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[Cancer]

[cancer] The CT news, and some further thoughts on walking with death on one’s shoulder

First off, the CT scan came back good yesterday morning, for that value of “good” which says, “You still have three tumors in your liver, but at least you don’t have any new ones there or elsewhere.” So, yeah. I’ll see my oncologist today, but at this point I don’t expect any redirection of treatment. There is always room for surprise, of course, but the nastiest ones have been avoided for now.

The radiologist summarized it thusly:

Recurrent/metastatic tumor along the inferior margin of the prior right lobe resection is minimally decreased in size. Trace soft tissue attenuation along the gallbladder fossa appears unchanged in size. No new site of metastatic disease identified.

Given that my tumors grew 50% in the four weeks before this third course of chemotherapy began, that they are stable and/or minimally decreased nine weeks in is a distinct improvement. I’m not sure that we weren’t looking for a more meaningful shrinkage, but that’s a much smaller class of problem that was feared. I’ll know more this afternoon.

But the fear. Oh, the fear of the scan. Abject, existential terror, to be more precise. And behind the fear, rage. Oh, the rage.

The really bad news in my life comes via CT scan. That’s how all three of my metastatic outbreaks have been discovered, the first one literally by accident. (They weren’t looking for anything of the kind on the CT scan that happened to reveal my lung metastasis.) When my terminal diagnosis comes, as it quite likely will sometime in the next few years, it will be via CT scan that we first understand the dreadful news. That’s what I (and many others) were afraid of with this CT scan.

I am reminded of William Gibson’s Neuromancer, in which The Dixie Flatline says, “Every AI ever built has an electromagnetic shotgun wired to its forehead.” For me, the CT scanner is that electromagnetic shotgun wired to my forehead. Literally any time I slide into that giant plastic donut on the motorized bed, I am at material risk of a death sentence.

This is magical thinking, pure and simple. The CT scan doesn’t actually have anything to do with the state of my cancer. I’m just potshotting the messenger. But the CT scan is when Schrödinger’s catbox gets opened. The uncertain position and velocity states of my cancer collapse. A thing which was true by not known until that moment is now true and known. The pivot point of the plot is reached in that moment of spiralling radiation. Thusly, the CT scan becomes my focal point.

Imagine for yourself how you’d feel if once every few months you walk outside your home and knowingly wait for a sniper take a shot. Maybe the bullet spangs off the sidewalk and whizzes into the cold distance. Maybe it hits you in some not-quite-vital organ, requiring months of treatment and pain. Sooner or later, that bullet is going to hit you someplace that can’t be treated. If you don’t do your part and go outside for the shot as scheduled, the sniper will just surprise you with a shot through the window some random day, except then they’ll use a much heavier caliber bullet.

That’s my life these days. The metaphor is imperfect. The CT scan isn’t the sniper, cancer is. But the CT scan is where I find out if the bullet hit the bone this time. And if I duck the CT scan out of fear, or its proxies denial and avoidance, the news will only be worse when it comes. Cancer undetected is cancer ascendant, after all. It almost never, ever goes away on its own.

How would you feel in this situation?

And to make matters worse, the time between hearing the gunshot and knowing where the bullet hit is measured in hours, or even days. In this case, I got the CT results about 24 hours after the scan.

It’s fucking terrifying. And there’s nothing to be done but endure. Ducking the CT scans would just mean we find the cancers more developed, therefore harder to treat and of even higher mortality risk. You can’t run away from this sniper.

Abject, existential terror. How would you feel?

My therapist says I walk with death on my shoulder — he cribbed that from Carlos Castaneda. I think he means my awareness of mortality is immediate and pervasive, unusually so for someone of my age. (Born in June of 1964, 48 as of this writing, for those following along at home.) Maybe this is supposed to make me feel serene or wise or something. Which might be true, if I were a working class hero on a spiritual journey. Mostly it just makes me afraid.

Except even fear becomes boring.

The CT scans, the scanxiety, that’s like a fear booster shot. Fear shifts from boring to immediate and agonizing.

Fuck cancer.

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