Episode 436 - The Fortnight of Survival: Insights from a Cancer Journey

Hi, everybody, and welcome to episode 436 of the Real Estate Sessions podcast. We are continuing with the Deep Dive crew as they break down episode six of my cancer journey blog from 2012 2013.Thanks so much for tuning in and especially for telling a friend who may be close to someone who could find value in these posts. Let's get started. Imagine for a second, just imagine being physically tethered to this machine, right?And it's just pumping toxins directly into your chest for 44 hours straight.

Right? Yeah.

And your decision, your reaction to this is to call it your party ball.

It's wild. It really is.

It's completely wild. Welcome to the Deep Dive. Today we are taking a really intimate, almost microscopic look at the human experience of navigating a chronic illness.

And we're doing that by focusing on a very specific window of time from the 2012 and 2013 records of Bill Risservice.

Right. And for those of you listening who follow the real estate world, you likely know Bill.I mean, he's the creator of the incredibly popular show the Real Estate Sessions.

Exactly. But today we are examining his personal documentation.Specifically, we're looking at episodes six of nine from his journey through colon cancer treatment.

Yeah. And the detail that really, that just caught my eye right out of the gate is the timing of all this.

The calendar disconnect.

Yes, the calendar disconnect. Because the post we are looking at, it's written in April, but Colorectal Cancer Awareness Month is March.

Right. So, you know, all the campaigns have launched the public, focused its attention for those 30 days the ribbons were worn, and then society just.They collectively flipped the calendar page and moved on.

Yeah, they moved on to whatever the April cause is because, well, public awareness campaigns are designed for the comfort of the public, not the patient.

Wow. Yeah, that's so true.

They operate in these tidy, manageable 30 day boxes. But a patient's lived experience doesn't just magically wrap up when the calendar changes.

You know, it doesn't just expire at midnight on March 31st.

Exactly. Bill continuing to document his reality into April. It perfectly illustrates that enduring, unglamorous reality of recovery.

Right, because when the public spotlight fades, the patient is still there, left dealing with the exact same grueling medical protocol.

And often feeling a really profound psychological isolation because everyone else has moved on. So Bill writing into April, it's almost like a quiet rebellion against that fading spotlight.

It's a statement that the journey persists.

It persists. Yeah. And that persistence completely changes how he tracks time I mean, he rejects the 30 day calendar month entirely.

Oh, completely.

His entire existence just becomes governed by this mandatory inescap 14 day cycle. He calls it the fortnight.

The fortnight, yes. It's a total restructuring of how a human being experiences their life.

I can't even imagine.

Right, because time is no longer measured by weekends or holidays or the standard work week. When you are on this kind of chemotherapy protocol, time is measured purely by your body's reaction to chemical toxicity.

Just weathering the storm.

Weathering the storm and then its subsequent desperate attempt to recover before the very next dose.

So let's unpack that. Because the choreography of this fortnight is intense. Let's break down day one. The physical mechanics of it are just. They're wild to me.

They are very intense.

He goes to the infusion center. He receives five bags of various fluids, and then they attach a pump to a port that stays connected for 44 hours.He literally brings the treatment home with him. Now, I hear the word port thrown around a lot in medical contexts, but what actually is it?

So a port? Port is a small drum, like medical appliance, and it's implanted completely under the skin.

Oh, wow.

Yeah, usually just below the collarbone. And it has a catheter tube that feeds directly into a large central vein just above the heart.

But why? I mean, why can't they just give him a pill or do a quick IV drip in his arm so he can go home unburdened?

Well, chemotherapy drugs are incredibly harsh.If doctors tried to push these continuous toxic treatments through the smaller peripheral veins in your arms, the veins would quickly scar or collapse or even burn.

Oh, geez.

Yeah, it's serious stuff. So the port acts as a durable direct superhighway into the bloodstream to handle that level of toxicity.

Okay, that sounds incredibly invasive, but I suppose it saves him from being a human pincushion every single time he goes in.

Exactly. It saves the smaller veins.

But the 44 hours. I mean, almost two full days attached to a machine.

That comes down to the mechanism of the specific drugs he's receiving. Sutin. Cancer killing agents work best not as a massive instantaneous bomb, but as. But as a slow, continuous siege.

A slow siege.

Right. Because cancer cells are dangerous because they replicate constantly.By trickling the drug into the system over almost two days, the medicine is constantly present in the bloodstream.

