LCSC Blog

More like in my wallet. After worrying for the past 18 months about possibly losing my health insurance, I finally hit pay dirt - and it didn't hit back. I have received my Medicare card and after I "dissenroll" from my interim "Obama Care" within the next week or so, I will officially join the ranks of the millions who have insured their health - so to speak - with the Federal Government. No more will I ifs, ands, or buts about hospitals, doctors ("medical" actually) and prescription drugs (parts "A", "B" and "D" for those of you unfamiliar with the alphabet soup). Dental and vision coverage I'm not so sure about, but at present, I can live with the coverage that I know I have now because the worst case scenarios have been addressed. And as a former insurance broker, solving and/or protecting against worst case scenarios was always my main concern. To invoke "Speedy" from those long-ago Alka Seltzer commercials: "Plop, Plop, Fizz, Fizz. Oh, what a relief it is." And even though I'm not plopping or fizzing, I am effervescent nonetheless at my arrival.
Reaching milestones (even destinations, sort of) is a way I've measured and evaluated my cancer experience. Not that I keep a chart or even a calendar with Xs marking the days but "I've looked at life from both sides now" (heck, I've looked at life from all sides now and in between, too) and my glass is still half full. I remain positive about my negative and despite having never having seen Joni Mitchell in concert (although I did have tickets to see her at Cole Field House in the 70s; once on stage, however, she realized she was too sick to perform and stage right she went. Occasionally, her songs have spoken to me.
Right now, the United States Government is speaking to me in the form of a red, white, and blue card. They are telling me that I have made it to the promised land, a land whose existence was proposed in 1965 and which became law in 1966 fulfilling promises made to all Americans who reach age 65 that health insurance is their right and not because they were privileged. Nevertheless, I feel privileged to be "Medichere." For 10 years, 10 months and 20 days, dating back to late December 2008 when I first experienced the pain in my rib cage which precipitated my visit to the Emergency Room, I have been under the proverbial gun. Sometimes, it's been holstered. Other times, it's been locked and loaded. So far, no shots have been fired, even though occasionally I've been in very close range. I can't say for sure whether I thought I'd actually get here, but let's be realistic, we all had our doubts. But now it's time to gear up. A tremendous weight has been lifted from my shoulders. All I have to do now is live with the fact that I have stage IV, non-small cell lung cancer, an incurable disease if there ever was one. But here I am, alive and reasonably well.
No more will I have to worry about who, what and where I'm going to be treated. From now on, I'm in charge (like Charles). As a result, I feel as if I've regained a little control of my life. And for a cancer patient originally diagnosed as "terminal," this control is an extraordinarily wonderful feeling. I wish I could bottle it like "Brighto:" "Brighto, Brighto, makes old bodies new. We'll sell a million bottles, woo, woo, woo, woo, woo, woo." (The Three Stooges in "Dizzy Doctors," 1937.) And that's just the kind of silly enthusiasm I'll need living forward. Hardly is the lung cancer I have on the run. I wouldn't even say I have it on the walk. A stagger, maybe. (Or maybe that's me who's staggering when I lose my balance because of the neuropathy in my feet.)
Cancer is an adversary unlike any other. It's going to do what it does. I doubt Medicare is going to scare it into remission. Moreover, my not worrying about having health insurance anymore probably isn't going to have much effect on "the cancer" ("Forrest, Forrest Gump") either. The biggest effect will be on me, emotionally. I just hope that's enough. Because I'm going to need all the ammunition I can muster.

Not to be morbid in the least or self-indulgent in the most (last week's column, "Something or Nothing" not withstanding), but recently I've had cause to hear about the future and be more concerned about the present.
I have a homeowner problem that, like all such problems, is way beyond my limited skills: a crack in the concrete slab which "porches" our house, apparently caused by a very large and old tree growing way too close to this slab. This is not a water-leaking-into-the-house problem. This is a structural-type problem identified by a home appraiser whom I've paid for - but not bought - to process a mortgage refinance. Given the two-week  time-frame during which I was expecting to schedule this assessment - considering the time-sensitivity of these applications, I was flabbergasted to learn that my expectations were totally unreasonable. Two weeks! I might as well have been asking for two months, which is what I ended up getting.
After hearing the nearly identical appointment-unavailability story multiple times, and getting increasingly frustrated and impatient at the unlikely timely resolution of my problem in my lifetime (no joke), I finally heard from a company that was able to schedule an appointment which they did so with an apparent straight face (as much as I could glean over the phone): "I can have someone to your house on October 25." I snickered. "October 25! That's two months," I said. ("I could be dead by then," I said to myself.) To the woman I said, "No. I need someone sooner, in the next week or so. Good-bye." (I made this call on August 21st.) When I hung up the phone, I started laughing at what I didn't say and why I hadn't said it. Being that I have stage IV lung cancer, I am not exactly on firm footing. I didn't say to the woman that I could be dead by then because those words were figuratively speaking a bit to close to my literal reality. It was a case of fiction being a bit too close to fact and my mouth actually being able to cash that check. In addition to providing fodder for this column, my calls to miscellaneous home improvement/concrete/foundation repair companies left me not high, still dry, but totally unrequited. I needed help. I put myself out there and received practically nothing in return. It is a lesson I'll take to the grave.
I don't want to sound unreasonable because I still think I'm of sound mind (not so much sound body), but being diagnosed with cancer does, at least in my experience, move up your timeline, so to speak. There's a certain amount of patience and accommodation that is totally ripped from your subconscious. When your life is in jeopardy, dealing with the daily double life and death becomes extraordinarily difficult, regardless of whether your answers are in the form of questions. The uncertainty of it all is very off-putting. Sometimes, you don't know whether your coming or going. Trying to live a "normal" life under these kinds of constraints - and restraints, can make Jack a very dull boy. And very often this dullness manifests itself in one's inflexibility. When your life is at stake, it's nearly impossible to act as if it isn't. Your brain seemingly gets rewired and re-purposed. As much as you attempt to retain your old and familiar self, this newer cancer-affected version slowly takes over. You're not exactly in "The Twilight Zone," but "imagine if you will" at age 54 and a half, expecting to live into your mid-80's as your both your parents did, instead being told that you have "13 months to two years" to live? Though I've taken it mostly in stride and lived way beyond my oncologist's expectations, to say one's stride is not changed by the experience is to give naiveté a whole new meaning. (Not to mention the fact that the neuropathy in both my feet makes walking extremely difficult.) Nevertheless, life goes on.
As such, as much as I want to plan for the future, sometimes, it's the present for which I need to plan.

That was a close shave, if I may euphemistically characterize my most recent, blade-free brush with cancer-like symptoms, especially considering that I thought my life was at stake. The pain was located around my left-side rib cage, exactly where the pain was on that fateful January 1st, 2009 day when I couldn't ignore it any longer and thus felt compelled to get off the couch and go to the emergency room. Though I didn't have any shortness of breath, or difficulty inhaling, exhaling and bending over (all of which I had back then); nonetheless, I thought the worst and didn't fool around this time and made an appointment with my primary care physician as soon as possible, which was for the following day. I didn't have a great sleep that night but it was somewhat improved knowing I might get an answer the next day.
To say that my life was beginning to pass by is a bit of an overstatement to be sure, but it was moving around a little bit. Trying to bury/compartmentalize what a possible recurrence/resistance to my current standard of treatment would mean before I actually met with a physician and received cancer confirmation was the immediate task at hand. Rationalizing that what symptoms I wasn't experiencing meant something positive/encouraging compared to what I felt 10 and a half years ago was one mental route I was traveling. The other was my usual and customary fall-back position: "It's nothing until it's something."
However, I have to admit 'something.' Though I can't speak for all cancer patients/survivors; for me, in spite of my inherited-from-my-father, positive attitude, being diagnosed with a "terminal" disease, as clearly described by my oncologist back in late February, 2009, creates a sense of inevitability, as does the "13 month to two year" prognosis that followed. Inevitability, as in one's demise (I'll never forget the walking-down-the staircase-with-a-yo-yo example he used) and then death is only a matter of time. Time which you don't have and quality of life which you'll never get back.
And when that 'inevitability' is most clear is when you have symptoms (related to your cancer or not; you don't know definitively, at least I never do), especially if those symptoms are identical to the ones that got you into this jackpot in the first place. So yes, I've had a difficult few days fighting the inevitable feelings and wondering if my amazing good fortune had finally run out. After all, a "terminal" disease doesn't generally mean you go on living a normal life expectancy. Au contraire. It means you don't! And at some juncture, the cancer spreads beyond modern medicine's ability to manage it. Then the patient is given a choice: stop the treatment and try to enjoy your remaining days without side effects, and thereby live a less cancer-centric quality of life with some freedom and independence - and hopefully feel some kind of better. And in those intervening days, try not to worry about the cancer doing what it inevitability (there's that word again) does, which is not cure itself. Or try some experimental treatment and hope for the best.
This is the emotional concern and challenge which hangs over my head. Never more so than when I have the symptoms that I did this past week. Fighting the cancer and fighting these feelings is two much. One at a time I can handle. Handle it I did as I sat in my doctor's office and in great detail, described my symptoms, and explained what I was feeling and what I wasn't. My internal medicine doctor listened intently as he has since the very beginning when I was first diagnosed. He was calm and reassuring in his assessment. My symptoms he said were not cancer-related. They "were muscular," he continued, "on the outside of my lungs." Not lung cancer at all. As such: No lab work. No X-Ray. No CT scan. No nothing. Another reprieve. Life goes on, until...

