joyful sound

We met with Dr. Surgeon for Wade’s post-op appointment last Thursday afternoon (November 24th).

The VG was really quiet that day. The lobby was barren. No line at the Tim’s station. No wait for the elevator. It felt like one of those most people have the day off holidays. Not quite Christmas, but a lot like Thanksgiving. Weird.

When we got to the 4th floor of the Dickson Building, we turned left and followed signs for Surgery Clinic. Turned a couple more corners and arrived at the Thoracic Surgery clinic. The reception desk was dark.

Eventually a floater of sorts comes along, in a white lab coat. She seemed to be monitoring what I can only assume is a couple (a few? several?) surgery clinics. She seemsed to be in charge of directing people (what people?) here or there.

She gestured toward the empty desk, told Wade to go back to the lobby, and instructed him to register at a kiosk we didn’t know existed.

I held our chairs while Wade went back downstairs. Held is a gross exaggeration, obviously. But I like the way it reads. Truthfully, beyond the lone floater we were the only ones around. Soon she and Wade disappeared and I was on my own.

When they both returned, she told us to pick a room. Pick a room? Ah…okay. We entered the room nearest the aim of her arm swing and sat down.

After a short wait of 15 minutes or so, Dr. Surgeon came in.

His hair had grown since Wade was discharged. It was kind of bouncy as he approached. Dr. Surgeon (who shares an age bracket with Dick Van Dyke & Leslie Nielsen!) had a boyish grin on his face and a spirited step to his walk. His face lit up when he walked in. We’ve never seen a reaction that cheerful and warm (even considering the very caring team we’re so lucky to have), especially from Dr. Surgeon. As you know, our impression of him has significantly improved, but that kind of exuberance was quite a surprise!

Initially, I was confused. Had a daughter just made him a Grandpoppie? Was this his last day before a long-awaited retirement? Had he won the lotto? What was he so effing happy about?

He asked a few questions:

• how Wade was feeling (great, besides the chemo side effects)
• what he was eating (almost anything in small portions)
• what was proving bothersome to his guts (partial list – beer, anything deep-fried, and anything too rich, greasy, or sweet)
• weight loss, if any (yes, but just a few pounds)
• pain management (after 1 prescription refill from our GP, no additional meds were needed)
• etc, etc, etc…

And again, he reaffirmed how happy he is with Wade’s case. We’ve heard all of this from him before, but he went on:

• how amazingly well Wade responded to chemo in the first place
• how that kind of response to chemotherpy makes his job so much easier
• how surprised and at the same time, thrilled he was to open Wade up and see that things weren’t nearly as bad as they had been 6 months ago
• the difficult nature of the surgery, and how well Wade tolerated it
• how well he’d recovered from the surgery itself
• etc, etc, etc…

And finally,

• he added a 3rd (or 4th) apology (quite unnecessary!) about the crazy length of Wade’s scar

Wade promptly made it clear that he doesn’t mind the scar at all. It matches a shorter, but equally knarly one on his head. Said he’ll wear it proudly. Also said it beefs up his street cred. Dr. Surgeon responded with a bright smile, and….a belly laugh!

I was happy to see this side of Dr. Surgeon, but was honestly thinking to myself: What has happened to this man, the matter-of-fact bearer-of-bad-news we once knew? Why is he so….giddy?

Turns out he was also pleased to announce more good news:

In addition to Wade’s stomach and lower esophagus, 14 lymph nodes (all located near and around the cancer’s origin) were removed during his surgery on October 4th and sent to the Pathology lab. Keen, Dr. Surgeon removed more lymph nodes than he typically would, wanting as precise a pathology report as possible. And…according to the Pathologist’s report, all but 1 of those lymph nodes were found to be completely free of cancer. YAY!

To be honest (with him & with you) we already knew about this development. I’ve been meaning to write about it for a couple of weeks now. Sorry. As it happens, Dr. Oncologist shared this news with us when we had our pre-chemo appointment. We almost didn’t mention it to Dr. Surgeon, for fear of crushing his fine mood, but we did, and it didn’t matter. He carried on:

So, this is really, really excellent. We will stay the (treatment) course as planned. The 2nd Round of chemotherapy should address any wayward moves the cancer may have decided to make prior to the surgery. Though he doubts that any such moves were actually made. Another big grin!

