Surviving In This Very Moment…

My Personal Battle with Prostate Cancer … And Life!

Archive for the month “November, 2012”

Going Home…I Think?

Hospital

Hospitals are absolutely no place to get a good night’s sleep. Even with the door to my room closed, the noise in the hallway at 4:00 AM was deafening. It seems that the patient in the room next to mine had a crisis to which the entire hospital seemed to respond. I was awakened by the shrill scream of one of the nurses, “Help me, I need help. I can’t do this alone.” She repeated this cry with some minor variations for about three minutes. It was enough to wake the dead.

I am scheduled to go home this morning. I am now waiting for the urology docs to arrive to release me. Up until today, my urine was clear but this morning it was a bloody red color. This morning, however, the catheter bag is filled with a bright red colored urine. I don’t quite know what this means, other than the simple fact that I am bleeding and the blood is finding its way into my bladder. I hope this doesn’t mean that I cannot go home until they figure out what is going on. On the bright side, the pains caused by the infusion of CO2 is much better. After the vampire came to draw some blood, I took a walk around the hallway and had absolutely no pain. These are the facts, the raw data. Now it is up to the chief resident and my urologist to determine if the bleeding is significant or not. I will project no further.

Here I Am, waiting in proximate space for the urology team to arrive. I decided to do something productive with this waiting period so I write my first coherent blog post in two days. I think that I want to comment on the bureaucracy that is in the hospital and how crazy some of the rules are. I start with the dispensing of medications. Yesterday, the day nurse came into my room at 7:00 AM with one pill I take on a daily basis. The problem is that I have a regimen of seven pills I take every morning and four that I take in the evening. I asked her why she didn’t have my full morning regimen. She told me that she would be back at 8:00 and again at 9:00 to complete the entire cycle. I asked her why this is scheduled so as to provide extra work for her and anxiety (not really but I thought it was important to mention it) for me. She just shrugged her shoulders and smiled. I would like to meet the genius who decided on this practice.

I could provide more examples but I’d rather concentrate on the effect of the modern bureaucratic design and just how that bureaucracy effects the patient/staff relationships. Bureaucratic organization reduces each task in the hospital to a specialty to be performed only by people with the proper credentials. It is the job and not the person performing the job that is important. As an example, I have now had blood drawn early in the morning by three different phlebotomists and one nurse. Is there any chance that, as a patient, I can develop any kind of relationship with the person drawing my blood? Down the line, after the blood is drawn, it is sent to a lab where a lab tech runs the blood through a machine which, in turn, spits out a set of numbers. These numbers are then sent to the medical team who, I believe, are not acquainted with either the phlebotomist drawing the blood or the lab techs running the tests on that blood.

This one example goes to the core of the bureaucratic organization that is designed to create a distance between patient and hospital staff. This scientific detachment is, I believe, creates a space in which errors are bound to occur. Doctors write general orders even when patients have specific medical issues that my be contrary to these orders. Nurses, while working with these standard orders on a daily basis, cannot be fully aware of the special needs of individual patients because they are trained to be scientifically objective rather than be an empathetic care provider. The very organization of the hospital is designed to reduce the individual patient into the same so that the interchangeable providers of care don’t have to think a lot about individuals. Hospitals, in this sense, are clearly bastions of modernity designed for efficiency and economy.

This is, of course, the very reason I anticipate going home, where my recovery from surgery will be provided on a human level.

FLASH: The urology team just left my room. I am going home. I expect to leave the hospital around 9:30 AM and be home around 11:00. YEA!

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From the Hospital

Calm Waters Photo credit: Roger Passman

Calm Waters

Surgery was performed yesterday, early in the morning. By the time I was introduced to my room, it was right around 6:00 PM. It seems I couldn’t be released from recovery until they had a room cleaned for me to occupy. This added about a 3 hour extension in recovery, a wait I didn’t mind for two reasons. First, I don’t recall to much of my stay in recovery because I slept most of the time. More importantly, my urologist found me in a moment of lucidity in recovery and told me that surgery went well and that it appears that he got everything. That news caused my blood pressure to drop into a normal range. It is amazing how stress effects one’s life.

