Cancer

Opening her pre-Oscar show with a prerecorded tour through a day in the life of the world's best-known critic, Winfrey followed Ebert through a schedule that could wipe out a man a third his age – three movie screenings, banging out his column, working out and hanging with his devoted wife Chaz.

He then took the couch – looking frail and strange, a radical departure from the big, talkative gadfly who's been a television fixture for nearly 30 years. Toting his Mac laptop, Ebert proceeded to answer Oprah's questions in a slow, computer-generated voice. But his words were as engaging as ever. "In my dreams I'm talking all the time," he explained. And amazingly, thanks to a career spent talking all the time, a company in Scotland has been working with him to construct a computer voice program based on clips of his real voice. Trying it out for the first time, his laptop intoned in pretty passable Ebert-ese: "In first grade they said I talked too much -- and now I still can." But though he's ebullient as ever, he insists there will be "no more surgery ... We have to find peace with the way we look and get on with life."

The critic then offered his Oscar picks – he's going with Bigelow and "Hurt Locker" – but he offered something much more. Toward the end of his segment, Ebert's wife read a statement that first appeared in the intense, fascinating portrait of him in the March Esquire.  The man who's spent his life answering to a job title with such negative connotations – critic -- issued as positive a review on life as anyone could ever give. "We must try to contribute joy to the world," she read. "That is true no matter what our problems, our health, our circumstances. We must try. I didn't always know this, and am happy I lived long enough to find it out."

I get why people follow a macrobiotic diets, raw food diets, blood type diets, any diet after a cancer diagnosis. We want to minimize risk, take control. Some of us feel better when we have a lot of rules to follow. I think most of them probably work, as most of them emphasize real food and minimize known carcinogens, like charred meat and alcohol. But I can’t do diets. Food is one of the greatest pleasures in my life, and I can’t bring myself to cut out entire categories of it. Cut down, yes. Cut out, no.

I prefer an additive rather than subtractive approach. I like to focus on foods that fight cancer, like berries, the cabbage family, mushrooms and flax seeds. So when I heard about new research about an old Ayurvedic wonder spice, I tried to make it work. I am a fan of David Servan-Schreiber, of his book "Anticancer, A New Way of Life" and of his blog, in which he updates readers with current research. Recently, an e-mail landed in my in box, informing me that turmeric, the spice that makes curry powder yellow, has some lab-proven anti-cancer properties, especially when combined with black pepper. Servan-Schreiber recommends consuming a "soupspoon" of the stuff a day. Perfect, I thought. I like curry. I’m a trained professional. I can make this work.

Turmeric is a rhizome, like ginger, that is most often dried and ground to a powder. It has been used in Ayurvedic medicine for thousands of years, and is thought to have powerful antiseptic and anti-inflammatory properties, among many others. Recently, Madhuri Kakarala published the results of her most recent study that show that curcumin, the active compound in turmeric, in combination with piperine, found in black pepper, are capable of eliminating breast cancer stem cells without harming the surrounding healthy cells. Like most foods that prevent cancer from growing, there is little downside to consuming the combination, at least health-wise.

The thing about turmeric is that it’s used in cooking primarily for color, not flavor. Alone, it tastes mostly bitter, slightly acrid. Almost, well, medicinal. Most recipes use it as one of many spices, rarely more than a half teaspoon at a time. Still, I thought, I can do this. I planned to make a batch of yellow split peas, warm and filling, redolent of Indian spices.

I added a tablespoon of turmeric to that first batch, along with more reasonable amounts of coriander, cumin and mustard seeds. Even my husband, with a palate dulled by years of allergies, noticed the flavor was off. We ate it anyway, but it did not make us feel healthy, or happy.

This weekend, craving warm flavor and comfort as we waited out a tsunami warning, I tried it again. This time, I took it easy with the turmeric. I finished the soup with a little butter to smooth out the flavor. We ate it, and we felt good about it, and I decided that a soupspoon of turmeric a day is probably best consumed in supplement form. Life’s too short to eat stuff you don't like.

