MY CANCER JOURNEY | photography

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MY CANCER JOURNEY

A work in progress

For friends and family only; not for publication or sharing on social media

I have advanced (stage 4) metastatic prostate cancer, which is going to take my life eventually. There is no cure; only treatments to slow its progress. My intention while I am still alive is to create a space that can be shared with my many wonderful friends after I’m gone. My hope is that it gives you a renewed sense of purpose and appreciation for life.

I believe we are the sum of all the people who have touched our lives; and those people carry within them a bit of us. It’s what makes life eternal. Each of you are part of what makes me the person I am today; and you carry within you a bit of me. I hope it helps make the world a kinder and more loving place.

My late friend Phillip Richards, with whom I shared many philosophical discussions while riding bicycles together over three decades, told me many times he was not afraid to die. He said he enjoyed a great life and experienced many joyful times with family and friends and would be OK with facing the end. I feel that way, too.

It’s easy to regret the things I will miss after I’m gone, like the many milestones in life my family will experience (birthdays, graduations, weddings, births, deaths), but I know that my wife Deena and my sons Chris and Dean and their families will carry on and support each other as needed, and with great love. If I have done anything in this world worthwhile, it was finding my beautiful wife Deena and with her producing the two wonderful men our sons have become.

There is much to say here so I will move on with it.

Always with love,
Don

Journal Entries (most recent at the bottom)

That Cancer is Gone (Not)

May 2019

I begin this saga sitting at the dining room table looking outside at our forest of more than 250 trees on the north slope of Galbraith Mountain in Bellingham, Wash. Less than one-half mile from our front door are the Lost Creek and Geneva Connector trails that connect to more than 50 miles of trails on the mountain. We are blessed to be so close to the natural world and to have the luxury of getting away from the traffic and noise of city life. It is truly therapeutic.

I share my cancer story with the hope that the men who will read it will get tested and examined for prostate cancer, and their partners, families and friends will persist in ensuring they get checked. As I write, I have a suprapubic catheter in my abdomen and a nephrostomy tube in my back – the latest developments in a seven-year journey with prostate cancer. Ten days ago I underwent two surgical procedures to have the nephrostomy tube inserted through my back and left kidney and into my ureter and bladder. A CT scan of my abdomen last month showed a mass blocking the ureter, which led to hydronephrosis -- a build up of urine in the kidney. My urologist went to the site of the mass and took several biopsies. While the pathology report showed no cancer, he was unable to penetrate the mass to sample it adequately. He referred me to the Seattle Cancer Care Alliance and the University of Washington Medical Center for treatment and for possible surgery to remove the cancerous blockage and reconnect the ureter to my bladder.

The doctors at SCCA think the nature of the mass is an indication that the prostate cancer I’ve been dealing with since 2012 has metastasized to the ureter. My PSA (prostate-specific antigen), an indicator of prostate cancer, has been rising over the past year, despite the fact I no longer have a prostate.

My cancer journey began in August 2012, when a routine physical showed a PSA level of 12. A number higher than four is an indication that cancer might be present, so I underwent a biopsy. It showed a malignant tumor with a Gleason score of six (moderately aggressive on a scale of one to ten).

After much consultation and deliberation, in March 2013 I underwent brachytherapy, a procedure that inserted 62 radioactive rice-grain-sized “seeds” into my prostate, followed by five weeks of intensity modulated radiation therapy (IMRT). At my follow-up exam with my urology oncologist, he announced, “That cancer is gone.” So he said -- and so I believed. My cancer journey thus far was looking to have a happy ending.

People often describe someone with cancer as “fighting a battle.” Obituaries typically say things like, “They lost their x-year-long battle with cancer,” or persons with cancer say, “I’m going to fight this thing!” I don’t like to think of it that way. I abhor violence and have only been in one physical scuffle in my life, when a kid in my neighborhood picked a fight and threw a punch at me. I swung back, it didn’t last long, and no one got hurt. It has always bothered me that U.S. citizens, part of a nation founded on war and with an economy sustained by it, think of everything as a fight or a battle. During every national election cycle, we find ourselves paying close attention to the "battleground" states.

It’s not that I want cancer to happen in my body, but it is nothing more than a mutation of cells caused by genetic or environmental factors, or a combination of both. Some people ask, “Why me?” My answer is simple: cells in my body grew abnormally, have the potential to cause problems with my health, and might lead to my death. I am the cancer and the cancer is me. I hope to do everything medically possible to stop it, but it doesn’t make me angry and want to fight. Anger is a self-defeating emotion that only foments more anger, is prone to linger, and will break you down mentally and physically. Cancer has actually given me a sense of peace as I have lived with the thought of my death during the past seven years.

After my treatments in early 2013, I resumed my normal activities and won several regional duathlons (run-bike-run). Because of this, I was named All-American and chosen to represent the U.S. as a member of Team USA at the World Duathlon Championships in Ottawa, Canada, where I finished fifth. I had the fastest time on the bike by more that 1:30, but lost on the run what I gained on the bike (I never like running very far). On Facebook, I posted about how fortunate I was to be alive and able to compete with the best athletes in the world.

I also continued to race bikes on the road and won the 15-race Southern California time trial series in 2013. In 2015, I won the Southern California-Nevada Cycling Association super-masters championships in road racing and the time trial. I was the fastest man on a bike in my age group and fulfilled a long-time goal of winning not just one, but two individual state championships. I also won the Southern California Duathlon Championship that year. I was fit and focused on winning national and world championships in cycling and duathlon.

Those goals went on the back burner in 2016 when my PSA began to rise again and my urologist performed another biopsy that determined the cancer was still in my prostate. I needed to undergo a radical prostatectomy and lymph node dissection. The radiation oncologist who declared me cancer-free threw up his hands and said, “I’ve never seen anything like this.”

Because of the radiation treatments I underwent in 2013, the surgery was very challenging and considered a “salvage” operation. I was fortunate to be referred to a fantastic doctor, Herbert Ruckle, M.D., at Loma Linda University Medical Center, who performed the robotically-assisted laparoscopic radical prostatectomy and lymph node dissection. (I memorized that because I knew I would be asked in the O.R., “What are you here for?” Everyone was impressed, of course.) Dr. Ruckle, a fellow cyclist married to a former teammate of mine, described the surgery as working with spaghetti noodles that had been allowed to dry in a colander – a mass of tissue without easily determined margins. The surgery was performed on June 6, 2016. It totally changed my life.

The procedure went well, despite being tilted mostly upside down on the operating table and having my abdomen filled with gas to separate the organs. I woke up with a face that looked like the Stay-Puft marshmallow man. The pathology report confirmed the worst: the cancer was now rated Gleason 9 and had metastasized to the lymph nodes.

The procedure required that my urethra be dissected and reconstructed and nerves severed, leaving me incontinent and impotent. I was forced to wear an adult diaper to catch the urine I could no longer control, but being physically fit, I was able to recover quickly and resume riding my bike. My cycling shorts were a bit puffy with a Depend under them, but I managed and carried spares in my jersey pockets, stopping frequently at a coffee shop or porta-potty to change. In order to stall the cancer’s spread through my body, I was referred to an oncologist and began a regimen with Lupron Depot, a hormone therapy that stops the body from producing testosterone, which prostate cancer "feeds" on. Men should have a testerone level of 100 or more; mine dropped to 3. I was chemically castrated -- a eunuch with testicles.

In addition to being impotent and incontinent, I was now undergoing “male menopause,” getting hot flashes and night sweats and having little desire to do anything. The Lupron also made me weak and I got very tired doing simple physical things. I developed anemia and, later, severe osteoporosis. Despite the limitations, my surgeon said his recommendation for people in my situation was to “be like me” – stay as physically active as possible.

Being too weak to continue road racing or duathlons, I set a new goal for myself to complete the Stair Climb for Los Angeles –- a race to the top of the 1,005-foot U.S. Bank Tower in downtown L.A. At 1,664 steps in 75 stories, it is the tallest stairwell west of the Mississippi. I trained for it during my lunch hours by climbing up and down the four stories of the Chemistry Building at UC Riverside, where I worked. I counted the number of stairs I completed by marking them in pencil on the wall at the top. After about a month, I was able to complete more than the 1,664 steps I was facing in L.A. I finished the event on Sept. 30, 2016, in 18:50 -- a respectable time, but not as fast as I hoped.

[pause for life stuff]

On Death and Dying

May 31, 2019

I’m sitting on the deck at our house on Lost Creek Lane in Bellingham, having dinner and thinking (again) about dying. The news at the Seattle Cancer Care Alliance on Tuesday wasn’t very encouraging. My case is so fucked up that I’m being asked to participate in a research study to study various plans of treatment and how successful they are. I’m among a few hundred patients in the study who are dealing with this stupid cellular anomaly. When I was asked to participate, there was no hesitation. Use my data, use my cells, whatever it takes so that other men (like my sons) can avoid or overcome it.

