My oncologist is not a poet. So, instead, I received this in my mail for the third consecutive month:
How to live dying
Just this morning, I received in my mailbox the above reminder: It was my appointment for Lupron injection on July 2nd.
The first two appointment notices I ignored. Both prompted phone calls from my doctor.
Each time he phoned, I complained that I was experiencing horrendous sweats followed by chills that were most troublesome at night because they would awaken me hourly; as a result, I received only three to four hours of sleep, as shown by my Fitbit. [The sleep log below was from my worst nights.]
“Those are the side-effects from the Lupron,” Doctor said, as though that would end my complaints.
“So on top of those side-effects, you want to give me another dose of Satan.”
“Lupron,” he corrected. “Your PSA numbers [an indicator of prostate cancer]will stay down only with the cumulative effect of the Lupron.”
I stared at the receiver. “But you said my last dose brought it down from 14 to .01.”
“But it will go back up.”
“No more Lupron, Doctor.”
He delivered the leaden “Well …” and then continued with, “We’ll just have to monitor your blood tests, then.”
That would have been in February or March, this year.
A little over a week ago, I awoke with the realization that I hadn’t had any night sweats or chills. My freedom from them continued throughout the day. After an entire year of torment and diminished sleep, I was now sleeping like a snuggly baby for over a week.
This morning, I got the above infusion appointment in my mailbox. Scheduled for July 2nd. Two days before Independence Day, they’ve scheduled me to lose mine. And they’ve given me over half a month to stew about it.
My appointment card calls it the “infuse private chair.” How sterile is that? They are, at 10 AM on Thursday, July 2nd (“please check-in at 9:45"), planning to ram two inches of sharpened surgical steel into this old man’s sunken ass-cheek. I wouldn’t be sitting in the chair, not this time, but standing beside it, my trousers clustered at my ankles. The nurse would take one final admiring glance at her handiwork before she scurried back to the break room and her waiting coffee cup.
Her job done, mine will have just begun. For a solid year, perhaps longer, I’ll be ticking the sleepless nights, as before, off my insomniac’s calendar — that is, if I choose to don, once more, the living shroud.
But what if I don’t? What if I choose instead to live dying? That’s what my oncologist is convinced I’ll be doing, though he wouldn’t be pronouncing my sentence in the distilled language of a bard. He would be sifting through his medical vocabulary to explain that when my PSA (prostate-specific antigen), rises past the 4, which is the normal range, soars up to 20, 40, even 140, which my doctor says he’s seen, my body, at some point becomes something resembling an SNL MacGruber spoof.
With less-than-hilarious consequences.
The cancer cells, now chittering and skittering about in their prison confinement in my fully-radiated, desiccated, and emasculated prostate, they can hear the prison door rattling. Soon it will open. It might be six months from my “no more Lupron” cant. It might be a year. Who knows? Two years might pass before the door opens.
But when it does the jubilant cancer cells will cram through the door and begin to migrate — doc likes to call it metastasize — throughout my body looking for fresh food to replace their meager diet in my prostate.
Death would most likely be speedy then.
Like the closing scene in MacGruber.
“Okay, Doc, what about other options? What about chemo?”
In the instant it would take him to answer me, my mind scurries back to the infuse room on that day, a year earlier.
My nurse and I weren’t alone a year ago, on the day I had my first Lupron injection. I’m trying to picture that day now in my mind.
Six or seven sunken-faced, slack-jawed patients were slumped in their “infuse private chairs,” which were in the recline position. A midnight blue curtain attached at the top to a rod that was bracketed to the wall at the side of each chair; when the nurse whisked the curtain across the rod in its half-moon circuit to its ending place on the wall at the opposite side of the bed, the chair’s occupant would be in a sanctuary of perceived privacy.
They were beyond caring about privacy anyway, and the curtain was rarely drawn.
A few diehards — I had been one of them during my first couple of chemo-therapy sessions 15 years ago — tried to fight the effects of the poison dripping into their veins from that plump yellow bag, above them and off to the side. They would find themselves reading the same paragraph in their book over and over as it floated and bobbed on the page. Or instead, they would stare, slow-blinking, at the TV screen, wondering what the audience found so hilarious in whazhizname’s whiny words in that whachamacallit, Big Bang Theory rerun. Like brief, happy explosions between words that the grappling mind almost made sense of before another explosion erased their meaning.
Soon even the diehards’ glimmering of intelligence fused into the inchoate background buzz and hum, their eyes rolled back, and their tongue, unclung from the roof of their mouth, drooped to its nesting places on their lower lip.
That was my subjective experience of chemotherapy, remembered from 15 years earlier; it commingled on that day of my first lupron infusion with the vacuous faces of the chemotherapy patients I gazed upon, knowing that what looked like sleep was but a jittery, jagged purgatorial prelude to what would be the hell of the remainder of their day, once they were disconnected from the machine.
I insisted on working after my first 8 A.M. session of chemotherapy. I went to my insurance office, flipped the sign to “open” and fell asleep at my desk, to be awakened a half-hour later by my first customer. The remainder of that day I remembered as though I were feeling my way through a dense, cottony fog, occasionally bumping into a customer, or stumbling toward their voices that were calling my name.
If I’m exaggerating, it’s not by much. The next aftermath of chemotherapy, a week later, my wife insisted that she occupy the office while I slept it off. She woke me eight hours later with a call to dinner, the thought of which nauseated me.
“Chemotherapy is not an option. Not at your age. With your recent history of congestive heart failure.”
“I’m not convinced I had congestive heart failure, Doctor.”
“Your cardiologist feels differently. So no chemo.”
He waited patiently on the other end of the line for my long inhale and sudden release.
“What is there besides Lupron?” I resisted calling it the living shroud.
“Only Lupron. Lupron is the best procedure. The only procedure.”
“Doctor…” My voice had an annoying pleading sound to it. “I can’t go another year on three hours of sleep a night.”
“Have you gone through that prescription I gave you?”
The green bottle was in my medicine cabinet, the plastic hymen of a protective seal still unbreached. “No. I’m — I’m afraid of it.”
“It is better to sleep without it.”
“Doctor, I’m a writer.”
“Yes, I remember seeing you at Barnes and Noble. A long time ago. You were autographing your book.” He paused. “Did I buy one?”
“You asked if it was appropriate for your children.”
“Yes, I remember now.” A long exhale. “So anyway …”
“Listen to me. I’m a writer. It’s all I have.” I felt my voice break. “My thoughts get all jumbled. I need sleep. This week was the only time in the last year I haven’t been awakened four, five times a night from the sweats and chills.”
“Good. Good. The side effects wore off.”
I waited, but he didn’t say anything further.
“Sleep is too precious to me. I'm choosing to say no to the Lupron.”
“I see. Knowing the potential consequences? You are saying no to Lupron?”
“I have to Doctor. No more Lupron.”
I waited for him to answer. He didn’t. Smiling into the receiver, I added
“I’m choosing to remove the living shroud.”