Light and Darkness

Luminarias in New Mexico

Mid-December brings greater awareness of light and darkness. The sun, something we take for granted most of the year, feels more precious, as she makes a briefer appearance each day. To compensate, many world traditions illuminate the early night with strung bulbs and candles this time of year, a time when light could not be more welcome.

As Katie pointed out during her visit to California last week, wintertime also naturally coincides with a looking inward. I've been thinking a lot about inward and outward, lightness and darkness, as the season seems to reflect my own process of dealing with mortality and seeking ways to bring greater light into life. After a few weeks of toil, I am finding that it is the interplay that makes each of these topics rich because without darkness, light does not exist. But this realization has not been sufficient to ease me.

Mortality has vexed the ages spurring philosophy, art, literature, and poetry since their inception and certainly troubling cavemen long before that. I know I am in good company. The trouble is that although everyone faces mortality, it is easier to ignore, to push death into the nebulous “that is going to happen later” category, if your life has not been knowingly threatened. Once you have been on the brink, how do you go back to selecting which kind of peanut butter to buy in the grocery store? Crunchy or smooth? Added sugar or just the mashed nuts? Or worse yet, how do you create long term goals or visions? I went through this same soul tug of war five years ago with my first cancer and now here I am again, struggling with the same questions. In many ways, I am finding round two more challenging. But yesterday afternoon I had a glimmer of one path forward. Think less, act more. 
 
Think less, act more.   This is contrary to how I have lived most of my life, so it is going to take some work but I am willing to give it a try because it aligns with my long term goal: inviting ease into my life.  This is an experiment. Stay tuned.

In the mean time, Happy Solstice and here’s to more light and less darkness ahead.

Not chemo

Had I not finished chemotherapy on election day, I would have been due for another round this week.  This possibility felt so present that Sunday I felt nauseous just looking at the crackers I would normally eat to settle to my stomach during the infusion, yet at the same time, I could not imagine doing it ever again. 

With each round of chemo I have grown more fatigued, never quite recovering to the energy level I had before the last infusion.  So when this week rolled around I struggled to imagine making the drive down to UCSF, voluntarily climbing in the chair and extending my arm for the next I.V.  Or opening another pack of Neupogen syringes and injecting them into my belly knowing that 12 hours later, my bones would split with pain as the medicine worked to boost my immune system. I kept thinking, how could I be doing another round this week? But if I had to, I would have and right now I would be hobbling around the house, likely tearful, trying to make the hours pass and at the end of each day, I would be grateful for just that, the end of the day. 

Remembering those days and nights acutely, David and I tried to celebrate the "not chemo" this week.  

Whenever we could remember, one of us would ask the other, "what are we doing now?"

"Not chemo!" the other would reply. 

Yesterday a beloved doctor of mine put things further into perspective, "Well you could have died.  That could have happened with chemo.  Check that off your list." 

Last night, I started thinking of all the things that don't happen each day.  All of the less obvious "not chemos."

Here is a start:

*car accident
*Luna escaping
*earthquake
*financial ruin
*crapping my pants
*complete amnesia

With my body slowed and mind jumbled by chemo, I now look for contentment in all the things that did not happen, rather than the things that did. 

The Departed

I learned about El Dia de los Muertos in high school Spanish class but did not actually experience it until living in New Mexico in 2008.  A parade assembled as it had for decades and wound through a gauntlet of cheering spectators in the South Valley of Albuquerque.  Cars transformed into mobile altars and floats transported dancing men and women dressed as skeletons in 19th century formal wear.  White and black were used to demarcate bone from empty space but everything else was ablaze in color.  The marigolds, dahlias, Mexican puppetry, music, dancing and altars honoring loved ones who have died were booming with life.  That Day of the Dead, I felt like a spectative sponge, taking everything in.  

 

The parade ended at a cement block community center housing local family altars with offerings of sweet breads, sugar skulls, flowers, fruit and often the family member's favorite meal.  Outside, strands of bright white bulbs connected vendor booths and illuminated families eating tamales and perusing artwork for sale below. Skull-masked grandmas pushing skeleton pajamaed babies in strollers covered in a rainbow of handmade tissue paper flowers.  Dogs wearing marigold wreathes. I went home thinking that Latin American cultures do a better job than most of joyfully commemorating their departed and bringing death out in the open.

