14: The Prognosis

Do not take life too seriously.

You will never get out of it alive.

Elbert Hubbard

“Please, sit down,” Dr. Punjab said, motioning to the chairs in front of his desk. “This is the oncologist I consulted, Dr. David Altinon. He’ll be advising us concerning your cancer risks.”

Phil pulled a chair out for his wife, while Toni moved a seat over from the corner. After they sat, Rajai began. David looked especially dour, and Toni wondered whether he’d ever cracked a smile. His expression was especially disturbing.

David was thin, with thin black hair with dark arched eyebrows. He also had a large mole on his left cheek. Phil was tempted to ask him if he’d checked if it was cancerous yet.

“As I suspected, your symptoms indicated a brain abnormality which was confirmed by your MRI.”

“Wait,” Toni said before he could get any further. “What symptoms?”

“His unusual behaviors, exaggerated actions, breaking his traditional relations and making all new—”

“I’m sorry, but you haven’t listed a single physical symptom. Instead, you’re passing judgment on his personal life. If you call yourself a physician, then let’s deal with facts. What’s the evidence say?”

“Toni,” Jane said. “Let the man say what he needs to.”

“The fact is, these are indicators something changed in his mental state. As I said, they were born out by his MRI.”

Dr. Rajai handed them an image of Phil’s brain, indicating a dark black spot near the back. “As you can see, you have a sizable mass in your lower back hemisphere. It’s pressing on your cerebellum and occipital lobe. Those regions control your vision and coordination.” Jane clutched Phil’s arm as he studied the image, but Toni took a different tack.

“Wait, you mentioned his coordination before,” Toni objected. “You’re making assumptions based on one video found on the internet, hardly an objective test. My father’s reactions are fine. Believe me, I’ve observed him more than you, both before and after he first called. He’s never had any problems with his balance or spacial abilities.”

“No? Then how do you account for his facial injuries, eyepatch, the cuts to his head or his living in a hotel? Let me guess, he ‘walked into a door’?”

“I’ve seen similar behaviors before,” David added, speaking up for the first time. “It’s generally not a good sign.”

“No. He was attacked and defended himself. Something he couldn’t do with the issues you’re describing.”

“You’re ignoring the MRI scan in front of you,” Rajai complained.

“No, you’re ignoring the evidence, and your tendency to jump to unjustifiable conclusions makes me question your opinion.”

Rajai flexed his hands, biting his lip. “Aside from his visions, actions and behaviors, the internal pressure inside his skull will continue impacting his abilities. His condition will only decline over time.”

“What about—?”

“Toni,” Jane chided.

Phil waved for quiet, pointing to his image.

“Doctor, the mass you indicated isn’t very large. It doesn’t correlate to what you’re describing.”

“That’s because it’s in a difficult to access area, hidden by the rest of the brain. Most views show portions of it, but it’s only when you compile them you get an idea of its true dimensions. The tumor is the size of a softball. Given it’s only been a week since your symptoms first appeared, it’s growing rapidly. You can’t afford to delay and this won’t be a simple surgery. As it’s hard to reach, we’ll need to enter near your spine, so the risk of—”

“Wait, you’re suggesting potentially paralyzing him?” Toni demanded. “What are the odds he’ll never move again?”

David leaned back, scowling, but Rajai continued on, obviously disturbed by the direction of the discussion.

“Better than the chances he’ll die,” Rajai said, glaring at her. “But the incision will be near his spinal cord, so the risks of complications are high. Depending on the type of tumor, we’ll also likely need to remove portions of his brain. Since it’s advancing so aggressively, it’s certain it’s cancerous. Though, to discuss that aspect, I’ll turn the discussion over to my colleague.”

“Wait, you’re already referring to it as a tumor, even though you haven’t conducted a biopsy,” Toni said, cutting David off. “Aren’t you jumping to conclusions?”

“I concur with Dr. Punjab,” David insisted. “Given the rapid growth, the physical symptoms in your father’s behavior and the looks of the scan, I’m convinced it’s not only cancerous, but extremely aggressive. We’ll need to conduct a biopsy immediately, as well as scheduling surgery as soon as possible. Given its advanced stage and apparent rapid growth, you don’t have any time to lose.”

