Pharmako/Thanatos: Or, How I Died.

Pharmako/Thanatos: Or, How I Died.
Journal notes, March 2017

I was rock-hopping: encouraging my aging cat to get some exercise, when I shouted “ouch” from a sudden pain in the middle of my back when I landed. It was like, “What was that?” And I forgot about it.

The next day I got a call from the Post-transplant Liver Clinic at the University of California, San Francisco.—I’d had my final two-year CT scan. They reported a sizeable lesion in one of the vertebra of my spine—T9—that they had not seen six months before.

Two weeks later I had a needle biopsy, and a week after that I was told it was liver cancer. A few malignant cells had evidently jumped ship before my liver was removed, had hid out for two years, and have now taken advantage of my necessarily suppressed immune system to stage a comeback.

     Dodge one,
     get hit by
     another.

By mid-April my back hurt just walking down stairs, and it was difficult to find a comfortable position in which to sleep.

“Fast,” I thought.
***

April

They treated the cancerous lesion in T9 with radiation, “as if” it were a solo cancer, which we all knew was unlikely. They used SBRT: stereotactic body radiation therapy, a beautiful marriage of physics, precision manufacturing, and some highly sexy computer programming. First the technicians made a mould of my body, so that during the treatments I wouldn’t move—they are going for millimeter accuracy. That is, the point is to irradiate the tumor with focused, lensed x-rays from a dozen or so different angles, all intersecting right on the tumor. They have to pour on enough radiation to kill the tumor to its edges, but they don’t want to kill the healthy bone that surrounds the tumor—they want the bone to be alive so that it can grow back and strengthen the vertebra. No one wants a fractured spine. I was told that this was a one time only procedure: that even with the focused rays the “collateral damage” to the rest of my torso was too severe to be repeated. And there is that spinal cord, no more than half a centimeter away from the lesion.

I had five treatments over a week. UCSF is a world-class research institution, and it shows in the attitude of the technicians.

For about a week or two after the SBRT, the back pain from T9 got worse, then it got better. Not gone, but better.

***

     For God’s sake, let us sit upon the ground
     And tell sad stories of the death of kings.

Some slain, yes, but not all in battle. Some were “collateral damage,”
or buried in an avalanche, or broken by a long fall.
Some disappeared, never found.
A dozen died from drugs, overdose or drowning in a bathtub.
Many succumbed to disease, mostly cancer.

Some faltered, betrayed by doubt, or caught by inner fears.
Some, yes, poisoned by wives or husbands.
Some found lives of success in worldly ways. Some built monuments on hilltops, or carved images in stone.
Some, clever, kept switching the ball from hand to hand, trying to win a free pass.
Some sought solace in purity, cleansed themselves, renounced certain pleasures.
Some, seduced by love, surrendered.
Some were lost to the cup.
One thought to find new lands, sailed west, others sought the source, sailed east.
Some denied the world to the end, froze their brains in liquid air.
Some ended life early by their own hands, one by a noose in a jail cell,
one by a cliff, others as they could.
Some died slowly, part by part, helpless immobile bodies, working in pain until the last breath, with which they blessed the world.

     Cover your heads and mock not flesh and blood
     With solemn reverence.

***
April 19, Mantis Hill

The Spiraea I’d spotted on the knoll had open up—all the stamens had unfolded. The white flowers were so tightly clustered in a corymb that it looked like an umbel. It’s clearly Spiraea betulifolia. Someone must have planted it. There are at least three different pollinators: one yellow wild bee, and two flies, one, some kind of hover fly, colored like a black and white tiger.

Our old female cat, Mushroom, came out and sniffed the bottom of the trash cans, then she started rubbing it, muzzle and shoulders both. The male bobcat must have come by–her teenage crush.

That must have been what she tried to tell us at 4 AM when she woke us up with a whole lot to say. If she had any fingers she would have been pointing. We didn’t recognize the song—just a whole lot of meows—but now I knew it was “My Boyfriend’s Back,” by the Angels.

***
Permeability

I remember noticing after my targeted chemo treatments three years ago that I felt “permeable”–that is, hyper-sensitive to nuances of emotion. (Even a mystery that I’d already read could be overwhelmingly sad and tragic). That was happening again.

I left Romeo and Juliet at the intermission. I wouldn’t go to the cinema, unless the movie was basically stupid. For two months I was having “shame attacks.” Even thought my next book would have to be “The Book of Shame.” It was all pretty pitiful stuff. Memories would come up of embarrassments from high school, or even earlier. One attack was about a bad line in a poem, for chrissakes.

There would be about a dozen attacks in the course of a day. Sometimes I’d trace the associations that would bring up the memory, generally short word chains from some fragment of conversation.

I just watched. Like visiting the geysers at Yellowstone. Some were banal, some were bizarre.

And all the while little things could make me cry. I had to be careful of music, especially any songs with words. Catharsis takes energy.

     Or does it? 

***

The Inner Critic has been very active also.

Merely because you are facing mortality doesn’t mean that the Critic will leave you alone: he will accompany you to the end. That is, at the top of the thirteen steps up to the gallows he will pause, look around, and say “Is this all the crowd you could draw?”

***