Breathing in The Grey Zone of the Incurable

Early on, when my oncologist had to complete my insurance paperwork, she wrote "palliative," and I panicked. At our follow-up meeting, I asked her if this meant I was heading for end-of-life hospice care. She reassured me: "No, it just means the cancer is not curable."

Over time, though, I’ve come to feel that the palliative label carries a more subtle implication for Stage 4 lung cancer patients: that proactive treatments which might extend survival aren’t typically offered unless symptoms demand it.

I hesitate to say “the system is giving up on advanced LC patients” - the phrasing is too emotionally loaded - but there does seem to be an element of cost–benefit analysis at work. Something along the lines of: How much effort should be spent adding two months to the life of a terminal patient, at the expense of other patients or of investing in prevention and early detection?

It’s a harsh calculation, but in a world of limited resources, it’s the kind of decision healthcare systems have to make. This is partly why guidelines exist. They shield oncologists from having to make these agonizing life-and-death decisions; they can rely on “the protocol.”

Yet, the science is changing faster than the paperwork. New treatments can now extend Stage 4 survival not by a couple of months but by many. This is no longer the cancer of a decade ago, and the protocols must be revised to reflect this progress.

Bureaucracies are slow to move by their very nature; for patients with terminal cancer, however, that slow pace is glacially slow. Time is a finite resource we simply do not have the luxury to waste waiting for the system to catch up.

Victory Memorial Park & Funeral Centre

A Stroll Through the Dome (with a taste of flowers)

One of the most interesting features at the Brew Creek Centre—where the Callanish cancer retreat was held one week ago—is the farm. They grow organic vegetables both indoors and outdoors, supplying fine restaurants and a few exclusive local grocery stores.

I visited one of their two geodesic growing domes. The air inside was pleasantly warm and humid, almost like a tropical garden. By coincidence, one of the growers was tending the dome at the time, and she kindly showed me around. She explained that this particular dome is devoted to edible flowers and plants used to decorate cocktails and dishes at upscale restaurants. The ones I’m munching on in the photo tasted a bit like radish.

A Guy Walks Into a Psychiatrist’s Office

I have a small tradition: I always wear a colorful  shirt to medical appointments.  My psychiatrist is the only doctor who ever noticed, even commenting on how cheerful my shirt was at our first meeting.

When I walked in today, he glanced at me but was too polite to mention that my shirt was plain.

I didn’t want him to worry that something might be wrong, so I reassured him: I’d simply run out of colourful shirts. To keep things interesting, I decided to do what many women do when updating their look—add an accessory. I turned my back to him, just enough to reveal the subtle addition. It was a fluffy, unmistakable white fox tail attached to my belt loop.

In Meaning-Centered Therapy, humor is one of the ways to "connect with life." As Viktor Frankl wrote, humor is "another of the soul’s weapons in the fight for self-preservation." It helps create the necessary distance from a situation to rise above it, even momentarily. The fox tail was proof that I understood the lesson. I didn't run out of clean colorful shirts; I did my homework and I was ready to graduate, even as I failed the exam on "Life as a Living Legacy."

The Perfect Cracked Shell

Wednesday morning’s group activity at the cancer retreat was about looking forward.

In the centre of the table lay a collection of moon snail shells from Haida Gwaii. Each of us chose one in turn. I was last, so it was fate’s hand that the only remaining shell turned out to be the perfect one for me—cracked, and thus different and unique, even if not the most pleasing to the eye.
We were given strips of Japanese paper, each meant to carry a written wish beginning with: “May I trust…”, “May I love…”, “May I find…”, “May I forgive…”. Then we returned to the circle to share some of our words, which would later be rolled tightly and placed inside the shells. Someone called them “Prayers in a shell.” My own “May I…” wishes are shown below.

May I love Sheryl forever,
and may Sheryl find another love.

May the next game level, the boss level,
be a never ending dream.

