Death, Sex, and You: The Cancer Edition

"Not Today."

There may be times in life when you find yourself interacting with someone with a scary, perhaps even life-threatening illness. Maybe you meet them at work. In class. At a bar. Making small talk with tact can be difficult amongst all that is icky and emotional. How does one discuss awkward topics like cancer without being awkward? How does one discuss all that is depressing and debilitating? 

Some initial tips:

- Don't insinuate fault. Don't mention karma, "life teaches us lessons", or any other potentially blame-laying notions. 

-  There is a fine line between being light-hearted and being facetious. It is best to assume you are 1. not funny and 2. any inferences you make regarding life expectancy will be wrong and/or insulting. It is also best to refrain from trying to parlay an anticipated life expectancy into a one night stand because "life is short as you know, lolz, yolo".

Or how about we just avoid the topic of death altogether? No dead relatives, no asking about how long I have left, or how I think I would be as a ghost (though I will credit the individual who came up with that particularly precious bit of pillow talk with the most creative take to date on discussions of impending mortality). I know it is super tempting to dive straight into anticipated funeral arrangements when a person you encounter reveals (s)he has been stamped with the "Big C" (or other life-threateningly fun diseases), but how about we all collectively decide to hold back on the er, charm until at least the 3rd date. Or 10th date. Or never.

Re: the dead relative comment. Yes, it can be brought up with a certain level of finesse. Let us assume you, and any of your friends, coworkers, drinking buddies, etc do not have that level of finesse and therefore should avoid mentioning someone who died from the same disease/disease family the person you are speaking with has recently revealed they have. Some of you may find this a bit silly, or unnecessary to address but you would be surprised by how quickly an acquaintance can turn around and say "Hodgkin's Lymphoma? My aunt/grandmother/aging rock star had that. She's dead though..." when you make the mistake of mentioning you are ill.

And on the topic of illness, how does one indicate interest without being intrusive? Follow their lead. 

For many of those recently diagnosed, they are completely terrified and haven't the faintest idea what to expect. They may not be the best resource for specific disease-related information, as they are likely overwhelmed by all the new medical jargon they have yet to become fluent in. Ask lightly and let them tell you what they feel like telling you. This is not the time to be pedantic or preachy. If you have suggestions, provide them gently. Everyone has an anecdote about some treatment x or some supplement y that cured z disease. Try prefacing each suggestion with "I'm not sure if you've heard of this, but..." or  "I'm not sure this is something you'd be into but..." If you want to share something, make it accessible. Or better, send them the bottle/box/book with the understanding they may never use said product at their doctor's request or simply because they forgot.

Comments on changes in appearance or hair style should be entertained with caution. Really, all opinions except those of the unwaveringly positive or life-affirming sort should be kept to yourself.  Chemo (among other treatments and medications) does funky things to all things hair, skin, and body and your sick friend is most likely fully, if not hyper-aware of any/all minute changes their treatment has caused. Whenever you feel compelled to make facial or verbal expressions of disgust towards your friend's deteriorating physical state you can instead choose to not be a completely selfish, emotionally destructive human being and keep it to yourself.

As a friend, it is not your responsibility to enumerate all the ways getting sick can inhibit social, academic, or professional success. Hours of waiting room visits provide plenty of time for sick kids to examine every possible angle, every missed opportunity, every friend who no longer calls, every trip that requires too much energy, every scenario that could end in rejection simply because it has been revealed one has a less-than-stellar immune system. Refrain from asking leading questions such as:

"Who will want you if you're infertile?" 

"Why won't you work/exercise/go out/drink?" 

"Shouldn't you be married/promoted/back in school by now?" 

This may be difficult for the Type A among us to grasp, but you don't get to decide what your friend's limitations are. Or what is an acceptable career, life path, or timeline. Even if it may seem that control over circumstances no longer falls with your sick friend, it most certainly does not fall with you.

