PET Scans to Image Prostate Cancer Advance Toward Mainstream Clinical Use – Prostate Cancer Foundation PCF
An interesting development in diagnosing prostate cancer. Click to read the article from the Prostate Cancer Foundation
An interesting development in diagnosing prostate cancer. Click to read the article from the Prostate Cancer Foundation
It is always important to reflect on the events of the past year, the traces of memory that make a life remembered. This past year has been a doozy with ups and downs that shake one to the core. Some of these events were anticipated while others were not. Some caused great pain while others inspired great joy. To say the least the peaks and valleys of 2012 felt a bit like being on a never ending roller coaster. I want to share the highlights.
I want to expand one by one.
In March I called my sister to inform her that while she was always a great aunt, she was once again a Great Aunt. Eddie was born on March 22 in Madison, Wisconsin sometime before dawn. Mark, my son-in-law couldn’t wait till the sun came up to call and tell us that we were once again grandparents. Both Susan and I jumped from bed to the showers, dressed, grabbed a bite to eat and brewed some coffee to take along for the 1.5 hour drive to Madison.
Anticipation is an emotion I somehow learned to suppress simply because it makes for doing stupid things. I set the cruise control at precisely 5 mph over the posted speed limit and drove from our house to Madison, following Veronica’s (my gps) instructions to the hospital. We were the first of the grandparents to arrive.
There he was in all of his 4 to 5 hour glory all swaddled with a wool cap covering his head, eyes shut even while awake and cooing. He was smaller than I remembered babies to be but they say that memory is the first thing to go. His fingers and toes were intact, he squirmed and fidgeted, cried a little but mostly he slept. As the other two, yes two, sets of grandparents arrived (my ex and her husband and Mark’s parents) the hospital room got smaller and smaller. After about three hours with Becki (she sometimes goes by Leah but that is a very long story) Mark, Eddie and the rest of the family we decided to leave with a few pictures and a whole lot of joy. Pointing the car back to Gilberts, IL we made the return trip and were home for supper.
Watching Eddie grow and develop for the past nine months has been the joy of all joys. He responds, is getting his top two teeth (he already has his bottom two) and is generally in good health. Who could ask for more?
In December 2011, my firstborn decided to pick up stakes and move from Phoenix to Austin, TX. He is in the throes of a midlife crisis that is quite interesting to watch. The move to Austin was motivated by the fact that his girlfriend wanted to go there, his son Drew (my first grandson and a joy to watch grow into a young man; he is now 14 years old) moved to Albuquerque because his mother landed a terriffic new job and he felt that since he really had no ties to Phoenix, why not.
In late April or Early May his girlfriend moved out leaving him stranded in Austin without any close connections or ties to the city. Within a few weeks the girlfriend decided she wanted back in but by this time Ben decided that he would be best served if he moved back to Chicago, his home town. After some discussion, he and his girlfriend got back together and she agreed to accompany him to Chicago. This is the stuff of soap opera scripting, yes, and it only gets better.
Ben called and asked if they could stay with us. We have a spare room and so it was decided that this would be okay. Now the girlfriend had two kids and Ben had Drew for the summer so, literally five new human beings moved into our house just days prior to my knee replacement. Ouch. It was a madhouse for nearly two months when things calmed down a bit as the two girlfriend kids were shipped back to Phoenix. Then it was Ben, the girlfriend and Drew for a few more weeks. Drew went back to Albuquerque and the house settled down to Ben, his girlfriend, Susan and me. Phew!
In October Ben and his girlfriend moved into a small apartment in the city; Susan and I were finally back to some semblance of normal.
Then the hammer blow, the girlfriend decided she missed her kids too much to stay in Chicago with Ben and she up and moved back to Phoenix leaving much of her stuff in storage in my basement. Ben spent some time agonizing about his move to Austin and then to Chicago, over his relationship with the girlfriend which he finally decided was going nowhere, and the fact that his ex’s contract in Albuquerque was ending and she was moving back to Phoenix to her old job plus a plumb promotion so Drew would be back in Phoenix. Finally, he decided to move back to Phoenix (a place I think he never should have left in the first place) so he could be close to his son.
During all this time we had a chance to talk, share ideas, ask for and provide advice and generally have a powerfully good time. I will miss his leaving at the end of January but I am also quite pleased that he may have stopped his nomadic ways. I can’t wait to see what develops in the coming year.
