And your wise men don’t know how it feelsJethro Tull, Thick as a Brick
To be thick as a brick
I have always been restless. I could always feel something coming. Something outside the door. Something in the hallway. Something breathing life into another dark path only illuminated by the next step. I’ve always wanted to leave. To just get up and go…
And sometimes I have. Sometimes I have just walked out the door. I went to school in Boston. I did a section of the Appalachian Trail. I moved to Albuquerque. I moved to Hong Kong (with Justine and Iggy). Oklahoma City wasn’t the best way to disappear, but I do know that very few people came to us visit us there. So maybe Oklahoma City is the best way to disappear.
But it always seemed like something larger loomed. Like something I was missing that just seemed obvious. I would wander in the woods in New Jersey with that feeling when I was eight. That’s not that surprising. The woods in New Jersey in Sussex County where we lived are magical, steeped in history, trod by the heroes of the revolution and the native people with names like Lackawanna, Hopatcong, Netcong.
I have perfect memories of being by myself or with friends on a gray autumn day wandering up the mountain that started in our backyard. Yeah it was a hill, but don’t tell an eight year kid from Byram it’s a hill. It’s close enough my friend. I would wander up that mountain with the that chill on my face, Rip Van Winkle’s ghosts playing nine pin, and I’d feel a particular call to be leaving. Like I should be going somewhere.
Apparently my mother felt that call as well, because one summer day we left New Jersey for Houston. It’s a long way. In 1983, to a 13 year old, it might as well have been on the moon. I complained, but it did satisfy some wanderlust in a way that I wouldn’t have been able to describe or identify when I was that age. It was big. My life would never be the same.
A year or two later, we went back to New Jersey for Christmas. My mother, siblings, step father, and I agreed not to get presents for each other that year. It was too complicated. We all wanted to go back to participate in the family Christmas gatherings. My siblings and I wanted to see friends and cousins.
I spent a few days with the Bryson’s up in Forest Lakes wandering around in the snow and playing on the ice. Daniel Bryson and I went Christmas shopping at Ledgewood Mall one night. I saw a Footprints in the Sand etching that I thought I had to get for my mother. It seemed appropriate. I stared at it for a while. Then Daniel said, “Dude. Just buy it for her.”
So I did.
On Highway 206 in Byram Township,New Jersey just north of Lackawanna Drive, there used to be a trading post (whatever that means). There were a lot of Native American crafts there like totem poles and jewelry. At this store, my mother had an experience with a Native American ‘troll’. Now who knows whether it has any real ties to Native American mythology, but it had that same aesthetic as the Lenape tribe’s totem poles and jewelry. It had a log body obscured by straw hair that was drawn up tight around its face. It had a stripped pine cone for a nose with red dried berries set in acorn caps for eyes and hands clutching a pine cone. She bought it for me.
This ‘troll’ captured the essence of the magical spirit of the Northern New Jersey forest. The lakes, streams, rock outcroppings, piles of rotting vegetation and leaves. The comradery, mystery, and adventure of my childhood.
I often wonder what it would have been like to come of age in New Jersey, but not in a wistful longing sort of way. I wonder what it would have been like to have to go to work and become an adult in a land that I found magical. Would it have lost that magic?
I went to visit New Jersey last summer. It was still that magical for me. I kept that ‘troll’ until July of 2017 when I moved out of my house on 14th street. I just took a picture of it and threw it away.
Coming of age in Houston was different as Houston was never magical. Not in the same numinous qualities of the Northeastern Woods. Houston has magic that people bring in little pieces from everywhere in the world. A certain transience that I had never experienced before.
That ‘troll’ scared some of my new friends. I liked that our New Jersey magic could scare some Houstonians, but I never got used to not having a mountain in my backyard. Houston is flat and featureless. There is magic in the dirt, but the magic has no identity. We build monuments of urban architecture to substitute for mountains, and we destroy and rebuild anything old to substitute for the memories the transient culture didn’t leave behind.
Far from satisfying that restlessness, Houston made it unbearable. I wanted to be gone the day I got here. I think many of us mistake that feeling for a deep hate for Houston. I grew up hearing people say they couldn’t wait to move away. I heard myself say it a lot.
I think it is just the nature of Houston to create that kind of culture. It was a crossroads in a malaria infested swamp. One road led to Galveston from what was north, and the other road went between New Orleans and San Antonio. People may have stayed to see what there was to gain, but they probably moved on.
Houston wasn’t very big when we arrived, but it had that big city drone. It’s always felt like an enormous city. And now it’s growing into that feeling.
For me, that big city drone came with a rhythm. A beat. It was constant. I felt it everywhere. I couldn’t sit at home. I wanted to be moving all the time. This got me into a lot of trouble. But still, even when I leave Houston, it’s a rhythm that comes with me. I thought I’d never be able to shake it.
Then I got cancer.
Leading up to my liver surgery at MD Anderson, I could definitely feel that rhythm. I was moving my body to it as I worked out for four hours a day. As I changed to a vegan diet. As I made arrangements with my friends and family. Even as I had chemo treatments through the fall. The day Troy picked me up and took me to the MD Anderson Cancer Center for liver surgery, that rhythm was silenced.
In August, when I arrived at the St. Joseph’s Emergency Room bleeding out of my ass, modesty never occurred to me. I was in the middle of a medical crisis. All modesty left the moment I took off my pants and dumped blood on the floor.
Throughout that stay at St. Joseph’s, it never occurred to me that my ass was exposed or that I was giving everyone a show every time I sat down in bed. That first night, Ashley and Troy sat in the room with me cracking jokes as I drank the bowel evacuation drink. The toilet was separated from that ICU room by a curtain.
