January 9, 2022

The mantra of realtors everywhere is “location, location, location.”  You could say the same thing about cancer. 

Last summer, a small but growing tumor was in the wrong place, blocking a liver duct and causing bile to back up into my abdominal cavity. A team of doctors huddled around my hospital bed, outlining a variety of surgical options. I offered one of my own.  Won’t the chemo eventually cause the tumor to shrink, solving the problem in the first place? 

The senior doctor of the group offered a remarkably blunt response.  “That never happens,” he said. 

I think I smiled a little bit when I heard that.  I love a challenge.  I was going to prove him wrong. 

Last week’s medical check-up and chemo treatment included a review of my latest CAT scan, the first since October.  The body language of the medical team was good, so I suspected the results were going to be positive.  While I was waiting for my turn to see my oncologist, he poked his head in the room and said, “The scan looks good.  I think we’ll give you chemo today.” And then he disappeared just as quickly.  

When we finally met, he said most of the tumors were the same, while two of them shrank.   

“How much?” I asked. 

This question threw him for a loop.  He hadn’t done the calculations.  He gave an estimated range of 10 to 20 percent. 

“Can I see the lab report?” I asked.  He handed it to me.  He confirmed that one of the shrinking tumors was located near my liver duct. 

Math isn’t my strong suit, but it seemed to make sense to compare the square area of the tumor then and now to get a sense of what sort of progress had been made. After the doctor’s visit, I asked a nurse if that sounded right.  She said she thought so.  By the way, medical people have a habit of saying that a lot.      

I ran the numbers, made an initial mistake of adding instead of multiplying, and then checked the numbers two more times. The surface area of the liver duct tumor had shrunk almost 50%, while the largest tumor on my liver shrunk by at least 40%.  

Meanwhile the report said that the original tumor in my pancreas was “poorly defined” with signs of atrophy, suggesting the radiation treatment I received at the end of 2020 had turned that malignancy into scar tissue.  

The next day, I was talking to one of the nurses to confirm the numbers, since there were typos in the two reports, and I wanted to make sure everything was aligned.  During our conversation, I had to ask her if it was unusual to see results like these almost 30 months into treatment.  She conceded that they were “rare.” Even on the phone, you could tell she was smiling about that. 

My advice? When it comes to medical prognosis, a little selected “skepticism” never hurts.  And the prayers are working.

After completing my 56th round of chemo, I headed to a local restaurant to take advantage of their annual St. Patrick’s Day special (corned beef, boiled potatoes, cabbage, and soda bread for under $8. That’s the type of bargain that would make my Dad proud). The computers were down, and the waitress asked with some embarrassment if I could wait for the check.  Of course, I said. By that point, I was too fascinated watching the Saint Peters University game to leave the place. A small Jesuit school from Jersey City was about to humble Kentucky, which boasts the winningest program in the history of NCAA basketball. In contrast, St. Pete’s NCAA Tournament record now stands at a lofty 1-3. 

Watching an underdog triumph in overtime got me thinking. I’m also an underdog fighting in overtime against an opponent that rarely loses. God and medical science have put me here. And I’m not playing out the clock. 

In fact, it’s been a good week for underdogs. Last month, I got an email from the Director of Acquitions at Broadway Licensing, the owners of the Dramatists Play Service and one of the top theatrical licensing and play publishing services in the world. He read two of my plays, “Horseshoes” and “Pets (and Their Humans),” and he wanted worldwide licensing rights for them, which includes publications. 

My conversations with him and his Acquistions Manger were helpful and professional. For two people who made their living out of drama, there was clearly none of it present during the negotiating process. 

It’s probably on the edge of irony that the last play I had planned do before sickness forced me to the sidelines was “Harvey,” a proud member of the DPS portfolio. On Tuesday, I signed a contract to join it. 

How this all came about is probably so convoluted and miraculous I would be at loss at how to explain it, so I will default to something easier to fathom.  Underdogs do win sometimes, just like St. Peters. After a long day at the office, God must kick back with a few beers and watch my little black comedy of a life with amusement. It must be too fascinating to cancel right now.

I have been reading lately Ron Chernow's remarkable biography of Ulysses S. Grant, one of the most misunderstood presidents in American history.  In the final year of his life, Grant raced to complete his memoirs before he succumbed to throat cancer.  He finished his final draft only days before his death.  Mark Twain, a personal friend who knew a little something about writing, was astounded by the quality of work, especially considering the challenges Grant faced to complete it. 

