The Deppman Family Website

When I met with my oncologist yesterday to discuss my future chemo treatments, I suspected right away that he had been talking with Nietzsche. He entered the room with a benign grimace, my medical chart, and a pencil from the Oberlin bowling lanes. Looking up from the pullulating numbers he observed me carefully.

– You’re still standing, I see, and not vomiting at this moment. Your nose is a blistered, peeling beet and a rash prevails on your legs like mold on two wet and forgotten baguettes. Your thumbs are twitching nervously like the lips of two blushing pilgrims, your platelet count is so low that you bleed spontaneously when you bite into a soft banana, and you smell funny, like cucumber moisturizer mixed with compost. In short, you are not in catastrophic physical pain but nobody has recently mistaken you for Michelangelo’s David.

– You have the situation.

– That is very satisfactory. And tell me, are you also suffering psychologically every day, fearing the short- and long-term consequences of chemotherapy on your spirit and body? Are you anguished by the fact that you can barely glimpse the end of your pain, that you cannot think about the future but cannot not think about it either? You worry about status of your liver, your eyes, your children, and the article you’re writing about Jean Anouilh?

– That’s also right, yes.

– Excellent. Now, remember that for any healthy kind of person the value of life is certainly not measured by the standard of such trifles as suffering or pleasure. Suffering might predominate, and in spite of that a powerful will might exist, a Yes to life, a need for this predominance. You must learn to think of the effects of the toxic drugs I’ve been giving you on your body and soul the way my drunken bowling competitor thinks of the advent of nihilism on European culture, i.e. as a necessary trauma, a transitional stage between a state of naïveté and a new phase as yet hardly recognizable. You are leaving behind an old skin – billions of unwanted cells – in a massive blast of creative destruction that will create the conditions for a new superhuman self either to perish heroically or to survive and revalue all old values.

- I’m sensing that I might not get a free SpongeBob band-aid today. Something also tells me that you’re not leaning toward reducing the dosage or the number of my remaining treatments.

- Four more infusions of Folfox and Erbitux at the maximum dose are the most I could possibly give you, making for a grand total of 14. Beyond that…

– So how many are you going to give me?

– Why, four more infusions of Folfox and Erbitux at the maximum dose. That will carry you right through July and into August. I guess you’re not bowling too much these days?

– Well, with the thumbs, you know.

– Of course. I’ll give your best to Friedrich. See you back here in a month.

June 10, 2009

For the last couple of months I’ve been receiving post-surgical, i.e. adjuvant, chemotherapy. After several treatment delays due to low white and red cell counts, my oncologist started giving me a biweekly shot of Neulasta to stimulate the bone marrow and produce white cells. This has been working and I’ve had only minimal levels of bone pain, the worst known side effect of the drug. Another new garnish to my diet is Emend, an anti-nausea drug that has helped me survive the most difficult days in my treatment cycle. I’ve also started taking the antibiotic doxycycline and it has helped control the rash I get from Erbitux.

On Tuesday, June 16 – Bloomsday – I meet with my oncologist to determine how much more chemo I am going to have. It will probably be either 2 or 4 more cycles, making for a total of 12 or 14 Folfox cum Erbitux. I am not going to lobby for any particular result because there is too little applicable research. Rumor has it that “length of regimen” studies are ongoing, but nothing has appeared yet that could guide this treatment decision. Besides, at this point I am more than willing to trust my oncologist; over the last year he has proven many times that he knows exactly what he is doing.

After my last encounter with Socrates and Glaucon, I thought I had reached a philosophical peace with my current condition: I would do everything possible to survive the chemo treatments and then try to delay or prevent recurrence through diet, exercise, and stress reduction. I would concentrate less on the high risk of relapse and more on the quality of the oyster mushrooms and the red sauce. Down with seething, smoldering, and anguish. Up with planting hibiscuses, picking asparagus, writing articles, and learning Chinese characters with the kids.

Then I ran into Friedrich Nietzsche at the Oberlin bowling alley. As usual he was on lane 4, which, despite its proximity to the jukebox, nobody uses because the lights flicker and lead to searing headaches and very low scores. “One longs for a condition in which one no longer suffers,” he said when he saw me, “but that is wrongheaded. In fact our pains are personally necessary for us and all life is experienced as the ground of anguish.”

He squinted at me as Steely Dan’s “Glamour Profession” began to purr its polished sound:

Brut and charisma
Poured from the shadow where he stood

 – But isn’t it natural to try to reduce one’s suffering? 

– Natural for insects, sheep, and philosophers like Socrates. The fact is that the path to one’s personal heaven always leads through the voluptuousness of one’s own personal hell. As I was explaining to that idiot Glaucon who lost his dollar and was pounding the jukebox a few minutes ago, all of us need terrors, deprivations, impoverishments, midnights, adventures, risks, and blunders just as much as we need their opposites. The sparks fly upward! You should let your suffering lie upon you, Jed, and experience it not as evil, hateful, and worthy of annihilation. It is no defect of existence except in the sad eyes of those who wallow in pity and worship at the religion of comfortableness.

