33 and Me
David R. Weiss – November 20, 2025
When Cancer Comes Calling – Book Three: Soundings #4
I’m not actually claiming an extra score of chromosomes. (That would make me a gray fox or a Przewalski’s horse, in case you wondered.) But over the past seven weeks I’ve had thirty-three sessions of radiation treatment for my prostate cancer. Thirty-three weekdays on which my morning to-do list has revolved around emptying my rectum, filling my bladder, lifting my shirt, and lowering my pants. You know, goals. Oh, and then supplicating science to restore a healthy measure of mortality to my cancer cells. Which is to say, kill off these damn cancer cells that have forgotten how to die.
Here’s a quick re-cap of the big picture. In early January 2025 I was officially diagnosed with prostate cancer. High risk. The biopsy showed maliciously malformed prostate cells: the type that are eager to metastasize—and only too happy to make a break for the bones. Fuck. In fact, a late January PET scan suggested that the cancer may have already set up an outpost in one of my pelvic lymph nodes.
In March I had my prostate removed, along with two lymph nodes. The lymph nodes were both benign. (Whew!) The prostate not so much. (No surprise there.) Still, the way oncologists score these things, my cancer moved from high risk to very high risk. Despite no seeming presence in my lymph nodes, the cancer had said hello to my seminal vesicle and neurovascular bundle on the left side. Both of these were also removed, but this made clear that my cancer was the traveling sort. Plus, there was a small “positive margin,” a place that cancer touched the edge of the prostate where it was cut out. Meaning some cancer may have been left behind. Small, as in only about a tenth of an inch. But with very high-risk cancer, a tenth of an inch is as good as a garage door. Fuck.
From March to mid-June was a waiting game. No next steps to plot until my first post-surgery PSA test could reveal whether I was (at least temporarily) “cancer free.” Or not. In the meantime, I focused on Kegel exercise to (successfully!) reclaim my continence. And I thought good thoughts.
But apparently not enough of them. Because in mid-June my PSA test revealed a persisting (dare I say apocalyptic?) presence of prostate cells—cancer cells!—in my body. A week later a PET scan indicated that neither of the lymph nodes removed in March was the one that was noted as suspicious back in January. That lymph node was now cancer-central. It was the only place harboring enough cancer cells to show up on the scan, although it now seemed likely that microscopic bits of cancer (too small to be picked up on the scan) were wandering around my pelvic area. Which is why “empty rectum, full bladder” has been my morning mantra since October 7.
That long gap from late June to early October was mostly me getting a grip on my rather grim prognosis. 85% of prostate cancers are low or intermediate risk, and in those cases the odds are decent for managing the cancer, even for effecting a complete cure. I know of at least four persons in my own extended family whose prostate cancer was like that. I assumed mine would be the same. But as one family practice doctor I saw remarked, “There are really two distinct types of prostate cancer—they almost ought to be called two different diseases. Because the high-risk type is an altogether heartless beast.” She said that after noting that both her father and her brother had the high-risk type. Like me. Fuck.
Getting a grip meant reading hundreds of pages, rearranging my medical team to center me and my goals and choices, and wrestling with the prospect of ADT: androgen deprivation therapy, i.e., chemical castration. In cases where radiation treatment is recommended for prostate cancer, ADT is often used to “frame” the radiation. ADT doesn’t typically kill cancer cells, but by depriving them of testosterone, it dramatically slows down their reproduction and may weaken them. It can hold the cancer in check. For a while at least.
But ADT is its own beast, with a host of challenging, debilitating, and cascading side effects. I was not eager to sign up. I managed to self-advocate for the one medication I viewed as the lesser of many evils. Then agreed to add a second ADT med—to achieve something called “testosterone annihilation” (fuck)—because doing so just might tip the odds a little bit in my favor. Where the odds are how long I can delay my cancer metastasizing, reaching my bones, and killing me. And there is a whole list of unsavory stops along that route.
Right now, my cancer (so far as we know) is still localized in my pelvic region: in my pelvic chain lymph nodes and the prostate bed (where my prostate used to be). I have no symptoms. No pain. No nothing. Just the foreboding knowledge that all day every day it dreams about my bones. Fuck. And so, because of its malevolent nature, our best bet is to hit it as HARD as we can while it’s still local. So that’s what we’re doing. ADT combination therapy to annihilate my testosterone, and radiation to try and kill as much of the cancer as we can. Right now.
