Quick, what’s the first thing that pops into your mind when I say “World War Two”? No matter your age or how you learned what you know about the war, one of the first images your consciousness returns when you access its CPU is a black and white photo of urban devastation. Bombed-out city centers are icons of the war.
Incredible investments of time, energy, expertise, money, engineering, and human life were made by both Allies and Axis in the bombing war. Germany’s early bombing “blitz” on residential London led directly to development of the first cruise missile (the V-1 “flying bomb”) and the first Continental Ballistic Missile (the V-2) that revisited destruction on London late in the war. Even the first combat-used jet aircraft, in Britain the Gloucester Meteor used to bring down the V-1s and in Germany the ME 262 configured as a bomber by Hitler’s direct order, were tossed into the bombardment game. The U.S. and Britain put together huge fleets of 4 engine heavy bombers so they could wipe enormous acreage out of cities on a 24/7 basis. Infrastructure in heavily bombed areas became essentially nonexistent. The human costs were enormous. Millions of civilians killed, maimed, or rendered homeless. The bomber crews, front-line job with the shortest life expectancy of them all. The bombing war was bad-ass.
But here’s the weird thing about it. Thorough analysis of macroeconomic data, industry output, productivity, transport, materials supply, population distribution and many other factors by which military “benefits” (in terms of degrading the opponent’s efforts to wage war) can be estimated show little or no effect of bombing until the very final few weeks of the war when the outcome was a done deal in any case [1]. In other words, the incredible investment of money, materials, and human lives made absolutely no meaningful difference. The war didn’t end sooner. Weapons production didn’t suffer. The body counts certainly went up, but everybody of marginally fighting age were out of the cities fighting the slogging infantry and armor battles. The taxpayers and the young people sent to war in their name bought nothing but death via “strategic” bombing.
This kind of threshold—where resources are available and expended, but yield no beneficial return—is a constant concern in patients (like me) who have terminal malignancies but at least a little time left in this life. The easiest path for the decision team—patient, family, doctors—is almost always to pursue some medical intervention. The patient has hope, the family is content that “something is being done”, and the docs are practicing medicine. It’s a win/win/win until you step back and look at the big picture. Which has a fat bull’s eye right where the “action to no effect” threshold sits.
I was in and out of the hospital for the past month or so, largely in recovery from the “side effects” of chemotherapy. When I was at my very sickest (is that a word?) a couple of weeks ago, I really thought I was too weak to continue. I started debating with the doctors whether we had reached me zero return point. I was actually quite surprised—and encouraged—by their insistence that we weren’t close. Their perspective was consistent with their prior thinking—that I could buy enough good time by investing in the chemotherapy. That we weren’t wasting time, money, expertise, or even my discomfort. We were still getting good returns.
What sold me, frankly, was the few days I had between getting out of the hospital after recovering from the first round of chemo and going back in yesterday for the second. I actually felt really good. Pain low, discomfort low, fluid leakage low, bleeding stopped. The only bummer was in an effort to replace my feeding tube hardware. It turned out the surgeon couldn’t slip the replacement copy down my throat—there is some kind of “blockage” grown into my throat. The surgeon says he can’t tell what it is—could be scar tissue, could be tumor, either way it precluded full replacement of the feeding infrastructure. But they replaced my Lowe’s plumbing with a more official looking medical tube kit, and the inner structure is functioning fine, so everybody’s happy.
Especially me. At least for the moment. If this round of chemo hammers me as hard as the prior, I may change my mind again. I was a really, really hurtin’ dude. Those of you to whom I owe email or other communications, I truly appreciate your patience. Your messages are each a dose of medicine at least as effective as any of my many pharmaceuticals. I love you all, and I’m glad you’re here for me. I’m fighting to be here as long as possible. Live ‘em while you got ‘em, because they are NOT forever. Thanks, everyone!
PS—now that I’m home perched on my hospital-style bed in front of the TV, I’m realizing again the primary benefit of working to get enough calories in to restore some of my former weight. The incentive is the pain in my butt when I’m sitting down. For nearly 6 decades, my hip skeleton was well cushioned by layers of lipid. Now they’re cushioned by nothing. Zip. Zero. Ouch. Over and out for this week, my friends!
