It snowed in my clinic today. How strange? The forecast for the Oncology clinic was once again for increasing periods of foggy depression with precipitation sure to follow. These “bad weather” days in the oncology clinic can blanket one in disappointment and squelch the slightest iota of joy.
This was not so for Jake, a twenty-something US Air Force Sergeant whose initial journey into the world of cancer brought good humors to the clinic. Despite his initial diagnosis of initially thought early stage testicular cancer, life was in full bloom in Jake and when first diagnosed he excelled at engaging it.
However, today’s clinic visit was a big one, the big one. His cancer was not early stage and today we would decide if our last assault in the war against the worst testicular cancer anyone could remember met with any permanent measure of success. Bad news meant it was time for raping his bone marrow, “nuking” his cancer with a bone marrow transplant and running to the rescue with harvested bone marrow stem cells-the Adam and Eve’s of his blood. A full year had passed since the last of intensive chemotherapy had coursed in Jake’s veins. His chest wall had been partially removed and his spine weakened. My ‘robo-patient’ sported space age alloy mesh for his right chest wall and two titanium rods strained to support his spine. He had started all this as a strapping six-footer. Although he stood tall in our eyes, we had mercilessly beaten him down to about 5’8 as if shrunken by a giant press of malignancy.
Today was the day all right. After all the surgery and chemotherapy was done, Jake had said it was quits if the cancer came back again. There was no mistaking his battle-wearied seriousness as he stated calmly to me before we reviewed the test results, “Doc, a man has to know what a battle is and what a war is. I am not going to confuse em. So, we are at a year now, a year since the last chemotherapy. If it is back again, well ah, I just can’t do no more. I won’t do no more. I ain’t afraid to die anymore, I have seen death” His eyes stayed fixed as if he was peering back and staring into the personal tour of hell he had taken in the past two years.
A little over two years ago Jakes’ saga that became legend was born. There was nothing typical about it. His traitorous testicular cancer cells had set up shop throughout the back of his abdomen, his pelvis, his brain and his lungs. Markers of the cancers’ activity in his blood were ascending like a ballistic missile. He probably had 20 pounds of the beast in him. The prognosis even with the chemotherapy, aggressive surgery and radiation treatment was poor although not impossible to cure but with a huge price and a reasonable chance treatment might not be survived.
Weaned in the rough and tumble barrios, Jake always had mountains to climb. He saw his initial diagnosis of the cancer as no greater peak than he had faced before. He embraced it with maturity beyond his years. In the beginning, chemotherapy was handled with bravery and grace as he spent that initial hospital time socializing with other patients; a regular poster child for just how well intensive treatment could go. Then the dam broke and all manner of havoc let loose. The chemotherapy had exacted a toll of relentless nausea and vomiting so severe it ripped his esophagus. It had also caused both kidney failure and near crippling lung disease. His diet was via tubes and transfusions of what he called, “high-octane intravenous go juice”. The chemotherapy’s assault on his bone marrow required many transfusions of red blood cells owing to profound anemia as well as platelets to prevent him from spontaneously bleeding.
Masses still clung to his chest wall and spine after chemotherapy. Although markers in his blood of cancer activity were negative it was likely that these masses, benign or not, would become locally invasive with a catastrophic outcome. All this left Jake simply too gaunt to even cast a shadow. Any more insults against this walloped warrior and he was gone.
Yes, Jake loved to climb mountains. His dream was to conquer Half Dome in Yosemite before he “checked out”. It became his vision quest, his daily obsession and reason to fight. We would talk of manly things, athletic escapades and the heroic exploits he would have when well. He loved our talks, hanging on each imagined adventure wringing them for every precious drop of hope. When it first was clear that we might lose the battle, his initially engaging and courageous demeanor smote me. It was the right stuff of heady inspiration. In time however, this demeanor gave way to one of simply surviving each moment, scratching out some modicum of feeble hope that one day he could really put one foot in front of the other and leave the hospital alive and well. The time came when Jake was pondering, should he even try. He was tired and had enough. He thought it was time to seal the contract and acknowledge defeat.
Rarely had I launched so fervently into supporting a patient with wavering will. All the stops were out. Every manner of cajoling, admonishing, preaching, challenging, cheerleading and commiseration was thrown at him. In shameless desperation, I offered a contract for life; I would deliver him from his travail and he would climb one last mountain. I did the ‘wrong’ thing. I promised he would live. I just knew a nasty exit was not yet in the cards. Jake did not. Yet somehow, agonizing in every moment, he plodded on.
His recovery from removal of his chest and spine tumors was bloody trench warfare, gargantuan suffering to gain a shot at cure. Nevertheless, gain he did. I thought we would lose him, but there was the promise, our contract. He fumbled on until now it was a year since the last of all the therapy; a crucial time in which if he was cancer free it portended well that he might remain so. We were in the clinic. This was the day.
I had seen him 12 weeks previously and we hoped then that we would declare him cancer free at the one-year mark. He was indeed cancer free at that time but he was a cane-assisted, barely walking testimonial to the melee and carnage of his journey. There may have been the faintest, almost imperceptible spark of life.
Today was different, very different. There was something impish, something teasingly spry this time. There was a lilt in his banter and swagger in his walk. An engaging hint of a wry smile flirted across his face. Crazy sprouts of curly black hair seemed to almost dance merrily on his once bald head. Something was up and so was Jake. He was impatient for me to get on with the checkup routine almost as if I were his Dad making speeches rather than passing out the presents on Christmas morning.
That was when he produced his prize. Unbeknownst to me he had gathered all manner of folk who had shared his saga over the past two years just outside the exam room. I think he even waved down passersby. Beaming and bouncing, he produced his treasure trove. It was a small banged up, seen better days, dirty cooler. With all the pomp and circumstance of a five star hotel concierge, he bid me to open it. There, placed on a bed of mountain laurels and glistening, as were both our eyes, was a wet, weeping ball of ice, a snowball. Before I could connect the dots, he produced the prize. Plain in God’s sight, shirtless with a deformed chest and rods in his back like bionic harpoons, was a photograph of Jake, high atop Half Dome in Yosemite, fists in the heavens, snowball in his hand.
It snowed in my clinic today. I think I will go out and play.