Ups and Downs

I had some trouble sleeping last night, so I took the advice I usually give to others and got out of bed.   That is why I am writing these words at 5:30 in the morning, after waking at 4– a cruel hour if there ever was one.   Sleep may be one of the only occasions this life offers in which—finding oneself unable to get down, one should just get up.

It happens sometimes in aviation, when an airplane’s wings begin to collect ice, and warmer air might be found at higher altitudes.   Then, going down might be more hazardous than climbing, so sometimes you have to temporarily go up in order to eventually land safely. Usually, however, what goes up must come down, and what comes down need never go up.

One of my day jobs is to teach a class at UCLA Medical School (now sadly named after David Geffen), where each week a new “case”– as physicians are trained to refer to humans in order to see them as less human– is presented and discussed.   The other week we presented the case of someone who was ultimately diagnosed with bipolar disorder, a mood disorder in which a person swings between periods of mania and depression (hence the outmoded term “manic-depression”).

Bipolar disorder is fairly common, affecting about 6 million Americans a year, but when I was seeing 30 clients a week I found it one of the easiest diagnoses to miss.   That is because when a person shows up in front of you who might be suffering from a bipolar disorder and isn’t in the midst of either a manic or depressive episode, there is nothing in their manner that would lead one to believe there is anything to diagnose. The diagnosis resides in the history (or herstory).

The psychiatric nomenclature (as codified in its “bible,” the DSM) reflects Newton’s law in that what goes up must come down, while the opposite doesn’t apply. One can be diagnosed with either a bipolar disorder or severe depression, but if you are severely manic then you must also be bipolar.   You just can’t stay manic forever. (You can, however, according to DSM, be “hypomanic,” which means you can go on a shopping spree and charge up all your credit cards as long as you don’t go over the credit limit.)

Mania, though, has been around a long time, although I suspect it has generally been viewed as less pathological than depression. Emil Kraepelin, the prolific German psychiatrist often cited as the founder of scientific (as opposed to Freudian, which seemed to emanate more from Freud’s imagination than empirical data) psychiatry, described mania this way over a hundred years ago:

The patient feels the need to get out of himself, to be on more intimate terms with his surroundings, to play a part. As he is a stranger to fatigue, his activity goes on day and night; work becomes very easy to him; ideas flow to him. He cannot stay long in bed; early in the morning, even at four o’clock he gets up, he clears out lumber rooms, discharges business that was in arrears, undertakes morning walks, excursions. He begins to take part in social entertainments, to write many long letters, to keep a diary, to go in a great deal for music and authorship. Especially the tendency of rhyming … is usually very conspicuous. … His pressure of activity causes the patient to change about his furniture, to visit distant acquaintances, to take himself up with all possible things and circumstances, which formerly he never thought about.

One of the first things I did when I awoke at 4 was try to rhyme some words (it’s a song lyric, and it’s not bad but needs a lot of work). On the other hand, I like my furniture exactly where it is and although I love many of my acquaintances, I will be happy today to stay home and clear out my lumber room. And not only am I no stranger to fatigue, she is my constant companion.   No, this is just simple anxiety-driven insomnia, probably about a scan I have coming up.   No mania for me.

It could be that one of the reasons I tend to miss the diagnosis of bipolar disorder is that it is one of those labels I have never applied to myself.   Surely I have had my bouts of depression, a few of which have immured me, but the idea of having boundless energy is as foreign to my nature as waking up one day being able to speak Russian.   Not likely in this lifetime.

The idea that what goes up must come down is echoed in the notion that one can go through life getting stronger or weaker.   Freud (who happened to be born a couple of months apart from Kraepelin but outlived him by 13 years) had a rather bleak view, and having been a military man saw life as a battlefield in which each battle leaves fewer troops surviving to fight the next.   Nietsche, from whom Freud undoubtedly stole the notion of an unconscious (and who, by the way, may have known Kraepelin as they both spent time in Leipzig) is famously quoted as having said that “Whatever you don’t die from makes you stronger.”   I don’t know if he ever really said that, but a friend once tried to console me by telling me that Nietsche said that.   No good friend should waste precious breath with consolation when confrontation could suffice.   There are just too many examples of things that happen, from divorces to lawsuits to car wrecks to marriages to chronic, debilitating illnesses that wear us down and from which recovery just doesn’t happen. Surely, what comes down often just keeps coming down.

On the bright side, however, I am reminded that in order to safely return to earth, one must safely leave it.   And I am convinced that home is made more soothing after having flown far from it and fought a few dragons along the way.   It is simply a matter of fact that one’s wings can collect ice at just about any altitude, and it is never entirely clear whether warmer air can be found above or below you. And in that sense, it may matter less whether one is going up or down than whether one is going at all.

