Pancreas Goes On Performance Improvement

Me: So, Pancreas, do you know why I brought you into my office today?

Pancreas: Is it about those vacation days I asked for? Because I’ve already bought the plane tickets. 

Me: Sigh. 

Me: First, as a pancreas, you don’t get vacation days. Because you are a PANCREAS. If you were the Skeletal System, we could talk about days off.

Pancreas: I work very hard.

Me: (sotto voce) And now we come to the crux of this discussion. 

Me: Are you entirely sure about that? 

Pancreas: That I work hard? Yes, I’m sure. Damn sure. There’s no harder working organ in this body.

Me: Okay. Okay. I think I should stop you right there, before Heart hears you. Or Lungs. Or Central Nervous System. Or Liver. Liver is working at full capacity even though it’s about half the size it was two years ago. Can you say the same?

Pancreas: Unfair. I cannot be cut in half. 

Me: (sotto voce) Well, you’re working like you were.

Pancreas: (suspicious) What was that? I didn’t quite hear you.

Me: I said, “I’m so cold. Brrr.”

Pancreas: (confused) You’re exactly 97.9 F. Perfectly normal.

Me: Right. Let’s get back to your performance. Can you explain your reduced enzyme output?

Pancreas: Resources are limited. I’m getting up there, almost 60 years old, you know. You had that surgery last year. It threw everything off. I’m tired. I need a vacation.

Me: Sigh.

Me: I assume you know that the heart is older than you are, by like 2 weeks. ANYWAY….

Pancreas: (makes raspberry sounds) Heart. Blah Blah Blah. All I ever hear is that Heart is better than me. Hmph.

Me: Look. Your enzyme production is down. Stomach and Intestines are requiring external enzyme support. I’m going to have to put you on a performance improvement plan. 

Pancreas: Oh yeah. How about I just quit? 

Me: Stomach and Intestines both think you already have. That’s why they’re demanding external enzyme support. Pancreas, this performance improvement plan is for your own good. If you don’t start making enzymes, you’ll be replaced entirely by enzyme pills. You don’t want that. You’d miss working. We’d miss your cheerleading at the daily stand up discussions. And your jokes! I’m still laughing about the hippo-zippo one you told last week. 

Pancreas: (a little teary) You liked that one? 

Me: I sure did. Do you want a tissue?

Pancreas: (nodding) I’m sorry. I’ll do what I can to step up productivity. I’ve just been feeling a little down. It’s the season, you know? You eat so much food during the holidays. 

Me: (angry face)…

Pancreas: Not that I’m blaming you. 

Me: Uh huh. Suddenly I’m excited to start taking those enzymes. (glares menacingly at Pancreas)

Much love.

Pancreas Goes On Performance Improvement

Scanning The Future And Maybe The Past

Driving across the state at this time of year, the hills are dotted with color, white and pink blossoms and the soft green of spring. I left the turnpike around Carlisle, Pennsylvania and drove through small towns with remarkable names like Jim Thorpe and Zooks Corner and acre after acre of farmland, lush with early growth. The hillsides here are dotted with cows, sheep, horses, and the occasional goat. With my air conditioner issuing only an unenthusiastic whisper of warm-ish air, I’m relying on vintage, 4×65 air conditioning. It’s mostly effective, cooling, if also fragrant with the earthy smells of animals, not the least of which was the 18-wheeler filled with cattle, their large noses pressed through the grates like dogs hanging out the car window.

When I lived in Florida, my car didn’t have AC. I’d get in and, first thing, wind down the windows – yes, with a hand crank – before going anywhere. Even if I was driving the mile and a half to the Piggly Wiggly, the windows had to be down. It was so hot in the car that, no joke, my camera tripod handle warped and it wasn’t even in direct sunlight. The 4×65 air conditioning didn’t exactly work. The breezes were mostly warm, smelling of asphalt and fumes. My roommates laughed from their white, AC-equipped cars but I didn’t care. I was 20 years old and living the dream, as they say. 

Back then, I had only an AM radio but now I listen to audiobooks while I drive. This time it was Dragon Day by Bob Proehl, a fictional oral history by survivors of dragon attacks. It was immensely enjoyable, though its audible and goodreads reviews are rather middling. I joke – often – about reading books with dragon sex (yes, they exist), but I generally prefer my literary entertainments sans dragons. This, however, is worth a listen. 

