June 12, 2023
Before we left home for my appointment I walked behind the house and looked at the garden and the lawn. More weeds had shown up, thanks to the hot South Carolina sun. As we putter up the block we see “Congratulations Graduate!” signs in front yards. People are stirring about at their lawn chores. They wave, I wave back.
We headed to East Greenville, made the right turn onto Commonwealth Drive then onto International. The street is lined with beautiful landscaping, enormous shade trees, and modern medical office buildings, clinics, and one of the Bon Secours hospitals. We pull into the lot, which is bordered by a garden and a shrine to the patients.
Everyone is friendly at the Institute. Cordiality, concern, sympathy are part of the mission. Patients wait maybe ten minutes at most for their labs, the phlebotomists get them right in. “Right arm or left?” they ask, followed by, “Band-aid or wrap?” Then back to the waiting area outside the oncology offices.
Promptly, or nearly promptly, a nurse calls the patient in and does the usual weigh-in (although you can decline it), blood pressure, and temp check. “Any falls?” she asks.
The six months of immunotherapy sessions have become a ritual. I show up, give blood. The lab checks the blood and, for most visits, sends the data to the physician-assistant. She looks at the numbers, some are always little high, others a little low. She asks me how I’m feeling. “You need to hydrate better,” she says. “Sixty to eighty ounces per day.” She then gives the pharmacy the go-ahead to mix the drug.

Last Thursday we went straight to the treatment room.
Dr. B. usually is on time. His appointments are scheduled for 15 minutes, but he’s always with us longer. He’s a young, good-looking guy with a lyrical South Georgia drawl, and he knows cancer, the big four therapies, radiation, chemo, surgery, and the newer drugs, but also the complex gene science that controls our lives. After my December 2020 operation he sent my tissue to Foundation One, the Boston lab that studies cancer at the cellular level. He wanted to know that much about my insides.
That’s where he was last week. He called up the new CT scan on the computer monitor, peered at it, and sat back. “You’ve got me stumped, Ed. I looked at these again last night.” He leaned forward and drew his hand across the shadows on the screen. “This is where we are. There’s some growth. But I don’t think we need to move to something stronger yet.”
I mentioned that the scan report showed a change in the liver tumor from millimeters to centimeters. “No, that’s wrong,” he said. He scratched out “CM” on my copy and wrote “MM” next to the number. “It’s a typo. I don’t know how they did that.” We let out our breath.
He got to his feet and turned to a white board and scrawled “Erdafitinib.” It’s a drug identified by Foundation One thought to benefit my er—situation. The disease has something to do with the mutation of a gene, dubbed FGFR3, that creates a protein used in cell functions. Mutation of the gene can cause cancer cells to multiply.
“If we decide that Keytruda isn’t working, we could go to Erdafitinib. It’s a chemo drug, taken in pill form. But it brings some toxicity—side effects—nausea, abdominal pain, others,” he said, still upbeat, smiling.
I like to think I was done with that.
The doc took his seat and leaned back, his hands behind his head. He asked about the Murph workout I did at Crossfit last week, how I broke up the sets. Then he moved on. “You’re tolerating Keytruda so well, I’m inclined to go a little longer. I’m not ready to say it’s not effective. You’ve got three more sessions, right?
“Let’s finish those. We may get you a few more, then another CT. Then we’ll make a decision. We’ve looked at your liver, no problems. Stay active. Keep doing everything you’re doing.”
I headed down the hall for immunotherapy session number eight. A decision, a path forward is what matters. The real start of decline in cancer, any cancer, is in your head: uncertainty, ambiguity, which creates the second stage, depression, followed by despair.
A smiling nurse, Becky, met me outside the treatment room. I walked with her past the other patients, some looking at their phones or sleeping, some with that blasted look of “what the heck is going on?” They’re the ones on the serious drugs, the major-league toxic medicines that kill healthy cells along with cancer, wrecking the body to save it. The room was nearly full.
“Looks like you’re busy,” I said.
“Always,” she answered.
Becky pointed at a Laz-Z-Boy next to an older lady. I sat, she inserted my IV. We waited 15 or 20 minutes while the pharmacists brewed the drug.
She picked up the plastic bag with the drug and hooked me up. The stuff flowed, I sipped water. The young chaplain, making his rounds, stopped by and exchanged pleasantries, asking if anything was new. I told him where I stood, he scribbled on his clipboard. He moved on to the lady on my left and chatted with her for a while. I was out of there in under an hour.
We headed home, into the minor-league rush hour traffic this minor-league city produces, past the lovely shade trees. We steered past pretty subdivisions and thick green pastures. As I drove, I wondered how many times I had visited the Cancer Institute. I had been seeing the doc now for two and a half years. For a couple of months he passed me to Dr. Z, the radiation oncologist, who pitched me back after radiation.
Then I thought of other things, the trip to Tennessee next month, the good, loving people around us, the cosmic events that create history, the blessings and tragedies we live through. The world creaked forward.





