Wigged Out

Mission accomplished with the wig. Faina was all smiles with her new coiffe, as much out of relief as out of the beautiful appearance. Her old hair had been mercilessly assaulted by the cats, who probably thought it was a synthetic mouse. It turns out the frisky felines did us a favor as the newer cranial prosthesis is a vast improvement on what became a pricey cat toy.

The house is full of lively conversation. Misha and Misha stopped in Brighton Beach for some shopping on the way down. Supper was the best a Russian delicatessen had to offer. We picked up Sonia from BWI.  Her travels began in Seattle and she was unaffected by a day of travel. Around midnight, the Leningrad Pediatric Medical School, Class of 1980 held an unofficial reunion, poring over old pictures, adding personalities, narratives, and updates on those captured on film over 30 years ago. For breakfast, the products of the Brighton Beach shopping trip made their way to the table as Misha fried up some blinchiki which were later topped with sour cream and caviar. Faina happily indulged in all the day had to offer.

As I draw on the close of a year, I look back on a narrative that would have done, Poe, Kafka,, or Beckett proud. I also reflect on many blessings some of which I was barely aware, others that did not catch my attention in the past and others that I have always recognized, only more so now. The lines separating trivial from important have been erased, priorities have been upended.  Appreciation for friends, family, acquaintances, and the random individuals who play bit parts in this drama we call life has been magnified. While to a great extent our hope floats on physicians' skills, CT and blood test results, and pharmaceutical wonders, quality of life is mostly sustained by the wonderful people who surround us, nurturing, encouraging, picking up the many pieces we have dropped, some working from inside the paint, others from the three point zone, and some out-of-bounds, yet in the arena, within yelling distance. The years I devoted to total immersion in existential philosophy have served to give me a language, a point of reference, and a means to make meaning of this experience. From that perspective, the ultimate experience of Being is in relationships, responsibility, and time. As Sartre said, "It is what it is." The spiritual side of this journey has given me yet another sense of peace. The mitzvot and other teachings related to healing the sick, caring for others, choosing life have also provided inner strength as well as provided inspiration for others to take action and revealed the many angels in our midst. I look forward to the next year, sustained by hope, trust in humanity, fearless courage, and the knowledge that we are not walking this road alone. I raise a glass to those who have touched us and to those who we, in turn, have touched.

Shanna Tova and Shabbat Shalom

Wig Salon Whoas

There we are in the wig salon. Faina's new wig is about to be pulled from the box, a prepare to a feast your eyes moment. At this moment, those windows to Faina's soul go into a dizzying swirl and she enters a state of breathless shock. Imagine expecting to see short chestnut hair, a Ginnifer Goodwin-Mila Jovovich look and getting more of a Shaun White (the Flying Tomato) appearance. With friends coming from far and wide to celebrate the new year, this tomato was not going to fly. Faina maintains a quiet cool while conveying a sense of hysteria, impending disaster, and the potential for mutual assured destruction. She has the codes and a finger on the red button. Pretty soon the 10 X 10 foot room is filled with activity. Can we find a wig to get through the weekend? How did this order go so wrong? Can we get the right one here in 24 hours? We leave the CMCRC with overnight shipping for the correct color (not 130/8, but 30/8, "Oops"), a 10:30 am delivery set, and a 1:00 pm appointment on the calendar.

It has now been a little over a week since the last dose of chemo. Faina doesn't have to poisoned feeling she usually has, but she still has the tingling in the finger tips and is still not feeling comfortable. The meds are minimally helpful. She has been somewhat sleepless the last few nights, but she "keeps on keepin' on." She is gamely sampling a variety of foods (lox, chicken, pelimeni, white roughy, soft boiled eggs).

We also observed a traditional Jewish interpretation of Christmas catching a film (Black Swan - give Natalie Portman an Oscar!) and supper at P.F. Chang's. This being Columbia, the dining population pretty much represented the Fertile Crescent (and a little further eastward). On Monday, we all went out for lunch to celebrate Margo's 22nd birthday anniversary. In the spirit of George Orwell, every day is a day to celebrate, some days are just more celebratory than others.

Cancer Cliche

This whole week has been pretty much cancer cliche to the tenth power. It is a chemo week so Faina has been miserable almost continuously. There was the sense of feeling like a walking Superfund site, 48 hours of nausea no medicine could overcome followed by hours of diminished nausea thanks to an IV dosage and another five-syllable pharmaceutical, an uncomfortable tingling at the fingertips, and a foul taste in the mouth brought on by the platinum in the oxalyplatin.

Another part of the cliche is the constant hope for a new option or even better, a medical breakthrough. We came a few steps forward on both of those counts. There was some progress with the pathology department at Johns Hopkins. We saw Dr. Koutrelakos, briefly, and he said that the folks at Hopkins are running tests with a different tissue sample than they were using before to find out if Faina is HER-2 positive. This could be potentially a big deal. HER-2 positive would mean Faina could start being dosed with Herceptin, a drug that has been used to treat breast cancer and has only months ago been approved for use with gastric cancer. In breast cancer patients Herceptin was able to shrink tumors, get rid of cancer cells that have spread beyond the original tumor, and help prevent recurrence of cancer. There is a 30% chance that Faina will be HER-2 positive so getting these test results has us patiently, cautiously anxious. Add to the cliche anticipating tests, being tested, and waiting for test results.

