The second round of chemotherapy brought blindingly painful abdominal cramps. On June 24, a Sunday evening, the pain drove him from his rented apartment back to the hospital. Curled up and shivering from pain and cold, he pushed the call button over and over in his search for relief. It took three hours for an intravenous pump to be set up to dispense a potent synthetic opiate, and more writhing and retching before an increased dose finally put him to sleep.
If not for his mother's watchfulness, he may never have woken up.
Cheryl Lilienstein, who had finally fallen asleep in the double room's extra bed, woke to a rattling sound. She jumped up to find her son's eyes and mouth open, his chest still. He had been given too much fentanyl.
She yelled for help, and nurses and doctors piled into the room to revive him. Again, Lilienstein was able to see what had happened with two sets of eyes.
June 26: Pain management must be among the most difficult jobs a doctor has. How do you balance the patient's awareness against their misery? How do you know you are not being scammed, when the patients themselves may not realize that they have become dependent? How do you not create an addiction while trying to help? And, by the way, careful not to OD anyone.
A week after his near-overdose, a CT scan brought shockingly good news. It showed no masses, no cancer, no need for further surgery.
But it will be weeks, maybe months, before Lilienstein recovers from the intensive treatment. Three months of low-dose "maintenance" chemotherapy lies ahead, a bulwark against what doctors describe as a less than 5% chance that cancer could return. But the bigger challenge will be getting over the anxiety that the next day, the next phone call, the next checkup could turn his world upside down again.
He is counting on the lessons learned to guide him as he heads back to Los Angeles in the fall to pick up where he left off in medical school.
"I very well may die of this," he'd said in May, during lunch near his Los Feliz apartment.
"But how do I want to live? I want to live positively and with attention. A positive attitude and a fighting spirit is a way to improve the odds, but also a way to live in the process."
[Unpublished Note: The italics may not display depending upon the archiving system you are using.]