Coda

Even though my life is being cut short, it has been my good fortune to have been married for over 42 years to a loving, supportive, and altogether wonderful wife. Susan is the sun around which the members of our immediate family-- she and I, our daughter, Liz, and Liz's daughter, Kayla, and our son, David-- revolve. Moreover, the gravitational pull of her love and competency on her own family-- her father, her father's friend, her brothers, sisters-in-law, nieces, and nephews-- helps to keep its members in orbit as well. Even within the members of my own family-- her in-laws-- her selfless willingness to assume responsibility exerts a palpable force.

As a helpmate, Susan enabled me to focus on what I liked to do in my career and in our private business affairs by doing all of the thankless tasks for our whole family. I never saw a bill, much less paid it. I even signed our income-tax returns as the "innocent spouse." In our horse business, I picked out the young horses at the sales, studied pedigrees, inspected and bought and sold horses, worked with the farm managers, veterinarians, and other professionals, and talked strategy with the trainers. She did the hard work, such as keeping the books, working out the depreciation schedules with the accountant, and purchasing the insurance coverages that I wanted. When we had a cat, Sparky, prone to biting and scratching, that developed first lupus, then diabetes, Susan was usually the one who put the prednisone pill in the back of his throat and injected him with insulin.

Engaging in all sorts of activities, from high-brow to low-brow, from attending academic lectures and concerts of classical music and jazz to playing and watching sports, we had countless wonderful times as a couple and in the company of other couples, friends, and relatives. When we were first married, I had nothing but debts for my education, and we would attend Yankees' games on a budget of about $10.00 for the day-- the centerfield bleacher seats were $1.00 each. As our time together grew short, we particularly appreciated the opportunity to travel last year to Paris and this year to New Zealand and Australia.

The most cherished memories of my life record the years when our children were small. Susan is a superb cook as well as mother, and she made the holidays special-- all that I had ever dreamed that holidays could be for a family. We had delightful vacations with the children as well, both domestically and abroad. I remember celebrating David's fourth birthday at an outdoor table at a Michelin three-star restaurant in Provence, L'Oustau de Baumaniere, where Liz and David were more interested in the kitchen cats than in the haute cuisine.  Each year, for the month of August, we rented a house in Saratoga Springs that left much to be desired, but had the redeeming feature for young children of containing one of the town's few in-ground swimming pools.

My worries about being dead concern its effect on my family. Nothing can fill a departed family member's void, and I am profoundly sad to be leaving my loved ones. Nevertheless, as I face the pain of departing from our family, I have the peace of mind of knowing that the sun of Susan's love will continue to provide our family with  gravitational stability, warmth, and sunshine. 

Sunday Morning on a Holiday Weekend

Yesterday afternoon, I developed a fever for the first time since my surgeries. People undergoing chemotherapy frequently develop fevers, but I haven't had chemotherapy in several weeks. Because of the fever, when I reported to MSKCC's Urgent Care facility to have fluid drained from my abdomen, the doctor on duty first checked for an active infection by testing my blood and urine and then ordering a chest X-ray. Finding no cause for the fever, she then performed an ultrasonic examination to determine where to place the needle to drain as much of the fluid as possible. 

Unfortunately, the fluid turned out to be behind the intestines and bowels where it cannot be drained. Meanwhile, my midsection grows ever more distended and painful, both internally and, as the skin grows tighter, externally. Based on my weight gain, I estimate that about twenty pounds of fluid has accumulated so far. The doctor also reported that my liver is swelling and my colon thickening. She thought that it would be worthwhile for me to come back into the Urgent Care facility on Tuesday morning for her to perform another ultrasonic examination, just in case some of the fluid shifts to an accessible location. Afterward, I will attempt to meet with or at least speak with Drs. Saltz and Glare.

It is a  sunny day in New York City, with low humidity. With many of Manhattan's residents away for the long holiday weekend, it is peaceful. Susan and I walked the dozen blocks from MSKCC's main campus to our home. The stretch along York Avenue in front of Rockefeller University is a particularly pleasant walk, paralleling an oasis of leafy trees harboring discreetly placed tennis courts.

What Is Required of Me Now?

For many years, I have used a motivational question that I cannot recall ever failing me: "What is required of me now?" I do not know where I learned this saying, or if it originated in Buddhism or other religious and spiritual traditions. It may be a commonplace secular motivational tool as well.

So far, since I was diagnosed with cancer 15 months ago, this motivator has continued to work for me. For example, if I awaken in the morning in a comfortable position and dread the pain involved in getting out of bed, asking myself this question and then answering it (i.e., "I have to inject myself with Fragmin") prods me into action. When I cease to respond to this motivational question, I will know that the spirit is going out of me.

