A note from my brother who has cancer.
18 August 2022
The reality of my mortality first became apparent in 2005, was reintroduced at the time of Bowie’s birth (the day of which I had my first Oncology appointment for evidence of recurrence), and again when there was evidence of metastasis to the lung and mediastinum.
The internet gave harsh statistics, mean survival after lung metastasis is 15 months; but like so many others, wanted to cling to the hope that this didn’t apply to me, so off to Cleveland Clinic. Androgen deprivation therapy with new drugs which had become available, length of disease free interval was uncertain but later turns out to be about 3 years (2 ½ years for me) with evidence of recurrence in July of 2021. The Cleveland Clinic seemed to be uninterested in searching for a source or additional therapy so when the the bone lesions began, first diagnosed in January…I transferred to UPMC. Much more concern and caring, additional imaging but a subsequent long delay to radiation therapy which may or may not have done much except slow their growth and cause temporary radiculopathy. Now rapidly rising PSA, multiple bone lesions. Next step is Taxel-based chemotherapy, every 3 weeks for 10 doses assuming that it works and no significant side effects with the next option being PMSA-LU 177. Less side effects, possibly more effective, but have to have failed Taxel-based chemo to be eligible and it is in short supply and is expensive.
I swore I would never undergo chemo, but here I am. First dose on August 16th. No significant side-effects as yet (mowed the lawn last evening), bone marrow suppression will occur during the 2nd week if it is to occur manifested by low WBC’s, fever, infections, need for IV antibiotics, possible hospitalization. Will probably go to the trail today.
My reading of Stoic philosophy suggests that I am clinging desperately for more time because I failed to live my life in the past. I sincerely believe that I do not fit into this category as evidenced by my prior writing on living in “stoppage time” or as described in another recent novel as “bonus time”. Every baby that was conceived as a result of Fran and my assistance and delivered by me felt like a gift that I had been given to share. My only regret was that I did not cut back on my schedule earlier so that I could have spent time with mom when her faculties were still intact, but did make the attempt to be there more frequently during her last 2 years. Cutting back allowed me to be there for the granddaughters and providing care while Sommer was in Grad school, flying to Spokane to drive Skip and Karen to Missoula, visiting the Buffalo Preserve, trips back to Minnesota in the spring. The Pandemic altered any plans for extensive travel back to Europe, extensive road trips in the US, concerts, athletic events. Stepping away from medicine was made easy by the corporate financial emphasis of administrators, never-ending rules and regulations, electronic medical records where repeated documentation of items were made mandatory for billing purposes rather than truly improving quality of care, entitlement of medical students, residents, new faculty and patients themselves that placed one at constant risk for censureship for “speaking truth to stupid”, constructive criticism, or pointing out that patients obesity or medical conditions would make pregnancy difficult, risky, and potentially lethal.
The Pandemic continued to make caring for the girls a non-option. In October of 2021, The West Run Woods bike trails suddenly appeared as an alternative way to make use of my “bonus time” to help create something of lasting value. The presence of bone lesions in January fueled my desire to see the initial trail completed and clear passageways for subsequent trails and obtain bids for bridges spanning West Run that would connect West Run Woods with the Baker’s Ridge trails (even though I would be unlikely to see their initiation or completion). The Delay in chemotherapy for 4 days allowed me to assist with partial completion of the smaller bridge that spanned a ravine behind Mon General and allowed an uninterrupted passage of the initial trail complex.
Stoic philosophy tells me that I have no control over my body and what will happen to it, that we are all a part of nature and destined to die, the time unknown. Our goal in life should be to live it, to find our purpose and live it to the best of our abilities to make the effort to be the best person that we can be and not to force ourselves or others to extend it beyond its expectancy. While alive, we will all be exposed to daily events, temptations, “impressions” that we should be able to reason with in order to make the correct decisions and at the start of each day acknowledge this and prepare for them. At the end of each day we should review our day, our failings, and make the attempt not to repeat them the next day. Nadia Bolz-Weber’s talk on Forgiveness at the Nantucket Project is a recurrent listen for me in order to try to help me forgive myself for past failings and as her 12 step partner said, “that shit is in the past, let it go. Luther’s concept of Confession, Forgiveness, Grace. Her description of dealing with “assholes” in our lives is difficult for me to follow, so at this am more inclined to follow the Stoic Philosophers belief that other people do not mean or do not recognize that they are being evil or inconsiderate but have simply not have learned the use of reason to control their impressions, and I should make use of their actions or life’s inconveniences (delayed flights) to practice our recognition that we can only control us and our response to these things. These behaviors of other people, life’s inconveniences, illness and mortality are things over which we have no control. We only can control our response to them. My only control is how I make use of my remaining “bonus time” which will be much curtailed by the chemo schedule. My only control is how I behave around friends and family, and my health-care providers, to not exhibit asshole behaviors that they will have to use Stoic philosophical principles to counteract.
