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.
Saw Avengers: Endgame on Tuesday. This was to distract me from being pissed at Centura Health, United Health Care and whoever else dragged their feet, waiting until the day before and the day of to interfere with my planned axumin scan. It worked. I know who dies in endgame, but I won’t tell. It’s a long movie and I’m not a super fan, so I know I missed a lot of the inside jokes and things being tidied up from the multiple movies that preceded it. I did, however, come out calm. The universe had been returned to mostly normal, seder had been restored. The underlying reason we like superheroes, mysteries, thrillers.
Yesterday I focused on an organ, the eye. Played space invaders for the nice man, or, as they insist on calling it, a visual field test. My field of vision is holding steady, no glaucoma encroachment. Pressures are good, the hole in my cornea is, as my ophthalmologist says, is patent. That means it’s still draining the fluid for me. Part of me, an important part, is functional and remaining so. With help from latanoprost and good surveillance.
Simcha. I’m coming to believe that joy and gratitude may be sufficient to get us all the way through life. I don’t mean silly puffy gladness, or just saying thank you reflexively, but heart and mind illuminating joy and deeply felt gratitude.
No scan. AARP Secure Horizons denied payment. When I asked how much it would be as a self pay. Pet scan, $2,600, axium dose somewhere between $1,000 and $3,000. Nope. And, I made the decision for the same reason AARP probably did. The scan’s accuracy is around 60% and that goes down the lower the PSA. My PSA is well above the reemergence marker of .2 at 1.3, but it’s still pretty low for imaging studies.
On this side of the wall, where you and I are, is the money used to pay everybody in medicine. If you are a one percenter, there’s a special gate you can walk through anytime you need it. You can access all of the excellent care that is available. If you’re the rest of us, no money passes through the wall unless several corporate, bureaucratic entities and individual people within them, say yes. Those entities include private, for-profit health insurance companies, medicare, medicaid, non-profit health insurance, banks, credit card companies.
Such a shift would eliminate all of the corporate gate-keepers who have an interest in profit for their company. Perhaps they could all go work for the TSA and use their previous employment experience to annoy the hell out of travelers.
Here is a cautionary tale about health care. On April 24th or 25th I scheduled my axumin scan for today. That’s twenty days ago. It’s purpose is to tell where my cancer reemergence is located and to help stage it. This after the rise in PSA caused consternation for both me and my urologist, Dr. Eigner. I was glad we could get it on the calendar so quickly.
Should I go in today, sign the waiver, and keep my appointment with the radiation oncologist on Friday? When I told Eigner my PSA rise, he said, “Get another PSA done and get into see me ASAP.” A post-prostatectomy rise in the PSA to .2 is a biochemical recurrence. That’s the clinical definition. Mine was at 1.3. Everyone I spoke with had a sense of urgency about this. That made me have one, too.
Spent yesterday and Saturday reorganizing the loft, continuing work in the Intensive Journal. Oh, and made a meatloaf. Better than my mom’s. I printed a copy of Jennie’s Dead as it is so far, about 50,000 words, found my third draft of Superior Wolf, and pulled out the Phantom Queen which I haven’t seen in years. Today and tomorrow I’m going to file the remaining documents from CBE religious school, mussar, First Sundays. Then, I’m going to take each book that is piled up near my chairs, give the top ten priority for reading, and shelve the rest.
Tomorrow the whole rising PSA matter gets lit up and scanned by the hospital’s p.e.t. machinery. Takes about 30 minutes, slowly moving from pelvis to head. This moves me from an indicator based concern, PSA, to the reality of where the cancer is now, in my body. I’m hopeful there are no metastases, of course, that whatever has returned is confined to the prostate fossa. I’m not ready for my expiration date, but, then, I suppose nobody ever really is. The best result in this case is a localized reemergence treatable with the Cyberknife.
I come from a long line of mothers. So do you. This thought always strikes me as strange. Think of how many things had to go right for you to exist. Sure, there’s that whole randomness of the sperm that crosses the finish line, but think historically, think evolutionarily, think all the way back to that first organism that took the lightning bolt or the warmth of the undersea vent. Whenever and however life first appeared. Your existence, and mine, means we exist in an UNBROKEN chain of reproduction from that first wiggler, that first animate entity. One after another after another after another, for billions of years. Maybe 4.1 billion years according to 
Go now, the workshop has ended. Paraphrasing the end of the Catholic mass. Appropriate in this case having just come Mother Cabrini’s shrine. The experience of being at Mother Cabrini was familiar in its physical surroundings. In college I would always retreat to Catholic sanctuaries to be still, to reflect. I always found them/find them, soothing.
Here are two examples of next steps that have me excited. The first is to do a dialogue with reading. In the dialogue section of the journal, orange tabs, there is a method for developing one to one conversations with people important to you, living or dead, fictional or actual. That seems to makes sense. But the other four tabs in the orange section: Works, Events, Society, and the Body perhaps not so much. It works though. The journal method posits that a dialogue can be had with work you’re doing. I wrote a dialogue with Superior Wolf and in it realized I needed to pull the novel apart and focus one story only on Lycaon. In the Body section I’m in the midst of a dialogue with cancer.
It’s a bit strange to be at May 10 and have the temperature at 24, snow covering the driveway, the roofs, the walkways. In Minnesota the safe time for planting was typically May 15. Don’t think it would work here, at least not every year. We warm back up next week. For now, though. Winter wonderland. Like, I wonder why it’s still winter?
Read yesterday in the group. Iam asked me afterwards if I was a professional writer. Well, I write novels. But, I’ve not sold any so I don’t know if I’m a professional. Drina, who works for a website connected with the founders of 
We wrote spiritual steppingstones, what experiences in our life have led us to our current spirituality. Those of you who know me know that it’s been a long journey. An ongoing one, too. I would characterize my current spirituality as a tablespoon Taoist, two tablespoons existentialist, a teaspoon Christian, a teaspoon and a half Reconstructionist Jew, and a half cup of paganism (of the earth, the sun, the starting of the universe, aware of it and finding it enough). Mix together and bake until dead. Then, we’ll see.