My arrival for surgery at MD Anderson Cancer Center was completely different. We arrived at 4:30am. There is the check-in, where you get a number. Then we sat in one of the flower-named waiting areas (MDACC likes these flower named waiting areas. They are all over the hospital.). This one was called geraniums.
There are a lot of people being treated at MD Anderson. The Houston Medical Center is enormous. MD Anderson is just one of many hospitals, but MD Anderson is itself made up of several gigantic buildings connected by skybridges and tunnels and parking garages. It would be easy to assume that these buildings were the result of over-zealous planning, but they are not. MD Anderson is packed with people getting treated for cancer from all over the world.
The waiting areas filled up slowly but steadily. Hundreds of people with family. After about ten minutes, a woman walked to the center of these enormous waiting halls for the cattle call.
“If you have checked in for surgery, please move past the check in desk and find the room with the number you were assigned at check in.”
She repeated this a few times as we all made our way to our rooms. In the room, another person came in to give me instructions and a hospital gown. She left, and I started to change my clothes with Troy sitting there. I think I made some awkward comments about not being at the level of immodesty I had at St. Joseph’s. I don’t know why this part of the story is significant to me.
Years ago, I wrote about Justine giving birth to Iggy. Birth is quite an experience, for everyone. Of course, it was a big deal to Justine. Then there was me, I had never witnessed a birth. There was the doctor, the midwife, the nurse, the doula. I think it is a profound experience every time. Maybe even addictive for a doctor or a midwife.
Women have this level of exposure at some of the healthiest times of their lives. A woman will give birth with many sets of eyes watching a new life emerge from her genitals. It’s amazing and wonderful. Men never experience this.
I have no greater insight into my own experience as an analog to birth. I just know that at some point, we are open to many sets of eyes. I could try to hide my experience with cancer. Just keep my mouth shut and wait for the other side. Death or life.
I remember thinking about Justine being exposed and whether it mattered, but really all of our secrecy is just a part of a social construct that we participate in or avoid. Either way, it is a part of us.
My point is that when we are incapacitated, or truly humbled, we forget the social construct, the contract, that we have with society. When we are completely dependent on the care of others, when all logic has left the situation, we definitely forget that our junk is hanging out for all to see. What is left of us when there is nothing else?
Addicks Reservoir is a 26,000 flood plain on the west side of Houston to the north of I-10. It contains a number of very large parks like Bear Creek Pioneer’s Park. A lot of the non-park land was used for grazing cattle in the 80’s. I don’t know if there is still cattle grazing. I did see that goats were re-introduced to the reservoir in 2019 to eat the overgrowth of weeds.
Psilocybe Cubensis is a species of mushroom that grows out of cow shit. Magic mushrooms. In 1985, when I was 15, these mushrooms grew all over Addicks Reservoir, and Addicks Reservoir was a ten minute drive from our house in Spring Branch.
My friends and I would drive out to the reservoir on Clay Road and park on the shoulder. Then we would find a suitable place to climb over the low barbed wire fence that contained the cattle. The brush was thick, so it was difficult to find a place through from the road. Getting over the fence was tricky, but easily accomplished with one person holding a space open between the wires.
It was best to go early in the morning after a rainy or foggy evening. The mushrooms were easily identified by their gold caps growing out of piles of cow shit. Because many species of gold capped mushrooms grow out of cow shit, a secondary confirmation was achieved by thumping the cap with a finger. If the cap bruised purple, it was psilocybe cubensis. I don’t ever recall going to Addicks Reservoir and not finding any mushrooms. In fact, we would just give up after a while having found more than enough.
I never really had a bad time with these mushrooms. In fact, I had some character shaping experiences that I cherish. One hot day, I spent an entire day walking four miles to get home with my friend Robert. It’s one of my happiest childhood memories.
With experiences like that, you’d think I would have pursued psychedelic drugs as an adult, but these drugs definitely have a stigma. After remaining drug and alcohol free through most of my 20’s and into my 30’s, any thoughts of experimentation with drugs were completely outside of my thought process. Mushrooms never crossed my mind in any tangible way.
When I was diagnosed with colon cancer in August, as each medical professional stopped by my room to deliver the news and/or offer consolation, there was some common advice. Get an oncologist and a liver surgeon. Then there were tonics and laxatives and natural remedies written on post-its from the cancer survivors among them. Without fail, they all recommended that I see my general practitioner to get a prescription for an anti-depressant. Specifically, a SSRI.
I have taken an SSRI, Paxil. It really helped me at the time. It gave me a break from anxiety and depression that I needed at the time. For me, Paxil provided an example of what it feels like to feel better that served as a goal when I stopped taking the drug. But I hate the side effects. Once chemo started, I couldn’t imagine mixing the side effects of the chemo with the side effects of the chemo. I went to see my general practitioner, Dr. Kuo, anyway.
“I have colon cancer.”
“Oh wow. I was not expecting you to say that.”
“Yes. I went into St. Joseph’s in August with an emergency and ended up staying eleven days. They removed half of my colon.”
Sometimes, medical professionals forget that they are talking to a patient and just start spewing things that maybe they shouldn’t say. Sometimes, you can even see it on their faces – the why-am-I-saying-this look. I have actually come to enjoy these moments. Doctors spend a lot of time in school. I know there must be a lot of discussion about what to say and what not to say, but they are human beings. Every now and then, an unexpected piece of information will throw them off and their mouths start moving while a secondary mental process tries to figure out what they should actually be saying.
“My brother has colo-rectal cancer.”
Dr. Kuo proceeded to tell me about how terribly painful the radiation treatments have been for his brother. I had not started chemo. I wasn’t even sure how they were going to treat me. Radiation seemed as likely a scenario as any. I listened to the whole story because the information was unexpected, and I didn’t know what to say.
