IamA 33 year-old radiologist. Two months after I got engaged, I was diagnosed with a 1:1,000,000 incidence cancer. I've since been filleted open like a fish, had some of my insides removed, had kidney failure requiring dialysis, and was on blood t...
So, all of the stuff I said in the thread title is true. Since I'm a radiologist, I want to show you my proof of all this like doctors show other doctors cases. I've tried to remove the really technical words and replace them with words that everyone will understand. If you're a medical person and want to read it in its full, annoying doctor shorthand glory, check out my post in /r/medicine.
History of present illness: The patient is a 32 year old male with a history vague and intermittent abdominal pain for the past two years. He has no other significant medical problems. Previously, the pain had been easily controlled with intermittent use of over the counter medications, but in the last couple of weeks had become acutely more painful and the pain became persistently present. On the day of presentation, the pain localized to the right lower quadrant which prompted the emergency room visit.
Past medical/surgical history: Well controlled high blood pressure. Prior sebaceous cyst and wisdom tooth removals.
Meds/Allergies: Lisinopril 20 mg daily (blood pressure med). No know drug allergies.
Other history non-contributory.
Relevant labs: Sedementation rate and C-reactive protein, both generalized markers of inflammation, are markedly elevated. Mild low blood counts with hemoglobin (basically, red blood cells) just below the normal cut-off. All other labs normal.
Some brief information about radiology conventions: we diagnostic radiologists like to pretend we're real doctors, so we always "look at the patient" when reading studies. So basically it's like we're standing at the foot of the patient's bed and looking at them, in the same way that if you face someone and look to your left, you'll notice that's their right. So, functionally, left and right are reversed on our pictures. It starts to make sense after a while (but I now sometimes confuse left and right like a
kindergartner3-year-old. Thanks radiology!)
We also have 3 major planes of imaging: axial, coronal, and sagittal. A picture, as they say, is worth a thousand words, so just look at this to understand what I'm talking about below, if it doesn't make sense.
And so without further ado, here's some proof of my shit-tastic disease:
Initial CT Scan
Axial CT at the level of the liver: Right from the get-go, things are looking grossly abnormal. There's organized fluid over the liver dome, which suggests it's thicker than just some water in the belly. There's some ill-defined, hazy shmutz (technical term) along the bottom curve of the stomach which is changing the appearance of the normal intra-abdominal fat. We radiologists say, "fat is your friend" because it looks black on CT. It helps separate out different structures so we can see where exactly something is. When there's too much white stuff on the black stuff, it tells us something isn't quite right.
Axial CT at the level of the kidneys: More belly fluid and possibly some enlarged/big lymph nodes along the major blood vessels. If you look just "above" the spine (it's really in front - think about those imaging planes), that's where the blood vessels run and, in general, the lymphatic system runs with the blood vessels. The lymphatic system is basically part of your immune system, so when lymph nodes get big, it means that your immune system is trying to fight something. So that's where we look for evidence of disease outside of the primary location it started. It's hard to see anything discreet/measurable because everything is kind of smushed together and covered with belly fluid, but there's a round, abnormal nodule near or in part of the small intestine.
Axial CT upper pelvis: The right colon is "jacked up," which is an official medical description. In all seriousness, though, there is a grossly abnormal appearance to the right sided large bowel, the colon, with significant wall thickening. See that big ugly circle thing on the left side of the picture (the radiology right side)? That's not normal at all. The bowel wall should be very thin, smooth, and uniform. Also, there's too much white stuff on the black stuff again in the middle of the belly. Something about it just doesn't look right after you've seen a bunch of normal scans and know what it's supposed to look like.
Axial CT mid-pelvis: Well, on the plus side, it's not appendicitis. That big arrow is pointing to a normal appendix. You may have to take my word for it, though. Again note the abnormal appearance of the colon.
