Chapter 12: More Birthdays

Find things to celebrate and celebrate them.

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From: Laura
Sent: Sunday, May 27, 2007 11:56 PM
To: Jennifer
Subject: Emma’s birthday

Hi Jen. Today was Emma’s 15th birthday. Since her birthday falls on Memorial Day weekend this year, we’re having the party for her friends next week, but today we had the family celebration.

In the morning, we showered her with gifts—books and DVDs that we thought she’d like, as well as camera equipment (she has a passion for photography). We let her pick what meal she’d like to go out for, and what restaurant. She wanted me to take her to lunch at Candle 79, our favorite Vegan restaurant in the city. Then we went shopping together at her favorite stores—Urban Outfitters, American Apparel, H&M.

In the evening, we turned out the lights, gave her a cake with 16 candles, one of which was for good luck, and sang “Happy Birthday.” I bought her the cake at Greenberg’s, one of the best bakeries on the East Side of Manhattan, where I’ve been getting the kids their birthday cakes every year since they were old enough to eat chocolate. Emma’s cake this year was pure chocolate—chocolate cake with chocolate frosting, and said “Happy Birthday Emma” in yellow icing on top.

As I watched Emma and Nate while we sang happy birthday, I thought about how different they are from each other. Nate has always been cautious; he looks so much before he leaps that sometimes he doesn’t get around to the leaping part. Emma, on the other hand, is absolutely fearless. When Nate and I used to cross the street when he was young, he would hold my hand, and ask, “Is it OK, Mom?” If Emma saw something interesting on the other side of the street, she would have dashed across if I hadn’t been holding her hand tightly. Since Nate is older and more cautious, he always looks out for his sister, and has since she was a baby and tried to put seashells into her mouth at the beach.

Emma is the most extroverted member of our family. When she was two and a half, we signed her up for a program called Discovery that was held for about three hours twice a week. On the first day, the other kids all had trouble separating. Emma looked in the room, saw that there were art supplies, and said “Bye, Mom!” She has always been like a Pied Piper for other kids—when she went to the park, all of the other kids wanted to play with Emma. She has a way of relating to kids of any age—whether they are younger, older, or the same age, she manages to find common ground.

Emma’s birthday today made me think back to her other birthdays, like the one when she was in third grade. I had taken a vacation day from work so that we could celebrate after school. She had the mildest case of pink-eye that day, so the school nurse wanted to send her home. Emma was initially sad to be kicked out of school on her birthday, but when I picked her up, I told her, “Emma, don’t worry. We’ll shop ‘till we drop!” As it turned out, after about three stores she was still bursting with energy but I was exhausted. She gleefully told me, “We shopped until YOU dropped, Mommy!”

I can't believe that Emma will be going to sleepaway camp in a few weeks. I'll miss her. She's like a bundle of sunshine—it's impossible to be sad around Emma. When she goes, there is this big hole that's impossible to fill. But she loves camp, and at least they cut it down from eight weeks to six. The first time Emma went to sleepaway camp, a woman in my building asked me how I was doing. I said, “My daughter just went to sleepaway camp for the first time, and I miss her.” The woman said to me authoritatively, “When my son went to college, I cried for two weeks. Then, I moved into his closets!” She was saying that in New York, it’s OK when a child leaves, because look how much you gain in closet space!

How are you doing? Do you think the baby will come today? Then he and Emma would have the same birthday!

Love
Laura

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From: Laura
Sent: Wednesday, May 30, 2007 5:49 AM
To: Jennifer
Subject: Great news

Dearest Jen,

Congratulations on Benjamin Matthew! You've used two of my favorite boys’ names in the whole world. I love the name Benjamin, whether it's Ben or Benny. Like Nate, he'll probably declare himself as one or the other.

How did Sophie react when you brought home her new brother? I’ll never forget bringing Emma home from the hospital. Nate greeted her at the door with a photo album and called her “Baby.” He showed her pictures of the people in our family and tried to teach her their names. He also showed her pictures from a trip to the zoo, and explained, “Look, Baby, here’s a peacock!” Emma couldn’t even hold her head up, much less scrutinize the photographs. But Nate was undeterred. At dinner that night, he offered Emma a forkful of his food and asked, “Baby, want some steak?” I had to explain that Emma was too young to eat steak, that so far all she could handle was milk, and that we would have to teach her lots of things.

