Lord of the Rings

Six years ago I had a pocketful of platinum for a few hours. A priest and a rabbi looked at me wearing a rented tuxedo and asked for the contents of my pocket. I handed the rings over, and two very close friends placed them on each other’s fingers. Decades ago, it was a very uncommon sight indeed to witness the wedding of a Jew and a Catholic. It was equally uncommon to see a platinum ring ground up into a powder, processed, and injected into the veins of a testicular or ovarian cancer patient. “Love conquers all” is the common expression. As we evolve and learn that religious affiliation does not, in fact, have anything to do with love, and that love alone does not, in fact, conquer cancer, I still cannot get the notion out of my head that “jewelry conquers cancer”.

When you’re diagnosed with cancer, friends and family alike are instantly divided into two groups. After breaking the news, and placing the platinum ring on your finger, so to speak (that means starting chemotherapy), you instantly become invisible for one of these groups. They mean no harm, but for some people the concept of impending death is just too much to handle. You have cancer, the subject is inevitably going to come up in conversation from time to time, and it is simply so uncomfortable for them that they have no choice but to cut you out of their lives, like a tumorous testicle.

The other group of course becomes more important than ever. They are your Fellowship of the Ring. When you cannot fulfill your daily obligations, they gather to help. When you wake up from a nauseous sleep, they are there by your bedside. You become truly thankful for their love, for their patience, for the simple fact that they do not fall prey to the powers of the ring. You are not invisible to them.

And for the lucky ring-bearers who survive, it is truly amazing how, when the day comes that you remove the ring, both groups are once again united in their ability to see you. This is not intended as a slight, I’m just pointing out what to expect should anyone in my shoes, or rather pants, be reading this, looking for what to expect. It’s funny though…you’ll be very pleasantly surprised at which of your mere acquaintances become good friends.

I showed up at the hospital early Friday morning to have a cannula inserted in my arm. My oncologist had not told me to avoid eating or drinking, and I had not thought to ask. But Thursday night, I figured it would be a good idea to not eat after dinner, and wait till after the CT scan. “But shouldn’t I have drunk some of that radioactive contrast?” I asked the nurse as she poked the needle into my arm. She informed me that it wasn’t necessary. “But they made me drink stuff for an hour in Tallinn.”
—Yes, they do things differently there. Here in Tartu, you don’t need it.

Obviously I found this a bit strange. One might even say “bizarre”. I went downstairs to Radiology and handed my hand-written paper to the registration lady. Ignoring the computers on her desk, she instead opened a hand-bound book so old it most certainly contained the ancient spells of Gandalf the Wizard, and searched for my name. Three minutes later she found it, and instructed me to walk three meters down the hall and wait.

A moment later a nurse came out and asked if I had swallowed the contrast. “No,” I told her. “No one said anything about it, and I even specifically asked.”
—Of course you can’t have a CT scan without contrast, she began to lecture me. Instead, I interrupted.
“It’s not my fault. Oncology specifically told me I didn’t need it,” I insisted. She huffed and walked back through her door, only to appear a moment later with two plastic cups each one-third full of clear, cardboard-flavored liquid. Why she didn’t combine them into one cup was beyond me. But whatever. I drank them. A few minutes later she brought me two more cups, and I was instructed to come inside and pull my pants down.

A French friend had given me a personalized T-shirt that said, in French, “I may have lost a testicle, but not my sense of humor”. I could think of no more appropriate shirt to wear on this day. So there I was, wearing this shirt, my pants pulled down, laying on a table under a machine with large letters printed on the top that said, “SIEMENS”. The nurses didn’t understand why I was laughing to myself in this situation. Had I tried to explain the concept of irony to them, they surely would have checked me in to the Psych Ward after the scan.

As the table was thrust repeatedly into the giant hole of the Siemens machine, an invisible man (was he too wearing a ring?) from behind the protective glass repeatedly droned on the microphone, “Breathe in and hold your breath,” followed by “Exhale”. He had all the enthusiasm of a bus driver. Years of medical school, and this was his job. To say the same thing again and again and again. I understood why he didn’t want to be seen. I would have felt ashamed too. Maybe he should have studied more.

I went home, knowing that today would be hard in terms of concentration. I was at work, after all. I worked quickly, fully knowing that when the call came, I would be unable to work for a few hours, either due to excitement and relief or distress due to impending surgical horrors. The call came a mere two hours after the scan. It was more or less word for word the same as in the previous post. I hung up the phone, Mrs. Mingus watching my face for clues. I told her, she hugged me a little too hard, and I just kind of stood there, no smile on my face. Nothing. My vapid expression would not change. Walking around our home for a minute, I just could not think. I found myself making an announcement on Facebook. I hadn’t even had a chance to stand up and there were already three “likes” and three comments. Within the hour, that number was over forty. I went outside to the balcony to get some fresh air. The leaf on the ground was particularly interesting. The pattern of the colors was both typical and unique, like a fingerprint. I could not stop thinking about it. Suddenly I knew the moment had come. I sprinted into my home, threw off my shoes and sat on my bed. The tears were already flowing. I was already laughing. Tears and laughter. I had a tear or two when my daughters were born, but nothing like this. I was crying with joy for myself. Did I deserve this? Did I deserve to appear happier for myself than I was for my daughters’ respective births?

This was the start of what I’m referring to as a mild case of “survivor’s guilt”. Of course I was happy. I was thrilled! But did I have the right to advertise this, in lieu of so many who have not been so lucky? Who have actually undergone extensive surgeries, only to meet a bitter end? People I have known. Friends and family of people I have known. My own friends. My own family even, although none were close family.

