Thursday, May 31, 2007

May 31, 2007 - Seeing the Surgeon

Today I visit the surgeon, Dr. Gornish, in his office, to consult about my upcoming biopsy. I've brought a huge pile of scan results with me, in their oversize envelopes (checked out from the radiology file room at Ocean Medical Center). I asked them to give me everything. It's sort of a data dump, but I didn't want to risk leaving anything behind that the doctor may need.

It turns out Dr. Gornish looks at none of them – the only thing he's interested in is the radiologist's narrative report that Dr. Lerner's office faxed over, describing the results of my recent CT scans of the neck:

"New enlarged right level IB lymph node anterior to the right submandibular gland measuring 21 x 13 mm.

New enlarged right supraclavicular lymph node measuring 19 x 17 mm.

New enlarged aorticopulmonary window lymph node measuring 16 x 15 mm."

That's radiologist- speak. In ordinary parlance, those are lymph nodes near the jaw, near the collarbone and somewhere deep in the chest.

Which one to remove? Dr. Gornish has a clear preference: "I don't do jaws, if I can avoid it." (Maybe because I'd be left with a highly visible scar?) Since the one in the chest is pretty inaccessible, that leaves the one behind my right collarbone as the most likely target. He says he'll plan to remove most or all of it.

He palpates the area by the collarbone, and locates the swollen lymph node. He moves my finger over to it, and I think I can feel it – though, if he hadn't pointed it out, I don't think I'd ever have known the difference between it and the surrounding tissue. Its size – 19 x 17 mm – is about the diameter of a nickel. It's down pretty deep. Because I'm overweight, the surgeon explains, he'll have to cut down through a large area of fat just below the skin, just to reach it. That will make the surgery more difficult – something I remember him saying about my port-implantation surgery a year and a half ago, which was in roughly the same area.

Then, I raise my biggest concern with him: anesthesia. I have sleep apnea, and use a BiPap breathing machine every night to keep my airway open. During my last two surgical experiences – the core-needle biopsy and the port-implantation surgery – I woke up on the table, feeling pain. I understand why this happens: under the relatively light sedation used in these quick operations, if I go into an apneic episode, the anesthesiologist scales back the anesthetic, until I start breathing again. Unfortunately, that also means I start waking up. It's not fun, believe me.

I explain to him that I've discussed the situation with my pulmonologist, Dr. De La Luz, who's offered to consult with the anesthesiologist about getting a BiPap machine, calibrated to my prescription, into the operating room.

Dr. Gornish explains that this is the anesthesiologist's department, not his. He suggests I get the phone number of the anesthesiology group, and talk with that doctor several days ahead of time – not just on the morning of the surgery, which is the usual practice.

I make a mental note to do so – but, to me, it's a tragic illustration of the fragmentation of modern medicine. There are many advantages to the hyper-specialization of medicine, but sometimes there are things that fall through the cracks. My experience has been that the specialists I don't see, or choose for myself – the anesthesiologists, the pathologists, the radiologists – are the ones most likely to cause problems. Most of them perform their narrow specialty duties extraordinarily well, but they don't know us, the patients. They only know a small piece of us. They have no opportunity to consider us holistically. Last time, I mentioned my sleep apnea to Dr. Gornish, and I also mentioned it to the surgical-masked anesthesiologist, as he came in to introduce himself to me, just before they wheeled me into the operating room. By then, it was surely too late to get a BiPap into the operating room, and have it calibrated according to my prescription. Even if I'd been aware of that possibility – and I wasn't, back then – I couldn't have done much about it, other than ask that my port-implantation surgery be postponed (and, with my first chemo treatment planned for the next day, I wasn't about to do that). The result was some really nasty – but entirely preventable – pain.

After speaking with the surgeon, I go into the surgical group's scheduling office. The date they offer me is Monday, June 25th, nearly a month away. (Mental note: call Dr. Lerner's office, and make sure this biopsy truly isn't so urgent.)

June 25th is just two days before Claire and I are due to fly to Utah, for a national retreat for Presbyterian ministers. I ask if I can travel so soon after the surgery. The booking clerk says she doesn't know, but calls Dr. Gornish in, and asks him. He says there's no reason why I can't fly – though I'll be wearing a bulky bandage, and I'll want to bring a lot of extra gauze with me.