I got some great news this week. After I finished the third cycle of chemo, they repeated the spine MRI and the CT scan, and they were negative! The spine MRI showed that the 3 cm tumor that I used to have in my upper spinal cord is GONE, and the CT showed that the lymph nodes are smaller. So chemo works! I don't need any more intrathecal chemo injected into my head, but I need three more months of IV chemo.

I thought I was supposed to get R-CHOP yesterday but apparently I'm getting it Thursday. That changes my chemo schedule in a way that means I get to be home on our 25th wedding anniversary. David and I are going to have a little ceremony where we renew our vows on our terrace, either that day or on the weekend after I'm discharged. It’s not going to be fancy—just the four of us, and maybe some close family friends.

The vows we’re going to read are from a list of promises we wrote to each other when I followed David to New York for medical school. It was so long ago we didn’t even have a word processor—we typed it on our old Smith-Corona typewriter. I looked at it today for the first time in years. The paper is yellowed and crinkly, and there’s a typo with a hand-written correction. The promises were pretty astute, though, especially considering that we were kids—eg “We won’t let our perceptions of each other’s parents blur our perceptions of each other” and “We won’t let each other be lonely.” And then there’s one that is unoriginal but still one of my favorites: “We will take care of each other in sickness and in health.” I’m thinking, damn, I'm glad we put that in!

Have fun with the new baby. It's an amazing time. And take advantage of any opportunity to spend time with Sophie, who was just “dethroned” by her new sibling—it'll mean the world to both of you.

Love
Laura

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From: Laura
Sent: Saturday, June 2, 2007 4:04 AM
To: Jennifer
Subject: The Prednisone Diaries, Revisited

Dearest Jen,

And here we go again—back on Prednisone! At least I can count on writing in the wee hours of the morning for five days a month. I’m in the midst of Cycle 4 out of 6 cycles of IV R-CHOP. I can't believe I have only 4 more chemos left (2 IV RCHOPS and 2 high-dose IV methotrexates).

We’re busy making preparations for Emma’s 15th birthday party, which will be on our roof tomorrow night. Since her birthday at the end of May usually falls on Memorial Day weekend, we generally have her party in early June.

Please let me know how the bris went, and keep me posted about Benjamin and Sophie and Jim and nursing and sleeping (or lack thereof) and everything else in your life that you want to share.

Much love always
Laura

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From: Laura
Sent: Monday, June 4, 2007 3:29 AM
To: Jennifer
Subject: Emma’s 15th birthday party

Hi Jen. Last night was Emma’s 15th birthday party with her friends. We had it on the roof of our building, so we could use the rooftop swimming pool, surrounding terrace with lounge chairs, other outside areas, and the room with the ping-pong table. I had heard that there was going to be a thunderstorm, in which case they would have either stayed in the ping pong room or gone downstairs to another party room in our building. Luckily, though, the weather held out, and they stayed on the roof.

Emma wanted to keep it simple—pizza, chips, soda, brownies—music from the iPoD—dancing—ping pong—swimming. Even with that plan, there was a lot to prepare. We got the food and the drinks (sodas and water), paper plates, and plastic utensils. We cut up carrots and celery for appetizers and Emma made a delicious dip (she is truly a fabulous cook). Emma made a playlist of the music she wanted to play. Three friends came early to help set up.

The party was a big success. One guy had forgotten to bring his bathing suit, and Nate generously went up to the roof to lend him one of his prior bathing suits, which fit the guy perfectly. We provided towels for everyone who wanted to swim. When you have parties by the pool in our building, you are obliged to use a lifeguard from the service that generally works at the pool, so the lifeguard was there. The party was from 7-11 pm. Since it’s already starting to stay light a little later, there was about an hour and a half of light before it got dark, and then they turned on the lights upstairs, which made the pool glow an inviting turquoise blue.

After the party, David, Emma, and I cleaned up. There were a few dishes to wash, and we had to throw away a lot of used paper goods. Emma was happy, bubbling over with excitement about the night. She had a stack of presents but decided that she’d open them in the morning.

Once when I was quizzing Nate on Spanish vocabulary in preparation for a test, we came across the word “Quincenara,” which is the celebration for a girl’s 15th birthday. I guess the Latina tradition is to celebrate sweet 15, not sweet 16. Emma had a wonderful Quincenara.

Love
Laura

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From: Junior Faculty Council (JFC)
Sent: Wednesday, June 13, 2007 10:39 AM
To: Faculty Nominated for Mentoring Award
Subject: MH 2007 Mentoring Award Nomination

Dear Colleagues,

We recently announced a new Memorial Hospital Award for Excellence in Mentoring. On behalf of the Junior Faculty Council, we are pleased to inform you that you have been nominated by a Junior Faculty member as an Outstanding Mentor.

