March/April 2020 – COVID crisis and challenges from new scans

The big news since my last blog is that I will soon add a new flag to the list of countries where I have had surgery since my career as a cancer patient began last year.

After the massive operation in Germany in August 2019 and the ablation of a liver metastasis in London in January this year, this time it will be my home country’s turn, where I will soon undergo a new procedure to remove another liver metastasis. This will be done in Pisa, where I come from, and I can see that people may wonder what was behind the choice of my new surgery destination.

To be clear: I am not trying to experience surgery in as many countries as possible in the same way as a food lover may wish to try all the fancy restaurants in London. I am simply trying to survive and beat my cancer in a world that keeps throwing new challenges and, this time, it presented the greatest challenge of all: the COVID virus.

Italy has experienced one of the highest mortality rates in the entire world as a result of COVID – so it is definitely not the obvious ideal surgery destination! To explain how, out of all countries, I will end up in an operating room in Pisa, I need to take a step back.

Just days after the lovely holiday in the Amalfi Coast described in my last blog, the whole COVID virus crisis began, with countries introducing various degrees of lockdown over a period of just a few weeks.

The UK was one of the last countries in Europe to introduce severe restrictions, but eventually schools were closed, working from home policies were introduced and people’s ability to leave their homes was progressively restricted.

Quite rightly, governments around the world have been preoccupied with the huge impact of these unprecedented measures on the economy as well as on people’s mental health. I totally sympathise with the latter issue: for many people, being stuck in a confined place and with constant worries about the future and the potential financial implications of the crisis must become quickly unbearable.

As far as I am concerned, the impact of the lockdown on my mental state has been virtually zero. Since the day of my diagnosis, I have got so used to a life full of uncertainty and restrictions that the incremental effect of the COVID mess has been pretty minimal. As Bob Dylan wrote in his famous 1965 song Like a Rolling Stone: “When you ain't got nothing, you got nothing to lose”.

This is not to say that my day-to-day life has been unaffected. I spend more time with Jane and the kids, which is great, but I do miss seeing my friends (virtual meetings do not really work for me), going to the office and attending my gym sessions.

Moreover, my chemo sessions have become tougher to deal with. Guests are no longer allowed and the medical team has to wear masks and gloves, which makes the whole experience much more serious and tricky to go through.

But all in all, I could not really complain too much until I received the results of a new set of scans at some point in April, which delivered two major surprises.

First of all, in its conclusion, the CT report highlighted the presence of a “new” 1.5cm metastasis in the liver. However, as described in the main body of the report, the lesion was not really new – apparently, it was already there in January and, since then, the lesion “has increased in diameter”.

I discussed this apparent contradiction with my oncologist, who helpfully explained that the lesion in January did not look active (unlike the other one that was subsequently ablated at the end of January) but since then its characteristics and behaviour have obviously changed, meaning that now we had to deal with it.

The second, somewhat disconcerting, finding of the CT scan was summarised in the report as follows:

“There are expected lung changes, which could be covid-19 related”.

WHAT??? Did I get the virus at some point without ever experiencing any symptoms whatsoever? This seemed totally bizarre to say the least, considering that I have been repeatedly told that I am particularly vulnerable to COVID due to my cancer, the immunosuppressive effects caused by the ongoing chemotherapy treatment and, importantly, the fact that I left my spleen behind in Heidelberg last summer as part of the surgery I underwent there. In short, this seemed like a total mystery.

Anyway, since I was totally fine (no fever, no breathing issues, no cough, no cold and not even a sore throat), I quickly forgot about the lungs finding and I immediately got in touch with the surgeon who had ablated my liver metastasis in January asking for his help in dealing with the newly active lesion.

The surgeon was happy to organise a call a couple of days later and I was relatively confident that he would be able to sort something out as quickly as he did the last time.

I could not be more wrong. During our phone call, he explained the consequences of something that I was already aware of, namely that due to the COVID crisis, the private sector has recently reallocated almost its entire national hospital capacity to the NHS (see, for example, https://www.standard.co.uk/news/uk/private-sector-allocates-hospital-capacity-nhs-a4393951.html). As a result, medical procedures would now take much longer to be performed.

“How long do you think it will take for my case to be addressed?”, I asked.

“This is impossible to know for sure as the order in which each case will be addressed is going to be assessed by a committee, but realistically you may have to wait for weeks if not months. This will depend on how serious your case is going to be seen relative to other cases”, was his reply.

“That is really worrying. How risky is it to wait?”

“Well, the rate of growth of the new metastasis is not particularly fast – the lesion measured 1cm in January and it now stands at 1.5cm. As long as the lesion does not exceed 3cm, an ablation similar to the one we did in January should be effective. Things would become somewhat less straightforward if the size of the metastasis were to grow beyond that size”.

We left it like that and, for the first time since my diagnosis, I felt totally abandoned by the system.

I was in a little park next to our house when I took the call and, as soon as I put the phone down, I started pacing back and forth, thinking hard about how to solve this new and unexpected obstacle.

I desperately wanted to avoid a long wait because I did not want to give the chance to the metastasis to grow to a size that would be difficult to remedy or to facilitate the formation of new lesions.

At the same time, I did not know who would be able and willing to help me this time. I thought about Germany, which seems to be coping with the COVID crisis much better than the rest of Europe, but I could not see how they would be able to accommodate my request within a short period of time.

I then decided to call my parents in Italy and ask for their views. My dad is a retired doctor (specialised in blood), who had a very successful career first in Pontedera and then in Pisa. I asked him whether, by any chance, he knew a surgeon who could help me. His answer was that, since he had retired more than 15 years ago, it was unlikely that anyone he used to know would still be around. But, of course, he offered to look into it.

A few hours later, I was sitting on the sofa still thinking hard about what I could do, but coming up with nothing whatsoever. Then, my dad called me back and said with a cheerful voice:

“Andrea, I think I have found a good solution!”

I did not give him the chance to explain what it was since I immediately burst into tears, thanking him over and over. Both my mum and my dad were overwhelmed by my extreme emotional reaction. And so was my dog Cookee, who jumped on my lap trying to lick my face to console me (Jane and the kids were out, which partly explains why I let myself go in that way).

Once I managed to calm down, I allowed my dad to explain what his proposed solution was. He told me he had found a liver surgeon in Pisa whom he used to know when he was still working and who was apparently very happy to help. I just needed to fly to Pisa and get the thing done.

Easier said than done under the current circumstances, as I will explain in the next blog!