I was reminded recently of a trip I took to Cape Cod as an undergrad at Rutgers. A couple of faculty members set up a 1.5 credit course titled “Geology and Ecology of Cape Cod”. We spent a week camping on the Cape, a group of about a dozen grad students and me. I didn’t know any of the grad students very well, and they didn’t know me. One night I spread out my sleeping bag under some hemlocks at the edge of the firelight while the grad students sat up drinking and conversing. Eventually their talk turned to me. I had spent every bit of field time sloshing in the cold water grabbing specimens, and earlier that day I caught a couple of big black racer snakes, interrupting their mating to show the class (one of the instructors was a vertebrate zoologist). The consensus among the grad students was that I was “like a football player who went a little crazy” (I wrote the quote inside the front cover of my field guide to mollusks).
The weird thing about it was that that was PRECISELY what I was at the time. A few years later, working on my doctorate at Georgia, I exploited that “crazy” love for field work. I spent two years driving a university vehicle around the southeast, collecting small mammals, herps, and birds, studying their relationship to parasitic (and medically important) mites. “Chigger” mites are pestiferous in North America, where sitting on a pine log can get you a load of mites that will make you itch miserably and swell up like you ran into a patch of poison ivy on steroids. In the tropics, chigger mites vector a number of serious diseases, explaining why the U.S. Navy was interested enough to fund esteemed Dr. C, my major prof, for research on mite ecology.
Of course, chiggers are not the only arthropod pests in the woods and fields of the deep south. On one trip to Sapelo Island off the Georgia coast, I managed to acquire a shitload of tiny, angry ticks. One evening I counted them as I removed them with tweezers. Actually, I quit counting when I got past 300. I also stopped picking them off, and simply went to sleep.
A couple of weeks later, back on campus, I started to have nasty headaches (and, except for occasional migraines as a child, I NEVER got headaches), painful joints and muscles, and running a low-grade but slowly climbing fever. The campus clinic drew blood samples that revealed Rocky Mountain Spotted Fever, a tick-vectored rickettsia (rickettsiae…I think that’s the pleural…are rather like bacteria without the tough cell wall surrounding their protoplasm). Before I got too sick, they slapped me onto antibiotics and cleared things up.
At that time, tick-born diseases were all the rage. Lyme disease had been discovered just a few years prior (possibly released in North America from a U.S. bioweapons laboratory, see Lab 257: The Disturbing Story of the Government's Secret Germ Laboratory by Michael C. Carroll, 2005). The panic was far from the equivalent of the present hysteria over Ebola, but it was definitely in the Zeitgeist.
That was also when Superfund was just getting started, and environmental cancers were of great concern. Of course, in retrospect, we know that cancers “caused” by uncontrolled hazardous materials in the environment are very rare (and generally limited to radioactive wastes or asbestos). By far the greatest triggers for human cancers are lifestyle choices and/or bad luck.
Whenever new doctors quiz me regarding basic background information, they are invariably shocked to find I have never been a smoker. My tongue, throat, and lung cancers are typical smoker’s diseases. My parents were both heavy smokers, but in truth the linkage of cancers to second hand smoke is only weakly significant (the latter in the formal, statistical sense). I’m afraid my own lifestyle choices are the source of my present difficulties. Ethanol (beverage alcohol) is a potent carcinogen. And I drank buckets of beer, wine, whiskey, whisky, gin, and rum. I also self-medicated chronic mouth infections with copious quantities of Listerine mouthwash, which is also high in alcohol content. I have to acknowledge that all those bottles of silky, creamy viognier and thick, syrupy zinfandel are highly likely to have triggered that tumor at the base of my tongue, the one that started it all. Having spread to my parotid gland, and eventually into my lymphatic vessels (despite the doctor’s best efforts to remove as much of my lymph system as possible from the line of fire) and lungs, there is little doubt about how I got to my present condition as a dying invalid.
