Interesting Days

Bortozomib Blues

Well, it’s Monday morning around ten o’clock. The last four or five days have been really interesting. Last Thursday I went to the hospital for my weekly injection of bortozemib, the proteasome inhibitor that I take along with my chemo meds and dexamethasone. My bortozemib injections have always left a type of raised, red rash at the injection site on my belly. To try to alleviate the itching and swelling I took fifty mg of Benadryl to try to counteract the rash and swelling caused by the bortozemib. We also applied Benadryl cream to the injection site. The rash doesn’t hurt per se, but it’s super itchy and I feel like I need to reach down inside of the injection site to scratch my insides. It’s very annoying. Probably more important, though, is staying on this course of treatment. We had to stop a previous attempt at treatment with another chemo cocktail because the injections of the drug I was getting during that treatment were causing a huge rash, fiery red and raised, covering most of my midsection. This time I wanted to keep the rash under control so I could carry on with this chemo cocktail.

This past Thursday, the oncology nurses looked at the rash I was getting from my injections (which seemed to be getting worse week by week) and decided to bring in a doctor to see if there was anything we could do to mitigate it. After some consultation, they decided to inject the bortozemib into my right arm instead of my belly. Along with that strategy, they recommended taking more Benadryl. Well, I can say that the strategy was a success as far as the action at the injection site is concerned. There is way less irritation, rash, and swelling at the injection site in my arm than in my tummy. Today, five days after the injection, the irritation is minimal. However, now I had to deal with the effects of increased doses of Benadryl.

I didn’t think I could sleep that many hours straight. Last Friday I was more or less fine during the day and into the evening. We even went out for an hour or so late in the afternoon. Later, at around eight o’clock in the evening, I took fifty milligrams of Benadryl to try to really hit the rash before it got going. Well, that worked. Even though the dexamethasone usually keeps me awake all night, this night was different and I slept all night. In the morning I took some more Benadryl and was less than alert after that. In fact, I was pretty much stoned the whole day. Remember, I’m taking hydromorphone, a synthetic opioid, for pain already. Stacking Benadryl on top of that left me incapable of much of anything, especially clear thinking. Reading and writing were beyond me. Saturday night I went to bed around eight o’clock, fell asleep as soon as my head hit the pillow and stayed that way until seven-thirty on Sunday morning except for a couple of pee breaks. Even then, I was still semi-stoned. Sunday was a day of backing off the Benadryl! We found that the swelling and the rash around my injection site on my arm were not too bad. We applied some ice and that helped calm down the swelling too. Today, the itch is pretty much gone. I’m pretty happy about that.

So, the moral of the story seems to be that I have to get stoned to mitigate the swelling and rash that are caused by the bortozemib. Oh well, if that’s the price I have to pay, so be it.

Lab Work

Today was one of my regular lab days. I have standing requisitions at the lab every two weeks for one set of tests, once a month for another set, and once every three months for a set ordered by my kidney specialist. The techs are getting to know me at the lab in Cumberland. Today I gave up five vials of blood and a container of urine. Later today I’ll be able to access the results of some of the tests online via MyHealth. I’ll do that and carry on here then.

Okay, so it’s five o’clock and I checked my lab results. The few results that are in point to numbers back within reference ranges or in very positive, normalizing trends. Works for me.

Thursday will be another interesting day. We’ll be going to Campbell River Hospital to get my right femur x-rayed and for a consultation with the orthopaedic surgeon. I’m kind of worried about the excavations in my femur. I’m hoping the chemo and the zoledronic acid have done something to stabilize my bone marrow over the past couple of months. We’ll know more next week.

About pain, cold sweats, hallucinations, delayed chemotherapy, rashes and, other fun stuff.

[A note: I’m used to writing posts here of approximately a thousand words. Because I’m so fatigued with anemia and other conditions that affect my concentration, for the foreseeable future I’ll make my blog posts a little shorter. That way I will be able to continue writing and not tire myself out too much.]

