This is a hard entry to write. Please bear with me. I might drift off the track some or get lost in irrelevancies. But I’ll work to keep it on point and target-centered. If I wander, just walk with me a few steps. We’ll get back to the path together. I promise.
Messy comes in many varieties. There’s purposeful, directional, forward-looking messy. This is the kind of mess you find in the laboratories of scientists headed for breakthroughs, novelists finishing masterpieces, painters getting those last strokes onto a long worked and re-worked canvas. It’s the kind of messiness that, in the end, is irrelevant. Tracking backward from the finished product, you can trace the threads of its maturation, growth and birth through the piles of shit left along the way—the heaps of empty paint cans, stacks of books and papers, empty coffee containers, and pizza boxes. The mess, in this case, is a means to an end. And so, in a twisted way, possessed of an odd kind of inherent interest, kind of the way projectiles dug from the soil of civil war battlefields, the latter as close to a “perfect” mess as it may be possible to contemplate, are artifacts linking the messy process it took to get there to the outcome that made a world a damn site less messy than before.
Then there’s messy that’s just a mess. Because we live in a universe defined by dimensions of space and time, “mess” is not stasis. It fluctuates, sometimes bigger, sometimes smaller, always pushing forward, like a mole rat hell bent on moving 10 or 15 meters of African desert soil from its tubular highway to a heap on a roadside. But it doesn’t necessarily have a purpose, a direction, an objective. It’s just the mess that goes with life and living.
Or with death and dying. The universe as a whole doesn’t care who or what is alive and losing entropy or dead and re-upping the entropy supply. It may ultimately be that the universe likes having entropy compiled and then dissipated, a process that produces order from the cold fragments of black eternity. But I’m not prepared to go there yet. I’m only prepared to say that I don’t think the universe gives a rat’s ass whether it’s my butt using energy to keep entropy at bay, or something else—like maybe an actual rat’s ass.
Friday I went in for a PET scan. That’s the one where they inject me full of radiolabeled glucose, wait a while until the tissue starts to accumulate same in proportion to metabolic activity, and then image the residual radioactivity, yielding a graphic showing metabolic hotspots, which in a healthy human include such high-energy machinery as the brain, liver, kidneys, and heart. In an unhealthy human, malignant tumors rock and roll on that fludeoxyglucose, slurping it like an Ann Rice character lost in Texas Chain Saw movie.
The accessibility of the software seems to vary from visit-to-visit. This time, I’ve not been able to get the clearest or easiest-to-see images for you. Which actually makes the point rather vehemently. What I CAN see in these images is frightening. And you’re talking about a guy who thought he had seen “frightening” become passé in the years of radiation exposure, chemical treatment, and surgery.
The PET scan image above shows my brain in bright red and orange shows that the brain tissue is doing what it does—work. Hard. All the time. The human brain is massively energetically expensive. The bright color in the images demonstrates that the radiolabeled sugar is being absorbed rapidly and massively and used in place to make sure that my mind is…uh…minding the store, so to speak.
Now, one of the other figures is the scary one.
The image above shows a disembodied orange spot in the middle of my neck. That has no business being there. The normal tissue there plugs away at a none-too-swift metabolic rate, maintaining the mucosal surface, operating the swallowing and speaking muscles, generally just making sure things run smoothly. The fact that there is a bright shiny hotspot of radiolabeled glucose uptake there in that region of mostly slow chugging tissue is a really bad thing.
My friends, I haven’t begun to come to grips with the meaning of all this. I do know that treatment options are a lot more limited this time. My body’s taken pretty much all the radiation dosimetry it can take for quite a while, so generic radiation treatment is out of the tool kit. Leaves us with chemotherapy and surgery. Neither one sounds particularly attractive to me at his point. I’ve been getting better and better, my voice becoming more understandable, my energy level increasing, my grip on life becoming tight again. I taught the first class of the semester on Thursday night, and the kids could understand me just fine.
Let’s hope that whatever has to be done to fix this new physiological contretemps means the students can understand my voice all the way through the semester. That’s gonna be my benchmark for this one. If I can teach the full class without drastic remedial activities of any kind, I’ll take it as a good sign.
Next week, I expect Dr. H to look over these PET and CAT scans and schedule an MRI in prep for surgery. I’ll keep you plugged in. I’m a little concerned about this recurrence, I have to admit. I’ll need all of you out there pulling for me this time. Thanks for being here for me!!!
We spend a lot of our life between things. Between lovers. Between jobs. Between classes. Between houses. Between meals. And at the margins, between life and death. Living between things is, I think, a good place to be. It means you believe in the future. That something has passed to the…uh…past, and now you’re just waiting for the future end of that track to poke you in the ribs and say hello. It means you’re not living in the past, surviving on memories and leaving the future to its own devices. It makes you a player in the game of life, puts you in the position of having finished x, now must do y; having seen a time to see b, having experienced t, now ready for t +1.
