Daniel Menaker

Onconversations XXXIII

Friday, May 18, 2012

(On a bench in Central Park on a beautiful May day.)

OLD FRIEND:  You look tired.
ME: You know, I’ve always thought that that is one of the worst things you can say to someone.
FRIEND: I meant to be sympathetic.
ME: All it does is make a vain person like me feel bad.
FRIEND: You’ve always been too sensitive.
ME: I have not!
FRIEND: See what I mean?
ME: Where do I look tired?
FRIEND: Under your eyes, and you also look pale.
ME: Great.
FRIEND: It’s because I care.
ME: Sure.
FRIEND: How was your lunch with ____________?
ME: Extremely interesting. We talked a lot about his father [a famous man, deceased].
ME: And what?
FRIEND: Don’t fuck with me. And what did he say?
ME: He said his father, and I quote, “dug himself into a hole with his mistress and couldn’t get out.”
FRIEND: By all accounts she was a harridan.
ME: Yes. But I said to ________, “He could have gotten out, you know.” And ________ said, “What do you mean?” And I said, “Well, he could have gotten out—that’s all. If you aren’t an actual slave or tied up or something, you can get out.”
ME: Aha what?
FRIEND: Aha, you have just shown me that despite all your fancy positions against free will, you actually believe in it.
ME: I showed you no such-a thing.
FRIEND: Yes you did. You said he could have gotten out.
ME: What I meant was–
FRIEND: Oh no you don’t! You said he could have gotten out, which means you think he could have made a decision to get out but chose not to.
ME: Look, I talk like everyone does on this social–
FRIEND: You believe in free will–it’s clear to me and you can’t wriggle away from it this time.
ME: Let me finish. I talk like everyone else on this social level–she could have not dyed her hair purple, he could have married Susie instead of Sally, my boss could have chosen to let me offer more for Atul Gawande’s first book.
FRIEND: Yeah–what happened there, anyway?
ME: I’ll tell you later. My point is that like everyone else, in ordinary conversation I talk the way people talk, as if people have real choices about what they do, agency independent of their physical brain’s neurological functioning. But I don’t actually believe it. We just use it as a model. I don’t actually believe that _________’s father could have gotten out of that hole. He stayed in it because that’s just the way he was. It was his brain that kept making his consciousness so-called “choose” to stay in the hole. In fact, I think that’s exactly what _______ and I were talking about: his father’s not being able to choose to get out of the hole.
FRIEND:  Oh, wriggle wriggle.
ME: OK, then–I choose to return to the subject of my looking tired.
FRIEND: What about it?
ME: Well, if you must know, I had a terrible night last night.
FRIEND: I’m sorry–what happened?
ME: I had this weird chest pain.
FRIND: And did you call the doctor this morning? You should have.
ME: No. I did freak out a little, I admit. When you have cancer you sort of automatically become a hypochondriac and also a rationalizer at the same time.
FRIEND: You have no choice.
ME: Get off it, OK?  I didn’t call the doctor, because it just didn’t feel like anything cardiac.
FRIEND:  Call the doctor.
ME: No, I really don’t think I have to. I think I figured it out.
FRIEND: _______
ME: So at first I was sure it was angina–my father had it.
FRIEND: What did it feel like?
ME: Just to the left of my sternum, this little bud of warm pain would blossom every four or five minutes and then sort of evaporate. It wasn’t severe but it kept me awake.
FRIEND: Call the doctor.
ME: So I got up and Googled angina and learned all about stable angina and unstable angina and so on. With stable angina, it says the patient can predict when it will occur. So at first I thought, Oh, well, I can predict this because it seemed to be coming and going regularly.
FRIEND: What time was this?
ME: It started at 2:30.
FRIEND: You got up and looked at your computer at 2:30? By the way, stable angina sounds like an equine disease, like dogs with kennel cough.
ME: Very funny. This is serious, So just to make sure, I went back and lay down and timed the pain buds–sure enough, every four to five minutes. So then I went back to the computer and looked more and found put that by “predictable” they meant that patients could predict like, well, after a stressful event or too much exercise, they knew they would have an angina attack.  They didn’t mean that it would occur at regular time intervals.
FRIEND: Well, of course not. Moron.
ME: What did you say?
FRIEND: Oh, nothing.
ME: You said “moron.”
FRIEND: No, I didn’t.
ME: Yes, you did. Anyway, so now I was really getting scared that I would have a heart attack. Now, you know I have gotten through all my cancer treatments without much in the way of hypochondria. Just simple, justifiable dread.
FRIEND:  You’ve handled this whole thing very well.
ME: Thanks.  But at this point, anyway, cancer actually came to my rescue.
FRIEND: Tell me.
ME: I realized that what I was experiencing was chest-wall pain. Which is a famous side effect of the the fancy radiation therapy I finished in the winter.
FRIEND: But that was months ago.
ME: That’s the fiendish thing about some radiation side effects–they can happen six months, a year later. And chest-wall pain and rib fracture can be among the most delayed. So I decided that’s what this was, took an Advil, and finally went back to sleep. But I was up from about 2:30 to 5 in the morning.
FRIEND: This is all to explain why you look tired?
ME: Exactly!
FRIEND: Very convincing.
ME: I’m sure that’s what it was.
FRIEND: Call the doctor.
ME: With Gawande’s first book, by the way–it was a collection of his pieces from The New Yorker, and my boss just had this reflexive reaction that collections of already-published pieces were a bad publishing bet. So I couldn’t match another publisher’s offer.

