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.

Intimate moments

They know when I'm full of shit. They know when I have to urinate. They even know when I wouldn't mind farting. And then they see my crotch.

They are the technicians administering the daily radiation to my prostate gland, a process which should kill it and the cancer in it. Before they do it, I lie on a mold made of my pelvic area and they line up the three tiny tattoos I had for this with laser beams. Then they go in and do a low-dose MRI to target the prostate gland accurately. That's when they see all the inside stuff. 
It's a little weird, but they are professional about it and when they do much of this they're behind glass and the jokes they make about me, if any, go unheard by me.

What's next

Arnold Schwarzenegger with a woman.

I'd bet that men are less likely than women to believe that hormones influence their feelings and moods. Part of being human is thinking you have control over your decision making process and that you behave rationally. 
When men age, their testosterone levels drop. Many fight this and get supplements. Others are OK with it. Sophocles is reported to have said, when asked how he felt about the effect of age on his libido, "I feel as if I had escaped from a mad and furious master." That would have been around 410 BCE. 
The reason I'm thinking about this is that starting next week I'll be taking pills that will reduce my testosterone level. I'll continue taking them for six months. This is in combination with five weeks of radiation to my prostate gland and surrounding area to try to kill the cancer there. (Honestly, what I'm looking forward to the least about this is the twenty-six trips to the hospital where this is being done. It's under thirty miles but the drive is a winding, indirect one and will take about an hour on a week day.

Sophocles on June 17, 437 BCE.

Silly to complain about this, as so many have much worse commutes, but that's me.)
Studies have found a link between high testosterone levels and prostate cancer. So what the hell, I might as well try it. 
It'll be interesting to see whether the therapy will change my mood. Chemical castration was used in the 1980s on repeat sex offenders, so I guess some feel that it does, but I never saw a study showing that. 
I'll post things about it here in the future. 

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?
 

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.

Unending ends

Yesterday, the Complete and Total Loser had hours of scans of his lungs and his leg, either or both which may be harboring a kind of cancer for which there is no treatment and would kill him within a year.
The tests over, the Loser stopped off at a fancy supermarket (Whole Foods) and bought, with a gift card from a dear friend, things he usually doesn't buy. For example, he paid over $3 for a slice of pizza. It had things on it that looked delicious and nice, thick cheese. As he asked for it, the woman behind the counter said, "This one? The vegan pizza?" The Loser nearly changed his mind on hearing that it was vegan but he didn't want to reveal to the woman what a narrow-minded bigot he is so he bought it. 
He took it home, heated it up, and ate it. It was ... excellent! Much better than many regular slices he's had in his more than five decades of eating pizza, with none of the grease regular pizzas have. A nice lunch as a reward for doing without breakfast due to the tests.
Then the phone chirped. The caller I.D. showed a foreign sounding name unfamiliar to the Loser, so he answered warily. It turned out to be a doctor the Loser had never seen calling to see if the Loser was OK because the tests he'd had just a few hours before had been sent to the Loser's knee guy and found that the Loser has a pulmonary embolism. He prescribed medicine to thin the Loser's blood, which the Loser got right away. He also made an appointment to meet with the doctor the next day.
It's unlikely that the embolism will kill the Loser, but still. It's upped his tally of illnesses for 2017. 

A new fare collection device at a suburban Philadelphia train station.

So far, the Loser has or may have:

• Prostate cancer (has)
• Ascending aortic aneurysm (has)
• Sarcoma that will require leg amputation or take root in a lung and kill (may have)
• Eczema (has and it's getting worse)
• Pulmonary embolism (has)

The Loser went to the city via train. He walks slowly now, like an old man. Young people swirled around him, all good looking, dynamic, in charge. Everything is changing around the Loser and even though he's got a few months before hitting sixty, he feels increasingly out of touch and irrelevant. Part of this is the season. As he writes this, just days before the official start of winter, sunlight tilts in ways that cast long shadows and the day's end nears by 3 o'clock.

A camera up there

Yesterday, the Complete and Total Loser spent over half an hour with a camera up a part of his body he regards as an exit-only portal that required cleansing steps prior to the camera's insertion. It wasn't a camera as most would understand it, with a lens. It was more like a probe and the procedure in some ways resembled ones you'd hear alien abduction victims (i.e., crazy people) talk about having used on them in the 1990s, when that was a thing. 
The idea was to get an MRI of the Loser's cancerous prostate to check the progress of said cancer to determine how urgent its removal may be. That's not a step most bother with, but the Loser has other health issues going on and will refrain getting his gland yanked if those other issues arise as they will kill him within a year, making removal of the prostate unnecessary. 