With that big picture under our belts, I can update on my status. In general, I am doing as well as somebody with terminal respiratory cancer and ongoing treatment with powerful chemotherapeutics can do. I’m on oxygen when I’m sitting around, but I can lose the O2 to walk. Although I can’t walk very far or for very long. Until the past few days, my pain was well controlled by my pharmaceutical regimen. Pain level has crept back up lately, but as Cathy points out, I have access to a couple more tabs of dilaudid per day. That will certainly tide me over for a while. A couple months ago I actually felt good enough to go off a skin-patch delivered opiate called Fentanyl, which is a long-acting formulation (compared to the dilaudid, which is high-powered but fast-acting). I may have to go back on the Fentanyl if the pain doesn’t re-subside, but that’s not really a hardship.
So, all in all, there’s not much to report from here. Which, all things considered, is a good thing. The next bit of excitement—or at least trepidation—comes next weekend. Chemo on Friday. I’m hoping to hell I won’t be back in the emergency room on Sunday.
We’ll just have to see. Tune in next week for all the exciting news! And in the meantime, use ‘em while you got ‘em. Because they are NOT forever!
HO-O-LLLYYYY SSSSHHHIIIIIIIITTTTTT!!!!! It was only a matter of a few hours after I posted that chirpy, perky blog entry last week that things started to deteriorate in serious and savage fashion.
But let’s not start there. Let’s start with traffic in endangered and threatened species. Today’s Washington Post ran a long piece on international trade in elephant ivory and rhino horn. It’s a depressing story of human stupidity and the rapacious nature of market forces. In the past few decades, the African elephant and all half-dozen or so species of rhino around the world have been decimated. “Artistic” carved ivory is one reason, but the primary one is the weird belief in China and Vietnam that rhino horn is an aphrodisiac. I mean, the stuff is keratin—horses hoofs, human fingernails, that material. How the hell can somebody in the 2000 and teens believe it’s an efficacious biologically active compound?
Anyway, when I was a kid, there was a shop in the Port Authority Terminal in New York that sold beautifully tanned red fox pelts for $5 and grey wolf pelts for $20. This was not illegal at the time, of course. My Aunt broke down on one trip into town and bought me a fox pelt. It was one of my treasured possessions for years. Eventually I used it to tie many dozens of trout flies, light cahills (always one of my favorites) with the underfur and unnamed but remarkably effective streamers from the long tail hairs. I never did save enough for a wolf pelt. Which is just as well. It was only a matter of a few years before grey wolves were listed and illegal to possess.
Fast forward 30 years or so. In Kuwait there is a shopping district about a 40 minute drive from Kuwait City that is known for shops with quality goods and decent prices. It is a mecca (so to speak) for people who can’t go to a Middle Eastern country without making an elaborate ritual of nickel-and-diming the locals on the price of sweatshop-produced rugs and then backcasting receipts so they can further nickel and dime U.S. customs when the rug is declared. Every individual I’ve been to the Muslim world with, from lawyers and international administrators to scientists, has made this odd game a focal point of their trip.
Personally, I’m not a rug guy. But the diversity of artisanal products (and associated ripoff reproductions) that passes through small shops in the souks of the Arab world is amazing. I shop for musical instruments, glassware, art, costume jewelry, interesting trinkets, etc. Most of the stuff isn’t local. But it can be outstanding if you shop with care. One of my most prized adult possessions is an Indian ritual bell, cast of pot metal, that will ring with an absolutely gorgeous G note if rubbed with a piece of wooden dowel (which the shop owner through into the bargain). I would note that on the shop shelves, there were dozens of nearly identical bells. When I looked at them and started testing their tones (which were consistently unattractive), the guy reached under his counter and pulled out the heavier, higher-quality bell I now own. I note that haggling over price is indeed a treasured ritual in the region (although I believe Americans should always overpay), and I tried to talk him down a few dinars (he quoted the same price for the quality bell as he had listed for the crappy ones). He refused, quite reasonably, to drop his price.
