Wednesday, December 24, 2008

Christmas Message

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I've been remiss in not posting for a while. Ah, Christmas is a wonderful time, but some of us get rather disorganized throughout the run-up and I am one of those people. Check your dictionary under the word, "procrastinate," and my cheery-yet-frantic face will be staring up at you. Well, maybe not, but it should be.

Among other deficits this year, I've not sent out any Christmas cards. Yet, I have many friends and a great many blessings to be thankful for this holiday season. The list will not be complete, but it's a start. I know some of those it mentions will read this, and so, this is my message to them. Or to you, as the case might be.

C & J - My children. They haven't just grown up over the past months, they've stepped up and taken over many tasks without complaint. They've weathered a storm that they did not deserve to endure and they've done it with poise, humor and grace. My love to them, now and always.

My Parents - Imagine, if you will, the stress of having both of your children fall seriously ill at the same time. Now imagine that one of them lives hundreds of miles away and you've got yourself quite a conflict. That was some really out-of-control sibling rivalry, if I do say so myself! Mother and Dad, thank you for your indomitable and unquestionable love, your faith, your generosity and your many, many prayers on my behalf. I couldn't have gotten this far without you. No way.

Janet - For being the ultra-capable surrogate Mom to my kids when I couldn't be there, and for taking care of me without question or complaint–even to the point of running to McDonalds when cheeseburgers were the only things I thought I could possibly eat–I am forever in your debt. For offering your shoulder to lean on, a readily available sympathetic ear and those swift kicks in the butt; and for your wisdom in knowing which was necessary at any given time, I thank you. I will never take a bath again without pondering the necessity of flotation devices. You are family to me.

Mindy - A new friend, but possibly a long lost sibling. Our minds are too eerily similar to suspect anything other than genetic manipulation by aliens. I thank you for your understanding, your phone calls, for the little *cough* something that I'm not going to mention here, but you know darned well what I'm talking about, and for having the wit and wisdom to be practical and forthright at all times. Thank you.

Cody - For Courage. Made me cry, you little scamp!

Boyd - Another new-ish friend, but a lifer to be sure. Thank you for being so incredibly concerned, yet respecting my need for privacy and my bit of admitted self-centeredness during the worst days after the diagnosis. I know how hard it must have been for you to stay away. My wish for you this Christmas is that you'll somehow find the time to write your novel. It's a good one. I ought to know.

Lou - For phone calls, chauffeur services, talismans and tough talking. My hat is off to you, ma'am, and I don't take the hat off for just anybody!

Caledonia Presbyterian Church - some day I'll get around to thanking the pastor and congregation properly. The circle of love that's been wrapped around myself and my children has been a blessing beyond compare. From this small congregation, mighty things have been done, many bills have been paid, many meals have been delivered and they sing a mighty fine selection of carols in sub-zero temperatures too. The Lord is my comfort and He works through such as these.

Members of the Wisconsin Regional Writers Association, Pauquette Wordcrafters, Writers at the Portage and my friends from Norbert Blei's classes (including Norb himself, of course!)
- for food, for letters, for phone calls, for monetary support, for prayers and encouragement. Writers tend to be somewhat insular in nature, yet the friendships I've made in this community are amazing and humbling.

Members from Greyhound Pets of America-Wisconsin (Especially Ginny, Ellen and the "anonymous" donors.) Although it might seem bizarre to the non-animal lover, one of my greatest fears in those first very bad days was the growing conviction that I wouldn't be able to financially or physically support Simon, my nine year old greyhound, throughout my treatment. Simon is my ever-present comfort, my "heart-dog," if you will. When I relayed my condition on the GPA-WI forum, the response was both unforeseen and incredible. Through the care and donations from GPA-WI members, Simon had food delivered, his nails trimmed and a collection was taken up for a much needed dental and a biopsy for a lump on his leg–including transportation to and from the vet's office. It was a large bill and it was completely covered. Words cannot express my gratitude. Simon sleeps beside me every night and watches over me through some pretty long days. He is an exceptional friend and I thank you all for the gift of being able to keep him with me.