We received many outstanding nominations and we thank you all for your contributions to mentoring. The recipient of this award for 2007 will be announced at the JFC Town Meeting, Tuesday, June 19th in room M-107, 12:30.

We hope that you can join us in celebrating this important achievement.

Congratulations,
JFC

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From: Laura
Sent: Saturday, June 16, 2007 10:15 AM
To: Jennifer
Subject: Wedding anniversary

Dearest Jen,

When I read your note about how tough it can be with the second baby, I remember back to when Emma was born. It is much harder after the second than the first, because there are two tugging at your energy and attention. That was when I considered going part-time, and almost did it. It wasn't until Emma was about six months old that I felt I was kind of hitting my stride again a little bit. It's good that you had a baby nurse for awhile. How is the nanny doing? Are you getting to spend any time with just Sophie?

Time is going by so quickly now. Wednesday was our 25th wedding anniversary. We renewed our vows on the terrace with the kids. It was just the four of us because the Berkowitzes couldn’t come. I wore a white lace shirt, a colorful print skirt, and a white hat, and David wore a suit. We alternated back and forth reading our promises to each other, with the sweeping East River and the Tri-Borough Bridge as the backdrop. Then we gave each other gifts. David got me a new ring, with a plain gold band sprinkled with tiny diamonds. I loved it because it seemed to be a perfect metaphor for our marriage: multiple tiny sparkling moments that add up to a lifetime of being together. I gave him an engraved watch. Afterwards, we asked the kids what they wanted for dinner and ordered out for Thai food. That's a 25-year marriage.

On Thursday, I was admitted to the hospital for my second-to-last round of inpatient chemo. Everything moved slowly that day. I had a 9 am appointment with Phil. I was very anemic and he wanted to give me a shot of darbopoeiten, but that had to be ordered from the pharmacy, so I waited until 11 am. Then I went to Admitting, but I had left my hospital card at Phil's office, so I had to go back and get it, and while I was there they wanted to change an appointment, which took time. I got back to Admitting at almost 12, and it was afternoon by the time I got to M8. Then they had to do a blood test for electrolytes and wait for the results; it took forever to start the bicarb drip.

I usually need to be on the drip about 4 hours to alkalinize my urine pH above 7.5. Only after the urine pH is high enough do they order the methotrexate, which then has to be mixed and delivered from Pharmacy. I didn't start the methotrexate until 8 pm, and it's a 4-hour infusion. Once I get the methotrexate, then 24 hours later I get leucovorin "rescue," and continue to get leucovorin every 6 hours as long as I'm here. So it means that my schedule for the leucovorin is 8-2-8-2 (which means I have to get up for vital signs at midnight and then they hang the leucovorin at 2 am). The first night I only slept about two hours, but I got a little nap on Friday, so I was OK.

David came in the morning on Friday and we had breakfast together, which was nice. Lots of visitors on Friday, including Cindy and our wonderful technologists with whom I’ve become very close over the years—Youngduk, Indira, Anita, and Joanna—and they came with frozen yogurt! I brought my guest book back with me this time and most of my visitors signed it and wrote in it, like they did during my previous admission.

Emma came by herself later in the day and did my nails in a beautiful sparkling white. Nate joined her, and then David came. We all hung out together until they went home around 8:45, and I went to bed. Slept until 4 am, woke up drenched (I have night sweats), got up and showered and changed, and then felt so awake I walked my laps around the nurses' station. Then I came back to my room and napped about two hours, until 8 o'clock when Kathy, my nurse, came in to hang the 8 am leucovorin and give me my morning meds.

They’ve decided I need a total of 16 chemos, not 18 as they originally thought, and I've had 13 out of those 16 chemos already. If everything goes according to plan, I need three more chemos after this: two outpatient IV R-CHOPS and one more admission for IV methotrexate. My last chemo will be at the end of July, less than two months from now. In August, I’ll have another re-staging work-up, including an MRI and a bone marrow. I'm trying to figure out how I'll compose my life when the dust settles. I need a kinder, gentler life.

With this illness, my priorities became crystal clear. I don’t want to lose that clarity even if the death threat is gone. Any guilt I used to feel about doing what I want to do instead of what I “should” do has vanished; I’ve paid my dues many times over. I want to spend more time with David and the kids, and I don't want to waste time and energy on stuff that is less meaningful. I hope I can keep my eye on the ball.