Then there were the low points. In late April or early May I slipped and suddenly was unable to place any weight on my left knee. Susan was meeting me for lunch that very day; rather than lunch we went to the emergency room where they put me in a brace and told me to make an appointment with an orthopedic surgeon.
I met the orthopedist a couple of days later and he told me I had three choices: First, I could do nothing and suffer, second, I could try injecting the knee with a substitute cartilage that, if it works, will provide relief for six to nine months and could be repeated until it no longer worked, or third, I could opt for a total knee replacement.” I opted for the second choice. Unfortunately it didn’t work.
I believe suffering is reserved for martyrs or saviors so I opted to undergo a total knee replacement. Being no stranger to orthopedic surgery (I have had two total hip replacements and a laminectomy) I thought that I was aware of the recovery period and what I could expect during recovery. The doc told me that knees are more difficult than hips or back surgery so in my mind I compensated for that as I prepared for surgery.
Oh man was I disappointed. Waking from surgery I was in the worst pain I could have ever imagined. Thoughts ran through my head that were as mild as “Why did I ever agree to this?” to “I want to die right now!” In the past I never needed heavy duty pain relief. I recognized the pain as bone trauma and that it would get better over the course of six to eight weeks. But with this knee surgery I was pushing the button on the morphine (or whatever drug was in there) machine as often as I could. The pain was unbearable most of the time.
The morning of the second day, the physical therapist walked into the room and said, “Time for your morning walk, ready?” I was in a fog, but I knew that if I did what I was told that I would get better faster. So with much help I got out of bed to begin my first walk post surgery. Offered a walker or crutches I chose the crutches but I couldn’t find balance that first time so a walker it was. I made it about twenty steps out of my room before I needed to stop. Finally, turning around I slowly walked back to the room where I was ready for bed. No such luck. It was time to learn how to sit in a chair, go to the bathroom and get back into bed with some help.
The afternoon walk was actually a bit easier and I pushed myself to walk to the nurses station. This time the crutches worked, I found balance and they made the walking easier. The next day I was walking up and down stairs, learning how to get in and out of a car and walking longer distances with the aid of crutches. But the constant pain was still there. We tried many drug combinations to help relieve the pain and finally decided that, in spite of my history, Norco in combination with Tramadol would be a reasonable choice. I went home with that cocktail the morning of the third day post-surgery.
I started out patient physical therapy two weeks post surgery (for the first two weeks a home-bound physical therapist visited me 3 times a week); for the next three months I dutifully went to PT and while I could see results in flexibility the pain would simply not go away. I couldn’t sleep well because the pain was agonizing. Drugs helped but couldn’t provide enough relief to make me happy I did this surgery.
One morning in mid-September, I woke up and noticed that my knee, while stiff and a bit swollen, didn’t hurt. It was as if some switch was turned off. I stopped taking the Norco which led to withdrawal symptoms for ten days but that was a small price to pay.
I continued with PT until mid-October and today, six months post surgery, all seems okay with the knee. While I think I have some fluid on my knee, it doesn’t bother me too much, other than making standing for long periods of time difficult. I see my orthopedic surgeon on January 4th so I’ll know more then.
Then there was the kick in the head. In September I saw my internist for what amounted to an annual physical. He was quite concerned that I had a PSA of 23. Wow, so was I. He told me to see my urologist as soon as possible to track down the cause of this spike in PSA. Getting in to see the urologist has always been a difficult thing. Waiting two to three months was not unusual. When I called for an appointment I mentioned that my PSA spiked to 23 and the appointment person said, “Oh, then I can squeeze you in next week, would that be soon enough?” I responded in the affirmative and the appointment was made.
During the week prior to the appointment, I began to puzzle with my own mortality. What would be my contribution to this world? I didn’t much worry about what the transition to death might be like other than it is a deeply personal transition that only I could make, there are no substitutions possible.
When I saw my urologist he drew blood for another PSA (the result was 26) but when he did a prostate exam he felt nothing out of the ordinary. Several years ago I had a spike in PSA which required three needle biopsy procedures of my prostate, all of which were negative. BPH was the diagnosis which led to a procedure called a Trans Urethral Resection of the Prostate (TURP) and the biopsy of the tissue removed was negative for cancer. I vowed that I would never do another needle biopsy again, however, now I had to rescind that vow because of the unusual set of circumstances.
The biopsy was scheduled for the following week (in the past I had to wait two to three months to be inserted into the schedule). When the results came back he called me to tell me, “You have cancer of the prostate.” We set up an appointment for the following week to meet and discuss options. This diagnosis was like being kicked in the head by a mule.