This cancer is eventually going to kill me, but as I told a friend recently, “I’m not ready.” That said, I’ve been thinking about how it should go in the end. Before we moved here, I confirmed that Washington is a Death With Dignity state, meaning if I am diagnosed as terminal with less than six months to live, I can take my own life with a prescribed medication.

In 1996-97 I watched my sister Cheryl deal valiantly with cancer and succumb to it in her bed in the living room of her home. I was at work on January 17, 1997, when I got the call she had died I and drove to her home, crying and pounding the steering wheel of our ’77 Chevy van. The sense of loss was overwhelming and the fact I wasn’t there with her in the end was devastating. I could not have asked for a kinder, more genuine person for a sister than Cheryl. I miss her and our regular Sunday evening phone calls and sharing stories about our kids and our "crazy" beloved mother. I can still hear the sound of her voice as she said my name, “Donny.”

I also wasn’t present at my dad’s death, but got a call in the early morning of January 24, 2007, that he left his body in his bed at Redlands Community Hospital after a host of medical issues that arose after surgery for a gangrenous appendix. I went to the hospital and said my goodbyes. I was at his bedside the night before and as I was leaving, I asked him, “Are you OK? Do you need anything?” His reply was simple, and typical: “I’ll be fine.” He was a father like no other. His love was always unconditional and I have always tried to live up to the example he set. As a kid, relatives and friends referred to us as, "Big Donny and Little Donny." I have always been proud to share his name.

I was present for my mother’s death, also at Redlands Community Hospital. A lifetime smoker like my dad, she lived with COPD for a couple of decades before she passed and I knew it was her lungs that would finally give out. Predictably, she fell at home and broke her hip while trying to get to the bathroom in the middle of the night and developed pneumonia after the surgery to put her frail body back together. She was eventually placed on a ventilator and had no brain activity, so according to her wishes we decided to turn off the ventilator and let her tired, raspy lungs take their last breath. It was really hard to let her go, but I said in her ear many times that night, “We love you, Mom. We'll be fine. It’s OK to let go.”

I don’t want my family to endure those kinds of scenarios and prefer to leave my body before the pain is so intense that I’m not alert and able to make decisions. I’m not afraid of death and look at it as inevitable. Death is not an end; it is a transition -- a transfer of energy. Being able to choose the time and place and saying goodbye to loved ones sounds ideal to me. Tears will flow, but so do rivers and streams, so let those tears flow with the rhythm of the universe. I’ve shed plenty while writing this.

Curiously, the band Lord Huron’s song Dead Man’s Hand is playing and it includes the line, “I stared out into the endless void.” Is that what death is? If so, should we be disappointed? What is heaven? For me, it's pretty simple: find a state of peace and leave your body knowing your spirit lives on through all the interactions you have had with others in your life. Remember the smiles you saw on their faces, the love and joy you found in their hearts, and how they passed that love onto others. This is how we live on. Love, then love some more, and it will all go on through you.

Enough of my last days. There are many remaining days in which to cultivate that state of peace.

Death is not an end; it is a transition -- a transfer of energy.

[pause for life stuff]

Ends of the Earth

July 2, 2019

I’m sitting with my MacBook on the La-Z-Boy chair in our bedroom listening to Lord Huron’s Ends of the Earth on my headphones while Deena watches TV. I discovered Lord Huron when their music was used in a wonderful movie, A Walk in the Woods, starring Robert Redford and Nick Nolte. It’s a great story of friendship and includes a scene where, during their attempt to hike the Appalachian Trail, they come upon a glorious view of a forest valley below and Nick Nolte gasps at the beauty of it.

Here are some of the lyrics of the song:

Oh, there's a river that winds on forever 

I'm gonna see where it leads 

Oh, there's a mountain that no man has mounted

 I'm gonna stand on the peak

I'm on a river that winds on forever

 Follow 'til I get where I'm goin' 

Maybe I'm headin' to die but I'm still gonna try 

I guess I'm goin' alone

[pause for life stuff]

Just Be Done With It!

December 11, 2019

It’s been a while since I wrote, and with good reason: I’ve been in a lot of pain as the cancer progresses throughout my body. I’m now officially on the opioid bandwagon, taking oxycodone as needed. Unfortunately, I need it more often than not, especially to sleep. My blood pressure has gone off the rails, often as high as 200+/100+. I’m on my second medication to reduce it and it’s not working very well.

I need to get my BP down before I can begin a new cancer drug named Aberaterone (aka Zytiga), which will drive my BP up. Like the Lupron I have been given since 2016, Aberaterone is an androgen inhibitor that stops the production of testosterone, which prostate cancer “feeds” on. While Lupron stops the production of testosterone in the testicles, Aberaterone moves up the glandular chain and targets the adrenals as well as the receptors in the tumors, which over time develop the ability to produce their own testosterone. Yep, my cancer is smart.

As usual, there are a lot of potential side effects with the treatment, including death. When my mom and dad were in their later years, they each had a row of pill bottles and inhalers on their dresser and I created for them a printed checklist of what to take and when. Being Mr. All-American world-class masters athlete, I thought: “Not me; Not Mr. Vegan Athlete Health Guy. I’ll never be like that.” Welcome to reality, Don. I now have a full medical history and long list of medications that I carry with me so health care providers will (hopefully) know how to deal with me.

I have zero energy now and get winded climbing a flight of stairs. My daily hikes in the forest with Molly are a thing of the past. Ten days ago I felt pretty good and hauled soil and organic matter around the yard to build up Hügelkultur garden beds. I could barely move the next day and the pain was over-the-top. I recognized the inevitable and sold one of my bikes. The others will go, too, once I get over my attachment to them and their history with me.

Next week, I will undergo another surgery, this time to add a nephroureterostomy stent to my right kidney, which -- like the left one -- is hydronephrotic because of the tumor growing at the base of the ureter. In time, the cancer will collapse the nephrostomy tubes in my ureters and that will create another medical crisis to deal with. I’m getting tired of the ever-increasingly complicated diagnoses and treatments. Just be done with it! This body is failing and with it I’m losing my desire to carry on. "Quality of life" and "palliative options" are the oft-repeated phrases in the doctors’ offices now.

The Death with Dignity policy in Washington says that a doctor must certify that a patient has less then six months to live in order to prescribe the end-of-life medication. I mentioned the policy to my oncologist’s nurse recently and she said, “We’re not there yet.” How much will I have to suffer before we ARE there? Will I have to be in hospice care, stuck in bed with bedsores, having a nurse clean up my shit and so doped up with morphine that I can’t form a lucid thought or say anything meaningful, or even understandable? Such is “health” care in America. There is a lot of money to be made from disease and illness. A cure for cancer would devastate the economy. Jobs would be lost. “Oh, the humanity!”

The Holidays

December 24, 2019 (Christmas eve)

Remarkably, I have been pain-free since yesterday, when I noted in my notebook, "Slept w/o pain meds!" I suspect it's the result of the week's-worth of antibiotics I finished for a urinary tract infection. Or could it be the new cancer medications I started December 19? I don't know but I feel better than I have in months. I really thought I was going to die last month when I went to the E.R. twice in two weeks. Deena was visiting her sister in Arizona on November 13 when I was in pain and began to feel lightheaded, nauseous, and very weak. I checked my blood pressure and it was 216/101. I Googled my symptoms and saw they resembled kidney failure. Recent tests showed my left kidney was functioning at 17 percent and my right was 83 percent. Tests also showed my right kidney was now developing hydronephrosis from the cancer blocking its ureter. I called my urologist's office and they said I should go to the E.R. immediately.

I called Dean, who rushed here to take me to the hospital. Thinking I might pass out or not live through the night, I unloaded on him with a list of things for him to do if I died. We have an estate plan, wills, and advance directives that we've shared with our sons, but I think I scared the shit out of Dean that night. He was incredible: helping me check in at the hospital, answering questions on my behalf for the care team, and being with me the entire time. It reminded me of the countless times I was in the E.R. with my mom and dad in their later years.

A CT scan showed the right kidney had now developed moderately severe hydronephrosis and the cancer had grown in my bladder, lungs, lymph nodes, and prostate bed, where it originated. The doctors decided an emergency nephrostomy wasn't needed, gave me a prescription for oxycodone and I was discharged, listed as "Condition: Serious." I followed up with my urologist the following day and the nephrostomy in my right kidney was scheduled for Dec. 17.

Two weeks later, on November 27, the pain was so intense that Deena took me back to the E.R. This time, the Dilaudid pain medication they put in my I.V. had no effect. A urine sample showed I had a urinary tract infection. They started me on antibiotics and wanted to discharge me, but -- to her credit -- Deena would not allow it. She shot videos on her iPhone of me moaning and convulsing in pain as my bladder spasmed. I was admitted to the observation unit overnight despite the hospital's policy of "no admission for pain management." I had to sign a waiver saying I could be charged for being admitted because Medicare would not cover it. Deena slept in the chair next to me as I finally got some relief and rest and went home the next morning (Thanksgiving) full of antibiotics, pain meds, and prescriptions for more. Happy Thanksgiving!