That evening, gathered around the fireplace, we spoke about the day and how we felt about the retreat. I went first:

“I read earlier in the news that Vancouver will experience a king tide over the next few days. That means big waves washing ashore. It made me think how the days at the retreat have been like the ocean—sometimes big waves, sometimes small ones. Overall, I feel it was worth riding them.”

I don’t regret coming. It allowed me to witness moving stories and raw emotions from wonderful human beings sharing a similar misadventure. While the psychological approach here may not align perfectly with my analytical, cerebral worldview, I can see how it helps others heal.

I had a follow-up conversation with the counsellor, and we agreed that Callanish can’t be everything for everyone—nothing can. I knew the kind of retreat I was coming to, and I chose to attend because I was curious and open to different approaches. This isn’t a place to debate the nature of reality or consciousness; it’s a place to face loss and grief.

She asked me, “Did you come here for healing?”

“Not necessarily,” I said. “I wanted to be at peace with dying, and I’ve found that in recent months—by becoming comfortable with the unknown from a scientific perspective, without relying on the supernatural.”

She said she was glad I came, and that there are many ways to feel.

Exit Through the Gift Shop

This morning’s group session at the Callanish cancer retreat began with each of us sharing how we felt about it being the last day. I didn’t want to offer any concluding remarks—they would have sounded too terminal.

Instead, I said:

“On the way from the lodge, by the creek, there’s a patch of red, flaming leaves standing out against the green grass. As I passed by, I thought I’d like to gather them and bring them home, to scatter around like rose petals—since I don’t think the gift shop [ed: there isn’t one] has anything Sheryl would like.”

One of Them Is Not Like the Others

This afternoon at the Callanish cancer retreat, I had a one-on-one session with the creative arts clinical counsellor. She began by saying we could take the meeting in different directions, depending on what I preferred.

I asked if she could help me express my feelings instead of my thoughts. I told her I’m an analytical overthinker — as my psychedelic therapist once said, “feel more and think less.” During that session, I even had to increase the psilocybin dose just to let go, because I’m too cerebral.

She spent the next half hour reassuring me that it’s better to stay true to myself than to force emotions or imitate the way others express theirs.

I apologized for turning an art therapy session into counselling and asked if I could still create something. She smiled and said, “Of course — you can come anytime the room is open and work on it.” I chose yarn as my medium, though I admitted I didn’t know how to knit. She suggested using transparent glue to attach the threads to paper.

My piece, shown below, represents the eight other group members as straight, coloured threads. My own thread is white and set diagonally — different, but “cut from the same cloth.”

As the Sesame Street song says: “We all sing the same song.”
She also chuckled at my attempts at humor, so I figured we were on the same page.

A Stone by Any Other Name

The second day of the morning’s group session at the Callanish cancer retreat included a grief ritual. The intent was to release feelings of loss that may have been bottled up, through a symbolic ceremony.

In the centre of our circle was a table with a pile of stones, carefully picked up from the beaches of Haida Gwaii, with the permission of the elders. We were instructed to choose stones from the collection, think about loved ones we had lost, and inscribe their names on the rocks.

I picked up just one stone, the smallest I could find, to stand for the infinitely small, insignificant grain of dust I represent in the grand scheme of things. On one side I wrote self. There wasn’t enough space on the other side for a long word, so I wrote not. I’m not myself, and I’m grieving for the loss of the self that is to come.

I had time left, so I started making little animals out of rocks.

The ritual ended by laying down the stones in a bowl of water and covering it with petals.

The World, and I

Sunday morning at the Callanish cancer retreat began at 7:45, before breakfast, with chanting, followed by mindful meditation. We continued with a Qigong practice and ended with a crystal bowl meditation—the part I liked most, because I’m fascinated by the way the vibrations seem to entwine and linger in the air.

Afterward, we gathered in a circle to talk about our individual experiences—coping with cancer, or, for the lucky ones, navigating recovery. Then came a group activity: working with clay. As a tactile person, I’ve always preferred petting moss when it’s soft and green after the rain. Clay, on the other hand, is either wet and sticky or hard and cold. The instructions were to create something unconsciously, without worrying about aesthetics.