But the least welcome comment (in my opinion) is a prediction of failure. Perhaps you feel you the sick friend needs to be "brought back down to earth" with some friendly statistics, risk profiles, or mortality rates. They don't. And they especially don't need it from you, defeatist-masquerading-as-realist, non-medical-expert. Unless you have the spy capacity of the NSA or are a mind reader (in which case I'm impressed), it is safe to say you do not know what your sick friend knows or doesn't know about their treatment or potential quality of life.

"But what if I'm the god of death?"
All you need to know is:
not today.

Rap of the Lovesick Sick Kid

Personality Test

Answer the following to the best of your ability:
When left alone in the hospital for several hours, how do you spend the time?
A. Sleeping
B. Watching Maury
C. Learning Klingon
D. Contemplating life and its mysteries
E. Beginning a journey to rap superstardom via Youtube

The title of the post impedes upon the integrity of this exam.

For some perspective, the video involves me in my hospital bed, wearing a hospital gown, and for added fun: with an IV jetting out of my left hand.
It is as terrifying as it sounds.
It required several takes; not for performance value per se, but due to the periodic intercom blaring that added just a tad too much authenticity. Not to mention, nurses get weirded out when they walk in on patients imitating Eminem to their laptops. Apparently such activities are unusual. 

The first few lines of this "rap" should erase any and all doubts of how absurd a person I am. (Or illustrate the dangers of mixing delirium with painkillers. The jury is out.)

Oh, damn
I feel woozy
is this a fever or
did you just kiss me?

Then there is a chorus of cliches and references to iron deficiency, Catholicism. I may very well be the next Lil' Wayne.
At the very least, my hair looks passable because the chemo-shedding had not yet kicked in.
(Hair Update: I have successfully managed to get traces of my DNA all over New York. Fingers crossed there isn't an unsolved murder any time soon.)

The periods of bedridden solitude that serve as fertile ground for the utter strangeness that lurks in my mind's corridors are interrupted by visitors: some announced, some checking for evidence of proper kidney function.

Every morning a flock of white coats in masks (There is a dress code to visit me. I am like the Pope.) arrive and stand clustered in silence at the foot of my bed while the most senior among them asks me questions, commands me to breathe. A med student would later inform me interaction with the attending (physician) inspires a certain kind of terror. I am merely annoyed. This white coat mafia is impervious to my usual escape tactic of inciting pity via demonstrations of wellness and boredom like the greatest of magicians. The attending shows his prowess at silencing bratty patients by announcing an order for massage therapy. (This is apparently a thing. And it is awesome.)

A woman comes by asking if I want communion, which I accept on the account that it is non-forced interaction with a human being who does want to talk about my bowel movements. (Standards. I have them.)

Soon after, a friend comes bearing a different kind of gift that in my heathen opinion is far more deserving of a "nectar of the gods" tagline: a Financier raspberry macaron.

A hopelessly bored medical student also finds his way into my room, probably because I am the only sentient being on the premises under 40 and unfamiliar with the hospital caste system. (As a sub-intern he is essentially an Untouchable.) He, of curly hair and Jewish descent, is a comfort amidst the unfamiliarity: it is as if I never left campus! My heart does not palpitate as it had with the male nurse (which is good, because it would have set off an alarm...) but our chat does prompt some of the usual getting-to-know-you anxiety: How would you describe yourself? What do you want to do with your life? How many children do you want? (I kid on the last one but given five more minutes I swear we would have picked out a white-picket fence for our future dog Baxter.) I should mention this conversation involved a mask and fuzzy yellow clothing cover and not at all in the sexual way!
I like my men like my hospital rooms: sterile.

Amidst all these demonstrations of friendship, I was being pumped with fluids via a technique I will unabashedly refer to as "double bagging". Meant to bump up frighteningly low numbers on the blood pressure monitor, it leaves one feeling like an overinflated balloon in a room of needles. (Sausage fingers: it's what's for dinner...dun dun dun) Sausages trying to escape their casings are terrible for typing, which is how I find myself weeks after the fact recalling all of these treasured moments for your amusement.

Until next time.

