Surgery in Philadelphia
Success and Surprise
The surgery trip to Philly went as planned. Pascale and I were greeted with great hospitality on July 26 by my niece Jessica, her husband Jeff and their boys, Oliver and Zachary. The next day we went to Abington Hospital and met Dr. Steve Fassler, the surgeon. Steve is a smart young doc, confident but not cocky, with a good sense of humor. He likes to be informal with patients, which is fine with me since that is similar to the way I teach. He is usually followed around by a minion of residents, some of whom look older than he is. He is obviously a star.
We spent a few days in New York visiting my parents before the surgery took place on Pascale’s birthday, August 2nd. I gave her a present with a note saying that I hoped her next birthday could be spent in a more fun place than a hospital waiting room.
The surgery took two and half hours. It accomplished the primary purpose of removing the tumor and diseased part of my colon. A pathologist examined the removed portion of the colon and pronounced its outside margins clean. This is an excellent result, meaning that it is unlikely that any cancer was left behind in the colon.
There was one big surprise. The secondary purpose of the surgery was to remove the stint that my gastroenterologist had inserted in April to prevent the tumor from obstructing the colon. But the stint was not there. Dr. Fassler had made an inch-long incision above the site of the tumor, through which he pulled out the resected portion of the colon and planned to pull out the stint. This along with a few little holes for the laparoscopy tools was all the violence he planned to inflict upon me. But with the stint missing in action, he had to look for it. So he made the incision large enough to insert his hand and search for the stint manually. When that produced no result, he gave me an unplanned colonoscopy. In the end, the stint was never found, so he concluded that it must have passed. (Ironically, my GI doc in Monterey had questioned the wisdom of the surgery, saying that the stint could stay in the colon for many years.) It turns out, therefore, that it was a very good thing to have done the surgery when we did, because, without a stint, there was still a danger of the tumor causing obstruction of the colon.
The Recovery Floor: It’s a Gas, Gas, Gas
When I woke up several hours later, I was on a floor dedicated to patients coming off anesthesia after major surgeries. I could not move at all in the beginning, due to the pain in my midsection and the consequent abdominal muscle spasms. After a few days in this ward, I noticed the most frequent question that the doctors and nurses asked the patients was, “did you pass any gas?” It turns out that the intestines are the last part of the body that wakes up and thaws out after anesthesia. If they are still anesthetized, then it is impossible to pass gas. So, like it or not, you can’t get out of that ward until you flatulate. The nurses do their best to make this a humorous subject. They are fond of saying that their floor is the only place where passing gas is not only socially acceptable but worthy of applause. A roommate of mine in the hospital said that it doesn't matter who you are, when you enter the Jumping-Jack-Flash-It's-A-Gas floor, you park your dignity at the door.
I did not get out till the fifth day. Near the end, there were some bad cramps in my belly. These were caused the trapping of four days of normal intestinal gas build up, but also the extra air that had been pumped into my abdomen to create more room for Dr. Fassler to perform the laparoscopic surgery.
On the third and fourth days in the hospital, I received physical therapy so as to learn how to walk and climb stairs again. The loss of use of the abdominal muscles makes a lot of things complicated. The PT was surprisingly effective, fortunately. I have to admit my fighting spirit was at a low at the start of the PT, but the pros in that department know how to encourage their patients effectively.
Convalescing
I left Abington Hospital with gratitude for their competent and compassionate care. I spent another week at Jessica’s recovering from the surgery. The nicest thing was all the visitors. My brothers came to see me, along with their wives and some of their kids. My good friend and colleague Terry Harrison came too. My first PhD student, Terry is now a famous professor at Penn State. He stopped off on his way to Newark airport, where he was catching a plane for a short teaching gig in Singapore.
Karla Hoffman, another good friend and colleague, came up by train from Washington, D.C. It was so kind of her to dedicate a day for the visit. When she first heard that I was sick, Karla suggested that I consider getting treatment at the National Cancer Institute and invited Pascale and me to stay at her and her husband's home for as long as necessary. What a class act she is!
Pascale’s dear friend Ray came down from New York to see us. We were truly honored by his gifts of time and samples from his vast music collection.
Each day I would try to walk a little further. At the beginning of the convalescence week, Jessica and Jeff’s driveway was the limit of my range. The improvement was slow but steady.
On August 13th, we flew back to Monterey. It was a smooth flight and we were happy to get home.