This leads me to the most interesting appointment of the week - Dr. Jesus Esquivel, oncological surgeon at St. Agnes. His first comment to Faina, and she hears this a lot, was on how healthy she looks. While this could be an exercise in building a patient's confidence and self-esteem, it is accurate. She has maintained her weight and much of her vigor. This was also in the last hours of a chemo cycle that would resume the next day. Of material interest regarding this physician is that he is uniquely skilled in a cutting edge surgical procedure, HIPAC. In addition, we found him to be exceedingly down to earth, charming, personable, sensitive, and, as it turns out, a neighbor. He pulled out a piece of stationary and sketched out the abdominal cavity, explained how the digestive system functions and dysfunctions, and the science behind HIPAC. His immediate advice, take walks and "Get fat." (With this advice in mind, Mom sent a kugel.) The potential for going ahead with this procedure will depend on Faina's next CT scan which will take place in the first week of January.

One more interesting appointment, - Since Faina's hair is thinning out, we went to the wig salon at the Claudia Mayer Cancer Resource Center. Our appointment was scheduled for Tuesday evening. The CMCRC is warm and welcoming and offers a great variety of services "for those living with cancer, their families and friends." This trip was made into more an event with the participation of Margo and Tanya. Faina and her entourage were offered coffee and tea. A high school student from Long Reach was there working on a video project and asked for Faina's permission to tape her visit, which was unhesitatingly granted. Faina tried out straight, wavy, and curly looks, assuming the countenance of a variety of actresses. One wig brought Meg Ryan to mind, another Ashley Judd. It was remarkable how different she looked with the various wigs. It is no wonder they are part of the detective/spy disguise repertoire. Selection made and final fitting, next week. The receipt, with a nod at the insurance company (our other partner in this journey), is for a "cranial prosthesis."

And so it goes.

Delightful Weekend

It is great to have had a pleasant last few days before starting up the whole chemo cycle tomorrow. We did some shopping on Friday and had lunch out. She wants to shriek every time she catches a glimpse of the basement carpet and so we looked at carpeting, made some choices, forked over a down payment, and even scheduled installation. This is fuelled, in part, by Faina wanting the house to look right for some visitors coming from distant parts of the country over the winter break. We had neighbors drop by Friday night and other friends on Saturday afternoon. Big smiles from a bouquet of flowers and from a gift basket.

A big highlight - Since Jamie's Thursday night dance performace was snowed out, we went to the Saturday night show. Between dropping her off more than an hour before the show; getting to the school early enough to get good seats; 90 minutes of wonderful tap, modern, hip hop, and ballet; and a celebratory post-performance supper, the evening was an all enveloping family event. It felt Norman Rockwell normal, a step removed from the new normal where everything is refracted through the lense of adenocarcinoma. Jamie is a Junior and we've been to five of these events. It is a treat to be present for these milestones, relishing the geometric progression of her dancing skills and confidence on the stage. A fine time was had by all.

Faina spent the better part of Sunday with her BFF Tatiana. Besides a few hours of Russian television, they made a project of concocting a pot of turkey soup.

Monday will be back to business. An early AM appointment at Maryland Oncology and a much awaited appointment with Dr. Esquivel, exploring the possibilities of HIPEC (Hyperthermic Intraperitoneal Chemotherapy). There could be more on that later. For now, I will savor a weekend to be cherished.

Rap Rhythm

One of the blessings of having a teenager in the house is that you are challenged to listen to music you would never intentionally play. Left to my own trajectory jazz and rock would fill the air. Jamie ads a healthy dose of show tunes (performed live), hip-hop, and rap. None of this is growing on me, but I am developing an appreciation for the manic, aggressive, angry, immediacy of rap. This past week has been played to a rap rhythm.

When this cycle of Faina's chemo started a week ago, Dr. K was satisfied that the treatment is working, which is to say that it is holding the cancer at bay, maybe even shrinking the tumors. To keep this in perspective though, this is like bailing out a sinking ship. As long as you are passing out buckets of water it stays afloat, but as soon as you stop bailing, it will take on water. That is pretty much the point Elizabeth Edwards reached, a news story that added a degree of gloom to this household. Mrs. Edwards' chemo was no longer effective, she stopped treatment and the flood comes in until the ship sinks.

We may be getting a bigger bucket. Faina has a 30% chance of qualifying for a new therapy for gastric cancer. The drug, Herceptin, has been successful in treating breast cancer and last month was approved for treatment in gastric cancer (it was approved in Europe back in February). It may be weeks before we know, especially since we are hung up in the less-than-cooperative pathology department at Hopkins, which has the stomach tissues that were removed in August 2009. Nudging them has become a daily task.

Faina will also have a CT scan in about three weeks, so we will have a measure of how effective the treatments have been. Meanwhile, we have an appointment on Monday with Dr. Esquivel at St. Agnes to explore the possibilities for that "Hail Mary" of a surgery-chemo procedure about which Dr. Avital at NIH-NCI told us.

On Monday, Faina started to get her energy back and our activity level picked up. We are in a rap rhythm, manic, aggressive, angry, and very immediate.

