Showing posts with label Cancer. Show all posts
Showing posts with label Cancer. Show all posts

Saturday, March 5, 2016

Pat Conroy and My Own Reading Life

The passing of Pat Conroy is yet another loss in my reading life.  He touched a lyrical nerve in that life, and the magnetism of his dysfunctional family years brought me into his writings.  Although a southerner, he was a kindred spirit.  Even his college basketball days chronicled in his My Losing Season resonated on a personal basis. He was a point guard in college, one of my dreams when I was much younger, although unrealized.

He died of pancreatic cancer.  The worst kind I can think of, my own father having wasted away from the same. And now a dear friend of mine, after successful Whipple surgery five years ago, fighting the unrelenting return of that dreaded disease.

One by one, the writers I grew up with, Richard Yates, John Cheever, John Updike, and now Pat Conroy, passing.  There are other writers taking their place.  Literature is alive and well even in this 140 character world, thanks to luminaries such as Conroy.

In his very personal memoir, My Reading Life, the dedication cried out for being reunited with his estranged daughter: This book is dedicated to my lost daughter, Susannah Ansley Conroy.  Know this. I love you with my heart and always will.  Your return to my life would be one of the happiest moments I could imagine.

My entry on that book, written soon after I emerged from the hospital following complicated open heart surgery, also noted that dedication and expressed my hope that it might lead to reconciliation.  I wonder whether it happened, as much for her sake as her father’s.

Goodbye Pat Conroy.  You brought beautiful fiction into my world, a Phoenix rising from the ashes of a sorrowful childhood.

Thursday, March 13, 2014

Jeremy -- A Smart(er) Cancer Survivor

A dear friend of mine, Jeremy Geelan, a colleague from my working days, the son of another colleague, Peter, who sold our books in Europe, celebrated a significant milestone this month, the three year anniversary of his radical surgery to deal with pancreatic cancer.  From all signs it was a complete success and Jeremy is now in full bloom as Chief Marketing Officer & Conference Chair at KAAZING Corporation.  He morphed into all things Internet from his humble beginnings as an analog publisher, but true to his nature even then he was looking to the future being founder and publisher of the "21st Century Studies" series (back in the good ole' 20th century) and some of those I co-published in US (Jeremy at the time was in the UK).

He confronted the lethal diagnosis of pancreatic cancer head on and entrusted his Doctors in Denmark to perform Whipple surgery, not an option for all forms of pancreatic cancer but, in his case (and probably Steve Jobs had he not pursued naturopathic options), a hopeful means of addressing this dreaded disease.  My father died of pancreatic cancer and I can attest, it is among the most terrible ways to pass into nothingness. 

This radical surgery is a nightmare and it is hard to imagine what Jeremy had to endure, during, after (I recall he was on his back for a very long period of time, trying to type in compromised positions to get on with his work) and then the dreaded follow-up chemotherapy.  As he describes the surgery: "The Whipple procedure cost me the lion's share of my pancreas, all of my gall bladder, a goodly portion of my stomach, and a portion too of my duodenum (small intestine)."  Yes, it is that radical, but Jeremy has his life back.

Soon after his Dad died -- of cancer as well (he was a mentor to me as I would like to think I've been to Jeremy), Jeremy presented me with a bound edition of the 1979 edition of Logophile, The Cambridge University Journal of Words and Language of which (naturally) Jeremy was the editor.  It is inscribed "To Bob from Jeremy 18 iii 1993.  Like books "words ought to be a little wild, for they are the assault of thoughts upon the unthinking" (John Maynard Keynes).  This day in loving memory of Dad, I'd like to present you with a volume of wildness.  It's where it all (for me) began -- in a garret undergraduate room at Cambridge belonging to an Open Exhibitioner in English called Jeremy Geelan."

From there Jeremy threw the gauntlet down and never looked back -- in spite of such health adversity.

I commend any reader to visit Jeremy's blog.  He doesn't post there very often, although he Twitters regularly.  But in response to his latest post, I responded,

Dear Jeremy,

I don't know what led me to your blog today. Call it an instinct. You don't post here very often, but I felt I ought to visit, and there it was, your fairly recent post. Brilliant. True. Very Jeremy. But ever since I've known you -- how many years, at least thirty? -- you've always been "smart." But you were "bucking bronco smart" -- undisciplined, your mind wondering everywhere. I would say your terrible, but successful bout with pancreatic cancer has made you more focused. You are now more smart in a focused way, about your career, and about the things that matter in life. I feel privileged to have known you so long, and to say congratulations on passing the third year landmark of your successful surgery. You did it bravely, trusting your doctors, and embracing your loved ones and your friends and colleagues. On to the future! Yours, Bob

I am copying his complete post below:

What Doesn't Kill You Makes You Smarter
In ten days' time it will be three years to the day since I was successfully operated on for pancreatic cancer.  Some of you reading this may be unaware of the prior story; worry not, this is not a post about cancer. It is, though, a post about survival.