I seem to have gotten a little lost in story telling here…where were we? Oh yeah. Endangered species. The next trip I made to Kuwait, I went back to the bell shop. I wandered up to the second floor…and was absolutely stunned. About a quarter of the upstairs space was taken up by an enormous stack of untanned but complete wildlife skins. There was a tiger, a number of wolves, foxes and jackals, extremely rare small cats, cheetahs, and several lions that I suspect were the essentially extinct Asian subspecies (which exists only in a carefully managed population in a dedicated national park in India). The most stunning was the tiger. It was absolutely gorgeous. I must admit that I, a dedicated professional scientist and ecologist, was tempted. The price was unbelievable—the guy wanted the equivalent of $300 U.S. for it. The next day I mentioned the tiger pelt to my class. They generously offered to hold it for me if I bought it, and work on finding a way to get it to me in the States in a later diplomatic shipment (did I mention that my class was attended by high-ranking individuals?).
Eventually good sense and scientific instincts suppressed my momentary interest in becoming an international smuggler and contributor to population decimation of critically endangered charismatic megafauna.
And why am I wasting your time with rambling tales of global wildlife mismanagement rather than focusing on terminal cancer, the nominal topic of this weblog? Because there is an important medical lesson buried in the sordid story of rhino poaching and elephant hunting. For years, I’ve been holding out hope that the ridiculous but spectacularly profitable market in “erectile dysfunction” drugs (are there really that many men with some sort of inability to have sex? That just seems really unlikely, doesn’t it?) would be the salvation of pachyderms around the world. I mean, why would you pay tens of thousands of dollars for a few grams of grimy ground up rhino horn (which is also impossible to authenticate) when you could pay a few tens of dollars for a bottle of actually efficacious product over the internet?
Turns out I’m obviously wrong about this. The price of rhino horn increases daily, and the Post article cites some of the incredible values it has achieved. I guess it’s not so much a matter of whether something actually works as whether somebody believes it works.
But not in my case. Let’s come back to cancer here for just a paragraph or two. When we started this course of chemotherapy intended not to “cure” me but to give me a few comfortable months of life, I was skeptical. I mean, it was clear from the PET CT scans that large areas of my lung surfaces were affected. I didn’t really believe that weird pine-bark-derived molecules that differentially slow cell substructure assemblage (operating more effectively on cancer cells because of their enhanced metabolism) would make a damn bit of discernible difference in my health.
But it has! I have active and aggressive lung cancer, and with the chemotherapy infusions I can breathe pretty well—not much of that childhood asthma claustrophobia. And I feel generally pretty good, although I must admit I can tell that various organ systems are deteriorating over time and becoming more dysfunctional.
The only thing that’s really bothering me now is the fact that every chemo session except one has sent me to the emergency room and gotten me admitted to the hospital for periods varying from a few days to more than a week. This week’s was particularly vicious. I posted the chirpy blog entry on Saturday night. By midday Sunday I was feeling sickish. By Sunday evening I could tell I was in trouble. Around midnight, I started vomiting. Every hour or so overnight I vomited a notable quantity of blood and mucous. I became really weak, started to shake, and rapidly dehydrated. So, Monday morning, it was off to the ER. Poor Colin, who was home from Tech for his autumn break, had to spend his second visit in a row sitting for long hours watching me writhe on a stretcher in the emergency room at GBMC while they got me admitted. And I was really sick this time. It took them two full days to get me stable, partially rehydrated, and able to take necessary medications, fluids, and nutrition. By Wednesday, there was still a question as to whether I could be released this week. Finally the doctors reluctantly agreed to discharge me on Thursday.
In this case, they think I got sick from a massive infection rather than from the chemotherapy drugs. I’m now taking two serious antibiotics to get me cleared out in time for the next chemo in a couple of weeks. I must admit I’m a little suspicious, because the timing of getting sick was synchronized with the chemo just like prior episodes. But the chemo does decimate the immune system, so it’s not unlikely the docs are correct. In fact, a goodly portion of my hospital stay involved getting my white blood cell count, red blood cell count, and immune system all back into some sort of balance. I ended up getting another unit of whole blood, along with powerful drugs providing WBC support.
