Chapter 11: Test Results

Ask people to pray for you. Get in shape. Go iPod.

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From: Laura
Sent: Friday, Apr 20, 2007 2:17 AM
To: Phil
Subject: Treatment thoughts and questions

Hi Phil. Question: will I be getting intrathecal chemo when I see you at 9:45 am this Tuesday, prior to my admission that day? And do I come straight to you first for the appointment, and then go to the Admitting Office afterwards?

Don’t worry about the ridiculously early time on the email. My sleep schedule is odd, but I'm getting enough sleep. I usually take my evening pharmacy of medicines around 8-9, sleep about four or five hours, wake up and write for a couple of hours, and then go to sleep until somewhere between 4 and 6 am. So I get about 6 hours of sleep a night (I have never been a good sleeper). The prednisone may contribute but I have a similar pattern off steroids.

I keep thinking about our last visit. I had so wanted the CSF cytology to clear and I’m concerned that it may not be clearing. If you need to switch to a bigger intrathecal gun, I will do it. But I also wonder if there is still the possibility that these cells in my CSF and I can co-exist, because maybe what I have is a weird thing on the cusp between autoimmune and malignant. Maybe we could treat until the cows come home and I'd still have funky lymphocytes in the CSF, and maybe it would be OK. I don't want you guys to treat my numbers and kill me in the process. Please keep that in mind when you talk to Sam after the flow results are back. And please keep me in the loop.

I was so relieved when Jack said he thought the visual trouble was from the steroids and not worsening lymphoma. I am paring down the faculties I absolutely need to live a happy life, and unfortunately vision is among them.

Laura

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From: Laura
Sent: Friday, April 20, 2007 4:36 AM
To: Gerald
Subject: Help

Hi Gerald. We don’t know each other well, since you just joined us at Memorial a few months ago, but I’m a long-standing fan of your cancer research. That’s why I’m asking you for help.

This winter, I was diagnosed with disseminated lymphoma and started treatment with R-CHOP, intrathecal methotrexate, and high dose IV methotrexate at Memorial. A recent Omaya tap showed persistent atypical cells in my CSF. Phil, my oncologist, sent flow cytometry yesterday, which is pending. He says that if the atypical cells are lymphoma, we have to switch to stronger (and potentially more toxic) chemo.

Can you look at my lymphoma cells and design a targeted drug that would destroy my lymphoma cells and not kill the rest of me? I know you’ve been successful using this approach before in non-lymphoma cancers. I love my family more than you can imagine, and I’d like to have the chance to grow older with my husband and watch our kids grow up. I know that this kind of research can take years, and I may not have that kind of time.

As cancer doctors, we’re trained to accept dying as a part of life. Now that I’m on the other side, I see how hard it is to stare death in the face and confront the possibility of leaving the people you love. I realize that my request is enormous (if not impossible), but if anyone can do it, it’s you.

Laura

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From: Laura
Sent: Saturday, April 21, 2007 7:25 AM
To: Jennifer
Subject: Movie

Dearest Jen,

I can see that you really read my emails—you rattled off a list of the people who make up the cast of characters of my life as if you had been there living it with me (which you are, in spirit!). I’m also glad you don’t think my outburst traumatized my kids for life. That helps me a lot, coming from you.

You'll be delighted to hear that yesterday (Friday) was much better than Thursday! It started in the morning. The super was coming up to meet with David about the terrace and the bathroom. Nate thought that if I saw Jesus again I would explode, so he wanted to make sure that I wouldn’t have any contact with the super. He told me that when the super comes, I should either go into another room or leave the apartment. He refused to go to school until David promised him to make sure that I did one or the other. Emma had already left, so I went into Emma’s bathroom to take a shower, and stayed there with the door closed until David came in and told me that the super was gone.

Apparently it went well with the super. Jesus told David that they would finish the terrace within the week, and that the painters were coming in an hour to work on the bathroom. Jesus also told David that he has a prayer group, and he would like to bring his three friends over to pray for me. So I have to set a date to have the super's praying buddies make a house call!

I wanted to leave before the painters got there, because I knew it would make me upset. Luckily I had a good place to go. My friend Terri, an oncologist who makes documentaries about people living with cancer, had asked me to be in a film she was making called “The Physician as Patient,” and she was filming that day. I had to pick the right clothes for the movie. I ended up wearing a muted purple silk shirt, a patterned multicolored yellow and purple skirt that I bought in St. Johns once on a Caribbean vacation, and a sweater in a combination of gold and purple. The most important decision, of course, was the hat. I picked a hat called the Butterfly, which is a soft mauve crown with medium brim and a muted gold silk organza butterfly-shaped bow.

