My Hospital Adventures, Part 2

If you haven’t read Part 1, you’ll want to begin HERE.

I came home from the hospital on the afternoon of Friday the 21^st, feeling mighty proud of myself to be up and about only four days removed from major surgery. Of course it was difficult to move around easily—I wasn’t yet able to put on my socks and shoes—but my surgeon, Dr. K, and his team of residents warned me that it would take some time.

Meanwhile, I was still waiting for my plumbing to get fully functional. Part of the problem was the pain I felt whenever I tried to go; even deadened somewhat by the Percoset they gave me, it still hurt. The other part of the problem was that everything felt really, really tight. My stomach was swollen, but I’d been told it was due to the surgery. A lot of skin and muscle had been cut and retracted, and it would take time for the swelling to go down.

As the weekend progressed, though, I wasn’t so sure. It became harder to move around. Getting up off the couch was a major physical feat, and I would get some sharp pains in my torso. They had told me to keep walking, so I’d pace around but have to pause and concentrate to get a nice full breath. At first I attributed it to some kind of gas buildup, but then, as I lay in bed Friday night, my imagination took over. I envisioned my bladder expanding into my other organs, restricting their functioning; I pictured my bowels knotted up beyond function or repair. I could feel myself break into a cold sweat of panic.

When a small breakfast of tea and grapefruit came back up, I phoned the on-call urologist, and she told me to sip water throughout the day and keep walking.

Later that day, I noticed that my legs were swelling right above my sock line. A quick trip to the internet gave me the word edema, or water retention. It was a common effect of surgery.

It was a relief, but relief was temporary because I was really, really uncomfortable. I started to worry that I was retaining too much water when I saw that I was bloating out in different parts of my body (more on this later) and when I stepped on the scale to see it read 197 pounds—about fifteen above my normal weight.

Sunday was more of the same, so on Monday I spoke with Dr. C, the Chief Urology Resident who was a member of my surgical team and had been seeing me regularly the week before. I described my symptoms to him.

“Well, I don’t hear anything really alarming, but why don’t you come in today and we’ll have a look.”

Later, down at the office, a nurse practitioner named Teresa inspected my belly.

“This looks like edema, but I’ll have the doctor come take a look.”

“There’s something else,” I said and then delivered those four words that every nurse longs to hear: “My penis looks weird.”

She was unflappable and didn’t miss a beat. “What does it look like?”

I showed her, and she assured me that it, too, was just water retention that would eventually go away. She left to go find my doctor.

A few minutes later Dr. K walked in.

“Well first of all, there’s some good news,” he said. “Everything we took out was mature teratoma. Totally benign.”

Somewhere in the back of my mind I knew that the pathology had probably been completed, but I had not allowed myself to think about it. Now here it was, and all the dread that had built up in my mind about it evaporated in a flash. It’s tough to capture the joy of that moment. Shannon and I looked at each other, and on cue our eyes welled up. I could feel my throat go tight, and it wasn’t until then that I realized I had fully expected the news to be completely different; I was convinced that they would see something they didn’t like in the biopsy and that somehow—and I wasn’t at all sure how—I would have to make it through three more rounds of chemo.

But no. No more chemo, no more cancer. Everything benign.

And suddenly everything between that very second and that afternoon back in October when my oncologist walked into the exam room and said, “Your numbers are up” just melted away, and I could feel, for the first time in a long time, my life start to come back to me.

Even now, as I write this, the relief of that moment is so powerful, so palpable, that I can feel the tears rising steady as a chant. Cancer free, cancer free, cancer free.

“Now let’s have a look at that belly,” Dr. K said. He poked around a red patch that I hadn’t noticed before.

“There might be a little infection below the skin. I think I’ll pull a couple of the staples so it can drain, and I’ll send you home with wound care instructions.” He looked up at me and smiled. “After the big news, you can handle that, right?”

“Right.”

“Why don’t you hop up on the table.”

