Year of Plagues

by Fred D’Aguiar

  My chemical castration is complete. It took three cuts. (Fingernail applause, burst-hydrant crocodile tears, world’s smallest violin played with one pincer by that literate crab in Walcott’s Omeros, begin rendition of my self-pity blues.) Bicalutamide made the first cut. One 50 mg tablet each day. I needed something to stop my male hormones from feeding my cancer.

  Simply put, bicalutamide blocks testosterone and dihydrotestosterone (DHT). Male hormones, or androgens, rely on the testes to produce them and send them around the body to stimulate various organs to function in particular ways. Testosterone heads out in search of receptors in cells to join up with and trigger these functions. An enzyme converts testosterone to DHT (associated with hair loss). In my case, testosterone helps me work out longer and harder to build muscle mass, and I have a sex drive, thanks to the properties of testosterone as it meets my muscles and brings along with its glad tidings key chemicals that assist my muscles in those particular ways. Bicalutamide’s antiandrogen activity stops that work by latching onto the androgen cells, in effect covering the ends of the cells that need to be unimpeded in order to grip and attach to the receptors of the other cells and deliver its good news.

  If you think of one aircraft refueling another in midair, the aircraft with the fuel extends a long, hollow pole with an end that fits into the open end of the jet that hopes to receive the fuel, that ball-and-socket fitment allows fuel to flow from one aircraft to another. Think of bicalutamide and Lupron Depot as the interlopers that obstruct the ability of the refueling aircraft to join the other craft that needs its tank to be filled. In the body the result is that bicalutamide and Lupron Depot shut down the production of testosterone and its offshoot, DHT.

  Leuprolide acetate (Lupron Depot) in the form of an injection made the second cut. For the appointment I wear my best underclothes, no frayed threads or faded fabric on my boxers, no cuddly looking mini balls of cotton, those proverbial pills, on my cotton socks. I take a long time in the shower. I cream my skin to hide the patches that start to look ashy and dry an hour or so after a shower. The COVID-19 restrictions make the drive nervous for me. You have to keep your distance, wear a mask and avoid public gatherings with hospitals—right where I’m heading—as number one among venues where the virus festers. Unsure of what I’ll be told and trying to avoid the usual cut-and-weave driving of LA, I try to be gracious as cars form adversarial relations with each other and break them just as fast to take up with other cars nearby. I allow my car to be overtaken at speed and tap my brakes without honking as cars pull in front of me way too close to my front end. The blue sky displays a canvas of warmth and frolicking cloud. The odd crow and seagull flick across it. Parking is not easy. I have to wait for the reverse lights of a car as the driver takes some time to reverse out of the space. No worries, I tell myself, at least I have a space and I am early for my appointment.

  Nuclear medicine is in the basement of the hospital. Chernobyl comes to mind, its reactor cores deep in the ground that melt and belch up into the domesticated air of its citizenry. It makes sense to bury the poison of nuclear medicine. It has to be doled out in minute quantities to kill things in a place where it causes even more harm than the thing it is meant to cure if the doses dare exceed prescribed levels.

  The nurse is named Angela. I’m in the city of angels. Surely I’m to be saved? Angela explains the many side effects of the medicine, principally the hives, or swellings or difficulty breathing, that should they occur I must call my doctor right away. The drug, all 11.5 mg of it, comes in powder form, which is in a capsule. She inserts the capsule into a tube and adds a clear liquid, saline, to the mix. She shakes the tube. Adds a long needle to the end of it and tells me to pull up my shirt and pull down my boxers. I wish Angela’s angel dust concoction the luck of a warm hand with dice in Vegas. She tells me to expect a pinch. It is more than a pinch, more like what an aunt did to me in Guyana when I went against her orders: she gathered a bit of my flesh on my arm or ears or back or leg in a pincer move of clamping thumb and index finger, and twisted it. My aunt’s move made me howl and hop away from her as fast as possible and left me with a sore spot for a couple of days. The needle was my aunt at work in slow motion. I gritted my teeth and winced with my face turned away from the nurse, who asked me to relax my buns.

