As usual upon waking up, I took Pepcid and Imodium to keep my stomach happy. I made my coffee, took Henry the dog out, then got back in bed with dog and coffee and Wordle and cuddling, which is my favorite way to start the day. I felt a little queasy, but sometimes just sitting quietly would calm things down, so I sat, and breathed, and tried to relax it away.

And then I sneezed.

The sneeze blasted through my relaxing, and I vomited water and coffee into my mouth. I clamped my hand over to try and keep it in, but there was too much, and it came out like a dam bursting all over my lap. Henry licked it off the computer.

How did your day start?

In PT school, we learn medical terms for conditions typically described more colloquially. Redness under the skin? Erythema. Bruising? Ecchymosis. Swelling? Edema.

And vomiting? Emesis.

I have always been what I would call a reluctant puker (there is no official word for the person with the emesis; emetic is the quality of having emesis, but it would also be a good name for the individual emetic-er). In the past, if I drank too much, or had a stomach flu, and vomiting seemed imminent, it was always high drama. Lying on the bathroom floor, mouth watering, minutes oozing by, knowing that I would feel better immediately if I vomited and yet couldn’t, and by the time I was ready, it would be the most dramatic hurk-hurk with streaming eyes and red face (erythema) and panting.

I’ve long contended that I would rather have a knife stuck in my arm than have anything wrong with my guts. I still hold this to be true, but nowadays, it’s become such a common occurrence, I feel like if I turn my head too fast I’m gonna puke about it.

In the past few months, I have vomited: on the 405 freeway (literally on it, cos I didn’t want to mess up the Uber driver’s spotless vehicle); over the side of my bed in the middle of the night in one complete body-emptying upchuck out of nowhere; and mid- session with a patient, where I excused myself from the room before returning with a mint.

It seems my hurk-hurk days are truly over, which is a weird flex, but if life hands you nausea, etc.

“Fuck Cancer!”

People tell me this, or comment it on social posts. They hold it high, like a talisman leading the charge. They mean it. “Fuck Cancer!”

“Fuck Cancer!” I agree, weakly.

I don’t disagree with the sentiment, but this cancer is part of my body. I made it, and it feels weird to tell part of myself to fuck off.

Fuck Cancer! Feels like “We hate that this is happening to you, a lot!” It’s nice. I wonder if they hope the talisman affords them some protection.

If we move the !, we get Fuck! Cancer. That creates a satisfying decrescendo after the exclamation that reads right for the moment.

Or we could add a !, which gives us Fuck! Cancer! I enjoy that, but it suggests the cancer is a surprise, which it no longer is (this isn’t a gender reveal party that ends with some trees on fire).

Suck it, Cancer! Good for when I’m in treatment. I get to feel both righteous and nauseous.

Suck It, Cancer? For the unimpressive pills and injection that are treatment right now.

Força! from the Portuguese. It signals strength for the fight.

Vamos! from the Spanish. Tennis players yell it after they score the point that starts to turn the game around.

I’m not turning this game around. But Vamos! and Força! we go. Fuck! Cancer!

Technically speaking, I’m back in treatment, though treatment now is a bimonthly shot and some pills that I haven’t started yet. It doesn’t feel like ‘real’ treatment, not without my weekly visit to the infusion recliner. This round of treatment isn’t chemo, and it isn’t radiation (I learned yesterday), and it isn’t surgery. So am I really in treatment?

Equally weird is trying to figure out the impossible looming question: does the fact that the tumor came back so soon correlate to my expected life span? Last time I got 3+ years before I needed treatment again. This time it was only a few months. (Spend an afternoon pondering that and tell me it doesn’t make you feel weird.)

There’s also a new degree of sadness in the responses from friends and colleagues when I tell them the tumor came back already. It’s not great to be on the receiving end of, though everyone is well-meaning. Why are they so sad? Do they know something I don’t know? Have I started dying? Why are people doing things for me for free?

It’s probably not yet time for döstädning (Swedish death cleaning, in which you deal with all your clutter so that the people left behind don’t have to), but my instinct is to start doing it anyway, just in case things go south quickly and I end up physically unable to do it sooner than I expected.

It’s also hard to think about, let alone participate in, work that I can postpone, like creating content for my company, planning product drops, etc. Doing that work implies that there is a future in which I will benefit from it, and I can’t count on that future. Do I do it anyway, just so I’m not spending more time ruminating?

