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VAIL CHAPTER 3 - “PARALYSIS” FALL 2008

Megyn

SETTING: EARLY 30-SOMETHING NEWLYWEDS MEGYN AND BRADLEY SIMPSON EMBARK ON A NEW LIFE IN VAIL, COLORADO. BRADLEY GRADUATED WITH TOP ACADEMIC HONORS AS THE #1 STUDENT AT BOTH NOTRE DAME UNIVERSITY AND CREIGHTON MEDICAL SCHOOL. THE COUPLE DATED WHILE IN COLLEGE - HOWEVER BOTH WENT SEPARATE WAYS AFTER GRADUATING. THEY MET AGAIN ON A RETREAT AT GEORGETOWN MEDICAL SCHOOL WHERE BRADLEY WAS FINISHING HIS FELLOWSHIP IN ORTHOPEDIC TRAUMA - AFTER COMPLETING A FIVE-YEAR MAYO CLINIC ORTHOPEDIC RESIDENCY. MEGYN WILL BE EMPLOYED BY VAIL VALLEY HOSPITAL AS A SURGICAL SCRUB NURSE. BRADLEY WAS HEAVILY RECRUITED AT MANY MAJOR CENTERS AS AN ORTHOPEDIC TRAUMATOLOGIST - HOWEVER DECIDED ON VAIL DUE TO THE MEDICAL STAFF SUPPORT, ABILITY TO CONTINUE HIS RESEARCH, SECRET DESIRE TO OBTAIN A NOBEL PRIZE IN MEDICINE, AND HIS LOVE OF SKIING. MEGYN WOW - I DIDN’T REALIZE HOW MY TENNIS GAME HAS FALLEN OFF THE CLIFF. BRADLEY WE BOTH NEED WORK - BUT THE VAIL RACQUET CLUB HAS REMEDIAL SESSIONS FOR TRANSPLANTS LIKE US. MEGYN WHAT WAS THAT CALL FROM THE FERTILITY GUYS ABOUT THEY WANTED TO TALK TO YOU SPECIFICALLY. BRADLEY WE NEED TO SIT DOWN AND TALK SOON. MEGYN I DON’T GO TO WORK FOR A COUPLE HOURS - THESE MIDNIGHT SHIFTS ARE KILLING ME. AND THE HOSPITAL IS STARTING TO REALLY GET FULL. NO ONE CAN EVER HAVE ENOUGH ATTENTION FROM A NURSE. BRADLEY I’LL TALK TO YOU IN THE MORNING - MY CLINIC DOESN’T START EARLY - AND I HAVE NO SURGERY YET - BUT SOMETHING COULD COME IN TODAY. MEGYN SOMETHING IS GOING ON - BRAD I DON’T FEEL NORMAL -

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HECK LOOK AT MY TENNIS -I COULDN’T CHASE DOWN ANY BALLS. AND MY CLOTHES DON’T FIT. I’M TOO BIG. BRADLEY OK - BUT IT IS STUFF YOU DON’T WANT TO HEAR. I’M SORRY. MEGYN OH NO - I’M DYING AREN’T I - IT IS SERIOUS. BRADLEY OK - IT IS SOMETHING WE CAN TREAT. MEGYN WHAT IS MY DIAGNOSIS ? I FLAT OUT NEED TO KNOW AND NOW - IT DOES NO GOOD TO HIDE IT FROM ME. AND BESIDES WHY DID THE DOCTOR CALL YOU INSTEAD OF ME ?

Bradley & Megyn

BRADLEY WELL I’M BOTH A PHYSCIAN AND A LOVING HUSBAND, THIS IS ROUGH TO TELL SOMEONE, AND I FEEL I NEEDED TO BE HERE WITH YOU AT HOME. MEGYN GET ON WITH IT BRAD - NO BS. HOW MUCH LONGER DO I HAVE ? BRADLEY NONE OF US EVER KNOW IF WE ARE TO GET OUR NEXT BREATH. MEGYN DAMMIT BRAD - YOU ARE SO EVASIVE. I’M LEAVING IF YOU DON’T TELL ME - I KNOW IT’S SERIOUS AND I’M PROBABLY DYING - IT’S MY BODY - I DESERVE TO KNOW. BRADLEY I AGREE - MEGYN YOU HAVE METASTATIC OVARIAN CANCER. MEGYN WHAT - I HAD A NORMAL GYNECOLOGIC CHECK UP JUST FOUR MONTHS AGO. NO WAY. THIS CANNOT BE. BRADLEY WELL DURING YOUR LAPAROSCOPY THERE WAS SOME INCREASED SEROUS FLUID IN YOUR PELVIS - AND THE G Y N SURGEON SAMPLED IT FOR EVERYTHING. AND ?

