3:33am September 24, 2014

Apparently, fat is so scary it would be better I die of this cancer

I’ve just gotten back from my first visit with an oncologist, Dr. Cheung Wong (who is, regrettably, the head of gynecological oncology at Fletcher Allen, a position for which he is unqualified by reason of having his head up his ass).

I have first stage endometrial cancer. I know standard operating procedure for it is a radical hysterectomy, which is usually the only treatment needed. I’m, overall, a very healthy 57 year old. My blood pressure was, today, a typical 110/70. My arteries were imaged a few months ago, and to quote the doctor, were “wide open”. After 1 minor stroke probably connected to a basilar migraine I wore a heart monitor for a month, with no abnormal readings whatsoever. My A1c tests are great, ditto for an echocardiogram I’ve had, and the same goes for the stress test I have a few years ago. I’m good to go for surgery, right?

Ahh, but for two things: I’m in a wheelchair, and I’m a fat woman.

The moment Dr. Wong walked in the room, he expressed great interest in my wheelchair. No, not whether the model made crisp turns and handle well on rough pavement — whether I could actually get out of the wheelchair. I can, a litlle bit — I have arthritis, not paralysis — and I explained what I was able to do, all the while puzzling over what any of this had to do with cancer treatment. He appeared unsatisfied with my response when I said I could walk the length of the exam room (with a lot of pain), but not take a walk up and down the hallways.

Noting again to myself that he was an oncologist, not a gym teacher, I still wondered what the fuck any of this had to do with endometrial cancer.

Then he got to the matter at hand. There were four possible approaches, he said. Doing nothing, which he didn’t recommend (good, because I have plans for a nice long life). Radiation treatment, which he said could be almost as effective as surgery (I don’t do “almost”, especially not since I’ve been severely overexposed to radiation as a kid and as a result have twice the risk for things like ovarian cancer, which would get in the way of my plans for a nice long life), and then there was surgery, which —- and now we cut to the chase

he did not recommend because, being as I was fat, it was just too risky.

(Like, um, leaving cancer in place isn’t a bit of a risk, too???)

He didn’t add “and you’re a gimp to boot” though I now had no problem filling in that part. I’ve been asked fewer questions about my mobility by rheumatologists and orthopedists than I was this afternoon by him.So I asked him what this putative risks were. My heart, he explained. And one of the meds I was taking. Except for the point that my heart has been tested every which way and comes out stronger than most 57 year old hearts, and the part about how I can just discontinue the med a week before surgery just like everyone else who takes that med does before surgery, I’m totally buying this pathetic excuse for reason.

Then we get into the, umm, fat of the argument. It’s the fat. The tissue could compress the lungs in the laparascopic surgery position (this may make some sense here) and he didn’t even know if he had surgical instruments long enough to perform the surgery lapascopically. And — with a pause suggesting he thought this should worry me greatly — if they have to do it conventionally, I’d have a scar lengthwise across my abdomen.

Yes, I, a person with a neck to ass scar on my flip side, should be so frightened by a surgical scar on the abdomen that I’d prefer instead to take my chances with second and third line cancer treatments over the one method that almost always yields a cure.

That, or perhaps he was really saying that disabled people and fat people don’t deserve equality of health care. And especially not a disabled fat woman (three strikes and your out, or dead, or something like that). Somewhere in this conversation he even used the phrase “quality of life” which disability activists have long understood to mean “excuses to arrange your death.”

The National Cancer Institute has run a cohort study of us twisted sisters (girls/women with severe scoliosis) who were exposed to the kinds of x-rays I had had as a child, at the very time the ovaries and breasts are beginning to develop. It turns out we have — unsurprisingly — a lot more reproductive cancers. Zapping my ovaries with yet more radiation presents an actual hazard of ovarian cancer, a cancer that is difficult to detect and seriously deadly. He of course thought it would be a very good idea indeed if, instead of surgery, I had radiation treatment.

He tried to tell me that in this great and wondrous modern age, they could carefully target the radiation. And I’m sure if I hadn’t known that this great and wondrous age was occurring in the very same universe that I learned about when I majored in physics and mathematics, I might believe that. But, being as I did major in physics and mathematics, and I was quite sure that this great and wondrous age had no mechanism to create a perfect classical vaccuum between the radiation and my uterus, I knew that any radiation beam in the real world does not have a neat and clean edge. When radiation hits air molecules, stray parts of me, etc, probably a stray bit of the quantum foam every now and then, and even the table I would lie on, there is scattering. Think of what a flashlight beam looks like, and you understand the problem (this isn’t an analogy, by the way: it’s more like precisely the same behavior, but at lower energies). The ovaries next door would always pick up a radiation dose — the kind of “incidental” dose that, were it to have been recorded on my film badge back in my cyclotron days, would have had me immediately sent to a doctor by my employer, and banned from radiation work for a good long while.

Think about it: if scattered radiation wasn’t an issue, why do radiotherapists wear (and hide behind) shielding?

I agreed nonetheless to talk to the radiotherapy department (though I did not agree to forget the laws of nature in this universe). I also agreed to talk to anesthesiology (maybe I’m a glutton for hearing how a relatively routine hysterectomy to end a cancer is deadly to me, but how, if I were asking for the considerably more risky and invasive gastric bypass surgery, I’d be good to go —though it’s possible the anesthesiologist has more sense than that). And I have a referral for a second opinion at Dartmouth Hitchcock, which is a much better hospital than Fletcher Allen, though regrettably it is still a part of the same social universe that generates disability and fat hatred.

(P.S. — any assholes who think that now is an appropriate time to tell me that my problem is that I’m lazy and undisciplined and ugly and need to lose weight, because, of course, you are very concerned about the health I apparently am destroying by eating ten big macs a day*, I want to know why your deep concern for me, a stranger, does not extend to my becoming cancer-free?)

(* My neighbor reads this. That snark was for her. She knows what I eat, and it sure ain’t ten big macs a day. Or year. Or decade. Fat haters who don’t know anything at all about me always know so very much about how to improve my life by doing exactly what I’ve already been doing for years without weight loss.

Question: what is the first thing you run into when you walk into my kitchen? Answer: My short barbell.

So shove it up yours in advance, bigots).