While the news is quite good, I am not yet out of the woods. For the next two years I will be asked to submit to CAT scans four times a year, the next two years I will be asked to submit to CAT scans twice a year and thereafter one per year. Somewhere in the back of my mind, prostate cancer will always be with me.

I will be spending a second night in the hospital mainly because I am experiencing extraordinary pains deep in my shoulders from the carbon dioxide gas they push into the abdomen to allow the robot to see what is going on. It only effects me when I am walking in the corridor and it takes quite some time to go away. But even this pain cannot take away from the news that I am currently cancer free.

I need some time to process all this, deal with the post-operative side-effects and add the outcome to my gratitude list. I couldn’t have asked for a better result.

The Day of Surgery Finally Arrives

As with all things, the passage of time brings new experiences. After waiting for about one month since I was diagnosed with prostate cancer the day of surgery finally arrives. I am making final preparations getting ready to leave for the hospital, about an hours drive from my house. Yesterday afternoon I was instructed to arrive at the hospital at 6:00 AM for a 7:30 AM procedure. In all the operation should take about 2 hours so I should arrive in my hospital room no later than Noon Chicago time.

I have just a few things to do before I go but I thought that one more post is in order. I am bringing my laptop to the hospital and expect to post from there (assuming that wi-fi is available). For now, I am wrapping up that which must be done and off I go.

I am actually a lot more nervous than I have ever been before any other procedure. I don’t quite know what is causing this stress because I don’t expect to wake up with much pain, certainly not the pain of joint replacement surgery. Perhaps, because I am entering the hospital feeling quite good. At this stage, cancer is not painful, it is not making me sick, it is just there. Unlike when my hips or knee was replaced I am in no pain at all. In addition, perhaps this anxiety is caused by the overall gravity of this procedure. After all, left untreated, the cancer will be the proximate cause of my death. Treating it leaves no guarantee thus making the import of this surgery greater than any other I have ever experienced.

For now, I plan on sitting quietly, meditating whenever I can up to and until the point where the anesthesiologist does his magic and knocks me out. I will continue to do that which must be done in between.

The Day Before Surgery…Embracing Chaos

Chaos

Chaos (Art Credit: Roger Passman)

This morning I woke up with a sense of dread. This afternoon I am obligated to force some 32 pills down my throat over a period of about one hour in order to begin the process of cleansing my colon. Then later in the evening I have to do it all over again albeit with about half the number of pills. As I write this, I can only speculate about how I will be effected, how long I will be doubled over with pain as my colon empties not once but twice. Of course, I waited until the very last minute to read the pharmacy blurb that comes with prescriptions as I recounted in an earlier post. I am happy to report that the matter has been settled and that a replacement was found and that is that. It still took an additional phone call to the urologists office to get things settled. I really dislike dealing with bureaucracies of any sort.

Of course, I must still anticipate a phone call from the hospital telling me when to arrive tomorrow. I am hoping for an early morning appointment with the DaVinci robot but there is simply no guarantee as to when I will be scheduled.

I am finding it very difficult to stay focused. I want to read a bit today but I can’t get through more than one or two pages when my mind begins to wander off into somewhere where I choose not to be. The simple truth is that I am completely stressed out just waiting around.

Now I can be quite manic about this condition by acknowledging the situation as being rather abnormal and let it consume me. Or, on the other hand, I can choose to simply stoically accept that once in a while chaos creeps into one’s head and it simply won’t go away so embrace it and let it be. The simple truth is that, while I have had surgeries in the past, each one presents a set of unknowns that cannot be accounted for. I think the worst of those conditions is the interminable waiting within a space that is anything but proximate. There is a scientific distancing separating the patient from those servicing the patient in order for the staff and surgeons to maintain a professional distance yet it is precisely that distance that makes the waiting feel unnatural.

