Interlude: Tuesday, January 29, 2013

Within seconds of me sitting down in the examination room,  Dr.Verma opened the door, blurted out, "The CAT scan was fine," and stepped inside. 

As we say in poker when an anticipated card appears on the flop: "No waiting."

I'm eight months out from treatment and have had four scans. Dr. Verma gave us a considerable fright after the first scan, which showed all sorts of gauzy looking “infiltrate” where the tumor once resided.

He had no way of telling what the fuzz was without a biopsy. His concern became my concern squared.  

So the pulmonologist knocked me out, stuck a wire down my nose and into my lung and fished out some of the material, which could have been cotton candy or cotton balls or the ghost of Cotton Mather for all I know, but it wasn't cancer.

And since scans 2 and 3 were clean, why should I have worried about No. 4?  Because  lung cancer does not like to take no for an answer.

  

Dr. Verma performed a cool medical parlor trick on the computer. He showed me all the scans from left lung starting with a year ago. Unlike all the others, the latest scan is clear. A pretty picture indeed.

I'm almost a member of the Clean Lung Club. (We'll ignore the residual damage caused by 35 years of cigarettes that don't appear in the scans.)

Dr. Verma remarked that I seemed in better spirits that the last time we met.

"Clean CAT scans will do that for you," I said.

Of course, he did not see me earlier in the day, sitting at my desk, battling against the big bawl. I had things to worry about. The appointment with Dr. Verma was one. A couple of friends are in the midst of their own serious health issues. My one buddy in the Big Fight has to begin a chemo/radiation regiment after her clinical trial fizzled. 

I was working on a spread sheet with Radiohead blasting through my headphones. The somnolent sounds turned into emotional dodgeballs I could not avoid. Tears rolled down my face. I got up, grabbed my coat and rushed outside outside. Tough guy me did not want to be seen crying.

Outside, I had not walked far when a man and a woman passed me. The man turned and asked abruptly: “Editor or writer?”

I stopped and looked at him. “Writer.”

  

I'm guessing he was in his late 30s. He was short and trim, with spheres of tight curls emerging from beneath his ballcap. I waited for him to tell me he needed $5 or $10 for gas.  

Instead, he blurted out that he has college degrees,  a strange opening line for a panhandler. He said he worked in as a mortgage broker until the housing bust and then found himself homeless. The streets surrounding the PD is a flyway for the men as they march to and from from the shelter. 

The woman with him appeared to be in her early 20s. She stood behind him, silently smoking a cigarette.

  

He spoke with great indignation about the horrors and injustices at the large homeless shelter a few blocks north of The Plain Dealer.
  

He complained about how the shelter makes them wait for hours outside in the cold and rain; how clothing never reach the men who need them; and how the workers don't display the proper Christian attitude toward their brothers in need.

I don't know much about how the shelter operates. I do know that Cleveland has been praised for how it helps the homeless and has become a model for other cities.
  

He then said something that intrigued me. He said he has been writing down the stories of the men's lives. Stories. 

“If you really want to make a difference, tell their stories,” I said. “Go to the library, they have computers, set up a blog and tell their stories.”

“I am computer literate,” he said.

"You should think about it," I said. "Their stories could mean something."

He nodded and I walked away, eager to begin a walk on an unseasonably warm January day. He headed in the opposite direction, the woman trailing behind him.

  

Sometimes stories are all we have.

Friday: January 27, 2012 (Part Two)

I waited a short time after the radiation dress rehearsal for my appointment with Jeannie Hamker, Dr. Greskovich’s nurse. Starting next week, the plan calls for me to see Jeannie and the doctor every Thursday after treatment.

  

Jeannie spared no details in her explanation of what I faced. As good as the technology might be, it’s not a laser pointer they will be aiming at me. The power of the linear accelerator is both its strength and its weakness. While it’s good at zapping tumors, collateral damage is unavoidable.

The first side effect Jeannie talked about is fatigue. While they pump tons of energy into you, treatment robs you of whatever reserves you have.

  

In my case, there likely will be damage to the esophagus. My tumor is in a sneaky spot – in the upper lobe of the left lung, hiding next to aorta and close to esophagus
.

Eventually, Jeannie said, the irritation to the esophagus might reach a point where I won't be able to swallow without the help of a yummy concoction called BMX. It’s a solution of Benadryl, Maalox and Xylocaine that numbs your gullet and allows you to get liquids down your throat. 

If food becomes too irritating, high-calorie protein drinks might be my main source of nutrition. Jeannie set my target at 2,500 calories a day. Radiation produces creates a miraculous example of self-preservation.   Innocent cells immediately switch into repair mode when damaged, a task that drains the body of energy.
   

Jeannie handed me a recipe that, to a health-conscious individual, would cause them to swoon. It includes  ingredients like heavy cream, Carnation breakfast drink, powdered milk and, if you'd like, ice cream. It added up to around 800 calories a serving.  

“It’s important that you maintain your weight as best you can,” Jeannie said.

Jeannie also asked how I felt mentally. I told her I felt guilty, for being so selfish and making the people I loved most to suffer because of it. Jeannie said I needed to stop beating myself up. We all do things in this life that we regret. It’s time to move forward.

I nodded my head. My friend, Bob, has become my spiritual adviser. He reminded me that God has forgiven me and that I don't have a choice in the matter. 

While Jeannie laid out all that I faced, she assured me that she and others will help me through it. Ultimately, it is up to me and me alone to summon the strength to weather this storm. It's just about time to head for the fallout shelter to wait for the shit storm to pass.

I wonder the world will look like when I finally emerge.
   

Friday: January 27, 2012 (Part One)

Not a good day on the Cancer Ranch.

I know I have a bad disease. Dr. Verma told me my chances at the start. But those numbers resided in my head as something abstract. The warrior spirit I'm employing to fight through this medical thicket has been trying to ignore the dangers.

Today, those dangers hit me center mass. 

