Saturday, September 26, 2009

Digging for Gold

The biopsy.

To do a biopsy on a lung is rather different than doing a biopsy on a more stationary organ. The lung moves constantly. That's its job, inhaling and then exhaling; without we suffocate. So nothing stays still unless you will it. And even then you can hold your breath and your lung is in one position and hold your breath a second time and the lung has moved ever so slightly yet putting the tumor out of reach of the needle that is poised to retrieve some matter from it. In addition to moving in and out, your lung also moves up and down the stationary rib cage, so you have another shift that the doctor has to account and adjust for in a successful retrieval. This tumor measures less than 3cm by 3cm so even though that sounds huge to me, it is rather slight for purposes of capture when it's a moving target.

I learned this after we showed up at 6am to the hospital and I was checked into a day room where I disrobed for the procedure, was given an intravenous shunt on top of my left hand, hooked up to a saline drip, and waited. Luckily C, my ob/gyn, who has delivered all three of my children, and who has become a good friend was there to greet us and engage in small talk with my daughter and me, which was reassuring and helped pass the time. Eventually I was wheeled down to level A for the procedure. At some point I met Dr M, the radiologist in charge of the procedure, who was very highly recommended by my ob/gyn. He explained both the process and how the working of the lung made it difficult. He told me that they were going to try both ultra sound and ct scan to visually locate the tumor and then shoot it with the needle punch. He fired the needle punch for me so I would know what it sounded like and then a sedative was added to my drip, but not so much that I would fall asleep as that would negate the process because they needed me to be alert enough to hold my breath.

Dr. M began by numbing the section of the back that was going to take the needle. It took 4 stages to completely numb the area, as he went into the surface tissue first and then into the deeper skin levels with the anesthetic. Then they used both the ct scan and the ultrasound to look into my lung and locate the tumor or growth. The ultra sound did not seem to be providing a clear enough image so they gave that up and positioned me in the donut hole of the ct scan machine. Then I was instructed to breath and then hold it. When Dr. M was prepping me, he said not to take a big breath like I would if I were singing, but to take a normal breath and then hold it. I probably took a breath and held it for them at least twenty times. First they had to mark where it probably was with an 'x' on my skin, then I had to take a similar breath so it showed up in the right position so that the needle punch could take a core sample. At one point Dr. M said, "we're almost there," and then of course my breathing went all off base, so we were back to 4-5 rehearsals, and without warning, he stepped in and >bang< it was done. The ct scan showed the needle going into the tumor and he was quite certain that he had retrieved the desired matter. Which, he then told me was a good thing, because if he had had to do additional needle punches, the danger of lung collapse increased greatly. It was a little like putting a small hole in a balloon.

So, he showed me the material which was a tiny whitish thread held in clear liquid preservative. The nurse and tech cleaned up the punch site, which turned out to be right below my left shoulder blade. That was rather a shock because I thought our lungs were much longer. And then I was whisked upstairs in the new gurney by a wonderfully polite orderly, where I visited again with my daughter and C, and then slept until they took me back to level A to x ray my chest to see if the lung had caved in. It had not so I was taken back upstairs for another hour or so of wait time and then a second chest x ray.

They had given me dilaudid for the pain, and at some point after the second x ray, I became severely nauseous as a result. Apparently it is a common side effect of opioids. That held up my discharge for a bit, but I was home by 1:30pm.

Now we are waiting again. First for the biopsy results, then either for more tests and eventually for a meeting with the doctors to determine a treatment protocol. I am assuming that this is cancer because of the growth on my vocal cord that has reduced my voice to a whisper and barred me from singing was identified on the first ct scan as a metastasis. What they are trying to do right now is learn where it metastasized from. But if by some miracle, they were to tell me that there has been some screw up and it is all benign, I could live with that. Right.

On to more waiting!! My favorite.

I remember as a child not being able to sleep Christmas eve and getting up and taking apart and putting the wind up clock in my bedroom back together. But quietly so I wouldn't wake my younger sister. Right now, I'm looking for something similar that will last longer and it could even be slightly noisy. Have not found it yet.

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