You Got This

There are three phrases you hear again and again when you tell someone you have cancer.  They are, “You’ll be fine” or “Everything will be okay”, or “You got this.” Clearly there is hope and love in each of these statements.  And God thank you for every single soul that has uttered them since I decided to just let it hang out that I have renal cancer.

For stretches I can accept these statements as true.  But then the thoughts of what if crawl into my mind.  In my job I have met so many people that doctors have promised the world and delivered only ashes to.  Yeah there are a great deal of what ifs that abound when you are facing down surgery.

But I am opting to stay with the line that says these people and my doctor are correct.  Life has been good to me so far.  I want more of these joyous breaths. Thank you to all of you who have uttered these phrases.  

The Flower Man

I offer the above flower as an act of contrition for what we as Americans have become.  I loath our (p)Resident.  I don’t know if he actually won the election but that is water under the dam.  Right now we have to save our country from its own worst tendencies.  The racism, the homophobia and xenophobia are just staining our souls, perhaps indelibly. The merciless redistribution of wealth is just horrid.

Oh don’t go on about how Obama and Clinton were disasters too.  They were.  But they did not advance the cause of fascism and the cult of personality as the man who holds the chair they once did.  His unmitigated disdain for long held international relationships, the disavowal of treaties and compacts, the unilateralism, well these are the moves that reflect a citizenry who have given up on their duties.

I have given up talking.  You either believe the man is returning us to an America that was strong and potent and just, or you believe he is all in for the monied and the white and the Christian.  When I say these things out loud people react viscerally.  Some say yeah and some say you sonofabitch.  I just can’t take it.

Most days I try to post a picture of a flower and a comment that encourages or brings a laugh.  I want to see people as people. It is all I can do given the schism between the Trump supporters and the people I believe are focused on democracy first.  

Take a moment with a flower.  Left or right it doesn’t matter.  What matter is this fragile world, this fragile set of interwoven lives that we must protect. 

Blood and Alcohol are the Trump Cards Today

Today was a no mostly thought of cancer day.  I spent the day at a seminar learning, well actually confirming learning already done, about alcohol absorption. I mean the mechanics of alcohol metabolizing play a key role in my job.  Thus knowing how quickly after one stops ingesting alcohol the blood alcohol level peaks and knowing the rate at which alcohol leaves the body are key issues.  Alcohol leaves most bodies at about .018 BAC an hour.  But based on other factors it can leave the body at as slow a rate at .012 and as fast a rate as .030 an hour.  I can see your eyes glazing over. But to me this stuff is important.

Next week will be a big week.  Ann Arbor on Friday for a second opinion.  Detroit on Saturday for a concert.  I will go from facing the music to being transported by the music.  Decisions will be made soon.

Of course during the seminar I was attending I got two phone calls.  One was from a friend who is meeting me at this concert.  The second was from a pharmacist at U of M.  I have no idea what either of these calls were about.  I tried to call the pharmacist back but I sat on hold for 1/2 hour.  So much from the quick response time from U of M.  Carl was good but I am not sure it that translates across the system.

A Digression Into Philosophy

When it comes to the underpinnings of philosophy, I guess I’m on board with Descartes. Most commonly his primephilosophical premise is translated as, “I think therefore I am”. From my perspective this really doesn’t convey the essence of what he is saying. I have seen several other iterations of this phrase. One that has stuck is something along the line, “Because this thought process is in some manner occurring, therefore something must exist”. I get that. I accept that as a starting point.

Because there is even a question floating around in the ether somewhere, the mere existence of that question means there must be some form of sentient being that exists. All human existence may in fact be the dream of a giant sleeping on a hill in a world or universe which we could never comprehend, but something, some life, must be there to generate activity. 

So, accepting as a starting point that there is existence, I adopt the pragmatist stance as to the rest of the questions of reality. What I see and who am I seeing are real and not simply the constructs of the Giant’s mind or my own mind. For me I don’t have to dig into the whole, “Are you and everyone else just a figment of my mind”, ala Leibnitz.  The whole monad thing doesn’t work for me.  The table is a table.  The chair is a chair.  Sex is sex.

