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When you have cancer that's going to eat away at your bones until you are dead, it's good to be involved in your care, but only to a point.

When I got a phone call from my doctor's office this morning to 

set up an appointment to consult with him to discuss what to do about the results of a recent bone biopsy, I didn't probe deeply when talking to the woman setting up the appointment. First, she's a physician's assistant; it's not her role to tell me about the interpretation of the tests. Second, what good would it do for me to know now? Today's Tuesday and I'll be seeing my doctor a week from today, his schedule being what it is. The details of the pathology report are likely scary ones, but without the details at hand I can put it on, if not a back burner, a middle burner for now and think about other things for the next few days. Household chores, meal preparation, the book I'm reading, contact with friends, walks outside.

I accept that there's a mind and body connection that influences health, but not over the course of a week. Time not focusing on bad news is good for mental health, right? When I was young, I thought of myself as a realist who wouldn't shy away from unpleasant truths. Now in my sixties, I see the value of not dwelling on them.

Uncomfortable questions about Alex Trebek

The Jeopardy! host, Alex Trebek, posted a video recently in which he described his grim medical condition—late stage pancreatic cancer. Trebek talked about it with courage, honesty, and even humor. His attitude is an admirable one.
He also asked for prayers on his behalf. 
Questions about that:

• If he lives, is that proof that prayers work?
• If he dies, is that proof that prayers don't work?
• If he lives and it means that the Christian god responded to the prayers, why would this be so? Would it be because of the volume of prayers? If true, why would that matter? 

Trebek seems to be a good person. He has participated in USO tours, donated land to conservancy organization, and donated millions to education. As a percentage of his net worth (a reported $50 million), however, his totals are not exceptional. He does his job well. There are many people, however, who are as upstanding and do their jobs well but few will ever know who they are. Their jobs are not jobs that ever touch the lives of others in any significant way, no matter how well they do them. Trebek has never cured a disease or ended suffering for anyone, to my knowledge, though he may have been a fine son/brother/father or spouse.

My 240 million-year-old friend

A Pappochelys, with friend.

On what is now a riverbed in Germany, a Pappochelys basked in the sun 240 million years ago, its belly full of meat it got from gnawing on the carcass of a fish. The sun rose and set, insects whirled through the air. At the time, air had a higher percentage of oxygen than it does now. Animals moved with greater energy and those flying insects were a size impossible for them to reach today. 
The Pappochelys developed cancer in its femur, cancer which spread unchecked, killing it before its natural lifespan was up, a team of JAMA researchers said in a New York Times article today.
This cancer is similar to my own in every way, though on the opposite limb. Also, unlike the Pappochelys, I have a slight chance of survival thanks to the amputation of my leg last year.
My hope is that a century from now people will look at cases like mine and many others and shake their heads sadly, bemoaning that so many died of something so curable in their time, the way we do when reading about people die of simple infections.

Radiation routine

The twenty-six appointments to destroy my cancerous prostate gland are scheduled for three o'clock at the cancer center, but I always arrive early because they can often take me earlier. This may be because others' procedures go more quickly than the schedulers anticipated, or other patients were unable to come. I get to the parking building by 2:15. It's dark, gloomy and dirty, leaks on all floors when it rains, and though it has many handicapped parking spaces it's always hard to find one. There are many cigarette butts near the elevators. This sort of makes sense: People with unhealthy lifestyles are more likely to be at a place like this or have friends who are. But still ... smoking at a cancer hospital?
As I sit in the car I drink the sixteen ounces of water I've brought with me in a thermos. They want my bladder to be full before the treatment so I'm to drink at least twenty minutes before it. The drive there takes fifty minutes and now, nearly at the end of the treatments, that region of my anatomy is so inflamed that I have to urinate often and with tremendous urgency. Getting to the nearest restroom after the drive is always a priority. So far, I've made it without incident. 

The reception area waiting room.

