A Wonderful Fourth of July

After a week of almost debilitating nausea and fatigue, the past weekend was a blessed and refreshing time for seeing friends and relaxing.  For this round of chemo, it wasn't the chemo that took me down as much as the IV bone strengthening treatment.  Sleepy and nauseous and panic attacks, oh my!

The latter was the strange one.  Perfectly asleep and dreaming good dreams then awake and panicking for no reason.  Had to grab hold of reason and tick down through a mental check list to make sure I was truly having a drug reaction:

1.  Family OK?  Check
2.  Friends OK?  Check
3.  Finances OK?  Check
4.  Feel good?  Plus minus but not terrible
5.  Future plans?  Check

Quick check on the medication side effects and there it was:  "Can cause anxiety issues or panic attacks."  Half glass of wine later, I'm back asleep.

Despite all of those events, I have spent every morning pushing myself to ride my bike in the cooler early AM and then working out to rebuild my strength.  Top everything off with a good relaxing swim.  Seems to be working.

Over the weekend, slept more than 12 hours a night and felt my energy really rebound.  It was great to see Doug, Miso, Shawn, and even Mayor Tom Leppert at a Saturday event.  Was just as exciting to see Tye, Patti, Patti's parents, and the kids on Sunday at their home where we enjoyed excellent grilled burgers and a phenomenal pool.  We'll be doing more of that in the future for sure.  Topped it all with a monster 4th of July stop at sushi buffet restaurant Osaka.  I'm still feeling the effects of that meal today.

Today, I felt compelled to update the blog after receiving several more e-mails full of support and prayers for my and my family's well being.  I cannot tell you how much those communications keep my spirits high.  It heartens me to see and read that people can take time out of their busy, stressful, and hectic lives to offer encouragement to someone that some of the writers barely know.  All provide the energy and positive thoughts I live on to strengthen my outlook.

One writer asked if that I would one day consider penning a book recounting all of my experiences and hopefully accumulated wisdom.  I agreed that it would be something I would consider, but given that I have only been diagnosed since late April, I need to fully experience what I will experience over the next, hopefully, several years before I can provide a recounting of everything that needs to be written.

Until then, I will have to satisfy my urges to write with this blog.  If I haven't put you to sleep already with my writing, have a peaceful night's rest.

Still here. 8o)

A blessed good afternoon to everyone,

I am still here.  As I sit through my second dose of chemo, I finally have time to update the blog.  The last 7 days have been a bit hectic as I sift through a LOT of paperwork.  Also went back to home base, UT Southwestern to give a lecture about life and being prepared for the unexpected.  It was great to see SO MANY familiar faces and many old friends.  I am amazed at the progress of the program and glad to see that the program is still going strong.  Good to see that a large number of the faculty I trained under were still there.  It was supposed to be a short morning Grand Rounds but I ended up not leaving until almost two hours after the completion of the time allotted.

I was also touched to hear from a resident whose brother is also going through advanced cancer at a much younger age than mine.  I hoped that my message and advice provided them with a framework with which to attack this disease and condition and most importantly, provided the family with the concept of NOT treating him as a terminally ill patient.  Who knows what could happen in the next few years.  New treatments are exploding onto the cancer scene.  He may outlive his family or at the very least live a long, productive, and fulfilling life.  The important thing to provide the positive thoughts, words, and prayers that all of you have done for me, on a daily basis.  Family members of cancer patients should not and cannot treat the person as a patient.  He or she is still the same family member you always have known and should be treated as such.

The fear of death every cancer patient experiences even for just a few moments, cannot be reinforced by the words and actions of those surrounding him or her.  It needs to be stomped out because how can you enjoy life, however long or short, if you are always fretting about when your time will be up?  Having had my near death/real death experience, I want to reassure everyone I meet that there is life after death.  I now understand what people that experience near/real death mean when they say they no longer worry about what happens after death.  They saw it.  They were there.  They were no longer afraid.  It is incredibly reassuring.  It should also serve as a warning to those who would hurt others for money, personal gain, or greed in general.  Do you want to see the Elysian Fields version of Heaven I saw or do you want to see pitchforks and fire?  If more people feared the consequences of their bad actions in life, the whole world would be a better place.  At least a lot more quiet.

In the interim, I have been working hard to get into better physical shape and trying to stay on the straight and narrow on my meds and my vitamins.  There are so many of them that you sometimes get overwhelmed remembering what you have and haven't taken each time.

Aside from that, I feel more positive and enthusiastic than ever.  Physical issues aside, I am determined to remain a positive influence on those around me and I am hoping in the near future to make an announcement that will show what hard work, generosity, and networking with like-minded individuals can accomplish.  I hope that our work will show what can be accomplished in a relatively short amount of time and how the work can make our community better and even more generous in every way.

I was very excited to hear that one of my neighbors had decided to start a cycling team with my name under Lance Armstrong's LiveStrong Foundation!  I have made it my goal to get into good enough shape to at least ride a short distance with the team.  May have to break out the training wheels though.  If and when that happens, I will let everyone know when our first race will be.  Thankfully, through the generosity of Del Jantzen and his obviously better half, Ellie, I have a new bike at an incredible discount that I can ride in a race.  I also now know why they call these modern bikes, NUTCRACKERS.

Once again, I hope everyone is enjoying a beautiful and blessed day and don't forget to smile and laugh with your loved ones and share your happiness and joy with everyone.

A Title For Dallas

I can't believe I have lived long enough to see the Dallas Mavericks finally win an NBA championship!  What a great evening with my wife and younger son after dropping off the older one in Austin for the University of Texas swim camp.

Watching the series between the Mavericks and Heat reminded me of how important true teammates and true teamwork is for all endeavors.  No one outside of the Mavericks faithful expected the Mavericks to win.  The Heat had more of the one name stars:  DWade, Lebron, Bosh.  The Mavs?  Dirk (or maybe it should be LeDirk, or ReDirkulous, or LeDirkulous).  But what I found most heartening is that the Mavericks won with a team of focused contributors who went beyond any perceived physical limitations and displayed what true teamwork can accomplish in the face of adversity and supposed insurmountable odds.

Every player on the Mavericks team was a vital contributor to the championship in at least one game.  EVERY SINGLE PLAYER.  Who would have thought Ian Mahinmi would have been crucial in providing rebounds, defense, and even 4 points in last night's game in so few minutes of play?  Before the playoffs, who would have bet good money that J.J. Barea would have been a contender for series MVP?  Who would have thought Peja Stojakovic still had some movement in his legs and could still fire off key, clutch 3 pointers?  Who is Brian Cardinal?  No, seriously, who is Brian Cardinal???

Like Rick Carlisle, I too am relying on a team effort to beat my insurmountable/unbeatable odds against cancer.  I am relying on every doctor, nurse, technician, family member, friend, and the unknown faithful to help push me through the battles.  There have been some big bumps early, but I have faith that my path is still clear to me and that everyone around me will keep me focused and lead, push, or drag me to the right choices and the finish line.

No one can build a dream, a champion, a full life, or a winner against cancer without THE team.  The Mavericks have shown that it isn't about age, how high you jump, how many times you dunk, how many tattoos you have, or how many bad commercials you make.  They have shown how a group of humble and relatively unknown individuals can put aside their differences and focus on the elements that make them function as one cohesive and nearly unstoppable unit.  When you look back at the recent spate of NBA champions and you see teams with multiple stars like Kobe, Shaq, Rondo, Allen, etc., it should amaze you that a team like the Mavericks with some proven but aging veterans and a 6 time all star player with 13 years in the league, was able to power their way through the playoffs and the Dream Team Heat.

Some times it really isn't about the stars, or the Benjamins, or the glitz and glamour.  Some times it truly is about determination, resiliency, and HEART.  I am beyond happy to have seen the Mavericks bring home the gold.  I am even more determined to match their determination, resiliency, and heart to bring back my life to the team that is my family, friends, and caregivers.

Have a great day, and SEE YOU AT THE PARADE!

Infusion Port is in

SAY HELLO TO MY LITTLE FRIEND!!!

BARD PowerPort is in place and finally, I don't have to get stuck a billion times in my arms and end up looking like a junkie.  Better not clot off.

Great job by Dr. David Fosdick (port site doesn't even hurt) and by Dr. Thomas Russell, who kept me very comfortable.

Hopefully can be back to work soon.

On Monday, I was able to speak to another cancer survivor, 3 years with my exact same cancer (even in the same primary location as well).  I was heartened to hear that he still works as a practicing interventional cardiologist and has not let his condition deter him from having fun in his life and continue to work.  What shocked me about his situation is that he was diagnosed stage IV at age 32.  So just when I thought I was the only one with the less than ideal luck situation, I find someone else with an even more unbelievable situation.  Puts everything into an even greater degree of perspective for myself and hopefully for anyone reading this blog.  Hopefully, it makes you realize that getting cut off in traffic, having something spilled on you, having an argument over who gets to take their break first, etc., really isn't that big of a deal.