Waiting in proximate space is not at all stressful. Waiting for the other to respond to that announcement of “Here I Am!” is quite different than waiting for a call to be somewhere of bureaucratic choosing. The former is a space created by the self in anticipation of being of service while the latter is a space created by separation leading to the anticipation of simply waiting as if in free fall. Proximity is created by the former while distance is created by the latter.

So here is what I decided to do. I am going to take a nap, sleep until it is time to stuff those poop pills down my throat with gallons of water and then, tonight when I finish round two, go back to sleep until it is time to get up to go to the hospital. It is a simple solution with very few drawbacks. At least I won’t have to think about the distance.

Panic…or Don’t Medical Records Count for Something?

Don't Medical Records Count for Something?

Don’t Medical Records Count for Something?

So my urologist prescribed OsmoPrep, a total of 32 pills to act as a bowel cleanser prior to surgery. I filled the prescription at a cost of $56. I left it in the bag until this morning. When I took it out of the bag and began reading the long sheet that the pharmacy supplied discussing the drug, its actions and contradictions my eyes nearly bulged out of my head. Right there in plain text it said that the drug is not recommended for anyone that has had a gastric bypass where stapling of the intestines was used. Oops, I have had such surgery (I lost about 100 pounds in the process).

What is the use of providing medical records if physicians don’t pay any attention to them. Prior to this surgery I specifically mentioned the gastric bypass to my urologist as we were discussing the placement of the five puncture holes used in this surgical procedure. I also provided him with an updated medical history, the same history was provided at my pre-op testing and clearance that was performed at the hospital’s pre-op testing clinic and the gastric bypass was done at the same hospital and through the same physician’s group as this cancer surgery so it appears in my medical records at the hospital as well as in the records of the group. You’d think that the physicians would pay a bit more attention to the medical records they ask for rather than write standard orders…Just saying.

Were I to take this prep, the potential for my food intake pouch (what is left of one’s stomach after bariatric surgery) is that the pouch could simply explode requiring extensive repair were I to survive the explosion. I am certainly not willing to take that risk when there are alternatives that do not carry the same potentially lethal side effects.

Right now, I am waiting for a return call from the urologists office. There are substitutes preparations that will cleanse the bowels and all I need is a prescription called into my pharmacy to make this work. If we cannot get this taken care of this morning I suspect we might have to cancel the procedure and find the next open spot. Talk about things outside of one’s direct control…

On Suffering

All that is past and that is future draws near to the present. Time shrinks, the line between the eternities disappears, only the moment lives and the moment is eternity.
Martin Buber,  Hasidim and Modern Man

Mask by Carl Milles (Photo credit: Wikipedia)

Suffering Mask by Carl Milles (Photo credit: Wikipedia)

Existentialists find life itself absurd, that suffering, that feeling of dread and woe, is the hook upon which absurdity hangs. Through suffering one comes to the very profound conclusion that even in an absurd life one must still live a life of responsibility; to behave in an ethical and moral manner toward one’s fellow man. Briefly, assuming responsibility for one’s actions toward the other.

I would like to take a different approach to the very notion of suffering, one that centers around choice and action. Let me start with the very idea that suffering is nothing more that an overload of external (or internal) datum experienced as a turning inward to the exclusion of the rest of the world. An escape from the real into the depths of despair  In this sense, when faced with such an overload of phenomenological sensations one is, in reality, faced with a choice; turn inward, thereby derailing one’s ethical compass or embracing the sensations yet projecting those sensations outwardly as an empathy for the suffering of the other. Self pity or empathy are the choices when facing potential suffering in one’s life. Nothing lies in between.

Suffering is born of projection into the future emboldened by fear that is coupled with a profound regret of the past. When one complains of pain, real or imagined, or hurt, or loss, or any other thing one is truly embracing the experience of self-pity and seeking attention from others. “Oh woe is me,” is really a cry for sympathy, a cry for understanding of those fears and for the guilt of the past, whether deserved or not.

