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Bad Chinese Food • Good Fortune

Cancer as Metaphor 2009:

David Sedaris suggests some children’s reenactment of the Christmas story should come to an immediate halt, “if there’s a cancer, you must treat it at the earliest possible opportunity.”

President Calderon, responding to the killings of a police officer’s family by Mexican drug kingpins, “These contemptible events are proof of how unscrupulously organized crime operates, attacking innocent lives. And they can only strengthen us in our determination to banish this singular cancer.”

An Afghani spokesman says of his own country: “Corruption is the cancer that is spreading across our country.”

Home
The day after I get home from the hospital, my partner leaves on a business trip. Two of my best friends come to take care of me. We all like good food and I remember the surgeon’s parting words, “Eat whatever you want to.” On my second evening home we share Mexican food, by the second weekend, Chinese. The next day, when the friends are about to leave, my ornery intestines rebel once again. My partner gets home and I reveal my distress but declare that I will soldier on. By one in the morning the intestines are battering relentlessly. I call the advice nurse at Kaiser. She recommends a trip to emergency in case an infection has set in. I wake up my travel weary partner and apologize, “I have to go back to the hospital.” On the way there I lose my cookies and moan. The emergency doctor orders a bunch of tests: a full torso CT scan, vaginal ultrasound, blood work, and IV morphine. By six in the morning it is time for another Lovenox shot. The attending nurse bustles about and says, “I can give it to you. Do you want me to give it to you. I can give it to you or do you want to do it?” In a morphine stupor I mumble agreeably, “You can do it.” She holds the syringe two feet above my abdomen, aims and POW!, like a hawk plummeting for prey, she plunges the needle into my belly.

All the tests are negative. The blood work shows mild dehydration and anemia. The severe pain has subsided. Conclusion: the guts were not awake enough for Chinese food.

When I get home, my oby-gyn calls to see how I am doing, having heard that I went back to the hospital. “Well here is some good news, she says, the pathology report says there is no papillary serous.”

I can’t believe my ears. I’m ecstatic. I want to cry with joy and thank her for telling me. Why hasn’t the surgeon/oncologist called? Doesn’t he know that my future has been teetering on a pin head, hanging from a thread, dangling on edge? (Am I forgetting once again how many patients he has?) Relief makes it easy to forgive him. I cannot eat anything but saltines and water; I cannot sit up without assistance; all my internal female parts and more have been extracted, but I am not one of the 10% of endometrial cancer patients* who have papillary serous.

*Uterine papillary serous carcinoma (UPSC) accounts for 10% of endometrial carcinomas but a higher proportion of deaths due to its aggressive nature and poor response to chemotherapy and radiotherapy.

Faratian D, Stillie A, Busby-Earle RM, Cowie VJ, Monaghan H.
Department of Laboratory Services (Pathology), Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK.

I mourn for the women who are afflicted with this aggressive cancer.

A few days later the oncologist’s office calls to make my follow up appointment, at which time he will discuss my prognosis. His assistant gives no indication that there is no papillary serous carcinoma. Should I believe my good news any less? My trust in the accuracy of diagnosis is tentative. A misplaced test tube, a switched slide, the wrong stain, the misspelling of a name. So many things can go wrong.

When I go back to the oncologist he says, “The good news is you do not have papillary serous. You do not have to have chemotherapy, only radiation. But you still have a stage two cancer. It can show up again anywhere in your body, in any organ, at any time.

Tributes 2010

Jan 19, 2010:  Kate McGarrigle, Canadian singer-songwriter, dies aged 63; had been battling cancer since the summer of 2006. The cancer started in her small intestine and spread to her liver.

We watch a PBS Special about opera auditions at the Met and fall in love with a 30 year old black singer, Ryan Smith, who, with little formal training makes it to the finals and embarks on his singing career. We feel triumphant until the credits. Just months after the film was completed, November 2008, he died of lymphoma.

Focus


The diagram of health in and out of balance haunts me (see blog entry “Out of Balance”). The misaligned wedges seem to be a metaphor for my eclectic life. During my childhood, my mother’s perpetual quest was that I should not grow up to be like her – in want of a self-defining career. She encouraged me to explore, to try many different things, and I followed her lead.

