Nervous, excited, anxious, energized, hopeful, realistic would all be appropriate terms for me today.I was ready to get the long awaited advice for the best treatment plan.I had so many questions and I was eager to hear the answers, good or bad.I had already spent many hours reminiscing about each consultation I had.The wide eyes, the blank expressions, the confused looks, the elusive quotes: “I’m…lost,” or “You’re so young!”I remembered the findings on the reports and the CT images were still fresh in my mind.These all served as puzzle pieces I meticulously connected over the past month.The size of the masses, the diffuse spread in the liver, the multiple modules, all these pieces began to form an image of the treatment.I could make out the overall outline of my puzzle.It was almost complete.The best treatment aside from a miraculous recession would be a liver transplant.I was missing one piece:The doctor’s referral.
My parents and I found ourselves back in Dr. Satay’s office.“I spoke with Dr. Chow.He hadn’t heard of it either.He suggested an aggressive chemotherapy regiment of four drugs.But after looking at your scans, I’m afraid your liver will have a hard time handling it.If you want to get a second opinion, I won’t be offended.I can refer you to City of Hope, I have no problem doing so.”In strange way, he reminded me of Pilate, as if he was trying to wash his hands clean.
“How bad is my liver?”
“It’s fried.” You mean Satay’d…
“How much of it has affected my liver?”
“It’s everywhere. It’s irresectable. “
“How long has it been there?”
“You’re guess is as good as mine.We have no reference point.” After all these questions, I needed a more specific reference of the gravity of this condition.Other than “you’re so young,” or “we see a mass,” I wasn't offered any firm grasp on how mild or serious my liver had been hit.In a split second, the question I needed to ask revealed itself.“If you were to look at the CT scans and blood reports, what would you expect to see from this patient if you hadn't met me?”
“I’d expect him to be in very poor physical shape with a serious loss of appetite.Weight loss, fatigued, possibly bed-ridden, itchy….” Perhaps a miracle was already taking place. I was still pain-free, active, and quite hungry.
Despite the reality of his opinion, I found his honesty and concise speech refreshing.I treasure relevant information.The dodgy diagnoses and advice from many previous consults frustrated me.I trusted Dr. Satay’s judgment.“If I get a second opinion or if I go to City of Hope, I will be starting this process all over.I will wait two, maybe three more weeks, only to hear the same thing: ‘We’ve never heard of this...This is what we think you should do.' I'll have gained two weeks lost and be back at square one. I've waited for professional advice for over a month now.I feel that you’re competent in your field and will give me the best solution for a treatment plan.”I went for the gusto “What are the options for a liver transplant?”
He shook his head. “There’s too many nodules in the lung.It’s metastasized.No one will touch you.”
“How many nodules are we talking about?”He opened the program and began scrolling through my lungs, occasionally pointing out to these white specs, invisible to the untrained eye as the lung scans are littered with white trails from the oxygen filled vessels leading to the heart.“There’s one, there’s another.One here, here,”he scrolled some more “another here.”Most were on the peripheral walls, but I was surprised to see that he had started at the top of my lungs.“There are nodules all the way at the top?” I asked, having expected them in the bases since it was closest to the liver.“They’re everywhere,” he said.
“What if I got a lung and liver transplant?”I naively asked, knowing that my odds of living would be better than the odds of surviving that procedure.“That would be…heroic,” he stated.I was determined to get a transplant, especially after hearing about the horrid stories of chemo and being told that my liver may not be able to filter out the poison, but mostly since no chemotherapy has been proven successful with this type of cancer. “What about a live donor?”his eyes lit up.“You have a donor?”
“Some have showed willingness to donate their liver.But it’s something I know little about and haven’t put much thought into it.”
“A living donor transplant is tricky business, I think UCI had a program, but they don’t do it anymore.There’s been recent concern about the dangers to the donor.”He continued on, mentioning other Ivy League schools that practiced this procedure. All the while, he continually stressed that the metastases would deter any surgeon from transplanting me."Can you refer me to a surgeon?"I asked.
"I'll put in a referral for you."
“Ok, so what’s plan B?”
“Go with Dr. Chow’s Chemo regiment.He suggests we treat you with an intensive four drug regiment.One of them is Avastin, which has recently shown great promise with sarcomas, along with Doxil, Taxotere, and Gemzar.”These sounded more like names Sarah Palin would assign to her grandchildren.“I, however, am afraid your liver won’t handle all these at once, so I want to start slowly.We’ll begin with a quarter dose of Doxil and monitor your results.We’ll then add a small dose of Taxotere.If everything works out, I really want to get to Avastin.”
“When can we start?”
“Next week.Like I said, I don’t have a problem if you want to get a second opinion.”
“Can we start sooner?”
“We can start tomorrow.”I looked at my parents.They were mute.“What do you think?”I asked them.My dad broke the silence.“I think we should start treating it instead of waiting.”
“Let’s do it.” I said confidently.Dr. Satay called the nurse to begin the paper work and approvals.He then excused himself as he left to get information about the chemo drugs.I looked around his small office, which blended eastern and western art.He had a modest taste.A large Indian canvas hung on the far wall.A calendar with scripture passages lay next to a porcelain set of three angels, similar to the precious moments characters. Both of his large bookshelves had an empty shelf dedicated to family pictures and treasured artifacts.I noticed two young adults, male and female.Those must be his kids.
There is a high level of trust and faith we place in our physicians hands.Without the luxury of a doctor in the family, this level is compromised.Doctor Satay returned with a packet in his hand."Here is information about the drugs you'll be receiving.It provides you with a list of side effects.The most common is nausea.I am prescribing you Zafron for that. If you begin to feel nauseous, immediately take a pill."It didn't really matter what he was saying at this point.I had just one question in mind.
"Doc, what would you do if this was your son?"He looked down at his desk."I would give him half my liver…and then put him on the transplant list." A silence fell upon the room. "So...I'll see you tomorrow at 10:00am."
New priority #1 on the to-do agenda- Get on that list.
I decided to take Niko up on his offer.I spoke with my uncle and his family that night and informed them of the happenings. Not only did I want to visit them, but I wanted to discuss these issues with the eldest survivor in my immediate family tree. I informed them I would be coming up.They opened their houses to me.I checked online for flights: Still $69 one way including taxes.I love Jet Blue and the Long Beach airport.There were 18 seats open.I can wait.Maybe the prices will go down some more.