Hemo Intuition

Today is Chemo Day 36, out of 56 in this chemo block.  Of course, that’s not counting the 21 days we spent waiting for Cali’s counts to recover mid-cycle, or the 3 days we postponed her second treatment to align with her doctor’s preferred Thursday clinic schedule.  Including these delays, it’s more like day 60.  But really, Cali started chemo back in July and has been going steadily ever since.  You could fairly say Cali is on chemo day 249.  Unless you are talking collectively, Cali and me together.  Then it’s more like day 623.  I am not exaggerating.

At any rate, it is the day before the last day of March in 2017.  The day I originally told Ronald McDonald House we would be moving out, the day we were coming home to Santa Cruz for good.  (Yes, I know we will have appointments here at Stanford for months, even years, to come, but there are no more planned extended stays in Silicon Valley after this chemo block is over.)

But alas, we are still here.  And what’s a few more weeks at this point?  Who is really counting?  One of Cali’s favorite nurses passed us in the hospital hallway yesterday and said, “Oh, hello again!  I feel like you guys live here!”  And I thought, We do.  We really do.  Everyone at the hospital seems to know us by name.  The hospital librarian stock-piles Junie B. Jones books just for Cali, printing our check-out number on the inside book flaps without even consulting her computer.  Even the severe looking guards who man the check-in podiums in the hospital foyer print our sticker admission tags without asking our name or destination; they are probably breaking some security protocol, but who can blame them?  Who can ask a the same person their name hundreds of days in row and not feel redudant?

And since I have been collecting data on blood cancer treatments for so long, 623 days to be exact, I am developing some specialized intuition about all things hematological.  And one of these things is when a blood transfusion is needed (and when it is not).

Cali finally resumed active chemo again last Thursday, and her initial shower of infusions went relatively smoothly, with only a few episodes of isolated nausea and minimal complaints. Twice weekly monitoring labs are standard procedure during this chemo block, so on Monday, we casually popped into the Bass clinic after morning hospital school, and we were pleasantly surprised to be summoned back to the lab within minutes of arriving.  After Cali’s quick blood draw, we took the liberty of getting de-accessed (taking the needle out of her port and covering it with a band-aid) and headed back to Ronald McDonald House.  After all, everyone knows it takes more than a week for blood counts to drop after chemo administration; there wouldn’t be any required blood transfusions yet.

Cali formalCali was looking forward to many exciting activities that afternoon back at RMH.  Lunch was being catered by a local business, and her grandparents were coming to visit!  She had plans to show her grandparents the “American Girl” store across the street at the mall and maybe talk them into a Jamba Juice.  But most importantly, we had already missed the opening hours of a special “clothing boutique” happening all day on the third floor, just feet from our room.  In honor of the upcoming Ronald McDonald House’s annual dinner-dance event, “A Night In Hollywood,” formal attire of all sizes had been donated by local charities, from which house families could choose freely.  Cali had her heart set on a sparkly blue dress she had spied through the locked window door the night before, and was hoping to find dress shoes to match.

Just as we were dropping our bags at our room, I got a call from the Bass Center.

hollywood invite“Can I go to the boutique by myself, Mom?” Cali pleaded, one foot already out the door.  I nodded my head “yes” as I answered the call, stepping out into the hallway so at least it looked like I was watching her, just in case anyone questioned my diligence.

“Hi, this is Carolyn from the Bass Center.  Are you guys still close by?”

Hmmm.  Weird way to start a conversation.  I explained we were back at the Ronald McDonald House, not too far at all.  Why?

“Well, we need you to come back immediately.  Cali’s hemoglobin is 4.”

Okay, so hemoglobin is basically the red blood cell count.  Red blood’s primary purpose is carrying oxygen around the body.  The normal range of hemoglobin for kids is about 11-13.  Cali hasn’t been above 10 for months, but if she’s not hurting for other reasons, being 9 or 10 doesn’t keep her from speed walking after her favorite baby friends and dancing to GoNoodle up in our bedroom.  Sometimes she is in the eights, and then she usually favors more sedentary activities, but not always.  However, if she drops into the sevens or sixes, she is noticeably pale, fatigued, and often complains of a headache.  It is time to transfuse.

But 4.  4 is unheard of.  4 is 30% chance of cardiac arrest.  4 is emergency.  4 is how are you even still awake?  No wonder they wanted us to come back.  But I didn’t skip a beat.

“Impossible,” I told the nurse on the phone.  “She is running down the hall right now.  She has all kinds of energy.  This morning was the first morning all week she told me she didn’t need her wheelchair.  Her color is great.  There must be a mistake.”

Jen and Cali go formal
Cali and I go formal!

Luckily the experienced nurse on the phone knew us well.  “You are probably right, ” she conceded.  “Must be a lab error.  But we do need to get you back here ASAP to do a retake.”  So much for Cali’s shopping spree.  Even though my gut told me she was fine, the mamma bear in me was anxious to confirm she was not running around with a hemoglobin of 4, about to keel over at any moment. Winking at the volunteer in charge of the “boutique,” I told Cali I would give her six whole minutes to pick out her allotted three items, while I got us ready to go back to the Bass Center for urgent labs.  Righteously grumpy, she started flipping through formal gowns like the building was on fire.

 

I’ll admit, I was grumpy, too.  I also had alternative expectations for the afternoon.  I had arranged for my parents to come down from Marin County, primarily so I could go to my own oncology appointment in peace, but also to take some needed R & R time, alone.  My parents were scheduled to arrive in minutes.  I raced back to our room to repack our bags with coloring books and the iPad, just in case Cali really was a 4 and had an afternoon of infusions ahead of her.  Then I called my parents and rerouted them to the Bass Center waiting room.  Lucky for me, my parents are endlessly flexible and supportive, and they met us at the modified destination with smiling faces.

When we convened in the all-too-familiar Bass Center waiting room, I did about two minutes of proprietary hemming hawing before I allowed myself to be convinced to take my break anyway (so much for being worried), and let my parents handle the blood re-draw.  Cali seemed happy to see me go.  She was confused and grumpy about the retake, but she knew one thing was certain; there weren’t going to be any Jamba Juices until I was out of the picture.  Two hours of waiting room time later, they learned (Surprise!) she was actually only an 8.1, and they were released from captivity.  Lowish, but not that low.  Lab error.  So much for a quick lab day.  However, much to Cali’s relief, there was still time for Jamba Juice.

Cali's self portraitCome Thursday, today, another chemo infusion day, Day 36.  Each day since Monday, Cali’s energy had been declining.  She was requesting the wheelchair more and more.  She had close to a week of chemo drugs all simultaneously beating down her counts.  I thought, if I was a doctor, and I saw her blood was already a low 8.1 on Monday, I would want to check her blood on Wednesday before blasting her with more chemo early Thursday morning. Yet no one was requesting labs.

This is the part where intuition wrestles with tact.  I can never bring myself to order doctors around.  Not that there is necessarily anything wrong with ordering doctors around.  Living here at Ronald McDonald House, I have heard many a story where parents saved their kids lives by insisting doctors do something differently based on their parental intuition.  However, so far, my intuition has never felt strong enough to justify overriding a reasonable doctor explanation.  Maybe I have been lucky.

But there is a difference between overriding a reasonable explanation and plain human oversight.  I completely get that doctors are human, busy, and can only retain so much in their brains at one time.  They cannot keep track of the less important details of every patient perfectly; minor oversights happen all the time.  We just all hope they get the big things right.  When my intuition tells me we may have strayed off-course a bit, I see it as my job to gently nudge us towards my intuition, leaving plenty of room the doctors’ egos.  (Let’s face it.  We all have egos and we are all easier to work with when our egos stay in tact.) If there is truly an important oversight, my nudge is usually enough for the doctor to catch the oversight and set things on track.  If I have the wrong idea, which does happen, my nudge is gentle enough that the doctors usually aren’t offended, and instead take the time to explain their methods.  Either way, the doctors and I stay friends and end up in agreement.  It (almost always) works like a charm.

stage door
This is where we got our nails and make-up done.

In accordance with my nudging technique, I called the Triage Nurse at the Bass Center yesterday, the day before chemo.  I acted like I was mostly calling to request a month refill of Ranitidine, but, while I had her on the phone, I was wondering if maybe Cali’s doctor wanted to check her labs today before chemo tomorrow, since they were kind of low on Monday.  (Nudge, nudge.)  I guess my question was legitimate enough; she agreed to page Cali’s doctor and call me back.

 

A few minutes later the phone rang.  “I spoke with Cali’s doctor.  She will work on your prescription for tomorrow morning,” the Triage Nurse relayed, “and I saw in the computer her chemo for tomorrow is already on the procedure calendar, so she must not need labs today.”  Shucks, foiled by a computer.  This is when my technique breaks down.  You see, computers don’t really respond to tact and nudging.  They don’t see what you are getting at when you say you “just might want to check her blood.”  But my inuition wasn’t that strong.  It wasn’t like I thought failing to check her blood before today’s chemo was a fatal mistake, just a resiliency factor, an ability to weather chemo more comfortably.  So I didn’t press the issue.

We showed up bright and early this morning at 6:45 am for the scheduled Day 36 intrathecal infusion, which involved knocking Cali out while they injected methotrexate, a powerful chemotherapy agent, directly into her spinal fluid in her back.  When she was in the procedure prep room, I got back to my mission with the procedure nurse.  “So, are they going to check her blood today? Because her labs were kind of low on Monday.”  (Nudge, nudge.)

However, before the lab results were back, Cali was being wheeled into the procedure room and I was kissing her goodnight.  Wasn’t I happy the procedures were running on time today? the nurse asked cheerfully as we piled up my stuff into her wheelchair and pushed it back out to the waiting room.  I guess so, I thought.  But I was really wondering what her lab results were.

the red carpet
The Red Carpet

When Cali first awoke, she seemed great as always.  (This is about the tenth time we’ve done this very same procedure.)  Some kids wake up from anesthesia crying, others angry, and a few sleep for hours and have trouble arousing at all, worrying their parents to no end.  Cali, always the perfect patient, wakes up pleasantly and simply asks, “May I please have my glasses?”  Then she lays flat on her back and watches Frozen on the hospital T.V. until she is allowed to sit up all the way and have a juice box.

 

Everything was on time this morning.  Her doctor arrived promptly even before Cali was vertical.  “Her counts were quite low this morning,” Cali’s doctor told me immediately.  (I knew that.)  “We were going to put in an order for platelets.  And maybe red blood.”

“And if we don’t get red blood today?” I asked. “The weekend is coming. I would rather not end up in the E.R.” (Smile, nudge, nudge.)

“Yes, you are right,” said Cali’s doctor rolling her eyes up to think about the schedule.  “We should do blood today if we can.  If not today, then first thing tomorrow.” (Score.)  “Are you ready to sit up, Cali, so I can listen to your heart.”

I shot a glance at the recovery nurse.  “Is Cali okay to sit up now?” I asked sweetly, but what I meant was, this is your part.  (Nudge, nudge.)  It hasn’t been thirty minutes yet.  (Nudge, nudge.)  You should tell the doctor as much. But the recovery nurse didn’t say anything.  (Nudge failed.)  The nurse just raised her eyebrows and her shoulders as if to say, She’s with the doctor.

Cali sat up, and for about ten minutes she was fine.  But then she started to look ghostly and hold her forehead in her hands.  Oh, no.  The spinal tap headache.  We had encountered this once before.  I lowered her head back down, but she was still squeezing her eyes in shut in pain.

“It’s a ten,” Cali moaned.  The nurse got Tylenol for her, but as she pulsed it down Cali’s ng-tube, Cali vomited all over the nurse.  Strike one.  We cleaned up, and started over.   Another vomit.  Strike two.  We took off Cali’s soiled clothes and changed the sheets on her bed.  Then she had to go to the bathroom.  Getting up triggered her nausea all over again.  Strike three.  Minutes later, our doctor was back.

“I guess Cali sat up too early,” said the doctor humbly.   (Yes, I know.)

“Could it also be she needs blood?” I ventured. (Nudge, nudge.)

“Fluids, blood, it will all help.  I’ll make sure she gets the blood as soon as possible.” (Score.)

RMH 3-23-2017-253So we spent the day waiting for platelets, waiting for fluids, and finally getting blood.  All through the platelets, all through the fluids, Cali was miserable, vomiting and in pain whenever her head was elevated more than about ten degrees.  It was a long day of iPad and occasional games of Uno.  For lack of anything else to do in that windowless recovery room, I read the better half of The Liars Club, a wonderful, but horrendously dense, book for one sitting.  Finally, at five o-clock, when the blood was finally done infusing, Cali got a spark in her eye.

“Mom, I am fine now!  I can sit up.  I feel good.  We can go home now.”  Just like that.  And an hour later, Cali scarfed down a huge dinner, including three bowls of applesauce, a microwave pasta dinner, a bowl of chili, and a serving of steamed spinach, and then adjourned to the playroom to participate in a ruckus game of indoor hide-and-seek.

I collapsed on the communal couch and finished the rest of my book.  I just knew she needed blood.

Everyone at play
Last weekend all the kids had an overnight here.  We were so happy to all be together.

Feeling Lucky

Saint Patrick's Day Fun
St. Patrick’s Day fun!

It was Friday night, Saint Patrick’s Day, and I was dog tired.  I was slouching in a squishy, velvet armchair of the Ronald McDonald house living room, watching  Cali and some other kids glue puffballs and sequins on construction paper pots of gold.  I was trying to think about making dinner, but instead my mind kept spiraling towards things I didn’t want.  I didn’t want to do battle in the kitchen tonight.  I didn’t want make chili or potato pancakes.  I didn’t want a Trader Joe’s microwave pasta dinner.  I didn’t want to relapse.

 

It had been a hard week.  My birthday had been on Tuesday.  For some people, turning forty-one might be reason enough to have a hard week, but I am not like that.  I love my birthday.  I always treat myself to hot chocolate and put on peppy music and dance my way through the day.  After all, it is my birthday!  It is a day to celebrate me!  I love an excuse to indulge myself and do it my way.

