Thanksgiving’s over, we’re starting that slide to the winter holidays, and I’m still alive. All of which is, nominally at least, a replay of this same time the past few years. Except. It was just before Thanksgiving two years ago that we discovered my cancer had beaten all the therapeutic ammunition we threw at it. It was right around this time that I went back to the hospital to have my tongue excised, and had a prescription for medical leeches (which come from the pharmacy in cute little harnesses. If I hadn’t been so devastated by the surgery and cancer recurrence I would have put some in little reindeer costumes. Opportunity missed—my bad), and had the entire lymphatic system cut from my throat and chest. In short, I was a mess, physically and psychologically.
Thanksgiving bailed me out of my “shitI’vegotcancerandI’mgonnadie” funk that year. I had a fabulous time, and an enormously important reminder of why life, whatever we have of it, is so beautiful. Got me through a whole year of physiology wars.
THIS year, we know the cancer not only recurred, it prevailed. It’s a bit of a surprise, and a tribute to the medical team at Greater Baltimore Medical Center, that I am not dead. Although I do LOOK dead (as Pete Townsend said of Keith Moon at the first show of their first Quadrophenia tour in San Francisco). I must note at this point that I tried to warn all Thanksgiving guests that I look horrific. Congratulations are due to all, as nobody choked, gagged, or recoiled visibly. In fact, Thanksgiving this year was, because of my “delicate condition” coupled to the love and friendship of all who attended, contributed, wished they could attend, or simply sent heartfelt greetings, even more life-affirming and fantastic than usual. It was, without doubt, The Best Thanksgiving Ever.
Reality will soon rear its ugly head, however. I will be dead in the not-too-remote future. Making this the Last Thanksgiving Ever for me. With that said, I would like to recount a few of the wonderful components that combined to make this 2014 Thanksgiving such an awesome party. Consider:
• The Bosbells took “longest trip” honors for getting here from the mountainous suburbs of Denver AND provided bagels that were a big hit throughout the proceedings
• A consortium of old friends and colleagues shipped in a selection of movie DVDs and music CDs, none of which were duplicates of titles already available in-house (how awesome is THAT in a place with nearly 10,000 audio CDs at least a couple hundred DVDs?), a bottle of Willamette Valley pinot noir that was like a silky, 15% alcohol, cherry-and-chocolate flavored syrup (in other words, absolutely frickin’ FANTASTIC), a true pastrymaker’s pie, and an outstanding, full flavored spiral-sliced ham that was voted “Best Main Dish” by a wide margin of guests
• The Y family contributed a fantastic free range turkey with massive quantity of meat on its frame. Then, when it became clear that I could not stand up long enough to de-bone said turkey, Dr. Y stepped in and, like a guest surgeon on an early episode of MASH, slipped the bones of that bad boy out and left the full-flavored meat and skin to stuff for the Maghreb style turkey, and Ms. J made sure we had an outstanding hand-crafted pumpkin pie for that classic Thanksgiving flavor
• The group as a whole put together a bar’s worth of high-end wines and beers, plus Dr. Y stepped in and replaced the bottle of Chinese Shit we emptied last year. I note that it is apparent that our group is aging, as several people reported this bottle of Gujingongjo was “not as bad as the other stuff”, a statement that can only be attributed to age-battered and generally dysfunctional taste buds
• The L family, who, along with Bob and G (who also came, bearing a classic and high-powered pecan pie) had strayed elsewhere in recent years, provided delicious frickin’ fried oysters from a really cool restaurant quality deep fat fryer, hand-smoked fish still being foraged by Jesse on his way to the night shift, plus, as a bonus, outstanding jambalaya that was slurped by the ravenous crowd in a frenzy that resembled nothing so much as a tour group of anorexic supermodels in a high-end Swiss chocolate shop
• Ms. M supplied smoked salmon, supplementing that assembled into cute cream cheese and pastry rolls, in addition to a fabulous dessert pie
• Dr. D M provided our south of the Mason Dixon Line cred with a luscious collard greens casserole and a life-saving, hangover-fighting breakfast casserole
• Ms. M of local provenance came bearing pumpkin bread, while Mr. E cracked a high-end bottle of bourbon which latter quickly found out this is NOT the kind of crowd good whiskey should mess with
• The kid’s Aunt V provided cranberry sauce and an innovative and refreshing lemon trifle
• Ms. L from the American Heartland shipped in a gorgeous bouquet that served perfectly as a centerpiece
• Frank J. from my Jurassic past made a four-hours-each-way drive to visit as the weekend wound down just to wish us a happy holiday and get us started thinking about Christmas and the New Year
• If I’ve forgotten anything or anyone above, please slap me around and I’ll edit this column in real time. I’m so grateful to all of you, so thankful, that I could easily have missed something in my enthusiasm. As usual, I need adult supervision (sad as it is for a 61 year-old!).