This year I saw an ad in the newspaper advertising a Day of the Dead parade in Petaluma, a town 17 miles south of Santa Rosa.  I recruited David and Ellen, not knowing what to expect.  This is not New Mexico.  We arrived at the purported starting place, the bridge joining the Petaluma Riverwalk to find only a handful of other white people in street clothes like us. I was already disappointed.  Then the skeletons filed in, joining beach ball sized paper mache faces on sticks, and two costumed dance troupes.  Toddlers, grandparents and many teenagers inbetween comprised Grupo Coyolxauqui, masked and adorned with three-foot-feather headdresses, shells jangling at each ankle creating a rhythm even before the first drum strike.  The crowd grew as twilight fell.  A skeleton dressed as Pancho Villa distributed candles amongst all comers, helping people light them one by one.  Competing music from different ends of the mob rumbled and suddenly we were in motion along the riverwalk. It was then that I realized we, everyone, was in the parade. 

Soon we found ourselves in near darkness, the only light from hand held candles and a few widely spaced street lamps.  As we turned right onto the edge of Washington Boulevard, the procession necessarily narrowed to accommodate traffic and David, Ellen and I found ourselves on the heels of Grupo Coyolxanqui, dancers still spinning in unison already thirty minutes into the parade.  Wafts of tamales and pupusas from the vendors at the community arts center ahead soon overtook the cedar incense emanating from the procession.  After mingling with death, dance and drums I found myself very much alive, and ravenous. 

The town of Petaluma built a community altar within the arts center where the parade ended but clearly the party had just begun.  The mulitiered altar had a chair on top.  After wolfing down a pupusa we doubled back along the parade route to downtown.  We couldn't find our car.  We couldn't remember where we had parked our car.  I knew David and Ellen would pull it together and locate it.  Instead I followed behind them thinking about the chair.  The chair was for the departed.  A place to rest during a visit back with the living. 

As winter nears, wimpy as it may be in California, I thought about what I wanted to let go of and what I wanted to invite back.  The list in both columns is quite long but one has tugged on me since the Day of the Dead. I let go of many things during seven years of medical training, as is done by necessity.  Some were small and became routine: sleep, sitting down to eat, peeing when I needed to pee.  Some where big and painful: baby and wedding showers, birthdays, weddings, funerals, reunions.  Events commemorated on altars.  During medical training I missed many more than I attended.  And even for those that I successfully pulled a massive schedule swap and incurred federal government level favor-debt to attend, I often could only give my physical presence.  That ate at me because that is not who I am.  So now, I am inviting back events to sit in a chair and fully celebrate their significance, even if just for myself, as some are long departed. 

Pruning chemotherapy

Days before

I walk the yard
looking
for crisp edges
brown spots
yellow wilt

I pick leaves
one at a time
rub them between my thumb
and fingers
see what they can feel,
rough then nothing

I pluck faster
as a goat
finishing the rose bushes
stuck with thorns
to cherry tree branches
my scars stretch

Afterwards,
the sap in me
that makes the leaves curl
weak yellow brown,
from where I lie
the window only shows green

When Lightening Strikes Thrice

David's Mom, Mary, was diagnosed with breast cancer last week. I lagged in writing a post because I struggled to form sentences about these seemingly incomprehensible circumstances. So here is the truth told from three perscpectives.

Story 1: When I had cancer in medical school, Mike, my boyfriend at the time, was a PhD student in a high-powered Stanford Lab, the Principal Investigator of which just won the Noble Prize in Chemistry two weeks ago. When Mike went back to work and shared the news of my cancer, one of his lab mates pulled him aside and said,
"I'm so sorry Mike. When are you going to break up with her?"
"What?" Mike responded, utterly confused.
"Well you better do it soon, cancer is contagious." He honestly believed this.

Theory number one: Mary got cancer from me. So watch out friends and family, you better start wearing Xena Warrior Princess-style iron brassiere if you want to safely remain in my proximity.

Story 2: Jerry shaved his head even before I started chemotherapy to be in solidarity. Mary, not one to be outdone by Jerry, decided to go the extra mile and get breast cancer herself. These are Mary's intrepid words.

Theory number two: extra compassion gave Mary cancer.

Story 3: There actually is no story.

Theory number three: Mary was diagnosed just months after me, just months after our families connected, for no particular reason at all.

Religions have worked on the stomach-knot producing issue of finding reason in misfortune for milenia. In Christianity you often hear phrases such as, "This is my cross to bear" or "God only gives you what you can take" when a misfortune strikes. In Hinduism, hardships in this life are a reflection of ills your soul has made in previous lives. In Buddhism, there is no inherent suffering, it is our reaction to our circumstances that produces suffering.

None of these really jive with my experience or sentiments right now, although I am working on the Buddhist one. Why? Because it gives me an interesting task of reflection.

And doing is the only thing that helps.