Although I've had a pretty good run of late not writing much about "the cancer"—to quote "Forrest, Forrest Gump"—the reality is, as you might imagine, cancer is ever present - in your head and in your heart (and for me, in my lungs). Never more so than when your quarterly CT scan is imminent. As I sit and write this column on a Sunday, Wednesday—three days hence—Is what you'd call 'imminent.' Not that there's much preparation; there's not. But with electronic media being what it is, one does receive multiple reminders: text, email, and the occasional call. And even though I don't actually have to do anything in advance, I am reminded nonetheless, in advance, what there is yet to be done: show up! (Apparently, many cancer patients, staff have told me, are not as compliant as you'd expect them to be.)
But it's not the 'advance' or the after that I'm addressing in this column. It's the way before and how a CT's imminence affects one's life. As much as I write and talk/act a good game, living one's life pretending to minimize cancer's presumptive/possible/"prognosed" impact is indeed make believe. Not that I'm a glass half-empty person; I'm not, as you regular readers know. However, there's nothing like a computerized tomography and a post-scan appointment with one's oncologist to focus your attention on the fact that you have been/are living with what your oncologist originally characterized back in early 2009 as a "terminal disease”: non-small cell lung cancer, stage IV (and giving you a "13 month to two year" prognosis to boot). A disease whose initial progression (doctor-speak for growth/movement) eliminated surgery as an option, but one for which there have been multiple lines of chemotherapy, none of which was ever been said to be a cure. In the spirit of that reality, how does one live in the present and plan for the future? (Jeez, that last line sounds right out of one of the Carrie Bradshaw's "Sex and the City" voiceovers.
On the one hand, the one with no sense of reality, I suppose one is simply to go about one's varied business with nary a care or concern in the world. On the other hand, the one with enough a sense of reality to choke a horse, I suppose I am to mark time, count the number of days until my next scan, plan for today and think about tomorrow - but not too many tomorrows as there's no sense getting ahead of oneself or else one will get behind. And if that sounds mixed up, it is. Because for cancer patients "time is a godforsaken paradox." As Captain Katheryn Janeway of Star Trek: Voyager further explained many star dates ago: "The future is the past, the past is the future. The whole thing gives me a headache." And if you do get any headaches, you need to contact your oncologist because in 30% of lung cancer patients, the cancer moves to the brain. A location which presents all sorts of treatment and quality of life challenges. And a manifestation there, should it appear, scares the living daylights out of me. But never mind. Just keep on planning and pretending that you don't have a "TERMINAL" disease. You know, the type of disease for which there's "NO CURE."
Then again, if I do get bogged down by certain realities, I'll be no work and no play - and no fun (neither do I want to be a dull boy). And no fun is no way to live - in the past, present or future, and that's no paradox. So if and when the chips and/or the "chippee" is down, one needs to be thankful for the chips that you do have and for the ones you hope yet to accumulate. Otherwise, you might as well see the cashier on your way out. Life's too short (don't I know it) to live only in the present and not consider the future. And if I don't consider the future, it's unlikely I'll have one. Just because I've now had a past that lasted years longer than I expected shouldn't mean I can't have a future I never anticipated.
 

Except I was not sitting in the audience for "The Price Is Right" when I heard my name called. Nor was I needing to guess the cost of my infusion with my treatment that day contingent on my guess not exceeding the "actual retail price." And neither were there any of "Barker's Beauties" to wave their hands and showcase what items I would be attempting to price right. No. There were only multiple oncology nurses standing in front of the Infusion Center's entry door calling out the names of the next patients lucky enough to begin their treatment. It wasn't exactly "Plinko," but once inside the Center, the fun, such as it is, really begins.
At least that's the way the activity appeared to me. The preceding day was July 4th so the Center was closed forcing those Thursday patients to be rescheduled to either Wednesday or Friday. As a result, the waiting area was particularly full with patients, along with their family and friends, all of whom are encouraged to attend. In the midst of this crowd, I sat and waited. We hadn't exactly been assigned numbers, but we were assigned oncology nurses and therefore could only enter the Infusion Center with their assistance.
Then, while all of us "waiters" looking at the entry door waiting for an oncology nurse to walk through and call our name, the door lock clicked open and out walked two oncology nurses. As soon as they cleared the door and entered the waiting area, they called out their respective patient's names (unfortunately not mine). Upon hearing their names, the two patients and nearly half a dozen of their supporters got up and moved eagerly toward the entry door. It reminded me of the beginning of "The Price Is Right" when three audience members' names are called in quick succession and implored to "Come On Down!" by George Gray (Johnny Olson, the original announcer, retired years ago) and officially become one of that day's contestants.
However, once inside the Infusion Center, It's dead serious. Your life is at stake, maybe even at risk, depending upon your cancer/treatment, and at this point, you're not playing any more games (although occasionally, you may be guessing the price of things and wondering how it all gets calculated). So you slide into your Barcalounger, hold out your arm to have your barcoded wrist ban scanned and prepare for your hopefully, life-saving infusion, and don't smoke 'em, even if you got 'em.
It's rare that you'll see your oncologist in the Center. Typically, they'll be seeing patients in examining rooms, performing surgery or rounding in local hospitals. But they're always a phone call away should the nurses need any additional instructions or clarification. Generally speaking, once inside the Center, all goes as anticipated for us patients: you're in, you're treated, you're out. And when you're out, new patients names are called and on and on it goes, just like "The Price Is Right," except the program doesn't end in an hour. And just like "The Price Is Right," where there are no shortage of audience members wanting to participate, at the Infusion Center, likewise, there seems not to be a shortage of patients wanting to be treated either. (Granted. it's not exactly the same thing, but you get my drift, I'm sure.)
Cancer is not fun, nor funny, and an Infusion Center is not filled with anticipation of cash awards and magnificent trips. There is however, lots of empathy and understanding - from your support system and from staff as well. But it's the last place you want to be, unlike "The Price Is Right."
 

As I half expected, with my oncologist out on vacation this week, he and the endocrinologist didn't speak. As a result, after sitting in the examining chair, the first question the doctor asks is, "So you have thyroid cancer?" I snickered and said something like "Hopefully," before I began to elaborate. Though she had access to my medical records, I can't say she was prepped and ready for our appointment. As she listened to my story, I could she see was simultaneously trying to review my medical history on her computer. In fact, as I hemmed and hawed in response to some of her medical questions, I kept saying/pointing to her computer for her to get the proper answer.
Nevertheless, eventually we were able to move forward in the determination of exactly what kind of cancer I have: thyroid cancer or lung cancer - or both (it's possible, she said). To that end-result, the doctor performed a biopsy on my "Adam's Apple" tumor, as I call it. The biopsy I had two weeks prior was from a lymph node. The results from which caused my oncologist to call me with his "exciting news." Apparently, those results were not enough for the endocrinologist (who had never seen me before) to make a definitive judgment, so in her office, that day, this second biopsy was performed. Fine with me since a second biopsy from a different tumor is absolutely moving the ball forward, as it is so often said these days; I just hope it leads to a touchdown instead of another possible fumble.
For the last nearly 11 years, I've been diagnosed with non-small cell lung cancer, stage IV. Now after two biopsies, not so much. Right now, the assessment of my cancer status is somewhere between a definite maybe and a confirmed I don't know. Will I now know - in another week's time (when the results of this most recent biopsy are confirmed) - whether my non small cell lung cancer is actually thyroid cancer or will there be additional biopsies, additional diagnostic scans, injections of isotopes, etc., to make a once-and-for-all confirmation of what the heck is going on (or has been going on) in my body? If so, it's been a long time coming. I first went to the emergency room Jan. 1, 2009 so it's sort of an anniversary of sorts as I write this column. I'd just as soon we get it right this time, if in fact it was ever wrong.
I have a few questions, some of which were answered by the endocrinologist. Yes, I can have two types of cancer. Could my lung cancer have changed to become thyroid cancer? No. And the underlying curiosity/question: During this cancer life that I have lived, I have been told, and seen multiple times on discharge-type paperwork I've received, that I have "metastatic cancer" meaning that the cancer has moved. Moreover, when one considers the staging aspect, my cancer was stage IV. Stage IV means, among "relevancies" (like inoperable), that the cancer has moved from its "primary " location. I remember asking my oncologist where did my lung cancer come from (I'm a lifelong non-smoker with no cancer history in my immediate family). His answer, if I recall correctly, and I may not due to "chemo brain," a confirmed side effect of chemotherapy, was that he didn't know, and if I further recall correctly, he wasn't particularly interested in finding out and accordingly no additional tests were ordered. Perhaps we misunderstand the need to know now or misunderstood the answers we were given then (Feb., 2009). But as of this past Friday, Team Lourie is sort of wondering as was the endocrinologist.
As of this moment, our focus is on hearing back from the endocrinologist. With the New Year's holiday/truncated week ahead, I expect we'll hear sometime during the first week of January. Until then, we'll try to move forward. What's done is done and we'll hear back when we hear back. I have what I have (and have had what I've had) and right now, all we can do is wait.
That being said, we are having a little difficulty restraining ourselves. We can't get past the fact that my oncologist called us in the first place, and in the last place, if he wasn't so sure, why call us and get our collective hope sky high? Why go out on such a presumptive limb? In spite of that call, somehow, we have to internalize and compartmentalize and try to synthesize fact from fiction. So far, it's proving extremely difficult.

