(Im)Patience

After my treatment this afternoon, I hiked up the hills south of Loma Linda. Turned out to be a pretty steep hike up roads used primarily by off-road vehicles and mountain bikes. The top of the hill where I turned around afforded a great view of Loma Linda and beyond. The large white building to the left is Loma Linda Hospital. The little white structure in the middle is the physicians' office building. The low-lying building to the right and somewhat in the distance is the Veterans' Hospital. In the far distance is San Bernardino and beyond it the mountains that separate the Inland Empire from the Mojave Desert. Growing up in southern California, I took the mountains for granted, an oversight corrected by living for 14 years on the Llano Estacado—one of the largest expanses of flat land in the world. Returning now to this area, I'm constantly amazed by the mountains that rise on almost every horizon. Reminds me of Billings, Montana.

Texas Tech's internet system had a hitch in its git-along today. All day. Operations that normally happen almost instantaneously like opening an email or closing it took 3 to 5 minutes and sometimes simply didn't happen at all. Talk about frustrating! And of course, it happened on a day when I needed to receive and acknowledge assignment submissions from 20 students. Also on a day when we needed to use the system to support my conversation with my Dramatic Analysis Class via Skype. For the latter, we finally resorted to using a student's cell phone set on speaker phone—a kluge, to be sure.

I felt like I got nothing done. I spent what seemed like hours staring at the little wheel on my computer screen spinning and spinning and spinning, telling me it was tryin'—tryin' real hard. Frustrating!

So frustrating that it didn't occur to me until I was hiking up that hill that 20 years ago or so, I couldn't have done this at all. Most students didn't have computers, cell phones were unknown, and if there was email, I didn't know about it. We used the mails. "Snail mail" we call it now. As for Skype and its ability to transmit both voice and video like something out of the Jetsons (and to do it free of charge)—forgetaboutit. Twenty years ago, getting an assignment from 1000 miles away and only waiting a mere 3 minutes for its arrival— Well, it would have seemed like a miracle. Twenty years ago we didn't need the word "kluge."

Twenty years ago, I would have been on sick leave or leave without pay. Period. But then, 2o years ago, there was no proton treatment for prostate cancer.

So I need to develop some patience and remember to be thankful for the technology that makes my life possible—even when it pitches its little fits.

Treatment Count: 19 down, 26 to go.

Misconceptions

I need to correct some misunderstandings about proton treatment at Loma Linda.

The first couple misconceptions are mine. I believe I have written that I thought there were about 40 or 50 patients in the program. I learned tonight that the proton department can treat up to 160 patients a day. Currently the program is slightly under enrolled; it has about 140 proton patients. Of that number approximately 65% have prostate cancer. That means there are slightly over 90 prostate patients in the program—almost twice my estimate.

Secondly, I wrote some time ago that I had not met anyone who was experiencing any negative side effects from the treatment. I have now met several who are experiencing the same side effects—urinary problems. These take the form of urgency to relieve the bladder and then painful burning sensations combined with the inability to urinate. These side effects are alleviated by Flomax. So there are side effects during treatment, but compared with the horror stories I've heard about other forms of treatment, these are almost laughable. I personally have not experienced any side effects to date.

I frequently receive well wishes from friends who express concern about the difficulties I must be experiencing. For instance, my mother always urges me to stick with it and see it through. No doubt these concerns find their basis in reports about the suffering that goes along with other forms of cancer treatment—surgery, traditional radiation, chemotherapy, and (for prostate cancer) hormone therapy. At the risk of losing the support of my friends, support that I value greatly, I should make it clear that no such difficulties attend this form of treatment. A pastor who is in the program said he's afraid to tell his congregation how easy it is and how much fun he's having for fear they'll all stop praying for him. It's certainly an inconvenience to be away from home for 2 1/2 months, and for me that entails being away from Amy—a real deprivation. There's a fair amount of expense involved including apartment rental, travel expenses, insurance deductibles, etc. Then there's that daily balloon. But that's it, as far as unpleasantries are concerned.

A good friend recently said she's waiting for my blog entry that will be titled "Cured!" I had to tell her she's probably in for a long wait. As near as I can tell it works like this: I get the set 45 treatments which adds up to 81 Gray (a measurement of radiation). Then they send me home. No pronouncement of cure. I will get periodic checks (PSAs, etc.) by my doctors at home and may, at my option, come back here after 4 months for a check up. I will continue to monitor my PSA for years—probably until I have no more vital signs. The PSA should descend to around 1, but a fair number of patients experience a "PSA bounce" after a few years with the PSA going up, then down, then up, then down, then eventually staying down. So when "alumni" come back and attend the support group meetings, they are always asked what their most recent PSAs are. They have uniformly been below 2—often below 1. Again, no pronouncements of cure, but a general assumption that the cancer is gone if the PSA stays down.

By the way, the idea of a set number of treatments sounds like a one-size-fits-all regimen. That's also somewhat of a misconception. Most of us, indeed, get the standard 45 treatments. But some are in an experimental program where they're receiving double doses for a shorter time—20 treatments. Others receive a combination of proton and traditional radiation, especially if there's reason to believe the cancer has spread to the lymph nodes around the prostate. Some patients are also receiving hormone therapy. So indeed the doctors tailor make each patient's treatment.

To those readers who are sending thoughts and prayers my way: please don't stop. Having written this entry, I have the same fears as the pastor I mentioned above. But I think it important to be honest about my situation.

Treatment count: 18 down, 27 to go.

Centennial

Today I took a self-guided walking tour of historical sites on the Loma Linda campus. This is an especially appropriate time for such a walk. In 2005, Loma Linda celebrated the centennial of the acquisition of the area by the Seventh Day Adventist Church, and this coming weekend, the School of Medicine will celebrate the centennial of its founding.

The tour begins at the Good Samaritan Monument at the center of campus. Jesus' parable of the Good Samaritan in Luke 10.25-37 established a model which Loma Linda aspires to emulate.

The Centennial Pavilion is just being completed. It houses state-of-the-art class rooms and teaching labs.

The imposing University Church sits near the Good Samaritan Monument.

Most of the university structures built during the first half of the 20th century have been destroyed, so the walking tour is more a tour of sites than of buildings. However, a few of the original patient cottages still exist on a hill in the middle of Loma Linda called The Mound. The first (failed) attempt to settle and develop the area, in fact, was called Mound City, and early developers tried to market it as "The Switzerland of America Where Health and Pleasure Are Twins."

Back at the University Medical Center, another group of bronzes evokes the story of Jesus welcoming the children. It combines Jesus in Biblical dress with children, the sick, the aged, and their care givers in 20th century clothes.

I have no intention of turning this blog into a publicity spiel for Loma Linda. However, perhaps it's appropriate to be appreciative of an institution that is saving my life while also preserving and enhancing its quality.

Scheduling

As any responsible patient knows, who has arrived for a doctor's appointment five minutes early, only to sit in the waiting room for an hour and a half, accompanied by out of date magazines that seem to yellow while time crawls on and on and on, medical scheduling is an inexact science. Maybe that's why we're called "patients."

Scheduling has its peculiarities here at Loma Linda, too, but here things are a little different. Here's how it worked today in my case.

My treatment was set for 2:15. Monday's also the day when Dr. Bush sees patients in clinic, and I knew from past experience that my visit with him would only take about five minutes. So I checked in at the reception desk on Level A (the clinic level) at 1:30. I figured I might be able to see Dr. Bush sometime before 2:00, meanwhile drink my 24 ounces of water at about 1:45, and be down to Level B (the treatment level) 15 minutes early for my 2:15. What great planning!