Walking the dogs off-leash near Willowside west of Santa Rosa. Watching them investigate countless scents in the underbrush, now lush from one good rain.

Re-potting my house plants that have outgrown their soil, watering them, then watching new leaves spring forth just days later.

Carving Halloween pumpkins then watching them rot and slump off our porch railing after two days of mid-October 90 degree weather. The greyish white mold inside was thick as the fur of a wolf.

Watching Hannah, the 1.5 year old daughter of med school friends, investigate the two foot radius around our restuarant patio table. Fallen limes, a dislodged patio stone, a discarded mini-US flag, seven assorted jelly containers. A world of possibility.

Mazes

On Monday, David and I went to a four acre corn maze nestled between highway 101 and Stony Point Road, not far from the town of Petaluma.  David had an unexpected day off from work and we decided to take advantage of the lack of crowds.  We were one of the first cars in the parking lot.  The corn maze entry booth still stood empty.  Soon someone trotted over from across the field where she had been arranging pre-picked pumpkins for sale. 

"Do you want a map?"

"Nope" David and I chimed in unison without hesitation.

"Okay then, that will be 10 dollars even."

 

David and I started out trotting down the path buttressed by 12 foot tall corn stalks.  We took turns choosing the next turn when the path divided into two, sometimes three directions.  There were no dead ends in this maze so occasionally we would confidently trot in a circle and find ourselves at a familiar looking fork or corn stalk. 

Early on we firmly agreed, on no basis whatsoever, that the overall strategy of the maze involved reaching each other edge.  That at some point we would skirt the west, south and eastern edge of the square plot before finding our way to the exit on the northern edge, just meters from the entrance.  So when we spotted cars in the parking lot that bordered the western edge we cheered, then did the same when we spied the fallow field bordering the southern edge of the maze.  Then the path opened and we found ourselves standing in a hub where six  paths came together, we guessed right then found ourselves at a similarly designed hub amongst the corn, or was it the same hub?  We took the SE path then came back to the hub, then the NE path then came back to the hub, or was this yet another six-pronged hub?  And if it was, where was it in relation to the other six-pronged hub we had just stood in.

 

A twinge of anxiety overtook our original giddiness.   We found ourselves disoriented and it was beginning to get hot.  We kept circling.  On one jaunt we could see the outer eastern maze loop but again and again we could not find a way to get there.  I grew tired.  I sat on the ground in the middle of one of the hubs.  David ran loops, each time finding his way back to me rather than the way out.  We sat down together for a rest.  David spelled "Help" with shredded corn husks on the ground.  We were stubborn.  We had ran into two other groups, each with maps and declined a look.  We once again looked longingly at the eastern outer loop, we felt it was our ticket out, but were too proud to cheat through a few rows of corn to meet it.  We again sat down in he middle of one of the hubs, now not at all sure which hub it was.
 

I like how you can sort of see the
reflectionof my bald head
in this photo of the map

A pair of parents and their eight year old child entered the hub in which we sat.  This was the third time we had seen them. This time David and I asked for help.  The girl spoke to no one, incredibly focused on her task at hand as she was leading the way for her family.  The Dad however let us have a gander at the map, an areal photo printed on a postcard.  To our surprise there were four identical six pronged hubs.  And you had to traverse all four to get to the final outer loop to exit.  No wonder we were confused.  We parted ways with the family and set out to find the outer eastern loop that would lead us to the exit.  We started trotting again with renewed energy, holding hands.  We made a few false turns but knew the overall path out.  Then a few minutes later the corn rows parted and the vast pumpkin patch stood in plain view.  I felt relieved.  Free. 

We ate lunch and then David dropped me off at my Acupuncturist's office in Sebastopol.  On a small table in a treatment room I had not yet been in before, I spotted a circular metal disc etched with a maze.  Next to it lay a thin pointed stick which I presume one is supposed to use to etch their way through the maze.  I had seen this type of maze before, very intricate with the end appearing to be in the middle, but I had never given it much thought before. 

 

During the second part of my acupuncture treatment I lay supine on the table with a few needles in my feet, shins, hands and ears.  Dr. Prange gave me a breathing exercise, one that I could try during chemo the next day.  During the breaths I was to visualize a loop in the body, a breath in starting at the feet drawing up to the heart, then a breath out down to the palms, then a breath into the crown of the head, then a breath out down the spine and back of the legs to the feet.  I thought about my blood cells traveling in my body and that they too travel in maze like loops from arteries to arterioles to minuscule capillaries on to venuoles and then veins and finally back to the heart.  Just like the corn maze and just like the metallic disc on the table.  And I wondered why mazes are repeated in so many cultures.  Mazes are everywhere.

