Post Surgery Note

To my sister and brother

September 23, 2014

Dear Jan / Luke:

Thanks for your calls.

I had four and a half hours or so of surgery on Friday afternoon, 19th

September and it went well with MD Anderson surgeons eventually
removing a large mass - apparently the size of a fistful or a hockey
puck, oval in shape - including the tumor itself and hopefully all
"suspicious" surrounding tissue. Given the life-saving nature of the
surgery, the amount of neck removed, and the duration of the
procedure, I feel awfully good.

The tumor might be as big as a pea or pencil eraser, but the surgeons
delve deeply, as they have to secure positive margins . . . as much
clear, clean, non-diseased tissue as they can get. In fact, they break
during the surgery to leave the surgery and go down the hall and
consult in real time with a pathologist and microscopically inspect
pieces of neck tissue to see what they look like. If there's any doubt
that a sample is diseased, they keep cutting. Logistically and
medically it seems a rather rudimentary procedure up and down the
hall with chunks from my neck - but I am confident that it's been tested
on others1 and works.

I have a prominent scar across my left neck under my jaw. 2 They took
all or most of my left chest pectoral muscle out to rebuild my neck, a
so-called pec flap. The most obvious evidence of this little
reconstruction is a foot long scar across my chest decorated by a
couple of dozen nice shiny staples. Since most of the left side of my
neck was removed, the pec flap procedure is deemed essential. I had
originally understood that it was largely cosmetic, but later learned that
it is so that my head does not fall off. Once they've taken Shylock's
pound of flesh dearly bought - in this case not figuratively but literally
there is little remaining in one's left neck. Muscles, nerves, sinew of
1 At least tested on small, unsuspecting mammals . . . better yet, reptiles, plants or more rabbits.
2 Later, I read the surgeon's notes which begin, I located a large crease in patient's neck and made opening incision.
 every type, everything except for the carotid artery has to go.

On the morning after surgery, a Saturday, the assistant surgeon did

rounds and managed to take the time for a long conversation with us.
Did you take out veins?. I innocently asked the young doctor, a bright
and abidingly patient Lebanese fellow.
Yes, we took out virtually everything that might be cancerous or close
to the cancer.
Everything?
Well, a lot.
Veins, arteries, muscle?
Sure, we have to get all of that . . . all the stuff that surrounds the
tumors.
Surely, not the jugular vein?
Yes, of course, we removed that. We have to. It's in the field.
Can a person live without his jugular vein? I asked.
He smiled slightly and hotly responded, Apparently.
How does blood from the brain find a way back?
He grinned again, It finds a way. It has to find new routes. 3
I knew from freshman biology and TV crime shows4 that arteries took
blood to the extremities and veins were the channels for the blood's
return to the heart.
What about the carotid artery?
He grinned more widely this time but was a little more stern and direct.
No, we don't take that . . . we can't take that . . . .
Or the patient dies?
Well, I can't say that we've never taken the carotid artery, he replied,
Let's just say it's a measure that is highly unusual . . . something that
is a sort of last measure.
Presumably this was reassuring, that they left my carotid.

I have a world-renowned surgeon who I had become comfortable with

his assistant early on this Saturday morning, me laying in bed having
been carved up only ten or twelve hours before. For this type of
throat / neck cancer and the unfortunate surgery which, so far down
the treatment road, was required, therefore I feel confident that I am
getting the best medicine and medical approach and execution, so to

3 I suppose the bodys efforts to find new routes to return de-oxygenated blood from my brain might have something to do
with the splitting headaches that I've experience for the past year.,
4 Not to mention, though I do, that my father was a cardiologist.
 speak, as is possible. MD Anderson is an incredible place . Absolutely
world class in every respect. I am grateful for that.

In view of the seriousness and intrusiveness of the surgery, (they don't

call it radical for nothing!) I feel terrific. Radiation and chemo made me
something worse than miserable . . . sick as a very sick canine. Often,
admittedly, not wanting to go on, not wanting to endure the next
treatment. Now I have a sore neck, shoulder, chest, of course, given
the deep and broad scope of the surgery. But I'm in little pain, moving
around pretty well - I spent 1/2 hour on the stationery bike at the hotel
tonight about 72 hours after the end of surgery - with speech and
swallowing fully intact and functional . . . at least for right now.. My
attitude is my normal, to the disappointment of some folks, no doubt.

Only time will tell if the surgeons were successful. Unbelievably, more
chemotherapy and radiation are planned as post-surgical treatment.
They seem to want to kill this sucker one way or the other, though I
sense that they are running out of ideas sledge hammering fleas. 5

The surgeons are blunt and matter-of-fact about my prospects.

There's no great optimism, they just tell us that mine is/was a
particularly aggressive and stubborn cancer and that there's not a lot of
knowledge about how these cancers move and progress. This
evasiveness is technically known medically as "bummer" and
"whatever."

Perhaps 80% to 85% of these cancers initially respond to chemo and

radiation therapy. I'm in the unfortunate minority of folks having
chemo and radiation resistant" cancer.

I worked pretty hard physically to get in shape for this, lifting weights,
stretching, doing biking every day. Though I only had a couple of
weeks' notice, I wanted to present them with the best possible
pectoral muscle which they could then fillet, rice and dice as they, in
their infinite medical wisdom. And, so far, even though it's only been a
little while, I think that's paid off in terms of, all things considered, a
very fine recovery. (Morphine and Oxycontin helped short term with
recovery, until those were ceased. I even have some left, if you want

5 Indeed, one of the main reasons that the surgery is so radical, so extensive, is in fact that after a cancer like this recurs,
there's the surgical procedure followed by re-radiation and re-chemo, but that's about all they can do for me. This, I
learned, is essentially my last shot and the surgery is deep and broad because if the cancer returns after this, hope and
prayer will likely be the last things available. We'll see.
me to violate federal law and ship it to you. We'd have to first discuss
price, of course.)

You probably don't remember, but I had both knees replaced at the
same time- a few years ago. One surgeon stands on one side of the
table and does one knee and the other is across the table replacing
the other. They start and finish at the same time, presumably.
Anyway, for many months I worked hard to get in shape, lifting weights,
building my quads and the rest of my leg muscles and upper body
too, because that's needed for strength and balance preparing for
the knee surgery. And that went fantastically. Never a problem . . .
walking fine . . . or at least walking . . . a few hours after surgery.
Later I asked the head of the physical therapy department how I was
doing and he answered, You? Why you're our star!. That was only
because I had worked so hard at what I call prehab. If I had a good
recovery from the knees, it's God and hard work teaming up together.

I'll be home in Memphis on Wednesday night Sept 24th probably, and

look forward to some healing time, then just back to daily life, absent
the past six months of difficult recovery from the grueling chemo and
radiation treatments which ran from late November last year through
mid-march and from which I still have a number of lingering problems
and side effects, painful and debilitating, but all minor in the very big
picture of continued life.

Being treated for this cancer is not an individual task. It necessarily

has to be a shared burden. You all have been with me every step and
are surely candidates for sainthood.

And, more important, the Patriots, Wesleyan Cardinals and Trinity

Bantams all won this weekend, so life is good.

All my love,

Michael