CT report

The results of the CT scan are as expected: Some further progress in shrinking the bladder tumor, some reduction in size of the affected lymph nodes. The great news for me though is that I was totally mistaken in thinking that I would be "under pressure" to have surgery. On the contrary, the oncologist not only is not pressuring me in the least, he now seems to be of he same mind and thinks surgery would not be a good idea. For some time now I had already decided I would decline surgery no matter what, but it's great to have the support of the oncologist himself. The plan is to have two more 3 week cycles beginning on Jan. 9 as proposed earlier, more scans and then most likely stop the chemo and go to check ups every 3 months or so. Also there is a new immunotherapy drug that has already been FDA approved for one type of cancer, and he expects it to be approved for bladder cancer with in the next 6 months or so. It may well be worth a try.

The doctor does emphasize that chemo is not a "cure", and that my cancer is metastatic (which we knew). It is very difficult to get a straight answer on typical survival time/rates for someone in my position, but I think the truth is simply that no one really knows--which has been my position all along. We don't know, so I'm going to just assume that I'll beat whatever odds by a wide margin. After all, I've always been an odd duck, so why shouldn't I be an anomaly in the cancer world as well? In any case, today's meeting has left me feeling more confident than ever. And I'm sooooooooooooooooooooooooooooo glad to be taking a break from the "nectar of the gods"!

I found out today that Jina's training was in ballet, but her professional dance career was modern dance in Japan for a few years. I was surprised to find her unaware of the fact that receptionist Priscilla spent several years in Japan as well, as some kind of exchange student, and still corresponds regularly (every week, I think she said) with her host family. So I'm helping the Urology Clinic folks to get to know each other. Now if only I could get Radiology and Urology to communicate...

What's behind the sky? Part II.

                                                                               
                                                                               
According to the script and the stages of grief, I think I'm supposed to       
be wallowing in self-pity and/or angry. But it would be absurd to feel sorry   
for myself even for a second, even if I thought the cancer would kill me       
in a few months. I'm 63 years old, and I have had a wonderful, amazing,        
incredibly fortunate life. I inherited some pretty darn good genes from        
my parents.  I have a wonderful, loving mother. Although my relationship       
with my father was rocky, it was much smoother for me than it way for my       
three siblings, and it is largely to him that I owe my life-long               
interests in mathematics, languages, and athletic endeavours.  I have          
those three amazing siblings. I grew up in complete economic security,         
with virtually unlimited educational opportunities, free to follow my          
own dreams. And follow them I did, from the joy of climbing to the joy         
of mathematics. I got a job I love at my absolute top choice university,       
here in Seattle. I have the most wonderful amazing wife who I love. I have two 
beautiful daughters who never cease to inspire and amaze me. I have two        
grandchildren who have been determined by an independent consulting firm       
to be the cutest grandchildren on the planet. At a low point of my             
youth, I had the incredible good fortune to meet Jay. It was through him       
that I met Wendy and almost all of the wonderful northwest friends that        
I've known for 40+ years. Hell, even in cancer I've been lucky: I am           
only a pleasant walk across campus from one of the top medical centers         
for cancer treatment in the world. Feel sorry for myself? Neanche per          
sogno! (A delightful Italian expression meaning ``no way!'', or                
literally ``not even in a dream''.)

And who would I be angry with? God? One of the oldest recorded writings        
on this theme is the Book of Job, which includes this memorable exchange       
between Job---who was in much worse shape than I am now---and his wife:         
                                                                               
Job's wife: ``How long will you go on clinging to your innocence? Curse        
God, and die.''                                                                
                                                                               
Job: ``Foolish woman, have you lost your mind? We have accepted good           
fortune from God; surely we can accept bad fortune too.''                      
                                                                                                                                                             
Shortly thereafter Job completely loses his cool and begins ranting            
bitterly against the injustice of it all.  One can't blame him really,          
under the circumstances, but his initial response was much more to the         
point. Here I note that the words ``from God'' can be removed without          
changing the meaning at all; it is just the religious person's way of          
saying ``we have accepted good fortune; surely we can accept bad fortune       
too''. In my case, to curse fate or fortune or whatever would be               
ridiculous, even comical. Curse you, God! You have given me an easy,           
comfortable wonderful life for 63 years, with no pain or hardship worth        
mentioning whatsoever; how dare you betray me now!

