September 19, 2007 - My Well-Traveled Slides

Today I get a call from Angelica, who works for the stem-cell transplant program at Hackensack University Medical Center. I’d expected to hear the results of the Tumor Board’s review of my case, which was supposed to take place this morning. As it turns out, they’ve had a hard time locating the pathology slides from my most recent needle biopsy, and have postponed consideration of my case until next Wednesday.

Someone from the Hackensack staff called Ocean Medical Center, Angelica explains, only to find that the slides were still at Memorial Sloan-Kettering (Dr. Portlock’s staff had told me they were going to send them right back to OMC, but evidently they didn’t). The person then called the MSKCC staff, who located the slides in their archives and lobbed them across the Hudson.

“Hackensack’s a large hospital,” Angelica continued, apologetically, “and sometimes it’s hard to find things here.” By the time they'd located my slides, in the mailroom or wherever they'd landed, there wasn’t enough time for the pathologist to review them prior to the Tumor Board’s meeting. The Board will meet again next Wednesday morning, to consider my case.

The delay’s not a big deal, medically speaking. We’re in a slow-motion, “watch-and-wait” mode, after all. That’s not to say I haven’t been anxious to hear the results. But it’s OK, I can wait another week.

This story highlights how important medical records are to cancer patients. The last time I watched Dr. Lerner open my file, it had grown to 3 or 4 inches in thickness – all that paper, in less than two years! Everywhere I go, in my peripatetic quest for wellness, I seem to trail scan films, data CDs and microscope slides in my wake. I’ve tried to pick up after myself, making sure my primary records all end up at Ocean Medical Center, eventually, but that’s not always up to me. I’m just glad the Hackensack people located them eventually. I wouldn’t want to repeat a biopsy because slides have gone missing!

When most of us think of medical decision-making, we tend to picture a wise doctor with a stethoscope, poking and prodding and questioning a patient, then making some carefully reasoned but intuitive judgment. I’m sure some diagnosis still happens in that old-fashioned way, but you don’t have to venture very deeply into lymphomaworld before you discover the hands-on approach has been largely replaced by quantitative analysis. As the numbers are crunched, it’s not typically one individual leaping to a brilliant, intuitive conclusion. The work is done by interdisciplinary teams, weighing columns of data against established protocols.

Decisions are being made about my treatment plan by people I’ve never met, and probably never will meet – pathologists peering through microscopes, Dr. Donato’s unnamed colleagues on the Tumor Board, other specialists who may be called upon to review particular details.

At least the Hackensack staff seems pretty good at keeping me informed. I appreciate that.