My New Tumor

Two days after Senator John McCain announced he had a brain tumor, I underwent a biopsy to diagnose a new mass in my left leg and determine whether it is cancerous.

Medicine Buddha statues at Land of Medicine Buddha, Santa Cruz

It is.  It’s a big fat ugly tumor the size of a baseball.

I’m still in the dark about treatment.  My oncologist has mentioned something about an experimental drug.  Personally, I am leaning toward a drug that is non-experimental, one known to work.

When I know exactly what my options are, I will consider them with the knowledge that I am terminal.  Nothing is going to save my life.  That being the case, if my doctor’s plan is to subject me to an aggressive therapy that will make me sick and miserable, on top of the pain and misery I am already experiencing, further degrading the quality of my life, I am not sure that I am interested.  If the treatment might save my life, I would think differently.  But it’s just to keep me alive a while longer.  My feeling is that quality of life is more important than longevity.

Needless to say, I hate all this.  While it is tempting to bemoan my rotten fate, I have to look at this as an opportunity.   It’s as if the gods of destiny, fate, karma, whatever you want to call them, decided that I am just too lazy these days to practice on my own accord so they figured to give me something really serious to practice about.  They keep doing this and I wish they’d just leave me alone.

“With a good heart, compassion for others, whenever a problem arises, you experience it for others, on behalf of other sentient beings. If you experience happiness, you experience it for others. If you enjoy a luxury life, comfort, you dedicate it to others. And if you experience a problem, you experience it for others—for others to be free of problems and to have all happiness up to enlightenment, complete perfect peace and bliss. Wishing others to have all happiness, you experience problems on their behalf.”

– Lama Zopa Rinpoche, The Joy of Compassion

Lama Zopa Rinpoche’s teachings were very instructive and encouraging to me a few years ago when I was preparing for a liver transplant.  Based on Medicine Buddha practices, some of it steeped in Buddhist mysticism, much of it practical and empowering.  He makes clear that healing begins and ends with our hearts and minds.  He maintains that there is no healing without compassion, and indeed, compassion itself is an important source of healing.

“The best healer is someone with the realization of bodhicitta, the altruistic thought to achieve enlightenment for the sake of all living beings…  Every single breath of someone with great compassion is medicine…”

What the immediate future holds I don’t know – but I have made a decision on the end.  I do not want to die in a hospital, or here at home, I want to die in a Buddhist setting, in fellowship with other Buddhists.  My thought is to conduct the end of my life as though it were a personal retreat.  I’ve been looking into Buddhist hospices.  Unfortunately, there are not many.  I’ve only found three:  Zen Hospice in San Francisco, Tara House at Land of Medicine Buddha, and Enso House in Washington state.  If you know of any or if you are a Buddhist caregiver, please contact me.

In the meantime, may you be happy and at ease, and free from suffering.


The Interconnectedness of Death

Last February neurologist and Awakenings author Oliver Sacks learned he had terminal liver cancer. He shared this news with the world in an op-ed piece in the New York Times. I was moved by his thoughts about dying and I wrote a blog entry about it. As you may already be aware, Sacks died Sunday. He was 82.

oliver-sacks3His cancer was metastatic, and I’ve read that liver metastases is considered an absolute contraindication for liver transplantation.  However, it was treated. Sacks stated in a July 24 Times piece that in February, the cancer was treated with embolization, a procedure where substances are injected to try to block or reduce the blood flow to cancer cells, and the metastasis was “wiped out.” But a July 7 CT scan showed the metastases had regrown and spread beyond the liver.

He’d started immunotherapy treatment, but it was only to buy him time, and obviously it did not buy much of it.

In an appraisal written for yesterday’s edition of the Times, Michiko Kakutani wrote that in his work, Sacks cast light on the interconnectedness of life. The interdependence of life is a well-known Buddhist doctrine.  There is, too, an interconnectedness of death,  as stated so well by John Donne:

any man’s death diminishes me,
because I am involved in mankind.
And therefore never send to know for whom
the bell tolls; it tolls for thee.

Life and death are interconnected. What Buddhism calls “the cycle of birth and death” is a continuum. Life is the active phase and death is the passive phase. It is said that the continuum of a human being, or more precisely consciousness, is beginningless. As to whether it is endless or not, there are divergent opinions.

From my perspective, finding myself in a situation very similar to that of Sacks,  beginningless and endlessness are not so important. What matters most is the indivisibility of life and death. Fear is one of the greatest sources of anxiety, particularly fear of one’s own death. When we realize the oneness of life and death, its interconnectedness, and the emptiness of all things, there is, as the Heart Sutra says, no fear and no illusion. This is wisdom and with this wisdom we enter into nirvana, which is nothing more than this mundane world of life and death.

That is from the ultimate truth. The relative truth was stated by Sacks himself: “I cannot pretend I am without fear.”

