Losing Bodily Organs

Because of the pernicious and persistent growth within my body (see previous post), I must undergo major surgery. The surgery should excise the growth, the carcinoid tumors, but the process will entail some incidental casualties. I’ll probably lose some organs and parts of organs. These are organs I have little understood and formerly gave scant thought to as they labor ceaselessly in the murky obscurity of my abdominal cavity. Now, with their loss imminent, my attention belatedly turns their way. I’m thinking of my Appendix, a portion of my Ascending Colon, some Lymph Nodes, my Mesentery Structure, my Gallbladder, and possibly some fragments of Liver (I’m treating these organs’ names as proper nouns because right now I feel like personifying them). For decades, these organs have toiled ceaselessly on my behalf. My disregard of them is perhaps testament to their amazing functionality and ceaseless labor in the task of keeping my innards well and happy. Before they suffer injury or perish in the tumult of my upcoming surgery, I would like to acknowledge their yeoman service.

Dear Appendix, you dark and secretive cul-de-sac hanging off the junction of my small and large intestine. Your purpose seems to remain largely unknown, even to medical science. Some call you a useless vestige of a bygone stage of evolution, but I know different. Surely you serve a purpose, though it may be elusive. The evolutionary process either repurposes or prunes away unneeded body parts, useless organs are not retained. Your presence as nothing more than a defunct relic would not have been endured all these millennia, especially since you sometimes cause trouble—and (let’s face it) trouble is what you’re mostly known for. But recently I’ve learned that one role you may likely play is to maintain gut flora during times of extreme illness. The idea is that, when sickness purges most of the gut’s beneficial bacteria, you serve as a refuge for a remnant population, which later restocks the intestines. If that is so, then I’m glad to know that you’ve been there for me all these years, even if I never needed that particular service. An even more veiled function of yours may have to do with immune function as a component of the lymphatic system. Although I don’t pretend to understand this, I can appreciate you for it nonetheless. So, thank you, Appendix, for whatever it is you’ve been doing within my dark recesses. You’ve given me no trouble, and I’m sorry to see you go. I will miss you, if for no other reason than just knowing that, like a good friend, you’ve been there for me year after year.

Ah, dear Ascending Colon, passing upward on the right side of my abdomen. I know your purpose—or part of it anyway: to extract moisture from the waste coming out of my small intestine. It’s a vital role, and I always thought I couldn’t live without you. So it was quite a shock to learn that you would have to go—at least part of you, probably most of you. I couldn’t believe it when the surgeon told me I’d be losing you, and it was even more astonishing to hear him say that the rest of my colon will learn to compensate and that, after recovery, I’ll likely not even miss the absent section. But I will miss you. And what will fill the gap—I mean physically replace the missing section? Answer: the surgeon will just stretch the small intestine up and stitch it onto the remaining colon. Incredible! I still have trouble picturing this, but so it shall be.

And Lymph Nodes, dear cute things (though I’m not sure what you actually look like). Such a pleasant-sounding name. And what is it you’ve been doing all this time? Well, I know it’s complicated. You’re part of my lymphatic circulatory system (distinct from that more renown circulatory system of blood). Perhaps I’ve not fully appreciated your vital role in the operation of my immune system, but I’m pleased you’ve been there all this time. I’m also really glad there are so many of you, and, though I stand to lose some of your number, I’ve been assured that others will remain to pick up the slack. I’m sorry that the malignant old carcinoids are so attracted to you. And though I’ll carry on without those of you who go, I’ll miss you and always be grateful for your service on my behalf. Thank you, Lymph Nodes, one and all.

And what about the Mesentery Structure? Honestly, that’s a new one on me. I’m just getting to know about you. My understanding is that you’re basically the tissue connecting my intestine to the abdominal wall. You’re also the home to the Lymph Nodes I’ll be losing, so you’ll also suffer some indignities. Well, Mesentery, I’m sorry for the trouble, and I’m not sure how this will come out for you. You’re strong, no doubt, and we’ll tough it out together, even if we don’t come out whole. Thanks for holding on.

Dear Gallbladder, you mysterious (to me) sac of fluid. When I thought of you at all over the years it was only in vague terms; you were just part of the general mess of nondescript viscera. I’m sorry to say that, until recently, I didn’t even know where you were—tucked into the folds of my Liver (whose location I also wasn’t quite certain of). I knew next to nothing about you—only that you stored bile and sometimes got clogged with “stones” that give old people pain. Well, you’ve never given me any pain. In fact, I suppose you’ve been doing your job well and are continuing to do so. I now know that your job consists of storing and concentrating bile produced in the Liver and sending it on to the small intestine as needed for digestion. I suppose some of those gurgling noises I’ve heard coming from my belly region were really you squirting your bilious juice in just the right amounts into my digestive tract. Oh, I know they say that I’ll get along fine without you, that the bile will be delivered anyway, and that other components of the system will learn to compensate for your absence. They say I won’t miss you—but I will. Call me sentimental, but I already feel your loss. I’ll sacrifice you, so that I may go on living, and that’s just the way it is, because, if you stayed, you’d be in danger of getting clogged as a side effect of the medicines I’ll need to take to maintain my health. It’s a cruel thing, and I’ll grieve your passing. So, thank you, Gallbladder, for your excellent service over these many years.

