Sunday, June 3, 2001

Terminal-cancer patient hopes it's the perfect time for throat surgery

By Marjory Sherman Eagle-Tribune Writer

At 6:30 this morning, Ric Blake boarded a plane at the Manchester, N.H., airport for the National Institutes of Health in Bethesda, Md., where he faces potential surgery for thyroid cancer tumors in his neck.

Mr. Blake, 56, wants the surgery now. Not in three months. Not next winter. Now.

His wife of 34 years is of a different mind.

She hopes the surgeons will take a look at the images and decide to wait.

"My hope is that it's still so microscopic that they can't take it out yet,'' said Diane (Zanfagna) Blake. "I'm bargaining for time.''

When Mrs. Blake thinks of her husband's first surgery in a small New Hampshire hospital six years ago, she recalls it as a nightmare.

"When we talk about surgery, to me it's really scary because his first surgery was so difficult. They told me he'd be out in two hours, and I was still in the waiting room six-and-a-half hours later. I don't ever want to go through that again,'' she said.

Still, she understands her husband's yearning to have the tumor removed.

"If he has a tumor growing, he wants it out because he doesn't want it growing, attaching itself to his vocal cords, or his voice box. That's a very small area inside your neck,'' she said.

Mr. Blake has just about reached his limit with all the waiting. It was almost 12 months ago now that he learned of the tumor in his neck. He is ready for action.

"This is going on almost six years. It's a long time ... changing and growing and getting very interesting. So I'm not really good at waiting anymore,'' he said. "If nothing else, cancer teaches you patience.''

Mr. Blake undoubtedly is thinking, as his wife did, of the bad times back in 1995 when doctors removed his thyroid in an emergency surgery. He remembers how his vocal cords froze, how he couldn't talk or breathe afterward, and how doctors inserted a tracheotomy weeks after surgery.

But he is ready. He is almost completely focused on having this invasive procedure, the first since publication last winter of his story of living with terminal thyroid cancer in hopes it raises consciousness about end-of-life care.

"As much as I love today and my garden and having a group of friends over, I'd like to be there tomorrow and have them cut my throat. I want it over,'' he said. "Putting it off, in a lot of ways, is harder than having the surgery.

"I understand they want to wait until the time is optimal and they'll get it, but I still keep thinking what if we waited one day too long,'' he said.

He wrote the same to his endocrinologist at the National Institutes of Health, Dr. Nicholas Sarlis.

"I'm ready. In fact, I'd rather do it sooner than later because my greatest concern is that we'll wait one day too long and the tumor in my neck will grow that one millimeter too far and enter some structure that will really complicate my life,'' he e-mailed Dr. Sarlis.

Dr. Sarlis indicated that based on the results of the Massachusetts General and National Institutes of Health scans, he was of the opinion that surgery should be withheld until the end of the summer, at least. The key is waiting until the growth is large enough to show up well on scans but small enough that it has not yet invaded nearby structures.

To look at Mr. Blake, one would not guess that he is sick. He recently cropped his reddish hair even shorter. He looks like a healthy, strapping 6-foot-plus guy in his mid-50s.

But he is sick. His thyroid cancer, diagnosed at Stage 3 in October 1995, is growing again. The tumor marker is three times what it was a year ago. Just as he was in the midst of a whirlwind of activity preparing for his journey to the National Institutes of Health, he started to have choking episodes -- periods when he would wake up and couldn't breathe. He worried that the tumor was pressing on his esophagus or vocal cords.

He is far more tired today than he was six months ago. Little by little, this man who once slept five hours a night is requiring more time to rest.

A round of Prednisone that his primary care physician, Dr. Donald McDonah, prescribed seemed to help. And by last weekend, Mr. Blake was hosting his own send-off party.

Dubbed the "Cut-Here Party'' with a drawing of a saw on the invitation, it was a small gathering to thank his friends and peers. He wanted to thank the people who have helped him in his last six months of dealing with terminal thyroid cancer, and he wanted to do it with laughter and hugs.

This was no ten-hanky affair.

There was a gussied up and wigged-top pink flamingo named Flash in the garden, fake "specimens'' in the refrigerator, and tours of his garden that thrives in his condo complex.The only thing missing was the temporary tattoo of a "Cut-Here'' dotted line that Mr. Blake had hoped to stick on his neck.

"I'm telling you, you've got to laugh. Honestly. You've got to lighten up a little bit,'' he said. "I think the whole process is hysterically funny on one level. On another level, the whole process is not fun. The secret is balance, to have both.''

The group of about 30 people included fellow thyroid-cancer survivors, fellow photographers, gardening pals, palliative-care coalition partners, the leaders of his advanced-cancer support group at Lowell General Hospital in Lowell, and various and sundry others.

Amidst the laughter, there was one poignant misty-eyed moment when Mr. Blake spoke from his heart to the group, thanking them for their support and positive energy.

"When he said he was going to take all of the positive energy gathered in the dining room with him down to NIH, it really felt like that could happen,'' said Barbara Keller, who is Mr. Blake's counterpart at Lawrence General Hospital, as public information officer.

Ms. Keller, herself a survivor of breast cancer, believes we all should take a page from Mr. Blake's book.

"I don't know how he does it. He has such as great outlook. He dispensed with all of the extra stuff in his life and he's just cutting directly to what's important. He's really looking for the joy in life,'' she said.

Mr. Blake biggest fear is not for himself but for his wife.

"The hardest thing about this I would think would be for Diane because for her, her whole world turns upside down. She's leaving work. She has to go 500 miles away, her husband is going to have his throat cut and he's going to find out how bad the cancer is,'' he said.

Just about every conceivable turn of events has been mulled over by Mr. Blake. He worked on his intensive medical schedule for the next week, helped a reporter and photographer plan to follow him to Maryland, got himself a palliative-care consult, and helped his wife make plans to stay at a friend's home. He even began to plan for post-operative radiation treatments at Massachusetts General.

"The medical community would tell you I'm an exceptional patient,'' he said. "That means that by the time I get to N.I.H. I will have a plan in place for doing external beam radiation at Mass. General, as opposed to 'Oops, you mean you want me to do what?' ''

Mr. Blake imagines that sometimes the medical establishment rolls its collective eyes and says "Oh, here he comes again.''

On the other hand, doctors and nurses and social workers are entranced.

"I think they're fascinated. In some ways, it probably makes their work easier. Here's somebody who's saying, 'Well what about this?' On the other hand, it probably makes too much work for them in the short term.

"Well too bad. (It's) my throat, not theirs,'' he said.

And, if Mr. Blake's hopes are realized, he will get the word on Friday from his surgeon, Dr. Richard Alexander.