To my mind, “no fear” does not refer to the absence of fear, but rather to how we handle fear.  It means the absence of anxiety, or better, winning out over the anxiety that fear brings. It means facing even death with hope and confidence.



Burning Pain for the Journey

I had the pleasure of meeting Jimmy Carter once. It was in 1982. He was in Los Angeles to promote his book Keeping Faith: Memoirs of a President and staying at the Beverly Wilshire Hotel where I worked. A few of us had copies of the book and one of the Secret Service guys took them up to Carter’s suite for him to sign. That evening we were asked stand outside the entrance to greet the former President as he left the hotel to attend some event. Flashing that famous grin, Carter shook all our hands. As he shook mine, I thanked him for signing the book and he replied, “My pleasure.” A brief but memorable encounter.

I have always admired Jimmy Carter. Many people believe his was a failed presidency. I don’t know. He made a number of tough, unpopular decisions. He followed his conscience, stayed true to his beliefs. I respect that. Most of all, he made a campaign promise never lie to the American people. As far as I know, he never did.

Now, Jimmy Carter is battling cancer. He had surgery on Aug. 3rd to remove a cancerous tumor from his liver. There are a number of different ways to deal with tumors on the liver. With me, it was with inter-arterial chemotherapy and radio frequency ablation – using chemo and high frequency radio waves to bombard a tumor and kill it. Carter had a resection where they cut out about one-tenth of his liver. A healthy liver, which I assume his is, will regenerate very quickly.

During a press conference, Carter said his doctors suspected the cancer had originated in another part of his body. Later, they discovered melanoma spots about “two millimeters” in size on his brain. Cancer that spreads from the place where it first started to another place in the body is metastatic cancer. That is what has also happened to me.

I had cancerous tumors on my liver but we thought my cancer was a thing of the past after I had a liver transplant in May 2014. For months, my scans looked fine, and then this past April my doctors found a malignant tumor in my left femur. It was metastatic. It came from somewhere else, probably my liver. How could this happen, I asked. It wasn’t a question that could be answered. Perhaps there were minute traces of cancer that got into the bone marrow. Perhaps the doctors simply missed it. Medicine is not an exact science.

They cut my leg open, drilled a hole in the bone, removed as much of the cancer as they could, and then put a rod in to give the bone support. After the surgery, I received ten radiation treatments to wipe out any remaining traces of the cancer. I believe Carter is also to have radiation treatments.

Since the surgery, I have had a couple of CT scans and a full bone scan at the end of June. Everything has looked good, but, very likely the cancer is still there, somewhere, hiding.

The problem with metastatic cancer is that evidently there is no effective way to control it. Eventually it will spread to some area of the body where there are vital organs and it will kill you. I don’t think Jimmy Carter’s case is any exception. From what my oncologist told me, mine is not, either.

Carter has one advantage I don’t. He has an immune system. He will be taking a drug called Keytruda to boost his immune system, supercharge it. My immune system is pretty much non-existent because of the medicines I take to suppress it. If I had a healthy immune system, my body would try to reject the transplanted liver.

At his news conference, Carter said, “I’m perfectly at ease with whatever comes.” I can’t say that I am perfectly at ease with the recent turn of events, but I have found it acceptable.

To paraphrase a passage in the 2nd chapter of Chuang Tzu, “Both the acceptable and unacceptable are acceptable.”

You can’t waste your life worrying about your death. When you accept that sufferings and death are both inevitable, you gain a certain amount of freedom. It is not that you resign yourself to a particular fate but rather you become liberated from it. The idea is to free your mind, to make it bamboo mind. Most bamboo is wind tolerant. Because it bends and yields to the wind, it is very stable. A purpose of Buddhist practice is to develop a mind that is stable, so that you can withstand the fierce winds of suffering.

Everyone knows they will die.  We usually think of death happening sometime far off in the future. To truly accept the reality that death may come sooner than you expected is one way you learn to flow and harmonize with life.

We must embrace pain and burn it as fuel for our journey.”

– Kenji Miyazawa (1896-1933), Japanese poet


Cancer Again (Naturally)

In December, I started having knee pain. I didn’t think too much about it, even though the pain was intense at times. I’ve had intermittent knee problems for some years, and figured it was probably arthritis or age. It went away after about a week, but then it came roaring back in January – deep throbbing pain that would not go away. I went to a couple of orthopedic surgeons and a rheumatologist. They discovered a lesion in my left femur. Possible cancerous. Possibly not, said one orthopedic oncologist.

The only way to know for sure was to do a biopsy. Last Wednesday, they drilled a hole in my bone, went into the left femur, removed tissue from the lesion, and the pathologist on hand during the surgery declared it cancer. Metastasis, to be exact, cancer that spreads from one part of the body to other parts. We, meaning I and the doctors, thought all the cancer was removed when they took out my old liver and gave me a new one.  But, I’m not getting that easy.  There must have been some cancer cells hiding somewhere, perhaps in bone marrow.