More like in my wallet. After worrying for the past 18 months about possibly losing my health insurance, I finally hit pay dirt - and it didn't hit back. I have received my Medicare card and after I "dissenroll" from my interim "Obama Care" within the next week or so, I will officially join the ranks of the millions who have insured their health - so to speak - with the Federal Government. No more will I ifs, ands, or buts about hospitals, doctors ("medical" actually) and prescription drugs (parts "A", "B" and "D" for those of you unfamiliar with the alphabet soup). Dental and vision coverage I'm not so sure about, but at present, I can live with the coverage that I know I have now because the worst case scenarios have been addressed. And as a former insurance broker, solving and/or protecting against worst case scenarios was always my main concern. To invoke "Speedy" from those long-ago Alka Seltzer commercials: "Plop, Plop, Fizz, Fizz. Oh, what a relief it is." And even though I'm not plopping or fizzing, I am effervescent nonetheless at my arrival.
Reaching milestones (even destinations, sort of) is a way I've measured and evaluated my cancer experience. Not that I keep a chart or even a calendar with Xs marking the days but "I've looked at life from both sides now" (heck, I've looked at life from all sides now and in between, too) and my glass is still half full. I remain positive about my negative and despite having never having seen Joni Mitchell in concert (although I did have tickets to see her at Cole Field House in the 70s; once on stage, however, she realized she was too sick to perform and stage right she went. Occasionally, her songs have spoken to me.
Right now, the United States Government is speaking to me in the form of a red, white, and blue card. They are telling me that I have made it to the promised land, a land whose existence was proposed in 1965 and which became law in 1966 fulfilling promises made to all Americans who reach age 65 that health insurance is their right and not because they were privileged. Nevertheless, I feel privileged to be "Medichere." For 10 years, 10 months and 20 days, dating back to late December 2008 when I first experienced the pain in my rib cage which precipitated my visit to the Emergency Room, I have been under the proverbial gun. Sometimes, it's been holstered. Other times, it's been locked and loaded. So far, no shots have been fired, even though occasionally I've been in very close range. I can't say for sure whether I thought I'd actually get here, but let's be realistic, we all had our doubts. But now it's time to gear up. A tremendous weight has been lifted from my shoulders. All I have to do now is live with the fact that I have stage IV, non-small cell lung cancer, an incurable disease if there ever was one. But here I am, alive and reasonably well.
No more will I have to worry about who, what and where I'm going to be treated. From now on, I'm in charge (like Charles). As a result, I feel as if I've regained a little control of my life. And for a cancer patient originally diagnosed as "terminal," this control is an extraordinarily wonderful feeling. I wish I could bottle it like "Brighto:" "Brighto, Brighto, makes old bodies new. We'll sell a million bottles, woo, woo, woo, woo, woo, woo." (The Three Stooges in "Dizzy Doctors," 1937.) And that's just the kind of silly enthusiasm I'll need living forward. Hardly is the lung cancer I have on the run. I wouldn't even say I have it on the walk. A stagger, maybe. (Or maybe that's me who's staggering when I lose my balance because of the neuropathy in my feet.)
Cancer is an adversary unlike any other. It's going to do what it does. I doubt Medicare is going to scare it into remission. Moreover, my not worrying about having health insurance anymore probably isn't going to have much effect on "the cancer" ("Forrest, Forrest Gump") either. The biggest effect will be on me, emotionally. I just hope that's enough. Because I'm going to need all the ammunition I can muster.

More like in my wallet. After worrying for the past 18 months about possibly losing my health insurance, I finally hit pay dirt - and it didn't hit back. I have received my Medicare card and after I "dissenroll" from my interim "Obama Care" within the next week or so, I will officially join the ranks of the millions who have insured their health - so to speak - with the Federal Government. No more will I ifs, ands, or buts about hospitals, doctors ("medical" actually) and prescription drugs (parts "A", "B" and "D" for those of you unfamiliar with the alphabet soup). Dental and vision coverage I'm not so sure about, but at present, I can live with the coverage that I know I have now because the worst case scenarios have been addressed. And as a former insurance broker, solving and/or protecting against worst case scenarios was always my main concern. To invoke "Speedy" from those long-ago Alka Seltzer commercials: "Plop, Plop, Fizz, Fizz. Oh, what a relief it is." And even though I'm not plopping or fizzing, I am effervescent nonetheless at my arrival.
Reaching milestones (even destinations, sort of) is a way I've measured and evaluated my cancer experience. Not that I keep a chart or even a calendar with Xs marking the days but "I've looked at life from both sides now" (heck, I've looked at life from all sides now and in between, too) and my glass is still half full. I remain positive about my negative and despite having never having seen Joni Mitchell in concert (although I did have tickets to see her at Cole Field House in the 70s; once on stage, however, she realized she was too sick to perform and stage right she went. Occasionally, her songs have spoken to me.
Right now, the United States Government is speaking to me in the form of a red, white, and blue card. They are telling me that I have made it to the promised land, a land whose existence was proposed in 1965 and which became law in 1966 fulfilling promises made to all Americans who reach age 65 that health insurance is their right and not because they were privileged. Nevertheless, I feel privileged to be "Medichere." For 10 years, 10 months and 20 days, dating back to late December 2008 when I first experienced the pain in my rib cage which precipitated my visit to the Emergency Room, I have been under the proverbial gun. Sometimes, it's been holstered. Other times, it's been locked and loaded. So far, no shots have been fired, even though occasionally I've been in very close range. I can't say for sure whether I thought I'd actually get here, but let's be realistic, we all had our doubts. But now it's time to gear up. A tremendous weight has been lifted from my shoulders. All I have to do now is live with the fact that I have stage IV, non-small cell lung cancer, an incurable disease if there ever was one. But here I am, alive and reasonably well.
No more will I have to worry about who, what and where I'm going to be treated. From now on, I'm in charge (like Charles). As a result, I feel as if I've regained a little control of my life. And for a cancer patient originally diagnosed as "terminal," this control is an extraordinarily wonderful feeling. I wish I could bottle it like "Brighto:" "Brighto, Brighto, makes old bodies new. We'll sell a million bottles, woo, woo, woo, woo, woo, woo." (The Three Stooges in "Dizzy Doctors," 1937.) And that's just the kind of silly enthusiasm I'll need living forward. Hardly is the lung cancer I have on the run. I wouldn't even say I have it on the walk. A stagger, maybe. (Or maybe that's me who's staggering when I lose my balance because of the neuropathy in my feet.)
Cancer is an adversary unlike any other. It's going to do what it does. I doubt Medicare is going to scare it into remission. Moreover, my not worrying about having health insurance anymore probably isn't going to have much effect on "the cancer" ("Forrest, Forrest Gump") either. The biggest effect will be on me, emotionally. I just hope that's enough. Because I'm going to need all the ammunition I can muster.