To kill the time between 9 am and the movie shoot at 11:30 am, I went to our new clinical offices at 61st St. I wrote you when I saw the bare suite, but I haven’t been back since everybody moved in. They moved offices when I was just starting treatment. I’ve had many prior office moves in the hospital and previously I’ve always packed and moved myself, meticulously labeling every box with books, journals, articles, and other items. This time, I didn't pack or move a single thing. I delegated it all to Lea, who did a spectacular job. She had even hung my pictures on the walls, so it really seemed like my office. And the windows that I was so excited about when I saw them for the first time—Jen, they actually open! And I look right at a huge sign that says Bed, Bath, and Beyond. The office is about twice the size of my previous radiology office, and the sun streams in through the windows.

Around 11:00 I left to go to the St. Regis Hotel, on 5th Avenue and 55th St. The hotel has an ornate lobby with lots of gold trim. I asked at the front desk where Terri was making the film. They told me the suite and I went up. When I entered the suite, they had just finished filming an 81-year-old doctor who had previously had head and neck cancer and now had prostate cancer. I chatted with him and his wife for awhile. Then the couple left and they set up for me.

The make-up part was a riot. I had blush, some kind of powder, and lipstick that I borrowed from Emma, but since I never wear make-up, I didn’t know how to put them on. Terri and I went in front of the mirror in the bathroom, a room that is bigger than my entire apartment, and she applied the makeup to my face. She is absolutely meticulous—things had to be exactly balanced on both sides—it was like having Monk as your make-up artist! Emma's lipstick was too orange for me, so I did a trick that the cameraman from India suggested. There was a bowl of raspberries in the room, so I rubbed some raspberries on my lips to make them red. Apparently that is how the queens in India do it, so I guess now I have the qualifications to apply for a job as an Indian Queen.

The filming was done in the living room of the hotel suite, with overstuffed chairs, huge picture windows, and cut lilies in the background. It was a little hot in the room so they put on the air conditioning. I sat in the chair and I was wired up so tightly with mikes that I probably couldn’t have escaped if I had wanted to. The film crew was two guys: Chris was in charge of the camera and Alex was in charge of sound. They were very friendly and joked around to try to put me at ease.

When it was time to start, Terri sat in the chair opposite me and asked questions. I got to tell a lot of my stories (although I left out the one about the panties and the brain surgery) and we talked about stuff I haven't really fully articulated in my mind (eg do you believe in life after death, do you believe in God, etc.). She asked questions about whether I got nervous waiting for test results, and I said not really. It’s interesting that I said that—in the moment I completely forgot how terrified I am waiting for the results of the Omaya tap to see if the CSF has cleared. I guess the mind compartmentalizes. I had to take a couple of nausea pills to get through the filming. Afterwards, we went to a little outdoor plaza nearby to take some still photos.

Later, I met my friend Karen for tea. She’s a breast imager from California and was in New York to visit her daughter. I've always admired her, because she does terrific work while still managing to keep her priorities straight. If she's invited to give a talk and she has family plans, she will do the family stuff and blow off the meeting. Her daughter is a sophomore at Columbia, studying Hispanic Studies and Human Rights. After tea, we walked back to my apartment and met up with her daughter. I took them for a walk on the boardwalk by the East River, and then I brought them home and introduced them to Emma and Nate. They left before dinnertime.

I was afraid to look in the bathroom until David got home, because I knew if I saw the fungus again I would lose it. When David came home, we looked at the bathroom together. Jen, it was a miracle. Those painters had scraped everything down to the bone, it was pure white, and the fungus was GONE. So it was worth it. One less thing trying to kill me.

That's all for now. Today I’m going to St. Patrick’s cathedral to light candles with Cindy.

Love
Laura

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From: Laura
Sent: Saturday, April 21, 2007 9:56 PM
To: Jennifer
Subject: Lighting candles

Hi Jen. Cindy and I met this afternoon at St. Patrick’s cathedral, as planned. It was a gray day, lightly drizzling when I got there. I was wearing a black hat called the Lachlan, which has a square crown, medium brim bucket, and knot trim, in a soft waterproof fabric. The hat was perfect for the rain outside, but was hot in the church, so once we were inside, I took off the hat and put on my Monk cap, which I had stuffed into my purse.

