I want to talk about optimism, because, going through cancer treatment removed in me something that I was born with, a pessimism that is actually a form of cowardice. If I wasn’t born with it, I became a pessimist pretty young, maybe in middle school. The argument for pessimism is concise, if nothing else. It goes like this: if I expect the worst, then I am never disappointed to the same extent as an optimist, because fortune surprises me, and misfortune does not.
As of this writing, in the past year I have had five surgeries, at least five blood transfusions, four rounds of high-dose, inpatient chemotherapy, two ports installed and removed from my body, a sepsis infection, a two day long episode of delirium and psychosis brought on by a cocktail of anesthetics, and one short incident in which my heart rate approached three hundred beats per minute. I have been on every painkiller imaginable: hydrocodone, which is my favorite, morphine, vicodin, oxycontin, oxycodone, ketamine, my least favorite, and several others. I have been pricked with needles over two hundred times, not counting intravenous medication. By my count, I have spent about three and a half months in hospitals, not counting outpatient visits. I mention this all from the start because the context of these events is so much more important than the mere fact that they happened. I want to talk about context.
Here’s the second inconvenient fact that I want to get out of the way at the start. I knew I had cancer well before I was diagnosed, and my pessimism, which is a form of cowardice disguised as shrewdness, led me to avoid medical treatment for a substantial amount of time. It is impossible for me to deny that this is a shame. The medical debt that I have accrued is pretty staggering, and I have scars all over my body, and I will for the rest of my life. I have raked my family over the coals of shock, anxiety and depression. I have been burdensome, in other words. But I want to be able to talk about why, in my case, cancer has also been kind of a blessing. I say this with full knowledge of how privileged I am to be able to say something so seemingly absurd.
A bit more background: I was diagnosed with Stage 3 testicular cancer. There is no Stage 4 in this cancer type, although some doctors colloquially refer to Stage 4 testicular cancer when the malignancy has spread to the brain. That being said, if it spreads to the brain it is not necessarily more life-threatening than if it spreads to other vital organs. My cancer ended up in my liver, my lungs, and my abdomen, and offshoots of non-malignant but still invasive teratoma was present throughout my chest, including surrounding both of my kidneys. So I was in pretty rough shape. Doctors don’t like to talk about survival rate percentages with advanced stages of testicular cancer unless they are pressed, and I don’t blame them, although the statistics aren’t that bad. The survival rate for advanced testicular cancer is 71%. I was almost definitely on the outer fringes of this statistic, and so I believe that my chances of survival were probably closer to 65%. The glass was still more than half full, in other words.
I want to emphasize what a relief it was to finally have a diagnosis and a course of action. I was quite weak by the time I went to the doctor, and it turned out I was severely anemic. My first two days at the hospital, Lutheran Medical Center, were spent in an emergency room, where I shared a curtained-off area with a man in his nineties who spent all night requesting more pain medication to no avail. My orchiectomy was the first operation, after lots of scans and other tests, and as I recovered from that, I was transferred to Mt. Sinai hospital in Manhattan. There they installed the chemotherapy port in my shoulder and began to administer the first round of chemotherapy. I was discharged from the hospital after another week or so, and within hours of being discharged, I had a fever of about 105 degrees. An ambulance came and took me to another emergency room, this time in Morristown, NJ, close to where I grew up. There I received treatment for sepsis, which they believed I had contracted from the chemotherapy port installation. So they took the port out, medicated me for high fevers and dehydration, and I finished my first round of chemotherapy–they gave me a drug called Bleomycin, which I would not be given in the next three rounds of chemotherapy. Bleo causes at least one degree of oxygen toxicity, so for the rest of my treatment my doctors and nurses were very cautious when administering supplemental oxygen.
During this time my parents and my brother were especially incredible. They got me off of my crap insurance and switched over to my parents’ insurance, and they arranged for me to be transferred to a hospital in Seattle, where I would be close to my parents, and where I would receive some of the best possible treatment for my disease possible. My fever from the sepsis infection started to subside the day that it was time to to leave for the west. My brother had contacted a nonprofit that gives corporate jet rides to cancer patients whose immune systems have been compromised, and who need to seek treatment elsewhere, and so I and my parents found ourselves on a small jet full of insurance executives, on our way to LAX. From there we went on an even smaller jet, on which we were the sole passengers, flown by a very nice husband and wife pilot team, to Boeing Field in Seattle. From there we took a car straight to the hospital, where I met my new oncologist for the first time, Dr. Craig Nichols, a very stoic man who was one of Lance Armstrong’s two main doctors in Indiana during his cancer treatment. After that I was admitted and began my second round of chemotherapy.
