Chapter 56: Scanning

 Chapter 56: Scanning

It was November 29^th. Three months ago, I had completed my second cycle of radiation. I was doing well and had recovered from the extreme radiation fatigue. A scan from nine weeks ago was good and showed relatively diminished tumor burden. Today it was time to be scanned again.

I was lucky enough to have 4 good days of skiing with friends leading up to the scan. My skiing ability was the same or improved. The day before, I completed some driving occupational therapy. The therapist confirmed that I was relatively safe to drive and that I was using coping mechanisms effectively. I felt reassured. These were good signs that would be incongruent with a worsening scan.

Regardless, as November 30^th (reading day) approached, my anxiety grew like bacteria on an agar plate. I was on so many diverse treatments: I switched to a keto diet, I took pembrolizumab, I wore the Optune device. If these weren’t working, why had I endured the discomfort? And what else could be added? There was nothing.

On November 28^th, I began noticing every yawn, every instance that my memory faltered, every time my attention waned. Was this due to recent poor sleep? Or was the cancer growing and these new symptoms? Without having a log, it was difficult to tell if they were even new to begin with. I had been sleeping poorly for the last several days and I genuinely believed this the cause. A motor or somatic symptom would be more likely for cancer.

November 29^th. The MRI was scheduled for late afternoon and at a different clinic from my usual             

. Lying on the machine table, I noticed several, nearly imperceptible differences. The headrest seemed less comfortable, and the mirror position differed. Whether these were real differences or not, I didn’t know.

Usually with brain MRIs, I experienced an imaginary head “tugging,” as though I could feel the alignment of my water molecules by the large magnet. Today, the tugging felt more spread-out.  I chalked it up to the larger patient table. To begin with, there was certainly no way that I could be feeling the MRI. I knew it was likely due to the repetitive and rhythmic shakes and noises of the machine. Cancer enables a certain paranoia.

I slept poorly on the 30th. Like before, I continually checked my patient chart for scan results before the visit. I managed to remain calm and engaged in the early visit before we discussed the scan. I dutifully emphasize how well I felt, and how skiing was going well—as though it would influence the results of the already completed scan.

We opened the scan. Perhaps it was equivocal. One area that had appeared mass-like on the previous scan had improved; however, there were several new wispy areas of enhancement across the whole brain, and what was likely new growth in the thalamus and the frontal lobe. I had difficulty making sense of it. On one hand, the overall total tumor burden was likely similar if not minutely increased; but on the other hand, wider distribution of disease was certainly a negative prognostic factor.

I was afraid of the new lesions. Symptomatic affect to the thalamus would be disastrous from a functional standpoint. And I was already on many disparate treatments. What could I change or add? We agreed to reach out to Minnesota where a vaccine trial would be soon underway for which I might be eligible.

At the same time, it could be prudent to wait until the next scan before making changes. We had no way of knowing if my current treatment was working, and for all we knew the wispy bits could be treatment-related inflammation. Whatever the case, the improvement of one area was certainly inspiring. I was likely safe from significant deterioration for the next two months, and I should be happy for that.

But I was scared. I was heartbroken. The miracle train had stopped, and I had deboarded. Without initially realizing it, I had made a list of things to do if the 29^th scan had been a definitive improvement: I would pick up my violin, I would restart learning Japanese. Hell, maybe I’d even start running or lifting again. But these were activities for someone flush with time. I’ll continue to invest in my relationships and to write and to ski. Who knows, maybe there will be another train to catch.