December 31, 2005 - The Mass

This morning I return a voice-mail message from Dr. Lerner that I discovered late last night. The message said he'd spoken with Dr. Portlock, and wanted to touch base with me prior to my trip to New York. His answering service tracks him down, and we speak a few minutes later.

Dr. Portlock, it seems, is especially keen to see my pathology slides. After reviewing the narrative report of the PET scan indicating the size of the mass in my abdomen, she wants to have her pathologist review the slides to make sure Dr. Lerner's diagnosis is correct. She wants to confirm that it is indeed the "matted mass of enlarged lymph nodes" Dr. Lerner has supposed it to be, and not a "bulky tumor." A bulky tumor, Dr. Lerner explains, would mean a more aggressive cancer. The way to determine the true identity of the abdominal mass is by carefully analyzing the microscope slides: if the tissue sample is composed of mostly small cells, he says, I do indeed have an indolent cancer. If there are other sorts of cells there, I could be in for a very different sort of ride.

After hanging up, I begin to worry a bit. Does Dr. Portlock, the famous lymphoma specialist, have some sort of inside track that leads her to suspect I may have a more serious condition? But wait, I say to myself. She hasn't seen all the data yet: she's just responding to the narrative report from the radiologist who read the PET scan. She hasn't even seen the PET scan films. They're still inside that big envelope sitting in the entry hall of our home, awaiting my trip to New York on Tuesday.

Dr. Portlock is simply doing what a good physician does, in preparing to issue a second opinion: she's taking everything back to the beginning, so she can look at all the evidence afresh. It's entirely possible, even likely, that her diagnosis will end up being the same as Dr. Lerner's.

I'm aware of how many of Dr. Lerner's conclusions are not based on his work alone. He's the oncologist coordinating my care, but he's depending heavily on the efforts of other professionals: the technicians who have administered my various tests and scans, as well as the other physicians – radiologists and pathologists – who have read the results. I've been hearing about the importance of a team approach in treating cancer, and it seems I've already got such a team. It's just that I've just never met most of them.

All these anonymous, white-coated professionals are interested in the "mass" inside me. What a nondescript word that is! Intentionally so, at this stage of the game. It may be a collection of swollen lymph nodes, it may be a tumor, or it may be something else altogether. The word "mass" is a sort of place-holder, a temporary term for everyone to use while the diagnosis and staging of my disease is still under way. We could just as well call it a "thing," a "lump," or even a "whatchamacallit" – though none of these terms offers the proper aura of scientific objectivity.

Suddenly my situation seems rather uncertain, still – nearly three months after that day when the ultrasound technician first remarked that something on the computer monitor didn't look right. These things take time, I have to remind myself. Indeed they do...