Chapter 5: Hats and Silver Linings

Look at this as an opportunity to get new hats.

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From: Laura
Sent: Friday, March 23, 2007 2:03 PM
To: Jennifer
Subject: Hats

Dearest Jen,

Where do I begin to tell the story about the hats? (Love Story music in background.)

Maybe I should start with the diagnosis of cancer, when I realized that I should look upon this not as losing my hair but as an opportunity to buy new hats. And then maybe I'll skip to the point where Emma & I went on-line to look up hats, and found the most beautiful hats I'd ever seen, made by a woman named Christine A. Moore. When I looked up her website, I found she has a studio in New York. She answered my phone call herself. “Christine?” I asked. “Yes?” she replied. “My name is Laura,” I explained. “I’d like to come and see your beautiful hats.” She said, "Are you a buyer for a store?" I told her that I’m a doctor in a cancer hospital who just became a cancer patient, and if I wear her hats and look fabulous, she will sell a lot of hats. She inquired, "What time would you like to come in?" We arranged it for today at 10 am. Just in time. My 47th birthday is tomorrow, the day my beautiful Emma is going on a class trip to Paris.

Yesterday I called Christine to confirm. Her address was near Macy’s on the West Side. Although I had a tough time with the intrathecal chemo yesterday, I slept better last night than I have in a long time. I fell asleep around 10:30, and woke up as usual between 2 and 3 am, but I listened to Carole King’s “Music,” which struck me as incredibly rich and melodious. I fell back asleep until after 7. Then I got up, showered, and was ready when Emma awoke.

Emma was wearing a grey and white striped shirt and ripped jeans. I had on a skirt and blue shirt, and wore a brown hat we picked up at Bloomingdale's last week. We buzzed for a cab and our favorite car service driver, Mischa, was there. He’s a Russian immigrant who enjoys practicing his English—every time we drive with him he has incorporated some new big word into his vocabulary. He drove us to Christine's.

We took the small elevator up, and there were white halls with white doors, each one a different place of business. When we knocked on Christine’s door, a young woman answered who said she was Christine's assistant. Jen, the place was perfect. Her studio was small, about the size of the first office I ever had at the hospital, with hardwood floors and white walls. All around us were a million wall hooks and hat stands, and every available space was covered with hats. There were all the hats I had seen on line and even a few more hats that are for her new spring collection. The hats were in every color of the rainbow, in every possible style and a million different fabrics. I said to Emma, "Oh, Emma, we've come to the right place."

Christine entered. She was about my age, long dark straight hair, tall, nice smile. She told us that she was inspired to go into the hat business by her love for the theater when she was young. Christine also said that people talk to people who wear hats. I said, "That's good, because I want people to talk to me!" and she said "Me too!" We turned our full attention to the hats.

I tried on hat after hat. I had studied the hats online and knew a lot of their names, which impressed Christine. I tried on some of the hats I recognized and others that I hadn’t seen. The hats differed in the crown (shape of the top), material (straw or fabric, including silk, cotton, a fine weave, satin, or a sort of rain-proof material), brim size (small, medium, large), brim direction (neutral, up, or down), and trim (band, bow, flowers, feathers, combination, or none). Some hats sat higher on the head than others; after I lose my hair, the ones that sit lower will be better.

I tried on the Easy and the Davenport and the Roz and the Natasha and the Reese Paisley and the Lucy and the Ruby and the Butterfly, and some cotton hats whose names I don't remember, and the Lachlan and I don't even know what else. Turquoise and rust and brown and black and tan and white and pink and gray. Across the room, I spotted a hat in a beautiful shade of purple with a big flower. I had to get that one. I said to Christine, “With a hat like that, I have to win.”

By the end, I had ordered 15 hats! After we paid, Christine asked if she should ship them, and I said yes. She's shipping them on Monday; they should arrive on Tuesday. When Emma is in Paris on Tuesday, she will know that somewhere in New York I am getting a huge delivery of beautiful birthday hats in huge white hat boxes tied up with big yellow satin ribbons.

At the end, I gave Christine a big hug and she asked me what kind of cancer I have. I told her it was lymphoma. She asked how far along I was in the treatment. I replied that I'd had neurosurgery already, and had received three of 18 chemo treatments.

I got the hats for a lot of reasons. I did it because I like to look for silver linings. I did it to teach Emma that even when life is hard, you can do things to make it better. I did it because it gave me something wonderful to think about for the past few days as I started chemo. And I did it because it will help me beat this. Because honestly, Jen, how can I lose the battle with cancer if I'm wearing a hat like that?

Love
Laura

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From: Laura
Sent: Friday, March 23, 2007 3:19 PM
To: Cindy
Subject: Balloons!

Hi Cindy and "Breast Friends" (Cindy, can you forward this to all co-conspirators?)!

I'm writing to thank you for the incredible bunch of pink balloons that you sent. I have never seen so many balloons in one place. They are a fabulously happy birthday present, and will be even more therapeutic than the chemo. Thanks!

Love
Laura

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From: Laura
Sent: Saturday, March 24, 2007 4:23 AM
To: Jennifer
Subject: Birthday balloons

Hi Jen. Happy birthday to me! Yesterday after Emma and I got home from the hat shopping, we were resting in the family room and the doorman buzzed, and came up with a huge bouquet of balloons in different shades of pink, all helium-filled, with long twisty pink ribbons that came together tied to a weight with a pretty bow at the bottom. The balloons (which were from the "Balloon Salloon," I kid you not) could barely fit through our front door! The gift was from Cindy and the other breast folks. They had wanted to throw me a party on Monday but I wasn’t up for it—the balloons were the perfect birthday gift. Emma and I laughed, and even the boys laughed about it when they got home.

Emma is going to Paris today for spring break, and David has been working hard to get everything ready for her. He also had to do our taxes, and is dealing with legal stuff for us. The kids were both out for awhile last night with friends, so David and I had a little time together. We sat and listened to Bill Evans and made a list of things to do, and then we curled up to watch the Hitchcock movie with Cary Grant and Grace Kelly, To Catch a Thief.

Keep writing. What music are you playing now?

Love
Laura

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From: Laura
Sent: Saturday, March 24, 2007 9:38 PM
To: Jennifer
Subject: Birthday

Hi Jen. Thanks for the wonderful Blue Mountain birthday card! And that’s terrific that you’re working on the Bach Suites for Unaccompanied Cello. I have a recording of Yo Yo Ma playing them on my iPod, and it’s one of my favorites—especially the first part (prelude) of Suite 1 in G Major.

I had a fabulous 47th birthday. I went back to sleep after I wrote to you, and I felt good when I woke up. It was beautiful here, sunny and just a little cool. Emma woke up first. I snuggled with her in bed and she told me about a party she went to with her friends last night. David woke up and we awakened Nate, who likes to be at the soup kitchen where he volunteers by 10 am. We all had breakfast together—David made scrambled eggs and home fries. Thank God Emma inherited her cooking talent from David, not from me. When we were in college, I was a better cook than David, but then he met a guy in his medical school class who was a gourmet chef on the side and taught David everything he knew.

Today, to celebrate my birthday, we separated the pink balloons from their attached weight so that the balloons could fly all over the apartment. We played an impromptu game of balloon volley ball, and David and the kids let me win, because I’m the birthday girl. Emma tied four balloons to the glass at the top of the walls on our terrace. They look festive, especially since it's a little windy and the balloons are dancing in the breeze.

The family did the traditional "Showering of the birthday person with gifts," in which the rest of the family practically trips over each other to keep a secret of the wrapping of presents and the signing of cards, and a bag is brought to the "surprised" guest of honor (who is never quite surprised). They gave me gifts I’ll definitely use: books by Perri Klass, a woman doctor who is one of my favorite writers, and CDs to put on my iPod (Glen Gould playing Bach Goldberg Variations, the album from the Producers, and an amazing jazz guitarist named Nino Josele playing the music of Bill Evans). Nate went to his volunteer gig, and Emma and David finished packing for her trip.

David had rented a car to drive Emma to her school today, because the kids going on the class trip were all meeting there to take a bus to JFK for their trip to Paris. I wasn't sure I'd be up for the car ride, about an hour each way, but it was a gorgeous day and I felt good so I went. Emma was the first student there. We met Emma's French teacher, and then Emma took us on a little walk on the beautiful campus and showed us her favorite deli for lunch where they name their sandwiches after superheroes. We were unanimous—we all wanted the Batman, which has turkey, honey mustard, and slices of green apple. After a quick lunch we walked back up the hill to her school, helped Emma get her bag on the bus, and waved goodbye. She went off to Paris.

I finally get the secret of living a good life. You have to create your magic in each individual day. Today, for example, there was the birthday and the balloons and seeing Emma off; yesterday we got the hats; and last weekend we had David's birthday party. There’s always a lot of shit that will either be prescheduled or will happen spontaneously. The way to make the balance good is to pack in the good stuff too. I bet that advice is in every self-help book I’ve ever read and ignored, but somehow I get it now. Even on the days when I have chemo or something else that sucks, I can build some magic into it. Maybe in this book I can express that in a way that will help people understand. You shouldn’t have to get Stage IV lymphoma to figure it out.

