Cocktail Hour

Three radiation days down, twenty-seven to go. In at 8:30 am, out in under an hour. The photo in the link from my last post is pretty close to me - but eventually I will ask my new techs to take one in my own Silence-of-the-Lambs-y mask.

As before, they really do screw your head down to the gurney. But the machinery is different - more like the PET scans - a big-ass white donut into and out of which you slide. Noisier than before, and a different noise. A shakey-grindey noise that circles around you - the raygun, blasting away. Does not sound like a gun, though - a lot more like a bartender with his shaker. A mixologist, as they say, orbiting around your head. My version of a Stinger, Mr. Morgan - I make it with gin...

Guest Author

Well, for another take on this process you can go here. It's about the coach of the Denver Nuggets. Good luck George.

Speaking

The challenge here is to be a voice, not just words on a screen. It gets really tricky when you are hoping to be facetious, or sarcastic, or using some other emotion where tone and face convey something different or more than the words. Salinger, my hero (see my post 9/13/08) tried to get part way with italics, and I do too.

These days I see folks using emoticons, which strike me as profoundly creepy. My view isn't right, it's snobbish, the users are trying to improve the truth of their communication... but eew.

There are some things that just don't convey without the tone, or the eye contact, or the pursed lips. Take my response to the many good folks who ask how I am, and know that there may be a complicated answer. I say only, "OK." But kind of slow, with a lift at the end. Ooo-kay. Tired of the process, hopeful, grateful for the well-meaning question, not eager to get into detail, without irony. Can you pack that into two syllables that have no intrinsic meaning? I think so. I hope so.

You Don't Have to Be Jewish

One of the best things about driving or biking to work on Saturday is the sight of Jewish families walking to or from their synagogues. I see them and think, peace and civilization.

Wouldn't it be great if we all had to walk somewhere one day a week. Sidewalks, even in the suburbs, with people. Fewer cars. Less machinery, more conversation.

So, by one's faith. Christians: walk to church! Muslims: walk to mosque! Other believers: walk to your congregation! Agnostics: walk to a bookstore! Atheists: walk to a tavern!

The weekends would come alive.

Tick Tock

We are all waiting for something, or more than one thing. Waiting for children to be born: cool, but kind of scary. Waiting for the demise of a relative who might leave you something: grisly, but we all do it. Waiting for warmer days. Waiting for the Second Coming. Waiting, of course, emphatically, whatever it means, for Godot.

At the top of my personal wait list is this radiation thing. I know pretty well what it will be like, and so it isn't really anxiety-provoking. Mostly it's just that the clock slows down, tick... tick... tick.. come on. Get me from here to there.

I'm sleeping a lot. It's a trick I learned from Tom, the lead guitarist in my band in boarding school. Back then we were all waiting, all the time, for the next vacation, really for graduation, really for what we thought would be freedom. Tom's theory was that the more you sleep, the faster times goes by. Of course it also means that you are reducing the amount of time when you otherwise could be conscious and alive. But we didn't think it much of a life (how wrong we were) and wanted it behind us.

I do want this next stage behind me, in that rear-view mirror and growing smaller, and there's a ways till then. Plus I gave up drinking for Lent. Bad idea.

Masque

Today I went in for the new mask.  The old one won't fit my new less-cherubic face.

The mask is used, as those who have followed this saga will recall, to screw my head down to a table while they pull a VW-sized gizmo over me and blast away.  Starts next week, ends  late April, five days a week.  Starts easy.  Ends crappy, if it's like the last time.

The radiation oncologist raised the possibility of chemotherapy as a kind of cherry on the sundae, and I started to get rebellious.  He opined that it was probably not worth the extra "toxicity".  No kidding.

The old mask is in the garage, awaiting a new function. I am thinking of turning it into a birdhouse.

Badda Bing Badda Boom

OK so I've got to go back for more radiation.

The calculus is kind of interesting.  The numbers are based on what I've heard and read but they are basically made up by me,  because I am quickly becoming a class of  very few on this particular neck cancer:  occult primary, removed nodes from left side, radiated left side, found and removed nodes on right side, radiate right side.  My numbers are:  If no radation, odds of very problematic cancer emerging in the next two years:  1 in 10 to 1 in 50.  So this radiation is 90+ percent likely unnecessary.  If radiation, odds of this neck cancer emerging in the next two years: 1 in 50 to 1 in 1000.  If radiation, odds of some kind of damage to the neck over the next 20 years that will be hard to cure:  who knows.  Probably signficant.  If radiation, other immediate side effects:  more whacks, this time maybe cumulatively worse, to taste and the rest of the things that one takes for granted in a normally-functioning bouche.

