Game Over

Tonight, along with five others who are also finishing treatment, I gave my graduation talk. This ritual concluded the wrap-up of my program that began a week ago with the discharge class.

Two days ago I had my final consultation with Dr. Bush and his resident, Dr. Do. As usual, this visit didn't take very long. I've had no side effects, and all has gone as designed, so aside from monitoring my progress the doctors had little to do on my case once they had set up my program of treatment. "We expect success," were Dr. Bush's parting words.

Then, this afternoon, I had my last treatment and said good-bye to the techs who staff the afternoon shift in Gantry 3—Brian, Nancy, and their assistants. After my treatment, they gave me a big black marker with which I wrote "D-O-N-E-!" on my pod. The insulation with my body imprint will be discarded, and the pipe that forms the pod's walls will be recycled. They also gave me the wax bollus that helps shape the proton beam and—lest I forget—a balloon apparatus. These items will be enshrined on my mantle at home.

Perhaps strangely, I don't have a sense of jubilation over the conclusion of my treatment. I think, in large part, my ambivalent feelings have to do with the fine care I've received. Never did I feel like someone's science project. Always, from receptionists to techs to doctors, everyone on the Loma Linda staff treated me like a person. They embodied the Loma Linda motto, To Make Man Whole. Then also, the end of treatment means leaving this beautiful part of the world with its temperate climate and returning to the south plains of Texas where, yesterday, they experienced 70 mph winds and this morning the thermometer registered in the 'teens.

It occurs to me that, had I undergone surgery, I would very likely still have had a period of several months out of circulation while I recuperated. But what a different experience that would have been! Instead of hiking, making friends, sharing stories, enjoying life, and productively carrying on my teaching, I would have encountered physical pain, incontinence, loss of sexual function, and quite possibly severe depression.

What lies ahead? In terms of my cancer, I can expect it will gradually disappear as a result of the radiation. I'll have my first follow-up appointment in 4 months and then at 6-month intervals far into the future. These sessions will consist of PSAs and digital rectal exams as well as dealing with any side effects that might show up. The expectation is that my PSA, over time, will drop to near zero and will stay there and that the side effects will have little impact on my quality of life.

In terms of the rest of my life? I honestly don't know. We hear that we will never be the same. However, I don't think the nature of any changes will appear until later. A week or so ago, I began to ask guys who were almost done how the experience has changed them. Few could pinpoint any significant changes. I'm guessing that now is too soon to know.

I expect that much will remain the same as I return to normal activities at Tech, at St. Johns, and within the Lubbock community. I hope I can find interesting places to continue hiking. I look forward to reuniting with Amy. Then there is the realization, as Lynn Martel reminds us weekly, that we will eventually die—not from prostate cancer, but die nevertheless. As Lynn also pointed out at tonight's support meeting, a brush with cancer heightens one's sense of mortality. The point is to greet each day as a new opportunity, as a gift—This is the day the Lord has made; let us rejoice and be glad in it .

Treatment count: 45 down. Done.

Island

Yesterday at 9:00 I boarded the Islander, along with 50 or so others, and headed out for Santa Cruz Island, part of Channel Islands National Park.

Occasionally the sun would pierce the clouds, and constantly, off our port side, Anacapa Island, neighbor to Santa Cruz and only dimly visible in the picture, rode the horizon.

After disembarking and receiving a briefing from a Park volunteer, I set off on my walk.

The thousands of years of Chumash culture on the island left little mark on the land. But in the 19th century Anglos began using Santa Cruz for raising cattle and sheep, and it will take years—maybe centuries—for the island to recover from our exploitation. Thank God for the National Conservancy and National Park Service who share ownership of Santa Cruz and are, together, committed to restoring and preserving its natural beauty.

To a walker like me, the island seems immense and its hills and mountains stunning. I have to wonder what the vegetation was like, pre-sheep.

And how beautiful its coastline of pebbled beaches and rugged cliffs as in the picture I took near Potato Harbor!

Eventually my wanderings brought me back to the inlet that shelters Scorpion Landing. There in the distance waits Anacapa. Maybe someday I can visit that island.

At 3:30, the Islander began the loading process, taking on camping gear, scuba diving equipment, and the string of kayaks in the picture.

As we left the island, the sun and clouds again painted a picture over the island. My iPhone camera does it only partial justice.