Axial CT lower pelvis: This picture is lower down in the pelvis. Those big white things on either side are the pelvis bones. All that uniform appearing dark-ish stuff that's the same color as what the circle is drawn around is fluid. In a man, pelvic free fluid is never normal and should prompt a search for the underlying cause. In a woman, it's normal to see a small amount of free fluid. It's related to the menstrual cycle. But even this is way too much pelvic fluid for a woman, too.
One thing people, even other doctors, sometimes don't understand about radiology is that, we're not directly looking at jack squat. These pictures are just a really fancy density map of the body. The white parts were where a bunch of x-rays get absorbed. The black parts are where a bunch of x-rays can pass through the tissue without getting absorbed. Everything else is a shade of grey, and we can only tell you, really, about the relative differences in density.
Sometimes, that means we can make the diagnosis with great confidence. Radiologists call those "aunt minnies," because it's so obvious that even your Aunt Minnie can see the finding. But more often than not, things look the same. A lot of diseases from very different categories (i.e., malignancy/cancer versus inflammatory versus autoimmune versus vascular, etc.) can look the same. And so we, as radiologists, try to look at the pictures, evaluate them, and then say what it could be, preferably in order of probability. We call that the differential diagnosis. Other physicians do the exact same thing with people's stories and labs. We just do it from the pictures.
So hopefully that will drive home this point: When everybody (the ER, the GI doctors, the surgeons, and the radiologists) looked at the pictures, this was our differential diagnosis: (1) inflammatory bowel disease (things like Crohn's or ulcerative colitis) (2) inflammatory bowel disease (3) inflammatory bowel disease (4) something besides inflammatory bowel disease. That is how I would still read a case like this, quite frankly. And it made sense. Those things fit with my age and symptoms. I wasn't some old guy with a bunch of cancer risk factors. I was actually in okay shape, just overweight according to my BMI (probably just from my huge, arnold-style muscles, duh). I exercised a few times a week. I don't think that cancer was even on anybody's radar at the time.
So what do you do when they think there's something wrong in the colon? They shove a camera up your butt. I got to drink a gallon of what is basically salt water to clean it all out before they could take a look. That stuff is nasty. Anyway, the colonoscopy was... normal. So I thought I was good. We still had that nodule thing up in the small bowel near the stomach, but it's not all that rare for people to have benign tumors in their GI tract (meaning, the fact that they're there and that the grow is not normal, but they won't turn into cancer). No one could explain the right colon findings to my satisfaction, but hey - at least I didn't have Crohn's disease, right! Hooray!
Well, we still had that mass in or near the small bowel. They stuck another camera down my throat, through my stomach, into the small bowel. The camera also comes with an ultrasound probe on the end, too (nifty, right?), and so they looked at that thing really close up and were able to take samples of it with a small needle by using the ultrasound pictures to guide them. We sent that off to the lab for the pathologists (the experts in tissue, and the people who are the gold standard test for making any cancer diagnosis).
They also thought the CT scan didn't give them enough information, so they decided to get an MRI of the belly too. Just as an aside, CAT scan is like nails on a chalkboard to a radiologist. They're "computed tomography" scans. "See Tee scans." When you say CAT scan, this is what I think of. And so now you know. And that's half the battle, as those important childhood lessons learned from GI Joe remind us all.
Just a bit about our radiology tests, too. People think that x-rays are the worst, then CT is better than that, and then MRI is the best of all. I mean, kind of. Really, you use different modalities depending on what question you're trying to answer. X-rays are actually still the best first test for a suspected broken bone, for instance. As I said above, CT makes a density map of the body, and that's useful for a lot of things, actually, too many to list here.
But MRI is a bit different. In an MRI, we have a really strong, always-on (it's a superconducting magnet) magnetic field. It turns out that when you put protons into this field, just-over-half of them will "line up" in the direction of the magnetic field (the other slightly-fewer-than-half face the other way). Once we get everybody "facing the same way," we shoot a radio pulse into the protons. This basically knocks them over, and as they stand back up to face the way they were facing before, they send some radio wave energy back out, and we can listen for that. And the really neat trick is that protons stand back up at different rates depending on their environment, so a proton inside of a pathologic lesion is almost certainly going to "look" different than one in normal tissue. So it's a lot easier to tell apart tissues of juuuuuuust a little bit of difference. Radiologists call this "contrast resolution."
