The Road Ahead

Wednesday was a long day. We left home at seven-forty in the morning, as the sun was coming over the Arkansas Hills, and returned after sunset, which meant we saw some spectacular alpenglow like that in the photo below, but we didn’t get home until after dark. In between we drove to Denver for an appointment with Richard’s radiation oncologist and his “fitting” with the radiation techs who will give him his five-day-a-week doses of radiation.

Alpenglow
I’ve been thinking about what we learned, turning it over in my mind, letting it compost until I could make use of it. The most immediate news is that we know have a date for when Richard will be starting the six-week course of radiation therapy: the Monday after Thanksgiving.

By the way, if you want to know how radiation therapy works, the radiation oncologist on Richard’s case, Dr. Chen of the University of Colorado Hospital, explained it very simply: Gamma rays kill cells. But all cells aren’t equally susceptible. Those with mutated DNA like cancer cells (the mutated DNA is what distinguishes them from the ordinary cells of your body) go first. So the idea is to blast the affected area with high enough levels of radiation to kill the cancer cells and not kill the healthy cells around them. Of course, some healthy cells die too, but the plan is to keep the damage to a minimum.

In Richard’s case, they’ll be radiating much of the right temporal lobe of his brain. That means they have to be really careful to not injure his optic nerve (vision) or his brain stem (basic bodily functions like breathing and heartbeat). Yikes.

We also learned that in the case of brain cancers like Richard’s, the radiation has to be done in one continuous chunk of time. Why? Because the nature of mutation in cancer cells–and thus their resistance to the radiation–varies. The weakest cells die off first, and as the cumulative dose of radiation builds up over the course of treatment, the most resistant cancer cells eventually die too. But if treatment is interrupted for any reason, those more resistant cancer cells that have survived keep growing and dividing unchecked.

Hand

Here’s the problem: Thirty business days of radiation beginning November 30th run to the middle of January (allowing for a few days off for Christmas and New Years). Including the time between December 26th and January 3rd, when Richard was planning to travel with me to Isla Espirtu Santo off La Paz, Baja California, to help with the writing workshop I’m leading there. 

When Dr. Chen explained that the radiation would be much less effective if Richard took time off to go to Baja with me, and that make it much more likely the cancer would return, Richard asked if he could start the radiation and chemo after the trip.

“Maybe,” said Dr. Chen. But it’s risky to wait, he explained, because the tumor could return in that time. We looked at each other, and asked a few more questions. Pretty soon it was clear: Richard should start treatment on the 30th. We would figure out what to do about the Baja trip later. 

Southpark
We held hands and talked about the implications all the way from the radiation clinic on the south edge of the Metro Area to the Anschutz Cancer Center, where we found a sunny bench to eat our picnic lunch before Richard’s fitting with the radiation techs, and then we continued our discussion–and the hand-holding–on the drive across the city on I-70, south on C-470 to the exit for US Highway 285, through the Dakota Hogback, and winding up and up with the highway through the foothills, over Kenosha Pass, and across South Park in a drawn-out pastel sunset.

Before I spotted the new moon, the thinnest crescent of ghostly silver just above the dark western horizon, we had decided: Richard will stay in Denver and I will go to Baja without him. It’s a painful choice for both of us. I want to be there to snuggle next to him, to hold his hand, to make special meals, and generally coddle him throughout this grueling treatment. He wants me to take the time to do what I love. We are rarely apart, especially not at times like this. But I see his point: Sometimes taking care of each other means our paths diverge for a while. I don’t like it, but I agree.

Newmoon
This is a hard road. But we’re fortunate: no matter where it takes each of us, we still share the moon. Years ago, when work regularly separated us from time to time, we began the practice of reminding each other to look up at the moon each night, no matter where we were, and think of the other, seeing the same ghostly orb sailing across the heavens. We still do it. And sometimes we can hold hands and witness the moon together, as we did on Wednesday night, driving the last miles toward home. We watched that thin crescent disappear over the black edge of the horizon, like a silver scimitar vanishing into the night.

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