Me, reflecting as usual

Monday morning I awoke at 3 am. I dressed, brewed a cup of tea, and left the house. A full moon lit the way, casting long shadows across the path to my truck. Out east, the horizon bristled with silhouettes of fir trees.

I drove to my youngest son’s house. Isaac and his wife also live in the Upper Hood River Valley. We enjoy having them close by. In the winter, he works as a cinematographer for Nimbus Independent. Their crew would be spending the next three weeks in Japan creating ski videos. I’d volunteered to get him to the airport for his early morning flight.

We wound our way along the deserted roads through the outskirts of the city and onto the 84 heading west to Portland. I’ve written before about the perils of the Columbia River Gorge Highway. Monday, though, conditions were benign: no snow, ice, or traffic.

Winter in downtown Hood River

We chatted quietly, enthralled with the unusual light. Mostly, we praised the beauty of the Gorge Scenic Area, which at this time of the morning, under a full moon, cloaked our mood with its magic. The cliffs to our left loomed like the ramparts for a fantasy kingdom. To our right, the river laid flat, a canvas upon which the moon painted its desire. I put the cruise on 70 and we sailed through a wonderland of light and shadow.

We arrived at the departure gate by 5 am. I double-parked. Hurriedly, we unloaded his ski bag and camera equipment, shared a hug and said our goodbyes. I left him with the fatherly admonition to be safe. Then, I drove away, looking forward to the long beautiful drive home.

Later, I would have to work a full day. I wasn’t worried about being too tired following the early awakening. Monday is steroids day. The current treatment for my cancer, multiple myeloma, consists of 10mg of revlimid, three weeks on, one week off, along with the steroid dexamethasone, 20mg once a week.

My cat Spanky chasing his tail.

I’ve adjusted well to the revlimid. The side effects do not trouble me. For its $10,000 monthly cost, however, you’d think it would not only cure the cancer, but make me a better golfer, writer, and lover. Alas, it has barely slowed down the progression of the myeloma, while providing no other benefits. Accordingly, upon the recommendation of Dr. M, three months ago I agreed to add a steroid to the mix.

Dex side effects, of course, are another story. MMers universally hate what the dex does to them. Fortunately, the low dose I take has a small, if annoying, window to its downside. On days one and two, I am perky. My mind whirls but doesn’t focus well. I bustle about the workplace, happily stoned with nervous energy that accomplishes little, equivalent to a cat chasing its tail.

By days three and four, though, clouds begin to roll in on all this sunshine. The artificial energy transforms into authentic fatigue. I just want to lie down and close my eyes. And, at work I’ve been known to nod off during a lull in business. Sometimes, my mood takes an impatient turn. I must be careful not to snap at people, especially customers.

It's time for something big

By day five, things are back to normal or, at least the new normal that patients with cancer learn to accept. I can handle these side effects as long as there is a corresponding improvement to my condition. Thus far, the results seem positive. Just today, I learned that the M-spike, the best measure of myeloma’s status, dropped for the second straight month. Furthermore, I underwent an X-ray screening of my pelvis and the long bones in my arms and legs. Myeloma often causes lesions in the bones that lead to painful fractures. As of January 2012, I do not show evidence of bone involvement. That is a promising prognostic factor for any myeloma patient.

I also heard from Isaac this morning. He sent a brief email saying he’d landed safely in Sapporo, Japan and that he was going straight to bed.

Tom, Mary, Jim, & me---The puppy's name is Skipper.

Recently, I visited family in San Francisco, my hometown. My roots are urban, but 40 years ago, my wings carried me to more rural environs. I was born at Children’s Hospital on California Street in 1946. My parents worked hard providing their five kids with the basics: bikes, baseball mitts, and a safe home.

I have three brothers and one sister. All of us siblings pursued middle-class careers: fireman, utility worker, airline employee, librarian, and postmaster. We inherited our blue-collar work ethic from Mom and Dad. My father was a body and fender man at an automotive dealership. My mother worked decades as a nurse, often choosing swing or graveyard shifts in order that we kids would have at least one parent home for meals.