Tube Man Goes Bradycardic

December 17, 2019

I had already been through it twice: an interventional radiologist had placed a nephroureterostomy stent in my left kidney, ureter and bladder, followed by a replacement tube four months later. In each of those two procedures, I was given Fentanyl to put me in a "twilight sleep," and I didn't remember anything about the procedure afterward. This time, I heard and felt everything and mid-way through it had a vagal response: my heart rate and blood pressure began to crash (bradycardia), I muttered "I'm getting nauseous," and I started vomiting. I was given an anti-nausea medication through my I.V. and the doctor decided not to try to place the stent into my bladder; instead I went home with two leg bags: one collecting urine from the catheter in my bladder via my left kidney, which was draining through a stent; and one draining my right kidney, bypassing my bladder. We went to Bed Bath and Beyond and bought a big foam wedge so I could sleep mostly upright in bed to drain my kidneys into two leg bags. I set iPhone alarms to wake me every two hours to drain the bags. I sent Dean a text the next day telling him about the new nephrostomy tube placement and he replied with an image of the cover of the album Best of the Tubes. I told him to call me Tube Man from then on.

A Renaissance

February 2, 2020

Well, I made to 2020 and with a little luck will make it to my 70th birthday June 20. That's one goal; the other is to document with photos the seasons in the forest around our property. I don't know it was the antibiotics that killed my UTI or the nephrostomy that relieved my right kidney's hydronephrosis, but I feel like I'm getting stronger. I knew things were improving when I went to the Seattle Cancer Care Alliance this week for blood work and a consultation with my oncologist, Dr. Todd Yezefski. Dr. Todd, as we call him, is a great doctor who has been frank, honest and positive about my prognosis and the pros and cons of many treatment options available. He's also a road cyclist like me and competed in the Redlands Bicycle Classic in 2006, representing a team from Connecticut.

At the appointment, I had blood drawn to see if the new Abiraterone androgen suppression therapy was working and if my electrolytes were stable, my kidney function was good, and what my PSA level was. About six weeks earlier, when I was in so much pain, my PSA had jumped to 10.1 and was doubling very fast -- a sign the cancer was active. I gave Dr. Todd my copy of the book Draft Animals by former World Tour pro cyclist Phil Gaimon, who won the Redlands Classic three times. I told him I was feeling fantastic and was riding my bike indoors and hiking again -- then asked, "What was my PSA?" To my delight, he said it had dropped to 1.8. I was ecstatic and repeated to Deena all day: "One point eight!" I asked him if I could have a glass of wine occasionally, travel, and ride my bike on the road again. "Yes," he told me. "Go enjoy your life." I told him I would like to do a time trial in the spring, leg bags and all. He told me to go for it. I will surely finish last, but -- hey -- racing bikes is what I do.

A Sacred Place
February 13, 2020

I realize I'm on borrowed time. The new Abiraterone seems to have put the cancer in a holding pattern for now. Being able to spend time with Deena and our pets, watch my grandchildren blossom, be outside to hike in the forest with Molly, work in the garden, and shoot photos -- these are all gifts. I've been reading the book Walking Meditation by Vietnamese Buddhist monk Thich Nhat Hanh, which is inspiring. Here is the back cover:

Our property is 1.55 acres and has about 250 trees on it. From my seat on the sofa in the living room there are eight sets of windows and everyone of them is filled with green, mostly bows of the western red cedars that surround us. We also have fir, alder, hemlock, big-leaf maple, and birch trees. I am so fortunate to be able to spend my final days in this beautiful house in a very quiet private community surrounded by trees and trails to hike on. All of our neighbors are wonderful people and many of them have become close friends.

I have been naming the trees on our property. The big cedar in front of the house is now named for my late sister Cheryl, the two tall Douglas Firs in our circle driveway are Mom and Dad, and the twin cedars in the back are Pete and Repete -- names Deena's dad gave to her and her twin sister Darlene when they were born. The others are named for family and special people in my life.

We don't really own the trees; no one owns trees. They belong to the earth, but we are blessed by their presence and the peace, the oxygen and the birds they provide. Also in front of our house is a ring of five cedars with a stump in the middle. I call them the Five Pillars of Peace and like to sit on the stump to meditate and absorb their energy. I like trees better than most people. I touch them, talk to them, and thank them.

This place has truly become sacred to me and I remind myself daily how fortunate I am to be here. I thought Deena was getting tired of my daily exclamation, "I love this house; I love this place!", until she said it to me yesterday. Our kitties have three levels of the house and an outside deck to explore and Molly loves our yard and the many trails we hike in the forest. Deena and I stay very busy with the property and love the city of Bellingham and the friends we've made here. Like every time I've been sick of injured, she's been my loving and caring nurse. Our marriage is stronger than ever. I am truly blessed.

Reflections On My Experience of Having Cancer

(An early narrative recently found on my computer)

Today, Monday, March 18, 2013, was the last day I repeated what I've been doing every weekday for the past five weeks: got up at 4:45 a.m., fed my cats Gracie and Suzy and my dog Molly, ate my breakfast, showered and got dressed, took Molly for a walk at 6:00, drank 24 ounces of water at 6:30 to fill my bladder, packed my lunch, and headed for Redlands Community Hospital at 6:45. I parked in my usual spot in the north end of the parking lot and headed inside for my 7:00 appointment. On the way, I passed through the doors of the Surgery Center where I waited during my mom's hip surgery two years ago and where I was admitted for brachytherapy in December of last year. I turned left, then right, then went in the door to Radiation Oncology.

I sat in the chair by the door inside and watched the CBS Early Morning Show until my Radiation Technician Matt opened the door to greet me. I went into the room in the back where the accelerator is located. On the monitors in the control room and on the south wall of the accelerator room were a photo of me and host of numbers and diagrams that describe how I am supposed to be aligned and the doses that would be given. I left my coat and belt on the hat rack and headed for the metal table. As I laid down on the mold of my torso, Matt covered me with a small sheet while I dropped my pants to my knees, and he proceeded to make sure the three tattoos he put on my belly and hips were properly aligned. Once that was done, he left for the control room on the other side of the 10-inch-thick lead-lined walls and turned on the accelerator. While I held a foam ring to make sure I didn't move, I hoped the iPod in the corner was playing something nice. I closed my eyes and relaxed and meditated while the machine went through its motions. Beginning below the table on my right side, the machine rotated to seven different positions around me and sent 61 microbeams of radiation from different angles into my body. Twelve minutes later, the sound of the machine stopped, Matt returned, I rushed to the bathroom to pee and was done. For the last time.

It will not be the end. In the months ahead, there will be blood tests to be done to see of my prostate PSA is going down, an indicator that the cancer is in decline. Last week, my PSA was 10.7. Normally, this would be cause for alarm because 4.0 is considered an indicator of a tumor. In August 2012, mine was 12.1. This journey with cancer started last year when I went for a physical in an effort to qualify for supplemental disability insurance (a story for another time). Being an elite athlete for most of my 62-year life, everything about my physical was perfect -- except for my PSA. I was pretty devastated and concerned about what was ahead for me. My doctor referred me to a urologist for follow up. I called for an appointment and was told it would be several weeks before I could get in. When I mentioned this to my good friend, cycling teammate and radiologist Steve Mera, M.D., he said, "Let me make a call." I think it was the next day when urologist Dr. Robert Torrey's office called to say, "Can you come in this week?"

Dr. Torrey told me what my research had already suggested: while PSA isn't necessary a true indicator of cancer, a PSA of 12.1 is a pretty strong one. He did a digital (i.e., with his finger, not a computer of any kind) rectal exam and told me there was an area of induration (hardening, indicative of a tumor) on the right side of my prostate. Next up: a biopsy. If you know where the male prostate gland is located, you realize that getting tissue from it for a biopsy is a challenge. I'll spare all the details, but it involves drinking magnesium sulfate the night before and enemas (yes, enemas -- plural) in the morning. It also involves perforating the walls of the rectum, so the biggest risk is infection. Guided by an ultrasound probe, the Dr. Torrey took a dozen tissue samples during a process that sounded (and felt) like a nail gun going off inside of me. The prostate is one of those organs you don't really know you have until it hurts like it did after having a series of chunks of it removed. Needless to say, the next couple of days were a challenge that included pain meds, the antibiotic Cipro, and frequent, painful, bloody urination.