I had never been inside St. Patrick’s before. It was like a European cathedral. Incredibly high ceilings, ornate gold everywhere, and stained glass windows in vibrant colors with light shining through. When you come in, there’s a marble water fountain on your left, which Cindy said has holy water. I asked whether you drink it, and she said no, you bless yourself with it. Apparently you are allowed to bring a bottle with you and take some holy water for the road. I dipped my fingertips in it and sprinkled some on my head and shoulders.

We walked around the church. In the center were multiple long wooden benches. At the periphery were statues of saints, each enclosed by a couple of marble steps and a small fence. A little plaque near each saint explained the name of the saint and what the saint stood for. To your lower left as you looked at the saint, there were bins that had many round, relatively flat, unlit candles. More centrally, there were several rows of small glass cups, some with lit candles inside. The round candles fit perfectly into the glass cups. There was another bin full of wooden sticks, thinner and longer than chopsticks.

If you want to light a candle to a saint, you pick up an unlit candle, gently pull up the wick so that it’s standing rather than flat against the wax, and drop the candle into an empty glass cup. You take one of the wooden sticks, put the tip in the flame of one candle, and use that to light your candle. After the candle is lit, you can blow out the flame on your stick or extinguish it by putting it directly into this thin rectangular planter full of dirt. We enjoyed putting it into the dirt, because it made a satisfying little hissing sound as the fire went out.

Cindy recognized the saints, although I didn’t know most of them. I read all the cards. I was looking for a saint for 47-year-old women with lymphoma. None of the saints exactly fit the bill, but I was able to find saints for the sick, the dying, the departed, and people in need. I figured close enough, and lit the candles. After we had walked halfway around the church, there was a quiet area with several benches separate from the main central portion of the Cathedral. From the benches, there was a beautiful view of the stained glass windows and an altar at the front. We sat there quietly for awhile. Then we got up, looped around the other side of the church lighting candles for a few more saints, and left the cathedral.

Although it was near dusk, the light outside glared after the dim of the church. It was also jarring to come out of the cathedral and immediately be inundated by the bustle and commercialism of New York City, including an Armani Emporium right across the street. Cindy and I didn’t talk much. It had stopped drizzling by then. We walked back to the Upper East Side, where Cindy had parked her car. We gave each other a hug. She got into her car and I hopped a cab back to my apartment.

I know that lighting candles in a cathedral is an odd experience for a nice Jewish girl. I’m not a born again Christian (or any kind of Christian). When I was growing up, my parents shared a strong sense of Jewish cultural identity but weren’t religious—my dad used to say that many atrocities in world history were committed in the name of God. But confronting the fact that I might die makes me look for answers and spiritual solace wherever I can find them. I need to connect with other people, with the universe, and with what, if anything, is beyond it.

Tomorrow, back to earth. Emma and I have tickets to see a Broadway show.

Love
Laura

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From: Laura
Sent: Sunday, April 22, 2007 6:18 AM
To: Q
Subject: Invitation

Dearest Q,

I’m writing this letter to invite you, Steve, Nick, and Ben to our "re-wedding." David and I are going to celebrate our 25th anniversary by getting unofficially married again. We're hoping to have the celebration on Sunday June 10 (the actual anniversary is June 13), either on our terrace if it's ready or in Carl Schurz Park if it's not. It will be very simple—just the eight of us (no rabbi or other officiating person) and we'll read something out loud and give each other a hug and a kiss and that's it. Afterwards we'll have dinner. Can you join us?

Love
Laura

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From: Laura
Sent: Sunday, April 22, 2007 11:25 PM
To: Jennifer
Subject: Spring Awakening

Hi Jen. I had a wonderful day with Emma today. It was sunny and warm outside, maybe the first real spring day we've had so far. I wore a hat called the Olivia, which was a fabric cloche with piped crown and hand-rolled roses in a luscious lime green.

Emma came with me to drop off some dry cleaning, and then we went shopping. We went to Eileen Fisher, and bought some comfortable pants with an elastic waist in beige and black. I also got a button-down sweater that doesn't pull over my head. All my clothes have to be easy now. No energy to spend on snaps and zippers and buckles. We also got a great jacket for Emma from the Petites section. Then we went next door to Le Sportsac, and Emma helped me choose a pouch I can use to organize all the stuff I carry with me now (Meds, iPod, anti-nausea pills, pencils, toothbrush, toothpaste, numbing spray, and anesthetic cream).