Sutro Forest is behind these homes

My last sojourn to the city occurred in May of 2010 when my son graduated from the Berkeley School of Law. Prior to that, I visited in June of 2008 just before embarking on my stem cell transplant for multiple myeloma at the Seattle Cancer Care Alliance. My sister precipitated this year’s mini-reunion. She works for the Milwaukee Public Library in Wisconsin and chose to vacation in San Francisco.

I am the youngest of the boys. My brothers all live in California. My sister and I live out of state. On my periodic visits, the family always convenes at my brother Tom’s house. He and his wife live atop Stanyan Street on the slope of Sutro Forest. This is one of the few places in the city where you receive nightly visits from raccoons, opossums, and a revolving door of homeless cats.

Looking north down Stanyan Street

Their dining room on the third floor provides an expansive view of neighborhoods stretching northeast toward the bay. On many afternoons, fog creeps forward. It mutes the city’s hubbub and spikes the air with a blend of the ocean’s salt smell and the pungent aroma of eucalyptus from the adjacent forest. An opaque shroud covers the houses below, hiding intersections clotted with traffic.

In spite of my origins, I’m something of a country bumpkin when revisiting the city. What I used to take for granted now awes me. How, I wonder, does its frenetic energy coalesce into order? The infrastructure of a big city is a miraculous creation. An interdependent web of systems designed to accomplish specific goals exists as a backdrop to hundreds of thousands of individuals. Utility workers maintain the complicated networks that power daily tasks; crews devoted solely to handling the city’s waste products keep the streets clean and sanitary. I could go on, but the  point is that the whole is greater than the sum of its parts.

In the neighborhood

In a way, our body mimics the activities of a metropolis. Our respiratory and circulatory systems, for example, just go about their business, independent of any input from us. Our blood flows; we breathe in and out. Another example, apropos to my situation, is the immune system. It is comparable to a police force. When lawlessness, in the form of an invasive intruder, threatens to undermine our health, a SWAT Team of antibodies races to the rescue. In the case of multiple myeloma, which is a cancer of the immune system, the police, unfortunately, are corrupt.

The Golden Gate in the afternoon

Siddartha Mukherjee, in his Pulitzer Prize winning book, The Emperor of All Maladies, theorizes about this corruption. He alleges that the gene for cancer is inherent in our DNA. Genes are programmed to mutate; it’s an evolutionary imperative. Normally, our body discards unproductive mutations. However, as we age, the more stubborn mutations withstand our immune system’s defenses. Many cancers, certainly multiple myeloma, are age related. MM is generally a disease of older people whose immune systems are wearing down. Mutations also occur in response to toxic stimuli in the environment. Perhaps this explains the seemingly increasing incidence of MM in younger people.

Soon after returning to Oregon, my monthly blood work revealed a small up tick in the numbers specific to multiple myeloma. Dr. M and I decided to add a low dose of steroids to my maintenance chemo. MM does not herald its coming. Like the fog in San Francisco, it slips in quietly. One moment the blood work is clear then, suddenly, things are murky. I’m ok with this little tweak in treatment. I lean toward the theory that these drugs work better in combination than alone. Furthermore, my numbers remain quite low and I feel good.

Oriental Poppy

Recently, at twilight, a deer appeared in my driveway. Silent as the emerging darkness, she stepped carefully onto the gravel. Behind her, a creamy froth of clouds smeared the horizon; crickets chirruped in celebration of the declining day. I watched as the doe slipped into the tall field grasses. After several minutes, I walked out to where she had crossed the road and exposed herself to danger. The failing light hid her path. She had vanished, leaving behind only the scuff of her hooves in the gravel.

