The Year in Review: Seeking Normal

Just about a week into 2019 I have found myself  in a pretty reflective state of mind, looking back at 2018 and further, as thoughts of graduate school have crept in regularly. As many of you likely know, about 16 months ago I was diagnosed with prostate cancer that had metastasized to my hip bones and then surgery last April found cancer in the pelvic lymph nodes as well. It’s likely, then, that you are thinking it natural that receiving a diagnosis with a 29% 5-year survival rate might cause anyone to look back. And I suppose you might be right, at least partially. I will spare you an attempt to untangle proximal and distal causes here, but at least some of the reflection is induced by more practical circumstances.

In my early graduate school years, I suffered mightily at times from what had been diagnosed as “colitis.” Sometimes violent episodes sapped my energy to the point that I couldn’t get out of bed. As I got older and wiser, I learned to recognize the signs an approaching episode and learned how to head them off. I got so good at managing the condition that as the decades went by I forgot I was even doing it. If you asked me why I ate small amounts throughout the day instead of large meals, I was likely to shrug my shoulders and say that I preferred that. Ask me why I didn’t sit around and socialize after a meal and you probably got the same answer. I’ve thought about these things lately because as I write this, I am 17 treatments into a 33 treatment regimen of “whole pelvis” radiation therapy designed to halt or slow cancer cells in the prostate bed, pelvic bones and pelvic lymph nodes. It took all of two of those sessions to pretty much unravel the decades of colitis management I had been doing.

The radiation therapy has also reminded me of the spiral fracture of my left humerus suffered during an intramural basketball game during the third year of graduate school. As they wrangle me around to get me aligned, the therapists must remind gently but insistently, nearly every time, that I am not to try to help with that work. The broken arm occurred as two of us went out of bounds to save a ball, crashing to the floor in a heap. I got up to get back into the play and realized I couldn’t move the fingers of my left hand. I looked own to see the arm pivoting aimlessly about a point well above the elbow and I sat down on the floor, drifting toward shock. The very kind rec staff put a rolled up mat under my head, called an ambulance, and had me sign a waiver that I was way too far gone to read. Three paramedics showed up – Kevin, Kurt and Karen. They called the emergency room to get permission to administer morphine in order to splint the arm for transport. The doctor said no. They tried again and got “no” again. They told me they would try one more time and if it was still no, they would give me a towel to bite on and splint quickly. They got a “yes” the third time and I watched the drops of morphine enter the IV they had given me to bring me out of the shock. Instantly the world went soft. I had a vague notion that my arm still hurt but really, really didn’t care. What I recall most vividly is Kevin, Kurt and Karen rolling me up to splint the arm and all three shouting simultaneously, “Don’t try to help! Let us do it!”

More broadly, the whole year and a third of observing and learning about the medical and insurance systems in action has reminded me of how much I learned about the legal system the two times I was called for jury duty as a graduate student, once for a case involving a prolific freeway sniper. But those are stories for a different time.

Reflecting on the year just passed, it’s safe to say it has been unique for me. I started by teaching the astronomy class in January-term. Teaching a laboratory science course in the compressed format of J-term is challenging under the best of circumstances and I did so while also teaching our upper level astrophysics course to a pair of students by arrangement, all while taking two hormone therapy drugs – Zytiga and Lupron, used to suppress testosterone production from a variety of sources. I have a hard time recalling the details of last winter and spring. My wife will say, “You remember we decided to do that this way in a committee meeting last year. It was your idea.” I won’t have the slightest idea what she is talking about. With the surgery in April, we stopped the Zytiga but remain on the Lupron. That has helped, to the surprise of some of my physicians. I am still pretty useless in the evenings but have a good bit more energy than I did in February or March and have lost much of that cognitive fog, I think. I hope. They suggest that it is supposed to be the Lupron that is the primary energy zapper. People tolerate Zytiga well. All I can say is that I am doing a little better with just the Lupron. I expect we will stop that as well some time this year and then we will see how things go. Of course, the prostate surgery had its own unique challenges, as does the ongoing radiation therapy. I just taught a full load of courses this fall and it went pretty well, despite my energy deficit. The data season last summer was a struggle. Staying up for the night sky is quite a bit harder than it used to be.

There is, or was, an advertisement on television for a drug for metastatic breast cancer. The announcer says something to the effect of “She can’t do everything she used to do but she can do a lot of things. She calls it her new normal.” We referred back to that frequently as the year unfolded and we experienced our new normal. It is, however, an evolving state as we move from therapy to therapy and experience the cumulative effect of long-term testosterone suppression – a succession of new normals. I suppose life has always been a succession of new normals. It’s just that the cancer and our aggressive approach to treating it have made that succession more rapid and, thus, more apparent. It has me thinking about the continuity of self, or the lack of continuity of self, and how we define what makes any one of us the one of us we are, or think we are.  

There are a few concepts that I am constantly trying to stress the importance of to students. One of those is the stochastic nature of much of reality. No matter how good a job we do we aren’t in full control of how things turn out, usually. Looking at life through a probabilistic lens is valuable, enlightening and, in its own way, freeing. One challenge for me, a challenge I think I have met so far, is to remain cheery and engaged while recognizing that best we might hope for on the other side of this series of new normals is a coin flip outcome.  We may slow this cancer for a good number of years or we may not. It is not completely unlike teaching. Talking about the universe and the human desire and drive to understand the universe has wrapped up in it more beauty than I am able to articulate, despite my trying and trying. Every new semester is like that same coin flip, maybe some of that story will take for students and maybe it won’t. We only have 15 weeks together after all and life is full of distraction. All we can do is just keep working at it and appreciating the journey.