Got to go. Energy is fading. Nate had a friend over for awhile and they watched March madness (college basketball) on TV. Since UCLA beat Kansas, Nate is leading his NCAA bracket now. Life is sweet.

Love
Laura

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From: Laura
Sent: Sunday, March 25, 2007 7:41 AM
To: Emma
Subject: To Paris from New York

Hi Emma. It's Sunday morning and I'm in the living room, writing to you from the lap top. I slept well and feel good. Half the birthday balloons are still as high as the ceiling, and the other half have sunk to about my height. A few are almost on the floor. How many days will it take all of them to come down, I wonder? The balloons that you tied to the terrace walls are still there, dancing in the breeze, but now they are just slightly higher than eye level. I like to see them because they remind me of you.

I love you more than the sun, the moon, and the stars.

Can't wait to hear about your trip.

Love
Mom



From: Emma
Sent: Sunday, March 25, 2007 12:34 PM
To: Mom
Subject: From Emma in France

Dear Mom,

There's a computer in the lobby of this hotel that I’m using to write you this email. All the computer commands are in French! I should be able to get back here tomorrow, but I’m not sure, and I have no idea whether or not the hotel in Paris has a computer. The flight was good. I slept on the plane for a few hours. Tell Dad that bringing extra contacts was a brilliant idea because I could take them out before I fell asleep and put new ones in when I woke up.

After we got off the plane, we went to a part of town where we walked around, shopped, and ate. I had a brie, tomato, and watercress sandwich on baguette and a waffle with bananas and chocolate. I also took a lot of amazing pictures and I’m worried that I might not have enough space on my camera if I keep taking around 250 pictures a day.

Sun, Moon, Stars
Love
Emma

____________________


From: Laura
Sent: Sunday, March 25, 2007 4:47 PM
To: Emma
Subject: Love to Emma in Paris

Dearest Emma,

Thanks for your email! Now you understand how I used to feel when I was traveling a lot for work, and my biggest challenge of each day on the road was to figure out how to get to the next computer so that I could send and check email. Don't worry, I'll assume it may be days before you get to check it; if there's anything urgent, Dad and I can get in touch with you through your French teacher.

It's still a beautiful Sunday. Dad was out for most of the morning to round on his patients at the hospital and then he went grocery shopping. Nate and I talked about a short story he's reading for English by Melville called Bartleby the Scrivener, about a man named Bartleby who works as a "scribe" or copyist for a lawyer, and whenever anyone asks him to do anything, he says, “I would prefer not.” Nate has to write a paper about it, so that’s what he’s doing today.

I love that you’re taking so many pictures. When we went on our family trip to Paris a few years ago for Aunt Laura’s “end of chemo celebration tour,” I took a million digital pictures too—do you remember? I had to spend hours downloading them each day so I would have enough memory on the camera to take more pictures the next day! Thank goodness for those electrical adapters.

I'm so glad Elena is your roommate. I know you hoped she would be. And I really love her parents—they’re always so nice at school events, and I liked talking to them at your recent basketball game.

I’ve been listening to French music in honor of your being in Paris. There’s a beautiful sonata for clarinet and piano by a Parisian composer named Poulenc that I used to play in chamber music class with my friend Susan, who was a wonderful clarinetist. The sonata has three movements: allegro tristamente (fast and sadly), romanza tres calme (romantic and very calm), and allegro con fuoco, tres anime (fast with fire, very animated). We can listen to it together when you get home.

G2G (see? I listened when you taught me that G2G means Got To Go). Going to take a nap. I love you so much.

Sun, Moon, Stars
Love
Mom

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From: Laura
Sent: Tuesday, March 27, 2007 1:07 AM
To: Jennifer
Subject: Liberation

Hi Jen. Don’t worry that you and Sophie had to interrupt your shopping and leave the store because Sophie was fussing. It’s OK that Sophie is not an Olympic shopper yet. Emma took awhile to grow into her profound love of shopping, and now she is everything I could have dreamed of in a shopping companion and more.

Monday was fine. I went to the office. Cindy organized a birthday lunch for me with all the techs—chicken vegetable soup and vanilla frozen yogurt, two of my favorite foods. I went home to Nate by 4 pm, and we made a game of guessing how many days it would take for all of the balloons to fall down. The person who guesses closest without going over is the winner—no prizes, just the satisfaction of success. Some of those balloons are still hanging up there by the ceiling! The ones that fall we either throw away, puncture, or "liberate”—meaning that we go onto the terrace and release the balloons into the heavens. The balloon liberation was Nate's idea—at first I was going to discourage this practice because I was concerned about its impact on global warming, but then I thought hey, it looks like fun

Love
Laura

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From: Laura
Sent: Tuesday, March 27, 11:26 PM
To: Jennifer
Subject: Cornell trip

Dearest Jen,

Let me tell you about this amazing adventure Nate & I had today. Last week we had to fill out some forms for Nate's college applications, and on one of the questions they asked if we had any personal ties to specific colleges. David and I wrote about where we went, but then Nate asked me, "Mom, aren't you a professor at Cornell or something?" and I realized that yes, I am! Along with my faculty appointment at Memorial, I have a medical school appointment at the Weill Medical College of Cornell University. Here I am, always advising the women faculty to be aware of all of their appointments, and I don’t even remember my own! That got Nate thinking about Cornell.

We planned a day trip to visit Cornell. It had to be today. Tomorrow (Wednesday) I get intrathecal chemo at 3 pm and Thursday I'm admitted for inpatient chemo, so this is my narrow window. We arranged to take a flight from LaGuardia to Ithaca that was supposed to take off at 8:30 am and land at 10 am. We planned to take a tour at either 11 am or 1 pm depending on exactly when we get in and stroll around the campus. I also booked a hotel for the day (they have a hotel school at Cornell, so they actually have a real hotel called the Statler right on campus) so that if I get sick or tired I could sleep. We booked the return flight for that evening from Ithaca to LaGuardia.

The day deviated from the plan. We got up on time and made it to our flight, but the plane sat on the runway for 45 minutes before it took off, and then they couldn’t land in Ithaca because of fog. We circled in the sky for over an hour, and finally they landed in Syracuse at 11 am. So much for the 11 am tour. By the time we got to the Cornell Admissions Office in Ithaca, it was 1:15 pm, and the 1 pm tour had already left. Nate and I were both tired and hungry by then, so I suggested that we just go to the hotel, dump our stuff, have lunch, and explore the campus ourselves.

The Statler Hotel was right next door to the admissions office, and it was like a quaint country inn. I had booked a room on the 9th floor with twin beds so we could both lie down if necessary and have our own space. Jen, the view of the campus and mountains from that 9th floor window was breathtaking. It was worth the whole trip just to see that view. Nate and I pulled up two chairs to the window and looked at the map of Cornell, and Nate figured out which building was which. We ordered room service for lunch. I got tired after lunch and took a nap while Nate went off to explore on his own.

When I woke up two hours later at 4:00, the sun had come out. The first thing I saw was the panoramic view of the campus, including an old clock tower with bells that chime like a European cathedral every 15 minutes. I got up and splashed some water on my face and at that moment, Nate walked in. He had explored and procured us ice water and fresh fruit. I asked him to take me on a tour, and he gave me the short version: two stops and three breaks. We went to the James Olin library and the Cornell store, and Nate bought Cornell t-shirts for the whole family. After a quick dinner at the hotel, we went back to the Ithaca airport and took an uneventful trip home.

The trip meant a lot to me. I was touched by the way Nate looked out for me. It was great to imagine him in that pastoral setting and to see his life opening up with possibilities. I liked helping him get familiar with the process of the college visit, so he can make some future visits on his own or with friends. Best of all, I loved the fact that we seized the moment between two chemos to do something special. I’ve since found out that my white blood cell count was essentially zero when I went. Breathing recirculated plane air is not a great idea when you have no white blood cells with which to fight infection, so I’m glad I didn’t know my white blood cell count at the time—I probably would have been scared to go, and I would have missed it.

Got to go to sleep—out of juice. More tomorrow.

Love
Laura

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From: Laura
Sent: Wednesday, March 28, 2007 7:30 AM
To: Jennifer
Subject: Third time’s a charm

Hi Jen. Great news. You know how I’ve been vomiting like crazy every time they give me the intrathecal methotrexate? Well, today I didn’t throw up!

I was scheduled for my third dose at 3 pm. I had been taking a nap, and I forgot to ask Carmen to wake me up, so I almost overslept my doctor’s appointment. Luckily I had arranged to meet Cindy at the oncologist’s before 3. Thank God for Cindy—when she couldn’t find me, she called me on my cell phone. I was the last appointment of the day, but Cindy convinced them to stay to give me the chemo. Good thing I only live ten blocks from the hospital. I jumped in a cab to Memorial.

This time, the intrathecal methotrexate was much better. As Phil had suggested last week, I took some anti-nausea meds beforehand. There is a wonderful pill called Zofran that tastes sweet and melts in your mouth—which is perfect, because when you’re nauseated, you don’t really feel like swallowing anything. Unfortunately, Zofran costs about $40 per pill. Remember the episode of Seinfeld where Elaine is worried that the Today Sponge, her favorite form of contraception, may be discontinued? She buys a case of Sponges, which may be the last in existence, and before having sex with a guy, she has to decide if he’s “spongeworthy.” Well, when I’m nauseated, I have to decide if the nausea is “Zofran-worthy” or if one of the many cheaper nausea pills (like Compazine) would work. Intrathecal chemo is definitely Zofran-worthy.