Later that day I learned that the metallic disc at the Acupuncturist's office was a replica of the famed Chartres Cathedral labyrinth built in 1230 in France.  Pilgrams from all over Europe came to walk the labyrinth as a devotional substitute for a pilgrimage to Jerusalem.  This process of walking quietly was felt to be an act of prayer.  Some scholars think that arriving at the center signified finding peace with god at death before the pilgram slowly retraced their steps to re-enter the outside world, be re-born, and go home again.

 

Although there are many labyrinths in Europe, labyrinths dating back to 1200 BC are found in Arizona (Tohono O'odham and Pima tribes), India, Egypt and China.  According to an O'odham oral historian, the labyrinth design depicts experiences, dreams and choices we make in our journey through life.  A legend in China tells that since evil spirits were only able to travel in straight lines, mazes served as a way to either trap them or protect the good.  Similarly, a story in Scandinavia tells that fisherman built pebble mazes on the beach before embarking on journeys at sea so as to trap bad luck on the shore.  According to Hindu lore, the universe itself is a game, a lila, that the gods play.  Walking a labyrinth is following in the steps of Shiva, the divine transformer who is lord of the dance.  Whether for protection or devotion or entertainment, I can understand the universal appeal of labyrinths that has cut across cultures and time.

I suppose there are as many labyrinth designs as interpretations of their meaning, but when I was in the corn maze I realized a couple things:

1. When you are in the maze, there is nothing else.  I did not think of cancer, of a future job, of the grocery list, of bills to pay.  It reminded me of the end of yoga class while laying in shavasana (corpse's pose). During this meditation you are supposed to empty our mind, yet I was never able to do so.  Next time I will remind myself of how easy that was in the corn maze.

 

2. There are no dead ends in life.  No matter what fix you get yourself in, there is always a way out.  And when you do, you celebrate. 

Preparing to jump...

...for joy













Harvest Fair



Is this a secret tomato-sling sign Lynne?

Last weekend my two best friends from medical school, Lynne and Sahar, came to visit.  Naturally, we had to hit up a harvest festival because that is how we roll.  Although there were several competing harvest festivals in Sonoma County that weekend, David found just the ticket.  Shone Farm, affiliated with Santa Rosa Junior College where he works, was having their very own harvest fair.  There were fields of pick-your-own tomatoes, pumpkins, sunflowers and squash, a petting zoo, hay rides, a build-your-own scare crow station, lasso practice, and a tomato slingshot activity. The festivities were set on a beautiful 365 acre farm overlooking the Russian River Valley and surrounding vineyards now turning golden yellow and vibrant crimson. 

No, we did not fit either demographic present: young families or senior citizens. 

Yes, you are correct, we dominated in the tomato slingshot activity. 

First, Sahar collected fallen, half-rotten tomatoes straight from the field.  Next we got in line with about five boys aged 8-10.  Then, we went for it.

This is the most upper body work I have engaged in since my mastectomy.  The tomato slingshot mechanism was similar to Therabands used in exercise classes and by many physical therapists, but with the added reward of hurling a soggy tomato towards bails of hay while enthusiastic boys already covered in dirt and tomato mush cheer you on.  As you can see I used the squat technique which produced reasonable launching results.

Sahar used an unconventional pose, I will call it the heal-dig half-lotus warrior, which provided excellent control and impressive distance.  Well done Sahar.








This is our new llama friend smirking at us from the barn across from the tomato field. I think he felt our slingshot technique was average judging by the expression on his face.

David, thanks for finding this beautiful farm for us and providing photo documentation.

Llama, thanks for not spitting on Lynne.

17 Nails

At the end of last week, my bone pain and weakness eased, and to my surprise my anger emerged. 

Why the f--- do I have cancer. 

Again.

My Mom happened to call as my rage was escalating.  She asked what I was angry at. 

I paused because I didn't know the answer to the question at first.  Then I knew, "The Universe."   Because to what else can I direct my anger?

It is not 1917, and my own well water did not give me typhoid fever like my great grandmother. I could not be mad at the well or Salmonella typhi.

It is not 1925, and I was not killed in a wagon accident like my great grandfather.  I could not be mad at the wagon or the horse. 

It is not 1941, and I was not Polish, impoverished, hungry and resisting occupation like my paternal relatives.  I could not be mad at Hitler.

It is not 1955, and I was not suffocated when an doctor covered my face with a breathing mask with no oxygen supply connected like my other great grandmother.  I could not be mad at the doctor.

