Tag: cancer

No Autopilot When Spiraling In

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spiral

As we continue our corkscrew toward the ground, we took another turn today. My wife can no longer easily swallow, causing her to cough when taking medications. Because she is so short of breath, she cannot cough up that which she has aspirated and she begins wheezing which results in her vomiting. Because she is not eating, the only thing she vomits is green bile from her stomach. It is a vicious circle as we spiral in.

The kids are convinced now that something will happen the day I drive them back to college. Given how we have tightened the spiral, I’m not sure I disagree.

Looking outward from inside this corkscrew is disorienting. As soon as I am convinced that something has settled, the wings tilt inward still further and we spin that much faster toward the ground. But one can find focus in this spin. When I least expect it and am most ill prepared, the gravity and magnitude of the situation (essentially the finality of it all) clubs me with a mighty blow after which I find myself gasping for breath, crying and floating directionless in the air until the reality of current circumstances force me to see the spinning and rapidly approaching ground through the windscreen.

There is no peace when spiraling in. Life’s obligations and daily tasks still require our attention: the dog needs to be fed and given his meds, the laundry never stops, groceries still need to shopped for, bills still need to be paid, work still needs to be done. However, there is a certain feeling of mechanization about it all. We go through the motions of shopping, eating, dressing, sleeping, as we have all summer, but there is no soul in it. Put your seats in the upright and locked position, return your tray table to its stowed position, tighten your seatbelt tight and low around your waist. The captain has exited the aircraft and will not be returning. Cancer is now piloting the aircraft. Thank you for flying the terminally ill skies.

The insanity of the situation is that all but one of us will survive the inevitable crash. We will survive but in what condition? And as hard as this flight has been, I cannot imagine how we will carry on after we bore into the ground. And it is approaching ever faster and filling my field of view. Unfortunately (or fortunately), I cannot see it clearly, because of the blinding rage and constant tears.

A Vierordt Summer

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7617471_sIn 1868, German physician Karl von Vierordt published a book on his experiments into the psychology of time perception. In it included what became known as Vierordt’s Law “a robust phenomenon in time estimation research that has been observed with different time estimation methods.” Essentially, it states that “short” amounts of time tend to be overestimated and “long” amounts of time tend to be underestimated. This has been the basis of our summer. The clock has barely moved while the calendar has flown.

The kids are heading back to college in 20 days. These interminable hours belie the fact that they have been home since mid-May and have known the awful fact that Lisa will no longer be fighting this awful disease. They are terrified to leave her knowing it may be the last time they ever see her. I tell them they must go, they cannot forestall their own futures, they must continue on their own paths. It is the truth. I also know that the routine of school, with friends around them, and classes to occupy their time will distract them from the cruelty the universe is throwing at them 150 miles away.

Sitting here day after day at my desk watching my wife slowly wither away in bed; watching my son and daughter sit with their mother doing the same as me is heartbreaking. No amount of preparation can prepare you for the monotony and sheer terror of watching someone, anyone, much less someone you love, slowly suffocate to death. Cancer is a suicidal disease bent on killing its host at the cost of its own existence. Watching it happen with no more arrows in the quiver is akin to watching Captain Smith walk into the wheelhouse of the Titanic, lock the doors and wait for the ship to sink. With no more options, one seeks the course of action with the most dignity. Don’t get me started on whether there should be better options for better dignity.

Sleep used to be easy. I could roll over, shut off the world and be out in a minute, and wake up in the morning (if not refreshed) ready to go. Now sleep is like a cruel joke. I am exhausted from running all of the errands of the day, worrying about Lisa and the kids and watching a clock that does not move but terrified of a calendar that will not stop because I know that each day that passes brings me closer to a day I know is coming and one I dare not consider. Lisa does not sleep well now. She wakes me because she cannot breathe well. I give her meds and turn up the oxygen concentrator. I rub her back, hoping she will calm down, that her heart rate will return to “normal” and her body will be lulled into a false belief that it is generating enough oxygen to fuel the system. If I’m successful I’m awake. My mind goes to dark places so I read. It usually takes a good hour to flush the dark thoughts in order for me to attempt sleep again. Sometimes this happens two or three times a night. The clock stands still. The calendar whirls.