Love
Laura

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From: Junior Faculty Council (JFC)
Sent: Tuesday, June 19, 2007 2:07 PM
To: Faculty
Subject: 2007 Award for Excellence in Mentoring

1st Annual Memorial Hospital Award for Excellence in Mentoring

This award was established to recognize outstanding commitment to mentoring and will be given annually to a Memorial Hospital faculty member nominated and selected by the Junior Faculty. We received many outstanding nominations and congratulate all who were nominated.

This year’s recipient is:
Laura Liberman MD
Attending Radiologist, Breast Imaging
Director, Breast Imaging Research Programs
Director, Program for Women Faculty Affairs
Memorial Sloan-Kettering Cancer Center
Member, Memorial Hospital
Professor of Radiology
Weill Medical College of Cornell University

Congratulations, Laura! Thanks to all the Junior Faculty who shared their experiences.

JFC

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From: Laura
Sent: Thursday, June 21, 2007 5:46 PM
To: Jennifer
Subject: Anniversary presents

Dearest Jen,

Thanks for your thoughtful anniversary gifts. The books are wonderful, and I didn't own any of them! I brought them with me to the hospital, but my mom finished writing her autobiography and sent me the manuscript, so I read that instead. It’s called My Life into Art, and is about her development as an artist. My mom grew up in Israel and her brother and first boyfriend were killed in Israeli wars; her father died young of a heart attack. She has had too much loss in her life. I knew some of the stories but didn't know all the details. I think I understand her better. Did I tell you that she’s been emailing me a Blue Mountain card every day since I told her that I have cancer? It makes me smile when I click on the link and the background music starts blaring out of the computer.

Emma is packing to go to sleepaway camp—she leaves June 30, a week from Saturday. I miss her so much when she’s away. But she loves camp, and six weeks will go by pretty fast. Both kids have survived their exams and they are finally free. By the end, we were all exhausted. We may have limped to the finish line, but we got there.

The Junior Faculty at my hospital started an award for Mentor of the Year. There were 15 doctors and/or scientists nominated, and I won! They announced it at a seminar on Tuesday. I was so touched that I was actually speechless, which (as you know) is not my natural state. They gave me a plaque that says Mentor of the Year with my name. They forgot to engrave the year, and they wanted me to give them the plaque back so they could put the year on it, but I like it better this way—now every year I can look at it and think I'm still the Mentor of the Year.

David and I went out to hear music last night at the Blue Note, a jazz club—McCoy Tyner on piano, his trio, and Toots Thielmanns playing jazz harmonica. Toots is about 88 and hasn't been healthy, but he sure can play. It's amazing to hear those sounds coming out of a harmonica. I spent too many years being in the office for too many hours a day. I want to spend more time with my family now, and take walks by the river, and listen to music, and read, and write.

I have more I'd tell you but there is a reception for medical students who are participating in a summer NIH program and I want to do my part to welcome them. I’m wearing a special hat for the occasion called the Ruby, which has a beige crown, medium brim, and off-white silk organza roses and bows.

Please keep in touch. I love to hear from you.

Love always
Laura

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From: Laura
Sent: Saturday, June 23, 2007 6:57 PM
To: Jennifer
Subject: Grace

Hi Jen. Today I went to visit a friend of mine in the hospital. Her name is Grace, and she works in the Radiology Department at Memorial, scheduling general radiology exams. I’ve known her for years. She’s a quiet person in her 40s, very thoughtful and spiritual.

I found out that a couple of weeks ago, she showed up for work as usual around 7 am, and in the middle of taking a phone call she collapsed and became unresponsive. It looked like she was having some disaster in her brain. They took her to New York Hospital right across the street (we’re connected by a tunnel), where she was immediately admitted. They did a bunch of tests, and apparently she had a stroke. She’s been in the Neuro Intensive Care Unit ten days now.

When I was strolling this morning, after I walked south on the boardwalk, I went down a flight of stairs and kept walking south until I got to the exit at 71st Street, and then I went over a little walking bridge to get back to the street. The entrance to New York Hospital is on 70th Street between York and the River. I showed the people at the NYH information desk my Memorial ID, and was given permission to go up to the Neuro ICU. When I got to the ICU, I was surprised at how young all the doctors looked, and then I remembered that it’s July, the time of year when the experienced doctors-in-training leave and new ones start.

