Heart and Soul

Today was my first post-chemo diagnostic test.  One of the agents used in my biweekly chemotherapy regimen, Adriamycin (Doxorubicin), holds an 11% cardiac adverse event rate.  As mentioned in one of my previous blogs, this most commonly causes heart arrhythmias (heart rate issues) or cardiomyopathy (enlargement of the heart).   This being said, the side effects are dose dependent.  The more medication received, the higher the risk of cardiac issues.  However, most people will not incur chronic problems unless having repeated courses of chemotherapy with this medication (only 1.7% incidence rate).  Yet, two factors put me at a slightly higher risk of developing heart issues, my lower ejection fraction before initiating therapy and my hypertension (high blood pressure). 

If you recall, way back to January, my first echocardiogram (ultrasound of my heart) showed a slightly lower ejection fraction (EF), which indicates how much blood your heart pumps to the rest of your body.  It was presumed this was due to an “athlete’s heart” (a phenomena where heavy training/exercise actually reduces EF).  My initial EF was about 50% (normal is 55-70%).  As a consequence of this diminished EF, my echocardiogram was repeated after 2 months of chemotherapy to assure that this EF didn’t decrease any further (a sign of Adriamycin toxicity).  Fortunately, my second echocardiogram came in nearly exactly the same as my initial echo. 

Well, today I received my 3^rd and final echocardiogram, at the conclusion of this treatment regimen.  As I’ve continued to run and walk intermittently, and remained relatively symptom-free and normotensive (normal blood pressure), I remained hopeful.  My pace while running is currently 2-3 minutes slower than my norm and my mileage decreased by more than half (particularly as I have been walking more than running).  Yet, I have not experienced chest pain or shortness of breath with running or climbing stairs. So, I was eager to receive these results. 

It was nearly 5:00, when I received the call from my cardiologist.  “Well,” he said, “I think we can put to rest any issues with your heart from the initial echo.  Your ejection fraction actually improved and is now normal.”  Other than being ecstatic, several theories ran through my mind.   Were the enlarged nodes in the middle of my chest and surrounding my pulmonary artery to blame for my initial poor EF and now they’re gone?  Or did my “athletic heart” get deconditioned from my decrease in running and hard training, helping it to return to normal?  Is hard training and running 50 miles/week actually bad for your heart?  Reviewing the measurements (I always leave with a CD of my own), revealed a 5% increase in EF, actually putting me back into the normal range (barely, but I’ll take it!)  While I’ll likely never know the answer to my questions, I think these results delivered another message. More likely than not, the decrease in my training and intensity resulted in my improved heart function.  While I’ve been meaning to back off for years, once again, I needed a slap in the face to give me permission.  Running, while valuable due to the meditation and reflection time that it provides, can also become an obsession (ok, I know some of you are laughing).  Like vitamins, alcohol, and work, too much of anything can be harmful.  Finding a balance is key.   This will be my greatest challenge in the upcoming months.  But today, I rejoice in knowing that my heart remains strong. 

No beauty shines brighter than that of a good heart.  

The best and most beautiful things in the world cannot be seen or even touched - they must be felt with the heart.  ~ Helen Keller

These 2 photos were taken during recent "runs" (note the water droplets on the rose and antlers on the deer).  I see a lot of beauty (with my heart) on my runs. 

The Awakening

It’s taken me a whole week to sit down at the computer and write.  As if doing so, will awaken me from this dream and I’ll discover I’m in the midst of chemo again.  At first, I wonder if fear has kept me away.  What will I say?  Or maybe I’m fearing that the end of chemo, will be the end of kindness?  Mine eyes have seen an immense goodness in people along this journey that a part of me doesn’t want it to end. The visits from people I haven’t seen in years, walks with friends where the conversation never seems to end, the countless meals shared, smiles given, cards received and messages of love.  I want to bottle it all up and share it with the world.  If only everyone could feel such love and happiness, imagine how the world would be?  Terrorism, war, discrimination may not completely be eradicated, but possibly diminished, if we treated every individual with the love and understanding that we bestow upon our friends and loved ones. 

