Status and Schedule

This morning, I had appointments with Dr. Jarnagin, the liver surgeon, and Dr. Saltz, the medical oncologist. Dr. Jarnagin removed the remaining 36 of the original 40 staples-- four had previously been removed to treat the post-surgical infection that developed. Dr. Jarnagin also scheduled the second surgery, to remove the right lobe of my liver, for August 3. Dr. Saltz indicated that he will probably re-start my chemotherapy a few weeks after the August 3 surgery.

Dr. Jarnagin indicated that the trauma and pain associated with the second surgery should be comparable with that of the first. Just a day or so ago, the pain from the surgery on June 15 began to subside. I am starting to sleep a bit better and hope soon to start getting through the nights without the assistance of a nurse's aide. Yesterday, I was able to walk for the first time with a fairly normal stride and posture. Today, I began to cut back on the pain pills. A visiting nurse service is coming twice a day to change the bandages on the infected wound, and I am scheduled to continue taking antibiotics for approximately another week. Although my belly is still distended-- I am wearing size double extra large sweat pants--  the swelling is starting to subside. As soon as I have reduced my ingestion of pain medication enough so that I am not groggy, I will post an update on this blog inviting visitors.

Returning Home

Charlie will be returning home about the middle of the afternoon. We may walk from the hospital, which is probably .7 miles away. Should they be needed, there are a number of benches along the route. Yesterday he did 48 laps of the hospital hallway, but only four at a time, so the challenge will be the sustained effort, not the total distance.

The infection is healing well, but the open portion of the incision will need to be dressed on an as-needed basis--in any event, twice a day. So I will be trained this afternoon for my new role as Nurse Susan. I must say that the patient has a decided lack of confidence in my capabilities, although the doctor and (real) nurse say it will be easy and that I really cannot hurt him.

"Not Even a Speed Bump"

Having no knowledge of the blog or my post, Dr. Jarnagin just told me that the infection is "not even a speed bump." He said it would have no effect on anything from here on out, noting that the infected place is very small and already responding well to the antibiotics. He said the area would be completely healed in about two weeks.

A Bump in the Road

I had intended to entitle this post "Setback", but after hearing this morning's medical report, I decided to change to the above. I am hopeful that the new title better fits the situation.

Last night, after two consultations with the doctor on call, Charlie and I returned to Urgent Care (MSKCC's emergency room). The area around the incision had become redder, and the redness was spreading. At 2:30 a.m., after blood tests, cultures, and opening of several stitches to clean the wound, a bed was located in the completely full, in-patient part of the hospital, and Charlie was readmitted. He is on intravenous antibiotics.

This morning, the doctor said the infection is already better, meaning that it is responding to the antibiotic. The plan is to keep Charlie in the hospital one more night. After he goes home, a visiting nurse will change the dressing daily so the area can be kept open for continued drainage. Dr. Jarnagin's fellow says this happens in about ten percent of cases, and he appears optimistic about the outcome. I will post again later today with an update.

Incremental Progress

Charlie wanted to wait for some sort of major news before posting again, but I thought some of you might be wanting an update before then. I would describe his progress as incremental, a little bit day by day, but with a startling contrast when comparing today with a week ago. This morning he ate and enjoyed a full breakfast--oatmeal and juice before I got up, and eggs, bacon and toast with me. Last Wednesday, he ate a little jello and some fruit ice. Today he spent an hour or two with the newspapers. He didn't touch the newspapers we delivered he whole time he was in the hospital. He's walking two or three times a day over to the East River and back. One or two laps at a time around the hospital hallway was last Wednesday's exercise.

Pain control and fatigue remain major issues. When he is feeling up to visits or phone calls, we will notify everyone here. He still loves e-mails!

Happy Fathers' Day!

Less than six days after being admitted to the hospital, I have just arrived home.  Prior to the surgery, the surgeons had estimated that I would be released from the hospital sometime between six and 14 days after the surgery. I was interested to learn that the appendectomy that had been performed on me about 50 years ago had pushed my colon upwards and to the right. The pain on the right side of my abdomen that caused me to seek medical attention was owing to this unusual location of the colon (colon cancer does not usually present as a painful condition). I do not know whether or not the displacement of the colon had anything to do with the cancer or its failure to be detected in an earlier stage of its development.

