Saturday, February 22, 2014

It Might Get Messy

A long time ago, in a galaxy far, far away…no, wait. It’s THIS galaxy, in fact, this planet. But it WAS a long time ago… .

Anyway. Set the Wayback Machine for early in the formation of the solar system.  Earth has existed as a sun-orbiting entity for a couple billion years. In that time, the ridiculously intricate chemistry of the young planet has given birth to living things. The atmosphere cloaking the dark, salt-less seas and lava-hot landforms is rich in hydrogen and helium, with a growing proportion of carbon dioxide thanks largely to those life forms. For a billion years or so, this is the earth: a retort of complex chemicals and metabolizing microbes in soupy water, battered by lightning, volcanoes, asteroids, and intense solar radiation that has yet to be tamed by a functional magnetosphere.

At some point, a few of those little packets of life experiment with a new approach to metabolic chemistry. They discover that all that carbon dioxide is an excellent source of energy and, as a bonus, an easy foundation for constructing the carbon-based infrastructure that supports all that cranked-up metabolism.

But this bit of evolutionary experimentation has very dark implications. A waste product of this new-fangled biochemistry is oxygen. And oxygen is acutely toxic. In fact, as CO2-based organisms proliferate (this metabolic pathway is very efficient, and makes its proud owners overwhelmingly successful competitors in the day-to-day life-and-death warfare that is the ecosystem), a threshold is crossed. The resulting “Oxygen Catastrophe” [1] is an enormously profligate extinction event. In fact, as atmospheric oxygen levels increase, nearly all of the living things that have been happily proliferating and diversifying for the past billion years die. The shattered remnants of biology on earth are the pitifully few scattered entities that can prosper, rather than fail, in an oxygen-rich environment.

And the rest is history. Well, technically, I suppose it’s pre-history.

Anyway. This bit of biochemical review gets us where we need to be for today’s entry. The point is simple: individual organisms function in an environmental context, much of which is beyond their control. This very obvious point, in fact, could serve as an accurate one-sentence summary of the science of ecology. But we don’t need to get grandiose, here. By simple analogy, those of us victimized by cancer and damaged by medical intervention function in an environment. The status of our “health”, “condition”, and “recovery” are all, then, relative to the larger social world in which we live.

For example. My recovery has made progress. If I take my meds, stay hydrated, and sit still in the recliner with a blanket draped over my legs and a heating pad stuffed up into my sweatshirt, I can almost forget I’m sick. I have to keep a big handful of paper towels in my lap to mop up the secretions that leak from my nose, mouth, and especially, tracheostomy tubing, but that’s no hardship when I’m reading, writing, and listening to music. 

However. If I start to move around, the volume of secretions increases immediately and enormously. Again, if I’m moving around the house, say, to prepare dinner, this isn’t a big issue. I keep myself mopped up, sit down frequently to stabilize things, and wash my hands obsessively. I can function, despite the increased volume of saliva, mucous, and occasional blood fluids pouring from my person.

Conversely, if I go to the supermarket, say to pick up a prescription, the Niagara Falls mucous flow becomes a real problem. Earlier this week I was at the pharmacy counter. Pharmacist asked a question. I leaned over to scribble my answer on the back of my shopping list. The act of leaning forward precipitates a big-ass flush of liquids from my person to my environment. Which in this case includes the pharmacy counter. So I have to busily and self-consciously mop up the goo, while the people behind me try (without much success) to contain their disgust, and while the pharmacist runs to get disinfectant and a box of sterile wipes. 

Yeah. It’s icky. And, unfortunately, the flux of bodily fluids is highly correlated with my activity level. If I hike into the Patuxent Reserve with my hot new camera, this isn’t a problem. I just stop in the woods to slobber. But if I’m trying to do something more social, say, visiting a museum, going to a movie, shopping at a mall or art supply store, I have to deal with a difficult and disconcerting volume of goop. This means I need to carry a roll of paper towels with me, and also that I have to haul along some safe and sanitary way to dispose of the resulting sticky and septic paper. Which is logistically complicated, and again, as I can see despite coughing fits and mop-up breaks, disgusting to my fellow shoppers, movie goers, or museum visitors.

So here’s my major dilemma at this point on the long and rocky road running across the mire that is the post-cancer landscape. When I sit quietly, med-up, and read, write, practice guitar, watch TV, or work on cut-paper art, I feel rather normal. I don’t feel sick. I don’t feel impaired or constrained. And this feeling, which is, I acknowledge a good thing, leads to severe frustration. Because, being well and feeling normal makes me want to do normal-person things. Go out. Go shopping. Attend sporting or artistic or musical events. Interact with people. And, as we’ve seen, any such activity immediately precipitates embarrassing symptoms which are not only disgusting, but threats to public health as well.