When he was finished, there was an awkward silence. Then I said, “I came here because I have been told that it would be a good idea to get a prescription for an anti-depressant. I don’t need it right now. I seem to be handling this pretty well, but I’ve never done chemo. I have no idea when I’m going to need it. I also thought it would be a good idea to let my GP know what was going on.”
“Yes. Of course. I will make a note of it. Call me to make an appointment when you need it. Also, don’t wait too long. You don’t want to be suffering for too long. Cancer treatment is a long road.”
Cancer treatment is a long road. Yes it is. And it leads all over your life. There is no end to the tangential journey. Everyone I have ever known. Every experience I have ever had. They all come back.
Sometime in the middle of the third chemo treatment, I was watching Apocalypse Now with Troy. I have seen this movie at least 100 times. The meaning changes over time. This time, in the middle of chemo, watching Lance wander, full of wonder, along the trench after dropping that last tab of acid he’d been saving, a couple things that I’d read over the years jumped into my head.
“I read somewhere that Johns Hopkins has been doing research with psychedelics on cancer patients.”
“Yeah I heard a guy on Joe Rogan talking about that.”
“Ya know, they told me to go to my general practitioner to get a prescription for an anti-depressant. So I went to see my doctor. As I was sitting there, I really got okay with the fact that I didn’t want to do that again. Now that I have started the chemo, I’m really convinced that I’m right about that. I’d be better off dropping a bunch of acid and see where that took me.”
“But maybe I should just drive out to Addicks Reservoir to pick some mushrooms. They weren’t as intense and I remember I just felt okay. I mean I’m doing all right, but I’m okay with this being a little easier. Maybe even a little high or something. I’m not toughing out the pain to make a point or anything like that. I just don’t want to mix all those fucking side effects. Mushrooms at least I know they are clean. I never had any side effects.”
“Hmm… I wonder how you find a supplier. I heard there was some company in… I want to say Colorado… that is making a tea or something that you can buy.”
“I read somewhere that Colorado recently decriminalized the possession of psilocybin, so maybe that’s true. I don’t know. I just know I’d be a lot more comfortable doing mushrooms than an anti-depressant.”
A week later, I was having a conversation with another friend about the possibility of taking mushrooms. He told me about a book he was reading by Michael Pollan called Change Your Mind. I ordered it while we were on the phone. It just so happened that the book and the mushrooms arrived at my apartment on the same day.
The mushrooms were actually psilocybin truffles. A small bag of raisin sized nodules. I didn’t touch them for weeks. I read the book and continued treatments. I read more about micro-dosing online and discussed it with friends.
I also discussed the possibility of micro-dosing with my psycho-therapist. I hadn’t seen her in close to a year. There was the usual catching up. I have cancer. This is what happened. This is where I am now.
“I was told that it might be a good idea to get a prescription for an anti-depressant since the treatments can beat you down pretty hard.”
“I can see why doctors would offer you that insight,” she said skeptically. I seem to choose my mental health professionals based on their skepticism of prevailing wisdom around psycho-pharmacology.
“I am really not looking forward to more side effects. I have been thinking about micro-dosing psilocybin. Mushrooms.”
“I’m not looking for permission. I just thought it would be a good idea to talk to my therapist about this before I did it. And perhaps you would have some insight that might sway me one way or another.”
“I’m not sure that I do, but it is interesting.”
“I have been reading a book on the subject, and I am feeling more comfortable with the idea all the time. I had no idea that there was this much research going on around psychedelics and cancer.”
“Really? What book are you reading?”
“The Michael Pollan book. Um… I can’t remember the name of it.”
“Change your mind. Yes. One of my patients gave me the book not that long ago. I haven’t gotten around to reading it yet. I will put it on the top of my stack.”
“Wow. That is amazing. I haven’t thought about mushrooms in forever. Now I’m finding that it’s almost mainstream. I haven’t done them yet. I just wanted to tell you about it before I did it.”
“Well I will be very interested to think with you more on this subject when we meet again. When is your surgery? Do you want to schedule more appointments?”
We scheduled a slate of appointments leading up to and shortly after the surgery.
Then one day, I just did it.
I took about two raisin sized truffles sometime in November. I wasn’t on a quest to get high or even to have a profound experience. I just wanted to see if it was easier to maintain a feeling of well-being. That dose was a little too much, because I definitely felt it ‘kick in’. The lights changed and I felt a little more buoyant. It was a good evening, and that night, I slept more easily and for longer.
The next day I took one raisin size nodule. I didn’t get high at all. I continued doing this every morning. I would often forget to take the doses with very little to no consequence. The effects were subtle.
The thing I noticed over time was that it was easier to stay on the tight rope. It is difficult to stay in that very narrow line of thinking between hope and despair. I easily drop off into either side. Psilocybin didn’t keep me from falling off. It just made it easier to get back on.
“You look great,” can lead to a false sense of hope. I have a long way to go. I spend a lot of time visualizing what remission looks like, but I keep myself from thinking of it as a foregone conclusion. This keeps me working toward a goal.
Feeling beaten by cancer treatments can lead to a spiral of despair. I am already dead. There is no point in carrying on. And a whole bunch of other maudlin shit.
I still hit those highs and lows. Since I have been taking the psilocybin, it’s just easier to get back to that narrow line of thinking. It’s easier to tell myself to do the right thing. It’s easier to recognize when I am starting to stray before I go too far.
Every now and then, I do a little too much. I see these times as a bonus. I have been able to find some peace with mortality. I have been able to examine my life with some detachment. I’ve been able to just enjoy some visual hallucinations and some vivid dreams.
Leading up to the liver surgery, the truffles were a really great tool. I achieved an almost trance like focus on preparation and a meditative peace with the odds.
On January 2nd, I had my last therapy appointment before the surgery. I must have had some instinct about this appointment, because I set three reminders on my phone for 24 hours, 8 hours, and 1 hour. I still missed the appointment.