Off we go - or not, into the wild blue yonder. It seems that my most recent CT scan's results, described as "a little worse" by my oncologist, are indeed cause for some reflection and change. (I'm not quite able to say "cause for concern" yet.) As such, to make the most effective change, per my oncologist's orders, I am scheduled for a needle biopsy on the Wednesday this column publishes. This procedure will determine, if there is a match, to the specific type of cancer tumor that I have. (Without boring you with too many details, the short version is that all cancer tumors are not alike. Biomarkers/genetic mutations such as ALK, BRAF, EGFR, NTRK, PD-L! and ROS1 are the most common, and certain medicines work better against certain tumor types. Variations in the tumor types, such as the ones I've described, is a relatively recent discovery in lung cancer research.)
What this research has led to is another new kind of cancer treatment known as "targeted therapy." This means rather than "flying blind"--to use one of my brother, Richard's, favorite expressions--and employing a one-size-fits-all kind of approach to treatment, oncologists now have specific medicines to infuse when the tumor's genetic mutation is confirmed. Wednesday, hopefully, will confirm something. However, researchers have not discovered all the tumor types so it's possible that this biopsy will reveal nothing useful for me and in effect, I'll be back to square one-ish.
As for what 'square-one-ish' means? It means that I'll likely be infusing medicines that previously worked for a time but whose infusions were stopped after they all ran their successful course years ago. As I've been told whenever this change became necessary, cancer cells eventually figure out what's happening to them and then the tumors begin growing. Once this growth is indicated on the CT scan, a new medicine is usually started, and on and on it goes until, apparently now, for me anyhow. "Targeted therapy" offers lots of new medicines. I just need a match. Unfortunately, there's no guarantee the biopsy will provide just such a match. There's only one way to find out. On Wednesday, we will begin to find out. To say I have a lot riding on this determination is the understatement of the year; at least for Team Lourie, it is. If I'm forced to repeat infusions from medicines that stopped working years ago, it'll be "Katie, bar the door," as we say in Boston which means, "Look out!"
I'm trying not to 'look out' though. I'm trying not to look anywhere, except straight ahead. Just because my life may be at stake, is no time to deviate from the norm that has been my modus operandi over the past 11 years. I'm not quite ready to consider that my stage IV lung cancer survival is coming to an end. Maybe it's just staggering and within a week or so, I'll get my bearings again. New medical information getting me new medical treatment is sure to put a bounce back in my step. For the first time in 11 years, to quote George Costanza from Seinfeld: "I'm back, baby." This could be the jolt my body needs to get me through to the next research level. The Team Lourie strategy has always been for me to try and live long enough to reach the next medical breakthrough. So far, I've benefited from a few: tarceva, avastin and alimta; all miracle drugs according to my oncologist, and here I am, living proof that it has all worked.
Until I hear, post procedure, from my oncologist, in the interim, I am re-experiencing many what-happens-if-and-when emotions that I've not wrestled with for years. Unfortunately, this hospital visit is taking me back to the visit/biopsy I had in Feb. 2009 which confirmed the malignancy in my lungs in the first place. And here I am, hopefully not in the last place, waiting for the results of a biopsy yet again. It didn't work out so good in 2009. I just hope I have better luck in 2019.

Off we go - or not, into the wild blue yonder. It seems that my most recent CT scan's results, described as "a little worse" by my oncologist, are indeed cause for some reflection and change. (I'm not quite able to say "cause for concern" yet.) As such, to make the most effective change, per my oncologist's orders, I am scheduled for a needle biopsy on the Wednesday this column publishes. This procedure will determine, if there is a match, to the specific type of cancer tumor that I have. (Without boring you with too many details, the short version is that all cancer tumors are not alike. Biomarkers/genetic mutations such as ALK, BRAF, EGFR, NTRK, PD-L! and ROS1 are the most common, and certain medicines work better against certain tumor types. Variations in the tumor types, such as the ones I've described, is a relatively recent discovery in lung cancer research.)
What this research has led to is another new kind of cancer treatment known as "targeted therapy." This means rather than "flying blind"--to use one of my brother, Richard's, favorite expressions--and employing a one-size-fits-all kind of approach to treatment, oncologists now have specific medicines to infuse when the tumor's genetic mutation is confirmed. Wednesday, hopefully, will confirm something. However, researchers have not discovered all the tumor types so it's possible that this biopsy will reveal nothing useful for me and in effect, I'll be back to square one-ish.
As for what 'square-one-ish' means? It means that I'll likely be infusing medicines that previously worked for a time but whose infusions were stopped after they all ran their successful course years ago. As I've been told whenever this change became necessary, cancer cells eventually figure out what's happening to them and then the tumors begin growing. Once this growth is indicated on the CT scan, a new medicine is usually started, and on and on it goes until, apparently now, for me anyhow. "Targeted therapy" offers lots of new medicines. I just need a match. Unfortunately, there's no guarantee the biopsy will provide just such a match. There's only one way to find out. On Wednesday, we will begin to find out. To say I have a lot riding on this determination is the understatement of the year; at least for Team Lourie, it is. If I'm forced to repeat infusions from medicines that stopped working years ago, it'll be "Katie, bar the door," as we say in Boston which means, "Look out!"
I'm trying not to 'look out' though. I'm trying not to look anywhere, except straight ahead. Just because my life may be at stake, is no time to deviate from the norm that has been my modus operandi over the past 11 years. I'm not quite ready to consider that my stage IV lung cancer survival is coming to an end. Maybe it's just staggering and within a week or so, I'll get my bearings again. New medical information getting me new medical treatment is sure to put a bounce back in my step. For the first time in 11 years, to quote George Costanza from Seinfeld: "I'm back, baby." This could be the jolt my body needs to get me through to the next research level. The Team Lourie strategy has always been for me to try and live long enough to reach the next medical breakthrough. So far, I've benefited from a few: tarceva, avastin and alimta; all miracle drugs according to my oncologist, and here I am, living proof that it has all worked.
Until I hear, post procedure, from my oncologist, in the interim, I am re-experiencing many what-happens-if-and-when emotions that I've not wrestled with for years. Unfortunately, this hospital visit is taking me back to the visit/biopsy I had in Feb. 2009 which confirmed the malignancy in my lungs in the first place. And here I am, hopefully not in the last place, waiting for the results of a biopsy yet again. It didn't work out so good in 2009. I just hope I have better luck in 2019.

Given the extremely sad experience I shared with you all in last week's column: "Chino Lourie, Rest in Peace," this column will be an attempt to bounce back to my usual and customary reality, one oddly enough that has nothing to do with cancer (well, much, anyway). Instead it has to do with unexpected joy.
The joy to which I refer has to do with a subject which typically provides me little joy: I refer to our two automobiles, a 2000 Honda Accord and a 2018 Audi A4. The former inherited from my parents, payment-free but  rarely hassle-free, the latter not free of payments, unfortunately, but free of hassle since its maintenance is covered by the warranty.
Nevertheless, for the past few years, off and mostly on, both cars have had an indication that all was not right. Each had illuminated dashboard warning lights (aka "idiot lights"), constantly reminding the driver that attention to some detail was required. For the Honda, it was twofold, a "Main't Req" light and a "Brake" light " were dashing." For the Audi, it was "onefold," an icon which looks like an upside down horseshoe, sort of, which I learned, after thumbing through the owner's manual, meant low tire pressure, appeared directly under the speedometer. Since I felt no give or take with the Honda and saw no evidence of low tire anything with the Audi, I learned to take their reminders in stride and figured I'd wait until their respective next service calls to respond to them.
Those service calls have now occurred. And I am extremely glad and relieved to say that their necessary/underlying repairs have been made. Glad/relieved not so much because the repairs/obvious safety issues have been addressed. Rather, glad/relieved that in making those repairs, the dashboard warning lights are no longer illuminating their disdain with the idiot behind the wheel: me, neglecting them.
No more, after starting either car, will my initial focus be on the dashboard to see if miraculously the warning lights have disappeared and finally stopped their incessant, non-verbal badgering. No more will I be forced to ignore their illumination and attempt to compartmentalize their visual reminders that all is not well under the hood (so to speak). And finally, no more will I have to worry that one day - or night, the other mechanical shoe will drop and I or my wife will be left stranded on the road somewhere waiting for a tow truck to drag us to our car-repair maker.
And though this dashboard-warning-light-turn-off is really a turn-on, I am still able to keep its effect in perspective. It's not a cure for cancer and neither it is a cure for my "stable" issue as written about multiple times recently ("Please Relief Me" and "Apparently, Not a Stable Genius"). However, as we say in sales: "I'll take a yes;" as they say on the high seas: "Any port in a storm;" and has been said for the last century: "Don't look a gift horse in the mouth." For the official record, I am not horsing around in the least when I say how thrilled I am now that every time I start our cars, I see no lights reminding me what an idiot I've been. As a cancer patient, I don't need that kind (or any other kind, quite frankly) of negativity in my life, or in my car either. Eliminating it from my activities of daily living adds a bounce to my step and a joie to my vivre.
I realize I may be over stating the significance of this momentous occasion, but when cancer takes over your life, it does so emotionally before it does so physically. As such, finding relief is HUGE. Moreover, solving a problem, however insignificant in the scheme of things it appears to be, provides the building blocks of success that, as a cancer patient, help strengthen your foundation as you navigate your daily routine. A routine which is already filled with enough challenges. So yes, I am going to make a mountain out of a molehill. And I am going to fill myself up with as much positivity, nonsensical or otherwise, as possible.
I need to be pulled forward, not dragged backward.
 
