Milestone

October 21, 2024

Five years ago Saturday, October 19, a urological surgeon removed my left kidney at Sentara hospital in Woodbridge, Virginia. The procedure, performed with an advanced tool called the Da Vinci system, took six hours.

The kidney is the most complicated organ in the human body, packed with veins, capillaries, and channels that carry substances like myoglobin and creatine, products of muscle exertion, from throughout the body to the kidneys to be treated for removal. The kidneys are the body’s sanitation system.

The procedure is a ureteral nephrectomy, the standard for kidney cancer. If the tumor is located near the surface of the organ, the doc sometimes can reach in and snip it away. Your kidney will recover. If the tumor is a deep “renal pelvic mass” like mine, then no discussion, it comes out. The kidney is too complex and too dense for surgical acrobatics.

The Da Vinci system, which can be used for many minimally invasive operations, consists of a computer console, a sidecart with several interactive arms, and a 3D camera. The surgeon manipulates the arms, which are fitted with surgical instruments, to perform incisions, observing his work via the camera.

When you lose one kidney the other one takes over. Kidney care means hydrating, sixty ounces of water per day. I’m still trying to get that right.

It took more than a year to get to that October day. In June 2018 our family doctor did some tests, then sent me to the local urology practice. The urologist wanted more tests, which were no fun, no fun at all. Then he wanted an MRI.

I got the MRI at a local imaging place the morning we left on our cross-country road trip. A couple of hours later we were on the highway. We headed out on U.S. 50 from Woodbridge and crossed into West Virginia. That night we camped at a state park just east of Parkersburg, an old industrial town on the Ohio River. The next morning we drove into Ohio.

Three days later we crossed the Mississippi into St. Louis. We rode the elevator to the top of the Arch and looked out at the city. Then the cell phone rang. The nurse practitioner at the urology practice said they needed a biopsy. She gave me a week.

Instead of turning around and driving home in a bad mood, we pushed onto historic U.S. Route 66 just west of St. Louis. We followed the Mother Road through Missouri, Oklahoma, Texas, New Mexico, and Arizona. We camped and saw some interesting stuff: the World’s Largest Rocking Chair in Fanning., Mo., the Blue Whale in Catoosa, Okla., the Cadillac Ranch outside Amarillo. We took a detour to see Sedona, Ariz.

We left the van with daughter Kathleen in Las Vegas and flew home for the biopsy. Two weeks later we were back in Vegas. The kidney situation ended the road trip. We picked up the van and headed for home, but did stop to see the Grand Canyon, the Alamo, Galveston, and New Orleans.

I wondered, we all wondered. In June I had just finished an ultra-trail run. Sometimes after these things there’s bleeding. After a mountain race four months earlier I spent three days in a hospital with rhabdomyolysis, a condition caused by dehydration that stresses the kidneys.

Home from the road trip, the medical stuff took over. Cancer? I thought I was in pretty good shape. This was a “high-grade” urothelial carcinoma, which is one of the reasons folks lose kidneys. The surgery was set for October. Then in late September, the chest pain, the ER visit, the new diagnosis: “thymic carcinoma,” a mass in my chest. The urologist canceled the nephrectomy.

In December a cardiovascular surgeon at Arlington Hospital Center opened my chest and cracked my sternum in a mediastinum “resection.” He found the mass next to my heart and aborted the operation. “You need further treatment,” he said.  

Our son Michael, a radiation medical physicist, arranged visits with surgical and radiation oncologists at Penn Med in Philadelphia. My insurance didn’t work at Penn, we ended up at Virginia Cancer Specialists for 30 days of radiation and then chemotherapy, which flowed through a chest port. The radiation blasted my lungs. I lost weight. Then eight months of recovery.

October 19 arrived. Staff people wheeled me into the Sentara surgical space. Six hours later I woke up. Getting better included a couple of ER visits. I got acquainted with my right kidney.

A year later, in September 2020, we sold the Virginia house and packed for South Carolina. The day before the closing I saw the Virginia oncologist for the last time. “You need a biopsy ASAP,” he said. “We’re moving out of state tomorrow,” I answered. It was all I could think to say.

The doc said, “I have a med school classmate who ended up in Greenville. I’ll call him.” We shook hands, I left. We had the closing the next morning, then got on the road to the Palmetto State.

In mid-November PRISMA Health in Greenville called. The new doctor ordered the biopsy, a PET scan, an appointment with a surgeon. Before Christmas I was in the operating room.

It turns out that the 2019 nephrectomy did not go smoothly. Urothelial carcinoma cells migrated and reconstituted along the ribcage. So another operation, another month of radiation. A year flew by. In late 2022 a scan found a recurrence of the thymic carcinoma in my liver and pleura, the lining of the lung.

The doc assigned a year of immunotherapy. No progress. In January he switched me to oral chemo, six milligrams, or two pills per day. I keep a chart, most days I remember to take them. A CT scan this week will show what’s going on.

I recall: October 19, 2019 was crisp, cool, clear. From the hospital room window the sky was an iridescent blue. I shifted in the bed stiffly. The temporary stent stung when I moved. Five days later I was out of there.

I’m doing better with hydrating, not easy. So far, Mr. Right Kidney is OK. Still getting out to trails.

We may look back on five years, any five years, as a rush of moments of joy or regret, some we create, others are created for us. With cancer there’s no choosing. We become witnesses, seeking meaning, understanding. We learn, we persevere. We move on.