Back in December, Nick discovered a lump in his neck while he was shaving. He pointed it out to his internist at his next check-up. Doctor H. \u00a0was not alarmed. He suggested that it might be \u00a0just an infection reaction.<\/p>\n
However, come February, the lump remained.\u00a0\u00a0Doctor H. said it was good that Nick returned to him to have\u00a0\u00a0it rechecked. \u00a0He arranged\u00a0for Nick to have an ultrasound of his neck\u00a0area. The results were that the lump \u00a0was either a\u00a0swollen\u00a0 lymph node caused by either infection, \u00a0or lymphoma, or squamous cell carcinoma.\u00a0Infection, please let it be you!<\/p>\n
Nick goes to \u00a0an ENT team in Hamden (or Milford) for his ear issues, so he made an appointment for a check-up with them. They performed a\u00a0biopsy on the swollen lymph node. It was not an infection. \u00a0The diagnosis was squamous cell carcinoma. At that point, I knew very little about squamous cells, but it\u00a0seems that we all have many of them, especially in our skin and in our mucous membranes. Squamous cell carcinoma never originates \u00a0in a lymph node, so\u00a0 it must\u00a0\u00a0have metastasized from somewhere else in the head\/neck area. A PET scan was ordered to find out the source.<\/p>\n
The PET scan examined Nick’s body from his head to his thighs, and \u00a0it was great news that \u00a099% of his body showed nothing abnormal. \u00a0But the other 1 % was\u00a0 an “area of concern” at\u00a0 the back of his tongue. We returned\u00a0to his ENT doctors for a tongue\u00a0biopsy. The doctor told me \u00a0he “biopsied the hell out of” Nick’s\u00a0tongue even though \u00a0he didn’t see or feel anything unusual. The result: the source of the carcinoma is indeed \u00a0the back of Nick’s tongue.<\/p>\n
A diagnosis of cancer implies the need for surgery, radiation, and chemotherapy. \u00a0Tongue surgery is not \u00a0typically done because it impacts negatively on people’s\u00a0abilities to swallow and to talk. But the doctors did want to remove the malignant lymph node in Nick’s neck.<\/p>\n
The ENT doctors use a surgical center \u00a0in Hamden (or Milford) for their work rather than \u00a0a hospital. We had to be there at 6 AM. I remained\u00a0in the waiting room rather than going home and returning, because it couldn’t take very long to remove\u00a0one malignant\u00a0lymph node, or so I thought. \u00a0At 11 AM, after I had read every magazine in the waiting room twice, \u00a0I started pacing. The nurses put me in a private waiting area\u00a0because I \u00a0was upsetting everyone\u00a0in the regular waiting room. \u00a0At 11:15 AM, they brought Nick out of the surgical area. His\u00a0anesthesia was wearing off, and\u00a0he was very wobbly. \u00a0He had thirteen\u00a0\u00a0staples holding the \u00a0six inch long incision \u00a0across his neck together, and a drainage tube connected to the incision. All this for one lymph node? No, the ENT doctors had removed about a dozen lymph nodes from\u00a0\u00a0Nick’s neck for checking. Fortunately, only the original one was malignant.<\/p>\n
Then they gave me a sheet\u00a0of paper that contained directions telling me\u00a0\u00a0how to be a post-op nurse. I was to keep Nick\u00a0from getting a fever, to apply salve to the staples in his neck, and to check \u00a0and empty the drainage tube. If any of those things became\u00a0problematic, I was to call them. We live 35\u00a0minutes from the doctors, so if something went wrong, how could they help him, being that they were such a distance\u00a0away? Thankfully, nothing went wrong.<\/p>\n
Before the doctor dismissed us, told us to\u00a0make appointments with a radiology oncologist and a medical oncologist. He told Nick not to lift anything for a \u00a0month. \u00a0 I wasn’t worried about Nick\u00a0lifting anything because he could barely stand up. But when\u00a0we got home, \u00a0 after a worker arrived to install our new window treatments, I turned around to see Nick carrying the old ones to the basement.\u00a0So much for not lifting anything!<\/p>\n
I have to \u00a0explain that Nick has a good friend who\u00a0had practically the same diagnosis, squamous cell carcinoma, several years ago. Nick wanted to go to the same New Haven \u00a0doctors\u00a0who helped his friend. But \u00a0his friend lives in New Haven!\u00a0I asked the ENT \u00a0doctor who \u00a0did Nick’s\u00a0neck surgery \u00a0if there was a any medical reason that Nick needed doctors who practiced in New Haven. They assured us that\u00a0\u00a0we could take the diagnosis to doctors closer to home, and they would follow the same established procedures as would New Haven doctors. \u00a0Nick was reluctant not to use his friend’s doctors, but\u00a0he agreed to go local. Hello Norwalk Hospital, 6 miles from home!<\/p>\n
Our next appointment was at Norwalk Hospital, with Dr. P., \u00a0who would be Nick’s radiology oncologist and who had been mine 25 years ago when I had breast cancer. Now he is head of the department as well as an instructor at Yale. He remembered us! Then \u00a0we met Dr. N., a medical oncologist, also an instructor at Yale. They told us that Nick would receive radiation daily for seven weeks and chemo concurrently\u00a0once a week. We learned that the chemo was specifically designed to make the radiation more efficient. In fact, they described two different types of chemo, each of which with its own side effects, and told Nick\u00a0to choose! The one he selected attacks squamous cells; the one he rejected could cause eye and ear difficulties, which Nick wanted to avoid. His choice had to be approved by the insurance company, because it costs $30,000. Twenty-five years ago, my entire cancer experience was at a cost of $27,000, and now it’s more than that for \u00a0just the chemo!<\/p>\n
