The Biopsy: Dad's Perspective

I hate waiting.  J inherited the fidgets from me, I am certain.  When I'm being a doctor, I love efficiency.  Wednesday night, after chatting on the phone with the pediatric oncologist (not her usual way of dealing with new patients, but as of this point everything we knew was from my domain of medicine, I had more to tell her than she had to tell me), we had a nice plan in place.  J would not eat after midnight.  The surgeons would meet us the next morning. They would let us know they have a slot for surgery that afternoon, and we would have preliminary results by Thursday evening.  We would then go home that night, because it was a simple surgical procedure that could be done as same-day surgery.  That was the plan.


Reality has a way of showing that there are few things in this world that you can control.  Surgeons are the most difficult thing to control.  They have minds of their own.  (OK, I like a number of surgeons, and glad that they are the way they are).  I slept on the comfy couch in J's room Wednesday night and was ready for early morning rounds by the surgery team.  It didn't happen.  I met the surgery resident late in the morning.  She was a little surprised that J wasn't eating and did not think surgery would happen that day, but she would talk with the senior resident, and they would talk with the attending.  Fine.  I can try to be patient.

We met the pediatric residents.  We talked in person with the pediatric oncologist.  We also met the urology resident (just in case since there was the weird pain the day before, and this mass was pretty close to the bladder).  We met nursing staff and all the neat support staff in place to help children who have to be in the hospital.  By the end of the day we had met everyone we wanted to, except the surgeon who would be performing the biopsy.  Did I mention I hate waiting?  At least we had a portable Wii to play.

The next morning we met the surgeon.  He didn't tell us anything new, but he shared his concern this would be a rhabdomyosarcoma (I hoped it wouldn't).  The plan was simple.  He would take a small piece of the mass.  The pathologist would look at a piece of it to tell if it was obviously cancer or if they couldn't tell (this is called a frozen section, and is a very limited look at the tissue without the extensive stains that they use to fully assess the mass).  If it was obviously cancer, they would place a medication port in his chest and the oncologist would sneak in and do a bone marrow biopsy.  If we couldn't tell for sure that it was cancer (an unlikely final diagnosis, but on frozen section, a real possibility), we would have to schedule him for additional surgery at a later date to get the port and the bone marrow biopsy.  Along the way, I must of signed consent a hundred times for various aspects of treatment.

Mom was able to be with me Friday February 13 at the hospital while we waited to be called to surgery.  The time came late in the morning and we went to pre-op.  What an experience (that I have tried to forget from medical school).  Narrow bed spaces, lots of curtains.  Lots of beeping.  Lots of monitors.  Everyone in blue scrubs.  For every patient there is a nurse, a nurse tech, anesthesiologist, nurse anesthetist, surgeon, resident, and probably three or four other people.  J was quiet.  He seemed nervous.  He was offered a portable DVD player and began watching Harry Potter and The Goblet of Fire.  He disappeared into his own world and would barely say a word.  Our friend is a nurse anesthetist and stopped by to see how he was doing, which was a nice distraction.  It was his last day of work, so many people stopped to wish him well, which was also a nice distraction.  We met the pediatric anesthesiologist (who happens to live in our neighborhood, as does our pediatric oncologist), and soon they were wheeling him away to the operating room.  We were walked out of the pre-op area and went to wait in his now empty room on the children's floor.

The wait wasn't horrible.  Mom said to me that she hoped it wasn't a bad result.  I asked what she thought would be a bad result and she thought cancer.  At this point in time, I thought a bad result would be an inconclusive frozen section with almost certain revisit to the operating room after the pathology was complete.  The best news at this point would be that it looked like lymphoma (I did not like the idea of treating a sarcoma).  But lymphoma is often very treatable.  I hoped surgery would last longer, meaning they would place the port and perform the bone marrow biopsy and we would be that much closer to treating.  A short surgery was not what I was hoping for.

While we were waiting, we discovered that a friend of ours was in surgery at the same time.  We found her husband and invited him up to our room to help pass the time away.  Friends and distracting conversation are a great blessing!

The oncologist came to our room after a while and informed us that the frozen section looked like lymphoma.  They were placing the port and getting the bone marrow biopsy and then we would see him in post-op (although we didn't know where that was).  The surgeon arrived and escorted us to post-op (right down the same room as pre-op) and we saw J again.  Aside from being groggy from anesthesia, he was still our son, even now that we knew he had cancer.  Nothing had changed that.  He was not somehow a different person.  It was our son with a new challenge to face.  In medical school we talked about the importance of people remaining who they are and not becoming their disease.  It's an important lesson.

Mom saw him briefly and then she was sent away so she could go celebrate our oldest daughter's birthday with some of her friends.

My friend showed up with food (from the restaurant we were trying to get food from on Wednesday). We made it back to the floor and the room.  We ate a nice meal while J discovered that incisions hurt and that laughing isn't always the best medicine (because it makes the incision hurt).

After Mom was done with dinner, we met back at our house to finish celebrating our daughters birthday (which is really the following day on Valentine's Day, but she never gets to celebrate that day).  It's strange that even with major life changing events, life just keeps going forward.  Birthdays still need to be celebrated.  Friends move away.  Children still take tests in school.  We still get bad weather.  As much as I would like the world to just stop for a moment, we have to keep moving forward, but now with a different load to bear.