The wait for the news was a really difficult time and when Dr. Torrey met with me he was very direct: I had cancer. He said that if I was going to have cancer, this was the cancer to have. It is generally slow growing and treatment is usually successful with a minimum of side effects. One out of six men will be diagnosed with prostate cancer in their lifetimes and three-quarters of men who live past 80 will die with it -- but not from it. Dr. Torrey said if I was 20 years older, he would recommend that we do nothing about. Because I am 62, he provided five treatment options: 1. A radical prostatectomy using conventional surgery (through an incision in the abdomen), 2. A radical prostatectomy using robotic surgery (two small incisions on each side of the abdomen), 3. External beam radiation, 4. Proton beam radiation, and 5. Brachytherapy (radioactive seed implants). Before we went ahead with treatment, a series of tests needed to be done to see if the cancer had metastasized. The time waiting for the biopsy results was difficult, but I had a pretty good idea I had cancer based on the physical exam and my PSA. Waiting to see it had gone to my lymph glands, lungs, or bones (likely targets if it moves past the prostate) was a really hard time.

September 7, 2013

I have cancer. Until you can truthfully say that, you really don't know what it means. It's humbling. It's scary. It's one of those things you thought you would be able to deal with if it happened, but you can't really be prepared for those words. I'm fortunate, actually, that mine is in my prostate and as I learned this week, hasn't spread into the surrounding tissues, my bones, my lungs, or anywhere else in my body. The odds that it will be successfully treated are good. The road ahead will be challenging, but easy compared to the challenges others have faced, like my sister Cheryl, who succumbed to it in 1997 at the young age of 43. I've thought a lot about Cheryl over these past few weeks. I realized that if my time was up, I enjoyed 20 years more than she did on this planet. I was able to watch my boys graduate from college and become amazingly successful men. I've seen many things, met many amazing people, enjoyed time with family and friends. I live with a wonderful, devoted and loving wife in a nice, comfortable home filled with splendid memories of family and friends, and a long list of cats and dogs who have shared our homes. The thought of dying from cancer was comforting in a way. Yes, it's painful and ugly at the end, but it gives you time to prepare. To say and do things that are really important.

There is a place on the eastbound 10 freeway in Redlands where I once thought to myself as I was driving home from work, "I would hate to die in an automobile accident." It would be so sudden and because someone did something stupid and thoughtless. I wouldn't have a chance to say good-bye and everyone I know and love would be in shock. My family's life would be turned upside down in an instant. I imagined lying on the burning hot pavement of summer as my last breath approached, and thinking, "Not here. Not now."

Coronavirus and COVID-19

March 17, 2020

It's here: COVID-19 is in the U.S., running rampant throughout Seattle 90 miles south, and cases are emerging here in Bellingham. I'll be brief here because there is a lot I want to do in case it's already in me, or finds its way into me. If it does, the respirator should go to someone else. I have a terminal illness, essentially one functioning kidney, and very little immunity due to the cancer drugs I'm taking. I really hoped that I could choose the time and place of my death and administer the Death With Dignity drug with family present to say goodbye. It's entirely possible that I will instead die in isolation, drowning in the fluids that fill my lungs. It has always been my hope that when my oncologist says I have less than six months to live that I could write a personal note to all of my family and friends and say thank you for your love and friendship. If that doesn't happen, please know that I love you and wish you the very best in the years ahead.

Life in Quarantine

May 30, 2020

So far, so good. Cases in our county have slowed to a trickle thanks to the Governor Jay Inslee's stay-at-home order. Deena and I have ventured out very little since March and after some bumps in the road are able to get groceries either delivered or put in our car via curb-side pickup. Being introverts at heart, we've been loving it. We miss going to our local independent theater, The Pickford, and attending twice-weekly wine tastings at Seifert & Jones Wine Merchants, where we are wine club members.

Loving Kindness

June 16, 2020

The last few weeks have been illuminating and life-changing.

One More Spring

September 13, 2020

OK, I got distracted again. Apparently I was so illuminated in June that I didn't have words to describe it. I'll get to the life-changing part of that post later, but the newest developments with my health are indeed life-changing. A CT scan that was performed in August showed the nodules in my lungs have increased in size and number and there is now evidence of metastatic lesions in my liver. I underwent a biopsy of the liver at the University of Washington Medical Center in Seattle last Tuesday, Sept. 8, and will meet with my oncologist Dr. Todd next week to discuss the results and treatment options. Actually, there is only one remaining option: chemotherapy. Which drug or cocktail of drugs they use will depend on the nature of the tissue samples: prostate or a form of neuroendocrine cancer. There is a clinical trial I might participate in because my situation is so unique.

I Googled "prostate cancer in liver" and found a study published by the Journal of Clinical Oncology, titled, "Men With Prostate Cancer Metastasized to the Liver Have Worst Overall Median Survival." It says, "Median overall survival was . . . 13.5 months (range, 12.7-14.4) for liver metastases." Dr. Todd won't provide a time frame and I'm not asking for one. I've known since we first learned in 2016 that it was metastatic that it would take my life in time. Now I have a timetable of sorts, which casts a whole new light on each and every day. Will I be here next year for my grandkids' birthdays? Will I get to watch another beautiful spring unfold here at Lost Creek Ridge? Will I get to eat the corn I want to grow in my new garden bed next year?

All of those questions are really moot and I can't allow myself to dwell on them. I say moot because there is truly one moment worth pondering -- the present one. The illuminating and life-changing things that happened in June were three books I devoured: How to Meditate Like a Buddhist, How to Communicate Like a Buddhist, and How to Talk to Yourself Like a Buddhist, by Cynthia Kane. Each of them taught me new lessons about how to experience the spirit of oneness with everything around us -- both on earth and throughout the universe. That experience can be fleeting if we allow the distractions of everyday life and the scenarios that run constantly through our heads to interfere with that connection. I heard a quote recently by a person whose name I cannot recall: "You are not what you think." Kane refers to the ongoing soliloquies that we deliver in the theater of our mind. Buddhist meditation teaches us not to empty our mind, but, as she writes, "To be mindful in Buddhist meditation means to witness and observe thoughts without attaching too much importance to them . . . simply let them pass by like clouds across the sky.” Kane also refers to the Buddhist tradition of loving kindness -- seeing the world through kind eyes and not judging others, whose lives and experiences we cannot truly understand.

The late actor James Dean is quoted as saying, "Dream like you will live forever; live like it's your last day." I suggest instead that we make every moment matter:

Get rid of the clocks

The calendars, too

Turn off your phone

And listen to you

All the things from your past

That dwell in your head

The future seems bleak

And something to dread

But now, in this moment

Just take a deep breath

And look all around

And see the great gift

Of this beautiful earth

And all it provides

Feel the love all around

And take it inside

Each breath that you take

Can serve to remind

We are all truly one

Eternal, alive

Be here now and listen

To the sound of forever

Keep reminding yourself

Make every moment matter

COVID and Chemo

October 4, 2020

The U.S. death toll from COVID-19 is now more than 209,000 and the president has been infected and is in the hospital. Everyone seems to think the same thing: 2020 has been a fucked up year and it's time to move on. The uncertainty about the election is weighing heavily on our minds and wildfires are destroying ecosystems, property and the lives of many people. The economy is in the tank and people are losing their jobs, their homes and hope for the future.

Deena and I are among the fortunate few who have a steady income and a home where we can isolate and still enjoy life. We miss contact with family and friends, but we have to resist the temptation to abandon the guidelines for safety like the president and many others have done. It's especially critical for me to be careful now that I'm receiving chemotherapy. The guidelines are intimidating: no raw honey or nuts, no tempeh (one of my favorite foods), no non-pasteurized fruit or vegetable juices, strict water safety guidelines, no contact with soil or cat litter. The list goes on.

The biopsy of my liver showed it's populated with a growing number of large-cell neuroendocrine carcinoma cells, which is very rare and there is no literature on how to treat it. The small-cell version of this carcinoma is common in the lungs, so they are treating it with the same cocktail of drugs they commonly use for that. When I asked my oncologist, Dr. Todd, about my life expectancy without treatment, he said, "A few months." We went over the details of how the Death With Dignity process will work when the time comes. Deena and I had a long, tear-filled discussion on the ride home, revisiting my wishes before and after I die. She has been a real trouper through all of this and I am so fortunate to have Nurse Deena at my side.

The chemo is a crap shoot -- it has the potential to add months to a year to my life, but there is no data to support it. Infusions are done over three days every three weeks for a total of four sequences. The first day, Friday, Sept 25, was rough: a one-hour infusion of the immunotherapy drug Atezolizumab, a two-hour infusion of the chemo drug Etoposide and the one-hour infusion of the chemo drug Carboplatin. Through all of it, Deena was at my bedside and drove me back and forth to the Seattle Cancer Care Alliance each day. I felt great the first morning afterward and we went back for another one-hour infusion of Etoposide. As the day wore on, I got more tired and by the next day (Sunday) when we went back for another dose of Etopside, I was exhausted.

