Referral-ception.

I’ve not gotten nauseated by the (now) two times I’ve been under general anesthesia, but I sure do get dizzy as shit when I stand. Rena was able to get me into her small SUV with the help of a volunteer at the hospital, but getting from the street to my house took a little more of a coordinated effort. My frame dwarfs hers and it was like one guy trying to move a large box that barely fits through a doorway solo: technically possible, but not advisable if it can be avoided.

She put me into bed and started a medicine journal for me. After some dozing, I joined her on the couch and we started watching “American Manhunt: OJ Simpson” on Netflix.  I vividly remember the OJ Simpson trial as a kid in the 90s: the courtroom drama, the main cast of witnesses and their tabloid exploits, and of course the white bronco. Sadly, this was the one part I wanted to see the most and I managed to doze off for only that episode.  Not doing anything besides being put to sleep and cut open is absolutely exhausting.

Eventually Rena passed me off to someone we’ll call Addison for now. Addison and I had just started dating and despite everything going on with me, she was still subscribing to the idea that I might be worth trauma bonding with over this experience. She even shopped with me the night before the procedure to make sure I had throat-friendly foods to survive off of for at least a few days, and kept me from buying more than one thing that were poor investments to this end.

Addison kept up the maintenance of my medicine schedule and kept vigil until the evening. Because of my prolific napping during the day, I’d managed to stay up well beyond my normal bedtime but eventually managed to go to sleep.

Rena once again escorted me back to the hospital for a follow-on ENT appointment two days later with LTC Sierra. She basically reaffirmed she had no reason to change her opinion on the findings despite Pathology not having completed the biopsy yet, and began to run down the complete cast of characters I was about to see in the coming weeks through referrals and referrals from my referrals. 

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Your average law enforcement interaction.

In preparation for the eventual official diagnosis I made plans to go to Canada with Addison. See, she’s actually Canadian and was floored that I’d never been, what with having spent so much of my life in states bordering the great white north. My Detroit Red Wings were on their western North America road trip and this was as good of time as any to go see them. Hell, for all I knew it was the last time I was going to get to see them. I found us reasonably priced tickets, and she was going to be my chaperone as we made our way to Vancouver (she likes to joke that this was actually the second time I’d been in Canada).

Fortunately, I made the call Saturday that I was feeling well enough to travel because my sore throat was just about gone and I was able to choke down (bland) solid foods. Mother nature gave us her best shot as we braved significant snowfall all the way up I-5 in her seasoned RAV4, but we made it to the border where Canada was rolling out the red carpet on the heels of the Trump tariff announcement.

I handed the Canadian border guard our passports, answered the line of questions your average American would expect from law enforcement, and went on our way. 

Addison immediately turned to me and said, “Wow, I’m sorry she was so extra; that’s more aggressive than anything I’ve experienced before.”

Me, visibly confused, “What do you mean? That is about what I expected…”

Addison explained to me that what I found to be a very standard law enforcement interaction was, in fact, incredibly unusual and that I was treated with undue hostility.  I was still amazed that we were the only car at the gate for the entire interaction and that no one was visiting Canada or even returning home on a Sunday afternoon.

We had an absolutely amazing time checking out the Grandville Island district, checking to see if the rumors were true about Canadian Costco carrying bulk hockey gear (fake news), and heading into the arena.

Something you need to understand about hockey, if you’re unfamiliar, is that both anthems, Star Spangled Banner and Oh Canada, are played if one of the teams is from the other country. This is fairly standard practice across both nations, and the crowd sings, or is at least respectful of, both anthems. Because of the tariff announcement, two Canada games from the previous night involved the crowd booing the U.S. anthem. This is almost unprecedented, as there are even documented instances of both anthems being sung by the opposite crowd when PA systems fail. You have to understand and appreciate hockey culture to really understand how fucking angry fans have to get to break with this tradition. This is peak hockey civil disobedience.

Vancouver fans are generally the rowdiest of Canadian fanbases, and they had a whole 24 hour sports news cycle to soak this up. I was expecting boos during the anthem, but Jesus Christ. It was loud, it was uncomfortable, but I held my hand over my heart and my lips shut and stood respectfully silent for both anthems. I mean, I get it, they have a right to be upset and symbolically voice their distaste. Of all forms of protest, this was pretty innocuous if the other end of the scale is blocking an interstate highway.

Fortunately, it was a fairly standard hockey crowd and even leaned, perhaps, at least 20% Red Wings fans. Despite dealing with the stress of an overtime game as an “away” fan in my weakened state, it was an overall good experience and I’d go back.

We eventually made our way back south, and got caught in the throng of Americans returning home for the weekend where we experienced a very cheery, albeit short staffed, American border crossing guard that lightly roasted Addison for admitting she didn’t buy me anything.

The next day I was officially diagnosed with cancer.

