Cancer Survivor 2.0: Transitions

“You were dying.” I seem to get that a lot, and by “a lot” I mean more than once. Once is enough, right? The first time around, it revolved around the cancer itself.[1] This time, it had to do with the aftereffects of the treatment.[2] I was well out of the woods, the base-of-tongue tumor a good five-plus years in my life’s rearview mirror. But I wasn’t well. “Glad to see you made it in,” the doctor said when the test results came in. “Because looking at these numbers, I don’t know how you’re still walking around.”

“He’s been grumpier than usual,” Heidi, my wife, told the receptionist after I dropped the clipboard with the new patient form down on the counter in frustration and told Heidi she could fill it out. It was a rude, inexcusable, over-the-top reaction to her matter-of-fact observation that my handwriting was illegible. It was March 8, 2019. Grumpiness earned me a doctor’s visit. Hopefully, that says something about my regular demeanor.

Without controversy, 2020 has been crazy. But the crazy for me started well before the pandemic and violent protests of this historic year. In retrospect, the cause of my condition should have been obvious. All the symptoms lined up, I just never assembled them for the same crime. If I had, I might have agreed to see the endocrinologist when I could still manage to keep my cool.

Suspect No. 1: High Cholesterol

My previous employer offered yearly wellness checks, part of which was a basic blood test to measure cholesterol levels for heart disease risk. In June 2016, my total cholesterol level (TCL) was 311 mg/dL (less than 200 is the desired range). We made some adjustments to my diet, substantially decreasing the large daily dose of raw eggs that were a major component of my protein shakes. Two years later, my TCL had climbed to 390, nearly double the healthy range.

The result made no sense. From 2016 to 2018, I lost weight—two pounds, to be exact, but decrease is decrease. I carried 171 pounds on my 5’ 11” frame with considerable ease. It wasn’t the food, so I blamed cortisol, the body’s stress-response hormone implicated in high cholesterol levels. Not that I “felt” stressed, mind you. But my body has always been a faithful witness to what my soul ignores.

Suspect No. 2: Peripheral Neuropathy

I wear gloves in summer and make a point to push my legs to their limit because Cisplatin, the chemotherapy drug I was given as part of my cancer treatment, did a number on my nerves. Walking was difficult during the initial recovery phase. Cold hands and numbness in my feet persist. Chemocare.com lists peripheral neuropathy as a less common but serious side effect from the drug and notes that “neurologic effects may be irreversible.”[3] Nothing to see here, folks. Move along.

Suspect No. 3: Depression

Depressed? Who, me? No way.

I was sad. In early 2018, after seven accolade-filled years of managing the hauling operations for my former employer, they gave my post to someone better suited to their executive succession plan.

I was lonely. Work moved me from my central-hub office that I affectionately named The Fish Bowl, to an office in a practically abandoned suite at the back of the maintenance shop I called The Cave, where I toiled away—a manager on hold with only contracts to supervise.

I was grieving. My brother Eric passed away on New Year’s Day, 2019.

Suspect No. 4: Fatigue

As a hauling manager, I regularly worked 10 to 11-hour days, five days a week. When they changed my post and I became effectively a manager without portfolio for close to six months, I still put in over forty-five hours a week on average. In August of 2018, I began managing our main recycling facility. 55-hour work weeks were not uncommon. I walked five miles a day doing the job. Then came the weekend when I studied, preached, and wrote. Yep, I was tired. I had reason to be.

Suspect No. 5: Emotional Lability

I didn’t see this suspect, my family did. Emotional lability is the psychological term for rapid and often exaggerated changes in mood where strong feelings such as uncontrollable crying or heightened irritability—hello, grumpiness—occur. I wasn’t irritable. I was focused. And if I cried at the drop of a hat, it was because it reminded me of my brother. At least, that’s what I told myself. My family told me I was grumpy. It wasn’t until I was getting better that they told me I was dying on them.

It’s late August 2013, before the chemo, before the radiation. The professionals reviewed the treatment protocol with all its promises and potential pitfalls. I listened. Heidi took notes. The chance of the treatment not working was low, the possibility of coming through unscathed nil. We knew at the start that the radiation would bombard my thyroid gland on its mission to destroy the cancer cells on my tongue and in my lymph nodes. Once I could eat again, we folded in a natural thyroid supplement into my protein shakes. As the years ticked by, the level of supplementation increased. If I missed a dose, I had a sense of crashing. I should have stopped. Instead, I fell into my default of pushing through.

I pushed through projects. In March 2018, I published Wind, Water, and Fire, a book about the Holy Spirit. As soon as it launched, I began writing Love Everlasting: A Practical Theology of Time, which I published in March 2020. In the same time frame, I started writing Valley of Wolves, the sequel to Gypsy Spy.

I pushed through work. In August of 2018, I assumed active management of our community’s largest post-consumer recycling facility. I had managed a small materials recovery facility and transfer station in the early years of my waste management career. Taking on this plant was like going from a go-cart to a high-mileage Ferrari. The workers and machinery required direct attention. I jumped into the fray at full-throttle. The post was nominally an office job. I was the general manager of a multimillion-dollar operation. I wasn’t in the office much. Flesh and blood, metal and grease are more my style.

I pushed through play. I went on business trips; nice trips to San Diego and Orlando, company funded and wife accompanied. I attended writing conferences that we turned into family vacations. Slowing down is something I am still learning to do.

