Uncertain Results
The heart scan revealed that Kaplan had an enormous mass in his chest. During our interview, Kaplan struggled to keep his emotions in check as he recalled the day he received the news and the days after when there were so many questions. It was clear the situation was dire—Kaplan was sent to follow up with an oncologist the very next day. The oncologist, who came in on her day off to consult with Kaplan, said that she would need to do more testing to identify what was causing the mass. “They got me a CT scan that morning. The oncologist gave me three potential causes for the mass: thymoma, lymphoma or primary lung cancer. Of course I was shocked. I have never smoked a day in my life.”
Kaplan had the CT scan at a hospital where he had seen and treated babies for 20 years. Although he was no longer seeing babies at that hospital, the radiologist knew him and called him into the reading room after the procedure. “He sat me down and said, ‘I have to be honest with you. I don’t know how you are standing on two feet right now.’” The growth had the volume of a grapefruit and had tentacles out that completely surrounded Kaplan’s aorta, one of his carotid arteries, and several other significant blood vessels. “Apparently, my being a runner was both a blessing and a curse. My cardio fitness level helped me get through the initial stages of my disease, but it also made my body able to tolerate much more before I finally shut down, leading to a more advanced condition.”
Kaplan had a port placed and had a biopsy taken of the growth. Then the waiting game began. Of the three potential cancers, thymoma and primary lung cancer had a significantly worse prognosis than lymphoma, and the aggressive appearance on CT made it look most like a thymoma. “They told me that if it was that form of cancer, there was nothing they could really do. I went to see a cardiothoracic surgeon who looked at it and told me, ‘This is so bad. I wouldn’t let anybody in Dallas touch you.’ He wanted to send me down to a doctor at MD Anderson in Houston who he said “might be able to shrink it,’ but it was pretty obvious to me that he was saying [shrinking] it wouldn’t be possible.”
“It was one of those icy days in Dallas when you don’t want to be on the roads,” explained Kaplan. “The cardiothoracic surgeon was so gracious and kind to meet with us with the weather being what it was. I walked out of that appointment thinking this could easily be the end for me. My wife and I began discussing next steps for getting my affairs in order. We were driving home from the appointment in a pretty somber state. Suddenly, we get a call from the general oncologist. When I answer, she starts screaming, ‘You’re CD 20 positive!’ I told her I should know what that means, but I didn’t. She said, ‘It means it is lymphoma and we can treat this with chemo, and you’re going to be just fine.’”
Kaplan went from considering the worst to finding out his cancer was highly treatable in hours. “I had all the emotions in one day,” he recalled. “When I thought I was dying, it sounded like I had very little time left. At that point, I did not really have the emotional space to think about what would happen to my practice. When I found out I would be ok, I had to consider how I would be able to take care of myself, my patients, and my practice while undergoing chemo.”
His diagnosis story did not end there. Genetic testing was done, and fortunately Kaplan did not have the genetic markers that would limit treatment options. “It [the cancer] was so widespread that it was already stage 4, but because of the type of lymphoma it was, there was a 75% chance that a single course of chemo would take care of it, which is what ended up happening.”
