After Surgery

It's now been three weeks since my surgery and I am finally getting down to writing my first post.

First, I'd like to thank Nancy, Sean, and JoAnne for all their help. I couldn't have made it without y'all.

Adjusting to the drastic change in my plumbing has been quite difficult. Trust me, human technology is no substitute for the human body, as "designed" by millions of years of natural selection. The notion that this is how my body is going to work for the rest of my life is taking some getting used to.

So far, my last year of cancer treatment has resulted in a distinct decline in my quality of life in return for a purely theoretical extension in my life expectancy. I guess I won't know for some time how the calculus comes out in the end, but, right now, it's not at all clear that the cost/benefit ratio is less than 1.

Astrodome.

The hotel room where I'm staying the night before my surgery overlooks the Astrodome, where I've attended many a baseball game during my life. I once slept in the parking lot to get playoff tickets. I took my daughter there when she was just a few months old--smuggling beer in her diaper bag to avoid paying high prices for warm beer. On a night like this, it's a good view.

Tomorrow's the Day

Tomorrow's the day for my bladder surgery. At best, the beginning of new way of life. I hope everything turns out OK.

Mutilation

So, next week I'm going into to surgery to have my bladder removed. I'll go under anesthesia with a relatively intact body and wake up with pee coming out of a hole in my belly. I think that this is one of the strange things about cancer therapy in general. As a cancer patient, you let doctors do horrible things to you when you are feeling relatively well in complete reliance on the expert's assertion that, if you don't, you will get sick in the future.

Decisions

My doctor did a cystoscope yesterday and decided after looking around inside my bladder and kidney that the best thing to do is to remove the bladder. This presents all sorts of decisions. What happens if I decide to keep my bladder? If I have it removed, do I replace it with a new surgically constructed bladder (which involves wearing a diaper while being toilet-trained again)or an external stoma (which involves walking around with a bag of pee on my stomach for the rest of my life)? What to do about work, housing, caregiving, etc.? Lots of questions floating around. I need to work on the answers.

Going Home

This morning I'm flying to Philadelphia for a brief visit to see my mother, brother, and sister. I'm going this weekend because next week I'm beginning my treatment at MD Anderson and I suspect that I will not be able travel easily for some time in the future, if ever. Because of their disabilities, my mother and brother can not easily travel from Pennsylvania to Texas to visit me, so I'm going to see them. I'm glad to be able to go, but it will be a bittersweet trip for me.

One-Hoss Shay

Have you heard of the wonderful one-horse shay,
That was built in such a logical way
It ran a hundred years to a day,
And then, of a sudden, it--ah but stay,
I'll tell you what happened without delay,
Oliver Wendell Holmes "The Deacon's Masterpiece or the 'Wonderful One-Hoss Shay'"

For more that sixty years, my body worked pretty well without much intervention by medical science. No broken bones, not much in the way of infections, not too much routine maintenance. I got fat in my forties, but other than slowing me down a bit, it didn't change my general perception that I was a healthy guy. I ate what I wanted, did what I wanted, and generally felt fine.

Last fall that sense came to a sudden end. Within the course of a few weeks, I was labeled a borderline diabetic and diagnosed with urothelial cancer of my kidney. I had my kidney removed and learned to control my blood sugar by changing my diet. I lost a few pounds. I felt pretty normal, but my sense of immunity was gone.

Now, the cancer has come back in my bladder and I have lost all confidence in my body. It's like Oliver Wendall Holmes's "Wonderful One-Hoss Shay," the buggy that was built to last 100 years, each part equally strong. It ran perfectly for a century and then, on the anniversary of its construction, collapsed into a pile of rubble, as every part failed at once. It seems like a perfect metaphor for my situation, but when I've alluded to it, nobody gets it--apparently Holmes isn't much read any more.

So, follow the link and read the poem. It's funny. And it helps me think about my mortality.

What do you think the parson found,
When he got up and stared around?
The poor old chaise in a heap or mound,
As if it had been to the mill and ground!
You see, of course, if you're not a dunce,
How it went to pieces all at once,
All at once, and nothing first,
Just as bubbles do when they burst.

End of the wonderful one-hoss shay.
Logic is logic. That's all I say.

M.D. Anderson

Yesterday, I visited M.D. Anderson Cancer Center for the first time as a patient. This is the cancer hospital in Houston where my wife was treated for almost 7 years before she died. The hospital has grown (sort of like a tumor)during my 11-year absence, and the clinic building was built since my last visit. Nonetheless, much about the place was familiar and it brought back lots of memories.

My doctor seems very knowledgeable and inspired a good deal more confidence than the doctors who have been treating me in Austin. I hope its not too late.

Positive Thinking

Since my diagnosis with bladder cancer, I have had several conversations with friends who have urged me to "think positive!" This is an admonition to which I respond generally negatively, for reasons that go back to the time when my father was dying of cancer in the mid-seventies.

In those days, there was a popular idea that there was a "cancer personality:" introverted, pessimistic. I found the idea hurtful and unscientific. Cancer, I believed, was strictly a consequence of events in the physical world. The idea of preventing or curing cancer by thinking happy thoughts was superstitious nonsense designed to blame the victim and, perhaps obscure the reponsibility of polluters who were pumping carcinogens ino the environment.

Since then, my ideas about how the mind interacts with the body have changed significantly. Since I conceive of human consciousness as a manifestation of physical events in the brain and since we know that the major function of the brain is to control the functioning of the body, it seems perfectly possible to imagine that how a person thinks and feels can effect how his body reacts to cancer or anything else. The brain is an organ of the body connected to the rest of it by nerve, blood, bone, etc. and the function of the brain effects the other organs just as their function effects the brain.

So, what bothers me now about the admonition to "think positive" is not the notion that positive thinking might help, but my inability to understand what it means for "me" to decide how I will think or feel. If my self, my ego, is, in fact, a consequence of my brain function, how can "I" cause my brain to think about things differently when "I" am, in fact, an idea or sensation produced by the material action of my brain? The causation arrow runs the wrong way. Indeed, it seems that my optimism waxes and wanes with my physical state--I think optimistic thoughts when I have had enough sleep and eaten healthy food.

So, rather than trying to fool myself into believing things that are not true, my conclusion is to try to improve my state of mind by taking care of my physical body by making decisions about what to eat, exercise, etc. Hopefully, that will produce the positive brain activity that will help me survive.

A slight change in direction

It's been almost a year since my last post on this blog and I am sure that no one is still checking to see if anything new has been posted. So, I've decided to revive it for a new and different purpose. Maybe someone will find it and read it, but mostly I'm just writing for myself. If you do happen to come across it feel free to comment.

Last September (2010), I was diagnosed with a urothelial tumor in my left kidney. I had my kidney removed and hoped that the surgery would cure the problem. Within a few weeks I was up and about--about 30 pounds lighter and with a big scar on my belly--but otherwise no worse for wear. However, recently I discovered that the cancer has now manifested itself as multiple tumors in my bladder. Obviously, this new development ups the ante considerably.

Next week I'm off for a consult at the GenitoUrinary department at M.D. Anderson Cancer Center in Houston, the same hospital where my late wife, Helen, was treated for breast cancer for almost seven years, a place that, I fervently hoped, I would never see the inside of again. Having confronted death by cancer in people I loved on several occasions, I have developed some pretty definite notions as to how one ought to deal with the challenge of this life-threatening disease. We'll see if I'm up to it now that it's my turn.

My plan is to post ongoing reports on my journey through life as a cancer patient--a journey I've observed from close quarters but never before from the inside. I hope this will be helpful for me, and, if anyone ever reads this, for my readers.