41...XLI...101001

41 is, among other things: the 13th smallest prime number; the number of Wolfgang Amadeus Mozart's last symphony; the international dialing direct code for Switzerland; the sum of two squares (4² + 5²), the sum of the first six prime numbers, and also the sum of three prime numbers (11+13+17); and the title of a song by the Dave Mathews Band.

Today is Daniela's Birthday. She is, among many other things, 41.

Post Scriptum:

Driving home from work...expecting Sinéad O'Connor, I was greeted at the door by Pat Benatar. Xuxa, Daniela's hairdresser, had vetoed the close crop in favor of 80's nostalgia. (The interim coiffure was complimentary, as was the open invitation for a date with the clippers.) Tudo Bem! De qualquer maneira, olhará bonita.

Tired of Waiting...

Earlier this week, Daniela sat on the stairs with a blue comb in her hand. "The texture is different, and I can feel it," she estimated hesitating before combing her freshly washed hair. The ficus tree sat a mere ten feet away foreshadowing the changes in follicular foliage.

Almost two decades ago, I had a conversation with a Lecturer in graduate school, Ranjini Obeyesekere. We were discussing a different foliage, and I still remember her comments as she envied the displays of chromatic intensity adorning the trees in the small central New Jersey town. She meditated on the dignified displays of dye and dying...a performance in hues...a farewell spoken in polychromic dialects. I recall how those leaves, each fall, were released in a mesmerizing display, dotting the townscape with impressionist brush strokes of ochre, auburn and saffron. There is no such pageantry in chemotherapy-induced hair loss.

Earlier this afternoon, Daniela called me at work. She had scheduled her own adieu, an appointment with her hairdresser. "I'm going to cut it very short," she warned me. I heard her chuckle. "That's OK," I smirked back. The setting is not as rustic, but the surroundings will still provide a pageantry, albeit more subdued. The salon will become a surrogate landscape with its own version of colors and dyes...and dialects such as Portuguese and Vietnamese swaying in the breeze, a dignified farewell nonetheless.

Peruke Yuke....

[The list to the left is courtesy of Georgetown University Hospital's Oncology Department. The image of the bust with the solitary stare is a fragment of a photograph courtesy of www.stefpix.com.]


"I can feel my hair...dying," Daniela grimaced earlier today as she ran her hands, in slow motion, up along the sides of her face. Eight fingers parked atop the parietal lobe as she massaged her scalp. Thumbs, manicured mud flaps, caressed her ears as her face contorted in a hybrid gesture...part hesitant scowl, part confident grin...a caricature of a frantic phrenologist in self-diagnosis mode. "I wanted to go to the wig shop today" she confessed, "I called them, but they are closed Sunday, Monday, Tuesday."

Thirteen years ago, she had a wig. I can't remember if she bought it or if it was a gift from a friend, or her parents. To the best of my recollection, she never wore it. So her interest in the wig caught me off guard. I know it is her decision. And trust me, if she wanted to wear a turban made of tea bags, or sport a sombrero made of sea kelp, I would encourage her (...while holding my breath). I just can't separate the image of a wig from its styrofoam perch...faceless, frozen, lightweight, listless. Even the more realistic mannequin-style perches have a soulless gaze that saddens me.

I can still recall the last chemotherapy malaise and how her fringes molted away. Those turquoise eyes still managed to overshadow the pallor...emitting a scintillating sense of self-assurance. Unlike the first wave a decade or so ago, this second iteration of chemotherapy imports a nauseating duality, the immediate assault (the vertigo and its effect on her senses, taste and smell) and the recall (resurrected emotions...indexical symbols intensifying the experience). Most of her favorite foods frighten her, but today she cheerfully consumed a serving of french fries. She allowed me this digital glimpse...

Maybe all the waffling about the wig has a tactical purpose. The presence of options--a wig, a scarf, a hat, a crew cut, a shave--seems to crochet a cloak of comfort, a comforting delay. These days her body and its biochemical machinations are the gears of a new temporal grammar. She listens. She anticipates. This new clock...when its hands strike the floor, or the pillow, or the shower drain...will compel her to make a choice.

In the meantime, she combs other emotions while lounging in bed...the addictions of a political junkie riveted by this evenings political debates streaming live from South Carolina onto her computer...presidential candidates pulling at each others hair...split personalities, split infinitives, and split ends, of another sort.

The Infusion Coliseum...(Chemo Session #1)

We arrived at N5, the infusion center, a few minutes before 9:30 this morning. This chemo session was an experience both adorned by the unexpected and punctuated by the peculiar. Daniela signed in at the main desk as I noticed the giant jellyfish down the hallway. As Daniela and I sat down in the main waiting alcove, we were welcomed by five faces...two chemo neophytes and their supporting casts. There were no awkward silences. There were no curious glances. The room resonated with a radiating rapport...each guest aware of their fluency in the language of shared experience. Two of the three main characters in the chemotherapy multiplex, the other patients, introduced themselves, not with names, but rather by reciting their positions in a chemotherapy timeline. This is my first cycle. Mine too. I'll be here for six cycles... I have eight cycles...three weeks apart. How about you?...they asked Daniela. She obliged and joined the exchange. Not one individual spoke of a diagnosis...nor mentioned the ingredients prescribed to them. I sat in awe as a web of affinity spun itself around the room in mere minutes, gently ensnaring these three strangers. Later on, the group slowly disbanded as nurses ushered the patients to their numbered niches. We spoke with our friends again throughout the morning, gradually infusing each other with greater details from other non-medical experiences...as the other infusions progressed.

