Cogitations and Prognoses

The results from my PET-scan were available to me on the cancer center’s portal within an hour or two of the procedure yesterday (Wednesday) morning. As usual, the findings in the report were laced with medical terminology and, therefore, not completely clear to me. But I understood the radiologist’s summary well enough to know the scan was not what I had hoped for. Among several concerning statements from the report’s “Impression” section was this one: “Development of hypermetabolic nodularity in the posterior and medial right pleural space compatible with pleural metastasis.” A quick online review of the prognosis associated with pleural metastasis suggested I might have a relatively brief, rather bleak., future.

Later in the day, when I met with the oncology nurse and the oncologist and told them what I had found, I was advised not to rely on Google for medical opinions. Yes, I was told, the results were not good, but they were not nearly as bad as they might have been. I was presented with various treatment options to consider, going forward, among them: switching out some of the chemo drugs that have been used so far to fight the cancer; additional radiology treatments; and exploring clinical trials conducted by M.D. Anderson Cancer Center in Houston that might be a fit for my situation. In addition, I learned that it is possible that my recent bout of COVID-19 might have had the effect of accentuating some of the physical manifestations of cancer…so the results could conceivably have been overstated; they will explore that possibility.

After a fairly lengthy consultation, we collectively reached some decisions: 1) my oncologist will present information about my case to M.D. Anderson, requesting consideration of my inclusion in one or more clinical trials [one of my brothers had suggested that more than a year ago]; 2) in about four weeks, I will have a CT-scan to enable the oncologist to determine the extent of changes to the disease; 3) after the next chemotherapy treatment, the drugs used will be replaced by others that may hold promise; and 4) I will consult with the oncological radiologist about further treatments. The realities of my circumstances are pretty stark, though. I have Stage 4 lung cancer, which is generally considered incurable, so the medical response to the disease tends to focus on limiting the cancer’s growth, improving the quality of life by minimizing symptoms, and extending life expectancy.

I mentioned to the oncology nurse (who I like very much and who shares our sense of humor), after I read the results of the PET-scan yesterday, I coincidentally received a piece of promotional mail from the Neptune Society, gently suggesting I consider pre-paid cremation. We got a good laugh out of that. The nurse responded that I should not to plan to go into hospice care just yet. And mi novia replied that she would just have to unpack the hospice care “go-bag” she had prepared for me. Gallows humor.

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Dealing with the idea of death through humor seems both powerful and absurd. Death is inescapable; there’s no point in denying it. And there’s no point in insisting on treating the concept of death with unshakable solemnity. But to laugh at something so utterly final—something that alters the world left behind—suggests more than a hint of madness. “We cannot conceive of our own death.” I’ve read that many times and I suppose I agree with it, yet even in facing that impossibility I still insist on trying. Thinking about death leads to all sorts of questions. How long does death last? Does one’s consciousness simply disappear at the moment of death…and, whether it does or not, what happens to it? Does the death of another person manifest physically in survivors in some way? Is death equivalent to flipping a light switch? Of course, there are many people who believe death is simply the next stage of some kind of magical or spiritual existence…how do they square two (or more) different dimensions? Far more questions than answers.

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I wonder if anyone will ever read the thousands of pages of blog posts, etc. that I have written? Much of my writing today gets an occasional view by a very small number of people, but the vast majority of what I’ve written in the past decade or two has never been seen by eyes other than mine. I certainly understand why the output of my fingers is not lapped up by eager readers. There’s too damn much of it to cope with and the number of idea “gems” buried in it is far too small to warrant the time and effort to read through the rest of it. But, still, without someone to read it, all those hours at the keyboard seems completely wasted. Except that those hours probably rescued me from my own madness.

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My weight seems to have stabilized, more or less, but yesterday’s weigh-in at the doctor’s office surprised me. I had lost a bit more weight, tipping the scales at 169 pounds. A few years ago, at the peak of my corpulence, I was 82 pounds heavier. I am pretty sure most of my recent weight loss (in the last year or so) has been the result of losing muscle. My skin and flab hangs off of me like clothes that are several sizes too big. Had I been smart and disciplined, I would have worked to at least maintain my musculature, rather than let it weaken and shrivel. “Should have…” Ach!

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For some reason, I feel incredibly weak at the moment, as if I haven’t eaten in days. But I have. I’ve eaten as if I have been trying to gain back all the weight I lost. Perhaps a cookie is what I need. And maybe an Ensure. And a nap.