Month 189 – Hourglass & Graveyards

Update

I’ve penciled into my calendar my next PSA test next week. It will be interesting to see if it continues to increase at a slower pace or return to a faster climb. Once I have the results and PSA doubling time calculated, I’ll contact the medical oncologist (MO) to see what our next steps should be.

You may recall that the original plan was to do a CT scan which I have scheduled 23 November with a follow-up with the MO on 8 December. The PSA results may dictate that we reevaluate that plan and do something sooner.

Of course, the MO was all hot-to-trot to put me on intermittent Eligard + enzalutamide back in June, and I’m guessing they’ll continue that recommendation. Part of the research that I’ve done does seem to confirm that starting that combination therapy earlier has shown delay time to metastasis, so I’m seriously considering it knowing the likely side effects that come with it. I’m all ears from those who may have insights.

I hope to get back on my regular posting schedule in September, which is Prostate Cancer Awareness Month.

And now, our featured presentation…


Hourglass & Graveyards

I was originally pretty excited about writing this post, because I was planning it to be a tongue-in-cheek talk about me entering what I was going to call the “ancestral death zone” by outliving the first of my six immediate ancestors (parents and grandparents). By my calculations, that milestone would have occurred on 26 May 2026.

But I goofed.

How did I learn that I goofed? By visiting graveyards.

Life Hourglass

Long-time readers of this blog may recall that, about five years ago, I shared a video of Tim Urban’s TED talk on procrastination. In it, he developed a graphic representation of a 90-year life in the loose form of an hourglass. Of course, you know by now that this spreadsheet nerd had to create my own version. Each horizontal row represents a year lived, each vertical column represents one week in that year, and the blue cells are the weeks that I’ve lived so far.

In order for me to determine if I was entering the “ancestral death zone,” I had to calculate and plot how many weeks each of my ancestors lived. I also threw in the average of all of them and the life expectancy of a U.S. male and plotted them in different colors on the hourglass.

The hourglass is visually impressive, but the spreadsheet nerd in me had to take it one step further. I calculated how many days each of my ancestors lived, and then figured out the specific day that I would theoretically check out of this world if I lived as many days as each of them did. A hard “deadline” date packs considerably more “Oomph” than a grid of colored squares.

You can see that I’ve already outlived two of my ancestors but, because of my error, I didn’t realize that until recently. How did I discover the error? Well…

Graveyards

Maternal grandparents, 1960

A few months ago, my sister asked me to see if I could find a particular photo of our father. I couldn’t, but what I did find was a map of the cemetery where my maternal grandparents were buried, with a handwritten note from my mother showing the approximate location.

My grandfather died in 1963 and my grandmother died in 1971 (I was five and thirteen years old, respectively). I hadn’t been to their graves since the mid-1970s before heading off to college, and I had only a vague recollection of their exact location.

That made me think about my paternal grandparents’ graves, too. I knew the cemetery and their general location as well. My paternal grandmother also died in 1971—three weeks before my maternal grandmother—and my grandfather died in 1987. It had been decades since I had been to their graves, too.

During my trip back to Chicago in May, the geography nerd in me decided that I was going to find their graves and actually map them in Google Maps and in an app called What3Words1 so that other family members would know their location. (I also mapped other family members’ graves, too.)

It was during this graveyard scavenger hunt that I discovered that I had my maternal grandmother’s birth year wrong—the one that I used in my hourglass calculations. She was actually born in 1905, not 1901, which meant that I had already outlived my first ancestor and entered the “ancestral death zone” two years ago.

That discovery was a bit of a pleasant surprise—I have already outlived two of my ancestors—but it also took the wind out of my sails for the timing of this post.

Thoughts on the Life Hourglass

One of the main lessons from Tim Urban’s talk was that life moves on whether we want it to or not, and it’s important to take advantage of the time that’s given to us. Yes, it’s cliché, but there’s always a bit of truth in clichés.

