Chapter 7: Home

Cancer is the best excuse you’ll ever have—use it!

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From: Laura
Sent: Monday, April 2, 2007 10:00 PM
To: Jennifer
Subject: Home

Hi J. I am home, and it is even more wonderful than I remembered. Just to be free from the IV pole is bliss.

Hope your Seder was fun. Did you drink in the reclining position? Who asked the 4 questions? Sophie’s probably too young, or maybe her questions were, “When do we eat? Can we eat now? When can we play? When do we go home?”

Happy Passover.

Love
Laura

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From: Laura
Sent: Tuesday, April 3, 2007 10:56 PM
To: Jennifer
Subject: Shopping with Emma

Dearest Jen,

Emma and I went on a shopping spree today after work to get spring clothes. I wore one of my Christine Moore hats for the first time. I chose the Easy, which has a beige straw cloth slouch crown with a medium up brim, a little bow, and thin trim in a pattern of tiny vertical stripes in turquoise, pink, yellow, and white.

First, we went to a shoe store called Arche. They had just gotten in their spring sandals, and they had a style that fit me perfectly: it was as if they had custom designed these shoes for my feet! I bought them in four colors (turquoise, yellow, pink, and tan). We went to Eileen Fisher, and I bought some clothes to wear when I’m in the hospital. Then we went to Olive & Bette’s to get summer camp clothes for Emma. David thinks I was having a manic episode, and maybe I was, but losing your hair is tough—I had no idea my head was so white—and the stuff I got will help me feel beautiful, or at least I’ll feel like my shoes and clothes are beautiful.

Tomorrow I'm going to work in the Women's Office. Thursday I have to get a blood test, and then I'm going back to the wig place. Now I wish I'd just gotten a wig with short hair. Life is too short to waste time with stuff that doesn't matter.

Love
Laura

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From: Laura
Sent: Thursday, April 5, 2007 5:22 AM
To: Cindy
Subject: Re: checking on you

Hi Cindy! I missed you yesterday too!

I came to work and got great stuff done in the Women's Office. Did I tell you I'd like to create a Women's Oncology Network (abbreviated WON) that is an international society of women doctors and scientists dedicated to eradicating cancer? So yesterday, I decided on the T-shirt slogan, and on the society stone and color. See the following excerpt from the grant proposal.

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The goal of WON is to provide mentorship, collaboration, and unity among women physicians and scientists dedicated to the clinical treatment and research investigation of cancer. Our T-shirt slogan will be: “WON for all and all for WON!”

The color/stone of WON will be turquoise, long considered a stone that is holy, brings good fortune, and fends off the evil eye. Al Qazwini, the Persian scholar, wrote: “The hand that wears a turquoise and seals with it will never know poverty.” The Aztecs in Mexico believed that the sky blue gemstone directly connects the sky and the sea. In Orthodox Judaism, turquoise is the only non-white thread in the prayer shawl, representing the uniqueness of individuals. Turquoise has been deemed to provide protection from darkness, to guard horses and riders from unexpected falls, to endow shy people with confidence, and to be responsible for faithfulness and constancy in relationships. Turquoise is the perfect stone for WON.

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Between you and me, the real reason I picked turquoise is because I love that color and it goes with my eyes. I'm also tired of pink for girls and blue for boys. This way we get our own blue, and a beautiful blue it is!I stopped by to see you in Mammo but it was after 5 pm and I must have just missed you. I wanted to show you my new hat, called the Natasha. It’s a soft weave with a medium brim, silk binding, and a beautiful silk bow, all in a deep violet.

Love
Laura

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From: Laura
Sent: Sunday, April 8, 2007 8:56 PM
To: Jennifer
Subject: Quiet Sunday

Dearest Jen,

Today was quiet. I went out for a brief walk in the sun, but came home after a block and a freezing gust of wind. A good day to stay home and be warm. Emma and I watched the DVD of Season 1 of Project Runway (one of our favorite shows). Now I'm going to bed.

