Since my films are now clear, my oncologist tells me that I have a good shot at living for what seems like a long time: my five-year survival odds are in the 25-30% range, if I understand the data correctly. Those odds are much higher than anyone with metastatic colon cancer has any right to expect—for which I’m very grateful. It may sound strange, but I’m a very lucky guy, as my cancer patient friends know well.
The news isn’t all good. If I’m not in that happy 25-30%, my life expectancy is two years, maybe a little less. Apparently, the mortality curve for someone in my situation is not a bell curve with a long tail, as I had assumed. Instead, the curve has two humps: one that begins in about a year and a half (again, if I understand the relevant data), and another one several years later. Odds are, cancer will either get me soon, or not for a long time.
In the meantime, I seem to be nearing the end of the treatment road, at least until the cancer pops up again. Chemo begins in a little over two weeks, and will last for a few months. Then, I wait. If and when the cancer comes back—probably in my lungs, since it’s already been there—chances are, it won’t be treatable.
All of which means I’m living in between: between the surgeries and the chemo rounds that take a large fraction of life’s energy and the disease that takes the rest. It’s a common story. Cancer strikes, surgeries and chemo sessions kill the tumors, the patient seems to have come back from the dead—but the comeback is temporary; the disease returns, and this time treatment doesn’t work so well. That in-between time can last a very long time: sometimes, even with stage 4 cancers, the disease never comes back, and you die of something else. Usually, though, metastatic diseases eventually claim their hosts. How soon will “eventually” be? My doctors don’t know, and God isn’t talking. The farther down the cancer road one goes, the less likely it is that some data set captures your situation. Past that point, it’s all hazy extrapolation and educated guesswork.
I haven’t yet learned the art of living in this indeterminate in-between time. I’m an academic—I have books I want to write. Does it make sense to try to write them? How crushing a blow will it be if things go badly, and I leave a desk full of half-written fodder for the recycling bin? What is the best use of my time, and of my all-too-limited mental energy? I feel as though I’m staring at an hourglass, but I can’t tell how long it will be till the sand runs out.
Could be, I’m better off not knowing. The right approach, I suspect, is to keep my head down, do the best I can, day by day—and leave the course of the disease in other, better hands. But it’s very hard to live as though I didn’t know what I do know: that I’m living under a cloud, and the storm could come anytime.
When I was a kid, my brothers and I liked to play “Risk,” a wonderfully designed board game for would-be world conquerors. One of my brothers described the game’s genius this way: the game creates the illusion that skill wins out, when the luck of the dice actually rules. One of cancer’s worst features is that it creates the illusion of knowledge—the sense that your future is an open book, and that you can figure out when the last chapter begins. Sometimes it may work that way, but not often, I think. Hard as I try to pry that book open, the covers remain closed.
Maybe ignorance really is bliss, as the famous saying goes. Or, maybe knowledge is power, as another famous saying puts it. Either way, I’m finding that a little bit of both is surprisingly uncomfortable. I guess that’s just part of the in-between character of this in-between time.