So here we are. Thirty-three and me. I look just fine. And feel just fine (except for the side effects of treatment itself). But somewhere inside me are cancer cells playing a long game . . . in which I die. In response, I’m doing my best to play a long game of my own. In which I live. And live well. For as long as possible. And for the past seven weeks, that long game has revolved around emptying my rectum, filling my bladder, lifting my shirt, and lowering my pants. Small steps. Big hopes. Here’s how it works.
I had my initial meeting with my radiation oncologist in late August. I liked her. A lot. She was clearly invested in supporting me (and honoring my agency in setting my goals and making my treatment decisions). Beat the cancer, yes, but never lose sight of the patient as person. This is a rare gift: to professionally—and graciously—accompany people like me through unchosen liminal seasons in their lives. I am glad she’s my oncologist.
We agreed I would start the first ADT med in early September, add the second ADT med in mid-September, and then commence radiation therapy in early October. The initial ADT med I chose (Orgovyx) suppresses testosterone faster than other ADT meds, so the one-month lag time between starting it and starting radiation was sufficient. Plus, my PSA had started to rise again in August, which meant my cancer was reading travel brochures and it was time to act.
In late September we did my “simulation” session. This involved a CT scan creating a very through 3-D image of my pelvic area. It was my first “empty rectum, full bladder” protocol. The first hinges primarily on my regular routine (thanks, Metamucil!), the second on chugging 20-24 ounces of water about an hour beforehand—and holding it until the session is over. Alas, this is not an exact science! But for my simulation it worked fine.
The reason for this protocol is that both the rectum and bladder are immediately adjacent to the region (pelvic lymph nodes and prostate bed) targeted by the radiation. An empty rectum lies relatively flat and stays out of the way. Paradoxically, a full bladder pulls up and out of the way. Together, an empty rectum and a full bladder allows the radiation to pound the targeted areas while minimizing risk to healthy tissue right next door.
Radiation works by damaging the genetic material in cancer cells, eventually leading to their death. Two striking ironies here. Unlike most other diseases, cancer is not an outside pathogen infecting the body; it is one set of cells in the body … going rogue. It is part of my body turned against me. Second, these cells go rogue in large part by refusing to die. Our normal healthy cells die on a regular basis and are replaced by new ones. It is cancer cells’ quest for eternal life that threatens my desire to simply fill out my allotted years. So, radiation practices a form of “tough love,” reminding cancer cells the hard way that their role was always to die, so I can live.
Back to this simulation. The goal was to match the PET scan from late June (which pinpointed the cancer-stricken lymph node) to my empty rectum/full bladder body in September. And then use those overlaid scans to create the radiation plan specific to me. Besides this, the simulation scan also mapped my body with enough anatomical reference points so that each of the next thirty-three times, when I laid down on the table, they could line my body up in sync with that September 24 scan to ensure the programmed radiation would be accurate each time.
My radiation oncologist decided how much total radiation to use—and over how many sessions. The goal is to use sufficient total radiation to maximize damage to the cancer, but spread it out over enough sessions so the body can handle the inevitable collateral damage. Even as precisely as the radiation is targeted (98% of it hits the targeted 3D point), the other 2% takes a real toll on healthy tissue. However, unlike cancer cells, which can’t repair themselves, healthy cells can. Hence, my thirty-three sessions included weekends off, so my body had a chance to make repairs along the way.
After the simulation, someone—a dosimetrist, which I’m pretty sure is just medical speak for “wizard”—ran the calculations to create my specific treatment plan, determining precisely where in my body the beams of radiation would be aimed. I never met my dosimetrist, but I am in awe of their wizardry.
Beginning on October 7 and concluding on November 21, every weekday was empty rectum, fill bladder, lift shirt, lower pants. Though, of course, there’s more to it than that.
My treatments were done at the Radiation Cancer Center at St. John’s Hospital in Maplewood (part of the MHealth Fairview system). I couldn’t have been more pleased with the Cancer Center. I had my own “reserved” parking space in a dedicated parking lot just for cancer patients right outside the Cancer Center. I didn’t feel like I needed to park close, so most days I parked across the street to get some extra steps in. But it was nice to have the option on days when the weather was nasty.
The two receptionists were cheery and very quickly greeted me by name each day. It’s a small thing, but with so much at stake, small things matter. And getting compliments on my wide range of social justice and Pride t-shirts: priceless.
