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!