We met and the facts were laid out in front of me. I had a cancer of the prostate with a Gleason score of 8 (4+4) with a PSA of 23 (my internist did a second PSA which came back with a score of 21) so the average of 23 appeared to be the best working number. This meant that I had a very aggressive cancer and that metastasis had to be ruled out or identified. This meant a bone scan and a CAT scan. Both of these turned out negative, but the CAT scan was inconclusive due to interference from my hip replacements and back surgery so the lymph nodes in the groin could not be clearly ruled out.
Surgery appeared to be the best course of treatment. A biopsy of the lymph nodes along with the prostate post surgery would find the lymph nodes clean and the prostate 35% involved with the tumor almost at the margins of the prostate but it does seem that the disease was entirely contained within the prostate.
So what does all this mean. For now, I am a prostate cancer survivor but even this is tentative. Some cells may have escaped prior to surgery or even during surgery and are just waiting to settle in to wreak havoc. For the next year I will have my PSA checked every three months and once a year thereafter for the remainder of my life. It is as if I have cancer rather than I am a cancer survivor and that cancer is just waiting around like a monkey on my back.
So there you have it. Some highs, a bit of drama, pain and suffering, and finally hope. What a year this has been!
The impossibility of approaching the other (autrui) without speaking to him signifies that here thought is inseparable from expression . . . consist[ing] in the intuition of sociality by a relation that is consequently irreducible to comprehension.
Emmanuel Levinas, Basic Philosophical Writings, p.7
As the new year approaches, less than two weeks away, I think it is important to reflect on the past year, the ups and downs, the natural fluctuation of the randomness of time, in order to digest the traces left behind that continue to affect me. As I age I find that life presents new, often unique, challenges that simply come with getting older. I also find that concurrent with those challenges is a desire to connect with friends and family through increased social contact. Additionally, while I have always been struck by nature, I find myself increasingly being in awe of the beauty and violence of the natural world. Both of these connections require one to approach the other (in the case of social contacts) and the Other (in the case of natural phenomenon) with a speaking, a conversation or perhaps as Levinas equates this use of language, with a (non-theistic) prayer (more like a polite but insistent asking or imploring) said without reservation or expectation.
Two major medical issues seemingly exploded, disrupting my life since May. The first of these required a total replacement of my left knee, a procedure from which I am still recovering. I am no stranger to orthopedic surgery having had two hips replaced and a L3-S1 laminectomy fusing my lower spine with titanium rods and screws but I had no idea how difficult it would be to recover from knee replacement surgery. After three and a half months of physical therapy I regained nearly full extension of the knee but I remain plagued with a stiffness that seems to haunt me during the day.
As if that were not enough, I was diagnosed in September with prostate cancer. Considering that the biopsy of the prostate found an aggressive strain (Gleason score of 4+4) and a spike in my PSA to 23 (a range from 21 to 26 over three samples) there was every reason to believe that the cancer was metastatic. This proved not to be the case on bone and CAT scans but the CAT scan was inconclusive because of the amount of metal surrounding my groin. In consultation with my urologist and internist and long talks with my wife, we decided to undergo a robotic radical prostatectomy, a procedure performed on November 28th, nearly one month ago. Once again I dodged a metastatic bullet when the biopsy of the prostate found the tumor completely contained within the organ and the lymph nodes free of disease. At this very moment I can look forward to many more disease free years.
As a result of the prostatectomy, I am left with two side-effects. I am currently required to wear diapers due to incontinence and I am unable to become aroused. I don’t know if these are permanent or temporary and I am not certain I want to undergo additional surgery to correct them. I meet with my urologist on the 27th of December and expect to have a frank discussion with him to see what he thinks. While he will be handing me off to a new urologist, one of his partners, as he moves to a new position out of town, I believe he will be more than straight forward with me about these two side effects.
So the point of retelling these two medical tales is simply this, for me, most of 2012 was consumed with medical issues. It was also met with family tragedy as my youngest cousin, Steven, passed away from multiple myeloma, a particularly virulent cancer that simply consumed his body but never his spirit. About a month before he died I was in Los Angeles to celebrate a 60th wedding anniversary of my wife’s closest friend’s parents. While there I had breakfast with Steven, my sister and several other cousins. Steven, I believe, knew the end was near but he never let on. We talked, laughed, shared stories of our younger days and, without knowing it, said our good-byes. A month later I was back in LA to attend his funeral.
