Tuesday, April 16, 2013

I Hate Melanoma!!!!!!

I spent several minutes staring at my computer screen wondering how I could come up with a quippy beginning to this semi-serious blog post.
It's not that I don't take melanoma seriously.  It's just that the only way I got through the experience was a lot of humor and a little bit of misplaced operant conditioning.

The first question people ask me when they found out I had melanoma was what the spot actually looked like.  I recall very clearly walking up the stairs at Clearwater Marine Aquarium in 2005, looking down at my left arm and thinking, "Wow, that mole looks darker than I remember it."

And that's about where I left it.  This is a massive feat for me, because my second profession is Hypochondriac Extraordinaire.   I've diagnosed myself with illnesses not seen since 1749, but on the plus side I've learned about terms such as anisocoria.  I don't just extend this tender worry to myself, but to my animals too.   People who live around me know this peer-reviewed scientific constant (known as Cat's Hypochondria Constant): If you cannot find me in the usual places (e.g. work, home, Publix's bakery), I'm sitting at a 38 degree angle at my computer, breathing very 3 minutes, absorbing WebMD information and/or google-imaging people or animals with illnesses I'm convinced we have.

So why, other than pure irony, would I not have (correctly) instantly diagnosed myself with melanoma when I saw, you know, melanoma on me?  Well, according to my research, I probably have one of twelve forms of dementia.

So before my brain is completely useless, let me share this story with you.

So I spend six months glancing down at this black spot, thinking that because I'm getting tanner, so must be this particular mole.  When my internship ended, I had to go back "home", which wasn't really home to me at the time.  My parents had moved from my native Chicago to New York City while I was doing my internship, so I went from a subtropical paradise with horrible traffic to a concrete city with horrible traffic.  And, within a week of being there, my mom informed me that I'd have to see a dermatologist since I'd been in the sun so much.

New York, the city that never sleeps or cleans up its garbage.

That's when the panic struck.  I stared down at my arm and knew for sure that something was wrong.  Just like I'd known two weeks earlier that my hair was falling out and I was going to be bald by 30.  Or three months earlier, when I just knew my cat had been bitten by a venomous spider only found in parts of Middle Earth.

By the time I got to my appointment, I was wrought with worry.  I couldn't think about anything else.   When Dr. Michael Jacobs (J-Dog, for short) entered the room, he quickly scanned me and decided to Remove The Cause Of My Concern.

A week later, my family took our annual trip to Rhinelander, Wisconsin.  We decided to stop first in Chicago, then drive the rest of the way up north.  I spent some time with my best friend Kelly, and returned to the hotel in excellent spirits.  I checked my cell phone and saw that I'd missed two calls.  From J-Dog's office.  And there was a Voicemail.

There are three things in this universe that make my blood run cold.  Here they are (in no particular order):

1) Seeing anonymous phone numbers + voicemail on my phone screen
2) Seeing doctor's phone numbers + voicemail on my phone screen
3) When the Tagalongs box is empty but I thought for sure there was one more in there

May you be ever full of tagalongs!

My shaking hands picked up the phone and listened to the voicemail.  It was J-Dog's office, telling me to call them right away.  And then they added:

If We Are Closed, Here Is The Doctor's Personal Cell Phone Number So You Can Call Him Without Delay

Oh GOD!!!!!!!!!! That's it, I'm dying.

When J-Dog picked up the phone and learned it was me, he told me the news in a way I could really understand.

What J-Dog said:
"That spot on your distal left bicep has a Clark's Level II melanoma nevus with a Breslow depth of 0.36mm.  You'll have to come in immediately for surgery."

What I Heard:

"Better start telling people who can have your stuff."

He asked me if I understood what he'd said.  As a fellow medically-oriented person, what with the years of WebMD research, I answered confidently that OF COURSE I understood.  I hung up with J-Dog and called my parents who were with some family friends.  When my dad picked up the phone, I lost all composure and told him the news.  I'm 75% sure I said something like, "I have stage 2 melanoma and I have to go back to NYC for surgery." And then I started crying.

My parents rushed back to the hotel and called J-Dog again.  They got the real information, which did not include stage 2 melanoma, but Clark's Level II, which is just a fancy method of staging the depth of the cancer.  And luckily for me, Clark's Level II ain't so deep.  In fact, it was well within the curable range.    And, we learned further, I could absolutely wait a week to have the surgery.

With that minor fire extinguished, I had the daunting task of enjoying my vacation a) in spite of the melanoma diagnosis, b) my deeply ingrained character flaw in which I live in worry in the past/future, but not the present moment and c) I had no access to a computer and therefore WebMD and I were forced apart.  

I spent most of my vacation really scared.  I spent time in my bed worrying about prognosis.  I'd never had surgery before, and I didn't know what was entailed at that time.  I also became completely and irrationally convinced that I had to avoid any exposure to sun, because maybe that would make the melanoma get worse before I had the surgery.  So when I did force myself to get outside to enjoy the outdoors, I found myself avoiding the sun in Vampiric Proportions.

