A Carcinoid in April… or Why I Got so Skinny

Not really mine, but I thought it looked good. Thanks Wikipedia. I’ll post the real X-ray when I get it from my doctor.

That we had actually gotten to the hospital at the designated time made me a little nervous. Jessie and I hadn’t been on time for anything in thirty years, so the mere fact that we had arrived on the dot — at five-thirty in the morning, no less — reminded me how serious the next few hours would be.

The Kaiser pre-op area was an enormous, fluorescent-lighted room with at least 15 bed-cubicles situated along its perimeter. By my count, ten of these little cubicles were now occupied. In just a few minutes, ten souls in various states of disrepair, including your narrator, Russell S. Buchanan, would be cut open and — if all went as planned — repaired.

While we waited for them to come wheel me to the operating room Jess posed an interesting question. “Hey, how do you think they make sure they’re working on the right — I mean, the correct — side?”

Hmmm. The confusing way she asked her question, with the homonymic “right,” made the question all the more compelling. My left side was the target, of course. But how would the surgical team know that for sure before they started carving me up?

As I began planning my escape, my surgeon, Dr. Yakoub, entered the cubicle, introduced himself to Jess then signed his name under my left armpit with a black Sharpie. Whew.

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Let’s back up a little, though. What brought me to this world of scalpels, gurneys and black Sharpies began in January with a persistent variation in my body temperature, including a slight fever. There was also a bit of a worry about the weight I’d been losing for about a year and a half. Even though I had shed about 30 lbs. over six months, the weight loss was somewhat more explainable and less concerning for a few reasons. We had purposely been eating smaller portions to lose weight over much of that time — Jess had lost weight too. Also, I had been walking my dogs religiously at 4:30 every day for up to an hour, up and down the calorie-burning hills around my house. Not to mention, I’m about to turn 64. If my dad’s “spindly shanks” — as my mom called dad’s legs during his autumnal years — were any indication, losing weight is just something male Buchanans do when they get old. There was also the comfort in knowing that my Anthem/Blue Cross doctor, who was aware of my weight loss, had given me a clean bill of health just two months before, after giving me a complete check-up that included a chest X-ray. Oops.

But the temperature fluctuation was another matter. I’d wake up many mornings with my thermometer reading 100. An hour later, back to my normal low of 97.7. Two hours later, 96.7. Then back up to 101. No cough, no shortness of breath, no other symptoms at all. I even bought a snazzy new digital thermometer to be sure the problem wasn’t in my analog one, which had probably been handed down through ten generations of Buchanans. I went to see my new GP at Kaiser, Dr. Slingenberg.

Based on my fevers and what the chest X-ray indicated was some wispiness in the lower lobe of my left lung, Dr. Slingenberg figured I had managed to develop a bit of pneumonia there. So the doc wrote a prescription for antibiotics and I went home.

As you might have guessed by now, that was not the end of the story. Dr. Slingenberg called a few days later.

“Hello, Mr. Buchanan. It’s probably nothing to worry about, but remember that wispiness in your chest pictures?”

“Uh-huh?”

“Well, I’d like you to have another chest X-ray. Something about that wispiness looked unusual.”

Unexplained weight loss, mystery fevers, lifelong smoker of cigarettes… I had hoped to live my entire life without hearing the words “you,” “chest,” “X-ray” and “unusual” uttered in one sentence by my doctor. But Dr. Slingenberg had just scuttled that hope.

Even with my cancer indicators, though, the chance of me actually having lung cancer was remote. No cough, no malaise, no cancer markers in my blood tests. Not to mention, nobody in my family — grandparents, parents or sister — had developed any type of cancer during their long lives. Cancer does not like my DNA, I kept telling Jess and myself… again and again.

