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Now that we've fully settled into our home for the summer in the Costa Brava, I'm becoming increasingly aware of my obligation to follow up and catch you all up on my last blog post, regarding the announcement about my recently urgent health situation, prostate cancer. Today, I'm clocking past three weeks after that period of my life. Pardon my urge to put some distance between that seemingly interminable period of radiation therapy.
What sticks in my mind was the quiet meditative quality of those days. You see, the actual therapeutic procedure was quick, somewhere around 15-20 minutes. The routine upon the start of sessions was to present myself to the staff at the head of their monitoring station, essentially a desk in a vestibule atop it a row of computer monitors. They would ask me my "last four" (SSN, a VA Hospital security question), the date of my birth, and for me to state my name in full. All this, a routine two make sure they don't apply the wrong procedure to the wrong patient. That done, I'm escorted to the room adjacent, where the external beam radiotherapy machine was sited. Despite my attempts to chat the staff up and pester them with questions about the machine, I was continually rebuffed, clearly evident it was that they were all about business and nothing else. So, I'm forced to describe the machine now and probably forever in prosaic terms.
The aesthetic was that of science fiction movies, think 2001, A Space Odyssey with a touch of Star Wars. White porcelain baked enamel, grey durable surfaces where patients are in contact. Wood grain walls. The ceiling, rimmed in an array of LED's along the perimeter for mood lighting to induce calm; a drop ceiling tiled with backlit photographs of trees and sky, POV: from below (I imagined the clouds to be moving, an illusion that was hard to break with a stare); A suspended monitor to the side displaying incomprehensible data (to me of course), cameras and lasers to verify the position of the patient within the machine. A sliding sled was my destination, it was prepped with an array of bedding material whose foundation was material very similar to diaper fabrication, the significance I was later to learn quite vividly.
Shoes off, I flip my shirt up and on I hopped onto the sled. The nurses draped a towel for modesty over my nethers and I then pull my pants down to my thighs. Down, I am instructed to lay still like a sack of potatoes while they positioned my body to align with the guiding laser beams, aided by tiny dot tattoos earlier administered in preparation which later on they would augment with black fat marker lines and crosshairs. The nurses then asked me to confirm that it was indeed my photograph displayed on the monitor, a final precaution. They then turned on music, an additional layer to induce calmness. Many times, I wished I could have hooked up my own music playlist, but the serious demeanor of the staff was granite. Then, the sled slid with me into the machine.
The machine. It is a projection of four or five devices that orbits the body, an accurate count evaded me because some of them folded away and there were other more pressing concerns that had preoccupied me, more on that later. One pair was probably a simple x-ray, no doubt to document my current condition, organ disposition and most certainly to align the machine's beam to the markers within my prostate, installed earlier as described perhaps too vividly in my previous announcement video.
The emission of probing x-rays have a characteristic sound, a rasping burst that you can probably recreate in your imagination. There's a whole other world of details I will withhold from this blog post, about the restrictive dietary requirements that help render the diagnostic scan effective. In short, no fresh vegetables and no diary. This is a whole other universe of consequential description. Then happens, nothing... a pause, where I can only imagine that the team is gearing up for the main event. The principal tool of the machine is something I'll nominate with little exaggeration, the Eye of Sauron. A fat disk endowed with a glass lens into which the darkness within I could make out a set of something I'll call grinding teeth, probably an x-ray absorbent material suitable to help via a variable orifice shape the beam upon emission. When Sauon orbits in action, he utters a sound which in my perhaps my too fertile mind resembled a predator devouring its' prey. A more sober mind could identify this sound as the set of servo mechanisms behind. But then again, I remember that such sounds weren't present when the eye was inactive and other rotations were in effect, supposedly also requiring servos. During operation, the eye would emit the sound that is easily identified as high energy x-ray beams, targeting first my surrounding abdominal lymph nodes to where the cancer cells had escaped the precinct of the prostate capsule and then finally to my prostate, proper.
