I was going to title this blog entry, "Back to ER," but I think I already have about six previous entries entitled that and it's getting kind of confusing . . . need to come up with something else . . . I'll get back to that . . .

Bob was home for ten whole days before going back to the ER, then back up to 7D, at the recommendation of his primary care doctor and his cardiologist. Overall, he seemed to be doing okay, but as the days progressed, he has become more and more exhausted, plain and simply wiped out. He slept a lot and when he woke, wasn't rested, took enormous amounts of energy to do even the lightest of tasks . . . This past week and a half had also presented us with some daunting homework: to gather as much information as we can about Bob's options, which boil down to surgery or no surgery. To sort through the risks vs. benefits of each option, quality of life issues vs. curative issues, and all kinds of other heavy, heavy things I am so unprepared, ill-equipped, scared to death to deal with. And that's just my point of view. . .as much as I try, I will never, never, never begin to understand even one tiny iota of what goes through Bob's mind every second of every minute of every hour of every day. Maybe that has compounded his overall feeling of crappiness . . .

We already have Bob's oncologist's opinion (if you can call it that), which is a big cloud of doom, no matter how he looks at the situation: surgery is fraught with enormous, life-threatening risks and lots of unknown outcomes that will undoubtedly alter Bob's life dramatically. And in his opinion, despite surgery, there is still a 50% chance the cancer will come back. Yeah, but, I say weakly, doesn't that also means a 50% chance of it not coming back? Not doing surgery means we call hospice . . . what the hell kind of choices are those?

So, the longer I thought about it, the way I see it, is that this is one person's perspective, just one person out of countless players in this great, big, humongous event. And we've seen time and time again, evidence of how vast and varied, conflicting and confusing as all hell doctors' opinions can be, even with the most minor of situations. As my friend, Julie says, "Just because a doctor says something, doesn't mean it's true . . . " I've had to tell myself that over and over and over a million and one times this week, and still am not entirely convinced. Damn him and his Doctor title. . .

We have several other people to consult with, to get other perspective, opinions, insights, multiple times, if need be. Today's appointments were with the orthopedic oncologist who will be doing the main act of Bob's surgery, removing the tumor; the colorectal surgeon, who plays a supporting role; and his cardiologist, who needs to give the thumb's up that Bob's heart is able to withstand the ungodly demands of the surgery. The appointments were back-to-back-to-back, meaning everyone had to be on time or one of these critical appointments might have to be rescheduled, which would require an act of God, who is, I'm sure, really getting tired of intervening on our behalf . . .

So, we go to the first appointment, the orthopedic surgeon. Once again, I've got my page and a half of questions ready to fire off at him, my speech prepared. I'm ready. And, once again, as it's happened in the past with this doc, I've hardly had to ask a one, because he covers all bases, anticipates almost all of our concerns, as though he somehow, mysteriously, managed to sneak my notebook and peruse my scribbled notes before we arrived. The long and the short of it is, in his opinion, why would Bob not want to proceed with the surgery? So long as Bob gets cardiology clearance, the surgery is his only curative option. Based on the most recent CT and MRI scans, is still absolutely do-able, even given Bob's heart history and everything else that's crumbled down upon him.

The doc pulls up the scans and retraces the area of bone that will be removed along with the tumor, explaining how, that even with that amount of bone loss, Bob's body will recover. It will be a long recovery with a lot of rehab, and yes, there will be some adaptations to his mobility and possibly other functions, but he will recover. He looks at the tumor on the scan and more to himself than to us, says, "The tumor doesn't appear any different, really, than the last scans . . . " his finger traces squiggles, shadows and other foreign objects dotting the charcoal image. "These look like they could be air pockets, which might be evidence of a dead tumor, spaces that were once cancer now filled with air . . . can't say for sure until the tumor is removed, but that's what it looks like . . . " He's straightforward, doesn't sugar coat anything, but fills me with a sense of confidence and calm as I sit and listen to him, almost in awe that he isn't the black cloud of doom that Bob's oncologist is. Wait a minute . . . could it be, a little ray of hope pinpointing the darkness of the past eight months and counting? Don't get too excited, Jen . . .

"So," I say, tentatively, "the surgery 'cures' Bob of the cancer. What about his quality of life? So what if you can remove the tumor? What if his quality of life isn't any better than it is right now? Is that worth all the monumental risks? 'Cause I'm here to tell you that Bob is about tapped out here . . . can you tell us with a measurable degree of certainty that Bob will be able to go back to work, will drive again, will regain his life back, with this surgery? Because if not, then are all the risks worth it?"