My cancer, multiple myeloma, is equally enigmatic. One moment, it is here and the next it is gone. I carry all the evidence of its existence but the substance cannot be grasped. I rely on my support group, sponsored by the Leukemia and Lymphoma Society, to keep me grounded in the realities of this disease. At the monthly meetings, I interact with individuals whose various presentations of the illness cover the entire spectrum of multiple myeloma.

Delphiniums at dusk

Always, there are new faces seeking to buttress themselves against the shock of a cancer diagnosis. Others are long-term members of the group, survivors of up to a decade or more of treatments. Some, like myself, have a passive variation. We responded well to our choice of therapy. A few have complications from the MM, which has advanced and evolved in spite of numerous therapies.

Due in part to my association with this group, I became a “First Connection” volunteer with the Leukemia and Lymphoma Society. Periodically, a social worker with the LLS puts me in contact with a patient who has multiple myeloma. The idea is simple: connect an experienced person with a novice. In the course of the last eighteen months, under the auspices of this program, I have spoken with individuals from all across the United States. Most often, those I speak with are considering a stem cell transplant.

Spanky, finding his balance

Controversies surrounding transplants have blossomed due to the recent success of “novel agents” like revlimid and velcade. What was once the absolute standard of care, SCTs are now an exceptional treatment, recommended on the one hand and discouraged on the other. Some clinics believe the transplant procedure is too harsh on the body. They argue that the latest drugs deliver comparable remissions with less risk to the marrow environment. Other institutes extol the virtues of a transplant. They assert that a SCT (or two) plus extensive maintenance with the new drugs can deliver remissions that, for some patients, border on a cure. What’s one to do?

I can’t answer the question as to which protocol is best. This weekend I am celebrating the three-year anniversary of my own transplant. I naively went forward with the procedure seven months after diagnosis. It worked well for me. I enjoy excellent health; I have not had so much as a cold in over a year. The cancer boldly appeared in my blood when I sought the cause for persistent anemia. Then, it retreated when we fought back with chemo and a transplant. We still detect its footprint in my monthly blood labs. Essentially, though, it is well behaved… for the time being.

What I call a Monkey Flower

I keep it simple when talking with a newly diagnosed MMer through the First Connection program. Transplants are not, in and of themselves, curative. The procedure is arduous but I emphasize its tolerability. You will feel crummy for a period of four to six weeks. Following that, recovering your stamina will be slow but sure. Transplants are relatively safe. It’s not possible to foretell how you will respond; yet my leap of faith succeeded and I am not unique.

Everyone must make his or her own decision. Therefore, it behooves you to become informed. That is the first step in a lengthy journey with this disease. Yes, I was naïve with regard to stem cell transplants. Nonetheless, my wife and I performed the due diligence necessary to “own” our decision to undergo the procedure.

More happy flowers at dusk

Since that time, new treatments have advanced quickly. Now, the options are greater. Patients enjoy a wealth of choices. However, the decision on how to go forward can be confusing. Accordingly, one must be thorough in determining what works best for them. My choice had as much to do with logistics as it did an assessment of what I thought I could handle. Don’t be paralyzed by your doubt. Accept the uncertainty, trust your decision, and, most importantly, fight back.

Norway Maple Leaves

For three months, the west wind scoured our Hood River Valley with an abrasive, hygienic brush. It burnished the trees, leaving behind a lustrous sheen of renewal. During that time, the Oregon spring doled out single days of warmth. Plummeting temperatures followed each balmy interlude. Yet, in spite of inclement weather, the earth simmered. Right on schedule, the roots of field grasses spurred their shoots upwards and wildflowers stalked the delinquent sun.

Last night, my cat, Spanky, awakened me at one in the morning. He pushed his paw against my cheek. I rolled over. Undeterred, he hopped onto the bedside table and nudged my glasses to the floor with a clatter. I pretended to sleep. Then, he began wrestling with the strap to my camera. His attempt to attract my attention worked. He wanted me to know that summer had arrived. Reluctantly, I arose.