But starting as early as 1 am on March 14, I knew it was going to bad day.  I was in severe pain from a raging sinus infection.  I had spontaneously gone surfing with my son at Cowell’s a few days before on a rare visit home, and had been feeling sinus pressure in my left cheek ever since I got out of the water.  However, in the wee hours of Tuesday morning,  the pain had escalated from a three to an eight.  (You know, hospital scoring , scale of one to ten.)  I was up the entire night, my head pulsing, my airways clogged.  The double dose of tylenol I tried at 4:30 am did nothing.  While it was still dark, I stood in a hot steam shower, waiting for the sun to rise, trying to relieve the pressure in my head.

Later, while Cali slept, I started to text Mike about my pain, when Cali suddenly called “Mommy!”  I put down the phone, and went quickly to her side.

“Mom, disconnect me!”  she said with urgency.  During the night Cali, is connected to a bag of formula that is slowly pumped through her ng-tube into her stomach.  When the system works, the nighttime formula keeps Cali from losing too much weight, since her appetite is faltering a bit during these intense days of chemotherapy.  However, in the morning, Cali has to be disconnected from the formula bag before she can get out of bed and move around.  Her call sounded like a typical bathroom emergency.

I sucked water into the clean plastic syringe I keep by her bedside for flushing her ng-tube, and handed her a water bottle.  (She hates the feeling of the pressure of in her nose when I force liquids down her ng-tube, and we have discovered if she sips water while I flush, the sensation is more tolerable.)  I paused the formula pump, and pulled the formula line out of the ng-tubing joint, being careful to cap the formula line before sticky syrup dripped all over my hands.  Then, just as I started to flush her ng-tube with the syringe, without warning, Cali projectile vomitted red lava all over my hands, pants, bedclothes, floor.  All those strawberries from last night, back atcha. Good morning!  Happy Birthday!

“Cali!” I said, without stifling my irritation.  (It was my birthday today, God Dammit, I could be grouchy  if I wanted!)  “TRY TO TELL ME WHEN YOU ARE GOING TO THROW UP!”  With just a little bit of warning, I would have grabbed the catch-all pie tin I keep at arm’s reach just for such emergencies.  But then I instantly felt sorry for her.  She obviously wasn’t feeling very good either.  “I’m sorry, Cali, it’s okay.  Let’s get you changed.”

“I didn’t even get it on my shirt, Mom!”  Cali said, as I was helping her undress.  Since she was wearing brand new cupcake pajamas a rep from Jacob’s Heart had given her only days ago, this was an important achievement.

“Good, good.  Let’s wash your jammies anyway, just to be extra clean.”  Even though my head throbbed every time I changed elevation, I bent down and mopped up the mess with my clorox wipes.  We detangled her from the bed sheets and made a pile of soiled articles to launder later in the day.  Then I helped her to the bathroom, where we washed her face and teeth and started a warm bath.

“I feel better now, Mom!” she said brightly.  I closed my eyes and held my head in my hands.  I wish I did, I thought.

While Cali relaxed in the bath, singing little songs and making gentle waves with her fingers through the water, I sat nearby on the toilet cover with my phone and tried to conduct a little business.  First, I called Walgreens to get my antibiotic prescription switched from Santa Cruz to Palo Alto.  I was counting on this working.  This drug was my best hope at immediate relief.  Next, I finished my text to Mike, who by now had lovingly sent me a “Happy Birthday” message with hearts and rainbow emojis.  I wrote back:

Extreme sinus pain.  It’s an eight.  Cali just threw up.  All over me.

That was my happy reply.  However, the horrible start to my day was also a little bit satisfying.  The pressure was off.  I didn’t have to have a happy day.  My birthday was going to be a bad day, and I was going to righteously wallow in it.

Love Power
Cali’s “Love Power” super-hero self-portrait.

Despite her false start, Cali actually ate breakfast and dressed for school, so I followed her lead, thankful to let others provide her morning entertainment.  We walked out to our car, and the bright blue sky and glittering morning sunshine glared into my cracking head.  I put on my darkest sunglasses and pulled my hat further down over the eyes.  I wanted to hide in a windowless closet all day.  The hospital school waiting room sounded just about right.

 

After school, we drove directly to Walgreens.  I made a beeline to the prescription desk, leaving Cali to browse the toy aisle.  Name? Jennifer Bennett.  Birthdate? Today, forty-one years ago.  Oh, you want the numbers?  Wait, I have to think for a minute.  Cali’s birthday and my birthday are thrown around so much these days, it is hard to remember whose is whose.  Mine would be March 14, 1976.  2009 would be too young.

Suddenly, I heard a familiar voice calling in the distance.

“Mamma?  Mamma?”

“Just a minute,” I told the pharmacist, much to the frustration of the people with canes and walkers waiting in line behind me.  I found Cali wandering in the toothpaste aisle.  “Mom, you almost lost me! Can I get these bubbles?”  Whose birthday was it, anyway?

We made our way slowly back to the end of the pharmacy line, this time together, with bubbles, and waited again. When we got to the front of the line, by some miracle, my prescription was actually ready, there, at that Walgreens in Palo Alto, and minutes later I was swallowing the first lima-bean-sized pill in the front seat of the car with the warm remnants of a stray water bottle I found rolling around on the car floor.

Unfortunately the effects of the antibiotic were not immediate.  In fact for a few hours, it got worse.  I spent my birthday afternoon shivering under the covers of our bed at Ronald McDonald, praying I would feel better soon. Luckily, Cali was great about entertaining herself; she danced to Go-Noodle on her computer, read Arthur books, and sang along to Kindergarten songs she so adeptly finds on Google, happy to have a captive audience.

Finally, around five o’clock, just before Mike and the kids showed up for my birthday dinner, I started to feel a little of bit of life coming back.  The fog in  my head was starting to lift, and I could actually think, slightly.  Not a lot. Just enough to greet the kids with a little pep, force a strained smile at the cards they brought, deliver them to their respective playrooms, and tell Mike – Surprise! – he was making dinner while I took a rest.  While I was happy to see their shiny faces, I staggered through the evening, tired, pained, grumpy, and relieved when I kissed them goodnight.  What a bad birthday.  Humph.

While the pain was definitely better on Wednesday, it was still hard to sleep.  On Thursday, it was more of the same, and I was really dragging.  I was beginning to wonder if the Augmentin was not enough for this tough infection.  By the afternoon, my head was throbbing in the afternoon heat, and I finally decided to cancel my birthday hiking plans for the weekend and make an appointment at the cancer center for the next day.  Maybe I needed a more aggressive antibiotic.  Or something.

Yet, when I woke up on Friday morning, Murphy’s law, I felt much, much better.  The pain was nearly gone.  My energy was back.  I canceled the appointment and Cali-care I had scrambled to arrange the day before.  However, it was hard to cancel my thoughts.

You see, my whole leukemia journey started with a sinus infection.  Similar to this recent episode, it wasn’t an infection that precipitated from a cold.  Similarly, that original infection hurt a lot but the doctors couldn’t see much.  Similarly, it took about four days of antibiotics for the pain subside.  In fact, it was the infection’s resistance to antibiotics that triggered the substitute nurse-practitioner to order some routine bloodwork.  Just to see.  Just because. And when the sinus infection finally went away, and the bloodwork was slightly off, we all veered towards the bloodwork, and forgot about my sinuses.

Now anyone who knows me will tell you I am not a worry-wart.  I am the kind of person who can walk into unknown backcountry on a stormy day a few months after a bone marrow transplant with a friend and her newborn, without a map or a cell phone, and be okay with it.

And, I would be the first to tell you, if you are regular healthy person and you get a sinus infection, and you think it is a sign of leukemia, you are a paranoid hypochondriac.

But I get special exemptions here, because this actually happened to me.  One day I had a sinus infection, and the next day I had leukemia.  So no matter how hard I try to stay on the logical right-side of my brain, sinus infections are just going to bring stuff up for me.  In those late sleepless nights of last week, with my cheek burning and my sinuses popping as they momentarily cleared before filling again, it was very easy to go to a place I had so far avoided: the possibility of relapse.

After I Googled AML and post bone marrow transplant relapse and sinuses and prognosis, I was not liking what I was seeing.  Although there were treatment possibilities for relapse after transplant, less than 20% of people make it even 6 months.  That’s crazy-talk.  Why do the statistics for my disease always have to be so extreme?  I mean, less than 50% people living two years, or even five years, would be scary enough.  Why does AML have to be so show-offy?  And it’s not like nobody relapses.  Even though I had not considered relapse an option for myself, the bare statistics are one out of every three AML transplant patients relapses, and most of those people die, fast.

Fast being the operative word. If a person relapses less than 6 months after transplant, they are a guaranteed goner.  But even a year, two years, five years after transplant, a relapse can happen, and the person can be very sick in a matter of weeks.  The outlook is still pretty grim.  And when can you stop worrying about relapse?  How many years is considered a cure?  Well, everybody I have talked to says indefinitely.  Once you have had leukemia, you are always at greater risk.  You are never really out of the woods.

I studied the charts late into the night.  I figured since I felt like hell anyway, what difference would it make if I spend the night studying relapse?  My disease was AML, aggressive.  My category was high risk; why else would they try a transplant?  I was one year out from transplant, but only one year out from transplant.  Relapse was still well in the window of probability.  On the bright side, I was still alive.  People who were still alive had a much better chance of staying alive.  What kind of conclusion was that?

So you can see why I was so tired, come Friday.  Too much infection, too much bad birthday, too much thinking, not nearly enough sleep.  I twirled in the lounge chair, procrastinating dinner preparations.  Then an idea started brewing inside my mind.  A delicious idea.

“Cali, what do you say you and I go out on the town?” I ventured when Cali got bored of pots of gold and came to sit on my lap.

“No,” she said automatically.  She was tired.  She was hungry.

“I am not taking no as an answer.  Come on, Cali.  Let’s go get gussied up.  Mom needs a break.  I need someone to wait on me.  I’m going out.  Tonight, it is Mom’s choice.”

What could she say?  I took her upstairs.  I found some Irish music on Pandora and turned the volume of my cell phone up to a healthy blare.  I started dancing around the room; I was ready to break free.

“What are you going to wear, Cali?  Your flashing green hat?  Your green necklaces?  Your sparkly penguin shirt?”  She looked away, feigning disinterest.

Puttin on the Ritz
Puttin’ on the ritz.

I pulled out the only clothing I had with me that was remotely festive, a busy green and blue print shirt and a cotton knit flower skirt, something I had never considered wearing together.  Leather sandals without socks.  Leggings.  I threw on a few of the Mardi Gras beads that had some how migrated to our room.  I surveyed myself.  I looked wild, sparkly.  It kind of worked.

 

Cali started to change her shirt, but then stubbornly changed back.

“Look,” I told her.  “You don’t have to walk.  We will bring your wheelchair.  I will just push you around, and then we will go out to dinner!”

“I don’t want people to look at me,” she whined.

I put on her light-up green sequin hat.  “Look at this hat. They won’t be looking at you, they will be looking at me!”  And without giving her time to question my reasoning, I rolled her out the door.

Downtown Palo Alto at 4:30 pm on St. Patrick’s Day was not quite the happening scene I had imagined it to be.  However, it didn’t matter.  We strolled up two blocks of University Avenue, and back one-and-a-half like we owned the place, and between Cali’s neon pink jacket and bald head and general heart-wrenching cuteness, and my light-up sequin hat, everyone who passed wished us Happy St. Patty’s Day.

When we reached the Cheesecake Factory, I decided Cali had to to see the tall ceilings and ridiculous light fixtures, so I pushed her inside, fully intending to push her right out again after a quick peek.  However, when the hostess mentioned the words “Kid’s Menu,” Cali was set on staying for dinner.  Although it wasn’t quite the Irish venue I had in mind, I rolled with it.  Here we are now, I thought.  Neither of us wanted cheesecake, but I ordered a Guiness and a hamburger, and Cali was thrilled with her Shirley Temple.  The waiter kept calling her “Shirley,” and she thought it was the funniest thing.

When we had sat for as long as Cali could tolerate, I politely asked for the check.  However, no check came. In fact our waiter had all but disappeared.  Finally, we asked another waitress if we could get our check.  She disappeared.  More time passed.  Finally, a third waitress came to our table to see if she could get us anything.

“Well, we really just need our check, thank you,” I said, smiling.

She smiled back and said, “Oh, didn’t they tell you?  Your bill has been taken care of.”

“What do you mean? Who paid?” I asked, confused.

“Oh, somebody.  She want’s to keep it a secret.”

“Why?” Cali wanted to know.

“I told you, Cali.  It’s my green hat.  Everyone was looking at me.”  And I nearly skipped right out of there.  The weight of relapse and sinus infections and statistics had evaporated with the pain and the bill.  It’s amazing what a Guinness, and a burger, and a little St. Patrick’s Day luck will do to lift your spirits!  Thank you for making my day, Secret Leprechaun.

tulips

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ladies in Waiting

Some people practice extreme skiing, some extreme biking.  Here at the Bass Center for Childhood Cancer, we practice extreme waiting. I am petitioning for a new name for this branch of the children’s hospital: The Bass Center for Practicing Patience.

Mom and CaliLast Monday, Cali and I arrived promptly for our scheduled 12:00 pm blood draw.  Since Cali was in a lot of pain over the weekend stemming from an ng-tube  nose irritation, I had called the clinic earlier in the morning to see if she could see a doctor in conjunction with her blood draw.

“Sure,” said the triage nurse who answered the phone.  She knew us well by now.  “Keep your same time.  We’ll just tack-on a clinic visit.”  Tack-on, like a post-it note.  Quick, fast, easy.  In my opinion, the phrase “just tack-on” should be reserved for changes that add less than four hours to one’s total wait time.

We were called back for our lab draw roughly an hour after we arrived.  An hour delay, okay, it happens.  After the nurse accessed Cali’s port and drew blood, a process that takes Cali all of eight minutes these days, we were back in the waiting room.  Then we waited for another hour while the labs were processed.

Perhaps the wait wouldn’t be so excruciating for me if I could engage Cali in some activity.  However, once we enter the waiting room, Cali enters a impenetrable tunnel.  I cannot communicate with her, and she does not engage in the outside world.

