Diary of a Detour

This book-in-progress began as a blog to update friends when i was undergoing chemo. It revolved, initially, around cancer and chickens. But, as the journey continued via many detours, it morphed into a series of bloggessais about many things.  You can read the pieces in any order but if you want some orientation try reading the first post,”Chickens Saved My Life,” first.

The Ecology of Cancer, and What do Ants have to do with it?

Ants are like cancer cells. Conversely we might say that cancer cells are like ants.

Even though they sometimes feel more mammoth-like and slothful, lumberingly prehistoric rather than tiny and socially frenzied. “They feel.” Of course cancer cells do not have feelings so far as I know. What I mean is that they feel to me, these colonies of CLL cells that circulate through the bone marrow and the blood and the lymphatic system, they feel to me massive and heavy and slow. Or more accurately, they make me feel like a sloth, I imagine myself as one of those creatures I saw a few weeks ago in the Tar Pits in Los Angeles: slowly dragging my massive body over the never-ending earth. But in the last few weeks I have also been having nightmares, dark and jagged dreams in which a massive sloth-like creature is out there, lumbering over the horizon, coming closer, filling the screen, threatening to engulf me. This CLL beast exists, I guess, both within and without.

When I heard Deborah Gordon declare that ants are like cancer colonies I experienced a rush of resistance. I did not welcome the idea of analogizing my condition to a common-and-garden insect that lives in colonies, rather than to the singularity of an exotic species of mega fauna now extinct. I was alarmed not charmed by the image of colonies of ants scurrying around in my body. But also in some peculiar way I did not yet quite understand, this analogy—of cancer cells to an ant colony—struck a chord. Suddenly a new image, one not immediately accessible to my habits of thinking and feeling, began to reverberate.

Ants, the ants that I know, live in my garden, not in my body. It has always been mysterious to me the way ant colonies would spring up in the garden, how they would know where the aphids were congregated, how they would march and scurry from their nests to my favorite rose bush, devastated by a colony of aphids. Aphids are small insects that suck the life out of plants and then secrete a sugar-rich sticky honeydew that ants love. In fact they “farm” the aphids, protect them from predators and parasites and nurture their eggs. In the face of this alliance—a mutualistic relationship or type of symbiosis—I would feel very small and ineffectual. All I could do would be to hope for an invasion of ladybugs (to eat the aphids, and thus deflect the ants) or I could spend hours everyday hosing off the aphids with jets of water. Sometimes you would sink a pitch fork into the compost pile and as if from nowhere a black mass of moving matter would crawl up your arm. After initial panic—rushing around dementedly shaking arms, trying in a frenzied manner to brush the ants off—I figured out that in the process of pursuing their own ends, foraging for fabulous stuff to take back to their nests, they were doing me a favor. Like worms, they were doing their bit to toss and turn and hasten the process of decomposition in the compost. In the end by leaving things be—as much as is possible for a neurotic controlling gardener—the garden settled into its own ecology. Or rather, it became more possible to observe the interaction of plants and creatures. To see, for instance, which plants attracted bees and when. African blue basil and rosemary are bee magnets. The weedy fennel, when it’s younger is a host for the swallow tail caterpillar that turns into a spectacular butterfly, flits around the garden and then sashays off to Mexico. Later, when the garden is festooned with the fennel’s yellow umbels the bees come swarming in.

But the story is not so simple, not such a paean to natural balance and harmony.

Enter the chickens.

Nowadays there are no infestations of ants, no plagues in the garden. The beak of a chicken and a squirrely squirming ant—these things exist together in a powerful force field of attraction. Heaven if you are a chicken, pretty dismal, I guess, if you are an ant. Though maybe the ants have just changed their habits, become invisible to chicken and human eyes, or moved on over to my neighbor Mrs Tam’s garden. Chickens also love worms, but since the birds are surface scratchers and since the vegetable beds and the compost are barricaded the worms survive there, in fact they survive everywhere deep in the soil, doing their work, sifting and turning.

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Ants are like cancer cells, says Deborah Gordon, in so far as they are regulated but without central control.

An ant colony is regulated, its survival depends on the distribution and co-ordination of tasks and roles. Communication, or an exchange of cues, exists between the ants. The tasks and roles themselves are not fixed, but shift and change as the environment shifts and shapes. The ants exist in a dynamical social network. A hub may form for instance simply by ants moving into a space where there are lots of interactions. Gordon calls it the anternet. Ants do not always behave the same way. Foraging behavior for instance changes in times of drought. If one element changes (e.g. the availability of water) then the behavior of the colony changes. These changes, in turn, shape social and reproductive patterns. By observing these changes in patterns of behavior or modes of regulation, scientists can observe how natural selection is working on this colony.

There are many biological systems, apart from ants, that function without hierarchy. Bird flocks, without a leader, turn in the sky, fish schools swerve to avoid predators, tropical forests develop patterns of diversity… and cancer cells mutate and metastasize. For all of these systems, we still don’t fully understand how the parts work together to produce the dynamics, the history, and the development of the whole system.