I started the chemotherapy drugs, lenalidomide and dexamethasone last Thursday morning. I was to take one lenalidomide tablet and five dexamethasone, continue with the lenalidomide for three more weeks and five dexamethasone tablets every Thursday morning until they were done. Frankly, it was a relief to finally get going on a treatment for my multiple myeloma (MM), any treatment. Well, you know what they say about the best laid plans of mice and me. They never go according to plan, and this was not about to become an exception to the rule.

It must have been Saturday (I got a CT scan that day) when I noticed that my butt was getting really itchy. Well, naturally, I scratched it. I knew it isn’t a good thing to scratch an itch, but I just couldn’t help myself. The welts just got bigger and hotter and covered my whole midsection. I developed a slight fever. Carolyn, my very competent care aide spread some lotion on my backside and up under my armpits to relieve some of the itching. Damn good thing too because I was close to losing it.

Well, it turns out that the reason I developed this rash in the first place is that I happen to be allergic to my main chemotherapy drug, lenalidomide. Now, that’s not cool! Lenalidomide is an oral therapy drug, and for that reason is very convenient to take. So, it’s the weekend, I’m itchy as hell, but I persist in taking my chemo meds. On Tuesday, yesterday, I call the oncology nurse in Victoria who seemed quite concerned about the rash. She tells me that she would try to track down my oncologist to get some idea of what to do. My regular oncologist was out of the Cancer Centre at meetings but she tracked down his colleague who told the nurse to tell me to cease taking lenolidomide immediately. So, great. Here I am, not a week into taking my first course of chemo meds and now I can’t take them anymore! What the hell is that all about, universe?

I was pretty bummed out for a time there, but then I realized that this is not an uncommon turn of events in oncology. In fact, about 40% of people enrolled in the lenalidomide/dexamethasone regimen turn out not to be able to tolerate the drugs.

A Cancer Clinic receptionist called this morning to set up a telephone consultation with my oncologist for the 20th, next Wednesday. At that time I should learn more about my next course of treatment as well as what they learned from my last CT scan. Strangely enough, I also got a call from the hospital here in Courtenay telling my that I needed to call them and set up a second course of treatment. She mentioned lenalidomide and I said it’s unlikely that it would be for lenalidomide because in all likelihood, I’m allergic to it and I was told to stop taking it. I guess it takes a while for messages to get from Victoria to Courtenay and back. I soon learned to take all phone calls from the hospital or the Cancer Clinic with a grain of salt and usually wait for confirmation from a third source before moving on with anything.

In my next post I’ll address the fun topics of pain, hallucinations, and cold sweats.

I was going to write a post about the social triage that happens in emergency departments everywhere, and I will get around to that, but for now I have other more pressing issues to deal with. I’m intent on documenting my experiences with myeloma as completely as possible so, for the moment, that will be my priority for this blog. One strange thing that’s happened to me is that I have a recurring dream about the emergency department at the Royal Jubilee Hospital. More on that to come.

Lose your job to automation: Mourn or celebrate?

The three links below of several hundreds that can be found on the internet news sources these days indicate clearly the rapidly accelerating advance of automated technology moving towards the elimination of jobs.

Walmart

Australia

Japan

So far, the action seems to be very widespread but is moving especially rapidly in retail as is clear from the evidence in Australia, Japan and the US. The rationale used to justify automation by Walmart management in the US is creative and ridiculous at the same time. Nobody in management wants to say that their companies are trying to reduce or eliminate their workforces altogether. But that’s exactly what’s happening.

Karl Marx predicted this very outcome in the mid-19th Century arguing that in their efforts to control or reduce their costs of production, businesses, after overproducing in the search for profits, turn to automation to control their labour force and return to profitability. The process has been going on for a long time.

