I’ve been silent because I’ve been so very sick: swallowing has gotten much harder, and aspiration of food or liquid much more common, to the point that on July 1 I got a new PEG tube put in. Given how much removing the previous tube felt like a triumph, the new installation, although it’s keeping me alive, hurts. Literally and figuratively. Other physical problems I might write more about later are bedeviling me too—to the point that I wonder how much time I have left.

Being physically sick is one crisis; the second is that recent scans show that Seagen’s PDL1V is not holding back the tumors any more. I have to either switch trials, which I’m not sure I have the energy to do, or accept the end. Bess and I are working on a possible trial switch. But I’m swamped by headaches and fatigue. I don’t wake up properly. Foggy-headedness never abates. It may be that I’ve written my last essay (Bess saw this over my shoulder and she says she thinks I’ve not, but she’s an optimist about my longevity and writing abilities). I finished “Uncomfortable truth: How close is ‘positivity culture’ to delusion and denial?” a month ago. I meant to turn the last year’s writing into a memoir, like I’ve meant to do many other things, but cancer treatment is a more-than-full-time job, and now physical problems are knocking off a bunch of IQ points. I don’t know how many watts the brain typically consumes, but I feel like I need more, and the energetic processes that normally sustain and propel me are dysregulated.

Another recovery for a period of time is possible. If I don’t get there, thanks for reading. I still don’t know how to say goodbye, except by example.

An update. If you’ve gotten this far, consider the Go Fund Me that’s funding ongoing care.