My butt had barely touched the waiting room chair when I heard the receptionist say, "Mr. Bert, they're ready for you down on Level B." I gulped down three cups of water, took the elevator down to B, and walked out just in time to see Nancy the Tech gesturing for me to go back and dress out.

Chop chop.

"You guys are ahead of schedule," I said as I climbed into the pod and assumed The Position. "We're trying," Nancy replied, and inserted the balloon.

Minutes later, I was on my way back to the dressing room, and they were sending my chart upstairs for my consultation with Dr. Bush.

This time, I waited maybe five minutes on Level A before they called me back to see the doctor. Everything seemed to be in order. "See you next week," he said, and I left.

I checked my watch as I exited the building. 2:05. Ten minutes before my scheduled treatment, and I was done. Beats the hell out of waiting an hour and a half.

The picture at the head of this entry is a schematic of Level B. The circular apparatus in the lower left hand corner is the synchrotron (accelerator) that whips the protons into lightening speed. When called for, they shoot down the long tube that runs along the lower edge of the picture. Depending on where they're needed, they make a 90° left to one of the three blue gantries. Mine, #3, is on the far right. And in 30 seconds another treatment is accomplished.

Treatment count: 15 down, 30 to go. One third of the way through.

End-Start

Let's wrap up the story of how I got started on my treatment here at Loma Linda.

In June this year, I had my third biopsy. The PSA I had in preparation for that procedure was elevated—8.45. Of the 12 samples taken in the biopsy, two came back positive for cancer—both on the left side. One malignancy occupied only 2% of its sample and had a Gleason score of 6; the other sample showed 50% cancerous with a Gleason of 7. The facts that more samples were positive than in the first biopsy, that the positive samples were larger, that they had a higher Gleason score, and that they showed up on the opposite side of the gland from the first positive sample—all of these factors made it clear that it was time to take care of the problem.

Dr. Vallabhan, of course, recommended surgery and said that it could be scheduled within the next couple weeks. I asked for, and received, the names of several patients he had already treated—all by robotic surgery. It turned out that one of them was in the clinic at the present time for a check up. The nurse asked if he'd be willing to visit with me, and he said, "Sure." He was 5 years or so older than me and had a number of other health issues in addition to prostate cancer. He had his surgery a couple months before our visit, and said he was quite satisfied with the results. He had some incontinence which he and the doctor were working to correct. He was no longer able to function sexually.

I went home and immediately contacted Loma Linda to get the ball rolling for proton radiation treatment. In July Amy and I vacationed in California so that I could attend my 59th high school reunion. While in the area, we attended a Wednesday evening education/support group meeting at Loma Linda. The speaker that evening happened to be Dr. Carrot, of whom I've already written, and we had the opportunity to visit with other patients at our table. We were impressed with the positive, almost evangelistic atmosphere and the holistic approach to healing that we sensed.

Within the next month, I was given an appointment to consult with a Loma Linda radiological oncologist at the end of October; assuming no problems surfaced, my treatment would begin by mid November and would conclude near the end of January. Meanwhile Loma Linda's insurance department contacted my insurance (Blue Cross/Blue Shield of Texas) to clear the way for coverage.

I scheduled a visit with my Primary Care Physician, Dr. Walter Hyde of Grace Clinic, to get a referral to the Loma Linda doctor. When Dr. Hyde heard about my chosen therapy, he told me he had another patient who had just finished proton treatment at M. D. Anderson in Houston. He said it was a good experience and appeared to be a good therapy. "Good choice," he said.

It turned out that BC/BS TX would approve payment for the therapy, but only on an out-of-network basis, no doubt because similar treatment was available in Houston. I was still convinced that, even though it would cost me more out of pocket, I'd prefer to go to Loma Linda where they had longer experience with the methodology and had the holistic approach to health that I've mentioned repeatedly in this blog.

Then it became apparent that, because my insurance works on an calendar-year basis, if my treatment lapsed over into 2010, I would have to pay double the deductible and overage expenses. In early September, I called Mila, the Loma Linda staff person who manages scheduling, told her about the problem, and asked if we could delay the entire process until after the first of January in order to get it all in a single calendar year. She put me on hold for a while, then came back and said that, if I was ready, we could schedule my consultation for the end of September, begin treatment in early October, and wrap it all up before Christmas. I visited with Fred, chair of my department, to make certain we could make arrangements for alternate teaching methods for my courses, and then I called Mila back to confirm scheduling.

The next couple weeks were really hectic as I went about putting things in order to be away for two and a half months. Working on the basis that I'd rather have the facts out there than have people making up their own stories, I was very open with everyone about my diagnosis and treatment plans. I saw no reason to hide the facts, and lots of reasons to share them. And as I indicated in the very first of these posts, I got huge support from Fred, my colleagues, my friends, and my students.

So that's my story. Tomorrow I have my 15th treatment and will be 1/3 of the way through the program. Thinking over the story of the past 3 years, two statements stand out: "The good news is, you've been diagnosed with prostate cancer," and "Good choice!"

Catalina

Yesterday I took a day trip to Santa Catalina Island. I boarded the Catalina Flyer in Newport Beach at 9:00 in the morning. (Those who remember the Inland Empire chant "One hour to the beach . . ." will be interested to read that it took me exactly one hour to drive from Loma Linda to the boat terminal.)

The Flyer, a double-hulled ferry boat, flew along at 30 knots and covered the 22 miles between the mainland and Catalina in an hour.

It was foggy and overcast when we left Newport Harbor, but by the time we reached Avalon Bay, the fog had burned off. Avalon looked much as I remembered it from my childhood with the round Casino (built by Wm. Wrigley, Jr. in the early 20th century) and the collection of yachts moored in the bay.

The Carnival cruise ship Entrigue was anchored off shore, and I thought Avalon would be mobbed with its passengers; however, I guess the town and the many island tours absorbed them because the town didn't seem crowded at all.

I decided to take the Nautilus boat ride to see the fish in the kelp beds off the island's shore. The glass bottom boats that I remember from my youth still run, but I thought this semisubmersible vessel might get me up more close and personal with the fish.

In addition to providing a good view of underwater life, the Nautilus is a real Disneyland kind of ride, complete with simulated diving sequences.

The fish showed up on cue. Hundreds of these opals plus thousands of sardines and a sprinkling of bright orange Garabaldis, the California state fish. The Nautilus is fitted with feeding devices at each window. For six bucks, I purchased four loads of food. When I pushed the button, a shower of food shot out, setting off a true feeding frenzy. In Catalina, even the fish live off the tourist trade.

Back on land, I took two self-guided walking tours around Avalon. In an earlier blog entry, I marveled at the wealth of vegetation in southern California. Avalon—perhaps because its climate is even more temperate—seems to me to outdo even the mainland in this respect. For instance, I saw whole forests of huge jade plants, seemingly growing wild.

While the island has a fair number of cars, the favored mode of transportation seems to be the golf cart. Avalon has one gas station to serve its population of 4000 residents. According to the guide on the Nautilus, it also has 2 policemen, no jail, seven churches, and 35 bars. Readers are free to make up their own jokes about these statistics.