Anyway, here's what my MRI looked like:
Axial fat-suppressed T2: Since we know what the fat signal is going to be (since we know how fast fat protons "stand back up"), we can send a signal into the scanner at the right time that's the exact opposite of the fat signal, and they cancel each other out. This is called "fat suppression." T2-weighted images a basically "fluid sensitive" images. If it's really bright on T2, it's probably fluid. So this is just proving that the stuff around the liver is fluid.
Axial fat-suppressed T2: The stuff in the pelvis is also fluid. Look how it fills the potential spaces on either side of the urinary bladder. This is bad news bears.
Axial C+ fat-suppressed LAVA: C+ means that these pictures were taken after they gave contrast. Contrast (as is probably obvious from the name) helps you differentiate between tissue types. It's generally related to the amount of blood flow to the lesion. Since tumors like to grow, and growing things need nutrients, tumors secrete proteins that tell your body to build new blood vessels to them. So, tumors usually light up after you give people contrast. There's an abnormal enhancing lesion along the lesser curvature of the stomach, helpfully demarcated by the measurement tool. Additionally, note the abnormal enhancement around the margin of the spleen along the lining of the abdominal cavity.
Axial C+ fat-suppressed LAVA: This is what that small bowel nodule looks like on MRI. It's a bit easier to define the margins. It's still unclear whether this is inside or outside of the bowel, but it's definitely abnormal.
Axial C+ fat-suppressed LAVA: Grossly abnormal thickening and enhancement of the right colon. Some of the enhancement along the surface of the abdominal cavity is normal, and some is abnormal. Trying to figure out the difference can be VERY tough on MRI. When you're not sure if it's normal or abnormal, the diffusion sequences can be very helpful. Self-respecting tumors will generally restrict diffusion, a concept I will explain presently. See below for more info.
Axial C+ fat-suppressed LAVA: Enhancing nodule or lymph node in the right pelvis. Again, some of the belly surface enhancement is probably abnormal, but it can be difficult to determine how much enhancement is too much.
Coronal C+ fat-suppressed LAVA: Just another picture of the nodule near the stomach/upper small bowel. You can also see the right colon, and the low signal fluid around the liver and spleen.
Axial diffusion weighted image: Okay, so what is diffusion. Well, normally, water molecules are free to move around in the extracellular space. When you have something that causes swelling (edema is the fancy word), there is not only more water present, but it's also usually jammed into the cells in the area, and therefore less able to move around. So when we send in those radio pulses and then listen for the echo, water that can't move keeps getting more and more energy, and so the signal is higher. Water that gets hit by the radiowave but then moves out of the spot we're listening to will have low signal. So it's helpful to identify true swelling/edema. This image is at the level of the right colon. All of the high signal in the right colon is abnormal, and we know it's not just T2 shine-through because the same area is also dark on the ADC map (T2 shine-through is bright on both).
Axial ADC map: Just to confirm the diffusion restriction. If you don't understand the whole DWI-ADC map relationship, that's okay. It doesn't really matter for the story.
Well, the biopsy results finally come back. The differential diagnosis for the way the stuff looked under the microscope is read by the pathologists as, "florid mesothelial hyperplasia versus peritoneal mesothelioma." I looked all of this crap up about 15 seconds after I got the phone call from the GI fellow with the results. I had never even heard of it, and I'm a freaking doctor. When you say, "mesothelioma," everyone thinks (1) asbestos exposure and (2) it's a lung cancer (technically, it's a cancer of the lining of the lung, but that's semantics).