Clinical Trial Diaries

I arrive hours early to sign off my consent and re-learn what the protocol entails. My official cell guy is out, so I get a Brit with a deep, sexy voice paired with an anorexic-looking nurse. I have him repeat "cytotoxic t lymphocytes" a few times for good measure. The high-cheekboned nurse asks if I've ever gotten an IV before. I resist the urge to attack. She then fumbles around with the one thousand or so multicolored vampire tubes that will soon be filled with whatever blood they can squeeze out of me.

After that we play a little game called "let's find a vein". which involves heat packs, slapping, and just a touch of squirming.  After that there is a round of "vein wrestling", which is surely equivalent to alligator wrestling, but with sharper teeth and (slightly) less carnage. (I've been running a bit of a losing streak lately. It seems the 2 years of poking holes in my circulatory system have started to show.) The nurse looks up at me as if the failure is a lack of will. Pushing tears back into their sockets, I have to wonder how four years swimming alongside the best and the brightest failed to prepare me for these moments of inadequacy. I am then left to muse about the practicality of ski resort warning signs on cancer patients. I would gladly walk around with a triple black diamond around my neck if it meant nonexperts would stop swerving all over my scar-ridden terrain.

Then, we pre-med and hydrate. Benadryl in the drip makes me less hostile to the nurse and generally unable to form coherent sentences. My very patient friend Dara arrives and hangs out while I nap-talk. I get "THE CELLS!!" or CTL (see above) and they are fortunately pushed in (doctor talk for "slowly injected") by the sexy Brit and not the green circle skier/vein wrestler. These cells have apparently been frozen and contain preservatives. I wonder if high fructose corn syrup is at all involved, and if they make a lean cuisine version of EBV-targeted cytotoxic t lymphocytes, and if Dara has 4 or 5 of them in her freezer. Like any lean cuisine, the preservatives make me nauseous and I am at the mercy of the green circler to remedy me via the sauciest of Zofrans. I inhale from the remaining sips of my Lemon Tea Snapple, hoping to evade the staleness of the room and constant disinfectant.

After 4 hours of observation and obsessive temperature-taking, I am untethered. My wrist is bandaged sucide-watch style and the orange taint of the disinfectant gives off the impression of carrot jaundice.

Freedom! If only til Monday.

Mutants and Missiles

My brain is melting. I am operating in a permanent semi-fog. I am the perfect date because I will say just enough to maintain conversation. In my period of hyperenergy, untethered by the swampy stew of decaying cells currently swirling about my thinking bits, I had developed a tendency for saying too much, too often, too loudly. Praise be, the curse has been lifted! Now I may operate like the friendliest of robots.

I take comfort in knowing that although my creativity has run off with my youth and vigor, my sarcasm remains in these mushy-mind times.

This latest dose of chemotherapy is not the worst I’ve had, for sure. My hair has a few more weeks to see if it’s going to stay, the nausea meds are hanging on tight, and I can still swallow at will. I will pat myself on the back after a brief bout of narcolepsy.

(...)

I have managed to walk myself into (surely?) the most hastily thrown-together clinical trial at such a prestigious institution. Initially I was sold on the idea of applied immunotherapy. I was assured it was “great science” and would only require a semi-regular dose of some mutant tcells who would, like biological X-Men or the finest of heat-seeking missiles (whichever analogy you prefer), target the blasted spots unlike anything has before and then I would skip off into the sunset, tumor and worry-free. I lie, of course. This sunset I speak of is actually a bone marrow transplant, with its own set of commitments and considerations.

I digress. Surely you wonder, dear reader, why I’m speaking of chemotherapy when the clinical trial pitch only mentioned tcells. Ah! What an astute observation. The chemotherapy was not mentioned during their pitch, nor follow-up, nor follow-up to the follow-up. And when the topic was breached, the requirements shifted no less than 3 times. 24 hour chemo? few hours chemo? 7 hour chemo? Oh, we can speed up the hydration to…5 hours. Oh good. Let me sit in this chair, with a tingly feeling akin to ice surging through my wrist, as you deliberate on the best course of action. Now that I have graduated, I have all the time in the world for you to determine the best possible way to kill off my white cells to “make room” for your well-disciplined mutants.

