In mid-1989 my fortunes changed. Slowly, imperceptibly, I began to grow weak. The least physical exertion produced tremendous left shoulder pain. I also developed migraines 2 to 3 times each week. Like all young physicians at a medical university, I attributed these symptoms to stress and lack of exercise and sleep. Their persistence, however, forced me to see an orthopedist, who diagnosed left shoulder bursitis. The neurologist diagnosed frequent migraines with aura and started verapamil. The symptoms relented somewhat by late 1989 but soon returned in earnest. My weight dropped 10 pounds. I was perpetually weak and tired.

My wife's birthday was on January 31st and I had intended to take her to dinner. My body had other ideas. I developed hemoptysis, fever, and phlegm. A simple pneumonia, I thought, or perhaps even tuberculosis, either of which needed only antimicrobials to cure me. All I needed was a chest radiograph to confirm my diagnosis. But, as the radiograph emerged from the processor, my pulse quickened and the acrid taste of metal filled my mouth. A large mass filled the anterior mediastinum and left paratracheal area.

I dashed from one benign diagnosis to another. I took the radiograph from the view box and walked outside. My physician-wife was in the hall and asked me how it looked. I could not look at her; I could only mutter that it looked bad. We went into the reading room and placed the image on the viewer. "Squamous cell carcinoma of the lingula," was the calm, indifferent diagnosis offered by the radiologist. But it was me!

All of life's problems pale into insignificance when one is faced with a terminal disease. I felt as if all the burdens of the world weighed on my soul. I couldn't move. I was a participant yet was not really there; it was as if it were an odd dream, a cruel scene in a play I watched from afar. Reality came crashing back when the radiologist asked for some history and my wife whispered that I was the patient. I knew then I was going to die. It was so cruel and so unfair! I had had it all. The list of alternative diagnoses offered by the radiologist could not temper my feelings. I walked away broken, shattered, emotionally destitute.

After facing my own mortality, still I had to tell my parents. I postponed the call, dreading their reaction. I got them both on the line and began to explain the radiograph's abnormality. But I couldn't continue. My heart pounded, my throat constricted, and my eyes filled with tears.

In the days to follow, I ran the entire gamut of emotions. I became convinced that the diagnosis would fit an atypical presentation of tuberculosis. Anger consumed me, and then self-pity. Why me? It was not fair. Self-pity gave way to utter despair. I agonized over my wife and son. Who would teach him to be a man?

I began to bargain with God. "Please make this a treatable disease, and I will do all the right things," I promised.

It came time for the biopsy. As I walked into the CT room, I knew life would never be the same. Whatever the diagnosis, I knew that shortly after chemotherapy would start and I would be less of a person than before. It stunned me as I disrobed and lay on the table. I was a patient!

I was jerked back into reality by the pain of the intravenous needle and I heard a soon to be all-too-familiar line, "Your veins roll". Three additional tries, then success, and the examination began. The tumor was located, the biopsies secured, and then I waited for the results. It seemed that hours passed. The radiologist returned with a presumptive diagnosis of large-cell lymphoma. There I lay, mercilessly perched between the bottomless pit of despair on one side and the faint offer of hope on the other.

I knew it was not the best diagnosis, but I also knew it was not certain death. How do you feel when you are told that you have a slim chance of survival? I was elated!

Within 2 days the hemoptysis worsened. The permanent stains rendered a verdict of poorly differentiated germ-cell carcinoma with seminomatous elements. Chemotherapy commenced immediately. I received a triple regimen of bleomycin, etoposide, and cisplatin.

As I lay in bed on day 1 of cycle 1, I had no idea what to expect. Prehydration and osmotic diuresis produced only the nuisance of polyuria. But when bleomycin was started, all the cruelties of chemotherapy became manifest. I began to shiver, each spell lasting 3 minutes and reappearing in another 10. Then the shivering became worse. My body began to jump and writhe; the episodes were longer, maybe 10 minutes with only 3 minutes off. Waves of heat and cold permeated my body simultaneously. I thought I was stoic, but now I was no longer in control. I was alone in a sea of uncertainty and discomfort.