When taken in conjunction with the MRI findings, this is highly concerning for malignant peritoneal mesothelioma. But they still weren't 100% sure, so we had to stick some cameras in my belly to take a look. They did that and took a bunch of samples. They were also doing it to see how much disease was in there (I mean, look at those pictures. There's some really fucked up shit going on inside me).
We didn't think I was a surgical candidate when all of this started. People who can't get the surgery and the cancer removed have an abysmal prognosis. Like, 6-18 months type of prognosis. Well fuck.
They have a system to estimate the extent of disease, called the peritoneal carcinomatosis index. It's a scale that goes from 0 to 39, and the bigger the number the worse it is. Based on the MRI , my index was 31/39. Almost all of the published literature and studies on this shows that patients above a PCI of ~12-13 don't do well. The final tissue diagnosis is malignant peritoneal mesothelioma, epitheliod subtype.
As luck would have it, there happens to be a team of oncologists where I'm training, both surgical and medical, that specializes in cancers that have spread to the abdominal surface. The team decided to try a two-step surgical approach, that was developed at Columbia in NYC, which has taken people with really bad disease and made their outcomes similar to those of people with lower PCIs. The general idea is this: get the worst of it out with a first debulking surgery. If there's anything there that's going to make the surgery really hard, or force the surgeon to remove an entire organ that they really kind of don't want to take out, they leave it. After the surgery, you do chemotherapy in the abdomen, and then later you go back in for a final surgery where the goal is to take out everything they see. With both of the surgeries, too, they do something called heated intraperitoneal chemotherapy (HIPEC). The idea is that, you can physically remove the bulky disease you can see, but there are probably microscopic cancer cells you gotta kill too. That's what the HIPEC is supposed to do.
So, we go to surgery. They took out my spleen, distal pancreas, gallbladder, right and transverse portions of my colon, all of the omentum (stuff that covers the bowel), and a bunch of the lining along my diaphragms (the muscles that move your lungs) and throughout the belly. It took them 12 hours to do the first surgery and HIPEC. Obviously, this is a huge ordeal and I'm in the intensive care unit for the first few days after surgery and everything hurts like a motherfucker. I learned during that hospitalization that Dilaudid is my homie. I don't know how I would have tolerated the pain without a drug that's basically as powerful as heroin. Also, I'm pretty sure I know how it feels to do heroin, so, thanks for that too, cancer.
They used cisplatin for the HIPEC procedure, and that drug is well-known for being very effective, but also for having the potential to trash your kidneys. I still to this day don't know exactly how this happened, but instead of getting just a dose to the inside of my abdomen and a tiny bit absorbed by the rest of my body, I get a fuckton absorbed by the rest of my body, and it pissed off my kidneys somethin' fierce, as we say in the south.
I went into acute kidney failure. They hoped that the injury would hit the peak of its badness and then I'd start to get better and my kidneys will start working again. It doesn't happen. After 4 days of continually worsening renal function, they decide I need dialysis. So we go down to interventional radiology (aka, IR) and they put a tunneled line exactly like this into my chest and right sided neck vein. The medical term is a "right internal jugular central venous catheter." To translate from "doctor" to "normal English speech," you need a big honkin' hose to be able to move enough blood to do dialysis. I ended up being in the hospital for about 10 days all together.
I figured I'd be on dialysis for a few days. Not a good event to have happen, obviously, but ultimately no big deal. Nope, it was way worse than that. I had to be dialized 5 days in a row in the hospital, and then we started doing it "only" three times a week. Even after I was discharged, I was on dialysis for two months until my kidneys recovered enough on their own that things like my electrolyte levels weren't getting out of whack anymore. You can die from fatal heart rhythms from having too much potassium in your body, for instance.