There's a saying about how 'What doesn't kill you makes you stronger' that many undergoing chemo- and/or radiation therapy often hear, or even use themselves, to make light of the unpleasantness of the process and to remind themselves that there is a flip side to the nastiness of the "planned poisoning" that they are enduring: it may extend their lives and is therefore “better than the alternative” (as in, death).

My purpled Twitter avatar, to mark World Cancer Day last month (Feb 4)

But recently a colleague of mine in the world of the Internet, Guy Kawasaki, hit upon a headline - I have yet to check whether it was Guy's own or whether he was passing on something from elsewhere - that, for me, is much more pregnant with meaning and possibility, in terms of viewing cancer in the first place, and chemotherapy/radiation treatment in the second, as a potential inflexion point for anyone who survives one or both:

What Doesn't Kill You Makes You Smarter

This, for me, is the much more honest and uplifting statement. Do I feel stronger, having dodged the bullet - thanks to radical Whipple surgery - of the deadliest of all the cancers? Not really. If I could restore my strength to pre-diagnosis levels or above I'd be happy as a clam; realistically speaking, it is not especially likely, as there remain one or two challenges associated with Whipple surgery which tend to linger no matter how hard one tries - a surgically rearranged digestive system is plain not as effective as one that's been left intact.

On the other hand, do I feel smarter? Most emphatically, yes. The things that addressing and overcoming adversity teaches you - about yourself, about those who love you and are loved by you, about your professional colleagues both direct and indirect, about total strangers and/or long-lost friends; about nutrition, about the Internet, about the healing power of music and above all of love, about cognitive mysteries such as "chemo brain" and the reassurances increasingly offered by brain science; about physical capacity, about mental agility, about emotion, about faith…

In truth there isn't a single aspect of the human condition about which you do not, on being confronted with an early departure from the game of life, end up a tad smarter if on the contrary you have the good fortune to survive.

"Survival" and "survivor" remain the metaphors of choice when dealing with people like me but, speaking here only for myself, I am not sure how useful those words are. We are *all* survivors, after all; we all survive, daily, onslaughts of inconsiderateness or even plain cruelty, of injustice either direct or indirect, of disappointment and/or even despair. We all survive week in, week out the challenges of work and play, of life and love, of learning and of teaching, and of the eternal search for meaning in which we are all, to greater or lesser extents of awareness, engaged.

So the human being who "survives" cancer, of whatever variety, is no different from one who survives any other of life's curve-balls: bereavement, for example, or financial ruin. There is a commonality, and it is that of the bounceback or comeback. We humans are resilient. We have mastered endurance. We are *all* survivors. Of something. Of life itself, perhaps.

But the Kawasaki headline offers a more nuanced perspective.

Just as travel broadens the mind, or university, so pancreatic cancer it turns out is a hugely enriching life-phase that does, no doubt about it, leave you smarter. That it might just as easily have left you dead is not I think the point; many things kill us, from traffic accidents to natural disasters. But how many things actually make us smarter? We learn about humility - that is a given when quite literally your life (in the form of your innards) is for multiple hours in the hands of a surgeon. We learn about the irrefutable power of positivity. We learn about the boundaries of medicine and the central role of self-healing. We learn about the perils of certainty, and the corresponding importance of flexibility and agile modification of behavior and/or treatment. We learn about the often neglected importance of hydration. We learn about what truly makes us, and those around us, tick.

Now don't get me wrong. There are other ways to become wiser in this world, all of them less painful, less intrusive, and less detrimental and disruptive to the routine of yourself and your family. But that does not detract from this one, enduring truth, and I can vouch for it first-hand: What Doesn't Kill You - really, truly madly, deeply...take it from me - Leaves You Smarter.

Indeed, very Jeremy.

Saturday, October 5, 2013


We've gone through a week of hell, a slight cough precipitating an X-Ray which revealed, as I had expected, an old pleurisy scar from my college days.  But that is just the beginning.

