Kwame did it. He poisoned the lake.

[Part 5 in the "Libertarian cancer patient reads the Sunday paper" series. Intro here. Part 1 here. Part 2 here. Part 3 here. Part 4 here.]

Page 9A plays host to the annual acronym convention, in a piece entitled, "EPA to expand PCB tests in St. Clair Shores," which I first read as "PCP tests" and wanted to go swimming in the lake.  The lede:

The U.S. Environmental Protection Agency will expand testing in the spring in a St. Clair Shores neighborhood where PCB contamination has baffled federal, state and city officials since its discovery in 2001.

Despite spending more than $10 million on multiple cleanups, the problem persists in the 10 Mile Drain in the Bon Brae and Harper area and near the Lange and Revere canals. Colleen Moynihan, an EPA remedial project manager, said details of the additional field sampling are being worked out.

For what it's worth, PCB can apparently cause cancer.  Which puts it in a category with "everything" and "nothing."*

This issue has apparently baffled officials for a decade.  And not just the EPA:

The EPA is working with the state Department of Natural Resources and Environment, St. Clair Shores officials, the Macomb County Drain Commission and Macomb County Health Department. Moynihan said the testing could expand outside the Bon Brae and Harper area...

 ...At one point in 2002, the Macomb County Prosecutor's Office and Macomb County Sheriff's Office were working to determine the source of the contamination. That year, Crime Stoppers Alliance of Michigan offered a $5,000 reward.

"We even had the FBI do extensive research to see if anybody had been dumping in the drain in the area," Hison said.

That's eight, count em, eight government agencies trying to clean up one site for 10 years and $10 million dollars.

Look, this might be a terribly difficult problem to solve, and I'm sure the people involved are all hard-working and qualified.  But if I went to a doctor who said he couldn't figure out my lymphoma, I'd go to another one. And if that doctor couldn't figure things out, I'd go somewhere else, until somebody fixed the problem.  You don't get that choice with a government agency.  If the agency you're dealing with can't figure out the problem...well, tough luck.  They'll just continually "ask for your patience" and cackle with glee at more federal grants. 

(*Seriously.  My cancer was officially caused by "nothing;" it was a random mutation.  As for "everything," well, I drink more green tea now for whatever reason (antioxidants and whatnot).  One bottle I was drinking mentioned the healthy effects of Epigallocatechin gallate, or EGCG, in the tea.  So I looked it up on Wikipedia where I came across the sentence, "This property may be responsible for anticarcinogenic however also a carcinogenic potential of the substance" under the heading: "Possible carcinogenic potential."  So yeah, everything can cause cancer.  And nothing can cause cancer.  So good luck).

Guh.

Presented without comment.

April 29, 2010:

Officials accused of looting DPS of $3M

May 16, 2010:

High lead levels hurt learning for DPS kids

May 19, 2010:

DPS budget worse than a year ago

December 24, 2010:

DPS teacher shortage makes learning tough in district, teachers say

January 3, 2011:

Detroit schools to receive 45,000 computers through stimulus money

News that didn't figuratively throw up on my shoe

I know the title doesn't make any sense, but you start running out of titles around post 160. 

I got a call from my contact at Sloan-Kettering today, and their conclusion is that, given my characteristics and the circumstances of my case, neither CNS prophylaxis (the injections of chemo to the spine) or additional chemotherapy is needed. 

I haven't decided how significant this recommendation is to me.  There's no question that a recommendation from Dr. Zelenetz - the Chief of the lymphoma group at one of the country's best cancer centers - is significant.  Also, he has an authority-commanding beard.  That said, I would prefer to speak to the doctor myself (and they know that - hopefully I will get to do that on Friday), and the recommendation was officially, "get another PET scan in 3 months, then call us," which seems a little too much like a "wait and see" approach for my comfort.  Once I know the rationale behind their decision (and once they know my priorities), I'll feel a lot more confident in their recommendation (not that I'm not confident now, but I understand enough about my condition to be able to participate in a more in-depth conversation). 

Really, I would have been cool with a recommendation either way, so long as it didn't add any more uncertainty.  Tell me to do more, tell me to do less, I don't really care at this point.  Anything that nudges me one way or another is helpful.  Of course, I'll always have the "what if" question, but that's a part of living with cancer.  Sometimes the best choice isn't the most popular one.* 

That's it for now.  More to come, of course. 

(* I wrote that sentence before I read this, a blog post from Michigan Athletic Director, who writes, "This is not going to be a popularity contest. My job is to get the right coach."  Which, argghhhhh parallels between my life and Michigan Football!)

Dude in the hands of an angry something

I'm not a very religious person.  But there comes a time when even I start to believe that there's some cosmic force out there - maybe a supreme being, maybe the universe, who knows - that has me in the crosshairs. 

