It Might Get Messy

If you hike from the highway into the remote desert of central or eastern Jordan, you will of course be watching for wildlife and birds. And keeping your eyes open for the thin, dark shadow that might indicate the edge of a wadi—a drainage feature or canyon representing the landscape diversity that would increase your likelihood of finding jackals, foxes, hares, Palestine vipers, maybe a falcon (it’s been millennia since lions, tigers, bears and wolves lived there, and centuries since the last leopard, cheetah, ostrich, eagle, or antelope. I would have put hyenas in the latter group if I hadn’t talked to the Jordanian soldiers up on the Syrian border who killed one recently in concert with their Syrian compatriots). But eventually, even if you’re a crack biologist but geological dimwit, it dawns on you that there is something odd going on with the rocks underfoot in this stony region. Now that your eyes are open to it, you can see that the ground is covered, nearly completely in some spots, with simple stone circles. The circles vary in size from a meter or two in diameter to hundreds of meters. The largest are the subject of active research (http://www.dailymail.co.uk/sciencetech/article-2814715/Mystery-Jordan-s-Big-Circles-Ancient-stone-rings-desert-left-archaeologists-baffled.html). The smaller ones, which are scattered across the entire desert floor, don’t seem to have triggered any academic interest. Which is, I suppose, understandable. Given that they consist of fist-sized rocks resting on the ground surface, there is no way to tell whether they were put there by kids joy-riding to Aqaba from Amman in Dad’s 2014 BMW, Roman soldiers staking out sleeping quarters, or Neanderthal migrants hoofing their way out of Africa toward their destiny in Europe. Still, the circles as a whole represent a LOT of human activity. And there is something vaguely disturbing about them, given how abundant they are. People haven’t been able to live in these deserts in the millennia since Petra was a community of stone-workers who carved an entire city out of rock faces in such a fashion that every drop of dew or rain (back in the days when rain fell here) was collected and stored. Until recently, the Bedouin peoples were truly “migrants”, and seldom stayed more than a few nights in a particular spot in the non-watered desert. For some reason I got a little creeped out when I realized that these circles stretched off into the distance as far as I could see. Not sure why. Possibly watching the “Tremors” movies franchise one too many late nights… .

After I’d seen the circles, and after Nicholas and I took a sort of a Hunter Thompson-meets-Jason Bourne-via-Marx Brothers expedition from Amman to Aqaba through the heart of the stone-circle country, I got in the habit of asking anybody who seemed to know something about the desert: “What’s up with the stone circles?” People I asked included our driver, our driver’s brother-in-law (who stocked the back of the wagon with vegetables and fish, and brought a big thermos of spiced tea and one of spiced coffee to share), our government hosts, every academic of every field we met, people from the U.N., and every consultant we crossed paths with. Nor did I limit the inquiries to people we met in-country. While we were preparing our component of a big-ass report, I asked everyone we worked with or ever talked to over the phone. The universal response? “I don’t know.” And that’s it. No one among the dozens of people and hundreds of potential documentary sources I consulted had anything else to offer. Actually, the uniformity of the response—everyone said PRECISELY “I don’t know”—started to make me a little squeamish. You’d think SOMEBODY would have added a little variation to the chorus. Something like “I have no idea”. Or maybe “I don’t think anybody really knows”. Nope. Everybody said “I don’t know”. This seems benign enough, I’m really not sure why this bothered me. Possibly watching too many bad, late-night movies predicated on some variation of “Stepford Wives”.  You know, the one where even though the characters look and sound human, their identical repertoire of responses reveals that they are pre-programmed aliens sent here to “take over” the earth. 

Anyway. “What”, I hear you asking, “the Hell does this load of verbose crap have to do with cancer”? “Well,” I reply, “more than you think.” It has to do primarily with that honest and ethical “I don’t know” phrase. Here’s the deal.