[1] Overy, Richard. 2013. The Bombing War. Allen Lane, London. At Amazon US: http://www.amazon.com/Bombing-War-Europe-1939-1945/dp/0713995610/ref=sr_1_1?s=books&ie=UTF8&qid=1409436011&sr=1-1&keywords=the+bombing+war
I’m giving you the citation for the UK edition of Overy’s monumental study. His US publisher cut nearly a third out of the book by excising the analysis of Axis bombing. I figure if you’re gonna make the investment to get through a honking encyclopedia like this, you might as well go all the way. If you prefer the more slim and trim version, it’ll come up when you punch into Amazon.
Having cancer is officially a Bad Thing. It’s hard on the individual sufferer, and it is hard on society in general. About 1/3 of human beings die of cancer vs. all other causes. In terms of a functioning ecosystem, however, cancer probably comes as a net positive. It is an important component of “environmental resistance”, which is the ecosystem arranging things such that a runaway population of a single species—Homo sapiens, say—doesn’t run amok like lemmings on a Swedish island, consuming all available food and dying in place by the millions.
Cancer is an ecologically “proper” disease. It strikes primarily after the victims have reached or passed reproductive age. The physiological processes that cause cancer (or allow it to occur) are complex and relatively rare, so sudden, massive outbreaks are uncommon. A functional ecosystem requires constraints on populations that would otherwise expand without end. Life, as we have discussed here before, requires death. A sort of flexible balance between birth and death is one of the components of a happy and healthy environment.
Quintessential “improper” diseases are those which are lethal, blow into town, infect a high proportion of the population, and then disappear as quickly as they arrived. They disrupt the regular comings and goings of matter and energy by throwing one or more population so far from equilibrium that the ecosystem reconfigures itself to account for this unanticipated disruption.
We are seeing in Africa an outbreak of Ebola, a hemorrhagic virus of savage means [1]. Mortality rates in infected individuals are very high, and the virus spreads easily. A closely related virus, Marburg, is waiting in the background, its population simmering beneath the boiling pot of Ebola. On a global scale, influenza remains an enormous threat, despite advances in prophylaxis and treatment.
I bring this up by way of putting cancer into an ecological context. The tragedy of cancer is to the individual and his or her social circle.
Which is certainly not to demean that tragedy. My own cancer has reached a
complex phase. With the lining of both lungs crowded with malignant cells and my liver involved, we are far beyond the point where any kind of remission is possible. Rather, we are simply trying to keep me alive and functioning for as long as possible. The collapse of my health after the first round of chemotherapy a few weeks ago landed me back in the hospital for almost a week. The next round of chemo will be a week from this coming Wednesday. One reason my health has sucked so much recently is my inability to “eat”. As many ways as I could try to get the UN emergency rations down, I could not get enough to maintain my weight. Meaning that not only am I dying of cancer, I was starving to death.
While the cancer portion of my medical problems is intractable, the dietician came up with a work around for the starvation component. I now hook up to a peristaltic pump operating very slowly to drip the liquid food directly into my peg tube and thus my gut. I still feel bloated and full and often more-than-borderline nauseous, but I don’t have to force-feed myself. The pump does it for me. In fact, we set it up to run overnight so I end up eating pretty much 24/7. Which is bizarre. But just another example of how %^&*&^% complicated cancer treatment is.
It wouldn’t be so bad if the pump was dropping bits of a big cheese and bacon omelet, with a side of hash browns and a big mug of thick, bitter coffee. Alas (is that still a word? It looks more quaint than grammatical…). I’m getting the same non-dairy milky substance that I’ve been subsisting on for the past 3 years.
Alack (I have absolutely no idea what that word means. I just associate in my head with early morning cartoons from the 60s where the protagonist (whatever talking rabbit, horse, moose, squirrel, mouse, etc. is in the starring role) says “Woe is me. Alas and alack.” So I’m going to go ahead and use it. If the grammar police bust me, the code phrase will be “to boldly go”. If you get an email from me with that phrase, it’s your cue to dress in phony Special Forces fatigues and bust me out of the Howard County Correctional Institution. They want correct? I’ll give ‘em correct. Alas and alack…. .
