The Drugs of Wrath

Every day, twice a day if not more often, I down a veritable pill factory full of drugs. These are the deceptively named "supportive medications" - designed to counter the deleterious side effects of the primary poisons being pumped through my system on a weekly basis.

Daily, I take Acyclovir, Colace, Fluconazole, and Ranitidine. Some of these drugs speak to my suppressed immune system: Acyclovir is an antiviral that protects against herpes simplex; Fluconazole is an antifungal. The other two comfort my disturbed digestive system: Ranitidine inhibits the production of stomach acid and Colace is a stool softener. The chemo drugs kill a lot of the cells lining your stomach and intestines, so your innards aren't too happy (or functional).

On weekends, I take Septra, an antibiotic designed for those with a compromised immune system (originally developed for HIV/AIDS patients). And every other day, I swallow a bunch of Prednisone, a steroid. Prednisone suppresses your immune system, which may seem somewhat counterproductive, but actually serves a useful purpose: preventing the cancer cells in your lymphatic system (part of your immune system) from fighting back against the cancer drugs.

Prednisone is not a pleasant drug. Its seemingly endless list of symptoms and side effects includes weight gain, facial swelling, depression/mania/other psychiatric disorders, fatigue & weakness, mental confusion, blurred vision, abdominal pain, ulcers, infections, painful hips & shoulders, osteoporosis, insomnia, joint pain, cataracts, stretch marks, nervousness, acne, rashes, increased appetite, hyperactivity, frequent urination, diarrhea, and, in the most attractive description of all...removes your intestinal flora. On top of all that, after about a week of taking it, your body stops manufacturing the natural adrenal steroid it mimics, so you have to wean yourself gradually off the drug in order to avoid a life-threatening "Addisonian crisis" - convulsions and other medical emergencies caused by a lack of adrenal hormones.

The pills taste terrible and sit uneasily in my stomach no matter what I've had, or not had, to eat or drink. But I tell myself they're doing some good...right?

New Math

Halfway. I'd attached myself to it, if somewhat uneasily. It's not the most reassuring word, halfway. Halfway house. Halfway to heaven. Halfway to hell.

Or halfway as its own destination of sorts. Purgatory. When I was a kid, we used to drive from Southern California to Phoenix a lot, to spend time with my grandfather and my uncle and their families. At six hours back in gas-saving 55-mph speed limit days, it was a long drive even for me, a child of the Inland Empire's freeway culture well inured to living life on the road.


Halfway between the states was Blythe, a boiling hot patch of gas stations, fast food, and a prison melting in the desert amidst endless horizons of sand and saguaros. A spartan bathroom, a fresh tank of gas, and a cold drink as you disappeared in a curl of smoke on the white-hot sidewalks. Then you packed quickly back in the car to roll across the shrunken Colorado and start the engine-saving air-conditioner-less slog up the mountains into Arizona. Halfway there.

Halfway's deceptive though. Is it really halfway? Traffic jams. Flat tire. Stops for dinner. Change of plans. Road construction. Detours. It could be early afternoon when we hit Blythe, and late into a dark, steamy August night before we rolled up at my grandpa's familiar stuccoed cul-de-sac. So I touched the word gingerly this time around, unsure. Halfway.

Yesterday marked the halfway point through my chemo. I'd counted out eight weeks of chemo, a week of scans, a week of radiation. Or so said the hand-written calendar given me by the nurse practitioner in week 1.

Today, my uncertainty was justified, as "halfway" became "almost one-third of the way". My chemo is to be followed by a full 28 or more days of radiation - daily visits, 7 days a week, four or five weeks straight. Much more restrictive than my current schedule, which, surprisingly, has proved quite liberating. I was disillusioned and disappointed. I'll find out soon exactly when the radiation treatments will start and end, how long it will take each day, when during the day the appointments will be, and which UCSF facility (out of the dozen or so) I'll visit.

D'ici là, I rework my calendar and re-count the days.

Determination

This past weekend I visited my dad in Southern California. He misses me a lot (even when I'm not sick!), but with all his independence and good health, he is in his eighties, so it's usually easier to bring the mountain to Muhammad.

It was a fairly aggressive weekend, starting with rushing across town last week to make it from the hospital to the airport in time. The busy, sundrenched schedule of events incorporated two church performances, a twilight, windswept hike across the Santa Rosa Plateau, two very attractive (if unfortunately tasteless) meals, and a whole heck of a lot of road time. Oh yes...and some R&R: transcriptions and compositions, pecking at the piano, playing with a good friend's 7-month old, researching for my fall travel adventures.