Ah, those college days when we thought time was a personal continuum, guaranteed to last forever, and so we did whatever we liked, reckless things at times.  I was studying for finals in my Sophomore year and the dormitory was ablaze with late night studying, frequently with the help of NoDoze, strong coffee (or caffeinated tea in my case) and a cigarette burning from my lips or ashtray.  We were on a caffeine induced self-perpetuating high -- a contest of how long we could stay up, and memorize for those tests, walking around like zombies and proud of it.

After finals I collapsed and developed pleurisy -- in fact a very serious case -- and I was brought over to the Brooklyn Hospital, put in a ward with some twenty other patients, and had a female pulmonologist assigned to me (unusual in those days).  I never forgot her name as I found it almost comical: Dr. LafLoofy.  She tested me for, among other things, Tuberculosis, and suspected I had some form of it, but never confirmed though.  But the pleurisy was her main concern as I could hardly breathe and the pain was almost intolerable.  I was given dosages of antibiotics or penicillin, vintage 1960's, and they were even considering drilling a hole in my back to extract fluid, but it never came to that.  The worst pain came from coughing or laughing.  Visitors were told not to make me laugh and all would arrive with such somber faces that I would immediately burst out laughing, then howl with pain, as they quickly but still somberly retreated.  No more visitors for me.

So I spent two weeks in the ward, while the medications did their job.  My companion most of the time was Theodore Dreiser's "Cooperwood Trilogy."  It seemed like such a perfect piece of literary work to consume during my infirmary.

When I finally emerged from the hospital, I swore off all-nighters, took a little better care of myself, but I was right back smoking, and continued to smoke a pack to a pack and a half for the next 13 years.  I had smoked three years before, so that's 16 years of smoking plus both my parents smoked and our house and car were always a blue haze of smoke.  Those were simply the days when everyone smoked.

Fast forward to this past week.  So, when my slight cough could not be explained, my Internist took an X-Ray which to no one's surprise revealed that old pleurisy scar from a half century before.  That being explained, he put me on an antibiotic, but the following morning he called me to say that he decided to compare my current X-ray to one taken two years ago as a precaution. He thought he saw a change in that scar and thus a CAT Scan was ordered.  He called the next day with scary results; I had an 18x18x23mm mass in the upper left lobe, partially calcified.  This was completely unrelated to my pleurisy scar, so it was considered an "incidental finding."  I was referred to one of the top thoracic surgeons in the area.  We were stunned.

The anxiety level for me and my wife started to go off the scale.  I probably spent most of that day on the Web reviewing the sad, gory details about lung cancer, something with which I was already familiar as one of my best friends, Howard, died of the disease at only 62 and I know what he went through.  It has to be one of the worst cancer deaths, surgery, radiation, and chemo, mostly ending in limited life spans.  What's the point I thought?

The first appointment I could get with the surgeon was not until the following Tuesday, a wait of four nerve wracking days.  Before all this began, Ann had already left to attend a Jane Austen Society of North America convention in Minneapolis, where I insisted she stay, so I was alone for those four days to do more research which only resulted in more anxiety and the need for accepting whatever fate was about to throw at me. 

It occurred to me that as I handle all investments and bill paying, running the house, my poor wife could be left with a quagmire so I spent a good part of this time, piecing things together, trying to put together a coherent document for her.  In effect, I was doing that hackneyed phrase of "getting my affairs in order."  I was preparing for the worst, hoping for the best, but getting done now what I might not be able to once operations and/or treatments began.  I even reviewed our Trust documents, found questions regarding that, and made a list to discuss with the firm that would become the trustee.  Luckily, friends were around to have dinner with, so there was some diversionary activity, but when I returned to the quiet house at night, dark thoughts interceded.

Finally, Ann returned home last Monday night and so, together, began a week of Doctors' visits, testing, and anxiety.  The surgeon reviewed the Cat Scan with us and was brutally frank in his assessment: it most definitely appears to be cancerous and because of its location and my prior thoracic battle with open heartsurgery, made it unlikely that I would survive the "gold standard" surgical operation of removing the mass.  His recommendation was the "Cyberknife" alternative, a remarkably non-invasive method of "cutting" out the tumor with high dosages of radiation that are aimed directly at the tumor from multiple angles. 