Things are about to get even more complicated here in Cancer Land (trademark, copyright). Discharged from the hospital last week after they stabilized my bleeding, breathing, and dehydration, I shifted my venue to home (we have a better cable package here than the hospital). On Monday next Dr. H is going to have me knocked out so he can perform the 10 minute procedure necessary to replace my rapidly-degrading feeding tube hardware. Then we’ll confab with Dr. T who will, on Wednesday, strap me into one of the recliners in the infusion clinic and dump in a bag of anti-cancer syrupy goo. Which should, according to all the doctors (I quizzed each separately in an attempt to get more honest opinions) be the one that actually starts slashing and burning the malignant tissues.
I sure as hell hope so. And I REALLY hope I react better to this round of treatment. Because if I end up like I did last time, I’m going to be very, very bummed. Which will leave you, fans of this weblog no end of profanity, whining, and generally inappropriate prose. Until then, remember I love you all. I have rather dropped off the face of the earth…well, at least the email stream…the past few weeks, being too sick and weak to respond in polite and timely fashion. I’ll plug back into email and respond as needed. Thanks for being here for me, everyone. You provide the motivation for me to continue living and writing. So my thanks include your key role in keeping me alive.
Rock on, everybody. Use ‘em while you got ‘em, because they aren’t forever. And they are damned precious when you DO have them!
Notes
[1] http://www.ctvnews.ca/health/ebola-outbreak-five-reasons-why-it-s-out-of-control-1.1971747
And shockingly so, given the past two weeks of reportage here. That is, however, one of the many things that make life itself so delightful. As opposed, say, to death.
Or so I imagine. Anyway, I’ve been in the hospital since midnight Sunday when Colin and Cathy scooted me here to try to stem the bleeding. Have not been well since. Shitloads of pain, bleeding, vomiting, weakness, yaddayaddayadda. In fact, I felt bad enough to post the past two entries here, and assumed I would be leaving the hospital, if at all, for a very brief time doubly enbriefed (“enbriefed”?!?!? Good Frickin’ Godd, at least I can still write!!!) by palliative care based on lethal tools administered in a comfortable and quiet home environment.
And there I was content to let things sit.
Except you know me by now. And I am rarely content to let anything sit, no matter how cozy and relaxed. Which brings us directly to this week’s agenda: LIFE! MEANING!! AND THE SHEER BLIND CONTRAST OF HUMAN EXISTENCE IN A BIG-ASS AND APPARENTLY COLD AND DARK UNIVERSE!!!
Well, yeah, of course the third was an add-on stapled in as a response to Robin Williams’ death last night. A death that went down precisely in rhythm to where I figured I’d be at the moment. A thought that frightened me enough to kick me in the ass and get me to push my functional abilities and emotional status.
This was not a metaphorical epiphany. From where I was sitting, and considering the information I had within easy reach (mostly my medical records), things were dark and suicide seemed a quite credible and rational response. Consider. My breathing had regressed to my 15-year old asthmatic nightmare. I was too weak to make the 6 or 7 meter trip to the bathroom without the ridiculous expedient of crawling on my hands and knees. I could hold down neither food nor water, the smallest squirt of either through my rapidly-crumbling feeding tube infrastructure yielding a disproportionate vomital response. I couldn’t read or noodle on the guitar (all positions allowing such yielding substantial pain in my reconstructed throat or cancer-suffused lungs).
You get the picture. I was a hurtin’ dude. But the hurt was more than physical. Given the reality of my physiological condition, and as I understood things at the time (4 more chemotherapy sessions that I presumed would additively punch me every session), it was going to a get a whole shitload worse brfore it got the slightest bit better. And “better” was going to be intensely uncomfortable, involving chronic pain, COPD, and endless reruns of “Diners, Drive-ins, and Dives”. So I was, I must admit, beginning to work out possible methods of dropping myself back into the universal pool of matter and energy from which all our cards are drawn.
The entire focus of my medical care at the moment is to see how long we can keep me alive comfortably. My panic was tied directly to this goal. Because if the chemotherapy was going to slap me around like this every time, and leave behind a lengthy, mucous- and vomit-infused recovery period, well, I just wasn’t going there. I started making that case to the medical team when I woke up in hospital Monday morning. That I was seriously thinking of foregoing further treatment and stepping directly into hospice care where, as the Be Good Tanyas (and others, but their version is by far the best) have put it, it would be “easier to be waitin’ around t’die”.