I had a “dry run” this morning for my first radiation treatment on Monday at the Cleveland Clinic. I had a great dress rehearsal, giving a bravura performance that consisted of me taking my shirt off, revealing an upper body that is the envy of none, and lying very still on the treatment table for 15 minutes with my arms above my head as technicians did a bunch of stuff out of my view.  

They sounded quite efficient as they went about their work. The techs explained some of what they were doing and I asked a few questions. It was all new information given how I've studiously avoided going on the Internet to look for information about lung cancer and how it's treated..

I don’t want to know. It’s too scary.

Dr. Greskovich, the radiation oncologist, has told me I'm better off than most people with lung cancer who don't realize they have the disease until it's too late. They found my tumor relatively early, which makes me lucky.

Dry run completed, Danny the technician handed me a couple of sheets stapled together that listed the times and dates for my next 40 treatments.

Cleveland Clinic? We have a problem here. No one has said anything about 40 treatments. The last thing I was told was that it would be 15, followed by another couple of weeks of prophylactic brain radiation.

How did three weeks magically become eight? The techs didn’t know. They literally were following the doctor’s orders.

I sank onto the chair where I had placed my shirt and coat and wept. I had plans, and they did not include trudging down Cedar Hill five days a week for the next two months to get blasted by radiation. My already fragile psyche had just been given a different, unwelcome jolt.

Because Dr. Greskovich was out of town, it became the job of his faithful resident, Dr. Jason Hearn, to tell me why the plan had changed so drastically.

Dr. Hearn artfully explained that Dr. Greskovich had decided the presentation of both small and non-small cell cancer, my relative youth and decent physical condition meant that he would almost triple my treatments and leave nothing to chance.

“Does this mean my cancer is worse than you all originally thought? I asked.

Dr. Hearn tip-toed a bit, but finally answered: "Yes."

I have been overwhelmed my horrifically frightening moments in the dark of the night over the last few weeks. Today, that terror revealed itself in the light of day.

It's not a pretty sight. 

Interlude: Welcome to the Videodrome

Giving yourself cancer does not do much for your self-image. I don't even have the will to call one of those 1-800 lines to see if I can join their class-action suit.

Should the bill come due, I will have to pay.

During those first days of chemo, with my mind racing at its manic pace, I became obsessed with the thought I had to do something, that I needed to tell them! Cigarettes will kill you!

Even in my manic state, my brain found a way to process the fact that, um, people pretty much know that already. But I did have an idea that might have legs.

What if we were to make a documentary about my treatment. Allowing people to watch me suffer could have value.

If they were to see what I'm being forced to endure, surely that could convince someone, somewhere not to smoke.

Even if it were just one person, knowing that we've saved a life would make it all worth it. It became, at least in my mind, too important not to do.

The written words -- this journal -- became a secondary endeavor in my mind. I know all too well that the reading habits of the American public have gone to crap. I thought I would keep a journal and then patch something together from the notes to publish in the paper or maybe even release the journals verbatim online, where they would likely be ignored.

But a documentary could have value. After all, people now have 15,000 channels to watch on their 90-inch TVs. They can choose to watch a billion online videos, a half billion of which do not have cats in them.

Let’s make a snuff film of sorts starring Mark With Lung Cancer. Let’s call it … “High Noon EMT” (Electronic Martyrdom Time).

My bosses embraced the idea and assigned Lynn, the talented and complicated videographer/photographer I had requested.

I asked for Lynn because I knew her best of the videographers on our staff. We’d worked and partied together in the early 1980s at the News-Herald in Willoughby. In the years since, we had become work acquaintances residing on different branches of the journalism tree.

Over the next four months, she got an eyeful. She stood on legs of steel in an operating room for four hours as a surgeon sliced and diced my left leg. She tracked me traveling back and forth to the loo dragging my IV pole during chemo. She pointed the video camera at me as I cried. 

There is a large amount of unedited footage that is languishing somewhere on a computer. I’m guessing at least 100 hours.

And what will become of it? "Nothing" is the likely answer. Oh, well.

Edited properly, I still believe it could have been an effective tool that the American Lung Association or American Cancer Society could have used to scare off future and current smokers.

Just one life. That’s all I wanted to save. One puny life.

***

Lynn at least had the opportunity to meet the guardian angel who accompanied me on some of my trip through Cancer Land. Her name is Jeannie Hamker. She is the primary nurse for my radiation oncologist, Dr. Greskovich.

All Clinic employees are required to wear identification badges with their photos on it. I could not help but notice the woman on Jeannie’s ID badge was not her;  or at least not her today. That woman had darker hair and weighed at least 100 pounds more than the small, trim woman standing before me. She seemed quite proud when I pointed out the difference.

While it might have been Dr. Greskovich sitting behind the wheel of The Big Machine, it was Jeannie waiting in the pits in her flame-retardant nurse’s uniform, poised to deal with the damage Big Machine had wrought. And she we warned me there would be damage.

Early on, I asked her how she could cope, day after day, with the seriously ill and dying. Her answer buoyed me.

“It’s easy,” she said “They do so much more for me than I could ever do for them.”

With that, we both had a little cry.

And it was Jeannie who provided me with the credo that I embraced all through treatment.

“You’re a man, and you’re used to being in control,” she said to me in a stern but motherly tone that demanded my attention. “You need to forget that. You're not in control any more.

"You need to leave all of this in the hands of God and the doctors.”

And that’s what I did. I became the most compliant patient on the planet. Some thought that absurd. Me? Compliant? I have a long history of rebelliousness.

But if the the docs had told me to put on a hula skirt, coconut breasts and stand on my head twice a day for 15 minutes, I’d have happily done it. I want to live.

So I followed her advice. I relinquished control and it seemed to work.

Thank you, Jeannie.

Thursday: January 19, 2012

Thursday has become the day Mike McIntyre of Plain Dealer and WCPN fame and I eat pho and shrimp spring rolls at Minh Ahn. Mike and I are good friends. We're quite alike in many ways and way different in others. I have come to rely on him quite heavily in recent days.