I get out of bed slowly. Neuropathy in my feet and lower legs makes me unsteady. Within moments, though, it is as if I shed the skin of disability. The numbness subsides with movement. I shuffled toward the entry. Spanky wove between my legs, nearly upending me in his frenzy to go out. I opened the door. After a brief pause to sniff for danger, he disappeared into the seething magic of the June night.

Spanky and Wildflowers

The seasonal transition energizes me. My body continues to improve its tolerance of the maintenance chemo’s side effects. My cat notwithstanding, I sleep well. I feel strong and rested for both work and play. My peripheral neuropathy reached a plateau in April. Since that time, the instances of nerve pain moderated. My M-spike holds steady at 0.5 mg/dL. But the numbers don’t tell the whole story. The six-mile walks I take 2-3 times a week are the best barometers of my health. Most often, I finish these jaunts refreshed and eager for the next opportunity. The anemia that bothered me when I first began taking Revlimid ceased as my body adjusted. I have vitality to spare that feels natural.

At times like this, my cancer, multiple myeloma, does not feel so scary. I don’t underestimate its resilience. I know numerous individuals whose experience with this illness parallels mine. Moreover, I know that all of us will eventually relapse. One person, dear to me, is fighting right now for every single day. Nevertheless, this cancer’s ability to advance after successful treatment does not intimidate me. For the time being, I enjoy a good quality of life. That is enough.

Full Moon

This morning, I awoke, as usual, at 5:30. I plodded to the kitchen to brew coffee. From there I returned to the front door and called for Spanky. He galloped across the deck and slipped inside, crowing all the while about his nighttime adventures. Seedpods lay tangled in the downy fur of his belly, remnants of his prowl in the pasture. The long grass had dampened his coat. After a snack and thorough cleaning, he lay curled on my lap, tired but contented. My hands rested on the keyboard, and I wondered what I was going to say.

Pine forest and the Deschutes River

I’ve been traveling.

Recently, my wife and I attended the graduation of our niece from Whitman College in Washington. Tillie, the daughter of my wife’s sister, received a degree in Theatre with a minor in Spanish. She landed a much sought after two-year position at the college admission office, which will provide her income and experience as she considers grad school. Her parents work for the State Department. Their children were raised for the most part overseas. Tillie and her brother, also a Whitman student, are exceptionally bright cosmopolitan kids.

Following graduation, our two families vacationed in Central Oregon. The Cascade Mountains divide the state into yin-yang topography. To the west are brooding fir forests, the fertile Willamette River valley, and damp coastal areas. To the east, pine forests, high desert, and dry wide-open spaces prevail.

Early morning pine tree detail

When I was Tillie’s age, I spent several years in Yosemite National Park. More than the grandeur of its granite cliffs, it is its pine forests that resonate in my soul. The trees of the eastern Cascades resemble those of the Sierras in California. The species of pine are different but the smells of the needle strewn forest floor and the airiness of the pine canopy invoke memories of my youth.

Our families are compatible. We have vacationed together for 15 years or more. Normally, we rendezvous in August at the same Central Oregon resort. Due to graduation, this year we chose the week before Memorial Day when we were already gathered together on the west coast. The weather was not conducive to swimming or other summer activities. Instead, we bundled up for long walks, read books, and played parlor games in the evening. All in all, we found the time equally relaxing without the sunburn.

Back home, the lushness of spring, enhanced by late showers, gave our property a hint of abandonment. Weeds advanced on my perennials. Knee-deep grass on the lawn begged to be mowed.  I eagerly set about catching up on outside chores.

Flowering tree in my yard

Once I minimized the look of neglect in my gardens, I sat on the porch with my cat, Spanky. We basked in the sun’s warmth, sheltered from the breezes. Together, we watched as the wind wove tapestries amongst the burgeoning trees, entwining the branches on the rise of a gust, and then untangling the mass as the current lapsed. I had enjoyed our time on the road but it felt good to be home.