Love
Laura

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From: Laura
Sent: Monday, April 9, 2007 9:57 PM
To: Jennifer
Subject: Playing the cancer card

Dearest Jen,

My friend Maureen taught me that cancer is the best excuse you’ll ever have, so use it—she calls it “playing the cancer card.” So far I’ve only done it once, to get the dinner reservations for David’s birthday party. But today I found the perfect opportunity to do it again.

In our building, people generally get cabs on a first-come, first-served basis. But you know how some people believe that the social contract doesn’t apply to them? Well, there is one Evil Woman in the building who always jumps the line. It’s so annoying—no matter how long you’ve been waiting, she cuts ahead and barrels into the cab.

Today, I was waiting for a cab when finally it pulled up into the driveway. Suddenly, the Evil Woman appeared and started to cut ahead of me in line. I said to her calmly, “Excuse me, but I have cancer, I need to get chemo, and that’s my cab.” She stopped in her tracks and stared at me, open-mouthed. While she gaped, I jumped in the cab and drove away. Success! I wish I had thought of doing this a decade ago. And the best part of all—I wasn’t even going to chemo, I was going shopping at Bloomingdale’s!

Love
Laura

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From: Laura
Sent: Tuesday, April 10, 2007 6:19 AM
To: Jimmie
Subject: Statistics, and update

Hi Jimmie. Thanks for the wonderful talk—it’s great to be able to discuss how it feels to be a doctor and a cancer patient with the former Chair of Psychiatry at Memorial, who practically invented the field of Psycho-Oncology.

I'd love to read the Steven Gould essay you suggested about statistics in cancer. Now is a perfect time for me to read it, because the statistics are against me. I’d also love to read your book on The Human Side of Cancer. You can send them to me either at the hospital or my home address.

Re update—I'm doing great. I've finished one month out of 6 months of chemo, and I'm a little euphoric about it. I have bought 15 beautiful new hats (I am looking at this not as losing my hair, but as an opportunity to buy new hats), and people are starting to give me hats as presents. I knew that the hats would be a fun distraction for me and would help me feel better during treatment. What I didn’t anticipate is another huge benefit: hats are terrific icebreakers. You know how some people just don’t know what to say when you have cancer? Well, when somebody can’t think of anything to say, I can always ask, “Do you like my hat?” and, relieved, they comment on my hat.

I'm writing a book. I’ll send it to you when it’s done.

Love
Laura

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From: Laura
Sent: Tuesday, April 10, 2007 5:30 PM
To: Jennifer
Subject: Chemo OK today!

Hi Jen. Thanks for the beautiful baseball cap that says “Chemo means never having to have a bad hair day!”

I went for outpatient chemo today. I got to the hospital around 9 am. After my blood test came back, I had to wait two hours for them to mix the R-CHOP so I went to a colleague's office and worked on the computer for awhile. Around 11:30, they started the chemo. Some of the premedications made me sleepy. My nurse was named Marina, from the Ukraine. I got the chemo, napped an hour, and was done by 3:00. It was much quicker than last time—they go slow for the first R-CHOP to make sure you're not going to have a reaction, and since I passed that test, they could go much faster. Tentatively, they plan to admit me to the hospital for another inpatient chemo in two weeks.

I'm sorry you've reached the "no sleep" stage of advanced pregnancy. Do you have funky pillows in many shapes? That seemed to help me. Although being able to breathe probably would also be a big plus. Don't worry, these days will pass, and soon you'll get to meet your wonderful son, and I hope he brings you all the joy that Emma and Nate bring to me.

Love
Laura

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From: Laura
Sent: Tuesday, April 10, 2007 8:47 PM
To: Jennifer
Subject: Ode to a Neutrophil

Hi Jen. I know I just wrote to you, but there’s one more thing I forgot to tell you. I’ve been going through piles of old papers at home, throwing away massive amounts of stuff. It’s always been hard for me to throw things away, but somehow, having cancer makes it clear to me that there are some things that will never be high enough on my radar screen for me to devote time to them, so I’ve felt freer to jettison old crap.