Well. As you might expect, this panicked the docs. Over the three long days in the hospital, they made their case:
• I have a better-than-even chance that additional radiation therapy will have therapeutic (i.e. cancer-reducing) value
• The side effects that hammered me so hard last week are worst in the first session. It will get easier from here on out.
• One chemo treatment is insufficient to determine if the procedures are “working” (suppressing the tumor tissue)
• I can always step out of the active treatment and into palliative (hospice) care.
• The best time to make the decision to abandon active therapy is probably not while you’re spending a high proportion of your time vomiting, eating pain killers like M&Ms on a cold day.
I had to think about it some—I was really, really sick. But I could, by this point (late on Tuesday night, having gotten to the hospital ER late on Sunday night) actually feel that they were right. My breathing would clear for longer periods. The pain would subside once in a while. I might…actually feel good once in a while! And since the next chemo is scheduled for a couple weeks out, I had time to relax and would likely feel pretty strong, clear-headed, and free of screaming pain and stress.
And damned if that’s not how it’s going down. I got home from the hospital Wednesday afternoon. If I hadn’t had a feeding “incident” yesterday (put in too much liquid so that I had a nasty hour of vomiting with a 6 hour recovery time), I would be in pretty good shape. In fact, I AM in pretty good shape. Can keep my breathing clear. Read. Write. Do “art”. Play guitar. Stumble to the bathroom on my own (sometimes. Let’s not worry about the full face plant stage dive I took last night over the rocking chair on the way to the can.). With Cathy’s intense care and attention (I’m afraid, disgusting as I am myself, she has to deal with the even more disgusting consequences of those disgusting traits), I really am feeling better.
Can I do this routine one more time, as the doctors agree I should? In a sort of “Team America World Police” mode: “CANCER TREATMENT! FUCK YEAH!!” Yes, sports fans, I am in for the duration. I am afraid you are stuck with me for the duration. Dunno what that duration might be. Should have a better grip on that starting after the next chemo treatment. If this works out the way the doctors insist it will. I may still be alive for the holidays. And you know what that means. Two things it would mean would be turkey. One copy of the Maghreb couscous turkey from last year. And a second one, which frankly I think will even better, a Dinde Presse, a turkey preparation based on the deep French classic le Canard du presse, pressed duck.
I recommend everyone go to the web and find a video of somebody making pressed duck. It will weird you out. But I seen worse!
Thank you all so much for the calls and emails. If I continue to improve at this rate, I should wade back into the email stream this week. Thanks for bein’ here for me, as well. I cannot express to you how much it means to have you in my camp. Camp? Jimmy, fire up them freeze dried beans with pork fatback. Let’s get a prairie supper goin’ here, Pard!
OK, sports fans, it’s time to start winding things down. And by “things”, I mean my life.
Oh, we still have some time together. The course of last-ditch chemotherapy I’m on itself will last weeks. The likelihood of it buying me at least a couple, maybe 6, months, is pretty good. And we can accomplish a lot with that much time to spend.
Now, if you are anything like me (only the good bits, of course. Believe me, I have no illusions regarding the bulk of what I jocularly refer to as my “personality”), your first thought was something like “uh oh. “Winding down” sounds suspiciously like a logistics nightmare”. Actually, the legal and financial details are indeed abundant, but not intractable. Well, let me rephrase that. If you have a responsible adult running the operation (Cathy, of course, in my case), the heaps of paper can be dealt with without the need to chew off any of your own limbs (you will run into lawyers and financial specialists who will make you want to chew off THEIR limbs, but that’s a topic for another posting).
With the paperwork neatly compiled and filed and safely in the hands of others, you are now facing the intellectual and emotional blast wave and associated shrapnel and afterburn that will precede and follow your increasingly imminent death.
But first, there’s the continuing nightmare of physical illness. When you are down to months of life, how much pain and discomfort you are willing to endure is largely up to you. The doctors will continue to treat you for as long as you want to be treated. I’m staying on board for at least this last course of chemotherapy because of simple greed. I have at least a little more life to live, and I need to spend some final time with my family. But I’ll tell you, it’s a tough slog. Today is Friday, second day after my first dose of the chemo drugs. And I have spent the entire day leaning forward over buckets struggling desperately not to barf. Hopefully this will be the worst day. The chemo course has something like 5 more doses spread out one every 3 weeks, so I am going to spend a bunch of my remaining time in physiological hell. We all have to make our choices and live (or, in this case, die) with the outcomes.