In addition to these domestic comforts, my mood is buoyed by recent events from the world of multiple myeloma. I have dealt with this blood cancer for 3 1/2 years. The sense of its passive/aggressive nature is palpable. In some patients, treatments struggle to hold back the progression of the disease. In others, for reasons not clearly understood, the cancer dawdles; it shows little enthusiasm to proceed as long as care is provided. In the last ten years, vigorous research into remedies made significant improvements in the lives of those patients in the 2^nd group.

The first event that gave me hope came from the International Myeloma Workshop held in Paris. Long-term studies indicate that revlimid maintenance treatment following a stem cell transplant extends remissions. Furthermore, the data confirms that patients undergoing this protocol live longer.

The second promising news about myeloma came from a speech given by Kathy Giusti, the CEO of the Multiple Myeloma Research Foundation. She delivered the commencement address to the graduating class of the Harvard Business School, her alma mater. What I appreciate about her remarks is the affirmation that sound business practices can speed up the FDA’s regulatory process. Treatments move from the bench to the bedside in years, not decades. Research for solutions to MM thrives under her excellent leadership.

Bridge sign: Don't jump to conclusions.

My cancer is stable. During the last two cycles of treatment with revlimid, I did not experience any physical letdown. I sleep well. My energy is good. I work full time and pursue my favorite activities. I feel confident about my health, optimistic for my future, all the while wary of the staying power of multiple myeloma. If I can keep the disease out of my bones and kidneys, then I should be around for the graduation of Tillie’s younger brother, my nephew Joey. He’s got three years to go. That’s a realistic goal; one I expect to make.

Another wonderful stormy spring day.

Spring is putting on airs, choosing to arrive fashionably late. Each year our community celebrates its agricultural roots with Blossom Weekend. Normally, pear and apple trees, festooned with an array of white and pink blossoms, attract thousands of visitors. They arrive like bees, pollinating local merchants with disposable income. This year, nary a blossom presented itself. Instead, a cold windblown drizzle greeted the tourists. T. S. Eliot got it right when he said, “April is the cruelest month.”

It was two years ago in April, that I started back to work following a lengthy break to undergo a stem cell transplant for multiple myeloma. Other than periodic checkups, I have not missed a day. This January, I began a regimen of oral chemo with the wonder drug, revlimid. I take a daily maintenance dose of 10mg, three weeks on, one week off.

At the end of the last cycle, I experienced a significant drop in my energy level. For three days in a row, all I wanted to do was nap. At work, I felt as if I were walking uphill in sand. I attribute that slump to a low percentage of red blood cells. Soon, my energy picked up as my body replenished itself during the break.

Revlimid capsules

The drug has slowed the progression of my disease. Dr. M and I would like to see a further drop in the cancerous cells, which hold steady after months of slow growth. Accordingly, we will continue with this treatment into the fall as long as the side effects do not create more problems than the drug solves. The goal is to achieve another sustained remission.

Doubt, hope, physical side effects, remissions that tease us, and relapses that punish us; these are factors that make up the complicated equation of living with this blood cancer. I meditate about these things on my blog and my ruminations help me to work through the stress associated with a life threatening illness. The only thing, however, that truly alleviates the alienation of a cancer diagnosis is interacting with others undergoing the same experience.

Each month I attend a multiple myeloma support group hosted by the Leukemia and Lymphoma Society. The value of these meetings extends well beyond their educational promise. I leave each get together not only wiser but also spiritually refreshed. It never fails that I glean something from the two-hour session that changes the way I think about others and myself. This past week was a general meeting. Rather than listen to a medical expert enlighten us about the disease, the moderators asked each of us to give a brief history of our diagnosis, treatments, and something we had learned along the way.

One gentleman’s moment stood out. He recounted how a counselor encouraged him to participate in art therapy as part of his recovery from a stem cell transplant. This opportunity enabled him to renew his values with a focus on creativity, purpose, wonder, discipline, and courage. Then, he proceeded to introduce us to the Jewish concept of Dayenu.