The radiation oncology floor is a level down from the entrance level. On crutches (now and forever), I take the elevator. At the check-in desk Beverly puts a hospital bracelet on my left wrist. We greet each other on friendly terms. She uses "Mr." and my surname. I told her early on that she was welcome to call me by my first name, but she demurred. I get that. I used to work in a hospital and I know that they are nearly as hierarchal as the military. Also, making the sort of pseudo-friendship with people many tend to do may not be a good idea at a hospital that treats cancer patients exclusively; it's easier to say, "Mr. Smith died" than "John died."
The waiting room at the front desk for new patients is large. Told where to go my first day, I know to head for Waiting Room C, down the long, wide hall and on my left. I go there and enter one of the two small dressing rooms, where I strip from the waist down, put my clothes in a locker, and put on a hospital gown. When ready, I enter the waiting room.
The waiting room has a dozen chairs but I've never seen more than three patients in it. Unlike me, most of them are accompanied by a family member or friend, so talk between them and me is infrequent. 
There are large stacks of old magazines and a television tuned to ABC. I don't watch TV anymore and if I did it wouldn't be daytime TV. If I'm there before 2:30, Who Wants to be a Millionaire is on. The show's pattern is always the same. Easy first questions with jokey answers, then one or two at a normal trivia level, and then ludicrously difficult ones, something like, "Of these four nations admitted to the United Nations in the nineteen sixties, which was last?" That show's followed by Right This Minute, the most irritating kind of show there is: People sit at monitors and comment on clips that have become popular on the internet. There are four of them and their comments are supposed to be funny or thought provoking but never are. They often repeat the clip several times, as though the viewer can't comprehend visually what happened the first time like they have, or that viewers really want to see video of people slipping on ice and falling down again and again. As stupid a show as it is, it's both visually and auditorially noisy, making it hard not to glance at the screen now and then during it.

Radiation oncology waiting area.

I'm often called before this show is well underway.
The technicians who perform the procedure are friendly and polite. They are usually women. Although I go to the same room daily, one of two rooms that does this procedure, I seldom have the same two technicians because some of them work part time. The room is darkened, which is calming. I sit on the table, one takes my crutches and puts them aside, and I lie back. I raise my pelvis and one puts the mold that was made of that area under me. They put a cloth over my lower pelvis and pull up my gown before telling me to lower myself. The cloth is about the size of a dishtowel and it covers my genitals. That's as good for them as for me—I hate getting naked in front of strangers, even in a medical setting.
Having my pelvis properly aligned is important, so I had three small tattoos before I began this. Next, they raise the table I'm on and then, with one on either side of me, tug on the large cloth I'm lying on to align the tattoos and the laser. "I need a two," one will say to the other. Tug, tug. "Three." Tug. During this, I relax and remain passive, like a lump of clay being thrown on a potter's wheel, a crooked picture being adjusted. When they're done, they go into their control center. The big machine goes around me, taking a low-resolution MRI of my pelvis to make the alignment perfect, which it does by moving the table millimeters in whatever direction is necessary. This feels like I'm in bed and a dog jumps up on it, or that I'm lying on a floor during a mild earthquake. 
After this, one of the technicians says over a speaker, "Beginning treatment." I never know if I should say anything or not. How loud should I speak if I do? I trying to keep my breaths shallow, so I don't respond. Again, the machine circles from below around me clockwise for one minute, pauses for a few seconds, then circles back again counterclockwise, again, for a minute. As it does this it emits an electronic sustained "la." The entire procedure last just minutes. Music from a Spotify account plays in the room and once, the whole procedure fit into the length of just one song, though that song was over eight minutes long (Don McLean's American Pie). 

