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07.16.08

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Phaedra

Photograph by Tom Kwai Lam

Full Catastrophe Living:
The Cancer Chronicles

After the shock and terror, there came a strange calm

By Geoffrey Dunn


On the first night after I had been diagnosed with colorectal cancer, in June of 2005--after the gripping fear and rushes of adrenaline and the inadequate explanations and overwhelming uncertainties--I finally settled my shattered psyche sufficiently to drift into an uneasy sleep. From the distance now of three years, I am surprised that I slept at all. My dreams that night were vivid and intense. In one of them, my wife and I were in a boat--a small, rustic wooden skiff--out beyond the Santa Cruz Municipal Wharf. Massive waves more than 50 feet high were threatening to swamp us, and as I rowed frantically to maneuver us outside the break-line, bigger, more massive mountains of water formed on the horizon.

Finally I couldn't row any more, my arms and lungs failed me, and we were swept up by a wave and hurled toward shore, the weight and the power of the ocean crashing down upon us.

Somehow, we made it to the beach, breathless, nearly drowned, the skiff shattered, and the two of us face down in the wet sand, holding on for dear life. When I awoke, my fists were desperately clutching the sheets of our bed. My body was rigid and drenched in sweat.

I have remembered that dream often over the past three years, remembered its insidious fear and its naked horror. But mostly I remember that we made it--that in the dream, at least, we made it safe to shore.

A few weeks ago I reread an article by the late Washington Post columnist Marjorie Williams that appeared in the October 2005 issue of Vanity Fair in which Williams chronicled her own horrific three-year battle with liver cancer. One particular passage threw me. "We have all indulged this curiosity, haven't we?" Williams asked rhetorically. "

'What would I do if I suddenly found I had a short time to live?' ... I had entertained those fantasies just like the next person."

I suppose I wasn't "just like the next person." Those were "fantasies" I never entertained. Ever. This was absolutely new existential terrain for me. Even in the midst of middle age, I had never confronted my own mortality.

Not like I was being forced to confront it on the 15th day of June, 2005, in the offices of Dr. Robert Allen, a talented surgeon and colorectal specialist, who was telling me in no uncertain terms that I had a large, advanced, malignant and aggressive tumor in my sigmoid colon, and that if the cancer had spread, or metastasized, I might not have long to live.

What is the sound of dreams shattering?

I had just turned 50. I had two young children, Tess and Dylan, then 10 and 6 years old, respectively. There had to be some mistake.

Only I could tell that the doctor was not mistaken. I would come to learn over the next three years that Dr. Allen has a wonderfully wicked and dark sense of humor, but he wasn't joking. He was dead serious.

Let me add, not so parenthetically, that Dr. Allen also gave my wife and me a ray of hope that day in his assessment of my medical situation, a very bright ray as it turned out, and one to which I clung fiercely over the next three years, and to which I will cling for the rest of my life. But I will get to that momentarily.

"You have a very long road ahead of you," he said solemnly. "A very long, hard road."

People often ask me if there were symptoms. Well, yes and no. For several years, I had been experiencing minor rectal discomfort and other irregularities in my lower digestive tract. I had gone to see my general practitioner on two occasions when these symptoms had flared up, and to an emergency room physician on another, and on all three occasions my "symptoms" had been dismissed. On one of these visits--based on a suggestion by my Aunt Gilda--I even asked if a colonoscopy might be in order. I was informed by my physician (she was young and fresh out of medical school) that the pain was probably caused by anal "fissures," and that the loose bowels were likely the result of dietary factors, coffee and too much stress. She diagnosed it as a mild case of "irritable bowel syndrome" and prescribed some suppositories for the fissures. A colonoscopy, she said, wasn't "indicated" by standard medical protocol until I turned 50.

