Tuesday, May 31, 2016

Closing In

13 days left.

It got me thinking about luck. It's hard to hang your hat on it, ya know. I don't believe that it was bad luck that Hope got cancer. And I don't think she'll need to be lucky to continue to be healthy after her treatment ends. But on the other hand I also don't think God gave her cancer or took it away, or that if we just pray hard enough it won't come back. That's not the God I believe in. So where does that leave me?

Genetic mutation and variation isn't lucky or unlucky - it just is. It's remarkable to me that cancer isn't more prevalent. Life on a molecular level is insanely complicated. So much has to go right. And even with the number of fail safes in the system, you would think that the combination of unrestrained cell proliferation and the prevention of cell death would happen more often.

If I did rely on luck, I suppose I might have to buy into the notion of how too much talking about the future might "jinx" us. But I refuse to believe in causing genetic mutations because of conversations or thoughts or a lack of prayer or even a lack of goodness. I won't put human agency or omission on the hook for a process that even the smartest scientists in the world and the holiest spiritual leaders can't explain.

Did you read Humans of New York over the last few weeks? HONY is an incredible website and Facebook page that tells people's stories - with an image or two and a few paragraphs of text, it manages to convey the breathtaking, heartbreaking, mundane beauty of being a human being.

A couple of weeks ago, I noticed a HONY post that one of my FB friend's "liked" in my feed. The picture accompanying the post had a bald kid in it - so needless to say, I clicked on it. HONY was just beginning a series of stories about families and medical staff at Memorial Sloan Kettering's pediatric oncology unit. Everything I've ever wanted to tell you about the bizarre juxtaposition of joy and terror - and so much more beyond my experience - are laid bare in these stories. When the telling was done, HONY had raised $3.8 million for pediatric cancer research.

Too many kids suffer. Too many families have to endure this journey. It gets so much worse than what we have gone through. And I know better than to say, "I could never endure what they have." Because some paths are forced on you. Sometimes you find yourself not at a crossroads but on an entrance ramp, and you have no choice but to get on and hope for an easy exit. Some things just happen.

*******

12 days left.

For the last month it's been raining. Like every day. Reading the first half of this post, you might wonder if I'm suffering from a little seasonal affective disorder.

This morning, Hope looked out the kitchen window for her daily weather report and exclaimed, "Mom! It's no rainy anymore!" I'll take the opportunity of this sunny day to add to some slightly rosier musings to the rather fatalistic words above.

It's not about luck. And to my way of thinking, it's also not about convincing a higher power you deserve a different path - nor did the God I believe in choose this for Hope or for the rest of us so we could learn something or find some "meaning" in it. S/he can't be bought or sold - and S/he isn't some kind of a sadistic puppetmaster.

I think it's just what life is. Each of us hurtling around the sun, accumulating experiences for as long as our existence lasts. Sometimes our eyes are really open to what is happening around us, but usually we get lost in the details of physical and social tedium - next meal, next paycheck, next meeting, next project, next workout - and that's OK. Because we all have moments every day that jolt us awake for a split second - to notice the way the raindrops are plunking in the puddle or the sounds of giggles from the living room or the aha moment of finally understanding something that had alluded us. And sometimes the moments are longer and we can luxuriate in that knowing that we are living the real thing.

Our last 27 months have been that oscillation between those two aspects of living: the details and the breakthrough moments. The details - of chemo and doctors and temperature checks, of figuring out what to eat and when, where to go and how, how to live and play and work between all the responsibilities and needs of the five of us and the demands of cancer - and moments of recognizing that those details are just the time-fillers, the distractions from the main events of life. Maybe the details of Cancerland make that contrast starker. But lots of human experiences create that striking juxtaposition - some filled with sorrow but others with joy - new babies, time spent in old forests or at the ocean, the loss of a family member or friend, falling in love. Some experiences we seek out, crossroads we are happy to encounter, and others are doors we are pushed through.

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11 days left.

For the last week or so, Hope's been asking each morning if we can go to the hospital.

"Why?" we ask her. "See the downstairs doctors," she replies.

"Not today."

"One more time see downstairs doctors?"

"Right. Do you remember why we are going to see them one more time?"

"Take my port out!"

This daily script also includes the reminder that she does not like "that little pillow." Every. day.

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10 days left.

When looking at local schools for the big kids years ago, I visited our old neighborhood school where the kindergarten teacher showed me a bulletin board filled with identical worksheets. Each had the numbers 1-10 on little squares that had been cut out and glued on the paper in reverse order. "This is how we learned to count backwards from 10," she told me. Sigh.