Vierordt had no idea how easy his experimentation could have been had he simply gone to any intensive care unit at any hospital and found the waiting room and talked to the family members and friends of the terminally I’ll patients. They would have told him how long minutes last and how quickly weeks fly.

Stupidity Fatigue

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Head in HandsThere is a saying in the lottery industry when the public will not purchase tickets for a seemingly high jackpot called “jackpot fatigue.” It is caused by the ever increasing and ever publicized jackpots always available to the public. The public has seen it all before and heard it all before and nothing new can be said about the jackpot total to get them to the convenience store to purchase a ticket. It’s all been done before.

I find myself suffering a similar kind of fate lately regarding the public at large. Events that used to anger me now no longer pique my interest or at least no longer send me to my computer and my Twitter feed where I would once fire off a pithy comment. Twitter especially has become the bastion of trolls ready to engage in bumper sticker based retorts and troglodyte tantrums rather than the necessary thought out debates. It is the AM radio of the internet.

I feel guilty for abandoning those things about which I am still passionately concerned: gun violence prevention, women’s rights, protecting my children from all manner of political stupidity, animal welfare, etc., etc, but I know that there are still those out there whom I trust to carry the ball downfield while I suffer this miasmatic ennui. I still read and I still write, just not at the same temperature as before.

Right now there are about 300 GOP candidates running for president, so there is still time for me to come out of this spin and focus the laser. Right now the moms and dads of Moms Demand Action for Gun Sense in America are meeting in Minneapolis to discuss next steps. In another universe, a universe where I wasn’t working with hospice to care for my dying wife, I would have joined them to learn what I could do to better fight gun violence in blood soaked America. But that is not the universe in which I currently reside. I do not make excuses, but only present facts. I am tired, physically and mentally.

I am tired of the stupidity of the southern white male with his pickup truck emblazoned with hunting decals and NRA stickers, tired of the stupidity of religious hypocrites festooned with Christian stickers on their cars and quick to criticize anyone not their mirror image. I am tired of the stupidity of the 300 GOP candidates running for president who are fighting for air time by reaching for the lowest common denominator in their demographic and ultimately the shallowest of the public gene pool. I am tired of cancer and the stupidity of its suicidal march toward the murder of its host. I am tired of the stupidity. I am suffering from stupidity fatigue.

The Rose

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DSC_0062_-_CopyOscar Wilde wrote, “A flower blossoms for its own joy,” and while he is one of my favorite authors, I disagree with this quote. Flowers can neither enjoy their own fragrance nor know their own beauty or the joy they bring to others.

As one last outing, Lisa wanted to go to the nursery to see the roses on Sunday. She had not been out of bed in almost two months, so the procedure we went through to get her there, with the wheelchair and oxygen tank stuffed into the car on a 90+ degree Texas summer day was daunting for me and the kids, it was punishing for Lisa. We had traveled no more than half a mile before she vomited all of the pain medication pills I had given her not ten minutes before. And yet she would not allow me to turn around. We were going to see the roses.

Of course, anyone who knows Lisa knows how much she loves her garden and her flowers, especially her roses. She researched and selected each one, labeled them with brass tags and spent countless hours pruning and tending to them. Like the rose in Antoine de Saint- Exupéry’s The Little Prince, she loved each of them because of their pure beauty and the work she had put in each of them.

As I pushed her wheelchair through the rough, rocky terrain (and pulled the oxygen tank behind me) she stopped me to read about the varieties of roses and admired their beauty (as if she was looking to fill a hole in the garden). It was then that it dawned on me that she is just like a rose. There is no better description or personification in nature than the rose. She is a rose.

She is brutally honest and unflaggingly faithful. She reminds me of the quote from Alphonse Karr, who wrote, “Some people grumble that roses have thorns; I am grateful that thorns have roses,” and the quote from Anne Brontë, who wrote, “He who dares not grasp the thorn should never crave the rose.” Having her in my life has brought me thorns and flowers, but I would never have traded the former for the latter because one without the other would destroy the rose that she is.

Even now, after being brutalized by cancer and chemo, she can be seen in the poem of Robert Frost

“The rain to the wind said,

‘You push and I’ll pelt.’

