An Unwanted Journey: Day 0434 - My National Geographic Special

"Would you like us to take your glasses, Mr Spencer?" asked one of the nurses in the endoscopy unit.

"No, that's alright. I'd like to watch the monitor."

Just a few moments later, "OK, Mr Spencer, first my finger.", was how my surgeon got started.

"Now, the scope," again, from the surgeon.

Because the procedure was a flexible sigmoidoscopy and was being done only to examine the anastomosis, there was no sedative involved, no intravenous hook up, nothing but those marvelous blue hospital gowns and slippers and my assumption of "the position."

"Are you watching, Mr Spencer?", the nurse asked.

"Yes," I responded, but I was thinking, "You bet my ass I'm watching!"

"Don't be alarmed, Mr Spencer, if you see some blood. It's coming from the biopsy sampling and is minimal," explained the surgeon.

As Robin Williams once said of his own colonoscopy, in which he decided to forego any sedatives, it truly was like "having my own, personal National Geographic documentary." Everything was so clear and clean. The surgeon moved the camera lens for me so that I could see the tissue surrounding the anastomosis as well as the bowel passageway. It was awesome, despite the humiliating posture and the daunting prospects of finding more cancer through this exercise.

My surgeon, a person not known among medical staff and patients as someone who offers a lot of bedside chatter, offered useful commentary to me to put me at ease as well as to explain exactly what he was doing. He took five biopsy samples, and there was blood, but no pain since the rectum does not have nerve endings. The only unnerving aspect of what I was seeing on screen was the size of the "jaws" which took the biopsy samples. On screen, they looked enormous, but are really very small.

"That looks to me like granulation tissue," he said as he took the samples. He then went on to explain that the visual evidence of the sigmoidoscope was what he expected. It did not look to him like recurrent cancer, but he was happy to defer to the expert opinion of the gastrointestinal tumor board's recommendations to do the sampling earlier than he had originally recommended. He also suggested that we will be doing another flexible sigmoidoscopy in about 3-4 months from now, again, just to be safe and to see how the granulation tissue appears at that point.

It was very reassuring to hear him speak with such confidence about the visual evidence. Of course, the five samples will be closely examined by a pathologist and possibly an immunologist and we will meet again in about one week's time to review the reports. But...I feel pretty good about what I saw on screen and his confident demeanor.

An Unwanted Journey: Day 0433 - Real Acceleration

The surgeon who will be performing my endoscopy and gathering the biopsy samples had his assistant call this morning to see if I'd like to get the procedure done tomorrow instead of waiting another 17 days. Yes! By all means. Unfortunately, because we don't have much time for preparation, I will have to go back to the phospho-soda, gawd-awful solution that I used just 2 months ago for my last colonoscopy. But at least I won't have to wait so long for the procedure or the pathology report. We just might even have that report by the end of next week - good or bad.

Leroy Sievers was blogging last week about how he could hardly wait for his Radiofrequency Ablation procedure to happen. In that procedure, they stick a needle through the chest wall into the tumor and burn the sucker from the inside out. I know how he feels - not about having had experience with that particular procedure, but with the anticipation of finally doing something after the waiting period. It's always better to be doing something than simply waiting and wondering.

And for my buddy who "has my back", thanks. I can't express just how much your friendship has meant to me. You're the best!

I Won More Storage

I couldn't get to CES this year in Las Vegas, but I was able to submit an entry in the Podtech/Seagate I Need More Storage So That contest. In fact, I was a winner! Not the first place winner, not the second place winner, but in a group of about 20 who still got something for their efforts.

What we get is a Seagate Pocket Hard Drive. I'm not sure whether I'm getting the 2.5GB, 5GB, 6GB, or even 8GB drive, but one way or the other...I still win! Here's a Digital Trends review of the 5GB model.

An Unwanted Journey: Day 0432 - The Next Biopsy

The next scheduled endoscopy and biopsy sampling will be Friday, February 16th, this time at the Grand River Hospital again, the hospital where I was first diagnosed with cancer as a result of my first colonoscopy in November 2005. This will be the 4th endoscopy procedure for me in about 14.5 months. I also have a followup CEA lab test scheduled for the 27th of February and a consultation with the medical oncologist. Presumably I won't have to wait the full 11 days to get the pathology report, but maybe so.