Yellow Split Peas with Cauliflower and Yam

Ingredients:

1 tablespoon olive oil
2 cups chopped onions
1 teaspoon black peppercorns
1 teaspoon coriander seeds
¾ teaspoon cumin seeds
½ teaspoon mustard seeds
1 teapoon ground turmeric
2 carrots, peeled and chopped (about 1 cup)
1 jalapeño pepper, seeded and chopped (about 1 tablespoon)
2 tablespoons peeled and minced fresh ginger
1 small yam, peeled and cubed (about 2 cups)
2 cups small cauliflower florets, about half a head
2 cups yellow split peas, sorted and rinsed
salt, to taste
2 tablespoons butter

1. Heat olive oil in a large, heavy pot (a Dutch oven is ideal). Cook onions slowly over low, even heat until browned and tender, about 20 minutes. 
2. While onions are cooking, prepare the spice mixture. Heat a small skillet. Toast whole spices in pan, starting with the biggest seeds, the peppercorns and the coriander. Spices are toasted when they are aromatic; cumin and mustard seeds will begin to pop. Grind in spice grinder or mortar and pestle. Add turmeric. Set aside. (Note: You can use pre-ground spices for this mixture, but toasting whole spices lends depth to the dish.)
3. Add carrots, cauliflower and yam to the onions. Stir and cook, about 5 minutes. Add ginger and jalapeño, cook a few minutes more. Add reserved spice mixture, stir, cook for another 2 minutes. Add 4 cups water, then split peas, stir. Bring to a simmer, reduce heat, and cook, uncovered, about an hour. Stir occasionally and add more water if needed.
4. When split peas are cooked, add salt and butter. Taste, and adjust seasonings as desired. Serve with a dollop of plain yogurt and fresh cilantro, if desired. 

Oh, what miracle of life has brought me here! That is, I mean to say, I survive, I heal, I celebrate my healing and I wonder: In what skin or bone lies the code of reconstruction? What blueprint is held in what vault for just such an occasion as a partial sacrectomy? How do I heal? Is it I who is doing this healing? All I do is sit around and heal. I do not know how I heal. I live and I heal. I sleep and I heal. I watch teenage crime wave 1950s black-and-white movies on TCM and I heal ("Teenage Crime Wave" was awesome). And besides the cutting and slicing of flesh, what do I heal from? Oh, sheesh: Sacral nerves 3 through 5 severed and removed! Got a clue what they do? No. 2 mercifully saved, meaning that I walk with relative ease, I suffer only minor nerve pain in my left foot (the nerve pain's from the still-intact S-1, says Dr. Ames: We had to muscle it around a bit to get it out of the way, and it's still a bit roughed up). Only the, ahem, functions of S3-5 are impaired. So otherwise I am a laughing miracle of Cafe La Boheme, writing at our sunny table again on a Friday noon after missing only seven Fridays!

Seven Fridays I was out of the game, confined to couch and bed, allowed only to stand, walk or lie, never to sit for seven weeks. Seven weeks without a chair! Seven weeks without relaxing into the plush holding hands of an armchair. Seven weeks without sitting at a desk to contemplate.

Then Monday the doc says go do what you can do. And so I humbly try to get back in the game. I am slow, weak and in some pain, but I take a shot at it.We've still got to schedule a few weeks of proton beam radiation therapy at Loma Linda; that's going to be no picnic. But I'm alive, and I'm outside! I'm spending cash!

I have just gone out for the second time since Dec. 17. The first time -- yesterday -- was a dry run to see if I could drive OK and get in and out of the truck (painfully, stiffly, but yes, in and out). They were only errands but what errands they were! Ace Hardware on Noriega, Walgreens on Taraval, and Kragen Auto also on Taraval across from the tempting stereo repair store. (Really irrelevant parenthetical: Once when the old Quasar set crapped out and Norma said nobody gets TVs repaired anymore, they just buy new ones, but the only new ones were like a thousand bucks so I took the Quasar in and got it repaired for $125. I still get a glow of accomplishment every time I pass that place.) But anyway, on my first foray I was in the zone: Ace for lightbulbs and felt glides for the dining room chairs; then Walgreens for a new razor and the best parking spot possible opened up for me as I pulled up. (Oh, the ecstasy of a perfect parking space; oh, the ecstasy of a new, close shave!) And then Kragen for lithium grease to take the squeak out of the driver's side door (oh how I neglected that truck, synecdoche for my flesh)!