MEGYN

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BRADLEY AND THE TUMOR SAMPLES CAME OUT METASTATIC ANAPLASTIC ADENOCARCINOMA WITH AGGRESSIVE FEATURES - HIGHLY SUGGESTING AN OVARIAN PRIMARY. ONE OVARY WAS REMOVED AND THIS WAS GROSSLY POSITIVE FOR TUMOR. MEGYN WHY DIDN’T THEY TELL ME THIS LAST WEEK WHEN WE WERE IN DENVER ? BRADLEY I’M NOT SURE - BUT YOU WERE UNDER ANESTHESIA EFFECTS POST OP AND MAY NOT HAVE REMEMBERED OR PARTIALLY UNDERSTOOD. MEGYN SO THEY HIDE IT FROM ME ? BRADLEY NO - THEY TOLD ME - BUt AGAIN THEY WERE NOT SURE UNTIL THE FINAL PATHOLOGY - THEY DIDN’T WANT YOU GOING HOME THINKING YOU HAD CANCER WHEN YOU DIDN’T. MEGYN I’LL GIVE THEM THAT - I FEEL AWFUL NOW. I CANNOT WORK. BRADLEY SOMETIMES IT’S GOOD TO WORK - ESPECIALLY AS A NURSE SINCE YOU’LL BE A BIT MORE SENSITIVE TO PATIENT’S NEEDS. MEGYN YOU WANT ME TO GO TO WORK AFTER HEARING THIS STUFF ? ARE YOU KIDDING ? BRADLEY YOU DON’T HAVE TO - I’M JUST SUGGESTING THAT IT MAY HELP YOU GET THROUGH THIS. I DON’T KNOW - COUPLES EVERYDAY GET THIS INFORMATION. EVERYONE DEALS WITH IT DIFFERENTLY. MEGYN OK - THAT IS YOUR WAY OF DEALING WITH IT - MINE IS TO SCREAM, PRAY, CALL MY FAMILY - I DON’T KNOW ? BRADLEY I DIDN’T THINK YOU’D DO WELL WITH THIS - I KNOW YOU KNEW SOMETHING WAS GOING ON - BUT WHO KNOWS 4


THE SYMPTOMS AND SIGNS ARE NON - SPECIFIC. MEGYN WHAT WOULD YOU DO BRAD ? GO TO SURGERY ? BRADLEY I MIGHT. I MEAN EVERYONE IS DIFFERENT. YOU CAN CRY ALL YOU NEED TO BECAUSE I HAVE ALREADY. MEGYN WE JUST MOVED HERE TO VAIL AND WHAM - WHAT NEWS ! BRADLEY IT’S THE WORST NEWS I’VE EVER EXPERIENCED BY FAR. MEGYN WELL HOW LONG DO I HAVE ? BRADLEY NO ONE KNOWS - ONLY GOD. MEGYN I GET IT - I’M IN FOR MORE SURGERY, RADIATION, CHEMO, WIGS, NAUSEA, WEIGHT LOSS, ANOREXIA, FATIGUE - THE WORKS. BRADLEY I DON’T KNOW - THEY WILL MEET WITH US TOMORROW IN DENVER - AND THEY’LL HAVE A TREATMENT PLAN IN PLACE. SOME OF IT WILL HAPPEN IN VAIL. MEGYN I NEED TO THINK ABOUT THIS. IF I’M TO DIE - I DON’T KNOW IF I WANT TO UNDERGO ALL OF THIS. BRADLEY NO ONE WILL FORCE ANY OF THIS UPON YOU. YOU MAY BE CURED OR PUT INTO REMISSION. I DON’T KNOW. YOU WILL GET VERY AGGRESSIVE TREATMENT I KNOW THAT - IF YOU CONSENT. MEGYN SO I’M TO GO TO WORK KNOWING THAT I’M PROBABLY GOING TO DIE A MISERABLE DEATH. THAT WILL BE FUN. BRADLEY I’M HAVING A TOUGH TIME DEALING WITH THIS ALSO - THIS WILL AFFECT BOTH OF US. I WANT TO GIVE YOU ALL THE LOVE AND CARE I CAN - EVEN IF IT MEANS QUITTING MY JOB OR A LEAVE OF ABSENCE. MEGYN HUG ME BRAD. I CAN’T QUIT SOBBING. I LOVE YOU SO 5