 
 

I never want to look a gift-oncologist in the mouth or take a "stable"-type CT scan with a grain of salt, however; self-preservation is a funny instinct. It can change from day to day (heck, even hour to hour) and dominate your pre-occupation or intrude your thinking not at all.  You can rationalize away the good, bad or indifferent (results) or irrationalize away the less-than-expected or the more-than-anticipated. Results from lab work and/or diagnostic scans are the axis on which your entire life revolves. You either roll with the punches or you get knocked down by them. For a cancer patient, the punches often keep coming.
The punches thrown in my direction occur bi-weekly when I have my pre-immunotherapy lab work for my every other Friday 30-minute opdivo infusion. (Although the actual lab work and even the infusion is more of a jab.) The left hook/right cross combination occurs quarterly. That's when I slide through the computerized tomography scan and wait for results (as I had been for most of the last week). Since I have generally been asymptomatic - other than for miscellaneous side effects from the various medicines with which I've been infused - the tale of the tape, to continue the boxing references, happens when my oncologist emails the radiologist's report to me with a brief sentence summary: "a little worse" (this time), "stable," or something less discouraging that needs to be discussed at our next face-to-face appointment which generally is scheduled a week or so after the previous week's scan.
Regardless of what these mostly cryptic emails have said, until I hear exactly what my oncologist says, I am neither too high or too low. Granted, hearing "stable" is extremely encouraging whereas "a little worse," not so much. Nevertheless, the fight goes on. Cancer treatment is a series of actions and reactions (punches and counter punches, you might even say) so depending on how one's body reacts, determines what action is recommended. I am living proof, literally. Over my nearly 11 years of treatment, I have been infused with upwards of a dozen medicines. Once one treatment loses its luster, we change to another, hoping it will be more effective, and so on. It's science, not arithmetic. As such, any guarantees left the building with Elvis.
Being a cancer patient is not for everybody. One has to make the most of the least. It's easy to let the hard facts make you soft. Unless you find a way to be up, the cancer will take you down. Somehow, even when it's doing the worst to you, you have to be at your best. Being positive generates positivity in return. When I look at people, I try to smile so that they'll smile back (I'm being selfish, really). Do you remember George Costanza describing the look of disappointment on his mother's face when he told her he wanted to play the accordion?  Like that, only the complete opposite.
When I interact with people, I don't want them feel "poor, poor, pitiful me" to quote Warren Zevon from his song first sung in 1976. And I don't want them to see cancer either. I want them to see everything about me. I may be diagnosed with a terminal form of cancer: stage IV, non-small cell lung cancer, but I don't want to be defined by it. Just because I'm living with cancer doesn't mean it's who I am. It's what I have, that's all.
And what reminds most me that I have cancer and what challenges my reactions to it more than anything, is when I have these quarterly CT scans (and the annual MRI, too). As much as I try to fend off the possible effect on my mortality (my true sense of insecurity), I'd be lying if I said I was always successful. In truth, I'm always worried about it. How could I not be? I guess I'm not quite ready to throw in the towel. I suppose that means, regardless of what my oncologist says at our next meeting, I'm still ready to live and fight another day.
 
 

As difficult as the last few weeks have been, with Chino's at-home hospice-type care and ultimate passing and the "Catch-22 A" realities of "reverse-mortgaging" my house "perplexed" by the "derelicht" stable/shed on my property, my upcoming quarterly CT scan hasn't even "blipped" the radar. Though it will have occurred already by the time this column prints, it's quite possible, due to the Thanksgiving holiday, its results won't be known for much longer, 12 days in fact, than has been customary. And so far, between my wife, Dina and I, none of this has even been discussed. Yet, as I sit and write on Sunday, the scan is on Wednesday, three days away. Close enough to where it should have been front and center instead of where it's been: back and off to the side.
But so what, really? My attitude is, and has always been, to quote John, a close friend: "It is what it is, and it will be what it will be." By the time I slide forth and back under the CT scan's arch, or earlier I imagine, the damage to my body such as it is - or isn't, will have been done. Either the cancer has grown/spread or it hasn't. Certainly hearing and/or reading results from the oncologist will confirm facts at present not in evidence, but there is, without being particularly negative about my circumstances, an inevitability to it. One day, my amazing nearly 11-year run is going to come to a walk and eventually to a lie down. And I will deal with it when the time/results come. In the interim however, this next scan is merely another stop on the less-than Merry Go 'Round.
I don't mean to make light of an extremely heavy burden that us cancer patients have to carry: the prospect of death. As Lee J. Cobb said in The Exorcist: "I only mention it in passing." Cancer causes enough internal problems (physically), one doesn't need, if possible (and so far for me, it has been possible) to cause external (emotional) problems as well. Maybe it's a kind of resignation or some kind of accommodation or acceptance of reality that has enabled this one to have lived so long beyond my original "13 month to two-year" prognosis (offered up on Feb. 27, 2009), an accomplishment I am proud to say occasionally has led to my oncologist showing me off to his medical students; his prize cow, I call myself.
Honestly, what's the point, really? I'm only in control of so much. Focusing on things I can't control seems a waste of time and energy. Life is precious. Why dwell on things beyond my reach? Grasping at straws, if you can even find one, is likewise counter-productive. And setting oneself up for failure or disappointment is counter-intuitive almost. Why do that? The cancer is already causing enough havoc in your body. Don't let it affect your mind too. "Piling on," as the NFL referees used to call this major infraction. Now I believe its called "Unnecessary Roughness." For cancer patients, doing anything, physically or emotionally to hasten your demise/adversely affect your quality of life is most definitely unnecessary roughness and should be penalized.
Learning to live with what ails you seems a more prudent plan than "woeing" is me or bemoaning the process. Sure, we'd all love to be on the President's plan where you're examined in the morning, scanned in the afternoon and operated on in the evening. But none of us are on the plan and wishing we were, to quote Jean Luc Picard from "Star Trek: Next Generation," is not going to "Make it so." But I can live with that. I have lived with that for almost 11 years now and counting. I'll learn the results from my scan soon enough. Good or bad, life goes on. To quote my friend John's daughter, Melanie: "Whatever."
 

Given the extremely sad experience I shared with you all in last week's column: "Chino Lourie, Rest in Peace," this column will be an attempt to bounce back to my usual and customary reality, one oddly enough that has nothing to do with cancer (well, much, anyway). Instead it has to do with unexpected joy.
The joy to which I refer has to do with a subject which typically provides me little joy: I refer to our two automobiles, a 2000 Honda Accord and a 2018 Audi A4. The former inherited from my parents, payment-free but  rarely hassle-free, the latter not free of payments, unfortunately, but free of hassle since its maintenance is covered by the warranty.
Nevertheless, for the past few years, off and mostly on, both cars have had an indication that all was not right. Each had illuminated dashboard warning lights (aka "idiot lights"), constantly reminding the driver that attention to some detail was required. For the Honda, it was twofold, a "Main't Req" light and a "Brake" light " were dashing." For the Audi, it was "onefold," an icon which looks like an upside down horseshoe, sort of, which I learned, after thumbing through the owner's manual, meant low tire pressure, appeared directly under the speedometer. Since I felt no give or take with the Honda and saw no evidence of low tire anything with the Audi, I learned to take their reminders in stride and figured I'd wait until their respective next service calls to respond to them.
Those service calls have now occurred. And I am extremely glad and relieved to say that their necessary/underlying repairs have been made. Glad/relieved not so much because the repairs/obvious safety issues have been addressed. Rather, glad/relieved that in making those repairs, the dashboard warning lights are no longer illuminating their disdain with the idiot behind the wheel: me, neglecting them.
No more, after starting either car, will my initial focus be on the dashboard to see if miraculously the warning lights have disappeared and finally stopped their incessant, non-verbal badgering. No more will I be forced to ignore their illumination and attempt to compartmentalize their visual reminders that all is not well under the hood (so to speak). And finally, no more will I have to worry that one day - or night, the other mechanical shoe will drop and I or my wife will be left stranded on the road somewhere waiting for a tow truck to drag us to our car-repair maker.
And though this dashboard-warning-light-turn-off is really a turn-on, I am still able to keep its effect in perspective. It's not a cure for cancer and neither it is a cure for my "stable" issue as written about multiple times recently ("Please Relief Me" and "Apparently, Not a Stable Genius"). However, as we say in sales: "I'll take a yes;" as they say on the high seas: "Any port in a storm;" and has been said for the last century: "Don't look a gift horse in the mouth." For the official record, I am not horsing around in the least when I say how thrilled I am now that every time I start our cars, I see no lights reminding me what an idiot I've been. As a cancer patient, I don't need that kind (or any other kind, quite frankly) of negativity in my life, or in my car either. Eliminating it from my activities of daily living adds a bounce to my step and a joie to my vivre.
I realize I may be over stating the significance of this momentous occasion, but when cancer takes over your life, it does so emotionally before it does so physically. As such, finding relief is HUGE. Moreover, solving a problem, however insignificant in the scheme of things it appears to be, provides the building blocks of success that, as a cancer patient, help strengthen your foundation as you navigate your daily routine. A routine which is already filled with enough challenges. So yes, I am going to make a mountain out of a molehill. And I am going to fill myself up with as much positivity, nonsensical or otherwise, as possible.
I need to be pulled forward, not dragged backward.
 
