A Movable Feast

Since we arrived back in New York from Paris about a month ago, I have taken advantage of my unscheduled interlude by eating lunch with one or more friends almost every day and attending some sort of party or dinner with Susan and one or more couples almost every night. The only ill effect to report from all of this activity is that I had to take all of my trousers to the tailor to have them let out an inch. 

Meanwhile, I have continued to go either to physical therapy or to the gym almost every morning, and I have steadily regained energy, strength, and flexibility. Although the surgeries and their complications have left their marks, I am in good spirits, eating and drinking con brio, and feeling remarkably well as I look forward to making plans to spend time in the New Year with other family and friends. 

On Monday morning, Susan and I will head south by automobile. We will divide the driving in our usual fashion: She will drive; I will read. She can't read in a moving vehicle, and I can't stand to waste time. If the snowplows do their job, we should arrive on the 23rd in Ponte Vedra, Florida, where our son will join us in a Christmas-time visit to my parents. The next morning, we three will drive west from Ponte Vedra across the state to St. Petersburg, to spend Christmas Eve and Christmas Day with Susan's father and one of her brothers, Tom, his wife, Judith, and their son, Nick. 

On the 26th, Susan and I will travel partially back across the state to Ocala, to visit friends and horses, including Statesmanship, the most successful horse that we have, to date, ever raced (in partnership with Mike Rankowitz and the late Peter Karches). Thanks to the kindness of our friends, Jill and John Stephens, Statesmanship is now a happy Florida retiree.

We will wend our way up the Atlantic coastline, visiting people who currently cannot easily travel:  a friend in Charleston; my aunt, Lucy, and an unrelated couple in Virginia Beach. We intend to arrive back in New York City on New Year's Eve.

Before I retired at the end of last year, Susan and I had intended to take more advantage of New York than I had ever had time to do while working. We had envisioned spending leisurely lunches at fine restaurants before heading off to museums. 

My extended interlude should enable us to realize a bit of that retirement dream. During the first week of January-- always a quiet week in New York, with everything available on short notice-- we are going to pretend that we are foreign tourists in New York. Today, I made luncheon reservations at Bouley, Aquavit, Le Bernardin, Jean-Georges, and Eleven Madison Park. Tomorrow, we will pick concerts and plays. We won't decide now on museums: I can't think of many more pleasant topics to save for luncheon conversations than discussions of which exhibits to visit that afternoon.

I wish for you a happy and healthy New Year!

Hallelujah!

From August 22 through September 12, 1741, George Frideric Handel composed in London a rough score of Messiah, consisting of some 250,000 notes written with quill pens. (Presumably, he wasn't spending much of his time during those 24 days watching television or on the internet.) One of the earliest performances of parts of Messiah in the New World took place in October of 1770 at Trinity Church, at the same location at the foot of Wall Street currently occupied by Trinity in its second reconstruction consecrated in 1846.

Handel conceived of Messiah as an oratorio to be performed during Lent, just prior to Easter. In recent years, performances of this retelling of the life of Christ have become part of the Christmas tradition. Often such Christmas-season performances consist of "Part One, The Prophecy and Birth of Christ Our Redemption," including only the Hallelujah chorus from "Part Two, Redemption's Cost: The Passion of the Scorned, Suffering Lamb; His Resurrection and Ascension," and omitting entirely "Part Three, Redemption Fulfilled; Thanksgiving for the Defeat of Death." 

Christmas-time performances of the entire Messiah have become critically acclaimed and popularly anticipated annual events at Trinity Church. This year, two performances were scheduled: one for yesterday afternoon, which Susan and I attended; another for tonight. Prior to yesterday's performance, an uncomplaining line of people stood in a cold rain, occasionally moving forward a step, waiting to squeeze through the one open door to pick up tickets purchased on the internet-- or even in mostly vain hope of being able to buy tickets-- at a table staffed by distracted volunteers. When the performance began, I doubt that there was an empty space in a pew or an unoccupied folding chair in the aisle (where we sat, near the front) of this beautifully proportioned, perfectly maintained, Neo-Gothic church. 

This year, Trinity Church's Messiah is sung, as it has been for many years, by the Trinity Choir, accompanied on period instruments by the debuting (in current configuration) Trinity Baroque Orchestra. The guest conductor is Jane Glover, Music Director since 2002 of Chicago's Music of the Baroque and now also Artistic Director of Opera at London's Royal Academy of Music. Yesterday's performance was broadcast live on WQXR 105.9, and tonight's will be recorded and available on video at trinitywallstreet.org. 

To my tone-deaf, untutored ears and dim vision, yesterday's performance of my favorite"Christmas music" was completely satisfying: expertly and charmingly conducted and performed, in an appropriate and sublime space. Not only did a number of the sopranos, altos, tenors, and basses take turns singing the solos, but also the facial expressions of the entire choir were consistently appropriate to the passage at hand.  The orchestra not only employed period instruments, but also it was sized as sparely as the ones for which Handel had composed Messiah. A medium-sized church, Trinity's undistorted resonance flattered the enunciated words in the lovely voices of the singers and the precise and spirited playing of the musicians. 

In spite of the solemn nature of Parts Two and Three, it was manifest that not only the members of the audience, but also the singers, musicians, and conductor were excited, proud, and happy to be part of this august occasion. Amidst the audience's still thunderous applause, we filed out, pulling on our coats against the cold and rain, crossed lower Broadway in winter's early darkness, walked down the stairs into the subway, and thence home. My Christmas season, my favorite time of year, had begun.

Hallelujah! 

 

At the Cafe d'Alsace

Last night, at the Cafe d'Alsace, our host acquainted us with these lines from "The Kasidah of Haji Adul El-Yezdi," by Richard F. Burton:

                                         

                                        Cease, Man, to mourn, to weep, to wail; 

                                        enjoy thy shining hour of sun;

                                        We dance along death's icy brink,

                                        but is the dance less full of fun?

Avastin

Recently, I heard that Avastin is the leading cancer drug in the United States, as measured by dollar sales. On November 24, Britain's National Health Service announced that, as a result of a cost/benefit analysis, it will not make Avastin available to patients like me with metastatic colorectal cancer. Avastin is an anti-angiogenesis drug: Avastin shrinks the blood supply that tumors create to feed their rapid growth. When I go back on chemotherapy, I will probably receive Avastin in conjunction with the same cocktail of poisons, FOLFIRI, that I received when I was on chemotherapy previously. Although Avastin does not have subjective side effects, its rare physical side effects include cardiovascular events and stomach perforation.

Britain's National Health Service rejected the use of Avastin even though, in conjunction with chemotherapy, Avastin shrinks tumors in 78 percent of patients with my condition. That benefit sounds pretty impressive until one considers, according to what I read on the internet, that it translates into median survival of 21.3 months, as opposed to 19.9 months without Avastin. A modest improvement in median survival does not of course mean that some patients do not benefit significantly from Avastin.

Given our society's many needs and the budget deficit, should Medicare pay, as it will, for my Avastin? Although I have not attempted to follow all of the twists and turns of the healthcare debate, I do not think that the cost-containment proposals currently under discussion by our politicians in Washington include consideration of eliminating Medicare payments for things like Avastin (especially, one could argue, for folks who could afford to pay for it themselves). Until our nation has completed the squandering of the U.S. dollar's status as the world's reserve currency, I wonder if our politicians will have the temerity to suggest to us, the American people, that we will have to accept that there are painful limits to what our country can afford, whether it be for medical care, other entitlements, bailouts of businesses, pork-laden stimulus programs, or some notions of national defense?

But Not Today!

A friend says that my attitude reminds him of a man's who says to himself, "They've got me. But not today!"

The Joke

I fear and respect my opponent, the cancer that constantly gains ground against me, within me. And yet, is not the joke on it? When it kills me, it too will die. So it can't beat me in our death struggle: At the end of the day, we will go out together.

Interlude

This afternoon, I had an appointment, scheduled about a month ago, with my medical oncologist, Dr. Leonard Saltz.  The purpose of the appointment was for him to determine whether, given my objective of maximizing the quality of my remaining days, I could continue my respite from chemotherapy through the holidays. Because I am feeling so well, I was pleased but not surprised when he agreed that, unless I have a turn for the worse, I can extend my holiday into January. 

As I write this entry, I realize that I may never again be as free of pain, or as energetic, or as able to taste food and otherwise enjoy life as I am now. During this interlude between the miasma of the surgeries and their complications and the renewed poisoning of chemotherapy, I hope that I can keep the perspective of finiteness in the forefront of my mind from moment to moment in the precious minutes, hours, and days ahead.

During this interlude, my major time sink is spending a couple of hours a day in either physical therapy or at the gym. But I think that this expenditure of irreplaceable time is worthwhile. I am given to understand that patients with advanced cancer not only feel better, but also may live significantly longer if they follow a program of vigorous daily exercise. In my situation, I know of nothing else that does not require a tradeoff of quality of life for quantity of life. The exercise also seems to be helping me to rebound physically from the two surgeries and their complications. 

Moreover, I experience a considerable psychological boost from doing something active to fight back. While I know that the cancer is winning and will kill me in the end, struggling against it feels good. If, today versus yesterday, I can lift more weight, stretch over a wider range, and go faster, longer on the cardiovascular machines, am I dying? When I have added more weight to the bench press and am completing the last of the repetitions that I have assigned myself, as I did today: In that moment, I have won. I have won!

