When Words Fail

It's funny. Some of the times that you feel like you should be on the top of your game as a writer are when you fall flat. It's not quite like writer's block, because writer's block is more like lack of inspiration--at least that has been my experience. It's not because I'm putting too much pressure on myself either. Usually when I do that, I'll come up with something, because I'm in survival mode. It's like the old college effect. You either write and pass the assignment or don't write and certainly fail. It's sink or swim.

Tonight is different.

Tonight is better.

Tonight I know, that no matter what I write, it won't adequately communicate the thoughts and feelings inside of me. Sometimes, but not often, words fail. Usually it requires a lack of a reference point such as when something is beautiful beyond description (like the birth of your child, so I've heard) or something is unspeakably evil (think 9/11).

So here I am trying to wrap my head around something to make it more understandable for those who are reading and I don't know where to start. Maybe it's impossible for you to understand unless you have heard the words, "You have cancer," and then spent the majority of the next year trying to avoid thinking about the what ifs while recovering from surgery, radiation, and chemo. Hard as it is, I have to try, because days like this don't come very often.

It's what I was expecting, I guess, my doctor's appointment, I mean. Last Friday, as I outlined in my previous post, I had my first PET scan since my treatment finished up. I was able to withstand the needle and the time alone in the tube, thank God. Today, however, the results of the scan would be made available to me during my check-up with my radiation oncologist. But after going to the doctor every day for nearly two months, the apprehension of "What's the doctor going to say?" wears off and you are left with routine. I forgot somehow that today was not routine.

I forgot, that is, until I heard my doctor say, "The PET scan looked great...better than we expected. It was everything we could have hoped for." Then I remembered that I hadn't heard anything close to resembling that in the past year-and-a-half. And this is where words fail me, because I just don't know what to write.

Like I said, I was expecting to hear good news. But despite the fact that I thought I was prepared to hear the good news and be on my way, I wasn't. I wasn't able to just sit and be told that the cancer, at this check-up anyway, was not there. I wasn't able to not care enough to be deeply affected by what my doctor said. I had too much invested. I had given too many drops of blood, sweat, and tears to not care. My memory flashed back to the mouth sores that were so raw I would spit up blood; the daily ritual of sweating in fear and apprehension as I climbed upon the radiation table; the tears of both the physical and emotional anguish that would surprise me in the middle of the night and the middle of day and sometimes, the middle of a conversation.

Sometimes words are meant to stand alone: "The PET scan looked great!"

Back at It

If any of you have ever had cancer, then you probably have experienced a PET scan. I think that I have covered the science of the PET scan in a previous post, but it would have been a long time ago so it doesn't hurt to have a quick review. PET is short for Positron Emission Tomography--yeah, say that 10 times fast. Basically, it's a test for the presence or absence of cancer. That is it's sole purpose.

To understand the theory behind it, you must first know that cancerous cells and tumors consume energy at a faster rate than the rest of your body (normal tissue). This energy comes in the form of sugar. The fluid for a PET scan is a molecularly-modified concoction of sugar with a radioactive tracer chemically attached to it. In preparation for a PET scan, you get hooked up to an IV and they pump some fluids into your system. Then, they bring out a stainless steel cancer that looks as if it came from a cheesy, futuristic, science fiction film. This canister contains the sugar concoction necessary for the scan. They hook the canister up to your IV and slowly inject the fluid into your body.

In all honesty, I think that this is the worst part. Imagine for a moment that someone gives you a shot and that the shot they give you consists of nothing but ice water. Essentially, that's the feeling you have when they inject this fluid into you because it is kept cold. A refrigerated liquid is being pushed through your blood vessels and it gives you a very specific, very cold feeling until it warms up to your body temperature.

So after the radioactive tracer/sugar solution is fully injected into your body, then you sit around for about an hour while it makes its way through your body. Now here is where the knowledge of the sugar-consuming habits of cancerous cells come into play. The more active the cancerous cells and tumors are, then the more they consume the sugar that they need to survive. And the more sugar they use, the more radioactivity will be present in that particular spot. So, after the hour of waiting and your body metabolizing the sugar solution, they run you through a machine that seems to be half MRI, half CT scan--that is, not as big as an MRI but bigger than a CT. The machine scans your body and measures the amounts of radiation in particular spots. If everything congregates in one place, then you probably have a tumor. If it is evenly dispersed, then you probably don't--this test is accurate with tumors as small as 1 centimeter. Anything smaller than that won't show up, thus the reason it is necessary for cancer patients to have regular check-ups every 6 months at a minimum.

