Saturday, December 18, 2010

An Uncommon Man

The year is almost over, and I can't think of a better time to post my last blog entry of the year. My last post was about six months ago, and since I can't think of a better topic than the one I was writing about back then, I'll just continue with that topic today.

A while ago, I wrote on my Facebook profile that I had just been diagnosed with two more medical conditions, bringing the total up to four. I mentioned that they began with the letters A, B, C, and D, but I didn't I didn't spell out exactly what they were, so I'll do that now.

A. I keep forgetting about this one, so if I'm not thinking I'll sometimes say it's amnesia, but it's actually anemia, which I was diagnosed with in late June. My count was about half of what it's supposed to be, which meant I was pale and tired all the time. I thought I was pale because I'm a white guy who spends too much time indoors, and I thought I was tired all the time because I was waking up early to go to my physical therapy appointments for my bad back. But I ended up getting a blood transfusion, and my color and energy level eventually got back to normal.

B. This is an old condition, something I've had for about 20 years. I've got a few herniated discs in my lower back, and most of the time they don't bother me, but when they do it's sometimes so debilitating that I can't walk, or sit, or lie down, or do anything else. I don't know if there's a medical term for this condition, so I just call it a bad back.

C. This one's easy. When you think of a medical condition that begins with the letter C, what do you think of? Cystinosis? Conjunctivitis? Chondroblastoma? Chicken Pox? Maybe you do, but chances are you think of cancer instead. I was diagnosed with pancreatic cancer in 2005, and if you know a little about pancreatic cancer, you know that it can be extremely aggressive, but if you know a little more about pancreatic cancer you know that there are two kinds: the aggressive adenocarcinoma (which Patrick Swayze died of not too long ago), and the much less common, much less aggressive islet cell tumor (which Steve Jobs has). As I mentioned once before, I happen to have the less aggressive type, but that's pretty much all Steve Jobs and I have in common, as far as I can tell, other than the fact that we're both male humans of roughly the same age. For example, I'm not a billionaire, I don't wear black t-shirts, I'm not an egotistical despot, and I don't own any Apple products. Of course, there's always a chance that we could have a lot more in common than either of us knows about. For example, we might have the same blood type, or maybe we both enjoy solving crossword puzzles. But getting back to the topic at hand, one of the anti-cancer drugs I was taking has a side-effect of anemia. For various reasons, I'm not taking that drug anymore, and I no longer have anemia. Maybe that's just a coincidence.

D. On the day I found out I had anemia, I also learned that I have diabetes -- type 1 diabetes, to be specific. I don't know if you know this, but you get type 1 diabetes when your pancreas is no longer able to produce insulin, and my poor little cancer-stricken pancreas can no longer cut the mustard in that regard. So I'm pretty sure I got diabetes as a result of having pancreatic cancer. Anyway, it turns out that all that weight I lost was due to my untreated diabetes.

The interesting thing (to me, at least) is that type 1 diabetes is much less common than type 2, just as islet cell tumors are much less common than adenocarcinomas. For what it's worth, I also have a very rare blood type. This is all medically insignificant, of course -- I'm only mentioning it to illustrate that where cancer, diabetes, and blood type are concerned, I am anything but common.

Okay, that's enough of that because, believe it or not, I don't really like talking about my medical health. It sort of feels like I'm violating my own privacy. But here's the thing about cancer and other incurable diseases: People are always saying stupid things like "live life to the fullest" and "live each day as if it were your last." Fortunately, nobody's ever said those things to me, but they're still pretty common sentiments. If you don't believe me, look them up on Google. I did, and here's what I got:

"Live life to the fullest." 2.6 million hits
"Live each day as if it were your last." 62.4 thousand hits
"Live each day to the fullest." 1.79 million hits

I didn't check any of the other linguistic variations on this particular theme, except for this one:
"Living life to the fullest." 306 thousand hits

So it's a popular notion, as well as a romantic one, but the reason I think it's stupid is that, unless I completely misunderstand it, it's just a meaningless platitude. I don't think you should live each day as though it were your last, unless you inhabit some weird sort of artificial reality such as the ones depicted in bad movies. If I thought each day was my last, I'd never do my laundry or clean my house or shop for groceries. And I certainly wouldn't pay any bills. I probably wouldn't even write this blog, and then what condition would the world be in?