Now, I want to find as many options as I can, not only for myself, but for the above gentleman and the others I have spoken with over the past two weeks to make sure all options are available.  The Lucanix vaccine trial looks promising:  It is a vaccine made of the 4 most common kinds of non-small cell lung adenocarcinoma which have been virally modified to be inactive but still immunogenic.  Very promising study that will be yet another option should I fail my current and future treatments.

I hope no one is baking in the near 100 degree heat outside and hope everyone is having a great day.

Thoughts From the Weekend

It has been a good weekend.  Some nausea and some weakness from the chemo but all in all beatable with good nausea medicines, ginger root, and strong cups of coffee.

A friend of ours asked my wife and I how we could continue to live as normally as we have and how we could smile and joke around as we always do with each other, the kids, and our friends.  She wondered if we were in denial and needed to have counseling, a thought shared by some of my professional peers as well.  We thought long and hard about that question and my wife's response best summarizes our attitude:

"If I knew or even felt that crying would melt away my husband's tumors, I would cry every second of every day.  The fact is that it won't so why do I want to feel sad and show him sadness when he needs me to be upbeat and happy for him?"  Likewise, I do not feel it is necessary to express sadness, despair, and hopelessness when I see my family and friends, especially since I want to see them happy, which in turn makes me truly happy.

Do I feel sad and occasionally hopeless each day?  Certainly.  To say otherwise is to deny the reality that I am fighting a battle every single second of every day to live, thrive, and enjoy the moments I want to feel with my family and friends.  While most people can simply change clothes and go out and enjoy the moment, I have to push my body to exercise to build energy and momentum for the day, ensure I have taken the right medications and done the right exercises for my breathing, test the sore spots of my body for too much wear and tear, eat frequent small meals, then determine if I can honestly make it to an event.  It can be overwhelming, but when your back is truly against THE wall, you find the energy to push through it to make sure you aren't wasting precious time.

Yesterday was a challenge to say the least.  One that I powered through with my wife's support but a challenge nonetheless.  I attended the birthday dinner and party of my brother from another mother, Douglas Won.  After a day collecting appropriate gifts for someone turning 40 years old (Depends, Preparation H, Extenze, etc.), it was fun to finally get the party started.  In the process, our mutually close friend Michael Rimlawi graciously (foolishly?) allowed me to drive his new Lamborghini LP 640 Murcielago from the restaurant to the downtown Dallas W Hotel.  I might have broken the speed limit once or twice or 7 times in third gear.  Another memorable moment that I wouldn't have gotten to enjoy if I had wallowed in misery at home.

I was able to enjoy a couple of hours of fun with great friends and see the mother of all belly dances given by a truly gifted dancer to the birthday boy.  Even my wife had to admit, she was talented.

So to return to the point of the post, what do I truly have to be sad about when I can still enjoy great times and great dreams with great people in a great environment?  I am truly blessed to know each and every friend that I have in this world and I can only imagine my life getting better from this point on now that I have finally started to treat and fight my cancer.  Long overdue but at the forefront of my efforts.

Don't let the little setbacks and irritations of the day roll all over you.  You will be the better person when those bumps no longer knock you off your pathway.  Don't let them distract you from seeing and enjoying the fragrances of all the flowers of life that surround you.

Finally!

Today is the day my fight against cancer officially begins!  Chemo gets started in a few minutes and I am more than ready to get this party started.  Feeling good physically today, minus the permanent cough.  Have met more people that have beat lung cancer and want to keep that positive feeling going.

I am amazed at the number of people that have fought this fight and succeeded.  Each story I hear heartens me and makes me realize that I am truly just beginning my journey.  I hope to continue a positive pathway physically and as for mentally, all of your prayers and words of support and encouragement have kept my spirits high no matter what strange situations I have had to encounter.

Enjoy a beautiful day outside and I thank you all for your support!

News That Could Have Been Better

Genetics back today.  Of course EGFR AND EML4-ALK negative.  Double whammy, no love.  Here comes the time for chemo and then surgery.

Just when I thought my luck was turning around, another comet to the forehead.

Still, doesn't mean I'm giving up.  Just means fight took a wrong and totally unexpected turn.  Should have been candidate for Tarceva or crizotinib, but instead two strikes.

Thoughts After a Restful Weekend

It's been a great three day weekend after an initially rough start to the holiday.  Since then, aside from a minor setback (re-broke the left T6 rib after major coughing spell, but doesn't hurt as bad as first time), managed to squeeze in some daily stationary biking and light weightlifting.  Pushing hard to get back to work and back to a sense of normality in my life.

I wanted to touch on a subject that as a stage IV cancer patient, most people going through this kind of illness can relate to.  When you are hit with this diagnosis, the obvious hope is that somehow, some way it is treatable with conventional medicine.  When you are told that you are likely not going to have a significant life span, many people including myself begin to look for alternative treatments and the "miracle cure."  There are certainly a number of people out there, peddling miracles from all types of sources.

I bring this topic up today because after a couple of weeks of looking at a variety of alternative treatments, I have run afoul of a number of scam and con artists, but some legitimate providers as well.  Most brazen among the scam artists were a pair of San Antonio men claiming to have cured 250,000 people of cancer since 1973, yet not being able to introduce me to even one of those survivors.  They also claimed to be seeing the sister of Ted Turner the same time they were seeing me, to treat her cancer.  One problem:  Ted Turner's sole sister, Mary Jane Turner, died 52 years ago at age 17 of complications of lupus.  What was originally promised to be free treatment to me (for which I would gladly pay large sums of money if legitimate) then turned to "if you could donate $10,000 to my charity 501 foundation in Romania" now, then another $15,000 in two weeks regardless of the outcome of the "treatment," of course raised my suspicion.  An inability to provide any information on the specific content and nature of the treatments also raised my suspicion and ire.

Unfortunately, these types of subhuman vultures abound in the world, preying on those whose desperation will allow them to throw away all of their resources for treatments that have no evidence or testimonial support to back them.  Again, all I asked was for one person to talk to me about how they were cured with the evidence to back it up (scans, lab work, etc.).  After 250,000 successes, you would figure it would be an easy situation, yet somehow not a single person could be found to tout the benefit of these treatments.

Conversely, I have met/talked with several physicians, oriental medicine doctors, and other alternative providers who have given realistic expectations of their treatments and have emphasized the need to consider their treatments as complementary to conventional therapy or as treatment of last resort should all else fail.  I have met a pulmonologist in Denton, Texas who decided to try alternative treatments for his mother who has stage IV renal cell cancer and who had been sent home to expire peacefully at home.  He decided to try alternative medications (largely high concentrations of multiple vitamins) with substances that have been shown to be toxic to cancer cells in small trials, but which have minimal side effect/toxicity profiles for humans and now more than six months later, her cancer volume has reduced by over half since he started his treatments on her and she has returned to almost normal in her activities of daily living at age 79.  With his medical mind, he is keeping track of her treatments and responses to multiple dosages of his treatments and hopes to begin studies to prove this is not an aberration.  I hope to be able to help him begin to organize and publish the results of these case by case situations.

I believe these types of COMPLEMENTARY treatments have a strong future in the treatment of cancer or at the very least, in the amelioration of symptoms and side effects of cancer and its treatment.  I am starting these vitamin infusions as well to see what benefits I may derive from them.  I am NOT suggesting everyone with cancer start beating down their doctors' doors asking for high dose vitamin infusions, but instead, I am using my situation to filter through the variety of treatments we never hear about outside of conventional treatment.  After all, what have I got to lose and if all I get from the infusions is that wonderfully luminescent yellowing of my pee, then at least I get to say I produced such a pretty color each day.

As always, I welcome suggestions for treatments and as stated, I will try to filter through all that I can to provide suggestions for those who may follow in my unfortunate footsteps in this journey to heal my body.

Work hard, take pride in your work, stay safe, balance your needs with those of your family and your responsibilities, KEEP YOUR FAITH STRONG, and may you all have and enjoy many blessed days to come.

Rallying For My Family and Friends

It has been an interesting day.  It started off as bad as the last several days with me struggling to draw even one deep breath.  Accompanying my wife and younger son as she dropped him off at school almost ended with me passed out in the car.  Quite frankly, I found myself sinking again and while I wallowed in self-pity and struggled to breathe, I happened to log into my e-mail account and received an e-mail from Allison Wright, the wonderful nurse (of a group of great nurses) that took care of me at the Heart Hospital Baylor Plano after my biopsy complications.  At just the right time, she sent me an e-mail talking about how her faith in God and life in general had been renewed with what she had seen and helped with in my fight against my cancer.