It is not 1992, and a surgeon did not place a faulty mesh in my aorta causing rupture much sooner than if the aneurysm had been left alone as happened to my great uncle.  I could not be mad at the mesh. 

It is not 2010, and I did not live courageously with myotonic dystrophy then lose my footing and fall down the stairs, fracturing my spine like my cousin.  I could not be mad at the stairs.

It is 2012, and I have cancer again.  Cancer carefully knit together by my own cells.  I could not be mad at my own cells.  Because then, where would I be?

So I was mad at the Universe. 

And I pounded 17 rusty nails into a board I found discarded in our backyard.  Nail after nail after nail. The tinny smacks of each strike echoed off the adjacent apartment building.  I began to hear my own coarse breath as I tired.  Nail after nail. 

When I could hammer no more, I noticed Luna and Olive watching me from two feet away, out of my peripheral vision when I was pounding the nails.  I put down the hammer.  Still crouched down, they ran up to me and wildly licked my bald head, tails wagging.

I wasn't angry anymore.


Time Slowed

This has perhaps been the longest weekend of my life.  In fact, prior to this weekend I did not think it possible a weekend could feel long.  Usually one tries to pack in as much fun and activity as possible before Monday rolls around and even those weekends that one intentionally sets aside as a low key weekend-- slow cups of coffee, unstructured time and general lazing around-- those weekends go by equally quick, if not faster.  This weekend is different. I am actively trying to pass the time because I am in the darkest days post-chemo. 

I have an arsenal of prescription drugs to calm various side effects of chemotherapy.  Ibuprofen and loratadine for bone pain.  Ondansetron, lorazepam and prochlorperazine (in that order) for nausea and vomiting.  Docusate and polyethyleneglycol for constipation.  Loperamide for diarrhea.  Viscous lidocaine for mouth sores.  Various broths and teas when I can't bring myself to swallow anything esle.  Acupuncture, L-glutamine, and nutrient-dense foods to stay strong and prevent peripheral neuropathy and other complications. 

During round one, Igained experienced with these tinctures and treatments and done my best to find effective cocktails.  But here on day five after round two, I have learned that nothing takes bone pain or fatigue or weakness away, nothing except time.  And suddenly I find myself grateful that time can only go in one direction, forward.  And even when I feel the clock ticking at half pace, I find solace in its direction.  Time reliably passes.

For a moment yesterday I had an existential blunder where I felt guilt for wishing time away.  Everyone should be grateful for each moment, right?  Especially a cancer patient, I mean how rude to wishes minutes away?  Then I thought, that is bullshit.  Sitting on the sofa savoring a moment filled with sharp pain radiating through my legs, pelvis, and hands is masochistic and not helpful.
 
So now I have a new strategy: distract myself and allow time to pass on its own.  Napping, taking short walks, and watching movies surprisingly cannot fill the day.  So late Saturday, David and I moved on to Garage Band and created our first auditory masterpiece for iTunes.  As David figured out the mechanics of the Apple program I rested my head on the kitchen table.  We agreed on no retakes or advanced planning.  I did lead vocals and piano.  David did back-up vocals and bass.  One and a half hours passed, just like that.
 
https://www.box.com/s/d15eayc2t8q7ng6p8ikc

Depending upon how sensitive you are to poor pitch, the song may or may not pass your time quickly.
 

A Touch of Anaphylaxis

Thanksgiving 2009:
Just say no to anaphylaxis.

On Tuesday, my second round of chemo started out on the bright side:  my blood counts were good enough to proceed, my medical oncologist sort of offered me a job, the UCSF Infusion Center was running ahead of schedule, and my nurse got my IV started with one stick.  I was settling into an episode of Parks of Recreation when all of a sudden my face felt aflame, my chest felt compressed by a buffalo, and I started wheezing.  Then came intense abdominal pain. 

"Oh shit," I thought, "anaphylaxis."  


Everything felt oddly calm.  Many Nurses ran in, there was a lot of commotion, but everything was molasses slow from where I sat.  I remember having a few fleeting thoughts such as, "Where is the epinephrine?  Is the airway cart (with intubation supplies) within reach?"  But I don't remember being able to speak.  And then I don't remember really caring about the answer to those questions.  I was awake but I didn't feel there.  Then came a bunch of IV medications and then I fell into a fluttery twilight.

  

I was stubborn here too.  This was the summer I only
 wore my swimsuit backward.  Andrea seemed to like it.

Fast forward about three hours, after a re-challenge at my request (yes I am stubborn), and a second, milder allergic reaction, and that was the end of Taxotere for me.  My Mom handled everything with grace.  Including carting me out of the Cancer Center in a wheelchair because I was too wobbly to walk. 

