Thursday, April 5, 2007

A Trip Across the River


So the U was...a very different experience.

First, we met with a pulmonological oncologist (obligatory med student in tow), followed by the oncological thoracic surgeon (with the same med student).

Everything was kind of tentative, since Hospital I had couriered over everything but the xrays, PET and CT scans. After the U appointment, we went back to Hospital I, picked those up, and hand delivered them.

The lung guy stressed how lucky we were that we'd found this 'early' -- despite the size, the cancer is probably a stage 1-A or 1-B. One is good, four is not.

The surgeon was apologetic that he wouldn't be able to tell us much without seeing the films. He's done about sixty pneumonectomies, and a couple hundred lobectomies. "This is all I do -- cancer surgery."

He's also a lot more cautious -- he wants a brain MRI (Monday morning), three weeks of pulmonary rehab (starting Tuesday morning), and a differential VQ scan to learn more about exactly which lungs are doing what. He was more concerned about Diana's current lung capacity than the first guys.

We both felt better about all of the people we met today at the U, and they made a good case that a serious tertiary-care hospital is going have a lot more resources to deal with any contingencies. They answered all of our questions frankly, in terminology we could comprehend, and with compassion.

We think we're staying there. The U surgeon seemed very amenable to working with folks from across the river or with whomever we wanted on our team. We didn't get that feeling from Hospital 1. The oncologist from the Hospital 1 team has a sterling reputation, but we haven't met his parallel from across the river.

Tough enough to make decisions like this without having to deal politics along the way...

The first surgeon said that he was ready to "trust the PET scan" and take the lung without biopsies of the lymph nodes. The new guy will do a separate procedure to get biopsies of assorted "N2" lymph nodes (the yellow-colored ones on the lung model). That may happen the same day as the surgery, or he might do it ahead of time.

So that's a pretty different timeline than we had two days ago. Still, we've turned over care of Mom to our new "staff" -- we've got 24/7 coverage, and even a couple of backup options. Now to reframe Diana that taking care of Diana is enough of a job for now.

4 comments:

nancyturtle said...

This sounds a whole lot better to me. More thorough, less "on the fly" decision making...
By the way, the med student is not obligitory, if you'd prefer not to have them there. Just say no, please and thank you.

nancyturtle said...

I also meant to say to "H" with the politics!

Anonymous said...

You are also within your rights to insist that the primary surgeon perform the surgery, not the senior T/Onc Surg resident or a Fellow, as may be the case if you don't ask. I figure the more info you have up front, the better the likely outcome, so go for all you can get. You've heard me rant about the politics and the working environment, but the cancer care folks at the U of I are top-flight (wealthy Iowans compete to give them tons of money), from the diagnosticians to the surgeons to the floor nurses to the techs, and i have full confidence in them. Keep up the good work!

nancyturtle said...

Excellent point, anonymous!