In this series of journal entries, Dr. Anthony Benchina recounts his own personal journey from physician to patient as he navigates the many stages of lung cancer diagnosis and treatment.
2012 was going to be a banner year for me—retiring after plying my trade as a Family Physician for 41 years, the first 7 in my Canadian hometown and the remainder in my newly adopted home Cullman, a small town in North Alabama.
I had set a retirement date of April 1 and at the start of the year I notified my patients of my plans and spent the next three months trying to ensure that they would have continued medical care and just generally winding down my affairs. It was a trying time both emotionally—saying goodbye to nice folks who had entrusted me to look after their health care for up to almost 35 years—and physically— as I was very tired, partly from the stress of this major life event and partly because I was now an elder in my 66th year.
My wife Susie and I had made plans to move to Tampa, Florida to be closer to our younger daughter and now we were about to start enjoying ourselves. As many people do we had forgone many adventures due to the demands of work but now were about to reap the rewards of our long wait.
So what happened? Well, my first simple task in our new home was to help with the housework by dusting the bedrooms. Thirty minutes in, Susie came to check on my progress and found me sitting in my bedroom rocker complaining of being tired and the job barely started. She thought I was just lazy and she was partly right but I knew there was more to it. We would sit down to dinner and I would complain of something not being right but I couldn’t pinpoint anything specific. I’d had some standard blood tests just before retiring and everything was normal. I saw my ENT to follow-up on a vocal cord problem and nothing much showed up. I remember his asking if I thought something was wrong and I answered yes but we had no explanation for it. I had an evaluation by an internist and nothing showed up. I touch upon these incidents not to criticize those doctors because they were very good at their jobs, otherwise I would not have seen them. But whatever was ailing me was very insidious and showing just non-specific manifestations.
Then little things started happening.
I was at a dance lesson and my teacher Kim would make small talk and give me pointers as always but I had trouble finding enough breath to easily reply. Then I developed a nighttime non-productive cough and a slight wheeze. During a visit, my son-in-law Charles told me that I should “get that cough checked out.” He was right but I didn’t tell him that I had already made an appointment to see my cardiologist friend in Birmingham. If his work-up was unremarkable I planned to see a pulmonologist next. I thought for starters I would have a cardiac evaluation to be sure I wasn’t in occult heart failure.
Next, Susie and I went to Birmingham and I had scans that indicated normal heart function and no sign of lack of blood supply to my heart muscle. As a final step I was to have a treadmill test, which I expected to perform reasonably well as I had been doing some low-level workouts on our home stationary bike. However, within 10 seconds on the treadmill I was wheezing to beat the band, and neither I nor my cardiologist Mike could believe it.
Then I was referred to a pulmonologist, Mike, to whom I had sent many patients over the years. I saw him the next week and thought he would find some type of airway problem, perhaps some form of asthma. My pulmonary function tests were fine as was my blood oxygen level. My physical exam was normal. My chest x-ray showed a barely visible questionable abnormality in the left lung, likely nothing, but MIke had me return the following week for a chest CT. I also tried an inhaler that didn’t seem to help.
The following week Susie and I went down for my chest CT and were to see Mike the following day. Halfway home we received a call from Mike’s office telling us that he wanted to see us at 1 PM that day. I turned to Susie in the car and told her “You know what that means.” I had made calls like that in my career, calls that I always dreaded knowing how life altering they would be. We vowed to remain calm and deal with whatever was ahead of us in a determined manner.
The next day, Mike took us into his office, told us “It didn’t look good” and pulled up my scans on the desktop monitor. To say it didn’t look good was an understatement. Tumor evident in both lungs, enlarged lymph nodes in the chest and neck, a suspicious area in one adrenal gland, an abnormality around one kidney, a lesion in the liver and some small spots in the spine. Whammo! Going from feeling tired with a few minor symptoms to probable Stage 4 lung cancer in the space of a couple of hours. In the next few days I had a brain MRI that was normal and a PET scan confirming tumors in the involved areas. After these staging tests all that remained was to confirm the disease with a microscopic examination of a tissue biopsy.
It was a long drive home.
What to do next? Should we tell the girls? We decided to hold off saying anything until we had a more concrete diagnosis. Should we take the house off the market? Should we move? Should we sell the house and rent in Birmingham where I would be closer to treatment? Should we tell my brother Joe who is disabled and in a nursing home in Toronto, and for whom we are his long-distance caretakers? So many crazy things went through our minds it felt as though our brains had come apart.