After a quick lunch, Emma and I went to see "Spring Awakening," a Broadway musical about a young girl's coming of age. We’ve been listening to the CD, but hadn’t seen the show yet. Emma and I have been seeing musicals together for years. I love our excursions. I’ve always been a big fan of musicals, and the boys never want to go; David and Nate both believe that people should not spontaneously burst into song. It’s great to spend time with Emma—she’s such a bundle of joy and energy. Any experience is more fun if Emma is there to share it.

I remember our first mother-daughter outing to the theater more than a decade ago. Emma was three, and I had gotten tickets for us to see the ballet at Lincoln Center. All around us were mother-daughter couples, including one couple next to us with a mom in her 50s and a daughter in her 30s who have apparently been coming to Lincoln Center together for more than twenty years. Emma was very excited at the beginning of the show but when I turned to talk to her as the curtain rose at Intermission, I saw she was fast asleep. The most expensive nap in history.

We loved Spring Awakening. There were young actors we’d never seen before and the music had a strange combination of dissonance and consonance as well as a mix of styles including classic show-tune, gospel, and rock. Afterwards, I got Emma a Spring Awakening t shirt and the script of the play from which the musical was adapted (although the story was primarily an excuse for the music). We took a cab home and the four of us had dinner together. Nate and David went out to a jazz club. Emma and I listened to the music from the show and fell asleep before the CD ended.

Love
Laura

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From: Laura
Sent: Monday, April 23, 2007 11:59 AM
To: Peter
Subject: Flow cytometry

Hi Peter. I had a repeat Omaya tap to see if there are still lymphoma cells in my CSF. As we discussed, I’d be very grateful if you could give me a buzz to discuss the results of the flow cytometry. I gather this is the critical test. I’m at x5728.

Thanks!
Laura

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From: Laura
To: Phil
Sent: Mon Apr 23 12:07 AM
Subject: Go with the flow

I talked to Peter about the CSF flow results and he said it's negative for lambda or kappa clonal excess. Apparently that means there’s no lymphoma in the CSF! That’s one for the home team. After Cycle 3, we have to confirm that the cells are clear in the LP. I’ll set it up.

Laura

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From: Laura
Sent: Monday, April 23, 2007 9:45 PM
To: Jennifer
Subject: Good news

Hi Jen. Thanks for your note. I know how hard it is to find a new nanny. I wish I could launch a Philadelphia spin-off of our Nanny Resource list-serve for you now and find you the perfect nanny. I’ll ask Carmen if she knows of any nannies in Philly.

I got some good news today—the flow cytometry on my CSF showed no clonal excess! In English, that means that the funky lymphocytes in my CSF are probably NOT lymphoma. I need to confirm that finding with another lumbar puncture (LP, or spinal tap), to make absolutely sure that the CSF is clear, but this raises my chances considerably. This result is just what I was hoping for, and I’m glad about it, but I can’t completely rejoice until we confirm the results with an LP, which will happen after I finish this round of chemo.

Yes, I'm being admitted tomorrow for more high-dose IV methotrexate. I'll probably go home Sunday. I hope I get admitted back to M8. They were so nice to me the last time.

Have to pack for my admission. My next emails will be from the hospital.

Love
Laura

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From: Laura
Sent: Tuesday, April 24, 2007 9:49 PM
To: Maureen
Subject: Thank you

Hi Maureen. Thank you for leading Athena tonight! I already hear through the grapevine that you did a fantastic job. Can't wait to hear the details.

Love
Laura

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From: Laura
Sent: Wednesday, April 25, 2007 1:21 AM
To: Gerald
Subject: Never mind

Hi Gerald. I’m writing to apologize for the desperate middle-of-the-night email I sent you a couple of days ago. I’m glad I got your autoreply that you’re out of town with limited email access. When I sent the email, it looked like my lymphoma wasn’t responding to the chemo and I got scared. Luckily, the news this week was great. My CSF is clear—no lymphoma! So we’re both off the hook for now. Hopefully, when you get back, you’ll read both of these emails at the same time and know not to worry.

In this place where we spend most of our lives fighting cancer, it’s good to have you on our team. I won’t be shy to write if I need you again.

Best wishes
Laura

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From: Laura
Sent: Wednesday, April 25, 2007 2:54 AM
To: Jennifer
Subject: Second admission

Hi Jen. I'm sorry you're short of breath. You're so petite, the baby occupies a substantial portion of you, and when your diaphragm tries to descend to allow the lungs to expand, your belly is telling your diaphragm "stay away from me!" Don't worry, this too will pass, and soon you will have your beautiful baby boy. I can't wait to meet him!

