Needle in the Hay (and Also My Abdomen)
Stabbing pain, a trip to the ER, and getting high for the first time in six years: This is how I found out I had cancer (again).
People ask: How did you find out? It’s often everyone’s first question, like asking a musician about their influences. The subtext, obviously, is: How will I know if it happens to me? After all (alarming statistic alert), one in every three women will get cancer in her lifetime, as will one in every two men1. I’ve collected a few of these stories over the years, and they range from the harrowing to the mundane. What follows is the story of how I found out. Actually, it’s only about the first two-thirds of that story, but I hope you’ll agree, assuming you make it that far (sorry, this post is long), that we reach a reasonably good stopping point.
For me, the period separating the onset of my symptoms and my final diagnosis was about four weeks, during which the pain, confusion, and fear built to a crescendo worthy of Wagner. It started with just the slightest twinge of discomfort in my abdomen. I was up in San Francisco for the first time since we’d moved down to LA in early 2022, sleeping fitfully on my pal’s pull-out sofa. During one of several tosses and/or turns, I felt a poke on my right side. I didn’t think much of it, figured it was caused by that notorious human-torture device, the sofa bed. I switched to a hotel the next day, but the poke persisted. Even then, I chalked it up to a muscle pull or something. A day or so later, I started getting these itty-bitty fevers at night. I didn’t think much of those either: I was in SF in April, it was chilly. Each of us has different proclivities when it comes to this stuff. Are you someone who tends to obsess about little abnormalities with your physical person? I tend not to be. I got this from my dad: Just ignore it and most of the time it’ll go away.
But the pain got worse, the fevers more intense. Back at home in L.A. a week later, I started getting these night sweats. I’d wake up at 3 a.m., my sheets soaked. Nightly fevers, abdominal pain, sweating in my sleep—what the hell? I went to this new doctor I had started seeing when we moved down here, a nice but harried guy that we’ll call Bad Doctor, who ran a practice that felt like the DMV. I didn’t even get to see him at the appointment, but his physician’s assistant ordered blood work and an abdominal ultrasound.
Now, the last time I had an ultrasound was 11 years ago, under a similar cloud of uncertainty2: My right testicle was swollen, had doubled in size. My doctor back then—a godsend of a man who served as my medical quarterback for nearly two decades, who was quick with a joke and who gave me his personal Gmail for quicker access during trying times, of which there were too damn many—had ordered an ultrasound, and assured me there were other things it could be besides the thing we all feared it was. Leaving the ultrasound lab after my appointment, I got a call from said doctor in the hospital parking lot: Come directly back to my office, he told me. Maybe 10 minutes after having the jellied wand on my scrotum, he was giving me the news: They think it’s a malignancy. The next day, I was meeting with a urologist, and by the end of that same week, the urologist had surgically removed my right testicle. In hindsight, it all happened so incredibly fast3.
I didn’t get the ultrasound results back as quickly this time, which you could interpret as a good sign, but it was still a disconcerting experience, because mid test the lab tech summoned a colleague to offer a second opinion about whatever was appearing on the screen, then informed me when I asked that, per policy, she was not allowed to discuss the results—what the hell!? Later that afternoon, I was sitting on the couch when Danielle came down and asked me how it went. I told her about the odd moment with the second colleague and recounting it all triggered a wave of grief and dread. For whatever reason, I hadn’t really been worrying about the c-word prior to this. Now, suddenly, I was.
A few days later, Bad Doctor called. The results from the bloodwork and the ultrasound had both come back negative: It wasn’t kidney stones or gallstones, wasn’t my appendix. The likely culprit, he explained, was some kind of infection. Keep taking the antibiotics I gave you and things should clear up.
Great, we thought, then walked into a casino. It was Danielle’s birthday and I’d planned what turned out to be the world’s lamest Vegas trip. I was tired most of the time and still getting these annoying fevers. Each night we’d come home around 9:45 and I’d sweat through a series of hotel robes in my sleep, then have to explain to housekeeping that we required several new fresh robes. On top of that, I lost a few hundred bucks at the tables. About the only thing that made it tolerable was the fact that Bad Doctor had given us that reassuring news: an infection! Keep taking the antibiotics and things should clear up.