Still, I tried.  Would you like a snack? No.  Are you thirsty? No.  Would you like to color? No.  Call Daddy? No.  Watch the waiting room movie?  No.  iPad?  No.  Story?  No. You just want to sit here doing nothing?  She nodded her head yes.

“What are you thinking about, Cali?”  I prodded a little later.  I obviously could not let it drop.

“I am thinking about getting this over with,” she said very reasonably.

Stiff thumbs up
At my prodding, Cali gives a reluctant thumbs up in the the waiting room.

So she just sat there like a stiff statue, lost in another world, while I tried to distract myself with my own activities.  I read the newspaper for a while.  I checked my e-mails and phone messages.  I wrote in my journal.  I was hot.  The wait seemed endless.  I could not relax.

Still feeling guilty for not being able to distract her out of her silence, I continued to bombard her with a new litany of suggestions every ten minutes.  Are you okay?  Do you have to go to the bathroom?  Do you want to play a computer game with me?  Of course, her answers were no.  Even her bladder was on hold.  So I used the bathroom, returned to my diversions, tried to find something to occupy my monkey mind.

Finally we were called back to a clinic room.  After a relatively short wait of 15 minutes, the nurse-practioner came to see us.  She asked us some very simple questions, inspected Cali’s nose,  and brilliantly told us what Cali and I already knew.  The old ng-needed to be pulled and a new one placed on the opposite side, allowing her sensitive nostril tissues to heal.

However, guess what?  The day hospital didn’t quite have room for us yet, so we had to go back to the waiting room.  “Really?” I asked, a little exacerbated, but the nurse ignored my subtle appeal.  Cali said nothing and stayed in her tunnel while I pushed her back to the waiting room for a third time.  We’ve only been waiting about four hours now, I thought sarcastically,  What’s a little more?

“It sounds like you and Cali have really different ways of dealing with stress,” observed our family therapist at Ronald McDonald House when I was recounting our clinic visit later in the week.  Yes, in addition to providing comfortable accommodations, frequent hot meals, a full kitchen, organized activities for children and adults, a supervised playroom, Ronald McDonald guests receive mandatory family counseling by a well-qualified physocology student intern.

At first I was wary of this counseling.  I had never done this kind of thing before.  Was this really how I wanted spend an hour of my free time?  But I admit, I have come to look forward to our therapy sessions.  Here is how it goes:  I tell our therapist whatever is on my mind while Cali does arts and crafts.  Then the therapist repeats back to me what I just said to her.  Magically, I walk out feeling great.  This therapy stuff is amazing.

“You like to keep yourself busy,” the therapist continues.  “Cali likes to dissociate or focus on one thing.  In essence, she is practicing a form of meditation.  These methods for dealing with stress are very different, but both healthy.”

So true.

Back to the waiting room…Now that Cali was certain she was going to be subjected to the dreaded ng-tube change – a painful, but usually quick, procedure that involves pulling a 36″ long tube out of one nostril and pushing a  new 36″ long tube down the other nostril – her focus became even more intense.  “Are you scared?” I asked her gently, hoping that by talking about her fears, she might relax.  She gently pushed me away, as if to say, Don’t bother me.  I am concentrating.  Will I ever learn to leave her alone?

Just before five, a bed finally opened in the day hospital, and they called Cali’s name.  “This will be nice and quick,” the nurse said as she escorted us to our station, trying to exude cheerful energy, even though I was certain we were her last patient of the day.  Surely she was also ready to go home.  I smiled weakly.  I would believe “quick” when I saw it.  She asked a few more questions – tape preference, tube size – and then promptly disappeared.  FOR THIRTY MORE MINUTES!

Now that we were in a room with a bed, Cali finally allowed me to cuddle with her and watch the first few scenes of Frozen.  She was getting tired.  I was getting tired.  I was hungry.  How could she not be hungry?

Cali's garden poem
Cali’s “Garden” poem

At last the nurse reappeared with an assistant to help with the procedure.  I prepared a water bottle with a straw to soothe her throat after the tube went down.  I assumed position, holding Cali’s hands firmly in her lap to prevent her from impulsively grabbing at the tubes during the procedure. Then, in a mere torturous five minutes, the offending tube was pulled, a new tube was inserted, and we were free to leave.  It was six-o’clock.  We had been at the Bass Center for six hours.

All of a sudden, Cali was talkative.  She was wondering what was for dinner, coloring in her coloring book, asking the nurse where she lived.  As I rolled Cali out to our car, she said, “That was easy, Mom, right?”

“Really, Cali?” I asked in wonderment. “I am so glad.”  Cali was energized.  A giant burden had been lifted from her psyche.  Her pain had subsided almost instantly.

Me?  I was exhausted.  For me it had been a very long day of doing virtually nothing.

Now we are waiting again.  Before we can start the second half of this block of chemotherapy, the block that is holding us hostage in Palo Alto away from the rest of our family, Cali’s white blood neutrophil counts have to rise above 750.  Every several days, technicians draw her blood and check her levels. 120, 210, 240, 310, 420.  After each check, the doctor calls and assures us her counts are recovering robustly, albeit slowly, that we should be starting chemo again soon, but not yet.  However, we are now going on three weeks of delay, transforming our predicted 56-day block into at least a 77-day block, perhaps longer.  To everyone’s frustration, Cali’s white count rise is stubbornly slow.

Everyone except Cali, that is.  When I ask her how she feels about staying longer at Ronald McDonald, she says, “I don’t care.  It’s more Mommy time.”  She is tougher than me.  It seems Cali is winning the race of extreme patience.

Bubbles!
Bubbles!

 

 

 

 

 

Telling Stories

I used to think I was a big deal.  I used to think my story was unbelievable, a series of odds so unlikely, I should have gone into gambling or at least played the lottery.  Each new life event seemed to trump the last.

Listen to this:  A woman’s second child is born with rare genetic syndrome called Sotos Syndrome, which causes the baby girl to have a variety of special needs.  When their first two children are ages three and six, and the parents finally catch their breath, they discuss having a third child.  They decide they won’t have a third.  The husband has a vasectomy.  A week after his procedure, the woman discovers she is six weeks pregnant.  Four weeks after his procedure, they learn she is pregnant with not a single fetus, but twins.  Defying statistics again, she easily carries the twins to their full term of forty weeks, and they are born naturally with no complications.  When the twins are two-years-old, the woman is diagnosed with leukemia at age 39, requiring intense chemotherapy and a bone marrow transplant.  While she is away being treated, the husband is laid off from his job.  One year after the woman’s diagnosis, her daughter with Sotos Syndrome is diagnosed with lymphoma, a related blood cancer.  What next?

St. Patty's Day Crafts
Cali does St.Patrick’s Day crafts at Ronald McDonald House.

When I meet new people I rarely tell them our whole story, for fear they might faint or think I’m a compulsive lier.  Our family’s luck is so surprising, it’s boring.  In fact, I bet you even tuned out while reading that last paragraph. Usually I present a more digestible story.  Perhaps I tell them I survived leukemia, but I don’t mention Cali’s cancer.  Or maybe I mention my four kids and how one has cancer, but I don’t talk about my health.  I might mention I have a child with an extremely rare genetic disorder and three-year-old twins, but I skip the cancer part.  There’s just not enough room in an everyday person’s mind for all the stories I have.

If I told you all that went down, it would burn off both your ears.

-The Grateful Dead

But now that I am at Ronald McDonald House, my perspective has changed.  “The stories that go through this house are unfathomable,” I tell my husband one night over the phone.  “Somebody has to write them down.”

“Why don’t you?” he suggests, fending off my twin preschoolers as they whine for another Tinkerbell movie.

“I can’t be responsible for other people’s stories.  I can’t pretend to understand their lives, their pain.  I probably don’t know half of it.  I can’t hold their lives in my words.  It is enough to hold my own life.”

But as the days pass, as the stories accumulate, I can’t let go of the urge to record what I am hearing, seeing; it is a fundamental part of my experience here at the House.  So what follows are just stories.  Some of the facts are slightly wrong or twisted around, by accident or on purpose; but the stories are as true as my impresssions will allow.  Pieces are missing; we only tell the what we are willing to let others hear.  Details aside, these stories are real as the sun that shines in the sky, all under one roof.

***

There is a family of seven from Seattle.  They have three boys and two girls whose smiles are so similar, you know they are full siblings.  Most nights, the mother is at the House with four youngest children. The children wear bright smiles and have glossy hair, pulled into braids or the latest side-ponytail fashion.  One boy plays the violin, and the older girls are always in sporting uniforms, rosy from the afternoon’s practice.  They sit around the table at dinner over lasagna or a caserole, playing games, laughing.  The mother is always part of the fun; she engages in camaraderie with her school age kids, and then all her children help with the clean-up without complaint.  I am continually in awe.

The youngest child has the tell-tale backpack, an external heart.  He is waiting for a heart transplant.  However, this is not the first heart-transplant in their family.  Two of the other children have already had heart transplants here at Stanford.  This is the family’s third time staying at Ronald McDonald House waiting for that life changing call.  The doctors claim there is no traceable genetic link to their three cases.

“Has it been they same everytime?” I ask, not even sure what I am asking.

“Well, pretty much,” she answers. “Except each time the wait for a heart gets longer.”  She smiles, but there is a seriousness in her eyes that tells me this is no laughing matter.

“How long have you been here this time?” How long does a child have to wait for a heart?  Do you get extra points if this is your family’s third heart? I wonder.

“Well, this time it has been a little over a year, and we are still waiting,” she replies.   Cumulatively, her children will spend as many as three years growing up in this house, attending local schools.  This house really is their home.

***

flowers2
Cali and I are enjoying the local gardens!

There is another heart patient with an external heart.  He is about Cali’s age, and Cali follows him around like a big brother.  His parents brought him here directly from their rural home in Southern California when their son’s heart was in imminent failure, functioning at only ten percent of capacity.  Recovering from the surgery to install an external heart was difficult.  He spent many precarious weeks in the ICU, but you wouldn’t guess it now.  He looks shiny, jovial.

Like so many others, the boy is here because he is waiting for a heart transplant.  However, he is not even on the call list yet.  It will be many more months before the slow process of removing unwanted antibodies from his system will allow him to be eligible.

However, there is another reason both parents are here.  Shortly after they arrived last July, summer wildfires ravaged their community.  They lost their house, their car, their jobs, everything.  When the father returned home for a few nights to pick through their belongings, barely anything was salvageable.  Now they are just waiting.  Waiting for the anti-bodies to go down, waiting to be eligible for a heart, waiting to start a new life.

“Well, at least our overhead is low,” the mother tells me.  “No mortgage, no car payments, no gas, no utility bills. After we get the transplant, we can start over anywhere we want.  Anywhere close to a major pediatric heart center.”

***

In a small class about managing stress put on by a Ronald McDonald House family therapist, I meet an amazing mother from Florida.  In her fast, confident speech I detect a hint of accent, but she is obviously American through and through.  She is passionate about her career, and her husband works full-time, too.  This fact is almost unbelievable given her family constellation.

She tells us she has a typically developing seven year old son.  Anyone with special needs experience knows what’s coming next when a regular kid is labeled “typical.”

“I also have five-year-old twins,” she tells the group.

“I have twins, too,” I start to say, trying to find common ground, but she glosses right over me.  She has much more to tell.

“Each twin was born with a different genetic disorder.  My daughter was born as a little person, a dwarf.  Her twin brother has down syndrome.  So we have a developmental five-year-old the height of a one-year-old, and a normal height five-year-old with a developmental age of about two-and-a-half.  They are both having trouble potty training for different reasons.  My daughter has trouble getting on the toilet because she is so small, and my son is mentally not quite ready.  Our bathroom is a mess. But my biggest sources of stress is my daughter now has a brain tumor.  That’s why we are here.”

She describes her schedule at home as a wheel that never stops turning.  On week days, she get home from work at 5, precisely as therapy specialists walk in the door to with with the twins every day from 5-8.  Their house is small, she explains, so each adult takes a corner and the kids get the middle to play.  At 8, it is finally time from all the outsiders to leave.  She turns the heat up, so everyone will go to bed.  At 9 or 9:30, she turns the heat down so she can sleep, and falls quickly into slumber, only to wake at 5:30 the next morning to start it all again.

To make life possible, she has let her housekeeping expectations go.  Clean laundry is stored in laundry baskets with each child’s name.  Breakfast and dinner are the same – eggs, hot dogs, something easy that everyone will eat. Luckily, she and her husband take turns having breaks on the weekend, to go to do household shopping, to get their hair cut. Only a woman this smart, this organized, could keep her life together under her circumstances.  One has to wonder if there is truth to the adage, “God only gives us only what we can handle.”

She is frustrated because she is staying in a nearby hotel with only a day-pass to the Ronald McDonald House.  She is on the waiting list for the house, but she probably won’t get a room, at least not this week.  Give this lady a break!  I want to shout.  I am almost ready to offer my room right then and there.

***

There is the girl who, at age eleven, suddenly developed an auto-immune disease, triggering a kind of self-induced leukemia.  She was rushed to Stanford from the Central Valley for neurosurgery to relieve pressure on her brain and spine.  Now the doctors are using aggressive chemotherapy to get the disease under control, and she may need a liver transplant due to all the damage caused by the disease.  Once the disease is under control and her condition is stabilized, she faces chemotherapy once a month for the rest of her life to keep things in check. Today she is using her wheelchair, weak from the emergency procedure last week required to relocate her shunt. Just last spring she was on the traveling soccer team.

“They shouted ‘Eighty-one!’ today,” the Mom tells me with  baffled, tell-it-like it is laugh.”I asked, ‘Eighty-one what?’  They told me eighty-one cat-scans since last July.”

“Eighty-one!” I say in disbelief.  Doctors are trying to minimize Cali’s cat scans to less than ten.  Hopefully less than five.  “Isn’t that a lot of radiation?”

“Yeah,” she says flatly.  “The doctors have told me it’s almost a given she will develop real cancer.”  I shake my head.  What words could I say.

***

There are so many more stories to tell.