As you probably infer, during the more broadly defined interlude between diagnosis and death, the time-consuming writing of this blog is, for me, another way of struggling, of fighting back.

Mob Scenes

One night a couple of weeks ago, while we were in a taxi in Paris halted by a surging swirl of yelling, flag-draped, Algerian soccer fans on foot and leaning out of honking automobiles, my mind turned to other mobs in which I had found myself surrounded. Two such scenes had temporarily seemed similar to me to the one in which I found myself in Paris.

Spring is a season particularly conducive to rioting (many of us at Princeton rioted at the onset of spring during my sophomore year). On May 1, 1976, our family was on holiday at a resort in Puerto Rico. Before driving into San Juan for dinner, my wife and I watched the Kentucky Derby on television with especially keen interest. The favorite in the race, Honest Pleasure, was (and remains) the shortest-priced favorite in the history of the Derby. He was trained by the trainer of our horses at the time, Leroy Jolley, and we had watched Honest Pleasure develop from the beginning of his two-year-old season. But Honest Pleasure was upset that day by a horse named Bold Forbes, a supposed sprinter that "stole" the Derby  by taking the lead at the beginning of the race and holding it to the finish. As it happened, Kentucky-bred Bold Forbes was not only owned by a Puerto Rican, but also had begun his racing career in Puerto Rico. On the way into San Juan after the race, I soon had to halt my car because of the exuberant crowds in the streets, on foot and in cars. It took hours to make our way into San Juan. I had had no idea that horse racing was so popular in Puerto Rico or that the populace was so proud that a top horse was owned by a Puerto Rican! 

The next morning's headlines in the local newspaper were all about the previous night's huge May Day Communist demonstrations.

On April 29, 1992, I flew from New York to Los Angeles for board meetings of the two Santa Anita Companies, both listed on the New York Stock Exchange-- one company conducted racing at the racetrack owned, along with other real estate, by the other, a real estate investment trust. My flight arrived about 9 p.m. California time. I got in a taxi, gave the driver my destination, and dozed off. I was jolted awake with when the driver slammed on brakes. We were surrounded by men and women peering into the taxi, their arms loaded with merchandise. My adrenaline pumping, I noted that we were on a local road rather than on a freeway and that there were no other cars on the road; that some of the stores around me, including a liquor shop, were in flames; that my driver was African- American, which struck me as potentially a good thing, as the members of the mob looked African- American as well; and that the doors to the taxi were unlocked. I quickly decided that it would not be a good idea to show fear by trying to lock the doors. The crowd seemed more exuberant than angry. They didn't seem to want to harm the driver, and I couldn't see why they would want to put down their armloads of television sets, clothes, and whiskey bottles to bother with me. Slowly, the crowd in front of the taxi parted; and slowly, the taxi started forward, gradually gaining speed. I asked the driver what was going on, and he told me that the police officers who had beaten Rodney King had been acquitted. As I surveyed the burning buildings along La Brea street, I asked him where the police were. He replied that the police were afraid to come there, which did make me wonder about his judgment in choosing our route. After checking in at my destination, I went to my room and turned on the television set. City Hall, which was right next door to where I was staying, was under siege! During that night and the next two days, 53 people were killed, 2,383 were injured, and there were some 7,000 fires. 

That summer at Saratoga, I was dining out on my tales of the Los Angeles riot. At a party, the late Joe Hirsch, the dean of racing writers, asked me where I had been staying in Los Angeles that night. 

"Well, Joe, I was staying at the California Club." 

"Oh then, you couldn't have been safer, Charlie." 

"What do you mean, Joe? You know that the California Club is a ground- floor building, and there is just one employee on duty at night." 

"Safest place in the world, Charlie. You know perfectly well that the California Club would never permit anyone to enter who wasn't wearing a coat and tie!"

Happy Thanksgiving

I have much for which to be thankful this year. Everyone else in my family is in pretty good health. Our two children are here with us for the holiday (today, we went to a Broadway play, "A Steady Rain"-- two fine actors, Hugh Jackman and Daniel Craig, in a slight play). Three close friends will be joining us at the Thanksgiving table. As usual, all are eager to do justice to Susan's annual feast; as I write this entry, my appetite is being tantalized by smells from the kitchen. I am grateful for the respite that I have been allowed from chemotherapy and expect to be able to be able to hold my own at the dinner table. Indeed, I feel better than I have since early this year, a month or so before my cancer diagnosis at the beginning of March.

As you would expect, the poignancy of knowing that it is not unlikely that this Thanksgiving will either be my last or, if not my last, the last that I will be in any condition to enjoy, heightens my appreciation of the occasion. During each of the few trips that I have taken since March-- to Saratoga Springs, Miami, Jacksonville, and Paris-- I have been constantly cognizant that I might be seeing a familiar place for the last time. Whenever I have seen a friend who lives somewhere other than New York City, I have wondered if it were for the last time: a thought that I assume has been reciprocated. 

I am grateful to have so much not to take for granted.

White Truffles and the Hand of Gaul

In France, November is in the season for wild game, oysters, mushrooms, and white truffles. This year, it was also the time when Algeria played Egypt and France played Ireland for slots in next year's World Cup football (soccer) finals.

Although Parisians seem to refer to "La Crise" in the past tense, it is still much easier to get a table in most good restaurants than it was a couple of years ago. As you would expect, at most of the restaurants where we dined, the chefs incorporated seasonal delicacies in their menus. Most memorable to me are the white truffles, the mushrooms (especially the cepes), the oysters, and the grilled, stuffed pigs' feet. 

Yesterday and the second day of our stay, we ate lunch at L'Huiterie Regis, which is on the Left Bank near the covered food market just off the Boulevard St. Germain. At the same location, this wholesaler of oysters to other Parisian restaurants also has a very simple restaurant that can barely hold its seven tiny tables, each with two seats. The menu consists primarily of the types of oysters that have arrived that day; the wine list has a Muscadet and several Sancerres. On one of the days when we ate lunch there last year, the menu also offered sea urchins; I have not had a chance to eat sea urchins often, but they were by far the best that I have had. This year, there were bright orange, flavorful, wild shrimp on the menu on both occasions; and yesterday, there were also Belon oysters-- the big ones, Belons No. 00, not the smaller Fines de Claire and the Speciales de Claire pictured in my previous blog entry. For some 30 years, I have carried the memory of Belons No. 00 that I ate at Prunier, the famous seafood restaurant on Avenue Victor Hugo in Paris. The Belons that I ate at L'Huiterie Regis yesterday matched those of that memory.

I didn't realize until this week that sports fans in the United States are not serious. Algerian soccer fans are serious. Algeria played Egypt on Wednesday in Khartoum, Sudan, after having lost to Egypt in Cairo last Saturday. Before Saturday's game, Egyptian fans had stoned a bus carrying the Algerian players, inflicting bloody head wounds on three of them. In the ensuing riots, 32 people were injured, and Egyptian-owned businesses in Algeria were attacked. For the re-match in Khartoum on Wednesday, the Egyptian and Algerian fans were housed miles apart, with 15,000 riot police patrolling the streets. I had no idea that so many Algerians live in and around Paris until the streets of Paris were mobbed with cars and pedestrians waving Algerian flags following Algeria's victory on Wednesday. We were caught in a taxi during the melee. Although our taxi was hit on the windshield by a wet projectile, we were merely inconvenienced and never felt in danger. (Why should there be any danger? Algeria had won!) 

Later Wednesday night, France was playing Ireland in Paris. Ireland, which had not won in France since 1938, was leading 1-0 until late in the game, when  a French player "handled" the ball in passing it to a teammate who then scored. The referee missed the impermissible "handling" of the ball, and the tie put France in next year's World Cup finals. As we tried to fall asleep in our hotel room, the raucous Algerian fans were joined by the more decorous French fans in the streets of Paris. European newspapers yesterday were filled with coverage of the outrageous result. They referred frequently to a similar situation in the 1986 World Cup, just four years after the Falkland Islands war: Argentina's Diego Maradona won the match by punching the ball into England's goal. Maradona referred to his bit of cheating as "The Hand of God." London's Daily Telegraph promptly dubbed this French incarnation the "Hand of Gaul."

Eating Well in Paris

"Living well is the best revenge."

Last Tango?

One week ago, I underwent a CT scan, and on Thursday of last week, I had an appointment with Dr. Saltz, my medical oncologist. Dr. Saltz indicated that "everything is growing, but not rapidly." In tacit keeping with my previously stated objective-- now that the possibility of cure is off the table-- of maximizing the quality of my remaining days, Dr. Saltz gave me the option of postponing for a while longer the resumption of chemotherapy. Two thoughts flashed through my mind: I could fly down to Jacksonville, Florida, to visit my parents in nearby Ponte Vedra; and I could go with Susan to Paris, getting back to New York in time for our daughter's visit to us from November 20th through the Thanksgiving holiday. 

For months, I have wondered if I would ever see my parents again, and I have been thinking it unlikely that I could go abroad again. Susan was with me last Thursday in Dr. Saltz's office, and I asked her if she would prefer a destination other than Paris? She was not hesitant in her response.