They so smote the garden bed.

That the flowers actually knelt,

And lay lodged — though not dead.

I know how the flowers felt.”

And yet, while the rose is fading, she does not know her own beauty or the joy she brings to others, she is loved. She is a rose. She is my rose.

Cancer, be not proud

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Cancer

I can neither understand, nor accept that it is divine will that a disease was designed to kill its host and itself in the process, other than to surmise that if it is God’s will, he/she/it is neither the omnipotent nor benevolent being we were taught to love/fear in organized religion. And, further, that the process under which the individual must ultimately perish (and their family/friends give comfort and assistance) is neither compassionate nor illuminating. However, if you believe in a paradisiacal hereafter, I offer this twist on John Donne’s Holy Sonnet 10 where I substitute “cancer” for “death” and piss on its grave.

Cancer, be not proud, though some have called you

Mighty and dreadful, for you are not so;

For those whom you think you can overthrow

Die not, poor Cancer, nor yet can you kill me, too.

I cannot understand your suicidal need,

To grow without boundaries and murder your host

When to do so causes your own harm the most

Like a terminal drought caused by a nefarious weed.

You are a slave to enzymes, proteins, and desperate DNA,

And must with poison, war, and evil dwell,

And a warm embrace or gentle music can make us sleep as well

And better than your sting; why do you brag then?

One short sleep past, we wake eternally,

And cancer shall be no more; Cancer, you shall die.

In short, Fuck You, Cancer.

I Hate Cancer

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inhofe snowI am so sick of cancer. I have seen it eat away, like rust or termites, healthy individual’s lives, and the lives and futures of their families and friends. Whether it happens slowly over a long period of years or quickly over a few months; whether it is painful or pain-free, the wasting, the consumption, the evaporation of dreams and promises to one another, the snatching away of future weddings, graduations, births, celebrations of all kinds, extinguished like so many candles, this insidious disease remains unchecked despite science’s best efforts.

At a time when politicians throw snowballs on the floor of the United States Senate to convince us that global warming is a hoax (while prohibiting experts from testifying!), when those who deny evolution control the purse strings of the country’s science foundations, millions of people continue to suffer because we continue to lump 300 unique diseases into a single category and call them all “cancer.”

There will always be competing interests, but perhaps it would be best for our infrastructure priorities to be funded based on input from the nation’s most respected civil engineers and our most pressing medical priorities to be funded by input from our nation’s most respected physicians. Senator Inhofe holding a snowball in February proves nothing more than it is February, and in February one is likely to find snow in D.C.. Who would he have on the Appropriations Committee on cancer funding, Dr. Seuss?

Inhuman

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PainPublilius Syrus in the first century B.C. wrote “when Fortune flatters, she does it to betray.” Plutarch reinterpreted this as “I see the cure is not worth the pain.” Somewhere over the past two thousand plus years we have lost the connection between humanity and the humane.

Setting religion aside and ignoring the politics and ethics of Dr. Kevorkian, it is, none the less, barbaric how we treat our loved ones at the end of their lives.

We have somehow bridged the moral abyss with compassion for our beloved pets by “humanely” putting our beloved pets out of their senseless misery, ending their meaningless pain, answering their pleading eyes with the selfless, heartrending compassion of euthanasia.

We have somehow sanitized capital punishment of the worst criminals from fatal and barbaric corporal punishment to a “humane” (although still debatably barbaric) dream-like sleep out of existence.

And yet, we allow our loved ones to face “natural” death filled with a fear, pain and confusion making anything that happened at Abu Ghraib look like Walt Disney World.

This suffering is multifaceted. Of course, there is the physical pain, which is no better controlled today than it was 50 years ago. The opioids still rule as the best we have to offer. The problem is that they are systemic, meaning that they travel throughout the entire body. If the pain is in the hip, the hip gets the morphine, but so, too, do the little finger, the ear lobe and the brain. The result is that the little finger and ear lobe are no better or worse, the hip suffers an incomplete relief of pain and the brain suffers the confusion, paranoia, nausea and narcolepsy unnecessary to treatment. This is the best medicine has to offer in 2014? The other suffering it brings is to the family members who must endure watching the physical suffering of those they love hampered by the incomplete relief of pain. Meaningless suffering is the worst kind. Love of another means the willingness to shoulder their burden. The helplessness felt by the family member watching their loved one jerk in pain or crying out as they try to move them or comfort them is an indelible stain on their soul.