It may be a little early to determine where my finish line lies, but I do sense a similar challenge. When I started writing plays about eight years ago, I focused on the output, not the promotion.  I have been extraordinarily lucky and blessed.  I'm still amazed there are actors out there willing to take the time and energy to bring my words to life. 

Tuesday night, six actors gathered around the table for the first read-through of my play, "In Danger of Falling in Love," which will debut on the weekends of May 13th and May 20th at the Villagers Theater in Somerset.  Normally, I simply enjoy listening to the words, but the real joy tonight came from watching the genuine delight on the faces of the actors as they followed the story.   This is really going to be good. 

Just a little warning, fair readers.  Expect a lot of nagging from me over the next few weeks to buy tickets.   

"Everyone has his superstitions," Grant once said. "One of mine has always been when I started to go anywhere, or to do anything, never to turn back or to stop until the thing intended was accomplished." 

A race has only one direction.  When it ends is less important than how you finish.

Spend Saturday sitting at the counter of the relentlessly busy Keyport Diner, eating a waffle smothered in fruit and recuperating from my first business trip in more than two years.  The company planned “back to the office” celebrations, and I indicated to my boss that I would be willing to travel out to Colorado.  I hadn’t been in an office since COVID struck, and I missed the old business rhythms that comes from talking to colleagues face to face.  

Of course, the entire idea made no sense at all.  I was asking my body to tolerate a flight across two time zones only days after my 57th chemo treatment (I understand I now qualify for a lifetime supply of Heinz products).  I was going to sit through two days of meetings, participate in a few after work activities (like dinner with members of the Comm team), and stay energetic and focused through the whole thing.  Even in the best of health, I was tackling something that promised to a bit audacious. 

But I also saw it as a test.  How far could I push myself? Would I let my cancer dictate my actions or vice versa?  In this context, I let my natural competitiveness take over. 

The first two days of the trip were brutal.  My intestinal system seemed to be in constant distress and the high altitude didn’t help matters. My neuropathic feet kept reminding me that the office was practically a corporate Stairmaster.  But my bow ties distracted people; they thought I looked good, and that helped disguise my symptoms pretty well. 

By day three, I was starting to feel more normal, and by the last day, I was settled into my seat for the flight home, mission accomplished and an eager rendezvous with my bed only a few hours away. 

And that’s when things got really interesting. 

I broke one of my cardinal rules by booking the last flight out.  It was delayed, an early bad sign, but we also had on board a group of Rabbinical students, dutifully doing evening prayers.  I assumed God would be listening.  He wasn’t. 

Midway through the flight, we learned that Newark was closed by high winds, so naturally we were diverted to the “Windy City.” It was chaos at O’Hare.  Confused service representatives, struggling with computers that weren’t working and muttering about their shifts coming to end.  To lighten the mood, I started playing Eddie Floyd’s, “Big Bird," on my iPhone.  No one seemed amused. 

It was time to pull out the “cancer card.”  I explained my medical condition to one representative who was conveniently standing next to a supervisor. I said my medicine was in my luggage, and I just wanted to get to a hotel and crash.  They pulled me aside and put me in this “secret” room (it didn’t even have a visible door) where they managed to resolve everything, including a connecting flight. About an hour later, I was in someplace called Schaumberg, talking to a hotel clerk who could have given lessons on being dour to Henry Winkler’s character in the movie “Night Shift.” 

The following day was raw and rainy, spoiling plans to take a walking tour of Chicago and catch the Cubs in action at Wrigley. I went back to the airport, hoping to find an earlier flight. The best they could do was airdrop me into LaGuardia in the middle of the afternoon rush hour.  The Uber driver couldn’t speak English, leading to a lovely scenic tour of Staten Island on the way home, but by seven, I was comfortably lying in bed.  

I was pleased that somehow my stamina held up, even late at night as I negotiated myself out of the mess in Chicago. Ultimately the winning factor once again was my persistent, New England stubborness. "Stubborn people get themselves in a lot of trouble," Anna Paquin once said.  "But they also get things done."

Passover isn’t a great day for Egyptians.  A megalomaniac leader, refusing another people’s separate nationality, tries to crush them with overwhelming force, only to be surprised when his army gets wiped out by an unexpected intervention.

Sound familiar? 