My quarterly scans were this morning, scheduled early, allowing me to visit a favorite breakfast spot as a little post-scans celebration. The tests are a love/hate experience but the after-scans breakfast is a way to honor being here for another day, something I might not have except for that life-changing CT in December 2023. If this feels like a nudge, it is. YOU too probably need preventive care that you’ve been putting off. 

I’m writing this from another hospital, where I’ve spent my afternoon, acting as the patient support for someone getting their preventive colonoscopy. There was just a code O in obstetrics, which made me worry for strangers in the way one does at a hospital. As another patient once reminded me, very few of the people at a hospital are there for happy reasons but I always think of obstetrics as being one of the exceptions. Until that code O. 

An accordion-playing busker in Squirrel Hill has garnered much attention during his performances. He was good enough for me to cross the street to throw some cash into his open case. I’ve looked for him since and regret not asking his name. Buskers are frequent throughout the city but good buskers are rare. Years ago, there was a great singer, in our Oakland neighborhood, who could stop traffic. He busked in the late 80s, his voice deep and rich as he sang gospel, swaying to and fro on his flipped-over milk crate. I looked for him — a big, stooped-shouldered man with a tangle of black hair and dirty clothes — long after he stopped busking on the sidewalk near the McDonalds.

Much love.

Scanning The Future And Maybe The Past

7mm From Free

Fall in Pittsburgh – foggy mornings, brisk sunny days. Walking to the coffee shop again is like putting on fluffy socks as the temperature drops. Much about the store itself has changed but not the customers. Every day, I see someone I know and we share a smile, sometimes a few words. Community, my friends. 

A quick health update: scans show no evidence of disease in my liver. That 7mm spot in a pulmonary lymph node – found in my December 2023 scan – is still there. We’re calling that a watched spot, lol. Next scans in January. So far so good. 

There’s a group behind me talking about sourcing materials. It’s a very serious discussion, almost presentation-like. Reminds me a lot of standing in front of a client, pitching our enrollment tools. That’s an experience I don’t miss at all. One time, many years ago, when I was responsible for creating the health plans that self-insured clients purchased, a potential customer approached us about creating a policy that did not cover pregnancy. We had a lot of internal conversation about that and as was often the case, I was the only woman at the table. Of the six or eight men in the room with me, only one agreed that it was grotesque to even consider that request. Luckily for me, having to write that coverage, and for the women who would purchase it, the man who agreed with me was the vice president of sales. We didn’t write the business. 

The coffee shop is bustling, lots of people enjoying the weather. A child – early teens, maybe – has just come in. They have that tentativeness of the teen years, when you think everyone is looking at you and you really want to act normal, whatever that is, or really cool, again however that looks. Their money is folded in their hand. They have to unfold the little square of bills to pay. 

After a few moments, they’re handed a large mocha with a mound of whipped cream and a drizzle of chocolate syrup. It looks delicious. Apparently, it’s not quite ready to drink, though. They head to the coffee bar, use a straw to stir the whipped cream into the drink and then pour in a bunch of cream. A taste of it confirms that it needs even more cream. A second quality check confirms that perfection has been reached. The lid is snapped on; their remaining money is carefully folded and tucked into a pocket, and off they go into the sunny afternoon. 

I just finished reading Demon Copperhead. Oh Lordy. Was that a journey of a book. It took me a couple weeks to read because it is stark, filled with trauma, making it one of those novels to be read in short sessions. I have to say, though, that it deserved the Pulitzer. Barbara Kingsolver has written a protagonist whose voice is so powerful I can still hear him talking in my head, days after I finished the book. 

Recently, thanks, I think, to all of the death in Demon Copperfield, I had a dream about my paternal grandmother. She died when I was 17 – cancer, plus two strokes – a particularly bad death. She was dying again in my dream and I was going to see her one last time. It doesn’t make sense – do dreams ever? – because in the real world I was with her when she died. It was, in fact, the first time I watched someone pass away. 