When Phil came in to give the intrathecal injection, Cindy jumped up to spray my head. Phil had trouble getting the needle into the Omaya, and encountered a fair amount of resistance to injection, so he had to inject very slowly. An injection that usually takes seconds now took a couple of minutes. I waited for the nausea, but it never came. I felt so fine that I asked Phil afterwards, “Are you sure you gave me the chemo?” Yes, he was. Maybe it was the Zofran, but I wonder whether the injection rate also has something to do with it. Could it be that a slower injection of intrathecal chemo is less likely to cause nausea and vomiting? I have to ask Sam, my neurologist.

First admission tomorrow. I’ll write from “inside the house.”

Love
Laura

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From: Laura
Sent: Wednesday, March 28, 2007 9:35 PM
To: Cindy
Subject: Thanks, and hats

Hi Cindy. Thanks for calling me today to wake me up to get chemo, and for making them stay to give it to me.

And guess what? The hats came!

Love
Laura

Chapter 6: First Admission

Get doctors you trust, and do what they tell you.

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From: Laura
Sent: Thursday, March 29, 2007 11:59 PM
To: Nate
Subject: Your visit

Hi Nate. Thanks so much for coming to visit me on my first evening in the hospital. I take it as a good sign that there was a 5-episode marathon of The Office on TV.

I’m delighted about the SAT. What a relief to know that you’re done with that now. It's a huge weight off your shoulders, and one that you've been carrying around for months. Let it feel lighter—it is!

The college thing will sort itself out. It’s great that you’re figuring out what you want in a school. You'll have a lot more information about all the schools by the time you make a choice.

Tomorrow is Dad's actual 50th birthday—can you make sure to wish him a happy birthday from me first thing in the morning, and give my love to Emma?

I love you, Nate.

Love
Mom

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From: Laura
Sent: Friday, March 30, 2007 12:49 AM
To: Jennifer
Subject: First hospital admission

Hi Jen. It was so wonderful of you to call and wish me luck the night before I was admitted. I was a little nervous about being hospitalized. I thought I was acting pretty cool about the whole thing, but you can see right through me, as usual. It just shows your insight into the human psyche (or at least into mine!). I like your suggestion that if I’m scared, I should just listen to Bach.

Let me tell you today’s chemo story. We got in at 9 am Thursday morning to admitting, and a woman named Sandy checked me in. We were supposed to wait for Escort but they took forever—now there's a shock!—so David and I jumped ship and went up to the eighth floor ourselves (I promised the woman in admitting that we would claim we snuck out and would never let on that she knew we were leaving). David helped me settle into the room here. We put my iPod and cell phone on a little table beside the bed, on their respective chargers. The room had a bed on which I spread a fuzzy green blanket from home, window with view, TV, DVD player, closet, private bathroom, and working hospital computer. I take the computer as definitive proof of the existence of God.

The floor I’m on, M8, is the Bone Marrow Transplant (BMT) floor. Although I’m not getting a BMT now (that’s plan B if the chemo is unsuccessful), sometimes lymphoma patients who are not getting transplants stay on this floor. Every patient gets a single room for two reasons. First, BMT patients are susceptible to infection, so they like to keep them isolated. Second, because the BMT patients are often here for long periods of time, sometimes up to two months or longer, the rooms are often spacious enough so that a family member can sleep over. Another thing that’s good about being here is that if I do end up needing a BMT eventually, at least I’ll be familiar with where it’s going to happen.

The nurse, Trish, accessed the port, which she did fairly painlessly, using the spray. We started with four hours of hydration using a salt solution (normal saline with bicarbonate), with the goal of making the urine less acidic and more alkaline so that the methotrexate won't crystallize in the kidneys. They check the pH, which is a measure of urine acidity, before giving the methotrexate—the higher the pH, the less acidic and the more alkaline, and you want the urine to be alkaline, meaning a pH of 7.5 or higher. Mine was 8 (I've always been an overachiever). When the urine is alkalinized, they run in the methotrexate, a large bag of ugly yellow stuff.

One of the main complications of the methotrexate is painful ulcers in your gastrointestinal tract anywhere from the mouth (north) to the derriere (south). Trish told me that the best way to prevent those ulcers was by rinsing my mouth out frequently with a mouthwash called Biotene or with a bicarbonate wash. I did that every hour while I was awake.
The night nurse, Jonathan, was very nice and knew what he was doing. I had no problems or reactions, and I've been peeing up a storm—the goal is 150 cc/hr and I am doing far better. They'll hydrate me more tonight and check another urine pH. If the pH is too low, meaning it’s acidic, I'll need to take oral bicarbonate.

Aimee, the ultrasound technologist from 64th Street, came to visit today with a card about how the Lord is walking by my side. When people ask what they can do to help, I say without hesitation, “Pray for me.” I can't tell you how comforting it is to have people from all different religions praying for me. I have Jews writing my name on a piece of paper and sticking it in the Wailing Wall in Jerusalem and former radiology trainees in Croatia making pilgrimages. A dear friend of mine in New Orleans sent me a small wooden bracelet with pictures of the saints. I grew up in a reformed Jewish household and was never much of a believer, but somehow I feel that this positive energy in the universe channeled in my direction has got to help. And maybe there's more out there than we think.

I love you very much. I know you will have an incredible son. It is so great to have a boy and a girl!

Love
Laura

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From: Laura
Sent: Friday, March 30, 2007 1:19 AM
To: David
Subject: Happy Birthday!

Dearest David

(Imagine wild music in the background and a strip tease)

Happy birthday to you
Happy birthday to you
Happy birthday dear David
Happy birthday to you

Are you 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25,26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48,49..........50? (You can't be 50; to me we will always be college students, making love in a carrel in Baker library.)

I think our boy and girl will both be OK. I love you today and every day.

Love
Laura

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From: Laura
Sent: Friday, March 30, 2007 2:23 AM
To: Sam
Subject: Update, and question

Hi Sam. Just an update and a question. I tolerated the first IV R-CHOP without a hitch. I've had three courses of the intrathecal methotrexate. My first two intrathecal chemos were injected fast and I puked my guts out, but the third was injected much more slowly and it went fine. Does injecting the intrathecal chemo slowly decrease the likelihood of nausea and vomiting?

Best wishes
Laura

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From: Laura
Sent: Friday, March 30, 2007 2:37 AM
To: Cindy
Subject: St. Patrick's cathedral

Hi Cindy. Can I come with you one day soon to St. Patrick's cathedral, where you’ve been lighting candles? I've never been. Maybe one day next week?

Am I allowed to light a candle for myself, or is that considered "self-referral"? 

Love
Laura

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From: Laura
Sent: Saturday, March 31, 2007 1:23 AM
To: Jennifer
Subject: More stories from inside

Hi Jen. Another day, and so many stories. I can't believe I was just admitted two days ago—it feels like a lifetime has gone by.

This morning there was a risk management lecture in the Department of Medicine Grand Rounds in Hoffman from 8-9 am. The Departmental secretary had emailed us that we should try to go to this one if possible; otherwise the Radiology one is in August, which is pretty far away. So I asked permission to go to the lecture, which was an elevator ride downstairs from M8. The doc covering the lymphoma service said it was OK, so I went with face mask, IV pole, and all. It was funny how people responded—most people already seemed to know; some looked right through me; and some were terrific, as I would have expected. I sat with a couple of friends from Radiology. The lecture wasn’t great. A malpractice lawyer spoke, and she was disorganized and didn't say much. But it was good to get off the floor for awhile.

Did you know that when you're an inpatient at Memorial, you're entitled to a massage from Integrative Medicine? I had Reflexology, which is a massage for your hands and feet. If the computer in the room didn't convince me of Divine Intervention, the Reflexology did. If it weren’t for the chemo, my room would be a prime vacation spot!

David and Nate came to see me yesterday. It was David’s 50th birthday; he looked exhausted. Nate was in a good mood. I think he feels better about applying to college now that he’s visited a school. Even if he decides not to apply to Cornell, our trip there seems to have demystified the process. I had other visitors yesterday also, including Cindy, who brought me frozen yogurt.

I’m not sleeping much, but I’m getting a lot of writing done. Sam agrees that the third intrathecal methotrexate was easier than the first two because the oncologist injected it very slowly the third time. Apparently, when you inject it too fast, once the chemo hits the fourth ventricle it tickles the vomiting center in your brain and you puke. I'm going to ask the oncologist to inject it more slowly in the future.

Looks like they're shooting for a possible Monday discharge, but it depends on the methotrexate level. As Phil said, "It's all about urination now." I have been exceeding expectations in the urine output department. They want 150 cc/hr. I laugh at their 150 cc/hr, and raise it by 50 cc/hr!!

I’ve been listening to Bach, as you suggested. I listened on the iPod not only to Yo Yo Ma playing the Bach Unaccompanied Cello Suite in G Major (one of my favorite pieces of all time), but also to the other five unaccompanied cello suites, to Hilary Hahn playing Bach partitas for solo violin, and to Glenn Gould playing the Bach Two- and Three-Part Inventions. You’re right—Bach has a way of making order and beauty out of turbulence and chaos.