As I walked home, I thought about how Celia and I would count backwards before going down a slide, as we played rocket ship, as we jumped off a curb or the bottom step.

For Hope, the setting at this stage of development was a little different. We count up and down along with the elevator at Hopkins. There's a little screen at Hope's squatting level that flashes the numbers as you travel up and down from the 11th floor. And a kids voice announces the floor when you arrive.

Sweet Hope, bald and masked, excitedly shouting out the numbers as we headed up for chemo or down to the pharmacy. Elevators full of people astounded by her.

Counting down.

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9 days left.

It was Hope's last day of preschool




She missed out on a lot of her early childhood, but she worked on making up for that lost time at her Play School. She made a couple of good friends, she climbed and spent hours on swings, she loved and trusted some loving, trustworthy teachers. She got clued in to the humor of 5 year olds (hint: poop and being "stinky" are hilarious). It was exactly what she needed.

*******
8 days left.

We are counting down, but strangely as soon as we get to zero, we'll start counting up again. Days and then months and then years of being "off treatment" or OT. The further you get with no "events" - which I think is the medical euphemism for relapse or a new cancer diagnosis - the better, of course. You hope it's the count that doesn't end - with the most significant milestone being 5 years OT which is considered "cured."

*******
7, 6, 5 days left.

Busy weekend. Quinn performed in his first stage production - he was the narrator in Into the Woods -- and he was fantastic. It was so cool to see him take on a new activity with enthusiasm, work at it, and then shine on the stage, clearly enjoying himself so much.

Celia had her last POL today - Presentation of Learning - it's a formal presentation of her year's school work, with reflections on her learning and thoughts about how she will grow in the coming year, for a teacher, her parents and invited guests. Poise, good humor, intelligence and so much insight in evidence.

As for Hope, she is ALL DONE with Methotrexate. I gave her the last dose last night. She's been taking it orally on a weekly basis since November 2014, and I think it makes her feel kinda cruddy. But I hold a major grudge against it because of how horribly she reacted to the much higher IV doses she faced during frontline treatment. The mucositis that led to weeks in the hospital, morphine, loss of 25% of her body weight, fevers, breathing troubles, and so much misery - methotrexate was the culprit. So very glad to finally put it behind us.

Sunday, May 8, 2016

Keeping track

32, 31, 30, 29, 28...

We are down to the last month - 28 more nights of oral chemo. That's 106.4 mL of mercaptopurine and 32 mL of methotrexate.

I teared up when the pharmacy tech handed me the last bottles. June 4th she takes her very last dose of chemo.

Each night for the last couple of weeks when I return to our bedroom, peeling off the glove and putting the chemo bottles away, I update Greg on the countdown.

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Within the first couple of days of treatment one of Hope's inpatient nurses brought us her very first Beads of Courage. It's a program where kids with cancer and other diseases get different types of beads to represent each and every aspect of their journey. 

A red bead for a blood transfusion.
A yellow bead for a night in the hospital.
A black bead for a poke.
A white bead for a chemo infusion.
Bone marrow aspirate, lumbar punctures,  hair loss, X-rays - everything has a bead. 
And there are special beads too - for personal milestones or challenges. 

And a purple heart bead for completion of treatment.

In those early days and weeks of treatments nurses would deliver tiny bags  of beads at the end of every shift. I can't remember when exactly I asked them to stop but I remember why. I saw a photo online of a little boy, about 10 years old, who had reached the end of his treatment for leukemia with strings of beads draped around his neck and shoulders. So many beads I thought the weight of them must actually be uncomfortable. He was smiling broadly and the post was triumphant. It was extraordinary to see what he had been through and know that each one of those tiny beads represented another small horror that he had lived through. 

The next day I told our nurse no more beads.


Something about that photo was too much. I couldn't bear the thought of collecting these mini monuments to all Hope would be forced to endure. And projecting myself to June 5, 2016, I could think of nothing I would want to see less than a colorful testament to every stick, poison, and sob from the years spent battling leukemia.

But not surprisingly upon recent reflection I've realized that I was wrong. That Hope deserves to see what she is capable of and to know that her strength is worthy of pride. That we who witnessed her weeks, months, years of treatment should be overwhelmed by the image of Hope draped in impossibly long loops of glass and plastic and clay beads of every hue, of her most precious and light-filled smile despite the weight of it all.

We could catch up - add the dozens - probably hundreds - of beads that Hope has "earned" since February 2014. It would require counting up her clinic and ER visits, her infusions and procedures, blood draws and X-rays. And then we'd have to string them...

OK, let's be real. That seems unlikely. So maybe we'll just post photos of Hope and her smile and imagine those loops and loops of beads in rainbow patterns spilling off her shoulders.