No thanks, I think to myself. The retreat would hardly be the relaxing, restorative experience it's meant to be, if I were worrying about caring for a surgical incision. And, if I were to have a post-operative infection, thousands of miles from home – I don't even want to think about that. Better to sacrifice my enrollment deposit than be a nervous wreck for days. (It's a good thing I haven't bought plane tickets yet.)

That timing also means I'll find it difficult to get any quality time in our Adirondacks place this summer. During the month of July, when I'd planned to be up there, I'll need to be running back and forth between Dr. Lerner's and Dr. Portlock's offices, getting their opinions on what the biopsy results mean, for good or for ill.

Bottom line: whether or not this is actually a relapse, cancer is still causing havoc in my life. I'll do what I have to do. But I won't be very happy about it.

Tuesday, May 29, 2007

May 29, 2007 - Peace Comes Dropping Slow

Where do you find peace, when you’re living with cancer?

That’s a question Leroy Sievers posed, in one of his recent blog entries. It generated a vigorous discussion, from many of his readers.

I was led to post a reply myself, quoting a favorite poem, William Butler Yeats’"The Lake Isle of Innisfree":

"I will arise and go now, and go to Innisfree,
And a small cabin build there, of clay and wattles made;
Nine bean rows will I have there, a hive for the honey bee,
And live alone in the bee-loud glade.

And I shall have some peace there, for peace comes dropping slow,
Dropping from the veils of the morning to where the cricket sings;
There midnight's all a glimmer, and noon a purple glow,
And evening full of the linnet's wings.

I will arise and go now, for always night and day
I hear lake water lapping with low sounds by the shore;
While I stand on the roadway, or on the pavements gray,

I hear it in the deep heart's core."

What is it I like about that poem? It celebrates contentment, and gently teaches that contentment is wherever we can find it. For those of us dealing with cancer, that means amidst doctor's appointments, and test results, and side-effects and worries about how we're ever going to pay the medical bills. When else will we ever find peace? The world’s not going to pause for us, while we engage in a quixotic quest for self-fulfillment.

So, where is this idyllic lake isle? It's not a place in terms of geography, at all. It has, rather, to do with the geography of the heart.

The thing the poet teaches me is that peace is found in the dailyness of it all. It's not found in ceaselessly striving for the bigger and the better (as our consumerist culture would have us believe). It's not found in having perfect health (as if there were such a thing). It's found in accepting the good around us as good enough.

I won't deny that the news of my upcoming biopsy has stirred me up a bit, but I’ve been fortunate to discover islands of peace in the midst of it all. Like yesterday evening, for example, as I sat with the family on the front porch, after we’d enjoyed a simple Memorial Day cookout. We sipped coffee, as the warmth of the day turned to cool breezes, and we enjoyed a cake Ania had baked for no particular reason. Her simple joy in baking and decorating it grounded me, and peace came dropping slow.

It truly doesn't get much better than that. In such minor epiphanies can be discerned the gift of peace.

Monday, May 28, 2007

May 28, 2007 - A Humbling Experience

Cancer is a humbling experience.

I'm not talking about the sort of humility that's associated with standing before a crowd at an awards ceremony and saying, "Aw, shucks, lots of other people deserve this coveted award more than me." That sort of humility is usually considered a virtue – although one that, for obvious reasons, is impossible to brag about.

No, I'm talking about the word "humble," used as a verb. To humble others is to force them to their knees, even against their will. Sometimes we can be said to humble ourselves, but the verb ordinarily refers to forcing someone else's compliance.

It's a pretty good word to describe what cancer does. Cancer doesn't necessarily make you humble, in the virtuous sense. A person with cancer is no more likely than anyone else to give the spotlight over to a competitor. Some cancer survivors may count that sort of humility as one of life's learnings, but it hasn't been that way for me, at least not yet.

"Humble" has its roots in the Latin humus, which means soil or earth. What cancer does is place two firm, gauntleted hands on your shoulders and press you down to the ground. Then, it rubs your face in the dirt. It matters not whether this journey from independence to subservience is undertaken willingly. It's going to happen, regardless. Cancer doesn't care. It's one of life's brute forces.

I'm thinking that way as I imagine my calendar for the next few months. I've got many things to do, some of which I've been planning for quite some time: weddings to perform, a trip with Claire to a national Presbyterian pastors' conference, a family trek to North Carolina to celebrate my mother's 80th birthday, my vacation. I've been looking to spend as much of my summer vacation as I can at our little house in the Adirondacks, six and a half hours' drive from home, and – incidentally – my doctors. In a couple of weeks, though, I'll be going under the knife, and that biopsy could change everything – or then again, it may not. In this awkward, in-between time, there's no way of knowing what the next months are going to look like. And that's humbling.