As we waited for our noodles, I told him how I had my life seems to be subsumed by grace.  Mike’s childhood was as strongly steeped in Catholicism as mine. Our friendship meant that I did not have to explain what that meant.

His adult life is buttressed by a strong belief system, that I envy and an indomitable but nonetheless rebellious spirit. We mulled the sense of power and wonderment that grace provides. And we reached the same conclusion at the same time:

As brightly as the flame might burn, you must be able to let it recede, like the pilot light of a furnace.

“People whose flame always burns that bright are usually crazy,” Mike said.

That would be me. Manic and a bit crazy. It feels as if I’ve become someone else. My head spins with creative energy and what feels like startling clarity of thought.

All of this manic energy is no doubt serving as a shield of some sort, keeping the fear at bay. And it has largely worked. Mary Lou believes I’ve been “touched by God.” Perhaps she is right.

Yet there have been several occasions since my diagnosis when, deep in the night, abject fear descended upon me. Death’s dark, grim prospect felt too real to be imagined. I peered into a future that no longer was mine.

My manic energy has enervated and sustained me. But those other unspeakable moments won’t allow themselves to be ignored.

Wednesday: January 18, 2012

Trouble loomed as I walked upstairs to get dressed for the third and final day of my first round of chemo.

My mind and body had begun to betray me after another sleepless night fed by nausea and insomnia. I needed help in a big way. Mary Lou agreed to take me to Parma.

Killing myself with cigarettes is one thing. Causing fatal accidents on I-480 is quite another.

I don't like riding in cars much. I'm a control freak. I drive. I let Mary Lou drive only a couple hours at most on long trips, which is silly. Not only is she an excellent driver, she once had her pilot’s license. Flying a plane obviously requires much more skill and attention to detail than driving a car. 

Yet the trip to Parma made me want to scream. Did this woman not know how to properly drive a car?  Sleep deprivation had driven me to the edge. I felt surly and mean and didn’t care.

We arrived about a half-hour late. My recliner in the corner had been taken and I settled for one of two empty seats across the room. I squeezed Joanne's hand when I walked by, but we didn't talk.

Cindi served as my nurse du jour while Richard attended to other patients. I told Mary Lou yesterday that I'd developed a man crush on Richard because of how well he had taken care of me the first two days.

  

All of this led me to contemplate what it must be like to work with those who are extremely sick and, in many cases, dying. I guess that a certain distance must be maintained with their patients, that emotional firewalls must be built to get through one day and return for the next.

Mary Lou sat with me for a bit and then left for work. She would be returning after my afternoon brain MRI to take me home. The second two days of my chemo routine are much shorter than Day 1, which takes nine or 10 hours. I receive just the smallish bag of etoposide, saline and some anti-nausea medication through my IV on Days 2 and 3.

My mind calmed as I settled into my recliner. I wrote a bit, listened to one of my favorite albums (Green Day's "American Idiot") and read a few pages of Copperfield.

I also got a call from an unfamiliar prefix at The Plain Dealer on my cell. It was one of the big bosses. He said everything I had hoped to hear: The paper was ready to help me and my family in any way possible. I asked if the paper might let me chronicle this adventure. We agreed to talk the next day in the office.

Cindi unhooked me from my IV and released me to the world. I had just enough time before my MRI to bolt down a greasy grilled ham-cheese-tomato sandwich. I took a few sips of Italian wedding soup, one of my favorites, but found it too irritating to swallow. 

Dr. Verma called for the brain MRI to determine whether those nasty small-cell bastards had marched northward from my lung. (To that point, I'd had an X-ray, two MRIs, a needle biopsy, three CAT scans, a PET-scan, a bone scan and probably a couple others tests I had forgotten. If the unexamined life is not worth living, I've got a lot of living to do.)

  

After pushing some old people out of the way at the radiology department  check-in desk (I have a considerable size advantage over most elderly folks), I made it to the front of the line. I filled out the obligatory questionnaire and headed back into the bowels of the operation to don an ultra-fashionable hospital gown and wait my turn.

  

I shuffled to the changing room, got "dressed" and walked back to the waiting area situated at the epicenter of the various testing rooms. Nearly all of the seats were taken by people in street clothes apparently not awaiting for tests. My mood darkened again.

I muttered, somewhat quietly, that the place "looked like a fucking bus station waiting room" and braced myself to just stand there until my name was called. In my present mood, I could not muster the will to ask someone to move the hell over so some poor schmuck with lung cancer could sit down. There are limits to my abilities, after all.

But an attractive younger woman reading a Kindle must have heard my profane outburst. She looked up at me, shifted just a bit to her left, and offered me a seat next to her. Embarrassed, I thanked her and sat down. Good to know that people can be kind to idiots, too.

We talked a bit about her Kindle. She then looked at me and said: "If this is a bus station waiting room, maybe this is what purgatory looks like."

That made me chuckle.

The MRI tech eventually called my name. She explained that she’d be doing 20 minutes worth of scans, would then pull me out, inject a radioactive solution into me, and do 10 more minutes of scans.

For the uninitiated, the narrow, tube-like confines of an MRI machine can be scary, especially if you are claustrophobic like me. You wear ear plugs to shield your ears from the fearsome noises the machine makes as its magnets whirl and do their magic.

The first 20 minutes flew by. I think I might have even dozed off. As she pulled me out and injected the solution, we talked a bit about why I was there. She said she had quit smoking years ago, yet her last full pack of cigarettes remained in her freezer. She recently considered throwing it out.

"But then I think, I better not," she said.

Like most former smokers, she still dreams of cigarettes. Her decision to quit smoking came at age 35, when the choice became cigarettes or birth-control pills. She chose sex. Good choice.

The small kindness of the woman in the waiting area and the time the busy technician spent talking to me lightened my mood again. Dressed again, I waited in a quiet area with Copperfield and my iPod for Mary Lou to fetch me. She eventually drove me home without complaint or incident.

