Permutations and combinations . . .

It’s Sunday night and I should be watching the Olympics. But I’m boycotting. I’m still pissed off that my use of Lasix has disqualified me from competing in my specialty: synchronized swimming.

So I’ve decided to put this unexpected windfall of free time to good use. I’m going to try to anticipate all the possible scenarios that I may hear from my NY doctor. And I WILL hear from him this week. He may be a rock star, but this week I’m gonna wear his staff down until it’s clear to them that the path of least resistance is to tie him to a chair and force him to watch my latest video. It will take a few calls. And I won’t be the most popular guy in his office this week. But I will get the job done.

Anticipating the spectrum of what I may hear gives me a jump start on what the appropriate responses(s) might be. And therefore better prepares me to move forward in a well considered manner. So where do I start with this assessment of what I may hear? Let’s start with what I know. That’s fairly easy – I know damn near nothing. Let’s see, the following appear to be givens:

1. My heart pounds like crazy. All the time. (Personal observation.)

2. My heart is slightly enlarged. (Medical opinion based on X-ray observation.)

3. If I consume sodium, my lungs fill with fluid and I can’t lie down without coughing incessantly. The fluid retention also makes me feel fatigued and subject to becoming winded easily. (Personal observation.)

4. The above conditions are symptomatic of “congestive heart failure”. (Medical opinion.)

5. A “large myxomatous mass”, “mobile with the movement of the mitral valve”, is present in the left ventricle and is obstructing outflow. (Medical opinion based on echocardiogram review.) Note: I was shown a brief video allegedly confirming this, but to my untrained eye I may as well have been looking at the ultrasound of a goat’s testicle.

6. After reviewing my ultrasound and medical history, a local cardiologist indicated that this was likely to be recurrent sarcoma and urged me to seek immediate hospital admission for open heart surgery the following day. His report stated that I will “likely need mitral valve replacement within the next several days.” (Medical opinion.) That was eleven days ago.

Given the above, it occurs to me that the spectrum of possibilities covers the following:

1. Benign tumor, no imminent danger of fragmentation causing stroke;
..1.1. Inoperable;
..1.2. Operable with significant operative risk and/or consequences;
..1.3. Operable with moderate operative risk and/or consequences;
..1.4. Operable with low operative risk and/or consequences;
..1.5. Non-surgically manageable;

2. Benign tumor, imminent danger of fragmentation causing stroke;
..2.1. Inoperable;
..2.2. Operable with significant operative risk and/or consequences;
..2.3. Operable with moderate operative risk and/or consequences;
..2.4. Operable with low operative risk and/or consequences;
..2.5. Non-surgically manageable;

3. Malignant tumor, no imminent danger of metastasis and/or fragmentation;
..3.1. Inoperable;
..3.2. Operable with significant operative risk and/or consequences;
..3.3. Operable with moderate operative risk and/or consequences;
..3.4. Operable with low operative risk and/or consequences;
..3.5. Non-surgically manageable;

4. Malignant tumor, moderate danger of metastasis and/or fragmentation;
..4.1. Inoperable;
..4.2. Operable with significant operative risk and/or consequences;
..4.3. Operable with moderate operative risk and/or consequences;
..4.4. Operable with low operative risk and/or consequences;
..4.5. Non-surgically manageable;

5. Malignant tumor, imminent danger of metastasis and/or fragmentation;
..5.1. Inoperable;
..5.2. Operable with significant operative risk and/or consequences;
..5.3. Operable with moderate operative risk and/or consequences;
..5.4. Operable with low operative risk and/or consequences;
..5.5. Non-surgically manageable.

Of course, within each of the above line items there are myriad nuances and considerations. Life rarely fits within predetermined outlines, despite our best efforts to so shape it. So this may ultimately play out “off the outline”. That’s the way things usually work out for me. Particularly this early in a data gathering / outline development process.

It’s also possible that my NY doctor may refuse to disclose any substantive information until I’m in his office; that’s the way he played it seven years ago. So I’m fully prepared to make a quick jaunt across country on short notice. Either way, it’s time for that guy to pay some attention to this longtime customer . . .