The Rabbi Spanky

Dayenu is a song that is part of the Jewish holiday of Passover. The word “Dayenu” means approximately, “it would have been enough for us.” Essentially, the song is about being grateful to God for all of the gifts he gave the Jewish people, such as taking them out of slavery, giving them the Torah and Shabbat, and had God only given one of the gifts, it would have still been enough.

Attending a support group will not cure my cancer. Nevertheless, it does cure me of the dread that occasionally shadows my optimism. Catharsis often accompanies the sharing. We testify to our individual fears. We bear witness to what has been lost. In addition, we rejoice in what renews us. Together, we discover that no matter where we are with respect to the disease, diverse paths to affirming life exist. Sometimes we just need another to point the way.

The before kitchen during demolition

Thus far, I seem to be managing the side effects of the oral chemo. The peripheral neuropathy in my feet has increased, pestering me with nerve pain. At times, it feels as if my feet are burning. I also experience muscle cramps in my lower legs. Both conditions, though, are transient; they come and they go.

If my support group is any proof, each presentation of multiple myeloma has its own temperament. Mine acts indifferently. Following my stem cell transplant, the disease remained stable for a long time. Dr. M and I watched over the last several months as the level of bad protein in my blood slouched along toward a relapse. We chose to begin treatment before the movement gathered momentum.

For oncologists, the bad protein, commonly called M-protein or the M-spike, constitutes the unique fingerprint for multiple myeloma. Remember, this is a cancer of the plasma cells in blood. Healthy plasma cells create antibodies to fight infection. Those antibodies reveal themselves in the blood as proteins.

Six weeks later

Proteins are the workhorses of a cell; they carry out the bulk of cellular functions. With multiple myeloma, the plasma cell/antibody/protein is abnormal. It occurs in conjunction with healthy plasma cells but provides no benefit. Instead, the switch for cell division is stuck in the “on” position allowing it to replicate itself at a torrid pace. Furthermore, the myeloma overrides the process of programmed cell death. Consequently, it floods the marrow environment, spills out into the bloodstream, and, well… there goes the neighborhood.

The recent death of Geraldine Ferraro underscores the tenacity of this disease. Ms Ferraro lived 12 years after her diagnosis. She utilized the prominence of her political career to advocate on behalf of all patients with MM. Ultimately, efforts to control the cancer’s prolific growth profile failed. Everyone in the myeloma community mourns her passing.

My personal disease profile continues its lethargic behavior. As I mentioned, the M-spike measures the concentration of the bad protein in blood. When tested two weeks ago, my number had decreased slightly. It’s too early to know if the new drug I’m taking caused the reduction. But I’m optimistic.

Spanky likes the heated ceramic tile floor

It’s easy to get hung up on one’s numbers. This is particularly so during the winter months when much of one’s activities are internalized because of the weather. The daily pill taking leading to each month’s labs kept reminding me of a reality it would be nice to forget.

Still, life goes on outside the internal workings of my blood. Recently, I found distraction from the tension of waiting for the periodic results. Our kitchen, long neglected, underwent a renovation comparable in degree to my stem cell transplant. We demolished the old and rebuilt it anew from the ground up.

We bought our home in 1978. It started out as a 600 sq. ft. bungalow but grew with our family. Over the years, we added one room after another, including a second floor. The kitchen, however, was always “next in line” for improvement. We had many setbacks to our good intentions: car repairs, college tuition, medical bills; it was always something.

Another view

Now, at last, the work is completed. The mild weather in January and February helped make the upheaval of our living space tolerable. We waited 30 years for this and six weeks of frozen dinners during construction seemed a small price to pay. In fact, the delayed gratification due to previous sacrifices only sweetens our appreciation of the finished product.

The kitchen overhaul had helped me to focus on matters other than my health. From hereon, spring will take over where the renovation left off. Yesterday, between rain showers, I scratched with a hoe at the perennial beds in my garden. Afterwards, my youngest son joined me for a therapeutic walk. All the medicine I need, at least for my soul, can be found in the verdant pastures, the activity of wildlife, and good company.