Doc O kind of looks at me like I'm a little bit nuts (I'm used to this look by now), but continues in a dumbed-down yet highly effective manner. "See, sometimes tumors are soft, and the effect on nerves isn't quite so dramatic, but an osteosarcoma is basically a rock. Bob has a big hard rock on his sacrum, and the nerves involved are pinched, strained and stretched around, against and within this rock-hard surface. It's kind of like a rock in your shoe—hurts like hell, and the only way to get rid of the pain and discomfort is to remove the rock." Sounds convincing, but still, it's not like he's going to be removing Bob's appendix here. This is a tumor, along with a lot of bone, and who knows what else . . . nerves are entwined, too . . . so many things that affect his ability to get around, do the things he used to do, live life again . . .

I ask about the other non-surgery, palliative options, such as the burning or freezing of the tumor as had been suggested a while back. Palliative measures are, at best, a last resort, we're told, because they don't get rid of the rock or reduce the pain. It might kill some cancer within the tumor, but the tumor is still there. The other option of destroying the nerves affected by the tumor and causing the pain is at best, experimental, because the tumor will still be there and likely eventually grow and spread, and the entire mobility of the leg will likely be affected. By removing the tumor, they get rid of the cancer. And because they're freeing the nerves from it, Bob's pain will be diminished dramatically and eventually, he will be able to resume much of what he did before the cancer. Maybe with a leg brace, a cane and/or a few other adaptations, he continues with a shrug, but his quality of life will absolutely improve. . . and he will be alive.

From our continued conversation, it appears he wants to move sooner than later, so getting cardiac clearance is a high priority. He also tells Bob to make sure and mention to cardiology that he's not feeling well; if anyone needs to check on that, cardiology is the team. We move on to the next appointment, the colorectal doc. His speech, in an abbreviated version, is much of the same. His role is more of a supporting role, he tells us, but I tell him otherwise. "You're the expert on bodily functions that could be severely impacted by this surgery. I personally, think it's pretty important . . ." He tells us that by the CT and MRI, the colorectal functions may not be as impacted as they first thought. "Yes, we need to be prepared for anything, because we don't know for sure until we get into surgery, but the tumor doesn't seem to be as close to the rectum and its nerves as we initially thought . . . " We're told to not worry needlessly about something that isn't a certainty . . .

By this time, Bob is feeling pretty lousy. Nothing specific, just the generalized lethargic, wiped-out, exhausted kind of lousy that has progressively gotten worse over the past several days. We noticed it over the weekend, but he, in usual fashion, has tried to tough it out, shake it off, see if it'll pass. It ain't happenin'. We're dismissed from colorectal and head up to cardiology, thank god in the same building, just up two floors, or we might not have made it, given the time constraints. Primary care is right next to cardiology and we decide we'll take a jaunt over there after Bob's cardiology appointment, take advantage of this new team in Bob's care, as they told us last week to stop in or call at any time if anything seems amiss.

We don't wait long before we're ushered into the cardiologist's exam room and are joined by Bob's cardiologist a few minutes later. Can I just say that I love this man? He's confident bordering on cocky, obviously an adrenaline junkie (he likes to tell us that he's had some of his personal best times in treating heart attacks with Bob's two incidents, as though it were the Heart Attack Olympics) but has a genuine interest in his patients' health and well being. He strides into the room, takes one look at Bob and exclaims, "My god, you look great, Mr. Andrzejek! I can't believe it. I mean, that's all relative, given I usually see you on death's doorstep in the cath lab, but really, you look great! How do you feel?" Not so great, Bob responds, and immediately, Doc B delves into Bob's most recent history, asking a million questions that I can barely keep up with, regarding his recent hospitalization and discharge, what's going on, what symptoms is he having, what needs to be done . . . eventually, he decides that Bob likely isn't having any kind of cardiac event, "Because I've seen you enough times in a cardiac crisis, and I truly don't believe that is what's going on," but is teetering on the verge of dehydration again, that and being severely malnourished. He looks at Bob and says, "My gut says that all you need is some IV fluids and some lunch, but to be safe, let's admit you to ER, so you can be closely monitored and see how you do there. If need be, we'll have you admitted if there seems to be something else going on."

So, with that, we were whisked back down to ER, Bob was hooked up to an IV, and we sat for over five hours. An EKG was done which appeared questionable—not because a heart attack was going on, but because Bob's trembling limbs (side effect of weakness and meds) seemed to be interfering with getting a clear EKG . . . but again, to be safe, the attending docs, his primary doc and cardiologists decided, in an effort to try to stay on top of things, admitted him back up to 7D, hopefully as a preemptive strike against another major medical crisis.

It was nearly 6:30 pm when we were finally escorted back up to 7D. Immediately, Bob asked if he could order dinner and when it arrived, he inhaled it. A few tending docs arrived, poked, prodded and questioned Bob a bit, then said the main docs would be by in the morning, to give us a more detailed game plan, and that for tonight, the goal is to get Bob comfortable and settled in.

Eyes are so, so tired but wanted to get this out, try to sort out the details of the day. . . the info we got from the docs today was so much more encouraging than we've heard in a long time, and I know Bob felt at least a little boost by talking with them. Seriously, have so much to write down, but having a helluva time keeping my eyes open. Maybe more tomorrow. . .