November 4, 2005 - Oncologist

Today Claire and I visit Dr. William Lerner, oncologist and hematologist. After filling out an extensive medical history form, and offering up four vials of blood to the gods of medical research, I find myself sitting with Claire in an examining room, hearing Dr. Lerner talk of something that has been growing in my abdomen for some time. It is a "mass," he informs us, nine to ten centimeters in size, surrounded by a number of swollen lymph nodes.

I first became aware of the existence of this mass in the office of our family doctor, David Cheli. After some prompting from me during an annual physical, he had authorized an abdominal ultrasound to check for a possible aortal aneurysm. There were no physical indications of such a diagnosis, but my father had had a severe problem with one, requiring heroic surgery – so it’s something I’ve always thought it would be wise to watch out for. Due to the size of my abdomen (the result of my personal curse of obesity, mostly, though I’ve long suspected something more), Dr. Cheli was unable to perform the usual manual check for the existence of an aneurysm. I had mentioned this worry of mine during past examinations, but he had always brushed it aside, saying my blood pressure was normal and such things were rarely a problem for people my age. This time, without further explanation, he scribbled a prescription and instructed me to go have the test. Did he suspect something, or had he finally given in just to put my mind at ease? I don’t know – although it is now emerging that his decision to order the ultrasound would change my life.

In the ultrasound room at Ocean Medical Center, the technician seemed to be taking more time than I imagined was normal. She called in a more senior technician – Deborah, a member of our church – who examined the glowing screen along with her, and let me know there is "something there," although its image was indistinct. I lay for a while in silence on that examining table, before the original technician returned. She informed me that the nameless radiologist had confirmed that, indeed, something didn’t look right. I expected no more information than that, knowing that the usual procedure is to leave it the physician who has ordered the tests to explain the results. Surprisingly, I did not find it difficult to "let the day’s own trouble be sufficient for the day," and wait for the results to come to me in time – "good," or otherwise.

Several days later, I sat in Dr. Cheli’s office and heard him confirm that there is indeed "something there." Something vague and nameless, several centimeters in size. Something requiring the further analysis only my first-ever CT scan can provide.

I followed the same procedures I’ve heard so many parishioners describe to me – abstaining from all but clear liquids after midnight, arising before dawn to drink a somewhat chalky-tasting fluid (oddly, it was flavored with banana), then several hours later lying prone on a table, as groaning machinery presented my body to the invisible electronic eye that is the CT scanner, marvel of modern medicine.

During hospital check-in procedures, I had found myself standing in line next to Dottie, a friend of ours. Dottie is a retired minister, and a cancer survivor, who was there for a CT scan herself. "I hope everything’s all right," she said to me, giving me the sort of quizzical look that said she would like to know more, but wouldn’t press it.

"Just a test," I told her, trying to make it sound routine. Even with the present obsession with HIPAA privacy regulations, it’s hard for a pastor to remain medically anonymous in his own community. As much as I like Dottie and know her to be a person of discretion, I was just as glad not to see any more of her that morning. I preferred to deal with the challenge of that day in solitude.

The CT scan technician was matter-of-fact and efficient. She told me nothing of what the scan revealed, nor did I expect her to. Did she even know what she was looking at, or was she merely pressing the shutter on a camera? Again, I found it easy enough to look no further than whatever news the day would bring.

After nearly a week, I again sat in Dr. Cheli’s office. He informed me that the CT scan revealed a "mass," several centimeters in size, that appeared to be an enlarged lymph node. It was located, he said, towards the back of my abdomen, in a hard-to-examine location. He told me he was referring me to Dr. Lerner, an oncologist with a strong local reputation. His reputation goes beyond local, Dr. Cheli me – Dr. Lerner participates in various critical trials and has access to the sort of up-to-date information typically available only "in the city" (by which I took him to mean Manhattan’s Memorial Sloan-Kettering Cancer Center, the distant Emerald City for reluctant pilgrims).