Sigh, he says, as a lone alto saxophone plays soto voce off in the distance. I’m only “recovered” and healthy relative to certain very specific environments. Like my recliner. Relative to other, less constrained environments, I remain sick, physiologically and socially impaired. 

Thank you all for being here. I am deeply in your debt. I was only able to prevail in my very real life and death struggle because I knew if I let the powerful tentacles of death that coiled around me win, I would lose all of you. And I was not willing to let that happen. As you think about your life, perhaps musing on the balance of “good” and “not so good” things you’ve done, consider this. You saved my life. And this is not an allegory or metaphor. You actually saved my life. And I love you for it. 

Oh. One more thing. I’ve stumbled across some fabulous music recently. Delain is a Dutch art metal outfit that is wildly original, positioned high on my World Beat Death Metal Fave Rave List. They are all over Amazon US, easy to track down. Salem is an Israeli thrash ensemble that weaves regional folk and popular music into their otherwise chops-rich heavy sound. It devolves that Israel, for some reason, is a real hotbed of high quality metal. You can download a free sampler album that is truly awe-inspiring here: 

http://www.metalindiamagazine.com/news/from-israhell-with-love-compilation-released-as-free-download

Rock the hell on, everyone. Just because you can. At my age, I need to take advantage of every opportunity to put the hammer down. Because the status of such opportunities is, as I have learned over the past nearly four years of dealing with vicious physiological impairments, fragile. Grab it while you got it. And I repeat: Rock the Hell On!

Notes

[1] An interesting, if not overly informative, discussion of this deep history is available at http://earthasweknewit.org/pages/oxygen-atmosphere

Saturday, February 15, 2014

It Might Get Messy

Sherman, set the Wayback Machine for northern Europe, winter of 1944/45. Things are cold and dark and wet. Of course, that pretty much describes northern Europe any time, any season. But this year the cold and the wet are more intense than usual. 

It’s also dangerous. There are hundreds of thousands of people wandering around with weapons of destruction, both personal (pistols, rifles, submachine guns, knives, grenades, mines) and mass (artillery, machine guns, tanks, warplanes, warships, aerial bombs, rockets, even intercontinental ballistic missiles). Hatred, fear, panic, privation, starvation, resignation, fatalism, and near-catatonic oblivion are universal. 

It’s a bad time. Front line allied foot soldiers, the hunter-killer riflemen who are the blunt instrument of warfare, see and do things that no human being should have to experience. Most of them have been in the theater for at least a year, having arrived across the beaches of North Africa, Italy, Southern France, and Normandy. They live—those that did in fact survive—under exhausting, emotionally degrading, and physically shocking conditions [1]. Many—perhaps most—were at the end of their strength and abilities. Desertion, suicide, PTSD, addiction, and self-inflicted wounds increase at alarming rates.

But, these men, and some women (while the front line soldiery were universally male, there were substantive numbers of women subject to the same madness—drivers, pilots, correspondents, nurses, clerks, etc.), had risked their lives and their physical and mental health in a noble cause. They drove themselves to the end of endurance, but by springtime 1945, they could see the end of their journey, and a successful end at that. The timing of things couldn’t have been more propitious. Just as everybody was reaching the end of their tether, the war was ending. The human wreckage engendered by unceasing brutal combat were about to get what they most desperately needed. Time to return home to families and friends. Time to come to grips with the devastation wrought on their psyches. Time to watch their kids grow up. Time to watch their lawns green up while they slurped high-powered cocktails to blunt the razor-sharp edges of their wartime memories. 

Except they weren’t going to get these things. They were going to get a few weeks to contemplate their precarious condition while they sailed in crowded and uncomfortable transport ships to the Asian theater of war.

When it became clear that the end of the war in Europe was not going to end their horrors of endurance, it must have been soul-crushing. Devastating. They were going to move their desperate souls from the cold wet of Europe to the hot wet of the Pacific rather than to the bucolic warmth of Brooklyn or San Diego or Evanston . And go right back to seeing and doing things that nobody should ever have to see or do. Except that, by now, many of them had seen and done so many of those things that they could not see or do any more without incurring permanent crippling damage . I can’t imagine the horror of opening a new set of orders demanding immediate shipping out to the brutality of the Marianas when I was still shaking from the brutality of Bastogne.

And why am I subjecting you to this rather rambling discourse on the psychological nightmare of armed conflict? Because it is an apt metaphor for certain aspects of the devastation wrought by cancer and cancer treatment. 