He’ll be seeing Wade every 6 months or so. He and Dr. Oncologist work very closely together and will follow Wade as a team, but we will likely be seeing Dr. Oncologist a bit more often. Makes sense.

So, I guess Wade’s first round of chemotherapy took care of all but 1 of those affected lymph nodes. Very good news indeed! It’s impossible to express how lucky and thankful we are. Now that I think about it, I can’t help but wonder if Dr. Surgeon was thinking the same thing – just how fortunate Wade is. Hence, the big smiles, belly laugh, and the joyful sound of his voice.

I might be WAY OFF, but this is how I see it:

The prognosis for this type of cancer is not good. These were, essentially, the very first words we ever heard from Dr. Surgeon. Specifically, he said “This is not a good cancer to have. The cure rate is less than 50%.” I asked what that meant, even though it was clear. His response, “It means that even if we treat it aggressively, the cancer may not respond to treatment, or if it does, it will very likely come back.”

His mood was sombre, his expression was piteous, and his message was like a punch in the gut. He knew it. We knew it. Wade might die from this. In fact, it’d be no big surprise if he did.

No wonder he couldn’t wait to get out of there.

A reminder: just a few years ago the cure rate for Wade’s cancer was a mere 22%. After the Magic Trial in Europe, it nearly doubled to 42-ish%. Much better, but still. Only 4 out of every 10 people with this type of cancer will beat it .

Very few people are diagnosed with Aggressive & Advanced (Fast-growing & Stage 3) Adenocarcinoma of the Gastro-Esophageal Junction. It’s not one of the common ones.

Furthermore, the large majority of people diagnosed with this type of cancer are older. In many cases, they are officially elderly. Senior citizens and beyond. They have lived long lives. They have had families complete with grandkids (sometimes great grandkids), they have had long careers, they’ve had time to live their lives. [Not that their age makes this diagnosis okay. Nothing makes it okay. But…] Having to share that level of disparaging news with us, a young-ish couple in their early/mid 30s, must have been quite difficult for him. At the very least, he appeared to struggle with it.

But in nearly all cases of this cancer, this advanced (diagnosed in Atlantic Canada), Dr. Surgeon eventually sees them. He’s the guy who will eventually cut them open. His patients come from 3 provinces (NS, NB, PEI). Given their typical age, many of them are unable to tolerate the aggressive nature of the chemotherapy treatment. Sometimes they have to skip chemo, or cut it short, and go straight to surgery.

Now that I think about it, Dr. Surgeon must lose a lot of his patients with Adenocarcinoma of the Gastro-Esophageal Junction. It’s nearly impossible to detect early, so the staging is likely advanced in most, if not all cases. He must watch people who have this particular disease die on a regular (dare I say frequent?) basis.

Maybe that is why he was so happy to see Wade last Thursday. Maybe he was excited to see Wade, who is so far a short-term survivor, with good potential for long-term survival. He didn’t say exactly that, no. But….I think that’s what it was.

I don’t envy Dr. Surgeon. I don’t want his job. It must be horrible sometimes. But today was one of his good days, and we were quite thrilled to share it with him! I will never forget the sound of his voice.

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[Correction: I just Wikipedia’d Dick Van Dyke & Leslie Nielsen. DVD is 85. Leslie was 84 when he passed away in 2010. Dr. Surgeon’s thick mane of white hair obviously threw me off. In keeping with the hair association…a more accurate  age bracket would be somewhere between Steve Martin and Donald Sutherland, at 65 and 76 respectively. Sorry!]

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[Note: I’m drafting another post right now about staging. Staging as it applies to Wade’s case. Remember, cancer is a disease as unique as it’s hosts. What I plan to share is based on my own understanding. It’s purpose is to further clarify why we are (and should be) so happy with Wade’s journey thus far.]