“How long have you had this?” Dr. Landeros asks.
I’m sitting on the examination table in his office. He has guided my hand to the left side of my throat where, my heart quivering, I finger a rock-like lump.
“I have no idea,” I say.
He holds up a hand mirror and tells me to tilt my head back. I see a protrusion: a foreign object pushing at my skin from the inside. I’ve never looked at my reflection this way. If I had, would I have noticed the bulge?
“Don’t worry,” he says, apparently reading the tension on my face. “We will take an ultrasound to see.”
My knees get watery and the room wobbles. I have a growth in my throat. Is that why I haven’t been able to shake being sick? In Thailand, I had an ear infection and vertigo. In Australia, I couldn’t shake a cough. As a nomad, I had self-treated these on the road. But now that the symptoms roared back here in Mexico, I’d decided to get proper medical attention. A tumor was the last thing I expected.
The doctor walks my husband, Dave, and me to the next building, where he hands me over to another physician who, to my surprise, draws me into a back room and performs the ultrasound right then. Dr. Landeros watches a big screen and explains I have a mass in my thyroid.
“It’s large,” he admits. “About the size of a lemon.”
My palm tingles as I imagine cradling the density and circumference of a lemon. What I felt on my neck was the tip of the “fruit.” I recall lying in a hotel bed in Vietnam a few years ago; when I’d tried to swallow, a panicky feeling took over as my throat froze. Occasionally that sensation returned. No wonder.
Through the haze of my thoughts, I register that Dr. Landeros is talking, reassuring me that most thyroid nodules are benign, but I need a needle biopsy to be sure. I nod numbly, thinking about how a surgeon said the same thing six years ago about the tumor in my brain. That walnut-sized mass was discovered when I had a seizure. Back then, the brain surgeon predicted the tumor was benign; that the growth in my head wouldn’t kill me. She was right. The post-surgery pathology report determined it wasn’t cancer ― and three months later, Dave and I traveled to India and Sri Lanka, my surgeon’s advice ringing in my ears: Forget this ever happened. Move on with your life.
Will I be so lucky this time? I take a deep breath. Don’t catastrophize, Kate. But I can’t help it. Silly me to think after brain surgery at age 50, I’d triumphed over the one major medical challenge of my life.
I know almost nothing about the thyroid, so I consult Dr. Google and learn it’s a butterfly-shaped gland housed below the Adam’s apple that controls many of the body’s important functions by secreting hormones. I imagine one wing of my butterfly pinned down by a lemon and unable to fly.
The next day, I lie on a gurney, shivering like I’m immersed in ice water. The nurse brings a warm blanket but nothing can allay my trembling, not even Dave at my side. Using an ultrasound as a guide, the physician inserts a long needle into the mass in my neck and swirls it around. As the painful gouge is repeated four times, I imagine myself as a stone statue. I wonder if even breathing too hard might cause the needle to slip into a vital artery.
The test results will take about a week. Over the next few days, I check my email incessantly. Then one day as we ride in the car headed to the store, I glance at my phone to see a message from the hospital. I click it open to my diagnosis: papillary carcinoma.
“Dave,” I say, as he steers us down the bumpy dirt road. “I have cancer.”
Staring out the windshield, he reaches over and takes my hand.
A hurricane whips around in my mind. I will need surgery. Cancer treatment. Should I do it here in Mexico? I think my insurance will cover me wherever I am, but I’m not sure. Is this the end of the nomadic life that I love so much? My mind stutters to a stop, not daring to plunge into the abyss.
I text Dr. Landeros — yes, he’s given me his cell number — and he offers to see me right away. He greets me with the customary quick kiss on each cheek and then explains the surgery. They’ll also have to extract a few lymph nodes to see if the cancer has spread. If the malignancy is advanced, I will need to undergo radioactive iodine, or RAI, treatment. He explains his three-person team will perform the procedure with “care” and “love,” which makes me want to hug him.