I read that letter and it reminded me that I need to practice what I have been preaching all these weeks, no matter what the difficulty is.  Granted breathing is not quite an optional activity, but I am able to walk, talk, and otherwise do activities, so I have to buckle down and push through this phase.  After losing 23 pounds, my wife was determined to reverse the trend, so after a morning coffee, we ate a healthy (healthy as in large) lunch and after returning home, instead of lying down to rest, I headed straight to the gym.  After a 30 minute ride at super turtle speed, I hurled as only I can hurl, but continued to push through a workout of light weights.  As I hoped would happen, I started to feel better.  Extremely short of breath, but if I didn't pass out, I was going to continue to workout and for the first day in three weeks, I didn't nap the entire day.

More calls and texts from friends voicing their support gave me more energy and I was actually able to play a game of pickup basketball with my sons.  It reminded me of the joy of being able to spend time with my family, no matter what my condition and to Allison, Marina, Patty, Peter, Tony, and everyone who checked in on me today, I give you my heartfelt love and thanks for motivating me to power through my difficulties.  Faith is just one part of the equation of healing and recovery.  Support from others plays an equally important role and the final piece of the equation is your own drive to keep fighting.  I lost the latter these last 4 days.  I have rediscovered that drive and I plan to keep powering through my ailments and stay positive even though my anger was heavily kindled with the rediscovery of my pathology slides.

I haven't quite been able to forgive and certainly haven't forgotten that egregious dereliction, but I can't allow it to occupy my thoughts and my time.  To all that read this post, please remember to hug your loved ones and your friends and spend your time savoring those moments and anticipating the next.  Like Allison wrote to me, I should live every day as if I will be gone tomorrow, and I had forgotten that mindset and was living like I was going to live forever.  I will not and can not do that again.

Just When You Thought it Couldn't Get Stranger

The missing slides, the ones that couldn't be found neither hide nor hair, the ones that didn't exist because in fact all of the tumor was in just the one slide used to make the pathologic diagnosis such that I had to have a second biopsy procedure and every complication known to man two weeks ago, HAVE BEEN FOUND!  That's right, all that I am currently enduring and have endured from pneumothorax and coding to readmission for severe dyspnea, all did not have to happen had someone done their job and kept track of my slides.

I don't know whether to laugh or cry or both.  I have been out of work for two weeks, will be out indefinitely until and IF I regain my pulmonary function, and have endured more pain and listlessness FOR NOTHING.  It should have never happened.  It's been a bad dream sequence loop.

The lesson in all of this is that like I mentioned in the Starbucks situation in a previous post, everyone needs to take pride and ownership of the work they do.  You may not be doing the work you had hoped to be doing.  You may dream of other jobs.  You may absolutely hate your job, but for everyone's sake, do it with pride and passion.  A simple mistake can affect someone you know or don't know in such a way as to bring him or her to the brink of death for no reason.  That is where I have been.  Through the lowest of lows and a feeling of unbelievable helplessness, I have fought to persevere, but I can't believe that this kind of error could happen and cause so much havoc in my life.

While I would normally be of the mindset to just let things go, I don't know if I can do that this time.  An extra procedure, two chest tubes, coding/near death experience, now 16 chest X-rays, 7 CT scans, days of struggling to take even one normal breath, not to mention all that my family and friends have had to endure, all adds up to a head rolling.

Tonight, I will pray for the strength to get through this new set of challenges and pray for the strength to forgive.

A Small Step Back

This past weekend was to be a weekend of rest and rejuvenation but instead turned into a battle to breathe and withdrawal from pain medications.  I stopped the pain medications on Saturday morning primarily because I wasn't hurting that bad and I didn't like the lightheaded/sleepy feeling I received with each dose.  Throughout the weekend, I experienced minimal pain but struggled mightily to breathe such that I could wear myself out every hour just struggling to get air in.  Attended a Saturday night barbecue at a neighbor's house and within 30 minutes, had to go home and sleep the rest of the night.  Sunday was worse.  Never could get out of bed until Emily dragged me with her grocery shopping and again, had to sleep the rest of the day after getting home.  Received a pep visit from Doug and Miso and that cheered me up.

In recalling this, I find it again somewhat humorous that all of my issues thus far stem from everything ASIDE from my cancer.  In trying to obtain a formal diagnosis, I have endured more than I had ever thought was possible in this situation.  I find myself pondering how different things could have been if my first slides had not been lost/misplaced/had more tumor on it, had not had the CT guided biopsy, or just gone ahead and done the big whack and gotten the whole primary out.  The latter would likely had me in a similar position, but the former might have allowed me some semblance of normality in my life.  Water under the bridge but still a thought that pops up even now as I struggle to breathe while typing.

As always, Emily has been my super positive cheerleader, never letting me sink too low and never letting me forget to at least try to get on my feet.  I can only wonder what my state would be if she was not who she is or was not in my life.  I imagine a very different situation without her in my life.

Today, I will be readmitted to Baylor Plano Hospital for further evaluation and tests for this shortness of breath.  I wouldn't mind finding out it is all in my head, but at this point, I kind of doubt it.  CT Angio for ruling out pulmonary embolus seems reasonable and a full battery of spirometric tests likely.  Where they lead from here is anyone's guess.  Surgery?  Breathing treatments?  Supplemental oxygen or breathing apparatus?  Who knows.  Anything to be able to draw a deep clear breath without using all my strength.

In the interim, I remain vigilant and continue to keep myself on as even a keel as I can.  Trying to maintain my sense of balance gets to be a challenge periodically but everyone's thoughts and prayers have been a tremendous boost.  Keep those who suffered through last night's tornadoes in your prayers as their journey is just beginning and needs your support to reach its conclusion.

A Day Back at Work

Probably a little too early, however the chance to work with my friends again was too much to pass up.  Up at my usual 0505 AM, light exercise, walk around the block, change, get into the car and there at work by 0655 AM.  Takes about 20 minutes to actually get back to the OR as I can't pass up all the hugs, handshakes, and conversations that happen along the 50 or so yards from the front of the facility to the OR area.  It feels great to be back.  I'm feeling it, the nurses are feeling it, everyone is upbeat and that just makes me feel great.  I take the opportunity to console Patty on the loss of her two teenage nieces in the Alabama tornado and Sergio whose father has passed from a stroke.  I should have been there for them when they happened, but if not, at least now I can comfort them face to face.  Patty hugs me so hard, I think she is about to launch me toward the roof.

A straight forward spine case by Dr. Mark Valente is on deck and we head back and get the patient off to sleep and positioned for the surgery.  By that time, I know something is not right.  I feel light headed and short of breath.  Have to sit down.  Finally realize it's the OR mask that makes me feel like I am suffocating.  Can't take it off in the middle of the case, so get Parkland creative and hook myself up to oxygen with a nasal cannula.  Works like a charm.  Case goes smooth and patient does great postoperatively.

On the other hand, I feel like I can't take a deep breath.  I have to pass on visiting other parts of the facility to see everyone there.  As I am about to leave, the Starbucks regional manager and the barista mentioned below call.  Although I should just tell them to call back later or keep the conversation very short, I cannot pass up the opportunity to educate and hopefully inspire the young barista as well as the regional manager.  What breath I have left is consumed in the conversations and by the time I return home, I have to swallow more pain pills and use a nebulizer.

Before giving myself time to lie down, I have to take the wife to lunch at one of our new favorite lunch spots, Cafe Elite, a vegan restaurant.  Yes I said vegan.  Before you carnivores start to roll your eyes and close your mouths, this place has amazed me with the quality of their tofu/plant based meat substitutes.  I honestly cannot tell the difference in most of their dishes or if so, only a slight difference.  The fact that they are 100% organic, use no MSG, added salt, sugar, meats of any kind, taste great, AND are dirt cheap just adds to my level of amazement of what they are able to prepare.

What did I eat?  A sloppy joe.  Would never eat a sloppy joe over the past 6 years because of my exercise diet.  This sloppy joe was the best I've ever tasted.  No sugar, no meat, no processed crap, and still a wow taste.  Six dishes, 1 hour, and $26 later wife and I felt satisfied and ready to rest.  For people complaining that the only cheap food they can find are chain restaurant food, LOOK HARDER.  I only wish I had started eating at this place a lot earlier.  I'd have more money saved up and felt healthier.

The rest of the day has been a struggle to breathe.  I almost passed out at my older son's concert this evening because of its location in a humid over crowded school gym.  That close to collapsing.  Left the place struggling to make sense of why I was so short of breath.  Regardless, I still think this has been a great day.  Spent some time back at work with the people I love to work with and spent most of the day with my beautiful wife.  I am still the luckiest guy in the world no matter how my body may feel.  Tomorrow beckons and I am looking forward to what challenges that might present themselves to me.

HOME!

Decided that things have been too hectic and I haven't been at the top of my physical game to keep moving around the state on a daily and weekly basis.  Saw Dr. Brian Lin, radiation oncologist and got some great feedback on treatment options from that field.  Things have changed since I first thought about radiation oncology as a specialty.

It was fun and energizing to see Brian and his wonderful family open their arms to someone they had not seen in over 5 years and offer to help in whatever way they could.