I had been dreading the “staple removal” stage. It didn’t look like they were coming out without some kind of fight, and I worried about just how much of a fight they would put up. When I was in the hospital, I asked one of the residents what it was like, and he said, “No big deal, not a problem.” When I then asked him if he’d ever had staples taken out of him, he looked at me sheepishly and said, “Well, no…”

I lay down on the table, and Dr. K stood over me with the removal tool that looked angular and sharp, like an angry metal bird who liked to bite.

Having staples removed is not pleasant. It’s certainly not the worst thing I encountered—not even close—but it’s not “no big deal.” Each tug was accompanied by a sharp little pinch, and for the several staples that got stuck on their way out, there was a little bit more.

After Dr. K removed a few down where the incision swerved around my belly button, he took a cotton-tipped swab to probe the opening a little.

And then suddenly I was gushing fluid. Like cutting a hole in a waterbed gushing.

It burbled up out of the wound and spread down my pelvis and sides. Dr. K and Teresa started ripping open gauze packages to staunch the flow. At first he thought it was a pocket of infection draining, but it kept coming. I made the mistake of looking down, and I could see that the bottom part of my incision was gaping wide.

“This is a big wound,” Dr. K said evenly. “I’m going to want to readmit you.”

“Readmit me to the hospital?”

“Yes.”

Sonofabitch was what flashed through my mind. I was this close to going home…

Then he started talking about a possible torn fascia, which could be serious. He told me that if the fascia below was torn, they’d have to reoperate to close it up. He asked me when I’d last eaten, and I told him that I had a sandwich a few hours earlier.

“I need to look around in there, and to do that I need to get rougher with you than I can here,” he said. “I’d like to get you in an OR tomorrow morning.”

The liquid kept coming, and I have to say that I finally felt some relief from the pressure that had been building this weekend. Still, though, it was a pretty messy. The gauze pads were useless; Teresa had gotten towels which I held over my midsection, and both were getting soaked with this pinkish-yellowish fluid. I just lay there as he told me that he’d get me admitted and be right back.

So there I was, about to be readmitted, looking at (at least) one more trip to the operating room. Once again I was dumbfounded at how quickly things turn. A few minutes earlier I had been told I was free of cancer and was halfway out the door and back to my life. Now, who knew what was coming?

The curtain of the room parted and Dr. C came in. He’d spoken to Dr. K and wanted to have a look of his own.

It became quickly apparent that whereas Dr. K was reluctant to “get rough” with me, Dr. C had no such compunction. He snapped on a glove and started to probe my wound. And by “probe” I mean he really dug around in there. I groaned and clutched at the exam table.

“What’s wrong?” he asked mildly.

Uh, your goddamn FINGERS are in my BODY.

“Hurts,” I managed to squeeze out.

“I’m not feeling a fascia tear,” he seemed to say more to himself than to me. Then he went right back to digging around inside me.

He stopped and told me that he’d like to get something called a wound vac on me when we got to my room. He explained what it was and what it would do, but I was too distracted by the knifing sensation, which was slow to ebb.

“No surgery?” I croaked.

“I don’t think so,” he said. “I’ll be right back.”

I was still panting when he returned.

“Okay, here’s what’s going to happen,” he said. “I’m going to pack your wound with a field dressing and then we’re going to walk briskly over to the hospital. When we get to your room, we’ll get some pain meds in you so that I can do a more thorough exam.”

“You mean like walk walk? Like literally walk?” That “more thorough exam” part also stuck in my head, but I had to take things one at a time here.

He looked at me. “Do you have a better idea?”

I had several, and not one of them involved me getting up on my feet. I had made that walk before when I had some pre-op tests done. It was about five minutes through a parking lot. I looked down at my body. I needed a new towel.

Dr. C packed the wound and started layering big gauze pads on top of me until my wound bulged to about the size of a softball. Then he slapped a giant abdominal pad over it and taped the whole thing down tight. He reached into a cabinet and tossed me a clean towel.

“You ready?”

My sweats were soaked almost to the knees, as was the back of my shirt. I had a gaping, wound in my midsection that was gushing some kind of fluid. And now I was supposed to get on my feet and walk “briskly” for about three hundred yards.