Job's key question is ``why me?''.  I        
could ask this too, but the only reasonable answer is ``why the hell           
not?''. Millions upon millions have had cancer and died from it,               
including many younger than I. One of my early mathematical mentors died       
of stomach cancer at 49. The wives of two of my colleagues succumbed to        
breast cancer, in their late fifties I think. We all know many examples.       
                                                                                                                                                            
So there's nothing special about it. In fact one can and should take           
this a step further: What's so special about cancer? I suppose it is the       
fact that it is a long, drawn-out battle---which some win, some                
lose---and a very painful one at the end, if it comes to that. In              
contrast, a colleague in the math department recently drowned while            
kayaking the upper reaches of the Yangtze (or was presumed drowned; his        
body was never found). That, surely would be a better way to go. But he        
was only around 40. My cousin David died in his sleep at age 16, of some       
strange disease that was never properly diagnosed. I can still picture         
the last time I saw him, a few years before that. I was with my family         
at the airport in New York, waiting for our flight to Belgium in the           
summer of 1964. A few cousins came to see us off, including David              
limping along on his club foot---with a big smile, as always. As usual         
we broke out the chess set and played a game in the waiting room. He           
called the knights ``horseys''. ``You can't take my horsey!'' he would         
exclaim. 

 It is much too late to be angry. To be angry now only raises the               
question: why weren't you angry before, when David and so many others          
died long ``before their time'', as we like to put it. I have accepted         
good fortune. Surely, I can accept bad fortune too.                            
                                                                                                                                                              
Since I have quoted from the Old Testament, and may well do so again,          
before going further I digress to clarify my position on that venerable        
text.  As some readers of this blog know only too well, I once spent three            
years studying the Old Testament.  I came to three main conclusions.           
                                                                               
First, that it is a work of great historical interest, providing a             
window into a corner of the ancient world in and before the first              
millenium BCE---a small corner, but one that for better or for worse           
intersected at various times all the major empires of a much broader           
region: Egyptian, Assyrian, Babylonian, Hittite, Persian, Macedonian,          
Roman. It is of course filled with innumerable myths, legends, and             
transparently tall tales, but even these provide interesting insights          
into the times, and into the minds of the legion of diverse authors who        
wrote the various ``books''.      

Second, if viewed as a work of literature, some of it is quite good,           
although one does have to watch out for editing by late redactors who          
felt that the original did not conform sufficiently to the theological         
dogma of their own day. The remarkable Book of Job (often the favorite         
of tree-hugging cappuccino-sipping pointy-headed pinko intellectuals           
such as myself) was among the worst victims of this corruption by pious        
meddlers. I personally recommend the beautiful translation by Stephen          
Mitchell (no relation). It too inevitably takes liberties with the             
``original text'' (to the extent that such a thing can even be                 
determined), but at least it captures the fury of Job's shocking charges       
against God, without the white-washing and censorship added by the late        
meddlers. When they were not busy altering the text itself, the meddlers       
were fond of making up the most absurd interpretations of it. In the           
erotic love poem ``The Song of Solomon'', the King James translators           
added chapter headings in which lines such as ``your two breasts are           
like two fawns that feed among the lilies...oh queenly maiden, your            
rounded thighs are like jewels...'' are introduced by ``Christ setteth         
forth the graces of the church''. The Book of Ecclesiastes has been            
attributed to King Solomon, for example by the Catholic church which           
appealed to its supposed Solomonic authority to add weight to its              
refutation of Copernicus' theory: The sun also riseth, and the sun        
  goeth down, and hasteth to the place where he ariseth. But as scholar       
R.B.Y.  Scott of the Anchor Bible Series points out: ``There is of   
 course no possibility that the Solomon of history composed this book; to       
claim this is like claiming that a book about Marxism in modern English        
idiom and spelling was written by Henry the Eighth.''                          
                                                                               
Third, if the Old Testament is to be viewed as a guide to                      
morality, then it is one of the most disgusting, repulsive documents of        
its kind ever written; large parts of it are virtually unreadable              
without a stiff dose of ondansetron.                                           
                                                                               
But these many failings of the Old Testament (or of the bible in general,      
of the Koran or whatever ``Holy Scripture'' is on offer at the moment)         
should not lead us to reject it wholesale. Hidden among the horrors, the       
absurdities and the sheer soporific tedium are a number of real gems,          
most notably the Book of Job.                                                  
                                                                                                                                                             
In the next installment I'll finally confront Kaia's question.                 
What is behind the sky? Where did we come from? What happens when we           
die? What are we to make of this sometimes beautiful, sometimes ugly           
world we find ourselves in? What does ``God'' have to do with it?              
                                                                               
I have no answers, but I do have a vision I want to share. There is an evident danger here, succinctly put by British philosopher A.J. Ayer in his famous monograph ``Language, Truth and Logic'':               
                                                                               
``If a mystic admits that the object of his vision is something which          
cannot be described, then he must also admit that he is bound to talk          
nonsense when he describes it.''                                               
                                                                               
Nevertheless, I'm going to give it a go.     

