The Indian Clerk

A large Norway maple in my back yard.

The cancer continues to sleep. My oncologist, Dr. M., ordered blood labs of CBC, CMP, SFLCA, and SPEP. Nothing stood out, just a bunch of numbers. The myeloma is stable 17 months post transplant. I am not on any maintenance therapy. I take a multi-vitamin, 1000 mg of calcium, and a low dose aspirin each day. That’s all. I work fulltime. Simply put, I feel good… well, pretty good.

For several nights, a head cold accompanied by a scratchy throat disturbed my sleep. A low-grade fever accentuated all my age related muscular pains. The peripheral neuropathy in my feet throbbed. I thrashed about. My mind churned irrationally with anxiety about the bogeyman of multiple myeloma living in my marrow. The cancer awakened in spirit, if not in my body. What to do? Motion is my antidote for worry, so first some stretching, and then yoga, before heading out for one of my six-mile walks.

The Indian Clerk

On Sunday, heavy wet snow fell most of the day. My maple trees drooped under the weight. I stayed home, rested and finished reading The Indian Clerk, a work of historical fiction about the Indian mathematical genius, Srinivasa Ramanujan. The book, by David Leavitt, culminates with the prodigy’s death. At one point during his illness, Ramanujan’s mentor, a renowned English mathematician, says, “Oh, what a sloppy science is medicine!” I laughed out loud with respect for those I know who suffer from the clumsy treatment of their blood cancer.

Monday morning the dirty residue of December’s storms lay covered in a fluffy meringue of snow. The footprints of a solitary fox pocked my driveway. Birds twittered when I appeared outdoors. I scraped clear a feeding station on the gravel and scattered their morning meal. Quail arrived from a distant thicket to inspect the offering. Juncos alighted in their midst, flicking their tail feathers as they dodged the bobble-headed game birds.

A lucky shot

My virus had run its short course and work beckoned. I have not missed a day since returning last April. My immune system seems to have fully recovered from the stem cell transplant. As I review my treatment history, I admit the SCT was a shot in the dark that, due to nothing more exacting than luck, hit its mark. Even if I were to relapse sometime this year, the drug-free period I’ve enjoyed has been worth it.

Such is the confounding nature of myeloma. The glut of clinical trials cause as much confusion as they do clarity. Every imaginable combination of velcade, melphalan, thalidomide, revlimid, doxil, bisphosphanates, and steroids has gone to trial with positive outcomes. Arguably these drugs, which cost us four to eight grand per month, are geese laying the golden eggs for their respective pharmaceutical companies. You don’t need to be a math whiz to realize somebody is making a lot of money off of multiple myeloma. Now, if only there were a consensus of opinion as to how to treat this disease.

January morning

Instead, debates about cure vs. control and the pros and cons of transplants exist in the myeloma community. There are MM specialists on each side. All have compelling arguments, beautiful résumés, and statistics to back up their ideas. The trend, regardless of which protocol a patient chooses, leans toward myeloma evolving from an incurable cancer with a relatively short prognostic trajectory to one that may be managed for years and years. That’s good, but the choices continue to be difficult. The side effects of the chemo’s toxicity, along with the economics of insurance, add problems to the solutions.

Yes, medicine is a sloppy science, cluttered with guesswork, ego, and the taint of money. Nevertheless, it is our science. We’d like our care to be as neat as a mathematical theorem. Unfortunately, the complexity of human biology defies easy answers. Its best practitioners must be artists as well as clinicians. Alas, if only Ramanujan were alive he might write the equation for a cure: C = x + whatever. But he’s not. For now, I’ll commit only to staying active. After all, bodies in motion tend to …

RIP

On January 14^th, I had to have my beloved cat, Buckwheat, put to sleep. Since my last post when I mentioned her claim to our household as a private domain, she deteriorated rapidly. She’d stopped eating and moved from her perch on the couch only to sip water. When doing so, I observed that her back legs, particularly on the right, were poorly controlled.