Oh, I see. So it's just waiting.

Exactly. It's waiting to interrupt the cancer cells the exact moment they try to divide.It maximizes the damage to the tumor While trying to keep the overall toxicity just below the threshold that would become lethal to the patient.

It's a terrifying balancing act.

It really is.

Okay, so he is physically tethered to this machine, receiving a slow siege of poison. And he nicknames the pump his healing orb. Or his party ball.

Yeah, the party ball.

I just. I don't get the party ball nickname. I mean, why would anyone joke about a toxic chemo pump attached to their chest?Isn't that just, you know, a form of deep denial?

Well, it looks like denial from the outside, for sure, but structurally, it is a highly effective psychological tool called cognitive reframing.

Cognitive reframing?

Yeah, when you are stripped of your physical autonomy, like when an external device dictates how you sleep, how you shower, how you move, you experience a profound loss of control.

Right. You're at the mercy of the machine.

Exactly. So humor is a mechanism to reassert dominance over the situation. By calling it a party ball, he mocks the severity of the device.

Oh, I see. Taking away its power.

Yes, and calling it a healing orb is even more functional. He is forcing his brain to override the immediate physical discomfort by associating this heavy, uncomfortable tether with a cure.

Wow.

It's an active, hourly mental exercise to remind himself why the suffering is necessary.

Because the suffering hits hard. I mean, after day one, he enters what he dubs the bad weekend. That's days two through four.

The bad weekend? Yeah.

Day two brings the fatigue and nausea. On day three, the pump finally comes off, which he calls freedom.But he is so exhausted, he basically sleeps away the entire day, just completely wiped out. And day four, a Saturday, is his absolute lowest point. He is trapped on the couch watching playoff games.But through all of this, the primary symptom he mentions fighting isn't just exhaustion.

No, it's much more specific.

Yeah, it's severe neuropathy in his throat and his fingers. He mentions it physically hurts to drink cold liquids or even touch anything cold.

Right.

Why does chemo make cold things hurt? That seems so bizarre.

It's actually a very common side effect.

Yeah.

Chemotherapy drugs often cause peripheral neuropathy by directly damaging the nerves that send sensory information from your extremities to your brain.

Okay.

Think of your nerves like electrical wires wrapped in insulation.

Like the rubber coating on a wire.

Exactly. The chemo degrades that insulation.So when a healthy person touches a cold glass, their blood vessels constrict to conserve heat, and the nerves simply send a clear message saying, you know, this is cold.

Right.

But when those nerves are stripped and damaged by the chemo. That same temperature change causes the nerves to misfire wildly, Just short circuiting. Exactly.And the brain receives those scrambled signals and interprets them as intense stinging electrical pain.

So it's a completely compromised sensory system. He's exhausted, nauseous, tethered to an orb, and his hands and throat are firing off pain signals.

It's a brutal first half of the.

Fortnight, but then by Sunday, he starts forcing himself to walk. He wants to speed up his recovery. Which brings us to really the psychological rebellion of the second half of the fortnight.

Good weekend?

Yes, the good weekend. Once that toxic fog lifts and he hits his stride, his itinerary is just baffling to me.

He pushes his physical boundaries to a degree that really challenges medical logic.

That is the understatement of the year. Listen to this. On Monday, he is back to work, Appointments, workshops, sales meetings, just jumping right back in.And then Tuesday, he boards a cross country flight to New York to be an ambassador for Real Estate Connect, which is this massive Inman news industry event. He is mingling with a thousand of the top real estate agents in the country. He's exploring startup alley.He's doing dinners, bar hops, late night networking. He even catches a performance of Glengarry Glen Ross on Broadway.

It's incredible.

Is he losing his mind? I mean, why would someone halfway through a brutal chemo regimen subject themselves to that level of sensory and physical exhaustion?

Because illness fundamentally attempts to erase your identity.

Erase it?

Yeah. In the medical system, you quickly cease to be a dynamic professional. You become a patient, a chart, a set of lab results that need to be managed.

And just do diagnosis to them.

Exactly. So defending your core identity becomes a matter of psychological. Psychological survival.

Oh, wow.

By flying to New York, navigating a massive convention center and talking real estate tech, Bill is vigorously defending the person he was before the diagnosis.

He is refusing to let the cancer have the final say on who Bill Risser is in the world.

Right. He's saying, I am still this active real estate professional.