Is there a future in which I am still living, say, 10 years from now? My oncologist is optimistic about it, but that’s his job. He would be a pretty shit onco if he advised me to just give up.

Am I dying? Likely sooner than anyone else I know. (NB: I am not suicidal. Do not read into this.)

So what do I do? How do I feel about waking up alive each day? How many more days do I get? (And anyone who wants to come at me with that “live each day with gratitude” had better watch it.)

Yes, there is meditation, and yes, there is therapy, and yes, there are ways to help cope with these impossibilities. But there isn’t an answer, and an answer’s not going to come.

Am I only really dying once we run out of treatment options? And should I get busy living until then? Do I participate in the life going on around me? Do I retract, close ranks, and go deeply internal instead?

People ask me all the time about the physical pain from my hip, and yes, it’s still problematic. But this is the stuff that is a lot harder to deal with.

In essence, I’ve had hip and pelvis pain since chemo ended in February. Some of it has now been managed, but pain in the front of my right hip has been intense enough that I got an X-ray, which showed a possible fracture (yeesh) so then the team moved up my scheduled PET scan from July to 2 weeks ago, and the PET confirmed the fracture and more importantly uncovered that I have had some tumor regrowth on that right hip as well as on my spine. So, fuck.

Since this discovery, plans have been hatched for medical as well as radiation treatment, and I started the medical treatment unceremoniously with a shot in each cheek last Friday that brought on a bone-deep fatigue which left me sleeping for 2 days. Pills I’ll be taking as well will have some chemo-y side effects, but fortunately, hair loss is not one of them (I’m planning on a fauxhawk as my next cut). With that said, nausea and fatigue are for sure on the list, and I usually fall prey to both of those. I’ll keep you posted if any other exciting symptoms show up like an allergic rash or increased blood sugar.

What I’ve learned with this now third round of treatment is that the hardest part isn’t the physical pain, it’s the psychological endurance. While I’m glad the earlier-than-scheduled PET caught the tumor regrowth before it had time to get any bigger, which should make it easier to treat, I am disheartened that it returned so quickly. I wanted more time off, more time where I could do and feel normal things again.

I will try to write as much as I can; it’s helpful to me, and I appreciate all of your willingness to read it.

6:02AM Take medication; determine if any more sleep will happen. Probably not.

6:05AM Assess GI situation. Drink THC beverage for intestinal distress. Drink is quite tasty, remind self that it’s not just a delightful beverage and not to overdo it.

6:20AM Trundle to kitchen, consider coffee, the drink I have loved with most all of my heart for decades.

6:35AM Attempt to drink coffee, discover it now tastes like an ashtray, feel pang of sadness that the drink I have loved with most all of my heart may now be on the cannot tolerate list that they tell you about. Wonder if I will ever enjoy it again, feel more upset about this than anything else going on.

6:40AM Make Earl Grey tea instead, drink it with milk because my youth was spent in England and that is how you make tea, barbarians.

6:45AM Return to bed; drink tea and faff around online. Discover that the feeling of nausea sometimes means I’m hungry, but more often than not it’s time to poop.

7:30AM Encourage dog to go wake up mother, who famously hates to get up early, but now is the primary caregiver for both of us.

8:00AM Request the classic breakfast of slightly nauseous champions, mashed up banana on toast. Feeling a little sassy today; request a layer of peanut butter under the banana.

8:30AM Shower while sitting on my grey plastic shower chair. Reminisce about the days when I could balance on one leg to wash the other foot. Decide that was an overrated skill and sitting down in the shower is where it’s at.

9:00AM Drive myself to chemo because I am an adult exercising my adult rights, even though I’m tired most of the time. [Caveat: Like Rain Man, I have great confidence in my driving skills. Maybe don’t try this if you don’t.]

10:00AM Arrive for chemo, get weighed by nurse. Observe that I’m losing weight without trying. Ponder an alternate use for chemo as a weight loss drug; decide the side effects are too gnarly, even though I haven’t needed to shave my legs in weeks.

10:15AM Shoot dirty looks at the older man receiving treatment who doesn’t know how to silence his phone while watching fishing videos on YouTube. Feel bad for doing it, but not bad enough to stop until a nurse intervenes.