And today, Saturday, well I’m feeling pretty damn good. Not great, mind you. But not bad. It sure as hell could be a lot worse—like last Sunday night. Instead, I’m doing some reading, research and writing, I’ll wander around the yard looking for stuff to photograph, and I’m able to “eat” and take my meds without too much travail. And next week? I’ll introduce you to the bureaucracy involved in registering a body to be donated to the University of Maryland system for teaching or research. It’s a more interesting story than you think.
Remember everybody: use ‘em while you got ‘em. Because they are NOT forever. We’re all gonna run out of them—some of us sooner than others, of course. Have a great week everybody.
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!
Thinking back over my life, just what, I inquire, has been my proudest accomplishment as a parent? The answer is simple and clear: raised 3 children and never visited a theme park. This is a real conversation stopper at parties—people seem to equate this ellipsis [correct word?] with child abuse. We get almost as many shocked looks as we used to get in supermarkets when one of the kids was jealous of another and we would tell said child that we loved child B more than child A so child A might as well clam up.
However. Just because I didn’t drag the kids around expensive real estate populated by actors in talking rodent suits doesn’t mean I didn’t work in such an establishment in my younger days.
Warner Brothers Jungle Habitat in West Milford, New Jersey (you got there by making a left onto the park access drive just before the A&W root beer stand at the “Y” on the Greenwood Lake Road) was an odd (and ultimately unsuccessful) enterprise in which happy vacationers drove through a series of enclosures holding a variety of showy exotic wildlife in a carefully manicured version of the Upland Hardwood Forest that used to cover this landscape [1].
I learned a lot while I worked there. For instance, if you carried a garden rake when you walked past the pen holding the baby white rhinoceroses (is that really the plural of rhinoceros? Looks awful clumsy…), they would squeal with pleasure and run to you to get their backs scratched as hard as you could scrape the sharp metal across their very thick hide. I also learned that dromedary camels are generally unpleasant and are likely to bite at the slightest…or even no…provocation. And that electrified fences and massive guard dogs are insufficient constraints to hold a couple dozen baboons under any circumstances.
Anyway. My job had nothing to do with the livestock. I was the Chief Garbage Man for one summer (the opening year, in fact), in charge of a crew tasked with keeping the trash cans empty and the rest rooms clean. Neither of which was as simple as it sounds. It turns out the park designers grossly underspecified the number of both needed to handle the daily visitor load. It took us a while to sort out tricks to keep things at least moderately sanitary. And, in fact, women’s sanitary products were our most difficult challenge. The primary rest room in the cantonment area (snack bar, souvenir stand, etc.) tended to accumulate them in heaps unless we could get staff in every half hour or so. Which we seldom did.
Despite technical difficulties, it wasn’t a bad summer job. Certainly beat packing books for shipment or loading and unloading trucks in the warehouses jammed along Route 3 in Totowa. My last day of work, a bunch of us hung out long after the park closed, drinking Mateus Rose (cheap Portuguese sweet wine, for those of you too young to remember the cute little rotund bottle) and imitating the animal sounds for most of the night. All things considered, I’m still surprised that we didn’t attempt to enter the lion enclosure or tease the baboons into a homicidal rage.
WARNING: WHAT FOLLOWS IS REALISTICALLY HONEST AND THEREFORE DISGUSTING. READER DISCRETION IS ADVISED.
And why, I hear you inquiring, am I regaling you with summer job tales here in this cancer diary? Because having a lingering, chronic, terminal illness comes with a tremendous waste-management challenge. One that makes snowdrifts of blood-splotched feminine hygiene products look antiseptically sanitary in comparison. For one thing, both the disease (cancer of the cells that make up the mucous membranes of my lungs and pleural cavity) and its treatments (destructively massive doses of radiation and barely sublethal concentrations of chemotherapy drugs) cause constant “weeping” of mucous that has to be mopped up with paper towels and discarded somewhere the dog can’t dig them out. Then there is the episodic bleeding, which is a similar, if more colorful, problem. And these bodily exudates invariably reach more than paper towels. Clothes, for example. And bedding. Stuff that has to be washed more or less frequently.