It has often felt to me as though the garden is a battlefield. The march to the rose bushes and the swarming in the compost bin seem to be ant maneuvers carried out with all the efficiency of military campaigns, masterminded by some center of control (and sometimes the body too feels like and is popularly conceived of as a battle zone where the war against cancer is waged). Indeed this is how the great and pioneering ant scholar E.O. Wilson described ant society—in terms of hierarchy, conflict and regimental organization. So why should we relinquish this view (or feeling) in favor of the model proposed by younger scientists, including Deborah Gordon? Most significant for me, in terms of the efficacy of the analogy, is that Gordon and others tell a different sort of system story, emphasizing situated (therefore variable) processes of recognition and response. They understand the ant colony as composed of flexible units (whose functions change according to situation) and propose a system characterized by different architecture and components. Nodes of interaction are at the heart of Gordon’s model and frequencies of interactions at nodes are what shape material social orders. It is this that grounds the argument against the way that Wilson’s analogy works, wherein the behavior of ants is offered as a sociobiological model for human behavior. Ants, Gordon argues, don’t provide moral lessons or insight into behavior or feelings, but they do provide insight about the dynamics of networks, systems without central control.

It’s a tricky business, this maneuvering (is it a dance or a battle?) between feelings and conceptual models, between the garden and the body, ants and cancer cells. Sometimes new images, just as much as new data, can interfere with feelings and reorient one’s thinking.

What matters in networks is the ecology of the system.

So, taking our cue from ant colonies, how might we think about the ecology of cancer? What are some of the ways that cancers diversify and spread? How is organization regulated? How, with answers to some of these questions, might we approach intervention in ways less dramatically belligerent?

Cells in the body act collectively—for example, as networks of neurons to produce sensations, or as patrolling T-cells that mobilize other immune cells to respond to pathogens. It seems they communicate with one another. In the process of metastasis, the cancer cells may use signals from healthy tissue to recruit other cancer cells to a new location, where certain areas of tissue constitute an attractive resource. If researchers can figure out how cancer cells are recruiting then maybe they can set traps to prevent them from doing this.

All very well, but it doesn’t solve my problem (and my oncologist’s) which is how to understand the malignant cells of my cancer, Chronic Lymphocytic Leukemia (CLL), as part of a cancerous system, given that it is a cancer of the blood not manifested in solid tumors. In CLL the cancer cells (malignant B cells, a type of white blood cell) course through the marrow and travel through the blood and lymphatic system. What happens in a “normal” body is that the B cells are recruited to fight infection, they die off often and regularly and new ones grow. In CLL, because of some genetic glitch, they don’t die off but in fact relentlessly proliferate, interfering with and crowding out the production of healthy white cells, red cells and platelets.

Although the cancer is in the blood and not localized in tumors the cells do cluster, they form hubs just like ants. They cluster in lymphoid tissue. Research has identified a form of regulation in this lymphoid tissue, or micro-environment, whereby malignant B cells communicate with other healthy cells. Curious about the relation of the cancer cells to certain healthy cells Dr Kipps and his colleagues looked at this relationship in the lab. They found that when the CLL cells were removed from the “suspicious” healthy cells, the CLL B cells began to die, whereas the same cells, when replated back onto the healthy cells, perked up immediately. Because they supported the survival of CLL cells and because CLL B cells became attached to them, the researcher group called them “nurse-like cells,” or NLC. They concluded that one of the ways CLL cells survive is by recruiting these protector cells.

Dr K describes CLL as a very social beast. By this he means that the survival of the cells depends upon a network of relations, which indeed amounts to a form of regulation, without central control. The relation between the NLC and the CLL B-cells is symbiotic just like that between ants and aphids. In a dynamical system like an ant colony it is possible to observe how when one element changes (e.g. the introduction of drought) the behavior of the colony changes. So, similarly, by focusing on the microenvironment of another dynamical system – a colony of cancer cells – it becomes possible to envisage forms of intervention more akin to the strategic introduction of drought, rather than war. Rather than therapies which are the equivalent of carpet bombing, indiscriminately destroying good blood cells along with the bad (which anyway doesn’t work with CLL which is notably resistant to standard chemotherapy), the solution might be to try and intervene in the signaling system to change the behavior of the cancer colony. Or, as Dr K puts it: to foster therapies that isolate the CLL cells so that they die of social neglect.

To observe how cancer colonies evolve, how cellular activity is regulated, how selections are made: this chimes with other ideas vibrating in the air in this second decade of the twenty first century when the Darwinian inheritance is being reconfigured. We humans have made such a mess of the planet that perhaps our only hope lies in attending more closely to other forms of organization, to looking more closely at ants and fungi and chickens (with whom we share about 60% DNA) and extinct species like the sloth from the Paleolithic era to species like bees that are disappearing by the day, as we poison the environment and our own bodies. By looking outside the human body to other “bodies” or clusters of living cells in the natural world it seems to me that we have more chance of figuring out solutions, or ways of being in the world, perhaps even ways of living with cancer rather than definitively conquering it. Just as in certain approaches to invasive species in habitat studies. It’s a reversal of the gaze or perspective. Rather than trying to understand the natural world through the lens of human society, we reverse the perspective so that a description of a natural society—an ant colony in this instance—can illuminate how we think about modes of organization in the human body. Or, more pertinently (since reversals always carry the dangers of dualism) we can begin to think of the nature-society play as itself like an ant colony.