But then I looked at Dr. C, who had not a shred of doubt that I was going to make that walk. Emboldened by his confidence in me, I hiked up my soaking sweats, held the towel close over my dressing, and stood up.

He was a fast walker, and I did my best to keep up. It was a little difficult, because we were barely out of the building when I could feel that the dressing had given way and fluid was dripping down my leg. Halfway across the parking lot I looked behind me and could see a little trail. We hit the hospital lobby and made a beeline for Admissions.

“Have a seat over there,” he said, and turned to one of the admitting nurses.

I sat down for a few minutes and considered my soaked lap. I could feel the fluid rolling down my body, down my legs. When Dr. C called to me, I stood up and cringed at the giant wet spot on the seat. A puddle immediately began to collect on the floor between my legs. I looked over at the one other person in the waiting room—a man who stared at me, wide-eyed.

We hustled up to my room, where a nurse was waiting. He inserted an IV and started some pain meds while Dr. C was fiddling with some equipment.

“Okay,” he said. “Let’s have another look at that wound.”

Let me confess here and now that I would not hold up under torture. I always suspected as much, but I didn’t know for sure until I was on the bed in my room and Dr. C had his fingers in my body again. The meds had kicked in—I knew that much because my head was swimming—but it didn’t do much against Dr. C’s insistent fingers.

“Everything feels pretty good,” he said, which I mistakenly interpreted as meaning that he was finished. He wasn’t. He went back in twice more.

Finally, he was done. He packed the open wound with some foam and attached the wound vac, which was a little nozzle taped down tight over my belly and attached by a long thin hose to a portable unit. Once he got it fastened and turned on, pinkish liquid started to fill the reservoir tank on the unit.

It filled fast. Five hundred milliliters in about twenty minutes. When they changed the tank, they had to clamp off the suction, and a few seconds after they did, I could feel liquid seeping out from the tape around my wound and rolling down my body.

I filled a lot of tanks that night. The first couple took 20-30 minutes, and then they held steady at about an hour each. At some point, they brought in a big red box that said HAZARDOUS WASTE, where they deposited the full tanks. I wondered about that “hazardous” part; I had, after all, left a trail of this stuff across the parking lot and downstairs lobby, not to mention the puddle in Admissions.

Once they analyzed the fluid, there was a diagnosis. I had something called chylous ascites (KYE luss uh SITE eez), which was a possible complication of this surgery. What happens is that the channels that convey the lymphatic fluid get compromised during the surgery and don’t seal up, leaving the fluid to continue to flow and collect in the body. It resolves on its own, but timetables vary—days to months. It’s also exceedingly rare, occurring in only about 2% of patients who have the surgery. I knew it was rare because every doctor who visited me in the days that followed—Dr. K, Dr. C, a resident named Josiah and a medical student named Dustin—went out of his way to tell me just how rare it was.

I wasn’t sure what I should take away from that stat. Why should I care that it happens to only 2%? All that mattered right now was that it was happening to me.

Meanwhile, I continued to leak like a tanker run aground.

It was weird watching those tanks fill up. Those times when our bodies betray us have to be the most disorienting sensations there are. Our very identities come under siege, and from within no less—a civil war between our mental and physical selves. We all face it at one point or another and to varying degrees. Maybe we sweat uncontrollably in an interview or have a sudden gas attack in a crowded elevator. Or maybe it’s more serious—some cells decide to start growing and not stop. For sure, I’d been at war with my body since last October, but this last bit here was too much. I lay in bed that night and the next day and watched that fluid collect and collect with no end in sight, and there was nothing I could do except put my head back, close my eyes, and hiss, through clenched teeth, “STOP LEAKING.”

Not very effective.

They put me on a thrice-daily shot of Octreotide, a hormone that would reduce the production of the lymphatic fluid. They also put me on a no-fat diet to help accomplish the same. That’s “no-fat” as in zero fat, which is a lot different from “low-fat.” My meals consisted mainly of juice, tea, skim milk, and a plate of something like this:

They also started to give me a tiny sip of something called MCT oil every three hours, which extended through the night. So, every three hours I’d be awakened to drink a tiny amount of oil.