But as I said, maybe I don't really understand this idea of living life to the fullest. Maybe you have a different understanding. If you do, you should leave a comment for this post. And if you agree with me, maybe you should also leave a comment, just to let me know I'm not alone. And if you don't have an opinion, or you have an opinion but you're not sure what it is, you should probably still consider leaving me a comment.

I invite all comments, but I know I'm just wasting my breath, because I realize that very few people actually read this blog, and those that do aren't generally inclined toward commenting on my brilliant posts. But today I generously extend the offer anyway, in the spirit of the holiday season.

But to continue with the theme of this post, instead of living life to the fullest, I think you should just take care of the things that need taking care of, and the rest of the time just enjoy yourself. If you're lucky, you'll enjoy taking care of all the things that need taking care of. If not, that's okay too.

Enjoyment is sort of a nebulous concept, of course. We all know what it means, but in practical terms, it means different things to different people, since we don't all enjoy doing the same things. So just decide what it means to you, and then do it.

But you don't have to enjoy yourself to the fullest, just do whatever you want. For example, sometimes I like to do crossword puzzles, sometimes I like to stay up late watching bad movies on cable, and sometimes I like to read the idiotic comments that people post to articles they've read online.

But while we're still on the subject of meaningless expressions, another one I don't really like is "Happy New Year." It's okay as long as you say it to someone during the first week or so of the new year, but it doesn't make sense when you say it during the last few weeks of the old year, which is when you hear it a lot.

You could argue that it's short for "Have a happy new year," but that doesn't make a lot of sense either, since the new year is only new for about a week. So when you say "Have a happy new year," you're telling someone to enjoy the upcoming year, but only while it's still new, which, as I said before, is only for about a week.

So what you should say at the end of every year is, "Have a happy next year," which this year is good all throughout 2011. Or better yet, you should tell people what I'm about to tell you: Have a happy next year, but don't bother trying to live it to the fullest because it won't make you any happier. Just do what needs to be done, and the rest of the time enjoy yourselves.

Sunday, June 27, 2010

Waiting

In my previous post I talked about weight, so in this post I'll talk about waiting.

I've been spending a lot of time in doctors' offices over the past few years, which means I've been spending even more time in waiting rooms.

The time I spend waiting varies from doctor to doctor, but it's usually pretty consistent for each doctor. You shouldn't really have to spend an hour in a waiting room just to see a doctor for five or ten minutes, but I don't really mind, since waiting rooms are sometimes pretty good places to catch up on your reading. Not always, though -- sometimes they're too noisy.

I'm pretty easily distracted, but I don't need absolute silence or anything like that when I'm reading. So if people want to quietly speak to each other, that's fine with me. But a lot of people are unfamiliar with this simple courtesy, so they speak in loud voices and end up making a lot of distracting noise.

As I said, this varies from one waiting room to another, so naturally I have favorites. But in most of my favorite waiting rooms I don't even try to read, since I know from previous experience that the wait won't be more than maybe ten or fifteen minutes.

I have a few herniated disks in my lower back, but most of the time they don't bother me. However, every now and then I'll do something like lift something too heavy, or lift something the wrong way, and I'll end up in severe pain. So I have a back doctor that I see once in a while. You always used to have to wait forever before seeing him, and it was a fairly quiet waiting room, which made it an ideal place to read, as long as you weren't distracted by the intense debilitating pain in your lower back. But the last time I was there, they'd added four or five widescreen TVs that constantly and repeatedly play videos advertising how highly-rated their physicians and orthopedic facilities are. The sound blaring from the speakers was so loud that I couldn't avoid it, no matter where I sat. I tried reading, but it was impossible. The next time I go there, I'll have to bring earplugs.

One of my favorite places to read has always been the outpatient cancer center at Cedars-Sinai. You can usually find a fairly quiet place -- especially now that they've done some remodeling -- which is fortunate, since this is one of the places I usually have to wait the longest. And when the nurse takes you to an examination room, you usually have a pretty long wait there as well, but it's even quieter, except for the occasional nurse who wants to take your blood pressure or your temperature or ask you a bunch of questions about your symptoms or what drugs you're taking.

But even though I just got through telling you about one of my least favorite and most favorite waiting rooms, that isn't really what I wanted to write about.