Weighing the Odds

Yesterday, Susan and I met with Paul Glare, MD, the Chief of MSKCC's Pain & Palliative Care Service, and with one of his colleagues. 

Dr. Glare volunteered to talk about my life expectancy. Previously, I have had to rely on the literature and conversations with non-MSKCC scientists to estimate how long I may have to live. According to Dr. Glare, if I wanted to enroll in hospice at this time, I would qualify. In other words, in the absence of more chemotherapy, it would be reasonable to assume that I would die within the next six months. Most of the colon-cancer patients sent to Dr. Glare die within two to 12 months-- including patients who continue chemotherapy and those who do not-- with a few outliers dying within two months or after 12 months. 

From Dr. Glare's specific examination of me and my records, his guess is that if I were to forego additional chemotherapy, I would probably make it through this summer and die this fall. If I were to undergo additional chemotherapy, and it were to prove efficacious, I would probably die later, but probably still within 12 months. He noted that third- and fourth-line therapies tend to be less efficacious than first- and second-line therapies. (In my case, the first-line therapy, FOLFIRI, was moderately efficacious; the second-line therapy, FOLFOX, was not at all efficacious.) 

I am still studying the probable and possible side effects of embarking on the irinotecan/Erbitux chemotherapy and trying to decide if a six-month course of it, followed by a recovery period of a month or so, would make sense for me, given my values and expected longevity. Here are some excerpts from Erbitux's package literature per se (irinotecan causes its own adverse reactions): "The most common adverse reactions with Erbitux (incidence > 25%) are cutaneous adverse reactions (including rash, pruritus, and nail changes), headache, diarrhea, and infection. The most serious adverse reactions with Erbitux are infusion reactions, cardiopulmonary arrest, dermatologic toxicity and radiation dermatitis, sepsis, renal failure, interstitial lung disease, and pulmonary embolus.... As with all therapeutic proteins, there is potential for immunogenicity." 

Dr.Saltz told me that when Erbitux is efficacious, patients always get a rash, and that patients for whom Erbitux is not efficacious may get the same rash. This rash looks like acne, may itch, and may extend from head to toe. While this rash is present, the skin has to be kept covered in ointments and cannot be exposed directly to sunlight. When Erbitux is discontinued, this rash usually, but not always, disappears, typically within a month.

Dr. Glare noticed that Susan was carrying a cloth bag from Coolmore Stud in Australia. He is Australian and said that he has kept his membership in the Australian Jockey Club. He asked if we have horses. I replied that we do and in fact had a runner, Hot Money, entered at Belmont Park for the next day. He asked if I fancied Hot Money's chances. I said that I did, but only at high enough odds to compensate for the risk that his disappointing previous race indicated some undetected problem. 

In Hot Money's race today, he was bet down to 5-1 odds. He ran well, closing fast at the end to gain third place. Before placing any bet, one should always weigh the odds.

St. Charlie

My brother, who lives in Virginia, is visiting my mother. When I spoke over the telephone with her this evening, she told he that he had just read her a May 24 article, "A Good Trade," that was written about me by the eponymous Ray Paulick, editor of the online thoroughbred horse publication, The Paulick Report (www.paulickreport.com). She exclaimed about Mr. Paulick's writing skills and about the dozen or so on-line responses to his article. 

I told my mother that I certainly concurred with her about Ray Paulick's writing and that the responses to his article were more than kind about me. I added that I was, however, having a little trouble adjusting to my new role as St. Charlie. She started laughing and agreed that that would be a lot to live up to. She was still laughing as I bade her goodnight.

Last Option

Yesterday, as previously scheduled, I had more blood tests, and Susan and I met first with Dr. Jarnagin, the surgeon who operated both times on my liver, and then with with Dr. Saltz. Dr. Jarnagin told us that last week's CAT scan showed that the chemotherapy was having "at best" no effect on the tumors. In response to a question of mine, he also said that, although there was no surgical intervention that would be efficacious against the tumor progression, drains could be inserted into my abdominal cavity to drain some of the fluid that keeps accumulating in my belly.

When we met with Dr.Saltz a few hours later, he confirmed that he was discontinuing my treatment with FOLFOX. He thinks that I now have tumors both in my abdominal cavity and in my stomach and that the fluid is cancer-related.

