Cancer Diaries— Fatigue That's Almost Like Trudging Through The Snow Of Thought

I Don't Even Know If That Makes Sense To Anyone But Me

That's me today with a self-portrait of Debora Iyall

Remembering vaguely from last time, I knew chemo would be exhausting, but there’s no real way to prepare for this kind of fatigue, even if you’ve been through it before. It’s not just being tired— it’s something deeper, heavier, almost existential. It’s like gravity has doubled, and every movement, every thought, every effort feels like wading through wet concrete. Last night I got home from the hospital and nearly passed out. I slept deeply, but for short periods of time. Today I want to get some work done and a few weeks ago I agreed to be filmed for a movie about Debora Iyall, the lead singer of Romeo Void, the band that in a certain sense launched my music business career. Now I’m too exhausted to do it but the filmmakers came to L.A. especially to shoot me, so I have to.

I’m guessing that the combination of Gemzar and Abraxane does its job well—attacking the cancer, keeping it from spreading— but it’s also draining me in a way that’s hard to describe. It’s not just physical exhaustion, though that’s certainly there. It’s a bone-deep weariness that seeps into everything. Even lifting a glass of water— even wanting a glass of water— feels like a small battle. Even forming thoughts, putting words together, can sometimes feel like trying to start a fire with damp matches.

Did you read “The Crack-Up,” an essay from a collection of essays of the same name by F. Scott Fitzgerald? This sounds eerily familiar: “Of course all life is a process of breaking down, but the blows that do the dramatic side of the work— the big sudden blows that come, or seem to come, from outside— the ones you remember and blame things on and, in moments of weakness, tell your friends about, don’t show their effect all at once. There is another sort of blow that comes from within— that you don’t feel until it’s too late to do anything about it.” It's even older than I am! It first appeared almost 90 years ago in Esquire.

That’s what this feels like— not just being tired, but slowly dissolving. Not all at once, but piece by piece, like an iceberg melting, each fragment drifting away, never to return. At first, the exhaustion comes in waves. One moment, I think I can sit up, maybe even write. The next, I’m overcome, as if some unseen hand has pressed me into the mattress, whispering, no, not yet. The simplest tasks become absurdly difficult. Even lifting a spoon requires calculation. Even thinking feels like trudging through waist-deep snow.

The fatigue isn’t just psychological— it has a direct, biological cause. One of the main culprits is Gemzar (Gemcitabine), a chemotherapy drug that works by interfering with DNA replication in rapidly dividing cells. That’s what makes it effective against cancer, but it doesn’t just target tumors; it also hits healthy fast-growing cells, including those in bone marrow. This leads to anemia, reducing the body’s ability to carry oxygen, which in turn saps energy at a cellular level. Then there’s Abraxane, which disrupts microtubules— structures essential for cell division— triggering widespread inflammation and nerve damage. The result? Profound, unshakable exhaustion. The body is waging an internal war, and energy is being diverted to the front lines, leaving little for anything else.

I'm finding that fatigue is making itself known in every moment. It turns light into glare, sound into noise, movement into burden. There’s no rest, not really. Sleep is fitful, alternatively deep and shallow, never enough. I think my body is working, repairing, fighting a battle unseen, and there is no reprieve. The air itself feels heavier, pressing down, insisting on stillness.

And yet, within this fog of exhaustion, there's still the mind, still the will, still the stubborn refusal to disappear into it completely. The world is blurred, muted, shifting— but I’m still here. I don’t want to sound maudlin but for now, I’m still here.

It comes in waves, too. One minute I might feel almost normal, and the next, it’s like a switch flips, and I’m completely spent. Sleep helps a little, but it’s not restorative the way it used to be. The body is in a constant state of repair, and it’s working overtime.

I’m still here, still writing when I can, still grateful for the treatment, for Medicare, for the doctors and nurses who do this work every day. And for all of you who have reached out, who are reading, who care. Believe me, that means more than you know. I like the way my friend Rachel phrased her well wishes yesterday: “May we all live to see the end of U.S fascism— and that's likely take quite a while.” And my life-long friend Michael sent me this inspirational song.