Surviving In This Very Moment…

My Personal Battle with Prostate Cancer … And Life!

Archive for the month “October, 2012”

Under the Circumstances…The Best I Could Hope For!

I am relieved to learn that my prostate cancer is contained in the prostate.  Both the CAT Scan and the Bone Scan were negative for metastasis.  But a contained tumor with a Gleason Score of 4+4 (8) indicates a very aggressive tumor calling for surgical removal.  The surgery is scheduled for late November, after Thanksgiving and is to be done by a DiVinci Robotic system.  This seems to be the best option available and may even lead to a “cure.”  It may also lead to significant side effects; one worse than the other.  So once again I enter the state Levinas calls proximity.  In Postmodern Ethics, Zygmunt Bauman writes of proximity as follows:

Proximity is ‘beyond intentionality’.  Intention already presupposes a measured space, a distance.  For intention to be, there had first to be separation, time to reflect and ponder, to ‘make up one’s mind’, to proclaim and announce.  Proximity is the ground of all intention, without being itself intentional. (p. 87)

Understanding that proximity issues from my responsibility for the other, in a face-to-face dyadic encounter, a dyadic intimacy if you will, the encounter with the other serves as a simulacrum for my responsibility for the absolute Other, the unknown and unknowable infinity that bookends existential being.

Two states come immediately to mind when thinking about proximity that issues from this ethical responsibility: waiting and acting.  In either case, proximity depends on the Levinasian fundamental ethical obligation, that of commanding the other to command.  It begins with a silent (sometimes vocalized) announcement, a presentation of the self to the other; Here I Am! made without reservation or expectation which commands the other to command.  Perhaps the other will ignore the presentation or perhaps the other will issue a command; either way, the self relinquishes control when the Here I Am is made without reservation or expectation.  Once made, the only thing left to do is wait.  If the other issues a command, as commanded, then the only ethical choice is to act.  While the ethical presentation of Here I Am creates the state of proximity, the command of the other violently rips at the very fabric of proximity in order that the self may act.

Once one finds oneself in proximity, once one finds oneself simply waiting, there is no reason to reflect or ponder what might be or should be or what one wishes to be.  There is either a command to be commanded issued which simply requires waiting for the command and nothing more, or there is not.  If the fundamental ethical obligation was entered into without reservation then there is nothing to be gained through projection.  Waiting only occurs at this very moment, a moment which fades into the past as soon as it is existentially experienced.  Until the command comes from the other, there is little to do but wait.  Yet, once (if) it comes, there is but one thing to do…Act!

Proximity comes when one encounters an existential other, but it also comes when one hears the words of the absolute Other.  In a dramatic sense, when one hears the words, “You have cancer,” it is a stunning encounter with the infinity that is yet to arrive.  While the dyad is no longer human being to human being, it is, nonetheless, an ethical dyad established by the very fact that my response to these words was to simply present myself to the absolute Other; Here I Am! Made without reservation or expectation, I am required to wait as the absolute Other speaks through doctors and laboratories, through testing and results.  Not until I am presented with test results can I act.  It follows, that there is no room for pondering or thinking about or even wishing for a desired result.  It simply requires waiting until the professionals have had their way with me.

Now that results are in, I once again make an ethical presentation, Here I Am, making me responsible for the responsibility of the Other.  I can do nothing more than await the command of the other, unknown until surgery is completed.  Along the way, I’ll be commanded to present myself for pre-operative testing, get medical clearances and generally follow some pretty simple instructions, all minor commands that respond to my commanding the Other to command.  So, once again, I present myself without reservation or expectation to the absolute Other…Here I Am!  And now I wait…

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Test Day Arrives

As a student and graduate student I studied for tests.  I controlled the knowledge I needed to excel.  I scoped out my professors, understood exactly what was expected and planned accordingly.  As a teacher and professor myself, I constructed tests that my students had complete control over, including framing the questions that were asked.  Today, I am taking two tests that I have absolutely no control over, that simply scan for tumors that are either there or they are not.  These two tests will determine both the treatment for and the predicted mortality based on whether or not the cancer is localized.