While preparing for this post, I came across a line of dialogue I had jotted down in my idea journal. It’s dated May 22, 2018. I didn’t assign a character to it and can’t be certain of its inspiration. Did I overhear someone say it? Did I read it somewhere else? Was it just part of one of those conversations that fictional players have a tendency to whisper in my head? Maybe it was just my Freudian slip showing.

“Too many folks hurry about like they was rushin’ to die.”

You think?

We met with the endocrinologist. He ordered the blood work and told us he would see us a couple of weeks after the results came in. I went in for the blood draw on the last Monday in March 2019. That Thursday, the 28th, held the typical whirlwind of activity during which I either ignored my cell phone or couldn’t hear it ring (recycling plants are noisy). I walked up to the main office and the receptionist told me I needed to call home—now. “The results are in,” Heidi said. “The doctor wants to see you today.” Today? What happened to two weeks?

I like to think of myself as brave, but let’s be honest. Once you’ve been a recipient of a deadly medical diagnosis, a busy doctor saying you need to come in immediately is terrifying. My boss’s face when I told him I had to go didn’t help much. He was still a bit traumatized from watching me go through treatment. “You gave us a pretty good scare there, Nik,” he told me once. For a reserved man, his confession exposed much. He looked at me wide-eyed. “Good luck.”

They led Heidi and me into the exam room. We knew our places. She sat in the chair. I perched on the exam table. We waited. We wondered. We prayed. The doctor came in, report in hand. He looked at it, he looked at me. “Glad to see you made it in. Because looking at these numbers,” he lifted the sheet of paper, “I don’t know how you’re still walking around.”

He had ordered a thyroid panel. They checked my blood for T3 (triiodothyronine) and T4 (thyroxine), which are produced by the thyroid and TSH (thyroid stimulating hormone) which is released by the pituitary gland when it thinks the thyroid needs some encouragement. My T3 and T4 levels were nowhere near the low end of the reference range. And my TSH?

“I don’t know,” I said. “I’m still working over fifty hours a week. I probably walk five miles a day going through the different plants.”

“Well, let me put in perspective for you. Most of my patients, if their TSH level is at 10, are in my office demanding that I do something. At 12, they are barely functioning. Yours is at 72.75.”

Measured in microunits per milliliter, the sweet spot for the TSH level is 1.8. My pituitary gland was on overdrive trying to wake up my radiation exhausted thyroid. I was in full-blown hypothyroidism, symptoms of which include high cholesterol, peripheral neuropathy, depression, fatigue, emotional lability, and weight gain.

What, weight gain? Wait a minute! I was a full-grown male, average weight for my height with a body mass index of 24 which was thankfully inside the normal range. Funny how we can use one fact to deny that a part of us is dying.

“It was like it took everything for you just to hang on,” Heidi told me. “We were watching you. You were gray. You didn’t look well. You snapped at us. You were dying.” She got me to the doc. My mother was a nurse. Dodging medical diagnosis was a habit I learned early in life. Heidi saved mine. Again.

Medicine is a practice. Over the course of the next several months, the doctor increased the daily dosage level of my thyroid medicine. The good news: I was getting better. The bad news: the edge on my emotional lability took a while to dull. Generally diplomatic to a fault, I had become increasingly frank with my boss and with ownership. I jotted a note in my journal after a particularly trying meeting with them in early August 2019.

“The false satisfaction in blame never resolves the problem.”

It all came to head a couple of weeks later during a staff meeting filled with brass in which I made statements and presented information that painted upper management into a corner. Speaking truth to power is never without risk. Doing it on edge can bring sudden life transitions.

After 12 years of a job I often described as “a joy ride,” my employer and I had an amicable parting of ways. I left the world of a thousand spinning plates to return to the trade of an office furniture installer—a hybrid of mix of carpenter, mechanic, assembly line worker, and logistician. It’s difficult to measure the load you are carrying until you put it down on the scale. I never fully appreciated the level of tension I was under until my employer released me. I breathe easier now.

I had blood work done at the end of August 2019. Treatment was working. My total cholesterol was down to 170, a 56% drop from its highwater mark and inside the normal range. My T3 and T4 levels were normal. My TSH was at 1.31, which made the doc happy happy. I was less grumpy. And my weight? Apparently, I was overweight at 171 pounds. When I was 18, fresh out of high school, I might have weighed 152 pounds soaking wet. I am fifty-five. In my current job, I walk about seven miles a day, some of it on my knees and much of it carrying or pushing freight. The hours are reasonable, the stress negligible. If I stick with eating five times a day, I manage to keep 150 pounds on my 5’ 11” frame.

If you had sat down with me seven years ago and on the tail of hearing from the medical professionals all the true horrors of the treatment I had signed on for and said, “After all this is done, you are going to be a better man than you were in your 20s.” I would have laughed. And cried. My thirty-year-old self was in much worse shape than the twenty-year-old version and I had added a lot of mileage since then. But my Father is the Creator of the heavens and the Earth. My God is the Redeemer. In His hands, nothing goes to waste. He makes all things good. He is the master of transition and transformation. Just keep holding His hand. Everything is going to be okay.

[1] In case you missed it, you can read about it in “Dealing with a Death Sentence.”
[2] I shared about my treatment experience in the post “Pizza Night: Milestone on Recovery Road.”
[3] http://chemocare.com/chemotherapy/drug-info/cisplatin.aspx accessed August 29, 2020.

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