There is the family with three kids out of seven being treated for various life-threatening conditions, ages 20, 14 and 1.  Their various conditions probably have a genetic link, but as of now, insurance won’t pay for the test.

There is the family of six with new premie twins. On the day the twins were released from the hospital and cleared to go home, they received a shocking call from their landlord of many years.  They were being evicted.  What are people thinking?  There is no way they can stay in the Bay Area with the current rental market.  They are going back to the midwest to live with their parents until they can catch their breath.  A cross country trip with twin preemies, a toddler, and a preschooler. Fun.

There is the family who doesn’t speak any recognizable language, who turns shyly away when I try Hello, Hola, even a head nod in the elevator.  The foods they are cooking are fascinating.  Their stature is petite; Cali towers over even the tallest grown man.  I am sure the United States is not their first home.  I don’t know their story, but I can sense there is a long one, a heavier one than I will ever understand.  I say a silent prayer for them, that they will not be deported with their little ones in critical care.

When Cali was first diagnosed, Mike and I asked in hushed voices to the attending oncologist in the PICU, “Do you ever see this?  A mother and child with the same cancer, just randomly?”

“Not often, but it happens,” the doctor replied with a faraway look in her eye.  I thought the faraway look was covering her white lie.  I thought we were the first to suffer such incredible luck.  But now I know, she was covering pain.  She sees everything, scenarios far worse and improbable than what we have endured.  Stanford is a magnet for such cases.  And the heart and soul of this star-crossed clientele can be found at the Ronald McDonald House.

These days I feel lucky.  Really, really lucky.  That my cancer is gone for now.  That Cali’s cancer is going away and is highly curable.  That we have a lovely home in a beautiful place called Santa Cruz.  That I have such an energetic, capable, dedicated husband.  That my other three children are very healthy.  That my children’s grandparents are still healthy.  That I live in the wide-armed support of a community and family that would never let us fall.

But for those of you who do land an inauspicious string of events, who strike unlucky when timing is worst, know that you are not alone.  Bad luck happens.  Bad luck happens over and over.  Bad luck happens to good people.  It is no wonder olden-day folklore embraced fantastical concepts like witchery and superstition and curses.  How else can we justify such fortitude?

The amazing part is how these people with really bad luck manage to carry on, to show up at breakfast and pour their cereal, play Bingo on Tuesday nights, take their kids back to the hospital clinics day after day, put one foot in front of the other.

I had the pleasure of walking next to a fast flowing creek last weekend.  The creek winded its way through a dense redwood forest, and then took a sharp bend to the right.  In the distance, I could hear water falling, but from my vantage point it was impossible to see where the creek was headed.  As I stood there watching the cold clear water flow swiftly over the rocks and around the bend, heedless of its imminent destiny, I thought, Faith is to flow like water, even when you have no idea where your stream is headed.

Cali in the garden
After a week off, Cali is walking again – yay!

 

 

 

Three Reasons to Believe

 

be-free
Be Free

January 21, 2017

Thousands came to march,

each carrying her own sign.

One message: Hear me!

Women’s March

With children and snacks

the-next-generation
The Next Generation

(because that’s how we do it)

of course there was  peace.

Weathering the Times

All that rain and wind,

yet most of the trees still stand.

We are built to last.

For Bookheads Only

For a long time, I didn’t publish this article.  It sat in my “drafts” section of my blog editor, growing longer and longer every month.  Eventually the article got so long, it was embarrassing, and I figured I would never make this list public.

I started this article after many of you e-mailed me, asking innocently enough, “What are you reading these days?”  You were probably just trying to be nice, conversational, light.  You probably weren’t expecting this 6000+ word diatribe.  However, you did ask.  (And if you didn’t – and even if you did – please don’t feel compelled to read this.  Just skip to the asterix* at the end.)

Reading has meant survival for me over the last two years.  Thanks to my wonderful friends and family, my unread book box has been consistently overflowing, even when I was in isolation from all places public.

As I reflect on what I have read throughout my treatment, it is interesting how the immediate contemporary details of my life gave special context and meaning to each book I read.  I now realize we cannot separate the book (or blog) from the subjective reader; it is the reader who makes the written words alive, making the reading experience uniquely hers by the story she herself brings to the table.  Unread words are just marks on a page.  Today I am thankful for all of you who have read my blog for so long, making my words come to life for you.

Without further ado, in the order of actual appearance…

Glitter and Glue by Kelly Corrigan

I was given this book by my mother before I got cancer.  She probably noticed it was a book about mothers and daughters, a book about a young women who goes abroad to find herself.  Even as I started the book, I thought it would be a nice light read, maybe a pleasant flashback to my pre-kid years when Mike and I traveled to foreign countries across the pacific.  However, things started to get sketchy when the protagonist took a job nannying.  When it was later revealed the mother died of cancer, I began to question my book choice.  Was this really the first book I wanted to read in the hospital?  However, a strange thing happened while I continued to read this story.  A resolve started to develop deep within my soul.  I would not be like the mother in this story who died.  My family would not be motherless.  I was going to survive.  Maybe this was a good first book after all.  With this determination firmly in place, I resisted reading anything else about cancer, fiction or non-fiction, for the next year.  Why challenge my positive outlook?

The Art Forger by Barbara A. Shapiro

This book is a page-turning contemporary art world mystery, and more importantly, is completely unrelated to cancer.  I enjoyed learning about the impressionist painter Edgar Degas and the fascinating underworld of art forgery.   All the talk about brushstrokes and color inspired me to do some painting in the hospital, which became an enjoyable escape for me.

Neapolitan Novels by Elena Ferrante (4 novel series) – My Brilliant Friend, Story of a New Name, Those Who Leave and Those Who Stay, and The Story of a Lost Child

These intense four novels follow the lives and friendship of two women in a poor neighborhood in Naples from their earliest memories into their senior years.  Ferrante’s literary ability to capture the nuances of real, complex relationship is unlike any I have read previously.  She seemed able to put to words feelings I subconsciously understood but never imagined trying to describe.  True to life, her characters were never all good or nor all bad.  Each had moments of flying brilliance as well as periods of mistake, regret, and selfishness.  I was plastered to these books from the moment I started them, living in an alternate Neapolitan reality, and they carried me through some hard times: my first induction chemo at Stanford, a trip to the ER where I encountered traumatizing anaphylactic shock, hot Indian Summer days hiding in my bedroom when I could not go outside.  By allowing her characters to be wonderfully inspiring yet have glaring imperfections, Ferrante also allowed me to relax about the imperfections in my character and life.

The books raised some questions I continue to ponder.  Where did Lena go?  Who is the stronger character: Elena who works hard to “get out” of her neighborhood, only to build a career on writing about the imperfections of her neighborhood, or Lena, who stays in the neighborhood and tries to make it better, only to turn her back and run away in the end?  Is violence (both personal and global) an unescapable aspect of human nature?  Is friendship something we choose or fall into?  (Anyone want to start a book club?)

Her characters and stories were so honest and raw, I couldn’t believe the novels were not at least partially autobiographical.  In my curiosity, I researched Ms. Ferrante on the internet, a habit that became addictive after finishing a good book.  As many of you probably know, author Elena Ferrante is an internationally popular Italian author who writes under a pen-name.  Only her publisher knows her true identity, and she grants very few phone or e-mail correspondence interviews.  At one point critics were speculating maybe she was actually a man or perhaps, several people.  When questioned in an interview, Ms. Ferrante (always a feminist) replied “If a book is good and appeals to both genders, people can’t believe it is written  by a woman.  It must be a man author.  Or several men.”  In her interviews she stressed her value on truth in character and situation.  It has to feel real.  She said she scraps her work all the time, abandons whole manuscripts that do not ring true.

I found this point this interesting because my primary qualification for acceptance of my own blog entries was also truth.  Not truth like all the little facts.  Often names or times or events were slightly rearranged for the convenience of telling or emphasis of an idea.  But truth in essence and honesty with myself.  Without being honest with myself, the writing process was not cathartic and was worthless to me.  However, what amazes me is the ability of authors like her to have truth in pure fiction.  Imaginary characters living imaginary lives that are extremely true.  How does she do it?

Where’d You Go Bernadette? by Maria Semple

This is a humorous, quirky and completely surprising novel about an overachieving mother who has a midlife crisis and literally runs away to Antarctica.  I will always associate reading this book with chain-sucking lemon drops as I buried myself in this story to escape acute throat pain during my induction chemo.  When I was discharged from the hospital, I was thrilled to leave this book behind as a present for the doting and passionate nurse who kept me supplied with lemon drops on her own dime.

Barbarian Days: A Surfing Life by William Finnegan

Finnegan captures waves and the surfing lifestyle with the precision and truthfulness that Ferrante (see above) captures relationships.  It never occurred to me to describe waves and the unspoken mindset of surfing with the detail Finnegan awards these subjects in his memoir.  Although one might think a book this long about surfing could get boring, I was captivated.  Besides bringing to light thoughts I have had on the water that previously lived only in my subconscience, the book took me on a geographical journey that included ironically familiar haunts of my past – Maui, Samoa, San Francisco, Santa Cruz – as well as new places – South Africa, Portugal, New York.  A virtual surf trip was just what I needed when I found myself in the hospital for the fourth time in 2015 with an unexpected fever.  The book begs the question, “Why do we surf?”

Joy For Beginners by Erica Bauermeister

This contemporary novel features a woman who successfully overcomes breast cancer, a woman with twins, an aspiring writer…it’s no wonder the book was passed along to me.  In the story, a group of friends agree to face personal challenges they have been avoiding.  Whether its sorting through an ex’s books or floating the Colarado River, each woman finds new self-strength in facing their unique challenge.  I couldn’t help wonder what would be my personal challenge?  Unlike cancer, twins, job lay-offs which are challenges imposed from the outside world, the nature of this kind of challenge is internal.  Some people feel you overcome cancer when you overcome the internal obstacles you are fighting.  What are my internal obstacles?  To truthfully answer this question, one must be prepared to look honestly and fearlessly at oneself.  I am afraid I am not there yet.

Big Sur and the Oranges of Hieronymus Bosch by Henry Miller

Hidden among the symphony of words, words, words flowing from Henry Miller’s bizarre collection of essays and character sketches of his artistic life in the Big Sur mountains are amazing moments of philosophical clarity.  I found myself jumping up mid-page, chemo lines and all, to grab a highlighter, a pencil to make notes in the sidelines.  If there are flaws in your paradise, open more windows!  We resist only what is inevitable…. As I entered my days of room lock-d0wn, I increasingly related to the eccentric writer on the mountainside.  I was living my own kind of writing-painting hermit life in the hospital room, connected only to the outside world through the passing visitor who braved the barriers of the hospital to find me or through written correspondence, of which there was so much!  While I admit, I skipped a chapter here and there, especially when the prose turned to French or early century cultural references and became pages of blurring textual art, I did not skip the last story.  The strange and so delicately depicted Moricand will forever haunt my memory as if I met him in person.  We all know a Moricand, a person or a problem  we try to fix who cannot be helped.  We are usually told to let that person or problem go, but it can be so hard to let go.

Bossy Pants by Tina Fey

A good back-to-the-present follow-up to my surrealist journey in Big Sur.  Tina Fey’s book was, of course, funny, especially the first several chapters where she pokes fun at her own parochial and very Greek upbringing.  However, while theoretically interesting, the second of the half of the books’ humor was lost on me since I am pathetically ignorant of TV culture and the current events of the last decade.  (Give me a break, I’ve had four kids in the last 10 years.)

Colorless Tsukuru Tazaki and His Years of Pilgrimage by Haruki Murakami

We all live in a world of our thoughts, and sometime when we are alone our thoughts can become deafening.  I found this to be true in the hospital with so many endless hours alone and I started writing my blog to silence the noise.  In this latest book by Japan’s popular and prolific novelist Haruki Murakami, the story lives half in reality and half in the thought-mind of the protagonist and his mental journeys through dreams and memories.  Is it necessary to face insecurities and suppressed pain of the past to move forward?

Behind the Beautiful Forevers by Katherine Boo

This is an incredible but completely true story of a group of families surviving on the airport slums of Mumbai (Bombay), a strip of wasteland sandwiched between a putrid disease infested swamp and the swanky modern international airport.  Making its living buying and selling recyclables rummaged from the airport trashcans, this under-community amazingly hangs on to life by a thread, though disease, crime and death are rampant.

Despite the squalid living conditions and dismal opportunities for success, the children of the community to grow up with dreams – going to college, owning a house, marrying, living a long and healthy life.  Like communities everywhere, families feud, take advantage of one other, show incredible acts of love, and find hope when hope seems futile.

Journalist Katherine Boo spent years living among these families, recording their conversations, observing their lives, and fastidiously collecting data – police records, medical reports, court records.  The book reads like a novel, but in fact, is entirely non-fiction.  I was completely mesmerized by the people’s ability survive on nothing.  The descriptions of their living and medical conditions made my hospital existence seem like heaven.  Is the hopefulness of youth inherent in human nature?  It seemed unfathomable the children living in such poor conditions could be hopeful about anything and yet they had dreams and romances and diversions like any other youth across the world.  Can a quest for righteousness and goodness grow out of lots of bad experiences?  I would have said no, but there seem to be some people who can find the light even in the darkest of places.

One Flew Over the Cuckoo’s Nest by Ken Kesey

It was quite interesting to read this famous story of mental institution antics while myself in a hospital.  I was taking some of the same medications as the characters!  Coincidentally the story was based on Kesey’s experiences working at Menlo Park VA Hospital (only minutes from my hospital room) while doing graduate studies at Stanford University.   Told through the stream-of-consciencenss eyes of a schizophrenic patient, the tale has a timelessness that reminds me of classic drama and leaves many topics for discussion.  What does it mean to be insane?  Who gets to define “insane”?  Is Big Nurse insane?  Is McMurphy insane?  Are the patients happier inside or outside the ward?  Is Chief Bromden ready to leave the ward?  Did McMurphy want to die?  Will Chief Bromden “survive” in the real world?  Does McMurphy or Big Nurse “win” the battle for ward control?

