Blind Curves

Not counting circumcision, my first surgery was a tonsillectomy at age five. I hardly knew what was going on, and the event certainly did not inspire me to undertake any assessment of myself or of the seemingly infinite future that stretched before me. They put me under with a hideous-smelling gas called ether, which I fought with all my puny might but with predictable futility until I drifted into some unconscious place. After I awoke, my throat hurt, but not too badly, and once I learned that ice cream was the preferred palliative for children in my situation, I played it for all it was worth, feigning horrible, disabling pain long after any real pain had faded. So successful were my pitiful pleas for relief, so much ice cream (all vanilla, I remember) did I consume that I could hardly bear to look at the stuff again til I was past my seventh birthday.

Despite my family’s lack of material wealth, I was blessed with certain key advantages (or so I thought). I lived the first twenty-four years of my life without personally knowing a single person who died. None of my friends could say that. Of course, most of them had living grandparents, whereas three of mine, and all of my great-grandparents, had passed long before I was born. I suppose that fact alone should have told me that we had a few sketchy genes in our family line, but somehow it never occurred to me that the same factors that had led to their early passings might also be lurking inside me. Nope, I never thought anything of the kind.

The other big blessing was that the tonsillectomy (now but a vague memory) was my only personal medical event of note until I was in my forties. No broken limbs. No appendicitis. Nothing more than a couple of cavities. Not even eyeglasses. By 40, my blood pressure was creeping up, but what of it? My doctor prescribed an anti-hypertensive, I lost twenty pounds (with the aid of a treadmill), and things came back into line, more or less. Bad-a-bing, bad-a-boom.

And when I did finally experience another surgical invasion, at forty-two, it was both minimal and elective. Actually, it was prompted by my wife, who reminded me with a certain firmness of my promise -- a promise made years earlier in the madness of youth, I must say -- that I would eventually take my turn as the primary agent of birth control in our relationship. There was no escaping it; she had fed herself pills, filled herself with diaphragms, and endured the aggravation of intra-uterine devices, while I enjoyed a sex life unfettered by artificial devices or risks of side-effects. I could hardly deny that it was my turn to take the helm.

There followed a fleeting period of what I can only call irrational doubt. Would this affect my sex drive? Performance? Was I a thousand percent sure I never wanted to sire another child? Even if I didn’t, would I feel that my manhood was diminished? I didn’t have unequivocal answers at the time. But I put any residual concerns aside and forged ahead.

You might think that someone who contemplated surgical modification of so dear a part of one’s anatomy would talk to friends and colleagues who had experienced similar operations. You might think such a person would do a bit of comparative shopping, speak to the most highly recommended local urologists, attend a consultation armed with a list of all the questions that one might reasonably have about the nature, risks, and possible outcomes of such procedures. But in the event, I did what any self-respecting male would do in those years: I opened the Yellow Pages and called the first urologist with a name that seemed solid and reliable. There was a pre-op consultation, but it was thoroughly perfunctory. “Here’s how it goes,” he said, and gave a brief well-practiced description of the procedure, concluding with, “So do you have any questions?” I allowed as how that was all pretty clear, and the interview was over. The vasectomy was equally routine, more memorable for my discomfort at the flamingly effeminate male nurse than for any memory of the event itself. Not that I’m homophobic, mind you. It was just … weird.

I went home straight away and was treated to a couple of days of welcomed devotion from my wife, who waited on me hand and foot while I sat gingerly in the living room recliner. My sons, aged around nine and eleven at the time, found the entire matter thoroughly disgusting and unworthy of discussion or even acknowledgment And after a few days, the soreness, the smug pride that I would never be the proximal cause of anyone’s unwanted pregnancy -- indeed, the whole matter -- faded into history, never to be raised again except on rare occasions when I had reason to say quietly “Yeah, I had one too, quite awhile ago now.”