Walking, like any really worthwhile activity, stimulates insights into the self. I learned something about my self on Santa Cruz with which I'm not altogether comfortable:

I'm a loner. In a way, I'm as isolated as an island.

As I was talking to the Park volunteer, making certain I knew where I was headed, a young East Indian, Gary, joined us, asking questions about the same destination—Smugglers Cove. Eventually the question that I was dreading: "Do you mind if I walk along with you?"

Yes, I really did mind. Why? After all, the guide sheet said, "Never hike alone!" and here was a ready made buddy for the day. He seemed like a nice enough guy. I could get acquainted with someone new. Why did I mind?

Unable to come up with a good answer, I said, "Sure." It took me a while to get set to leave—stash my sweatshirt, extend my hiking poles, that kind of thing—so Gary said he'd get started.

It wasn't long 'til I caught up with him, even though he turned out to be a stronger, faster walker than me. We visited a bit, but I was increasingly uncomfortable with the necessity of engaging in conversation when I enjoyed the silence, of matching my rate of walking with Gary's.

So at the first junction, about a mile along the way, I consulted my map and told Gary that I was having second thoughts about Smugglers Cove and had decided to do the Scorpion Canyon loop instead. We went our different ways. I felt like a prisoner who had won release.

As I thought about it, I had to face the fact that I'm not a very sociable guy. I like being an island. I almost never feel lonely—even when compelled to be by myself for extended periods of time. On the contrary, I can be positively uncomfortable in groups—what do I say? how do I relate? what do I do? Some of my most moving, most enlightening, most enjoyable experiences have occurred when I was by myself—my solo bike rides to Ruidoso, New York, and Big Bend, to mention a few.

I find this realization uncomfortable. It seems somehow non-human, embarrassing—a fault. There on the trail, I worried, for instance, about the future of my new-found hiking hobby. I had thought I'd like to share this joy with Amy, with Ted—a veteran hiker. But now I wondered. How would that work out?

Clearly, doing things with Amy has always enhanced the activity. Many have been the times over the past 2 months of basic solitude when I've thought, This would be so much more fun with Amy. But what about hiking? What if our rates of walking don't match? What if I want to stop and look and she doesn't, or more likely, she wants to stop and look, and I want to march on? Maybe we can devise some solutions to make certain both get from the experience what each most enjoys. What solutions? What arrangements? What agreements? I know Ted has often hiked with others, so maybe he will have some insights that will help me——

Again walking becomes an analogy for living. If we are essentially individuals—islands—yet we have this capacity, this drive, even this necessity for relationships, how do we manage? One would think that by the age of 67 I would have figured it out. Maybe 2 divorces testify that I haven't.

Well, I've got some years left to work on the problem. I hope Amy and friends like Ted can put up with me while I do.

Curing/Healing

I've wanted to post the following piece on this blog ever since I heard Bob Marckini read a portion of it when he was here at Loma Linda last month. He sent it to me today.

From time to time I've mentioned the idea that curing a pathology and healing a person are related but different. Both are important, but the spiritual, relational, and emotional aspects of healing give it an edge. I'd go so far as to say that curing without healing is terribly inadequate, while healing without curing is sometimes the best that can be done and, in fact, is sufficient. I first read about this difference some years ago in a book on Jesus written by John Dominic Crossan who suggested that, whether or not Jesus cured diseases may be open to debate, but that he healed people is certain.

Although Loma Linda pioneered proton treatment as a cure for cancer, what really convinced me to come here was the expectation of healing. The healing has to do with Loma Linda's mission to make man whole. I have not been disappointed.

The author of the following piece is Fred Recklau, apparently a Lutheran pastoral theologian. I know nothing more about him, Googling his name will turn up multiple sites that present these contrasts. They're worth repeating here.

Cure alters what is; Healing offers what might be.

Cure is an act; Healing is a process.

Cure acts upon another; Healing shares with another.

Cure manages; Healing touches.

Cure seeks ultimately to conquer pain; Healing seeks to transcend the pain.

Cure ignores grief; Healing assumes grief.

Cure encourages mystery as a challenge for understanding; Healing encounters mystery as a ready channel for meaning.

Cure rejects death and views it as defeat; Healing includes death among the blessed outcomes of caring.

Cure may occur without healing; Healing may occur without cure.

Cure separates body from soul; Healing embraces the soul.

Cure tends to isolate; Healing tends to incorporate.

Cure combats illness; Healing fosters wellness.

Cure fosters function; Healing fosters purpose.