The steroids have me so sped up that sleep is short, rare, and restless.

On Sunday, I visited my aunt and uncle. I am very close to them; they have been a second set of parents to me since childhood. Among many other specific and general life lessons imparted over the years, my aunt taught me to cook: not just the mechanics, but the art. That an orange-colored lemon is the sweetest, and that rolling it around on the counter before slicing it makes it that much juicier. To use ice water when making pastry crusts for the ultimate melt-in-your-mouth flakiness. To ask at the meat counter for extra innards to blend and simmer up for the giblet gravy at Thanksgiving. To clean as you go to avoid a big kitchen mess greeting you after dinner's over. The magic of timing all the dishes just right (I still struggle with that one!). My aunt's cooking was legendary, particularly the deftness with which she processed the hundreds of pounds of peaches produced by a single backyard dwarf tree: sliced, frozen, and in shakes, cobblers, and pies by the dozen - one year, she famously mixed gallons of peach filling in the bathtub.

Not long ago, my aunt discovered she had a brain tumor, and went through radiation and surgery to treat it. It took much from her, perhaps more emotionally than functionally, even. Her recovery has been slow, fitful, frustrating. My uncle has heroically and selflessly, unhesitatingly devoted his every waking moment to her progress and care, dueling with insurance companies and hospitals, out-researching the doctors, marshalling a small army of caregivers and specialists, and always pushing, pushing, pushing. He has never stopped believing, even when the family, and my aunt herself, despaired.

I try to sidestep any despair of my own treatment. Dealing daily with the unremitting and unpredictable barrage of my side effects, short- and long-term, it is not always easy. I push myself, sometimes almost too much. I try, I tell myself with success, to distract myself with various flavors of busyness. By scheduling activities I "can't" cancel. By forcing myself to take care of myself - walk to and from the shuttles and trains and buses and not take a taxi; walk or bike to get groceries and not order in; do my laundry and keep my room clean and wash the dishes. And some hours, days, or weeks definitely feel more comfortably "normal" than others.

Sometimes, though, it's an immense struggle just to go from horizontal to vertical. To crawl across the floor to take my morning or evening medications. To force down the nausea and greet people pleasantly, to concentrate in a meeting when my mouth is on fire, to walk the next four blocks when my heart is pounding and my head is reeling, to ignore the lingering pain of an operation scar or metal port under the chafe of a backpack or the cutting strap of a heavy bag.

And yet - as my aunt so aptly put it, "You can walk." For all the mind-over-matter I've employed over the past few weeks - it's only been a few weeks, and my impairment's been limited. She has a much longer road to travel, and her progress is necessarily so much slower. And I cannot express how heart-burstingly proud I am of my aunt, and her resolve, and her progress. Every action, no matter how seemingly small, a firm grip in the morning, an eye blinking on command, a few bites of real food, a trip - via sling and wheelchair and uncle and caregiver - outside, to sit for a moment in the sun - it is a milestone, an achievement thought unaccomplishable just a few months ago. And each miracle only strengthens the resolve and the impatience to achieve the next.

It would be unconscionably arrogant of me to say, If I can make it, then you can. Instead, it is this: If you can make it - you! - then what the heck is holding me back?! What excuse do I have?

This one's for you - both of you. We have so much living left to do...all three of us. I can't wait.

Side effects

The first few weeks, when I went in for treatment, I was afforded my own private room. Dominating the view in these small cubbyholes is a large green chemo chair, which unfortunately I keep forgetting to capture on film. Designed for comfort, the chemo chair - boxy, overly padded, draped in wires, tubes and controls, bolt upright, and in a bold hue I can only describe as hospital green - welcomes you with all the charm of an electric chair.

My past two appointments, though - last Friday and yesterday - I came in the morning. Mornings are considerably busier than late afternoons, meaning crowded waiting rooms, shared treatment areas, cheerier hospital staff...and perhaps surprisingly, faster service (more personnel on the clock, I assume). A crowded waiting room is a noisy one, even the oncology clinic isn't exactly the pediatric ward or the emergency room. Most patients are accompanied by a companion, the purpose of which I can only imagine is to cheer and comfort the patient; but in actuality, these delightful guests seem only to provide (or encourage) sounding boards for endless streams of complaints. A crowded waiting room is also an impatient one. Perhaps the large volume of patients creates an unconscious current of scarcity (though unfounded: there are concurrently extra staff on hand to treat the increased volume of patients). Whatever the reason, the topic on all lips is most frequently, anxiously, "What is taking so long? When will they see me?"