When I let my family know that I was diagnosed with prostate cancer the outpouring of love and support was absolutely overwhelming. What I learned from my cousin Steven was to never ever give up on life, to live life on life’s terms, to experience every moment of existence as unique and filled with the joy of breath; there will be time enough for whatever the antithesis of celebration might be in the grave so there is no need to feel sorry for oneself for a life well lived.
None of my lived-experience of the past year comes close to my being able to comprehend the consequences of these events. There being no intentionality causing the events to occur (I see the universe we share as a gigantic random number generator where probability trumps intentionality) I find that I take great solace in the long and sometimes quite brief conversations I have had with those closest to me. I am learning to extend myself to others in powerful ways and even find myself making new friends along the way. I am buoyed by a fresh look at the natural world in which I exist and the awe inspiring power ranging from the smallest micro-organism to the power of a tiny river’s capacity to carve a Grand Canyon, to the ravages of a blizzard in winter. Taken together, these events, these conversations, my ability to see the absolute beauty in nature and to be awed by the universe itself make this life a life worth living.
“In every sorrow there is profit” (Proverbs 14:23).
How can a sorrow turn a profit? Let me relate this to my own sorrow, my battle with prostate cancer. The words, “You have cancer,” even when these words are somehow expected given the circumstances, are stunning. In my particular case, these words placed me in immediate confrontation with my own mortality. I certainly understood that life itself is a terminal condition; that one cannot expect immortality or at least a corporal immortality. I knew that I was going to die someday but suddenly the prospect seemed utterly possible.
The cancer was discovered through needle biopsy prompted by the fact that my PSA had a range of 21 to 26. The cancer biopsy found about 5% of three samples had a Gleason Score of 4+4, making the cancer itself quite aggressive. In consultation with my urologist, internist and my wife, I decided to follow the recommendation of the urologist opting for a robotic radical prostatectomy, a procedure that would provide me with the best chance for a “cure.” Since my bone scan was negative for metastasis and my CAT scan was mostly negative for metastasis (because I have a great deal of titanium shielding my pelvic area (two replaced hips and a laminectomy l-3 to s-1) the pelvic area being a question mark, the diagnosis of non-metastatic cancer was on hold until the biopsy of the lymph nodes surrounding the prostate. All that was hard to swallow especially when I had to wait a month for the prostate surgery to take place because the gland was swollen due to the needle biopsy procedure.
The instant one learns that one has a potentially fatal disease, prostate cancer is the second leading cause of death in men, the prospect of eternity becomes real. But what exactly does eternity mean? For me, the prospect of eternity means a reversal of the transition of exiting one infinity, a condition that is emergent at the very moment of birth to the transition of returning to that very infinity at the very moment of death.
This transition is one in which one moves from existential time, the lived-experience, to archival (remembered) time, the traces left behind for friends and family and possibly for others outside a direct connection to the self. The first time I heard the words spoken aloud, “You have cancer,” it was like a kick in the head. The last time I experienced such a sensation was when I heard the not unexpected words, “Your father is dead.” Everything stops, stands still, refuses reality. It is the first stage of any sorrow, that of denial. I found a quiet place to sit, to embrace the stillness, the silence that surrounded me. I wanted to be completely alone, to sink into myself allowing me to feel sorry for the loss or potential loss that is approaching. In very real terms, I found myself embraced by and embracing a deep sorrow. In poker terms, however, I had a few outs. Not all the cards were played and not all the possibilities were known.
I soon discovered the profit promised in the proverb that inspired this post. The strength I had working for me was the fact that I had some outs; that there was the possibility that the surgery would be curative so rather than facing immediate mortality, I would be safe, at least from this disease, for some time to come. This gave me the strength to rethink the ethics proposed by Emmanuel Levinas summarized by what Hillary Putnam called the fundamental ethical obligation: I am responsible for the welfare of the other without reservation or expectation of reciprocity! This fundamental obligation provides one with the ability to live in this very moment, the moment of existence, without projection and without memory in the sense that what is done is done and, without reservation, one cannot dwell on regret as a predominant emotion to the traces of the past.
The sorrow imposed by prostate cancer provided the opportunity to profit from the knowledge that Here I Am! responsible for the welfare of the other, the fundamental ethical obligation, as a call to live ethically in this very moment. Living in this very moment is both exciting and freeing. I can’t imagine living anywhere else.