It's been a week since the infusions and I'm finally feeling normal again. I've been spared the side effects of fever, nausea, vomiting and diarrhea. I shaved off my beard, but still have the hair on my head, sparse as it is. We'll see what happens with that. Every person responds differently to the drugs they are administered. The anti-nausea medication they gave me before each infusion caused a couple of days of painful constipation, but that's been resolved. Dr. Todd repeated what he told me a long time ago: stay active, but don't overdo it. I've been doing short hikes with Molly every day and working in the yard and garden (with gloves where soil is involved). I continue to be thankful for every day I get to enjoy our slice of heaven at Lost Creek Ridge.

The intermittent blood in the urine from my left kidney and bladder has finally resolved (mostly). An ultrasound done last week showed no abnormalities and my urologist attributes it to irritation of my ureter and bladder from the nephroureterostomy stent and suprapubic catheter on that side. My right kidney, which drains directly from a nephrostomy tube continues to produce clear urine and does about 80 percent of the work compared to my damaged left kidney. I asked my urologist about the shooting pains I get down my left leg and numbness in my left foot and he said I should see my primary care physician to see if I have sciatica. It turns out I do, and I'm scheduled for an MRI in 10 days to see if physical therapy can help with the persistent pain. I was prescribed a pain med that is specific to nerve pain and it's helped me sleep like a baby the last two nights. A good night's rest works wonders for our bodies and our minds. Thank you, Dr. Dean (Williams).

We will go back to Seattle for five days during the week of Oct. 12, beginning on Monday with a COVID-19 test and education on how to manage a chemo port. The following day, an interventional radiologist will place the port in my chest, eliminating the need for needle sticks in my arms for IVs over the remaining course of my treatment. On Friday, Saturday and Sunday of that week, we'll endure another six hours of infusions over the three days. I'm already tired thinking about it.

I've shared this journal with a few close friends and Deena posted on Facebook that I started chemo, but I'm reticent to broadcast my situation widely. I've found that people treat you differently when they learn you have a "terminal" illness. Every life "terminates" at some point, so assigning a timetable to it is senseless. As my poem above says, I try each day to make every moment matter, to see the world through kind and loving eyes and give everyone I encounter a sense of appreciation for who they are and what they do. People often advocate that we perform random acts of kindness. I suggest instead that we make those acts persistent, a part of our being and everyday view of life. It's especially challenging in this era of rampant hatred and discord that President Trump has inculcated, but as Dr. Martin Luther King and Mahatma Gandhi both said, love will always triumph over hate. We cannot allow ourselves to take the bait of hate and anger that is on that hook.

Feeling Thankful

November 4, 2020

Chris, Brandi and Ana arrived Tuesday morning of last week after driving, living and quarantining in a rented Dodge Caravan for four and one-half days. In the van with them were their dog and two cats, a litter box and portable toilet, and food for at least a week of being on the road. They were forced to divert from their planned route because of a bitter storm ahead and found themselves caught in the tail of it, followed by sub-zero temperatures in South Dakota and Montana.

They arrived two days earlier than planned and we are thankful to have them here for more than a month. The Davidson Clan of the East is reunited with the Clan of the West to celebrate Halloween, Chris's 40th birthday and Thanksgiving. I am in love with five-year-old Ana, who is charming me to no end and has grown into a beautiful young girl who is smart as a whip. Brandi and I agreed it's nice to have other adults to talk with during the pandemic. She is a loving mom and has done so much in bringing Ana along through homeschooling and dealing with her many challenges. Chris is enjoying a well-earned leave from his Air Force duties.

Meanwhile, my cancer journey keeps on truckin'. My hair began to come out in clumps in my comb, so I shaved my head. Ana laughs when I ask her if my hair is messed up: "Grandpa, you don't have any hair!" Deena and I went to SCCA today for me to undergo a CT scan and full-body bone scan. We'll go back Friday for blood work, a meeting with Dr. Todd, and for our long day of three infusions, lasting about six hours. Dr. Todd will first review with me the results of the scans to see if the chemo is slowing the cancer down, especially in my liver. As always, I am hoping for the best and preparing for the worst.

During the infusions, the nurses will repeat countless times during their double check: Donald Patrick Davidson, patient number U4885156, and the name and dosage of the chemo drug. They'll put on their double layer of gloves, face shield and heavy-duty gown and put in my veins the drugs they cannot allow to spill or come in contact with their skin. The shit is so toxic I have to flush the toilet twice to ensure it's out of the bowl. We had our septic tank inspected last week and the guy who did the work was surprised the bacteria in the tank was still active. Oftentimes, chemo drugs will kill it.

Oh, yeah, and yesterday the cluster-fuck-of-the-century happened in the U.S. with the presidential election. I won't begin to share my utter disappointment in the character of our nation and its citizens. That kind of focus is bad juju; it poisons my soul and I won't let it. I'm trying to fill my days with joy and find things to be thankful for. Last week, as I was swinging Ana on the swing in the backyard, I let out a big sigh. Brandi was nearby and asked, "Are you OK?" I looked around at my family and our dogs surrounding me in the backyard, our beautiful home, the trees and blue sky, and replied, "I am so fucking happy."

Best Days Ever

November 15, 2020

We've been mostly stuck at home for the past two weeks, with the exception of the three trips to SCCA for my chemo infusions two weekends ago. The first few days were really shitty -- a sense of total body poisoning, with low-level nausea and deep fatigue. I've been able to anticipate and deal with the painful constipation from the anti-nausea drugs, but my body is wasted. Thankfully, Ana is here to lift my spirits every day. She loves our property and being my "hiking buddy" on Lost Creek Trail. I tell her every day is the best day ever -- and it is.

The news from Dr. Todd was good and bad: the tumors in my lungs and liver are not progressing and in some cases are smaller, but the bone scan confirmed what the x-rays of my spine for sciatica suggested: the cancer has metastasized to my bones. Notably, it is in several of my ribs and places on my spine. We don't know if they emerged before or after the chemo treatments began, but the drugs I'm getting are the same ones used in treating bone metastases. We'll know in a few weeks if the chemo is working in those areas when we get new scans.

The cluster-fuck-of-an-election turned out well, with Biden and Harris kicking Trump's ass, but he remains fixated on his need for adulation and is busy figuring out how to avoid prosecution and remain the center of the media-fueled zeitgeist. While he simmers in the White House, Americans are dying in record numbers. Putin couldn't have written a better script for his reality show: "Divide and Conquer: How I Helped a Megalomaniac Destroy the U.S. From Within." Democracy is a good thing, but when more than 70 million people vote for Trump, you have to wonder about the intelligence of the electorate and how easily they are manipulated.

COVID Christmas on the Roller Coaster

December 26, 2020

We had a wonderful Christmas this year, despite the pandemic. Deena got a beautiful tree and decorated it, along with the outside of the house. Dean brought New Mexico tamales for dinner on Christmas eve and we opened gifts (according to CDC guidelines). We still had snow on the ground from the recent storm -- our first-ever white Christmas. We connected with Chris, Brandi and Ana via FaceTime on Christmas day and it was like we were all together again. Deena and I listened to an audio recording I made on Christmas morning in 1984, when Chris was four years old and Dean was five days away from turning two. Chris opens his stocking to find a banana and says, "All I got was a banana! Stupid Santa."

While Christmas was over-the-top happy, the days leading up to it were definitely among the lowest since I was diagnosed with cancer eight years ago. (I apologize for all the details that follow, but I want to document it.) I underwent my final three rounds of chemotherapy and one of immunotherapy in Seattle on December 2, 3 and 4. I was also given a blood transfusion because I was so anemic. The week after that was pure hell as I was overwhelmed with nausea and a feeling like I was being poisoned. I mentioned the feeling to Dr. Todd at my appointment before the infusions and he said, "Well, it's because you ARE." The following Friday, December 11, I was scheduled for an interventional radiology procedure at the hospital to have my nephroureteral stent and nephrostomy tube in my kidneys replaced. The day beforehand, I noticed my left calf had an unexplained painful bruise on it and my ankle and foot were swollen. I read about the symptoms of lymphedema in cancer patients and sent a message to my oncology care team at SCCA about it.

At the hospital, I showed my swollen limb to everyone involved and the decision was made to proceed with the procedure. Afterward, as I was recovering, I checked my email and the nurse at SCCA told me I was at risk for a deep vein thrombosis (DVT, or blood clot) and that I should go to the ER immediately. Hoping to avoid a trip to the ER, my nurse Paula, who was observing my recovery in the short stay unit, told me she would make some calls on my behalf. She was able to get an order for an ultrasound of my leg at nearby Mt. Baker Imaging. I called them and they got me in as they were closing the office. The technician Trent was awesome and when he saw the DVT in my leg, immediately got on the phone to my doctor, who told me to go to the ER immediately. Oh, well, back to the center of the COVID pandemic, I thought.