Needless to say, having a hole drilled in your bone is extremely painful.  They put a rod in to prevent fractures and make the leg weight bearing. Still, it hurts like hell and pain medication does not provide total relief.

Next is to get with the oncologist I worked with before and decide how to start fighting this thing. From what I understand there are three modes of treatment: radiation, chemotherapy, amputation.

And two battlefronts: the external one, involving the treatments I just mentioned, along with any others that might be available, and there is the inner front, the battlefield of bodymind and spirit. In future posts, as I did before, I plan to share a few of the highlights of my wayfaring through these stages of cancer.

I do have mixed feelings about putting my personal business in front of the public. But, ancient Buddhist texts describe two kinds of illness: those of the unenlightened, and those of the enlightened. The latter are for the purpose of providing opportunities to teach. I would never claim to be enlightened (I can pretty much guarantee you I’m not), nor am I egotistic enough to think I have much of anything to teach anyone.  Yet, if sharing more of my healing journey can be of benefit to others, so be it.

My approach to inner healing is centered on the Healing Buddha (whose image appears in the new header above), and my way is a bit unorthodox. In Tibet, Medicine Buddha is among the Highest Yoga Tantra. I received a Medicine Buddha Empowerment from Taklung Tsetrul Rinpoche in 2002, but I am not convinced that such empowerments are necessary.

In Teachings from the Medicine Buddha Retreat (Lama Yeshe Wisdom Archive, 2009), Lama Zopa Rinpoche says that in Healing Buddha teachings, “The person has to practice Medicine Buddha and have a good heart, with a sincere wish to help others.”

That is the only requirement, and this sentiment fully captures the essence ofBuddhist practice. Just do it. Try to help others. All awakening stems from that.

Now, for some reason, the song, “Alone Again (Naturally)” has been in my head lately.  There are some nice versions available (Sarah Vaughn, Diana Krall) but I chose the original because I liked it when it was first released and it has a beat.  Since I started letting folks know about this new development, the most frequent response I have received from family and friends has been, “I am so sorry you have to go through this.”  I’m sorry about it, too. It’s a real drag, and I am very tired of the pain, but what can I do? I got it. It’s mine.  I own it. I have to heal it.  Actually, that makes it sound as if cancer were something completely external.  It’s not.  I am the cancer.  I have to heal myself.

I have to admit, though, there are times when I feel downhearted.  So, dear readers, here is about the only self-pitying you will get from me, and it will be over in three minutes and forty-two seconds:


Our Own Lives

I don’t know if you read Oliver Sacks’ op-ed last Thursday in the New York Times where he revealed that he has terminal liver cancer. The piece was of particular interest to me as someone who survived liver cancer via a liver transplant only 9 months ago and has lost 2 family members to the disease in the past 13 months.

I think it should be of interest to everyone because we are all terminal. To paraphrase the title of a humorous and ironic song by Hank Williams Sr., none of us will get out of this world alive.

Oliver Sacks by Elena Seibert
Oliver Sacks by Elena Seibert

I must confess that before this I was not too familiar with the life and work of Oliver Sacks, who is a professor of neurology at the New York University School of Medicine. I knew that his 1973 memoir Awakenings about his work with patients suffering from the sleeping sickness, encephalitis lethargica, was made into a film with Robert De Niro and Robin Williams, which I enjoyed. And that he wrote another book titled The Man Who Mistook His Wife for a Hat, but I have read neither and had to go to Wikipedia to learn more about him.

It’s not necessary to know his life story to be moved by Sacks’ reflections. They are poignant and inspirational. The valuable takeaways for me were the appreciation he expresses for his life and the sense of detachment he has found. Both are indispensable to Buddhist practice, and even though some mistakenly think they are mutually exclusive, they are not.

Buddhism teaches that human life is precious, and that is reason enough to be grateful for the blessing of life. When you face death and survive, appreciation for life seems to blossom naturally. It is a shame to wait until you have a crisis for it to unfold.

In regards to detachment, Sacks writes,

I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work and my friends. I shall no longer look at “NewsHour” every night. I shall no longer pay any attention to politics or arguments about global warming.

This is not indifference but detachment . . .”

That is the kind of detachment Buddhism encourages us to develop, but again, while there is still time to watch the news, pay attention to the world, to argue, to forgive, love and cry. We form attachments to so many things – desire, material possessions, even our own sufferings – and it is vital that we learn to let go. As Thich Nhat Hanh tells us, “Letting go gives us freedom and freedom is the only condition for happiness.”

There is not much more to say about the piece. It is called “My Own Life.” It could have been titled “Our Own Lives,” as it speaks to and for us all. Please read it. Here is the link:

Oliver Sacks on Learning He Has Terminal Cancer February 19, 2015