The procedure isn't at all bad, but I've disliked the process. The drive, the parking, the undressing and dressing, the waiting. These are complaints other cancer patients would gladly trade for their own. Years ago, when I was a newspaper reporter, I interviewed a woman with brain cancer who had undergone extensive chemotherapy. "Ever cell in my body hurt more than you can imagine," she said. She later died from the disease. In my case, the sarcoma I also have is likely to kill me pretty soon, meaning that the prostate cancer treatment will have been unnecessary.
When the procedure is over, I rush to the dressing room and then to a bathroom as by now my bladder is ready to burst. The drive to the turnpike is winding, suburban-like. I head west, toward home. 
The afternoon sun highlights a surprising number of jets and their contrails in the sky as the jets also head west. The jets are close to one another, sometimes just half a mile or so apart, but at different altitudes. I think about the hundreds of people on them. They're heading toward or away from family members and friends, joyous or sad events, different jobs or business ventures, vacations, experiences. New lives.

Nothing worse than this

Fatima Ali, a fan favorite on the show "Top Chef," who died Friday, January 25, 2019, of Ewing's sarcoma.

When you have a rare kind of cancer like I do, there are few things that will ruin your day faster than hearing about someone dying from it.
That happened to me just minutes ago.
Day ruined.
And really, there is something worse than this. Much worse.

Celestial events

I went outside last night around ten thirty to see the lunar eclipse. It had started, with the earth's shadow taking a bite of the moon's lower left quadrant. The sky was clear but there's a temporary cold snap in my area so I went back inside after a few minutes. An hour later, I found that I could see the moon from a skylight in the house, so I watched the last bit of the lunar surface fade to shadow from there. 
The moon gets a pinkish hue during these because the light hitting it is passing through the earth's atmosphere. I heard an astronomer describing it on the radio yesterday as it being like the light of a thousand sunsets. Poetic. 

The best lunar eclipse I ever saw was in 1985. I was living in Nagoya, Japan, and I didn't know it was going to happen. I was sitting on the balcony of the apartment I was living in enjoying the evening when I saw the moon getting shaded. Seeing it this way, I felt a little of the wonder and awe that people must have felt centuries ago. 
Watching it last night, I thought about how part of the reason people like watching things like it is that they happen rarely and the times between their occurrences can be long. I also thought about how many people like me, with multiple health conditions that will likely kill me in a year or two, regard every sunrise as a celestial event.

End of another year

It was so fun when I was a little kid and New Year's seemed like this great, big, important thing that required planning and activity. There'd be all these rituals that had to be carried out correctly. The coming new year seemed to have a physical presence that would need to be accommodated, an ocean liner nearing a small harbor. For decades now it's just brought on a shrug and the only plans have to do with what stores and offices will close early New Year's Eve and closed New Year's Day.

Me, alone, in 1960.

2018 has seen the amputation of my right leg, the shattering of my right shoulder, a likely terminal diagnosis related to the cancer that took the leg and prostate cancer bad enough that I'll be getting radiation treatment for it beginning on the third day of 2019.
When you tell young people about the bad things that happened to you in a given year, they say cheery things about the new year being a better one. That makes sense when you're under forty. At that age, your sadness comes from things that will heal—a pet's death, the end of a relationship, the loss of a job. When you get older that rule breaks. You're aging. Your immune system permits access to disease and nothing will make your muscles as firm and your skin as taut as before. The next year is probably going to be worse than the one you just survived, and that's true of the year after that and all the years that follow until none follow. 
I'll spend the night alone, as usual. I am always alone and have been for so long now that I prefer it that way. 

Five days later

The results of the tests I've been getting every three months are done in a day but when five days passed without getting them and hearing the guy I called to ask about this say that if the results were "sensitive" it may take longer I was ... what's the right word? "Anxious" doesn't seem to do it. When I was a kid I'd have said "shitting bricks," but I'm too old now (sixty) to say such things. "Perturbed" might be all right, but sounds too low-level and is stuffy, too. 
Anyway, I just got them and I'm happy to say that they indicated that I'll be around for at least another several months. It's odd to read something with the word "no" in it so many times and take it as good news. It's also a little sad that when I see the word "stable"—I do have bad stuff going on inside me—I'm happy. 
Meanwhile, family drama. A dispute with a brother over my behavior. Wait, that sounds wrong; it sounds like I've been getting drunk at parties and breaking things. It's about my anger at how while I was hospitalized my sisters-in-law threw out things that meant much to me. (Note to all: Never do that.)
My brother got quite agitated, waving his arms around and, for some reason, mimicking me. Honestly, I don't sound weird or anything. He was more doing it as a tactic, I think. I've never done that. Yes, I've done impressions of people behind their backs, but often as a compliment to them, though if that were true I'd do it in front of them so I'm being weasely saying that. You got me. Still, I'd never do it to him or anyone else, no matter how angry I was.
Family trouble. Shit. I'm not going to think about it. I got good news today.
Meanwhile, tomorrow I go in for an MRI of my prostate gland. This will involve something not suitable to discuss in mixed company.

