Today is the fourth--and probably last--day without the chemo.  I'm to call the oncologist tomorrow morning before resuming, but I think he'll recommend going back on the treatment.  I'm not sure whether we'll maintain the current dosage (600 mg.) or go down to 400 mg.  Very few of the subjects in the clinical trials were able to maintain the intial 800 mg. dose, and most went down relatively quickly to 400.  I stayed on 800 for only a month or so because the meds drove my blood pressure up so much, but I've seemed to support the 600 mg. relatively well for over a year now.  The other time that I suspended treatment, I had a feeling of exhuberance when I didn't have to open the bottle of pills and pop three in my mouth.  This time, my feelings have been more matter of fact. 

During the first thirty hours after I stopped the Votrient, I felt almost like my old self: I didn't take a single nap on Monday, I didn't have any emergency trips to the john, and by evening, I had a good appetite.  Tuesday morning, I woke up feeling energetic.  And then suddenly--at the exact moment that a repairman arrived to replace the icemaker in the refrigerator (for $281)--I could only point toward the kitchen as I ran to the bathroom.  I had no appetite for lunch, and plopped myself in bed for over two hours of sleep.  By late afternoon, I had cramps and then vomiting.  And then suddenly, as quickly as they had struck, the symptoms disappeared.  I was ravenous and knew exactly what I wanted to eat: a wedge of iceberg lettuce (a reversion to childhood tastes?) with feta, golden raisins, bacon, and apple slices and a half pound of medium rare hamburger, no bun or other accoutrements.  I cleaned my plate and kept it all down.  Wednesday was sort of up and down, and this morning I feel good. 

I wish the results of suspending the chemo were more clear cut.  But there are so many variables--of both causes and effects--that it's hard to pinpoint what causes what. 

Last time, I mentioned that my colleague Mo was thinking about self-censorship in writing memoirs.  Her reflections made me think of what role self-censorship plays in writing this blog.  The most obvious example for me is that while I love my friends and would be lost without their support, many of them are academics and many of those teach English; ergo, there are a number of eccentrics (or more nicely eccentricities) among them.  When I'm writing an e-mail to an individual, these quirks make for what I hope are amusing stories.  I often try for vivid and humorous character sketches.  But in a public blog, I can't include what I think, but others may not, is funny.  I'd like to enliven the blog with more humor, but I stifle the impulse to do so.

It's also difficult to preserve my own self-image, to find a balance between an honest description of my feelings, indignities, and fears and my sense of myself as a "tough cookie" who doesn't like to complain.  If I write that for the 46 days that I was in the abduction brace I couldn't even wipe my own tuches, it's hard to maintain much dignity.  Should I have left that out?  How many times can I write about diarrhea?  Even if that influences every decision about going out, isn't it ok to skip some of the details?  If in the back of my mind, there's always the nagging thought that maybe I've turned the corner (and not in the right direction), do I need to mention that in every blog?  It's hard to know what is just sparing the reader repetition and what is self-protective.

And then there's one relevant fact that I've been most conscious of not mentioning, the most flagrant example of self-censorship: I smoke, as does Mohamed.  Of course, my friends here know it, as do those elsewhere whom I've visited or who have visited me here.  But for those others, I've kept quiet.  I didn't start smoking till I was 45 (not logical, I know, but true).  That means 22 years of doing something that almost all of society thinks of as disgusting and that everyone knows is dangerous.  After I had a heart attack in September of 2010, Mohamed and I made a concerted effort to quit.  We got down to three or four cigarettes a day with certain rules: no taking the cigarettes with us when we left the house, no smoking in the house.  During the brutal 2010-11 winter, we would stand in the snow and cold for a puff or two and then retreat, smokeless, into the house.  Since we thought we were selling the house and moving to Florida, we had pulled up all the carpet and refinished or installed hardwood floors; all the wallpaper came down, and all the curtains were replaced.  The house smelled pristine.  We never got down to zero cigs and it was always a struggle, but we had almost succeeded.  But then in April of last year, the prognosis was that I had less than a year to live.  And rationalization being what it is, it was easy to say "this is a really stressful tme" and "what the hell...why should I spend the last few months being grumpy if I'm going to die soon anyway?"  And so we backslid and resumed the smoking.  Before the last series of results, my friend Darrell very reasonably suggested that if the results were good (and they were), it would make sense to stop.  Why fight the cancer if I was going to drop dead of a heart attack?  But we haven't stopped, so what's the rationalization now?  It's feeble, but it's still "well, it's a stressful time and smoking is relaxing" and "I don't enjoy food or wine and I can't travel or even drive, so why not enjoy one of the pleasures that's left?" 

Censoring the fact that I smoke, however, changes some of the earlier thoughts.  In a much older blog, I talked about someone's having asked me whether I felt as if in some way I deserved the cancer.  I answered in what passes for philosophical discussion here, in terms of final causes (and their absence).  But I left out the obvious efficient cause.  Although no one really knows what causes kidney cancer, smoking is always listed as a contributing factor.  Later, when I talked about why bad things happen to good people, I talked about perhaps not being viewed as a good person by some because I was gay or an atheist, but I conveniently left out a much more obvious detail: bad things may have happened because I asked for them.

So a casual comment by Mo leads to a little less self-censorship.