Given the gravity of these tests and the fact that I am a passive participant, I am simply looking at the experience as one of proximity.  I present myself, silently shout Here I Am without reservations or expectations.  The results of the test will give voice to the deafening silence of the Absolute Other, the infinitely unapproachable Other.  Nothing more can be said of the experience.  I am in a state of proximate waiting without anticipation or demands.  Sometimes the ethical simply sucks.

I want to be angry but to do so somehow diminishes my responsibility.  In my personal battle, I must present myself to many others without reservation and without expectation (which is much harder to do).  This simply means that I am responsible for the responsibility of the other.  I take the ethical risk that my doctors are skilled, have my best interest at heart, would do everything possible to achieve a successful outcome yet I also know that with risk comes potential failure; that even the best efforts of those professionals within whom I am responsible may simply not be able to control this particular disease.  So, Here I Am, ready to listen and follow, to do what I am told to do, to participate responsibly in my own treatment; in short, to plunge into the asymmetrical relationship, the responsible relationship with my medical team and perhaps they too will answer the call.

So today, I present myself to the radiologists with a the presence of a silent Here I Am!  I will follow instructions and then return to a state of proximate waiting for results.  In the meantime, it is time to live, laugh, love and have a good time. 

Proximity and the Absolute Other

One purpose for writing this blog is to work out difficult concepts of life and death.  Contemplating one’s own death is quite interesting especially for one who claims no religious affiliation other than a nominal one and who does not find enough evidence to believe in mythologies that claim a life beyond the grave as a reward for the life lived here.  So I rely on a postmodern ethical stance that serves as a guide to my personal struggle.  One never really knows what one believes until faced with the absolute necessity to examine carefully those foundations that guide everyday life.  For the past fifteen or so odd years I have understood the world through a postmodern lens guided especially by Emmanuel Levinas, Jacques Derrida and now Zygmunt Bauman.  Today’s post explores Levinas’s position concerning proximity or waiting on the other.

At the core of Levinas’s work is the idea of responsibility for the other.  For Levinas, the other person represents the wholly or absolute Other, an unknowable, ineffable state absolutely beyond all ontological knowledge.  When Levinas insists that I as an ontological self, can break free of ontology by being responsible for the other he is making the claim that ethics is the first philosophy, surpassing ontology as the foundational effort of philosophy.  Once I assume responsibility for the other I have broken cleanly away from the interiority of the self by entering a world of the exteriority of the other.  Responsibility for the other is asymmetrical; the other is approached without reservation and without any expectation of reciprocation.  Responsibility is not a contract or covenant; responsibility for the other is, simply put, waiting.

For Levinas, the absolute Other, the infinity book-ending existential life, the life as we know it, is reflected in the face of the other person as the self engages in ethical encounters.  By embracing the alterity, the diverse difference of the other person, one begins to gain insights into the absolute alterity of the absolute Other.  The very act of responsibility, one that Zygmunt Bauman argues rests in the unintentional act of the self commanding the other to issue a command to the self.  Every ethical encounter is thus initiated by the self which, in turn, may or may not be reciprocated.  The relationship is asymmetrical and is entered into without reservations or without expectation of a response.  Levinas calls this proximity; a state of anticipation or waiting.  But waiting for what?  For the other to issue a command, one that may never come but when it does that command insists on the self acting upon it, even to the point of one’s own death.

Proximity is a relationship of choice.  It is a relationship for which there is no possible substitute, no proxy, no alternate, no surrogate possible.  Once the self commands the other to command the self the die is cast and until such time as the other commands the self one must simply wait.  Proximity does not represent distance, time or space; it is merely the anticipation of waiting.

The ethical command issued by the self to the other is contained in the Hebrew word hineni, “Here I Am!”  This announcement is used frequently in the Torah when God calls upon people to act.  Adam, for example, after eating from the fruit of the tree of knowledge seeks to hide from God.  God asks, “Where are you, Adam?”  Adam responds, Hineni, Here I Am!  Adam’s response is one that is made without reservation as he trembles before the infinite.  It is Adam’s command to God, the speech act of presentation, the Here I Am, that opens the door to the ethical act.  The command of presenting oneself to the other may be ignored by the other, may be reciprocated by the other with varying potential results up to and including unwanted results, but when that command is given without reservation or expectation, the presentation to the other is assuming the responsibility for the other up to and including responsibility for the responsibility of the other.