“Hold on,” Toni cautioned, “but you both seem to be jumping to the most extreme conclusions based on non-conclusive evidence. Shouldn’t we perform the biopsy before we decide how we’re going to treat him, if at all? From everything I’ve seen, I agree with my father. I’ve seen no sign he’s suffering from anything at all.”

“We’ll take a biopsy, of course,” David explained, “but time is of the essence here. Thus I plan to perform a craniotomy, where we open him up, perform the biopsy, remove the tumor, and treat any further impacted areas of the brain. The biopsy will tell us more about the nature of the tumor. Due to the high risks, we’ll have several different cancer specialists on call, so we can address whichever cancer this might be, though I’m fairly confident which is most likely.

“The mass is especially dense, which indicates it’s already well-developed, even though there’s no indication it’s been there long. It’s also leeching into the surrounding tissue, indicating the cancer is metastasizing to the rest of the brain. We may not be able to stop it, but we’ll almost certainly need to remove any impacted portions of the brain. We’ll remove the tumor itself, extract any impacted portions of the brain, and then provide follow-up therapy with either chemotherapy or proton therapy.”

“By having the specialists on hand and waiting, we can take care of it immediately, rather than waiting for it to worsen,” Rajai continued. “We both strongly believe that time is of the essence. However, at this point, we’re both sure of the prognosis.”

“How long ... does he have if we don’t...” Jane inquired, kneading her hands.

“Given the aggressive growth and advanced size, I’d only say a couple weeks,” David pronounced. “A month at the maximum, but he’ll be in bad shape for most of that time.”

“I love your bedside manner,” Toni said, crossing her arms. “Any other encouraging words?”

“We require your decision immediately,” Rajai warned. “We need to assemble a team and make preparations. Between the neurologists trained to handle this kind of surgery, and the different cancer specialists, we need to coordinate several highly trained—”

“I’m sorry, but this is ... devastating news,” Phil said, still examining the scan results. “I’ll need ... a little while before I’m prepared to make a decision this major.”

“We can’t afford to wait,” Rajai insisted. “If you delay, the specialists I arranged will be reassigned to other tasks.”

“I won’t be pressured into making a snap judgment. I’ll contact you in enough time to make arrangements, but I’ve got a few important decisions to make. Come on,” he said, standing and motioning for his family to accompany him out. “I have some thinking to do.”

A honking horn distracted Phil in his solitary reflections. Turning to see what the disturbance was, a car parked by the edge of the park and three people: Ethan, Jacob and Alice, ran through the clearing to confront him.

“Please, I just want some time to contemplate my future,” he protested.

“Yeah, we heard, but we wanted to reinforce what you’re fighting for.” Ethan faced him, taking the lead, as Alice and Jacob stood on either side. “While you received some bad news, you can’t do anything about it. Given the prognosis, there’s a decent chance you won’t survive, or become an invalid for life. That’s terrible, and I don’t mean to belittle your pain, but it doesn’t change what you can accomplish.”

“You’ve fundamentally changed each of our lives,” Alice argued. “We were coasting through life, trying to survive the best we could. You hold the power to effect the same changes for multitudes. While you’re unable to change the direction of your own life, you can still alter the lives of hundreds. No, make that thousands when you factor in the families, lovers, companions and friends they’ll make over their lifetimes.”

“Do you want to die surrounded by your family, clutching your hand and changing your diapers?” Jacob asked. “Or go out fighting in a way everyone will remember. Believe me, we’ll all recount your achievements over the next several weeks for the rest of our lives.”

Phil cocked his head. “Where’s Emma? Did she put you up to this?”

Ethan shook his head, glancing over his shoulder. “No, she doesn’t know what we’re up to. She wanted to respect your privacy, but we couldn’t stand idly by while you made the biggest mistake of your life.”

“He doesn’t seem convinced,” Jacob observed. “Alice and I will try plan ‘B’.” Without explaining what that was, they left him and Ethan to wrestle over his choices.