Put to the Testicle, Part 2

So I found myself getting thick blue dye slowly injected between my toes.

I chose Memorial Sloan-Kettering Cancer Center in Manhattan for my post-operative tests and treatment, as I might as well take advantage of my proximity to one of the world’s best cancer centers. Given the dire cases they confront, mine would likely be a day at the office for them anyway. And I trusted that the high costs went toward more than the zen-inspired design of their tranquil but lavish waiting rooms.

On my initial visit I limped in and filled out a series of forms. Any diseases in your medical history? Well, cancer, I guess, which is why I’m here. Are you sexually active? Not lately but what can you do. I turned over my prior blood test results, Xrays, scans and biopsy slides from my previous doctors but was told I’d need another full round of scans on Memorial Sloan’s own equipment. Now when a dentist pulls that kind of thing I might think he’s behind on his boat payments but here I didn’t protest. So they removed my staples (thankyouthankyouthankyou) and scheduled me for some CT scans. Turns out their imaging equipment was indeed newer and their barium cocktails still-bitter but a bit better.

My doctors at Memorial needed to observe the progress of my surgical wound, so they examined me on a few occasions. Now this was easy when it was the urologist and his male medical intern, but not so when his other associate, a beautiful young co-ed, took part. Reminded me of the Twilight Zone episode in which a thief uses his power to transform his face to escape crime scenes. Trapped in an alley by his pursuers, he tries in vain to think of a face to change his into. With only seconds for me to concentrate and hopefully sport a semi, I tried in vain to conjure up some arousing thought but — nothing! I'm choking!

Having been blessed with good health my whole life, it took some time for me to get used to being among very ill people, and it was jarring amid the studied hipness of New York to see people of all ages simply fighting for their lives. On my first day there I waited with a girl of about six or seven. She was losing her hair and looked fatigued, but appeared unafraid. She seemed comforted by her mother, and her brother bothered her until she couldn’t keep from giggling. She looked remarkably like one of my nieces. A week or so later, wearing a hospital gown in an elevator on my way to some test, a nurse wheeled in a woman about my age. She’d apparently suffered some sort of bone cancer, as the left side of her jaw was absent, the graceful curve of her jawline on the right side of her face abruptly sunken in on the left. I was happy to notice that she was wearing a wedding ring, when she looked up at me. Her eyes held no sign of self-pity, just real fear. In our matching getups we looked at each other for a few moments and I smiled at her with as much kindness and concern as I could muster. She was probably in too much pain to return the smile but her eyes watered, as mine did as well. I recall wishing more than anything that she was loved and appreciated, that her husband was wonderful.

Once my doctors had full information to determine my course of treatment, chemotherapy was deemed unnecessary, because the biopsy indicated that my tumor had been a seminoma, the less-aggressive type of testicular cancer, and because no swollen lymph nodes were detected by my radiologist. Considering the size of my tumor and the amount of time I had procrastinated, this was very, very lucky. Since I’d need radiation therapy, though, my urologist referred me to a radiation oncologist who would take things from there.

It was recommended to me that I look into sperm banking prior to my radiation therapy. Apparently it’s a good idea to freeze some soldiers as a means of fertility insurance because surgery and radiation can damage the reproductive system. My radiation treatments were to start in two weeks, so I hadn’t much harvesting time. Years ago as a lowly temp I worked at a small office with key to access the bathroom; the key was kept at the front desk, where sat a comely receptionist. I don’t recall using the facilities that week. Now years later here I was at ReproLab; this whole procedure was humiliating enough without having to hand some Natalie Portman lookalike a cup. Anyway, I walked down a hallway and the dowdy clinic became a seedy Bangkok porn palace as thank-you cards and baby snapshots gave way to dog-eared smut magazines. The Collection Room offered a dimmer switch among its mood-setting amenities. One thing I learned through the process of storing the troops was that apparently my sperm count’s so low I can’t even adopt. The technician said I was in the low-end range for the number of swimmers useful for your basic artificial insemination procedure. All in all, a wholly humbling experience.

Although none of my tests had found evidence of the cancer spreading beyond my tumor, it was determined that radiation could eliminate any cancer cells that may have metastasized to my abdominal lymph nodes. My oncologist told me about my upcoming treatment — a few imaging tests, some measurement procedures, then twenty sessions of external beam radiation — and handed me a pamphlet entitled Radiation and You, which described most of what was ahead. Unfortunately it didn’t cover Lymphangiograms.

The Lymphangiogram is an imaging procedure that might have made Josef Mengele proud. It’s a step in creating the lead plates that shield your body from radiation during treatment. (When receiving external beam radiation, you lie there and get blasted as thick, carefully-shaped plates prevent nearby organs from getting nuked. In order to carve these plates with precision, extremely detailed Xrays of one’s lymph system are taken.) To provide the imaging contrast that makes these Xrays possible, a dye must be introduced into the patient’s lymph vessels. This is injected through catheters on the top of each foot. Worse still, to help pinpoint the vessels in the foot for the catheter’s insertion, the doctor injects dye into the patient’s feet, which makes the lymph vessels visible.

