Hair in Como, Head in Thoughts

Hi Friends,
This is a picture of Julie dropping strands of my new hair in Lake Como over the March Break. I was hoping Catherine and I would get there this summer, but that just wasn't meant to be; instead, Julie kindly completed this ritual when she was there on holidays. Thanks, Jul.

Before the blog begins to wind down, I wanted to share a passage that I read months ago that has stayed with me throughout my treatment. Last July, after our dear friend Sharon Rosenberg received her terminal cancer diagnosis and I got a callback for a biopsy, I was trying to make sense of what was happening to Sharon and how to prepare for what might be coming for me. I picked up Sherwin Nuland's How We Die: Reflections on Life's Final Chapter. Both Julie and Catherine had read it and both really found it very compelling; I too found it gripping. In this book, Nuland, a surgeon, describes how many of us are likely to die (heart attack, stroke, cancer, Alzheimer's disease, amongst other ailments), but he does so in a way that is compassionate, poetic, and informative. And unnerving.

When I read his chapter on cancer, I came across these passages, which I'd like to quote at some length:

"Cancer is best viewed as a disease of altered maturation; it is the result of a multistage process of growth and development having gone awry. Under ordinary conditions, normal cells are constantly being replenished as they die, not only by the reproduction of their younger survivors but also by an actively reproducing group of progenitors called stem cells. Stem cells are very immature forms with enormous potential to create new tissue. In order for the progeny of the stem cells to progress to normal maturity, they must pass through a series of steps. As they get closer to full maturity, they lose their ability to proliferate rapidly in proportion to the increase in their ability to perform the functions for which they are intended as grown-ups...[Cancer] is a different creature entirely. Some influence...has acted as the triggering mechanism to interfere so early in the pathway of maturation that the progress of the cells has been stopped at a stage when they still have an infinite capacity to reproduce...Knowing no rules, cancer is amoral. Knowing no purpose other than to destroy life, cancer is immoral. A cluster of malignant cells is a disorganized autonomous mob of maladjusted adolescents, raging against the society from which it sprang. It is a street gang intent on mayhem."

I remember when I read this last description of cancer as a gang of raging adolescents, I put the book down, struck--and alarmed--by this image. Once I had my diagnoses, and told that my tumor was "showing signs of aggression," I imagined my cancer as a nighttime beach party with drunk, strong, out-of-control youth running amok. I worked then to wipe this image from my memory, not wanting to give the cancer too much power. I worked against this image for months.

Then I read Gilda Radner's It's Always Something, the story of her struggle with ovarian cancer. Radner's description of cancer cells was so radically different: she imagined them at dining tables, ready for their meals. But in their gorging, they mistaken chemo drugs for food, are poisoned, and can't recover. Whereas when healthy cells take a hit they get back up, brush themselves off, and resume their predetermined task, cancer cells lie there and whine, then crawl away and die off. I liked Radner's description, and throughout her book I laughed out loud, teared up and cried, but mostly, I took inspiration from her. Loud stupid whiners, that's all they are.

I believe my initial refusal to know the type and strength of the cancer cells helped me in my fight. It wasn't going to help me to know how big the beach bullies were, or how much alcohol they had consumed. Catherine held all of this information for me, and I so appreciate her for that (amongst many other things!). Only once I knew I had a "complete response" could I learn more about what I had been facing.

Of course, not even a clean pathology can guarantee that the cancer is gone. Catherine and I were reminded of this yesterday when we went to see the radiation oncologist. The oncologist was with the patient in the next room a very long time and when she came out, we overheard her dictate that her patient had had a recurrence. It's chilling for me to hear stories like that, they chip away at the confidence I'm so thoroughly enjoying every day.

But, as Radner says, "The goal is to live a full, productive life even with all that ambiguity." As a result of reading her book, I have decided to join Gilda's Club in Toronto. They have Tai chi, yoga, lectures on complimentary medicine, and various other forms of support. Thursday I have my first meeting. I'm not sure what to expect, but I hope, like her book, Gilda's Club inspires me.

Kip