I also learned today that I certainly have a ways to go from the complications I endured last week, and I need to ease back into my normal life.  For my kids, it has to be that way to ensure I can still do the things any dad wants to do with his active, creative sons.  My neighbor told me that the first day my younger son heard that I would be coming home the next day, he couldn't stop smiling and bouncing around like a pogo stick at the house and later at In and Out Burger in Frisco.  When she asked what had changed his mood from somber and slightly withdrawn, he would just smile.  When she asked, "is it because your daddy is coming home?"  His smile went supernova and all he could do was nod his head up and down.

As I sit contemplating what else to write, he is sitting next to me drawing of all things, a Phoenix.  Those of you from the SDN network understand how ironic that is, but even from the perspective of what has just occurred to me, I find it an appropriate image to ponder:  Like the Phoenix, I will rise from the ashes of these past two months.  Unlike the Phoenix, I will not have to die first.  I hope.  8o)

Once again, I hope everyone has taken enough time this week to enjoy friends and family and have plans for the weekend to maximize their relaxation and time away from work.  If you have to work, maximize your productivity while there and enjoy the rest of the time off.

To the lethargic San Marcos Starbucks "barista", if you cannot find it in your abilities to actually put the shot of espresso, light whipped cream, and Splenda we requested in our drinks so that we could drive the rest of the way home awake and alert, please find another occupation that requires less critical thinking and manual dexterity.  We should not have been wondering why we were both still falling asleep an hour after drinking "renowned Starbucks espresso."  I would have been extremely upset if after all I have done and plan to do, I got taken out on the road because of a Grande Starbucks Frappucino BLANK!

Edit:  Gotta give credit where credit is due.  The above barista called me today to apologize for our experience and offered to make up for it in any way.  I told her that I wasn't interested in hearing her grovel, beg for forgiveness, offer me free stuff, etc.  I wanted her to know that everything we do at our jobs can have the butterfly effect:  that small ripple of air generated by a butterfly in China could start a domino of events shifting weather events halfway across the globe.  Do your job with effort and pride and only by chance will you make a mistake once in a blue moon.  Perform your job with disdain, without pride, or lackadaisically then you and everyone else will see your mistakes quite frequently.

An Interesting Day in San Antonio

After returning home yesterday, today's trip to San Antonio almost didn't occur.  Not being able to fly because of my pneumothorax turned a 1 hour flight into a 5.5 hour drive.  Last night, my shortness of breath returned and that with shaking chills necessitated a visit from my physician neighbor Rick.

The verdict?  Stop trying to tough out the pain and take your pain pills.  Advice taken and problem eventually solved.  Sometimes, we physicians truly make horrible patients through our horrible decision to be the "tough patient."  Today has been an up and down day and I find that if I don't stay on top of my pain control religiously, the pain returns in such force as to make me feel even worse than this past Thursday.

Felt bad that the employees of the bookstore in San Antonio had to watch me sleep on their chair looking like I was on death's door.  Kindly enough, one of them asked if I wanted a blanket.  I politely declined but that did make me feel happy.

Today's lesson to myself is that through all of the problems that have arisen over the past two weeks, I need to maintain my calm and balance and not get caught up in the anger over the situations that have occurred.  Priority one is building energy up for the big fight.

Once again, many thanks to my friends who have called and are willing to listen to me vent over topics that really aren't important at this point in my life.  Of course, hearing their voices coupled with not being able to work, makes me miss them even more.

While some patients may pray to be healthy enough to go about their day to day activities, I pray to be healthy enough to work with my friends again and still have more than enough time to spend with my wife and kids.  If you are reading this post tonight, GO TO BED!  The next day beckons to you and tomorrow is going to be a GREAT day.  8o)

The Night Before I Go Home

It has been a very pleasant day with visits from family and friends (Patti, Marina, Rick, et.al.) and a phone call from a long time friend I hadn't heard from in a long while (Jennie Huang, Hi Jennie!)

Jennie reminded me of an old Buddhist proverb about all life flowing from the same river that gives birth to each of us individually as it flows over waterfalls.  Each drop represents each individual we see in our lives.  At the end of our individual journey, we come back together at the end of the fall and once again rejoin with our companions as the next journey begins to our next destination.

That thought and Jennie's tears moved me to revisit my life in general and my waning spirituality.  Through my early years raised Roman Catholic, to my later years gravitating toward Buddhist philosophies of non-violence and doing good to everyone and everything you meet, I realized that I had strayed from the pathway by forgoing my faith in even the smallest ways.  Simply put, while I have always been a believer in God and Jesus Christ, I had forgone the spiritual necessities of praying and seeking out divine wisdom.

So tonight, for the first time in a very long time, I got up from my hospital bed, got on my knees, and opened my heart and my soul to God.  I asked for forgiveness for my time away from God, I asked for forgiveness for what sins I had committed, and I prayed for the strength to continue to positively influence the lives of those around me and those who believe in me.  I prayed for the strength of my children to continue to be the good and faithful persons they are, but most of all, I prayed for the strength of my beloved wife Emily to be able to continue in my absence whether that time be months or years from now.  In all of my life's trials, I have placed faith in God for my pursuit of a higher purpose in life.  This trial is simply another one I must navigate to find a better understanding of the world we live in, the people we meet in it, and most of all the strength of my own convictions and my soul.

As you think about all I have said tonight, take time to thank a greater power for giving you the chance to experience a life that can be as full as we are willing to make it.  From the simple pleasures of a kiss and a hug to the lifetime commitment to families and friends, we are all truly blessed to have lived lives so full of love, adventures, and the challenges that define who we are and what we will become.

A story from a reader here

I have gone back and forth about messaging you, but I have shed enough tears reading your blog that I wanted to share a quick thought with you.

My father was diagnosed with esophageal adenocarcinoma when I was a toddler (he was your age at the time). He never smoke or drank, ONCE, in his life. He was a clean and upright man, which sounds similar to you. He had a hiatal hernia, which caused Barret's esophagus, which had become cancerous.

Long story short, he went through it all. Esophagectomy, chemo, radiation. He fought with all he had for five years.

The POINT of my story. As a child, I remember him coming home from chemo/radiation and playing baseball with me...And laughing at how he could barely catch a ball (he was quite a baller before all of this). I remember riding on his shoulders on the beach. I remember him taking me to school each day. I remember him spending many afternoons sitting on the front porch with my mom. I can still hear him cheering for me at my tee-ball games.

You are doing it right. The TIME my dad spent with me is priceless. His big smile is unforgettable. I would encourage you to continue spending this TIME with your family, with as upbeat attitude as you can muster. TIME is life's most precious asset.

I hope I'm not wasting your TIME () with another sob story. I appreciate your bravery and will continue to follow your posts. I am always amazed at how resilient the human body is....continue that FIGHT.

Prayers,


***

May 15, CHEST TUBE OUT!

What a wonderful Sunday morning I am seeing out my window.  Temperatures in the 60's, slow breeze, not a cloud in the sky.  I should be outside with my family enjoying this beautiful day, but I have been lucky to have stayed in a hotel like hospital where all of my nurses this weekend, Allison, Tari Anne, and Silby have given me the treatment usually afforded to a visiting head of state.  I know where I want to be in the future if I need to have chest surgery.  The Heart Hospital at Baylor Plano is a palace.

The output of my chest tube has trickled down to only 30 cc's overnight.  It can come out soon.  The pain is noticeable, but the itching of the statlock  trapping the tube against my skin is almost unbearable.  Soon it will be over.  Yesterday, I received visits from Doug and Miso, Gabe and new girlfriend (sorry name escapes me), neighbor Janice, practice partner Hoang Nguyen, CT surgeons Mike Mack and William "the mad Scotsman" Wallace, and a mystery guest that came when I was in the restroom then left.  Miso brought me the largest Starbucks frappucino I have seen in a while.  Gabe brought hundreds of dollars worth of toys for my kids.  I just want to see everyone, but Gabe wants my kids to feel special, which they already know they are.

At 8:15 AM, Dr. Erwin dropped by to pull out the tube!  After a milligram of Dilaudid, Ged started pulling off the dressings and the statlock, which I have to say felt better than anything I have experienced in the last year.  No more uncontrollable itching!  As with the May 12 incident, the tube doesn't come out easily and he has to cut the coiling wire to get it to straighten out.  Maybe a manufacturing defect.  Regardless, IT'S DONE!!!!  No pain, no itching, breathing easy.  True bliss.

I want to write more, but I think I'll just take a quick nap and enjoy being able to just breathe!