What I wanted to write about is what I've been reading in some of these waiting rooms. I don't remember everything I read, nor do I remember the order I read them in, so they're listed here in the same order they appear in my bookshelves: alphabetical by author, then chronological by year published, except in cases where there's no room on a particular shelf, which forces me to stack some books on top of the row of books.

First, there's Paul Auster, one of my favorite writers. He's often referred to as a "postmodern" writer, but that's a pretty useless term as far as I'm concerned. Anyway, the books I read in waiting rooms are Travels in the Scriptorium, Man in the Dark, and Invisible. There was a piece on him in the New Yorker a while ago, and not a very complimentary one. The guy said that Auster's work is too formulaic. Well, sometimes it is, I suppose, but that's not necessarily a bad thing, since the formula changes enough from one book to another to keep things interesting.

Then there's Roberto Bolaño, whom everyone seems to like. He was recommended to me by an old friend of mine who also happens to teach poetry at the university level, and even though his tastes and mine don't always mesh, I don't dismiss his recommendations offhandedly. The book I read was The Skating Rink. It got pretty high reviews on Amazon, as did all his other books, but you're probably more interested in what I thought. Well, there is something lyrical about the way he wrote but, sorry all you Bolaño fans out there, this book didn't do much for me. I admit I read it in less-than-ideal circumstances -- I read it on and off over a couple of months, so each time I picked it up, I had almost no memory of what I'd read the previous time. Still, I'm not likely to read another Bolaño book for a while.

This post looks like it's going to be a lot longer than I wanted to be, so from this point forward, I'll try to keep it brief.

The Women by T. C. Boyle: I'm a big fan of Boyle, but I don't always like his historical fiction. (I had to plow my way though Riven Rock, for example, but that was about the worst of it.) The Women is about the women Frank Lloyd Wright was involved with, but no matter how dramatic or explosive those relationships were, after a while I just lost interest. I also thought I should be reading an actual biography of Wright rather than a fictionalized history of him. Still, anything he writes, I'll read, because most of the time I really enjoy his books.

Falling Man by Don DeLillo: I don't remember this book too well -- I vaguely remember that it was somehow related to the 9/11 incidents -- so I'll just say something about DeLillo in general, which is that I tend to like his newer books more than his older ones. His early books seemed heavy and dense, but his more recent stuff seems breezy and airy without being any less engaging.

Shadow Tag by Louise Erdrich: I just finished reading this book a few days ago. Back in the '80s I read a lot of her books, but as they became more about American Indians and less about people in general, I sort of lost interest. But I read a glowing review of Shadow Tag so I decided to pick up a copy. It's definitely worth reading.

The Sea Came in at Midnight, Our Ecstatic Days, and Zeroville by Steve Erickson: I read these books one after the other with no other books in between, which may seem like a lot of Erickson to take in at once, but it turned out to be the right way to do it. The Sea Came in at Midnight and Our Ecstatic Days were written years apart, but in some ways they could be different chapters of a larger book, and Zeroville is just one of those books you don't want to put down, for some strange inexplicable reason. Reading anything by Erickson is usually a challenge, but the rewards are generally worth the effort.

After I finished the Erickson books, I thought about reading the Inherent Vice, the latest book by Thomas Pynchon. I'm so far behind on my Pynchon that it isn't even funny. The last book of his I read was Gravity's Rainbow, and that was back in the '70s. He's written a few books since then, and there a copy of each one in my bookshelves, but I haven't read any of them yet. He can be pretty challenging to read as well, so I decided on something more accessible instead.

But before I get to that, I have to mention David Mitchell's Cloud Atlas. I'm glad he wrote it, and I'm glad I read it, but I honestly don't know if I liked this book or not. Maybe it's because it's actually six loosely-connected books whose literary connection is sometimes more tenuous than the glue and binding that physically holds the pages together. That's not a criticism, though -- it's exactly the way the book should be. Reading it wasn't always that great an experience -- especially the part that was written in some post-apocalyptic patois that bore only the flimsiest resemblance to modern-day English. I'd never heard of David Mitchell before -- maybe you haven't either -- but a lot of people apparently have, and a lot of people apparently liked Cloud Atlas, since it's supposedly being made into a movie sometime this year. When it comes out, I'll definitely see it, if for no other reason than to see how anyone could possibly turn this book into a movie.