Sometimes I wonder just how many significant opportunities to escape the mundane, day to day activities of life are offered up in a single lifetime. A group I belong to, one that relies on platitudes to make a point, drills into its membership that one must live life on life’s terms. For the most part, that means accepting the humdrum of a random life, one that offers up both challenges and boredom, and mostly boredom. So perhaps the question of escaping the day to day absurdity of the lived experience is not the goal, rather the challenge is to learn to live with the chores of existence while being open to the challenges that sometimes come along.
Challenges appear without notice. There is no announcement that a challenge will present itself on Wednesday at 7:47 AM so be ready. No, challenges strike randomly from apparently nowhere in particular. They are random occurrences that follow the mathematical laws of probability. Most challenges sort of creep up on you. Once noticed, they don’t seem to have a point of origin. They are suddenly just there, presenting themselves in a way that causes one to remark, “Where did that come from?” Others present themselves suddenly, without any real warning even when a point of origin can be readily identified. The evening after my bone scan and CAT scan, sitting at the dinner table, when my urologist called and said, “You have prostate cancer,” proved to be one of the latter challenges. Those words were like a glass of cold water being thrown in my face, a wake-up call that, while perhaps anticipated, came as a shock.
Challenges offer one some choices. In the case of my diagnosis of prostate cancer, the choices were quite simple. I could turn inward, sit on the pity pot, sink into a depression or I could choose to become an advocate for life, to turn a theoretical ethics into a practical ethics, to become available for myself and for others. I chose the latter as being the only reasonable approach. I chose to live life on life’s terms. This is not to say that I didn’t make aggressive treatment choices, I did. A prostatectomy is major surgery even when done robotically. I chose this approach because it provided the best possibility for a long-term “cure,” although I don’t believe there is ever a “cure” for cancer, only a set of survival statistics, probabilities, percentages. If I understand my own mortality statistics, there is a 15% probability that I will die as a result of prostate cancer in the next ten years. Certainly nothing to go into a grand funk over. After all, I am 69 years old and I would think that I have around a 15% chance of dying from anything over the next ten years.
What this challenge has provided for me is something that I could not have anticipated, the ability to turn my humdrum lived-experience into an ethical one. This is not to say that daily living will not still be filled with routine, be commonplace, rather it means that I am always already present for the other. Here I Am! does not mean that sudden changes will occur in my life. To the contrary, I am creating proximate space that may or may not be addressed by the other (person) but the moment it is, the moment I hear the call of the other (person) I must act for the benefit of the other (person)…period. I see this ‘calling’ to be concentrated on benefiting prostate cancer patients but it is not limited to that sphere of influence. To be truly ethical it must not have walls to contain the effort. So, once again, Here I Am! I stand at the ready in proximity simply waiting to be called.
I almost bought Christopher Hitchens, Mortality, today but decided to take a pass. I am a huge fan of Hitchens, his wit, his thoughtful analysis of events even when I didn’t much care for his conclusions, his rational stand on religion and his approach to atheism in general. In Mortality he talks about facing his own imminent death from esophageal cancer, a battle that recently took his life.
As I fingered this short book, read a bit of the introduction finding it as intriguing as anything I ever read from his active mind, I decided to put the book down and walk away mainly because I didn’t think it was time for me to be reading about this grim subject. After all, my cancer is still diagnosed as a Stage P1C with a very bright prognosis. There is plenty of time to think about my own mortality if and when I am facing it. Besides, the book is out in hardcover and I thought I could wait for the paperback version (or perhaps the Nook version) before I plunk down some hard to part with money.
Speaking of printed material, my wife ran into a representative from the American Cancer Society while I was having my scans. A package arrived yesterday from the American Cancer Society that has any number of pamphlets, most written so that a third grader might be able to glean some information from them. They are written in terse language and overgeneralize. A glossary was included in one that had terms like cancer, tumor and chemotherapy among others. I was reminded of a paper one of my 8th grade students once wrote, an autobiography in fact. This student had several surgeries to remove benign tumors from the brain stem. At the back of the paper was a medical glossary containing terms like surgery, tumor and brain among others just in case I wasn’t aware. While my student’s glossary was simply perfect, the assumption of the American Cancer Society brochure was that most people are simply too stupid to make heads or tails of their illness. The language panders to the least common denominator and, quite frankly, I found it insulting.