I was walking around the track at Memorial Park somewhere in my fourth mile when my phone rang. I did not recognize the number, but I answered it anyway. As soon as I heard Victoria’s voice, I realized that I had missed the appointment anyway.
“Oh shit. I set like three reminders for this appointment. I still forgot it.”
“Well maybe you just knew you weren’t going to want to come.”
“Well I have been withdrawing from everyone. I’m just trying to do prep.”
I happened to be crossing Memorial at the time to the south side of the park away from the crowds. I suggested that we just do the appointment over the phone. Victoria agreed. I wandered off into the woods while talking. It was wet and just getting dark. I don’t remember much of the conversation. If anything, it was just a reminder that I had done everything I needed to do. I’m pretty sure that I have never been more thoroughly prepared for anything in my life, but I was also profoundly disturbed.
What is left of us when there is nothing else?
I actually remember nothing after changing into the hospital gown and lying on the gurney. I remember little about post-op. Just some vague recollections of medical professionals looking busy.
After being moved to the Post Anesthesia Care Unit (PACU), I don’t recall any pain over a seven. My abdominal discomfort was minimal. I was definitely not all there, but I was okay. Troy and my mother were there. I didn’t talk to either of them very much except to comment on whatever they were saying. I remember an account of Dr. Tzeng coming out to report on the results of the surgery.
“He came out and he said that they only took 10% of your liver and that they didn’t need to take your gall bladder at all.”
“Wow. Really? No shit.” I felt around for the drainage tube Dr. Tzeng suggested I might have when I came out of surgery. It was not there.
“Yeah he said your liver looked really good.”
“Really?” Dr. Tzeng sounded like he had been downright effusive.
“Yeah he said there were no surprises and that he was able to close everything up very easily.”
Troy left sometime in the afternoon. An hour or so later my mother left. She was just too tired. I wasn’t going anywhere. I felt stable even though I was still trying to get my bearings. I certainly wasn’t going to be much of a conversationalist. That’s when the reflux started.
A paralytic ileus can occur anytime after the administration of anesthesia. Some people are more prone to it than others. I think that a lot of people just opt for the opioids to get them through to the other side of the paralytic ileus. That is not an option for me since they don’t work, so I get to experience all of the joys of what happens to your body when your bowels stop working.
My stomach filled with acid and splashed up into my throat. I washed it down with water, which filled my stomach with more fluid that just wanted to come up. Lying down was just making it worse. I was going to have to up.
I was asking to be up on my feet by 6:30pm. I stood for thirty seconds and sat back down. An hour later I wanted to be up again. I needed two people to accomplish this each time since I still had a catheter stuffed up my penis, a heart monitor with twelve leads, three IV’s including an arterial line for continuous blood pressure monitoring, and an oxygen monitor on my finger. I was a goddamn pin cushion and they weren’t going to start removing things just because I wanted to be up like they had when I was at St. Joseph’s. They wanted 24 hours of continuous monitoring.
The twelve hour nursing shifts changed at 7pm. I made the new nurse, Monica, and the nursing assistant, Solomon, an imposing but affable man from Cameroon, unhook all that equipment, hang it from the IV pole, and follow me around the nurse’s station four times over that shift. It might have been five times. My ass hanging out. My junk exposed with a catheter tube. I walked around that nurse’s station at least five times each time I got up. One time, I went twenty-one times.
I didn’t care. I couldn’t lie in bed. My abdomen hurt, but the discomfort of the reflux was far worse. This conversation happened during the second set of laps around the nurse’s station.
“It’s always good to have a pain medication lined up.”
“I am on the muscle relaxers. Right?”
“Yes, but you are also on the nerve blocker.”
“The nerve blocker. It’s like an epidural, but it’s local. The anesthesiologist finds the major nerves in your abdomen, then they apply the nerve blocker over those nerves before they cut through them. That’s what the gray bracelet on your left wrist is for. It tells people not to put another local anesthetic on before this one wears off.”
“Oh yeah?” Monica nodded, “How long until the nerve blocker wears off?”
“Wow. That’s pretty awesome.”
“Yeah. But if it wears off and you have a lot of pain and you don’t have a pain medication lined up, it could be bad.”
I stopped walking, “This is going to get annoying.”
Monica stopped walking and looked at me, maybe for the first time, “I’m not going to do an opioid. They don’t work for me. I am not in pain. Do you have any ideas for a pain medication that is not an opioid?”
“A muscle relaxer.”
“I’m already on two. You gave me one through my IV when you came on shift.”
“They gave me those by mouth when I first woke up. I imagine you’re going to give me some more of those in a few hours.”
“I’m sorry sir. I just don’t want you to find yourself in a bunch of pain in a couple days when the blocker wears off.”
“Well I appreciate your concern,” I paused, weighing how I was going to say the next part. “But I don’t believe that’s why you want me to find a pain killer. I’m a pain in the ass right now, and you wish I’d go to sleep.”
Monica started laughing. It was a tired laugh, but it was a laugh. The first connection I had made with her. I felt the night from her perspective. Through the holidays, I was preparing for this surgery. Maybe the holidays happened for me, but liver surgery was always right there. Every conversation, Christmas light, gift, conversation… For Monica, she relished every day off. Every slow day at PACU. And they were slow. No one wants to give or get surgery through the holidays. She was tired. First day back to the cattle call of surgery.
Poor Monica and Solomon. They hit the lottery with me. I joked with them the rest of the night about what a pain in the ass I was.
Troy was there at midnight and 2am following me and Solomon around. Troy just keeps coming back. I have no idea how I ended up with such a wonderful friend. I really don’t. I am so grateful for Troy, but I could see that he was nearly asleep on his feet as well. I’m even a pain in the ass to my friends.
“I’m sorry man. I just can’t lie there.”