Then there is the issue of various liquids needed to survive. Surrounding my sick bed are tables holding liquid food, beakers of water, bottles of Gatorade, and cans of decaf coke, all begging to be knocked over onto the floor or (more traumatically) carpet. Plus, toileting is an issue. When the chemotherapy toxins rendered me unable to walk steadily enough to reach the bathroom overnight, I had to use hospital-style bed urinals. Which also need to be emptied frequently. And then there are the inner workings of the tracheostomy hardware. These little tubes fill with mucous over time, and need to be changed out. I keep a dish of half water/half hydrogen peroxide handy, and swap out four of the cannulae as needed. When the fourth gets too clogged to allow breathing, the entire enterprise has to be hauled to the sink for cleaning and refilling.
Anyway, you get the picture. Cancer is not only “not pretty” in a metaphorical sense, it is quite literally not pretty. It is also, by the intricate nature of its logistical demands (i.e., feeding, cleaning), inherently harder on the caregiver than the victim. Cathy has been uncomplainingly handling my mess for years now. And we finally got a nurse, but it turns out she’s not here to help out with general sickness items. She actually adds to it. She showed Cathy how to access my medical port so that I can be given intravenous fluids at home instead of at the hospital 40 minutes away.
So there you have it. Cancer is icky. Perhaps not unexpectedly so. I suppose it could be worse. As indeed it could have been at Warner Brothers Jungle Habitat. Several elephants were among the animal collection. I have a feeling that cleaning up after them would make changing garbage bags seem like a dream vacation.
References
[1] Interesting information and reminiscences at http://weirdnj.com/stories/abandoned/jungle-habitat/
Atlantic coast of France, early 1945. With the invasion beaches selected for D-Day, intelligence gathering begins in earnest. An obvious problem pops up almost immediately, confirmed by overflight photography, local partisans, and daring and dangerous insertion of agents. The far end of Omaha Beach is a series of sea cliffs. Perched on the cliffs are German artillery emplacements, sighted perfectly down the beaches. Under those guns, the invasion will be a blood bath (which it turned out to be anyway, but that’s a different story). Multiple tools were available for dealing with the guns: aerial bombing, naval bombardment, direct assault. All were implemented—a measure of the military importance placed on the matter.
The hardest but most assured way of assaulting the guns fell to U.S. Army Rangers. Long before Zero Hour, the rangers were put ashore with minimal burden of food, water, and ammunition, lots of climbing gear, and thermite grenades intended to disable the guns the old-fashioned way—by hand. As the invasion started to scroll before dawn on 6 June, rangers were coming ashore in a series of SNAFUs that included misidentification of the objective (the lead boat mistook another cliff for Pointe du Hoc, 2 of the assault boats sank before reaching the beach, etc.) [1]. Soon after dawn, however rangers were hanging by vertical cables and carabiners on the cliffs, with occasional German small arms units shooting at them and working to impede their low-technology assault.
It was a harrowing venture for the rangers. As night gave way to dawn, it was clear just how vulnerable they were. Suffice to say (there is, of course, a series of long stories collapsed into that phrase) the rangers rather quickly made it to the top of the cliffs and the German infantry units were by then occupied elsewhere along the beach front. There was only one problem: the guns that were the object of the entire exercise weren’t there. What you had was units of an exhausted ranger battalion with a brilliant view of an armada of warships that dwarfed any naval assault operation to date, and nothing much to do with their hands.
Suffice to say (have I used that idiom already? Dammit the chemotherapy drugs must be affecting my brain…or it could just be my brain…) the rangers spent something of a surreal morning wandering around French pasturelands on the margin of the massive clash of arms on the invasion beaches. Several recent television series have discovered and used newly discovered film, plus re-enactments, to good effect to document the assault on Pointe du Hoc, I commend these to you next time you’re in the mood for some hoppin’ History Channel viewing.
Anyway, in keeping with the surreal nature of the misty morning, a couple of the rangers hiking away from the main group to try to get a grip on things discovered the guns from the sea cliffs in a farm woodlot, unguarded, with their ammunition stacked nearby. They disabled two of the guns with the grenades they carried, returned to the unit for backup, went back destroyed the remaining guns and ammunition.
