Well, doing our best.
Three weeks ago, I saw my oncologist for what we both hope will be our last consultation for a long while - a full year, if all goes well, though I'm scheduled to meet with someone from the new Survivorship Clinic six months from now. There's evidence that I have some power through my "lifestyle choices" to reduce my risk of recurrence or metastasis, but medically speaking we've done everything we can to eliminate every last rogue cell that might have escaped from my original tumor to sail the salty seas of my body and seek out a new home.
I hadn't known before I read George Johnson's Cancer Chronicles that a cancer's place of origin has a strong bearing on where it might resettle and that this isn't a simple matter of proximity or circulation. As the surgeon Stephen Paget wrote way back in 1889, "When a plant goes to seed, its seeds are carried in all directions. But they can only live and grow if they fall on congenial soil." For reasons biologists still don't fully understand, certain "soils" are more congenial to cancer "seeds," so that a kidney may have as much exposure to malignant cells as the liver, but the liver is much more likely to play host. In a similar vein, muscle sarcomas are quite rare, and still more rare are the carcinomas that successfully metastasize to muscle - the heart resists colonization, while the brain often succumbs.
Beyond this general variation in vulnerability, specific organs and tissues support to greater and lesser degrees the far-flung ambitions of specific cancers. Prostate cancer finds the bones most accommodating, while lung cancer likes the adrenals. If my own cancer reappeared, it would most likely turn up in my lungs, liver, brain, or bones. But we're hoping it won't, and our hope is well-grounded. Having successfully completed the drug regimen Dr. Barnett laid out in February, I've also got the favorable odds she promised me then (though "promise" is a tricky word in this context): seventy of a hundred hypothetical women with my clinical presentation can expect to arrive at the five-year anniversary of their diagnosis without metastasis. The bad news is that, of the remaining thirty, half will likely be dead and the other half soon to follow. These high-grade, triple-negative growths don't mess around. According to Dr. Barnett, the next two years are most critical in revealing whether or not I'm truly cured - if I make it to 2016 without a recurrence, I'll very likely make it to 2019 and beyond.
Of course, I'd really like to avoid developing another cancer, and I remain at moderately heightened risk for melanoma (happy to get an all-clear from a dermatologist two weeks ago) and grave risk for ovarian cancer, but only for another week and a half. A week from Monday, I'll bid my wasted little seed pods an apologetic adieu. If I am in that lucky seventy-percent, and all goes well, August eighteenth could mark the end of this particular medical struggle, though even in the best scenario it would be a tapering sort of an end rather than an abrupt one. I'll still have plenty of physical and psychological de/reconstructing to do. Cancer treatment resembles a labrador puppy only in this: it swings a powerful tail. Best remove delicate objects and feelings to a high shelf or mantel.
The weekend after my appointment with Dr. Barnett, just as Peter and I were beginning to recover our balance, our beloved Barley - who's been with us for all but twelve weeks of her life and all but three months of our nearly thirteen years in Portland - became markedly droopy and unresponsive. I feared that she'd gone suddenly deaf, though in retrospect it seems that she was too much occupied by what was happening inside her to register the sound of her name or other, still less relevant human noises.
We're very fortunate to have two doctors (at one clinic) in whom we gratefully trust: Dr. John Kellogg (or "Old Kellogg," as he prematurely refers to himself) and Dr. Gary Hunt. Over the course of three days, Barley saw them both and allowed herself to be poked and palpated, prodded and scanned. She drooped further but held no grudges. An alarmingly high white blood cell count prompted a series of x-rays, and those x-rays revealed a mass almost as big as a second heart, buried deep in her lungs.
A specialist's opinion was required, the film sent off to a local radiologist. We learned the next morning that the anomaly most probably represented a pulmonary carcinoma, a.k.a. lung cancer. Barley's increasing reluctance to move and her sometimes labored breathing seemed to support this tentative diagnosis, but we couldn't - we can't - be sure. The mass is literally at the heart of her, so cozy with her most vital organs that a biopsy would be traumatic and dangerous even for a young dog, let alone for one two months shy of thirteen. Whether or not it's malignant, it is practically inoperable. A definitive diagnosis might satisfy our curiosity and possibly give us an inkling of what to expect, but it wouldn't lead us to a solution; it wouldn't help us to help her. Neither would it answer the vital questions that remain: how much time is left to us? how much of it joyful?
Old Kellogg's wife, Karen, sent us a lovely email prescribing love and cheeseburgers. Dr. Hunt advised us to have a "contingency plan" for when things went south, and we cancelled a much-anticipated trip to see my sister and her family in Baltimore; we were (and are) determined to see Barley through and to make the most of whatever time we have left with her. We supposed we would count it in days.
HOWEVER, Barley's high WBC count (the inciting incidental) indicated some kind of infectious process. Dr. Hunt guessed that this was likely secondary to the hypothetical carcinoma but put her on antibiotics and asked us to let him or Dr. Kellogg know later in the week whether we saw any significant lifting of spirits. We did! When I spoke with Dr. Kellogg, he emphasized the indeterminacy of the radiologist's report as cause for optimism: a benign mass "could not be ruled out." Additionally, Barley showed none of the anemia or wasting that he would have expected with an advanced cancer. "You'll be bringing her to my funeral," he told me.
That was two weeks ago. Barley swings a little low sometimes, and she's doling out kisses with unusual profligacy, but in the main she's back to her cheerful and sweetly stubborn self, sleek with extra treats and aglow with extra attention. Once she's through her three-week course of antibiotics, we'll sample her blood again and maybe take a hopeful x-ray. Looking to go deeper in hock, mortgage our hearts for a little more time.