I just got back from visiting my parents in Ponte Vedra. Tomorrow, I will see Dr. Jarnagin, the surgeon who operated on my liver. Wednesday, Susan and I will depart for Paris. Although I have some physical problems caused by the cancer and by the surgeries, I feel better than I have since February, and I may never again feel as good as I do now. Importantly, my taste buds are once again in good shape-- a prerequisite for a sojourn in Paris!

The Breeders' Cup Classic

Thoroughbred horse racing's most important annual two days of racing-- in the United States and arguably the world-- concluded today. The richest of those events, the $5 million Breeders' Cup Classic, was won for the first time by a filly or mare, Zenyatta, which closed out her undefeated career with her 14th victory. The second-place finisher to the favored Zenyatta was longshot Gio Ponti, trained by Christophe Clement.

Since 1995, Christophe has trained most of our horses. We feel close to him and his wife, Valerie, and their two children, Miguel and Charlotte, and we are proud of his well-deserved, growing success. When we first sent our horses to him, he was still in his twenties and early in his career as an independent trainer. Friends of ours had had horses in France with his late father, the successful trainer, Miguel Clement; and Christophe's older brother, Nicolas, now a successful trainer in France in his own right, had visited us as a teenager at Saratoga. Consequently, I had followed with interest Christophe's debut as an American trainer.

When I decided to switch trainers, I asked Christophe to take our horses, on the theory that if he was as good a horseman as I thought he was, he would soon be too popular to have room for our horses unless we were an established client. Once again, as happened to me so often over the years, I got lucky by giving a younger person a chance before it was obvious that he was ready. It has been a long while since Christophe has needed our horses in his stable. In an article in The New York Times two days ago, Joe Drape noted that of this year's top 10 American money-winning trainers, Christophe is the only one who has never had a horse in his care that tested positive for a medication violation.

Through talent, hard work, and superior organization, Christophe has been able to win important races while conceding an edge to those less scrupulous. Although he has quietly gone about his business rather than be strident or self-righteous about the improper use of drugs, he has shown courage on the topic when asked to do so. In 1999, I wrote an article, entitled "Full Disclosure," for the October 23 issue of a leading trade publication, The Blood-Horse, about medication practices in the industry in general and in the state of Kentucky in particular. To corroborate what I had to say, I asked Christophe if I could cite something in the article that he had told me. Unlike me, a minor owner/breeder with nothing to fear from those who would resent such exposure of industry practices, a young trainer like Christophe had a great deal to lose by gratuitously making enemies. Nevertheless, he readily assented to my use of his name.

Before publishing the article, the then-editor of The Blood-Horse, Ray Paulick, who certainly had to be concerned about industry backlash, asked me what I hoped to accomplish by writing it. I replied that I hoped to bring hidden practices into the open and start a dialog. (Of course, I was also mad. As my wife, Susan, says, "It wouldn't be fun to win by cheating, but it's no fun being beaten by cheaters!") To my surprise, the article kicked off a furor, including articles by others and, in Kentucky, a medication law being passed and a leading state racing official losing his job. If Christophe's association with the article caused him any problems, he never complained.

Not the New York Marathon

The New York Marathon had its fortieth running today, in ideal weather for runners. For the first time since 1982, it was won by an American.

We won a somewhat less important race today-- the ninth race at Aqueduct Racetrack, at a mile and a sixteenth on the grass for horses bred in New York that had never won a race. Our horse, a three-year-old gelding named Mustang Island, was making his first start on the grass and the second start of his career. Because of a minor injury, he had not run in nearly a year and was too keen in the early stages of the race, fighting with the rider, Joe Bravo, to be allowed to extend himself. Once Bravo swung Mustang Island out in the stretch for running room and let him go, Mustang Island swept by the pace-setter and won going away. 

Not only was the race not the New York Marathon, it also did not consist of a particularly good field of horses. But it is always fun to win a race and good to collect a purse. (Seven-to-one odds added a little spice as well!)  And whenever one wins with a horse that has been asked to do something for the first time (in this case, run on the grass), and it accomplishes what one has asked of it rather easily, one cannot help dreaming a little.

Bill Baggs Cape Florida State Park

As Susan reported yesterday, we enjoyed our holiday on Key Biscayne. If you haven't been to Key Biscayne, it is an island suburb of Miami six miles south of Miami Beach, with a population of about 10,000, reached by a four-mile causeway stretching over the Atlantic Ocean east of Miami. Some three decades ago, we stayed on Key Biscayne a number of times with our children, at a lovely, low-keyed resort, the Key Biscayne Hotel and Villas.

During the waning years of the heyday of Miami's Hialeah Park, when many of the powerful stables in the East and most of the horses prepping for the Kentucky Derby still wintered at Hialeah, we sent our more modest string of horses to Hialeah as well, under the care of trainer LeRoy Jolley. During that era, LeRoy trained a number of champions, won two Kentucky Derbies (including one with the filly, Genuine Risk, for Diana and Bert Firestone), and became the youngest trainer to be elected to racing's Hall of Fame.

Hialeah, with towering Royal Palms, wonderful tropical gardens, and spectacular flights of pink flamingos (imported from Cuba), was once Florida's leading tourist attraction. Eventually, it faded and closed. While it was still renowned as arguably the most beautiful racetrack in the world, we frequently visited our horses and went racing there in the winter. On Sunday mornings, LeRoy and I, and usually Susan, would fly in the dark on a rented helicopter roughly 100 miles north, to what was then called the St. Lucie Training Center, to watch the "babies" (the yearlings or two-year-olds, depending on whether it was before or after New Year's Day) work. In LeRoy's program, the riders worked the babies in fast times. Nowadays, Thoroughbreds seem more fragile, and trainers don't push young horses. LeRoy was aggressive, even by the standards of three decades ago. He would pair the babies off against each other. After a few Sundays, you had a pretty good idea of what you had.

We still send horses of various ages to that same training center in the winter. It is now called Payson Park. Our horses are trained there and elsewhere primarily by the very successful Christophe Clement. As Payson Park, the training center is much better maintained, but lacks the occasional thrills, in the form of rattlesnakes and alligators, that it offered as the St. Lucie Training Center.

On the way back from the St. Lucie Training Center in the daylight, sometimes we detoured to fly along the Atlantic coast from Palm Beach south, looking at the mansions along the shore and at the swimmers in the ocean, who were blissfully unaware of any sharks circling nearby. The pilot was the son of a horse veterinarian; he had flown helicopters in Vietnam and been a killer-whale trainer at the Miami Seaquarium. (He had quit his job at the Seaquarium after a male orca, that later turned out to have a fatal brain tumor, grabbed his head and held him underwater until, in desperation, he punched it in the eye.) One day I talked him into buzzing the pool twice at the Key Biscayne Hotel and Villas when I saw Susan and our children, Elizabeth and David, sunning themselves there. They didn't even look up! Key Biscayne was still undeveloped enough to permit the pilot to hover over a vacant lot across the street from the hotel and let me hop out. (Someone got the number of the helicopter, and he did get in trouble for that little adventure.)   We stopped going to Key Biscayne when the hotel's ocean-front property was acquired for replacement by a much grander Ritz-Carlton resort. 

During the five days that we just spent on Key Biscayne, staying at the Ritz-Carlton, we found the residential areas in the center of the island to be unrecognizable. Now there are huge condominiums clustered along  the beach, on either side of the property occupied by the Ritz-Carlton; and multi-story mansions stuffed into lots on the island's bays-- lots originally occupied by modest bungelows, some dating back to the island's development in the early years following the construction of the causeway in 1947. 

We were delighted to find that one of Key Biscayne's two large public parks, Crandon Park, which occupies the entire northern end of the island, is still the attractive playground that we remembered. Crandon Park has ample free parking spaces and features not only extensive beaches, but also playing fields, picnicking areas, an eighteen-hole golf course, and tennis facilities that host a professional tournament each year. 

The best surprise for us was the Bill Baggs Cape Florida State Park at the southern end of the island. Not only is its early 19th-century lighthouse now meticulously maintained, thanks to a private foundation, but also the park service was able to replant the park in indigenous vegetation after Hurricane Andrew denuded the island in 1992 of the hardy, non-native, Australian pines that for years had cut off sunlight and pulled the water out of the thin soil. Andrew, one of three Category 5 hurricanes to come ashore in the United States in the 20th century, struck the mainland south of Miami. Key Biscayne, always the first area of Miami to be evacuated when a hurricane approaches, was hit hard.  "It's an ill wind that blows no good!"

Sun and Surf

We just got back from five days in Key Biscayne, where we relaxed on the beach and made a few excursions to local sites and good restaurants in Miami. The weather was unseasonably warm, and we loved it.

Several people have indicated that they were worried about the lack of blogging, so I thought I would put this up promptly. Charlie is not willing, as I am, to write hastily and without creativity. He is feeling reasonably well and strong, and I'm sure he'll post again soon when he has a nice block of time to devote to what he writes.

"...A Little Help From my Friends."

Late this morning, I lost my cell phone in a taxi. The cell phone contained my only copy (I know, I know, I should have backed it up) of my electronic calendar. 

If you and I are scheduled to get together, please email a reminder to me. I neglected also to back up my brain!