What I take from this is how much do I want to be on the planet over the next two years; what am I willing to trade to be sure.  ("Sure", of course, subject to the possibility that I could otherwise be run over by a Zamboni.)  The answer is I want it a lot, I'm willing to trade a lot.

The next two years will include at least the births of two more grandchildren, my son's graduation from college, and who knows what else.  Just not going to miss them.

And there will be much more after, I'm sure.  It'll be great.  Watch me.

Chomping at the Bit

A debrief with my cool cat surgeon, and the news is basically good.

The operation was a lot less intrusive than the last one, in part because evidently the right side of my, uh, oral cavity is much more navigable than the left was last year.  This occurs, I suppose, afer years of talking out of only one side of my mouth....

What they found and pulled out were a couple of really small, 3-5 mm, lymph nodes.   Small, in this context, means they don't have a lot of cancer.  It may mean that they were found early but maybe not - in that maybe there is nothing left generating cancer cells at all, and that these are just the residual cancerous nodes left from the cancer that was coursing around before.    So, on that front, either good or better than good.

He carved out more of my neck than just those nodes, in order to try to remove any "surrounding" nodes.  (In quotes for an interesting reason.  Evidently there is a basic, well-established understanding of the plumbing mechanics - the drainage system -  of the lymph system in the neck.  So his view of "surrounding" is not necessarily x centimeters from the suspect nodes.  It is based on the system, and attacks those which are likely to be in the same drainage field.)  All that stuff had no cancer detected.  So it wasn't much in the first place, and it appears to be very localized.

Now I'm back to whether or not to get radiation and if so how much.  Which truly is deja vue, deja vue.  Dr. Haughey is not decided on what to recommend, and so I'm off next to the radiation ongologist for his view.  Which will be, as I said to my buddies at breakfast, like asking the candy man if I should eat candy.

It raises again the questions I struggled with before, and find that no doctor, even a brave one like Dr. Haughey, will weigh in upon with much firmness. Put simply:  what's the benefit, and what's the downside. The problem is that the question is simple at this level but harder when you get past the generalities.  At this point, I either have cancer that still threatens me or I do not.  If I do, will the radiation kill it?  Answer will probably be - probably.  If I do not have it, will the radiation hurt me?  Answer will probably be - yeah but not a lot.  And we can do less this time, so it may not be so bad.  Will it retard the ability to detect problems in the future?  Answer is yes.  Radiation is like leatherizing.  Would doing nothing put me in a position from which I can't recover i.e. that will kill me? Answer will probably be -  very probably not.

And after yes v. no on radiation, it will come down to calibration, as ever.

Today I feel pretty good.  Still a very sore throat, and there seems to be no way to process food or drink so that feels good going down - but unlike last time things don't taste bad.  I still have a wimpy and unsophiticated palate, however, which makes marriage to the world's finest cook a little tricky.  ("It's all lost on me," I'm sure, is not a favored reaction to dinner...)  Valerie the Westie, as a consequence, is dining better than ever, and I know she's grateful.

As am I.

Aphorism No. 2

When in doubt, tell the truth.

Always thought this one was mine. I only learned recently that Mark Twain said it first. Mixed emotions over that - sorry to lose the invention, glad it's one of the two greatest Missourians.*

I use the expression a lot in practice, when advising people how to respond to questioning. It's a cousin to the old maxim of lawyers - never ask a question to which you do not already know the answer.

Twain, of course, had a lot more to say about truth, much of it brilliant. My favorite is another cousin - If you tell the truth you don't have to remember anything.




*The other Missourian being, of course, Harry S Truman.

Aphorism No. 1

You ain't a veteran until you get a few scars.

Year of the Tiger

I'm back home, out from surgery, a lot less debilitating this time.

I'm not sure why. Could be that the first time, I awoke with a log-shaped air tube down my gullet and a feeding tube in my nose. Meds up the wazoo, especially heavy-duty pain meds. Just before this latest event, I was asked if I had any questions and I said yeah, was all that invasion necessary? Well, maybe not, we'll see. This time, I awoke with no tubes, and right now I'm on percocet.

Plus this time I weighed a lot less. That probably helped.

So if you're going in for surgery, I guess the message is get fit and speak up.

Also the omens were good. Mardi Gras. Winter Olympics. Valentines Day. And we are going into my year, the Year of the Tiger. Doubly my year, in fact, since 1950 and 2010 are the years of the Yang Metal Tiger. (The Chinese add one of their basic elements to the 12 "zodiac" signs.) (I have no idea what any of this means, but as usual Wikipedia has a lot to say.)