Another fun complication I had with all of this was a big ass clot where the catheter was in my vein. This happened maybe 4 days after I was discharged. It shouldn't have been a surprise, really. When you start listing the risk factors for blood clots, I had almost all of them: cancer, recent surgery, immobility, indwelling foreign device. My right arm felt tight all day, and then I looked in the mirror and noticed that the right side of my face was swollen. That little spot behind your collar bone where the skin kinda dips down was completely gone. It was puffed out the other way, actually. When I went to the ER, it was such a slam dunk diagnosis that they didn't even bother doing anything except starting me on blood thinners.
When you have blood clots like that, you can't wait around for the oral blood thinners to kick in. You have to start people on blood thinners that work right away, most often heparin. Doctors call this "bridging" someone. The thing that sucks about heparin is that there's no one dose that's great for everyone. You have to give it to people and then check a lab value related to clotting times (the PTT), and adjust the rate of heparin accordingly until you get the person to "their" dose. So basically you gotta get stuck a lot so they can test your blood.
I already have a one in a million cancer, but I also found out that day that heparin doesn't work on me. They kept giving me more and more and checking the labs all the time and they didn't budge, so they had to use a newer, way more expensive drug, and I was going to be in the hospital being "bridged" to the oral blood thinner (warfarin aka Coumadin). You can't safely discharge people until the warfarin is at a therapeutic level, so once again I was sitting in the hospital just waiting. Waiting for one freaking number to be above 2.
It took 6 days in the hospital to get there. The hospital is boring as fuck. The food sucks. You see your doctors for 3 minutes a day and then never again until the next day. They talk about you outside your room before they come in, and you can hear them. It was especially annoying for me, because I understood all the things they were talking about. Why wasn't I included in the discussion? I'm both the patient in question and a doctor.
Though, you get demoted real fucking fast when you put on that hospital gown. If you have any kind of title you worked hard for, and are proud of - things like captain, reverend, colonel, doctor, professor - and prefer to be addressed by, well, get used to "mister." All of the sudden, I was a "mister." Nurse practitioners fresh out of school (I'm 9 years down the medical education rabbit hole at this point) with less clinical experience than a third year medical student were calling me "mister." It was then that I realized I had truly become "the patient."
But, time's arrow moved, as it does, ever forward, and I finally got out of the hospital. I wasn't out of the hospital (for the second time) for more than a day or two before the next fun complication reared its head. There was a spot in my surgical wound which had always been little firmer than the rest of the tissue. Something wasn't quite right about it, but it looked okay and I didn't have any symptoms. But, on that day, I noticed that my shirt was soaked, and something didn't smell particularly good. The dressing of the wound was also soaked. I took it off to look at the wound, and it was pretty clear that it was infected.
We went back to the hospital. The surgery resident came and saw me. With big gross infected wounds like that, you can't just sew it back up. It will almost certainly get infected and form an abscess if you do that. No, open wounds have to heal by what doctors call "secondary intention" or, as I prefer to say, from the bottom up. You have to keep it open and let the tissue fill into the gap. But obviously you also want to clean it so it doesn't get infected again, so you shove wet gauze into it, let it try, then take it out and then repeat the process until it's healed. This is a "wet-to-dry" dressing, and every time you take it out, it removes some of the nasty crap from the wound and leaves only the good "beefy red" granulation tissue (what a delightful description, no?) .
When I say it was big and gross, it was. Actually, I'm a weird guy (duh, radiologist) so I took pictures of it as it healed. This is what it looked like the day after we opened it up in the office. My only regret is that I forgot to include a banana for scale. But, that smaller hole down inside the big hole is actually an opening right into the abdominal cavity. I could have stuck my finger down through that thing and touched my own intestines. I didn't, because that seems gross and also like a pretty bad idea, but I could have. It took this bad-boy about a month to heal up.
Also, with the open wound on my belly, and the dialysis catheter dangling out of the right side of my chest, I basically couldn't take a shower. I would sit on the edge of the tub and wash the important bits (you know what I'm talking about) and try to keep everything else as dry as possible. I don't know about you, but a nice shower in the morning is one of those small pleasures in life (right up there with the pee shivers after holding it in forever).
