And somehow we keep learning about what already was

The other day, A. decided he was curious if he remembered correctly: What had actually happened during chemo?

He opened the app that documents his medical records and scrolled back over a year and a half to the first time he was hospitalized. He’d had a fever that cycled up and down, up and down. He spent over a week in the hospital. It took days for doctors across several specialties to figure out what was happening.

Eventually, he was diagnosed with PCP pneumonia, which affects mainly people with HIV, blood cancers, or otherwise weakened immune systems (the rest of us manage to fight it off).

We remembered that he saw a pulmonologist. An infectious disease specialist. His hematologist.

But what were they thinking, before he was diagnosed?

A. reached the report from that appointment. And then came over to show me.

“Diagnosis: Possible sepsis.”

Oh.


The day I write up this story, I realize I’m close to filling up my current morning journal. It’s a 180-page five-subject notebook I started in November 2017. I took an unplanned break from writing for almost a year. Now, there’s room for five more mornings of journaling.

And so, for the first time in over a year, I turn back to the first entries in the notebook. I find documented, day by day, the second of six chemo cycles. And I read.

I read about the insanity of our lives in November 2017, about how many things were happening at the same time, about wanting to figure out rugs and wall decorations for the apartment we’d only moved into the day before the first chemo cycle. I read of trying to focus on the silver lining of having a treatable form of cancer and on the personal growth that came with it, but also of frustration at the cost of that growth, at the physical and mental exhaustion, at the fact that we barely had a chance to process what was happening once treatment started, at the destruction of the body of someone I loved. I read words of gratitude for all the help we received and words acknowledging how difficult it is to receive help. I read of resentment that we were in the position of having to be grateful. I read of attempts to maintain an emotional connection. I read of frustration with others, but also a willingness to engage on the things that mattered, to find a solution that worked well enough for everyone. I read of compassion. I read of fear and anger and a lack of confidence. I read of a compulsion to do rather than think, to get through the day.

As I read, I feel for the person who wrote these words, even as I feel disconnected, often reading with eyes wide in horror.

And yet.


In the school of Hellenistic philosophy called Stoicism, there’s a saying, “Memento mori.” Remember you will die.

The idea, as I understand it, is that being aware of death is liberating. It pushes you to live life, to have purpose and pursuits, because time is finite.

I wonder sometimes if we only say mortality, the passage of time, the changes of the season, motivate us simply because we live in a world subject to these things. If it’s like all other attempts to attribute meaning to something without inherent meaning.

Yes, there are studies that show shorter time spans increase productivity, but they all take place in this world of aging and disease and limited lifespans and changing seasons.


And yet, for myself, I find it’s true.

Looking back, I can recognize: I used to be there, even as my understanding of “there” changes with new discoveries and reflection.

And then: I have today.


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Sometimes, in the midst of a perfect moment, it hits us

Once in a while, A and I are doing something totally mundane.

Then, it happens.

Maybe we’re eating. Maybe we’re talking with loved ones. Maybe we’re gazing at the view.

The scene changes.

Maybe something goes flying and lands in an odd way. Maybe someone says something unexpectedly funny. Maybe we reach peak sunset.

We look at each other. Our eyes say, 

I’m seeing this. Are you seeing this? Because this is silly/incredible/beautiful/hilarious.* Thank goodness someone else is here with me to bear witness to just how silly/incredible/beautiful/hilarious this is.

We smile internally. We acknowledge the moment and each other.

Then, the unspoken dialogue shifts.

Our eyes brim.

One of us expresses our joint thoughts in words:

“We are so lucky.”

Thank goodness we got to live this moment together. To experience this day.

*Sometimes, it’s all four.


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The fine line between laughter and tears

My improv class started meeting outside of class to give us more time to practice.

At the end of the first meeting, we did this laughing/crying exercise: Everyone stands in a circle and two people hold eye contact as they start laughing together. Then, by unspoken agreement, they begin crying while maintaining eye contact. One person turns and makes eye contact with the next person in the circle; they cry together and then start laughing. And so on.

Watching this was amazing.

First, it was funny, seeing the way people cry on demand and laugh with their whole bodies.

Next, it was interesting, observing how the interactions developed and changed and differed among pairs. It was uplifting to hear laughter.

Then, by the time we made it to the final pairs in our little circle, I was almost in tears, even when other people were laughing.

Because this convergence, this edge, this brink of laughter and tears? I know it.

When something horrible happens, I’m on that brink.

You know the feeling?

You think: Did this really happen, on top of everything else?

You think: This is so bad, I can’t even process it.

