The Third Spot

Caughtcha’ I thought.  THERE it was.  I knew it.  I had it written in my notebook from January 2008 but it had gone AWOL for more than a year.  The first PET scan showed  THREE spots in the liver- one in each lobe and one at the inlet.  The MRI showed two -one in each lobe.  Two spots had been surgically removed.  It was assumed that the third bright spot on the scan was caused from some residual trauma that must have occurred during colon surgery.  But here we were looking at it again.  The devil in black and white.

“Let’s let it sit for a little while.  Your counts aren’t that high.  Obviously it didn’t respond to chemo before, so hitting you with more of the same wouldn’t make a lot of sense. And, it’s in a spot that nobody would touch surgically.  Well, I’m sure you could find someone who WOULD, but I wouldn’t advise it.”

Summer 2009.  We’d opened a shoe store about 2 months prior when we’d heard the big “R” word – “remission”.  The doc told us we should wait 6 months at least before investing in a shoe store.  Well, what do you do at a yellow light?  Go faster or stop?  “Wait” sounds like a yellow light.  We opened a shoe store.  His labs started climbing before we actually turned on the neon “Open” sign – but we were already committed.  It gave Jeff a reason.  We “sat on it” for a while.  And his numbers went up prompting the MRI that showed the allusive spot.

Jeff had already decided he wouldn’t do anymore chemo.  Only trouble was, he’d also decided he didn’t want to do that liver surgery again either.  It had been a killer.  But now, well, now he was looking at a real killer and he had to rethink his plans.  Do nothing- die.  Do chemo- why?  It hadn’t killed this spot, why do more?  Do surgery- maybe so.

We made appointments with two surgeons.  Our first visit was with the surgeon who had done Jeff’s initial liver resection.  He’s a man of few words.  He holds his chin and ponders a lot while he’s in the room.  He pulled up the MRI and we went through it slice by slice.  He didn’t think it was a part of the liver.  He was pretty sure it was a lymph node.  Good news!  But, if it was in the vein at all, he wouldn’t touch it.  “High-rent territory” he called it.  Too much high-stakes stuff going on there.  All packed in a tight space is the artery, vein and bile duct.  And Jeff’s liver was probably not healthy enough to withstand the interruption in blood flow that would be required to remove a lymph node from the vein.  That vein- about as big around as your thumb and filled with blood.  That’s a big vein.  He wasn’t willing to mess with it.  Too risky.

We went to the next surgeon.  He was a charismatic fellow and not much older than us.  He went through the MRI slice by slice with us.  He was certain the mass was part of the liver, and undoubtedly it was invading the vein.  That seemed pretty clear with the areas he pointed to on the MRI.  And, yes, it was “high-rent territory”.  But, he said, “If I don’t take it out – you die.  If I do take it out – you have a chance of living……or, you could die from the surgery.” 

My notebook had notations of various percentages of the likelihood of what might go wrong or what might go right.  The chance of Jeff dying on the table with this procedure was higher than the likelihood that he would have gotten colon cancer in the first place.  We didn’t have to think long.  We took the second surgeon.  It was a chance.  A chance to live.

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