Avalon has a great variety of architectural styles. Much of the town is quaint and beautiful, but it certainly has its share of eyesores—properties cluttered with junk, half-built houses that have apparently been abandoned, and homes in need of maintenance and a paint job. The town could use some code enforcement. Or maybe just some codes to start with.

In 1915, a fire broke out that leveled the town. One of the few structures left standing was the yellow four-story Glenmore Plaza Hotel, built in 1892 and still in operation.

At 4:30 sharp, the Catalina Flyer cast off from Float 3 in Avalon Bay, and and hour later—after watching some sea lions playing just off Catalina and spotting a couple of whales in the channel— we arrived back at the Balboa Terminal in Newport with its cupola and flag.

It may only be an hour from Loma Linda to the beach, but it took over twice that long to drive from the beach to Loma Linda, thanks to heavy traffic on the freeways.

I don't think I'd want to live on Catalina. It's too remote, too expensive, and too limited in its amenities. But I'd go back for a day or two in a heartbeat.

Adjustments

I've moved fairly often in my life, and I've spent extended periods away from my home—where ever that might have been at the time. But I don't remember ever being homesick.

Although I'm not experiencing homesickness now either, just over a month away from Lubbock, I am aware of some things I miss and some adjustments I have to make.

Aside from Amy—whom I miss on a daily and hourly basis—I most miss Marketstreet. A grocery store. What does that say about me? Well, that I like to cook and I like to eat. No secret there. But Marketstreet is a fantastic grocery store. And to think there are at least two of them in Lubbock! I have yet to find what I consider a decent grocery store here in the greater Loma Linda area. We do well on vegetarian, organic, and health food outlets, thanks to the influence of the Adventists, but no good, general grocery store. Produce? Forget about it. Unusual ingredients? Nada. Even usual ones. I have been unable, for instance, to locate canned pumpkin pie filling. Un-American. Congress should be notified.

The other Lubbock experiences missed—our Sunday school class at St. John's and the theology discussion group—both made up of people that gather around and continually derive inspiration from Ted Dotts. Those of you in those groups who are reading this: Count your blessings! You, your insights, your questions, and your laugh-out-loud good humor are wonderful gifts to me, to each other, and to the world. Enjoy, enjoy, enjoy!

On this end, how interesting learning to adapt to a town where 40% of the population is Seventh Day Adventist! In preparation for the Sabbath, things begin to shut down here mid afternoon on Friday. Sometime Friday night, they apparently roll up the sidewalks and lock all the cars in the garages. Loma Linda's a ghost town on the Sabbath. In fact, there's no US mail delivery on Saturday. Sunday, yes, but not Saturday. And on Sunday the entire community is back in business. Stores open up, the rec. center returns to normal hours, and it's life as usual.

It's also interesting to observe the Adventist obsessions with food. The core Adventist belief follows the Levitical code of avoiding foods the Mosaic law branded as unclean—pork, shell fish, and so on. But many Adventists, extrapolating from that center, eschew all meats. Some are pescatarians (fish 'n' vegies only). Some are vegans. Dr. Hans Diehl, founder of the Coronary Health Improvement Project (CHIP), has spoken to the prostate patients' group several times. I call him Doctor Carrot. He vigorously attacks the Standard American Diet (SAD) and advocates near veganism. And of course he has all sorts of statistics and published studies to back up his contention that the majority of our Western diseases (heart disease, hypertension, diabetes, and cancer to name only a few) are directly related to SAD. However, Stella, the nutritionist on the Proton Center's staff, is reputed to advocate a high protein diet—in other words, meats, and plenty of them—to counteract the fatigue that some proton patients experience later on in their treatment. At the Restaurant Tour dinner last evening (where, by the way, quantities of Italian sausage, veal parmesan, and cheese were washed down by wine red, white, and pink), someone commented that not only are Dr. Carrot and Stella not on the same page—they're not even in the same book.

Somehow I find it heartening that there's this kind of controversy within the Adventist community. Differences are almost always a sign of life and health; lock-step homogeneity makes me nervous and gives me a rash.

Treatment count: 14 down, 31 to go.

Urologists

It's high time I continue the story of my journey towards Loma Linda, the tale that I started in the post "Beginnings" last Saturday.

It's also time I add a picture, so here are the Loma Linda Hills where I walked last Sunday. Peaceful.

Back to my story.

As I said, while I waited for the date for my next biopsy to come around, I attended the ACS Man to Man meetings where I encountered a Texas Tech colleague of mine who had undergone radical prostatectomy performed by my own urologist. He had suffered intense depression and continued to be incontinent. We didn't even bother to talk about sexual function. He had since change urologists. I had known this colleague ever since I came to Tech in 1995, and I had always considered him a wise man. But he had simply accepted his (and my!) urologist's directives without question and without doing his own research, and now he was paying a terrible price. A cautionary tale to be sure.

One night at Man to Man, Dr. Girish Vallabhan presented a talk on the DaVinci robotics approach to prostatectomy. I was impressed with this method because recovery time is much less due to the smaller incisions, there is far less bleeding, and most amazing of all, the surgeon can actually see clearly what he's doing, unlike the case with open body surgery in that area. I was still convinced that, if I had to treat my cancer, it would be via proton radiation, but I thought that, if I had to undergo surgery, robotics would be the way to go.

However, what really caught my attention in Dr. Vallabhan's presentation was seemingly more minor. He indicated that he took at least 12 samples in a biopsy, and when I asked about anesthesia, he assured me that he always deadened the prostate because otherwise it was pretty rough on the patient. Tell me about it. These procedures—a minimum of 12 cores, under local anesthesia—corresponded to what I had read in Marckini's book as well as the other ones.

When my biopsy date loomed a couple weeks away, I called my urologist and, of course, was connected to his nurse. I asked her if I could please have local anesthesia for the biopsy. She replied that the doctor doesn't do that "because we can't find long enough needles." I was shocked. And disgusted. This was clearly not an equipment problem; if doctors nation wide, and in Lubbock itself, could find the tools, they obviously were available. I believe this was clearly lack of willingness to update old practices as well as blatant disregard for the well-being of patients. Nor was this a hole-in-the-wall, back-alley clinic. This was the urology department at the Texas Tech Health Sciences Center—a medical school that teaches the new generation of physicians. I called Dr. Vallabhan, scheduled a biopsy with him, transferred my records, and severed relationships with my previous urologist.

In due course, Dr. Vallabhan conducted a 12-core biopsy, plus 2 extra needles in the area where the cancer had originally shown up, and he did it under local anesthesia. I wouldn't recommend it as recreation, but it was a totally different experience than I experienced under the sadist who had worked me over before. Even more wonderful, the report came back totally negative. Either the cancer had gone into spontaneous remission, or the needles had missed it. I came to understand later that the latter was the more likely explanation. In any case, I called Loma Linda, cancelled my appointment, and began another year of watchful waiting—getting regular PSAs and scheduling another biopsy a year down the road.

During that year, Dr. Vallabhan discussed proton treatment with me. He said that according to his associates in radiology, it really wasn't all that different from other radiology, and that it incurred virtually as much morbidity (side effects) as did other treatment options. He also gave me an article by Dr. Patrick Walsh questioning the efficacy of the therapy because no recent studies had been published. And finally, he said that, while the immediate side effects of surgery could be devastating, they tended, over the long run, to improve, while those from radiation tended to worsen over time. Nevertheless, he avoided terms like "voodoo medicine" and "experimental procedures."

June 2009 approached, bringing with it my third biopsy. I'll pick up the story here at a later time.