I received a call late in the afternoon from Dr. Verma with my MRI results. The bad news? I have a chronic case of sinusitis. The good news? I'm virtually brainless, but what gray matter resides in my thick skull is cancer free.

Where is God?

The Baltimore Catechism tells us, “God is everywhere.”

I sheepishly admit that is all that I can remember of the Baltimore catechism, which was taught to me as a wee lad on Saturday mornings at Immaculate Conception in Madison, Ohio. I can recite most of the lineup of the 1970 Baltimore Orioles, but can’t remember much of the catechism.

God is everywhere.

This is the story about a vital part of my cancer experience that I must tell. I wish I did not. One of the sticking points in the PD’s rejection of my story was my treatment of my religious experience during the process. An editor did not think I was truthful, that I had tried too hard to make myself look good.

I might be a coward, a hypocrite, a backslider and a lousy bowler, but I’m not a liar.

This is my story, my truth. It’s presumptious, to say the least, to believe you know another man’s truth. Know why?

God is everywhere.

My parents and my church raised me as a perfectly fervent Catholic boy in a perfectly fervent Catholic family. I grew up at a time when, at least in Perry, Ohio, being Catholic was different. I can remember being upset by the anti-Catholic tracts that would occasionally arrive in the mail.

We literally built our church, St. Cyprian’s, which is still standing strong today. Our priest had an office a couple blocks from our house when our parish first organized and I would hang out with him often. He became an important role model. One of my good friend’s father, who had nicknames for everyone, dubbed me “Cyp.”

I became an altar boy and faithful congregant who took his Cathollic vows quite seriously. I considered  whether the priesthood might be calling. As young as I might have been, there were times when I felt filled by the Holy Spirit.

Things change. I can hardly discount puberty. And, as children inevitably learn, there are deep disappointments waiting just around the bend.

I’m not sure how old I might have been, probably 13, when the priest asked me to accompany him to Cleveland to help order new cassocks for the altar boys. He asked me because of our close relationship and my status as Altar Boy No. 1. Weddings, funerals, high holidays, it typically was me up on the altar ringing the bells and handing over the water and wine.

Father A. and I had made it to the religious supply store somewhere in Cleveland and then headed for home.. I have a clear recollection of where we were, on the Shoreway near Liberty Boulevard, a road that longtime Clevelanders will now recognize as Martin Luther King Boulevard. I don’t remember the context of what Father A. was discussing, but the word “nigger” comfortably rolled out of his mouth.

I was shocked. Ultimately, I did not want to believe that this holy man, my hero in many ways, had uttered the most vile word I knew. But he had. I, of course, said nothing in response. I recall the rest of the ride being quite silent.

I left the church right around the time I got my driver’s license. I would lie and tell my parents I was going to the 5 o'clock Saturday evenings at St. Mary's and would end up elsewhere. The downy feathers of Catholicism had molted into the sturdy wings of agnosticism. I saw no path for my return.

.

Mary Lou has raised our children in a wonderful Methodist church. She and the kids have been active members of a congregation that formed years ago as an amalgam of a predominantly black and a predominantly white church.

Redeemer looks like our community. Pastors there have long made a point of welcoming everyone and everyone came: the rich, the poor, folks of all color, gay, straight and transgendered. I’d attend on some of the high holy days. I've always felt warmly welcomed by the wonderful folks there, but it’s not my church.

Sam was around 7 when he asked Mary Lou why I didn’t go to church. She said she told him to ask me, but I can’t recall that he ever did.

Ironically, not long before they found the spot on my lungs, we had a conversation at Sunday dinner when I surprised ML and the kids when they learned that I believe in God. They had assumed all along that I was an atheist. I started to blather on about St. Thomas Aquinas and the Immoveable Mover but decided to drop it.

This is complicated stuff in my mind. As much as I can comprehend, I also accept the precepts of string theory and multiple dimensions and believe there is so much we don't know.

I believe in God, and I believe in science. I’m not sure how the two can be separated.

   

After I began writing this post, another bit of the Baltimore Catechism came back to me: What is a mystery?

A mystery is a truth we cannot fully understand.

So I won’t try to understand what happened to me after I learned I had cancer. But something did happen. Something wonderful that has helped guide me to this particular point in time with all the strange twists and turns that make us human.

It’s my truth, and it remains unknowable. 

Something made its presence known as I began my journey through cancer, something I can only describe as grace. Something good. Something kind.

What is grace? The Baltimore Catechism tells us it’s a “supernatural gift from God bestowed on us, through the merits of Jesus Christ, for our salvation.”

I’m not sure about all that. That’s what grace might be in Baltimore. But in Cleveland, grace appeared in the form of small gestures and deeds. Grace enervated me to an almost manic level at a time when I my being could have easily been consumed by sorrow and despair. Grace fed the wellspring of the tears I that served as a soothing balm.
  

The abundance of grace allowed me to believe that everything could be okay. It wouldn’t necessarily be so, but I knew I had a chance, slim as it might be. That’s all I really wanted. A chance.

Grace, I discovered most, was the presence of Mary Lou in my life, a person without whom I'm not sure I could exist.

This was not the first cancer rodeo for the Gillispies. Mary Lou is 11 years clear of recovery from breast cancer. After her diagnosis we agreed that we’d push through, do what needed to be done, and move on with our lives. We had babies who needed their mother. Everything had to be alright. I would not allow myself or anyone else to think otherwise.

We adopted the same attitude this time around. We’re going to get through this. We will be okay.

My belief in me is not so steadfast, however. If you were to press Mary Lou, she might say the same thing. We knew we were in big trouble. No one had to remind us what happens to the vast majority of people with smoking-related lung cancers.

I have and continue to tell people that I'm an outlier. Damn the numbers. I want to live. But the fearsome specter of cancer's return can't and won't leave. It probably never will. I push it as far into the background as  I can.

