So Long, FOL-FOX (Until We Meet Again).

It pleases me to report that I’ve just completed 18 weeks of FOL-FOX Chemotherapy. Some of you may recall that the objective of this round has been to continue to shrink the tumor at the primary sites, killing any cancer cells roaming free in my bloodstream, preventing such cells from invading my liver and lungs. Critical to the success of this part of treatment is preventing DNA changes from occurring that will reinforce the cancer. As a general must read the terrain, picking the most favorable ground to deploy his forces, the body is the terrain which must be read and whose impacts must be predicted. My medical team has found me a rather challenging case. My complex DNA (Afro-Caucasian-Ashkenazi Jew) makes interpreting lab results tricky and my chemo dosages - usually at 100% given the aggressive nature of my cancer - have needed adjusting more than once. My liver, which primarily filters the chemo drug, has been pushed to the red-line. To analogize my particular fight with Cancer so far (it’s different for everyone who faces it) one might imagine The Western Front in 1917; a long, slow war of attrition where the objectives are often hazy in the distance, and the daily metrics of progress aren’t always clear. 

In fact, I don’t have much to report, except that I’m due for a full battery of CAT scans on 9 July, and a panel review of said CAT scans three days later on the 12th. Ideally, MRIs and Endoscopy would follow shortly thereafter, in which case I’d have some hard data regarding my progress, at the very least. Further, MRIs and Endoscopy would be a sizable milestone; the first steps for the surgical team and my looming next step in treatment. The less ideal case would be, that my CAT scans show middling improvement, in which case further chemo may be ordered. 

One would be inclined to think that, given the fickle nature of my line of work, the “hurry-up-and-wait” game would be more tolerable. It isn’t. There is a pernicious myth about battling Cancer that can leave one with a false impression of the nature of that battle; that the fight is against the Cancer itself. What I’ve come to understand in the six months I’ve been engaged in treatment is that one actually doesn’t fight Cancer. That remains squarely in the province of mathematics. The Cancer is going to act in accordance with its own nature. At all times it can still kill you. All you can do is create the conditions that hamper its progress and deny it enough purchase in your body such that it can be contained and removed. I’ve done that through a clean diet, exercise, showing up for my treatment regime, listening to my oncologists, and taking as much enjoyment of the outdoors as my body (and our capricious Oregon weather) allows. The rest is up to time and the calculus of nature.

When in the brutal grind of chemotherapy and the endless cocktails of steroids, the only battle that seems immediately tactile enough to fight is the battle of the will. One’s morale fluctuates wildly - some days I’m just happy that I was able to eat a meal without immediately throwing it up like some Vampire. Other days taking my dogs to the duck pond is exciting as going to Jupiter. Other days I have to pep-talk myself to show up for chemo and trick my doubting mind into believing there’s a point to all this for just one more day.

The great Roman statesman Lucius Annaeus Seneca maintained that the greatest obstacle to living is expectancy. It is often misunderstood that the Stoic Philosophy is merely a grim resignation to the vagaries of life; an acceptance of the inevitable. The goal of the stoic is not to eliminate the emotions, to become devoid of feeling, but to attach the right judgements to them. We can enjoy love, happiness and beauty as long as we don’t desire more than is within our control. We can enjoy music, if at the same time we can not wish for it never to end. We can enjoy a cold drink in the sun, if at the same time we can not wish the moment never to pass. It is better to expend yourself against a goal with an uncertain outcome, than to experience the fear of a life without purpose. Whatever purpose you do find, do not stress about its achievement, for that is not up to you to decide. Stress instead, about the virtue of your commitment, and embrace the beautiful foolishness of acting without expectation. 

If, after this round of scans, I’m cleared to move on to surgical prep then I can look forward to something I’ve missed. Driving. At least for a little while. I haven’t been able to drive in nearly 7 months due to neuropathy (inability to feel my extremities), loss of balance and slowed reaction-time all caused by my chemo. My ability to get more enjoyment out of Summer has been stymied as a result. Every morning, while my dogs eat their breakfast, I go out and start my car - to keep the battery flattening from being parked all the time. I listen to the hum of the engine, and think about my next drive through The Columbia River Gorge, or to my choice spot under the airport glide path where the planes roar in right over your head at dusk. Being able to see friends and get on with things without feeling like a burden for others to schlep around. Independence isn’t just an abstract. It’s foundational to one’s sense of self and all too easy to take for granted.

There remains some pressure this Summer as finances are getting ropey and while giving my apartment up was a massive savings, I still had to create another bill to keep my things locally in storage. I’m planning to set up a small stretch goal to take the edge off the budget, If you out there wouldn’t mind taking a second to spread the word. It’s tough, because as a professional I’m always seeking to provide a clearly articulated ROI. In a case like this, such is tricky to actualize. I can offer an honest account of the experience and hope to transmute it into something helpful to other Cancer patients and those who care about them. So many of you have already donated to me, a few more than once and you got me through six long months. I remain forever in your debt. 

Many of you have reached out to check in, which never goes unappreciated even if I don’t always reply straight away. I’ve come to notice that Social media is a somewhat precarious thing for me at present. It’s hard to not feel like life is passing me by while I’m stuck on the sidelines with Hodor’s evil cancerous twin breathing down my neck and no clear end in sight. I decided to take some steps to digitally cleanse, and so my social media time is strictly limited to (and enforced by software) to a mere 30 minutes per day. Email and snail-mail are the best way to communicate with me. Texting to a lesser extent - I’m trying to break that Pavlovian response to the machines that go PING! and DING!

I will update all of you again after my next round of CAT scans. Thanks again, so much, for all of your support, patience and understanding. I’m still here and still cracking on. Stay safe, hug your loved ones, and enjoy the Summer - and for my Antipodean friends Down Under I’m insanely jealous of your weather this week.

That’s about all there is, for now.