My Mother's Wishes
Her efforts however were to no avail. When grownups asked me what I wanted to be when I grew up, I responded with no hesitation, “A nothing, just like Mommy.” She was funny, creative, generous. I didn’t care that she wasn’t a “Something.” Secretly, I had my own ideas about the perfect career.

Juggling Tadpole
The circus did not sweep me up. Though not a believer in such things, I have felt condemned since first reading my astrological chart: Cancer: Born between June 22 and July 22; creative, nurturing, indecisive. I have changed my focus too frequently to feel accomplished in any one area . Did this inability to set long term goals ultimately lead to frustration and stress, and stress to cancer?

Out of Alignment

If I had exercised singleness of purpose, would I have fought off the disease? One thing is certain. Getting a cancer diagnosis focuses all one’s energies.

Aligned

Out of Balance

When I get home, there is nothing I can do but heal and think, learn to navigate with severed abdominal muscles, research cancer, and try not to anticipate what the pathologists have found. I feel tender, smaller that the diminished sum of my parts. My belly swells over a ledge of sutures. I sit in a recliner and watch the world spin outside my narrowed boundaries. I read a book called ANTI-CANCER by David Serban-Schreiber, a doctor who survived brain cancer. He suggests that health and well being depend on the balance of our bodies’ various systems: autonomic, hormonal, emotional, and on the communication between these systems. If the communication is good, health emerges. If not, it vanishes. He uses this diagram to illustrate this idea:

The Balance of Being

The triangle is suggested by the correct positioning of the circles and their missing wedges, but they do not touch – implying that health is delicate, improbable, ineffable, like gravity. The slightest nudge could knock one of those circles out of orbit. Within a few days of being home, something has nudged one of my wedges.

Out of Balance

“Don’t worry,” says the advice nurse. “You have a yeast infection. The antibiotics you were on during surgery killed the bacteria that keep those yeast in check. We’ll give you a cream that will knock out the yeast. Start taking acidophilus.” “And what about giving myself the Lovenox where the yeast is? Will this shove them inside and wreck some other havoc?” “I don’t think so, but how about giving yourself the shots in your thigh?” I try this. The skin is tougher there and it hurts, but not a big price to pay as I nudge myself back toward balance. The implication here is that if health is so delicate, then some wispy hair trigger may control cancer.

Where do Sharps Go and What About All Those Dying Frogs?

Before the nurse discharges me, she shows me how to administer shots of Lovenox subcutaneously. “What’s it for?” “To prevent blot clots. Squeeze a small mound of belly flesh, gently insert the needle, slowly depress the syringe. Do it twice a day for the next 10 days.” She hands me the Lovenox kit. It is a box decorated with the faces of people over fifty. They smile against a background of butter yellow and baby blue – peaceful colors, calm colors, colors that say “Your blood will not clot, you will not have a post-surgery stroke.” Inside the box are multiple prefilled syringes and a red plastic container, a “sharps” depository, where I am supposed to put the used syringes. Then what?

Where Do Sharps Go?

On My Way Home

After the surgery the nurses give me four days of solicitous care. Round the clock, with patience and forbearance, they combat pain and discomfort. The sleepy intestines wake up in fits and starts, having been doused from one end with drugs that induce queeziness, from the other with drugs that suppress it. My stomach muscles are as sore as ever and there seems to be a disconnect between my brain and leg muscles. Remember those experiments – amputated frogs’ legs strung up to wires and zapped with electricity. Lo and behold they still twitched – with no brain attached. I could use a little zap right now to get things working properly. Regardless, the surgeon checks my wound again and says I can go home the following day. It’s good news, though I feel glass fragile. I’m about to leave under the weight of a staggering number of presents and flowers, wondering if he will stop by to bid me farewell, when I hear someone charging down the hallway.
Ready to Leave the Hospital

“Take it easy. It will take you about 6 weeks to regain your stamina. Eat whatever you want to. We’ll contact you after I hear from the pathologist and call you for a follow up appointment.” He gives me a big hug and is gone, on to the next conquest.

