things to be thankful for

Happy New Year! Welcome to the year of the pig!

The last month of the year of the dog has been a pretty challenging one for us, and we are very pleased to be entering the new year with many things to be very thankful for.

Some of you may have heard through the grapevine that I had a malignant melanoma taken off my back in mid January. I didn't want to write anything about it until I knew more about how things looked, but I do want to write something now that I have a clearer picture. Partly, I'd like friends and family who may have heard about this not-in-full to know what the deal is, and also it's a good chance for me to edumacate y'all about something that I wish I'd known more about.

Let's start at the end: the good news is that my melanoma was very thin, and we've checked my lymph nodes and they look fine, and we've done a CAT scan and all my innards look good. At this point, the doctors say that I should have checks every 3 months, but there is no further treatment required. So I am very, very, very (add in about eight zillion verys here) happy about that.

What you should know about skin cancer, and what I (very stupidly) didn't know was that although it is very treatable and has a good prognosis if it is on the surface of the skin or is very thin (less than 1 mm thick), if it gets deeper, it can very easily metastasize and get into the lymph nodes, and it then often goes for the liver or lungs, at which point the cancer is extraordinarily dangerous and the prognosis is not good at all (and that's putting it mildly). I had always had this idea of 'oh, yes, if I ever got an odd mole, I should get it checked out, but no rush'. Well, don't YOU ever think that, ok? Phet mentioned my odd my mole to me couple of months before we left Canada, but what with the nuttiness of having a new baby, travelling between Toronto and Sauble, and preparing to leave for India, I didn't get it checked out until just before we left, at which point I couldn't get in to see a specialist on time.

When we got to India, I did arrange to see a dermatologist as soon as possible, but still, very dumb to have left it at all. The dermatologist here took a look and said, right, let's get you in for surgery this week. No kidding around. So, his nice neice, the dermatological surgeon saw me later that week. I had also kind of thought that getting a mole removed would be like, g'bye mole, but they had to not only remove the mole, but the discoloured area around it. In the end, I said farewell to 4 cm by 1.5 cm of my skin. Then, there was a very horrible one week wait for the results. While I was waiting to hear back, Phet had to travel to Bhutan on business, and let me tell you that when I got back the results and he wasn't here, that was about the lowest point I hit. Don't want to dwell on it cause I don't want him to feel bad, but rather looking back it makes me realize how much I depend on Phet and how much I need him in my life. One more thing (person!) to be thankful for. I was also thankful that Mum and Dad were there for me by telephone when I had a big breakdown after getting this news. I was not thankful, however, for the dermatologist's attitude when I asked him to explain the details of my pathology report and he said superciliously, "Well, I'd have to teach you all of dermatology in order to do that." I was also further not thankful when he said, "If I were you, I'd go home and have a drink and feel thankful that this was caught early." Bastard. I didn't have a bottle of booze to drown my sorrows in!

The most difficult thing (aside from pondering grim possibilities of my possible lack of a long future) to deal with was figuring out what was what in terms of the medical situation and what we should do. Although the dermatological surgeon was good and knowledgeable (she'd studied in the US), she presented information in a haphazard way and we just didn't know what to do. They suggested we send the sample to the US to be analyzed by a special dermatopathology department at a major US university. This turned out to be an excellent idea, but it was hard to know whether it was a good plan at the time. Still, not knowing what else to do, we had it sent off, very scarily in the hands of India Post (Fed Ex and UPS won't carry human flesh, just in case any of you zombies out there were wondering). Then, there was an excrutiatingly long ten day wait while the sample was in transit and was being analyzed. During that time, we were very thankful that Aunt Cathie was able to put us in touch with a Canadian dermatologist who was able to tell us we were on the right path.

When we got the report back, it was quite positive: the melanoma was only 0.44 mm thick. The cancer centre in Toronto won't even see me as a patient because it was less than 1 mm thick! However, it was still worrisome because it had reached down into the lower layer of my skin. I'm going to talk to a doctor in Canada about this, but I'm guessing that the diagnosis is thin skin. Actual, not figuratively speaking.

