Body Image

Since losing 50 pounds in the late 1960s, I’ve been thin, but I didn’t realize that slimness had become an important part of my self-image.  During my recent stay at Memorial Sloan Kettering, so much liquid was pumped into me intravenously, that I gained 25 or 30 pounds.   It wouldn’t be so bad if the extra weight had been more or less evenly distributed, but it wasn’t.  When I looked in the mirror I was shocked to see that I looked like one of those Neolithic Venuses minus the breasts – all stomach, hips, and thighs. 

So when a nurse uncovered me, I would remark that I was terribly swollen, as if to say, “no, I’m really not like that.”  How ridiculous.  The nurse didn’t care how I looked, but I cared.  This was the first intimation that my body image was important to me.  It’s nice to learn new things, especially at my age. 

Zytiga

Last Friday, I met my medical oncologist at Memorial Sloan Kettering.  He gave me both good news – that Medicare has approved my use of a new drug, Zytiga (abiraterone) - and bad news -   that my cancer has spread to my lymph glands.  Neither news was unexpected.  Medicare has begun to approve the drug, and since the cancer had already spread to the urethra, the bones, the penis, a lung, and the heart, it’s not surprising that it has continued its relentless march through my body.

Prostate cancer is cunning.  The hormone I’m currently taking reduces the amount of the body’s testosterone, which acts as a kind of fertilizer for cancer cells.  So the cancer has begun to manufacture its own testosterone.  If the Zytiga works, it will reduce further the amount of testosterone in the body.  I’m too weak for chemotherapy, my doctor told me, so the administration of Zytiga is the next line of defense.

A bulletin to which I subscribe published the final clinical data for a trial of Zytiga.  Those men who took the drug showed an overall survival rate of 15.8 months whereas the survival rate for those who took a placebo was 11.2 months.  The difference of more than four months may not seem like much until you compare those four months to being dead.

When my wife and I entered my oncologist’s office, my one burning question was my life expectancy.  I didn’t ask, in the end, because it turned out I was afraid of the answer.  But after reading that bulletin, I do have a rough idea.  Of course those statistics are medians, with half the men above and half below.  Still, the answer is a lot more favorable than I had feared.  If I’m lucky and if I’m average, I’ll have more than another year.  Not so bad.

Quality of Life

Perhaps a year ago, I wrote about an elderly man who was about to undergo a dangerous operation.  Before the operation, his daughter, a physician, asked him what quality of life would be satisfactory to him if he were unable to speak for himself and the question of resuscitation arose.  As long as he could watch football on television and eat chocolate ice cream, he told her, he’d want to be resuscitated.

That wouldn’t be enough for me, I wrote at the time, even if I made more congenial substitutions for chocolate ice cream and football.  But while I was in the hospital, I changed my mind. It would be enough for me, with the important proviso that I was relatively pain free.  Even in the hospital there was much to be enjoyed – my visitors, the food, the television news, none of which required more than what’s involved in eating ice cream and watching football.  If I could read and write, so much the better, but these activities, so important up to now, would not be a sine qua non. 

There’s nothing like being faced with the alternative of death to make you realize that even a life of limited scope can be worth living.

Death Bed Scenes

“If your heart stops, do you want to be resuscitated, and if you can’t breathe on your own, do you want to be intubated (a procedure in which a tube is inserted down your throat and a machine takes over your breathing)?”  Those weren’t their exact words but that was the meaning of the questions that two young doctors were asking me in the early hours of the morning towards the end of my first week at Memorial Sloan Kettering Cancer Center.  I tried to explain that I didn’t want aggressive measures if they brought me only a little more time at the expense of a severe reduction in my quality of life.  