 
 

When I heard this word used recently, twice, I thought it was one of my father's made-up words like "surgerize" and "confliction" risen from his memory to finally enter the world of Merriam-Webster. And so they have, sort of. Apparently, "maturation" is a word some doctors use to answer any and all questions asked by patients inquiring as to why something or other health-wise is happening to them. In short, "maturation" means wear and tear. If Mick Mulvaney were the doctor, he might have said: "It happens all the time. Get over it!" Fortunately, he wasn't. Rather, he is the acting White House Chief of Staff, a man who likewise may be asking his doctor a few questions. The answers to which will likely not be "maturation." "What were you thinking?" might be first and foremost.
For a cancer patient (yours truly) who has survived above and beyond the call of his oncologist's original prognosis, "maturation" - to quote Boston Red Sox television announcer and Hall of Famer, Dennis Eckersley - "Is a beautiful thing." Diagnosed at age 54 and a half when all bodily functions were "performing within normal parameters" - to quote Commander Data from "Star Trek: Next Generation" - thinking I'd outlive my original prognosis from late February, 2009, and have senior-type moments 10-plus years later, was unrealistic, if I were to interpret my oncologist's rather grim demeanor. Yet here I am, Medicare card in wallet and still writing cancer columns as if cancer was only an astrological sign rather than the dreaded and feared disease, that it is. However, having cancer doesn't mean that I don't experience similar aches and pains as the rest of you. It simply means "Other than that, Mrs. Lincoln, how was the play?" A sarcastic reference to the fact that other things are still occurring, despite the obvious. Cancer doesn't preclude other older age medical realities from rearing their predictable ugly head: gray hair, bone loss, muscle weakness, memory loss, to name a few; it just complicates them and, in so doing, confuses you.
It complicates them by ignoring them for fear that they are cancer-related and thus life-threatening and visiting a doctor would merely confirm your worst fear: dying/death, an upside down version of what you don't know not hurting you. And by neglecting to see a doctor, the symptoms (for me, it was a pain in my upper left arm/shoulder which turned out to be a rotator cuff problem) become worse and more severe than otherwise would have become if you simply went to the doctor in the first place, and you end up suffering needlessly because it's actually not cancer, it's "maturation.'' So you're confused like "Bob's Big Boy" used to be: You don't know whether to stay or go.
When you're diagnosed with a "terminal" disease," you want to live, but it's extremely difficult not to think about dying. It dominates your brain and preoccupies your mind. Old age and living a full retirement become signposts in the distance that you can never quite read. And since you can never quite read them, you're not really prepared for what they say. Some of what they say or infer is that you're going to be visiting doctors more regularly than you ever have, and it's not necessarily all bad. It's merely a sign of your times which are now changing and you're living beyond a certain age, unexpected as it may have initially been suggested. As such, maintenance will be required to keep the older body and brain functioning. Ignoring symptoms, as my doctors have made clear to me, is NOT GOOD. Neither is assuming that such and such or so and so is good, bad or indifferent. It is what it is and It may be something or it may be nothing. Presuming facts and feelings which are not yet in evidence is a bit like putting the cart in front of the horse.
I know I'm afraid of dying. What these more recent pains and subsequent visits to the doctors have also shown me is that I can't be afraid of living.

Let me get this out of my system because until I do, I won't be able to write about anything else. Not to worry. This is not a cancer column. I am fine until they tell me otherwise which occurs every eight weeks after my bi-monthly CT scan tells the tale of the tape.
No, this column is about my lack of understanding and business acumen which twice has led me down the garden path only to be asked to leave before I got to smell any of the pretty flowers. Once (twice, actually) had to do with attempts at refinancing this old house (carbon dated to approximately 1750, according to a plaque the previous owner hung to the right of the front door), and most recently (also twice) to do with reverse-mortgage financing this same now older house.
With respect to the attempts at refinancing, I will make this short and not particularly sweet. Without getting into the lead paint, bathrooms, roof, door and window issues, it always perplexed me that if I could afford to pay $1800 per month at 6.75% interest, I could probably afford to pay $1400 per month at 3.75% interest. However, and this is where my lack of common banking sense manifests itself; my presumptive inability to pay $400 less per month was problematic for the lenders to be. And an over 800 credit rating did nothing to dissuade the lender's notion that whatever financial wherewithal I had exhibited over the previous 30-plus years was irrelevant borrowing forward.
As concerns the current issue: the reverse mortgage. To say my financial life depends on its approval might be a bit of an exaggeration, but not if you're in my shoes, even occasionally. I can understand the need for the installation of safety rails on the left and right side of the staircase going down to the basement. And grudgingly, I can understand the need for the structural integrity fix relating to the five wooden pillars sitting atop the cracked concrete slab which floors our front porch and apparently prevents the house from falling forward. But I can't understand why the old stable matters so much to the appraiser/underwriter.
It is not used or functional in any way other than as a repository for junk and as a landing spot/vantage point for the Turkey Vultures who nest there. This building is approximately 50 yards from our house and 10 to 15 yards from our neighbor's house. If it fell, like our barn did years ago, it would land on part of our two acres. Given its age, likely over 100 years, it was not, nor has it ever been, covered by our home owner's insurance. "Too old," they said. The structural engineer who submitted the report about our house did a-walk-around the stable with me and made note of its peculiar structural fixes which included cinder blocks and some rocks. However, in response to my "What do I do?" question; his answer: "We don't certify the structural integrity of 100-year-old buildings." Now I'm being told by my reverse-mortgage banker that I have to fix/secure the foundation of the stable or else the deal is likely dead. Dead over an out-building that nobody uses and was likely built before two century's turned?
The whole point of this application was to spend nothing and get something. It was not to spend something and get nothing. This stable, either structurally sound or not, provides me nothing as a living benefit. We're not moving into it. Nor are we selling the property. We're here for the duration. The stable, if it matters at all, will matter to whomever sifts through our financial remains, and since we have no children, those 'remains' are not really our concern. Yet according to the most recent email I received, either I make it my concern or stew in my own juices and slowly wither away.
When I began this process, I had hoped there would be an end in sight. I didn't realize it would be my own.

More like in my wallet. After worrying for the past 18 months about possibly losing my health insurance, I finally hit pay dirt - and it didn't hit back. I have received my Medicare card and after I "dissenroll" from my interim "Obama Care" within the next week or so, I will officially join the ranks of the millions who have insured their health - so to speak - with the Federal Government. No more will I ifs, ands, or buts about hospitals, doctors ("medical" actually) and prescription drugs (parts "A", "B" and "D" for those of you unfamiliar with the alphabet soup). Dental and vision coverage I'm not so sure about, but at present, I can live with the coverage that I know I have now because the worst case scenarios have been addressed. And as a former insurance broker, solving and/or protecting against worst case scenarios was always my main concern. To invoke "Speedy" from those long-ago Alka Seltzer commercials: "Plop, Plop, Fizz, Fizz. Oh, what a relief it is." And even though I'm not plopping or fizzing, I am effervescent nonetheless at my arrival.
Reaching milestones (even destinations, sort of) is a way I've measured and evaluated my cancer experience. Not that I keep a chart or even a calendar with Xs marking the days but "I've looked at life from both sides now" (heck, I've looked at life from all sides now and in between, too) and my glass is still half full. I remain positive about my negative and despite having never having seen Joni Mitchell in concert (although I did have tickets to see her at Cole Field House in the 70s; once on stage, however, she realized she was too sick to perform and stage right she went. Occasionally, her songs have spoken to me.
Right now, the United States Government is speaking to me in the form of a red, white, and blue card. They are telling me that I have made it to the promised land, a land whose existence was proposed in 1965 and which became law in 1966 fulfilling promises made to all Americans who reach age 65 that health insurance is their right and not because they were privileged. Nevertheless, I feel privileged to be "Medichere." For 10 years, 10 months and 20 days, dating back to late December 2008 when I first experienced the pain in my rib cage which precipitated my visit to the Emergency Room, I have been under the proverbial gun. Sometimes, it's been holstered. Other times, it's been locked and loaded. So far, no shots have been fired, even though occasionally I've been in very close range. I can't say for sure whether I thought I'd actually get here, but let's be realistic, we all had our doubts. But now it's time to gear up. A tremendous weight has been lifted from my shoulders. All I have to do now is live with the fact that I have stage IV, non-small cell lung cancer, an incurable disease if there ever was one. But here I am, alive and reasonably well.
No more will I have to worry about who, what and where I'm going to be treated. From now on, I'm in charge (like Charles). As a result, I feel as if I've regained a little control of my life. And for a cancer patient originally diagnosed as "terminal," this control is an extraordinarily wonderful feeling. I wish I could bottle it like "Brighto:" "Brighto, Brighto, makes old bodies new. We'll sell a million bottles, woo, woo, woo, woo, woo, woo." (The Three Stooges in "Dizzy Doctors," 1937.) And that's just the kind of silly enthusiasm I'll need living forward. Hardly is the lung cancer I have on the run. I wouldn't even say I have it on the walk. A stagger, maybe. (Or maybe that's me who's staggering when I lose my balance because of the neuropathy in my feet.)
Cancer is an adversary unlike any other. It's going to do what it does. I doubt Medicare is going to scare it into remission. Moreover, my not worrying about having health insurance anymore probably isn't going to have much effect on "the cancer" ("Forrest, Forrest Gump") either. The biggest effect will be on me, emotionally. I just hope that's enough. Because I'm going to need all the ammunition I can muster.