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The Mutant Reviewers From Hell - My movie reviewing friends and comrades. After the floods of June 2008, they came together and sent a care package and financial support. (I still have the pirate rubber ducky on my desk.) After the August diagnosis, they rallied around me again and continue to do so. I am so grateful to be a part of the Mutant Reviewers. I am so grateful for their friendship. I am so grateful that they haven't decided that I'm totally jinxed and voted me off the island. I love you guys! I really do.

My Friends at Interstate BP-Amoco - For phone calls, car maintenance, money in the jar, goody bags and visits to the bald shut-in. Special thanks to my boss, Bruce, for the two photo books which undoubtedly deserve a blog post all their own.

JoEllyn - It takes a special hair stylist to pull out the clippers and do what's got to be done. More than that, it takes a special friend. Thank you for everything you've done for me.

The Others - Anyone I haven't mentioned, and there are a great many of you. Thank you for being there, for caring, for praying, for lending aid, offering help, standing by for such time as you might be needed. Thank you all.

On Christmas morning, the kids and I will open presents, eat well, laugh, love and rejoice as we do every Christmas day. But no matter what I might find under the tree, nothing will compare to the gifts I've already received this year.

Merry Christmas to you all!

Friday, December 12, 2008

From The Front Lines: Rituxan and Vampires

This was written on November 25th. I've only just gotten around to typing it into the computer. (Spiral bound notebooks are my friends.)


I'm writing this from a treatment room in the UW Carbone Cancer Center in Madison, Wisconsin. Actually, "room" is not the correct word. I'm in a bay. Bay #9, if I remember right. I've been given my assortment of pre-meds, which consisted today of Tylenol, Benadryl, Prednisone, Zofran and Emend. Yep, all of that and the chemo hasn't even started yet. Except for the prednisone, I guess. That is considered a chemo drug in my situation.

I'm hooked up to an IV drip, (I've been carrying the needle around in my arm for a few hours prior to this,) and I'm waiting primarily for the Benadryl to kick in so they can get the infusion started for real. Figure about a half an hour.

The first stop will be Rituxan, a monoclonal antibody that specifically attacks B cells. It seems to be a new treatment in the oncological arsenal, and from what I hear, it kicks butt. The inconvenience of it is that it takes for-flippin'-ever to administer because too fast an infusion can bring about some major allergic reactions. (Thus, the pre-emptive Benedryl.) The Rituxan alone figures to take about three hours. The rest of the drugs combined, probably around one hour.

I'm sitting in a reclining chair. It's the first time I've been assigned to one of these. I usually get a room with a bed because of the length of my treatment. I was a little disappointed really, because I like to nap and this chair is not staying reliably reclined and I don't particularly want to be ejected from it unawares. (On the other hand, that would lend some excitement and adventure to the nurses' lives.) But, it's busy today and they did give me a room with a television. Ironically, I've never exercised the television option during out-patient treatments. Inpatient was a different story, but they kept insisting on wheeling me off to do tests and lab work during Hogan's Heroes. What was up with that?

Eh, I really can't complain. Like I said, the ol' cancer center is a bustling place. Lots and lots of folks in various states of alopecia are being shuttled along the assembly line. I even saw one in handcuffs and a uniformed escort out in the waiting area. Anyway, one of the nurses mentioned that Tuesdays are the busy days, Monday not quite as much. Today is, indeed, Tuesday.

I haven't spoken to my "neighbors" nor they to me, but that's completely normal. Wandering around and being social is not optimal when everyone is hooked up to their own IV pole. Even in the waiting room, most patients stick tight to whoever brought them here. (I drove myself.) We're not unfriendly, just a bit self-absorbed.

The woman directly across from me is about my own age, maybe a year or two younger. Her cell phone rang a little while ago and I got a kick out of the nonchalant way she said to the caller, "Actually, I'm not in my office at the moment." No further explanation given.

