A stranger in a strange land.

Walking back in MD Anderson today was just as hard as I thought it would be. As soon as we cleared the threshold from the parking garage I got a huge lump in my throat and a knot in my stomach.

We arrived at the hospital at around 9:00am, and stopped at the coffee shop in the "The Aquarium." The Aquarium is the what they call the main lobby, and it is filled with beautiful fishtanks, comfy chairs, tables, and a few recliners. There are always children. Unless children are patients, there are a number of places in the hospital that they are not allowed. Cameron and I spent lots of time when she was here watching the gold, silver, sunshine yellow and bright blue fish school around the plants. I ordered a small Mayan Mocha, a cheese danish, and water. While we were sitting and drinking our coffee, one of Patrick's radiation nurses walks by. "Hey! How are you? It's so good to see you." she says with a smile. Patrick tells her that unfortunately he is back because the cancer is back, and her face changed like a light switch. "Oh no. I am so sorry." They chatted a while, and then we made our way upstairs for Patrick's meeting with his neurosurgeon, Dr. Levine.

We waited a little while in a room filled to the gills with patients, and then we were called back to a consultation room. In it was a small round table, four chairs, a computer, and a large white board. A tech came in and asked Patrick a few generic questions, took his temperature, and blood pressure. Amazingly we only had to wait about 10 minutes, and Dr. Lavine and a student come into the room. He told us hello, and it struck me that he didn't say "It is good to see you." He asked "How are you?" His omission of the all time cookie cutter greeting screamed truth. It isn't good to see him. It is the exact opposite of good to see him - it is a nightmare. He began to talk about Patrick's surgery and what his plan is. They are going to blitzkrieg his sinus and the base of his skull. Cut him ear to ear not only to have access to his entire sinus, but they will also graft soft tissue from his head to use as patch material. They will take out virtually all of the bone at the base of his skull and part of the dura (the sack the covers the brain). Pretty much all of his sinus tissue will be removed and they will use the tissue they harvest from his scalp to repair the dura and other tissues they remove. As soon as they said "dura" my heart sank. That is as close to the brain as you can get before hitting white matter. He got up and showed us where he planned on making the incisions, the bones they would remove, and how he would put it all back together. He said they may also have to cut along the side of his nose to get even deeper access, but they wouldn't be sure of that until they had him in the OR. He inundated us with possible risks: headaches, spinal fluid leaks, vision problems like double vision or even blindness, bleeding, blood clots, stroke, coma, seizures, and death. I know that in order to sign an informed consent they are required to tell you all of those things, and the risks are hard to hear no matter how slim the chances. He said that this may be the end of the battle, or the cancer may come back. There was really no way to tell definitively. It did come back quickly inspire of the radiation, so they were going to removed everything and take huge margins. He did say that in hindsight he would have still done the surgery the same way before. It came back, and this is a whole new ball game. Patrick asked how long the surgery would take and he would be out of work. Dr. Levine said that they had scheduled it for 10 hours, but it may not take quite that long. He said that some people stay out a few weeks, but others go back to work sooner so they have distraction. He said that Patrick did need to be very informed about his ST & LT disability insurance programs just to be sure that we know what our financial situation was. He mentioned that we needed to be sure to plan way ahead - just in case he does have to go on LTD. He asked if I had questions, so I asked why the cancer didn't really show up on Patrick's scans. He said that after surgery and radiation, tissue is very different, and sometimes things are not very clear on MRIs and CT scans. He reassured me that if the cancer had metastasized somewhere else it would have showed up. That made me feel some better. I didn't really know what else to ask. I am sure when I get in the bed tonight I'll come up with a million. I'll be sure to write them down and have them ready for Monday.

After that appointment we went outside and sat on a park bench in front of the building. There were purple iriss in bloom in front of bright pink azaleas. The breeze was blowing and the sun was out - beautiful. We just sat down, and it reminded me of the afternoon we spent in the yard. We didn't really talk, we just sat together and enjoyed the sunshine before his next appointment.

Next we met with Dr. Kupferman. Dr. Kupferman is Patrick's Head and Neck surgeon. I thought that he was the lead surgeon on Patrick's case, but Dr. Lavine his neurosurgeon is going to be in charge this time. The meeting with Dr. K was pretty short. He talked about his role in the surgery as a support person for Dr. Levine, and that he would be doing some of the reconstruction. He said talked in a little more detail the risks involved with the incision on the side of his nose. He said that the scars from both the scalp incision and the one by his nose would heal very well, and that they would more than likely not be very noticeable at all, which I think made Patrick feel a little better. We signed more consent forms, and they asked if he had blood banked for him for his surgery. We didn't even know that was an option. I of course ask if I could go give blood right then, and have it for him just in case. (We don't have the same blood type. Patrick is A+ and I am O+, but O is the universal donor, I was ready for the needle) They told me that even if I gave blood right then, it wouldn't be processed and ready by Monday. I used to give blood regularly, but I haven't in a long time. I decided not to give after my seizures got under such good control. I figured I wouldn't rock the boat. There were more forms, and we were off to anesthesia consult.

Just like last year, anesthesia was packed and loud. We hadn't waited more than 15 or 20 min. all day - until then. After about 45 min of waiting, we were taken back and met with the anesthesiologist. He asked Patrick some generic questions about drug allergies and that type of thing. They gave us the short rundown of possible complications on anesthesia, and that was it. The day at the hospital was done. We stopped for a quick bite to eat, and then we went back to Krista's for a nap. Before bed we even got to video call home and talk to Cameron. It was so wonderful to see her. She sang us Jesus Loves Me, and she told us the recipe for grape drink - "sugar, purple, and water." It has only been a few days, but I miss her so much. Patrick does too.

MD Anderson Cancer Center is like an enormous melting pot. There are people like Patrick that don't look sick at all, and then there are those that look as weak as water. There children with shiny little heads running laughing and playing around the fishtanks in the lobby; and there are women wearing colorful headscarves. Today there was a particular man that caught my eye. He had deeply sunken eyes, slightly jaundiced skin, and he shuffled more than walked. He escorted his IV stand which hung heavy with bags of fluids through the busy lobby. He was tall and thin, and his hair was patchy at best. Don't ask me why, but he reminded me of the apple tree in my mother's yard. When I was 7 years old Hurricane Hugo nearly pulled the tree out of the ground. It lost a number of branches, and it still leans to the left, but after a few years of healing, it started bearing fruit and has for 20 years. This man was that apple tree. His branches were weak from the storm he was battling. His bark was tattered, and his leaves had long since let go, but he was still standing. I am sure it may be a while before he is able to bloom and bear fruit, but he is still standing. I only saw him for a few moments, and we never even made eye contact, but he will stay with me.

The old, the young, the weak, the strong … all in the battle of and for their lives. In spite of the many weeks I spent roaming this building last year, I still feel like a stranger in a strange land.