Dr. Saltz indicated that he has only one other chemotherapeutic option for me to consider: Erbitux combined with irinotecan. I was previously exposed to irinotecan, as it is an ingredient in the FOLFIRI cocktail with which I was infused soon after my initial diagnosis. Although FOLFIRI set off a bewildering Kaleidoscope of adverse reactions in my body, Dr. Saltz thought that I tolerated FOLFIRI relatively well. The more I think about my previous experience with irinotecan and study the literature on the irinotecan/Erbitux combination's probable and possible side effects, the more I marvel at its users' willingness to endure sufferings worthy of Job to try to stave off death .

If the irinotecan/Erbitux combination were to prove efficacious for me and its side effects were not life-threatening, I would receive it for about six months. Then, once-- and if-- I recovered sufficiently from the side effects, I might have one last period in which I could go out into the world again. 

On Sunday, I will undergo an invasive procedure under local anesthesia during which a drain will be inserted in my belly for some two hours. Dr. Saltz says that the chances of my getting another infection from the procedure-- I got a total of four infections last year from four procedures (two from one, none from another)-- are minimal and that the reduction in pressure should temporarily relieve some of the pain in my midsection. The fluid will rebuild-- perhaps over 48 hours, perhaps over three or four weeks. As the abdominal pain is starting to wake me up at night (I intend to avoid taking pain medication for as long as possible), the potential benefit of the procedure seems to me to justify its purportedly minimal risk.

Until forced to make a decision sometime in the near future, I will continue to mull whether the irinotecan/Erbitux regimen would be compatible with my goal of maximizing the quality of my remaining days. Meanwhile, Susan and I will meet tomorrow for the first time with MSKCC's palliative-care specialists. 

Appearances Are Deceiving

On Thursday, May 20, the book project's editor, publisher, and I met at my apartment for a working session via Skype with its designer and co-editor. Afterwards, on the sidewalk of East 57th Street, in front of my apartment building, the editor, Matthew Stevenson, snapped the photograph above of John Inglis, the publisher, and me. (John is the handsome young guy with hair and no glasses.)

A friend of mine saw the photo and remarked how well I looked in it. I must admit that I was surprised myself when I saw it. Either Matthew is an exceptionally skilled photographer, or it really is true that appearances are deceiving.

Man-Made Miracles

The cover article in this week's (May 22-28) issue of The Economist is entitled, "And man made life: The first artificial organism and its consequences." The article chronicles the background, and speculates about the consequences, of Craig Venter's, Hamilton Smith's, and their colleagues' publication in Science on May 20 of their creation of life from off-the-shelf laboratory chemicals. Their life form reproduces on its own and has a piece of DNA that carries about 1,000 genes.

In about 1997,  at an in-house meeting of The Institute of Genomic Research (known as TIGR and pronounced "tiger")-- Craig Venter's not-for-profit institution of which I was then a trustee-- I first heard Craig speak about this project. Although one should always expect audacity from Craig and should never bet against him, the notion of creating life from laboratory chemicals was even more mind-boggling then than it is now. 

Shortly after that meeting at TIGR, I attended a meeting at MIT at the Whitehead Institute that featured several of the world's leading geneticists. During the question-and-answer session, I asked if any of the panelists thought that it would be possible for man to create life artificially. None thought that it would be possible. 

Because mortality rates for most forms of cancer have not improved since federal funding for basic research in cancer began under the aegis of President Nixon's "War on Cancer," many have grown discouraged about the possibility of substantially improving outcomes for cancer patients. I, however, am excited and optimistic about the prospects both for improving cancer patients' quality and duration of life and for finding cures for various cancers, through the basic research being conducted in research universities and the drug-development work in the private sector. 

As far-fetched as substantial progress in the war on cancer may seem at times, creating life from chemicals seemed at least as improbable to many experts only 13 or 14 years ago. Whatever it costs, no matter how long it takes, basic research is the only hope for conquering cancer, and man cannot afford to give up hope. 

The Impulse to Philanthropy

What accounts for the impulse to philanthropy, especially for long-term projects like basic research into diseases' nature, causes, and cures? 

In a different era and context, Alexander Smith (1830-1867) wrote "... Knowing that his existence here is limited, a man's workings have reference to others rather than to himself, and thereby into his nature comes a new influx of nobility. If a man plants a tree, he knows that other hands than his will gather the fruit; and when he plants it, he thinks quite as much of those other hands as of his own." 

The Book of Job

Before someone who has received an initial diagnosis of cancer is asked to embark on a course of treatment, he or she should be given a copy of the Book of Job.

Book Contract

Yesterday, I signed a publishing agreement granting Cold Spring Harbor Laboratory Press (CSHLP) "rights to publish, and to license subsequent publication or other utilization by third parties, of a written manuscript entitled Incurable: A Life After Diagnosis...." For the last few weeks, I have been working with an experienced team, consisting of an editor, Matthew Stevenson, a co-editor, Michael Martin, and a book designer, Nanette Stevenson, to convert the material in my blog into book form.

