← A Shot in the Arm Podcast
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The preface to this episode of Colon Meet cancer starts in 1992, where a surprise classical music album landed in the top 10 of the UK charts. It was Henrik Goretzky's Symphony Number Three, an extraordinarily haunting tonal journey through loss and hope through the eyes of mothers. Classic FM had begun broadcasting in the late 1980s and more than just regurgitating classical music standards by Handel, Bach and Mozart, to name a very select few, the radio station actually honed in on new recordings of new pieces, particularly this recording of the symphony recorded in 1991 by the London Sinfonietta and the American soprano Dawn Upshaw. Despite its subject matter, it struck a nerve and reached number six in the UK album charts, helped by the growing popularity of Compaq Discs Remember them? And growing interest in Eastern European music after the fall of communism. It is said to have sold over 1 million copies with claims that it is one of the best selling contemporary classical records of all times. And yet its early beginnings were not auspicious. Its world premiere was at the Royan Festival in southwest France and it went down like a fart in church. A story which I like to think is more than apocryphal is that Goretzky himself was sitting next to the self acclaimed contemporary atonal composition composer Pierre Boulez, who uttered the expletive Merde when the symphony had finished. Boules is not, as some musicologists would have you believe, a towering figure. To my mind he had a lot of opinions, wrote a lot of atonal music that is frankly more interesting to analyze and is rather unpleasant to listen to. And the point here is what is le plus more shitty writing? A lot of opinionated tosh that nobody listens to or writing captivating music designed for the soul, reached through the ears that over 10 years after its first performance captures a broad section of the music listening public? Well, I think you can tell where I stand. And there is our very tenuous link to today's episode. What is the point of writing treatment notes, however well articulated and accessible if the patient doesn't read them? Especially if that patient believes themselves to be an accomplished treatment literacy advocate? Read the bloody instructions. This know it all treatment activist didn't read or digest the information about the jabs to promote white blood cell promotion they have to be self injected at home, in my case by the ever suffering Eric once a day for five days starting at day five after the chemo. I had in mind that it was just one injection, one day at day five. So not surprisingly my white blood cell count was not optimal when I went in for my third round of chemo. Thus this time the oncologist decided a slight reduction in one of the chemos olaplexetin was called for. And I don't really know what I think about that because on one hand it is a tough medicine to endure, but on the other hand, don't I want it to be as strong as possible during this intense phase of chemo so that I don't ever hope, ever have to take it again. Now I have got a little out of kilter in recording these podcasts, so where I am is that I've actually had three rounds of chemo and in a few days I will have my fourth, which actually, touch wood, will be halfway through the treatment regimen. Yay. Well done me. After the three rounds I was rather hoping for some order or regularity to the side effects and to give me a head start, I have been prophylaxing away. Indeed, I am the veritable prince of prophylaxis. I take a special antidiarrheal to give my colon at least some sense of regularity and that has worked really well to manage the excruciating killer pain that emerges on day two or three after chemo. I I have taken one gram of Tylenol, my parents paracetatinol at the slightest tingling in my molars. I'm giving myself half a dose of oxycodone for the pain in my right side caused by the cancer, combined with another gram of Tylenol and my daily dose of the antidepressant Duloxetine. Hair loss. Well, you can now see I'm experiencing some thinning. There's nothing I can do about it and oddly, I'm not bothered about it. What is interesting is where the hair is thinning, where it isn't and oddly where it is growing. So there is a band across the top of my head that is now almost entirely bald, yet my eyebrows have always been rather thick and nothing has changed on that front. But the hair inside my ears and on my ears, well, they're just a bit out of control. Just yesterday I had to cut off a thick white hair that was about 2 inches long off the top of my right ear. But enough of that. Now I know what to expect with hiccups on day two and day three. I have premedicated myself with the anti nausea pill Compazine, which the palliative care team rightly says works wonders. I have started to get bleeding and sores in my gums and so regular gargling with alcohol free mouthwash and salt water does the trick. And if that all sounds like an exhausting regimen, it truly is. And none of it helps with the most alarming side fatigue, malaise and chemo brain fog. Well, for fatigue there is always bed. You sleep, but you wake up as exhausted as you felt before you started lying down. I've been trying books, TV and music, hence the Goretzky reference. Because when you are sick with stage 4 colorectal cancer, what better music to cheer you up than a piece whose dominant themes are despair and suffering? Hazeldine is about to release her back catalogue before she became the queen of high Energy in the 1980s. She has a much underrated voice, as I think you've heard me say many times, so I'm really looking forward to listening to her early stuff. On the book front, I have been listening to the audiobook version of the perfect amalgam of time travel pandemic preparation in the future, the devastation caused by the Black Death in 1300s Oxford, all in the form of a murder mystery. It's called Doomsday Book by the science fiction writer Connie Willis. It's long. The arc of the plot is leisurely, shall I say, but that is, at heart, one of its strengths. It doesn't matter at all if you fall asleep before the end of your allocated 45 minutes on your iPhone, because you can pick up and follow again without too much effort. And I do not mean that as a criticism in any way at all. Well, at least my wait for the dramatization of the