Yesterday I was re-admitted for more IV methotrexate. Wearing my Monk cap, I went up to the 4th floor to see Phil in the Clinic. Cindy met me there—I wasn't sure if they were going to give me another intrathecal chemo today or not. After I had my fingerstick, they called us into the office. Phil told me that since my flow cytometry was negative, I don’t need to get more intrathecal chemo for the time being. HOORAY! He said that after the third round of IV chemo I’ll get an LP as well as repeat MRIs of the spine and brain, and then we’ll discuss with Sam whether I need more intrathecal chemo at all.

I went to the Admitting office, and finally I was admitted back to M8. It's a different room, but still fine. The computer has this weird soft rubber keyboard which takes a little getting used to, but the layout is normal (QWERTYUIOP etc.). I already had multiple visitors, including one who brought me flowers which I’m allowed to have today because my white blood cell count is still OK. When your white cell count falls after chemo, they don’t allow you to have flowers because they could be a source of infection.

The nurse “accessed the port” after I sprayed it, and hooked me up to the pump on the IV. The IV pump follows me everywhere, beeping whenever it’s unplugged. They started the bicarbonate drip and gave me the premeds. The methotrexate started at 7:30 pm and ran for four hours, so it was done at 11:30 pm. Now I'm getting more bicarb. I get hydrated all day tomorrow, and then I get the leukovorin rescue starting 24 hours after the methotrexate began. So far so good.

Terri is busy editing her movie on “The Physician as Patient.” She'll present it at the annual meeting of the American Society of Clinical Oncology (ASCO) in June.

I'm getting sleepy. While I go to sleep, I’m going to listen to Yo Yo Ma and Emanuel Ax doing the Brahms E Minor Sonata for Cello and Piano that you and I used to play together (Allegro non troppo, Allegretto Quasi Menuetto—Trio, and Allegro). Usually I’m asleep before the end of the first movement.

Love
Laura

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From: Laura
Sent: Wednesday, April 25, 2007 3:32 PM
To: Women Faculty
Subject: Athena lives

To Our Guests at Athena last night:

I'm writing to thank you for coming to Athena last night. It means so much to me that Athena lives even when I can't be there—it means that our group is self-sustaining. I especially want to thank Maureen for hosting the meeting while I was getting chemo. And I actually did join in the toast you had for me—I just did it with methotrexate instead of white wine. I’ve now received 9 of 18 chemos (halfway)!

I'll beat this. You can't keep a good woman down.

Laura

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From: Laura
Sent: Wednesday, May 2, 2007 6:29 AM
To: Jennifer
Subject: Tales from inside the house

Hi Jen. Sorry for my long silence. I had to focus on getting through my admission. But things are good, and I have many stories to tell you to catch up!

First, about the admission. I wrote to you that the high-dose methotrexate went fine, and the rest was also pretty uneventful, fluids and peeing. They put a plastic container euphemistically called a "hat" in the toilet that collects all the urine so that it can be measured, and they track my Intake and Output (Is and Os). The system is imperfect—they carefully monitor every cubic centimeter (cc) of fluid that I get IV, but then they ask me how much I drank, and I have no idea, so I just make up a number. No matter when they ask how much I’ve had to drink, I look at them confidently and say, “200 cc.”

They take my vital signs (pulse, temperature, blood pressure) every six hours. I had a running joke with the nurses' aides about the impressiveness of my vital signs. When the team came by to round in the morning I told them that I had the best vital signs on the floor. Some of the nurses' aides thought it was hysterical, and others seemed puzzled by me. Maybe some of the M8 patients getting bone marrow transplant who are in the hospital for weeks at a time get a little depressed and don’t talk much to the aides.

Apparently the fellow-in-training on my team heard me brag that I had the best vital signs on the floor, and when she presented me at Lymphoma rounds to the other doctors at a meeting behind closed doors she described me (in good humor) as a competitive overachiever. A friend of mine who is a lymphoma doc and attends lymphoma rounds told me what the fellow said. So the next day, when the fellow came to see me at rounds, I told her, "I hear that in rounds you called me a competitive overachiever... I just hope you realize that if I am a competitive overachiever, that I am the best competitive overachiever on the floor!" We laughed.