Treatment count: 13 down, 32 to go.

Mom

On October 21, 1917, Harriet, the fourth of Walter and Martha Bohen's six children, was born in the tiny farming community of Hope, Kansas. Before Harriet could attain school age, Walter—motivated in part by the need for more work opportunities and partly by missionary vision, moved his family to Upland, California. Walter was a Brethren in Christ lay minister, and the church had a congregation there. He and the three older kids—Gladys, Evan, and Elizabeth—went by car, and Martha followed by train with Harriet and her younger sisters Naomi and Mary.

In California, Walter plied his trade as a carpenter and planted little churches in Sunnymead and Moreno Valley—now thriving communities only a few miles from Loma Linda. When Harriet grew up, she attended the church's high school, Beulah Academy, and eventually married Eldon Bert. In due course, the young couple had a son, Norman, and five years later another, Arthur.

After serving as a non-combatant in World War II, Eldon built a home in Upland, and he and Harriet raised their sons there until they both married and moved out of state. Harriet pursued her calling as a home-maker and also found time to serve the church's youth program as an advisor, Bible quiz coach, and Sunday School teacher, and to contribute her beautiful contralto voice to the chancel choir.

Mom had a huge influence on my life. From her I caught my love for reading, a love that would make me a good student and guide me toward the humanities. She was also my earliest teacher of writing. The form was letter writing, and she would read my scribbles and make suggestions—usually, "add details," a good admonition. She also instilled in me an interest in religion and, in particular, a love of Bible study that was eventually given form by my teachers in seminary. And by tolerating my presence during family gatherings, I believe she unintentionally nudged me toward theatre. It was either listen to the men discuss business—a topic that bored me to tears—or sit in while she and Aunt Faye gossiped—by far the juicier, livelier, more dramatic option.

Eldon passed away in 2004, and Harriet now resides in Messiah Village, a Brethren in Christ retirement center in Mechanicsburg, Pennsylvania, where she spends much of her time reading. Today she celebrated her 92nd birthday.

Happy birthday, Mom! And thanks!

Today I passed the quarter-way mark in my course of treatment and added a yellow dot beside the green one on my name tag to signify my stage in the program.

Treatment count: 12 down, 33 to go.

Praise Songs

Tonight, at the weekly proton patient potluck, the entertainment was a young woman singer from the church of an alumnus of the program who lives nearby. She came fully equipped with a karaoke system for accompaniment, a strong voice unnecessarily aided by the public address system, and a ton and a half of missionary zeal.

When she informed us she is part of the praise band at their church and directed us to the handout of lyrics on the tables, I knew I was in trouble.

She launched full bore into her first praise song, all along slipping in asides urging us to "lift it up" (complete with motions, raising her hands heavenward, in case we needed a model). I glanced around the room at the other patients and their wives. Some were looking earnestly at their song sheets, and their lips were moving. Barely. Others, like me, were just sitting there. I didn't see anyone awash with our songstress's spirit. Or Spirit, for that matter.

I say they were sitting there like me, but I don't know if they were really scrunching up inside like me.

Now readers of this blog certainly know by now that I have a deeply religious turn of mind. I have been fully involved in Christian churches my whole life long, and I take deep comfort and strength from that source. But I cannot stand gospel praise songs and the whole rah-rah, clap-and-cry piety that accompanies them. My Aunt Faye calls this "Seven-Eleven music"—seven words repeated eleven times. This kind of religious expression disgusts, appalls, and embarrasses me.

I don't know why praise songs affect me this way. I have found peace, joy, and an expansion of my spirit sharing prayers with Muslims in their mosques, chanting with Hindus in their temples, meditating with Buddhists, even celebrating solstice with wiccans. Tears which issue from emotions I can't name have flowed down my cheeks while singing hymns in church, and I can think of few experiences more moving than listening to Roy Wilson's organ postlude at the close of service at St. John's United Methodist. And I've listened for—and sometimes heard—that still, small Voice in the silence of a Quaker Meeting. So why I can't abide praise songs, I do not know.

Suffice it to say that, after the singer's second number, I excused myself from my table as inconspicuously as I could, collected my casserole, and made my exit.

I ought to at least mention proton treatment in this posting. As a regular feature of the potluck, new patients are asked to introduce themselves by name and home town; they usually also add their PSA and Gleason score. It's a prostate cancer patient thing, I guess. Tonight, amongst the initiates, was a surprising variation in this group of greying men—a young woman. In a pleasant voice with an Eastern European accent, she said she comes from New Jersey and is here for proton treatment of a brain tumor. Then she added that the doctors apparently mislaid her PSA. She got a huge laugh on that line. If you don't understand why, you need to read the books I listed last evening.

Treatment count: 11 down, 34 to go.

Books

A couple entries ago I mentioned some books I read when I was diagnosed with prostate cancer. Details.

When I was diagnosed, Amy said I oughtta do some reading, so I asked her to help me find a few books. She came up with a remarkable trio to recommend. In the order in which I read them, they were:

• Robert J. Marckini's You Can Beat Prostate Cancer . . . And You Don't Need Surgery to Do It: What Every Man & His Family Must Know About Early Detection & Treatment.
• Dr. Patrick Walsh's Guide to Surviving Prostate Cancer, by Patrick C. Walsh & Janet Farrar Worthington.
• Stephen B. Strum & Donna Poglinao's Primer on Prostate Cancer.

What a great set of books! And how uncanny the selection! Some wise spirit must have guided Amy. Or maybe she's just a genius. Anyway, there are three approaches to treating prostate cancer: radiation, surgery, and medicine, and each one of these books represented one of those three therapies.

Bob Marckini is a cancer survivor, not a physician, but his background in engineering gave him an inclination to do research and the ability to understand the science and technology of prostate cancer and surgery. As a "graduate" of Loma Linda's proton treatment program, he's almost evangelistic about this approach to radiation and about this program. The book is readable, packed with facts, and—like Loma Linda itself—bathed in hope. I learned a hell of a lot from this book, and by the time I finished reading it, I was certain this was the treatment option for me. By the way, Bob is going to be here in Loma Linda in November, and I'm looking forward to hearing him speak.

However, I read on, and I'm glad I did. Dr. Patrick Walsh is a leading urologist. That identity means that he trained and has practiced as a surgeon. Coming from that background, Walsh understandably considers radical prostatectomy to be The Gold Standard. However, he is remarkably objective and gives what I consider a fair representation of the other therapies as well. He even has a section on proton radiation—somewhat remarkable since many urologists still consider it "experimental" (after a track record of almost 20 years and 14,000 patients) and even refer to it as "voodoo medicine." One admonition of Walsh's particularly sticks in my mind: "If you're going to get a prostatectomy, you must find a surgeon who is an artist." While my quotation is loose, the word "artist" is Walsh's.

Walsh's book is big, fat, and thorough, but I moved on to Strum's Primer. Dr. Strum is an internist, which means he gives special attention to hormone therapy, cryotherapy (freezing the prostate), and other methodologies that don't involve radiation or surgery. However, as is the case with Walsh, his book is thorough and relatively free of biases. One particularly interesting section of Strum's book is on diet and lifestyle issues for those who wish to be holistic about their treatment. Of course, prostates are prostates, and cancer is cancer. PSAs are PSAs, and the system of rating cancers by type and Gleason scores are the same across all therapies, so I got a lot of repetition of the basic facts, and as we teachers know very well, repetition is an effective learning device. I picked up even more nuances from Strum's book, and by the time I finished it, I was at least very capable of discussing my disease with doctors and other cancer patients. I could ask the right questions, and even understand the answers.