My sister and I had a challenging childhood. Grandma made things better. I felt closer to her than I can express; she only had two grandchildren so she lavished all her attention on us – not money as she had virtually nothing that wasn’t provided by my parents. We didn’t need to have expensive adventures. Sometimes we’d walk through the mall and buy a Friendly’s junior milkshake and fries to share. We’d guess how many steps it would take to walk the neighborhood and then we’d count as we walked and cheer whoever had come the closest. She taught us how to play Crazy Bridge and we taught her and her friends to play Uno.

Losing her in my teens was as inexpressible as re-losing her in my dreams. She already spends a not insignificant amount of time in my head. I can picture her clearly, a tiny woman with a huge personality, assertive, mouthy, fearless → except for cancer. She didn’t even tell us she was sick until it was far too late. 

When she eventually called my mom (rather than her only son!) and went to the hospital, it was her final trip. Doctors did exploratory surgery and concluded there was more cancer than body. It was the early days of hospice care. Grandma stayed in a regular hospital room surrounded by all the normal hospital noises. The care team did all they could to keep her comfortable while we waited for her to die. Just a few days after she was admitted, Grandma had the first stroke. She lost the ability to speak but could gesture to me that she wanted to roll onto her side (her left side because it was her favorite sleeping position). 

None of this reality occurred in the dream. Instead, she was sitting upright in a hospital bed and talking, her candy floss mass of white hair curling all over her head. I, on the other hand, was struggling to get out of bed, frantic to get to my last visit with her. What cruelty are dreams. I’d give a lot to dream instead about her driving us to Dunkin Donuts where we’d get honey sticks and the plain donuts with the dunking handle, the kind my mom liked to dunk in her coffee. 

Much love.

7mm From Free

I Thought I Was Olive Oyl

I’m sitting next to a black lab puppy at the coffee shop. He’s being a good boy so I can’t pet him, which is a cruel, cruel fact of training one’s puppy. Still, I get to look at his delightful face so I can’t really complain. 

There’s a group of women directly behind me who are having a very girl-talk discussion of their relationships and it is MESSY. One of them just said she can’t wait for her frontal lobe to develop. (Same, girl) It’s very clear that they’re having far more robust sexual lives than I did at their age. Hehe Anyway, I am exhausted just from eavesdropping.

Want to hear the story of my scans earlier this week? After accidentally going to the hospital instead of their outpatient facility two blocks away, I got an MRI with and without contrast. I should have known it wouldn’t go well, given the awkward start. (First I accidentally went to the Cardiac MRI unit at the hospital, then I waited for 30 minutes to get checked in – which made me 15 minutes late even before I walked all the way back to the parking garage, drove two blocks, parked in another garage and went to the third floor of the outpatient center.) According to the staff, this happens a lot, which makes me think they need to work for a solution since we patients are too stupid to do it right. 

Anyway, I had my MRI. If you’ve never gotten contrast, let me tell you that you can feel contrast enter your bloodstream; it’s cold. So, when my MRI was done, I pointed out that I hadn’t felt the contrast, you know, in case they’d forgotten to do it. Well, guess what? They’d accidentally closed the IV connector on my arm and since it didn’t form a seal, the contrast leaked everywhere (and left quite a welt on my arm too). They cleaned off the whole MRI bed and we did round two. Luckily for me, I only had to repeat about half of it since the non-contrast MRI had been successful. 

We’re not done yet …. Usually, the tech announces when they add the contrast. Instead, I knew I was getting the contrast in my arm because it burned like a hot match held to my flesh. Burned and burned and burned. Meanwhile, I’m going through the announced instructions to hold my breath, and breath normally, and hold my breath, and breath normally. I’m trying not to pant while this stupid contrast is – in my head – stripping the flesh from my body. Then, suddenly, it’s over. The bed slides out of the MRI and I tell the technician that I didn’t know the contrast hurts because it never did before. 

Friends, it isn’t supposed to hurt. The IV needle was through my vein and pouring 10 ccs of contrast into my bicep, which had ballooned into a football. The tech called the radiologist who, after quickly checking the scans, said, despite the oopsie, enough contrast had gotten into my system. No need to do a third MRI. We all had a good laugh about my Popeye arm and I went back to the garage, back to the hospital, into their garage, and then down to the correct radiology unit for my CT. 

