April 3, 2023
In April 1968 I got on a train in Springfield, Mass., bound for home in Jersey for spring break. From the far end of the car I could hear someone’s portable transistor radio (remember those?) playing Simon and Garfunkel’s “Sounds of Silence”: Hello darkness my old friend. I’ve come to talk with you again. The lyrics drifted through the car. I had just turned 19. Guys my age were dying in Vietnam.
The words were right for that raw, ugly time. Seems they are for another time, our time: unspeakable tragedy in our home town, Nashville; then lowbrow comedy in the indictment of a washed-up vaudeville performer/ex-president.
That long-ago sense of darkness resonates. We try to move on. For us, last Tuesday was CT (computerized tomography) scan day at Greer Hospital. The workup requires a catheter through which a dye is pumped into the bloodstream to highlight the body’s organs for the scan lens. The phlebotomist stuck my left arm at the inner elbow.
“The vein has blown up. We can’t use it,” she said. “Can I look at the right one?”
“Blown up?” I asked.
“It’s if the vein won’t let the needle in. It happens sometimes,” she said. She grasped my right arm and inspected it. “This one looks great. Let me get a new needle.” I winced when I saw blood spattered on my arm. She inserted the new needle and attached the catheter. She motioned me into the CT chamber. The CT technician smiled. “Hi, I’m Keenan. Let’s get you ready for your scan.”
I asked her about the vein. Medical people who stick me usually compliment me on my veins.
“Sometimes the needle just won’t go in, if the vein is stiff for some reason. Sometimes the needle is too big for the vein and goes right through, allowing bleeding outside the vein. But it’s okay. You’ve got the catheter.”
This CT was intended to check my lungs and liver after four treatments with the immunotherapy drug Keytruda. The theory: Keytruda stimulates the patient’s immune system to fight certain types of cancer.
Someone explained it this way: Our bodies create cancer cells every day, our immune system routinely detects and destroys them. Some cancer cells disguise or camouflage themselves from the immune system and propagate undetected. Keytruda unmasks those cells so the immune system can attack them. The immune system, not the drug itself, fights the cancer.
I bought the theory. After the four Keytruda infusions it was time for a look, via the CT. Keenan, the technician, positioned me flat on the platform, which passed through the CT scanner three times, a mechanical voice chirping, “Hold your breath … breathe.” on each pass. That was it. She uploaded the scan to a radiologist for his analysis.

The report arrived that afternoon on the patient portal. At the top: “The pleural-based nodule along the diaphragmatic pleural surface posteriorly on the left continues to enlarge. The low-density lesion/metastasis in segment 7 liver continues to enlarge. Multiple malignancies,” the report said.
That’s cancer. It keeps coming. The big weapons, radiation and chemotherapy, have major downsides, they kill healthy fast-growing cells as well as cancer cells. Surgery is traumatic and may be impossible. Now there’s immunotherapy, which for many folks means Keytruda. You imagine this wonder drug coursing through your veins, gently massaging your bone marrow and lymph nodes, headquarters of the immune system, directing it to pulverize cancer cells.
On Thursday the oncologist was sunny, upbeat—a big part of his job, since all his patients are depressed. He tapped a few keys on a keyboard and brought up on a wall-mounted computer monitor a bizarre upside-down image of my body, the organs kludged together like chaotic boulders. In a corner of the screen he brought up the data from my last CT, in November. He pointed to a faint shadow on the older image and a darker one on Tuesday’s scan.
The darker shadow, the tumor on the liver, had grown to about three inches long from two inches at the last scan. It looked like a good-sized chunk of the liver.
“It shows up on the scan, but we need more information,” the doc said. “It could be a dead or neutral zone, where the immune response is now being optimized. You didn’t start Keytruda until mid-January. That gave the lesion two months to grow,” he said. “So we’ll have to wait for the next CT to get an accurate look. But your liver function is normal.”
The spots on the pleura (lining of the lung) were ghostly lines barely visible on the screen. The doc pointed to the report with his pen. “These are stable,” he had written. The numbers were nearly the same for both on the new scan and the older one. But they probably explain why I’m usually out of breath doing almost anything.
He asked about side effects, nausea, headaches, insomnia. No problems, I answered. “Here’s a plan,” he said. “You’re getting an infusion today, we’ll schedule two more, three weeks apart, then a quick CT. Keytruda is a big option, we don’t want to give up on it. The other is surgery.”
One of the eerie sidelights of my cancer: no pain. Without late-stage trauma or side effects, you don’t know what’s working or not working. Every three months the doctor walks you through incomprehensible black-and-white computer images. He slides his mouse expertly across the screen, over this gray shadow or that one, assuring you in techno-medical language that everything is under control or will be shortly. It’s what he does for me, for all his patients, what we hope he’ll do until this is over—and it will be over.
He has a plan for all his patients, some with tragic terminal cancers, which still outnumber the medical miracles. He’s a young man who works in a world of darkness. “Sure, there’s a risk of metastasis,” he said. “There’s always a risk. But we’ll deal with that. Sound good?” He grinned and held out his hand.
Sounded good. We shook. “See ya,” he said, waved, and headed to his next appointment. I grabbed a bottle of water and headed for the infusion room.







