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.

And Then There Were Four

I am the youngest of seven children born under three marriages, but comprising only two constellations of siblings: Russell and Larum. I was perhaps six months old when my eldest brother Ronald went off to Vietnam. That should give you some sense of the remoteness the baby in the family can feel toward his oldest siblings. But ours was far from a normal family. “Blended” wouldn’t do it justice, so I leave that tale for another day.

Six boys and one girl, which means that both mom and sis were strong women in a way that could put to shame many a man I have known. Mom buried three husbands and two sons. I am very grateful she was already home to greet the latest departure. On Friday, September 29, 2017, Michael, my third-oldest brother, went home to be with his Lord and enjoy a family reunion I can only hope for. And then there were four.

The Four crop
The Four at Mike’s Night to Remember. R-to-L: Ronald, Eric, Barbara, and me.

One would think that having six siblings would minimize the intense sense of loss somewhat. But it doesn’t. Seven is the full set. Anyone missing leaves us less. I felt this first at the news of my brother John’s death in 1992. He was only forty-three; I was nearly twenty-eight and already overly familiar with the process of grief having lost my father when I was thirteen. As I recall it, I was deep into a construction project with my son Nikolai—a toddling two-year-old who loved stacking the blocks up into imaginary castles almost as much as I did—when I received the news. I was totally unprepared for my reaction: shock, sorrow, and relief. Relief? Yes, relief. I suppose it is time to introduce you to my brother John.

John Clark Larum
Brother John in his younger years.

John was my mother’s second son. She was a recently minted nineteen-year-old when she had him. Though young, the drama of life had already swept her into a tale that would ultimately rival any soap opera and still surprises audiences when I tell it. John was the only boy among us with black hair. “You don’t look like the rest of them,” folks would often say. “If I only had a dollar for every time I’ve heard that,” was his frequent reply. The rest of us boys were redheads. Barbara stood out because she was the girl. John, well, John was different.

All my siblings are charming, but I admit I am biased. John was charming in a way that would make women who knew better swoon. Handsome, athletic, driven, brilliant and armed at an early age with a sociopathic lack of conscience, John was an exhilarating and dangerous roller coaster to ride. As life would have it, he was the older sibling who showed up on the scene to “help” my mother when my father was dying of emphysema and lung cancer. “Help” meant that he was there to engage and challenge his teenaged baby brothers, Timothy and Nikolas (that’s me on the right—people often confused us even though our names only share two letters), who were the last left at home. And “help” is in quotes because his move to Arkansas from California wasn’t motivated by any sense of obligation or altruism. Narcotics officers were hot on his tail and he thought it best to let his California market fade away in his rearview mirror.

John taught us all the things older brothers shouldn’t teach their younger siblings and a few that they absolutely should. The shoulds ran the range from expanding my literary horizons to knowing how to put my fist through wood if necessary. The should-not’s I won’t list, except for this one: if you want to score a million dollars, don’t try stealing it from one guy; instead, find a way to con a million people out of a buck. That was John, the consummate conman.

Our last conversation was a godsend. We must have talked on the phone for nearly two hours. I laughed so hard I couldn’t cry anymore. “I finally got your number from Mother, but she still wouldn’t give me your address,” he said. I laughed. “John, you know I love you. I simply can’t afford you.” He laughed. Good times. He died of an overdose not long after that call. It was like having a chunk of my heart pulled out. I was sad he was gone and relieved that the danger had passed.

2007 was a monumental year for me. In June of that year, I began a new career in waste management. After nearly twenty years working in the installation and warehousing side of the commercial office furnishings industry, I landed a job managing a materials recovery facility. Essentially, I went from opening cardboard boxes to recycling them. I knew next to nothing about waste hauling and even less about running a processing facility. Fourteen-hour days were not uncommon and the commute simply added to the load. It was about midday on a Thursday when my wife called me with the news. There was no easy way to say it. My brother Timothy had passed away the night before. I have never been a big Halloween fan. His death on October 31, 2007, didn’t improve my opinion of the day any.

Classic me, I tried to keep working. I think I was able to function for about an hour and half before I admitted to myself the impossibility of it. I had to go home. Tim was my Irish twin. He was No. 6 to my No. 7, the only other biological child of my father. I should have been prepared for my reaction to the news: shock, sorrow, and ultimately relief. Relief? Yes, relief. Please let me explain.

Timothy wasn’t dangerous like John. As far as I know, he never ran a con in his life. He loved his family, cherished our mother, and adored his daughter. He was physically talented and fearless. I see cliffs as something to climb. He climbed cliffs to find higher ground to dive from. I learned to fight for self-preservation. He liked to fight for fun. I had to teach myself how to laugh out loud. His laughter could always shake the room and was more infectious than Ebola. Though some may disagree, I believe my head outweighs my heart. His heart was always bigger than his head.

Timothy taught me to dance, got me hooked on restaurant work, and had a way of talking me into schemes I should have known better to avoid—like driving him and his best friend to a party because mom never said I couldn’t take the car, never mind that I was only fourteen and unlicensed. In many ways, ours was a case of classic sibling rivalry. But our conflicts were always tempered with an abiding affection for each other. Being last in line, we experienced the most together. It was a treasure trove of memories none of the other siblings had in common. News of his death was like taking a .45-slug to the chest. The hole is still there.