I believe in him. I believe that he routed out all those virulent papillary serous cells and I will embark on life again.

Friends and Endless Questions

My friends and family hold vigil over me while I am in the hospital for 5 days. Mostly I am in a Dilaudid stupor and feel pretty good except for stomach muscles that refuse to lift or push. Sitting up is a challenge. My belly is swollen as though I am pregnant, which I have never been and of course never will be. I have time on my hands and begin to wonder again. I am filled with questions – and remember my first high school chemistry assignment. Write down as many questions as you can think of about a burning candle. I couldn’t think of any. At the time I was looking for answers, not questions, for stasis and solidity, for things to Be. I got lost and stuck in the names of things. Language, the very act of naming which is supposed to clarify, to enable knowledge to expand, got in my way.

What is a Candle?
I wanted things to be tidy like math seemed to be, with one right answer. But that same year my calculus teacher introduced irrational numbers and the concept of limits, of values that approach precision but never really reach it. Literature was the worst – open to interpretation. It presented no concrete answers. Two Kennedy’s and Martin Luther King were shot. Nothing was stable. Not numbers, not the US government. I seemed to live in a constant state of ambiguity and wanted out. But there is no getting out, even some 40 years later, and now I have questions, bundles of questions: I want to know. Did the surgeon get out all the cancer? Did some microscopic remnant remain that could travel to my heart, liver, lungs brain? How does the hospital dispose of cancerous tissue? Where do dead cancer cells end up? In land fill? Is their DNA capable of going dormant, of staying intact without a body to inhabit? What is cancer exactly? Who are we anyway? Supposing one of our primary purposes is to evolve through mutation or to host millions of other organisms – and all the rest – truth, beauty and the pursuit of happiness are just accidents of an upright stance and a larger brain. Whether intended to be or not, we definitely are hosts:

Science Daily (June 5, 2008) — The number of bacteria living within the body of the average healthy adult human are estimated to outnumber human cells 10 to 1.

According to a well referenced article in Wikipedia, we each have about 1013 human cells and these host 1014 bacterial cells, some living symbiotically and helping us digest carbohydrates. Others are potential pathogens waiting for our immune systems to be compromised.

But what about cancer? What is the advantage in killing your host? No wonder my cancer cells are freaking out.

Distraught Cancer Cell
According to the American Cancer Society:
Cancer begins when cells in a part of the body start to grow out of control. There are many kinds of cancer, but they all start because of out-of-control growth of abnormal cells.

Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells.

What if cancer holds the secret to longer life, what if it could be made to form new normal cells instead of abnormal? Could we possibly put cancer to some good use? What triggers the very first mutation that makes a cell cancerous – and is one cell enough to start the ball rolling or do bunches of cells have to mutate at the same time? What triggers cancer to metastasize? How does it travel from one part of the body to another – through blood? Lymph? Along nerve pathways? Are cancer cells a different color from the host tissue? Different texture? Why does one person and not the next get cancer? Why Me? (That again.) Because of all the toxic chemicals I have been exposed to?

toxic_things

Because I never had a baby, ate too much soy, had too much estrogen? Will nano technology finally CURE CANCER?

The gifts in my room pile up. Prayers come from every direction. Some fly across great distances. One friend sends  good wishes from the north rim of the Grand Canyon, “I was sitting at Bright Angel point . . . for (your) metta meditation.  I can still feel that absolute sense of peace with the rock under and around me and that vast canyon in front as the sun started to reveal it.”

Sometimes I Cannot Breathe

This week – October 27th 2009:
Sleepless at five in the morning, I read. In her collection, Unaccustomed Earth, Jhumpa Lahiri tells a story from the point of view of young girl who is embarrassed to observe the large nipples of a grown woman, a friend of the family, as they try on bras together. Later this woman dies of breast cancer. There are other hints of her illness. Her husband indulges her every whim, buys first class tickets from India to the U.S., looks for a palatial house to buy, brings her a sweater when it is inconveniently upstairs, far away. This is great writing: to nudge the reader so gently toward tragedy, that its denouement is a shock. This is how cancer appears, first secretly, and then with terrible consequences.