And sometimes, you don't appreciate things until they're gone. I sure as shit didn't appreciate things like, "not being in pain all the time" or "not throwing up bile every day because you actually still have your gallbladder." And, quite frankly, my previous good health. I took it as a given. I was only 32 when I was diagnosed. I'm not supposed to have any serious medical problems at that age. Certainly not something life-threatening. And certainly not something that's as likely, on a statistical level, as it is to have a major earthquake on the Hayward fault within the next 50 minutes and other rare things that almost certainly won't happen. This is not a go-to diagnosis. This is a, "what the actual fuck" diagnosis.
I finally thought I was doing better. I felt better. It was 3 months out from the surgery, and my wound had finally closed and I was finally able to eat okay and get calories in me and gain weight. I lost about 25 lbs from this ordeal and to this day I still find it very difficult to eat more than a small meal and put on weight. The silver lining, and perhaps something people might envy, is that I can eat whatever the hell I want and still look pretty good. I eat a ton of garbage food now in an attempt to gain weight. My last 3 dinners have been domino's, taco bell, and wendy's, for example. I'm scared I'm going to lose a bunch of weight again and look like nothing but skin and bones after the next surgery.
But the fun wasn't over yet! Remember how I said we were gonna do intra-abdominal chemo between surgeries? Well, we had started that at this point, and the way we were getting it into the belly was through what we call "ports." You may have heard about those before. They're usually used to have permanent, long term IV access in a safe way. They have a long tube that goes basically wherever you want it (vein, belly, whatever) connected to a hub or reservoir that they access with a needle, put in whatever med you're using, and then take the needle out. The reservoir is placed under the skin so they don't get infected (you access them with sterile technique). 1 picture == 1000 words.
Anyway, we placed two, initially. What were the odds that both would fail? Well, as you may be picking up by now, I'm one lucky motherfucker, because the one that was on the left side just stopped working and really hurt when they would attempt to flush it out with saline. So we stopped using that one. On the right, the stitches holding the reservoir failed, and the port started moving under the skin. Actually, it started tilting forward and pressing out on the skin. It actually really hurt.
One advantage I do have with all this is that I have better access to my doctors than the average bear. I have their work email addresses and pager numbers. So I got in touch and met up with my surgical oncologist. We both looked at it and agreed it needed to be revised, but it was a Friday evening when this took place. We planned on doing it early the next week. Instead, it eroded through the skin the next day. I got to enjoy that over the weekend.
And as you might imagine, once that happens it has to come out. And I had no access for the chemo I was supposed to get. So we went back to IR, took out both of the failed ports, and through something of a minor miracle, they were able to successfully place an intra-abdominal port in IR. All of us were skeptical it would work. One thing that happens after just about any belly surgery is that you get scar tissue in the belly. We call them adhesions. They prevent things from moving around as easily as they should, and can sometimes even cause bowel obstructions in people. One of the more common general surgery procedures, actually, is "lysis of adhesions" - they break up the adhesions from a prior surgery if they have to go back in for some reason. But the IR doc was able to sneak the catheter past all of that stuff and got it into position.
And that's basically where we're at. The most recent port problem happened about a month ago. I had to pack that one, too, but it was a lot smaller than the big wound and healed up in about 3 weeks. This thing really knocked me on my ass at a really inopportune time in my life. My now-wife and I had just gotten engaged on New Year's Eve, and I was diagnosed in early March of this year. I actually asked her if she was sure she wanted to "stay in the game" with me, so to speak. I would have understood if the answer was no. Truly I would have. This is fucking up her life almost as much as mine, at this point. But, and this is why I locked that shit down ASAP, my wife is the most amazing person I know. She told me to stop being a ridiculous idiot and that our wedding date was already set, so I'd better get to planning.
She is without question the love of my life.