I am greatly appreciative of offers to come and visit me. Once I feel well enough to receive visitors, I will so indicate on this blog. Also, I am appreciative of the e-mails that I have received since going into the hospital. My powers of concentration and recall have not returned to normal, and I hope you will forgive me if I do not remember some communications during this period. Although I do not intend to resume posting every day, I will post again when there is some significant change in my condition.

Progress Report

We are still hoping for a hospital discharge tomorrow, but a decision will not be made until perhaps this evening. Charlie feels stronger all the time, but he still has a considerable amount of pain around the incision. He says that yesterday's hallway laps totaled 25.5, equal to 1.8 miles. I lost count about midday.

First Breakfast Postponed

When I arrived this morning, Charlie was happy to report that the doctors had said he could order his first solid food since last Saturday. After much deliberation, he ordered scrambled eggs, oatmeal and apple juice. In an incident rather typical of hospital life, about ten minutes later, a nurse arrived saying he would be taken at 10:30 a.m. for a CT scan (part of a research study of Dr. Jarnagin's in which he agreed to participate). You cannot eat before an abdominal CT scan, and 10:30 a.m. is the cutoff for breakfast orders, so the nurse suggested reheating the breakfast delivered at 9:15 a.m. when he returns sometime after 11:00 a.m. That sounds like a delightful first meal!

I would like to report that Charlie is accepting all such incidents with good humor, but that is not the case. Still, I think his prickliness is just another sign of his continuing improvement.

Good News

Dr. Jarnagin was just in the room and said that Charlie is doing so well that he expects that he may be able to go home this week-end! He seemed noticeably better to me today, although he is still very fatigued and sleeps a bit after any exertion, and I'm pleased that my observation has been medically confirmed.

Thank you again to everyone who has e-mailed or left voice messages with well wishes. I pass on all of them to Charlie.

Good Progress

Charlie's color looks better this morning, and the medical staff says he's making good progress. He had a fever again last night, but it's down this morning.

Today's nurse, Susan Hertz, on hearing that Charlie did nineteen laps of the hallway yesterday (fourteen equals a mile), suggested that a balance of activity and rest is important. He seems to have taken her advice to heart, as he promptly got back in bed and went to sleep.

News from the horse racing front has not been good: Sacred Music finished fifth in her race at Longchamps this morning, and it's raining hard here, so W.C. Jones' race at Belmont Park this afternoon will probably be "off the turf." We imagine that his trainer will decide to scratch him. We did get a report on Monday of a good workout for our two-year-old colt, Backslider, at Keeneland.

Competitive Spirit

Charlie is stronger and more alert this morning. He had a fever during the night, but the private duty nurse had him get up and walk the hall, and that brought it down. Walking struck me as an odd antidote to fever, but Dr. Jarnigan's nurse practictioner confirmed this morning that the private duty nurse had done just the right thing.

As any of you who have had surgery will know, breathing exercises and walking are an important part of avoiding pneumonia, which is one of the most common complications. Charlie has a device with gradations that he needs to suck at least ten times an hour. The harder he draws a breath, the higher the plastic marker rises. He is not only interested in his own progress--his ability to raise the marker ever higher--but in how high other patients have been raising their markers. Doing laps in the hallway, he wants to know the standard for patient laps. As long as we can restrain him so he does not get too fatigued, I am sure this competitive spirit will serve him well in his recovery.

Dr. Weiser indicated that last night and today tend to be the peak pain days. Charlie controls a morphine drip with a button. When he's not moving, he does not have pain. When he's going to be getting out of bed, walking or doing breathing exercises, he pushes the button.

Overall, Charlie is doing very well in his recovery. Perhaps tomorrow he will want to dictate something himself to post.

The Morning After

The phone rang in my bedroom this morning at 6:20 a.m., and it was Charlie asking me to bring over his glasses right away. So clearly he is making progress. He was in a chair sitting up when I arrived. He is very tired--he's had little sleep for two days--but he's doing extremely well, according to the medical staff and by my observation. He will be up and walking a couple of times today, and Dr. Jarnagin's associate said he would feel like a real person tomorrow.

