'Twas the Night Before Surgery, When All Through The....

’Twas the night before surgery, when all through the apartment…

He stirred.

It’s not that he was feeling sorry for himself–oh, well, yes, maybe; yes, perhaps, just a little.

Assigning anger, imagining a cause

It was more a resentment, bordering on anger: Neoplasms had no business squatting in his bladder. None.

Their predecessors had been evicted and dispatched five years before. Vigilant, penetrating, inspections had been conducted ever since.

According to the info-sites maintained by the American Cancer Society, the Mayo Clinic, Johns Hopkins, UCLA Medical, Sloan-Kettering, Columbia University Medical Center, the Bladder Cancer Advocacy Network…. He was not in the high-risk group.

He never smoked. Never.

Second-hand smoke

He would dodge, and duck from, second-hand smoke, even if it meant giving affront to the puffers and exhalers at the entrance to an office building or an eatery; and, most certainly, at the entrance to a school building or near a hospital.

He’d avoid, detour away from, second-hand smoke even if it meant risking a pedestrian-traffic mishap. He’d scoff at the draggers and reserve his most severe scowls for those smoking in cars occupied by children. And often there were particularly choice utterances–delivered under his choking breath.

Third-hand smoke

He curses the environs that have been impregnated with the residue left behind by smokers: in lavatories; elevators; hotel rooms; rooms where drapery, carpeting, and upholstered furniture have absorbed the clouds and fumes of cigarettes and cigars. He curses the polluters.

He’s read condemning articles to confirm his antipathy; researched to justify his animosity. He’s learned that the human body processes inhaled tobacco carcinogens and excretes them in urine. On the way out, the tobacco chemicals pass through the bladder and can take up lodging in preparation for propagation.

What else might have been in the air, and inhaled?

There’s also exposure to harmful chemicals in a factory or a shipyard or manufacturing plant or…. The kidneys can’t filter continuous concentrations of those chemicals. Some of that awfulness makes its way into the bladder–and some of that can take up residence within, like a bad seed.

That hadn’t been his inhaling history.

He’s certainly had decades of exposure to lead pencils and ball-point pens. Triggers? Not likely.

Ahhh, but he may be super sensitive, susceptible (vulnerable) to the exhausts belched from trucks on so-called expressways.

There were, however, chemical-warfare simulations at Aberdeen Proving Ground and Indiantown Gap Military Reservation where the Army saw fit to put first-lieutenant wannabees to discomfort. But that was well over forty years ago. Almost fifty years ago. The VA and the DOD aren’t about to assume any responsibility for ancient inhalings that might have insinuated late-blooming neoplasms.

CSI – Cancer Suspects Interrogated

There’s blame to be placed–but on what, or whom?

There’s got to be a culprit–a suspect. Something to interrogate and indict; something ingested, inhaled or exposed to–something to prosecute and convict; condemn and execute.

The cell phone?

He never carried his flip-phone in a front trouser pocket.

The laptop computer?

Well, yes, it rested on his lap, but always (almost always) set on a dense fiberboard that shielded the mechanism from any direct contact with his vitals.

Sugar?

He does have a sweet tooth. Heck, he has a mouth full of sweet teeth; and the palate and taste-buds similarly inclined. But it’s been decades since he added sugar to anything–a tea or other beverage, cereal, or whatever.

Could it be the flavored ice-teas he quaffed every morning? Even though they are flavored with “pure” cane sugar? Even though they are sweetened with certified organic non-GMO, nitrate-free, nitrite-free, gluten-free sugar? Couldn’t be; can’t be.

Candy and cookies?

Yes, okay, he always has a few pieces of dark chocolate, close by. They have anti-oxidants, don’t they? Anti-oxidants are cancer-fighters, right? And, he can make a bar of dark chocolate last well beyond its designated two servings.

When there’s a big array of cookies and milk chocolates at a dessert table, he has had the resolve to refrain and abstain.

Soda-pop?

He hasn’t had more than two sodas in a given calendar year–and, oh, he misses a Dr. Pepper over lots of ice. Naah, couldn’t be.

Chips?

He only buys low-sodium low-fat high-potassium crisps that are baked, not fried. Couldn’t be; can’t be.

