Update: Surgery

Hi everyone,

I was finally able to meet with the surgeon at Emory. He is a wonderful man named Charles Staley.

Staley was extremely impressed with my response to chemotherapy. On the other hand, he admitted to me that my recurrence is extremely rare. Most colon cancer recurrences occur in the liver or lungs, whereas mine is the in the mesentary and peritoneum (i.e., in my guts and the surrounding "bag" that lines the intestines, stomach, liver, and surrounding areas).

Staley is the "best" surgical oncologist in Atlanta. Yet, he told me that the surgery recommended for rare recurrences like mine is one that he has never done. So he is referring me to the surgeons at MD Anderson in Houston, TX.

The surgery will occur after my chemotherapy is over + one month to recover from the avastin (which causes bleeding, so they wait for surgery after avastin treatment), so mid to late April, early May. The surgery is gruesome. It involves doing small resections of the mesentary and peritoneum. The problem here is that the mesentary and peritoneum contain networks of blood vesseles, arteries, and so on, all of which are connected to very specific locations in the gut. So in addition to resecting areas of me that were infected with cancer, they then have to "follow" the blood vessles these areas fed with blood and nutrition, and then resect those areas too, since once they resect the blood vessles in the mesentary, they have to also take out the areas that will surely "die" once those blood vessels are dead and gone. So, for example, if they resect an area of my mesentary that supplies blood to a 1 foot section of my small intestine, they have to also go on and resect that area of my small intestine. So there is no way going into this surgery to tell what you'll come out with. I could come out with areas of my small intestine, stomach, bladder, or liver (among other things) gone.

In addition to resecting areas of the mesentary and organs they supply blood to, this surgery involves perfusing the mesentary and peritoneum with "hot" chemotherapy. They insert a needle into one area of the mesentary and peritoneum with a solution of heated chemotherapy drugs (heating the chemo makes it more able to permeate small, microscopic areas) to kill any microscopic cancers that may still exists therein. They then insert a drain in my abdomen and sew me back up. the drain is removed a few days later, once the chemotherapy has left the system.

Sounds awful, I know, and I am worried, as are my parents. They call this surgery the MOAS (Mother of All Surgeries). It's also called the "sugarbaker," after the DC surgical oncologist who pioneered it, but which also sounds like a pastry. Is it a surgery, or a cookie? It's rough. But, on the bright side, it will increase my chance of remaining disease free (of having no other recurrences after 5 years) by about 50%. So even though the surgery sounds awful, I have hope about the fact that the surgeons at MD Anderson are some of the best surgical oncologists in the world, and that once this is over, it will FINALLY be over for good.

Wanted to just let you all know what's going on. If I die, I hope it's not in Texas!! Especially the home of Enron. If something goes wrong, just be sure that I am not buried anywhere near Ken Lay.

Love, Chet

#8: Ben

Treatment #8 was covered by my friend Ben. Ben flew in from Albuquerque, NM, where he works as a government spy.

Kidding -- sort of.

Ben and I met in Albany, about 9 years ago. We were young and foolish. We both loved classical music, and I used to attend Ben's performance of "The Messiah" every year. For those of you who do not know, it takes quite a bit of effort to sit through the Messiah, especially on the hard wood seats of Troy's Fleet Bank Music Center, where Ben used to perform. But I used to enjoy going to see Ben perform this and other pieces every year when he was part of the Classical Singers and Albany Promusica. He has a nice voice, among other things. My favorite was when Ben and Albany Promusica performed Verdi's requiem at a really, really old Catholic church in Albany. It was beautiful.

I have a favorite memory of Ben. When I first met him, he was an officer in the Navy. Ben spent his young adulthood spending 6-month stints on submarines! This isolation explains his tenaciousness and character, by the way. Anyway, I used to hassle Ben all the time to salute me. He never would, claiming that it was a very specific gesture only meant to be used in certain situations and to certain people. But one night, after several glasses of wine, I was walking Ben back to his car. I trailed behind him, bothering him the whole while to salute me. Finally, just as Ben got to his car, he spun around on one heel. His heels clicked together like thunder, and his right hand shot up, making a sound as it whipped through the air. And he saluted me. It sent shivers down my spine.

This treatment was pretty easy. Wednesday, of course, was awful. But Thursday Ben and I went to campus to see my friend Wendy give a talk about her new book, with her co-author, Barbara. We had a good time. It's unusual that I'm able to pack in this much activity during a treatment. I think Ben thoroughly enjoyed himself, as he commented that he never knew Birth (the subject of Wendy's talk) was so complicated and interesting.