I don’t for a moment think that Dr K and co are spending their time out in the desert down on their knees observing the behavior of ants. They are in the laboratory working late at night, separating the malignant B-cells from their nurse-like protectors and replating them, and trying to figure out how to intercept the signals. They are running algorithms. In defining the various cells, structures and molecules that protect the CLL cells they are working on the development of novel anti-leukemia agents such as monoclonal antibodies and immune-based treatment strategies and genetically engineered T-cells. No, they are not looking at ants; but for me, as a gardener and a non-scientist and someone with cancer, bells start chiming.

In writing this I have become less alarmed by the ant analogy, more attuned to the reverberations sparked by hearing Deborah Gordon speak. At some point analogy clicks and opens up a different link. A link to the ecological.

Even though he places emphasis on the environment Dr K is cautious: We still don’t fully understand how the parts work together to produce the dynamics, the history, and the development of the system, he says. There isn’t a single explanation for how CLL happens, let alone how it evolves, adapts, transforms. Unpredictable things happen. Needless to say there also isn’t a single solution.

Nevertheless, this perspective gives me hope. Not that a cure for CLL will be produced tomorrow, but certainly that more efficacious and less damaging possibilities are opening up that might prolong the life expectancy of people with CLL (so far this has not been possible). The outlook is considerably brighter than when I was first diagnosed six years ago.

It fills me with energy and hope: that this research can be understood in terms of a larger project, within an ecological matrix encompassing micro and macro environments, time scales ranging from the big bang to now, symbiotic relations as apparently diverse as the relation between ants and aphids in a garden and malignant B-cells and nurse-like cells in a CLL environment.

It gives hope when things are going well (like now, when treatment is resting in a sweet spot). Not when you are teetering on the edge of a chasm filled with black rising sludge and you see death edging its way up out of the tar pits toward you, like a massive land sloth.

In the dark times it is the sloth that imaginatively materializes, rather than a colony of ants. Although the ant analogy has greater scientific resonance, the sloth connects affectively to my bodily experience. But in the process of writing this piece I have relinquished the idea of ants scurrying around inside my body, am more able to situate ants and cancer cells in an analogous relation, within the framework of dynamical systems. This I realize: it is not necessary to feel ant-like in order to grasp the import of the analogy. You might say my cognitive apprehension has marginally improved. On the other hand, it is only through sensation, through ways that the body experiences being in the world, being in the garden as well as in the hospital and the lab, that understanding grows. Figures of speech, often fantastical, may seem to be at odds with scientific data, but the human sensorium involves a rich patterning of signaling networks. The connections between science and imagination are myriad and marvelous.

 

Notes

“Ants are like cancer cells”…….. Deborah Gordon in her talk “The evolution of collective behavior in ant colonies.” at the conference, “Anthropocene: Arts of living on a damaged planet,” May 8-10, 2014, organized by Anna Tsing at the University of California, Santa Cruz. Her writings include Ant Encounters: Interaction Networks and Colony Behavior (Primers in Complex Systems) and Ants At Work: How An Insect Society Is Organized.

“the researcher group called them “nurse-like cells,” or NLC”….. “Blood-derived nurse-like cells protect chronic lymphocytic leukemia B cells from spontaneous apoptosis through stromal cell–derived factor-1”

Jan A. Burger, Nobuhiro Tsukada, Meike Burger, Nathan J. Zvaifler, Marie Dell’Aquila, Thomas J. Kipps,  Blood. Oct 2000,96(8)2655-2663; http://bloodjournal.org/content/96/8/2655?variant=long

“chickens (with whom we share about 60% DNA)”….. NIH 2004 News Release. “Researchers Compare Chicken, Human Genomes: Analysis of First Avian Genome Uncovers Differences Between Birds and Mammals” National Human Genome Research Institute. Last Updated: November 17, 2011http://www.genome.gov/12514316.  Accessed May 15, 2014.

 

 

The Answer is not Coming

She waits in the freezing snow at the bottom of a huge mountain, an icy mountain lying between one country and another. It’s the end of the day, light is failing. Perhaps he has ditched her, or had an accident, or fallen into a crevasse. Doubt. Waiting. “The answer is not coming.” So writes Rachel Kushner at the end of The Flame Throwers. Though these are not quite the last words of the novel.

Two things are going on, as I see it. There’s a familiar quotidian experience: hanging about waiting for someone who doesn’t show. You’re in that place or moment when anxiety and boredom collide, anticipation runs headlong into despair. And there’s a larger metaphysical or perhaps structural thing going on: how to be in that experience, how to move through this waiting, or to let the waiting materialize as a non-conclusive ending.

The answer to the question of whether he is coming or not is simple, it becomes clear as night falls: He is not coming. But there is another question not answered, though what exactly this question is you can’t say and actually it doesn’t matter what the question itself is. It is not a man who will not come, it is an answer. For Kushner, I believe, it’s enmeshed in how to bring the novel to an end. In an interview she writes, “I was determined not to have the narrator ride off into the horizon in a blaze of triumph at the end. The plotline where the main character overcomes a weakness and acts with new empowerment is a form of narrative compression I usually find cheap and don’t much relate to.”

