A lot going on

You ever have moments where you think you've learned some perspective...but hope that you don't forget it?

I feel that way now. A lot has happened since I last wrote, and its good and its bad and it is perspective building.

(This may be a long entry...)

First, as you know Nicole is pregnant with our first child, who is healthy and 38 weeks along so far! At 18 weeks, we happily found out it was a girl. We made a big deal of it...we had the ultrasound tech not tell us, not show us, but write it down, so that we could make cupcakes with pink/blue frosting, and then have everyone over to have a reveal party where we'd bite into the cupcakes. They were pink...we were excited! So we grew, planned, and bonded with Ansley (our chosen name for her). However, number of our friends - Jenny Morrison, Andi Neely, and Gabby Kurtz all had breach babies (where the head is not in the birth canal, but instead the butt). At 36 weeks, Nicole asked the OB doc to make sure that Ansley was in good position, and not breach, for peace of mind. They did the ultrasound, and the position was good. "Oh great, she's in good position" we said. After the ultrasound tech caught on that we thought it was a girl, there was a long awkward pause, and then we hear..."Uhhhh....its...not a girl..."! Yes, the baby shower, girly decorations, and bonding with "Ansley" has already happened. I was shocked, and Nicole was a little upset, but the most imporant thing is that we have a healthy child. We quickly got over it, and now we've switched out the bedding and clothes, kept the walls the same (green), and trying out boys names.

On this very same day, we get terrible news. Nicole's mom Barbara is diagnosed with a large renal mass that is concerning for renal cell carcinoma.

It all started with a cough...a chronic, nagging cough that lasted 4-5 months. Sounded like a bronchitis, some of which take months for the cough to resolve. Then she developed a pulling sensation under her right ribcage. I thought, surely this is just irritation of the pleura (lung lining) or muscles of her ribcage, from the cough. Chest x-rays were done that showed nothing, and multiple antibiotics and strong cough medicines were given, but nothing got better. Thank god her doctor finally ordered a CT scan of her chest. It showed nothing obvious in her lungs...but it did show a mass coming from her kidneys. Then a CT scan of her abdomen revealed a large mass - about the size of a fist, coming from the top of her R kidney, pressing against her liver and diaphragm, probably causing the cough. This was about 2 weeks ago. We couldn't bear to tell Nicole's mom, but knew we had to. We got Barbara's twin sister to go to her house, and then we called her and told her. We should have known she had a clue..."you don't get 2 CT scans without thinking something is wrong..." We got the reports and the images FedEx'd to us, and we got Nicole's boss, Dr. Andrew Greganti (one of the best doctors I've ever met), who referred us to a urologist he really trusts, Dr. Raj Pruthi, who meets with us that Sunday morning to review the films. In the meantime, we formulate a plan for Barbara to come to UNC for evaluation and treatment, if she was willing to do so. She was, and bravely came to UNC for us to place her life in our hospital's hands. The next few days, scans of her abdomen, brain, and roundtable discussions about her case ensued, and it was decided - she would undergo surgery to remove her right kidney, and the mass. The surgery went well - a hand-assisted laparoscopic nephrectomy, and from what they could tell, there was no cancer left behind. The scans did show a few small "spots" elsewhere in her body, but its unclear what these are. There's no point in subjecting her to invasive surgery to remove these, or to chemotherapy to treat these, if its possible its not cancer, so the plan for these is to "wait and see". Overall, I think she got extremely quick and excellent care, the surgery went well, and she's now recovering and we're hoping for the best. I thought UNC was a pretty good place, and I took pride in our internal medicine program, but now I take extreme pride in where I work - the nurses, physicians, food service, volunteers, and secretaries were very professional and provided excellent care.

About 2 weeks before all of this, my grandfather past away. "Ye-Ye" as we affectionately called him (chinese for "paternal grandpa"), my father's father, died at 91 years old. I wasn't as close to him, but my dad was, so I knew it was tough on him. However, he had been suffering the last few years with spinal stenosis (the narrowing of the spinal canal, which pinches off the spinal cord). He couldn't walk, his legs always hurt, and he had bowel problems. He was a man who was patient, careful, loved to please others, generous as much as he could be. I respect my dad, who taught me to respect and take care of one's elders, even if it was unrequited, because it is the right thing to do.

So, 2 weekends ago, on a Friday Nicole (37 weeks pregnant) and I find out that our girl is a boy, find out that Nicole's mom has a large mass which is likely cancer. I work overnight Saturday, fly to my grandpa's funeral Sunday, and return Monday to pick up Barbara from the airport.

It's been a hell of a time.

Fortunately, I think things are ok. We have a healthy baby boy on the way. Nicole's mom's surgery went well, and we hope that she is cured. Our grandpa is resting in peace, and my dad is relieved that he isn't suffering. I just finished my residency and start my chief residency in 2 days.

Of course, its obvious now why I'm saying I learned some perspective. I think I did. It's all been said before, but I often brush off things like these:

1. What counts in life is people. Family and friends.

2. Don't waste time worrying about things you won't care about in a month, or a year. Better yet, don't wast time worrying.

3. Do what you want to do.

4. Remember that we're so lucky.

Love all of you,
Alan