After the Rhinelander vacation, I had several doctor's appointments that involved a lot of blood tests as well as Assessing The Ailed Arm.  My surgeon was (is?) a well-respected oncological surgeon at Sloan Kettering, which is within walking distance from my parents' apartment.  This doctor informed me that my surgery would entail a Wide Area Excision of the biopsied area, that the excision site would be roughly 3 to 5cm (an inch or so), and that while the original biopsy probably took out all of the cancerous cells, the excision would really make sure it was all gone.

I felt a wave of relief wash over me.  Then she said started quoting statistics of 5-year survival, of 10-year survival, and of recurrence.  My head was not necessarily in the right place to assimilate all of the numbers (plus, the part of the brain responsible for mathematics is notably missing from my head and has been replaced with a section entirely dedicated to thinking about Chris Hemsworth).  

Algebra or Chris Hemsworth? Uh, not even a question.

I asked for clarification.  The doctor said, "If this cancer comes back, it'll be in your liver,  your brain, or your spinal cord.  Have a nice day."  And my mom and I were ushered out of the office.

Finally, the day of the surgery arrived.  The nurses at Sloan Kettering were extremely kind and understanding, which was really great because you know, they see people on some of the worst days of their lives.  And even though my situation was far better than many others (for which I'm thankful on a daily basis), I can tell you that having another human being provide you with the tiniest act of kindness can serve as a light in the dark.  My light involved a nurse with a killer taste in music giving me a CD player and insisting I listen to the Beatles from the moment I sat in the waiting room until the moment I woke up from the surgery.

You boys made everything right!

Wait, wait, there was something else that happened that was awesome that day before the surgery began.  The bed/table/slab whatever you want to call it, was the most delicious, luxurious bed I've ever experienced.  It was soft and HEATED.  And then they gave me drugs to pass out.  It was really great.

When I woke up, I felt like I'd had the best sleep of my life.  I still heard the Beatles singing in my ears, and I felt so relieved that this experience was over.  The surgeon came out to debrief me on what she'd done.

The good news was the cancer was likely gone.  The relatively trivial bad news was that instead of a 3cm excision, I had a 9cm slash.  Whatever, I thought.  I just want to get home and watch TV and go back to life as normal.

I hallucinated while on the prescribed pain meds, so I stopped taking them after a day and just relied on good ol' Advil.  A few days later when I had to change the bandages, I saw the excision for the first time.  I looked like Sally from Nightmare Before Christmas, which I thought rocked.  What else rocked about my recovery?  Walking around NYC with my arm in a sling, especially on the subway.  People stopped bumping into me when my arm was in a sling.  In fact, long after I needed it, I still used it when I took the subway anywhere.

The scar, four weeks after the surgery.  Delicious.

But while my physical recovery was going well, my emotional one was not.  Not only was I naturally prone to being Convinced I Was Sick and Dying, but the one time I wasn't freaking out about something that seemed wrong was the one time I DID have something scary.   So it stood to reason that I probably had something else wrong with me, or another melanoma somewhere that was quietly growing and poisoning me.  

My anxiety became so bad that while driving up to Maine for a few weeks of summer classes I tried to reinforce myself with a bagel (it was a good bagel) for saying and thinking positive things about my life as it was.   It was a noble effort, but I ended up housing the bagel after a few tiny, positive-thought-laden bites.  I mean, who can seriously eat a New York-style bagel in anything less than 5 bites?

My primary reinforcement in 2005

My scar became keloid and served as a constant reminder of that time. My mom and aunt both went to the dermatologist after my ordeal and had melanoma spots found, but thankfully they were caught as early as mine was.  A close family friend passed away from metastatic melanoma a few months after my diagnosis.   To this day, as much progress as I've made, I still go through phases where I worry and worry and worry, driving everyone around me insane (well, more than I usually do).

Some people ask me why I chose a career of being out in the sun when I've had melanoma, but the fact is that my melanoma was well on its way to badness before I lived in Florida...I just noticed it a couple of months after I moved there.  I'm very careful in the sun, but the key is to go to a dermatologist regularly to make sure if anything does start to go south, it's caught before it's a problem.

So what's a good way to end this narrative?  Oh, I have no idea.  I mean, I still worry about these things.  But a year ago, I decided to finally do something commemorative about the experience.  I love body art, and wanted a sleeve for a long time, so I decided to get a half sleeve of dolphins on my left arm, which covers half of my scar.  It sort of juxtaposes an experience that obviously made me question a decision to work in the sun with what is reality now: every single day I am doing what I'm passionate about, and that is caring for animals*.

The sleeve after the third session was completed.  Thanks to Jesse Britten!!

So just as I had trouble starting this blog post, I'm having trouble ending it.  Maybe this post was a little more somber than others, but it's an important part of my life I wanted to share.   Nonetheless, I think I'll leave you with this cute picture of an old man dolphin.

* And eating cheese, but a half tattoo sleeve of cheese is not in the future.