Episode 438 - Navigating the Final Stretch: Insights from a Cancer Journey

Hi, everybody. Welcome to episode 438 of the Real estate sessions. Thank you so much for listening and for telling a friend.This episode is the eighth of nine blog posts I wrote in 2013 as I was nearing the finish line of my colon cancer journey. I hope one or more of these deep dive episodes can help you or someone you know on their journey. Let's get started.

And down the stretch they come.

Ah, the classic Kentucky Derby call.

Right? I mean, that is the famous call, but it's also the exact opening line of this really deeply personal journal entry we're doing.A deep dive into today.

Yeah, from back in 2013.

Right, exactly.And, you know, the author mentions that going to Churchill Downs to see the Derby live is actually on their bucket list, but they're using this racing imagery right now for a much more immediate reason.

A literal race to the finish line.

Yeah, because they are sitting in a clinic literally tethered to a chemo pump. It's therapy number 11. And they have just one treatment left to go for colon cancer, which, I.

Mean, it immediately reframes how we typically view a patient, doesn't it?

Oh, absolutely.

They aren't framing themselves as someone just, you know, passively sitting in a sterile room receiving chemicals. They're an athlete. They're grinding through this grueling, high stakes race.

And that mental shift is so crucial for survival, which, honestly is our mission for you listening today.We want to step completely out of the clinical jargon and really unpack the raw psychological reality of navigating the home stretch of a medical marathon like this.

Because the finish line is so clear to them.

Yes, they have it circled April 12th. The pump comes off on Friday. And then they just have to clear.

This one last hurdle and that fixation on a specific date. You, you know, April 12, it really acts as a psychological anchor. It stops being just a random square on a calendar.It becomes the exact coordinate where their normal life finally resumes.

That's the restoration of autonomy.

Exactly. Because when you're in the thick of treatment, you lose so much control over your own day to day existence.Having that concrete end date becomes the only thing keeping you afloat.

But of course, the brutal reality of medical crisis is that your body, your body doesn't actually care about your calendar,.

Not even a little bit.

Right. As they're lacing up for this final sprint to April 12, they hit a massive biological roadblock.And the way the author describes this devastation is just darkly funny.

The Jeopardy. Joke.

Yes. They set it up like a round of Jeopardy. They write, alex, I'll take best laid plans for $500. And the answer is, you can't have your treatment today.

Oh, man.

And then the ulcer buzzes in with the question, what is. Are my blood counts too low? Correct. Crap.

It's so good. I mean, humor is such a well worn armor against profound disappointment.But underneath that joke, we're really looking at one of the most agonizing bottlenecks in oncology.

Blood counts.

Right. Chemotherapy is fundamentally designed to kill fast dividing cells. That's the whole point.But the problem is the cancer cells aren't the only ones dividing rapidly in your body.

Right. There's friendly fire.

Exactly. The cells in your bone marrow, which basically act as the factory for your white blood cells and your platelets, they are incredibly active, too.So they just get caught in the crossfire.

So the bone marrow factory just shuts down.

Yeah. If the bone marrow takes too much damage, your white blood cell count just plummets.And administering another dose of chemotherapy at that exact moment, it could be lethal.

Because the body can't fight anything off.

Right. It's lost its ability to fight off a basic infection or even clot a simple bleed. So the medical team really has no choice but to hit the brakes.Or regardless of what the patient's calendar.

Says, which is incredibly frustrating for the author. I mean, they had mapped out their entire April and part of May based entirely on finishing on this exact Friday.

The whole house of cards collapses.

Literally. So they're sitting there with their wife Cindy, and Dr. McDonka, who they call a rockstar oncologist, by the way.

Love that.

Yeah. And they start listing out all these scheduling conflicts to the doctor. They have seven appointments to cancel. And then, I love this.They mention they're going to miss the Severar golf tournament, which tells us so.

Much about the human coping mechanism, it's fascinating.

You are sitting in an oncology clinic fighting colon cancer. Your immune system is dangerously depleted, and you are mentally bargaining with your doctor over a golf tournament.

