Of CT Scans and Kings....

March 8th, a day before my supposed scan, I got a call from Colorful Dress Lady of the CT Scan department. Apparently the scanner was broken, and I wouldn't be getting my scan and they'd reschedule for later in the week. Easy for them to say, they don't live four hours away. As it was, at least I got out of drinking the vile Gastrografin, though that wasn't to last for long....

No matter, I decided. I had to go in that day anyway for bloodwork, and would just ask my oncologist's nurse what to do. Maybe this time would be a chest x-ray, not a CT scan.

First stop, CT scan department. The scanner is indeed broken. The woman behind the registration desk (not Colorful Dress Lady) says tomorrow is a possibility.

Second stop, 11th floor. My oncologist isn't in today, but her nurse is. Thing is, she's not on Victoria 11, she's in the cancer center on Dickson ground floor. Whee! More elevator rides! But first I got my blood taken in the pleasant and wait-free confines of the 11th floor blood collection room. One elevator shaft and one hall later, I took a number and waited my turn. I explained everything to the registration desk person, after a few false starts.

It started simply enough, with the desk person asking, "How can I help you?" I told her who I needed to speak to. "That doctor isn't here today."

"I know, but I was told her nurse is."

"Yes, she's here."

"Can I speak to her?"

"She's not here today."

"Er, what?"

"I said, she's not here today."

"Not the doctor, the nurse. Can I speak to her?"

"Yes. Oh, wait, she's probably on lunch. So no. You'll have to wait." Fortunately, before I could beat my head against the desk, she did me the favor of phoning someone and finding out where the nurse was. As she dialed, she asked me "What did you say your name was?", but was cut off repeatedly by someone who kept switching between her and another person:

"What did you say.... Yes. No. Okay.... What did you say your name.... Yes. I need to find someone. Yes. What did.... 1643? Okay." She hung up the phone. She started dialing again. "I'll get it out yet. What did you say your name wa.... Yes, I'll hold." Finally, I blurted my name out. After some more talking to random people, the registration person said, "She's on the eleventh floor?"

I collected my jaw off the floor and insisted "They said she was here!"

Some more talking and the registration person hung up. "She is on the eleventh floor. You missed her."

Back down the hall and up the elevator, I got to the main desk at 11 Victoria again. After waiting my turn, I heard "You just missed her!"

"This time or last time?" (If it's this time I'm sitting on the desk and waiting it out.)

"Last time. I'll go get her."

Fortunately, she'd been briefed on what had happened by the time she saw me, and explained, "I phoned the doctor and asked her. She says to wait and see if the scanner's fixed tomorrow. We'll see if we can get you an early appointment. The only problem is that means you have to drink that Gastro-" She stopped and grimaced. Either she's great at empathy or she's had it before. I nodded, said I'd get some from downstairs, and take it that night.

The only catch is that I can't eat for four hours before my scan. Since I didn't know the time of the scan, I couldn't eat from four hours before I expect to arrive at the hospital, at 9 AM. So much for breakfast! Oh well, I've skipped it before and I'll no doubt skip it again.

I also had to procure a measuring device so I could sort out a 20 ml dose from the bottle I'd taken. Trivial enough, though all the local drugstore had was a child's medicine spoon. Hey, whatever works.

Incidentally, I took the twisty-turny stairs down from 11 Victoria North after meeting the nurse, since whenever I use that elevator down it seems like people need to stop at floors 5-9 inclusive. The stairs only get twisty and turny one floor away from the ground floor; everything else is fine. Though I did notice that most of the odd numbered floor doors are sealed off - you could get into the stairs, but not back out. One floor (one of the few with a window in the door) also seemed to open onto an office, rather than a hall like the others. Two people (a doctor and secretary, it seemed) sat chatting, oblivious to the crazy rantist peering at them through the door.

Finally at the hospital, I checked on the CT scanner. Still down. Colorful Dress Lady walked in and patted me on the shoulder "Hello Leonard!"