I suppose this is an experience more familiar to people much older than me. Age fifty is not supposed to be the time of life when you have to think twice about writing something on your calendar for two or three months hence, because you're not sure whether you'll feel up to it. I know some eighty- and ninety-something people who have elevated "one day at a time" to a fine art, living from doctor's appointment to doctor's appointment with graceful abandon, but I'm not there yet. A voice in my head screams, this is wrong, wrong, wrong.

This morning, on one of the websites I often visit as part of my ongoing sermon-preparation process, I come across these lines from a poem by John Bunyan, called, "The Shepherd Boy Sings In The Valley Of Humiliation":

He that is down needs fear no fall,
He that is low, no pride;
He that is humble ever shall
Have God to be his guide.

I am content with what I have,
Little be it or much:
And, Lord, contentment still I crave,
Because Thou savest such.

It's true, when you're on the bottom rung of the ladder, you can't fall very far. But, you can't look around and see all that much, either. All of us crave contentment. The trick is, finding it at ground level, with our faces in the humus.

Friday, May 25, 2007

May 25, 2007 - Here We Go Again

Today, I learn that some swollen lymph nodes in the vicinity of my neck will have to be biopsied. I haven't written about this unfolding develop- ment until now, because there's been an element of uncertainty to it. Now that I've got an appointment to consult with a surgeon, though, I suppose I'd better fill in the details.

The roots of this particular chapter of my story go back to March 9, when I met with Dr. Lerner after having a routine PET/CT fusion scan (I did write about that in the blog). A lymph node just below my right jawbone was lit up on the scan, indicating it was swollen. I'd had a cold several days before – which, in itself, could account for the swelling – so, Dr. Lerner thought it best to just watch and wait for a couple of months. When I saw him again on May 11, he spent an unusually long time palpating (feeling with his fingers) two areas: a spot under my right jaw and one behind my right collarbone. He told me he felt something that could be a swollen lymph node, beside the collarbone. It could be nothing, he said – or, it could be a recurrence of the cancer. He ordered an immediate follow-up CT scan of the neck – explaining that, if the area looked problematic, he'd send me to a surgeon for a biopsy.

That's exactly what happened. I went for the CT scan last Friday, May 18, and – with the intervening weekend – it wasn't until yesterday that I heard any more news. Claire was at a hospice team meeting with Dr. Lerner (he's the medical director of the hospice program). She got a few moments with him privately, to ask when he thought my scan results might come in. He said the results had just come in that morning, but he'd only had time to glance at the radiologist's narrative report, and hadn't been able to examine the pictures at all. Based on what the radiologist had written, though, he thought a biopsy was in my future. He told Claire I should call him back today, after he'd had a closer look.

This morning, as instructed, I left a phone message for Dr. Lerner. Around noon, I got a call back from Paula, a physician's assistant who works in his office. Dr. Lerner had asked her to call me, to explain that my CT scan highlighted three different lymph nodes: one by my right collarbone, another under my right jaw, and a third in my chest area. When I asked how that last one had shown up on a CT scan of the neck, she explained that it was in an area at the very edge of the scan – well beyond the neck region, but still visible.

Dr. Gornish, the surgeon - Paula explained - will have to decide which of these lymph nodes is most accessible. She thinks it will probably be the one under the jaw. He'll probably only need to remove one of them, because this surgery is for diagnostic purposes only. (Unlike some other cancers, lymphoma is not generally treated by surgically removing all problematic lymph nodes; one cancerous node indicates that the whole lymphatic system is already compromised, so surgical treatment is futile.) I'll see Dr. Gornish this Thursday, for a consultation.

Yesterday, I also phoned Dr. Portlock's office at Memorial Sloan-Kettering Cancer Center, to get the ball rolling for a second opinion, once the biopsy results come back. I asked Ernestine, the wonderfully helpful receptionist, if Dr. Portlock thought I should have the biopsy done in New York. After speaking with the doctor, she called me back and said that, while they could certainly do the biopsy at MSKCC, I could just as well have it done here, close to home, and bring the tissue samples and scan results into the city when I come to see Dr. Portlock. This is the same thing I did last time, with the core-needle biopsy results. I'm especially eager to have a second opinion, after my experience last time – when the MSKCC pathologist overruled the local pathologist, and changed the grading of my cancer to a more aggressive type.