If we knew the person who briskly drove into the parking spot we had awaited opening up at the grocery store had cancer and experiencing fatigue & nausea and likely didn’t even notice that we were waiting for that spot, we might approach the situation differently.  Rather than yell obscenities, in a rage, we might drive to a spot further away, thinking maybe there are others that need those close spots more than I.  More often than not, we assume the worst in people.  “What a jerk!”  “How insensitive!”  “Is your time more valuable than mine?”  That’s our usual thought when someone cuts in front of us during heavy traffic or waits till the last minute to get over on the freeway.  And yet, maybe the person was briskly exiting the freeway because they needed a restroom, or was unfamiliar with the area, not realizing that this was the direction to their destination.  Aren’t they easing the congestion by getting off the freeway anyway?  Why do we always surmise such malice? 

With 3 weeks to go before I re-enter the workforce, I’m fearing that I may re-enter the rat race at the same time.  While I vow to take the lessons I’ve learned from this journey, to live a life of love and forgiveness, will I too, fall in line of such anger and assumptions when the stress and pressure returns?  This is the fear that awakens me from sleep.  If returning to work, means returning to impatience, frustration and hostility, then I don’t want it.  This is one of the reasons I choose to live just a short distance from my office, to avoid traffic and the frustrations associated with it.  Yet, there will always be unforeseen circumstances such as computers not working, scheduling mistakes or just getting caught up in the frustrations of others.  I pray that I will remember the preciousness of life and respect for others, that I won’t blow a gasket nor let my frustration overflow into my actions or words.  To ensure my success, I will need to prepare and construct a new foundation or reinforce the old.  Running has always given me the meditation time necessary to reflect and prepare for the day, but I may need to create other buffers or breaks to help restore my energy level to tackle life’s challenges. Hopefully, these memories remain fresh enough to keep me grounded and remember what is most important in my life!

God, grant me the serenity to accept the things I cannot change,

Courage to change the things I can,

And wisdom to know the difference. 

Living one day at a time,

Enjoying one moment at a time,

Accepting hardship as a pathway to peace,

Taking, as Jesus did,

This sinful world as it is,

Not as I would have it,

Trusting that You will make all things right,

If I surrender to Your will,

So that I may be reasonably happy in this life,

And supremely happy with You forever in the next.  Amen.

~ Reinhold Niebuhr

Final Chemo - Infusion #12

6 months ago I started this journey.  And while today doesn’t mark the end, by any means, it is the beginning of a new chapter.  As I close the door to this round of chemo (completing a total of 12 treatments in all), I open the door to the next phase in my journey.  For now, I savor in the fact that I don’t have to return for chemo in 2 weeks, that my hair and energy levels should start to increase over the next 3-6 months and that I can remove my port and hopefully my right arm will return to normal.  I’ve been waiting for this day for the past 6 months and it finally arrived. 

How befitting that I arise at 5 am with blue skies and the sun shining through the window.  It’s going to be a good day.  The aroma of chocolate chip cookies still lingers from the night before.  They were already packaged and prepared for delivery to all of the wonderful people at the infusion center, who shared their kindness and compassion to clear the path, so that my journey progressed smoothly.   At 6:30 am, I finally thrust myself out of bed and onto the treadmill (for a brief walk).  With a joyful heart, my treadmill led me along a lake and through the streets of Lovatnet, Norway (with the help of iFit and google maps, I can walk or run anywhere in the world).  