I also got my CEA results from January 15th and was pleased that there was no evidence of higher levels. Instead, the result was virtually identical to what it was after my surgery and during my chemotherapy from June to September of 2006.

Again, I'm not quite sure how to feel about the acceleration of my endoscopy and biopsy (a full 6 weeks ahead of time). It was gratifying to see that my CEA levels had not risen, but that really doesn't mean too much. What is interesting, though, is the reaction that I'm getting from different folks about the news. Some seem to realize implicitly that this is serious stuff, that I'm not really in the clear yet, that there is reason to be anxious about the tests and results. Others seem entirely oblivious, assuming, I guess, that until I'm scheduled for surgery there really isn't anything to worry about.

One of the books I've read recently talks about this phenomenon for cancer survivors. The chapter is entitled "Who Showed Up" - as you can guess, it's about reactions from friends and family members. And as you might assume, you can tell a lot about a person from their reaction (or lack of reaction) to news about a life-threatening illness or the death of a close relative or friend. But like CEA tests, CT scans and MRI images, an individual's response isn't always definitive.

But you can only make excuses for someone's behaviour for so long. After a while, you might as well realize that if it looks like a duck, if it quacks like a duck, you at least have to consider the possibility that it is a duck (thanks to Douglas Adams).

An Unwanted Journey: Day 0431 - "Soft Tissue" and Recurrent Cancer

At the very least, my recent medical tests are giving me more subjects to research. I suppose doing this kind of reading may not be psychologically beneficial; after all, looking at CT and MRI images of recurrent rectal cancer leads to pessimistic thoughts, especially when the profiles of some of the individuals treated appear so similar to my own. On the other hand, even though I don't have the medical training required to fully appreciate the details of the academic papers, I get the gist quite readily. It doesn't take too long to break through the technical jargon to understand most (not all) of the issues.

A few things are very clear. Local recurrence of rectal cancer can be incredibly difficult to diagnose. Recurrence can happen very quickly after rectal resection surgery. CT scans and MRI images and CEA laboratory tests can all be ambiguous. Patients can have no symptoms of consequence and yet still be at very high risk. (See Recurrent Rectal Cancer: Diagnosis with MR Imaging versus CT).

Many other things are not at all clear, not just to a patient like myself, but to those practitioners who deal with such medical issues on a daily basis.

My medical oncologist has referred to the growth of "soft tissue" around the anastomosis. Right now, everthing seems "soft". The diagnosis is "soft". The prognosis is "soft". My sense of optimism is "soft". The statistics are "soft". I'd really like to be getting something more definitive, but I guess that is something I'll just have to get used to - it seems to be an integral part of this unwanted journey.

An Unwanted Journey: Day 0429 - Scope This!

My medical oncologist called late this afternoon to confirm that the gastrointestinal tumour board of the Grand River Regional Cancer Centre recommends I have another scope test (probably a sigmoidoscopy) during which the surgeon will take more biopsy samples for analysis.

Evidently the MRI was not only "suspicious", it also had evidence of "soft tissue" growth in the area of the anastomosis since the CT scan in December. My surgeon had told me in early December that we would do a sigmoidoscopy near the end of March just to take another look at the anastomosis, but that schedule has been accelerated to some time in February because of the tumour board's consensus review and recommendations. I will be contacting the surgeon early next week to get details.

I'm not sure how I feel about this. I'm relatively optimistic because of the results of the last biopsy in late November. The pathologist's report then indicated that the "suspicious" tissue was merely granulation tissue - no evidence of recurrent cancer. I think that bodes well for the next test. I am also pleased that my medical team is taking no chances, no matter what the last pathology report stated.

It is hard realizing that I'll have to go through my fourth scope test in less than fifteen months. My last colonoscopy really took all the energy out of me and left me barely able to walk into the hospital. We'll try another preparatory routine this time to see if it is any easier on my body.

But by ambivalent news is far better than the news another relative gave us this week about his tests. His biopsy revealed a sarcoma attached to his kidney. The surgery will mean the removal of the kidney as well as the tumour in all likelihood. We've been commiserating a little recently, but I suspect there will be many more conversations about cancer in the not-too-distant future.