So, with this in mind, I could ask about my cancer, “Why me?” But I am savvy enough to understand that whenever one asks a “why” question the only reasonable response is. “Because!” As I understand the universe we live in , the only place we have direct knowledge of, pretty much everything is based on probabilities. Once born, for example, the only outcome of life is not life or death. When not life occurs, however, is a matter of probabilities (if this were not the case all life insurance companies would necessarily go broke because of the inability to create reasonable actuarial tables). I like, then, to think of the universe as a random number generator complying with the mathematical laws of probability. The simple fact is, that I got cancer because the probability meter pointed toward me. It is as simple as that. I cannot dwell in the past trying to think about why or what I could or should have done differently to prevent this disease. If I did, I would be suffering needlessly; needless suffering is self-defeating because it only turns one more deeply inward leaving little room for escape. I also cannot project into the future a myriad of possibilities that hinge on fear and lack of knowledge for that is also self-defeating. I must, therefore, choose to live in this very moment.

Learning to live in this very moment is a difficult journey. For me two things are required. First, I make time for sitting quietly every day to clear my mind of wandering thoughts and just sit comfortably listening to the silence of the universe. Sometimes I chant a repetitive OM sound over and over until my brain hears nothing but my own breathing, while other times, just sitting quietly will do. Secondly, learning to let go of those things I cannot control, to not think about those things where I have no dog in the fight, where I have no interest whatsoever in reasons for or outcomes of, to accept the absolute worst outcome of those things that absolutely effect me, of things for which I have some level of control and then work for a better outcome; one might call that acceptance; I prefer to think of it as living in this very moment.

I cannot control the absolute fact that I have prostate cancer nor can I control whether or not it is metastatic at this very moment. I can, however, control what I will do about it when presented with choices for treatment. As readers know, I have opted for surgical removal of the prostate two days from now. Surgery and, then, pathologists will then determine what the next options will be. I have no reason to project beyond the surgical procedure and all I can do about that is anticipate the operation itself. The closer I stay to living in this very moment, the less I think about the procedure.

At the same time, I have accepted the worst possible outcome of the consequences of this disease; death. By acceptance I mean to eschew denial, recognizing that this is only a possibility among an finite number of possibilities but I refuse to deny that it is a very real possibility. In terms of probability I currently have a 15% possibility of dying in the next ten years from this disease (a bit more than a 5 to 1 chance of death). Should the biopsy of my lymph nodes prove positive the probability will increase to around 2 to 1, a near coin flip.

Yet, what do I have to complain about? Absolutely nothing! I am grateful for all those little things that make life worth living to its fullest up to and including this disease. Why, in other words, should I spend my time in unproductive suffering? I think the answer to those questions is that I should not. Rather than suffer, I choose to continue to live, to live for rather than to live with this disease, to live for rather than live with others. In short, I choose to be present in the world at the very moment of eternity contained within the immeasurably brief time represented by this very moment rather than to sink into the unproductive world of suffering. It just isn’t worth it!

Learning to “Think in Jewish”

Infant

Infant (Photo Credit: Roger Passman)

Later this morning my wife and I are going to an open house at the Chabad of Elgin and Hoffman Estates. The rabbi and his wife are celebrating the birth of their new daughter with the community they are building. I am looking forward to this event.

So what is an atheist Jew doing spending time with a Hasidic rabbi and his family? Funny you should ask. In this post I’ll try to explain, if not for you, for myself. Two reasons jump out to me. The first is that Rabbi Mendel is a meaningful example of living the fundamental ethical obligation, living a life of service without reservation. Secondly, and this is quite a selfish reason, I will be studying Jewish texts with Rabbi Mendel in order to better learn how to “think in Jewish.” Let me elaborate.

The Fundamental Ethical Obligation

About six months ago, Rabbi Mendel and his wife and infant son packed up and left Ohio for Elgin, Illinois. He was commanded to leave his father’s home, much like Abraham was commanded to leave his father’s home, and go to a land where he would build a Jewish community. With only a few dollars to his name and a donation of a house and some land upon which to build, he and his family set out on this great adventure. Arriving in Elgin, Rabbi Mendel announced to anyone who would listen, Here I Am! without knowing anyone there, establishing a proximate space and he waited. His announcement is made (it is an announcement made in this very moment without interruption) without reservation and without expectation of reciprocation, yet people hear it and they come.