Introducing “cancer” to your vocabulary forces you to look at your own mortality, at least during the initial weeks after the shock of the diagnosis. Now, almost sixteen years into this and better educated, I know that I’ll likely die with prostate cancer and not from prostate cancer. But with each failed treatment and each increase in my PSA, that calculation changes just a tad.

Some may view this exercise of creating the life hourglass and calculating death dates as bordering on morbid (or nuts), and that’s okay. I found that it gave me a unique perspective and a reason to be a bit more proactive in pursuing things, from last year’s bucket list trip to New Zealand, to just saying “yes” to everyday opportunities more frequently. (Or, conversely, giving me a reason to say “no” to things that may not be the best use of my time.)

Having this perspective can also make you question things about your time remaining. If I take one or two big trips per year, where will I go to out of all the possible places in the world? If I see friends or family once or twice a year, how many more times will we see each other? That scrutiny has you evaluating your priorities.

From the day we pop into this world, none of us knows when our time will end. Period. My nephew only lived a week, and two of my great-grandparents lived into their mid-90s. We just don’t know.

There isn’t a lot of longevity in our family, with average age at death for my six ancestors at 72.9 years. Dad died at 69 and his mom died at 69, with dad outliving his mom by 50 days. I’ll be 69 early next year and hope to break that trend but, if I don’t and I live 50 days longer than dad, I’ll be checking out on 5 November 2027. That’s not that far away.

While it may seem as though I dwell on this topic, I truly don’t. I don’t plan on going anywhere anytime soon. But, at this point in my life with cancer refusing to succumb to what we’ve thrown at it so far, I’m just a bit more pragmatic about it.

Again, no one and no goofy spreadsheet can predict when it will happen, but we do know it will happen at some point. Accordingly, I’m beginning to take steps that will make it easier for my family members to deal with my affairs once I’m gone (e.g., getting files in order, slowly clearing out things in the house that I haven’t used in ages, etc.). (Remember, I’m single and they live 2,102 miles / 3,383 km away from me.)

Thoughts on Graveyards

When I was in the Navy, I was stationed in Newport, Rhode Island, and I loved the history of being in a town that was founded in 1639. It was interesting to pop into a cemetery and look at some of the 300+ year-old headstones. Some were very basic, and others told a short story about the deceased. An hour and a half away in Boston, you could visit the graves of Paul Revere, Samuel Adams, and John Hancock, key figures in the American Revolution.

One thing I noticed as I wandered through all four of my ancestors’ cemeteries was the inequities even in death. Some graves had simple bronze or granite markers flush with the ground; others were a bit larger, but still modest; and then there were graves marked with towering obelisks on ornate bases that rose 20 or 30 feet (7 – 10 meters) above the ground. Yet, despite the differences in status above ground, the people beneath each of those markers were in the exact same condition. (One of the appeals of a national military cemetery to me is that, whether you were a seaman recruit or an admiral, you get the same headstone.)

This exercise made me think about the whole concept of burials and cemeteries in general.

Obviously, burials have been going on for thousands of years and, in some faiths, it’s a necessary step that’s part of the transition to the hereafter. I also understand that a burial can give a family closure, as well as a means to honor their loved one. Other cultures prefer cremation over burial.

Two of the four cemeteries that I visited were very well kept, and the other two needed some attention to varying degrees. In an older section near my paternal grandparents’ graves, headstones were leaning or simply toppled over. In the cemetery of my other grandparents, the asphalt roads were decomposing into gravel and the grass was in need of cutting.

Perhaps it was a pang of guilt for not having visited some of these graves in more than 50 years that made me ask the question, “Why? Why be buried and have a marker if it’s going to be ignored and neglected over the years?”

Realistically, it’s likely that the spouse, children, or siblings of the deceased are the ones who are going to visit and maintain the grave. But after that, I suspect the grandchildren will likely have little interest and, after them, the marker is just something someone a few decades or centuries later may stand over and ask, “I wonder who this Dan guy was?”