Love
Laura

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From: Laura
Sent: Saturday, March 31, 2007 6:07 AM
To: Jennifer
Subject: Saturday morning

Hi J—Saturday morning, almost 6 o'clock. Didn’t sleep much last night. The chemo part is done; the rest is just the leucovorin “chaser” and fluids. That will help lower the methotrexate level until it’s low enough that it’s safe to go home.

My hats arrived at the house last week (not a moment too soon), but in the hospital I’ve just been wearing the Monk cap that Cindy gave me. I can’t believe how Cindy has been there for me during my treatment. What a silver lining.

Charlie, who works in the file room of our outpatient breast center, is going to visit me today and bring home-made soup. He is a fantastic cook. When I was a resident taking weekend call and Charlie worked in the file room at the hospital, he used to bring in these savory lunches he had cooked with rice and chicken and shrimp and some kind of soup with a tomato base and a secret combination of spices. He also used to bring in fresh salad with these amazing tomatoes that he grew in his garden. All of the residents wanted to work on the weekends when Charlie was there.

Emma gets home from Paris today and will come to see me tomorrow. I can’t wait to see her and hear all about the spring trip.

Got to go—they want another urine sample. There's a Murphy's law (you know, “whatever can go wrong, will”) that says the nurses' aide always dumps the urine before they get to send it to the lab. I’m swigging the Gatorade now.

Love
Laura

____________________


From: Laura
Sent: Sunday, April 1, 2007 1:44 AM
To: Jennifer
Subject: Hair

Hi Jen. David picked Emma up at the Newark Airport last night, and I get to see her later today.

My hair is falling out. It’s so bizarre. You know how you brush your hair, and when you get to the bottom it stops? Well, now it just keeps going, and all the hair comes out in the brush. I know a lot of women who shaved their heads when that started happening, but I cling to the hope that a curl or two will hang on for dear life. Oh well, hair grows back. David said to me, "In September, the cancer will be gone, and so will your hair, and I couldn't care less about the hair."

Nate also helped me feel better about losing my hair. One of our family’s favorite TV shows is West Wing, the Sorkin drama about a fictitious Democratic President named Josiah Bartlett and his White House staffers. Early in the campaign, Bartlett keeps asking, “What’s next?” The staffers ask Leo, who has known Bartlett for a long time and will later become his Chief of Staff, what Bartlett means by that. Leo explains that Bartlett is saying that he understands the situation, has dealt with it, and is ready to move on. Nate reassured me that losing my hair means that the chemo is working, and that hair grows back. He added, “It’s OK, Mom. You can handle it. Do what Bartlett would do. Just ask, what’s next?”

Love
Laura

____________________


From: Laura
Sent: Sunday, April 1, 2007 7:49 PM
To: Jennifer
Subject: Laps and family visits

Dearest Jen,

Today was a wonderful day. After I emailed you, I put on my shoes and a mask and went strolling multiple laps around the nurses' station with my IV pole. The only problem with doing laps is that I have to unplug the IV pole from the wall to do it, and since the batteries are low the pump starts beeping and you have to hit “silence” every couple of minutes. But that’s a small price to pay for the freedom to roam.

The bone marrow transplant patients on this floor often aren’t allowed to leave their rooms. It’s such a luxury to be able to walk around. M8 was recently redecorated; the hallway walls are covered with large nature photos of trees, flowers, different seasons, sun, snow, and birds in the sky. The pictures (selected by Holly, the floor’s wonderful Nurse Manager) make you feel like there are windows looking out on a rustic landscape. There is also a small room called the family pantry where they have a fridge and freezer that patients and their families can use. They have coffee, tea, water, and juice there too. This morning I "went out for breakfast"—I lapped around the nurses’ station and went to the family pantry and had some delicious decaf with skim milk.

David and Emma came in the early afternoon. Emma was wearing a stunning pair of turquoise shoes that she bought on the street in Paris. They were perfect on her—they even showed toe cleavage (this is the latest thing—what a term!). She bought me a necklace with an antique chain and stones in muted colors as well as a little card from Paris with a hand-painted picture of a Parisian café. I have a bulletin board with tacks in my room, and she wrote “Emma” in the tacks on the bulletin board. David and Emma stayed about an hour and a half, and Emma told us all about her trip. After they left, I liked looking at the bulletin board, and seeing the “Emma” design—it made me feel like she was still there.

Nate came later. We had a quiet visit. Sometimes we didn't talk; I just read the paper while he was surfing the net on the computer. We walked 7 laps around the nurses' station together before he went home.

The Op Ed page of the Sunday Times featured a piece by Dr. Harold Varmus, the Nobel prize-winning scientist who is the President of Memorial, in which he said that we are winning the war against cancer. I always wanted to win the war on cancer, but for some reason I’m particularly passionate about it now.

Love
Laura



From: Laura
Sent: Monday, April 2, 2007 12:10 AM
To: Nate
Subject: Fro yo

Hi Nate. Thank you for coming to visit me, and bringing the frozen yogurt (“fro yo”)! I just took my midnight "constitutional" and got some fro yo in the family pantry—I finished the one that was almost empty and got a good healthy start on the one you brought. Thanks for providing my midnight snack. Now I'm listening to Stevie Wonder singing "Ribbon in the Sky," another beautiful song. I only did another one lap instead of seven more this evening, but it was good.

Love to Dad and Emma.

Love
Mom

____________________


From: Laura
Sent: Monday, April 2, 2007 1:36 AM
To: Frances
Subject: Prayer group

Hi Frances. Please thank your prayer group for the beautiful prayer they sent me, called “I Asked God.”

I asked God to take away my pain. God said, No.
It is not for me to take away, but for you to give it up.
I asked God to make my handicapped child whole. God said, No.
His spirit is whole, his body is only temporary.
I asked God to grant me patience. God said, No.
Patience is a byproduct of tribulations; it isn't granted, it is learned.
I asked God to give me happiness. God said, No.
I give you blessings. Happiness is up to you.
I asked God to spare me pain. God said, No.
Suffering draws you apart from worldly cares and brings you closer to Me.
I asked God to make my spirit grow. God said, No.
You must grow on your own, but I will prune you to make you fruitful.
I asked God for all things that I might enjoy life. God said, No.
I gave you life, so that you may enjoy all things.
I asked God to help me love others, as much as He loves me.
God said Ahhhh, finally you have the idea.

Love
Laura

____________________


From: Laura
Sent: Monday, April 2, 2007 7:21 AM
To: David
Subject: Coming home

Hi Babe. Just a note to thank you for bringing your button-down green flannel shirt for me to wear this morning. It makes me feel protected by you. It’s much easier to maneuver a button-down shirt than a pullover shirt when I’m hooked up to an IV—to get out of the pullover, I actually have to push it down to the floor and step out of it, and step into the next shirt and pull it up. And there’s another advantage to the button-down—it has a pocket for me to put the iPod in! I walked multiple laps around the nurses’ station this morning and then "went out for coffee" to the Family Pantry. Apparently 14 laps is a mile (a patient on 12 clocked it), so I can even quantify my exercise—I walked more than a mile today!

I slept well last night and took a good shower this morning. They're still giving me the leukovorin "rescue." It's my favorite part of the chemo. I'd much rather have someone give me a "rescue" than a "CHOP." They really have to rethink the names of these chemo regimens—“CHOP” is bad enough, but apparently there’s another one called “ICE.” What kind of message does that send? Anyway, I just called the cafeteria (euphemistically referred to as “room service”) to order breakfast, and they picked up the phone right away. Scrambled eggs and toast and decaf and a fresh orange and a banana.

They run the methotrexate level at noon, so it probably won't be back until 2. Do you want me to call you when they are actually discharging me? It’ll probably be sometime between 2 and 5 pm. I really want to go home today, so before they take my temperature, I will suck on ice chips to make sure there is no fever (only kidding—although it’s tempting).

I got an email from a former Croatian breast imaging trainee. He told me to “beat that crazy lymphocyte!”

I love you.

Love
Laura

Chapter 7: Home

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

____________________


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

____________________


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

____________________


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.

***********************************************

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.

***********************************************

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

____________________


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

____________________

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

____________________


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

____________________


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

____________________


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:

***********************************************************

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.

***********************************************************

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

Chapter 8: Reaching Out

Ask for what you need. Use your experience to help others.

____________________


From: Laura
Sent: Tuesday, April 10, 2007 6:20 PM
To: Mel
Subject: Heads up, and Jung-min

Hi Mel. I am writing for three reasons. First, I want to tell you how wonderful it was to see you at the National Institutes of Health breast cancer meeting on ductal carcinoma in situ (DCIS) in January. I loved your presentation of the data on DCIS from your surgical practice. You don't look a day older than you did when we met in Venezuela 15 years ago. It was like old times.

The second reason is that I want to give you a heads up on some stuff going on with me. I was recently diagnosed with an aggressive marginal B zone lymphoma and started six months of chemotherapy in March. So far, I’ve received 7 of 18 doses of chemo: 2 of 6 outpatient IV R-CHOPS, 4 of 6 outpatient intrathecal methotrexates, and 1 of 6 high-dose IV methotrexates. If all goes well, I'll be done in September.

