Three weeks or so have passed since I last posted an update on Chuck's rocky journey through the cancer maze. Portions of that journey have been simply too banal to report, some of it less than uplifting, some of it uplifting. Add to that my own lousy health of the last couple of weeks, and the result has been a persisting uncertainty that anything I say on one day will still be true the next. Something I've noticed about cancer is that it never proceeds in an orderly fashion. Thus, my tendency has been to wait for some new event that can be heralded as "news."
But here goes, with a warning that I am writing on a day when my body temperature is a few degrees higher than the actual temperature of the air during what may be an historical heat wave in New York. It's dangerous to breathe today and probably equally dangerous (for me) to try to write.
I'll start with Chuck's visit to see the oncology fellow assigned to follow his case, Dr. Bishoy Faltas, last Friday, July 12th. You know you're old when suddenly doctors start looking like they've just graduated from high school. Nevertheless, there is no doubt that Faltas is a real doctor and is pretty well acquainted with glioblastoma multiforme and its devious ways. Plus, to make certain he has covered the waterfront after his discussions with Chuck, he always invites the chief of the oncology outpatient clinic, Ronald Scheff, to stop by and take a look at Chuck. Scheff inevitably regards Chuck with what seems like x-ray vision; I always sense he is greatly less interested in what Chuck says than in how he says it and how he looks when he says it. Scheff is an expert in glioblastoma, and though I feel it might seem impertinent to ask how many glioblastoma patients he has known and treated in his career, I imagine the number is very high and that he is a very good judge of such patients. I'll just reveal my bias here and note that he's rather handsome.
Given that Chuck had the previous Saturday completed his third 5-day go-round with the oral chemotherapy drug that is the first-line therapy against glioblastoma tumors, the conversation was centered on Chuck's questions about the drug--questions mostly involving how long he would be on it. ("Oh God," he has said to me many times, "am I going to be on Temodar the rest of my fucking life?") The short answer is "No." Presumably, the tumor begins to mutate in ways that make it impervious to Temodar, at which point another drug, Avastin, which interferes with the development of micro blood vessels the tumor grows to better nourish itself, is used. (Apologies to queasy readers.) According to Faltas, studies have indicated that Temodar is effective against glioblastoma tumors for six months. That's the good news for anyone who has to take it and be subject to its side effects, which chiefly seem to be exhaustion and loss of mental sharpness.
Chuck, however, has repeatedly provided abundant evidence that, so far, he wants to do whatever is necessary to beat back the tumor, and so the good news is that Faltas indicated Chuck and Temodar need not necessarily be parted after month six (October). Scheff seconded this sentiment when he entered the room.
"The studies tend to indicate Temodar therapy will be effective for six months or so," he confirmed, adding, "but at this institution (Weill-Cornell NY Presbyterian) we have used Temodar for up to two years."
So there you have it. Good news, great news, but all will depend on Chuck's ability to handle the side effects of Temodar, which can impact the immune system and cause debilitation. So far, his blood tests indicate his immune system is intact and quite robust for someone in his situation.
There is no doubt that after the five-day Temodar course, Chuck quickly began to feel better. He had a few lunches, even a breakfast, with friends he hadn't seen in a very long time and was able to take fewer naps. He began to think about writing again. Perhaps as a prelude, he took on a major organizing task in his kitchen: throwing out a very large collection of vitamins and supplements that were past their expiration dates. The seeming betrayal of a couple of decades of vitamin supplementation was hardly lost on Chuck.
Chuck's stated desire to begin organizing projects throughout his apartment, many of which have been left undone for some time, seemed like a good sign to me. I'm not sure of what--grappling with unruliness, bringing order to disorder, making room for empty space to simply exist in an otherwise crowded room, providing a sense of calm for its inhabitant.