The ER was remarkably quiet, but Deena was not allowed to go in with me and waited in the car. As I checked in, they removed the wrist band from my earlier visit and I asked to keep it for my collection (see photo below - one year's worth). I was triaged and sent to a room shared by a Sikh couple. The husband interpreted her broken English and she was moaning in pain. I overheard she had fallen and broken a bone in her shoulder and was going home with pain medication. Thankfully, she had no COVID symptoms. After nearly two hours, I saw an ER doctor who decided I needed to start a regimen of blood thinners to break up the clot and keep me from experiencing a pulmonary embolism, which can be fatal. I was given an injection and sent home with a prescription for syringes to self-administer the medication daily. I gave myself the injection the next day and later developed a large bruise in the area. Nurse Deena gave me the injection Sunday (no bruising this time, of course) and on Monday, Dec. 14, my oncologist prescribed an oral medication to replace the injections.

On Tuesday, Dec. 15, I had my monthly appointment at my urologist's office to have my suprapubic catheter changed, which went fine. I had a little blood in my urine afterward, which is common after having a new tube coiled in my shrunken, cancerous bladder. In this case, I had two new tubes and was on blood thinners and instead of resolving, the bleeding got worse. By Sunday night, Dec. 20, the drainage bag on my left leg (urine from my left kidney and bladder) was beet red with blood, I was having waves of intense pain in my perineal area and left testicle, and was nauseous and light-headed. Deena called my urologist's after-hours number, which connected me to my doctor who was on call (and asleep). I described my symptoms to him and he sent us back to the ER. This time, I told Deena to drop me off and go home to wait for updates by phone, knowing it would be a while. I thought to myself, "Will this be the last time I see her? No -- not here, not now."

They did an ultrasound of my testicles and a CT scan of my pelvis and abdomen and found nothing to point to as a cause for the pain. My blood work showed I had lost a lot of blood and I was transfused with two units of generous-someone's A-pos cells. They decided to keep me overnight and Deena was allowed to see me in my room in the observation unit. It was beginning to snow and I told her she should stay home but she insisted on visiting and went home before the roads got bad. The grounds of the hospital on Monday morning, Dec. 21, were blanketed with snow in the morning and Deena said we had 3-4 inches at home overnight. After much discussion between the hospitalist and my urologist and oncologist, it was decided to discontinue the blood thinner and send me home. I was thankful for not having to explain to every MD, PA, NP, RN and CNA how my "rig" of tubes and bags worked for the millionth time. Over the course of the next few days I began to feel better as the hematuria started to diminish and by Christmas eve I was feeling normal again, albeit weak from the anemia. Thanks to COVID, it was a very different Christmas for everyone, but for us it was as good as ever because of the love of our family and friends and an incredible team of health care professionals. Every day is a gift and I am truly blessed.

A New Year

January 7, 2021

We were all so excited about 2021 -- the COVID vaccine is now available and Trump is on his way out -- and then yesterday happened: an armed insurrection in the Capitol Building while a joint session of Congress was preparing to certify Joe Biden's election as president. The near-universal level of disgust with what happened is refreshing in a sense, but even after January 20, the threat of domestic terrorism will persist, along with the white privilege demonstrated so profoundly yesterday. Getting off my soapbox now.

The news from Dr. Yezefski last week was good: the new scans show the cancer has not progressed and is smaller in some areas. I'll continue with the immunotherapy infusions every three weeks and get new scans in February. He pointed out that the full-body bone scan showed my left kidney had retained more of the radioactive contrast material than is normal and was at risk of developing hydronephrosis again. He recommended I contact my urologist about it, which I did. The decision was made to uncap the left nephrostomy tube so the kidney could drain directly into -- yes, I'm not kidding -- a third leg bag. Tube Man adds another tube to his collection.

The swelling in my lower left leg persists, despite the blood thinners. I went for a nice hike today and felt really good, albeit winded on the steep hills. I need to get more active and lose some weight. I saw a great quote today: "My resolution this year is to lose 10 pounds. Only 15 to go!" I weighed in at 167 over the weekend, which I think is more than I have ever weighed. I used to race at 145, but then I was riding my bike 150-250 miles per week. There are lots of culprits: being indoors because of COVID and the constant rain, holiday food and goodies, and cannabis giving me the munchies. I need to put down the Flamin' Hot Crunchy Cheetos, among others, including the three dozen Ghirardelli dark chocolate brownie cookies I made using oil infused with a quarter ounce of Nightfire OG cannabis buds.

Still Here

January 22, 2021

I stirred up quite a fuss in October by announcing to my family my oncologist told me that without treatment, I had "a few months" to live. Well, it's been a few months and I'm still here. The chemo put the cancer in hold for now, but my body is breaking down and it's taking a toll my psyche. I'm so fucking tired of thinking about what I need to do before the next, and possibly final, trip to the hospital. There is so much to do here at the house and on the property I don't know where to begin, but I'm too weak to do most of it (e.g., take the chainsaw to the cedar tree that was taken down by a dead birch that went down in a recent storm). I've been working with Deena to make sure she is prepared to be alone and do the things I have traditionally done. Being isolated by COVID makes it that much more difficult. "Here is what you'll need to do when I'm dead," is not a great topic for conversation.

The urine from my bladder is still laced with blood, sometimes like a light rosé wine, other times like a deep purple Syrah. The twice-daily ritual of changing back and forth from a large-capacity bedside drainage bag at night to a smaller leg bag for daytime is getting to be wearisome. I set up my bikes in the basement to get them cleaned up and ready to sell, but I don't have the energy to do it. There is something profoundly sad about saying goodbye to cycling, which was a huge part of my life for three decades. This is the first year since I began racing in 1987 that I didn't renew my USA Cycling license. I also need to find a home for the ton of cycling clothing and accessories I accumulated over all those years. There is so much "stuff" I don't need and prefer not to leave for Deena and the boys to deal with, but it looks like they will have to. It's too overwhelming right now.

Back to the ER

February 22, 2021

We had a bit of a scare last week, which ended happily. I had my follow-up CT scan Wednesday and asked to have a copy sent to my urologist for their records. Their nurse John called me Thursday and said the CT showed I had a pulmonary embolism, which can be fatal, and I should go to the ER immediately. For the Nth time, Deena dropped me off at the ER (where visitors are not allowed) and went home to wait for my call, or the call from the hospital. Also for the Nth time, we wondered if this would be the last time we saw each other. My vitals were good and my oxygen saturation was 100 percent, which I knew from monitoring at home. The ER doc reached out to my oncologist in Seattle and they all looked at the scan and decided the clot was small and not in a position to be a threat, so they sent me home to continue my blood-thinning medication as prescribed. I had paused it over the previous weekend after my suprapubic catheter change that week caused my bladder to bleed. (My oncologist recommended that when it happened in January.) While my urine cleared up, it could have led to the clot. It's also possible it could have been there for a while, possibly from the DVT I had in my leg in December. It will dissolve over time. My discharge instructions said exercise is the best way to prevent clotting, so I'm dedicated to hiking or hitting the treadmill every day. I see my oncologist this Wednesday to review my scans and talk about the cancer. I read the radiologists' reports on the CT and bone scans and it's advancing in my lungs, liver and bones and my PSA is up from 7 to 10. Is there more chemo in my future? We shall see.

I have a good friend and former cycling teammate who has been diagnosed with prostate cancer and he is understandably pretty distraught. His wife reached out to me for a referral to a urologist to replace the person he was seeing, who provided some bad advice. I shared with her the link to this journal, then realized it's a pretty scary story for someone facing cancer. Mine is truly a worst-case scenario and most men are treated successfully or monitored to see if it's a real threat. Thankfully, stage 4 metastasis like I'm experiencing is rare. Curiously, over the past two days, two good friends shared with me separately YouTube videos of the Grateful Dead. While I'm not grateful be be facing death before too long, I'm thankful that I have time to plan and prepare for it. And to prepare my family for it as much as possible. I follow the Facebook page of End of Life Washington, an organization that advocates for the Death With Dignity Act in our state and assists patients in overcoming obstacles to choosing to take their own lives without suffering when they have less that six months to live. Reporter John Sharify and photojournalist Joseph Huerta of Seattle television station King5 were recently awarded a 2021 Alfred I. duPont-Columbia University Award for their documentary Bob's Choice. It's an incredible story of one man's journey along the path toward a death with dignity and peace:

Back to Square One

February 26, 2021

As I suspected from seeing the reports on my scans and my PSA results, the cancer is active again and has advanced in my lungs, liver and bones. Like he did in October, my oncologist at SCCA told us two days ago that without treatment I only have a couple of months to live. The immunotherapy treatments I was getting were ineffective, so they started me on the chemotherapy drug Docetaxel, along with the steroid Prednisone. Docetaxel has shown good results with prostate cancer and the large-cell neuroendocrine variant of it in my liver. Like before, we won't know how effective it is until we get more scans in the weeks ahead. Thankfully, I'm feeling really good now: no pain, no blood in my urine, and good energy. Molly and I went for a vigorous hike yesterday, which was nice, and we'll do it again today. I'm expecting the fatigue and nausea to hit soon and my hair, which is finally long enough to comb (sort of), will be falling out soon. It's possible that with the Docetaxel it will be permanent. Oh, well. I don't have that much anyway. I did some research on the organization End of Life Washington, which is featured in the documentary Bob's Choice (above), and will reach out to them when the time comes to have one of their volunteers be here to guide me through the administration of the medications. They're a wonderful resource for information about the process. As always, hope for the best and prepare for the worst. Every day on this earth is truly a gift.