  

After my father moved into his upscale senior digs, I tried to make sure he got to various Catholic events, such as praying the rosary. Not long after treatment began, I arrived on a Tuesday afternoon just before rosary. I pushed him to the gathering of a half-dozen residents, all in wheelchairs, all cradling their rosary beads.

It had been 40 years since I prayed the rosary. I remained silent at first, but soon joined them in the prayers I knew. I cried silent tears as I prayed. Grace subsumed me in a way that I had not felt since my youth. I felt something deep and abiding.

The next morning, I got up early enough to arrive 20 minutes before the 6:45 a.m. Mass. I knelt and prayed in the darkened sanctuary while waiting for the priest to arrive. The retired priest who presides over the early morning Mass was running late when I stopped him outside the sacistry.

“Father?”

“Yes?” he said gruffly, clearly in a hurry.

“I need to take communion this morning and haven’t been to confession in a long time.”

“Okay,” he replied, perplexed.

“No, I mean a really long time. Like more than 30 years.”

He allowed himself a small, knowing smile and placed his hand gently on my shouder.

“I think it will be okay if you take communion. We’ll talk after Mass.” He then went inside to don his vestments.

I did take communion. It filled a hunger I had never realized I possessed. After Mass, the priest and I sat in the sanctuary and talked for about 20 minutes. He didn’t ask for a laundry list of my sins, which I admit was a relief. I’d have needed to transfer the data to a thumb drive to accurately account for all of the iniquities since my last good confession.

Not long after, I officialy joined the church. I met the main priest, a kind, intelligent man who left nothing to chance. He administered the sacraments of sacraments -- extreme unction. The last rites.

Mary Lou (and Hanna) were confounded by my decision to rejoin the Mother Church. I had become hard to live with. My mind raced, my energy coursed somewhere near the manic level. As patient and kind as she might be, even Mary Lou has her limits.

“You’re going a million miles an hour and I can’t keep up,” she said.

I told her I understood, but there was nothing to stop the runaway train my life had become at that particular point in time. I was trying to learn to cope with the very real possibility that I could soon be dead. Finito.

My father converted to Catholicism after he and my mother married and, in our family, his faith was the strongest. There were many Saturday afternoons when my father would stand in our back yard and yell out over the neighborhood that I needed to come home so we could go to confession.

Dad seemed as confused as Mary Lou when I informed him that I had rejoined the church. He told me he had never loved me more than he did at that very moment. But then he said something surprising.

“I don’t feel a need to go to church anymore. I get by just fine with quiet contemplation.”

A year later, quiet contemplation is my church as well. The path I started down early in my cancer journey proved not to be mine. The Catholic faith I thought I had discovered proved illusory.

There is a path is out there for me, but I don’t know yet where it starts and have no idea where it leads.

Quickly spurring my rejection were the trappings of the church that cannot and will not ignore. It began with the pastor reading the bishop’s sanctimonious letter about the Obama-fueled controversy over birth control. I refuse to believe that the priest did know that more than 90 percent of the women sitting in the pews before him had used one form of birth control or another at some point in their lives.

And that caused me to contemplate the sanctimonious and ridiculous notion that only men can serve the Lord in the Catholic faith. Any religion that insists on putting men, and men only, in charge is not one I want to embrace.

My move away was hastened about six weeks into treatment, a time when the toll of chemo and radiation made me quite ill and I no longer had the energy to drive anywhere, much less to a church whose morality I once again questioned.

That, gentle readers, is my truth. I wish it were not so. For a minute, I enjoyed the mysticism, the song, the prayers. But I cannot separate the men in the pointy hats from the people in the pews. I wish it were not so.

I guess my actions here are craven, crying out from the foxhole for God and dismissing him/her/it once the shelling had stopped. That's not completely true. I do think about God every day. I wish I knew how to pray. Sadly, I do not.

I’m just another confused human being, unsure of where to turn and unable to assign himself to the acceptance of any belief system, whether it's Jesus Christ, Mohammed, Buddha ,Vishnu or some other mystical figure keeping the religious ride on the road.

I believe we’re all comprised of an energy that makes for strong and wonderful connections, boundless love and, yes, mind-numbing hate.

There are no easy answers, so I won’t try to make any up. Judge me if you will, but please accept the fact that I'm trying to tell the truth as best I know it.

And do know this: God is everywhere.

Afternoon: Tuesday, January 17, 2012

I made it through chemo, which was just the smaller bag of etoposide, and the bone scan without incident. My nausea had subsided to what might be considered a bad case of acid reflux. But my day was not yet finished. I traveled next to the renowned Cleveland Clinic to set up radiation.

A young, attractive nurse named Trisha brought me back to the treatment area and got my vitals. Next came Dr. Jason Hearn, an equally young and attractive resident who could have been mistaken for the kid who waited on me at the Apple Store before Christmas. But young Dr. Hearn had a freshly starched white coat and his name stitched authoritatively in red. I soon learned the coat came with a medical degree from some dump called Harvard University, which counts for something I guess.

We were soon joined by Dr. John Greskovich, the doc in charge of my care at the Clinic. The first thing Dr. Greskovich noted was the golf pulllover I wore. I got it after playing a fund-raiser where I played 100 holes for the local leukemia group.

Dr. Greskovich said he worked on the ground crew at the club for 10 years while in high school and college.. There had been a number of strange signs and markers over the previous weeks. This appeared to be another.

I learned through Dr. Greskovich that my Kaiser oncologoist, Dr. Verma, is one of his favorite colleagues. That helps explain why my hook-up with the Clinic occurred so quickly.

Dr. Greskovich gave me the rundown on my treatment. Fifteen treatments over a three-week period. He would be blasting the diseased portion of my lung, the couple of lymph nodes to which the cancer had attached itself and a few other lymph nodes in the chest wall.

He said there are typically two ways to apply radiation to my cancer: Two smaller daily doses or one strong dose. He said he had decided on the once-a-day approach. I told him that would be fine. I like the aggressive approach.