It's just as well that I'll be having an excisional biopsy. The core-needle biopsy, a year and a half ago, came up with mostly scar tissue. Evidently, the pathologists barely had a big-enough tissue sample to put under the microscope. If there are any lingering doubts about what type of NHL I have, the larger sample, cut from an entire lymph node, ought to put those questions to rest.

So, now it's a waiting game, for the next several weeks. It's excruciating, of course – but, at least I've been there before. I know in advance how agonizing it will be, to have the thought of cancer surface in my mind, at unexpected moments. After a year of relative normality, it looks like everything could go topsy-turvy again.

But, then again, maybe there's some other explanation for the swollen lymph nodes. I'll know soon enough, I suppose...

Monday, May 21, 2007

May 21, 2007 - Healing or Wellness?

This morning I drive over to visit the newly-opened local affiliate of The Wellness Community – a national organization providing “professional programs of emotional support, education, and hope” to people with cancer. It’s in Eatontown, about 25 minutes north of here. They have a great location, just off the Garden State Parkway. The paint on the meeting rooms is still fresh, and not all the furniture has yet arrived, but it’s clear the staff and board members have great plans for the place. Classes, support groups, yoga, qigong, a resource library – all these will be offered to cancer survivors, at no charge.

I’ve gone up for one of their scheduled Newcomers Orientations, but today I’m the only one there. So, my orientation takes the form of a one-on-one chat with Jan, the program director. It turns out Jan knows my wife, Claire. She’s a clinical social worker who served on the same hospice team with Claire about 10 years ago.

In the course of our conversation, the word “healing” comes up. Jan explains it’s the philosophy of The Wellness Community to avoid that word as much as possible, favoring “wellness” instead. The reason is that many people associate “healing” with cure – and, of course, not all cancers can be cured. Would it not give cancer survivors false hope to speak of healing, when many of them will eventually die of the disease, anyway? Wellness is a better word – or, so declared the Community’s late founder, Dr. Harold Benjamin, in his book, From Victim to Victor. I have the sense that Jan may not be 100% on board with this impoverished understanding of healing, but she gamely presents the party line.

It seems to me that, in the 25 years or so since the first Wellness Community was founded, the meaning of the word “healing” has evolved and expanded. Now, it describes so much more than the mere cessation of physical disease. I know, from conversations with Claire about hospice ministry, that hospice team members consider the word to have multiple levels of meaning. Even death, in certain circumstances, can be considered a healing experience.

Leo Tolstoy – the Russian novelist and mystic – once observed that our true life is not the ordinary, material life we see here on this earth. Rather, it is the invisible, inner life of the spirit. The relation of our physical life to our spiritual life is like the relation between the elaborate scaffolding that construction workers put up, and the building itself.

The scaffolding displays the general shape of the true building. It’s easy for uninformed passersby to mistake this aggregation of steel pipe and wooden planks for the real thing – but it’s not. The scaffolding is important, and very necessary to the work of construction, but it’s only temporary. The scaffolding masks the true structure, which is slowly taking shape within, under the tarpaulins. One day the scaffolding will come down, and the true structure will be revealed.

That inner place is where healing happens. There’s no need to shy away from that word – even in cases when it’s clear, to the anxious circle of family and friends gathered around a hospital bed, that death is near.

"For we know that if the earthly tent we live in is destroyed, we have a building from God, a house not made with hands, eternal in the heavens. For in this tent we groan, longing to be clothed with our heavenly dwelling — if indeed, when we have taken it off we will not be found naked. For while we are still in this tent, we groan under our burden, because we wish not to be unclothed but to be further clothed, so that what is mortal may be swallowed up by life." (2 Corinthians 5:1-4)

Wellness is a great word: but healing is better.

Friday, May 18, 2007

May 17, 2007 - Santa of the Chemo Suite

OK, this story's a bit of a tearjerker, but I can't resist posting it. It's one of those little vignettes that portrays the humanity of cancer survivors, even as we're surrounded by all that medical technology.

A cancer patient named Michael Lewis posted it in the response area of Leroy Sievers' "My Cancer" blog on the NPR website. (It's part of Leroy's May 15th blog entry, in case any of you want to look it up in the original context.)

One thing I like about the story is the way it demonstrates how life goes on, even in the midst of cancer treatment...