What she meant to say--and what I have learned much to my outrage since--is that a cost-benefit analysis by medical insurance carriers in cahoots with the American medical profession calculates colonoscopies prior to the age of 50 as an unnecessary drain on corporate insurance profits. This is a medical policy determined by fiscal considerations, not by the best possible medical care.

But I did not know that then. There was a lot I did not know then. I accepted the irritable-bowel diagnosis. And I did not push for a colonoscopy.

A few years passed. As I neared my 50th birthday, the symptoms became more manifest, and my friend Norman recommended Dr. Allen, with whom I scheduled a colonoscopy a few months after my 50th birthday.

In between those two propitious dates, however, I received a startling telephone call: My father, Frank B. Dunn, 80 years old, reclusive and out of touch with everyone in my family for the last 17 years, was dying alone in a Montana veterans hospital of colon cancer. He had been diagnosed nearly two years earlier.

I should have been notified of his diagnosis, but I wasn't. As there is a strong genetic correlation with colon cancer, it might have tipped the scales in favor of my having a colonoscopy earlier rather than later.C'est la vie, as my old man liked to say. He died two weeks before my test.

The hopeful news that Dr. Allen presented on the day following my colonoscopy was that my tumor, in spite of its large size, was not firmly attached to the colon wall (it appeared to be a bit "loose"), which meant there was a possibility that it hadn't spread. It provided a slight edge to what were otherwise nasty odds.

The "long road" that he described involved various rounds of radiation and chemotherapy, then surgery, and then more intense chemo. There would also be additional tests to ascertain if the cancer had metastasized. (It had not.) I would need to secure a medical oncologist and a radiation oncologist.

Dr. Allen, who is a former Marine and both a Vietnam War and Desert Storm vet, did his best to put me at ease, but he also looked me in the eyes with a questioning glance as if to size me up.

"I'm ready," I said. Semper fucking fi.

Within 48 hours, the first rush of fear and anxiety gave way to focus and determination. I put on my warrior's mask. And I kept it on.

Anyone hit with a possible terminal diagnosis is immediately overwhelmed by a series of tasks and impending decisions, as well as a myriad of emotions. Your world is turned upside down. My response was to go into battle mode. And I called together the troops. My wife, Siri, was a rock. She had been down this road before with both her parents, and she took immediate control of the domestic front.

I already knew who I wanted to serve as my medical and radiation oncologists, respectively: Dr. Michael Alexander, who had treated many members of my family, taught at Stanford, and who was absolutely beloved by my late Aunt Betty; and Dr. Edmund Sacks, who had been trained by my wife's father. Both were well respected, no-nonsense kind of guys.

There was also another joker up my sleeve. My dear friend Joe Poen, a bit like a younger brother to me, is a leading Northern California oncologist who had also taught at Stanford. I called and asked if he would provide a second opinion on all aspects of my care. Graciously, he said that he would. It put me at ease immediately.

I knew that the most difficult task ahead would be telling my mother, who could be tough as nails in certain situations and also extremely fragile in others. "I didn't live to be 90 years old to see my son die of cancer," she raged. She was angry at the world, at life. How could this happen to her son?I assured her that I could walk through it.

That became my driving metaphor--to walk through it. I wanted to prove to her that I could. And to do it for my two youngest children. They took the news as young children do: there is absolutely no recognition of the possibility of losing Daddy. Similarly, I refused to accept the possibility that I would not be around to watch them grow up.

A key figure in those early days was my cousin Bill. Seventeen years earlier he had been diagnosed with a very serious and, most often, fatal type of leukemia. He had been a guinea pig for early experiments involving bone-marrow transplants at Stanford, and in the process had been hit with horrific doses of radiation and chemotherapy.

I had a repeating lucid dream in which a vast, terrifying horizon of white snow was stretched out before me. There was nothing else on this bleak and barren horizon but whiteness. But when I looked closely there were well-defined snowshoe tracks going through it. The tracks were Bill's. I merely had to follow in his footsteps.

