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.