One on one
He’s schoolyard superman

– Friedrich, you’re really saying that I should cherish my vomiting, neuropathy, neutropenia, nosebleeds, gastrointestinal disorder, all-body rash, weight and hair loss, psychological stress, short life expectancy, and cracked and bleeding skin?

– Obviously. Each of those little pains is as necessary as rhubarb in pie. And remember also that they are yours alone, that there is no use discussing them publicly like a frog in a bog. You should stop your blog.

I drove the Chrysler
Watched from the darkness while they danced
I’m the one

– But the responses to the blog have strengthened and consoled me.

– They may have distracted you, but as I said in The Gay Science all personal and profound suffering is incomprehensible and inaccessible to others. Whenever people notice that we suffer, they necessarily interpret our suffering superficially. It is the very essence of the emotion of pity that it strips everything distinctively personal away from the suffering of others. In fact your “benefactors” are, more than your enemies, the very people who diminish your worth and your will. They try to help but their intellectual frivolity is outrageous: they know nothing of the whole inner sequence and intricacies that are your real distress. And as I said, they never understand that you need every last bit of your anguish, alone and unaccompanied, whole and uncut (269-70).

Living hard will take its toll

– You know, you have a reputation as a nihilist but now you’re outdoing yourself — I love these people and their messages! What do you think people can do for each other?

– I would make those who wish to help – and I count myself among them – bolder, more persevering, simpler, and gayer. I would teach them what is understood by so few, least of all by those preachers of pity: to share not suffering but joy.

Illegal fun 
Under the sun

3.20.09.

I recently met with my oncologist and liver surgeon at the Cleveland Clinic. Arriving back in Oberlin, I ran into Socrates and Glaucon.

Socrates: It is nice to see you, Jed. We were just discussing the matter of your health and whether you now have reason to be philosophically optimistic, pessimistic, or something else.

Jed: Socrates and Glaucon, best of men, I would like nothing more than to discuss this with you. It has now been over a month since my liver surgery. The surgical margins were clear, my liver is returning to its normal size, and I have had no bile leaks, infections, fevers, or other complications so far. Last week I had a CT scan and the radiologist described no visible cancer in the remnant liver, lungs, or anywhere else, though he again raised questions about two enlarged lymph nodes. I’m trying not to worry about those, however, since a surgeon has already evaluated them. All in all my latest news is very good.

Socrates: We also remember that you responded well to chemotherapy before your surgery so you must surely be buoyed by joy and optimism. Now you can put your cancer behind you and return happily to your family and work, secure in the wonderful knowledge that you have heroically faced and defeated this dread disease forever.

Jed: Not exactly, Socrates, for the general statistics on stage IV colon cancer patients are rather bleak even for those who have surgery. More than 75% of us relapse within two years and only 20-25% of people in my condition are still alive 5 years after diagnosis. Even among the survivors, many are battling recurrent or incurable disease and face a life of permanent chemotherapy.

Socrates: I see. Well, then, with those thoughts in mind you must surely be overwhelmed by pessimism. You must be disoriented, dispirited, and suicidal, secure in the horrible knowledge that life is no longer worth living because cancer has taken you from your loved ones and utterly destroyed you.

Jed: Not exactly that either, Socrates. I am simply trying to balance my sense of having made real progress since last August with realism about what may lie ahead.

Socrates: How admirably philosophical. Let me suggest more empirically that your statistics must be dated by at least a few years and may be better than what you say. I’d say that you are also young for a colon cancer patient. And I know that you exercise, read poetry, own a pet, drink green tea made from filtered water and eat organic whole-grain anti-oxidant seaweed pomegranate berries. You have friends and family taking good care of you. All of that must be in your favor.

Jed: Yes, but then again behavioral activity is always of questionable value against poor prognostic features, genetics, and tumor biology. Here, take a look at my pathology report.

Socrates: Hmmm. Jed, I usually claim to know nothing so as to become free to receive exciting new knowledge, but here I confess to being frightened just by the sounds of all this medical vocabulary. Quick, Glaucon, open your laptop and Google some of this diagnostic information.

Jed: Socrates, with all due respect, it is my experience that Google and late-stage cancer data combine to form an ever-intensifying and time-devouring spiral of spiritual demoralization. A treacherous, postmodern hermeneutic field is produced by so many facts, questionable facts, interpretations, statistics, personal narratives, and new and experimental treatments. I have learned a great deal about my disease but have also come to realize that there are limits to what I can know and how I can apply it to my case.