I had terrific nurses. My day nurse was usually Trish, and my night nurse was a wonderful person named (of all things) Jen! It’s amazing how much the nurses affect your hospital experience. The doctors breeze in, glance at your chart, ask a couple of questions, listen to your heart and lungs for two minutes, and then disappear into doctorland to write notes and orders. When you need a Tylenol at 3 am or something hurts, it’s the nurses who come. The tooth fairy must be a nursing school professor—I’m amazed at how softly some nurses can tiptoe into your room in the wee hours of the morning and do what needs to be done without waking you up.

Guess what—Nate grew up! I never knew that I would be able to identify the precise date when he grew up, but it was Thursday, April 26, 2007. It was around 7:30 in the morning, and David had dropped by to have breakfast with me in the hospital. He started coming to have breakfast with me most mornings when I was in the hospital, after he got the kids off to school. It was our time together. That morning, while David was visiting, I called Nate to tell him I was worried because he didn’t seem to be doing much homework. Over the phone, I told him that I was concerned that he would jeopardize what he has spent three years in high school trying to achieve.

Nate calmly explained that he had already spoken to all of his teachers. He had discussed every single subject, reviewing what assignments he has, which ones he has to do, which ones he can skip, which papers he can hand in late, etc. Nate said he wanted to be in control of his schoolwork, which showed a great deal of insight and self-awareness; he can’t control my cancer, but he can control his work. He said that he hadn't told me because he didn't want to burden me, but that he’s taking care of his work and he asked that I respect that. This was no teenager; he was mature and rational. I hung up the phone, turned to David, and said, "He's an adult."

I had a lot of visitors. It's nice to see people, but sometimes it got a little out of control. It's hardest when four people who don't know each other come at once. For my next admission, I'm going to get a guest book and have people sign in and make comments at the door.

I narrowly dodged a blood transfusion. I was anemic to begin with (my hemoglobin was 8 point something; normal is 12), and then when they hydrated the hell out of me, my hemoglobin went down to 7.5 (basically they diluted my hemoglobin, a process called “hemodilution”). I had agreed to be transfused if it went below 7 but really didn't want a transfusion if it wasn't essential. So I claimed I had just become a Jehova's witness ("Jehova was just here! I witnessed Him!”) and talked them into giving me darbopoietin, an injection that helps your bone marrow produce more red blood cells. Thank God I avoided the transfusion. The more they do to you, the greater the chances that something will go wrong—or, as we used to say in internship, the more you stay, the more you stay. My hemoglobin started to come up, so it worked out OK.

During this admission, I continued doing laps around the nurses’ station while listening to my iPod and pushing my IV pole. At first I counted the number of laps, but then I started just doing an hour every morning, before I shower. Just turn on Stevie Wonder (At the Close of a Century, Disc 2) and I'm ready to rock and roll. I listen to a lot of classical music in the room (this time I especially enjoyed Mozart Violin Sonatas with Hilary Hahn and Natalie Zhu), but when I’m walking I go for more popular stuff.

I was discharged before noon on Saturday. David came to pick me up with his mom, who was visiting from California. We had brunch with the kids at home, toasted bagels and unsalted nova and cream cheese and fresh orange juice, one of my favorite New York traditions. After she left, I went to pick up new prescription glasses and I can see! It’s miraculous.

Re the plan for chemo etc.—I'm getting IV R-CHOP again tomorrow. After my next admission, I’ll be done with the third cycle of chemo and they’ll do restaging tests.

Love
Laura

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From: Laura
Sent: Saturday, May 5, 2007 2:56 AM
To: Jennifer
Subject: Seeing the light

Dearest Jen,

I’ve reached a new phase in this cancer thing. I've already finished 10/18 planned doses of chemo, so I’m past the halfway mark. I can see the light at the end of the tunnel.

I enjoyed my laps around the nurses’ station during my last admission so much that I decided to try walking on the beautiful boardwalk overlooking the East River by my house, called John Finley walk, in Carl Schurz Park. I enter the Park at 88th Street, right next to Gracie Mansion, which is the Mayor’s mansion (although Bloomberg doesn’t live there, because apparently his own apartment is even nicer!). When you walk on the boardwalk, you can see a majestic view of the river, boats, Roosevelt Island, the Triborough Bridge, light, and sky. A moderately paced walk from one side of the boardwalk to the other takes ten minutes, so you can do three complete laps back and forth in one hour. If you’re very ambitious, you can go down the staircase on one side of the boardwalk and walk further downtown as far as the East 60s, and then come back.

