Burt called on Tuesday evening to say the biopsy of the tumor in his lung had gone well, that he was home and feeling okay. He had an appointment with his primary care doctor on Friday by which time he expected to have the results of the biopsy. I was to go with him to help him remember what the doctor said. I told him Jerry and I would be there in the evening of the next day.
We set out Wednesday morning, taking the North Cascades Highway through the mountains. That road is closed in the winter because it is snowy and steep so it’s a marvelous drive through a changing landscape and climate. It begins in the placid Skagit River valley where the water flows evenly through fertile farm land. The climb into mountains is abrupt; the winding road rises steeply through fir forests and sudden overlooks of deep blue lakes and aqua-green glacial rivers and streams. The western side of the mountains is thickly forested. This year was so rainy that waterfalls are still crashing down the sides of the mountains,
As we drove east the mountains became more craggy, with sharp knife like peaks and sparser trees.
On the east side of the mountains are the two towns of Winthrop, a self invented “western theme” town, and Twisp which tries not to be like Winthrop. Then the two lane road winds through apple orchard country in lower hills, with the land becoming progressively drier. After we passed the Grand Coulee Dam there we were on an elevated plateau, at first mostly sage and scrub and finally gently undulating field after field of wheat, many still green. We could see where the widely scattered towns are by the huge silos silhouetted against the open sky.
We stopped at a Mexican restaurant in Davenport and arrived at Bert’s place just before dark. When we came into Bert’s small round hay-bale house his lanky figure was motionless in a chair with his long legs stretched out limply. I was shocked at how terrible he looked — thin and haggard. Later I realized that was partly because he didn’t have his teeth in. I asked how he felt and he replied, not too good.
The walls were covered with pictures Bert had painted, many landscapes and some views from an airplane. He said he had been feeling too ill to paint in the last week.
The three of us talked for about an hour. Bert assumed that he had cancer, as apparently the pulmonologist who ordered the second biopsy did. He talked of dying. I told him he could come to Lummi and stay in our apartment, but he said firmly, “I’m going to die here. When I can’t take care of myself any longer I’ll take my own life.”
Then we spoke of the Washington laws on suicide, of the Hemlock Society, of ways of killing oneself. The conversation shifted to a discussion of his financial and real estate assets, bank accounts and various vehicles including some airplanes and old farm equipment. Jerry is his executor and the next day was to be spent touring banks and signing papers. There was no call from the doctor with the biopsy results.
Jerry and I spent the night in a little travel trailer of Bert’s. It was not a comfortable night. The trailer had the same disadvantage as our camper; in order to get up to pee in the night one of us had to climb over the other because the bed is against one wall.
Bert seemed somewhat better the next day and we spent most of the day driving through wheat farming country around Davenport as Jerry and Bert did their banking.
I enjoyed the drive and Bert told us a lot about wheat farming. He said with modern equipment one man can farm 10,000 acres, and in the future GPS automated equipment will make it possible for one man to operate 4 or 5 combines at the same time, so even fewer people will be needed to work the land. He said this country opened up for wheat growing because of genetically modified wheat that matures in 90 days. Before that the growing season was too short and the land was used for grazing cattle.
While Jerry and Bert were banking I looked for a few items in the Davenport Pharmacy. It turned out to have only a small stock of drug store merchandise; it had a large section of gift items (chicken theme prevailed), flags and patriotic bunting, candy and a soda fountain and greeting cards with Christian inspirational messages. There was a liquor store in the back.
Bert’s place is in a hilly area that has sudden rocky outcroppings, not wheat growing land. He raises a few cattle each year. His “bone yard” is filled with derelict vehicles, boats, farm equipment and airplane parts. I found some wild life to photograph.
After a nap and a walk Jerry and Bert and I had a glass of wine together and discussed Bert’s never-ending dispute with the Noxious Weed Board. They sprayed weed killer on his land without his permission, and he is keeping a Davenport lawyer busy suing them. He wants Jerry to carry on the case after he dies.There was no word on the biopsy.
That night Jerry and I checked into a motel with a real bed. The Black Bear Motel carries out the western motif that seems popular in eastern Washington. There was lots of cowboy stuff and flags; the bird houses were shaped like guns. All the rooms had names. Ours was the “Prospectors” and had gold mining décor.
The next morning we were up early and, after walking the poodles, searched for breakfast. All we could find open was the Submarine Sandwich shop. We were surprised when we walked in to see 13 guys ranging in age from 50’s to 70’s, wearing work clothes and baseball caps, sitting together throwing dice for coffee. We chatted with some of them while we ate as they continued to throw dice. A couple of them were crop duster pilots and Jerry enjoyed himself talking about airplanes.
Then I went with Bert to see his doctor. The doctor was fairly young — 40’s or early 50’s — jolly and extremely obese. He asked his nurse to try to reach the pathologist who had processed the biopsy. We talked about Bert’s illness, and Bert complained about the number of tests he had had. He asked what the next step was. The doctor said probably seeing an oncologist. I said there was an immediate problem of Bert’s feeling so ill. The doctor said: “Immediate problem! Wait a minute, Bert, I wanted you to stay in the hospital and you said you were going home.” They argued a bit about who said what and the nurse knocked saying the pathologist was on the phone.
After a few minutes the doctor came back looking puzzled. He said it was sort of good news — there was no cancer in the tumor. I expressed great relief. Bert just seemed stunned.
But what was it? And what was making Bert sick? The pathologist had suggested a fungal lung infection. He didn’t think it was tuberculosis.
We left the office knowing that there was nothing more to be done until next week. Then Bert will go back to the pulmonologist. Jerry and I had a coffee with Bert before we started for home. There was no more talk of dying. I promised to do some research on the internet about fungal lung infections. Bert remarked that the thing had started with a dry cough at his place in Arizona last January.
Here’s the email I sent Bert yesterday after I had studied up a bit.
Dear Bert, I have been doing some research on the web about fungal diseases of the lung. There seem to be 3 possibilities: coccidiomycosis, blastomycosis, and histoplasmosis. The most likely is coccidiomycosis because it is specifically found in places like Arizona and Mexico. The spores of this disease are found in the soil and dust and during dry periods are dormant but when it rains they become active and can infect people or animals that breath the spores. The disease starts with an unproductive cough and flu like symptoms. It can become chronic and can be confused with cancer in the lungs by medical people who are unfamiliar with it. It is not hard to diagnose if it is suspected. The treatment is with anitfungal drugs all of which have a lot of side effects and I don’t think they should use those drugs on you without putting you in the hospital. If you want to read about these things look up the 3 diseases listed above. I think the Wikipedia entries are very good. I hope you are feeling okay. I think we will try to call you later today (Saturday). Anne
Jerry talked to Bert later. He had read the email, printed it, wrote his own comments on it and drove into Davenport to deliver it to his doctor! This was not a result I expected and I hope it doesn’t start trouble. But Bert is always ready for a scrap. He told Jerry he is feeling pretty bad. I worry about him. The disease that he probably has is better than cancer, but it isn’t good. He is elderly and not in good health anyhow.
It seems to me that the pulmonologist should have considered the possibility of an infection, at least after the first biopsy was negative. Some non invasive tests might have avoided the second biopsy. He is supposed to be an expert on diseases of the lung, so even if coccidiomycosis is rare (I had no trouble finding it on the internet) he should know about it, and if he had taken a careful history and learned that Bert had been in Arizona for the winter he might have suspected it.
This story is not over yet.