You think: This is so absurd, it’s hilarious.

Maybe you laugh. And then you remember. And you cry.

And while you cry, you think: Someday, this might make for a good story.


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Dreaming up a dream of cancer

Last summer, I convinced myself that we dreamed up the cancer.

A’s hair was growing back. He’d stopped taking chemo-related drugs. There were no more appointments. The follow-up PET scan was behind us. He went back to work and eventually settled in. We were planning the summer and the fall and living our lives again.

And cancer?

It didn’t really happen. It was a dream in exquisite detail, really, with all the medications and the moods and the nausea and the trauma and the visitors and the help. But it wasn’t real. How could it have been real?

This is in no way the same thing, but from what I’ve heard and read, I gather this is also the way people react to deaths. You forget that it happened, or you don’t believe it, you pick up the phone to call someone or you shout to the person who should be in the next room… and then you remember.

In this case, my reminder was my partner, who’d been through cancer treatment, telling me he needed to schedule another appointment. There’s no indication anything is wrong, okay? This is just routine follow-up. But you know what? There was no indication anything was wrong before, unless you happened to feel a lump on A’s upper inner thigh. And it took even A a while to think that that might be a problem. Externally? Nothing.

So. We’re in the car, and I’m driving, and he tells me this. I’m getting in the left lane, a few minutes from home. And I’m crying. Not loudly, not even audibly, but the tears are coming, even though nothing is happening, even though it’s not necessary.

“Necessary”. Ha.

And in my head, this is what’s happening:

I’m upset about this. Why am I upset about this? The cancer wasn’t real, right? It was just a dream. Who am I to be upset about this? A’s here next to me. 

And then: I thought I had more time before I had to think about this again.

And still: tears.

 


Today, as I write this, we’re nearly a month past a follow-up CT scan that found no signs of active lymphoma.

I’m not a religious person, but every time I think of this, I want to clasp my hands together and thank some more powerful entity for making this so.

A month ago, we were anxious, pre-scan. We were reliving it. Remembering last year. Imagining what our lives would look like if the cancer was back.

The evening of the appointment, when we found out it wasn’t, we were incredibly grateful. For that night and maybe the weekend that followed.

And then we went back to our lives.

And the cancer went back to being a bad dream.


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Dreading the end of chemo

About a month before A’s last chemo infusion, I suddenly realized that all the things we’d been struggling with before cancer—improving our communication, sorting our work situations, figuring out our priorities—all of those problems were waiting for us when treatment ended. They’d be there, whether or not we were ready to handle them, and we’d have to deal with them. And with all the mail that had arrived in the intervening months that we had ignored. With all the trivial and significant things we’d put on the back-burner. At that point, it felt like a lot of things.

I dreaded the end of the treatment. I wasn’t ready to deal with our problems, those lingering, patient yet insistent annoyances and struggles and obstacles and insecurities and inconveniences and irresponsibilities and well-the-math-doesn’t-quite-add-up-there-does-its. I didn’t even have time to process the preceding months—I’m still not quite sure I’ve done that—and I was totally unprepared to deal with real life. 


How strange that this happens. That cancer is so horrible, and cancer treatment potentially even worse—so much physical, emotional, psychological suffering; such a risk of unknown yet incredibly serious side effects; potential death due to any infection, even borne within your own body, during low immunity—and yet, we dread the end of it. 

Cancer puts everything else on hold. Nothing is as important as doing everything we need to, everything we—and family and friends—can do to get ourselves through it. Therapy. Reading. Conversations. With luck, a lot of support. And neglecting normal responsibilities just as much as we can, which often means completely. 

Cancer gives us purpose. There’s a problem, and (if we’re lucky) there’s a plan for how to solve it. We always have the option to go off the beaten path, but as long as the patient is well enough and the doctor has solutions for problems that come up, there’s a prescribed route. Appointments, biopsies, scans, blood tests ad nauseum, chemotherapy, rinse and repeat.

Someone else sets the agenda for us.

And then it ends.


The social worker A spoke with when he got a second opinion said that the couple of months following treatment might be when we’d need the most support (because we would have to actually adjust back to whatever normal life would now look like) and have the least (because we wouldn’t have any unless we made plans for it since people assume you’re done when the treatment’s over). 

In the months after chemo ended, I had occasional overwhelming feelings. Resentment about my small life. I didn’t leave the county for a solid year. Me. Who other people see as a world-traveler, a language-learner, an always-up-for-an-adventurer. The COUNTY. I was only semi-on top of things at home, always dropping some balls (often to do with paperwork and keeping the house fully, actually clean and not just haphazardly vacuumed/swept). A, even with cancer, traveled much more than I did in the year after he was diagnosed: he had work trip after the lymph node biopsy but before the results came in, and three more brief work and personal trips in the months before I also ventured out of town.