Uh-huh. Things did not clear up. After we got back from our weekend jaunt, things proceeded to get much worse. The night sweats became night drenchings, soaking my sheets and leading me to develop this absurd rotating-multi-blanket-taco routine I’d need a whiteboard to properly diagram. Fevers worse, abdominal pain worse. Still heeding my doctor’s advice, I finished the antibiotics and powered through the week, taking intermittent days off under the auspices of “my weird illness,” as it came to be known among my colleagues. But by Friday, I threw in the towel. The abdominal pain was now approaching stabbing, and the previous night’s fever had left me exhausted. I called Bad Doctor first thing in the morning to report my worsening symptoms, but he never called back and wouldn’t until much later that afternoon (bad doctor!). Starting to panic, I sought the advice of a friend’s wife, also a general practitioner, who after about five minutes of listening to my symptoms confirmed what I suspected was my next step: I needed a CT scan, and the only place to get one on a Friday afternoon was the ER. Danielle was in Santa Barbara celebrating her birthday with friends, so I packed a small bag and headed for the LA Metro. Just before I left, Bad Doctor called back. I explained that I was headed to the ER to get a CT scan.
“If you wanna do that, that’s up to you, but I wouldn’t recommend it. You’re going to be waiting a long time.”
This was the first time this guy was right about something, and it was the last time I’d ever talk to him. After that, my friend’s wife became my new GP, texting me advice and well wishes throughout the whole process. Lesson: If you think you have a bad doctor, you probably do.
Despite what every primetime hospital show would have you believe, ERs are not nice places, at least not from the patient perspective. Perhaps if you’re a doctor, an ER feels like a cross between a frisky college party and a game of medical Clue, where quick-witted orderlies exchange jibes with dashing residents and all the patients have exotic, vexing maladies that only suave and/or pouty would-be underwear models can decipher. But that has not been my experience. I’ve had the pleasure of admitting myself to ERs in Manhattan, Oakland, and now Los Angeles (twice in a month (I should get a punch card)). Trouble is, the first two admissions happened over twenty years ago, and I’d forgotten what miserable places ERs are, medical heroics notwithstanding.
No one would tell me how long I’d have to wait when I checked myself in on Friday around 5 p.m., but I could tell by the capacity of the place that it was going to be a while. This was fine, though. Sitting in the waiting room with my book, I was surrounded by cases that seemed much more pressing than mine, including a guy who’d shrouded himself in a blanket and was vomiting uncontrollably, and another man whose legs were covered in a scabby, oozing rash he couldn’t help himself from scratching. The hours stacked up, but eventually they called me back, led me through a series of checkpoints: an initial conversation with a doctor, some blood work, then back out into the waiting room for a couple more hours. Finally, sometime after 10 p.m., I was led to an alcove where I’d wait for my turn at the CT scanner. This is where things got weird.
For starters, my partner in the alcove was the rash guy. I’m not sure what he was waiting for, but he was experiencing quite a bit of pain, and kept calling the nurse over and asking if he could leave, and the nurse would explain that it was fine if he did leave but he’d probably end up worse off than he was now, then he’d agree to stay, then call the nurse over, and they’d have the same conversation all over again. The second thing that happened is I got high for the first time in six years.
In hindsight, I should have seen it coming. I’d been taking Advil and Tylenol to manage my pain the last few days, so I asked the nurse if she could give me some. I was hooked up to an IV at that point and my nurse asked me to quantify my pain on the ubiquitous 1–10 pain scale. Without thinking about it, I said probably a 5. Then she said: Let’s give you some morphine.