I’m guessing that’s why graves are leased in many countries. In my grandparent’s home country of Germany, you lease a grave for up to 30 years.2 If the family doesn’t keep up with the rent or renew the lease (if allowed), the headstone is removed and someone else is placed in the grave. (Apparently, burials are to be done in such a way where the coffin and body decompose to facilitate putting someone new on top of you. Alternately, your bones may also be removed and placed in an ossuary.)

On the one hand, I would like to think that we keep our departed ancestors’ memories alive in our hearts and minds—I think of my parents daily—and that’s how and where we should reminisce about them. We shouldn’t need to stand over a grave to remember them. Yet, on the other hand, as I visited each of the graves, I felt a stronger connection to them just by standing there and being in their presence.

I also understand our own inherent desire to leave behind some evidence that we existed and that we hopefully made a positive difference in the world. But, realistically, the world remembers the actions of Paul Revere, Samuel Adams, and John Hancock, not their headstones. Their graves are just a historical footnote to their stories.

So what does all of this mean for me? I know that I want to be cremated; it’s just figuring out what to do with me afterwards.

Having my ashes scattered at sea (Navy veteran, duh) has been on my list for a long time, but I also love hanging out in the mountains and have thought about being scattered there instead. Then there’s the issue of having a marker of some sorts. If I feel compelled to have one, where would it be and what would it look like?

I have thought about national cemeteries as a possible option, and there are two here in San Diego.

The first is Fort Rosecrans National Cemetery high atop a bluff on Point Loma overlooking both the Pacific Ocean and San Diego Bay. Unfortunately, with over 101,000 souls already buried there, the cemetery is full and isn’t accepting new interments for either caskets or the columbarium.

Miramar National Cemetery opened in 2010 and is inland, located adjacent to Marine Corps Air Station Miramar so you get to listen to military jets taking off for eternity.

The columbarium at Miramar was about what you would expect it to be, but I have to admit that the niches were larger than I thought they needed to be. The niches gave me the feeling of being shoved in a drawer and sealed, and I didn’t find that all that appealing. The cemetery did, however, have a section for memorial plaques, presumably for those whose ashes were scattered elsewhere. I’ll have to check into that as an option if I want one.

Of course, I can change my mind at any time, and my final decision will land in my When I’m Gone binder with all the instructions for my family members, and not here on the blog.

We all know that day will eventually come, so it really shouldn’t be uncomfortable or even taboo to talk about it and what we want to have happen. Yes, I may have taken it to an extreme with the hourglass and date calculations, and that’s okay. If we plan ahead, it will ease the burden on those left behind during one of their most difficult times.

Maybe this has given you some food for thought and, more than anything, just remember:

The clock’s a-tickin’.

Be well!


1 What3Words is a website/app that divides the entire world into three meter by three meter squares and assigns a unique three word address to each square. If you have the three word address, you type it into the website/app and it will display that specific square on the map.

2 Depending on the grave type, the family will have to pay $40 to over $300 per year for the lease. The family is also legally required to maintain the grave, so they either do it themselves or hire a grave gardener.

Header image: Fort Rosecrans National Cemetery, San Diego, California

A Life Well Lived | Yet Another Prostate Cancer Blog

In nearly nine years of blogging about prostate cancer, I’ve learned that there’s a small but very supportive community of fellow patients fighting this disease.

That community just got a little smaller with the passing of Jim from “Yet Another Prostate Cancer Blog.”

Jim and I never met in person, but he was the person who commented on my posts and emailed me more than any other person. We both shared a passion for photography, and he followed my photography blog, providing his commentary there, too.

I knew this day was coming, but it came upon us sooner than expected.

Jim was an inspiration with his strength and attitude. He’ll be missed by many.

https://yapcab.wordpress.com/2019/08/17/a-life-well-lived/

Day 3,175 – Unexpected Consult & Twisted Thinking

Last Thursday, a physician came into our office (keep in mind my office is in a hospital) and was asking about how to bring a volunteer on board to shadow him in radiation oncology. Of course, my ears picked up with the “radiation oncology” part of his request.