But now I must here discuss the rub, the most difficult aspect that had turned what I had anticipated as a day at the beach into another meantime within the aforementioned meantime, which had become in turn an even meaner time. In the male anatomy, the bladder sits atop the prostate. When expended, the bladder deflates and its' form resembles a beret atop the head of the prostate gland. This is bad news for those tasked with wielding high energy particles into the gland in question. In order to mitigate this obstacle, nurses become highly concerned -almost fanatical- that the patient hydrates to the point where the kidneys are in high gear, filling up the bladder such that the beret becomes a soccer ball, distinguishing itself clearly and out of the way from the prostate. With all this in mind, I ask that you please indulge me with your imagination and put yourself prone onto the sled awaiting the Eye of Sauron.
The experience is like water boarding in reverse. (I was hoping to find a "How Stuff Works" website with illustrations, to no avail.) Instead of a wet towel over the head under a cascade of water, inducing stress... maintaining a distended bladder at the nurses' definition of peak performance involves a dry towel over your genitals and the withholding of a mercilessly engorged bladder impossibly tasked with restraining a huge reservoir of water... or urine, that is by then mostly water anyway. Instead of attempting to keep secret vital information, the mind is shouting all sorts of intel as Sauron sets to eat away so loudly with such bad table manners. I anticipate that this description so far is too abstract. Let's see if I can concretize the actual experience a little bit more.
We have all had the experience of needing to visit the bathroom while dining or drinking at a bar. As I'm sure you all can remember, the moment that available bathrooms are occupied. No problem, you wait patiently... and you wait... and you wait... but your bladder can't tolerate the loiterers occupying the bathroom in the way of blessed relief. A covert alley is nowhere nearby. There are no other alternative bars or restaurants of refuge nearby either. So, you pace and maybe you dance a little, or jump up and down if no one can see you. In real life, the bathroom door opens and perhaps a sheepish customer exits, thank god almighty. But in the case of the occupant of the sled, no such luck. It's only a few minutes, shouts the mind over and over, but the cascade is pounding savagely at the urethral sphincter's door. Resist the urge to reach down and manually pinch off, the invisible x-rays are working away and one can only imagine the damage that could do to your hand. You can do it, screams the mind but then now and again, and after all, only a few agains are too many, your urethra lets you down to your utter humiliation. Hence, the detail of the diaper-like material mentioned above. Remember, the material physics requires the bladder stay away from the orbiting stare of Sauron, so you try to pinch it off hands-free as the skin around your waist registers the reality of your 98°F / 36.5°C internal body temperature, so terribly badly the body wants to relieve itself of its' burden. Remember firmly, my prescribed protocol involved 45 sessions and the number of times that I had failed are too many to recount because even once evinces too much shame. Talking with other patients in the waiting room with me revealed I was not alone, and perhaps my failure rate was on the lower end of the scale. But this is my pride doing its own special pleading. None of my fellow comrades went full Open Kimono... as I perhaps am flirting with now. Only for you, my dear devoted reader. Only for you.
I'm tempted to append a diary of those 45 days... but that might be an open kimono too far. The diary is quite descriptive, of how I counted down the days, of how I tried to hack my body's internal hydration code, and of course the real ratio of success to failure within the parameter described above. I was only partially successful in how to calculate and limit the volume of water I had to manage throughout the day, especially the morning hours bracketing the actual radiation procedure.
THE EAR WORM.
These attempts at calculation formatted the whole experience and all what is written above is a prologue for the main message of this blog post, a postscript of what specifically I am driven to convey to you today, my audience.
A stick, a stone
It's the end of the road
It's the rest of a stump
It's a little alone
It's a sliver of glass
It is life, it's the sun
It is night, it is death
It's a trap, it's a gun
It takes an hour and fifteen minutes to commute to the hospital from my apartment in the Lower East Side, Manhattan. The hospital is located within Fort Hamilton, within sight of the Verrazzano Bridge and Gravesend Bay (ominously named, yes), sandwiched between Bay Ridge and Dyker Heights, both iconic Brooklyn neighborhoods. Upon awakening each weekday, I had to hydrate my body in preparation for the procedure. Chugging water 45 minutes before hopping onto the sled is no good if your body is dehydrated. In order not to experience the bathroom scenario described above within the confines of the New York Metro subway system, I had to awaken at 3am. No problem, I love the wee hours anyway. The main parameter to bear in mind while hydrating is that the issue is not simply units in and units out. The body is a reservoir that once topped off, only then does it engage the renal function to fill up the bladder. This is a long way to say that a delay is involved in this affair, both before and after the procedure. My body's hydration needed time to equilibrate. So, the two and a half hours before I had to hop onto the D Train were minimum parameters, for my body, at least. Everyone in the city is asleep of course and again, I love the wee hours.