Stoic Philosophy rejects the concept of an afterlife, but that we return to the state of existence or non-existence prior to birth/conception and that the matter that makes up “us” is recycled. Many of them reject the idea of a disembodied soul that is separate from our body. This is difficult to reconcile with the Christian tradition that I have grown up with and becoming much easier to reject given the state of the right-wing radical “white Christian nationalist” movement that is taking over the Republican Party. The thought of spending eternity with these individuals would be another level of hell. Despite my questioning of the disembodied soul, I have found myself to be more in contact with my parents. Perhaps it is nothing more than the line from West World”
We are not really dead until the last person who remembers us is gone
I have enjoyed working along on the trail because I feel like my dad has been with me, enjoying the woods, the rocks, creating order out of disorder, providing memories of working with him, hunting and fishing with him. He primarily comes to me when I am alone. Mom, on the other hand comes at most unexpected times. We share the middle of the night wakening, knowing that sleep is not going to come so begin reading. Anyone who spent any time with her will remember that she would suddenly begin quoting poetry that fit the moment. I have found myself quoting obscure song lyrics while working on the trail when working with the younger people who look at me probably like I looked at my mom having no clue about what I am talking about. I found that, in general, song lyrics were my version of poetry but am now finding myself suddenly quoting poems that my mom would say to me. Is it her spirit talking to me or suppressed memories? I was leaving the house the other day and suddenly out of the blue said to Connie, I “shan’t be gone long”, something my mom would say to me when we needed to do something in the pasture or barn and she would complete it by saying “why don’t you come too”. Her shortened version of Robert Frost’s The Pasture often completed by her reciting the poem:
I'm going out to clean the pasture spring;
I'll only stop to rake the leaves away
(And wait to watch the water clear, I may):
I sha'n't be gone long.—You come too.
I'm going out to fetch the little calf
That's standing by the mother. It's so young,
It totters when she licks it with her tongue.
I sha'n't be gone long.—You come too.
And this morning as the sun was rising and I looked out of the bathroom window and looked at the fog settling over the neighborhood, I heard her quoting Carl Sandburg:
The fog comes
on little cat feet.
It sits looking
over harbor and city
on silent haunches
and then moves on
Suppressed memories, messages from the beyond? I only know I am glad that they pop into my head with all the emotions that they engender.
The reality of my mortality first became apparent in 2005, was reintroduced at the time of Bowie’s birth (the day of which I had my first Oncology appointment for evidence of recurrence), and again when there was evidence of metastasis to the lung and mediastinum.
The internet gave harsh statistics, mean survival after lung metastasis is 15 months; but like so many others, wanted to cling to the hope that this didn’t apply to me, so off to Cleveland Clinic. Androgen deprivation therapy with new drugs which had become available, length of disease free interval was uncertain but later turns out to be about 3 years (2 ½ years for me) with evidence of recurrence in July of 2021. The Cleveland Clinic seemed to be uninterested in searching for a source or additional therapy so when the the bone lesions began, first diagnosed in January…I transferred to UPMC. Much more concern and caring, additional imaging but a subsequent long delay to radiation therapy which may or may not have done much except slow their growth and cause temporary radiculopathy. Now rapidly rising PSA, multiple bone lesions. Next step is Taxel-based chemotherapy, every 3 weeks for 10 doses assuming that it works and no significant side effects with the next option being PMSA-LU 177. Less side effects, possibly more effective, but have to have failed Taxel-based chemo to be eligible and it is in short supply and is expensive.
I swore I would never undergo chemo, but here I am. First dose on August 16th. No significant side-effects as yet (mowed the lawn last evening), bone marrow suppression will occur during the 2nd week if it is to occur manifested by low WBC’s, fever, infections, need for IV antibiotics, possible hospitalization. Will probably go to the trail today.
My reading of Stoic philosophy suggests that I am clinging desperately for more time because I failed to live my life in the past. I sincerely believe that I do not fit into this category as evidenced by my prior writing on living in “stoppage time” or as described in another recent novel as “bonus time”. Every baby that was conceived as a result of Fran and my assistance and delivered by me felt like a gift that I had been given to share. My only regret was that I did not cut back on my schedule earlier so that I could have spent time with mom when her faculties were still intact, but did make the attempt to be there more frequently during her last 2 years. Cutting back allowed me to be there for the granddaughters and providing care while Sommer was in Grad school, flying to Spokane to drive Skip and Karen to Missoula, visiting the Buffalo Preserve, trips back to Minnesota in the spring. The Pandemic altered any plans for extensive travel back to Europe, extensive road trips in the US, concerts, athletic events. Stepping away from medicine was made easy by the corporate financial emphasis of administrators, never-ending rules and regulations, electronic medical records where repeated documentation of items were made mandatory for billing purposes rather than truly improving quality of care, entitlement of medical students, residents, new faculty and patients themselves that placed one at constant risk for censureship for “speaking truth to stupid”, constructive criticism, or pointing out that patients obesity or medical conditions would make pregnancy difficult, risky, and potentially lethal.