Highs where I live, southeastern Pennsylvania, won't get out of the forties for the foreseeable future, and it will freeze almost nightly. This time of year, at this location, this is the kind of weather that gives idiots license to sneer at climate change.
There's still some snow on the ground where I live. Bad, because it means I can't go crutching in the park because I only like doing it if I can get off the paved surfaces. I took this picture last week. Look at that sky. There is such beauty in the world, sometimes, no?
 

Scan time

Tomorrow, scan of my chest and pelvis. The chest to see if I'll be dead within a year or not, the pelvis to see whether the bone cancer has come back to the amputation site. If it does, more hacking away of my body would be needed. Imagine a disappearing man, bit by bit. 
Six days later, an MRI of my prostate to see if that cancer has gotten big and aggressive enough to warrant treatment. To date, the answer to that is yes, but a few treatments of targeted radiation should be enough to kill it. But the first cancer, if there, would make treating the second cancer a waste of time.

Valley Forge National Park.

They read scans fast these days. (Who reads them is unknown. I've heard some are sent overseas to cut costs.) I'm planning to join some friends for dinner the day after the scans. The question is, should I get the results before the dinner, in which case I'll either be exuberant or crushed, or put that off until the next day, in which case I'll be anxious?
Meanwhile, it's perfect fall weather here, a suburb of Philadelphia. I went crutching in the park this afternoon. Heart, lungs, muscles, all pumping away.

Mine eyes

Yesterday, I had an appointment with a doctor who I'm hoping will be able to zap the cancer out of my prostate gland. I've had a degree of cancer there for awhile now but I've been putting the sarcoma and the broken shoulder ahead of it.
Often these days, when seeing doctors you meet with a resident first. The resident takes some information and tells you things the doctor will tell you before going out and telling the doctor what you just told the resident. There's some redundancy there, of course, but that's probably for the best.

The resident was a woman. That's a surprise; not many women go into treating men for prostate issues. After I told her about my various problems and poor odds of survival she asked my if I was coping with it all. I shrugged and said yes. She looked genuinely concerned and a little doubtful of my answer. I didn't think anything of this until I got home and looked in the mirror.
The psoriasis around my eyes has flared up lately. I've been putting the prescription medicine I got last year on it when it first emerged as a problem for a few days but it hasn't calmed the condition much yet. Red and baggy. I looked like I'd been crying all day, and I'm guessing that's what the resident thought. That was sweet of her.

A stable loser

Why yes, as a matter of fact, I have been drinking. And the drinks I had were at 3:30 this afternoon. I don't usually do this. I go weeks, even months at a time without touching alcohol at all, and when I do drink, I don't drink much. I buy cases of beer that are exceptional because the beers are six ounce bottles or cans, far less than the usual, and when I'm in a drink-every-day mode I have just one a day, with dinner.
So why did I drink one of those and then a vodka martini (i.e., a glass of vodka with olives) after it? Because I wanted to celebrate getting a clear scan, that's why. 
I get, you see, scans every three months to see whether or not the bone cancer has spread to my lungs, which will ensure a lingering and unpleasant death. The scan I got two days ago has been read (they do that fast these days) and I picked up the report and the disc (for the doctor) this afternoon. 
If you're not in a situation like mine, with a sarcoma (bone cancer) that required amputation of my right leg six months ago, you won't have had the feelings I do when this happens. The anxiety is so great that you almost wish the report would start out saying something, "Uh-oh. You're history, pal," and just get it over with. Instead, mine this time kept using the word "stable," which is good. I do have a nodule in a lung, which is bad, but that showed up awhile ago and if it remains stable I'm all right. For now. 

