It’s a Life Lesson It’s Also a Pain in the…
I looked death in the face. All right, I didn’t. I glimpsed him from behind.
Ten years ago, I was diagnosed with cancer – of a highly treatable kind. I was told I had a 95% chance of survival. Which means that, as a drinking, smoking, saturated-fat-hound, exercise-free 60-year-old male – my chance of survival was actually improved by cancer.
Also, while cancer isn’t usually ridiculous, I had, of all things, a malignant hemorrhoid. What color bracelet do you wear for that? And where do you wear it? And what’s the fund-raising slogan? Maybe that slogan could be sewn in needlepoint on my embarrassing doughnut rear-end pillow.
To add insult to illness, I’m a logical, sensible libertarian-conservative, and my diagnosis came just weeks after Teddy Kennedy’s. That he had cancer of the brain, while I had cancer of the ass… But what should I do, ask God for a more dignified cancer? Pancreas? Liver? Lung?
It’s not every day that you get diagnosed with cancer and it makes you laugh. I’d had a hemorrhoid operation. Two days later the colorectal surgeon called. “I’m sorry to tell you,” he said, “your hemorrhoid was malignant.”
“Malignant hemorrhoid?” I said. “There’s no such thing as a malignant hemorrhoid.”
“In almost every case you’d be right,” the surgeon said and paused in a moment of sympathetic hesitation – and unintentional comic timing, “But…”
“Butt?…” I laughed, but I wanted to argue. “Malignant hemorrhoid” is an AM radio shock-jock insult. “Malignant Hemorrhoid” is a Dave Barry rock band name.
At least I had the good fortune to be in Washington, D.C. at the time of diagnosis. It’s a city replete with flaccid old guys like myself who spend their time blowing smoke out of you-know-where and being full of you-know-what and sitting on their duffs. The town is full of medical expertise about the body part in question.
D.C. is a city replete with flaccid old guys like myself who spend their time blowing smoke out of you-know-where and being full of you-know-what and sitting on their duffs.
What I had was a skin cancer, squamous cell carcinoma. Practically every melanin-deficient (let alone Irish) person who spends time in the sun gets this if he or she lives long enough. The oncologist said, “I call it ‘adult acne’ when it turns up on the face or arms.” But it occasionally turns up where it turned up on me. And why is something of a medical mystery. I mean, I was naked a lot in the 1960s, but not that naked.
Even though I had an undignified kind of cancer, there was still a loss of dignity involved in trading the awe-inspiring fear of death for the perspiration-inducing fear of treatment. There is hell on earth as well as hell in the afterlife. Until a generation ago, the remedy for anal cancer was a colostomy. Doctors have gotten over that. Most of the time. Now the remedy is radiation and chemotherapy.
Would I have to go to some purgatorial place for this? To Sloan Kettering in New York, a city I detest? Or out to the Mayo Clinic in Minnesota, although I have a phobia about hospitals named after sandwich toppings? “No,” the oncologist said. “The treatment protocol is standardized and is successfully used everywhere.”
I named my local New Hampshire hospital (and large animal veterinary clinic).
“Almost everywhere,” the oncologist said.
I asked about the Dartmouth-Hitchcock Medical Center, 90 miles from my home but still on the planet New Hampshire. Dr. Marc Pipas at Dartmouth-Hitchcock’s Norris Cotton Cancer Center came strongly recommended.
Dr. Pipas is an avid bird hunter and an advocate of reintroducing the prairie chicken to the eastern seaboard. So he and I had something to talk about in addition to my behind. I’d need radiation therapy every day for six weeks. (Every day, that is, Monday through Friday – the radiology department has to play golf, too.) And I would undergo two four-day stints of around-the-clock chemotherapy, carrying a fanny pack of poisonous chemicals to be pumped into my body through a surgically implanted mediport. (Dr. Pipas persuaded the infusions department to install this on the left side of my chest so that it wouldn’t interfere with mounting a shotgun.)
In theory I could get my radiation treatments elsewhere, within easy commuting distance. But it’s worthwhile to find out what a doctor himself would do if he had your medical problem. And he probably thinks he does. Several doctor friends have told me you can’t get through medical school without being convinced that you have every disease in the textbooks, including elephantiasis, beriberi, and Guinea worm infestation.
Dr. Pipas said, for anal cancer, he’d go to radiologist Dr. Bassem Zaki at Dartmouth-Hitchcock’s Norris Cotton Cancer Center.
Dr. Zaki is a Coptic Christian who emigrated from Egypt in his late teens. He and I talked about Middle Eastern politics, which, as far as I’m concerned, is the second most interesting blood sport after upland-game shooting.