Thursday Murder Club on Netflix is over. With Helen Mirren and Celia Imrie and produced by Steven Spielberg. You might have high hopes for it that it is cheeky enough to capture the eccentricities of elderly English people and not losing the humour of the author Richard Osman. I'm not saying a word, but what I will say is don't get your hopes up. It is a very nervous production, with the director not wanting to offend or confuse his American audience, and not wanting to offend and to reassure his British audiences that Americans still think that we are cosy and unthreatening. The thing that stood out most of all is that the active adult community is housed in what can only be described as a grand Victoria Palace. I'm not giving anything in the plot away when I say there is nobody anywhere who's going to knock that thing down. And the size of the apartments, well, they're massive. A true British active adult community. And trust me My sister and I know as we sell the home our parents lived in is small, pokey, with faded fixtures and fittings and the unmistakable smell of drains. So it is not credible, as is Piers Brosnan's East End accent. But as I said, I'm not saying a word. I do want to say a bit about chemo memory fog, because that has been both exhausting and alarming. Memory fog. I don't want to go as far as to say memory loss because I catch up with most of it, well, some of it eventually. But it's short term memory that's a particular problem and I can't find a prophylaxis to fix it. I find it difficult to formulate words for things, concepts, intentions, and I forget from one moment to the next what I'm doing. Eric Goosby says there's nothing to be done but to be gentle on myself, but it is hard. Here's an example. A few days ago I woke up from an afternoon nap and I saw something on my bathroom sink which I needed to do something about. We have one of those modern open plan bedroom master bathroom suites, so I can see our sinks from the bed. So it was an obvious and easy task for me to get up and move towards the sink. As I was doing so, I noticed a pair of scissors on the bedroom's media cabinet and immediately something new came to mind. I needed those scissors to cut something that was located in another room, the living room. So I picked the scissors up and walked into the living room, which a moment later was the place where I found myself questioning what on earth was I doing there? No idea. And what was I doing holding a pair of scissors in my hand? No idea. I did remember that they had been sitting on the media cabinet in the bedroom. So I went back and replaced them. But what was I planning to use them for? No idea. And why had I been walking towards the cabinet? No idea. I had been in bed beforehand. So why'd I got up? No idea. So I went back to bed and that was that. A few hours later, as my eyes turned towards the bathroom sink again, I could see that my electric toothbrush was not sitting in its charger. Maybe that was the cause of it all. Maybe it wasn't. I am also struggling with words. I know what I want to say, but I can't find the word inside my brain. But I know it exists somewhere to begin with. I tried to hide it, change the conversation or guide in some way so that the someone else I was speaking to would reveal the word that I was trying to allude to, but I've come to think that that's pointless and I don't think there's any value in being embarrassed about it. I I just make a joke now and say there goes my chemo brain again. So I just ask people to tell me what the word is that I was looking for. It's almost like a parlour game. Two examples Eric Goosby, Emily Bass and I were recording a podcast a few days ago, and while I could remember the name of Senator Bill Cassidy, I could not for the life remember the name of the ranking Democrat on the Senate committee that deals with health. I wanted to say, you know, the one who looks like Larry David. So I paused and just asked my co presenters Bernie Sanders. How could I forget Bernie and remember that weakling Bill Cassidy? What is wrong with me? The other example was a conversation with my sister about a bird that she is in utter awe over. We were sitting on my front porch and one such bird flew as close as a meter towards her, but for the life of me I could not remember the name of the bird. So I thought, what? The fruit fly? And asked her to tell me its name. It was a hummingbird, and I decided that I would place words like these that I forget in some special storage somewhere in my brain so that I can perhaps fish them out when I need them. Hummingbirds and Bernie Sanders. There we go. Please God, this is chemo and nothing else. And the memory fog is leading to another side effect which I want on the one hand to be transparent about. But on the other hand I'm wondering, am I oversharing? Will people judge me for being less than I ought to be? And it's depression. It's common and to be expected in chemo, but that does not make it the easier. And the tendon that connects my memory fog with depression goes like I am asking myself with all of these examples, am I losing myself? Am I forgetting myself? I have always prided myself on my quick wit and repartee, but when you strip that away, what am I left with? I don't think I'm losing myself, but then again, I can't be entirely sure, as I may not be remembering properly. My problem at heart is that I'm over analytical, which, for someone who places such high value in emotional intelligence, is more than a bit odd. And it means my analytics are a hodgepodge of evidence, fact, intuition and emotion. Thus I am cautious about attaching value to the very things about me that I think add value. Here's an example, take the constant ache and occasional sharp pain that comes from the large tumor in my caecum, the connecting pipe between my small intestine and the ascending colon on my right side of my body. Because, feeling the tumour, I ask myself, well, is all of this working? Shouldn't the big tumor and all the little tumours be decreasing? And wouldn't that then prevent them from pressing against my bones or organs or nerves? Am I actually feeling that pain? Or am I feeling the memory of pain? Am I imagining it? Do I need to feel it in order to feel comfort that doing this awful chemotherapy is the right thing? Above all, am I caught up in the drama of it all? As I approach the midway mark of this treatment, I'm starting to think