An Unwanted Journey: Day 0427 - Like My Mummy Did

I was listening to Sheila Rodgers doing an interview with Murray McLaughlin, who mentioned how his quadruple bypass surgery helped his marriage. During the interview, Murray mentioned that men have this "room" inside where they wonder whether their spouse loves them as unequivocally as their mother did. When he was trying to negotiate the stairs of his home after his surgery, and struggling like an invalid 90-year-old, his wife cared for him in exactly the unconditional, loving way that his mother might have done.

It occurred to me that his description of how surgery strengthened his marriage was indicative of my own experience. That "room" inside, hidden from view and almost never revealed, is no longer a secret place. My wife, just like Murray's, demonstrated love and concern for me when I was almost invalid in exactly the way my mother might have done.

Not every man is so fortunate. Not every man gets to open that "room" to the daylight, let the sun stream through, open the windows, and do the spring cleaning of the cobwebs we so desperately need. There's yet another unexpected blessing of this thing called cancer.

An Unwanted Journey: Day 0426 - Colorectal Cancer Screening for Ontario

The good news is that Ontario will spend about $193.5 million over 5 years for colorectal cancer screening in the province. The bad news is that only about 20% of people at average risk (over age 50) have been screened for colorectal cancer thus far. It doesn't appear that the government has figures for those with a family history of the disease who have been screened.

Starting in 2008, you will be able to go to your family physician or pharmacist, pick up a fecal occult blood test kit, take the samples, and then mail the sample in to a lab for testing. If the result is positive - meaning that microscopic amounts of blood are found in the stool sample - you will be scheduled for a colonoscopy, a far more definitive, yet more expensive and invasive procedure.

But it's all relative. As the story on CBC has it, over 20,000 people will be diagnosed in Canada with colorectal cancer this year. Of those, about 8,500 will die of the disease. Anything - almost anything at all - that the provincial government can do to introduce better screening is bound to be an improvement over the current situation.

In my case, a colorectal screening program might have gained me 2 more years in diagnosing the problem, maybe even 2 1/2 years. When I turned 50, if my family physician had been mandated to ask me to take a fecal occult blood test or, even better, a colonoscopy, we might have found the tumor at a smaller size and with fewer associated problems. That alone would have saved many thousands of dollars worth of medical treatment, not to mention the anxiety and loss of income for me.

Personally, I don't think the program introduced today goes far enough. In my view, because of the danger associated with delaying screening, it would make more sense to mandate an OHIP number cross-reference for all family members. Anyone 40 and over with a first-degree family relation history of the disease would then have his/her family physician notified of the need for a colonoscopy. That would save lives.

Fecal occult blood tests are better than nothing. I applaud the Ontario government for spending some money to save lives. But, the gold standard is still a colonoscopy, not the FOBT. Why not ensure that those at risk are strongly encouraged to have a scope test by using the OHIP information systems to link family physicians and trigger the suggestion for the test - at 50 for average risk; age 40 for a family history risk?

There may be an objection that the provincial medical records should not be used to cross-reference patients. But the first thing doctors ask is for a family history when trying to diagnose a condition. The disclosure could be anonymous; in other words, the triggering mechanism in the information system could be simply a notification that a first-degree family relation has been diagnosed with colorectal cancer and therefore OHIP is recommending a colonoscopy. The patient will, of course, have the right to deny treatment. But the right of survival seems to far outweigh the dangers of disclosure of private medical information, especially when safeguards can be put in place to help protect privacy.

In my opinion, lives are at stake here, and half-way measures, laudable as they might be, are not good enough!

Organ Donors and Faith Healing

This one's for my wife whose sense of humor is sometimes as wicked as my own, sometimes more so.

We were driving past our church recently and noticed that a new saying had been posted: "Become an organ donor - give your heart to Jesus."

I always find cutesy sayings like that ridiculous, as does everyone in our family. I much prefer the bland: "Worship services at 8:15 and 10:00 am Sundays. Please join us." This particular one was worthy of disdain too, so I responded,

"Tell ya what. I'll give him my heart if he gives me his rectum."

Well that got the whole car laughing, especially in light of my surgery last year. But it led to further discussion about how we perceive faith healing, especially the stuff you see on television. It seems that faith healing is as American as apple pie, the flag, football, and country music. It's the spectacle that matters, not the content.

What I don't understand is how otherwise smart people can be so gullible when it comes to the faith of our fathers. Why, for instance, is it that Jesus is so good at helping people find an empty parking spot at the mall, or dropping their crutches while on stage at a faith healing crusade, but apparently so miserly when it comes to healing serious injuries, replacing body parts removed during surgery, or growing missing limbs? Seems that the creator of the universe shouldn't have more difficulty with one than the other.

