Saturday, June 25, 2016

Napanee Vacation: Death, Cancer, Life

Death is always with us.  We maintain an illusion of life in which we know that death and life abound but somehow we are permanent.  Yet this life is by its very nature impermanent.  And each night I sleep.  I enter this death like equation where to my subjective self I leave the objective world of community and enter a dream like state, another world, as memorable as memories themselves.
Cancer is a disease of threatened death.  Immunologically we think of it as the body turned against itself, some auto immune phenomena, that is either a lack of recognition of the good self and hence destruction or a lack of policing of the bad self and hence destruction.
This phenomena of cancer has been associated with environmental disease as in those poor ladies who painted watch faces with radioactive paint till they succumbed of cancers or the mining men who breathed in asbestos.  That's the environmental stressor model.
Then there's the genetic angle.  Genes mutate and cancer is a mutation associated with age or the bombardment of the genetic code by various waves of unseen energy and particle some travelling through the ozone layers while others come from more proximal microwave emissions.  The Russians so certain of the science of the latter  spent millions bombarding the American embassy with hoped for disease causing EMF.  There are viruses too that trigger cancer, infections such as Herpes Simplex II which was so thoroughly associated with cervical cancer that it gave rise to the Pap Test as the principle preventative protective strategy.
Ever since I became a doctor cancer has been being cured with greater success though the greater length of life has resulted in this miracle being obscured by the apparently increased death in the elderly from cancer.  The wear and tear of the Australian beach crowd has with time created a whole group of melanomatous skin cancers with each year of excessive sun exposure and recurrent damage to the skin till cancer arises from the suns bombardment and aging.  Everywhere cancer is being cured.
Psychiatrists have long held that physical illness of chronic disease and even some acute illness is ‘anger turned inward’.  One is by definition either outwardly homicidal in attitude or inwardly suicidal in attitude.  As with all the physical attributes psychologically there is a balance, a right place between the polar extremes.  At that point the homicidal and suicidal tendencies of Freud’s forces of life and death are balanced.  Chronic disease follows the upset of the golden rule, that fundamental equation, ‘love thy neighbour as thyself’.  One must show a healthy balance of self care.  Too much narcissism and self centeredness results in hypochondriasis or real disease and the attraction of illness if only by shadowing doctors who work always around disease.
By contrast one can spend time mostly in the love of others, altruism and selflessness.  My brother is a husband and a parent and worked for the government which treated its civil servants psychologically as they did their military servants, expendable and hierarchically, socially stressful places despite their apparent union benefits.  There is stress from the juggling of the roles too and fulfilling the duties of society.
My brother has stayed. He’s a brick. I’m  He is the Rock of Gibraltar . He's the army to my navy.  He's the artillery and I’m calvary. He’s taken a tremendous amount of bombardment by staying whereas I’ve charged and retreated from the bullies that abound in our present day 'uncultured' society
The other psychiatric and philosophic aspect of the cancer which isconsidered from a communications perspective is that ‘ cancer is that which you can say in no other way’.  Communication theory sees us as essentially ‘communicating units’ and all we say and do are expressions of seeking and giving help.  A child cries and a mother comforts him or her.  Disease is a way of seeking help or solving a puzzle.  Gods come to us in disease is a saying that relates to the idea that when we are well and outwardly rewarded we do not tend to turn inward to consider the meaning of existence or to communicate our questions about existence or even our individual lives. Disease is doubt.  Happily ruling Wall Street with hookers and cocaine and simulated battles or impressing the ladies with ones muscles and tattoos in government circuits one can remain shallow and fatuous.  However faced with cancer there is an inward turning.
When I am wounded in battle my sword arm, until that moment so strong, is suddenly cut and no longer answers to the command of my ego.  What is the relationship between fate and free will, I ask myself. How is it that my enemy has found this weakness I did not know myself or what was I thinking to let down my shield.  Why does the zen master say one's enemy is a friend who teaches us our mistake. Why does the psychiatrist call disease the great teacher?
In the Bible the wound of note is the struggle between the angel and man which eventually lead to the naming of Israel.  These ideas are not new.  All philosophy and religion have been given to answering some questions about disease and death with cancer, the big "C" being the metaphor for "satan incarnate' or 'living death', the primo disease.  There are similar stories of wounds and myths around the world.    The crack in creation is where the light comes in. In sickness we are forced to consider the aloneness of sickness and life. I am born between piss and shit and I die, ashes to ashes.  Cancer is but  a slow death or a speeded up life.  My minister friend with cancer told me he'd only begun to really live when he was first diagnosed with cancer. He described an intensity of life he'd not known since childhood and how he'd been mostly a spectator for many years and now was pulled fully and completely into the game of life.