But the most important reason I'm writing is reason #3. I have the most fabulous fellow on the planet named Jung-min who has been doing research with me for two years. She has applied for the Oncology Fellowship at your hospital to begin July 2008. Since joining me, she has presented an abstract at a national meeting, written a first-author paper in press, and started a second manuscript. In addition, while I’ve been getting chemo, she has kept up my huge database on image-guided breast biopsy. Jung-min has allowed me to maintain an active research program when it would have otherwise been impossible. I don’t know anyone else who could have stepped to the plate the way she did.

Jung-min will be coming out to interview at your hospital soon (I’ll send you the exact dates). I’d love for you to speak with her. I know you’re not involved with admissions to the Oncology program, but it would be great if she could sit down and talk to you about the pros and cons of the different programs in your area that she’s considering, to help her decide what would be best for her.

She can be shy at first, but I know she’ll be comfortable with you. Don't let her quiet demeanor dissuade you. Jung-min is among the most outstanding trainees I’ve ever had in almost two decades as well as a caring and sensitive person, and I've worked with some pretty awesome people.

Love
Laura

____________________


From: Laura
Sent: Wednesday, April 11, 2007 8:28 AM
To: Mel
Subject: Kindred spirits

Dear Mel,

Thanks for your beautiful letter. I see that we are kindred spirits.

I didn’t know about your health problems—I am so sorry that you had to go through that! I am inspired by your survival, but it doesn't surprise me about you. If you can make it through an aortic dissection, maybe I can handle a pinch of lymphoma!

I am writing a book about the experience of being a doctor and a patient. I'm thinking of calling it "Both Sides Now" (like the Judy Collins song).

I still look for justice in the universe, in spite of all evidence to the contrary. For some things I can't find the justice. Maybe that's where faith comes in. I didn't think I had much of that, but I'm finding more comfort in the prayer stuff than I would have believed possible.

I will send you updates. Thank you for agreeing to meet with Jung-min. I love her like a daughter.

Love
Laura

____________________


From: Laura
Sent: Wednesday, April 11, 2007 8.45 PM
To: Mel
Subject: Backstory: David

Dear Mel,

I got an email back from the fellowship program director at your hospital. It looks like she is one of the good guys! I told Jung-min that she should look for you when she visits, and that you would look out for her. You will love her too.

You are right when you talk about how we meet at meetings and know so little about each other. Let me tell you more.

I met my husband, David, the summer before my freshman year in college. I was 16 (I had skipped a couple of years in school) and David was 19. He was my lab partner in Physics at Harvard Summer School. I was sitting in class on the first day in a pair of very short shorts (it was the seventies). David walked in: long black hair, moustache and beard, old beat-up sneakers, blue t- shirt, cozy flannel overshirt, and faded jeans, with a Dos Passos novel in his back pocket. He had a choice of sitting next to me or a woman with very large breasts named Liane who went to Wellesley. Luckily he picked me. I was especially lucky because I had originally signed up to study mime and juggling in Paris, Maine that summer, and switched to Physics at the last minute. Otherwise, I might have married a juggler!

After class, we went out for coffee together at a little café in the Harvard Science Center. He told me his name was David. I told him my name was Laura and that I had a brother named David (his age) and he said he had a sister named Laura (my age, living in Hollywood). When he revealed that his grandmother had a parakeet with the same name as my parakeet (Blue Boy), I knew that we were meant to be together. I found out quickly that he was a jazz enthusiast and was missing it terribly in Boston. He had brought two jazz mixed tapes and a small tape player, and listened to those tapes constantly. We shared a love of music; I’d previously listened primarily to classical music, but he introduced me to jazz.

A couple of nights after we met, I had to go get groceries in Harvard Square. David needed some stuff and asked me to pick it up and gave me his key to drop the stuff off in his room. I made a copy of his key. I didn't realize that this was a big deal, something that got discussed—I was just being practical. I figured I'm going to be spending time with this guy, so I need a key. I also got him one of those Hallmark cards that said, “Love is where you find it… I’ll be here all day.” And I wrote in: “…and for the rest of your life.” Why he didn't run screaming in the other direction I can't imagine.

We were long distance for four years in college—he went to Dartmouth and I went to Harvard—and we had a commuter bus ticket from Boston to White River Junction, Vermont. He was a year ahead of me in school, so he graduated first. He went to medical school in New York, and I followed him to New York when I graduated college. We lived together for two years in medical school and then got married. I had basically asked him to marry me the summer we met; a mere six years later, he said yes. (But the company line is, he got down on bended knee and begged me to be his wife. That’s our story and we’re sticking to it.)

David and I have known each other 31 years out of the 47 I've been alive, and we celebrate our 25th wedding anniversary this June. He’s a doctor specializing in Infectious Disease at Beth Israel in downtown New York, and does a lot of clinical work and research with AIDS patients. David is the most amazing husband and father. We go to jazz clubs together, and read books and hang out with the kids. He is my bird—we mated for life.

If I had to have cancer, I couldn’t have picked a better partner to help me through it. Sometimes I think it’s harder on the spouse than it is on the cancer patient. My mission is focused and defined (survival), while David has to pick up the pieces, emotionally support me and the kids, and deal with all the logistics of daily life. I tell the women faculty that one of the most important decisions they make is about a life partner. Life throws you a lot of curve balls, and if you’re going to choose a partner, it should be someone who’ll actually help. Unfortunately, by the time they’re women faculty they’ve often made the choice already, and that ship has sailed. Sometimes I think the best thing we could do in the Women’s Office is to find a bunch of suitable Significant Others for our women faculty, but I bet that’s way beyond our budget.

Love
Laura

____________________


From: Laura
Sent: Thursday, April 12, 2007 8:47 PM
To: Mel
Subject: Backstory: Dad

Dear Mel,

Thanks for your email. I loved the story of how your parents met when your father was pumping gas in a gas station and your mother was in the car with her step-mother. I’m sorry that they each lost a parent at a young age. It’s interesting that the lesson they taught you as a child was that everything you have could quickly be taken away from you. You asked about my parents, so I’ll tell you.

My father, Robert, grew up in Chicago in the Depression. His dad died when he was six years old. He and his mom lived with relatives who argued all the time. My father was a peace-loving man who would walk 20 miles to avoid an argument. Being dependent on cantankerous relatives taught him the importance of being able to make your own living. “Be financially independent” was the take-home message of my childhood. My dad was a gifted pianist and had studied with Vladimir Horowitz’s teacher. He could have been a concert pianist, but he hated to travel. More importantly, having grown up poor, he wanted a steady income.

The year my father graduated from high school, Sears/Roebuck gave a full tuition scholarship to the student who graduated first in his class from John Marshall High School, where my dad went. That person was my father. Being #2 would not have been good enough. That's how I learned to go for the top. He went to the University of Chicago (his home town) courtesy of Sears, joined the Army in World War II, and then attended Law School courtesy of the Army. When I went to college, it was a great source of pride to him that he could help pay for my education.

My dad was a law professor at Boston University. Law was an interesting career choice for a man who hated an argument. He practiced law only briefly. He mainly taught, and he was a wonderful teacher. He never pretended to know something he didn’t—instead, he asked someone who knew, looked it up, or figured it out himself. I learned that lesson from him, and it’s crucial, especially in medicine, where it can be life-threatening to pretend you know something you don’t.

He used to take me out on Sunday mornings to breakfast at a Jewish deli in Boston called the B&D, and he taught me how to do algebra problems on the back of a paper napkin. John is two years older than Mary. In one year, John will be twice as old as Mary is now. How old are John and Mary? And I was always amazed that my father knew so many Johns and so many Marys.

My father met my mother on a blind date when she was in law school and he was a practicing lawyer. A friend asked him if he wanted to meet a cute blonde or a big Israeli. He chose the big Israeli, Judith—that’s my mom. She’s tall, about 5’10”; he was 5’7”. She got the best grades in the class and worked the hardest. In a Master of Laws program they took after they got married, my mom studied like crazy; my dad just skimmed her notes the night before the exam. She got the highest score and he got the next highest—a hair lower, but with much less work. She laughs when she tells the story. I was a student in my mom’s tradition of relentless workaholism, while my husband was a more inspired and laid back student like my dad. My mom gave up law to be an artist, while my dad became a law professor.

Having pulled himself up from poverty, my father knew the value of hard work. He used to quote Thomas Edison, who said, “Genius is 1% inspiration and 99% perspiration.” We used to play the card game, “Hearts.” Usually, in Hearts, every heart you win counts one point against you, and the Queen of Spades counts 13 points against you. However, winning all of the hearts and the Queen of Spades is a landslide victory called “shooting the moon.” My dad always tried to shoot the moon, and usually succeeded. He taught me to try even when the outcome was uncertain. Again, he quoted Edison: when Edison’s initial attempts to invent the light bulb did not yield the results he hoped, he said, “I have not failed. I’ve just found 10,000 ways that don’t work.”