And the cycle is about to begin again

We are in the last few hours of this current chemo cycle. A reminder call came on Friday for today's 2:45 appointment. It is a blood test to make sure she is healthy enough for tomorrow's chemo. Before going to sleep, Faina asked me to take her out this morning. Her once soldierly marching into the fusilade of toxins that make up the FOLFOX infusion has shifted, replaced by anticipation of the week of feeling poisoned, experiencing the side effects of nausea, sleeplessness, a GI tract thrown into turmoil, and an emotional battering. She wants to make the most of the earlier part of this day and has laid out an agenda that includes a few stops before arriving at the oncology center.

The first thing Faina did today was reply to emails from patients and colleagues. Sentiments that come up repeatedly are: "You were always one dentist I felt cared about me as a patient and a person. Thank you for doing that ... I will say a prayer for your recovery." For year's it has been a treat to run into Faina's patients at public events and in public spaces, being introduced to spouses and children, getting big demonstrative smiles exhibiting her work, and seeing a certain rock star status, short of asking for autographs.

Another wrote, "Want to let you know I’m thinking of you and that you’re in my prayers. I was extremely saddened to hear that you’re ill again. You’re a wonderful, warm and strong person and I’m fortunate to be able to call you a friend. Stay positive, keep fighting and let me know if there’s anything I can do to help you."

It is difficult to say there isn't much people can do to help, although some individuals have proven far more imaginative than anyone under this roof. The highlights reel is filled with small graces like a challah or a zuccini loaf, flowers, a card, or a CD or interventions like when somebody or somebody who knows somebody has been able to clear a path, overcome obstacles, bend a rule, make a contact, and otherwise change the course of ordinary circumstances. These acts are the equal to any biblical miracle, creating something from nothing, parting seas, or endowing with new potential. It is amazing to witness the many "movers and shakers" in our midst, the angels among us. What to do? Stay in touch, keep Faina in your prayers, and pick up where she left off in the many projects she had to drop. Do forgive the miscommunications or the non-communications and know that she misses the people who she has been able to touch and who have touched her. Faina's greatest wish is that her narrative would not have included this plot twist. Nonetheless, there are chapters yet to be written.

The Daily Show

We had a glorious day yesterday taking advantage of Faina feeling generally decent in the second week of her chemo cycles. A former student put the "Audience Supervisor" at the Daily Show in touch with me and while trying to work out going to the show in a few weeks, I finally asked, "How about tomorrow?" Her answer was "Perfect" and we made quick plans for a day trip to Manhattan.

Jamie played hookey, Margo did her project work late into the night and took advantage of the WiFi on the Mega Bus, and Faina and I enjoyed the scenery from the upper deck, front row seats. At this point, we can't do much walking, so we took taxis everywhere, to Ben's for lunch, to the studio at 52nd Street and 11th Ave., to 5 Napkin Burger for supper and to 31st Street and 9th Avenue for the return trip.

Faina is a huge Jon Stewart fan and this family outing was a great treat. We were ushered into the Crew Lounge where we waited to be seated in the studio along with other "VVIPs" (Very Very Important People)as we were called by our handler. The "fluffer" (the warm-up comedian) got the crowd psyched and Mr. Stewart came out to take questions, at first saying that they had to do a lot of re-writes, were running late, only had 30 seconds, but took a lot of questions and was clever with his answers. Then the show started and WOW how fast the segments move along. It is taped around 6:00 pm for airing at 11:00 pm, but it moves as if it is live, the breaks between segments move in time as if there was a commercial breaks, there were no second takes, except at the end he re-read a few lines that would be "Seamlessly" edited in. He is every bit as charming, warmhearted, and self-deprecating live as he is on air. This whole day was a delightful Hanukka gift.

Tomorrow is our 24th wedding anniversary. Hanukka came late that year, so the two did not coincide, but we met at a Hanukka party, so this holiday has long been special for us.

Happy Hanukka and Shabbat Shalom

You Wouldn't Believe The Stuff We Watch

Faina has been a bit under the weather for the past few days, a cold. Of course in her condition, a cold is nothing to sneeze at (insert groan). With so much rainy, dreary weather of late, we have not gone out much and so television has been asserting its presence. We watch a lot of romantic comedies and last night we watched Leap Year. Tuning in to anything always carries the potential for hitting a raw nerve. In this case that moment came at a wedding party scene. The bride makes a toast and, given the setting, it is a traditional Irish one:
“May you never steal, lie or cheat.  But if you have to steal, then steal away my sorrows.  If you have to lie, then lie with me all the nights of our life. If you have to cheat, then cheat death because I don’t want to live a day without you.” The sobbing rose slowly and dissipated equally slowly. We hugged and held each other tight.

I was thankful that Faina slipped off to lullaby land before the end of Bored To Death. We tuned in late, but in this episode, George (Ted Danson) is diagnosed with prostate cancer and thinks he may not survive the surgery. Jonathan (Jason Schwartzman) visits him before the operation and after George is taken to the operating room sees that the medical file is for a different patient. This leads to halting the surgery and the discovery that George is disease free. In the closing scene George expresses his relief over not having cancer and that he is not going to die. Jonathan points out that his good news is someone elses unwelcome diagnosis.

This morning Faina woke up hungry for cream of wheat and a cup of Earl Grey. She is making a project of eating, trying to maintain her weight. The TPN is good for nutrition, but less of a vehicle for keeping on the pounds. She would also like to gain independence from the intravenous feeding. She gets the TPN for 12 hours now, much easier to deal with than when it was spread over 24 or 18 hours, but the line gets kinked and sets off an alarm and in the time she is up and moving around the tubing invariably gets caught on knobs or furniture and is a constant cause for concern. Dr. K says give it at least a few more weeks. And so it goes.