I think that's a little dramatic.  But then again, so is cancer.  All I know is that it's January 2011, I'm in remission, I'm supposed to start work in 5 days, and I'm as confused and depressed as I've been throughout this entire process. 

I can't believe the entire thing happened, but I'm over that part.  What I'm not really over is, as I've said before, the timing of certain events, along with this agonizing decision about whether or not to do more treatment. 

To tell you the truth, I pretty much had the decision made two days ago, after Sloan Kettering called me and essentially told me (in confusingly indirect language, of course) that they did not see the need for more treatment.  With roughly 8 docs in that camp, I felt safe enough to at least go to DC and see what Stanford had to say.  So I planned to rent a car, fill it with my stuff, and drive out to DC either tomorrow or Friday.  I was literally packing boxes yesterday when Dr. Al-Katib called me. 

And the guy who had been firmly in the "don't do more treatment" camp was suddenly all "maybe you should do more treatment."  I couldn't believe it.  I respect the hell out of Dr. Al-Katib.  He's been up front, honest, and wonderful throughout all this, and that's why I put so much weight on his recommendation.  But I'm not sure how this happened.  Maybe the misunderstanding was on my part; maybe it was on his.  It doesn't really matter.  The only thing that matters is that a doctor whom I thought was firmly against doing more treatment was not that, and that blew up my entire analysis. 

And then...the timing.  You all know about my diagnosis fiasco: finding a lump five days before the bar exam, getting biopsied the day before I flew to Maryland, being diagnosed 12 hours after I got back to Michigan.  Crazy enough, but whatever.  

But then things got better.  I had a second PET scan on September 30th, which showed significant reduction.  It was at that time that I finally was able to relax.  Emily got a job and moved to DC, and I finally felt comfortable looking for an actual place.

Emily had Columbus Day off, so she went looking for apartments on October 11th.  On October 12th, I met with Dr. Li in Ann Arbor who told me, "You probably have diffuse large B-Cell lymphoma, and we agree with your current course of treatment [R-CHOP]."  She said she would review the case with other doctors, and get back to me.  That afternoon, Emily and I placed a hold on a place in DC and submitted our rental application.  On October 14th, our application was approved.  On October 15th, Dr. Li called me.  "We think you might have a different type of lymphoma, and your current treatment might not be adequate."

If my PET scan was done after cycle 4 (as it could have been), I would have waited.  If Dr. Li told me at the October 12th meeting that they had concerns about my treatment, I would have waited.  But I guess that's not the way things were meant to work out.  

***

And don't even get me started on the eerie parallels between my cancer treatment and Michigan Football.  I had my first PET scan on the first day of Fall camp (August 9th).  Since the season held promise for everybody, the PET scan was a pleasant surprise.  Things went beautifully until October 9th - the Michigan State game.  Michigan lost 34-7.  Three days later, I was up at the U-M hospital.  Six days later, my treatment was downgraded to "might not be adequate." 

Michigan lost every game - and I lingered in mental purgatory - until November 6 against the Illini.  On November 8, I met with Dr. Kim who decided that due to my positive response to treatment, I needed only 15 days of radiation - I would be done with things in early December.  And things were great...until my November 19th disaster saw me in the Radiation Oncology clinic for four hours.  Michigan promptly got stomped by the Wisconsin Badgers the next day. 

Things got better in December, but only because Michigan wasn't playing any football games.  They did that again on January 1st.  Two days later, the coach that everybody in the universe thought was coming to Michigan (Jim Harbaugh) apparently decided he wasn't coming to Michigan.  A day after that, a doctor that everybody in my universe thought was solidly against doing more treatment revealed he wasn't solidly against more treatment. 

And so I watched this afternoon's Michigan press conference and Dave Brandon's "what the fu-- am I going to do now?" look on his face.  I had the exact same look. 

***

And so I sit here feeling like I'm not only on the fence, but that I fell onto he damn fence from a painful height.  I crunched the numbers - they're EXACTLY on my threshold that I set well before I started asking doctors for numbers.  If I was confident that the risks were minimal, I'd have done the more aggressive treatment months ago.  If we were talking two cycles of R-CHOP - pretty harsh stuff in its own right - I'd take it and smile.

But of course, that's not the case.  There are real concerns about added toxicity, and besides, it doesn't take a rocket scientist to figure out that high-dose (one of the drugs runs for 24 hours straight), aggressive, toxic chemotherapy is not something you mess around with.  I find that, even if I get over the hurdle of delaying my move to DC another several months (which I can do, because that's within my control), I run straight into the toxicity issues.  I'm not particularly concerned about enduring treatment.  I'm concerned about eliminating the cancer problem from my future and replacing it with something of a similar caliber.  That's not useful. 