Although a number of friends, including writers, have suggested to me since I started my blog that I should "write something," or at least rework the material in my blog into a book, I wondered if they weren't simply being kind about my writing, given my circumstances. Moreover, I doubted that I would have time to start a new book from scratch, and I couldn't be confident that I would have enough energy or time even to rework the material in the blog into book form. Not until Matthew, an oft-published author and editor, and a trusted friend of mine for decades, proposed to me a month or so ago that he and his team go to work with me on such a project did I stop dithering. 

Matthew presented to me a solution that would ensure the production of a ready-to-print manuscript even if I could no longer work on it before it was finished. Matthew keeps reminding us that "Every day counts," and we have made substantial progress. With the agreement with CSHLP in place and a literary executor, Al Perry, designated in my will, I am now confident that the book will not only go forward, but also be limited in its quality only by my writing and thinking.

Although Cold Spring Harbor Laboratory is especially well known for its basic research in cancer, I was both surprised and humbly grateful for CSHLP's interest in this project, as this prestigious university press is known primarily for its science books. While I was aware that CSHLP publishes some non-technical books as well, such as a recent biography of Francis Crick by Robert Olby, I did not think that anything written by or about a person of no historic significance like me would be a fit for CSHLP.

Because I have so little remaining time, I never presented the blog-to-book idea to agents or publishers. CSHL became aware of my interest in producing a book through a conversation that I had with a friend, Dill Ayres, the head of administration of CSHL, about some nascent ideas that I have regarding how I, or my estate, might utilize such a book in conjunction with fundraising for cancer research. Dill asked if he could tell John Inglis, the Executive Director and Publisher of CSHLP, about my interest in producing a book. To John's credit, negotiations proceeded  swiftly thereafter.

The book will be published this fall in hard cover: some 70,000 words printed on about 200 pages, with black-and-white photographs integrated into the text. Any author's profits will be donated by my estate, as directed by Susan, to cancer research. The overarching motif of the book is captured by Viktor Frankl's observation that ..."Everything can be taken from a man but one thing: the last of the human freedoms-- to choose one's attitude in any given set of circumstances, to choose one's own way."

Battling Cancer

Over the years, whenever I have read an obituary of someone who died of cancer, it invariably has seemed to state some variation on the theme that the deceased died after a valiant battle with cancer. While I have never doubted that anyone who died of cancer suffered terribly and bore his or her ordeal heroically, I have often found myself wondering if in every case the deceased fought his or her cancer, rather than sought some sort of accomodation with it?

If given an initial diagnosis of curable  cancer, most cancer patients probably choose to battle their cancer for at least as long as it is still regarded as curable. Even though cancer treatments involve poisoning, cutting, and burning with both temporary and permanent side effects-- some of which are disfiguring-- and risks of potentially fatal complications, the possibility of cure is sufficiently motivating for patients to undergo almost any horrors and humiliations. 

In my own experience, having been classified as incurable, then possibly curable, then incurable, I think that the risk/reward ratio of undergoing draconian treatments is quite different for the curable and the incurable. For the incurable, all cancer treatments are palliative. Speaking as an incurable, I doubt that I would choose to undergo many of these debilitating treatments in hope of extending life for some short period of time; and I have no intention of doing anything voluntarily to drag out active dying. "To suffer unnecessarily is masochistic rather than heroic." (Frankl, p. 136.)

For the incurable, the struggle may not be so much with cancer as with a medical establishment pushing in good faith, if sometimes mindlessly, the next treatment; as first one, then another treatment loses its efficacy. Fortunately, my medical oncologist seems to be honoring my decision to seek quality of remaining life rather than quantity of remaining life. 

Since my diagnosis and re-diagnosis as incurable, my struggle has been primarily with myself, not with cancer or the medical establishment. I must seek to use my remaining time wisely, to conduct myself appropriately, and to become a better person. If you read an obituary of me that says that I battled cancer bravely, you will know better.

Hiatus

Today, I had a regularly scheduled appointment at MSKCC to have blood tests and to be examined by Dr. Saltz and his associates. Then, if I were deemed to be in good enough shape to withstand another round of chemotherapy, I would go to MSKCC's chemotherapy suite. Although the blood tests indicated that my platelet count was at the borderline of being high enough for me to undergo another round of chemotherapy, Dr. Saltz decided for another reason not to proceed with the chemotherapy for at least a week.