Desk person and Colorful Dress Lady again insisted they'd reschedule. Nearing the end of my proverbial rope, I said "For about three months from now." and took my leave without elaborating.

11 North waiting room, 9 AM; 40 minutes before my appointment. I was waiting to speak to my oncologist's nurse, intent on explaining the mess and getting an x-ray requisition. Much to my annoyance, the window was stuck open and blowing 60km/h -5 Celsius winds into the room. Much to my surprise, my oncologist showed up at 9:05 and said "My first appointment didn't show up. Want to wait around a few minutes and get finished early?" Who was I to argue with that? "Oh, and about your CT scan: We could just get a chest x-ray done, or I could get you an appointment at St. Martha's. The radiology is very good down there."

I ruminated on my last misadventure there for a split second. Between the ReadiCat (more vile than Gastrografin), the Esophotrast (the demon marshmallow that violates your throat with vanilla), the two-month waiting period, and my mounting desire to get this mess over with, I decided it just wasn't worth it. Faking up a more palatable response, I said, "I'd prefer the x-ray. Besides, I've had quite enough Gastrografin for the month."

She nodded, laughed, and vanished. Well, walked away, but she moves at quite the clip.

A few minutes later, the nurse showed up. I was weighed (down a few pounds, thanks to the flu killing my appetite for a week). Despite commenting on my weight being a bit high last time, she seemed disappointed that it was down, saying it was fine as it was. (Though perhaps it was due to the method of loss, rather than the loss itself.) No pleasing some people.

My oncologist showed up post-haste. She explained the CT scanner problem in more detail. She mentioned there were approximately three machines in the area. One is the broken one. Another is swamped with work and only taking urgent and emergency cases (though there's no emergency service at this hospital, long story). The third is an older one one door down from the broken one (I KNEW there was a second one there, given that I'd sometimes return to the waiting room to find other people were scanned while I was on the machine). The catch is that it doesn't do lymph nodes well, and that's what my oncologist is most interested in. (It's also why I've never even seen this second machine before.) So it would be a waste of time.

Tagging along with the oncologist was a doctor in training. Two years away from finishing her training, in fact. I don't know exactly what the subtle differences are between "intern" and "trainee" and such, so I'm just going to call her an intern-type-person and pretend it's right. If I remembered her name, it'd be even easier. She didn't exactly do much, though. After my oncologist examined my neck lymph nodes, she asked me if I'd mind if the intern-type-person checked my neck as well. Well, if she went through the trouble of coming down the hall to see me, why not? Not only was she substantially less rough about it, she quickly focused on my left side. She said to my oncologist, "Can you take a look at this?"

"Where? Point to it," my oncologist replied.

"Here."

"Hmmm." I was briefly throttled in the name of science. "Oh, that's nothing. It's just that he's muscular."

Now, "muscular" isn't an accusation I hear that often, since the push-ups I do when the spirit takes me (not often, lately) aren't exactly known for gifting people with the neck muscles of Lou Ferrigno. (And this is the first time my muscles were a problem.)

I had to know what was going on. "Uhhhh.... 'Muscular?'"

My oncologist picked up on my surprise and said, "It's because you're a healthy young male. Most of the people a beginning doctor sees these days are emergency room patients, who are often old and infirm. When I was training you'd find a lot more people in an emergency room who probably didn't need to be there. Bad in a way, but it was great for us because we'd get used to dealing with patients with simple problems first. Now, you have to sort out chronic problems from what they're in for, or what they're waiting for tests to come back on.... You know, if you lived closer, I'd ask you to come in and get interviewed by the new doctors."

"Shame," I said. "I wouldn't mind having the, er, paperwork looked over by as many eyes as possible."

"Funny you should mention that. Someone I know once had a case where he thought the patient had an undiagnosed case of depression. But since everything is supposed to be confidential, if you tell his regular doctor then you're breaking confidentiality...."

"And opening up a whole new can of worms with the other doctor." (She didn't confirm or deny this one. But I know people well enough to know that some doctors don't like their work being second-guessed.)

