Not a reference to the iconic television series of my youth, but there was "danger," Ken Lourie, and it wasn't caused by Dr. Zachary Smith nor by "robot," (Robbie) either. And it wasn't a conspiracy. It was simply a confluence of absenteeism by my health care providers. Both my oncologist and internal medicine doctor were absent with leave and yours truly was caught in the crossfire, so to speak. Let me provide some context to help you appreciate my dilemma.
I have chemotherapy every six weeks. Accordingly, I have lab work the Wednesday before the Friday to check for anomalies, anomalies which over the years have occasionally delayed my infusion by up to two weeks waiting for my body to settle. In the early days of treatment, my white blood cell count was crucial; too low and no treatment; too high, it was never too high. No treatment and the cancer was left unchecked. An incredibly stressful occurrence when your treatment is stopped. Whether or not a week or two delay ultimately mattered in checking the cancer, it certainly mattered - emotionally, to the patient. You feel adrift, sort of, which is exactly how I felt during the first two weeks of January.
Typically, what my current lab work presents is my creatinine level and the associated glomular filtration rate, measuring kidney function/efficiency. After nearly nine years of infused toxicity, I have suffered some collateral damage to a major organ. My oncologist and internal medicine doctor are incredibly sensitive and concerned about this damage. Per these results, every medical decision made concerning me; from prescriptions approved to "normal" internal medicine stuff to whether I get "contrast" when I have my scans and MRIs to what chemotherapy drug I infuse and how frequently its infused, is decided with my kidneys in mind. Nothing happens medically until my kidneys sign off on it, if you know what I mean?
As it happened, my creatinine level for my January 12th infusion was higher than usual. When this measure occurs, I know to call the Infusion Center and ask the head nurse if I should come in for treatment. She will contact my oncologist and with his direction, will advise me what to do, except for this week. My oncologist was away and though another oncologist - whom I've never met, was covering, I'm not really sure she knows enough about my situation. Specifically that I'm a bit of a special case, per my oncologist's own characterization of me, and I've never gone seven weeks, let alone eight weeks without treatment. Delaying my infusion would break a multi-year precedent. In fact, around the holidays when I asked my oncologist if I could extend my infusion interval from six to seven weeks (to accommodate life), he emphatically said "No." Moreover (to complicate a covering physician's decision), my oncologist has also told me that if I were a new patient with creatinine levels as chronically high as mine, he wouldn't/couldn't treat me until those levels reduced.
So not only was I in the middle of an unprecedented one to possibly two-week delay in my infusion, but I also needed an oncologist - who I don't know and who doesn't know me, decide/make an exception/maybe risk her medical license (if something were to happen to me), to authorize treatment for a patient whose creatinine levels fall outside of protocol, and me not having either of my two primary-care physicians available for consultation. And other than the default emails advising that both were out of town, I had nowhere to go and no one to turn to. Heck, I might as well have been on another planet, given the limited choices I had.
"This column is my life as one of the fortunate few, a lung cancer anomaly: a stage IV lung cancer patient who has outlived his doctor’s original prognosis; and I’m glad to share it. It seems to help me cope writing about it. Perhaps it will help you relate reading about it."