The radiology tech waved me into his cozy dark room filled with bright screens. It’s usually off-limits to patients, but maybe he knew I was a local doctor and faculty member at Harvard Medical School, which can occasionally get me a backstage pass. With a smirk, he told me I should eat something, pointing at the air in my stomach on the X-rays he had taken moments earlier.
I’d had surgery to remove three metastatic tumors from my lungs just hours before, and every breath ended with a wince. Food was not on my mind, but the tech had made me smile — air in the stomach usually signals that the patient needs to burp, not hunger. I began thinking about the potential for a case report in The New England Journal — 34-year-old man with metastatic renal cell carcinoma needs a burp.
Back in my hospital room, my mind went to the last time I found myself in a radiology reading room. It was Jan. 19, 2018, and I was looking at my own CT scan images late on a Friday afternoon, self-diagnosing the emotionally incomprehensible image before me as kidney cancer just minutes before my primary care doctor called back with the results. I called my brother and kept him on the phone with me for as long as I could, and still it was the most alone I have ever felt. My doctor told me that the radiologist said it was Stage 3, which meant that it could potentially be cured with surgical removal of my kidney. There were tiny nodules in my lungs, but they were too small to say anything definitive about.
Within a week, an all-star cast of renowned experts in renal uro-oncology had removed my left kidney. I was told that there was about a 50 percent chance this cancer would never return, and I wanted to believe that. I knew the numbers: five-year survival rates of Stage 4 or recurrent kidney cancer, in the lungs for example, are under 10 percent, though improving every year with new treatments. If only I could stay at Stage 3, maybe I could put this all behind me and live the life I had always planned with my wife watching our little boy grow up.
In recovery from my initial surgery, I shared a room with a man whose face I never saw but who seemed much sicker than I was. From the noises coming from behind the curtain, he seemed to be in a lot of discomfort, wandering in and out of consciousness. I was recovering from a freak illness, I told myself, but this man was very ill — a different kind of patient altogether. He couldn’t tell that the blaring television was keeping me awake because most of the time he didn’t seem to know what was going on around him. Eventually I was discharged and got some rest at home, but I still sometimes wonder how he had fared.
In the year since that initial operation and recovery, I’ve begun to realize how much denial there was in my first assessment of that man. Refusing to believe that I might share his path may have been protective in the short term, letting me live this last year with love and laughter, work and play as though I could keep it up until my 90th birthday.
But my denial didn’t do anything to prevent the anguish I felt when my cancer sprouted a new nodule in my right lung 10 months later. It didn’t reduce the pain I felt finding out that those tiny nodules in my lungs at the time of diagnosis were cancer all along. Cancer patients usually attempt to maintain a positive attitude, and I appreciate how much better it is to do so than to be consumed by negativity, but no mind-set would have meaningfully muted the shock of my recurrence and the burden of having to tell my family that actually I’ve been in Stage 4 all along. We just didn’t know it.
This last year, I’ve lived more fully than ever before in my life, holding my wife and son tighter and saying “no” more readily to work projects and other demands on my time that wouldn’t enrich my life. I’ve learned to let life’s frustrations roll off me more casually, though the hospital parking garage still manages to make my blood boil. I’ve made sure to tell my family and friends that I love them.
No one can tell me with any certainty about what lies ahead. Will I be ready for it? These questions circle in my mind on an ever-present loop without resolution. I know that I can’t predict what comes next, but since my cancer recurred I have become committed to living in each moment and listening for clues about tomorrow.
In my recovery from last week’s lung surgery, I again shared a room with someone further along in his illness than I. While I have no access to the details of his case, the somber tones used by his doctors behind the curtain were telling. His treatments were not working. His cancer was advancing, and a new plan had to be formed urgently.
As with my last hospital roommate, I never saw this man’s face and we never spoke, but I feel immeasurably close to him, as though in some ways I know him better than my dearest friends. He heard me gasping for air through the night and yelping in pain as the chest tube got pulled, and I heard him trying to be brave for his family, reassuring them that they would go forward with whatever came next as best they could. I heard him speak in a reassuring voice to his children, only to hang up and weep loudly into the night until passing into a sleep from pure exhaustion.
Listening to him was like a kind of sonar, an echo bouncing back to me from my own future path, hinting at what’s to come.
When I was getting ready for discharge, I had the urge to pull the curtain and embrace him as he told me the secrets of what to expect next. I would ask how had he navigated the path from here to there. I would lay down the weight of uncertainty that surrounds my life and ask: What should I do now? How I can live with only a vague sense of dread of what’s to come as my guide?
But he could not have given me answers, just as no one could have articulated what lay ahead for me at other junctures, such as when I started medical school, became a husband and a father or at the time of my diagnosis. The next steps must be discovered in the journey itself.
Adam Philip Stern is the director of psychiatric applications at the Berenson-Allen Center for Noninvasive Brain Stimulation and an assistant professor of psychiatry at Harvard Medical School.