American medicine is advanced in many ways, but one way in which it isn't is when it comes to records and distribution of them. They still use fax machines! What is this, 1997? And they put the images on CDs, which many newer computers don't even have slots for. Part of what this means is that I have to drive six miles or so to pick up the report and disc. A nerve wracking drive which, if you're ever faced with would be better off done by someone else but I've always been alone (see blog's title) so I have to do it myself. I had to focus intently on the road ahead and calm my mind so I didn't do something dumb like blank on a traffic light. 
At the imaging facility, I had to wait five minutes for the clerk to bring me my stuff. As she approached, I studied her face. Nothing there. 

What would you do if handed a manila envelope with news that was tantamount to a thumbs up or thumbs down on your life expectancy? Open it right there, wait until you got to the car, or wait until you got home? My choice was to wait until I got home. I'd cleared the table of trivial stuff (the crossword puzzle in the newspaper, mail I hadn't opened yet) before leaving the house. When I got home, I put the envelope on the table and opened a beer and poured it into a glass. If it was bad news or good, a drink would be in order.
You know the next part. Good news. 
This means I'm good until the next scan, which will be in three months. I wonder if my seventy-five to twenty-five (bad to good) odds get better each time I get good results. I must remember to ask the doctor that when I see him on Thursday.
With my luck (always bad, throughout my life) I'll probably be diagnosed with cirrhosis next week.
Incidentally, two days after the last time I got a clean reading three months ago—this is only the second one—I slipped, fell, and broke my shoulder so badly that I'm still in pain. Alcohol had nothing to do with this. Stupidity did.

Odd thoughts

My Nutri Ninja Pro blender started to smoke two years ago. It smelled awful. I couldn't tell where the smoke was coming from and assumed the motor was the source. Wrong. The

Bad blender.

lower part of the blade assembly was rubbing against the body and the friction heated it up. The blender wasn't so old. Scrolling through reviews of it on Amazon yesterday, I saw that at least one other owner had the identical problem. A replacement part costs $35, not too far from the cost of getting a new one, $50. I looked and found a better blender, at least based on reviews on Amazon and elsewhere, for $150. 
Then I thought, what if the next scan that I have every three months shows that the cancer, which is untreatable, has spread to my lungs, meaning I'll be dead in a year or two? Why would I need a Cuisinart blender of much better quality? I doubt I know anyone who would want it when I die.

Good blender.

Then I thought about how strange it was to think such things and how doing so would have been unimaginable to me not long ago.

Dead, dead, dead

The three koi I had in a man-made pond died last week. 
It was partly my fault. Although the leg amputation in February and shoulder replacement in May have made getting out to see the pond risky because I'm using a wheelchair and there are two tricky steps involved, I had made the trip and could have kept doing so. If I had, I'd have seen that the power to their water and air pump was out. A friend fed them on Sunday, they were dead on Wednesday. The friend says he thinks the pumps were going, but I doubt that; the fish have survived much longer power outages, even in summer, when working pumps are essential (warm water holds less oxygen than cold water). I should have specifically asked him to check to see if the little waterfall was flowing. 

Other than things you can't see and some aquatic plants, this is empty.