From there the story slows down a bit. Chemotherapy at this dosage impairs your body’s ability to maintain white blood cells, and so it really impacts the body’s immune system in crazy and unpredictable ways. So in between chemotherapy sessions, I found myself being driven back to the hospital because of severe anemia (I would pass out if I stood up for more than a minute or so), and because of fevers and unavoidable dehydration due to my body’s inability to retain water. And when in the hospital, they would give me blood transfusion after blood transfusion, and pump me back full of water, and after a few days they’d send me on my way. When home I would spend those days where I was least affected by the treatment working on music and slowly resuming eating food in as normal a fashion as possible. I spent some of my savings from my job in New York on a small recording studio set up, which I continue using and mastering now.
And gradually the chemotherapy liquefied the cancerous tumors and my body flushed them out–through my pores, through my urine, and so on. Perhaps the least comfortable aspect of chemotherapy is the sensation that your body has become toxic–the way it smells, the way it feels, is so alien and chemical, and that doesn’t go away for quite a while. But eventually it was over. I remember midway through my treatment, Dr. Nichols brought in Dr. Christopher Porter to have a look at me. Dr. Porter was to be my chief surgeon. He did me the service of not sugar-coating his observations. He said it looked like it was going to be a difficult task, removing the remainder of the disease. And it was.
I had a couple months to recover from chemo prior to my first big surgery, and that was a really nice time. I did physical therapy, I started to feel more like myself, and occasionally I even got out to see a movie or to walk around Seattle a little bit. And eventually it was time to go in again. The plan evolved–prior to my first surgery it was not clear exactly how many surgeries I would be having, but it was clear that it would have to be staged. Because of how much stronger I had gotten in the interim, they really went for it that first surgery. They opened up my ribcage, took out one of my kidneys, scooped out as much bad tissue as they could, and then put my kidney back on the other side, next to the other kidney, closed me up partially, and waited for the swelling to go down and for my kidneys to start working again. I was intubated and mostly sedated through all of this. The surgery took 27 hours in total. I had dream after dream, some pretty scary but most just incredibly mundane and drugged up. When I started coming in and out of consciousness, they had put me on ketamine and another sedative, the combination of which produced a kind of delirium/psychosis. I was unable to communicate properly, but I was aware of my own inability, which was pretty frustrating. It was like being possessed–I couldn’t reassure my parents or my nurses that inside I was okay, and on the outside I looked pretty frightening, my teeth grinding, my limbs flailing, my eyes appearing terrified. It was an interesting experience, and eventually it subsided. The rest of my hospital stay was the grinding effort to regain enough strength in my arms and legs to get out of bed and walk. The pain was excruciating at times, but mostly it was just humbling to have to relearn how to move my limbs, and brush my teeth without drooling all over myself.
And then I was out again, and it was time to heal up and think about the future. They had managed to get almost everything they needed to remove, with the exception of a small area of tissue behind my liver, which was either teratoma or necrosis (teratoma is not cancerous, but can become so, and necrosis is just a fancy word for dead tissue). So there was some debate about whether I even needed to have another surgery. I certainly didn’t want to, but at the end of the day my doctors decided that the risk of that spot being teratoma was large enough that they needed to remove it. So I went in for another surgery about a month ago, and they got it. In comparison to the previous surgery, this one was a walk in the park, but it was still pretty difficult. I was in the hospital for about a week, while in the aftermath of the previous surgery I was in the hospital for a little over two weeks. I had one doctor’s appointment after I was discharged just to make sure everything was healing up okay, and now I wait until September, when I will have my blood markers checked and, assuming everything looks normal, then I will prepare to leave the Northwest and resume my life.
Amidst this whole process, the support I received from family and friends was staggering, and continues to be. This is one thing that is so easy to lose sight of when surveying your future before going on a yearlong trip like this–people want to help, and they want to be part of something bigger than themselves. And after awhile the embarrassment and the shame and the feeling that you’ll never be able to repay all of this generosity fades away, and all that is left is gratitude and simplicity. Perhaps this is the agent of change that made it possible for me to look at the world with a less critical eye, that allows me to think in less negative terms about everything now. I may be covered in scars, but those scars are such an important reminder of the experience that I have had, and the wisdom that I have accrued. I may have been physically limited over the last year, but all of that downtime allowed me a chance to reflect and to plan, something that is a real luxury. I may have experienced moments of unprecedented pain, but for each of those, there was the counterpoint of a moment of real grace and serendipity on the part of all of the people holding me up and propelling me forward. For an ex-pessimist, each negative moment is an opportunity to go through all of the steps of denial and regret and to finally arrive at a place of acceptance and even excitement. The act of optimism tempered with the critical element of pessimism is, for me, an ideal viewpoint. I can’t put it any more simply than that. It took a real year of tribulation for me to realize that what I had considered realism for my whole life was, in fact, a reductionist fantasy. As convoluted as my story may be, through the prism of painkillers that I continue to take to help me be more mobile and active as my body heals, I hope that it can help some other people come to the same realization without having to go through every step that I did. That’s all.