Daniel Menaker

Onconversations XIV

Monday, October 31, 2011

ME (shopping in Guido’s, a punitively expensive market in Great Barrington, Massachusetts, second home to many New Yorkers, one of whom, legend has it, said on a Saturday to an obviously local person, “Why don’t you people do your shopping during the week?”):  OK, now,  I bought a pound of fairly expensive Starbucks coffee, maybe $8.99 a pound, at Price Chopper yesterday, but I somehow managed to misplace it when I got home. With the snow coming, maybe I should buy some more, just in case I can’t relocate the original.
MYSELF: But it’s so pricey here.  What is this stuff, anyway? Jim’s Coffee. Jim’s? Really? http://www.roaste.com/product/jim/Jims-Espresso-Jimbo-Blend. $13.33 a pound?
I: It’s probably really famous and you just don’t know about it.  The price point is very distinguished.
ME: So in my situation, with this diagnosis sounding like a warning tocsin in the distance, I should just–well, you know.
MYSELF: Up to a point.  If you lose your financial caution completely, the disease will have made you into a different person and in a way gain the upper hand. “Be yourself” has a special application here. Or “Stay yourself,” maybe.
I: “Tocsin”? Can’t you stop showing off even when you’re talking to Yourself and I?
ME: How about the Sumatran Takengon French Roast? It says, “In a word: Transporting.”
MYSELF: How much?
ME: A lot.
I: How does it get to be  French roast from Sumatra?
ME: French roast is just the way they roast it.
MYSELF: Didn’t the French, like, own Sumatra at one point?
ME: Listen, I am going to go through this store and buy everything that appeals to me. I start radiation treatment next Friday. Before they actually start they put tattoos on my chest that will never come off. They pour some liquid around me that hardens while I lie perfectly still for half an hour and forms a body mold that they’ll re-use for every session.
MYSELF: That’s true. Didn’t the guy say that it could be as few as three sessions but they would do it in four because the lesions are close to your ribs and the beams of radiation are so strong they might break a rib?
I: You lying perfectly still for a half an hour is amusing all by itself.
ME: I have to keep my hands over my head for the whole time.
MYSELF: The guy said, “Bring a CD, or we can pipe some music in.”
I: Just think–“Leader of the Pack,” “Take a Message to Mary,” “Goodbye Earl,” “Teen Angel,” “Dead Man’s Curve,” “Maxwell’s Silver Hammer,” “Long Black Veil.”…
MYSELF: So OK–go ahead. What’s it going to be?
ME: Besides Jim’s, Monterey chevre with garlic and chives, SoCo vanilla ice cream–
MYSELF: Wait! You bought ice cream yesterday.
ME: Yeah–I thought it was Ben and Jerry’s vanilla–it was in the same freezer line that the vanilla was in and I was reaching around to get a fresher pint. But when I got home, I found it was Boston Cream Pie.
I: Yeah it was disgusting. It had orange streaks in it like a sputum sample from the eighteenth century, or like butterscotch grout.
ME: And some grey sole, Ghirardelli chocolate–
MYSELF: Get 70% cacao–much healthier.
ME:  60%. One of those fancy demi-baguettes, Tate’s chocolate chip cookies …

At home, the Starbucks appears on top of the plastic 33-rpm turntable cover.  I look up some descriptions of Jim’s coffees and I find, about one of them: “I was able to pick up on hints of chocolate, bread crust, and some floral flavors.”

I would say, “Bread crust?”

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Onconversations XIII

Tuesday, October 25, 2011

I am about to have a second needle biopsy done of one of the three or four very small nodules in the remainder of my left lung–one of which, seven months ago or so, was similarly biopsied and found to be malignant. This, like the first biopsy, is being done at a different facility from the institution where I’ve had my chemotherapy treatments, and it will be a one-time-only visit.  (You lie on a table, they CT-scan you, mark the place on your back that they’re going to puncture in order to puncture your lung and get a sample of the tissue in the nodule.) Why “three or four”? Because two or three nodules are in a cluster near the top of the remaining lower-left lobe, and it’s hard to tell if they are indeed two or three. The third (or fourth) is farther away, near the bottom of that lobe, and my oncologist and radiologist have advised having that one biopsied, to help determine whether I will have two courses of stereotactic body radiation therapy–SBRT is its lightsome abbreviation–or just one (for the cluster near the top). I’m sitting on the long, narrow platform on which they slide you into and out of the CT cylinder and I have been waiting and waiting. Finally, a harried-looking nurse comes in.

