Thursday 11/9 - pre-surgery consultation

Today we met with my surgeon, Dr. Morris. Here's what we learned:

• The surgery will start early next Wednesday (the 15th) and will last about 12 hours. After putting me under anesthesia, Dr. M will make an incision from the back to front, remove a large chunk of my hip (left ball and socket and some of the wing), insert a similarly-shaped piece of cadaver bone, add in a metal hip replacement, and fix it all up.
• Surgery Type - This ("allograft") surgery has the highest chance of being functional and durable for many years, as compared to the fully-metal-hip or flail-hip options--but even this is expected to be fairly weak: I should expect to have another major surgery if I live a normal-length life. The downside of the allograft option is a somewhat higher risk of infection, but Dr. M did recommend it since I'm low-risk in most other ways (young, light-weight, non-smoker, etc.) and have many hopefully-hip-using years ahead of me.
• Risks - Dr. M is optimistic but, as it's a major surgery, she did warn us about some of the serious risks involved (from most to least likely): femoral and sciatic nerve damage, nearby organ damage, hemorrhage, and death. Death during surgery is very unlikely (~1% chance).
• Recovery - The recovery in the hospital sounds grim: I'll have lots of IVs and icky tubes hanging out of me, likely an epidural to block pain through my spine, and likely ~2 weeks like this until I'm released for less-intense recovery at home. And that's best-case scenario!! If there are signs of infection (which happens ~50% of cases), they'll go back in and operate which could delay things further. This becomes a tricky balance, though of course, because it's also important that I get back to chemo. Oy! Luckily, at least, I do believe I'm in very good hands so I trust we'll manage any unexpected turns as best as possible.
• Results - About a week after the surgery, we should get a final pathology report. This should first confirm that the tumor's all out ("negative margins") and, secondly, tell us how much of the removed tumor was dead vs. alive ("% necrosis"). We hope for a high % necrosis because this means that the chemo has been effective in killing the hip cancer cells, i.e., likely killing smaller collections of cancer cells elsewhere in my body too.
• Next Steps - If all goes well and signs of infection are low, I'll return within a few weeks to the chemo regimen--with about 15 more weeks of treatment left to go. By the time treatment is over, the chance of surgery-related complications is much lower, but they continue to monitor how well the cadaver bone is mending with mine and, in some cases (~25%), there is "delayed union" which requires follow-up operation. Even in best-case scenario, I'll also need to continue using crutches (or a wheelchair) for about a year after surgery.

This was definitely a lot to absorb-- but after taking a long walk, I began to feel better. I wrote a poem inspired by that walk and I thought I'd share it, in case some of you might find comfort in that too:

1.

The tree that made me lift my chin

stood like roots reaching into the sky

telling of nature's great power;

I breathed in a big breath.

The red maple I didn't see coming

stood in the shade with a quiet brilliance

telling of nature's subtlety;

I breathed out quietly, slow.

The sycamore I spied through a gap

stood in a world far away, saying

yes, beauty is everywhere.

2.

And at last I reached the lake, 

circled by graceful tulip poplars

with their long, long wispy arms,

and I sat, still bearing a hardness; 

to the world, to the trees; 

and the trees stood still,

and the spring calmly bubbled.

It seemed my trust was shaken;

it seemed my trust might break;

but no, I realized then,

by the lake among the trees:

there is no hardness in me.

I am the sapling;

bending, not breaking.