I saw surgeon Dr. H and palliative care specialist Dr. S this week. Dr. H continues to be delighted—and surprised—that what’s left of my throat is smooth and healthy, with no signs of incipient malignancy. He was pretty upset when I told him I was having trouble with acute depression. I think Dr. H is a technician through-and-through. His vision is that we’ve saved my life, everything from here on out should be sweetness and light. 

Dr. S was quite sensible. He said “Let’s review. We’ve spent three years mangling your head and neck. We kicked the cancer, and now you can’t talk, eat, work, or function beyond a pretty low quality-of-life threshold. And you figured you shouldn’t be depressed why?” I explained to him that my depression wasn’t overt, weepy, withdrawn, sadness. Rather, it manifests as an inability to kick my butt into gear to start doing the zillion things I have to do personally and professionally. I told him that I am doubly disturbed by this because all the things I have to do are fun and productive. Some I’ve been waiting my whole life to have time to deal with. So finding myself parking my butt in the recliner with the TV remote, headphones blasting World Beat Death Metal, my computer, a book, and my basket of meds day after day and hour after hour is really disturbing. I should be excited at having the time to write prose and poetry, write and record music, work on pen-and-inks and acrylics, and especially pursue photography. But there’s no motivation for that. The recliner has trapped my psyche, along with my physical corpus, in a daily cycle of reading, taking meds, listening to music, watching TV and going to bed. 

This is a classic manifestation of depression, BTW. So I talked it over with Dr. S. In keeping with his practical, nonconvoluted approach, he suggested we up the dosage of my anti-depressants and anti-anxieties, make sure I take dilaudid when I need it (i.e., don’t be afraid of its addictive qualities, take advantage of its healing properties), and park my butt guilt-free in the recliner while I come to grips with the awful quality of life impairments I’m going to carry to the end of my days. He suggests I don’t panic over my inability to accept the physical nightmare of my post-cancer body. That it is going to take time for me to sort out and absorb the lifestyle degradation. That days are lengthening, and if I stop kicking myself around long enough to appreciate that, I should be able to bootstrap myself back to the functional world. 

Like I said, eminently sensible. Basically, he’s doing a workaround for my own parallel vision to that of Dr. H. It’s unfortunate, but having gone through three grueling years of physical and psychological insult, I’m not going home in triumph to the cottage on Staten Island. No, I’m afraid I’m shipping out, wounded though I be, to Saipan and Iwo Jima. My fight is permanent. Like some 22 year old Corporal trying to drink away the vision of Buchenwald while cleaning his Thompson for use in Pacific jungles, I do not get the luxury of going “home”. My “home” now has no tongue, a crippled epiglottis, and bucketsful of mucous. 

I hear exactly what Dr. S is saying. I appreciate the increased dosages of the pharmaceuticals. And I believe I can work my way out of this trap. It’s just gonna take some time. 

Time which I now have! Thank you all for being here. As I’ve told you before, I owe you my life. Without you, I never could have found the strength to survive to this point. Pat yourselves on the back. And please, please, have a slurp of an alcoholic beverage on my behalf. After carefully weighing all the impairments I now have to live with, I think not being able to drink may be the worst. So, all my love to you. Prozit!

References

[1] I am just finishing a remarkable three volume series on World War Two in Europe. The author is Rick Atkinson, the titles are An Army at Dawn (2002), The Day of Battle (2007), and The Guns at Last Light (2013). These books are incredibly, almost impossibly, dense and well researched. Yet the narrative Atkinson draws from the exhaustive research is so well written you will think it’s a novel instead of a work of awesome scholarship. I highly recommend this set to you. You don’t have to be specifically interested in the intricacies of World War Two history to benefit from this set. You will learn a ton, about the war, sure. But also about how to write an intensely documented work of nonfiction that reads like a good Young Adult Dystrophy cycle of novels. 

Saturday, February 8, 2014

It Might Get Messy

Ooh. I got slapped around pretty good for last week’s entry. Commenters complained about my absurd whining about struggling to find creativity when I produce more “creative” shit—writings, paintings, cut papers, songs—than your average 61 year old cancer survivor. One person skewered me for slipping into self-pity when I’d managed to avoid it for the long years I’ve been battling cancer and its aftermath. 

Possibly I should have explained myself better. But let’s not go there yet. First, let’s talk about creativity as a practical tool for living. And one of the keys to applied creativity is improvisation. 

