(posted by Linda)
The PA tells us that Bob has to be transferred to St. Mary’s Hospital off Monument, because St. Francis isn’t equipped for brain surgery. He will go by ambulance and be seen by the neurosurgeon on call.
I wonder about the ambulance transfer. Bob actually drove us over here. I know the way to St. Mary’s; I practically lived over there before I had my hysterectomy nine years ago, and I’m going to have to drive over there anyway. When the six hundred dollar bill arrives, I roll my eyes and shake my head. Why don’t they let the uninsured save money where they can?
While Bob was in MRI, I have wept quietly in Room 13 and then used the phone to call Bob’s sons, Adam and Eric. They share an apartment a couple of miles away, and they say they are coming right over. It is nearing six PM, and I haven’t eaten in hours. Our friendly PA lets me into the EMT’s break room, where I grab a microwave sandwich, an apple, and a packet of cookies. It’s going to be a long night.
The boys, Bob, and I sit in Room 13 and chat during the long wait for an ambulance. Our PA stops by again. Bob may have seen a doctor in here somewhere, but I haven’t.
“What is this?” Bob asks. “I have a thing in my head?” He points over his left ear, which is where The Bad Thing is reputed to be.
“It’s a mass. We’re not sure what it is yet,” our PA tells him. “You’re going to need surgery to find out. Whatever it is, it’s dead in the middle. Have you ever had any serious infections in the past?”
“No,” Bob says.
“Yes, you have, Sweetie,” I suddenly remember. “Remember your knee?” Years ago, before I ever met him, Bob fell on an ice slick in the middle of a surveillance job in the dead of Michigan winter. He broke both his knee and his ankle; his knee went septic and he was in the hospital for weeks and in a wheelchair and on crutches for a year. The injury ended his PI career. His first wife, also named Linda, took a job at H&R Block; when she got transferred here, Bob had written his first novel and was looking for a writer’s group to help him get it ready to submit to publishers. That’s how we met—poring over drafts of Private Heat. Years later, when Linda One died of a sudden, massive heart attack, Bob and I got to be a lot better friends…but that’s another story.
I know that the Ghosts of Infections Past can sometimes reincarnate as brain abscesses. (I also had a high school teacher who died that way, so I know these tales don’t always have happy endings.) But anything is better than a brain tumor—well, maybe except for Alzheimer’s. I seize on the tiny morsel of hope. Quickly, I tell our PA about Bob’s septic knee.
But deep down, I know better. If the ER staff really thought they had a diabetic with a brain abscess, they’d be running around placing IV’s, drawing blood cultures, and hanging some Big Dog Antibiotic Drips as if there were a house on fire. They aren’t. Which leaves me with the unhappy prospect of a fast-growing tumor, one growing so fast it’s cut off its own blood supply and is rotting out inside.
It is not a cheerful thought. I keep it to myself.
I poke around after hours at the ER desk, trying to find someone to retrieve our car now that the valet parkers have gone home. On the starlit drive to St. Mary’s, my thoughts swirl with worry and disbelief. How are we going to do hospice in out tiny, overstuffed condo, with boxes of stuff stashed behind the bed, the dining nook parquet coming up where we haven’t had time or money to replace it, and my Tempurpedic on the floor in the living room, where I can hide from Bob’s snoring and my back doesn’t hurt? Now I absolutely have to get someone else to handle my aunt and cousin’s affairs—and I already know no one else in the family will do it. How can this be, when last week our biggest concern was money for a few days at the beach? Bob is only sixty-three. Don’t I at least get him until he’s seventy?
I arrive to find my husband settled comfortably in a private room on St. Mary’s sumptuous neuroscience unit. They had wanted to put him in ICU, but ICU was full. The fact that they wanted to put him in there worries me.
Bob has an IV started and his blood glucose checked, but he isn’t allowed to eat, since the nurses aren’t sure when surgery will be scheduled. I still haven’t seen a doctor, and I am anxious to see the scans. A veterinary education leaves one prepared to read and understand almost anything. I feel a trip to Googol coming on.
A word to anyone with a relative or a pet under medical care: Medical staff are human, although we’re trained not to act like it. No one wants to alarm or upset patients or family members by pointing to something on an X ray or CT scan and saying, “Oh, shit,” or shouting, “Oh, my God!” In school anyone who does this is soon broken of the habit by a very stern resident or professor. In our own clinic, where the quarters are close and the wooden doors thin, exclamations like, “Oh, my God, did you see—“ followed by “Shhh!” are common. So I am well acquainted with the human emotions behind the medical understatement of the year delivered in The Professional Monotone. As someone who’s felt only part “educated professional” and mostly “regular Joe on the street” my whole life, I got the “Shh!” and the Glare more than most. So I’ve had to become practiced in the use of The Professional Monotone myself.