Again, my friends, we aren’t finished. I arrive in the waiting room and someone comes up to me: “Ms Zuroski?” That’s weird. Right? I say as much and the staff person tells me they’ve received multiple phone calls about me. About me? Yes, because, upon a second review, the radiologist determined that there wasn’t enough contrast and I needed a third MRI. Lol

Before that, they did my CT. Then, three – true story – three radiologists came in to look at my well-inflated football arm and determined that I would, in fact, survive to experience another MRI. And so I did. They had a hard time finding a working vein so I have a few extra holes in me today but overall it was a remarkably amusing experience. Sadly, my arm has since deflated. Perhaps I’ll try Popeye’s solution and eat a couple bags of spinach.

Don’t ask because I won’t have results for maybe 10 days. There’s a radiologist shortage. I’ll let you know the news when I know the news. 

Much love.

I Thought I Was Olive Oyl

Walking a Razor-thin Wire

I’m at the coffee shop again, the second time in months. It actually feels a little uncomfortable today, though I can’t articulate why I feel out of place. It’s as pleasant as ever on this edge-of-fall day. The big garage door is open, a cool breeze rustling the napkins and my chemo curls. I usually shave my head with a #3 razor but lately, defying the chemo thinning and chemical damage, I’ve let it grow out a bit. It’s a touch silver now with a little flip at the ends, slightly flattened by the baseball cap my daughter insists I wear in the sun. 

The sidewalks are quiet today. Schools are back in session but since projects aren’t yet due, the students haven’t settled into seats at the back of the coffee shop to work while they talk in hushed tones about their assignments and the cute student in chem class. 

A few minutes ago, a young woman, early 20s I’d guess, came over to my table and asked me a question. It was somewhat hurried; I’m somewhat hard of hearing. I asked her to repeat her question. She said, with a touch of pink on her cheeks, “Do you have wired headphones I can borrow?”

I don’t, my friends. Like most of the 21st century, I use bluetooth headphones. We all know, however, why she asked the silvery-haired lady. I’m pretty sure she just generalized that I, being of an older persuasion, would still be using wired headphones. Next, someone will address me as ma’am and I’ll have to acknowledge that only mentally am I still 17 years old. 

There’s a couple just seating themselves next to me – 70s or early 80s, I would guess. He leans a little forward as he walks, his hands slightly behind him, knees bent like he’s learning to ice skate. He’s on his way to the counter where he’s to order his (probably) wife a small coffee. She emphasized the size to him, as though he regularly brings her a 20oz cup. Now, while he awaits her order, she sits quietly awaiting him, her sky blue sweater flattering the stark white bob of her hair. 

I’m splitting my time today among a synopsis for a novel I’ve been working on for months, a creative nonfiction piece, and this blog. Occasionally, I’ll stop for a moment to look at my peeling nails and wonder about the year’s journey. Mostly, I put it aside but every now and again, I’m struck by the difference between my expectations and the year’s reality. I spend a few anxious moments reminding myself that the cancer was all removed and sometimes touch my tender scars as reinforcement. As much as I disliked the constant poking and prodding, the pills and the appointments, I sometimes now feel like a tight-rope walker who is performing without a net.

The scans that I’ve been anticipating for a month are next week and then the usual wait begins. I’ve been working hard on addressing my scan-xiety but it’s there, despite my efforts. I tap my chest where that 7mm mass is located (right under my breast bone) and remind myself that I’m feeling better, more energetic and less sick. That must be a good sign, right? But that argument doesn’t really work for me since I felt fine while there was a cancerous tumor growing on my liver. I guess the point I have to learn is that the only thing I can control is how I respond to the “slings and arrows of outrageous fortune.”

For a time, I obsessively googled cholangiocarcinoma, looking for miracle cures, hope in statistics, comfort for the fearful, perhaps. What I found was statistics that you wouldn’t bet against (my cancer has a recurrence rate above 70% and is terminal in something around 87% of cases). Since that kind of searching did nothing to appease my anxiety, I decided to stop looking for hope in those searches. Instead, I try to remember to spend my free time relishing the moments I have, sitting on the deck with my daughter, teasing my sons with terrible dad jokes, playing with my dogs. I won’t – I hope – waste whatever time I have pining for options that I may not even need. I could be one of the 13% who survive past the five year mark or I could get hit by a bus on my way home from the coffee shop. 