Enter, the ear worm. It's not unusual for me to awaken with a song playing in my head. I find it delightful and often I try to divine any subconscious signification that might be involved... to very little avail. This time, as the penultimate week approached and passed into the countdown to the final day, the lyrics of Tom Jobim's Waters of March floated into my consciousness and firmly stayed put.
This time, I had never felt relief that I thought a countdown would bring. In the days of my youth as a sailor in the US Navy, it was customary to count down with glee. When I first crossed the pier to the quarterdeck of my ship with a fresh seabag on my shoulder, fellow sailors would peg the ID clipped to my collar, identify my discharge date and tease me about how much time I had left in service, "OOOH SHIT! Rocks don't live that long!" As the final months towards discharge approached, three digits turned to two and I was then able to say with glee what I had heard from others during the years beforehand, "I'm a two digit midget!" Counting down the 45 days didn't register the same joy this time. For some reason in the grind of pre and post procedure, generally costing me seven hours before entering my studio shortly before lunch, this rigid routine never broke even a small crack to allow the joy of anticipation of that final day of radiation to shine through.
The oak when it blooms
A fox in the brush
A knot in the wood
The song of a thrush
The wood of the wind
A cliff, a fall
A scratch, a lump
It is nothing at all
Jobim wrote his song in both English and Brazilian Portuguese, so I've heard. It was a message addressed to the world, no matter the hemisphere. It's a mediation on the seasonal end of a persistent rain, a prolonged annoying event requiring patience, understanding, and the wisdom to discover the little, small sparkling jewels hidden within its' difficulty. The first stanzas juxtapose the unity of opposites: "It is life, it's the sun / It is night, it is death / It's a trap, it's a gun", joyful and not forgetting for a second, the gravity of a hardship endured. As the song continues, the noticing continues, tiny things could be wonderful if you only gave them a chance to be so.
For me, it was the early quiet hours where I could scan the headlines, read the news my friends would share about the art world, the books my friends would enthusiastically urge me to read. I was the only one awake initially, but Manhattan was rousing. Lights in bathrooms would spark and people started on their street paths of their day. Traffic surged slowly at first, and then the flood. I'd notice the same folks in the subway train. The construction workers with worn boots and pants, wearing clean t-shirts that won't be so soon, hardhats suspended from battle-worn backpacks and hand carts when heavy gear was necessary. That one older lady with a penchant for colorful dresses and ankle bracelets adorning her sandals, punctually going to work, getting off at the middle of the connecting bus route. Older guys I assessed to be fellow vets at the terminal end of the line. I welcomed the ritual unwrapping of my breakfast scone once the train passed 36th Street, to be savored slowly bite after bite until the train passed 79th Street.
It's the wind blowing free
It's the end of the slope
It's a beam, it's a void
It's a hunch, it's a hope
And the river bank talks
Of the waters of March
It's the end of the strain
The joy in your heart
The guards at the hospital, nodding in recognition as I grabbed my bag from the security scanner. Old guys, who looked like they've been around the block or two. The same staff, day after day, doctors and nurses and support teams streaming in from the parking lot with lunches in tow since the food in the hospital cafeteria was so typically horrible. (Why is that?) My fellow compatriot patients, old veterans, mostly from the Vietnam era, some of them taciturn, some beaming and one guy in particular happy to lift his shirt to show me the scar that had once been opened from his navel to throat. Most are black men, a Brooklyn metric probably. All dignified, some is subtle ways and most in very clear ways. Some fancy, not a few with swagger. I learned of their lives after service, some in law enforcement, some entrepreneurs. Some guys, not all that often, were on the brink of devastation, either of old age or of their various diseases. One very old guy in a wheel chair, pale and clutching a blanket to keep warm, accompanied by his private nurse, a man of few words but his furtive eye upon greeting was friendly and respectful.