People gave me a plethora of books and articles to read, but mostly it was a short phrase or passage that stuck. A good friend, John, living in Costa Rica, had recently survived prostate cancer. He told me about a book, Full Catastrophe Living (written by Jon Kabat-Zinn), and just the title alone so accurately described my current life that it provided a comforting perspective on the process.

And then John repeated to me a great Mexican proverb that, he joked, was particularly applicable in my case: "It's tough to kill a weed." It became my mantra.

Several friends gave me books by and about Lance Armstrong. Armstrong in many ways has come to define cancer in the New Millennium, so much so that his message is often diluted by crass commercialism and hype. But when you are faced with two alternatives, survival or death, Armstrong's casting as archetypal survivor provides an added source of hope and strength. My friend Dani gave me one of Armstrong's yellow Livestrong wrist bands and I continue to wear one to this day. It provides a constant reminder of where I've been and what I need to do to stay here.There were also random acts of what I will simply call grace. One friend, Jim, left a jar of hand-squeezed orange juice on my door every morning for several weeks. He said he wanted to give me a gift from the sun and the juice of God, that it would heal me.

Another close friend, Luella, sent me an envelope filled with colorful stars and pink cut-out hearts, like Valentines. One of them had the phrase "Expect a Miracle" written in her handwriting. I taped it to my computer and meditated on it every morning.

The initial regimen of chemotherapy extended over a six-week period. Wearing a chemo pump in a fanny pack 24 hours a day, seven days a week, there was never a physical or mental break from the grueling process. But early on I embraced the attitude that the chemo was my friend; it was killing the cancer inside of me.

Ditto with the radiation. It came five days a week, with breaks only over the weekends, taken concurrently with the first round of chemo. The radiation literally cooks you, so that you feel like a roasted duck on the inside when the process is over, but I managed to get through it all, bloodied but unbowed. I tried to "normalize" my activities as much as possible during the process--like playing cribbage daily at Cowell's Surf Shop with my friend Pete--but in the end, normalcy becomes merely an illusion. You realize you have entered a brave new world.

Afterward, my family and I took a boat trip to Alaska. I was exhausted and slept for nearly two days on the leg from San Francisco to Vancouver. It was a spectacular journey, filled with love and healing in preparation for my upcoming operation at Dominican Hospital.

Talk about full-catastrophe living. I lost several body parts during my surgery (including a couple of my favorites), and also got a new one; some of those remaining didn't (and still don't) work quite like they used to. I can laugh about it now, in a cosmic-joke sort of way, but the fact is that the surgery did not go as planned and I nearly died in the process.

Several of my friends and cousins--George, Gail, Tony, Joel, Kenny, Norman, Johnny "No No," Father Mike, Pete, Bobby, Tricia, MeriSue, Eddy and countless others too numerous to name--provided spiritual and emotional support throughout my stay. Several wonderful nurses--Colleen, Jan, Julie and Louisa--also provided excellent care, but no matter how good (or bad) the nursing staff, you need a strong advocate at Dominican when you are vulnerable to forces beyond your control. My wife provided that advocacy in abundance; she saved my life.

The post-surgical regimen of intensive chemotherapy was more challenging than the first round, more debilitating. In the end, it felt like someone had beaten me with a padded billy club, so that the pain and weariness sunk deep into the bone, and the remaining side effects two-plus years later continue to provide both physical and emotional challenges.

Dr. Alexander was a strong and assuring presence throughout the chemo process, and he also has an arid sense of humor. He's a Chicago Cubs fan, a lifelong affliction, and we bonded over baseball. It was an extremely important connection for me. When you are going through chemo, you need to hang onto whatever you can. His entire staff is remarkable and I cannot thank them enough. One of the staff nurses, René Curtis, is herself a cancer survivor, and on my first day of chemo she helped me find my way back to God or the force of the universe or whatever it is you want to call it. It was a religious experience.