As an analytical overthinker, I suspect my piece had the most details. I called it The World, and I. Most of the canvas was devoted to an idyllic, naive, childlike depiction of happiness: a flamboyant butterfly, a smiling yellow sun, baby-blue skies, a tree, and a moss-covered rock. Then, set apart in the corner, there I am—a whisper in monochrome. White, like the lung cancer ribbon that marks me. Black, like the shadow that follows.​​​​​​​​​​​​​​​​

Afterlife Edition

I read an article this morning: "Suzanne Somers's Canadian husband made an 'AI twin' of the late actress":

Alan Hamel, a Canadian entertainer and longtime TV personality, recently told People magazine that he's created an "AI twin" of Hollywood star Suzanne Somers—his wife and partner of 55 years, who passed away in 2023 from breast cancer. The AI was trained on all 27 of Suzanne's books and hundreds of interviews, "so that she's really ready to be asked any question at all and be able to answer it, because the answer will be within her."

When Sheryl heard about it, she said: "I want one of these AIs with your personality."

There's just one problem: what would we use to train it? There isn't enough of my own material to feed the machine. With EA's permission, we could use the source code I've contributed to over the past 20 years—but I suspect the resulting AI would only speak in half-finished comments and deprecated functions.

Conversations with it would probably be even more frustrating than the real thing.

Still, it's nice to think someone might want to keep talking to me—even if someday it will just be a deadbot chatting with another deadbot.

I asked Gemini to generate an image with my photo as a computer screen

My friend Vince

Vincent Lam, my friend and former colleague, passed away from lung cancer on Oct. 2. He was 50. Here is what I shared at his memorial service earlier today.

I'd like to say a few words about my friend Vince.

We met about 18 years ago at Electronic Arts. He was a model team lead—professional, kind, and thoughtful—a sentiment shared by many of his colleagues from Arista as well.

After he left EA, Vince was the one who took the initiative to keep us connected outside of work, organizing lunches with former colleagues: myself, James, and Mike. Over the years, my wife Sheryl, Alven, and Vince shared many good times together—swapping travel stories over meals, taking in concerts and performances, and even playing in the snow. This is the kind of human Vince was: a natural connector, bringing people together.

I’d like to jump ahead now to March 23 of this year, when I encountered Vince at BC Cancer as he was coming out of chemotherapy. I’ve always had anxiety around needles, so I asked him what the IV was like. He replied, calmly, that you only feel the initial poke in the hand, then it's fine. That’s the kind of human Vince was: calm, composed, and reassuring to those around him.

The very next day, March 24, I received the results of my own biopsy and was diagnosed with stage 4 lung cancer. This profound coincidence, where both of us were walking the same dark path, is something I feel will bind Vince and me for eternity.

Our last meeting in person was about three months ago, when we went for a walk on New West Quay. By then, I was struggling deeply with existential distress and death anxiety. Even though his medical condition was far worse than mine, he was the one comforting me—helping me face my fears about decline. “I’m not afraid to die,” he said. This is the kind of human Vince was: truly fearless and selfless, offering comfort even while enduring greater suffering himself.

Vince embodied the idea that Viktor Frankl wrote about in Man's Search for Meaning:
“The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity—even under the most difficult circumstances—to add a deeper meaning to his life. It may remain brave, dignified and unselfish.”

In our last message exchange, I mentioned a side effect of my medication—stomach upset—and told him that dietary changes weren’t helping. I was focused on my minor inconvenience, while he was enduring chemotherapy and radiation. He simply replied: "Ah, I guess so. But a good BM (bowel movement) will make one's day." This is the kind of human Vince was: humble, selfless, and still using humor to make his friend feel better.

Vince lived with quiet courage, grace, and humor to the very end. He brought people together, lifted their spirits, and faced life’s hardest moments with calm and dignity. Those who knew him will remember not only his strength, but the kindness and light he shared so generously with everyone around him.

May 2010. Vince hasn't aged at all