I don't really know the details of the surgery yet - exactly what was found, what wasn't found, what comes next. Right now I have a sore throat and a droopy thing when I smile, makes me look kind of sneaky.

But I'm back, and best of all, as ever, were the hugely-appreciated words of support. Thanks to one and all. The tiger is back, grateful, and ready to prowl.

Pre Op

Part of the industrial-strength medical world I now inhabit is a visit to the pre-operation screening department, where they nail your insurance, draw some blood, try to figure if you have sleep apnea, and let you know that You Can Always Say Stop.

Well, unless you're unconscious.

I did raise some of the crummier aspects of my last surgical adventure. There was some tut-tutting and at least one nurse who said if the air tube really is killing you, pull it out. If you're awake, you don't need it.

Mound City

At the beginning of the Civil War the Federals moved quickly to secure Little Egypt, the land between the Mississippi and Ohio rivers at the bottom of Illinois. Strategic border territory, even though in a Northern state.

Once secure, the area was a headquarters and provisioner of the River War. Cairo was a communications center and Fort Defiance was at the confluence of the rivers. Just up the Ohio was Mound City, where much of the Federal fleet was built, anchored and maintained.

Today Cairo is a wreck of an old city, like a set for one of those post-apocalyptic films. And its even poorer and more wrecked little cousin is Mound City.

But Mound City was once a great river port, as it says on a marker that is one of the best things left in the town.

"The Marine Ways - During the Civil War, the naval depot of the Western Fleet was located at Mound City. Here the keels of three of the famous Eads ironclad gunboats were laid, and a large force of workmen were employed to keep the fleet in fighting trim. The Marine Ways, still in operation, are 400 yards south of here. Erected by the State of Illinois, 1935."

So I navigated the Jetta 400 yards south, more or less, down some shabby streets, through a gate in a levee, to a desolate stretch of the Ohio River's bank, looking across to Kentucky. The Marine Ways may still have been in operation in 1935, but no longer. There is very little there. No signs, no markers.

But there is something.

Boat ramps. They have a certain dignity. There is nothing else.


Who knows if they are Civil War era. But this was Marine Ways, certainly. Now unattended. One big flood and I doubt anything will be left.

I know a little of the history, though, and it is grand. To you, Mound City, home of the ironclads.

Long Drive

Today a drive to Indiana for a meeting, and back. Just me, the Jetta, my thoughts, over about 400 miles.

Not a bad way to review the bidding. What is odd is that with each turn, the project falls a little farther away from the general pattern. You begin to hear a lot less of the stock patter from doctors - "so, what happens when we are in this situation is...." To really mix up the metaphors: we have left behind the blocking and tackling, and gone to signals called on the field and broken field running.

It's OK. I was never really enough of a jock to do much broken field running. Happy to start, it has a nice leather-helmet stiff-arm college backfield sound to it.

About a year ago, before all this cancer stuff kicked up, I did a similar drive and stopped at Carlyle Lake, in Illinois, where it was mostly me and a lot of gulls, geese, other big winter birds. Some in line formations, high in the sky.

They were back in the sky today, in greater numbers. Sheets of them. We were south of the lake, and I think they were heading for open water.

Not Washington's birthday, more like Lincoln's

They moved the surgery up, to next Monday, President's Day. I guess the markets will be closed. Good thing, you never know what the global financial reaction will be...

One thing I have learned is that when the doc wants to move things up, you should. There is a little cancer bad guy in there shooting darts, and he doesn't hit the bullseye every time. In fact he misses the board a lot. So cutting down on his time at the mark is a good thing, even if it puts stress (which this will) on one's professional life.

Last year's events turned out great in many ways, especially the reactions of my partners and associates, how they stepped up and covered and kept our clients protected and their matters under control. Great. But I let it happen to an extent where I have had to kind of bust my way back into a couple of things, and that's not so great. This time I'm going to try to treat this more like the flu.

Back At Bat

The main emphasis of post-cancer-treatment treatment is testing, to see if it's come back. Evidently the first year is very typically when it does.

In my case, evidently it has.

After the radiation treatment, we let things calm down for some months, then went back to the radiologists' kit bag and did CT scans, visual inspections, and finally a PET scan, my first since long ago. PET scans are where they inject you with a tracer, lie you down on a bed, and run you under a big machine. It detects metabolic activity that indicates cancer.