If I'm Dying, Why Do I Feel So Damn Good?

March 8, 2021

Deena and I had a telephone conversation last week with a social worker who works in Dr. Yezefski's office at SCCA about starting the Death With Dignity end-of-life process. Because it takes time to get all of the approvals and signatures, at our appointment next week I will be making my first verbal request for a prescription for the end-of-life medications. After that, I will have a conversation with another oncologist at SCCA to verify my diagnosis and my intentions. After that, there is a 15-day waiting period before I can make my second verbal request for the prescription. I will also need to provide a form signed by two persons certifying I am of sound mind and able to make this choice of my own free will.

Deena got understandably upset during the call and said what she keeps repeating to me: "You're not ready to die." She is right, I'm not, but I want to be prepared for the inevitable while I have the capacity to make the necessary decisions. She was uncomfortable with the prescription sitting at Hoagland, the local compounding pharmacy, waiting for me to pick it up, so we agreed it will remain at SCCA until the time comes to order it. I had a wonderful conversation this afternoon with a person at UnityCare Northwest, where my primary care physician is located. She is going to get me a referral to Whatcom Hospice to discuss palliative and hospice care options. Because Whatcom Hospice is associated with PeaceHealth/St. Joseph's Medical Center (a Catholic hospital), the nurse cannot be in the room when I take the end-of-life medication, but can be present before and after.

In the meantime, I feel better than I have in a long time. I'm getting on the trail every day with Molly for an hour or so and the signs of spring are all around us. I transplanted the peas, beans and greens I started indoors in to the garden last week. I'm pretty confident I'll make to spring on March 20, when the vernal equinox occurs and our hemisphere tilts toward the sun and the day will be as long as the night. Sunlight is slowly creeping up over the house and beginning to hit the garden. Now that the threat of frost has past, Deena spent most of today taking the straw off her 450 tulips that are emerging in the garden. I can't wait to see the incredible display of color in a few weeks. The new deck and paver project is progressing nicely and will add a lot of value to our home, and to our ability to enjoy it. I updated my gallery wall with some new photos and two panoramas of Lost Creek Trail -- one in winter and one in spring. I already had the beautiful, plush panorama from spring and when I went back to shoot it again last week, I thought I was in the wrong place. When I printed it and put the images side-by-side, the changes were incredible to witness. Like all of life, the forest is in constant transition.

I showed them to Deena and she said the one from spring was beautiful, but the one from winter was less so. Dull in its color and being mostly barren, I agree it doesn't fit our concept of beauty, but I look at the image from winter and get a sense of wonder and delight. The fallen leaves will provide nutrition for the nettles, ferns and countless other plants and creatures that will soon emerge and soak up the sunlight. It made me think: why do we celebrate a child's birth, but grieve over a person's death? I saw an interview with a person last week who counsels grieving family members who often lament: "There is has been so much death in our family." He hastened to remind us of the fact that 100 percent of all family members will die. Like the fallen leaves and other materials that replenish and nourish the forest, each of us has a place and a purpose in the never-ending cycle of life.

Another Perfect Day on Planet Earth

March 18, 2021

The title of this post is a variation of a hashtag my friend Sonya uses on her Facebook posts regularly: #anotherfundayonearth. I've written enough about death and dying for a while and think it's time to move on and celebrate living. Our trip to SCCA yesterday gave me a boost: the first dose of the chemo drug Docetaxel seems to have slowed the cancer as my PSA dropped from 10.3 to 4.8 in just three weeks. I received my second infusion yesterday and will be getting one every three weeks. We'll get new scans in six weeks. My best friends and cycling compadres from Redlands Bob and Steve are coming to visit April 22-25, which will be awesome. The Tree Amigos ride again! (Well, no cycling on this trip, but we'll take the car on a Bellingham brewery tour and consume a few.)

The improvements on the house are nearly done, thanks to the generous inheritance Deena received from her late mom Irma. We replaced our slippery, broken walkway in the front with pavers and added steps down to backyard, a landing and patio outside the basement entrance. We also replaced the not-very-sturdy, high-maintenance wooden deck on the second level with a new composite one and added a stairway to the landing below. It's a huge improvement that adds a lot of value to the house. We're also going to add a fence to enclose the back yard on the southwest and west sides to provide security and privacy. As Molly gets older and can't navigate the stairs in the house, she'll be able to remain downstairs and go out to do her business and not get near the street. She's already hesitant to take the stairs as her cataracts are affecting her vision. She'll have her tenth birthday next week and she still pulls me up the hills on our regular hikes in the forest. Best. Dog. Ever.

The vernal equinox is this Saturday, along with the birthday of my friend Larissa in Santa Barbara. I think it's fitting that she was born on the first day of spring because she has been a real light in my life. I've only seen her twice in person since we met at Claremont Graduate University in the late '90s, but we have so much in common and think so much alike that it's eerie sometimes. Deena calls her my "second wife" because we're constantly texting and sharing events in our lives. Happy birthday, Larissa! Happy spring, planet earth!

A New Lease on Life

April 9, 2021

So much seems to have happened since my last post I don't know where to begin. Larissa's dad underwent a quadruple bypass and was recovering nicely at home in Amherst, Mass., when my amigo/musketeer/PR Velo Founding Member Bob Estupinan required an emergency triple bypass that saved him from an imminent heart attack. He won't be visiting in two weeks as planned, but he's on the mend and enjoying what he refers to as his "new lease on life" in Redlands. We are all so thankful his condition was caught in time to save his life. Steve Mera is still planning to visit and we'll be raising our glasses in celebration of Bob's presence in our life.

It seems like every time my lease is about to expire, it gets renewed. Deena fell and bruised some ribs, so I went to SCCA by myself this week for blood work and my chemo infusion. The good news was my PSA was lower yet again and the tests showed my lungs, kidneys and liver remain healthy; the weird news was that I was severely anemic. I had been feeling very tired recently and would get out of breath climbing a single flight of stairs and thought, "OK, here we go -- the cancer is shutting things down." Dr. Yezefski was baffled by how my white blood count shot up, but my red blood count crashed in the three weeks since my previous visit. I'm not losing blood in my urine or stool, so I'm either not creating enough red blood cells or something is destroying them. I went back to Seattle the next day and received a transfusion of two units of blood (thank you, donors!). More tests are scheduled for next week. Could it be related to the Pfizer vaccine I received last month? There is no research to show how it affects cancer patients undergoing chemotherapy. At my meeting with Dr. Yezefski, I made my second verbal request for the Death With Dignity end-of-life prescription. I now need to submit the signed request form to the SCCA social worker in order to get the prescription, which I will do at my next appointment April 28.

All of that said, I'm feeling much better despite the effects of the chemo and will get out today and enjoy some much-needed vitamin D. It snowed briefly this morning, but the clouds are passing and we're supposed to have a week of sunshine and warming temperatures. We have new outdoor furniture arriving next week, new doors and screens for access to the deck and patio coming soon, and plans for a big fire pit surrounded by pavers in the backyard. We are so fortunate to own this amazing home and look forward to sharing it with family and friends. I told Ana during our FaceTime visit last week that one day she will be able to visit and pick a fresh apple from our newly planted trees and eat it on the spot. She thought that was pretty cool, and I do, too. I won't be here when that happens, but knowing it can -- and it will -- makes me happy. It reminds me of the words of Rabindranath Tagore: “The one who plants trees, knowing that he will never sit in their shade, has at least started to understand the meaning of life.”

All the Talk About Death

April 24, 2021

It's been a rough week for Deena emotionally. I reached out to the organization End of Life Washington and requested a volunteer to assist me by being present when it's time to take the end-of-life medication. I received a call from Kelly, who was very helpful in answering my questions and offering advice. She has been a volunteer since her mother exercised her Death With Dignity option and has assisted dozens of people with the process of having a peaceful end of life. We met with her in her home in nearby Deming today and she witnessed my signature on the request for medication form I need to give to Dr. Yezefski at my appointment next Wednesday. After that, all of the Death With Dignity boxes will be checked. Because Deena doesn't want to do it, Kelly has agreed to pick up the medication from the pharmacy when the time comes. She also suggested I reach out to Whatcom Cremation and Funeral to assist with taking care of my body afterward.

