The American Bottom


"The American Bottom is that 60 mile strip of lowland lying between the bluffs and the east bank of the Mississippi River. Its ealiest recorded history is written in the annals of France, England, and Spain, and the wars these nations fought against each other, and against native Indian tribes for dominion of the New World.


"Following the discoveries of Jolliet and Marquette in 1673 and the exploration of LaSalle in 1682, France claimed possession of the entire Mississippi valley, extending from the Appalachian Mountains in the east to the Spanish Empire in the west. Here in the center of this vast expanse known as the Illinois Country, Louis XIV erected a fort and settlers from Canada and France established the village of Cahokia in 1699, and the villages of St. Phillippe, Fort de Chartres, Prairie du Rocher, and Kaskaskia early in the eighteenth century... ."




From a sign on Illinois Route 3 to Chester.

Good-bye to All That

Yesterday, back with the surgeon for a checkup, and I'm good. Well, 95 percent, and still improving.

What's cancer-free? No detectable evidence of cancer in the body. That's where I am today. It's too early for the petscans and other detection, so this is just based on what he can see and I can feel.

Still, what about that darned occult primary? At this point, four possibilities, more or less in declining order of likelihood: (1) it was scraped up with the other stuff in surgery, and not caught in pathology; (2) the radiation got it; (3) it's still there but too small to see (or worry about), and/or (4) my immune system got it.

It really was a principal reason why I had any radiation at all. But my treatment was limited, and now it shows. I'm back to liking (but not yet loving) hamburgers.

So that's it, until further notice. The blog will stop being a cancer watch, and go back to all those things I care a lot more about. The Republic of Equity... Burr and Hamilton... my new jazz group, as yet unnamed... Sixth Amendment in Missouri.... the Mississippi-Illinois confluence... stuff...

The toad above was sitting by the pool and let me come close to shoot. A nice sunny day in September, when I felt like utter crap. He cheered me up.

What happens to him in November?

Broken System

Before your eyes glaze over at the idea of a discussion of healthcare let me say this is a little different. This is a few thoughts about the national debate from the perspective of a guy who is (a ) a business lawyer and (b) in the middle of cancer treatment. But: policy wonk alert. Go back to cruising hulu if you're just lookin' for fun.

One think that bugs me is the constant reference to the unanimous consensus that the system is broken. Hey... with a typical company medical plan I am using the best medical establishments in the whole damn world, on my way to survival of a serious cancer case, and not having to take on another mortgage to do it. Is this system broken for everyone but me?

This Broken System has placed an internationally recognized cancer treatment center 20 minutes from my house. The people I see in there for treatment are all colors and ages and walks of life. The Broken System treats them all, so far as I can see, with respect and courtesy. I know of no one who has abandoned this Broken System to get care in, say, Spain.

The insurance companies in the Broken System have been who they are: administrators of written policies of insurance. I'm going to have some issues; who wouldn't, with tens of thousands of dollars at stake at every turn. But they are not being evil, and it really offends me to hear the pols try to turn the populace into a lynch mob for evil insurance companies. Medical insurance companies sell coverage (or just administration) to companies based on written plans. If a company were to say - cover all my employees' medical claims, period; if it's a bona fide bill from a medical service provider, pay it -insurance companies could sell that plan, they'd be happy to. It would cost a fortune, however, and no company would buy it. So there are limitations based on pre-existing conditions, levels of care, types of illness that are not covered, location of the providers, etc.

In close cases the insurance companies have the job, as administrators, of making the call. But if something isn't covered, it's because the plan doesn't cover it. Not because insurance company executives are diabolical.

I know that this all is irrelevant to the person who is unemployed, or whose employer doesn't have a plan. They don't have care as good as mine, and it is probably costing society way too much to provide them the care they get. For this I'm sorry. But they don't have food or shelter or education as good as mine either; and I'm sorry for this, too. There is as yet no system that has figured out how to make all these things equal in a multi-cultural, multi-racial nation of more than 300 million people. (Please, forget Denmark. It has 6 million people, 80 percent of whom are fitness-oriented Lutherans. It's not comparable.)

What we do have, for now, is an American system of health care - organic, grown up in markets, complicated, private for those under 65, and with plenty of flaws. Driven in part by a long-standing tax break, where pre-tax dollars are used to pay premiums. It isn't broken. It has flaws that can be identified and addressed, one by one. It will never be perfect and will never, unless we want to become Cuba, provide exactly equal levels of medical care to everyone.

Waking Up

This must happen all the time. After surgery, or radiation, or one of the other dramatic things the medical profession does to us (often for very good reason) there is a period of recovery that includes a lot of discomfort, sleeplessness, disorientation and, well, drugs. It all becomes a muddle, until at some point - a point I reached last weekend - you say, enough. And you quit all the meds.

What happens next probably varies all over the place. In my case it didn't go too well at first and I grabbed for the anti-anxiety pills one of the many docs I have come to know had prescribed. But now I'm past that, and remarkably enough, tonight, on the heels of a really disastrous loss by the Cardinals to the Dodgers, I think I'm waking up.