Another thing to be aware of is the nature of false positives. They occur more often than you probably think. The reason for this is that other cells and tissues that use sugars (energy) at a greater speed than normal cells and tissues also force the radioactive tracer to congregate around it. An example of what may cause a false positive is muscles that have been exercised recently--in preparation for this treatment, I cannot exercise for a period of 24 hours prior to the scan. Also, tissue that is healing itself will also show up as a false positive. The latter example is precisely the reason that I have not yet had a PET scan. After looking at my mouth at my most previous check-up, my radiation oncologist informed me that my mouth was still in poor enough shape that undergoing a PET scan would be a huge waste of time and money. So, here I am, roughly a month later, getting mentally prepared to go in for a PET scan. My first PET scan since my cancer treatment ended.

What do I mean by mental preparation? Well, funny you should ask. There are two primary things that I need to be ready for. The first is a confined space. Prior to my radiation treatment, I never had any issues with claustrophobia. Now, I think about it all the time, even when I get on a plane. The second is the fact that if my cancer were to come back, it would most likely be within the one-year span from when my treatment ended. As many of you know, I just finished up last September 21--well within the one-year window. Therefore, I need to be mentally prepared for the slight possibility that it could have returned. HOWEVER, and let me be very clear on this, I do not feel as if I have cancer anymore. You may think it is impossible for me to know, but if there is one thing that I have learned throughout this process, it is that I need to listen to my gut instincts, because they are usually right.

If you are a reader of my blog, don't expect for any results to be posted for a few days. My scan will probably not be reviewed until the following week at the earliest. If, however, I were to find out anything, then I'll certainly post it so that you know what is going on. Thanks for reading!

Reflections

It is a new year and the season for resolutions. I hate resolutions. To be completely honest, I didn't even think of what kind of resolution to enter myself into this year until we were already a week into 2006. But in the spirit of new beginnings, the closest thing to a resolution would be my desire to hold on to the fact that I'm still alive.

2005 was not a kind year. Nor is it one that I would ever like to repeat. I'm bearing down on the one-year anniversary of my cancer diagnosis and it hardly seems possible. So much has happened and it is impossible to remember it all. I knew that it would be this way, and that I would forget, and it is one of the reasons why I kept a journal as best I could. It is why I shared my thoughts with you on the Internet. Sure there were other reasons like communicating my most urgent needs with all of you. Or simply communicating to each of you because I could not do so any other way. I remember the days when I desperately wanted to be able to pick up the phone and call a friend or family member, but couldn't because despite the fact I was on heavy pain medication my mouth and throat felt as if it were a pincushion--a black hole of pain.

Cancer does funny things to a person. For starters, it treats everyone differently. Some people can deal with it and others can't. I was somewhere in between--curiously removed from the captivity of my ravaged body yet desiring to hold on as if the pain was an act of cleansing. It is a type of baptism--sanctification through pain. I'm not 100% sure but I think that history has had its share of monks who have engaged in painful practice of self-abuse. If not outright abuse, than rejection of the body and full embracing of the soul. They willingly entered into this pain as a public renouncement of their bodies and turning towards the eternal, the spiritual.

Cancer doesn't care who you are or what you've done. It knows no friend and plays no favorites. I look back at the previous year with fondness, however. It's okay if you think I'm crazy. I'm the type of guy that if I knew I would live through a plane crash, I would want to do it just to say that I know what it is like. My cancer taught me a lot about life, and myself. It is a metaphor for life. I've been reading Lance Armstrong's biography entitled It's Not About the Bike: My Journey Back to Life. I'm only halfway through and it has nearly brought me to tears on more than one occasion, but that's beside the point. At one point in his book, Lance compares the general fear of cancer to the loss of hope. Hope is slowly eroded through cynicism just like the body is slowly (or quickly) destroyed by rebel cells. In both cases, death comes slowly and painfully, yet sickeningly methodically--death of the heart in the first and death of the body in the second.

It's difficult not to be philosophical about pain after going through a hand-to-hand fight to the death with cancer. And make no mistake about it--it is a fight to the death. Think about it: either it goes, or you go. in any medical book you read there will not be a fun, heart-warming story of the cohabitation of cancer and healthy tissue. There is no third road.

This could easily become a book, because there are lots of things to say about it. However, I'm tired (as usual) and I want to go to sleep, so I'll keep my thoughts abbreviated. If nothing else, coming face-to-face raises your threshold for pain. Things you never thought you would be able to survive now become not just doable, but almost normal. Another day at the office. The human body can withstand so much more than what we inflict upon it. Another thing it did for me was provided courage with a shot of caffeine. Every day I survived the pain inflicted on me was another day that I could mark off the calendar and say to my cancer, "You haven't got me yet...let's do it again tomorrow." But the real reward comes in knowing that life is precious and never to be taken for granted. In a way, I feel as if I've paid my dues for whatever "normal" days I have ahead of me, if any. Fragility is part of this world and while our mortal bodies are curiously strong and able to withstand more than we think it can, they are also susceptible to attacks from within. When cancer has been allowed inside your defenses like a Trojan Horse, things can get pretty ugly in a short amount of time. Come to think of it, that's a pretty good metaphor on its own.