He's trying to outrun the label, but.

The biology of his situation simply doesn't care about his willpower.

No, it doesn't, because he gets a harsh reality check. On Friday in New York, the conference winds down and he decides to take a victory lap of sorts. A walk through Central Park.

Which sounds lovely, except.

Except it is 32 degrees outside with 20 mile per hour winds.

Yeah. The environment perfectly exploits the vulnerability. He is trying so hard to ignore.

The damaged nerves in his hands. And throat. Just scream. The cold triggers the neuropathy instantly and he is forced to cut the walk short and retreat.

It's a stark confrontation between his mental willpower and his physical boundaries.

Yeah, he hit a wall.

He can mentally push past the identity of being sick, sure, but he cannot outrun the physiological reality of the drugs still lingering in his system.

But the wild thing is, he still tries.Oh, yeah, because after fleeing Central park, he flies back from New York on Friday night, gets home late, and then Saturday morning, he immediately drives to San Diego for a holiday weekend of golf.

It's relentless.

I really have to wonder if this level of frantic activity is doing more harm than good. I mean, his body is clearly signaling that it needs rest to repair the cellular damage from the chemo.

You are identifying the central tension of the chronic illness experience right there.

Am I?

Yeah. It's the battle between the body's need for cellular repair and the mind's desperate need for normalcy.

The mind versus the body, from a.

Strictly physiological standpoint, expending energy on cross country travel and continuous socializing, that drains the reserves his bone marrow and organs need to recover from the toxicity.

So it is hurting his physical recovery.

Physically, yes. But psychologically, locking himself in a quiet room to rest might induce a depression that is far more dangerous to his overall prognosis.

Oh, I hadn't thought of that.

The golf trip to San Diego, even if he plays terribly due to fatigue, is an investment in his mental fortitude.

So it's about keeping his spirit alive so he can keep fighting.

Exactly.

But willpower can only conquer New York and San Diego. Willpower has absolutely no jurisdiction over bone marrow.

None whatsoever.

And that becomes painfully clear when we hit day 14.

Day 14 is the great biological reset.

The reset. The frantic activity has to stop because every fortnight ends with a trip to the lab for a blood draw.

Right. They have to assess the internal damage before starting the cycle all over again the next day.

And he notes that he feels as close to normal as he ever does on day 14. The fatigue is gone, the neuropathy has faded, but he is terrified.

The dread is palpable.

He is currently finishing therapy number seven. He mentions how thrilled he is to be in the single digits with just five therapies left. But there is a massive threat hanging over him.His platelet count.

Platelets? Yeah, that's the hurdle.

For those of you listening who might not know, platelets are the cells in your blood responsible for clotting. If you get a cut, platelets rush to the site and Bind together to stop the bleeding.

That's right.

But why are platelets the make or break factor for him continuing his treatment? Why does chemo destroy them?

Well, we established earlier that chemotherapy targets rapidly dividing cells to kill the tumor.

Right, right. The slow siege.

The problem is that the cells in your bone marrow, which act as the manufacturing factory for your blood platelets, also divide very rapidly.

Oh, no. So it's friendly fire.

Exactly. The chemo cannot distinguish between a dangerous cancer cell and a vital bone marrow cell. It essentially bombs the platelet factory.

Wow.

If the factory sustains too much damage and the platelet count drops below a safe threshold, the doctors must halt the treatment. Giving more chemo at that point could cause catastrophic internal bleeding.

So the doctors pausing the treatment is actually a routine safety mechanism to let the factory rebuild.

Yes, it's for his safety.

But from Bill's perspective, a delay is a monumental disaster. He is fixated on his projected April 3rd finish date. Why is a one week delay such as psychological catastrophe?

Because of how humans process prolonged suffering. When you are enduring a grueling medical protocol, having a fixed finish line is your mental anchor.

You're light at the end of the tunnel.

Imagine being asked to hold a 50 pound weight in your hands.

Okay. Heavy.

Very heavy. You can endure the burning in your muscles if you are staring at a clock and you know you can drop the weight at exactly 60 seconds.

Right? You just count down.

But if you reach 59 seconds and someone pauses the clock and they tell you to hold it for an undetermined amount of time longer.

Oh, your mind would break.

Your muscles will give out. The weight hasn't changed, but your psychological capacity to bear it has shattered.

That is a brilliant analogy.

