The Certainty of Uncertainty

Alpenglow at the end of a rare sunny day.

Up on Mt. Hood, my son is testing equipment and shooting video for Nimbus Independent. There, at elevations exceeding 7000 ft., the thermometer climbs to 50+ degrees. The sky is clear and blue. Skiing aficionados refer to this phenomenon as Juneuary: spring conditions in mid-winter.

Down here, in the foothills, most days repeat the pattern of overcast skies and freezing fog. Temperatures in the Hood River Valley range from the low 20s to the low 30s. The world feels upside down. Last week, however, a brief respite from this Groundhog Day weather presented itself. The inversion layer lifted. My spirits rose with the aquamarine skies. So, I walked the Flats.

A glaze of snow; a vacant barn.

Our home sits in the southwest corner of the Dee Flat farming community. This trianglular shaped plateau, a tableland of volcanic sediment, rises above and between the middle and west forks of the Hood River. We bought our four-acre property in 1978. Little has changed on the Flats in the years since then. Oregon’s strict land use laws protect farmlands from speculative development.

This makes for good walking. Rectangular blocks of pear, blueberry, and cherry orchards map out the farms. Rarely do cars interrupt my reverie. I walk on the yellow line in the middle of the road. Other walkers are scarce.  Tidy rows of trees, clairvoyant in the absence of activity, patiently await pruning crews. Soon, their shears will stimulate growth implicit in the barren branches. Some days, only the barking of dogs reminds me that this is not a dreamscape, devoid of life.

Pear shoots soon to be pruned.

Physical activity is the antidote for cabin fever. While walking the frigid roads, my thinking liberates itself from the monastic confines of home. The rhythm of my repetitive stepping awakens the story teller in me and the soaring horizon of clear sky acts as a catalyst: homeopathic medicine for my chronic case of writer’s block.

As far as life’s problems go, writer’s block seems trivial. Perhaps, it is especially insignificant when considered against the backdrop of my cancer, multiple myeloma, and that of the many friends and acquaintances I’ve met since being diagnosed.

A dilapidated barn laden with snow.

Disease biology is destiny. I am no match for the pathology of cancer. Nor should I expect to be. It is going to do what it is going to do. Will my faux remission continue or will it relapse? My doctor and I watch and wonder. We experiment with drugs and procedures but its development is as tacitly assured as those buds in the pear trees awaiting the ascendant sun of spring. What chemo attempts to do, is suppress the impetus to grow and, in effect, create a persistent state of winter in the malignant cells’ environment.

Rows of dormant fruit trees.

Other than dormancy inducing drugs, what I’ve got going for me is good luck and something akin to the paradox of Heisenberg’s Uncertainty Principle. Basically, that means anything is possible. These comprise my personal gestalt for the cancer. Thus far, I’ve enjoyed luck in spades. I am also learning to be comfortable with the certainty of uncertainty. Yes, cancer is difficult, yet difficulty is inherent to living. There is no escaping the realities of aging, illness, or… writer’s block.

Speaking of writing, here are three favorite reads from this winter:

God’s Hotel by Victoria Sweet

“Slow medicine,” Hildegard von Bingen, and a pilgrimage pepper this memoir of caring for San Francisco’s indigent population.

Another barn adorning my walk on The Flats.

Dear Life by Alice Munro

Munro tells simple tales. The cadence of her prose massages our humanity. It’s not what you say, but how you say it.

The Last Policeman by Ben Winters

A classic police procedural: suicide or homicide? The kicker is the back-story: in six months the world will end. So, who cares? Detective Palace cares.

 

The Cat Came Back

Curly hard at work.

Recently, the cat who keeps me company at the Post Office, Curly, disappeared. She adopted our office as her home seven years ago. She spends her day sleeping in a chair atop a red, white, and blue blanket knitted for her by one of our customers. At night and when the office is closed, we place her outside to fend for herself.

This year, winter came early to the Hood River Valley. Our first snow fell on November 9^th. Then, just in time for Thanksgiving, the weather turned cold, very cold. While acclimating to the season’s onslaught, I was also grappling with my doctor’s suggestion to renew treatment for my blood cancer, multiple myeloma.

I understand the proactive thrust of Dr M’s idea. Clinical trials demonstrate that low dose oral chemo can extend remissions in patients who have undergone a stem cell transplant. Nonetheless, I waver. The fact that I feel good makes me hesitate. Why set the clock ticking on treatment now? Shouldn’t I wait until I’m symptomatic?

Our home after a recent snow storm

As I contemplated what to do, the cold snap broke and torrential rains threatened to flood the valley. Last week, the snow returned. Several brief storms dusted the trees, decorating the shoulder of each branch with white epaulets. Then, the full moon joined with the solstice and bore the gift of a lunar eclipse. In years gone by, such heavenly triangulation would have prompted pagans to sacrifice an animal. After all, angry Gods must be appeased.

That was when Curly disappeared.

In a world full of unpredictability, Curly’s steadfast appearance at our back door each morning, is appreciated. Throughout my workday, the transactional banter that accompanies the selling of stamps often includes an inquiry about Curly. Customers want assurance that she is safe. In this way, she acts as a touchstone helping to forge bonds in the community that would otherwise be absent.

After four days of worrisome questions from admirers, my faithful companion reappeared. She seemed no worse for wear, just hungry and sporting a suspiciously torn claw on her back foot. I theorize that she entered a building from which she could not escape.

Curly’s return brought to mind an old folk song: The Cat Came Back. The tale it tells speaks to the resilience of cats, uncanny in their ability to land on their feet in the direst of circumstances. As the song progresses, it takes on sinister overtones. The cat not only comes back but does so with a vengeance that grows in proportion to the effort to be rid of him.

Spanky, another cat who comes back a lot

Something similar occurs when cancers relapse. Remissions imply that one’s cancer has disappeared. With many blood cancers, however, the disease exists undetected in a dormant state. It is myeloma’s capacity to evolve that makes it, thus far, incurable. The cancer has resourcefulness equivalent to a cat with nine lives; its true regenerative force, though, may actually be infinite.

In a New York Times article, The Cancer Sleeper Cell, by Siddartha Mukherjee, the author postulates: “Chemotherapy unleashes a ruthless Darwinian battle in every tumor. A relapsed cancer is the ultimate survivor of that battle, the direct descendant of the fittest cell.”

Hence, my reluctance to begin a regimen of chemo; I wonder if doing so when my quality of life is high not only eliminates an option but also makes the cancer smarter. Like Curly, I do not want to enter a building from which I cannot escape.

I am a pragmatic optimist. I respect the ingenuity of life in all its forms, be it a life threatening cancer or a cleverly resourceful cat. I also admire the persistence of science. Right now, I’d say the brilliance of researchers is gaining on the lethality of MM. One of these days, perhaps in my lifetime, the cat, or rather, the cancer, will not come back.