The Passover tale transcends religious beliefs and reflects the terrible circle of human interaction, in which there are always oppressors and people to be oppressed.  Sometimes miracles happen, whether through the hand of God or a well-aimed Stinger missile. 

You can internalize these battles, too.  Recently a colleague of mine at work asked how I was doing and then stopped himself. “I bet you hate it when people ask you that all the time,” he said. 

Actually, no, especially when it is not perfunctory. The answer simply gets more complicated as my list of ailments grow.  Neuropathy has left my hands clumsy and my feet numb.  My liver remains grumpy.  My bowels like to surprise me at the worst moments.  I itch like crazy.  I have mysterious brownouts reminiscent of overtaxed power grids during a California summer.  Each day offers a new challenge, and they are usually not good ones. 

Time may be on The Rolling Stones’ side, but certainly not mine, but when you obsess about making every moment count, you find yourself paralyzed in achieving an impossible goal.  I’m trying not to worry about the final cosmic impact of fixing a toilet.  Or taking naps from time to time.  When you try to create bucket lists, often you find your foot in one of them. 

My rabbi kindly invited me to his house for Passover, and with my son in tow, I entered into a Sedar filled with noise, conversations, and boisterous reminders of life.  I reminded him that on a night that we celebrate miracles, he decided to invite one into his house not named Elijah. 

Passover and Easter represent moments of affirmation—one a triumph over evil, the other a triumph over death itself.   It betrays the inherent optimism of humanity.  Israeli professor Yuval Noah Harari expressed it this way, “You could never convince a monkey to give you a banana by promising him limitless bananas after death in monkey heaven.” I don’t worry how many bananas I have left to eat.  

The best we can do is to try to enjoy each one.  L’chiam. 

The volunteer rabbi from at MSK uttered the four words that every Jew dreads to hear—“They’re coming for you.”  Of course, context is everything, and in this case the rabbi was seeking to be optimistic.  After hours of fasting so that I could take general anesthesia safely, he was confident that my turn would come soon for my “procedure” to correct whatever was ailing my liver. 

I was less hopeful. After endless itching, yellowing skin, and soaring bilirubin numbers, it wasn’t safe for my jaundiced liver to tolerate chemo as well. My oncologist and I agreed to give it a weekend and see if the problem would correct itself. Instead the bilirubin levels doubled, and an early morning Lyft ride was in order to check into MSK’s main campus in Manhattan. 

MSK has been around since 1884, but I guess it still hasn’t gotten a handle on scheduling, so my early morning arrival didn’t automatically guarantee a time when I would receive my surgery.  

Apparently, an email debate was happening behind the scenes as various doctors were offering competing strategies to treat me. One approach was to use an endoscopy to clean out my stents, but that ran a higher risk of infection.  The other was a more direct approach to replace the stent outright.   The first day I fasted for 16 hours only to be told at 4:30 p.m. that they weren’t ready to see me.  We were headed down the same path on Thursday, when a nurse practitioner stopped by to tell me who won—the doctor who put in my last stent back in the fall. He said he had taken a personal interest in my case. 

On one hand, he was a talented surgeon filled with energy and confidence and a childhood desire to play shortstop for the Yankees (He was accepting of my similar dream to play centerfield for the Red Sox).  On the other hand, this was the same guy who had told me at the time that I had a fifty-fifty chance of getting a permanent drain. Turned out that he wasn’t even in the office.  Another member of his team would do the work.  He liked to look at his clipboard a lot with specific attention to the signature I just gave him consenting to the surgery.  He explained he needed to replace one of the stents, the procedure his predecessor said was so challenging in the first place.   

When I told him that I didn’t want a drain, he smiled, reminded me he was a pretty good doctor, and that was not likely to happen.  After he left, I confided in the nurse in the room that I was still a little nervous.  “Oh, don’t worry,” she said. “He’s been pretty competent today.”  Who can’t be confident with a ringing endorsement like that? 

Still it felt good to know that at least I was getting close to eating and drinking again, and I didn’t mind entertaining the surgical nurses on the second floor with a few appropriate lyrics.  They liked “Signed, sealed, delivered, I’m yours” as well as “Doctor, doctor, give me the news, I got a bad case of loving you.” 

Surgery went as planned; I woke up without a drain.  Celebrated with a bowl of oatmeal and strawberries.  And a big bag of homemade matzo dropped off by the rabbi.  Apparently he was impressed by my upbeat mode.  My bilirubin numbers remain high after the procedure, but that’s not unusual. It can take days for the liver to get the message.  For now, more of the same—cancer and hospital food.  Not sure yet which should worry me more.

