T Minus 30

Teague’s surgery is scheduled for one month from today, September 19. He’ll have an MRI the day before to determine exactly where they’ll go in (read: where they’ll cut). Then we’ll know if it’ll be behind Teague’s hairline or in front of it, along it, on his forehead, or what.

Surgeons think in terms of the best way in. Moms think in terms of maiming. In my mind I just see this long red scar running down the side of his forehead because that’s where your mind goes when you’ve been stewing on it for the last few weeks and you still have a month to think about it. I believe it will go fine. But the truth is, it’ll be what it is. We won’t know the outcome until we get it.

I’m feeling OK about things generally, but I know I’m not normal. Like, I’m quickly trying to schedule family pictures before they mess up Teague’s face or ruin his brain or both, and that's kind of embarrassing. The cuckoo part of me has created this nasty program that runs in the background of my daily, we’re-all-good mindset. Its message is that we have one more month for things to be as they are.

Time is my enemy. Last time, there was no time. Decisions were made and carried out right then, and there wasn’t room for second-guessing. The worrying came after the fact, when it was all done. In a weird way, it’s easier to make battlefield “Did we just DO that??” decisions than methodical “Is this what we should do?” ones.

Not that any of it is easy. What a weird concept. That’s the word Dr. Cheshier used to describe this procedure. Easy. Because he’s a neurosurgeon, and it’s easy compared to the things he normally does. But it’s not easy compared to the things we normally do. I’m still hung up on the chunk of brain they’re going to remove. It makes me sick, and it scares me.

I have to find a word that makes sense to me that can get me to that “easy” place. Something that lets me be reasonable as I think about the risks. Something that lets me be real without the crazy. “Easy” is  not that word.

Life has hard things in it, all the time. It doesn’t stop. Sometimes you get little breathers, but there’s always a challenge, always a worry, always something beyond your control, always something you don’t feel quite prepared for.

There’s always a reason to have faith that you’re being refined. Faith that through the grace of God, you’ll get the help you need to get through it. Faith to learn better than ever before how to trust God more completely than ever before.

I don’t know where I am with that. All I’ve got right now is knowing that the decisions we’ve made up to this point are the right ones.

(First day of seventh grade was today.)

Craniotomy It Is

We’re doing the craniotomy, which is a procedure similar to the way you cut out the top of a pumpkin to carve it. Except on Teague’s head.

Originally I was pretty dead-set on the needle biopsy because please, let’s not mess with this kid any more than we have to. But we met again yesterday with Dr. Cheshier, and while this growth is small enough to be removed with a needle, it’s more complete if he takes a margin.

We’re all very sure that whatever this thing is, it's benign (everyone except Quinn, that is—he’s already 10 miles down the cancer road in his mind, living in all the stress that brings). But benign things can regrow if you leave some behind, and we don’t want to ever have to do this again.

So here it is. Tiny, little troublemaker. Image makes it look like it's on the left, but they tell us MRIs are that way, and it's on the right. 

The procedure will involve an incision of several inches, most likely along Teague’s hairline just above his temple. Dr. Cheshier will retract the flesh, saw out a patch of skull, then take out a cube of brain tissue where this growth is. He tore off a piece of measuring tape to show us the length of what he’ll take out, but said to imagine it like the end of a Slim Jim for full dimensions. To a surgeon, it’s small, but to a mom, it looks huge. Because we’re talking about a piece of my child’s brain.

 The size of the chunk to be removed. Kind of horrifying. This is also about the depth from the outside of Teague's head to where the growth is, roughly 2 cm. 

Dr. Cheshier will then put the piece of skull back and secure it with pieces of titanium. I asked if we have to have the plates because really? Plates in his head? He said yes. When Teague was two, his skull was soft and was still growing and forming new bone, so they just sutured the piece of skull back in place. It’s different now. If the doc doesn’t put the plates on, the bone won’t stay still enough to heal, and eventually an indentation will form. So titanium plates it is.

Teague will spend 8 – 12 hours in ICU so they can watch for bleeding. Brain bleeds are rare, but they happen. Because you can't tie off vessels in the brain, they have to cauterize, which causes little scabs that can loosen and bleed. That only happens in about 5% of patients, and it’s within the first few hours if it’s going to happen. Teague will stay a night or two on the floor, and they’ll do an MRI before we leave the hospital to double-check for bleeding.

Dr. Cheshier explained that while this area of the brain does do lots of things, the info is repeated in other places, kind of like having cloud backup. So any gaps should be filled. He expects Teague to be unaffected by the resection. Prayers for that to be the case.

Pathology will come back within a week. They won’t do an immediate frozen sample on this one because the lesion is so small that they’ll need the whole thing for pathology. If it comes back as anything more than a non-cancerous, stupid nothing, everyone but Quinn will be surprised.

