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.
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.
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 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.
the Prostate Specific Antigen
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…
first ever picture of a black hole, taken by the Event Horizon telescope. 6.5 billion times larger than our sun. And, btw, this also a picture of the telescope’s namesake.
Abiogenesis: the original evolution of life or living organisms from inorganic or inanimate substances. Just learned this word today. It was in an article that debunked the likelihood of other intelligent, tool-using, space-faring intelligent beings. Unconvincing to me, but this word…
Think of it. It describes that moment (moments?) when the inanimate got a jump start. Began to move. Every living thing’s ancestor. (at least those of with this planetary home)
Maybe you knew it. New to me. Abiogenesis. Had to share.
Each night Cassiopeia, Ursa Major, and other stars of the northern sky orbit around Sirius, the pole star, doing their dance through and just above the lodgepole pines visible outside our bedroom window. Cassiopeia, like a shy maiden, appears right now behind a clump of lodgepoles early in the night, but slowly reveals herself, her trademark distorted W shape gradually appearing in full.
This morning the waning Recovery Moon and Jupiter sat next to each other, the moon with a pale wet halo, both over Black Mountain. This is wild country here. We saw a fox two mornings ago, a healthy red fox with a bushy tail held erect, running down Black Mountain Drive with either a critter or a kit in its mouth.
We’ll be in the 60’s this week, then more rain or snow over the weekend. When I picked up a prescription at King Sooper’s the other day, the pharmacy tech looked out the window and said, “Oh, god. It’s snowing, isn’t it?” It was. A bright blue sky and round shots of graupel struck the grocery store parking lot behind me. “I love snow, but I’m so tired of it.” “Oh, it’ll quit snowing eventually.” “Yeah,” she laughed, “in August.”
When sick, getting healthy is the most important thing on the docket. When well, all those pesky things you ignored take the top spot. Like that damned dead bolt. It sticks. And by stick I mean won’t move when we try to release it. This has taken a while to get bad. I could use a small pliers and a rubber piece (for traction) to open it for a while. Now that doesn’t work. Arthritic fingers and thumbs make these simple tasks go from difficult to impossible. Then, the toilet in the loft has developed an unpleasant habit of leaking from its seal to the floor or one of the bolts holding it down. Unusable in that state. Minor things, yes, but beyond the reach of an illness focused, snot for brains me. On them today.
Kate and Jackie
Don’t remember whether I said it here or not, but Kate’s up to 85 pounds! Wow. I made an arbitrary number, 90 pounds, as the signal that the mess from Kate’s bleed would be officially over. She’s getting there. Almost exactly six months later. What an ordeal for her.
Rigel has developed a habit that will force a change in my behavior. We’ve taken to leaving certain items on the counter like bread, chips, apples and to using a small wire container in the sink as an alternative to a wastebasket. We put a plastic grocery bag over it, throw trash in it, then tie it up and throw it in the trash compactor. SeoAh’s idea and a handy one. Except. Rigel. She smells stuff she wants and uses her size to reach up and get it. Result. Mess. In three rooms yesterday. Gotta get a bread box and clear out space for the other items in the cupboard above the counter. A rejiggering of storage is necessary. Dogs.
Kate and I missed our hair cuts last month due to pneumonia. We’re both a bit shaggy and look forward to seeing Jackie today.
Happy Pi day! I know it’s irrational, but pi’s got that kind of attitude. Will you be going to a recitation of pi? Some people will. Yes, that’s a thing. I like this day devoted to a mathematical phenom. I mean, who hasn’t heard of pi? And, it’s another holiday.
Our roof has curves. It looks like a sculpted chalet with deep sine waves marking the edges along the gutters and bulging hat shapes at the top. The road grader’s been by, guess the sagging power lines have returned to normal. This was a big one, stopping traffic in the mountains for a day.
Kate got her new delivery from Option Care yesterday rather than Wednesday. With the new pump we’ve got her on a 16 hours on, 8 hours off schedule now. Much better for living a life. She’ll be off pump from 10 am to 6 pm. She got some tasks done paid the bills, got started on the taxes. Her mood improved dramatically. As she gains weight and returns from malnourishment to normal, her energy level has increased and her spirits have improved. As she’s able to do more, she’ll feel even better.
Frustrating that we couldn’t see Gupta yesterday since the results of both the pulmonary function test and the CT scan have direct bearing on where we go next. Next week, I imagine.