Thanksgiving

I am most thankful for every day and every moment my family is together. Life pleasures used to be about the big events, the trips overseas, the jetting off to the west coast, road trips, and day trips. Wednesday night, it was about the four of us in bed watching Avalon. Last night it was about having my parents over at which we, as the song goes, "had a Thanksgiving dinner that couldn't be beat, went to sleep and didn't get up until the next morning."

Faina has been low energy the past few days being just at the beginning of a round of chemo. We made a side trip, after the takedown from the 48 hour 5-FU drip, to Maple Lawn Farm to pick up a fresh turkey. She was looking good last night and was certainly engaged in the food preparations, at least to the point of challenging the amounts of spice in the soup, salt in everything (never enough), the size of the ratatouille vegetables, the proper preparation and roasting of the turkey, and the setting of the table. She had a little of almost everything being served, stayed at the table through the meal, and contributed to the lively dinner conversation.

One of the story lines of Avalon was a family slowly breaking up. Thanksgiving is central to the narrative and the catalyst for that disintegration. It has been a rough year for almost everyone with whom we celebrated Thanksgiving last year. Despite the hurdles, we made this Thanksgiving a memorable time of drawing closer together.

Dodging Bullets

As I am writing this I am having a delightful glass of a Spanish Tempranillo and listening to Sgt. Pepper's Lonely Hearts Club Band. This is the album in which the first clues to the rumour that Paul McCartney was dead appeared. The song Within You Without You figured into the clues where Paul's head blocked the first two words to the song in the printed lyrics (this was the first album to come with printed lyrics), so the title appears as Without You.  While Faina breaking up this family-band was, for a time, a subject of discussion she drew me into, she has chosen a different path, her plan is to survive this disease. God may laugh at "Man's plans" as the Yiddish proverb goes, but women were the improved model of this sixth day creation and somehow I think their plans don't elicit the same mirthful response from the Almighty One.

Three of the verses in Within You Without You begin, "We were talking." We do a lot of that.

We were talking-about the love we all could share-when we find it
To try our best to hold it there-with our love
With our love-we could save the world-if they only knew.

It was a good weekend with Faina strong, enjoying Shabbat guests, David and Donna over for Kabbalat Shabbat, a visit from three of her work colleagues, some short car trips and a walk. On Sunday, we celebrated Jamie's and my father's November birthdays.

Monday morning was round three of chemo. Faina cried for the first time facing that prospect. These cycles has been far more difficult than in the past, usually leaving her sick for over a week. She frequently comments on the feeling of having been poisoned after these infusions. Tomorrow is take down day, she loses the 48 hour 5-FU chemo pump.

Today's highlight was trip to Howard County General's Diagnostic Imaging Department. The home health care nurse was concerned that the PICC line may have been pulled out and the TPN might not be going directly into the Superior Vena Cava; pardon the jargon. The point is that were that the case, she would have had to undergo, again, an uncomfortably painful procedure, and add infection risks and all sorts of other complications. Fortunately, things are ok for now. Our next stop was the pharmacy at our friendly neighborhood Giant. Faina gave the clerks and pharmacist a run for their money, insisting that the oxycodone pills came in a smaller form, something more easily swallowed. Dare I say we were "Saved by Kristin," who had the patience and the listening skill to figure out what Faina needed and was talking about. I would say Faina faces these challenges Stoically, except that insults the dignity of that term. If they knew, the Stoics would say they faced difficulties Fainaically.

Dodging bullets, just missing being struck by the manay calamaties that seem to lurk behind the next tick of the clock, is a relief, but the real highlights of the past days have been family and friends. George Harrison closed out Within You Without You with a verse that speaks to the continuity of the universe that so many people who surround us understand and live:

When you've seen beyond yourself
Then you may find, peace of mind is waiting there
And the time will come when you see we're all one
And life flows on within you and without you.

Thorns and Roses

I read about the Obama family playing a game called "Roses and Thorns." Everyone takes a turn describing one good thing that happened that day and one problem or disappointment. We've had more than our share of thorns lately, but this week, being the second week of the chemo cycle, was generally marked by the roses of Faina feeling better.

She woke up on Wednesday in the mood for a croissant and an outing to La Madeline. While soaking up the faux French country atmosphere, she declared her interest in seeing a movie. And so we headed over to our local cinemaplex, arriving just in time to see Red. As the film reached the beginning of its slam bang conclusion, Faina's Roxicet (pain killer) started to wear off. The spontaneity of the extended trip had us not bring the bottle along. As Bruce Willis, Morgan Freeman, John Malkovich, and Helen Mirren are disposing of bad guys, Faina is deciding do I put up with the pain and stay until the closing credits or head out now. She stuck it out (not for my sake) to the end. To the classic question, rating the pain on a scale of 1-10, she said, "10." Tough lady! She would have fit in well with that cast.

Today started off awful. Faina's whole GI tract was playing havoc. Patience, pills, pain, but by late morning, the misery passed and like the day outside, sunshine took over. The AM experience was pretty well banished by a return to gastro-intestinal peace, a healthy dose of Russian television, a UPS delivery of the book on CD Squirrel Seeks Chipmunk (courtesy of Betsy and Howard), and a new standard of Refuah Shlaymah greetings - a video get well card from the multi-talented Marilyn Fine and her Wednesday 5th grade class. http://www.youtube.com/watch?v=1ZYUotEyPiw (control & click on the link should work).