I won’t call myself a “cancer survivor” just yet. When, or rather if, I get the “all clear” in about five years, then I will refer to myself as a CS. But with cancer, every victory has to be savored. I came to the conclusion that yes, I did have the right to be happy for myself, despite the multitudes who were not victorious. If even one can survive—no, let me start that again. Every individual victory should give hope to others. I am part of the fight against cancer. It is not in any way my responsibility or my doing that determined which role in this fight I played. That is blind luck.

Life will soon start to return to normal. My hair will soon start to look normal. Yet what is “normal”? Normal is the way it was. Do I want that again? For the longest time, my answer was a resounding “Yes!” That was before perspective slapped me hard in the face, and it really hurt. It was just what the oncologist ordered. If I can manage to live my life the way I want to, then I will happily say that getting cancer was the best thing that ever happened to me. If. If I can manage that. Now begins the real test. Not to survive cancer, which I wanted to do. But to survive life, the way I want to.

Life is full of cancer, I have learned. Full of tumors. If you do not cut out these tumors, even at the microscopic level as with platinum, your life will not be a success. “Stay hungry. Stay foolish.” These words were recently rediscovered in a speech given by a rather famous man who built the computer I’m typing on right now, years before his cancerous demise. Yet he did not write them. He didn’t have to. He just had to remind us that these words had been said before. Hunger is youth. I will stay young and foolish for as long as life will allow me. He did say, however, that if you do not love what you do, keep looking. Don’t settle. Do not settle. I did not go through chemotherapy so I could devote my life to my current day job. I will continue to do this job well, of course. That’s not what I’m saying. But I will instead devote my life to my children and my wife, which admittedly I did not do as purely as I should have. That’s what I’m saying.

I find myself increasingly in the business of making people laugh. I have never done anything more fulfilling, more rewarding. I do it not for vanity, but for altruistic love. I am not rich, I cannot give money to help people. But I can instead give my thoughts, my words, to help others enjoy life more.

A few days ago I said I was looking forward to ending this blog with the words “The End”. That will not happen. I will forever be looking over my shoulder for cancer. “You will always have that worry,” several people have told me. I think a better way to describe it is, “You will always have a very good reason to be at your best.” I am lucky. I am lucky to be alive, and I am lucky to have had cancer, and I am lucky to have lost a testicle. It doesn’t hurt as bad when life kicks you where it counts.

The Call

The phone rang this morning, a mere two hours after my CT scan and bloodwork. “Hello?” I answered.
—Hello, this is Dr. X. I have your results.
“And?” I timidly asked.
—The scan shows no residue. At all.
“What does that mean?” I held my breath.
—There are no tumors. You’re absolutely clear.
“Clear?”
—Clear. She was laughing with the joy I was about to experience as well. This is the part of her job that makes it all worth it. For the first time ever, I envied an oncologist’s work.
“No surgery?”
—No surgery.
“Thank you.”

A complete recap is coming in the future, when I’m able to keep a coherent thought in my head for more than three seconds. In the future. Not to be overly dramatic, but that’s something I hadn’t really thought about for a while.

Bizarre

People have repeatedly pointed out to me that I’m a magnet for the bizarre. I also have a somewhat unusual ability to take a step back from myself and look at my life, my personality, my behavior. If I choose to, I see things rather clearly. If I do this, then that will happen, which will result in this, that or the other. It’s like playing chess, where you always have to think several steps in advance. However, I suck at chess. It’s because I have little patience for it. I can be good at it, if I choose to, but I usually don’t, and I find that bizarre. So what people repeatedly point out to me is redundant information. “Did you pluck your eyebrows? They look thinner,” one socially challenged acquaintance recently stated. No kidding? Tell me something constructive. The brows are indeed thinner, but I still have eyes.

Proof of the bizarre in my life can be summed up by the following statements I’ve made over the past few months:
It’s probably just an infection.
It’s probably just benign.
I probably won’t need chemotherapy.
I probably won’t need surgery.
I probably need to learn to shut up, because I’m probably causing these things to happen by speaking of the devil.

As I checked in to the hospital for my final five-day intensive chemo session and went upstairs in H corpse to the ward, I was told to wait for a couple hours, that my bed wasn’t ready yet. An hour later, I was told that around five in the afternoon, a bed might become ready, but that it would be too late for the hospital’s pharmacy to prepare the poisons for that day. “Come back tomorrow, try again,” I was told.

Basically what had happened was that I had inpatient chemotherapy scheduled, but the ward was unexpectedly full of other patients. Of course I asked myself how this could happen. It’s not like people call an ambulance, “Help! I think I have cancer! I need immediate chemotherapy!”

I went back the next day. I was told to wait for a couple hours, that my bed wasn’t ready yet. An hour later, I asked my oncologist, who was in her office, “This is a strange question, but would it be possible to just do this next week instead? Tonight’s my wife’s birthday—it would be a wonderful surprise if I could take her to dinner. Plus I have a lot to do next week, and it would be easier if I felt good. Speaking of good, I feel the best since before any of this even started. I would like to enjoy it a little longer before it gets bad. Would this be possible?”
—A delay of a week won’t have any effect on your overall therapy, she smiled. I don’t see why not. Come back next Thursday then, and have fun tonight!

Strapping on my backpack, I was out of that hospital faster than my cancer had metastasized. Mrs. Mingus was having birthday coffee and cake with her mother and sister at the former’s home, which was but a few minutes’ walk, so I started walking. I would surprise her. When I’d arrived at the hospital, it was sunny. When I left, it was cloudy. I can make it before the rain, I thought to myself. A flash of lightning followed by a loud clap and even louder splashes of rain proved me wrong. That was bizarre.

Arriving at the Mingus-in-Laws’ house, I peered through the living room window before knocking. All three of the ladies inside jumped with shock when, during a particularly brilliant flash, a bald man, soaked in rain and wearing a hood, was seen staring at them from the garden. I waved. They stared back. I took my hood off. They stared back.