Many more thanks are due to the group for taking care of the cooking, none of which I could do as I was largely confined to my hospital-style bed, and for operating a rolling hygiene operation that kept dishes and counters clean, tables clear, and the other logistics operations that need doing for a party of 30.
And finally, this. I noticed a number of you fighting back tears as we said our goodbyes. Clearly you looked me over and did the rough arithmetic regarding my appearance and the next time we might see each other. For most of us, I’m gonna lose that race, and I’ll be missing in action. In any case, I understand the sentiment, and I desperately wish I wasn’t causing you this pain. But there are some critically important things you need to know.
I have lived a wonderfully rich and warm life. And collectively, much of said richness and warmth came directly from you, the readers of this column and the Thanksgiving crowd. You gave me opportunities, did science and natural history with me, made me laugh, helped me out, and in general made my life the funny, productive, complicated, joyful time it has been. For all that and more, I am eternally grateful. And I’m tearing up now, which seems more appropriate to me. I love you all and I thank you all. I’ll fight my way to the end, motivated by the love, friendship, perspective, humor, and learning you all have given me. I hope to die with a smile on my face, but it is possible I’ll lose my grip and will cry in any case. Either way, just know that I am thinking of you all the way from here to the end.
A small selection of Thanksgiving photos follows below. Remember in most browsers you can enlarge by clicking or double-clicking each photo. I owe many of you and especially several regular readers of this column email replies. I’ll get to those this evening and/or tomorrow. Tomorrow I go in for chemotherapy. I’m hoping massively that I don’t end up barfing my guts out, because it’s clear the chemo drugs are working, keeping me alive and breathing.
Thank you, everyone. I love you!!!
Having a serious, progressive, terminal illness, I am starting to realize after years vested in same, comes with an odd affliction I call “Normality Creep”. Normality Creep is a subconscious survival mechanism in which the patient (me) accepts, even embraces, more and more discomfort and dysfunctionality in life as the disease progresses and time passes. Examples from my own case include simple speech. When the medical team was preparing the first couple of treatment plans, I told them emphatically that losing the ability to talk was a deal-breaker. I have made my living via public speaking and teaching. It is one of the very few innate skills I possess…ed. I could not imagine life without speaking, and instructed the doctors to withhold treatment if I was going to lose the ability to talk. I could survive without speaking, but my quality of life would suck and I didn’t want to go down that road.
Eventually the doctors realized they were not going to be able to save my tongue or provide access to my larynx. This despite the repeated application of medical leeches (attached to cute little harnesses in the pharmacy) in an attempt to save a thigh-muscle tongue graft. I was devastated. But was no longer willing to give up on that basis. I got various writing boards and learned to muddle my way through. My “new normal” had passed a hard threshold, and I just let it go.
Normality Creep simply demonstrates how complex life and dying are. Physically and psychologically, we learn to accept and live with bizarre contretemps as we stumble through life.