In the Recovery Room

David and I paid a brief visit in the recovery room. Charlie recognized us, appeared pleased with my report of the success of the surgery, but he was very groggy. We are home now and will be over again in the morning, at which time he should be in his room, #1636.

No Surprises

The surgery will be completed in about twenty minutes; Charlie is just being "closed up" right now. Both doctors reported that everything went exactly as planned. There were only the two tumors in the left lobe of the liver, and Dr. Jarnagin was able to remove both of them. The one in the awkward position had shrunk considerably with the chemotherapy, and he was able to remove it with margins with which he is comfortable. There were no complications in the removal of the right colon. David and I are very happy with the reports.

Charlie will be in recovery overnight. He will be sleeping and will not be aware of a five-minute visit from David and me, which we will be allowed to make in an hour and a half. We will go home after that for the night and return in the morning, when Charlie will be expected to be in his room.

A Late Start

Charlie did not leave the pre-surgical area for the surgical suite until 4 p.m., and I understand there may be as much as an hour of preparatory work before the surgery begins. Dr. Jarnagin, the liver surgeon, will operate first. It will be some time before we have any news at all.

Thank you for the many, many good wishes and positive thoughts sent our way in the last day or two. We really appreciate everyone's caring and concern.

A Beautiful Day

In order to maximize my energy for tomorrow's surgery, a nurse at MSK advised me to go for a walk today for exercise, rather than go to the gym. Although a session at the gym would have been more relaxing, it was a beautiful day for a walk-- sunny, just warm enough for a short-sleeved shirt, and low humidity. My son and I walked for a little over half an hour, to the 51st Street overpass over a dog park, and down alongside the East River. The dogs were in high spirits.

I have much the same feeling that I have had throughout my life when a vacation is coming to an end, and it is time to return to the real world: I feel as if I am returning to school or to work, but with an ominous overtone. Tomorrow, I will surrender myself to a procedure in which I will give up control and consciousness and emerge in a fragile, vulnerable, painful condition. But what wouldn't I have given a few weeks ago to have the possibility of longer survival or even a cure-- the possibility for which this procedure is a prerequisite? 

As I do chores and otherwise make final preparations for tomorrow, I am mindful of, and feel truly blessed by, the support of family and friends. Thank you!

 

Equanimity

It seems to me that it would be desirable to arrive for a major surgery in as much of a state of equanimity as possible.  Although I have had five abdominal surgeries, they were all routine. I cannot recall trying to prepare myself mentally for any of them. 

Today was calm. I slept late. We had lunch and dinner at superb restaurants with friends, as planned. (A special treat was a ride to and from dinner in a Maybach.) I read Saturday newspapers, and I went to the gym for two hours. In telephone conversations with Nicolas Clement in Chantilly and Christophe Clement in New York I learned that on Thursday there is a race at Longchamps for Sacred Music and a race for W.C. Jones at Belmont. I am about to watch a favorite old movie, The Spy Who Came In from the Cold.

I was heartened by conversations with my children and my parents, as well as with friends. The letters and emails that arrived during the day were also balm for my spirits.

Final Instructions

In two separate phone calls, I received final instructions today on preparing for my surgery. After midnight Saturday, I am to ingest no solid foods. On Sunday, I am to drink plenty of clear liquids, in conjunction with the same sort of bowel prep that one does before a colonoscopy. After midnight Sunday, I am to eat or drink nothing, though I may use prescription eye drops and brush my teeth. At 12:15 p.m., I am to report to MSK. At 2:15 p.m., the surgery is to begin. 

Late in the day, I called MSK to report that I am experiencing mild pain in my lower right abdomen. Pain in that same area had caused me to seek the medical attention that led to the diagnosis of cancer. The two surgeons, Drs. Weiser and Jarnigan, who are to operate on me Monday were to be notified by e-mail of my discomfort. If the problem worsens, I am instructed to go to MSK's emergency room-- which it calls its Urgent Care Center--over the weekend.

For days after my operation, I will not be permitted solid food. To prepare myself , I have been eating well all week. In addition to patronizing good neighborhood restaurants, I have had the pleasure of eating at Adour, Le Bernardin, Milos, Le Cirque, Gotham Bar & Grill, and the River Club. Susan and I are being taken to lunch tomorrow by some friends to L'Absinthe, a first-rate brasserie; and we are taking some friends to dinner at La Grenouille, arguably the last of the classical, formal French restaurants in New York City. It is too bad that I have been restricting myself to less than a glass of wine per day!  