Morphine Dependence and Withdrawal
The doctors and nurses were quite liberal in dispensing narcotic painkillers after the surgery. In the hospital, they hooked me up to an ever-present morphine IV, which was activated whenever I hit a button. After release from the hospital, I was loaded up with a stash of morphine pills, which I took for three solid weeks. They provided a lot of comfort, but the bad news is they really are addictive. I was not sufficiently aware of this problem, and went off the dope cold turkey. That resulted in an extremely unpleasant reaction of migraine headaches, vomiting and shaking. It got pretty bad. Pascale was in Southern Cal, helping her daughter Nina embark on her junior year of college in Paris. My wonderful daughter Claire came over to help me and then Rob Dell took me to the hospital emergency room. It was a very busy night in the ER -- we got there at 11p.m., but I was not seen till 1a.m. The ER doctor explained that I was having a morphine withdrawal reaction, and gave me IV’s to re-hydrate along with non-narcotic painkillers. Rob stayed by my side at the ER through the night, finally taking me home at dawn. How lucky I am to have such good friends!
I wish I had known more about morphine addiction and had managed the withdrawal better. It took a full week before I finally felt the fuzziness gone from my head.
On August 30, Roger decided that I had recovered sufficiently from the surgery to resume chemotherapy for the liver cancer. The battle resumes.
The Long Haul
When my acute problem was in the intestines, it was very easy to understand. Everyone knows what a belly-ache feels like. But having a sick liver is an abstraction. What does a liver-ache feel like? With the exception of a few occasions when my enlarged liver put pressure on the surrounding area, making it uncomfortable to lie on my side or take deep breaths, I’ve had no physical awareness of my liver. The doc even had to show me where it is.
So here I am with an incurable disease of an abstract organ, whose only symptom is constant fatigue. Unfortunately, all the doctors say that by today’s medicine, there is no cure. The long-term goal is to keep the cancer from growing and spreading with chemotherapy, and to hope that a cure will emerge in the interim. There is much reason for hope. There has been so much improvement in cancer therapy in the last few years. For example, chemo treatments are far less traumatic now than they used to be. For an even more important example, Roger says that my life expectancy would have been far shorter using the medicine of just two years ago than it is now.
I had been envisioning a day when I would walk out of the oncology center pronounced cured, like Lance Armstrong when he left Indiana. On my last day, I would bring a cake to Roger’s office with a big thank you to him and his staff on it, each person’s name in colorful icing. This may yet happen, but no one in the cancer community is promising it.
It is time to focus less on the day-to-day minor discomforts and more on adjusting psychologically to the big picture. I think the anti-depressant is helping. It is harder for me to see the effect but others seem to notice. The most important thing is to embrace each day as a gift and make the best of it. My family has been wonderful. Pascale has cut down her extremely busy schedule to make more time for us. We have even been playing tennis. We go out and hit for about 20-30 minutes. She runs hard, hitting each ball on the first bounce. I might hit a second or third bounce or whenever I get around to it. I may not be hustling like Andre Agassi, but we are hitting good balls and having a lot of fun.
Kiss Therapy
My three daughters have been visiting and calling often. Claire’s baby, my 15-month-old granddaughter Skylar, is getting very comfortable with me now. Since I shaved my beard a few weeks ago, she has been giving me lots of kisses and hugs. It doesn’t get any better than that! I surely would not be getting as many Skylar kisses if I were working as hard as I used to, so that’s one gift of cancer. Another gift is the frequent reminders I get of my good fortune to have so many close friends. Thank you.
A Parting Reminder
There has been one very good consequence of my being so open about this cancer battle. A dozen or so friends have told me that they got colonoscopies after learning about my condition. In at least one case, polyps were discovered and removed, averting serious illness. If you are of a certain age and have not had this only mildly annoying preventative measure, please talk with your doctor about it. It could have saved me a lot of trouble.
Photos
Here I am with my brothers Bobby and Andy, and with Jessica and her sons. It was nice of Oliver to let me hold his light-sabre.
Here is Dr. Steve Fassler. He may look young, but he has already done 500 laparoscopic colon surgeries.
Speaking of Skylar, here she is with her parents, Claire and Graham Nash.
The surgery trip to Philly went as planned. Pascale and I were greeted with great hospitality on July 26 by my niece Jessica, her husband Jeff and their boys, Oliver and Zachary. The next day we went to Abington Hospital and met Dr. Steve Fassler, the surgeon. Steve is a smart young doc, confident but not cocky, with a good sense of humor. He likes to be informal with patients, which is fine with me since that is similar to the way I teach. He is usually followed around by a minion of residents, some of whom look older than he is. He is obviously a star.