“That’s not why I’m here man.”
“I’m not here to get a comfortable night’s sleep in a recliner at the hospital. You don’t need to be a great conversationalist. I’m not here to be entertained.”
I must have fallen asleep for a minute between 5am and 6am, because Troy was gone. I felt like he was there. I felt like I could hear him breathing, but when I hit the call button to walk again at 6am, I turned to look and he was gone.
Strangely, I felt like Troy was there the entire time that I was in the hospital. I didn’t have anything to say to anyone those first two days after surgery, so it was an illusion easily maintained.
“Solomon you look like you could fall asleep right there.”
Solomon’s accent reminded me of a friend in Boston who was also from Cameroon. It was soothing, “Oh Mr. Larry. I know that’s right.”
“I’m sorry you hit the jackpot with me Solomon.”
“Thank you for apologizing. It is way past my bedtime. You really are a funny man. You know that?” This was the last time I was up when I hit twenty-one laps. We were passing Monica sitting at a workstation looking like she needed a caffeine IV. “Hey Monica. This is lap seventeen.”
Somehow Solomon was able to be polite, self deprecating, complementary, insulting, and sarcastic in one breath. I was super impressed. Monica has one of those infectious laughs that I cannot resist. My abdomen hurt quite a bit, but I couldn’t stop. Solomon started laughing and moved to support me at the same time. Monica nearly fell out of her chair.
After Monica and Solomon, there was Pam. I don’t remember anyone else. They were all awesome. I love MD Anderson so much. There was a woman with a safety video. I was sitting in a chair writing when she came in.
“Hello. Can you tell me your name?”
“Lawrence Lines,” this was followed by the usual questions.
“What you got for me?”
“I have a safety video that we strongly suggest you watch.”
“Outstanding! Give it to me! I want to see your safety video!” I was really losing my mind. I was starting to just blurt stuff out.
She laughed, “I don’t think I’ve ever gotten a response like that.”
“Well I’ve worked with Health, Safety, and Environment people on drilling rigs. They always have to deal with the big sighs from all the people coming to the rig. People from the office are always so dismissive of the rules like they don’t apply to them. Ya know: Do you have steel toe boots? A hard hat? They’d always be surprised that they wouldn’t be let on the work site without the gear. The HSE guys would send them away.”
This was apparently quite a mouthful coming from a guy sitting on a chair clothed in only a hospital gown with a catheter full of urine coming out from under it. She tried to laugh without appearing to be laughing at me, “Well it’s a pretty terrible video.”
“They always are.”
“Well they didn’t ask me to be in this one either because it was made before I was born in the 80’s.”
“Oh wow. This is going to very good. Could we dim the lights? Do you know who wrote it?”
“Oh nevermind. I’m sure it’s a masterpiece.”
I learned to know that Dr. Tzeng was coming because the nurse’s station would go quiet. He just has that presence. Then you hear the greetings.
“Good morning Dr. Tzeng.”
“Hello Dr. Tzeng.”
The door opened and there was Dr. Tzeng and Whitney the Nurse Practioner, and the Fellow Dr. Zafar. I don’t know what any of this means. There are several ‘Fellows’. He has a Nurse Practioner. I know the men by their titled last names and the women by their first names followed be a title: Dr. Zafar, Dr. Tzeng, Whitney the Nurse Practioner, Pam the Nurse, Monica the Nurse. The nursing assistants just get first names like Solomon. I can’t imagine the care hierarchy, or the political hierarchy, of MD Anderson is easily comprehended by the people that work in it, let alone the people being treated by it. But why do the male fellows introduce themselves as ‘Dr. Zafar’ and the women introduce themselves as:
“I’m Nancy. I’m one of the Surgical Fellows.”
I’m not going to speculate, but it is interesting to note.
Dr. Tzeng stuck his hand out. I took it. With Dr. Tzeng, every greeting and every goodbye is preceded by a handshake. I like this handshake. There is something both formal and informal about it at the same time. There is the establishment of contact, a peer to peer relationship, pause, respect.
If you can’t tell, I like Dr. Tzeng a lot. From the beginning, he projected confidence. He is not vague. His instructions are clear. His reasoning is rational. He also looks like a cross between two Chinese martial arts instructors I had in my twenties. One here in Houston, Sifu Chu. The other in Albuquerque, Sifu Lin. He sounds like Sifu Lin, which made his pre-op instructions very easy for me to follow. He told me what to do, and I did it.
“How are you, Mr. Lines?”
“I am okay.”
“Are you in pain?” This question sounds different coming from Dr. Tzeng. He doesn’t want to know about my pain scale number. He wants to know if I’m feeling something I call pain.
“No. I am not in pain.”
“Really?” Dr. Tzeng smiled.
“If I stand up, it hurts briefly.”
“But just lying here. No. It’s just the acid reflux. I am extremely uncomfortable.”
“Well the acid blocker should help with that,” he looked around at Whitney.
Whitney looked at her clipboard (Whitney was very pregnant), “Protonix.”
“Yes that should help.”
“That’s an acid blocker?”
“I’m sure that acid production is blocked in my stomach. But I need something to neutralize the acid in my stomach. I don’t feel any pain except in my throat. I burp. My throat burns. I wash it down with water. My stomach is too full because my bowels aren’t moving. The water makes me burp more. I drink more water.”
“Yes. Your bowels go to sleep from the anesthesia.”
“Yes. I know. This happened when I had the hemicolectomy as well.”
“Well we can’t give you any more acid blockers.”
“Yeah. I don’t want a blocker. I want a neutralizer.”
“Try not to drink as much water. Maybe some ice chips.”