Another abnormality that slipped across the threshold to normality is a persistent, irritating, sometimes painful sore on the right hand side of my tracheostomy tube. Where the tube infrastructure rubs against my throat, the skin degrades and I get a scabby sore that often leaks blood and/or lymph. On the left side, after about a year, the sore seems to have healed permanently. On the right side, it is persistent and continues to rebuild itself whenever I dress it and try to get it under control. I finally asked oncologist Dr. T about this earlier in the week. She said casually “Oh, I think there’s tumor tissue there. You’ll probably not be able to get rid of that blob of inflammation, as it seems to be driven by malignancy.”
Mind you, this didn’t seem like a casual matter to me. After all, I’m used to dealing with tumors as abstract entities buried deep in my anatomy, where they can sometimes be visualized via remote sensing technology, but generally represent an unseen enemy sniping at my health from hidden places. Sort of like Keanu Reeve’s Constantine, when Satan reaches into his lungs and extracts a large, black tumor from each. Or like high school health class, where films of black and goopy dissected tumors are displayed in an effort to reduce smoking rates among teenagers.
Thinking I had a unique opportunity to actually see living tumor tissue, I took a forceps and extracted a little chunk of the sore on the right of my throat. Disappointingly, it didn’t look different from every other scabrous sore I’ve ever had. So much for amateur science!
This did, however, raise the issue of life hiding in plain sight. After all, for years now, I’ve been looking at a hijacked chunk of what used to be me, now taken over by the cancer and so a separate, and distinctly unfriendly, blob of living material. Where else might we find the equivalent of Sherlock Holmes’ purloined letter, sitting on a desk top with dozens of other letters and so not coming to the bad guy’s attention until a new plot device was needed?
I immediately logged onto the web and started searching comet pictures for little elf-like creatures waving as the lander bounced down to the surface. Alas, no readily visible “hidden life” there. But. Comets have generally been around since the solar system formed, on the order of 4 or 5 billion years ago. And, as we know from dust samples recovered a couple years ago, they contain amino acids! And why does this merit the exclamation point? Because it means that we don’t have to posit the appearance of life from non-life on a planet-by-planet basis. If amino acids—the bricks and mortar of proteins that living things are made of—are chemical artifacts of the formation of the solar system, we don’t need a lengthy time for life and its chemical residues to develop. They’re ubiquitous. And ancient. Life is part of the fabric of the universe, if comets do indeed carry loads of amino acids.
So, my cancer “hiding” on the skin of my throat is following a 13 billion year old rule book for populating the universe with life. For some reason this comforts me in my illness. The atoms of which I’m comprised were forged in supernovae billions of years ago. When I die, those atoms aren’t going anywhere. They’re simply going to be re-incorporated into the warp and weft (correct usage??) of universal physics, chemistry and biology. I will no longer be “me”, but I’ll be part of many other things, living and non-living, across the universe (hmm….make a good song, you know?).
And that, as Gandalf makes it, “is a comforting thought”. So…Dig a Pony, everybody. To those of you helping to celebrate my Last Thanksgiving, by being here to share the moment or sending stuff to make that moment easy AND delicious, my eternal gratitude. I’ll give you the Thanksgiving Report next blog entry. Then, that Monday, I go back for more chemotherapy. I’ll report on THAT in the following blog entry. Lots to do in this busy time of year. Except for me. “Doing” in my case means parking my butt in my hospital-style bed and watching the world happen around me. Really, if it wasn’t for the pain and discomfort and inability to sip espresso, this could be a quite pleasant way to wind down my life. But, unfortunately, I gotta keep battling my runaway physiology. Unless they find some fantastic cancer drugs in the ice and dust of comets…. .
