In 2005, six months after his release from prison, Billy Joe noted some blood in his urine. By then he had moved back to New York City. He had had more than enough of the southwest.
He went to the Bronx Veterans Affairs Hospital to have it checked out. A month later, he received the news. He had prostate cancer.
According to the VA oncologist, his tumor grade and clinical risk were intermediate. He opted for radical prostatectomy followed by external radiotherapy. Other than some transient urinary incontinence and some radiation induced proctitis – which was literally and figuratively a pain in the ass – he recovered uneventfully. He did have some degree of persistent erectile dysfunction, but that was why they had invented Viagra. And, in the VA, it was basically free.
He went back to work as a mechanic in a small garage owned by a discreet ex con who asked no questions about his felonious past. Keeping true to his innate tendencies, he maintained a solitary lifestyle.
Billy Joe was now almost sixty years old. Other than the frequent memories that erupted without warning in both his waking and sleeping consciousness, there was no violence in his life.
He began to look forward to retirement in 2014, and the accompanying modest financial security that Social Security and his Vietnam War pension benefits would then provide.
In 2016, he began to feel pain in his left forearm. It looked somewhat swollen. He mentioned it to his internist at the VA who was now also treating him for mild hypertension and diabetes. He was referred to a young oncologist who had all the bedside skills of a mortician. That said, the kid was smart and well trained. After some tests, including a biopsy, he told Billy Joe that he had a sarcoma in the muscle of his left forearm. Nonchalantly, he added that, given Billy Joe’s history, it was likely that both his cancers were a result of exposure to Agent Orange in Vietnam. He added that, as a result, Billy Joe was likely to be entitled to additional benefits from the VA. He made it sound like Billy Joe had won a prize.
Agent Orange was the most commonly used defoliant during the Vietnam war. It is a mixture of two herbicides with, for good measure, traces of one of the most toxic dioxins known to man. According to some estimates, approximately 20 million gallons, or the equivalent of about thirty Olympic size swimming pools, of the chemical were eventually sprayed over the countryside, and at least four million Vietnamese were exposed to its effects.
Agent Orange’s military purpose was to remove as much of the enemy’s ground cover as possible. The Army initially maintained that it was harmless to humans.
Over time, it is become increasingly clear that Agent Orange is in fact causally linked to numerous adverse health consequences, including various birth defects and multiple types of cancer.
Billy Joe and some of the other Rats would sometimes joke that, given their level of exposure in the tunnels, they might as well have bathed in the stuff.
During his “spare time” at the New Mexico State penitentiary Billy Joe had read a lot. The prison library was incongruously well-stocked, and his literary tastes had roamed freely and broadly.
His religious perspective had coalesced around the philosophical viewpoint that most organized religions, particularly those who emphasized the dialectic of sin and redemption, were no more than a Machiavellian and brilliantly conceived mechanism for effective crowd control.
On the other hand, he perceived most philosophers as self-absorbed navel gazers who were overly infatuated with their solipsistic mental and verbal gymnastics.
He had also read enough to know that sarcomas were not a good thing.
Given this backdrop, he took the news with logical equanimity.
Shit happens. Then you die. It’s all a matter of stochastics.
That said, he was quite ready and willing to undergo a couple of attempts at treatment as long as these did not overly adversely affect his quality of life. However, if and when things got bad, he had no interest in pursuing any unreasonable and futile attempts to squeeze out a few extra moments of misery.
The oncologic surgeon said that he thought he could remove the tumor without the need for amputation. Billy Joe had already decided that amputation was not an acceptable option, so he agreed to a wide surgical excision followed by radiotherapy.
He ultimately required a skin graft for wound closure, which was achieved by transplanting some skin from his left thigh. This caused Billy Joe to sardonically wonder if he would now be able to walk around on all fours.
Overall, he responded well to treatment, and there was no evidence of local or metastatic recurrence.
Until June of 2019, when, after his routine biannual follow-up evaluation and CT scan, he was informed that he had developed new lesions in both his liver and lung. He was offered participation in a clinical trial testing a combination of chemotherapeutic agents which he could not pronounce or spell. After hearing the long list of potential side effects and the uncertain overall clinical benefits of treatment, he told the oncology team that, given that he had now attained the biblical threescore and ten year milestone, it was probably time to quit. They asked him to reconsider, and pointed out that his overall functional status was excellent, that he should therefore be able to tolerate treatment better than most, and that he would be advancing medical science.
“So, let’s say I agree. How much extra time do you think I might have compared to if I did nothing?”
“Well, that’s something we obviously don’t know for certain and that is why we need to do the clinical trials. But I would say it should buy you at least an extra year or so.”
“And how much of that extra year will I be feeling sick from the treatment?”
“Obviously, we don’t know that either for sure. But, it shouldn’t be more than six months.”
“Listen, Doc. I think you’re a nice guy, and I think you mean well. So don’t take this the wrong way, but you’re a fucking idiot.”