The End of the Beginning

It was November 25th at 12:36 PM. A day that would change my life. I was sitting in a conference room. I don’t quite remember what I was working on, but it wasn’t important compared to the call that was getting ready to come in. My phone rang. I didn’t recognize the number. I usually screen unknown numbers, but I was expecting a call that could change my life forever.

Actually let’s rewind... This story starts the week of November 11th. I had what I thought was a really bad flu. Which was uncommon for me. I never get sick. I’ve been the definition of great health for most of my adult life. But for almost 2 weeks, I had a hacking cough, night sweats and was struggling breathing.

My partner, Gina, was getting ready to fly to Minnesota for a week of important work meetings. We made a deal. If this persisted the day she was flying out, I’d see a doctor and get checked out. I woke up the morning of her flight out after another rough night of night sweats. A deal was a deal. I kissed her goodbye, told her to have a safe flight and caught an Uber to CityMD. I sat there doing some bullshit on my phone, thinking, “I’ll get prescribed some medication that I won’t take anyway, they’ll tell me I have some bad flu that’s been going around, and I’ll head home, make some bone broth, jump back into bed and let my immune system knock this out.”

The nurse called my name and brought me to a room. I told her my symptoms and the Dr asked her to take an X-Ray of my chest to see what was going on. After waiting for my results for about 30 minutes, the Dr walked in, his face as white as a sheet. “Mr. Anderson, your right lung is filled with liquid. It might be collapsed. This looks like a bad case of pneumonia.”

This is what a “might be collapsed” lung looks like

He pulled up the X-Ray for me to see for myself. “Fuck,” I thought. This can’t be good. Turns out, it wasn’t. There was one more thing.

“There’s, um, one more thing. The X-Ray shows a mass in your chest about 13 x 8 centimeters large.”

“Is that big?,” I ask.

“It…it is. You need to go to the emergency room right away.”

I head to the ER and text Gina to let her know about the pneumonia, but I still think I’ll be home by the evening with what’s surely nothing to worry about.

After several hours, another X-Ray and multiple doctors, finally Dr Ann walks in to talk to me. She tells me I definitely have pneumonia and the medical team needs to triage that right away.

But she also needs to discuss this mass in my chest. She’s very unemotional as she explains that it’s large and there are one of three possibilities:

1. A viral infection that’s somehow grown out of control
2. A benign mass, or…
3. Cancer

She was almost robotic in telling me this. In hindsight, I realize she must have to say shit like this to people everyday. I guess I’d probably be robotic after a while, too.

Now it’s my turn. My face turns as white as the doctor from the clinic.

I call Gina and ask her how her meetings are going. I’m trying to stay calm and keep it together. I want to tell her. But I think to myself that I’ll just tell her after she flies home in a few days. I still believe I’m getting out of here in another few hours.

She can hear it in my voice. “What’s wrong?”. I lie to her. “Nothing. All is good. Just a bad case of pneumonia it sounds like. I’ll see you in a few days at home.”

She knows. “Don’t lie to me. What’s going on?”. I tell her. You’ll have to ask her what was going on in her mind when I shared the news with her. But she sounded cool, calm and collected as she started figuring out how to get home. She was on a plane back to NYC in a matter of hours.

We spend the next 4 days in the hospital at Mt. Sinai Queens. They triage the fluid in my lung by sticking a needle in my back and puncturing my lung. I pass out the first time. We try it again and the doctor removes 20 ounces of fluid from my right lung. That didn’t even get us a quarter of the way through the fluid in my lung. This won’t be the last time we have to do this.

This is what ~20 ounces of fluid drained from a lung looks like, btw

Over the next 4 days, I have an army of doctors coming in and out to examine, poke and prod me. I’m terrified to find out whether or not my insurance covers any of this.

I walk out the door on November 14th and spend the next week meeting with a mediastinal surgeon to discuss the option of splitting my sternum open and doing surgery (“Fuck. Now my bench press is really going to be fucked,” I think) and a scheduled biopsy on November 19th. The results could take up to a week to come in.

Okay. We’re back to November 25th. I’m in the middle of an Accelerator program with 9 startups who have flown into New York from around the globe for our Blockchain Accelerator program, Tachyon. I’m the Managing Director, but I’m also the Phase captain for the upcoming Phase 2: Growth and Traction module.