Sometimes things go bump in the night, and if you fail to follow Jim Morrison's advice ("keep your eyes on the road, your hands across the wheel"), those bumps might come to you.  

A lesson learned while standing on Miller Avenue across from Costco in Hazlet. One day removed from returning from the hospital, I had nudged my Volvo wagan into a five year old BMW. Not a mark on my car (my car is black; you can sneeze and cause it to scratch). This eagle eyed woman from Rumson claimed to spot two new scratches on her bumper which was filled with many others. We pulled over and waited for the police. She made a veiled reference that she had just returned from the chiropractor (How ironic, I responded, so did I.). She was a registered nurse, but apparently chose to ignore my jaundice and my wan appearance.  

She also took the opportunity to promote a NYC doctor's "nutritional treatment" strategy for attacking pancreatic cancer built around taking over a hundred supplements every day and enduring purgings that included coffee enemas (each supplement with convenient links to Amazon, BTW).  She noted it might have been fate that we met, so that she could share this "potentially life saving" information with me.  I thought it was bad timing that all my anti-nausea medications were at home. 

The baby-faced patrolman who arrived on the scene probably hasn't had a first hand experience with a razor yet, but he was savvy enough to tell what was going on. I took blame for the accident, apologized, and after noting my own medical condition, emphasized that all I really wanted to do was to get home and go to bed. When he returned my paperwork, I said I'm fine with a ticket, but could he please give me one without traffic points. It was an unnecessary request. "I didn't give you a ticket," he said. "It was just a minor accident." 

Sure enough, 24 hours later, my insurance company sent me a notice that a claim has been filed. I called the claims adjustor to give my side of the story, charmed her for thirty minutes, and then the conversation ended with her reminding me that I pay "big bucks" for coverage just to be protected in situations like these. 

In sum, a woman living in a posh suburban community seeing an opportunity to take advantage of the system and get an old bumper replaced or maybe free medical care. It lacked both compassion and perspective, a sad reflection on what the rest of her life must be like. 

Any sour feelings from that experience were quickly sweetened by Rebecca Barry, an author and spiritualist, who spoke a few days later at this weekend’s TEDx conference on "Joy" at the Two River Theater in Red Bank.  I had been invited, because my ode to marital miscommunication, “Hostage Situation,” was being performed as part of the event (ironically BMW drivers are referenced inthis play).  I was feeling miserable, partly a reflection of my physical condition, and partly out of the frustration that I didn’t have the energy to properly enjoy or network at this event.  Barry’s talk, which followed my play, was simply a happy accident. 

Using the recent passing of her mother as an example, Rebecca told her audience about “Finding Joy in Death.” She talked about her mother’s good deeds and her acceptance of death with humor and grace. Rebecca filled her talk with warm anecdotes.  In the final days, the family would gather in the mother’s bedroom, sing songs, and break down in tears, only to have the mother finish the refrain (The spirit of these days are pleasantly reminiscent of a monologue I wrote for my play "Horseshoes."  Maybe my dialogue is even more real than I give it credit. 🙂 )  Knowing her mother's life was nearing an end, Rebecca cherished the opportunity to spend time with her before she finally passed. 

I made sure to reach out to Rebecca after her talk, to share my own story, and to express how much I had in common with her mother’s attitude.  She sensed a kindred spirit, wished me the best, “including my own journey going forward.”  Here's one example in which unexpectedly bumping into someone can be a positive.

We are on the cusp of summer and my pancreatic tumors in exile apparently prefer waterfront property; they have camped out around the bile ducts in my liver.   The chemo police have tried to evict these intruders, but unfortunately, they continue to cause a lot of mischief.   But they are also exposed and out in the open.  If they want to do a little sun worshiping, I’m happy to oblige. They might get a bad sunburn if they are not careful. 

After both liver stents collapsed, and I ended up in the hospital last month, I began asking a lot of questions about alternatives. The jaundice is gone and my liver’s resilience continues to surprise everyone (it clearly doesn’t want to end up on a plate with Fava beans).  After weeks of nagging (I mean constructive conversation), I did manage to convince my oncologist that maybe radiation made sense to cause these tumors to shrink.  Radiation seems to have destroyed my original pancreatic tumor.  Maybe it could do the same level of damage with its brethren in my liver.  