I also blame the gardeners my brothers hired to clean up the grounds (I admit I was slow to do this, which is why they stepped in and hired people without telling me, but I had planned to make a call that week). They uncovered the outlet to the devices and didn't put the cover back. There was a short but strong storm that Sunday that may have shorted out the power. Also, there was a sheen of oil on the water, which would have blocked oxygen, and I suspect it was runoff from the mulch they used around the pond. 
One of the fish was twenty-five years old and had been around when my parents were alive. The other two I'd bought five years ago. All three had many more years ahead of them. I'd named the three after my brothers and I. It's stupid to give pets names; it makes it harder when they die.
The way the fish died would have been unpleasant. It is a precursor to the way I'll probably die when the form of cancer that required removal of my leg spreads to my lungs. 
They will be my last pets. Ever. I can't have pets because I love them too much and they always die, saddening me for years. The joy they give when alive doesn't outweigh the misery. Once the sadness I feel now ebbs a little, it will be almost nice not to have to worry about anything other than a couple of houseplants. But that ebbing won't be for years, and I probably don't have that long.

Creepy as can be

When I was a boy, in the 1960s, a hypothetical question came up during a family chat. The question was, if you had cancer (which, at that time, nearly always meant you were going to die) would you want to know? The question sounds crazy now but it wasn't that long ago that patients weren't always informed fully of their conditions. My mother said she wouldn't. My brothers and I said we would, as did, I think, my father. 

Goya's "Saturn Devouring His Son."

These days we all have access to our medical records, of course, and it's for the best. Doctors make mistakes patients catch, or sometimes they don't think of something a patient might. I recently looked at a report based on the amputation of my right leg last month. It's like reading an autopsy report about yourself and in this case it is, indeed, about a chunk of myself. It's pasted below, but I don't plan to read it again.

 

B (2). Right leg, disarticulation: Received fresh in a specimen bag containing patient name and "right leg" is a right above-the-knee leg amputation measuring 81 x 17.5 x 16.5 cm consisting of femoral head and entire right leg extending down to the foot. The leg consists of an intact femoral head with a soft tissue resection margin that is red-pink and consisting of muscle, fat with overlying tan-yellow skin. The soft tissue overlying the thigh is serially sectioned to reveal a tan-yellow encapsulated lesion that is calcified measuring approximately 12 x 5.5 x 1.5 cm lying on the anterior surface of the leg. The mass grossly abuts the underlying metal rod implant and is 3.5 cm from closest overlying skin. The mass is 10 cm from the medial resection margin, 14 cm from the anterior resection margin, 11.5 cm from the lateral resection margin, and 16 cm from the posterior resection margin. The resection margins are inked black and the specimen is representatively submitted as follows:

B1. Anterior resection margin, representative

B2. Medial resection margin, en face, representative

B3. Lateral resection margin, en face, representative

B4. Posterior resection margin, representative

B5-B19. Tumor, representative, after brief decalcification

 

Gross done by Aidan P Kerr at 2/26/2018 3:39 PM.

Every day is worse

The diagnosis I got earlier this week, that I am terminally ill and that no treatment can save me, has changed my life, as you might expect. Although my condition was detectable only by various scans and I feel well, I'm questioning every little twinge and ache in my body. I know that's stupid, but I also knows that I have conditions in my lungs, heart, prostate and leg, so I'm not too wrong about this. 

Some cabins at Valley Forge Park.

I have been taking sleeping pills before bed and they work well but I still wake up before five in the morning and can't get back to sleep. During the days, I feel as though my clothes are made of lead. I took one of my walks in Valley Forge Park today, but rather than see nature's beauty, I saw only beauty that I will never see again in a year, two if I'm lucky. 
I wonder, will I adjust to this and be able to read or watch a movie again or will such things be too slight to distract me?

This will be the year

Yesterday at 8:06 a.m. the Complete and Total Loser completed his 56th year of living outside his mother's body.
Since he was in his mid 40s, the Loser has joked about how at a specific age, when he imagined getting money, work, women and himself sorted out he'd find himself feeling ill, see his doctor, and learn that he has pancreatic cancer and that there's no hope for any cure, as is usually the case with that kind of cancer and therefore the reason he choose it for the joke. The age he used was always 56 -- the age he turned yesterday. It just sounded right.
He spent the night in bed in the nice suburban house his late parents owned and he lives in now. He has hundreds of thousands of dollars to his name, thanks to those parents. His job sucks but he's at management level now and is secure, though he wouldn't mind if the job evaporated. Finally, he spent that night in bed with a woman he's been seeing for months now, the longest he's ever been with a woman, and he looks forward to her next visit.
The cancer is due any day now ...