Early December of 2005 I received a whole new attitude on looks in an elevator at my oncologist's. I'm a 64 year old guy, 5'9", with the rather unattractive little belly we fellows sometimes get. I'm also balding and sport a full, neatly trimmed white beard. The steroids taken with chemo created what my kids called "chipmunk cheeks". I admit that around Christmas time, I let the beard grow a bit and though I have never taken a job as a Santa, it would not take much to do so. I love it that, sometimes, at the market, I get the wide eyed (usually hopeful) glances from little ones. It sure is fun.

Bone tired from chemo, I entered the elevator, really not paying much attention to those around me. I have become accustomed to those tired looks in others and rarely have trouble sorting out the patient from the caregiver. But this day I became aware of the beautiful blue eyes of a six or so year old girl staring up at me. People came off and on the elevator. Finally, I knelt, looking straight into those eyes and, with my best Santa smile quietly said, "Ho Ho Ho". Her eyes widened for just a moment. Then she smiled and said, "Are you really Santa?"

I gave my stock answer, " No, but I help Santa a lot." thinking of the many gifts I had yet to buy. Thinking that this might indeed be the last Christmas with my little blue-eyed girl of 25.

Just then I realized that under her pretty blue scarf, this beautiful child had absolutely no hair. Thankfully, the elevator door opened and some inertia pushed us into the large waiting room.

Ashley, as I was to come to know her, sidled down the long row of chairs. She settled into the chair next to me. We made eye contact, she with a quiet, wistful look only little girls are capable of. I smiled and said, "Hi". We glanced at each others' wrist bands.

She began her conversation casually, as though she were talking about one of her dolls, "I've been very, very sick." she said. I nodded, "I know about that. I've been sick, too."

We continued our conversation for some minutes until her oncology nurse quietly sat by Ashley's side. "I have to go now. Would you walk with me in there?" blue eyes imploring.

"In there" was to the oncology suite. Through a door and down the long corridor I had long ago christened "Valley of the Shadow". Mom and nurse nodded at my enquiring eyes. Ashley slipped her small hand in mine as we walked a long, curtain draped hall to the bed which would be hers today. I sat in the chair beside her as the nurse prepared all the paper wrapped implements. Ashley held my hand. Thank God for lovely oncology nurses who know their business. Small tears at the pain were wiped away. We sat quietly as bags were hung. Chemo is a busy time.

Anne, my oncology nurse, rushed past the room, did a huge double take and blurted, "Michael, I've been looking all over for....." Onc nurses are busy folks and don't like their schedule messed with. But I'm proud of her. She got it right away. Smiling softly at Ashley she said, "I have to take him away now."

Anne and I just cleared her curtains in the Valley before the tears overcame us both. Curious heads bobbed out from curtained cubicles as Ashley's bright voice echoed from linoleum floors, "Thank You, Santa Claus!"

So if that image in the mirror bothers you today, just be thankful that you don't look like Santa Claus. It can be brutal.

As you said, Leroy, "..who ever said this was fair?"

Michael Lewis

Friday, May 11, 2007

May 10, 2007 - The Stupidest Tea-Party

“There was a table set out under a tree in front of the house, and the March Hare and the Hatter were having tea at it.... The table was a large one, but the three were all crowded together at one corner of it. ‘No room! No room!’ they cried out when they saw Alice coming.”

– Lewis Carroll, Alice in Wonderland, chapter VII, “A Mad Tea-Party”

Today I read an article about a situation that’s just about as unhinged as Lewis Carroll’s famed Tea Party. According to a recent study, “U.S. hospitals are charging uninsured patients about two-and-a-half times more than those with health insurance....”

Think about that, for a moment. What sense could it possibly make to charge MORE to people who have no insurance – to people who are not only financially strapped, but sick besides?

“‘The mark-up on hospital care for these individuals, especially for those who can afford it least, is unjustifiable,’ said Gerard Anderson, director of the center for hospital finance and management at Johns Hopkins University's school of public health, and study author.”

Thank you. It’s nice to hear SOMEBODY making sense.

‘Have some wine,’ the March Hare said in an encouraging tone.

Alice looked all round the table, but there was nothing on it but tea. ‘I don’t see any wine,’ she remarked.

‘There isn’t any,’ said the March Hare.

‘Then it wasn’t very civil of you to offer it,’ said Alice angrily.

‘It wasn’t very civil of you to sit down without being invited,’ said the March Hare.