I may have mentioned that I broke another toe about two weeks ago. It’s still swollen as a grape, not an image you necessarily wanted implanted in your brain but … hey … it’s already in mine so why not share with you?! I finally decided to call the doctor today because my walk to the coffee shop was painful. Can’t have my activities restricted by a stupid broken pinky toe. Unfortunately, I probably reinjured my plantar plate, which would be a bummer, but I’ll wait for yet another doctor appointment instead of opening up google to do more anxiety-causing research. The doctor asked if I got my foot x-rayed. HAHAHAHAHAHA Like I went to a doctor.

Two people just walked by with bouquets of flowers from the flower shop, Toadflax, just down the street. They hug and separate just outside the coffee shop entrance and one of the people comes in for a drink. The bouquet she brings with her is tucked into a little bag reminiscent of a flower pot. I want to take a big whiff of her flowers but I know they’re from a hothouse and have no scent. Still, the pink paper wrapped around the blooms complements the overall color scheme and adds a delicate air of elegance to this brick and wood establishment. More importantly, she’s clearly delighted with her purchase and isn’t that charming?

Much love.

Walking a Razor-thin Wire

A Case of the Augusts

No nap today, which is a big step up from Friday and Saturday. Those two days you’d have found me on the sofa, dealing with a bad case of WONKY. It’s hard to describe wonky. It comes in many forms. Sometimes, the world seems tilted a little and I can’t keep my balance. Other days, I’m slow-moving through molasses, heavy of limb and empty-headed. 

Life is going relatively well, all things considered. And by that, I mean my nails are still peeling and my heels are cracked, my stomach and my intestines are unpredictable, but those are my normal so, actually, I’ve got no complaints here.  

My daughter is in San Diego, enjoying a much-deserved break from all things cancer. Since she’s been doing the vast majority of the cooking, I’ve created a menu of low-effort meals for the week, necessary, since my energy is still rather sapped as the chemo slowly leaves my body. We’re having, in case you’re curious: pancakes and bacon, burgers, a ham slice and potatoes, a small roast with carrots and some roasted delicata squash, sandwiches, and meatloaf. If things get too real, there’s pizza in the freezer. And I won’t feel sorry in the least if I need to invoke pizza night because who doesn’t like pizza?!

The nurse who takes care of me called to wish me congratulations on my chemo break and to let me know that she won’t be checking in anymore. I knew that but it was still a bit of a jolt. It’s not that I need her to do anything but it feels again like the protective net is slipping. No doctor appointments, no nurse checking in with me, no bloodwork. What am I, a healthy person?

It’s move-in time at the college across the street. There’s an illegal amount of laughing and giggling going on. It’s weirdly like the kids are looking forward to ditching their parents and living without supervision. (This is sarcasm.) 

I never lived in a dorm. Even with some scholarship money, I couldn’t afford to live on campus. Besides which, during college, I worked 4-11 most nights to try to make up the financial gap between the bill for college and those beloved scholarship funds/student loans. By the time I started grad school in Pittsburgh, leaving the house wasn’t something special. My dad had already warned me that if I planned on living at home, he’d charge me $500/month rent. That was more than I paid for my first Pittsburgh apartment ($325/month baby, utilities included).   

The yearly karaoke hasn’t started yet. Believe me, I’m on tenterhooks, waiting for it. When it begins, if I go across the street and sing, do you think they’ll get the hint? I’d guess not. My singing is at least equivalent to some of the people who have performed there in the past. I know why karaoke is popular: alcohol. Since there’s no alcohol on campus, I cannot explain the success of this annual event. And since I only have part of a liver, I can’t even add alcohol to MY day to make the event more pleasing to my sober ear. 

Honestly, I love the college move-in tradition. What I dislike passionately is the capitalist effort to encourage parents to spend ridiculous sums on things their children will throw out in nine months when they clear out their dorm rooms. Trust me, parents, your children will not use 90% of the cleaning supplies you’re purchasing. Neither will they need a second set of sheets, shiny wall decor, and throw pillows. Many of them won’t even use the notebooks and pens that Target says you need to get them. I know this because I walk by the unopened packs of notebooks tossed on the sidewalk with the unopened cleaner, mops and brooms, hangars and clothes with price tags still attached. Community members, including me, have been trying for years to get the schools to collect these things for freecycling but it’s difficult to coordinate and easy to look the other way. 