The suicidal mission of cancer adds to the frustration. Bent on destroying its host, even at its own annihilation, cancer never rests. To paraphrase Siddhartha Mukherjee from his book The Emperor of All Maladies, cancer cuts the brake lines of some cells and jams the gas pedals of others, stopping the natural cell regulation process and sending the cancer cells into a proliferating frenzy steamrolling every other cell in its path. In his or her clearer moments, so too, the cancer patient undergoes a civil war; one side, engrained in all of us, pulls us to live, to continue fighting, while another force, armed with logic, understanding and ultimately love, forces the patient to begin facing the inevitable truth with no regrets and peace.

In his book Man’s Search for Meaning, concentration camp survivor and psychologist Victor Frankl describes inmates of the camps as surviving long stretches if they could find meaning in their suffering.  Some held on to the hope of outlasting the Nazis and returning to their loved ones (should any of them have survived), others found peace looking up at the sky and imagining conversations with their loved ones wherever they might then have been. Life was worth living if they held a kernel of meaning in their suffering.

I have searched and considered and yet find no meaning in the suffering loved ones endure at the end of their lives given the current state of medicine. Pain is pain and on a scale of 1 to 10, anything above a 1 means the medical field has failed. The root word of both humane and humanity is human, from the Latin humanus. However, we reserve those words for our treatment of pets and prisoners, not our loved ones. For them, and for ourselves, it is inhuman what we put them through, for them and for us it is nothing short of torture.

Give The People What They Want

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Give The People What They Want

I am many things.

Male

White

Short

Overweight

Middle aged

Married

College educated

New England raised

Living in Texas

A son

A husband

A father

An uncle

A nephew

A friend

An enemy

Blue-eyed

Left handed

Employed full-time

Middle class

Homeowner

Car owner

Non-smoker

Independent

I am all of these things and these are measurable demographics used by all manner of people and organizations in order to sell me things and, in politics, theoretically, represent me.

Having been raised in Rhode Island, I grew up thinking the majority of the country was just like me, white, Catholic, middle class. There were blacks and Jews in school with me, and while they were the minority, I did not treat them any differently, nor did they see me (I hope) as an oppressor. They were my friends and part of my world.

As I grew, I began to see the political landscape of Rhode Island as the basis for the fabric of America. At the same time, I joined the workforce and began to understand Churchill’s remark:

“Show me a young Conservative and I’ll show you someone with no heart. Show me an old Liberal and I’ll show you someone with no brains.”

Rhode Island politics is dominated by trade unions. Democrats control the legislature and the state constitution essentially renders the Governor moot. As I began to bring home part-time, high school student paychecks with deductions to anagrams I did not understand, I began to think like a conservative (Republican). I worked for this money; don’t give it to somebody else. Business drives the economy. Without jobs there are no unions. Ayn Rand would have been very proud. But in retrospect, I think this reaction was more a rebellion against the Rhode Island Democrat mindset and less a political ethos. Taxes were too high, handouts too easy and I did not feel my hard work was being protected in the state house. I was a Conservative with no heart.

As with everybody, as we get older, the world gets smaller. College, just next door in neighboring Connecticut, opened my eyes to other religions. No longer was Catholicism the dominant religion. No longer did liberal tendencies dictate legislation. So, too, were these the days of Ronald Reagan’s trickle-down economy. As a burgeoning economics major, this philosophy made sense and met with my understanding and expectation of things. However, as a college student trying to get loans and seeing my parents struggle to shoulder the weightiest financial burden for two college aged children with a third coming up through the ranks, coupled with the seemingly never ending string of corruption issues emanating from the Reagan administration, my conservative leanings were shaken. Was this a reaction to the financial situation I found myself in? Was it a reaction to the broadening of my understanding of the country and the world? Or was it simply another shift against the grain?

