 hours after the surgery had begun. Shortly thereafter, a nurse came into the room and asked me how I was feeling. I could barely speak but I managed to ask her "What happened?" she then asked me if I had spoken to the doctor, I shook my head to indicate NO and she then said I would have to wait until I spoke with him to find out the results of the surgery. I had somewhat convinced myself before the operation that I was going to awaken afterward and be told that everything was fine and after a few days of healing I would resume the normal course of my life. Given the way the nurse responded to my garbled question I knew I was absolutely wrong in that assumption. After a few minutes my wife, Mitzi, came into the recovery room and reluctantly shared with me her conversation with the doctor since he had to leave the hospital to attend to other patients before I awoke.
I was diagnosed with a well differentiated, diffuse, Squamous Cell Carcinoma (SCC) of the Tongue based on the results of the analysis of the frozen section. We were to meet with the ENT doctor a few days later, after I had some time to heal, to talk about the next steps.
When we met with the ENT doctor the following week he explained that I was going to be referred to a Head and Neck Surgical team at a teaching hospital about an hour away from my home in Southern California. This particular hospital is well respected for their head and neck surgery along with many other specialities. The appointment with the surgeon was scheduled for January 4 and I had healed up about 70% from the first surgery by the time we met with the new doctors. After examination by two different physicians I was counselled that the most appropriate treatment was further surgery, specifically, a partial glossectomy and a selective neck dissection. In simpler terms they were recommending removing a piece of my tongue, approximately 5cm in diameter from the right lateral side along with the lymph nodes on the right side of my neck. During the past few weeks the details have been arranged such that the surgery is going to be performed on Friday, January 21. The surgery will last from 4 - 7 hours and I will be in hospital for 5 - 7 days. I will have a tracheotomy performed as well as a feeding tube (for approximately 2 weeks). Any further treatment will be based on the analysis of the lymph nodes after they are removed.
So, naturally, I have been asking myself if or how this could relate to Geoff's challenge with Hodgkin Lymphoma and my amateur research indicates that it does not. I was diagnosed with Non-Hodgkin Lymphoma in 1998 and have had no recurrence after treatment with chemotherapy. Apparently that is also unrelated to Geoff's cancer, according to those that are supposed to know. I will undertake this journey with the SCC and its treatment with the support of all my family and friends and the confidence that is needed to prevail. I ask only for everyone's best thoughts and good feelings. Keeping the memory of my son alive in the hearts of those who knew him and now for many that never did is so important to me that I will focus on that commitment to help get me through these next challenging weeks. Knowing that I have 3 wonderful, strong, daughters, 4 fantastic grandchildren, a wife that loves me, 2 incredibly supportive step children and my own parents, siblings and in-laws that will be with me every step of the way mitigates the fear I imagine one would normally experience about this next period of time.
I will be communicating with all of you as soon as I am able. I have been in constant contact with Geoff's doctors in Kogarah at St. George Medical Center and I expect to have the official coroner's report within the next month, or so, and am anxious to try to come to some understanding of just what happened to take the life away from just a wonderfully happy and productive young man.
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