I gave up. I had tried to explain this to every nurse and doctor that I had seen since I had surgery, but no one was getting it. I am not sure of the cause of this communication problem. I cannot be the first person to experience this problem. If your bowels stop moving, your stomach will not empty. You will have heartburn. In those first hours and days after surgery, the objective seems to be to give you a bunch of drugs so that you’ll be asleep for this acid party in your throat.
If you complain too much, “Do you know what an NG Tube is?”
I know what an NG Tube is. They take a tube and they shove it through your nose, down your throat, and into your stomach. When it was described to me at St. Joseph’s, it sounded horrific. Now with the catheter in my penis, three IV’s, and a heart and lung monitor, I imagined myself walking around the nurse’s station with an NG Tube through my nose. Solomon would have a field day with that.
In any case, I have never felt like I was being completely understood on the reflux. I have issues with the way almost everything is communicated in a hospital. I think language should be way more specific when the stakes are so high, but there’s also a division of labor. Where there is a division of labor, usually the lowest common denominator wins.
“What do you want for the pain?”
When I was in treatment in the 80’s, my doctor fighting to keep me off of, and therefore independent of, psychotropic medication, I remember him explaining the reasoning behind his and the hospital’s positions.
“I want you to stay off of the medication first because I don’t think you need it. Even temporarily. You are able to hold a coherent conversation. You are able to sleep at least some. Then if you are on the medication, I can’t treat you because I’ll be talking to the medication. You’ll be a product of the medication. Also, you may become dependent on a medication you won’t need later. Then we’re fighting a substance addiction problem that we didn’t have to begin with.”
“They want you on the medication because they think it will ease whatever withdrawal symptoms you may have. Then they think that you are unpredictable without the medication and may become violent maybe. There are other patients. The staff. So safety concerns. If there isn’t something at least ordered for an incident, then they can’t actually give you anything until we have a discussion about it. My argument is that I can’t order a medication for symptoms that don’t exist.”
I thought about this and seventeen year old me said, “Medication is for the convenience of the staff.”
This experience with an inpatient psychiatric stay when I was a teenager informs my opinion about prescribed and over the counter medications. I’d like to say it was all well thought out like this, but some of it is actually anxiety as well. It’s a little baffling how I could have been the type of drug user I was as a teenager and then became the type of patient I am as an adult.
“Here take this.”
As a teenager, I would take the pill, put it in my mouth and swallow it. Then I would ask, “What was that?”
Under clinical conditions, “What is it? Why am I taking it?”
Then there is the contradiction even in my current life. I will drink a bottle of wine with no thought to the consequences, but I will wrestle with the concept of taking an Ibuprofen for a headache that the wine gave me. Perhaps it’s because I know why I prescribed the wine to myself. I wanted to change my mood by drinking a delicious beverage. The wine later causes a headache. An Ibuprofen is suggested.
An Ibuprofen is anti-inflammatory. On the surface, it seems to make sense. I have a headache because of inflammation caused by the wine. The Ibuprofen reduces the inflammation. The headache goes away.
But I just drank a bottle of wine. It seems like throwing water in the ocean to take a couple Ibuprofen in the face of the inflammation I just caused myself. The wine caused my body to use the fluid in my body in a different capacity. It makes sense to me to drink more water, and of course, I should be hydrating while drinking alcohol anyway because this is well known.
It sounds like total nonsense that people keep talking about the acid blockers I am already on while acid bubbles up into my throat. Let’s do something about the acid in my stomach. You can’t tell me that an NG Tube is the only thing available, and that outside of that I should take the opioid every other red blooded American accepts post operatively and just go to sleep. So I guess people that tolerate the opioids well just don’t feel the acid burn because they are high and asleep. Then when the bowels finally wake up from the anesthesia, the patient just wonders about that sore throat.
“Oh you know a lot of people experience dryness and soreness in their throats after surgery.”
And what about the fact that opioids slow down your intestines? So the intestines are asleep from the anesthesia, and now we throw opioids on top of that. I am a little disturbed by this formula, and it doesn’t seem to add up. If I was only talking about my experience at St. Joseph’s, then I wouldn’t be so taken by this subject, but I have now experienced the same bias toward this solution at MD Anderson.
Medication is for the convenience of the staff. Yes I know that I’m also a weirdo. Given a choice between no solution for pain and discomfort and being able to check out mentally on the pain and discomfort, the overwhelming majority of people are going to choose ‘check out mentally’. I don’t have a problem with this choice.
Dr. Tzeng continued, “Can I see the incision?”
“Yes. Of course.”
The exam continued. Dr. Tzeng told me about the condition of my liver. I appreciated every other part of our conversation. I feel like this team performed a miracle on me. A miracle they spent lifetimes preparing for. Dr. Tzeng shook my hand.
Whitney said, “I’ll come back to follow up with you in a bit.”
An hour later, Pam the Nurse appeared at my bed with a packet of Tums. I was ecstatic.
“That’s exactly what I wanted.”
“Well the order just came through.”
“Oh. No kidding. Wow. I am so happy.”
Tums. A hospital full of one thousand dollar medications, and the solution is Tums.
Whitney came back in the afternoon. I could tell it was Whitney, because her stomach arrived before she did. She was very pregnant. She asked me a bunch of questions about comfort levels, nursing staff, pain levels.
“Oh and did you get the Tums?”
“Yes. Holy shit. That did it.”
“That was a gift from me. I am eight months pregnant. Tums are my friend.”
“Oh wow. I guess that makes a lot of sense. You have some reflux.”
“I can’t eat anything. It’s like the baby is sitting on my stomach pushing acid into my throat.”
“Jeez. It made such a huge difference. I’m still gurgling fluid, but it’s not burning me.”
“Yeah. We can’t stop that. Your bowels are going to have to wake up.”
“I get it. I’m just glad that it’s not burning me.”
