Barbara was released from the Sloan-Kettering hospital on July 13th following her exploratory brain operation. She was given sheets containing hard-to-read instructions for taking her medications and some printed further information. Included in this were appointments with her surgeon, Dr. Gutin, (12:00 at the 53rd St. Campus of S-K) and with the oncologist, Dr. Omuro, (2:30 at 53rd St.), both on July 20.
We arrived on that day at 11:45. The receptionist had us down for a 2:30 with Dr. O. but no record of an appointment with Dr. G. She called Dr. G.'s office at the 67th St. campus and were told to come to 67th St. after we had seen Dr. O. When we were finished with those appointments it was nearly 5:00 and a call to Dr. G.'s office revealed that he was out of town and that, in any case, it was too late to accomplish our main purpose in seeing him, which was to have the staples removed from B's head. Were told to come back the next day. Fortunately, the waiting room at 53rd St. stocked small cans of juice and pretzels to keep us going while we awaited our oncological experience. That began shortly before 2:00 with the checking of vital signs. (B had already filled out some pages of forms with information, most of which is undoubtedly in the S-K computers.)
Then in a pleasant examination room we saw a series of people of whom I can mention only a few. Dr. Nayak (I am not sure of the spelling since she mentioned only her fi rst name and the papers with her full name on it are on some prescription forms that are no longer with us) came and examined B, checking the usual things that might reveal the state of her brain. (She was accompanied by a trainee from Paris where Dr. O. has some connection.) She explained that B has a tumor that is mostly grade 2 but with an admixture of grade 3. (On July 8, after the first look at the tissue from the biopsy, Dr. G. had already said that she has a glioma of grade 3. In a later discussion he mentioned that it is an astrocytoma, that is, a particular kind of glioma.) Dr. N. said that they would treat this tumor like a grade 3, in any case. As the literature we were given encourages the asking of questions, I asked how one distinguished grade 3 from grade 2. `Mitosis' she replied. When I tried to probe further, she told me what mitosis is. Dr. N. explained that the course of treatment would include radiation and chemotherapy. The chemo comes in pills nowadays and the one intended for the first treatments is a standard one for these cases. She also detailed the horrors of the possible side effects of the treatments. Although B has been bad shape till now, she hasn't seen anything yet, it appears. I also asked what kind of radiation would be used and was told that it would be concentrated radiation. I pressed a bit for more details and was told to ask the radiologist.
We were then left on our own for a time. In a little while, a nurse came in with prescriptions for the medication to accompany the radiation therapy. He kept expressing the dosages in meters2. He said the figures were based on the height and weight of the patient. I asked why one used units of area for medical dosages but got the usual kind of look that my questions usually produce in such places. I said there was no doubt a formula for this quantity and he agreed. But when I asked to see the formula he stonewalled me. I guess that it is easy enough to make one up if we assume most people have about the same density but I wanted to see if I could figure out why they use areal units. A bit later, Dr. O. came in and introduced himself. He was accompanied by Dr. N. He told us that B has a glioma of grade 3 with an admixture of grade 4. (He used some other word than admixture.) When I mentioned that Dr. N. had said grade 2 was the predominant character of B's tumor he explained that it was probably because the tumor is heterogeneous and that the tissue from the biopsy must have been predominantly grade 2. Dr. O.'s manner did not encourage questions so I did not ask how that jibed with Dr. G.'s assessing the tumor at grade 3 from the same tissue. He too went into the nature of the treatment and the nasty side e ffects that might arise. I asked what kind of radiation would be used. `Photons,' he explained. I suspect that my response seemed incoherent. (Actually, I gather from reading that they grade the tumors on the degree of abnormality of its cells.)
Other people came and went in the course of our three hours in the examining room including, at the end, a doctor whose name I did not get. She seemed to know something and when asked a question she could not answer said she did not know such things. A refreshing conclusion to a frustrating afternoon. We are to go in for staple removal tomorrow (July 21). Today was the second time we have been given a wrong appointment time, so I am not sure what to expect, though I now know enough to call ahead.
I (EAS) am sorry that I made this such a dull story but my memory for detail has been damaged by the events of the past (nearly) three months. And I apologize for mass producing this message but writing an individual response to each inquiry over the past 3- months has sapped my strength.
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