Friday was a pretty bad day, but I got through it -- mostly on the sofa. Ben rubbed my feet (yes, Carla and Henry, my feet). Saturday, Ben and I went to breakfast at the Flying Biscuit. Then we went to Outwrite Books, and bought some stuff to read (Hollinghurst's "Swimming Pool Library" for Ben, and a book on dissent in America, for me). After that, we went to see Pan's Labyrinth, a truly gory movie which illustrates the horror of Franco's Spain (just in case you were under the illusion that fascists were nice and played by the rules). Then we were joined by Jody, Andy, and Lexy. We went to dinner at La Fonda, yum yum. Lexy was quite concerned about the fact that Uncle Chet no longer has any hair. "Hair gone," she kept exclaiming. When asked where my hair went, she replied: "Hair went byebye." I tried to tell her that Uncle Chet's hair would grow back in time, but she just kept looking at my bald head with a furrowed brow and a look of deep concern. She seemed to like feeling the top of my head, but would then instruct me to "put hat back on," so that she wouldn't have to look at my naked melon any longer. Sweet girl, that Lexy.

Ben left today (Sunday). He's going to move from Albuquerque to Seattle, where his boyfriend Marc works for Microsoft (he helps design the XBox). Ben is going to earn a pile of money in Seattle and then open up an organic sheep farm on an island in the Puget sound. I can't wait!!! I love cheese!

Ben is also going to support me during my retirement. Thanks in advance, Ben.

Naked, Blue, and Unafraid

Naked and Unafraid

#5, 6 and 7: Wendy and Gregg

My last three treatments have been chaperoned by my friends Wendy and Gregg, as well as Wendy’s boys, Jake and Ben (pictures of them later), and their cats, Hinky (shown above) and Bumble (too much of a diva to be photographed, even more of a diva than Tache). Wendy is my friend from school and she just published a new book called "Laboring On." Go buy it.

I haven’t written lately because of the holidays. My trip to Wyoming was cut short by two days thanks to global warming and Denver weather. It’s 71 degrees in New York today, and 20 degrees in Wyoming: anyone see a problem here?

So my treatments are now more than half-way over. I really hope this is the end of everything because, to be quite honest, I cannot imagine doing more chemotherapy after this set is over. This is actually the end of my 19th!! Treatment, and by the time I reach #24, I wonder what’s going to be left of my body. I know my kidneys are in bad shape because I can feel them throbbing sometimes. My hair is now basically coming out in gobs. I'm shaving it all off soon. And even though, compared to others, I tolerate these treatments quite well (recovering quickly, leading a basically normal life for about 8 out of every 14 days), I’m really, really, really getting sick of it.

Everyone keeps telling me it looks like I’ve lost weight, but in actuality I’ve gained 4 pounds since beginning chemotherapy. I’m convinced that this weight gain is poison….4 pounds of poison trapped inside of my screaming body. Today I feel like my entire body has been marinating in toxins for the last 6 months. The poison is coming out of my skin. I have acne again, like when I was 13 but even worse. My hands look like the hands of an 80 year old, and my skin is peeling off. My sweat smells like a something you’d scour the bathroom with. I won’t sicken you with a discussion of my digestive tract.

Thank God for Wendy, Gregg and troupe. When I’m at their house I never really feel like a sick person (except for the actual being-sick part). Ben and Jake are always excited for one of my treatments because it means I’ll be staying over. They think I’m cool and I’m not quite sure why. Ben watches stupid Lifetime TV with me, which he cleverly calls "Deathtime" because all of the shows on Lifetime are about women being murdered by bad men and because all of the commercials on lifetime are about life insurance and dying. Jake, meanwhile, often just sits in my room doing something ingenious on the computer, trying to explain it to me in simple terms that a non-techy like me can understand. I like Jake and Ben because, unlike most other kids their age, they talk and, usually, what they say is pretty interesting. They also have good taste in movies and music. And they cook! Speaking of music, Gregg has the most amazing collection of music (all kinds of music – jazz, classical, opera, blues) I’ve ever seen. He gave me a recording of Rachmaninov playing Rachmaninov for Hanukkah. And even when I’m sick Wendy’s food is always delectable. If you ever want good Indian food go to Wendy’s house (be invited, though, don’t just show up...I don't think she'd appreciate that).

Well, I don’t feel like doing much besides complain today, so here’s a poem by Ted Kooser, the poet-laureate of the United States, introduced to me by my friend Gail Kohler-Shive.

PS – I started writing this a few days ago and actually feel fine now (1/13 CM).

At the Cancer Clinic, by Ted Kooser

She is being helped toward the open door
that leads to the examining rooms
by two young women I take to be her sisters.
Each bends to the weight of an arm
and steps with the straight, tough bearing
of courage. At what must seem to be
a great distance, a nurse holds the door,
smiling and calling encouragement.
How patient she is in the crisp white sails
of her clothes. The sick woman
peers from under her funny knit cap
to watch each foot swing scuffing forward
and take its turn under her weight.
There is no restlessness or impatience
or anger anywhere in sight. Grace
fills the clean mold of this moment
and all the shuffling magazines grow still.