“That’s why you’re still alive.”

It was the kind of thought that probably wasn’t intended to be spoken out loud. But for some reason it slipped off the speaker’s tongue and skipped out between his lips, resonating in the cerebrum’s of those present in the examining room. Too late to reel back in. The emotional detachment with which it was uttered was impressive even considering that the source was a physician, a member of a profession noted for emotional detachment. But I get ahead of myself . . .

On Wednesday, the day before the initiation of Chemo Infusion Round 5, Cecily and I visited a major medical center in Los Angeles that specializes in the dual modalities of radiotherapy and hyperthermia (heat therapy). The concept is that when radiation is applied to tumors in conjunction with heat, lower doses can be effectively applied. I had brought along a CD of last week’s CT scans for the doctor to review prior to our face-to-face meeting.

He performed a physical exam and then collected a detailed clinical history of my sixteen-year dance with cancer. I presented a detailed discussion of the isolated tumors of 1992 and 2000, and the metastatic Stage IV explosion of 2008. He seemed somewhat perplexed after my ten-minute soliloquy. Was I leaving something out? I conducted a mental search for any additional information that might help his understanding of my clinical history. The only thing I could think of was to mention that a CT scan was performed in October of 2005 that was allegedly all clear, but that recent review of those films indicated that the heart tumor was already present at that time but was missed by the reviewing radiologist. That was the missing bit of information for him.

“That’s why you’re still alive.”

If the filter on my brain was as dysfunctional as the filter on his, I would have replied to him with something along the lines of “What the fuck? Beg your pardon?”

What was he saying here? At first blush, it seemed like a stinging indictment of his medical colleague’s ability to fulfill their Hippocratic oaths, namely to “do no harm”. It was as though he was saying “If the medical community had gotten a hold of you more than three years ago we would have certainly killed you by now”. But that was not the intent of his statement.

“The human body cannot accommodate things that grow quickly. Tumors that grow slowly are more easily compensated for – the body is able to make functional adjustments. The fact that these tumors have been around a long time has given your body time to adapt.”

I forget that physicians that view the train wreck of my imaging studies before meeting me have a difficult time reconciling what those studies show with the functional human being with normal vital signs that stands before them in the examining room. I didn’t belabor the point that aside from the cardiac tumor, the rest of the tumors sprang up relatively quickly during the latter part of last year.

He indicated that the cardiac tumor could not be treated with their approach and that the other tumor of primary concern, the large one in my abdomen, was probably too large for radiation treatment. He said that because I’m relatively young and healthy, they could get me “though it” but it would not be easy. He concluded that I would be a poor first candidate for their new machine. I agreed.

He did mention an interesting aspect of liposarcoma tumors that I was unaware of, namely that they are an aggregate of cancerous fat cells and normal fat cells. Because the normal fat cells encapsulated within the tumor are not susceptible to either radiation or chemotherapy, shrinkage of those components of the tumors will not occur. So even in the case in which all the cancerous cells are killed, a portion of the lesion will remain, to eventually be surgically removed or just left in place. Interesting. We thanked him for his time and he agreed to contact us if and when they begin successfully treating larger tumors.

Incidentally, less than 24 hours after we left that medical institution, three staff member lay dead on the floor, victims of a double murder / suicide. It is ironic that if any of those three had been in the imaging room with the doctor before my appointment, all three of them would have thanked their lucky stars that they were not in my shoes. And yet I have outlived them all. Life is funny that way.

“That’s why you’re still alive.”

Actually, it’s never crossed my mind to wonder why I’m still alive. But if I weren’t, that’s when the questions would really begin.