Across the hall on a diagonal line is a patient who I can look at directly. If our chairs were on wheels, we'd be set up for a serious game of chicken. She's very young, early twenties, if that. She has long red hair in a ponytail. Most likely a newbie. I silently wish her well and I'm glad her sister is with her.

The decor in the bay is meant to be soothing, I'm sure. The walls are white but appear slightly yellow in a nicotine hue under the fluorescent lights. The floors look like hardwood–or possibly they're that fake stuff that just looks like hardwood. They're a pleasant rich honey shade. I like the floors in this hospital.

The upholstery on the furniture is a sort of subdued teal blue and the curtains covering the windows between the rooms are multicolored in a variegated geometric patterns–blues, greens and a sort of tangerine orange. They aren't as loud or obnoxious as my description might imply. I don't think I'd use those colors in my house though. Blue and orange haven't set well together in my mind since I had a bad meal at a Howard Johnson's when I was a kid. (They always put a cookie in their sherbet though. I remember the cookies with fondness.)

The bays with beds always have some sort of art print on at least one wall. Always scenery of some sort. Pastoral or garden-ish. The chair bay is smaller though. No art.

Rituxan started now. I have a blood pressure cuff secured to my right arm. It's set to go off every fifteen minutes. Standard procedure. I'm also supposed to let them know if I get itchy or short of breath. As this is the fifth cycle, I don't anticipate a problem.

My first stop this morning was to the lab to have blood drawn and the IV put in. That's also standard procedure. Today's vampire was a very pleasant lady, older than myself, who I think has possibly not been a vampire very long. Her first instinct was to use a vein in the back of my hand. I didn't exactly argue about it, but I did mention that I'd never had one put there before for chemo. You want a really good vein for chemotherapy.

She took no offense, but willingly expanded her search for a more northerly drilling site.

For long minutes, she palpated, heat-packed and palpated some more, trying to find the mother lode. Once she'd decided on a promising location, she took even more time to assemble everything she thought she'd need for the procedure. And then we were back to the heating and palpating again. Finally, she screwed up her courage, made the jab and . . . missed.

This didn't excite me at all. Hey, I'm a notoriously hard stick. I have shy veins that like to roll away from sharp objects. The record is five pokes and that was when I was inpatient.

So, since I was already punctured, the nice vampire lady went looking for that elusive vein with the needle. She tried going up, she tried going down, she went left and right, trying to catch that sucker and spear it like a sturgeon.

Then she hit a nerve and that, my friends, was quite enough. When I say, "ouch!" I mean it.

Distraught, she apologized to me. I, in return, apologized to her. It's not her fault my veins have mad Jedi skillz. I honestly felt a lot worse for her than I did for me. She called in another technician to take over the job. Same vein, but a little higher.

Technician number two . . . also missed.

During all of this, probably three or four patients had rotated through the other chairs.

Now, I can't say I was jumping for joy and clicking my heels over two bad sticks, but a small part of me was actually relieved that the second tech, a far more poised and confident individual, couldn't get it either. I really felt bad for the first tech. She tried so hard.

Tech 2 did her best, but finally looked up and said, "We need Vlad."

Enter Tech 3.

Vlad isn't her real name, of course. I made it up. It probably should be her real name though.


Duly summoned, Tech 3 strode over, flipped my arm off the side of the chair so that it was dangling out in space, picked her spot and had that sucker in there before the words, "little poke now," hit my ears. Dang. I was impressed!

They got the blood they needed, used some gaudy purple self-adhesive bandage to secure the IV gizmo to my arm, and sent me on my way.

Anyway, I'm going to stop here for today. Benadryl always makes me abominably sleepy and I really want to get a nap in before rituxan finishes up and the nurse comes in to do the other drugs.

I just hope the chair cooperates.


Postscript: The chair cooperated.

Tuesday, December 9, 2008

So, how's that working out for you?