And so life rolled along. There were ups and downs, moments of ecstatic joy, some times of abject misery, and month upon month of routine. But throughout the next 14 years, not so much as a hint of the knife. Blood pressure continued to challenge my GP, who threw various prescription medications at it seriatim. A beta blocker, a diuretic, an ACE inhibitor. Each one helped a little more than the one before. In every case, after awhile the numbers slowly rose. But I was no less vigorous than ever, or so I thought, and my heart was strong. Although I exercised only occasionally, my weight gain was modest (for my age), my blood work was consistently good. On one occasion when my wife insisted that I ask my doctor about dietary issues, he responded with a rather worn but mercifully brief speech about moderation that would have made Aristotle proud. All in all, no reason to curb my appetite for the richly marbled meats, fine cheeses, and full-bodied sauces that clearly were gifts from God Himself. I was in the full flowering of midlife, with all its trivial urgencies, unexamined mortality and unresolved issues.

And so it might have continued forever had it not been for tingly fingers. Just a couple of tingly fingers to begin with, and even those only occasionally. Hardly worth mentioning, and so I didn’t for a year or so. At some point, when the tips of all the fingers on my left hand were alternately tingly and numb, I figured I should mention something to my doc. His response was almost as casual as my report. “Well, let’s order an ultrasound of your carotid arteries just to be sure you aren’t having restricted blood flow to your brain.

I took that idea in stride. And the stride wasn’t broken even after the ultrasound revealed that my right carotid artery, the precious lifeline that carried blood, oxygen, and nutrients to half my brain – was 90 percent occluded, blocked by arterial plaque, the legacy of generations of ancestors and decades of unfettered living. What was I thinking? That the artery to the brain was all clogged up, but everything else was fine? That’s how it seemed at the time. Open that artery up, clean it out, and poof! Problem solved. And that’s how it seemingly happened. Back to life as usual. That’s how it went. Did I break stride? Hell no. Was I out of commission? Yep. For about six hours.

By the day of my fifty-fifth birthday a week later, I felt not only recovered but renewed. No more tingly fingers. My vitality and sense of immortality were back in full force, if they’d flagged at all. My horizons stretched endlessly before me as they always had, and I returned to the high-energy, multi-tasking, tactically successful, but ultimately directionless course of life I’d always known.

Almost two years later, I contracted a very bad cold. I don’t get colds of any kind very often, and this one was special. After what should have been a complete run, it settled in my chest, and as it did, I grew progressively weaker. So much weaker that it was tiring to get up from the recliner and walk to the porch. I went to work as I always did, but most of my time was spent trying to stay awake.

At last, with the aid of antibiotics, the bronchial infection was defeated and all the attendant symptoms faded away. Except for the exhaustion, which inexplicably remained. And remained. My wife pressed me to see my physician, who took a chest X-ray (negative), listened to my heart (negative), and sent me for blood work (“Call back in a few days”). The exhaustion continued, so I did call back in a few days, and my doctor’s response was brief: “You’re anemic.” I forget my exact response, but it was something like, “Ridiculous!” I ate a perfectly wide-ranging diet with plenty of protein. I might have mistreated my body in a thousand ways, but I’d certainly never shorted myself on protein, and I said as much to the doc. “Absolutely, I’m sure that’s true,” he replied. But you are anemic. Somewhere inside, you’re hemorrhaging.”

This was more than a little dumbfounding, but after considering it for a minute I had to admit that, given my dietary history and love of rum (a byproduct of a research career requiring summers in the Antilles), I might just possibly have a bit of an ulcer or something of the kind. My doctor went on to say that his nurse was going to set me up at the university hospital for an endoscopy as well as a colonoscopy, reasoning (I guess) that whatever was bleeding was somewhere in the digestive system. So, a week later, in they went, both on the same day, one following the other. Down the throat. Up the butt.

To my surprise, the endoscopy was negative. To my greater surprise, the colonoscopy was not; it revealed a lesion of some sort in the wall of the colon, up near the top where it meets the small intestine. Not clear exactly what it was, but they’d grabbed some of it for biopsy. Results would take a few days.

The Ringling Bros./Barnum & Bailey Circus came to town the next Saturday, and my wife and I had bought tickets for ourselves and our granddaughter, who was then just two and a half. It was her first circus, so we arrived early to make the most of it. She was delighted, of course, at the entire mise en scene, but especially of the pre-show parading of the elephants, the random warmup exercises of the acrobats overhead, the cavorting of the clowns, and most of all, the cotton candy. Her face glowed with the light of dreams that are reserved for the very young. It was magical.