Last week, we touched on the primary therapeutic difficulty with cancer—distinguishing destructive “otherness” from happy and healthy “wholeness”. This dichotomy, of course, is the source of my present difficulties, which consist primarily of battling the horrific “side effects” of chemotherapy. The chemo drugs degrade cellular substructures. If they could be focused specifically on tumor tissue in my lungs and pleural membranes (the latter are sort of a sack inside which the lungs function, it is important that it be clear and elastic to accommodate healthy breathing), I wouldn’t have the struggle with gastrointestinal symptoms like nausea, vomiting, and dehydration. Unfortunately, in practice, the taxol drugs (I’ve had several different ones in the course of 3 flights of chemotherapy, I think the current one is “docetaxel,” synthesized during efforts to increase the efficacy of the original pine-bark derived taxol) gum up cellular replication throughout the body. The thing that makes them useful in cancer therapy is that malignant cells have higher metabolic rates than “normal” cells. Meaning that you can hammer the whole system (that is, the patient, or, in this case, “me”) to near death with the drugs and find tumor tissue differentially affected. As long as you don’t kill the patient with the drugs. Based on my experience (especially the 911 ambulance rescue incident), I’d say we’re working pretty damned close to that lethality threshold.
But let’s not go there yet. Let’s revisit momentarily a place we’ve been several times before in this weblog: the moist, densely forested landscape of Europe after the last ice age.
Human beings are obviously among the most adaptable species on earth. We occupy all landscapes, from desert to permanently flooded tropical waterways and wetlands. And when we first occupy a “new” landscape, we don’t just slip in overnight, keep quiet, and commune with the local flora and fauna. Hell no. We reconfigure things (by “things”, I mean structural and functional parameters of the ecosystem, stuff like biodiversity, soils, water regime, carbon and nutrient fluxes, topography, geology, and a host of others) to our liking, and settle in for the long haul.
One key ecosystem parameter that’s given us trouble from our earliest evolutionary history to the present day is the presence of “others”. When Homo sapiens first wandered north from Africa 50,000 years ago, the “new lands” they found were already occupied by H. neanderthalis. Neanderthal people, as we now know, were smart, fire-building, tool-using people. They had been in place for hundreds of thousands of years. They were not easy to displace from what were then essentially their homelands.
So we (that’s the Royal We as in “we Homo sapiens”), didn’t bother to try to get rid of them, at least at first. Instead, we consorted (good word, no?). We had our hosts clean out the spare cavern at the back of the cave and convinced them to let us shack up. We interbred, to the point where H. sapiens carried a fair sampling of Neanderthal genes, and vice versa. Sweetness and Light prevailed.
For a while, at least. Newly published genetic findings from a 37,000 year old H. sapiens body found in Russia [1] suggest something ominous (well, ominous to ME, anyway. The article at [1] was obviously written by someone with a solid reputation to maintain and unwillingness to speculate, whereas I have no reputation and zero credentials to protect and so am free to speculate away like Erich von Daniken on a mescal binge) suggest that Cro magnan (pre-modern H. sapiens) and Neanderthals went on something of a gene-exchange orgy. This period of inter-species breeding (which, BTW, is problematic for the definition of species in the hominids, since the threshold representing different species is supposedly a LACK of interbreeding) was short and confined to the first few thousands of years after Cro magnan moved into Neanderthal neighborhoods. Soon after these early encounters, interbreeding ceased. The load of Neanderthal genes in Cro magnan people was fixed early and did not change afterwards—we stopped inter breeding [2]. From that point forward, Neanderthals occupied increasingly marginal and isolated locations. Neanderthal and modern humans shared the landscape for 10s of 1000s of years, but apparently cordial neighborliness was no longer a feature of their relationship. Eventually, Neanderthal people went extinct and H. sapiens took over the show. And the rest, as they say, is history. Or, more technically, pre-history. Or whatever. The point is, Neanderthals were no longer our buddies. And it seems likely that, once the family feud was underway, Neanderthal people were in deep shit. Nothing has more potential for biological devastation than modern humans with an irrational grudge and access to weapons.