This new one, done about ten days ago, showed some faint activity on the right side of my neck. (The first time round was the left.) So my surgeon, the cool New Zealander, brought me in and did an ultrasound - the thing they use with pregnant moms to see their babies - and found two lymph nodes that seemed irregular. He did a needle biopsy, and the pathologists' results are now in. The tissues are "suspicious", which according to Dr. Haughey translates to something like a 75 percent risk of cancer.

So, back under the knife, with a procedure very much like last year's. Put me to sleep, remove a large sample of the nodes, test, and if cancerous go in and take out a lot of surrounding tissue. Plus the doc takes what he calls his "little telescopes" to look around the oral cavity and see if can find anything suspicious, which one often does with head and neck cancer.

In my case, of course, we will be resuming the hunt for the occult primary - the primary cancer that we never found the first time. I am starting to think of this as like the hunt for Osama Bin Laden - send in some Special Forces with lasers and get Occulta Bin Cancer.

I go in on Washington's birthday (New System, Julian Calendar), February 22. An auspicious start. Back up at bat, swinging for the fences again.

Fort Girardeau

Once the Civil War broke out, the cities of the border states came into play, nowhere more than in Missouri. The major cities were fortified and the populations - of St. Louis and elsewhere - were put under marshal law.

In connection with my interest in the River War, I checked out Cape Girardeau, where the Federals moved to secure the city with a system of forts - Forts A, B, C, and D - and batteries called Fort Girardeau. Fort D, the principal fort and the only one remaining, is on high bluffs overlooking the Mississippi, some miles upriver from the convergence with the Ohio River at Cairo. It has a commanding view of the Missisippi and the new bridge over the river (the handsome Bill Emerson Memorial Bridge) is a little upstream.



Today's Fort D is located in a poor part of town, maintained by the city and the American Legion. A stone fort at the center of the site and stone gates were built in the 1930's by the WPA.










Some the earthworks remain.

They appear to be as originally sited, although evidently they were reestablished by the WPA.












I did find pieces of what could be the old stone fortifications, with no identifying markers, on the north side of the site


The town fathers of Cape Girardeau seems to position the place as a John Wesley Powell site, which I guess makes sense, as indicated in their website:


"In the summer of 1861 at the beginning of the Civil War, four forts were built around the strategic city of Cape Girardeau on the orders of General John Frèmont. Fort D was designed by German-American engineers from St. Louis. The forts were built by soldiers of the 20th Illinois Infantry, Bissell's Engineers of the West and local militia under the direction of Illinois Lt. John Wesley Powell. Powell, who would later gain fame as the explorer of the Grand Canyon, was detached from his regiment by a newly appointed general... Ulysses S. Grant, in order to raise a local company to man the forts. This Powell did, and his new Battery F served the forts until leaving for the Battle of Shiloh. Fort D featured as many as five cannons, the largest of which could fire a 32-pound cannon ball. The fort was manned throughout the Civil War. Of the four earthen forts only Fort D still exists, an intact survivor thanks to civic action in the 1930's..."

My own take is that Fort D is one of the last surviving examples of Civil War fortifications in Missouri. It is not grand, and its most immediate overlook is a big trashyard between it and the river. But if the trash and the views to the new bridge were cleared, it would be an amazing site.

Dragons

Back in the old days of US v. USSR I used to wonder if it was their economic failures, alone, that made the difference. The sensibility - kind of articulated by an old Robin Williams vehicle, "Moscow on the Hudson" - was that the real failure of the USSR was its failure to deliver consumer goods. There was political and artistic repression, to be sure. But since Khrushchev, the people had found ways to read Ayn Rand and listen to Charlie Parker. The real problems were that they had to stand in line for bread and couldn't buy blue jeans.

Which took me to the next question, and I asked it many times: what if the communists learned how to make economics work? Would that ensure the triumph of the left?

The USSR didn't figure it out, of course. But has China? Has its ability to deliver goods, jobs, infrastructure, et cetera overwhelmed the public desire for a free plebiscite once in a while?

I think the answer is yes.

But that doesn't mean that China will sail bumplessly into the future. They have too much history of political violence. I think the violence, when it comes, will not be because people want a vote and a free press. The impelling forces will be darker - maybe nationalism, Han racism, regionalism - than a democratic instinct. I think - although I have no proof - that the bourgeois democrats have been bought off, and others will make the next revolution against the emperor.

This Man's Best Friend



It's been cold, New Hampshire cold, here in St. Louis and I think Valerie has needed the sweater. She is not completely convinced. But it seems to add a spring to her step - OK, this is his idea of fashion, I'll make the best of it.