I am not saying faith is unimportant. I am not debating the value of prayer, especially for those in need of a healing human touch. I am not saying mystery and awe are to be pushed away in favour of statistical tables. But I am saying that far too much in North American religion is trivial, trite, and worthy of sarcasm.

Fee Ear and Low Think in Lost Wages

"We live in a jungle of pending disasters." - Hunter S. Thompson
"Fiction is often the best fact." - William Faulkner

Blogging is sometimes denigrated as the poor man's journalism. Maybe most bloggers do not write well enough to be hired as professional journalists...well, not maybe...we don't. But if you get hooked as both a consumer and creator of blog entries, it's because you perceive value; professionalism doesn't really matter.

One of the things I value in blogging is its in-your-face subjectivity, its blend of fact and fiction, its often blatant disregard for "just the facts, Ma'am...just the facts." That might explain why I like the blended genres of fantasy and science fiction in literature, the over-the-top, cult-status movies like Fear and Loathing in Las Vegas, or musicians who thumb their noses at the formulaic, opting instead to pick and choose riffs and rhythms from anything that catches their fancy.

I don't like being boxed in. I am still a child who became an autonomous semi-adult in the 60s, still carrying a torch for rebellion, flower power, hippies, and counter-culture - all the while appreciating the rewards of business, industry, and the establishment.

I value the equilibrium of family life and the subversion of the anarchist alike. I love Jesus and embrace Satan. I fear cancer and welcome its blessings.

An Unwanted Journey: Day 0420 - The Good Stuff

My wife. She is a constant, totally trust worthy, a sight for sore eyes, my protector and confidante, and the one person with whom I can bare my soul. During this past year, she has proven herself strong and courageous. Without her, my life would have narrowed considerably. Instead, I feel as though the borders have expanded.

My sons. They are teenagers, but two of the nicest persons I've ever met. They are smart, brave, funny, and keep talking to me, even when it's evident that I haven't the foggiest clue about their favourite musical styles and games. They deign to keep me in the loop and don't complain too much when I talk a little about myself. I am a very proud father.

My friends. They have called, written, commented, and made themselves available whenever I needed them. There are few things worth more than a lifelong relationship with a friend. Thank you.

My work. There are days when the last thing I want to do is go into work; but those are few and far between. Most of the time, my work is such that I come home feeling like I've made a difference and enjoyed doing so. Most of the time, the work is stimulating, challenging, fulfilling, and worthy of extending into some of my private time.

My family. My extended family is a mixed bag, just like everyone else's. You take the good, the bad, and the ugly and make the most of it, simply because that is the nature of family and kinship. Again, most of the time, I wouldn't have it any other way. But there are some who have demonstrated compassion and thoughtfulness far beyond my expectations. That web of connectedness makes even an unwanted journey one of meaning and purpose.

My medical team. You don't think about things like doctors and nurses and medical resources much until the time you need them. Then, they are indispensable. I am so grateful for their knowledge, compassion, and the resources they consume for my benefit.

My blog. Yes, maybe it's a little parochial, but having an outlet to share with all of the people who care about me, having the chance to achieve catharsis through writing, and having the opportunity to combine both without additional expenditures - it's been a true blessing.

An Unwanted Journey: Day 0419 - Another Tumour Board

After the fact, it seemed entirely predictable. The CT scan was "suspicious". The MRI was "suspicious". But neither were definitive. And so my medical oncologist is taking my case to the gastro-intestinal tumour board for review on 26-Jan-2007. The board will then decide what the most appropriate next step should be, but it is highly likely that their opinion will depend on what the surgical oncologist recommends. He has already told me that he wants to do a flexible sigmoidoscopy at the end of March, almost one year exactly after the low anterior resection he performed on 28-March-2006. But the board may suggest he perform the scope test sooner and may also suggest that multiple samples be taken for another biopsy.

Waiting is now what I'm faced with yet again. There's nothing I can do. There's very little anybody can do until this diagnostic phase is complete. But I have lots of experience in knowing what waiting is like.

