Category Archives: Third Phase

Aging, Health, Mountains, Shadow Mountain, Third Phase

“I won’t optimize the length of my life.”

May 3, 2019 Charles Leave a comment

Beltane Rushing Waters Moon

The Rushing Waters Moon is down to a thin crescent. 2% of the lunar surface illuminated. Maxwell, Cub, Blue, Shadow, Brook, and Bear Creek are still pulsing, but they will begin to slow as we move deeper into Beltane. Alan Watt’s little book, The Water Course Way, comes to mind when I write about these patient devourers of mountains. Soft wins over hard.

Cool today. 29 when I got up. Snow all gone for now. The prediction is for a wetter and cooler May, something both of these former Minnesotans can enjoy. Good sleeping. Too, coming after a wet winter, this sort of May will further reduce fire dangers. Told Kate yesterday it could be cool and wet right up to the monsoons, late August. A summer without fire worries would be nice.

Got an e-mail yesterday from Dave, of Deb and Dave, who own On the Move Fitness and have been my personal trainers for two years. He sent it to all those who use their small fitness center. Dave has brain cancer, up until this last week in remission. Not now. Resonates for me. I wrote him back. “Cancer’s a bitch.” Both he and Deb responded. Deb said, “I agree, cancer’s a bitch.”

coco Michelle is a mussar friend. Her husband has prostate cancer, too. Already metastasized. Leslie, also a mussar friend, has had her breast cancer reemerge twice. I mention these because it underlines that cancer is probably in your circles as well. Yes, treatments have improved life expectancy and some prevention efforts have helped, but cancer itself, in its multiple manifestations, continues to be an agent of Azrael, the angel of death.

In itself, as I’ve written before, I consider whatever ultimately kills me as a friend. Life is not forever. We cherish our mothers who bring us into this life. (Well, we cherish some mothers.) Why not cherish what completes our cycle? No, I’m not rooting for prostate cancer to be that friend. And, yes, I’ll wait as long as I can to meet my friend, yes.

In “Free Solo”, the documentary about his free climb of El Capitan, Alex Honnold says to his girlfriend, Sanni McCandless, “No, I’m not going to optimize the length of my life.” The comment hit me a couple of ways. First, it’s so contra-normative for this health obsessed age in which this diet or that exercise regimen or those supplements will ensure you’re not only healthy, but will live long. (and, maybe prosper) No keto diet or paleo diet or spinning class or hot yoga or ginseng will extend your life beyond a human’s natural limits. And the death angst that causes folks to fantasize that maybe this intervention will do just that is fantasy. Denial. Fear. I like Honnold’s up front recognition of death as a part of life.

Second, he’s not giving up his central purpose, to push climbing as far as he can, because it might kill him. Neither should we put any part of our life on hold because we’re going to die. Yes, cancer puts that right up in your face, like climbing free solo, but it does not control your response. If you’re brave enough to say with Alex, “No, I’m not going to optimize the length of my life,” then you’ve found a platform firm enough to withstand whatever existential threat comes along.

This is what Yamantaka wants to teach us. Our death is sure. Our fear is unnecessary and interferes with our ability to live. Life is precious, rare, and finite. It is a gift bestowed upon us without condition, ours to use, to enjoy, to contemplate, to share, to embrace. Don’t let anything get in your way.

Family, Health, Reimagine. Reconstruct. Reenchant., Shadow Mountain, The Move, Third Phase

Spinning out

May 2, 2019 Charles Leave a comment

Beltane Rushing Waters Moon

22 degrees. A thin layer of snow on the solar panels, Black Mountain’s lodgepoles topped in a floury white and the sky that Colorado western blue. Bright sun. Why we love the mountains.

Still spinning out, not working much, floating in caregiver world, distracted. It’s ok. I’m waiting intentionally now, Progoff workshop starts Sunday and I’ll go deep into this current version of me, self-guided, self-analysis, Jungian style. The week after it finishes I have my pet scan, then the meeting with the oncologist. Into the unknown, first my psyche, then my body. All in two weeks.

