How exactly does one prepare for major surgery? What is major surgery? I think liver surgery counts. I think it can at least be counted as a big deal. It’s a big deal to me. It’s tomorrow. I’m nervous.
On December 18th, I saw the liver surgeon, Dr. Tzeng.
“I have not been able to lose any weight, but I have been working out a lot.”
“That’s good. I need you to work out some more. Your CEA is down to 56. That’s really good. A normal CEA is between 5 and 30. You started at 581, so you are doing really well. Those are markers for tumor activity. Yours look really good at 56. The tumors are all but dead. The CT Scan confirms this. The tissues look dead just like the lymph node over by your colon. So we are doing really well.”
Dr. Tzeng brought up the CT Scan images on the computer in the exam room. I had seen three previous CT Scans. None were as clear as these.
“You see the edges here are really well defined. I want to just take these masses and what we call satellite nodules on the surface here. If we can confine it to resecting just these parts here, then it will only be about 10% of your liver. Then we’re going to take your gall bladder. But if we…”
“Wait. What? The gall bladder? This is the first time I’ve heard of taking the gall bladder.”
“Well it’s kind of standard. The gall bladder is right next to the liver. You don’t necessarily need it, and the risk is uh…”
“That since it’s so close, that it might have spread to the gall bladder?”
“Well we don’t see anything in the gall bladder, but it is connected and in the area. It’s just a standard thing that we do when resecting this part of the liver.”
“But these satellite nodules on the surface. They kind of worry me.”
“Why is that?”
“Well I can see them. They’re just on the surface, but we don’t know if there are additional nodules underneath the surface that aren’t showing up on the scan because of the interference from the main tumor.”
I nodded, but I still wasn’t getting it. He continued, “There could be additional nodules on the other side of the liver deeper inside the liver.”
“Oh,” now it was making sense.
“If there is evidence when I’m inside that there are additional nodules and I can’t be sure I’m getting all of the cancer, then I will just decide to take the whole left lobe of your liver. That’s about 30% of your liver. You can live with as little as 30% of your liver and the liver regenerates.”
“Okay. Yes I’d heard that.”
“So I won’t know until I get inside.”
“I get it. It’s like looking through a dirty glass in these images, but you’ll know when you get inside.”
“Well I can get a pretty good idea, but I really won’t know.”
“The map is not the territory.”
Dr. Tzeng looked at me intently, “Now I need you to prepare for this like you are a champion athlete. Like you have been training your whole life for this event.”
“I have been working out a lot. I haven’t lost any weight, because I keep eating enough to keep up with my caloric burn.”
“You need to work out more.”
“I’m already doing two hours a day.”
“What? Double that?”
“If you can do two, you can do four. Every minute you put in now will pay off on the other side.”
I don’t know what it is about the way that Dr. Tzeng talks to me. I get the objective. Be in really great shape to recover well. Eat well to get the inflammation out of your body. Get the fat out of the liver. It will be easier to work on. Low inflammation, no fat in the liver, dead tumors equals clean surgery. But the way that he says it is perfect for me. I wanted to start doing push-ups or jog out the door.
“I can do that.”
“Let me see your abdomen again. I want to see the incisions from the hemicolectomy.”
I lifted my shirt.
“Ah. They did a laparoscopic procedure. I’m probably going to cut about six inches right here.”
He traced a finger vertically just below my ribs on the right side of my abdomen.
“I get it. You have to be able to see what you are doing.”
“And when we resect the liver, the biggest risk of infection is bile escaping into the abdominal cavity. So we hook up a machine and blow air into the liver. Bubbles come out where the bile could escape. Then we can see where to put the sutures.”
The reality of this procedure was coming together. This was going to be a big deal. Dr. Tzeng had confidence, and he had my confidence.
“Do you understand?”
“I think I do.”
“Work out more.”
“I will,” and I did.
Years ago, I worked at a company called Production Access. It was my first full time programming job. I was laid off in 2003, but I went back to work for them in 2006. I had a lot more experience. I had a high degree of confidence in a great many things that our software did. I knew what I was doing.
Still, I had my moments of anxiety. We were working on a project for a company in Alabama called Black Warrior Methane. We had to travel to the field office. There was a great deal of preparation just to tell the company what we were going to do. It was up to me to present our proposal to the company leadership.