Recovery detour: If you haven’t had so much as a wisp of weed or a sip of booze in over six years, let alone any hard drugs, the experience of receiving an intravenous shot of hospital-grade morphine is, in a word, complicated. While I am an AA acolyte who will happily (tho not without an invitation) expound on the lifesaving potential of the 12 Steps, I’ve never been so dogmatic as to believe, as some AAs do, that various narcotics, used medicinally, should be off limits. And in fact, I’m certain that few if any of my personal friends and fellow community members would begrudge my decision to accept the nurse’s offer of pure, undiluted, straight-to-the-CNS opioids. But still, a part of me wishes this part had gone down differently. Because that initial dose of morphine ended up becoming the first of many. In fact, while I had no way of knowing this at the time, I’d be on alternating doses of morphine and OxyContin tablets for the next month. During what became my five-day stay at the hospital, I’d rotate between intravenously administered morphine and Dilaudid every four or five hours. And sure, I was in the hospital, in pain, because of what would turn out to be cancer, but I was also high, sort of, and being high when you haven’t been high in years is really, really weird, no matter the circumstance. What was especially weird was when they’d inject the stuff into me, which because a) it was opioids; and b) I’d watched Trainspotting a lot in my early twenties, gave me the distinct sensation of melting into the floor, which was viscerally pleasant for all the reasons drugs are, but also very disconcerting, for all the reasons drugs are, especially to an addict. To anyone out there reading this who’s in recovery, my advice to you is to think through a scenario like this in advance, and determine the choices that you would make, based on your values and your journey. I don’t regret the decisions I made in this context, I just wish I’d contemplated them ahead of time, and given future-me permission to make them, so that present-me (which is actually past-me?) didn’t have some part of his brain that was quietly agonizing over the decisions even if another part knew they made the most sense at the time.
Alright, so where was I? The guy next to me kept complaining about his rash and the nurse had offered me morphine, which I accepted as if this were just another Friday for me, in order to not make her uncomfortable. She plugged it into my IV. It coursed through my veins like pipe cleaner made of giggles. An orderly arrived and informed me it was my turn at the scanner, transferred me to a bed, wheeled me down the corridor. I was thinking mostly about drugs, about the fact that I was on drugs, that, like…it’s nice, being on drugs. And also: This sucks, being on drugs.
We arrived at the CT scanner. The patient before me was a woman wearing a cowboy hat…I think? I laid down on the motorized gurney and they connected my IV to the thing that administers the magical CT scan juice. Instructions were given, the machine was fired up, the gurney made its way into that big doughnut. Bleeps, whirrs, a series of countdowns. The gurney made its way back out, which is when I flagged the tech for a bag to throw up in, and then threw up in it. I guess morphine makes you nauseous.
Back at the alcove, the guy with the rash had finally decided to self-discharge, and also my mom had arrived. She’d driven up from Orange County to be with me, on account of the fact that Danielle was 100 miles away. There was more waiting to do, and then there wasn’t: Someone came to wheel me into a private room, and my mom and I sat there for no more than a few minutes before a nurse entered, and shared the news.
The CT scan had uncovered two “masses” roughly the size of fists, the nurse explained, one of which was pushing up against my pancreas, the other my intestines, hence the pain. The nurse didn’t use the c-word, but she informed us they’d be admitting me to the hospital proper and transferring me to another floor ASAP, where doctors would begin the process of orchestrating more tests. Then she left.
I put my hands over my face and said “fuck” a bunch. My mom came over and tried to comfort me. The trick is not to get ahead of the information, one of us said, and we knew this because that’s what we learned the last time this happened, and it’s good advice, but it’s impossible to follow. You hear “masses” and you think tumor, and then you think the c-word. You think, “It’s cancer and it’s going to kill me.” You don’t think about survival rates or the remarkable advances in medical science that will hopefully, probably save your life. You think about dying, death—the d-word—about d-wording from the c-word.
And then, depending on who you are and whatever else is going on in your life, you maybe think about some other things, too. In my case, I thought about how Danielle and I were 10 weeks pregnant. We’d been trying for a year and a half, and this was our second pregnancy, following the one we’d lost back in the fall. And that was devastating, but then we were pregnant again, and this one felt somewhat providential because it was sort of unplanned—we were due to start IVF in the spring, but ended up getting pregnant naturally. But now this—now c-word! Now, possibly, d-word. Now, possibly—and this thought was inescapable, lying there on the gurney in the ER at 1 a.m., all the worst-case scenarios blaring like car horns—I may never get a chance to meet my only child.
And see? I told you this would be a good place to stop.
Small consolation: 50 percent of all cancers are diagnosed in people over 70.
Surprise — you’re about to get a two-for-one here on cancer-diagnosis stories
I’d have to wait several agonizingly long weeks before they could test to see if the cancer had spread to my lymph nodes, which thankfully it hadn’t, but diagnosis + surgery itself happened with the speed of a Nascar tire change