In the Arms of Mr. Darcy by Sharon Lathan

This book is nothing more than a delicious, sensual contemporary sequel to Jane Austen’s Pride and Prejudice, wonderfully romantic for those of us who like to submerge ourselves in the luscious lives of Jane Austen’s world.  (Shh…don’t tell the nurses, I was up late reading under my covers with my book light, lost in the arms of Mr. Darcy.)

The Shift by Theresa Brown

Okay, I guess I did read one cancer book.  This book caused a stir on all of E1 Unit.  The book is a day in the life of a hem/onc nurse working in a bone marrow transplant unit Pennsylvania.  Ms.  Brown is dedicated to her profession, working 12-hour shifts, carefully holding (and sometimes losing) the lives of her cancer patients daily.  When my Stanford nurse spied the cover this book, he instantly wrote down the title.  Before the end of the day, all the nurses in the floor had learned of the book and they collectively ordered a couple of copies to pass among themselves.  The next day, another nurse received a copy in a secret santa exchange.  Little did my sister know her gift book to me would start an E1 craze!

The pace of the book compels you to read it quickly;  I read it in an afternoon.  Although I’m sure the book can be very educational for those not familiar with BMT, most of the technical information was so completely my life I just nodded and smiled.  I was particularly interested in hearing about the other patients and what happened to them in the end.  (Interesting where our priorities lie.)  However, by the book’s last pages I just wanted the poor nurse to get home, put her feet up, and spend some time with her kids!

The Lake House by Kate Morton

If you have read Kate Morton’s other books, then you know you are in for a treat.  Her latest book doesn’t disappoint.  It is page turning novel with a complex mystery spanning generations and involving an old mysterious house on the beautiful coast of Cornwall.  I read this book during my first weeks at the cottage, and as I strolled the streets of my new neighborhood, the ivy-covered turn-of-the-century brick mansions of this neighborhood merged with tale of my book into a an imaginary world of romantic mystery.  I imagined hidden passageways and buried secrets in the old walls and secret gardens of Palo Alto.  It seemed like every day I was finding a new gem.  Then when the PK virus hit, I seriously dug into the novel and it took me to another world, a distraction I greatly needed.  And although I was sad when the book came to the end, the conclusion was one of the most satisfying I have read in a long time.

Middlesex by Jeffrey Eugenides

This a beautifully told narrative of the coming age of a young Greek-American who learns she’s a hermaphrodite when she is a young teenager.  Like Elena Ferrante, Eugenides creates characters and families so imperfectly real and raw and true, I couldn’t believe the story wasn’t at least partially autobiographical.  I (once again) searched the internet to discover his work is entirely fiction; Eugenides is not a hermaphrodite or even a doctor who studies hermaphrodites, although he is Greek and he did grow up in a Detroit suburb.  Ironically, like Kesey, he did his graduate studies in creative writing at Stanford.  I wondered, how would I respond if I learned a good friend or someone I was dating was a hermaphrodite?  I related to the idea that you can’t change what biology (or God) hands you.  I was given leukemia.  It was not a choice.  Similarly with the protagonist Cal, there is no choice.  We are given the bodies we are given.  It does not mean we are doomed.  We take what we get, and move on in faith.

One Hundred Years of Solitude by Gabriel Garcia Marquez

Having just finished Middlesex, I was very surprised to find the first part of this epic classic extremely similar.  It reminded me of when a jazz player “quotes” a popular lick from another song in the midst of his solo.  However, One Hundred Years of Solitude being the older of the two books I guess it was Eugenides quoting Marquez.  Both featured multi-generations of immigrants.  Both featured family members intermarrying due to isolating circumstances, fully knowing and worrying about the genetic implications, but irresistibly drawn to one anther.  Both featured a strong dominant matriarch.  However, from there this long and circular story moved on to new ground.  Even when I was halfway through the novel I was considering not finishing the book.  There were war chapters through which I plodded, seemingly rambling on and on for the sake of filling up space (and in retrospect perhaps this was point, because how often wars ramble on taking up space without logic or conclusion).  But having won the Nobel prize in literature, I felt compelled to finish the novel and to try and understand it.

Throughout the book, I wondered what is the message of this book?  However, by the end, the themes were loud and clear and so beautifully wrought in a show-not-tell kind of way, I was almost ready (though not quite) to read the book again.  Ain my opinion, it was all about the cycles in time and families and towns and countries and war and innovation and weather.  About how things don’t actually move forward, but they go around and around, repeating the same patterns, experiencing abundance and and devastation and then abundance again, over and over.  About how problems aren’t really solved, just circumstances changed.  About how generations in the families repeat the same character traits and tendencies.  Yet all of this without being apocalyptic; simply a relieving acknowledgment of the truth (with a touch of the fantastic here and there for emphasis) that the world goes around and around, despite and in spite of what we do as individuals.  In acknowleging this pattern, I felt a little lighter knowing some of what happens out there in the world is just the natural ebb and flow of life and death, good and evil, inspiration and depression, health and sickliness, not something that can or should be controlled.

The theme of solitude was also an interesting idea given my recent experience with solitude in the hospital.  Many of the characters eventually find their way to self-imposed solitude towards the ends of their lives, locking themselves in rooms to study, tying themselves to a tree, floating in a bathtub of water and day dreaming, sewing the burial clothes for others, playing with small children in an attic.  The solitude created by Marquez is not the stereotypical solitude of old-age which includes loneliness and helplessness, but a strange kind of peaceful escape, where the individual envelopes himself in a quiet blanket of inward self-discovery and imagination, as if finally in he has found a way to live in the world.  However I am not sure if it is happiness.  Are Marquez’s characters happy in their solitude?  Was I happy in mine?  I was getting through, at times I was even truly inspired, but I wouldn’t call it happiness.

Palo Alto: A Centennial History by Ward Winslow and the Palo Alto Historical Association

A beautiful pictorial and complete history of the city of Palo Alto.

Streets of Palo Alto by Palo Alto Historical Association

A strange little book that tells the story behind the name of every single street in Palo Alto in alphabetical order.

Nice Day for A Stroll: A Walk Through Palo Alto’s History by Matt Bowling

A guided walk through downtown Palo Alto highlighting interesting buildings and quirky stories from the past.  Did you know the Jerry Garcia and other members of the Grateful Dead first met and jammed at a Palo Alto music store?  I played a little Dead on my i-phone for a moment of reverence standing in the doorway of the old storefront,  which is now under construction to become yet another trendy restaurant.  In the bustle of Sunday afternoon lunch hour, nobody passing by seemed to recognize the grand significance of this monumental site, not even giving my HEPA-mask-wearing, straw-hat-toting, Dead-playing presence a passing glance.

52 Days of Cancer by Jordan Lane

A few blocks away from my cottage there was a “little library” box with a pleasant bench for sitting and watching the ever passing bike-traffic on Bryant Street.  One of my enjoyable pastimes was to walk to this “library,” choose a book, and read on the bench for as long as I could tolerate my HEPA-mask.  I picked up 52 Days of Cancer at the little library because it told the story of a woman’s successful treatment of lymphoma at Stanford, as told blog style through the son-in-law’s perspective.  It seemed it was meant to be; it was time to read a cancer story.

It was fascinating to view the cancer process through the eyes of the caregiver, and for some reason it was very satisfying to read descriptions of the exact waiting rooms, units and hospital spaces I occupied only weeks prior.  Also the account reminded me that each person’s experience is very unique to their body.  Although this woman’s disease was similar to mine, she did not need a bone marrow transplant and her recovery took several weeks instead of several months like mine.  However, during her treatment, she ended up in a very scary two week coma in which she was very close to death.  Amazingly after two weeks, she came out of the coma and is now living cancer free.  The human body can truly work miracles.

Into Thin Air by Jon Krakauer

I am sure many of you read this popular true account of the disastrous 1996 climbing season on Mt. Everest.  So much of the author’s experience revolves around being cold and not having enough oxygen.  On a very minuscule scale, I felt camaraderie with these audacious climbers.  The hospital was also a cold place and having no head hair is cold too; I have developed lots of techniques for preserving heat – a whole collection of hats, scarves, jackets and IV-friendly shawls.  I even know how to put a hot washcloth on my head to keep my sensitive scalp warm while I shower.

More profoundly, I felt connected to their physical struggle of living and moving about with limited oxygen.  The definition of anemia is a below normal red blood count.  Since red blood is responsible for carrying oxygen to every cell in your body, anemia necessarily means every cell in your body get less oxygen.  Because of the leukemia and its successive treatments, I have been anemic to varying degrees since last July and have experienced first hand the ramifications of oxygen deprivation.  In anemia’s mildest form, I felt fatigued by everyday activities, easily winded during exercise, light-headed or dizzy at times.  When my blood counts further decreased, I felt relentless muscle cramping, fuzzy vision, impatience, mental slowness, forgetfulness, phantom sensations on my skin, chest pain, severe fatigue and I was easily overwhelmed.  The behavior of the climbers when they were in conditions that limited their oxygen – angry, impatient, self-centered, confused – was at once recognizable to me.

Prior to having leukemia, I have never had the desire to climb any tall  mountain where oxygen would become sparse nor scuba dive in the water where oxygen is also a precious commodity.  Despite the wonders adventurers claim, the idea of no oxygen has always terrified me.  Strangely, when I picked up this book, I found my perspective changed.  I still did not want to climb Everest or scuba dive, but I was no longer afraid of the idea.  I found myself thinking, well if I had to climb Everest to get rid this disease and get back my family, I would.  How bad could it be in the face of another certain death?  One foot in front of the other, listen to the leaders.  Get back to safety.  Luckily, the treatments at Stanford were no where near climbing Everest.  I got off easy.

Unaccustomed Earth  by Jhumpa Lahiri

This is a collection of short stories which are really relationship portraits.  While the characters all struggle with the unique challenge of straddling Indian and American culture, everyone will recognize the familiar relationship patterns that transcend nationality which Lahiri exposes so effortlessly: Mother-son, Father-daughter, Unrequited love, Mother-daughter, Sibling relationships, First-loves, Family deaths.

Teaching a Stone to Talk by Annie Dillard

So much more than nature writing, Annie Dillard transforms her precise observations into a meditation on life’s meaning in precise poetic prose.

Portrait of the Artist as a Young Man by James Joyce

Okay, so I picked this one up from the local book box with the sudden strange notion that I perhaps I should read classics, that reading classics might round out my heavily scientific post-secondary education and shed some light onto the meaning and logic of life.  These “big” questions plagued me more and more, as I gained space from the shock of my diagnosis and moved into the mental phase of recovery.

I worked through this book one page at a time, drifting off to sleep after only one or two paragraphs every night.  It took me the entire summer to read.  I jokingly called it my put-me-to sleep book.  Aside from a few slightly inspiring passages about the meaning of art, I can’t remember what happened or what was significant about this wordy novel.  If anyone would care to enlighten me, I have an open mind.

All The World Drowning by Ben Preston

In the form of a playful page-turning novel, this book explores the razor sharp edge between divine inspiration and insanity, with humor, absurdity, and an underlying seriousness of truth. The storyline is unusual, at times surprising, but the lucidness of the characters hooked me.  The characters continue to linger in my mind even nine months after I turned the last page. Can you know God, have visions, and be completely sane?  How does this spiritual knowledge fit into secular life, and what role do mind-altering drugs play in this dance?  The book opened my apeture for how I view mental illness, ever present in Santa Cruz.

Brooklyn by Colm Toibin

A delicious, satisfying romantic modern day classic.  What more can I say?  I am sure a lot of you saw the movie, which was almost as good.

The Crucible by Arthur Miller

Rereading The Crucible (I read this play in high school) restored my faith in classics, and marked a new effort to dive back into the classic literary world for some kind of message.  Although we are no longer intimidated by witchcraft, the age-old problem of people turning on one another, pointing fingers, and joining the bandwagon of name-calling in the name of power or fear is unfortunately an all too familiar theme.  Just look what is happening in American politics today.

The Picture of Dorian Gray by Oscar Wilde

I encountered this classic next to The Crucible in the same “little library,” most likely an end-of-the-semester purge for a local high school English student.  The margins of the first couple of chapters of this paperback were filled with the profuse and undiscriminating notes of an eager young reader.  However, after a few chapters, the pages were bare.  Perhaps I should have taken the hint, but I kept reading.

I found the narcissistic character of Dorian Gray completely unappealing, which I suppose was the point.  I think I kept reading to find out if Dorian Gray would ever redeem himself, to see if he ever became whole and human.  In my opinion, he never did, and I was frustrated and unsatisfied with the whole experience of reading this book.  However, I must admit, I think I will always remember the image of Dorian Gray’s aging portrait, racked in misery and age, carrying all the wrath and contempt of humanity in a dark attic.

Small Victories: Spotting Improbable Moments of Grace by Anne Lamott

I think I love reading Anne Lamott in equal parts because of her literary bravery and her reverence for the magical spaces in Marin county, for which I am always longing.  In this book, she finds humor, beauty and meaning, in the everyday life events.  She is never afraid to own-up to the less than desirable human traits of jealousy, laziness, or fear.  Her bold humor reminds me that life is always funny.  But it is her willingness to blend the more nebulous subjects of faith, grace, and God into the everyday fold of story-telling, to enter into the world of the spirit without proper credentials, that moves me every time.  My writing humbly leans toward her example, as I feel called to find the humor and the meaning in the world around me.

What I Talk About When I Talk About Running by Haruki Murakami

From the same Japanese author as the novel described above, this non-fiction meditation on running and writing is very unique.  As a runner (on sabbatical) and writer (in my fantasies), I was very satisfied by his focused collection of running thoughts.  As with his novel, Murakami is able to move seamlessly between the dreamworld of the mind and a very carefully described reality.  Such a long book just about thoughts about running might be tedious by another author, but Murakami has the special gift of making the mundane peacefully interesting.  I kept saying to Mike, “I don’t know why I like reading this book, but I really do.”

Catastrophic Happiness: Finding Joy in Childhood’s Messy Years by Catherine Newman

Not unlike Anne Lamott, Newman searches for the humor and meaning in mothering.  Her collection of essays is fast-reading, and her experiences are instantly recognizable.  Even though her kids are entirely different than mine, this tribute to the unseen work that mothers do is universal.  Mothers with children of all ages will enjoy this read.

