We all walk ancientrails. Welcome to the journey.

Written By: Charles - May• 22•19

Health “benefits” from Centura called this morning. Hey, guess what? You know those scans? Not approved. What! Twice in two weeks? What’s going on?

abdominal snowman

In spite of being the patient, hereinafter to be known as the victim, of our health care system, I was having a hell of time accessing any of it.

I don’t like phones. I like to see the people I’m talking to, even if I know them. It’s a thing and I’ve had it for decades.

This morning, however, was a phone morning. I called United Health Care. Nothing had been submitted for approval. Say what? It’s the day before these scans which were ordered last Friday. Who submits these things for approval? The doctor.

Anova Healthcare. Amanda, the heroine of the morning, or good Amanda as I think of her now, answered. The Littleton office handles authorizations. OH, I thought. She’s going to make me call them. Nope. She called. Vanessa, who has responsibility for my case, would call me back. Amanda had talked to the manager of the authorization department. I assume the same one that failed to get my axumin scan through.

Anyhow, Vanessa never called. I got a call again from Centura where I learned of another authorization hurdle. It’s internal to New West Physicians and focuses on Medicare claims. Oh. AARP Secure Horizons, which Kate and I have, is a Medicare advantage plan administered by United Health Care. Apparently this is the first point of contact with potential payors.

At the VRCC, Jan. 2018

Cindy answered. I’m sad and a little scared. Can you help me with this? The doctor ordering the test marked it as routine and Vanessa (bad Vanessa) only sent it to them yesterday at 3 pm. Oh, come on. The doctor had to change routine to urgent. Could you call the doctor? No, we usually don’t do that.

OK. Back on the phone. This time Amanda again. Answering machine. I told her what Cindy said. Amanda called me back in a short time. She’d already talked to Cindy. (Good Amanda) The bone scan is authorized. The CT is awaiting a decision. We’re half way there.

Here’s the thing though. All these phone calls, which took me all morning, were made by me, the victim. Ratcheting up my stress level each time. And, the result, which I sought all morning, was to get back to where I thought we were to begin with.

This left me with my head in my hands, talking to Kate at the dinner table, saying often, I don’t know. I really don’t know. A sort of ringing and head pressure came and went, my body trying to adjust itself to the feelings coursing through it.

I’m glad I’m not anxious, not much anyhow. But, I am stressed.

From a local facebook group

Written By: Charles - May• 22•19

So I get home this morning and my dog is laying on my porch covered in snow and mud and has a rabbit in his mouth. He’s not bloody, just dirty.
Now, my neighbors raised these rabbits for 4H and have blue ribbon winners. I instantly knew it was one of theirs. So I get the rabbit away from my dog, I take it inside, wash all the dirt off and before my neighbors got home I took it over, put him back in the cage and went back home.
Not 30 minutes later I hear my neighbors screaming, so I go out and ask them what’s wrong?
They tell me their rabbit died three days ago and they buried it but now it’s back in the cage. 🐾🤷‍

Celebrate

Written By: Charles - May• 22•19
From this last October

On Kate’s caring bridge site I posted about her upcoming surgery, June 3rd, to implant the feeding tube port. This represents the end of a long winding process requiring TPN, ct scans, visits (when we could get them) to the pulmonologist, to Lisa Gidday, our primary care doc, to Westermann, the rheumatologist, and one last visit, on May 29, to the cardiologist.

Ed Smith, the surgeon said, “Well, at least I don’t we’ll do you extreme harm now.” Reassuring. I give him props for insisting on the TPN, for Kate being as prepared physically as she can be for this procedure. I thought he was stalling. “Well, we’ve put this off as long as we could, haven’t we?” he said. First, do no harm.

To this, May 2019

Once the j-tube is in and Kate has it for ongoing nutritional support the remaining unaddressed challenge will be her lung disease. For the summer.

We had a t-bone, risotto, and asparagus last night to celebrate getting a date for the j-tube. Somehow I over-cooked the t-bone. Still good, but we like’em rare, not medium. Guess who cleaned up? Kate.

It feels so good to see her walking, doing ordinary chores. Laughing. Gaining weight. A victory already.

Gilroy on Friday

Written By: Charles - May• 21•19

Dr. Gilroy put me on his schedule for Friday. I’ll have had the ct and the MRI the day before. Hopefully this visit will begin to push back the veil. There may be a treatment plan or there may be a need to fight for the axumin scan. We’ll see.