When I was in high school, Stanford was my top choice for college. I looked at the map of the country and saw that Palo Alto, California was about as far as you could go in the United States from Newton, Massachusetts, and figured that's what I had to do to be independent. Luckily I was rejected. Maybe they thought I was too young at 16. But I picked up the broken pieces of my life and went to Harvard. Proximity to my family turned out to be a wonderful thing. My father had a heart attack the summer after my freshman year in college and then multiple strokes after that, and spent much of the next few years in and out of the hospital. Because I was in school so close to home, I was able to spend precious time with him.

While I was growing up, my father loved to play the piano. I remember falling asleep at night listening to him playing Chopin Nocturnes (how many girls are lucky enough to get that kind of lullaby?). Encouraged by my father, I started playing the piano when I was six. When I was ten and again when I was twelve, I was the guest piano soloist with the Boston Symphony Orchestra. We had two pianos at home, a small upright and a big grand piano, both in our living room. We played piano duets together, for fun and in concerts. My favorite was the Schubert Fantastia in F Minor, where the voices of the two pianos echo and complement each other like two inseparable friends.

My father loved to read and analyze literature. He was a terrific writer and published short stories. A gentle soul, he wrote surprisingly dark stories, some of which reflected memories of German concentration camps that he had seen in World War II. He loved to read books about the process of writing, like The Technique of the Novel by Thomas Uzzell. I got my love of reading and writing from him, and have passed it on to Nate and Emma. He would have loved to write a book, but he got stuck in the outline phase. Years of outlines, covering one yellow legal pad after another with his exuberant handwriting in black ink.

I remember speaking to him one night right after he had the stroke that robbed him of his ability to play the piano. I have never heard a voice so broken by loss. He told me that he was sorry I had been born, because he did not want me to get hurt someday as he had been hurt. He said, "Why couldn't I have brought someone into the world who is heartless, cruel, cold, and unfeeling? The world is no place for sensitive people."

When he was in the hospital, he had slurred speech from the stroke, but his mind was lucid. I remember how some of the doctors and nurses treated him like he was stupid because he couldn’t enunciate his words clearly. I couldn't believe what a difference it made to his outlook and self-esteem whether he was treated with respect and compassion or with the assumption that he was an idiot.

My father had always wanted me to be a doctor. When I was six years old and playing the piano, people would ask my father, “What does Laura want to be?” And he said, "She wants to be a concert pianist, but medicine will be her back-up profession." I remember thinking, “I never said that. That must be what he wants.” When my father got sick during my college years, I gave up my physics major (which I had particularly enjoyed because I was the only girl in the class) and decided to be a doctor. I figured that’s what he wanted, and I loved him so much that I wanted it too. Maybe I could keep people from suffering the way he suffered.

My father taught me what it takes to master something. He used to practice the piano for hours daily. He used to say, “If I don’t practice one day, I know it; if I don’t practice two days, my friends know it; if I don’t practice three days, the audience knows it.” After the first stroke, he was tireless at doing his rehabilitation exercises. He spent hours relearning activities like putting on socks, tying his shoes, and walking. He never got impatient or frustrated; if he didn’t succeed, he would simply do it again. Once I went to rehab with him, and I remember how he asked the therapist to give him more exercises. “I’m very good at practicing,” he told her. He was right.

My father died right after I began my radiology residency in New York. He had spent much of the last few years of his life terrified of becoming a vegetable from another stroke. As it turned out, he worried for nothing—he died of a massive heart attack in the middle of a chess game, and he was a knight and a pawn ahead at the time. If my father had only known that would be his exit strategy, the last few years of his life would have been so much better! He would have particularly enjoyed that at the moment of his death during the chess game, he was winning.

He wanted to be cremated and have his ashes scattered in the ocean. On the morning of his funeral, I couldn't believe that the sun was shining as if nothing had happened. We rented a boat in Maine, and released his ashes with Beethoven’s 7th Symphony, 2nd movement (Allegro) playing. I chose that music because it combines major and minor keys, expressing how life is full of both sorrow and joy: it’s sad that he died, but it’s even more glorious that he lived. The score starts with a simple base line, and then progressively adds more and more instruments until there is a groundswell of unbelievably beautiful music, analogous to starting at birth, finding more complexity and joy at each level of life, and finally earning the ascent into heaven.

During the funeral, I was comforted by the fact that my father had met and liked David, and that he got to attend our wedding three years before he died. However, I was seized by the thought that now my kids (who were not even a twinkle in my eye at that point!) would never get to meet my father. It was an odd thought. Until then I hadn’t been certain about having children, but when I lost my father, I realized that having kids was no longer a question of whether, only when. I wish I could talk to my father again, even just for five minutes, and I wish he could meet Nate and Emma. Talk about a sense of humor. He had it all.

That’s my story. Maybe that’s how I'll tell it in the book. The book may end up being emails that I write and receive during this journey. If it's OK with you, I may include the picture you sent me of the seed becoming a plant that grew right through the roof of your hot tub. That was a beautiful picture and a beautiful story. I hope to be strong like the seed, and to break through hot tub covers in a single bound.

Love
Laura

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From: Laura
Sent: Friday, April 13, 2007 5:36 AM
To: Mark
Subject: Pain: ideas

Hi Mark. I want to touch base with you in your capacity as a neurosurgeon about something important. I've had four Omaya taps for intrathecal chemo so far, so I speak from some experience. My lymphoma doc is a wonderful doctor and a terrific human being. The procedure itself, however, is painful.

Sometimes, as doctors, we feel that the most important aspect of treatment is killing the cancer, and if that means you feel a little pain, you should “suck it up.” I agree that if killing the cancer requires pain, suck it up. But if the cancer can be cured in a way that is painful or less painful but equally effective, the less painful method is the clear choice.

There is a feeling (of which I have also been guilty, when I got to play doctor) that focusing on the pain distracts from the major mission of curing the cancer. That's wrong. Even if the physician who has primary responsibility for killing the cancer doesn't want to be "distracted" by thinking about pain, we should make it a priority that someone on the team is focused on pain relief. We should not tolerate errors in pain management any more than we would tolerate giving the wrong dose of chemo, or treating with an improper antibiotic, or performing surgery on the wrong side of the body.

I have specific suggestions for pain prevention when putting a needle into an Omaya. For the past few decades in Breast Imaging, we’ve been doing pre-operative needle localization procedures, in which we place a wire in a woman's breast pre-operatively to guide the surgeon towards a breast lesion that can’t be felt. Before the loc, we spray the area of the breast with a spray called "Gebauer's Ethyl Chloride Medium Stream Spray," which is considered a "topical anesthetic skin refrigerant" and works instantly. Another good local anesthetic is Emla cream. It can be applied over the area to be accessed (eg the Omaya or Mediport), but unlike the spray, the Emla cream requires half an hour to work.

Since you put the Omayas in during neurosurgery, is there a way you can convey in the post-op instructions the recommendation for numbing prior to putting a needle into the Omaya to remove fluid or give chemo? You can even suggest the Ethyl Chloride spray and the Emla cream. Either the treating oncologist could give the patient the necessary prescriptions, or we can make sure that the meds are available in all the chemo suites so that they can be used to increase patient comfort for all needling procedures. The spray or Emla cream could also be used prior to other needling procedures elsewhere in the body, like accessing Mediports. After the anesthesia, the area can be prepped with sterile technique, so it shouldn’t increase the chance of infection.

Another thing. I learned through personal experience that the likelihood of vomiting is directly related to the speed of intrathecal injection. Sam, my neurologist, confirmed that if it's injected too quickly, once it hits the 4th ventricle it tickles the vomiting center and you puke. If we're rewriting the post-Omaya instructions, can we include the recommendation to inject slowly, and maybe even give a guideline as to the maximum suggested injection rate? Most intrathecal chemo patients probably believe that vomiting just goes with the territory, and would not think to ask the physician to slow down. We need to write it into the guidelines to make it happen.

I’d appreciate your thoughts. I am no wimp and if pain is necessary to cure my lymphoma, I’ll endure it. But if we can make it less painful or even painless, we should go for it. Even a small amount of pain per procedure over a long course of treatment adds up, and gives those individuals with cancer yet another thing to dread. It is our mission not only to cure cancer but also to relieve suffering. We can be the best at both. Let's do it. Then I will know that my lymphoma is for a good reason, and I will find the justice in the universe that I perpetually seek.

Best wishes
And in a spirit of making things better (always)
Laura

Chapter 9: Blurry Vision

Get your priorities straight.

____________________


From: Laura
Sent: Friday, April 13, 2007 8:26 PM
To: Sam
Subject: Blurry vision: questions

Hi Sam. Question for you about my eyes—I have worsening blurry vision the last few days, which makes it difficult to read (but you notice it doesn't stop me from sending an email!).

I've been near-sighted requiring glasses since I was six years old. I started to have trouble reading several months ago, and now have "progressives,” which I gather are the new “bifocals.” When I began having the neuro symptoms that led to the eventual diagnosis of lymphoma, I saw Jack of Ophthalmology here, who saw a few cells in my eyes that were suspicious for lymphoma (apparently that’s reasonably frequent if you have lymphoma in the CSF). .