Buckwheat

The veterinarian performed a brief neurological exam. When touching the right side of Buckwheat’s face, there was no reaction, not even a blink of her eye. Her forepaw and back foot drooped. Reflexes normally noted, were absent. The facial paralysis led the doctor to theorize a brain tumor. “And,” she said, following a pregnant pause, “Buckwheat is 20 years old.”

It was left for me to drop the other shoe. I’m pretty slow on the draw, but this situation demanded an immediate decision. The diagnosis surprised me even though I’d joked with Buckwheat that this might be her last car ride. Normally, when faced with this predicament, she’d sit on my lap grumbling with agitated disgust. Yet, on Thursday’s trip, she was docile.

I thought I was ready to make such a call. I’d wondered for the last two years if she’d make it through another winter. But, my composure broke when it became obvious this was not the time for procrastination. The veterinary staff tacitly conveyed a paradox of their profession: clemency is often the least tenderhearted of choices. I agreed with the vet’s implied suggestion to euthanize Buckwheat. Thereafter, the process moved swiftly with grace and dignity.

Bucks, watching her garden grow

An assistant shaved Buckwheat’s right foreleg. The doctor inserted an IV catheter and taped it in place. Bucks did not seem troubled by this, which provided more evidence of the lack of sensory response. She lay on my lap with her head resting in my hand… the hand of her best friend.

Though difficult, I consider it an honor that I shared in her dying. Later, knife pains of grief pierced my chest, but at the moment of the injection, I felt peace. One of the staff stroked Buckwheat’s brow and praised her long life. Buckwheat meowed softly once, then closed her eyes, and relaxed her head upon my palm. Finally, she did what she does best: she went to sleep.

Now, a couple of days after her passing, I recall other signs leading to this rapid decline. I’d assumed her wobbly gait to be merely arthritis. Most likely though, that hitch in her step, along with the occasional fall when jumping, and moments of apparent confusion indicated the presence of a more serious condition.

My Sensei

Already, I miss talking with her. Writers are solitary creatures, yet they crave an audience. Buckwheat was mine. During my early morning rambles as I wrote and read aloud, I bantered with her as if she were my editor. Most of my wonderings deserve only silence and I received plenty of that. Nonetheless, I appreciated her listening.

Buckwheat’s serene personality eased the self-doubt in much of what I try to say. She nursed me with a calming presence during my recovery from the stem cell transplant. Her companionship was a salve for my wounds and enhanced many of my joys. She loved to garden. Together, we dug in the dirt and enjoyed the butterflies that visited our efforts.

The responsibilities of animal care include food, shelter, and sometimes the vicissitudes of mercy. I feel blessed for having known this gentle soul. Letting her go was my final troublesome but correct gift for all she had given me. Respect at the time of Buckwheat’s death is the least I could offer in return for the friendship we shared. At home, in the hours following her passing, I made a shroud with her favorite blanket. Then I buried her in one of my wildflower beds, beneath a young maple tree. She will rest in a warm but shaded spot. There, I can visit whenever I wish to continue our chats.

Survival Stories

Books about survival

First, some book reviews of 25 words or less:

Because They Wanted To by Mary Gaitskill

Raw, kinky stories, populated by conflicted heroines engaged in short term urban relationships. Men are welcome; I think.

Unaccustomed Earth by Jhumpa Lahiri

These stories are comfortable as old jeans, but there are holes in the pockets through which all your money to call home has vanished… forever.

The Year of Magical Thinking by Joan Didion

Grief will make you crazy. But, that’s ok; it’s supposed to. It may also make you eloquent.

Netherland by Joseph O’Neill

A guilty survivor wandering through the grimy back streets of memory, the game of cricket, and New York, post 9-11.

Spanky

The mug shot to your left is that of a homeless cat I’ve named Spanky. Recently, he’s become my favorite survival story. I first spotted this fellow in the fall, prowling my neighbor’s pasture in search of gophers. In December, during our cold snap, when temperatures were in the single digits and snow covered the ground, I realized he’d taken up residence under our front porch. On several occasions I watched as he stalked the juncos and quail that I feed over the winter.

