Heading into Boston for cancer-related medical appointments can be intimidating. Yes the care is world-class, but the drive in from the hinterlands of New Hampshire is a bit like running a gauntlet. Traffic ranges from bad to terrible and these days the parking garage at Beth Israel Deaconess Medical Center seems to be under permanent construction, which means fewer parking slots.

It doesn’t help that the attendants wave cars up to levels where there are no openings, only lines of cars circling the tight lanes, driving past jackhammers pounding behind plastic sheets, looking in vain for a rare spot. Finally, someone pulled out of their slot just as I turned a corner so I found a spot after 15 minutes of looking.  I had a busy day ahead of me and my cushion of time had just evaporated. CT Scan first, which meant checking in on the fourth floor of the Shapiro Building, where my other appointments were scheduled as well. I drank my spiked water and about an hour later was led into a chilly imaging room.

There the attendant ignored my suggestion to use a vein in the crook of my inside left elbow and tried futilely to locate a vein first on my left hand then in the crook of my right elbow. She gave up and a more experienced nurse finally listened to me and found the vein that I had originally suggested in no time at all. Did I get an apology? No. Next time I have to remember to be more assertive. Some of the phlebotomists can find veins easily so I respect their professionalism. But the radiation techs are perhaps a bit more tentative. I don’t want to mess with their confidence but I don’t want to serve as their pin cushion either. 

Anyway, the scans went well. I remembered to take a benadryl capsule beforehand, which mitigated the itchiness the contrast dye typically triggers in my left eye and right ear. After the CT scan it was time for my brain MRI. Christopher was the mellow-voiced receptionist who informed me that I was late for it. I didn’t tell him it was because my CT technologist couldn’t locate a vein or that they had scheduled me too tightly. I said simply that I had arrived on time (despite the parking search). 

“Yes, I can see you did,” he said, his eyes flitting across the screen in front of him. “Don’t worry. Have a seat and I’ll see what I can do.”

He made a call and a minute later beckoned me to follow him. He led me to the MRI waiting room, where I changed into a hospital gown and drawstring cotton pants. I was led to another chilly room and again asked to lie down. This time my IV line was already installed. All that remained was to rest my head into the designated spot, and allow that plastic grid to snap over my face. 

The random, oddly calming sounds of the MRI buzzed loudly in my ear, as my eyes fluttered closed and I drifted off to sleep only to be woken 15 minutes later, at first befuddled then a bit refreshed. The MRI tech removed my IV and I was free to head to the 9th floor of Shapiro for my appointment with Dr. James Mier and Nurse Virginia Seery. 

It had been 6 months since my last scan and Virginia went through her checkup quickly. I told her that I felt pretty good, but still was easily fatigued. Also, my leg was sore at times, probably more because of hardware issues than a met (hopefully at least — the bottom third of my femur had been removed and replaced two years earlier, along with my knee). My left arm felt fine, I told Virginia, and the discomfort that had led to a false positive six months earlier had dissipated. As she listened to my breathing with her stethoscope I told her that I felt weird about not working. She told me not to.

“You’re my only patient who mentions that,” she said. “Don’t feel bad. You’ve been through a lot and you’re still dealing with a lot.”

“I appreciate that,” I told her. “I feel like I could work if I had to, but I worry about finding a job with good enough health insurance to cover me.”

“You don’t need that stress,” she said. “There’s a part of cancer called financial toxicity that refers to patients who aren’t covered by insurance, lose their jobs or otherwise have financial stress related to cancer.  And you say you can work, but you also get tired.”

“That’s true,” I said.

“So I think you should not worry about not working,” she said. “I’ll give you a call or send you an email when the CT Scans come in.”

Next to appear was Dr. Mier, who was his customarily upbeat self.

“I can’t see the images yet, but I fully expect they’ll show no evidence of disease,” he said. “And if they do, then we’ll see you in May. That would three years since your last recurrence.”

I allowed myself a smile. “That’s a big deal.”

“It is a big deal,” he agreed. “See you in six months.”

Then it was on to Dr. Erik Uhlmann, on the eighth floor, where the good news continued.

“The MRI looks very good,” the neurologist who had found 5 tiny brain tumors over the span of  several years, including one that a radiologist had missed. I trusted his assessment. “There’s a little bit of scarring, but nothing to worry about.”

He then turned to my medication list, which includes infusions of Remicade, an immuno-suppressing antibody, every 9 weeks. I take it to treat my arthritis, I told him, a side effect of my immunotherapy.

“I understand that,” he said. “I just don’t feel comfortable with you taking it. It’s a brake on your immune system and your immune system should be operating at full capacity.”

“I agree,” I said. “My symptoms were crippling without it but that was a couple years ago. I’ve talked to my rheumatologist about tapering off of it. We’ve started that process. I used to take it every seven weeks and now it’s every nine weeks.”

“That’s good,”  Uhlmann said. “I know that you know about my concern.”

“I have the same concern,” I told him. “I’m hoping that the tapering will continue. Maybe the next time we meet my arthritis symptoms will be under control without Remicade.”

“That would be good,” he said as he stood to leave.  “I’ll see you in six months.”

The next day, Seery sent me an email in the evening that made my clean bill of health official. The subject line was “Good News”:

Hi Peter, Your scans look great – no evidence of RCC. We are glad you are doing so well. It was nice to see you yesterday. Best, Virginia So, yes it’s a hassle to drive into Boston from Keene, NH. But if it wasn’t for people like Virginia I wouldn’t be alive today. That inconvenience is a small price to pay.