Of course, not everything fits easily into this benign model of the present linkage of immediate past to immediate future. There are many things it’s best not to be between. Between wars. That’s never worked out very well as a stepping stone. Between hammer blows. Of whatever kind. Between good and evil. It may be where we’re stuck, but it’s not a comfortable place to be.
Now I’ve got a new one for you. Between tumors. From 18 months ago, when the final set of post-treatment biopsies and remote sensing data showed me to be cancer-free, until Friday last (that would be 18 January 2013) when Dr. H told me the tissue taken the prior week was indeed malignant, I had been between tumors.
In the not-so-remote past of cancer therapy, “between tumors” was about as good as it got as a treatment outcome. Nobody would or could say cancer was “cured”. Your cancer was “in remission”. Could return any time. Often would return. If you made it past your 5 year survival date without a newly positive diagnosis, you would feel comfortable that you had “beaten” cancer. Still came with the nagging assumption that you could be stricken at any moment, but the longer things went, the closer to “cured” you were.
Nowadays, people really do talk about “curing” specific cancers. Localized tumors, even if they’ve anastomosed, can be identified, delimited, eliminated, and, with conscientious follow-up monitoring and treatment, in many cases that was it. The cancer was over. You were, as a practical if not theoretic matter, cured.
But not me. On Friday the biopsy results came back positive. I have another tumor in my throat, pretty close to where the original primary was, deep on my tongue muscle. It’s actually pretty active, now that I know it’s there. It’s pumping out its own mucous cap a couple times a day, and it’s starting to generate some aching pain of its own. Fortunately at the moment I have open scrips for both Xanax and Oxcycodone, a couple of each at bed time lets me sleep despite the creeping growth of out-of-control throat tissue working actively to make what’s left of my life miserable and short.
Well, that at least ain’t gonna work. I turned 60 years old on 12 January, and my brain feels like it’s younger and more open to new learning than it has ever been before (the rest of my body, not so much, but that’s a different story). I don’t really know the implications of this recurrent cancer. Dr. H sounded pretty disgusted, or maybe discouraged is closer, on the phone on Friday. But he’s had the weekend to think about it. End of this week, he’ll have PET and CAT scan output to look out, I’m betting I’ll be in for another MRI the following week. And by then Dr. H’ll have a concept, a plan, and a timeline. And we can have it.
Somehow, I thought I was getting away too easy from this cancer stuff. Guess that was true. Time to strap the gear back on, pack in the ammo, and stumble back into the trenches. Am I ready for it? We’ll just have to see. Haven’t had cause to whine yet, which I’ll take as a good sign. Hang in there, everyone. Having you out there in the world is a huge part of what makes me strong here in my little corner. Love you all. Better update, hopefully with cool graphics, next weekend. Hola, everyone!!
I was pretty sick the last time Nurse C took care of me. That would have been a year-and-a-half-ago, when I was admitted via the emergency room, required a couple units of blood, and was generally as close to physiological collapse as I ever expect to be. At least until I DO physiologically collapse.
Nurse C, sole post-surgery attendant hanging around the recovery rooms on Friday, remembered our past meeting. She says I look “good”. Which I know, now that I am a 60-year old cancer survivor, is a comparative thing. I do not look “good” on any rational objective basis. And a comparative thing that can only be taken so far down the metaphorical path. I’m sure I look “good” now compared to the skeletal 187 pounds of painfully bruised and dehydrated prosciutto I was the last time I chatted with Nurse C. Otherwise, I look like an unattractive 60-year old cancer survivor.
Be that as it may. My purpose in being in the operating room on Friday was to be biopsied following a nasty bleeding incident and discovery of strip of torn tissue in the back of my throat. The intervening couple of weeks had not been particularly uncomfortable. My throat wasn’t clear, but it wasn’t clogged, either. Let’s call it “perturbed”.
Still, Dr. H is solicitous of my throat. He worries about it. Which is good. I can worry about it, but having no real understanding of the shifting tides of cancerous tissues, my worry is that of an amateur. Dr. H is a professional. He knows what to worry about and why.
He says my throat tissue remains fragile. That irritating foods are plausible causes of bleeding wounds. This continues to shock me. I can’t believe we’ve more or less permanently rendered my oral mucosae so sensitive that I can’t eat without painful discomfort. But that seems to be where we are.
So here’s a photo of my generally irritated throat. There’s apparently nothing characteristically carcinogenic about this line of scabby tissue. The fact that it has appeared is enough to render it suspicious.
So Dr. H had the anesthesiologist put me under and slipped the knives in to excise some of the scab. Here you can see the scalpel and the rectangle of flesh ready to be pulled out and dropped into the vial.
And the post-surgery tissue, ready to recover.