Well, I know I promised to continue the saga of my journey toward Loma Linda, but this is enough for this time.

I just want to add that anyone diagnosed with prostate cancer should do at least the amount of reading I did. If you don't, you are at the mercy of your physician, and I've heard way too many devastating stories to believe that's an acceptably vulnerable position. You MUST take charge of your own decision making. If you don't, you'll have only yourself to blame for the results.

This afternoon, Gantry 3 went down, so my treatment was cancelled. However, Nancy the Tech called later to tell me it was back on line again and that I could come in at 10:15 tonight, so I'll sign off and head out for my 10th treatment. And by the way, it's a month today since I left Lubbock.

Treatment count (as of midnight tonight): 10 down, 35 to go

God

A Quaker's prayer, at start of Meeting:

I am here to focus on God's presence in me.

I am here to focus on my presence in God.

I am here to listen for God's voice in the silence.

A Quaker's doubts:

Will it make any difference? Is this just something I do for an hour on First Day and for 10 minutes each other day of the week? Does it cross over into the rest of my life? Will it make any difference when I grade script analysis papers this afternoon? Will it make any difference when I lie in my pod in the gantry, when the proton beam enters my body?

A Quaker's assurance:

Proton treatment is a useful analogy for God's presence in me, my presence in God.

The proton beam, as part of God's creation, is a manifestation of God. When it enters my body, I am completely oblivious to it. I don't feel it, see it, hear it, taste it, or smell it. Were it not for the whirring and beeping of the machinery that accompanies the beam but is not the beam, I wouldn't know anything was happening. If I were stone deaf—as certainly one or two of the 14,000 men who have undergone this treatment have been—I'd have no awareness of the treatment in progress. The proton beam is an analogy for God in me—maybe not just an analogy, maybe very God in me—and I'm unaware of its presence.

As I lie in my pod, I am surrounded by other, more palpable manifestations of God—in time, in space, in substance, in relationship. I'm part of over a century of investigation into particle physics, over a century of science and technology. I'm in the bowels of an institution with the mission To Make Man Whole. All around me, in every direction I look, I see the paraphernalia of technology. As I listen I hear the radio playing in the background, the voices of the technicians as they go about their duties, the wheel spinning, the indicators chirping. And the people—animate manifestations of God—some now dead who first discovered protons a hundred years ago and developed them into tools, some now living but retired, like Dr. Slater who created Loma Linda's proton treatment program, those thousands who have been through the program as patients, my doctors and nurse, these technicians who at this moment are in the room attending to me. I am surrounded by God like I'm surrounded by the air I breathe. Usually I never think about it. But it's there. The manifest presence of God.

Will it make any difference—this hopefully healing presence of God in me, this hopefully healing presence of myself in God? I believe it will. I have the evidence of those 14,000 predecessors. I have the books and articles I've read about the technology and its results. I have the stories I hear from fellow patients on a daily basis. It is enough.

Will my attempt to focus on God's presence in me and mine in God and my attempt to listen to God's voice in the silence—will these have any impact on my grading of script analysis papers? Enlightened by my proton treatments, I have to believe they will.

Beginnings

How did this whole prostate cancer thing begin, anyway? It's a long story, so let's get started.

I'd been watching my PSA rise slowly but steadily for several years, and when it hit 7.6 in the summer of 2007—anything above 4 is generally considered high—my urologist said it was time for a biopsy. Not a pleasant experience, that biopsy—a 10-needle sample done without anesthetic of any kind (and of course I had ridden my motorcycle to the appointment which made for a pretty miserable trip home). But worse than the pain of the biopsy, it showed up positive for cancer. It was a very small find—just 1/10 of one of those 10 needles with a Gleason score of 6 (low moderate), but cancer nevertheless. I was shocked. No one in my family had ever had cancer of any kind. The doctor scheduled me for radical prostatectomy (surgical removal of the prostate) in early 2008. I began to get ready for what I understood would be a difficult surgery with a long recovery.

When I told my counselor, Dr. Charles Keller, he said, "Oh my God! Don't do that! That's a terrible surgery!" He told me about another client of his who had undergone some kind of different radiation treatment at Loma Linda in California, and suggested I check it out. I called Loma Linda, and got another shock: The phone was answered by a real person—the very person I needed to talk to—not a mechanized system, and when she said she'd call me back and did so the same day, I realized Loma Linda must not be your ordinary, run of the mill hospital. She said she'd send me materials.

Meanwhile Amy picked out 3 books for me to read. I'll give specifics about those books in a future entry, but suffice it to say, by the time I went in for my pre-op appointment, I knew more about prostate cancer and treatment than my urologist. Now that may seem like a pretty over the top claim since he's got the degree and years of experience and I've read 3 books. But I leaned through this experience that medical specialists are narrow in their knowledge. As someone (actually a physician) told me one time: When you're a hammer, every problem looks like a nail. Some details later.

Also by the time of that pre-op appointment, I'd decided I would not be having surgery. I would choose proton radiation treatment. I had already lined up a consultation with Dr. Bush in Loma Linda for later that year.

Then the next big surprise. My PSA, taken in preparation for the appointment, dropped to 5.5. The urologist said, "Let's go back to watchful waiting and do another biopsy in May." When I told him about Loma Linda, it was clear he had never heard of proton radiation. He asked quite a few questions about it and took notes, but he recommended that I hold off on that process as well until after the next biopsy.

As part of my preparation process, I began attending the monthly Man to Man prostate cancer support group sessions at the American Cancer Society, and I learned some amazing things.

But this has grown long enough at this point—this blog entry, that is, not my prostate—so I'm gonna write: To Be Continued.

Work

I'm working too hard! And it's beginning to make me crabby.

Teaching classes via long distance is more demanding and time consuming than doing it face to face. Much that I usually do by scrawling notes on papers now has to be typed out in emails, a far more demanding process. Also I'm converting my lecture notes for Script Analysis from their ragged nature into a form that can be handed out, read, and discussed in class. While this task may make class preparation easier in the future, right now it eats up a huge amount of time.

Maybe now that I've read and responded to the thesis of one of my MFA students and the dissertation of one of my PhD students, things will settle down a little. 'Course I've got 15 scripts to read tomorrow for the selection process for our one-act play festival, and today I received 20 papers to grade, probably on Sunday. I've also got a set of PhD quals to read—and so it goes, on and on and on and on.

As a result, I go to the support groups, the patient potlucks, etc., but have yet to check out the gym, although we're urged on a daily basis to exercise. This is turning out to be anything but a "proton vacation."

'Course, unlike many of the other patients here, I'm not on vacation. And I'm very thankful that I can be teaching my classes, etc. instead of finding it necessary to take a leave without pay.

But then I have to wonder if it's the demands of my job, or if I'm just doing it to myself. Again.

I come from a long line of forebears who considered it a point of religion to work. To work was to do our Christian duty. Recreation was only acceptable in so far as it prepared us for more work, and even then it was a little suspect. If you worked, you were a valid person; if you didn't, you were worth-less. I watched both my grandfather and my father, in their last years, sink into what must have been a kind of depression. Just sitting. Just looking out the window, seemingly seeing nothing. Their work was done, but they were still alive. Why? What do you do when you have nothing to do? Who are you if you have nothing to do? Perhaps it's partly the fear of being the next Bert to end up sitting there staring out the window that keeps me from thinking about retirement.