A Cloud of Unknowing

Written By: Charles - May• 21•19
Dante Luca Signorelli (Own-work-Georges-Jansoone-JoJan-Taken-on-30-April-2008)

Another big medical week. But they all seem to be right now. Minor: had my teeth cleaned yesterday. “Your teeth are so clean.” Hygienist. So one part of my body’s in good shape.

Kate and I visit Ed Smith today. He’s the surgeon who will, we’ve been hoping for several months now, implant the j-tube. The pulmonologist has cleared her, the last remaining hurdle. I’m expecting (hoping?) that we will schedule a date.

On Thursday I have the standard of care imaging studies for prostate cancer reemergence, a ct and an mri. The axumin scan is a pet-scan. In a followup visit to Dr. Gilroy, the radiation oncologist, we’ll see what these tests have to say and revisit the axumin scan if it seems like it would increase the accuracy and efficacy of treatment.

William Blake

Each step on this journey makes things a bit more real. A bit more sphincter tightening. Right now, I have no idea where I am, except that I’m in a place I’d rather not be. No diagnosis except a rising PSA. No treatment plan. Just the knowledge that somewhere in my body are cells working against my survival.

Death Hendrick Andriessen 1607–1655

It’s a strange place to be, ethereal, filled with fantasy. They’ll find distant metastases and I’m doomed. They’ll find a small, localized tumor, zap it with a Buck Roger’s ray gun. I return to a new life free of cancer. The disease is slow, but not fully treatable. I’ll have to live for years with an invader slowly gaining more and more territory. A losing game of go.

I’m sleeping well, not overly distracted or anxious. Yet this is a moment of existential angst, the sort of moment that defines existential angst. Dante helps me see it more clearly. Here are the famous first lines from Canto One, modified just a bit.

Two thirds through the journey of my life
  I find myself within a forest dark,
  For the straightforward pathway has been lost.

Ah me! how hard a thing it is to say
  What is this forest savage, rough, and stern,
  Which in the very thought renews the fear.

So bitter is it, death is little more...

But, since it came to good, I will recount all that happened there.” This is v. 4 of the Canto and my hope. We’ll see.

May 21

Written By: Charles - May• 21•19

Not Gone

Written By: Charles - May• 20•19
Gertie, after the incident

Then there’s Kepler and Gertie. The two of them got jammed up against each other by the back door after Kate fed them lunch. Bloody. Gertie has, again, multiple wounds. A tough situation for us. The incidents are always situational, that is, something unexpected puts the two of them in a tight space or Gertie nips at Kep. Then, full on dog on dog aggression. Well, maybe not full on. Kep never goes for her throat.

We’ve learned from research and from vets that this kind of behavior is not extinguishable. Predator/prey instinct is at the base of the doggy brain, not gone. When it’s triggered, the dog is a hunter, or a self defender, both behaviors beyond any executive function that might have been trained into them.

Kep last week

We love both of them. Not rational, but we’re going to keep them both. In Tully’s case her Wolfhound on Whippet aggression was not situational. It was fully switched on and we had to keep them separate at all times. This was years ago, but we faced the same dilemma. We love Tully, we love Kona and Hilo. So, we managed it.

The Kep situation is, in some ways, tougher since it’s unpredictable. 99% of the time he and Gertie play, eat together, rest together. Are genuinely friendly with no residuals from Kep’s biting. Then, bam!

I’m keeping them apart right now. Kep’s up here in the loft as I write, wandering around since he’s usually not up here for any length of time. He prefers being outside.

And so close to Memorial Day

Written By: Charles - May• 19•19

A Winter Storm Watch is in effect for the Front Range ABOVE 9,000 feet and the High Country.

A strong storm system will move into Colorado on Monday and continue to affect the area into Tuesday. This system may bring heavy snow to the mountains and northern foothills from Monday afternoon into Tuesday with several inches of wet snow possible.

Heavy snow possible. Total snow accumulations of 8 to 16 inches possible with up to 20 inches in some mountain areas. Winds could gust as high as 35 mph.

* WHERE…Rabbit Ears Pass, Rocky Mountain National Park and the Medicine Bow Range, The Mountains of Summit County, the Mosquito Range, and the Indian Peaks and The Northern Front Range Foothills.

* WHEN…From Monday afternoon through Tuesday afternoon.

* ADDITIONAL DETAILS…Travel could be very difficult. The hazardous conditions could impact the morning or evening commute.

Zhuangzi on fate

Written By: Charles - May• 19•19
2014

Made potato, corn, bacon chowder last night. It took longer to make than I intuited from reading the recipe, but it was worth it. Kate finds good recipes, I cook’em.