Bill's April 3rd date is his timer. If his platelets are low, that timer gets paused and the horizon of his suffering extends.

He's entirely consumed by this timeline. He is stressing about his bone marrow factory, his April 3 finish line, his golf swing. His world is shrunk down to these intense internal anxieties.

Completely internalized.

But then an external event happens at the infusion center that. That completely shatters his focus.

It is a moment that forces him to look up from his own calendar and engage with the reality of the room around him.

Yeah, he titles this section Tales from the infusion center. During his treatment, a young couple, both around 30 years old, comes into the center.

Such a young age for that room, right?

They sit down with a nurse just a few feet away to plan out a treatment schedule. Bill can hear the nurse explaining the drugs and the side effects. And he realizes this young woman has recently been diagnosed with breast cancer.

He is watching a mirror image of the exact onboarding process he and his wife endured months prior.

It must have felt like a time machine. At first, the couple is stoic, asking practical questions. But then a breaking point happens.

The band breaks.

The young woman suddenly breaks down crying. But she isn't crying out of terror for her own mortality.She is crying as she tries to figure out how she is going to care for her two young children if these medicines incapacitate her. The way nurse is describing that is.

A very specific, profound terror of chronic illness for a parent.

It's heartbreaking.

The fear shifts from the disease itself to the fear of failing your dependence.She is looking down the barrel of her own impending bad weekends, realizing that the toxicity meant to save her life will simultaneously strip her of her ability to be a functioning mother to her children.

The nurse and her husband comfort her, and eventually she composes herself. But the impact on Bill is absolute.

It changes everything for him.

He realizes that while he has been consumed with anxiety about missing an April finish date or having a Central park walk ruined by cold winds or not playing well on a San Diego golf course, this young mother sitting just tables away is facing an existential crisis about the daily survival and care of her children.

It really highlights the sociological function of the infusion center.

What do you mean by that?

Well, medical spaces like this are profound equalizers. It is a share open room of extreme vulnerability. Right in the outside world, these patients occupy vastly different lives.A busy real estate professional, a young mother. But in that room, everyone is tethered to the same types of machines facing the same fundamental biological threats.

You're all just patients in the chair.

Exactly.And in that shared space, your own severe struggles, struggles that are completely valid and physically painful, can suddenly look like incredible good luck when held up against the nightmare unfolding for the person sitting at the next table.

Yeah, he writes once a fortnight, I am reminded how lucky I am. It's all about perspective.

Perspective is everything.

I mean, he has colon cancer. His veins are taking a toxic siege. His fingers go numb in the cold. But he looks at that young mother and feels lucky.

It strips away all the trivial anxieties and leaves only a sharp, clarifying gratitude for what remains intact in his life.

Wow. Throughout this deep dive into episode six of Bill Risser's journey, we've seen how a sprawling, infinite life can be forcefully.

Compressed, compressed into these tiny boxes of time.

It's exactly through his documentation you have seen how existence can be shrunk down into mandatory 14 day increments.Increments defined by exhaustion, a chemical tether and damaged nerves, but also by incredible rebellion, cross country flights, Broadway shows, and profound moments of perspective gained in a sterile medical room.

And it is really worth noting how Bill treats the public's curiosity about this journey.

Oh yeah, his attitude is amazing.

Early in his records he mentions that he is often asked how he's doing. He doesn't view it as an intrusion, he views it as an opportunity, stating, it's great to be seen.

It's great to be seen.

The call to action for you, the listener, is to carry that exact grace into your own interactions. When people in your orbit are facing long invisible battles that stretch far beyond the neatly contained 30 day awareness months, do not look away.

Don't ignore it just because it's awkward.

Ask them how they are doing. Acknowledge the messy, enduring reality of their journey. Make them feel seen.

Make them feel seen. Because the reality of the timeline doesn't end just because the calendar flips to April.

It sure doesn't.

We want to leave you with a final thought to mull over. Bill's entire understanding of what mattered was radically altered by living life in strict 14 day loops. Yeah, think about your own life right now.If your existence suddenly had to be measured, scheduled and lived in mandatory, inescapable two week fortnights, what trivial anxieties would you instantly drop? And what would you fiercely prioritize on your good weekends? Thank you for listening to the Real Estate Sessions.Please head over to ratethispodcast.com resessions to leave a review or a rating and subscribe to the Real Estate Sessions podcast at your favorite podcast listening app.