What I find more interesting, and more challenging is the issue of duality.  Do we have a soul?  Is there a life essence that is attached to our skin suits invisible to our eyes and undetectable to our instruments of discovery, that continues forever? Perhaps something like unseen radiation that has always been there but not measured or identified until the last century and a half of human history.  Those 17th and 18th century folks really worked doggedly to either prove or disprove the soul. Don’t think either side really prevailed. And when you talk about the soul you move from metaphysics into moral philosophy.  If there is duality you must address the problem of the existence of evil.

Accepting existence, I can move on to think on other more important questions in this world I inhabit. Me personally I think the questions that must be addressed right now on our Trump/Johnson world are primarily questions on moral philosophy and ethical philosophy. We humans must drill down and answer to ourselves what is good and right at the same time identifying what is not good and what is not ethical. Every single moment of every single day, because of these men, we are faced with choices that require decisions about propriety and goodness and what our efforts should be to ameliorate the evil these men are spreading. The thing is an answer to these questions is never, and I mean, never easy or clear.

And Behind This Door is Doctor #4

Doctors 2,3 and 4.

Like any good cancer victim facing the specter of cutting and chopping, and the pain and agony that is associated with surgery, I am seeking a second opinion..  I called my PCP immediately after the diagnosis and discussed my options.  Our talk ranged from the Mayo Clinic to Sloan-Kettering to the Cleveland Clinic and then to U of M.  He rattled off a few more that had specialties in different kinds of cancer.

After mulling it over I decided to go with U of M.  Hey, currently the diagnosis is that the cancer is small and slow growing.  U of M has enough credibility in medicine and in oncology that balancing distance and cost it won out.

Next came finding a doctor.  I immediately put feelers out to a group that we shall call “ladies in the know”.  In our community there is a grapevine of people, not necessarily all women, who are tied in to the neural net of the community.  They know who had what, who did what, where they did it and why.  The answer didn’t take long.  A name had cropped up a couple of times as the go to person for urological oncology.

I called my doctor.  He called U of M.  We waited.

Two days ago I got a call from a 734 number.  Ann Arbor is a city in the 734 code.  A calm voice began to speak.  “Is this Rufus.  Rufus I am Carl, I am the new patient specialist with the U of M urological oncology department.  We have received a referral from your doctor to see Doctor 2.  Is there a special reason you want to see Doctor 2?”

Quickly I responded.  I told Carl that I had renal cancer and that two separate people in my social circle had been treated by him with great results and glowing reviews.  Carl asked me, “Have you been told anything about your cancer?” I responded with what I have shared with you, I have Stage 1 cancer that is slow growing.  Carl was very precise, “Rufus you are simply not sick enough to see Doctor 2.  He specializes in advanced cancers that are aggressive and spreading.”  I tried to plead with Carl but he was the great curtain hanging before the Wizard.

Carl tried to throw me a bone.  “Rufus Doctor 3 has an opening next week.”  Carl implied Doctor 3 was the pro from Dover for tumors simply within the kidney.  But Carl’s position on whether Doctor 3 was appropriate for me would change.  Carl asked me how big my tumor was.  I volunteered it was about a centimeter by ½ centimeters per what Doctor 1 had told me.  Carl then offered, “Doctor 3 has recently changed his guidelines.  He will only see patients with tumors in excess of 4 centimeters.   Let me see.”  Carl then offered me an appointment on 08-02-19 with Doctor 4.

I asked Carl for the guy’s bona fides. Carl indicated that Doctor 4 had been at Sloan Kettering for 15 years and came to U of M 3 years ago to become part of the growing and specialized urological oncology department.  I assented.

