Thursday, July 28, 2011

Diagnosis III: The Mizrahic Mystique

When last we left our hero, he had nearly two weeks before a scheduled visit to a genuine oncologist, in this case Ron Blum at Beth Israel (date of appointment: July 28). So I went to the country to scream at the stars and read bits of novel to old friends, first Cat and Peter Bishop in Northampton, Mass., then Sue Arthen (and all the other Arthens) at Glenwood Farm in Worthington, Mass., the schedule being I would then move on to Laura and Tom Hanlon in Montague, Mass.

But after much corn on the cob and four episodes of Firefly (none set to music) and two or three episodes of bathing in local streams, I found the second cancer lesion on my toe, the one that grew slowly and never made trouble, was growing fast, had burst in mid-water, and was bleeding a bit. I was sufficiently freaked by this to cancel Laura, have Sue and Kyriel bandage my foot to excess (in fact it did not burst or bleed on the trip), and caught Mega Bus back to the city on the Saturday afternoon.

My podiatrist, Aditi Shastri, is not listed in New York phone directories, so I could not apprise her of the situation from up north, and a Friday night (and subsequent days) is not the greatest for tracking down an unfamiliar podiatrist in the wilds of New England (though H.P. Lovecraft claims a whole tribe of them once flourished there, ruminating on zucchini and murdering alien children), but I sent her an email as soon as I was home where I had her email address, and she made room for me Tuesday morning. Sue and Kyriel's bandages easily held out till then.

"I'll have to put the tourniquet all across your foot," Dr. Shastri said, and I thought, "This will be bloody murder," but in fact, as we chatted about tourism in India and so on, the thing came right off. Will it come back? That is beyond predicting. No sense sending it for a biopsy -- we already know the bad news (which had cost me $480 to get). On Tuesday night the toe stung, but by Wednesday night I was well enough to stand in front of the Delacorte Theater and cadge a freebie to All's Well That Ends Well, commencing a three-day orgy of Shakespeare as pre-birthday festivity.

Today, Thursday, having been apprised that Dr. Blum had an afternoon appointment, I biked to Beth Israel at 11am. Many papers to fill out. At last the doc, as urbane and charming as the others. "I find patients are either 'lay-it-all-out-for-me' or 'I-don't-want-to-know,'" he said. I said I was the former type; he said he was, too.

We talked about my bout with lymphoma back in '97 -- my beloved oncologist Ellen Gold departed the hospital, he told me, in fright after 9/11 -- and about the fact that most of his KS patients were either epidemic (i.e. AIDS-related) or endemic -- and that the latter were almost always Sephardic Jews, not Ashkenazic Jews. Now while there is a tradition that the first Yohalem (born 1792) might have been born in Palestine, he was (if so) almost certainly the son of Polish or Lithuanian Jews who had taken refuge there; Sephardic we're not. And everyone on every other side of the family is Ashkenaz.

"In that case," said Dr. Blum, "it probably is a case you acquired via sexual contact, though without HIV." What? Me have sex with another man involving physical contact at sometime in the last 20 years? How is that possible? (Under oath, after squirming, I admit: Yes, it's possible. Probable. Frequent. Okay? Just not lately.) And he jiggered his lightweight futuristic whatchamacallit with keyboard and Internet but not a word processor, very convenient no doubt but I want one with a word processor. Who can sum up a thought in 140 characters? I ask you? I have trouble getting it down to 1400 characters. And he said, "There are findings about non-endemic but non-AIDS KS in gay men of a certain age. I'll have to do some reading this weekend and get back to you on it." (My friend Anna, a paramedic, had said the same.)

"But my instinct is, if it were HIV, it would be all over your body; if it's endemic, it will stick to the lower extremities and not be very aggressive." Just like traditional KS.

So we watch and we wait and we pretend it isn't there unless it's there. Then we get rid of it and go about our business. Meanwhile plotting how to pay for any extravagant outbreaks.

No major tests escheduled. No chemo or radiation at least for now, though I am suspicious of that second lesion and how far it has gone, and how much remains. Dr. Shastri took X-rays before she removed the first lesion, and I have asked that they (the X-rays) be faxed to Dr. Blum.

Maybe I have a totally new sort of sexually-communicated KS. It's the sort of weird half-stunt I'd pull. No worries. Peter is making me a little statue of Aesculapius for my altar. Trust.

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