My Surgical Procedure

Although the surgeons have the final say, it appears that I have been cleared for my surgical procedure by the internist, Dr. Vincenzino, who was assigned to review my test results and to examine me. She examined me on Tuesday and detected a heart murmur as well as a resting pulse of about 45 beats per minute. As I have never had heart problems, she thought the murmur was probably just a result of my anemic state. Nevertheless, she ordered an echocardiogram. On Wednesday about 12:30 p.m., I got the news that the cardiologist who interpreted the cardiogram found no abnormality. (Historically, my resting pulse was about 50. Over the last year or so, it had gone up to about 60. No one has explained to me why it has dropped to about 45 currently-- I am on no new medications.)

After fasting and otherwise preparing myself as instructed on Sunday, I will report to MSK for surgery on Monday. Following the surgery, Susan will post updates on my condition on this blog. For those who are interested in the procedure itself, you may read about it in an article that a friend, Martin Corrado, brought to my attention:

http://www2.mdanderson.org/depts/oncolog/articles/06/4-apr/4-06-1.html

Looking Forward

In the seventh race at Belmont Park today, a seven furlong race on the turf, Hot Money won his second consecutive start. Although he was favored to win, the race was quite exciting for us, as he came from eighth place at the top of the stretch to win by a head. The turf course was listed as yielding today and good on the day of his previous win, which means that he has yet to run on a firm turf course. Because Hot Money has a sprinter's speed combined with "a good turn of foot," i.e., the ability to accelerate quickly, his trainer, Christophe Clement, thinks that Hot Money will be at his best on a firm turf course. 

As horses compete above the level of claiming races, they are moved into progressively more difficult competition, with higher purses. Thus, even though Hot Money has closed fast to win both of his starts on the grass in impressive fashion, he will have to keep improving to keep winning. If he does indeed perform better on firmer turf courses, he may very well be able to keep moving up the competitive ladder. Meanwhile, he is doing for us what a promising young horse does for its owners: He is giving us cause to look forward to his races. 

Sacred Music is slated to run at Longchamps in Paris on June 16, and there is a race for W.C. Jones at Belmont Park on June 20. If two-year-old Backslider continues to progress, he may be ready to make his debut within the next few weeks. Mustang Island is recovering well from his curb, and should be ready to make the second start of his career within the next couple of months. As I approach my surgery, I am looking forward to all of these races.

How We Die

Since being diagnosed with cancer, I have read surprisingly little. The only two books that I have re-read are Frankl's Man's Search for Meaning and Nuland's How We Die. I have long thought that these two books should be on everyone's short list of essential reading.

Nuland gives what I take to be a clinically realistic, but nonetheless sensitive, account of dying. He makes it clear that, "We rarely go gentle into that good night." The practical value of reading his book, for me, is to have a better idea of what one might expect when dying and perhaps somewhat ease the process thereby. As Nuland points out, "In his essay 'Use Makes Perfect,' Michael de Montaigne suggests that a lifelong acquaintance with the ways of death will soften one's final hours." In the epilogue to How We Die, Nuland writes about his personal expectations for dying: 

     The only certainty I have about my own death is another of those wishes we all have in common: I want it to be without suffering. There are those who wish to die quickly, perhaps with instantaneous suddenness; there are those who wish to die at the end of a brief, anguish-free illness, surrounded by the people and the things they love. I am one of the latter, and I suspect I am in the majority.

     What I hope, unfortunately, is not what I expect. I have seen too much of death to ignore the overwhelming odds that it will not occur as I wish it. Like most people, I will probably suffer with the physical and emotional distress that accompany many mortal illnesses, and like most people I will probably compound the pained uncertainty of my last months by the further agony of indecision-- to continue or to give in, to be treated aggressively or to be comforted, to struggle for the possibility of more time or to call it a day and a life-- these are the two sides of the mirror into which we look when afflicted by those illnesses that have the power to kill. The side in which we choose to see ourselves reflected during the last days should reveal an image that is tranquil in its decision, but even that is not to be counted on.