And there I was. Home. Running errands. Buying food, making food, cleaning up after food. Doing the bare minimum. Nervous about actually getting a grasp on our finances. Nervous about writing, and about not writing. Nervous about making a career for myself—about succeeding and about failing. About letting other people down. About keeping myself small. About how our relationship would be. About what the new normal would look like and how we would even get there.

The worries I had before, plus the worries triggered by cancer and months of chemo, multiplied by the months they lay dormant.

I don’t think I should have to write that of course we were incredibly relieved, joyous even, when A finished treatment; when his immune system came back; when his follow-up PET scan was clear.

But, as always, real life is a bit more complex. The good—the end of treatment, the clear scans—requires incredible emotional work to enjoy.

And then, of course, there’s all the paperwork.


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You should see the other guy

A sure sign I’m starting to get nervous about this upcoming CT scan is that cancer is gradually taking over my thoughts.

On the upside: material!

 


Last spring, A’s longtime friend visited us with his partner. They got into a–fortunately minor–car accident. His friend broke his wrist but didn’t tell his family, who would be picking them up at the airport when they flew home to take them straight to an Easter celebration. 

A joked that they would be astounded that his wrist broke on such a low-key trip—we weren’t exactly rappelling during their visit.

And then his friend responded. Or, I’ll say: You should see the other guy. He got cancer.

 


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PTS-Cancer

I know. I know.

The abbreviation doesn’t make logical sense.

But it sounds way better than P-Cancer-SD, and PTCSD is a mouthful, and PCSD sounds too much like PTSD, and, besides, PTS-Cancer sounds funny. So here we are.

 

PTS-Cancer is what we call cancer-induced anxiety or depression, though the anxiety is perhaps easier to describe.

For example…

My thought process one day shortly after the end of chemo:

A hasn’t called me back yet. He had a PET scan yesterday. He’s probably waiting to tell me till he gets home, like he did with the cancer. Oh my god, it’s back. I wonder how far along it is. Will it be watch-and-wait or will he need a stem cell transplant? 

and

What A experienced during the month of December:

A‘s talking an old classmate about her cancer diagnosis and treatment decisions. His grandmother is dying [the other one died a month after he was diagnosed last year]. He’s got a cold [a persistent cough originally led to discovering the cancer]. He’s got a CT scan scheduled for next month to see if everything is okay. 

PTS-Cancer is any time that downward-spiraling thoughts about cancer make us feel a need to pull ourselves together and put on a normal face in order to interact with the world.

 


A‘s beloved, sharp-witted, hilarious, somewhat feared grandmother died early this morning. May her memory be a blessing.


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What cancer taught me about our shared humanity

After A. was diagnosed with cancer, I began thinking of our experience as a way to better understand the human condition.

Pre-cancer

Before cancer, we never contemplated our mortality more than the average Joe or Jane.

For instance, soon after we returned from a trip Guatemala, an entire bus full of people fell off the side of a cliff; this led to several… minutes… of alternating shock and sorrow and relief over the next several days. (Is this callous? But how long do we usually spend contemplating events that are in the past and do not directly affect us, however horrifying they may be? How long did most people who found out about A.‘s cancer think about it?).

Our brushes with mortality were never significant enough to take away from our lives, to keep us from functioning. And so, even with our experiences, even with travel and actively seeking out other people’s stories, I was never really able to get, to really internalize, this key element of humanity:

Our existence is *quite* precarious

When A. was diagnosed, he said that we all have this hazard function, this probability of dropping dead on any given day; the difference was that now he was aware of it.

Or, as Nina Riggs tells it in The Bright Hour,

I am reminded of an image that one of my cousins—a woman who lost her husband to a swift and brutal cancer last year—suggested to me recently over email: that living with a terminal disease is like walking on a tightrope over an insanely scary abyss. But that living without disease is also like walking on a tightrope over an insanely scary abyss, only with some fog or cloud cover obscuring the depths a bit more—sometimes the wind blowing it off a little, sometimes a nice dense cover.

And now we’re aware. We can see all the way down. We may forget, we may intentionally put blinders on most of the time so we can function, but we’ve seen the abyss and have gotten to know the ridges near the top quite well. I think—I hope—this awareness is permanent, because it sure cost a lot to get it.

