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.