After radiating my chest, Dr. Greskovich said, I would receive a prophylactic round of whole brain radiation. Small-cell lung cancer has a nasty habit of traveling north to the brain and the current protocol leaves nothing to chance.

Small-cell lung cancer is a sneaky, invasive bastard. But Greskovich said that the combination of chemo and radiation exposes its vulnerability quickly. The problem is that it does a good job of mutating and figuring out how to linger in the body.

He also provided me with some new numbers. One-half of people diagnosed with small-cell lung cancer survive to 30 months. At five years, the survival rate is 28 percent and, at that point, folks are as likely to die of something other than lung cancer.

Woot! I had been living under the assumption I had a 15 percent chance of being alive five years from now. Dr. Greskovich had damn near doubled my odds!

 I now have a 1 in 4 chance of surviving this thing. And, as an added bonus, he said that on a scale of 1 to 10, for people with my type of cancer, I was a 9.5.

 The tumor was still relatively small and had been found relatively quickly. Technically, because the cancer cells had migrated to some nearby lymph nodes, my cancer was Stage 3.

While he gave no guarantees that I'll live to be 90, I found some much-needed comfort in what he had to say. The  reality that I might be dead soon remained an abstract concept. Processing the numbers and probabilities did not seem quite real.

As I mentioned early on, I've been a poker player for awhile now. Friends unfamiliar with the game refer to it as gambling. While I don't deny there are elements of gambling in poker, it's largely based on math -- odds and probabilities.

You know there are a certain number of cards that remain in the deck or are in someone else's hand that can help you. The decisions you make -- bet, call, raise or fold -- must be taken into account if you expect to be a winning player.

If I were in a hand and knew that my odds were 1 in 6 or even 1 in 4, it's likely I'd be folding. The percentages, in those instances, would be unfavorable.

But now I'm playing a game where my options are severely limited. I can't fold.

I want to live.

So ladies and gentlemen, it looks like the player in seat 7 is all-in. Good luck, sir. You're going to need it.  

Exposition: November 17, 2011

The week before Thanksgiving, I was awakened by the telephone at 5 a.m. Calls at that hour are never good. I’d gotten one in February 1993 telling me my mother had died of a heart attack. Nine years later, the call came informing me that my sister, Mary Ann, had just died of a massive coronary. She was 48.

The call on this morning was slightly alarming, but not nearly so tragic. It was from a nurse at the assisted living facility where my now 92-year-old father went to live after Mary Ann died. The nurse said Dad could not get out of bed and wanted to go to the hospital.

I hurriedly dressed and, less than an hour later, found him in the hospital's emergency room. He looked horrible, his face ashen, moaning incoherently as if in considerable pain. I felt certain that this day would be his last. I called my brother, Greg, in Montana, and my sister, Kay, in Bowling Green, Ohio, to deliver to the news.

Kay and her husband, Dennis, were traveling to Cincinnati to spend a fun weekend with one of their daughters and her new husband. At Dennis’s urging, they drove back to Bowling Green and Kay headed to Cleveland to join me. By the time she arrived around 5 in the afternoon, my previously dying father had rebounded to his normal, slightly confused self. No more moaning or pain. He said he was hungry.

  

His rapid improvement came as a relief, yet Kay and I faced the decision we had long dreaded. What do we do with Dad? The assisted living facility, as nice as it seemed, could not provide the care he needed.

A sympathetic ER doc understood our plight and helped set in motion the process to move him out by insisting he stay in the hospital for several days and then be admitted to a nursing home for a longish rehab stint. The outcome far exceeded our expectations. Instead of some dreary, depressing, piss-scented bedlam, Dad ended up in the geriatric equivalent of the Ritz. Great care, great food and an administration willing to let him stay permanently once he'd completed rehab.

After more than 12 hours in the ER, Dad finally got sent upstairs to a room. As the attendants wheeled him out of the ER toward a bank of elevators, my cell phone rang. I was surprised to hear my general physician at Kaiser, Dr. Clarence Taylor, on the line.

"Mark, I don't want you to be alarmed, but the radiologist found a spot on your chest X-ray at the top of the left lung that needs to be checked out," he said. "It's probably only scar tissue, but with your history of smoking, we should probably do some follow up."

I had recently seen Dr. Taylor for a literal pain in the neck caused by degenerative arthritis, a condition aptly named radiculopathy. He ordered a chest X-ray and, as it turns out, the sharp-eyed radiologist had found something abnormal in the upper lobe of my left lung.

Dr. Taylor told me I needed to get a CAT scan of my chest to investigate further and that I'd be getting a call to set up the appointment. This was unexpected and more than a little disconcerting, but I had more pressing matters to deal with and and went in search of my father.
   

Little did I know then that, had someone made a "last-longer" wager between a 92-year-old man in the hospital and his outwardly healthy 52-year-old son that the smart money might be on the old man.

Morning: Tuesday, January 17, 2012

 "Cow is giving kerosene, kid can't read at seventeen

The words he knows are all obscene, but it's alright

I will get by, I will get by, I will get by, I will survive."

-- Jerry Garcia/Robert Hunter

  

I drove to Parma for my second day of chemo after a sleepless night spent jacked up on steroids and hell's fire burning in my gut.

I felt okay initially after arriving home last night. The feeling did not last. My innards began to slowly simmer. A progression of coughs, belches and hiccups caused paroxysms of pain. It felt as if my throat had been coated with lighter fluid, and each convulsion served to ignite the flames.

I switched from recliner to couch and back to the recliner trying to get comfortable. I looked in vain for "Lockup" on television. I thought that watching men in prison would make me feel better about myself.
    

As I got into the car for the drive this morning, rain fell in sheets. I had refused Mary Lou's offer to take me. I'm a man. I don't need any help. It was supposed to be an easy day with a couple hours of chemo and a bone scan. No big deal.  

But as I pulled out of the driveway, my stomach convulsed. I paused the car at the end of the drive and leaned over the plastic bowl on the passenger seat that I had brought along for the ride. When nothing came up, I mustered what strength I possessed, pulled out into the street and drove off.