Treatment count: 42 down, 3 to go.

Discharge

About a dozen of us who are finishing our treatment program in the next week attended the discharge class today.

Surprisingly, I had never seen 3 or 4 of the guys at the meeting—surprising because I've regularly attended the weekly potlucks, education/support meetings, and restaurant tours as well as waiting in the lobby for my treatments along with other patients. Although I haven't made the acquaintance of many of the guys I see at these meetings, I recognize them. But here were several guys I'd never even seen before. As I thought about it, it became less surprising. There are upwards of 100 prostate proton patients in the program. But on any given night, attendees at the Wednesday evening support meeting probably don't number more than 8o, including spouses. I'm guessing the normal potluck attendance is about 30 (plus spouses), and even fewer participate in the restaurant tours. Probably the strangers at today's meeting simply haven't participated in any of these functions. The proton treatments cure the cancer, but these "extra" meetings are where the healing takes place. Opting out of them seems to me to be turning down a huge part of the therapy available at Loma Linda. At one point in Jesus Christ Superstar, an exasperated, harried Jesus screams at the crowds who are demanding his attention, "Heal yourselves!" I know this moment has its basis in a story in the Gospels. I understand Jesus' frustration. How often do we pray for miracles but not take responsibility for our own healing?

At today's meeting, Lynette, the nurse in charge of follow-up, went over the schedules and procedures for our care after finishing treatment. She explained what we could expect to happen to our PSAs, which we'll monitor the rest of our lives. Then she detailed the kinds of side effects we might experience after treatment—blood in the stool, urinary problems, erectile dysfunction, fatigue, and blood in the urine. Most of these have a very low percentage of incidence for proton patients, are transitory, and are treatable by life-style adjustments ("Drink more water!") or, in worse cases, medications. The most common—blood in the stool—occurs as collateral rectal damage from the radiation heals itself and creates new blood vessels that, at first, are thin walled and may break under abrasion from constipation or rough foods like chips and corn. This too will take care of itself in time.

There was nothing about diapers, nothing about kissing our sex lives goodbye, nothing about colostomy bags, nothing about installing penile implants or artificial sphincters—all of which I've heard about from recipients of other therapies.

As I walked home after the meeting, I felt two emotions—relief and suspicion. Relief that I would be very unlikely to face the devastating side effects so common amongst men who have gone through radical prostatectomies or suffered by survivors of other forms of cancer. Suspicion because I wondered, Can it really be this easy? Is there something they're not telling us? Are the statistics phony? I have no real reason to believe any of the information we received was falsified. I think my suspicions are simply the flip side of my relief. I'll certainly be alert, ready to take action should any side effects show up. But for now, I'll rejoice in my relief.

Treatment count: 40 down, 5 to go.

Amy

Happy birthday, Amy! Today you reached the ripe old age of 33, the same age as Jesus when he was crucified.

On your birthday, I want to tell you that I love you.

I love you because you make me laugh, and laughter is healing, so you heal me with your laughter.

I love you because you keep me young, and age creeps on apace, so I am glad to find in you my fountain of youth.

I love you because you see to it that I look young. Over the past three years you've accomplished a make-over on me, so I no longer look my age.

I love you for sharing with me your beautiful body which gives me such pleasure to see and which I long to hold again.

I love you for keeping me humble, for pointing out my faults, for reminding me at least once a week that I'm sort of funny looking, for reminding me daily that I'm a lucky old fart to have such a hot and sexy little lady as you to hang out with. I need all that. It's way too easy for me to get proud.

I love you for your energy and diligence, for your wisdom and your intelligence.

I love you for your uncertainties, your obsessions, your concerns, your hopes and your dreams.

I love you for your passion and commitment

I love you for your honesty, your commitment to the truth and to truth telling.

I love you for your creativity, your digital skills, your abilities with languages. I love to watch you develop your talents and skills.

I love you because we pray together.

I love you for your love of shopping, your eye for fashion, your familiarity with celebrities about whom I am totally ignorant.

I love you for your loyalty throughout this whole cancer ordeal.

I love you for the joy you bring into my life.

Your presence in my life is God's good gift to me.

You're a little concerned since, at age 33, you have not yet saved the world. Well, you've saved me, and maybe that's a good start.

Happy birthday, Kim Ye-min. Many happy returns of the day! And may I be there to celebrate many of them with you!

Treatment count: 39 down, 6 to go.