Chemical warfare

Give me an earthquake any day. Short, sharp, sudden, and gone before you even think to be scared.

Not like this looming, slow-approaching hurricane of chemo. The storm gathering ominously offshore, the winds strengthening, the seas rising, the pressure dropping. You, sitting at home helpless, watching a wobbly path that bends slowly and inexorably shoreward: not if, but when. The rain bands start to beat insistently on the windows and the winds tug at your shingles. Eventually the TV is subsumed by snow, the radio succumbs to static, the lights flicker off, the house sits thickly still in a ghostly absence of the hum of fans and air conditioners. And still you wait, hamstrung by the storm, hunkered down, butterflies beating about in your stomach.

Butterflies beating about. I think I'm hardening to the DMZ. Yesterday the blood-drawing tech was having a bad day. She screamed at me to hurry up when I was having my vitals checked by another tech across the hall. Then she screamed at me for putting my paperwork in her box at all, the wrong box for those with ports who need nurses to draw their blood: a blessing in disguise; now I can avoid the grouchy tech.

It took a long time to get going yesterday. My port was in very good condition, but it was still only two days post-op, and it hurt like hell when they poked the IV needle through. That necessitated a long, slow flush with saline solution while they waited for my port area to numb up and the results to come back from my pregnancy test. ("No, I swear, there's no way I'm pregnant...") They filled up the time with visits from nurses and pharmacists, and for once I was allotted the time to ask questions about the timing of appointments and the changes in lifestyle I could expect. After a couple of anti-nausea pills and a shot to shut off my ovary production for a few months, they at last broke out their barrage of pads and needles and syringes and bags and gloves, and were ready to begin.

I was terrified. It's a rather daunting experience. I wanted to read my magazine, listen to my iPod, and toy with my little stress ball, but the nurses had other ideas. This week's treatment came not through a slow-drip IV, but through large syringes that were hooked up to my port and slowly injected, to the accompaniment of a gentle saline IV flow. Watching noxious materials slowly enter your body would be bad enough, were it not paired throughout with the ever-so-helpful commentary from the nurse on all the characteristics and side effects of the drugs I was receiving.

I kept expecting to suddenly break out in convulsions, puke violently, or drop in a dead faint. None of this happened. In fact, I felt fine. It was odd. The butterflies still beat about anxiously in my stomach. After all, they were injecting me with (among other drugs) a form of mustard gas, still one of the most powerful and brutal drugs used in chemical warfare.

I left, took the shuttle, walked home, had dinner, felt fine. Couldn't figure it out. Sure, I was a little cold, but I've always been a lizard, cold-blooded, bad at generating internal heat. I layered up and started work on a couple of projects. Then the anti-nausea drugs began to wear off. Feeling a bit off-kilter, I ingested my daily battery of pills from the pill factory in our kitchen and went to bed.

It was a fairly quiet night, but a rough morning. Horizontal was a decent position, although the gremlins in my digestive tract were doing their morning tai chi. My body temperature was all off: too hot or too cold. I kept frantically checking to see if I still had feeling in my fingertips (peripheral neuropathy, or damage to the nerves on your extremities, is a possible side effect of the chemo drugs and one that I, as a musician, fear most). Vertical was not such a successful position; and even though the floor kept steady beneath me, it was a struggle against rising nausea as I crawled to the kitchen to take my morning pills. The nurses had said to use seasick medicine until I could get a prescription for some anti-nausea pills. It took a few minutes and some concentrated mental effort to reach up even for the trusty bottle of meclizine and swallow the little pink pill. Luckily, that quieted the gremlins enough for me to walk around for a bit and eat breakfast.

I'm glad I don't have many expectations for today, though. I feel beat up - sore on my butt from the bone marrow biopsy on one side and the shot on the other; sore on my right shoulder and neck from the port; fatigued mentally and physically from the pain; and my entire insides beat and battered and churning. At least I don't have to swallow down the nausea, brace myself against a lurching ship, and stand an alert four-hour bridge watch.

Give me an earthquake any day.