O gods of clorophyl and proteins: to almost lose life and then to get it back! How bright this earth now! How beautiful these faces! I stop at every stop sign and look around to see what new miracles there are.

Oh, I could take it or leave it, life, I thought before this happened. What's so great about this beating heart, these heaving lungs, these eyes through which the world enters and signs its name? But threaten to take it away and see how I change: What pleasure in every heartbeat and every breath! What complexity in the color of a rain cloud!

Look how I can walk again! No cane this time, I threw it off, left it on the back seat. No cane, no shuffling, no shoulder to lean on, I'm steeply soloing up 24th Street toward Guerrero. What neglected gluteus muscles are coming into play! Portions of the gluteus maximus muscles were removed from the resected lower part of the sacrum and tied to each other. Were they tied in a bow? That's how I picture them as I motor up Guerrero: tied together in a bow.)

So the body, temple and vehicle, again gains my gratitude. Me, lord and master, taken down a notch by the wisdom of disease. And driven to new reverence for photosynthesis and light! For the complex yellow of a squash and the red of an apple, the green of chard and the orange of an orange, the yellow of a lemon and the purple of a grape: These colors and their molecules will save me, I am sure. For what brought on that tumor? How have I allowed this deadly encroachment? I am not separate from my "body." I am not some absentee landlord: I was here, eating a bagel and cream cheese every morning for years. I was here ignoring the muted, dour warnings of high cholesterol; I was here, drinking coffee after coffee for the charge and the power, pretending the insane ups and downs didn't affect me. I kept getting warnings: a panic attack in 2004 that I thought was a full-blown heart attack; squamous cell skin cancer in 2008; and then this, the impossibly rare chordoma, a final warning for sure: Get well, my boy, live within biology's rules, with gratitude for the planet's cures; stop fucking around with your body.

So don't laugh if I go vegan. I'm not a halfway man. I could never stop drinking once I started, and I could never have just one cup of coffee or one cigarette, so if I appeal to the wisdom of the plant universe to reverse the machines of cancer, to turn back their deadly aspirations for eternal multiplication, then I doubt that I can have the occasional burger. Also: "The China Study" has me thinking about dairy and not in a good way, though the Cowgirl Creamery and the farms of West Marin are still brilliant and beautiful.

There is no moment now that I do not cherish. My mom and dad are gone, but they can rest easy in their graves: I'm going to be OK.

Also the long, strange nights on sleepless painkillers gave me a new and welcome craziness, allowed me to enter the neglected dark realms, the realms of Rimbaud, the realms of Baudelaire forgotten in the cheesy daylight of good advice. I'm just riffing here: riffing for my life, riffing for the spirits that live within me, riffing to wake them up and wake myself up, riffing to turn me on again, riffing to find a language for my reverence and joy, riffing to revere the engine of language, hoping for maybe an answering cry. Yep, that's it: an answering cry: We holler into the abyss and hope for an answering cry.

Not that we need it: Our riffing is sufficient. We don't need the answering cry. It's enough to ripple our muscles of speech, to sing uniquely in the night. 

My friend Brian tells me the sacrum is indeed something sacred. I love the sound of "sacral chordoma," like something you might sing in a church. I wondered about the etymology and Brian suggests his scholarly meanderings indicate that the sacrum was the preferred bone to offer up in animal sacrifice, thus the sacredness of the end of the spine; Eric Partridge suggests that a "sacrum" may be among other things "a small chapel," which is nice to think that the small chapel of my pelvis has been remodeled, and with a remodel as we well know comes the opening of walls and destruction of old obstacles and the letting in of light and improvement of energy flow, but that is not what I started out to say. I started out to say that I am somewhat shocked to find that I looked at the surgery as a life-and-death adventure, and that I do not hold my life so precious and dear that I would not risk losing it to prolong it; knowlegeable men had said that this is your only sane course, so I approached it as a gift, a gift of our century of science, a gift of medicine without which I would surely die a slow and painful death, so think about that for a minute, OK, it's mildly sobering is it not, but in that necessity lay also adventure: We stand on this cliff and our attackers grow close. We can wait for them to slaughter us, or we can leap from this cliff and take our chances in the water. So we leap, preferring a chance of survival, facing the fear of the unknown, our skin tingling as we fall until we splash down ...

and I awake in a bright room with tubes down my throat, unable to talk but ebullient with the knowledge that I've been given new life; I've jumped into the lifeboat and skilled men and women have done the remarkable, have done it with pride, intensity and courage, skill and precision and energy and inspiration, have journeyed into me with knives and slain my enemies microscopic and perverse, and so yes I awoke ebullient like a man who finds himself launched into space, who has been on an amazing journey and lived to tell about it and then is cared for like a baby, friends and family hovering.

