December 15, 2005 - The View From the Bone-Marrow Biopsy Table

This afternoon I am lying on my left side on an examining table in Dr. Lerner’s office, while he goes about the business of conducting a bone-marrow biopsy. Earlier he has admitted that this procedure may be "a bit uncomfortable" – which I took to be a tacit admission that it’s painful.

The nurse who weighs me and leads me back to the bloodletting room seems unusually solicitous, asking very specifically how I’m feeling. I tell her I’m a bit nervous – what does she expect? – and she goes out of her way to assure me that although the procedure is uncomfortable, I will feel no pain. Not with Dr. Lerner doing it, she says, proudly.

It turns out she’s right. He’s really good. A slight prick of the needle as the doctor numbs the skin of my lower back, down near the right hip, a wait of several minutes while the anesthetic takes effect, and he goes about his work. Breathe in through your nose and out through your mouth, and do it slowly, the nurse says. She repeats the mantra several times over the next few minutes, as they’re getting me into position. Even the doctor says it at one point. I’m reminded of the Lamaze breathing exercises Claire and I practiced years ago, before the birth of our children. I find this breathing instruction both calming and anxiety-producing: calming, because that’s what that sort of breathing does; and anxiety-producing, because they’re making such a point of insisting on it.

The nurse takes her position in front of me and presses down hard on my right hip with all her weight, to immobilize me. (Not a good sign, I think to myself.) The doctor inserts his needle into the bone to draw out some fluid, telling me exactly what he’s doing at each stage of the process. I feel pressure as it goes in, but it’s not painful. Then he does the same thing with some kind of handheld device that punches into the bone as he twists it like a corkscrew. (I didn’t actually get a look at the thing, but I expect it’s one of these lovely implements: click here.) Again, I feel pressure – much greater this time – but I wouldn’t describe the sensation as pain. There’s a sort of intense throbbing, down near my tailbone, that comes and goes. Dr. Lerner remarks that my bones are stronger than those of most people for whom he does this procedure: "It’s a good thing I ate my Wheaties this morning," he quips, as he leans in harder. He says he’s used to doing bone-marrow biopsies on people much older than me, whose bones are thinner.

It’s all over in about two minutes. Dr. Lerner bandages the wound, and the nurse tells me I must lie on my back for a considerable time, with my feet flat on the table and my knees drawn up. They call Claire into the room, and we check in with Dr. Lerner on how my case is progressing.

From my awkward position on the table, I tell Dr. Lerner that, as of today, I’ve finally been assigned a doctor at Memorial Sloan-Kettering. Her name is Dr. Carol Portlock. Dr. Portlock’s office is supposed to call me very soon, to arrange an appointment. Dr. Lerner recognizes her name immediately. "She’s famous in the world of lymphoma specialists," he tells me. I tell him I’d figured as much, having Googled her name this afternoon, and discovered all manner of references to journal articles and medical-conference speeches.

I ask Dr. Lerner about my mugascan results. They came back fine, he says: no heart issues that could interfere with chemotherapy.

I ask him about staging – which rating of severity he thinks he will give to my case if the biopsy comes back positive, and which if it comes back negative (the word "staging" refers to how extensively the cancer is spread throughout the body). Dr. Lerner tells me I should not be surprised if the test comes back showing some bone marrow involvement, as this is fairly common with my type of lymphoma. Should that happen, I will be at stage 4 (the highest stage). Should the biopsy come back clean, I’ll probably be at stage 2. But don’t put too much stock in the staging numbers, he warns – because with indolent lymphomas like mine, the far more significant figure is something called the FLIPI scale ("Follicular Lymphoma Prognostic Index"). In addition to traditional staging, this scale takes into account such factors as the patient’s age, hemoglobin level, number of affected lymph nodes throughout the body, and serum LDH level (a blood-chemistry reading). The FLIPI scale is a better predictor of how patients will actually respond to treatment.

We drive back home, and I spend the next few hours sitting and resting: first in front of the television, then in the living room, as the family hangs ornaments on the Christmas tree. My role in this year’s holiday tradition is purely supervisory. When we’re finished admiring the tree and I start walking up the stairs, I experience the worst pain of the day: about the level of a really nasty pulled muscle, all up and down my right leg. I’m OK as long as I don’t walk around, so I decide to sit down at the computer and write this journal entry. It feels good to be doing something productive, after being on the receiving end of treatment all afternoon. And that, good reader, is why I’m going through this crazy exercise of keeping a cancer journal. Studying and writing about this disease and my reactions to it feels like something positive I can do. It’s a small remedy for the lack of control I’m feeling.