Carl then in his ever pleasant voice began to explain the process.  There would be forms to fill out.  He would email them to me.  I would have to sign two of them and sent them back.  These would allow Doctor 4 to see all my slides and scans and reports before I arrived for my appointment. Next I would have to fill out a very specific release so that the Doctor and his staff could talk to the people of my choosing.  Finally there would be a 10 page form detailed every medical malady I had ever been burdened by, and all medications legit and otherwise I was using.  He told me he would be e-mailing these immediately.

Carl was true to his word.  He sent me 10 documents. Some were maps and directions.  One was the itinerary of my visit.  The rest were the forms.  I called Carl back and as God is my witness he answered the number he had given me and resolved my question about a couple of boxes and whether they had to be checked or not.

I have finished the forms.  I have the ones I have to hand deliver in my purse.  I have sent off my e-mail to my boss requesting time off next Friday for this visit.  My stomach is churning.  I know I have cancer, I just don’t want it to be any worse than I have already been led to believe it is.  Tomorrow I will Google Doctor 4 and check all the licensing databases and the Washtenaw Circuit Court filings on the dude.  I will do my homework.

On Saturday, the next night after the second opinion, I am headed off to Detroit to see Bryan Ferry perform all of the Roxy Music disc Avalon.  I will be catching up with an old friend at the Fox Theatre in Detroit both for food and the show. And then two days latter I will be celebrating my wife hitting retirement age.  Yeah, a whole lot is going on.  My hope is that Bryan Ferry can distract both my wife and I for a few moments.

Waiting for Doctor #1

Doctor #1 or Dr. M as I Refer to Him.

12 years ago my PCP (Primary Care Physician) noticed a slight increase in my PSA (Prostate Specific Antigen).  Based on a hunch he sent me to a urologist for a follow up.  With referral slip in hand I headed off to meet my new comrade in the cause we shall call “Keeping Rufus Alive”.

Dr. M was a shorter man.  He was of Arabic descent and had a perma-tan.  As our years together would reveal to me, he liked the ocean and he liked beaches.  Dr. M was confident but not cocky.  When he looked at my PSA change he gave me about even odds that I was dealing with something that was just aggravating my prostate.  Still, we had to check given that I was so young and all, a mere 50.  Men don’t get prostate cancer at 50. Testing would happen quickly.

Testing required I be sodomized by a staple gun in the shape of a dildo.  The results came back ambiguous.  According to the lab they might be inflammation but then again they might be symptomatic of prostate cancer.  Dr. M stated that the appropriate course of action was that I wait a short while to see if the inflammation resolved.  In a very knowing voice he told me that we would again do the anal probe in a few months.  To quote a script by John Sayles, “I did not ask for the anal probe.”  Say that six times with different inflections, emphatic, timid matter of fact, fearful, sorrowful and perhaps shocked.

In three months time there I was again on the examination table listening to the pop, pop, pop of the prongs taking flesh from my jizz generator.  Again confident but not cocky Dr. M told me we would have the results in a few days.  He told me he would call as soon as he knew.  This time he didn’t tell me he was sending the samples to Johns Hopkins for review.

True to his word he called 5 days later on a Monday morning at about 8:45 a.m.  He was calm but very direct, “You have prostate cancer and from my perspective given your age the best possible course of action is to remove the prostate.”  I was shell shocked.  I was looking for other answers.  I went to a noted local oncologist who looked at the results.  He too was Arab.  He did not hesitate to tell me that with these results at age fifty I had to have my prostate out.

For twelve years now I have followed up with Dr. M.  My PSA has remained nil.  After a decade you get told it isn’t coming back. For each visit I would wait for him by sitting on the exam table in the lotus position.  I find it more comfortable that the chairs they wedge in those rooms.  Each visit we would talk about Arab food.  Kibbie rules.  Each visit he would be supportive and understanding.

Taking the prostate out changes the places of pieces and parts of you innards.  Things shift.  Your penis shrinks a tad.  Damn miserable stuff.  Over time you lose a little muscle control front and back.  Yeah, I know too much info, but it is what it is.