There was very little pain in the beginning, as I had all the intravenous anesthetics at work. I returned from surgery with a glow. Now I know how heart bypass patients feel, how the saved-from-drowning feel, how it feels to surrender to the necessity of battle or flight or in this case the knife and return starkly changed by the ordeal.

Why do I keep thinking "northern," "an ordeal across the ice"? Waking up in the ICU felt like waking up at the north pole, or in an alien spacecraft, frozen, barely human, transformed, but in the presence of controllers who seem deeply committed to your well-being, and whatever autonomy you once had, for whatever reason you have now given up and do not give it a second thought, as walking out of here is not even an idea, every movement seems fraught with danger, the kind of danger you don't even kid about, as if it might kill you to turn over, and it might, but you cannot speak because of the tube down your throat, a big tube, and not the only one, so your wife hands you a tablet and you write "Happy!" on it. Happy, yes, to be alive, to have come out of that blizzard of anesthesiological magic, having passed through the gantlet of surgeons' hands, having been opened and lovingly altered and lovingly closed up and sewn together and wheeled in here like a birthday prize. You feel important lying there with all these people around, with the button that brings a bolus of dilaudid and the button that brings the nurse: Ah, to be in the center, the focus of attention. We are not supposed to long for that with such ardor but it is one of the many longings that I readily admit to now that I am completely, body and soul, an example for study: Waking up in that hospital bed with tubes coming out was like being a star on the stage with his makeup all done when the curtain opens; that ICU room was my stage and the room beyond it a vast audience; the machines monitoring me were the cameras and microphones beaming my performance across continents and nations; my body was performing admirably; the notices were good; all the preparations had proved wise. I had given the surgeons exactly what they needed; my performance was praised and remembered; there would never be another one quite like it, you can be sure.

And then there was blessed solitude of long nights alone in a strange room in and out of a dreamy half-reality among humming, glowing machines and blinking lighs, my tubes tying me to a great outside world of fantastic science and also to the great and mysterious dark inner world of my own biology, reading me in ways that I have no inkling of, as though my body had been purchased for study or amusement or both, purchased by an institution whose people were for some reason keenly interested in my blood, my skin, my urine, my healing wounds and their swelling fluids, my breathing and my pain levels.

Yes, my pain levels! How wonderful to be asked every few hours, on a scale of one to ten, how is your pain right now? Imagine a world of such compassion that we inquired of each other about our pain? How to ask: How is your psychic pain this morning, boss -- on a scale of one to 10? Good morning dear, how is your pain, your eternal pain of loneliness that even I cannot slake -- on a scale of one to 10? And if she says, oh, dear, it's nearly 8, then we take immediate palliative measures! Dear me, how touching. What a world of compassion that would be.

And to think that sometimes, surprisingly often, I would answer honestly it was only a 3. The dilaudid was coursing through me every 10 minutes or so, and if I ever forgot to press the button the pain would rush up on me like a squad of thugs and unleash and electric fury through my leg and up my groin and the raw pain of incisions and bone-cutting was also ever-present but at times the sea would calm and there was nothing but a distant ache, to which I assigned the number 3.

Other times I could honestly say it had crawled up to a 7, and if I was ever in true distress a nurse would appear almost instantly to care for me.

I would not care to do it again; next time I would like to go to Cape Horn instead, or to the icy wastes of Antarctica. But this was an adventure, not just a medical neccessity; however unpleasant, it was a journey; however unpleasantly it has transformed me, at least it has transformed me, and some of us, the restless types, seem to crave transformation of any kind above the stasis of simply doing well.

