As you know, I am currently receiving infusions of Keytruda for malignant melanoma of my dominant right thumb, for which I underwent partial amputation of the thumb and sentinel node biopsy of my axilla. I have been writing this blog to give my perspective of a surgeon becoming a patient, to give some perspective to other cancer patients, to share my faith, and to allow my friends and patients to keep track of my progress. Once everyone is up to date, I plan to write some blogs about healthy living and healthy habits that strengthen our bodies, decreasing overall inflammation and promoting immune system health to decrease one’s risk of cancer. But first, here is my firsthand account of the past 2 weeks, a story that is completely true, but one that could be hard to make up. 

Wednesday, November 17- The Bike Wreck

Although I have started to operate again on Wednesdays, there was no time available in the operating room on this particular day. Also, my son Gray and his fiancée Molly were coming in town for a few days, so I decided to take a day off work, and plan a fun day with them knowing that I was scheduled for my 5^th infusion of Keytruda the very next day. Gray’s friend, Jared Clements, was also in town with them.  Gray, Molly, and Jared are all in their last year of medical school at the University of Tennessee Health Sciences Center in Memphis, and all will be fine physicians in their respective careers.

Our day started off with beautiful weather and a 3-mile hike in the trails of Percy Warner Park. Gray, Molly, Jared, and me hiked together along with the dogs, Baylor and Bentley. Next, I had planned a road bike ride from our home in Nashville, through the beautiful West Meade area, onto the Richland Creek Greenway, and then over to Star Bagel for lunch. I rode with Gray and Molly. My wife Kellee, Jared, grandson Bradley, and grandson Jack met us there and we had a great lunch together. I kept commenting on “what a perfect day it had been so far” considering the weather, the hiking, the cycling, and the time with family. Oh was that about to change!

After lunch, we had planned to cycle back home on the same route, and we walked are bikes across the street, clipped into our pedals, and just started to head out. Somehow, while on the sidewalk, I must have become careless and allowed my front wheel to slip off the edge of the sidewalk at low speed. It slipped off right at the intersection with another sidewalk, leaving my front wheel in a low spot, abruptly stopping my bike at which time my rear wheel pitched upward, launching me over the handlebars in a complete 360, and landing on my side on the concrete with a hard “thud” and my bike on top of me. Immediately, I heard (and felt) my rib crack, knocking the breath out of me. Considering my severe pain, and inability to breathe, my family called “911” and an ambulance was summoned. I was transported to Vanderbilt University Medical Center with shortness of breath. I quickly became a patient on the Trauma Service there, with scans revealing a fractured 7^th rib, a right pneumothorax (collapsed lung), bilateral pulmonary contusions (bruised lungs on both sides), and a mediastinal hematoma (bleeding into my chest near the heart area). If a pneumothorax (collapsed lung) becomes severe enough that the lung continues to collapse more, then a chest tube is placed. Initially, there was just a small amount of air outside my lung but inside the chest cavity. But I progressively developed more pain and shortness of breath, and my repeat chest x-ray revealed further collapse of my lung, so my team of physicians consented me for a chest tube. An incision was made on the right side of my chest after some local anesthesia, and the tube was inserted through the soft tissues, over a rib, and into my chest cavity with a rush of air.  It was connected to a container that allows air to escape out and over time the goal is for the lung to re-expand and seal the leak.  I spent the next two days in the hospital with the chest tube. It was able to be removed on Friday night, November 19, and I was discharged home. The situation at that time was pain with hardly any movement, worsening pain with a deep breath, and severe pain with a cough or sneeze. I was unable to lay flat for the next 2-3 weeks. Obviously, the bike injuries caused my Keytruda infusion to be postponed.

Saturday, November 20 – The Wedding

My niece, Katherine, was scheduled to get married to Andrew the day after I was discharged from the hospital. It had been twice postponed secondary to Covid restrictions, and the big day was finally here. My sister, Andrea, and her husband, Ray, live just down the street. Their kids, Katherine, Charles, and Caroline have grown up with my kids so closely that they are almost like siblings. Our family is so close to each other, and there was no way I was going to miss her wedding, even though I had been in the hospital less than 24 hours prior to the wedding. Despite the rib fracture and chest tube dressing, I donned a tuxedo, took some Ibuprofen, and went to the wedding and dinner reception afterwards!

Thursday, December 2- Infusion Time

Well, two weeks after it was scheduled, I finally received my 5^th infusion of Keytruda. I had f/u CT scans while I was admitted to the Trauma Service. Overall, the scans were good news.  For my right upper extremity, there was no evidence of any cancer in my arm and no enlarged lymph nodes. My chest and pelvis were notable only for the traumatic injuries.  The abdominal CT did reveal a few small liver lesions that look to be more chronic; but to be on the safe side, a repeat liver protocol CT is scheduled in 6 weeks to make sure they are stable…prayers accepted!

Saturday, December 4- The Race

As everyone knows, I was in training for a triathlon when I got the diagnosis of cancer.  I have continued to train as much as I can because the exercise seems to combat the fatigue that I get on Keytruda. Months ago, Gray and Molly had signed up for the St. Jude Half Marathon in Memphis, Tennessee, and I had signed up for the St. Jude 10K. This event is a huge fundraising event for pediatric cancer research at St. Jude Hospital in Memphis. Despite the Keytruda infusion 2 days earlier and the painful breathing from the fractured rib, I was determined to finish this race.

For some reason, I have always been able to tolerate pain very well. One of my hobbies is horses.  I have been riding horses for over 50 years. We sometimes take our horses on vacation with us and trail ride. A few years ago, while riding in rural Tennessee in the Big South Fork National Recreation Area, I was thrown when my horse Highland slipped on a wet, rocky trail, and I broke my distal radius.  I kept riding the rest of the week on vacation, seeking care later when I got home.

Kellee was our support team, and her sister, Kristin, and Kristin’s boyfriend, Robin, both made the trip to Memphis with us to do the 10k as well. So, I ran the 10K along with the support of Molly’s mother, Robin, who ran along with me and helped encourage me. I wound up finishing pretty high in my age group. Gray and Molly both ran strong and outstanding half marathon races as well.

Suffering

In conclusion, I think about the last two weeks and the last 6 months, and I do think “suffering” is a good description for some of my experiences.  And what does that mean to me? Through all my suffering this year, I have continued to experience God’s presence in my life.   Psalm 27 of David, verse 1 states, “The Lord is my light and my salvation- whom shall I fear? The Lord is the stronghold of my life- of whom shall I be afraid?”

Some of my earlier blogs have mentioned moments that I feel are providential. I have not experienced God in an academic and impersonal way; for me, I have experienced Him in a real, experiential type of way. The comfort of His presence has drawn me closer to Him, closer to my family, and closer to my friends. Kellee and I have had a major reset in our lives, have simplified our lives, and have focused on our personal relationships with God through our hope in Jesus Christ, not the empty hollow promises of all the secular, worldly, influences that claim to bring us happiness.

Thanks for being part of my journey!