Hanukka in the Holy Land

Faina is back in Israel visiting with family and friends. She is still somewhat surrounded by physicians. Some of her classmates from the Leningrad Pediatric Medical Institute made aliyah and continued their careers in our historic homeland. She also has friends from her years at the Technion.

Above all, though, is family time. Mom is the main reason for going; brother and sister, of course; nephew Noam, no doubt; and two freshly minted nieces, the family's contribution to Israel's continued population growth, a new reason to visit.

Faina got to spend time with a branch of the family tree she rarely sees, adding another unique dimension to this visit. Faina, Igor, and Maya make for a fascinating set of siblings. Looking at today's map, the three were born in different countries. Maya, the oldest, was born in Siberia, Russia. Igor, the middle child, was born in the Soviet Zone of Berlin. Faina celebrated her first April Fools Day in Babrusk, Belorussia (White Russia). Maya also has a different father then her brother and sister. Maya's father gave his country the last full measure in the opening days of "The Great Patriotic War." Faina tagged along with Maya for a family event in the Tel Aviv area breaking bread with relatives she has not seen in decades.

Faina spent Shabbat in Tzfat. For most people, that holy "city" conjures associations with the Kabbalah, an historic battle in the War for Independence, a few historically significant synagogues, or the artists' colony. For Faina it is Fima and Olya, friends she thought she would never see again when she left the USSR and delights in checking in with when the opportunity presents itself. Their home has a spectacilar view of the Upper Galilee from which you can see the Golan and the northernmost tip of Lake Kinneret. Fima is not only a physician, but is also a TV personality known for his remarkable, insightful sense of humor. Despite the 24 hours of clouds, cold, and rain, Faina sounded as pleased as if she was sipping margaritas on a sun drenched Caribbean beach. Fima is a one man festival of lights and Olya is hardly a lesser light.

The trip has been restorative, a welcome break. Return flight, Saturday night 11:15 pm arriving 5:10 am in Philadelphia.

Looking Good and Feeling Stronger

The latest word from Dr. Schulick is that the percolating fistula has closed. That is pretty much the last of the post-surgical concerns. The next big date is December 22nd when Faina will have a CT scan. It will roughly mark the four month point since her surgery.

Faina is certainly gaining strength and expanding her culinary options. Other than spicy foods and sugar almost anything is fair game. On the other hand almost anything is like a spin of the roulette wheel. Will it make its way through the intestines dropping off vital nutrients along the way or not? Today yogurt is a good choice, tomorrow less agreeable. Keeping an eye on portions is also a challenge. Eating too much, or something more challenging to process and she becomes like a python, crawling into a quiet place and lying still until she has finished digesting.

She is not yet ready to go to work, so that will still be a few months off. We have resumed some of our social life. The first big public event we attended was the Gala at the synagogue, a great experience for both of us. Last Friday, Faina sat through a Shabbat service for the first time in almost a year. We also attended another BSO concert, conducted by the extraordinary maestra Marin Alsop.

About 24 hours ago Faina arrived in Israel. She missed her mother's 90th birthday anniversary in the summer and wanted to get to Haifa as soon as possible. Now looked like the best opportunity. She is looking good, feeling strong, and has a window of opportunity.

Music of the Intestines

The latest adventure for Faina has been that of eating real food. In the quiet of the night, and even sometimes with all the noise of the day, the tune of her intestines is abundantly audible. Last night, I got to listen to the melody of a somewhat benign biscuit working its way through the system.

I've been asking people, what would you do if you were in a new place, all foods were new to you, some were yummy and went down well and others made you violently ill? Would you find a few things that work and stick with them or experiment with new and different things? Faina is abundantly in the later category. No surprises there.

Yesterday, Faina got to turn around the bikur cholim (visiting the sick) obligation making a visit to a friend recovering from ACL surgery.

Fistula, after a period of silence, has resumed a low level of perkiness. We see Dr. Schulick next week for a scheduled appointment. We keep in contact with the oncologist, Dr. Koutrelakos, maintain a correspondence with a specialist at Sloan-Kettering, and keep networking with professionals in San Francisco and Haifa. Limbo, it's the new normal.

Sheherazade

Saturday night we went to the Baltimore Symphony Orchestra. They performed what feels like our theme song Sheherazade. This story has not quite been a thousand and one nights, even though it feels that way. Looking back, the preface to this story began in the Spring, with stomach discomfort, an appointment with a gastroenterologist, an endoscopy, and the discovery of "something common that you need not worry about." Dateline - April 6, the 12th of Nissan, a few days before Pesach, Judaism's three millenia challenge to the GI tract. Chapter one began with, "I'm sorry to have to tell you, but ... " That was just over six-months ago.