There’s no sudden and acute motor vehicle accident death or death by beheading in war.  Cancer a slow struggle, a marathon. The fight against the slow death is Sisyphus.  Kierkegaard said , Life is suffering unto death".  It's a simmer rather than a boil.   It’s a ‘siege’ by comparison to a charge.
The recovery changes a person.  It’s a near death experience on a daily basis with a whole reconsideration of the means of dealing with the external exigencies of reality. If a person ‘solved’ life’s problems one way cancer may well demand a whole new set of tools to overcome it.
Cancer is that which I can say in no other way is a consideration that if I can find another way of communicating then I might no longer need the cancer.  The pessimist becomes the optimist and the cancer disappears.  The independent soloist turns to the community for aid and surrender to the care of others who experiment with their various ideas of cure and success.  Witches brews and chemotherapy all contribute to the natural self healing of the individual who once was a neut like creature capable of regrowing tails and limbs, a genetic code which exists within, which hasn’t been lost, which we are again doing with the help of the lab.  Stem cells differentiate into whole new body parts.  We have the stem cells still.  We all are self healing.  Medicine and surgery simply assist.
It’s not like we plant the seeds but more that we weed the garden. All the seeds are there to grow resplendent but we must prune and care for the flowers we wish.  Cancer is it’s own robust weed.  There’s something incredible at the cellular level when we contemplate cancer. It’s dandelions on a golfers green.
We are always messing with creation. We are dictating to the universe that we want this order, this life we have created, not this other mutation. We are ‘stewarding’. We are leading. All self doubt is left behind because to cure cancer we must give it our undivided attention and solve the rubrics cube in a race against time.  Meanwhile all that is past is demanding equal attention as it did when one was well. The war goes on but my sword arm no longer lifts the sword. If I don't pay attention I can find myself kicking my feet like a kangaroo while dragging my sword arm behind me.  For 80,000 years I learned to slink off to the cave where I nursed my own wounds or formed a pact with a medicine man or woman and hopefully a child or wife or husband fed me in my monastic vigil and struggle with God. We are herd animals, not lizards. There's comfort in companionship.  I never admit it but I still like when a friend brings me soup when I am sick.
I want to live, I say and God, or the Great Unknown asks me ,how much or am I sure. It’s a Job like place this narrative of Cancer. .  The siege is on and the enemy is at the door.
I am here with my brother who was diagnosed as having pancreatic cancer.  He only learned when he was first diagnosed with pulmonary embolism. . Breath is the sacred nectar of life the rhythmic wonder of existence.  He was literally breathless when he began this journey.  The healing care and brilliance in Napanee and in Kingston has been stupendous to behold.  As a doctor I've been so thankful to know my brother has had the care of the oncology team there.  Pulmonary embolisms, blood  clotting oddly in lungs is so often a harbinger of cancer so the Sherlock Holmes began and found this pancreatic mass where it did not belong. The anomaly was called 'cancer'.
To date my brother hasn’t had any symptoms attributable to the cancer itself except fatigue. His loss of appetite, nausea and malaise have come with nerve sensation loss from the treatments.  It’s the same as if a terroist cell has taken up a presence in the centre of the city infiltrated key areas and is planning on setting off bombs and destroying all from within. No one knows they are there, except the police and soldiers who enters with the intent of getting them out. The only thing the city notices are the apparent wars started by the police and soldiers. It's so easy then to blame the cure for the disease.  We hear it all the time in politics.  There is a politics of disease.  The internet is rife with insanity and special interest groups, pseudoscience and marketing.  My brother, always wise, trusts in what is really known.  He trained as a scientist at the University of Manitoba.  He understands the depths of what the loving doctors are telling him. He has worked well with the Kingston oncology team and the Napanee outreach.
Now a year later and my brother’s cancer has not gained to any degree.  The battle has waged.  The weeding and pruning have taken place. The seeds of new plants have grown while some of the old have been demolished. There is new life but there is also death.  Having survived that first day of breathless near death he’s gone on to succeed a year against a Borg like phenomena whose kill ratio is 9 out of 10.  Only the A student solves the puzzle and lives beyond five years.  He's one fifth of the way along that life journey. It’s been a sharp learning curve.  My brother is a genius though. He was the smart one in the family. I was the slow learner by comparison.  I don't doubt his capacity to live. Cancer is a minor matter compared to the challenges he's faced so far and overcome.  His family are a testimony to his love and skill and merit.
