Ducks In A Row

As we sat across the desk from Dr. Plager for our consultation, I wrote notes as fast as I could.  Get it all down now and ask questions to catch up.  Some of the information is just now sinking in--15 years later.

 

50-60% chance that the tumors will respond
to this toxic biochemotherapy.
That would be Steve's 'glass-half-full' theory.

After however many cycles of biochemotherapy
would be needed and/or tolerated,
the next step would be surgery.
Then radiation.

The doc explained that biochemotherapy would hopefully shrink the tumors and involved lymph nodes.  It might also serve to knock back any free-ranging cancer cells that could be circulating in Steve's blood or just beginning to attack his lungs, liver, or brain. Late Stage III Melanoma is a monster.

Dr. Plager sent Steve to surgical oncologist Dr. Lee.  We met with the young surgeon two days later.

Dr. Lee pulled no punches.

"Big Operation"  "Long Procedure"  Risks  "Long-Term Side Effects"
He spelled it all out for us.

A ray of positive:  Steve's vitaligo told the doctors that
his body's immune system had already been attacking his melanin.
Melanin is the dark pigment in skin that is present
in a tan, mole, or melanoma.

Another big question was answered with ballpark figures.
Wow.
We were connected to a financial counselor at MDA
who helped me navigate all the insurance processes.

Our consultations were winding down now.  July was over now, and the date was set.

A catheter would be inserted into the vein under Steve's collarbone on Monday, August 3.  This was to be an outpatient procedure under local anesthetic.  The doctor didn't make any kind of fuss about it--In.  Out.  Ready.  Set.  Go.  While Steve was getting a wire lead  jammed into his chest on a fishing expedition for his subclavian vein,  I was sitting in a class with other caregivers, learning how to clean and maintain a sterile field for this cath.  Don't mind telling you that the gravity of the situation began to sink in a little that day.  If I didn't clean this thing correctly, the risk of infection alone could endanger Steve's life.  Let's not even think about the toxins that would be coursing through this port directly through his heart to his body.

I 'passed' my test and was called back to the treatment room where Steve was waiting to be released.  My normally stoic, upbeat, let-it-roll-off-your-back Hero was wounded--and fit to be tied.  The procedure was so painful that he couldn't believe he had not been sedated.  I believed the man who never cries "wolf" when he reported that local anesthetic had done nothing to block the searing pain.  Because they had a difficult time locating the vein under his collarbone, there had been repeated probes that were excruciating.

Steve dressed and we left as quickly as possible.  He's funny that way.  No matter what Steve had to endure, he'd be cooperative and pleasant with a little dry humor dusted throughout; and then he'd always be ready to walk out right away and never look back.  See Ya'!  Don't let the door hit you in the butt. 

Our medical ducks were all in a row for August 4th, 1998.

We walked to the car and retreated to our apartment for one last night and morning of life as we had known it.

July 1998 Continued

 

Consultations continued throughout July.  We took the advice of friends and neighbors, and sought a second opinion from an oncologist at MD Anderson Cancer Center in the Medical Center of Houston.  Though we knew the monster was Melanoma--the deadliest form of skin cancer--no one could locate its origin.  We learned that Melanoma can originate anywhere in or on the body: nail beds, eyes, in the mouth, or anywhere else.  So we traversed the maze of halls and elevators and signs and doors and waiting rooms at MDA to consult with dermatologists, opthamologists, dentists.

 

With no answers to the 'where is it?' Steve's oncologist assured us that a small percentage of cases were like this--Amelanotic, he said.  Was it the suspicious mole that had been removed from his collarbone in 1973?  Who knew.  At this point, it was time for a treatment plan for Steve's Late Stage III Amelanotic  Melanoma.

 

BTW--We learned that cancers are identified by stages.  Link here to a site that's very informative and specific to Melanoma.  

 

We met with Dr. Plager and he laid out the plan.

Step One
Biochemotherapy would include 5 drugs:
biological agents interleukin and interferon
would kick Steve's immune system into high fighting mode;
chemicals dacarbazine, cisplatin, and vinblastine
would destroy all fast-dividing cells.
Cancer is a fast-dividing mutation of cells,
but so is hair, normal skin, and the healthy linings
of stomach and intestine, among others. 

Steve would be admitted to MD Anderson for 7 days of biochemotherapy.  (I would realize later that this special floor of the hospital was like an intensive care unit for patients who were all receiving some form of this treatment.  Seven days, 24 hours a day.  Especially attentive nurses and technicians.  Some of the chemicals that dripped through Steve's iv's were so caustic that the tubing was routinely replaced every several days.)