Armed with this info, we went to see an oncologist at a hospital here who was recommended by International SOS, a medical help company for foreigners overseas. They were really helpful, and the doctor was too. He suggested that we have checks done to make sure that the cancer hadn't spread anywhere, and we requested a sentinel lymph node biopsy - this is basically a way that they first check which lymph node area your lymph drains into from the site of the original melanoma, and then they try to find the first and main lymph node in that area, take it out and analyze it. In the past, they would have had to have removed all the lymph nodes, which has quite a high chance of bad side effects. Apparently, this new type of check is also often done with breast cancer as well to check if it has entered the lymph nodes.

Originally we thought we'd have to go outside India to have these checks done, and we were planning to go to Singapore (and boy, we had a doozy of a time trying to set up a visit to a cancer centre there), but it turned out that we could have everything done in Delhi. Very luckily we got everything set up in a manner of days. We were in to see the doctor on a Tuesday or Wednesday, and I went in for checks on Friday, stayed overnight, and had my surgery on Saturday. Speed: something else to be thankful for. We were also very thankful for the doctor's gentle kindness and sense of humour; at one point he told us, "Well, we will just have to see whether this [ie the cancer] has been naughty or not." Phet and I were pretty happy to have something to smile about, thinking about my "naughty" cells, rather than my EVIL DEADLY cells.

The experience at the hospital wasn't really fun, of course, but we were thankful that we had a nice room, great room service, the ability for not only Phet but also Ji and Seung Yi to sleep over, and we had the attention of great doctors. The nurses, well, they didn't really understand much of what we said, most of them.

[On the morning of my surgery, I'm getting up and getting ready to shower and get dressed. A nurse comes into the room, carrying a long metal box in her hands.]

Nurse: "You shave."

Me: "Yes, I've already shaved."

Nurse: "You shave?"

Me: "Yes, see?" [Showing her my armpit]

Nurse: "No, you shave private area."

Me: [Aghast] "But they're operating on my back and my left armpit. Sorry, no."

[Later]

Nurse: "It says on file you must shave."

Me: "Please call the doctor."

[Nurse leaves]

Me, to Phet: "I am not shaving my punani. There is no way."

Phet: "Wouldn't really be so bad, would it?"

Me: "There is NO WAY. They're operating on my back and my armpit!"

[Nurse never returns. Nether regions remain free of razor burn.]

In the end, the surgery went fine. The doctor kept Phet posted by telephone every 10 minutes. The lymph node was frozen and run off to pathology while I was still under, they said it looked just fine, I got sewn back up (if it hadn't, they would've removed all the lymph nodes in that nicely shaved pit) and then slowly came back to consciousness.

My worst complaint about the whole experience physically was that MUM DON'T READ THIS: as always the nurse bungled my IV at first. Mum and I have a terrible time getting needles, and this time was no exception, everything went haywire, the nurse didn't even bother apologizing and didn't even pat me while I writhed in pain. A week later my wrists are STILL bruised, yecchh. But hey, a bruise? Damn, I'm thankful for THAT. I was pretty much willing to live as a head in a jar so long as I could still live to see my daughter grow hair past her ears, so what's a bruise or two among friends?

Right now, while I am still obviously scared and worried about everything that's gone on, I am just trying to sit back and enjoy life and to count every blessing that I have. I have a wonderful husband, two healthy and beautiful children, the best parents that could possibly be wished for, a caring and loving extended family (thanks Aunt Katy for the Leafs suit for Ji and the Gretsky video and the Princess Bride video, you can't imagine how much that cheered me up, thanks Aunt Theresa for the lovely email, thanks Aunt Cathie for your much-appreciated help), an amazing group of in-laws (happy new year aunts and gramma, we miss you SO MUCH), extraordinarily kind and thoughtful management at the new school I'm working at, I have a lovely nanny, a super driver who has gone to the hospital and clinic with me so many times that he just must be sick of driving to them, I have a comfy home, lots of good food, and I am just so grateful for all of you.

Happy new year!

An adorable new year's photo of Ji and his sister:

[Delhi-18-February-2007]