Tom Pollock

This morning, I received a call that Tom Pollock had died in hospital. Tom and I were schoolmates and friends from the fourth grade, when his family moved to our school district, through the tenth grade, after which I went away to school. I always thought that Tom was the smartest of our group of friends, and he did go on to be a Russian language and cultural expert for the National Security Agency. Tom and I had lost track of each other for over half a century, until we were reconnected by another childhood classmate, George Martin, when George learned that we both had colon cancer.

Tom's surgery in the middle of April seemed to be a complete success. He was released from the hospital and went home. Shortly thereafter, he developed the complications that presumably led to his demise. According to the account that I got, he slipped away peacefully, in no apparent physical pain. I hope that he was at peace in his final days and hours.

Daddy Bill

We grandchildren called my maternal grandfather "Daddy Bill." William C. Kiker died on April 11, 1953, when I was barely 10 years old, and I never got over it. He was only 67 years old when a heart attack killed him. That was not considered to be a long life even then, especially for someone who was not overweight, did not drink or smoke, whose father had lived past eighty, and whose mother was still living. 

Daddy Bill's mother was born at the end of the War Between the States, in 1864. I recall visiting her on the North Carolina farm where he grew up, which had been an English land grant to his ancestors. Daddy Bill's father specialized in growing seed corn, and he was able to put all five of his children through four years of college.

Daddy Bill has always represented for me a gold standard for how a man should live his life. A portrait of him hangs in my  home office, and I have studied it often when faced with  decisions with ethical considerations. He was graduated in 1909 with a degree in civil engineering, and won the honors prize in mathematics, from Trinity College in Durham, North Carolina (which later changed its name to Duke University). His bride-to-be, my grandmother, Blannie Emmie Berry, was graduated magna cum laude in the same class, with honors in Latin and English.  He and one of his brothers, Paul, played on what is now recognized as Duke's first basketball team. Daddy Bill received retroactively a Duke varsity letter "D" for the years 1907, 1908, and 1909. (When my son heard about that, he asked me, "Dad, whatever happened to the athletic genes in the family?")

Early in Daddy Bill's career, in the time of Pancho Villa, he worked as an engineer in Mexico on railway construction. He worked also on the construction of the Florida East Coast Railway across the Florida Keys. In 1918, he moved to the little town of Reidsville, North Carolina.  In the early 1920s, he organized his own construction company, subsequently building roads, bridges, and airports. He also was an entrepreneur and an investor. Among other things, he and two partners operated a highly successful ferry across the Peedee River, and he owned several farms and a small chain of furniture stores. During World War II, he constructed military facilities. 

During the war, my father closed his architecture practice in Jacksonville, Florida, to work for the Army Corps of Engineers. Subsequently, and he and my mother moved to Reidsville, where he joined Daddy Bill's construction firm, which was building military facilities. I was born on February 6, 1943, in Greensboro, North Carolina, which had the nearest hospital maternity ward.

Daddy Bill was a true philanthropist. Not only did he give generously to institutions, such as Duke University, but also he gave directly to needy individuals at all levels of society, including food handouts to hobos at the kitchen door. Always a sports fan, when the local high school needed a sports stadium, he built and donated it. He helped to start the local hospital, which he subsequently served as chairman. A civic leader and pillar of the local Methodist Church, he served as a member of the city council and the county board of education. He was a charter member of the local Rotary Club, and he took a year off from his business interests to serve as regional governor of his Rotary Club district.

What I remember personally was Daddy Bill's charismatic warmth, humor, integrity, wisdom, and kindness. He always wanted to be present for the birthdays of my older brother and me. We would travel out of Jacksonville's July heat to North Carolina for my brother Bill's birthday, and Daddy Bill and my grandmother would come down to Florida in February for mine. There were a lot of kids in our neighborhood in Jacksonville, and they would trail after him as he went on his daily walks. He delighted in children, and he would enthrall us with his observations on our wooded Florida neighborhood's fauna and flora and on the constellations in the sky. When he came to Florida in warmer months, he loved to swim in the ocean-- never in pools, which he considered unsanitary. He would swim far offshore, beyond the waves. In North Carolina, we would sit on his large screened porch at night and watch the fireflies, which were much more abundant then than now.  

