January 9, 2006 - A Talk with the Surgeon

Around noon today, I visit Dr. Aron Gornish, the surgeon who will implant the port-a-cath for my chemotherapy treatments. After introducing himself, Dr. Gornish reaches into the pocket of his lab coat and pulls something out. He starts swinging it around in his hand – kind of like the way Harpo Marx swings a coin attached to the end of a string. "Want to know what this is?" he asks, stopping the object’s orbits and showing it to me. He tells me it’s an implanted port: an example of the type of device he will place under my skin, near the collarbone.

It’s about the size of a stack of four or five nickels. In the center of the metal circle is a white, dome-shaped area, into which the chemotherapy IV needle will be inserted, through the patch of my skin that will cover it. Coming out of one end of the device is a thin tube made of some sort of elastic material, that will go into the vein.

Dr. Gornish quickly explains the surgical procedure, in rather more detail than I can easily comprehend. I get the gist it, though: he will make a tiny incision in my neck and thread a tiny wire down through my jugular vein, until it reaches a certain point inside the vein in my upper chest that is his target. Then he’ll make another incision near my collarbone, and implant the port under the skin.

He shows me several small holes around the diameter of the metal circle. He’ll use these to suture the device to a layer of muscle, so it doesn’t move. Then – I think I’m getting this right – he’ll cut into the vein at the proper place, and use the wire to pull the end of the catheter down into proper position inside it.

All this will take about an hour, during which time I’ll be sedated.

I ask how soon after the surgery the device may be used – whether we’ll need to allow any time for healing. No need for that, he replies – the port can be used immediately.

It’s a good thing, as it turns out. My surgery is scheduled for a week from tomorrow: Tuesday, January 17th. When I call Dr. Lerner’s office to tell them the date of the surgery, they confirm that my first chemotherapy treatment will be the very next day, January 18th.

The port will stay in my body for as long as necessary – probably a good while after the chemotherapy treatments are finished, Dr. Gornish says, just to make sure it won’t be needed again for subsequent treatments. The device will remain visible as a bump in the skin. The chemotherapy nurse will do what’s necessary to maintain it, flushing it after each treatment to prevent infections. If I go more than a month between treatments, I’ll need to come in to Dr. Lerner’s office for this periodic maintenance.

On the way back home from the doctor’s office, I stop at Costco to do a little household shopping. One of the things I regularly buy from that warehouse store is a jumbo-sized container of shampoo. My tastes in shampoo are rather simple: unlike my daughter, who fills the bathroom with a whole assortment of hair-care concoctions, I stick to a single brand and use it exclusively. It’s about time to stock up again, I think to myself. I put a bottle into the shopping cart. But then I remember: I’m on the verge of four and a half months of chemo. I’ve got more than enough shampoo at home, still, to last me several weeks. After that, I may not have any hair to wash. Feeling a bit strange about all this, I put the shampoo back on the shelf.