This is a novel that is dense and intriguing in its cutting between times and places, places in the US and Italy, in the 1970s and around the First World War. The threads of connection that link people to political and art movements are rendered through scenarios in which characters experience speed and slowness, talking, listening, waiting. Guns and motor bikes, riding fast and waiting about slowly not doing much. Techniques and technologies. Kushner, within the fabric of the daily, writes about a variety of technologies, mobilizing characters and ideas that attempt, variously, to forge a way out of the routine of the everyday. Her novel, too, shapes up—disintegrates, realigns—through a virtuoso enactment of technique. She herself is a flame thrower, filling the sky with colors and patterns, materializing through technique a range of possibilities, some lethal. Reading, immersed in the rhythms and the cutting between locales, alerted through technique rather than through authorial direction, to the present, you don’t expect a conclusion, particularly one that embodies a triumph over adversity. It isn’t simply that we are left with a question at the end, some plot thread that is left loose, given to us as a throw away scrap from the table of literary delights. No, it’s that the whole practice or technique of the novel works against triumphalism with all its moral underpinnings.

Because I’m pretty well right now I’m greedy to grab every moment to write or read scraps from lots of different books and so I’ve read this novel slowly, in some senses against the grain. Lindsey says, “For me it was cold and fast—a reading experience that I imagine is akin to riding one of those motorcycles she rides around Manhattan.” In the last third I speed up, glad to immerse myself in the novel during a Cancer Survivors Week, thus saving myself from getting hot under the collar about all the triumphalist rhetoric in the air. Saving myself, perhaps, from insinuations of guilt solicited by sentiment-drenched exhortations to give money to defeat cancer. I want to live longer, I want them (that great big them in the sky) to find a better form of treatment than the ghastly chemos people with tumors have to endure (and indeed there are people with blood cancers who endure these too). And being implicated, a receiver or beneficiary of the bounty, I know I should give more than I do so that people not as lucky as me in terms of time and place can get a better deal. But it makes me mad that so much of cancer, medicine in general, actually everything in general in this country, is so dependent on charity, on private institutions, on individual gifts. Matters of public concern rendered as a balancing act between the fortunate and the unfortunate, where individuals can be empowered by charitable acts, acts of giving.

The objective correlative of this is the celebration of survivors, the hullaballoo about the battle won by strong individuals. Empowerment through adversity. We are the strong ones, the ones who fought back and won, we are special, not like all those losers who succumbed and dropped dead without a proper struggle.

Of course it isn’t just around cancer that the ubiquitous grizzliness of positive thinking occurs. Jeffrey comes home from the gym the other day and tells me about an interview he saw on CNN while treading the mill. One of the young survivors of the ghastly Santa Barbara campus murders came forward voluntarily to offer witness. He said something like, “It wasn’t an entirely negative experience… some of us survived.”

Still, we need fiction sometimes. The fiction of survival is a charged fiction and through the charging, the living through, acquires a material reality. The reality that we are fighting, that we will overcome. When Isabel wrote to me, long ago it now seems, when I had surgery for lung cancer a year after the leukemia diagnosis, “vencerás,” (you will overcome) it was inspiring, it gave me courage, I started to believe that I would survive. She gave me a gift.

So what to do, what is the answer? Me fuming silently on my soapbox with a hand hovering reluctantly over a shallow pocket chockablock with scrunched up tissues and lists of things to do and a little cash isn’t going to change the circuit of charitable and uncharitable capital.

 

 

 

 

 

Some Musings on Metaphor

A good month, June. Feeling considerably better, with miles more energy. It has been amazing to look at the print out of my labs the last few weeks. Bloodwork shows much improvement, many items that were flagged too high or too low have settled into the normal category. Looking at the results each week (they come up on the computer a few hours after the labs these days) is like watching a soccer ball, soaring in slow motion, peeking and then descending. Hold your breath: where will it land, inside or outside the line?

My white blood cell count fell into the normal range fairly soon after starting treatment. But actually there are many kinds of white blood cells, and there are at least two kinds that are crucial indicators for CLL, or since each case is idiosyncratic let’s say for me at the moment. My neutrophils are slightly low – most likely induced by the revlimid. If they go much lower it means likely neutropenia (when you are dangerously at risk of infection, when you have to eat only cooked vegetables and fruit, wear a mask etc …. everyone probably knows someone who has had cancer and endured a period of neutropenia, induced by the chemo) but so far very borderline. Then there are lymphocytes. In the last month the absolute lymphocyte count has normalized. Marlene Millen, my primary care physician, said no wonder you are feeling better, when your lymphocyte count is up its like you have a constant virus, you are fighting it, day in and day out. My first reaction was Whoa, what would you know what it feels like. Stick to science, doctor, don’t presume to tell me how it feels. A flashback to hot flashes and the gynecologist (young, compassionate, efficient, female) who said, just think of it as a normal part of life, everyone gets hot, I get hot sometimes, and I just take a deep breath and drink some water and it passes. Well bully for you lady, may you wake one day in your best silk blouse suddenly sweating swinishly as you address a room full of bright-eyed and bushy tailed gynecology students. A moment ago they were hanging on your every word, now their eyes are fixed on the sweaty stained blouse clinging to your breasts. But Millen is not that gynecologist. She is tough and vigilant and frank. She is also a go-between, mediating between the various specialists I encounter, ping ponging from one to another. She was the one who really kicked me into treatment the first time. Listen, she said, Kipps will always say “it’s maybe time to start thinking about treatment, here are the options, of course it’s your choice.” “But I’m not Californian,” says Millen, “and not afraid to cut to the chase. You have put it off for long enough, and now you are saying well I think I’ll wait a while. You really need to start treatment NOW.” She must be about half my age, but she calls me “Sweetie.” “Well done Sweetie,” she will say when she thinks I have conquered the denial impulse and recognized some danger signal and given her a call. I find it very endearing to be called Sweetie. Bitter sweet like the Jane Campion movie.