We visited my Oncologist this week. Much like me, she is delighted with the status of my health. Particularly in the context of the cancer that has shuttled around my body from mouth and salivary gland to lungs, liver, chest cavity, and the remaining shards of lymphatic infrastructure in my torso. Also much like me, she would like to know more specifically where residual malignancies are, their size, and their potential to deliver the final swing of the Battle Ax that is going to put me in the vacuum-sealed specimen bag with preservatives, waiting only for a struggling couple of medical students to begin the dissection. 

However. When I asked her directly when I should expect to be taken ill again, and also when I should expect to die, she gave us a simple and direct “I don’t know”. When she said that, my mind clicked back to Jordan and the ubiquitous stone circles. I like to think of my cancers as linking me to the powerful philosophers of Greece and Rome. Even if it by a stretched-paper-thin metaphor based on rocks in the desert. 

Anyway. Undertaking (pun not intended, but now that I see it, I’m taking credit for it) the diagnostic procedures that would reveal the current distribution and condition of my malignancies comes with inherent costs and risks. As with most things in this entropy-powered universe, there is no Free Lunch. If we want to play, we’re gonna have to pay. Fundamentally, we need to understand and balance the cost/benefit aspects of the testing. 

Clearly this has been on Dr. T’s mind. While she completed a brief examination, she rattled off a monologue regarding these difficult cost/benefit tradeoffs. Doing a PET/CT scan to reveal the wheres and wherefores of my tumors comes with some inherent procedural risks including possibility of introducing an infection spot-on my heart where the “port” that provides access to my circulatory system ends; and potential for the radiation in the sugar cocktail to trigger a new malignancy. These risks are so unlikely that they can be discounted. But the more important question is, what would we do with the information we get from the scans? Dr. T’s monologue indicated that she would not re-start chemotherapy unless I was showing overt symptoms of the cancers. Since I’m very comfortable at the moment, and getting stronger and more functional every day, and my residual pain is well controlled, she would not put me through the hell that landed me in-hospital following every single treatment in the last course of therapy. Absent symptoms, treatment is counter-indicated. And, since my immune system is clearly sparing me from cancer symptoms for the moment, it is likely that when I DO become symptomatic, the distribution of malignancies will not be the same as they are presently. 

The bottom line, or punch line, of Dr. T’s excellent monologue is basically this: curious as we are, there is absolutely no reason to conduct PET/CT scans at the moment. Simple curiosity is just not a compelling reason to test. We’re gonna have to live with “I don’t know” until the crushing pain, bleeding, and buckets of mucous return to remind me who’s in charge of things. Or who’s not. The latter would be me. 

I agree completely with Dr. T’s reasoning on this. If this were an ancient Greek drama, presumably the gods would proffer some reward for the excellence of Dr. T’s monologue. She certainly gets as much verbal “reward” as I can offer every time we see her. Because she managed to give me 6 months (and counting) of relatively comfortable additional life despite the size and severity of my cancers. We go back to see her in a couple of months. If I’m symptomatic by then, we’ll plan on a scan to base (potential) treatment on. Of course, my physiological and psychological resources are finite, and it’s taken a massive investment of both to get me here even with Dr. T’s amazing medical skills. And if I continue to be asymptomatic then? Man, I’ll probably prostrate myself on the floor of the examining room, possibly with some incense burning and with a long, gentle raga from Ravi Shankar’s extensive library playing in the background. That would be 8 months of relative comfort and living life (no, that is not redundant. Many people fail to live while they’re alive, and I’m not in that camp. I was using ‘em while I had ‘em way before my cancer diagnosis), when, given the size, location, and intensity of my malignancies, I should have been dead quite a bit of time ago. Under the circumstances, that Dr. T was able to give me an “I don’t know” response to questions regarding the timing of the rest of my life, is a tribute to her and the other doctors and experts working my case at the Greater Baltimore Medical Center. And I really, really appreciate it!

I also really, really appreciate you all out there reading this wacky (and now lengthy, not to say “interminable”) web log. Thank you so much for the laughs, the love, the friendship, the wisdom, and…well, just for being here for me. I could not have gotten here without you!

A few spring flowers follow for your perusal.