Saturday was no better. I don’t know how much more of this I can take—hopefully, tomorrow, things will improve some.
Hopefully.
It Might Get Messy
The trendy set who pound down cocktails and white wines at what was once the Fulton Fish Market might get a kick out of the memory of tuna entrails, eel slime, and shark’s blood that the Helly Hansen ancestors of their Ferragamos stood up and worked hard in for 6 days a week.
Then again, they might not. Nothing like a big splurge of halibut guts to set up an ongoing relationship! (take that, “match.com”!). But that’s not our point here today. We are here today, I’m afraid, so that I can whine. Seems to me that’s it’s been a while since I’ve allowed myself a good, shaky, high-powered whine indulgence. And that I’ve recently accumulated sufficient more-or-less serious complaints to warrant a session of good, old fashioned bitching.
Let’s start on Tuesday afternoon. We headed into the clinic for my day’s dose of radioactivity exposure when I am stricken with a violent, world-shaking incidence of dizziness. I can barely lower myself to the floor to prevent falling and cracking my skull. Cathy runs to the reception area to call the hospital “Rapid Response Team” (who, to their credit, arrive in no more than 3 or 4 minutes with a dozen people and variety of tools for safety and diagnostics). I’m now lying in a big puddle of vomit and feeling, if anything, worse. So of course they admit me for observation (this has something to do with the insurance payments, BTW. Try to make certain that you are admitted as “in-patient”—it makes a vast difference in what is covered).
Anyway. I’m admitted, monitored, attended to. All seems fine. Eventually they get me on a stretcher and down for the CT scan that was the original objective of the visit. Looks good, although a bit scary. A whole landscape of incipient tumors is growing on the pleural surface of my insides, each waiting its chance to bust loose and pour malignancies into important components of my anatomy. Sigh. These very tumors are the ones that the first round of chemotherapeutic drugs are intended to hammer. And why the depressing “sigh” in that sentence up there? Simply this. When they hauled me down for the infusion of monoclonal antibody treatment, my body finally rebelled. Violently. The infusion sets off the chain reaction that is the classic anaphylactic immune response. My breathing stops. Heart stops. Body starts to shut down. Damn good thing I was in a large room containing all the hardware and software modern medicine requires, plus the doctors needed to make all that hardware play “Bolero” in any key you call.
Fast forward to Sunday evening. I’m sitting in my Recovery Recliner, working my way through the heap of pill, tablets, capsules, and gel caps that constitute my nightly medications. Then I settle in to watch a little TV and get set to head upstairs to bed. But after a few minutes, I notice Cathy and Jesse both staring at me. “What’s wrong?” they ask, simultaneously. “Uh, nothing that I know of. Why?” Well, it turns out I had been scribbling out a white board message to ask them a question. Then I realize, like Jack Nicholson in “The Shining”, that I’ve been writing the same sentence over and over and over on the white board. This is a little frightening. But there do not seem to be any other overt signs of a stroke, so we avoid the exigency of waking up the doctor who lives next door to come take a look. Rather, we drive to the Emergency Room at the local hospital (Howard County General) instead of the further away Greater Baltimore Medical Center which has been taking care of me to date.
After a couple days of “observation”, everyone agrees I can go home. So they send me on my way. So now, with the radiation over and done and the chemotherapy on its way, my life is gonna suck for a while. But notice that critical word: “life”. My LIFE is gonna suck. Which means the doctors are not yet ready to heave me onto the collection wagons. And I am CERTAINLY not ready to be heaved onto the etc.
Life: it’s not always pretty, and it’s not always comfortable. But dammit, it IS “life”. And I’m gonna be in that arena, Claymore vs. Claymore, battling the evil armies of mutated malignancies. In fact, on Wednesday, they’ll try the next chemotherapy drug in line. Not sure what it is. But if it has any side effects like the monochlonal antibodies, you’re gonna hear about ‘em right here next week. So remember to check back in. Worst case, there’ll be at least one or more humorous anecdotes to relate. Best case…well, let’s not go there yet. The best case is good, but highly unlikely. I’ll walk you through the technical details next week. So check back in. Remember that I love you all. And that I’m hoping your summer if going better than mine!!!