A Blessing

Last night, Susan and I were honored to be amongst the guests at a surprise 80th birthday party for a dear friend and mentor. As he and his wife and another couple entered the magnificent dining room-- the "pool room"-- of the Four Seasons restaurant, which had been reserved for the occasion, his assembled family and friends on the alcove above delighted in his genuine surprise and pleasure. In due course, making his way from friend to friend, he came to Susan and me. I got the sense that he might have been particularly surprised to see me there, given my recent travails. We hugged, and he said, "If only I were God." My eyes moistened.

"That's All."

According to Jane Brody in her Guide to the Great Beyond (Random House, 2009), Brooke Astor at age 90 wrote, "Death is nothing and life everything. That's all."

My appetite is improving enough so that Susan and I have gone twice with friends to good restaurants (once, as guests, to Daniel, which just was awarded a third star by Michelin) in the last few evenings and thoroughly enjoyed ourselves. In terms of stamina, strength, and flexibility, although I am still in quite diminished condition, I am making measurable progress during the two-hour workouts in which I engage most days. Friends who haven't seen me for a while are often kind enough to express how well they think I look--  perhaps expectations have something to do with that reaction. Towards the end of this month, Susan and I are planning a brief holiday on the other end of an airplane. In short, I am starting to be able to enjoy myself again and want to be as active as possible before likely resuming chemotherapy in early November. Even during this coming chemotherapy, based on my experience with most of the drugs I am slated to be getting,  I think it is reasonable to hope that I will have some relatively good days during each two-week cycle. 

"Death is nothing and life everything. That's all."

Sand in My Shoes

This weekend, although I am not taking the Orange Blossom Special to Florida, I am planning on getting "some sand in my shoes" and "losing those New York blues." ("Whoo, whoo!") Susan and I are taking up friends on a long-standing invitation to stay with them in their Long Island home on the oceanfront in Quoque. We will leave on Saturday morning and return to New York City on Monday morning. Traffic should be relatively light at those times: The ninety-mile drives should only take a couple of hours. Susan will drive; I will read the paper-- if I don't snooze.

The weather forecast is favorable, and I am looking forward to opening the bedroom windows at night in our hosts' lovely second-floor guest room and sleeping and waking and sleeping enveloped in the ocean's rhythms. When I was a kid, my architect father built first one, then, a few years later, another, summer home for us on the oceanfront at Ponte Vedra, Florida. Neither had air conditioning; both were designed to maximize the circulation of the sea breezes. Although it got hot and humid some nights, a little discomfort beat being cut off from the sounds and smells and breezes of the ocean.

This will be the second time since the end of February that I have left New York City. The first time was at the end of July, when Susan and I went to Saratoga Springs, New York, for six days, just prior to my second surgery. The effects of the surgeries and their complications are diminishing. My taste buds are working again, and I have gained two or three pounds in the last few days. I am working assiduously at a rehabilitation facility and at a gym: I spend about two- and-a-half hours a day on exercise and stretching. I am sleeping much better, sometimes for as long as three hours at a stretch, versus maximum sleeping stretches of an hour a couple of weeks ago. Nearly every day, I am again seeing friends, if only for short visits in our apartment.

The couple who is hosting us this weekend could not be warmer, more comfortable, or more fun to be around. Importantly, the male half of the couple is also a big New York Football Giants fan, so we will watch the Giants'-- the mighty, undefeated Giants-- game on television on Sunday in the best of company! I wouldn't be surprised if we watched the Florida- LSU battle of undefeated Southeastern Conference (SEC) rivals on Saturday night as well. My father is a Florida alumnus, so I grew up as a Fightin' Gators fan, back when the Gators were perpetual losers who had never won an SEC title, much less a national championship. Chomp, chomp!

Second Guesses

Before I was diagnosed with cancer, it had long seemed to me, without looking into the matter deeply, that an all- too- common outcome for people diagnosed with late-stage cancer is that they undergo terribly debilitating treatments, then die anyway. It seemed to me that if I ever got such a diagnosis, I should go to great lengths to avoid this trap.

My doubts about the wisdom of surgery, chemotherapy, and radiation in many, if not most, such cases was reinforced by the experience of my Aunt Daisy, my father's younger sister. When Daisy was some twenty years older than I am, she was diagnosed with lung cancer. After considering the effects of the proposed therapeutic treatments, she decided to accept only palliative care. It seemed to me that she lived out the remainder of her life with great equanimity. In fact, when I would speak with her, she was always in good spirits and up to date on the latest developments in the outside world. She was even reading about nanotechnology, which she discussed with me, knowing that it was a professional interest of mine. As far as I know, she never second guessed her decision to forgo treatment.

So here I am, without hope of cure, physically shattered by two surgeries and their complications, getting ready to embark on a second, more protracted, round of chemotherapy. As someone who has always second guessed his decisions, I have, as you might expect, been thinking about the wisdom of my decisions since my diagnosis. 

The first decision, in early March, was to start chemotherapy rather than go into hospice care. That decision seemed easy enough. I was losing energy, weight, and muscle mass rapidly; wine had tasted strangely for a few weeks and food was starting to do so as well. If the chemotherapy became intolerable, I could always quit it and go into hospice care. In the event, although the chemotherapy produced a galaxy of unpleasant and sometimes frightening side effects, I regained energy and weight and got to spend a lot of time with family and friends over a three-month period (two months on chemotherapy, one off).

The second decision was to undergo colon and liver surgeries. After having been told from the time of inception that my case was incurable, the unexpected chance at a cure was too precious a gift to pass up. It seemed to me that I had to undergo the surgeries, regardless of their certain trauma and potential complications. As my daughter, Elizabeth, pointed out to me recently, if I hadn't undergone the surgeries, I certainly would have second guessed myself for the rest of my life.

How about the pending decision to resume chemotherapy? I think that with the particular cocktail the oncologist has in mind, there is only a small chance of something irreversible happening before I could stop the regimen. So I'll probably go along with his recommendation. But I'm mindful of  the pattern of my treatment decisions: It seems to describe the very trap that I always wanted to avoid.

"Unfortunately, There is Bad News...."

"Unfortunately, there is bad news on your scan," Dr. Leonard Saltz, my medical oncologist, told Susan and me during our visit to his office on Tuesday of last week. The scan to which he referred was a CT scan that had been taken the previous week with the primary purpose of establishing a baseline observation of my newly hypertrophied liver, the product of my most recent, August 3rd, liver surgery. The bad news was two apparent tumors in the liver and perhaps a tumor in a lung and in my lower abdomen. Although it seemed obvious that Dr. Saltz was fairly sure about the tumors in the liver, he said that the next diagnostic step would be a PET scan, which I underwent two days later. 

Today, we met again with Dr. Saltz, who reported to us that the PET scan "lit up" on three tumors in the liver, in addition to a region in the liver along the surgical line that might be more tumors or just inflammation. Although the spot in the lung also lit up, he is not sure whether or not it is a tumor. In any case, he does not seem to think the possible lung tumor is a very weighty issue, as compared with the tumors in the liver.

Dr. Saltz recommends that I move forward with a lighter program of chemotherapy, tentatively commencing in early November for a six-month period, than he had planned for me when the possibility of cure, however slight, justified heroic measures, such as the back-to-back surgeries I underwent this summer. I conveyed to him that, if cure is not a realistic possibility, my objective in any treatment regimen would be quality of remaining days, not quantity of remaining days.  

Dr. Saltz refused to be drawn into any speculation as to how long I may live. From the little I've read and heard on the subject, I have in my mind as a working hypothesis that a year or two might be a realistic life expectancy for someone in my situation.  

Actually, I don't find myself thinking much about how long I may live. I do think a lot about what the rest of my life will be like and the decisions that I am likely to face along the way. I think a lot about the effect on my family of my remaining life, my manner of dying, and my being deceased.

Susan and I and our children have had a week to adjust to the roller coaster of no hope to slight hope to no hope of a cure. Now, I find myself turning my attention to trying to recover sufficiently, through diet and exercise, from the surgeries and their complications to enable Susan and me to resume some semblance of a normal social life and perhaps even take a trip somewhere. When I was a kid, my family spent our summers at Ponte Vedra Beach, Florida. I love the ocean, and I am fantasizing about a sojourn at some posh beach resort. We'll see what happens, what's possible. It seems that there is always something on which to pin one's hopes!

"Why Me?"

From the time I was diagnosed with cancer, not once in that context have I thought, "Why me?" Shortly after being diagnosed, I can remember thinking, "Well, why not me?" Particularly in recent years, I had tried to be careful about diet, exercise, and check-ups. So what? All that healthy living can do is improve the odds. Anyone can get cancer. 

But I must admit that when I think about my medical oncologist's estimate that someone with my cancer diagnosis who underwent the surgeries and chemotherapy slated for me should have about a 20 percent chance of being cured, I cannot help thinking, "Why me?" Why should I be the one out of five who makes it?

Missy Jones

My cousin, Melissa Ellen "Missy" Jones, died at age 61 on September 5 in Virginia Beach. Although she had not been well, her passing was still a shock. Tragically, both of her siblings, Patsy and Cynthia, had died of unrelated causes as young adults, early in their married lives. Missy was the middle child and was unmarried. She left behind her nephew, Mundy Hackett, Patsy's son, a wildlife biologist and a good man; and her mother, Lucy, my mother's youngest sister and as fine a person as I have ever known. While I can only wonder at Lucy's emotional balance, wisdom that enables her to find the good in life, strength of character, consideration of others, complete lack of self centeredness, delightful personality, and general good nature, she exemplifies these virtues and more in the eyes of all who know her.