It seems perfectly reasonable for businesses to try to become more ‘efficient’ by automating jobs that are tedious and repetitive, often dangerous. For individual businesses this seems like an effective strategy to control their costs and their processes. The problem is that there is anarchy in the business world, no coordination, and competition prevents cooperation between businesses in the same field of operations. The result is that there is a reduction in the aggregate number of workers in any given area and the reality is that bots don’t buy anything. Workers are also consumers so doing away with workers is doing away with your very own customers. Nobody I know in business is worried about taking customers away from their competitors, but if Walmart eliminates much of its labour force by automation that will inevitably also reduce its customer base.

So, the question is should you mourn or celebrate the loss of your job through automation? The answer is yes and no. The actual issue is not jobs, but income. You should definitely mourn loss of income. The loss of a job not so much. Jobs, i.e, employment, are not really in sync with the human capacity to work. Humans, as Veblen is quick to point out, are programmed to work, but if they are presented with meaningless, repetitive, boring work that is really to make someone else look good or get rich, they balk. So doing away with boring, stupid, meaningless jobs is a good thing in my mind. Several countries are now toying with a guaranteed basic income. It will take some time yet for the importance of this strategy to become more widespread.

We’re at a real crossroads at the moment. With the advent of advanced robotics, automation, and especially artificial intelligence, work will be required of fewer and fewer people for shorter and shorter lengths of time. There will be, in a very short period of time, a huge surplus of people as workers and a shortage of people as consumers. The elimination of tedious labour could result in an explosion of creative energy as people are freed to think for themselves and act according to their talents and abilities. However, they will need income to be able to do that.

One thing for sure, there will have to be a greater distribution of wealth because it does no one any good to hoard cash and take money out of circulation. It sure doesn’t help corporations involved in the sale of consumer goods. From this perspective, banks and financial institutions are at loggerheads with consumer driven businesses. There will have to evolve a very different ethic, one at odds with the current capitalist Neo-liberal one that I wrote about in my last blog post.

The Azure window collapse and ‘social ills’: a view from a ‘right wing’ website.

I realized  that there is no link here to the original article. Here it is: http://theduran.com/collapse-maltas-azure-window-can-teach-us-social-ills/

This is an interesting article with many Beckerian twists and turns. The basic argument is: Don’t sweat it because you die, we all die, and that’s just the way it is. We don’t need to be sentimental about species extinction or environmental protection.

So, should we be concerned about death, animal suffering, species extinction, climate change, the disappearance of viable forests and any number of other issues as being catastrophic and unacceptable?

I wanted to post this, but I’m not ready yet to comment yet in any detail. Soon. This is such an important moral question.

Quality and Morality

 

Quality Foods. Quality furniture. Quality trucks. Quality, Quality, Quality. Shite. Robert Persig some time ago wrote a book about quality. It’s called Zen and the Art of Motorcycle Maintenance. As Persig writes, his book has little to do with Zen and not much to do with motorcycle maintenance either. This was a very important book for me as I grappled with certain philosophical concepts in my youth. In Zen and the Art of Motorcycle Maintenance, the main protagonist goes catatonic after getting caught in his self-made vortex of contradiction around the idea of quality. As a fellow college instructor, I can relate to his descent into catatonia, although I was never able to quite make it all the way to its deepest reaches as Phaedrus (the eventual name of his protagonist) did.

 

The way we use the concept of quality these days drives me a little crazy but I’m not going to go grammar nazi and chastise all the unfortunates among us who constantly misuse the term or simply use it as a synonym for good. These days, quality stands for good. We seem to have lost the ability to qualify quality. Does Quality Foods refer to mediocre quality foods, poor quality foods or high quality foods? Well, that’s a silly question, isn’t it? Of course, the owners of Quality Foods mean it to refer to high quality foods. Any other conclusion would be nonsense. I presume that if we want to point out that a product or service is of poor quality we have to include the adjective ‘poor’ to qualify quality. Quality used by itself now means good. Any reference to any other kind of quality must be qualified with an adjective. Still pisses me off because it’s such a denial of the potential poverty of quality but I guess that’s just the way language evolves.