So I found myself lying on an operating table getting thick blue dye slowly injected between my toes by an oversized syringe resembling the one the guy used on corpses in the 1985 horror film Re-Animator. My relief after the first injection vanished as he turned back around with another full syringe and I remembered I had three more to go. Once the dye had dispersed in my feet, the lymph vessels now looked like dark veins. I’d soon find that the lymph system closely mirrors the circulatory system, though we never see it because it carries colorless fluid rather than blood. It had indeed been awhile since high school biology.

After a nurse administered a prickly pedicure by scrubbing my feet with a sterile solution, the doctor again injected my feet, this time with a local anesthetic. Once numbness set in (though not enough for my liking), he went to work. For some time I sensed occasional muted pain accompanying tugging and rubbing on the tops of my feet. Peering down after awhile, I spied more dye and blood than I’d expected. Deep indigo stains had spread between my toes. Amid a tangle of suture thread, a delicate tube was taped to the top of each foot, and blood fanned out in an inverted V from that point down to my ankles. An Xray monitor above me projected the image of dye travelling up my legs at a glacial pace. As my lymphatic system became illuminated on the screen, a burning sensation moved from my legs to my hips. I lay there and waited for the pain and stiffness to spread through my upper body as well. It helped me greatly to bear in mind that this was a mere suggestion of the pain that is chemotherapy.

When all the dye was injected I was stitched up and instructed to walk around to allow the dye to diffuse throughout my body. Padding up and down the hallways in my bloody hospital slippers, and still limping from my original surgery of a couple weeks prior, I couldn’t help but consider what a sorry sight I must be. When the Xrays were finished, I gingerly laced up my shoes and shuffled to the subway to work for the rest of the day. I now sport very realistic-looking stigmata wounds on my feet, as if I took part one of those Easter reenactments of the crucifixion that they do in the Philippines. And if peeing Tidy Bowl blue for a few days was my penance for avoiding chemotherapy, I was happy to pay it.

Now that all of my imaging tests were complete, measurements made, and protective plates fashioned, I had a daily radiation appointment for about a month. Although each session was painless, I could feel the radiation coursing through me like a current, a subtle but unmistakable and strange sensation. Likely side effects were to be skin burns, hair loss, and nausea. I did lose the hair on my chest and stomach and, given my aversion to body hair, I was disappointed when it eventually grew back. My only troublesome side effect was nausea, which was made more challenging by riding the hot New York City subway in June. Following my first treatment, I was on a train heading back to work when a bead of sweat broke free in the small of my back, creeping down like a spider, giving me a terrible chill. I knew I had to leave he train but held out for the next stop just in time to discreetly puke into a train platform trash can. It still makes me wonder how pregnant women — there must be thousands — commute to work on the subway. (Indeed one unexpected result of my cancer bout was identification with mothers the world over: My surgical scar wasn’t far from a C-section, while radiation nausea let me experience morning sickness. Though I’ve yet to compare scars with my sisters-in-law in a sort of cesarean scar-off.) Modern medicine once again offered a solution, as a Compazine prescription helped to mitigate my nausea for the duration. We really do have it easy these days; we have it so well.

Soon my cycle of tests, treatments and checkups was complete. The only lingering radiation side effect worth mention was about four more months of persistent ulcer-like symptoms, which made for many a Maalox moment but was mostly manageable.

While it was certainly no fun, it would be wrong to equate my experience with the millions of other cancer cases that are far more serious. A great many cancer patients face the very real possibility of their death; I did not. And though I had a few weeks of genuine uncertainty, the question at hand merely concerned the severity of my condition and thus my course of treatment; never my survival. So I feel at times like a mere dabbler, a cancer dilettante. I had simply to follow the steps prescribed by my doctors at each stage. I appreciate that I’m living in a time and place where something like this is not only treatable, but rather unremarkable. And although the process would ultimately cost me several thousand dollars out of pocket, my medical coverage saved me from real hardship. One can’t complain if the most lasting evidence of a bout with cancer is tall, Dr. Seuss-like stacks of insurance papers and hospital records.

I feel very much like I’ve won the cancer lottery. If this is the only cancer I contract in my lifetime, it appears this was the one to get. For some time now my cancer has been under surveillance, requiring periodic follow-up tests. While walking through the lobby after one of those visits, I passed the woman I’d seen in the elevator long before. She wasn’t in a wheelchair this time, but was sitting very close to her husband, sharing a confidential laugh. At that moment, even though this didn’t involve me in the least, I can say without exaggeration that I was happier than I’d been I think in years. Above all I felt lucky. Check your nads boys.


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