I heard from more senior residents in my Oral and Maxillofacial Surgery (OMFS) program that you could have a normal life in the 5 months on anesthesia rotation so I was looking forward to starting on anesthesia at the end of October 2017. It seemed like perfect timing because I started having soreness in my back around the same time so I figured with all this time on anesthesia I could start hitting the gym again to work on my six-pack. That was a bad idea. After the first time at the gym, my back started hurting even more than before. I started to have aches and muscles spasms throughout my back and abdomen that became so painful it was difficult for me to walk or lay down. I resorted to sleeping on the sofa in a semi-reclined position for over a month. I thought all of this may be due to a herniated disc and that physical therapy and time would take care of it. Over time, the pain worsened and I started to develop numbness in my legs.
December 16, 2017 was the day my life would change forever. Finally, the numbness in my legs had gotten to the point where I couldn’t ignore it any longer. I wanted to rule out any possibility that the numbness was cauda equina syndrome, which could cause permanent paralysis in the lower half of your body if not treated immediately. I went to the emergency department (ED) to get an MRI, expecting them to tell me I had a herniated disc or sciatica. They wheeled me down to the MRI machine and as I lay in there I heard them order for contrast, which wasn’t the initial plan. I thought that was odd, but when I asked the nurse she said that it was part of the procedure (afterwards I found out she knew something was wrong but she couldn’t tell me). After the scan was done, they wheeled me directly into the room where the radiologist read the scans instead of going straight back to the ED like most patients. That’s when I knew something was wrong. Having rotated through several different services the year before in my first year of residency, I knew this was definitely outside of protocol.
The on-call radiologist was in there and sat me down to talk me through the scans. His face and demeanor said it all. He explained that there were lesions in several parts of my spine and that my pain and numbness was due to a compression fracture at the T11 vertebra. I asked him for his differential diagnosis and, as a courtesy, he did not sugar coat it. He responded with cancer as top of differential followed by multiple hematomas, which would be really rare. He recommended further CT and MRI scans to find the primary source.
After leaving the radiology reading room and heading back up to the ED I wasn’t sure how to break the news to Varisara. I couldn’t believe that I could have cancer at 30 years old. As I was wheeled back into the ED I was silent for several minutes because I couldn’t say the words without stumbling through them. I could tell she felt something was wrong because I couldn’t look her in the eye. I finally said to her “It’s either multiple hematomas or” – my throat caught as I said it out loud – “cancer”. She couldn’t believe it either and I had to leave her there to digest this as they took me down for my CT scan.
I returned to the room and we waited, mostly in silence, for the results of the scan. About an hour later, the radiologist walked into my room with a bag of snacks from the cafeteria. At that point I knew it was the worst case scenario. Radiologists never visit patients, especially not with a bag of treats. He explained that they found a cavitary lesion in the left upper lobe of my lung as well as enlarged lymph nodes in my chest. The good news was that my brain and rest of my body was clear; the bad news is that it has already spread from the lungs and into my spine, which automatically made it stage IV cancer, the most advanced stage. My initial reaction was “What am I going to do about residency?”. I had worked tirelessly to achieve my dream of becoming a surgeon. “You’ve got bigger fish to fry, my friend”, the Radiologist responded. “You gotta batten down the hatches and get ready for a long ride.”
After the radiologist left, I asked Varisara to pick up Avery and my parents, who had come down to help us watch Avery. This was not news you want to share over the phone. While she was gone, the on-call neurosurgeon visited me to discuss the more urgent matter of my numbness and tingling that had been worsening. He told me I needed surgery in the next 24-48 hours to remove the tumor that was compressing the spinal cord and to fuse portions of my spine due to the compression fracture at T11. I was going to be admitted to the hospital that night.
When faced with such a devastating diagnosis your priorities in life come into perspective. I wondered how I was going to make sure my wife and 15 week old daughter were going to be ok. I wondered if and how I was going to finish residency. After much contemplation, I realized none of that mattered right now; all that mattered was knowing I have to do everything in my power to fight this evil disease so I could worry about all those other things.