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Day 1 – Embarkation

Arriving in Reykjavik a day ahead to recuperate was a very good idea. Going from the airport directly to the ship would have left us more exhausted than we already were.

The Skarfabakki Harbor Cruise Terminal is about three miles from the hotel, and a much cheaper cab ride. We were fortunate that our ship, the Viking Mars, docks at Skarfabakki 315. Other ships dock down the street at Skarfabakki 312, a long hike from our drop-off point The old terminal was demolished to make way for a new terminal scheduled to open in 2026..

The ship’s crew took our luggage after the cab dropped us off; Viking has set up a temporary facility that made boarding (“embarkation” if you want to be formal) efficient and easy. We entered this building, showed our passports and boarding passes, and walked outside to the boarding ramp. High tide made for a steep climb, but one of the crew took Peg’s Rollator ahead while she grabbed the railing.

Once inside the ship, the staff scanned our boarding passes, which put us into their system, gave us our room keycards, and offered us a hot, wet washcloth and glass of champagne. Then, they directed us down the hallway to The Restaurant where another crew member went through the mandatory safety evacuation protocol: how to put on the life vest and where to go if needed.

(At this point, I recommend getting a lanyard for your keycard. Otherwise, you’ll be fishing in your wallet or purse for the damned thing and risk losing it, as I did.)

We had to wait until 1p.m. before we could get into our rooms, so we went up to the World Café, a self-service buffet, on Deck 7 for a bite to eat.

After lunch we made our way to our stateroom, a long walk almost to the end of the narrow hallway. Our cabin steward, a friendly Indonesian man, greeted us by name. “Dr. Rivera and Mrs. Sullivan.” (All future greetings were an enthusiastic “Dr. David and Mrs. Mary!”) Our suitcases sat outside our stateroom door. He pushed them into the room and then hefted one of them onto the large vinyl pad covering the foot of the bed to protect the bedding while unpacking before orienting us to our room.

My fat ass in the doorway of our stateroom

The large sliding glass door at the end of the room opens onto a veranda with two chairs and a small table. An armchair sits just inside. There’s a couch to the right of the chair; a large wooden tray with Viking brochures and a copy of The Viking Daily – with a synopsis of the port stop, a morning-to-evening list of the day’s onboard activities, departure times for shore excursions, the dining hours, and a ship services directory with phone numbers – sits on a coffee table in front of the couch.

The long desk has drawers for storage at the near end and a mini fridge at the far end stocked with Sprite, regular Coke and Coke Zero; Carlsberg beer; tonic water; travel bottles of Bacardi Rum, Beefeater Gin, Smirnoff Vodka, and The Famous Grouse Scotch; two small milk chocolate bars, and two bags of nuts, all replenished once a day. (Our steward switched out the regular coke for Coke Zero after Peg left him a note saying we didn’t drink sugared pop.) We had a complementary bottle of champagne and two flutes waiting for the right time to celebrate.

The middle of the desk opens up to a lighted mirror, a pair of binoculars and abundant storage for cosmetics and toiletries. The devices next to the hair dryer are QuietVox audio receivers used for self-guided tours or for one’s tour director to herd the cattle back to the bus.

The king-sized bed has four pillows (Peg asked and received an extra), a comforter, sans top sheet, and a “Traditional Norwegian Marius-weave blanket.” Each side has a night stand with 110/220V outlets, two USB charging ports and a wall lamps. The switch just above the electrical bar turns on the nightlight for bathroom trips. The two little silver circles are reading lamps.

A credenza with even more drawers and two shelves sits across from the bed. The ship supplies a large carafe of water and two lovely blue drinking glasses, along with a card that said, “if you like these items, they are available for purchase.” Subtext, “if you steal these glasses, we’re gonna add $200 to your tab!”

A 42” television is mounted on the wall above. There are several programming options: movies, TV series, news channels (Fox, CNN, BBC), a variety of music choices whose categorization left much to be desired, broadcasts of previous lectures (which is how I found out Bluetooth was named after Harald Bluetooth, a 10^th century Danish and Norwegian king), and the perpetual view from the bridge camera, overlaid with classical music. My Cousin Vinny was one of the movie selections; however, we didn’t think showing Lifeboat and Titanic on a cruise ship was a wise choice.

The bathroom was superb! It has a heated floor which is so efficient I had to turn it off because the temperature became stifling. There are drawers on each side of the sink and toiletry racks for Viking’s “Premium Freyja® toiletries” on either side of the anti-fog mirror. We found large, fluffy towels and washcloths under the counter.

The wall-mounted toilet is very efficient and very loud when flushed. I’d like these in my retirement house because cleaning the bottom of a floor-mounted toilet is a colossal pain.

The shower is more than adequate despite appearing rather narrow in this picture. The knob on the left turns the water on; the one on the right controls the temperature. I discovered a button on the back that overrides the water temperature limiter if one wants hotter water. The water flow decreases if one opens the shower door while the water is running. I should note that showering while the ship is sailing requires some caution. Peg only showered when the ship was in port to avoid being hurled out the shower door in rough seas.

There’s abundant closet space opposite the bathroom with a lot of wooden hangers on one side and more than sufficient drawer space on the other, hidden by sliding doors with magnetic catches. There are two decent sized robes on hangers, and a wooden box on the floor holds two pairs of complementary slippers (I could only get half of my foot into one) and a bright red Viking umbrella for rainy shore excursions.

A shelving unit next to the closet houses a Nespresso coffeemaker, a safe behind a cabinet door, and more drawers, one of which housed a horse hair lint brush, a shoe shine brush and instructions for complementary clothes pressing, returned the next day.

After unpacking, putting drawer things in drawers and hanging things on hangers, it was time for another nap. We woke up around 5:30pm and arrived at The Chef’s Table just before it opened for dinner.

There was a line of people waiting at the restaurant desk to make reservations for the ship’s two specialty restaurants: The Chef’s Table and Manfredi’s Italian Restaurant., (Our booking class had allowed us to make reservations 70 days before the cruise departed, so we were all set.) Our host took us to a table in a bright corner near the back, next to the windows.

Our four-course menu started with the “Amuse Bouche,” a fancy name for appetizer that conjures an image of Beavis saying, “funny bunghole.” The Goan Potato Chop was a light vegetable and cheese stuffed croquette, served with Soave Classico, an Italian white wine. The first course was Chili Soft-Shell Crab in a light tomato-chili sauce, paired with a nice glass of Pinot Grigio another Italian white. (You can probably guess where this is headed.)