Mission actually accomplished. Of course, now the rangers had the problem of being a small unit of invaders away from the primary area of Allied assault. Over the following two days, they encountered and fought with various German troops. By 8 June, 90 men remained alive and fit for duty out of 225 in the initial assault.
This is a classic and interesting bit of D-Day lore. I recount it here because I had a sort of a “where are the guns” moment at the hospital this week. Respiratory specialists at two hospitals decided, over the past couple of weeks, that my pleural cavity was accumulating fluid from my lungs and would benefit from being drained. “Drained” in this case means they take a very long, lethal-looking needle, stab it through the abdominal musculature of my back, and attempt (via real-time ultrasound observation) to get the needle point into the pleura without pushing too far and puncturing and deflating a lung. Once properly inserted, they use the needle as a conduit to pull excess fluid from the pleura for discard with the day’s load of biological waste.
Well, Cathy kicked my butt out of my hospital-style bed in front of the living room TV and got me safely into the car. We buzzed up to the hospital at GBMC. I was quickly checked in and wheeled to the operating room. Appropriate gear was compiled—ultrasound visualizer, sterile kit with scary needles and fluid bags to catch the bad stuff, etc. The technicians sat me up facing the wall with my back exposed to the bed. Selected a needle and squished the ultrasound gel onto my back. Silence for about 4 minutes. And the tech says “Uhh…there’s not a lot of fluid here. Certainly not enough to extract.” She went to get the supervising physician who confirmed her diagnosis. No fluid to extract.
Talk about your missing guns! Actually, I’ve been feeling really good lately. No shortness of breath, lungs painless and dry. I wasn’t surprised they couldn’t find enough runaway goop to continue the procedure. I was certainly happy they wouldn’t be cramming the knitting-needle sized shivs into my back.
But there is more. That my lungs are functioning sufficiently well to keep fluid from leaking out and into the pleural cavity means that the chemotherapy is actually working. Oh, it’s not a miracle. My lungs remain cancerous, nothing we’re doing now can change that. But that wasn’t our objective in pursuing the catastrophically difficult and painful course of chemotherapy. We’re working to give me sufficient quality-of-life to spend a few more good months with family and friends, to write, think, play around with guitars, pastels, and photography, to sit on the front deck and enjoy the autumn weather.
And we seem to be meeting that objective (finally). This round of chemo did not dump me into an ambulance or the emergency room. Rather, it has given me (some) renewed strength. And enough symptomatic relief to be comfortable perched on my bed, reading, writing, strumming, and watching TV.
And at this point, that is what we’re looking for. A few comfortable months before the cancer gets its legs back and finally wrecks my respiratory system. And you know what? I’ll take it!
Thanks for being here, everyone. Hopefully after all the slogging you’ve had to do through whiny, painful accounting of medical nastiness, this bit of good news will perk you up as it has me. With home-administered i.v. fluids to keep me hydrated, and a peristaltic pump to “feed” me at a rate my physiology can endure, I’m hoping this period of relative comfort will last a while. But however it works out, it’s good news and the first such in a while. My love to you all. Tune in next week for further Adventures in Cancer Land (trademark, copyright). I’m taking y’all with me right to the end. Talk to you next week!
References
[1] http://www.6juin1944.com/assaut/omaha/en_hoc.php
Back at undergraduate days at Rutgers, it took me the better part of 4 ½ years to sort out such minutae as whether I would really flunk out, what major and/or minors I might pursue, what I could possibly do with myself after I did get out, etc. I learned a lot about myself along the way. And, because I experimented with course after course and program after program, I learned a lot of wacky facts and research results.
In the early days of experimental psychology (a field I rather enjoyed, and took multiple courses in), researchers were, for some reason, surprised to find that constant application of “negative stimuli” to dogs (such as keeping the floor of their cages electrified to the point of pain) eventually caused them to give up trying to escape and simply lay down and accept the hell. It didn’t occur to the experimenters, apparently, that absent any recourse, the dogs were just gonna run out of energy. Cross reference Ghost Busters for outstanding commentary on psychological research, BTW, if you haven’t seen it in a while. Hilarious.