Which brings us, perforce (I have absolutely no idea what “perforce” means or how to use it. This just seems like a place the word might have been inserted in a ponderous 18th century manuscript), to face the ominous implications of our interspecies relationship to Neanderthal people.
Basically, we decided Neanderthals had to go and that we were the instrument of their destruction. We drove them to marginal habitats and went to war. Possibly we put them on the menu. In any case, we were no longer willing to engage peacefully with the original “others” whose lands we were rapidly expropriating. We were efficient, too. In only a few 10s of 1000s of years, Neanderthal were down for the count and not getting off the canvas. It was all over but the celebrating. Perhaps something like the Ewok’s “hey, we just saved the universe, let’s drink ourselves into a stupor and party hearty” party.
It really doesn’t matter. What scares me about this scenario is the present turbulent geography of human beings on earth. Wars between “others” are ongoing and reshaping the earth. From Korea to Kashmir to the whole of Africa to the slums of Miami and Los Angeles, to Ferguson Missouri, people “not like the others” are battling each other. It’s making for dangerous and difficult times. Is it possible that our inherent dislike of “others” is genetically ingrained (or is it “engrained”? I have no real idea. But you get the point), and was fixed in our genome during the “Neanderthal Wars”? Because if so, keeping civil constraints on Vladimir Putin and his ilk (love that word), from tribal war lords in central Africa to tribal war lords in the Middle East to tribal warlords in _____ , take your pick, is a much more difficult and biologically-driven task than we’ve acknowledged to this point. If there is an inherent human tendency to eliminate “others”, then the dark side of the relationships between colonizers and native peoples (think “Trail of Tears” here) is likely to remain dark. Which clashes big-time with modern technological capabilities to travel and communicate globally and easily. It may be 10s of 1000s of years before we straighten this out. And the “straightening” process may be icky in the pools-of-blood, killing fields, mass grave sense. Not to repeat myself. But: icky.
Do you know what the difference is between Shiite Islam and Sunni Islam? Shiites believe that when The Prophet Mohammed died, his line of succession should have accrued within his family (and specifically his uncle Hussein, martyred at the Battle of Karbala). Sunnis (“Sunna” means “community” or “in group”, as in “not like the others”) believe succession rightly passed to The Prophet’s closest friends and advisors. Leaving us with a centuries old example of the power of “otherness” to provoke really stupid, counterproductive human behavior.
Which brings us full circle back to the ultimate test of individual “otherness”, cancer and my present condition. At the moment, my physiology is working pretty well. Having put the last round of chemotherapy behind me by more than a week, I feel pretty good. Breathing is good and clear. Except for sudden leakages of mass volumes of mucous several times a day (which I try to stay ahead of by ingesting mass quantities of Benadryl), I’m really not in bad shape. We seem to have gotten a good balance between “otherness” and “oneness” in my medicines.
Basically, I do not feel at the moment like I’m dying. I feel like an invalid, but one whose quality-of-life is more than sufficient to justify hanging around and fighting back against both the disease and its treatments. My primary difficulty now is ingesting sufficient calories per day so I don’t slowly starve to death. Haven’t mastered this one—I am slowly starving to death. But, I’m working on it.
I will provide one important disclaimer. I look absolutely horrific. I am a wizened, hairless, misshapen, frighteningly changed person. I look, basically, like a guy who has died after a long battle with cancer. I do not look like Dave. I am in any case a dead man walking (and not walking too far—my leg muscles cramp after 50 meters or so). For those of you coming to visit and to help celebrate my Last Thanksgiving, just be prepared. I look shockingly bad.
However. I’m still in love with life, with music, art, photography, and, most importantly, with you, my friends and family. Just try not to gag when you first see me!