I’m not into food porn; I started taking pictures when our palate cleanser, a lychee, guava and cranberry juice granite named Red Lotus arrived.

Our main course was Thai Spiced Rack of Lamb with eggplant, sweet chili and my sister-in-law’s nemesis, the dreaded baby corn, served with a ruby-red Rioja Tempranillo.

Dessert was a delightful Yuzu Cheesecake, whose namesake fruit provides a lemon flavor, along with fine ruby port.

An amateur restaurant critic seated with a foursome just behind us weighed in on the main course. I thought he might be a Texan, but he mentioned being from Oklahoma in passing. “Well, the lamb was very good but I’m kind of a meat and potatoes and beer guy.” Icelandic animal protein sources are largely lamb and fish, although beef would be available on the cruise.

He and his wife were celebrating their 40^th anniversary; the waitstaff presented them with a chocolate ganache-covered mousse, the size of a small curling stone, along with a glass of champagne. The couple at the table next to us were celebrating their 50^thanniversary and must have married young, because they didn’t appear to be terribly old; their mousse and champagne arrived shortly after.

Not to be left out, our waiter brought us a berry mousse covered with a strawberry ganache. And a glass of champagne. By this time my photographic skills were sorely lacking.

Fully sated and slightly toasted from the wine we had with dinner, we headed back to our room for bed. Our waiter graciously offered to send the leftover mousse to our room for us to enjoy over the next couple of days.

There’s no chocolate on the bed with the turndown service, but neither did we find the whimsical towel creations on the bed which are popular with other cruise lines that seem intent on forcing your happiness. I hung the room service request for breakfast outside door and sank into our nice soft bed. The Southern Coast of Iceland bus tour started 7:30am, an ungodly hour to be doing anything.

The best thing about dinner? Peg didn’t need time to “wind down” while fighting sleep. A few minutes under the covers and she was out.

Next: Touring the Southern Coast of Iceland by bus. Geothermal power plants, black sand beaches, waterfalls everywhere and a stop at the Lava Centre.

Our Icelandic Saga – Arrival

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When you have the time, you won’t have the money.
When you have the money, you won’t have the time.
When you have the time and the money, you won’t have the energy.

I’ve been wanting to go to Iceland since my 50^th and 60^th birthdays. We decided to combine my 70^th with our 25^th wedding anniversary and take a cruise around the island. Better late than never

We left from O’Hare’s international terminal, whose recent $1.3 billion expansion just made for a longer walk. We got a quick bite at Rick Bayless’ (famous Chicago chef) Tortas Frontera before heading for a two-hour wait at the gate.

Our flight left Chicago at 10:15pm on Icelandair, albeit on a dreaded Boeing 737 Max. (We survived!) If you’re old and going to do a long flight, I highly recommend shucking out the extra money for business class; it is a very long, six-hour flight. The seats are comfortable and accommodated my fat ass nicely. Each seat had a pillow, a comfy blanket and a cute little welcome bag made of reinforced biodegradable paper with socks, a sleep mask, toothbrush, hand cream and other stuff.

The flight attendants were a hoot; a skinny Indonesian looking guy, wearing an ascot and apparently enamored with his style, and an equally skinny young Nordic man. They treat passengers like royalty. They offered us bottled water, caramel corn, and free headphones (main cabin passengers had to rent them) and menus.

The food was great; delicate portions served on real china plates with real silverware. I tried 64° Reykjavik Distillery’s Angelica Gin, which tasted more like paint thinner and less like the typical juniper-based gin. However, on the way back I discovered their Rhubarb Gin. Very tasty!

The LED screens in the seatbacks provided a map of the jet’s progress along with information on altitude (36,000ft.), cruising speed (600 mph), outside temperature (around -56°F) and departure/destination times. Entertainment options included movies, TV, and Icelandic classical music selections. Peg watched the Barbie movie. I tried sampling the Icelandic music in between glancing at her screen and the one the next row up who was watching The Hitman’s Bodyguard.

About two hours after takeoff, the horizon started to lighten somewhere over Eastern Quebec. The sun was up by the time we reached the middle of the Labrador Sea. We passed over Greenland, but the clouds made it impossible to see the terrain. Finally, we landed in Keflavik at 9:30am local time, a beautiful sunny day. That was the last time we’d see the sun for the rest of the trip.

Getting off the plane provided our first shock. Tourist traffic has completely overwhelmed Keflavik International Airport and the crowds are worse than O’Hare. We had to walk down aluminum stairs rolled up to the aircraft; only departing flights get a jet bridge. The Rollator we gate-checked at O’Hare and assumed would be at the plane was nowhere to be found; we figured it went to baggage claim. We hobbled over to the buses that took us to the South Terminal, where we funneled in through a single set of doors like cattle being led to the slaughter.

Once inside, we took escalators to the second floor and made the long walk to Customs, entering the maze until the crowd stopped. We saw several Automated Passport Control kiosks wrapped in plastic that might have made the process faster but they hadn’t been installed .We stood in line for about 20 minutes. We finally made it through and took a short break; Peg’s foot was killing her by this time.

There are no people movers in the very long corridor connecting the South Terminal to the Main Terminal. I ran ahead of Peg to find the Rollator, but there was no way to retrieve it and then re-enter the secure area, so I came back, and we just kept walking.

Baggage claim is one floor down; Peg and I took the elevator. The first thing we saw before we got there were the requisite shops, including two familiar American shops:

I picked up our suitcases, but I couldn’t find the oversized luggage carousel, so I asked the young woman at customer service. I followed her (it was in plain sight) and apologized for being so clueless. She said, “That’s all right. You just wanted to meet me.” In the meantime, Peg got cash from a nearby ATM; banknotes come in 500, 1000, 2000, 5000, and 10000 krónur and like most foreign currency, they are very colorful. If that seems like a lot of money, keep in mind 1000 ISK is around $7.25, more or less.

Customs authorities must be very trusting because there were no officials at the “nothing to declare” aisle, so we walked through and found ourselves in the main terminal near the exits, across from the currency exchange Peg had expected near baggage claim. I looked for a bathroom but the nearest facilities were down one floor in a rather secluded area.