After showering and applying the EMLA cream to the skin overlying my port, I prepared myself for this glorious day.  The question still ran through my head, “What if my counts aren’t high enough?” First of all, I can’t imagine they wouldn’t be as we’ve set a pretty low threshold. Secondly, what’s a few days of delay at this stage in the journey.  If nothing else, I’ll get to visit with the people who have been so good to me and made a potentially miserable experience quite pleasant.  I will miss conversing with K, my infusion nurse, as she pushed the colorful toxins into my vessels.  We would talk about family, friends, book recommendations and life in general.  We would laugh together, challenge each other and occasionally she’d ask my opinion about a medical issue, which were generally simple questions, but validated my years of medical training and kept me on my toes.  I will miss seeing her smiling face every 2 weeks, but I know where I can find her!

My ANC remains at a whopping 300 (normal 2,000 – 7,300).  When the laboratory called my infusion nurse with this critically low value, she was elated.  They were confused.  Knowing that I was displaying no signs of infection and that we had continued the infusions at levels below 300 in the past, we both knew this meant proceeding with my final infusion today.  Pharmacy staff were notified and the pre-medications and chemotherapeutic drugs were mixed into IV bags and syringes for the final execution of any remaining, pestilent cancer cells. 

My beautiful and fabulous care team! 

Rather than describing the infusion process again, which has been discussed in previous blog entries, I will elaborate on the differences between today and the previous infusion dates.  We were all set to start infusions by 10:15 (after our 9 am arrival, blood draw, and pharmacy prep).  Everything was verified, as usual, except the pharmacy added little notes to the effect of, “Happy last day of chemo,” and “You did it!”  Excitement exuded from me and all involved in my care over the past 6 months.  The chocolate chip cookies I baked the previous evening, were placed at the unit hub, so all could enjoy.  Every one of them, from the medical assistant (MA) taking my vitals, to the pharmacist and lab personnel behind the scenes, they all played an active, vital role in my well-being throughout this cancer journey.  The way they work as a team, their relentless compassion, meticulous attention to detail and sheer joyfulness to which they forge through the day, diminished the sting of cancer.

The time flew by quicker than ever before.  The last infusion was completed by 1 pm.   We elected to return home for lunch as my hunger was thwarted by the excitement of it all.   I’m not sure the reality of this last chemo day has truly registered yet, particularly since the IV Benadryl riddled me with grogginess and dry mouth.  I could barely keep my eyes ajar and immediately plunged back into a deep sleep upon returning home.    My heart is full of love and appreciation today, for answered prayers, for the health and strength to make it through, for terrific friends supporting me through words, cards, flowers, walks and fantastic meals and for amazing care providers whom I entrusted my life and who kept me on course to be the survivor I am today.  Yes, this chapter is complete.  Now, I move on to the next chapter of healing, strengthening, giving back and fulfilling God’s plans for me.  This chapter in my life has become a stepping stone, directing me to more exciting adventures and insightful experiences.  Many more pages will be turned, before my book is complete.  

Piglet noticed that even though he had a very small heart, it could hold a rather large amount of gratitude.  ~ A.A. Milne

Today I close the door to the past, open the door to the future, take a deep breath, step on through and start a new chapter in my life.  ~ Unknown

 

January 15, 2016 - First Chemo treatment to June 17, 2016 - Last Chemo treatment

The Writer

“2 AM, Really?” She thought to herself, as she awakened in a blaze of heat.  Tossing and turning as the heat arose from her center to her head and then down toward her legs, she wrestled her sheets and comforter to the side.  Her husband, snoring away, as if a whole forest needed to be leveled, didn’t flinch.  He continued with his rhythmic pattern while she tossed her legs over the side of the bed and dragged herself to the closet in search of some slippers.  Normally, she would just grab a glass of cold water and return back to bed, in hopes that the coolness would hit her core and eradicate the hot flashes.  Not this time.  The words kept flooding her mind, invading that peaceful place and pushing her toward the computer to dump those thoughts onto the glaring, white screen (modern paper) of her word processor. 