Whitney left. My rant above is still relevant. I think the conversation about pain has to change. It’s not my mission. But I have experienced a little of the fallout of the current discussion between patient and staff, and I did not like it at all. I am so grateful that Whitney heard me and ordered something that worked. It seems like it should be part of the surgery protocol. Maybe it is at other places. I have no way of knowing.
I cannot overstate the amount of discomfort caused by acid reflux and an overly full stomach. Even the Tums didn’t remove the fluids from my stomach. I didn’t speak for much of the first sixty hours I was in the hospital. I was so uncomfortable that I couldn’t really follow much. I thought about my stomach all of the time. I also didn’t sleep much. I would wake up choking.
In the room was a clock on the wall at the foot of the bed. It was just a standard white wall clock with black hands and numbering. There was an additional circle of red numbering for the twenty four hour cycle of numbers. It ticked as the second hand went around. All night. All day. The clock moving. Slowly. The clock drove me to walking the halls. Especially after they took the catheter out and the monitor was removed. They even removed one of the IV’s that tapped into an artery to provide continuous blood pressure support.
This meant I could get out of the bed on my own. So I did. A lot. I would walk until I was so exhausted that I couldn’t help but sleep for an hour. Then I’d sit and listen to the clock. Troy was there a couple times a day and at last six hours every night.
“What is that noise?”
I looked at him. It must have been 3am.
“What is that noise?”
Troy looked a little scared, “Um…”
I sat and thought about it and concentrated on the sound. Suddenly I had it, “It’s the clock!”
Troy laughed nervously. I’m pretty sure this played out more than once. I remember it with Troy there probably because I was little embarrassed that I had to work out the sound of a clock ticking when I was staring at the clock. I know there was more than one occasion where I was having a conversation with Troy and he wasn’t there.
“I don’t know what’s happening to me.”
“What do you need?”
“What do I need?”
“I don’t know.”
I turned to make eye contact with him, but he wasn’t sitting in the chair.
I would like to blame the room, specifically the layout of the room, for these episodes and what was to come. But I’m pretty sure there was something else at play.
I dreamt of the Lenape troll. In the dream, it grew legs and its eyes glowed. It shoved sticks through the skin of my abdomen into my liver.
From the day that the first CT Scan was taken at St. Joseph’s four months earlier with its undefined lesion on my liver, I knew I was going to have liver surgery at some point. As the picture of my cancer became more defined, I dreamt of this procedure regularly.
There was the hard boiled egg version of the dream. The doctor cut into my liver through the gelatinous liver flesh uncovering a tumor that looked like a hard boiled egg. He cut it in half exposing the sickly gray yolk. There was the version where the doctor exposed the tumor and then used a spoon to remove it. There was the version where the doctor cut into the liver then took a handful of dirt and rubbed it in. This was the only version where I felt pain until I had the dreams in the hospital with the troll.
Every organ seems to have a metaphorical version. The metaphorical heart loves and is committed to a thing or a person. The metaphorical spleen is associated with anger. The metaphorical colon can be associated with ‘intestinal fortitude’ – courage, tenacity, endurance. What the hell is the metaphorical liver?
The liver cleans up what we put into our bodies. Alcohol, fats, starches, drugs… They are all dealt with in the liver. Is the metaphorical liver about the garbage we allow into our lives or what we allow ourselves to be exposed to? When I had half of my colon removed in August, a physical sensation that I called depression was removed from my body. I wonder how long I had relied on my colon to endure things that were uncomfortable because I didn’t have the courage to do something about what I those things I had allowed to be in my life. I wonder about the complicity and complacency I had with my own moral standards.
I don’t bring this up to find a real cause for my cancer. Just a metaphorical cause. I’m not sure that it means anything, but in relating the experience of a clock, my four month subconscious obsession with my liver manifesting itself in dreams, and the return of the Native American troll to my consciousness, I felt driven toward the detritus of my life. I thought many times in that bed: “How is it that I am nearly fifty, and I have not written a book?”
The troll always seemed to present itself for this internal debate. It didn’t seem to understand how this could have taken place either.
“Let’s look at your liver. Larry Fucking Lines, is this your liver?”
Then the troll shoved a stick in my liver. Through the skin. I felt the stick.
“What circumstances would you actually tolerate to give up that much of your life doing things other than what you felt you were born to do? Which mountain stream have you abandoned? Which magical stone outcropping? Which love of your life? What carrot were you chasing through ‘the streets at dawn looking for an angry fix’? Which unclaimed minutes did you sacrifice at the altar of complacency? How many rain-checks have you issued to late night discussions over coffee in a well lit corner of a darkened world that went nowhere and meant nothing but made the whole rat race worthwhile? Is this the beach that you will die on – ‘starving, hysterical, naked’?”
The troll had turned into a beat poet that shoved sticks into my liver and questioned my life choices. His eyes glowed. He was not ominous or scary. He seemed genuinely concerned. Perhaps he had been asking me these questions all along, and I had been relying on my liver to make him go away.
These are real questions. There are so many answers. Real answers. Life happens. I don’t even have to let it happen. It just moves on with me riding on the crest of its waves. Sometimes I am happy to be at the crest rather than the trough. Sometimes I am happy at the randomness of life’s gifts. Sometimes I intentionally sacrifice one thing for another. Sometimes the rewards of one sacrifice are so great that the sacrifice doesn’t seem sacrificial.
But the metaphorical liver wants to know if these things measured up over time. Eventually I had to reckon charges versus the credits to get a real life balance. Cancer seems to be doing that for me. For the purpose of my stay in MD Anderson to deal with the damage life has done to my metaphorical liver, that troll is the accountant. He needed to take some form, and he seemed to ask, “Was it worth it?”
As the effort to narrate this event in the unfolding dreariness of my cancer treatment with its continuous insults and barbs, the troll appeared to compare the dreams of a boy with the accomplishments of a man and the man fucking fell short. He just didn’t measure up. The hills and the magic and the leaving and the loves lost and shortened arrivals and abbreviated efforts at deeply meaningful cornerstones of my identity. It nearly killed me.