Top 10 Reasons Being Bald Rocks

10. Rubbing my head = good luck

9. No more sleeping in curlers

8. I knew my nickname was “V” for a reason













7. Bald goes with everything

6. Hair is so 20th century!

5. No gray hairs

4. Shaves seconds off my swim time

3. Scrunchies are getting so expensive

2. With big, dark glasses and a colorful head scarf, I’ll look famous

1. Three words: G. I. Jane

Tantalus

Three cheers for the unexpected.

I often take chances (or, "calculated risks").  Today started out rather chancy.  I ate breakfast, against the nurses' explicit pre-surgery directions, trusting in a fast metabolism and healthy digestive system (halfway through a 16-hour fast, I was starving).  I walked twenty minutes to the bus stop without confirming the shuttle schedule.  I didn't write down my appointment room number, trusting to a vague recollection in a photographic memory.

I figured all these chances were small, compared with the towering uncertainties of the sedation awaiting me.  So when my meal digested just fine, my shuttle arrived with five minutes to spare, and the receptionist cheerfully pointed me to the right floor, I still wasn't about to buy tickets for the Powerball.

I only half-listened as the doctor reviewed the pre-surgical disclaimers with me.  Go ahead, hit me with the big one, I thought.  The sedation part.  Not a word.  "Any other questions before we get started?" the doctor asked.  "What about the sedation?" I blurted.  "Sedation?" he replied quizzically.  "That would be too dangerous, to put you under general, or to sedate you heavily.  We'd have to insert a feeding tube and everything.  No, we're just going to use local, with some medication for the pain.  Do you...do you need general?"  "No, no, no...I'll be fine!  That's great to know.  That's what I was most worried about."  He looked confused.

Mt. Zion is a much more comforting facility than Parnassus.  No DMZ here.  The receptionists, nurses, and doctors were uniformly pleasant, approachable, and helpful.  Which was good, because the preparation for the surgery was, in itself, dehumanizing.  You strip to the waist and wrap in a threadbare hospital gown (with burn holes helpfully marking the more personal areas), then balance on a towel-wrapped diving board of an operating table.  Plastic trays snap in to support your arms and a large roll of blankets elevates your knees.  ("This should make you more comfortable!")  After the requisite pain of locating a vein for the IV (the last time for a while, I hope dearly), it is time to Prepare The Site.

First they removed the gown ("we're going to expose you for a minute here" - good thing I covered up for modesty) in order to tape down my right breast.  Amazons, athletes, or cross-dressing Revolutionary War soldiers - bless 'em all, maybe it gets easier with repetition.  It didn't exactly spur me to mount a charge against the enemy.

Then, they inserted the oxygen tubes.  This was, by far, the most uncomfortable part of the procedure.  Little icicles, burning cold, stuffed up your nostrils; the light-headedness hits you instantly.  Why dish out $20 a pop for an oxygen-bar hit?  (And how "flavoring" improves the experience, I know not.)  They dotted me with sensor diodes and strapped on a blood pressure cuff, which with bomb-ticking precision, every sixty seconds, death-gripped my right arm; meanwhile, on my left index finger, they snapped on a blood-oxygen sensor.  My pulse began to beep-beep-beep irregularly on the monitor.

They scrubbed down the site (my left clavicle) with a chokingly caustic orange solution, and taped around the site with towels and pads.  They raised my table and lowered the large ultrasound unit.  My field of vision narrowed to the blinding lights and an occasional nurse's head bobbing in and out; maybe a bloody glove or two.  "We're going to give you something to help you relax..."  Yuck.  My headache tweaked tighter.  I shut my eyes.  Beep-beep-beep went the monitor.  Squeeeeeeze went the blood pressure cuff.  Nurses talked about me in the third person.  Doctors circled like vultures.  Is this what you feel like, I wondered distractedly, when you're about to die?

Two doctors operated on me; one was clearly training the other.  The procedure basically re-threads a vein from your neck into your clavicle for easy access; the ultrasound helps the doctors locate the vein.  The lidocaine injections were not pleasant.  They never are.  The rest of the procedure was fairly rapid, consisting from my vantage point of varying degrees of pressure on my collarbone, punctuated compulsively with the beep-beep-beep and the squeeeeze, strange cold dripping feelings and the nurses' heads in sharp relief against the searing white of the operating lights.