For the most part, Spanky only succeeded with interrupting the bird’s dinner. The juncos skittery nature make them difficult to catch. Furthermore, they are not much of a meal. The quail also have survival skills: they feed as a group and position several scouts to warn the covey.

Then, one frigid morning, after spreading chick scratch under the rhododendrons, the cat appeared and began licking at the cracked corn. Obviously, he was starving.

Spanky's mantra

Finally, on the following day, as I spread the bird’s food, Spanky came up to me and introduced himself. He began nuzzling my leg and telling me in cat talk how strong and handsome and wonderful in every sense he was and, by the way, did I have any cat food to spare? Thus, the saga of what to do about this little rascal went to another level. Suddenly, I was involved with saving his life.

I reasoned that it would not be fair to my cat Buckwheat, given her advanced age, to introduce a young rambunctious male into the house. Buckwheat is, herself, a survivor; she’s lived for 20 years in coyote infested country. Therefore, she’s earned the right to idle away her remaining days nestled next to the pellet stove. There, she keeps me company as I read the likes of those books above.

But, what was I to do with Spanky? Fortunately, a customer made me aware of the Columbia Gorge Cat Rescue. This strictly volunteer group provides foster homes and adoption services for homeless cats. They required photos and a checkup at a cooperating veterinarian. I learned that Spanky is a healthy neutered male between three and five years old. I’ve checked with our few neighbors but he seems to be a stray. Now, the CGCR will post his picture and a story on their website and attempt to place him. Spanky’s future remains uncertain but things are looking up. In the meantime, I will not let him starve.

Will Spanky find a home?

Of late, a knack for survival, epitomized by this cat, appeals to me. Each month, at my multiple myeloma support group, I spend a couple of hours with a determined group of cancer survivors. Daily, I visit the blogosphere and read the exploits of others coming to terms with this disease. Each one, including me, has a tale to tell of their struggle. Like Spanky, we are scratching and clawing against harsh, unforgiving elements that threaten our lives.

The passive-aggressive nature of this blood cancer puts us in a state of limbo. Each diagnosis comes with the admonition that MM is incurable. Every remission has its relapse. Treatments have consequences. With cancer, you get a lot of practice at survival.

As evidenced in the books I recommend above, life is unpredictable. Relationships fail, accidents occur, and not everyone lives a long time… fair or not, it’s part of the deal. In the case of Spanky, who is either lost or abandoned, an opportunity presents itself. He reminds me that compassion is a gift given to us by those in need. All we must do is accept it.

Cancer in a Small Town

An elegant fire escape in Hood River

In a small town, the ripples of surprise caused by a cancer diagnosis don’t stop with family and friends. They spread outward through the secondary connections in the community: the merchants, the clubs, and the schools that tie us together socially. The pool in which they reverberate may be small but before the surface smoothes, many have felt the movement.

My wife and I moved to Hood River 32 years ago, refugees from the social upheaval particular to California in the 60s and 70s.We sought a place to settle and raise a family. Over time we became part of the nurturing continuity of this community. The vast natural environment of the Columbia River Gorge and the Mount Hood National Forest complement the unpretentious character of its people. The values of the town are reflected in our proximity to what is wild.

County Court House on State Street

During the three decades we’ve lived here, Hood River evolved from a sleepy agricultural community with a dying timber industry, to become a blend of both farming and tourism. The Hood River Valley’s outdoor attractions draw thousands of visitors. The river features unparalleled sail and kite boarding; the mountains beckon to hikers and skiers.

Hood River is popular but it retains a small town’s humility. Part of the community’s allure lies in its innate modesty. The city is beautiful but not flashy. We are but an ornament embellishing the grandeur of nature that surrounds us.