On November 1st, in the year of our Lord 2008, I followed my normal daily procedure and went to a small nearby restaurant for breakfast. Breakfast is a big deal for me these days. In the Pre-Cancerous Era, work began at 6 o'clock in the morning and breakfast generally consisted of coffee and more coffee. Honestly, I'm seldom hungry in the morning. It's just one of those things.

After the diagnosis, work was a non-starter and breakfast became mandatory. The number of medications I'm required to take varies a bit, but the minimum amount of morning pills is four. On a bad day, post-chemo, I might take up to nine at a time. (I also have meds to take in the afternoon, at bedtime and there are a few more in the 'as needed' arsenal.) Taking them on an empty stomach is not optimal.

So, that brings us back to the restaurant. I like the place. It's an easy door-to-door shamble on a sunny, warm day. The waitresses and regulars know me by name. It's seldom very busy when I go in, so I worry less about catching some bug while my immune system is out of whack. (Technically, I'm supposed to wear surgical masks out in public, but how could I eat?) It's extremely affordable, the food is quite good and it gives me a chance to get the heck out of the house. It's my little slice of daily sanity.

Anyway, on the 1st, I was sitting there eating eggs (scrambled), toast (white), and bacon, (just-right-crispy-good) when the door opened and a man walked in. At first, I was too busy writing my first dose of literary schlock for National Novel Writing Month to take much notice of him, but eventually it occurred to me that he was going booth to booth doing the handshake schmoozy thing.

Ah. A candidate. Making the pre-election day rounds. Things like this happen in small towns. Seriously, the last time we elected a mayor, the only candidate who didn't bother to attend a Q&A session hosted by the local charter school kids got eight votes. Eight. You schmooze or you lose.

Anyway, inevitably, the guy entered my peripheral vision and I looked up benignly.

"Hi!" he said with the kind of smile that suggests that the bearer has to apply ice-packs to his strained facial muscles every night before bed.

"Good morning," I replied and accepted his proffered hand in a brief, but warm shake. I think he'd been practicing. It was a good handshake. (I didn't spoil it by hauling out my mini-bottle of antibacterial hand sanitizer until after he left.)

He sized me up, clearly trying to fit me into some sort of niche so that he could, you know, relate to me. I have to admit that a bald chick wearing a "Cancer Sucks" baseball cap does not blend well into the normal constituency demographic. For all I know, he was trying to figure out whether I was going to live until election day. Cause, you know, otherwise, why bother?

"How are you?" he asked, buying time and focusing mostly on my hat.

I know my right eyebrow twitched, but I answered obediently, "Fine, thank you. How are you?"

"Great, thanks," he said, and went on manfully, "I just wanted to stop a moment and introduce myself. I'm [Insert Name Here]. I'm running for [Insert Office Here].

I nodded encouragingly. I'd seen that name on a million yard signs, and brochures featuring his face had been shoved into my storm door at least ten times. For a candidate whose platform seemed based on saving the planet and ecological responsibility, I'd always wondered if the ghosts of all those trees sacrificed on the alter of his saturation bombing style of publicity haunted his dreams at night. I should have asked him.

He paused a beat, then asked offhandedly, "Uhm, do you have cancer?"

"Why yes, Mr. [Insert Name Here]," I said without audible sarcasm. "I do."

"Oh."

"Non-hodgkins lymphoma," I added helpfully.

I really expected him to trot out some homily regarding health care or insurance. I mean, those are things candidates presumably have some sort of position about, right? At the very least, I thought he might do a little *tsk* of sympathy at life's unfairness.

What he said was, "So, how's that working out for you?"

How's that working out for me?

I think he was tasting his bunions before it was entirely out of his mouth, but sometimes you just can't stop that runaway freight train. I can relate. I've said a few astoundingly inane things in my time. We all have. It was just his bad luck that it happened on the campaign trail while dealing with a cancer patient of all things. At least there weren't any reporters around.