 

After his 7-day hospital stay, Steve would be released to 'rest' for 14 days.  Rest included keeping close track of temperature for signs of infection, trying to eat, and making trips several times a week for blood draws to monitor precarious blood counts.  Then, back to the hospital for another round.

 

Dr. Plager wanted Steve to stay in Houston for the duration of his biochemotherapy.  He shouldn't be so far away from the hospital during this time.  That would mean a minimum of 6 weeks away from home in Chappell Hill.  While that would have been an added challenge for many cancer patients, God had already provided in two very different ways.

 

First--Remember my Type A+ driver husband who couldn't stand the thought of a daily 3 hour commute when we moved to the country?  He had rented and stayed in an apartment in town in our old neighborhood close to work.  His apartment was less than ten minutes straight shot west of parking garage #10 attached to MD Anderson.  His familiar recliner, television, bed, a sufficient kitchen--all were in place before we knew we would need them to fight cancer.

 

Second--Young Son would be starting his junior year of high school, and, though he had a driver's license and access to wheels, we weren't ready to let him fly solo for 6 weeks or more 90 miles away in Washington County.  We explained our situation to Young Son's best friend's parents.  Before they even knew all the details, including how long it might be, they heartily volunteered to 'adopt' Young Son.  They were willing to keep him under their wings for as long as it was needed--no questions asked.

 

Some may think that these details are nice coincidence.  "Isn't it great the way things just fall together like that?" they might say.  "How lucky for you that Steve had that apartment."  "What nice friends."  I don't believe things just 'fall together' like that.  I see God's provision.  His guiding hand.  His fingerprints are all over the details of life.  Luck had nothing to do with any of this.  I believe God knows the end from the beginning.  His mercy and grace protected us and provided just what we needed before we were even aware of the need.

 

In my next post, I'll finish with the rest of Dr. Plager's treatment plan and other pre-treatment preparations.  But for now, I just want to remember how big God felt to me then, and how He demonstrated His care in such tangible ways.

 





 

God's Back Story

For man proposes, but God disposes. -Thomas a Kempis

 

People may make plans in their minds,

but the Lord decides what they will do.

Proverbs 16:9

 

 

We certainly made plans in our minds!

1. Find some land in the country, not too far away from Houston, but out of the city.

2. Build a comfortable house that we could use for weekends and holidays until Steve's early retirement (age 55).

3. Move to the country permanently after retirement when the nest was empty.

 

In order to set the wheels in motion, in 1994 we met with a realtor we didn't know to look at property in a rural county where we had never been.  We drove nearly 2 hours back to Houston that day with the ink on a contract for a parcel of land drying in our hands.  Who does such a thing in less than 8 hours?!  Plans for our retirement dream home danced in our heads, and peace filled all the space in our hearts.

 

BTW--I lied when I said I'd never been in Washington County.  One beautiful, crisp fall morning in 1990, I had been on my way to Bryan/College Station for a meeting when a scene vision unfolded outside my passenger window.  A pristine white 3-board fence caught the rising sun and cast soft shadows on the rolling pastureland that it framed.  Like a thin blanket of batting, misty fog hovered just above the pastures.  As my car and I floated past, I saw the steeple of a country church among deep green treetops.  "Hmm," I thought to myself.  "Wouldn't this be a beautiful place to live?!"  I didn't know where I was, since I had missed my turn several miles back.  But it sure was a pretty sight.  However, I digress . . .

 

This retirement plan thing.  It's hard to explain, but we felt drawn to our future home just like a spacecraft is drawn by a tractor beam to the Mother Ship.  I'll fast forward past the details that bounce around this story.  Our Houston home sold and the moving van dropped us with all our belongings on the threshold of a new life in Chappell Hill Texas in January of 1995.  Young Son enrolled to finish the second semester of 8th grade.  According to our projection (see #3 above), that's at least 7 years before we had planned.  Man proposes.  God disposes.

 

Being the Type A+ driver he is, Steve wasn't up for a daily round-trip commute (make that at least 3 hours drive time) to the family business, so he rented an apartment in Houston.  Friday night through Sunday afternoon was our together time.  From Sunday nights through Friday afternoons I kept the home fires burning.  Cook, clean, carpool.  Repeat.

 

The realtor that we didn't know?  He and his wife lived in a house right across the road from us.  They invited us to come to church and sit with them.  We joined that little country church.  For the first time in our 20+ year marriage both of us dove straight in to a sincere, warm, encouraging faith community.  My commitment to teach weekday Ladies' Bible Study kept me accountable for daily time to pray and study while Steve was in Houston.  Dailiness helped me fall crazy-in-love with the Lord.  Oh, did I mention?  This was the little country church whose steeple I had seen from the highway on that soft fall morning years before.