That afternoon, I Google RAI therapy and learn afterward you remain radioactive and must avoid contact with others for a week. Even worse, possible side effects include salivary gland malfunction, loss of taste or smell, dry mouth, chronic pinkeye and loss of hair. I read that 61.1% of patients report moderate or severe long-term side effects. I wonder how therapeutic such treatment really is, that it might be worse than the tumor. I’ve seen friends thrive from cancer treatments, but I’ve also seen others suffer tremendously and even die from harsh therapies. I decide I need a second opinion.
I talk to a doctor friend in the U.S. who agrees with the treatment plan. However, she says it will be better for me to work with a surgical oncologist and an endocrinologist, not an ENT. If my tumor was benign, I wouldn’t have flinched at having the surgery in Mexico because their medical system is so humane. But I decide to go to California, our former home.
This decision launches me into a morass of the U.S. medical bureaucracy. I am transferred from this department to that, asked a million questions, told to fill out a stack of online forms in different formats, call x person and wait for y person to call me back. I try to remain calm and remind myself how fortunate I’ve been to retire with a medical insurance package.
I try to breathe and take each moment as it comes, knowing stress is like fertilizer for the lemon-tumor. Dave talks me through guided healing meditations. I feed myself health: spinach and papaya smoothies with celery, pots of vegetable soup. One day at the beach, we see a rock jutting from the water come alive with hundreds of crabs scuttling about. Thousands of little lives. It seems my life isn’t any more significant than theirs.
That night, I shoot up from a hard sleep in the dark, my head swimming, chills shaking my body, my tongue a wad of cotton in my mouth. Dave lightly snores at my side. I panic, thinking I’m having a stroke or a heart attack. Switching on my light, I lean back against the pillows, taking deep breaths, exhausted but not able to sleep. When Dave’s eyes finally open, I’m staring at him and say I might need to go to the emergency room. I wrap myself in my bathrobe, wobble to the couch and sit, my head in my hands. Dave stands above me and asks me what’s going on. I explain the chills, the shaking, the feeling like 10 cats are piled on my chest. I imagine I see fear in his eyes. And exhaustion. I decide to return to bed.
Dave goes up to the rooftop patio for a tai chi session. I worry about how once again he’s being thrust into the role of taking care of me. I remember him helping me bathe because my right arm wasn’t working after the brain surgery, and rushing to the pharmacy for stool softeners because I had a bowel impaction. When he’d vowed “for better or for worse,” no way could he have imagined I’d need brain surgery after only a year of marriage... and now this.
Our neighbor Pete comes by and offers me a Xanax. I figure Dave must have told him what was going on. Could this really be just anxiety? A panic attack? I’ve never taken Xanax before but decide what the hell ― and in minutes I start to feel relief.
Clearly, the mind can mess with the body, and I can’t always control it with my woo-woo stuff.
When Dave returns, I tell him I’m feeling better. He quietly drops to a chair, wiping tears from his eyes. I go to him and hold him, silently sorry for what I’m putting him through. I know his back is hurting, that he’s feeling the weight of our world on his shoulders. I’m trying not to be too needy even though most of the time I just want to wrap myself up in him and stare into his blue-green eyes. I dread the idea of leaving this planet without him.
Once a palm reader in Hong Kong grabbed my hand and blurted out I was going to die at 80. If he was right, this cancer won’t be the end of me. If he was right, I’ll live another 24 years. If he was right, I have before me merely 24 springs and summers, 24 falls and winters. I clench inside at the thought that my remaining seasons are countable, but I’ll take them.
At my consult in California, Dr. Lin recommends a full thyroidectomy, given the tumor’s size, its cancerous nature and the fact that another smaller nodule is buried in my other “butterfly wing.” Alternatively, she could remove half, but the other side would need to be monitored regularly. I’m thrilled with the idea of not being on thyroid medication for the rest of my life until she adds that often people still need pills when half a thyroid can’t compensate. And I’m turned off by the idea of needing to get regular ultrasounds, keeping me constantly worrying if it’s growing.
I ask her what she’d do in my situation, and she says she’d take it all out. I concur. I notice she has small hands, which I pray will serve me well when I’m sprawled on the gurney having my throat slit open. When I ask about the picture on the wall of two cute kids, she says she has 5-year-old twins.
