On Christmas Eve, 2003 I went to the bathroom and had a very bloody bowel movement -- much more than I had seen before. I thought about going to the emergency room but realized that it wasn't enough to be immediately fatal. I could call my family doctor, but there was a problem:
I had just defended my doctoral thesis at the University of Michigan and was about to move to Washington, DC the following week to start a prestigious fellowship at the National Institute of Standards and Technology. If I called the doctor then I would have to go through a long series of office visits to diagnose the problem. But my medical insurance in Michigan was about to expire and if I didn't get to NIST by January I would lose my fellowship. So I decided that if the symptoms didn't continue or worsen I would wait until getting a new doctor in Washington.
The bleeding stopped after a day and I thought maybe it was a one-time occurrence. But it returned a few weeks later and recurred on-and-off over the next few months along with bouts of nausea. By June I was settled into my new job and, after changes to my diet to rule out a reaction to certain foods, made an appointment to see my new doctor.
His response was similar to my previous doctor's. The bleeding was probably from something simple like an anal fissure or hemorrhoids. He did a digital exam, found nothing, and sent me home with an occult blood test to check whether I was bleeding even when there was no visible blood.
That test came back positive, so he said that I should see a proctologist for further investigation. The proctologist did another exam and decided that we needed a colonoscopy to see what was going on. I was still 20 years younger than the recommended age for regular colonoscopies, so he expected we'd find something easily treatable like internal hemorrhoids or maybe irritable bowel syndrome.
I had to return to my family doctor for a heart and lung exam since I was going to be sedated for the colonoscopy. My doctor was booked up, so I saw an older doctor instead. Passing the physical was no problem since I was young and otherwise healthy. He reassured me that at my age the colonoscopy wouldn't reveal anything scary like cancer. That'd be a one-in-a-million chance and worthy of a report in a medical journal.
So I went for the colonoscopy expecting to find a benign or easily treatable cause of my bleeding. The preparation wasn't as bad as I feared -- I drank some tasteless powder dissolved in a large bottle of Gatorade and spent most of the evening going to the bathroom. It wasn't accompanied by cramps like regular diarrhea, so it wasn't as unpleasant as it sounds. I checked into the clinic, got an IV for the sedation, and was wheeled into the procedure room.
The next thing I knew I was woken up by a worried-looking nurse in the recovery area. She told me that I still had five good feet of colon and I would recover just fine. (Recover?! What's wrong with the rest of my colon?) Then the anesthesiologist came by looking dour and expressed his sympathy. I was still groggy from the sedation but knew something bad was up.
A few minutes later I went into the counseling room to meet with the doctor in private. He said the results were not good. They found a two-inch tumor in my sigmoid colon, just above the rectum. It was ulcerated and nearly blocking the passage. He showed me pictures from the colonoscopy which really helped me appreciate how bad it looked and understand that it was a real problem despite the fact that I otherwise felt pretty healthy.
He said that I would need surgery to remove a section of colon and sent me home with a list of tasks: schedule the surgery ASAP, get authorization from my insurance company, and get a blood test to check for cancer proteins. We didn't know for sure that the tumor was cancerous, but the doctor would proceed as if it was. My first question was: "Will I be able to take the trip to Italy I have planned in three weeks?". I guess denial really is the first stage of grief.
So I rode home with a friend, in a daze as I processed the expectation that I had a cancerous tumor. I called my mom, a doctor, to tell her the results and she made plans to drive down to Washington for the surgery. I had to make arrangements at work for my absence and realized that I didn't know how to deal with this diagnosis. I often laughed as I explained the situation to coworkers. It was so unexpected that it felt comical.
The colonoscopy was on August 12, 2004 and the surgery would be on August 17. I kept busy with preparations and went for a hike in Great Falls Park with a girl I had just started dating the previous week. I kept the news secret from her so that I could enjoy one more day of normalcy before the surgery.