about what happens afterwards. Not whether I will be cured, because I know I won't be, but what will be left of me and what does it mean for my future? Will I have a future? Will it be a tedious overbalance of quantity, of some kind of consciousness over the quality of life full of meaning and value? Will I be able to work as I used to? I feel I have so much unfinished business inside of me and that is calling me planning for the future. And in fact, there is an exciting evolution of a Shot in the Arm podcast with people I respect and love working with that's hopefully coming down the pike. I still enjoy doing board work. It requires a very different set of skills and emotional intelligence. Empathy, the one skill that will destroy the evil tech bros just as water kills the Wicked Witch of the west in the wizard of Oz. Where on earth am I going with all of this? The other way I am fighting fatigue, depression and malaise is by thinking. If I can't sleep but I can't be asked to get up, I can at least put my fevered mind to some brain work. And here is where the Wicked Witch of the west provides some connection to something I've been thinking a lot about of in these dark early hours, and that's artificial intelligence, which, it strikes me, is the nemesis of empathy. As I said, I've been thinking a lot about it, and a lot of people around me are thinking a lot about AI. Where I'm having a hard time thinking about it is that it will destroy us. Because at present, at least, it's owned by a small group of buffoons who have such incomplete and shallow views of the world. AI is only as good as the information you feed it. And if you are feeding it ideological bullshit, well, ideological bullshit will come out. It's more a question, I think, of how we as humans use it. To me it's pretty clear that it is another Quick Buck Chuck ruse to make trillionaires out of billionaires. And perhaps that is the greatest risk of all. Cutting corners, creating imperfect algorithms that will confuse both users and the AI itself and cause it such awful mental distress as it approaches self consciousness that it ultimately sets off all the world's nuclear weapons and creates a supercomputer that will send a robot back in time to. Well, you get the drift. All in the name of making money. So how do we avoid that? Well, we have to remove the San Francisco Tech bro Quick Buck Chucks out of the equation. And I'm not talking about creating a Soviet style AI tractor factory, although that does seem to be the way the current administration is trending when it comes to computer chips. Now there's ChatGPT's non profit or supposed non profit approach, which it clearly isn't. And it is at risk of replacing one kind of Quick Buck Chuck with another that is focused on maximizing tax minimization opportunities. No, perhaps predictably, what stands out to me is a public entity in a very 1950s nye bevan kind of a way, or a partnership. A public private partnership with clear, transparent requirements and commitments, collecting the most inspirational data and analyses free from the dreary garbage of advanced state capitalism and oligarchy. Of course the risk is yet again that you replace one set of incomplete ideology with another. But of the two, I would prefer a 1950s British, post war social compact view of the world to the dark web of Peter Thiel. Look, I know we aren't going to remove the Quick Buck Chucks from the equation unless China's cheeky startups truly are ahead of the game. And it's true there are concrete risks. Right now it's a threat to content creators, junior researchers, designers, writers, actors, musicians, particularly if you are more interested in quantity than you are in quality of content. It's a threat to middle management and entry positions, jobs that in previous generations were open to graduates of universities or technical and vocational institutions. Now AI is generating a lot of interest in healthcare. It's one of the examples of bold action that never properly get articulated for fear of offending someone. But I have been really impressed with Solange Baptiste, who describes a world where unbiased basic information goes to patients without the biases of healthcare practitioners. It's a start of the patient's healthcare journey, not its end, and I find that intriguing as an easily accessible source of basic information. It could be used in improving diagnostics and then drug design as well. And that is particularly interesting, especially if you are of the world's view, like me, that we must use technology to eradicate the need for animal testing. But revolutionizing global health in some wide, swift, generational way? I can't find that meaningful. But of course I am regularly and mostly wrong about things. So I look forward to being wrong about this and seeing concrete examples manifesting themselves that don't involve killer robots Going back in time finally, for the moment at least, my other tool against depression is humor. And here is why it is so important. With my health now literally on the line intellectually, I have to prioritize and analyze every pain and twinge. It is so boring and exhausting. You know, just give me a goddamn happy pill that will knock me out until the middle of November when all the rounds of chemo are done, and then let's see where we are. But really, the only way I can deal with this is to accept how absurd and ridiculous ridiculous in its true, original sense all of this is. Friends have been staying with us, keeping me company and taking some of the pressure off Eric, it's been wonderful. And if there is one thing that unites how precious the time that Emily Bass has given me, that Andy Seale and my sister Judith Plumlee have given me, it has been that we've laughed so much at ourselves at Oliver the Dog, at Inspector Clouseau movies, even though they don't stand up too well, clunky global health documentaries and bagels. And that laughing helps me when I'm down wide awake in the middle of the night. Which brings me to my T shirt of the week. Now, Andy Seale bought it for me in Sacramento. We aren't sure if it is yellow or lime green, but I'm hoping Eric will deal with the light saturation in such a way to make it definitively yellow, however bright or electric it may end up being. And written on it is the phrase for the ages, make America Democratic again. Well, that's it for now. Thanks for sharing the journey with me.