Patrick accompanied me to the oncology clinic to follow-up on the pathology report from the lung wedge surgery I had done only five days prior. We were taken to an exam room where the doctor sat across from us as she delivered the news. "I'm so sorry," she said, which is all she needed to say. She then began to read from the pathology report itself. I've reproduced a portion of it below:
A. LUNG, RIGHT MIDDLE LOBE, WEDGE BIOPSY
--- BENIGN LUNG PARENCHYMA WITH SMALL INTRAPARENCHYMAL LYMPH NODE
--- NO MALIGNANCY IDENTIFIED
B. LUNG, RIGHT LOWER LOBE, WEDGE BIOPSY
--- METASTATIC ADENOCARCINOMA CONSISTENT WITH COLORECTAL PRIMARY, SEE COMMENT
--- MAXIMUM LINEAR DIMENSION OF CARCINOMA: 1.5 CM
--- INKED STAPLED SURGICAL MARGIN IS POSITIVE FOR ADENOCARCINOMA
The sections reveal a lung parenchyma infiltrated by adenocarcinoma.
Neoplastic cell are positive for CK20 and CDX2 while negative for CK7 and TTF-1. Overall, the clinical history, morphologic features and immunohistochemical findings are consistent with metastatic adenocarcinoma from colorectal primary.
My birthday would be two days later. Christmas was less than a week away. What a rotten time to get news like this. I had a burning question after reading the report. It stated that "positive margins" remained after the wedge was taken. This meant that cancer cells near where the node had been cut off were still present. My question was: Why? Why when current theories of cancer promote the idea that a single cancer cell can eventually lead to death, why wasn't care taken to obtain clean margins? When the surgeon stated that the intent of the surgery was "not therapeutic" (see this post), I never imagined that the procedure itself, by its very nature could be instrumental in spreading the disease it sought to diagnose. That was naive on my part. I had assumed that a large enough wedge could be taken and would be taken such that the sought-for nodule would be completely removed, and all trace of nearby cancer cells with it. Why didn't the surgeon check for clean margins before closing? This question haunted me for weeks. I became angry.
If physical harm had been done to me, it was too late to mitigate, but
it wasn't too late to repair the spiritual damage that I could do to myself
by despairing or becoming bitter. I needed to forgive the surgeon. Some weeks later, with the help of a holy priest, and the Sacrament of Confession, I started the process. The priest explained that though I might not be ready to offer my own forgiveness, I could ask God to do the forgiving in my place. He shared with me this most-helpful prayer, carefully pronouncing each word with reverence, "Lord, forgive those bums for what they did to me." (Emphasis his.) The priest encouraged me to repeat this prayer multiple times a day, whenever I thought about what happened. "After enough time," he promised, "you'll forget what you're asking to be forgiven."
Since the surgery, I've been informed that I received the standard of care. Because the intent of a biopsy is never curative, maintaining clear margins is not part of the equation. The situation makes me wonder if I will ever know the right questions to ask before a procedure. Meanwhile, I haven't yet forgotten what I'm asking to be forgiven. Until then I keep repeating:
Lord, forgive those bums for what they did to me.