Volume 182: Check Your Lumps.
Check Your Lumps.
tl;dr: It might save your life.
When this edition of Off Kilter arrives in your inbox, I’ll be under the surgeon’s knife. He’ll be removing a 2cm x 1.4cm tumor from under my left cheek. Then I’ll be waiting ten days to see if it’s cancer. If it isn’t, I’m one and done. If it is, I’ll go back so that he can rip my face apart before putting it back together again using Lego blocks made from the flesh of dead people. I genuinely wish I were joking.
Normally, I wouldn’t share such a personal tale, but I decided that if someone reading this is compelled to get a lump checked afterward, it might save a life. And, on balance, that’s an outcome worth more than a few unsubscribes to me.
I first noticed it during the pandemic when going to a doctor wasn’t an option. It was much smaller then. It didn’t hurt, so over time, I got used to it and forgot about it even though it continued to grow. I then spun an internal narrative that it wasn’t anything to worry about, just some cartilage that had moved around. After all, I’d been kicked in the face as a student thirty years ago, and my jaw had never been quite the same since. So, of course, it must be that. Right?
Only it wasn’t. It had nothing to do with that. It hit me like a tonne of bricks when I found out, and I still kick myself to this day about my own capacity for denial.
Don’t be me, people. Take your lumps seriously, immediately. Even if they don’t hurt, especially if they don’t hurt.
Anyway, it kept growing until, eventually, no amount of stubble or stubborn denial could cover it up. I knew I had to get it checked out, and the people I care about told me in no uncertain terms that I had to. So I did, and the past few months have been unmitigated hell. The most horrific period of my life so far. Without question.
First, I had an ultrasound, which was so poorly analyzed by whoever looks at such things that they said we should “consider getting a neck CT.” The tumor sits just under my left cheekbone, so a neck CT would have been about as much use as scanning my big toe. Worse, the lack of urgency in the diagnosis kicked the health insurance industrial complex into denial of coverage mode.
At that point, I just wanted to crawl up into a ball and have the world swallow me up. Fortunately for me, my wife is made of stronger stuff and took it upon herself to right this wrong. Sure enough, after several multi-hour-long calls over several days, a CT of my cranial bone was eventually authorized. Unfortunately, it was inconclusive. So, biopsy it was. I don’t know if you’ve ever had one of those, but it’s a distinctly unpleasant experience. But, you know, you go with it.
Then, joy! My results came back, and they said it was benign. Oh my goodness, what a day. I mean, I still needed to get it out, but at least it wasn’t going to kill me. Or so I thought.
My ENT said he couldn’t do the procedure. Too complicated, too close to the facial nerve, too much chance of him screwing it up and causing permanent damage. So he sent me to Yale to see their head of face and neck surgery. I must acknowledge that I have the great good fortune of living close enough to the Yale Cancer Hospital that this was even possible.
It took six weeks to get an appointment. When the surgeon and I finally met, his opening line was basically, “I know you think this is benign, but we took a look, and we disagree. We think it might be cancer after all, but it’s complicated, and we won’t know for sure until after it’s been removed. So I recommend ripping your face apart and reassembling it using cadaver tissue.” Now, while I admit to having taken a little creative license in the above, it quite accurately summarizes the tenor of his opening statement, immediately after saying “hello.”
I don’t know if any of you have ever faced such a circumstance, but I have to give myself some credit that at the exact same time I was processing the terrifying possibility of having cancer, I retained the wherewithal to interrogate him for the next half hour about my options, about the likelihood of this really being cancer, about my chances of it being life-threatening, and about what we might do to avoid having unnecessary surgery on the off-chance that it isn’t, actually, in fact, cancer after all.
So, why share all of these gruesome details with you now? Well, some of this is, quite frankly, catharsis by newsletter, and I desperately need the emotional support that entails. More on that in a bit. But more practically, this whole situation has taught me some things that I want you to benefit from in case this ever happens to you. Here goes:
If you find a lump, get it checked. It doesn’t matter how silly it might seem. Some cancers can grow so fast that they kill in weeks and months. I didn’t know that.