We spent a few days in New York visiting my parents before the surgery took place on Pascale’s birthday, August 2nd. I gave her a present with a note saying that I hoped her next birthday could be spent in a more fun place than a hospital waiting room.
The surgery took two and half hours. It accomplished the primary purpose of removing the tumor and diseased part of my colon. A pathologist examined the removed portion of the colon and pronounced its outside margins clean. This is an excellent result, meaning that it is unlikely that any cancer was left behind in the colon.
There was one big surprise. The secondary purpose of the surgery was to remove the stint that my gastroenterologist had inserted in April to prevent the tumor from obstructing the colon. But the stint was not there. Dr. Fassler had made an inch-long incision above the site of the tumor, through which he pulled out the resected portion of the colon and planned to pull out the stint. This along with a few little holes for the laparoscopy tools was all the violence he planned to inflict upon me. But with the stint missing in action, he had to look for it. So he made the incision large enough to insert his hand and search for the stint manually. When that produced no result, he gave me an unplanned colonoscopy. In the end, the stint was never found, so he concluded that it must have passed. (Ironically, my GI doc in Monterey had questioned the wisdom of the surgery, saying that the stint could stay in the colon for many years.) It turns out, therefore, that it was a very good thing to have done the surgery when we did, because, without a stint, there was still a danger of the tumor causing obstruction of the colon.
The Recovery Floor: It’s a Gas, Gas, Gas
When I woke up several hours later, I was on a floor dedicated to patients coming off anesthesia after major surgeries. I could not move at all in the beginning, due to the pain in my midsection and the consequent abdominal muscle spasms. After a few days in this ward, I noticed the most frequent question that the doctors and nurses asked the patients was, “did you pass any gas?” It turns out that the intestines are the last part of the body that wakes up and thaws out after anesthesia. If they are still anesthetized, then it is impossible to pass gas. So, like it or not, you can’t get out of that ward until you flatulate. The nurses do their best to make this a humorous subject. They are fond of saying that their floor is the only place where passing gas is not only socially acceptable but worthy of applause. A roommate of mine in the hospital said that it doesn't matter who you are, when you enter the Jumping-Jack-Flash-It's-A-Gas floor, you park your dignity at the door.
I did not get out till the fifth day. Near the end, there were some bad cramps in my belly. These were caused the trapping of four days of normal intestinal gas build up, but also the extra air that had been pumped into my abdomen to create more room for Dr. Fassler to perform the laparoscopic surgery.
On the third and fourth days in the hospital, I received physical therapy so as to learn how to walk and climb stairs again. The loss of use of the abdominal muscles makes a lot of things complicated. The PT was surprisingly effective, fortunately. I have to admit my fighting spirit was at a low at the start of the PT, but the pros in that department know how to encourage their patients effectively.
Convalescing
I left Abington Hospital with gratitude for their competent and compassionate care. I spent another week at Jessica’s recovering from the surgery. The nicest thing was all the visitors. My brothers came to see me, along with their wives and some of their kids. My good friend and colleague Terry Harrison came too. My first PhD student, Terry is now a famous professor at Penn State. He stopped off on his way to Newark airport, where he was catching a plane for a short teaching gig in Singapore.
Karla Hoffman, another good friend and colleague, came up by train from Washington, D.C. It was so kind of her to dedicate a day for the visit. When she first heard that I was sick, Karla suggested that I consider getting treatment at the National Cancer Institute and invited Pascale and me to stay at her and her husband's home for as long as necessary. What a class act she is!
Pascale’s dear friend Ray came down from New York to see us. We were truly honored by his gifts of time and samples from his vast music collection.
Each day I would try to walk a little further. At the beginning of the convalescence week, Jessica and Jeff’s driveway was the limit of my range. The improvement was slow but steady.
On August 13th, we flew back to Monterey. It was a smooth flight and we were happy to get home.