And so I barely noticed when my cell phone vibrated in my shirt pocket. The caller ID told me it was my doctor, so I slid out of my seat, gestured to my wife about a phone call, and slipped out into the XXX where the noise was a little more subdued.

“Hi,” I said a bit hesitantly. “You’re working on a Saturday?” 

“Actually, I’m at home.  I was just catching up on a few patient-related things and it occurred to me to check if your test results had been posted yet.”

“And?”  I asked. I’d already thought it through, and I was pretty well prepared for the lecture about the need to improve my diet, to bring my lifelong assault on my digestive system to an end.

“You have cancer.”

I’m sure that those words have evoked thousands of different thoughts in millions of different people. During the coming weeks, many of those same thoughts would occupy my mind, too. But at that moment, the only thought that I had -- and I remember it precisely – was “Here I am, watching forty clowns making crazy eights on tricycles while two swaying elephants are shitting on a red plastic carpet, and someone is telling me I have cancer.”  The surreality of that one thought was so thoroughly captivating that nothing else could displace it.

The rest of the conversation was brief. It was operable. If it hadn’t spread, the outlook was pretty good. We’d talk at the office on Monday.

As I thought it through over the course of the next week, the impact of the news gradually diminished. Predictably, I spent hours at the computer, scanning web pages about colon cancer, colon resections, post-surgical pain, recovery, survival rates, optimal anti-cancer diets. The picture was good. If it was just one tumor and the cancer cells hadn’t spread, they’d excise it (and a portion of colon surrounding it) and I’d be back in stride within a couple of weeks.

In surgeries like this, it’s customary for the docs to grab any lymph nodes they come across, because those are the places where cancer first spreads, before hitchhiking along the lymphatic highway to colonize new organs. In my case, they grabbed seventeen. And all of them were clear of cancer, except one. That was the one that secured my place as a chemotherapy patient for the next six months. 

Major abdominal surgery is no fun. Not the surgery itself, but it hurts after. Chemotherapy is no fun, but even though mine lasted six months, it was a better experience than many report. In the days immediately following my diagnosis, I felt this was one of those Special Times, a turning point or warning of sorts, and I resolved to decide what really mattered to me and to focus the rest of my life on that. At one point after the surgery I concluded that happiness was indeed right under my eyes, right in my own back yard, as I resolved to focus on making the most of every day in the world I actually inhabited, and to stop pining for anything else. But in the end, it all faded as memories often do, and, after three years of followup colonoscopies, I was cancer-free and back to life as usual, albeit with a somewhat greater appreciation of the importance of Now. Voilá!

The cataract surgery and lens replacements (both eyes) four years later are hardly worth noting, so quickly was the matter diagnosed and remedied. The ophthalmologist opined that I was a little young for that sort of thing -- sixty-one, as compared to a more typical seventy. Still, in the light of my age and the procedures that I’d already experienced, a mere blip on the screen.

This is becoming a longer account than I intended, so let me just say that none of this slowed me down for more than a couple of weeks. Well, the chemotherapy had its moments during the last couple of months, but once it finally ended it took little time to bounce back.

Without ever saying as much, I was privately glad to have gotten so many of the ailments of older adulthood behind me. My blood pressure meds were finally configured in a way that actually worked, I no longer had cancer, my heart sounded good to every stethoscope that heard it, my eyes were brand new, my neck was cleanly plumbed, and oh, lest I forget, I was at no risk of impregnating my (admittedly now post-menopausal) wife. As a well-known politician of the day famously said, Bring it on!

And as some anonymous person of greater wisdom said, it’s not the stuff you see coming that challenges you so much as the stuff that comes out of nowhere. And so it was a year and a half or so later that I awoke one morning after a comfortable and otherwise uneventful night’s sleep, sat up in bed, and was greeted by a sudden stabbing pain in my lower back. The pain was undiminished as I swung my feet over the edge and pushed myself upright, and I gave rather loud voice to a couple of expletives, drawing my wife’s somnolent attention. “Hmm?” she asked, her eyes still hooded against the dawn.” “My back. I dunno, I must have twisted something.” Although movement seems to worsen the pain, I brought myself to a standing position, and immediately felt my right leg fold in half as I crashed to the floor. By now, my wife was wide awake.