One of the things I noticed in the past two to three years was that my bladder region has gotten tender.  Twice now Dr. M has run the camera up my penis, yes it is not very pleasant.  Twice the samples taken by this device from inside my bladder came back negative for cancer.

At Dr. M’s behest I was sent for therapy.  This involved sphincter squeezing exercises.  It involved a giant rubber band and a small rubber ball.  Finally it involved both exterior and interior massages.  Yeah, you got that right.  I had a fifty something woman using one of her gloved digits to massage the interior of my posterior.  Thing was it helped.  I mean I am still not gay but that digit thing made my bladder feel better for a couple of weeks.

Despite doing all the rubber band stretches and the rubber ball between my knees compressions, I still have an agitated bladder.  Dr. M decided to look a bit further to see if there was any structural reason for this, i.e., a tumor or something.  I was shuffled off for a CAT scan and well if you have been reading along you know the results.

What was different this time was that the personal touch of Doc M had changed a little.  After the CAT scan I got a call within two or three hours telling me I needed a biopsy.  This call came from a nurse, not from Doc M.

I got the biopsy and good old Dr. S who drilled in my kidney, the inerventional radiologist told me the results would come in 7-10 days.  Nyah.  The biopsy was on a Tuesday, two days later I got a call from Dr. M’s assistant asking me if I could make a 4:45 pm appointment with the doctor on Friday.

What freakin’ self respecting doctor is setting appointments on Friday afternoon in the height of summer?  I am going to attach a clip below, it is the ending to the movie A Serious Man.  The movie is very Jewish but watch it even if that particular experiential set is different from your own.  Crucial to understanding my reaction to the call for a quick appointment  is the part where the doctor in the movie calls the aspiring college professor. You need to see this to have an understanding of how terrorized I was. https://youtu.be/2Qk4H7yfwPg

To be called in on a Friday I was sure I had to be toast. (I still may very well be but that we will find out as time progresses now won’t we reader?) For 24 hours my guts churned, my mind raced and my toes sweated.  I was emotionally and physically drained by the time I reached Doc M’s office.

Sitting with my wife in the examination room the door opened.  The good doctor came in smiled a gentle smile and in a very matter of fact tone told me I have renal cancer.  He showed me the film and he told things like it was stage 1 and it was slow moving.  His advice is to remove some of the kidney but not all of it.  We will again use the DaVinci machine.

Why did he call me in on a Friday at 4:45 p.m., well because he knew me and he knew how worried I would be.  He wanted to sort out the good news from the bad and calm me down a bit.  Doctor M is a good man, the field of Urology will lose a good practitioner when he retires in December.  I asked him if he had ever seen a Serious Man.  He hadn’t. Kind of wish he had.

Grasping for the Light at the End of the Day

As I was walking to the library this evening the air was cooler than yesterday at the same time.  We had a brief but heavy thundershower early and it seemed to have both lowered the temperature and wrung the moisture out of the air. My passing through the neighborhood came at about 8:25 PM. Part way on my eight minute walk I caught a glimpse of light playing upon a stop sign. The angle of the sun illuminated the stop sign creating an almost aura like effort around the red and white octagon.

Quickly, well almost immediately I pulled out my phone. Over a minute I took a good 8 to 10 photographs of the glowing stop sign. One can never catch the golden light at the end of the day. Me, I try and I try but it never works out. Sometimes I get just a hint of what the reality of what I saw was. Sometimes if you play with the filters in the phone might get 80% of the way there. But the crucial thing is you never get there.

Know this there is no program on any phone, nor any computer, which will actually grab what your eye sees.  Nothing will ever capture the image on your retina perfectly.  Nothing will ever record it perfectly. I think that reality is why we should live life without any anxiety about the historical record, about memorializing the things we see in our passages. There is beauty that we can observe on an individual basis and individually is the only way we can observe it. What I think is incredibly important is that we try and catch the light at the end of the day.