A cancer surgery and the pain I didn’t want to face

By Ethan Hauser

NEW YORK – On Memorial Day, I was in the office covering for colleagues on vacation when my phone rang. I had gotten a CT scan that morning, and the radiologist was calling to tell me I had renal cell carcinoma — kidney cancer.

I did not know how to react, so I did what I am trained to do: listen and write.

I asked the radiologist a few questions, bizarrely apologizing for them. I don’t know how long the conversation lasted. Fifteen minutes? 30? Longer than either of us wanted, probably. That’s what she gets for calling a journalist.

Afterward, I looked at the notes I had taken, waiting for them to make sense or fade into nothingness as if they had never happened. I thought maybe they could be like movie credits and just dissolve.

They didn’t, so I called the radiologist back, explaining that it was such jarring information that I wanted to be sure I understood.

I am good at absorbing and writing about bad news as long as it’s happening to other people. A few years ago, I edited coverage of the coronavirus pandemic. There were scant pauses in the fright and suffering, and if I’d flinched at every outbreak and all the reports of mass death, making it through a single shift would have been impossible.

That second call, though, was akin to magical thinking. I wanted the radiologist to say: “That is not what I said at all. I have no idea how you heard that.” Or: “I mixed up your scan with another patient’s. I’m sorry for scaring you.”

Instead, she just repeated herself: “You have kidney cancer.” Then she added, “You need to talk to a surgeon as soon as possible.”

Before all this, I was in very good health. I’m 55, and my weight had barely fluctuated for 30 or so years. I ran intermittently, hiked and went to the gym. The only problems I’d had were an intransigent insomnia, blood pressure that could have been a little lower and some minor gastrointestinal symptoms (hence the CT scan).

Kidney tumours, I would learn, are often caught this way — “incidentally”, the doctors call it, showing up on tests ordered for other symptoms. Two days after the radiologist’s diagnosis, I spoke with the first of several urologic surgeons. He said I most likely had Stage 3 kidney cancer and needed a radical nephrectomy: complete removal of the kidney. It wouldn’t have to be replaced; my remaining kidney would then handle the work of two.

He noted that the surgery was serious but routine. Think of all the people who donate kidneys, he said. The editor in me quibbled with the word “routine”, but I didn’t say anything. I was far more invested in the precision of his hands than in the precision of his language.

About a month later, my wife and I took an Uber from Queens to the Upper East Side at 5:00 a.m. I don’t think we spoke much, just took in the violet sky and the transforming hour, when people are up for honest reasons: collecting garbage, squeegeeing storefronts, brewing coffee. We drove over the Queensboro Bridge, the East River below us calm, and I was jealous of everything and everyone.

The three nights I spent in the hospital were a blur of nurses and doctors, of IVs and their blips and blurps, of vital signs checked and blood being drawn. I had an 8-inch incision, sternum to pelvis, cinched by hidden intramuscular stitches and by metal staples, very much not hidden. It looked as if a kid had gone to town on my torso with a staple gun.

Before the surgery, I had approached everything with emotional distance: reading up on the details of the procedure, emailing physician friends of friends.

Little could pierce this impassive approach — not even the nurse who, a week before I was admitted, paused her paperwork, looked straight into my eyes and said, “I just want to tell you, this is a notoriously painful surgery to recover from”.

More magical thinking: She must be confusing me with another patient.

At the hospital, post-surgery, the fentanyl did its job. My doctors taught me to clutch a pillow to my abdomen if I needed to sneeze or cough or laugh — about what, I wondered? — to minimize the pressure on the incision.

The unbearable pain came when I went home.

There was no secret escape route. I woke up with it and went to bed with it, with brief respites when the prescription painkillers reached their peak. Even the name “painkillers” seemed like a tease and a lie. “Get ahead of the pain,” the doctors and nurses say at discharge, which sounds logical until you try.

Those first few weeks at home remain a fog. I suspect that’s normal: Pain makes you turn inward. I sometimes looked at the incision and touched the staples, gingerly, wondering if they would hold and what would happen if they did not.

I desperately wanted to believe my doctors and nurses, who claimed that this much anxiety and pain were all normal. But my trust in my body — maybe my trust in everything — had been shattered. I texted them daily photos of the incision, because they needed to monitor any signs of infection and because I craved reassurance that I was healing.

One of the worst parts of a cancer diagnosis is that surgery can be only one piece; you’re often healing toward the possibility of more pain: invasive procedures, radiation, chemotherapy.

In some ways, I am lucky: My infusions are a less-toxic immunotherapy drug, which I seem to be tolerating well. In other ways, though, I am unlucky — for men who are cancer-free at age 50, there is a 0.7% chance of developing kidney or renal pelvis cancer before the age of 65, according to the American Cancer Society.

The pain gradually eased, though it was hard to notice. Small tasks became doable. I made myself meals. I resumed some late-night dog walks, and she appeared to forgive my absence — though I think she holds a grudge. Slowly, I faced the shame of unanswered texts and piled-up voicemail messages. My wife had gamely become communications director, a role she could now shed.

I’m still surprised, all these months later, at the gulf between the sophistication of modern medicine and the violence it can do to your body, even while saving a life. Ahead of the surgery, I marvelled at the machines and peppered surgeons with questions that were mostly technical, even insignificant. But I never asked them how I would feel.

At least one person warned me — the nurse — though I rejected it. Preparing a body for surgery is a mix of holiness and desecration. There are washes, fasts, robes, and hands on you. In the lead-up, I chose, maybe not even consciously, the holy. Then the scalpel met flesh, and all that I’d ignored flooded the room.

People often use the word “blinding” for colossal pain. I don’t think it’s just some linguistic trope. Pain is the opposite of what I saw and felt as we drove to the hospital on that cloudless morning. The light, brightening minute by minute — that was now unimaginable. I didn’t know then how sweeping the pain could be: how it ran not just along my body, but that it could seize my mind, too.

I would close my eyes during the most intense spells, thinking peace might come with darkness. What I saw, though, wasn’t comforting. There were vague, formless images skittering across the inside of my eyelids. They’d disappear, giving way to a grey abstraction, wide and churning as the ocean.

But there wasn’t water, and there was no horizon line. There was nothing but an ungiving seam where the sea refused to meet the sky.

-New York Times

A shocking diagnosis led a writer to focus on the dispassionate medical details, until his body jolted him into confronting what he hadn’t -Kerstin Wichmann/The New York Times