Since early March, my belly has been growing more and more distended. It is now so large that the skin over it is stretched taunt-- like a woman's in her third trimester. Even though I have retained my sense of taste and a fairly good appetite, I can now eat only small meals because of the ensuing pain if I stretch my stomach more than minimally with food. I no longer exercise beyond taking walks of less than a mile, as the slight rotation of the torso that is part of each step generates both moderate internal pain and a shifting of the cloth of my shirt that irritates the hypersensitive skin over my belly. The reduced caloric intake and lack of exercise are causing me to lose muscle mass steadily, yet I am gradually gaining weight. Although the pain is not intense enough to interest me in pain medication, the only position in which I am now pain- free is sitting. Even my back hurts in other positions, presumably from supporting the big belly.

Dr.Saltz and his colleagues have not seen a similar case and have no idea why my belly is growing. They have scheduled me for more blood tests and a CAT scan and then for appointments on Tuesday, May 25, with Dr. Jarnagin, the surgeon who operated on my liver, and with Dr. Saltz.

There is nothing that I can do about this mysterious complication other than be practical. For the last few weeks, I have been relegated to wearing low-cut jeans. Consequently, I decided to send my clothes to my tailor with instructions to enlarge the waistbands of the trousers and the waists of the jackets to the maximum extent that there is spare cloth in each garment. I hope that some of them turn out to be wearable. With no chemotherapy, I may feel good enough this week to go somewhere that requires clothing more formal than jeans. 

Complaining

Because it is difficult to view one's own actions objectively, I may complain a lot more than I realize about my cancer-related physical sufferings. A great many cancer patients are enduring torments that are much worse than anything that I have experienced, and I assume that my own physical trials will continue to increase in severity. Thus, while I am far from stoic, I hope that I am not complaining much.

Economics 101

Recently, I was chatting with an economist and asked him what he thought about the U.S. dollar.

"I think it will be the world's reserve currency for a long, long time."

"Why are you so sure?"

"Because, we have the only thing that really counts."

"What's that?"

"The most nukes."

Misspent Youth

The Preakness Stakes, the second leg of racing's Triple Crown, was run today in Baltimore at Pimlico Racetrack. I have journeyed four times, though not in recent years, to that dilapidated facility-- known affectionately in its glory days, such as the era when Alfred Gywnn Vanderbilt was its president, as "Old Hilltop"--  to attend the Preakness. 

When I was a sophomore at Princeton, I won a daily double (i.e., I picked the winners of the first two races) at approximately 240-1 odds on a single bet at Pimlico on Preakness day, then followed up the next Saturday at another track with another big daily double on a single bet. Thereafter, I had a small following of freshmen who would cut class to take my bets to the tracks. Ah, misspent youth! 

Like most of us of a certain age, my powers of concentration are not what they were when I was an undergraduate. I made a single bet on the winner of today's Preakness, and I was lucky enough to win the exacta in the Preakness (i.e., I bet on the first two finishers in order) at 93-1 odds. Because I made two exacta bets, not one, the odds on my total exacta bet were cut in in half. As my bets on the Preakness were my only bets today, I did well: so well that I won back about half of what I lost betting on my own horses, Hot Money and Mustang Island, last week.

Aftershocks

The aftershocks of the financial crisis of 2008 are shattering complacency. Some of the pillars, or basic assumptions-- on which the civilization of the West in general and of the United States in particular currently rest-- look shaky. Among the pillars that never made sense to me that are now undergoing stress tests:

Sovereign debt of countries with mature economies, aging populations, and escalating social-welfare obligations is a sound investment;

Fiat currencies, subject to devaluation in order to stimulate exports or "repay" debt denominated in a debtor-nation's currency, are a storehouse of value;

The Euro, with no central fiscal authority and culturally limited mobility of labor, can survive sharply diverging member-country economic needs;

Governments have unlimited resources on which to draw to support domestic institutions and one another;

Because the dollar is the world's reserve currency, the United States is not constrained by the fiscal and monetary discipline required of all other nations;

The United States can conduct its foreign policy and military activities without fear of retribution within its own borders.

Eventually, it is reasonable to expect other pillars to undergo stress tests:

With a steadily declining percentage of world economic activity, the United States can continue to account for over half of the world's military expenditures;

The United States will not have to ration healthcare;

The social contracts that depend on working-age populations supporting retirees can survive declining birthrates;

With universal suffrage and largely uneducated populaces, democracies can make difficult decisions.

I have liked the world, with its convenient fictions, in which I have lived. I doubt that the reconfigured world will be nearly as privileged and comfortable for Americans like me. Nevertheless, I wish I were going to be around to see what happens.

Malcolm Gladwell

A friend brought to my attention an article by Malcolm Gladwell in the current (May 17) issue of The New Yorker, entitled "The Treatment: Why is it so difficult to develop drugs for cancer?"