There is a code of “caring silence” in the waiting room. We don’t know exactly why anyone else is here, but we know none of us is here on vacation. I could tell some persons were in more precarious condition than I am (right now). Each cancer journey is unique: an amalgamation of diagnosis, progression, temperament, and support network. My diagnosis is hardly cheery, but my progression is minimal so far, my temperament is upbeat, and my support network is stellar. I have a lot to be grateful for.
Across the empty rectum, full bladder, lift shirt, lower pants routine, the full bladder was far and away the most fraught. I learned by trial and error (and occasional panic and embarrassment) that depending on whether I ate breakfast and what I ate for breakfast, those 20-24 ounces of water one hour before my treatment might have barely started to fill my bladder—or might be straining against it with preternatural force. Eventually I settled on not eating at all until after radiation. Then I could gauge pretty effectively how quickly that water moved through me.
I also learned that I fared better if I didn’t drive on a full bladder. Something about being seated and jostled by every little bump put added stress on my bladder. So, I tried to arrive thirty minutes early and take a walk before treatment. (By the way, research suggests that moderate exercise—like walking—right before radiation, can agitate the cancer cells in a way that makes it easier for radiation to take them out.)
Many days, since I often walked right up until my appointment time, I’d check in at the front desk and be directed right back to the “personal” waiting room just outside the radiation room itself. Some days I’d barely sit down before being called back for treatment. Other days I’d be crossing my legs in panic as the minutes ticked by. A few times I thought of Alan Shepard, the Mercury astronaut who, when his launch was delayed repeatedly, was finally granted permission to pee in his space suit. His launch went off—wet, but successful. My situation was a little different. Besides NOT being in a rocket ship, if I peed myself, there would be no launch. Bladder empty, my treatment would have to be rescheduled. My Kegel muscles got a workout!
One day I sat in that small waiting room for a few minutes with a woman young enough to be my daughter. She was there while her dad was getting treatment. He’d been diagnosed “out of the blue” with stage four lung cancer just this past February. It had quickly metastasized in his bones and he was getting radiation to relieve the severe pain in his hips. He was just 66 years old … which is what I’ll turn next month. And my cancer is dead-set on reaching my bones. While I am “life-set” on keeping my bones cancer-free. We chatted amiably, almost reverently, about our respective journeys: mine and her dads. I kept unspoken my somber recognition that I may have caught a glimpse of my future in her dad.
From that small waiting room, one of the radiation therapists would bring me into the treatment room, affectionately known as THE VAULT. I think there were always two and often three radiation therapists present. Sometimes one of them was a student. The room itself has a very sci-fi feel to it. If you’ve ever experienced an alien abduction, this room is like that room. Well, minus the Grays. And I’m sure this tech is not quite as advanced. Still, it’s impressive.
I’d be asked to lay on a metal table covered by a sheet, with a foam wedge to rest my bent legs on and a foam cradle for my head. Every day they asked me my last name and birthday. I’m not sure why anyone else would try to sneak into my treatment session, but I suppose they needed to be sure I was me. Fair enough. And before long, they all knew my birthday (it’s Christmas Day), so I’m counting on a couple extra gifts this year.
They, they, they. I probably met 8-10 different radiation therapists or students. There were maybe four “regulars” and the others were students or persons covering someone’s shift on a day off. How to characterize them? Cheery, friendly, relaxed. Serendipitously I discovered that almost all of them were trained at St. Kate’s, where I used to teach theology and work in campus ministry. Like I said earlier, it’s a small random thing, but with so much at stake, small things matter.
Their jobs are many. They are the daily human face of my treatment; they sanitize and prepare the room before I enter; they carefully position me on the table; they double-check my position and my rectum/bladder status, and then they run the machine that does the treatment. It’s a mix of personal presence and technical precision. They practice it with gentle care with necessary boundaries. They greeted me warmly every day, but let’s be honest, there is no room for personal investment in their patients. Professional excellence and personal care, yes. But each of our diagnoses is different: some better; some far worse. For some of us these treatments are intended to be curative. For others they are “merely” palliative—that is to relieve the pain of cancer that has run amok.
Frankly, we are too many. And we would weigh too much for them to bear, if they tried to befriend each of us. But their daily demeanor of universal well-wishes was unmistakably genuine. I felt I was in good hands—and good hearts—every day.
So, once I’m on the table, I’d raise my shirts and lower my sweat bottoms and underwear to my hips. Sometimes they’d need to lower my pants a bit further. I’m really not that modest, but I didn’t want to “overshoot” the pants lowering, so I figured I’d let them adjust things as needed. They draped a light towel across the upper edge of my lowered underwear; a small courtesy. And they gave me a small blue rubber donut to hold onto with my hands on my chest as I lay perfectly still. Then, while watching that image of me made on simulation day, now beaming from a large monitor in the room, they’d pull the sheet beneath me this way or that way, until the me of today matched the me of simulation day.