Ketchup?

The packets he squirts onto a small puddle of mayonnaise to make a salad dressing he refers to as the peasant’s Russian dressing, or 500-Island dressing.

Red Meat?

Okay, maybe three (at most four) times in a calendar year. Burgers from an outdoor charcoal grille, and an all-beef hot-dog. It would be un-American to abstain from these Summertime delectables.

Shower soap? Talcum powder?

Yes, he’s applied an aloe vera powder or a menthol-and-zinc-oxide powder around his privates, prior to hoisting on boxer shorts. Some talcum powders are thought to have contributed to ovarian cancer–or so say some plaintiffs’ lawyers.

Tap water?

He filled his electric (plug-in) water-boiler from the faucet, and, of course, that water was boiled to very pronounced bubbles prior to being poured over herbal tea bags.

Should he trust the faucet’s ancient water pipes and the monitoring of the municipal water authority?

Water can be contaminated with arsenic and other chemicals, which even in very small amounts can be cancer-causing, for some.

From the 1950s through the 1980s, people living or working at the U.S. Marine Corps Base Camp Lejeune, in North Carolina, were potentially exposed to drinking water contaminated with industrial solvents, benzene, and other chemicals (including arsenic, it is thought). The incidence of bladder cancer in those environs is much higher than “normal.”

And there’s the municipal water in Flint, Michigan.

He now fills the water-boiler with bottled water. He hopes the spring sources are routinely checked and the bottling facilities well monitored. And he wonders if he has gone bonkers.

Soy? Tofu?

Lots of it–beverages, “yogurts,” fake cheese, alternative cream cheese, non-dairy frozen desserts…. Soybean and bean-curd-derived ingestibles have been his antidotes to all the artery-clogging fast-food he had enjoyed decades ago.

Sliced chicken breast?

It’s the brand–and only that brand–that swears no artificial anything; no trans-fats, no fillers; low sodium; sugar-free; no antibiotic feed additives used. Causal, nevertheless? Couldn’t be, can’t be.

Vitamins, minerals, supplements, meds?

How could they be the culprits? Surely the respiratory-rescuing mist from the broncho-dilator inhaler is above suspicion.

Laundry detergent and dryer sheets?

Surely these products do not infect his boxer shorts with cancer-causing microbes.

Plastic utensils?

It’s not like he chews and swallows them.

Plastic containers?

Could carcinogens leech into half-eaten apples and sandwiches?

Aluminum pans?

The ones that hold the leftovers from the late-night diner–the ones he slips into the toaster-oven the next morning. Could the reheated omelets absorb some carcinogens from the pans?

He couldn’t believe his ears

“I’m not liking what I’m seeing.”

(15 seconds later–an eternity)

“No… I don’t like what I see.”

To the day–to the very day–it was five years since his initial Transurethral Resection of Bladder Tumors (a TURBT, in med-speak).

He had undergone thirteen cystoscopies since then. At each of those transurethral scopings and viewings, the surgeon (a urologic oncology luminary, by any and all standards), would provide bits of encouragement and good tidings.

“Looking good.

“Just a little bit longer.

“Still looking good.

“Almost done.

“You’ve done it. You’re clear.”

The five-year cystoscopy was to be a graduation, of a sort: five-years without the return of a tumor in the bladder.

A “graduation” postponed

In a tone, that–ever so slightly–conveyed surprise and regret, along with quiet authority, the surgeon had sighed:

“I’m not liking what I’m seeing.”

“No… I don’t like what I see.”

The patient had been thinking about sharing the expected (good) news with his son, his daughter, and his god-daughter. He was thinking about how they would celebrate–sanely, with a quiet gratitude that would defy gravity.

Never once, in all the cystoscopies, did he ever look up at the monitor or at the surgeon or the nurse; he had always kept his eyes closed, for that allowed him to picture his kids and their faces.

With his eyes closed, his sensory registers offset the intrusion of the cysto-scope and seemed to heighten his hearing: his ears anticipated the surgeon’s up-close-and-personal reporting; the surgeon’s encouragement and good news, which he had come to expect, with good reason.

