My previous post describes in brief what the MRI scans discovered. The images were not a pretty sight. Filling much of the space from which my brain tumor was excised last August is a moonscape of recurrent melanoma—a heterogenous jumble of rind and pith. If I hadn’t seen for myself just how large and extensive the mets were, I don’t think I would have believed it. I can understand why surgery and radiation therapy are not good options for me. The visual evidence is damning.
Complicating my medical outlook is that melanoma cells have migrated from the tumor bed on the right side to the brain’s left ventricle and established a 3-mm met there. With such open access to the cerebral spinal fluid, cells have also floated down the spine and set up colonies, including a large lesion that descends 4 cm below L1. This region will be treated by standard radiotherapy starting next week, which should palliate the worst of the symptoms caused by the tumor (e.g. low back pain) and make me more comfortable.
This wide dissemination of melanoma weakens what little logic remains for treating the really serious mets in the brain. If they were the full extent of my problems, a good gamma knife team might do me some good. Unfortunately--to employ the medical cliché of the week--the cows are now out of the barn. Even though the only evidence of melanoma outside of the central nervous system is one small met in my right axilla, the brain is a notoriously difficult organ to treat and mine is in a hell of a mess. We’ve done about as much surgery and radiotherapy as can be tolerated without turning my brain to mush. I’m not willing to make that tradeoff given that I’ve already seen how hard it is claw back from brain treatment.
So while I reserve the right to change my mind, my decision—made with input from my family—is to not intervene in the brain. I met separately this week with my medical oncologist, radiation oncologist and neurosurgeon, and they all agree that Gamma Knife is unlikely to do me much good therapeutically and almost certainly would diminish my quality of life in the two to four months they believe I have to live. Dr. Curti, who does melanoma research himself, will check with specialists elsewhere to make sure there isn’t a clinical trial he doesn’t know about that might be open to patients with brain mets (which is rare) and for which the downside of treatment isn’t worse than what I’ve already experienced. I don’t regret having tried the ipi-whole brain radiation regimen; that was our best shot. It probably bought me some time, but was very unpleasant and I’m seriously disinclined to do anything like it again.
So in the last three days I’ve been assimilating the implications of my do-nothing strategy (other than palliative radiation to the spine). This is where the examination of my heart during Holy Week comes in. I’ve asked God for his clear diagnosis on my spiritual health. While probing our heart of hearts requires peace, calm and focused attention, it at least doesn't require the use of technology. This is a private exercise open to us all. I know that corruption lies within my heart and that this is where healing is needed most. While the odds of surviving the cancer in my brain are pretty slim, I know that God’s grace covers my heart. I will live into eternity based on the promises he has already made to me.
“Physicians will not heal you, for you will die in the end, but it is I who will heal you and make your body immortal.” –Pascal’s Pensees
I will in coming days be spending time with family and friends, resting as needed, and talking with God pretty much nonstop. As best as I am able, I will be sucking out the marrow of life. While I don’t know the number of my days, I expect to enjoy each of them to the extent my health allows. Radiotherapy of my spine should make my legs stronger in coming weeks so that I hopefully can walk comfortably again. We’ll be spending Easter morning with my Mom at her church in the Portland area, and tucking afterwards into what I expect will be a tasty brunch. After that we’ll head to our beach house near Waldport and enjoy a day or two of unusually mild spring weather. Is there any finer sight in Oregon than a blue-green corrugation of wild surf stretching out to a sky of robin's egg blue. Well, there may be, but this is one of the best for those of us lucky enough to live here.
I’m not happy about how melanoma has sidetracked the life I’d hoped to have while approaching my 60th birthday, but none of us gets a guarantee of our physical health as we age. We all are mortal. We all will die. I’ve been blessed with a splendid life and I know that when it ends it’s just beginning. On this Easter eve, my heart and mind turn to Jesus in the tomb, about to explode forth in new light and new life. His resurrection presages our own. Hallelujah!