In fact, the first time cancer seemed like a real possibility to me was right after my second chest X-ray. It was something about the way the tech spoke to me before and after the session — the way he said “good luck” after he’d had time to look at the pictures. Not only had there been a subtle change in the way he spoke, but his tone and transition sounded vaguely familiar. Then I remembered — it was the same way Dr. Slingenberg sounded during his last call about the wispiness. Both of these guys’ voices had become more intimate and personal — more careful and compassionate.

The second X-ray again showed signs of trouble in my left lung’s lower lobe and proved to be the healthcare equivalent of the umpire yelling, “play ball.” Batteries of tests were ordered — blood tests, breathing tests, CAT-scan — and, of course, my first bronchoscopy.

Imagine a colonoscopy. Now, imagine a little higher. Rather than inserting a camera in your rectum to examine your bowels, the camera goes into your mouth then down into your lungs. In my case, the bronchoscopy confirmed what the CAT-scan had indicated — and what my doctors had suspected — a mass about the size of a pecan was growing inside the bronchus of my left lung.

As an inveterate body abuser — eat-what-I-want, smoker, ex-dope fiend, former touring rock-and-roller (and all the sleepless nights and debauchery that suggests) — I believe it is a minor miracle that I had, until now, never experienced ill health of any sort, let alone serious ill health. In other words, I am a very grateful guy who would be the last person on earth to shake his fist at the sky and shout “Why me, lord?” I know darned well why. But at the same time I must admit that all this talk of cancer and diseased lungs was beginning to put me in a philosophical mood. I began thinking of shortcuts I might take that would complete the album I’ve been working on for the last three years. I mean, dying with 14 almost-finished songs trapped in my computer would have made me very cranky in the afterlife. I found myself reviewing my life a lot and began worrying about Jess worrying about me. Hell, I even worried about my dogs, and how distraught they would be — however briefly (squirrel!) — if the cancer killed me.

As it turned out, my morbid musings were unnecessary. Though they couldn’t be sure without biopsy — and biopsy of the mass would not be possible until its removal — Dr Yakoub and my pulmonologist, Dr. Drucker, were both confident that mine was a rare, slow growing, non-metastasizing (in my case) type of cancer known as a carcinoid, a type of growth that until recently was not even considered a cancer. Apparently, I had picked the right kind of tumor.

However, it did have to be cut out of my body. The date of my deliverance was set for April 14.

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A few minutes after Dr. Yakoub signed the correct side of my chest, my anesthesiologist, Dr. Chung, peeked in and introduced herself. I sat on the gurney marveling at all the activity going on around me.

“Honey, I know it’s idiotic, but I can’t help feeling guilty about all this,” I said to Jess.

“Guilty about what?” answered a male voice on my right. It was Dr. Yakoub, whom I thought had left the cubicle but was only hidden by a computer cart.

Great, I thought. Not only was my surgeon about to be subjected to my useless guilt rant, but he also probably thought I had just called him “honey.”

“Well, here I am with lung cancer brought on by stupid life choices — namely smoking — and now I’m blithely expecting all these people to snap to and come to my rescue. It just feels wrong and irresponsible and unfair. Hell, I don’t even have any pain… ”

Dr. Yakoub cut me off as he continued typing away at the computer. “Oh, your carcinoid has nothing to do with smoking,” he said. “We’re not really sure why carcinoids occur.”

That’s the last thing I remember before partially regaining consciousness in the recovery room. According to Jess, I was fairly miserable when I awoke – lots of shallow breathing and grimacing. I remember being wheeled through the halls to my hospital room, where apparently, I insisted upon placing my oxygen mask on my forehead.

My four-hour surgery had been successful. My growth — or “friend,” as Dr. Drucker called it, was biopsied immediately after it was removed and turned out, in fact, to be a carcinoid — a blessed little carcinoid. Dr. Yakoub also found a touch of pneumonia in my lower lobe behind the mass, just as Dr. Slingenberg had surmised.