Eventually, my leak slowed. The tanks started to take about three hours to fill, and then on Tuesday night, they put a new one in that didn’t fill until twelve hours later.

On Wednesday they removed the vac and packed the wound. I kept walking but had to bring a towel along, because the dressing would only hold up for about an hour before it needed to be changed again.

My nurse that day, Juna, found wound bandages that were little plastic bags with a spigot on the end. She figured this would work better than gauze because when the bag filled up, I could just empty it.

We had to empty it twice that afternoon.

Around dinner time, Josiah came in with the new plan. I would have a CT in the morning and they would insert a drain in my side. I wasn’t crazy about the first part and even less enthused about the second. At this point, however, I kept telling myself, cancer-free.

The way I figured it, this was way more annoying than dangerous. In my mind, Cancer was pissed that I won and was giving me one last kick on my way out the door. If I handled everything that had come before, I could handle this, too.

The next morning when I woke up, the bag was almost completely dry.

Josiah was surprised but wanted to see how I did after eating and moving around. In the meantime, he canceled the CT.

After breakfast and countless laps through the hospital, the bag remained dry.

On Friday morning they decided to discharge me. Josiah came in to go over some instructions. Something had occurred to me, and I wanted to ask him about it.

“So I have a question for you,” I said.

“What’s up?”

“Now I know this surgery is pretty rare, and this condition is even more rare, right?”

“Right.”

“So, are you guys a little excited about it?”

I’d expected to encounter an immediate denial and effusive reassurances that my care was foremost in their minds, but he surprised me.

“Oh, yeah. That fluid was really something. I mean, to actually see it. Most of us will just read about it in a textbook.”

Well, glad to have helped out with their education.

Then he got down to the discharge instructions.

“For the next two weeks, we want you to maintain a no-fat diet.”

“No problem.”

“Also, we want you to continue to take the oil every three hours.”

“All right.”

“And you’ll need to give yourself a shot of Octreotide three times a day. Your nurse will show you how to do that.”

“Um, what?”

My friends Barb and Deb were visiting that morning, and I immediately confessed my anxiety about giving myself a shot. They tried to come up with possible solutions—driving to my doctor and having a nurse there do it, talking with someone in the Nursing Department at our college—but the more I thought about it, the more I decided that I  didn’t want to puss out before I even gave it a try.

My nurse that day, Sil, came in with some needles and saline solution. Once she laid out the materials and I saw them right in front of me, I felt myself starting to freeze up. But then I felt something else—something gathering inside me. It wasn’t anger, exactly; it was more like a fed-upness with things. I’d been poked, prodded, poisoned, scanned, injected, cut open, and stapled up over these last several months, and I’d be damned if I was going to let this last wrinkle get me.

I tugged my sweatshirt up and over my head. “Okay, let’s DO this,” I said.

I’ll spare the details of the self-injection, though I will say that sticking a needle into my abdomen ranks very high on my list of things that I hope to never have to do again.

So now I’m back home, eating my zero-fat diet, drinking my oil, changing the dressing on my wound, and giving myself a shot three times a day. I’ve got an appointment next week that I hope will put an end to three of these (I’ll still need to change the dressing), but if they have to go on a little longer, I can do it. And if something else comes up and I need some other procedure, I can do that, too. All of these scars have got to count for something.

My Hospital Adventures, Part I

A lot has happened since I last checked in. At the time of my last post, on March 8^th, my surgery was still nine days away and the real dread hadn’t yet set in. But when it came, it came gradually and then rapidly, kind of like this:

The hours just before surgery were the worst.

The procedure, even in its abbreviated form—RPLND—sounds awful. All those letters. The full name is worse, of course. Retroperitoneal Lymph Node Dissection. “High risk,” according to my surgeon and everything I had been reading on the internet. Six hours on the table, an incision running from my sternum to below my belly button, scalpels (and whatever else they use) slicing around organs, nerves, and two major blood pipelines—the aorta and vena cava.