May 12, a Near Death Nightmare

On Thursday May 12, I arrive at Zale Lipshy University Hospital at 7:20 AM for my CT guided trans thoracic needle biopsy of my lung cancer.  I get the IV placed and am taken back to the CT room, positioned somewhat uncomfortably with my right arm trapped beneath me lying on my right side.  I get a pre-procedure CT scan and am immediately prepped on my back for the biopsy.  Fentanyl rolls into my vein and all of a sudden, I feel real good.  Dr. Watamull numbs my back up and goes to town with the biopsy needle.  Chunk after chunk of cancer is obtained and I am glad that we have done this to obtain more specimen.  That all changes near the end of the procedure, when suddenly, I can't breathe.  My voice is less than a squirrel's chirp.  Sensing my issue and not wasting time to talk to me, Dr. W immediately slams in a catheter chest tube and immediately starts evacuating the air out of my lung cavity.  Finally, I can breathe again!  I get a third CT scan to confirm placement of the tube, which is confirmed.

I am taken to the recovery room where over a period of 6 hours and 4 portable chest x-rays, I continue to feel excruciating pain from the presence of the tube, but I can breathe an there doesn't appear to be an air leak.  Dr. W decides to pull the tube at the 6 hour mark which is surprisingly painful.  I see the coiled up catheter next to me and feel a great sense of relief that it is out of my chest and for a couple of minutes, I feel great.  No pain, breathing very easily, I may get to go home after all!

You know that wasn't going to be the case.  I have seen and heard of patients experiencing a sense of impending doom and that is exactly what I started to feel.  Nothing specific, but I knew something was wrong.  I tell Emily to go find help soon because "something bad is about to happen."  BOOM!  My legs start to shake, then my body goes bright, hot red, my arms shake, my head shakes, my eyes roll toward the back of my head and I collapse and code.    I would later find out that Emily had run to the nurses' station to request emergent help and all three nurses pick up the phones and start dialing numbers.  "Isn't this a ****ing hospital!!!  What are you doing?  Calling 911?  Someone get back there and help my husband!!!"

Riding a beautiful, perfect horse, next to my beautiful Emily also riding an equally perfect horse, a wonderfully cool breeze was blowing through the tall grasses as we rode our horses toward a bright building in the distance.  We were in no rush.  We just knew that was where we were headed.  I held her hand tightly in mine and enjoyed the slow gallop toward our destination.

Then I was awake with an oxygen venti mask off to the right side of my face and a resuscitation mask directly over my mouth and nose being held in place by a nurse.  "Oh, I am not at home waking up from a dream, am I?"  Faintly, I hear "50/0, 50/10, 60/20, 60/30 . . ."  My blood pressures?  Apparently so.  In the 5 minutes I was down, I turned blue after initially turning red and my wonderful dream may not have been just a dream at all.  Dr. W quickly rushes me to the x-ray room.  Must be another tension pneumothorax.  I am asked if I can stand by the technician.  Yeah, right.  If you want to see my head crack open on the floor.  I am positioned against the x-ray plate holder while sitting on the side of my stretcher with my chin/face mashed against the top ridge of the plate holder.  Great more radiation.  Lung looks expanded, but now there is fluid in the right chest cavity.  Lots of it.

Back to the CT procedure room for my 4th CT scan of the day, prep and drape of my back, and placement of my second catheter chest tube on the right, followed by my 5th and final confirmatory CT scan.  Back to the recovery room where a badly shaking Emily has notified our friends to arrange to pick up our kids and keep everyone up to date about my situation.  She would later tell me that Dr. Hostin was infuriated over the whole situation starting with the lost pathology slides that led to an extra and unnecessary procedure being done with the subsequent life-threatening complications.  I am happy to be alive, but he wants blood.  I would later join him in that hunt.

By 4:30 pm, I have had two chest tubes, a pneumothorax, have coded, endured 5 CT scans, and 10 formal and portable chest x-rays.  Unbelievable but true.  Dr. W knows I need to be transferred to the care of a pulmonologist and/or cardiothoracic surgeon and suggests St. Paul University Hospital.  I refuse.  I want to go to a place where I know all of the surgeons and staff members and where I know I can convalesce in peace and quiet:  the Heart Hospital at Baylor Plano.  Yes BAYLOR Plano.  Despite the nightmarish sequence of events over the past two weeks, I am angry primarily with Baylor Downtown, not Plano.

Of course to top it all off, I am informed by the EMS technicians that their truck does not have an air ride suspension system of any kind and the stretcher I am to be transferred on is basically a stiff board on wheels.  A 45 minute ride from Zale to Plano ensues in which the driver mistakenly believes the northbound highway route is blocked with an accident (Emily took that route and got to Plano in 25 minutes) and takes a detour to the worst possible choice of roads in north bound rush hour traffic:  Preston Road.  I feel every excruciating pothole and speed bump along our "alternative" route and finally have to have more pain medications to continue with this rodeo on wheels.  I then beg the driver to head east two blocks to Hilcrest Avenue where I know the traffic will be significantly lighter.  He agrees and 5 minutes later, we are at the Heart Hospital.  I am delirious, nauseated, have 10/10 pain everywhere from my right side to my back and I know I am hypovolemic.  I look down at my drainage bag and see 500 cc's of bright red blood in my pouch.

The nurses get me settled in on my bed in a room big enough to compete with most hotel suites with all of the amenities.  I am alive and Dr. Matthew Curry is there to see that I stay that way.  My wife has called the CT surgeons we know and informed them of my presence.  I am stabilized overnight with a ton of fluids and the next morning, Friday May 13, I am told by one of the surgeons that I have to have chest surgery to stop the bleeding.  I am too tired to exclaim my usual "Really?"  Fine let's get it over with.  If I had known the biopsy was going to be this much of an adventure, I would have had the surgeon take out the entire primary cancer mass so the pathologist and oncologist could have a ton of tumor to play with.  Only one problem:  I have eaten a full breakfast.  Case delayed to around 3 pm then.  In the interval time, dozens of my physician and non-physician friends drop by to say hi and cheer me up.  They, like I, are incredulous that Baylor PBM could lose my slides and lead me to this path of near death, tortuous procedures, and tons of radiation.  I too start to feel my happy-go-lucky personality evaporate to reveal the dragon.  Someone will pay for this.

My wife asks her brother to bring materials and bowls to a Buddhist temple in his hometown of Austin around noon as an offering to the big guy.  Perhaps by total coincidence, my bleeding slows and between 1 and 3 pm, is only a trickle.  "Norm we aren't going to take you to surgery.  Let's see how this settles out over the next 24 hours and go from there."  Is it possible that my unlucky streak has been derailed?  Dare I hope to not be tortured again?

May 9 - May 11, the Next Steps

After a wonderful weekend with the family, I was back to a full schedule of work on Monday.  A great day and I even got back into the gym without passing out!  Again, what wonderful people I get to work with on a regular basis.  Tuesday was more of the same:  Great cases with great surgeons and great staff members, even great patients!  My wife is now juicing beets, carrots, apples, and all manner of healthy vegetation for my daily consumption and to be honest, I like it and overall feel healthier.

Then came Wednesday.  The day of travel to Houston to MD Anderson, the mecca of cancer diagnosis and treatment.  I drove there with my wife and upon arriving first at a gas station to fill up the car, I discovered that I have a bladder capacity well in excess of a liter.  Ouch.  I received a call from a former intern of mine when I was chief resident at UT Southwestern's Department of Anesthesiology and Pain Management, asking for a reference for a friend of mine.  I gave it and when she asked how I was doing and where I was calling from.  I laid down the hammer and repeated my spiel to her about getting regular checkups and being prepared.

After checking in at Anderson, we wait and are first met by an oncology fellow.  A very nervous oncology fellow.  Don't worry, I don't bite (much).  I have all my shots.  Through the usual history and physical, I discern that I will get little information from the fellow and await Dr. Fosella.  He arrives in a blazing flurry of motion and speech and within 10 minutes, my H&P is done and we are going over options.  He is not optimistic:  Chemo only, no surgery, no radiation unless palliative, protocols no different from Southwestern.  Somehow he seems too formulaic for my situation and I decide to continue to use MD Anderson as a reference and fall back option, but I am pretty sure I want to get my primary treatments in Dallas.

The wife and I spend the afternoon eating in Houston and Sinh Sinh asian seafood restaurant then hit the road for Dallas through horrific Houston rush hour traffic at 4:45 PM.  We arrive home at 9:30 pm through two hours of driving thunderstorms and a lightning storm unparalleled to anything encountered to this day in this north Texas thunderstorm season.

May 3 - May 8, Not the Best of Luck

So I arrive at the Baylor Plano PET scan facility on Tuesday, May 3 and am injected with radioactive sugar to find out where all my cancer is.  An hour later, still haven't gone back to get scanned, yet I'm the first patient of the day.  What gives?  Well, Dr. Wu, the machine broke.  What?  Yes, the machine broke.  Not what I wanted to hear.  Abner, the technician decides to go ahead and try and scan me even though the monitor is not showing anything.

After an hour in the scanner, I'm off to work, taking care to avoid small children and pregnant women (I am after all "glowing").