The Pandemic continued to make caring for the girls a non-option. In October of 2021, The West Run Woods bike trails suddenly appeared as an alternative way to make use of my “bonus time” to help create something of lasting value. The presence of bone lesions in January fueled my desire to see the initial trail completed and clear passageways for subsequent trails and obtain bids for bridges spanning West Run that would connect West Run Woods with the Baker’s Ridge trails (even though I would be unlikely to see their initiation or completion). The Delay in chemotherapy for 4 days allowed me to assist with partial completion of the smaller bridge that spanned a ravine behind Mon General and allowed an uninterrupted passage of the initial trail complex.
Stoic philosophy tells me that I have no control over my body and what will happen to it, that we are all a part of nature and destined to die, the time unknown. Our goal in life should be to live it, to find our purpose and live it to the best of our abilities to make the effort to be the best person that we can be and not to force ourselves or others to extend it beyond its expectancy. While alive, we will all be exposed to daily events, temptations, “impressions” that we should be able to reason with in order to make the correct decisions and at the start of each day acknowledge this and prepare for them. At the end of each day we should review our day, our failings, and make the attempt not to repeat them the next day. Nadia Bolz-Weber’s talk on Forgiveness at the Nantucket Project is a recurrent listen for me in order to try to help me forgive myself for past failings and as her 12 step partner said, “that shit is in the past, let it go. Luther’s concept of Confession, Forgiveness, Grace. Her description of dealing with “assholes” in our lives is difficult for me to follow, so at this am more inclined to follow the Stoic Philosophers belief that other people do not mean or do not recognize that they are being evil or inconsiderate but have simply not have learned the use of reason to control their impressions, and I should make use of their actions or life’s inconveniences (delayed flights) to practice our recognition that we can only control us and our response to these things. These behaviors of other people, life’s inconveniences, illness and mortality are things over which we have no control. We only can control our response to them. My only control is how I make use of my remaining “bonus time” which will be much curtailed by the chemo schedule. My only control is how I behave around friends and family, and my health-care providers, to not exhibit asshole behaviors that they will have to use Stoic philosophical principles to counteract.
Stoic Philosophy rejects the concept of an afterlife, but that we return to the state of existence or non-existence prior to birth/conception and that the matter that makes up “us” is recycled. Many of them reject the idea of a disembodied soul that is separate from our body. This is difficult to reconcile with the Christian tradition that I have grown up with and becoming much easier to reject given the state of the right-wing radical “white Christian nationalist” movement that is taking over the Republican Party. The thought of spending eternity with these individuals would be another level of hell. Despite my questioning of the disembodied soul, I have found myself to be more in contact with my parents. Perhaps it is nothing more than the line from West World”
We are not really dead until the last person who remembers us is gone
I have enjoyed working along on the trail because I feel like my dad has been with me, enjoying the woods, the rocks, creating order out of disorder, providing memories of working with him, hunting and fishing with him. He primarily comes to me when I am alone. Mom, on the other hand comes at most unexpected times. We share the middle of the night wakening, knowing that sleep is not going to come so begin reading. Anyone who spent any time with her will remember that she would suddenly begin quoting poetry that fit the moment. I have found myself quoting obscure song lyrics while working on the trail when working with the younger people who look at me probably like I looked at my mom having no clue about what I am talking about. I found that, in general, song lyrics were my version of poetry but am now finding myself suddenly quoting poems that my mom would say to me. Is it her spirit talking to me or suppressed memories? I was leaving the house the other day and suddenly out of the blue said to Connie, I “shan’t be gone long”, something my mom would say to me when we needed to do something in the pasture or barn and she would complete it by saying “why don’t you come too”. Her shortened version of Robert Frost’s The Pasture often completed by her reciting the poem:
I'm going out to clean the pasture spring;
I'll only stop to rake the leaves away
(And wait to watch the water clear, I may):
I sha'n't be gone long.—You come too.
I'm going out to fetch the little calf
That's standing by the mother. It's so young,
It totters when she licks it with her tongue.
I sha'n't be gone long.—You come too.
And this morning as the sun was rising and I looked out of the bathroom window and looked at the fog settling over the neighborhood, I heard her quoting Carl Sandburg:
The fog comes
on little cat feet.
It sits looking
over harbor and city
on silent haunches
and then moves on
Suppressed memories, messages from the beyond? I only know I am glad that they pop into my head with all the emotions that they engender.
61-69, M