I have always felt particularly close to the Jones branch of my family, and it was hard for me to accept that I was too ill to travel to Virginia Beach for Missy's Episcopal Church funeral service. No matter how difficult the circumstance, Missy had always made me feel especially welcome. My brother, Bill, was able to attend. Lucy sent me the program from the service. The closing prayer reads:

                                  O Lord, support us all the day long until

                                    the shadows lengthen and the evening

                                    comes, and the busy world is hushed,

                                  and the fever of life is over and our work

                                     is done. Then in Thy mercy grant us a 

                                     safe lodging and a Holy Rest and peace

                                  at the last through Jesus Christ our Lord,

                                                                 Amen.

                                                         In Memoriam

                                                    3/15/48  --  9/5/09

Out of a Miasma

Except for one posting on August 12, I have not been posting on this blog since August 1.  From the time of my second surgery on August 3, until a few days ago, I have been on narcotic painkillers and haven't trusted my brain. Also, I haven't been able to sit without pain for long enough to type out a blog entry. Most important, as I have not been able to do much and have just started once again to see friends, there has been very little interesting in my life to report. 

I feel as if I am crawling out of a miasma of pain, drugs, and hospital admissions and readmissions to deal with, among other complications of the second surgery, an infection in the body cavity, a separate infection 0f the incision, and 35 pounds of edema in the lower body. Supposedly, there is about a four percent chance at MSK of getting an infection from one of the surgeries I underwent; I have heard no theories on why I got three infections from my two surgeries. 

So far, since the second surgery, I have almost no appetite; most food does not taste to me as it always has, and the new tastes are unappealing. I am now allowed to drink wine, and I enjoyed a glass of rose; but I couldn't drink the other two wines, a Champagne and a California cabernet, that I tasted. (I have been told and fervently hope that, in time, food and drink will regain their tastes and appeal.) I can sleep only for about an hour without awakening in discomfort. 

I recall that Vince Lombardi was quoted to the effect that fatigue makes cowards of us all. He certainly would have been right in my case. After a few weeks, it was hard to think of the big picture that led me down this path, that there is a chance of cure from undergoing these surgeries and the chemotherapy to follow. I just wanted the pain and the unremitting feeling of sickness to stop.

Ideally, the medical oncologist would like for me to be resuming chemotherapy about now. However, he said when he saw me six days ago that I had to gain weight by eating as much high-calorie food  as possible, as well as to gain strength through exercise, before they could start the chemotherapy-- otherwise, a single dose might kill me. I weighed 161 pounds that day. This morning, I weighed 155, as a result of digestive tract problems that caused MSK to send me to its emergency room for most of the day. So far, the tests do not reveal any medical problem to be treated.

The best news on the medical front is that I have been freed to exercise again. I have started physical therapy, and I have reactivated my gym membership. I cannot do much, and I get very tired, but it feels great to be moving again and to observe some faint signs of rehabilitation. If you recall the model, Twiggy, from the 1960s, she was robust by comparison with me. So I have lots of room for recovery. 

Even better news is that I am feeling up to seeing friends again, if only for short visits at this point. I hope to see you soon. With this update having been posted, we can talk about things other than my health when we get together. I think of the current period as a brief window, as there is no way of knowing how sick the chemotherapy will make me.

Doctor Appointments

Yesterday, Charlie had a follow-up visit with the surgeon, Dr. Jarnagin (I was playing golf), and later in the day, I joined him for a meeting with the oncologist, Dr. Saltz. Both doctors believe Charlie needs more time to gain his strength before starting chemotherapy again. He will be reevaluated in two weeks with a probable start date for the chemo at the beginning of October.

In the meantime, his instructions from Dr. Saltz are to eat a calorie-laden diet of high-fat foods (nutrition be damned) and to do his best to get an hour of aerobic exercise a day. Given his poor appetite, it is not clear which assignment will be more difficult. I have visions of the two of us appearing for the appointment in two weeks with me the one who has gained ten pounds!

Charlie is facing the upcoming chemotherapy with apprehension. Dr. Saltz said the regimen will be changed to the one known as Folfox from the Folfiri he had before the surgeries. A different set of frequent side effects is worrisome, especially that Folfox often causes numbness of the fingers, and Charlie already suffers from Reynaud's syndrome, which has similar symptoms.

Out To Dinner

Not everyone has been sure that "no news is good news," so I thought I would make a brief post to say that there has been some progress--a little more strength, a little less pain, and a lot less bloat. Charlie's weight is back to what it was before the surgery, although he has clearly lost weight and is still carrying excess fluid, primarily in his feet. Tonight we will see if the Italian restaurant Raffaele, on First Avenue near 57th Street, can fatten him up a bit. It will be the first time we have been out since the beginning of August.

Home Again

Charlie came home today weighing twenty-two pounds less than when he entered the hospital a week ago. He is out right now enjoying a walk in the lovely weather here in New York, and we walked home from the hospital in the early afternoon when he was discharged. What I think he needs most right now is good food and lots of sleep. I will make every effort to see that he gets both.

One Month Anniversary

Tomorrow will be the one-month anniversary of the second liver resection surgery. Although it has been a very difficult month, and we did not expect that Charlie would mark that anniversary as an inpatient at MSK, I feel like we are now in the home stretch.

The most important things are that all known cancer has been removed from his body and the liver is regenerating. The infections have been cleared up, and the excess water is coming off. His weight is about nineteen pounds lower than when he entered the hospital last Friday.

It appears that Charlie does not process the oral version of Lasix--there was virtually no progress when he was switched over from the intravenous version, and he has now been switched back. That is the main reason he is still in the hospital.

Having provided the rosy picture above, it is important for me to report also that he faces probably four months of chemotherapy in an attempt to kill lingering, undetectable cancer cells, and that will be difficult. Also, he is still not completely comfortable, and that has affected his sleep for weeks. He is very exhausted.

Minus Thirteen

There is nothing much in the way of news today, and that is a good thing. As of this morning, Charlie had lost thirteen pounds since entering the hospital on Friday. The doctors switched the Lasix delivery today to oral from intravenous in anticipation of returning home within the next couple of days. The wound looks better and smaller. On the negative side, a considerable amount of discomfort and inability to find a completely pain-free position continues.

Still Losing

The treatment continues to be the same, and Charlie lost a couple more pounds on the scale. As seen in the frequent blood tests, he is tolerating the Lasix well. If that continues, the doctors may increase the dosage again tomorrow. He is still uncomfortable. While the look of his legs is no longer elephantine, it would be hard to say they are anything but huge. In answer to my question this morning, the fellow said that Charlie would probably remain in the hospital until most of the fluid is gone.

Minus Seven and Counting

The more aggressive treatment is producing results. Charlie has lost seven pounds since he entered the hospital yesterday. He is not yet comfortable, but the loss is encouraging. Being in the hospital where his blood profile can be tested as often as needed, the doctors are able to give him larger doses of the diuretic Lasix. (Lasix is widely used in horse racing and is often thought to be performance enhancing, so this regimen has been the subject of a few bad family jokes.)

Another very good medical development is that the incision wound has healed to such an extent that use of the wound V.A.C. is no longer necessary or even feasible. This means the wound is well on the way to being completely healed. An additional bonus is that Charlie no longer has any external equipment to carry around with him.

Back in Room 1937

We had a regular appointment with Dr. Jarnagin this morning, and he recommended hospitalizing Charlie again for a couple of days to treat his continuing edema and other related issues more aggressively than is possible at home. He will also receive a transfusion for the anemia he has had ever since last March. Unlike previous returns to the hospital characterized as setbacks, detours or bumps in the road, this one is really to put him on a faster track to full recovery and make him more comfortable. Continuing to carry thirty plus pounds of excess fluid is very unpleasant, so Charlie is actually happy to be readmitted. By coincidence, he is in the very same room he had last time, 1937.

Hooray!

Charlie and I spent the day at MSK, and all the news was good. An ultrasound and blood work showed his kidney function is fine, so the diuretic dosage could be quadrupled to help rid his body of the thirty or so pounds of fluid he is carrying. The remaining staples were removed from the incision, it was not as painful as last time, and the infection is healing well. (They estimate that the wound V.A.C. has already saved him two to three weeks of healing time versus the old-fashioned dressing.) His abdominal cavity has dried out and the drain was removed--no more plastic bag to pin inside his clothing when he goes out. Ultrasound of his legs revealed no new blood clots. All of his blood work was favorable.

We feel pretty good tonight. It looks like Charlie has turned the corner after the infection detour. (But have I picked up Dr. Jarnagin's cliché habit?)

A Challenge

When I am working with my trainer at the gym and tell him something I am doing is hard, he always replies that the exercise is a challenge for me. Evidently, a trainer learns never to allow a characterization of "hard" on the theory that "challenge" is more positive and will keep the client motivated. Keeping this in mind, I would say that being at home with the drain and the wound V.A.C. is a challenge for Charlie and for me as the primary "caregiver." Nonetheless, Charlie seems to be making gradual progress. The interventional radiologist will evaluate where we are with the drain on Monday. Charlie definitely looks better to me, and he is now out for his third four-block walk of the day.

This afternoon, we watched some of the Saratoga horse races on television. Charlie and David are looking forward to the Giants preseason game against the Bears this evening.