Now I've finished four intrathecal methotrexates, two IV R-CHOPS, and one high-dose IV methotrexate, with the most recent intrathecal methotrexate and IV R-CHOP being this past Tuesday 4/10 (which I tolerated fine). In the past several days I've noticed a worsening of blurry vision, which makes it difficult to read. Could this be related to the steroids (I'm on day three of five days of oral prednisone through Sunday 4/15)? If it is due to the prednisone, is the blurry vision likely to get better when I’m off prednisone? I’m especially concerned because my eyes are key in radiology, especially breast imaging—you have to be sharp if you’re going to pick up the tiny microcalcifications that may be the only sign of an early breast cancer. Alternatively, could the visual blurring be due to worsening lymphoma of the eyes, especially in light of the abnormal cells in my eyes before I began treatment?

Should I have labs checked (and if so, which labs and when, and can you put in and release the orders)? My next scheduled appointment with my oncologist is on Thursday 4/19 at noon, when I am scheduled to get more intrathecal chemo. Should I make another appointment with Jack, see my outside eye doctor to get my prescription checked, or just wait until Thursday and see my oncologist then?

Thanks for your advice!

Laura

____________________


From: Laura
Sent: Saturday, April 14, 2007 4:32 AM
To: Jennifer
Subject: Saturday

Hi Jen. We had a great day yesterday. In the morning, David rented a car to take Emma and me to a parent-teacher conference at Emma’s school. I wore a hat called the Gordon, which was a sewn straw fedora in a muted pink with flip brim and silk gray trim.

I was so proud of Emma at the conference. Going from elementary school to high school is a big transition, even without having a sick mom, and she’s been handling it beautifully. Emma came to the conference with us, and became a little shy when her advisor read all the fabulous comments from her teachers. Afterwards, Emma went to class. David dropped me off at the hospital and went to work.

The main event on my calendar at work today was a meeting about “the MSK Nanny Resource,” an internal list-serve we’re creating to address the issue of child care for employees. We brainstormed this idea with Amy and Nancy, my colleagues in Work/Life, after we collaborated on a seminar called "How to Find a Nanny." On the Nanny Resource, employees can post if they want to hire or share a nanny, or if they have a great nanny they no longer need. We met with the information technology guy, Kevin, who was helpful. We left with a list of things to do, all doable. I think it will happen!

Every month we put a new “Quote of the Month” on the Women Faculty Affairs website. This month we’re posting a poem by Emily Dickinson. I’m sending it to you below, because I thought you’d like it.

*******************************

Hope is the thing with feathers

Hope is the thing with feathers
That perches in the soul,
And sings the tune without the words,
And never stops at all,

And sweetest in the gale is heard;
And sore must be the storm
That could abash the little bird
That kept so many warm.

I've heard it in the chillest land
And on the strangest sea;
Yet, never, in extremity,
It asked a crumb of me.

*******************************

Love
Laura

____________________


From: Laura
Sent: Sunday, April 15, 2007 7:29 PM
To: Jennifer
Subject: Bird by Bird

Hi Jen. Today I spent most of the day rereading one of my favorite books, Anne Lamott’s Bird by Bird. Although the book is ostensibly about writing, it might just as well be about dealing with cancer. The title story is derived from an incident in which the author’s big brother, as a kid, was assigned to write an essay about the birds of North America. He found the task overwhelming. When his father asked him what the problem was, Lamott’s brother said that there were a lot of birds in North America. His father looked at him reassuringly and said, “Bird by bird, buddy. Just take it bird by bird.”

The story reminds me of advice Maureen gave me shortly after I was diagnosed, when I was considering declining treatment. She told me I don’t have to agree to the whole deal; I could just agree to start, and then take it one day at a time. The advice was comforting. This approach let me maintain the illusion of control (“it’s no illusion; you ARE in control,” Maureen would say). It also broke up the impossible task of six months of chemo into a series of manageable tasks, dealing with each individual day. I would do it bird by bird.

Love
Laura

____________________


From: Laura
Sent: Monday, April 16, 2007 4:56 AM
To: Jennifer
Subject: Broadway

Hi Jen. Q and I went to see the Eugene O’Neill play “Moon for the Misbegotten” starring Kevin Spacey on Broadway yesterday, and it was fabulous. I decided to wear a hat that didn’t go up too high on my head, so I wouldn’t block the view of the person sitting behind me. I chose the Reese paisley, which has a fabric slouch crown with a split cuff brim and a “self trim,” which means part of the same fabric as the hat serves as the trim. The fabric is a subtle silver, beige, and black paisley pattern, with a small sewn silk flower at the side.

The play was great, but it desperately needed editing. If I were an English professor, I would assign my students to cut an hour off of it—the run time was almost 3 hours. It took me two nausea pills at $40/pill (that Zofran is worth its weight in gold) to get through the play. If the play had been an hour shorter, I could have done it in one nausea pill. Do you think the Estate of Eugene O'Neill would listen to reason? They owe me 40 bucks.

The hardest part of the outing was afterwards, when Q and I went to get a cab. It was rainy and the streets were slippery. As I was getting into the cab I slipped and almost fell, and then hit my head (the part with the Omaya) against the cab. I started to cry. Q helped me up and pulled me into the cab and gave me a hug, which I desperately needed. I try to be brave and optimistic about all this, but the bottom line is that cancer makes you feel vulnerable, and I used to feel invincible.

I don’t remember if I told you—I started having severe visual blurring, which is bothersome, because reading and writing are integral in my life right now. The blurring began around the time I started my latest course of prednisone. Sam, my neurologist, said that visual blurring is common on prednisone. Apparently the symptoms can be triggered by either raising or lowering the steroid dose but usually disappear after steroids are stopped. Steroids can also cause cataracts or glaucoma. These possible side effects are not good news, but all of them are better than having the visual blurring represent worsening lymphoma in my eyes. Yesterday I took my last dose of prednisone for the month, so hopefully the symptoms will improve. I’m still going to see the eye doctor to make sure.

My father is on my mind a lot these days. I’m listening to piano music that he played, like Schumann’s Kreisleriana; he especially liked part 1, for which the tempo marking is “agitatissimo,” or very agitated. The piece is fiendishly difficult, requiring a massive reach for both hands. My father used to tell me how Schumann injured his right hand, possibly as the result of a mechanical device he used to increase the strength, independence, and span of his fingers. Apparently Schumann became psychologically unstable, and spent the last two years of his life in a mental institution. Schumann’s wife, Clara, an excellent pianist who was the daughter of Schumann’s boyhood piano teacher, was the one who held it together in their family. Any frustration my father ever felt was released in the Olympic-level workout of the Kleisleriana.

My father loved to play Beethoven sonatas, especially the ones that were the most technically challenging. I’ve been listening to one of his favorites, Beethoven’s “Appassionata” Sonata #23 Op. 57. I remember him playing the third movement, with a tempo marking “allegro ma non troppo” (fast but not too fast). As I watched his fingers fly across the keys, I doubted that it was possible to play it any faster. My dad used to tell me that Beethoven started to lose his hearing in his twenties and was completely deaf by age 50. It struck me as ironic that a man who was so passionate about composing music lost his hearing. I thought about Beethoven going deaf when my father lost his manual dexterity and his piano playing after a stroke.

I’ve been listening to Mozart sonatas that my father and I played together. One of my father’s favorite books was a biography of Mozart by Marcia Davenport. My father loved to tell me stories about Wolfgang Amadeus Mozart: when Mozart was three, he watched his older sister Nannerl play the piano; when he was four, his father Leopold started to give him piano lesions; he began composing at age five; and he spent his subsequent childhood traveling with Leopold all over Europe, performing as a child prodigy. My dad always said that Mozart wrote more than 600 priceless compositions, but died “a poor churchmouse” at age 35. I knew that if my dad had been Wolfgang’s father, he would have encouraged him to find a better paying job.

One of the first pieces my father and I played together was the Mozart Sonata for 1 piano, 4 hands, in D Major, KV 381/123a. I used to laugh when our hands got tangled up as one of us reached over the other for a trill or arpeggio outside of our own “turf.” As I got older, we each wanted to have an entire keyboard to ourselves, so we preferred music for two pianos, like the Mozart D Major Piano Sonata, K. 448. To this day, D Major still feels to me like a joyful key of innocence and youth. Listening to the music my dad played, and especially to the music we played together, makes me feel like he’s up there looking out for me.

Love
Laura

____________________


From: Laura
Sent: Monday, April 16, 2007 5:22 PM
To: Jennifer
Subject: Emily Dickinson

Hi Jen. I worked in the Women’s Office today. I wore a hat called the Roz, a two-piece cloche in black and brown with a curved pheasant feather rising up from the side. On the way to a meeting, I was in the elevator with an elderly couple. The wife was looking at me and speaking to her husband in Italian. I smiled at her and said, “You’re talking about my hat, aren’t you?” And she said to me in a thick Italian accent, “Yes. I love your hat!” When I’m wearing these hats, I never have to worry about making conversation.

I found the perfect Emily Dickinson poem that captures my feelings about how I want to use my experience with pain to help others. Here's the poem:

*************************************

If I can stop one heart from breaking

If I can stop one heart from breaking
I shall not live in vain;
If I can ease one life the aching
Or cool one pain,
Or help one fainting robin
Unto his nest again,
I shall not live in vain.