When in doubt, trust your instincts.

Since last October, we’ve discussed a course of action. I digested statistics from clinical trial findings. The doctor weighed in with his experience. Opinions from several other respected sources aided me in my deliberations. Finally, I assessed my own treatment history. No doubt, the chemo I received in 2008 altered the environment of my bone marrow. Those drugs subdued the disease. Over time, though, the cancer adapted and the surviving cells began to grow.

During the intervening months while thinking about what to do, MM claimed the lives of two members of my support group and an online acquaintance. That, coupled with the undeniable activity of my disease, broke the resolve to withhold treatment. I agreed to begin a maintenance therapy of 10mg of revlimid daily, three weeks on, one week off … indefinitely.

My rationale is a gut decision as much as it is about the clinical findings. Stable disease lulls one into complacency. This creates a Hamlet-like dilemma for the patient. Do you strike out at the cancer, or wait? No matter what you decide, it’s a coin toss with your life in the balance. Heads or tails; make the call.

A pretty winter morning, then the rains came.

Elsewhere, life goes on indifferent to my stewing over the choices. Winter arrived with enthusiasm. Ski resorts opened early. The season’s frigid momentum persisted through the holidays, clenching the long nights in an icy grip. Then, with New Year’s arrival, its hold loosened when the rains of El Niño drenched the western states.

At home, our modest sized Hood River, swollen to flood stage, growled with boulders tumbling downstream. Pear farmers renewed the premiums on their crop insurance as the thawing ground awakened the roots of trees accustomed to dormancy.

Dormancy, as blood cancer patients and farmers know, is a good thing. Temporary inactivity helps plants rest and rejuvenate. Nature’s balance depends on a period of suspended animation that unleashes itself in a nurturing climate. Too early, and the plant is vulnerable; too late and it may not mature.

Sleeping trees-That's Mt. Adams to the north.

Cancer, on the other hand, is more about co-existence with a situation that is out of balance. A patient, such as I, attempts to stay one step ahead. If eliminating the disease is unlikely, then perhaps suppressing it can moderate the ill effects. With luck, a durable remission is possible. In fact, given the dynamics of research into multiple myeloma, surviving until new treatments become available is a reasonable strategy.

Am I convinced about my decision? No. But I feel fortunate to have choices. The dirty little secret about revlimid is that a 21-day supply of this miraculous drug can cost over $10,000.00. That is not a misprint. Obviously, I don’t pay that. I have health insurance that happens to cover the drug. But for those that don’t, the choices about their cancer treatment are much more difficult than mine.

True Grit

This winter, my wife and I, along with our two sons and daughter-in-law went to see the re-make of the classic western, True Grit. I liked this version of the movie more than the original. I think the Coen brothers better captured the coarseness of an era when one’s self-respect found moral value in vengeance.

The protagonist, a young girl named Mattie Ross, wants justice for her father’s murder. She hires Rooster Cogburn, a gruff hard drinking marshal, to lead her into the badlands of the old west. Off they go on a journey laden with comedy and violence, their saddlebags full of cornbread and bullets.

The theatre in our hometown of Hood River is small. My wife and I always sit in the back row. There, our older eyes and stiffer necks can relax. The rest of our family sat up front. About halfway through the movie, my oldest son, Noah, headed to the lobby. The rubber tires of his wheelchair whispered on the carpet as he rolled past our seats.

His paralysis resulted from a vehicle accident in 2002. A careless mistake on the part of an uninsured driver led to a broken neck and an irrevocably changed life.

Noah surrounded by his posse at graduation from the U of O in 2006. .

The road we’ve traveled these last eight years roughed us up pretty good. The wrong done to my family felt so egregious, I yearned for the visceral satisfaction of revenge. Like little Mattie in the movie, I too, wanted the perpetrator to face a day of reckoning.