Technicians stand by an MRI machine, waiting to abuse the Loser.

Needles, injections of contrast fluids, a noisy machine, a narrow bed that would jerk back and forth an inch or so to get good images. No fun and in a few days he'll be undergoing something as bad at the same place for his lungs and decrepit leg that will take several times longer. 
Meanwhile, as he writes this, Southern California is burning and snow is falling in the Loser's southeastern Pennsylvania town even though it's twelve days before the start of winter. It is very pretty and calming to see, and the Loser may spike his eggnog later, sit by a window and enjoy the view.

Long walks

Last week, the Complete and Total Loser walked three times in Valley Forge National Park. He even got off the trail and walked on rough surfaces. This is a big deal to him since the knee replacement surgery he had in June went only so-so and what he's walking on is a hinge connecting two rods. Also, last week the Loser had a "manipulation," an attempt to make his bad leg bend more than forty-five degrees. It was unsuccessful.

A part of a trail at Valley Forge National Park.

The doctor said laparoscopic surgery was an option, that another doctor could go in and scrape away the built up scar tissue and make the leg more flexible, but the Loser is wary of yet another procedure. If he never rides a bike again, so be it. He's nearly sixty anyway and it's unlikely that he'll be sixty-five, let alone seventy. He can walk, he can drive.
By the end of the year the Loser's prostate will come out. The surgeon he spoke to about this said the numbers of men these days who are left incontinent and impotent are low, but the Loser knows he'll be among them. He just knows it.

Since late April

Here is the Complete and Total Loser's health tally from April 24 to September 14 of this year, 2017:

• Knee replacement surgery that found his childhood bone sarcoma had returned, making the replacement surgery impossible. The surgeon took out the knee, put in a concrete spacer, stitched the Loser up, and told him he'd try again in a month or so. Meanwhile: crutches.
• Being told by this same surgeon that he needed a cat scan of his lungs after being injected with a dye for contrast because the bone sarcoma "liked to migrate" to lungs and that there was a one-in-three chance of that happening which, if it does, will kill the Loser within a year. He's to have this test every three months for the first year, less often after that.
• Finding, from the blood test that determined the Loser could tolerate the dye, that his PSA level had shot up, and then having a prostate biopsy that found the Loser's prostate to be cancerous enough to require it's removal at some point in the near future.
• Knee replacement surgery, successful this time, but not with the kind of artificial knee most would get but a hinge and two titanium rods hammered into what's left of his bones. The replacement weighs five pounds, which doesn't sound heavy and isn't until it's inside you like that.
  
• Learning today, after his second lung cat scan, that although his lungs are fine he has an aortic aneurysm of about four centimeters and must go on high blood pressure medication soon. Usually, aortic aneurysms develop slowly and don't burst right away (which always kills you) and don't require surgery, but the fact that the Loser's has appeared so quickly—no one said anything when the first scan was done—has him wondering if he's not an exception to this. He'll find out more from his general physician tomorrow.

The Loser is 59. He never thought he'd make it to his fifties and he knows he won't live to be seventy, but now he's starting to wonder if he'll live to be sixty.

Waiting

Commuters wait for a train.

This is one of the many weeks the Complete and Total Loser simply waits. In this case, he waits to find test results that may (will; you watch) indicate that he has a good enough chance of having prostate cancer that a biopsy will be needed, which will interfere with the pending second try at knee replacement surgery, and the Loser will have to continue being on crutches, his ruined right leg dangling uselessly, probably indefinitely.
It is not fun and the Loser is tempted to do something as corny as make a list of things he's grateful for. Why not? It's not like it could hurt.

Getting ready

The Complete and Total Loser is getting ready for a total knee replacement, which will happen the 24th of this month (April, 2017). He is not looking forward to it, even though his knee has hurt for years now. 

A woman using a shower chair.

The Loser is even trying to find excuses to cancel it, like his sore hip, which will need replacing in a few years. He knows he'll go through with it and put up with the intense pain and probably not be as good at the rehabilitation part of it as he should be because he has no one in his life who loves him and will make him stay motivated. And he also knows that before he's at all recovered and back in shape something else will come up, like prostate cancer, and he'll probably be killed by it before he's even had a chance to enjoy the painful surgery's benefits.
Meanwhile, he has bought a shower chair. It cost $55, a lot for a cheap plastic device, but the Loser knows he'll probably need it again before long.

