by Terry Ratner, RN, MFA
…..in the seventh month, on the tenth of the month, you shall starve your vital energies and do no manner of work…. For on this day it shall bring atonement upon you, to purify you, before God shall you become pure of all your aberrations. (Leviticus) 16: 29-30)
A day to remember
It was a Thursday, October 9—Yom Kippur, Day of Atonement, the most solemn day on the Hebrew calendar, when my husband, Michael, underwent an endoscopic procedure. He laughed the day before when the doctor said, “Nothing to eat or drink before the test. Can you manage that?” Michael smiled as if he had a secret. “I always fast during the high holidays and this one isn’t going to be any different.”
On the Day of Atonement, we went to synagogue for the morning service. Michael’s procedure was scheduled for 12:45 PM. “Perfect timing,” he said stroking his two day whisker growth. “I’m able to immerse myself in prayer and in between undergo a medical test before returning to temple and breaking the fast.”
For thirty long minutes, I sat in the outpatient waiting area, looking around at the starkly decorated walls, half listening to the conversation between two receptionists as they talked about restaurants and dating, wondering how everything happened so fast. I noticed his mild symptoms four days ago: some difficulty swallowing, a dry cough when drinking liquids, a slight hoarseness, and an early feeling of fullness while eating a meal. A variety of diagnosis crossed my mind; hiatal hernia, a narrowing of the esophagus, or perhaps a nerve involvement. As a nurse, my imagination went wild.
On October 8th, our internist had scheduled Michael for a barium swallow and US (ultrasound) of his abdomen which showed a suspicious area at the bottom of his esophagus. The gastroenterologist urged him to undergo the endoscopy the next day—that was my second hint that something was very wrong. I wondered what all the hurry was about. I tried to stay calm, but my stomach felt skittish, light, like it was being forced up to my neck and then down into my chest cavity.
A nurse holding a clip board poked her head out the double doors. “You can come back now, Mrs. Ratner,” she said without looking up at me. “Your husband’s in recovery.” I asked her how it went and suddenly this friendly preop nurse didn’t want to talk. “The doctor will be out shortly to explain his findings,” she said without looking me in the eye.
The Diagnosis
“Your husband has a tumor at the junction of the stomach and the esophagus. I sent several biopsies to pathology. It looks like cancer.”
Being a nurse, it wasn’t necessary for any further explanation to understand the doctor was saying the unspeakable—telling me my husband has cancer, a fast growing cancer in the esophagus. My head started to spin and my legs felt like rubber as I tried to keep them from shifting side to side.
“Maybe you need to sit down and discuss this,” I replied as I stared at the doctor’s white coat focusing on his last name embroidered in black thread above the pocket. I glanced at my husband’s face; his eyes were closed and he looked relaxed for the first time since his symptoms began to surface—six days ago. His body lay hidden under a cream-colored blanket and I wondered if he heard the word, “cancer.” I needed to let him rest for a while and not worry about anything, as there would be plenty of time to agonize in the weeks to come.
The talk
The gastroenterologist had biopsied enough tissue from the tumor site to feel confident about his diagnosis of esophageal cancer. “The pathology report will be her in a couple of days,” he told me, giving me a slim hope that he might be mistaken.
“This is not a good time,” came out of my mouth as I began to sob. “There never is a good time for this type of diagnosis,” he told me with compassionate eyes. I must have asked him three times, “What is the size of the tumor?” His response was a number I won’t likely forget—2.5 centimeters.
I drove my groggy husband home. He asked me a few questions about the procedure and told him we’d talk later and he needed to rest. The truth was I didn’t want to tell him what I knew, what the doctor had told me. When he woke from a short nap, he refused any food or water even after I assured him God would permit it under the circumstances. But instead he waited until sundown to break the fast, after the evening service with a few slices of Challah, some herring, and a glass of wine.
My husband I lived with a secret for the weekend—Michael had esophageal cancer. It was one of those secrets I chose to keep to myself until we had a definitive diagnosis. We played word games Saturday and Sunday, never once uttering the unspeakable word—cancer. Our lips formed the words tumor, swallowing disorder, and hiatus hernia, but we shied away from the ‘C’ word.
We continued to pray throughout the weekend, long after the evening service, long after the Sabbath, long after the Kol Nidrei and the Yizkor, in an attempt to elevate our spiritual being and thwart away this vile disease.
The pathology report came back on that Monday. When the gastroenterologist phoned me at home, I already knew what he was about to say—our life, as we knew it, was about to change.
Risk Factors:
GERD ( gastroesophageal acid reflux)
Alcohol Consumption
Cigarette Smoking
Chewing Tobacco
Barrett Esophagus (patients with chronic reflux should undergo regular endoscopic exams and biopsies).
Signs & Symptoms
Difficulty swallowing
Substernal pain
Hiccups
Respiratory difficulty,
Heartburn, halitosis,
Significant weight loss (a later sign)
Hoarseness
Halitosis
Coughing
Excessive salivation
Nocturnal aspiration
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