Incidentally, the rest of the examination was going on during this. Intern-type-person has already positioned herself so my oncologist will be in the way of, ahem, the scenery once I lowered my pants. Much better preparation than the nephrologist.

As I was getting dressed, my oncologist pawned off the x-ray requisition-filling off on the intern-type-person. (Ah, interns. Though she wrote out the bloodwork requisition for my next trip up herself.)

I went to the main desk, where they scheduled my appointment wrong (must fix that) and I didn't notice because I was too busy worrying about the still-deteriorating weather conditions.

Since I've taken the 11 South stairs before (previous updates) and 11 North before, I decided to take the 11 West stairs. These ones, for reasons I fail to understand, start twisty turny at floor 12 and straighten up on the way down. Whoever designed these things didn't do well on consistency.

Down to the 3rd floor, I walked up the Long Hall and grabbed a number at diagnostic imaging registration. It was packed. They were on #40, I was #57. I skipped off in search of a bathroom. And another flight of stairs. For different reasons.

Back a few minutes later, they were only on #42. I read a poster on PET scanners to amuse myself. Unfortunately, it had less on the technology than I already knew, and more on fundraising.

After registering, I tromped down the Long Hall (between this and the hall one floor below it, that's about the 7th time in two days) and tried to hand my requisition to the person there. She was more interested in chatting a coworker up about last night's reality shows. I proceeded to wave my paper, clear my throat, and otherwise annoy her into getting rid of me. She gave me the most perfunctory set of instructions and then proceeded to ignore me. I went down the hall and took off my jacket and dress shirt.

A number of people were ahead of me. Notably, when one fellow's name was called, he was nowhere to be found. Turns out he was in the main hallway waiting. Since he was in full hospital duds (down to the funny slippers that feel like stretchy styrofoam), I suspect he was an admitted patient. Meaning Lil' Ms. Reality Show at the front desk probably ignored him completely since she didn't have to take any paperwork off him, even to the point that she didn't tell him where he was supposed to sit.

My x-ray was quick. Strangely, the tech vanished just before the patient ahead of me was called and was replaced by someone who came seemingly out of nowhere. I asked this new tech if the radiopaque Gastrografin would mess anything up. She said "no, that should all be in your stomach and intestines now, unless you inhaled it". Wow, snorting Gastrografin. Sounds like no fun whatsoever.

This done, I (thankfully) left for home. Other than seeing two eighteen-wheelers off the road on the way back (told you the weather was bad), it was an uneventful trip. And once out of the immediate Halifax area, even the weather was nice.

(The second drink the next day would've been more appetizing had a bug not decided it was a good place to land. Stupid bugs, you'd think they'd realize the container of liquid held by the human is about the single worst place to land that doesn't have the words "bug zapper" in its name.)

It was the afternoon June 14th when I showed up in the Victoria building to be subjected to my regularly scheduled pincushioning. Unbeknownst to be, I was going to have 50% more pin for my cushion.

After the weighing (one pound up from last time) and the inevitable string of questions I expected, it was time to see the doctor. It wasn't long before I heard the familiar rapid left-right beat of her shoes hitting the floor.

Except it wasn't her. It was an intern (or whatever they're called), who had already picked up the habit of rapid walking. A very nice young lady, we spoke at length about some of the things the nurse had asked about, including such minutiae as regular self-examinations (can't stress this enough, guys - self-exam your testicles once a month, it's how I found my tumor).

Down to the Dickson first floor area for the first time in a while. Where, after waiting five minutes, they told me I was supposed to be upstairs like normal and they had no idea why I'd been told otherwise.

Four people in the elevator, again it only stopped at floor 11. This is depressing. An older man got off the elevator just behind me and walked towards the desk. The secretary/receptionist/whatever was otherwise occupied, so we stood by, waiting. He caught my eye gestured at something on the reception desk. I looked at it. Seemed to be a sign-in sheet. It meant little to me, though I suspected it had to do with chemo. I backed away from it a bit, even though I wasn't really blocking his access to it, then went back to waiting. He caught my eye again. "You got here first, you sign the sheet first."