The Progoff method is a pet scan for the psyche, letting me see the things within that have been hidden by busyness, anxiety, stress, competing demands, looking away. Once I’ve seen them, like the pet scan’s images of my cancer, I can diagnose my situation and make a plan. That’s diagnose in its etymological sense: from Greek diagnōsis, from diagignōskein to distinguish, from dia- + gignōskein to know. Merriam-Webster

My suspicion is that I’ve entered a different moment in my life, one that began with two dramatic changes, the first being the move to Colorado. It took about a year to process. All the financial squirming of two houses, moving and pitching stuff, lots of stuff, removing ourselves from Minnesota and moving onto Shadow Mountain. The second change. Prostate cancer. In which I went from a normally healthy aging man to a cancer patient. The sudden push back into the space of a cancer patient, after thinking I’d put it in the past, been cured, has jarred me in ways I’ve barely begun to realize.

20180909_183444 — September 9th, easing the SMA induced nausea and cramping

Kate’s slowly, but now surely, rebounding from her long ordeal. She’s able to take on the dog’s second feeding, a modest, but real return to pre-bleed life. Our visit to Dr. Gidday, a post the most recent hospitalization appointment, gave her situation much more clarity. Dr. Gidday agreed that if her hemoglobin numbers don’t stay up, she has labs drawn weekly for the tpn feedings, then she’ll go to iron infusions. That will resolve, or at least attenuate, her anemia. Continued weight gain will happen through the j-tube placement. (remember the j-tube?).

The final piece of the puzzle, her lung disease, awaits either a lung biopsy, which she does not want, or a close reading of the high-resolution CT scan she had on April 2nd. With a diagnosis and the resulting treatment for the interstitial lung disease all the presenting problems of the past year plus should be addressed. A long, long time coming. Just how far back toward her old life she can expect to come is unknown, but if she can get back to sewing, driving, going to CBE and to Bailey Patchworkers and the Needleworkers group I’ll count her better.

Then, maybe I can get back to more abstruse obfuscations here rather than this medico-journalese I’ve had to adopt over the past several months. The tincture of time, as Kate would say.

Family, Health, Science, Third Phase, Weather +Climate

How do we know?

April 30, 2019 Charles Leave a comment

Spring Rushing Waters Moon

Kate was in the dentist’s chair for 3 hours. Four crown preps. All that drilling. Exhausting. She has temporaries on now. May 13 she gets the actual crowns. Much shorter visit.

Snow much less than predicted. Maybe 3 inches rather than a foot. Weather5280 reeled back their forecast, but we still got less than their numbers.

OK. New pastime. Looking up data about prostate cancer reemergence treatments. Ugh. So much information, so little of it digestible by this non-medical, non-science person. Imaging studies like the axumin scan have competitors. The data comparing those competitors is available, but mostly in journal articles. I can only read them for so long before my attention rate drops.

Another issue that arises is availability of certain imaging modalities. A promising new isotope based on gallium is not yet approved by the FDA. Only two , a choline based isotope which the Mayo Clinic uses, and the amino acid based axumin, have passed FDA trials. Even then, the trials vary in their consistency and in the type of information gathered. The gold standard of evaluation in imaging studies is histologic examination of their findings. That is, the sites identified by the imaging have biopsies and the pathologist determines if the cells are cancerous or not. Difficult to pursue in any numbers.

Once the imaging is done, which can produce 3-D maps of cancerous lesions, but with real caveats, especially the lower the presenting PSA rise, like mine, treatment plans are next. After a radical prostatectomy there are two treatments: hormone therapy (think chemical castration) and radiation. A huge issue in choosing treatments, especially newer ones like Cyberknife is the slow growth of prostate cancer. Statistical studies must be conducted over 10-15 year periods. If your new treatment is less old than that, the likelihood of good studies following actual patients are difficult to impossible to find.

So in both cases there are problems. This isn’t big news to those in medicine. Docs have to work with incomplete and unverifiable data all the time. That’s a major part of what makes practicing medicine such a high wire act and something I’ve come to admire the more I’ve learned. Even so, as a patient, I prefer certain knowledge and definitive options. Just. Not. Possible.

One more issue. Where to get treated. Right now my urologist has referred me to Anova Cancer Care. Anova and Urology Associates (my urologist’s group) are in the same organization. The more I think about it, the more I want a second opinion. Not because I distrust anybody, but because I want the chance to explore options other than the Cyberknife.

Although. Cyberknife does match up well with what I understand about my reemergence. The confounding factor with is the necessarily imprecise nature of the petscan. Cyberknife can kill lesions and tumors it knows are there. But, not ones that the petscan can’t find. There’s more, but I’m tired of thinking about it for now. Gonna go have breakfast.