Dr. H figures to get biopsy results back middle of this coming week. In the meantime, he does not seem all that impressed with the inflamed spot of interest in this round. He thinks it has a fair chance of being malignant, but that it is compact and could be treated rapidly, easily, and surgically.
Which is good. Not sure I’m ready to go through another course of radiation and chemotherapy, at least not the intensive twice-a-day treatments I got in the first round. Conversely, I’m hoping to be left with enough functional mucous membrane in my oral cavity to be able to talk, eat, and breathe. Maybe not comfortably, but functionally.
Hopefully I’m there. We’ll find out later this week. If this tissue isn’t malignant, I’m going to take that as a very good sign. And if it is, I’ll take Dr. H’s confidence in its compact treatment as a good sign. Either way, let’s say it looks like I’m getting closer to closing out my cancer.
Then back to dealing with real life. I wonder if I’ll miss the distraction?
In 1883 in the morgue deep in the bowels of the Berlin City Hospital (I do not in fact know that the morgue was “deep in the bowels” of the building. I make the assumption for purposes of narrative interest), a guy named Hans Christian Gram was trying to find a way to make bacteria stand out from lung tissue in microscope slides prepared from tissues of pneumonia patients. Gram devised a procedure by which the thick sugar-and-protein cell wall of certain bacteria could be stained purple, via a method that left bacteria lacking the peptidoglycan layer pink. For a long time, Gram staining was a critical method in bacterial identification and description.
Many human pathogens are Gram positive. And many of the most ubiquitous antibiotics work by interfering with the production of the thick layer of sugar and amino acids that characterize Gram positive bacteria. Streptococcus and Staphylococcus are both Gram positive.
When I was a kid, I had bad lungs. I know that’s not very specific. My lungs definitely were bad. I had chronic asthma, which occasionally erupted into acute asthma, and often tended to devolve into bronchitis, inflammation of the upper respiratory tract.
Occasionally, the bronchitis would slip deeper and more permanently into my lungs as pneumonia. On the fundamental assumption that my lung infection was of streptococcal origin, at this point Dr. G would start me on antibiotics and send off a swab of tissue for culture identification. Generally by the time the lab results came back, the antibiotics had corralled the infection and I was on the mend, winding down from heavy dosages of norepinephrine, room-temperature apple juice, and weak tea with honey (but NOT with the shot of gin that Armenian-born and Soviet-trained Dr. G recommended, because gin and tea is absolutely disgusting, sick or not), and finally getting some sleep because I could lay almost horizontal without shutting down my respiratory system.
Except one time. My asthma acted up, bronchitis arrived, pneumonia crashed my lungs. Dr. G gave me antibiotics and sent off a sputum sample. I remained drastically ill. Serious difficulty breathing. Increasingly intense asthma. An all-around respiratory mess that dragged on and on.
The lab results came back. Turned out I did have a bacterial, not a viral, infection. But it was Gram negative. The “normal” antibiotics had no constraining effect on its reproduction. As soon as we swapped meds to one that would wack the cell wall construction of my Gram negative inhabitants, the pneumonia loosened up and I started to recover. Was an uncomfortable couple of weeks.
I was reminded of that incident earlier this week. The antibiotics Dr. K gave me for a possible sinus infection, which treatment had Dr. H’s concurrence, were having no noticeable effect. My throat was swollen, pain was increasing, swallowing was increasingly impaired. In the short term, I kind of thought I’d feel better with the infection knocked back by the antibiotics, and that there would follow a slow increase in throat irritation as the new damaged tissue that Dr. H discovered expanded.
Instead, my throat continued to hurt for a couple days after the antibiotic prescription ran its course. Then it started to feel better. Less pain. Less disruption. Less blockage. Less ickiness. And definitely less mucous.
My speech has been responsive to my Arabic exercises. I don’t hurt down in my throat. I got all my pre-operation tests out of the way last week. On Friday I go under the knives for Dr. H to slice biopsy samples from the back of my throat. Until a few days ago, I thought this was an exercise in futility. That there was clearly new tumor tissue sprouting around my mouth, tongue and throat. Now I’m not so sure. I think it’s possible there’s just another nasty sore spot left over from the radiation. The way long time ago radiation.
But that’s where we are at the moment. I’m optimistic. My mouth’s not sore. Swallowing still sucks, but I’m moving back toward solid food, lacking the pain that would justify skipping it. With a little luck, I’ll have a productive week at work, and a negative biopsy on Friday.
That would set me up for a wonderful winter. If I don’t have to be treated again, so that I can continue to reconstruct my professional life with duct tape and super glue, I’ll be happy. And healthy. Er. Healthier. I gotta live with the reality of an impaired oral apparatus. But if it’s not a recurrent malignant impairment, things’ll just be rosy. This week? Set me among the living, and the happy to be alive. And we’ll just have to wait and see what the biopsy results are before we decide which bucket to dump me in next week.