Since diagnosed with prostate cancer, the focus of my responsibility for the other is two-fold.  First, I choose to present myself to friends and family being quite open about my disease and the potential treatment and prognosis.  This presentation, this personal Here I Am, is an opening for others to deal with me as they will.  Some, it seems wish to be sympathetic, others don’t care to talk about it.  Some have even offered prayers for me, hum, praying for an atheist…well I suppose it couldn’t hurt.  Secondly, by presenting myself to the other, I am also presenting myself to the absolute Other, hence the proximity to the infinite, to the absolute unknown that lies beyond the grave.  All I can do at this very moment is wait, embrace proximity; I await the command of the absolute Other, a command I hope comes none too soon.

Solitude: The Irreplaceable “I”

Emmanuel Levinas’s ethics creates an impossible condition, that of being present for the other; of being responsible for the other person without reservation or expectation.  Fundamentally, the self is irreplaceable in the sense that absolutely no other person can substitute for the self to act upon this sole responsibility.  In a social world, this responsibility can only be performed by the self, the irreplaceable “I.”  Along with this astonishing responsibility comes the solitude of responsibility.  There are no rules to follow, no guidelines, no legalities, just the terrifying knowledge that the “I” is irreplaceable.  Contained in this idea of responsibility is the very notion that one truly is one’s brothers keeper.

But, there are moments in one’s life where the outward looking self is required to turn inward, to look for strength within because one faces adversity that is overwhelming.  Protecting interiority is, during these moments, more important than the exteriority of the other.  Moments like the death of a loved one, the loss of a child, the breakup of a long-term relationship all cause one to turn inward in order to deal with the emotional pain involved with the experience.  These moments are generally short-lived but purposeful in their ability to cleanse the self and to return to a normal (whatever that is) life.

Having a diagnosis of prostate cancer is, it seems, one of those moments.  Unlike the death of another, facing one’s own mortality requires one to dig down deeply into one’s own interiority to find the strength to fight.  It is an interesting place to be, focused on myself and my determination to fight this disease.  On the surface, everything appears to be unchanged.  I am still spending time with friends, reading the books I love, thinking about the ethical applied to education and making future plans.  But that is the face I present to the world.  The face I present to myself is quite different.  It is dogged by the constant knowledge that I have cancer, that my mother died from ovarian cancer, that my father survived lung cancer only to die from what the doctors thought was an after effect of the radiation he received fighting his cancer, that my paternal grandmother died from an unnamed abdominal cancer when I was fourteen (my first encounter of the death of a loved one).  As I sit and wait for a more detailed diagnosis so that treatment can begin, I realize that only I can participate in fighting my very own cancer.  No other person can replace me as I hunker down to focus my strength on the battle to come.

Sure, I will have a team of doctors focused on state of the art treatments, nurses that focus their partial attention on me, a wife whom I love but who likes to hover, children and grandchildren who will not learn of my struggles unless they come upon this blog, and friends who will show concern.  But in the end, none of them can substitute for me.  I fight this disease alone, in solitude, while surrounded by friends and family.  The solitude comes from this irreplaceability; it is nothing, however, if not a place to find and develop the strength to face the absolute unknown with dignity and deference.

Here I Am: Ethical Engagement with the Infinite

Last June I had a total knee replacement.  It is now the end of October, nearly four months since that surgery and I am about to finish my physical therapy today.  Now it is not that the knee is fully recovered, but I no longer think about it the first thing in the morning, all day long and the last thing before I go to sleep.   It must be getting better.  So rather than completing that recovery before having to face another major medical problem, I get whacked over the head with prostate cancer.  Who ever thought life was fair.

I have been convinced for quite some time that the universe is a very large random number generator, that probabilities rule, that there is little purpose in the universe save for the personal responsibility asymmetrically undertaken to live an ethical life.  To command the other to command me is the essence of the ethical project of Emmanuel Levinas.  I take that responsibility quite seriously and now that my own mortality is called into sharp focus, the impossibility suggested by that asymmetrical ethical stance is being put to the test.  I cannot ask for a stand-in, for a substitute, as I come face-to-face with the otherness of the infinity of death.  Oh, I don’t think it is an imminent possibility, but the truth is that I have a disease that is likely to end my life; a daunting reality to say the least but the simple truth is that I must face this possibility alone while surrounded by friends and family.