This elderly woman will probably outlive the Complete and Total Loser.

The Fundraiser

The Complete and Total Loser has a coworker who's mother is dying of lung cancer. (If you smoke all your life, you will have a premature and unpleasant death. The coworker doesn't seem to get this and still smokes, even in the house with his mother.) Recently he and family held a fundraiser to help cover her medical costs. Until she left due to illness, she'd worked in a bank and had good health insurance. The copays got her. 
The fundraiser was well attended but it wasn't the Loser's kind of event. It was as if a hundred people entered a room that could accommodate fifty and decided to shout as loud as they could for no reason. The Loser was hungry and got there late so he ate a piece of aging beef. The plastic forks were bad ones even by plastic fork standards. The Loser had to use it more as a shovel. The piece he got in his mouth was the largest piece of anything he'd ever eaten. At one point, he wondered if someone present knew the Heimlich Maneuver. Somehow, he got it down and twenty minutes later he felt like he'd had a vitamin B-12 shot.

To many, noise equals fun.

Lung Cancer

A coworker of the Complete and Total Loser learned recently that his mother has lung cancer. About 75 percent of lung cancer victims are dead in two years. Is his coworker upset? Sure. Has he quit smoking? Nope. Has the Loser said, "You really should quit smoking"? 
No. He's proud of himself for not saying that.
But he should.

Eric Lawson died Jan. 10 at his California home. The cause was respiratory failure due to chronic obstructive pulmonary disease, or COPD. The ruggedly handsome Lawson portrayed the smoking cowboy in Marlboro print ads from 1978 to 1981. He also had bit parts in such TV shows as Baretta and Charlie's Angels before injuries sustained on the set of a Western film ended his acting career. A smoker since age 14, Lawson later appeared in an anti-smoking commercial that parodied the Marlboro Man and an Entertainment Tonight segment to discuss the negative effects of smoking. (People Magazine)

Regrets

The Complete and Total Loser's high PSA level (5) means the disease will kill him. (And please, none of that "Well with that attitude of course it will!" bullshit -- unspeakable optimistic people get killed by lesser cancers all the time, and nattering nabobs of negativism conquer virulent cancers without trying as often.)

Although his death may be a few years from now, the Loser is thinking of how he'd list his regrets. His first and most overwhelming of these is never having a successful relationship with a woman. From it, much else could have flowed. Maybe even a career he liked and that gave his life meaning. He'll never know.
In his dark times, he looks at couples and wonders how they make it look so easy. Standing casually, chatting, no anxiety. The Loser studies these couples, baffled.

How to die of cancer

It rose. A lot. The Complete and Total Loser's PSA level was a comfortable 3 a year ago but it's gone up to 5, last week's blood test showed. 
It's too early to write up his will, but still. The Loser is 55 and his father got a prostate diagnosis at age 60, so the Loser can't help but think his time is here. Besides, he is a Loser and he knows himself better than his doctor, who is just for sitting back awhile and getting retested in three months. Note this now: It will be cancer, full blown.
His father made the Loser wonder how he'd deal with his own illnesses when they came. 
He decided to:

• Shut up about it; tell no one
• If he didn't have a loving wife or kids, do little to stave it off (he has neither). Why live for years wearing diapers and scheduling appointments when your life is meaningless?
• Read more
• Meditate more
• Eat out more
• Visit the friends and places he made when living overseas in the 80s
• Do something about getting laid (it's been fifteen years to date) or at least go to strip joints
• Give or otherwise dispose of everything that wouldn't fit in an overnight bag
• Get stimulates and other drugs and take them
• Rather than die gasping in a hospital bed, write a nice goodbye letter and hike deep into the woods with a bottle of great alcohol and a fist full of pills. Bury self, take a fatal dose, die quietly, be absorbed by nature