Like I said, a lot of these guys are Vietnam veterans, most of whom I met were marked deeply in the meat of the war period. Only marginally qualified to be ranked in the same cohort, the war ended in my first year in service and during my first WestPac deployment. My only contact with that experience was when my ship rescued refugees afloat in the South China Sea. Hospital staff continuously thanked me for my service, and I felt a bit shy about accepting such gratitude. However, note carefully the gratitude abounding there.
The bed of the well
The end of the line
The dismay in the face
It's a loss, it's a find
A spear, a spike
A point, a nail
A drip, a drop
The end of the tale
Then there was the Radiological Department itself. Think, layers of an onion. The public face was the constant genuinely kind smile of the lead receptionist, whose desk is festooned with small gifts given by years of former patients, a revelatory detail. She knew everyone's name.
One layer deeper, the two lead nurses who watched over my vitals weekly and were ready at hand if there was anything else I needed. Smocks and Crocs. Thank goodness my needs were few. There were other patients I've met who were not so fortunate. The nurses were there for them.
Another layer in the order of encounter are the doctors in residence, who helped me understand the nature and scope of my condition, what the various protocols indicated, along with the attendant up and downsides. I'm naturally inclined to be a bit impish when confronted with technical challenges and I'm reporting here that the doctors at this level were naturally generous with me. I've met others elsewhere where this was not so.
Down we go into the next layer, the doctors who are tasked with, let's say, is the more mechanical, quasi surgical work. These guys (all guys) are stone faced, all business, no fooling around. Let this passage be a testimony of my discretion since there is much here to describe but it borders on gore and nether parts... enough said. I was the first patient to arrive at the unit every morning, and so I would greet each of the team as they freshly arrived, smiles and hellos with hand waving. Not so with these quasi surgical guys. Eye recognition, yes, but no frosting on top. All business, no fooling around.
Now we peel to the team of the radiological technicians, proper. There are about ten or so of them, rotating into smaller teams to stay fresh on the job. Young an old, mostly female, a wide range of ethnicities, they are to me facets of a jewel who each glittered in their own way. A couple were super serious, but I was able to get them to crack a smile now and again. One guy, I almost got into trouble since he was disposed to entertain my persistent questions. This was frowned upon, his superiors told me to direct these questions to the head of the department. 45 sessions and 9 weeks allowed me to get to know them from a professional distance, witnessing the flashes of graceful patience and solicitude. They would trade off the task of coaching my hydration, and with this I was able to appreciate their different styles. Even when I touched initially and then occasionally upon my lowest point, they would let me know either explicitly or implicitly that they have seen worse. I've met some of the guys in the waiting room, they weren't kidding.
The core of the onion was the head of the department, whom I consulted with weekly. She too balanced generous solicitude and absolute no-nonsense. Leaders do color the character of their team, this is a law of the universe. In all of these passages describing the personnel, I've tightened up for the sake of discretion. They even frowned upon group photographs as I rang the bell on the last day. My lips are sealed.
A sliver of glass
A life, the sun
A knife, a death
The end of the run
And the riverbank talks
Of the waters of March
It's the end of all strain
It's the joy in your heart
Every day, after I pissed out the morning charge (a non-trivial process), cost me another hour to get to Sunset Park via the NYC MTA where I could have three to four hours in the studio until I had to get home to work out at the local gym. Any later than that and my energy would be completely spent. The parallel protocol of hormone blockers have a tendency to waste my muscles and deplete my bones of calcium, so weight training is a prescription. The silver lining after the initial grind, this has its' own payoff in terms of wellbeing. All the aforementioned is punctuated with mild bouts of exhaustion. Then comes dinner and a streamed series with my wife and to bed by 8pm. This was my weekday / day-to-day for a long time.
All these things and more -that now I am now beginning to forget- were the harmonics with which I resonated with in that Jobim song. Hard times have silver linings.
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Complete lyrics to Waters of March, Antônio Carlos Jobim.
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Postscript:
This will not be a cancer diary blog. Unless the situation turns worse -and there's no reason to anticipate this immediate eventuality- this kind of content, I will sunset immediately.
The central topic here is art: what I'm imagining / making, and the state of play of art history as we live it.