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I was diagnosed four years ago with Stage 4 lung cancer. I've been fortunate to have participated in three drug trials: I belong to the small minority of people for whom recent drug advancements have made a big difference. But my prospects have worsened recently. The most recent trial drug was not effective, and I've now switched to traditional chemo treatments.
So I try to be completely attentive to my place in time. I concentrate on the things I’ve always loved — the morning coffee, a conversation, a walk on the beach — and even on my new reality: the constant stream of medical procedures.
A few weeks ago, I had another biopsy at Massachusetts General Hospital. It's a simple procedure. A doctor sticks a hollow needle into the lung at just the right spot, slides a smaller needle inside the first, and removes the targeted cells.
The sedation nurse explains to me that she typically gives patients two types of drugs. The first is administered by syringe at the needle site in order to numb any pain. The second, administered intravenously, is a mild sedative that would help me relax, and blur any memory of the ordeal.
I have absolutely no desire to miss even a moment of this, so, as always, I refuse the sedation. But moments before the doctor inserts the needle — about four inches long — into my chest, I question my decision. It's too late. There is a slight pressure on my chest, then the needle is in, and I'm rolling into the CT scanner.
I'm not allowed to speak during the procedure. But that doesn’t mean my radiologist, Dr. Shaunagh McDermott, and I don’t communicate during the biopsy. We do so with our eyes, as I lie on the table facing her and she leans over my chest.
Afterwards, she says it's a bit unsettling to have a fully alert patient watching so closely, since most patients have lost their focus. I suspect she, like a portrait artist who turns the easel away from her subject, prefers to minimize distractions by working unobserved.
In many biopsies, the target is clear: a large, solid tumor. In my case, my very small, scattered tumors present a much greater challenge. I was told there is an art to selecting and hitting these elusive nodules. Carefully choosing what appears to be the best site, one that is easily accessible and non-life threatening, improves the odds, but in no way guarantees success. There is always a very real chance that none of the samples will contain anything of value.
Final positioning begins with the doctor pushing the hollow needle a very small distance further into my chest. I feel only the pressure; there is no pain. The slow progress reminds me of a classic high school math question, “If you move half the distance toward a goal during each turn, how many turns will it take to reach the goal?” The answer to this question is an infinite number of turns.
The room empties and I’m rolled in and out of the scanner for a new image. Returning to the room, Dr. McDermott concentrates on the fog of pixels on the screen while I search her eyes for any concern. She is focusing on the needle as it edges ever closer to the target. I feel my consciousness drifting up and away from the operating table, as though I'm on a balcony overlooking the room.
Time swirls as Dr. McDermott deftly repositions the needle, calls for a scan, and studies the screen again. She repeats the process a half-dozen or more times until she calls the team to action: The needle is finally in position.
The hands of the clock move again as the room comes alive. Blue gloves retrieve the first very long needle from the table, transport it across the room, and place it in the outstretched hand of my doctor. To my surprise, she slides it into the first needle, up and down in a rapid, pumping motion. This is not what I expected. Why pumping? (I learn later that these first needles are designed to capture free-floating tumor cells — hence the pumping motions — in contrast with later needles that gather more solid tumor cells.)
Finished, she hands the used needle to one of the waiting cell technologists, who disappears from the room through a side door. She does the same with the second clean needle, again rapidly pumping it in and out of my chest before handing it off to the next technician.
Activity in the room stops. All eyes have shifted to the side door. The doctor awaits the initial laboratory report. Did she select a good position, or must she try again?
A research technician returns to the room and reports the samples have the cells we need. I look up expecting to see a sense of satisfaction or relief, but instead I see a stage manager directing the team to proceed.
As though following the tape marks on a stage floor laid out in advance by the choreographer, blue gloves with white coats move from position to position in the room, and at just the right moment. The white coat with a smiley face pinned to the lapel provides core needles. The doctor irrigates the hollow needle as a precaution to avoid an air embolus and inserts the core needle. I hear a sharp “click.” The needle is withdrawn and handed to the white coat with the squeaky sneakers. The blue gloves with dark green pants apply the proper destination label: “drug company," “hospital" or “research laboratory.” This movement is repeated every 60 seconds for 10 to 15 minutes.
When all the cores have been taken, the team removes my EKG leads, the IV and the straps. I’m told to relax and not to impede them while they reposition me. In one quick motion, the doctor removes the hollow needle from my chest and places a small Band-Aid on the wound. A dozen blue gloves instantly flip me to a prone position. I’m puzzled that a Band-Aid and gravity can protect me from serious infection and a collapsed lung after such invasive surgery.
I spend three hours on my stomach, more X-rays are taken, then finally I am allowed to sit up and talk. I am visited by Dr. McDermott and proceed to barrage her with questions, which she patiently answers. I never want to see her again — unless I need another biopsy. Then I don’t want anyone else.
As I leave the hospital, I ask my nurse if anyone else skips medication during this procedure. She doesn't hesitate. “Yes,” she says, adding that middle-aged men and elderly women often choose to remain alert.
I like to think we in this cohort have reached the same conclusion for similar reasons: We cherish every minute of life. We don’t want to miss a moment — even moments full of needles.
Dave Kimball is a retired software entrepreneur whose interests include sculling, cabinetry and hiking. He recently returned to the University of Connecticut, where he is taking a creative writing class.