How I Learned I Have Hodgkins
On Saturday, Nov. 6, I noticed I had a swollen lymph gland just above my right collarbone. Bob--my husband--wanted me to go to the doctor, but that struck me as a bit of hypochondria. I didn't feel sick. I figured a lymph node had sucked some infectious agent out of my system and was inflamed. But when it hadn't gone down by Monday, I agreed to go to the doctor. After I worked out at Curves and took mom to lunch and went to the dentist (where I was given a pat on the head by the hygenist for having done a good job with my new electronic toothbrush, improving my peridontal scores--felt like I had aced a test or something) I went to Cleveland Clinic Urgent Care.
Every year, right before I travel somewhere (usually New Mexico) it seems as if I have some weird problem that sends me to Urgent Care at Chagrin. A couple of years ago it was an abcess that had to be drained. Last year it was a sore throat (and one of my students had strep.) I felt silly going because my lymph node was swollen. But went. The nurse practitioner saw me--which pretty much told me how seriously to take this. She looked at it and said, 'Well that's weird.'
So she called the doctor in. He palpitated. It was soft, seemed to have come up recently. "Have you got a cat?" he asked. I like this guy, I've seen him before. He did residency on the Navajo Reservation and we've talked about Hanta Virus.
"No, no cat." Adam--my kid--is allergic, so no cats. Of course, the dogs would love if we had a cat.
He was hoping for cat scratch fever. "What," I said, "have you had a case recently?"
The Nurse Practitioner laughed.
"I had one when I was a resident," he said. In Navajo territory. We joked about bubonic plague--since I had been in New Mexico, but back in May. He told me to to take 600 mg of anti-inflammatory three times a day and go see my doctor if it hadn't improved in a couple of days.
By Wednesday it was still the same, I thought. And it had begun to bother me slightly--probably from worrying at it, testing the size with my fingers. I felt it would probably go away on it's own if I ignored it. But in the back of my head I worried a little. Two weeks before, I found out a friend has prostate cancer so cancer was on my mind. And I knew it was on Bob's mind, since both his parents had died of it. I called Cleveland Clinic Solon and my doctor was too booked so they gave me an appointment with Dr. Kendelle Cobb.
Dr. Cobb was a young black woman with small, careful hands and no pretense. I liked her immediately. She asked me all the usual questions--sore throat? No. Fever? No. Night sweats? No. Unexplained weight loss? I should be so lucky. But she didn't like what she felt, I guess. She got me a chest x-ray across the hall, had blood work drawn and scheduled a CT scan for that afternoon. Scary. Turns out, by the way, that you can't eat before a CT scan. You have to have not eaten for four hours. Something to do with what they call 'contrast', which in my case was injected--I assume iodine dye that the CT Scanner would pick up.
Contrast is weird stuff. The technician was great with the IV (as they all are. If you're going to have blood drawn, get a tech to do it, they're wonderfull at it.) She warned me that the contrast might cause me to feel as if my face, ears, hands, feet and buttocks were burning, and that it might make feel as if I had peed in my pants. There would be a metallic taste. Delightful. It was an open scanner--maybe all CT scanners are. Bob thinks only MRIs are closed. It was, of course, miraculously non-invasive and since I got to stay fully dressed, an easy test. Off the gurney, back out and into the car and back to Solon where Dr. Cobb would talk to me about the results.
I knew she was worried about cancer. So when I got home I typed lymphadenopathy into Google (the diagnosis on my referral sheet.)
I found a reasonable site--The American Association of Family Physicians.
On the site it says:
"Findings from a Dutch study revealed that only 10 percent of patients with unexplained adenopathy required referral to a subspecialist, and only 1 percent had a malignancy."
So that pretty much reassured me that I didn't have cancer. You know, two hours on the internet makes me a diagnostician, right?
I was wrong.
But I slept quite well.
I teach on Thursdays, although it's my short day (only one class.) I had my ENT appointment at 2:00. The doctor is a tall silver-haired guy who gave me a hard time for saying clavical instead of collarbone. "Why don't you say collarbone like everyone else?"
I told him I watched too much ER. We agreed the show had gone downhill drastically. I liked him, he looked at me when he talked to me. Why is it so important to like my doctor? Probably because some craven part of my brain believes all those medical tv shows where the doctor's connection with the patient means the docotr goes the extra mile and saves them. He asked the same questions and a few more (had I lost my voice? Did I have persistent throat clearing? Nose bleeds?) palpitated my neck.
And then he told me, he was pretty sure I had lymphoma. I've been trying to think of how to describe the sudden flush, the adrenaline wash like heat that swept through me, almost like being startled. What about Bob? What would I tell him? How could I do this to him? Everything is now different. And then it was like I had already sort of known. I knew that Dr. Cobb had thought it might be cancer. And as I said, I had been test driving the idea since Saturday. But that had been emotional logic, intellectually I knew that a lot of my apprehension was because I had been thinking about my friend and his cancer. Like medical students who think they have whatever they are studying.
The only way to tell, the doctor explained, was to do a biopsy, and he would schedule me for one on Wednesday. Wednesday was his surgery day. I listened and sort of assessed myself. Everything was different, but of course, it wasn't. I still felt the same. I'm still, in a weird way, healthy. Although if something isn't done, I won't be. The doctor continued, that he couldn't be certain it was lymphoma, but he was going down the hall to talk to the oncologist. So I sat, and after a moment, I opened up THE DA VINCI CODE and read until he came back. Very strange, but I was able to concentrate. I wonder, was it so easy to accept because, thanks to depression, I sort of always expect the worst? The doctor came back and told me that the oncologist would see me the Monday or Tuesday after the biopsy--they apparently can't do a forzen slice to determine malignancy the way they can in breast cancer. There's protocal. No food or drink after midnight on Tuesday.
Bob was in Toronto. He had just gotten there. So I called him from the parking lot. I said the doctor was concerned, and that it might be lymphoma. But they wouldn't know if it was lymphoma or an infection until they did a biopsy. I didn't want to tell him in Canada, away from home, but I wanted to tell someone. But I also wanted to leave him a way out. I explained what the doctor had told me, that if it was lymphoma, given my age and the location of the lymph nodes, the prognosis was very good. All true and really, I don't think I quite believe that there is going to be much change in my life. It's foolish, I know, but I was thinking that this will be a major inconvenience, some discomfort. At the same time, I think things like, maybe I won't outlive the dog--and I won't have to go through Smith's death from old age. This way I never have to be like my mother, who is deep in dementia. I will never be alone in a nursing home.
I went online and looked up Lymphoma.
Nights were the worst. I tend to get anxious at night anyway. And now I went to bed wondering if I'ldl be able to sleep. Despite my inability to think of this as serious, I wondered if I ought to clean my office. I mean, I couldn't leave that office to Bob, it wouldn't be fair. If I am sick, or die, who will take care of my mother? She has dementia. Granted, taking care of her just means taking her to the doctor's, taking her out to eat on mondays and Fridays, buying her clothes and make-up and paying her bills. But it's like raising a kid. I know what she might wear and we she won't--blouses, blue, with a sort of late seventies business look. She only wears blue. She needs a new pair of sneakers. I bought her white leather keds and she has worn them to pieces. But she wouldn't wear anything that would look like a modern gym shoe, and she wouldn't want canvas. It's hard to buy her things because I give them to her and an hour later she doesn't recognize it as hers. She hasn't worn anything I've bought her in the last six months, for example.
So far, that has been about the worst place I've been, mentally.