There’s an interesting media frenzy about a celebrity’s child attending Carnegie Mellon this fall. Mostly, we residents (and the students) don’t care much about this stuff. CMU is renowned for its student – and alumni – fame. My roommate, a million years ago, was the son of an ambassador. I was in class with the great-granddaughter of our founder, as well as full professors, children of CEOs, international students of government officials. It’s hard to be entitled amongst the entitled. I suspect she’ll blend in with a student body that is singularly unimpressed by fame. After all, the shine of privilege gets decidedly less shiny the first time you have to tell your roomie that he has vomit in his hair. 

Much love. 

A Case of the Augusts

Mary Oliver Knows What’s What

The neighborhood is quiet again. For six weeks during the summer, there’s a camp across the street. The kids are quite … audible from about 9AM to 4PM. It’s delightful, really, the sounds they make, their shrieks of laughter and chatter. Now, it’s easier, again, to hear birds but the noises of childhood are all gone. Probably that’s not true in most neighborhoods but ours is an older population. There are few children here and their giggles are muted. 

In her poem “Don’t Hesitate,” Mary Oliver writes, “Joy is not made to be a crumb.” She tells us to embrace the joyful moments we come upon because they are few and unexpected. Isn’t that a child’s laugh? The smell of the bread my daughter is baking? When my son teases me and we chuckle because I called Deadpool Spiderman? I can’t wait for an end to cancer to experience joy because there might not be an end to cancer but if we don’t seek it out and celebrate those found moments, there will definitely be an end to joy. 

It’s cycle 8, the last cycle of chemo for now. And it’s been full of delights – vomiting, attacks of unproductive nausea (if you know, you know), cold sweats, dizziness, and lots of unspecified gastrointestinal delights. At least I know I’ll have a break soon. 

My nails have started peeling but thankfully, my hands and feet are not. Yes, that’s a pretty common chemo thing – peeling appendages. Ken struggled with it. His feet especially looked like dried alligator skin. Nothing seemed to help him. I’ve been more fortunate and more responsive to my daughter’s entreaties to please use the body lotion people have so kindly sent me. It’s working; so, thanks, everyone. 

It gets tiresome, you know, to constantly think about your own wellbeing. We’re all mostly oblivious to the functions of our bodies until those parts are not quite working. Back aches, stomach upsets, sore feet are all experiences we’ve had and moved on from, not giving them a thought. But in the midst of an extended health event, everything is about what’s working and not. And after a bit, it’s annoying to be constantly spotting problems. 

One morning, I woke up thinking “I feel sick.” Then, I sat up and had terrible vertigo that did not end when I lay back down. Closing your eyes works (in case you ever experience vertigo). After a few moments, the dizziness was gone but the nausea stayed. I have to eat to take my chemo pills so I had a glass of milk for breakfast and an egg for dinner and nothing in between. Tiresome, you see what I mean? Who wants to constantly be thinking about whether they feel okay? 

Recently, I was shopping at Costco with my daughter – we had run out of milk which is a catastrophe in our house. We were discussing the merits of a clearance storage item when I suddenly felt very wonky and started to cold-sweat. My worst nightmare is to have a health event at Costco and there we were, health-event underway. I sat on one of their display sofas for a bit, visited the bathroom for reasons you can imagine without further explanation, sat on the sofa again, and then decided to wait in the car where I could direct air conditioning on my very sweaty brow. 

Alas, that was not to be as the car had a very dead battery. Yes, that’s right. A 90 degree day and a dead battery – so, back I went into Costco to sit on that convenient sofa. 

My daughter made sure I was okay on the sofa, did all the food selecting, checked out, and loaded the car. I took on the easier task of jumping the battery with our lovely battery charger (having one in the car is so unnecessary until your battery is dead!), with her providing the essential moral support because I was really going through something as we like to call it. On the way home, she even put up with the frigid car temperature so I could cool my very sweaty self. And then she put all the groceries away while I lay on the sofa. One of the silver linings, I guess, is having the opportunity to see my loved ones shine in my rather dark place. 

Next week starts my long chemo break. I’ll have scans in September and visits with my surgeon and oncologist in October. I wonder what our next steps will be.

Much love.

Mary Oliver Knows What’s What