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Onconversations XXXII

Wednesday, May 09, 2012

(Since I started these Onconversations, about a year ago–with the recurrence of malignant nodules in what remained of my left lung after a lobectomy in 2008 for a 2.5 cm. adenocarcinoma–this site has gotten as many as a hundred and as few as zero clicks a day, according to Google Analytics.  Even a hundred is nanochicken-feed, I realize, so those of you who do stop by here for a few minutes every now and then, thank you, and please share the destination with others who might find it interesting or amusing and maybe even worthwhile. It’s by no means just a matter of raising Google-search numbers and seeing if there’s enough traction here to consider a book project for myself. Though it is partly those things, I confess.  It’s also a matter of being in touch with and creating a community of cancer patients, physicians, and those close to them who have some philosophy about and perspective on the illness–something beyond the usual [though useful and helpful] medical sites, professional and patient-generated. I’ve found that every instance of others’ intelligence, insight, humor, and candor about cancer has proved to be tonic in itself–and, paradoxically and most important, has proven antidotal to obsessing about it.

Small as the site’s visitor numbers may be, you-all have landed here from just about everywhere–Japan, Ukraine, Bangladesh, Finland, Brazil, Singapore, Croatia, India, Argentina, Canada, Germany, Malaysia, Norway, Pakistan, Mexico, Belgium, Brazil, Georgia, England, Papua-New Guinea, France, Colombia, Greece. Not Italy yet, as I recall. What’s up with that?  This is thrilling to me, not just out of self-regard but because it gives evidence of what kind of potential good–or at least pleasure and interest–a global globe can provide, even about cancer.

Anyway, I meet a friend and fellow-patient on the street very near my apartment. He has on a black jacket and his left arm is close to his side, his left hand in his pocket.)

ME: So, I take it you’ve had the surgery. (It was, as I recall, surgery for a recurrent tumor that would paralyze his arm.)
FRIEND: Yes. (He nods toward the arm). It’s now just decorative, I’m afraid.
ME:  You can’t use it at all?
FRIEND: Nope. Useless.
ME: Well, I’m sorry. But on the other hand–
FRIEND: Watch it!–
ME: It wasn’t deliberate, I swear. On the other hand, you’re well now.
FRIEND: From your lips to God’s evidently pretty deaf ear.
ME: You look well, anyway.
FRIEND: Thanks, but that’s about one-twentieth the battle, don’t you think?
ME: It depends on how vain you are, I guess.
FRIEND: And you?
ME: Finished radiation treatments–very fancy and futuristic–three months ago, and the last CT scan was encouraging.
FRIEND: Oh, yes–encouraging.
ME:  No, really! But I have another scan in July which will be more telling.
FRIEND: Good luck with that.
ME: What are you doing around here, anyway?
FRIEND: I’m taking part in a wall-to-wall Gertrude Stein thing at Symphony Space.
ME: A fellow-cancer patient.
FRIEND: Yes. Not so encouraging.
ME: You know, you are just too quick. You do two-upsmanship better than anyone else I know.
FRIEND: Well, you can find anything you want in Gertrude Stein to bolster whatever you are trying to bolster. In our situation, my favorite would be “Considering how dangerous everything is, nothing is really very frightening.”
ME: Excellent. I’ll keep it in mind as July approaches.
FRIEND: Are you going out to the Southampton conference this summer?
ME: Yes, but I’m not sure what I’ll be doing.
FRIEND: In our situation, getting there will be almost all the fun.

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