Socrates: So you have rescued angst from drowning in hope and hope from withering in angst, but how does this leave you philosophically? Can you now avoid the paralyzing extremes of optimism and despair, of too much and too little information?

Jed: I don’t know, Socrates, but here is how I’m trying to think. I assume that there are three groups of patients who find themselves in my position. The lucky ones can do whatever they like – drink Scotch and smoke pan-blackened pepperoni – without ever having their cancer return. The unlucky ones can also do whatever they like – drink turmeric infusions while practicing zen yoga and enjoying wheat-grass enemas on shimmering leaves of bamboo – but will never ward off their cancer. The last is the make-your-own-luck group. Without knowing it, these patients have the chance to influence outcome with behavior. Now, since we patients cannot know in advance how big each group is nor to which one we belong, our most logical approach is to hope we’re lucky but to act as if we were make-your-own-lucky. Thus I am beginning four more months of chemotherapy on March 24 — it might make the difference.

Socrates: So you are trying to be neither optimistic nor pessimistic but something else, say, probabilistically practical.

Jed: Yes, and every month or so I’ll try to remember to let you know how it’s going. Glaucon can show you where I’m posting the updates.

I AM A SICK MAN…. I am a spiteful man. I am an unattractive man. I believe my liver is diseased.  – Fyodor Dostoevsky, Notes from Underground

Story the short: on Thursday, February 12, I underwent an extended right lobectomy at the Cleveland Clinic. This is a radical kind of hepectomy in which the whole right lobe of the liver and part of the left are removed along with the gallbladder. The surgery went well, all visible cancer was removed, and I am now home recovering. Soon I’ll be meeting with doctors for post-op appointments, getting new CT scans, removing the staples from my stomach, and preparing for 4 more months of chemotherapy. During this last difficult week my family and friends saved my life a hundred times and I thank everyone for so many sacrifices and warm wishes.

Story the long: I was under general anesthesia so was only able to get one image from a medical resident. It was taken just before surgery, when my muscle tone was a bit better. You can see that the doctors have attached two IV lines to my wrists and that I’m just losing sight of the heavens:

After the operation I came in and out of morphine-colored consciousness in the PACU (post-anesthetic care unit) for about 24 hours before being transferred (on Friday the 13th) to G101, a ward with many liver surgery patients, including transplants.

When I awoke I found the following attachments – full-size, alas, not Lilliputian – to my body: a foley catheter, a jp drain, an NG tube, 3 IV lines, and oxygen tubes to each nostril. There were also 6 telemetry hookups (rubberized squares) on my chest, each attached to a different wire, all of which were coiled up and attached once more to a heavy metal transmitter dangling down my front. It, in turn, broadcast my heart’s movements wirelessly to a monitor. Of course many of these attachments were also attached to an IV tree carrying a welter of bags and canisters.

I was not a big truck. I was a series of tubes.

For the next 3 days I couldn’t eat or drink anything (literally: everything was immediately expelled again via the NG tube), couldn’t sleep, couldn’t breathe out my nose, couldn’t take anything but the shallowest breaths due to pain, couldn’t talk more than a word or two at a time without choking (from NG tube & drymouth) or move without feeling the painful itching from my Erbitux rash. I had severe abdominal pains, stomach pains, and a crushing sinus headache (the NG tube goes straight through the sinuses). As Emily Dickinson put it:

There is a Languor of the Life

More imminent than Pain –

‘Tis Pain’s Successor — When the Soul

Has suffered all it can –

A Drowsiness — diffuses –

A Dimness like a Fog

Envelops Consciousness –

As Mists — obliterate a Crag.

21st-century surgeons now call this pain-beyond-pain condition the Cheney point. They knew I had reached it when I began telling everyone in a white coat who “the other terrorists” were (the patients in rooms 19 and 26, as well as nurses Jennifer, Dina, and the other Jennifer, unless it was the same Jennifer all along) and where “all the weapons” were (mostly in the fur of my Scottish terrier, but she is very sneaky and might also have hidden some near the piano bench.)

For three days I found myself looking up deliriously at white coats from my hospital bed. Edgar Allan Poe understated but nonetheless captured something of my experience when he wrote about it in the “Case of M. Valdemar”:

“I presume that no member of the party then present had been unaccustomed to death-bed horrors but so hideous beyond conception was the appearance of Jed Deppman at this moment, that there was a general shrinking back from the region of the bed… Upon the bed, before that whole company, there lay a nearly liquid mass of loathsome—of detestable putridity.”

Then suddenly the NG tube came out in a rainbow of blood and bile.

Then I began to begin to begin to breathe.

Then I drank some juice and did not vomit, clutched a sheet and slept upon it.

Then Hsiu-Chuang waved her hand and the roiling, mutinous tubes began to part and recede. She strode through them like an angel untouched, took me by the hand, and with my parents and children we emerged once again to see the stars. 

 Il l’ouvrit et ne trouva rien.

