Ox Fall Down

Memorial Sloan-Kettering. I'm late. They rush me through registration. I have another id card. Blue like the others.

Dr. Guido Scalabas from Bern examines me. Europe's not footing the bill for research, he says. Assume thoughts extending into geo-politics.

He leaves and I call Andrew. A knock on the door and it's Singer. Last time I was here they kept me waiting in a robe, alone and without reading material for an hour and forty minutes. Note to self: schedule appointments early in the day. Less time for them to run late.

He thinks the surgery is very aggressive. I try to have him explain how he thinks it more aggressive than Yoon. He keeps his cards close to his chest. But he's specifically worried about the vasculature. He appreciates Cambria's take on the collateral circulation but cautions that surgery could disrupt even that. He's not wild about intra-operative radiation. The aorta and celiac axis are high pressure systems that want strong walls. Radiation and surgical shaving for margins clearly weaken vessels.

So the strategy is to have another CT or PET scan with a broader scope. The lungs haven't been scanned since October. Make sure there's no other visible disease. If we're going to take this risk than make certain they get everything out at once. Prior to surgery queue up the wish-list. Start with full resection and have Yoon assess once he's seen the final scans and has me open on the table. Have an exit strategy.

How do I feel? Happy to have so much of Singer's time. He was very gracious. Thorough. He raved about Yoon. And repeated Yoon's assertion that MGH has the best facilities for IORT. I know I won't be negligent to continue treatment in Boston. That's a relief. Now, only to await the results of the arteriogram and make the hard call.

With a nod to Toner, I think I'm going all in.