Hey, I was nice! I smiled. I told him, briefly, that I was undergoing treatment and that the treatment was going well. I don't know if he ever heard me, because I think his internal replay was absolutely writhing at the stupidity of his question. He wasted no time in extricating himself from the situation by wandering off to introduce himself to a couple he'd already introduced himself to. It was sort of cute.

But it does bring up the question: is cancer a subject you really want to broach with a cancer patient? Or should it be considered a conversational 300lb. gorilla to be avoided at all costs?

For this cancer patient, it's not an off-limits subject. Not at all. I don't mind people asking what I have. (Keeps them from staring at my chest and speculating whether I lost one or both.) I don't mind questions. I do try for the most part to keep my answers informative but reasonably short. Unless you really want to hear phrases like 'anterior mediastinal mass' or get a play-by-play recitation of my latest CAT scan adventure or a monologue about nausea, brevity is best. Well, if you're reading my blog, maybe you do want to hear about all that stuff, but its probably not appropriate for the man-on-the-street. I am cognizant that there is such a thing as "too much information." I'm okay with that.

Really asking is better than speculating. After all, it's my 300lb. gorilla. I'm not going to let it throw bananas at you or anything. (Although it's not my fault if you feel like you've tripped on a peel.)

Oh, but if you're wondering if I voted for Mr [Insert Name Here], I'm afraid you're going to have to keep wondering. I don't talk about things like that.

Friday, December 5, 2008

All Dogs Go To Heaven

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When I bought my house, (with generous aid from my parents, to be honest,) it seemed pretty well perfect. A well-kept block of homes, easy walking distance to the center of the small town I live in, a fenced yard and a property that was large enough for a family of three without being too much for one person to maintain. After all, the kids will move out someday. I think.

I didn't expect any trouble, but trouble was what I got. Within a month of moving in, the trees had been T.P.'d and some cute prankster had turned on the outside water faucet while I was at work; a water bill I would not care to repeat. Worse than that, I began to suspect that at least one neighborhood urchin had a key to the front door. Nothing ever disappeared from the inner sanctum of hearth and home, but when you come home to a door that is–shall we say–ajar more than once, you have to chalk it up to something other than sheer forgetfulness or poltergeist activity.

I had the locks changed, but that didn't resolve the feeling of danger or fear of invasion. Believe me, it's no joke for someone of my nature, (cowardly) and stature (wimpy) to go from room to room, checking closets and the basement for an interloper. When the kids were here, it was easier to tap into the bravery gene. Mother's instinct and all that jazz. But on the days and nights when they stayed with their father, my cute little house seemed a lot less welcoming. The neighborhood seemed a lot more hostile. And lacking a significant other, I decided to do the next best thing.

Time to get a dog.

For years and years, I'd had a fascination for whippets. As a teenager, I'd briefly worked for a woman who had a few. They were sleek and athletic looking, but generally quiet and companionable. Whippets, however, are prohibitively expensive for the convenience store flunky budget. My fantasy of eventually becoming the crazy old whippet lady of Portage was not to be realized.

Besides, in the matter of deterrence, I had criteria that needed to be met by my prospective canine companion.

1. I wanted it to be large.

2. I wanted it to be good natured. After all, I had kids of my own. Cujo need not apply.

3. I wanted it to have a nice big bark.

With that sleek whippety silhouette in mind, I web-searched out greyhounds and hit the mother lode. Wisconsin had a few active greyhound racetracks and therefore there was a ready supply of retired hounds needing to find couches to call their own. I did some research and found pretty much everything I was hoping for in the breed description – including the good news that greyhounds are not heavy shedders by any stretch of the imagination. Bonus!

I sent in an application to the Wisconsin chapter of Greyhound Pets of America and waited. This led to a home visit by two group representatives and a humongous boy-hound with a cast on his leg. The reps were actually a little nervous because poor Red's injury had brought him off the track only a short time ago and he was still new to the idea of house breaking. Despite this, he was friendly, happy and very quiet. Though he was not destined to be ours, I was sold on the breed.

