Discovery and Diagnosis

Discovery
On Sunday, July 30th, 2017, after a great weekend of camping and hiking, feeling healthy and vital and just plain old good, I looked in the mirror and noticed a sizable lump on the left side of my neck, just below my jaw. It had appeared instantly. One moment nothing, the next moment a lump. And this is where my cancer story begins.

Over the next few days I did have some other symptoms - mild sore throat, fatigue, a bit of ringing in the ear - but nothing alarming. After roughly two years of not even catching a cold, I assumed maybe some strange virus had finally caught up to me. Nonetheless, I made an appointment with my primary physician.

Investigation
She had the same initial conclusion - very healthy guy, likely just a passing oddity of a cold - but initiated testing to be sure. We eliminated the mumps, and my bloodwork was normal. An ultrasound scheduled for a few weeks out - should the lump still be there and, frankly, neither my doctor nor I really thought it would be - would maybe give more clues.

The lump remained and we did the ultrasound. It confirmed that, indeed, I had a lump in my neck. Likely a lymph node. An MRI was recommended.

We didn't wait weeks for this. Within a few days I had done my MRI. By the way, this was a fascinating experience. I was placed on essentially a large tray, with a comfy warm blanket draped over me, earplugs in my ears and a plastic cage-like device over my face. The tray slid into a cocoon-like tube. I am not claustrophobic, but this was a bit intimidating, so I decided to try to use it as a chance to meditate. Wow, was I right.

I describe the actual scanning as a series of sonic events (they are not sonic like an ultrasound, but they involve a lot of sound for the patient). Some of it was pulsing, some of it was long stable tones. Some of it had intricate harmonies underneath, and some of it I swear had percussion. I lay in the tube, completely isolated, breathing deep and focusing on the tones. The 40 minute process passed by in a flash and I left the medical center in an unexpected state of relaxation.

Good thing I was relaxed, because as soon as the results were available my doctor called and said we needed to get a PET/CT scan. The MRI had picked up, in addition to my funny neck lump, an abnormality in my throat.

The PET/CT works as such: radioactive glucose is injected into your blood stream. Active cells - heart cells, brain cells and, oh yes, cancer cells - take up glucose more quickly than less active cells. The PET/CT scan involves a similar, but less claustrophobic and much less sonically interesting tube-like scanner. Once the radioactive glucose has had a chance to circulate through your body, they put you in the tube and scan to see which areas of the body are taking it up the quickest.

Sure enough, an area of my throat, along with this one lymph node, showed up nice and bright on the scan. They were loving the glucose.

Now that this test showed something serious happening in my neck, it was time to see the Ear Nose and Throat (ENT) specialist. Friday morning, September 1st, the beginning of the Labor Day weekend, the ENT's office calls me at work, just as I was eating my breakfast of fresh berries and plums in low-fat yogurt to see if I can come in within the next hour. With a bit of a knot forming in the pit of my stomach, I said yes.

Diagnosis
My memory on this meeting is a bit blurry, save for a few details: My ENT is in a new facility, and the architecture is great, with lots of open space and natural light. The receptionist was warm and treated me kindly. The nurse/medical assistant (I don't remember exactly) has a great smile. The ENT himself seems vaguely familiar, like someone I might have grown up with.

Right off the bat, we got into it. He told me that we could not confirm anything until we did a biopsy, but he felt very confident that I had throat cancer. He even felt confident he knew what kind.

I asked a lot of questions. He was patient and somewhat cautious. I am sure the range of reactions is varied and I felt he was gauging mine with each bit of new information. At some point I asked one more question, I don't remember what it was but it was basically about how sure he was. His look said it all. But then he also stated it clearly,

"You have cancer."

And with that he preps five syringes. Time to collect samples for the biopsy. He starts by aspirating the lymph node, the funny lump in my neck. The needle going in stings a bit, as he warned me it would, but the sensation of tissue being pulled from my neck into the syringe is what gets to me. I was breathing as deeply and slowly as I could but I couldn't get my mind to settle. Thoughts were racing through it while a feeling of levitation entered my body. I was feeling disoriented and ungrounded. After the third one I had to recline in order to not pass out.

I bounced back after a couple of minutes and he finished with the syringes. Then it was time to scrape my throat. He numbed me up and took a couple of small chunks of tissue. This wasn't too bad. Much better than the needles in the neck.

We talked next steps: wait for the biopsy to confirm the diagnosis, but in the meantime begin early preparations for treatment, i.e. look into arrangements at work, postpone major travel, start telling family and friends, with the caution that the biopsy was still needed to confirm everything. We would meet again in a week to finalize things and go from there.

We wrapped up with a handshake. I wandered out to my car, forgetting to stop at the kind receptionist's desk to book my follow-up.

The parking garage felt cavernous and empty as I found my car. I slumped into the driver's seat, breathed deep and dialed our home number. As it rang I felt myself falling through space, completely untethered and completely alone.

Marissa picked up and I told her right away,

"He says I have throat cancer."

"What?" she said, as if she hadn't heard me clearly.

"I have throat cancer."

"What?" This time I knew she heard me, but had the same disbelief I did when I first heard.

Yes, I told her, this is what the doctor said. It still needed to be confirmed through biopsy but he was very sure it was cancer.

She paused for one deep breath and said,

"Okay then. Let's do this. I am ready."

And suddenly I was no longer lost in space. I was no longer alone.