The trip to Parma was against rush-hour traffic, but with the rain falling hard in the early morning gloam, my eyes blurred by lack of sleep and my body suffering from the after-effects of deliberate poisoning, I realized long before I reached the highway that I had made a horrific choice, something akin to getting behind the wheel after consuming a quarter of Jack Daniels. Pure idiocy.

I managed to white-knuckle my way to Parma without killing myself or anyone else and got my radioactive injection for the bone scan. I had time before my 9 a.m. chemo appointment and, despite the napalm flames shooting down my throat, could not escape the basest of human urges: hunger.

Somewhere inside of me was a pathetic creature in need of food. I found the cafeteria, ordered an omelet, home fries and toast and, after a longish wait, tucked into a breakfast that I consumed with surprising gusto. Maybe, just maybe, I thought, I'll make it through the day. Maybe, just maybe, I'll live.

Styrofoam plate cleaned, I headed to the infusion center and took my corner seat. A few other patients were scattered about the room. Richard quickly hooked me up with an Emend pill and a bag of anti-nausea medication.

A woman walked in and sat in a recliner halfway across the room. We smiled at each other as we both settled in. I'm not sure why, but I pulled the bag of Twizzlers out of my Nike tote, walked across the room and offered her a piece.

  

"I haven’t had one of these in awhile," she said and took just one stick.

We made our introductions. Joanne was being treated for lung cancer, too. A nagging cough prompted her to quit smoking in January 2011. She was diagnosed with cancer a couple months later and had been undergoing chemo for the last 10 months. Despite the doctors' best efforts, the cancer refused to leave her body.
   

I'm guessing Joanne was in her early '60s. I didn't ask. She had wrapped a scarf around her head. Her normally mocha-brown skin was a strange shade of brown. She said she was trying hard to keep her life stress free, but that people in her life had made it difficult. She tried to remain philosophical. 

"I'm blessed," she said. "I woke up this morning."

I reached out my hand, which she took and held for a few wordless seconds. A minute ago we were strangers. Now we were deeply connected by the exigencies of our disease and our abiding fear of death. We had a short cry together and I returned to my recliner, ready or not, to face the day.

Interlude: Coffee and cigarettes

The fact that I could get cancer or some other dreadful disease from cigarettes did not completely elude me. Hey, I'm pretty sure I read the warnings printed on the side of each pack at least once.

But smokers have an amazing ability to block out the consequences. Being addicted to such a wickedly awful drug like nicotine can do that.

And, believe me, I was an addict. I finally quit a week after starting chemotherapy, nearly three weeks after receiving my official diagnosis.

I don't care to spend much time analyzing why I began smoking cigarettes, but I'm sure it was rooted in part in a need to rebel against something or someone. It did not take long to become a slavish addict.

I had two groups of friends in my life as a teen. There were the students with whom I took the college prep classes in high school and played sports. And there were the kids from my neighborhood went to vo-ed. I mostly hung around at home with the vo-ed kids, most of whom smoked. I started smoking when I was 15 or 16 and never stopped.

It wasn’t difficult for an underage kid to buy cigarettes in the 1970s. There were plenty of cigarette machines to drop quarters into. And I could buy all the smokes (and beer) from the grocery store where I had a part-time job. The owner, a man with a lecherous reputation, never objected.

I went into the Army after high school. The U.S. government made cigarettes dirt cheap for us fighting men. (Okay, I was a finance and accounting specialist.) During basic training, the drill sergeants would tell us, “Smoke ‘em if you’ve got ‘em.” A butt can sat outside our barracks.

Mary Lou never rarely said anything to me about my cigarette addiction. She thought I would end up smoking forever and would be fine. This was the rare instance where she was wrong. My children were another matter. Modern elementary education includes a stringent anti-drug and tobacco curriculum. There were questions and concerns from Sam and Hanna, which I did my best to deflect and ignore.

One of the lessons cancer has taught me is this: Smokers who believe they’re only hurting themselves are delusional. I now know how selfish I have been. I’m too embarrassed to try to calculate the money I’ve spent on my nicotine habit. I don't want to know. And I won’t attempt to describe the look on the faces of Mary Lou, Sam and Hanna when I told them I had lung cancer.

Even now, months removed from successful treatment, the anxiety remains. Hanna had a nightmare a couple nights ago about me smoking again.

A vivid recollection: Sam and I were driving home on a dark, cold night after a winter baseball workout somewhere. As best I can recall he was 10 or 11 at the time. Less than a mile from the house, I stopped at a gas station but did not pull up to the pumps. Sam quickly deduced why.

“Please, Papa. Don’t go in there,” he pleaded from the back seat, tears in his eyes.

What did I do? I ignored him, went in and bought two packs of Salems.

Please forgive me, Samuel. Please find it in your heart to forgive me.

Monday: January 16, 2012 (Part Two)

My first day of chemotherapy had proceeded without tears until Kathleen, the social worker, sat down in the cheap plastic chair by my recliner and introduced herself. The last couple of weeks had produced numerous crying jags. Having a potentially fatal disease will do that to you.

The day at Kaiser had begun at 8:30. By early afternoon, with the “good stuff” finally filling my veins, I encouraged Mary Lou to go to work. I insisted that I’d be fine.  I had my iPod, David Copperfield and this small notebook that I’m filling at a feverish pace to entertain me for the next four or five hours.

                                                                                         

Mary Lou has more than 20 years' experience learning to read my confusing and conflicted moods. She knows when I need space and, I’m guessing, sensed I could use some. I wanted to be alone to wallow in the thoughts muddying my brain.

But here’s Kathleen, dressed in her white coat, talking to me in a soothing voice. The various drugs I'd been given had sent me into a strange fugue. Nothing seemed quite real, including Kathleen. She seemed, at that moment, an angelic creature who easily moved me to tears.