  Leuprolide acetate is a synthetic protein that overstimulates the production of testosterone. Leuprolide targets the anterior pituitary gland, which produces the hormones that stimulate the production of testosterone. Lupron Depot floods the anterior pituitary and the result is to desensitize the gland and undermine its function as a regulator of testosterone. More specifically, the hypothalamus receives the message of a flood of Lupron Depot in the body and it sends the signal to the anterior pituitary that there is too much testosterone present and it should cease and desist, which triggers the response of fatigue in the gland from overproduction to a drastic reduction of testosterone levels in the body. The body reacts to the stimulus as if flooded by the hormone and ceases production of it. Testosterone stocks in the body decline as a result of the presence of Lupron Depot. My injection lasts for three months, thankfully. The hormonal disguise circulates in my body, mopping up testosterone. By the end of its prolonged release I should be free of the major source of my worry, my prostate, and well into bouts of radiation and chemo as needed in a mop-up operation of my own.

  This is the last thing my cancer wants to hear from my body, its food source on many fronts. The site of the cancer atrophies as a result of a lack of testosterone, though not by much. The damage of the cancer continues in its spread to other areas. Lupron Depot happens to be my Anansi. My Brer Rabbit as well. What tricks the two of them play to fool my testosterone stocks and deplete them! I say play on. All I carry is a sore spot on my right rump that lasts a couple of days. I picture the deployment of the drug as waves of angels spreading their messages of goodwill throughout my body and reducing my prostate-specific antigen (PSA) test result from its fantastical reading of 256 when it should be way below 1—yes, 1.

  Tamoxifen dealt the final death cut to complete my medical castration. At 10 mg, twice a day, I find it a palliative. Every time I lift a tablet to my lips I feel a shot of goodness run through me in my belief that some useful action has been set in motion to strangle my cancer. It is like tilling soil. That sounds too grand. More like the raised vegetable garden (two eight-foot-by-three-foot beds) that Debbie and I built last fall from planks of wood nailed together and lined with tarp and topped with twenty bags of a soil mix, and seeded with lettuce, tomato, basil, and thyme.

  Tamoxifen. If only I were a man at ease with my body no matter its permutations. Instead, I baulk at the tenderness around my nipples and the slight swelling about the size of a dollar coin or English fifty pence (though not an equilateral-curve heptagon, that would be too much). A strip of engorged flesh runs along the outside edges of both breasts. At a glance I look like someone with enviable pectorals. Up close they tell a different story. I see the new cartography of my body as cancer territory. Sensitive to the disbelieving probe of my fingers, the swelling dearly wishes to pass as just my body on a growth spurt. But I am too old for such generous displays of physical prowess. I know the denial of testosterone in my body brought about by the combined onslaught of Lupron Depot and bicalutamide has led to the dominance of estrogen. Enlarged breasts derive from my estrogen, given free rein in me in the absence of testosterone. Damn right, I need something for that.

  As I said, I wrote to my doctor saying that I noticed the alteration to my chest, and I wished to curb it. Debbie’s research helpfully found the drug that works to inhibit breast growth. I added it to my note to the doctor. He dutifully wrote the prescription. In fact, he had mentioned the side effect on our first meeting when he prescribed bicalutamide tablets and the Lupron Depot injection. (Debbie suggested tamoxifen as the likely fix if the need arose.) At my health web portal I dug into UCLA’s information on how the drug works. The patient information tells me
how to pronounce the name and how to take the drug and what to look for if things go wrong for me. Though useful, the pages for patients seem preliminary as far as learning about the makeup of the drug and its pathways of operation in the body.

  Tamoxifen blocks estrogen and treats breast cancer, and acts as a prophylactic as well. Among its many side effects is the counterintuitive possibility of more breast swelling (as if I needed more of it and vaginal discharge (which is not my worry). The hot flashes, which wake me and stop me midactivity several times in the day, occur in 70 percent of men. Signs of tiredness and fatigue and a bloated feeling, some weight gain, thirst, and cravings. All plague me to such an extent that I begin to measure out my favorite almond yogurt into a four-ounce container that I’ve saved, rather than trust my eyes and scoop it like ice cream from the large container into a small bowl. As I serve myself I try to add one spoonful less than usual of Debbie’s culinary delights (that have multiplied in excellence with COVID-19’s enforced housebound rules, and have become a major challenge for me, for being a major refuge), and I always attack the salad as the go-to filler of my famished urges. Nevertheless my love handles inflate from neat handgrips to unwieldy handfuls of corpulent excess. I find her quiche the most tempting of all. She adds an array of cheeses to her mix, Swiss, sharp cheddar, Gouda, and broccoli. The crust is just so crumbly and yet adhering to the pie (is pie the right term for the contents of a quiche?), with a slight sweetness to it and a little bit of chewiness to the multiple cheeses in play. Not to mention the oils sweated by the cheeses. Nor the way a salad with tomatoes from the makeshift garden compliments that quiche. I always go back for more with the rationale that I began with a small slice. I try to chew each mouthful sixteen times to abate that unquenchable sense of needing more, always more, like a gormandizing version of Oliver Twist.