And my Liver—oh, goodness! I never thought you would be touched, but touched you already are. Apparently the carcinoids have gotten to you, traveling there via the lymphatic highway. The hope is that there are just little spots on the surface, which the surgeon can just scoop out. He says that the nature of carcinoid tumors is such that this can be done. And though some chunks of organ will be lost, the damage should heal over, and all should be well. That’s the hope, anyway. Still I’ll likely have to receive periodic octreotide injections from here on out to hold any remaining slow-growing remnants of the disease at bay. It’s a gritty hope, dear Liver, so hang in there. Thanks for your good work, and I look forward to having you around and functional for a good long time to come.

I have trouble imagining this looming somatic cataclysm. So much will be rearranged, remodeled, and removed. Perhaps I’m hindered by my tendency to think of the organs involved as individual entities, to anthropomorphize rather than regard them simply as components of a whole, one beautiful organism—me. But I can’t help it. In fact, I could go even further; I could consider the individual cells. Thank you, myriad Cells that comprise my organs and devote yourselves each to your particular minute process. Thank you for your steadfast service. I mourn your demise. Silly as that may sound, thinking this way comforts me. I contain multitudes, and I care for them all. Can I really lose so much of my insides and still live a normal life? The eminent surgeon has said it is so, and I’ve decided to trust him. Still, it’s mindboggling. It’s distressing. I hope this all works out. I hope all these sacrifices are not in vain, for my body already aches. I’m frightened and also hopeful. I’m trying to come to terms with all this. It seems I’m about to undergo a metamorphosis and be forever changed. But perhaps, when the ordeal is over, I’ll look back on it and regard the makeover of my insides as not such a big deal. Whatever the outcome, right now I’m here with these apprehensions and thoughts of pending loss.

Carcinoid Comeback

Basic Story
On December 20th, I'm having major surgery at Oregon Health & Science University (OHSU) in Portland. I have a slow-growing form of cancer called carcinoid tumors and the related syndrome. It's spread in my body, and some intestine and other stuff will probably have to come out. Depending on the extent of what the surgeon (Dr. Rodney Pommier) finds once he gets in there and starts mucking around, I will probably be 5 to 10 days in the hospital. Leela will be there with me (I'm so grateful for her!). My surgeon believes that, even given the most extensive scenario, after a few months of recovery, I should still have a fully functional digestive system and not be limited in my activities. Hearing this astonished me, considering the breathtaking scope of the pending procedure. And, most encouraging of all, the cancer will likely be, if not cured, in abeyance for the long term. Meanwhile, I'm apprehensive and, yes, frightened. Fortunately I am currently pain free and feeling well, and my activities aren't limited. My only symptoms are frequent facial flushing (which some of you may have noticed, since it's been going on for a while), transitory dark-purple splotches on my forearms (which I normally keep covered), and some minor intestinal distress. I'm glad to discuss this with anyone.

More Details
About 11 years ago, I had this same kind of tumors I in my small intestine, which nearly killed me due to internal bleeding. At that time, 40cm of small intestine was removed. I recovered quickly and have, until recently, remained symptom free, so I thought I was pretty well done with it.

Alas, that was not so.

This year my annual blood test revealed an elevation of a telltale marker. This prompted my oncologist (ever the cautious one) to have me undergo a series of scans. The final scan turned up a ~2cm mass in the tissue that connects the intestines to the abdominal wall (the mesentery). He thought this could probably be removed through a small incision in my belly button (like last time) and the process would be pretty simple. So he sent me to Dr. Rodney Pommier at OHSU in Portland, who happens to be the West Coast's premier expert on carcinoid cancer (a specialty among specialties, it seems).

"Not so simple," Dr. Pommier said as Leela and I sat in his exam room on October 5th. The presence of the cancer in the current area indicates that it has most likely spread. The mesentery structure is dotted with lymph nodes, and the lymphatic system can act as a highway for cancer cells. Major exploratory surgery is necessary. Carcinoids are fairly slow growing and, in some other ways, unlike other forms of cancer, but it can still do you in. It could be in my liver or the ascending portion of my large intestine or both. This time I don't have the intestinal bleeding, though I do have the rather benign symptoms mentioned earlier. The surgeon will cut out whatever needs removing during the same operation as the exploration. The procedure is booked as a "diagnostic laparoscopy, intraoperative ultrasound liver, bowel resection, possible cholecystectomy, possible liver debulking." I'm glad to talk about this with anyone. I think it helps to talk.