Well, 'first' only by virtue of being last into the elevator. That seems even more trivial to me than a pair of identical twins arguing over who's 'older' because of who horned his way out of the womb first. Still, the point was moot. "Is that for chemo?"

"Yes."

"I'm not here for chemo. Just a checkup."

The older man nodded. "Oh. One of the lucky ones."

Something about his tone rubbed me wrong. Not strong enough to be malice, but not weak enough to be envy. Too sharp for irony, too docile for resentment. Even his face didn't betray his emotional state, neutral with a shading of something that didn't seem entirely well-intentioned, but might have been.

Lacking a proper response, I just grunted. To fill the awkward silence before it developed fully, I noticed he still had a substantial amount of hair and asked "So, how's the chemo treating you?"

It lost something in the translation and the response was "Every day this week." Before I could rephrase, the woman at the desk finished her work and called me over. A few seconds later and I was heading down to the waiting room.

This had been the second person that day who commented on my medical state in such a way that it left me with vague feelings of unease. While I try not to be superstitious, these visits put me on edge enough that I caught myself wondering if it was an ill omen.

I saw the nurse and doctor early, I think because the doctor saw me in the hall and knew I was there. As I was ushered into the last waiting room at the end of the hall - one with a unique view of the parking area due to its position at the end of the hall - I mentioned that I'd never been in this particular room before. The nurse jokingly said, "Well, we have to give you the full tour!" I spoke with the nurse at length, mostly about completely nonmedical stuff like man's inhumanity to man.

In the parking lot of St. Martha's, I was parked across from a Toyota Avalon. This was good luck - last weekend's New York Times Sunday Crossword had the clue "Toyota model" and all I had was -V---N. "AVALON" fit perfectly.

Unless I've misremembered, they've moved the "take a number" thing since I've last been in for blood collection. It makes some more sense now as it's not on the far wall, but it's in a place where someone just walking into the waiting room might not see it, because it's obscured by the privacy wall they've erected between the typey-people and the waiting room. Is this an improvement...?

With all the seats (not much - about a dozen and a half) taken, I was left standing in the hall with a few others. Next to me were a clatch of women chatting and gossiping. Where I was leaning against the wall and doing my best to look broody, they were standing in the middle of the hall and forcing everyone walk around them. Unsurprisingly, when the clatch broke up, one member went into the waiting room and proceeded to collect a second group of chatters, who successfully blocked the door between the waiting room and the blood collection room.

My number still three away from being called, I wandered away to check out that "cardio-something" room I had, years previous, mistaken for an opthalmologist's office. It's a cardiorespiratory clinic. How the hell did I mistake "cardiorespiratory" for "opthamology"?

I returned and the number counter still hadn't moved. More depressing, no one had been called to have blood (or assorted other specimens) taken. No wonder the place was packed. About ten minutes later, my number finally came up for typing adventures. In that time, one person was called in to get jabbed.

After exchanging greetings, I handed over my pile of paperwork, health card, and slip of paper with my number on it. After confirming I was who the system thought I was, the woman started typing in the information on my requisition form. It appeared to take her a bit of time to acquaint herself with the Halifax-style form, and to dig up the names of the Halifax doctors on her computer, but she got up to speed. She seemed very competent, better than some of the ones I've seen.

I noticed that, after a short time, the machine started beeping when she typed and she was using alt-key combinations far more than she looked comfortable doing. She excused herself and went to talk to the people in the blood collection room. I considered leaning over the desk and confirming my suspicion that the phrase "Maternal Studies" was somewhere on this screen.

Instead, I waited quietly. When she came back she kept typing for a while, before stopping to grab a sheet from under her keyboard. "Beta HCG....", she mumbled.

Without missing a beat, I said, "BHCG." But she was faster than some of the others - she'd already found it.

"You're right! You've been down this road before a few times, haven't you?"