Even the CEA test will require waiting for about ten days, since the results require sending the sample outside the Grand River Hospital to another lab in London. I know what my CEA was like just before I began treatment last January and I know what it was like near the end of chemotherapy in September. Although it's not a definitive test either, it sometimes helps determine the threat of cancer. In my case, it was at its highest in January 2006 just before treatment and at its lowest at the end of the treatment cycle.

Am I frustrated? Yes, you bet. But I have to keep coming back to the excellence and thoroughness of my medical team and the fantastic resources available to take me through this medical maze.

But I'm also nervous and a little anxious. If we go ahead with another biopsy from multiple samples, and should the pathologist's report determine that I have recurrent rectal cancer, that means more surgery, a colostomy for sure, and the end of natural function in that part of my body. That's regrettable, but it's not what sets the hair on the back of my neck standing. What leaves me cold and frightened is the prospect of a large cancerous growth at the site of the anastomosis within 8 months (30-Nov-2006 was the date of my surveillance colonoscopy) of surgery. That would mean that whatever few cancer cells survived radiotherapy, surgery, and chemotherapy grew wildly. That would mean that my long-term prognosis would be poor - at least that's the way this medical layman sees it.

But, like I said, there's nothing I can do except wait. In the meantime, I will live my live "normally" and hope, yet again, for better times ahead.

An Unwanted Journey: Day 0417 - Are We Worth It?

As many of you know, I read Leroy Siever's blog almost everyday. Not only is Leroy a very good writer and a person whose reflections on battling cancer are thoughtful and insightful, but we are almost the same age and have both had colorectal cancer. Sometimes, I have to admit, especially when I am feeling sorry for myself, I turn to his writing as a kind of tonic and wake-up call - things are simply better for me in my struggle with cancer than they appear to be for Leroy.

By way of example, I am worried about tomorrow's consultation at the Grand River Regional Cancer Centre with my medical oncologist during which we will review the MRI from last Monday. The images should help determine whether or not I am in any danger of recurrent rectal cancer. But Leroy has not only had recurrent cancer, he has had additional tumors appear in his brain, lungs and spine. His doctors have suggested he take his trip to Hawaii soon while he is still well enough to enjoy the vacation. And his consultations, while they are sometimes better than expected, usually would tear me apart emotionally.

But we also share something else. At some point or another, the cost of our treatment has come into question. Leroy's blog entry from yesterday put the issue of whether or not we are worth the effort into stark, almost brutal, perspective.

One woman, named Pam, commented on his blog to "question the morality of expending unknown amounts of resources extending the life of one adult 'victim' who, it appears, has lived a privileged life up to this point." She adds, "Am I alone when I ask this question?"

No, Pam, you're not alone, despite what many have written condemning you on Leroy's blog yesterday. I ask myself that very question. In fact, my family and I have discussed the nature of what we call "problems of luxury" that we have in the western world, including cancer. As Pam knows, if I or Leroy happened to have been born somewhere else in the world that is less privileged, we would probably already be dead from the ravages of cancer, if not something else.

I believe that we have a responsibility to become citizens of the world. I believe we need to grow, well beyond adulthood, so that eventually we can begin to identify with those who suffer, not just in our own family or neighbourhood, but with those half a world away. I believe a global perspective and respect for all humanity, in fact for all life, is one of the omega points for which we strive.

But how do we take that perspective, that sense of moral obligation, down into the details of a life lived here-and-now? It doesn't make any sense to me, for instance, to suggest Leroy or I refuse treatment in the hopes that somehow that money will be spent saving the lives of children in Iraq who might be the victims of a suicide bombing. In fact, try as I might, I can't even imagine how one might renovate our own communities so that someone like me could redirect medical funds to less privileged persons here in my own city.

I don't think, Pam, that the problem is a failure of imagination or morality. I think it is simply a matter of doing what one can with the resources available at the time. I really do believe, despite my occasional misgivings, that my responsibility here-and-now is to fight for my own life as hard as I can and with all the resources I have at my disposal. I have a great deal left to contribute to my family and my community and I am worth a very substantial effort and, dare I say it, a large expenditure of funds to do so.

And so I approach tomorrow with trepidation, realizing that my focus will be parochial, it will be narrow, it will be personal. My wife will come with me, because she too has a focus that is specific to my predicament. My doctor will focus his attention on me and my MRI. And should the news be bad, we will regroup and begin the battle anew, spending money, time, effort, and emotional currency to fight our little battle against cancer, my cancer.