Indeed, there is no place holier than a chemo room. I believe that. I walked into my first one in fear, and I now enter them filled with love and admiration and spiritual purity. To sit with someone undergoing chemotherapy is a powerfully bonding experience, and I made several friends during this process, including two great men, John Cain and Bob Madsen, courageous and funny both, and they both lost their battles to colon cancer a short time afterward. I mourn those losses daily.

And I celebrate them. To be diagnosed with cancer is a double-edged sword. It is also a great gift. It reminds us all how precious life is--how blessed are our friends and loved ones. Each day becomes a celebration. I have often thought about the iconic speech given by baseball legend Lou Gehrig after he had been diagnosed with the debilitating and fatal illness that would come to be named for him, at the age of 36. "I am the luckiest man alive," he said. I feel exactly the same way. Mostly.

According to the American Cancer Society, 7.6 million people died from cancer throughout the world last year. One out of three Americans will be diagnosed with cancer at some point in their lives. These are sobering statistics. Indeed, in the three years since my original diagnosis, scores of friends and family members and friends of family members have been diagnosed with various forms of the illness. I have found a new role in life trying to help them--and their families--navigate through those early emotional minefields. I also try to provide them with a sense of hope. Cancer remains a devastating disease, but it is no longer a certain death ticket.

A few weeks ago, I went to the laboratory at Dominican for my quarterly blood tests to determine if there were cancer markers in my body. The tests came back clean. It was a relief, of course, but also a reminder. No matter what my blood tests say, my life from here on out is short. It is for all of us.

There are a few great lessons that I have learned in this three-year process: That love is a great healer. That fear is poison. That all life is cyclical and that our brief presence on earth is part of that miraculous and holy cycle. That time is an illusion. And that the real challenge in life is to live in the present as fully and consistently as possible. The present is all we ever have. Oh, and that one never beats cancer; one survives it. I also believe in the power of prayer.

On a quiet autumn afternoon, not long after my surgery, I was drawing water for a sitz bath to heal my wounds when I noticed a "daddy long-leg" spider about to be washed down the drain. I reached over and scooped it up and placed it on the window sill, where it stood, not moving, with small, nearly infinitesimal beads of water sparkling on its fragile legs in the sunlight. We looked at each other in mystic wonder.

Most of the time these days I feel a lot like that spider--happy to be alive, though not always certain how I got here--perched precariously, amid all the madness, on the window sill of life.

DESCRIPTION

Photograph by Tom Kwai Lam

Chemotherapy


It isn't death by firing squad,
but it somehow has that feel,
that sensibility.
The nameless faces circling
in bleached shirts and white masks,
the shot of electricity
when the first rush of leucovorin or oxaliplatin
or whatever poison is in the clear bag today
hits the vein, then the heart,
the reminder of the death that waits,
somewhere on the horizon.
The bolts come down,
steel to steel, ashes to ash,
randomly, without justice,
without summation--
out in the Mexican desert,
near Ciudad Juarez,
the date on the post card, 14 Julio 1916.
Knees buckling, the bowed head,
a cloud of blue smoke and
cracked adobe walls. The morphine
kicks in, the lungs labor,
and a nurse that cannot
and will not look me in the eye
pours water on my lips. I smell her skin,
taste it with my tongue,
only to imagine
an alternate ending, a varied image
on the post card.

Geoffrey Dunn

The Quick Fix

If you can survive it, CrossFit will get you ripped in 30 minutes a day

By Steve Hahn


The burning in my shoulders intensifies as I lower my inverted body closer to the sweat-stained mat. My face twists with pain as I use all my strength to push my body back up to a rigid handstand position.

I have completed one handstand pushup. Only 51 more to go. Next up are the modified pull-ups--I need to do about 52 of those. Oh, and did I forget to mention the rowing? I still need to do about 1,500 meters on that machine. Welcome to CrossFit, a unique workout style that has evolved from a bunch of guys in a Santa Cruz garage to a viral Internet sensation with branches around the world. The CrossFit style emphasizes short, integrated workouts that combine endurance and strength exercises in workouts that usually last no longer than 20 or 30 minutes. By the end of my session at the Scotts Valley branch I was exhausted and sore, but I still got home in time for dinner.

