The Cancer Diaries, Part 23


Happy New YearI started the New Year with another welcome three days off, with the final third of my radiation treatment ahead in the next few weeks.

I can’t say I’ve ever been quite as happy to see a year pass as I have with 2020. As if the widening pandemic, lockdowns, Trump’s madness and treason, the nail-biting US elections, the stupid and selfishanti-maskers and anti-vaxxers, the QAnon idiocy spreading among the gullible, Brexit, Jason Kenney and the UCP destroying Canadian unity as well as Alberta, the waste of $9 million locally for the Saunderson Vindictive Judicial Inquiry (SVJI), and Erin O’Toole’s election as Conservative leader weren’t enough to drive a person around the bend or at least into despair, I had to get cancer as well. It has been the worst year of my life, but I suspect a lot of people feel that way about it, even without having cancer.

Susan and I had a subdued New Year’s Eve, Thursday, ordering a takeout meal from a local restaurant. In previous years we would have gone out to celebrate the New Year and toast the anniversary since we met. This was our 38th, and we celebrated over dinner at home and a glass of wine from a box (at least it’s Ontario wine). Susan has been the continued light in my dark year.

We capped off the night with a mediocre movie, then a Star Trek: Next Generation episode (we’re re-watching the series for the third time), followed by an hour or so of reading in bed. Exciting, aren’t we? Didn’t even stay up until midnight to see in the start of the new decade. But it’s not like I got a full night’s sleep: my hot “flashes” and full bladder woke me up several times, as they do every night. 

I would like to see my way through the next decade — 2021-2030 — assuming that my various treatments kill off, or at least manage my cancer sufficiently. I’d like to live to at least 80, although both my parents reached their 90s, as did my maternal grandfather and paternal aunt. I figure it’ll take the next decade just to finish reading all the books I’ve bought in the past few years. I have a duty to read them all. The average life expectancy for men in Canada is 79.9 years. I’d like to be at least average in this aspect.

The five-year survival rate for prostate cancer that is restricted to the prostate and immediate area is almost 100%. That’s a cause for hope. But it falls to a low 31% if the cancer has spread to other parts of the body. I don’t know where I fit in that, but suspect from comments made by my urologist after surgery, and the need for subsequent, lengthy treatment after it, that it may have spread further. So I may be in the latter group. If in the former, then my chances of reaching the next decade are 98% and 15 years is 96%. I live in hope. But less than one in three if it has spread. It’s a question I’ll have to ask either my urologist or the oncologist at our next meeting.

A recent study in the USA showed that “…people who have survived cancer in adulthood have a greater risk of developing and dying from new cancers than people in the general population.” That’s not encouraging. The article added,

It is well-known that people who have survived cancer typically have a greater risk of being diagnosed with the disease again, even if their first cancer has been successfully treated. In many cases, this is recurrence of the original cancer or metastatic disease related to the original cancer. It is also not uncommon for treatments for the primary cancer to unfortunately cause another cancer, but in many cases this link is hard to definitively prove. The American Cancer Society study looked at new cancers thought to be unrelated to the first cancer diagnosis.

Facing your own mortality is a challenge everyone with cancer has to meet along with the diagnosis. I don’t like to call us cancer “victims” because that suggests something outside has attacked or violated us, when really it’s our own body doing it. We’re not harmed by crime or accident, but by ourselves; a sort of biological, cellular-level suicide. Nor are we simply passive like “innocent” bystanders in crime reports (where do all the guilty bystanders get to?).

I don’t like to use the term “cancer survivors” either, as if we were in some banal “reality” TV show set on an island replete with venomous insects, angry reptiles, and underhanded challengers who vie to be the last one standing through their ability to eat the former two. Cancer isn’t a competition. And even with a full regimen of treatment and care, none of us really knows if we’ve “survived” cancer or simply delayed the inevitable. Our cancerous cells (or rather the DNA within them) may be lying dormant, waiting for another opportunity to express their malevolence.

And let’s face it: none of us is getting out of here alive. We all die; it’s only a matter of how and when. Cancer rings the doorbell to let you know death is walking up to the house. 