Yet a brief outline: I was diagnosed in November 2009 with a rare cancerous tumor located in the area of my lower back, on the front side of the sacrum; it measured about 9 cm by 8 cm by 6 cm and is called a sacral chordoma. The procedure with the highest probability of cure is a surgical removal of the tumor and enough surrounding tissue to ensure that no cancerous cells have remained. After numerous visits and consultations surgery was scheduled for Dec. 17. The operation is a long and complex one involving a neurosurgeon, a colorectal surgeon and a plastic surgeon as well as the anesthesiologist. It was estimated that the surgery would take from 12 to 16 hours but it did not take that long. I think it was about 8 or 10 hours.

Preparation for the Thursday morning surgery began Tuesday at midnight with a fast, followed by a colon-cleansing routine Wednesday involving this liquid that you drink that cleans you out completely. Then you wake at 4:30 Thursday morning to arrive at the hospital at 6; we took our places in a crowded and dark waiting room; we were among many other people also waiting for surgery. They were all types. It was nice to feel that we all had something in common. We were mostly a quiet bunch.

Anyway, as I said, a straightforward narrative is beyond the powers of your narrator; please allow it to suffice for now to say that I have been through an ordeal of some magnitude and have sensed throughout that some wisdom must be found somewhere in the experience but that for the time being the experience itself is far too large to be digested or contained or turned into fable or metaphor, and that I am too busy having the experience to contemplate it. At the same time I do feel the need to reach out and talk.

Some friends bought me a Kindle. That was a high point. One of them, the effervescent Mary B., brought me the Kindle while I was in the hospital all hooked up to tubes and wires and patched up with gauze and monitored constantly. The Kindle has been a revelation. Much will be said about that, I suspect.

There is also much to be said about pain, and about drugs and recovery and the particular strained indolence of staying home slowly getting better.

But for now that is mostly it. Everything takes longer now. That, too, is probably a revelation.

But all revelations lie in shadow now, while we are busy with the business of simply getting by, simply getting better.

***

After decades lighting up the screens of memory and emotion, revealing ghosts, making dormant patterns appear as if dusted with fingerprint powder, finding heat to make readable the invisible ink of preconscious inscriptions, decoding obscure languages spoken by personal archetypes, learning the many disguises of my personal demons, their modes of influence and preferred times of visitation, having illuminated enough of the inner world to have a fluent vocabulary of need, fear, pain, joy and etc., so that I could with some regularity hear the pain and fear of others and decode the secret systems revealed in the invisible ink of strangers, I had come to feel that few dark and inaccessible areas still existed in my self.

Then I got cancer and was thrust into the darkness of my own body. I know nothing of its languages, its schemes and symbols, its humor and irony, its brilliance; I have no idea where to search for the string that is going to lead me out of this. Suddenly I am an ignoramus of my own self.

Thrown back upon myself in this way I am reminded of the great attraction of the kind of modern existential book in which a baffled, tortured character is encased in cement or hooded, thrown into a maze, made to suffer repeated and meaningless tortures, how such books appealed to me as a young man because they mirrored my experience of my self and the world, and how, to my chagrin, over the years, with the exception of a bracing ranter like Thomas Bernhard or someone as strangely keen and indicipherable as Robert Musil -- or, for that matter, Haruki Murakami of "The Wind-Up Bird Chronicle" -- I have preferred to read those who shed light rather than reflect back my own darkness.

So here I am again in a kind of mysterious, dark cell. I know very little of what is happening to me. I have it on good authority that I have been saved from a terrible death. This much seems reliable. Modern science has rescued me from a slow and painful death.

Having been found and brought to safety, I now am left with a set of residual difficulties arising chiefly from the methods used to save me.

I bear no grudge. I prefer living with these difficulties.

But I have no language with which to spell out the themes with which these difficulties are bound into story, or how one small cause led to this conflagration and hell, what primal sin it was, what is to be learned from the concatenation of seeming trivialities ... thus one is reduced to writing as cleverly as possible about what one does not know -- chiefly, as is obvious, by contrasting it with what one does profess to know.

And in the night if not too messed up on opioids or drowsy on gabapentin, a distant memory of beauty and order makes its feeble visit.

What happened? What is this strange life I am now leading, when at the end of the day a walk near the beach at sunset is an ecstatic release, when the Marin mountains to the north seem eternally beautiful and the tight-packed corrugations of gray, wintry storm clouds seem deeply lustrous and full of untold secrets?

I do not know. I do know that having been saved by surgery, being weakened and humbled, I am alert to every fiber of life, and raw to the wind.