I have long thought I need to develop the ability to enjoy life and feel worthwhile even though I'm not being productive. However, I don't really have time to do it, 'cause I have all this work to do.

Well, at least I'm not bored here in Loma Linda.

Treatment count: 9 down, 36 to go.

Flatland Film Festival

Won't be a long entry tonight. It's been a full day, and I'm pooped. Lots of class prep this morning, reading Radhica's dissertation most of the day—she defends on Monday—, treatment number 8, and the proton patient "Restaurant Tour" this evening (Ruby Tuesdays, a rare occasion on which the Tour has gone to a chain restaurant and not a choice that I'd recommend repeating.)

Today was the first day that I wished I could have been back in Lubbock. Not even for the full day, but just a couple hours this evening to see our Llano Estacado Blues screened at the Flatlands Film Festival. I feel like an absentee father. Fortunately Amy could be there. After all, a birth with an absentee mother would really be unnatural. Also Jim Bush attended. Let's see. Following this birthing analogy, I guess he'd be the Godfather, or maybe better the obstetrician.

And Amy kept me posted all the way, from delivering the DVD this morning, through her 4-hour quest for just the right outfit to wear (Thanks, Scott!), to her taking a wrong turn on her way to the Arts Center but getting there on time anyway, to her assessment of the evening's program and her report of the comments she received after the screenings. Thank God for cell phones!

Now tomorrow morning she meets with Will Streider in the School of Music to try to even out some of the sound. Do these things ever get finished? I'm familiar with the idea of play scripts getting tweaked, revised, rewritten, and so on ad nauseam, but I was under the apparent misapprehension that a movie got wrapped, put in the can, and was done. Shows what I know.

But it sounds like, in spite of its technical rough spots (which I can overlook but which stick out for Amy like whole fists-full of sore thumbs)—in spite of all that, it sounds like it showed pretty well.

The playwright's whine—Well, I guess they didn't need me any more. And the playwright's cheer—They liked my dialogue!

And so to bed.

Treatment count: 8 down, 37 to go.

Various things heard today—

Good news! You've been diagnosed with prostate cancer! Just think what would have happened if they hadn't found it.

If you want to be healthy, avoid foods with nutritional labels. Does a tomato have a nutritional label? Does ketchup? Does a potato have a nutritional label? What about a bag of potato chips?

How long would it take you to eat a tube of Pringles? Half an hour. That's a third of a pound of fat, downed in half an hour. It's the equivalent of the calories in 11 potatoes. How long would it take you to eat 11 potatoes? Eleven days.

Caloric density.

This is a religious institution. We make no excuses for that. No one comes here by accident.

[By the way: No one here seems very intent on turning us into Seventh Day Adventists. But they're rabidly evangelical about healthy eating, exercise, and healthy living. There's at least one vegetarian market and two organic markets within a 4 mile radius.]

The American tsunami of cardiac disease, diabetes, hypertension, and obesity does not have genetic causes. It's directly the result of environment—in particular, what we are eating (diets high in animal fats, sugar, and salt) and what we're not doing (exercising).

The majority of erectile disfunction in older men is the result of plaque laden veins. What you do in the kitchen affects what you do in the bedroom.

Two men—one a current proton patient and the other an alumnus of the program—said that they had undergone radical prostate surgery—touted by urologists as The Gold Standard—and suffered all the side effects of incontinence, erectile dysfunction, etc., only to have the cancer return. The alumnus said that, after proton treatment, his PSA dropped to undetectable levels. (PSA=prostate specific antigen, a substance in the blood that is a marker for prostate cancer)

Japanese medical schools used to have to buy diseased cardiac arteries from American hospitals in order to educate their students But now that the Japanese have adopted Western eating habits, they produce enough heart patients to supply their own specimens for study.

Treatment count: 7 down, 38 to go.

Joshua Tree

Two sayings newcomers to this area hear on a daily basis from the locals: "This all used to be orange groves," and "It's just one hour to the beach, one hour to the mountains, and one hour to the desert."

Yesterday, on Amy's last day here, we opted for the desert. Joshua Tree National Park, to be exact.

As a child, I'd been to the little towns on the Park's north edge—Yucca Valley, Joshua Tree, and Twentynine Palms—but I don't remember ever going to the Park itself. In fact, I sort of wonder if it had even been designated a National Park back then.

What a fantastic surprise!

The northwestern quarter of the park, where most of the roads are located, is a wonderland of strange vegetation, weird outcroppings of rocks of all sizes, and mountain vistas.

There's a camera shot waiting at every turn in the road. The first picture here shows the trunk of a Joshua tree in the foreground and then several other specimens and one of the many rock hills in the center. The next two were taken at an area called Jumbo Rocks. Good name.

The weather was perfect—neither as ferociously hot as it can be in the summer nor as icy as it can get in the winter.

As Amy remarked, the place has a sort of soul-cleansing, peace-instilling effect.

There were others there, including a bus load of German tourists and an Asian couple in suit and wedding dress making what will certainly turn out to be a remarkable collection of wedding pictures. But the place is so vast that it was almost like having it all to ourselves.

About half-way on our drive from north to south, we came upon the Cholla Cactus Garden. This "jumping cactus" earned its name by attaching its segments to unwary passersby and doing it so readily that it seemed like the cactus jumped at the victim. Those nice, fuzzy looking branches are actually covered with thousands of barbed spines.

We got back to Loma Linda in plenty of time for my treatment—"just one hour to the desert." Whether it was due to being tired from the day's travels or relaxed from the Park, I think I actually drifted off to sleep during the 30 seconds in which the proton beam was doing its work. Is it even possible to go to sleep and wake up again in that short a time? Brian, the main tech, said, "Oh yes. That pod's really comfortable, isn't it? Just made for you."

Treatment count: 6 down, 39 to go.

Busy

Wow! What a busy day! After breakfast at Mimi's Cafe. Amy sent out invitations all over the place for our screening of LLANO ESTACADO BLUES at the Flatlands Film Festival this coming Thursday. Meanwhile, I prepped notes for Orada (my T.A.) to teach my Script Analysis class on Wednesday. Then we taped narration for a short video of my high school reunion last July. We went in for my weekly doctor's appointment, and Amy got to meet Drs. Bush & Kang. Then there was my fifth treatment. After that we had a nice Chinese bistro meal and then shopped 'til we dropped at Amy's favorite Nordstrom. Came away with empty hands and full wallets. Nice. And somewhere along the line I managed to do a load of laundry and send out more invites to LLANO ESTACADO BLUES.

Busy-ness has its uses. Both Amy and I find that, during this separation, our many activities keep the lonelies away. But right now, for a few wonderful days, it's great to be busy together.

Treatment count: 5 down; 40 to go.

Tour

Today Amy & I took a tour of the proton rooms and equipment. Here are some pictures.

This first one is a room I'll never see again. It's the fixed beam room where cancers of the head, neck, etc. are treated. On the left end of the table is a mask used to immobilize and position the head of a patient. Two other masks on the table, fitted with Mickey Mouse and Spiderman faces, are used for children. Proton treatments are especially useful in treating children because they are far less detrimental to developing tissue than conventional radiation.
These two objects are used to shape the proton beam. Each prostate patient has a set of these. The one on the left, with the handle, is extremely heavy; I believe it's made of lead. The blue one, called a bowl, is made of wax. Don't ask me how they work, but their effect is to precisely shape and control the beam. Each is barcoded so there is no mix-up getting the right beam shape for the right patient. I understand that, at the end of my treatment, I will get to keep my bowl as a souvenir.