MUCH. LET’S TACKLE THIS THING HEAD ON. BRADLEY GREAT - GOOD ATTITUDE. MEGYN IT MEANS WE’LL NEVER BE ABLE TO HAVE KIDS - RIGHT ? BRADLEY NOT NECESSARILY - WE WILL INVESTIGATE EVERY POSSIBILITY. THE FERTILITY DOCS MENTIONED THAT WE’D BE GIVEN ALL THE NEW AND EXPERIMENTAL STUFF IF WE NEEDED AND WANTED IT. LIKE WHAT ?

MEGYN

BRADLEY WELL THEY MAY REMOVE SOME OF YOUR ORGANS AND REPLANT THEM AFTER YOUR CANCER TREATMENT, ADVANCED SURROGATE TREATMENT, FETAL TRANSPLANTS, DNA REPLICATION, AND STEM CELL TREATMENTS - THESE ARE JUST A SAMPLING OF WHAT TO EXPECT. YES WE WILL GET OUR LITTLE IRISH QUARTERBACK - BUT WE’LL HAVE TO GO THROUGH A FEW THINGS FIRST - INCLUDING GETTING RID OF YOUR CANCER. MEGYN SHOULD WE ADOPT IN THE INTERIM ? BRADLEY I DON’T THINK SO AT THIS POINT - IT MAY BE TOO MUCH FOR US TO HANDLE WITH SOME INTENSE TREATMENT COMING UP. WHEN DO WE START ?

MEGYN

BRADLEY PROBABLY AS EARLY AS 48 HOURS - WE’RE SEEING A GYNECOLOGIC ONCOLOGIST TOMORROW AT 9 - WE’LL LEAVE HERE AT 6 TO BEAT THE TRAFFIC, AND GIVE US SOME TIME TO FILL OUT THE ENDLESS PAPERWORK. MEGYN OK - I’LL BE READY - I’M GOING TO WORK SOON. I’LL LET MY STAFF AT THE HOSPITAL KNOW. THERE IS NOTHING TO HIDE. I’M AN ILL WOMAN - BUT I WILL GET BETTER. BRADLEY OK - I’LL JUST DO WHAT I CAN TO JUGGLE MY SCHEDULE. 6


I’LL TALK TO DR. HUDSON - YOU KNOW THE COUPLE WE SAW AT THE RACQUET CLUB. HE’LL HAVE THE SCOOP ON TREATMENT AVAILABLE HERE IN VAIL VALLEY. I KNOW THERE IS AN ONCOLOGIST WHO IS QUITE GOOD - BUT I’LL CHECK INTO IT WITH THE GUYS FROM DENVER ALSO. MEGYN I’LL LET MICKEY KNOW WHAT IS GOING ON. SHE JUST MOVED TO IOWA CITY AND IS TEACHING AND COACHING VOLLEYBALL AT THE UNIVERSITY. BRADLEY WELL CRAZY DEPRESSED AND MANIC MICKEY CAN LET YOUR FAMILY KNOW - AND I’LL CALL MINE IN THE SPRINGS TONIGHT. MEGYN SOUNDS GOOD - I’M OFF TO WORK - MORE KISSES AND HUGS. GOOD BYE - LOVE. LOVE AND GOOD BYE.