Relying on the expertise of Becky, the adoption rep I worked most closely with, I let her choose the greyhound that she felt would be right for us. Dressed to the nines and late for a Christmas party, she dropped off . . . well, she dropped off the anti-Red. It was brindle. It was wild. Its name was apparently Kurt.

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Within two minutes of entering our little family circle, Kurt promptly counter-surfed across the stove top, then ran down the hallway and decided to try out the bathtub. (That was the first and last time he ever jumped in voluntarily.) I swear Becky's SUV left skid marks on the street while she was making her getaway.

She and I still laugh about that.

Not particularly liking the name Kurt, and since he didn't respond to it anyway, I renamed our new hound Simon. Over the course of the next few weeks, he growled at the kids, snapped at yours truly, shedded like a yak in spring thaw and steadfastly refused to bark at anyone who wasn't small, squeaky or featured on Animal Planet.

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Simon and I came to an understanding. Eventually. In fact, these days he is my shadow, my constant companion and an immense source of comfort during those sleepless nights when the brain just won't quit chewing over problems which certainly can't be resolved at 3am. Sometimes you just need to hug your dog.

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Anyway, because greyhounds are like potato chips – you can't stop at just one - I began fostering other greyhounds for GPA-WI. Fostering offered Simon, (who at the time had developed a hint of separation anxiety when the hand-that-fed went to work,) some fraternal companionship. It was also a nice non-commitment way for us to find out for ourselves whether the household was big enough to contain two greyhounds.

First was Lonnie, a sweet three year old girl who was fresh off the track, yet smart enough to discover that a greyhound can fit very nicely into the big blue recliner in the living room. Simon, clearly impressed, quickly followed her example. The recliner has been Simon's turf ever since. I get a folding chair.

The next foster was Lucky, a sweet old girl who sure never lived up to her name. Her health problems were legion, up to and including a missing toe. She was an exercise in patience and somewhat eroded veterinary-related skills on my part. She also knew how to smile, the only greyhound I've hosted who could do that. Past nine years old and special needs, I was under the impression that she was a lifer as a foster, but she was adopted by a woman who fell in love with her hard-luck story. I was sorry to see my Lucky girl go, and devastated a few years later when I learned that she'd died. Of cancer.

We had a short term foster dog after that, a perfectly amiable fellow named Johnny, who occasionally and without provocation launched into poor Simon with snarls and teeth. To this day, Simon has the scars from Johnny's assertion of male domination. I wasn't unhappy to deliver him to his adoptive home.

And then came Flower.

After Lucky, I didn't think I'd ever run across a more needy foster hound, but Flower was the embodiment of neediness. My understanding is that Flower and another greyhound, were owned in Texas by a person who, for health reasons, could no longer take care of them. After an undetermined span of time of living with sub-standard care, they were shipped to Wisconsin with a load of chihuahuas. The recipient was expecting the little dogs, but not the large ones. When the new owner attempted to send the greyhounds to the local humane society, GPA-WI was called and Flower eventually ended up with me.

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She smelled just about as bad as a dog can smell. Her ears were full of gunk. She was wormy. She was thin. She was absolutely terrified and completely disoriented. But my God, she was so sweet. During her first full day with us, she guiltily crept up onto the couch–she clearly remembered couches–and stayed there for the next week, leaving it only to eat or to go outside and do her business. She seemed, if I can anthropomorphize a bit, to be of the opinion that the couch might disappear if she didn't maintain her vigil.

She broke my heart.

Eventually she learned that the couch was a permanent fixture in the house. She learned that food was ample and that cuddles were freely given and lovingly received. She discovered our crate full of dog toys, and as though she thought she was doing something naughty, she played only when she thought no one was looking. But she did play, her half-amputated tail a helicopter rotor of delight that threatened to lift her right off the ground. She snuggled and wiggled and loved us as strongly and fiercely as a dog can possibly love anyone.

