Our dad had his first post surgery visit with Dr. Krishnan today. Prior to his appointment, our dad has a Chest Xray, and then proceeeded to his scheduled visit. He met with Dr. Krishnan's Nurse Practitioner, Kristin, first to briefly discuss how he has been doing since his discharge. Kristin is warm and positive with our dad. She remarks that our dad looks good and reminds him to continue to challenge and strengthen himself with activity, including his physical therapy exercises. Kristin then removed our dad's sutures from the chest tube incision.
Dr. Krishnan enters soon after and launches into his perspective on our dad's Chest Xray. He comments that it has improved a lot, but is not perfect yet. Dr. Krishnan explains that our dad's lower left lobe had a significant amount of scar tissue from his heart surgery in 2000 and as a result, he likened the view of his lower lobe to a "tight knot." Our dad's continual and frequent exercises with the incentives spirometer and flutter valve, along with increased activity--walking, deep breathing, coughing, etc.--ought to help 'loosen the knot,' open up and clear that lobe for optimal function. Dr. Krishnan remarks that our dad's oxygenation seems quite good. He removes the oxygen and wants to 'test' his level without oxygen during activity. He sends our dad and Kristin for a walking test. Our dad's O2 remains in the mid-high 90s. As a result, Dr. Krishnan tells our dad he may use the oxygen "as needed" for the interim until he sees Dr. Nadeem on Friday for further instructions. This, definitely, was a positive development. Our dad was visibly pleased.
Dr. Krishnan also offered us the opportunity to see images of our dad's lung, tissue, ribs, and, of course, tumor, from photos taken post surgery. Our dad seemed very interested in seeing the photos. It was amazing to listen to Dr. Krishnan explain the contents of each slide and show us the tumor from different imaging perspectives. Dr. Krishnan obviously loves his profession. Fascinating to me was his eagerness to share and articulate as multidimensional a picture as possible for our dad his disease. The opportunity to see his tumor gave our dad and us an incredibly concrete visual of this insidious enemy and how it had invaded our dad.
Dr. Krishnan and Kristin wish our dad further strength in his recovery and schedule another visit in one month for another Chest Xray followup.
The next visit, with the oncologist, Dr. Treisman is scheduled for 3:30, though as we wait for our dad to be called, we learn that scheduled appointments rarely follow "schedule." Our dad, already nervous for this appointment, becomes increasingly anxious and frustrated that we are not seen. Finally, over an hour past his scheduled time, we are seated in a room. Dr. Treisman comes in and begins to talk about the chemotherapy recipes that are used with our dad's nonsmall cell lung cancer, naming each drug and talking about the combination "recipes" that can be chosen. It is overwhelming for us, as patients, to listen to these foreign names and follow as Dr. Treisman speaks of combining one drug with another, and offering perspectives on the merits of choosing drug B over drug C. He explains that this portion of chemotherapy followup is recommended for patients whose tumors have been completely resected as an added measure to prevent recurrence. He suggests that the research indicates more favorable outcomes for patients who undergo a short course of chemotherapy post surgery over those who do not have chemotherapy. It is unclear that precise difference, but it is clear that chemotherapy is strongly recommended. This "recipe," as it is called, will be followed in a course of 4 infusions, once every three weeks, beginning in approximately 3 weeks.
Dr. Treisman continues by adding that a national Reseach Evaluation Study "E1505" is currently underway and recommends to our dad to add this chemotherapy element to his course. This added component would extend his chemotherapy, as it would include a specific number of infusions for the next year. Dr. Treisman explains that he really likes this drug and believes it is tolerated well by patients. He suggests that our dad would benefit from participating in the study. He sends us home with a 28 page consent form packet that discusses the treatment drugs, their potential side effects, and other basic information to consider before proceeding the chemotherapy course.
Our dad seems emotionally drained by the day's end. Despite knowing that chemotherapy was an almost assured inevitability, he still remarks that he had "hoped he would not have to go through chemo." Chemotherapy seems ultimately scarier and more daunting than the excruciating pain of even his surgery. He is quiet and accepting during his appointment with Dr. Treisman, but (to me) seems upset over this next step. Dr. Treisman's professional style and personality are markedly different than Dr. Krishnan's. While we have the reminder of Dr. Treisman from our dad's sister, Rose's, experience (and her deep affection and adoration of him), he is nevertheless new to us. This relationship is new, scary, and will take time to develop, we agree. Everyone we talk to seems to love Dr. Treisman and think he is fabulous. We trust these testimonials. As we look ahead, we must begin to put our faith in the process and help our dad see this future with optimism and light.
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