The fanny pack came with a bag of protective clothing and instructions for dealing with chemical spills… I was supposed to do, by myself, what the entire U.S. government had done during the 2002 national anthrax panic.
Dartmouth-Hitchcock Medical Center is a sparkling edifice, full of light and air and surprisingly good art. The architectural style is higgledy-piggledy 1980s modern — two million square feet, every one of which is between you and where you have an appointment. Finding your way around is a trial run for Alzheimer’s, but a small price to pay for the pleasant surroundings. Even the food in the cafeteria is good. Various scientific studies have shown that patients recover better and faster in cheerful environments. (I don’t know what the scientific studies say about patients who don’t recover and might wish the cheeriness would foff.)
The staff at DHMC is also cheerful, but not too cheerful. The staff members don’t make you feel like a small child at the receiving end of an overambitious preschool curriculum.
Perhaps they know better because DHMC is a teaching hospital. The Dartmouth Medical School is the fourth-oldest in the nation, founded in 1797. DHMC is venerable as well as modern. But not too venerable. It doesn’t use leeches.
Being at a teaching hospital puts a patient in a democratic relationship with the institution’s staff. People are expecting to learn something from you, not just do something to you. But let’s not push the idea of equality too far. There’s a current notion that you should “take charge of your disease.” No thanks. I’m busy. I’ve got cancer. I’m willing to face having cancer. I’m not willing to face having cancer with homework.
I promised Dr. Pipas and Dr. Zaki that I wouldn’t show up with sheaves of printouts from the Internet containing everything on Wikipedia about malignancies. They laughed with detectable notes of relief.
(Although I suspected that my wife had made her way into the health-blog ether. Fish-oil pills, raw kelp, and other untoward substances started showing up on the dinner plates after I was diagnosed.)
“I’ve got cancer” is more than an excuse for rational ignorance about medicine. It’s an excuse for everything. From a niece’s wedding to your daughter’s piano recital to an IRS audit, you’re off the hook. I even tried my excuse on the Pope. I couldn’t go to Mass because of the effect that germ-swapping Vatican II “sign of peace” handshakes could have on my radiation-weakened immune system. And I continued to employ cancer as an excuse until an exasperated spouse finally shouted, “You’re curable! You can too put your dirty dishes in the sink!”
The radiation treatments weren’t bad – 20 minutes propped on a machine in a humiliating posture. Most of me was exposed and the nurses were embarrassingly pretty. But it’s interesting, the connection that physical modesty has with physical vanity. Once past sixty you can reasonably abandon both. This was one of the life lessons with which having cancer abounds.
I hate life lessons. Consider all the I-hope-you’ve-learned-your-lesson experiences: skinned knees, high-school romances, wreckage of Dad’s car, flunked college courses, horrible hangovers, failed marriages. I tell my children, “Avoid life lessons. The more important the lesson, the more you should avoid it.”
The chemotherapy was worse than the radiation. The pump in the fanny pack of poisonous chemicals made a whining whirr every minute or so – not frequently enough to get used to and too frequently to let me sleep. A long plastic tube that attached the fanny pack to my mediport allowed me to bury the pump and its noise in a mound of pillows. But then I’d forget that I was connected. As with all attempts to forget one’s troubles, I was courting disaster. I’d get up in the middle of the night to go to the bathroom and be yanked back to the mattress by the tubing.
The fanny pack came with a bag of protective clothing and instructions for dealing with chemical spills. According to these instructions I was supposed to do, by myself, what the entire U.S. government had done during the 2002 national anthrax panic.
The cumulative effects of the treatments were unpleasant. The loss of my previously full, thick, un-grayed head of hair met with no sympathy from my-age cohort of males. I developed fatigue, mouth sores, and a rash around my loins as if I’d been dressed in nothing but hip boots and an Eisenhower jacket and had been turned on a spit in a tanning salon, and I itched.
What evolutionary purpose does the itch serve? Maybe we itch not for biological reasons but to give us a moral lesson about surrendering to our strongest passions. I had the strongest passion to scratch certain parts of my body. If, however, I had scratched these parts of my body near a school or play-ground, I would have been sent to jail.
Dr. Pipas, Dr. Zaki, and the Dartmouth-Hitchcock staff were attentive to my complaints and gave me generous doses of things to turn complaints into complaisance. But I was nagged by a concern about the quality of my medical care. Was it too good?
I was well-insured and passably affluent. I asked Jason Aldous, Dartmouth-Hitchcock’s media relations manager, “What if I weren’t?”
“We’re a charitable institution,” Aldous said. “No one will ever be refused care here. On the other hand, we have to keep the lights on. We do try to find any possible means of payment – government programs, private insurance, et cetera.” The hospital has a whole department devoted to that.