The Art Gallery at 3rd and Cascade Street in Hood River

Our country hospital is suitable for the size of the populace. Most cancer patients, however, must obtain their treatments elsewhere. The hospital performs X-rays and MRIs but not radiation. Nor does our town have a resident oncologist. Following primary treatment, patients can have their care managed by a once-a-week visiting oncologist. Here, he oversees an infusion ward with eight or so stations. That’s what I do. I went to the Seattle Cancer Care Alliance for my stem cell transplant but for the last year have done follow-ups with the itinerant Dr. M.

Small towns have few secrets. As Postmaster of an upper valley community, I have something of a public persona. I know a lot about my customers and must discipline myself to be circumspect in what I say. In turn, residents can scrutinize my life. Most people know I have cancer.

Looking west from 2nd and Oak Street

Once each month, I travel 60 miles west to Portland to meet with others living with multiple myeloma. That’s because Hood River doesn’t have the numbers to provide support groups for the many varieties of cancer. There is, however, an informal clique of compassionate cancer survivors in our community. Updates of prognosis for one another circulate like weather forecasts: sometimes we get it right, sometimes we don’t.

Cancer in a small town occurs much like it does everywhere else. The ebb and flow of the illness is a common denominator among all cancer survivors. What’s unique is our inter-connectedness. In Hood River, our paths cross more frequently at places where we work or perhaps the waiting room of our shared doctor.

Waucoma Bookstore, a hub of community activity

The healing power of community cannot be over estimated. Misfortune, in whatever form, finds support in the informal connections and sense of place that bonds us together. A serious illness or injury may tear a hole in the fabric into which we are all woven. In time, though, the cloth is mended with the generous spirit of belonging.

The Winter of My Contentment

Winter cloud formation

Four nights ago, winds buffeted the house.  Chimes, hanging from the eaves, rang like instruments in a Balinese Gamelan and disturbed my sleep.

At first light I ventured outside. There, I retrieved our empty garbage can, which the wind had blown westward like a piece of tumbleweed. Then I proceeded to feed the quail and juncos that inhabit the thickets on our property. As I scattered chick scratch on the ground, a frigid tongue of air licked at the collar of my sweatshirt. Dead leaves, dried to a crisp by the cold, levitated and whirled with dervish unpredictability about my legs.

The east wind that scoured the valley ended any pretensions autumn held with the weather. Technically, it still claims territory on the calendar, but a dusting of snow lays like sugar on my resting flowerbeds. Winter has asserted itself; today, at 5 am, it is 1 degree Fahrenheit with highs of 15-20 optimistically forecast for the coming week. In Oregon, fall is over.

Noah studying during last year's power outage.

Our family will be together for the holidays. Isaac, my youngest son, lives just a few miles away. He and his wife own a piece of property that abuts the Hood River. Noah, our oldest son, flies home just before Christmas. He lives in Berkeley, CA and attends Law School at Boalt Hall. It is a family joke that when he arrives the weather turns bad. Last year, while I recuperated from my stem cell transplant, his visit coincided with one of the worst stretches of winter storms we’ve experienced in three decades. On consecutive nights, the power failed from dusk until early morning. By the third night, everyone, including our cat, was crotchety.

That pattern reprised itself this week. After three days of bitter cold, the power failed and my wife and I awoke with the insecurity of losing what was taken for granted. We lay under our quilts hoping the problem would find a solution. Eventually, the day beckoned, cold floors notwithstanding, and we exited the house without breakfast or coffee.

It’s always instructive to do without, or, so I rationalized while on my way to work with a growling stomach. A cancer diagnosis triggers similar reactions in the gut. During the term of my illness, nearly two years now, my desire for things to be stable and predictable has confronted the ever-altering reality of life. I’m getting better at absorbing the shocks.

Our house on a bitter cold morning

As I proceeded to drive away from the power failure at home to the one awaiting me at the Post Office, my mood improved. I noticed one darkened house after another on the country highway leading to town. This was not a case of misery loving company. Instead, it was the realization that others shared my problem and were coping with it as best they could.