Being sick-y
Feels really icky
So we hope that you will feel well soon.

It has been a rose bush of a day.

Shabbat Shalom!

Feeling the Love

Faina was in good spirits most of the day yesterday and spent hours on the phone electronically travelling about 20,000 miles going transcontinental to Seattle and San Francisco and intercontinental to Holland and Israel. It is great to have a diaspora of friends and even better being able to stay in regular contact with them. It is our friends who have sustained us most through this ordeal. Some a steady presence and others an uncoordinated tag team sending a random email, a card, a book, movie, or CD.

Margo helped me draw this into focus yesterday. She ended a 10 year friendship with a friend who has gone above and beyond proving to utterly "not be there for you." Ordinarily, I would have expected more angst over closing this particular door except that Margo sets this friend in juxtaposition with dozens of caring, nurturing, supportive friends who have risen to the challenge, who call on a five minute break in a busy work day, text message from near and distant points on the globe, come by for a visit, make lunch or dinner plans, or partner up for a workout at the gym.

Yesterday, at mid-day a white van came down the driveway. I assumed it was a delivery from Hopkins, the next week's worth of TPN. I open the door with that expectation and there amid the gloom of a bleak rainy day is an exuberanly cheerful delivery man with a dozen roses. It was from Lesli. For weeks I felt a growing emptyness knowing that we would miss Nate's Bar Mitzvah. We were looking forward to being part of this simcha and throughout Shabbat I imagined the celebration, Friday kiddush, Ayn Kamocha, D'var Torah, aliyoat, closing Haftarah blessing, and evening party. Amazing thing the power of a dozen roses and a well written note. That's a friend.

Later in the day, I had some insurance forms to drop off at Faina's office. Somehow I thought I would just come in, give the forms to Trish, and be out of there in two minutes. Not a chance. Faina has been working with some of these people for 15 years and a few she knew in dental school. She is even in regular contact with some of them, so there is a steady stream of information going back and forth. Still, I could give a first person account and Kathy, Trish, Bach,  Millard, et al. were not going to miss the opportunity to connect. These are friends.

Friends are as vital a nutrient as vitamins A, B, and C. They help you see the world in all its multihued brilliance, fight off our inner demons, and heal from the cuts and bruises that evade our best defenses. One of Columbia's most popular citizens, the Kinderman, sings, "Friends, friends, one, two, three. All my friends are here with me." That about sums up how I feel on this sun drenched morning.

Roxicet Run

For the past few days Faina has barely had the energy to get out of bed. She has been experiencing a lot of nausea and pain. The chemo hit her hard again, but maybe the next few days will be better.

She ran out of the Roxicet late on Sunday and when it was out of her system, the pain returned. I made a run to Md. Oncology to get a prescription renewal this morning Why Adam didn't write a new prescription last Thursday I don't understand. Was it really a problem that the bottle wasn't yet empty? I know, it is a powerful controlled substance. Cancer, on the other hand, is a powerful uncontrolled substance. That was a misstep and I voiced my displeasure.

Sunday evening was family TV night. We all watched a double feature of Dexter. GTG.

Chemotherapy - Round Two

The last two days, which were the first two of the second cycle of chemo, have been rough.

It is great that Faina has had good energy the later part of today. The morning was not great. I left the room to fix a cup of tea and when I got back, she was crying, "I don't have a life." Not too long after, she refocused, remembered a project she had in mind and we were off to Home Depot. She picked a plant, we got some shelving, then moved on to Homegoods and returned shoes to Marshalls' ("I'm never going to need those shoes," she said).

Two weeks in a row of memorable challot delivered. Russell picked up a wonderful one last week and today Cheryl and Mark were the shlichim bring four of Janice's homemade challot. The kitchen smells like Shabbat.

Faina received a few beautiful notes this week, two from a patients, one from good friends, another from her office, and a stack from a second grade class that brought great joy and laughter.

Candle lighting time. Shabbat Shalom!

A Few Good Days

We have had a run of a few good days. Faina has had good energy and a lack of pain. The Fentanyl has probably kicked in and she has pretty much stopped taking any of the other options; the morphine, the Percocet and the Roxicet. Not only has the nausea passed, but Faina is wading into eating real food. The hit list: Chinese food, wonton soup in particular and fork fulls off of other people's plates; Russian comfort food, potatoes and pickled herring; and baked apples. All evidence is that there is no blockage in the GI tract.

We met with Dr. Koutrelakos and he was highly encouraging. Faina looks infinitely better than she did a week ago. A second cycle of chemo started today. It was the two hour drip and a carry-out 48 hour chemical pump. For good measure was an anti-nausea drug. Let's see how this goes down. While we are in the "wait and see" mode, Dr. Avital (National Cancer Institute) pretty much said he would not be able to do the procedure he proposed. (A two stage procedure, Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPC). I will leave the details of this for later. For the really curious, here is a "For Dummies" abstract http://www.springerlink.com/content/3320043177940k32/) He referred us to Dr. Esquivel at St. Agnes in Baltimore. This surgeon is interested in meeting with us. For now we will continue with the chemo and check that for effectiveness. Dr. K holds Dr. E in high regard so even he was encouraging that risky, radical option.