To the right are the accoutrements of TPN, the source of Faina's nutrition since August 12th. Since coming home from the hospital, every day it has been the exercise of organizing a sterile work area, pulling the TPN bag from the refrigerator, adding: 6 ml of Zantac, the pre-filled Ascorbic Acid syringe, and 5ml from each of the two MVI (Multi-Vitamin Infusion) vials. This last ingredient's package takes a magnifying glass to read, but on close examination the ingredient lists vitamins A, B1, B2, B6, B12, C, D, K, and more. The next step is attaching the IV tube, priming the pump, cleaning Faina's PICC line, injecting a saline wash, attaching the tube to the PICC line and starting the infusion. This whole process is pretty meditative. It is about the only block of the day that nothing breaks my focus as I proceed from step one, to step two, to step three, and on. There is a beauty to filling the syringe with the two vials of MVI. Vial 1 is a clear solution and Vial 2 is a light yellow. I push 5ml of air into the vial and then the pressurized vial pushes back and fills the syringe itself. With the second vial I slow down the pushback. The vitamins are suspended in an oily solution so the yellow streams in and swirls into the syringe, a bit like a three dimensional paint spinner artwork, except with a higher purpose. Sometimes as the fluid streams in, the yellow goes to the bottom of the syringe and slowly the two mix together, like a rising tide; other times the mixing seems to go from the center of the tube toward the outside, like a growing tornado.

My dwelling on this procedure borders on the nostalgic. In reality, I look forward to it being a part of the past and as of this Shabbat morning, we will put this daily exercise to rest. Other than a monthly vitamin B shot, for life, Faina's nutrition, will all be the old fashioned way. Over the past few weeks she has been testing the culinary waters, yogurt, cottage cheese, potatoes, pasta, kasha, salmon, and tuna, pretty much easing into everything she ever ate before our personal Sheherazade began telling this story for 203 American Nights and counting.

Never going to keep me down

I get knocked down
But I get up again
You're never going to keep me down.
Tubthumping (by Chumbawamba)

When naturalist and science writer Steven Jay Gould was five years old his father took him to the Museum of Natural History, on the itinerary, the skeleton of a twenty-foot tall tyrannosaurus rex. Gould writes, "As we stood in front of the beast a man sneezed; I gulped and prepared to say my Shema Yisrael [last prayer]. But the great animal stood immobile in all its bony grandeur, and as we left, I announced that I would be a paleontologist when I grew up."

The Shema is our traditional prayer for when dying is immanent. When the doctor says, "It's cancer," you are facing a protracted struggle, not the quick strike of a giant animal. In Faina's case, it is like getting knocked down, but not knocked out. She has been getting up, making her days meaningful, just about every flick of the calendar, since the doctor's call (yes, she found out by phone) on April 13th, the first knock down. She pines for returning to her office and resuming her practice. She occasionally despairs of her life on hold. Through it all, nothing keeps her down.

Things have been much better lately, the knock downs farther apart. Last Tuesday, she was told she can start drinking and the varieties of herbal tea in our cupboard have grown. She called me at work, two days later, when the flow from the fistula went from near zero to about 40 milliliters over the span of about an hour. Since that episode it has gone back to zero, so drink up. A few days ago, she even took a sip of my IPA while watching the Phillies make their way back to the World Series.

Today, a big step. Real solid food. Ever true to her Leningrad upbringing, stepping up to the plate, she did the mashed potato. Now we watch, wait, and listen as the tuber makes its way through her intestinal tract. This can be a milestone, starting the transition from TPN to gaining nutrition, for the most part, the old-fashioned way, fork and knife in hand. We'll have an order of tyrannosaurus burgers please!


Warning! This song was number 12 on Rolling Stone's list of the 20 Most Annoying Songs.

Tubthumping

Hatov V'Hameitiv

The news yesterday could not have been much better. Dr. Schulick took a look at the quickly approaching single digit numbers on the output from the fistula, and the healthy looking, progressively less open incision, liked what he saw, and told us that there is an 80% chance that the fistula will heal on its own and there will be no need for another surgery. He went on to say we will not have to come back to Hopkins for a month and that we will report in by phone, twice a week.

Faina's fear of a possible kink in the intestines was allayed by the evidence that from end to end the GI tract is fully functioning. To really put the system to the test, Dr. S said Faina could start drinking two cups of liquid a day. We have to phone in results on fistula output on Friday, but by the end of next week the possibility is that Faina will be able to start eating real food.

We left Hopkins turning left on N. Caroline Avenue and not stopping until we reached Fells Point. We took a stroll around one of the "City of Neighborhoods" original neighborhoods, enjoying the real and metaphorical sunshine, and Faina ordering her first cup of tea since early August.

Baruch Ata Adonai Eloheinu Melech HaOlam HaTov V'Hameitiv
Praised are You, Adonai, Ruler of the Universe the Good and the Doer of Good.

Tossing and Turning All Night

Faina often wakes up in the middle of the night. The two leading causes are nightmares, which have not been in the least bit unusual since last April, and the TPN alarm going off if there is a pinch in the line. Last night featured both.

The nightmares she rarely shares with me and at 2:00 am I really wasn't in a mood to probe. Two hours earlier or four hours later my curiosity is in fuller bloom. They are usually stories of death and destruction, pain and suffering, and populated with people near and dear to her.

The TPN alarm is another matter. With the usual tossing and turning in her sleep the IV line gets pinched. In particular, its not good for the pancreas to have the nutrition suddenly cut off, but generally it would be a problem just to wake up with the feeding cycle incomplete. This wake up call is a regular occurrence and I usually get it straightened out before Faina even wakes up.

Today is finally the Dr. Schulick appointment we have been anxiously awaiting for two weeks. It could be hugely informative or it could be a total letdown. The possibility is that Faina will have regained enough of her health to be ready for a third surgery to close off the fistula and that Dr. S will advise proceeding with that procedure, that our patience has been rewarded and the fistula is closing off of its own accord, or that we'll all have to wait another week or two.

Time to go play, Good Morning Baltimore.