I immediately thought of my multiple myeloma support group. Our shared dilemma diminishes with each artifact of our lives that we impart to oneanother. My physical health is one thing. For that, I rely on modern medicine. My emotional and spiritual health are something else altogether. For that, I depend on you, the readers and writers and talkers who cope with the same problem and its unique presentation. The lesson of doing without, whether it’s electricity or good health,  rests with finding perspective amidst the disorder. I cannot attain that perspective alone. Gratitude for life in all its permutations, good and bad, comes easier when we commune with others.

My Post Office

Many of my friends with MM, both online and through my support group, live with this cancer’s serious complications. For some, each day is a trial. I recognize it’s easy to be an armchair philosopher when all goes well. So, forgive my Pollyanna parable. Yet, I’m also living evidence that treatments can slow myeloma’s advance. Hope is not an illusion.

I’m not concerned with jinxing my good fortune by talking about it. I accept that it is subject to change. All life has death concealed within it. I need only look at the barren state of my gardens for confirmation. Accordingly, I want people to know I am grateful for everything that life offers, from the frigid wind of winter to the warmth of family.  I’m also pleased that the electricity, tenuous as it is, works again.

Peace on Earth; Good Will Toward All.

Mystery

A blanket of overcast sky lies across the state of Oregon from November to March. Intermittently, the colorless clouds darken and rinse the northwest with showers. I continue with my six-mile walks but, in such a climate, it helps to also have sedentary activities.

A good day for an axe murder

I love to read. In fact I’m an inveterate reader; I always have a book or two or three at hand. My tastes are eclectic, but once the rains arrive, I feel an urge to curl up with a good mystery. Few things cheer me up more than a cozy chair, a cup of hot tea, and the search for a ruthless serial killer.

My favorite mystery writers are the phlegmatic Europeans, in particular, the Swedish couple, Per Wahloo and Maj Sjowall. This husband and wife duo co-authored several classic police procedurals; The Laughing Policeman, The Fire Engine That Disappeared, and The Locked Room, to name just a few. These date back to the 60s and 70s but their skill at creating tense realistic puzzles transcends the generations.

Wahloo and Sjowall composed tales driven by the characters, not coincidence, guns, or sex. Instead, the detectives ruminate on the smallest of clues. Slowly they build a scaffold of facts that assist them in reaching a solution. All the while we peer at the inner workings of their imperfect personal lives, conducted under the pall of Nordic winters. Simply put, their imaginative problem solving occurs in the most uninspiring of circumstances.

The Oregon sky at midday, yes that's the sun to the left above the power pole.

Good medical research proceeds in much the same way. It’s a plodding and unglamorous career choice. It too relies on the assembly of facts gleaned from doggedly pursuing clues down theoretical rabbit holes. Many of these lead to dead ends. Eventually, though, the puzzle pieces begin to fit together.

Serial killer whodunits, such as multiple myeloma, a cancer with which I am afflicted, are slowly being solved by determined clinicians. Fortunately, the perpetrators don’t shoot back. But these sociopaths, living in the otherwise ordered community of our blood system, find themselves being stalked, cornered, and eliminated.

Recently, the Leukemia and Lymphoma Society treated my MM support group to a presentation from Dr. James Berenson. It’s fair to say he possesses the skills of a good detective: a patience and persistence necessary to catch a wily foe such as MM.

Dr. Berenson is the founder of the Institute for Myeloma and Bone Cancer Research and one of the world’s foremost authorities on multiple myeloma. The title of his presentation was Myeloma Treatments: Pacing Yourself for the Future.

Some highlights from his 90-minute talk:

Sky of mystery

1. He no longer recommends stem cell transplants in his practice. New drugs and their combination with other established drugs provide strong responses with less toxicity and side effects. He pointed out that multiple myeloma is a slow moving disease of the bone marrow. Therefore, it is illogical to think you can sustain that environment over the long term if you bomb it with high-dose chemo and a relentless regimen of maintenance therapy.