Careers, a marriage and parenthood quickly followed. Once again, I found myself trying to provide for my family and build a career in an economy growing under Clinton’s watch through economic structures established by his Republican predecessors. And once again, living in the Rhode Island Union, I saw the expansion of social programs as a long term detriment to the local economy, but those were heady times and we were all (relatively) happy living on the dotcom bubble. When that burst, and September 11, 2001 hit, Rhode Island was slow to respond to the economic crisis that ensued. Like the rest of the country, I was angry and wanted to strike back at somebody for the evil perpetrated on my neighbors (Boston, from where the flights originated and New York). Following the morally damaged presidency of Clinton, I fell into the political pit warned about by Bertrand Russell when I voted for W:

“Our great democracies still tend to think that a stupid man is more likely to be honest than a clever man.”

I had ascribed FDR’s tenet, “I’m not the smartest fellow in the world, but I can sure pick smart colleagues” to W and assumed he would do the same. Unfortunately, I think Kurt Vonnegut put it best when he said:

“The last thing I ever wanted was to be alive when the three most powerful people on the whole planet would be named Bush, Dick and Colon.”

My wife’s diagnosis with an aggressive breast cancer in 2008 forced us to reevaluate our lives. Because family and her survival weighed so much more over career and home, we picked up stakes and moved to Texas to seek treatment at the University of Texas M.D. Anderson Cancer Center in Houston.

At first, this change of environment seemed to meet my expectations and stereotypes. Southerners were friendly and slower. Northerners were rude and always in a hurry. I ignored the conservative predispositions of Texas even though Texas-bred W took us to war in Iraq over bogus intelligence and OBL and the Taliban hid in the lawless Hindu Kush on the Afghanistan/Pakistan border. And even though Rick Perry, W’s intellectual equal, continued to gut the education system and pilfer jobs from other states, it didn’t matter to me as long as my wife was receiving the best medical treatment. My once expanded understanding of the world didn’t matter to me when my family was suffering.

Then, on December 14th of 2012, while working on my laptop at the hospital while my wife was undergoing restaging tests, news broke of a shooting at an elementary school in Connecticut. I read with horror as first the casualty total rose and then it was reported that children were among the victims. That day, coupled with the local reaction in the following weeks caused a seismic shift in my perception and attitude. No longer was Texas the friendly, slow state with questionable education standards and a job-pilfering, slow-witted governor, now it showed itself to be a gun loving, religious zealot, paranoid, racist, American anachronism. Unfortunately, as time elapsed, I came to understand that this political/religious background was neither limited to Texas, nor the south. “Red” states throughout the country began to show their prejudices, paranoia, fear and hatred. The “Gun Control” debate had ripped the genteel mask of civility off of otherwise, (seemingly) generous people. I saw the people who attended the NRA’s Annual Paranoia Jamboree here in Houston. I argued with them. I argued with the dimwitted grandfather who brought his grandson to a gun control rally in Austin to argue for more gun rights. I was scheduled to debate a state senator, who had introduced a firearm protection act, on television, until he chickened out. I had become a liberal without a brain.

And then it hit me. The Kinks were right!

Why, I asked myself, was I always going against the grain? Why were my political positions always running counter to the culture in which I lived? How could I be represented by people so contrary to my positions? Lightbulb! Ted Cruz was elected by people who were pleased by what he claimed to represent. Louie Gohmert was elected by people who believe what he believes. Steve Stockman was elected by people as deranged as him. And so it is. Give the people what they want.

And so, the reason congress is in a perpetual state of paralysis is because America is in a perpetual state of paralysis. We seek to impose our ideal democratic notion on the rest of the world while ignoring fractures at home. Russian president Vladimir Putin wrote, warning America not to consider ourselves exceptional. George Bernard Shaw wrote,

“Patriotism is, fundamentally, a conviction that a particular country is the best in the world because you were born in it….”

The fact I find most interesting is that Congress has a 19% approval rating, according to Gallup. If we elect representatives who represent our interests and convictions, why is our approval of the job they do so low? At heart, are we not happy with our own convictions? The devil is in the details and it is this process that divorces concept (patriotism and democracy) from reality (legislation and personal responsibility). We cannot give the people what they want because they are not prepared to work for that which they think they deserve.