The article uses Synta Pharmaceuticals as a case study.

 

Clearly, Gladwell appreciates the crudeness of extant cancer therapeutics and the difficulty of discovering new ones. My own reaction to his fine article is that we know a lot more about biology and cancer than we did even a few years ago, and we can't let ourselves get discouraged. We have to keep putting resources into basic research. And even though the classic venture capital model is broken, we have to find some way to keep financing small biotech companies like Synta (which is now publicly traded).

Urgency in Limbo

I am finding that my psychology evolves as my cancer progresses. Currently, constantly mindful that I am dying of cancer, I seem to be calmly accepting of my fate. Nevertheless, since being informed by Dr. Saltz that we are running out of cards to play, time has sped up for me again. Living in limbo, I have a newfound sense of urgency.

When I see a friend now, or watch on television an annual event like the Kentucky Derby, I am well aware that it may be for the last time. Although we renewed our subscription to our box at Saratoga-- there is a years'-long waiting list for those boxes-- for the race meeting from late July through Labor Day, we have not rented a place to stay in Saratoga.

Since my first CAT scan after my second surgery detected tumors in my liver, it has been clear that any additional treatments that I might receive would be palliative, rather than curative. Thus, the stakes were lowered. From then on, whether a particular chemotherapy were efficacious or not would not be a matter of life or death. (Awaiting test results, cancer patients who are in remission or still have hope of cure have a much harder time than I do.)

As I look at alternatives-- given that any treatments that I might undergo would be merely palliative and my willingness to trade quantity for quality of remaining life-- the final treatment that may make any sense for me to endure in order to try to extend my life is FOLFOX, the chemotherapy protocol that I am currently following. Consequently, I am quite concerned about my ability to tolerate FOLFOX and about its efficacy for my cancer.

Dr. Saltz will not know whether FOLFOX is shrinking my tumors until my next CAT scan, which has not yet been scheduled. By contrast, throughout each day and much of most nights, I am acutely aware of symptoms of my body's rebellions to being poisoned by the FOLFOX cocktail. Other complications from the poisoning have to be ascertained by medical testing.

Yesterday, in spite of my dosage of FOLFOX having been reduced by 20 percent, a blood test indicated that my platelet level has once again plummeted-- a rare response to FOLFOX, according to the literature. If my platelet level does not rebound significantly by this coming Tuesday, the 18th of May, I think that the best for which I can hope is that my next infusion of FOLFOX  will merely be delayed.

Meanwhile, I feel better today than I did yesterday. To avoid inconveniencing others, I am no longer scheduling social engagements. Nonetheless, I agreed on short notice to have lunch with a friend who is leaving town for the summer. Since that pleasant lunch-- at Raffaele, a neighborhood Italian restaurant-- I have felt even better. Moreover, I am having a fairly productive day. Though it is raining and unseasonably cold, I am joyful. 

 

Analgesic

Although I don't like to lose, I was content with Mustang Island's second-place finish in his race today as the 3-1 betting favorite in a field of 12. The race was at the same distance and over the same surface-- Belmont Park's inner turf course-- as Hot Money's race yesterday. Owing to a recent lack of rainfall, that course has been inordinately hard and fast; the last six sprint races over it, including Mustang Island's race today, have been won by the front runner.

Nevertheless, because Mustang Island is overly anxious to run, our trainer, Christophe Clement, instructed the jockey, Rajiv Maragh, not to go for the early lead, but rather to "cover up" Mustang Island behind and inside other horses. The idea was to teach still-inexperienced Mustang Island to relax in his races until the stretch run. Maragh rode to instructions, and Mustang Island ran well, even though he was not able to overcome the current course bias in favor of the front runner.

I had had a miserable night and day and did not make up my mind until mid-afternoon to go out to Belmont Park with Susan. During the hour or so that I spent with friends in the owners' boxes, visiting the paddock before the race, and watching the race, I felt no pain.

A Different Kind of Pain

For the last few days, I have not been very productive. I have been beset not only by fatigue and other  common reactions to chemotherapy, but also by relatively minor bone pain from Neulasta, a drug with which I am injected two days after undergoing chemotherapy, to counteract chemotherapy's suppression of my production of white blood cells. 

Nevertheless, my anticipation of Hot Money's return to the races has been steadily growing. For me, there could be few better antidotes to chemotherapy's poisons than to have a horse with Hot Money's talent win decisively, with the whole racing season in front of him. So I summoned my energy and went with Susan to Belmont Park to see him in the paddock and watch his race.