The six-inch gauze pad and two drainage tubes under my left armpit told me that the simpler, less invasive thorasocopic procedure that Dr. Yakoub had hoped to employ, which would have left me with two tiny holes and a much shorter hospital stay, had not been an option. Dr. Yakoub explained to me later that my tumor’s proximity to a major artery required him to go in the old fashioned way — through my ribs.

I spent four days in one of the many rooms of the post-op wing of Kaiser Panorama City, the same hospital that took my tonsils 50 years ago – my only other surgery and hospital stay. Sadly, they were in the process of tearing down the actual building of my tonsilectomy, but I got to see its gutted shell from a fourth floor window every day during my doctor-prescribed walk around the wing.

In just four days the post-op staff at Panorama took my already good opinion of Kaiser and put it in the stratosphere. Nurses, kitchen staff, on-call doctors, housekeeping — every single person I dealt with during my stay — was professional, upbeat, caring, smart and pleasant to be around. I now have an appreciation for nurses that borders on worship. These gals and guys on the fourth floor were constantly busy with patient medications, bathroom assistance, assorted emergencies, etc., but always came to my room right away when I hit that button. They even walked the floor with me the first couple of days. One of my fondest memories will be my petite Philippine/American nurse and me strolling down the corridor, belting out old Chi-lites and Commodores hits (she belted, I kind of grunted and winced), while I guided my IV tree with one hand and valiantly tried with the other to keep my butt from peeking out through my half-open hospital gown.

As a sworn enemy of America’s health-as-commodity, private insurer-based system and Anthem/Blue Cross survivor, I can’t believe I am now going to sing the praises of a health insurance company, but here I go: Ever since I joined Kaiser Permanente in December I have been in various stages of awe and admiration. The past month, with all my appointments, tests and such has only intensified my appreciation of this behemoth org.

I’m new at Kaiser so I’m still trying to figure out what makes this company so good at its job while others continue to fail so miserably. Of course, Kaiser’s one-stop shopping, with labs, diagnostics and doctors of all specialties located in one place is a godsend. With Anthem I’d still be waiting for my first X-ray, which, if approved, would likely be conducted at an imaging center twenty miles away at rush hour. Also, I assume one big reason my doctors Slingenberg, Drucker and Yakoub have been so clear and patient with me and so expert with my case is that with Kaiser handling the administration, traffic, marketing and other non-medical duties doctors traditionally loathe, Kaiser doctors are free to be healers. Well-informed healers, at that; according to my Internet research, doctors are often flummoxed by the very uncommon carcinoid. Not my Kaiser doctors, though. They were all on the carcinoid trail well before the bronchoscopy pictures all but confirmed the theory.

Overall, Kaiser seems to have hit upon a magical formula of super-efficient, digitally-driven healthcare administration combined with absolutely top-level employees. The computers take care of the pain-in-the-butt-but-important stuff, such as parking (digital readout of available spaces and their location) and blood-test traffic (take a bakery-type number at lab entrance and wait for your number to be called. I’ve yet to wait longer than 20 minutes, usually far less time). The employees take care of the actual healing and support duties along with their job of representing the organization to the patient and making the patient feel valued.

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Well, I am home now. My carcinoid is probably in a landfill somewhere or may still be in Panorama City, getting to know my tonsils. I feel surprisingly good, considering that just nine days ago the good Dr. Yakoub opened me up, bent my ribs out of the way, cut through a few centimeters of my muscle, adipose and lung tissue and then sewed me shut.

At the risk of diminishing the wonderful sympathy I’ve been getting from Jess and the few others who knew about this thing, I must confess that the pain has been curiously minimal. Minus the hours after the procedure, which I really don’t remember very well, and the occasional attention-getting tweak from my drainage tubes, which were removed before I was discharged, the discomfort has really been much closer to annoying than excruciating. Granted, I was taking Percocet every four hours with an occasional shot of Dilaudid for four days, but even so I expected the pain to be much worse.

I’m glad it wasn’t.