Many of the people who do this stuff for a living aren’t paying attention. You’re just an image or a data point to them. Most will never meet you, yet they dictate your future via diagnoses based on glances at ultrasounds, scans, and biopsied tissue. As a result, you must advocate for yourself. And be mentally prepared to do so, even when you’re emotionally at sixes and sevens. Having someone who cares about you, like a brilliant wife who smashes down walls on your behalf, helps.
Diagnoses can change depending on who you’re talking to, and sometimes, the recommended course of action might feel like what’s easiest for them rather than what is right for you. Don’t accept everything they say as they say it. Ask questions, interrogate your situation, take some time to think and reflect, get a second opinion if you have to (if you have the luxury of time), and work with them to find the path that works for you. And only agree to that path when you feel ready to.
Finally, as I alluded to earlier, there’s the emotional roller coaster that will shift you from the highest of highs to the lowest of lows.
I’m not going to lie. I’m scared. I’ve been scared for months. And I’ve realized that fear isn’t new to me. I’m almost 50 and just realized that my primary driving emotion since I was a kid is fear. Fear of failing, fear of being humiliated, fear of rejection, fear that’s just plain old fear.
But this was different. This was the fear of being dead. Fear of being mutilated. Fear of having a new face. Fear of having to learn how to talk all over again. Fear of not seeing my son graduate.
Rationally, I know these things are unlikely. Rationally, I know the most likely outcome is a straightforward procedure and then home the same day with a cool new pirate scar.
But nobody told fear that terror should be rational. So it isn’t. It’s toxic. It eats away at you every day. It makes you inconsolably sad. It makes you unconscionably angry, and sometimes it does both simultaneously.
As a result, I’ve spent what feels like all year wallowing in what I can only describe as a self-inflicted, months-long, self-absorbed form of emotional abuse. I was shaken to my core when my mother-in-law and a good friend both died within a day of each other right before I got the results of my biopsy. Then, after processing that, my father had to have life-saving emergency surgery (Thankfully, he’s now fully recovered).
And yet, in the face of abject terror, we must wear the mask of normality. Even when I’m terrified, and all I can think about is that I MIGHT BE DYING.
I started telling myself stories that maybe this was punishment for being a bad person. Maybe I am a bad person. Maybe this is me getting what I deserve. Maybe I deserve to die a horrible death from cancer. I started obsessing over all the times I’ve been a bad person. And all the people I’d been a bad person to. Over and over and over again.
It was exhausting, debilitating, horrifying. Thankfully, I’m not in that place anymore. But that dark place scares me. I don’t ever want to go back there, but now that I know it exists, I’m scared that maybe I will.
The biggest challenge has been the conflict that occurs when you hide blind emotional panic behind a mask of normality. Getting sick on top of the lump and requiring enough antibiotics to knock out a bull elephant hasn’t helped. I’m pretty sure my mental state drove that particular complication.
But no matter how normal we might appear, the terror can’t help but bleed through. Off Kilter has been sporadic recently because I just haven’t been able to bring myself to care. And when I do write, it invariably turns into a polemic raging against something, mostly because I’m raging against myself.
I screwed up a pitch because I wasn’t in the necessary emotional state to kiss the ring of some third-rate banker to get his business, which normally wouldn’t matter much, but I let down some good friends in the process and wasn’t able to bring myself to tell them why. Another friend came to me with a great opportunity to help build a potentially huge new business. And, well, I completely screwed that one up too. And probably the friendship in the process. It’s just so hard to get excited and to be present for anything and anybody when you’re absorbed by the sheer terror that you might not be around for much longer. It’s just constantly bleeding through.
So, why tell you all of this? Is there a point to be made? To be honest, I don’t know. I’m just exhausted, and I want this shit to be over.
But maybe if I let you know how I’ve been feeling, it might help you realize that it's not abnormal to be scared, terrified even. It’s OK to be scared. But it doesn’t have to define your very existence. I tried that and it didn’t work. So now I’m out the other side. Everything is going to be OK. Even if I have to have my face ripped apart, it’s going to be OK. And if my life changes because of it, then so be it. I’ll adapt. I’m human; we’re good at adapting.
So, go live your life and do the things you want to do. We don’t get another shot at it. Check your lumps. And remember that it’s OK to be scared. And, most likely, everything will probably be just fine.
So. See you all next week. I promise not to be so narcissistic for a while.