  Part of my tamoxifen blues rests in a psychological sense of the neutrality of my gender. I feel neither male nor female. My crotch attached to clear principles of pleasure along a masculine trajectory has retreated into pure functionality. I hold tamoxifen responsible. My Anansi savior and my crucifix, with the bonus of bouts of hot flashes, add an image of me tied to a pole turning over a fire. Brer Rabbit tamoxifen. Two tricksters in one drug, present for dual application by me, and going by the long list of side effects, my cancer too. What began in my prostate now languishes far from it and conducts skirmishes in my breasts. I think of the keys of my spine along which the cancer must sing its blues progression as it climbs to my heart and brain.

  The Nicholas Brothers, in my body memory, work their tap and acrobat dance for me. I rename them Anansi and Brer Rabbit. I hope they work as if doubled for my cancer as well, though I know that the trip up my spine along my lymph nodes resembles the choreography of those talented brothers. Tamoxifen, tap dance, like them. Somersault and backflip like them. Neutralize the growth of my breasts, and I will gladly pay the price of becoming a eunuch. Eat less of Debbie’s quiches and cakes that are myrrh and frankincense to me. I’m caught in a tactical retreat from the variety of my life into a simpler, stripped-down version of it, still vital though lighter, still complex, if far less complicated.

  Today Debbie and I braved an LA drizzle to walk the dog. A little rain cannot stop us. Neither of us is Lot’s wife, a pillar of salt who had to avoid water like the plague. COVID-19’s housebound rules make this walk necessary whatever the weather. The grains of sparse water speckle my glasses and sand my face, as in a breeze on a beach flung at me, that I twist my spine to turn my back to, and save my face. I wish for rain to lather me. With the summer nearing, this rain will be the last for many months. Let it not be my last. Make it a baptism of the many days ahead with or without rain. So that I live to see the city find its feet one step at a time and one day after the next.

  Tamsulosin is exempt from this hatchet job on the grounds that its function of relaxing my muscles to help me pee, while it indirectly shrinks my prostate, provides a critical service. I take one 0.4 mg tablet at bedtime. I sleep all night thanks to it. No more trips to the bathroom twice in the night. Tamsulosin cannot be a blues of my despair. More the jazz of my survival, it remains a testimony of likely reparations paid to my spirit. There is a reverse dance between my cancer and this drug, a dance that follows the drug’s Nicholas Brothers gymnastics at the site of the cancer to uproot it. The reverse dance is a backward journey to drive that cancer away from my breast and back down my spine to where it started in my prostate. The dancer must be someone as good as Alvin Ailey. Or simply my brother Greg, at Ballet Rambert in 1978 or ’9 in a grande jeté that I swear he held for a whole second longer than all the other boys around him so that he floated across the stage and high above those boards, coming down on his lead leg, his right, like a feather loosened from a pillow.

  I have more time to devote to my death with so many assets on my side attacking the size of the cancer and reversing the ground gained by it. Today I undergo my prostate-specific membrane antigen (PSMA) test. This test provides the eyes that the surgeon wants in order to operate on me. Today I give him his eyes. I wake at 4:15 a.m. worried about the six hours, when I have to be nil by mouth, before my noon appointment, except to take a sip of water if I have to swallow any meds. There are two tablets, the tamoxifen and the bicalutamide, that I consider knocking back early to avoid water (as if I were made of salt) and preserve my six-hour fast.

  I will my body to make this penultimate stride to the surgery after a phone call from the hospital that asks me to take a COVID-19 test two days before the operation. If the test is negative I am allowed to go under the knife. If it is positive all these last four months of strategy and worry come to naught, the operation will be postponed and rescheduled and I will have to be tested again before it to be sure I am COVID-19-free.