It was sunny and cool, with low humidity: perfect weather for racing, or just about anything else. The turf course was firm. Hot Money was calm in the paddock, fit without being lean, with a shiny summer coat-- just the way one would like to see one's horse at the beginning of a campaign! In a field of eight, he was the 8-5 betting favorite. 

After breaking alertly from the outside post position, Hot Money settled on the outside of the field, several lengths from the lead, as his rider, Majiv Maragh, assessed their unfolding position in the race. Nothing was opening up towards their inside. In order to avoid losing too much ground on the sweeping turn into the stretch, Maragh either had to pull Hot Money towards the back of the field or gun him towards the front. Maragh decided on the latter course of action, and Hot Money accelerated around the field, reaching the leader with a quarter of a mile to run in the six-furlong (i.e., three-quarters-of-a-mile) race. 

At that moment, I thought that Hot Money was going to draw away from the field and win in fine style; he had finished strongly in his morning works and his winning races. But his momentum faded, and he finished fourth. Although he seemed to be fine afterwards, it often takes a few days after a race for problems to manifest themselves. 

Despite my skepticism about rationalizing and excuses, there are plausible explanations for his tiring that have nothing to do with his health. Perhaps he wasn't as fit as we thought after his long layoff and simply got tired from a premature move in a fast-run race. Jockeys are convenient scapegoats for owners , trainers, and bettors, and one could be critical of Maragh's decision to unleash Hot Money so early in the race. In any case, as an antidote for my worries about my health, I will have worries about Hot Money's health until he wins again.

My hopes turn to Mustang Island's race tomorrow.

From Chemotherapy to Horse Racing

Yesterday, after reviewing my platelet levels and examining me, my medical oncologist, Dr. Leonard Saltz, recommended that I undergo another infusion of the chemotherapy cocktail called "FOLFOX." He said that he thought from his examination that the first two cycles of treatment with FOLFOX might be shrinking my tumors. I accepted his recommendation and commenced the third cycle of treatment.

If I feel well enough, I will go out to Belmont Park on Long Island: on Friday, to watch Hot Money run in the sixth race; and on Saturday, to watch Mustang Island in the 10th race. Based on Hot Money's performances on the turf to date (two wins in his first three tries and favored at $0.95 to $1.00 in his third start, in which he cracked a splint bone) and the apparent quality of his opposition, he will probably be favored to win. Although he has been away from the races for a long time, his trainer, Christophe Clement, is renowned amongst bettors for having his horses ready to run after long layoffs.

Mustang Island's prospects on Saturday are more difficult to assess. He is a little behind Hot Money in coming to hand this spring. Unlike Hot Money, he is still shedding his winter coat, and he has had one or two fewer works than Hot Money. The talent of the competition in Mustang Island's race is more difficult to assess, and Mustang Island has never before been asked to sprint on the turf. He won last year at the distance of 1 1/16 th miles in his only race on the turf. In that race, he was rank and fought with his jockey; we are hoping that in a six-furlong race, which will have a faster pace, Mustang Island will settle under light restraint behind the early leaders. Like Hot Money, he will be ridden by Majiv Maragh, a talented young jockey. 

I think that the probable favorite in Mustang island's race will be Onzain, which belongs to a friend of mine, Bill Punk. As owners and trainers say about their friends' horses, if I can't win it, I hope Bill does!

Mortality and Immortality

I think a lot about the dying process, and I fear it greatly. I do not dwell on thoughts of being dead, except for its effect on my family. Since I was a small child, I have equated being dead with nothingness.

With respect to physical and spiritual mortality and immortality, we humans differ from, for example, most if not all other mammals in our acute knowledge of our mortality. This great awareness of the life cycle does nothing to free us from it. We are conceived; we are born; we live for a time, during which we may reproduce and nurture offspring; and we die. I do not believe that, other than through genetic contribution to progeny, there is literal life after death for us or for other forms of life. (A species of jellyfish has, however, evolved to biological immortality.)

We human beings have unique power, through our big brains and technology, to affect planet earth and all forms of life that it supports, long after our individual lives cease. Unfortunately, it is easier for a human being to wreak long-lasting damage than to create long-lasting good. 

Eventually, both the human species and our planet will cease to exist. Thus, immortality seems to me to be a meaningful concept only if defined oxymoronically as having temporal limits coterminous with the survival of planet earth or with the human species. 

Our ideas may achieve immortality-- if not ascribable, then through their own DNA. Ideas interact with other ideas that give birth to other ideas, and so on. Hunting, toolmaking, know-how, language, oral tradition, music, farming, literature, religion, superstition, war, politics, science, teaching, law, technology, medicine, art, architecture, trade, business, finance, design, games, and all other human endeavors are based on, develop, and amplify ideas. Thus, in any human invention or innovation, there is potential immortality.