That was a close shave, if I may euphemistically characterize my most recent, blade-free brush with cancer-like symptoms, especially considering that I thought my life was at stake. The pain was located around my left-side rib cage, exactly where the pain was on that fateful January 1st, 2009 day when I couldn't ignore it any longer and thus felt compelled to get off the couch and go to the emergency room. Though I didn't have any shortness of breath, or difficulty inhaling, exhaling and bending over (all of which I had back then); nonetheless, I thought the worst and didn't fool around this time and made an appointment with my primary care physician as soon as possible, which was for the following day. I didn't have a great sleep that night but it was somewhat improved knowing I might get an answer the next day.
To say that my life was beginning to pass by is a bit of an overstatement to be sure, but it was moving around a little bit. Trying to bury/compartmentalize what a possible recurrence/resistance to my current standard of treatment would mean before I actually met with a physician and received cancer confirmation was the immediate task at hand. Rationalizing that what symptoms I wasn't experiencing meant something positive/encouraging compared to what I felt 10 and a half years ago was one mental route I was traveling. The other was my usual and customary fall-back position: "It's nothing until it's something."
However, I have to admit 'something.' Though I can't speak for all cancer patients/survivors; for me, in spite of my inherited-from-my-father, positive attitude, being diagnosed with a "terminal" disease, as clearly described by my oncologist back in late February, 2009, creates a sense of inevitability, as does the "13 month to two year" prognosis that followed. Inevitability, as in one's demise (I'll never forget the walking-down-the staircase-with-a-yo-yo example he used) and then death is only a matter of time. Time which you don't have and quality of life which you'll never get back.
And when that 'inevitability' is most clear is when you have symptoms (related to your cancer or not; you don't know definitively, at least I never do), especially if those symptoms are identical to the ones that got you into this jackpot in the first place. So yes, I've had a difficult few days fighting the inevitable feelings and wondering if my amazing good fortune had finally run out. After all, a "terminal" disease doesn't generally mean you go on living a normal life expectancy. Au contraire. It means you don't! And at some juncture, the cancer spreads beyond modern medicine's ability to manage it. Then the patient is given a choice: stop the treatment and try to enjoy your remaining days without side effects, and thereby live a less cancer-centric quality of life with some freedom and independence - and hopefully feel some kind of better. And in those intervening days, try not to worry about the cancer doing what it inevitability (there's that word again) does, which is not cure itself. Or try some experimental treatment and hope for the best.
This is the emotional concern and challenge which hangs over my head. Never more so than when I have the symptoms that I did this past week. Fighting the cancer and fighting these feelings is two much. One at a time I can handle. Handle it I did as I sat in my doctor's office and in great detail, described my symptoms, and explained what I was feeling and what I wasn't. My internal medicine doctor listened intently as he has since the very beginning when I was first diagnosed. He was calm and reassuring in his assessment. My symptoms he said were not cancer-related. They "were muscular," he continued, "on the outside of my lungs." Not lung cancer at all. As such: No lab work. No X-Ray. No CT scan. No nothing. Another reprieve. Life goes on, until...

Not to be morbid in the least or self-indulgent in the most (last week's column, "Something or Nothing" not withstanding), but recently I've had cause to hear about the future and be more concerned about the present.
I have a homeowner problem that, like all such problems, is way beyond my limited skills: a crack in the concrete slab which "porches" our house, apparently caused by a very large and old tree growing way too close to this slab. This is not a water-leaking-into-the-house problem. This is a structural-type problem identified by a home appraiser whom I've paid for - but not bought - to process a mortgage refinance. Given the two-week  time-frame during which I was expecting to schedule this assessment - considering the time-sensitivity of these applications, I was flabbergasted to learn that my expectations were totally unreasonable. Two weeks! I might as well have been asking for two months, which is what I ended up getting.
After hearing the nearly identical appointment-unavailability story multiple times, and getting increasingly frustrated and impatient at the unlikely timely resolution of my problem in my lifetime (no joke), I finally heard from a company that was able to schedule an appointment which they did so with an apparent straight face (as much as I could glean over the phone): "I can have someone to your house on October 25." I snickered. "October 25! That's two months," I said. ("I could be dead by then," I said to myself.) To the woman I said, "No. I need someone sooner, in the next week or so. Good-bye." (I made this call on August 21st.) When I hung up the phone, I started laughing at what I didn't say and why I hadn't said it. Being that I have stage IV lung cancer, I am not exactly on firm footing. I didn't say to the woman that I could be dead by then because those words were figuratively speaking a bit to close to my literal reality. It was a case of fiction being a bit too close to fact and my mouth actually being able to cash that check. In addition to providing fodder for this column, my calls to miscellaneous home improvement/concrete/foundation repair companies left me not high, still dry, but totally unrequited. I needed help. I put myself out there and received practically nothing in return. It is a lesson I'll take to the grave.
I don't want to sound unreasonable because I still think I'm of sound mind (not so much sound body), but being diagnosed with cancer does, at least in my experience, move up your timeline, so to speak. There's a certain amount of patience and accommodation that is totally ripped from your subconscious. When your life is in jeopardy, dealing with the daily double life and death becomes extraordinarily difficult, regardless of whether your answers are in the form of questions. The uncertainty of it all is very off-putting. Sometimes, you don't know whether your coming or going. Trying to live a "normal" life under these kinds of constraints - and restraints, can make Jack a very dull boy. And very often this dullness manifests itself in one's inflexibility. When your life is at stake, it's nearly impossible to act as if it isn't. Your brain seemingly gets rewired and re-purposed. As much as you attempt to retain your old and familiar self, this newer cancer-affected version slowly takes over. You're not exactly in "The Twilight Zone," but "imagine if you will" at age 54 and a half, expecting to live into your mid-80's as your both your parents did, instead being told that you have "13 months to two years" to live? Though I've taken it mostly in stride and lived way beyond my oncologist's expectations, to say one's stride is not changed by the experience is to give naiveté a whole new meaning. (Not to mention the fact that the neuropathy in both my feet makes walking extremely difficult.) Nevertheless, life goes on.
As such, as much as I want to plan for the future, sometimes, it's the present for which I need to plan.

As you can imagine - or read every week in this space - my health, especially considering that my stage IV non-small lung cancer is incurable/"terminal," is top of mind. (Truth be told, it's middle of mind, bottom of mind, and every other mind in between and all around.) That being said -  I am prone to exaggerate the significance of seemingly unrelated peculiarities and draw them into my cancer "centricity" without any facts to support them. Though I feel fine-ish, mostly, (the previous weeks' columns "Barbasoul" and "Side Splitting But Not Very Funny" notwithstanding), there are a number of things in my life which aren't doing as fine and have given me pause for this column.
First and foremost is Chino, one of our two diabetic cats ("The Diabetic Duo" as I call him and his brother, Biscuit) is now up to 14 units of insulin per day and is a shell of his former self, literally. His appetite remains good but he's confined in the kitchen because he doesn't seem particularly interested or aware of his litter box. His co-diagnosee, Biscuit, has had the complete opposite reaction to his medicine. He's down to two units a day and appears quite himself. He's free to roam around and seems quite clear about the reason for the multiple litter boxes located throughout the house. Unfortunately, Chino is slowly getting worse and, despite following doctor's orders and feeding him prescription food, nothing really seems to be stemming the tide.
The rest of the examples I'm about to give pale in comparison to Chino's situation but in the aggregate, they represent a pattern that's making me nervous.
My inherited model year 2000 Honda Accord is most definitely showing its age and may very well be nearing the end of its useful life. I have given up trying to make the necessary repairs suggested by the multiple idiot lights illuminating my dashboard. As determined as I am to ignore them, the different sizes, shapes and colors of the various lights/symbols are drawing me ever closer to the wear and tear they represent. I fear the worst, as with Chino.
Now into a more mundane world, a world in which technology has ensnared us. What would we do without the various hand-held devices with which most of us are all too familiar? I'm getting regular messages that unless I act accordingly, I'm about to find out.
My museum-piece flip phone is dying. It won't hold a battery charge for nearly as long as it used to. Either I'm speaking into it or I'm speaking at it because I only have one bar and I need to charge it. As a result, it's become unreliable and a bit of a bother. If it had any legs, it would be on its last ones.
The battery-operated key fob for my car has recently advised me that it too is dying and unless I make the necessary battery replacement it will no longer start my car. Do I really need my key fob communicating with me? A metal key never bothered me with such trivialities and so long as I was inserting it into the car to which is was mated, I was usually able to reach my intended target - without any backtalk.
Finally, I've been receiving messages on my television that the remote control is unhappy and also needs a battery replacement and unless I respond, it too will fade into nothingness and I'll be staring at a blank screen. I don't mind a smart TV, but I do object to one that persists in its demands.
All these elements, crucial in their own way, are intersecting with my cancer life at the same time and all seemingly headed in the same direction: south. I can ignore and compartmentalize some things, but I can't ignore and compartmentalize all things. After all, as the old joke "punchlines:" I gave you lots of warnings.
 