At work, again have a fun time with all my friends I have been missing.  They in turn are the best people I could possibly work with.  Another non-dramatic day concludes and I return to Baylor Plano hoping that the technician has salvaged my scan.  He manages to do so but I can tell from the tone of his voice that something is not right.

By 3 pm, I have the disc in my hands and am personally carrying it to the radiology reading room.  The good radiologist has tried for the past 30-40 minutes to pull up my scan, only to realize that it has to be physically brought from the PET scanner by disc to the reading room.  He loads up the file and my heart sinks back to the depths I reached after first being diagnosed with the cancer.

The cancer is everywhere:  My right lower lobe, multiple right lung lymph nodes, my liver, my left hip, 3 spots on my spine, and of all places, my shoulders.  The last one was a bit of a weird location.  I am devastated.  I was sure it was just my right lung, the nodes, and the liver spot that showed up on the CT scan.  I wasn't expecting to see so much bony involvement.  I have no symptoms!  How can this be possible!

I make the call to my partners and my friends:  "The cancer is everywhere."  I sink back into depression and anxiety and begin to think about what the future might hold for me.  Before leaving Baylor Plano, I drop by the OR to see my friends there, whom I haven't seen since being diagnosed.  At the front desk, I see a blur of people moving in the office behind the glass, but don't see anyone at the desk.  Oh well, just bad luck that no one was there.  Then I see a small figure emerge from around the door and she comes up to me and gives me a hug:  "We miss you Dr. Wu" she manages to say through her tears.  I miss them too.

As I am walking out of the OR area with my wife, a service technician approaches us from behind and says to us, "I don't know what you did to those girls in the office, but they're all behind the door crying." My depression wanes again; I am loved and feel the support of the people around me.

Over the next two days, denial and hopes for a scanning mistake give way to acceptance and a new desire to find all available options for my treatment, from traditional western medicine, to herbal and holistic mixes.  What have I got to lose?  Try everything.  Emily makes an appointment to go to MD Anderson to see an oncologist recommended by my partner Dr. Brannon Marlowe.  I have a renewed energy.  I talk to a person Helen Bouldin whose husband was cured of acute myelogenous leukemia with nontraditional medicine and I am intrigued and want to give it a try.  I meet a 20+ year survivor of not one, not two, but FIVE malignant cancers, including lung cancer of a type much worse than my own.  He emphasizes to me that a positive attitude, faith in the Almighty, and a tenacity to do whatever it takes to survive are NOT optional.  After 20 years, he is working full time as the owner of a furniture distributor.  He is the good friend of another special friend mine, Ronald Duperroir.

The ever sensitive Ron, found out about my scan and could not let me go without speaking to his friend with the cancers.  It was a great move.  I needed to feel, if not see, the energy of survivors who pushed the limits of their diagnoses and prognoses.  "I will not go quietly into the dark!  I will not leave without a fight!  I will not abandon my family with so much life left in me!"  I hear that in my head.  I want to scream it out loud.  I don't because I don't want to get arrested after such a great and uplifting encounter.

Thursday, May 5, rolls around and I am reinvigorated.  Work a full day and do so happily.  A 10 hour revision adult scoliosis repair.  Blood everywhere but I am in control and it feels great.  I joke with Dr. Hostin, Debbie, Amy, Dan, Eric, Mike, and Del throughout the case, and with Marcia at the end of the case.  It is a great day, until I get a strange call:  from the office of my oncologist, Jennifer, his nurse, tells me that my pathology slides containing samples of my tumor from Monday April 25, are missing.  They are gone, nowhere to be found.

Again, REALLY?  Can this really be happening?  I am dumbfounded.  Has a drunk, red leprechaun parked himself at my house?  Well, I will give them a chance to fix this.  I call the Baylor University Medical Center at Dallas, PBM Pathology practice and ask them to try in earnest to find my slides.  The lady asks me, "Dr. Wu did you take some of your slides with you?"  What?  Is it common for patients to grab a few slides here and there after emerging from deep sedation for a hyperstimulating transbronchial biopsy?  "Uh, no."

"Did Dr. Gary Erwin take a couple of them?"  Truthfully, I don't know so I call him and ask and the response is, "I have never kept a pathology slide after collecting a sample after a procedure."  Well back to square one.

On the next day, Friday, still no sign of my runaway slides.  The PBM folks now change their tune and say that perhaps the slides had no tumor in them and were discarded.  Then they say a pathologist at the downtown facility has checked them out.  Well then go retrieve them!  Before heading to UT Southwestern to meet with Joan Schiller, the chief of medical oncology an thoracic oncology guru, I have my partner look up my EGFR lab results that were supposed to be completed that day by a laboratory that PBM had sent a portion of my tumor specimen to.

On the report:  No tumor is present in the specimen provided, therefore no test done.  What?  Has the red, drunk leprechaun cloned himself and now parked himself on my head?  So PBM sends a blank to a special lab for a procedure I have to pay for that can't be done because they can't find my tumor slides?  Anger replaces positivity.  There will be hell to pay.  I have now lost two weeks of time in getting to treatment as this tumor marker is a critical determinant of treatment course.

On Friday afternoon, I meet with the extremely knowledgeable and pleasant Dr. Schiller and she provides me with a long list of options and gives me a sense of positive feeling that this is just the beginning of my life.  Lung cancer is a field of cancer whose treatments are just starting to develop as new tumor and genetic markers emerge and patterns of therapy begin to sort themselves out.  Yeah for me!  I sign up/volunteer for everything I can.  Want my DNA for future testing?  Take it.  Want me to follow up with research volunteers?  I'll do it happily.  Want me to enroll in an experimental protocol?  I'll see what frontline treatment I can take then decide after the first round.

Want my tumor specimen to test for 12 genetic markers and hopefully develop a quick and easy blood test in the future for my kids and their generation?  Well, I'd say yes except my specimens WERE LOST!  Thank you Baylor and PBM.  Not to worry says Dr. Schiller.  I will schedule you for a CT guided transthoracic biopsy with Southwestern's superior interventional radiologist, Laurie Watamull.  OK, I'm feeling a little better but not happy I have to have a second procedure to get samples.

That evening, I accept a ticket to watch the Mavericks beat the Lakers in game 3 of the 2011 NBA playoffs.  I have to leave early, but before I leave, I see my friends, Tony Whitworth and Kevin Morrill, two top neurosurgeons at Southwestern.  Drunk as skunks, I still have to let them know what is happening:  Gentlemen, I have stage IV lung cancer.  Even through the haze of their multiple alcoholic beverages, they are stunned.  I have seen the reaction before.  Just a few minutes earlier, I told an orthopedic surgeon friend of mine also at the game and he could not get over that feeling of helplessness.   He wanted to help but couldn't do what he most wanted to do, cure me of my cancer.

Not to worry, I told each and every one of them.  Leave that last part to me and my determination.  As I walk out of the Dallas American Airlines Center, a gentleman approaches me and asks me for my ticket. After all, a full half has yet to be played.  I ask him if he has a family, to which he shows me a picture of a wife and two sons.  I ask him why he isn't with them at home.  "I want to see the Mavs and Lakers live.  How much do you want for the ticket?"  My reply is nothing.  I just want you to know that you could be spending that time watching the game at home with your family and instead, you are talking to a total stranger, having missed the first half trying to get a ticket to get into the arena.  Oh and by the way, I have stage IV lung cancer, so I can and will shoot you straight from my hip.  Enjoy your life with your family!  Don't waste it blowing a big chunk of cash to see from 50 feet away, what you could see 5 feet away from your television set.  He starts to tear up and tells me if there is anything he can do for me, I just need only ask him.  I told him I would like for him to go home, but now that he has the ticket, enjoy the game, but don't go drinking afterward.  Go home to your family.

I hop a taxi to where my car was parked and the taxi driver refuses to charge me after hearing about my situation.  You see, there are good people in this world.  We just never take time to recognize and nurture them.  We idolize reality TV personalities for their gumption when we should be idolizing people who go out of their way to do the right thing for both friends and strangers.  I return home to hear my son screaming in victory as the Mavericks have salted away the Lakers.  Again, I am rejuvenated.

I spend the weekend with my family and my parents and watch my older son destroy his competition over three days of a swimming competition.  Again, how could I have missed this?

May 2, Back to Work

Thank God, I'm back to work.  A great day at MISI and a great day working with my all of my friends.

For the first time in a long time, a regular day.  How I missed these days with no drama.

That night, ready to go to sleep, I received this text from Gabe:

My mind and my prayers are constantly with you and your family.
Your actions and persona echo into the halls of our reality.
You are an inspiration and in these hard times - you are Hope.
Thank you my dearest friend.

Hadn't had tears in my eyes for several days and this message brought out the waterworks.  Thank you Gabe for your thoughtful and inspiring words.