The Mischief of the Mistletoe: A Pink Carnation Christmas by Lauren Willig 

Something about Christmastime motivates me to read Jane Austen sequels.  Nearly a year after I read the last Jane Austen sequel, I picked up this one.  A whimsical and entertaining mystery, I whipped through this story in a days, the rain pounding on the roof, my tissue box handy.  Going to bed for a few days with a good book was just what I needed to fight my 400th sinus infection of the season.  (Okay, I’m exaggerating…)

 The Born Frees: Writing with the Girls of Gugulethu, by Kimberly Burge

This book is a true memoir of an American woman who goes to an impoverished township in Cape Town, South Africa, to lead a weekly writing group for teenage girls.  In watching the girls unfold and process the reality of their lives through writing, I realized I was doing the same thing.  By writing about and sharing my difficult life experiences, I was releasing the experiences and permitting myself to dream beyond cancer.  I thoroughly enjoyed reading this uplifting account, showing the power of writing for youth.  The book inspired me to work with Cali to write about her experiences and feelings through her treatment and beyond.

When Breath Becomes Air by Paul Kalanithi

It feels like sacrilege to even talk about this book objectively.  This book is the heart wrenching, true story of a resident brain surgeon who is learning to operate on severe brain cancer patients, when very abruptly he himself is diagnosed with terminal lung cancer.  In his last months, he wrote this book to describe his experience of suddenly switching from doctor to patient and the reality of facing death in more than a medical way.

The first part of the book is filled with engaging description and moments of brilliance.  However, as the cancer metastasizes to his other organs and eventually his brain, the quality and density of his writing fades.  The afterward, written by his devoted wife, also a medical doctor, describes his rapid decline and death.

I found myself deeply disappointed, and then extremely ashamed at myself for being disappointed.  As a reader and fellow cancer survivor, I wanted him to live.  I wanted him to prevail and overcome that darn disease.  And if he couldn’t physically overcome, at least I wanted him to arrive at some mental solace, at some peace with death.  I wanted this harrowing experience to culminate in some grand epiphany.  However, the story just petered-out, which is exactly the hard truth.  Real death is not usually a grand culmination.  It is not a graduation speech.  It is slipping into another world without a satisfying concluding sentence.

Usually, I give  books to my friends after I read them, especially hardbacks I purchase at the bookstore at full price.  However, I could’t bring myself to recommend this book to anyone, not for lack of quality, but because of a truth I was not ready to face.  I buried the book sideways on the top shelf of my living room bookshelf, but it still stares down at me like a pair of eyes.  I may have to revisit this book again.

The Middle Place by Kelly Corrigan

A friend recommended this book, telling me it reminded her so much of my blog and my story.  Strangely, it is by the same author as the book that started this reading adventure.  In this memoir, the author and her father simultaneously undergo treatment for different kinds of cancer.  In refreshing relief to Kalanithi’s story, both of the cancer patients survive radiantly, which is a helpful kind of story for me right now.  However, the story is so much more than a cancer memoir.  The characters of Kelly’s family spring to life, and I was drawn into the drama and love of her family as if it were my own.  In studying her writing, I realized how processing her cancer experience was like a tool for investigating her own life and drawing out the most important pieces.  I have benefited from cancer in the same way; somehow the shifted focus has given me fresh insights I don’t think I would have found any other way.

*

I haven’t figured out why, but writing this ridiculously long book review and re-reading it over and over has given me extreme pleasure over the last two years.  The escape I feel when I am reading and writing these reviews is even better then the experience of reading the actual books.  It is a phenomena I don’t understand.  I kept asking my sister when we were living at the cottage, “Do you think I am really weird?  My most satisfying pastime right now is writing reviews of books I read.  I think I am reading books just write reviews.

She said wisely, “If you makes you happy, why are you questioning it?”  I guess writing the reviews was kind of a way of marking progress, in a an otherwise timeless period with no footholds.

But now here is a little twist.  Here is a possibly forthcoming publication.  Do you think you would read it?

When Lightening Strikes Twice: Finding Inspiration Against All Odds by Jenny Lovejoy Bennett

When a self-employed mother of four is unexpectedly diagnosed with leukemia, she is very suddenly ripped out of her life and away from her family to undergo aggressive treatment, requiring isolation and a bone marrow transplant.  She chronicles her adventures with both humor and pathos, bringing readers inside her world to experience cancer treatment from her unique perspective.  However, her story takes on a bewildering and heart-wrenching twist when, just as she is starting to recover, her seven-year-old daughter is shockingly diagnosed with lymphoma, a similar blood cancer.  The author is forced to switch immediately from patient to caregiver, deepening her experience of cancer and challenging her ability to find inspiration against all odds.

 

Partial Collapse

“Would you like to take the wheelchair or walk?” I asked Cali.  We were parked in one of the eight handicapped parking places in front of a medical complex in Menlo Park.

“Walk,” she snapped shortly, rolling her eyes at me.  Wearing her favorite pink sweatpants, her neon pink jacket and sparkly, rhinestone high-tops, she was dressed to impress.  I held out my hand to help her as she laboriously leveraged herself to a stand from the low car seat, but she swatted my hand away. “Stop it, Mom!”

Feigning hurt feelings, I pushed my face into a exaggerated frown, “I am just trying to help you.”  But secretly, I was thrilled.  This spunky attitude, this insistence to walk, were sure signs of recovery.  Only two days ago she had been begging me to wheel her from her bed to the toilet, a distance of about twenty feet.  Now she was willingly hobbling, unassisted, several hundred feet from the car to the physical therapy office.  My breath relaxed a notch. I was so relieved to see her walking again.  But I stayed at arm’s reach in case she needed to grab my willing elbow.  I had seen her collapse without warning one too many times.

Cali reached into the foliage adjacent to the glass entry door to press the partially hidden wheelchair button, activating the automatic door-opening mechanism; by now she knew all the tricks of independence.  We entered a mellow hallway featuring unremarkable pastel art and low acoustic tile ceilings.  The building housed a variety of doctors and offices: an ENT, a gastoentologist, an OB/GYN, a dentist, and in the back half of the building, Lucile Packard’s satellite rehabilitation offices for patients like Cali who are well enough to leave the hospital.  These offices were a pleasant collection of benign practices with a relatively healthy clientele.  Even though getting to the satellite office a required congested drive across town and a slow trek down a long hallway, Cali’s weekly PT appointment was a welcome break from the charged environment of the hospital.  Or at least, it had been.

Two weeks ago we encountered a minor traffic jam at this very same door.  Just as I approached the door with Cali in her wheelchair, an severely hunched, grey-haired man lunged in front of us and grabbed for the door handle.  Trying to be polite, I wheeled back to give him space.  He struggled to pry open the heavy door and thankfully a second younger man stepped forward to help him.  Graciously the younger man continued to hold the door for us, and we wheeled through.  I naturally assumed the two were together.

When we were all safely inside, the door holder surprisingly walked right past the elderly man and continued into an elevator, without so much as glance in the elderly man’s direction.  I barely had time to realize these two men were strangers before the elderly man began to tip forward from his precarious right angle and approach an acute angle.  He grasped frantically at a poorly anchored picture frame for support, which swung out from the wall threatening to crash on his head, and I instinctively let go of Cali’s wheelchair and rushed to his side. I tried to put my arm around his waste, hoping to steady him.  “Do you need help?” I asked foolishly, already quite sure of the answer.  At that moment his knees suddenly buckled below him, and since he was a large man, all I could do was soften his fall.  Frantic, he clambered to his knees and continued to crawl forward, calling out in slurred, raspy speech, “I just need to see my doctor!”

This man needs medical attention immediately, I thought in a panic.  I looked around.  A couple of patients sat waiting on benches in the distance, hiding behind their newspapers.  How could they be so oblivious?  I couldn’t leave Cali alone with him.  Nor could I leave the man alone. He tried to stand again, but once more, his legs collapsed. I had to do something.  What could I do?  I was about to bust into the nearest unlocked door and call for help when a nurse happened to walk down the hall.  “Excuse me!  I don’t know this man, but he just collapsed here in the hallway.  I think he is by himself.  He says he needs to get to his doctor.”

In moments she paged a towering, uniformed medical assistant, who grabbed an empty wheelchair from the foyer – what a concept!  Why didn’t I think of that?  “Are you having any chest pain, sir?” he asked loudly as he lifted him into the wheelchair.

In a barely intelligible slur, the elderly man forced, “I was having pain at home.  That’s why I drove here.  Just get me to my doctor!” The medical assistant and the old man quickly disappeared into an open elevator.

I looked at Cali’s face.  It was white.  She seemed shocked speechless.  I tried to fill in the words for her, struggling to make some sense of what we had just witnessed.  “That was really scary, wasn’t it?  I am glad he is going to his doctor.  His doctor will know how to help him.”  Cali and I had spent hundreds of hours in the hospital together, we had certainly heard sad stories of patients in critical conditions, yet this was the closest we had personally come to tragedy, a collapsing man alone in a quiet hallway with only Cali and me to help.  It made the busy, doctor-filled hospital halls look appetizing.

A few minutes later in the PT waiting room, when Cali finally gathered her words, she asked, “Mom, is that man going to die?”  I couldn’t honestly tell her that he wouldn’t, but I told her his doctor would know how to help him.  I told her he might have to go to the hospital.

“Mom, is he going to my hospital?”  she asked with concern.  I explained that he was very old, that sometimes emergencies happened to very old people, that he would go to a grown-up hospital.  But she and I both knew that emergencies also happened to kids, and even Moms.  “Mom,” she insisted, needing a clear picture in her mind, “Are you old?  Is he going to your hospital?”

“Yes, Cali, he probably will go to my hospital, but I’m not as old as he is.”  A look of terror came across her face.  She looked away.

During therapy, she was very distracted.  I knew she was thinking about the man.  I was, too.  In a very pivotal moment, I had been unable to help him.  I had wanted to keep him from falling, but I was not strong enough.  I had wanted to run for his doctor, but I couldn’t leave my own daughter alone with him, lest she collapse herself.

Forty-five minutes later, as we exited the PT appointment, an ambulance was blocking our car.  “Is the man in the ambulance?”  Cali asked with urgency, but no sooner could I answer than his stretcher wheeled past us in the hall with a crowd of medical personnel following close behind.  He was strapped tightly to a board with an oxygen mask over his face.  His eyes were closed.  “Mom, is he dead?”

“I don’t know, Cali,” I answered truthfully.  We both watched in silence as they popped back the wheels of the stretcher and slid him into the rear cab of the ambulance.  In minutes, they were speeding away, sirens blaring, and then all was quiet again.  I wheeled her out to our car and got in.  We didn’t say anything.  We were both thinking about the man, and worrying about each other.

That was a few weeks ago, and because I am superstitious, I will call that event that kicked off our downward spiral. In the next two weeks no sooner did we deal with one challenge than another appeared.  First it was Cali’s intense intestinal cramps, then Cali’s extreme sleepiness as a negative reaction to one of her chemotherapy drugs.  Next a stomach bug kept both Cali and I bathroom bound for about twenty-four hours.  Vaguely abnormal blood cell counts at my own check-up last week reminded me I was not completely out of the woods, and having wound myself up into a tizzy worrying after the appointment, I locked my keys in the car.  The next day Cali needed an unexpected platelet transfusion that was supposed to take one hour, but took all day, and Cali’s weight fell a shocking eight pounds.  No sooner had we cleared all those hurdles then Cali started waking in the night with extreme shin-bone pain.  “Mom, it’s a ten, it’s really a ten!”  When Cali says pain is a “ten out of ten,” I respond because this is the girl who didn’t cry when she broke her arm at school, who finished junior guard competitions the day before she was admitted for emergency chemotherapy for a tumor the size of a watermelon pressing on her lungs.

Luckily, rapid change is a halmark of Cali’s chemotherapy journey.

flowersI am happy to announce that this week, the tides have turned for the better!  All of sudden, Cali is eating voraciously, and she is no longer sleepy.  She is walking, and her stomach cramps and shin-bone pains have gone as quickly as they came.   But there is more to celebrate:  miracle of miracles, I can finally smell, which means my seemingly endless head cold is (at least temporarily) in reprieve.  AND last night, when I pulled back the hair on my forehead, I discovered a new layer of Jenny-Lovejoy-orange hair growing below my unfamiliar greyish-blond curly mop!

But the best news of all is I had repeat bloodwork done on Monday, and all my blood count levels are back to normal.  The aberration was most likely caused by all my minor illnesses.  So, at least for this week, there is no big scary relapse monster hiding in the closet. Things are really looking up!

 

 

 

 

 

Anchored By A Plate

Please Note: I am so glad Cali and I have been able to stay at Ronald McDonald House, where we have the company of the other House families and the support of the many House resources.  Creating a homelike environment where more than sixty concurrent families can live comfortably during stressful times of illness is no easy feat.  The Ronald McDonald House is nearly perfect in every way, but with so many different families living so intimately, comical moments are inevitable.  Hopefully my humor never belies my deep gratitude for the many, many generous donors and volunteers who make the House possible.  Thank you all from the bottom of my heart.

I don’t always bother with kitchen creativity.  There are nights when Our Lady of the Saintly Orthodox (or something like that) comes to make us Chicken Dinner, or a generous local business springs for an All-House Pizza Night, and Cali and I always partake.  Other nights, we heat a chicken pot pie, slice some apples and call it good.  But every now and then, I dive into the kitchen and actually cook something familiar.  I am not talking about gourmet cooking; I am just talking about eating a meal that reminds me of home.

When I am planning to cook, I do the mental work-up in our bedroom.  Okay, what ingredients do I have downstairs in my personal Room 301 pantry shelves?  What items can I omit?  What can I pilfer from the community cupboards?  By all means, I do not want to show up in that frenetic kitchen without a plan.  It is hard enough to cook, weaving around bodies and multi-language conversations, let alone think.

rmh-kitchenThe south facing walls of the RMH kitchen are a long line of appliances with pleasant windows overlooking the backyard.  There are five gas-ranges, four sinks, and three dishwashers, strung together by vast stretches of three-foot-deep counter.  Drawers below the counters are stuffed with an unorganized consortium of pots and pans, serving spoons, can-openers, and a knife or two if you are lucky.