It makes it hard to concentrate on reading a good book.

Shared treatment rooms are another side effect of morning appointments. A shared room has two or three hospital beds, sometimes separated by curtains. Hospital beds are somewhat awkward for me, because I like to sit up, not lay down. My bed yesterday was a particular challenge. I kept shifting around, trying to find a comfortable and at least mildly supported seating position, but every time I'd adjust, so would the bed. It was like a mechanical, time-delayed waterbed, subtly (if noisily) lifting and lowering to match my every move, frustrating my futile attempts at proper posture. Finally, the nurse informed me that the bed was designed that way, for those confined to the horizontal, to alleviate stress on the body and help prevent bed sores. I felt a little sheepish.

Yesterday, my companion across the curtained room was an older woman who apparently was in great pain. She moaned loudly with every breath, tossing and turning relentlessly in her hospital bed. On first appearance by the nurse, she started haggling for heavy-duty pain drugs and muscle relaxers, which thankfully, quieted her down for some time. But later, when the nurse came to take her vitals and ask her to quantify her pain (we all have to quantify our pain, which is devilishly difficult for me: on a scale of 1-10, how badly does it hurt? Um, does 10 refer to being disemboweled and burned at the stake alive? Well...I guess maybe a 1 or 2??), the moaner and groaner only offered up a "3 or 4". 3 or 4?! That's well within the grin-grit-and-shut-up stage for me.

My companions last Friday were an elderly man who spoke little English and had to be led out since he had shown up for the wrong treatment, and a middle-aged woman next to me whining out a litany of complaints from before she even lay down. Now my perspective on side effects is, they happen, deal with it. Chemo isn't exactly a day at the spa. My nurses want me to inform them of my side effects, but I generally confine it to a brief list: what, where, how long. I haven't taken any of the "optional" side-effect-reducing medications, figuring it's better to have my body fight back (and anyway, I already choke down a cocktail of drugs daily in addition to all the IV toxins pumped in each week). A few times, the well-meaning but somewhat overbearing nurses have instructed me to call the on-call doctor if I notice any side effects from week to week, but honestly, unless I'm having life-threatening symptoms, what can they do? "Drink a lot of water, take some anti-nausea pills, call me in the morning." Or even better, schlep all the way across town to the hospital to have them tell me the same thing? No thanks. I'll deal.

Well, this woman, apparently she could not deal. Two solid hours of complaint after complaint, as nurses shuffled by, most not listening. Again, not very conducive to book-reading or music-listening, as I sat next to her, trapped by my IV and a slow-infusing drug. Her eyesight, her toes, her feet, her arms, her sense of balance, her depressive thoughts, her wakefulness or sleepiness...amidst the long and endless list, another woman appeared with a styrofoam take-out box. "Here, I brought you lunch," she said to my companion, and disappeared.

Now, the one undeniable symptom all chemo patients share is nausea. Loss of appetite, strange tastes, a digestive system that doesn't want to cooperate, and above all, nausea - to some degree or another; it never goes away. Even if you're otherwise feeling great...food...it's still not your friend. You find what works for you on a daily, or weekly, basis - a fizzy juice drink, saltine crackers, ice cream bars, popcorn. You never know. It's usually something mild and somewhat liquid.

This woman popped open her box and started devouring a very spicy, very pungent, very large taco salad. Ravenously. In between crunches, she continued to toss out complaints.

I think I see why the nurses don't trust me when I say I'm doing fine.

'Til it's gone

So, my toes are the ten latest casualties in my private little war on cancer. They're only the most recent converts to a growing list of body parts declaring anarchy from the autocratic rule of my central nervous system. Like early-stage frostbite, or the initial lack of sensation when standing up after sitting way too long in contorted positions, my feet still respond when called, but my toes aren't rogering up. You don't realize how prehensile your toes are until they don't grip the ground anymore.

One of the initial-surge casualties was my stomach - in fact, my whole digestive system. Healthy-eating gurus are always telling people to "listen to their stomach talking". I doubt they'd want to put up with the noise of mine lately. Its speech has been reduced to a single, low grumble, which generally can be translated into one of the following mutually exclusive ideas: (a) "Feed me, I'm starving!"; (b) "What the hell were you thinking, putting food in me?!"; or (c) "I'm angry at the whole world! GRRRRR!!!"