Daddy Bill and my grandmother took me and a woman, Mary, who had worked for them for many years as a domestic, on a visit to New York City. I had never been there, and, as Daddy Bill said, "Mary had never a chance to go anywhere." When we went to have dinner at the restaurant at the top of the Empire State Building, the restaurant would not seat us because Mary was black. We went elsewhere for dinner. I remember once in North Carolina being in a car he was driving down a dirt road through woods at night. Suddenly, he stopped the car and got out. He had seen a figure beside the road. He helped the drunken black man into the car with us and drove him to the hospital.

Nothing has ever made me prouder than walking along the sidewalks of Reidsville's main commercial street with Daddy Bill on a Saturday, when the farmers came to town. It seemed that everyone-- bankers, merchants, farmers-- knew him and came out to greet him, with obvious affection and respect; and he always introduced them to his grandson. I never had more fun at sporting events than I had going with him to the class D, minor league games of the Reidsville Luckies (Reidsville's major employer was the American Tobacco Company, manufacturer of Lucky Strike Cigarettes).

I have always known that I was lucky to have had such a role model. But I have never felt that I could live up to Daddy Bill's standards. Two days after he died, the local newspaper, The Reidsville Review, included in an editorial on his life the following words: "He developed notable ability in managing and directing business affairs, achieving conspicuous success. Much more important was his unselfishness, for as his business enterprises increased in importance and magnitude, he committed responsibility and authority to young men who under his wise guidance learned how to manage and direct important ventures. He was wise in counsel, loyal in friendship and exemplified the qualities of good citizenship." The editorial concluded: "Although curtailed in his customary activity for the past two years or more, his affability and cheerfulness did not diminish. A good, useful citizen has departed from us but the memory of his kindness, generosity and countless deeds of helpfulness will ever be cherished."

Belmont Stakes Day

Dunkirk was my bet to win this year's Belmont Stakes. He finished second to long-shot Summer Bird. That result was typical of my bets today-- I cashed only one ticket.

As poor as my handicapping was, it could not ruin my day. Susan, David, and I had fun, as did our guests. We enjoyed excellent sight lines from our new box. (We recently swapped the box on the front row that we had rented for many years for one out of the sun, which I am instructed to avoid while on chemotherapy.) The weather was perfect; the racing was first rate; and I saw many friends and acquaintances in the racing world that I had not seen since last August at Saratoga. The hard part of my day was informing some of those friends about my condition. 

Susan, David, and I hope to return to Belmont Park this Wednesday to watch Hot Money run. He is entered in a seven furlong turf race, and he is the probable favorite to win. Thunderstorms are expected to pass through our area on Tuesday and Wednesday. If the race is taken off the turf, we will have to examine the condition of the main track and decide whether to run him or scratch him. If we run him on dirt, and he performs poorly, we will have taken a race out of him at a time when he is training exceptionally well. But at some point, it would behoove us to find out if he can run as well on dirt as he does on turf. In this country, there are many more races on dirt than there are on grass. 

Charlie of Saratoga-- and Arabia

Mary Corrado very kindly sent more photographs, which just arrived, that she took during my same trip to Abu Dhabi and environs. In addition, she sent some photos from a visit that the Corrado family paid us in Saratoga Springs, New York, a year and a half earlier, during the August, 1978, racing season. The first three photos above show me studying intently the horses in the paddock; the fourth depicts Susan and me at the track; the fifth captures Martin Corrado and me at the kitchen table concentrating on handicapping the next day's races.

Tomorrow is the Belmont Stakes. I'm not sure, but I don't think that I have missed a Belmont Stakes since 1964, when I skipped my Princeton University graduation ceremonies to attend. So tomorrow, I'll be concentrating on my horse-race handicapping once again!

An Engineer's Perfect Pitch

This morning, I had a delightful visit from a sculptor, Julio Sanchez de Alba (www.juliosart.com/2009/04/my-new-website/), from whom I had bought a bronze of an elephant in 2005, one of 35 copies of his first piece, "Tantor." Julio was a mechanical engineer from Bolivia who got laid off in 2000. He proceeded to teach himself sculpture and metallurgy in the course of creating Tantor. Since then, he has pursued a career as a full-time sculptor. Judging from such recognition as the public commissions that he has received, it would appear that he is a commercial success. Having seen Julio's enthusiasm for his work and his ability to create bronzes of all sizes starting from tin foil models, I think that if I have ever met anyone who has found in midlife a field for which he has perfect pitch, it is Julio.