I went through a spell a few years ago of reading half a dozen quasi-scholarly books on improvisation. I’ve spent my life not only functioning primarily by improvisation, but really, really enjoying it as a way of going. For a time when I was younger, I worried about this. I suspected it was actually due to laziness and procrastination. Ignoring ubiquitous advice to “be prepared” for presentations, discussions, operations, etc. (by using notes, and rehearsing and rehearsing and rehearsing, memorizing and memorizing), I thought, must be symptomatic of indiscipline and shallow intellect. 

And, of course, I have indeed lived my life with maximal laziness and procrastination. Complicating this exercise in self-analysis. However. After careful thought, I concluded long ago that living on a knife edge, where the delta between success and failure via making it up as I went along was categorical and high-risk, was a real endorphin rush. 

Being a successful improviser is actually very hard work. John Coltrane is the Big God of improvisation. When he pitched into his tenor sax (or, later, his soprano sax, bass clarinet, or flute, the latter two gifted to him by Eric Dolphy’s mom after Dolphy’s death from insulin shock during treatment for an acute episode of diabetes while he was in Europe), he said the most profound and fascinating things that have ever been said. As we’ve discussed before, I’m basically non-, or a-, religious. But when I hear Coltrane play, a crack ripples across my atheism. While I’m listening to Coltrane thinking (which is what improvisational musicianship reveals), I feel the tendrils of gods reaching for me, exploring my being for worthiness. And Coltrane achieved his status as hammer of the gods by intense study and practice. He practiced constantly. When his band took a break between sets, he went backstage and practiced. He studied ethnic musics worldwide, dug deep into western classical music, and translated it all into the most creative conceivable improvisation.

Then there’s improvisational wedding photography. If you go to 

http://www.huffingtonpost.com/2014/02/04/russian-wedding-photos_n_4724608.html?utm_hp_ref=mostpopular

you will see some of the most hilarious and creative wedding photos ever. And they were taken at a wedding in Russia! I guess Pussy Riot doesn’t have a lock on catchy creativity in the Land of the Great Proletariat. 

For me, creating by improvisation meant that I had to know as much as possible about the subject at hand. If you study up about, say, German wine production, you can deliver a dynamite impromptu lecture, with white board graphics and real time web examples, for someone headed for Germany (I bring this up because Ms. Linda, colleague from a prior lifetime, recently reminded me of my classroom session on German wines before she and others on my staff left for project work in Germany years ago). For another example, having spent a lot of time browsing books about Russian cuisine, I was able tonight to produce a nifty Olympics-oriented dinner of blini (yeast-raised buckwheat griddle cakes) with mushroom duxelles and a slather of Greek yoghurt with dill, and a casserole of sauerkraut, onions, apples, beets, potatoes, and sausages. Eminently edible, I was assured, by those members of the household still able to eat via the traditional process of masticating and swallowing foods ingested by mouth. 

So improvisation is not a recipe for shoddiness. Successful, creative improvisation is damned hard work. But the product burped up a good improvisation can be awesome, in ways that product yielded by plodding, systematic, detailed planning can not. 

Improvisation even has a role in cancer therapy. Dr. N, my radiation oncologist, recently told me that, for my second round of treatment, he gave me a far more intensive dose than other doctors would, because he had a feeling he could get away with it, that I could take it, and that it was necessary due to the awful prognostic odds against successful treatment. Dr. N’s improbably successful improvisational handy work, then, is why I’m here, breathing, watching Men In Black as a break between Olympics coverage, and typing up this blog entry. 

Anyway. Back to my creativity issues. I have two major complaints about my personal “creativity”. The first is that all my stuff is derivative. My art, my music, even my writing, sadly, are all grounded in work by my betters who actually COULD create. All I can do is apply their tools to my pitiful efforts. Knowing that my artistic products are directly linked to other people’s creativity is something of a bummer.

But the real bummer is the other complaint I have about my creative abilities. Nothing I produce has any remunerative potential. In other words, nobody’s gonna pay me for my papercuts, poems, pen-and-inks and songs. I have been able to eke out a living by prose. But the creative products that generate cash aren’t the most satisfying ones. The latter—like this weblog, for instance—aren’t generating revenue streams. Double bummer. 

In summary, I suppose I’m guilty as charged—whining about my lack of talent, and getting down and wallowing in the accompanying self-pity. But at least it’s more complicated than it seemed at first blush. Hopefully I can get a little slack cut on that basis. Not that I really object to being hammered about quirks and corners of my writing. That’s how I learn. Maybe, if I live long enough (potentially problematic given the rather fragile state of my post-cancer physiology), I’ll even learn to produce something absolutely original and state-of-the-art. That’ll be a good day. But I’m not holding my breath. Or putting a cork in my tracheostomy tube. 