All this is background for today’s consultation in Dr. Lerner’s office. In the waiting room, I silently wished for anonymity – I had no desire to burden anyone other than Claire with whatever news might come – but it was not to be. No sooner had we taken our seats in the waiting room than a fellow minister of our acquaintance entered from the inner sanctum of the doctor’s office, and took a seat beside a couple of elderly friends of hers. We knew she has been receiving cancer treatment for some time. When she saw us, she came over and said hello, asking us in a cheery voice what we were doing there.

As quietly as I could, I told her I was there for a consultation, that there appeared to some kind of problem, but we didn’t know yet what it was. "Please keep it confidential," I said, sotto voce – whereupon she immediately turned around to the man sitting with her, and offered to introduce us.

Had my request for confidentiality even registered? Evidently not. The man came over and politely shook my hand. He was active in a nearby church, she informed us brightly – with all the breezy informality one might expect in a supermarket line. I wished I had Harry Potter’s invisibility cloak. Ordinarily I would have been glad to meet someone new, but at that place and time this man was the last person in the world I needed or wanted to talk to. I greeted her companion briefly but cordially, and nodded at the older woman still sitting across the room.

Our colleague continued to talk with her friends and with us in a chatty way, pulling out several beautiful quilts she had made – she figured they were something she could "leave behind," she said. They were a good way to occupy her time while her cancer treatments continued. We politely admired her quilts – the artistry was superb – but with little real interest. I silently cursed the medical-scheduling Fates that had assigned us appointments at the same hour, and hoped she would have the discretion not tell others afterwards just whom she had encountered in the oncologist’s waiting room. Not yet, I said to myself. We don’t even know yet. One thing at a time.

Claire knows Dr. Lerner, as he is medical director of the Meridian Hospice program in which she serves as chaplain. I had met him before, at some social function or another, but it had been a mere passing acquaintance. As our conversation begins, I find him to be everything a good doctor should be – well-informed, compassionate, a good communicator. He offers us all the time we need to ask questions – although we both know the only question that matters is the one he is as yet unable to answer.

Reading the narrative report of my CT scan prepared by the nameless radiologist, Dr. Lerner informs us that the mass in my abdomen is 9-10 centimeters in size – considerably larger than anything Dr. Cheli had told us about. It is surrounded by a number of enlarged lymph nodes. The nature of the mass can only be confirmed by a biopsy, although he is first going to order a second CT scan (this time, of the chest and neck) and a PET scan. These tests must precede the needle biopsy, because the intrusion of the needle will cause inflammation that could cause difficulties if the high-tech diagnostic tests were performed later.

Speaking matter-of-factly but kindly, Dr. Lerner informs us that he strongly suspects lymphoma, although neither this diagnosis nor the staging of whatever type of lymphoma it may be can be confirmed until after the biopsy results are in. He wants these tests to be done in the next two weeks and – rather ominously, it seems to us – he wants us to go swiftly to another diagnostic center if Jersey Shore University Medical Center is unable to schedule a PET scan within a week. Perhaps I should ask why he’s in such a rush, I think to myself, but he would probably say this is standard procedure, just in case this is one of those cancers in which time is of the essence. Do I have one of those cancers? Do I even have cancer? There are so many unknowns. The full picture is emerging only gradually.

Have I just received the dreaded cancer diagnosis? Perhaps I have, although it seems unreal. It’s so oddly anti-climactic. Dr. Cheli had mentioned lymphoma to me as one of several possibilities, and today that word has floated to the top of the list. "Suspect lymphoma" are the words Dr. Lerner tersely writes on the prescription scripts for the CT and PET scans. But it’s still only a suspicion. Isn’t it?

I feel oddly calm about all this. Right now – as long as our chatty friend in the waiting room can keep her counsel, anyway – it remains a secret. Whom should we tell, and when? Three major tests are ahead of me in the next week or so. It may be hard to keep the news from our children, Ben and Ania; and from Claire’s sister Eva and her two kids, Cory and Elizabeth (Cory lives with us, and his mother and sister are constantly over at our house); and from the church staff, who may have to deal with changed appointments and rescheduled meetings.

If it is indeed cancer, what impact will the sharing of that news have on my ministry? The minister will need to be ministered unto – something I’ve never been especially comfortable with. I have watched several colleagues from afar, as they have gone through similar experiences. I have never, on an conscious level, dreamed I would be one of them.