“What are you doing here?” Mrs. Mingus asked as she eventually opened the door.
—Surprise! I rescheduled for next week, so I can take you out to dinner tonight.
“That’s a wonderful birthday gift!” This last statement was followed by one of those hugs you remember forever. The kind where you can’t possibly make any closer contact with each other. At least not in front of your mother-in-law.

***

After a wonderful week, I checked in once more for the last inpatient treatment, and was ushered directly into a private room. An hour later, with platinum being pumped into my veins, I started watching the entire series of the original Star Trek, from the Sixties. It was hilarious, yet also thought-provoking. Good enough to make the days pass by unnoticed. Well, lots of sleep also helped. I had strange dreams. Scotty beamed me up, but left all the affected lymph nodes down on the desert planet for the Klingons to play with. Twenty-fourth century cure for cancer.

The nurses were wonderful, even the older lady who wouldn’t stop talking. She talked so much and so often that I would pretend to be asleep when she entered. Actually, a lot of times I wasn’t pretending. “Are you asleep?” she would ask.
—I was.
“Ok, go back to sleep then.”
—What’s wrong?
“Nothing, I just wanted to know if you were sleeping.”
I bit my tongue to restrain myself from saying something about my eyes having been closed. My food was served.
“Wake up! Lunch is here!” she sprightly announced.
—I’ll eat it later. I want to sleep now.
Fifteen minutes later, “Are you finished with your lunch?”
—No, I’ll eat it later. I want to sleep now.
And so on, and so on. It was bizarre. Once, while I was out for one of my three or four daily walks, dinner arrived. When I later asked what time to expect dinner, she replied, “It was already served, but you didn’t say you wanted to keep it for later.”
—That’s because I wasn’t here. What time did it come?
“Four o’clock.”
—It’s four fifteen now.
You gotta’ be quick in this hospital if you want to eat. If you want to eat. The nausea was pretty bad this time. Its cumulative effect was quickly building. When I left the hospital, I think I had eaten on average about two hundred calories per day, and that continued until the end of the week. I could no longer tell if the knot in my stomach was nausea or hunger. A few times at home I ran to the toilet and gagged, but I never threw up. Not once. I’m proud of that. Bizarre thing to be proud of.

I slept a lot upon my return home. At school, my older daughter was asked to draw a picture of her family. She, her sister and mother were all holding hands, standing near a closed door. “Where’s your father?” we found out the teacher had asked.
—He’s behind the door, sleeping.

I acquired a joint. I didn’t like pot, and never had, and now I remembered why. Just a couple puffs and my brain went haywire. Shaking, I knew I had seconds to get to bed before I’d pass out. Luckily I made it, and woke up twelve hours later. I did manage to eat some cereal and a banana when I woke up though. That Friday night, four days after the hospital, I still felt horrible. It was the worst one yet, the nausea from this hospital stay. I forced myself to drink a Guinness. I didn’t like Guinness, and never had, but now I couldn’t remember why. It tasted amazing. This bizarre incident was proof that my taste buds were messed up. Don’t get me wrong—I can clearly recognize that Guinness is a quality beverage. It just wasn’t appealing to me personally.

But that Guinness triggered my recovery, I’m sure of it. I slept well, started eating, stopped taking the nausea meds the next day, and within another week I had full energy. Every day I had the extreme pleasure of bicycling with my older daughter, so she could practice her new skill. I pretended I was Lance Armstrong. The last two Bleomycin treatments came and went. No panic attacks. No hair either. That had stopped growing again.

I started to focus on the surgery, now that chemo was officially over. I’d made it. The way I saw it, “it” was either over, or the hard part was coming. Research showed that the laparoscopic version of this surgery presented far fewer long-term effects and complications, and recovery was a fraction of the time as well. Less scarring. There is no justification for not choosing this form of surgery, if it’s available.

It’s not available in Estonia. Apparently, if a treatment or procedure is not available here, the Health Insurance Fund has to pay for you to go abroad to receive it. I haven’t made up my mind about that. To be honest, and I know this is bizarre, I would feel somewhat guilty for costing the state so much money to send me to Finland, or Sweden, for an expensive surgery.

I’m scheduled for a CT scan in the morning of the fourteenth of October. Tomorrow. This is the first time this blog has been absolutely up to date. For the longest time, I didn’t know what I had to do. I knew the date, but I didn’t know the when, the where. I tried calling my oncologist. No answer. I flipped through the mountain of paperwork I’d collected since June. I had seventeen telephone numbers for reaching doctors. I called them all. No answer. I called each of them several times a day. No answer. Not even voice mail. I didn’t know where I was calling either. Dr. X at home? The office? Which office? Upstairs in the ward? Reception? Nurses’ station? McDonald’s?

Finally, I sent an email to the main oncologist in Tallinn. Two days later she replied, last Saturday. She also answered my questions. For the first time, I kind of knew what to expect. Basically, if I have a tumor remaining that is larger than one centimeter, I will need surgery. If it’s less than a centimeter, or if there’s no tumor at all, then surgery is not necessary. “But we won’t be able to say that you are cured,” she cautioned, “without studying the lymph nodes in question. But the chance of relapse is six to nine percent.”

What I read was somewhat different. If there’s a mass, there is a forty-five percent chance it is necrotic tissue—harmless. There is a forty-five percent chance that it is a benign tumor. And finally a ten percent chance that it is uncured cancer. If it’s a tumor, it will possibly mutate into a chemo-resistant form of cancer at some point. I couldn’t find any statistics for how likely that was, or how long it would take. So I’ll assume a hundred percent, just to be safe.