Friends are curious and always asking: what is it like? Much of the time we look quite normal, when you go the CLL support group you might think you were in a room of perfectly healthy people, the swollen lymph nodes and spleens are not visible, nor the haywire white blood cells, cavorting platelets, nor the havoc being played in bone marrow. Nor the sense of utter exhaustion and fluishness. People often say to me “how are you? You look great!” On bad days this can be a trifle irritating, because typically they ask a question and answer it themselves, pronouncing you well and fine. This was a refrain after my dance with death just before our Boxing Day party, though on this occasion not in the least irritating. Boxing Day is the day after Christmas and this last year it was also the day after I came out of hospital. The cause was an infection that went haywire over night, landing me in the ER. Four nights in hospital and then I was fine, immensely relieved, and we went ahead with our Boxing day tamale party. Teddy Cruz gets the most delicious Guatamalan tamales from a source he refuses to reveal. They are wrapped in banana leaves and steamed. Unwrapping is at once a delaying mechanism, a stringing out of anticipation, and a process of revelation. As you unwrap the smells start swirling, not just one smell but many. The masa (or corn dough) inside the banana leaf wrapping is in turn wrapped around the filling—pork or chicken—and a sauce that is beginning to ooze out so you have to lick your fingers to get a taste of what is to come. You pause, fingers in your mouth, imagining. And then you break into the tamale. Inside there is pork and a piece of fruit, and even though there is a melting moment flavors are distinct—sharp, sweet, meaty. You scoop a bite of tamale into in your mouth, and enter heaven.

I have never met this woman who works in her kitchen at home and conjures these magical tamales into being. Teddy is the go-between. But I do know something about her. A week before Christmas her husband, who had been living and working in San Diego for years, was walking along the street not far from our house when a Homeland Security van pulled up and stopped him, requesting his papers. He had none. He was pulled into the van and deported from the country.

Although I sometimes find the “you look great” refrain irritating, receiving it as vacuous routine politeness, actually I know that when people say this they are more often than not performing an act of sympathetic magic: they are wishing that all is well, they want you to be well, they want to believe that everything is fine. And you participate in the performance. You are relieved to be alive and want to look as normal as possible. On Boxing Day I was particularly glad to be alive and celebrating. But the scary thing is the knowledge that it could be something like this that will take me out. Most CLL deaths (because CLL is a disease of the immune system) are from simple infections that flare up quickly and can’t be controlled. This is what Millen has always been trying to impress upon me: be alert to the signals, act immediately, don’t be so cavalier. She was pregnant and on leave when this happened, but when she came back she said, “Well done Sweetie, you got yourself to ER in time.”

Millen offered the metaphor of living with a virus. There is an aptness to it, it’s graspable, something one can offer to others. Kipps offered another. After my first treatment I said to him It’s like a miracle. I had no idea how awful I had been feeling. For years. This is the real normal and it’s a great sensation! Kipps said many patients say exactly the same thing. And he offered a metaphor: it’s like hiking up a hill with a back pack on your back. You start with a few pebbles in your back sack and after a while you add a few more, and then after another few miles the gremlin at your back tosses in just one more stone, but this one is a little larger, heavier. And so it goes, and as you climb you accommodate to the weight and the difficulty, and you come to imagine this as normal.

Rather than being affronted by Kipps’ simile, or his presumption in describing my sensations, I experienced a surprising sense of gratitude. His image was not exactly intricate or poetic, and certainly far from scientific. Perhaps though this is precisely the key to understanding how it works. How a simple metaphor describing an illness can spark delight. Why, I wonder. Clearly, on one level it’s because of recognition. It offers a mirror image, a confirmation of identity. Thus, it might be argued, it doesn’t do much to shift anything, simply confirms the way things are, the way you feel. And although I hate the kind of feel-good triumphalism that validates every feeling as evidence of self-worth nevertheless I think there is something crucial that happens when the language of medicine or science is blurred by the poetic impulse of metaphor. Many illnesses, particularly chronic ones, as well as many psychological states, are isolating, for the patient it’s hard to situate what they “feel” as anything other than ultra-personal. There are times when you think maybe it’s all in my head, or maybe I am inducing this illness because of the way I feel. So to have an image flashed up, from elsewhere, from someone else, that is evocative and feels accurate – this is like getting a hit of immunoglobulin. You want to shout out Yes! That’s it! Something surges through your system, is energizing, and it isn’t a drug. This kind of metaphor differs from the destructive metaphors that Susan Sontag so brilliantly described in Metaphor as Illness. Metaphor literally means a bridge between two things, two words, two images. The more unlikely the linkage the more powerful the metaphor, and the more it can be spun out the greater its capacity to inspire intrigue and wonder. But in addition to confirming the way you feel, metaphor has the potential to perform an intricate dance of difference. There is always that space of difference, of something incommensurate that stretches between the two unlikely images. A patient is and is not a hiker. In that tension, in the surprise, in the fact that the image flashes up from elsewhere – it is in this process that metaphor has the capacity to open your eyes, to introduce not just sameness and recognition, but newness. The drugs serve to lighten the load, but words too.

