Blackened, Blue, Bewildered

Finally, I can sit at my keyboard with minimal pain from surgery.  Also, my head is clearer than when I wrote my last entry.

This is a two subject piece but they are related as I’ve come out of surgery pretty beaten up, dark, angry purple bruises on both legs and staples holding the pacemaker “wound” together on my chest, with limited range of my right arm, essentially a metaphor for how I feel about the election.

We all now know that if it were not for the arcane Electoral College method of electing the president, Clinton was the clear winner.  So Trump was right in saying beforehand (haven’t heard it after the election from him, wonder why?) that the system is rigged.  Can you imagine if the results were exactly opposite, Trump winning the popular but losing the EC?  Instead of the relatively peaceful protests we’ve seen spontaneously erupting around the country, we’d have Trump’s heavily armed militia in the streets.  Revolution and bloodshed.  So, in a way, for the safety of our citizens at least short term, this outcome has that one benefit.

Long term, it’s a different deal.  There are so many issues where an unrestrained Trump presidency can wreck the future of this country and the world, that it would be senseless to detail them all here. 

First, though, as much as I thought Trump’s candidacy was a joke during the initial months of the primaries, I took it quite seriously later, my fear growing in direct relation to his Teflon ability to say anything and, what used to matter, our 4^th estate -- the Press -- having little effect to act as a foil.  If I was in a prolonged coma and came out of it to hear a presidential candidate talk about shooting someone on 5^th Ave. with no consequences, grabbing women by their pussies, etc., I would have thought the Press would have been able to eviscerate that candidate long ago.

But cyber bullying was the factor in this campaign which made it unique.  Facebook and Twitter had more to do with the outcome of this election than all the newspapers and TV news media combined. Trump’s attention span is ideally suited to 140 character tweets and his reality TV personality gave him entrée to TV coverage whenever he wanted it, gratis.  And in spite of his racist overtone, he did carry a persuasive populist message, the forgotten plight of the white middle class male.  Whether he can make good on promises to that minority group is highly unlikely, especially with his tax cut proposals which will benefit his own economic class most.  (I don’t believe in trickle down prosperity. The “wealth effect” is to make the wealthy wealthier.)

So based mostly on anecdotal evidence, I thought Trump had a better chance than the polls reflected.  I grew up only a couple of miles from his neighborhood in Queens, NY and we’re almost the same age.  Although more than 50 years have passed since I’ve lived there, if I close my eyes when Trump speaks I hear street talk I’m familiar with.  Between his celebrity status and his strong appeal to the middle class, people were willing to overlook the big picture and especially loved the way he took down the ruling oligarchy (including the now vestigial Press and traditional mass media).  And given the unpredictability of what people do in the privacy of the voting booth (perhaps ashamed to be backing Trump publicly, but will pull the lever for him privately), I went into surgery thinking that this election was a tossup, especially with the FBI making unprecedented statements to Congress and Wiki Leak’s one sided email revelations, so ripe for Trump’s conspiracy campaign (imagine if the RNC’s emails were similarly exposed). 

Thus, nothing about election night truly surprised me.  In fact I called the outcome at 9.20 PM, turned off the TV and went to bed with the residual effects of anesthesia still in my system.  I woke up in pain throughout the night but refused to look at the TV or phone to confirm “my call.”  The next morning my heart sank, in spite of being prepared for the outcome.

So here’s the existential dilemma: how does one, as a citizen of a country he/she loves, support its new leader, while having complete disdain for that leader, his policies, his narcissistic disorders, and fearing the damage he and his administration might do?

While I could go into a long litany of all the specific issues, I’m trying to look at this from 50,000 feet so they don’t overwhelm. To me, I see a world undergoing turbulent change, hastened by a technology revolution.   The industry I came from – publishing --is just one example of the incredible forces of creative destruction that technology has fostered.  More books are being published (including e-books) using far less labor than in the past.  The majority of book titles are now printed on demand.  Warehouses are not needed for those and the process is completely automated.  The whole landscape has changed.  Robots now make the majority of heavy industry products.  This trend is only accelerating.  Capital finds the most efficient venues for its deployment.

Anyone who believes that Trump can simply bring back manufacturing jobs like we once had is self-deluded, abetted by the master manipulator himself, Donald Trump, who told the victims of disintermediation what they wanted to hear…….that things would return to the way they were. 

I do believe there is a path to expanding jobs and prosperity for the forgotten middle class, but it means abandoning the past and embracing the future.  America’s export is intellectual capital and technology.  Our educational system needs to reflect those realities and build our industries with those as a foundation.  Let the manufacturing of goods that require handwork reside in low cost labor countries, such as those which made Trump’s hats.

Going further up from a 50,000 foot overview you see a planet whose delicate atmosphere which protects us from the sun’s ultraviolet light and governs the balance of glaciers, oceans, and climate – all under siege.  Can we afford to aid climate denial forces in our society, simply because it is the easy, short term answer to some of our economic ills?  Here again is both a threat and an opportunity, an opportunity to develop the alternative energy and mass transportation industries, a win-win situation, jobs and a healthier environment for future generations.  America has to lead other countries in this effort. 