I didn’t understand why they were asking me those questions but later I learned that the oxygen level in my blood had dropped to a dangerously low level and that my life was in danger.  The doctors bid me good night and I was left with my own thoughts.  It suddenly struck me that the two doctors would not have come to me late at night if death were not an immediate possibility.  I ought to be reviewing my life, I thought, taking note of my successes and failures, my hopes for my children and grandchildren, giving thanks for what had been a good life.  But no, I thought, I’m not up to it.  All I wanted was to luxuriate in the warmth of my bed and in the freedom from pain which my medicines had brought me.  “Is this,” I wondered, “what it’s like to die?  If so, it’s not so bad.” 

I shouldn’t have done it but, feeling that the end might be near, I called my wife at three or four in the morning.  I don’t remember what I told her but she came to the hospital as soon as she could.  “I’m letting go,” I told her when she arrived.  “It’s all right,” she said, “you’ve had a good life and it’s okay to let go now.” 

I fell asleep and when I awoke I felt a lot better.  The drop in my oxygen level, however, set in motion an effort to find the source of the problem.  A CT with contrast revealed a tumor, surrounded by clots, that was traveling in a pulmonary vein into my heart.  My wife and daughter called our immediate relatives, including our son in California, who dropped what they were doing and came to see me.  This gave me an opportunity to tell each of them that I loved them and in one case to ask for forgiveness.  I consider myself lucky to have had the opportunity to do so.  But I also felt a bit like a fraud, for by this time I was feeling pretty good.  “From now on,” I told them,  “you’re excused from further death bed scenes with me.”

How the Old Man Got His Trunk

Down by the East River stands one of the world’s great medical establishments, the Memorial Sloan Kettering Cancer Center.  One day an elderly professor ventured inside with what he thought was a minor complaint and didn’t leave for another 17 days.  In the course of his treatment, his blood oxygen level fell so low that he was given a high-speed oxygen delivery system that included a beautiful blue-green plastic tube that was placed over his face and reminded him of an elephant’s trunk.

“If Kipling were alive now,” he remarked to his night nurse and his respiratory therapist, who were both attending him, “I’d ask him to write a story about how the old man got his trunk.”  The nurse and therapist looked at him blankly.  It was clear they had never read or heard Kipling’s  Just So Stories.  So the old man told them how the elephant got its trunk.  The story charmed them, even though he scarcely did it justice.

Curious, the old man asked his son, who had flown in from California, and his daughter if they knew the story.  They did not, even though the volume had been in their library when they were children.  Perhaps their having grown up in Israel explains this gap in their education, thought the old man.  So he asked another nurse and then another, but neither knew the story.

A crocodile did not create the old man's trunk nor was a crocodile responsible for its being taken away.  The old man's breathing slowly improved and although his blue-green trunk was beautiful, he was not sorry to say goodbye to it.  But he was sorry that the generations after him don't know what happened when a curious baby elephant, in the days before elephants had trunks, asked a crocodile, down by the great gray-green greasy Limpopo River, what he eats for dinner.

Return

Last Tuesday, September 11^th, I returned from the hospital, where I had spent 17 days.  To make a long story short, my prostate cancer has metastasized to my lungs – an exceedingly rare occurrence – and a tumor traveled from a pulmonary vein into my heart.  For reasons I don’t understand, the tumor has collected blood clots, which have a chance of breaking off and causing a stroke or worse.  What are the chances?  A surgeon told me that it’s less than 50% but more than 1%.  He estimated it at 15%, but he has no firm data to support his guess.  In the meantime, my doctors are trying to dissolve the clots with anticoagulants and to retard the spread of the cancer with new medicines.  They sent me home to get strong enough for chemotherapy, which as I understand it would be given to me in the spring.  I’m considerably stronger now than I was when I left the hospital and I hope to recover sufficiently to walk in Prospect Park again.   Right now I’m doing my best to enjoy what there is to be enjoyed – and there is still much to be enjoyed.

I’ll try to return to posting three times a week.  I’ve several posts in mind about my hospital experience.  If I stop posting, don’t assume that a clot has found its mark. I expect a few more gaps in the months ahead.

To those who have sent me e-mails, I apologize for not having yet answered them.  I haven’t opened my e-mail for almost a month.  That’s next.