Faith and Spirituality, Health, Judaism, Myth and Story, Original Relation, Reimagine. Reconstruct. Reenchant., Third Phase

At the Jabbok Ford

April 27, 2019 Charles Leave a comment

Spring Rushing Waters Moon

jacob Phone call today from buddy Tom Crane. In referring to the current kerfuffle within my body, those cancer cells, he said I was “wrestling with a dark angel.” That is so.

Yet what it called to mind was one of my favorite biblical passages, one I’ve written about here before and about which there are many wonderful works of art. Jacob at the Jabbok Ford.

Through the night Jacob wrestles with what the text refers to at first as a man. When the man, now revealed as an angel, sees he cannot best Jacob, he says, “Let me go, for dawn is breaking.” Jacob, strong enough to hold an angel fast through an entire night, is not willing to do that. “I will not let you go unless you have blessed me.” It is at this point that the angel, who had to dislocate Jacob’s hip to keep from losing the match, agrees: “Your name shall no longer be called Jacob, but Israel, because you have commanding power with [an angel of] God and with men, and you have prevailed.” Jacob (now Israel) continues to limp the rest of his life. He names the spot Peniel, (I) saw the face of God.

Wrestling with angels is a tricky business. Just ask the Egyptians. That one, the angel of death, sometimes called Azrael, passed over the lamb blood smeared doors of the Hebrew slaves and killed the firstborn of Egypt. What would have happened to Jacob if he’d been beaten by the angel? No blessing, I’m sure.

Wrestling with Azrael, cancer forces this struggle on the psyche in the same way Jacob’s angel blocked his passage across the ford, could be represented as happening at a ford of the river Styx. Lose a match to Azrael and, to mix mythological systems a bit, you can catch a ride with Charon.

As with Jacob’s angel, no contest with Azrael will result in victory, Azrael wins all struggles in the end. But in the interim, as with Jacob’s life after the Jabbok Ford, we can go away changed in heart, identity, and fate.

ruin_stairs_leave_destroyed_broken_dirty_building_factory-921666.jpg!d Recalled as I wrote this that I had a dream:

“I was in a non-descript house or building, bare of furniture. Someone, or something, was in the basement. I could hear gun shots. I hunted for entrances to the basement and found two, one a door and one a grate.

Down there were steel pillars covered in concrete. Whoever or whatever down there wanted to bring the building down. The blue painted concrete had shattered on many of the pillars exposing steel beams. They still stood strong.

Somebody handed me a rifle. I readied myself, though frightened, to go down and save the building.”

Surely this is Azrael. I woke up before the contest could begin, so I’m going to imagine the rest.

I went down the stairs, grateful for the rifle, thankful for whoever handed it to me. But, could I use it? I’m not a man of peace exactly, but I’m not a man of violence either. Still, desperate times. The basement had a little light, enough to make shadows. Gunfire echoed more loudly as I got to the bottom. Whoever it was, was serious.

The gunfire stopped. “You shouldn’t be down here.” A voice cold and firm. From the depth of the shadows. “Leave now and I won’t destroy you. Not right now.”

OK, I thought, back up the stairs. This is too scary. However, I didn’t move. I lifted my rifle and aimed it toward the voice. When I pulled the trigger, it clicked. A rifle with no ammunition. Well, that settles it. Back up the stairs. Nope. Stayed. Scared, but unwilling to give up.

The gunfire did not resume. The air had faint patterns of blue dust from the pillars that had been shot up. The silence was complete. No voice. No evidence of another.

My feet began to move before my mind caught up. Whoa, I thought, feet where are you going? I knew, though. Straight toward the depth of the shadows. I heard what I imagined was a rifle clatter to the ground. Hmm. Even up, I guess.

“Come no further unless you want to meet your end.” Cold, firm. Closer.

My mind said, back up the stairs. My feet kept moving until I lost sight of them in the darkness of the deep shadow. Heart racing, adrenaline swimming through my bloodstream, setting me on fire. We closed.

How long we struggled, I no longer remember. He was strong. Much to my surprise, so was I. We went back and forth, pushing, straining legs and arms, trying to gain an advantage. This was all in the darkness of the shadow. I could not see him and I assumed he could not see me.

Oh. Wait. Not a he. At one point, arms locked together, we touched at the chest. Breasts. A woman! Didn’t change my situation. She was still there to bring down the foundations of my life.