Observations from a Recent Holiday

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Orwell 1984

War is Peace

Freedom is Slavery

Ignorance is Strength

George Orwell, Nineteen Eighty-Four

A change in my wife’s chemotherapy regimen recently opened up the opportunity for us to visit Paris and London. It was originally supposed to be an early 25th anniversary gift to my wife last September (our 23rd anniversary), but a sudden, nasty infection forced us to cancel the trip hours before we were to leave for the airport. Crestfallen doesn’t begin to cover our disappointment. When presented with this window of time (before she began a new phase II clinical trial), we decided to schedule a last minute trip and take our twins with us who were home from their freshman year at college.

Armed with my own agenda of sights and attractions I wished to see, I found that instead, I saw the trip through the eyes of my family. My daughter, studying fine art and enamored with art history, provided me with a different appreciation of the architecture, style, culture and art of these cities that I would otherwise have missed. My son, the philosopher, showed me the political and societal differences beyond language that I would otherwise have missed. My wife, showed me that while the Champs Elysses essentially looked like Fifth Avenue or Oxford Street or any chain-choked mall in suburban America, it was the small side streets two blocks removed from the tourist centers that offered the best food, flowers and shopping. And together, they all agreed that while it was important to tick-off as many items from our “bucket list” as possible, we all enjoyed and appreciated sitting at a sidewalk café eating tomato, basil and mozzarella sandwiches on the most amazing bread while watching the world go by the most. To a person, we all agreed that we wished it was our second trip to these wonderful cities so that we could immerse ourselves in the local culture and pace without the pressure of “seeing” everything. I was forcing us to run everywhere, to the detriment of my wife and the chagrin of my children.

Having never traveled outside the country before, it was also interesting to see both how other countries existed, but also how they perceived Americans.

My son noticed (and was not a little bothered by) the soldiers patrolling the Eiffel Tower armed with very large weapons. So too did he notice the constant government monitoring in London via video cameras. These were visible on motorway markers and Tube stations, as well as mentioned repeatedly on notices throughout the city. Ironic, that London (Airstrip 1), would spark this observation in my son. Although to be fair, the only mustachioed poster we saw was not of Big Brother but of Brad Pitt on a poster for World War Z. We neither saw Winston Smith, nor any IngSoc signs.

Rather, I had an interesting conversation (or perhaps only a glimpse of a conversation) with the taxi driver (who was an (East) German expat). Sitting in the passenger seat of the small minivan on the way to the apartment we were renting, he asked me where we were from.

Instinctively, I replied, over the whine of the small engine, “The States.”

“Not Canada?” he asked, shooting me a quick, knowing look.

I admit that it took me a few seconds to digest the meaning of his question. Full of ourselves for being the “world’s police,” United States citizens somehow have managed to believe that we can belittle the rest of the world’s population while assuming  we are both more civilized and, therefore, more entitled and have convinced ourselves that the rest of the world is somehow beholden to us. Apparently, more cautious travelers hide their US heritage beneath a more innocuous Canadian visage.  Surely an interesting question from an ex-East German citizen obviously more sensitive to European viewpoints of Americans than me!

Other, more obvious, observations include the size of the cars driven. Nowhere did we see the parade of Tahoe’s, Suburban’s or tricked-out F-150’s that I see on my way to work here in Houston on a daily basis. Rather, the number of Vespa’s, motorcycles and bicycles moving like fruit flies in and out of traffic in Paris showed that the sudden appearance of a Suburban near the Arc du Triomph would generate both a traffic jam and trigger an enormous number of iPhone photos. All of the cars were very small, and yet, we saw no horrific accidents (or even a fender bender). And while they drive aggressively, there is no animosity in their intentions. It is simply a matter of getting from point A to point B. Perhaps “Road Rage” is an American phenomenon (which, coupled with the number of guns in our population can only lead to more problems). Something else we noticed was the absence of bumper stickers on the cars. There were no French flags or Union Jacks on the rear windows, no stick figures of every family member, no honor roll declarations, no personalized high school football/basketball/baseball/swimming/band/dance stickers, no NRA stickers, no Molon Labe stickers, no Come and Take It stickers, no NASCAR stickers, not even stickers of universities or professional sports teams. Apparently, rear view windows are there to provide visual clearance and bumpers are there to absorb collisions rather than replace our Facebook pages.