Newness and surprise are great medicines.

Much of the time I swim through Kipps’ language, feeling an idiot because I haven’t done my homework and there is still so much I do not understand, and sometimes despair that I ever will. And there’s not much time. And how will I ever make the right decisions about which therapy if I’m so clueless? He has a lot of patients to see on this one day of the week when he isn’t doing research or flying around the world talking about CLL. Often I call up Sheila Hoff, our CLL nurse and case manager, and she patiently spends hours going over it all, translating, helping with decisions by giving examples, and always she says, think about what kind of a person you are, how you want to live your life, which treatment will suit you best. Or I turn to a patient advocate site on the internet, like that of Chaya Venkat. Sadly she has announced this week that she is retiring. Her husband died of CLL. Though not a medical doctor she is a science writer and she started the site (http://updates.clltopics.org) to link her husband’s journey with others’, to mediate between the scientific community (and scientific language) and patients. For twelve years (eight while her husband was alive, four after, by herself) she has done a quite amazing job as a patient advocate, and as a magician of words. Understanding the language, yes, but something more. Finding the words. Saying the words. Her retirement blog is very poignant.

When I was looking for good crime novels (when not?), the kind you can lose yourself in, Patricia Montoya, my friend and neighbor (who has herself recently been through hell, survived a rough stem cell transplant, now back for the summer in her bitter-sweet home, Medellin), suggested I read Tijuana Straits. It’s a surf noir novel set primarily in the Tijuana River Valley, the area that stretches from Imperial Beach in the northeast corner of the Valley (and the US) along the border with Mexico. Twenty minutes from where I live. It begins in the Estuary, with the main protagonist whose charge is protecting certain migratory birds (most notably the western snowy plover and the light-footed clapper rail) discovering in the early morning dawn a woman in distress, who seems to have crossed by an illegal route where the border fence cuts the valley in half. Kem Nunn evokes the area vividly: the crashing surf, the Lighthouse in Las Playas on the Mexican side of the fence, Yogurt Canyon, Smuggler’s Gulch, the routes through the Valley on this side – Monument Road at the edge of Border Field State Park, Hollister Drive, Dairy Mart Road – and the maze of dirt roads and horse trails. I started reading the novel after a particularly hairy infusion, and experienced a peculiar delight in recognizing these places, even seeing these names in print, saying them out loud. There is the comfort of familiarity of course, but also there is always a slight, maybe infintesimal, mismatch between the image offered and your memories. There is a pleasure in puzzling out how the images cohere, form a landscape, in imagining even when you can’t be there. Nunn wrote this novel shortly before Homeland Security hacked into the landscape in 2003 so brutally, demolishing a mesa, filling in a canyon and building a new, second wall flanked by a perfectly asphalted wide road, a road where no one drives except the occasional border patrol vehicle. So sometimes he describes a landscape I hardly knew, and I try to conjure it, ripping out the new steel fence, and the asphalt road, and restoring the canyon in my mind.

You picture and imagine a landscape, a configuration of space shadowed always by various histories, some quite personal others social, unfolding oblivious to your personal existence. It is like this too with simple metaphors, thrown up in the haze of misrecognition, when you do not know how to make sense of this place where you find yourself.

For me the Boxing Day party was a celebration of being alive, of having escaped again, of friendship. The house was packed, the air was festive, people drifted in and out of the garden, unlikely people became entranced by the chickens and entered into chicken conversations. The tamales, however, as well as being delicious were a reminder that cancer is a card you can carry, it’s like having papers, if you are lucky enough to have medical care people are basically on your side, they want everything to be fine, they want you to be well. Of course you live with the fear of sudden, or slow, death. But as people who have cancer and Buddhists and even total strangers with whom you strike up a conversation in the long queque at the pharmacy remark: we are all going to die, death is a part of life, and anyway who knows you might walk under a bus tomorrow. True no doubt. But it is also the case that many people in this country live without any papers at all, let alone a cancer card, and they live in real and daily fear of a chasm opening up when and if the Homeland Security van pulls up one day as they stroll to work, to the shop, to neighborhood park.

Chicken Joke

A man believes that he is a grain of seed. He is taken to a mental institution, where the doctors do their best finally to convince him that he is not a grain, but a man. No sooner has he left the hospital than he comes back, very scared, claiming that there is a chicken outside the door, and he is afraid that it will eat him. “Dear fellow,” says his doctor, “you know very well that you are not a grain of seed, but a man.” “Of course I know that,” replies the patient, “but does the chicken?”

This joke is told by Alenka Zupancic in The Odd One In: On Comedy. She says that what is at stake here is the post Enlightenment assertion: I know very well, but nevertheless…. (I know very well that there is no God, nevertheless I pray that God will save me from this awful situation, pluck me out of this shit hole). She traces a thread of connection between Hegel and Lacan, between the Phenomenology of Spirit and the concept of the Other. Her twisting of the skeins is provocative, she takes a paradox and plays it as though it were a queen of hearts or seven of spades, the paradoxes proliferate, the tricks are blindingly spectacular. Is it sleight of hand or logic refined to the nth degree?

