It Might Get Messy

On the remote southeastern corner of Guam there is a large beachfront bar, hopping on weekends with locals and U.S. service personnel. It has a rather incredible claim to fame: it is where Shoichi Yokoi, Japanese soldier who missed the end of hostilities on the island in 1944 when the U.S. took it back from the occupying Japanese, appeared from the jungle in 1972. It seems that his teeth finally deteriorated from his diet of freshwater shrimp, insects, and wild plants, and in his weakness he let himself be discovered by local farmers. Still not convinced the war was over, he decided he would die of malnutrition soon any way, so he might as well surrender. Instead he got his photo taken by every patron of the bar, and was shipped home to Japan as something of a war hero. 

I spent a delightful evening at that bar on one of my trips to Guam. Fascinated by Shoichi’s story, I examined every photo in detail while slurping fruity cocktails. Mostly I admired the stoic Zen courage this guy had to have to live for 28 years alone on a tropical island subject to seasonal monsoons, massive hurricanes, long dry spells, and a dearth of things to eat. And when he finally gave it up, he wasn’t resentful or angry or frustrated. He was all smiles in all the photos, and was, according to news clippings posted on bulletin boards, friendly and psychologically perfectly well adjusted.

Shoichi is my role model for stoic courage under fire as I accept the physical and psychological hammering associated with terminal cancer of my respiratory system. If I survive long enough to finally get my tattoos, along with a tiny Coptic cross, I would get a portrait of Shoichi. He was, in my humble opinion, Da Man!

Anyway. So far this year, all my physiological problems have been from the treatments, not the underlying illness. Given that those problems have included a 911 rescue by ambulance and several week-long hospital stays (with a special holiday for four days in intensive care at one point), cancer treatments here in the 21st century are unavoidably brutal. Certainly in the short term they are more devastating than the course of the disease. But in the longer-term interests of survival or at least quality-of-life, they must be endured. In brief, my response to treatments went something like this: first course of radiation burned the crap out of my face and neck and, along with simultaneous chemo, put me in the hospital for recovery. Next attempt at chemotherapy after disease recurred, using monoclonal antibodies, sent me into anaphylaxis and put me on a respirator to survive the incident. Subsequent doses of more conventional chemotherapy—taxol products derived from various species of evergreen trees—sent me into the hospital after each treatment, primarily for intractable vomiting and dehydration. 

Finally, in the last round of chemo before yesterday’s, we seemed to get it sorted out. The docs and nurses changed the intravenous antinauseals to two chemicals that apparently make it impossible to vomit for weeks. And sure enough, after that last dose of chemo, I didn’t vomit at all. In addition, anticipating potential dehydration in any case, they called in a nurse on our position to teach Cathy how to administer intravenous fluids via my state-of-the-art “power port” which is a wristwatch-sized device inserted in my chest as a gate to a tube that runs right down into a major artery leaving my heart. Rather than having to find a vein in my arm or hand when I need i.v. access, they just stab a specially designed needle into this permanent access port. Less physical trauma, and faster distribution of materials because distribution is by artery rather than vein. 

On Wednesday, we visited my oncologist. Dr. T was practically ecstatic at my progress (the last time she saw me I was pretty much non-responsive). The real key, in addition to my growing physical strength, is the lack of fluid accumulating around my lungs in the pleural cavity. Fundamentally, this means that the chemotherapy is successfully suppressing the cancer inside the lung tissue. It actually sounded like she intends to continue the every-three-weeks chemo infusions beyond the five courses originally prescribed, if it continues to help the lungs and does not yield the repeated need for hospital admission. She even hinted that, in her estimation, I might survive longer than the few additional months that was the medical team consensus when we started down this third road of treatment.

She even has backup plans. There is an ongoing clinical trial of a specific lung cancer treatment at Johns Hopkins for which I would be a potential candidate if the taxol fails. And the Hopkins faculty at “my” hospital, the Greater Baltimore Medical Center, is in the conceptual phase of developing a clinical trial for another, new and potentially powerful lung cancer treatment. Again, I am not a candidate while the taxol is working. But should it lose its therapeutic value, I might at least be able to make a contribution to science via a clinical trial (problem being, of course, that neither you nor the treating physicians know whether you are in a treatment or control group). 

Among her many qualities, it is clear that Dr. T is not a quitter. And this is important for me, from a psychological perspective. Only a few months ago, when I was desperately miserable from the aftereffects of the treatments, I was ready to die. And the balance continues to play out in my head, regarding how much I’m willing to put up with (and force my family to put up with) in dealing with my disease vs. just picking the time to move to hospice care and let myself return to the ecosystem from which I came. But Dr. T’s optimism, based as it seems to be on the reality of treatment success and potential alternate paths, is giving me some optimism that my end may not be as soon or as difficult as I’ve believed.

We’ll see. I had chemo yesterday, and have to go back on Monday for another unit of whole blood (my RBC count is still low). The vomiting, if it returns at all, isn’t expected until tomorrow or Monday. And starting Monday, I’ll get the home-administered i.v. fluids to keep me from dehydrating. If this coming week goes smoothly, I have to say my spirits will be considerably brightened.

In closing this entry, I must thank masters B, L and S for the wonderful visit on Thursday. I wish I was stronger and could have held up longer than the two hours we had, but it was great to see them. 

And finally, this: use ‘em while you got ‘em. Because they ain’t forever (I was reminded to include this customary closing by a panicked call from Dr. K who noticed it was not included in last week’s entry, and thought this might indicate a change for the worse in my condition. When it was, of course, simply a slip-up on my part). Thanks for being here, everybody. I love you all. And I expect to be around for at least another week, so be sure to check in for the next entry!