BRADLEY MEGYN

BRADLEY OH MY GOD - WHAT IS WRONG WITH YOU ? MEGYN I CANNOT WALK - MY LEGS ARE NUMB AND WEAK. BRADLEY WOW - THEY REALLY ARE - SOMETHING IS GOING ON. MEGYN BRAD - DO SOMETHING - I’M PARALYZED - FIX THIS. AND I JUST URINATED WITHOUT EVEN KNOWING IT. BRADLEY OK - I’LL HAVE TO GET A SCAN - DON’T EAT OR DRINK. MEGYN WELL GET ME TO THE HOSPITAL. I KNOW THAT MUCH. BRADLEY I’M MOVING - I’LL CALL THE MRI SCANNER ROOM AND LET THEM KNOW YOU ARE ON YOUR WAY AND TO HOLD ANY NON-EMERGENT SCANS. MEGYN YOU ARE THINKING THIS TUMOR HAS SPREAD TO INVOLVE 7


MY SPINAL CORD - RIGHT ? BRADLEY MAYBE - I JUST DON’T KNOW. I’LL CARRY YOU TO THE CAR. MEGYN I NEED DIFFERENT CLOTHES. I’VE GOT A NURSING OUTFIT ON. BRADLEY DOESN’T MATTER - I’LL BRING CLOTHES LATER - JUST HOLD ON. MEGYN BUT BRAD YOU WON’T KNOW WHERE CLOTHES ARE AND WHICH ONES TO GET - TRUST ME. BRADLEY WE’RE GOING TO THE HOSPITAL SCANNER AND THEN YOU ARE ADMITTED - NO QUESTIONS. NOW YOU ARE MY PATIENT - I DON’T THINK ANYONE HERE DOES EMERGENT BACK SURGERY. BUT YOU DO. EXACTLY.

MEGYN BRADLEY

MEGYN WELL I TRUST YOU MORE THAN ANYONE. GO FOR IT - I CANNOT LIVE LIKE THIS. BRADLEY MEGYN, WERE YOUR LEGS FEELING NUMB OR WEAK ANYTIME BEFORE TODAY ? MEGYN WELL YES - I DIDN’T WANT TO SAY ANYTHING. YOU REMEMBERED I COULDN’T GET TO SOME EASY TENNIS VOLLEYS. BRADLEY IT ALL MAKES SENSE NOW - YOU ARE IN DENIAL OF A MONSTROUS NATURE. MEGYN I GUESS - I JUST THOUGHT IT WOULD ALL GO AWAY - I DIDN’T WANT OUR MARRIAGE AND HONEYMOON IN VAIL TO EVER END - ESPECIALLY WITH ME SICK.

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BRADLEY I UNDERSTAND - BUT YOU ARE A NURSE - TRAINED AT GEORGETOWN - HMMM..THEY NEVER TAUGHT PATIENTS TO HIDE CLINICAL FACTS FROM THEIR DOCTORS I PRESUME. MEGYN WELL NO - BUT I FELT THAT I WOULD WRECK EVERYTHING FOR US. YOU UNDERSTAND. WHO WOULD WANT A SICKLY NEW BRIDE ? BRADLEY YES - BUT NOW - THINGS ARE DIFFERENT - YOU ARE PARALYZED. YOU PROBABLY NEED A SPINAL DECOMPRESSION. IT IS EMERGENT AND I NEED TO GET THE JOB DONE – IT’S THAT SIMPLE. ALL I NEED TO KNOW IS WHAT LEVEL TO GO IN AT. YOU MAY HAVE METASTATIC TUMOR ON OR COMPRESSING YOUR CORD - WE’LL CERTAINLY FIND OUT. MEGYN OK JUST CARRY ME IN - DON’T MESS WITH ALL THE STRETCHERS AND FUSS. OK - HERE WE GO.

BRADLEY

MEGYN BRAD THEY WANT US TO GO THROUGH ADMITTING OR THE EMERGENCY ROOM PROTOCOL. BRADLEY YOU MEAN WE CANNOT JUST GET THE SCAN AND MESS WITH THE PAPERWORK LATER ? DOESN’T LOOK LIKE IT.