I wondered why everyone would not opt for that treatment, but I suppose the gold standard of surgical removal is "gold" for a good reason.  He explained that when a needle biopsy is done through my back and into the lung, the radiologist would leave a fiducal marker which would be used as a target for the radiation treatment.  As anyone can imagine, we left his office reeling with fear and dread.

First, though, he ordered a PET Scan which I had to prepare for, hoping that it would not reveal any other cancers in my body.  Preparation included not eating any foods with carbs or sugars the day before and then fasting the day of the procedure. The afternoon of the PET Scan I was injected with radioactive isotopes (with their caution that I can't be near children or small pets for six hours afterwards because I would be emitting radiation).  After injection, I had to go into a dark "quiet room" so the radioisotopes could be fully absorbed by my body.  Nearly an hour later, I was led into a room with a long, narrow tube where a full body PET scan and CT was  performed, and had to lie perfectly still in this confined space for a half an hour.  Given what I was likely to go through afterwards during the next several weeks, I thought this a piece of cake.

The following morning, we had to pick up the PET Scan (all images on a disk of course) as well as a radiologist's written report to give to my surgeon with whom we had an appointment only 20 minutes later.  Naturally, we opened the report in the car beforehand, looking for any sign of malignancies elsewhere in my body.  Hooray, there appeared to be none, but reference of course was made to the tumor in my upper left lobe.

So, we arrived at the surgeon's with a list of questions regarding the biopsy, the need for a marker (collapsed lung is frequently the consequence of fiducial markers), the timing of all of this (Ann had a trip to Africa planned which she was planning to cancel that very day), when treatments would begin, the required follow-ups, and of course the prognosis.

When the surgeon and his nurse entered the room, I told him we had peeked at the report, was thrilled there was nothing else, and then started to ask him about the biopsy.  He said, what biopsy, the tumor is benign, that the Pet Scan clearly showed that.  We were stunned.  What?  Huh?  No, he said, the scan showed there were no active cancers.  We had won the lottery he was glad to report (no apologies about his prior certainty that it was cancerous).  Unfortunately, we did not recognize the "doctor speak" when reading the PET Scan report. Phrases referring to the mass --- such as "this is grossly stable; no abnormal uptake is identified" were key, identifying no active cancer, no need for a biopsy at this stage, and only a CAT Scan follow up in 6 months. The tumor might be an old TB granuloma (my speculation), and if so the likelihood that it will become active after all these years is slim to none.

We left his office both stunned and elated, hugging and dancing in the parking lot of the medical office, shocked at this totally unexpected piece of good news.  But the whole experience left me with renewed appreciation of the struggles of any cancer patient and I remember friends such as Peter, Lindy, and Howard, all of whom died of the disease, and of course my own father who had perhaps the worst, pancreatic cancer.  My friend Jeremy (one of Peter's sons) had pancreatic cancer but it was the type that could be addressed by the radical Whipple surgery.  He went through hell, and as a relatively young man, but survived.  It was the same kind of pancreatic cancer Steve Jobs had but who, instead, chose a naturopathic route.

Luckily, we hadn't told the world about the "fact" that I had lung cancer.  We wanted more details from the biopsy first. Nevertheless there were a handful of friends, and of course our sons, who knew what we were going through.  Support is such an essential element in facing this dreaded disease so we thought we would bring a few into our beginning nightmare.  To those we involved in this tale early on, thank you for your emotional support, and we're sorry you, too, were taken on such a distressing emotional ride.

I had but a brief glimpse into the emotional path cancer patients have to walk -- into a void of fear and unknowns that the medical community might be inured to, but not the patients and their loved ones.  I was certain I had read something very profound on that very topic and discovered that a few years ago I had already quoted it in my blog, but it bears repeating here.  It was written by John Updike in his Widows of Eastwick, towards the end of his own life and only one who has walked the walk could have written this (in the novel, Jim has cancer): Jim's illness drove her [Alexandra] and Jim down from safe, arty Taos into the wider society, the valleys of the ailing, a vast herd moving like stampeded bison toward the killing cliff. The socialization forced upon her -- interviews with doctors, most of them unsettlingly young; encounters with nurses, demanded merciful attentions the hospitalized patient was too manly and depressed to ask for himself; commiseration with others in her condition, soon-to-be widows and widowers she would have shunned on the street but now, in these antiseptic hallways, embraced with shared tears -- prepared her for travel in the company of strangers

Briefly I had thought that was to be my own fate, and, just as worse, Ann's, but thankfully not yet.