And at the very investigation that was to be his release, the investigation that was to put an end to the regular scopings, he heard–

“I’m not liking what I’m seeing.”

“No… I don’t like what I see.”

Was he dreaming–the kind of bad-news dream one has in order to ward off bad news; the kind of prophylactic imagining (and imaging) that the subconscious devises to chase away and nullify an unwanted development?

Dazed and Confused

He heard the surgeon speak of an operation, just like the one five years before – five years ago to the day.

Statistically, the incidence of a return declines with each “out year.” He is “a five-percenter.” Dubious distinction.

The following week – the week before Christmas – was an option, but not a desirable one. Best save those OR time-slots for emergencies and dire cases.

So he would bring in the new year with a TURBT and maintain a silence all through the holiday nights.

An MRI – to detect nomadic neoplasms?

With his PSA edging upward, yet again, an MRI of the prostate was scheduled, prior to the TURBT. It would not detect cancer, per se, but would indicate an area – or areas – for an eventual biopsy.

Was there a suspicion that tumors made a cross-border leap? had become undocumented aliens in adjoining territory? He was very much in favor of banning such immigration, if only he had the power to do so.

The MRI as a refuge

To spare himself the chatter, sights and smells of a crowded bus or subway car, he indulged himself and took a taxi to the hospital.

The in-taxi video featured “Live! with Kelly” and the mega-decibel performance of a Hip-Hopper.

Who are those people in the studio audience whooping it up – on cue? of their own volition? Why aren’t they at work, or at home vacuuming or dusting or doing laundry?

Housework, that’s what he wishes he was doing. He’d be okay being a busy home-body, if only his body would cooperate. He can’t wholly tune out the thudding and decibels from the in-taxi TV, which now rivals the jack-hammers and sanitation-truck hydraulics. He’s not in a charitable mood, though he does tip the driver well. That’s good luck, in his calculus.

There is no auditory peace in the diagnostic-imaging waiting room. Who thought it would be a good idea to have the overhead TVs turned to “The View” just as Whoopi Goldberg and Joy Behar were inciting verbal riot? And then there is the party of twelve carrying on as if the waiting room, that morning, was the ideal venue for a boisterous family reunion, catered with vending-machine snacks and deli leftovers.

Oh for the peace and quiet of the MRI. At last, the pongs and pings, the zips and buzzes, the rat-tat-tat and pulses, of the enclosure were welcome; a respite from human cacophony.

And within the cocoon – where he was so comfortably nestled with pillows and bolsters – the surgeon’s “inside-scoop” findings came back to him. Even through the pongs and pings, the zips and buzzes, the rat-tat-tat and the pulses, the surgeon’s reports reverberated.

“I’m not liking what I’m seeing.”

“No… I don’t like what I see.”

On that very silent of nights

’Twas the night before surgery, when all through the apartment…

he stirred.

Non-skid stockings will allow him to walk a hospital corridor with care,
Semi-sure-footedly, to demonstrate his readiness to be discharged out of there.

Not able to nestle all snug in his bed,
visions of catheters had danced in his head.

In both pre-op and recovery, there’s an intra-vesical cap.
Trepidations preclude settling into an untroubled nap.

When from the kitchen there arose such a clatter,
He sprang from his chair to see what was the matter.

Ahhh, the plastic take-out containers had tumbled and crashed, Wheeew, rinsed, it was only water they splashed.

By moon he departed with new-fallen sorrow
For procedures scheduled for that very morrow.

His wandering thoughts traveled to people he holds dear,
He had been through this before, in a previous year.

Still the chemo names came back to him quick,
Surely, again, they’d do the immuno-therapy trick.

The insertion and infusions onward they came,
And he whistled, and shouted, and called them by name.

Now Hexaminolevulinate HC, helps the urologic surgeon the better to see.

This blue-light optical imaging agent for NMIBC is administered prior to surgical Cystoscopy.

Now Photodynamics light the targets in a blue glow For a Transurethral resection, before tumors grow.

Then Mitomycin, the antitumor antibiotic, Oh if only there was something a bit more robotic.

T’would be foolish to decline this intra-vesical infusion, For it retards any immediate tumor profusion.

Yes, you tumors, from the hospital hall, dash away! dash away! dash away all!