We stepped outside to the taxi stands. We could get to downtown Reykjavik for about $68 each via Flybus Airport Transfer, but a friend of Peg’s who has been to Iceland told her it would let us off at a designated bus stop a few blocks from the hotel. We weren’t going to schlep two suitcases, a Rollator, and a carry-on bag so we opted for a cab.

The nice young man staffing the taxi stand told us there were fewer cabs than usual, which at that time meant none, except for an empty van with no visible driver. They arrived one at a time, several minutes apart. We stood in line with a few other passengers and enjoyed our first view of Iceland on the ground.

Predictably, there was one American asshole who pushed to the head of the line, thinking he should take priority. He wanted to go to the Parliament Hotel in Reykjavik and tried to bum a ride with a couple that was going into Keflavik. The next available cab was a full-sized SUV. Peg asked the driver, “Is the Hotel Konsulat near the Parliament?” The asshole quickly interjected, “No!” Seriously? Later Google maps indicated the two hotels are about 4 blocks apart. It’s probably better that we didn’t ride with him.

Downtown Reykjavik is about 31 miles from the airport. The landscape between Keflavik and Reykjavik looks like Eastern Montana; very rough terrain covered with moss, the first thing to grow on volcanic rock. The highways are two-lane and not as wide as our Interstate or major US highways. They were well maintained, without the abundant and often perpetual potholes in the Midwest.

We approached the outskirts of Reykjavik and, while most of the businesses have Icelandic names, signs on the buildings have a mixture of English and Icelandic. And Iceland isn’t immune from American influences; we saw Subway, Domino’s Pizza and KFC. There are no Starbucks in Iceland because, as this What’s On article notes:

“The absence of Starbucks in Iceland is not a sign of a lack of coffee culture; rather, it represents a conscious choice to prioritize local businesses and foster a thriving scene for specialty coffee. Icelanders value the craftsmanship and dedication of their local roasters and baristas, who treat coffee with the same reverence that they extend to their beloved natural landscapes.”

Gasoline in Iceland is expensive, about $9.60 a gallon when we were there. Most of the cars we saw were small, including an electric Nissan Leaf, but there were a few Beemers and Mercedes. The Orkan petrol chain, with its bright pink color scheme, advertises “Cheap Gas.” N1 and Olís stations tend to be more expensive

Our driver took us through narrow streets in the downtown area before stopping in front of the Reykjavik Konsulat Hotel, which one would miss it if walking by casually. There is no big lighted sign and no parking lot, and the door isn’t automatic. That is because it was formerly a department store in the early 1900s, owned by Konsul Ditlev Thomson.

The hotel is very charming. The reception area and the wine room off to the left are done in dark wood. The elevators are very narrow; one of them could only hold two people. The top part of the car is papered with old photos of a store or apothecary shop; the bottom was wood, looking like rows of small drawer fronts. You can see more photos of the hotel at their Facebook page.

Our room was on the 4^th floor, small by American standards, but typical of European hotel rooms and quite cozy. The first thing we noticed was the king-sized bed had two individual comforters and no top sheet! The bathroom walls had large tiles from floor to ceiling; the wall behind the sink was done in mosaic tile. The shower had two heads, and the body wash, shampoo and conditioner were in refillable bottles.

There was a very small balcony through a narrow door just to the right of our bed. I took these pictures of the Radisson Blu 1919.

Eimskip is an Icelandic shipping company.
(According to Google Translate eimskip is “steamship”, and eimski is “stupid.” What a difference a letter makes.)

We were exhausted. Bu this time it was noon local time and we’d been up for 24 hours, so we got comfortable and jumped into bed for what turned into a five-hour nap. Neither one of us had the energy to find a restaurant after we got up, so we went downstairs to the bar to the right of the reception desk. It was quiet and cozy, with floor to ceiling windows, comfortable chairs and an attentive bartender. Peg ordered Iceland’s domestic beer, Gull, and I had a glass of white wine. Prohibition in Iceland began in 1915 and, while wine and spirits were legalized in 1922 and 1935, respectively, beer only became legal in 1989.

Bæjarins Beztu Pylsur (The Town’s Best Sausages), sitting just outside the bar, is the iconic hot dog stand that’s been in downtown Reykjavik since 1937. Icelandic hotdogs, made with lamb, are longer than our domestic dogs, and can be customized with Remolaði sauce, Icelandic mustard, fried or raw onions, and a ketchup sweetened with apples instead of sugar. They are also relatively cheap, about ISK790, or a little less than six bucks. There are people lined up in all seasons, but they are served quickly. We noticed two things: everyone paid with a credit card and the soft drinks are small; no extra-large or Big Gulps. The straws are recyclable; Iceland banned single-use plastic in 2021. You can see the crowd over Peg’s shoulder.

There is no real night in Iceland during the weeks either side of the summer solstice, only a four-hour period of dusk. The downside is there’s only a four-hour period of daylight during the weeks around the winter solstice.

I opened the balcony door in the middle of the night; there isn’t any air conditioning, and the room was becoming stuffy. There’s a bar, Hornið (trans: the corner), on the street and the rowdies sitting outside were at it until at least 3am. Someone was singing, “I don’t wanna wait,” but my sleep-deprived brain kept hearing “Power 108” as in “KPWR 108.3 FM.” (Actually, KPWR is a real radio station in Los Angeles, “Power 106” – 105.9FM)

We slept in and missed the hotel’s breakfast buffet, so Peg had hot tea while we waited for the 11 am cab we had arranged. I considered going across the street to Joe & The Juice for a cappuccino, but I didn’t want to miss our ride. (I discovered Joe & The Juice isn’t exclusive to Iceland; there are stores across Europe and seven in Chicago!)

I regret we were about to leave Reykjavik without having visited Hið Íslenzka Reðasafn, The Icelandic Phallological Museum. Maybe next time.

Next: Embarkation (fancy talk for boarding the ship)

Saga Redux Part 2

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The CT simulation takes anywhere from twenty minutes to an hour. The patient lays on the table and the body area being treated is immobilized with either a mask (for head and neck) or a Vac-Lok^TM cushion filled with Styrofoam beads. When air is removed from the cushion, it creates a unique mold, so that the patient is in the same position for each treatment. The tech also marks the target area with tattoos, guided by laser beams across my abdomen.