While sifting through ancient papers, I found a poem that I wrote during my first year of medical school at Columbia College of Physicians & Surgeons about the neutrophil, a white blood cell (also called a polymorphonuclear leukocyte or “poly”) that fights infection. This topic is particularly dear to me now because chemo lowers my white blood cell count, making me susceptible to infection. The poem describes how the precursor cell, the myeloblast, grows up into a neutrophil, and then experiences the life and death of a hero combating infection in his host. Here it is:

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Ode to a Neutrophil by Laura Liberman

Now once there was a myeloblast in bone marrow awaiting
The day when he would grow up and start differentiating.
His mother, a promyelocyte, urged him with voice emphatic,
“Develop! Get some lysosomes! Be metachromatic!”

He was about to do it when a red blood cell nearby
Said, “You’ll regret it if you do it, pal.” “Regret it? Why?”
The red blood cell explained to him, “If you become a poly
You’ll live 2 days in tissues and then die. It would be folly

For one so young, such as yourself, to throw your life away
And live 2 days when you could live 4 months another way."
“I'd live 4 months? How could it be? You mean there’s hope in sight?”
The myeloblast demanded of the young erythrocyte.

“Of course,” replied the RBC, for you know very well
You live 120 days if you’re a red blood cell.”
So saying, the erythrocyte got up and swam away.
The myeloblast thought over what his friend had had to say,

And he resolved to try it. Yes, he would run any risk
In order to transform into a red biconcave disc.
And so, instead of synthesizing many lysosomes
He tried to make just hemoglobin off his polysomes

So he could carry oxygen just like a red blood cell.
The myeloblast then tried to lose his nucleus as well.
His mom, a metamyelocyte, about to be a band,
Said, “What’s holding you up, my son? I do not understand.

You should have had those granules inside you long before.
Now, hurry! There’s no time to spare! You can’t wait anymore!”
“But, Mom,” replied the myeloblast, “I can’t do what you do
‘Cause if I do that I’ll become a neutrophil like you.

And die after two days of life. But red blood cells live on
So to erythropoietin I must learn to respond!”
His mother, then a neutrophil, said, “Son, give up this game.
The situation’s desperate ‘cause the tissues are inflamed.

I know there’s an infection. I feel it in my lobes.
I know that those bacteria are entering in droves.
And only we can stop them, son. It’s true our life has flaws
I know that we must die for it, but we die for a cause.”

She turned and left the bone marrow, swam through the sinusoid
And gave a last long look at her delinquent little boy.
He thought it over. No, he couldn’t selfishly ignore
His duty as a neutrophil as he had done before.

“Longevity is nice,” said he, “but I must do what’s right,
And so I’ll be a polymorphonuclear leukocyte.”
And so, our friend the myeloblast gave up his former ways.
He turned into a neutrophil in less than 14 days.

And then he left the bone marrow, swam through the circulation,
Diapedesing when he found the site of inflammation.
“The place is full of bugs!” he cried. “Now what am I to do?”
A nearby poly said, “Just eat it, get it inside you,

And let your granules do the rest.” Our friend then heard the moanin’
Of an unlucky bug who had been coated with opsonin.
He hit it with his 2-1 punch until it was digested
Then turned to other bugs with which the tissue was infested.

It was a hard-fought battle, but the polys won the war.
The tissue, once inflamed, became just as it was before.
But yea, alas, our poly was breathing his last breath.
His two-day life was over. He died a martyr’s death.

So let us thank the neutrophil, who gives his life to us
Who fights with our bacteria and dies with them in pus.
No choristers will sing for him. For him will toll no bells,
But we will thank the neutrophil, the noblest of the cells.

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As I recall, when I recited the poem to Dr. John Lindenbaum’s hematology class at Columbia P&S, there wasn't a dry eye in the house.

Love
Laura