Handelian addendum

Some clarification of the previous post: I think the pattern is clear by now, that when it's in the worst stage I get kinda whiny about it. When I spoke of only having the energy to sit at the table for half an hour (watching the baking extravaganza), that was true at that particular time but it does get better.
One problem has been that for a couple of weeks now I've had a lingering cough/cold, which combined with the chemo does get a bit tiresome. Anyway, it's only bad for a few days at most following infusion, and even then I keep doing most of my normal stuff. For the next four weeks or so it should get better and better!

While I'm here I'll report that today's CT-scan went much more smoothly than the last, because (a) I made a point of only drinking half the bottle, and (b) they actually got me in on time. On the other hand, I have to constantly battle these nurses who want to draw blood for testing. Look, I get it analyzed every week and you've got it on the computer. I'm a quart low as it is and really don't want to donate blood to random passers-by. "Oh, but we need to test such-and-such for kidney function and they may not have done that." On the contrary, sir, I can assure you they test for everything. They test for basophils, monocytes, and nucleated RBC. They test for sodium, potassium and creatinine. They test for performance-enhancing drugs, LSD and crack cocaine. They test for anti-freeze, brake fluid, and recycled motor oil. They test for quarks left over from the big bang, and for little green men in miniaturized yellow submarines. Check it out if you don't believe me.

Five minutes he comes back. "You're right, you're good to go." Imagine that!

I can Handel it!

At the eighth meeting of the 8th floor SE tower Operatic Society, on Friday, Sara reported on her progress with the Handel opera "Semele" she will see in March (as will we). At first she didn't like the recording because it reminded her of "church music", specifically Handel's Messiah that her parents used to play all the time. Having listened to it a couple of more times, however, she now thinks it's great. "The singing seems really difficult", she added. I also learned that Jina (a nurse in the urology clinic who is my hero because she gave me a number to call that actually gets answered) used to be a professional ballerina. Will have to ask her about that on Wednesday.

It occurs to me that there could be a reader of this blog who also has done or is doing chemo, or knows someone who is. With that in mind, I don't wish to give the impression that it's all been easy. Friday night in fact was my worst yet, with that awful feeling of "looming nausea" (I don't know how else to describe it).  But I can Handel it! I just get out on walks no matter what, this weekend being particularly beautiful. Any kind of distraction helps too, whether it is mathematics or Italian or football or opera (have just finished L'Elisir d'Amore, Pique Dame and Jenufa) or the original Swedish "Wallander" series (what better than a gruesome murder mystery to take your mind off things? Very well done). And of course the munchkins, although it's frustrating I have so little energy for really playing with them. Saturday the most I could manage was sitting at the kitchen table at their house for half an hour, watching them make Christmas cookies with their grandma.
It doesn't get any cuter than that! Kaia was wearing a typical outfit:
petticoat, her wedding "headband" and a Christmas apron. What a hoot! Wendy says that later Finley lost interest in the cookie-making and spent an entire hour playing with the soapy water in the sink. The little guy has an amazing attention span when he gets involved in one of his projects.

Speaking of opera and football, sometimes it's good to combine the two by turning off the TV sound and putting on opera instead. My real dream though is that after scoring a touchdown the player, rather than going into the hokey celebratory dance they like to do,
belts out the final measures of "nessun dorma", a la Pavarotti: "Vincero'...Vincero'...VIN...CER...OOOOO'! ("I will win".) Wouldn't that be cool?

Anyway, the good news is that I'm taking a break from the chemo as of now.
With Abby's Washington D.C. recital in early January, there's no way I'm going to get on a plane feeling like I do now. So (and they're very flexible about this) we won't start cycle 5 until January 9th. Actually it's not yet certain what the next steps will be. Tomorrow I have another CT-scan, then meet with the Doc (and Jina the Ballerina) on Wednesday. I don't intend to make any decisions until I'm feeling better, but at least I'll have more information. As to the CT-scan, now I know the drill. They should have a special half-size bottle for the "Mitchell bladder" that I and my siblings are all handicapped with, but they don't so you just have to smile and nod and when they're not looking pour half of it out. 

For those who are interested, the next installment of "What's behind the sky?" will appear soon. Meanwhile, Happy Holidays!

Ducks 51, Cisplatin 13

It's Saturday morning, after Day 1 of Cycle 4. On Day 1 of a cycle I'm in the infusion ward for at least seven hours; this time from 1 to after 8:30. So what are they actually doing all that time?