I keep mom-guilting that we should have done Teague’s MRI earlier in the summer. Not like we didn’t have things going on, like a missionary coming home and moving into a new house. And we had honestly expected to just go up there that one day, check everything, and come home and forget about it. Now we’re headed back to the land of brain surgery with regular follow-up MRIs.

I’m not thrilled about Teague having surgery right as he starts junior high. He’ll probably miss a good week of school, and he’ll go back with a visible, healing incision. New school, new town, and this. Bleh. But he doesn’t seem too bothered about it. This kid has always been so much better than I am.

Bring It On

The meeting was Wednesday. Quinn and me and Teague, Dr. Cheshier (neurosurgeon), and our oncologist, Dr. Bruggers. Teague was a hard sell to even show up. Not because he was nervous, though that may have been part of it; he said he wasn’t up for a boring car ride. But since this meeting was all about whether we should have this thing removed, and because the thing in question is in Teague’s head, he had to be part of it.

Teague only had two questions for the surgeon: 1. Have you done this before? and 2. I’m going to be asleep the whole time and won’t feel it, right? With satisfactory answers to both of those, Teague was on board.

Here are the details.

The “thing” is on the top portion of his brain, nowhere near the former tumor site. If you take your right hand and just set it on top of that side of your head, it’s under there. Right middle frontal gyrus.

It’s tiny, like a tic-tac, if tic-tacs were round, and it’s not deep in there; just sitting kind of on top of his brain. I realize now that I don’t actually know how deep. Another question for the surgeon.

Seeing it on the scan was an experience for me. Up until that point, I had thought of it as small and superficial and I could easily lean toward leaving my child the heck alone. We had gone in there knowing, though, that we should have it taken out—we don’t want to later wish we had. Looking at my son’s beautiful, normal brain and then seeing a bright white spot on it solidified that decision. It took me to a “get that out of my kid’s head” place.

Dr. Cheshier said the procedure will be “easy” and that he may be able to get it with a biopsy needle and leave a minimal scar. Just one or two nights in the hospital, no ICU.

Here’s the “but.” There’s a chance he may see fit to do a craniotomy (cutting a little jack-o-lantern plug in Teague’s skull) so he can take a bit of a margin—I didn’t know you could do that in a brain, but evidently you can. Then if pathology comes back with something surprising, like if it is some weird low-grade cancer of some sort, they’ll already have a margin and they’ll know more.

Personally, I’m not expecting this to be cancer. No one is. It’s just some stupid growth. It’s a ball of hair and fingernails or something benign. It didn't enhance with the contrast on the MRI, and cancer usually does. So that's encouraging.

A craniotomy would require an incision of several inches so he could peel back skin and make room to get in there. He would do that along Teague’s hairline so that it would be able to hide better when it heals. It’s definitely a plan B.

Oh, and there’s risk of brain bleed with either procedure because evidently this growth is in a rather vascular area.

Either way, it’s another freaking brain surgery for Teague. I might not be done being upset about that. I go back and forth between being horrified about it and being OK. In my OK moments, I wonder if I’m crazy. This is brain surgery, but because I can compare it to what we did 10 years ago, it seems minor.

In my not-OK moments, it feels at worst like we’re back in that place where our kid could die and at best I realize that they’re going to open his head and dig in his brain. It’s kind of terrifying.

When I allow all the similarities in, like getting calls from the neurosurgery department or talking about hospital stays and cutting my kid’s head open and sutures and scars and recovery, it brings back the old cancer-world feelings, and I get edgy.

But it really is different this time.

The first time, everything was immediate. We found the tumor on a Friday, and Teague was in surgery first thing Saturday morning. This time, they’re just scheduling us like a normal appointment. It'll either be on Wednesday or Friday of next week.

The first time, they opened up the back of Teague’s head, pushed apart the lobes of his cerebellum, removed a cancer that was almost as big as a ping-pong ball, and scraped bits of tumor off of his brain stem. This time, they may be able to get it with a biopsy needle.

The first time, Teague had a 10-day stay in the hospital followed by a couple of months of radiation and all that came with that. This time, we’re looking at one or two nights and then rest up at home.

It’s still pretty scary. I know I’m carrying stress somewhere because my jaw is knotted. And sometimes I feel heavy-hearted and can’t place why until I think about it.

But the kid is OK. He still has that gift he got long before he came into our family—something God gave him when created him that I hope he never loses. I don’t know exactly what it is. There’s a purity and a calmness to it. Maybe it’s trust or faith or bravery or love or all of it.

It showed every day when he was fighting cancer and many more times and in many more situations as he’s grown from a toddler to a preteen. And it showed in his reply to my sister when she messaged to see how he was doing with the decision to go under the knife. He said, “I’m feeling really good about this. Bring it on!!!!”