Surgery

This entry in my blog is written on the assumption that all goes according to plan.

There are three major surgeries, and one incidental surgery, within the overall surgical plan for me. On June 15, two surgeons will operate on me-- I am not sure who will go first. In the first major surgery, the colon surgeon, Dr. Weiser, will remove my right colon in an open-incision procedure that will take about an hour. In the second major surgery, the liver surgeon, Dr. Jarnagin, will remove the two cancerous lesions that have been identified on the left lobe of my liver, one of which is in a difficult location from a surgical point of view, plus any other cancers that he may find on the left lobe. In the incidental surgery, Dr. Jarnagin also will remove my gall bladder, because it's "in the way" of the liver surgery. Finally, Dr. Jarnagin will tie off a major source of blood supply to the right lobe of my liver, in order to make it atrophy, which will increase the regeneration of the left lobe of my liver. The third major surgery will be performed by Dr. Jarnagin six to eight weeks or more later: He will remove entirely the right lobe of my liver. The idea is to cut out all discernible cancer in my body and leave me with a large enough liver to avoid liver failure. The liver will then quickly regenerate. Although I do not yet know if I am to receive chemotherapy between procedures, chemotherapy will resume sometime after the third major surgery, as the odds of recurrence of the cancer are high. (It is my understanding that, when cancer is said to recur, it actually was not completely eliminated from the body.)

The surgeons' expectations for June 15 are that, not including preparation time, the colon surgery will take about an hour, and the liver surgery will take at least three hours. After the surgery, I will stay overnight in the recovery room and then be moved into a hospital room. I will be gotten up to walk starting the day after surgery. A couple of days after surgery, I can begin to take liquids and, after a few more days, solids. I will have a device which will, within limits, enable me to administer my own pain medication. Six days to two weeks after surgery, I will be released from the hospital. It will take six to eight weeks or more for me to regain strength and full powers of concentration. During the initial stages of my recovery, I will be under instructions not to lift anything heavier than a newspaper or a glass of water. Eventually, following recovery from the second procedure, I can look forward to resuming a normal diet. Dr, Jarnagin told me not to give away my wine collection.

As I learned only eight days ago that surgery was a possibility for me, I am still adjusting my thinking to this new course of action. It seems to me that, even though the June 15 surgery is an important event fraught with risk, it is intended to be but a part of a multi-stage process. I have to be to be prepared mentally to stay the course in a multi-year marathon, while being thankful for life each step of the way.

Four Appointments

Today, three months after my initial cancer diagnosis, I had four appointments at MSK in preparation for my scheduled surgery on June 15. The first appointment was an ultrasonic reexamination of my right leg to determine the status of the blood clots that led to the insertion of a filter in my vena cava (they have not migrated and have diminished significantly in size). The second was a follow-up meeting with the surgeon who will operate on my liver, Dr. William Jarnagin. The third was an initial meeting with the surgeon who will resect my colon, Dr. Martin Weiser. The fourth was for pre-surgical testing. On June 9, I will meet with the physician who will clear me (presumably) for the surgery and be available to deal with any issues that might arise during my hospital stay that would be outside the provinces of the two surgeons.

A lot has happened to me in the last three months. I will post tomorrow on what I learned today about my upcoming surgery.

Charlie of Arabia

Mary and Martin Corrado, American friends living in Abu Dhabi, just sent me the two photographs above, which they entitled "Charlie of  Arabia." Although I wasn't there with T.E. Lawrence, these snapshots were taken on a business trip about 30 years ago, back when I still had hair. The photo at the top was taken at a stable in Al Ain, an oasis at the nexus of Abu Dhabi and Oman, just south of Dubai. The Arabian horse had a really hard mouth, and I remember him well. I think that the other photo was also taken in Al Ain. Wherever we were, it looks as if I was horse trading.

As I mentioned elsewhere in this blog, I tended to live in the present and future. I never kept a photo album or took many photos. Seeing these two colorful photos, I wish I had . They bring back memories of an adventurous time in my life.