Anyway, here are some fun stats you might not know about malignant peritoneal mesothelioma: it exists. The incidence is about one in a million. There are about 300 cases of this per year in the US. The average age of diagnosis is about 60. It's not as clearly related to asbestos exposure as the pleural variety. People with high PCIs generally don't do well, but that's often because they're not surgical candidates. The single most important factor for survival is the completeness of cytoreduction - if they can get all the disease out, people do better. You can go from a PCI of 39 to 0 with a good surgery.
The epitheliod subtype has the best outcomes (outside of an even more rare cystic variant which is almost always seen in women). There's also a sarcomatous variety and a mixed type, both of which do worse.
I have to take the radiology boards in November and then we go right back to surgery after that. It's unclear if I get to keep my stomach; I'll find out what they had to do to get rid of all the disease only after I wake up in the ICU. The thing that scares me the most about the next surgery is the possibility of another severe kidney injury which would probably put me on permanent dialysis. I'm now chronic kidney disease stage III (V is dialysis dependent, so I'm a bit over halfway there!). But I don't really have any underlying risk factors that would continue to degrade my kidney function, so I could do okay for a long time like that without another huge insult. Again, only time will tell. Feeling out of control of your life is very frustrating and scary, particularly for people like doctors who all think we're in total control of everything in life. Protip: we're not.
After the second surgery, I should be at a cytoreduction score of 0, meaning they got everything out. At least, that's the plan. After that, they want to do more chemo, but this time intravenous/system with a platinum based drug and pemetrexed, a derivative of methotrexate, and the only medicine FDA approved for mesothelioma.
One of the most famous guys in this field, Dr. Sugarbaker (the one in DC, not MD Anderson) put a series of 29 patients on a protocol of cytoreductive surgery, early post-operative intra-abdominal chemo, and then 6 cycles of cisplatin + long term intra-abdominal alimta. They're projecting their 10 year survival in those patients to be as high as 73%. I'm going to push my team to go in the same direction, if they'll offer that therapy to me.
It may sound stupidly optimistic, but I think I actually have a shot at a very good outcome. And I also think this has made me a better/more empathetic doctor. I understand now what patients go through. Little things matter to them/us. It's nice when people go out of their way to make sure your scan and your appointment are on the same day, for instance. It's even more important when you're talking to patients who drive 1-2 hours (or more) just to get to the hospital. They really appreciate stuff like that.
I learned that I need to go out of my way to introduce myself to people before you do a procedure on them. In a training hospital, often, the lower level residents go do the pre-procedure paperwork and the upper level residents just operate or do cases all day. Someone you have never met, whose name you don't know, may be sticking their hand (or at least a wire) into your body while you're unconscious. I met the surgical oncology fellow, for instance, as I was counting backwards from 10 falling asleep from the anesthesia. You know, that monstrous, 12 hour beast of a case that this whole thing has been about. In my head, I went, "Whatt thhhhhheeee fuuuuu [out]." I will never do a case on someone who doesn't know my name, and whose hand haven't shaken (well, unless the patient doesn't want to shake my hand).
I went into radiology specifically to do interventional radiology, but now I'm absolutely chomping at the bit to get back into the clinical world. I want to drop TACE and Y-90 beads (procedures to treat cancer that has started in or spread to the liver) into all kinds of bad things for people so they can give cancer the big "fuck you." I want to actively do things to help patients, like, all the time now. Not that I was a complete dick before or anything, but after this kind of experience, you just "get it."
Lastly, it also taught me that there's no time like the present to start living your life. I got married to the love of my life a couple weeks ago and we just got back from a super-kickass honeymoon. I plan on continuing to do awesome things with the people who matter until I literally can't get out of bed.
Fuck cancer, and ask me anything!
(And now I will shamelessly plug my scuba diving footage from the aforementioned honeymoon, just like those professors who put the pictures they took on vacation in their powerpoints. I actually worked really hard on it, so please check it out my friends!)
edit: Proof: https://i.imgur.com/J9poMIv.jpg