Monday, January 14, 2008

The Best Time

I am writing this from a warm place in a small town in a cold state. 

It is a little bit more than 16 months after I was diagnosed with a rare cancer that will more than likely kill me. It is also little bit less than two hours until I begin fasting to prepare for a PET scan that will take place about 14 hours from now. The scan will, hopefully, tell us that the chemotherapy and radiation I have already endured have worked well enough to make surgery to remove my tumors possible. Or it may reveal that the cancer is elsewhere, that it has found a convivial home in my lungs, or liver.


PET stands for positive emission tomography, for what it's worth. In this part of the cold state, the equipment is located at a small, underused and depressing Catholic hospital. After checking in, you are led through a series of corridors out to what is essentially a loading dock. A semi-trailer is backed up to the dock, which is separated from the hospital proper with a series of doors reminiscent of a movie airlock. There are radiation signs everywhere. You are lead to an odd vinyl armchair in a tiny two-person capsule, where a technician opens an IV in your arm. An assistant removes something -- a vial of radioactive sugar -- from a machine that has a thick door like a bank vault. They inject the sugar. Then you wait in the dark and stare at the ceiling and listen to the faint traffic from outside and watch the foot of the silent, sleeping man next to you twitch occasionally. You cannot see his face. 

If I sound portentous, forgive me. The damn scan is portentous. I'll tell you the rest -- and I'll tell it for real, and in the first person -- tomorrow. I have only had this test once, not long after my diagnosis, and I mostly remember how it felt, not how it looked. I wasn't writing then.

It would have seemed impossible to me 16 months ago, but the stakes are higher for this test, the one that will begin 14 hours from now. After nine months of chemotherapy and a huge dose of radiation, and then seven months of often-fraught rest, I am finally beginning to feel human again. The treatments battered my tumors -- this is why I am still alive -- but it did not, we know, kill them. The question now, with this test, will be: Where are they? Tumors are hungry. What they do is grow. If the scanner detects sugar being devoured outside the box of my pelvis, where the cancer began and spread to my lymph nodes before the radiation and poison beat it back, I'm doomed. If the monster is still in the box, I have some options. Bad ones, to be sure, but options all the same.


A while ago I began finding occasions to quote an aphorism to my wife and kids. "The best time to have planted an oak tree is 25 years ago. The second best time is today." I don't usually go around quoting shallow bits of advice (I normally make up my own shallow observations, thank you), but this one became a family joke, enough so that I can summon it with just the first three words, delivered with orotund self-mockery: "The best time..." I wanted to start writing after the first biopsy, then the second, then the CT scan and the PET scan and the MRI, after the first chemo and then the second, after all of the many hospitalizations and the dozens of radiation treatments and now, tenuously, after beginning to feel like a diminished but somewhat whole version of myself. 

I did write morose letters for my children, and occasionally funny e-mails to my friends, but I didn't keep a journal of my illness. But the agony of facing this test makes me want to put something down. In some ways, it feels beside the point. It's so late; so much has already happened. 

But I'm just going to go ahead and plant the damn tree today.

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