It's all so surreal.  Sometimes, I wish I wasn't that asshole who had to be so involved in his treatment, who had to go and ask so many questions and gather different opinions.  What I do know now, as Dr. Al-Katib told me, is the precise nature of the issue.  I think this is pretty common in medicine.  The only difference is most people aren't active enough in their own treatment to realize it.  I am, and it's tough.  Reality is really difficult to handle sometimes (you see this in politics more than anywhere else, where people convince themselves that their opponents are idiots as opposed to real people with real ideas).  It's really easy to delude yourself or maintain some sense of enforced ignorance, but I've failed at that.  If I never go anywhere besides my one doctor - like most cancer patients - I'm perfectly happy right now.  But would I be better off I don't know. 

I know I have to make a decision and go with it.  I think I can do that.  But I'm not as sure I can deal with, "well...in that case, you might want to think about more treatment," and "oh you didn't have CNS prophylaxis? We'll call you back."  It goes back to my original point: At some point, you become convinced that something is out to get you.  I'm convinced that, if I do more treatment, something is going to go wrong.  I'm convinced that, if I don't do more treatment, I'll relapse. 

I know it's stupid.  I know it's irrational.  I know the statistics and all available evidence are against either of those things happening.  But it's the first time in all this that my mind has failed me.  The first time when I don't feel mentally strong enough to deal with reality.  Every fucking time I feel like I can make a decision and get on with my life, I get another phone call that shoots everything to shit.  Every time I convince myself that the side effects are not that severe, another doctor comes along to tell me "you can kill a person with chemo."  Every time I convince myself that we can monitor closely and treat only if we have to, I have another doctor who comes along to tell me "well then you would need a transplant to have any meaningful long-term prognosis."  And then I have doctors who come along and say both of those statements aren't quite true.

I was up til 4am last night because I can't stop thinking about this crap.  I stayed in bed until noon because I didn't want to get out of bed and start thinking about this again.  I know it's all on me.  I can't really listen to my parents - hell, even they are split on whether I should do more treatment.  I can't listen to other people: Oh you think I should do more treatment?  Thanks for the advice.  It's nice to hear that from somebody who has absolutely nothing to lose.  Let's pump your kidneys full of methotrexate, and then we'll talk.  You sit your ass in a hospital for three weeks, then rest for a couple, then do it again, and then we'll talk.  You take shots of toxic drugs into your spine, and then we'll talk.

Same goes for people who say "just get on with your life."  Thanks, buddy.  So when I come back with a tumor lodged next to my spine, will you have some advice for me then?  No, you won't.  Because no matter what you suggest for me, you won't have to live with the consequences.  I do. 

***

And yeah...I'm doing more of that now.  Snapping at people, getting pissed off at people, and so on.  It's probably not justified.  And I try - really, I do - to remember that most people would kill for "very good" chances of being cured of cancer.  That's rare in the cancer world.  I understand that.  And I think my doctors are wonderful, and my treatment went well, and so on.  I really do take those into account.

But dammit, I'm at the point where I'm convinced that those things are just the universe lulling me into a false sense of security as it plots its next cosmic nut-punch. 

Anybody have a coin?

The meteor probably would have been an upgrade

Quick quiz:  See if you can guess which of the following did not occur in the past 24 hours:

• Rich Rodriguez was fired
• My contact at Comcast disappeared.  Her e-mail gives me an "I am away from the office" autoreply and the phone number she provided goes to a voicemail says "I am out indefinitely as of September 19th."
• Rich Rodriguez was not fired
• My contact at Stanford disappeared.  He last e-mailed me on December 8th and indicated that he would "talk to the doctor and get back to me."  He has not responded to me since, did not give my medical records to the doctor, and was presumably fired (seriously). 
• HARBAUGH!!!
• We finally got in touch with the people at Comcast, who indicated there was no record of my account and no record of any installation appointment.  I forwarded them confirmation e-mails of these things sent to me by their own employees.  
• My contact at Sloan-Kettering in NY called me and indicated that the doctors there recommended that I get a PET scan in 3 months and then call them.  Which...is not really a recommendation on how they feel about more treatment.  So I asked her, "So no additional chemo or CNS prophylaxis," and my contact responded, "Wait, you didn't have CNS prophylaxis?  We'll call you back."
• WAYNE FONTES BRADY HOKE.  BOOK IT.
• I spoke with Dr. Al-Katib, who seems to be less solid on his recommendation that I should not do more treatment.  He's now probably closer to Dr. Li than Dr. Anderson. 
• I finally got a call from a Comcast rep who indicated that "somebody would call [me] within the hour to set things up."  I'll give you one guess as to whether or not that happened. 
• A meteor came and destroyed the f'ing earth.  

