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A War for My Kidney and Soul

Posted by on July 2, 2010 in IL-2, Immunotherapies (IL-2, IL-15, PD-1s, etc.), Medical Procedures and Other Drugs, My Health Updates - 2 Comments

 

There is a war being waged for my kidney and soul. It is big. It is existential. It is cosmic. It is good versus evil. Wrong versus right. America versus al Qaeda.  Elliot Ness versus Al Capone. Luke Skywalker versus  Darth Vader. Dogs versus cats. Donnie versus Marie. It is one oncologist versus another, and it is a battle being waged on the 9th Floor Ward.

It is a fight over whether to continue my IL-2 treatments or not. Can my heart, my lungs, my kidney handle further toxic injections? As we push forward with more and more treatments and the poison accumulates with each successive dose, is it worth it? One doctor says yes, one no. These medical proxy fights tend to occur while I am eating a Chick-Fil-A sandwich in the basement of the hospital.

Dr. George, my primary oncologist, a renal specialist, is an optimistic and aggressive doctor. He sees progress in the CT scans and radiology reports. Admittedly this is like seeing a butterfly in a Rorschach Test, a confusing patch of tumors that have not shrunk but have not grown either but have merely shifted in geometric form, cracker-shaped after one CT scan, peanut-shaped after another. His job is to rid my cancer, whatever it takes.

Dr. Morse, my other oncologist, is the one who actually administers the IL-2. He is a conservative man who follows strict protocols. He doesn’t know my particular case as well as my primary, but he knows the ins and outs of IL-2 better than anyone. His job is to keep me alive and healthy during the periods of slow-drip IVs and morphine-calmed shakes, whatever it takes.

We are not seeing the kind of progress that warrants this level of toxins in your body, Dr. Morse says. There will be no fourth round. I tell him that Dr. George, my primary oncologist, sees evidence for pushing forward. Dr. Morse is unimpressed. Evidently my comment is like telling one chef that another thinks his pastries are too sweet.

“I want you to come in early Monday and do some testing,” he says.

I am immediately paranoid. Is one general outflanking the other? What kind of testing? Entire conversations play out in my mind.

Is this because I passed out in the bathroom last time? I ask.

No, of course not.

It is, isn’t it? I’ve embarrassed you and now you want to run me out of here on rails.

Yes. No. I mean. Look, there are a lot of embarrassing incidents. The bathroom thing. Those ridiculous yellow socks. Your strange relationship with the hospital clown.

It is not entirely clear to me what kind of testing I must undergo next Monday. It is not the standard bloodwork and such. It is heart stress testing, I think. Maybe pulmonary. It seems sudden and unexpected. Which is all the more cause for paranoia, as Dr. Morse is such a by-the-book kind of guy and this does not seem by the book. It seems spontaneous, and spontaneous is not in the protocol.

I worry that he is not only making a case against a fourth round but preparing to cut off the treatments immediately, forgoing even the second cycle of the third round. I envision him talking to his nurses in doubtful and conspiratorial tones. We can’t have this guy around here passing out every time a needle comes within eyesight. It’s bad for my rep, man. Besides, there is something weird going on with his heart.

Maybe there is something genuinely wrong. Of all the side effects, there are two that stand out as potentially lethal if not contained: heart irregularities and fluid in the lungs. Heart irregularities lead to obvious complications, like heart attacks. Or maybe a really lousy case of heartburn. Fluid in the lungs, known as pulmonary edema, can result in collapsing the lungs. Both of these side effects can be lethal, but Duke, which follows Dr. Morse’s strict protocols, has fairly well put an end to such deaths by stopping treatments at the first sign of trouble.  This is why my last round of treatment was stopped short, at six doses. My lungs were taking on fluid.

Perhaps Dr. Morse has seen something irregular in the sea of data compiled during my hospital stays, something ominous among the heart rate monitor readouts and blood pressure hills and valleys. Maybe the lungs absorbing water gives him concern. There could be too many problems with creatinine levels and kidney function. Maybe there is something to the blackouts besides mere social awkwardness.

Or maybe I’m just paranoid.

In any case, I am unsure what to expect next Monday. Perhaps the grand struggle between doctors George and Morse will have resolved itself. (I sure hope they are not reading this post. My sense of humor is a cultivated taste; mostly it’s just offensive. So I apologize for pitting you two in this good-versus-evil-struggle thing; I’m not even sure who goes where but somebody’s got to go somehwere dammit – I’m a former journalist, and this is how good journalism is done. Stereotyping and categorizing are are proper protocol.) Perhaps the unknowns and conflicting perspectives will continue despite my best efforts to reduce the world to black-and-white simplicities. Cancer can be stand-offish in this way. It is the teenage girl of lethal diseases.

So. Here I am twiddling my thumbs, holed up in my parent’s study, trying to keep up with work long distance, trying to avoid too much exertion so that I don’t screw up my stress testing next Monday (or pass out again) … trying not to stress out too much … does stress impact a stress test? … Waiting, waiting. Again.

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