Somatic Recoveries #4: the third chemo

 

Mean I am. Come close and I’ll spit. Knives? This porcupine can throw quills.

(And again, I’m struck by the similarity to withdrawal—tight nasty thought loops repeating over and over.)

Liver. “Live her,” Charles Olson said as he lay dying of cirrhosis. Robert Duncan had crawled into bed beside him and was holding him.

Track 2: my masochistic love in an early relationship.
Boy, was I out-classed—a lightweight in a heavyweight ring.
Why couldn’t I see it?

The golden boy, with his superior spiritual insights, walks into the fray to solve what the psychiatrists and her previous marriages could not, eyes wide shut. Oh yes, and after that there are some windmills, sir.

Come close. I dare you.
Guilt        made her do it.
Shame    made him accept it.

Track 3. Track 1. Movies on the wall. Count the breaths.

“Hey you, thoughts. I been here before. I know you. Shut the fck up.”

Oh well.
Track 3. Track 1.
Six. Seven.

 

 

 

 

 

 

 

Then there were more tests. And once in a while, as in any profession, you have to deal with a J.A.C.N.—or, “just another conceited narcissist.” Somebody told me that orthopedists have more than their share. I’ve always thought it was cardiologists.

“He’s brilliant,” the nurse said.

Well, sure, maybe so. But one thing I’ve noticed about brilliant people—the truly world-class brilliant people—is that they listen.

It started with the nurse: “So when did you quit smoking?”

“Well, 15 years ago I reduced my tobacco input to occasional puffs–maybe 1/4 of a cigarette several times a week.”

“That’s still smoking. When was your last cigarette? We need a date.”

Then it was the same with alcohol.

“15 years ago I cut down to just an occasional glass of wine, like on my birthday and at a fine restaurant.”

“That’s still drinking. When was your last drink?”

(Lie to them, Dale, they are lying to you. At this point fiction is closer to the truth.)

12 Steps for Writers:
“Hi, my name’s Dale.”

“Hi Dale.”   “Hi Dale.”   “Hi Dale.”

“Well, my story . . . it started out . . . I’d just write down little thoughts, you know. Or sometimes it would just be a reminder of something I had to do. And then, pretty soon, I started putting them puppies into my pockets, you know, for later . . .”

Before the procedure, they wouldn’t let me have any juice–orange, apple, anything. And not because of any interference with imaging, but just because they didn’t want me throwing up on them. So the doctor said. As if. The real reason is just that they always say that. My own experience, whether out fishing in a tossing boat, or drinking half-poisonous brews, is that something in the stomach helps a lot. I don’t mean to contradict the fasting routines of any particular tradition, if one is working in that discipline. There are lots of reasons to fast, but avoiding nausea is not one of them. The Washo eat a meat stew before sitting up all night eating peyote.

I said: “I’m recovering from chemo. I’m nauseous from hypoglycemia. Can’t I just have some sugar water?”

And nothing. Like I wasn’t there. Except that the cardiologist, who had that well-scrubbed teetotaler look to him, proved that it was my moral turpitude that ruined my liver. “Just Hep C won’t hurt your liver unless you drink alcohol.”

Which is partly true, but not entirely. “And yes doctor, I’m well aware that I got just what I deserved. Or not even what I deserve. Actually, if all of us humans got what we really deserved, the plants would have a huge new load of fertilizer.”

Then somehow he let it slip that the imaging was being done by gamma rays.

“Where are the gamma rays coming from?”

“From inside you.”

“What is there inside of me that is giving off gamma rays?”

“Technetium.”

“You just injected technetium into my heart?”

“Yes. It has a very short half-life, though. Just four hours.”

I told Laura how there are no stable isotopes of technetium, how for many years it was this hole in the periodic table, that none of its isotopes have half-lives long enough for it to have lasted since the formation of the earth. And when it was discovered in stars spectroscopically, that was proof that stars could form heavy elements—heavier than iron, anyway.

There was a flash of a smile, and perhaps confusion, on the doctor’s face. I’d already told him that I was local, which, perhaps, meant to him that I’d grown up in a rural county picking grass seeds out of my teeth with a stalk of straw. Also, I was wearing my second-best pair of jeans, with one knee patched. Add in an obviously dissolute life-style to that and things weren’t adding up. It took the doctor about one second to regain his commanding composure and state that technetium is produced in a nuclear reactor.

Which is not quite right. The half-life of the technetium 99m is far too short to transport it anywhere. What they produce in the reactors, only about five of them in the world, is the precursor: molybdenum 99. Molybdenum 99 is highly unstable also, with a half-life of only 66 hours, so the whole supply chain requires very quick footwork.

99Mo is a fission product of heavy neutron bombardment of highly purified uranium 235. Close to 90% of the 99Mo, when isolated and put into a “moly generator” and shipped to hospitals, becomes 99mTc through beta decay. That is, a meta-stable nuclear isomer of technetium 99 that emits gamma radiation. Half-life 6 hours. After which the technetium becomes ordinary Tc99, with a half-life of a couple of hundred thousand years and a weak beta decay. About as good as you can get for a radioactive nuclear medicine to mainline.

The radiation dosage is about 10 millisieverts, or about 500 chest x-rays. Or about half of what you get from an abdominal CT scan done with and without contrast. For the stress echo-cardiogram, I had to take the dosage twice. There was some discussion about whether this dosage gave me a 1 in 1000 or a 1 in 5000 chance of developing cancer. It may not kill us, or it may, but I can’t see how it’s going to make us stronger.

I know lots of doctors. My best friends. I don’t know any brain surgeons, though. I wonder how they stack up against cardiologists.

 

 

 

 

#
New Spoonful Blues, in A-Minor

It’s always hanging over me
like a cloud that I cannot see—
when I go to meet my Maker at the end
I’m gonna pack a spoon with me, boys,
I’ll take a little spoon with me.

That spoon, that spoon, that spoonful.

Every time I touch that spoon now,
she makes me want a little more;
so when you come to visit—you’re my brother for life—
you got to leave your guns at the door, yeah,
leave your guns at the door.

That spoon, that spoon, that spoonful.

Sugar comes in both white and brown;
you can buy salt in a pill:
smoke was rising from the dragon’s lair
when they caught my fingers in the till, boys,
when they caught my fingers in the till.

That spoon, that spoon, that spoonful.

She knows when to call on the telephone
any night that I am alone,
sayin’ let me slip in—let me underneath your skin—
cause you know how I love it when you moan, child, 

you know how I love it when you moan.

That spoon, that spoon, that spoonful.

#
So, yes, well, yes.