May 1, A Message to the Student Doctor Network

I awoke on this beautiful Sunday truly recharged.  Who wouldn't after riding a Maserati all day when you're used to driving a used car, albeit a Mercedes, but a used car nonetheless.  My spirits lifted, I looked forward to lunch with my friends at Kirin Court for dim sum.  Before departing, I ventured back to an on-line venue that served as both a lifeline and venue for encouraging, instructing, and learning from peers across the country:  The Student Doctor Network or SDN.  In reviewing multiple posts talking about life insurance and disability insurance and life in general, I felt compelled to put fingers to keyboard and hopefully teach and inspire my colleagues to learn from my situation:

My post to my SDN family:


Good Sunday afternoon to all of my friends and acquaintances on SDN.


I have been debating on whether or not to post this information but in light of several posts I have recently seen on the site, I feel that I can contribute to the ideas and thoughts of those of you in training and those of you still young to the private and academic practice worlds.


This past Wednesday at the ripe old age of 40, I was diagnosed with stage IV invasive adenocarcinoma of the lung.  Don't smoke, don't drink except socially, never did drugs.  Wouldn't have found it had I not gotten pneumonia from my brother.  A big curveball on the road of life thrown at me at just the wrong time.  Some tears and some down feelings, before my wife and my friends and family threw their support behind me and I kicked myself in the tail to remind myself I'm not dead yet.  Close, but not yet.  :)


No overt signs or symptoms over the past 2-3 years (which is the estimate of how long I have had this).  Over the last year, some fatigue, but as busy as I am, not something out of the ordinary, and considering I worked out 7 days a week including an hour of cardio every day, well within acceptable tolerances.  No weight loss and in fact have gained 10 pounds.


In writing this post, I want to first of all tell everyone, ENJOY LIFE!!!  No one goes to their grave wishing they had worked a few more days.  I can tell you that having taken this past week off, even something as simple as walking with my wife to a coffee shop (my first caffeine in almost 16 months) during the morning hours with the wind rustling the leaves of the red oaks of our neighborhood, I felt like I had missed out on so much, if even something as mundane as this moved me so much.  That doesn't even begin to touch on the times and events I missed with my kids as I drove myself to exhaustion on a day to day basis with work, side businesses, politics, administration, etc.


I am not saying drop everything you are doing and never come back but take time off consistently to enjoy the day to day activities that we as type A professionals tend to forsake for our careers.  You will feel better for doing it and you will have more energy to tackle those seemingly insurmountable tasks you have piled up for your work days.


Secondly, don't ignore symptoms.  Don't treat yourself without finding out for sure what you are currently experiencing.  While I had no symptoms, I did get checked out regularly with my internist, have already had an EGD, colonoscopy, CT scan, X-rays, and lab work done and this still managed to sneak in.  That being said, it is still better to be consistent and thorough to pick up more obvious ailments.


Make sure you have good life and disability insurance.  That was a topic recently brought up and as a just turned 40 year old now with a much shorter than expected shelf life, I can tell you that the anxiety of wondering what will happen to my family far outweighs any anxiety I have about my condition.  I do not fear death.  Never have.  I fear uncertainty for my family more than anything else.  Of course, I just recently terminated a life insurance policy in preparation for changing to another.  Now out of both.


Save, SAVE, S A V E!  Investments, gambling, stocks, fast cars, big houses, etc. all are fast ways to keeping you poor in the short term and likely unprepared for just such an event.  I was balanced but if I had to do it over again, I would have put just a bit more into savings than into risky situations and cars.  Of course, that was when I was younger and invincible.  Having a war chest of funds safely tucked away in whatever non-depreciating savings form you desire will give you the peace of mind to live comfortably and to be prepared for life's unexpected lightning bolts.


I will certainly miss the wonderful discussions we have seen over the past 8 years and I regret that I have met so few of you face to face to put a proper name and image to the screen name.  Maintain the integrity of this board and help each other as we have all seen many people do over the past 8 years that I have been privileged to be a part of.


May all of your lives be filled with happiness and joy and may we all one day see an end to the strife, conflicts, and wars we so readily relegate ourselves to, on Earth or in Heaven.





A wonderful dim sum lunch followed with my friends and we then took my son Hanson to his swim competition, naturally in the Maserati.  He won three first and one second place finish.  In short he is becoming a swimming beast.   How could he have gotten so good in just a year of swimming and how could I have missed so much of his growth?  We went home after first dropping by our favorite neighborhood Baskin Robbin Ice Cream store where Hanson received a winner's treat and the owners' received the shock of their lives.

At home, I felt recharged and uplifted.  Depression?  HA!  Crushed by the Maserati!  That evening, my other neighbors got a chance to ride THE RIDE and you could see the stress lifting from their brows as they put the Maserati through its paces.  250 miles in two days.  Oops, did I do that?

In bed that night, I dreamed of beating cancer and doing it with the fire, flare, and power of the special gift I had received for that weekend from a special person.

April 30, A Special gift on the First Weekend

Well, yesterday, couldn't do my PET scan as hoped so went back to work.  Funny what you miss when life doesn't allow you to do it.  Worked at the new Minimally Invasive Spine Institute and saw all of my friends there.  A wonderful, genuine group of caring people.  Who wouldn't want to work there each and every day?

Had a lunch meeting with several more close friends, Dr. Nicholas Vuong, his partner Shawn Terry, and Mr. Texas A&M himself, Scott Struwe.  At this, our favorite Chinese restaurant, the Kirin Court in Richardson, Texas,  revealed all to my friends including the restaurant owners. Anson and Fannie Chan.  So much for the business meeting.

Again I marveled at the strength and number of my close friends.  Kids activities and a family dinner back at Kirin Court followed in what was otherwise a relatively normal day.

The following day, Saturday April 30, I awoke to an unfamiliar roar in front of my house:  a 2011 Maserati GTC convertible sitting in front of Doug Won's Audi R8.  What the ****?  "Norm it's yours for the weekend.  Have a blast."  More tempting words have never been spoken to my ear.  Enjoy it?  Have a blast?  Oh HELL YES!  Seventy mph to our lunch site with Doug and Miso and our kids.  Wonderful brunch at Mignon with the best friends you can imagine having.  A very satisfying meal, feeding the ducks and fish in the manmade lake by the terrace (including what could only be described as a Durkey - duck crossed with a turkey), then back to the Maserati.  "Let us know how you like the car Norm!"

Oh how I put that car through its paces:  90 mph in 3rd gear, 140 in 4th gear, Porsche's, Mustang's, and even a Ferrari, eating my dust.  What an unbelievable purr of an unbelievable engine in an unbelievable car.  Never had the thought crossed my mind about buying such an expensive toy but today was a different day.  "Dude, that is one HOT car!"  Yes I know that sir!  Hit on by 4 girls and even 2 guys that day with the top down.  Picked up my kids from older son's swimming practice in the Maz.

Dinner that night with Rick Hostin and family at Korean BBQ in Plano, a place I will never go to again: How do you have no meat at 7 pm on a Saturday at a place named Korean BBQ?  No problem, hop in the Maz and zip over to Japanese restaurant for food.  A good dinner with friends talking over all our issues followed.  When you are terminal (as we all are, just to varying time frames), you feel a sense of boldness to state what you are thinking as bluntly as possible.

Home to Willow Bend in Plano and a promise to park the car and head over to Rick's to watch MMA.  A little too early to stay up very late.  Out as soon as I hit the bedroom.

After an unusual and special day like this one, no depression, just dreams of racing around town in a 6 figure supercar!  My son would later in the week have a nightmare:  "Harrison, what was your nightmare?"  "Daddy, we went to see the Maserati but we couldn't get it!"  "And???"  "Daddy that was it."  :o)))

April 28, A Fall from the First High.

I awoke on the 28th, almost at my usual time.  Straight to the gym I headed, but instead of an hour of grueling stairmaster, it was 30 minutes of stationary biking.  I felt good, but very tired.  So tired in fact that I started coughing again and feeling like crap.  Too much too soon.

Took the kids to school, came home, straight to sleep.  Panic, anxiety, depression, all at the same time.  Was I becoming bipolar?  The calls, texts, and e-mails of support came pouring in.  Word spread quickly.  Everyone was devastated, but in that devastation, they all had the strength to send me their heartfelt prayers, words, and support of any kind.  I felt incredibly special and couldn't help but smile with all of the support being showered on myself and my family.

Plans were made, an oncologist selected, visits for labs and multiple studies set.  I felt energized.  Maybe my disease wasn't so bad.  Maybe surgery could fix the majority of the issues.  Maybe I could beat this!

How about that!  Positive thoughts from me.  Time to move forward.  Next up:  PET scan.  Time to search the web and find out all the options.

Saw the oncologist and came away with mixed feelings:  Chemo only?  No surgery?  No cool and promising studies?  Was told to try MD Anderson and at least one or two other consultations to be sure I knew all the options.  OK.