So by that logic, if there’s a mass revealed in tomorrow’s scan, there is roughly a fifty/fifty chance of cancer again in the future. Fifty, versus six to nine. I am confused once again. I want to believe my oncologist in Tallinn. If the scan shows less than a centimeter tomorrow, I will choose surveillance. Theoretically, tumor markers in a blood test would reveal any recurrence, and I would immediately undergo the same surgery anyhow. Best of all would be no tumors revealed. The largest in the first place was two and a half centimeters. We’ll see how that little guy behaved through all this. Did he listen to the chemo and get the hell out of my body? Or is he like the Red Army and just doesn’t know when he’s not welcome?

This frightens the hell out of me, I won’t deny it. Tomorrow night, I’m going out. To celebrate or to dull my fear, that will become apparent tomorrow afternoon when I get the call from my Tartu oncologist with the results of the scan and bloodwork. I won’t say this time that I probably won’t need surgery. I’ve learned to shut up. I want my life to be normal again. I’m tired of the bizarre. But I’ll talk about the term “normal” in the next post. As for now, I’m anxiously awaiting the day when I can end a post on this blog with the words “The End”. This time doesn’t count though, which is why I wrote this last sentence.

Circles

For the remainder of session two of my intensive chemo, I basically took it easy. It didn’t feel good. Of course it didn’t feel good. But I didn’t feel like rot, either, as I was led to expect. I’d also been reassured by numerous doctors and nurses that I was handling the treatment extremely well. I also knew the effects were cumulative, and that I would not feel as strong after this session as I had after the first.

On the day I got out, I was not prepared for the news I was given, either. My oncologist presented me with the checkout papers, and informed me of the bloodwork I’d had done the previous Thursday. This was Monday. Honestly, I was a bit surprised the news hadn’t been given earlier.

“Your bloodwork is clear,” she stated with a smile.
—Clear? What do you mean? I hesitantly asked.
“Your tumor markers are all normal.”
—What does this mean?
“It means the treatment is working,” she reassured me.
—But these results are only from the first treatment?” I pressed.
“Yes. We’ll still do the remainder of the treatments, just to be safe.”
—Wait, so this means…this means I’m cancer-free?
“Yes,” she confirmed. “Cancer-free.”
—And no surgery?
“I don’t see any reason why.”
—It’s that simple?
“Yes.”

She grinned again, nodding. I thanked her, took the papers and my bag, and left the chemo ward of Tartu’s hospital, H corpse. I didn’t know what to feel. It was over. Was it over? Can’t be that simple! No way…

I called Mrs. Mingus, who was already waiting in the parking lot. It simply was not possible for me to wait another half minute to tell her. “Yeah, the doc said I’m cancer-free. Can you believe it?” A few seconds later, we were hugging. All the emotion of that moment brushed aside any chemo nausea. Her embrace was confirmation that all the doctor had told me was true. I was going to be fine. I already was fine.

When I got home, I posted the news on Facebook. Over a hundred “likes”. I called my parents. Tears, joy. Then I crashed and took a nap. The nausea, as expected, couldn’t be kept at bay forever. I was going to be fine, but first I had to deal with what had already been done to me. Done to me to save my life.

The next night I tried to eat dinner out with friends. Marginal success. And again the next night, where I was a guest at a dinner that frankly had made me nervous, due to how I’d been warned it would be spicy. They tamed it down for me, it was delicious, and the chemo flavor had already been greatly reduced in my palate.

The chemo flavor. Most describe it as metallic. That wouldn’t be entirely inaccurate according to my experience. But I would instead tend to describe it as sort of a concrete powder smell and taste. Like when you buy a bag of concrete, to mix with sand and water. Cement. It’s kind of like that. Not that bad really, but when that’s all you can sense for days at a time, any additional smell, like paint, becomes instantly associated with nausea. Mrs. Mingus had painted the kitchen while I was away for this session—Surprise! she showed me when I arrived home. I smiled and tried not to vomit from the smell. I told her about it only a week later.

There’s also a sensation of “mint” in my stomach during the nausea. Not the flavor, but the feeling. It’s very strong, cannot be ignored. And it is simply not possible for me to describe it in any more detail. Except that I don’t like it.

Then that Thursday, as scheduled, I continued with an outpatient session of Bleomycin. I felt strong entering, they hooked me up, and within half a minute I was experiencing my first psychologically “abnormal” moment in my life. It began with sweating. Heat. I quickly (and probably correctly) surmised it was a panic attack. It took all my patience and self-control to not rip the cord out of my arm and run. In my panic, I also realized I would not be able to communicate my problem to the staff. I instead opened my laptop and focused on watching a video. This was very difficult for me, very strange.

Within twenty-four minutes, the session was done. Mrs. Mingus was not expecting to get my call for another hour at least. I called her while exiting the building. “Please come fast,” I urged. At that moment, I assumed she’d not believe me that I felt I was in serious trouble, so I didn’t say anything. I nervously paced up and down the sidewalk for just under half an hour, and finally she arrived, completely unawares. I tried in the car to describe the panic attack. She believed me of course, and took me straight home. I ate ice cream and took a nap.

Of course, I’d forgotten to take anti-nausea medication. Maybe I needed it still, maybe not. But that night, I had a mild fever—nothing in the official “chemo danger zone”—and more or less felt the full effects of how I understood chemo nausea to be. It was horrible. Flu, hangover, no concentration, no rationalism, gagging over the toilet bowl. I knew that if I tried to swallow a pill, I’d merely lose it immediately, so it would be safer to wait till I’d recovered a bit. Make sure the pill was used. But in the end, I never actually vomited.

Around midnight, the nausea started to break. Well, now I know how it feels. I’d done research on different people’s reactions to chemo. Of course there are horror stories of people who would choose to suffer from cancer rather than suffer from chemo. These stories didn’t seem so far-fetched any longer.

In terms of other side effects, I had a few. My hair spontaneously started growing back. Blond. Am I going to be blond? Well, maybe for a while. But it wasn’t very full, and my beard was also growing. Long white hairs would appear on my jaws and chin and neck every day. Like they’d been waiting to come out, half a centimeter long. I continued to shave my head.