Feeling her way down the stairs, she realized she didn’t have her glasses.  She returned to the bedside table until she felt the cold metal and glass frames in her hand.  She descended back down to the kitchen and through the family room without turning on any lights.  Noticing all the little green and red lights, signifying the power button of an electronic device or time on a clock, she wondered if every household was this colorful or well illuminated, without ever flipping on a light switch. 

Grabbing a tall glass from the cupboard, she hovered over the coffeemaker, debating whether a cup of coffee would be a good idea at this hour.  She quickly quelled that thought and turned toward the refrigerator for the pitcher of cold water in the door.  This would certainly help hydrate her before the diuretic effects of her morning coffee, would do the opposite.   Finally settling down at the computer, she let her fingers do the talking, while the brain dumped.  On one of her runs, she pondered about writing and recalled these words flowing through her head, “The ability to write requires the organization of scurrying brain impulses, which we call thoughts.”    

Nearing 3 am, she thought, “that’s too profound for this hour of the day, I really just need something to return me to the slumber of my bed.”  What was bothering her?  It could be the 5:50 am wake up time.  After getting accustomed to awakening when her body told her, early morning meetings were still a struggle, particularly when they were infrequent, as she feared that she would sleep past the dual alarms set to awaken her.  Even still, she didn’t think this was the trigger. She may have believed that it was the proximity of her “last infusion” on her mind, except that she still had two more days and nights to ponder over the implications of that.  It flashed, like one of those silly pictures with the lightbulb appearing above the cartoon character’s head.  Over dinner with friends, a multitude of topics were canvassed, from gun control to school curriculum, but one topic lay dangling inside her head. 

Upon leaving her friends’ home, she nearly forgot her purse and lying next to it was a book that her friend had recommended reading and loaned to her.  “Opposite of Loneliness” was the title.  The author, a 22 year old graduate from Yale University, died 5 days after her graduation.   The book was produced by her grieving parents who wished to honor their daughter by publishing her many writings.  The story, not only intrigued, but struck a chord.  Writing was her passion.  Her words sang melodiously as you read them.  And yet, Marina Keegan’s dream, was snuffed out by a car accident in Cape Cod. 

The reality of a fellow writer, being taken from this world before her story could unfold, was likely the culprit and propeller driving her to tap away at the computer at this early hour.  Just like the 50 people senselessly murdered in a shooting spree in an Orlando nightclub over the weekend, we never know when our time on this earth will end.  We never know when the inspiration for our writing will run dry or the passion fade.  As if Marina Keegan was reciting the words herself, “You must continue to write,” swirled through her head.  “I can’t get lazy.  I can’t stop writing.  My book must be written before I pass from this world.” 

Why?  Why do some people feel compelled to write?  She couldn’t really answer this question, as the reasons changed depending on the day.  After hearing about Marina Keegan, she would say, “to inspire people.”  Inspiring people to pursue their passion, to make their mark, fulfill a dream or encourage enthusiasm in their daily lives is a start.  It more likely than not, stems back to that 7 year old’s dream of “helping people feel happy.”  This was the reason she had pursued a career in medicine.  But now, she saw that writing can impact more lives than can be touched in one day at the office. And, as much as words, either spoken or written, can be vicious or painful, words can equally evoke a fervor inside or generate feelings of love and happiness, in both the author and the reader.  Translating words to feelings is an art, and if God provides the talent, it is the job of the artist, to show their work to the world as Marina’s parents did by publishing her work. 

As the typing slowed, she knew that it was time to put the lid back on the well, before it dried up entirely.  Although there were only 2 hours to go before the alarms would jolt her back awake, she felt content to return to her slumber.  She could close this loop for today, knowing that Marina Keegan’s story had been told.  Despite her death, she still provides inspiration for others, through her writing.  

To write means more than putting pretty words on a page; the act of writing is to share a part of your soul with the world. ~ Unknown

If a story is in you, it has got to come out. ~ William Faulkner, American writer and Nobel Prize laureate.  