10:30AM Shoot dirty looks at a woman receiving treatment talking loudly on her phone, as I have anointed myself HBIC of the chemo room and will not abide noise that offends me personally. Yes, I am wearing noise cancelling headphones and yes, I can still hear her through them because yes, for whatever reason cancer treatment has made me excessively sensitive to noise and no, I’m not proud of my behavior.

12:00PM Drive home while sipping THC beverage like I’m pre-gaming my nausea.

1:00PM Lie in bed watching Grey’s Anatomy for the remainder of the day, drift in and out but manage to follow the plot nonetheless. Wonder what other shows I will watch when I finish all 22 seasons.

6:00PM Dinner discussion; everything sounds like nothing when you have no appetite, but I make myself eat so that I don’t lose even more weight.

8:00PM Reflect on how there is a simplicity to being in treatment, where you put one foot in front of the other, your head down, and you do what is required. The rest of life stops for you, for a bit; this time around, I’m faster to accept it, and even enjoy that I’m forced to slow down for this. The days slip into a familiar sameness, varying only by appetite, nausea, and fatigue levels. I feel justified in withdrawing from the over-stimulation of modern life to concentrate on what I need to do each day. If I’m going to bring anything with me from treatment once it’s over, it’s my newfound emphasis on protecting my peace above all else.

Before I had cancer, I did not know what to say when someone told me they had cancer, and I definitely said stupid things to more than one person. Nobody really knows what to say, except people who have had cancer, or have experienced a similar trash tornado life event. Those people understand that the correct response is, “Well, fuck.”

The exact opposite, and therefore incorrect response is, “You got this!”

(Note: you cannot improve it with any punctuation except a question mark, because “You got this?” is darkly hilarious, but in a know-your-audience way. Ditto emojis, unless it’s the skull or poo emoji, and again, audience specific.)

“You got this!” is a good response to situations that are difficult, but have a positive outcome, and most importantly, that you have chosen to do, like grad school, a marathon, or moving to a new city. When you’re lumped with a crappy situation whose outcome is - at best – a net loss, it’s a poor choice.

Imagine your life as a rooftop party – you, friends, family, everyone’s there. Every now and then, someone spills their drink, or steps on someone’s toe, but for the most part, it’s an ok time, even for the introverts, who have located the dog and are deep in conversation. Then suddenly out of nowhere, a giant gust of wind blows you – just you – off the roof, and as you are free falling backwards through space, possibly towards death, your friends peer over the edge, raise their drinks, and yell: “You got this!”

I don’t want this. I don’t got this. I don’t want to have to got this, and I would like the option to come totally unhinged and not got this whenever I feel like. For overachievers, “You got this!” plays into needing to win at cancer, but the house always wins in the end, and if you’re lucky, you don’t lose it all.

As much as some cancer survivors and those around us need to feel we ‘beat’ cancer, somewhere along the way, we realize just how much our survival was a lucky spin on the cancer roulette wheel, and that plenty of people who were super tenacious and fought like hell still died.

In my free fall off the building, I know that it’s not their fault that I’m the one singled out. I don’t blame anyone; I just don’t want them to wish me good luck with it. I want them to recognize that yes, I have been through a fucking battle more than once now, and I’ve been lucky enough to make it out both times. Battles always leave a mark, and I can’t return to the party and pretend that nothing’s changed.

What can you say instead of “You got this!”? I recommend the following:

“I see you.”
“I love you.”
“You are in my thoughts/prayers/meditation.”
“I am here if you want to talk.”
“I made 5 freezable casseroles for you.”

“Though I am afraid of your dog, I will come walk him tomorrow.”

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If you’re expecting a “journey,” this might disappoint you.

A journey implies personal growth, and meaningful lessons. What I mostly have are infusion chairs, lab portals, and an impressive familiarity with my insurance company’s hold music.

I’m a physical therapist. I understand bodies. I understand systems. I understand probabilities. None of that prevents any of this.

This space isn’t about bravery, manifesting positivity, pink ribbons or curated resilience.

It’s about the absurdity of conversations about nipples.
The economics of staying alive.
The way identity shifts when your body becomes someone else’s science project.

My humor runs dark, so you’ll know pretty quick if I’m not for you.

For now, this is free. At some point, I may move some pieces behind a paywall because staying alive is expensive and writing takes time.

Thanks for being here.

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