How to Lower your PSA

Prostate Specific Antigen is the stuff that liquifies your semen so you can inject women with your filthy, dirty DNA and make this hopelessly overcrowded world even more stretched for precious resources than it already is. It's what rape kits look for and is produced by your prostate gland. When you have prostate cancer the goo leaks into your bloodstream and a measurement of it indicates whether or not you have prostate cancer. Or not. 
A variety of things can make more of it show up. Having sex, a vigorous bike ride, being fucked in the ass. If you have your PSA level checked annually, like the Complete and Total Loser does because his father had it, the Loser is over 50 and he is a loser, one thing to look for beside the number is the velocity of it. How much did it rise over a given time period?

No one really knows how anything works.

The Loser had it checked in May of 2012 and it was 3. He had it checked in June of this year and it was 4.5. Uh-oh, said his doctor. Zero is great; 4.5 is shitty if you're under 60, which the Loser is, and means a biopsy is warranted. For those, they shove stuff up your ass and take tiny cores. After them, there's blood in your piss and ejaculate.
"If you go to a urologist," the Loser's doctor said, "he'll tell you what I'm going to tell you which is to get it checked in three months and see where we are."
OK, said the Loser. In between he read a big book about it that gave him enough info to bore others with, which he has mercifully confined to this site (he's told no friends or family). 
When you get a book on medical stuff what you look for is the most current one written by someone who works at a hospital you've heard of. The Loser found The Whole Life Prostate Book, which came out last year.
The book went on and on about diet, which many medical books do. Dull, nagging reading, but it reminded the Loser of what he's long known but wasn't acting on: The American diet is a bad one. The most telling fact about this is that when people emigrate from countries with different diets and low cancer rates to America, their rates of cancer match ours within a generation or two. 
The Loser's ready to die, but he doesn't want death to come from his own cells going apeshit and eating him from inside. No. He wants to die by diverting a terrorist attack of some kind. To avoid death, the Loser took some steps. Three months later he went back to his doctor and had blood drawn. Two days later, his doctor called.

Bend over and spread 'em, Loser.

"I have wonderful news!" he ejaculated. "Your PSA level came back at 2.9. The thing to do now is nothing until your next annual physical when we'll do another test." 
Here's what the Loser did to lower his PSA level;

• He bought those bags of lettuce you see at supermarkets and ate salads every night. Leaves, a few cubes of tofu, a handful of walnuts, oil and vinegar salad dressing = dinner. He always ate a decent breakfast and lunch. He now eats almost no meat. Fish about once a week. Never beef, never lamb, seldom chicken. Pork? Are you kidding?
• He cut a lemon in half every morning and squeezed half into his smoothie and half into his nightly beer. Lemon juice is supposed to be good for you blood. It changes its PH level. Not that doing that has anything to do with cancer. 
• Speaking of that nightly beer, the Loser bought a case of 7-ounce bottles and limits himself to one a night, two on days off. With less booze and the salads, he lost 15 pounds over the first two months and gets on the scale every day now to keep an eye on is weight.
• Before his last test, he stayed off his bicycle and didn't jerk off for three days. That last part, the jerking off, is very easy to do for him, by the way.

The Loser has no idea if this reversed anything or made him less likely to get cancer, but until June of 2014 he doesn't have to worry about it and that's enough for him.

The news

Not to bore you with details, but the Complete and Total Loser whined several times over the past three months over his impending death from prostate cancer. His self-based diagnosis came from his 1.5 rise in his PSA level over the period of one year (which made it go from 3 to 4.5), his family history of the disease (his dad, who didn't die from it but died anyway in '11), his age (under 60) and his general loser life.

This means he'll spend more years alone. Great.

Three months ago the doc said to come back around now to retest and see where it was. You want to look at the velocity of the rise before you dig in around that region and snip things that bring on impotence (already there for other reasons) and incontinence (no thanks). 
The test two days ago found a level of 2.9, lower than it was sixteen months ago.
The Loser's first thought: I'm going to live! 
The Loser's second thought: I'm going to live.

I guess you had to be there to hear the difference in intonation. Actually, that wouldn't have mattered as they were thoughts and you wouldn't have heard anything. 