In a willowy voice, she told me that I would emerge on the other side of treatment a changed person, someone who I will have learned to love. That was not something I had considered since this all had begun. Okay. Better than the self-image I’d been whittling with the sharp-edged scalpel of guilt, self-loathing and pity.

My cancer is a self-inflicted wound. Nobody gave it to me. I didn't win some perverse lottery ticket that entitled me to a carcinogenic death. I sucked down the soothing menthol smoke of (how many?) Salems, the poisons collecting, polluting.

While Kathleen and I talked, Dr. Verma dropped off an envelope containing discs of my scans and my medical chart that I’ll need to take with me tomorrow for my first radiation oncologist appointment at the Cleveland Clinic. Dr. Verma informed me straightaway that my treatment protocol would include simultaneous radiation and made the arrangements with a friend and colleague at the Clinic.Things were moving so quickly.

I had not come to Parma convinced that I would begin treatment that day. We were prepared to say, "No, thanks," and leave.

Mary Lou had been treated for breast cancer at University Hospital 10 years earlier. While her experience was not perfect, it proved quite positive. She admired her docs and we got the outcome we so desperately wanted.

This time, we were both anxious about the lack of a diagnosis. Little did I know they were sending my tissue hither and yon to get opinions from other pathologists, which I acknowledge was prudent, but we were understandably anxious not knowing where we were headed.  At Mary Lou's urging, I made an appointment at UH that had been set for Wednesday, two days hence.
 
But then I met Richard and wonderful spirit. He oozed kindness. Then I had my first substantive discussion  with Dr. Verma. I liked his matter-of-fact approach. He impressed me as someone comfortable in his own skin.

After Dr. Verma left us, Mary Lou reminded me that we did not have to stay. I said I had made up my mind and stay we did.

After Kathleen stepped away, I opened the manila envelope and looked at the top sheet, a report about my cancer. I read near the top that the tumor had grown since it was first measured in early December. I put everything back in the envelope. Kathleen emphasized that I need to remain positive. I wish it were so easy.

I'm 90 minutes into my first chemotherapy treatment and I have not yet puked or spontaneously combusted. I guess those are both good signs.

During our conversation, I mentioned to Kathleen that I was considering writing about my treatment experience, but wondered whether the world needed another cancer journal. She encouraged me to do it, nonetheless. It strikes me as a bit self-indulgent for some reason.

If there really is a better person to be found on the other side of cancer, I really do want to meet him.

After the Cisplatin bag finally emptied, Richard hung another chemotherapy drug called etoposide. It emptied in less than an hour. After that, I received fluids designed to flush all the toxins out of my kidneys. I rolled my IV pole into the bathroom eight or nine times over the next few hours. Richard's smile seemed like a mental gold star each time I passed by his work station. I'd been toilet-trained all over again.

It was after 7 by the time I returned home, in a strange fugue of hyper-alertness and bone-tired weariness. It would prove to be a long, long night.

Monday: January 16, 2012 (Part One)

Sweet Virginia cigarette, burning in my hand.

You used to be a friend of mine, but now I understand.

You've been eating up inside me for some time.

Oh, in the morning there'll be hell to pay, somewhere along the line

In the morning there'll be hell to pay, somewhere along the line."

-- Billy Joel

1:05 p.m. Monday, Jan. 16, 2012.

Richard, the oncology nurse, plugs in the first bag of a platinum-based chemotherapy drug called Cisplatin into my IV line. Poison to kill the poison; an elixir that may or may not extend my life. I'm in the transfusion center of the Kaiser Permanente Medical Center in beautiful Parma, Ohio.

It's a large room with 15 or so vinyl reclining chairs of various vintage and design lining three walls and wherever else they can be squeezed in. Dress up the place and give it some charm and it could be a waiting room for a tire store.

  

I have a corner office next to a cabinet containing sheets and blankets. In a room where privacy doesn't exist, it's the best I can do. And I am a private person, which makes this exercise an interesting and strange byproduct of the strange and overwhelming circumstances that I find myself in today and for the unforeseen future.

This Cisplatin is in a big bag. Richard tells me it will take about two hours to empty. Dr. Verma had talked to me that morning about the side effects. As many chemo drugs do, it causes your hair to fall out. Truly, that’s a minor inconvenience. There's neuropathy -- tingling and loss of feeling in the extremities – potentially permanent hearing loss and numerous other bad things.

I don’t care. Bring it on. It’s not like I have a choice. Guess what kids? I want to live.

Richard, a long, tall compassionate soul keeps a close eye on me. His concern seems genuine. But he and his fellow nurses are busy. Lots of sick people show up every day at Kaiser to do battle with cancer and other serious illnesses that require IVs and bags of medicine.

While a doctor had told me a month ago that I more than likely had cancer, the official diagnosis came less than two weeks ago from a surgeon who had hoped to cut out the tumor. But things were not quite so simple, he explained. The pathologist had found a confusing mix of non-small and possibly small cell cancer in the biopsy.

They needed to send the biopsy elsewhere, the surgeon said. He said a finding of non-small cell would be “good.”

Small cell, which has a nasty habit of spreading like wildfires in a dry wind, are not so good. Surgery is not an option. Nice choices. Then again, neither was 35 years of cigarettes. 

  

I received a call three days ago – Friday, Jan. 13 -- from Dr. Ravi Verma, the oncologist I’d met just the day before. He confirmed what everyone expected. I had hit the lung cancer daily double: small cell and non-small cell. No surgery for me. He said he’d seen three such cases in almost 20 years of practice.

“Mark, I need you to come in and begin chemotherapy on Monday,” Verma. said.

I did not respond as I gathered my thoughts.
 
“You can begin Tuesday if you’d like.” he added. I told him Monday would be fine.

Monday would not be fine. The day after never would be mighty fucking fine, thank you very much. Thoughts about this new reality began pummeling an already fragile psyche.

We discussed time and place and I managed to ask one question before I got off the phone. What's my survival rate?
  

“It’s 15 percent if you remain cancer free after five years,” he said.

Oh. That's not good. Not good at all.