Many cancers, we know, are the result of environmental effects or lifestyle choices, some of which were unknown at the time, or misunderstood until further research showed them. In Ode II.13, Horace wrote:

From one hour to the next, man never knows
how to sidestep danger…*

Some cancers, however, are self-inflicted. Smokers, for example, create the conditions within their bodies to develop many cancers, not merely lung cancer. And since no one today can ever claim they are not aware smoking causes cancer, it seems a deliberate, conscious act; suicide by tobacco. I sometimes sit in the waiting room of the treatment centre with smokers — you can tell because they stink of cigarette smoke they are obviously still smoking even while they are being treated for cancer. I cannot fathom this sort of behaviour: is it madness or stupidity? It’s almost like they want to die, painfully and horribly.

Like my feelings towards the anti-vaxxers, I find it hard to be sympathetic towards anyone who smokes, much less anyone who smokes after being diagnosed with cancer. I know that’s unkind of me, and in opposition to the beliefs and philosophy, I l try to follow. Marcus Aurelius wrote in Meditations, 4.40 that we should consider everyone as part of our own existence, that others are not separate but rather integral to our own experience:

Constantly think of the universe as a single living being, comprised of a single substance and a single soul; and how all things issue into the single perception of this being, and how it accomplishes all things through a single impulse; and how all things work together to cause all that comes to be, and how intricate and densely woven is the fabric formed by their interweaving.

Very Buddhist of him. I wish I were that wise. Buddhists call sympathy anukampa or sangaha: “the ability to identify with another person’s feelings, state or situation. Like compassion, sympathy empathizes with others’ pain and distress but it also understands their point of view, is convivial towards them, and wants to find commonalities with them. Thus we may say that sympathy is that place in the heart where love, compassion, sympathetic joy, patience and tolerance meet.”

I’ve spent more than five decades reading about and exploring Buddhism, and the last couple of decades exploring Stoicism. But not with enough vigour to keep me from sniffing the tobacco stench and thinking bad thoughts. I can’t help but feel it is karma. I find no commonalities with smokers. Perhaps I need to work on my anukampa more.

In his Meditations, Book 3.1 (Hays translation), Marcus Aurelius wrote:

Not just that every day more of our life is used up and less and less of it is left, but this too: if we live longer, can we be sure our mind will still be up to understanding the world — to the contemplation that aims at divine and human knowledge?
If our mind starts to wander, we’ll still go on breathing, go on eating, imagining things, feeling urges and so on. But getting the most out of ourselves, calculating where our duty lies, analyzing what we hear and see, deciding whether it’s time to call it quits—all the things you need a healthy mind for . . . all those are gone.
So we need to hurry.
Not just because we move daily closer to death but also because our understanding—our grasp of the world—may be gone before we get there.

I often turn to his words to both help me understand how the Stoics dealt with life and death, but also as grist for further contemplation and just general wisdom. The Stoics and Buddhists have a remarkable amount in common, and I find inspiration, wisdom, and consolation in both, even if I’m not always able to assimilate their words into my own perspective. But I digress.

After my last radiation treatment this year, I will have several more weeks to wait until I see my urologist and get my second hormone injection. There will be blood tests, too, in the months that follow, as doctors track the level of my PSA to see if the cancer has subsided or, even better, gone. If not, if it continues, the next step is chemotherapy, something I dread. But I’ll deal with that if it arises. As much as any patient can “deal” with anything; we either take the treatment or we die sooner.

Meanwhile, I spent the weekend blogging and reading about metaphors how they and other forms of speech define our ability to communicate complex associations and ideas. And on Sunday, I watched a Godzilla film on my laptop. I get such a delight from these films that for their duration my mind is taken off any thoughts about cancer.

Radiation treatment, 25th session: Monday.

A slightly earlier session today, again doing the new “boost” treatment that blasts the protons at a smaller, more compact region of my abdomen. The next two weeks I’ll be getting these “boosts” almost exclusively. I had hoped that the tighter beam focus might spare by intestines from some of the side effects that bother me, but everyone I ask about it warns me “things will get worse” before they get better. But they all say I expect I will recover, albeit slowly. Rather irksome because my irritable bowel is the most annoying side effect to date.