My first objective when I enter the battle zone is to stake out a bit of real estate for food prep activities.  A couple of core families generally monopolize the prime cooking locations, and I honor their territories.  These families often start cooking dinner at eight or nine in the morning, hacking frozen raw animals apart directly after breakfast, and continue to stand stirring through the good part of the day.  I am in awe.  I am never going to be a start-chicken-soup-in-the-morning, stir-all-afternoon kind of gal.  Instead of investing lots of time, I usually opt for the more creative tactic of taking my food prep activities away from the counter area to the adjacent high eating tables.  While less convenient, the tables are usually empty during pre-dinner cooking time, and Cali can sit farther away from the meaty scents of the stove-tops, which make her double over in nausea these days.

young-chicken
Young Chicken thawing at breakfast.

My next step is to locate any necessary cooking utensils. At this point, I usually swear I’m going to buy my own selfish collection of essential accoutrements, but I quickly discard this idea when I see how crowded my 301 pantry already is with just our essential food staples.  Kitchen knives, cutting boards, and the solitary vegetable peeler are all hot commodities.  Securing these items can take the better part of my prep session.  Hot mitts, counter diseinfectant and clean dish towels just plain don’t exist; I have stopped looking.

When I have done as much cooking as I can without a stove or sink, it is time to find a crack in the frontline where I can make my entry.  I assess each range.  Three out of four burners in use at range one, two out of four burners in use at range two, and the range in the back is severely crowded by a boy in a large wheel-chair with an oxygen tank.  It wouldn’t be right to force myself into that corner.  Wait!  The range in the middle has three empty burners.  Ah ha!  I have found my foothold.  Luckily I am just skinny little me and I can easily sidle up between the other soldiers.  I don’t have a bulky infant carrier or a needy toddler for a side-kick; Cali prefers laying down on the dining room bench seats to standing in the middle of this cooking frenzy.

Once I have food on a burner, everyone shifts around to give me some room.  We all keep our eyes on our own projects, trying not to gawk at this very close opportunity to snoop at how other people do “dinner.”  On one side of me, a family is frying handmade egg-rolls, on the other, a father douses black meat is with mystery spice to be barbecued (outside in the rain).  If someone standing next to me happens to speak my language (Mainland-America English), I might try to strike up a casual conversation.  So what is your kid dying of?

However, when I tried practicing my Spanish, I realized I had a very limited vocabulary for the subjects at hand.  I didn’t even know how to say “red pepper.”  I just stood there with my mouth open, pointing at their vegetables, which made me look kind of crazy and rude at the same time.  I am learning that a friendly smile and an occasional “lo siento” when we accidentally bump rear-ends is getting me further in cross-cultural friendships then any sentences I can eek out in the busy kitchen.

calis-favorite-bench-seat
Cali’s favorite bench seat.

Finally, I stack all my dirty dishes in a little pile, carefully tuck any perishables into my fridge cubby, and make 422 treks between the kitchen and the absolute farthest dining room table, since Cali insists on the camping on a bench seat close to the exit door.  Okay, so it’s only a few trips back and forth, but it always seems like a really long walk; I bet it takes almost thirty seconds.  I am thinking a waitressing tray would be a good investment. Then again, this walk is my major form of aerobic exercise for the day.  I should try to maximize my mileage.

After we eat…why am I kidding myself, only I eat these days; Cali just watches.  After I eat, I return to the kitchen, and now you will see a minor flaw in this kitchen’s design.  Recall that there were five stoves-tops on which to cook.  But there are only four sinks, and there are a measly three dishwashers.  Yet, the number of people who need to wash dishes is actually more than the number of people who actually cook, since those who choose take-out or left-overs usually have some dishes to wash.  The jockeying gets intense in the post-dinner phase.  If I dare step away from the sink to dump a potato peel into the garbage, the next washer slips in to use the faucet before a drop even hits the stainless steel basin.  At least we are not wasting water!

However, the big problem comes with the dishwashing machines themselves.  I swear when I got my first tour of RMH back in October, the director requested I load dirty dishes directly into the dishwashers.  But maybe my memory is wrong, because 95% of the people at RMH don’t use the dishwashers.  Not that people are messy; the residents carefully scrub their dishes with dish soap, rinse them well and put them on the counter to dry.

At first, I was a dishwasher warrior.  Even though my peers avoided the shiny silver machines, I dutifully loaded my dishes every time.  However, this commitment lead to a lot of extra work.  If the washers were full of clean dishes, I first had to unload them.  In all honesty, I didn’t mind unloading.  I took pride in helping the house.  But sometimes the dishes were clean, and not dry.  Then I had to hand dry the dishes in order to put them away.  Cali didn’t tolerate my indulgence in this extra chore very well.  But what were my choices?  Put the dishes away wet?  Leave them on the dirty counter to dry?

The real problem became when the dishwashers were half-full and the lights on the front were blinking half-done.  When I looked closely, some of the dishes looked clean and some looked dirty.  Hmmm.  Knowingly putting dirty dishes in the cupboards would be a sin far worse than leaving hand-washed dishes on the counter.  But if I re-washed all the dishes, that felt wasteful.

tender-bird
Blurred boundaries.

The convention seems to be facedown dishes are washed and are ready for reuse.  But we all have kids and families who are clamoring to eat.  We all leave dirty dishes on the counter, too, to be washed after dinner.  While these dirty dishes are usually face-up, the boundaries between dish piles become a little blurred during the busy hours.  And how can you tell when a knife is facedown? I am not the only person who eagerly grabs a coveted blade after it has been merely hand-washed.  Sure, it crosses my mind, I should probably rinse the knife, just in case the person before me used it to sever raw chicken breasts, but caught up in the race to cook, I usually don’t.

And then there are the counters themselves.  I mentioned the missing counter cleaner.  With chicken juice and baby formula and reheated beans splattering left and right, why are we putting clean dishes directly on the counter tops?  We clearly are not thinking.

 

When Cali and I ascend from the boisterous kitchen to our quiet room, the focus switches from feeding myself to feeding Cali.  After I lead Cali through her long bedtime routine – bathing, nightly Lovenox shot, ankle stretches, teeth care, evening meds, reading practice – she finely drifts into peaceful slumber, but I still have a delicate dance to perform.  While she is sleeping, I have to dispense formula and medications through an ng-tube that goes directly to her stomach by way of her nose.  I artfully manipulate the timing, order and rates of distribution, to ensure Cali gets her meds on schedule and receives enough calories, and I get enough sleep.  If she vomits, I loose points, we have to start over.

Through careful trial and error, this week’s post-bedtime schedule is:

8:30 pm     Give nausea med.

9:15 pm     Give steroids.  (Sounds weird, I know.  These are actually a form of chemotherapy.)

9:30 pm     Prepare and start her formula.  This week’s magic rate is 30 mL/hr.  Strangely the less she eats during the day, the less she can tolerate at night.  Unfortunately, with this new block of intense chemo she is in a pattern of losing weight again, but I guess some calories are better than none.  Hopefully her appetite will turn around soon.

10:30pm     Give her lactulose, a thick green, voluminous syrup that is hard to push through her line and causes diarrhea.  This part is tricky.  The thick liquid often leaks sticky drops onto her pillow, briefly waking her.  In her sleepy haze, she shouts “No!” and yanks her ng-tube from me, spraying green goop on both of us.

Step three from above, preparing and priming the formula pump, is not actually that hard, but it is hands down my very least favorite part of this whole routine.  (My husband is equally unenthusiastic, and when we are at home, he and I play roe-sham-boe to see who gets the honor.)

Partly, it is the hour. The priming always happens precisely when I am ready to read the newspaper or watch a movie or take a bath or whatever luxurious non-kid activity I choose at the end of day.  Prepping the formula takes just long enough and requires just enough mental and physical exertion to put a real damper on my wind-down.

Because you are all dying to know exactly how one prepares formula for an ng-tube feeding, and because you want to relieve me one night while Mike and I actually have a real date, here are the detailed, full-color instructions!

First you have to calculate how many boxes of milk she needs to last the whole night;  there is nothing more infuriating than awakening to a screeching beep about an hour and forty-five minutes before you are ready to wake up.  Each box has 237 mL (a nice round number), which becomes the divisor in the equation.  To get the dividend, you multiply the number of hours you want to sleep by the pump rate Cali can tolerate (guess and check, she vomits, you turn it down).  The resulting quotient is the number of boxes you will need. (Always round up – see beeping note above.)

Next you retrieve the necessary formula boxes from underneath Cali’s dark bed, being careful not to hit your head on the bed frame, and locate a fresh plastic pump bag with attached connector tube.  You carefully take the pour tabs off the boxes, making sure not to spill; the sweetened condensed formula dries into a hard sticky glue that is very hard to clean. You gingerly pour the formula into the bag.  (If you pour too quickly before the bag expands, the thick formula overflows like lava all over your hands and onto your favorite shirt sleeve.  Worst of all, your volume calculations are now incorrect, and you have to start over.)

I used to spill almost every time, but I have honed my skills.  Now I am a mean pouring machine.  I time my pour speed perfectly such that in the time it takes to toss the emptied first box in a waiting trash can and pick up a new box, the fluid level from the first box has just finished settling, and I can start the next pour without skipping a beat.  I keep waiting for a talent scout to notice my hot skills and invite me to the next episode of Star Search, but so far it hasn’t happened.

Then comes the dreaded priming. First, you position the connector tube end in a place where, if formula leaks, you won’t be mad.  For a long time I cockily convinced myself I could stop the flow right before the formula came out the tube end.  I now have a lot of formula drip stains on the rug by Cali’s bed.

animals-in-the-rain
The animals and flowers are enjoying the rain.

The fasted way to prime the line is to hold the bag as high as you can over your head, but it never feels fast.  Even though priming only takes about 60 seconds total, my arm muscles burn instantly when I raise the bag above my head.  You would think with the nightly practice, I would be get stronger, but so far it’s not happening.

The catch is, at the same time you are holding the bag over your head, you have to delicately press on the tube release valve with the thumb of your opposite hand, using tiny thumb muscles you never knew you had.  If you press too hard, you pinch the tube and cut off the flow completely.  Then you are just standing there with the bag over your head, your arm muscles burning, your thumb knuckle cramping, cursing the bag for not priming, until you realize your silly mistake.  Somehow the combination of holding one arm strongly overhead, while delicately maintaining thumb pressure with the other arm at shoulder height, requires just enough coordination, concentration, and muscular effort to be totally infuriating.  Every single night I find myself whispering under by breath, I hate this.

Finally, you take the primed bag into the dark corner where Cali is sleeping and thread the connector tube into the pump by braille.  I can’t possibly explain; I will just have to show you when you come over.  There are a lot of ways to make a mistake, and if you do, the pump will let you know with a high pitched squeal that wakes everyone up, including both sets of neighbors, and all the local dogs.  Don’t worry.  You will get the hang of it after about two hours of practice.

Have I convinced you to Cali-sit yet?

A few days ago, while creeping down to the kitchen for a late-night glass of water, I saw a surprising sight!  Special RMH kitchen fairies were working in the wee hours, taking all of the “clean” dishes off the counters and loading them into the dishwashers.   After running the machines, they unloaded the dishwashers, and did it again and again, until all the dishes were clean.  So that’s why the morning dishes in the cupboards are always so clean and dry!  The fairies also wiped all the surfaces in the whole kitchen and dining room with a hospital grade disinfectant.  I was notably impressed.

Discovering the fairies made me feel better about overall kitchen cleanliness at RMH, but I was still confused about how to handle my own dirty dishes.  I started wondering why I even bothered cooking or using washable dishes at all?  Why not use the readily available, 100% recycled paper plates RMH stocked daily?  I shuddered at the thought, not because of the waste, but because of my need to be anchored.

The reason I yearn for ceramic plates and metal silverware is the same reason my Mexican friends knead their own masa dough in an empty corner of the crowded RMH floor, even in the presence of an endless supply of store bought corn tortillas in the communal fridge.  In our world, where lodging is transient, where good health is fleeting, where life itself seems tenuous, we cling fiercely to anything permanent, anything grounding, anything that symbolizes home.  Even if it’s a ceramic plate for a daughter who doesn’t eat.

Layers

calis-new-birthday-clothes
Cali shows off her new birthday outfit.

Trying to get comfortable in a reclining, faux-leather lab-draw chair, Cali nuzzles her bare head into the ball of my discarded down jacket.  She positions the screen of the personal hospital T.V., attached to the adjacent wall by a long pivoting metal arm, in just the right way to block the glare of the fluorescent lights above.  The screen also affords protection from me, who is pummeling  her with annoying questions.  Do you want to do some math pages?  Do you want me to read a story?  Do you want to play with my phone? Does your stomach hurt?  She hugs her knees tighter, and silently pulls the screen closer.  Her eyes feather shut.  Are you just really tired, and you want me to leave you alone?  This last question solicites a slight nod.

The truth is, I am also exhausted, and Cali knows it.  I don’t really want to work with her on her math or read her a story or even actively engage in setting up a movie on the touch-screen T.V.  It is all I can do to sit quietly in the nearby chair, and bury myself in my book.   I was up every hour, on the hour, projectile vomiting into the toilet bowl myself last night.  After a final episode at 8:00 am, I couldn’t imagine how I was going to rouse Cali and get her to the morning’s chemotherapy infusion appointment.  However, somehow I muscled my way into the shower and pushed us both to the car.  We miraculously arrived, albeit an hour later than scheduled, but an hour is nothing in the oncology waiting room.

calis-birthday-lego-set
Cali works on a new Lego set Reef gave her for her birthday.

However, Cali is more than tired.  She is delirious, practically sleep walking.  She requested her wheelchair to get from the car to the clinic, and can tolerate no diversions; the i-pad and my phone hold no interest today.  So my questions, disguised as those of a doting, conscientious, possibly hyperactive Mom, are really probes into the seriousness of her condition.  How much should I emphasize to her doctor that she is very sleepy.  How much do I push for the doctors to draw an ammonia level?  How much do I want to end up in-patient again, watching her try to poop out ammonia for two weeks straight?