The Visiting Nurse

We finally left the hospital in the early afternoon. I had arrived at 7:00 a.m. for an early departure, but a couple of snags kept us there in rather ill humor until 1:00 p.m.

Amazingly, things brightened considerably with the arrival of a nurse from the Visiting Nurse Service of New York. A few of our previous contacts with VNS had not made us especially hopeful for anything beyond a person with technical competence to use the V.A.C. wound therapy machine. But the nurse assigned to Charlie's case, Phil Leon, proved to be knowledgeable, kind, helpful and professional. He demonstrated his "can do" attitude when we found the box of supplies provided by the V.A.C. machine rental company did not include a crucial type of wound dressing. He called another client and arranged to go to his home and borrow what was needed to install the V.A.C. today and then returned to finish the job. He gave some great suggestions for getting more protein and calories into Charlie's diet, and he volunteered to arrange for in-home physical therapy to help with the back pain situation. Charlie and I both felt relieved and optimistic when he left. He is scheduled for visits three times a week, but he offered to stop by tomorrow to check on how Charlie is doing and to see if there are any problems with the V.A.C.

Apprehension

Although I am sure Charlie will enjoy being home--sleeping in his own bed, eating home-cooked food and reading in a comfortable living room--he is apprehensive about the discharge tomorrow. The visiting nurse will come only three times a week, and that is the only planned contact with a health professional until next Tuesday. His confidence in my nursing skills has not risen, and I will be in charge of the drain twice a day. (My duties actually relate more to those of a plumber than a nurse.) Despite the problems with hospital life, there is something comforting about knowing that a trained person is only a few steps away.

An aching back is an additional contributor to a less than cheery Charlie. The fellow has ordered an ultrasound, just to make sure the problem is musculoskeletal. The nurse practitioner says everyone complains about the uncomfortable beds here at the hospital, so we all suppose the back problems relate to the bed and to moving about without full use of the abdominal muscles.

With luck, I will be making a more upbeat post from home tomorrow. As I see it, we have some inconveniences, some things with which we must deal, but the health picture is much better than it was four days ago, and monumentally better than four months ago.

Preparations for Discharge

The current plan is to discharge Charlie on Wednesday. One high-tech and one low-tech treatment will be ongoing at home, and the staff here at MSK is helping us make plans to manage those. The high-tech treatment is called V.A.C. therapy. It uses a battery-operated device that applies sub-atmospheric pressure to the incision wound through a specialized wound dressing. This therapy promotes wound healing, and the dressing needs to be changed only three times a week, rather than twice a day. Charlie is lucky that his wound is amenable to this therapy. The speed of healing when using the therapy can be very dramatic.

The low-tech (or maybe just lower-tech) treatment is the drain that is continuing to remove fluid, albeit at a much reduced rate than previously, from the abdomen. The drain will be removed at the earliest next Tuesday, and it could be needed for some time beyond then.

Charlie's temperature remains normal, and the scheduled discharge is obviously an indication that he is making progress. He looks well but is very fatigued from this ordeal. So am I!

Status Quo

There is not much to report today. The fellow covering for Charlie's fellow made a brief visit before I arrived. (Dr. Jarnagin has left on vacation, but is available to the fellows by phone.) Apparently the covering fellow inquired as to how Charlie feels, which is quite well, but offered no opinions or information. The nurse says the wound looks good. The drain is still outputting. The diuretic is beginning to take effect. Charlie's appetite is good, and he is eating very well.

Under Control and Improving

The fellow just made his evening rounds, a bit before evening because his family is arriving from Ottawa, Canada, and confirmed what seems obvious from observing Charlie. He is much better. The drain is removing copious quantities of liquid from the abdomen, and the blood work is all fine. The culture of the drainage material was negative, but that was predicted, because Charlie was already on antibiotics.

Charlie's appetite is excellent, he looks well, and I am feeling very positive. The wound care team plans to send him home next week with an automated vacuum dressing that needs to be changed only every three days. We were both impressed with the size of the wound when it was fully opened up today for cleaning, but the team said it looks very good.

Clearly Improved

The drainage procedure took place yesterday afternoon under sedation and local anesthesia, so last evening Charlie was groggy and on bed rest. The nurse says there is a lot of drainage, which is what the doctors want.

This morning, Charlie is feeling better. He ate a very large breakfast, and, when walking in the hallway, was more erect and speedier than he has been. His fever is normal. Someone from the wound care specialist team will be visiting him this morning.

The doctor came on his rounds very early this morning, so I was not able to speak with him. After his evening rounds, I will make another post.

Today's activities, for Charlie, David and me, include watching the last episode of Season 2 of the Mad Men television show in preparation for the start of Season 3 tomorrow. We have a DVD player, a flat screen TV and a Bose CD player in the room.

A Setback, But The Wheels Are Not Off

As you have probably noticed, Dr. Jarnagin and his team are prone to clichés, and the latest is that Charlie's current situation is a setback, but the "wheels have not come off." We are also told that they can "fix this."

He has a lot of fluid in his abdomen (seen on a CT scan), and it is most likely infected. This afternoon an interventional radiologist will insert a drain, remove as much fluid as possible, and leave the drain in place, where it will remain for more than a week. He should start to feel a lot better pretty quickly after that. The incision will be cleaned and repacked a couple of times a day for a while.

The liver looks "great" on the CT scan, a lot larger, and most of his blood work looks good. The liver is functioning well. His protein is low, but as the infection diminishes, better appetite and nutrition should correct that.

Of course, we are concerned and disappointed, but we are told they deal with this situation often when they have done aggressive treatment procedures. Charlie is getting a lot of attention and has had multiple visits from members of the team. I have confidence in them. I will post again tomorrow, unless there is significant new information later today.

Optimistic Bias

Last night, Charlie began to have a fever, and when I changed the dressing on his incision, there were signs of infection. So we ended up back in Urgent Care. He was seen almost immediately by a surgical fellow, and, unfortunately, when staples were removed, the incision proved to be infected. More staples were removed this morning, so the incision is open and packed along almost its entire length, and Charlie is again on IV antibiotics. His fever is back to normal.

After seeing the doctor, we spent another four hours in Urgent Care while waiting for a hospital room and then for "Patient Escort" to take him to it. During the last hour (1:00 a.m. to 2:00 a.m.), Charlie, David and I strangely became a little silly, and the two of them began accusing me of optimistic bias in my blog postings and suggesting how I might spin this latest development:

• "His temperature dropped to only 99 within two hours of the incision being cleaned."

• "He was pleased to see one of his favorite nurses, Marilou, when he arrived on the nineteenth floor."

• "Only the exclusive nineteenth floor had private rooms available, and Charlie has a beautiful view of the Manhattan skyline and room decor by the Four Seasons hotel chain.

All of the above is true.

I don't want to make light of a bad situation. It is very disappointing to be back in the hospital. On the other hand, I have a feeling that everything is under control. The nurse is trying to have the wound care specialist team see Charlie later today. He looks well and was up walking the hallway before 7:00 a.m. this morning.

Still On The Job

I thought my blogging days might have ended, but Charlie finds using the computer very tiring, so I will be posting for a few more days. The recovery is definitely following an upward trend, but it is not a straight line. Some days are better than others, and there are always issues with which he must deal with the help of the medical staff. This seems to be a normal and expected part of recovering from major surgery, and the nurse practitioner answering calls this week is particularly kind and helpful.

Today is a good day. Charlie has been out four times to walk around the block, about a quarter of a mile each time. Overall, he is feeling much stronger and more comfortable than yesterday.

Near-Term Objectives

Following my first surgery on June 15, I recovered sufficiently to meet the surgeon's criteria for withstanding removal of 68 percent (a bit more than he may have anticipated) of my liver on August 3. On June 14, I weighed approximately 172 pounds, five pounds or so more than I might ideally weigh to get comfortably in most of my trousers. On August 2, I weighed 161 pounds. Since the surgery on August 3, my weight has ballooned as high as about 196 pounds and was 193 pounds this morning.

I have a couple of primary near-term objectives: to stay home and to start thinking more clearly. The medical team is working not to readmit me overnight to MSK (the team is having to deal with two or three problems). Meanwhile, I am struggling to regain enough power of concentration to hold a thought firmly in my grasp from the beginning of a sentence to its end.  

Back at Home

Charlie was discharged early this afternoon. He is feeling much better today, and the doctors are happy with his medical progress. He is definitely more comfortable than he was at this stage after the last surgery. I am again being allowed to hone my nursing skills, as the incision is still draining and needs redressing frequently.

Being out of the hospital seems to have lifted Charlie's spirits. He is even allowing himself to think that we may make it back to Saratoga toward the end of the meet.

"Just Where We Want Him To Be"

Charlie's IV came out today, and he is being switched to oral medications. Tomorrow morning, the doctors will evaluate whether he can go home later in the day, but they have indicated that they are in no hurry and will see how he feels. He seems stronger today, has a better appetite and is able to concentrate a bit more. The fellow said he is just where they want him to be at this point.

It was fun to be able to watch horse racing yesterday on ESPN. Although New York City cable has a horse racing channel, the hospital does not carry it. In fact, we cannot even see horse racing on the computer, because we use the hospital-provided wi-fi, and any website with a connection to gambling (or to pornography or social networking) has been blocked, apparently to keep the employees focused on their jobs. Yesterday's racing was especially exciting for us, because we were thrilled to see our trainer, Christophe Clement, win the Arlington Million.

