Wednesday, September 01, 2004

Interesting is a curse.

God and I are going to have a little come-to-Jesus meeting.

I found out Monday morning first thing that the intelligent, polite, charming 21-year-old man I took care of prior to his brain surgery had a metastatic tumor, not a primary tumor as we'd hoped.

Quick definitions: "metastatic" means "arising from somewhere else in the body." "Primary tumor" means "started wherever it is and might go somewhere else if it gets the chance."

Metastatic brain tumors are bad news. Because of the way the body works, the brain is segregated from the rest of the body by something called the blood-brain barrier. This is, in short, the thing that keeps you from getting an infection in your brain every time you get sick. It's very difficult for critters, viruses, cancer cells, and drugs to cross the blood-brain barrier (with a few exceptions that I won't go into here).

See, cancer loves the brain. The brain uses pure glucose for energy--nothing else. A PET scan, in which slightly radioactive glucose is injected into a person's body to show the areas of high cellular activity, will show the brain and various glands as bright white. That means that there's a whole lot goin' on in those areas. It'll also show cancerous tumors as bright white. That's because cancer cells are normal cells with their inhibitions removed: they reproduce and use glucose at phenomenal rates.

If a cancer cell gets into your brain, it's in heaven. No immune response to speak of, nice soft tissue that won't keep it from forming a tumor and expanding, and all the food it wants. It's a tough trip to get there, but once you're there, man, you've got it made.

So this fit, handsome, charming young man has cancer *somewhere* (we don't know where) that's gotten jiggy enough to move into his brain.

And this is patently unfair. Mean people, I've noticed, tend to live for damn near ever with very few problems. The good ones get shafted.

Still, the fact that this kid is healthy and fit and has a loving family and a wonderful girlfriend works in his favor. I am remaining resolutely optomistic and refusing to believe that he won't get better. So many of our patients *do* get better that it's hard to take when one doesn't. I am therefore avoiding pessimism.

But God has got some explaining to do, and I hope He's ready.

Other things I'm avoiding

I'm avoiding replying to an email at the moment because I haven't found quite the right casual, insouciant tone to use in it. It's one of those emails that could be the fuse to a powder keg, and I don't want things blowing up in my face. Not in a bad way, you understand, but in a complicated way.

I'm avoiding thinking about how hard it is to get used to not being constantly off-balance. For years I was off-balance on a regular basis--not in a bad way, but in a challenging, interesting way. Things have settled down and gotten peaceful lately, and it's a bit tough to get accustomed to.

I'm avoiding wondering why creditors are calling my phone number looking for other people. With my luck, my identity has been filched and some bad guy is running up tons of debt buying junker cars under my name.

And, right now, I'm avoiding cleaning house.

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