"You could say that, yes." She finished her work and printed off the labels (two, one for LDH and one for HCG and AFP), paperclipping them to my number slip and to my requisition before handing the pile to me. I skimmed the paper and asked, "It tried to send me to Maternity again, didn't it?"

"Oh, no, it just asked if the results should be sent to Maternal Studies." Well, close enough.

"That always happens. Believe me, I've got a few weird looks over it."

Evidently I'm more clever than I thought I was, because she laughed. I left to wait again. Eventually, a second phlebotomist came on duty and people started going through the blood collection room much faster. It didn't happen fast enough to keep me from becoming utterly bored, though. I read some of the other, unchecked, tests listed on my form. I guessed at a few chemicals with standardized names* and took particular interest in the section with items like "barbiturates" and "ethyl alcohol". Some evil part of me wanted to check those off, just to see what would happen.

(* Lipase, for instance - obviously a fat [lipid] related enzyme [-ase**]. Proper definition from dictionary.com: "An enzyme secreted in the digestive tract that catalyzes the breakdown of fats into individual fatty acids that can be absorbed into the bloodstream".)

(** Short educational moment at end of item. Because I feel like it.)

I was called some time after reading the name of the number-slip dispenser company for the second time. Getting the blood taken was quick and almost painless. Kudos to the phlebotomist.

And now comes the waiting.

The one I get tested for is lactate dehydrogenase. The biggest difference between lactic acid (lactate) and pyruvate is a pair of hydrogen atoms. These enzymes (there are several) help remove the hydrogen from lactic acid to make pyruvate, or turn pyruvate back into lactic acid. With some cancers, there's more of this in one's blood.

The ones that build our DNA are polymerases. (DNA, after all, is a polymer - a long molecule built up of smaller bits called monomers.)

One without an obvious name is the enzyme diastase, which separates starch into dextrin and maltose. Its name comes from the Greek "diastasis", meaning "separation". It's the one from which we first got the "-ase" naming convention.

The one that copies RNA back into DNA, against the natural DNA->DNA and DNA->RNA 'flow', is called reverse transcriptase, and is responsible for a lot of HIV's trickery. Unlike a lot of diseases, HIV exists as RNA that is copied into DNA at the point of infection. HIV's reverse transcriptase is a lot glitchier than our polymerases, so HIV doesn't always copy properly into our DNA - in other words, HIV mutates, and it mutates a lot. The faster mutation rate allows it to adapt to external pressures (like anti-HIV drugs) rapidly, which is why patients with HIV take so many pills. You have to sledgehammer the disease with everything you have, else it will rapidly grow tolerant to any one treatment.

Whenever our DNA copies, the last few bits fall off - if DNA were a string, then it's like the string starts to fray. We have a defense against this, called telomeres - junk DNA that just exists so it can fray off without hurting the information contained within the DNA. The catch is, as we age, our DNA has copied so many times that eventually there's no more telomeres and the information does start getting damaged. Once that happens, the cell dies with no hope of repair. This is one of the things that causes our bodies to fail as we get older. There's an enzyme that rebuilds telomeres, called telomerase, that essentially stops the fraying from ever happening. (A funny thing - because telomerase's telomere 'blueprint' is RNA and not DNA, telomerase is also a reverse transcriptase.) Most cancers have 'relearned' how to generate and use telomerase, a trick only a few cells in our body can naturally do. (Stem cells, which need to divide a lot, have limited telomere regeneration.) Because of this telomerase, a lot of cancer cells are immune to the ravages of time. A prime example are the HeLa cells, cervical cancer cells from a woman named Henrietta Lacks, who died in 1951 in her 30's. Those cells are thus well over 80 years old and still multiplying as strong as the day they were first removed from her. It's a sick and subtle irony most cancer patients never know: The immortality we've sought for millennia is contained within the cancer cells that kill us. While a cancer cell can die from disease or chemicals or starvation just as a human can, it will almost never die from old age.

But who knows? Perhaps, with research and experimentation, this is the path down which the forging of our own immortality lies. Now that is an irony I could live with.