I was able to get back on my feet, and to walk successfully as long as I focused on each step. But even after a day’s practice, at first, I fell to me knees every two or three days. My GP took X-rays and sent me to an orthopedist, who took more X-rays, inserted an impossibly big needle full of steroids into my spine, and laid down the diagnosis: A degenerative disc, which in English means that what passed for padding between my fourth and fifth lumbar vertebrae (in my lower back) was worn down to almost nothing, leaving the vertebrae to rub against each other and to aggravate and otherwise compromise surrounding nerves, all to the detriment of my locomotion and overall pattern of pain-free living.

As my GP predicted, the more or less constant pain lasted for a little over a month. When it had faded, though, all was not restored. I remained unable to climb stairs except a foot at a time. For months, I could only raise myself from one step to the next with my left leg. At last, after a lot of practice, I could lead with my right leg, but only if I held tight to a railing for security.  Bending over for more than a few seconds was painful. Walking for long distances was painful, too, as was standing in one place for more than about ten minutes. Things persisted that way, and so they persist today. Thus compromised, over the next couple of years my body slowed a bit, my energy flagged a bit, and by some point that I can’t identify now, I felt older. I don’t know whether it was just the various ramifications of the degenerative disc, or if that was just the most obvious element of a more complex aging process, but the me I’d known throughout my adult life was beginning to slow and weaken. Not horribly, but perceptibly. I moved around a little more slowly and cautiously. Reviewing those couple of years, I now see that others were aware of it as well. More doors held open. More offers of help carrying this or that.

My own theory was that I was on the way back, although more slowly than I’d have liked. If I just got a little more exercise. If I just didn’t have a desk job that kept me immobilized for much of the day. And so on. But at heart, I knew that I was only partly right at best. A bigger part of this was the natural course of human development, and it wasn’t going to be reversed. Not ever. There were experiences I would never repeat again, and as time passed, the count grew. Carrying a canoe from a car top to anywhere, no matter how close. Changing a tire without agony. Playing hopscotch, however badly, with my granddaughter. Leaping from anything to anything. Running at any pace faster than a light trot. The list grows longer every day. But in truth, it was just as long on that morning when I first felt the stabbing pain in my back. I just didn’t know.

Most people I know who are in their mid-sixties have had some kind of ailment that can be classified as serious. Some have more than one. Some accept the encroaching physical limitations with grace, some live in denial. Most bear their particular cross without public complaint, knowing (as we all do) that younger people (which is most people) just don’t want to hear it. Of course, some few of us older ones actually still inhabit what look like forty-year-old bodies that seem inexplicably to have fought the aging process and won. Yet those of us in the former group, the ones who accept their situation as an inevitable part of living, are, I think, the majority. We are the ones who don’t mind having doors held for us. Who actually welcome it when someone in the Home Depot parking lot offers to carry the window air conditioner from our cart to the trunk of our SUV. We proudly claim the Senior discount at any retail outlet that offers one. We are Growing Old Gracefully, or at least we’re trying. This emphatically is not the same as resigning ourselves to a slow and inexorable march toward the grave. Not at all. More of which later, but first, the most recent piece of my story.

Which began around three a.m. one otherwise unable morning about three weeks ago. Having had a rum and ginger ale followed by a glass of wine just before bedtime, and having a glass of water by my bedside as was my nightly custom, I naturally awoke a couple of times during the night to relieve myself. The second time, I was aware of a slight pain -- sort of like having someone gently press the butt of a screwdriver into my chest on the left side. It was there when I awoke and inched my way to and from the bathroom in the dark and when I laid back down, but it wasn’t bad enough to keep me awake. I fell back to sleep, but at some level I was vaguely aware of it of and on – or did it come and go? --  through the remainder of the night, and it may have been the discomfort that caused me to wake up a few minutes before the alarm rang at 7:00. It was clear to me what was going on: I’d turned a little too suddenly in my sleep and twisted a bit of my left pectoral. Or something. There must have been a tiny element of self-doubt, though; otherwise I never would have mentioned it to my wife, knowing as I did what the consequence would be.