Okay, the next book on the list is Noah's Compass by Anne Tyler. This was the book I decided to read after I got through all the Erickson books. I've read every one of her novels, and this is her most recent, but the strange thing is, I don't remember this one at all. I don't know why. But since I liked all her other books, I'm pretty sure I liked this one too. I have a vague memory of reading it, and I have a vague memory of liking it. I just can't remember what it was about. I read the blurb on the book jacket to refresh my memory, and it turns out it's about a guy with amnesia, which is interesting to me but not very helpful. Maybe I'll just have to read it again.

And that, my friends, brings us to the end of the list. I have an appointment with a new doctor on Monday, so I have no idea how long the wait will be, but just to be safe, I've decided to bring a book along. The book is Point Omega, the latest novel by Don DeLillo. I haven't started reading it yet, but if I ever write anything more about doctors' waiting rooms, I'll be sure to let you know what I thought of it.

Sunday, June 13, 2010

I Know What I Weigh

I know how much I weigh, so you don't need to tell me I've lost weight.

Well, strictly speaking, that isn't true, since I don't actually know what I weigh. But I'll address that a little later in this post.

But here's the thing: In the last five years or so, I think I've lost almost 35 pounds -- most of it in the past few years -- and people I barely know are making comments to me about it. It gets sort of tiresome after a while -- especially when they ask how I did it, since I don't even know -- and I guess I'd be happier if the loss of weight weren't so obvious to everyone, but I suppose it's still better than gaining 35 pounds.

If you read my previous post, you know that I was diagnosed with cancer about five years ago, so you might jump to the conclusion that I'm being slowly eaten alive by cancer, and I'm losing weight accordingly.

That idea had crossed my mind, and I still haven't ruled it out, but my oncologist doesn't think it's a factor. He tends not to jump to conclusions, however. So far, in my conversations with him, he has jumped to one conclusion and has refrained from jumping to two others. But as far as my weight loss and cancer are concerned, he doesn't think there's a connection.

He says that people with cancer lose weight when they don't eat enough -- for example, if they can't tolerate their medicines or if they're prone to nausea or if they're just too sick to want to eat.

So far none of those conditions holds true for me. I haven't had any side-effects from the medication, I can't remember the last time I felt nauseous, and I continue to eat like a two-headed pig.

And one other thing: when I said I lost 35 pounds in the last five years, that isn't necessarily true. Since I don't have a scale at home, I never weighed myself. It wasn't until the last five years that I got weighed regularly, because that's when I started seeing doctors regularly. And because I don't have a scale at home, I don't know what I really weigh, since they weigh you when you're fully dressed at all the doctors' offices I've been to.

So perhaps it's appropriate to explore some other possibilities.

Since I'm always weighed with all my clothes on, maybe my weight is remaining constant and my clothing is losing weight. A simple investigation of the lint trap on my clothes dryer seems to confirm this possibility, but I'd have to guess that my clothing has, at most, lost only one or two pounds.

The second possibility has to do with exercise. I know, usually when people stop exercising they get disgusting and flabby and fat, but not always. In my case, I know I've lost some muscle mass, mostly in my thighs. I don't know if I've lost 30 pounds of thigh muscle, but I do know that it's easier to fit into pants.

Or maybe my metabolism is changing as I grow older. I know that as you age, it's harder to stay lean, but maybe I'm an exception. I don't have anything scientific to back this up -- all I have is the fourth possibility, which is that I'm entering the next phase of my metamorphosis.

And by the way, by "metamorphosis," I don't mean that I'm mutating into something (since I believe, possibly incorrectly, that mutation can only occur from one generation to another) -- I'm thinking more along the lines of what happened to Gregor Samsa in the short story "The Metamorphosis." Just to refresh your memory, I'll quote the first sentence from the Willa and Edwin Muir translation: "As Gregor Samsa awoke one morning from uneasy dreams he found himself transformed in his bed into a gigantic insect."

And as a further side-note, in casual discussions about the story, people often talk about how Gregor Samsa turned into a cockroach, but in two of the English translations I know of -- the Muir translation and a translation by Ian Johnston that I just found online -- no mention of the word "cockroach" is ever made.