First, of course, they check your temperature, oxygen uptake and blood pressure. (These days you can't even go to the Jiffy Lube without someone wanting to take your blood pressure .)
Then they do a blood draw and send it off to the lab, and won't begin the infusion process until the report comes back. That can take up to an hour. If the report confirms that you're still alive, they start 2 hours of hydration (saline drip) for kidney protection, along with no fewer than three different anti-nausea drugs. Then the cisplatin, about an hour for that. Then a half-hour I think for the gemcitabine, then a couple more hours of hydration. Then they change the Picc dressing and you're good to go. It's a long process, but most of it is spent sitting around and doing whatever you feel like.

This time around was different because I had a cough/cold. With grandkids around (not to mention college kids) the only way to avoid getting sick would be to walk around all day in a hazmat suit. Although I try to keep sniffling grad students at bay, there's a point beyond which I refuse to miss my Kaia-Finley time! Last weekend we were up in my home office drawing pictures, using the electric pencil sharpener (I have exceptionally sharp pencils these days) and playing chess (Kaia is genuinely interested in how the pieces move; Finley is more interested in wreaking mass destruction across the board). Anyway, with Kaia sitting on my lap coughing, I guess it's no surprise that I finally got it too.
I called Sara the nurse practitioner for advice, she consulted the doc and the upshot was that I would come in anyway and she'd check me out at the beginning before giving the all clear.

So we're still awaiting the lab report when Sara, effervescently cheerful as always, pops her head into the luxury suite, in this instance serving as the biohazard isolation unit: "Mr. Mitchell! How ARE you?" Now, we've had "the talk" about how even my undergrads are given the choice of addressing me either as "Herr Professor Doctor Mitchell" or "Steve", but Sara (who I believe is in her 30's) insists on "Mr. Mitchell". At first I panicked: Should I have been calling her "Nurse Practitioner Hunt" all this time? "No, no" she laughed, just "Sara".  Seems asymmetrical, but okay.

Then she sees the bandage on my right (non-Picc) forearm and wants to know what that's about. Oh, I took a fall on a steep, muddy, icy trail in the park during that cold weather. All the weight came down on the arm. "MISTER MITCHELL!!" she exclaims in some indeterminate mix of real and pretended horror, "WHAT are you doing? If your platelets are low you could bleed to death!" Yeah, but my platelets have been fine so far. Just then the lab report comes in on the computer. "Hematocrit looks fine...your platelets are good..."  See? I told you so! These are not ordinary platelets we're talking about, they are the platelets of a TOPOLOGIST!

On the other hand, I was feeling worse and worse from the moment I set foot in the medical center.
It might be the cold, but I also suspect a certain psychosomatic effect, that my subconscious has learned that these visits are followed by feeling lousy the next day, and has perversely decided to speed up the process. I'll have to try some imagery/self-hypnosis/whatever ahead of time to ward it off.  (Darn subconscious! If you have something to say, just say it for cryin' out loud!)  Was only able to read a few pages of "Spin geometry", although it did result in a modest breakthrough. Switched to reading Italian. Even that was too much. Listened to my current audiobook, "La provinciale" by Alberto Moravia. Couldn't eat anything. The one saving grace, though, was that the Ducks were playing Arizona for the Pac-12 championship at 6, and for the first time ever I turned on the TV.

The Ducks being the Oregon Ducks, for those who are not quacker backers. (My infusion nurse's interest in such things was quickly revealed by her question "is it a basketball game?") Now, I can hear the gasps of horror coming from Husky-land, the horror that I, a Husky Professor, could even moonlight as a quacker backer. But in this, as in so many ways, I have always been peculiar. To me it is not so much about rooting for a home team, it is about the game itself. My dream, in fact, is that football games would be conducted like Wimbledon: As the players break from the huddle, the umpire admonishes the crowd "Quiet please", and there is absolute silence in the stadium as the quarterback calls the signals. It would be so much more exciting and suspenseful! And sensible; why should the crowd interfere with the opposing quarterback? It's about seeing excellent play, not artificially influencing the outcome. Oh well. I am resigned to my fate as a social outcast and oddity.

In any event, I was glad to be able to watch the entire first half and the start of the second, with my wonderful Wendy who arrived at dinner time. She likes the Ducks' uniforms.:)  Still couldn't eat but the game was a nice distraction. Final score, in my book: Ducks 51, Cisplatin 13.

Well, my motto has always been: If you don't feel like getting out for a walk, you should immediately get out for a walk. As now I shall, topologically reinforced platelets and all. Quack Quack!