So I drove myself to the nearest hospital, which also happens to be the best in the city. The EKG was negative, as was the blood work, but the low level intermittent chest pain persisted. I clung stubbornly to my pulled pectoral theory, and my conviction was bolstered by the results of the coronary ultrasound, which also were thoroughly negative. “You know,” I said somewhat condescendingly to the cardiologist who dropped by my room in the Observation Unit, “I really appreciate you guys’ thoroughness, even though it turned out that nothing was wrong.”

The cardiologist muttered, “Umm … hmm … yeah, well I think we’ll go ahead and do a nuclear stress test, just to be sure.” I saw this as little more than an insurance grab, but once I learned that it could be accomplished in less than an hour, I agreed to go along with the gag.

The tech who conducted the test was professionally close-mouthed, politely deflecting all my efforts to learn what she actually saw on that screen. It took less than twenty minutes, and I was ushered back to my room. When the cardiologist appeared a little later, his account of the stress test was brief. “A lot of it looks okay,” he said. “But there’s an area that seems somewhat oxygen-depleted.”

“And so?”

“Well, so we’ll do an angiogram and figure out what that’s about.”

“You mean with the wires and cameras in my veins?”

“Arteries.”

“Yeah, those.”

This wasn’t quite the outcome I expected.

The angiogram took barely longer than the stress test, then back to the Observation Unit. In time the cardiologists appeared, two of them, and an intern. They spent a few minutes explaining the details, but the bottom line was simple: My right artery was 90% blocked, and to aggravate matters the left (main) coronary artery had 70% stenosis. They were also concerned about an area in the heart wall. So … triple bypass. And oh, there was a hint of a leaky valve, but there’d have to be another test before the bypass to check that out. I had a few questions. Would they cut my sternum in two? (Yes). Would they stop my heart altogether while they performed the bypasses? (Yes). How many days would I be in the hospital? (Five at best). When could I drive again (four to six weeks). I already knew all this, as I’d done my homework on my smart phone while waiting for the cardiologists to come around. Just in case. In reality, there was only one question I truly cared about: Would I be okay? I didn’t ask that one.

In the end, I was okay. I was okay despite the fact that I turned out to need a valve replacement as well as the triple bypass. I was okay despite the fact that I also turned out to need a new aorta-- a Dacron one, as it turned out -- and I was okay even though, to ensure my eventual survival, the surgeons had to drain me of all my fluids and lower my body temperature to 20 degrees for awhile. “You presented a lot of problems,” my lead surgeon said afterward. “We had to kill you, there really was no choice. Fortunately, we were able to bring you back.” Back indeed. Mostly human, a little bit pig, and a small part Dacron. I have parts with serial numbers.

But the silver lining, as I saw it, was that I had weathered sufficient health risks, and skated sufficiently close to the edge of life, that I was bound to have a decade ahead of me that would be largely free of serious health issues. Justice, after all, demanded as much.

--------

The next Spring I joined a Medicare Advantage plan and had to change my GP to an in-network doc. Just as well, I thought, because my cardiologist and the hospital where I’d had the heart surgery were both part of the same network. And because he GP worked for the same multidisciplinary provider, he had access to all the digital records associated with my heart surgery and the subsequent follow up. Part of that follow up had been a CAT scan, which was done a month or so after the bypass operation to make sure things were working okay.

As I was concluding my first visit with the new GP, he asked, “You were aware of the pulmonary nodule that was noted on your CAT scan last April?”  I had no idea what he was talking about. It didn’t look very big, a centimeter or a little more he said, and 99% of nodules in the lung prove to be benign. But better safe than sorry, so he scheduled me for another CAT scan just to be sure it wasn’t growing.