This surgery was the focal point of my existence from the moment I left St. Joseph’s hospital. I was certainly more introspective during this stay than I was at St. Joseph’s. Maybe more introspective than I’ve been since I wandered around that mountain in my backyard on a cold fall day with the wind stinging my cheeks.
I have been searching for a rock outcropping in my life where I can have my head above the trees and see the splotches of color in the countryside. To feel the damp chill of a gray fall day on my face and know that this is the day that I will leave. This is the day I will leave and it means something. Maybe that meaning accomplishes nothing but setting free a metaphorical boy from the stifling confines of a modern adult life. It’s just such an odd discovery to find that rock outcropping is cancer and that cancer won’t kill me. It’s life that will kill me.
By Tuesday night, I was really having a hard time knowing whether the interactions I was having were real. I had multiple hallucinations where I was talking out loud to Troy as I walked around or as I was lying in bed – only to turn around and find that he wasn’t there. At other times, I would be sitting in silence for hours and then turn to see him there. I slept for a few hours. I had a dream where I conversed with a twelve year old me with my weird haircut and fat cheeks.
“What did you do with your life? My dreams?”
I listed some things, but they were more like images than words. School. Music. Work. Relationships. Children. Caught up in my own accomplishments, I forgot that I was answering a child’s question.
“Did you write a book?”
“What? No. I haven’t. Not yet.”
He took on more of my own voice, “I only wanted one thing. To write a book. One thing. You are 50, and you haven’t written a book? We are 50? You haven’t written even one book?”
Then there was a plant on a windowsill (later found to be born from a photo sent in a text from emilie). A washed out desert landscape outside the window. The plant had long thin curly leaves that grew in spirals to fill the entire window casing obscuring the light. The remaining pinholes of light turned into glowing eyes that provided a disturbing comfort. I found myself lying in the dirt beneath the plant with eyes open staring up into the leaves. Waiting…
I woke up sweating. I got out of bed and walked for an hour as the floor woke up. There were no familiar faces on the floor. It was a little disorienting.
This conversation with myself has been ongoing since August. This reflection on every aspect of my life. This measuring of my accomplishments against the things that I wanted when I was a child. The dreams. The magic of a place. The history of connection. The non-cynical version of me. How much have I compromised? To how much have I remained true?
I have had a very good life full of good things and good people. I have often done the things that I wanted to do. But I can totally see that you-had-one-job concept about writing a book being true. I could answer that complaint with foolproof adult logic.
“Exactly what kind of book did you want me to write?”
“The kind with words you fucking moron!”
I have been unable to ignore this imperative. I don’t have any urge to ignore it. One book? What is left of us when there is nothing else? And I started writing. And I can’t stop.
On Wednesday night, I was moved to a different floor that didn’t involve acute care for post-op patients. Troy and Ashley came to hang out with me for a while. I was definitely more awake and alert. I talked about the books I was reading – Change Your Mind, Sex at Dawn, Bowen’s book about schizophrenia.
I asked how they were doing. Definitely a changed focus. Ashley was suffering from a headache. I felt like I could just walk out of the hospital. Troy was a little incredulous.
“You look entirely different than you looked last night.”
“I feel entirely different than I felt last night.”
“Were you here for any of the times I was trying to figure out the clock noise?”
“Oh weird. I was lying here staring at the clock. And I was trying to figure out where the sound was coming from and I turned to you and said, ‘What the fuck is that noise?'”
“Oh yeah. I was here for that. I couldn’t figure out what you were talking about, and then you said, ‘Oh it’s the clock.'”
“Did I do that more than once?”
“Not while I was here?”
“I know I remember having that conversation with you more than once.”
“You were not in good shape.”
“Yeah. I definitely was not in a good spot.”
I have been wondering since I got out of the hospital about these hallucinatory experiences. Perhaps the liver is connected to the brain somehow. Or maybe the liver shuts down briefly when experiencing trauma, backing up toxins that make the brain do crazy stuff. Or maybe I just have a lot of karmic baggage stacked in my psychological storage unit. I guess we all have to deal with our garbage eventually.
Troy and Ashley left, and I slept. It was not a satisfying sleep. It was an impatient sleep. I was/am ready to move on with my life.
In the morning, Dr. Tzeng, Dr. Zafar, and Wendy the Nurse Practitioner came to see me. Dr. Tzeng shook my hand.
“How are you feeling?”
“A thousand times better.”
“You look a lot better.”
“Bowels are moving.”
“Great. We’ll get you some solid food. If you tolerate that, then we’ll send you home.”
They left the room. I ate some food, and they sent me home.
Justine came to get me. We stopped at Lua Viet for some more solid food. I ordered it on the phone while she drove. She went inside to get it. More Shaking Tofu. As I waited in the car, there was nothing left. So much of my existence had been eaten up by this liver surgery. Cancer can really take every bit of your life. There isn’t really much you can do about it. What is left of us when there is nothing else?
Words. The clouds in the sky. A bitter wind on a magical mountain. A totem guide. A flood plain full of magic mushrooms. Therapy on the phone while walking through the woods at night. The kindness of friends and family. The rhythm of a city. A moment…
Justine got back in the car.
“So really after this surgery there is no cancer left in your body?”
“Well yeah. But I have to do seven more chemo treatments to kill the cancer cells we can’t see.”
“Yes but it’s all gone for now.”
“Yes it is.”
“So it only took you four months to beat stage 4 cancer Larry Fucking Lines. Six times six is thirty six sir.”
“You can’t make me laugh. That’s the only time it hurts.”
“Remember that time you had stage four cancer?”
What is left of us when there is nothing else?