  The PSMA shows the exact paths taken by my cancer. My body should light up with it and all the surgeon has to do is collect the shining gems of my illness, Hansel and Gretel style. Of course he can go only so far into my body before he has to give up and exit and close me up. The good news is the PSMA picture of my cancer will be utilized in any radiation and chemo treatments that follow the surgery. It is my word of the day. PSMA is my song put to the tune of the Village People’s “YMCA.” Here is the song in full for a sing-a-long.

  P-S-M-A!

  I want to have it now.

  P-S-M-A.

  For the surgeon needs eyes

  For my cancer’s disguise

  ’Cause I want to live

  And have my life back.

  Help me sing it now.

  P-S-M-A!

  All I have to do is work out the choreography for it. I must ponder that P as a dance move. How? S is a doddle. Try this. I want people to clasp their hands as if in prayer and raise those clasped hands above their heads and bring those hands down like a snake, yes, down like a snake, in the shape of an S, go, in the shape of an S. The rest is easy thanks to the Village People.

  The PSMA machine has a magnetic resonance tube and I am fed into it on a gurney that the tube moves up and over me, and it reads the nuclear fluid injected into my veins to see which parts of me have absorbed that fluid. There are markers in the radiation that target the cancer cells or the antigens manufactured by the membrane of my prostate. Wherever those cells have migrated, that radiation will find them and latch on to them and send out a message that the imaging machine reads and maps for the surgeon. There is a different tune for this search-and-flush-out process of my test. I hear a melodramatic tune without lyrics: the Mission: Impossible soundtrack as the chemical is injected into my arm and starts to seek out the cancer.

  I might end up gamma-super-powered after all these infusions of radiation. It could be my superpower, a bit like the Hulk but without the ugly. A new cancer might spring out of this nuclear bombardment of my body. When I think of the treatments that involved radiation, what comes to mind is history. In a poem by the Guyanese poet Grace Nichols titled “I Is a Long Memoried Woman,” Nichols imagi
nes the Middle Passage from the perspective of a woman, a terrain previously the domain of male poets and fiction writers. There are many memorable passages; for instance, “it isn’t easy to forget / what we refuse to remember.” Its apparent tautology invokes one big drama of the Middle Passage, that of willful forgetting. As a mechanism, forgetting achieves the opposite of its intentional amnesia, because the forced part of it serves to impel memory. But for me the telling phrase is when the poem’s narrator declares, “I have crossed an ocean / I have lost my tongue / from the root of the old one / a new one has sprung.”

  We speak in tongues. For me, what is new is that which I wish to stay news. It concerns the lessons that I learn out of all the pressure of my symptoms, their diagnosis and treatment. Cancer instructs me about my life even as it seeks to annihilate me.

  There is a hip-hop chant for my penultimate PSMA appointment. (Just in case my Village Peeps are not enough—when are they ever anything less than more than a handful!)

  Big-up PSMA! Hip-hop hooray!

  What have we here today? We got PSMA!

  There is a cheerleader quotient to my choreography with my cancer. I am on the sidelines championing another version of me in a contest with cancer. My cheerleader self is kitted out with pom-poms and butt-creased shorts. I have multiplied into a troupe. We semaphore with our pom-poms and chant our PSMA songs. The version of me in the game against cancer is an amalgam of Muhammad Ali, Claudia Jones, Toussaint Louverture, Sojourner Truth, Bruce Lee, C. L. R. James, Ma Rainey, Bob Marley, and Ip Man. I know that is quite a cut-and-paste job of radical innovators. I need every corpuscle of their bodies to help me in my contest with cancer. As my disease morphs, so I call upon my heroes to step up and help me with my fight. As I remember them in their fight in their history, so they help me with mine.

  My memory is invention. My experience of history (How, you may ask, can a finite body experience the long curve and straight line of history, is that not an oxymoron?), as I glean it from education, research, and life, makes history a living thing. My brief history with cancer makes my cancer and me living entities within history. As long as I keep the two (my cancer and me) in history I stay living. I am not consigned to a dead history. I remember in order to live. I hope cancer, despite its extensive arsenal, has no memory. As it duplicates my skills to counter me with Anansi and Brer Rabbit and the persons out of my personal collection of history (and fable, myth, and magic as well), I want cancer to forget the making of my history with it as that history is being made. I want my cancer to be unaware of our current, shared flux as an event in an unfinished story.