They gave me these instructions to follow before my simulation appointment:

I’m not sure how many people are able to empty their bowels and bladder on command. Everyone’s physiology is unique, so generic instructions like this should be taken as suggestions, not dogma. I used a disposable enema in preparation for the simulation and drank water as ordered. CT appointments were running late, and I had to cross my legs by the time the tech called me.

“Is your bladder full?”
“It’s more than full. My teeth are floating.”
“Well, you’re going to have to hold it for at least 20 minutes. Do you think you can do that?”
“Oh, hell no!”
“Well, empty your bladder a little bit but not too much.”
That’s easy for you to say…

The CT simulator room was down a long hallway past steel double doors and far from the treatment rooms. The tech placed what looked like a heavy, vinyl sleeping bag on the bottom half of the simulator table before I lay down. A few minutes later I felt the Vac-Lok^TM bag harden around my legs. The tech left the room after all was set, and all I had to do was lie back and think of England for the next 20 minutes.

When the scan was finished, she made three cross marks with an ink pen – one in the middle of my lower abdomen and one near each hip – and covered them with waterproof tape. I’d get permanent tattoos at my first treatment. Before I got off the table, she took my picture with a small digital camera. My DMV mugshot looks like a Rembrandt portrait in comparison.

A radiation physicist and/or medical dosimetrist uses the information acquired by the scan to calculate radiation doses, precise target locations and the number of daily treatments required. This can take a few days or a couple of weeks. (I also think they use the time to ensure treatment is covered.) Treatment starts after the radiation oncologist approves the plan.

I got the call on January 24 to start treatment the following Monday.

The Radiation Oncology treatment center runs about 80 patients through two rooms every day. New patients are fitted into available slots for the first week or two; they get a regular appointment time as other patients complete their treatments and leave. My appointments were anywhere from 1:15pm to 4:15pm before getting a 12:30 slot at the end of week 2. This was a great time because there were more available parking spots near the entrance.

On Monday I arrived 15 minutes before my appointment only to find my first treatment session was cancelled because of some issue with the machine. Carla explained someone had called me, but I didn’t recognize the number and had ignored it. (Note to self: add important number to your contacts.) She assured me their technical people were working on it and I should be able to start the following day.

Peg had gone into work, so she called to ask for an update.

“So how did your first session go?”
“It didn’t. The machine was broken.”
“What happened?”
“Well, it got stuck and the guy who was in there got a massive radiation dose and he exploded all over the place. There are guts on the wall, and they had to bring in a hazmat team to clean it up.”
“WHAT? Oh my God! That poor man! I can see where they’d need hazmat with all that radiation…Wait, did that really happen?”
Me snickering on the other end.
“You’re an asshole.”

On Tuesday Radiation Oncology called me just as I was getting ready to leave.

“We’re still having problems with the machine, and they are waiting for a part.”
“What, STILL??? So, I’m going to have to wait another day?”
“No, we are trying to work people in. Can you come for a treatment at 4:15 today?”
“Yeah, that will work.”
Not as if I have a choice.

Peg was livid when I told her.

“It’s not a problem for you; you’re retired, and it’s only a 15-minute drive for you. What if it was someone who was working and had to arrange time off? Or someone who had to drive 30 or 40 miles to get to their treatment? If we have a problem with our computer system, someone is on it right away! If this is going to be a regular occurrence, we might have to think about going to one of their other facilities that is more reliable for your treatment!”

Carla took me back to the treatment area for the first time and showed me the locker room. After that, I was allowed to pass GO and head back on my own. There were separate locker and waiting rooms for men and women, not unexpected since most patients wore hospital gowns to expose their treatment areas.

The flat-panel TV on the wall drowned out the overhead speaker playing classic pop music from the 1960s to the 1980s, appropriate for our ages. There was a rotating collection of old guys in the waiting room during my first week; we recognized our arrivals with nods or grunts while watching Bonanza and Rifleman reruns. Several times one man sat in the corner reading a book. I assumed he was there supporting his wife since no one ever called him back for treatment.

Mostly we kept to ourselves, but one day an older man started talking to me about his disease. I wasn’t sure what to say so I just listened.

“I had prostate cancer and now it’s in my bones. They did this procedure (therapeutic plasma exchange) where they take your blood out and clean it and put it back in and that’s helped a lot with the pain.”

He seemed far less upset than I might have been, but maybe that’s part of getting older. You’re resigned to the things you can’t really change and just hope the eventual end isn’t terribly painful.

I couldn’t have any metal (rivets, buttons, zippers) near the treatment zone, so in the beginning I changed out of my jeans and put on a hospital gown. By the third week I’d learned to wear sweatpants and slip-on shoes after seeing another guy wearing them. One might figure they’d make that suggestion to patients, but one would be mistaken.) I’d toss my jacket, car keys and shoes into the locker and was ready to go.

I played around with the amount of water and the time when I started to drink. I learned not to eat a Reuben just before drinking because the fat slowed down water absorption. I tried drinking a lot more than usual to get my bladder to fill, but I paid the price when I peed like a racehorse for a couple of hours, long after my treatment ended.

I started wearing Depends because it was difficult to fill my bladder enough to keep the techs happy but not so full that I might leak. One time the tech, a young guy probably in his 20s, told me my bladder wasn’t full enough and I should drink more water before the next treatment. (That’s easy for you to say.) I’d gotten the sudden onset of explosive diarrhea right before my session and unless I clamped the hose with a chip clip, my bladder was going to be on the dry side.

My routine: Every day the techs call my name and escort me to a long desk on which sat several computer screens. Each time they ask for my name and date of birth, which I think is a bit silly. They know my name, my picture is on the computer screen, and I can’t imagine why anyone would sneak into radiation treatments for the hell of it.

There are three large signs above the entrance – HDR, BEAM and XRAY – which illuminate depending on which process is active. The department uses high dose radioisotopes (HDR) such as iodine-131 (I-131) for treating thyroid cancer. I’m getting Intensity-Modulated Radiation Therapy (IMRT) which uses higher doses of x-rays (BEAM). XRAY lights up when doing a CT scan, a much lower dose, before treatment.

I walk in past a 10” thick door filled with lead and into a lead lined treatment room. When I told Peg about the lead, she said, “See! The chances of a disaster are low but not zero!”

