It's been nine months since I wrote to you last, and as I've said a few times on here: If you don't hear from me regularly, that's because everything is fine.  I'm happy to report that everything continues to be fine.

My most recent quarterly CT scan is essentially exactly the same as the one I described back in May.  Pulmonary fibrosis in the left lung's upper lobe mostly obscures anything else that might be in there.  But there are no signs or symptoms of active cancer cells there.  That's as a good a report as I can get, so I'm pleased to hear it once again.

It has now been five years since I was diagnosed with stage four lung cancer.  There was a time, not too long ago, when living for five years with my condition was an unusual feat.  Cancer treatment has advanced rapidly since then.

Let me paraphrase how my oncologist, Dr. Martins, puts it.  I used to tell my patients, he says, that if they make it to five years, they should bring me a cake at our next appointment.  He continues: When I started practicing oncology, I had a handful of patients who lived that long.

Then Dr. Martins pulls out his phone and starts showing me pictures of himself with a series of patients, each of them holding a cake.  There are a lot of pictures.  He says, I had to change my policy -- now you shouldn't bring me a cake until you make it to ten years.

So when he and I got together earlier this month, no cake was involved.  He did, however, say something that no medical professional had ever said out loud to me before.  Once again I'm paraphrasing: Bill, you know, it's possible that you will die of something other than lung cancer.

On one level, I guess that's obvious -- I mean, I need to look both ways when I cross the street just like you do!  But on another level, it's a big paradigm shift for me.

When I was diagnosed with metastatic lung cancer, I was told that I would almost certainly die from it.  The treatment goal has been to improve the quality and length of my life.  That's what "palliative care" means; going by the book, all metastatic lung cancer care is palliative.

So I guess my takeaway is that if you survive five years with this disease, you don't have to buy your oncologist a cake, but you do get a new paradigm.

None of which is to say that I'm not going to die from lung cancer sooner or later -- that's probably still the shorter-odds bet.  But the longer-odds bet isn't 100-to-1 or anything like that.  And that's a paradigm that will take me some time to get used to.  It's a pleasant problem to have.