Another observation was the amount of complaining we heard. Parisians are very animated in their discussions with those with whom they are dining. And yet, there was, again, no animosity in their demeanor. While I couldn’t possibly understand what they were discussing, the physical cues they exhibited showed them to be in stark difference on whatever subject they were discussing. And while voices were occasionally raised, never once (and this goes for London’s pubs as well) did I feel that a disagreement was about to escalate into a brawl. That cannot be said for most places I’ve been in America. Testosterone and bravado seem to flood the American male much quicker than their European counterparts. In fact, the only complaining we heard in all of the lines we stood in was from Americans.

The gardens at Versailles are enormous, dwarfing the colossal chateau itself. As my wife is saddled with the side effects of chemotherapy (and despite her Herculean spirit), we thought it was a wonderful idea to rent a golf cart to tour the gardens, rather than expend her energy walking the estate. The firm contracted to provide the carts could expand their supply a hundredfold to meet the demand, therefore, the line was long and did not move quickly. As we (finally) reached the front of the line, the young man working there, who spoke English and was of Indian decent) took me aside and said that his family was visiting him in France and he was going to give them the next cart. My first thought was, hey, those are the perks of working here! Good for you! However, the woman from Kansas two couples behind us was not so understanding and went on and on about how she would have done this and that to the kid, blah, blah, blah. Truly, the only complaining we heard was from Americans.

I am not naïve enough to think that everything we saw was perfect, nor that what we did see constituted the “average” life of a citizen of these cities. However, there were stark differences and while I continue to struggle with paralysis in Washington, the torpid national response to everyday gun violence in America, the wholesale abdication of personal responsibility, the vitriol of the Tea Party, the ongoing religious hypocrisy of the right wing, the adoration of celebrity, the acceptance of lower educational performance, the increasing fracturing of societal ethos, epistemic closure as an unintended consequence of the internet and the vapid, ossified acid spewed on AM radio, I am reminded that is up to us to make tomorrow better than today. Our children are watching, and so is the rest of the world, and like our children, they will not wait.

Shadows

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I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.      – Abraham Maslow, The Psychology of Science: A Reconnaissance (1966)

A hungry stomach cannot hear.    – Jean de La Fontaine, Fables, IX, The Kite and the Nightingale (1678-1679)

The hungry are forgiven for thinking of nothing but food. Consider the cartoons of your childhood where the starving predator sees something (prey or any inanimate object) and it transforms, in his mind, into a sizzling pork chop or a talking fried chicken leg. So, too, the cancer patient can think of nothing but disease. Every cough, every twinge, every sniffle conjures up images of metastasizing evil reaching its suicidal fingers into new corners of their betraying body. However, unlike hunger, cancer has the ability to cloud the perception of those who love and care for the cancer patient.

Such was the case of our beloved dog Delbow. Stung by the appearance of a cancerous tumor in the muscle on the right side of his neck last year, an incomplete resection of the area was followed by cautious but deliberate irradiation of the area in 21 sessions over three weeks, concluding last spring. As with my wife, whose ongoing war with breast cancer leaves her with scars and nightmares, our dog, blissfully oblivious to the prognosis and baffled by the ongoing medical attention carries the painful reminders of his ordeal.  Suffering from increasing head tremors and restricted head mobility, coupled with teeth gnashing (a new manifestation), we sought answers from his veterinary oncologist.  Examinations were made and tests were run, all in our endless quest for information. Nothing was found to account for the changes.

We were referred to the neurologist, who suggested a myriad of horrible conditions which “may” be responsible for his symptoms. Again, tests were run, information was gathered but conclusions eluded us. Finally, the prospect of a temporomandibular joint condition was proposed and we were referred to the veterinary dentist. As my son and I waited (as my wife was too ill following another round of systemic poison being administered to her), the dentist informed us that it appeared the cancer had returned. In concert with the oncologist (with whom the dentist and neurologist are colleagues in a multi-specialty veterinary clinic), it was revealed that there were at least two, one half centimeter tumors on the back side of his neck. In addition, there was an inflammation in the area of his optic nerve within the orbit of his left eye and a huge mass pushing the lens out of position. The tumors on his neck were excised and sent for a biopsy and we returned home with a beloved family member lethargic from sedation and partially shaved with a four-inch, sutured incision on his neck.