It is a war of attrition: other casualties have included, intermittently, my skin (unexplained rashes and bruises), my jaw (seizing up), the inside of my mouth and throat (symptoms of painful mouth sores without any actual lesions), my internal temperature control (a private Arctic under the beating sun), and with enduring unsettlement, my sense of taste. It is not just that the messages from my taste buds wax and wane in their intensity, or that certain types of taste (sweet, salty, bitter) trip on and off line. Instead, the communiques from my mouth are simply randomly garbled. A bottle of Evian slips past like the foulest tap water. Marinara sauce tastes of Italian dressing. Broccoli like carrots. It is indescribably disturbing to realize, halfway through a delicious and pleasantly sweet-tart apple, that your mouth isn't actually tasting anything like an apple at all. Your brain is just remembering what a good apple tasted like and silently editing the gaps between crispiness and yumminess.

I tell myself my fingertips only ache because of the hours pounding and plucking stringed instruments. But the truth is, they're losing accurate sensation too, placing everything from rapid-fire typing to bike-riding in peril. And one of the last outposts of resistance to the relentless siege, my hair, is gradually losing its tenuous hold on my body.

It is strange to watch your body disintegrate beneath you. To watch as unconsciously, your heart and lungs and brain and muscles summon up their reserves, substituting one sensation for another, altering your gait, your posture, your habits. To sit idly by as the one bedrock set of resources you thought you could always count on - your body - can't, or won't, respond to your commands.

I am war-weary. I can't wait to start rebuilding my forces.

A balancing act

My new life has assumed a peculiar rhythm. First of all, my weeks begin on Thursday. Day 1 of each new chemo treatment. And not Thursday at midnight either; Thursday at precisely the moment I step across that line into the DMZ on the 5th floor of Parnassus.

After treatment, I take the shuttle, walk home, eat something quickly before my stomach can catch up to the drugs (it's usually been a good 8 hours since breakfast), and collapse in bed. I'll drag myself out of bed around 10 to swallow pills before crawling back horizontal. It's a similar struggle in the morning. The nausea's the worst at first, but it gradually fades from a primal scream to a dull roar.

I sleep a lot the first 24 hours and don't eat much at all. I force myself to drink as much as I can to flush the drugs out of my system, but it goes down uneasily at times. The first couple of days I'm fatigued, tire easily, and find it hard to concentrate on much - even reading a book or listening to music takes a focused effort. My mind gets restless and my dreams are vivid.

Over the weekend, depending on that week's drugs of choice, I start to recover, some weeks more quickly than others. Side effects come and go - muscle cramps, mouth sores, weird tastes, headaches, always an uneasy digestive system - but they're generally at the nuisance stage and I'm able to catch up on chores and errands. My heart and lungs can't keep up with a hard workout, but I do a lot of walking and bike-riding (the happy consequence of no car). Food still tastes funny, if it tastes like anything at all (I'm becoming an expert in cardboard-and-styrofoam cuisine), and my stomach's not sure it wants any anyway.

By Monday, I'm ready to get back to work. I'm still tired - Monday mornings I don't force myself to get up super early - but putting in a full day at work feels good. It's always a race to keep up with, and stay ahead of, the constant information flow at work - partly because I'm still learning the responsibilities of my job, and mostly because I'm only there three days out of five. It forces me to be ruthlessly efficient with my time and, for the most part, keeps me distracted from a nagging stomach or a sore mouth or an aching body. Except when I'm sitting in a particularly long and boring meeting, which I've never liked to begin with.

Tuesday and Wednesday are a blur. I'm on overdrive, not tired, sleeping little, catching up with emails and phone calls and finances and keeping my mail sorted, setting things up at work for the days I'll be out for chemo, making post-treatment plans, working on projects at the apartment, enjoying the outdoors, going out for live music or a club, maybe even eating a triumphant meal out - triumphant because I can actually (a) taste the food, sort of; and (b) consume it without feeling sick, mostly.