The BP cuff got on my nerves.  I started squeezing back.  Who am I to lie there in quiet submission?  Every time it started pumping up, I'd clench my fist and flex my biceps.  Squeeze.  Flex.  Squeeze.  Flex.  Flex.  Ha.  It always gave up first, slowly deflating in defeat.  Ha.  Me, one; BP cuff, zero.

When it was over, a nurse cautioned, "Don't stand up just yet."  As if I could: I was still entangled in a web of towels and tubes and tape, with the ultrasound unit hovering just inches above my chest.  Eventually all my parts and pieces were disconnected; I swung my feet around and stood up.  I walked to the door.  The floor lurched gently beneath me.  The nurses were a bit taken aback, too surprised to sit me down.  "Are you sure you're ok to walk?" they asked, reaching to steady me.  "Sure, I'm fine," I replied, confused.  "This is just three- or four-footers.  Wait 'til you get in 12- or 15-foot seas.  Then things really start to fly."

It was all a bit anti-climactic.  My neck has a permanent crick.  I can't turn my head more than an inch or two to either side.  The non-rate who drove me home (inexplicably, I have to say, as I was not sedated and had no problems walking around: the shuttle would have worked out just fine) took me on a screaming Grand Theft Auto tour of San Francisco, complete with screeching stops and blaring music: probably not the best treatment for someone with recent neck surgery.  The lingering headache I always get from local anasthetic is finally wearing off.  And I got home starving - dove for the freshly stocked refrigerator - and winced to discover that chewing and swallowing were terrifically painful.

But I have a guaranteed direct line to a vein for the forseeable future.  They can use it for labs, and CT scans, and as long as it's flushed at least once a month, I can keep it in.

Three cheers for small miracles.

I'm just here for the drugs

When I met with my doctor last week, he presented me with a personalized copy of my Stanford V drug regimen - a simple spreadsheet with big unassuming "X"s to mark which drugs I'd receive in which weeks. Simply put, the regimen alters weekly between destroying cells and building them up. Some drugs can better distinguish between cancerous and non-cancerous cells; but there are not, as yet, any magic drugs: cells are cells and they all die rather indiscriminately. Hence the recovery weeks.

In addition to the IV regimen, I'll be swallowing a pill factory of "supportive" medications: some daily, twice daily, or three times a day; others twice a day only on weekends. (Go figure.) These supportive medications are aimed at controlling some of the more deleterious side effects of the primary drugs.

As someone who, as I said, eschews even her daily dose of "Vitamin M", I had to research all of these drugs to see exactly what was being fed into my body, tarnished temple of the Holy Spirit that it is. Thus I begin an occasional series of "Meet the Drugs", in which (at the risk of shrinking into the miniscule, rapid-fire disclaimers bracketing all good pharma ads) I shall introduce each of these chemical concoctions, for the greater edification of all.

So, (with a great debt to Wikipedia,) we begin with this week's drug of choice: Doxorubicin, C₂₇H₂₉NO₁₁, which I will take on odd-numbered weeks (1, 3, 5, & 7). Doxorubicin is a widely used cancer drug, which unwinds DNA, preventing the double helix from resealing and thus breaking the replication chain.

Doxorubicin is one of the drugs that I'll be taking which causes hair loss (or alopecia). It can also cause nausea and vomiting, skin darkening, sores on the mouth and lips; and in high doses, cardiac problems such as irregular heartbeats and congestive heart failure. (My cumulative dose will be about 1/5 of the typical threshold for serious heart problems.)

Doxorubicin is sensitive to light, so it often is shielded with an aluminum bag to prevent it from decomposing before it enters the body.

Would you believe...

It was a great weekend. Three busy, sun-drenched days in Portland, Bend, and Beaverton, where I adhered strictly to the post-biopsy recovery regimen of "pound the pavement incessantly". It hurt to sit, so why chance it? Adding to the weekend's luster was the long-awaited arrival (during my absence) of my hotly anticipated household goods, which I've only just started to unpack. Indoor camping is fun, but it's hard to reject the comforting domestication of dishes, sheets, and a few extra uniform t-shirts.

Leaving my roommate sequestered amidst my cornfield maze of boxes, I headed up to Parnassus yesterday to receive my results and treatment plan. My sunny demeanor immediately vanished upon arrival at the oncology clinic on the fifth floor, which rests securely behind the vast and sterile wasteland of the DMZ - the Dehumanizing Medical Zone.