Speaking of the washrooms, the other men's room on this floor was renovated recently. I walked in and had that panicked instant where I wondered if I'd stumbled into the women's restroom by mistake, before trekking forward and spotting the urinal. (I suppose I could've reopened the door and checked that, but then there'd be risk of someone in the hall seeing me. In retrospect that's not great logic, but after one accidental ladies' room trip in my life, the brain shorts out in this situation.)

I roamed back down the hall and waited some more. A doctor (not mine, but one in the same office) came by and helpfully unlocked the door for me five minutes early. I went in and spoke to the secretary. It took a good bit of effort to convince her that I was supposed to be there. Eventually I told her to ask the doctor. She did, and I guess he gave me the okay. I was led into a small room that I've seen him use for quick visits or as a second examination room. Judging by the soft toys and pictures of what babies can do (and look like) at 1-12 months on the walls, I suspect it's also an infant examination room.

Of course, that makes this one quit-smoking thing on the wall somewhat incongruous. It's aimed at the parents, perhaps, but you can't help but think it's meant for chain-smoking infants.

My doctor popped in a minute later and, after brief greetings, got the needle ready. He said it wouldn't be a long visit, but rather a "quick and painless" one. He also added that he prided himself on painless flu shots. Then he took the wrapper for the needle and tossed it at the garbage, missing by a wide mark. I said "I hope it's more painless than your aim is accurate. No, wait. Did I say that right? More painless... accurate.... Uhhh. Hmmm." It was somewhere during my attempts to untangle myself from the verbal mess I'd made that he jabbed my arm with the needle, and I was so involved in my thinking that I barely noticed. When I was a kid, he'd distract me by asking me about the colors of the suncatchers on his window. Now, I helpfully distract myself.

I finally gave up and said "You know what I mean." and noticed he was almost done packing everything up.

He asked "Painless?"

I smiled. "Painless. Of course, I just had an IV and bloodwork today, so I might be a touch biased. Flu shots are nothing."

"Speaking of bloodwork, you had a bit of a scare there."

"Yep, but it seems everything's okay now." (Unbeknownst to me, I was speaking too soon.)

"Yes, the interim bloodwork came back fine - I get copies of everything sent to your oncologist. These things happen sometimes, something will jump up but then go right back to normal. You're doing fine."

I thanked him and left.

I walked to the top without thinking too much about the signs and, much to my surprise, found myself staring at a door labelled "FLOOR 12". Apparently, the west wing stairs go a floor higher than their southern counterparts. Back down a floor, I finally noticed the sign that said there was no exit above Floor 11. Well, there certainly was, but the door might not have opened from this side.

I walked out the Floor 11 access and found that all the jostling up and down had (illogically) quieted my guts substantially. Which was a good thing, as the front desk secretary saw me from down the hall and called me over. I don't like witnesses to my frenzied Gastrografin-charged rushes to the bathroom. (Another person who remembers me? I've hit the jackpot.)

"So," she said, "you took the stairs?"

"Yep." I said, managing to get it out between gasps.

"You're in better shape than a lot of us."

If I were in better shape, I thought, my legs wouldn't be filing for asylum on someone else's body.

Curiosity (and a newly-added television flooding the waiting room with Regis Philbin) encouraged me to try the 11 North stairs and see how far they went. I did. They didn't stop at 11. Nor 12. They stopped at 13, again with the warning that there was no exit above 11. So we have a staircase from 2-11, one from 2-12, and one from 2(?)-13. Who designed this place? and what the hell happens on those top two floors?

After a while in the waiting room, my oncologist's nurse showed up. Before I could react, she was pulled into a conversation with a couple who were in the waiting room a few seats down from me. They gave her a present of some sort, and hugged her. After the chat ended, the nurse told me to follow her.

Once out of the waiting room, I said, "I feel terrible. Christmas and I didn't buy you a thing!"

She gave me a look and said "No! Don't worry about that. I appreciate the things people give me, but I feel bad about it. I mean, I'm not working here for glory and gifts. My personal life is full."