Then my hands and toes got sore. I noticed a few bumps here and there. Web forums revealed it was not that common, but very temporary, and definitely not unheard-of. The bumps were of a darker skin pigment, mostly just very sore blisters that fortunately didn’t pop. This lasted about a week. Handling, holding anything was somewhat of an effort.

A week later for my last dose of Bleomycin for session two of my treatment, I was better prepared for a panic attack. It did happen, but I was calmer. The computer helped distract me. The effects left almost immediately, and having Mrs. Mingus come much sooner this time also aided. I mentioned it to my family doctor during a routine check-up the next day. He wasn’t surprised, and offered me a sedative for the next time. I said I would just play it by ear, and probably just ask the staff themselves if the need arose.

Then finally the day came for me to check in once more for a five-day intensive session of chemotherapy. My last one. This last time was just a formality. I could handle it. Over the previous two days I hadn’t felt better since before this whole cancer ordeal began. No soreness after my surgery. Full energy after recovering from the previous chemo sessions. Great mood. I was happy.

I bravely marched into the ward, met with my oncologist, and asked her to repeat the wonderful news once more that I was cancer-free. The news she had been so specific in confirming to me just two weeks earlier.
“Well, we can’t know until you have further analyses,” she cautioned, in a complete reversal of our last conversation.
—What do you mean? You said I was “cancer-free”. I could feel a lump forming in my throat. A lump is never what a cancer patient wants to feel.
“Yes, you definitely have nothing growing. But there could still be some non-malignant tumors in the connective tissues of your lymph nodes. If that’s true, you will still need the surgery.” I was stunned. Again.

Paint?

When I was a kid I had braces on my teeth. For a while I had this contraption in the roof of my mouth that was supposed to widen it. Twice a day I had to stick a small key in the middle of the device and push it back, effectively expanding the metal and plastic. I could feel separation anxiety in my nose and jaw. It wasn’t so much painful as it was annoying. Like having a piece of popcorn stuck between two close teeth. You felt abnormal enough to where you couldn’t concentrate on anything for a while.

This immune system booster I had to have injected in my stomach multiple times caused a similar effect, but in my pelvic bones, spine and thigh bones. If you moved, you winced. Being in bed proved difficult. The only thing that helped was standing up and being still. Then I thought, “Hey, here’s an idea. Why don’t I look this up on the web and see if there are any kinds of painkillers I can take?” That was a good idea. One I would normally have thought of immediately, except for the constant flashes of distraction barraging my thoughts. Paracetamol. A couple tablets of that and I felt good as new in about fifteen minutes.

I went for my last Bleomycin treatment. First the normal blood tests. The oncologist (my regular Tartu oncologist) said that my immune system was restored. Finally! I can get treated! “No,” she said. “Not today.”
—Wh, why not?
“It’s not that important. Let’s get you back on schedule. Come back tomorrow for your second five-day session.”

So I raced home on my bicycle—a chemo patient biking to the hospital for treatment—and tried to organize all my affairs so I could disappear for nearly a week. The next day, I checked in. At the registration desk, I was given a bracelet with my name on it. I walked the half kilometer through the wings of the hospital in Tartu to the “H korpus”. “Korpus” means “wing” or “building” in a complex. People asked me later where my room was. “It’s in the H corpse,” I would jokingly reply.

Upstairs—and this is a nice hospital, I would like to add—I approached the doors to the chemotherapy ward. There’s a handle on the door, so naturally I tried to turn the handle. Locked. I tried again. It had failed to magically unlock in the previous five seconds. Suddenly I heard this high-pitched yelling coming from the other side, up the hall. A late middle-aged Russian woman was quickly approaching from a distance, waving her arms frantically, yelling at me to not touch the door.
“Don’t touch the door!” she frantically yelled. I jumped back in fear. I’d triggered the auto-destruct for the hospital apparently. I considered jumping through the fifth-floor window. “Don’t touch the door,” she repeated in a thick accent, drawing closer.
—Well, how do I get in, then?
“Wave!” she rudely replied from behind the glass. I did not care for her attitude. I’d done nothing wrong. So I held up my hand in front of her face. And waved.
—Hi, I said. Can I come in?
“No. You have to wave.”
—I am waving. Don’t you see?
“Put your feet in a box and wave,” she stubbornly insisted.
—Alright, I have no idea what you’re talking about, I said as courteously as possible. She pointed behind me, against the wall. Box. Yes, there was a box on the floor with something blue in it. I cautiously approached, bending over to examine it like a caveman in some movie. “Ooh, gla gla,” which of course means, “Wow, fire.”

I stuck my foot in it as she watched on, nodding in encouragement. A loud snap! and my shoe was covered in blue plastic. Oh, I get it now. I repeated this for the other shoe and looked at her.
“Wave!” but this time she pointed at a black sensor on the wall. I moved my hand back and forth in front of it. Nothing happened. She then turned the same handle I’d tried and opened the door. “You can’t just come in here!” she continued. “There are people in here with no immune systems!” she bellowed. I couldn’t believe how I was being treated.
—Look, there is not a single sign on the wall or anywhere that says what I should do. Please be more polite to people. You can’t just talk to people like that.
“People are sick here!”
—I’m sick! I lost my temper. I have no immune system! That’s why I’m here!

I quickly recovered myself, told her bye-bye and walked to the nurses’ station. Two very friendly nurses smiled at me. The first thing I said was, “What’s her problem?” and I laughed.
—Russian temperament, they both replied in unison. Don’t worry about it.

After giving them my paperwork, one of them walked me to my room. It was a double room, but I had it all to myself. Instead of the high-rise sea-view I’d had in Tallinn, I had an equally beautiful view of a forested park outside the window. I like trees. I find them more interesting to gaze at than Soviet panel buildings.