MEGYN

BRADLEY OH - THERE IS HUDSON - HE’S CHIEF OF STAFF - MAYBE HE CAN OVER RIDE ALL THE BS - WE NEED TO GET YOU SCANNED - I HAVE AN ANESTHESIOLOGIST AND O.R. CREW WAITING - I BUMPED THE SPORTS MEDICINE GUYS - ONE OF THEIR FELLOWS WAS TO ASSIST. MEGYN OK HUDSON SAYS PUT ME IN THE SCANNER. I’VE GOT ALL MY METAL OFF. MY CREDIT CARDS ARE OUT - BUT I WOULDN’T CARE IF MONEY IN THE ACCOUNT WERE ACTIVATED BY THE MRI MAGNET SINCE WE HAVE NONE.

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BRADLEY HERE YOU GO - NO TALKING - HOLD STILL WHILE THIS LOUD NOISE ERUPTS. IT WILL ONLY TAKE 20 MINUTES TO DO YOUR BRAIN AND ENTIRE SPINE - I’M ADDING A FEW MINUTES TO GET A TOTAL BODY CANCER SCREEN ALSO. MEGYN BYE - LOVE. YOU KNOW THIS ACTUALLY SUCKS - BUT OH WELL - ALL I CAN DO IS CRY AND PRAY. BRADLEY IS THIS THE O.R. ?.........YES IT’S DR. SIMPSON - I NEED THE SPECIAL SPINAL INSTRUMENTS FOR SPINAL DECOMPRESSION/FUSION. CALL THE REP, INFORM THE FELLOW HE WILL NEED 4 - 8 HOURS AVAILABLE FOR ASSISTING, AND INFORM ANESTHESIA TO PUT A HIGH EPIDURAL IN FOR PAIN CONTROL POST OP. BRADLEY YES - I KNOW THE HOSPITAL RULES ARE FUZZY REGARDING OPERATING ON YOUR FAMILY - ESPECIALLY YOUR WIFE - BUT WE ARE IN VAIL, THIS IS A MAJOR NEUROLOGIC INSULT THAT CANNOT WAIT FOR SPECIFIC RULES TO BE INTERPRETED, AND IT’S UNFORTUNATE IT’S MY WIFE. I HAVE NO CHOICE. I CHECKED WITH HUDSON CHIEF OF STAFF HERE AT VAIL VALLEY - AND HE SAYS IT’S OK. I’LL BE UP IN A HALF AN HOUR. YOU CAN COME AND GET MEGYN IN FIVE MINUTES. MEGYN MY GOD THAT MRI HERE IS LOUD EVEN WITH EAR MUFFS ON. WHAT DID THEY FIND - A HIDDEN BABY ? BRADLEY NO MEGYN - IT IS A BAD PROBLEM. THIS TUMOR HAS SPREAD INTO YOUR UPPER LUMBAR SPINE AND ENCASED THE CORD. IT WILL REQUIRE OUR SURGICAL TEAM TO REMOVE THE TUMOR DELICATELY AROUND YOUR SPINE AND REPLACE THE VERTEBRAE ABOVE AND BELOW WITH SYNTHETIC VERTEBRAL IMPLANTS SINCE THE VERTEBRAL BODY ABOVE AND BELOW ARE INVOLVED WITH TUMOR, AND THEN PLACE A DRAIN. IT’S WEIRD, BUT YOU MUST SIGN AN ANESTHESIA AND SURGICAL CONSENT. MEGYN MY GOD BRAD, SHOULD WE BE DOING THIS. WHY NOT JUST LET ME GO ? I DON’T KNOW IF I WANT TO GO THROUGH ALL THIS WHEN THE END RESULT WILL NOT CHANGE. I AM GOING TO DIE SOON ANYWAY. BRADLEY MEGYN - WE DON’T KNOW THAT - YOU MAY BE OK AND GET 10


YOUR SPINAL CORD FUNCTION BACK SOON, AND YOUR TUMOR MAY BE AMENABLE TO TREATMENT. WE MAY BE ABLE TO STILL CONCEIVE. I’M DOING THIS FOR US.

MEGYN

BRADLEY NOW YOU JUST MUST SIGN THE CONSENTS MEGYN. MEGYN CALL MICKEY. HERE COMES ANESTHESIA. SEE YOU IN A FEW HOURS. BRADLEY WE WILL GET THIS DONE MEGYN - I PROMISE - LOVE. SEE YOU TONIGHT.

MEGYN

Megyn

END VAIL III

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Vail - Chapter 3