The new scan showed that the nodule, situated near the outer wall of my upper right lobe, had grown from about 1 cm to 1.2 cm in a year’s time. Not a terribly fast rate, and certainly slower than some of the more voracious lung cancers, whose tumors can double in size in a few months or less. Still, the prudent step would be to schedule a biopsy, a simple procedure involving penetration of the lung by means of a needle inserted between the ribs through a small incision in the side of the chest, and extraction of a small sample of the suspect nodule. Once this was accomplished, all that remained was to wait a few days for the result. I figured that 99% was practically as good as certain, so I was already looking past the biopsy report to my summer travel plans.

But probability is not certainty, and so it was that the pulmonologist called the following Thursday morning to tell me that the nodule was indeed cancerous. An adenocarcinoma, its size indicating that it probably was in a fairly early stage of development. Probably. Whether any of the cancer cells had escaped into the lymph nodes was a question that could only be resolved through surgery, and surgery would be necessary in any case to remove the nodule itself. The good news was that the extraction of both the nodule and the requisite sample of lymph nodes could be accomplished by video-assisted techniques using smallish incisions and little cable-controlled cameras and surgical implements. The other news, which surprised me, was that the surgeon intended to remove not just the nodule and some lymph nodes, but the entire upper right lobe of my lung. When I asked why he couldn’t simply extract the items of direct concern, his answer was unhesitant: “Absolutely not. That would be malpractice.” A lobectomy it would be, and nothing less.

The surgery was scheduled for two weeks hence. Meanwhile, there was the attendant uncertainty, not about the surgery itself, but about the lymph nodes. Cancer cells in the lymphatic system  would mean, at the minimum, a period of chemotherapy, which would require abandoning or rescheduling a host of other plans and commitments, not to mention the inevitable monitoring to ensure that the chemical assault had achieved its objective. So the two weeks before the operation passed slowly, and when the day of surgery arrived I was more than ready to get on with it. 

I presented myself at the hospital at 5:30 a.m. as instructed, and within 90 minutes I’d been deposed, gowned and otherwise prepped, and as on my way to anesthetic Lala Land and the operating room. When I awoke in the typical post-sedative haze a few hours later, I was on a gurney in the recovery area and, to all available evidence, ready to be moved to a room where I could spend the next two or three days preparing to go home.

Anesthesia has a way of creating time warps, so I don’t know how much time passed before I took notice of my blood pressure on the vitals monitor at the end of my bed. After being settled in the room and before dozing off again, I remembered my wife excusing herself to go home for a bit of rest. Now, the nursing staff were off taking care of other business, and the room was dim and mostly quiet. The monitor showed my blood pressure at 105/72, which I remember thinking was impressively low for someone who had struggled with hypertension for years. I also noticed the room seemed warmer than before, uncomfortably warm, so I pressed the nurse call button, which was met with an almost immediate response. The nurse reported that the thermostat read 73 degrees, and she lowered it to 69. Ten or 20 minutes passed before my eyes landed again on the monitor, which now read 95/68. That was moderately disconcerting, and I wondered vaguely if the drop in blood pressure might be related in some way to the beads of sweat that had formed atop my head. I pressed the nurse call button again. The nurse returned, mopped my head gently with a damp cloth, lowered the thermostat a few more degrees, and assured me that the blood pressure was nothing to worry about and that, indeed, swings in blood pressure during and after surgery were fairly common. 

After another ten or 20 minutes, the monitor was reading 84 over 52. I rang again for the nurse, who appeared some minutes later and responded to my concern about the continually falling blood pressure by telling me, with undisguised annoyance, that it was only falling because I was focusing on it. Now, I know that the demands on a nurse’s attention are numerous and diverse, and I’m usually a pretty cooperative patient, but that young lady’s response lit a fuse. “Listen,” I said, making to effort to hide my anger. “Here’s what we’re not going to do. We’re not going to blame me for the fact that my vital signs are failing. Now, you go get the charge nurse, and do it INSTANTLY!” I think she almost welcomed that directive, as she had concluded by this time that I was a grouchy old man who was determined to find something to complain about. The charge nurse appeared right away, took one look at the record and called the nearest resident. By the time he arrived my blood pressure had fallen even farther. Within a few more minutes, there were at least 15 medical personnel in my room. Suddenly, it was obvious to everyone that I was bleeding out. The only mystery was why, and from what? Someone was on the phone with my wife, asking for authorization to rush me into emergency surgery. Then I was in the hall. I was surrounded by medical staff, but the operating room wasn’t ready. It was a Babel of voices, mostly indistinct (as I was losing the ability to concentrate), but the intonations bespoke urgency. 