There’s a large psychological factor at play in bowel problems. It affects your dignity, your sense of self-respect. Having to run to the bathroom several times a day would be deeply embarrassing if I were not at home and out of the public eye. And don’t get me started on hemorrhoids. There’s an anecdotal story that Napoleon suffered from them and that his discomfort caused him to lose the Battle of Waterloo. No actual proof; it’s all conjecture, but I can understand now why it might have distracted him. I wonder if a tube of Anusol would have changed history?

The news today has been all about COVID-19, further lockdowns, more cases, more deaths, and the utter failure of our provincial government to manage it effectively. And, of course, Trump’s efforts at a coup, and his followers’ attempts to destroy American democracy. As if my life weren’t depressing enough as it is. Some days I really don’t care to hear the news.

There were only two screeners when I arrived. The lineup was short on my arrival, but considerably longer when I left — and still only two screeners.

I didn’t have much time to read before I was taken into the treatment room, but I did get them to play me some Puccini while the machine worked its magic. I also got my schedule for next week, and spoke to a different nurse from my previous reviews, to go over my treatment to date. She told me recovery of my bowels would take several months after treatment had ended.

I really didn’t like getting a new nurse, especially this late in my treatment cycle. Switching therapy staff, doctors, and now nurses makes it difficult to build a rapport with any of them. With the new nurse, I had to start all over describing my symptoms and side effects. With different radiation therapists almost daily, I have no chance to have any conversation that extends beyond the single day. It all makes the whole process seem colder, more clinical, less personal. My earlier feelings of familiarity, of comfort, and confidence have largely dried up with the arrival of the new nurse.

Driving there and back was easy, the only problems being with the rather large number of assholes in pickup trucks who felt the need to drive a metre from my rear bumper when |I was already travelling at 90 km/h. What is it about pickups that makes people assholes?

Radiation treatment, 26th session: Tuesday

In 1981, The Moody Blues released their tenth album, Long Distance Voyager. It’s one of my favourite of their albums. On it was a song called 22,000 Days, which has stuck with me ever since I first heard it. Its chorus goes,

22,000 days, 22,000 days
It’s not a lot, it’s all you’ve got
22,000 days
22,000 nights, 22,000 nights
It’s all you know, so start the show
And this time (this time)
This time feel the flow, get it right

Despite their dire warning, my 22,000th day on this planet passed some time ago: in mid-September, 2010. As of this writing, I am in my 25,762nd day; a decade older than the time allotted in their song. The Hebrew patriarchs, the Bible says, lived even longer: Abraham 175 years; Jacob 147; Noah 950; Methuselah 969. Not that I believe those myths and their impossible longevity. Nor, it seems did all of the biblical authors. Genesis 6:3 limits our life to “one hundred and twenty years.” And the later Psalm 90:10 shortens it even more:

As for the days of our life, they contain seventy years,
Or if due to strength, eighty years,
Yet their pride is but labor and sorrow;
For soon it is gone and we fly away.

Well, I’m in my 70th year and have hopes to reach 80, biblical strength notwithstanding. Assuming, that is, my treatment works and my cancer didn’t spread, or at least not very far. But the message of the song, even if its dates are a bit short, is still relevant: make the most of your time. Time, it says, is our only real foe:

Even though I know it’s only me and my dreams
That drive me, so let me go, please
Let me go onto tomorrow
One day at a time
Now I know the only foe is time

Well, I suppose I’ll find out soon enough. This morning there were three screeners, but by the time I got to the front of the line it had snaked back outside the building, and remained very long by the time I left. The treatment went quickly, with a little Verdi for my music — La donna è mobile from Rigoletto was the first piece. Delightful: it was one of the very first opera pieces I ever heard. I’m midway through disc 8 of the audiobook, too.

HDMI switchI got an inexpensive bi-directional HDMI adaptor today from Amazon and it worked like a charm: I can now watch DVDs on my monitor (using a Sony player) or use it with my laptop for work and games with a simple button push. I watched The Terror of MechaGodzilla as my first film with the device. The next day I watched Godzilla: Final Wars. Great fun, both of them.