The ride home was like being five years old again coming home from the county fair, way past bedtime, clutching a stuffed animal won at the ring toss.  You know the stop lights, turns, and traffic pauses signal your approach home, but you can't open your eyes to confirm it.  Then suddenly I was home, so happy to see David and the dogs and crawl into bed with my jeans and shoes on. 

So now, two days later, I am at UCSF again with my Mom and Dad for a second attempt at my second round of chemo but this time with a new agent called Abraxane (paclitaxel) to be followed with the same old Cytoxan (cyclophosphamide). 

In medical training, and only amongst residents, sometimes we would try to lighten dark medical situations by saying "Ms. M has a whiff of tuberculosis and AIDS."  Or "Mr. W has a touch of multi-system organ failure."  Obviously you can't have a whiff or a touch of any of these conditions, but in the middle of the night with just you and one other resident in the hospital running the inpatient medicine service, it felt softer, almost safer, to throw in "a touch of."

So, I had a touch of anaphylaxis.  And my Mom carried me home.
 


Except on Tuesday I was sans blankie. 
And we were not on the Texas Farm.

 

The Half Taco

 

Six months ago yesterday, David and I went out on our first date to our neighborhood CarnicerIa.   We got two plates of tacos to go.   So yesterday we celebrated our Half Taco.  Between my chemo and David's two jobs, including being the new Head Coach of the SRJC Cross Country Team, we did little planning.  My parents took Luna and Olive, we packed up the car with camping gear, and hit the road toward Point Reyes National Seashore.  All of the SF Bay Area beat us to the first-come, first-served camp sites in Marin County so we stepped into plan two: rambling around doing whatever the heck we wanted the rest of the day with the goal of using a whole tank of gas and seeing as many new things as possible.  First destination:  Mount Tamalpais. 

 

I was not up for a long hike but I was determined to get a view.  We scrambled up to a shaded knoll along Mt Tam's crest. The day was so clear that you could see the top of the Golden Gate Bridge peaking above the Marin Headlands, San Francisco, Alcatraz, Sausalito, and all of Oakland and Berkeley across the bay. To the west you could see 100 miles into the Pacific and every sailboat, freighter, and fishing vessel dotting the sea in between us and the horizon.

Next we found our way to Bolinas. This hidden, unincorporated surfing town was built on a spit of land going into the Pacific.  I had read years ago that reclusive locals took down all road signage so as to make it more difficult for outsiders to find their town.  I can see why. The main street street has an eclectic combination of a historic saloon, oyster joint, cafe, community library, grocery and mercantile.  There were lots of friendly, unaccompanied dogs roaming about that clearly new every inch of town and every resident.  We walked to the end of the peninsula were the quiet Bolinas Lagoon meets the roiling Pacific demarcated by a fleet of seasoned surfers of all ages.  The Inn above the Saloon was booked so we headed north on Highway 1. 

In Olema, a few miles from Point Reyes Station, we stumbled upon the most delicious and messiest grilled fish tacos I've ever eaten and sealed our Half Taco anniversary celebration. 

We continued north on Highway 1 and skirted the northeast shore of Tomales Bay.  The sun set producing a spectacular color show, the likes I have never seen since leaving New Mexico.  We stood on Bodega Head as the wind whipped and night fell over the Pacific. 

 

We took Bodega Highway back to Santa Rosa and ate each component of S'Mores one at a time while listening to David's mix CD he made for our adventure.  Now the sixth time played that day, we knew all the words to all of the songs.  And we sang. 

In residency, every day was full.  And although each day was hard, when you got to go to sleep, you went to bed knowing you had really lived that day, even if things went terribly wrong or were frustrating.  I relaize now there was a certain satisfaction in that. And maybe that is what keeps residents going even though as a resident, I remember longing for just one unfull day.  Now I realize that what I really needed was an unplanned day.

David and I went home and pitched the tent in our back yard.  We left the rain fly off so we could see the stars through the meshed ceiling.  Traffic on the 101 whirred in the distance.  We heard someone playing the bongo drums then later a steel guitar somewhere downtown.  A jet flew silently overhead.  A mess of stars glinted above it all.  I remember no day more full of unplanned beauty and laughter.  I can't wait for the Full Taco.

You have more than you think

When you read this blog post title I imagine that many of you thought this entry might be about inner strength, community support, or spiritual wellness.  Although the title applies to those important arenas as well, I am referring to hair.  My hair. 