I asked the nurse a few questions, like how much time I had before the chemo would start that day, could I take walks at my leisure, and if so, could I leave the chemo ward? After she answered all my inquiries, I realized I’d understood absolutely everything she’d said, and she me. Language was not an issue. This was the right hospital for me. We’re going to get along just fine.

The chemo started a couple hours later and the day passed by without event. In the early evening, after the session was over, I exited the ward, as I was allowed to, and spent about twenty or thirty minutes slowing walking in circles around the hospital complex. So many new corpses everywhere, a shiny new hospital. I was served dinner. The food was still hospital food, but it didn’t repulse me like the Tallinn stuff.

Why? I wondered. Was it because the main course consisted of something other than a piece of bread and bologna? The bologna served in the Tallinn hospital was ironically called “doctor sausage”. That’s what happens to bad doctors. Next time I’m in the deli I’m going to look for “registration office worker sausage”.

But seriously, I think the main problem with the Tallinn food—apart from the food itself—was how it was served. In those big, blue foam boxes. Those boxes had a strong chemical smell, I could remember in hindsight. A wet chemical smell. And coupled with chemo nausea, it just seemed like an incredibly irresponsible idea. In Tartu, food was served on plates, plates served on cafeteria trays. It didn’t stink like Sillamäe. The more I thought about it, I became convinced that if Tallinn served more variety in their food, and on trays instead of foam, their chemo patients wouldn’t lose so much weight.

The next day, I went for more walks before and after chemo. I was very careful to be sanitary with my shoes when I re-entered the ward (instructions on printed out paper had suddenly appeared around the door sensor and shoe-cover box, yet I didn’t see the angry Russian woman again). I’m not sure how much of a difference those little shoe covers would make though. They weren’t required in the rest of the hospital, and the chemo staff weren’t required to wear them in the ward, and they regularly walked in and out of the ward, contaminating their shoes with the germs of everybody else. I can understand needing these things if you're wearing slushy boots in winter, but in summer, what are you going to bring in from outside? Sunshine? But I would respect their wishes. “Kord on kord,” I’ve been told many times over the years. “The rules are the rules.”

During an afternoon nap, I awoke to a strange sound. A sort of scraping sound, then a loud clearing-of-voice sound. A metallic clanking. Paint smell. I looked around. Above my bed was an older woman on a ladder painting and spackling the wall. I looked at her. She looked at me. “What?” she seemed to say rudely with her eyes. “What’s your problem?” She went back to her work. I noticed she wasn’t wearing shoe covers, and her shoes were filthy. There was a mild, dusty haze in the air. Now would be a good time to go outside for a walk, get some fresh, hygienic air.

On the way out of my room I found two men doing something with the pipes in the toilet. “Jõudu!” I cheerily said as I exited.
—Hey, could you hold this for a second? one of them asked.

No, I’m just kidding. They didn’t reply to me at all, just nodded. But I would have helped had they asked. I felt fairly good. Day two of session two complete. Strange things, as always, continue to happen to me. That’s just how it is, I guess. The only thing I can do is laugh at it. Because everything is funny with the right attitude.

Goon Tomorrow

It’s simply amazing, I’ve noticed, how something as meaningless as hair can have such a profound effect on a person. If you lose it over the years in the inescapable process of aging, it’s a constant reminder of mortality. If you choose to look at it that way. But if you lose it in the course of one day, or one treatment of chemotherapy, it’s quite a different matter entirely.

I had long, curly brown hair, flowing locks of it covering my neck and scalp. When it was gone, my scalp was grayish, bluish almost. It looked like I had just shaved, because I had. But its loss was expected, and I have to say that having my child help cut it off was probably the most therapeutic thing possible in that situation. A friend suggested this, and I thank her profusely. I did not mourn the loss of my hair.

Instead, I boldly, baldly walked through the streets of Tartu, careful to stay in the shade. I felt like Anne Rice’s vampire Louis awakening to a new life—a completely fresh perspective. I saw hairless people everywhere. Most of them young. I imagined they were giving me secret expressions of community, brotherhood. Could there really be that many cancer patients here?

A man in green army fatigues walking a pug on a leash gave me an almost imperceptible nod. Welcome to the club, brother, he seemed to say as he noticed the discoloration on my scalp. I had tried unsuccessfully for nearly fourteen years to fit in with the population of Tartu, and here all I had to do was get cancer and shave my head! Ha!

***

The anti-nausea medication I’d taken during my first course of chemo was called Kytril. According to the Internet, it had several side effects, one of the rarer ones being irregular heartbeat. So that at least answered that question: I had apparently suffered from a side effect on my second night in the hospital, not the toxicity of the poisons meant to save my life or even my childish distaste of the hospital’s food.

But there were other side effects as well that quickly became apparent, as I read more. Abdominal pain, constipation, drowsiness, heartburn, trouble sleeping, taste perversion. Taste perversion? I explain it as looking at a photograph of a familiar object, then reversing all the colors. That is what has happened with my ability to enjoy flavors. “Get over it,” Mrs. Mingus lovingly chides me. “You’re just pregnant!”

And those side effects did not last for long at all after I stopped taking Kytril. But the way this drug works is that it blocks the effects of serotonin in the body. Serotonin, of course, is the “happy” chemical for the body. “Low levels of serotonin in devout religious people may be associated with intense … religious experiences,” one medical site revealed.

What about low levels of serotonin in devout atheists? Could that explain my antitheist rant from days earlier? Probably. I do not regret anything I said, but I will fully admit that I normally would not feel that passionately about something I do not believe in.