This is Gantry 3 where I receive my treatments. The picture shows a variety of things. First, note the gantry itself, the round walls shaped like the inside of a nose cone. The object on the left is the portal through which the beam is delivered. The shaping devices in the previous picture are fitted into this as is the wheel pictured in the center. This wheel, as I understand it, helps determine the target depth at which the protons will "ignite" and release their energy. When the beam is about to be delivered, I can hear this wheel begin to rotate and whirr. The object between the wheel and the gantry wall is an X-ray imaging screen that is used to direct the beam to each patient's prostate. This screen and the machine on the left are mounted to the gantry wall. This portion of the wall rotates so that in one day's treatment the beam comes in from the left (as configured in this picture) and the next day from the right. Finally, the cradle like object, draped in cloths, in which the wheel rests, is a pod. The patient lies in this device and then the table on which it rests slides into the gantry for the treatment.

We also got to see the machinery that accelerates and then delivers the protons. It's an amazing array of electronic equipment that looks extremely sophisticated and mystifying. It's amazing to me that it doesn't break down more often. According to the tour guide, it's only been down for repairs during treatment hours under 2% of the time over the years of its usage.

LLUMC's proton system has treated 14,000 patients since it went on line in 1990. To construct the area anew would cost over $100,000,000—and yes, I counted the zeros twice.

Highly interesting.

Two unrelated thoughts from Quaker meeting this morning: From Peace Pilgrim: The good we do, say, or think goes on and on and on forever. The bad, in contrast, only lasts until eliminated by the good. It's a comforting thought and should help us deal with the scorn we feel in the jibe "do-gooders."

From Mother Theresa: We can't do any great thing, only small things with great love.

Tomorrow: treatment #5.

Dis-ease

In his book Jesus: A Revolutionary Biography, when discussing Jesus' miracles of healing, John Dominic Crossan differentiates between curing a physical pathology and healing the psychological and social impacts of the pathology. I don't have my copy at hand, so I can't quote Crossan's terms, but I'm going to use "sickness" for the physical pathology and "disease" for the psycho-social results. Of course this is a somewhat artificial distinction, since sickness and disease are both parts of a single event. But they can be discussed separately, as in HIV/AIDS (the sickness) and the isolation from family, erstwhile friends, careers, etc. that used to attend this diagnosis and probably still does. As I remember, Crossan leaves open the question of whether or not Jesus really cured sicknesses, but he emphasizes Jesus' miraculous ability to heal diseases.

It strikes me that LLUMC does a good job at treating both sickness and disease. The prostate cancers of my fellow patients and me are treated by the proton beam as well as, in some cases, conventional photon radiation and hormone therapies. Amazing indeed.

But the real miracle here is the healing of the associated disease. LLUMC proton patients are perhaps the happiest, most energetic, "healthiest" group of men I think I've ever met. How does LLUMC pull off this Jesus-like miracle? Here are some ways: Tuesday evenings, the proton patients gather for a potluck dinner that includes jokes and programs and conversation. Wednesday afternoons, there's a patients-only support group. Wednesday evenings there's a educational/support group gathering with a snack. Thursday evenings, there's the "Restaurant Tour" that goes to a different local restaurant each week. Dietitians and social workers are on the staff of the Radiation Department, and diet counseling is part of the program. We are given membership in the Drayson Center (a rec center) and constantly urged to use it to exercise, get massage therapy, etc. Then there's BOB (Brotherhood of the Balloon), a web-based support group for all active and former proton patients. There's also the ubiquitous focus on healthy life-styles that results from the Adventist concerns with diet. And finally, it's all done in an area that is beautiful with its hills, its trees and flowers, its mild climate, and its proximity to the mountains, beaches, and deserts of Southern California.

Amy, who is here for a few days, wondered if any other place in the country, or maybe the world, has put together this array of healing ministries. I don't know if LLUMC is unique in these respects, but it's certainly special.

"To make man whole." The wholeness in the Medical Center's motto brings together the curing of sicknesses with the healing of diseases.

It's a good place to be.

Llano Estacado Blues

Next week Llano Estacado Blues, our short film about poverty, will be screened at the Flat Lands Film Festival at Lubbock’s Louise Hopkins Underwood Center for the Arts.

Llano Estacado Blues is a twelve-minute slice-of-life portrait of what happens in the daily lives of the poor and those who try to help them. In the film, three women, one a social worker and the other two food voucher clients, become more and more frustrated as they try to deal with the policies that regulate hunger relief. In the end, none of the women’s needs are met.

Seeds for the script were sown when I witnessed a similar incident unfold in real life at The Bridge, a faith-based organization that serves east Lubbock. At the time, I was on sabbatical researching to write a full-length play, The Gospel According to Jesse.

A few months later, after watching a modern dance performance, I decided I’d try to write a short play patterned on jazz forms. I dug out my notes from the incident at the Bridge, and the result was a short play that has since been performed in Arkansas and Los Angeles.

Amy got the idea to turn the one-act into a film because it fit both her artistic needs and her sense of moral obligation. She thought the script was powerful yet simple and would be manageable for an emerging film maker. She also wanted to raise awareness about the conditions of the poor.

We got support from Tech’s Department of Theatre and Dance, The Bridge, and Family Promise, an agency that assists homeless families in Lubbock. Amy then recruited a small but committed company consisting of Dr. Jim Bush of Tech’s theatre program, who would serve as director of photography, and actors Pam Brown, Millie Casillas, and Sheri Boyd. Millie and Sheri were theatre students at Tech, and Pam is a frequently-seen actor on Lubbock stages. With Pam’s help, Amy also recruited the youngest member of the company, one-year-old Jackson Speer.

The film was shot in two days in February at The Bridge in the exact same spot where I had watched the original event unfold. Over the spring and summer, Amy and Jim edited the footage into a finished film. Then in late August, David Dees of Tech’s School of Music agreed to devise and perform original saxophone music for the film’s score. The result was Llano Estacado Blues.

We’re really excited to have our film included in the Flatlands Film Festival. I only wish I could be there for the screening.

Treatment count: 4 down, 41 to go.

Oranges

I grew up believing the modernist doctrine that progress is inevitable. Interesting that both Marxists and capitalists share this basic belief, tho' what each considers to be progress differs radically. In any case, I no longer believe in the inevitability of progress. Things change, yes—constantly—but they don't necessarily improve.

Which brings me to oranges.

When I was still a preschooler, my dad, freshly returned from his role in World War II, built our home. It was set back from the street behind several rows of orange trees. You couldn't really see the house from the street. These orange and lemon groves stretched for miles in every direction—a huge, seemingly endless forest of citrus trees.

I thought they had all disappeared by now, but lo and behold, there are still some orange groves here in the Redlands area—like the one on California Street pictured above.

This grove takes me back to my childhood. It looks exactly like the area all around where I grew up—right down to the trash on the ground. Notice the brown thing dead center in the picture, almost hidden under the tree? That's a smudge pot, used to fend off freezes. And the stubby little concrete thing under the dying tree on the right? That's a standpipe through which water would flow into furrows to irrigate the grove.