 

 

 

Don’t Let George Do It

I learned to fly in a venerable Cessna 150, which I once overheard referred to as “the closest thing to not having an airplane at all.”   The controls on the 150 couldn’t be simpler, and the idea of equipping one with an autopilot would be a bit like adding GPS guidance to a lawnmower.   It was a good thing that the 150 had no autopilot, because if it did a newbie might be inclined to use it, and in the process lose precious time actually learning how to fly.

Early autopilots were primitive, and seemed to have a mind of their own.  Flight instructors—even to this day, are fond of grilling their students on the many ways to shut them off, because historically they were so unreliable that even turning them off often failed.   That’s when the department of redundancy department came in.

Autopilots are supposed to be designed for simplicity, but if engineers could talk they might tell you the more complex the instrument the more difficult it is to prevent it from going haywire.   To invert and paraphrase the song from Hair!, it’s hard to be easy.

I am happy to report that my own airplane, the Diamond DA40, has a marvelous autopilot made by a company called Garmin (the name being a portmanteau for founders Gary Burrell and Min Kao).   It has 11 ways to shut it off, although I can only remember 4 or 5 of them at any time.  Prosaically called the Garmin 700, it is fully integrated with the airplane’s navigation system, which means that once you tell the airplane where you want it to go, with the press of a single button it will take you there.   It corrects itself three times per second, which anyone who knows me will tell you is much more often than I do.

Ever since flying behind an autopilot I have heard them referred to either as George or Otto.    The reason they are called Otto is apparent, but I often wondered why they were also referred to as George and not Fred, Nancy or Butch.   Turns out that it was the RAF pilots who first encountered them who jokingly decided that they should simply let the airplane’s true owner, King George VI, fly the airplane.   “Let George do it.”

Nowadays, the use of autopilots is de rigeur, and the term has worked its way into common parlance.   When we do things by rote, without giving it much thought, we are said to be on autopilot.   But flying on autopilot can be hazardous to your health, as we learned from Air France 447, whose pilots flew into the icy Atlantic Ocean killing all aboard when they couldn’t manage to hand fly the airplane once the autopilot had been degraded.

As life in these United States gets increasingly complex, most of us rely on variations of our own internal autopilots.   This can be deadly, as when someone is so used to driving they think it should be no problem to let the car drive itself while applying makeup or reading text messages.   One could argue, and many do, that the reason autopilots have become necessary is that the tasks associated with daily living have just become too complex.   It stands to reason, then, that the best way to turn off our collective autopilots would be to simplify the tasks ahead of us.   So, perhaps out of a strange desire to be symmetrical, I am going to try to list eleven ways of simplifying, enabling us to shut off our autopilots, hand-fly our airplanes and get the most out of our lives.  If you can come up with your own list of eleven, I would be proud. Here’s my list:

Simply unplug.   Everything.  Then observe what is going on around you.

Meditate.

Uni-task.   Simply create a “task boundary” around you and insist on doing one thing at a time.   Take that one task to completion.

Observe the Sabbath as Orthodox Jews do.   No cars, no elevators, nothing with electricity or fire.

Take a familiar task and make it unfamiliar by breaking it down into its smallest manageable parts.   Instead of brushing your teeth or taking a shower on autopilot, focus on each component part of the process.

Use chopsticks instead of forks and spoons when eating.   Eat slowly and savor every bite.

Write something by hand.   Instead of sending emails or tweeting, write a postcard.

Pay restaurant checks with cash.   Try using exact cash and count the change in your pockets.

Park your car and walk as much as possible to do errands.

Have a garage sale and rid yourself of everything extraneous in your life.

Cancel any future commitment or event that doesn’t enrich your life somehow.

I am convinced that the less we allow George to take care of us, the more we will feel as though we are flying our own airplane and getting the most out of our lives.   And that is why most of us learned to fly in the first place.

 

An Anniversary

Exactly one year ago today I completed my last radiation treatment. As far as I know, no detectable cancerous lesion has returned since then, which makes this a cautious but happy holiday. The caution is prudent, given the size and mass of the original tumor and the fact that it had metastasized to lymph nodes, thus increasing the chances that it will pay a return visit. If it does, according to my medical oncologist, it will do so “with a vengeance” having cleverly re-engineered itself to evade the effects of chemotherapy and radiation.   A relatively prompt death is likely.