 

So, now I want to apply the concept of quality to morality. Can we talk about the quality of moral precepts? Can we come up with a hierarchy of moral precepts that go from good to evil or are all moral precepts supposed to be good. What does it mean to be a moral person? To what does ‘morality’ refer? I turn to this last question now, the others I deal with later and in subsequent posts.

 

The dictionary that comes with the Mac operating system defines morality as ‘principles concerning the distinction between right and wrong or good and bad behavior.’ The Miriam-Webster Learner’s Dictionary gives a “Simple Definition of morality [as]

  • beliefs about what is right behavior and what is wrong behavior
  • the degree to which something is right and good: the moral goodness or badness of something.”

 

Fair enough. That seems straightforward, but is it? Are we born knowing the difference between right and wrong, good and bad? If you believe that you probably also believe you were born knowing how to speak English. Not likely. Good and bad are social constructs and can only exist socially.

 

Obviously any judgment of behaviour can only be made when more or less discrete behaviours are compared with one another. The concept of morality cannot apply to an individual’s behaviour divorced from its social context. ‘Good’ or ‘bad’ are inherently relative concepts. There are no behaviours that I know of that can be universally and consistently viewed as good or bad. You might argue that killing and rape are universally and always bad. If you did, you’d be wrong. Killing is only bad in certain contexts particularly when it is unsanctioned by the state[1]. In certain cases, such as in military combat, a soldier may be court-martialled for not obeying a direct order to kill an enemy combatant. In many contexts, killing is expected of one, so killing is not a universal bad. In fact, it would be considered morally reprehensible not to kill if it meant putting innocent people in danger. No matter how strongly we may be repulsed by it, rape is also morally ambivalent and in certain contexts is considered a duty. The Bosnian War was the scene of mass rapes perpetrated by combatants who were given direct orders to do so by their commanding officers.[2]

 

In Emile Durkheim’s work, morality is a word that describes how to measure the intensity of our connections to our societies. I add that it’s used to judge the quality of individual behaviour as it aligns with overall social (including sexual), political and economic values. It stands to reason then that in a class based society[3] moral judgments of behaviour will need to be made in a context where, as Marx noted, the ideas of the ruling class are the ruling ideas.[4]

 

To be continued…

 

Up next, morality and sexuality. I touched on this briefly in my last post, but I want to consider how important moral judgments are around sexuality.

Following that, I want to explore the politics of morality or why poor people are considered to be moral degenerates and made to feel shame and guilt for their situation.

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[1] The ‘state’ is one of those words that elicits controversy. I once did a graduate course decades ago now where the only task we had was to define the state. Not a simple task as it turns out.

[2] http://www.independent.co.uk/news/world/europe/bosnia-war-crimes-the-rapes-went-on-day-and-night-robert-fisk-in-mostar-gathers-detailed-evidence-of-1471656.html

[3] I won’t question the popular unquestioning definition of society here. I’ll leave that for a future blog post. Harold Adams Innis is a masterful critic of the conventional definition of society. I wrote my Master’s dissertation on Harold Innis’ work and it’s available on my blog.

[4] Of course, the ruling class is not homogeneous, it evolves over time, gaining and losing power in times and places. Still, there are some basic precepts and expectations of behaviour that we find are fairly ubiquitous in societies where the capitalist mode of production predominates.

Why do we so often refer to sex as dirty?

My next post was supposed to be about morality and that will be the subject of a number of future posts, but I was listening to the CBC this morning and the guest host of the morning program was interviewing a comedian and talking about his upcoming show. That tweaked my interest as I sipped my coffee. The host asked the comedian if his show was going to be clean. The comedian responded that for the most part it would be but that it would also be dirty at times. Well, I just had to weigh in. Morality will just have to wait a bit.

By dirty I know, and you know, that the host and the comedian were referring to the use of  swear words like fuck and shit and piss in his routine. He was not, however, going to make specific reference to the sex act and have some fun with that. That would be too raunchy. After all, you’ve got to keep it safe for a regular audience or they won’t come back to see you again. Swearing, it seems, is fair game. It’s okay to make fun of your wife or yourself in a comedy routine, but it’s not okay to talk explicitly about what went wrong or right the last time you had sex. That will be okay in the not-too-distant future, I expect.

