Some fun with all this before it gets deep. A note from Matt... We have learned that when a neurosurgeon makes a hole in your skull for biopsies, it is called a burr hole. Many of my friends know what a die grinder is, and a burr. I'd like to think Neurosurgery is further along than that and it is just miss named.  I walked around hours after that procedure, so Dr. House at least had a very steady hand, maybe trained hands porting cylinder heads at his other job.

About two weeks after Matt’s brain biopsy, the results started to come in. A blessing and a curse, they appeared in a portal called MyChart that allows patients to see them before speaking with any doctor. The first results to show up were three different molecular tests, tests of the genetic code of the tissue.

Apparently, the past five to ten years of brain cancer research have enabled doctors to understand exactly how an individual’s brain tissue becomes cancerous, and therefore how it will likely behave and respond to treatment. About twenty pieces of Matt's brain were removed from four sites in the right hemisphere through a single 3mm burr hole during his craniotomy. Many of these samples were sent for genetic testing—a complex, branching pathway of analyses meant to determine exactly what mutations led us here.  Other biopsies were sent for histopathology (a neuropathologist examining very thin slices of tissue) to study the cellular architecture of his brain mass. Additional pieces underwent special staining to look for markers on the cells that would help the pathologist make a final interpretation.

Cancer does not just result from a single event. The cells of our bodies are constantly turning over, and with each cycle of replication there is potential for a mistake in the genetic code—a mutation. Some mutations trigger unregulated replication of cells. Our immune systems normally catch and eliminate these aberrant cells before they turn into cancer. But sometimes even the immune cells meant to protect us mutate and stop doing their job. All the genetic testing on his brain biopsies was to understand exactly what had gone wrong.
And the results were coming in painfully slowly.  As they began to trickle in the Monday before Matt's Thursday morning appointment at the Huntsman Cancer Institute at the University of Utah, it became clear that he was not a straightforward case. What we did know was that the pathologist said the biopsies from all four sites looked the same—meaning that the eight-centimeter portion of his brain that appeared abnormal on MRI, and that we had hoped was just swelling, was in fact all tumor. An 8 cm tumor taking up most of his right hemisphere. The report gave a preliminary diagnosis of “at least WHO Grade 3 infiltrative astrocytoma.” This was not the news we had prayed for.

Feeling devastated, we decided the best thing to do that afternoon was go for a hike at Alta to check out the early season snowpack. Incidentally, that was also depressing.

I wish I could say we handled the first 48 hours of news with calm acceptance. The truth is, we went through all kinds of irrational thoughts when faced with the idea that our time together might be shorter than Matt’s pile of primers and powder might indicate. We had very matter-of-fact talks about estate planning logistics, interspersed with moments of deep sorrow and sleeplessness. It was awful. And we hadn’t even talked to a doctor yet about the results.

Given the chance to do it all over again, would we still have looked up the results on MyChart? Yes. Absolutely yes. By the time we sat down with the neuro-oncologist three days later, we were ready; we had a written list of questions, a detailed timeline of events, and a somewhat detached sense of unreality.

When the doctor told us that the Cancer Board had discussed Matt’s case the day before and that all the neurosurgeons agreed trying to remove the brain tumor would pose more risk than benefit, we were almost relieved. Our best hope now is that radiation and chemotherapy will keep the mass from growing. But honestly, Matt’s so upright and neurologically normal that if it doesn’t get any bigger, all he needs is a self-driving car to be fully functional! The doctor also explained that primary brain tumors don’t spread elsewhere in the body. And given how neurologically normal Matt is—other than the vision deficits—the doctor suspects the mass is relatively slow-growing and has likely been there for a long time. Given all the stress and shock of learning that Matt has high-grade brain cancer, this all felt like good news.

The plan is for Matt to start chemotherapy and radiation in about two weeks, pending some scheduling and planning around the Thanksgiving holiday. The wait also allows healing of all the biopsy sites, which we now realize were quite extensive to obtain all the tissue needed for testing. We’ve been told that radiation will last six weeks and will probably be the roughest part. After that comes four weeks of rest and recovery, then a year of maintenance chemotherapy. There will be many MRI scans along the way to monitor things. The plan may change depending on the final classification of Matt's brain tumor.

All in all, Matt’s still himself—and feels great. How many high-grade brain cancer patients can say they went on a hike at altitude and had four CNC machines running in the shop just days before diagnosis, without any symptoms?

And there is one more silver lining. Radiation treatment is just blocks from the aforementioned Crown Burger, our new favorite spot. When life gives you lemons, say “no thank you, I will take hot pastrami on a cheeseburger if you please.”

A note of praise: Thank you to everyone who has kept us in your prayers and reached out with words of encouragement. It’s working! How do I know? Because on our way to the neuro-oncology appointment—worried, distracted, and in the middle of rush-hour traffic—an F350 truck suddenly careened into our lane in a narrow section of freeway with concrete barricades all around. Of course, it came from the left, so Matt didn’t see anything until he heard the screech of brakes and the mayhem behind us as I expertly, like an F1 driver, steered us to safety. Thank you, God, for taking the wheel and reminding us that You are ultimately in control of all of this.

Thank you, God, for also sending our friend Andrew right when we needed his words of encouragement. It wouldn’t be a gathering at the Yore’s without best friends, a beat up veteran or two, and a rifle being assembled in the kitchen. For those who know Andrew, he is constant reminder of God’s love through adversity. For those who know Javier, he is constant proof that laughter is the best medicine.