Thursday mornings are the worst, particularly if treatment isn't until the afternoon. I feel as well as I'll get for the week, but it's of small comfort: I don't want to eat too much or I'll feel sick later; it's the middle of the day in the middle of the week, so I can't exactly go celebrate; I can't go out for a hike or go to work or just enjoy feeling good because I don't have all that much time before I have to walk to the shuttle and ride up to Parnassus. I charge my iPod, pack a few books in my bag, put numbing cream on my port, and the week begins anew.

It is a brave new world.

Happiness is not a matter of intensity but of balance, order, rhythm, and harmony. -Thomas Merton

Odd weeks

I can do without the odd weeks, I have decided. Last week was so unnaturally...well, pleasant. Approaching normal, even. So few symptoms; plus, I had energy. I traveled, hiked, worked, and danced late into the night at a Tuesday-evening party (just don't tell my doctors!).

Odd-week drugs are not so blithe of spirit. Weeks 1 and 5 I receive mechlorethamine, doxorubicin, and vinblastine; weeks 3 and 7 the mechlorethamine is replaced by etoposide, which can't all be delivered in one day. So after several hours at the hospital today, tomorrow morning, I return for round two.

Etoposide, C₂₉H₃₂O₁₃, interferes with the coiling necessary for DNA replication. It is derived chemically from the Mayapple, a completely toxic plant except for the mature fruit. Etoposide is delivered very slowly via IV, as it can lower blood pressure (mine, luckily, was remarkably consistent today).

In addition to low blood pressure, side effects can include hair loss, pain or burning at the IV site, constipation or diarrhea, metallic tastes, bone marrow suppression (lowered white and red blood cell counts; lowered platelet counts), nausea, rash, fever, and mouth sores.

Odd-week drugs sap a lot out of me. I slept for six hours this afternoon and am more than ready to crawl right back between the covers for another eight or ten tonight. Horizontal is easy - I drift and dream and idly calculate how much longer I can legitimately put off choking down another round of pills.

My white blood cell count was low today; so tomorrow, I'll get a booster drug. I've been warned it will cause severe arthritic-type bone pain throughout my body.

While lingering in the DMZ today, I was hit up by a hawkish, rail-thin woman representing the Leukemia and Lymphoma Society. I do not doubt they provide very helpful and supportive services to patients and their families, but being plied with personal questions by this overbearing, piercing lady in her dazzling fuchsia satin blouse and overly made-up face while I sat with tubes and needles cascading from my shoulder, awaiting treatment...let's just say, her timing was less than ideal.

To add to the joy, this week's nurse was of the patronizing variety. Just because you are my mother's age doesn't mean you can treat me like a small child. An honest concern and care; straightforward questions about my symptoms; clear and necessary direction for managing side effects: these are, of course, welcomed. But the wide, flat, indulgent smile, accompanied by any comments beginning, "Now, honey...," well, I tend to shut down.

I have no grand closing words tonight. I'm tired and feel yucky. Bedtime.

A song of ascents

I am a mountain goat. Always have been. Ask anybody who's been hiking with me. Sure, ordinary trails, I might amble along; but give me a good rocky hill to scramble up and I'm looking down before you know to look up. (I'm a lot slower picking my way back down hill, though...)

Chemo does strange things to mountain goats.

One of the side effects of chemo is inhibition of lung function. When Lance Armstrong went through chemo, he had his doses adjusted specifically to protect lung function.

Surprised that this week's treatment left me feeling relatively well, I took off on a last-minute trip to Las Vegas for the weekend, arriving in time for a good friend's baby shower, throwing in a "bonus visit" to see my aunt and cousin. Sunday, with the shower over, the partiers dispersed, and my aunt at work, I headed for the hills of Red Rock, one of my vividly positive memories of Las Vegas from an otherwise awkward junior-high-religious-school-orchestra-tour-to-Sin-City trip, many years ago.

It was a beautiful desert day - warm, sunny, dry, breezy - with the last of the spring blooms still coloring the sandstone. Fondue-dipped in heavy-duty sunscreen (chemo increases sensitivity to light), bandanna for my baldness, and armed with sunglasses and a camera, I set out on a nice, "easy", flat, gravelly, one-mile loop.

But the sandstone at Red Rock is irresistible. Up against the rock walls, shaded from the sun, my feet and hands reached for the crevices and footholds and like that, I was up, scrambling, stretching, skidding a bit, balancing. Up, sideways, up, over, always up. My legs and arms throbbed with excitement. My fingers savored the grit of the rock.