After explaining the process to bring his volunteer on board, I asked him if Dr. W was still in radiation oncology. Dr. W was the radiation oncologist that I saw in May 2018 to discuss my rising PSA, and he told me then that he planned on retiring in the next year or so. Dr. W had, in fact, retired according to Dr. B, the physician with the volunteer question.

Dr. B asked how it was that I knew of Dr. W, so I explained that I had the consult with him for getting zapped for recurrent prostate cancer. A bit to my surprise, Dr. B started asking a question or two and, the next thing you know, we’re having a ten minute consultation in the lobby of my office.

In a nutshell:

  • His threshold for starting salvage radiation therapy for recurrent prostate cancer was when the PSA hit 0.10 ng/ml.
  • He talked of how statistically the likelihood of the cancer being in my prostate bed is pretty high. In a tangential way, he implied that having positive margins confirms that the cancer is still in the prostate bed; having negative margins, as I did, makes things slightly less certain.
  • We had a very cursory conversation about imaging technologies, but my sense was that his view of the newer technologies was more optimistic than what I’ve read about their effectiveness at my PSA level.
  • He talked about how deciding to treat is a very personal decision and that there’s no right or wrong answer. But, with a PSA of 0.10, he said that I will be dealing with this again at some point in the future and, if I wait too long, the options for dealing with it become fewer.

At the end of the conversation, he was saying a treatment decision is also based on life expectancy and overall general health. Nothing new here. If I was 85 and had a cardiac condition, he wouldn’t recommend zapping; but if I’m younger and in generally good health, he would treat. “I would get treated if it were me.”

I thanked him profusely for taking the time to have a hallway consult when he was under no obligation to do so. I told him that I have another PSA test coming up at the beginning of October, and that we’ll see what that brings.


Now for the funny part and insights into how twisted my thinking can be at times…

Dr. B’s comment about life expectancy struck a chord with me because it’s something that I often joke about.

My father died at the age of 69 and his mother also died at the age of 69, so I’ve always joked that I’ll follow in their footsteps and die at 69, too. “It’s hereditary,” I’d say. Most would find it pretty morbid and tell me to knock it off.

If you’ve been reading this blog for longer than three minutes, you know I’m a numbers guy (see post title). So on the bus ride home after speaking to Dr. B, curiosity got the better of me. I wondered how freaky it would be if my father and grandmother lived the same number of days in their 69-year lives. When I got home, I ran the numbers.

I plugged their birth and death dates into the duration calculator that I use to calculate the day number of these impromptu posts and found that they didn’t live the exact same number of days, but it was close. Dad outlived Oma by 49 days.

You know I couldn’t just leave it there.

If I live as long as my grandmother, I’ll be checking out of Hotel California on 29 July 2027. If I live as long as dad, it will be 16 September 2027. If I follow Dad’s trend an outlive him by 49 days, it will be 4 November 2027.

And then I had my “Oh, shit!” moment.

I may have less time remaining than the amount of time that I’ve been running this blog—3,029 days (best case) vs. 3,175 days.

I began to wonder what I will do in those eight remaining years. If I have only one big trip a year, what are the eight places I want to go see? How many more times will I see the people important to me if we see each other only once ever 1-3 years? How much longer will I continue to work?

I know it’s cliché as hell, but it was a bit of a wake-up call to get me off my butt and doing more than I am right now. Nothing like having a deadline to motivate you, eh?

I also know that there are no guarantees. I could get hit by a car crossing the street tomorrow, or I could live until I’m 90. I don’t dwell on any of this, but it’s nice to be reminded—albeit in a twisted way—that none of us are getting out of here alive, no matter how hard we try to avoid the inevitable, and that the days we have left should be cherished and embraced, whether in ways big or small.

Oh. If I make it to 5 November 2027, everything from then on is icing on the cake. 🙂