I do not believe that "things happen for a reason," or that a personal God has a plan for each of us, or indeed for the human species. I do not find any meaning in my cancer, other than as an ordeal that I hope spurred me to grow during my remaining life. Although I allow for the possibility of free will, I think that our individual fates are largely determined by randomness: It is good to be lucky, as I have been in so many ways in my life.

I am 67 years old. In another 67 years, there will be at most a few people who knew and remember me. In 500 years, like all but a handful of my 6.8 billion living brethren, I will be traceable, if at all, only in genetic material and/or genealogical records. Nevertheless, like any of my fellow humans, my fleeting mortality may leave in its wake contrails of immortality, however untraceable and dilute.

Derby Doings

Last Saturday's Kentucky Derby was won by Super Saver, ridden by Calvin Borel.  Jockey Borel's winning ride was his third Kentucky Derby victory in the last four years-- an unprecedented feat, accomplished on an extreme long shot as well as favorites or near favorites. Each of these rides has been a variation on a theme: Drop the horse to the inside rail at the beginning of the race, relax him, save ground throughout the race, then surge along the rail to the finish line, as the tiring horses in front drift out towards the center of the track. 

Everyone knows what Borel is going to do. Nonetheless, in the Kentucky Derby, the other jockeys, who usually make a point of not being shown up by letting a horse through on the rail, let Borel through unimpeded. My only explanation is that the Kentucky Derby must be so important to the other jockeys that they are more concerned about getting the best out of their mounts than they are about reaffirming their territorial "rights."

We once had a pretty good horse, Statesmanship (winner of  eight races in his career, including five graded stakes), which was repeatedly ridden up the rail to victory by his jockey, Jose Santos. Eventually, in the Bernard Baruch, a graded stakes race at Saratoga, the other jockeys deliberately bottled Statesmanship up on the rail.

Fortunately, I had a bet on Super Saver, who went off at 8-1 odds. That payoff almost got me back to even on my day's wagering.

Family Golfing Lore

My mother's father, whom we called "Daddy Bill, " died nearly a half century ago. One of our family stories about Daddy Bill concerned the instance in the mid-1930s when he loaned Bob Jones (popularly known, to his displeasure, as "Bobby Jones") his golf clubs when Jones found himself at Augusta without his own clubs. 

My father inherited that set of clubs from Daddy Bill and added its one iron to his own set of clubs. The rest of the clubs in that set, rendered sacred relics in our minds by Bob Jones, were eventually lost or stolen. When my father stopped playing golf, he passed the one iron along to me. I found it nearly impossible to hit and donated it to the museum at Redtail golf club in Canada, to which I then belonged. (Of course, there is no disgrace in not being able to hit a one iron. As Lee Trevino, who had been struck by lightening on a golf course, once said while exiting a course after a lightening alert and waving a one iron over his head, "Even God can't hit a one iron!")

Recently, my sister sent me some old newspaper clippings. One of them chronicles Daddy Bill's interaction with Bob Jones. It seems that the setting was not Augusta National, which had just been completed, but Forest Hills, in North Carolina. Jones was using borrowed clubs and was struggling with the driver in the set. At the ninth tee, Daddy Bill joined the small gallery following Jones's foursome and loaned Jones his driver. Jones hit Daddy Bill's driver so well that he even used it once for his second shot on a par five.

How did that tale become so embellished? Was it just the process of retelling over a period of years? My father was the keeper of golf stories in our family, and he loved to tell a good story. I don't know if my father was familiar with Mark Twain's dictum, "Never let the truth get in the way of a good story, unless you can't think of something better." Once my father told a version of a story that he liked, he stayed with that version until it became his memory of the event. If my father had been shown the newspaper article, I'm sure that he would have added to his repertoire my magnificent gift of the one iron, never touched by Jones, to the golf museum.

I played Augusta National only once, as a guest of Ted Danforth. When we reached number 12, the famous three par on "Amen Corner," I didn't realize that the pin was in its treacherous "Sunday-at-the-Masters" position-- the quintessential sucker pin placement. Ben Hogan once said that if he ever birdied number 12 on Sunday at the Masters, you would know that he had missed his tee shot. Not knowing any better, I took dead aim at the pin, and my ball came to rest about two feet from the hole. Not only the other members of my foursome, but also the caddies couldn't contain their laughter at my dumb luck. 

Striding across the Hogan Bridge spanning Rae's Creek on my way to the hole, all I could think about was the glory of making a birdie at number 12 at Augusta with the pin in that storied location. I missed the putt.