If I Should Die Tomorrow…

This blog is neither a premonition, a post about regrets, or meant to cause alarm or ill feelings, but rather a reflection of a life well lived.  I would be remiss, if I didn’t admit that, along with many others, the threat or murmur of cancer, doesn’t lend to thoughts surrounding death and dying.  In fact, I started this entry months ago, but was afraid to finish, as I didn’t want to alarm people.  As I near my last infusion (one week from today), I feel that I am creeping out of the woods, that maybe now I can post my innermost thoughts about living, and dying.  For some people, this may be too personal, too painful or too soon to think about death.  None of us really knows when that time will come.  Personally, I truly believe God has greater plans for me before departing this world, that I don’t anticipate death any time soon.   But, if you are ready, come with me, into this journey of the mind.

If I should die tomorrow, I don’t want you to cry about a life short-lived, but rejoice in happiness over a fulfilling life.  The multitude of memories that I have shared over my 48 years on this earth outnumbers what most people create in an 82-year lifespan.  I have seen the uprising and takeover of computer technology.  I have lived in an era of modern-day saints and leaders like Mother Teresa, Mahatma Gandhi and Nelson Mandela.  I’ve seen us travel to the moon and back, with inhabitants currently living in space at this time.   I’ve traveled extensively across the world, from China to Tangiers, Turkey to the UK in addition to Europe and nearly every state in the United States. My eyes have seen nature’s marvels, phenomenal architecture, and intriguing people, with their unique customs and cultures. Yes, there will be much greater feats ahead, but the ones that I have witnessed are no less remarkable.

I am blessed with 3 beautiful, intelligent, compassionate and loving children, who will, without a doubt, become leaders and leave the world a better place.   With them, I impart my legacy and I’m certain that they will bring more laughter, goodness and love to this world than either Chris or I alone could provide.  We’ve done our best to instill family values of respect, charity, cooperation, honesty and ambition.  We expect them to always give their best and to utilize their God-given talents.  With this foundation, we have seen them flourish and know that they will continue to inspire their own children and many others, through their work and guidance.  With this knowledge, I can truly rest in peace. 

If I should die tomorrow, know that I leave this world, with only positive, happy memories in my heart and soul.  Nobody’s lack of attentiveness, mistake or shortcoming has caused me to die.  It is only God’s plan that determines our destiny.  I do not hold any grudges or anger in my heart, as I’ve found that these only pull me down like an anchor into the depths of darkness, and releasing that anchor has allowed me to live freely and happily and reach the light.  Like a plant, reaching for the light, has helped me grow stronger and blossom.  So, never fear about the last words exchanged or argument encountered, those were flushed down the drain long ago.  I choose to see what’s in your heart.

It would be a lie to admit that I leave this world without regrets, but those regrets are not related to a trip not taken, goal not accomplished or an adventure not planned.  The regrets, that I have come to accept as part of my learning process, are related only to my relationships with others.  I regret that I didn’t learn to forgive at an earlier stage in my life, as harboring anger is destructive to the soul.  I regret that I didn’t hug enough, say, “I love you,” enough or that I didn’t show my appreciation to all the people that have touched my life.  From the friendly courtesy clerk at the grocery market to the receptionist at work and across the board, I feel so loved and blessed to have met you all.  Because, through your smile, your helpfulness, your kind remark or your friendship, you have made me a better person and for that I am truly grateful. I hope, that in some way, you know, that YOU have touched my life and helped shape the person that I am today.

Do I lament about missing future plans such as attending a wedding, graduation or the birth of my grandchild?  I no longer worry about these events as I plan to be present in some way, shape or form.  Is their advice that I yearn to provide?  Only that you follow your heart and let God be your guide.  If you listen and develop that personal relationship with God, or whatever higher power you believe, you will receive the answers to your prayers.  Being just, forgiving and honest in all of your actions, lends to happiness, despite difficult circumstances.  If there are lessons or plans that you envisioned with me, realize that some lessons are better learned by my passing, than by my presence. 