It's wild.

It's like treating a life or death health crisis. Like a stubborn corporate project management timeline. Yeah.You know, you're trying to force your own microscopic white blood cells to adhere to a gaunt chart.

But I mean, when you strip away a person's biological control, controlling the schedule becomes a proxy for survival.

Oh, wow.

Those seven appointments, that golf tournament, they're tangible proof of life.

Yeah.

They are evidence that the author still belongs to the world of the living, the world of normalcy, you know, rather than just the World of the sick.

Right.

So when the body rebels, the mind just clings to the schedule.

And that was exactly where Cindy, the author's wife, really has to step in, because she gently reminds him, you know, the therapy has to come first, Treatment trumps all other plans.

She has to be the grounding force.

Yeah, she's not just resolving a scheduling conflict. She's pulling him back to the harsh reality of his present physical condition. And the author admits it, Right? In the text they write. She's right.I know it. I just don't want to accept it.

Because it's the collision of this rigid goal and just an undeniable biological truth.The doctor has to look at the blood counts, sure, but he also has to look at the cumulative physical toll the treatment is taking on the patient's nervous system.

And that brings us to the actual physical symptoms that are forcing this delay. Because Dr. Mendonca assesses the author's worsening neuropathy. And the description the author gives is just visceral.

It's intense.

I really want to push back on the way we normally talk about this. When you or I hear the word numb, we usually think of, like, nobody came to the dentist. Right.

A total absence of sensation.

Exactly. Just avoid. But the author's experience contradicts that entirely.

Yeah. The term numbness is a massive oversimplification of peripheral neuropathy. It totally fails to capture the aggressive, active nature of the pain.

Right. They describe their feet first. They say the bottom half inch of their feet feels completely numb, but the rest of the foot is hypersensitive.

Right.

They write, I know it makes no sense, but. But every time their feet touch carpet, concrete, or even just the bed sheets, it physically hurts.You have this deadening numbness, and a screaming, painful hypersensitivity happened at the exact same time.

The mechanism behind this is wild, actually. That chemotherapy toxicity doesn't just turn the nervous system off, it damages it so that it actively misfires.

Misfires? How?

Think of a frayed electrical wire.

Okay.

It's failing to deliver a clean, normal signal, which is what causes that deadened numb sensation. But the exposed wire is also throwing off violent, random sparks.

Ah, so that's the hypersensitivity.

Exactly. The brain receives these corrupted, chaotic signals and translates the most benign textures, like a cotton bed sheet, into a noxious, painful threat.

And it affects the hands, too. The author says their fingers feel like there is no blood flow above the second knuckle. They are perpetually cold and super sensitive.

It's exhausting just thinking about It.

But the symptom that really underscores the misery of all this is the throat. The author states they haven't been able to drink anything with ice in it since October 23rd because of the sheer pain of swallowing cold liquids.Wow. And this journal entry is from late March. That is over five months of not being able to drink a cold glass of water.

And this specific symptom, it points directly to the type of drug being used.

Oh, really?

Yeah. Platinum based chemotherapy drugs are basically notorious for damaging the ion channels in nerve cells.It makes them hyperexcitable to cold temperatures.

So it's a chemical reaction to the cold.

Right. Touching a cold glass or drinking cold water triggers this intense spasming pain Right.

In the throat, which totally forces a reevaluation of what a side effect actually means. I mean, we categorize side effects as things like a headache or nausea that comes and goes.

A minor inconvenience.

Right. But this is an all encompassing alteration of reality.You have to calculate every step you take, every object you pick up, every single sip of water you swallow.

And the cognitive load of that is staggering.The mental exhaustion of navigating your own home like it's some obstacle course of discomfort, it grinds a patient down just as much as the cancer itself.

So, okay, the author is physically battered, the blood counts are too low, and the nerves are literally screaming, but they still desperately want to finish on April 12th.

They need that finish line.

Yes. And this is where Dr. Mendonca steps up with a really tailored medical pivot. He proposes a compromise to keep the plan alive.