So I don't know what the next step of my metamorphosis will be -- or even if there will be one. Keep in mind that at this point, it's only a theory, but my guess is that whatever is causing me to lose weight is probably a combination of the possibilities I mentioned above, along with any explanations I'm likely to think of in the future.

But I don't think I'll come up with any future explanations, because the truth is, I don't really care that much. For the last three months or so, my weight hasn't changed at all.

Sunday, May 16, 2010

Five Years of Cancer

It's been five years since I was diagnosed with cancer, so I thought I'd commemorate the event by posting something about it on this blog. But what I'm posting here today isn't something I wrote recently. Sometime in June 2005, after reflecting on my situation for several weeks and organizing a few thoughts that were wandering around in my head, I started writing things down. A few weeks after that, I ended up with what follows.



When I found out I had cancer, I didn't know how to react. I knew I wasn't supposed to be happy -- and I wasn't -- but I thought there were a few stages I was supposed to go through, like denial and anger, which I seemed to have completely bypassed.

(Before I go any further, let me clarify something. I understand that a lot of people have written about their experiences with cancer. I've never read any of those accounts, but I imagine that some of them are uplifting and inspiring, while others are poignant and bittersweet. Some are possibly a combination of the two. This account will be neither, since I'm not particularly inspirational by nature, and I'm not very good at being poignant. With that out of the way, I'll continue with my story.)

You might think that when you're told you've got cancer, it would come as a big shock. Maybe it would, but it didn't for me. One of the reasons the news was so easy to digest in my case is that it was fed to me in small doses. I didn't think I was perfectly healthy one day and find out I had cancer the next -- I learned it slowly over the course of a few weeks.

The first thing I learned was that I had a high level of amylase in my blood. I didn't even know what amylase was, but I found out it's an enzyme secreted by the pancreas. My doctor told me that a high amylase level didn't necessarily mean anything, but he said it was worth looking into. So he ordered a CT Scan.

When I went to get the scan, they had me get out of my clothes and into one of those hospital gowns that tie in the back. The dressing room had a full-length mirror that I couldn't avoid looking into, so I had an opportunity to look at myself without all my clothes on.

The first thing I noticed was how good I looked. I was in pretty good shape for a fifty-year-old guy who hadn't been inside a gym in about fifteen years. (I stopped working out somewhere in my mid-thirties, after I herniated a few disks in my lower back, but that's a story for another day.)

Anyway, I was happy to see how fit I looked. Even if my waist wasn't quite as narrow as it used to be and my upper body wasn't quite as muscular, my torso still looked more like a V more than any other letter in the alphabet. (I'm referring here to the Roman alphabet, by the way. There might be a closer match to my torso shape in the Greek or Cyrillic alphabet, but I haven't verified this.) For the past decade I'd been a vegetarian -- and practically even a vegan -- so I figured I had that to thank for my decent physical condition.

But a few days later, I got the results of the test: a two-inch tumor on my pancreas and a few abnormalities on my liver. My doctor ordered some more tests: a liver biopsy to find out what those spots on my liver were, and an endoscopic ultrasound of the pancreas, which in my case served no purpose other than to facilitate the transfer of money from patient and insurance company to hospital and doctors.

The doctor said I should have those tests right away, but due to an overabundance of sick people, the hospital was all booked so I had to wait a while for the procedures. The liver biopsy was scheduled for the following week, and the endoscopic ultrasound was scheduled for the week after that.

So I had two weeks to learn everything I could on the internet, and everything I read pointed to pancreatic cancer. The most depressing thing I learned is that it's usually fatal and that most people die from it within six months of the initial diagnosis. I started thinking of everything I wanted to do, and I wondered if I'd be dead before I had a chance to do it all. As it turned out, there weren't that many things I wanted to do -- which may be a revealing comment about my life in general -- but six months still didn't seem like a lot of time.

I'll spare you the details of the liver biopsy, other than to tell you that it's about a 30-second procedure that required me to stay in the hospital for seven hours.

Well, I will say one more thing about it. As soon as I found out I had a tumor, I gave up vegetarianism and started eating a lot of salmon. My diet had been heavily carbohydrate-based, which I wanted to change, but mostly I wanted to increase my intake of Omega-3 oils, which I was told have been shown to decrease the size of tumors. The only reason I mention this is that after the biopsy, they showed me the liver samples they removed from my chest, and I thought they looked a lot like slivers of raw salmon.