After the bleomycin came the etoposide and cisplatin and from these came extreme nausea and a visceral retching such as I had never experienced. The inevitable diarrhea only added to the discomfort of total misery. The sight, smell, or thought of food became abhorrent. The mere knowledge that the meal cart was coming produced a return of the retching. I became utterly depressed. I wanted all visitors out of the room. No one was welcome to share my despair—no clergy, no friends, no family. Life held no real meaning. I simply didn't care. My only reality was the clock on the wall. No matter if I slept or daydreamed, there it hung, motionless, watching me.

After an eternity, cycle 1 was over and I could go home. But I could not escape the nausea or the depression. The small pleasures of life were gone. The agony and dread of the next cycle filled their place. At least the migraines were gone.

A radiograph 3 weeks later revealed that the tumor had shrunk in size by more than half. I was overjoyed! Life took on new meaning. I almost looked forward to cycle 2, even with the portocath placed when all my peripheral veins sclerosed.

But my joy was short-lived. The radiograph obtained after cycle 2 revealed no further change in the tumor. My kidneys began to deteriorate and my hearing decreased, further obscured by tinnitus. I began to lose my hair. Each morning I would awaken to a pillow case covered with hair. The shower drain would clog with it. Now, as I looked in the mirror at my balding head, my sunken eyes, and my emaciated body, I knew I might not survive. The thought of that parasite of my own body, sucking the vital essence of my being, revolted me. How could I persist in nourishing this unwelcome intruder? How could I get rid of it?

Cycle 3 came and went. The decision was made to proceed with a thoracotomy because the radiograph revealed no further change in size. They talked of postoperative radiotherapy. Even if I survived, what would be left of me? The bleomycin had ruined my lungs. The cisplatin had irreversibly damaged my kidneys, my hearing, and the sensation in my feet. I decided against cycle 4. If I had such an arduous road to travel, why augment the present damage? My wife insisted and convinced me to proceed.

The day of the thoracotomy arrived. I greeted it with no emotion. I was a prisoner. I had no way to turn. My life was in the hands of the surgeon and God.

Stabbing chest pain awakened me several hours later in the surgical intensive care unit. It would not be discovered until 12 hours later that the epidural catheter for postoperative analgesia was malpositioned, and I had been given no pain relief. During this time of lancinating pain, my wife appeared at my bedside. Her voice was sweet as honeydew, and her message was one of victory: No viable cancer cells were seen in any of the sections—no more tumor!

With such news, I could easily tolerate the next several days. Nothing seemed to bother me anymore, not the incessant examinations by the third-year medical students, not even the nurse awaking me at two o'clock in the morning to see if I was asleep. All of this became insignificant as I realized I had won.

Looking at my body in the mirror, I could see the ravages of the battle that I had just been through. The midsternal scar was beginning to heal. Another ugly reminder was the portocath under my left clavicle. My oncologist suggested we remove the portocath; it was no longer needed.

The nightmare would not be over quite as quickly as I had hoped. During removal of the portocath, the dissecting blade sheared 7 inches of tubing. This 7 inches migrated into the right ventricle and promptly caused bursts of ventricular ectopy. How could this happen to me? After all I had been through, after all the chemotherapy, the pain and anguish of the thoracotomy, was I to die from a ventricular arrhythmia due to a silly mistake like this? Was I going to be allowed to run the entire marathon, only to collapse within sight of the finish line? Fortunately, an experienced angiographer was able to access the right femoral vein and hook this unwelcome piece of tubing and end my nightmare.

It has now been 3 years since diagnosis. All post-procedural examinations have been within normal limits. I was given the unique opportunity to see life from various extremes. Being a patient was terribly unpleasant. I know how my patients feel. I know that there is much more to being a good physician than just being a good diagnostician. I have learned empathy and compassion. Facing death itself produced an awareness of my own mortality I will never forget.