Know that I have not suffered.  Any pain that I incur is minimized by the love, support and graciousness of my care providers, family, friends, coworkers, neighbors and patients.  The suffering incurred through death is no greater than the suffering endured through a marathon or climbing Mt. Everest.  People endure frostbit toes, blisters or fractures while performing these feats and yet continue their quest. Suffering can be minimized by the mind.  For me, just thinking about the ones I love and how gracious God has been to me, leaves me in a peaceful state, where no pain can penetrate.  Even if you physically aren’t present at my death, I review, in my mind, all the good times we have shared, and feel your warmth and presence by my side, providing solace. 

If I should die tomorrow, promise me that you will go on living.  Promise me that you will celebrate a life well lived and remember to always look to God as your guide.  Be kind to others.  Live honestly and forgive those who have wronged you.  Strive to always give your best.  Lead by example, so that others may be inspired and want to share in your happiness.  Most of us will never make it into a history book, for future generations to learn of our feats.  However, all of us can have an impact.  Make sure that the footprints you leave behind, lead others in the right direction.  

The tragedy of life is not that it ends so soon, but that we wait so long to begin it.  ~ W.M. Lewis

As a well-spent day brings happy sleep, so a life well used, brings happy death.  
~ Leonardo da Vinci

This eagle flew overhead on my run today to show the clouds opening to share the light beyond.

Death, be not proud, thou some have called thee mighty and dreadful, for thou art not so.  ~ John Donne 
(I was selected to analyze & memorize this sonnet for a high school English class and have never forgotten it! If you have the chance, read the whole sonnet.)

Letting Go

Some days I lose track of the date or day of the week.  At 48, I have no intention of retiring this young, but imagine that this is how retirement would feel.  As I lay in bed sweating, with puffy, swollen hands and feet, I feel old enough to be retired, but when I hear the birds singing, I smile and propel myself out of bed.   I’ve been on this journey so long already, that I nearly forget my previous working life.  Acclimating to life outside of the clinic took about 2 months.  I can only imagine it taking as much time, if not longer, to get accustomed, once again, to a daily routine of seeing patients, charting, reviewing results & correspondence, refilling prescriptions and the list goes on.  I’ve been lucky enough to keep in touch with the administrative side of medicine – attending meetings, reviewing performance reports and quality metrics, so, at least I know the environment in which I’ll be returning. 

As I near the final treatment in this chemotherapy regimen, the planner in me yearns to take over and start to outline what returning to work will be like.  Every attempt to foreshadow my schedule and envision my re-entry into a normal routine is thwarted by the “what ifs”.  Although my last chemotherapy treatment in this course is scheduled for June 17^th, my white cell count still needs to return to normal, my port needs removal and my PET scan needs to show clearance of disease before I can regain a normal routine.  Since my PET scan is slated for mid-August, I know that I will have at least a month of transition, before changing from the “sick person” schedule to a pattern where I no longer worry or think about what appointment lies ahead. 

While I certainly had hoped for a clean house, purging all the junk in the garage, or at least an accomplishment to display, this journey was not meant for those tasks.  My house is only slightly cleaner than the day I took leave.  While I organized some files, the new workload of medical bills, insurance EOBs (explanation of benefits), disability paperwork, committee meeting minutes and medical information on lymphoma have added more papers to the pile.  The garage is still full of meaningless boxes that were moved from my old house in Seattle, before Chris and I were even married.  Yet, internally, there has been some purging, organizing and cleaning. 

Days are no longer measured by accomplished tasks, but more by how I feel.  If I’m tired, I take a break, a nap or walk instead of run.  I’m no longer running to get my fastest time or reach the finish line so I can move on to something else.  When I run, I breathe in the cool, fresh air, listen to the birds chirping (or music), and smile as others run past me.  I’ve learned to embrace and enjoy the process more than just the accomplishment.   Even when my legs feel like lead weights and my fingers tingle from the cold, I know that these steps will decrease my nausea, improve my energy levels and I feel thankful for the ability to walk at all. 