I know I'm not explaining myself well here. But I really do believe that is all we can do, that is what we should do, and that is what we will do.

An Unwanted Journey: Day 0411 - Magnetic Resonance

Today's MRI included two intravenous injections - one was gadolinium used for a second set of images as a radiocontrast agent; the other was buscopan, an anti-spasmodic used to relax the gastrointestinal walls so that no movements occur during the imaging session. Neither seemed to have the stressful side effects of excessive diarrhea following the treatment session. The session lasted for about one hour for the images and another hour waiting to ensure the buscopan didn't have a negative effect on my vision (evidently, it can cause blurred vision in rare cases).

Another phrase used by the MRI technician which I hadn't heard before was "5 gauss line'. MRIs use superconducting magnets with very strong fields. There is a line marked on the floor of the MRI theatre with different coloured tiles on either side of that line. The 5 gauss line indicates an area where extra precautions must be taken to safeguard both the patient and the technician. Pacemakers and some surgical implants may stop working properly or, in the case of implants, torque and cause internal bleeding and pain. Although I didn't see a 10 gauss line, not even watches, library cards, or credit cards may go within that limit.

Still, the experience of an abdominal MRI is something unlike any other medical diagnostic test. Keeping still for upwards of an hour in a claustrophobic tube-like environment while listening to either the voice of the technician in an adjacent room or the industrial pounding of the magnets is something that must be experienced first-hand. Descriptions do not come close to illustrating what it sounds like. The volume of sound can be deafening, sometimes going up to 90 decibels - thank goodness they issue ear plugs!

My experience with MRIs is not nearly as bad as that of other people. The staff at the Grand River Hospital are professional, courteous, and gentle in preparing the patient for the experience. From putting extra pillows under my feet and knees to giving me a breather and cool down period while the gadolinium was injected, the technician did everything possible to make me comfortable. Even so, nothing anyone could do would prepare one adequately.

Now, comes the waiting and anticipating.

Breaking the fourth wall

It's January 7th, no snow on the ground, puddles of rain water accumulating like memories of a lost love. Still, the sun shines through the patio doors, warming thoughts and thighs alike...or maybe the heat is merely the notebook computer resting in just the right place.

Tim Horton's coffee - black, no cream, no sugar - sipped from a cup almost too hot to handle. An iPod recharging and copying selections in preparation for the next venture in our 2004 black-as-night Toyota Camry. Lyrics from Irving Berlin's What'll I Do sitting adjacent to Microsoft's Live Writer where imprints magically appear as I dance across the keyboard. A Macromedia Dreamweaver 8 tutorial sitting, waiting patiently in the background, along with an Adobe Acrobat copy of Leo Tolstoy's War and Peace, like Dreamweaver, expecting attention from the man in front of the screen.

The flat-screen Panasonic Tau, too, sits idle, a DVD splash screen on the Yamaha DV-S5750 player waiting, anticipating: "Press play key to continue." A border terrier expectant, standing by the patio doors, looking attentively at the woman in red "testing" jig-saw puzzle sets for the Christmas season before determining whether to keep them or toss them out with the trash.

The sound of preparations for work in the bakery at the Real Canadian SuperStore in the upstairs bathroom as the tallest of the family showers, shaves, and sips his version of Timmy's - large, single cream.

A quick snippet of conversation about a P.D. James' novel come to the big screen - "Children of Men". Talk about Julianne Moore, Clive Owen, and Michael Caine.

Another few sips of piping hot coffee, another few phrases entered on screen - artifacts of life beyond the fourth wall.

An Unwanted Journey: Day 0409 - "Pick up shirt Monday"

"Vanitas vanitatum, omnia vanitas" - "Vanity, vanity, all is vanity." - Ecclesiastes 1:2

Vanity, pride, hubris - it's been on my mind this past month. As has cancer and its concomitant - death. I have had occasion to feel wounded, not just physically, as I've coped with the omnipresent neuropathy in my hands and feet; not just psychologically, as I've undergone diagnostic tests and medical procedures to determine whether or not I have recurrent rectal cancer; but emotionally, as I've dealt with my own and other people's perceptions of me, my capabilities, and my future.

Feeling wounded leads one to thoughts about the end of life, prospects for an uncertain future, and, I suppose, reflections about vulnerability and the appropriateness of assuming a defensive posture. I guess it's just part of our animal nature - this fight-or-flight response - but what sets us apart from other animals (this is pure anthropomorphic bias, I suppose) is that we are capable of transforming fear and uncertainty into vanity.