Feeling Better

Charlie says he is feeling better than yesterday and a lot better than day before yesterday. He is allowed to eat anything, but he has very little appetite and has been content with a little applesauce or a banana. The fellow (MSK term for resident) came early this morning, so I did not speak to him myself, but I understand he reported that everything is coming along fine. The nurse also said he is doing well.

Charlie had a (very painful, because of the positioning) CT scan last evening in connection with Dr. Jarnagin's research study, and his liver looks as expected. He continues to have an IV connected to his mediport, which would seem to indicate that he will be in the hospital at least a couple of more days. He is sleeping a lot, and his activities have been pretty much limited to the highly recommended walking and sleeping. He did not do much reading after the last surgery either, but the amount of sleeping is much greater this time around. I believe he is not as uncomfortable as he was the last time, and that is allowing him to get more rest.

We are all looking forward to television coverage this afternoon of both golf and horse racing. We are rooting for our trainer, Christophe Clement, to win the Arlington Million with Gio Ponti and the Secretariat with Laureate Conductor. These races will be on ESPN.

Still Moving Forward

Charlie is not always comfortable, but his medical progress is continuing. Dr. Jarnagin is pleased with how he is recovering. The increased pain and discomfort relate in part to the normal, expected buildup of fluid and gas in the abdominal area. (I found it interesting that he has gained about twenty pounds since entering the hospital, while eating and drinking nothing but clear liquids until today. Obviously, he is still retaining a lot of fluid.)

David and I continue to trade off shifts from time to time at the hospital, but he has done more than his share today, allowing me to get over to the gym and have lunch at home with Pepper. In addition to David's help at the hospital, I derive great comfort from having him with me during this stressful time.

Spirits Lifted

Charlie was started on antibiotics this morning to combat cellulitis around the incision, and he became quite discouraged. As he increased his usage of the patient-controlled pain medication, he became groggy, and to David and me, he did not seem as good as yesterday.

But Dr. Jarnagin and his full team were just here, and Charlie's spirits have improved tremendously with the news that his liver function is returning to normal, the suggestion that he needs to remember how far he has come, and the characterization of the cellulitis as hardly a "self-respecting infection." So, back to the hallway for more laps!

Looking Well

Charlie continues to look and feel well this morning. He is experiencing much less pain than he did with the last surgery. As a result, he is using his morphine drip button less often, which makes his mind clearer and his ability to enjoy the newspapers and his e-mail greater.

Not surprisingly, Charlie's liver function is not yet normal, but the doctors say that situation is expected and should resolve in a few days. They are not concerned. Dr. Jarnagin's nurse practitioner told Charlie this morning that, in her experience, patients often have a decline in energy on the third day, and he should anticipate that possibility and not be discouraged.

At this moment, Charlie is walking the hallway with the respiratory nurse. (He did ten laps, .71 miles, yesterday.) As with all surgeries, there is a lot of focus on keeping his lungs clear, so his diligence with the walking and spirometer is important.

Afternoon Report

A few months ago, I was advised that there are a lot of "curves in the road" with cancer, and it is best not to take any of them too fast--not to get too high on the good days or when there's good news, and not to get too down when the news is bad. Today has been such a good day that I am having to try to remember not to get too elated.

Charlie looks, feels and acts better than he did at this stage after the first surgery. We are guessing that the shingles he got right after the last surgery, which were only diagnosed after-the-fact when a rash appeared, took more of a toll than we realized. It seems easier to manage the pain this time, and he is able to walk with a much more erect posture.

When Vivian, the physical therapist with whom Charlie had great rapport during the last stay, saw he was in the hospital again and due for therapy, she immediately signed up for his case. She has presented a new challenge, although I could see she was a bit alarmed at the level of enthusiasm from her patient. This afternoon she timed him with a stopwatch to see how many hall laps he could do in six minutes. Two and one-quarter laps is now the six minute benchmark, and, in addition to working toward maximum mileage, he also has a speed goal.

One member of Dr. Jarnagin's team was here this afternoon, but we are expecting the whole team this evening. I hope they will confirm medically what I am observing: that Charlie is recovering remarkably well.

First Morning Update

Charlie was moved from the recovery room to room 1629 this morning at 9:00 a.m. Because the level of nursing care in recovery is more intense than on the floor, he was kept there for the full night until all lab reports were good. He is comfortable (he just rated his pain for a nurse at "1" on a scale of 1 to 10), and David is reading him various news reports on horse racing and New York Giants football. He will be getting up to walk within the next hour. He is concerned that the back spasms he experienced in the last two weeks will interfere with his setting new distance records doing laps in the hallway, but the staff is certain they will be able to control the spasms should they be a problem. All in all, he is doing very well.

Favorable Signs

David and I had a short visit in the recovery room with a very groggy Charlie, but there were signs he was still himself:

• David told him that there are reports from New York Giants training camp that Eli Manning is throwing flutter balls, and he gave an exasperated sigh--one of his favorite contrarian theories being that the Giants would be much better with a different quarterback.
• He immediately asked for his glaucoma drops and supervised the nurse's administration of them.
• And, of course, he smiled with pleasure on hearing Dr. Jarnagin's report on the surgery.

We are home now and will go back for another ten minute visit in the recovery room about 8:00 p.m. The nurse told us that it takes longer after liver resection surgery than after other surgeries of comparable length for the anesthesia to wear off because of the role of the liver in metabolic functions.

Once Again, No Surprises

Charlie is in recovery, and Dr. Jarnagin reported, as he did after the last surgery, that there were no surprises--no cancer in other parts of his abdomen, the left liver lobe looked as expected following the resection of seven weeks ago, and the removal of the right lobe went as planned. He will remain in recovery overnight--until perhaps 5:00 a.m. tomorrow morning--as is standard with this type of operation. David and I will see him for a five or ten minute visit in another hour. Meanwhile, we are going to get some lunch.

Roseanne's Report

Roseanne, the Patient Liaison Representative, just made her rounds of the lobby and reported that Charlie is tolerating the surgery well and that the surgeons are now at the stage of "clamping off the arteries and blood vessels". She said it will probably be another hour, but that she doubted that she would see us on her 3:00 p.m. rounds.

Surgery Underway

While waiting in the lobby, David and I just received our first report from a woman whose job is to report every two hours to the families waiting for patients in surgery. What we learned was only that the procedure got underway at 9:50 am. Dr. Jarnagin previously told me that the surgery will take about three to four hours.

Four Days of Racing at Saratoga

Although I lost a modest amount of money on the races, and there was considerable rainfall until today, attending the first four days of racing at Saratoga was a tonic for me-- appropriately enough, as Saratoga Springs was a spa long before the racing began in 1863. There were some good races all four days, with the outstanding card today featuring the Grade I Diana on the turf for fillies and mares and the Grade II Jim Dandy for three-year-olds being prepped for the "midsummer Derby," the Grade I Travers, four weeks from now. 

In recent years, the town of Saratoga Springs has become more prosperous and gentrified, in the midst of the chronic economic depression of upstate New York.  Horse owners have restored Victorian mansions; developers have constructed, and are still constructing, attractive condominiums (I do not know if they are finding buyers); chain stores have mixed in with the mom-and-pop shops on Broadway; and, although the  proprietors of Saratoga County's best restaurant, Chez Sophie, are closing it and moving to France, there are more good restaurants in and around town than ever. 

In spite of all the changes, Saratoga Springs retains its magic. The town not only has the natural advantage of its springs, but also a setting amidst lakes and rolling farmland. The perennial success of the race meet defies all logic, particularly in the context of the accelerating decline of the sport of thoroughbred racing. Saratoga Springs is located far from major metropolitan areas; the clubhouse and stabling facilities are antiquated; there is a severe shortage of hotel and motel rooms, parking, and seating; the horsemen have to pay inflated rents for housing; and on the days when it isn't raining, it is often hot and humid. Like most horse owners and fans of racing, there is no place I would rather be from late July through Labor Day.

With the exception of  some horsemen, particularly Californians, who go to Del Mar,  most of the leading figures in American racing come to Saratoga for at least part of the six-week meet. Days on the racetrack start before dawn, and Saratoga's social life, at all levels, is non-stop during those six weeks. Daily life offers summertime small-town charms, such as the farmers' market. For thoroughbred horse-industry professionals and insiders, the focus of activity, including conferences and yearling sales, continually shifts throughout the meet: during a given week, one might find the steeplechase crowd in town, or the Kentucky breeders and yearling consigners, or the coach-horse people. There are families of owners, breeders, and trainers that have been stalwarts of racing and come to Saratoga for decades. There are new owners who have made a lot of money in the latest hot area of the economy, most of whom disappear from racing and Saratoga in two or three years, a few of whom endure to become part of the fabric of the industry.

While I would love to get back to Saratoga before Labor Day, I cannot set such an objective. I simply have to follow the cliche of taking each day as it comes. Following my surgery on June 15, it was predictable that I would be weakened and lose weight, but it was not predictable that I would develop shingles, an infection of the incision, a blood clot, and muscle spasms of the lower back. In addition to the pain killers, the various drugs that were administered to me for these complications also robbed me of energy and clarity of thinking-- as reflected in the paucity of my blogging since the surgery. (After I got off the last of these drugs two days ago, other than the blood thinner with which I will have to continue injecting myself for at least six months, I was relieved to find that my handicapping of the races improved markedly yesterday and today.) 