For the past several days, I’ve been doing this walk for an hour each morning, wearing my iPod, listening to different music every day (The Supremes, the soundtrack of Wicked, Carole King, James Taylor). It's fun! There’s a whole culture out there in the mornings, with runners, walkers, newspaper-readers, bike-riders, stroller-pushers, etc. I particularly love seeing the people play with their dogs in a special fenced off-area. The dogs hang out on one side and the people on the other, like it's a big cocktail party. The other day a man sat on a bench reading the paper, and next to him was his large long-legged dog. The dog’s front legs were on the pavement, but his butt and hind legs were up on the bench—he sat on the bench like a person! I wish I’d had my digital camera.

Today I went to my 61st Street office. I read through snail mail, which included more cancer presents, and emails. For the book I’m writing, I'm trying to decide whether to include just the emails I send, which are mostly to you, or whether I should also include emails I get from other people. I've gotten some wonderful and supportive emails, and it may be nice to include them, because one take-home message I'd like to give people is that if you reach out to people, sometimes they are there for you in wonderful ways. If I do include other people's emails, I’ll let the authors of those emails read the book and ask their permission to let me use the emails as written.

Tonight David and I had a date. We went to see Cassandra Wilson at the Blue Note. She is a wonderful jazz singer who doesn't do a lot of club dates in the States anymore. I wore a new black sleeveless dress, a turquoise sweater, pearls, and a hat called the Lucy, which is a black weave with a soft silk silver bow. The music and dinner were fabulous but we were crushed in like sardines. It was the first time David and I went out to hear jazz together since his birthday party. I looked at David during the music and pictured him at jazz clubs over the years, starting when he was a kid in the Bronx and too young to get into the clubs so he would listen by the door.

I figured out how this lymphoma will behave. I’m going to go into remission with the chemotherapy, and will transform this acute threat on my life into a nice chronic disease for which I'll have to take pills and have follow-up tests. Every few years I will recur, because that's what lymphomas do. When I recur, they’ll blast me with chemo, which I’ll tolerate remarkably well, and I’ll go into another remission. As time goes by, they’ll do more research; the chemo will get better and the remissions will be longer. And I could percolate around like this for twenty years, or maybe longer, until one day the recurrence will get me or I’ll be hit by a bus or something entirely different. And maybe I'll outlive everybody else, and be looking for someone to whom I can send emails at 2 am. Good plan?

How are you today? Do you feel like the baby will come any minute now? When is the actual due date again?

Love
Laura

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From: Laura
Sent: Saturday, May 5, 2007 1:27 PM
To: Mike
Subject: Your hat

Hi Mike. I guess Mel told you about my lymphoma. How wonderful that you sent me two hats! I bought 15 hats at the beginning of chemo, and since then people have been sending me hats as presents (usually baseball caps). Until today, I had 28 hats; your hats are #29 and #30. At this rate, I'll be able to get through the rest of my chemo and never wear any hat more than three times!

I’m impressed that you wore one of the hats during a New Year’s Day Alcatraz swim, and the other when you finished the Ironman World Championship Triatholon in Hawaii. I love the card, “Wear these be victorious.”

Keep those prayers coming. If God hears from a rogue like you, he'll know something is up that he has to take seriously. Since you’re Greek, maybe you should pray to a Greek God. Let's get Zeus on board.

I'm doing great. I’m more than half done with the chemo, and I started walking about an hour every day on this gorgeous boardwalk by the East River, right next to my house. One of these days (after my white cells come back), I mayl jump in the water and become a Polar Bear like you

I'm writing a book about being a doctor and a patient, and it's more than half done. I was going to call it Both Sides Now like the Judy Collins song. Unfortunately, there are already about a million books with that title. These books include, but are not limited to, Both Sides Now: A Twenty-Five Year Encounter with Arabs and Israelis, “Both Sides Now: The Story of School Desegregation’s Graduates, Both Sides Now: Living and Dying in San Francisco, and, my personal favorite, Both Sides Now: One Man’s Journey through Womanhood. I had to come up with another name. I’ve decided to call it I Signed as the Doctor because when they gave me the consent forms to sign for those god-awful procedures when treatment began, I kept forgetting I’m the patient, so I signed as the doctor!

We're already fantasizing about the post-chemo celebration vacation to Turks and Caicos in September. Blue sea, white sand, not a care in the world, and I hear I can bump into Donna Karan by the pool. But I'll be in the ocean snorkeling with fish in the reef.

Love to Sheila. Keep the faith.