Today I got a glimpse of how much pain Faina can tolerate. It was heroic. The last two times she had the paracentesis (draining fluid from her abdominal cavity) I was sent to the waiting room. This time I was allowed to stay with her. The doctor used a sonogram to locate the fluid, a dark area on the monitor. He proceeded to use two anaesthetic injections to the abdomen (Faina nearly crushed my hand with those), then inserted a tube which then was attached to a bottle and the peritoneal fluid flowed like a mighty stream, about two-thirds of a liter. Heading to the car, Faina was telling me that she tolerates the pain because she is going to live. We took the scenic route home.

Mood Swings

Remember when email, the internet, and cell phones started becoming plot devices in books and movies. Gordon Gecko used a cellphone in Wall Street (1987). A very young Sandra Bullock got tangled up in The Net (1995). I'm sure these technologies made earlier appearances, like Maxwell Smart's shoe phone or the 1982 version of Tron. A plot device that Faina has pointed out that totally makes her cringe is cancer. This is not just an obvious, logical response. It is that is gets thrown in as a surprise plot twist. For the last year she has been reading novels by some of her favorite writers and then boom, three-fourths of the way through the book, cancer is the surprise plot twist. A writer who knew that she would be reading their latest best seller could just as easily have chosen something else, but no such luck. Last night Faina was enjoying Liam Neeson, Laura Linney, and Antonio Banderas in The Other Man when, three-fourths of the way through the film - Pow! You guess the plot device. (Don't consider this to be an endorcement of the film. Rotten Tomatoes critics gave it a 16%, their top critics a 6% on the Tomatometer.)

Yesterday Faina continued with a gloomy, pragmatic mood. It is not rare that she mentions my next wife. The qualifications she churns up are vastly different from what I had in mind when I met Faina at a Hanukka party 30 years ago. She has also exacted a promise that we be buried together, that particular rabbis be a part of her funeral service, and I keep the house for at least few years. She is also identifying which daughter gets what jewelry. She treads lightly around what happens with her car, which she knows I don't particularly love, although I can authoritativly attest to its durability in a crash. 

Faina had a pretty good day today. She went back to the Fentanyl patch and started with a strong, liquid version of Oxycontin (Rush Limbaugh's drug of choice) called Roxicet. Pain relief - stay tuned. She also received a CD from Betsy that got her really excited, Earth. As Betsy acknowledged, back in the day, we called these "Books on Tape." She is a huge Jon Stewart and the Daily Show fan. She was also deeply touched by an envelope full of refuah shlaymah cards from Shuli's third graders.

Shabbat Shalom

Fentanyl and Morphine

I spoke with Dr. K on Monday about pain management. He wrote two prescriptions, one for a Fentanyl patch,  and the other for morphine. The catch became a lack of anyone who could stay with Faina while I picked up the prescriptions. None of our neighbors were around. Russell to the rescue, little bro dropped what he was doing and came over in a flash. It took two pharmacies to fill the order. Since the Fentanyl takes time to enter the system, the morphine got a lot of use for the first 24 hours.

Tuesday marked one week since the start of chemo. Faina was still feeling awful. It was clear from the manner and look on the faces of the four people who take the most direct care of her at Maryland Oncology, that we have moved into a whole different stage in her treatment. They have been great all along. They just have gotten better than great.

Yesterday was Faina's best day in more than a week. It was busy with a visit from the home healthcare nurse, my brother, and then my parents, just back from Florida. In the afternoon she pulled off the Fentanyl patch, not liking how it made her feel. Not a great night. Restless, dream filled sleep for Faina. It looks like a gloomy, rain soaked day ahead of us.

We have not yet heard from NCI-NIH.

Pain Management

Saturday night was spectacularly awful. The greatest blessing was that in the morning Faina did not remember anything of it. She was in pain most of the night and did not find relief until around 4:00 a.m. when the combination of Ambien and Percocet finally did their work. She then slept until about 10:00 a.m.

She was comfortable through most of the day and, joined by Tanya, the epitome of a BFF, being friends since kindergarten in Leningrad, enjoyed a few movies. After the last of the Trick or Treaters rang the doorbell, the four of us (Jamie with her Halloween booty) tuned in to Dexter. About half way into the show Faina started shaking. This was not the first time she has had these tremors, so I was not as shocked as I was the first time. It began slowly, at which point, I sent Margo and Jamie off for the night. The tremors then built to a more violent rate, the thought of it registering on a local seismograph crossed my mind. Her teeth were chattering at a frightful rate. I wrapped the two of us in a blanket and held her close until she calmed down. Not wanting to push the limits of her digestive system, Faina took two pills, an Ambien and Prochlorperazine (anti-nausea). The later was to improve the chances of her not losing the oxycodone which she took 10 minutes later. She quickly fell asleep. After a day in a zombie like, sleep deprived stupor, I soon crashed, not even enough strength to check to see if the Giants were one step closer to their first San Francisco World Series victory.

The children are doing okay. Jamie has many friends among them a great confidant, Christine. Margo is managing as well, clearly appreciating the coincidence of having just graduated from university and now living at home.

It is Monday and it looks like a beautiful autumn day is in the offing. Maybe we can manage a walk to the corner or some time on the deck.

We Don't Do Standard

Yesterday, Faina was outfitted for TPN, intravenous feeding. She had not been able to keep food down for days and the situation was getting worrisome. She finished the first dose of chemo. Next round, November 9th.