The inevitable call came, just before Christmas, that a family had indicated some interest in Flower with an intent to adopt her. I spent one sleepless night watching the lights flicker and dance on our somewhat dilapidated Christmas tree. I studied the back end of a fuzzy squeaky toy that had somehow been ballistically and enthusiastically lodged in the upper branches.

I sat on the couch with Simon at my feet and a blissfully sleeping Flower beside me, her head pillowed on my lap.

I thought about sending her to a home that undoubtedly offered more than our measly little one-income, low-income household ever could. I thought about sending her away from the couch, from security. And while I know, to this day, that she would have adapted, it was not within me to strip her security away ever again. Not for any reason.

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I called the adoption coordinator and made Flower an official part of the family.

She bloomed with us. She adored the kids and worshipped the ground Simon walked on. Not exactly a canine Einstein, she was silly and goofy and sometimes downright dumb. She crept up onto my bed every night and displayed no respect for personal space. Often I would wake up and find a paw draped chokingly across my neck or feel greyhound snot being lovingly dribbled into my ear. You couldn't get mad at her because she was so sweet and clueless. She was even mugged by a squirrel once.

We had her for almost three years of unconditional love.

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In September of 2007, my daughter and I held Flower and loved her as a veterinarian administered a fatal dose of barbiturates. Flower did not want to go.

I will never, ever forget that she did not want to go.

To this day, I have to remind myself that the decision I made was made out of compassion and a desire to spare her prolonged misery from an out of control, wickedly suppurating tumor. I have to remember that her fate that would have been no different if we'd put her through more surgery or treatments. We could have kept her a little while longer, but at an unfair cost to her.

Cancer again.

How ironic is that?

The sappy anthropomorphics among us like to talk about the Rainbow Bridge, a pathway to the Other Side, where our dearly departed pets wait for us to join them. I believe in Heaven, I don't know if I believe in the Rainbow Bridge.

But when I think of Flower these days, I see her on a grassy lawn, patting her front paws wildly up and down in her distinctive dance of joy. She looks young. Not a puppy, but there's no tell-tale white of aging on her face. Her tail gyrates wildly and she looks up at me with absolute delight that I am still paying attention to her, still loving her, not ever forgetting her.

I am, in many ways, a practical person. The image I have of Flower dancing on that green grass is not something I would intentionally fabricate. I'm good at guilt. I hold it tight and I don't let go of it. I don't ever try to duck it, or make light of it. I wallow in it. I marinate in it.

But Flower simply came. And when my thoughts turn toward her, she is still there, still delighted and still loving me.

It's enough to make you believe in the Rainbow Bridge.

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Thursday, December 4, 2008

Down To The Marrow

It had to happen. By the fifth chemotherapy treatment, I came to a point where my white blood cells just weren't bouncing back as enthusiastically as they ought. Neutropenia wasn't exactly a new story for me, but this was the first time my doctor decided that I needed to go one step further than simply wearing a charmingly fashionable surgical mask while out in public. It was time for "the shot".

It's a drug called Neulasta, (pegfilgrastim) and if you watch TV, you've probably seen the ad for it. It features a strikingly attractive African American lady with close cropped gray hair, wielding a paint smeared pallet and a brush. A lady of the arts, perhaps an intellectual, the sort of lady you'd quite like to be friends with. And oh my goodness, she has cancer. The catch phrase is, "Are you ready to start chemotherapy?" She is. Yes indeed. She's got her Neulasta. You just know she's going to make it. I mean, I was inspired when I first saw the ad, and that was long before I was diagnosed.

When you think about it, Neulasta has sort of a nice ring to it. New-last-ah. Good syllables. Solid, reassuring, sort of upbeat. You can dance to it.

In a nutshell, Neulasta gives your immune system a jump-start by helping boost the production of white blood cells–or neutrophils–with which to fight off infections. As with many drugs, there are risks of various icky side effects, (ruptured spleen anyone?) but the most common by far is, "mild to moderate bone pain." The Neulasta website claims 31% of patients experience it. Other medical advice sites claim up to 57%.