My lungs weren't so happy. Neither was my digestive system, which wasn't used to the tumult (abandonment of one's viscera at 3,000 feet is never recommended) nor my heart, which thirsted for oxygen as it sucked at blood thinned of its life-carrying cells.

I had to rest. It wasn't easy. I crouched in the shade and waited for my body to catch up with my spirit, distracted by the excited calls of kids and hikers and climbers echoing in the canyon. At long last, I crawled down from my rocky perch and slunk back by rappellers and picnickers and backpackers. I flopped in the car and cranked the A/C and flipped through the trail map for a long, flat trail, devoid of the temptation of rocky verticals and horizontals.

My second hike of the day was much easier, much flatter...and still a struggle to climb the last gentle slope to the parking area. I tell myself I made it - hiked a couple great trails, kept my muscles limber, my heart and lungs challenged, beat back the turbulence rumbling inside...and I traveled, saw family and friends, ate real food, enjoyed the heat. That I'm surviving. Still, sometimes, it hurts. It hurts to get worn out at a baby shower and have to crash for two hours in a side room like a little kid. It hurts to eat food and not taste it, or find even the purest bottled water tasting like milky Southern California tap-water sludge. It hurts to get winded walking up stairs, when taking a deep breath stings and standing up too fast blacks me out. It hurts to get tired after only half a day at work, and ten hours of sleep before that. To admit that no amount of effort or positive thinking will get me to 100% right now.

I tell myself I will never be challenged beyond what I can bear. And that perhaps, I am only learning the limits of what I can bear. Maybe my strength is yet to be proved.

I will lift up mine eyes unto the hills, whence cometh my help.

Week the Second

So Week Two begins auspiciously. My blood counts were good; I felt (relatively) healthy and well going into my appointment yesterday; my port was hardly painful at all during the blood draws and chemo; and best of all, I'm feeling none of the nausea today that so flattened me last week. (Partly due, I am sure, to the different regimen of drugs I received this week.) I've been able, so far, to avoid many of the "optional" supportive drugs, which I like to believe is helping my body launch a more vigorous response to slaying the cancer cells and getting back in fighting shape.

I'm starting to lay the groundwork, ever so gently, for post-treatment life: plans for collecting my car from Alabama, for various short- and long-term work projects, for vacation travel and other small indulgences.

This week, I received vincristine and bleomycin; but I'll backtrack for a moment and talk about two of last week's drugs, mechlorethamine and vinblastine (since I already explained doxorubicin, the third).

Mechlorethamine, C₅H₁₁Cl₂N, is a type of mustard gas. Its anticancer properties were discovered (or, confirmed) as an unexpected "side effect" of a terrible accident in Bari, Italy, during WWII, where a stockpile of secret mustard gas exploded and thousands of civilians and soldiers died. While the incident was classified until 1959, and covered up for years after that, autopsies of those killed during the tragic event showed that the exposed experienced lowered white blood cell counts, demonstrating mustargen's potential anticancer effects.

Mechlorethamine simulates the effect of radiation on cancer cells, making the double-helix strands in DNA unable to uncoil and separate - and thus unable to divide and replicate. It is, as might be imagined by its chemical warfare uses, very damaging to the skin if it escapes the veins, causing extensive tissue damage and blistering.

Side effects include nausea, vomiting, hair loss, mouth sores, darkening of veins used for infusion, fever, poor appetite, metallic taste, ringing in the ears, loss of fertility, and low blood counts.

Vinblastine, C₄₆H₅₈N₄O₉, is a vinca alkaloid. For the gardeners among you, yes, that means it is derived from a periwinkle plant. Its anticancer properties were discovered when scientists realized that people drinking this periwinkle tea lowered their white blood cell counts.

Vinblastine works by halting mitosis, the process by which a cell separates and replicates its chromosomes for division into two daughter cells. The protein tubulin is needed to fuel this process; vinblastine binds the tubulin and thus starves the cell of the food it needs to produce mitosis. Like mechlorethamine, vinblastine is a vesicant and will cause extensive blistering and tissue damage if it escapes the vein.

Side effects include low blood counts, fatigue, nausea, vomiting, poor appetite, constipation or diarrhea, hair loss, mouth sores, metallic taste, headaches, jaw pain, high blood pressure, muscle and joint pains, depression, shortness of breath, and peripheral neuropathy (the aforementioned and dreaded numbness and cramping in fingers and toes).

