Before the May 25 cancer surgery that took my tongue, I’d been lifting weights, steadily but poorly, for a decade, and that habit is in part responsible for me pulling through the horrific aftermath of the surgery. The more physically robust a person is, the greater the margin for pain and for recovery—and I feel like I barely made it through the long, brutal surgical recovery period, which constituted the whole summer, followed by chemo in July and August, and then by an indolent infection in September and October. I weighed 175 lbs before my first cancer surgery, in October 2022, and bottomed out in the 133 – 136 range last summer. Now I’m hovering between 138 – 142, despite extensive, annoying, continuous efforts to eat more, via both mouth and feeding tube injection. Eating can be a pleasure or pain, but eating for weight gain isn’t fun, particularly when the weight gain is elusive.

For months, food has stolen too much focus from me, because I need to avoid missing meals to maximize calories. Did I just wake up? Time to make a smoothie, or blend some leftovers, and then inject a bag of Liquid Hope through my feeding tube. Is the sun scooching past its zenith, which means lunch time is a little behind me? Then some calories need to go in. Are we getting past 8:00 p.m.? That’s a potential problem because of acid reflux if I lie down too soon after eating. Whatever else I’m doing, or learning, or concentrating on, there’s an annoying cognitive process weighing my food needs running in the back of my mind. Weight training can help me gain weight, yes, but to make the weight training effective, I have to consume enough calories—with “enough” tending to mean “somewhat more than I’ve been able to ingest on any given day.” Since I can’t chew or swallow normally, food must be blended with water for either injection or swallowing, and water reduces caloric density.

Eating is important, but, as noted, I hope to augment food with lifting. Before that first surgery, I could rep 145 lb on the squat fairly easily, and I was working my deadlift reps towards 225 lbs—”two plates,” in meathead parlance.[1] Not a lot, but better than no training. When I got back into the gym maybe a month after my first partial glossectomy in November 2022, I felt like I could barely lift my arms, and had to re-start with the bar on the squat rack, and 15 lbs training bumpers on either side of the deadlift hex bar. I started re-building as best I could, though I knew that radiation therapy would probably knock me back again.

In being knocked back, I feel some kinship with the totality of humanity. For most of human existence, humans have been building up all kinds of tribes, structures, and/or civilizations, only to be knocked back by weather, climate change, internal dissension, greed, barbarians, technological regression, disease, or some other force. It’s only since the Industrial Revolution that humans have managed to mostly transcend the condition of agricultural misery and paucity, though we might wind up in such horrifying conditions again, via nuclear war or plague or some other malady. As individuals, we’re less robust than contemporary societies or cultures, and we’re prone to setbacks like the ones I’ve experienced. I suspect that how a person responds to setbacks says something about them; my view is that the appropriate response to adversity is to persist, even futilely, even as one possibly rages against the dying light.

That philosophical outlook is evident in me going to the gym despite feeling wretched and janky. To not go is to risk not replenishing my margin for future, and (realistically) inevitable setbacks. To not go means there is worse to come. Sure, as long as the clinical trial drug petosemtamab keeps working, I can probably hover in the 140 lbs range without risk of organ failure or starvation. Apart from being skeletally thin, the other worry is the next bump in the road. What if I need another surgery? What if there’s more chemo in my future—which I expect before the end, even if “more chemo” is an effort to hold the line as I exit one clinical trial and before beginning another? What if a clinical-trial drug causes nausea? What if re-irradiation comes, and the pain that already accompanies swallowing worsens? I list the known unknowns: the unknown unknowns are infinite.

As I write this, I take a break to check my weight: 140.1 lbs. Not great but could be worse. The last week hasn’t been ideal regarding the gym : on Monday I was wrapped up in a project, Tuesday I flew to San Diego and got settled there, Wednesday I had a petosemtamab infusion, Thursday I flew home, Friday I withdrew from the prescribed dexamethasone—a steroid—that is supposed to help prevent infusion reactions to petosemtamab, and today, Saturday, I finally got in to do overhead press, hangs, and the leg press. I should’ve squatted but delayed, making excuses. The fire that used to inspire me to pump iron is gone. Meatheads speak of the “pump” when they lift; Arnold Schwarzenegger described it in Pumping Iron:

The greatest feeling you can get in a gym or the most satisfying feeling you can get in the gym is the pump. Let’s say you train your biceps, blood is rushing in to your muscles and that’s what we call the pump. Your muscles get a really tight feeling like your skin is going to explode any minute and its really tight and its like someone is blowing air into your muscle and it just blows up and it feels different, it feels fantastic. It’s as satisfying to me as cumming is, you know, as in having sex with a woman and cumming. So can you believe how much I am in heaven? I am like getting the feeling of cumming in the gym; I’m getting the feeling of cumming at home; I’m getting the feeling of cumming backstage; when I pump up, when I pose out in front of 5000 people I get the same feeling, so I am cumming day and night. It’s terrific, right? So you know, I am in heaven.

I personally haven’t experienced the level of, um, endorphin rush that Arnold describes—I suspect few people do, or gyms would be packed—but I’ve gotten a pale imitation of the physical satisfaction he cites. My occupations have been thinky and sedentary, and running or lifting contrasts with sitting in the chair or standing and typing. Unfortunately, whatever physical pleasures lifting once brought have dissipated. Now, it’s more chore than not. An important chore, but a chore. It used to be fun. I used to know how to make it fun. I’m sad that that sense of fun is gone, and I’ve not really been able to rekindle it.