She also cleaned up the kitchen last night. Her stamina and strength have both improved so much. She builds on it by regular p.t. and using her rollator less and less.

Decided two things yesterday. I’m not going to expect support, but I’ll appreciate it when it comes. Also, what’s good for the dogs is good for their human friend. I kept their routines as normal as possible while Kate was in the hospital and at rehab. I’m going to stick with cooking, working out, reading, writing Ancientrails, working on my novels, painting, going to CBE, seeing the grandkids. The usual stuff. With one exception. I want to go hiking more. Shinrin-yoku. Forest bathing.

Wu Zhen. Fisherman. ca.1350. Metropolitan Museum N-Y

In other words, I’m going to live my life. It’s one that’s fed me, kept me sane, allowed me to make contributions to others, to create, to love.

I remember a story about Chuang Tzu, a Taoist sage. Also written as Zhuangzi. Here it is:

“Zhuangzi’s wife died. When Huizu went to convey his condolences, he found Zhuangzi sitting with his legs sprawled out, pounding on a tub and singing. “You lived with her, she brought up your children and grew old,” said Huizu. “It should be enough simply not to weep at her death. But pounding on a tub and singing – this is going too far, isn’t it?”

Zhuangzi said, “You’re wrong. When she first died, do you think I didn’t grieve like anyone else? But I looked back to her beginning and the time before she was born. Not only the time before she was born, but the time before she had a body. Not only the time before she had a body, but the time before she had a spirit. In the midst of the jumble of wonder and mystery a change took place and she had a spirit. Another change and she had a body. Another change and she was born. Now there’s been another change and she’s dead. It’s just like the progression of the four seasons, spring, summer, fall, winter.

“Now she’s going to lie down peacefully in a vast room. If I were to follow after her bawling and sobbing, it would show that I don’t understand anything about fate. So I stopped.”

by Tom Crane

And so it is with my cancer. However it turns out, it’s nothing more than the Great Wheel turning. Excuse me while I go get a tub and a wooden spoon.

Get Your Hands Dirty

Written By: Charles - May• 18•19

Just to show you I’m not only about death and cancer. Here’s a response I wrote to Bill Schmidt after reading this article, “Modernity, Faith, and Martin Buber,” from the New Yorker. He passed it along from his friend Nancy.

Bill, it took me a while, but I did get around to the Buber article yesterday. Interesting. I’d not read a synopsis like this before.

He was a contemporary of Mordecai Kaplan, the founder of Reconstructionist Judaism and the only rabbi excommunicated by the Orthodox rabbinate in the U.S. My kinda guy.

Martin Buber


I would put Buber, Dewey, Kaplan, and Emerson together. They all questioned received wisdom, hankered to get below the surface of thought to find the substrata. Dewey (and William James) as a pragmatist might be the outlier here, but the pragmatists were a unique American contribution to Western philosophy and as such took issue with the philosophical tradition they had been given from European thinkers. Buber, of course, is the only one of the three that is not an American, but he took Jewish thought in a direction I think is very congenial with Kaplan.

In a quick search I couldn’t find any evidence that Kaplan used Buber’s work, but their mutual insistence on a human centered approach to religion, perhaps even in Buber a human/pagan approach: “When something does emerge from among things, something living, and becomes a being for me… It is for me nothing but You!” and on Judaism’s culture, as opposed to dogma, makes them simpatico. “Buber exhorted his listeners…not to abandon their Judaism but to reinvent it.” Reconstruct it.

This is congruent, too, with Emerson who wanted a book of revelation to us, not the dry bones of revelation to them. Emerson I know had a lot of Taoist influence, don’t know about Buber.

Mordecai Kaplan

We might find a distinctly American twist on religious sensibility by looking at all of these thinkers, even though Buber was German. I’d say my project about reimagining or reinventing faith is in this tradition. That tradition seems to say, take nothing from books as true. Test their ideas against reality, test them against reality at its deepest in your Self and at its broadest in the world beyond the Self. Be ready for the sacred to surprise you in the petals of a flower, the flow of an avalanche, the innocence of a puppy. Find the divine within your Self and bow to the divine within the other, be it rock, animal, fungus, or human.

The gooseberries and me

In my work I’ve found the soil, the power of plants, perfect examples. When we consider our reliance on the first six inches of top soil, on the mystery of photosynthesis, on the divine miracle that is life whether green or furry or pink or barked, then, we don’t need to go to Luke or the Torah. My scripture and its most profound secrets exist in the wonder of rootlets reaching into the dark for the nutrients held for them in living soil.