The central question of life is ‘fate’ and ‘free will’.  Buber described the idea of “I and it’ and then the move to “I and thou’.  The "other" is the whole world.  Here the "other' is cancer. "I and Cancer".  There is to immunology the central theme of ‘self’ and ‘not self’.  I have a white blood cell response to a foreign bacteria that invades my body.  My basic immunological system has ‘boundaries’ and the foreigner is removed.
We all have cancer. Our bodies are restoring the homeostasis daily by the minute and hour.  The self healing structures are removing mutations and clearing the diseased cells away.  Our treatments expedite this.  We assist the self healing process.  We fight the invader and we strengthen the host.  The terminology of medicine is full of ambiguity.  We call a person the ‘host’ as if they have invited cancer for dinner and are now having their own personal party but can't alone throw the cancer 'bore' out of the party.
 I have gratitude for today. I am here at Hay Bay and have known another day with my brother. He’s an amazing man, his marriage and home and children a reflection of he and his wife’s dreams.  I love seeing his love in action, all the years I’ve watched him devote himself to his family in a world where individualism and selfishness are the halcyon call of our Kardashian and Myla Cyrus day.  I don’t even think he’s ever snapped a ‘selfie’ of himself.  He’s a quiet man in that way.  At the same time he can talk a persons deaf with tale upon tale, a trait we both share with our beloved Irish mother.  On the surface he might at times chatter but with him still waters run deep, not stagnant.
He’s angry as all cancer patients are.  There’s a grieving process that Elizabeth Kubla Ross described regarding dying.  As cancer is the offer of a slow death or a chance of recovery , this horns of the dilemma is met with all the range of appropriate emotions. We daily grieve to some degree the lost dreams of yesterday. I never was the astronaut I wanted to be as a kid and became instead the prosaic doctor. My brother would have loved to fly but walked instead and now must even crawl awhile to get a head.  We're not stationary in our family.
I am grateful to be here.  So much of family and medicine is being present.  The world as a whole run away from disease thinking fearfully living a life of trying to avoid all distress.  Cancer is like lepracy.  Disease is stigma.  The struggle is personal. It’s not a public matter. It’s a private matter. The parasitic people would still like to take advantage of another's misfortunes.   Family and friends gather.  We are there as much for protection as our own learning.  Socrates is speaking.  He never did need to take the hemlock. He did not wish to be exiled so did, but he could have left.  I can live or I can die. My brother has chosen life and I'm glad to be a cheer leader if only that.He has my rapt attention. I am honoured to be welcomed by this great artist and he creates his masterful Houdini trick of escaping cancer and death this time. We both accept that 20 or 30 years from now we may wish to succumb but not now, not when we are both so young. My father lived till 94. My mother said she was tired and wanted to go at 89.  A son should outlive his parents.  My brother has the will and gifts.  He loves life.
Having worked in medicine some thirty years with tens of thousands of patients and so many facing cancer, disease and old age, along with the gun shot wounds, I’ve been never certain what the outcome will be.  The house always wins in the long run , but countless winners gladly take their millions even from the lotteries.  It’s never over till the fat lady sings. It’s also not over unless the bullet has your name on it.  A WWI soldier who survived Vimy Ridge taught me that. He was my patient in his 80's.
The success of this generation is in the longevity. We are all living a decade longer and all the killers of a while ago are cured.  Even these new diseases of deadly destruction are being beaten with alacrity. I know so many cancer survivors.  
Even the old go on and on so that there are nursing homes galore and the courts are all about physician assisted suicide not because people are dying but because they refuse to.  Life is so good that the historic killers of war, disease and starvation aren’t doing their former job to the satisfaction of politicians. Our society, thanks to science, technology and wisdom is living longer and better than ever before.  And not just millions, but billions more than ever before.
The media is sick.  That is a central source of societal disease.  Fear mongering negativity and deceit.
The successes are amazing. But yes, when we are a hundred, we may wish to remain asleep. Neither my brother or I am there yet.  Now we celebrate life .  But at a hundred I wouldn't care so much if he left me.  I would have liked for my mother to have stayed another year or two but even Dad was ready to leave at 94.

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