I checked in at 5:30 on the morning of the seventeenth. Outside the hospital it was dark and quiet; inside the hospital, the only activity was from the few of us scheduled for surgery. Me and Shannon, an older couple, and two women. It was easy to identify which person in each group was headed for the table; told to wear “comfortable clothes,” we all opted for sweats and slippers. After we handed over our insurance cards and got tagged with wristbands, we shuffled over to the elevator and headed up to pre-op.

Prepping for surgery entails getting naked, being hooked up to machines, and waiting.

When you’re waiting to do something unpleasant, time does funny things. It’s both longer and shorter than usual. At one point I lay there for what seemed like an hour to see that only ten minutes had passed; another time, the clock had jumped from 6:30 to 7 seemingly in the blink of an eye. During all of this, I was visited by various people—all kinds of nurses, members of my surgical team, anesthesiologists.

At a certain point, you just have to give in and see yourself as a piece of meat to be poked, prodded, moved around, cut open, and put back together.

Close to 7:20, they wheeled me into the OR, put an epidural into my back, and not long after that I was asleep.

I blinked myself back into awareness in the recovery room. People were calling my name. I made no attempt to move, and nobody asked me to. I couldn’t have even if I wanted because of a few new tethers—two more IV lines (though they weren’t attached to anything), cables on my chest, an oxygen line under my nose, leg massagers, and a catheter.

They didn’t have a room ready for me, so I lay in recovery for a few hours, over which time I became vaguely aware of a dull ache down my middle. I had two triggers for pain—one upped the epidural and the other Dialaudid, a painkiller. While I was there, they continued to wheel people in from the operating room. The only one who made an impression on me must have had some serious sedation based on her anesthesiologist’s half of their conversation, the only half I could hear:

“MICHELLE! Wake UP!

“MICHELLE!

“MICHELLE! Can you raise your right hand?

“MICHELLE! Raise your right hand!

“MICHELLE! Wake UP!

“MICHELLE!”

  

The first day was all about immobility, and only partly because of my huge incision. The drugs from the epidural had not quite distributed themselves evenly, so my right side was way more numb than my left. I couldn’t, in fact, really move my right leg at all.

I was in the first bed of a semi-private room. My roommate was a gravelly voice on the other side of the curtain. I asked him how long he’d been there, and he just said, “Long time.” Other than that, I only heard him say “No” (in response to the nurse asking if he wanted to get out of bed), “Pain meds” (in response to the nurse on the other end of his call button), and “Nausea meds” (in response to the same).

When lunch came that first day, the voice croaked out, apropos of nothing, “You should get the baked fish. I get it every day.”

“They’re not giving me anything yet,” I said. “Not even ice chips.”

“The baked fish is good. I get it every day.”

“They said I might get some liquids tomorrow.”

“Y’oughta try that baked fish.”

Okay, I thought. Please stop saying “baked fish.”

Shannon brought the boys to visit on Tuesday afternoon. I wanted to at least be on my feet for that, but nothing doing. Instead, a nurse’s aid helped me into a wheelchair and rolled me out to a lounge area, where I had the energy to visit for about a half hour.

On the ride home, Shannon told me later, Tony said that he didn’t like how everyone could see my butt. I didn’t have the heart to tell him that my catheterized wingwang had also been on pretty prominent display.

The next day they removed the main dressing and I got the first good look at my scar.

The days unfolded in long stretches of nothing punctuated by short bursts of intense activity—a nurse appearing to check my vitals and give me a shot, a resident stopping by to look at my incision, my phone ringing. This would go on through night, too. I’d be lucky enough to slip into some pocket of deep sleep, only to wake up as a nurse velcroed a blood pressure cuff on my arm.

And everyone asked the same question—Have you passed any gas?

I slowly shed my tethers—first the EKG cables, then the oxygen, and then the epidural. I wanted to start walking, and my main inspiration was my roommate.

I never really found out what was wrong with him, but he never had any visitors, and I overheard his nurses talk about moving him to a care facility. I thought he was pretty old, but one night, there was an Emergency marathon on the retro channel that he never seemed to shut off, and he said that he watched that show as a kid.