It’s quite telling that in English swearing is almost exclusively sex based or has to do with genitalia or bodily functions of one sort or the other. In French Canada, swearing is entirely different, or at least it was when I was a kid. In French swearing relates to religious things although it can stray into combining sex or bodily functions with objects or persons of religions significance. For instance, a great swearing line in French refers to the ‘holy cream of an old nun.’ It’s probably changing now to a more ‘cleanly’ sex-based expression. Tell me if you know. I’m not up on Québecois swearing behaviour these days. In English, of course, fuck is the word or choice in a number of expressions not at all related to sex, but the word clearly relates to coitus or the sex act. For instance we might exclaim upon seeing a cute cat video: “Wasn’t that just the cutest fucking thing you’ve ever seen?” Or, listen to George Carlin classify people into three categories. He says that there are stupid people, people who don’t give a shit and people who are just fucking nuts!

So, what about this sex is dirty thing? Well, Ernest Becker (in his many books, but especially The Denial of Death and Escape From Evil, concludes that it all goes back to our fear or terror of death,* which also has a lot to say about how women are so often poorly treated in our world and in times past.  So what does considering sex as dirty have to do with our fear of death and the way women are so often (mis)treated?

It’s a bit of a truism to say that we all live and die. Yes, we do, but we don’t necessarily like the dying part so we concoct all sorts of cultural mechanisms to help us deny  that fact. One way we do that is to separate ourselves linguistically from other animal species by referring to ourselves as ‘human’ and to those other things as ‘animals.’ Of course, we are animals and it’s hard to deny that because we’re obviously not plants or rocks, but that doesn’t matter. We deny anyway. That kind of attitude allows us to treat animals in all kinds of nasty ways, because, well, they aren’t human and God did say that he put them here on earth for us to have dominion over. We are spiritual beings, animals aren’t. Enough said.

More significantly however we also take great care to separate ourselves into male and female classes. Yes, I say classes because that’s what’s happening. Just as we consider ourselves spiritual beings and animals as spiritless, we have also contrived historically to consider men as spiritual beings and women as physical beings. In many parts of the world in every time in history women have been considered a lesser species than men.

There’s a simple, yet devastating reason for this. Women remind men at every turn that they are mortal. Women exude blood on a regular basis. Babies are born between shit and piss in an orgy of blood. You lose blood, you die. Men have gone to extraordinary lengths to deny their physicality, their animality, and emphasize their spirituality to the detriment of women. Men in some cultures wear anal plugs to show that they don’t need to shit. They are above that. Menstruating women are often shunned for fear that they might contaminate something or other. Men denigrate women at every turn. Not all men, of course, but our culture and many in the past have built massive institutions that denigrate women. The pornography ‘industry’ is a good example of that. It’s popularity attests to how important sex is to us, but how important it also is to objectify women and treat them as sexual objects and as not quite human. Generally speaking, women are way more important to men for their genitals than for their brains. Hillary Clinton is facing this fact right now in the U.S. Many men just can’t see the president of the United States being fucked. Tell me it ain’t so.

Sin, in Christian, Muslim and Judaic mythology often refers to succumbing to the temptations of the flesh, female flesh that is. The flesh is the territory of the devil. If you want to live forever  in the light of God then stay clear of unauthorized sexual pleasure. “Unauthorized’ here is a critical element in the preceding sentence. Although constantly being revised and rethought, when and how sex gets authorized and becomes okay is strictly defined in cultural precepts. That’s fodder for another blog post.

Oh, we take sex very seriously in our culture, in our time, but we have very contradictory ideas about it. Yes, the sex act is fun and all that, but it also brings us clearly into the physical world and that’s a dangerous place to be if you want to be immortal.

In my next post, I’ll consider how sex and our animality fit into our broader moral world.
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