Since you are currently reading this post, I think you'll be able to find the fake bullet point.  Everything else is more or less true.  It was a fun day.

Since this is a cancer blog, the Dr. Al-Katib and Sloan-Kettering bullets are probably the most relevant.  I spoke with Dr. Al-Katib for a while yesterday.  I understand the issue much better than I did when I last met with him, so I wanted to speak with him again briefly before making a final decision.

Dr. Al-Katib asked me what my priorities were. I told him - as I've said here 100 times - I don't want to do this again.  Because...I don't want to do this again.  He responded that if I want the best chance at that, then more treatment might be the best option.

This isn't groundbreaking or new information.  Everybody would agree that doing more treatment would boost my chances of staying in remission.  Hell, doing 9 more cycles of IVAC would improve my chances of relapse to 0%.   Of course, that would be because I would be dead.  But still.  100% cancer-free there.

But it was interesting coming from Dr. Al-Katib, especially since he had been staunchly "you're ok" for months.  I'm not exactly sure how this happened - I thought I have been very clear with my goals throughout this process, and I know I have been with Dr. Anderson.

The biggest piece of information is that Al-Katib thinks my chances of being cured are closer to 80% than 90%, and that we could boost them by about 10% with more treatment.  So...there are your numbers.

I asked Dr. Al-Katib the obvious question: Why did he recommend 6 cycles of R-CHOP and radiation to the point where he said he would treat his own son like that?  And his response was "80% is a fantastic cure rate."  Which is true, really.  Most cancer patients would kill for a cure rate like that.  They thought they had a very good chance to cure me without putting me through hell or potential serious side effects.  I understand it.  But a lot depends on how much a patient is willing to tolerate and what the patient's priorities are.  My goal is to be done with this for good.  It's fantastic that I get to choose between "good" and "great."

And obviously, I would prefer great.  But my earlier analysis applies.  I'm not doing this unless the net benefit would be great enough to justify the risk and the hassle.  Dr. Anderson thinks the net benefit is near 0%.  Dr. Li thinks its about 10%.  Dr. Al Katib is somewhere in the middle.  My golden number is somewhere in the middle.  It doesn't change the analysis that much, but makes "more treatment" slightly more likely than it would have been if Al-Katib thought there was no real benefit.  We'll see what the others say.

As for me, I'm three days into a week in which I really want to put this shit behind me, and I'm more confused than ever.  It's at the point where even I expect the absolute worst (Sloan-Kettering and Stanford say "more treatment") or at least more confusion (one of them comes back with a third option), and I still get burned (by Dr. Al-Katib's newfound thoughts on more treatment.  It's like being a Michigan Football fan right now. 

From cancer patient to lawyer

It is with great pleasure that I announce that I have recited a paragraph of text, pledged my allegiance to a state in which I will never reside or work, and successfully completed my physical fitness requirements.  As such, I have officially transitioned from cancer patient to lawyer.  I'm not sure if that's an upgrade.  People will sure hate me a lot more.

A photo of the mass swearing-in ceremony in Annapolis last month

While I didn't have much of a reaction to the "remission" news last week, finally getting sworn in as an attorney was definitely a relief.  It makes sense really.  Statistically, the chances of me botching some part of the bar admission process - missing a deadline, forgetting to pay some fee, failing the bar, failing the character and fitness portion because I didn't report a parking ticket from 1992, throwing myself out the window at the MANDATORY COURSE ON PROFESSIONALISM, etc - were much greater than the chances of me botching the "beat cancer" thing.  If you factor in the entire process of becoming a lawyer, from the LSAT through yesterday, beating cancer was far more pleasant and far less costly.  So it's safe to say my reaction to yesterday's swearing in was one of profound relief and subtle accomplishment.

Mine was much more intimate

True to my form, I didn't want to make a big deal of the whole ordeal.  So of course, my swearing-in was marked by stirring, emotional speeches that brought half the people in the lavish courtroom to tears (no joke).  Which was fine.  It's better to not get what I expected in that way than to not get what I expected back in July. 

And then, as a fitting end to this long series of meaningless gestures, it was oath time.  I at least understand the point of many things that I disagree with.  Not so with oaths.  Still haven't figured out why I must swear to "bear true allegiance to the State of Maryland" in order to do my job.  The oath also requires me to "demean myself fairly and honorably," which, I get what you're going for, but can't we choose another verb there? 