Anyway. I’m starting to feel like one of those dogs. On Wednesday this week I got out of the hospital after spending 4 days in intensive care and 3 more in the oncology ward. I was still not fully recovered from the prior chemotherapy infusion when it was time, yesterday, to go in for the next one. So I just shuffled on in to the infusion center and got my hit of docetaxel. While there, we found out my red blood cell count is seriously anemic, so early Monday morning I have to go back in for several units of whole blood—I think they concentrate the RBCs in it before administration.
In short, I’m a frickin’ mess. But I am, for the moment, still alive. Not kickin’ very hard, but trying to. Keep me in your thoughts this week, everybody. I’m gonna need all the help I can get to get through this round of chemo. With the little bit of incentive that the lung tumors responded, I’m just piling along for the ride, looking to see what happens next. And as soon as I know, you will.
Thanks guys. Hopefully I’ll be more lively and able to provide more interesting material next week. My love to you all!
Human beings evolved in Africa. Then, as they walked out across the Sinai, species-by-species and individual-by-individual, they stopped and occupied the desert wilderness of the greater Middle East. In fact, there are a number of easily accessible sites in Jordan where, even today, you can stroll around on the tell (a “tell” is a hill, an enormous mound, of layers of the ruins of settlements, built one on top of the other, over millennia) whose onion layers begin with Neanderthal and run through Byzantine, Egyptian, Greek, Roman, Muslim, civilizations right to today (of course, the time period we are discussing runs much longer that this, going back past Homo neanderthalensis to Homo habilis and beyond). At one remote site, with a donkey tied up to chunk of Roman blockwork, a woman squatted in a shady nook busily producing the big thin Levantine bread characteristic of the region. She gave one to Nicholas and I. Apart from the stone fragments that made it crunchy and dentally dangerous, it was incredibly delicious. I asked our driver if we could pay her. He said she would be angry and insulted. So we drove on. To this day, I hope he paid her something from his (hefty) fee for the day’s driving.
Umm…I wandered a little bit there…where was I trying to…Oh. I remember. The point is that the western Middle East is, oddly, given the ecosystem in place, essentially the earliest human landscape. By which I mean a geographic suite of ecosystems that shaped, and was reciprocally shaped by, people. In that context, however, the carrying capacity (number of human beings per unit area) was low 10,000 years ago, and it remains so. Water sources are scarce, and without water, no people. Arable land is scarce and patchy (which is why there are so many goats. Goats can prosper on land that could otherwise support scattered spiky shrubs and lizards. This is also, BTW, why vegetarianism makes no sense ecologically. Much of the land on earth is not suitable for plant crops, but animals can serve as a vector to convert what dribs and drabs of primary productivity there are to human biomass and activity).
I have seen big chunks of the desert in the western Middle East. In Kuwait, one day we drove to the Saudi frontier, the next, to Iraq. I spent some time in the vacation “hunting” camp of a senior Kuwaiti security official in the north of the country. We hiked across the anti-tank trenching created during the war, which put us within naked-eye vision of the Iraq border. From Amman in Jordan, we drove into the northern mountains to the guard stations on the Syrian border (one of the guards, our guide said after chatting up the guys with the guns, had shot a hyena the prior morning!). I also went way out into eastern Jordan, approaching Iraq (this was also the trip we visited the miles and miles of windrows of shot-up Soviet tanks, guns and trucks from the first Gulf War. But that’s another story. I gotta dig out those slides and get them digitized for you). And I went to Aqaba, on the Red Sea estuary, hard against Egypt and Israel.
The most consistent aspect of this large and ancient “human” landscape is that it is nearly devoid of people. Yeah, there are scattered Bedouin encampments pretty much anywhere, family groups with a big tent, big pickup truck, and plenty of satellite antennae to grab television for nighttime entertainment. But not many people get by as itinerant Bedouin these days. Rather, there are a few small villages, far fewer large ones, and a couple of cities—Amman and Aqaba. With a couple hundred liters of spare fuel in back, you could drive off into the desert for days and not see another human person, beyond the red and white Bedouin camps off in the distance.