Yet there is something left over for me, something that she doesn’t directly address though perhaps it lurks and swims around in the lower depths of the joke. What is left over is fear, a kind of fear embedded in category confusion and realized most obviously in phobias, but also in simple fears like the fear of dying. It’s not just me and the chicken, me and the other, but there is a third term: this thing, this grain of seed or let’s call it a corn kernel. Self and Other, these terms are mobilized in a circuit of exchange involving Other Things, and at some stage this circuit involves (or threatens) consumption, and disappearance or annihilation.

I came to chickens and to Buddhism at roughly the same time. Not entirely true, I grew up with chickens, and as an adult have had chickens in my life whenever possible, so in part I was enacting a repetition of the familiar (rather than the sense of discovery implied in the notion of “coming to.” But my relation to chickens has been very different this time). Buddhism was not familiar. After coming to political consciousness as a teenager I settled into an habitual semi-conscious cynicism about religion, or let’s just say faith, or spirit with either a small or large S. But in Shambhala I have found myself sometimes in a not-unfamiliar place. Not the place of religion, but of therapy, specifically psycho-therapy. Another form of repetition, therefore.

Chickens became an obsession when I was pretty unwell and heading into my first treatment. It was hard to work and to write and to do research, actually it was simply hard to find the energy to focus for long on anything. But oddly enough I was able not only to focus on chickens but to allow the chicken world to consume me. It became a totally encompassing obsession. (You can read about this in the piece “Chickens saved my Life”). Obsession, I’m convinced, is potentially curative. It is a form of denial certainly, a delusional projection, an enactment of repetition in the face of death. But it works. Sometimes it works. It takes your mind off things, prevents you from succumbing to another competing repetition, to the mantra of despair, or worse – of resignation.

If we want to use the language of psychoanalysis we might say that chickens are the way the subject’s unconscious (and her relation to herself) are externalized.

Cancer brought me to meditation. I signed up to Shambhala (a version of Buddhism) in order to learn some techniques for meditation. There is no doubt that meditation is a way of calming the body, reducing stress, promoting the anti-toxins, giving energy. Science tells us this though anyone who has meditated can tell you the same thing (still, the scientific writings are fascinating, keep a look out for the coming blog on the “bliss” app). But when I started going to Shambhala I found that the “techniques” of meditation were not so separable from the “ethos” of this version of Buddhism. One way of looking at this is to say that you bring into meditation a whole lot of baggage, and meditation itself shakes loose the careful packing (or repression), interferes with habitual patterns, throws into the unconscious—in slow motion—a Molotov cocktail. “Baggage” has become a remarkably familiar term in everyday language, it’s the kind of language that makes me squeamish. And indeed there are aspects of the Shambhala training that have induced squeemishness (many new age therapeutic models such as mindfulness training           draw on and are heavily influenced by varieties of Buddhism, and then in turn varieties of Buddhism adapted to a western environment, borrow the familiar new-age language). Sometimes I have yearned for a more severe practice, for what I imagine the spartanness of Zen to be. But then I remind myself that after all I am not Tibetan, like others in the room I am a predictable westerner looking to Buddhism to change something. So I tell myself this: suck it up.

I came to meditation hoping to find a way of being more at peace in the world (and therefore healthier, better able to fight the cancer). Of course once you start shaking that can of hope around the worms all come squirming out. And you find that you are faced with the phantoms of repetition. And you would like to change, quite simply (and even though it makes me squirm to say it) you would like to be a better person. Being more at peace might also have pay offs – for those around you, those who suffer the importunate blasts of bad temper, inveterate quibbling, acerbic barbs exploded randomly, not to mention hardly-muted envy.

Squirm and quease. Buddhism has in common with psycho-therapy a serious engagement with the unconscious (even though the word “unconscious” may not occur). Often the distinction is made between acknowledgement (just letting it come to the surface, letting it be) and analysis (analyzing dreams, jokes, stories, memories and so on). This distinction is hard to maintain but let us put aside this objection for the moment. Some of the Shambhala trainings are built on a dyadic structure. In a workshop you are given a question, or situation, and then the group divides into pairs. The first person has five minutes to speak (or not). The other person listens, they are not to respond in any way, they should not smile or offer encouragement, express agreement or approval or disagreement. And then you swap positions. And then there is five minutes for dialogue. The hard thing, the really hard thing, is not speaking, but listening in such a way as to resist solicitation.

Over and over again we repeat the same moves. We enter analysis (let’s say analysis, but perhaps we enter into other therapeutic spaces too—the sangha, the garden, the yoga studio, the church). You do this because you want to change, you want to break old habits, alter the way you relate to others or to the Other. Or you want to face life (and death) more fearlessly. Or both these things. But in analysis, as Zupancic points out, it isn’t enough for the analysand to become conscious of her unconscious. Often the belief is that the analyst will enable the analysand (through bringing to consciousness the patterns of repetition) to recognize their repetitious fatality. The analysand is prone to believing that when the therapy is over they will reemerge into the world and be liberated, “cured,” able to act differently. But actually nothing will change until the analysand fully recognizes the Other as something other than a projection of self. And this has to take place in the world.

