I mean, he didn't even examine me, which he rarely does. (The CT scan pretty much tells him what he needs to know, so he says.)

In addition (or is that subtraction), he didn't even ask me the standard questions he typically does about my quality of life, activities of daily living and general health and welfare. In fact, near the presumptive end of our appointment, as peculiar and uncharacteristic of an appointment as it was, I felt compelled to blurt out the answers to all the questions that he didn't bother to ask that for years he's always asked: any pain, shortness of breath, coughing, headaches, neuropathy, muscle weakness or any new or persistent symptoms? All he could muster was a perfunctory "Do you need any prescriptions filled?"

And then the semi-out-of-the-blue-bombshell: “Are you familiar with Palliative Care?”

Followed by the offer to refer us to a book that he thought we might find helpful/useful.

Helpful? Useful?

I didn't say it at the time because the entire appointment was so odd and impersonal almost. But WHAT?! Palliative Care? What are you talking about? He has never brought up palliative care before. (Although way back when, he had given us a brochure titled "Final Wishes.")

You see, we know about palliative care. We've attended multiple conferences organized by LUNGevity, "the largest national lung cancer-focused non-profit in the country" where palliative care doctors often have spoken. Palliative Care is not hospice care, but it's a transitional level of care, to be sure.

If I'm transitioning, I wish somebody would have told me, and not by asking about my familiarity with this type of care.

In a word, palliative care is a type of downsizing, as best as I can describe its subtleties; separate and apart from hospice care, which is, if you don't know it, "the last train to Clarksville," if you get my euphemism (and hopefully someone is meeting you at the station). But so far as I've been told, I'm not on the last train to Clarksville or any other final destination.

In fact, I rarely take the train. Not that being on or off the train matters when one comes to the end of the line.

Nevertheless, as I review in my mind what my oncologist said this past Monday, I have to wonder if he was feeding me a line, throwing me a line or just reciting a line that is required of oncologists in their regular communications with their cancer patients – a sort of caveat emptor for long-time cancer survivors who are inexplicably still alive (as evidence of such sentiment, my oncologist refers to me as his “third miracle”).

But I didn't feel much like a miracle on Monday. I felt more like a dope. Like I was being told something I didn't realize, sort of an emperor has no clothes “something.” It was a feeling I had never experienced before; during or after any of our appointments.

Previously, even at the initial Team Lourie meeting in late February 2009 when the hammer came down, I had – though having it in utter disbelief – a grasp of the obvious: "terminal cancer," with a "13-month-to-two-year" prognosis to boot. The particulars of which would be sorted out over the following weeks and months, beginning with my first chemotherapy six days later.

And boy were they ever sorted. Ten years and almost six months later, I'm still sorting.

Was I just given an updated "terminal" diagnosis/prognosis or was my oncologist merely having an off day?

Obviously he knows that his words carry enormous weight and significance and create terrible burdens for his patients and their families. But he can't simply toss out the phrase palliative care like it has no impact. Its impact is huge.

It's akin to being hit by a speeding train, the likes of which would prevent one from getting anywhere near Clarksville, let alone being on the last train.