I have always thought of myself as having fine hair.  And compared to women with curly, voluminous hairdos that I envy, I didn't think I had that much of it.  So, when that first clump of hair fell out about a week ago, I felt a moment of panic and then, as medical training prepares you to do, I immediately turned my brief panic into practical stoicism. "Ok, here we go, I am going to be bald by sundown.  I must locate my bandana." 


Exhibit A. Penny for scale.
A few hours worth of hair loss.

Then the next day came.  I woke up with hair in my mouth.  My scalp ached (this is normal and now I understand what my patients mean when they say their hair hurts).  More hair fell out onto the floor and into the bathroom sink as I brushed my teeth. But when I looked in the bathroom mirror, I still had a good head of hair.  The day went on and hair fell into my clothes as I dressed and into my eyes while driving.  I thought, "surely, by nightfall today I will be bald."  But nope. 

This shedding has been going on for nearly a week.  I have out competed Luna and Olive.  Yet still I hair remains.  Sure, I am developing a bit of a friar look because the crown of my head went first, but THERE IS STILL HAIR ATTACHED TO MY HEAD.  Once again the human body amazes me.

Hair, I have more than I thought. 



The Anti-Fallout

Mark, myself and my ponytail.

My hair is going to fall out within the next few days so I decided to beat chemo to the punch. Both of my chemo agents cause hair loss but Taxotere often causes sudden hair loss.  Meaning you wake up one morning with most of your hair in your bed or you take a shower and clumps let loose in the tub.  One of my own patients had hers fall out in the supermarket.  That process seems rather horrifying if you hair is 12 inches long like mine. So take that chemo, I foiled your plans!

Lynne arranged for my hair extravaganza at an Oakland salon called La Nana nestled in the back of a flower shop.  Mark, quite possibly the best maker of hair experiences on earth, introduced himself with a hug outside the salon as Lynne and I were looking at mini-pots of succulents for sale.  Oakland could not be hipper.

First step, I donated my hair to Locks of Love http://www.locksoflove.org.  Mark tied my hair into a pony tail and then lopped it off.  He did this unceremoniously.  Mark put my ponytail on the counter, looked me in the eye and said "ok then! Let's go to the sinks."  He gave me a scalp and neck massage while washing my hair during which I might have drooled a bit I felt so relaxed.
Second, he gave me a pixie cut so when my hair falls out, there will be just a little to fall out.  During the course of the hair cut he gave me three band recommendations, told me people pay him a lot of money to get my natural hair color, adjusted the Pandora station to a mutual favorite band, and told me I was going to look hotter than Sigourney Weaver in Alien after my hair falls out because I have way better bone structure.  Mark had to pause my haircut twice because we were laughing so hard it was unsafe to continue with the scissors so close to my head. 

David, thanks for the pep talks the night before when I felt nervous and sad.  Lynne, thanks for turning what I thought would be the worst haircut of my life, into the best. 
Mark of La Nana Salon, I wish I could get my hair cut again tomorrow.

Addendum:  I must fess up.  Jerry, David's Dad, was the first to beat my chemo to the punch.  Nice work Jerry!

Flight

Ten years ago yesterday I moved to London with my monolingual Spanish-speaking boyfriend, Sergio, and about $400 between us.  We each carried two duffle bags filled with clothes, a handful of family photos and mementos, my 35mm Canon camera, and his acrylic and oil paints. 

We decided to fly on the first anniversary of 9/11 because the flights were $300 cheaper than the day before or after, and it was about the right time anyway.  My classes at the London School of Hygiene and Tropical Medicine would start in ten days.  The school recommended seven days to find a furnished flat and we added an extra three to open a British bank account and cash my Rotary scholarship check in order to pay my tuition before orientation.  Ten days seemed tight to accomplish these tasks in a city neither of us had ever stepped foot in, but we couldn't arrive earlier because each day in London was costly. 

Flying on 9/11 did not put Sergio or I on edge, but it did everyone at the airport.  Passengers fumbled with their luggage, airline employees made keystroke errors when attempting seat assignments, and the security line was the longest I had ever seen. 

While waiting to check in, a local news crew worked down the nervous line interviewing people about their destinations and decision to fly on 9/11.  Soon they made their way to me.  Sergio, my parents and I quickly became the center of news attention.  They had found a story.  Not too many people move to London departing from our small Dane County airport.  And not too many parents 'allow' their twenty-three year old daughter to do so on 9/11 with a brown skinned man who does not speak English. 

At each security check point, the authorities padded down Sergio and thoroughly searched his carry on bag.  When they learned he did not speak English and we were traveling together, they questioned me about our backgrounds and travel intentions.  Sergio and I arrived in London exhausted and embarrassed for my country. 