“If you can handle that, surgery is probably a snap,” I crack, and she laughs.
I cling to the fact that she tells me that thyroid cancer is one of the “most curable” types — and that RAI, if I need it, is simple: swallow some pills and sequester.
Easy for her to say, sitting there all young and pretty and accomplished behind the armor of her medical pedigree. I’ve scrolled thyroid surgery Facebook groups and learned that the 61.1% of patients with side effects are real people who suffer. I don’t want permanent dry mouth. To never again be able to smell a newly-picked tomato. To have perpetual pink eye. If I can waive radiation, I’ll kiss the ground.
Surgery takes four hours, and when I rise out of the mist of anesthesia, I try to squeak out a question but can’t speak. Dr. Lin assures me my voice will soon return. She says I need only one night in the hospital and she’ll call me in a few days, as soon as the pathology report comes in.
The only external evidence of the surgery is a Band-Aid on my throat. Although I can eat, it’s awkward to swallow and stressful to talk too much. It’s hard to focus ― I keep waiting for the phone to ring with the pronouncement of my destiny. Has the cancer spread? Will I need radiation or any other possible cancer treatments? What is happening in the dark alcoves of my body?
A week passes. Then a second one. I call Dr. Lin’s office several times and am told the pathology is taking longer than usual. I try to suss out from the nurse’s tone if that is good or bad, but in a flat voice, she merely reconfirms that the doctor will call me the minute the results are in.
Finally, one afternoon while I’m sitting on the couch trying not very successfully to read the newspaper, my phone rings. I see it’s a Stanford number and fumble to answer.
“Kate,” she says. “It’s Dr. Lin. Your results have come in.”
I grab a pen from the coffee table, my pulse thumping in my ears.
Her next words make my breath hitch: “I have good news. Your tumor is benign.”
The room sways. Is this a dream? I don’t have cancer. Your tumor, but really not my tumor anymore. It sits in a lab somewhere or maybe has been strewn into a garbage can. A piece of me I will be leaving behind when I jump on the next plane out of here.
She explains that the needle biopsy results had not been wrong but that I had “Niftip, a noninvasive follicular thyroid neoplasm with papillary-like features” ― a type of tumor that used to be called cancer but was downgraded two years ago by the American Medical Association.
“It’s no longer deemed a carcinoma,” she says, “because it has never been shown to spread beyond its capsule. That’s why the pathology took so long, because the whole capsule had to be examined. If your tumor had been discovered a few years ago, you would have had to undergo RAI. But now it’s not necessary.”
I think of Dostoyevsky in front of the firing squad, whose blindfold was whipped off and he was told, “You’ve been given a reprieve. Go home.” When we hang up, I cry tears of relief and shock, my raw throat constricting. Dave hugs me as the past fearful six weeks crash to a halt.
Two tumors, two surgeries, no cancer. Knowing so many people who’ve had cancer, I almost feel guilty about such luck. Then again, maybe it’s not so fortunate to have had a non-cancerous organ removed. But I remind myself of the lemon, that it had begun to obstruct my swallowing. It needed to come out.
Afterward, searching old pictures to find ones with my head flung back, I identify the bulge in my throat, completely oblivious to something that could have undone my life. This thing had been in me for much longer than two years — and if it had been found earlier, I would have undergone unnecessary cancer treatment. I look it up and discover that according to “JAMA Internal Medicine,” up to one-quarter of patients likely do.
Forget this ever happened and move on with your life.
It’s good advice. But perhaps not completely attainable.
Because my scars — the two-inch line running horizontally across my throat and the indentation in my skull hidden in my blonde hair now streaked with gray — will always be reminders that, as the Hong Kong palm reader instructed me, I have a countable number of springs and summers left. Maybe 24, maybe not.
Kate Evans, Ph.D., is the author of seven books, including “Call It Wonder: An Odyssey of Love, Sex, Spirit & Travel,” winner of the Bisexual Book Award. Her new memoir "Nomads at Home" is forthcoming. She lives part of the year in Baja California Sur, Mexico, and the rest of the time she travels. For more from her, visit www.kateevanswriter.com and find her on Instagram and Facebook.
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