I almost said, "My living room's cluttered, too." but I left it pass.

The nurse told me my bloodwork was fine, asked me all the regular questions. We picked up on the topic we were discussing last time, making the intervening three months one of the longer pauses in face-to-face conversation I've ever had.

A few minutes after the nurse left, my oncologist showed up. That's what happened with the funny bloodwork. I didn't like that.

After exchanging niceties, she sat down and showed me the newest bloodwork. "The irregular bloodwork from last time had your HCG at two when" (flip back through the previous 3 bloodwork results) "it's normally one or below. The interim bloodwork came back as" (flip) "0.1, which is very low. These things happen sometimes. If you take enough blood samples, eventually something will be elevated on one of them.

"But now," she continued, "there's this." She pulled out the radiologist report for my CT scan. I noted with some surprise that a paragraph of the report was stamped with a page-wide CAUTION stamp. She read through the report out loud, though she didn't pull any punches as far as the medical terms went, so I had a hard time following along. She stopped to explain one part carefully, though: I seem to have a triangular opacity on my lung. But it's apparently been there for a while, so it's nothing to panic about. I have to admit I wasn't listening as well as I should have been. Maybe that distractingly worrying CAUTION paragraph had something to do with it. (This is why they tell you to bring someone with you who can listen for you for your first few treatments.)

The caution paragraph was devoted to a lymph node in a Latin-named region which my doctor said roughly corresponds with my midriff. Apparently, in the six months between CT scans, one of my lymph nodes has grown from 1.0cm x 0.5cm to 1.1cm x 1.0cm, roughly a doubling in size along one dimension.

"Now, I don't think this is something to panic about. For one thing, you bloodwork is fine. For another, this lymph node is in your front, and the ones where we'd expect to see changes first are all in your back."

"Which is why some testicular cancer patients need that surgery where the surgeon puts their intestines in a sterile bag to get at everything in back. RP... uh...." My mind groped around in the dark for the last three letters of RPLND, but my oncologist did me one better:

"Retroperitoneal Lymph Node Dissection," she said, with the practiced ease of someone who knows what the peritoneum is.

"Yeah, that one."

Continuing to read the papers in her hand, my oncologist pointed out that radiologist report recommended a followup in three to six months. "Since you're moving to four months between visits, that's exactly what I think we should do. So next time you'll get another CT scan. And I want you to get bloodwork done at the two month mark, just in case. With what you had, I think anything that comes back will show up in the bloodwork very early."

She filled out a bloodwork paper and wrote two dates on it, one for February and one for April. "Now, when you take this to your local hospital, get it back from them for use your next time here." She suddenly looked off into the distance, her face tainted with a touch of uncharacteristic pensiveness. "You know, I should've been doing that all along."

I silently lamented the trees and took the proffered paper.

She snapped back to the present and looked at me. "We're going to watch you closely, but I don't think this is something to worry about. It's not in the right place, and well over 90% of recurrences in men like you have happened before Year Four." She gave my leg a slap. "And you're not going to be in the other ten percent, you hear me?"

I smiled. "I'll try my best not to be."

There's probably not a lot of guys in this world who can truthfully claim they have a professional relationship with a woman who slaps them around a bit and then gets them to take off their clothes. I'm one of them.

The physical examination was the same as all the others, but in keeping with the strange subject matter we sometimes discuss while I'm on the table, this month's chatter somehow got onto the topic of my social life.

"So there was this girl at work," I said as I was getting dressed, "who I thought was really cute. Had something of a crush on her, actually. So, I took a day working up the nerve to talk to her, and fifteen minutes later, I was ready to gnaw one of my own legs off to get away."

My oncologist tapped her head with a finger. "Nothing up here, huh?"

"No."

And with that moment over, I was dressed and ready to leave. We wished each other a merry Christmas, and went our seperate ways.

And that's year three post-surgery done. Looks like there'll be an update in two months as I get more interim bloodwork done. See you on the other side of the calendar change.

Best wishes to you and yours,
The Archon