2. He sees little difference in the quality of life between a stable disease and complete remission. He subscribes to the theory that “less is more” with regard to dosage with drugs such as revlimid and velcade and steroids.

3. He advises not dwelling on lab numbers. He said it is more important to focus on protecting one’s bones and kidneys than it is to strive to reduce the M-spike to zero. Accordingly, he recommends the use of bisphosphanates even in the absence of bone lesions.

Penetrating the gloom

The mystery of MM will be solved, or, so says Dr. Berenson. He explained what he believes are the tactics to help us survive. His advice is to pace our selves for the developing strategies that will ultimately lead to a cure.

Whether or not you agree with Dr. Berenson’s ideas, his optimism matches a common theme expressed by others in the myeloma medical community. Though their theories differ, all anticipate a solution to the puzzle of multiple myeloma. Will the momentum of their investigations continue? I don’t know the answer. I am, like many of you, a character in this story, a clue to the mystery.

Unremarkable

Recently, I met with my oncologist, Dr. M. His practice is located in Portland, OR. Each Thursday, however, he travels 60 miles up the Columbia River Gorge to Hood River. Here, he spends the day attending to cancer patients in our small community.

The mighty Columbia River

He commented that my disease continues to be in “complete remission.” His opinion is based on the ratio between my lambda and kappa free light chains. Usually, in addition to a CBC and Chemistry Panel, the SFLCA is the only test he orders to check on the status of my multiple myeloma. Once again, the ratio is normal.

So, I enjoy a drug-free remission fourteen months in duration since my autologous stem cell transplant in 2008. And, Dr. M extended the necessity for our regular appointment from two months to three. I will not see him again until January of 2010.

In many ways, I am an unremarkable patient with multiple myeloma. My age is consistent with the most prevalent group of individuals with this cancer. I have a monoclonal band in the lambda region of IGG, a common variety. I was diagnosed under typical circumstances: while undergoing a routine physical examination.

Sky at sunrise from home

To recap my disease history, I became aware I had MM in December of 2007. My only symptom was anemia, detected when being turned away from Red Cross blood drives on several occasions dating back to 2006.

At diagnosis my IGG level was above 6400 mg/dL and my M-spike was 4.6 g/dL. These numbers reflected stage one multiple myeloma. My risk factors looked good: I had no bone involvement, my kidneys functioned well, and there were no cytogenetic abnormalities. I immediately started a combination oral drug therapy of thalidomide and dexamethasone.

Simultaneously, I requested a referral to the Seattle Cancer Care Alliance for a consultation on a stem cell transplant. After four months of the thal/dex, I opted to do the transplant sooner, rather than later. Peripheral neuropathy in my feet, a side effect of the thalidomide, troubled me.

Autumn sky and Mt. Hood from Lost Lake Road

In early 2008, thal/dex followed by a peripheral blood stem cell transplant was the standard of care. The transplant experience, though arduous, occurred without a hitch. The SCCA has numerous specialists in MM and perform hundreds of these procedures each year for a variety of blood cancers. I marveled at their competence. The near flawless execution of the complicated outpatient process impressed my wife and I. Obviously, I’ve responded well.

A remission, though, is not a cure. Another blogger said it best, and I paraphrase, “Stable disease does not mean it is dormant.” In August of this year, I underwent a skeletal survey. No overt evidence of lesions appeared. The radiologist did note subtle lucencies on my left humerus, the large bone of the upper arm. Of course, as soon as I left the doctor’s office, that arm began to bother me. Like a chipped tooth, I couldn’t leave it alone; the tongue of my imagination rubbed itself raw with worry.

Moonrise from home

Over the course of the next two months, I received my childhood vaccinations, traveled across country and back, and went about my usually active lifestyle. All the while, the left arm persisted in aching. The pain was two on a scale of ten. If I did not have MM and the suspicion of bone lesions from X-rays, I would have ignored the feelings, assuming they resulted from overuse.