Gertie, ready to leap in the snow
My cold continues. Sneezing, coughing, generally feeling crummy. Hard to take since I had just begun to feel normal when it arrived. Still, as Kate said, it won’t last forever. Glad.
The dogs have found the snow a joy and a burden. It comes up to their chests, even Rigel’s, and they walk through it deliberately. Kep loves the snow and stays out much longer than Rigel and Gertie. He wanders all over the yard, poking his nose here, then there. Gertie goes outside and immediately plunges her head into a snowbank. She comes inside snow sticking all over her face. Even so there were times yesterday when Rigel didn’t want to go outside. Too much work, I imagine. Gertie, too. Kep? Nope. He goes outside eagerly.
When spring comes close, that’s how we roll up here on Shadow Mountain.
The waning Valentine Moon hung over Black Mountain this morning, Jupiter dangling below like a pearl pendant. The beauty here, the distinct and unique sense of place, the simple knowledge of being in the Rockies makes this a special place, hard to leave. Conversations still underway, no decisions until we talk to the pulmonologist, Kelly Green. Even so, moving seems the most likely outcome.
Every day I’m getting a bit stronger, stamina improving. Probably back to a new workout in a few days. I’m feeling the need to get moving, but my trainer said to wait another week. As my buddy Mark Odegard pointed out a couple of years ago, our old bodies don’t snap back the way they used to. I went way down with this whole illness and my body will require time to climb back up again.
We saw Edwin Smith, the surgeon, yesterday. He’s methodical, taking care to make sure that this operation will actually benefit Kate and that she’ll come through it well. He talked about a feeding tube placed down her throat. Kate said no thanks. He wanted the tpn. It’s in and working. Now he wants Kate’s visit to a pulmonologist to happen before he’ll schedule surgery. Makes sense since she had the pneumothorax (collapsed lung) and some concerning findings on x-ray about her lungs.
The methodical approach has an element of foot dragging and ass-covering to it, I think, but I believe I overestimated that. I was in the middle of my no good, very bad horrible three weeks the last time we saw Smith and I formed an opinion colored by my own malaise. Now I believe he sees a tricky and mildly questionable (in his opinion) procedure he’s to perform on a 75 year old woman in fragile health. First, do no harm. Even though it drags the process out, I agree.
Due to Kate’s more intensive care needs at this point I’ve bowed out of all my CBE obligations. I’m not reliable since Kate’s situation seems to get more fluid over time. This is true now because of the build up to the feeding tube, then the feeding tube placement, and the aftercare.
So here’s my summary of the last 17 days. I got ill. My doc thought it was influenza A. That lasted 10 days, then I got really sick. The pneumonia is clearing. I have more energy each day, though I’m still weak. Eating and sleeping. Still the main activities.
All these mortality signals keep whizzing by. The third phase is an existentialist phase no matter your theological orientation. Somewhere in the no longer so distant future is a personal and permanent extinction event. Made me read the news of Opportunity with a pang I might not have otherwise felt.
The struggle we have over these deep questions in our own day to day has gotten interlaced with our creations. It seems like taffy or a Chinese finger puzzle. The more we try to answer them the tighter the puzzle grips our finger. And when a plucky, brave, dogged machine just keeps on ticking, year after year, moving and sensing and communicating, all on a planet not our own, we see its slow, but confident progress, its unwillingness to stop until the last trickle of current ran from its batteries, as life itself. Until we say it out loud. Do we put quotations marks around death? What do we do with the emotions we feel for something made of silicon and metal?
“Our beloved Opportunity remained silent,” Thomas Zurbuchen, associate administrator for NASA’s Science Mission Directorate, said Wednesday… Her power dropped to a trickle, and she was last heard from on June 10…Keri Bean was among those who helped send that last radio signal. Losing Opportunity, she says, is like a death in the family…But at least it was Mars that killed her — it wasn’t the rover failing or something else. It was Mars. And I feel like that’s really the only appropriate death for her at this point.” NPR
It’s possible that we’ve been making a category mistake all along about death. We assume that we are individuals, clothed in an impenetrable skin with a mind mysterious and often hidden even from its self. What if that is too narrow? Way too narrow. What if we are also those things in which we invest our life? That is, I am not only the meat sack that turned 72 yesterday, but I am also Kate, our house, the dogs, even our Rav4. I’m not making a weird boundary issues statement here. I’m trying to point to what Buber calls the I-thou*. Buber saw the I-thou as a relationship with another that is permeable. I love this idea, but want to say that we can extend it, in some instances, even into the realm of what Buber calls I-it relationships.