We also had a Zoom TeleHealth conference this week with Kathy, a palliative care nurse at SCCA, who discussed services they can offer if I develop symptoms while still receiving treatment. "All the talk about death" (Deena's words) has been hard for Deena to process and she broke down today. She reached out to Whatcom Hospice last week to inquire about counseling and is waiting for more information. She confessed at our meeting with Kelly today that she is concerned the chemotherapy I'm receiving is not affecting the small-cell neuroendocrine carcinoma in my liver. I'll get new CT and bone scans Monday and discuss the results with Dr. Yezefski on Wednesday. My anemia and persistent fatigue are a concern and Deena is already convinced the news will not be good. So here we are . . . at another in a long series of crossroads.

It's ironic that all of this is happening as spring is exploding around us. Deena's tulips are blooming and the garden is resplendent with color. The big-leaf maple trees are filling with leaves. The robins, chickadees, juncos and finches are back at the feeder and the barred owls are making noise, dueling over females and territory in the forest. I spotted the first trillium of the season on the west side of our new fence and the area is full of promise of more to come. We've been busy moving loads of compost and planting trees and ornamentals around the property. The bare-root apple trees we planted are sprouting leaves and doing great. I demo'd the chicken runs that were attached the coop and created a new bed where I'm planting the maple seeds Ana found and that we sprouted in the refrigerator. It's time to stop all the talk about death and get on with savoring every moment of life.

Finding the Mother Tree

June 29, 2021

I can't believe it's been two months since I posted here. So much has happened since then. Deena's sister Sue visited in May and we had a really enjoyable time. She is one of the most caring and compassionate people I know. Larissa also came for a visit in May and it was a lot of fun. She is so easy to be with and has a great sense of humor. We did a few touristy things, but spent most of the time relaxing at the house and watching birds. She picked up my guitar and sang John Prine's song Angel From Montgomery on the patio and I thought an angel was singing it. She has a beautiful voice. I had a perfect 71st birthday/Father's Day/summer solstice a week ago, thanks to my amazing family and friends. Deena made me two delicious birthday cakes.

Dr. Todd at SCCA reduced the amount of Carboplatin in my chemo infusions and put me on a four-week schedule instead of three. The extra days in the recovery phase are much appreciated, but the side effects in the first week are becoming increasingly brutal, even with the reduced dosage. I was barely able to make it up the stairs last week and spent three days mostly prone, but I'm slowly feeling better. We're experiencing a major heat wave (it's been hitting 100 in the shade on our deck), so I've been hanging out in the basement where three of the walls are concrete backed by soil that keep the space in the 70s.

Being unable to do a lot physically, I have had a lot of time to read and just finished a fantastic book, Finding the Mother Tree, Discovering the Wisdom of the Forest, by Suzanne Simard. It was recommended to me by a wonderful hospice therapist I've been working with whose spiritual training was in the Tibetan Buddhist tradition. We share a love for the forest as a sacred place that offers peace, joy and a connection to the earth and the universe. She is more of a teacher than a therapist to me and she recommended another book, The Five Invitations, Discovering What Death Can Teach Us About Living Fully, by Frank Ostaseski. From the book: "When we release our clinging to what used to be and our craving for what we think should be, we are free to embrace the truth of what is in the moment." She has agreed to serve as a death doula when the time comes for me to leave my earthly body and for my spirit to make its transition. She suggested I set up an altar to help guide my meditation and to smudge with sage to clear the space in order to let positive energy flow. I added a crystal singing bowl tuned to the heart chakra which provides a beautiful aural entry into meditation. It is a place of peace for me. My therapist suggested a few mantras for me and I settled on this: Let go, be open, and trust. She has been incredibly helpful in helping me to be, as Ostaseski says, free to embrace the truth (and joy) of what is in the moment.

Back to Square One

Finding the Mother Tree is a beautifully written and deeply personal memoir by Suzanne Simard, a professor of forest ecology at the University of British Columbia. The book takes us on her journey as a young child in a family of loggers to her research that demonstrates that trees and the organisms around them are connected, communicate and cooperate for the common good. She writes: "The scientific evidence is impossible to ignore: the forest is wired for wisdom, sentience, and healing." Her ideas inspired the Tree of Souls in James Cameron's movie Avatar and she is featured in the film Fantastic Fungi (available to rent on Amazon Video -- you must see it!). She delivered this wonderful TED talk that has been viewed nearly five million times:

Also from the book: "Western red cedar is known as the tree of life to the Aboriginal people of the West Coast of North America, for whom it is of great spiritual, cultural, medicinal, and ecological significance." We are fortunate that our house is surrounded by western red cedars, many of them named for my friends and family. The forest south of us, which Lost Creek Trail runs through, is full of stumps of old-growth cedars that were logged many years ago and it is now mostly Douglas firs. While the cedars on that portion of mountain are gone, their decaying stumps continue to serve the forest's plant and animal life, part of the unending cycle of birth, death, rebirth and flow of energy through all living things.

The Time is Near

September 12, 2021

I'm sorry to have to repeat the opening sentence of my entry from April: It's been a rough week for Deena emotionally. We went to SCCA two days ago for chemo and to review with Dr. Todd the new bone and CT scans that were done last week. I saw a copy of the bone scan in advance and adding that to the way I've been feeling, I knew that the chemo was not slowing the cancer down. It has grown and metastasized to other parts of my bone, which confirms for me why I've been having a lot of pain in my ribs and spine. They are so involved that they are fracturing with very little pressure on them. The CT scan showed the cancer has also advanced in my lungs and liver, so we decided to stop the chemotherapy. I'll be getting a referral to a radiation oncologist to "hit the hot spots" (my terminology) in my ribs and spine to reduce my pain. After that one treatment, I'll be referred to hospice for the remainder of my care.

Hospice

September 30, 2021

We went to SCCA on Monday for the one-time radiation therapy on my spine and ribs, which was the end of my treatment. We met with the intake nurse with Whatcom Hospice yesterday and I'm officially on board for in-home care when the time comes. The end-of-life medication prescription is at the local compounding pharmacy and we're on board with Whatcom Cremation to take care of my body after I transition, so everything is in order.

Our best and longest-time friends Ron and Peaches Brown visited for several days this month and we had a wonderful time. We were in each others's weddings and really miss being able to visit them in San Clemente like we did for so many years as we both raised our children. Deena's sister Sue is arriving tomorrow to visit for six days. It will be nice to see her and for Deena to be distracted from all the talk about me and my end-of-life. We are really fortunate to have her support this week and for my end-of-life ceremony and the days afterward. I'm getting weaker and weaker and able to do less. I get out of breath climbing the stairs and will need to get setup in the basement with a hospital bed soon. Every person I have met or spoken with associated with Whatcom Hospice has been incredibly compassionate, caring, and accommodating. It takes a special breed of person to do that kind of work. I am fortunate to have such a great team to work with.

Declining Rapidly

October 8, 2021

Sue left yesterday we had a wonderful visit. She was a great help to Deena and me as I'm limited in what I can do physically. Hospice delivered a hospital bed, walker and a commode yesterday and we opted to set it up on the main floor at the end of the dining room. Because I was having to get up in the middle of the night to take more Norco (hydrocodone and acetaminophen), I'm now on 12-hour time-release morphine. And a pile of other drugs to keep me alert during the day, put me so sleep at night, keep my bowels moving, prevent reflux, and keep my blood pressure normal. The radiation treatment damaged my esophagus and I'm having trouble swallowing, which means I might not be able to take the end-of-life medication as planned. In any event, my body is declining rapidly and the drugs are turning me into a zombie, so this might be my last post here.

It was my hope that I could send a note card to a long list of friends, telling each of them how much they meant to me in my life. If you're reading this, you are one of those wonderful people. Wishing you peace, joy, and love.

End of Life Ceremony

October 23, 2021

It's curious that my last post was the day after Sue went home and today is two days after she returned. After many emotional discussions with Deena, we have agreed that next Wednesday, Oct. 27 will be my End of Life Ceremony and I will take the Death With Dignity medication and leave my earthly form. Having a date made my impending death very real for Deena and she reached out to Sue to be here alongside her. We are so fortunate to have her love and support. Chris has arranged for leave and will be here for the week and Dean will be off work as well. The ceremony is a mix of Buddhist and Lakota Native American traditions that my therapist/death doula practices. Here is one of the poems she will be reading that I really like:

Returning Home
by Tu Weiming

Your vital energy is returning to the source

Like a flowing stream returning to ocean.

Heaven is our father, Earth is our mother.

All people are our brothers and sisters

and all things are our companions.

In this gentle, peaceful journey,

you are forming one body with heaven

and earth.

Entrust yourself in the transforming and

nourishing care of the cosmos.

Listen to the voice of love in silence.

You have heard the way;

Return home in peace.

I am so fortunate to be able to choose the time and place where I return home in peace, surrounded by my family and filled with love.

DON DAVIDSON

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