When the doctor makes her rounds, I rattle off my observations.  She vomited last night, but so did I; it could have been food poisoning for both of us.  Her walking has been worse the last couple of days; it could be the Vincristine, but it could also be that she is tired.  Very tired, even though she slept a lot last night, from 8pm until 10am this morning.  Her physical therapist admits Cali’s endurance is down, but notes Cali’s strength and flexibility is still on the rise.  I gingerly suggest, “Do you think her sleepiness is from the Peg-Asparagenase again?”

There is a careful edge between the roll of parents and the roll of medical staff in the children’s hospital.  I noticed this edge immediately when Cali was first admitted to the ICU.  I remember sitting in a glassed room during Cali’s first days as a cancer patient.  Recently extubated and just coming off sedation, she was writhing in thirst and discomfort, but unable to talk through her parched vocal chords.  “Should I give her more Ativan?” a nurse asked.  I assumed the nurse was just talking to herself.  I didn’t acknowledge her question.  She spoke a little louder, “Mom, do you want me to give her more Ativan?”  I looked up at her.  I couldn’t believe she was seriously asking me this question.  I could see in her eyes that she had an opinion, but she was definitely waiting for me to give the okay.

“Oh, well, you would know better than me,” I fumbled, having no idea what was best for Cali in that moment, barely able to comprehend where I was, or which one of us was the patient.  And I even knew what Ativan was, how it felt in my body, the gentle peaceful sleep it granted when the body was tormented.  Imagine the parents who had no idea?  In the days to come, I was amazed at all the permissions requested of me when I happened to be present.  May I wash the vomit off your child?  May I change her exploding, poop-filled diaper? May I start the chemo now?  May I give her anti-nausea medicine?  Every time an obvious question was asked of me, I wanted to shout, “Why are you asking ME?  Aren’t you the nurse?”

One day, when I was feeling talkative, and Cali’s condition had become much less critical, I asked a nurse, “Why do you nurses and doctors always ask us parents if you may give this medicine, if you may change the sheets?”  I figured it must be some kind of parent inclusion protocol, to get the parents involved in the care of their child so they feel part of the team.  But she said simply, “Oh, because we find that parents really do know best.”  My eye brows knit together.  I wasn’t sure I wanted that kind of responsibility.

calis-scrabble
Cali and I keep up the Lovejoy family Scrabble tradition.

However, time has shown, the nurses are right.  Children can’t be expected to lobby for their care the way adults can in a grown-up hospital, and nurses and doctors come and go.  Parents are the continuum.  They are the ones present for every different doctor meeting, for every nurse shift, for all the days at home.   They see how much throw-up really happens in the night and how much their kids actually drink.  They know which drugs make their kids crazy and which actually help, because the parents are the ones who get the water bottle thrown at them in a unprecedented fit of rage, or who toss the uneaten dinners away, night after night.  Parents know what idiosyncrasies will send their child into a tizzy (shutting the bathroom door all the way) or what might tempt their child into permitting a wound dressing change (let’s time the nurse to see if she can do it in less than two minutes!)

So, as I see Cali slipping into a scarily familiar sleepy state, one that brings back the carnal memory of folding Cali’s sleeping body, commotose, onto her wheelchair for a cold 10 pm ER trip, where she incited the alarm of the on-call doctors with her dangerously high pulse and skyrocketing blood-ammonia levels, I feel called into parent watch-dog duty.  Not by choice, but by expectation.  Doctors have made it clear that I am to be a integral part in her treatment.  Even though I have a torturous stomach-bug and would much rather leave the game to them today, I am obligated to stand at attention.

The problem is, with this medical condition there are so many layers.  I am starting to appreciate a broken arm.  With a broken arm, your kid falls, boom, she cries.  You go to the doctor and they do an x-ray.  Amazing!  On precisely the arm she smashed, there is a crack in the bone.  Everything makes perfect sense.  The cast is applied, the arm heals, the pain gets better.  Everyone is happy.

But in this chemotherapy immune-system disease thing, it is not nearly that simple.  There is the layer of being a kid in the winter, and getting colds and stomach-bugs.  There is the layer of successive chemo doses that are accumulating in her system, causing overall fatigue, nausea, and pain.  There is the chemo-induced dip in her blood values, making her anemic and more susceptible to all kinds of internal infections.  There is her mysterious, sometimes present, sometimes not, adverse reaction to one of the key chemo-drugs, Peg-Asparagenase (which it turns out is actually a bacteria related to E. Coli – no wonder her body doesn’t like it!).  And there is coming off steroids, which can make a person feel angry and tired and nauseated.  Like the leaf litter of the thick wet forest, there are so many levels of decay you can’t really isolate one root cause; you just have to be content with a conglomeration of answers and responses.

the-el-camino-as-car-club
You just never know what will show up at the Ronald McDonald House.

My disease is similar leaf litter.  On Monday, I went for a routine check-up with my BMT doctor, which always involves some basic blood work.  I have come to expect the labs values to come back completely normal; I guess I am moving on from being the patient and fully embracing the role of caregiver.  I was startled when my doctor told me my blood work was slightly abnormal.  I had slightly elevated liver values, and slightly low white-blood cell counts, and a few other minor aberrations.  She seemed fairly certain the labs were off because of my slew of recent illnesses (see previous post –  Coughers and Smokers), but she was not certain enough to let it go completely, and I was to come back for a lab recheck in two weeks.

I tried not to worry about the slightly “off” results, but the conversation knawed on me , and eventually I succumbed to a full over-analysis of my blood work, digging up results from when I was first diagnosed and performing a layperson’s assessment to determine if I was going into relapse.  As the hours pressed into the night and my Google searches became more futile, I became more and more frustrated with myself for even staying up, for letting myself go down this self-defeating road. The more I dug, the more I confirmed what I had already known; there were too many layers for even the best doctor to guess.  Only time would tell.

Cali’s doctors decide to stay the course with the planned chemotherapy, but also treat her for a possible adverse reaction to Peg-Asparagenase, asking me to keep a a low threshold for calling the clinic over the weekend, and posting orders for her blood levels to be checked again on Monday.  Funny, isn’t that what I suggested?  Or maybe I am just imagining things;  I am not sure, I am tired.  Now Cali and I will both go back to our creekside room at Ronald McDonald and sleep.

 

 

Coughers and Smokers: A Valentine Plea

do-not-enter-signOkay, I have something to get off my chest.

On every door entering the Bass Center for Childhood Cancer at Stanford, there is a threatening red stop sign  that says, “For Patient Safety: Do Not Enter if You’re Sick, this includes if you have a fever, cough, runny nose, rash, recent infection exposure such as chickenpox, mumps or measles.”  Here is my confession:  I have been blowing my nose or coughing continuously since the beginning of November, and I keep walking through those doors.

This is really horrible to admit.  I have been the neutropenic bone marrow transplant patient with the white blood count of zero.  I have shared a hospital rooms with leukemia patients dying, not of cancer, but from complications the from common flu.  I, of all people, should know better.

Sure, on the days I was really sick – feverish, achy, red-eyed – I was extremely careful.  I wore a HEPA-mask and held the door handles with the edge of my sweater. But the reality is, even though I just can’t seem to completely kick the residual crud of winter’s germ-fest, Cali’s treatment must go on.

Each time I see the sign, I think, I should not step through this door.  At least I should wear a mask.  But then some little voice of “reason” jumps in and says,  Who else can possibly take her to her many appointments?  And after all,  it has been several weeks since I had the flu.  I can’t possibly still be contagious. So I use a lot of hand-sanitizer, stay as far away as possible from others, and don’t look anyone in the eye, for fear they might see deep into my sinuses and know my true guilt.

cali-on-dolphinLuckily, I have recovered to the point where I really only have to cough two or three times a day.  I can go hours, whole nights, without a hack.  However, as soon as I walk though that Bass Center door, something happens.  The mucus lining in my throat increases exponentially.  My tonsils burn. My voice box churns out words in a low gravel.  My eyes water.   But I keep that cough at bay.  I will not be discovered.

Cali goes instantly to the touch-screen computers in the cancer center waiting room to play a coloring game. I open the complimentary USA Today.  But actually, I am thinking about that cough.  The more I think, the worse it gets.  Finally, I run to the bathroom.  I turn on the fan, lock the door, and let out my wet, barky blasts into a paper towel.  Phew, I made it. Now I will be okay for a little while.

When Cali and I are called back to a private room, safely separated from all the vulnerable patients, my urge to cough magically disappears.  I decide I must not really be sick.  I must have an anxiety cough.

Now that we are living at Ronald McDonald, I have to up my ante.  It’s not just the Bass Center waiting room I have to worry about; it’s everywhere!  I have to suppress my urges in the kitchen, the halls, the elevators, and most definitely in the lobby.  After all, it was in the lobby where I signed an affidavit stating if I – or anyone else in my family – developed so much as a sniffle, we would promptly vacate the premisis for at least three days, to return only with symptoms completely gone and a doctor’s note in hand.  Oh yeah, and we lose our room.  At RMH, coughs and colds are S-E-R-I-O-U-S business.

So here I am, sneaking around RMH with my little anxiety hack, coughing quietly in my room, alone in the elevators, in the empty exercise room, or even behind the refrigerators when no one is looking.  (However, just today I noticed a a little camera on the ceiling pointed right where I go.  Apparently I am not the first to try forbidden activities back there…)

calis-horse
Cali shows off a horse she made at school!

I know what you are thinking.  Why don’t I go to the doctor?  Why don’t I get some antibiotics or something and be done with my cough?  Here is the brilliant answer:  I have! (And then some.)  I have had nose-swabs and chest x-rays;  I have taken Tamaflu, anti-fungals, and two strong courses of antibiotics.  If you could see my “gut-lining” where all those supposed “good bacteria” hang out and proliferate, it would look like the Sahara Desert.  Everything good, bad, and neutral has been completely obliterated.

My bone marrow transplant doctors say I am fine; my inability to fight viruses quickly is par for the course.  You know how toddlers can have a runny nose all winter long?  Well, that’s me.  Toddler Jenny with a toddler immune system, because my immune system was only born a year ago.  Nothing more, nothing less.  Imagine that!

I still feel guilty, very guilty, most of the time.  Sometimes this guilt makes me grumpy and gets in the way of my parenting.  But I am thankful for one thing:  at least I am not a smoker.  Nobody – NOBODY – not even the punkiest, tattooed, rebellious adolescent, feels good about being a smoker at Ronald McDonald House, where every kid has cancer or heart disease or some other affliction made ten times worse by second-hand smoke.   (Not that there are any such teens.  The few smokers that come through RMH look like ordinary Moms or Dads, wearing pink V-necks pull-overs or pilled fleece sweatshirts, who wish to they could quit, but just can’t.)

Now these smoker-parents are all cheery and proud when they are with their children, parading around the halls.  They are filled with love and smiles and goodness.  But the moment they have to go out for a smoke, they shrivel before your eyes.  They avert their gaze in the elevators.  They don’t answer questions honestly.  They craftily conceal a cigarette lighter in their palm, hoping to creep out the back door before someone like Cali shouts, “Hey!  Where are you going?”

swollen-creek
The San Francisquito Creek in Palo Alto was dry this time last year.

Of course there is no smoking allowed inside Ronald Mc Donald House or even anywhere remotely near Ronald McDonald House.  So the smokers are forced onto a strip of mulch on the outside edge of the back parking lot, sandwiched between four lanes of traffic and a swollen creek, threatening to breach its banks at any moment with the recent atmospheric river.  We see them when we park the car in the evening, their bodies hunched in shame, their cigarettes glowing in the twilight.

Cali is drawn to the smokers like a moth to a flame as she is with anyone suspicious. “Why do you take so many walks?” she asks a grandmother smoker, putting her on the spot.

“Well, unfortunately, I do unhealthy things I hope you never do,” the woman answers, laughing nervously in her raspy voice.  Cali looks at me in confusion, unsure if the grandmother is joking or if she should be scared.

Yet, there is one interesting man who seems to have compassion for these poor smokers.  By every prejudicial observation, he himself could be a smoker – heavily tattooed, prolific nonconventional piercings, overweight.  Yet I keep watching, and I really don’t think he’s a smoker.  In daylight hours, he often stands jovially with the solitary smoking father or pair of aging aunts that sneak a smoke on the mulch.  However, his hands are in his pockets. I never seem him light up.  He never smells like smoke, and I’ve seen him sit for hours reading outside the hospital school without needing a “break.”

Inside the house, he is especially friendly to the smokers, calling out a cheerful “Halloo!” when one of them skulks towards the back door.  When he greets them, the smoker looks back with a smile of relief, silently thankful that at least one person isn’t glaring at them.

calis-birthday-writing
Cali turns eight on Sunday!

Maybe the smoker-friendly man is an ex-smoker.  Maybe he is an undercover AA leader that just happens to have daughter being treated at Stanford.  Whatever the reason, there is something beautiful in this man’s effort to reach out to these RMH rejects, because this is love in its rawest form.

Please don’t get me wrong.  I’m the last person you’ll see willingly standing in a billow of second-hand smoke out of compassion.  And even though I, myself, am guilty of bringing micro-germs into the house, you can bet I will be moving away as fast as possible if I hear anyone coughing or snotting in my vicinity.

However, when the man greets the smokers with kindness, the smokers’ relief is real, and even though the smokers are still smoking, you can bet his offering of kindness is going travel.  The smokers will feel less guilty, less depressed, and better able to take care of themselves and their loved ones.  Maybe even able to face the incredible hurtle of quitting.

Perhaps there is a lesson to be learned from this smoker-friendly man.  What is needed most in the world right now might be a willingness to reach out to those who seem most threatening, a willingness to forge friendship across forbidden lines, to offer pure love with no strings attached.  And if I may extend this to myself, a willingness to love myself despite the “bad” things I do, to offer true self-forgiveness, because guilt doesn’t get me anywhere.  Happy Valentine’s Day.

cali-with-heart