The Busiest Week of my Year

Dr. Hugh Tildesley

This past week I looked forward to with some trepidation. It is by far my busiest week of the year. This year even more so as I met with Dan Renouf, my oncologist to discuss future strategy on Monday to start the week.

On Wednesday the week prior, I had had a repeat CT scan to compare with the images from a month prior, and later the same day a repeat biopsy of my liver for fresh tissue for genomic testing in the hopes of getting targeted therapy.

The CT scan was on time, the staff incredibly friendly and efficient. After the scan, respecting the fact I am an MD, they escorted me to see Dr. Chan who had my images from the previous study.I introduced myself and he was a little taken back that I was both an MD and the “patient”. He was very deliberate going over the comparative images.

In every disease there something I call the footprint. Is it deep, i.e. well established and likely to cause early and significant mischief, or light, less aggressive and likely to follow a longer and indolent course. In my disease with already significant metastatic deposits, there was a chance it could explode, making control difficult and unlikely. His interpretation left me room for optimism. There was no change in the original pancreatic lesion, the large liver met had grown slightly, the other satellite lesions little or no growth. I was not exploding.

The next test was a repeat liver biopsy. Under ultrasound guidance, repeated passes are made into the liver lesions to acquire tissue. Dr. Martin was very thorough in his explanation, even though I am a Doc and had had the procedure 4 weeks prior he described what he was going to do, his complication rate and how long he would be observing prior to my release. He was superb, slight discomfort with freezing but little else. He made 8 passes and with each one commented on how satisfied he was with the sample. It was a relief to have Deborah and Hamish on hand for support and company.

I see humour everywhere. The porter was a cheerful, whistling chap. He had a lot of miles on him. He took me back to my university days, when there was always a patron sitting alone in the corner of the tavern nursing a Molson’s 24. (Quebec remember). These guys generally sat alone but if you started up a conversation they would engage and stay engaged.

This guy took great pride in his driving skills. His turning technique made me feel that I was in astronaut training!

Astronaut training

The next porter had a different demeanor; same spin and sprint but a talker/philosopher clearly just visiting the planet.

I was lying on the gurney awaiting an ultrasound to determine if I could go home. He starting quizzing Hamish.

The conversation went like this:

Porter: What is the most precious time?

Hamish: Right now

Porter: No, the past is depression, the future is anxiety, so what is the most precious time?

Hamish: I don’t know

Porter: The most precious time is that spent with Hamish

The porter starts to walk towards the elevator

Hamish: I think there is a chemical leak in there

Porter: Maybe so, but it still takes us up and down. It’s a miracle

Hamish: It’s an elevator

A few days later I had further blood testing and the genetic tests I had done previously were back. Dr. Renouf reviewed all of this information. Both Deborah and Jim Russell were at the meeting, and at the conclusion I felt fully informed and ready to make a decision. I mused for 24 hours and have decided we will start chemo “ heavy” in early June. I have continued to feel well with my only concern being weight loss of about 5 pounds. I did not believe the scale, as if anything my belt was getting tighter!

First Round at Bandon

I have faced these situations in life before. Most notably when Butler and I had finished our opening tournament round. We both had played poorly and were dead last! Those who know us are aware that we live for competition. We looked towards one another to find out the next day’s strategy, and simultaneously said: “fire the caddy!” We thrived under the new guy, we nicknamed Psychologist Phil as he appropriately nurtured our emotions not our flawed swings. The last day of the 4 day tournament we were the medalists and finished just out of the money.

Your Fired

The new scale reads my previous weight; the old scale has been dealt with appropriately.

The rest of the week went fine. Wednesday was my usual golf game followed the annual Greek Gold plate dinner. Each year I remember my late friend and colleague and buy a couple of tables. There is a reverse draw for a luxury car, and 2 years ago we won $5K, which funded a trip to Pebble Beach. This year we were out with still 100 tickets on the board, still a great night.

Vlahos Lecturer: Dr. Dan Drucker

The next day we entertained Dr. Dan Drucker at Point Grey. A world-class scientist with a passion for golf. We partnered and relieved Russell and Butler of some blue bills. A small world as Jim Russell was an attending when Dan was a resident; both have had stellar scientific careers.

Dr. Bill Vlahos

That evening was the Bill Vlahos lecture presented by Dan, followed by dinner. Bill’s three sons and Father in law George Chronopoulos were the usual guests of honor. Bill would have been extremely proud of his boys!

The week finished of with our Diabetes Directors Seminar. Another successful meeting that has been going for 27 years.

My office hours will be adjusted as I will travel prior to starting chemo with side effects which are hard to predict.