And we get to see the crucial difference between a medical technician who just, you know, follows a manual and a true healer who treats the whole patient.

Exactly. The doctor suggests dropping the oxalapant drug from the therapy. Now, the author has already taken 10 full doses of it, Right?So by dropping it for this final round and moving forward solely with the other drug, which is called 5fu, they achieve two massive things which are huge.

For the patient's quality of life.

Huge. First, the five FU drug doesn't require such a critical white blood cell or platelet count to be administered safely.And second, dropping the oxaliplatin gives the author immediate relief from that worsening neuropathy.

And to understand why this actually works, we have to look at how these two drugs behave differently.

Okay, Break that down for us.

Chemotherapy is usually a cocktail, right?Oxaciplatin, that platinum based drug we mentioned, attacks the cancer by binding to the DNA and creating these cross links that basically prevent the cell from dividing.

But it causes the nerve damage.

Exactly. It's highly toxic to the nerves and really heavy on the bone marrow. But five FU operates totally differently. It's an antimetabolite.

A what?

An antimetabolite. It essentially disguises itself as a normal building block of DNA.

Oh, like a trojan horse.

Yes. So the cancer cell absorbs it, tries to use it to replicate, and the whole process just breaks down.

Okay, so five FU is still fighting the cancer, but it bypasses the specific toxicities that are currently destroying the patient's quality of life.

Precisely. The doctor maintains the offensive line against the cancer While strategically retreating on the nerve damage and the bone marrow suppression.

Which raises such a fascinating question for you listening right now in this specific moment. What is the doctor actually treating? Yeah, I mean, yes, he's managing the blood counts and the damaged nerves.Yeah, but it really seems like his primary target is the patient's immense psychological need to hit that April 12th finish line.

He knows how much that date matters, right?

He could have just paused everything and said, well, we'll resume in May. But he actively found a loophole to keep the train on the tracks. It's the art of medicine overriding pure, rigid science.

Because the psychological momentum of a patient is a vital medical resource. I mean, in medical school, the focus is all on optimal protocols and gold standard dosages.Sure, but in clinical practice, breaking a patient's spirit has real physiological consequences.

How so?

While prolonged hopelessness and intense stress, they spike your cortisol levels, and that can further suppress the immune response and actually hinder recovery. So by tailoring the chemistry to preserve the April 12 goal, the doctor is literally leveraging the patient's hope as part of the treatment plan.

It changes the entire dynamic. So the immediate crisis is averted, the new plan is locked in, and the author is sent home to wait out this highly anticipated home stretch.

The waiting game.

Yeah, and because of their reduced immune response, they're given strict instructions to avoid crowds. But the way they choose to pass the time in isolation is incredibly jarring.

Well, sickness forces isolation, but the human mind rejects a vacuum. You know, they have to fill that.

Time, and they fill it by diving straight into work.

Unbelievable.

You'd think they'd be, I don't know, meditating, resting, or contemplating the fragility of life.But the author says they're going to spend the time fine tuning their AAR spring conference power sessions, which they even joke is a blatant plug right in the middle of a cancer journal.

Always be marketing Right.

And then they mention they can finally get some serious work done on an ibook they're developing for their commercial and builder services team.

The instinct to work here makes perfect psychological sense, though.

You think so?

Oh, yeah. Look back at the golf tournament.When your biological foundation is deeply compromised and just chaotic, mundane work becomes a powerful grounding mechanism.

Because it's predictable.

Exactly. Sickness has new rules. It's totally unpredictable.But formatting an ibook or preparing presentation slides, those tasks have clear rules, predictable outcomes, and you have absolute control over them.

It is just a deeply human juxtaposition. You are fighting for your life.Your blood counts are volatile, your nerves are vibrating with pain, and you are sitting at your kitchen table worrying about the layout of a commercial services ibook.

It's surreal.

It really illustrates how normalcy isn't just a luxury, it's a necessary anchor. It stops you from drifting off into. Into the existential dread of the illness.

And that anchor is reinforced heavily by community, too.