Eliminating the most disruptive, unhelpful or painful aspects of my life has been my purging.  Rather than increasing my anxiety over how I can possibly complete all the tasks for the day, I prioritize what needs to be done and settle for what I can accomplish.  The world is not going to end if I don’t finish my to-do list today.  If I’m getting further behind, then I need to eliminate something.  It’s a time to re-evaluate what I am doing, whether I’m doing it well and if there is value to what I’m doing.  While blogging was initially a struggle or chore for me, it has now become a focal point.   When I find myself wandering aimlessly, I return to writing, to provide the compass for my trek. 

I’m no longer plagued with “checking things off my bucket list”.  If I never make it to Australia or fly in a seaplane, it will be okay.  I live to see tomorrow.  If I wake up to a cloudy, dreary day, then I embrace the cool weather and the ability to work around the house or listen to a book.  Should the day greet me with sunshine and warmth, I will venture outdoors to smell the roses and savor nature’s beauty.  Whatever life throws my way, I know that, with God’s help, I will make it through.  This joy and freedom cannot be extinguished by the destruction of chemotherapy, the elimination of titles or positions, the loss of strength or the reduction of my income and patient panel.  My biggest fear in returning to work, is losing sight of this quintessential focal point and getting buried in the clutter once again.   Like a wild race horse, I may need to rely on blinders to avoid distractions and stay on course, but the peace of this moment makes the journey worthwhile.  

Out of clutter, find simplicity.  From discord, find harmony.  In the middle of difficulty, lies opportunity.  ~ Albert Einstein

Even majestic Mt. Rainier would be more elegant & pristine without the building, telephone lines and cars in the picture.

Infusion #11 - The Precious Rose

My secret is out!  It may or may not surprise you to find out that I write my blogs well before I post them.  Although I am writing about my infusion, it actually hasn’t occurred yet.  But, I do promise that, by the end of this post, it will be infusion day.  You see, I don’t actually have the energy to finish a whole blog post in one day, which is why I reduced it down to 1-2 blog posts per week. 

There is definitely a cumulative effect of chemotherapy that blindsided me.  Some days, I feel like a complete idiot that, as a doctor, I was in the dark about the escalating fatigue repercussions of chemotherapy.  Certainly I knew about the potential for neuropathy, hair loss, nausea/vomiting and the low counts.  But, the level of fatigue and how it progressively worsens over treatments, caught me by surprise.  Yes, I’m aware that different chemotherapeutic regimens have different effects on different people.  Some regimens kill more normal cells during the process of destroying the relentlessly, reproducing cancer cells, which would obviously require a longer time to recuperate. Unfortunately, as a family doctor, we don’t often see a patient while they are undergoing chemotherapy.  Cancer patients already see their oncologist so regularly that they don’t come to see us until months after completing their regimen.  So, we don’t generally see them during their darkest hours.  At least that is this week’s excuse for my naivete. 

But, I digress (which is another common side effect of chemo and also one of my son’s vocabulary words for the week).  Today marked my 11^th infusion, which means, that in 2 weeks, I will be receiving my LAST infusion for this treatment regimen.  Rather than count my chickens before they’re hatched, I will try to keep focusing on the race, not the finish line. 

Today’s doctor visit and chemotherapy infusion was pleasantly uneventful.  We left the hospital before 1 pm and that’s after grabbing a quick bite to eat in the cafeteria.  (They actually have decent food including wood fired pizzas, grilled food, salads and sandwiches made to order and a variety of entrée choices as well).  Chris bought a Cuban sandwich (spicy pork and ham) while I had my usual salad (but oriental chicken).  My absolute neutrophil count (ANC) was still hanging out at 300 (normal range is 2,100-7,000).  The Benadryl still knocked me out (I slept for probably an hour during the infusion and 2 hours after returning home).  The nausea and fatigue started escalating almost immediately with the first chemo drug but always worsens with the final drug, Dacarbazine.  On the bright side, I haven’t had a mouth ulcer for a while and no cough, shortness of breath, or fevers that would inhibit me from completing my regimen.  In 2 weeks, I hope to complete my last infusion of this regimen and take a break from being a patient and soon return to providing medical care for others.