This went on. And on. I grew weary. So did she. Panting, both of us. Our moves more feeble. She touched my left shoulder and my left hip. Pain. Agonizing pain. Giving up not possible, I hung on, endured the pain, chose it.

“We must end this,” she said.

“Not until you stop. I need those pillars, I can’t let you wreck them.”

“If not tonight, later. You know that.”

“Of course. Yes. I know. And when it’s time I will not fight you, but come willingly.”

She dropped her hold on me. My shoulder and my hip blazed. The adrenaline was gone. I felt weak. “You must bless me and I will leave.”

Later, back up stairs, the door to the basement closed and locked, I sat at a small wooden table, drinking coffee. I had a new name. Just like Jacob.

Aging, Commentary on Religion, Faith and Spirituality, Family, Health, Judaism, Mussar, Reimagine. Reconstruct. Reenchant., Third Phase

A Difference Maker for My Heart

April 26, 2019 Charles Leave a comment

Spring Rushing Waters Moon

20190420_173752 Back to mussar yesterday. First time in quite a while. It was a gift, as was the minyan for Debra Copes’ mother’s memorial the night before.

Odd though, in both instances. I find myself an insider and an outsider. There is no question that Beth Evergreen accepts both Kate and me. I’m of the community, not a Gentile pagan interloper. Yet when the prayers are said and the knee bending and bowing begins, I feel like an outsider. I don’t know the words, nor do I fully understand why we’re bending and bowing. I try to follow the person next to me, but I feel awkward and a bit inauthentic. Also, I don’t wear the kippah during services. Again, it doesn’t seem authentic for me since I’m not of the tribe.

When Alan Rubin and I went to lunch on Wednesday, for example, I ordered a reuben, a pannini. When Alan ordered a salad, I said, “Oh, on your diet, eh?” “Well, yes, but also we can’t eat bread during Passover.” Oh? Oops. Passover, it turns out, is 8 days and eating leavened anything during this time is out. Yet they trust me enough to teach in the religious school.

Being away for a while makes me more aware of these moments. Yet Debra wanted me at her mother’s minyan. She did a universal worship service which consists of lighting candles for Hinduism, Zoroastrianism, Christianity, Buddhism, Islam, Judaism, and a general candle for other witnesses to the divine. Rabbi Jamie said, at a meeting a couple of weeks ago, “This ex-Presbyterian understands Reconstruction better than anybody else around this table.” Around the table were key leaders of the synagogue.

Yesterday I offered what was for me a mussar interpretation of a table of virtues set out by Renee Brown, a favorite author of many in the congregation. Yes, to generosity. But, also, yes to retaining sufficient resources for yourself and your family. Yes, to freedom, but also yes to submission, to recognizing those times when serving others is more important. Yes, to accountability, but also yes to breaking the rules, to recognizing that not all instances of being held to account (even by ourselves) are equal or worthy.

20180316_191858 The Jewish approach to death, too. Sitting shiva with someone after a death. Having those in mourning stand and be acknowledged during the mourner’s kaddish at every worship service. Celebrating each year the yahrzeit, the year anniversary of a loved ones death. Calling together a minyan as Debra did for honoring her mother. Those who knew it, repeated the mourner’s kaddish from memory. A vital and key part of maintaining community, acknowledging that the dead live on, not gone, just absent.

When I told Alan about my new reality with the axumin scan and oncologists, he said, “You know you’ve got the whole congregation behind you?” He meant it. Wow. Makes me feel like crying. Because I’ve always chosen an outsiders role, I’ve rarely known complete acceptance in a group; but, I feel it at CBE like I felt it in the Woollies. Profound. A difference maker for my heart.

Aging, Health, Science, Third Phase

Sigh

April 25, 2019 Charles Leave a comment

Spring Rushing Waters Moon

By Textefuermedizin - Own work, CC BY-SA 4.0, Cyber knife — By Textefuermedizin – Own work, CC BY-SA 4.0, Cyber knife (looks sort of ominous, doesn’t it?)

Cancer seems to move the wheels of medicine a bit faster than other things. My axumin scan will happen on May 14th. A radioactive molecule of an amino acid, leucine, cancer cells take up axumin “avidly” according to Blue Earth Diagnostics. PET scans can observe this activity through gamma ray emissions. According to one website, each dose of axumin costs between $3,000 and $4,000. My cost will be much less, probably around $200.