Throughout my life, I had never felt, either intellectually or viscerally, that I was at death’s door. But at that moment, I did. There’s no point in describing that that feels like; I’m guessing it would be different for everyone. For me, the reality of it was penetrating and undeniable. And in me, at that moment in that situation, it engendered a defiant response. Then, in a moment, there was a voice saying, “It’s not time to go. Not time. You have to hang in.” The unspoken subtext was just as real: “But it’s your choice.” I determined to remain conscious until I saw the lights of the operating room. And when they came into view, I faded quickly into unconsciousness.

----

We arrived at Orly three weeks ago on a flight from JFK. At that point, the remaining two right lobes of my lungs had replaced perhaps 60 percent of the breathing capacity that I’d lost with removal of their uppermost companion, and I was still oozing occasional small amounts of fluid from the mostly-healed incision where the lymph drain had been placed during the surgery. Mercifully, the biopsies of the lymph nodes had been entirely negative; the nodule had indeed been caught at a very early stage, and no chemotherapy was required. I’ll need to have another scan in five months or so, just to be sure nothing else has popped up. Even more fortunately, the surgeon had managed to identify the location of the loose surgical staple in my pulmonary artery, probably just in time to forestall a massive a massive heart attack resulting from blood loss. 

After that last medical adventure, two weeks in southern France just seemed inadequate. So in July, 2017, we commenced what had beensa years-long goal: living for a year in France. We rented our house in the U.S. and signed a one-year lease on a house in Entraigues-sur-la-Sorgues, some 12 km from Avignon, I will not bother to enumerate all the reasons why our change of plans was financially and logistically imprudent. Yet there we were, looking out on the Luberon mountains to the east as we had our morning coffee, inhaling lungful after lungful of thin, clean Provencal air. The oozing from my lobectomy suture had abated, and my pulmonary capacity felt almost fully recovered. I felt grateful, not just to be alive, but because I had not allow my various confrontations with mortality to stand in my way of moving forward. We set out as funds allowed to explore Provence and the Riviera, from Nice to Narbonne. Visitors came, and we proudly became their personal tour guides, introducing them to places that we’d only just discovered ourselves. Our wonderful granddaughter, herself fluent in French from her school in the U.S., was spending that year with us. But the French are fairly liberal with school holidays, so we were afforded several opportunities to venture farther afield for a week or more at a time, visiting other regions of France, Germany, Switzerland, and Italy.  In late October we were preparing to leave on one such adventure when I stepped out of the bedroom to call something downstairs to my wife, clad a a pair of newly purchased socks. The socks seemed a little slippery as I crossed the ceramic tiles to the top of the stairwell, and it was there, as I stood on the top landing talking with my wife, that my foot slipped off the edge and sent me hurtling headlong down 15 stairs to the bottom. Without handrails (building codes can be a little loosey-goosey in Europe), tee was no way to stop myself. My wife screamed in terror at what she saw, and then screamed more. To my amazement, I sat up when I reached the bottom -- a little woozy, with blood streaming down my face from the three-inch gash that crowned my forehead. There was other, less forceful bleeding from my knees and elbows, and the right side of my chest felt bruised.

“I’ll be fine,” I told my wife as the cold compress that used to be a dish towel finally stemmed the hemorrhaging from my scalp. “We need to get going.”

“Like hell,” she replied, with a finality that was all too familiar. “Get in the car, we’re going to the hospital”.

So off we went to the Centre Hôpitalier d’Avignon. I wasn’t surprised that the gash in my head required stitches, and the ER doc sewed in seven of them. The chest x-ray revealed two cracked ribs, one of which had punctured one of the two right lobes that were left after the lobectomy. It took five days in the hospital bed, hooked up to a hefty tube that continually drained fluid from that lung, before they were able to close it up. Along the way, they also did an X-ray of my head, which revealed that my skull was still completely intact. Too bad no one thought to look at my brain.