Adam and Eric have gone home and I have waited up with Bob. I am afraid we will have to wait until morning to talk to a doctor. But Dr. Richard Singleton, bless him, comes to our room at midnight. He performs a quick neuro exam and shows us Bob’s MRI.
I am aghast. A gigantic black hole has taken up the cranial portion of my husband’s left temporal lobe. Together with the “Milky Way” flare of edema surrounding it, it looks like it’s taking up nearly a quarter of the available space inside his skull.
I open my mouth. Automatically, The Professional Monotone comes out. “That’s very large,” I hear myself say.
“That’s the thing in my head?” Bob says, pointing. “My gosh. That’s really big.”
I know Dr. Singleton knows more than this. We always do. He isn’t volunteering any more information beyond when surgery will be scheduled, how long a procedure like this generally takes, and how long Bob will have to be in the hospital. I will have to pin him down.
“In veterinary medicine,” I say, hoping I don’t sound like a moron, but not much caring at this point. I need to be prepared. “We often have to make an educated guess about what a tumor might be. We have to, because people don’t have any money, and they’re trying to make a decision. You know, based on the age and size and breed of this dog, our top three guesses are X, Y, and Z. So, based on what you see here, your top guesses would be what?”
“Based on the age and size and breed of this dog,” Dr. Singleton repeats, apparently somewhat amused. I don’t care; fine with me. “Metastatic tumor or an astrocytoma.”
By metastatic tumor I know he means lymphoma or lung cancer. Lymphoma might not be so bad. Many lymphomas are highly responsive to chemo now, if not curable. We’ve had cats do well with CNS mets. But Bob is a smoker. Lung cancer would suck. It would really, really suck.
Astrocytoma. Breath spray for my date with Googol.
Down the street from St. Mary’s is a 7-11. I stop there on my way home and buy a king-size Nestle drumstick. I wander around the darkened shops at Libbie and Grove at midnight, trying to tread the idea into my brain. Yesterday everything was fine; today my husband may be dying. I compare the new trees on the street with the huge ones that have been there twelve years. I stare at the flowers in the darkness.
The clerk in the 7-11 gave me the perfunctory, “How are you?”
“I don’t know,” I blurted. “My husband just got diagnosed with brain cancer.”
***
I am sitting in front of the computer at two o’clock in the morning, trying to find out what I am likely to hear on Monday. Monday is surgery day, five days from now, first thing.
There are four grades of astrocytoma. I am relieved to find out that the lower two, especially the first one, are very slow growing and are associated with survival times of ten years.
If Bob has one of these, that sucker must have been in there forever. This could bode well. Then I read about the higher grades. “Aggressive…highly malignant…tend to recur with higher grades than the original tumor.” I know what this means. Rapidly progressive disability, head pain, seizures…I try not to picture my husband in such a terrible condition. Bob has the most agile, fun mind of anyone I know. Why is God so much like a borderline parent? Whatever the child loves the most, pick that to take away. The median survival time for a Grade IV astrocytoma, also known as glioblastoma multiforme, is about a year. I know that most of that year isn’t likely to be good time at all.
There are age predilections. I read, hoping for a Grade I. I realize with a sinking heart that almost all of the Grade I’s are young people. The vast majority of people Bob’s age have the Grade IV’s. While this could be considered some degree of mercy from God, I suppose—at least the younger people who haven’t really lived yet get the longest life expectancy, rather than the older people who’ve already lived—right now it doesn’t make me feel much better.
I rush ahead, keying in “glioblastoma—images.” You can find anything online these days. Can you tell what it is from the scan?
The first MRI I click on looks exactly like my husband’s. Same black hole, same Milky Way flare—it’s even the same size and same location in the brain. I compare it to scans of mets, Grade I’s, and Grade II’s.
I go back to the first image I saw and scan the text. “Highly distinctive appearance…can often be diagnosed on MRI.” They aren’t kidding.
I am sitting alone in front of my computer at four AM on the morning of August eighteenth. Before Bob, before Adam, before Eric, before anybody else except Dr. Singleton, I already know my husband is going to die.