On May 17th I meet with the radiation oncologists at Anova Cancer Care. Dr. Gilroy will review the axumin scan and use it to recommend a treatment plan. Given the velocity of these matters I imagine the treatment itself will happen soon after.

How this effects Kate and me is uncertain right now. She still has a diagnosis of her lung disease ahead of her, which might entail a lung biopsy, as well as the surgery to place the j-tube. These may happen concurrently. If she’s recovering from surgery and I’m receiving radiation? Not sure how that will be.

Geez. Downbeat. I know. Wish my reality were different. Oh jinn of the lamp where are you? Even so, it’s life. Kate asked me if I was thinking, why me? I said no, never. Why? Because I’m human and we’re frail creatures, our bodies a compromise between life and entropy. Entropy always, always wins.

Korea Hydro and Nuclear Power has started up its new Shin Kori 4 reactor

The technology involved in all this fascinates me. My buddy, nuclear engineer William Schmidt, studied the underlying physics of it all, utilizing nuclear power to create electricity. Now it will find those little bastards that want to advance the entropic time schedule for my body. When my prostate was cancerous, I wanted it out. In this situation there is no thing to cut out, no organ to remove. It’s similar, I think, to a forest where small fires have been ignited by lightning. None of the small fires, in themselves, will destroy the forest, but they have the potential to kindle whole forest consuming wildfires.

I looked at myself in the mirror yesterday. The same. The seven small scars from the DaVinci robot in a jagged curve, hardly visible. Yet, somewhere inside something nasty is happening. My former internist, Charlie Peterson, said we’re all black boxes to a certain extent. Right now, hanging between my psa numbers and the axumin scan, I’m in a limbo where all I know for sure is that there is some cancer, some where in that torso.

Not depressed, but melancholy. A heaviness settles in at some points, some staring. Numb, like my whole body rests on my crazy bone.

Cooking, Health, Politics, Science, Third Phase, Weather +Climate

No to impeachment

April 24, 2019 Charles Leave a comment

Spring Rushing Waters Moon

abyss Jupiter hangs west of the Rushing Waters Moon while Antares sits below it, also to the west. Black Mountain has a faint reddish glow as dawn sun pushes up the Shadow Creek valley. In this light our lodgepole pines look lush, a vibrant healthy green against the red-tinted Black Mountain. Another Rocky Mountain morning.

Made corned beef and cabbage last night using the Instapot. I can’t say why I like this appliance so much, maybe the idea of using a pressure cooker at altitude. This was on Kate’s list of meals for me to cook this week. Strangely liberating, having someone else come up with the menu.

Got a call from Anova Cancer Care last night. A warm young woman. We scheduled an appointment for May 17th, hoping that’s out far enough for me to have had my axumin scan. They want a cd of it. The docs at Anova are radiation oncologists. Who wants to need an oncologist? Nobody. But, to have them available and experienced when you do. Pretty damned valuable.

Impeachment. A bad idea. Trump needs to be invalidated at the ballot box. Impeachment and all the hoopla surrounding it would only embolden all the creepy crawling things wearing those red hats. Vigilantes at the border. Proud Boys gearing up to attack the liberal left. McConnell. Republicans who have been Jim Jonesed by the orange tumor on our democracy. The regular white folks who think putting others in their place, domestically and abroad, is what Americur is all about. The judges who somehow believe in the infallible words written in the constitution, not by founders who were complex and nuanced, but by the almighty herself working through their pens. We need all these folks to suffer defeat in the democratic way, in an election, a fair election. Which might be more difficult to pull off than we imagine.

Health, Science, Third Phase, Travel, Writing

Swimming in da Nile

April 22, 2019 Charles Leave a comment

Spring Rushing Waters Moon

axium Swimming in denial. That’s me. I sent an apology e-mail to Dr. Eigner saying I had misstated my PSA. I wrote it to him as 1.2, but it was really .12, I said. Just got a call from Anna Willis, his PA. Nope. I had it right. It was 1.2. Guess I wished it to be .12 so I decided it was. Nope. The second PSA I had was, in fact, 1.3. Well.

Numb. In shock. Doing what I do to sort things out, write.

I’ll be getting an axumin scan, a relatively new pet scan procedure that can identify active cancer cells and locate them. This not only helps target therapy, a very good thing, but can also say whether the cancer has spread (metastasized) or is confined to the prostate fossa, the area where my prostate used to be. After the scan, I’ll visit the cancer care folks at Anova. They’ll discuss what treatments, probably radiation, might work.