For me, focusing on our common humanity is what helps me put one foot in front of the other. Common humanity is about both what I can offer and what I better understand. Realizing, and remembering, that we can use our experience to show other people what this can be like, that we can demystify it a little, that we can generally be open and available so that one day when it happens to someone else our experience can support them a little bit—this, to me, is half of the purpose of this experience.

The other half is this: that through this experience of being a partner and caretaker for someone going through cancer treatment, I’ve learned a lot about mortality. About disease. And about struggles in life in general.

Empathy: An upside to contemplating mortality

I believe there’s a small set of things we want in life. The details vary from culture to culture and from person to person, but on a high level, the set of potential desires is pretty small: We want some level of security—physical, nutritional, financial, emotional, psychological. We want to be healthy, to be able to use and rely on our bodies and our minds. We want some kinds of freedom of choice. We want to have some variety of love and/or companionship. We want some of these things: meaning, purpose, to feel like we’re growing and making progress.  There’s more, of course. I haven’t thought this through enough to claim this is all. The specifics matter, but I believe that for empathy, the circumstances matter more.

And these circumstances: they are complex. They are nuanced. And they, much more than the desires, are often invisible. It’s easy to assume you know all about other people’s lives, but what allows us to empathize with others is realizing that we don’t know, making a point to recognize the potential for all sorts of nuance we can’t actually see.

Getting that, understanding that we all have these super-unique circumstances—that is one of the major, expensive lessons that I learned from cancer.

Could I have learned it another way? Definitely. Sure, this way was effective. The downside is that it comes with lifetime toxicity for my partner and a host of mysterious, to-be-discovered short-, medium-, and long-term side effects. Plus, you know, all the depression and anxiety and life-interruption and still not solving all our problems from beforehand. So I don’t recommend learning this way. Learn by talking to people. Read books. Try method acting. Work or volunteer somewhere. Don’t get cancer, okay? Okay. I’m glad we’re on the same page.

The understanding, the relating to others, is one of the reasons I like to tell people what I can when they ask—because there’s no other way of learning how other people live life and what they face, and of therefore realizing down the road that even if the specifics differ, you’re not alone in struggling. In facing mortality. In wondering how you’ll make it through the day.

The paradox is that the differing specifics bring us together. You can only share your perspective, but it is exactly that story that allows you to reach and teach other people.

What we all have in common is nuance.

Story time

A. went to a sushi restaurant in the spring. It’d been ages since he’d had sushi because the chemo compromised his immune system and raw fish isn’t recommended when you have no way of fighting infections.

He sat at the bar next to an older couple.

They married in the mid-1960s, so they’ve got to be at least in their mid-70s. They looked healthy, fit, young, happy, even joyful, out at one of their favorite restaurants, being treated to free dishes because it was the restaurant’s anniversary and they’re regulars.

They talked. A. mentioned he works at the university. The woman said that’s great, we need as many doctors as we can get.

Oh, but I’m not a medical doctor. I’m a professor… But speaking of doctors, the reason I didn’t eat sushi for a while is because I was going through chemo for a rare type of Hodgkin’s lymphoma. 

And guess what? She said she’s had Non-Hodgkin’s Lymphoma for nearly 20 years.

When the couple left, she grabbed A. by the shoulders and told him to look into the mirror every morning and say to himself, “I am at ease. I do not have this disease.”

Here’s what I like about this story:

First: A., who is normally an incredibly compassionate person, was seeing and sitting next to and talking to this couple. In the midst of struggling to go back to all of his life roles and responsibilities after just completing cancer treatment, he told himself they were happy and healthy and probably never had to face problems like his.

The reality appears to have been the opposite: this particular couple probably knew how to appreciate a good moment when they had it. Which is a reminder that you can never assume you know what other people have experienced in life, and also that it is possible to emerge from the depths of disease and struggle, even if they quite literally accompany you forever, and find ways to enjoy life.

Second: I grew up keeping a lot of things to myself or within my family. I thought it wasn’t appropriate to talk to other people about negative experiences, so I didn’t.

What I have found repeatedly through this experience is that you are often rewarded when you share. You tell someone else about your humanity, your past or present struggle, and amazingly, surprisingly, upliftingly, sadly, shockingly often, way more often than seems statistically probable, you will hear about someone else’s similar struggle. And then you are together for a moment.

Our shared humanity, remembering that we are in this together, that even the bad things bring us closer together, helps us make it through. It doesn’t make the bad things good. It doesn’t make them worth it. But you don’t have a choice about the bad things, certainly not once they’ve happened. So at least this: a reminder that there’s still water in the glass.


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