I worked with a few people on that trip into the evening; Scott, Parag, Mario. I was terrible at being a person. I used a lot of vulgarity all the time (I still do, but I have filters depending on the company). I couldn’t help myself. I still felt like an impostor. I felt young and unqualified – even at the age of 36.
After we were done with the prep, Mario asked if I felt like I had all of the information for the presentation. I said, “I think so.”
Mario said, “You think so? I don’t like the sound of that at all.”
Mario had a big voice. I loved listening to him. He had that Louisiana accent that almost sounded like Brooklyn.
“I think so.”
“What else do you need?”
“I don’t think I need anything else. I’m just a little nervous.”
Parag said, “Nervous?”
Mario said, “Yeah that doesn’t sound like the Larry I know. Nervous? Come on.”
“Really? What do you mean?”
Parag said, “Yeah. Come on. You’re Larry Fucking Lines. You tell them what we’re going to do.”
The room erupted in laughter, including me.
“What? Do I come off like that?”
“Yes you come off like that,” Mario said. “You make me nervous when you say stuff like this. You always say it like you know exactly what we’re going to do.”
I laughed again, “I didn’t know I sounded like that.”
Parag said it again, “Yeah you sound like, I’m Larry Fucking Lines. Get in line people. We got work to do.”
I have referenced this conversation often since then. I told Justine, my now ex-wife. She said, “Goddamn right. It’s maddening. She did a comical imitation of me, I’m Larry Fucking Lines. Let me tell you how it’s going to be. Yeah that’s a good way of describing it. You have no idea how awful that can be. You also say things in a way that just make people jump up, like yeah Larry Fucking Lines said we’re going to take that hill.”
Justine and I had a running joke that came from a reality show on the Discover channel or something like that. It was Marine SEAL training. Justine used to love it. I only watched a few episodes. One of those episodes had all of the SEAL candidates swimming in frigid water in pairs as the drill instructors yelled at them to keep going. Everyone looked terrible. There was one guy that looked like he was going to pass out. He was turning blue. The guy with him looked fine. Nothing wrong with him. The instructors pulled both men out of the water. They wrapped them in blankets and took their temperatures.
Then the instructors started asking both of them questions, “How do you feel marine?”
The guy that was turning blue could barely get it out, “I feel bad.”
The other guy said, “I’m fine.”
“Fine? Do you want to get back in the water?”
“Yes sir,” he stood up.
“No sit down. Sit down.”
The instructor turned back to the blue guy, “What’s six times six?”
“Six… times… “
“Six time six marine.”
“All right. Don’t hurt yourself.”
The instructor turned to the other guy and said, “Six times six marine.”
He perked right up and said really loud, “Six time six is thirty-six sir!”
Justine and I laughed and laughed.
The drill instructor turned to the camera and said very quietly, “He’s got hypothermia.”
The cameraman pointed at the blue guy, “He’s got hypothermia?”
The instructor shook his head and said, “No he’s fine.” He pointed at the other guy that was completely coherent. “He’s got hypothermia.”
Justine and I laughed at that for years. After the Larry Fucking Lines episode, it became her way of telling me I was being imperious.
“So we are going to tear down this wall on this side and put a door over here.”
“Six times six is thirty-six sir!”
Larry Fucking Lines.
I keep thinking of airplane pilots. I have been afraid of flying at times. I’m not sure if it’s fear really as much as a trigger for anxiety. I haven’t let anxiety rule my life. I just get on the plane when it’s time to go.
I tell myself that the flight has nothing to do with me. The pilot is flying the plane. I am not qualified to help in any way. He/she is going to fly the plane, and it’s going to go where it goes. I have nothing to do with that operation. Crash, successful arrival. I am just along for the ride.
The surgeon is in charge. This operation requires nothing of me now that I are here. In fact, I will be asleep. All of my anxiety is for before and after.
I took Dr. Tzeng’s directions quite literally. Since December 18th, I have worked out for four hours a day. I am trusting him to do his part. I am in complete control of what he asked me to do.
A typical day was two hours or walking (six miles), one hour of tennis, and one hour of martial arts, calisthenics, and stairs. I do a workout on my arms with steel rings that I have from my kung fu days in Albuquerque. I haven’t done the full ring workout in ten years. I have done that workout every day since the 18th. On some days, I can hardly walk. The foot that I dislocated six years ago hurts a lot. My lower legs and knees start out stiff every morning. I may not be losing weight, but I changed shape. I’m looking forward to the surgery, so I can get some rest and recover from these workouts.