The next few days saw his demeanor change, his energy decrease, confusion increase and us wondering if the end was nigh.  Cancer had again forced every other consideration of our lives to the very distant background. Sadness fought with anger for position as the overwhelming emotion we faced. Like walking out into an August day in Houston from the conditioned atmosphere of our home, the concept of life without Delbow hit us in the face within moments of awakening every morning. Sicknesses, such as cancer, have a way of forcing us to prioritize our lives, jettisoning the trivial matters eating up precious brain activity in favor of the immediate and irreversible concepts surrounding mortality. However, while this is true in the long-term (or even the mid-term) it is not true in the immediate aftermath of learning such news. Rather than prioritize the various weighted obligations we face, all other considerations (all other thought) drown in the dissonant din of this cancer-caused, immediate threat.

Weary from these considerations and exhausted from a lack of sleep caused by us each holding Delbow in shifts throughout the night because of his almost constant, semi-conscious leaps of pain (followed by a desire to stand alone in a corner with ears down, tail down and a sad, empty stare), our arms held him tight against us like living seatbelts, our voices soothing as we spoke tender deceits of everything being “ok.”  A week passed like this and we were finally scheduled to return to the oncologist to review the findings of the biopsy. Unable to convince Lisa to stay home, the four of us and our little, fluffy, white ball of radiating love made the trip together.

The first indication that this would not be just another doctor’s visit came to us upon entering the examination room. Rather than the exam table locked into place like a deployed, closet ironing board center, complete with rubber-backed bath mat for the patient’s comfort, there were simply five chairs in the room. It seemed that any pretense of medical art had been dispensed with and a consultative, group therapy session was about to ensue. What followed was unexpected, bordering on unfathomable.

The biopsy of the tumors from his neck came back as benign, dermatopath lesions, non-cancerous. However, the inability to conduct a biopsy of the optic nerve enlargement left the physicians dubious of its construction or intent. That, coupled with what was originally thought to be a massive, mature cataract on the CT scan was now believed to be a suspected soft tissue ciliary body tumor. One step forward, two steps back. Because of Delbow’s extensive medical history (exclusive of his cancer and treatment), including two TPLO surgeries, one on each back leg, and an emergency retinal reattachment surgery four years ago, it was thought that his ophthalmologist might be able to provide some (if you’ll forgive me the word) “insight” into Delbow’s visual condition. This was at 11:30AM. A quick, frantic call to his ophthalmologist, where I simply needed to drop Delbow’s name (as everyone who knows him finds him beautiful, adorable and memorable), and we were scheduled to meet with the ophthalmologist at 1:00, thanks to a double booking trick of the office staff.

The benefit of having a background in the health insurance field is that no generational or geographical biases prevent us from seeking out the best practitioners (we moved from Rhode Island to Texas to obtain treatment at M.D. Anderson and took Delbow to Chicago to have eye surgery). The “benefit” of having a two inch thick file on Delbow at the ophthalmologists (I put benefit in quotes because to amass such a file necessitates ongoing physical conditions requiring medical treatment) is that this history provides benchmarks against which current issues can be gauged.

It turns out that the enlarged shadow the oncologist saw on the CT scan near Delbow’s optic nerve has always been there (or in the words of the ophthalmologist, “he most likely came that way from the factory”). As for the huge, globular mass distorting the normal position of his lens, it is simply the silicone oil injected into his eye four years ago as part of the retinal reattachment surgery he had in Chicago. It appears as a mass because the silicone oil is now sharing the area inside the eyeball with accumulated tears, and, as we know, oil and water don’t mix.

So, it turns out that sometimes a shadow on a CT scan is just a shadow and not an exposed, nefarious shade. A good lesson and a difficult one to learn outside the painful necessity of experiencing it, the thumping warning signals, the paranoid expectations of the other shoe dropping are not fleeting.  No, but while we’re not out of the woods yet (we still don’t have any plausible explanation for his ongoing pain and behavior changes) we no longer see the forest before us as raw lumber in search of a nail in search of a hammer.