References
[1] http://www.reuters.com/article/2014/11/06/us-science-genome-idUSKBN0IQ2QK20141106
[2] http://theconversation.com/ancient-dna-sheds-light-on-the-origin-of-europeans-33907
OK, sports fans, it’s time to ante up and put up the date and time for the shitrain to fall. In other words, I had chemotherapy yesterday. This was after a week off to get two units of blood and give my platelets time to recover on their own. Yesterday they did all they could proactively to try to keep me out of the ER following this round of chemo. Short term antinauseal. Long term antinauseal. Steroids, just because steroids help fix the symptoms of pretty much anything. Rebalanced my electrolytes. Then they dropped the green flag and stomped on the accelerator—in went the nasty chemicals synthesized after discovering that a number of molecules found in the bark of free-growing evergreen trees had anti-cancer activity. So it’s off to the races here at noonish on Saturday.
But before we go there let’s tackle a technical issue that’s been bothering a number of my astute and intelligent readers.
I’ve been taking something of a pounding from several smart readers challenging my contention that alcohol “caused” my cancers. In general, these people are correct—with very few exceptions, it is impossible to attribute a specific cancer to a specific exposure.
Perhaps I should explain myself.
“Conventional” poisons are the kind of thing you get in television crime drama, or from World War One movies. Cyanide, chlorine gas, mercury, lead, botulinum toxin, etc. These compounds function on a rigorous “dose-response” basis. That is, the more of the poison you ingest (or are otherwise exposed) the sicker you get, until you reach a level that kills you—the latter being called “lethal dose”. Like all things in the physical world, the response of a body to a specified dose of poison varies. It differs among different species of organism, so understanding the toxicity profile of these poisons requires a separate dose-response curve for each species. Toxicity also varies with a variety of more-or-less random variables—a long list of things that can be discovered and evaluated scientifically (timing, age, simultaneous exposure to multiple compounds, etc.). It also varies on a random basis—the “lethal dose 50” (LD50) is technobabble for the concentration of chemical that kills 50% of the organisms exposed. There is some randomness in this number—it varies slightly experiment-by-experiment. But, in general, the random variability in effect of conventional poisons is low. If you give 100 mice an LD50, you have damn near a spot-on likelihood that 50 of them will die. A few less, perhaps, if their physiology is randomly on the “good” side, a few more if they show up on the “bad” side. But this variation is relatively low.
Now, certain “non-conventional” poisons operate differently. The mechanics of toxins whose primary response to dose is cancer are particularly distinctive. In these compounds, if you remember back a couple years of this blog, we discussed how complicated a chain of physical, physiological, biochemical, and immune processes yields (or allows) cancer. This complex of events multiplies uncertainties at every phase. In addition, many, many things have a finite chance of chambering the round that leads to the target that triggers cancer. Bruce Ames, a government scientist is California is a pioneer in this field. He has documented the overwhelming abundance of foods, drinks, and incidental items (soil and airborne chemicals, primarily) that cause cancer “naturally”. The bottom line is that about a third of human beings develop lethal cancer(s) during their lifetime. According to Ames (and many other scientists who manage to be technically objective in this most acrimoniously subjective field) cancer is a damn near inevitable public health phenomenon, primarily because of cancer-causing substances in the natural world.
And relatively few cancer cases can be directly attributed to specific doses of specific chemical compounds. In other words, industrial chemicals in the environment are responsible for very few malignancies. Estimating the likelihood of contracting cancer in a manner analogous to that for “conventional” toxins is somewhat different. The dose-response curve is potentially more relevant to individuals from the exposed population (BTW, this runs counter to the convential heuristic shorthand that holds that conventional toxicity is an individual problem, and that cancer accrues only to populations. As you will see in the following paragraphs, I am taking a different approach to this, one that discerns individual impact of otherwise collectively measured intoxication). Thus a cancer that has an LF50 (likelihood of 50% contraction) for a population means that you, one of the potential victims, have about a 50% chance of affliction with whatever form of cancer can be caused by the methylethyldeath to which you have been exposured. That is why every new doctor I see spouts the first question: “how long were you a smoker”? They are consistently shocked to learn that I never smoked. This is because the dose-response curve for tongue and oral glands (parotid, in my case) is severe—if you smoke, you have a very high probability of getting these specific cancers.