This October, after Dr. M happily shared the results from my blood work, I mentioned the arm. He referred me to radiology for an MRI. There, I received a thorough imaging that included an injection of dye to definitively detect any lesions or tumors present on the bone or in the marrow.

Today, Dr. M’s medical assistant called with the results. The radiologist had commented that the MRI was … unremarkable.

The view from my desk

In spite of my positive review of the SCCA and the strong response to the SCT, I must confess that we’ve arrived at this juncture operating by the seat of our pants. It worked out, but it was somewhat due to the luck of the innocent. I would not go so far as to suggest others should undertake a transplant ASAP, as I did. Now, in late 2009, there are other choices that have been added to the menu.

In just two short years, treatments for MM have progressed rapidly. Data from numerous clinical trials, of both manufactured drugs and natural supplements, bode well for the futures of those newly diagnosed. Options expand, as well, for patients with relapsed disease. The grim prognosis long associated with MM tips closer to manageable as opposed to incurable. Now that is remarkable.

Where The Wild Things Are

“All the soarings of my mind begin in my blood.”

Rainier Maria Rilke

Sometimes, Wild Things can be found in grocery bags.

The seasons fold into one another like origami. Several days of hard frost caused my tomatoes to droop with dismay. As if on cue, east winds set the maples ablaze with fall color. Then a front of marine air, spring-like, collided with the desert breezes and snow dusted the valley.

I and the other wildlife go about our autumn rituals. Squirrels scamper along the fringe of the forest. Their cheeks bulge with food for winter. I pull cartloads of dead plants from my gardens while grosbeaks mob the elderberry. Other small birds twitter as they feast on the gone to seed flowers. I drain and roll my irrigation hoses; then I board up the crawl space beneath the house.

Wild Thing, I think I love you.

Toiling in one of my garden plots, I unearth remnants of my boys’ imaginative childhood. Toy soldiers and metal cars routinely appear when I work this piece of ground. Years ago, I’d dug a hole and filled the area with pavers’ sand, atop which I built a small shelter. A ladder led to an eight-foot high platform. It was topped with a sheet metal roof that clattered in the Oregon rain. A thick-knotted rope hung from the roof beam and descended through a hole in the floor to the sandbox below. Here, my sons played until adventures on their bikes led them far from their home and innocence.

Wild Things in a truck

Against this backdrop of domestic familiarity and memories, I ponder on the finiteness of life. Everyone with cancer peers into the unknown of mortality, much like a child looks frighteningly into the world of adults. The territory of my contemplation is as magical as any child’s daydream. It’s scary… and thrilling. There are monsters with horns and big teeth. They howl and bark. A terminal illness steals from us the comfortable blanket of adulthood. We can no longer stroke its silky border of oblivion for security. Suddenly, we are awkward and self conscious as adolescents; our hair falls out, our GI tract turns somersaults, or worse, freezes solid. Our body is not to be trusted. We sulk and just want to be alone.

A Wild Thing lives next door.

Perhaps now is the time to consider the mischief we’ve made along the way. Probably, it’s not as bad as we thought or others made us feel. Magic awaits; the world remains ours to behold. Cancer cannot foreclose on my astonishment at the mystery of life. For me, the wonder of being also glows in the terrible murky haunts of our perishability. At times, I am afraid; yet I am nourished, encouraged even, by my fear. And, in the face of it, I’ll continue to plan for the future.

My brain percolates with ideas for next spring’s gardens. I envision more of one color here or there, maybe even a pond for the birds. It’s nothing dramatic, just a few improvements to satisfy my imagination’s appetite. The sandbox now belongs to me. I want to play there and, as for the monsters, well, they can join me. Together, we’ll raise a rumpus.

Harvest

Anjous or Bartletts?

Last Sunday morning, I walked six miles. Then, I spent the afternoon working in my garden. I dug up a row of potatoes. I rooted after the spuds like a wild pig. I got down on all fours and, with a potato fork acting as my snout, unearthed the crop. I washed and sorted the modest yield before clearing the clutter of my overgrown tomato and pepper plants. I trimmed and weeded them under the inscrutable gaze of my cat, Buckwheat.

