Riding the Bronch and the magic of words

I got out last Sunday late in the afternoon. After seven days in the hospital, I have eaten all the jello that I ever care to eat. I spent this week at home “recovering.”  So, here is kind of status update, plus an observation about things that would appear unrelated to most people but seem related to this quirky old fellow.

I had acute Bleomycin pulmonary toxicity (BPT).  Basically, the lungs become inflamed and fail because one of the chemo drugs (Bleomycin (Bleo)) decides to play nasty. People who suffer from Hodgkin’s lymphoma (HL) are typically treated with Bleo as a  part of the chemo cocktail and that puts them at risk. The potential consequences BPT are not insignificant. See, for example, here.

With help of an infectious disease specialist, a lung specialist and my oncologist working together, I was fortunate. They were able to diagnose and treat the problem rapidly and effectively. Without going into detail, both the diagnose and treatment of BPT are tricky and require close coordination between the specialists. After receiving their fine help and enjoying this week’s rest, I restart my chemo regime this coming Tuesday, but without using Bleo. The absence of Bleo in the regime is not a good thing, but there is no substitute for that drug in the current treatment protocols. Besides, there is no hard data that suggests that discontinuing Bleo at my age, and given my otherwise good progress, will make a difference in dealing with the HL.

Now, hold on, I am about to turn abruptly.

Radical legal realists (previously know as the “Crits”), and many language theorists more generally, believe that resolving disputes can never be based upon words having immutable meanings. That is, there is no “right” answer to the meaning of words and consequently the correctness of a legal decision. According to these folks, the judge should pick the meaning of words that takes into account the causes and consequences of legal disputes and legal decisions. Any other approach is “word-magic”or “transcendental nonsense.” JOHN HASNAS, BACK TO THE FUTURE: FROM CRITICAL LEGAL STUDIES FORWARD TO LEGAL REALISM, OR HOW NOT TO MISS THE POINT OF THE INDETERMINACY ARGUMENT, 45 Duke Law Journal 84, 90 (1995) (footnotes and citations omitted).

Tighten your grip, I am about to swerve again.

While I was in the hospital, I rode the “Bronch” (for the purpose of lavage). Basically, what happens is that a lung doctor sticks a scope with a camera down your throat, the doctor visually examines the lung, the doctor injects a saline solution through the tube and into the lung, and the doctor withdraws the saline solution for later analysis. In my case, the doctors, a technician (I think) and a nurse came to my room dressed in “yellow hazemat” suits with their machinery and equipment.  The lung doctor explained the procedure and assured me I would feel nothing since I would be lightly sedated. Below is a pretty good photo of somebody like me riding the “Bronch” from his hospital bed.

 

The lung doctor asked if I had any questions. I said that it sounded like he wanted permission to “water board” me. Without missing a beat, the doctor replied that he preferred to think of it as “power washing.” We both laughed, and the sedative began to flow. The last thing I remember is drifting off amused by the magic of words.

RGK

 

 

 

 

 

 

 

 

 

 

Too much of good thing?

Monday, I had a bone marrow biopsy.  Not as painful as some folks claim. No report yet on whether the Hodgkin’s lymphoma has gotten into the marrow

Today, I saw my old neighbor in Omaha, Dr. Jim Armitage, who is one of the world’s leading authorities on the treatment of lymphoma. He is at the University of Nebraska Medical Center. What a gentle, kind man! He will consult with Dr. Nate Green my local treating oncologist. I have great confidence in Dr. Green as well.

Earlier, I had a CT guided needle biopsy of the lymph nodes but the PET scan that followed isolated activity in the left lung as well as activity in the lymph nodes. Dr. Armitage therefore suggested a biopsy of a nodule in my left lung revealed by the PET scan. While it is unlikely, he wants to rule out the possibility that there are two different kinds of cancers taking a bite out of me at the same time. So, off to UNMC on Friday to have a CT guided needle biopsy of the left lung by an interventional radiologist. Thereafter, the pathologists at UNMC, who are also world-class when it comes to lymphomas, will be able to tell if the growth is the product of Hodgkin’s lymphoma or some other cancer.

At the local hospital, I will have the port installed tomorrow through which chemotherapy will be administered.  On Thursday, once again at the local hospital, the ejection fraction of my heart (pumping capacity in lay terms) will be tested so that the doctors have a good baseline. Certain chemo drugs can impair the heart and with a proper baseline that concern can be monitored properly during the administration of chemo therapy.

Hopefully, early next week, Dr. Green will tell me what he and Dr. Armitage have decided is the best course of treatment. After that, I can start planning on how to balance my caseload with the demands of treatment. My wonderful colleagues have offered to lend a hand in any way I might need. But, I can’t make any firm plans until I have a better insight into what may be ahead. In this regard, I am very sensitive to the fact that lawyers need to know where they stand, but feel awkward inquiring. (“Say Judge, I know you have cancer and all, but are you going to be able to try my fucking case that you continued twice already?”) Truly, as soon as I have firm plan of action, I will let my colleagues and members of the bar know what I will be doing.

To conclude, let me ask a question: Can you ever get too much of a good thing?  By the looks of things, I am out to answer that age-old question. More later.

RGK

PS.  I appreciate the many words of support and encouragement.  When I can, I will respond individually. But for now, know that I appreciate the thoughtfulness. That appreciation even extends to David Stickman, Nebraska’s excellent Federal Public Defender. In part, David wrote: “This type of cancer must be like the guidelines, no longer mandating a harsh result. Advisory in the sense it must be properly diagnosed (and treated) but then wholly disregarded!”  David Stickman, March 7, 2014 at 8:46 am. David, you have no shame, but I have always liked that about you.

He’s alive!

I thought I had shut down this blog forever but something came up that warrants reopening.

In December of 2013, I wrote that I suffered from blood clots in the left leg. E.g., Merry Fucking Christmas. On January 1, 2014, I announced that I was ending the blog. Among other things, I wrote that: “Although I am truly worn out, I am OK. I am not quitting because of health reasons.” I didn’t know it then, but I was wrong.

Since my attempt to kill the blog, the pain in my left leg worsened and the swelling refused to abate even though the new miracle drug for blood clots that I took was working. As a result, I began a magical mystery tour of doctors including, but not limited to, my general practitioner, a cardiologist, an orthopedic surgeon, an interventional radiologist, a gastroenterologist and a oncologist/hematologist.

Yesterday, I learned that I have Hodgkin’s lymphoma. For what it is worth, that is the “good” kind.  It also explains my exhaustion and the blood clots that suddenly appeared while I was in Sioux City trying a case in December of 2013.

My very experienced oncologist tells me that the disease is at stage III or IV and a bone marrow biopsy next week will determine whether it is stage III or IV. That is not nearly as dire as it sounds. “Hodgkin lymphoma is one of the most curable cancers. Cure is even more likely if it is diagnosed and treated early. Unlike other cancers, Hodgkin lymphoma is also curable in its late stages.” Hodgkin Lymphoma.

Because I made such a fuss about legal realism and transparency while this blog was active, remaining silent seemed dishonest. I won’t start treatment (chemotherapy and possibly radiation) until shortly after March 17, 2014. Periodically, I will let you know how I am doing.

By the way, I am pretty proud of myself. It seems that I have resurrected Generalissimo Francisco Franco. (He’s alive!) And that, my dear friends, is the perfect exemplification of Article III power.

RGK

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