Doesn't mean I feel like running a marathon or eating a cheeseburger. Still tired. But I'm getting to a level of clarity - and recognition that it's once again an interesting thing to be a man, husband, father, partner in a law firm, with a lot of people and things and events I'm responsible for.

Stop Whinging

I want to move quickly past the last post's woefulness and say once again that my journey has been loaded with blessings. The greatest of these has been reconnection with a lot of people from my past. That's certain. Less certain, but if it stays also a huge benefit, is a serious reexamination of my life and my priorities and making some steps in new directions. And probably most ephemeral, but cool for now, is dropping about 50 pounds and the beard.

Joe Carpenter took the picture, looking north from his balcony, with Forest Park in the background. The balloon race started about 30 minutes later.

Not Wonderful

Six sessions to go.

Well, I promised that when the bad side effects came along I would report. Keepin' my word, even though it's a downer.

Radiation itself is painless, just like an x-ray (which is really just a lower-voltage version.) But in cases like mine, where it zeroes in on your neck, the pain comes from the damage to your neck and mouth.

Mostly it's back to really, really hating putting anything in my mouth. It isn't loss of appetite. It's anti-appetite. Things taste bad, feel bad, leave a bad feeling which I obsessively try to scrub out with mouthwashes, toothbrushes and hacking and spitting like a geezer in a cornfield. Even water tastes salty and stings, so I've come up with this mixture of baking soda and fake sugar that I mix in, and it stings less. The stinging comes from mouth sores (I know, this is way too much information, but if I go totally sardonic and elliptical with this it will not be true.) The diet is principally Ensure Plus, plus a generic Walgreens version because I'm so cheap and don't care about the taste anyway, and Muscle Milk.

I still have a nostalgic memory about the whole tasty food thing. Pizzas look great. But imagining putting a slice in my mouth... no thanks. I'd as soon bite a squirrel.

My skin is increasing looking burned, although recently some friends said it was more George Hamilton than, say, Geronimo.

The process is literally self-destructive. I am strapped down and letting folks blast away with the intention of killing cells. Some mornings you have to march yourself to the appointment, with part of you screaming that you should turn around - indeed, that you never should have done this in the first place. Radiation creates permanent changes that they can't fully predict. These bad side effects are only going to get worse, for weeks after the treatments end.

The answer to this, as I've said before, is that this beats death, and that's what cancer portends. OK. Hard to grasp, though. At no point in the process have I felt like I was dying.

And there is this glorious silver lining. Despite the tut-tutting of my nurses I have lost a ton of weight, and everyone says I look great. I don't yet feel great, but I see it ahead. Next post: pictures!

Second Front

This odyssey has been made more stormy because the treatment, and maybe the cause, of my disease are tangled up with another disease I have had for many years. It's called psoriasis, and I have both skin psoriasis and psoriatic arthritis. The condition first appeared in my 20's, and ramped up hugely in my 40's.

Many people know psoriasis only through a trivializing piece of ad copy from the 1960's, Tegrin's "The Heartbreak of Psoriasis." It seems to put the disease somewhere on the shelf with dandruff and athlete's foot. In fact it is much more serious. It is rarely discussed, and frequently hidden by those who have it. For years I have told people, for example, that I don't like sitting on the beach or swimming. Both are lies. I just didn't want to be seen with my shirt off. In much of history it was conflated with leprosy; in the Middle Ages, for all I know, I would have been wearing a bell. And the arthritis component actually turns out to be even worse. Like rheumatoid arthritis, it causes your joints not just to hurt, but to deteriorate.

Some drugs have appeared in the last few years, and eventually I got to one of them, Humira. Very expensive, self-administered by shots twice a month, in a class called biologics. Humira was a miracle. After several months on it I literally forgot I had psoriasis. My skin cleared and my joints no longer hurt, my hands felt as free and fast on the keyboard as they had in college.

About a month before my cancer was diagnosed I had an episode at the office where, after several days of working on a fairly intense deal, I became unshakably light-headed. One of my partners drove me to the emergency room and the diagnosis was vertigo. Vertigo is another under-appreciated disease (perhaps more a symptom than a disease). It can be quite incapacitating; fortunately there is pretty effective medication. In my case its cause was unknown, but it may well have been caused by stress plus Humira, my wonder drug.

Occasional episodes of vertigo, while not appealing, would not be enough to take me off Humira. But cancer has knocked me off - all the doctors have said to stay off it, at least through the radiation process. So the psoriasis is back, worse every day.

I can live with this for a while, but not forever. It presents me with a dilemma. There appears to be some connection between biologics and cancer, although I have found nothing specifically connecting Humira and my kind of neck cancer. The doctors see no obvious scientific connection. But how would anyone know? This drug is brand new, only approved for psoriasis in the last couple of years. I have found one recent article by dermatologists who recommend more research into whether there may be connections between the new medications for psoriasis and what they call "malignancies."

So there are more waters to cross and suitors to slay (to return to my metaphor) before I settle back down in Ithaca with Penelope. Sharpening my sword.