And that’s the reason I dragged you all the way through the above rambling essay. When you’re watching the news on TV these days, talking head after talking head is spouting off about how terrorist “army” ISIS or ISIL or The Islamic State is a new kind of existential threat to the West. The heads draw this conclusion from the ease with which these people spilled out of Syria to run over and “occupy” big chunks of Iraq. The heads tell you that this is a new and more terroristic kind of terrorism because ISIL is “taking over” big swaths of land [queue colorful map behind the commentator with ISIL lands in red, everywhere else in other colors]. And that prior terror groups like the Taliban and bin Laden weren’t trying to acquire real estate.
But here’s the thing. Any bozo with a RAV4, a couple cans of gas, and a Kalashnikov can run over and “occupy” big swaths of Middle Eastern desert. Hell, you could drive in a circle hundreds of kilometers in diameter and not see another human being. You could put up flags and “No Trespassing” signs. As my trips to desert frontiers of multiple countries suggested, ISIL actually occupies a tiny fraction of those big, colorful wall maps the news people are using. And an exercise in “connect the dots” is how the government and news outlets attempt to foment panic in the masses: “They’re coming for us. They’ve taken over Syria and Iraq. Soon they’ll be on our doorstep… .”
This, I suspect, is pretty much bullshit. The Islamic State has taken over and brutalized villages throughout the region. But they don’t have possession of large areas of ground. That’s left to the Bedouin who, except for the TV and the trucks, have owned and operated the deep deserts since well before the time of Christ. The Middle East is a complicated place, there is no doubt about it. But ISIL is just one of many groups claiming, fighting for, or dreaming of, making that desert exclusively their own. But there is no way that is happening.
My own landscape this week would also have to go in the “complicated” category. It started two Wednesdays ago. I collapsed in the foyer and couldn’t move. Scared the hell out of poor Cathy, who immediately called 911. The ambulance arrived in incredible time—maybe 10 minutes at the outside. The two women on board were around 40 years old. They both operated with military precision. One of them had a weathered desert look to her skin. I’m guessing the pair of them had spent recent time stitching up marines in combat zones. They did an awesome job delivering me to the emergency room.
My acute problems had to do with intractable dehydration (I couldn’t keep even small sips of Gatorade down) and associated imbalances in my electrolytes. I was pretty sick. In fact, they stashed me in the Intensive Care Unit for the first four days, moved me to Oncology Ward for the last three. Now, this was not my usual hospital. It’s the local shop—all three of our kids were born there.
They did a great job. I was so dehydrated it took the whole first four days to fix that. Then, being good doctors, they noticed my chronic respiratory distress and started to address that. After a couple days they realized my respiratory issues were from the cancer and not pneumonia or a fungal infection. When they cultured up my sputum, it sprouted what the impressed nurses said was a very impressive microbial diversity. Finally it clarified for the docs that they were not about to repair my breathing, that they needed to hand me back to GBMC for that.
Thus, I’m home. And am feeling much, much better. The oncologist at Howard County General (local hospital I spent the past week in) looked over the charts and tests and said that the chemotherapy is clearly working. You can’t imagine the wave of relief that coursed through me at that point. Gonna make it easier to take the beating from the next chemo infusion knowing that I’m not just making myself desperately ill every three weeks for nothing. Quality-of-life during these final months of my life is the primary objective we set for the treatment. And it seems like we’re going to meet that objective.
So, YYYYEEEEEEEEHHHHHHAAAAAAAAAAA from Cancer Land (trademark, copyright) this week. Much more will be going down this week. I see doctors, have tests, generally keep working on hitting back at this disease. I’m feeling more and more akin to an aging boxer who keeps getting into the ring, getting his lights punched out, waits three weeks and climbs back into the ring. But when I’m feeling good—like I am now—it is more than worth it.
I leave you with that bit of optimism, my friends. Hope you are all well. Live ‘em while you got ‘em—they aren’t forever!