At home, again with nothing else to think about, depression.  Major depression.  Went to sleep after answering more uplifting messages, but still down overall.  Then came a call from Dr. Gabriel Rodriguez:  "How can this happen to you!  You are such a good guy and such a great friend!  How can this happen!"  More emotions were released and in the end, I felt a special caring from Gabe that I know I can count on.

I went to sleep more on a high than I thought I would.

April 27, The Day After and the Rallying of Friends

I awoke the next morning tired, depressed, and confused.  Emily would have none of that.  Taking me with her to drop the kids off at school, she called our neighborhood friends on the way home and once home made me walk with our neighborhood friends  on that beautiful Wednesday morning to the local coffee shop.  It is amazing how enjoyable that something so simple as walking with your spouse to get coffee becomes when you give yourself the time to do that and don't just grind yourself into the ground at work.  Slowly my mood improved and with the good cheer and smiling faces of our friends, I slowly worked out of my funk.  A few jokes even escaped my lips.

Nowhere have I felt so special than in our close knit neighborhood combined with all of our special friends at our multiple work sites.  I walked home with my wife somewhat rejeuvenated and was able to bring myself to start planning the tasks I needed to plan out for my treatment.  Still physically drained by a month of pneumonia, however, I felt the ebb of my energy weigh down my newfound enthusiasm.  Again, I slept with dark thoughts and again I awoke depressed but this time with a superimposed feeling of super anxiety.    Asleep, awake, asleep, awake, the cycle continued.  Finally it was time to pick up the kids from school.  After that, we went to a Jamba Juice where I enjoyed my first shot of liquid wheat grass.  A little late to eat healthier?  Maybe but what have I got to lose.

A repeat of the prior day with the kids activities and then home again to depression when alone or with nothing else to preoccupy my thoughts.  That night, I received a call from Dr. Michael Rimlawi regarding a business venture.  Promising news meant nothing to me.  As he finished his dialogue, I thought of just acknowledging the news and hanging up.  I didn't want him to share my misery.  I wasn't sure I should tell anyone else.  In the end, as my friend, I felt he deserved to know.

"Mike, I have cancer.  Lung cancer."
"What???  Are you *****ing kidding me?  How?"
"Mike, I have stage IV lung cancer.  I'm really tired and depressed."
"Norm, you know we have all appreciated everything you have done for us and I can't believe this is happening!  You know if there is anything I can do for you, you have it!  Norm, I can't believe this is happening!"
"Trust me neither can I.  You remember how I was berating my brother for giving me pneumonia, well today, I called him and thanked him for giving me pneumonia.  He asked me why and I told him, otherwise I wouldn't have found out that I have cancer.  He asked me if he was supposed to feel happy or sad and I told him happy because otherwise I would have never found out about it."

Thoughtful and wonderful promises of support followed and we concluded our conversation with me feeling happy to have great friends.

Perhaps 30 minutes later, another special friend, Dr. Douglas Won, called me upset, emotional, and stunned with the news.  I felt bad not calling him these two days, but I had no desire to spread my confusion, anger, sadness, and depression.

"Hey Norm, I just heard the news.  I'm stunned, I can't believe this!  It's not fair!  Norm, we're going to beat this mother******!  Don't give up!  You are going to be here for years and we're going to look back on this time and laugh about what we thought was the end!  You've gotta fight!  You can't quit!  I love you and I won't let you quit!  You have a beautiful family that needs you and you need to be there for the rest of their lives!"
"Doug, I will fight, but I need you and everyone else that I know to promise me to take care of themselves.  IF there is one thing GOOD that comes from this, I want to know that all of my family and friends are taking the time to rest, spend time with family, friends, and loved ones, and aren't driving themselves into the grave.  No one goes to the grave wishing they had worked a few more days.  I need you to promise me that you will REST and take care of yourself.  I promise you I will fight."
"You better fight!  I'm going to call you every morning, every day.  I'm here for you my brother.  I'm here to see you through this!  Fight!  Don't give up!  I won't let you do that!"
"I will fight, but I need you to promise me, Doug, that you and Miso will take care of my family if I can't beat this.  I need to know that my kids will have a mentor and father figure to look up to and that they will never want for something they need.  Promise me that."
"I promise you that.  Your kids are my kids.  Your family is my family.  I will take care of them, I promise you, but you are going to beat this!  You are going to kick cancer's ass!"
"I will fight.  Today has been the best day of my life and all I did was take time off and walk with my wife outside to a coffee shop holding her hand, listening to the wind rustling the leaves of our neighborhood red oaks.  Isn't it amazing how wonderful things are when we actually take time out of our hectic lives to actually enjoy the simple pleasures!  You have to promise me Doug that you will do that.  I can't go to the grave knowing my friends are following me down the wrong path!"
"I promise you my brother!  We're going to fight this!  Don't give up!"
"I won't.  Take care of yourself Doug."

It's amazing what you can remember in life's most emotional moments.  I told my wife who I had spoken to and what promises I had made.  I intend to keep them.  Miso would later tell me that Doug was so affected with the news that it took him some time to compose himself to make the call to me this night.  I went to sleep energized and for the first night in a several days, awoke without a panic attack.

April 26, The Day of Doom

Well, this wasn't exactly the diagnosis I was expecting.  For the past 6 years in private practice anesthesiology, I have been an avid physical fitness nut, doing an hour of cardio every morning at 4 or 5 am, followed by an hour of weight lifting.  Worked full schedules every day, developed/developing multiple side businesses, in general a type A workaholic.

After contracting pneumonia from my brother, I couldn't seem to shake it.  Granted, I didn't exactly close up shop and rest.  I kept a full schedule including calls, had meetings on some nights until well past midnight, and didn't always eat properly.  On Wednesday, April 20, I coughed so hard that I tore rib cartilage.  On Friday, April 22, I coughed so hard at a meeting, I broke the left T6 rib cleanly.  Thereafter, each cough felt like someone was stabbing an ice pick into my back and side.

I had gotten a chest X Ray earlier that Friday, which showed what I thought was a bad pneumonia.  My good friend and pulmonologist Dr. Gary "Ged" Erwin, reviewed the X-Ray and put me on antibiotics.  I rested that night with cough medicine and a glass of wine then the next day, went to get a haircut.  Yes a haircut.  The pain finally became unbearable and Dr. Erwin quickly brought me into Baylor Plano Hospital and had me undergo a CT scan with contrast.  I reviewed the results with the radiologist and knew immediately that the result was not good:  5 X 9 cm right lower lobe lung mass (actually two masses with a connecting bridge) with spiculated irregular margins and multiple enlarged hilar and supraclavicular lymph nodes.

That's medical terminology for "Oh ****!"  Ged knew it was bad.  He scheduled me for a biopsy on April 25.  The biopsy was done after, yes, a half day of work, and I was taken care of by my practice partner Dr. Terry Latson.  I went home and took the next day off.  On that afternoon, Tuesday, April 26, I got THE CALL from Ged:  "Norm, you have invasive adenocarcinoma of the lung."

LUNG CANCER.  Me.  At the age of 40.  As a non-smoker.  As a non-drug user.  No family history.  Really?

Sitting next to me was my younger 9 year old son Harrison.  Do I tell him?  Do I lie to him?  Do I ignore it?  I chose to tell him.  He is a mature 9 year old and I didn't want him to find out later from someone else.  I certainly didn't want him to find out after I dropped dead at some point, so I told him. Tears were shed by both of us.  I was devastated and depressed.  The next person to find out was my beautiful wife Emily.  Ever the strong soul mate she has been, she teared up but immediately started pushing me to fight.  Next were my practice partners, Dr. Michael Huss and Dr. Joy Ghermay, and simultaneously my mom.  They had to know why I wasn't going to be working for a while.  8o)  Next was my neighbor and great friend, Dr. Richard Hostin.  After that, I was too confused and emotionally spent to continue to make calls.  I wanted to tell my best friends but could not pick up the phone any more.

I entered my first episode of depression.  I had to lie down and quite frankly, I didn't care if I woke up.  Panic set in and a thousand things to do and think about entered my mind.  Did I save enough?  Were the kids going to be able to handle this?  How would my kids turn out if I'm not there to mentor, nurture, and guide them?  Questions with no answers kept popping into my mind and suddenly I was having my first ever true anxiety attack.  I have never and will never fear death.  As a health care professional, I have seen and heard too much to not know that there is life after death.

Once again, my bastion of strength, my beautiful wife Emily, rallied my spirits and dragged me out of the house to take my kids to their basketball and swimming practices.  I could say nothing and think of nothing other than when was I going to die.  Emily and I watched the kids practice and occasionally, I would smile at the antics of my younger son's basketball team.  We took the kids home and once there, did our usual routines.  After the kids went to sleep, Emily and I spent our time together alone.  When she fell asleep, I was awake by myself and once again sank into a dark, deep depression.  Death that evening would not have been turned away by my waning will to fight.  A dark sleep overtook me and I dreamt of the confusion and sadness my family would feel after my death.  I awoke at least a dozen times that night and each time, felt more depressed than before.