Needless to say, I feel a deep responsibility to these 26 individuals and the success of their startups. So I’m back in the office. Besides, I need to work to get my mind off of things.

The call comes in at 12:36 PM. My doctor has the results of my biopsy. I hop in a phone booth and try conferencing in Gina, but we’re having technical difficulties. So I open up my notebook and start taking notes. My hands are trembling as I write.

Notes from my diagnosis

“Mr. Anderson, we have the results of your biopsy. I’m so sorry. The diagnosis is T-Lymphoblastic Lymphoma/Leukemia. You have to go to the hospital right away to begin IV chemotherapy.”

I’m numb. I shake myself out of a fog.

“Are you sure? Can I get a 2nd opinion?”.

“I’m so sorry. There’s no time for that. It’s aggressive and you need to begin IV chemotherapy right away.”

I make the mistake of asking what that entails.

“IV Chemotherapy is an aggressive protocol to treat an aggressive cancer. It’s going to wipe out your immune system (I mistakenly write ‘bone marrow’. She’s talking about a bone marrow biopsy but I’m barely processing). You’ll feel fine the first 2 days and tired days 7–10.”

She gives a ton more detail that I’m not ready to hear. I scribble notes.

“I’ve already notified the emergency room at Mt. Sinai Upper Eastside. They’re expecting you in the next hour and will be ready to admit you. You’ll be there for a few weeks. Again, I’m so sorry.”

I just got hit with a bombshell.

I hang up and try Gina again. I get ahold of her and tell her the news. She’s leaving work right away and we’ll hop in an Uber to head to the hospital.

I walk back in the conference room to grab my stuff. One of my colleagues is sitting there. There’s no fucking way I’m about to drop this ton of bricks on her.

“I have to head out. I’ll email you guys later on” is about as smooth as I can be as I pick up my stuff and head out the door.

Gina and I talk the whole way there. I’m terrified. As we get to the emergency room and I jump out of the Uber, my driver says to me “It will all be okay. I’m praying for you.” He was listening to our conversation the whole ride there. I tear up. He has no idea how badly I needed to hear something like that in that moment.

The Highlights

The details of the last several months probably don’t matter all that much. Here are the highlights:

• I was diagnosed w/ T-Cell Acute Lymphoblastic/Leukemia or T-ALL for short. It’s aggressive and progresses quickly, hence the 13 x 8 centimeter mass in my mediastinum.
• It’s non-germline, meaning it’s not passed on in my genes, rather it’s a genetic mutation.
• Leukemia and Lymphoma are liquid cancers, which means they originate in the bone marrow and make their way to the immune system and/or the lymph nodes. Leukemia and Lymphoma are on a spectrum. That’s why my diagnosis has both in it and why my mass originated in my mediastinum (one of the lymph nodes).
• There are no stages to T-ALL like there are to solid cancers (think breast cancer, lung cancer, etc.). T-ALL means it’s a cancer of my T-Cells (as opposed to B-Cells) in the immune system. It originates in the bone marrow. This is somewhat confusing, but my bone marrow is clean. No cancer is there. I still don’t fully understand how that works, but so far I’m fortunate in that I don’t need a bone marrow transplant. Others aren’t so lucky.
• Because of my “healthy immune system” I was put on an extremely aggressive protocol called Hyper-CVAD. Or, as I like to refer to it affectionately as, white-knuckle chemo. It’s typically reserved for pediatric care and young adults who have healthy enough immune systems that can handle the aggressiveness of the protocol. It’s not for the faint of heart. For 8 cycles, every month, you get 4–5 days of a couple of different types of a chemo cocktail that alternate each cycle — the purpose is to knock out this cancer while not having it mutate and evolve to handle a specific chemo cocktail. Cancer is tricky and highly evasive to the immune system. Each cycle is followed by 2 spinal taps to check for any cancer in the CNS and chemo is injected into the spine JIC. It’s an aggressive treatment to knock out an aggressive cancer, to put the patient in full remission and “cure” them. Or at least that’s the plan.

Just When You Think You’ve Got Things Under Control

In the middle of my treatment, the world was hit with a Global Pandemic — Covid-19. Just when I was getting into a cadence of dealing with my cycles, doctors visits and treatments, while getting back to work, a global pandemic rocked the world and NYC quickly became the epicenter of the US outbreak.

A pandemic like Covid-19 is particularly problematic for someone going through chemo, because every month after a cycle, around day 11, I have what’s called a Nadir period where the immune system is knocked out. It’s a delayed response to the chemo. Chemotherapy attacks fast replicating cells (like cancer) but is non-discriminatory, so takes out other fast replicating cells like hair, skin, stomach lining and white blood cells, red blood cells and platelets.

From days 11–16 the after-affects start to kick in. My white blood counts drop to near zero (which means I have no immune system to fight off any kind of infection), my hemoglobin levels drop to levels that make me anemic (meaning I’m carrying very little oxygen throughout my body and a major fall risk) and my platelets drop to near zero (which means any cut, bruise or internal bleeding and I’m fucked).

The lesson here — bad news tends to come in waves. Just when you think you’ve got a handle on things, you’ve got to deal with something else. But that’s life. You adapt, you endure, and you keep moving forward.

That was certainly the lesson for me. I’ve kept on with my treatment during Covid-19. Many others haven’t been so lucky. They had a long pause, which is not what you want if you’re trying to battle an aggressive cancer.

I was fortunate. As long as my medical team was comfortable, I was comfortable. I kept strapping myself into that chair during Covid. I just knew I had to be extra vigilant on days 11–16. No fucking around.

The Beauty of Cancer

I hold an uncommon opinion that one should optimize for suffering in life and not comfortability. All the greatest things in my life have come from putting myself in situations where I had to suffer and endure. It’s that second-order consequence where all the gain is.

As I reflect on the last several months of my journey with cancer, I’ve been given tremendous gifts that will last a lifetime. You don’t go through something this significant without scars. But those mental scars remind you of the battles and the gifts. For me, that’s how those gifts stick.

Here are 10 gifts I’ve been given during my battle with cancer that are permanently scarred in my mind:

• Facing my biggest fear in life: I had to confront fears that I had never shared with anyone. Not Gina, not my best friend. No one. My biggest fear, for most of my adult life, was losing control of my health. Throughout my adult life, I obsessed about my health, under the ruse of being a “hobbyist bio-hacker.” You name it, I’ve tried it. Maybe at some point I’ll come back here and list out all the things I’ve experimented with and tracked over the years. I promise, it’s ridiculous. But I did so, unconsciously, largely driven by an existential fear. If you read the science, modernity has done wonders to lift people out of poverty. And death by violence is largely improbable, especially in the modern western world. That hasn’t always been the case. What’s going to kill you is most likely already inside of you. Most of us will die due to one of the big 4: Heart disease, Cancer, Stroke/Alzheimer’s, and chronic respiratory disease. Knowing this, I’ve spent the better part of my adult life taking really good care of my health. This would allow me to spend a lifetime in good health chasing my dreams and living the life I value. My #1 value in life is freedom, and I don’t want anything to hinder that. I want to have the optimal health and energy to pursue my dreams and the freedom that comes with it. Ah, the irony is sweet, isn’t it? It appears life isn’t without a sense of humor. Confronting cancer has forced me to walk into the cave I fear most — losing control of my health. It took me a solid month to wrap my head around my new reality. I was forced to face the biggest fear, the driving fear that I have had my entire adult life.

The physical pain of a bone marrow biopsy is one thing. The mental grit to endure it is another.

I had to walk into dark caves that my mind didn’t want to walk into. That’s a metaphor of course, but it also became a visualization practice. I would literally visualize myself walking into a dark cave, alone, and talk to myself. “No one’s coming to save you, motherfucker. No one’s coming to help you. What the fuck are you going to do now?”. I had to become my own therapist. No one knows me like me. Not my partner, not my best friend, not my parents. I’m the only one who’s been here for it all. That’s not to say I haven’t had help. I have. There are a ton of amazing people who are fucking heroes, who saved my life. My partner, Gina, who stayed by my side. But none of them could help me through this, fully. My medical team, my oncologist, Gina, close friends, family — none of them have to sit in that chair and go through chemo. I did, by myself. None of them had to go through the several bone marrow biopsies. I did, by myself. None of them have to have their spine tapped and chemo injected into it. I did, by myself. And to prepare for that mentally, I needed to confront my fears. By myself. It was the most liberating and freeing thing I’ve ever experienced. That’s not to say the fears don’t come back. They do. But each time they do, I go back into that cave by myself. You can’t kill a man who’s been forced to confront his deepest, darkest fears. That man becomes indestructible.

• Learning to feel the full range of emotions: Anger, sadness, numbness, guilt, these are all things I’ve felt and allowed myself to feel. During the course of my treatment I have also felt deep gratitude, connection, love, joy, happiness, grace, humor and elation. I made a deal with myself in the very beginning not to fight any emotion. To feel it fully. And I’m really glad I did. I got to feel the full range of emotions. The entire rainbow available to us as humans.
• There are far fewer things in this world that we’re actually in control of: I knew this, intellectually, before my diagnosis. But during my treatment, that learning became very real and I understand just how small the circle of things I can control really is.

The journal entry acknowledging how little I have control

During my treatment, my body failed me many times, my schedule was not in my control, my finances were at risk, I had no idea if I would be able to keep working and/or lose my career and healthcare in the process, in addition to realizing that my life spent taking care of my health meant nothing when confronted with the random genetic mutation that delivered my cancer to me. C’est la vie: That’s life. You think if you take care of yourself or work really hard, or whatever the fuck you think, that you can control your circumstances. You can influence them, yes. But you have much less control than you possibly know.

• Letting go of guilt: When I was diagnosed, I felt sorry for myself. As if I did something wrong. But even worse, I felt guilty that I had just resigned my partner to a life of misery while dealing with my disease. This was not what I wanted for her, or for us. Many times during the process I thought back to us first meeting, to all of our memories and to all of the plans I had for us.

My Partner, Lover and Love

And I felt guilty that I convinced her to be with a guy that now had cancer. I cried, multiple times, thinking of it. It was obviously nonsense. Not only did that thought never cross her mind, but my cancer has brought us closer together.

• Grit and perseverance: I thought I already knew these two traits, but this has caused me to learn them even deeper and they have become my superpowers. Most of life is fairly uneventful, then all of a sudden — bam! A non-linear event takes place. Grit is your ability to push through and deal. And perseverance is staying the course, setback after setback after setback. Perseverance is sometimes lumped in with persistence. But they’re different. Perseverance is keeping in your mind on what the end state is, and working through all the setbacks until you get there. There were multiple times when my treatment was really rough. There was one instance where I traveled, like an idiot, on a plane to Denver, CO. This was in February right before Covid hit the US hard (I don’t regret the trip).

And I was in the middle of my treatment. That trip put me in urgent care for a week with the flu and a triple-bacterial infection. I eventually had to have my Hickman catheter removed due to the bacterial infection and a new PICC line catheter installed in my arm. Worse, this caused my treatment to be delayed 20 days. Grit and perseverance kept me going. I stayed focused on rebuilding my health and getting my ass back in the chair for my next cycle.

• Adapt to circumstances in order to make progress: I actually got this in a fortune cookie one night, and it was extremely serendipitous. I was angry in the beginning of my treatment. I was lashing out at doctors, nurses, Gina — anyone who “screwed up” or “made a mistake.” I was in the hospital for a few weeks during my first cycle, I had a PleurX catheter inserted into my lung to drain it of fluid and, as a result, the original plan was to keep me in the hospital for the duration of the first cycle until cycle 2 concluded, which would mean that I’d be in the hospital for 2 months. I started my treatment at Mt. Sinai, which is a teaching hospital, which simply means that it’s affiliated with a medical school and that they rotate doctors, some of whom are medical students. In the middle of all of this, my rotating oncologist told me that I’d be going home — which was in direct conflict to my original oncologist. I was mentally breaking down, angry and I felt trapped in a system where I had lost all of my freedom (my #1 value). Both doctors eventually got on the same page, and we convinced them I needed a break between cycles and they sent me home.

Wisdom from a Chinese fortune cookie

One night I was angry and bitching and yelling so hard that saliva was flying out of my mouth and finally Gina said to me “You can lash out with venom at everyone if you want. But that’s doing you no good.” And she was absolutely right. My anger had gotten out of control. And, in fact, it was probably doing me more harm than good. Literally a couple nights after that, we ordered dinner from a halal Chinese food restaurant in our neighborhood and I got this in my fortune cookie. It’s been a constant reminder and a lesson I’ve finally learned in my life. You can fight circumstances and push against them, or you can simply adapt to them in order to make progress.

• I learned to rely on others: Especially during my treatment, it’s been interesting to have the lens I have, with a global pandemic and society at each others’ throats over the killing of unarmed black people as a backdrop. It’s really easy see people as “others.” Humans are tribal by nature. But at some point, you may need to rely on others. I’ve been self-reliant since 17. I received two tremendous gifts from my parents very early on in life. From my Mom I learned to be self-reliant. And from my Dad I was given the gift of insane confidence in my abilities. If I was willing to put in the work, I believed I could accomplish anything. And I still do. But with every gift, there’s the other side of it. I’ve relied on myself for most of my life. If I was going to accomplish something, it was going to be because I did. Neither of my parents went to college. We spent the bulk of my youth in a lower-middle income household and if I wanted something, I had to go and get it. You’d be hard pressed to objectively look at the things I’ve accomplished and not say “that guy really turned nothing into something.” It’s probably the greatest gift of my childhood. And I did so by learning to rely on myself. But cancer changed all of that. It figuratively and literally brought me to my knees, and for the first time in a very long time, I had to rely on others. I had strangers and loose acquaintances help me — that’s how I ended up w/ Dr Tallman at Memorial Sloan Kettering as the head of my medical team.

This is like having the Michael Jordan of cancer treatment as the head of my medical team at the country’s #1 cancer center. I had nothing to give them in return and no strong emotional ties, yet so many people helped in so many unexpected ways. I had two business partners who not only covered for me for almost a month while hospitalized, but came to visit me in the hospital and support me in amazing ways as I wrapped my head around what I was going through. I left them stranded in the middle of an onsite program during a portion that I was supposed to be leading. They were amazing. And my partner, Gina, dropped everything to project manage my healthcare, so that I could focus on my mental and physical wellness. Not to mention all the countless healthcare workers who take care of me when I’m hospitalized for each cycle. People need people. I’m no exception.

• Can’t kill me. Not Dead: This became my mantra. “Can’t kill me” means that I decide when I die, not cancer. And “not dead” means that if I have even an ounce of breath in my lungs I keep fighting. I used this mantra during the dark days. One week in particular was tough. I had multiple blood transfusions, 4 days in a row when I had to go to the ER, and during one of those ER visits on Jan 1 of 2020, I had bone pain in my sternum so bad that I thought I was having a heart attack and my vision blurred. ER thought I may be having a stroke so they triaged me for 3 hours before finally giving me morphine injections for the crippling pain I was experiencing. And through it all, I used this mantra to remind myself that I can endure, that cancer can’t kill me and if I’m not dead I can keep fighting.
• Literally everything can be rebuilt: With cancer, I lost a lot. I lost control of my body, I lost control of my work in the beginning, I lost control of my time. But the thing I lost more than anything was my fear. In battling cancer I had to rebuild everything. Which ended up being a gift. The first thing I had to rebuild was my mind. I got real honest with myself. I wasn’t living life to my fullest potential. I was scared, anxious, afraid of losing what I had built, afraid that others would figure out that I was a fraud. I wasn’t playing life at 100% and I couldn’t fake it. I had a lot of time to think, and I let myself go to some dark and honest places. I had to admit a lot of things about myself that I didn’t like. And slowly I built myself back up. I rebuilt my mind. I rebuilt my emotions. And I rebuilt my body. Brick by fucking brick I’ve rebuilt myself. And through that process, I learned first-hand that almost everything in life can be rebuilt if you have the courage to do the work.
• A sense of humor will get you through the dark days: I didn’t laugh much in the beginning of my treatment. But eventually I learned to laugh a lot.

I shared this w/ my Radiologist to lighten the mood, right before one of my Lumbar punctures. We both had a good laugh.

Even dark humor has become a regular go-to, which I find funny. We laughed at many a joke about my cancer…While laying in my hospital bed, I told my nurses that I was working on my summer bod, I’d joke with close friends that know when they started complaining about something small “Welp, at least you don’t have cancer.” My cancer became something that I stopped letting control me and something that I started learning to make fun of. And humor became a powerful ally in my journey.

If You’re Reading this and Recently Diagnosed With Cancer, Here’s My Advice

(feel free to skip if you haven’t been diagnosed with cancer)

Cancer is a motherfucker. Chemo is even more of a motherfucker. And only other patients who have been diagnosed truly understand what it means and what you’re about to go through. I found solace in speaking to other cancer patients. We love our family, friends and partners, but only another person who has had to strap into that chair and go through that experience can truly relate. Here’s some advice I have to give (unsolicited of course), if you’ve just been hit with what can feel like a ton of bricks:

• This is the time to prioritize your health: Eat to Beat Disease is a book I highly recommend. Dr William Li was an oncologist and has done some of the leading research on cancer and diet to date. He wrote this book to help people use nutrition to rebuild their 5 major regenerative systems using, in sequence: clinical trials, epidemiological studies and new laboratory discoveries that show tremendous promise. Start with this video:

• You need two types of people in your battle: The first is what I call the emotional supporters. They’ll love on you, emotionally support you and help you deal with the shock of what you’re going through. They’re the ones that will help you process those initial emotions. But then you need to pivot and the project managers in your life become essential. Dealing with cancer, while also having to deal with the medical system, insurance, new medications, protocols, while also trying to manage your mental state is A LOT. These people will help you. They’re the GSD people. They’ll help you track blood results, follow-up on scheduling appointments, manage medications, help you research. They may not be as good at the “emotional support” stuff, but they’ll help you get into action mode. And you need to be on top of your medical team, your medications and your own research. Which is my next point…
• Get Busy In Your Own Rescue: I studied cancer. And it helped me understand the disease but also talk to my medical team. This free course from John Hopkins on Coursera is a great starting point. Humans are tribal. And tribes have a vocabulary they use. By learning the vocabulary of oncology I‘m able to talk to my medical team in ways they’re familiar with. I am a dilettante when it comes to oncology. But I learned the vocabulary and phished around PubMed looking to understand what clinical trials my medical team was basing their recommendations on, what new clinical trials I might be a candidate for, and asking about cutting-edge technologies like CAR-T immunotherapies that I might be a candidate for. I learned about the latest in liquid biopsies. I learned about my disease. And when discussing these things with my medical team, it keeps them on their toes. They know I’ll ask a lot of questions, do a lot of research and they need to bring their A-game when speaking to me. I recommend you do the same. A lot of my questions were probably dumb and I didn’t qualify for any of the clinical trials, or immunotherapies I asked about. But I got a very different type of care than other patients. Several of my hospital mates shared that with me.
• Get yourself some Aquaphor: Chemo is going to do some damage to your skin, hair and nails. Don’t worry. Everything grows back. Aquaphor will help with the skin, and bone broth can be helpful with the skin, hair and nails as well.
• WebMD is not your friend in the beginning: Don’t research your chemo regimen in the beginning. It will only create anxiety and fear. You need to kill the cancer cells, and depending on your protocol, the standard of care has a more than a 20-year history. They’ve worked a lot of the adverse affects out with multiple medications. Ask questions, but trust the protocol. Do research on your chemo later.
• If you’re getting Neupogen (aka Filgrastim) shots as part of your protocol ask your medical team about taking Claritin, JIC: A small percentage of people (18%) have adverse effects from Neupogen which include severe bone pain. Claritin is one of the medications that can keep that bone pain from taking place and is a low-toxicity solution to what could be an otherwise unpleasant event. I wish someone had told me about this before an ER nightmare.
• Headaches are a sign that you might need a blood transfusion: Trust me, this is better than the alternative, which is passing out and hitting your head. Head to ER or urgent care right away, especially if you haven’t had a blood draw in a while. Better safe than sorry. Don’t assume this is just a side affect of medications.
• Get comfortable learning to negotiate with insurance and your medical facilities: You’re going to get a lot of paperwork and it will feel overwhelming at times. This is also a place where your project manager person can help you. But learn to speak to your insurance company and the people in the billing department at your hospital. No one will tell you this, but everything is negotiable. And when I say everything, I mean everything. At some point I’ll try and come back and update this with my negotiating notes. You can also have a social worker assist you if you’re not comfortable. But I think getting comfortable is a better route to go. Just an opinion.

I Wish Cancer On You

I obviously don’t really wish cancer on you. I don’t wish this disease or the need for cancer treatment on anyone. In fact, I’ve decided that I will spend the rest of my life working to fight this disease until it’s eradicated from society. It’s tough. And it’s tough on the people around you. And not everyone wins their fight. And that might include me one day.

We decided to ride in Cycle for Survival to raise money in the middle of my treatment. It was definitely a game time decision.

During my treatment, I’ve learned to use humor as a way of dealing. Occasionally Gina and I would be walking, and she’d share with me a friend complaining about something or dealing with an issue. All struggle is relative, but as we walked at first the joke was “Well, at least it’s not cancer.” And we’d both cringe but have a good laugh. But after a while, the joke, for me, turned into “I wish cancer on them.” Gina’s jaw would drop and there would be no laughing. She’s seen first-hand what this journey looks like, and it’s not something you’d wish on anyone.

Here’s what I mean. First, the things you stress about and treat as problems aren’t problems. They’re annoyances. They’re inconvenient. But they’re not problems. You know how I know that? Because getting cancer is a fucking problem. At one point I was just like you. I stressed about bullshit in my life that doesn’t matter, and I turned mole hills into mountains. Because again, everything is relative. Now I know better. I know what a problem actually is.

The second thing is, I wasn’t sure if I was going to overcome this when first diagnosed. I thought for sure this was a death sentence and it terrified me. But to go through the endurance and perseverance of it, you come out the other side fearless. You can’t kill a man or woman who has to confront their own mortality and deal with that. And doing so makes you think: “What else am I capable of? Have I really been playing life full-out? What will I do with my life if I’m given it back? Maybe I’ve been holding myself back this whole time?”

I’m not here to preach to you or anyone else. And just to be clear, I’m not done with cancer. It can come back. As of this writing, I haven’t received my final diagnosis and I’m gearing up for my 8th cycle.

But here’s what I know. At the beginning of this journey, I had no clue I was capable of enduring and going through such an aggressive treatment to kill an aggressive cancer. Having to confront something that seems impossible to you and getting to the other side of it, raises the bar.

So I wish for you, having to confront the thing you fear more than anything. So that you are forced to confront it and see what you’re truly capable of. And in doing so, I hope it challenges you, so you know what problems really are and you let go of the worries, fears and anxieties you bring on yourself from petty bullshit. I wish cancer on you.

Final Reflections

In my 20s, I lived my life hard. I was a budding entrepreneur and was a little reckless in my personal life. I remember flippantly saying out loud, “If I make it to 40, it’ll only be by the grace of god” as I was laughing with a friend in some nightclub. I may have been on ecstasy. Another story for another time.

I remember that moment right now, because as of the writing of this post, I’m heading into my 8th (and final) cycle and I turn 40 in 3 months. I’m not laughing about that anymore.

During my 30s, I discovered the philosophy of Stoicism. And I’ve found it to be a useful operating system for me for the past 8 years, give or take. Some duties in life we choose. Some are chosen for us.

The poet in me resonates with Dylan Thomas’ “Do not go gentle into that good night” poem. But the Stoic in me is ready to face whatever Fate has in store for me, including my own mortality.

The optimist in me is hopeful that my 3rd and final PET scan shows that I’ve defeated this and that my medical team uses the word “cure” in my final diagnosis. But the Stoic in me is ready for whatever Fate has in store for me, including the return of my cancer and having to hop my ass back in that chair.

The hopeful in me wants to see his 40th birthday and many years beyond and realizes that a young and dumb 23 year-old me would, too. But the Stoic in me is ready to let Fate decide my outcome.

Even if my fate is the best case scenario, the maintenance period for my cancer is another 2–3 years. And from what I understand from survivors, until you get to year 5, you don’t really breathe a sigh of relief… if ever. If even one cancer cell has survived this round of chemo, or even a cancer stem cell, this could come back to haunt me. And every doctor’s appointment from here on out is a roll of the dice.

So is my fate. This is merely the end of the beginning. But finally I have a worthy adversary.

“Let Fate find us prepared and active. Here is the great soul — the one who surrenders to Fate. The opposite is the weak and degenerate one, who struggles with and has a poor regard for the order of the world, and seeks to correct the faults of the gods rather than their own.”

Seneca, Moral Letters, 107.12

Gradatim Ferociter,

Gabriel — June 20, 2020