MSK is one of only two hospitals in the US with the tools and targeting strategy to inject higher than normal doses of radiation.  The approach is fairly similar to giving the Ukrainians a lot of lethal toys to blow up Russian tanks.  

Radiation treatments last about 90 seconds, but they pack a punch, usually making me both nauseous and tired.  Since I have shrunk to my high school weight, I have no choice but to eat even if I don’t feel like it (I’ve concluded that the first rule of eating when nauseous is never being afraid to vomit, which actually happens less often then you might think). I’ve finished the first week of sessions with two more weeks ahead of me, including another chemo treatment, my 59th if you are still counting at home. 

My radiation oncologist seems pleased so far, which means the technicians are aiming their ray guns at the right place.  That’s good, because I’ve never been a fan of cooked liver anyway. 

Soon I will reach the third anniversary of my original diagnosis, a rare milestone for my condition.  A nurse in the medical team recently offered the best compliment that she could give.  “You keep surprising us,” she said.

In the fall of 2019, I met three Colgate classmates in a bar in New York City--Kate Sweeney, Mark Herr, Blake Michaels, and Jim Joyce. We spent the time swapping old radio stories from our days at the college station back in the late 70s and 80s and Katie shared her plans for a reunion to recognize WRCU-FM's 70 anniversary the next year.  I loved the idea, and pledged to be there. 

Of course you would have had a hard time finding a Las Vegas bookie willing to post odds that I would fulfill my promise.  I had been diagnosed with stage four pancreatic cancer a few months earlier.  At best, my odds were 20% that I would survive 12 months.  A June reunion would be cutting it close. 

And then the pandemic hit, and the reunion went into hiatus for two years. 

Last Friday morning, after finishing the 14th of 15 radiation sessions designed to pulverize a tumor lurking in my liver, I threw a bunch of stuff in my Volvo V60 XC and headed north.  I was feeling weak and drained from treatments, forced to leave a day later than planned, and well aware that my physical state might resemble a well worn, damp dish rag after my four and a half hour trip was over.   

It didn't matter. People with chronic illnesses like to talk about good and bad days.  Unfortunately, that's too black and white.  Most of my days fall in between, and each one forces you define  how much you value the way you live your life.  You balance the cost (discomfort, sluggishness, isolation) with the gain, which for the most part is the overwhelming absorption of energy that comes from socialization.  People turn on a switch in me, and a cranky and corroded power grid wheezes and waxes as it jump starts.  But those moments are priceless. 

I also have the perfect car.  Volvos are for life, and I doubt the Swedes really understand how true that phase is.  My Volvo acts as my exoskeleton.  I literally feel better when I drive in it.  I don't think I could have made the round trip in any other vehicle. 

The reunion was a double reunion.  Members of the class of 81 were also there, to make up for our lost 40th reunion the year before.  Among my friends to meet me, the incomparable Cathy Law, who served as my guardian angel, eager to drive me around when my neuropathic feet would no longer adapt to the hills of Colgate’s Hamilton campus. Old friends came from everywhere.  Hugs were not in short supply. They were the witnesses hanging on the sidelines of a marathon, cheering me on to reach the winning circle at the end of the race.  My health made it difficult to experience quantity over the weekend; quality made up the difference. 

The highpoint of the WRCU reunion was a special weekend radio show that ran over two days.  Jim Joyce kicked it off, his voice still clear and forceful after 40 years.  I would be the anchor that closed the event, so on Saturday afternoon, sitting in a gorgeously renovated radio control room, armed with a carefully curated list of eclectic selections, and accompanied by two students ready to lend a hand, I navigated by first radio show in decades.   

Both students, including the current station GM, seemed impressed by the musical connectivity of my thirty minute jaunt.  One, a self-confessed heavy metal enthusiast, admitted he wanted to check out “this Jade Bird” artist.  They were delighted that I added an infamous one-hit wonder by the Buoys (ranked 32 on the Billboard 100 that same weekend in 1971) with “Timothy,” a Rupert Holmes penned song about cannibalism.  

I made sure to close the show with some subtle, positive vibes, the Velvet Underground’s “Rock and Roll” (“You know, her life was saved by rock and roll.”) and Collective Soul (“Let the word out/I’ve got to get out/Oh, I’m feeling better now.”) 

My music ended at 29:30.  I hit the ID at the top of the hour.  I still got it. 🙂. Promise kept.