In today's busy world, these short, extremely intense sessions make the CrossFit workout perfect for the desk jockey just looking to lose a few pounds between workdays at the office or for the casual athlete looking to enhance his or her conditioning. It can even help the occasional wimpy, out-of-shape writer.

That's not to say CrossFit is only for the 9-to-5ers looking to tone those abs. In fact, the system has become extremely popular among special operations forces in the U.S. military, professional mixed martial arts fighters, Olympic contenders and football players in the NFL.

It's hard to say exactly why Navy Seals and lanky accountants are both attracted to the CrossFit system, but part of it must be the simplicity. There are no weight machines, and the movements are very easy to pick up, even for the uninitiated, such as me. The infinitely diverse workouts--there is a different one every day--are all arranged using only a few standard tools. Dumbbells, pull-up bars, climbing ropes, medicine balls and barbells are each used in a variety of ways to strengthen different muscle groups and build endurance. The workouts definitely left me struggling to get out of my car after the ride home, but I never felt in the dark when it came time to do each exercise.

Birth of the Grueling
As I struggle to regain my sense of balance after one particularly nasty workout, veteran CrossFit trainer Jason Highbarger tells me a bit about the unique and colorful history of the CrossFit system. It started in the Santa Cruz garage of former gymnast Greg Glassman during the 1970s, and until 2001 the system was largely restricted to that garage. Then, responding to prodding from some of his students, Glassman decided to launch a website where he would post a new workout every day.

Within weeks, it had spread like wildfire. Highbarger compares it to the SETI (Search for ExtraTerrestrial Intelligence) program--except in this case there were actually some responses.

"We were sending these signals out into the universe, and slowly we started getting signals coming back," he remembers. "People were really getting into it, and eventually we were flooded with emails of people saying they loved the program and wanting to know how to become certified."

Over the years, the CrossFit system has exploded, and the website now plays host to a virtual community that draws postings from everywhere, from the battlefields of Afghanistan to the suburbs of New England. Santa Cruz County has three different CrossFit gyms. The system has more than 400 gyms worldwide and an immeasurable number of web-based devotees who do each daily workout on their own.

This is one of the keys to CrossFit's appeal to military personnel. Weight machines are an inconceivable luxury when camped out in a hostile foreign land, but almost anything heavy can be modified for use in a CrossFit workout. Similarly, martial artists can easily integrate the workouts into their training without having to clutter up a school--which needs space for mats and sparring--with expensive machines.

All this talk of military personnel and martial artists might be a bit intimidating for someone just starting out. Believe me, it's not as hard as it sounds. Each day definitely provides a new and unique challenge (and a new set of sore muscles), but I always felt as if it were possible to complete the workout if I pushed myself. During my workout sessions, I saw 50-year-old women lifting weights, receiving hearty encouragement and smiling (after grimacing through the workout, of course). The trainers are very conscious of each person's needs and limitations and will tailor the workout to the individual. There are variations to each movement that make it easier or harder.

In fact, most of the clients at CrossFit are average workday folk. Trainer Brendan Gilliam, who co-owns the Scotts Valley CrossFit and has trained Olympic athletes, finds some of the most pleasurable moments come when he's working with out-of-shape pencil pushers.

"I've had some of the guys' wives come up to me and say, 'Thank you for making my husband less of a wimp,'" Gilliam says. "It's funny, but just coming in here for an hour or so a day can really change your entire lifestyle."

North Santa Cruz CrossFit, 300 Technology Circle, Scotts Valley; CrossFit Santa Cruz, 207 McPherson, Suite B, Santa Cruz; Westside CrossFit, 1010 Fair St., Santa Cruz.


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