Archive for April, 2026

Gluttony

This morning the tide was at its lowest this month, leaving a good part of our cove empty. I happened to catch it just in time and put on my wellies to survey the oyster population for the first time this year before the rising tide would make a dry survey impossible. What I found were the remnants of voracious eating by what may be the green and tiger crabs that have invaded our cove. I did not see any of the crabs but I saw the trace of their gluttony: dismembered oyster shells everywhere as well as the shells of other sea creatures that were supposed to protect them but they had not. The shells had holes in them or were broken open. It was a real battlefield, if one can call it a battle when hungry creatures eat other creatures to stay alive. Last year I could wade out at low tide and pick up a dozen oysters in no time, leaving plenty behind. This time it took a lot of time. There was some urgency as the tide started to come in and my hands were getting numb from picking up shell after shell. Nearly all turned out to be just one half of an oyster already consumed.

Looking over what the crabs had left behind after they gorged themselves on the oysters, mussels and other smaller shellfish in our cove, I could not help to think of manmade battles and in particular the destruction created by my adopted country and its allies in places like Ukraine, Lebanon and Iran, where civilians were going about their lives peacefully, just like these shellfish. And then, suddenly, they saw their lives destroyed by aggressors, who left behind nothing but destruction and shell-shocked individuals with not even an intact shell to withdraw into. These aggressors are hungry, like the crabs, but, unlike them, not for food. They are hungry for oil and land. Their survival does not depend on destroying what others have built. It is a different kind of gluttony.

As the water reached the top of my boots it was time to stop the search. I had found ten whole oysters. Unlike the crabs, I am not hungry and don’t need oysters to stay alive. For me it is just a gastronomical delight. This morning I was just like the crabs, an aggressor, on the wrong side of the equation. But I’ll have them for dinner just the same.

Rays for real

There were two long planning sessions before my treatment could start. The first one was last week to measure and tattoo my body and do whatever they needed to do to produce the plan that would direct the rays to obliterate whatever cancer cells had stayed behind.

The second one was yesterday, to test the plan. I was positioned on a table, propped up with foam and pillows. It was not very comfortable, especially given that my head was turned at a 90 degree angle towards a blank wall. My curiosity was thwarted. I could not find out what was happening behind me and take a look at all the machines that were making these mechanical & tech noises. There is a large moving disc that looks like it belongs in a spaceship. Since my head is pretty much immobilized, turned to the wall, I cannot see much, except when that disc starts to descend into my view. I could imagine that being kidnapped by aliens, this arrangement may be familiar. I was looking for small green creatures inside that disc.

My friend Isabella offered to take me to the hospital. I had planned to drive there myself, not quite knowing what to expect other than that the treatment would not leave me incapable of driving home safely. On the urgings of Axel and Isabella to accept the support that was offered, I gave in. Isabella’s daughter, who went through this journey 11 years ago, had some advice for me, one of them to listen to music. It was great advice, as I had not thought about taking my phone and hearing aids into the treatment room. Sound goes directly from my phone into my hearing aid, so if I have both available I can listen to anything I want, music, books, podcasts, etc. without bothering people around me. The radiation technicians said that the lead in the room may interfere with the sound. It didn’t. I was able to listen to the final chapter of a fascinating book and so the it was more of a literary feast than a medical intervention.
Isabella hardly got to read her book before I was done. With little traffic, and the very short treatment, the new daily routine will take about one hour and 15 minutes out of my day – just as much as each of my exercise classes. All of them focused on my health and well-being. No fuss!

Worlds apart

I have just read, am listening to and reading books that are all set in the mid to end 1800s. Two of them are biographies and one is historical fiction but anchored in the reality of that time, all in different places. I finished the biography of the German doctor, botanist and well rounded scientist Philipp Franz von Siebold (written in Dutch – The Zwevende Wereld – by Annejet van der Zijl). Right after I finished that book I started to read and listen to Vilhelm Moberg’s four volume series ‘The Emigrants’ which chronicles the (fictitious) family of Karl Oskar Nilsson as he decides to emigrate to the US to move out of the clutches of poverty, the church and the governing class in Sweden at the same time that von Siebold was ‘discovering’ Japan. The Emigrant series was recommended by one of our Home Exchange hosts in whose house we will stay when in Stockholm. The Nilsson family leaves Småland to settle in Minnesota. The series is well informed by sources held by the Minnesota’s Historical Society. It appears that Axel’s grandfather emigrated from there, albeit it a little later. And then, the third world apart is the world of Isabella Stewart Gardner in Boston’s High Society at about the same time (her biography – Chasing Beauty – written by Natalie Dykstra).

While Kristina Nilsson and her husband struggle to survive in the wilderness of Minnesota, not even able to pay the extra postage of 15 cents to claim a letter received from Sweden, the Stewarts and Gardners are living in the lap of luxury, awash in money. They travel back and forth to Europe, and are buying up real estate in the newly available Back Bay, and on the more accessible coastal lands on Boston’s North Shore. Their riches come from the influx of cotton from the south and trade with the Far East, with its riches of spices and other luxury items that only the wealthy could afford. In Japan von Siebold was stationed as doctor for the Dutch colony on Decima, the trade post island of Nagasaki that the Dutch had established in Japan, the only western country allowed into this very closed society of Shogun Japan. All of them lived in a time of huge changes in society because of inventions in just about every aspect of daily living (transport, science, trade, the arts, etc.). Von Siebold was not as poor as the Nilssons and not as rich as the Gardners, for him money was a constant concern but it did not keep him from his explorations and discoveries, adding to humankind’s trove of knowledge.