At the edge of the DMZ, there is no clear waiting area or line; just a sign warning you not to pass, lest you interfere with other patients' protected health conversations. So you wait patiently at the sign, unacknowledged, as four staff members sit at their computers, gossiping blindly amongst themselves. You continue to wait, and wait, and wait. They continue to gossip and mill about. Finally a patient who is not so patient, or perhaps one who doesn't read English (or pretends not to), breezes past you and checks right in with one of the staffers. (Try it yourself and they pummel you, screeching from their guard shacks.)

At long last, after a series of coffee, smoke, and cell phone breaks, they summon you with yawning disdain. You fill out an endless sheaf of Xeroxed forms, identical every time, including a laundry list of symptoms you might have experienced since your last visit. (No, no, no, no, no, no, no, and no....next column...no, no, no...) There were a couple boxes to check if you'd had a biopsy or any lab tests since your last visit. I had started my marathon staging day at Parnassus on Friday, so I figured that section was extraneous. "No," said the receptionist. "You definitely need to write that down." She tucked in a page of pre-printed labels. "505 for the folder, 504 for your labs." "I'm not having labs today," I said gently. "I'm here to see the doctor for my results." "Oh, are you sure?" she sniffed distrustingly. "Yes," I smiled grittily, "we confirmed this on the phone when I made the appointment." "Wait over there."

Having threaded through the snipers, you sit gingerly in a "waiting area", consisting of a thin string of chairs winding around a sharp corner. The chairs are almost all filled. Some come and go quickly; others seem frozen in their chairs, there before you arrived and there after you've gone. It's like the line for visas at the embassy during a war. Sometimes a few words are whispered, and one or two people disappear down a back hallway, never to return. The view behind you is beautiful, breathtaking from your cliffside perch, but the chairs are positioned backs to the windows. Instead, you stare at uniformly tan walls and colorful posters in Spanish for lymphoma support groups.

Aides emerge at times and shout a name, but if you're around the corner, it's hard to hear. About a half hour later, after not responding to a mangled fragment of a last name I didn't recognize as mine, they shouted ever more shrilly until I finally figured it was my turn for vitals. Vitals are taken at every appointment, regardless of type or timing: weight, height, blood pressure, blood oxygen, heartrate, and frame size. Why one's height or frame size changes between appointments is beyond me. Then they tried to shunt me across the hall for bloodwork. "I'm not having labs today," I repeated. "Just go across the hall," they said patronizingly. "I'm just meeting with the doctor." "He will still need labs." "I just had all my staging on Friday. I don't need labs today." And so forth.

By the time you've fought across the DMZ, your originally sunny mood has been replaced by a glowering tornado of anger. I walked into a small treatment room and waited for my doctor. I steeled myself for the possibilities. Advanced Stage IV, incurable with less than six months to live....Would you believe bulky Stage III, with an extended treatment regimen and targeted radiation?...How about a stiff neck and a runny nose?

What the tests revealed, instead, was straightforward and relatively benign: involvement on both sides of my collarbone (left & right) and in my upper chest. Being otherwise asymptomatic, this classified me as Stage II, entailing eight weeks of Stanford V treatment starting Thursday of next week. On Tuesday, I'll have a port installed (a direct line to the blood vessels, obviating the poke and prod of the needle army), necessitating complete sedation, about which I'm none too excited. The sedation, that is.

Appointment request in hand and headed out, the DMZ once again lay before me. It took several minutes of frustrated conversation to communicate to the appointment secretary exactly what I needed. He kept quoting me days and dates that didn't line up. The doctor had very clearly written that I was to return next Thursday. "Ok, I've got you down for the 23rd." "But that's this Friday." "No, in June." "But I'm supposed to start Thursday." "Your doctor isn't free until July." "I don't need to see my doctor." "Cheryl [the nurse practitioner] isn't in next Wednesday." "I'm supposed to come in on Thursday." Too bad a pack of rationed cigarettes doesn't work as a bribe anymore.

It's a good thing I kept my customized body armor.

Dance of the Hours

The bone marrow scan was only the first of three staging appointments this past Friday. Immediately after, I rushed across town for the next step: PET (positron emission tomography)and CT (computed tomography) scans.