Though the other driver erred, my son’s accident was, … well, it was an accident, unexpected and unintentional. Much of my pain stemmed from grief without closure. I wanted to indulge in the primal urge for retribution, an urge, mind you, that accounts for the popularity of movies like True Grit. My guns were loaded, revenge was mine, but I had nothing to shoot. Anger grew from the frustration, a cancer that soon metastasized into depression.

Meanwhile, Noah persevered. His success at dealing with the injury helped me heal. He painstakingly completed his degree at the University of Oregon, graduating summa cum laude with a BA in Spanish. Then he enrolled in law school at the University of California, Berkeley. He paid for his graduate education by winning a prestigious scholarship from the Jack Kent Cooke Foundation. He finished his final term last December, attaining high honors. Just this week, he accepted a position with the Environmental Protection Agency as an associate attorney in their San Francisco office.

Noah

Along the way, I managed to contract a blood cancer, multiple myeloma. Some people suggest the disease resulted from stress. Perhaps … it’s as good a theory as any. At one time, I would have happily agreed to bargain my health for the health of my son. Ultimately, it doesn’t matter. What matters is that our family can now pause to celebrate. The last eight years moved at an agonizingly slow pace but the box canyon of paralysis was not, after all, a dead end.

Celebrating was exactly what we were doing at the showing of True Grit. Following a short break, my son returned to his seat. We all watched as Mattie got her man amid a fair amount of entertaining collateral damage.

In the real world, Noah has regained much of the independence stolen from him. The true achievement, however, was his distillation of loss into purpose and anger into courage. Re-routing his life took a lot of grit. And that, is all the revenge I need.

The back of our house-blue skies before the storm

The ASH meetings provide the latest in research on all blood cancers, including, of course, multiple myeloma. I’ve already examined much of what went on at this conference but I looked forward to asking questions unanswered by the press releases. Unfortunately, winter weather prevented me from traveling through the Columbia River Gorge.

We only received three inches of snow. However, the weather pattern consisted of a relatively warm Pacific storm with significant moisture butting up against a stationary cold front. The transition causes freezing rain and treacherous driving conditions in the Gorge.

Instead of a Q & A on myeloma, I spent the day with my new Christmas present, a Kindle. The Kindle is a brand name for a book reader sold only through Amazon. What’s a book reader? It’s a digital device into which books may be downloaded wirelessly and read from a screen similar to a book’s page.

When the weather is nice, I like to read on this bench under the Walnut tree

The Kindle does for book portability what the iPod did for music. Theoretically, I can carry around with me a personal library of reading material. Better yet, I can supplement that library wherever I find a Wi-Fi connection.

Prior to owning a kindle I deluded myself about the importance of sensual contact with printed pages. Those reservations went out the window once I put mine to use. The elegant design and simplicity of operation converted me instantaneously.

My Kindle library now contains four books. 61 Hours by Lee Child is a barnburner of a mystery, a perfect temporary remedy to crummy winter weather. Memory Wall is a collection of short stories by Anthony Doerr. The prose is excellent; the tales are compelling. The locations vary while always examining the theme of remembrance. I highly recommend this book.

Currently, I’m into The Lotus Eaters by Tatjana Soli along with another collection of short stories, What Becomes by the fascinating Scottish writer and comedian, A. L. Kennedy.

My Kindle came with a bodyguard

I read a lot. Book readers do not make reading easier or more fun. At the moment, I’ve still several questions about their shortcomings. Things such as how to loan books to friends, or what happens if you lose or break your Kindle. In time, entrepreneurs will come up with satisfactory answers.

Whether or not you find this brief review intriguing, rest assured that the way we read and access books is changing. As Kindles and their competitors develop, the utility of book readers will, for better or worse, alter the conventional necessity of bookstores and libraries. There is no going back.

PS: My favorite book of 2010 was The Art of Racing in the Rain by Garth Stein. If you’ve ever owned a dog or cat, gerbil or parrott, turtle or pet rock, read this book.