Big event today - National Cancer Institute-National Institutes of Health. We met with Dr. Avital who is heading up a study that is a combination of surgery and chemo. He painted a none too rosy picture of Faina's prognosis, paused a bit, and, recognizing that this was a reality with which we have already grapled, continued to present the pros and cons of treatment. We are talking about buying time, months, at best. He is devoted to leading edge treatment. His work ethic, "We don't do standard." We are going to have to wait a week to hear if he will be able to treat her.

A Rough Day

Today was exhausting. Faina began chemotherapy this morning. Two hours stretched into five. All beginnings are difficult and this is a re-start of a process we have been engaged in for over a year.

Many aspects of her health have started to change quickly. Over the last few days Faina has suddenly become unable to keep food down. To counter that, tomorrow she will have a PICC line put in and will begin to get nutrition intravenously. Since cancer cells produce a lot of water, she will be undergoing a paracentesis procedure for the second time in less than a week. On Friday, two liters of water were drained from her abdomen. Two weeks ago we were strolling down the Las Vegas Strip. Now, walking to the stop sign at the corner is a challenge.

We were in touch with Hopkins to get medical records. The people we spoke to were somewhat less than warm and fuzzy about getting this information ready for our Friday appointment at the National Cancer Institute. They will try to get the material ready was as far as they would go in making promises.

Before turning in for the night, I sent an email to Religious School families informing them of what is now going on in my life. Hitting "Send" bordered on the physically painful, a concession to a new reality.

The encouagement Faina has been getting from Dental Care Alliance has been great. The same goes for my colleagues at Beth El. We are moving forward, mostly into a thick fog of uncertainty.

Shaken To The Core

Faina had checked out of the hospital on September 10, 2009. For almost a year her health was good. We took advantage of the open window catching Baltimore Symphony Orchestra concerts, many memorable restaurant meals, more than a few exceptional films, a Mediterranean cruise, visiting family in Israel, and enjoying a wedding weekend with Faina's Leningrad medical school classmates in Seattle.

In August, an MRI indicated a growth on the liver, the region that defined the original gastric cancer as stage 4. Dr. Schulick thought that it could not be cancer and advised against surgery and a biopsy. He proposed waiting a month, redoing the scan and planning based on that data. We felt that a bullet had been dodged.

After an anxious month, we received a blood test report that was "Off the Charts" for cancer. The Carbohydrate Antigen 19-9 score, which had been 21 on July 22, 2010 was now at 2619. The report read "Results cannot be interpreted as absolute evidence of the presence or absence of malignant disease." The CT scan removed all doubt, among the statements, "peritoneal carcinomatosis should be considered."

We have entered an entirely new phase. We have renewed our communication with Sloan-Kettering. We are developing a relationship with National Cancer Institute-National Institute of Health. Dr. Koutrelakos at Maryland Oncology/Hematology is once again our rabbi. Chemotherapy begins tomorrow.

Between monents of calm I reach out to two cultural icons that have been the background track of my adult life, Allen Ginsberg's poem Howl and Edward Munch's canvas Scream.

     I saw the best minds of my generation destroyed by madness,

     who drove crosscountry seventytwo hours to find out if I had a vision
     or you had a vision or he had a vision to find out Eternity.

CT Scan

Monday was the long awaited CT scan. Hopefully, for the next two years, this will be an every four months experience. Faina pretty much puts all planning on hold in the weeks leading up to the scan and then is a little more open to contemplating trips, concerts, and medium term planning after seeing the report. Monday's scan was clean, other than some thickening of the intestinal walls, an indication of anything from irritation to a recurrence of the disease. A colonoscopy is on the Friday calendar. Thank you Dr. Silverman for finding time on your schedule for a pre-op check-up ("How soon can you get over here?") and Dr. Gertner for the discovery of a warp in the time-space continuum. And so we ride the waves, from crest to trough, up and down.

Faina has been working, three days a week since the beginning of the month. Her energy level is good. She rarely makes it through the first segment of the Daily Show.

Back to Work

Faina is back at work. She was warmly greeted by her colleagues with flowers, cake and cards. She is feeling comfortable with a syringe and a drill in her hands and is thrilled to be back in the frenzy of a busy office.

We are in an uncomfortable anniversary zone. It was on April 6, 2009 that an endoscopy discovered a growth and on April 13th that we got word that it was cancer. All of this was woven into Pesach, Hag HaHeruteinu, the Festival of Our Liberation. My hopes are that this coming year will be one of liberation from this insideous disease.

As I sat in shul on Shabbat, the reading of Shir HaShirim led me to reflect on Faina.
Arise, my beloved, my fair one, and come away.
For behold, the winter has passed; the rain is over and gone.
The blossoms have appeared in the land, the time of singing has arrived,
and the voice of the turtledove is heard in our land ...
Arise my beloved, my fair one, and come away. (Shir HaShirim 2:10-13)

Ahead will be a coming away from a year-long winter. The landscape has changed, as has our perception of it. It is a time to sing, to open up our senses and to give new expression to our experience of the world. It is time to arise, to greet the dawn of a new day.

The Caregiver

I'm lucky to be writing this now. Fortunate to have waken up in my own bed only with bruised muscles, a mild abrasion on my right arm, a left arm that I can almost raise to full extension, and a Volvo sitting in a lot awaiting a representative from the insurance company to decide its fate.

