Mapping my tumors

Monday, May 21 was the first stage of my treatment with Y-90 radioactive beads – although it didn’t actually involve the beads themselves at all.

Instead, Monday I received, or underwent, a “mapping arteriogram.” The point of this procedure was to determine exactly where the tumors are that the radioactive beads will be used on, and also to make sure that it will be possible to get the beads to the tumors through my circulatory system.

To find all that out is a fairly elaborate matter, though still an outpatient rather than inpatient procedure. I remember none of it, though it’s possible I was faintly aware of what was going on as it actually happened, since I wasn’t under full anesthesia. Still I understand the basic idea: the interventional radiologist inserted a catheter into my femoral artery in my groin, and then ran that catheter through my circulatory system all the way up to and I think into my liver. Meanwhile, a tracer substance (perhaps targeting a liver protein called albumin) was injected through the catheter so that the radiologist could see exactly where the catheter would be delivering treatment. As I understand it, also, the radiologist wasn’t relying just on looking at whatever scan they were running to follow the catheter’s progress; there’s also some elaborate mathematical analysis done after the procedure itself is complete, by which they make the results as precise as possible.

Teresa spoke with the interventional radiologist about the initial results (possibly while I was still unconscious), and they were quite encouraging. The blood vessels to my liver are something of a challenge, I think because when my intrahepatic pump was installed they had to cut off one of the two main veins to the liver as part of getting the pump’s catheter connected up properly to the liver. That now makes delivery of the beads to their targets somewhat harder, but the radiologist assured Teresa that the procedure is still safe and should be productive – and so we’ll be moving on to the actual infusion of the beads in a couple of weeks.

To carry out this mapping arteriogram required a great deal of organizational and human skill, and reminded me of how fortunate I am to be getting treatment at Memorial Sloan Kettering. In the course of the day I interacted with five nurses; an anesthesiologist; at least three or four staff members, including more nurses, in the procedure room itself; another staff member who returned me (in bed) to the recovery room; and – though I was never conscious of it – the interventional radiologist who was the center of all this. Everyone was friendly and professional, and from my perspective things went pretty smoothly.

From Teresa’s perspective, out in the waiting room after I’d been taken to the room where the procedure was done, things weren’t so good. As I’ve mentioned, the interventional radiologist spoke with her; that part was fine. But we had been puzzled all along by the fact that I was scheduled yesterday both for this procedure, starting at 7:30 AM, and for an appointment in “Nuclear Medicine” at 1:00 PM. We weren’t sure what that second appointment was, but it turned out that it was another scan, I think meant to check whether any of the injected tracer had gone to the wrong parts of my body. For me, this went perfectly smoothly; they wheeled me into the scan room after the arteriogram itself was over, and then wheeled me out and over to the recovery area after that.

But meanwhile Teresa, in the waiting area, was being told on the phone by an increasingly impatient nurse that she (Teresa) might be accompanying me to the scan after the arteriogram was over. This was not going to happen! It would be two hours more after the scan before I was ready to be discharged, and I didn’t get out of bed in that entire stretch. I was in no position to be discharged from recovery and to walk somewhere else in the hospital – and in any case I’d already been wheeled to the scan and had it done.

Back in the recovery room, I was a bit surprised not to see Teresa at once, and I asked a nurse if she could let Teresa know that she could join me. The nurse said they’d done so, or tried to do so, once already, but would do so again – and a few minutes later Teresa appeared. From my end, this seemed simple and straightforward, but it hadn’t been that way out in the waiting room. So Sloan Kettering did all the medical stuff right, but not what might have seemed like the easy part: letting Teresa know when she’d be able to rejoin me! Anyway it was really good to see Teresa, and we spent the next two hours waiting, or dozing, as the two nurses on duty, one of whom was training the other, made sure I was ready to go.

The nurses were a good-spirited pair. We discussed why my last name has two n’s (was I German? No, Jewish. But you can be German and Jewish. Yes, but my Ellmanns were from Rumania) and then moved on to the important topic of what to eat for a special meal. We agreed that desserts – lots of different desserts – were good, and what do you know – Teresa made a berry gratin for our dinner at home. Delicious!