Shadows

I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.      – Abraham Maslow, The Psychology of Science: A Reconnaissance (1966)

A hungry stomach cannot hear.    – Jean de La Fontaine, Fables, IX, The Kite and the Nightingale (1678-1679)

The hungry are forgiven for thinking of nothing but food. Consider the cartoons of your childhood where the starving predator sees something (prey or any inanimate object) and it transforms, in his mind, into a sizzling pork chop or a talking fried chicken leg. So, too, the cancer patient can think of nothing but disease. Every cough, every twinge, every sniffle conjures up images of metastasizing evil reaching its suicidal fingers into new corners of their betraying body. However, unlike hunger, cancer has the ability to cloud the perception of those who love and care for the cancer patient.

Such was the case of our beloved dog Delbow. Stung by the appearance of a cancerous tumor in the muscle on the right side of his neck last year, an incomplete resection of the area was followed by cautious but deliberate irradiation of the area in 21 sessions over three weeks, concluding last spring. As with my wife, whose ongoing war with breast cancer leaves her with scars and nightmares, our dog, blissfully oblivious to the prognosis and baffled by the ongoing medical attention carries the painful reminders of his ordeal.  Suffering from increasing head tremors and restricted head mobility, coupled with teeth gnashing (a new manifestation), we sought answers from his veterinary oncologist.  Examinations were made and tests were run, all in our endless quest for information. Nothing was found to account for the changes.

We were referred to the neurologist, who suggested a myriad of horrible conditions which “may” be responsible for his symptoms. Again, tests were run, information was gathered but conclusions eluded us. Finally, the prospect of a temporomandibular joint condition was proposed and we were referred to the veterinary dentist. As my son and I waited (as my wife was too ill following another round of systemic poison being administered to her), the dentist informed us that it appeared the cancer had returned. In concert with the oncologist (with whom the dentist and neurologist are colleagues in a multi-specialty veterinary clinic), it was revealed that there were at least two, one half centimeter tumors on the back side of his neck. In addition, there was an inflammation in the area of his optic nerve within the orbit of his left eye and a huge mass pushing the lens out of position. The tumors on his neck were excised and sent for a biopsy and we returned home with a beloved family member lethargic from sedation and partially shaved with a four-inch, sutured incision on his neck.

The next few days saw his demeanor change, his energy decrease, confusion increase and us wondering if the end was nigh.  Cancer had again forced every other consideration of our lives to the very distant background. Sadness fought with anger for position as the overwhelming emotion we faced. Like walking out into an August day in Houston from the conditioned atmosphere of our home, the concept of life without Delbow hit us in the face within moments of awakening every morning. Sicknesses, such as cancer, have a way of forcing us to prioritize our lives, jettisoning the trivial matters eating up precious brain activity in favor of the immediate and irreversible concepts surrounding mortality. However, while this is true in the long-term (or even the mid-term) it is not true in the immediate aftermath of learning such news. Rather than prioritize the various weighted obligations we face, all other considerations (all other thought) drown in the dissonant din of this cancer-caused, immediate threat.

Weary from these considerations and exhausted from a lack of sleep caused by us each holding Delbow in shifts throughout the night because of his almost constant, semi-conscious leaps of pain (followed by a desire to stand alone in a corner with ears down, tail down and a sad, empty stare), our arms held him tight against us like living seatbelts, our voices soothing as we spoke tender deceits of everything being “ok.”  A week passed like this and we were finally scheduled to return to the oncologist to review the findings of the biopsy. Unable to convince Lisa to stay home, the four of us and our little, fluffy, white ball of radiating love made the trip together.

The first indication that this would not be just another doctor’s visit came to us upon entering the examination room. Rather than the exam table locked into place like a deployed, closet ironing board center, complete with rubber-backed bath mat for the patient’s comfort, there were simply five chairs in the room. It seemed that any pretense of medical art had been dispensed with and a consultative, group therapy session was about to ensue. What followed was unexpected, bordering on unfathomable.

The biopsy of the tumors from his neck came back as benign, dermatopath lesions, non-cancerous. However, the inability to conduct a biopsy of the optic nerve enlargement left the physicians dubious of its construction or intent. That, coupled with what was originally thought to be a massive, mature cataract on the CT scan was now believed to be a suspected soft tissue ciliary body tumor. One step forward, two steps back. Because of Delbow’s extensive medical history (exclusive of his cancer and treatment), including two TPLO surgeries, one on each back leg, and an emergency retinal reattachment surgery four years ago, it was thought that his ophthalmologist might be able to provide some (if you’ll forgive me the word) “insight” into Delbow’s visual condition. This was at 11:30AM. A quick, frantic call to his ophthalmologist, where I simply needed to drop Delbow’s name (as everyone who knows him finds him beautiful, adorable and memorable), and we were scheduled to meet with the ophthalmologist at 1:00, thanks to a double booking trick of the office staff.

The benefit of having a background in the health insurance field is that no generational or geographical biases prevent us from seeking out the best practitioners (we moved from Rhode Island to Texas to obtain treatment at M.D. Anderson and took Delbow to Chicago to have eye surgery). The “benefit” of having a two inch thick file on Delbow at the ophthalmologists (I put benefit in quotes because to amass such a file necessitates ongoing physical conditions requiring medical treatment) is that this history provides benchmarks against which current issues can be gauged.

It turns out that the enlarged shadow the oncologist saw on the CT scan near Delbow’s optic nerve has always been there (or in the words of the ophthalmologist, “he most likely came that way from the factory”). As for the huge, globular mass distorting the normal position of his lens, it is simply the silicone oil injected into his eye four years ago as part of the retinal reattachment surgery he had in Chicago. It appears as a mass because the silicone oil is now sharing the area inside the eyeball with accumulated tears, and, as we know, oil and water don’t mix.

So, it turns out that sometimes a shadow on a CT scan is just a shadow and not an exposed, nefarious shade. A good lesson and a difficult one to learn outside the painful necessity of experiencing it, the thumping warning signals, the paranoid expectations of the other shoe dropping are not fleeting.  No, but while we’re not out of the woods yet (we still don’t have any plausible explanation for his ongoing pain and behavior changes) we no longer see the forest before us as raw lumber in search of a nail in search of a hammer.