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.
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.
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.
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.
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.
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.
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.
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.
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.”
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.
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.
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.
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.
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.
Mortality signals. Coming through loud and strong. A frisson of the world without me. “Are you going to be ok,” Kate asked, “Psychologically?” “Yeah, I think so. I’ll tell you if I’m not.”
Hard to avoid running the recent news all the way out to the literal end. (see post below) I’m neither a pessimist nor an optimist, I’m a realist. The indicators are not good. But. At this point that’s all they are. Indicators. As Kate also said, “We need more data.” Yes, an axumin scan would have helped, but a ct and an mri will get us started.
Yamantaka and I have been friends for a long time now. I’ve imagined my death, my corpse. Meditated on it. When my mind insists on following the bread crumbs, I let it. I end up the same place Yamantaka has taken me. The same place we all come to. The question isn’t whether, but when.
Yes, this is morbid. And, yes, even if all the signs are negative, nothing’s happening soon. But I can’t be other than where I am. Right now, on this chilly May Saturday, I’m still absorbing.
I do feel I’ll be ok. Psychologically. Which doesn’t mean I won’t be scared. The unknown is the landscape between here and death. Will treatments be able to slow down the cancer? Is there still a chance for a cure? Unknown.
There a couple of mantras I’ve said over and over for quite a while. Live until you die. I intend to do that. Live in the present. I’m doing that except for those pesky moments when the blood hound of logic starts baying at the trail. I still have books to write, paintings to finish, friends and family. Dogs. Those will not change. Books to read. Places to go. Mountains and nearby states to explore.
On that last. I will see the National Gallery of Art in Taipei. This is the museum which contains the Qing emperors collection, all the best of Chinese art over its long history. Chiang Kai-Shek gathered the collection and took it with him to Taiwan after a losing fight against Mao and the Red Army.
Here is a large copy of one piece I most want to see:
So. Saw Dr. Gilroy, the radiation oncologist. His office, appropriately, is close to Skyridge Hospital where I left my prostate 4 years ago. Gilroy is a man in his 50’s, a friendly broad face, short cut but curly hair, a thick, but not fat body, and a kind demeanor.
All the folks at Anova have been kind. Which helps. Kate was there, sitting second chair this time, as I’ve done for her appointments over the last year. These patient rooms are the same. An exam table, two chairs for the patient and support person, a stool and a small desk projecting from the wall, a computer. Sometimes drug company posters on the wall: Pulmonary Hypertension and You, How to rate your bowel movements, Glaucoma and the eye. Bland wall colors. Sensible carpet. A sense of depersonalization. The focus is on you, the sick one. Or, the maybe sick one.
The news so far is sobering. The rise from .1 in January of 2018 to 1.3 in February of this year is rapid according to Gilroy. The velocity of the rise can be an indicator of the severity of the reemergence.
“Have you had a digital exam since your prostatectomy?” In this case of course digital means, with a digit. “No.” “I need to do one.” “Oh.” “Drop your trousers and bend over the exam table.” And so I did.
He could find no nodules. Had he found one he said it would have indicated the likelihood of a localized reemergence. Rapid velocity. No digitally findable nodules. Could mean metastases.
Next up are the traditional imaging techniques. CT and MRI. The MRI scans bones for mets and the CT looks for what I’m not sure. Next week sometime.
I’m not afraid to die. But. I’m not eager either. The gap between those two does produce a quickening, a stomach drop, but I’m not experiencing, nor do I expect to experience, dread. Into each life a little death must fall.
It’s been warm, even hot down the hill. When I went to the Avengers movie, it was 85 when I came out. Largest temperature swing I can recall. It was 66 when I got back to Shadow Mountain. Not a fan of the heat.
Kate went to the board meeting at CBE last night. She stayed for the whole time, three hours. Her stamina has improved a great deal and she’s using her rollator less and less.
Just put the all season tires in the truck. Headed to Stevinson’s this morning to replace the snow tires and get some dye in the air conditioning system. We’re gonna fix the air conditioning one way or the other this time.
Then, Anova Cancer Care at 12:30. Told Kate yesterday that I want definitive treatment rather than quick treatment. My anxiety level is low. Doesn’t mean I’m not feeling some stress. Of course I am. Just not projecting outcomes, results. So, Dr. Gilroy, here we come.
I did see this yesterday, Judge rips insurance company: “A federal judge blasted UnitedHealthcare last month for its “immoral and barbaric” denials of treatment for cancer patients. He made the comments in recusing himself from hearing a class-action lawsuit because of his own cancer battle — and in so doing thrust himself into a heated debate in the oncology world.” The issues are slightly different, but guess which insurance carrier I have?Immo