The biopsy – tomorrow

This week has been filled with surgery consultations, calls with nurses, logistics etc. I ended up skipping the trip w/family to Boston because I needed to deal with this biopsy decision, consultations and etc. I was originally scheduled to have it done yesterday (wed) but that moved to Friday (tomorrow). So I’ve been flying solo for a few days which is both good and bad. Good because I can tie up some loose ends and get stuff done around the house and catch up with some folks I haven’t seen; bad because I’m not with family during the holidays – which is a real bummer despite facetime/technology.

The biopsy is much less straightforward than expected. Turns out the location of the tumor they are sampling is non-ideal. Specifically it’s attached to the mesentery which supplies the small intestine with blood. Injuring this area would be bad. So the original plan was to needle biopsy this area laproscopically using 3 ports: 2 for navigation/cutting, one for visualization. But a needle would poke the tissue blindly too close to that area. Another surgeon available looked at the scans and suggested doing this open where he can use his hands and stem any bleeding manually. Why screw around? This would be a 6″ cut down my abdomen – WAY more invasive than originally planned, or than the original biopsy. But potentially safer despite 2-3 weeks of recovery. Ugh!! This is a balance of safety vs. recovery vs. getting the best sample possible. And of course all this is in the bigger context of time and planning. Again I want this done asap. There is no perfect in these kinds of situations.

I requested a call with the surgeon that wanted to open me up. The surgeon and I aligned yesterday on a compromise – he will first attempt to do this laproscopically. But he will not use a needle but rather some other cutting tool. If he gets into trouble or can’t get a good sample he will then shift to open surgery. I put together a quick model below to ensure I wasn’t missing anything glaringly obvious and that this approach makes sense.

In the model laproscopic w/open scores close but higher than just doing open surgery. I basically combined the 2 likely outcomes of lap w/open to derive a single score for the decision to go with this approach. Note that lap w/open specifically means starting with laproscopic with an option to switch to open surgery should a) complications arise, or b) the surgeon can’t get a good tissue sample. I think the decision output makes sense despite the weightings and scoring system being complete SWAGs (medical friends please chime in if I’m missing something obvious; one example might be inclusion of surgeon quality though I really haven’t been able to find a way of assessing this except back-door knowledge through other surgeons which is obviously time consuming and not scalable). Based on this I don’t see a strong argument to ONLY do open surgery. As I see it the main way this model could be off is if I’m grossly underestimating the risk profile of the laproscopic procedure, e.g., regarding intestinal damage (which would require a resection) or bleeding, but based on conversations with 2 Kaiser surgeons and one friend who does this kind of thing (thanks Charleen!) I don’t think this is the case.

Meantime the whole family is in Boston. They’ll return on Friday evening. My brother is flying in tonight to support me while Michelle is out and to help with all the things that need to happen (e.g., transition to/from hospital) – whenever that is. This is supposedly outpatient but if they move to open surgery I’ll likely be staying overnight, possibly more. So there’s a very real possibility I’ll be spending new years in the hospital. And for sure in lots of pain.

The other day I treated myself to a movie – first in I can’t remember how long. I saw free solo on Christmas. This was the perfect movie for me to see given my situation. I cannot recommend it highly enough, whatever you think about the ‘sport’ of free climbing (lots of people plummet to their deaths). The one sentence summary is Alex Hannold climbs El Capitan in Yosemite without ropes becoming the first person ever to do it. But this really doesn’t do the film – or the staggering accomplishment – justice. The stakes are perfection or death. The cinematography is phenomenal. But what’s most interesting is the mindset and psychology of such a feat. And the training and strategy to prepare himself. He essentially breaks up the wall into 6 main sections. He works each one with ropes until his comfort level is so high that it totally eclipses his fear (a quite fascinating way to think about fear). There is a fundamental and raw element of the human spirit on display. This is worth watching if only to check your own values against someone who likely differs from you in significant ways. For example he is non-materialistic (lives in a van), abhors comfort (obviously), and is willing to risk his life for what he loves (would you?). I found myself relating to him despite our significant differences. Going through cancer one realizes how precarious life is. This type of rock climbing heightens that sense and I suppose that’s a large part of the appeal; living on the edge quite literally. Anyway as a metaphor for life it’s perfect. At one point he says his main value is performance and the warrior spirit, while his girlfriend values comfort. It’s interesting to see how this psychological oil and water mix.