(5) 1 May 2013 – War on Terror

Friends have been commenting that it’s been a long time since I posted a medical update, and expressing the hope that no news is good news. And it has been. There has been nothing, really, to report for months other than treatments and tests being carried out on  schedule, plans turning into events, without anything expected or alarming. In the fall, I had a light dose of dacarbizine followed by a standard series of four doses of ipilimumab, at three-week intervals, all without severe reactions. In January I had the first of 20 or so CT scans to monitor for any sign of cancer. In April, I had the second. I’ve been feeling strong and perfectly healthy except for a slight restriction in my left shoulder, from the surgeries.  I formed the plan to write this post as soon as I got the results from the April scan. I expected to say that, once again, there is no news—that the last known tumor was removed by surgery last July, and everything since then has been  housekeeping—mopping up. I expected to say this would be my last post on the subject—unless something unexpected were to happen.

Predicting the future is hard, I’ve noticed. When I consulted my oncologist after the April scan, he told me something showed up—in my right buttock. He asked if it hurt to sit down. Not at all—I couldn’t feel a thing. The buttock, he said, was not a site where melanoma was expected to go first. The  radiologists must have been looking very hard to have found anything at all, for it was very small—about 1 cm. in diameter. And there was another spot, even smaller, on the outside wall of my colon. The one on the colon would be impossible to find with ultrasound, but the one in the buttock should be checked out. So I had ultrasound, then a needle biopsy. On the table, I asked, “What does it look like?” Answer: “Nondescript.” Hoping for something reassuring to report to Claudia, I asked, “Liquid or solid?” “More liquidy,” was the answer. “That’s a good sign.”

Another weekend passed before I saw my oncologist again. “Unfortunately it is melanoma,” he said—yesterday. He sketched out a plan  starting with a PET scan later this month. If there is only the one spot of melanoma, I’ll get another round of radiation. If it looks more systemic, then probably another round of ipilimumab. He has also asked for another look at the biopsy sample to look for signs of my immune system attacking the melanoma. Ipi is designed to alter the immune system to see melanoma as an enemy.

So, I’m sorry to say, my life is becoming abnormal again. My family is worrying, and neither Claudia nor I got a lot of sleep last night. My work on the book I mentioned last year hasn’t been going particularly well; it’s hard to concentrate. It is, perhaps, more upsetting this time around. I’d been feeling as though the war was over—the radiation, and the IV’s in the chemo unit, were only memories. I was looking forward to a life of increasing normalcy.

‘Looking forward’ is an emotional impulse that is hard to rein in. We reflexively imagine our personal futures, and we can’t help being affected by these highly unreliable depictions. Even when we know better, they engage our fears and our appetites.

I called this piece “War on Terror” because it reminds me of the unwholesome emphasis on security which has infected our public life since 2001. An anxious, mistrustful state of vigilance, and cameras everywhere, the Department of Homeland Security’s alert level wobbling between yellow and orange, occasionally flashing red, never going to green. Months go by without incident, then suddenly the enemy sets off a pressure-cooker bomb. We think, “The Enemy,” but there is no enemy nation, no gathering of troops on borders—only a couple of guys who caught a meme off the internet. Maybe some helpers, but who knows where they are?

This hardly feels like a Phantom Self post. Once again, concern for self rears its homely head.  I must cut it short—I have things I have  to do this afternoon.  I’ll post again when I know something.

But I must add  that I am strengthened and encouraged by the warm wishes I received from friends, and from people I have never met, in response to these posts. Thank you. Everyone has his or her own struggles, and we are all tempted, at times, to hunker down and tend our own gardens. Yet life itself consists in the strands of our communications. Communication is the only kind of immortality that’s going. We survive as each other.