“In about sixty percent of cases,” Aldous said, “people who think they aren’t eligible for any assistance actually are.”
Then there are the people who have income but no savings, or assets but no income. Discounts are provided and payment plans worked out. Failing all else, treatment is simply given free – $63 million worth in 2007.
I asked Aldous about who gets what treatment from which doctor. Do my means affect the hospital’s ways?
“The doctors,” he said, “don’t know how – or if – you’re paying.”
What Aldous told me seemed true from what I could see of the hospital’s patients, a cross section of Yankees, flinty and otherwise. The Norris Cotton Cancer Center was treating more than 5,000 people a year.
And we were all amiable in the waiting rooms. Anytime someone new came in and sat down he or she was tacitly invited to spend about three minutes telling everyone what was wrong. Then the conversation was expected to return to general topics. The general topic of choice during the summer of 2008 was how the Democrats were trying to destroy the private health care system that was saving our lives. Majority opinion was that when medicine was socialized we’d have to sit in waiting rooms forever. If we lived.
In my case at least, the waiting room amiability had something to do with painkilling drugs, of which I was on plenty. There’s a lot of talk about the “Opioid Crisis.” Nobody mentions the “Opioid Blessing.” I shudder to think what being a cancer patient would have been like without them. And when I see people on opioids who lack my medical excuse for being stoned out of their gourds, I don’t shudder. In fact, I sometimes wonder if they haven’t, maybe, made an understandable choice about how to cope with the miseries of life that are more subtle than cancer. Of course, being addicted to drugs is not a good plan for the future. But not everybody has one.
As it turned out, I did. Therefore I had to get rid of my opioid addiction. I claimed at the time that it was no big deal. I said to my wife, “It was no big deal. Over the course of three months I gradually reduced my pain-killer dosage…” (My wife said to me, “Over the course of three months you were a miserable, peevish jerk.”)
Besides opioids, my other great cancer blessing was my old friend Greg Grip. Greg was batching it in a cottage on Mascoma Lake, 15 minutes from Dartmouth-Hitchcock. He’s divorced, and his college-age daughter was away on a summer internship. “I’m not saying you can stay at the cottage while you get treated,” Greg said. “I’m saying I will be deeply offended if you don’t.”
Dr. Zaki arranged my radiation treatments for late on Monday afternoons and early on Friday mornings. My wife and children were spared self-pitiful weekday grousings. And I missed them, so I was on good behavior when I went home on weekends.
Greg is a splendid Weber grill cook. Charcoal fires produce carcinogens, but the chemotherapy had that covered. Dr. Pipas said I could have one measured Scotch each evening. But he failed to specify the measure. I think the pint is a fine old traditional measure, although the liter is more modern and up-to-date.
Another side effect of the radiation and chemo was that I couldn’t tolerate the sun. But Greg’s cottage was on the southwest shore of Mascoma. The patio was in the shade all afternoon. I read a lot, mostly histories of World War II concerning the Russian front. Everyone on the Russian front in World War II was having it worse than I was.
While I was being treated, Tony Snow, the former Bush administration press secretary and another old friend, was dying from colon cancer. Tony wrote a wonderful essay about how his sense of mortality promoted “the ability to sit back and appreciate the wonder of every created thing.”
Every created thing put on a wonderful show for me at Mascoma Lake. A family of mergansers with six ducklings was living under the dock. A pair of mallards had taken up residence in the shrubbery. Beavers swam up and down the lake. (I don’t know why – Mascoma has a concrete dam.) There were bird sightings – hawks, turkey vultures, kingfishers, a bald eagle, even an extremely wayward pelican. A hummingbird visited the patio every evening. Water skiers and Jet Ski riders took amusing falls. At a nature reserve across the lake, skinny-dipping sightings were also on display.
The weather itself was kind and cool. Greg’s pointer Weezy slept on my bed each night, though this may have had less to do with doggy compassion than the fact that Greg won’t let her sleep on his. Weezy’s dulcet snoring drowned out the chemo fanny pack pump.
I’m fine now. Anal cancer can be invasive, but mine seems to have had a wimpy EU-style foreign policy.
That summer was not the worst summer of my life – loving family, kind friends, skilled and considerate care, a big warm dog in the bed.
In fact, the worst summer of my life was forty years before, when I was young and healthy and didn’t have a care in the world. But there was this girl, and a novel that refused to write itself, and anomie, and angst, and Weltschmerz…
Getting sick with a frightening disease is a lousy way to learn life lessons. And, as I mentioned, I hate life lessons. And yet, for me personally… I should have gotten cancer when I was 20.