Also: I'm terrible at oaths.  Why?  Because every time I take an oath, I think of this:

And the whole thing turns into a battle to keep from cracking up in the middle of a sentence.  Plus, the relationship between an oath-giver and oath-taker is a lot like the quarterback-center relationship.  You need to develop a rhythm - a cadence of sorts.  Otherwise you spend the entire oath wondering when the oath-giver is pausing for you to recite, or just breathing.  And you can't screw it up, or else you end up like Obama and you're not really President because you screwed up the oath AND you're a Keynesian.  It's all very stressful. 

D-Day approaches

Took me about 5 minutes to make this in Paint.  I'm so clever.

If it was totally up to me, I would already be in the hospital.  I might already have been through a three-week cycle of IVAC.  If I was diagnosing and treating myself, I would just look at a path report from the NIH, see the word "Burkitt's," and treat myself with the chemo more commonly used for Burkitt's lymphoma.  Even if there was some dissent, I'd probably err on the side of overtreating. 

But of course, I'm not treating myself. And thank God for that.  The issue is nowhere near that simple, and that's why I'm in the unenviable position of having to make a life-altering decision based on the analyses of others who understand the issue more than I ever will. 

Here's what I do understand: costs and benefits.  This separates me from most politicians.  But it will serve me well here.

So here's my basic goal: I do not want to do this again.  I don't want a "wait and see" approach.  I don't care much about short term pain or discomfort.  My job will be there whenever I am. And I'll probably be able to make things work financially (since I would be locked into a lease without any source of income). 

But I'm also not going to put myself through a horrific course of treatment - two, three-week stints in the hospital plus several weeks of recover - for shits and giggles.  Doing this "just to be safe" doesn't cut it.  The benefits have to outweigh the risks for me.

So here are the main issues for me:  1) The percentage chance that I am currently "cured," i.e., the chance that this is staying in remission, and 2) The percentage chance that I would be "cured" if I underwent more treatment, and 3) The percentage chance of risk associated with more treatment.

And then there's my own analysis:  How much would my chance of being cured have to increase to get me to do more treatment?  I probably wouldn't put myself through hell for a 1% gain; I definitely would for a 25% gain.

On top of this, there are a million little things that go into the analysis:  How comfortable I am with the doctor making the recommendation; how experienced the doctor is; the reasons for their recommendation; whether they've examined me directly; how many doctors agree with a particular recommendation; the consequences of each one, and on and on.

***

So here's where I'm coming from:  I think there needs to be about a 10%* net gain in my chance of cure before I sign on to more treatment.  Maybe a little lower.  If, when all is said and done, I'm convinced that doing more treatment bumps my chances by that amount, I'll do it.  If I don't think the benefit is that high, I won't.

(*This isn't just a random number.  By "net gain" I mean the amount by which the benefit outweighs the risk (so a 5% gain minus a 5% risk gives me no net benefit).  I figure, with all the uncertainty, there's a certain margin of error involved in this.  So a small benefit - 3-5% or so - is rather negligible.  And while this is a medical decision, my desire not to go through more of this stuff, my desire to move to DC, and my desire to not lose tens of thousands of dollars (by not working for several months) does have some impact on this.  A 1-2% gain is not worth the hassle.  And, in a more complicated medical issue, if I do relapse, the cancer could still respond to the more intense treatment.  If we fire that bullet now and I relapse, the cancer would probably be chemo-resistant.  That's worth another couple percentage points.  So if I'm going to put myself through hell, the benefit has to be large enough to outweigh the uncertainty, risks, and intangible drawbacks of treatment). 

Of course, this all depends on the three critical issues I've discussed above.  I've come a long way in figuring out how I'm going to figure this out, so I'm finally able to have the same discussions (and ask the same questions) to all my doctors.  I've discussed this issue extensively with Dr. Anderson and Dr. Li so far. 

And wouldn't you know, they're pretty much in agreement, especially on issues 2 and 3.  Both Dr. Anderson and Dr. Li would probably agree that my cure rate would be exceptionally high with more treatment - probably around 95%.  And they would both agree that the chance of running into serious problems would be about 5% - low, but certainly higher than most other forms of chemotherapy.

So that leaves us with issue 1: the chance that I'm fine and cured right now.  And that's where the docs differ.  Dr. Anderson thinks the chance is "into the nineties;" Dr. Li thinks the chance is around 80%.

This - the roughly 10% gap - makes all the difference in the world. There's no point in undergoing a brutal course of treatment with a 5% chance of growing me a third arm for a 1% gain in the cure rate.  There's no point in trading a 5% gain for a 5% risk.  But if we're looking at a 15% gain, then it makes much more sense to me. To put it another way, think of playing a game of Russian roulette, and the difference between playing with a 5-barrel revolver (a 20% chance of relapse) or a 10-barrel revolver (10% chance of relapse). I know which gun I'd like to play with. 