Irony of ironies. In my job description, I'm essentially the one who makes the decision on whether or not to hold school or cancel classes. My first consideration is the risk factor to my teachers. Many of them drive greater distances than the boundaries of Bethesda. They hit the road well before the students and often sufficiently after they have gone home, time to face even more treacherous road conditions than their students.

On my way home last night from the evening classes I thought we could fit in before the storm made road conditions dangerous, I hit a patch of ice, slid across four lanes of highway, came to rest in the right lane just in time for an 18 wheeler to pound into the passenger side door. The engine had stalled out and I had a second or two of watching the truck bearing down on me, make contact, and push me 20-30 feet.

So, a quick recap of some Groundhog Day highlights:
1) AM appointment with Faina at the oncology center.
2) Get home: Toby the cat's illness has advanced, his breathing is labored, quick run to veterinarian who presents options, including euthanasia, which we go ahead with.
3) Highway mishap. (Roadside rescue - David Q - Get home, pop open a Lucky Cat IPA, the caption on the inside of the cap - "You're In For A Surprise" - L'chayim)

Thirteen Days In

Faina is now thirteen days into her first post-surgery cycle of chemotherapy. The plan is for three three-week cycles. The chemo is supposed to get progressively more difficult as there is a cumulative toxic effect. The treatment is hitting her a lot harder this time around, but she has no doubt that she will make it through the nine weeks. Tomorrow will be a hydration appointment at the oncology center. Next week, the second cycle will begin with the three letter bomb, ECF. Throughout, she has a Walkman-like pump steadily administering the F of the three, fluorouracil. In the still of the night, or at quiet moments, the pump's intermittent dosings break the quiet like a subtle reminder of its presence.

It has been interesting having Margo home mending from her bunionectomy at the same time. Together they have burned through every DVD or On Demand offering of Dexter and are working through Michael C. Hall's earlier work, Six Feet Under; the HBO production set in a funeral home. Yea, put that image in your pipe and smoke it.

Faina is still working on the whole eating thing. Not having a stomach anymore re-writes that playbook. Certainty is out, unpredictability is in, big time. Sometimes foods go down easy, othertimes she is practically catatonic, just lying still waiting for a wave of discomfort to pass by. The five course meals of old are out, lots of small meals are in; concerns about weight are out, noshing over the course of the day is in; Coffee is out, tea is in; Sugar is out, honey is in; Crackers are in; almond biscotti is in; and, to her even greater pleasure, gin and tonic is still in. Every morning her night table bears the signs of a nocturnal field trip to the kitchen, a banana peel, an apple core, occasionally a wrapper of one kind or another.

Every day is a gift, a new adventure, a never ending string of surprises.

Chemotherapy - Round Two

The first time we were in the treatment room at Maryland Oncology we were both on the verge of tears. It helps that the practice has been moved to a beautiful new building, the room is larger, the windows are larger, and the exposure is southward. Today was cloudless so the room was far to the sunny side on the Cheery-Gloomy scale. There was an abundant feeling of being back with a staff that was warm and welcoming, who picked up the relationship where they had left off six months ago.

Day one of Faina's first three week cycle is the longest. It involves a hydration drip and the three chemical coctail that wages warfare against whatever cancer may lurk beyond detection. Over the course of the five hours, people come and go, men, women, elders, middle aged, all variety of cancers, different stages in their treatment, some heads covered with scarves or wigs, and a few bold, bald pates.

The first time we were in this place, almost a year ago, we felt like we had entered a Dante-esque lower circle. We quickly came to see it as a life giving, place of hope, another piece of the picture puzzle supporting the climb up out of a deep hole.

Faina spent most of the hours surfing the internet looking for cats, searching for a feline companion for the most recent animal to our home Toby, the Russian Blue. Over the last year we have gone from being dog people to cat fanciers. Dogs, are known for their tenacity, their readiness to work until the last gasp. Cats, curious, quiet, mysterious, and for their nine lives. The inspiration for Toby's name, after weeks of various tries to find a good fit, came from our clothes steamer, Tobi. The name Toby is related etymologically to Tobias and Tuviya, meaning "God is Good." From Faina, the devout athiest, it is a certain affirmation for the view, there are no coincidences. Onward!

Cycling Around

Immediately after Faina's surgery on August 12 and the results of testing were in, a new question arose, "Should Faina go through the post-operative three cycles of chemotherapy?" Dr. Schulick, the surgeon, thought not, after all he cut out the cancer. Her oncologist, Dr. Koutrelakos, similarly advised, "No, there are no signs of cancer." Dr. Gelmann at Columbia-Presbyterian and Dr. Meng at Sloan-Kettering said, "Yes ... that is the protocol." Complications from surgery, most notably the fistula, rendered any serious consideration of further chemotherapy more an academic exercise than anything else. Now, with that obstacle out of the way, the question became, once again, a viable challenge.

After weeks of physician appointments, emails, research, and a wide range of advisors; with physicians consulting physicians; the professionals left the decision up to Faina. Dr. Bui, a radiation oncologist and professor at University of Maryland, Greenebaum Cancer Center, proposed that radiation would not be needed, but that going ahead with chemo would at minimum do no harm (given her history of tolerating the treatment), could be beneficial, and should the cancer reoccur she would not have the lingering doubt that she had not done everything she could have to prevent it. That was the confirmation Faina needed as that was her inclination all along.

The three three-week cycles begin on Tuesday.