I thank you all, once again, for being here for me. I know in my heart that without you, I wouldn’t have had the strength to survive to this point. You have my love and my gratitude. And, possibly, I can offer something more concrete by way of thanks. Did I mention that the drug carrier in my THC gel caps is sesame seed oil? I’m seeing a “magic” salad dressing one night at the beach this summer… . 

Saturday, February 1, 2014

It Might Get Messy

Back in Thee Olde Dayes of ecology, say maybe the 1950s, we were all about “limiting factors”. Via forestry and agriculture, we figured there was always one (in the real early days) or more (as we got sophisticated) environmental parameter(s) constraining runaway expansion of one population vs. others, and that the balance of multispecies multiple limiting factors generated the complex biological communities we found in various locations around the globe.

Now, of course, you can recite the limiting factor lists and chuckle over our primitive belief that temperature, moisture, oxygen, nitrogen, light, whatever, assembled the puzzle pieces of organisms on the geological card table where we found them and counted them.

Of course, in many ways, we now know that it is just that simple, at some level. There is always too much or too little of something keeping organisms from thriving or even surviving. And of course, in the most fundamental (and brutal) way of things, there are boundaries beyond which life as we know it—carbon-chemistry, water-operated, cellular-bundled, DNA-recorded—is impossible. 

I suspect we’re going to find that “life as we know it” is in fact a tiny sideshow in a much larger universe of “living” things that confound us as to what the hell they are and how the hell they operate. Cross-reference here last week’s entry in this blog pointing out the quirky appearance of that blob in the time sequence of photos from Mars last month. 

And yet. There will still be limiting factors. Temperatures, for an easy example. Maybe there are things that “live” on solar surfaces, and some that “live” in the barely-above-absolute-zero of dark matter and dark energy swirling in intergalactic space. Still, at temperatures where matter comes apart or ceases to move, we will find there is only physics. Not even chemistry, let alone biology.

But, for the moment, in the real world of earth’s biosphere, temperature is indeed an important constraint on life. I know it’s important to ME, anyway. These last few weeks of intense cold have put some clear boundaries on my ability to function. I went out to run a few errands one day, and almost seized up at the pain of the cold air pouring through my bronchi into my lungs. Because, of course, the air I breathe now runs right through a hole in my throat, bypassing the nice and warm sinus cavities that, back when I had a functioning physiology, made the air nice and warm and moist on its way to my respiratory system. 

So, my recovery is actually stalled by my own new world of limiting factors. I can barely make it out and back to retrieve the newspaper, much less walk myself and/or the dog around the block. 

And this is not, in the long run, healthy. The longer I sit with my butt parked in the recliner, reading World War Two history and living from medicine-dose to medicine-dose, the longer it’s going to take me to reach some level of functional strength in the spring when I can take my shiny new Canon with the 50X optical zoom out to photograph the hell out of the Patuxent Reserve across town. 

Even this forced time out, though, comes with benefits in my world of body-by-cancer and/or surgery/radiation. Slowly, the glandular production of slop—mucous—in my oral cavity and throat, seems to be reaching a sort of balance. I no longer risk drowning if I don’t take massive doses of antihistamines. I can take a comfortably reasonable dose, prop myself up on some pillows against the headboard, and generally sleep with only occasional moments of panic needing me to cough up goo so I can breathe. 

Plus, I get to read a lot of World War Two history. Now, if I can discipline myself into a moderate level of activity, working on things like retaining my mouth gape in an environment where my mouth no longer serves any real function, and getting my brand new photo printer up and running so I can put together a portfolio of framed photos from my big backlog, I’ll be ahead of the game when spring finally gets here.

Meantime, it seems like there’ll be at least a small party on hand for the Super Bowl tomorrow. In addition to Cathy, Lucy and me, we’ll have Molly, plus Jesse and Kim. I’m gonna make some crisp salmon bites (Seattle) and Bison Balls (Denver). Maybe some sausage carne secca, fruit chunks, and small stuffed pastries, just for general principles. 

Since the Winter Olympics are shaping up to be more entertaining from the geopolitical than athletic perspective, we’ll have to take maximum advantage of the Super Bowl as epic winter sporting event. 

I’ll have my butt parked right here in front of the TV. Until I’m released from my limiting factors, when spring cycles around. And until then, my love to all of you. Take a moment every day to simply savor the fact that you’re alive, breathing, functioning. Because that’s the simple, brutal message of Stage 4 cancer. Those days are numbered. Make every one count!