April 27, 2012: Trying to Understand Suffering

I always try and wake up an hour before I have to leave for a race. Sometimes that means waking by 4:00 AM, but I need to do so because I am always nauseous the morning of an event in which I know I will be suffering. It’s weird. It’s like my body is trying to convince my mind that it’s not worth it, to go back to sleep. And it doesn’t matter how many races I’ve done. Always the same. Wake up, feel sick.

Friday was the Uriyah Duathalon, an event combining ten kilometers of trail running with thirty of mountain bike riding. It’s a new event that was launched to coincide with the moshav’s 100th anniversary. We got there early since if at all possible, I try to get to events with plenty of time to spare. Even if that means standing around for a while. It gives you time to see others and have some friendly conversations while waiting to put your body through the wringer.

Stella feels sick the morning of chemo, long before she actually gets the drugs. It is the psychological dimension of what her body is going to go through that makes it rebel. Usually she can fight through it and we try to get to the hospital as early as possible. A number of people do so and despite what all the patients are in store for, people seem quite friendly and relaxed as they sit around waiting for the real day to begin.

A woman rolls through with a cart of goodies. Of course, most are too anxious to eat anything but the volunteer’s smile is more comforting than the food anyway. We pick out our chairs (recliner for Stella and standard metal chair for me.) We plug in the laptops and wait for them to bring the chemo and start the treatment.

The race started with a hilly ten kilometer loop. Running a 10K is very different that running a marathon. You run at a much higher speed and it’s not always easy to pace yourself. You shouldn’t go too fast for the first few kilometers or you will burn out. On the other hand, you can’t take it too easy since you don’t have much room to make up time. I probably went a little too fast for the first five kilometers. But just when I felt I would start to slow down, my coach Chaim waited for me and then paced me through the second half of the race. At that point, it is more psychological than physical. Your body CAN run fast for 5K, IF your mind can deal with the suffering. Having Chaim beside me giving me constant encouragement helped me push through the mental blocks and keep running strong.

Stella has two chemotherapy drugs that she gets on treatment day. A third drug is taken orally every day. The first is called Oxyplatnum. Like all chemo drugs, it’s job is to travel through the body and find cells that act like cancer cells and kill them. Cancer cells are normally distinguished from other healthy cells because they divide at a very rapid rate. So it does a good job at killing them.

Unfortunately, there are other cells in the body that by nature divide quickly. Cells of the digestive system, hair follicles, various other places in the body. The chemo cannot distinguish between the healthy fast dividers and the cancerous ones. So it takes a shotgun approach and kills all of them. This is why there are so many unpleasant side-effects associated with chemotherapy. It’s why at times the cure can feel worse than the disease.

Usually, about halfway through the treatment, Stella will start to feel sick. I try and give her encouragement and ease the psychological suffering that accompanies the physical discomfort. Sometimes I read e-mails and facebook posts from friends. Sometimes I just hold her hand. I can tell when it is really starting to get bad because she gets her “game” face on. She closes her eyes and just fights through it.

The truth is that there are many cancer patients who quit chemo. They give up, and I can’t say I blame them. They simply cannot get through the suffering of chemo and prefer to take their chances with other forms of treatment. But in our case, it is clear that the chemo treatments offer the best possible hope. So Stella fights through.

After the 10K run, there was no time to relax. I ran to my bike, changed shoes, strapped on my helmet and gloves, and took off. The bike portion was composed of two 15k loops. Each loop had a long, gradual climb, followed by a steep descent and then a twisty single track.

I took off on the bike, but within a kilometer a wild dog came out of nowhere and started to chase me. In my effort to evade him, I missed a trail marker and went off course for about a minute. When I realized my mistake, I had no option but to turn around and hope I could make up the lost time.

Thanks to Chaim’s pacing, I had finished the run ahead of most everyone else. Now I had to move up again because of a dumb mistake. But sometimes things are just beyond your control and you have to do the best you can.

In the sun, trying to ride fast up a long hill, it really started to hurt. With the finish line at least an hour and a half away, there was really nothing to do but hammer away on the pedals and remember that everyone else was hurting. I was able to pass a bunch of the guys who had passed me when I went off course. Seeing everyone else out there suffering made me feel much better.

After the Oxyplatnum, Stella gets a bright orange drug called Epirubicin. Her three drug cocktail is a fairly recent development and while there is no single agreed upon standard for fighting gastric cancer, this combination has had the most promising results. If Oxyplatnum is the artillery, Epirubicin is the commando unit. Once again, in their zealousness to kill cancer cells, they cause a lot of “collateral” damage.

Stella digs deep when it gets to this point. She tells me that it helps her to get through it by imagining that for some people, it feels much worse. When she sees elderly patients (and most people with cancer are older) dealing with it, she calls herself a “wimp” and tells herself just to deal with it. She is by no means a “wimp.” Not at all. But I understand the technique. The difference is that in a race, I am glad that others are suffering more. For Stella, she feels nothing but compassion, even guilt that she is getting off so “easy.”

The last few kilometers were actually fun. There was a steep and rocky descent and then a twisty, narrow path with a few obstacles that had to be navigated. The pain was replaced by adrenaline, and I found I could actually ride a lot faster as the finish line beckoned.


When I finally got myself across the line, a flood of good feelings made all suffering worth it.

For Stella, the end of a treatment is not so easy. She can’t wait to be unhooked and go home because for her, this is still just the start of her race. It usually takes about ten days for the effects of the chemo to fade. For ten days, she tries to smile as her body reels from the toxins circulating in her veins. She is mostly in bed and just focuses on getting better. I try and help as much as I can, to “pace” her, but I know I can never really understand what she is going though.

The kids come home from school and she tries to pretend that everything is normal. She does not dwell on the fact that she is in bed for a week and no matter how sick she is feeling, when one of the kids come up to her room she hides it away. She e-mails friends and tries to put the best “face” on her words.

In fact, she deals with chemo week better than the rest of us. On Shabbat, we sit around the table and try to enjoy the food (my cooking is getting much better,) but her absence is felt. No matter how many times we have been through this cycle, I always end up panicking and threatening to call the Doctor. I see her at the worst times and I feel powerless and terrified.

But she always tells me to be patient. That as soon as ten days go by, she will be fine. (And she is always right.)

There is a point to suffering. I don’t know why the world is set up that way, but that’s the way it is. The medicine will make Stella suffer, so that she can be cured. I use running and biking as an escape. I suffer because it releases me, at least for a short while, from having to worry about anything else. For an hour or two, I am not dealing with Stella’s cancer. I am riding the Tour de France. I am an Olympic Athlete, winning the gold medal. I am running past hundreds of thousands of spectators at the Boston Marathon as I set a new world record.

Or maybe I’m just riding around Moshav Uriya, competing against other middle aged guys who have to go to work on Sunday. Doesn’t matter.

The suffering somehow builds us up, makes us stronger. No matter how bad I feel when running or riding, all I have to do is think of Stella battling through a treatment, and I know I have nothing to complain about.

Would it be better if chemo drugs could kill the cancer without the terrible side-effects? Of course.

But they don’t (at least right now.)

So like a wild dog chasing you off course in a bike race, sometimes you just have to accept how things are and deal with it.


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