NURSE (opening and closing equipment drawers): OK, we start with this.  (Takes out a syringe). No, wait–this isn’t right. (Tosses the syringe back into its drawer and opens another drawer.)  Where is it? (Opens the first drawer.) I already looked here–that’s right. It’s not here.  Oh, I think it’s here.  No, I don’t think this is right either. Where is it?  Oh, no–I already looked here, too. Now, where is that vial? (Opens and closes more drawers and scrabbles around in them, holding up this syringe or that whatever and peering at them and then hurling them back into the drawers and scrabbling some more and opening a fifth or sixth drawer.) Oh, right–I start with this. (Ties a rubber junkie-type tube around my upper right arm.) You have nice veins.  Very nice!  Excuse me for a minute–I need to check something. (Unties tube.)
ME (as politely as possible): What’s going on?
NURSE: I’ll be right back.  (She leaves. She comes back after a few minutes.)
NURSE: You see, we just had a meeting and so I wasn’t quite ready. (She ties the rubber tube around my arm again.) Really beautiful veins–yes indeed. (She turns back to the drawers in the equipment cabinet.) OK–so this is what we’re going to do first.

Before all that, the doctor who was going to do the biopsy came into the little curtained-off waiting cubicle to have a pre-procedure talk.

DOCTOR: So what are we having done today–can you tell me?
ME (proudly, and resisting the adolescent temptation to say “Liver transplant” or “Nose job”): A percutaneous needle biopsy of one of the nodules in the remaining lobe of my left lung–the nodule lower down.
DOCTOR: And can you tell me why?
ME: One of the other nodules, in the bunch higher up, has already been biopsied and was found to be malignant. If I’m going to have radiation therapy–I think it’s called (feigning layman’s ignorance/deference) SBRT–then they want to know whether I’ll have one course or maybe two.
DOCTOR: Excellent! And you’ve just saved me a call to Dr. ______.
ME (to myself): Really? Because no matter the nature of the call might have been, that’s kind of disturbing, if you think about it.

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Onconversations XII

Monday, October 10, 2011

DOCTOR FRIEND:  Let me tell you, if Dr. _____ didn’t try to get you on the operating table then and there, that means that radiation really is a viable alternative. Dr. _____ really loves to do surgery.  [The surgeon had talked to me about the advantages and risks of having an operation–a wedge resection or segmentectomy.  What happened to the idea of a pulmonectomy, I wondered–the removal of the entire remaining lobe of my left lung. But I forgot to ask.]
ME:   Well, good. And since then, I’ve gotten the name of another lung-cancer specialist at ______ to consult with about proton therapy. But I don’t want to offend anyone at your outfit by deciding to jump ship: They have all been so excellent and patient.
DF: Jump ship! Jump ship!  If you find something that seems better that we just don’t do, jump ship. The stakes are too high to worry about offending anybody here, and anyway, this happens all the time in cancerland. Everyone understands that.
ME:  But I did it once already–remember? I left _______ to come to your place.
DF: Makes no difference.
ME: I remember what the doctor said at the first place, before I switched. He had sent me to your center for a consultation, and he read me what Dr. _______ said: “‘I met with your patient, Robert Menaker’–oh, then he says something really nice about you which I won’t read to you.” I said, “Read it to me, read it to me, for God’s sake. I have lung cancer.” He said, “No, it’s not relevant to the medical issues.” I said, “Read it to me anyway,” but he just laughed. So it makes me wonder if hospitals and clinics may be in competition to get patients and hold on to them.
DF:  Robert?
ME: What?
DF: ” … Your patient, Robert Menaker”?
ME: Oh, Robert is my legal first name. Daniel is my middle name.
DF: Why do you use it?
ME: My father’s first name was Robert, and since we were a “progressive” family of the Forties and Fifties, we called our parents by their first names. So to avoid confusion. I ended up Danny. Daniel. Well, Dan.
DF: So, about photon therapy.
ME: Proton therapy.
DF: There is such a thing as photon therapy, you know.
ME: I know–I’ve read all about it. Many of the online cancer sites have been burned out by me singlehanded.  But anyway, proton therapy, photon therapy, Motown therapy.
DF: (laughs): Motown therapy. You listen to the Four Tops for an hour every week. (http://www.youtube.com/watch?v=2wYoLQc-x5g)  It’s like that guy who wrote a book about curing himself by watching funny movies. Was it Norman Cousins?
ME: I think so.
DF: Well, anyway, back to the issue: I kind of believe in not doing at any time anything more invasive than needs to be done, especially when it has been caught this early. So this is a sign that the arrow is pointing toward radiation right now, and I’m glad about that.
ME: Me too. Maybe I could even start with Motown therapy.

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