I met Rabbi Mendel about a month ago. I explained to him that I do not believe in god, that I was raised Jewish but I rejected the religious aspect of my life. While I still acknowledge my Jewishness, I do not chose to perform the tasks required of the religion. I explained that my interest was to learn to “Think in Jewish.” I already know how to “think in Greek” the logical discourse that the West took from Athens and made its own but because of the influence of Emmanuel Levinas and his ability to synthesize thinking in Jewish and thinking in Greek, I wanted to develop a competence in “Thinking in Jewish.”

I responded, reciprocated if you will, to Rabbi Mendel’s open invitation and, in spite of the fact that I did not absolutely fit his Hasidic mold, I was embraced. That’s right, my difference was and is embraced by this man from Ohio who left his father’s house and set out, like Abraham, to find his own way. The fundamental ethical obligation to be responsible for the welfare of the other sets up the obligation to embrace the other as one finds him or her; to embrace difference without reservation. Certainly, this obligation is part of the lived-experience of Rabbi Mendel. It provides me with a living model of the ethical experience, one that reaches well beyond the theoretical.

Thinking in Jewish

In graduate school I was trained to think in a logical, deliberate manner, to think in the language of philosophers, to think in Greek. During my academic career that thinking served me well. I published academic papers, wrote a book that was published, presented academic papers internationally and influenced the lives of many of my undergraduate and graduate students as well as the lives of many of my middle school students before I entered post-secondary education.

Then I discovered Levinas’s work which led me to deconstruction and a different way of thinking. Somewhere along the line I decided that if I were to become competent as a complete thinker, I needed to learn to “Think in Jewish” as well as Greek. I tried reading Jewish texts without a teacher and found that, while there is a logic to the approach, that logic is not completely clear to me. Like deconstruction, a method that concentrates on language use, the sages of the Talmud uncover meaning through concentrating on language, sometimes on single words and sometimes on single letters within words. How words are pronounced also creeps into the logic of the Talmud (Hebrew and Aramaic being vowel-less written languages making pronounceation a matter of interpretation).

Without a competent teacher, one may uncover the methodology for reading these texts but it is a difficult chore. For quite selfish reasons, therefore, I sought out a competent Talmudic scholar to help me understand how to “Think in Jewish.” When I told Rabbi Mendel of my reason for wanting to “Think in Jewish” he stood ready to help me in my studies.

So there you have it. A true model for the ethical life I know in theory and someone, because of his commitment to what I call the fundamental ethical obligation (thanks to Hillary Putnam), is willing to help me learn how to “Think in Jewish.” What more could one ask for except to be able to celebrate a new life on this beautiful Sunday morning.

What Have I Got To Lose?

Meditation Spot

Meditation Spot (Photo Credit: Roger Passman)

As the day of surgery comes ever closer I find myself reflecting on a few ideas that make this whole experience with cancer remarkably peaceful. Sure there is some stress; it would hardly be normal to approach a major operation with some potentially life changing side effects without some anxiety but that is not the peace I am referring to. I suppose the best way to describe this experience is a strangely interesting connection to the alterity of the absolutely infinite other awaiting me.

In part, this experience is guided by the unquestioned fact that there can be no substitute for me in this experience. The surgery, facing cancer, an eerie exposure to the infinite is mine and mine alone. While I have others who love and care for me, my experience is singular and unconditional. This very moment, as I write this, the absolute interiority of this journey of mine is unconditionally. I am presented with a continuum of choices ranging from denial to acceptance. To steal a line from “Flight,” the new Denzel Washington film, with a slight adaptation, “I have used up my allotment of denial.” Acceptance, on the other hand, means thinking in terms of the worst possible outcome, accepting that outcome, and working to achieve a better one. The worst possible outcome, in this particular case, is, quite simply, death. I must accept that possibility but I also must work to achieve a better outcome.