Making things more awesome is this:  Both docs fully admit that there's no real data on my particular form, that they might be wrong (not necessarily wrong, but they both admit that the difference between 80% and 90% is not great, and that the real chance is probably somewhere in that range), and that, if they used the other doc's analysis (if Dr. Li thought my cure rate was 90%, or Dr. Anderson though my rate was 80%), they would probably switch their recommendations.

My doctors seem to be on different parts of the same page. I'm not sure if this is good or bad.

***

I think what is unequivocally good, though, is the fact that I now understand this.  Here's what both doctors are doing:  They're looking at the statistics, and then trying to apply them to my case.

That seems simple enough, but I am a nightmare for cancer statistics.  I'm young.  I'm otherwise healthy.  I don't have any number of associated risk factors.  I tolerated treatment well.  My treatment was effective.  Officially, I have no clue what type of lymphoma I have.  But what matters is not the name, but that all three path labs (Henry Ford, U-M, and NIH) have observed the same things.  And it's a very rare type.  I was early stage.  There was no liver, bone marrow, or intestinal involvement.  The tumor was not near my neck or spine.  I was diagnosed and treated very quickly.  I had R-CHOP instead of CHOP.  I was dose-dense (on 14-day cycles instead of 21).  And so on.

So Dr. Anderson looks at the statistics, takes all of the above (and more) into account, and says my chance of never having to deal with this again is about 90%.  Dr. Li does the exact same thing and comes out a little lower.  Quite frankly, I'm surprised at how close their conclusions are.

So I take my discussions with my doctors and think of more things:  U-M is highly ranked; go with them.  My case has been through Henry Ford's tumor board twice, which gives me the indirect recommendations of numerous oncologists, pathologists and so on; go with them.  Dr. Li is a lymphoma specialist; go with her.  Dr. Anderson is 25 years older and has probably seen four times as many lymphoma cases; go with him.  Dr. Kaminski (at U-M) is a recognized lymphoma expert; go with him.  Dr. Al-Katib is a recognized lymphoma expert; go with him.  I'd rather err on the side of caution; go with U-M.  But Dr. Anderson has been with me since day 1 and knows my case better than anybody else; go with him.  I have two doctors who are telling me I'm fine versus one who recommends more treatment; go with the two docs.  But the consequences if those two docs are wrong are greater; go with U-M.

As you can see, this little game stopped being fun a while ago.  I can't get anywhere in the current scenario.  It's not that I won't analyze the situation until I get the other recommendations.  It's that I have analyzed this to the end of the earth, and I absolutely cannot decide what to do.

I'm not doing more treatment "just to be safe."  First of all, there's nothing "safe" about one of the most intense chemotherapy regimens available.  Second, the intangibles I listed above - getting to DC, going to work, starting my life - have some impact.  Third, "just to be safe" is a cop-out statement.  If you recommend a course of action, back it up.  (I originally thought U-M was taking the "just to be safe" approach, but I went up to talk to Dr. Li for an hour and discovered her rationale.  This is my big fear with Sloan-Kettering and Stanford - that I'll get a "just to be safe" recommendation from some administrative assistant and won't be able to get into the rationale with the actual doctor, which I'm more than capable of understanding and which I really need right now). 

So that's all I need.  I have all the tools necessary here, I know the issue, I know what I want...I just need something to tip the balance.  If I get one doctor who makes a good case for doing more treatment, I'll probably do that.  If I get two docs who say I'm fine, then there's no way I can decide to put myself through more - and more awful - treatment if roughly 10 doctors say that's not a good idea.

And even though I'm in a really tough spot right now, I'm very happy about this:  I left it all on the field.  There will be no way in hell anyone could say that I left a stone unturned during this ordeal.  Between me as an active patient, and the number and caliber of doctors that have reviewed my case, I am confident that I have received better treatment and a better evaluation of my case than virtually any other cancer patient in the world.  So whatever result that analysis produces, so be it.  It will be the right one.  And that will go a long way toward my ability to not spend every day looking over my shoulder, wondering what might have been.

Our actions might have cost you $800,000, but don't get mad at us because THINK OF THE CHILDREN!!

[Part 4 in the "Libertarian cancer patient reads the Sunday paper" series. Intro here. Part 1 here. Part 2 here. Part 3 here.]
 
Page 6A of last Sunday's paper gives us a pretty interesting article entitled "Worth Township property owners face major tax hike after couple win nearly $1-million verdict in zoning lawsuit."  The gist:

At the center of the controversy are George and Margaret Paeth, who have been trying for 10 years to renovate a lakefront cottage they bought for $48,500 in 1998. Over the years, they've butted heads with the township over their plans, landing in court twice.

In 2007, the Sanilac County Circuit Court reversed a zoning board decision involving a variance issue, allowing the couple to resume work on their home.