20181011_181109 I have a sort of buzzing in my head, a feeling of my body as more of a barrier to the world, heavy. Staring, sort of off into the distance. As I’m writing, I stop. Then, realize I’m stopped. Go again.

Black Mountain is gone, disappeared in the fog, or the cloud surrounding us right now. Appropriate. What’s going on in my body right now is covered in the fog of unknowing. I’ll have to wait, as I will for Black Mountain, to see what can be seen.

Sighing. Distracted. This will pass, this feeling. Then reality will settle in, take another bit of time to figure out, to feel into this changed circumstance.

And, of course, the continuing weirdness of having a terminal condition (if left untreated) with no symptoms. I feel fine. Good. Healthy. Except…

Good thing Kate got good news from the scale this morning. 94! Some of it no doubt due to the prednisone burst she’s on right now, water retention, but not four pounds. She’s gaining weight, feeling more optimistic. Thank god. She said, “After your radiation or whatever treatment, we’re going to board the dogs and go on a cruise.” An excellent idea.

Cooking, Family, Health, Humanities, Myth and Story, Reimagine. Reconstruct. Reenchant., Shadow Mountain, The Move, Third Phase

No Cheffing Required

April 20, 2019 Charles Leave a comment

Spring Rushing Waters Moon

Kate and I discussed ways to relieve my stress. One source of stress for me was the evening meal. Part of me, a very strong part, wants to be a chef every night. Something new, something remarkable. Understand the ingredients, bring out their best, try new techniques. Problem. That requires a lot of forethought. Buy the right ingredients. Have them to hand. Try to replicate things I barely understand. And, it results in duds. Failures. Sometimes. Unnecessary stress.

Kate’s solution? She’ll make a menu plan for a week and I’ll cook it. Oh. I can do that. That relieves me of the need to create and in this instance I’m happy to let it go. Last night I followed her suggestion: spaghetti and sauce, spinach. Straightforward. Tasty. And, no cheffing required. Doesn’t seem like it would be much, but I felt so much better when I saw that menu plan.

No word yet on the Progoff workshop. When I registered, there were only 4 of us and they require 7. Hope it happens. I need the clarity about this time that these workshops always give me. The Colorado years have been wonderful, filled with family as we wanted, saturated with mountains and wild life and blue sky, anchored by new friends and community at CBE. The Colorado years have been awful. Cancer. Sjogren’s. Knee and shoulder replacements. (which have helped us both) Kate’s bleed and the sequelae. Interstitial lung disease. Trips to the E.R. Hospital stays. Vega’s death.

alvarez-adventure-caving-spelunking-1 So much here. The grit of my life over the past three and a half years. How has all this changed me? What direction does it suggest? How might I live into it with greater joy, greater passion, greater serenity? I also need a break from the every day. Not just because it’s been stressful as I said below, but because it’s been a long time between breaks. Tom and Mark’s visit was a nice respite, but too short.

The Progoff workshop is five days, morning and afternoon in a retreat center. I’ll be a commuter because of the dogs and Kate’s tpn, plus it’s cheaper. If it doesn’t happen, I’ll have to figure out some other way to get perspective and get a break.

Aging, Art and Culture, Health, Jefferson County, Mountains, Science, Third Phase

Cancer Returns

April 15, 2019 Charles Leave a comment

Spring Rushing Waters Moon

Had to go at this head on, today, while it’s fresh. When I got to my appointment with Anna Willis, Dr. Eigner’s P.A., the first person in the room was Eigner himself. Grayer and thinner, he smiled, shook my hand. When I said it was good to see him, he said, “It’s good to see you, too, but I’m not happy about the reason.” When I told him my anxiety made me move the decimal place on my PSA, his relief was obvious, “Thank god.” Anna came in about then.

They both remembered me. Anna remembered my glasses and our visits. Eigner remembered me partly because I’d sent him a couple of emails over the years thanking him, telling him about my life. It was one of the warmest visits I’ve had in a doctor’s office and that felt good.

Davinci_roboticArm_skyRidge_Low — Davinci robotic arm, Sky Ridge (where I had my surgery)

Turns out though. “When you’ve been perfect (a .1 psa which means essentially undetectable) and that changes, it’s scary.” He went on to say that it most likely does mean a recurrence, a relatively rare thing for those who choose prostatectomy, even rarer if the pathology report read, as mine did, clear margins. Clear margins means no cancer was found on the outside of the prostate. The best news.