To deny that I am facing this coming surgery with trepidation would be transparent bravado. With my memory of the first surgery so fresh, I have no illusions about the suffering that is in store for me, even if all goes well. Debilitated not only by lingering effects of the four complications that developed after the first surgery, but also by loss of weight, muscle mass, and stamina, I go into this surgery with much less strength in reserve. But the surgeon seems to think that I am doing relatively well and that I am capable of staying on an ambitious schedule. Apparently, some patients have to wait months between the two surgeries. I keep reminding myself that for the first two months after my diagnosis, I was told adamantly that surgery was not an option for me and that my disease was incurable. 

Having undergone these two surgeries, I will have much better odds of surviving for a few more Saratoga race meets, and even some chance of being cured. I approach Monday morning's surgery keenly aware of how lucky I am to be going into it with strong support from family and friends. Susan plans to communicate with you by posting on this blog after she returns home from the hospital.

Saratoga Springs

This morning, after having my blood platelets level checked at MSK to see how I am reacting to the daily injections of blood thinner, Susan and I drove up to Saratoga Springs, New York. The racing starts Wednesday and continues through the Labor Day weekend.  I have been coming to Saratoga for the racing since 1963, and Susan started coming here with me a few years later. There are more important races at Saratoga than there are at any other race meet of comparable duration. Saratoga also features races for two-year-olds. I particularly enjoy going to the walking ring before the maiden races (i.e., races for horses which have never won a race) for two-year-olds to try to identify future stars among the horses that have not yet raced and to study the characteristics of the progeny of young stallions.

Just before I got my cancer diagnosis, we had rented an apartment in Saratoga for the entire racing season. One of the things that we had wanted to do when I retired was to spend as much of the racing season up here as we pleased. In addition to the horse-related activities, there is plenty to occupy one's time in Saratoga. When I was working, we drove back and forth between New York City and Saratoga on weekends. If possible, I also took a vacation for the entire week during which the Saratoga yearling auctions are conducted. Often, I bid on several yearlings and bought one or two. 

This year, we can stay in Saratoga only through August 1, as I have to get back to New York City for my surgery on August 3.  Although I am still limited in my activities by back spasms, and dopey from the medicine that I am taking for the back spasms,  we will just make the best of these next few days.

Bad Habits Die Hard

In getting exercise, when I act both as the athlete manqué and as my own trainer or coach, stupidity tends to prevail. My instinct is to push constantly for personal bests, even though I try to tell myself to go slowly and not experience a setback by injuring myself. On Saturday and on Sunday morning, as part of each of the three two-and-a-half mile walks that I took, I climbed up and down a staircase with 57 steps. I put aside the knowledge that I am still very weak from my June 15 surgery, and I mused about whether I should try to get each walk up to five miles before my surgery on August 3. 

Now I am nearly immobilized by pain in my lower back, which I am not permitted by the doctors to treat with anti-inflammatory medications. I hope that this self-inflicted problem does not compromise my stamina too much heading into the surgery, or leave me to deal with a combination of abdominal and back pain after the surgery. I hope also that the back pain does not curtail either my ability to see people before the surgery or our plan to go up to Saratoga Springs for four days before the surgery. 

Tom Watson

Tom Watson is the only top tournament golfer I have met. Eleven years ago, the night after he won his last PGA tournament, the Colonial, I happened to be seated next to him at a dinner at the Links Club in New York at which he was the guest of honor. It was considered a remarkable feat for him to have won a PGA tournament at the age of 48. I found him to be a good dinner companion-- dignified, personable, and interested in more than just himself and golf. Thus, I was not surprised that he conducted himself so well today after his crushing failure to maintain his lead-- at age 59, with a recent hip replacement-- on the final hole of the British Open. One could not help comparing and contrasting his demeanor with Tiger Woods' swearing and pounding the tee box with his club after hitting a bad shot in the same tournament. 

"It's an Ill Wind that Blows No Good"

For the first time this year, I visited the glaucoma specialist whom I had been seeing every two months for eight or nine years. Interestingly, my intraocular pressure was the lowest that it has ever been (that's a good thing), and my visual field test seemed to indicate somewhat less damage than previously (which I'm not sure is possible, as dead neural ganglion cells don't revive or get replaced). Glaucoma is thought by at least some specialists to be an autoimmune disease, and chemotherapy suppresses the immune system. Thus, chemotherapy may be efficacious for glaucoma-- or, at least, my chemotherapy regimen may be beneficial for my particular type of glaucoma. Until I got cancer, my only material ailment was glaucoma, which is to some extent heritable and from which my mother is now legally blind. In addition, my father suffers from wet macular degeneration, which makes it more likely than otherwise that my siblings and I will develop that cause of even more blindness than glaucoma. Thus, prior to my cancer diagnosis, I had worried about outliving my eyesight.

Over the last few days, although I am still instructed not to lift anything over five pounds in weight, my strength and stamina seem to be returning more rapidly than heretofore since the surgery. Today, I took advantage of beautful weather and walked over five miles, including two separate walks of two-and-a-half miles along the pathway paralleling the East River. It is a very nice walk, as I have to cross only two through streets going out and coming back. A highlight of the walk is an enclosed dog run, in which the dogs always seem to be frolicking together. I suppose they fight with each other sometimes; but as I walk by, I haven't seen or heard any signs of quarreling.

My Mother's Birthday

Today is my mother's 95th birthday. She and my father and sister are going out to dinner to celebrate at the Ponte Vedra Club. 

Susan and I and a friend went out to Belmont Park today to watch one of our horses, Hot Money, run in a stakes race restricted to three-year-old horses bred in New York. Hot Money was the 4-to-5 favorite in a field of nine. He finished next to last. 

Yesterday, I received a call from MSK that the radiologist reviewing the CT scan that I underwent the previous day had detected a pulmonary embolus-- a blood clot-- caught in the IV filter that had been inserted in my vena cava when the doctors had earlier found a blood clot in my right leg. These blood clots are almost certainly a result of my cancer. Such clots must be treated, as they cause heart attacks and strokes. Starting yesterday, I am now injecting myself once a day in my stomach with a blood thinner, a low molecular weight heparin called Dalteparin or Fragemin. I will have to have my blood platelets checked twice a week at MSK. Starting today, I began wearing compression hosiery, which I found to be hot and uncomfortable. (I can't get them to stay up. Maybe they're the wrong size-- or maybe I need a garter belt.) Because I am now on a blood thinner, I can no longer take anti-inflammatory medications like NSAIDs (aspirin, Ibuprofen, etc.) or Celebrex to control the arthritis in my hip. A primary concern for me is whether either the blood clots or the blood thinner will preclude certain chemotherapy options. In any event, I will now have to continue to be treated for blood clots for a minimum of six months. Subsequently, if I were no longer deemed to have active cancer, such treatment could be discontinued.

A New View

The feature article on page D 1 of today's (July 14th's) "Personal Journal" section of The Wall Street Journal is entitled, "A New View, After Diagnosis. Experimental Group Therapy Aims to Help Cancer Patients Find Meaning in Face of Mortality." 

http://online.wsj.com/article/SB20001424052970203547904574276434196118914.html#mod=todays_us_nonsub_pj

The article discusses an experimental program at Memorial Sloan Kettering aimed at helping "cancer patients find a sense of meaning, peace and purpose in their lives, even as the end approaches." The program is based in part on the writings of Victor Frankl, specifically Man's Search for Meaning. As I have written previously in this blog, particularly on March 20, one of my first thoughts when I got my cancer diagnosis was to go home and start re-reading Frankl to help structure my thinking about my short remaining lifespan. I count myself as fortunate that I had read this book, and therefore was aware of it as a resource, prior to my diagnosis.

Today, I spent the day at MSK having my liver and general condition tested and examined. It seems that the right lobe of my liver is atrophying and the left lobe of my liver is growing in line with expectations. Moreover, even though I am appalled at my loss of condition this calendar year, the doctors and nurses seem to think that I am rebounding exceptionally well from my first surgery. Thus, the tentative August 3 date for my next surgery is now a firm target.

The doctors and nurses cannot figure out what caused the skin around, and particularly below, my surgical incision to become hypersensitive, then peel and become pink and itchy. The best guess seems to be that the trauma of the surgery triggered a mild case of shingles--a  mild case because I had been vaccinated for shingles. Whatever caused this condition, it seems to be running its course and is now only a minor irritation. I am hoping that the next surgery will not cause it to flare up again, as a mere touch of cloth to my abdominal region was difficult to bear, which  interfered with my sleep and added to my pain when forcing myself to walk for exercise.

A Little Progress

After a wet, cold spring, the last few days' weather in New York City has been sunny, with low humidity, and temperatures not exceeding around 80 degrees. I had enough energy on Friday to visit Belmont Park to see the two horses that we have stabled there currently. On Saturday, I went out to lunch with a friend who very kindly drove into Manhattan to see me. Today, I took three walks totaling, according to my pedometer, 2.45 miles.

Since Friday, the nursing service has had to come only once a day, instead of twice a day, to dress my infected incision. With luck, the incision will heal not only before my next surgery, but also in time for me to go up to Saratoga Springs for a few days prior to the surgery.