Although I've had a pretty good run of late not writing much about "the cancer"—to quote "Forrest, Forrest Gump"—the reality is, as you might imagine, cancer is ever present - in your head and in your heart (and for me, in my lungs). Never more so than when your quarterly CT scan is imminent. As I sit and write this column on a Sunday, Wednesday—three days hence—Is what you'd call 'imminent.' Not that there's much preparation; there's not. But with electronic media being what it is, one does receive multiple reminders: text, email, and the occasional call. And even though I don't actually have to do anything in advance, I am reminded nonetheless, in advance, what there is yet to be done: show up! (Apparently, many cancer patients, staff have told me, are not as compliant as you'd expect them to be.)
But it's not the 'advance' or the after that I'm addressing in this column. It's the way before and how a CT's imminence affects one's life. As much as I write and talk/act a good game, living one's life pretending to minimize cancer's presumptive/possible/"prognosed" impact is indeed make believe. Not that I'm a glass half-empty person; I'm not, as you regular readers know. However, there's nothing like a computerized tomography and a post-scan appointment with one's oncologist to focus your attention on the fact that you have been/are living with what your oncologist originally characterized back in early 2009 as a "terminal disease”: non-small cell lung cancer, stage IV (and giving you a "13 month to two year" prognosis to boot). A disease whose initial progression (doctor-speak for growth/movement) eliminated surgery as an option, but one for which there have been multiple lines of chemotherapy, none of which was ever been said to be a cure. In the spirit of that reality, how does one live in the present and plan for the future? (Jeez, that last line sounds right out of one of the Carrie Bradshaw's "Sex and the City" voiceovers.
On the one hand, the one with no sense of reality, I suppose one is simply to go about one's varied business with nary a care or concern in the world. On the other hand, the one with enough a sense of reality to choke a horse, I suppose I am to mark time, count the number of days until my next scan, plan for today and think about tomorrow - but not too many tomorrows as there's no sense getting ahead of oneself or else one will get behind. And if that sounds mixed up, it is. Because for cancer patients "time is a godforsaken paradox." As Captain Katheryn Janeway of Star Trek: Voyager further explained many star dates ago: "The future is the past, the past is the future. The whole thing gives me a headache." And if you do get any headaches, you need to contact your oncologist because in 30% of lung cancer patients, the cancer moves to the brain. A location which presents all sorts of treatment and quality of life challenges. And a manifestation there, should it appear, scares the living daylights out of me. But never mind. Just keep on planning and pretending that you don't have a "TERMINAL" disease. You know, the type of disease for which there's "NO CURE."
Then again, if I do get bogged down by certain realities, I'll be no work and no play - and no fun (neither do I want to be a dull boy). And no fun is no way to live - in the past, present or future, and that's no paradox. So if and when the chips and/or the "chippee" is down, one needs to be thankful for the chips that you do have and for the ones you hope yet to accumulate. Otherwise, you might as well see the cashier on your way out. Life's too short (don't I know it) to live only in the present and not consider the future. And if I don't consider the future, it's unlikely I'll have one. Just because I've now had a past that lasted years longer than I expected shouldn't mean I can't have a future I never anticipated.
 

Except I was not sitting in the audience for "The Price Is Right" when I heard my name called. Nor was I needing to guess the cost of my infusion with my treatment that day contingent on my guess not exceeding the "actual retail price." And neither were there any of "Barker's Beauties" to wave their hands and showcase what items I would be attempting to price right. No. There were only multiple oncology nurses standing in front of the Infusion Center's entry door calling out the names of the next patients lucky enough to begin their treatment. It wasn't exactly "Plinko," but once inside the Center, the fun, such as it is, really begins.
At least that's the way the activity appeared to me. The preceding day was July 4th so the Center was closed forcing those Thursday patients to be rescheduled to either Wednesday or Friday. As a result, the waiting area was particularly full with patients, along with their family and friends, all of whom are encouraged to attend. In the midst of this crowd, I sat and waited. We hadn't exactly been assigned numbers, but we were assigned oncology nurses and therefore could only enter the Infusion Center with their assistance.
Then, while all of us "waiters" looking at the entry door waiting for an oncology nurse to walk through and call our name, the door lock clicked open and out walked two oncology nurses. As soon as they cleared the door and entered the waiting area, they called out their respective patient's names (unfortunately not mine). Upon hearing their names, the two patients and nearly half a dozen of their supporters got up and moved eagerly toward the entry door. It reminded me of the beginning of "The Price Is Right" when three audience members' names are called in quick succession and implored to "Come On Down!" by George Gray (Johnny Olson, the original announcer, retired years ago) and officially become one of that day's contestants.
However, once inside the Infusion Center, It's dead serious. Your life is at stake, maybe even at risk, depending upon your cancer/treatment, and at this point, you're not playing any more games (although occasionally, you may be guessing the price of things and wondering how it all gets calculated). So you slide into your Barcalounger, hold out your arm to have your barcoded wrist ban scanned and prepare for your hopefully, life-saving infusion, and don't smoke 'em, even if you got 'em.
It's rare that you'll see your oncologist in the Center. Typically, they'll be seeing patients in examining rooms, performing surgery or rounding in local hospitals. But they're always a phone call away should the nurses need any additional instructions or clarification. Generally speaking, once inside the Center, all goes as anticipated for us patients: you're in, you're treated, you're out. And when you're out, new patients names are called and on and on it goes, just like "The Price Is Right," except the program doesn't end in an hour. And just like "The Price Is Right," where there are no shortage of audience members wanting to participate, at the Infusion Center, likewise, there seems not to be a shortage of patients wanting to be treated either. (Granted. it's not exactly the same thing, but you get my drift, I'm sure.)
Cancer is not fun, nor funny, and an Infusion Center is not filled with anticipation of cash awards and magnificent trips. There is however, lots of empathy and understanding - from your support system and from staff as well. But it's the last place you want to be, unlike "The Price Is Right."
 

Except I was not sitting in the audience for "The Price Is Right" when I heard my name called. Nor was I needing to guess the cost of my infusion with my treatment that day contingent on my guess not exceeding the "actual retail price." And neither were there any of "Barker's Beauties" to wave their hands and showcase what items I would be attempting to price right. No. There were only multiple oncology nurses standing in front of the Infusion Center's entry door calling out the names of the next patients lucky enough to begin their treatment. It wasn't exactly "Plinko," but once inside the Center, the fun, such as it is, really begins.
At least that's the way the activity appeared to me. The preceding day was July 4th so the Center was closed forcing those Thursday patients to be rescheduled to either Wednesday or Friday. As a result, the waiting area was particularly full with patients, along with their family and friends, all of whom are encouraged to attend. In the midst of this crowd, I sat and waited. We hadn't exactly been assigned numbers, but we were assigned oncology nurses and therefore could only enter the Infusion Center with their assistance.
Then, while all of us "waiters" looking at the entry door waiting for an oncology nurse to walk through and call our name, the door lock clicked open and out walked two oncology nurses. As soon as they cleared the door and entered the waiting area, they called out their respective patient's names (unfortunately not mine). Upon hearing their names, the two patients and nearly half a dozen of their supporters got up and moved eagerly toward the entry door. It reminded me of the beginning of "The Price Is Right" when three audience members' names are called in quick succession and implored to "Come On Down!" by George Gray (Johnny Olson, the original announcer, retired years ago) and officially become one of that day's contestants.
However, once inside the Infusion Center, It's dead serious. Your life is at stake, maybe even at risk, depending upon your cancer/treatment, and at this point, you're not playing any more games (although occasionally, you may be guessing the price of things and wondering how it all gets calculated). So you slide into your Barcalounger, hold out your arm to have your barcoded wrist ban scanned and prepare for your hopefully, life-saving infusion, and don't smoke 'em, even if you got 'em.
It's rare that you'll see your oncologist in the Center. Typically, they'll be seeing patients in examining rooms, performing surgery or rounding in local hospitals. But they're always a phone call away should the nurses need any additional instructions or clarification. Generally speaking, once inside the Center, all goes as anticipated for us patients: you're in, you're treated, you're out. And when you're out, new patients names are called and on and on it goes, just like "The Price Is Right," except the program doesn't end in an hour. And just like "The Price Is Right," where there are no shortage of audience members wanting to participate, at the Infusion Center, likewise, there seems not to be a shortage of patients wanting to be treated either. (Granted. it's not exactly the same thing, but you get my drift, I'm sure.)
Cancer is not fun, nor funny, and an Infusion Center is not filled with anticipation of cash awards and magnificent trips. There is however, lots of empathy and understanding - from your support system and from staff as well. But it's the last place you want to be, unlike "The Price Is Right."