But within days of the court order, the township -- allegedly at the direction of [Worth Township Clerk Marcella] Bartniczak -- posted a stop-work order on the couple's property, without the notice required by state law or giving the Paeths a chance to be heard.

That, the Paeths said, was retaliation and a violation of their due process rights. A federal jury in Detroit agreed, awarding the Paeths $600,000 on Aug. 13. Another $200,000-plus in attorneys' fees and interest was tacked on, bringing the total to $860,008.79.

The interesting thing:  These paragraphs - which form part of a perfectly adequate lead - begin with paragraph 17 in the piece.  What seems to be the crux of the issue is buried in the piece.  Why?  Because the focus of the article is on Township Clerk Marcella Bartniczak, who citizens allegedly blame for the adverse judgment.  And, because the city only had $100,000 in liability insurance, taxpayers are on the hook for about than $200 per property owner.  This has people upset.  So they made billboards:

The article focuses on the boards.  And on the children:

In recent weeks, five billboards have gone up denouncing Township Clerk Marcella Bartniczak, whom some blame for the legal mess. A recall petition is circulating. A Web site has surfaced detailing all the dirt behind the controversy.

"This is a pill that everyone is going to have to swallow," said resident Doug Varty, who launched the recall campaign. "They're furious, absolutely furious."

Not quite, says Bartniczak, who insists that a handful of locals are out to get her.

"It's personal," she said.

Erecting billboards criticizing her leadership was one thing.

Planting one at the corner where her kids get on the school bus -- well, that went straight for the jugular, says Bartniczak, who is at the center of a growing controversy in this tiny resort town of 4,021 residents along Lake Huron.

The billboards are arguably stupid. But I doubt the people upset about having to pay extra in taxes sat down and though, "hey, let's figure out where her kids board the school bus and put a billboard there!"  And the dramatic tone of the article is apparently designed to evoke some sympathy from the reader.

I don't know the facts of the case (perhaps that would be something a newspaper article on the case could educate the reader about).  But there's at least some evidence that this government official's intentional actions damaged a couple to the tune of $600,000. In particular, a jury verdict to that effect and some pretty venomous rage amongst the townspeople not at the plaintiffs or even the verdict, but at the city government.

But the article is notable for a couple reasons:  First, it's cute that the only thing that makes a newspaper freak out about taxes is a specific tax imposed by a court in response to an actual harm perpetrated by a government entity.  Second, it's nice to know that if a jury finds that a city violated the civil rights of its citizens and caused $600,000 worth of damage, those officials can count on a somewhat-sympathetic (the print headline: "Township clerk blamed for cottage's big verdict") article in a major newspaper that really doesn't get into the facts of the case.

The situation is perhaps captured best in the article's second paragraph:

The otherwise quiet resort town along Lake Huron is in an uproar over a nearly $1-million jury verdict that taxpayers are stuck with -- all because of a screw-up at township hall.

Public officials screw up.  Taxpayers are on the hook.  Sounds familiar.

This Week

I have my PET scan results back and they've been sent out to Sloan-Kettering and Stanford.  I'm going to try to get in touch with them this week.  Sloan-Kettering should be pretty easy - my contact there has been quite responsive, and she knows what I'm looking for (a chance to chat with a doctor for a bit about certain issues, as opposed to a simple "recommendation").

Stanford is a riddle wrapped in a mystery inside an enigma.  I attempted to contact them several times over two months, finally got a call back when their original coordinator was out sick (and his replacement called me back), sent them all my records, exchanged numerous e-mails over the course of two weeks, which ended with a December 8th e-mail that reads, "I will talk to the doctor and get back to you either way!"  I have not heard a word from them since.  If you're a hot girl, then it's perfectly acceptable to ignore people.  Not so much if you're a cancer clinic coordinator. 

So that's my goal right now: get in touch with these doctors, and figure out if I'm doing more treatment or not.  At this point, I'm right on the fence (and I'll get into this issue more in a post either today or tomorrow).  It's not that my analysis is incomplete; it's that I've done a ton of analysis and everything puts me right on the border.  So I need to talk to these doctors and see what they say.  If doing more treatment is the best option, fine.  If not, let's move on. 

I'm going to do all this while somehow attempting to focus on starting work next week.  I'm not sure if that would happen, but as you might be able to guess, it requires my presence in Washington, DC.  As you might also guess, I'm not there at the moment.  So...fun week ahead.  Stay tuned.

Enter 2011

So?

So.

It's January. It's 2011. I'm done with cancer unless I'm not.  I beat cancer unless I didn't.  I have more hair, but not too much of it, and it's disproportionately prevalent on my upper lip and sideburns. 

