Wednesday, June 14, 2017

Destination Medicine

The Plummer Library at the Mayo Clinic. This is not a museum: staff and students study here.
A couple days ago I took the light rail to the Minneapolis/St. Paul Airport. I walked past destination boards, trying to avert my eyes from the Tokyo/Haneda departure.

My destination, Rochester Minnesota, was not on those airport boards. No Bloody Mary in the lounge, no splendid isolation on a 12-hour flight, no stepping off a plane in a foreign land.

I boarded an airport shuttle to take me to Rochester, 80 miles to the south.

The sprawling IBM facility alerted me we had reached the outskirts of Rochester. Years earlier I had visited that site to meet with two of their scientists and some engineers from the Mayo Clinic. Much of the wealth of Rochester can be attributed to the Mayo and IBM.

Private jumbo jets fly directly to Rochester's airport from around the world carrying the ultra-wealthy to confront their mortality at the Mayo Clinic. People like me take public transport or drive themselves. This is called Destination Medicine.
Landow Atrium, Gonda Building, Mayo Clinic.
Surgery and radiation have not cured my prostate cancer. The tumor has possibly metastasized (spread to another part of my body). I needed to better understand options for my future cancer journey. I needed to visit a place that sees a lot of cases like mine.
View from the 10th floor of the Mayo's Gonda Building where I first checked in with the Division of Medical Oncology. You can see the Kahler Grand Hotel, our home during our time in Rochester. When it first opened in 1921, the hotel had surgical operating rooms.
Integrated Healthcare

Little details demonstrated how well the Mayo knows how to deliver integrated healthcare services.
Before my visit:
A Mayo pathologist reviewed microscope slides from my 2016 biopsy and surgery, and a Mayo radiologist reviewed my CT, bone and MRI scans from the past year. I could read their full reports on the Mayo app installed on my phone.
I printed an eight-page personal appointment guide via the Mayo Web site. The guide left me in no doubt about the details of my two days at the Mayo. I knew when to fast, and where and when to present. I knew what each appointment was about. A friend pointed out the instruction that I should not wear an underwire bra during the CT scan. Good to know.
During my visit:
When I checked in for each appointment, I was handed a pager. When a nurse or technician came to fetch me, my pager went off. There was no announcing of names in waiting areas.
Lab results started to appear on my Mayo app within minutes of the blood draw.
When I met the oncologist on the second afternoon, he had reviewed reports for all the tests and scans I had during my two days at the Mayo, as well as my recent medical history. 
This machine scanned my whole body from head to toe, looking for evidence of cancer in my bones.
At the end of the first day, my partner, Dwight, drove down from Minneapolis. A couple hours earlier I had been advised to drink plenty fluids to flush out a radioactive tracer that had been injected into a vein for a bone scan. Beer fitted the bill: doctor's orders and all that.

The Upshot

My final appointment on the second day was with a medical oncologist. He was respectful but to-the-point: lots of ors and ands, caveats, percentages. Minimal time was used up on small talk. That's why I came. Just the facts as best we know them.

Don't get me wrong, I appreciate kindness more than ever these days, but this was not the time.

The oncologist talked in medicalese with Dwight (he's also a doc) which was exactly what I wanted. After an expertly applied kick, a printer on the floor came to life and delivered a February 2017 New England Journal of Medicine article which describes a study that covers people in my situation.

We agreed a daily dose of a drug for two years was my best bet to shut down but not kill the tumor. The doc explained more options I could consider if or when that treatment stops working, .

Meanwhile I feel no effects from the cancer. I do have side-effects from the treatments, but nothing that prevents me from packing my 35-liter backpack, jumping on a plane, and heading to some corner of the world. Life is good.
The Mayo brothers.


  1. Take care of yourself. I will pray.