In hindsight, I realize that from time to time during the preceding two or three years, I’d briefly feel a little vertigo, but because I discovered that I could pause whatever I was doing and take two or three deep breaths nd it would go away, I ignored it. Dummy me. The rest of 2017 slipped mercifully into the past, and 2018 looked pretty bright. Our older son, who was living in Germany, joined us (and his daughter, our granddaughter) in Provence for the holidays, and we learned how to do Christmas the French way. Then one day in mid-February I was waiting in the checkout queue at the Intermarché in the nearby town of Sorgue. Suddenly, my left thumb locked jerked into a “cocked” position and locked. The next time I was conscious, I was on a gurney in an ambulance, and the firefighter-medic was explaining in very fractured English that I had experienced a grand mal seizure in the supermarket, and would be en route to the hospital. They had retrieved my cell phone and contacted the most recently called number, thus reaching my wife. She would meet us in the ER.

A cranial MRI soon revealed what the x-ray in October didn’t: two small dark areas measuring 16 mm and 10 mm in diameter that appeared to be nodules of some sort. One of these probably had touched a part of the brain that set off the seizure. Once the docs heard my history, they concluded that the nodules were in fact metastases from the lung cancer. I protested that the pulmonary tumor was tiny, and staged as 1-A.  They started me on steroids in the hope of forestalling a repeat performance but there were no guarantees.  However, the neurologist explained that, whatever these anomalies might be, they could be reduced and possibly destroyed altogether by something called Gamma Knife radiosurgery -- a means of destroying foreign masses in the brain using targeted radiation, with no cutting, and even better, no side effects. Unfortunately, nobody in Avignon possessed the requisite technology, but it did exist 80 km  south at La Timone, the vast teaching hospital of the University of Marseille. If I was interested, they could arrange a consultation. My immediate response: Where do I sign up?

The consultation was arranged, we drove (my wife drove, I rode) to Marseille.  Meanwhile, I’d learned that the neurology department at La Timone did almost nothing else but Gamma Knife procedures, in fact haad done some 20,000 of them with a high success rate.  On April 11th, we returned, and the next day I was wheeled down the hall to a room, where I was put into a chamber that closely resembled an MRI machine. Thirty minutes and exactly no pain later, it was over. Thirty days later, the smaller nodule was gone and the larger was much reduced. Thirty days after that, there was nothing to detect. Although they reminded me that I would need additional followups in case of recurrence. Still, I was elated. Friends and family argued lightheartedly about how many lives I might have left.

I brought records and images documenting all this back to the States when I returned in August 2018. As a result, my hospital and clinic here continue to record me as a Stage 4 lung cancer patient with metastasis to the brain. Maybe I am, but who really knows? One thing you don’t get with radiosurgery is cell samples, slides that can be examined by pathologists. What is scientifically known and thoroughly defensible is that there were nodules in my brain. Their origin, and degree of malignancy if any, are unknown. My attitude is, if life hands you lemonade, don’t waste time trying to turn it into a lemon.

Except for a couple of colonoscopies (remember the colon cancer?), a little squamous cell carcinoma that was easily removed with a Moh’s procedure, and a string of PET scans, MRI’s and blood tests, there’s been no big news in my medical story since then. Something will happen next, of course. Who know when or what? Certainly not me. So is there anything to conclude? I ask myself that question all the time, and I often recall the closing lines of Pete Seeger’s song Get Up and Go:

I get up each morning and dust off my wits

Open the paper and read the obits

If I'm not there, I know I'm not dead

So I eat a good breakfast and go back to bed.

Just as often, I’m reminded of something that a few of my church-going friends say when asked how they’re doing: “God woke me up this morning, so I’m not complaining.” I’m quite aware -- one might even say uber-aware -- of my good fortune, and I am deeply grateful for it. I know that I’m a more spiritually aware person than I used to be. Perhaps that happens to everyone as the age, I don’t know. I do know that I have an aiding reverence for life, human and otherwise, that was not so much in evidence before. As I continue to reflect on that, I hope I can uncover other lessons that might be there to learn. Optimistic people often remind us that today is the first day of the rest of your life.  I’m here to remind you that tomorrow may be your last.