Unable to handle our luggage on the hour long tube ride requiring three train changes, we spent £60 on a cab to Battersea Park where our weeklong room sublet awaited.  The cab dropped us off on the High Street, traffic horns blazing as we blocked traffic. We quickly hulked our luggage into a pile on the sidewalk and rung the doorbell of the flat.  No one answered.  I doubled checked the piece of paper with the address, we looked expectantly at the locked door and rung the bell again.  No one answered.  We sat on our luggage for a an hour, staring into space hoping the guy we had made arrangements with would show up at his flat and let us in.  No one came. By now it was noon, London time.  Sergio and I hadn't slept in over thirty hours.  We had about $300 (£180) left. 

We located a Travelodge three block away.  We took turns carrying the suitcases down the road, resting along the way because now our arms and backs ached and we were delirious.  Then five £20 notes just floated from my hands to those of the Travelodge clerk. 

Sergio closed the motel room window shades and ten hours later we awoke atop the covers, shoes still on, and limbs numb from lack of movement.  I drew open the shades and saw a different London.  High Street was aglow.  A pair of women in heels clicked along the sidewalk below.  One woman threw back her head and laughed.  An oncoming car's headlights illuminated her face for a moment. I looked back at Sergio and smiled.


That is how the best year of my life began.  The best year of my life until now.  

David and I finding eachother is just the beginning.  Have I got serious plans.

One chemo down

My Mom sat next to me at the UCSF chemo infusion center on Tuesday for for my first go around.  I knew why my chemo nurse was gowning up, putting on rubber gloves and a face mask before she hooked up first my bag of taxotere.  I also knew the steps that had occurred prior to the drugs being delivered to my chemo chair, as they call it.  I recalled from medical school that the hospital pharmacists, also gowned, gloved and masked, carefully prepared then loaded the chemotherapy medications into their plastic bags under a laboratory hood that vacuums away harmful fumes. Pharmacists and nurses take these measures because they are handling toxic poisons. 


Doesn't chemo look so simple here?

My Mom did not know this, why would anyone outside the medical world know this, so she asked my nurse about her gown, gloves and masks.  I went 'la la la' in my head during their conversation because in about 4 minutes that toxic taxotere was going to flood my veins.


My chemo nurse, Heather, could not have been better.  She exuded wit, light, compassion and appropriate obsessive-compulsive behaviors that are necessary for an oncology nurse to care for her patients safely.  She tripled checked every step and medication, then watched me like a hawk for any adverse reactions.  She knew when to tell a funny anecdote and when to leave me alone to watch "Blades of Glory" on David's iPad.  But best of all, she did not dole out platitudes or condolences.  Instead when various depressing things came up throughout our 4 hours together, she looked me in the eye and said, "Well, life is just absurd isn't it."  To this, I could whole-heartly agree.





see you at the martini mixer in 60 years

At the end of my chemo session she added, "My best friend and I tell each other that after this life, whatever happens next, we will sit together with a cigarette in one hand and a martini in the other and exclaim to one another, 'well what the heck was that all about!'", gesturing wildly with her hands.  She added, "Neither of us smoke or drink but you need the cigarette and martini to get the full affect, don't you think?" as she disconnected my last chemo bag and disposed of it in the large biohazard bin.   

 

Three additional thoughts on unexpected chemo side effects:

 

1. When you get a touch of poison oak on your ankle the weekend before starting chemo, it turns out the high potency steroid you have to pre-medicate with prior to your chemo to help prevent anaphylaxis is a nice two-fer.  No more itchy ankle!

 

2. When your car is side swiped while parked in front of your home the night before your first chemo, you don't care when you find your rear view mirror on your front porch.  Especially because your Dad is going to take care of the police report, insurance claim, and taking it in for repairs.  And what do you say to Geico when they tell you about the $500 deductible?  Ha!  That is nothing compared to what you paid to get your eggs extracted and frozen at UCSF three weeks ago.  Take it Geico!

 

3. When you wake up from another 4 hour afternoon slumber in the days following chemo you find you have unexpectedly re-written David Bowie's Space Oddity song that starts "Ground Control to Major Tom" to "Poison Control to Dr. Les" and all the lyrics thereafter, while in your sleep. Unfortunately your saline filled breast expander slows you down just enough to not reach your bedside pen and paper to jot down the new, fleeting lyrics as you awaken.  Trust me they were good.

 

Final thought:

Dad, thanks for agreeing this print was unacceptable chemo waiting area artwork.