I have believed in and witnessed the truth of the saying that “we die the way we live.” Among other things, I have lived a life of short-term pessimism and long-term optimism.   Things will work out in the long run, I have always thought, but the rub is in the present and immediate future.

Unfortunately for me and those committed to living with me, this has made me a rather troubled and troubling companion.   For if the diagnosis of stage 4 cancer does anything, it creates a shift in perception.   Whatever cuddly visions I have had of the long-term future quickly vanish into the thin air of fear.   Some say cancer is a wake-up call, but for me it has always been more than a challenge to wake up at all, let alone from a nightmare  that projects itself into the waking state of monthly hospital checkups, blood tests, radiation-rich carcinogenic body scans, and the harrow of waiting for results.

Yet without the battle there can be no victory, and today is a time for celebration. And in this very moment, as others around me are wont to remind me, things are looking good. And as I try to remind myself, this very moment is the only moment that matters; it is the only moment which this brave and betraying body of mine can ever embrace.

And, perhaps in spite of what you have been kind enough to read so far, I am not a whiner.   I have fully embraced my father’s dictum that life isn’t fair, and that it is all of our jobs to work with what we got.   And though it’s too easy for me to miss what is right in front of me, I’ve got a lot.

It is about 4 in the morning, still unaccustomed to the time shift from L.A. to Galway. Yesterday my wife and I walked over 5 miles along the coast in the gray chilly mist, as the sun set over the Atlantic between this continent and the Aran Islands. Gas-fueled flames in the faux stove heat this cozy AirBnB, a modern addition to a traditional rowhouse just four easy blocks from the pub-lined High street that twists through shops packed with a mix of tourists and locals. And peregrinating through the streets of this, one of my favorite cities, I am constantly reminded that there is nothing quite like the amity, charm and wit of the Irish. In this, the only moment there is, life is good.

So today I will struggle again, as I have each day, to find a suitable folder in which to file the fear that each of these bizarre symptoms that arrive daily, uninvited and unwelcome, are signs of the cancer returning.   No, they are just the creaking of an aging body or the teasing of my guardian angels.   I will, today, try again to inhale the crisp air of gratitude and allow its sweet calming effects to wilt the tension in my muscles.   I will, today, if only briefly, imagine the soft embrace of a mother’s arms in order to protect me from the ill wind, and soothe the bristles of expectation.

 

Flying on my Bicycle in the Blind

I spent one year of my life living at 24 Randy Road in Framingham, Massachusetts.   It was 1964; I was 10 years old and the world was in the midst of upheaval.   JFK was shot the year before, the Beatles appeared in the U.S., a war was developing in Southeast Asia, “the pill” had taken hold and a revolution in sexual freedom was in swing.   I was painfully shy, and my best friend was the bicycle that came with me from Queens, where I had lived for six years before.

Riding my bicycle was one of the few things in my life that I felt as though I could do confidently, and somehow the sense of being carried along while houses whisked by held a primitive feeling of safety, even serenity.   The sweet thing about living on Randy Road was that it was a hillside (one that shrunk considerably when I visited it with my kids more than 30 years later), which meant that I could get on my bicycle and with some help from gravity could pedal myself into tremendous speed while turning at the base of the hill.

I had repeated this act of cyclobatics so many times that I was confident doing it both with my hands off the handlebars and blindfolded.   I would close my eyes, stretch my arms out to the side, and become a human sail against the wind created by my movement.   One day, as I rounded the corner with my eyes closed, I had the wind knocked out of me as I turned into the trunk of a parked car.   I tumbled over the handlebars as one of them poked me in the chest, and ended up sprawled on the roof of the car and denting it with my very skinny body.   That was the last time I tried that particular trick.

Although my hands were not on the controls, I had at 10 years old what pilots call a “controlled flight into terrain (CFIT).”  Although my eyes were closed, I knew exactly where I was at the time; I just didn’t know what else happened to be occupying the space that I was entering.

CFIT accidents happen for many reasons, but one of the most common reasons is that pilots become overly confident in their abilities.   Confidence in a pilot is a good thing, but just like so many other good things, too much of it can kill you.   The problem with confidence is that it can easily bleed into cockiness, which is the kind of stupidity that leads to decisions like turning your bicycle into a car while blindfolded.

I don’t think that any amount of confidence could have prevented the cancer that came to reside inside my throat.   I have made many decisions in my life that I regret, but none that I could imagine could lead to this outcome.    Truthfully, I am not a big believer in karma;  I have known too many people who do mostly good things in their lives and suffer tremendously, and others who have done horrendous things and live peacefully.   I do believe, along with the great philosopher Martin Buber, that humans are basically good and evil, and the ones among us who live life fully manage to do more of both.