Naturally, a need for Neulasta wasn't exactly the news I wanted to hear two days before Thanksgiving, but the doctor quickly reassured me on that point. Side effects usually take several days before they reveal themselves, so I could enjoy my turkey and stuffing in serenity. Well, unless the chemo itself made me sick, of course, but you can't have everything.

So, on November 26th, I dutifully drove myself to the local hospital and presented my arm for puncture. It's a slowly administered shot. It also stings like an irritated nest of hornets. Still, no pain, no gain, right?

On November 27th, I did indeed enjoy my turkey and stuffing. Okay, I popped a few Compazines to keep the chemo effects at bay, but no problem. I even had pie!

Throughout the long holiday weekend, I lived in a state of vague anxiety, waiting to experience my share of "mild to moderate" bone pain. I mean, what is bone pain anyway? Seriously, how bad could it be?

By Monday, I was breathing a smug sigh of relief. Let's hear it for being one of the lucky 69! Or 43! Or whatever! Yippee!

When I woke up on Tuesday morning, my feet hurt. My feet.

Throughout the course of the day, the pain spread. And spread. And spread some more. I mentioned it to a late-morning caller who asked what it felt like. A whole-body migraine, I answered with perfect truth.

It got worse.

If you've ever hit your thumb with a hammer, (or slammed your hand in a car door, or given birth without an epidural,) you might have some reference point from which to understand the intensity of my experience with *cough* moderate *cough* bone pain. You know how it is in those first moments after an intimate encounter between hammer and thumb? You clutch and cradle your hand between your knees. You hiss profanity between your teeth in an uncannily accurate imitation of Yosemite Sam. You might hop up and down or sway side to side or simply stand in a paralytic stupor of pain. It hurts so bad that your teeth sweat. And all the time, your thumb is throbbing. Throbbing. Throbbing in an exquisitely excruciating crescendo of intolerable agony.

Are you with me here?

Okay, now imagine that every bone in your entire body is a hammer-struck thumb.

During the worst of it, as I huddled under my blankets, passing the time by counting my pulse via the thudding in my clavicles, my darling daughter meandered in and gave me a critical once-over.

"Have you considered a body cast?" she asked with raised brow.
"Can't writhe in a body cast," I grated. It was a writhing kind of day.
"Hmm. Then I have to recommend a clinically induced coma," she stated firmly and headed for the kitchen to make me a cup of hot chocolate.

I think she's seen too many episodes of House, but I have to admit, it wasn't a bad suggestion.

I called my best friend at work and pitifully snurfled my tale of woe and presumed osteo-implosion. It's pretty unusual for me to whine about anything cancer related, so she took my clenched-jaw griping with the gravity which it undoubtedly deserved.

"Try a hot bath."
"I honestly don't know if I'd be able to climb back out of the tub," I mourned.
"So just keep adding hot water," she shot straight back, waited a thoughtful beat, then added, "and don't fall asleep."

Your femurs probably aren't supposed to hurt when you laugh.

Over the course of the next twenty-four hours, it did gradually get better. By last night, it was almost a memory, although once in a while I'd experience a full-body cringe when the ribs or vertebrae thumped at me in a reproachful sort of way. This morning, I feel practically normal. For a given value of normal, of course. At least I can sit in a chair without wishing for an out-of-body experience.

I don't want to disparage the makers of Neulasta. By golly, I know they worked really hard on it and it's a dandy little gem of a drug, no doubt! Love that name! Good syllables, like I said.

Nor do I want to discourage anyone from getting it if their doctor recommends it. Thank God, for Neulasta, say I. If it helps, it helps, even if it hurts. Let my white blood cells be fruitful and multiply. Go, you wild little neutrophils, go!

But I have to admit, I'm not sure I want to be friends with that nice artsy lady in the commercial anymore. Although I certainly wish her the best.