Dr. Eigner took out a piece of paper and drew a sort of oblong on it. “This is the prostate. They can’t take sections from every part, so they take representative slices. If the cancer is between those slices, it won’t show up on the path report.” Oh, shit.

Since it is three and a half years since my surgery, and since the number for the uptick is relatively small, it means the recurrence is probably local, that is, in the area where the prostate used to be. That’s good news, much better than metastasis.

The plan is to redo my PSA in three months, doing the super sensitive one that can take the numbers 3 or 4 places rather than just two. If it’s still rising, I’ll get a referral right away to the oncologists to discuss radiation. “We’ll just go in there and kill it,” he said. “If you were older, I’d tell you not to do anything. This will take ten years to manifest anyhow, but at 72 you’ve still got a lot of life ahead of you.” That’s my opinion, too.

Radiation has some potential downsides, so I hope we don’t have to go that route. But, as I said to Kate, I’ve always chosen treatments that offer the best chance to remain active, and alive. I chose repair for my torn Achilles even though it means two months of no walking and crutches for a good while after. I chose knee replacement over other treatment options because I wanted to continue exercising. I chose a radical prostatectomy because that gave me the best shot at a cure. Likewise here, if radiation is the option that gives me the best chance to survive and thrive, I’ll choose it. No doubt.

All that’s the rational side, and that’s pretty damned important because these are high risk, high reward decisions. But they’re not all of it.

On the way back from Eigner’s I drove through Deer Creek Canyon. When my biopsy confirmed my prostate cancer in 2015, I drove Deer Creek Canyon, too. Going through there I felt the rock, rock so old that our human scale word ancient is quaint. This rock rose millions of years ago and it will slowly soften, the rough edges frozen and thawed, rained on, plant roots will crack them, and Deer Creek will carry the pebbles and sand to the Platte River on its way to the Gulf. Not only will I be dead long, long before then, it may be that the human race will have ended itself well before then, too. This comforts me.

Laramide Orogeny, 70 million years ago, begun. 35 million years ago, ended. Built the Rockies

William Cullen Bryant’s “Thanatopsis” came to mind. See the opening stanza below.* He goes on to make the point that the earth itself is a great tomb, holding all those who once lived. Again, this comforts me. Death has not chosen me for a special fate. No, death itself is a universal for all who live. It seems harsh and cruel, yet it is, rather, the opposite. Death ends suffering. Allows the world to carry many creatures, but not all at once.

Here there were Utes and Apaches, Comanches, too. And even they were not the first. Older humans preceded even them. And before all came the Rockies, then the trees, the lodgepole pines and the ponderosa and the bristle cone, the aspen. Mountain lions, deer, elk, rabbits, raccoons, pikas, prairie dogs, bison, moose, wolves, fox, martens, fishers, beaver. All here before humans, most will be here after we are gone. I can look at the lodgepoles in my front yard and know that their direct ancestors flourished here thousands of years ago and will do so after I’m dead.

All this brackets whatever troubles I may experience, even cancer. And cancer may be that friend that carries me off to the mighty sepulchre. Or, it might be something else. Whatever is my death-friend will not be an enemy, but the specific cause of my life ending. And that is, for all of us, in spite of our fears, a good thing.

Kindred Spirits by Asher Durand William Cullen Bryant and Thomas Cole

* “To him who in the love of Nature holds

Communion with her visible forms, she speaks

A various language; for his gayer hours

She has a voice of gladness, and a smile

And eloquence of beauty, and she glides

Into his darker musings, with a mild

And healing sympathy, that steals away

Their sharpness, ere he is aware. When thoughts

Of the last bitter hour come like a blight

Over thy spirit, and sad images

Of the stern agony, and shroud, and pall,

And breathless darkness, and the narrow house,

Make thee to shudder, and grow sick at heart;—

Go forth, under the open sky, and list

To Nature’s teachings, while from all around—

Earth and her waters, and the depths of air—

Comes a still voice—

Yet a few days, and thee

The all-beholding sun shall see no more

In all his course; nor yet in the cold ground,

Where thy pale form was laid, with many tears…

The oak

Shall send his roots abroad, and pierce thy mould…

Thou shalt lie down

With patriarchs of the infant world—with kings,

The powerful of the earth—the wise, the good,

Fair forms, and hoary seers of ages past,

All in one mighty sepulchre.”