Three headshots
14 February 2016, updated 3 May 2025
This post is about three headshots taken in 1983, 1984 and 2016, and how appearances can be misleading.
In the first photo, taken at my brother Dan’s wedding in December 1983, I was 26 years old, 5'11½", 155 pounds, and had a BMI of 21.3. I looked healthy but was actually seriously ill.
Back in 1980, while learning physical exams in medical school at the University of Michigan, I found a small lymph node in my left lower abdomen. A health service physician, probably the notorious Dr. Robert Anderson, told me it was a harmless, shotty node and that may have been a good diagnosis at the time (I was unable to confirm that he treated me, and I was not molested). I kept checking it every few months, and by December 1983, during my first term at Michigan Law, I noticed something new, a rock hard mass, 6 x 6 cm (2.5 x 2.5 cm), next to the lymph node. In an instant, my life changed. One moment, I was studying for finals; the next, I was convinced I had advanced abdominal or pelvic cancer. I told no one - I was in shock.
At Dan’s wedding shortly thereafter, I looked around at my family, thinking I might never see them again.
Telling my parents was the hardest call I had ever made. I then arranged a biopsy with Dr. John Niederhuber, my former medical school instructor and current University of Michigan surgeon. Before the surgery even began, the diagnosis was confirmed, indirectly. As the nurse prepped my upper thigh, not the site of the mass, I spoke up that she was doing it wrong. She checked with the surgeon and said no, the drapes were in the correct spot.
The surgeon was not stupid (he later led the National Cancer Institute). He was removing tissue from another location that was easier to access (below the skin of the thigh is easier than entering the abdominal or pelvic cavity). This meant that it definitely was cancer and it had spread. He was doing a biopsy to determine what type of cancer it was.
A CT scan confirmed extensive spread through abdominal and pelvic lymph nodes. I had major surgery in January 1984: a splenectomy, liver and bone marrow biopsies and a long abdominal incision. The tumor involved the spleen but spared the liver and bone marrow. Diagnosis: Stage IIA Hodgkin’s disease, now called classical Hodgkin lymphoma, nodular sclerosing subtype. I left the law school dorm for a week long hospital stay.
Complications followed. A coagulase negative Staphylococcus wound infection meant my incision was left open to the depth of the abdominal musculature, where it healed by secondary intention. I did not like being in the hospital, so I wore my street clothes and asked for a “day pass” so I could attend classes. I would wake up in the Old Main Hospital (now demolished), see the doctors at morning rounds, have my tubes disconnected and walk out of the hospital. I would take the campus bus to the main campus, walk to the Law School, stop at my dorm room and say hello to my roommate (I did not tell him where I was, sorry Bill). I assume I looked like a wreck. Then I would attend classes, pick up any needed clothes, and return to the hospital.
After discharge from the hospital, treatment was radiation therapy over the pelvis, abdomen, chest and lower head and neck. Twenty years before, I would have been dead, but with radiation therapy, there was a high cure rate (today, treatment is with chemotherapy). It was uncomfortable having the young female radiation technologists carefully place lead blocks in the pelvic region to preserve my fertility (use your imagination). Still, there was no actual sensation from the radiation. After the first radiation dose, I went to class and threw up during the lecture. Fortunately, I brought a plastic bag with me, and other than leaving the room, I am not sure anyone noticed (at least they didn’t mention it). After that, I changed the timing of the radiation therapy appointments so I was throwing up right after lunch, in the basement bathroom of the Law School Commons. I got used to it. I did wonder if it would ever stop, but of course, I did not throw up on weekends when I did not get the radiation. I lost 20 pounds, and the tailor had to keep taking in my tux for my sister’s upcoming wedding. In June 1984, when the second picture was taken, I weighed about 135 pounds (BMI 18.5).
In April 1985, my oncologist, Dr. Vi Dabich, a seasoned physician, told me about the most recent CT scan. She had tears in her eyes. The CT report, which I still have, indicated "multiple new hepatic lesions most consistent with metastases." The tumor had apparently moved to a new site. Liver involvement, although not necessarily fatal, was not good. But if I was dying, I felt pretty good. I had an ultrasound guided liver biopsy, which was inconclusive (no tissue was obtained, only blood). The resident doing the biopsy, who I knew, insisted he was in the tumor. I then had another operation to do an open liver biopsy and remove a chunk of the liver. The diagnosis was multiple hemangiomas, a benign (i.e. not cancerous) tumor of blood vessels. I have not found any reports of hemangiomas caused by radiation therapy, but that seems to me to be what happened. Every time I had another abdominal CT scan (which used to be quite slow), the radiologists would stop the scanner when it was over the liver and they saw the "obvious" liver metastases. I had to tell them that this was not a new finding and to look at the old films. I had many other side effects of the radiation therapy, but fortunately, none of them were life threatening, as of this essay.
Due to my lack of sufficient exercise and willpower, and likely due to my then wife’s spectacular cooking, I started gaining weight, and reached 189.5 in the spring of 2008. I tried dieting for a dozen years, and could not lose the weight. I eventually got a diet coach through Health Alliance Plan, my medical insurer. At some point, I started using a smartphone app to record my caloric intake and exercise and bought several diet scales to weigh my food. It seems obsessive / compulsive, and perhaps it is, but I did reach my target goal of 148 pounds (BMI of 21 at my new height of 5 feet 10 1/2”), at least for one day (see my blog post about diet by clicking here). The third photo is from today, weight 152.5 pounds, BMI 21.3. I admit my face looks too thin – the fat has accumulated in other parts of my body where it apparently does not want to leave. I feel great, eat healthy (mostly vegetarian, low fat except for desserts), and exercise a lot (100-150 miles of bicycling in good weather).
So appearances may be deceiving.