This Is Your Uterus

I'm sorry to say
but sadly, it's true
that Bang-ups
and Hang-ups
can happen to you.
                         -----Dr Seuss

The first meeting with the Dana Farber Cancer Institute and Dr. Muto went well. I mention Dana Farber because I’ve found that it will be a fully realized presence and personality in this narrative.

While I am not a connoisseur of all things hospital, I have dealt with enough medical facilities--on my parents’, Peter’s and my own behalf—to recognize them as living, breathing entities with distinct personalities. New York Hospital (now New York Presbyterian) is huge and impersonal. The magnificent machine grinds irrevocably forward for its own inscrutable purposes, processing patients at its own pace and with its own—and only its own—convenience in mind. In stark and happy contrast is Overlook Hospital in Summit, NJ, which has adopted patient-centered model of care. Their processes are designed to make patients welcome and comfortable. Compassionate care and a good-natured common sense typify Overlook’s patient treatment model. And then there’s Dana Farber—it’s the Overlook model ramped up, souped up and super-charged by high-end high tech. The staff contact you when they say they will, scheduled appointments are on time, the staff is eager to help and ceaselessly cheerful. The gadgetry is fabulous (you're given a GPS while you're on the premises so they can locate you), the place chimes with good vibes, a motivated staff and doctors who seem genuinely interested in you rather than their jam-packed schedule.

But enough about them, for now. Let’s talk about me. Right now, it’s all about me. I’m trying to stay out of the swamp, but I am in a foggy place where I knit ferociously, play solitaire mindlessly and endlessly, and remember nothing effectively. Friends around me are having all sorts of surgery, and I find myself shame-faced and embarrassed about remembering their life changing events only when reminded.

I know, the moving lips are a little creepy....

We’ll see if this get’s better or worse as my little drama makes its way towards its inevitable conclusion.  That's not being morbid. It’s neutrally fatalistic: what will be will be. And what will be may not be bad at all. I just have to wait and see. But, oy, the waiting is starting to wear on me.

So let me get to the details you’ve all been waiting for. Dr. Michael Muto looks like a taller, thinner version of John Hodgman. He was calm, reassuring, and apologized for not having his usual posse of assistants in tow. His minions were elsewhere attending computer training to bring them up-to-speed on the newest version of an already state-of-the-art system. Since I was quite happy with the level of intelligent attention and care I’d received thus far, I am still trying to imagine what other services the posse provides. Fresh omelets? What he did have was a third year Harvard medical student (John) who listened with rapt attention to every word that fell from the doctor's lips.

In a nutshell, I have a very slow growing form of cancer, and happily, I discovered it very, very early. Dr. Muto took a piece of paper, drew a uterus and proceeded to describe who, what, where and how.

The ovary on the left has just realized what's coming her way.

To paraphrase Dr. Muto, the uterus is simply a big muscle whose sole purpose is to push out babies. “Think of it as a thick slab of steak,” he suggested. There are several possible scenarios for the cancer. It could still be on the very surface of the organ’s lining, or it might have starting growing into the muscle, with its severity being judged by how far the cancer has penetrated. It’s also conceivable the cancer could have migrated into the fallopian tubes and/or the ovaries. But it’s all speculation until the uterus and ovaries have been removed for examination and pathology tests.

This will be a laparoscopic hysterectomy, with four tiny incisions in the abdomen through which the blood vessels to the fallopian tubes, ovaries and uterus are severed and cauterized. An incision is made inside the vagina to separate the uterus, and the organ is removed intact through the vagina. (By the way, I am sparing you some graphic pix that would have put you off your feed for several weeks.) The lovely little thing is handed over (literally, it seems) to the pathologist for immediate examination and an initial appraisal. Dr. Muto referred to this as being done in ‘real time’: the patient is still anesthetized on the table while the pathologist reads the tea leaves. Any further exploration into suspect lymph nodes or surrounding organs is determined by the pathologist’s first read. If all appears reasonably clear, the surgery is concluded, and the final pathology results are ready in a week. 

I have absolutely no concerns about the surgery. To paraphrase Mick Jagger, hysterectomies are like babies--they happen every day. It’s the pathology results that are the clincher. And the seeming unpredictability of the pathology findings reminds me of a lottery ticket: you’re either a winner or you’re not.




But back to the meeting with the doctor. He finally paused and asked if I had any questions for him. Dr. Muto turned to young John and to tell him that the explanation so far should have anticipated most—and optimally, all—of my questions. And amazingly, it had. I skimmed my list, realizing that he had covered everything. Then, explaining that he was about to use this as a teaching moment, he asked John to guess how much of his explanation the average patient might be expected to retain. Always the first kid in the class with her hand up, I volunteered, “40%! I think I got about 40% of what you said. But every time you said the word cancer, I think my pupils dilated and then I blanked out for a few seconds.”

Gesturing in Peter’s and my direction, “See them? They’re educated and they came prepared. The average patient gets between 10 and 30%.”

Well, prepared or not, we are moving forward, with the surgery scheduled for Thursday, May 28. Here's hoping for sufficient serenity to see me through 'til Thursday, and then a winning lottery ticket.