The Big C

Is there an easy time to introduce cancer into the conversation?

I've been living with prostate cancer for over five years. It's a part of my body now, something like an unwanted wart or the nobbly fingers sculpted by arthritis that work but with less elegance and grace than before.

"What are you going to do about it?" I've been asked by my friends as well as physicians. And when I tell them "nothing," they shake their heads more in bewilderment at my madness than in sympathy.

We live in a fix-it culture. If there is a problem, solve it. If something is broken, repair it. There are two solutions for cancer: cut it out or poison it. Get it out of my body, and/or kill it, NOW.

But the "it" is a part of my body, a few cells that have got their signals crossed, that reproduce erratically and unendingly, the cutoff switched bypassed or forgotten. The mass, the tumor, the shadow on the x-ray, is The Blob that will grow like topsy until it kills its host, me. Many (most?) cancers are fatal. It is a sign that my body is killing itself, committing suicide, without involving my head. How very strange!

Life, of course, is a terminal disease. No one here gets out alive (to quote my friend Jerry's book on The Doors). Who are we to wish it were otherwise?

My diagnosis came at a very difficult time in my life. I was trying to write a phd dissertation and my marriage was falling apart, not exactly in that order. The recommended treatment, surgery or irradiated seeds, was not convenient. It's hard to make these decisions while living in a borrowed room. In the first flush of discovery, I researched prostate cancer as if it were an academic conundrum. I attended a support group and met a sad man whose prostate had been removed, with all the attendant complications and a long healing process, but whose cancer had spread nonetheless. All that work and no reward. The common side effects of conventional treatment are scary: incontinency and impotency. The later I certainly did not need as I embarked on a new life as a single man. I learned that most men develop prostate cancer in their later years, and most of them die from other causes. But in some cases it spreads out of control. Timothy Leary, Frank Zappa, and my dear friend Peter Troxell died from it.

At that moment, not long into the diagnosis, help came in the form of an invitation from Dean Ornish to join his clinical study of prostate cancer. Ornish, who discovered that exercise and nutrition will cure heart disease (and wrote a number of best-selling books about his methods), was applying his ideas to prostate cancer (and by extension hopefully to breast cancer because the pathology is similar). For several years I followed a non-fat vegan diet, meditated and did yoga for at least an hour a day, exercised aerobically for three hours a week and attended a weekly support group meeting in Sausalito where, in addition to conversation and exercise, we were fed gourmet vegan meals and given more food and vitamins as well to take home with us. At the end of the study, Ornish determined that the PSA (blood test to determine the degree of cancer) of those adhering to the research guidelines did not rise as rapidly as that of those in the control group who did not follow the protocol. But the difference was not nearly so dramatic as in the more successful heart study.

Ornish's funding for a longer study eventually ran out and he turned his attention to advising giant food corporations on how to jump on the organic bandwagon. I found the weekly commute to Sausalito too demanding and the siren call of meat too irresistible. Did the diet and the exercise and the support slow the growth of my cancer? I really don't know. Ornish was careful to pick study participants with low PSAs. Mine was in the 6's; when Peter was diagnosed, his was in the 100's. Now, five years later, my PSA is slightly above 12. How does that correlate with tumor growth? Even the scientists and the urologists are not sure. Why do some cancers grow rapidly and others take their time? No certainty on that one either.

What is certain is that we will all die at some time. What merit is there in fighting it, now or later? In stories, the dead are usually given high marks for their valiant struggle against the dread disease, as if they are in competition, the cancer or me. But the cancer IS me. And failing to except that means we are fatally divided. Far better, I think, to embrace all parts of ourselves, the good with the bad (kind of like in an ideal marriage). Surely we've learned by now that healing is not always a cure.

My feeble religious faith, with insights from Christian, Buddhist and Hindu teachings, tells me that death is not the final answer. The universe is not random and meaningless. Whether something of me will continue or will merge with the whole I do not know. Jesus said over and over: "Be not afraid." And yet it is often Christians who are most fearful of death. The sign that we hear his Gospel and follow it should be not only that we love one another (and our enemies as well) but that we face death unafraid. Anything less is a travesty.

For myself, I've decided to let my body take its course. I joke that if I discover my cancer has decided to speed up and race to the finish, I will retire to a beach on an island in south Asia, with all necessary drugs to ease my pain and discomfort, and a young housekeeper to keep the flies away. Like the old elephant who leaves the herd on a journey to the dying ground, the Shangri-La of ivory tusks, I prefer to spare my family and friends the vision of a death scene. I want them to remember me not as a medicalized patient grasping at life but as the stubborn, cantankerous old fart that I am.