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!