Mortal Stakes

Only where love and need are one,
And the work is play for mortal stakes,
Is the deed ever really done?
For heaven and the future´s sakes.
from “Two Tramps in Mud Time” by Robert Frost

First, let me tip my hat to Robert B. Parker, creator of the Spenser detective novels. Mortal Stakes is the title of his third novel in the series. The title has always been one of those that has stuck with me and it is lifted from Frost’s poem that I have quoted above. I never really assimilated the import and meaning of the title until the past few weeks.

If you’ve been reading this blog, you are well aware that a week ago Wednesday, I had a biopsy to screen for cancer of the prostate. The results were negative but inconclusive. That means they did not find cancer but cannot rule conclusively that it’s not there and they missed it or that it won’t develop at some point in the future. They noted some “pre-cancerous changes” to the tissue which my urologist says may mean nothing and may never proceed beyond that stage. But I’m 57 years old and these things often happen to men of similar age. (A friend of mine, a long serving army officer, told me that he had his done by a corpsman who seemed enjoy inflicting the indignity of the exam on an officer. He was of a similar age.) The bottom line (yes, pun intended) is that I will need semi-annual or (if I’m lucky) annual biopsies and semi-annual and possibly quarterly monitoring of my Prostate Specific Antigen via blood tests. Why am I telling you all this? Well, read on.

The first surgery of any significance I experienced was in 2003. I had to have a parathyroid gland removed. This one gland (of four) had become enlarged and was causing a condition called hyperparathyroidism. Without getting technical, it is a condition of too much calcium in the blood stream. The only way to address it is surgically. But a surgical excision of the bad gland is, literally, a cure. It required general anesthesia and an overnight stay in the hospital but by the time I left, I could already feel that I was better. It’s that quick a cure.

When my urologist said the word “biopsy” this past January 13, I started crying. It was not that I was frightened that having a biopsy meant that I had cancer. As my wife explained to him while I regained control of myself is that I was afraid of the biopsy procedure itself. For a few days I was pretty shook up and fearful. Then several friends got hold of me and combined sympathy with some tough love. After a few days of processing all of it, I reached the acceptance stage and felt better. I was not going to let a fairly simple medical procedure turn me into a blubbering mass of jello. And as in the past, the reality was far more benign than the anticipation, imagination and fear. (Okay, I was aided by 25 mg of valium, but it really wasn’t that bad.)

The pathology processing and report takes about a week. While I was being biopsied, the office had already scheduled the follow-up consult which was one week later. Throughout that week I felt like I was coping well. My wife thought to the contrary. She has known me for 37 years and is extremely adept at discerning the nuances of my behavior and demeanor, even when I think I’m being perfectly normal. By the time I went back to work the following Monday, I could detect that I was feeling stressed. The first thing that goes when I get stressed is my patience. And I could tell that I was being impatient with everything and everyone. Which raised the question in my mind. Why?

The only cancer that has been in my family was an uncle who died from lung cancer that spread throughout his body. He, like my father, was a heavy smoker. So there was really no history of cancer on either side of my family about which to be concerned. But there it was. The pathologists held the key to my future. Literally, my future. My friends kept telling me not to anticipate what I did not know. While that is excellent advice, it didn’t change the reality that I was going to hear cancer or no cancer (and that’s not like having Howie Mandel say, “Deal or no deal”).

So there we were sitting in a room very like the first one we had been in at the urologist’s office. I had my book with me but could not concentrate on reading, a sure indication of stress. My wife was reading her book; outwardly very calm but I recognized tightness in her. Finally, the doctor came in and sat down, just like the first time. He opened the folder and pronounced the verdict (and that was exactly how it felt): no cancer but inconclusive. I’ve already told you what the import of that is so I need not repeat it here.

As we were leaving, I could tell my wife was not happy. I asked her about it and she said she would have preferred a conclusive answer one way or the other. I understood what she was saying but knew in my heart of hearts that the words “no cancer” were the most important words I would hear that day, that month, that…well you get where I’m going. The next day, I was happy to almost the point of euphoria. I did not have cancer.

This was my first true brush with my own mortality. Throughout my life, I have been blessed with remarkably good health. This is very fortunate because I’m a big baby about being poked and prodded in any medical manner. But it also left me unprepared for encountering medical issues as I have aged. Regarding the parathyroid issue, to this day, I find myself being upset at my body for malfunctioning, for letting me down. And while there is always a danger in going under general anesthesia, I knew I was in no danger of death and that following surgery I would be cured.

But the road down which cancer leads is a completely different thing. I was aware of all the things about how curable and relatively benign prostate cancer is. I am aware of the non-surgical methods of addressing cancer of the prostate. I was as well prepared as I could make myself, mentally, to face the possibility. But if the word “no” had been missing from the doctor’s statement, life would have changed.

What I had thought would be one of those life-altering moments, confronting my own mortality, turned out to be one of those things that went out with a whimper rather than a bang. There was no one moment where I realized that life might end or even that life as a healthy person would end. It has been over a period of a few days that I have even begun to assimilate the import of what I had experienced. I have lived through the death of my father, four grandparents and many other people who have meant a great deal in my life. There was never a time that I can recall where I did not understand the concept of death. I always knew that if something lived it was bound to die, including ourselves. (A friend who teaches high school English is in the habit of asking a class how many of them think the person next to them will die. Everyone raises their hand. Then he asks them how many of them think THEY will die. Only a few hands go up.) There are some people so obsessed with worrying about their deaths that they are unable to live. As badly as I have suffered from depression, I have never been one of those people. I do not fear flying in airplanes even though they sometimes crash (although I will never bungee jump or do other “death-defying activities).

I have not become a person who fears death. But I have become aware of the fragility of the vessel in which the essence of who we are is contained. With the myriad of things that can go wrong with the human body, it is almost more amazing that people, in general, remain as healthy as they do. Evolution has given us an amazing ability to resist disease despite the many biological and environmental challenges we face. But once a word like cancer enters your lexicon in a personal way that entire world view changes.

I stop and look back on the past 57 years and wonder how did I get this old? I don’t feel that old, even if my left knee sometime hurts for no reason or my vision deteriorates every year or I have arthritis in two of my right toes. But my internal sense of who I am still feels like a kid. I like Jimmy Buffett’s philosophy of growing older but not up. But I sometimes feel that 57 means that statistically, more than half my life is behind me. That sense that had been so remote is no longer quite so.

So what have I learned? I have learned that life is a series of events from which we stumble from one to another. I have learned that no matter how much we take care of ourselves, no matter how many physicals we have, the body does not always keep us healthy. I have learned that no matter how much you may not want to have needles inserted into your body, when it is necessary it is going to happen. But most of all, I have learned to value the people in my life and the color they contribute to it. When I needed support they gave me support. When I needed tough love, they kicked me in the bum. And through it all they gave me their prayers and concern. If that’s not life affirming, I don’t know what is. When the stakes are mortal, it is good to be surrounded by people you love and who love you back.