To combat the fatigue, I continue to try and walk or run, feeling satisfied with a 3 mile walk when I previously would have been discouraged with less than a 6 mile run.  When I look around the house and yard, it’s easy to feel frustrated that I can’t complete the things I’ve always enjoyed, like gardening.  Fortunately, I am blessed with friends and family who help me out and force me outdoors. 

Yesterday, we worked on trimming some branches near a trellis leading to the backyard.  The branches had become so overgrown and dense that they were killing the grass below.  They needed trimming to allow the sunshine to get through, so the seedlings could sprout and survive.  My friend’s mother, in her mid-60s, standing 5 feet tall and weighing less than 100 pounds, reaching well above her head, lopped branches more than an inch in thickness, with incredible ease.  She moved along rapidly and I found myself motivated by her strength, as I went to retrieve a stool to reach the higher branches.  Upon my return, I setup the stool, but given her short stature, my height was needed to reach some of the taller branches.  As we moved along, we started unveiling the clematis that was planted by an arbor.  The clematis was blossoming with flowers, laying on top of the magnolia branches, rather than on the arbor.  It too, yearned for the sun.  We meticulously unraveled the intertwined vines from the boughs and leaves of the magnolia tree, revealing the most delicate, star-shaped, magenta flowers, which hadn’t been seen for years.  We then proceeded to my neighbor’s yard to trim some unreachable limbs, and after some pruning, discovered a solitary, deep red, velvety rose coming from a bush I had planted shortly after we moved to this house, 17 years ago (see below). 

As the rose was on a fairly long, straight stem and couldn’t be seen well from the other side, my friend cut the flower and presented it to me.  I promptly put it in a vase as a reminder of this moment over the next week.  It’s hard to explain why, but that rose is special to me.  When I posted about it on Facebook, another friend (and previous coworker) expressed it most eloquently.  As she explained, this pruning project is a lot like my journey.  After trimming the dead branches and getting rid of the “ugly parts”, the sun shines through and sometimes, reveals treasures and beauty, such as the rose and clematis.   The clematis is like the friendships and support that I’ve discovered and were revealed after removing the top limbs.  Each and every one of you is like a flower on that vine, showing your beauty.   The rose, as she so thoughtfully expressed, continued to persevere and bloom where it was planted, despite the thick cover.  She never mentioned the significance of the thorns (but who doesn’t have thorns), but acknowledged, “I see the rose even has a stress mark on it (they get grey too!)  But it made it through the weight and heaviness of what was around it. We wear our grey well!”

As I sit at my recliner staring at the rose on the table, I reminisce of the boughs and dead wood pruned throughout this journey.  Pruning any misconceptions, anxieties, bad habits and disentangling the beautiful flowers that lay beyond the dead limbs, is what I needed, to let the sunshine enlighten and reveal the beauty beyond.  Yes, I continued to persevere and push through the dense brush, despite its heaviness and darkness.  But, the beauty couldn’t be seen, until the parts thwarting my growth, were trimmed.  Reflecting on my past and anticipating my return to work next month, I know that I must setup a maintenance plan to keep out the weeds, prune the overgrowth, water and fertilize, in order for the sun to shine through and flowers to blossom and grow to their fullest potential.   

When we can become skilled at selectively knowing what to prune out of our lives, what remains becomes stronger, brighter, clearer.  ~ Lisa Byrne

A thorn defends the rose, harming only those who would steal the blossoms.  ~ Chinese Proverb

2 large piles of pruning (in front and behind the arbor)

The aromatic, delicate rose discovered under the brush.