Love
Laura

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From: Laura
Sent: Saturday, May 5, 2007 3:13 PM
To: Jung-min
Subject: Hi! And a few things

Jung-min—are you at the American Roentgen Ray Society meeting today? I left you a message on your cell—I called for a few reasons:

1. Good luck! Your presentation will be fabulous.

2. Can you pick up an abstract book for me? If they give you a hard time, tell them it is for a colleague of yours with cancer who couldn't come to the meeting. And ask for it early in the week—by later in the week, they tend to disappear.

3. Who is the moderator of the scientific session at which you’ll be presenting? Before the presentation starts, go up to the moderator, introduce yourself, and check out the podium. Make sure you know how to advance the slides or go back, how the pointer works, and where the timer is so you can pace yourself.

4. I’ve gotten multiple phone calls about you for recommendations for the various programs for which you’re applying, and I tell them you are fabulous. But promise me you won't accept any offers until we talk. I want to give you my best advice when you have all the offers on the table.

You can call me back on my cell, email me, or call me at home. Which day is your talk, and when are you coming back? Are you staying at the meeting hotel? Are the accommodations OK? Do you know anyone at the meeting?

It is a beautiful day in New York today. I hope your trip was gentle and that you are having a wonderful time. Enjoy!

Love
Laura

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From: Laura
Sent: Tuesday, May 8, 2007 4:10 AM
To: Jennifer
Subject: Baby?

Dearest Jen,

How are YOU? What is the status of Baby Boy Menell? When I didn't hear from you I thought you had the baby—what's going on?

Can you email me your cell phone, home phone, and work phone numbers again? In my prednisone craze I can't find them. Otherwise, I’m doing great and will resume writing to you more regularly soon.

David and I saw the play "Inherit the Wind" on Broadway, and it was fantastic. It’s funny how a play about evolution vs. creationism can be so relevant to current times. I’d been excited to see Brian Dennehy, but I was really blown away by Christopher Plummer. They were both amazing.

I miss you and love you very much, and wish you every joy in your new son, whenever he decides to make his debut.

Love
Laura

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From: Laura
Sent: Saturday, May 19, 2007 10:44 AM
To: Jennifer
Subject: Third admission

Dearest Jen,

It's been awhile since I wrote you a good long letter, so here it comes. I'm an inpatient now, finishing up Cycle 3 of chemo with the high-dose IV methotrexate and leucovorin rescue. The chemo went fine on Thursday—no problems. I got admitted a little earlier than usual, so they were able to start the chemo earlier, which made the schedule flow a little more smoothly.

I've been feeling good, in spite of my ongoing worry about the LP I’ll have when this cycle of chemo is over. I’m walking laps around the nurses’ station again with the iPod, but I miss the boardwalk. I had so many visitors during my last admission that this time I brought a guest book—you know, like they have at a country inn or someone’s wedding? The guest book had a soft green cover and cream-colored paper, and I had bought it at Kate’s Paperie. I invite my guests to sign in and make comments. I considered having a cover charge and a two-drink minimum, but apparently that violates hospital regulations.

Today I had tickets for Emma and me to see A Chorus Line that I had bought months ago, but since I’m still in the hospital, Emma invited a friend to go with her. It will be her first Broadway show without me. I hope they have fun.

So when is this baby going to appear? Keep me posted!

Love
Laura

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From: Liberman, Laura/Radiology
Sent: Wednesday, May 23, 2007 1:27 PM
To: Jennifer
Subject: LP results

Hi Jen. I had my LP (lumbar puncture, or spinal tap) yesterday. The procedure is done by a neuroradiologist under fluoroscopy (“fluoro”), x-ray equipment that provides moment by moment images of your bones and other structures. You lie face down on a table, and then the table tilts so that your head is up and your feet are down, at a bit of an angle. The neuroradiologist uses the fluoro to help figure out exactly where to put the needle, which is usually between the third and fourth of the five lumbar vertebrae (the back bones in the lower spine). My wonderful friend Hilda did the LP, and Sam came in person to hand-deliver the fluid to the lab.

Today, they already have my LP results. There were only two white blood cells, down from 76, with no clonal excess. In English, that means no evidence of lymphoma! With the negative LP and the negative Omaya tap, we can say that the CSF is clear. I wish I could play the music from “I Will Survive,” but that will make me feel like dancing, and I’m supposed to lie flat for several hours after the LP (I actually shouldn’t even be sitting at the computer to write you this note, but I can’t resist). I bought the DVD of “Dream Girls,” which I never saw before, and Carmen and I are going to watch it together.

The baby is due any day now, right? You must be so excited. You’ll finally get to meet your son!

Love
Laura