Not only is there no stand-in for my death, there is no stand-in for me as I fight to remain alive, to battle this disease with every ounce of my resolve and strength.  While surrounded with support, I am the one that must live at this very moment; only by living in the moment will I find the resolve to play my part.  If I spend too much time regretting the past or projecting into the future I will be unable to live at this very moment; I will be unable to present myself by crying out “Here I Am” as a presentation without reservation to the work that I must do.

At this very moment, my work is to wait patiently.  I cannot push Monday to this moment so I will sit and wait.  My plans call for me to complete physical therapy today, pick up veggies at the Farmers Market on Saturday, help a friend design a website for his mayoral campaign in the afternoon, visit my 7 month old grandson on Sunday, cheer for the Bears on Sunday.  On Monday I’ll go to the hospital to have the bone and ct-scans and then I’ll go back into waiting mode.  It seems so simple.

For years I told my students a simple Zen story, one I feel compelled to repeat here:

There was a young monk seeking enlightenment but it wouldn’t come.  One day he went to his master asking, “Why can I not find enlightenment?”  His master replied, “Have you had your supper?”  The monk responded with a terse, “Yes.”  The master said, “Go and do your dishes.”  The monk was immediately enlightened.

If I keep doing that which is directly in front of me, that which needs doing, then I am taking responsibility for the very responsibility of the other, those other people I meet as I shout silently, “Here I Am!”

Holy Cow, What Do I Do Now?

Just four days ago I was told by my urologist that I had prostate cancer.  The results from my biopsy were in showing an aggressive adenocarcinoma in around 5% of three biopsy samples.  This was a diagnosis I was expecting but, nevertheless, I was stunned by the news.  I was taken back to my parents, both of whom were diagnosed with various cancers, my father lung cancer and later prostate cancer as well while my mother died from ovarian cancer after an eighteen month battle.  Even more ironic is that my diagnosis comes at precisely the age my mother was when she learned of her ovarian cancer.  I am a mere 69 years old as I write this.

I met with my urologist yesterday and in a brief meeting he outlined potential courses of treatment, each one dependent on whether or not the disease has metastasized into the bone or lymph nodes.  This determination is made after a bone scan and ct scan are completed and read by a radiologist.  The scans are scheduled for Monday meaning I will remain in suspense until at the very earliest Wednesday for the complete results to be revealed.

I think the worst of this at this very moment is the waiting; the limbo that comes with partial information and the inability to make any meaningful decisions about treatment or the future.  So I wait…

Of course, it is not only treatment that depends on the localization or metastasis of the tumor that is called into question.  So is the ten-year survival statistics which, depending on the scans range from 45% to 85%, from a coin toss that I’ll live an additional ten years to a pretty good bet that I’ll survive this whole ordeal.  What I must remember, however, is that since those numbers represent the mean or the average, that from 15% to 55% of those with prostate cancer will die before ten years.  It is a good thing I am in individual and not an average.  The average smooths out the data reducing the data set to a universal number.  That is good for a benchmark but is not applicable to the individual patient.  So I plan to treat this disease in the most aggressive manner possible; for that I take full responsibility.  What I have no control over is the effectiveness of any aggressive treatment so I am resigned to let the chips fall where they may.

One last thought for today.  Men, it seems, are 35% more likely to be diagnosed with prostate cancer during their lifetime than women are likely to be diagnosed with breast cancer yet breast cancer awareness is ubiquitous.  NFL players, coaches and referees trot around wearing hot pink to call attention to breast cancer awareness throughout October.  Isn’t it time that prostate cancer get the same kind of recognition?  I don’t wish to diminish breast cancer awareness, that would be foolish and counter-productive.  The fact is that this is not an either/or proposition, rather, it is a YES / AND proposal.  I believe that working with existing cancer groups, a national prostate cancer awareness month can and should be a priority helping men become aware of screening and treatment options.  Won’t you join me in this effort?

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