As for the endoscopic ultrasound, I don't have much to say about it, but only because I was so heavily sedated that I slept through the whole thing.

I didn't mind the tests so much; what I dreaded was the office visit -- the one in which I'd find out the results of the tests. I dreaded the thought of sitting in the waiting room for half an hour, then waiting in an examination room for another half hour, and finally being told that I have cancer.

Fortunately, I never had to endure that particular variety of mental torment. For some reason, when the doctor who performed the endoscopic ultrasound introduced herself to me, she casually mentioned that she had seen the results of the liver biopsy and they indicated that I had a cancerous islet cell tumor in my pancreas that had spread to my liver.

So the office visit on the following day was nothing to dread. I already knew the diagnosis: I had pancreatic cancer that had spread to the liver. That was the bad news. But there was some not-so-bad news as well. According to everything I read, it turns out that as cancers go, pancreatic islet cell tumors aren't so bad. People die from them, but it takes a long time -- a lot longer than six months. And the next day, the doctor more or less confirmed this. He said that islet cell tumors were rare and incurable, but they're slow-growing and not as life-threatening as the more common adenocarcinomas. So after reading so much about pancreatic cancer fatality rates, when I found out I had a less aggressive kind of pancreatic cancer, it was a relief.

As a result, I felt better knowing I had cancer than I did a few days earlier when I still wasn't sure. There probably aren't too many people who can say that.

I was in pretty decent spirits that day, all things considered. I don't know why -- maybe I was just being foolishly optimistic. But when I went to bed that night, I had trouble getting to sleep. It was confirmed: I had cancer. One part of me wondered if I'd live to see the next day, but that wasn't what was troubling me. What kept me awake that night was that I was afraid of what I might dream. I wasn't so worried about having nightmares -- I was more worried about having happy pleasant dreams, only to see them vanish in the morning when the reality of my condition hit me.

But each night was a little easier for me, and not being able to fall asleep at night was never really a problem.

It was harder to wake up each morning and face the day. Sometimes I'd lie in bed and ask myself, "What's the point?" But I don't know if that had anything to do with having cancer, since being able to get out of bed every morning was never one of my strengths to begin with.

I didn't have any symptoms, so most people didn't know I had cancer. I didn't try to hide it from anyone, but I wasn't exactly advertising it either. So one of the problems I faced early on was trying to decide how to respond when someone who didn't know about it asked me something like "How are you?" Most of the time, I just said "Okay," which seemed like a reasonable compromise between "Fine" and "I've got a rare form of incurable cancer."

The first time I did tell someone I had cancer, I heard the words come out of my mouth and they almost startled me. I'd never heard myself say "I have cancer" before. But with each person I told, it got easier for me. So the word "cancer" never had any special power over me. There was another word that gave me a lot of trouble, though. That was the word "incurable." I'd heard that word all my life, but it was just another word to me and I never paid much attention to it. But hearing it applied to a disease of mine gave it a whole new importance.

*

When you find out you have cancer, it's all you can think about at first. Everything else fades into the background. But life goes on and other thoughts keep entering my head, so knowing I have cancer is no longer the first thing on my mind. Sometimes it's the second, sometimes it's even the third or fourth. Sometimes I'm so busy with other things that I don't even think it's on the list.

I don't think about it much anymore, but during the first few weeks after my diagnosis, sometimes I lost my desire to live. It never lasted very long, and I never felt like actually killing myself -- but there were times when I just didn't feel like going on with my life. For example, one time I was stuck on the freeway in a traffic jam that lasted for about half an hour. We were barely moving, and there was nothing to look at except cars and angry drivers and concrete and asphalt in every direction. It was an ugly sight, and I found myself thinking, "This wouldn't be such a terrible place to leave behind."

I don't have thoughts like that anymore, and knowing that I may have a relatively short time left on this planet sometimes fills me with a certain peace. Suddenly, it isn't so important whether or not I accomplish anything significant in my lifetime, and as a more practical matter, I may not have to worry about having enough money for my retirement.

But I still don't have any symptoms, I still look good in front of a full-length mirror, and I feel just as healthy as I ever did, so I haven't stopped contributing to my 401-K plan yet. Maybe I don't know how to be poignant or inspiring, but at least I can be optimistic.