Now, here’s something even more bizarre. Hospitals are billing the uninsured at a rate of two and a half times greater than they bill the insured, but they realistically expect to collect only about ten percent of what they’re billing:

“But patients without health insurance, about 45 million people in the U.S., lack the ability to negotiate. As it stands, hospitals only collect about 10 cents on the dollar charged to uninsured patients, Anderson said.”

So, every time a hospital bills a patient – EVERY time – the amount billed has NO relation to the real cost of the services provided. If the patient’s insured, the hospital bills for the amount the insurance company says it can bill. If the patient’s uninsured, the hospital jacks the sticker price up to an impossibly high amount, an amount the hospital knows it’s not going to get in a million years. It’s an amount calculated to strike terror into the heart of the hapless, uninsured patients – who slit open their window envelopes, weeks later, and instantly have visions of losing home, car, livelihood, everything.

I was at a meeting last week, where I learned that unpaid medical bills are the leading cause of homelessness among the working poor.

Is it any wonder that, the next time these patients get sick, they will do everything possible to avoid seeking medical help? Is it any wonder that a certain percentage of these uninsured patients will DIE as a result of that desperate decision – as more than 18,000 uninsured Americans do die needlessly, every year?

“‘Take some more tea, the March Hare said to Alice, very earnestly.

‘I’ve had nothing yet, Alice replied, in an offended tone: ‘so I can’t take more.’

‘You mean you can’t take less,’ said the Hatter: ‘it’s very easy to take more than nothing.’

‘Nobody asked your opinion,’ said Alice.

‘Who’s making personal remarks now?’ the Hatter asked triumphantly.

“The real problem of course, is that we live in a country where we don’t guarantee coverage for everybody,” [AHA policy analyst Carmela] Coyle said."

THANK YOU! It’s nice to hear somebody else making some sense, for a change – so very refreshing. But, the strange creatures gathered round the table aren’t hearing. They’re still not pouring any tea.

“This piece of rudeness was more than Alice could bear: she got up in great disgust, and walked off: the Dormouse fell asleep instantly, and neither of the others took the least notice of her going, though she looked back once or twice, half hoping they would call after her: the last time she saw them, they were trying to put the Dormouse into the teapot.

‘At any rate I’ll never go there again!’ said Alice. ‘It’s the stupidest tea-party I ever was at in all my life!’”

Monday, May 07, 2007

May 7, 2007 - Glad I Didn't Miss It

Every once in a while there comes one of those moments that makes a parent’s heart fairly burst with pride. Yesterday afternoon, our son, Benjamin, had his senior recital at Monmouth University, where he’s a music major (soon to graduate). His instrument is guitar, and he also sings.

This e-mail he shared with me – from Monmouth University music professor David Trippoldt to Department of Music and Theater Arts chair, John Burke - says it all...

Dear Jack,

This is only the second recital that I've attended at MU that I had wished that we had a designation of credit with honors. Ben Wilton has set the standard for what a "popular" music venue recital can be. He beautifully navigated a recital of many musical genres commencing with two classical guitar pieces, then four acoustic folk and pop classics, playing and singing such beloved tunes as Norwegian Wood, by John Lennon and "Blowin' in the Wind," by Bob Dylan, then to electric lead in a jazz trio, playing such classic tunes as "Four" by Miles Davis, "Equinox" by John Coltrane, and "Take Five," by Paul Desmond. Finally, he performed two original songs with his rock band named "Garuda." The group played very, very well, the drummer our very own Anthony Leprotto, offering up fine guitar solo work in a quasi latin/rock mixture. The concert consisted of 15 pieces in all, each performed with great style and with careful attention to stylistic accuracy, ensemble balance and blend. Ben sang well and played the guitar exceedingly well, improvising most effectively in the jazz pieces. The very satisfied audience of 75-90 included Professor Rotella and Laura Dubois. This comes on the heels of Ben's super performance as bass soloist in the Haydn mass a couple of weeks ago. This is what a popular musician should be - musically literate, historically grounded, and artistically sensitive.

Bravo Ben!

Dave T.

I’ve heard people with cancer say things like, “I want to be around to see my child graduate from college... get married... (whatever).” I’m just glad I’m in remission, and that I had this opportunity to hear this fantastic concert. Truly, it's a day I’ll always remember.

Enough said.

Ben, we love you, and we’re very proud of you.

Saturday, May 05, 2007

May 5, 2007 - Losing My Edge (Or, Regaining It)?