My last conversation with him was a godsend. I was at work checking on one of our auxiliary warehouses when he called me on my cell phone. He was distraught over many things. He had recently been assaulted at a gas station by a group of thugs who felt he had cut them off on the highway. The experience had left him humbled and profoundly shaken. Our brother Eric, with whom we were both very close, had moved back to Spain. To make matters worse, the Spain we had grown up in no longer existed. Prone to nostalgia, the physical loss of the country he grew up in left his identity somewhat adrift. Last but not least, his little girl was going to be a legal adult and the chances of her deciding to move out to him were slim to none. There was really ever only one salve for our wounds: Jesus.

As I spoke with Timothy, we encouraged one another in our faith. I believe I helped him define his distress and in doing so, brought some relief. If the above leads you to believe that the conversation was sad and somber because of its content, then I can only surmise that the reader hasn’t spent much personal time in the company of Larums. That is not our way. There are few traumas that we can’t laugh our way through. Aside from the usual jocularity, the joy of this conversation was in the shared hearts of brothers who truly knew each other.

Timothy Larum
Brother Timothy as he was often found – laughing! (With his daughter Tiffany.)

Timothy worked hard and played harder. He died of a heroin overdose. Mother said he must have been shocked to come to and see Jesus. She believed as I do that the high was his aim, not suicide. He was only forty-four years old.

Hard as John was to live with, Mother never fully recovered from his death. Timothy was the only honest-to-goodness mamma’s boy among us. I feared she would sink in the sorrow of his passing and never return to us. She proved me wrong. She was always surprising like that. I had been casting about in my mind for how to broach the subject of God’s mercy in Timothy’s exit with her. She kindly beat me to the punch. “Sad as I am,” she said, “I am thankful he went that way. Maybe God allowed it to save us all from something worse. What if he had gotten into an accident drunk behind the wheel and killed someone? He wouldn’t have been able to live with that. I think God was merciful to us.” That is what I mean by relief.

My earliest memory of Timothy and Michael is the same. Ron and Mike were playing catch with Tim in the living room of our California home. Timothy was the ball and he was having a blast. Having older brothers over six feet tall when you are a toddler is like having your own personal amusement park. If Timothy wasn’t an adrenalin junkie at birth, he certainly was one by the age of three.

My next memory of Michael was of him working on our mother’s car. It was an Opel coupe. I recall coming out of the house and walking down the driveway just in time to see him reach under the hood, pick the engine up, and set it down on the ground. Did I mention that Michael was big? Some people don’t believe in giants. I grew up with them.

An imposing six-and-a-half feet tall, Michael was a gearhead and a consummate prankster. When Charles Manson was going helter-skelter, Michael was knocking on the neighbors’ doors and keeling over with a toy knife protruding from his chest, his white t-shirt smeared with ketchup. I don’t know if he ever encountered an engine he didn’t think needed to come apart. He worked as a lumberjack, married young, had two children, and ultimately found his way to being employed by IBM. My grease monkey, lumberjack, giant of a brother wound up being an executive in a high-tech computer company. Folks who may consider me to be loud and perhaps a bit obnoxious have little appreciation for the din of brilliance I grew up under. As the baby, I had to be persistent to be heard. If that didn’t work, I got louder.

Siblings
November 2005 – the last time we would all be together. L-to-R: Barbara, Timothy, Michael, Mom, me, Ronald, and Eric

Our last conversation was a godsend. Michael suffered a catastrophic stroke early in 2012. We were unsure at the time if he would survive it. He did, but not entirely. Strokes have a way of removing restraint on certain aspects of personality. Certain aspects of Michael’s personality were in continual need of restraint. His wife and children were heroic in his care, but not without a price. Eventually, my nephew Matthew had to set Michael’s phone to receive only. I had not called him in some time. My sister Barbara reached out to me to let me know Michael really wanted to hear from me. Were it not for her, I would have missed the opportunity.

I am ashamed to say that I never ventured out to California to see him in the nursing home. At first I was dealing with enough fires on the home front. But ultimately, it boiled down to plain selfishness. Selfishness and fear. I had made my way through cancer. I was weary of digging holes. I didn’t possess the courage to see him that way. I kept my distance. I’m the baby, gotta love me.

I called Michael and we had a beautiful talk. He reminisced about his last visit to Virginia. I had taken my two oldest boys, Nikolai and Gavin, to play disc golf with my brother Eric. While we were chatting in the park, an old geezer who looked like a slightly run over Mark Twain shuffled his way to us and started talking to the boys. It was all I could do to keep a straight face. Michael had them going a good while before he stood up to his imposing full height and removed his Billy Bob teeth to reveal himself. We still laugh about it. The kids were so impressed that my wife bought Billy Bob teeth for all to wear when they met the new dentist. The gag worked great. Thanks, Michael!

We talked about that epic day in the park, about the time he came to my church, about the grace of God, about the love of family. In his bed, paralyzed from the waist down and a good chunk of his brain missing, Michael talked with me as a loving, older brother. He asked about my life, about my kids, about my plans. How does someone love like that? Here I was, almost put out to call him. There he was, laid low in a nursing home loving on his baby brother. It leaves me undone.

He wrestled with survival, unsure of whether he wanted to stay or go. When the news came, the feelings were familiar: sorrow and relief. His suffering was over. His time had come. Mom had a party in heaven, I am sure.

I know our times are in His hands. I believe in the imminent return of Jesus Christ and hope to experience having my mortality swallowed up by life. But if that doesn’t happen in my lifetime, I know that my corruption will put on incorruption. All that being said, if I go before He comes the only one I want feeling any relief is the Devil. I want to be full of years and in a good old age. I want to be in the same shape as Moses, whose eye wasn’t dim nor his natural force abated.

Rest in peace, my brothers. The days of our reunion will by far outweigh the days of our lives.