Andover
Those instances are not as few as we might think. Yes, family. Yes, friends. Yes, members of a community important to us. Yes. But also the dog who sleeps in your bed. The tree you care for each spring and fall. The flowers that you plant. And, yes, the machines that extend your self into the wider world. These machines, like Opportunity, do function independently from us, are definitely an it in the usual understanding of the term, but perhaps we misunderstand the distance, the separateness. “Our beloved Opportunity remained silent.” “Like a death in the family.”
Opportunity was not only the physical entity on Mars. It was also a literal physical extension of those who made it, those who guided it, interacted with it, and gathered its data. It was like a hand or an eye, an arm or a leg, not separate, though able to operate independently. As such Opportunity’s death was just that, a death, the loss of an I-thou relationship.
How do these relationships happen? I believe this quote says it very well:
“Real isn’t how you are made,” said the Skin Horse. “It’s a thing that happens to you. When a child loves you for a long, long time, not just to play with, but REALLY loves you, then you become Real.”
“Does it hurt?” asked the Rabbit.
“Sometimes,” said the Skin Horse, for he was always truthful. “When you are Real you don’t mind being hurt.”
“Does it happen all at once, like being wound up,” he asked, “or bit by bit?”
“It doesn’t happen all at once,” said the Skin Horse. “You become. It takes a long time. That’s why it doesn’t happen often to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don’t matter at all, because once you are Real you can’t be ugly, except to people who don’t understand.” chewy.com
*Buber’s main proposition is that we may address existence in two ways:
The attitude of the “I” towards an “It”, towards an object that is separate in itself, which we either use or experience.
The attitude of the “I” towards “Thou”, in a relationship in which the other is not separated by discrete bounds.
One of the major themes of the book is that human life finds its meaningfulness in relationships. In Buber’s view, all of our relationships bring us ultimately into relationship with God, who is the Eternal Thou. wiki
This morning the waning crescent moon had its horns turned up toward Venus and Jupiter, Saturn hovered beneath it. Antares and Scorpio glittered beside them. We have much less light pollution than the Denver metro.
My no good, very bad, terrible horrible day on Wednesday gave way to a morning spent in bed with a substantial fever, chills, generally icky feelings. I was sick on Wednesday. No wonder the end of the day felt like I was swimming through jello. Today, not so bad, but I’m going to rest today, too. Illness didn’t occur to me on Wednesday because it’s been such a long time since my last one, maybe a year and a half, maybe more. That streak’s over.
At this age I felt relieved when the sickness declared itself. There are other possibilities. Blocked arteries around the heart, in particular. One passing the threshold into active blockage could reduce blood flow to the heart, make me tired.
Instead, a virus. The zombies of the pathology world. Bits of DNA or RNA floating around as virions, ready to pierce host cells and use their internal machinery to create more virus. Wish they’d skipped evolving, been an evolutionary dead end. But, no. As a current host, I can say that these are not organisms you want to invite to the party. They’re gate crashers and they leave a mess behind.
What would have been an inconvenience in my 30’s or 40’s raises issues of mortality in my 70’s. What if I get pneumonia? What if I can’t shake it? Is it really an illness or are the symptoms coming from something more systemic? Am I gonna die? A good run while it lasted. Goodbye.
Or not. I feel better, though not well, this morning. I’m glad because the degree of fatigue I felt on Wednesday could have been the harbinger for a much more serious issue. When the fever came yesterday, I felt the relief I described above, but I also felt a mild level of fear. Will this escalate? I’m not frail, in fact I’m in excellent health for a man of my age; so, I should still be able to ride out even a moderate to serious illness, but I’d sure rather not.
What a pair, we said to each other more than once yesterday.
I suppose, by definition, Ultima Thule, the more than ancient rock of the Kuiper Belt, lost its right to its name the second its photograph got taken. Way out there, man. I mean way out. The Kuiper Belt. Next stop, the Oort Cloud.
Oh, where is our warp drive? Where is the wormhole navigation beacon that could steer New Horizons to places beyond our galactic borders? Where is my flying car?
Like the Mars lander and China’s moon lander New Horizons keeps humans in space exploration, but only by distant extensions of our machine building prowess. Homo sapiens, the tool maker. New Horizons is a tool, one sent far away to work beyond the direct reach of its makers. Beyond the direct reach of its makers solar system. Pretty damned cool.