Last week the kind doctors at Hospital B performed a biopsy on my thyroid. I have never done a biopsy before, and I wish to never do one ever again. However, I don’t think I’ll escape that. And you’ll find out why in a bit.
If you’ve been on the internet long enough, you’re probably familiar with these two phrases:
- You’re now breathing manually
- You’re now aware that you’re blinking
And just like that, you have become aware of two parts of your nervous system that are highly automated and that you’re usually not aware of. That is, until someone lets you know all the things it’s doing.
The same goes for me, I am human after all, so when the doctor told me “do not swallow” as he was sliding needles into my neck to get a good sample of cancer juice, there was more swallowing than in Japanese gonzo porn. If you are not familiar with the genre: there’s a lot of swallowing.
“Every time you swallow, the needle comes out,” the doctor said, prompting me to swallow once more. I figured I would let him know I had to swallow so he could brace for impact. And secretly I was hoping he would use this information not to accidentally pierce my carotid artery. “It’s OK Brian. Swallow as much as you want.” I could hear the defeat in the doctor’s tone. “Do you always swallow this much?” No, only when people tell me not to swallow.
Getting your thyroid stabbed is an unusual experience. It’s done under a local anesthetic, so you’re not supposed to feel much—that is, if you don’t swallow. If you do swallow, you will feel it. A lot. You know that feeling when you take a bite from a piece of bread, and parts of a particularly sharp crust get stuck in your throat? Meanwhile, an increasingly frustrated Arab man—not that that matters—presses on your throat? This is the best description I could give of my experience. I left looking paler than I had ever seen.
With two ice compresses around my neck I drove home. Driving in the UAE is not for the faint of heart. A country with a large expat population, some hailing from countries with questionable licensing infrastructure, indicators are barely used, the right of way does not exist, and more than once will you be cut off by a large SUV who realized 50 meters before his exit that the left-most lane does in fact not allow them to exit, but exiting they will, at the expense of everyones safety.
Neck dexterity therefore is a must, although my fellow drivers seem to disagree, and with my neck basically immobilized I drove home asking the various deities I had revisited since my cancer diagnosis to bring me home. It would be on-brand for me to die from a car accident on the way home. But I made it home. Perhaps there is a deity presiding of my journey in life after all. Exhausted from the biopsy I slept and woke up a few hours later. The day progressed normally as many have since the day I was born.
The next day I got a phone call from the hospital. Left side is clean. Right side is papillary cancer. OK. My left side has lymph nodes involved. Although not unusual to have those affected by cancer too when the thyroid is involved, I would prefer not to have cancer there. So, what’s next, Doc? I realized I must have sounded like AliExpress Bugs Bunny. “You have two options,” the doctor said. “One is, we do what is known as active surveillance. This means you come back after 3 months to see how the tumor is growing. The second option is we take out your right lobe.” Those are two very different things. Watch the cancer grow? Does that make sense? It does not sound like it makes sense. “We think it’s a low-risk tumor. It doesn’t seem to grow. The operation is a major surgery and not without the risk of complications.”
Low-risk cancer. Cancer, the low-risk kind. At first I felt concerned, similarly to how Hospital A has treated me. It felt like they were not taking me seriously. Then I started Doing My Research™[1] and read about the surge in thyroid cancers. Or as one paper put it, the rise of detection of thyroid cancers. As imaging technologies increase and become more prevalent, the detection of cancers that previously went undetected would naturally rise. Now, Japan and Korea are the pioneers of waiting and seeing. They’re so good at it that they wrote a paper about waiting and seeing when it comes down to thyroid cancer. In some cases, when the tumor is small, they measured, doing nothing will have the same result as doing the surgery—but without the risk of complications. So that covers my case. The only downside? Checkups every 3 months, perhaps at larger intervals later. The plus side? No need for medication, no need for major surgery.
I’ve been thinking since I got the results of the biopsy, together with my wife, on what to do. There is one major asterisk that should be mentioned. Thyroid diseases run in my family. My father has Graves. My half-sister has Hashimoto’s. Especially Graves is an indicator that cancer is more likely to progress compared to people without it.. For now, it feels like I have more breathing space. I can take my time reading up on the latest papers in the exciting world of oncology, and I can ask around multiple doctors and hospitals what their opinions are. Because I might not be in the UAE in 3 months, I asked my doctor to write me a referral that I can use in Japan. Or at least, I hope I can use in Japan. Since wait-and-see was invented there, I am not sure if these doctors will recommend anything different.
Cancer sucks. But it seems that whatever is brewing in my thyroid sucks less than others. In a way, I feel guilty. Or maybe conflicted. Or maybe I just want to talk about it? Barely three weeks ago I had a friend pass away from colon cancer. In January the mother of a friend passed away from lung cancer. In both their cases it had metastasized. And here I am with my cancer that’s so harmless, apparently you can “wait-and-see.”
I guess for now, that is what we’ll do.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC7042648/