“I’ll pay by Visa.”
“Great. Please wait here for the surgeon to collect you. Your wife and son may join you in the changing room.”
That was 7:30 am one week ago today. Hugs and kisses to Tina and Soren at 7:50, and by 8:00 I was on the surgical table for my CRS HIPEC surgery. The anesthesiologist and I exchanged pleasantries, then came the word that I was going under. “Boa noite,” I said.
Moments later — to me, anyway — I was in a bed in the ICU, Tina at my side. She asked how I was doing. “I’m in pain and I want to sleep.” That was 4:40 pm. I slept most of the night, waking now and then to nurses pushing more pain meds and changing my catheter bag.
In the morning, two nurses attended to me, and shortly after, a physiotherapist arrived and taught me how to get in and out of bed and chairs. To my surprise, by noon I was being wheeled up to the hospital ward — faster than the one to three days in the ICU my surgeon had estimated.
Attended by four nurses, I arrived in my private room and, to my amazement, an infinity reflecting pool overlooking the Tagus River. I asked if I could go swimming. A slight chuckle: “Not yet.”
The nurses gave me the room orientation and hooked me to an IV tree of my main meds. When they left, I opened my gown and looked down at my belly. A large vertical dressing covered everything below the belly button, and two hoses ran out of my right side into separate blood bags.
A push notification from the Champalimaud app: a summary of my surgery results, already. In my pain-medicated haze, I uploaded it to AI, as I’ve done throughout this entire cancer journey.
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The Results
Surgery took just over seven hours.The cancer that started in my cecum back in 2024 had come back — not in the colon, but scattered as small deposits across the lining of my abdomen. That lining is called the peritoneum, and cancer that settles there doesn’t respond well to chemo alone, because drugs in the bloodstream don’t reach it efficiently. So the approach is different: go in, physically remove everything visible, then wash the abdominal cavity with heated chemotherapy to kill what’s too small to see. The removal is the CRS — cytoreductive surgery. The hot wash is the HIPEC.
Surgeons score this kind of disease using the PCI — the Peritoneal Cancer Index. They check thirteen regions of the abdomen and score how much disease is in each. The scale runs from 0 to 39. Mine came back at 5 to 7 — low.
The number that matters more is the CC score, for Completeness of Cytoreduction. It answers one question: when the surgeon closed me up, was there any visible cancer left behind? Mine was CC-0. Nothing left that the eye could see.
To get there, they removed my omentum, my gallbladder, the peritoneal lining in several affected areas, three deposits on the surface of my liver, and the affected tissue in my pelvis. They saved my rectum. Then ninety minutes of heated mitomycin C circulating through my abdomen.
Blood loss was 400 mL. For an operation that size, that’s nothing.
One item is still open: a handful of millimeter-sized deposits on my small intestine went to pathology. Those results will lock in the final PCI number.
CC-0 with a low PCI is the best outcome this operation offers. I’ll take it.
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The Recovery
Two days after surgery, 4 am. I’m sitting up in bed and take a small sip of water — and a feeling overcomes me that I haven’t felt in 32 years. Choking. Then a rush of fluid onto the floor. Then another. I stretch my arm to hit the nurse call button, and the nurses rush in as the third wave spills onto the floor. “Bucket, bucket,” I yell, and they grab one just in time to catch the fourth, milder wave.I’d been eating like a mouse for two days — feeling fuller and fuller, sending back meals of applesauce and yogurt unfinished — and still no bowel movements. The same thing happened after my previous surgery, when my bowels took days to kick in. I knew what this meant.
Later that morning came the bad news. “Craig, we need to place a gastric tube through your nose and down your throat to drain the fluids. It is not a nice feeling.” I was well aware. I had one last time, and steering the tube down the correct path — not toward your lungs — is difficult. At CUF it took four attempts, mostly because it was the nurses’ first time. Lucky me.
The nurse asked if I was ready, and reluctantly I said yes. “Should I put my chin to my chest?” I asked. He said no, but I kept my chin low anyway, remembering CUF. He started slowly. I felt the tube reach the back of my throat and began the swallowing motion as he instructed — then the gag reflex hit, and I ripped the tube out of my nose. The sensation I’d gone 32 years without was back as I scrambled blindly for the puke bucket. Just in time — the coffee-colored bile landed in the bucket, not on the floor.
I took a ten-minute break to catch my breath while he preached, repeatedly, about why this had to be done. I know. I know. And you were wrong — I do need to put my chin to my chest. He started again, and this time the tube went down smoothly. The rough feel of plastic I’d endured two years ago was there, and it needed to stay in for three days. Damn it.
Three days turned into five, and then they connected me to a feeding tube to maintain my calories. Tubes coming out of everywhere on my body except my ass.
The pain was intense the first three days — meds running almost around the clock through the catheter in my neck. The max count at one point: two blood-bag tubes, one feeding tube, the gastric tube, and a portable vacuum tube compressing bandage over my incision.
My bowels finally kicked in, which meant diarrhea — difficult to manage with this many tubes attached. Two days ago I hit a low point. The discomfort seemed impossible to cope with, and I could barely respond to messages from family and friends. But here I am today, writing a full blog post.
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The Money
Champalimaud sent me an estimated cost for the procedure and said to be prepared to pay it on the day of surgery if insurance didn’t approve.The estimate: €32,262.80 — about $37,400. That single number covers the hospital, ICU, operating room, drugs and consumables (including the HIPEC chemotherapy), and the surgeon’s professional fees.
For the same operation, a US academic center bills $200,000–$400,000+ before insurance. Memorial Sloan Kettering quoted me $7,235.94 for a single consultation visit.
Our insurance approved it. The €500 I handed over at the front desk that morning was the deductible — the only thing I paid on the day of surgery.
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The Hospital
I’m not sure why I ever questioned using Champalimaud. This is a world-class facility less than 30 km from my house. Everyone gets a private room that feels like a four-star hotel: a snack-bar fridge and a coffee machine, a Japanese-style bidet with temperature settings for the water and the dryer, a single remote to control the TV, lights, and shades. The staff is highly skilled and friendly. And the view — my god, the view. I can’t say enough good things about this place.* * *
The Concert
I sold my tickets to the David Byrne concert because my surgery was the next morning. Friends of mine attended the show, including Daniel, who visited me in my recovery room and pulled up a photo on his phone.
It was the first picture shown at the concert: David Byrne standing in front of the Champalimaud logo sign. Byrne shared that he’d come across the Champalimaud Centre for the Unknown — loved the name — and joked that it reminded him of The Twilight Zone.
I’ve been driving past those words on that lawn for two years. Seeing them on the screen at the show I was supposed to be at — that made me quite emotional.
The moment, caught on LinkedIn.
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