Diagnosing Mesothelioma

Once upon a time there was a retired bricklayer named Bill. For someone 76 years old, Bill was in pretty good health. Sure, he had the expected stuff—heart disease, some acid reflux, a few more pounds around the middle than he had forty years ago—but he could still play ball with his grandchildren, mow the lawn, and take out the garbage. Not bad for an old geezer, he used to tell his wife, Susan.

Then one Saturday, while chopping back the hedge, Bill noticed some trouble breathing. He could inhale well enough, but there was a sharp and growing pain at the side of his chest, and he couldn’t take in enough air to keep working. He had to sit down and take a break halfway through the job, something he’d never had to do before. Just age, Bill decided.

But it kept happening, and the pain was getting worse and more constant. Joining the pain was a cough, dry and hacking. Finally Bill couldn’t hide it from Susan any longer, and she insisted he go see the family doctor.

“Pneumonia,” the doctor said. It seemed odd to Bill, because it was high summer and he’d never had a cold in his life. But he swallowed all the pills, rested quietly at home, and let Susan take care of him.

But it got worse. The family doctor sent him to a lung specialist. This doctor took chest x-rays.

“You’ve got fluid in your chest,” she told Bill and Susan.

“In my lungs?” Bill asked.

“No,” the lung doctor said, “in the chest cavity around them. It’s called a pleural effusion. The fluid makes it hard for your lungs to expand and take in oxygen. That’s why you’re having trouble breathing.”

“What can we do?” Susan asked.

The doctor snapped off the light of the x-ray viewer. “We drain the fluid.”

They did it that day in the doctor’s clinic. She stuck a needle the size of a fencepost into Bill’s back and sucked out enough red-tinged yellow fluid to fill a two-liter soda bottle.

“We’ll send it to the lab for testing,” she told them at the end of the procedure. “Then we’ll know what we’re dealing with.”

Bill felt better immediately. He didn’t have his old energy back, but at his age, maybe that was too much to hope for. But at least he could breathe without pain. He could tootle around the house and yard some. Good, he thought. It’s over.

But when the doctor called with the lab results next week, he was disappointed. “We can’t find anything in the fluid that would have caused your symptoms,” she said. “There’s a few cells that look pre-cancerous, but Bill, I don’t see any lumps or growths in your lungs. We’ll have to wait and see what happens.”

What happened was that the fluid returned within a month. This time, when the lung doctor sucked the fluid from Bill’s back, she didn’t seem so confident. And for the first time, Bill was really afraid.

Again, the lab results were inconclusive. And now Bill was definitely feeling worse. All of his energy seemed to be draining away, and the paunch around his middle went with it. He had trouble swallowing. Sometimes he had a fever. He spent more and more time on the recliner, sometimes even sleeping there, so he wouldn’t wake Susan with his coughing.

“I want to take a biopsy,” the doctor said the third time Bill showed up in her office with a chest full of fluid. “The fluid isn’t telling us what we need to know. I want to put you into the hospital for a day and perform minor surgery to cut out some tissue. Maybe that will tell us more.”

Bill was awake during the surgery. He felt no pain, only some pressure, as the doctor cut a small slit between two of his ribs and stuck in a tube with a tiny video camera attached to its end. He watched the TV screen along with everyone else while the lung doctor maneuvered her “knife and fork” and cut off a chunk of flesh from inside him.

“Right there,” he overheard the doctor say to a nurse. “See that nodular thickening along the pleura? That’s the problem spot.”

Bill saw it, too, a lumpy-looking area that seemed to be the inside of his chest wall. Surely it wasn’t supposed to look like that?

The doctor came to visit him first thing in the morning. She looked worried.

“Did you ever work with asbestos?” she asked.

“Asbestos?” Bill said. “Isn’t that the stuff they used to put in insulation? I was a bricklayer.”

“They used insulation in plants anywhere there was heat,” the doctor said. “Did you ever install firebricks into a boiler? At one time they contained asbestos.”

“About once a month,” Bill said. “Are you telling me I’ve been poisoned with asbestos?”

“No,” the doctor said quietly. “You have mesothelioma.”

Mesothelioma is a rare form of cancer that attacks the chest or abdominal wall rather than the lungs or any other organ. There are only about 2,000 cases per year in the United States, so many doctors, even specialists, have trouble diagnosing it. It’s often mistaken for other lung problems, such as pneumonia, but of course, antibiotics can’t cure cancer. And in fact, nothing can cure this cancer. When the doctor told Bill that he had mesothelioma, she pronounced his death sentence.

Bill is a fictional character, and his story is a combination of a number of case histories. Every person’s situation is unique and will vary according to their medical condition. But the early stages of mesothelioma are often like this.