Here is the chemotherapy session in a series of images:



To view the images and captions at your own pace, click here.

Almost eleven hours ago, Daniela's vein stopped slurping the toxic nectars. She has been asleep for about two hours. Before going to bed, she reached for one of the vials of anti-nausea medication...the Compazine. After the pill and plenty of water, she groused, "I feel pukey." Dyspeptic dreams... nauseating nightmares... I wonder how her new chemo acquaintances are faring.

The Night Before Chemo...Pilule Play

                               

Earlier today, most of the Washington DC metro area was draped in a moist layer of rich white frosting...a few inches of snowflakes...a cleansing ivory intensity. After school, the kids donned their snow pants and headed for the park while I was left to untangle a cipher of side-effects.  

Chemotherapy is the main medical entree, but I forgot about the canapé. My introduction to the prophylactic aperitifs was visceral. As I read the lists of instructions, side-effects, precautions, and drug interactions, gentle waves of nausea lapped at my concentration. Ironically, two of the three medications prescribed purport to soothe the feeling of sea sickness.  

Anzemet®, the pharmaceutical stage name for Dolasetron - anti-nausea medication, rolls of my tongue...Anzemet. The incantation seems to conjure philological cadences of long ago, Ottoman utterances perhaps. Yet, there is nothing imperial about this errant eponym. I wonder about the pharmaceutical hand that delivered this moniker. Anzemet...a linguistic C-section of sorts...a deliberate incision made into a dictionary, a vocabulary, a travel experience, or perhaps a memory. Anzemet, a sterile sound scarred by a routine (outpatient) phonetic operation. 100 mg. Take one tablet daily for four (4) days, start the day after chemotherapy.

Prochlorperazine, another anti-nausea pill, is the generic version of Compazine®. Two anti-nausea pills...apparently these two pellets prescribed to Daniela share an affinity with teenage girls and like to go to the bathroom in pairs. 10 mg. Take one tablet every six (6) hours as needed.

Dexamethasone is a corticosteroid, a.k.a. Decadron® and Hexadrol®, prescribed to counter some of the effects of Docetaxel, half of Daniela's chemo cocktail. 4 mg. Take two (2) tablets daily for three (3) days, start one (1) day prior to Docetaxel.

Mensch ägere dich nicht....a tranquilizing board game.

All Clear...three days'til chemo

Earlier today, Daniela met with her oncologist, and they reviewed the results of her CAT Scan. All clear.... Her cancer is officially assessed as Stage One.

CAT Scan...four days 'til chemo

Early this morning we rushed over to Georgetown again, after depositing the kids into two separate neighborhood bank accounts. The appointment this time was for a CAT Scan (also known as a CT Scan). This scan will serve as a necessary baseline for future monitoring. Here is a sequence of images from our trip.



In order to view the slideshow, or read the captions at your own pace...click here.

(I did edit out a few images from this morning's sequence. Here they are after placing them in their proper context.) After the scanning was done, Daniela and I wanted to glance ahead in time by surveying the shores of the infusion archipelago. We were impressed. The first nurse we encountered offered to give us a brief tour. The atmosphere was serene, only a few patients. There were rooms with beds. There were many windows successfully seducing the sunlight. The walls were painted a hue of sea blue. In a few days, Daniela will return...marooned...in her chemo chaise...to watch the giant jellyfish float towards her and deliver their mild sting.

Eight Days 'til Chemo...

Today, Gabriela's Girl Scout Troop gave Daniela 616 square inches of moral support. Here is the 22" x 28" card:
Earlier in the day, Daniela spent hours hunting and gathering in the great Swedish labyrinth of IKEA. The purpose of her trip was to search for a small computer desk for the kids...sorry, out of stock...it will be in next week. So, she called me while I was at work to inform me about the absent desk. She also told me that she was bringing home a Ficus, which she introduced with much fanfare when I arrived home this evening. The formal introduction to the Ficus included an unexpected waltz...thirty minutes of 3/4 time...Daniela and the Ficus gliding around the living room in search of the perfect arboreal abode. Daniela eventually discontinued her orchestral queries, (Does it look better in this corner? Should I rearrange the living room? Do I need to move the painting?) and the tree quietly settled into its new space in our living room.

Hours later, the kids have gone to bed, and so has Daniela. I stare at the tree, her new dance partner. I recall a Ficus tree we had years ago in graduate school, and how it shed leaves shortly after arriving at our apartment. I thought the tree was dying, but someone told me that Ficus trees shed leaves as a means of adjusting to new surroundings. It makes sense, now. This new Ficus is also a chlorophyll ally. Soon it too will shed its leaves in synchrony...a soothing ecological empathy as Daniela sheds her leaves while wrestling with chemotherapy.