The star of the show is the Varian TrueBeam^TM Linear Accelerator. The kV x-ray generator and flat panel detector are at 3 and 9 o’clock. The Electronic Portal Imaging Device (EPID) is at 12 o’clock. The linear accelerator treatment head is at 6 o’clock.

I drop my pants and jump on the table, putting my legs in the Vac-Lok mold. They ask if I want a blanket, but I decline because it’s warm in the room. They are quick to cover my nether regions with a pillowcase, but I think it’s for their peace of mind more than mine. Old man penis, like its owner, is tired and not much to look at. Laying on my back is uncomfortable. I’m trying to keep my bladder from leaking, and my right shoulder hurts when I put my arms above my head. I just want to get it over with.

They raise the table and push it towards the machine. They still need to adjust my body by yanking on the sheet beneath me. “Pull a quarter. Pull a half. Pull one.” When the lasers are lined up with my tattoos, they leave the room. I hear the door creaking as it closes, and I wait.

The CT parts move into position. The machine then makes a single smooth rotation and forms a CT image of my pelvis which appears on the computer screens at the desk. Then the tech compares a digitally reconstructed radiograph (DRR) with the scan for fine alignment. The scanner parts are moved back to their resting positions, and I wait while things are lined up. Sometimes the tech remotely adjusts the table before the treatment begins.

There’s a dull thud a few minutes later which I assume is the accelerator powering up. A red light on the wall starts flashing. There’s another thud followed by what sounds like a swarm of cicadas as the machine starts to rotate. This time the machine’s movement is a little jerky. (Dr. Howard told me that happens as the collimators in the treatment head adjust, shaping the treatment beam.) It makes one full rotation, pauses for six seconds and then rotates in the opposite direction.

Occasionally the machine will stop and beep. They told me afterwards not to worry, because automatic sensors stop it if the sheet got too close, and no, it wasn’t continuing to fry my innards. They had to reboot the computer system during another treatment. You’re sure everything is OK out there?

The machine stops and I can hear the blast door opening. The techs lower the table as I pull up my pants. They remove the mold and help me sit up. I say, “See you tomorrow.” Then I make a beeline for the bathroom.

Every Tuesday they take my weight, and then Danielle escorts me to an exam room and asks me the following questions:

“How are you feeling?”
“Pretty good.”
“Any problem with diarrhea?”
“Not enough to need Imodium.”
“Any problem with urination?”
“Nope.”
“How’s your energy level?”
“It sucks.”
“OK, I’ll tell Dr. Howard you’re ready.”

Some side effects can be debilitating. A friend of ours, who is really skinny, suffered radiation burns to his lower abdomen that were so painful his wife had to drive him to his appointments lying flat in the car. The mother of someone with whom Peg works has to drive 40 minutes to her sessions and sometimes is so tired she can barely get out of bed.

Diarrhea has been the worst side effect. I initially thought it was because I no longer had a gall bladder, but it was much worse than that. The first bowel movement of the morning is normal; after that it’s watery like my colonoscopy prep. I can hear my intestines gurgling and I get sudden urges for the next few hours.

Fatigue has been the most frustrating. I have a long list of things I’ve wanted to do since I retired, but motivation is near impossible. I want to nap all the time, but I fight the urge, which does me little good. I’m still tired and nothing gets accomplished.

Dr. Howard comes into the room a few minutes later and goes over what the nurse has told him. I verify my answers for him, and he says, “You are doing remarkably well. I’ll see you next week.”

During one visit I asked him, “What’s the chance of recurrence?”
“Let me look at your pathology report.”
“Gleason 9 with EPE (extraprostatic extension.”
“Yes…I think we have an 80-85% chance of cure.”

This wasn’t surprising given my tumor was aggressive. If I’m lucky, any recurrence will be slow and late enough that something else will kill me first.

My visits with Dr. Howard are short because I am a physician and not a typical patient. We speak the same professional language and have an intuitive understanding of each other. (Peg says we share “the secret handshake” that grants me access to special courtesies like being released from the hospital three hours after my prostate surgery.) I’ve had very few side effects and there is little need to spend a lot of time with me.

Lest you think the physician visit is superfluous and merely a reason to charge for the visit, I can assure you it’s not. He or she is monitoring a patient’s progress and needs to be aware of anything that might require altering the treatment plan.

The average patient is likely to be overwhelmed with a cancer diagnosis and subsequent treatment. Nurses have a special role as the intermediary. Patients will often impart far more information to the nurse because “I don’t want to bother the doctor.” They pick up on a patient’s non-verbal cues such as reluctance, anxiety, frustration, or anger. And it’s not unusual for a patient to tell the nurse one thing and the physician something entirely different or contradictory.

I got a garden-variety cold the last week of treatment and I was far more tired than usual. (I suspect it’s because my niece had one the week before me. She is a pre-school nurse, and her charges are disease-spreading vermin who rarely suffer as much as adults with the same maladies.) As I left the treatment room the second to last day I said to the tech, “I’d like to say I’m gonna miss this but I’m not.”

Finally, it was over. I dragged my tired ass out of the locker room and rang the large bell sitting at the desk, signaling the end of treatment. I said goodbye to Danielle and hugged Carla on the way out. The staff was great, and I can’t thank them enough.

It’s been a few weeks since I finished treatment. The diarrhea has slowly gotten better, but I still have a throbbing, painful hemorrhoid reminding me every day. I’m less tired which may be due to more sunny weather as well as recovery.

I’ll get my first post-radiation PSA and see Dr. Howard at the end of June. It probably won’t be down to zero because radiation therapy isn’t like a laser blasting everything in its path. Instead, it kills some cells and damages the DNA of others so those cells can’t replicate. (How Radiation Therapy Treats Cancer-NCI)

I’ll discuss the aggravation of dealing with billing in another post, but the ballpark estimate of charges for my treatment is around $69,000.

Featured image © Can Stock Photo / focalpoint

Saga Redux

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In December 2019 I had surgery for prostate cancer after my annual PSA levels, which I’d beengetting since 2007, started to gradually increase in 2017. The surgical pathology report showed my tumor was more aggressive than the biopsies, and even though the resection margins were clear, the tumor had already started to extend beyond the prostate. Radiation treatment for a recurrence sometime in my future was likely inevitable. I would get PSA tests every three months for a couple of years, then every six months if they remained negative or stable. Eventually, if all was well, I’d get annual PSA testing for the rest of my life.

My PSA levels during 2020 were <0.014 ng/ml, below the level the test can detect. The first one of 2021 was 0.015 ng/ml, a very insignificant increase. My levels rose again slightly before hitting a plateau between 0.022 – 0.027ng/ml. In December 2021 Dr. Fine, my surgeon, recommended I get tested every six months. In June 2022 the result was 0.023 ng/ml, and I was relieved it had gone down.

Six months later my PSA was 0.044 ng/ml, almost double the previous level.

I sat at my desk for several minutes, starting at the results on the monitor. Intellectually I’d known this was a possibility, but now it had become reality and I wasn’t sure how I felt. It wasn’t a death sentence and the low level meant I didn’t have a large cancer with metastases. I was more worried about how Peg would react.

“My PSA was point-zero four-four.”
“Ok. How do you feel about that? It’s been a good three years.”
“I dunno. I’m not surprised but I’m not sure what to do next. I should probably ask Dr. Fine what he thinks.”
“Well, I’ll support whatever you want to do.”

Now, back in the good (or bad) old days, before e-mail, smartphones, and websites, I called patients on an antique, corded landline to discuss important issues, like abnormal Pap smears and biopsy results. Now most large health care organizations use MyChart, an application that allows patients to schedule their own appointments, communicate with their healthcare providers, view their medical records and test results and pay outstanding bills, all while adding another degree of separation between patients and said providers.

My health care organization, Suburban Medical Center, is more interested in efficiency and revenue than customer service; their medical providers are tightly scheduled and controlled. They prefer to communicate via email, often after hours or during a rare break. There are no direct phone numbers to any of the offices; one has to call the generic department number. If I want to talk with a physician’s nurse, the department personnel might try to contact her (usually her).

I sent a message to Dr. Fine through MyChart.

Me: Level has doubled. Now what?
Dr. Fine: Since lower than 0.05, I recommend repeat PSA in 3 months. We can follow it a bit closer. If it continues to rise, we would consider planning for salvage pelvic radiation therapy.
Me: Pelvic salvage sounds like a sunken ship. So is this likely tumor cells, residual tissue or Karma messing with me?
Dr. Fine: Not Karma Salvage RT sounds bad but can provide cure for you. We went 3 years with just surgery which is great for your very aggressive cancer. If you’d like, I can arrange a visit with our radiation oncologist, Dr. Howard.
Me: Only if you think we’re at that point. It seems the experts don’t agree on the threshold; 0.05, 0.1 and 0.2 are the numbers I’ve come across.

Whether to treat or continue monitoring depends on the level and the rate of PSA increase, but in the end it’s what the patient wants to do. Ultimately, I decided that continuing to follow PSA levels would only increase my level of anxiety and delay the inevitable.

I asked the office to set up a referral and ran into my first problem. Someone entered a referral to Hematology/Oncology. I tried the “Find a New Provider” option in the application, but Radiation Oncology didn’t appear on the list. I found Dr. Howard on the organization’s general website but there was no option for making an appointment. Round and round we go.

I thought making an appointment in person would be more expedient, given the office is only a few miles from my house. Carla, a diminutive, cheerful woman greeted me as I walked in.

“My name is Carla. How can I help you?”
“Is this Dr. Howard’s office?”
“Yes, it is.”
“I had surgery for prostate cancer 3 years ago and now my PSA levels are going back up. Dr. Fine suggested I talk with Dr. Howard about radiation. I’ve been trying to make an appointment and it hasn’t been easy.”
“How soon are you hoping to see him?”
“Sometime in January is fine.” (I didn’t want to ruin Christmas with potentially bad news).
“Well, let me see what I can find.” She looked at the schedule for a few minutes.
“He’s got an opening on Tuesday January 10. You’ll meet with his nurse at 8:30am and she will go over a lot of information, then you’ll see Dr. Howard at 9:00am.”

I knew Peg would want to come to the appointments because she cares deeply about my wellbeing and doesn’t trust the health care system as far as she could throw it. She also asks far more questions than I do. I mostly wanted to talk about whether radiation was a good idea, how long it would last and what side effects to expect.

There were several other people in the waiting room on our appointment day. Everyone had to wear masks, but for some people rules are mere suggestions. There was an old guy in a wheelchair whose daughter hovered over him while he took sips of coffee in between hawking up hairballs, sans mask. Why have a coffee machine in the waiting room if you’re supposed to keep your face covered.

Danielle, the nurse who does pre-consult counselling, called us into a room and, over the next 25 minutes or so, gave us an overview of radiation treatments, side effects and how to deal with them, and warning signs like rectal or urinary bleeding. I don’t remember a lot of details; you’d probably have to ask Peg. Having the nurse see the patient first is probably a good idea, especially with elderly patients, given that nurses tend to be far more patient. She gave us a packet of information and left.

A few minutes later Dr. Howard came into the room and gave us a warm greeting. He was a tall, thin bald guy who reminded me of Ru Paul. I shamelessly told him I was a retired physician; that often changes the tenor of the interaction. There’s no need to dance around delicate subjects like clinical judgement, diagnostic or therapeutic uncertainties, disability or death.

“We’re here because my PSAs have gone up relatively quickly in the past six months. Given my tumor was more aggressive than the biopsies and there was extraprostatic extension, I figured we’d be doing this sooner or later. Is there an advantage to doing this now over waiting and following PSAs?”
“I know what I’d do in your situation. Radiation is like battling an army. I can fight against 1000 soldiers or 10,000 soldiers. So, doing it now increases the chance of cure.”
“So, how do you know where you’re shootin’?”
“We direct radiation at the bed where the prostate was. Before treatment we run what’s known as a CT simulation and map out the area. It takes about 2 weeks for the radiation physicist and me to set up a program. We’ll call you when we’re ready to start treatment. You’ll come in five days every week, but initially we’ll be putting you in to different time slots. You’ll have a regular time slot in a week or so as other patients finish their treatments.”
“How long is this likely to take?”
“Usually about 37-40 treatments. We’ll start doing PSAs again in about three to four months.”

I left with an appointment the following Tuesday at 4:00pm for the CT simulation.

Preauthorization

There’s a meme on the Internet that exquisitely illustrates the differences between the American and Canadian health care systems. (Since I don’t know if this is copyrighted, click here to view.)

Breaking Bad Canada
You have cancer.
Treatment starts next week.
END

Just because you have insurance doesn’t automatically mean the insurance company will approve payment without question. They require approval for anything that is likely to cost them a lot of money. Our insurer is very good at authorizing treatment. Other companies make their subscribers jump through a lot of hoops, even for cancer treatment, looking for ways to weasel out of paying. (A friend of ours whose wife ultimately died of her second cancer had to fight for things our insurer would have approved without question.)

Peg works for our insurance company, which stresses the employees are the “first line of defense against waste, fraud and abuse,” and as such are diligent guardians of precious health care dollars. And did I mention she hates the health care system in general?

She called our insurance company to ask about preauthorization for my simulation and treatment. This started a week-long exercise in futility, prompting her to wonder, “How do they manage to open the doors in the morning?”

“I started with one of our care coordinators who was very helpful. I asked about getting a pre-authorization for the CT simulation and therapy and how much this was likely to cost us out of pocket. She told me Suburban Medical hadn’t submitted pre-authorization requests yet, so she called Linda in Radiation Oncology. Ultimately, they determined there was no need for the pre-authorization for the simulation because it’s not for diagnosis. We’ll need it for treatment, but they can’t provide a cost estimate until after the provider submits a treatment plan.
“So, then I called someone else to try and get a ballpark figure for radiation treatments. He found general cost estimates for prostatectomy and brachytherapy but nothing for radiation. He suggested I call Suburban Medical, which I did but I left a voicemail and haven’t heard back.”

A week later she tried again.

“I called the care coordinator again; she hadn’t gotten a pre-auth yet, even though it’s been ten days since your consult and your simulation was at the beginning of this week. Suburban Medical told her she wouldn’t get any requests until the imaging results were available. It usually takes a couple of days to approve it, but she said she’d fast track it for us before treatment starts.
“I called Suburban Medical but whoever I spoke with couldn’t supply any cost estimates. She suggested I call our insurer back, which I did. Our rep said the provider should have this information easily available since this is their business. He’d need more information because estimates are based on the individual provider, the specific plan and reimbursement contract. He did say, ‘You’re likely to blow through your deductible and out of pocket before this is over.’
“I finally gave up and went to Google. Estimated costs for radiation therapy for prostate cancer recurrence range from $33,000 to $67,000.”

Wow!

I’m fortunate having insight into the health care system as well as a tenacious woman looking out for my interests. Imagine, though, the aggravation and anxiety a person with little disposable income has to endure, navigating through a confusing bureaucracy and wondering how to pay for several thousand dollars of treatment while coping with a cancer diagnosis.

I’ll discuss the simulation and treatment in my next post.

Memories

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It’s been a little more than two months since Baxter crossed the Rainbow Bridge. We miss his furry little face every day, but we have so many memories of him to ease the pain.

The Early Years
Baxter was a very smart puppy. We took him to an obedience class at Pet Smart soon after we got him. He impressed the trainer, learning the commands quickly while the other dogs seemed to struggle, although the training treats were a great incentive. He learned the usual tricks – sit, high-five, shake hands – and every new visitor to our house was an opportunity to show off.

Peg taught him some unique tricks, like “let us pray” and “sign of peace” so he could join Sunday Mass on the television. I taught him “Bang, you’re dead,” which he did with a dramatic flair. Then I’d tell him to roll over and give him two treats for an Oscar-worthy performance. One trick he never learned was “put your toys back into your crate,” no matter how many times Peg tried. He’d look at her as if to say, “Why should I? That’s your job!”

Baxter lived with a cat before he came to us and adopted many cat habits. He liked to stretch out on the back of our couch. Sometimes when we picked him up from the groomer, we found him on the counter next to Miz Laura’s cat who either tolerated or ignored him.

He got so excited when we took him to the groomer, Miz Laura for “Spa Day.” He’d start squealing and jumping around the car when he realized where we were going. He strained against the leash until we got inside, then ran around in circles when Miz Laura came out to get him. They often let him roam free after his grooming. Miz Laura always put a bandana or necktie around his neck, and he looked really handsome!

He figured out how to get to the island in the middle of the kitchen by jumping from the couch to the dining room table to the counter and then the island. I learned to put meat into the microwave to rest after catching him mere inches from the “spoils of war.” Peg didn’t believe me when I told her about Baxter’s acrobatic feats. “He can’t jump that high!”

Her skepticism bit her in the ass the first Halloween with him. I was out of town on a job and Baxter got into leftover chicken bones she had left on the counter, which led to an emergency visit at the veterinarian’s office and a $300 bill. When she called, I said, “Thank you, Jesus,” having avoided the royal ass-chewing I would have gotten if it was my fault.

He loved sharing our dinner, but we quickly learned he wouldn’t eat his dry dog food nuggets if he got people food first. He didn’t like eating alone, so we’d sit in the family room while he dined, then we’d adjourn to the dining room for his “Taco Bell Fourth Meal.” He’d sit on the floor between us, or he would jump on the dining room chair next to me if the handouts weren’t coming fast enough. He’d jump on the table if he was particularly impatient.

And he was very fast. Once evening he grabbed a stick of butter off the table and flew to the floor before Peg could catch him. Another time he sat on the chair at the far end with his paws on the table while he eyed Peg’s steak intently, calculating his chances of success. I imagined Ennio Morricone’s Spaghetti Western music playing in that little brain.

When he got bored with the nuggets, he’d toss a toy into his bowl. Or he’d say, “Fuck the nuggies! I want your food!” We eventually switched to four-dollar-a can dog food, mixing in a bit of dry food for adequate nutrition, but there were still evenings when I ended up tossing it in the trash.

Baxter was a carnivore who loved any kind of meat, but he was especially fond of my brother-in-law’s pulled pork, cooked low and slow on his beloved smoker. One summer the family gathered at our house for pulled pork two Sundays in a row; Baxter thought he’d died and gone to doggie heaven. He was positively miffed when, the next Sunday, the family brought pizza. He gave a snort of disgust and retreated to the family room.

Baxter also loved sweet things like whipped cream, Dairy Queen and Culver’s frozen custard. I’d take him to Dairy Queen in the afternoon and we’d share a soft-serve cone. Usually, he dove into it but sometimes he would wait until the third or fourth offer before remembering, “Oh yeah, I like this stuff.” We often took Baxter with us when we went to Culver’s for a sundae, rewarding him with samples on the way home. He also enjoyed the Pumpkin Shake, available only in October and early November.

Our local grocery store Jewel shares the same parking lot with Culver’s. One evening Peg drove to Jewel to pick up a few things, taking Baxter along for the ride. (If I recall correctly, he ran to the car as soon as Peg opened the door to the garage.) He kept looking at Peg as she drove past Culver’s: “Wait. You’re not going to stop? Why did you bring me in the first place???”

The Guardian of the Cul-de-Sac
The Tibetans bred Shih-Tzus (which translates to “little lion” in Mandarin) from the Pekinese. Pug and Llhasa Apso. The little dogs were initially used to warn the royal court of intruders but later became companions. Baxter appointed himself as our guardian, standing sentinel at the patio door for any riffraff that might pose an imagined threat.

He went ballistic when people walked by and became more incensed if accompanied by a dog, large or small. It didn’t take long for him to figure out that whomever he saw from the patio door would reappear on the other side of the house. He’d run upstairs to the guest room, jump on the bed and continue yelling until they were out of sight. If anyone walked on the sidewalk in front of the house, he’d run back and forth between the guest room and our room, sounding more like a thundering herd of cattle than a fifteen-pound dog.

The Daily Rituals
I took him out to pee every morning and then fed him breakfast, followed by an insulin injection once he became diabetic. He used to demand a walk before I could have coffee, but as he got older, he was content to take the early morning nap, followed by a quick stretch before the late morning nap. We settled into a predictable routine which included daily afternoon recreation.

He loved car rides. When he wanted one, he would stare at me or jump onto the couch and paw my hand. If I asked, “Would you like a car ride” he would bark and go to the back door. Sometimes he’d run to the car if I opened the door to take the garbage out. Occasionally he’d try to con me into a ride at 11:00pm. Sometimes he’d get lucky, and I’d indulge him since a short trip around the neighborhood was enough.

He liked going for walks up to the playground near our house and back. I started taking him to another park after he yanked a muscle in his neck playing “whose dick is bigger” with the dog behind the neighbor’s fence. He couldn’t see her but knew she was there. That turned into a midnight visit to the emergency vet during COVID.

The Nightly Rituals
Baxter wanted to go upstairs at 5pm during the winter because it was dark and, in his mind, time for bed. We resorted to putting up a gate in the hall because otherwise he would run upstairs and start barking for us to join him. He’d reluctantly stay with us if we were watching television, but his patience ran out around 9pm, when he started pulling my socks off with his teeth.

I started eating a mozzarella stick at bedtime to keep my fasting blood sugar at a reasonable level; Baxter soon expected me to share. Our nighttime ritual evolved into a protein snack, several Old Mother Hubbard cookies, a drink of water and four pieces of Pill Pockets. If Peg wasn’t fast enough with the Pill Pockets, he climbed on her and tried to snatch the bag out of her fingers. His attitude towards cookies was, “We’re done when I say we’re done!” One night when he started barking for more Peg told him, “You’ve had enough!” The little shit then jumped off the bed, ran downstairs to one of his many stashes, brought a cookie back to the bedroom and devoured it while looking directly at Peg.

He slept at the foot of our bed, but I would move him closer to us before we went to sleep so he wouldn’t roll off the end. He growled but never opened his eyes. He used to love curling up in bed under my chin when it was cold; I’d listen to little puppy snores through the night. If he woke up before me, he would stare at me, willing me to get up.

Toys
Baxter loved ripping the appendages off his favorite stuffed toys. He went through several Gorillas and Dragons. He liked to pull the stuffing out of Panda and ripped out Peg’s repairs several times. He had a pink rabbit who, after having his ears and legs torn asunder, became a blob we nicknamed “Stinky Bunny,” well-marinated with doggy saliva. We tried to send Stinky Bunny to the farm upstate, but Baxter managed to rescue him from the trash.

Flying Bear was another favorite toy. He loved to grab it with his teeth and whip it back and forth. We tried to find a replacement when Flying Bear became overly ripe, but didn’t have any luck.

Quirks
He liked to lay on the couch’s footrest and watch television with us; he’d lay very still and stare intently. Sometimes the only way I knew he was still awake was when his ears would twitch. But several things would set him barking at the screen while jumping against the entertainment center:

The Buick jingle
Any program in black and white
Black people on TV (though not in person)
Animated films (Peg gave up trying to watch Disney’s Brave because he’d go berserk)
Animals on TV, even if he’d never seen one in person.

When I left for a job, he would put several of his toys on my office chair or in my spot on the couch. I guess he was keeping my spot warm. When I came back from Springfield, he knew when I was about 15 minutes from home, because he’d sit by the door to the garage. Peg called me and we’d count down the streets until I pulled into the garage. Sometimes he and I would bark at each other over the phone.

I learned to devote the day of my return from a job to the happy homecoming and indulge his every wish/demand. “Your ass is mine!” We had to go for a walk or a car ride IMMEDIATELY! I had to walk him for a walk every morning before he would let me work in my office.

Later years
Baxter liked to greet anyone coming into the house until he got older. Then he’d run upstairs, coming down only when he thought it was time for people to leave. He turned into a grumpy old fart like his daddy.

Baxter couldn’t easily get up on the bed in the guest room to survey his kingdom the last year he was with us, so he spent his time in a day bed on the floor in Peg’s office. He developed some quirky habits like scratching anything that struck his fancy: the filing cabinet; a binder on the floor; the trash can. Sometimes he would drag a piece of paper off one of the numerous piles on the floor and shred it. Peg would yell, “Stop that!” He’d give her that “What?” look and then resume digging, sometimes deliberately looking at her. He started knocking over a box of beef sticks under Peg’s desk. She would put them back in the box and he’d knock it over again. Eventually, she gave up.

Sometime during the summer, he developed the habit of wandering down the hallway like the night watchman before he finally settled down. He didn’t want to sleep on the bed with us, so I bought another doggy bed for our room. Some nights he preferred the bed in Peg’s office.

I think the most remarkable thing about dogs is they live in the moment. They don’t appear to grouse about getting older and I don’t think they ever contemplate mortality. Every day is a good day, even when it isn’t.

Notes from Dr. Dave

Musings from forty plus years as an OB/GYN and a writer.