Dr. N.\u00a0told us that during chemo Nick’s skin would be very red, and would be covered with a rash, but there were medications to ease the itch and to prevent infection. \u00a0Dr. P. described side effects of radiation. We decided to deal with each one as it arose.<\/p>\n
Dr. P. wanted to be certain that Nick’s mouth was ready for\u00a0the treatments that were to follow. He called Dr. F., \u00a0a periodontist to whom he refers his oral cancer patients. It typically takes three months to get an appointment with Dr F., but he saw Nick the next day. In the morning Nick had his teeth very thoroughly cleaned. In the afternoon, the Dr. F. stitched\u00a0\u00a0Nick’s gums. Dr. F. told\u00a0Nick \u00a0to call him any time, even if he was on vacation. He said he’d rather have ten calls that didn’t amount to anything rather than miss one important\u00a0one. He also explained that he would be giving Nick oral check-ups every six weeks for the following year. He was well aware that \u00a0all this is not covered by insurance. He told Nick that if the bill was a problem, he should pay what he could, when he could.<\/p>\n
Then Dr. F. made Nick an appointment with an endodontist in order for her to further investigate a spot on one of Nick’s dental ex-rays; she had to fit him in the next evening because her regular appointment slots were filled. She has a 3-D mouth CAT scanner! \u00a0She sent the images she took to a specialist\u00a0in California \u00a0for further analysis. He\u00a0concluded that the\u00a0area of concern with Nick’s\u00a0lower front teeth was actually not a problem.<\/p>\n
Having \u00a0had only \u00a0one page of directions in being a post-op nurse, I had no idea what \u00a0was happening.\u00a0\u00a0I was afraid Nick’s neck would continue to swell. What if it ruptured? I’ve watched many medical\u00a0shows. What if he bled out while I was driving?\u00a0Highway driving is not my favorite thing. On\u00a0\u00a0Friday nights there’s \u00a0extra traffic, and \u00a0there would probably be\u00a0\u00a0extra patients in an inner city ER. \u00a0Fortunately, a friend was able to drive us.<\/p>\n
The ER at St. Raphael’s\u00a0\u00a0in New Haven was different from any other I could recall. There was a \u00a0young couple \u00a0there with a toddler\u00a0and a newborn who was obviously the patient.\u00a0There was also another family\u00a0that was so large that\u00a0\u00a0I could not determine who\u00a0was the patient. It seemed that aunts, uncles and cousins kept arriving, all greeting\u00a0each other with hugs and kissses, more like a party than a visit to the ER! Fortunately, Nick’s ENT doctor \u00a0had called ahead so the ENT resident and his student were ready for us. They were\u00a0both charming! They told me that Nick had\u00a0\u00a0a hematoma. Did I know what that was? Of course not. The last time I heard that diagnosis was on the TV show “Ben Casey” when I was in high school. They explained that a space in his neck had filled \u00a0with blood and “other fluid.” \u00a0They withdrew two syringes of the blood and other fluid. They also installed another drain, and instructed us to\u00a0see the ENT doctor on Monday. Fortunately the rest of the weekend was uneventful and after another round trip to\/from Hamden (or Milford), the second\u00a0drain was removed.<\/p>\n
I neglected to mention that both Dr. N. and Dr. P. asked Nick how long he was in the hospital after the surgery that removed\u00a0his lymph nodes. They were amazed to hear that he was never in a hospital at all. I know\u00a0that hospital\u00a0stays\u00a0are very costly, and that many people get sicker in hospitals than before they were\u00a0admitted. However, in my opinion,\u00a0\u00a0 Nick needed\u00a0to be monitored by a health care professional after his surgery rather than being dismissed to my care. I\u00a0do take \u00a0annual classes in first aid and CPR, but they did not address\u00a0the tasks given to me. \u00a0At this point I became\u00a0unable to sleep soundly for fear that something awful was about to befall \u00a0Nick.<\/p>\n
Many people have asked how Nick reacted to the news of his cancer and its \u00a0impending unpleasant treatments. \u00a0One of his favorite stories has the punchline, “With all this manure, there must be a pony somewhere!”\u00a0He has reacted like a scientist, trying to “find the pony” \u00a0and \u00a0figure out how to\u00a0resolve each day’s challenges.<\/p>\n
Before the treatments began, we met with a\u00a0\u00a0nutritionist. Dr. P. \u00a0had told me to try to get Nick to gain weight, and I wanted suggestions for doing it in a way that would not bring back his diabetes, from which he has been officially cured for a few years by keeping his weight low. The nutritionist\u00a0had some helpful suggestions for us. \u00a0I\u00a0presented \u00a0her with a description of our typical daily \u00a0diet, after which \u00a0she said to Nick, “Listen to your wife.”\u00a0I should have that embroidered\u00a0on his pillow!<\/p>\n","protected":false},"excerpt":{"rendered":"
Back in December, Nick discovered a lump in his neck while he was shaving. He pointed it out to his internist at his next check-up. Doctor H. \u00a0was not alarmed. He suggested that it might be \u00a0just an infection reaction. However, come February, the lump remained.\u00a0\u00a0Doctor H. said it was good that Nick returned to … Continue reading How It Began<\/span>