I switched to a vegan diet about nine days ago. The inflammation just poured out of my body. I feel like I have been deflated. My fingers look like I have been in the bathtub for too long.
This morning I felt a little maudlin. I wanted something familiar to listen to, but I ended up picking another song from another difficult part of my life. A song from a band called Little Hands of Asphalt. The song is Oslo. I wrote about it in 2008 when Justine was in the hospital with Lucy in her stomach for seventeen days.
There is so much that has changed since I wrote all of those entries eleven years ago. Divorce. Illness. Moved to Oklahoma and back. So much of who I was then is still the same. So much is different.
Often, when I am at MD Anderson talking to the oncology team, I feel their affectionate impatience with my anxious questions about feeling sick, skin problems, nausea, Avastin, blood pressure, nose bleeds. They can’t say what that impatience is about, but I have guessed often.
When I am in the infusion department with the chemicals being pumped into my chest, I am the only one upright. I don’t wish to read too much into this because I have some residual superstition about hubris. I don’t want to speculate about how strong I am. (Let’s all knock on wood.) But this is my interpretation of that look from my oncology team.
“Have you seen what happens to people on chemotherapy Mr. Lines? Have you seen how far people are set back by their treatments? Do you understand that you walk into our office, and it’s hard to believe that you are a patient?”
Yes I do. I understand that. But somehow, even with all of my strength, my great attitude, my willingness to confront most problems immediately, somehow I still got cancer. No one is more surprised that I am the patient than me. Do I believe that I will get better? Sometimes. Belief has to come with some convincing. Right now the only thing I’m convinced of is that I have cancer.
It’s still a long road to remission. That road leads through liver surgery. I have prepared my body. I hope that I present a body to the surgical team that is strong, unnecessary inflammation free, and a fat free liver with dead tumors that are easily resected.
I didn’t need that gall bladder. It didn’t seem to like me very much anyway. It always attacked me when I was least expecting it. But we have been together for nearly fifty years. I don’t believe that I will miss it, but we will see.
Those looks from the oncology team say that I will be fine. I believe them. I really do. As surely as I believed that Lucy was going to make it. Just as it was when I wrote that blog entry back in 2008, the backdrop to this scene is a world in chaos. People are angry beyond description. My crisis is small compared to what is happening in the world. My loves have changed, but it is still my world. It means everything to me. I’m going to have to plug back in later to see what happened.
“You have always done what’s right for your children all the way back to when Iggy was in Justine’s stomach. You will continue.”
I misunderstood this when I first heard Emily say it. I thought it was a gentle nudge to keep doing the right thing by my children. I felt defensive. Of course I would always do the right thing for them. But it was an acknowledgement. I have always done the right thing.
“You will continue.”
There was a note of confidence in there, “I know who you are Larry Lines.”
The right thing for my children right now is for me to do anything and everything in my power to stay alive. To find whatever it is that makes me Larry Fucking Lines and use it for me. To be selfish in ways I have not allowed myself in a long time. This use of my energy cannot be limited to my recovery. They have to see me live again – even more than I have before I was ill. To feel like I deserve to be alive and take from life what I can.
A few days ago, Rebecca read me a poem that she wrote about a road kill coyote she saw on her way to Fort Worth to see her daughter over the holidays. She felt a surge of empathy for the fate of the coyote and got choked up.
“I couldn’t pull over to the side of the road in the middle of Austin to weep over a dead coyote. I started writing a poem. Of course I couldn’t pull over to write the poem either, so I just started saying the lines out loud and memorized them.”
There are a lot of things happening. Sometimes I feel like that road kill coyote – just a casualty of modern life on the side of the highway. What is my plight versus the billions of other stories? Does my story matter? This is just another case of cancer. Just another liver surgery.
I am nervous. I am superstitious about about being overly confident. Like a batter in the World Series re-strapping his gloves before each pitch. He knows damn well that those glove straps are secure. Re-strapping those gloves isn’t going to help him hit the next pitch. I hang onto my nervous energy like that. Re-strapping it. Making sure I don’t forget that I’m nervous. I will do anything for my kids. For those I love. For myself. Then I step back up to the plate like I’m Larry Fucking Lines.