Medicare, Day 1

Yesterday was a huge day. It was a good thing I had stayed home from work with a cold; you were having your first appointment at St. John's, and I got to go with you. After getting lost twice, we finally got to the hospital's 'garden level' where the cancer treatment center is. It was pretty posh, and the other people in the waiting area looked like they were well-heeled. You had to fill out lots of paperwork and spend quite a bit of time convincing the secretaries that you were not on Kaiser's Medicare Advantage. Since you had just cleared that up with my school district, you were very sure of it. They kept saying you had Kaiser for Medicare, you kept saying you didn't. You prevailed. They were apologizing and getting cards for you. You only had a $155 deductible to pay. We spent a lot of time waiting, even after you were finished with the paperwork, and I had to go feed the parking meter. It was a lot of walking, not good for my cold. I had had to call in the relief caregiver early on Sunday because I couldn't take Dad to church. I stayed in bed all day and missed the neighborhood ladies tea, much to my dismay.

Saint John's seemed to be empty, big, and beautiful. All the patients were white. They looked well-0ff. The facility was state-of-the-art. And the parking was a nightmare. $12 flat fee or street parking in two-hour spots. And the parking structures are out of the question. I don't think they'll be giving me any free parking passes.

When we were taken into the waiting room, the nurse asked us from how far away we had come. Apparently, they have patients from all over. The fellow you were talking to in the waiting area had come down from Bakersfield. I get it. It's famous.

The doctor was so informative. He came in with a colleague. They examined you. I saw him pull your socks down to check for edema in your ankles and look for healthy veins. They looked at your skin and asked me about different spots on your back. One doctor asked you if you had a leaky valve. I said no, you said yes. WHAT??? Since when have you had a leaky valve, and why hasn't it been repaired?? We talked about your medical history but, despite your multiple medical conditions, he thinks you're pretty healthy, a good candidate. I agree. And there IS a surgery that can be done! AHA!!! But it's tricky, as you well know. It involves grafting the SMA (superior mesenteric artery), which is no small task. We learned more from your latest Kaiser CT scan as the doctor put your disk in the computer and went over it. There is not only an SMA but a SMV (superior mesenteric vein). That makes sense: what goes in must come out. Both have been impacted by your tumor. The SMV has found other pathways for returning the de-oxygenated blood to your heart. But the SMA is going to be strangled if the pressure is not relieved. The surgery he has performed is a Whipple (removal of a portion of the pancreas along with the tumor) that involves grafting and rebuilding the SMA. The normal Whipple doesn't mess with the SMA or SMV. And the only pancreatic cancer patients who live five years or more have had the Whipple. I am calling this new procedure a 'Whipple Plus'. What makes it tricky is that at the point where the SMA and the tumor come together is a network of branching vessels leaving the SMA to take blood to the intestines. The SMA is the blood supply for the entire intestinal tract. And that's a busy place down there! He would need to make a graft and replicate the vessels. The surgery would take 10 -12 hours and is delicate. There is a 3 - 5% chance you could bleed out right there in the operating room. There is a chance he could get in there and discover it is too difficult to attempt, and he would just have to close you back up. He has done about a dozen of these 'Whipple Pluses' but, despite that small number, no one else in the country has done more than he. He ordered another CT scan, this time with thinner sections, and you had it done this morning. He is wondering whether or not he should wait until you have tried the new chemo you will be taking at St. John's before he does the operation. If your tumor responds to the chemo by shrinking, then it would create a better surgical scenario. Neither one of us heard a clear answer from him on that one. I guess the new CT scan will give him the information he needs. The doctor will be out of town for the rest of this week. He will call you after he has reviewed the latest scan.

What we both liked about this meeting was that we had finally found a doctor who didn't look at you like you were a dead man. It was so nice to meet someone who was trying to find a way to not only keep you alive but who would try to eliminate your cancer. This was a good change for you. It's not a coincidence that you are turning 65 exactly at this time. It's not a coincidence that your tumor is not growing at this time. It's not a coincidence that I was ill Monday. (I can hear the Christians chuckling....) It's called a God-incidence. Too bad you don't believe in it.

Today you said you hadn't seen a cardiologist since your follow-up to your triple bypass three years ago. You haven't? You said that along with an appointment with the new oncologist on Thursday, you have an appointment with a cardiologist, Dad's cardiologist. Well, we've certainly made enough visits to his office, and he's the only person Dad will obey without question. And you're thinking of changing psychiatrists too.