============

My tumor has more civil rights than the average North Korean citizen.

I saw the pathology report in Genesis the moment before LTC Sierra called me. It confirmed everything she’d hypothesised up to that point: oropharyngeal squamous cell carcinoma with p16 marker, meaning HPV related. Congrats on being one of the fewer than 30,000 people, overwhelmingly men, that get this a year, Kyle! The good news, if it can be called that, was that because I wasn’t a smoker or drinker, my flavor of cancer was much more responsive to treatment.

What does that mean? I was being referred to the following for evaluations and preparation to find out:

• Radiology Oncology
• Medical Oncology
• Speech Therapy
• Nuclear Medicine
• ENT Oncology at a nearby civilian hospital
• Nutritionist
• Behavioral Health
• Social Worker
• Case Manager
• Genetics

I could hear the appointment wait line music start to play in my head.

“All of these people will call you, you shouldn’t have to chase anyone down,” she said as visions of appointments danced in my head.

The tentative treatment plan would be surgery, radiation, and chemotherapy but the “Tumor Board” (this is not a euphemism for the chain of command board in the company HQ, as PFC Cancer would have cracked a joke about earlier in his Army career) would convene on Friday to “stage” me and formally recommend treatment. This would all hinge on the results of my “PET scan,” which was a type of scan designed to see if the cancer had spread to any other parts of my body.  Cancer in other parts of the body = Fire up the John Cena tracker.

The Tumor Board is all the heads of state of the relevant departments; in my case ENT, Radiology, Radiology Oncology, Medical Oncology, and Pathology coming together and voting on a plan to present to me for approval. There’s even meeting minutes, of sorts, in my Genesis records.

They presented their plan to me immediately following the meeting, at my previously scheduled onboarding appointment at radiation oncology: No surgery was being recommended, but still to see the ENT Oncology civilian expert to get his opinion. I was being told radiation and chemo were my path forward, but that I was free to ask Medical Oncology their thoughts next week on immunotherapy. The silver lining, of sorts, was that the PET Scan didn’t reveal anything but some, probably, unrelated scarring on my lungs and a mass in my liver that was probably a benign rogue blood vessel, but I’d need a separate MRI of that just to be sure.

Let me backup and explain the PET Scan real quick, with the help of our friends at ChatGPT:

“A PET scan (Positron Emission Tomography) is a type of medical imaging that helps doctors see how your body is working, rather than just what it looks like.

Here’s how it works in simple terms:

1. A special substance (called a tracer) is injected into your body. This tracer contains a small amount of radioactive material that can be tracked.
2. The tracer moves through your body, and certain parts of your body (like organs or tissues) use it. The tracer gives off tiny particles called positrons.
3. A scanner detects the positrons as they are released, creating images of where the tracer has gone. This helps doctors see areas with changes in activity, such as tumors, infections, or problems in the heart or brain.

In short, a PET scan helps doctors look at how things are working inside your body, not just the structure, by using a special tracer and detecting the energy it gives off.”

What happens in reality is you show up to Nuclear Medicine after 24 hours of only being allowed to eat plain meat or solid plain cheese and water, in your comfy clothes, get an IV placed into your arm and brought into a room with dim lights, no sound, and a warm blanket. The rationale here is that a stimulated brain and shivering muscles will absorb the radioactive material you are getting injected with, which is universally seen as bad.

Just in case you glossed over the first few mentions: you are literally getting injected with radioactive sugars. The tech brought it into the waiting room in a lead-lined case, in a lead-lined syringe and injected it into my IV. Awesome, at least if I have cancer I also may develop superpowers for a short time as a result.

Then you lay in yet another MRI-esque scanning tube to get your PET and another round of CT with contrast. After the CT with contrast my face had a reaction to the contrast, which was a slightly itchy face and the slight look and feel of being sunburned. I am just glad I didn’t get actually cooked by the scan- it would be a real bummer to have cancer and radioactive blood to go along with a sunburned face.

Fast forward back to Radiology Oncology.

Radiology Oncology itself is quite possibly the scariest appointment I’ve been to to date. Everything being described by the Dr, a jovial fellow we’ll call MAJ Rafferty, was horrific to my non-medical mind.

After every disturbing side effect of radiation and chemo was listed, it was always capped off with, “…but your type of tumor will just melt away by the end.” 

Fortunately, he did place a referral to the nearby highly regarded cancer center called “Fred Hutch” to see if a different kind of radiation might fit the bill better, one generally given to pediatric patients but, once again, because of my age, I may be a candidate for.  The perks of being “the youngest we’ve seen” I suppose.

The next entry of this journal will be somewhat delayed, the reasons for which will be covered in the next journal entry.

The views and opinions presented herein are those of the author and do not necessarily represent the views of the Department of Defense or the U.S. Army.