A Teacher Down to Her Last Cells, a Cancer Patient Hands Her Case to UF’s Med Students

Editor’s note: This is the latest in a series by Jo Ann C. Nahirny, a veteran English teacher at Matanzas High School and FlaglerLive’s Teacher’s Trenches columnist, who’s chronicling her journey through cancer treatment in Gainesville.

By Jo Ann Nahirny

“If you haven’t experienced any unusual or severe side effects so far, you probably aren’t going to,” Dr. Robert Zlotecki, my radiation oncologist, assured me at the end of last week.  “We’re more than halfway there. If something bad was going to happen, it more than likely would have occurred already.” He adds: “Okay, then I’ll see you next week. Enjoy your weekend.”

Enjoy my weekend? How can I? Does anybody in my situation actually enjoy anything? Is that even possible?

My husband Mike and I leave the University of Florida’s Davis Cancer Center and walk along Archer Road, turning south on  16^th Street  en route to the American Cancer Society’s  Winn Dixie Hope Lodge , where we’ve been staying since September 19. As I write this, I’ve endured 26 of the 42 radiotherapy sessions, (or  “fractions”) prescribed for me –once every morning and once every afternoon, each weekday.

Several physicians on an interdisciplinary “tumor board” met in August at the University of Florida,  and  together determined  the course of action which they believed would offer me the best chance  of eliminating retroperitoneal sarcoma once and for all.  They decided that while my tumor will need to be removed this autumn, that twice-daily (“neoadjuvant”) radiation treatments prior to the surgery might prevent a recurrence. The key word there, of course, is might.  Nobody knows what will happen afterwards, if it will happen, or when –if at all.  One thing is certain though, and that is that some folks will be observing my situation closely –and they’ll gain a great deal of knowledge from it in the process.

Although I’m not part of a clinical trial, I’m acutely aware that medical students will learn much from my case.  And as a longtime teacher,  the only thing I’m  gaining any real satisfaction from these days lies in knowing that even though I’m unable to stand in front of my students and classes at Matanzas High School this semester, I’m still doing my part as in educator –albeit in some oblique, indirect way.

That is, after all, part of what patients at a “teaching hospital” sign on for when they come to a place like the University of Florida for treatment. Yes, you’re an individual patient, and you get innovative, top-of-the-line care, not just from one doctor, but from a whole cadre of doctors, medical students, interns and residents.  But you also simultaneously become a human “teachable moment.”

How clearly I recall January 9, 2006, the day I had my first cancer surgery at Shands UF.  That morning, about two minutes before receiving an epidural and anesthesia (for a procedure that would ultimately span more than eight hours) someone shoved a clipboard in front of my face with a form on it and handed me a pen, requesting, “Mrs. Nahirny, can you sign this to give your consent for medical students to observe your surgery?”

Now I’m extremely nearsighted.  I wasn’t wearing glasses or contacts because they’re not permitted during surgery. I was already trembling uncontrollably in fear at what was about to happen to me.  But in a nearby corner,  I could make out a group of about a dozen young people clad in surgical garb, face masks, and caps, all huddled together, talking nervously, excitedly. It seemed blatantly obvious they were looking forward to watching their professor, Dr. William Cance, the Chief of Surgery at Shands at the time, work his magic, not just for my benefit –but for theirs.

So they are going to see everything? These kids look barely older than the students I teach back at Matanzas.

Clearly, the expectation was that I wouldn’t mind. And honestly, I guess I didn’t. So I signed. At that point, I remember thinking, “Even if I don’t survive this, at least they’ll learn more about how to perform a complicated procedure like this so maybe someone else will make it the next time. I’ll be a teacher until the bitter end.”

I lived, of course, despite the removal of a tumor that weighed eight pounds, along with my left kidney, which the tumor had so entangled that it was impossible to extricate it. For nine straight days afterwards, during morning “rounds,” I recall Dr. Cance coming in at the crack of dawn. He had medical students following closely at his heels like eager puppies, listening to his every word, scribbling down his commentary on their notepads, after taking turns examining the multiple, stitched incisions  — their professor’s skilled handiwork.  I felt like a museum piece on display for a limited engagement.

Later, one student told me, “You know, we even got to take pictures of the tumor after the surgery.”

“Really?  What did it look like?” I asked, wondering if I could perhaps gain fame or fortune by allowing the former occupant of my abdominal cavity to become a   textbook illustration.  Probably not.  Who knows what rights I’d signed away on the form I’d signed in my pre-surgery stupor anyway?

“Well, kind of like this gross, yellow gelatinous thing,” she said. “I can probably get you a copy the photo if you want.”

“No thanks,” I decline.

Flash forward to 2012. Things haven’t changed much. The coterie of interns, residents and medical students can seem annoying at times, especially after I have to repeat symptoms and side effects three or four times to the succession of young people who rotate through the examining room before the oncologist comes in –and then  again to the doctor and yet the group which invariably accompanies him.

And it doesn’t stop there. Even during treatment sessions, my usual radiation therapists, Pam and Stephanie, introduce Tim.

“Tim’s new this week and we’re going to be working with him while he does the rounds and learns the ropes,” they explain.

They try to distract me from my clear and uneasy discomfort at the presence of a male technician, and an inexperienced one at that, who’s manipulating the sheets and my clothes, to better draw marker lines on my lower left abdomen , hip and lower back,  to facilitate the week’s treatment.

“How was your weekend?” Stephanie asks. “Did you do anything fun?”

“I went to an Improv show at Stetson to see one of my former students perform,” I respond. He was….”

I stop speaking because I realize she’s not listening. She’s observing and correcting Tim –-as she should be– who is now awkwardly plying the midsection of my body to line it up properly.

“How’s your sagittal line?” she questions him severely. “Don’t forget the sagittal!”

After the treatment, I head to Dr. Zlotecki’s office, which I must do every Monday morning. After a nurse takes my vitals, weighs me and asks me the same litany of questions which will likely be posed to me again by several more people this morning, we wait in the examining room for Dr. Zlotecki. Ten minutes later, he walks in with a young woman holding a clip board.

“Good morning,” he greets us. “I’d like you to meet Dr. Rosenthal. She’s my new resident. She’ll be with me for three months, and she’s replacing Dr. Bryant, my former resident, whom you met in September. You’ll still see him around here, but he’s moved on in the rotation.”

Mike and I stand and shake hands with the young woman, who smiles nervously. To me and Mike, this has become routine, but to her, it’s clearly all new. All frightening.

And then it hits me: this young lady is going to learn something from me, even if the knowledge imparted comes from a clump of unwanted, irregular, invasive cells buried deep in my abdomen, and not in demonstrations, nor in words or lectures coming out of my mouth.

I may be stuck being a cancer patient. But no matter what, I’ll always still be a teacher.  One way or another.

Jo Ann C. Nahirny, a 1985 graduate of Columbia University and a National Board Certified Teacher, teaches English at Matanzas High School in Palm Coast. Reach her by email here.