The Pervert in Winter

We call him The Perv.
He is elderly, over 65, probably 70. You can tell he works his old muscles out and that he hasn't accepted his age. He always wears the same thing: Baggy shorts wrong for his spindly legs, a long-sleeved collarless shirt, sneakers, a cap. 
He's a member of the art museum and his thing is to follow solo women a third his age or less, Asians often, around the galleries and hit on them. He's there at least twice a week.
"Are you an art student?" he'll ask, and go from there with offers to guide them to a part of the museum they "really should see." At some point he'll try to get their email addresses. He also tries to pick up the museum's front line staff.
A few have reported him to the guards and he's been what the security people call 302'd: Put on watch. At times they follow him to see if he bothers someone. The admissions staff tried to have his membership revoked but the membership department didn't allow it as he hadn't done anything overt; making others uncomfortable is not an actionable offense and, if he were young and appealing his actions would be welcomed by some. (And if he were young and appealing he wouldn't be pathetically trying to pick up women three times a week.)
It bothers the Complete and Total Loser to see The Perv. Not because of what he might do; he's a harmless annoyance, nothing more. It's that he makes the Loser think of what he might turn into in just a few years (provided his prostate cancer doesn't kill him first, which it probably will).
Sad. Needy. An object of derisive laughter. 
Then again, this is likely true now.

A sad, lonely old man leaves after trying to win affection from women a third his age.

   

The Loser is Losing

After weeks of dieting, the Complete and Total Loser is finally feeling a small difference. He can put his pants on without having to suck in his repulsive gut. 
The secret is, of course, not to eat. No fun, but once you get used to it, the constant hunger can become a companion and you stop thinking about only food.
He is eating salads. He hates salads. Or so he thinks. Really, they're not so bad. A pain in the ass to prepare, even though he's using those bags of various greens you get in supermarkets that kill people with e. coli from fecal matter now and then. (It's hard, apparently, to teach poorly paid, undocumented migrants from developing nations to wash their hands after taking a shit prior to handling food others will eat.) 
The Loser wants to be the fittest prostate cancer victim he knows. He's got a ways to go to achieve this. 

Fat asleep: The Loser often falls asleep while taking the train home after work.

Doctorspeak translations -- prostate cancer

• Your PSA level's a little high. = You're dying of cancer.
• Don't worry about it, but we'll retest it in three months. = It won't be long now, but we'll dangle hope and get as much money from you as we can before you die.
• Doing a biopsy would show us what's going on and determine a future course of action. = The cancer you're dying of will spread all over from that stupid little gland no one ever thinks about.
• There's a lot we can do before we talk about surgery. = There's no hope for you. You're dying of cancer and your death will be slow and painful. Stupid gland. The only way anyone can feel it is through your asshole. That oughtta tell you something.
• Targeted radiation therapy is the best option. = You've heard about how prostate cancer has a good cure rate these days? Not for you!
• The best thing to do now would be to remove the prostate. = During surgery, we'll position you in a such a way that you can kiss your ass goodbye.
• The surgery was successful. Come back in six weeks and we'll see how things are. = Have fun with the humiliating incontinence. Hope you said goodbye to sex! All that, and you're doomed anyway. Now you can bore coworkers and family to death about your stupid prostate gland.

Goddamn Sundays

Off for just a week and the Complete and Total Loser has forgotten what it's like to have a full-time job. Getting up at six, his summer smoothie for breakfast, getting to the train station in time for the 7:32, at work by 8:30, doing reports. 
He likes not working and would do it all the time, if money permitted. Perversely, the idea of not working is a thin silver lining to his impending diagnosis of prostate cancer. His attitude will be like the character Mike's in Breaking Bad: "Shut the fuck up. Let me die in peace."

But there is something about Sundays for the never married and alone. No matter how late you sleep, they stretch before you like a wide road, curiously empty, shimmering in the heat.

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.

First drafts

He is a negative thinking fatalist, the Complete and Total Loser. Or not. He thinks both that his higher PSA count will spell his doom, yet part of him expects the retest in three months will make his doctor comically wipe his brow and go, "Whew! Guess that last test was a fluke! You're fine!"
No, not expects. Hopes.
Last night, lying in bed, the Loser felt feverish, as if his entire body were mildly inflamed. (He has a new word for feeling off: Cancery.) 
While in bed, he was thinking of how he'd write a final letter to the people he knows. He thought of the details of delivering it; compiling email addresses, which of his two brothers to entrust with the duty of sending the posthumous message, what he'd say.
The subject line matters. He wouldn't want people he's fallen out of touch with to delete it, thinking it's spam. He'd use the simple one he used when his parents died less than two months apart in 2011: Name, date of birth, dash, date of death.

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