I found Grace. She was in her own “room,” really more a cubicle with a curtain separating it from the other cubicles. She was lying in bed. Her entire body was massively swollen, probably due to having received lots of IV fluid to stabilize her when she was admitted. She had tubes and lines everywhere—a nasogastric tube going through her nose into her stomach, an intravenous line in each arm to deliver fluids and medications, an arterial line in her wrist to check the oxygenation of her blood, and a catheter in her bladder to collect her urine. She couldn’t move her body on the left side.

I leaned over so that I was in her field of view. She couldn’t speak, but her eyes seemed to smile with recognition. One of the new young doctors came in, accompanied by an older doctor—the new intern, supervised by his more experienced resident. They said they were going to have to put another tube in her called a Swan Ganz catheter (also known as a “Swan”) that they insert into a vein in the neck and thread into the heart to monitor the pressures at different levels in the circulation. They asked me to leave but I told them that I’ve been a doctor at Memorial for 17 years and that I have done and watched countless procedures. They let me stay.

I tried to imagine what it felt like to be Grace at that moment. She could see what was going on around her and recognize people but was unable to talk, and nobody explained what they were doing and why. I took her right hand, which she was still able to move, and softly told her what had happened. “You had a stroke, Grace,” I said. “You’re at New York Hospital in the Intensive Care Unit, and you’ve been here for 10 days. They have all these tubes in to give you nutrition and medicine. You can’t move your left side because of the stroke. Often there are things you can’t do right after a stroke, because the stroke damages brain cells. After you’re stable, you’re going to have rehabilitation and physical therapy so that you get back as much as possible.”

She seemed to nod with her eyes, although she couldn’t move her head.

The intern started to clean her skin and put a sterile drape over her neck in preparation for the Swan. I could feel her fear. I explained, “Now they’re putting in another tube so they can monitor the pressures in your heart.” I had my iPod, which I always bring when I take my walks. I put one of the earpieces in her ear and played a song from the musical Spring Awakening called “I Believe.” It sounds like a gospel song, and the lyrics keep repeating, “I believe there is love in heaven. I believe all will be forgiven.” When the song ended, I just played it again, a continuous loop of faith.

Grace’s right hand, which had been tense in mine, relaxed. By the time the intern had finished inserting the Swan and putting the final stitches into the skin, Grace’s breathing was rhythmic and steady, and I saw that she was asleep. She must have been exhausted. I let go of her hand, kissed her on the cheek, whispered “God bless you,” and left. My friend Hilda has suggested to me and other friends of Grace that together we should get Grace her own iPod, which is a wonderful idea. Grace has a daughter who is computer-savvy and can put music on it for her. I thought about Grace and the iPod as I walked north along the East River, up the stairs, on the boardwalk, and then home.

You know how sometimes when someone is sick, you want to comfort them, but you don’t how to help? That’s how I felt when my father had his worst stroke, but it wasn’t the case today. When I saw Grace, I was certain about what to do and how to do it. Cancer has given me that.

Love
Laura

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From: Laura
Sent: Sunday, June 24, 2007 8:54 PM
To: Jennifer
Subject: Tea with Emma

Hi Jen. Today Emma and I went out for tea. We’ve had a tradition of going out for tea together for several years now. A few years ago, we got a book called The New York Book of Tea, which lists places in New York City “to have tea and buy teaware.” We looked in the book, marked the places that interested us, and systematically explored them. Emma especially loves Earl Grey tea, and we’re both fond of those tiny tea sandwiches, especially the ones with cucumber and watercress. And going to tea gives us a chance to be together and talk.

We’ve tried a lot of tea places together. The Lobby Lounge at the Stanhope Hotel has Limoges china, with delicate designs of birds and flowers. The Mayfair Regent has a fruit snack with mixed berries. And the Gallery at the Carlysle, probably our favorite, has soft couches, and they serve “high tea” on a large silver multi-level platter, with three tiers: tiny sandwiches on top, scones in the middle, and desserts on the bottom. Next to the tea place inside the Carlysle is Bemelmann’s bar, which features walls hand-painted by the guy who illustrated the Madeleine books.

Today we went to the Gallery at the Carlysle. I wore a hat called the Erica, which has a square forest green crown, medium up-tilting brim, and a trim of lavender silk binding and roses. We asked for the high tea, with two orders of tiny tea sandwiches and no desserts. We tried a new kind of lemon tea which was tart and fragrant. We brought the Sunday paper and looked at the theater section to see what other musicals are in town. I want to get us tickets for some shows that we can see together after Emma gets back from camp. If we have the tickets, maybe the time she’s away will go by faster.

Love
Laura