In another of the many brochures in that package was a piece that spoke about just how much should be revealed to the patient, how much should you tell your loved one. Screw that. I spent too many years in school, earned a doctorate in language and literacy, did significant educational research, was published in scholarly journals and even co-authored a book; I’ll be damned if I’ll be pandered to. No, I want to know. I understand the statistics, laws of probability and the like. While medicine is not my field, I can read the relevant research and come to meaningful conclusions myself. I expect to be kept fully informed regarding the progress (or lack thereof) of my cancer. All I have to fall back on is knowledge. Like Hitch, I have no religious faith to fall back on, I am an atheist because there is no evidence that there is a god out there and so I depend on knowledge in this very moment, in the present because only knowledge provides me with the tools to fight this disease.
So, I didn’t buy the book, I did get rather angry reading the American Cancer Society pamphlets and so I decided to rant just a bit.
I am something of a statistician, having endured five semesters of post graduate statistics and research methodology classes while working on my doctorate. As part of that education I read an article by Stephen J. Gould discussing mortality statistics and cancer survival. Wikipedia summarizes the contents and force of that article as follows:
In July 1982, Gould was diagnosed with peritoneal mesothelioma, a deadly form of cancer affecting the abdominal lining and frequently found in people who have been exposed to asbestos. After a difficult two-year recovery, Gould published a column for Discover magazine, entitled, “The Median Isn’t the Message”, which discusses his reaction to discovering that mesothelioma patients had a median lifespan of only eight months after diagnosis. He then describes the true significance behind this number, and his relief upon realizing that statistical averages are just useful abstractions, and do not encompass the full range of variation.
The median is the halfway point, which means that 50% of patients will die before eight months, but the other half will live longer, potentially much longer. He then needed to determine where his personal characteristics placed him within this range. Considering that the cancer was detected early, the fact he was young, optimistic, and had the best treatments available, Gould figured that he should be in the favorable half of the upper statistical range. After an experimental treatment of radiation, chemotherapy, and surgery, Gould made a full recovery, and his column became a source of comfort for many cancer patients.
The whole point of Gould’s position is that the median, which in the case of cancer is highly skewed to the left due to the fact that many cancers are not discovered early making the overall statistic biased toward terminal patients discovered in the late stages of the cancer, as the proper statistic, rather than the mean or average, is a very powerful statistic. Mortality statistics begin with the day of diagnosis, not the time of the onset of disease. So my diagnosis places me in Stage 1, while that could have been, and may still be, Stage 4, depending on the presence of cancer cells outside of my prostate. If, in fact, I am truly in Stage 1 then my chances for survival of this particular cancer are far greater than if I fall into Stage 4. Because mortality statistically begins at the time of diagnosis, there is a significant bias toward the later stages of cancer where treatment is often unsuccessful.
Taken in total as I look at the mortality statistics and my own adenocarcinoma of the prostate, I can take some comfort in the fact that the cancer was discovered quite early and I am relatively healthy for a 69 year old male. With the sole exception of some significant osteoarthritis and well controlled atrial fibrillation, my health is quite good. The fact that scans do not indicate any metastasis is also a good sign; the fact that the CAT scan is inconclusive around the groin area muddies those waters a bit but a resection of the lymph nodes around my prostate will either rule out or confirm a metastatic migration of the cancer. Only time will tell if the Stage P1c is a correct stage diagnosis.
As things stand at this very moment, I have a very good statistical probability for long term survival. In probabilities, however, it is black letter that if something can happen it will. As an example of probability I can relate the time there were ten people left in a poker tournament at Caesar’s Palace and the last nine players would get paid. I had three nines after the flop with two in the hole at a table of 5 players. I went all in, expecting to collect the chips in the pot without opposition. Everyone folded except one player who had three-3s. I was a 99% favorite to win that pot and double up almost assuring that I would be in the final nine. My opponent had only one card in the deck, the final 3, to win the hand unless I got the final 9. The very next card to come on the turn was that 3, the 1% possibility happened and I lost the hand and was knocked out of the tournament. Probability is good when it is in your favor but it is never a sure thing.
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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(Almost) Jewish in Beijing and California
A weirdo unleashed. . .riding the spiral to the end.
An egotistical flight of fancy into the random ramblings of a semi-demented mind.
An English Rabbi in New York
The everday ramblings of Anne and her Goose
Life after a tango with death & its best friend cancer
sharing the joy of the human spirit in mid air around the world
Therapy Resources and Ruminations
In your light, I learn how to love. In your beauty, how to make poems. You dance inside my chest, where no one sees you.