Radiation treatment, 27th session: Wednesday

Another earlier-in-the-morning session, but I arrived on time. The lineup for the three screeners was short, but the lineup into the cancer centre was much longer. Still, I managed to get in, get irradiated, and get out in a relatively short time. With a little Miles Davis played while I lay there. I’ve started disc 10 of the Next audiobook.

One side effect I’ve not mentioned previously is that my testicles have shrunk. Not a big deal, since after my operation they are mostly ornamental these days. It’s likely because of the hormonal treatments (Lupron). Reducing testosterone is crucial in controlling the growth of the prostate cancer cells. But I suppose I’m now open to all sorts of jokes and jabs about not having big cojones. In another post, I might have something witty to say about toxic masculinity in response.

Late Wednesday afternoon, we learned that Democrats had won the Georgia senate elections, breaking the iron grip of the traitor “Moscow Mitch” McConnell. At the same time, Trump’s armed Repugnican mob were staging their coup attempt in Washington, assaulting the capital building and ending the nation’s business by forcing congressmen to flee. They were incited and encouraged in sedition by their president — appropriately nicknamed “Putin’s Puppet.” America and its troubled democracy are under siege from the fascist right. I predicted he’d launch a coup to stay in power months ago. Seems I was right.

Radiation treatment, 28th session: Thursday

Some days it feels like I’ve been doing this for years, not months. The familiarity doesn’t make me feel better or more comfortable, however. It feels more institutional to be coming here every weekday.

There was a short line up, no issues getting in, and I was in the waiting room with time to spare. Unfortunately, a clean-up after an infected patient was treated (we weren’t told with what) was required by protocol, and that added a 30-minute delay to my wait time. I finished the Next audiobook on the way home, and was listening to an interview with author Crichton on the final disk as I pulled into the driveway.

My bowels seem to be getting more irritated with continued treatment, and the frequency I excrete is increasing. Also, they seem more aggravated and sore at times more often. It makes me hesitate to go far from the house once I get back. Despite enjoying a fairly healthy and balanced diet (albeit without eating any mammal or octopus), I can’t seem to make this better.

Radiation treatment, 29th session: Friday

Another week of radiation to go, then I can start my slow recovery. Not the end of my treatment, but just the end of the radiation portion. And eventually the end of the torment my bowels have been going through. Radiation continues to work months after treatment ends, so it won’t happen right away. But even when I am healed, I won’t feel safe to mingle with friends until I can get my COVID-19 vaccination.

So far, I have been remarkably fortunate in having clear weather to drive there and back. This time of year we usually see a lot of snow, and road conditions here can deteriorate quickly. There are even some impassable areas during a snowstorm or blizzard. But I’ve had nothing more daunting than slush and some blowing snow to challenge me. Next week looks to be the same, weather-wise.

This morning the drive to Barrie was quite pretty. There had been a mist or frost overnight east of the Edenvale airport that covered all the trees, the roadside bushes, the weeds, and the fields with a light, white layer that caught the light. The rising sun reflected off this frost, giving each branch a bright aura, and made it all sparkle like a million diamonds. It looked magical. I wanted to stop and take a photo, but the pressure of the traffic behind me kept me moving. By the time I came back, the warmth of the sun had melted it all away. 

I listened to some Firesign Theatre skits on my drive. I’ll have to load up a new audiobook for next week.

I arrived in time to read a poem by Horace (in the McClatchy edition, cited below), then got called in. I heard some Velvet Underground songs this morning, but the therapists hadn’t even heard of the band. My cultural references from the 1960s are as distant from these younger people as Rudy Vallee and Ruth Etting were to me when I was growing up and first listening to The Beatles. I was back home by noon.

* Rosanna Warren translation, from Horace: The Odes; New Translations by Contemporary Poets, edited by J. D. McClatchy, Princeton University Press, 2002. In the 1983 Penguin edition, W. G. Shepherd translates this as “Man never studies enough, from hour/to hour, of what he should be ware.” And in the 2004 Loeb edition, Niall Rudd gives us, “A man can never take sufficient precautions from hour to hour against what he should avoid.”

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Ian Chadwick
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