“Okay, we’re going to leave the room now.” Which is a polite way of saying, “Shit’s about to get real.” It is, after all, a foot-thick door they close on the way out. It’s called THE VAULT for a reason.
Is the room really a circle? I doubt it. But the ceiling has a large lit circle on it, with the sensors that help them position me. And a bunch of twinkling lights inside the circle, much like the star maps you might’ve seen if you’ve ever found yourself on an alien ship. Anyway, they keep your mind occupied since you can’t move. And you have to pee. I spent more time in that room looking at the ceiling than anything else. So, circle it is.
In the control room, they run a quick CT cone scan. Don’t ask me to explain. All I know is that it’s much quicker than a regular CT scan—and most importantly involves much less radiation. I had thirty-three of these, one each day, so less radiation is way better. This is the moment they can see whether my rectum is empty and my bladder full. I know, it seems a bit TMI, and yet, I’d rather they know if things are not right than just cross their fingers and hit “start.”
There were several days that, after the CT cone scan, they’d come back in and say, “David, your bladder is only 60% full. You’re going to need to drink some more water and sit out in the waiting room while we do the next person.” Ouch. Walk of shame. But the last thing I wanted was to have my bladder or rectum hit by radiation. So, I’d swallow my pride—and some more water—and wait for my next turn. One day, after the scan, one of the therapists came back in, told me to lie very still, and explained that my sweatpants had a metal ring to guide the drawstring. They needed to get that ring out of range without moving anything else. I (sheepishly) lay perfectly still while she lowered my pants to my thighs, and then we proceeded. That was the only day I wore those sweats!
The machine that does the CT cone scan has two parts. One sends the beams, the other receives them. In between is me. They rotate around me, 180 degrees opposite each other. The beam-sending part struck me like the head of a praying mantis … examining me. Not exactly a cheery thought, but once thought, I couldn’t unthink it. So, I simply began greeting it as “Mr. Mantis” each day. (I’m glad I didn’t christen it “Miss Mantis”; those encounters never end well for the man!)
After the scan is done—this takes maybe two to three minutes—there is an interminable pause between when the two scanner pieces retract and the radiation begins. I suspect it’s probably all of sixty seconds, but I always spent those sixty seconds wondering, “Why is it taking so long? Is my bladder not full?” “And, if it is, then why the hell aren’t we starting?” Einstein discovered time was relative to speed; it’s equally relative to the pressure on your bladder.
Finally, the table would “lock,” and it was Showtime. Did it actually lock or move? I don’t know. It did something, which felt like a slight but sudden shift underneath me. At times I felt for a split second like I might roll off. Yikes. A perceptual quirk of stillness, no doubt. A moment after the table shifted, two bright white lights blinked on the ceiling. And then, humming loudly, the Varian Edge Linear Accelerator would get to work. It was a big metal disc (the size of a truck tire?) with a small window in the center, from which it sent a controlled beam of x-rays into me. It could rotate 270 degrees around me. It made four slow arcs from my right to my left and then back again. Maybe 60 seconds per arc. One pair of arcs was treating my lymph nodes; the other my prostate bed. That’s how it was for 28 days. The last five days only my prostate bed was treated, so just two arcs on those days.
At some point early in my treatment, I began to imagine the radiation itself as Kali, the Hindu goddess of destruction. I needed her penchant for destruction—aimed at my cancer cells determined to live forever. Against the sound of the buzzing, I pictured Kali, a necklace of skulls bouncing around her neck and a bloody cleaver in her hand, doing her worst—to my benefit. Sure, her bedside manner was a bit brusque, but the image fit and I used it every day. I even wrote a poem about it—which I shared with my oncologist and therapists.
After the final arc, the buzzing stopped. I’m guessing that meant the treatment was over, but I lay still until I heard a voice say, “We’re all done.” Then I’d return the donut, pull up my pants, pull down my shirts, and hop off the table. From the time I entered the room until I left was only 10-15 minutes. I always said, “Thank you,” and “See you tomorrow” or “Have a good weekend.” But I was also always in a hurry to get to the bathroom, so no small talk.