Three of my relatives were fully employed in citrus related jobs: Uncle Jake Bert sprayed groves; Uncle Chester (my mom's brother-in-law) cultivated and irrigated them; Maynard Book (Mom's cousin) was a manager at a packing house. Many of my friends and acquaintances earned money during high school and college tending the smudge pots.

Ah, smudging. When the temperature dropped several degrees below freezing, and the frost report on the radio announced that the dew point was at the danger point, the call would go out to light the pots. They would be full of low grade oil, and the guys would go around with torches and light the oil. The heat plus the thick smoke helped protect the trees from freezing. In the morning a dense, black smoke hung in the air. If you blew your nose, black soot filled your handkerchief. Talk about air pollution. I can't imagine that the smudge pot in the picture is ever lit these days.

As a boy I would run through the groves with my friends. We'd have orange fights, play in the irrigation water, and hunt jack rabbits with bows and arrows. The rabbits were pretty safe; I can't remember a single instance of any of us bringing one down. We went barefoot all summer, and by September, the soles of my feet had developed a tough layer of skin akin to shoe leather. No one ever worried about us being kidnapped, even if we didn't get home before dark. Such things just didn't happen. Or if they did, we never heard about it.

Then the pickers would come to harvest the oranges. Big covered trucks would drive up hauling trailers loaded with ladders. A bunch of Mexicans would jump out of the trucks, grab ladders, and spread out in the groves picking the fruit. You could hear them singing and shouting to each other in Spanish. I was sort of afraid of the pickers, but the memory of their songs and calls falls pleasantly on the ears of my mind.

This all changed in the '50s as war veterans and others from the East moved into California by the thousands. They had to have houses, and ranchers found it lucrative to sell off their land to developers. Bull dozers would come in and push the trees into great heaps. Once the trees dried a bit, they would be burned. Again, I can't imagine what the EPA would do about this practice today. Well, maybe I can.

As a child, I found it terribly sad to see those project houses planted where there used to be fruit trees. And the people who moved into the houses were different. They had left behind their homes and families in the East, and it seemed to me even then that they had also left behind their values and much of their humanity.

My world was changing, but it wasn't getting better. Maybe that's when I began to lose my faith in modernism.

Today the grandchildren and great-grandchildren of those project dwellers, and many who have since moved here to join them, fill the houses and shop at the malls that have replaced the groves. The groves are primarily memories now, preserved by names (Orange County, Citrus Street, Valencia, Grove Avenue) and by local logos like the one pictured above on a City of Redlands street sign.

So it's been a kind of sad joy to come across small groves that have somehow survived here in Loma Linda and Redlands. I've heard nostalgia defined as warm feelings for a time you really wouldn't want to go back to. And in any number of ways, those good ol' times were also bad ol' times. In fact, while some things have deteriorated, many others have improved. I wouldn't want to go back to the late '40s, but when I see these patches of groves, I can almost feel the hot dirt on my bare feet and hear those pickers calling to each other amongst the trees.

The proton machinery broke down this afternoon, so today's treatment was postponed. That will mean one more day longer in Loma Linda. At this point, that seems like a gift.

Levity

Things have been pretty serious on this blog lately. Time for some humor. I collected the following jokes at last night's Proton Potluck and this afternoon's Proton Patients' Support Group.

A warning to the upright: Proton patients are all men, and we all have cancer in a gland related to sexual function, and we all put up with certain indignities on a daily basis that readers of this blog are well acquainted with. Readers who are easily offended by below-the-belt humor might do well to skip this entry.

A man was driving down a country road when he noticed a chicken running along side the car. He sped up to 40 mph, then 50, then 60. Still the chicken was right beside him. When he passed a farm, the chicken made a quick turn down the farm drive way. Curious, the motorist turned around and drove up to the farm house. As the farmer came out, the man saw the chicken nonchalantly pecking at the ground in the yard, and he noticed it had three legs. "Does that chicken have three legs?" he asked the farmer.

"Yup," the farmer replied. "See there's just me, Ma, and Junior, and we all like drumsticks, so a fella down at the extension station developed these here chickens specially for us."

"Wow," said the motorist. "Well how do they taste?"

"Dunno," said the farmer. "Ain't been able to catch one yet."

One patient, who only has a couple treatments left, told the support group he's afraid he's going to miss the balloon. As the laughter died down, he said, "Every morning I wake up, turn on my side, and wait."

A man told his friend, "I had a doctor's appointment today, and I had my first ever digital rectal exam."

"How'd it go?" asked the friend.

"Well, he had me drop my pants and bend over. Then he put his right hand on my shoulder, and— Wait a minute. No, he put his left hand on my shoulder, and— Wait! No! Son of a gun! Now that I think about it, he had both hands on my shoulders!"

After treatment, a man developed unusual side effects. He and his wife visited his urologist, and after questioning them, the doctor asked the man to leave the room. Once he was gone, the doc told the woman, "This is a very serious case. The only way to treat it is this: He must have sex every night for the next year. After that, he must have sex every other night for the next five years. Now he has to do this, or he'll go blind. No other way."

The woman went out to the car, and as she got in, her husband said, "Well? What did he say?"

She replied, "He said you're gonna go blind."

Three cowboys sat around the campfire swapping stories. One was from Kentucky, one from Montana, and one from California. The Kentucky guy started to brag about Kentucky bourbon, and the other two said they'd like to try it. "No problem," he said. "I got a bottle right here." He passed it around and after taking a swig, the Californian and the Montanan praised it to the skies. The Kentuckian tossed the bottle in the air, pulled his pistol and shot it to smithereens. "Why'd you do that?!" the others asked. "Shucks," he said, we got lots and lots of it in Kentucky."

"You boys ever had any Napa Valley wine?" asked the Californian. The others said no, but they'd sure like to try some. "Got a bottle right here," he said. He uncorked it, they each had a swallow, and they averred they'd never tasted better wine. The Californian tossed the bottle up, pulled his six shooter, and shattered it in mid air. "Why'd you do that?!" the others asked. "No problem, boys. We got lots and lots of it in California."

Not to be outdone, the Montanan said, "You ever have any Bozeman beer?" 'Course they wanted to try some, so he pulled out a bottle, twisted off the cap, and passed it around. "Wow!" they said, "That's really good beer!" The Montanan drew his pistol and shot the Californian dead. "Why'd you do that?" said the shocked Kentuckian. "Shucks," said the Montanan. "We got lots and lots of them in Montana.

True story: A patient here told his tech, Brian, that he didn't think he'd ever get used to the balloon. Brian said, "If you do, best not tell anyone." He inserted the guy's balloon and the guy said, "Hey! Easy!" Brian said, "Oh, did you want me to use lube?" Then he said, "Uh-oh! Where's my watch?" Anyone see my watch? It was right here a minute ago!"

Brian's on the late shift in Gantry 3—my gantry—and my treatment's at 10:30 tonight. Gives me something to anticipate.

A man went to his doctor complaining about his sex life. "My wife's lost all interest," he said.

"Here's what you do," said the doctor. "Go home, break down the door, rip her clothes off, throw her on the table, and go at it."

A few days later the doctor ran into the man down town. "Did you take my advice?" he asked.

"Sure did," answered the man. "I busted down the door, ripped off all her clothes, threw her on the table, and went at it."

"Well what did she think?" asked the doctor.

"I dunno," said the man, "but her bridge club sure liked it."

There were more, but you get the idea. If laughter's the best medicine, we should all get well real soon.

Treatment count: (as of 11:00 tonight) 3 down, 42 to go.