Yesterday in the obituaries, there were four pronounced deaths from cancer, today two. Some families choose not to reveal the cause of death. One of the cancer victims has windswept hair. She is middle aged but looks young, vibrant, athletic. A scarf sweeps over her left shoulder. Though all we see is her face and shoulders, it seems like she is standing on a promontory after hiking to a high elevation. She is smiling with that look of accomplishment one has after physical exertion. Sometimes I think of cancer not as a the executioner, but as something necessary that culls the population because there are too many of us, as something as natural as breath. Other times I am filled with terror of its sudden greed.

Sometimes I Cannot Breathe

Woozy and Uncomfortable

The surgeon comes to see me after the surgery. An intern accompanies him. She is tall and willowy and has a faint accent that renders her exotic and appealing. They are both smiling. “The surgery went well ,” he says. Now we wait for the pathology report. That will take one to two weeks, and will let us know whether the cancer has spread. We’re going to keep you here for a few days until your bowel wakes up. Intestines are weird. They don’t like to be disturbed and go to sleep after surgeries like this.“

“Could you see the cancer? Did it spread? Was it in my lymph nodes?” He is patient with me. “I don’t know. The way it works is that as I remove tissue, a runner takes it to the pathology lab and they examine it. I removed everything I told you I would remove. You may or may not have a reaction to the lymph node removal – some times this can cause a swelling in your legs that may be permanent, may be temporary – or may not happen at all.” He checks my wound. “Looks good!”

To me it looks ragged, messy, crude, as though he had used a serrated knife to slice through my abdomen. There are no external stitches or staples, just a long row of butterfly bandages sealing the wound. Under each one is a smear of dried blood. I prefer not to look at it.

My stomach muscles have been severed; my intestines and bowel are asleep. On the second day after the surgery I am so dizzy I cannot even turn my head without feeling waves of nausea. Maybe it is the Dilaudid. Maybe it is just the overwhelming trauma my system has just borne. By the third day I am starving and eat with relish when the aid brings my first real meal. My guts are not ready for the onslaught.

Intestines Sleep

Close Up of Sleeping Intestines:

Intestines Sleep Close-Up

In the mean time my room is festooned with flowers. Friends and family visit and bring books and get well cards. One friend brings a multicolored striped ski cap for the anticipated hair loss. I am touched by this.

Waking From Oblivion

Just before the surgery, I decide I must see my Chinese Acupuncturist. I have not seen him for a few years. He looks at my face and says “You have had a lot of stress. I can treat you for this. We can save your uterus.”  “For what ?” I ask. Startled, he looks into my eyes. He sees my fear and confusion, sees that I am determined to extract the cells gone haywire. He takes my hand, feels my pulse. “Never mind I said that. You go ahead with the surgery. You will survive this. Don’t you worry. I will give you a treatment today to make you strong. You come back again after the surgery. Don’t worry.”

The day of the surgery arrives. I dress in the requisite backward facing gown and lie waiting on a gurney. The surgeon comes to make sure I understand the imminent procedure. “As I remove the uterus, ovaries, omentum, cervix, lymph nodes, the pathologist will check them for cancer cells.” “How many lymph nodes will you take out?” “As many as I feel necessary.” I wonder how many I have, how many I can afford to lose. These worry me more than any other body part. In my private book of cancer, contaminated lymph nodes mean metastasis and metastasis means death.

The nurse inserts an IV that starts me on powerful antibiotics. The anesthesiologist patiently explains everything she will administer. The conversation is long and drawn out. The plunge into oblivion is immediate. I am vaguely aware of being rolled away. Suddenly I am being transferred from one surface to another and feel agonizing pain in my gut. “Ih huhrs! Ih huhrs!” I cry out, aware momentarily of the frustration stroke victims must feel when they cannot articulate. Then, more oblivion until I awaken in recovery.
At first I am high on all the pain medication and sedatives and am quite the chatterbox. The next day I can barely speak I am so nauseated by the slightest effort to move. But I have to hobble to the bathroom and notice that I have the first bikini shave of my lifetime!

bikini450

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Cancer Frog Blog by Judith Ogus is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.
Based on a work at cancerfrogblog.randomarts.biz