I had completed chemotherapy treatments for colorectal cancer on July 19th, 2018. Prior to that, I grinded through radiation/chemotherapy, major surgery, followed by more chemo. This was considered the “gold standard” of treatment for ass cancer, and my doctor’s were pretty confident I was out of the woods. After completing the final phase, the plan was to continue checking in with doctors (including scans and bloodwork), followed by a minor surgery to work on some internal plumbing. The surgery was supposed to take place 6-8 weeks after my last round of chemotherapy; however, it didn’t actually take place until 3 months later, likely due to the overloaded healthcare system. The waiting was extremely frustrating, I just wanted to be done, yet I continued to remind myself to let The Universe unfold as it should.
In the meantime, I learned more about my disease from my oncologist. We talked numbers and statistics, along with expectations moving forward. Dr. G mentioned that we would monitor heavily for 3 years, as most cancer patients will relapse within a 36 month period. If we can get to the 5 year mark- beautiful. Data shows that individuals who remain cancer free for 5 years after treatments have a very good chance of never enduring the disease again. These were exciting numbers to discuss, and although I was a long way out, I was confident I could meet those marks with time.
As the weeks passed, frustration grew while waiting for my surgery date. Soon, the 8 week mark went by. I began calling Kaiser on the regular, attempting to get something scheduled. They continued to jerk me around, and I ended up filing a grievance which finally put the plan in motion. In early October, I received a surgery date for the end of the month. It was a simple procedure, taking less than an hour; although it did require full sedation/anesthetics. My date was scheduled for Monday, October 29th, 2018. I couldn’t wait to get it over with and finally move on from the disease of cancer.
Prior to the surgery, my doctor had one last CT scan and round of blood work completed. I eagerly awaited my scan results, as the “scanxiety” was settling in. Several days later I received a message from my doctor- everything looked wonderful. No signs of disease and the blood work checked out. We would move forward with the surgeon as planned, and I’d have time to recover and get back to “normal life”, with a plan to start teaching again in January of 2019.
My old man flew in for the surgery. It was business as usual- I picked him up from the airport the day before, we enjoyed some beach time in Oceanside, had dinner, and would wake up early for a 6 AM check in at Kaiser. Surgery was scheduled for 7:30 and I’d be out of the hospital in a day or two. Upon arrival at the hospital, I felt relatively confident. We went through the usual routine- checking in, taking vitals, placing an IV, meeting with the anesthesiologist, and a chat with the surgeon (Dr. K). Everything was a green light, I told my old man I’d see him soon and we’d be outta there. From there, the nurses wheeled me back to the OR.
Laying on the table, I was like a duck in a pond. Calm on the surface, with my feet churning a mile a minute underneath the water. I was confident Dr. K would take care of business. The nurses administered the anesthetics and I was forced into that unfamiliar realm of nothingness. Darkness overtook me in a second, and the next, I began to gain consciousness and wake up.
I knew something went horribly wrong the moment I woke up; mainly because I was in absolutely no pain. I was in the same physical state as I was before the surgery. I immediately began asking for a nurse; they all seemed to avoid me- nobody was approaching me. Several minutes later, my old man appeared. The moment I saw his face, it was obvious something had gone wrong. His eyes told the story, He had a blank, empty expression and approached me, saying, “Dr. K wasn’t able to do the surgery because the cancer is back”. It was devastating. It didn’t make any sense. How could it be? Every scan, every test- checked out. I had finished the “gold standard” of colorectal care just 3 months ago. How in the hell could this disease be back after 3 months?
Shortly after my dad broke the news, Dr. K showed up. It was evident that he wasn’t in his best state, obviously shook up from his findings. He explained that after I was sedated, he started with a routine exam of my butt. When he was in there, he found something that didn’t feel right and took a biopsy which showed that it was another tumor. Dr. K was compassionate, putting his hand on my shoulder and letting me know I could ask any question or raise concerns. I had nothing; shock had taken over, I just wanted to get outta there and go home.
The cancer recurrence was more detrimental than the initial diagnoses. We had worked so hard the previous 12 months; I did everything possible to get healthy. The feelings and emotions of the recurrence were unbearable- feelings of failure, sadness and overall depression. I was tired, exhausted, and didn’t want to continue. I hated the idea of having to go through everything again, and thought, “What’s the point? It’s obvious this thing is out of control. We just finished the gold standard of treatment, what the hell am I going to do?”. With no motivation or intent, I slipped into a depression and simply went through the motions over the next 4 weeks.
My oncologist caught wind of the news and even he was throttled by it. Deliberations ensued between him, my surgeon (Dr. K), and now back to Dr. S (radiation oncologist at UCSD). Initially, we didn’t have much of a plan. Nobody really knew what to do. Dr. G thought more chemotherapy was pointless, as it was obvious it didn’t have a great impact on the disease. Not only that, but it became more and more evident that Kaiser wasn’t the hospital program to handle this recurrence. I needed more options such as clinical trials offered through University systems. After more discussions, I later learned that Dr. K had mentioned to my father that it was his impression that my cancer is likely a rare mutation and obviously extremely aggressive. He was perplexed by the relapse after just three months.
In an effort to learn more about my cancer, Dr. G (oncologist) put in a request for a Molecular Profile. A Molecular Profile is a process in which they use tissue from the tumor to learn about the specific mutations in the cancer; and fascinating enough, it was conducted by the IBM Watson computer- comparing my tissue with thousands of peer reviewed, published research articles within the medical community. Cancer and tumors are so extremely complex, with hundreds, even thousands of different types of mutations to the cells. From my profile, we learned of two very rare mutations that were thriving within my body. One is called the KRAS G12C Mutation… I often refer to this one as KRAS the Krakken. A Krakken is a mythical creature from the deep sea, somewhat comparable to the mystery mutation killing my body. The other mutation is labeled as the TP53 mutation- another aggressive, unknown component to the disease.
I’ve always been a numbers/stats guy, letting science/data drive the operation. After receiving my Molecular Profile, I scoured every word to comprehend what I was facing, and with that, I reviewed the numbers and statistics regarding my rare mutations. The prognosis for these mutations isn’t good; yet I decided to throw those numbers out the window. I was already so far outside of the data norms regarding this disease- 29 year olds rarely get colorectal cancer. Combine that with my history of childhood cancer, and it’s hard to apply the data towards my situation as I am way outside of the standard cancer patient. Perhaps it’s part denial or wishful thinking, but I believe that by ignoring those numbers, I can gain a mental edge over the disease.
Over the next several weeks, we had come up with a plan to attack the disease. I would redo radiation/chemotherapy similar to round 1. The same routine, only this time, I would receive radiation 2x per day for 3 weeks. I would go into UCSD around 7 AM, receive treatments, and head back no earlier than 6 hours later for my second treatment of the day. Treatments would start soon, just after Thanksgiving. The clock was ticking, slowing down for nothing as the cancer continued to attack.
During the few weeks of planning, I was still in a state of shock and had slipped into a spell of depression. I just couldn’t fathom it, I couldn’t get a grip on it that I was sick again. Looking back, I think I placed myself in a state of denial in an effort to avoid the whole thing, thinking maybe it would just go away. It would take me all the way up to my first radiation appointment to shake off these feelings; I was at my first appointment and as I lay on the table for the start of more radiation, some external force had taken over and kicked me in the head, saying, “Get over it Flack, things could be worse. You’re still moving, you’re still breathing. Tons of people are out there in far worse situations. Get it together. It’s time to get back on the horse and ride this thing out again”.