The doc’s second question, then, is “were you a drinker”? Again, beverage alcohol (ethyl alcohol) has steep dose-response profile. Every time you consume alcohol, you get closer to that 50% likelihood. I am scrupulously honest with the doctors. I explain that I drank for about 40 years, and over 20 of those years, I drank the alcohol equivalent of more than a liter or wine per day. This is a massive dose of a highly carcinogenic chemical. The odds are very high (although the effect remains a probability the probability is very high) that those years of extraordinarily massive drinking contributed massively to my cancer, swamping other sources of carcinogen exposure (see Ames’ recent public research demonstrating the carcinogenicity of such important foodstuffs as broccoli, peanut butter, potatoes, et al. Just punch Ames into any browser to see complete lists in various publications).
What this means (and my apologies for dragging you through all this technocrap), is that I cannot, with 100% certainty, attribute my cancer to alcohol. But there is a very high probability, based on the inherently intense carcinogenicity of ethanol and my other life style choices. Some of the latter are positive (carcinogenic): exposure to the second hand smoke of my parent’s heavy smoking (although it is worth recalling that the likelihood that second hand smoke is carcinogenic, it is only weakly so), consumption of fish, frogs and turtles from local contaminated waterways, use of and exposure to industrial solvents and preservatives in laboratories, etc. Others are negative—never smoked myself, worked in gloves as often as possible, ate very little peanut butter, again etc. In addition, I spent years self-medicating various infections around my wisdom teeth, using high-alcohol mouthwashes.
The net outcome of my lifelong exposure to beverage alcohol buries the anti-cancer lifestyle choices I made (an aspirin a day, periods of intense exercise, cautious use of pesticides, and more).
I can state, with a high probability, that alcohol consumption contributed big-time to my present condition. It’s not the sole source, and it’s possible (although unlikely, given the other aspects of my life) that it’s not a “cause” at all.
So my read (and that of most of my doctors) is that alcohol was one of, if not necessarily the only, finger squeezing the trigger on the chain of physiological events that has left me terminally ill.
Which circles us all the way back up to paragraph 1 above: my health and ongoing treatment. So far, now about 20 hours since they dripped in the therapeutic toxins, and I’m doing ok. No nausea, no vomiting, no internal bleeding. But that’s not unusual. Generally, the shitrain holds off until Sunday following a Friday round of chemotherapy. So tomorrow, by early afternoon, I should have a feel for just how bad it’s going to be.
Either way, next week’s chapter in this serialized e book will give you the update. If it’s from the hospital, you’ll know that our defense collapsed, allowing the savage chemo drugs to once again hammer my body into a ¾ dead roadkill. If it’s from home, and all chirpy and optimistic, you’ll know that we finally got the balance of antinauseals in the chemo cocktail and continuing home administration of antinauseals, pain killers, and now i.v. infusion of hydration fluids to do their collective jobs. Under these circumstances, I may gain a few months of productive, fun, relaxed life until the inevitable end not much after that.
No way to tell at this point. I would request that all of you think about me for at least a few minutes to tomorrow. As you know, I’m personally not attuned to formal, join-up religion, so can’t pray myself. This doesn’t mean I don’t think, in a pagan/animist sense, that interpersonal action-at-distance has value. As does the collective love among friends and families. So I’ll be attuned to the waves of good wishes as they come in. And I’ll be thinking of all of you, the friends and family I’ll leave behind when the tumors chamber that last round and fire away. I love you all. And I admonish you to use, actively and positively, the time you have to your credit. Because you need to use ‘em while you got ‘em. They are NOT forever!
The thing about cancer…well, one of the many things about cancer…is that it is not an attack on your physiology by outside forces. With few and rare exceptions, cancers are YOU, and the medical battles amount to a civil war with your own cellular and organismal functions.
