I'm on an operating table right now, probably.

Mon, Nov 3, 10:13 AM

I am writing to you on the evening preceding an early morning surgery.

At the present time, I'm well. Pleased, satiated, happy. Hopeful. Excited for life on the other side of the operating table and thankful for the events that have brought me here.

For the past three surgeries I've had, I've taken the opportunity to leverage modern technology and schedule-send emails to be delivered while I'm blacked out and intubated on an operating table. Most of you probably haven't received one of those purgatory emails, but I thought it would be fun to make this mass email one of those. So presumably, when this is delivered to you Monday morning, I will be undergoing internal modifications.

A recap: Read the prior notices if you want. I think we last left off sometime around April when they did the previous lung surgery.

Short story: Some time ago, these nodules popped up in my lungs. It's a common spot for this cancer to spread to; the liver usually first and then the lung. They stuck a needle in my lung, looked at the contents of it under a microscope, and confirmed it's cancer.

So I did some chemo. Different cocktails of drugs that at this time I forget due to irreverence and not forgetfulness. The chemotherapies didn't shrink the lung tumors/lesions/nodules/whatever you want to call them.

As a small insight into the world of cancer doctors (and I generally really like my oncologist), there was a time when these nodules first showed up and she said they were too small to do anything with. I disagreed with that sentiment...I thought we could shoot them with radiation when they were a few mm in size. She said they were too small.

Some time and some chemo later, they had gotten bigger, and I told her we needed to do something about it. She suggested they were too big to treat. Kind of humorous. But I lobbied for mechanical intervention, and she presented my case to their board of cancer doctors. The radiation people said it was too risky and didn't love the treatment approach. The surgeon was all on board, though.

So, on April 2nd, he went to remove the upper lobe of my right lung (that lung has 3 lobes), but instead of taking the whole lobe, he just took the bad chunk out. When he was trying to remove the lobe, he found that the lung was pretty stuck to the pulmonary artery. He said that happens after chemo sometimes. So instead of removing the whole lobe, he did a wedge resection.

I was in the hospital for, I think, 20 hours after the surgery. I woke from anesthesia, they wheeled me to a room, I hung out for a bit while they monitored vitals and such, they watched my lung to make sure it didn't collapse, they eventually pulled a giant tube out of my ribcage (chest tube. Google it, it's cool) and then I walked out. The nurses and staff absolutely hate it when you walk out, so I make a point to do it. They want to call the wheelchair people and roll you out.... Ridiculous. I had some lung removed, not a leg.

We walk while we can walk.

So anyway, these nodules have always been present bilaterally, but you can only operate on one lung at a time (something about needing to be able to breathe...).

So after that surgery, I hopped back on a round of chemo but then had to go to Europe for a month.

I came back from Europe and did more chemo. But I also went to Iowa, Colorado, and South Dakota. I'll send pictures in my next email.

The chemo has had absolutely no effect on the lung nodules. They just keep growing. But thankfully, my lung surgeon is happy to go chop away.

So in 8 hours, I'll wake up and go to downtown Houston to have a left lung lobectomy. When the surgeon comes to say hi before they knock me out, I'm going to try to talk him into not taking the whole lobe. I like breathing. But he's also one of the best in the world, so I suppose I'll trust his judgment.

Assuming they do take the lobe, I assume the recovery time may be longer, perhaps a one or two-day stay in the hospital, but my goal is to beat 20 hours.

Every month I do a circulating tumor DNA blood test; it's a newish technology that can measure semi-accurately how much cancer is floating around in your blood.

In the past couple of years of monitoring, the number has slowly but definitively come down. The past two times have been the lowest. This suggests chemo is working overall, which is good.

So if all goes well, the hope is that number can possibly get to 0, but it's statistically and physiologically improbable. It is, however, a worthy endeavor.

Regardless of that and what the road looks like ahead, I hope to see you on the other side of this particular tunnel. And I promise I'll send some photos and a more comprehensive update in some days. As it happens, I've procrastinated in my writing of this, and I'm typing it on a cell phone in bed, but it seemed appropriate to update you, and I do love sending emails while incapacitated.

Some FAQs maybe.

Can you breathe okay? Yes. Breathing feels normal. I did some lung function tests prior to surgery 1. They said I have 120% normal lung function.

How long does it take to recover? - Based on the last one (which is not necessarily indicative of this upcoming surgery), I felt no pain after 3 days. The only pain I did feel felt like that brief stabbing sensation when you have a stitch in your side after running or something. It got progressively better every day, gone by day 3.

Will you be cured after this surgery? - No. Stage 4 cancer is like a felony. It doesn't go away. There is no curing it. Very, very rarely it can go away for a while.

What happens after the surgery? A few weeks of recovery and then back on the chemo wagon. Then some scans to see what is going on in the body and where, if anywhere, the cancer is remaining.

Are you scared/mad/nervous? Certainly none of those. I'm kind of excited. It's a waste to lament that which you can't control. Truly, I think this is all kind of fun, but I'm a droll fellow.

With that, I'll leave you for now and hope that this finds you well. There are maybe 10 to 15 of you that I keep updated on these matters, so cherish it. And don't tell anyone else. Mostly. It's a HIPAA violation.

See you on the other side.