***

Due to my low leucocyte count, I spent a week, well, doing nothing. Recuperating. I slept well, I tried to exercise, I ate healthily, I tried my best to stay positive, and I did a lot of thinking. Another thing I do not believe in is boredom. There is not a moment of my life where I can recollect not having anything to do. My mind wanders. Usually I can focus on a given topic, and if a question needs an answer, I either find it, or I let it “sit on the back burner”, as I like to say, until the answer presents itself. And if it does not, I am fully happy with not knowing, because that gives me something to think about.

These thoughts I have come and go on a regular basis, often leaving no record of having entered my mind at all. It’s not an unusual question for Mrs. Mingus to ask me, “What are you thinking about?” To which I reply, “You don’t want to know.” That means it’s something boring. Is time travel possible? What if I could live my life all over again, but with my current memory intact? Avoid the wrong choices in life.

I would probably make new wrong choices. I would invest money wisely. That would result in a very different path in life. One on which, because I’d be rich, in not having met my wife at all. Why would history’s shrewdest investor come to Tartu to study Estonian before entering the diplomatic corps? Why would the man who single-handedly foiled Bill Clinton’s blowjob want to write a blog about losing a testicle?

And so one day, without realizing why, I found myself searching the Internet for “cancer comedy”. A comic named Tom Greene appeared. He had also lost a ball. At the time, he worked for MTV, and did a special cancer program. I watched segments of it on YouTube. Without warning, it showed graphic footage of the surgery I would have to have after chemo. The man’s entire abdomen was being sliced open. Stomach muscles painfully separated with a scalpel. The whole of his small intestines were removed from his body to grant access to the affected lymph nodes for removal.

I could neither look nor stop myself from looking. Ten seconds was all I needed. Eyes glued to the computer screen, I blindly reached my hand around the back of the machine and turned the power off. I bolted to the toilet, almost knocking over Mrs. Mingus, who was vacuuming the hall.

“What’s wrong?” she asked in a panic. “Do you feel sick?”
—Yes.
I dry-heaved.
“Your stomach?”
I shook my head. I held up my hand to wave her back, to give me space. I needed space. Air. Intestines. Space and air for my intestines.
—I saw it.
“Saw what?” she asked.
—The surgery.
She understood immediately. “What the fuck is your problem?! Why would you do that?!” she yelled. I could not blame her for being angry.
—I didn’t know, I explained. They showed it without any warning.
“Why would you do that? Why would you watch that? Are you stupid?” she persisted.
—Stop! Please! You don’t have the right to be angry with me about this. I’m sorry. Just believe me when I say that.
Those words were pressed from behind clenched teeth. A few moments later I’d recovered from the initial shock. Now I was just numb.

I went outside. I paced back and forth in the back yard. I came back in. I tried to lie down on the bed. The images slowly disappeared. An hour later, it was time for me to go to the hospital again and have an outpatient chemo session. I walked all the way, to clear my head. Tartu’s great in that sense—the hospital is only fifteen minutes away on foot.

Once again I had trouble explaining to the registration primates at the hospital that I just needed a quick blood test, and then maybe something else. Eventually I was allowed to enter the chemo ward and have my blood drawn. “It’ll take about an hour for the results to come in,” I was told, so I just went and waited outside Dr. XY’s door. With hundreds of other people.

Because all the oncologists were on vacation.

An hour and a half later, a man sitting next to me went to the doctor’s closed door and just opened it. “I had an appointment two hours ago,” he practically roared. The nurse flatly told him to wait in line. I could see where this was going. When the next patient came out, I ran into the room.

“I’m sorry, I just need to know the results of my bloodwork. Here’s my name. It’ll just take a second, and then it’s one less person for you to have to deal with today.” I smiled.
Dr. XY understood and looked at my paperwork, sitting at the bottom of a stack on his desk. Cutting in line was the right thing for me to do.
—Actually, you cannot get medicine today. Last week your leucocytes were one point oh, but today they’re oh point fifty-six.
“What? But how is that possible? What does it mean?”
—It means you have to be careful. Wash your hands. And give yourself a shot three days in a row.
“A shot?”
—Yes, like an immune system colonizer. A booster for your bone marrow.
“I can’t give myself a shot. I can’t even watch a nurse draw blood from my arm.”
The doctor exhibited no derision at my meager courage.
—Then go upstairs to the oncology ward, and they’ll give it to you. But you have to come here every day for three days.
“And then what? Can I get treated? I mean, I have cancer. I need to get treated to get well!” I was losing my cool. I was beginning to get aggressive, and I couldn’t stop it.
—We’ll know next Wednesday. Come back then. I’m confident it will work.

I went upstairs, got the shot in my stomach, and walked home. I stayed in the shade. I ignored the bald men with pugs. There was no community for me. I was alone. I was sick. I was not even healthy enough to get treatment. I was having a low point, which was to be fully expected.

When I walked through my door, alone at home, I called no one. I took my shoes off and collapsed on the bed, and began to weep. I sobbed, I cried, I wept. Never in my life have I cried so hard. I was shaking. I had to wash the pillowcase afterwards. Intestines. They had been put inside something like the pillowcase, to keep them wet like my eyes.

I thought of nothing as I sobbed. My mind was empty. I was bored. “Think!” I tried to tell myself. “Think of anything!”

This probably lasted for the better part of an hour. When I started to regain my composure, I realized I’d been repeating, over and over, “I did not ask for this. I did not ask for this.” I did not know how many times I had said these words.

Of course I hadn’t asked for this. Of course not. And I lifted myself on one elbow and stared at the green curtains. This was the moment. Green. Green with envy of the healthy? Green with nausea?

No. This was my decision. This was my moment. I found new life in myself. I got up. I went to the computer and played this song. I called my wife to tell her I would be alright, and that I loved her. That I was happy. Happy with things exactly the way they had turned out.

Hair Today

After a week of steadily being on the mend, it was time for another outpatient appointment. The full cast of Planet of the Apes was at work that afternoon in the registration office, using intermittent mis-asjas and ahh-soos and oo-hoos and continuously inhaled jahs. They finally decided that yes, the name on my identification card did in some way resemble the name printed on my cordial invitation to receive chemotherapy. I was granted passage.