“Procrastination,” they say, “is the thief of time.” That particular thief’s been nosing around my house in recent months, and I don’t like it.

Lately, I’ve been feeling overwhelmed by various long-term projects, both professional and personal. I’ve gotten myself into the position more than once of putting things off till the last minute, then working frantically to meet the deadline. Some deadlines I’ve missed altogether.

E-mail is part of the reason. Like a lot of people these days, I feel swamped by a rapidly-rising tide of e-mails, many of them trivial. Reading and responding to these ephemeral messages devours a growing amount of my time. We’re all learning how to use this technology, which is still in its infancy. Some of us are more adept than others. It’s so easy to click on our mail program’s “forward” or “reply all” buttons, thereby multiplying exponentially the hours everyone has to spend slogging through these messages.

Yet, e-mail isn’t the only reason. I’m coming to realize that one of the side-effects of cancer treatment, at least for me, is a cranky refusal to put up with the trivial. At times, I’ve had a devil-may-care attitude about lots of mundane-but-important tasks: “I’ve just been duking it out with cancer, and you dare ask me to fill out my income-tax return?” (I’ve gotten an extension on my taxes, this year.) Life is filled with deadlines: and, cancer or no cancer, many of them come back and bite you eventually, if you keep putting them off.

Post-chemo recovery is deceptive: you feel like you’re back to normal, but you’re really not. There’s a certain lack of focus, a fear that perhaps you’re losing your edge. With cancer, you just don’t wake up someday and say, “I’m better, now.” The PET scan results may keep coming back clean, but that doesn’t mean you’re not still living with certain more subtle, long-term effects of the disease.

Stephen Covey’s bestseller, The Seven Habits of Highly Effective People, contains a memorable illustration he calls “sharpening the saw.” Covey tells of two lumberjacks who are laboring hard to cut down a mighty tree, using an old-fashioned cross-cut saw. Back and forth they pull the saw, their motions synchronized in perfect rhythm. Yet, the longer they work, the less effective their labors become. Each stroke seems to be taking a smaller bite out of the tree trunk. Stubbornly, the laborers keep sawing.

What they need to do, Covey says, is to stop and sharpen the saw. But there’s something soothing, even hypnotic, about the rhythm of the sawing. The more exhausted they become, the more easy it is to imagine that if they just keep going, they’ll finish the job. “Who’s got time to stop and sharpen the saw?" they think to themselves.

I’m still trying to figure out what it means for me to sharpen the saw, in these months after cancer treatment.

Thursday, May 03, 2007

May 3, 2007 - Cancer Sound Bites

This evening, I attend an organizational meeting for a community-action group that's seeking to address the homelessness problem in our county. At the meeting, there are several people I know from other gatherings of this sort, church folk from other congregations in the area. Milling around in the time before the meeting, several of them come up to me and ask how I'm doing, in a focused way that clearly indicates they want to hear about my medical condition. Word does get around – or, more accurately, it got around a long time ago, but people evidently still look at me and think, "Cancer."

I respond with the answer I've gotten used to giving, in recent months: I'm in remission, finished chemo a year ago, getting scans every three months – so far, so good. (I use a few more words than that to tell the tale, but that's the gist of it.)

My questioners smile, say they're glad to hear it, tell me I'm looking good. All very warm and supportive, in a casual, "Hey, I haven't seen you in a while" sort of way.

It's a story I've gotten used to telling. One of the life-skills you need, as a cancer patient in remission, is the ability to dispense a summary medical report in succinct, sound-bite fashion, at a moment's notice. Inquiring minds want to know.

I do appreciate the inquiries. It feels good that people remember, and remember to ask. I wonder how many prayer lists I must have been on, back when I was popping prednisone pills and had no hair. I wonder how long this earnest, supportive questioning is going to last – how long before people will look at me, and not think of me as that guy with cancer.

It may be a while.

If I'd been walking around, back then, on crutches, with my leg in a cast, the first word out of people's mouths when they see me, a year later, probably wouldn't be, "How's the leg?" Cancer's different. Once you bear that label, you're tainted. You become the subject of earnest entreaties, far into the unpredictable future. A broken leg will heal; everybody knows that. But cancer? It continues to stalk its victims, its hollow footfalls sounding at a distance. Look back over your shoulder, and you see nothing . But, take a few more steps down the deserted sidewalk, and you hear those footfalls again – or do you?