The opportunity for a meltdown occurs when you first hear the diagnosis. Cancer is like that. The moment you get that diagnosis is etched in your memory. It’s similar to how people know exactly where they were and what they were doing on 9/11. The news can be disorienting, and over the first few days your emotions can swing wildly. When I reflect back on my own experience, I now know that how you internalize the diagnosis is very important for yourself and for the people who care about you. Take it slowly. It is important to go with the flow during that time. Don’t alter your near term plans. It’s not a time to make big decisions or big changes. Here’s how it happened for me.
For a couple of months (my wife would say for even longer), I had been experiencing periodic hoarseness; no other symptoms, just hoarseness. I remember researching the causes of hoarseness, and way down this list was the “C” word. I took note, but I was not particularly concerned. By early January, the hoarseness had gone from episodic to persistent. So, I was off to see my primary care physician, who then referred me to an ear, nose & throat specialist
When the ENT doctor examined me, his camera quickly revealed the likely cause of the problem. I had a polyp on my vocal chord. The doctor explained that he would surgically remove the polyp, and he said that more than likely this would resolve the problem. He explained that the polyp would be tested to determine whether it was benign or malignant. The surgery was scheduled, and I hoped for and expected a successful outcome.
The surgery (known as a Laryngoscopy) was conducted on February 1, 2017. All seemed to go well. I had expected my voice to return to normal after a week of rest and healing. But this was not to be the case. Something was still not right. My voice was not recovering.
My post-surgical follow-up visit was delayed by a snowstorm. Because of my schedule and the limitations of the doctor’s office hours, my appointment was ultimately pushed out to Valentine’s Day. Coincidentally, this was the same day that I was scheduled to depart for Antarctica. It was special trip with and for my daughter, Krista, arranged over a year ago to celebrate her receiving her MBA from the University of Texas.
Mine was the first appointment of the day. I arrived early, as in less than an hour, I would be on my way to JFK airport to fly to Argentina. After parking my car, I sat for a few minutes and reflected on the likely outcome of my meeting with the doctor. What would I learn in just a few short minutes? Should I expect to learn that the polyp was malignant? While I hoped for good news, my instincts told me that I should prepare for the worst. I remember asking myself “what’s your prediction?” As I opened the car door, my mind told me to get ready for the ‘C” word. While a part of me still hoped I would not receive a cancer diagnosis, the fact is that, at that moment, the mental and emotional battle had begun. I had already started thinking about how I would deal with it.
Before I knew it, I was in the examination room and, much to my surprise, the doctor showed up promptly. It had been almost two weeks since the surgery to remove the polyp. The doctor had received the biopsy results well over a week ago. We talked about how the winter storm had played havoc with our schedules. He told me that he was going to call me earlier, but when he saw I was on his schedule he decided to wait. He could hear that my voice was weak and raspy. He wasted no time in explaining that my voice had not recovered because of the cancer. The biopsy had shown the polyp to be malignant. Boom! There it was. The dreaded diagnosis. Time seemed to stand still. Even though I thought I had prepared myself, the truth is that I felt like I was in shock. My rationale self started to ask questions. How far along was the cancer? Was it treatable? What would treatment entail? What were the next steps? But I am not sure I was fully hearing the doctor’s answers.
The doctor was calm, and I tried to be as well. He spoke positively about the prognosis. I thought he said something like “it seems we caught it early” evidenced by the fact that my only symptom was the hoarseness. He also said something about the biopsy results suggesting that the cancer could have had its origins with a virus. But he did not say whether that was a good or bad thing. Then he explained that the typical treatment would entail 6-8 weeks of radiation and, potentially, chemotherapy. It was too soon to say with any certainty. Special testing would be necessary to determine exactly how wide spread the cancer was. The biopsy of the removed polyp only confirmed that there was cancer in my throat. But how far had it spread? Getting a pet scan would be the next first step.
I had told the doctor previously about my planned trip to Antarctica. Now, in light of the diagnosis, I asked him if I should still go. He did not hesitate or hedge in answering. “Absolutely” was his advice. He said it could take at least a week or more for a pet scan to be arranged. He also said that it would take some time to research oncologists and get an initial appointment scheduled. “Of course, go to Antarctica” he said. “I would.”
Before I left his office, I had an appointment scheduled to get a pet scan. It would happen the day after I returned from Antarctica.
It seemed like hours since I had arrived at the doctor’s office, though it was probably only about 15 minutes. And ever since the doctor had told me that the biopsy revealed the cancer, all I could think about was “how would I break the news to my wife?” The ride home from the doctor’s office took about 20 minutes. The entire way I thought about what I would say and how I would I to say it. I hated that I had to put my wife through this. Ugh. Would it make sense to wait until I returned from Antarctica? It took only a second to dismiss that idea. The only thing that made sense was to share exactly what I had learned, without embellishment, interpretation or extrapolation. The news was not positive, and there was no sugarcoating the fact that the biopsy revealed the presence of cancer in my throat. But that was all we knew at this point.
When I got home, my wife, Debra, was working in the office on the top floor of our home. My daughter was finishing packing for our trip. The car service would be picking us up in about am hour. I asked Krista to come up to the office because I wanted to share the results of my doctor’s appointment with her and Mom at the same time. And that is what I did. My recollection is that I was calm and matter-of-factly in giving the report. Before the question could be asked, I related the doctor’s strong encouragement for me to continue with the trip to Antarctica as planned.
There is no doubt that Debra was very worried. She told me that she had expected the news to be bad. “I knew it” she said. She did not argue that we should cancel or reschedule the trip. But she expressed her concern about any delay in starting treatment. I tried to reassure her, based on the doctor’s information, that it would take significant time to get the start of treatment whether or not I went on the trip. I knew she was not fully accepting of this explanation at the time. But nonetheless, she was outwardly supportive of the decision to continue with our longstanding plans. As I will explain further in a subsequent blog post, this was a great decision me, initially a very difficult one for my wife, and one that bore out the doctor’s predictions about how long it would take before any treatment would begin.
My lesson from the day of diagnosis is that it is important to continue living. This does not mean to ignore good medical advice or common sense. The diagnosis of cancer must be taken seriously, of course. But if the context of the diagnosis is otherwise good health, continue to live each day to the fullest. In my case, I did not feel sick and I was not experiencing any pain or functional limitations. Remember, my only symptom was hoarseness. My doctor had been very clear that there was no treatment benefit to be had from changing my plans.
Now I know that having plans to travel to Antarctica at the time of a cancer diagnosis is not a particularly common situation. But the lesson is applicable even if your plans at the time involved more routine activities. Don’t stop beING you are or doing what you do. Yes, it is easy to start thinking the worst. It is easy to begin asking yourself “what if” questions. But for yourself as well as for your family and close friends, don’t panic and don’t stop living. Be pragmatic. Give yourself time to internalize the diagnosis, which is a process. I’ll discuss my process and what worked for me in the next blog.