Holy shit, I thought. I watched that show as a kid. He couldn’t have been more than fifty.

He was in a bad way, but it was also clear to me that he was playing a kind of game with his nurses. During a shift change, I heard his nurse tell her replacement that he could move all of his limbs but refused to get out of bed. And at least twice a day, when his nurse suggested that he get out of bed and sit in a chair, he’d respond, “Nice try.” Once, he even warned the nurse, “I’m going to spoil your day today.”

Near the end of the week I was free of everything but my IV (the catheter came out Wednesday, and it was not a pleasant experience). I worked hard to get out of bed and into a chair by myself. To do that, and to then get myself out of the chair, I had to focus on using just my arms and legs. This is harder than it sounds; we use our abs for nearly everything. But whenever I’d use mine, a lightning bolt of pain would rip down the front of my body.

Once I could get up and out, I would amble, turtle-like, around the halls outside—first one lap at a time, then three, then as many as I wanted. There was a magnetic board with little cars on it in the hallway where patients could keep track of their laps (twenty-six equaled a mile, apparently), so I commandeered a green pickup truck and started keeping count. 

Every time I walked past that board and the sign next to it—“Bed is the patient’s #1 enemy”—I thought of my roommate, and how the nurses were now working on a new problem with him. He’d been constipated for four days.

“Ya better bring the dynamite!” he told them at least five times, inexplicably cheerful.

I’d hear this and think, Oh, hey, here’s an idea, Mr. Beddy-Bye: get up off your ass and stop packing your gullet with baked fish.

I couldn’t hang around that room. I walked lap after lap in the hall, and then I’d venture outside the ward and into the hospital proper. I kept track of the NCAA tournament games on my phone, and when a close one was winding down, I’d slip quietly into my room to catch the end.

Discharge came a day early—Friday instead of Saturday. The charge nurse removed my IV, went over instructions with me, and asked if I wanted to be taken downstairs in a wheelchair.

I didn’t. I worked hard to get walking again, and I wasn’t about to be wheeled out. Before I left, I wished my roommate luck. I felt bad for him. Life in a bed is no life at all. I had no idea what led him there or what was keeping him there, and I didn’t want to know. I hope I never know.

Leaving that hospital, I was happy to be heading home, and I felt a lot better than I had on Tuesday.

What I didn’t know at the time was that things were going to change over the weekend, and that in a few short days I’d be readmitted.

False Peaks

When I biked across the country, my single worst day came pretty late in the trip. I was crossing from Tennessee into North Carolina on Highway 165, which is known around those parts as the Cherohala Skyway. My new friend Lawson—whom I’d met about a week earlier in Clarksville, Tennessee—told me that it was beautiful country.

And it was. Or I guess it was. It was kind of hard to pay attention because soon after I started out on it, I was climbing.

Obviously, at that point of my journey, I had done my share of climbing with a loaded touring bike. I’d already made it through the Lagunas in southern California, the Rockies in Colorado, and the Ozarks in southern Missouri. But the Appalacians—the mountain range I was crossing here—presented a different problem. Even though they’re not nearly as high as the Rockies, the roads are cut into them much differently—steeper and more winding.

I also had no real idea where I was. My phone read NO SERVICE almost as soon as I started up, and on my map, the road was little more than a squiggle through a big green field. No markers, nothing.

And then there were the motorcycles. Hoards of them passed me in both directions all day long, their motors chopping the air in rising fits until they’d appear either in front or behind me. I came to hate that noise, those thick tires, all that shiny chrome. I came to hate their riders, too, with those ZZ Top beards, leather vests, and thick, hairy forearms.

Okay, I didn’t hate them all. The ones who threw me a peace sign or a thumbs-up or a few quick taps on the horn as they passed, they were all right. But the others had to go. And so did their engines, which did all the work for them.

But the worst part about that day were all of the false peaks. I climbed for six hours, twisting and turning up and up, telling myself as I rounded a bend—panting, sweating, ready to fall over—that this had to be the last one, this had to be the top, the road had to level off here and start to drop.