Someone recently told me, "You're not a doormat. You have nothing to apologize for. This past year you've worked at the most important thing of all, battling for your life. Never apologize for that." There is truth in that advice, to be sure. But there is another dimension that I can't quite articulate yet that has been hounding me lately. When does self-preservation and bravery become vanity?

The preacher says all is vanity. Is that true?

I've just watched a DVD video from the 1990s television series Northern Exposure. The episode is about Mr. Unknown Person, someone who dies in Cicely, Alaska in Dr. Joel Fleishman's office without any identification and before Joel can even examine him (first aired 22-Apr-1991). Nobody in town knows who he is, but they adopt his dead body, protect it from wolves, and hold a town-wide funeral for him. The other threads of the episode all deal with human vanity, but all of that is put into relief by the death and funeral of Mr. Unknown Person.

I couldn't help but think how pertinent this episode is to my current situation. We are all unknown persons who leave behind us artifacts of our sojourn - things like a slip of paper in our pocket which reads only "Pick up shirt Monday."

This coming Monday, I will undergo yet another diagnostic imaging session in the Grand River Hospital, an MRI to help my medical oncologist determine whether or not the possibility of recurrent rectal cancer is significant. That MRI will be an artifact of my existence, a piece of evidence of my time here and of those who provided medical care for me. But what I've discovered over the past year or so is that I am responsible for providing the context for these medical artifacts to anyone interested. That goes for all the members of my medical team. Each time I go to an appointment, each time I discuss an issue with someone on the phone - I am the only one who can provide the complete context for all those artifacts.

"Pick up shirt Monday." Ultimately, we are all, each and every one of us, Mr. Unknown Person. Only we can weave the meaning and purpose of our journey here. I don't think that is vanity. That's our obligation to ourselves and to those we touch every day of our lives. Our ability to help one another, to care for and provide worthwhile artifacts for each other, depends on a solid sense of our own worth and the importance of the journey we travel.

All I know for sure, as I've thought about this over the past month, is that the artifacts which truly matter are the ones in which we've both preserved our self worth and enhanced that of others. Ultimately, that medical image which will survive me is nothing compared to the memory of a hug and kiss, freely given and freely accepted, along with words like, "I love you, son." Those moments may leave no external record, but they preserve the meaning of life.

Finally, a couple quotes from the TV episode:
Maurice: "A man should not leave this earth with unfinished business. He should live each day as if it was a pre-flight check. He should ask each morning, am I prepared to lift-off?"

Chris: "You've been listening to The Adagio from Beethoven's 7th Symphony. I think Ludwig pretty much summed up death in this one. You know, he had lost just about all his hearing when he wrote it, and I've often wondered if that didn't help him tune into the final silence of the great beyond."

An Unwanted Journey: Day 0407 - MRI: Off Again, On Again

Magnetic resonance imaging provides a superior diagnostic tool to CT scans. And so it appears that my off again, on again MRI follow-up will actually occur next Monday rather than the end of March 2007. The rationale is this. Even though I had a colonoscopy and biopsy in late November in which the pathologist's report stated unequivocally that there was no recurrent cancer in the sample, my medical oncologist wants to be sure. The biopsy and the colonoscopy deal with the interior of the bowel wall, just by the nature of the procedure itself. The MRI will, theoretically at least, allow a good cross-section of the outside of the anastomosis to be revealed to my medical team.

I'm not sure what to think at this point. I'm pleased that my oncologists are so thorough. But I'm also becoming a little nervous again. What if the MRI offers evidence of suspicious tissue on the outside of the bowel wall? Will this mean another biopsy, perhaps a needle biopsy in order to sample tissue from outside the wall? It will be about another ten days from now until I've had another blood test taken and the medical oncologist consults with me about the results of the MRI.

Another reason for concern (again, I'm jumping to conclusions already) is that needle aspiration biopsies have been linked with an increased likelihood of spreading cancer because of the biopsy (fine needle aspiration cytology or FNAC). Sometimes, the suspected tissue is sampled using a combination of a fine needle aspiration technique in which the needle is guided during a CT scan.

OK. So there it is. 2007 starts with another cancer concern, one that, admittedly, may turn out to be absolutely nothing. But...