**************************************

Love
Laura

____________________


From: PWFA/President's Office
Sent: Monday, April 16, 2007 12:48 PM
To: All Women Faculty
Subject: Athena Tuesday 4/24, 5 pm

To Women Faculty:

Please come to our next meeting of ATHENA, our informal group for women faculty! Info is:

ATHENA, Tues 4/24 5-7 pm, Faculty Club
Come for a few minutes or stay longer, if you like! Refreshments will be provided.

I hope you’ll join us!

Best wishes
Laura
Laura Liberman MD
Director, Program for Women Faculty Affairs

____________________


From: Laura
Sent: Monday, April 16, 2007 7:58 PM
To: Jimmie
Subject: Your amazing book!

Hi Jimmie. Thank you for sending me your amazing, wonderful, awesome, incredible book, The Human Side of Cancer, which is exactly what I need to read right now! I feel like you wrote it for me. After I finish reading it, can we talk? You are a fantastic writer!

Also, thanks for sending me the Stephen Gould book, Full House: The Spread of Excellence from Plato to Darwin. I especially liked the chapter called “Case One, A Personal Story: Where any measure of a central tendency acts as a harmful abstraction, and variation stands out as the only meaningful reality.” Basically, Gould seems to be saying that even if the median survival of your cancer is 50% at one year, that means half of the people with that cancer live less than one year, but half live more—and some people may live ten, twenty, thirty years or longer. This news is particularly good for people like me, who are told that their illness has a lousy median survival. When I saw Figure 7 on page 55, I imagined myself way on the right, at the highest end of the survival bell curve, waving and smiling.

Your book and Gould’s should be recommended for every cancer patient.

Best wishes
Laura

____________________


From: Laura
Sent: Tuesday, April 17, 2007 2:13 AM
To: Jennifer
Subject: Nate’s college forms

Hi Jen. Nate is working on his college applications. We started to talk about colleges last summer (the summer before his junior year) when we were on vacation in Hilton Head, South Carolina. Nate and I biked over to the only tiny book store in town and bought the one copy of the Fiske Guide to Colleges. I suggested that Nate make an Excel spread sheet listing the colleges he was considering and their characteristics, to organize his thinking. It was an opportunity for me to teach Nate an important lesson: many of life’s problems can be solved, or at least helped, by a good Excel spreadsheet.

Today Nate started to work on the nitty gritty of applying to college. The process at Nate’s school is very organized. They have all these forms and questionnaires for the students to fill out in preparation for a meeting with the college counselor. Students have to express their interests, talk about the subjects they enjoy, and describe what their extracurricular activities have been. The parents have to fill out forms too. Nate’s interests have been non-traditional, centering on teaching and community service.

Nate’s first exposure to working with kids was when he was in fifth grade, and his elementary school partnered each fifth grader to a first grader in their “buddy class.” The summer after eighth grade, Nate was a camp counselor for a group of 5-year-olds. I know the students adored him because one summer day a 5-year-old girl in his group recognized him as we were walking down the block and ran up to him to give him a hug. She hugged his knees, because they were as high as she could reach. The girl’s mom, who recognized Nate, said to her daughter, “Do you know who that is?” And the girl said, “That’s Nate, my counselor!” as if he were a rock star.

When Nate went to high school, he started tutoring third-graders in a bilingual Spanish/English public school on the West Side. One student drew a crayon picture of Nate as a superhero, complete with uniform, sword, and shield; it’s still hanging on Nate’s wall. Nate told us about a girl in the class who failed a math test. On one question in which she was asked to draw a triangle with vertices C, A, T, she had drawn a cat, not a triangle. Instead of berating her, Nate commented on the realism of her drawing, and asked, do you have a cat? What’s the cat’s name? What kind of cat is it? The girl was so engaged that when he started to explain the math to her, she listened.

During the summer after he finished ninth grade, Nate volunteered at a neighborhood soup kitchen that gave groceries to individuals and families in need. I thought it was just a summer gig, but he kept it up weekly throughout high school. He rose through the ranks and eventually ran the line for distributing food to the elderly and disabled. I was proud of his dedication. During the subsequent summer and school year, he also volunteered to teach in a program to help low-income New York City elementary school kids prepare to apply to challenging public or private high schools. A student of Nate’s became one of the first three students in the program to get admitted to a New York Independent School. Nate described these experiences in his college essay.

I like the way Nate writes: get your thoughts down on paper first and edit later. That’s a method Anne Lamott suggests in the chapter “Shitty First Drafts” in her book, Bird by Bird. I think getting any thoughts down on paper and then cleaning it up is a great strategy because it takes an impossible task (taking the blank page and filling it with a beautiful story) and breaks it into two smaller, easier tasks (writing the “shitty first draft,” and then editing work you’ve already written).

It wasn’t only Nate writing today—David and I had to fill out parent college forms. In addition to the name, rank, and serial number stuff, they asked us to specifically name where we would like him to apply to college. We wrote down that we wanted him to go where he wants to go, so he can be happy. I don’t understand pressuring your kids to go to the same school you did. Your kids are not you; they have their own tastes, interests, and abilities, and need to find schools that are right for them.

The college application process with Nate has taught me that parenting a teenager is like getting a bird to eat out of your hand. You love the bird; you want to feed the bird; you have only the bird's best interests at heart; you would never, ever hurt the bird. But if you make big sudden movements, the bird will fly away. You have to be casual. You stroll over, toss out a few seeds, and step back, like you don't even notice. Maybe he won't come at first. But then each day you put out a few more seeds and step back. Eventually he may come, and maybe at some point (if you're very lucky!) he'll take a seed before he bolts and then another and another and finally one day you'll feel the tickle of his beak in your hand before he flies away.

Love
Laura

____________________


From: Laura
Sent: Tuesday, April 17, 2007 9:40 AM
To: Maureen
Subject: Athena

Hi Maureen. Question for you. There is an Athena gathering on Tues 4/24 from 5-7 pm in the Faculty Club. I am getting admitted for chemo that day. Can you lead this Athena? There are a few announcements to make, and basically I want someone to be there to make people feel welcome. Would this be OK?

Do you want to pop by here this morning (I'm in the women's office) and catch up for a few? I'm going to the Junior Faculty Council meeting at noon.

I’m doing OK. Intrathecal chemo Thursday, another admission Tuesday. Have finished seven of 18 doses of chemo—only 11 left. After the next admission is done, I'll have finished nine of 18 chemos—the halfway mark.

Love
Laura

____________________


From: Laura
Sent: Thursday, April 19, 2007 2:08 AM
To: Jennifer
Subject: Seminar

Hi Jen. I loved what you said about how nobody calls you Jenny. It's like with Nate. When he was born, David and I named him Nathaniel, and figured we would call him by that name. But from the moment of his birth, he’s been such a thorough and complete Nate. We have a video of bringing him home from the hospital right after he was born. We carried him over the threshold and said, "Welcome home, Nathaniel." I don’t think we’ve called him Nathaniel since. I remember once when he was three, a friend’s mom called him “Nathaniel.” Nate said, "Don't call me Nathaniel. My name is Nate!" I was shocked that my three-year-old was so certain of his own identity. On rare occasions, some people call him Nathaniel, but he's mostly Nate to those of us who know him best.

I went to a fabulous career development seminar today. I wore a hat called the Tracy, which had a beige straw cloth square crown with a large down brim and muted green hand rolled roses. The seminar was jointly run by Cornell, Columbia, Sinai, Einstein, and NYU. Sometimes these seminars get a little whiney, but this one had the best speakers, and there were terrific people to meet.

A woman who is Director of Diversity at Columbia University spoke about diversity in the workplace, and was absolutely spectacular! She talked about how people (women and men) are looking for balance in their lives now, and it's no longer acceptable for many of them to work 24/7. I know this to be true. I also think we pay the consequences for our overwork. Relentless stress takes its toll on our psyches, bodies, spirits, and families.

We have to figure out a way to let people work but also let their work lives fit with the rest of their lives. Even if the goal is simply to get as much work as possible out of a person, it is better strategy to allow them to try to make the pieces fit. Life is a marathon, not a sprint. If you give all your steam on the first leg of the relay you'll have nothing left for the finale. I know that this is true, but how do we make it a reality when we are all such Type A personalities, want nothing short of perfection, and work in a cancer hospital where the stakes are high and mistakes can have lethal consequences?

Another amazing speaker at the conference was named Catherine J. Morrison, J.D. She gave two terrific sessions, a general lecture on negotiation and a seminar on conflict resolution. I especially liked her Frank Zappa quote: “Reality is an optional experience!” I’m going to follow up with her and see if she can give a session for our women faculty.

At the seminar, a female junior faculty member who took a grantwriting course sponsored by Women Faculty Affairs just found out that she was awarded her grant from the National Institutes of Health! Isn't that fantastic, wonderful news? This Women Faculty Affairs job is great—I get to play Point Guard. I feel like Teresa Weatherspoon of the New York Liberty in the WNBA: I get the ball to the Center, and she gets it into the net.

The seminar was held at Columbia University, which is gorgeous—a beautiful college campus right in the middle of New York City. After the seminar, I went to the college bookstore and bought a CD of classic Beatles tunes to put on my iPod. I’m still listening to a lot of music these days, especially when I'm in the hospital or getting chemo.

The only bad thing about today is that my vision is still blurry. It’s hard to see the traffic signs across the street. I never realized how scary it is to go out in the world unable to see.

Love
Laura