Mystery Diagnosis

Around the end of October of last year, I noticed what I thought was a swollen lymph node on the right side of my neck. I was a bit distressed because I thought it meant a cold was coming on, and that was the week I was to host our playgroup's Halloween party. However, days passed and no cold symptoms appeared. The swollen lump on my neck was getting more sore and tender to the touch to the point where I was popping ibuprofen several times a day.

When after a week the swelling had not resolved, I reluctantly decided to walk into the student health clinic. The irony of UCSF student health is that at a hospital world renowned for hiring and training the foremost physicians in every field, the physicians that are hired to treat the students at Student Health seem like they were scraped from the bottom of the medical school barrel.

After the doctor assessed my neck lump, she ordered some standard labs to look for signs of infection (CBC, mumps and mono antibody) and also suggested I suck on sour candies to induce salivation in case I had a blocked salivary gland. When I followed up with her later that week, my labs had come back normal, but the swelling had not improved. The poor student health doctor seemed at a loss. She actually told me she was going to step out into the hall so that she could pace up and down and think about what to do. After returning, she decided to empirically prescibe some antibiotics in case I had some kind of subclinical infection.

Another few days go by, and the antibiotics do nothing to help the swelling. In fact, if anything the lump had gotten worse, having grown from the size of a grape to the size of a walnut and occassionaly waking me in the middle of the night due to discomfort. Still baffled, my doctor referred me to Radiology to get an ultrasound on my neck. When I met with her two days later, she told me that the ultrasound had showed a "heterogenous mass" that was inconsistent with an inflamed lymph node or a blocked salivary gland. Then the report dropped the N-bomb: Neoplasm.

The recommendation was further imaging by MRI with contrast. I was ushered into the MRI early that same afternoon. The closest personal experiences I have had with MRI is when Ruby had one to image what was discovered to be a small teratoma on her tailbone when she was 2 weeks old and also what I have seen on House. Unfortunately, the experience was at least as, if not more unpleasant than what I imagined. The tube of the machine, although narrow-looking on TV, seemed much narrower in person. Also, perhaps because I was getting a MRI of my head and neck, my head was wedged in on both sides and something that looked like a cage ala Hannibal Lecter was placed over my face. The most unexpected part of the procedure was the sound, which made the experience akin to being buried alive with a jackhammer trying to dig me out. I was told that it was imperative to remain absolutely still during each image. Any slight movement such as swallowing, blinking, breathing too hard would render the image unusable and it would have to be repeated. Each image took anywhere from 2 to 6 minutes to take. All tolled, I spent approximately 50-55 minutes in the machine. By the end, I was ready and willing to give up military secrets.

Since the MRI was done on a Friday afternoon, an appointment was made with an ENT (ear, nose and throat) specialist for Monday morning to go over the results. This gave us the whole weekend to stew, which was more than enough time for me to convince myself that I had some kind of weird cancer. Although on the surface that weekend was just like any other weekend (we went to the zoo, hung out with friends), inside my head I was not able to stop myself from touching on the deepest, darkest thoughts. What if I am no longer able to take care of Ruby? What if I'm not around to see her grow up?

For one weekend, all of our plans for the future halted. We could not return emails to our architect regarding our planned home remodel; I cancelled the experiments I had planned for the following weeks; we held off on ordering the Thanksgiving turkey. For one weekend I could not eat or sleep or look at Ruby without crying. The doctor's words turned over and over again in my head, "I want to move quickly on this. You're young, and you have a young child ..."

To spare those of you who didn't already know the worry and suspense, I did not have a tumor, and I am not going to die. However, the journey to the diagnosis had just begun and turned out to be much stranger than I could have imagined.

TO BE CONTINUED ...