This is problematic physically and psychologically. The physical problem, of course, is that cancer-fighting therapies have to be effective against your own body and your own bodily functions. You’re not defending against outside interloping microbes, you are battling a runaway version of YOU.
This is an intricate technical challenge, demanding recognition and destruction of “bad you” in a body that is otherwise “good you”. And that bad you doesn’t differ greatly from the good you. The delta between bad and good, in this case, is too small to provide an easy way out. In many cancers, the disease manifests via alterations of very few genes, or the biochemical consequences of very few altered molecular pathways. Basically, to stop cancer, you have to stop appropriate parts of YOU. The most brutal analogy is probably limb amputation as a life-saving medical response during the civil war. Experience quickly demonstrated that a minie ball or even a spherical musket projectile penetrating a thigh and dragging filthy clothing fibers and matted gunk from the skin surface deep into the muscles yielded inevitable, fatal gangrene. So surgeons routinely treated such wounds by amputation. On the assumption that the victim would rather be alive and missing a leg than spending several weeks of increasingly painful bodily wreckage leading directly, if too slowly, to the grave.
We really haven’t progressed very far from mid 1800s therapy here in the 2000 and teens. Thus first we destroyed part of my tongue and my entire right parotid gland. Then we hacked out the rest of my tongue and butchered my palate. Then we flayed my torso and dissected out my entire lymphatic system north of my tummy.
And all that surgery? Still not enough. Now we are working on destroying the squamous cells lining my lungs, hoping to slow my forced march to death.
Sigh. It’s a rough road to ride. And yet. The drastic chemotherapy is actually working. I can take full, clear breaths, deep into my lungs, where a few months ago I cold only wheeze in and out a small portion of my lung capacity. I’m building enough energy to walk…well, shuffle…a few hundred meters every day. Which I have to do, because otherwise the string of 24 hour days not leaving the hospital-style bed in front of the TV is making my leg muscles so weak they cramp on the way to the toilet.
This week just passed continues the holding pattern my treatment has been in for a while. First, we met with oncologist Dr. T’s assistant Doc, who helped re-sort my pharmaceuticals and pass on the thought that if the chemotherapy really is working palpably (appropriate usage?), we might consider continuing beyond the originally prescribed 5 infusions. Then, of course, yesterday (Friday) was chemo day. But the preparatory blood screens showed that both my platelets and red blood cells (RBCs) both remain impaired by the last round of chemo. So on Monday I go in to the infusion center for 6 hours of whole blood transfusion. And schedule the round of chemo for next Friday, assuming the platelets will come around on their own. Now we also have high-powered meds in the refrigerator intended to prevent my white blood cell count from crashing and burning, impairing my immune system and leading to the nasty infection that the docs think was the issue driving my last trip to the emergency room after the prior round of chemotherapy.
But you know, at least for the moment, the ridiculous (not to say savage) ongoing treatment is more than worth the tradeoffs. I’m feeling good. I’ve gotten some of my guitar chops back, and can play all of the instrumentals I’ve managed to write since my voice went into the bio waste buckets with my tongue a couple years ago. I can read, and write, and watch movies. If I move sufficiently slowly, I can cook (wait until you taste my cinnamon scone roses. They are awesome!). And, having practiced last weekend with other members of the household, I can direct the kitchen staff from my perch on the bed in the corner of the room. So I’m expecting Thanksgiving to be spectacularly delicious this year. Given that it is, unfortunately but inevitably, the Last Thanksgiving for me (make a good novel title, now that I think about it), I intend to have a walloping good time.
So I hope everybody had a fun Halloween. I leave you with a few photos, I know some of you have seen these, but I like ‘em, so I’m repeating them here. Thanks, everybody. You make this war worth fighting. And remember to use ‘em while you got ‘em, ‘cause they are NOT forever!