What all books have in common is the very corseted world that circumscribed precisely how each member in society was allowed to behave, to dress, to earn their living, to worship and to interact with others, especially the opposite sex (different of course for males and females) based on the societal rung their families occupied as they entered into the world. That made life easy or difficult and strapped them into a fated future in a way many people still are.

It feels like nothing has really changed in the 175 years since, even though some of the hierarchies may be less obvious and many people have risen above superstitions and prejudices, but this is not true everywhere. I am aware that there are still many Kristinas and Karl Oskars who are struggling to keep their heads above water after leaving behind their war torn homelands, deep poverty or oppressive regimes, and now with the added threat of ICE. Maybe I should send Mr. Miller the Emigrant series so he gets to read about the people he dismisses so easily and with such cruelty. I also wonder how many people living now in Minnesota are aware of the sacrifices of their forebears. The scientists, the tech bro billionaires and the immigrants – they are still worlds apart.

Probabilities

I have now completed all the consultations and collected the expert opinions of the members of my care team. It does not quite feel like a team in my experience of what teamness is all about. It seems more like a collection of busy individual specialists who can all open my dossier from their computer and see the same data and talk about me from time to time. Apparently this ‘team’ met in mid March, after the lumpectomy, presumably on a Zoom call, and came to the unanimous conclusion that radiation was called for. Unfortunately, the medical oncologist we consulted earlier this week, had not been in on that conversations about my situation and had his doubts about the conclusion, leaving me with doubts.

I was able to get a phone consult on short notice – the radiation treatment starts next week, so that was important – with the radiation oncologist and laid out my doubts in the form of questions which she answered to my satisfaction. It’s been a bit of whiplash, yes to radiation, no to hormone therapy, no to radiation, yes to hormone treatment, or yes or no to both. It is all about probabilities, calculations that are difficult to make by someone who is not up to date on the research and remembers nothing about the Intro to Probability Statistics course that I took some 50 years ago. As I am wading into this very complex universe of the cancer cell, I am told about probabilities of recurrence. It may be local recurrence, a cancer cell left in the breast that starts to multiply, and/or a different cancer that develops spontaneously, like my breast cancer did for who knows what reason, elsewhere in my body. The radiation would take care of missed cancer cells in my left breast and the hormone treatment would make sure that any similar type of cancer would not receive sustenance any longer from certain hormones.

I have found, and in one case been told, that everyone stays in his or her lane: the breast surgeon cuts, the radiation oncologist radiates and the medical oncologist prescribes pills or infusions. Sometimes the lanes ran in parallel and sometimes one or two lanes veer off. So here I stand, looking ahead. I think it is going to be parallel roads for the next month until the radiation is done and that road veers off; after that I will stay on the hormone road for many years to come, which hormone is yet to be determined, that too is mighty difficult to decide.

Rays, early dinners and no visits in the evening

A friend of mine called me radiant when she saw me recently, in spite of my recent health challenges. Since I am going to have to start radiation treatment soon it made me reflect on the words that suggest I am emitting rays. Soon these rays will not only come from me but also from a machine. It is hard to switch my mind from radiation being harmful to being a cure. Apparently there is a minuscule chance of the radiation treatment creating, rather than curing cancer. Lawyers here tell doctors that they have to tell you about even the tiniest risks of a treatment.

Yesterday I met with the radiation oncologist. She is a young woman (most of our healthcare providers these days seem to be younger than our children). When I saw her name I asked whether she was from Nigeria. Yes, she was. We talked about my many visits to Nigeria to help Nigerian colleagues improve the performance of their local health systems. I told her that of all the countries I have visited in Africa, Nigeria was to me the most exotic, most colorful and most fascinating. She doesn’t get to hear such compliments much. For many Americans Nigeria evokes images of con men trying to get your bank account and social security numbers.

I had imagined that during our consultation she would go over the many reports and then tell me that she didn’t think I would need radiation. After all, the reports had been negative: a tiny lump of lobular cancer cells (stage 1) – now removed; the oncotype report that put it at number 8 on a 100 point scale (very low risk), and the fact that no cancer cells had traveled to my lymph nodes and that the margins were clear. Instead I learned that although the margins were clear, the space between the cluster of cancer cells and the posterior wall of where the cancer was located was not as large as it should be. It was an unpleasant surprise that changed my mind about radiation.

And so I will be starting my radiation treatment soon. From April 14 on I will present myself every (work) day until May 14 to the radiation center of the Lahey Clinic in Peabody to receive the rays that are expected to kill any remaining cancer cells that may still be present. They will prep me for that in a simulation (a ‘sim’) treatment next week. This is when they will make tiny tattoo marks to help focus the beam of rays and set up the equipment. I am told to expect a bit of sunburn and fatigue. “You will want to go to bed earlier,” she told me. I replied that I already go to bed very early, around 8PM. “Well, then you will want to go to bed around 7PM.” I sometimes already do that. So, until mid sometime mid to late May it will be ‘early dinners and no visits in the evening.’


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