An east wind carried the sounds of Hood River’s pear harvest to my home. In the distance, tractors strained to lift bins full of ripe fruit. High in the trees, pickers chattered and whistled to one another. Our valley is one of the predominant pear producers in Oregon. Anjous, Bartletts, Bosc, and Comice constitute the principle varieties. The harvest lasts from mid-August until mid-October in orchards ranging in elevation from 600 to 2000 feet.

Golden brown Bosc pears

2008’s harvest slipped by me unnoticed. One year ago, this week, my wife and I returned from Seattle following 3 1/2 months of cancer therapy. There, I’d undergone an autologous stem cell transplant as treatment for multiple myeloma. It included 10 days of comprehensive testing to determine my fitness for the procedure. Then, a pre-transplant chemo protocol was administered. This was followed by a brief hospitalization caused by pneumonia and six weeks of recovery. Finally, I received the transplant: high-dose chemo and stem cell rescue. A month later, I was released to return home bald, bloated, and weakened from the ordeal.

By the time I became sufficiently cognizant of my surroundings, the pear harvest was completed. From then on, my recovery exceeded any benchmarks one might have established for a myeloma patient. My recuperation did not result from positive thinking or prayer. Those are useful tools for coping with the emotional turmoil but have little effect on the biology. Instead, I benefited from excellent medical care and lots of good luck.

Another kind of harvest

I entertain no illusions about my disease. It will return. Yet, it comforts me to acknowledge that reality. Only by confronting it can I let it go. For now, I am as healthy as anyone daring to peer into my little world of cancer survivorship. I enjoy a drug holiday that stretches into its second year. My stamina continues to improve, demonstrated by last weekend’s activities.

One of the things I’ve gleaned from this cancer experience is confidence in the wisdom of being here now. Don’t worry; I won’t attempt to articulate a theory of “acceptance of what is.” Such efforts often end up complicating what should be left simply observed.

Buckwheat

My sensei, Buckwheat, communicates all we need to know about how to cope in an unpredictable world. She is 20 years old. Her arthritic hips add a little hobble to her step. My lap is the maximum height of her ability to leap. Day to day, she must feel physically worse than many of us do. Yet, she finds nirvana in simple routines: a nap on a sunny ledge, restful proximity to her companion as he digs in the dirt, or a water cup in its familiar place next to the pellet stove. She accepts these routines as gifts and purrs with gratitude. She doesn’t worry about whether they will be available tomorrow. She is too busy enjoying them today.

Next Sunday, September 27th, I will be 63 years old. I think I’ll go for a walk.

Summer Daze

Where We Stayed in Chicago

Soon after posting here in August, my wife and I flew to Chicago. There we attended a three-day symposium advocating for the spinal cord injured community. My wife is Executive Director for the organization that hosted the event. I acted as staff photographer. I powered through the busy weekend and the flights all the while adding further testimony to my improving health. Here is a link to a short photo essay created from the experience.

Wildflower in my garden

Back home, I worked hard on my golf game as I have since April. I prepped myself to participate in a competitive event, the first in nearly four years. I didn’t achieve all my goals. However, I walked both rounds in 80-90 degree temperatures, which is the equivalent of twelve miles. Last summer, while undergoing my stem cell transplant in Seattle, my goal each day was to climb the 99 steps to our apartment.  I’ve learned that success is relative and, as to the golf, it’s always good to have excuses. So, I’ll blame my mental errors on lingering chemo brain.

Harvesting my tomatoes

It’s been a busy summer for the Smith family. Both of our wonderful sons continue to thrive in their chosen activities. Today, Isaac is attending the movie premier of Contrast, a film on which he is one of the principal videographers. His brother, Noah, continues to plug away with Law School at the University of California, Berkeley. Meanwhile, I enjoy the simple delights of my gardens, happy to be alive, and full of energy.