Yes.

The author dedicates a really significant portion of the entry to expressing overwhelming gratitude for their support network and noticed the specific nature of the help they received. It wasn't just vague well wishes.

No, it was incredibly tangible. They list notes, articles, cookies, a food of the month subscription, and bags of healthy food dropped off.

Real sustenance.

People stepped right into the gap to provide the physical fuel needed to keep going. And they specifically shout out two people. Their wife, Cindy and Kev.

Yeah.

They note that while Cindy and Kev have very different styles, both are extremely effective and loved as big as the sky.

Pay attention to that phrase. Extremely effective.

Why is that important?

Well, in the midst of trauma, emotional support is great. But competent, effective action is what actually keeps you afloat.

You need people who do things.

Exactly. You need people who can manage the logistics of daily life when your entire capacity is consumed by the logistics of staying alive.This network pushed the author through the uncertainty of the diagnosis, the physical trauma of surgery, and this grueling marathon of therapy.

So all of this scaffolding, the flexible doctor, the grounding work, the effective community, it all brings us to the horizon. The author celebrates the April 12th finish line, but they also outline what comes next.

The aftermath.

Yeah. And it's a stark reminder that in oncology, finishing chemo is really just the start of a different kind of race.

The narrative shifts from active warfare to surveillance.

They map out the timeline in the journal. After April 12, they won't even see the doctor for three months until they have a scan.Then in early September, which marks one year post surgery, they'll have a follow up colonoscopy.

A major milestone, by the way.

The author literally stops mid sentence in the journal to issue a passionate plea to the reader.

Oh, I love this part.

They write. Sidebar. If you are 50 or over, have you had your colonoscopy yet? What are you waiting for? Go.

Exclamation points and all.

Yes, it's this sudden burst of advocacy from the trenches.

Transforming personal suffering into a protective warning for others is such a common and powerful response to trauma. They want to spare someone else the reality of that chemo pump.

Absolutely.

And the timeline they detail, the scan, the colonoscopy, it's all building toward an ultimate goal they call the magic five year mark.

So why five years? Why is that the magic number?

In oncology, hitting 5 years cancer free is statistically monumental for this type of cancer. It's the threshold where the risk of recurrence drops significantly. It's the point where you can finally start to tentatively exhale.

Let's step back and look at the whole picture we've uncovered here. Just by diving into this single journal entry. We've seen how surviving a medical crisis is this incredibly precarious dance.

Yeah, it really is.

On one side, you have the unforgiving realities of clinical treatments, cellular biology, and bone marrow suppression. But on the other side, you have the messy, stubborn, incredibly human need for goals, flexibility, mundane work and community support.

Because the overarching lesson is that medicine is applied humanity.

Applied humanity. I like that.

The body has to be treated with chemicals, sure, but the spirit has to be sustained by the environment.The flexibility shown by the medical team, the grounding nature of routine work, the tangible logistics handled by friends, those elements are the scaffolding that allows the chemical treatment to happen at all.

It completely changes how you view the whole process. But, you know, I want to leave you with a lingering thought, something for you to really mull over as we wrap up this deep dive.

What's that?

Well, the author ends this journal entry by returning to the Kentucky Dubbie hook. They write, and down the stretch I come. The finish line in plain sight.

Sweet, right?

All of their psychological energy is hyper focused on crossing that tape on April 12th. But what happens on April 13th?

Oh, wow. Yeah. The transition out of crisis is often harder than the crisis itself.

Think about it. For months you have been in this highly structured, adrenaline fueled state of fighting a disease.You have rigid protocols, weekly appointments, a dedicated team analyzing your blood.

You have a mission.

You are at war. And your mission is crystal clear. But when you cross that finish line, the race abruptly ends. The crowd goes home.The doctors step back and say, see you in three months.

That is a huge drop off.

How do you navigate that psychological whiplash?How do you transition from the intense, active fight into the quiet, deafening anxiety of just waiting, Waiting three months for a scan, waiting five years for a magic number, wondering if the finish line you cross was real or just a mirage?