At the imaging lab, I was injected with a radioactive sugar solution, then led to a small, birch-paneled room where I was to don lab-provided pajama pants, drink two cups of lab-provided water, and decompress in absolute silence until summoned - talking makes the sugar congregate in the neck muscles, thus disturbing the scan. (The sugar collects in the brain, liver, and in cancer cells; the CT scan provides three-dimensional reference points: together, they accurately image the cancer's spread throughout your body.)

Another young woman hunched gauntly in the opposite corner, silent in her lab pants, draped in a lab blanket, reading a magazine, two empty paper cups on the table beside her.

I looked up and smiled. Apparently the order's Rule of Silence also encompassed nonverbal communication. She carefully focused her gaze on lurid drunk-limo tabloid shots of Lindsay Lohan. She disappeared first.

At last, the sugar having taken root in my cells, I also was directed to the bathroom, then led into a dim room spotlighting a long, towel-draped locker room bench emanating from a luminous Hollywood Bowl halo. I stretched into a rather inelegant balletic fifth position on the bench, my arms extended rather uncomfortably over my head, my lower body twisted precariously on the thin beam.

To the accompaniment only of my own slow heartbeat (metal objects, including earphones and iPods, are anathema during these scans), I slid slowly back and forth through the halo. I was busy calculating walking distances and shuttle times - my doctor had asked me to bring some medical records to my last appointment of the day, and I'd forgotten them at my apartment a few blocks away.

After a while, the tech hooked up the IV to circulate contrast dye through my veins for the CT scan. The contrast dye seeps like slow-boiling water just under your skin, concentrating in the neck and groin and other areas of high blood flow. The heat gradually subsides as the dye exits your body, but a peculiar subcutaneous seared sensation lingers. "People have tried since the Middle Ages to figure a way to boil people's blood in their body - a great medieval torture technique," I told the lab tech. "Yes, they've finally got how to do it," he replied, "and it's a diagnostic tool."

Two down; one to go. I gloss over my high-speed side trip to my apartment to retrieve my medical records, because I probably shouldn't talk about gimping across San Francisco just a few hours after a bone marrow biopsy. Suffice it to say that, medical records in hand and only slightly sheening with sweat, I made it up to the 13th floor (yes, that was the 13th floor) of the hospital just on time for the last appointment of this long and endless day.

The pulmonary function test is, well, rather disheartening. Its purpose is to gauge how deleterious the chemo drugs will be on your lungs, a baseline memory of original function. You sit in an airtight booth and breathe in various patterns into a breathing machine, which I can only describe as french-kissing an athletic mouthguard glued around a plastic paper-towel roll. At times, and without warning, the air stops, leaving you deflated, like someone is testing the air seal on your scuba tank or SCBA.

The over-enthusiastic tech, who was, no doubt, long past ready to begin her weekend late on this hot Friday afternoon, talked me through a number of fancy breathing exercises I was to perform while hooked up to the plastic contraption. The panting; the deep, short breaths; the powerful puffs: I was quickly light-headed and the tech was just as quickly annoyed at my apparent inability to produce the right sorts of breaths. Hell, I'm a swimmer and a singer, not a gasper, Jim! At last, we arrived none too smoothly at the final component, in which I was to inhale deeply, then exhale slowly and smoothly. Now this - this I could do. With great pride, I sustained a prolonged exhalation for nearly a minute. I was ready to start circular breathing when I noticed the tech's angry grimace. "A little faster, please," she spit out sharply. Oops.

Lung function documented, I then sat down (gingerly - sitting was much more painful than standing or walking) for an arterial oxygen count. This pleasant test consists of skewering your wrist with a long metal stylus, then ripping out an artery. Well, that's what it felt like. After my gritted "Owwwww...", the tech stopped, mid-yank, and asked, "Does this hurt?" Immediately estimating it wasn't worth the hassle, she abruptly aborted, brusquely wrapping my wrist in Day-Glo Ace bandages. "If my doctor ordered it, though..." I said, confused. "Oh, no," she replied. "It's just an extra test we're doing for our research here." Yeah, great, thanks. So glad to be at an educational institution.