Yet, this cancer does feel as though it is a form of controlled flight into terrain.   Right before the first symptoms appeared I was in excellent health, doing yoga 3 times a week, going on long walks, exercising and eating well.   My life was in a better spiritual place than it had been in years.   Then, there it is, the parked car that wasn’t supposed to be there.

From flying on my bicycle to flying in my beautiful Diamond airplane, I am now on a different flight, a flight in which to a large extent the world of science and physicians are at the controls.  Whether one flies down the street with eyes closed, or carefully plots out the path of radiation to a tumor, the world can be a dangerous place in which to fly.

 

Grounded

I am so grateful for those of you who read these posts, and for those who take the time to comment either via the “comment” function below or by writing me personally.   Based on some of the responses I have received some of you may not realize that, while occasionally some news event prompts me to write a reaction that I send out right away, most posts are written well in advance of the time they appear.

My writing comes in fits and starts.    Sometimes, when the moon is just right and the stars are aligned, the words come through me like a cool breeze and with just a touch of editing they are ready to go.   But frankly, that almost never happens.   Most often, the post starts with an idea, a title perhaps, or an observation, and then I struggle to write something coherent about it.   And struggle and struggle.

All of the posts you have read since August (except this one) were written in August while my wife and I were up in Point Arena, where we have been fortunate enough to escape the Southern California heat for the last few years.   I was able to finish about 6 to 8 posts there, sometimes writing only three lines a day, and due to the wonders of the internet I was able to schedule those posts to appear at the rate of once every two weeks through November.

While I try to write in ways that have some significance, I fear that much of what I say are platitudes.  In the face of real pain, real suffering, words have little meaning.  Real suffering has a life of its own, and each of us responds in our ways to the various acts of kindness we hopefully receive.

The last post, for example, was written on the topic of dealing with crosswinds, and refers to a crosswind landing I was particularly happy to make in Nevada.   Within that post there are all the intended inferences to life’s crosswinds, but I can tell you very clearly that flying is not life and life is not flying.   Life’s crosswinds don’t always end up well.

I say all this because I have been royally grounded.  Not due to the kind of weather you encounter when you step out the front door, but the kind of inclement weather that resides within us, and can release itself into the most terrifying kind of thunderstorm.

Here is what I wrote yesterday, on the day the crosswind post came out: I am writing this in a place I would rather have never gotten to see in my life, on the infusion unit at City of Hope, where I am receiving my first infusion of chemotherapy that will hopefully begin to shrink the cancer that is growing rapidly on the base of my tongue and in my trigeminal nerve.

It has been a few weeks since I received the diagnosis, confirmed by biopsies and every kind of scan imaginable.  It probably started months, even years earlier, and was not symptomatic so I had no idea it was there.   In retrospect, there were minor signs, but they were minor, and I have had many regular physicals that couldn’t catch it.

Staying in the flying metaphor, I have performed all my scheduled maintenances, done all my pre-flights, but even still, things can go terribly wrong.

Although I know that flying can and even has been terrifying at times, and even though that terror stems from what appears to be imminent death, there is nothing in the flying world that I have encountered that comes close to the abject terror I have felt once I learned of my cancer diagnosis.

To some degree, terror is terror, and in the panic of terror our frame of reference narrows, our thoughts become unreasonable and constricted, our hearts race uncontrollably, and our minds wander to the worst case scenarios.

My tumor is large, and I try to judge by looking into the physicians’ eyes how hopeful or hopeless the situation is.   The best doctors seem to have the best poker faces: they typically repeat, “I don’t know,” when it comes to any statement about the future.  Occasionally they leak something that is not encouraging, but I have little choice to go with the program.   I have trust and faith in my doctors, and I have an extraordinary family and friends surrounding me, researching for me, sticking close by my side.

One thing that is clear is that I may never fly again; if I do, I will be one fortunate bastard.  I have looked back a bit at some of my earlier posts, and I realize at once how silly some of them are, how trivial, but also forgive myself because my intent is also to entertain.  Occasionally I take something away, like the post I wrote about flying through the crash.   There is so much more to say here, but I am well over my self-imposed limit of 700 words.  One thing I feel strongly about is this:  I am deeply grateful for those of you who take the time to read these posts.  I know most of you have better things to do with your time, and it is an odd way to feel connected to someone.   But without you, this practice of writing would be merely a therapeutic exercise, rather than one of connection.   And I do believe, to some extent, there is healing in that.