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.

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.