 

People may make plans in their minds, but the Lord decides what they will do.

 

 

So there we were in July of 1998.  

We had put down roots for 3 1/2 years. 

We were growing and blooming in our new environment.

First Son was in college up the road at Texas A&M.

Young Son was navigating high school with a couple of good friends.

Parents, siblings, and extended family were still living in Houston.

Steve was nesting in Houston each work week.

Practically every neighbor in our rural subdivision left home Sunday morning

in time to be at that little country church.

 

We were connected in deep, meaningful ways.

 

 

God's Back Story . . .

Life Lines

When we were pushed into the deep end of the pool named Cancer--Late Stage III Melanoma, I bobbed to the surface by instinct.  Doggy paddles while gasping for a clear breath.  Eyes blurry from trying to see underwater.  Where's the bottom?  When will my feet touch?  How far to the side, or the step?

 

I would come to understand though, that God already had some clear life lines in place. 

 

The first person I called from the Day Surgery Waiting Room on July 6th was a friend and sister in Christ with whom I had been meeting on Monday mornings for prayer.  Her voice cracked and quivered.  And she promised to pass along my prayer requests to what I would come to experience as a powerful life line--the Prayer Chain in our little country church.

 

One member of our church had buried her husband less than a year prior.  Pancreatic cancer had taken him quickly.  On this day, that shy widow of few words knocked on our kitchen door.  As she handed me a copy of an article, she confessed deep regret that they didn't seek a second opinion.  "Do it," she said.  Her courage and transparency were a life line.

 

A toll-free life line to the National Cancer Institute
Information Service.

 I began to research and record information that might help process our new life.

A Chappell Hill neighbor and friend had retired from her job as Lab Tech at MD Anderson.  She called a trusted co-worker at the Melanoma/Sarcoma service at Anderson, and passed along a recommendation.  This major life line was attached to a sturdy life boat!

Our friend Joan had contacts, and she researched the go-to doctor
for us to request for a second opinion.

In hindsight, God had been at work for years weaving a network of family and friends that would be precious touchstones and supporters over the next 5 months of battle.  God's back story with us is fascinating.  If you had dusted my life for fingerprints, you'd have found God's hand all over the place.    

Our 1 Subject Notebook

One of our helpful companions throughout this battle/experiment/journey through the rabbit hole was a green 1 subject notebook with 70 wide-ruled sheets.  It's the kind one would carry to school to record lecture notes and doodles in History class.  Here are the first entries from our green notebook.

These were tidbits from General Surgeon  Dr. GREYGREEN, the Coward.

We began to identify the monster by process of elimination.

More tests were necessary.



The first oncologist we visited--let's call him Dr. YAWWWN, the Apathetic--
was not affiliated with MD Anderson.
 

With everything but a yawn,
Dr. YAWWWN, the Apathetic explained his treatment plan to us.
The plan did not include aggressive chemotherapy and bio-chemotherapy,
which was, in his opinion, basically too risky on anyone but the dying.
His recommendation:  1. Surgery  2. Radiation  3. Interferon injections
Then he ushered us out of his office by a back door
where we stepped directly into the parking garage. 

So, finally after 2 weeks, the monster had a name:
Amelonotic Melanoma, Late Stage III
We had direct gut confirmation that we weren't coming back to this particular oncologist.
And we had the prayer support of dozens of loved ones and friends.

Biopsy

Fifteen years ago this month, my husband Steve and I walked through the doors of MD Anderson Cancer Center.  We were not visitors.

Four weeks before, in July, 1998, at an area hospital, Steve had a biopsy of lymph nodes under his left arm.  It was his preference to do this without telling any other family or friends, so I sat comfortably alone in the day surgery waiting area until I heard the question announced.  "Bingham family?"

A stout tower of greygreen scrubs informed me (and every other person there in the day surgery waiting area) that my husband "had waited much too long to see about this matter."  As I stared at a starched, sterile chest, the surgeon's voice said he couldn't tell what type of tumor he had removed and sent to the lab.  (Naming the monster would take several weeks.)  I watched the jaw and its paper surgical mask beard deliver its judgment.  Greygreen shook his head, turned on his heels, and left the room.  My first thought was, "What a coward!"  No private conversation, no questions.

That day, my 50 year-old husband and I began a journey that would take us deep and wide--beyond every known boundary that we could imagine.