I was still under anesthesia today when the surgeon came out and spoke to Hsiu-Chuang. He told her that I was going to feel as if I had been punched in the stomach. He was right.

Luckily he was only being perfectly literal. That is in fact exactly how my body feels after the laparoscopic survey of my innards. From a more formosophical perspective, however, I feel that I have been granted a new lease on life (but no, there will never be any talk here of leasing to own).

As was the case for Charles at the end of Madame Bovary, with the simple difference that he was dead and it was an autopsy, I was opened up today and nothing was found. Well, nothing that the last CT scan said might be in or around the colon anyway. I won’t give more surgical details than does Flaubert (lèse majesté cools the epiphanical flow) but let’s just say I don’t think it was for lack of trying.

Perhaps it’s the clear-liquid diet, steroids, narcotics, antihistamines, psychological trauma and physical pain talking, but to my fevered neural network today’s events represent another major foe eluded. At the start of the Inferno, Dante had to get past a leopard, a lion, and a she-wolf just to get his journey started, and that feels about right. Chemo and death anxiety inspire allegoresis, so let me put forth my leopard as my colon resection, my lion as chemotherapy, and my she-wolf as peritoneal spread (no, not as you, Zhen Zhu, vicious animal though you are). If any of these things had gone wrong, if, say, my cancer had not responded to chemo or had spread to the peritoneum then I would not have been able to enter the gates of hell. Or rather, I would have, but only literally, making for a very short 1-canto tale, and, so we see – wheels within wheels of blind Fortuna! — sometimes the literal is not the best option.

I am now trying to get deeper into the vision which, I can’t forget, ends improbably well for Dante. For some reason I find myself attracted to improbable endings, though I am not necessarily dreaming of a sublime experience of the pure presence of God in the Empyrean catalyzed by an impossibly idealized earthly love. It’s more like I’m hoping the spaghetti will stay down long enough for me to enjoy it. Yes, bless all our hearts, that remark was both allegorical and literal.

The next 3 cantos currently exist in cartoon form. 1. I proceed with the portal vein embolization this Thursday with an overnight stay at the Cleveland Clinic. 2. Then I receive some more chemo, presumably because my side effects are running low. Today the nurse had to ask me if my rash was really all over my body, though this may merely have been politesse. I mean the nurse’s manner, of course. The rash is due to the long half-life of the biological agent cetuximab in my body. 3. I remove a nice big portion of liver in mid-February. My funny valentine for HC.

Thanks again to everyone for so much literal and other support. 

Thanks everyone for so many well wishes. I met with my doctors (12 surgeons surging) this week and on January 6 will have an exploratory laparoscopic surgery and biopsy to see what is going on with the local recurrence. It could be quite terrible (2 tumors looming), it could be rather innocent (2 scars a-scaring), or who knows what (3 colon birds). Only 2009 will tell. It did not light up on the PET scan, which is good, but that does not mean it cannot still be something terrible.

If it turns out that I do have a terrible problem at the original site (chute) then, well, let’s not go there unless we have to — it might involve a trip to Pittsburgh (3 hours a-driving). If I don’t have a big issue, then (ladder) I will have a portal vein embolization (PVE) in my liver during the same hospital stay (so, maybe the 7th) and then (ladder #2) liver surgery a few weeks later. The liver (peck) as the ancients knew — think Prometheus — can quickly regenerate (peck) to something like its original size (one liver living).  

Jed had a CT scan on Monday 12/8 and his fifth Folfox infusion the next day. The results from the scan were both bad and good. On the one hand, his oncologist confirmed that he has an aggressive cancer and it looks like he may already have a recurrence at the original tumor site. On the other hand, his liver has responded extremely well to chemotherapy. He is scheduled for a PET scan on Thursday 12/11—this should give more information about the colon reccurrence—and will meet with his surgeons in the next week or so to discuss future options. The plan for now is to continue with chemo.

Jed is extremely grateful for all the warm wishes & dishes sent to his family during this difficult time. Another update will come after he meets with his surgeons.

Jed is continuing with chemotherapy and is negotiating the side effects as best he can. In December he will have another CT scan and discuss future treatment options with his doctor. He is infinitely grateful for all the warm wishes & food!

For the next 8-10 weeks, Jed is on the following chemotherapy schedule: Starting 10/7, every other Tuesday he gets Erbitux (a.k.a cetuximab) and Folfox (i.e. 5-fu, oxaliplatin, and Leucovorin.) He also gets a 46-hour take-home pump for slow-drip 5fu straight into his jugular. Starting 10/7, every Tuesday he gets Erbitux.

Jed says he hasn’t felt this toxic since Sam Slote threw the “bad wine & cheese” party in grad school.

Jed had his follow-up appointment with the oncologist today, which went well. The current plan is to start chemo on October 7th. Wish him well!