And, it turned out that nobody needed my medical records after all. So much for my frantic cross-town hobble.

Tomorrow at noon I get the results from my doctor.

But the flesh is weak

'Give us some more blood, Chekov.' 'A little won't hurt, Chekov.' 'Take off your shirt, Chekov.' 'Roll over, Chekov.' 'Breathe deeply, Chekov.' 'Blood sample, Chekov.' 'Marrow sample, Chekov.' 'Skin sample, Chekov.' If...IF... I live long enough, I'm going to run out of samples!

You'll live.

Oh yes, I'll live, but I won't enjoy it!

So I survived. Not that it was pleasant. My day started early, with a two-mile walk to the UCSF shuttle that took me to Parnassus for an appointment they rescheduled earlier, because there weren't enough nurses. I arrived and the staff hadn't even shown up yet.

Every time you go to the clinic, they start out by checking your height, weight, blood pressure, blood oxygen level, and pulse rate, as well as taking liberal blood samples. I have very deep, thin, small veins (compounded by a low pulse rate and abnormally low blood pressure), which hate surrendering their tiny drops of blood and collapse without the slightest provocation; so taking blood is always a bit of a pincushion voodoo exercise, leaving my arms bruised and the nurses frustrated.

That over with, I was taken back to a cramped room with a bed. I passed by two nurses in heated argument - one desperately trying to run home to retrieve forgotten keys. I sat down on the hospital bed and in walked the keyless and distracted nurse. She started mining for a good vein for my IV. With little success. After nearly an hour of poking, slapping, tourniqueting, squeezing, palpating, and puncturing, at last she hit pay dirt. Then I listened to a dispassionate recitation of my laundry list of drugs for the morning.

A short explanation here. I hate drugs. I mean, I HATE drugs. I don't take Tylenol for minor aches and pains and I'm leery of cold medicine even when my head's exploding. My wisdom teeth and biopsy were both done under nothing but local anasthetic. I don't like surrendering control of my body to anything, particularly some inanimate liquid, powder, or pill. I want to be aware.

So, the endless recital of mind-altering substances wasn't exactly reassuring for me. Particularly when they got to the Lidocaine, the local anasthetic. Local anasthetics aren't very friendly to me - I usually require about 3 times the normal dose, it wears off incredibly quickly, and leaves me feeling extremely nauseous. Luckily, the nurses and doctors listen to me now when I tell them that anasthetics aren't that effective on me - I vividly remember a dental cavity filled under, effectively, no anasthetic as a child.

They started with the Adipan (anti-anxiety) and morphine. The nurse kept lobbying the nurse practitioner who was performing the procedure to increase my dosages, and I kept objecting. The morphine crashed over me, leaving me barely able to flip over on the bed and my head erupting in my hands. "You're not supposed to feel anything," the nurse reassured me blindly.

The Lidocaine shot into my lower back with two tremendous, lasting stings, angry wasps attacking me and then sticking around for the party. I turned up the volume on my iPod until Jars of Clay drowned out the nurse, NP, and lab tech endlessly verbalizing the play-by-play behind me for my sure edification.

Jesus' blood never failed me yet, never failed me yet...

Silent tears soaked my face as the morphine continued to sizzle through my brain and the NP began drilling in my pelvis. First, a hole is drilled. This you feel as a crushing pressure on your lower back, until the bone is broken through, at which point a stabbing pain explodes into you. Once the hole is drilled, the aspiration is performed, then the biopsy, necessitating more searing pain and immense pressure as the marrow, the bone chip, and finally the drill exit your body.

This one thing I know, that He loves me so...

When it's over and bits of my insides are being sliced, stained, and immortalized on small clear slides by the lab tech, I'm rolled over to put direct pressure on the extraction site. The bed is raised, lowered, folded, and bent, a Sleep Number origami that moves none too gently. We all laugh as the bed crankily rejects the contortions, suddenly dropping beneath me. I don't have long to recover because I have to catch the shuttle to my next appointment.

Jesus' blood won't fail me yet, won't fail me yet, won't fail me yet...

(To be continued...)

Desk Watch Officer

Out of all the side jobs in all the non-operational offices in a decidedly non-operational unit…somehow I landed the most operationally-flavored assignment possible. I'll be in charge of security and force protection here at the base. Liberally garnished, of course, with other tasty collaterals (such as Morale Officer).