In short, it is not simply that in analysis the subject has to shift her position (or even adapt herself); the major part of the analytic work consists precisely in shifting the external practices, in moving all those “chickens” in which the subject’s unconscious (and her relation to herself) are externalized.”(16)

I wonder sometimes if I am not Becoming Chicken, clucking and cooing and chirruping, grubbing around in the hedgerows looking for worms. Flapping around like Charlie Chaplin in The Gold Rush. Holly, Lula Mae, Sabrina (and Funny Face when she was alive) have coaxed from me a much more intimate relationship than I have ever before experienced with chickens. Is this identification? Have I wormed my way successfully into the being of the chicken? Or perhaps more profoundly found a way of acknowledging the otherness of Chicken-Being, realizing how the chicken thinks and feels, out there in the world, independent of my consciousness. I wish this were so, for it would mean a moving around of chickens, a changing of the way of being in the world. Often, as I sit in the garden at the end of the day and the chickens pick and peck and scratch I feel remarkably contented, at one with the world, grateful to have passed through the repetitive obsessive phase. And then Sabrina will suddenly extend her neck, cock her head and stare. Eyes glinting blackly she will dive at my leg and peck. It hurts. She thinks I am a corn kernel.

I know very well of course that I am not a kernel of corn. Nevertheless…

Chickens Saved My Life

Chickens changed my life. Saved my life. Though it is also true to say that as we surf the stormy waves of birth, old age, sickness and death, many things, people and events change what we call our “life”. A life is merely a conglomeration, a concatenation of effects and affects, often unpredictable, though even when predicted things seldom turn out as expected.

And it was not by chickens alone that I was saved. But among all the therapies—chemo, meditation, acupuncture, naturopathic treatments, exercise—chickens, four glorious chicklets-becoming-hens—have changed things most dramatically. Holly, Lula Mae, Sabrina and Funny Face flap, flutter and jump onto anything that might resemble a perch, including human shoulders and heads. They frequently land together on one side of their feeder and tip it over. They also landed like a miracle, about six weeks ago, on me, and tipped the balance from death to life.

I have an incurable cancer, a form of leukemia called CLL (chronic lymphocytic leukemia), so like everyone else I am going to die but probably not tomorrow. Still, life was becoming rather hard to live. Now – after spending the summer in chemo-and-chicken therapy, I have been given a reprieve. I have been wanting chickens for years, and for years have been putting it off, there were always other things to do, work to get done, fetish desires to satisfy. CLL is one of the slow cancers, for some people it does not progress beyond what used to be called the “indolent” stage. For others it can race along alarmingly fast for a slow cancer. My symptoms just got gradually worse, though I wanted to defer treatment for as long as possible since once you start treatment you also start damaging your body’s ability to fight back. As my wonderful oncologist says, there are no such things as side effects. All drugs have a range of effects, some good some not so good (and sometimes the connection between good and not-so-good is knotted, complicated, only measurable over time). So when my oncologist said I think its time to start treatment and I saw the summer disappearing into an infusion center the absolute horribleness of my condition (so far no treatments have lengthened life for CLL patients) took hold, gloom defeated an habitual pollyannerish reflex. And then, in the midst of gloom, my thoughts turned to chickens. Chickens turned into obsession.

Soon I could think of nothing but breeds of chickens and what color eggs they lay and coops and ventilation and chicken manure and compost and predators and fencing and automatic watering and mites and fleas and worms and herbal remedies, and the chirruping noise that chicks make. I dreamed of collecting fresh eggs from free ranging chickens fed on weeds and greens and fruit from the garden. I could smell the omelettes made from these eggs, buttery and sizzling, sprinkled with herbs. I could also smell the chicken shit and rapturously and endlessly imagined the compost we would have, how contentedly my garden would grow. J, my partner, embraced the idea even more whole heartedly than I, encouraging a flagrant defiance of budget in order to get the project happening. I spent endless hours on the internet, ordering books from the library, reading back copies of Backyard Poultry, visiting friends and perfect strangers with hens in their yard. Planning in minute and exacting detail. My treatment lasted three months and some of that time was spent back-breakingly (not me) and obsessively (me) assembling “el palacio de las princesas,” so named by my friend Isabela. And then the ordering. And then the arrival one morning, through the mail, of a cardboard box containing four day-old-chicks. Through all this demented focusing on chickens I had been feeling not too bad, forgetting the C word. And now my forgetfulness morphed into full-blown happiness. We started laughing. The tiny chicks are fluffy and adorable but also absurd in their pomposity. As the chicks grow their absurdity develops along with their adorability, keeping us laughing, tickling a severely compromised immune system, kicking it into gear.

Two weeks ago I saw the oncologist and he told me what I already knew, could feel, that so far the results are good. This isn’t the end of the story, there will be more tests and more treatment sooner or later. But for the moment I’m feeling better than in years and it feels great. This blog—about chickens and therapy and cancer—will tell the story of the chickens from the moment a vague idea became focused as an all-consuming passion. But it will also be about other things, because just as a life can be changed by a chromosome going awry so it can be changed by a chicken or a book that one is reading or a feral plant that takes root in your garden, and grows into an intriguing presence, altering the culture of the garden and making you see and feel differently.