I am also learning that if I approach this very moment as if it is a new opportunity for a re-beginning, that this very moment allows me to open a door to a completely new beginning, I am, in fact, acting in concert with the exteriority of the absolute other. On this measure, I find myself seeking a mirror of that absolute other in the face of the other, in my basic human relationships. I measure that connection by my actions and how those actions are embracing of the exteriority of the other; by how I respond to difference. Do I make myself available through my desire to create proximate space or do I shirk from that ethical obligation because I am wrapped up in myself.

Finally, I can measure just how my own experience brings out all of those things for which I am grateful. Waking up, brushing my teeth, eating meals, playing with my dogs, talking with my wife, having breakfast with my family these are the things I am grateful for. I find the little things to be more important than politics, religion or anything else that is outside of my control. Not that I can control the little things however I do have some choices with those things for which I make a decision or two. All of those little things add up to a lived-experience that is uniquely my own, that, while parts are shared with others, much is more private than public. I believe that making some of that private experience public is at the core of understanding the mirror of the infinite that is contained in the face of the other. I’ll have to come back to this later because I am not sure how to work it out quite yet. I think of this as a note to myself to return when I can.

In the final analysis, what I have to lose is the existential lived-experience. On the other hand, I have the absolute potential to gain entrance to the absolute infinity that only I can enter. I don’t know if that is a fair trade but I do know that it is inevitable. I do what I can to postpone the inevitable.

Research Accomplishments – Prostate Cancer Foundation (PCF)

I don’t know about you but I found this interesting.  Clearly some things to speak to my urologist about in the coming weeks. Why not take a look for yourself and see if you find anything interesting there.

Research Accomplishments – Prostate Cancer Foundation (PCF).

Recovering from the Crowd just to Celebrate

Thanksgiving Dinner (Photo credit: The Vault DFW)

My house was quite warm last night as 23 (I forgot to count someone) people were stuffed into our house for a grand Thanksgiving dinner. I opened some windows for a bit of fresh air. My nephew’s step-daughter played the fiddle and my grand-niece sang a song or two. They are like 7 and 8 years old and are like sisters. Both love an audience and we were happy to provide one for them. Food and company were great and all had a grand old time. My goodness, I am so glad that is over.

Today is a very special day. 26 years ago today Susan and I got married. I was then, and I am now, completely under the spell of this woman. My father often said that Susan was the best thing that ever happened to me but he was wrong,,,Best is hardly enough to accommodate the effect of this relationship on me. Language is sometimes far too limiting to make sense of the world we live in so I’ll just bask in the sunshine that Susan brings to my life.

This is also day three of my final preparation for surgery. Clearly, the switch from my normal NSAID to acetaminophen is taking a toll on me. My newly replaced knee is tightening up and appears to be a bit more swollen than usual. My back aches and I find myself stooping a bit, shoulders sloped inward and head leaning down. The only upside of this preparation is that I won’t bleed to death during surgery. Well, that’s not quite true. There is another amazing benefit; the gift of humility that may arrive under stress.

Humility begins when one concludes that they are not the center of the universe, that they are not THAT important, that everyone and everything doesn’t revolve around them. It is a practice that recognizes the exteriority of others and embraces the differences that others bring to the table. Humility requires one to place the other person’s needs before one’s own needs. It is interesting that adversity, such as pain or stress, often is the trigger for either a self-centered rant against the universe or is the boundary between ego and humility, the setting aside of ego in lieu of the other. Humility is a gift presented unexpectedly requiring no reciprocation and it comes with absolutely no fine print or strings attached. Humility is the place of responsibility for the other. In a very practical sense, it takes one’s mind off of the stress and pain, thereby minimizing the need to complain. Humility arrives when one makes the decision to let go of the self, to become available and act on the decision. It is a true gift because it cannot be reciprocated or returned. It may be put on the shelf for a while but once attained it is always within one’s grasp.

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