It’s not a bad gig, although it’s accompanied by the concomitant complement of headaches: contract security, parking decals, security packages. Just yesterday we had a Suspicious Package, which was sequestered forlornly on a patch of grass in a parking circle for several hours while we interviewed mail clerks and waved away curious bystanders. Eventually, the local EOD’s curious droid rolled up on a long, skinny electrical-cord leash to peer carefully at the gleaming white box and fire a few charges at it while the rest of us crouched behind vehicles and inside buildings, outside of the potential "blast zone". And thus was demolished a long-forgotten PO2’s retirement certificate.

Benefits of the job include frequent range trips (and unlimited access to a virtual range); a large private office in a building where I’m the senior person; two fantastic chiefs running the division; and the incomparable and highly coveted Key to the Island. Less pleasant, perhaps, are the requisite pile of manuals and instructions to rewrite; the cat-herding inherent in supervising a security force comprised of collateral-duty members; and the inevitable random tasks expected of the most junior officer in a short-handed wardroom.

Can’t wait for the new JG to get here this summer.

Avarice

PALM, n. A species of tree having several varieties, of which the familiar "itching palm" (Palma hominis) is most widely distributed and sedulously cultivated. This noble vegetable exudes a kind of invisible gum, which may be detected by applying to the bark a piece of gold or silver. The metal will adhere with remarkable tenacity. The fruit of the itching palm is so bitter and unsatisfying that a considerable percentage of it is sometimes given away in what are known as "benefactions."

Ah yes, the itching palm. Properly channeled, of course, this deadly sin can gleam with virtue: thrift, hard work, good stewardship. And I’ve always found the best way to control an onslaught of avarice is through dispassionate largesse. After all, if you’ve given it away, how greedy can you be?

Furthermore, my furtive longings for lucre have always been somewhat contained by decidedly unglamorous surroundings: a hobby farm in rural Oregon, a tiny, edge-of-the-ghetto apartment in Virginia, and a tree-lined, working-class street in Alabama – let’s just say, even on limited paychecks, I out-earned most of my neighbors.

Here, it’s not so painless. I tell myself it’s not just because gas, groceries, and rent are all sky-high: after all, I’m receiving extra compensation for that. Not just because sofas cost $3000 instead of $350, or because even at 80% off, a nice skirt in the local shopping center still goes for $75. All that means is my frugal side kicks in, hunting down the name-brand bargains and avoiding the exorbitant markups.

And it’s not even that consumption is all that conspicuous here, at least not in the circles where I’ve moved thus far. Money is spent, and in vast quantities; but not ostentatiously. Instead, what cuts to the core is the sheer casualness with which my peers, the city’s young professionals, toss around talk of their six-figure salaries and multi-million dollar equity stakes.

Now for doctors, for lawyers, I feel different. I completely respect their sizable earning potential; I know I’d never have had the patience for all their intense post-graduate schooling. And anyway, they’re paying off crushing school loans.

But the finance guys, the computer techs, the teeming throngs of management consultants – their path hovers just beyond my reach: if only I’d gone to Stanford instead of Oxford…if only I’d used my math skills as a springboard instead of my English talents…if only I’d concerned myself more with profit and less with personal pursuits and the public good. That’s generally where this train of thought screeches short. I’m not, nor have I ever been, willing to whore myself out for money.

My palms still itch sometimes, though...particularly here.

Limbo

Have I mentioned how impatient I am? Yes, here I am again, waiting.

I signed a lease on my new apartment, but without furniture or possessions, I haven't moved in. I didn't know what furniture I'd need, and didn't want to be lugging it around, so my furniture was either rented out with my house in Alabama, or put in long-term storage when I still thought I was going to Hawaii. I've bought a bed and will be looking at some other (used) furniture this week, but it's expensive to furnish an entire apartment all at once - even a relatively small and shared one.

