(3) 23 May 2012 – Post-Op Report

Three weeks have passed since my surgery. I’m pleased to report that it was done on the right arm—I mean the correct arm, the left one. I’m also pleased that nothing more was found than we expected: one axillary lymph node infected with melanoma, out of eighteen that were removed and tested. A margin of skin around my second tumor site was cut out at the same time, and the pathology report on that too was negative.

I did have one concern last Saturday night. We were at the lake for the long weekend. I noticed a new lump beneath the skin on my arm where the margin was removed. It felt to me just like the lump I’d found earlier, which turned out to be a lymph node full of melanoma. Reluctantly, we decided to cut our trip short and return to town. Yesterday morning I called the surgeon’s office. He was fully booked, but sacrificed what remained of his lunch hour to see me. He booked me for surgery the next day (today) but, out of caution and experience, recommended checking it out with an ultrasound before cutting. I saw him at 1 PM, had the ultrasound at 3, and results by 4: the lump was not a reactive lymph node, but a seroma, a harmless pocket of fluid that can form when blood vessels are damaged in surgery. So I am spared another cut today.

I must say I’m impressed with the attention I’ve been given, and the overall performance of the Canadian medical system. So far I’ve been able to get a timely and effective response whenever I’ve thought I needed one. That said, I have taken an active interest in the proceedings, which has occasionally led me to seek a second opinion, another option, an earlier appointment. As a result, I have fared better than I would have if I’d adopted the passive attitude suggested by the noun, “patient.”

Claudia has also taken an active interest in my medical treatments, and that has been a great help.  Two heads are better than one when navigating such complex and unfamiliar terrain. So far on this adventure, I have been treated by my GP, two dermatologists, two surgeons, two oncologists. They do not all agree about everything, so one’s judgement comes into play. I’ve had four surgeries (only one requiring general anaesthesia). I’ve started taking baby aspirin (one a day) as a precaution (probably too late to do any good). I’ve started to wear a hat and use SPF 85 sunblock (which is also a bit like locking the barn door after the horse has escaped). I’ve read two books on melanoma as well as a large number of web postings. Claudia, as my self-appointed ‘case manager,’ has phoned melanoma treatment centres in Edmonton and Seattle, scouting out possibilities for adjuvant drug therapy.

I feel we—for Claudia and I are a team—are managing the whole process effectively. We are vigilant and proactive. This level of involvement has a cost, of course. Our work has been impacted. And there is an emotional drain, which is the main point of this post.

So far, Claudia has suffered a greater emotional impact than I have. She described yesterday as a roller coaster ride. Anxiety about getting an appointment, and anxiety again when waiting for the results of the ultrasound. When I got home at a quarter to four, I knew the ultrasound had found something, but the clinicians wouldn’t tell me what they saw. Being an inveterate worrier, Claudia assumed it was probably bad news. Fortunately, the report that it was just a seroma came through from the surgeon’s office within twenty minutes, and she was relieved. But the emotions took a toll; she was worn out.

I was also relieved. Actually, my feelings were more complex than that. I had thought it was probably an infected lymph node. My first reaction, when told that the radiologist identified a seroma, was disbelief. Part of me wanted to be right in my self-diagnosis! I wasn’t satisfied until I heard that the seroma would be drained, and the drained fluid would be tested for melanoma. But my cognitive disbelief began to fade when I remembered that all the diagnostics, so far, have been borne out. If the radiologist thought it was a seroma, then probably it was. And an hour or so later, my emotions caught up with my thinking, and I felt genuinely more relaxed and cheerful.

So far, throughout this whole experience, my emotional tone has been fairly moderate, more so than Claudia’s. I put it down to my work over the past three years on personal identity and the self. I don’t mean to suggest that I am indifferent as to whether I live or die. I’m not. My life is important to me. But my life is not all that is important to me; it is only a fraction. A significant fraction, but a fraction.

When facing a danger to one’s life, the ‘natural’ reaction is to be plunged into the turmoil of ‘fight-or-flight’ emotions that galvanized our ancestors in the jungles and savannahs when they were threatened by predatory animals, hostile people, or natural disasters.  But what worked for our ancestors isn’t necessarily the best thing for ourselves, who encounter threats of a very different nature. I have argued that the emotions I group under the label ‘self-concern’ are, by and large, overkill for situations in which people who live in industrialized nations, under the rule of law, find themselves in today. The ‘fight-or-flight’ emotions are a very bad fit for common problems like the one I am presently dealing with. Fear and panic cloud thought and judgement. They spur us to lash out or run away—but against whom, and from what? A cooler motivation—one that does not impair one’s social skills—is more effective. In order to negotiate effectively with the representatives of the medical system—not only the overcommitted specialists, but their support teams, the nurses and receptionists who have to juggle patients and schedules, make triage calls, deal with too many messages and cope with recalcitrant computer systems—one must maintain the ability to put oneself in another’s shoes and see things from their point of view. To succeed, one must be vigilant and proactive, yet not over-demanding.  Assertive, but not too greedy. An attitude of sympathetic concern towards oneself—the attitude one might take towards a friend who needs help—is more effective than traditional self-concern, which, being overly motivating, can spur one to fly off half-cocked in an ill-considered direction. Just as bad, too much over-the-top emotion going on too long causes emotional fatigue. When that happens, people ‘tune out’ and stop paying attention. In that way, excessive self-concern may cause someone to fail to respond to a relevant change of circumstances.

The ‘fight-or-flight’ responses which form the core of our self-concern tend to inhibit our social responses, the workings of the mirror-neuron system which have contributed so vitally to our evolutionary success, and which may matter more to our survival now than ever before.  Despite their importance, the social emotions receive scant recognition from the prevailing zeitgeist. I have argued for reforming the concepts of person and self, as an antidote. But conceptual reform will not be complete—indeed, cannot even take hold—without emotional reform. My experience with melanoma has served, so far, as a kind of practical lesson in the effectiveness of emotional reform.  In order to come to grips with the more serious problems we presently face as a society, and as a species, we cannot afford to be driven by emotions which attach so much significance to ourselves that the rest of the world loses meaning. In most situations (short of being attacked by a mugger or a grizzly bear) sympathetic concern is enough to impel us to manage our own lives well. More importantly, it leaves us with the strength and ability to engage effectively with the problems of the wider world.


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