Every Wednesday (so seven times during treatment) after my radiation session—and after that stop in the bathroom—I met briefly with my radiation oncologist to check in. First a nurse would take my temperature, blood pressure, pulse, oxygen. And ask about any side effects. During treatment my oncologist was mostly concerned to monitor any side effects and support me in mitigating them. I didn’t have any significant side effects, so our check-ins were mostly short and sweet.
By week three or four I admitted that my long-established and dearly held bathroom rhythms were in in complete disarray. Soft, thin, frequent stools. An annoyance, but very tolerable. “But no diarrhea?” my oncologist asked every week. (Diarrhea is a common side effect when radiation is so close to the rectum.) “No diarrhea,” I said each time. (And thank goodness). But she kept asking, and I could never quite tell if her question was mere medical curiosity, or if she was wondering when my bowels were going to break.
I’m also up 3-4 times a night to pee. And I have some slight burning. Both were expected side effects as my bladder is understandably irritated—probably pissed off at me. It means my sleep is less sound, and I’m a bit more tired as the day goes on. Again, an annoyance, but very tolerable. All of this should resolve within a month or so after treatment ends.
I seem to have battled fatigue (a significant side effect of both ADT and radiation) to a draw by maintaining a 10,000+ steps per day average from start to finish. And I’ve started a resistance training routine three days a week. It seems the best way to offset fatigue is to stay active. Go figure. Well, I have done that with zeal.
Nonetheless radiation fatigue is cumulative. It builds as your body works repeatedly to repair the collateral damage—and to tolerate the intentional damage. Many people report “sailing through” the first half of radiation … and being caught off guard by the fatigue when it hits HARD over the last several weeks. I haven’t been caught off guard, but I will confess that for the past two to three weeks it has hit HARD. My days are now stitched together by deep sighs. I wake up bone-weary. Most afternoons I take a 2-3-mile walk, and from the first step to the last, I am bone weary. I take a bath, and I am bone weary—and ready to doze off. I spend several hours each afternoon or evening thinking “I should do something productive,” only to discover that I am too zoned out to do anything more than breathe. And that with some effort.
This is weariness like I have never known. It, too, will abate by Christmas. Though it will linger for some time after treatment ends, because the damage done by the radiation continues to unfold for some time, too. But bone-weary has been met by beast-mode. My step-count for November is better than 11,000 steps per day. The two exist side by side right now. The weariness and the determination to stay active.
I’m on an embarrassing cocktail of prescription meds right now—six of them. I’m grateful, of course. But it can feel disempowering when my wellbeing seems to hinge on forces beyond me. Radiation included. Yet, I also have started using a variety of vitamins and supplements to support my body’s own capacity for health. I eat a healthy diet—and I practice time-restricted eating (all my calories are consumed within an 8-10-hour window, and I fast in between). That not only levels out my energy, it also inexorably stresses the cancer cells (which are not adapted for fasts like this). I read (a lot!) to understand my cancer and its possible treatments. And I walk. In all these ways I have learned to empower myself to be a partner in my treatment.
So much could go wrong. So much could go right. Whatever happens, I will not be a bystander in how it plays out.
In three months, I’ll meet with my radiation oncologist again. We’ll review my latest PSA test to gauge the effectiveness of these treatments. (The combination of radiation and ADT will continue to kill cancer for several months, which is why we wait to assess it.) I am both eager and anxious. I know my odds are long. I know I’m doing all the right things. I know there are no guarantees. And I know when we meet, we will both be fully present to each other in the room. (Margaret, too.) And today that promise of full presence is enough.
Until my next post, from bone weary to beast mode, I am … radiantly yours.
I’ve been chronicling my prostate cancer journey since my diagnosis in January 2025.
Find my first set of blogs (January-June 2025) in a pdf here: When Cancer Comes Calling: Innocence.
Find my second set of blogs (July-August 2025) in a pdf here: When Cancer Comes Calling: Awakening.
My third set (September 2025 and beyond) is under the theme “Soundings.” So far it includes:
#1 Self-Advocacy: Sorry—Not Sorry.
#2 ADT – Making Deals with the Devil.
#3 Courting Kali, Goddess of Destruction.
#4 33 and Me
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David Weiss is a theologian, writer, poet and hymnist, “writing into the whirlwind” of contemporary challenges, joys, and sorrows around climate crisis, sexuality, justice, peace, and family. Reach him at drw59mn@gmail.com. Read more at www.davidrweiss.com where he blogs under the theme, “Full Frontal Faith: Erring on the Edge of Honest.” Support him in Writing into the Whirlwind atwww.patreon.com/fullfrontalfaith.