My other household goods are en route, hopefully to arrive sometime this week. Until then, and particularly after having lived like a transient in Alabama for a couple of weeks in between leaving school in Rhode Island and getting orders out here (since I didn't know from day to day how long I'd be staying in Alabama, since I needed to be ready to go at moment's notice, and since I needed to keep my house ready to rent out immediately upon my departure, I slept on the floor in a sleeping bag in an empty house for two weeks, with not much more in the refrigerator than a couple beers and some condiments) - until then, I'm waiting. I have little desire to resume a life of semi-privation while I await my stuff...nor am I eager to purchase new sheets, towels, kitchen utensils, and other accoutrements of domesticated life, when I know that all of that will be arriving post-haste. I hope.

Until then, I've lingered in my airport hotel. The bed is comfortable, the towels fresh, the location not too inconvenient; and if I manage it correctly, the free breakfast lasts me most of the day. Not that it's cheap; but for the time being, the scales are tipped slightly in favor of its worth.

Most of all, I hate waiting because I want to get treated and move on. It's particularly unnerving to observe the hungry pace at which the cancer appears to be spreading, while I wait. Less than five months ago, I noticed the first lump. Now there are several, in at least two locations on my body (meaning Stage II, at a minimum). I still have few symptoms, but that's hardly reassuring. My bone marrow scan is set for May 16, with the other staging appointments still to be scheduled. So the earliest I could see the doctor for a treatment plan would be a week past that, and the earliest start for treatment would be yet another week - almost into June, then.

Did I mention I'm impatient?

Parnassus

UCSF's main campus is located on Parnassus Avenue, high above the city of San Francisco and overlooking Golden Gate Park. The view from the fifth floor, where Hematology/Oncology is located, is breathtaking. On a clear day (like yesterday) you can see all of the city, the parks, the bay, and the tops of the Golden Gate Bridge, in all their vivid greens, blues, and reds.

After taking a commuter train and a shuttle, I arrived at UCSF's Ambulatory Care Center early - which was a good thing, because I had to fill out a mind-numbing stack of new patient forms ("does your right toe hurt? How about your left upper eyelid? How would you categorize the pain on a scale of 1 to 10, 10 being the worst pain felt by a waterboarded terrorist just prior to passing out?")

As I was waiting to see the doctor, a man sitting next to me started talking. He had been diagnosed with a type of leukemia just two months prior, and had qualified for a study in which he took a magic pill once a day, which would apparently put his leukemia in full remission. "Don't be too encouraged by the folks you see sitting out here," he whispered conspiratorially. "They look pretty healthy, like you and me; but as you walk down that hallway, you'll see some very sick people. Bent over in wheelchairs, curled up on hospital beds, barely alive. You'll wonder how they're still making it."

Luckily the nurse called me at that point. My conversation with the doctor was fairly superficial, given that I still need to be staged. He said that I would most likely be treated with a modified Stanford V regimen (adding targeted radiation at the end), which is a very intense form of chemotherapy that lasts half the time of other treatments (8-12 weeks of chemo, depending on stage). He outlined how they would monitor carefully the effects of each drug they administered, reducing doses as necessary to ameliorate side effects. Chemo, he said, starts with the highest doses and then gradually tapers off. The drugs given on alternate weeks have opposite effects - killing off cells one week, trying to restore your immune system the next.

Then he launched into the laundry list of side effects. Stanford V, because of its reduced amounts and duration of drugs, has a good prognosis for avoiding chemo-related cancers in the future, like leukemia. But there's still the delightful thought of hair loss, memory loss, nausea, rashes, loss of lung function, heart arrhythmias, and - what, as a musician, I dreaded most - loss of sensation or nerve damage in your extremities, particularly your fingertips. Stanford V is apparently not as damaging to the reproductive system as other regimens, which is why it is used on younger patients - in one study, 25% of patients had successfully conceived following treatment (that is not saying that they all tried). To add to my chances of protecting fertility, I'll be taking a drug that temporarily induces premature menopause - so here come the hot flashes and mood swings! Nothing like getting to go through it twice.

The next step is staging, which they will be scheduling in one long and grueling day, to occur within the next 10 days or so. Until then...they finally decided today that they want me to come in to work each day until I start chemo. Thank goodness! I've been keeping myself busy with moving out here, and projects I'd put off for some time, and books I'd been meaning to read - but I am very glad to be going to work.

Mt. Parnassus, in Greece, is tied in legend to the Muses, associated with poetry, music, and learning.

I take that as a good omen.