A full minute later I was already out of the outpatient chemo room. They had already taken the blood sample. I would have to wait an hour, but meanwhile, since Dr. X from last week was now on vacation, it was time to visit Dr. Y. So I went.

“You have cancer,” Dr. Y informed me.
—Yes, I’ve become more aware of that lately, I tried to bite my tongue.
“So you know what kind you have? And the treatment?”
I explained that I already had an oncologist, one whom I trusted, in Tallinn, and that I’d already completed a five-day session of chemo.
“Then why are you here?” she almost seemed on the verge of annoyance.
—I live in Tartu. My Tallinn oncologist said I could do the outpatient sessions here.
“You don’t need them. It’s just bleomycin. You can skip them entirely,” she repeated the words of Dr. X the previous week.
—I’m very sorry, but I disagree. She has an excellent reputation, my Tallinn doctor. She makes the decisions, I just get the treatment here.
“Yes, you can get treated here, but here you are my patient, and I make decisions,” Dr. Y stated. “You also don’t need the surgery.”
—Umm, this is very odd, I have to be honest. Please look at it from my point of view. I’m getting conflicting advice from three different doctors. Is this not unusual in your opinion?
“Your bloodwork is not ready yet. Come back in a few minutes.”

So I went back to the corridor and waited. Five minutes later, another door opened and I was called in. A tough-as-nails older woman—very polite nonetheless—introduced herself as Dr. Z.
“You have cancer,” Dr. Z informed me.
—Yes, several people have told me that, so it must be true. I was having trouble biting my tongue. What happened, I continued, to Dr. Y?
“She’s on vacation.”
—But I just saw her five minutes ago.
“Yes, and now she’s on vacation. You cannot have treatment today, your leucocytes are too low.”
—What? What does that mean?
“Go home, just rest for another week. This is common,” she tried to reassure me.
—Is there anything I can do? Anything I can eat to speed this up? I want to get better, I want to do anything I can possibly do to adhere to my original schedule.

I was beginning to see my Holland and Belgium trip fading…

“No, there is nothing you can do but rest. Your leucocytes are at one point oh. They should be at least one point five.”
—Do I need to take any special precautions?
“No.”
—Can I ask your advice? You are the fourth oncologist I’ve talked to now. What do you think about my surgery? And the bleomycin in general?
“You don’t need it. Any of it. Just cisplatin and etoposide,” she emphasized.
—But how can you be so sure? Why did an entire “consilium” unanimously agree on this course of treatment, including surgery?
“I don’t know what they’re thinking. I can call your oncologist if you want.”
—She’s on vacation.
“I know. Just a moment.” And she called. No answer. “She’s not answering.” And she frowned in disappointment.
—I wouldn’t answer either if I were on vacation.
“Hmph.”
—Alright, so I come back next week and speak to you then? What time?
“Come at the same time, but talk to Dr. XY. I will be on vacation.”
—Seriously? Another oncologist? Is it really a good idea for everyone to be gone at the same time?
“He can handle it. He’s very experienced,” Dr. Z affirmed.

I looked up Dr. XY. Started practicing last year.

***

That night was my eleventh anniversary with Mrs. Mingus. As mentioned on my restaurant review blog, we ate at Kapriis. We later moved to a new vinothèque on Rüütli Street in Tartu called Vein ja Vine. Vein means wine, not the blood vessel. Vine means buzz, not wine or the plant. It was pretty cool. There were no tables or chairs, but a waiter named Kristjan was watching for potential customers and quickly and politely sat us around a stool he brought to temporarily house our carafe of red wine that was automatically served to us.

My Tallinn oncologist said I could have a vodka cocktail on our anniversary. Avoid beer and wine. Dr. Z, whom I’d spoken to that day, said beer and wine was fine, but just try to keep it down to just a few, like three or four. I had a couple beers at dinner. All they had was Saku (so my first alcohol in a month tasted like lake water…hey, I’m used to good Tartu beer!).

After about fourteen people joined our table—all friends and family celebrating our anniversary with us, as is our custom—I had another two glasses of wine. Even after a big dinner, I felt rather drunk. I knew it was a bad idea for me to drink, but I did it anyhow. The way I understood it, drinking during chemo is just bad for the immune system and liver, if taken to excesses and frequently. This one time, this one last time, wouldn’t hurt.

I felt a bug in my hair. I had long, curly brown hair. When I reached for it and pulled it out, several hairs came as well. It had begun. Not in huge clumps like you see on television, but more than the expected one or two. I pulled from another part of my head. Same thing. I pulled again, I couldn’t stop. I wasn’t panicking, but I felt a bit depressed. Mrs. Mingus and some of the guests figured out what was happening. She leaned over to me, “Not here, not now. Do you want to go?” I told her no, I just wouldn’t touch it again. But I would like to go relatively soon anyhow, as I was pretty drunk. From four drinks.

By instinct, I went into funny mode. I started telling ball jokes. The table roared with laughter. “Good thing I’m not a general, because half my army was dishonorably discharged!” or “My favorite food is the deviled egg.” or Mrs. Mingus’s personal favorite, “Finally, my wife likes tea-bagging!”

The next day, it was quite clear my hair was falling out. From my chest, from my groin (Brasil Brasil!!!), a bit from my arms and legs, and of course my head and beard. I told Little Mingus I wanted her help in cutting my hair. She got serious, somehow understood the gravity of the situation, and nodded her head. She cut it all off, down to the last centimeter. Littlest Mingus stood by and watched. “Daddy, why are you cutting your hair off?”
—Because I don’t want it anymore.

When it was all done, I went over it with hair clippers and left it all at about a millimetre.

Mingus Two-Point-Oh.