But no. Each time I would curl around a wall of rock and trees only to find that I was still going up.

This day came back to me two weeks ago, when I met with a surgeon to go over my latest scans. After my fourth and final round of chemo, my doctor scheduled a PET/CT scan. The PET part of things checks for cancerous activity, while the CT would provide a picture of the tumor sites to see how they compared with the scan I had back in October, at the start of it all.

The PET was clear. No real surprise there; my blood had been free of tumor markers since the second round of chemo. The CT, however, was a different story. Not much change from before. The specialists involved—my oncologist, my urologist, and my surgeon—were in accord on two points. First, that the tumors were more than likely benign, and second, that they had to come out. Surgery. A big one, as it turns out.

The procedure is called a retroperitoneal lymph node dissection, or RPLND for short, and I’d been putting it far out of my mind since my initial forays onto the internet back in October. It’s an invasive, complicated, and, yes, risky procedure given the proximity of the tumors to a few important innards, like my aorta.

As my surgeon ran through the finer points—six hours on the table, maybe close to a week in the hospital, a couple of other details that didn’t make it through the blood pounding in my ears—I kept thinking about that road that climbed forever. I felt like I was on it again. Just when I think I’ve crested, just when I think I can start to cruise a little bit, I turn the corner to find another false peak, that there’s still some climbing to do.

It started to feel like too much for me.

And then I remembered how that day on the Cherohala Skyway finished up.

Things came to a head late in the day. I was on hour six of the climb when I saw a little grassy area with a picnic table off to the left. That was it for me. I’d had enough and pulled over to camp for the night.

I leaned my bike against the picnic table and changed out of my soaking jersey. Feeling a  little better, I unhitched the bag containing my tent and sleeping pad from the rear rack and let it drop to the concrete pad with what I thought would be a definitive thump, but it caught the edge of the table and rolled onto the soft grass with hardly a sound. The only place to pitch my tent was on a narrow gash of lawn that almost immediately became forest. A quick rummaging through my handlebar bag revealed the contents of my larder: a few almonds, dried blueberries, and a pouch of tuna.

It was overcast and cool as the day headed into dusk. A blanket of trees defined the contours of the rolling mountains, and pockets of mist were starting to form in some of the indentations. These were the same woods that lay just beyond the picnic table; I could walk into them and within ten feet the road, these tables, and my bike would all disappear. In a few hours the forest would come alive, its inhabitants looking for food.

I remembered reading that bears could smell food up to eleven miles away.

The road had been empty for a while. Did the police patrol it at all? Maybe a state trooper would rouse me from my tent in the middle of the night. Better that, I figured, than a bear looking for my nuts and berries and tuna.

My phone still read NO SERVICE. If something were to happen, I had no way to call for help. And under a thick blanket of night, even with my lights, escape might be more dangerous than staying put.

At that point in my trip, I should have been more immune to the indecision of the road than I was. I walked to the edge of the grass trying to make something materialize in the forest, some clue that would tell me if I’d be safe that night, but there was nothing.

I picked up my bag, not sure what to do.

I’ve got to get out of here.

I’ll be fine if I stay.

No, I’ll die if I stay.

It was six-thirty. With rows of mountains behind me, the sun was already invisible, and its remaining light was being swallowed by the long shadows spilling from the forest. In another forty-five minutes or so, those shadows would roll right over me.

I decided to go for it.

And what did I find? The summit of those Goddamn mountains that I’d been climbing all Goddamn day was slyly waiting for me barely a half mile up the road. As I crested the top, I took a deep breath before hurtling down—beating the bears, beating the dark, beating my own bonked out, noodle-like legs—to a little town called Robbinsville.

So I’m hoping that this surgery on the 17th isn’t another false peak, that there won’t be any complications, that I won’t have to go through another round of “insurance” chemo. I’m ready for this road that I’ve been on since last October to start to level off.

But if it doesn’t just yet, I know what I’m supposed to do. Keep pedaling.