Morphine Dependence and Withdrawal
The doctors and nurses were quite liberal in dispensing narcotic painkillers after the surgery. In the hospital, they hooked me up to an ever-present morphine IV, which was activated whenever I hit a button. After release from the hospital, I was loaded up with a stash of morphine pills, which I took for three solid weeks. They provided a lot of comfort, but the bad news is they really are addictive. I was not sufficiently aware of this problem, and went off the dope cold turkey. That resulted in an extremely unpleasant reaction of migraine headaches, vomiting and shaking. It got pretty bad. Pascale was in Southern Cal, helping her daughter Nina embark on her junior year of college in Paris. My wonderful daughter Claire came over to help me and then Rob Dell took me to the hospital emergency room. It was a very busy night in the ER -- we got there at 11p.m., but I was not seen till 1a.m. The ER doctor explained that I was having a morphine withdrawal reaction, and gave me IV’s to re-hydrate along with non-narcotic painkillers. Rob stayed by my side at the ER through the night, finally taking me home at dawn. How lucky I am to have such good friends!
I wish I had known more about morphine addiction and had managed the withdrawal better. It took a full week before I finally felt the fuzziness gone from my head.
On August 30, Roger decided that I had recovered sufficiently from the surgery to resume chemotherapy for the liver cancer. The battle resumes.
The Long Haul
When my acute problem was in the intestines, it was very easy to understand. Everyone knows what a belly-ache feels like. But having a sick liver is an abstraction. What does a liver-ache feel like? With the exception of a few occasions when my enlarged liver put pressure on the surrounding area, making it uncomfortable to lie on my side or take deep breaths, I’ve had no physical awareness of my liver. The doc even had to show me where it is.
So here I am with an incurable disease of an abstract organ, whose only symptom is constant fatigue. Unfortunately, all the doctors say that by today’s medicine, there is no cure. The long-term goal is to keep the cancer from growing and spreading with chemotherapy, and to hope that a cure will emerge in the interim. There is much reason for hope. There has been so much improvement in cancer therapy in the last few years. For example, chemo treatments are far less traumatic now than they used to be. For an even more important example, Roger says that my life expectancy would have been far shorter using the medicine of just two years ago than it is now.
I had been envisioning a day when I would walk out of the oncology center pronounced cured, like Lance Armstrong when he left Indiana. On my last day, I would bring a cake to Roger’s office with a big thank you to him and his staff on it, each person’s name in colorful icing. This may yet happen, but no one in the cancer community is promising it.
It is time to focus less on the day-to-day minor discomforts and more on adjusting psychologically to the big picture. I think the anti-depressant is helping. It is harder for me to see the effect but others seem to notice. The most important thing is to embrace each day as a gift and make the best of it. My family has been wonderful. Pascale has cut down her extremely busy schedule to make more time for us. We have even been playing tennis. We go out and hit for about 20-30 minutes. She runs hard, hitting each ball on the first bounce. I might hit a second or third bounce or whenever I get around to it. I may not be hustling like Andre Agassi, but we are hitting good balls and having a lot of fun.
Kiss Therapy
My three daughters have been visiting and calling often. Claire’s baby, my 15-month-old granddaughter Skylar, is getting very comfortable with me now. Since I shaved my beard a few weeks ago, she has been giving me lots of kisses and hugs. It doesn’t get any better than that! I surely would not be getting as many Skylar kisses if I were working as hard as I used to, so that’s one gift of cancer. Another gift is the frequent reminders I get of my good fortune to have so many close friends. Thank you.
A Parting Reminder
There has been one very good consequence of my being so open about this cancer battle. A dozen or so friends have told me that they got colonoscopies after learning about my condition. In at least one case, polyps were discovered and removed, averting serious illness. If you are of a certain age and have not had this only mildly annoying preventative measure, please talk with your doctor about it. It could have saved me a lot of trouble.
Photos
Here I am with my brothers Bobby and Andy, and with Jessica and her sons. It was nice of Oliver to let me hold his light-sabre.
Here is Dr. Steve Fassler. He may look young, but he has already done 500 laparoscopic colon surgeries.
Speaking of Skylar, here she is with her parents, Claire and Graham Nash.
posted by Rick Rosenthal | 9:37 AM
2 Comments:
Rick--a great mix of objectivity and emotion. I'm inspired by your courage and fighting spirit!
--Steve Baker...
Rick,
You are an inspiration for sure. As my professor, you have taught me so much. I am currently sharing a battle with Lymphoma with my father. He is battling much in the same way you are. I have talked to him and we shared that life is made up of moments. Each as precious as the next. I am traveling to CT next week to visit with my father in the hospital, we have been fighting this for about a year and though we have had some good news, there is more bad than good. I will keep you in my thoughts and my prayers, you are one of a kind and special to each and every one of those students like me that you've touched. You keep fighting!
Stephan Picard
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