Out of the laundry list of symptoms for mechlorethamine, vinblastine, and doxorubicin, I probably experienced just about every one over the course of the previous week, at one point or another. Luckily, the side effects seem to have faded prior to this week's treatment.

Thus begins Week Two.

Though my flesh, it be destroyed

This was not the post I'd intended to write.

Stirred by distantly sardonic thoughts of new mornings each bringing with them unexpected "new delights", I sought out the famous poet who could best help me encapsulate that utter bleakness of spirit that accompanies every new and unexpected journey through this Scylla and Charybdis of cancer treatment: the ache of the left-hip bone marrow biopsy drowned out by the sharp reminders of the right-shoulder port surgery; the daily tightrope wavered between hunger and nausea, between a full stomach stuck roiling in bed and a productive empty one; the constant cupboard-baring hunt for drinks and snacks that might slip, unnoticed, past a mouth screaming with sores, a jaw locked down, a tongue rippling metallic aftertastes; the twice-a-day ritual of choking down a colorful array of foul-tasting pills beneficial in thought but nauseating in deed; the chilling, inescapable cold closing about me as my blood counts drop; and above all, the fatigue, the enervating fatigue leaving me flat out in bed, mind racing, unable to even focus on a book, distracted and entertained, at last, only by music.

This was the irony I sought to so deftly portray.

But it was not the irony that found me. Turns out the lines of "poetry" lurking about in my mind were instead lyrics, words to a song one rarely forgets, once heard.

Morning by morning, new mercies I see.

In the midst of a crushing devastation, the still-smoking destruction of his country, his people, even his own person, the lamenter still cries out, "It is because of the Lord's mercies that we are not consumed...Great is Thy faithfulness!"

All I have needed, thy hand hath provided.

My relatives were tortured and died in concentration camps and gas chambers; were hidden in basements and with strange families; captured by enemy forces and starved in prison camps; pioneered in unforgiving new countries; were massacred and murdered and pogromed; and from the earliest, scraped by on dirt farms, surviving the relentless bad harvests, plagues, famines, droughts, floods, political and religious upheavals, the uncertainties and poverties and bleaknesses, always sacrificing, never knowing for how long their suffering might last or what good it might come to, always with the unyielding hope that just maybe, through all this sacrifice, the next generation might just make it, might just inch a rung higher on that elusive and slippery ladder of societal success.

Strength for today and bright hope for tomorrow...

I have eight weeks to endure. Eight weeks, under the care of one of the country's best hospitals; eight weeks, with cutting-edge drugs and treatment regimens; eight weeks, paid for almost entirely by an unbelievably generous healthcare plan; eight short weeks, supported at every turn by the bedrock love and care of an army of friends, supervisors, co-workers, and family. Just eight weeks.

This, instead, was the irony that found me.

Great is thy faithfulness, Lord, unto me.

Total Assault: Seek & Destroy

Yo, EA, Take Two, I got this crazy new idea for your next video game. It's called "Total Assault: Seek & Destroy."



You play the warrior, on a battlefield of cancer. Your mission: kill all the cancer cells before they kill your host...or before your host succumbs to a range of debilitating and possibly deadly side effects. Your only weapons are the powerful but undiscriminating cancer drugs, which you can combine in standard regimens or dole out in experimental new doses.

You're on a race against time as you speed through the inner workings of your host's body, peering around every corner for the dastardly cells, cognizant of the declining half-lives and varying efficacies of your weapons. You rack up points for destroying cancer cells, but lose them every time a normal cell is killed in "collateral damage". You also lose points as your host succumbs to side effects like nausea, weight loss, hair loss, low blood counts, mouth sores, or decreased heart and lung function. Your only remedy there is to spend your hard-earned points on supportive medications for your host. Maybe they'll make your host feel better...maybe they won't. Earn bonus points if your host is in relatively good health: the host will be able to help you fight back against the nefarious cancer cells.

So you've gotten all the cells, you think? Made it through the chemo regimen? Well, game's not over yet. Hopefully you have enough points left for the bonus round: radiation. In this rapid-fire round, you only have seconds to memorize the CT/PET scan map and then target your radiation at any remaining cancer cells. OD on the radiation and your host dies. Miss out on some cancer cells in your haste and lose the game.

For a real challenge, Total Assault warriors can test their skills on hosts with a variety of types and stages of cancer. And as an added handicap, warriors will notice their reaction times slowing or increasing along with the relative health of their hosts.

I swear...it will be a total sleeper hit.