In one week, I could be working in Washington, DC. I could also be sitting on my couch at home. Or in a hospital in Detroit.  Or in a hospital in Ann Arbor. Or in New York or Palo Alto.  In one month, I could be a damn-near fully recovered, normal, working stiff, or I could be hairless, nauseous, and immune system-less, my existence confined to a hospital room and my house for another couple months. 

This is not the uncertainty I wanted to bring with me into 2011.

***

I never really treated "The New Year" as a big deal.  Most resolutions are bullshit; I've always disregarded them accordingly.  The New Year has always fallen in the middle of a school year for me, so it wasn't a natural beginning or end to anything.  I just never really gave it a ton of sentimental value.

But this year was different.  As much as I (honestly) downplayed the "remission" announcement, it was nicely timed to fall three days before the end of the year.  2010 was a wild year that started off pretty strong and really stumbled down the home stretch.  But at least I can't say it was anything less than wildly interesting.  There were very few dull moments. 

It would have been nice - mentally, psychologically - to be able to neatly put all this in the past.  To close the door on a chronologically defined unit of time and say, "cancer...that was soooo 2010!"  To look ahead and see 2011 as the year of a new city, new job, new life, and so on.

But you know what else would have been nice?  Not catching cancer in the first place.  And one thing you learn quickly, as I've said here before, is that this thing doesn't allow you to call the shots.  Shit happens.  You have to adapt, you have to endure, and you have to understand that cancer does not care about your mental landmarks or chronological milestones. 

And I learned that a long time ago.  So while I'm disappointed that all this is coming with me into 2011, I'm not going to beat myself up over it.  Cancer - as horrible as it is - teaches you quite a few valuable life lessons.  For example: Don't be a whiny little bitch.  But the more refined version of that is the lesson that you can control only that which you can control.  It sounds obvious enough, but think of how often in our everyday lives we get bent out of shape about things we just can't control.  It happens to everybody.

Well cancer is a more extreme version of that.  It takes control away from you the second you're diagnosed, and really, it doesn't relent for a decade or so.  You spend your time hoping, praying, thinking that things are going well, and you never have total control of the situation.  Then you go into remission and you hope, and pray, and thank that things remain well, and you still don't have total control.

So you think about things, try to rationalize a bit, and try to stay reasonable.  And for me, that hasn't been terribly difficult.  Because what cancer does when it takes so much control away from you for such an extended period of time is it teaches you to quit worrying about control-sapping events of a much smaller magnitude.  Oh, the bus is late.  So what: It's not cancer.  Oh, you have to work late.  So what: Won't make your hair fall out (at least, not acutely).  Oh, you might not have everything worked out before 2011.  So what: I'm in remission; not dead.  I see people bitch and moan about what I now consider the "little" things, and I shake my head...but it's perfectly normal.  I don't blame anybody.  I probably used to do the same things.  Maybe I still will.  But at the very least, I have something to compare those small inconveniences to, and that "something" absolutely dwarfs them. 

***

The uncertainty sucks, to be sure. But after a while, like the cancer, you just get used to it.  This crap has been going on since mid-October.  And it's just become a part of the whole ordeal. I'll figure it out at some point.  Probably at least.  And then I'll decide what to do and go with it.

And on that point, I'm very happy to report that I've reached complete apathy.  I just don't care anymore.  Put me in the hospital, put me in an office, I don't really care.  I'll probably be fine either way.  And if I'm not, somewhere down the line...well, there's not much I can do about that.  There was nothing I could do about getting cancer, but I caught it early, acted on it literally within hours, was diagnosed as quickly as I could have been, and got right to work on defeating it.  And I "breezed" through treatment, didn't get sick, didn't lose weight, and maintained this site.  When all is said and done, I will have had six doctors from some of the best hospitals in Michigan and the country directly review my case, along with countless other doctors who have indirectly reviewed my case during tumor board meetings and conferences.  I mean, everything I could possibly control, I controlled.  My decision about whether to do more treatment is agonizing, but probably won't be terribly difficult (unless Stanford or Sloan-Kettering come back with a third recommendation, which, for the record, I am fully expecting and will absolutely put money on it). 

So I think apathy is an accurate term.  You can call it acceptance or resignation as well.  The bottom line is that my current mood is just...whatever man.  Put me in a hospital or put me in an office.  I know where I'd rather be but I learned a while ago that what I want doesn't really matter in all this.  So there's no sense in whining when you don't get what you want.  I did what I could.  Whatever decision I make will be the best one for me.  And once I make the decision, I'm just going to go on living my life and I'm going to quit worrying about this crap.  Because there's absolutely nothing more I can do about it.

So no, I didn't want to drag this baggage into the new year.  But I'm much more able to handle 2011 because of the lessons I learned in 2010.