So here I sit, foggy and embittered, willing my immune system to “make room” for tomorrow’s houseguests. Let us hope they are well-behaved.

I know this blast comes out of nowhere for those of you who have become used to my poetic plodding, but I’m afraid this may be the tune of the day (week, month, some other unit of time). Also, for those who seek updates and know I am terrible at giving them, consider this part one. I think it is safe to assume if you are reading this, you are vaguely interested in the goings-on of my life. Or are a spam bot, but I'm not picky.

Cosmo Guide to Getting Guys: The Cancer Issue!!

Discuss growth. And by growth, I mean tumors. Use phrases such as "dead tissue" and "eating me alive" for extra oomph. We <3 (literally) damaged chicks!!
Remind them of that time you were bald. Visuals are huge.
Discuss death, emotional disconnect with loved ones, and general notions of despair. This is particularly effectively if you manage to tie in your melancholy to everyday items, like what you had for dinner or vacation preferences.
Important theme: morbidity. you know what's hot? morbidity. 
If you can, provide a play-by-play of your reaction the last time you got chemo.
Casually mention that you've had to carry around a card for being radioactive.
Outwardly muse that you feel you may actually *be* radioactive and/or toxic. Guys are totally into danger.
Suggest a day trip to your chemo ward next time they're in NY. (points if you offer to introduce them to your oncologist, who you think is a total bro)
Go into detail about the various scars/radiation markings you have covering your body. you know what really gets a guy going? scar tissue, baby. all about .. scar tissue.
Show them the wig. Or better, have it sticking out of a drawer in clear view. If they ask, say "you don't want to know"
Mention that time you had trouble eating and/or swallowing and offer him a nutritional shake of your choosing. (Hospitality is key.)
Assert your superiority via your sobriety. you know what's cool? not. drinking.
Elaborate on the (dys)functioning of your internal organs! Particularly if it's at all connected to the digestive track. mhm, bowels.
Elicit opinion on future treatment plans, with particular focus on side effects such as kidney failure or DEATH! People like to express their opinions.
When he asks what you're up to this weekend, say a PET scan. (Blood tests are total overshare.)
Lament that no one understands you. Allow them to make empathetic comment. Then, sigh loudly.
Brag about your recent Hemoglobin level. Maybe even platelets. Mention your ANC though and you're just an asshole.

waxing nonsensical

I've been in hiding. A rabbit who digs a hole only to emerge among foxes. I have emails in the hundreds I've read and considered answering, texts sitting hopelessly, all demanding explanation. 
'Where are you?'
'What are you doing?'
I feel trapped by a need to explain and the explanation itself. Yet, instead of addressing basic human interaction, I resume focus on churning out words that require constant replacement and hoping someone will simply approach me without having to ask.

I've been muted. In a most cruel, Pavlovian way my throat's sharp rejection of utterance forces an opt for silence over commentary. Restraint over laughter. Although the torturous swallowing has come and gone with each cycle, I remain conditioned. Instead of projecting, I whisper. I don't know if this will subside. The recommended baking soda cure-all only provides temporary relief. I'd rather not chance it.

I'm bald and just nearing the point of washing my wig to make myself presentable to the public. or I could just stay hidden.

I'm in my own little bubble concentrated around my room and the hours most mortals take rest. I'm nocturnal now. 

Finals have provided a new impetus for hibernation and a reason to disregard hygiene. My android-like attachment (Central venous catheter), with its ever-pressing neediness and demands to be covered with skin ripping plastic every shower made cleansing seem much less necessary. Why change pillowcases I'm only going to cough into again the next night?

My room is a collection of dust bunnies. The ones that hop from one surface to the next, fearing Lysol. Apparently ceiling fans are meant to interrupt their stranglehold on my living space - I discovered this magic a bit late into my allergy attack. 

I'm not sure if this is melodramatic enough.