We seem to be at a Malthusian tipping point in the history of the world.  Population is growing exponentially but while Malthus was concerned about the food supply keeping pace, little could he foresee the other factor, now a bigger part of the equation of whether humanity can survive changes to the environment itself because of our addiction to fossil fuels.  

So these are just some of the big picture things I’m concerned about.  I want to support my President but I fear that progressives will have to fight tooth and nail, hoping the country can hang on for four years.

If I’m around then, it will because of incredible medical technology, the kind that allowed me to survive my fourth pacemaker implantation with the removal of existing leads being the most dangerous part of the operation.  New leads then had to be implanted, these being MRI compliant which my old leads were not.  As I age, an MRI is inevitable.  First they had to connect me to a temporary pacemaker as I am 100% dependent on the ventricle pacing by threading leads through each of my legs and then to a temporary pacemaker during the operation. Then they opened my chest to remove the existing pacemaker and begin the long arduous task of removing the existing leads, an operation of great delicacy to not injure the heart.  Unfortunately, a small part of the lead in the atrium broke off and the surgeon felt it was just too dangerous to go after that last piece and thus I lost the MRI compliant feature.  Overall the operation went well and now I’m trying to rest and rehabilitate,

I’m grateful to family and friends who expressed so much care and particularly to my wife, Ann, who stayed with me in the hospital room, sleeping on an uncomfortable cot, and watched over things for me, shaving my chest, stomach and legs and helping me take the first of two antiseptic showers before the operation.   I can’t say enough positive things about the nurses at the University of Miami Hospital.  To me they are as important as the surgeon, maybe more so.

Thus, I am slowly getting back to form, but to a political landscape that has been shaped by fear and intolerance.  I have low expectations that Mr. Trump can suddenly function as the leader we all need to help us coalesce as a nation.  His narcissistic personality must be fed and that is going to be a constant obstruction to doing the right thing, such as selecting Cabinet members who are NOT just yes people or those connected to his business interests or family.  Can one imagine Sarah Palin, a climate change denier as Secretary of the Interior as rumored?  He’s already appointed a denier, Myron Ebell, as the head of the EPA transition team.   

My good friend, Artie, reminded me of H.L. Mencken’s prophetic quote from nearly 100 years ago:  “As democracy is perfected, the office of president represents, more and more closely, the inner soul of the people.  On some great and glorious day, the plain folks of the land will reach their heart's desire at last, and the White House will be occupied by a downright fool and a complete moron.  Perhaps that time has come.

Nonetheless I’m desperately trying to end this with something positive:  Trump is now going to become OUR President and I for one will try to give his administration a chance to do some of the right things for the nation as a whole.

After I wrote the preceding though, I read David Remnick’s incredible article from the November 9 issue of The New Yorker, “An American Tragedy,” perhaps the most important of the many I’ve read.  Highly commended.  

Update

Overall the operation was a success.

Home the day after in some pain and residual stupor from four hours under anesthesia. But nothing can compare to waking up this first morning home to the election results, with ominous implications for the world order and the environment.

We should be careful what we wish for but as difficult as it is, time for coming together as a nation and giving the new administration the chance to work for all people. More when I feel up to sitting at my computer. 

Another Health Hurdle

The last time I faced a really serious health problem was sudden open heart surgery.  It was a 15 day ordeal in the hospital, with excessive bleeding and intubation complications causing the long stay and a difficult recovery.  But eventually I got back on the proverbial horse and have been happily riding the trails of life again.

My heart problems are not only those of the “plumbing” variety but electrical as well. As a 54 year old I had to have a pacemaker implanted as my heart was beating only 30 BPM, even though I was going through my usual day at work, driving, etc.  I noted I couldn’t climb a flight of stairs without becoming breathless.  My doctor couldn’t believe I made it through the day without passing out and I was checked into the emergency room.

They suspected an advance case of Lyme disease, which can affect the heart’s electrical system, so I was placed on high dose antibiotics to see whether that would solve the problem.  It did not so a week later a pacemaker was implanted.  That was twenty years ago.  During that period I’ve had the pacemaker replaced two times and the battery on this, the third, is now running down so I thought I would soon be getting my fourth.  Not a big deal swapping pacemakers.  This time around though I was told that the leads implanted 20 years ago were beginning to fail and, now, I am 100% dependent on the pacemaker and have no residual 30 BPM in the bucket.  My life literally hangs by wires connected to a minicomputer under my skin, and a battery.

This is a much more delicate operation, my most serious one since open heart surgery.  Normally this procedure does not involve the invasive opening for bypass surgery, but if anything goes wrong, it could, something I was told I would not “tolerate well.” Nonetheless, I must have a lead extraction; no choice here. 

Rather than going into the details of such an operation, this is a good site if anyone is interested.   The procedure can take up to six hours.

I’ll be going to a leading specialist for such operations, Dr. Roger Carrillo at the University of Miami hospital. So, again, I’m in the hands of a skilled physician at a critical health impasse.  It’s hard not to feel a sense of anxiety, recalling Bette Davis’ comment “growing old isn’t for sissies.”  It is reassuring though to be in good hands, and to have the support of friends and family, and, particularly, my wife, Ann.

I like the early mornings so I leave this entry with pictures of the recent Hunter’s Moon setting down our waterway and the sun rising over the golf course where I walk most mornings.

Reprieve

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.