...ficus et amicus...

A Healthy Appetite...Ten days 'til Chemo

This past week, we have enjoyed both a disorienting and a sobering sense of calm. Daniela is well-rested, and has been sleeping soundly. She is more at ease with the expanders, which have absorbed a bit more saline during a recent visit to the plastic surgeon. This addition of sterile brine has literally and figuratively infused her with a welcome buoyancy. At ease in her role as custodian of her interim bosom (It was only a few weeks ago that Daniela taunted her torso with the self-effacing appellation--Frankenbusen.) her recent spells of cheerfulness have managed to (re)enchant our routines. The culinary considerations that diligently arrive at our door have been a precious gift from many friends. These palatable presents have allowed us to spend less time in the kitchen and more time at the dining room table...cooking up stories, dishing glances, and sauteing a bit of silliness...a wonderful family recipe. For this opportunity, we are very grateful. Thank You!

Since so many of you, our local friends, have shared their recipes, I will share one I recently found:

Ingredients:
1 Daniela
1 bathroom with shower
1 towel
1 Ari (seven-year old boy)
1 Gabriela (ten-year old girl)

Ensure your household standards of modesty are comfortably preheated to European Mode. (If they are not...stop reading immediately!) Steam Daniela in the shower, but not for too long, during your average weekday morning rush. Place towel out of Daniela's reach. Stand Gabriela in front of sink to brush her teeth. Throw in Ari, who needed to go to the bathroom in a pinch. Time the conclusion of Ari's streaming with Daniela's exit from the shower. Imagine as the inquisitively candid seven-year old looks at his mother and asks, "Mama...were have your pimples gone?!" Sprinkle generously with bubbling laughter from both mother and daughter as they correct Ari's anatomical misnomer. Add more laughter (from Ari).

Servings: One portion, but it will feed a lifetime of retellings.

A Preface to the Chemotherapy Chapter...

Today, Steffi (Daniela's Sister) and I accompanied Daniela to her first appointment with Dr. Minetta Liu, the oncologist at Georgetown University Hospital responsible for the chemotherapy portion of Daniela's treatment.

The appointment was scheduled for 1:30 pm. We were given instructions to arrive early, so we did. We also did quite a bit of waiting...and waiting. There was so much waiting that it wouldn't all fit in one waiting area. So as our bodies flowed from waiting area to waiting area, our impatience almost overflowed along with us... I was able to contain mine. Daniela's was contained by the required, routine, and repetitive paperwork. Once again, she had to retell her medical history, a retelling without an audience, an infuriating banality. Fill in the blank. Check the appropriate category. I sensed the volcanic voices...her Sicilian totem, Mount Etna...a chorus of arias steaming below the surface. No eruptions today, thankfully.

As Daniela and the other patients scribbled away, reproducing themselves again and again in fragments of medical significance, I noticed the irony.... Here we sat in an oncology department's waiting area. I glanced around at the many other patients, the purpose of their visit to seek treatment for metastasis unchecked, as they diligently spread check marks from page to page, an efficient and encouraged reproduction, not of cancerous cells, but rather of cursive signs. This space for cancer patients, their bodies colonized by replicating malignancy...willing recipients of life-saving chemotherapy, was transformed into a space for replicating medical bureaucracies...willing recipients of life-numbing monographs. Who will invent a chemotherapy for metastatic bureaucracy?

I will ground the poetic flights for a moment. Here is another flight schedule...Chemotherapy information:

Georgetown University Hospital

Chemo Session 1: January 18, 2007; *TC Regimen

Chemo Session 2: February 8, 2007; *TC Regimen

Chemo Session 3: February 29, 2007; *TC Regimen

Chemo Session 4: March 21, 2007; *TC Regimen
(*Taxotere/Cyclophosphamide)

Notes:
1. Daniela will have a full CT scan before her chemo session on the 18th of January. This will provide a baseline for future monitoring and also confirm the lack of metastatic activity elsewhere (B"H), from neck to pelvis.
2. The chemo infusion treatments will be at Georgetown U. Hospital, a total of four (4) infusions, three (3) weeks apart.  Daniela will have to visit Georgetown the day after each chemo session for a dose of Neulasta, a white blood cell booster.
3. Once the chemo sessions end, Daniela will schedule the second major surgery to finalize the reconstruction process. Concurrent appointments with the plastic surgeon will dot our calendar during the course of chemo sessions.


During the final few minutes of the appointment today, Dr. Liu, another physician with an uncannily soothing bedside manner, tried to ease Daniela's concerns about the upcoming CT Scan. After Dr. Liu left the room, I repeated..."The scan is a baseline, a photographic control they can compare to variables" [e.g. cancer activity]. Daniela just looked at me, her resurgent anxiety framed by the tension in her torso. "The good news is that you just have four cycles of chemo...," I gestured. She took a deep breath while biting her lower lip, then settled, "I'm still going to lose my hair...."


Here is the day in images (cum captions)...


To view the web album, and read the captions at your own pace...click here: