(More) Recent Glimpses of...

...another walk on a rainy day.  This time Daniela has outflanked her trusty security detail, and is on the left.

...silly reindeer games.  Somehow Gabriela has managed to convince her younger brother that it is not a drag to dress up as a reindeer queen.

    

JP Drain Obituary...

Jackson-Pratt Drains. 14 Days, 23 hours, 10 minutes...my best estimation of the lengthy silicone embrace, medically necessary, albeit emotionally suffocating.

Daniela is now, as she exclaimed earlier this evening-drain free! Her last remaining leech deprived of it's hemoglobin nourishment was cast into a plastic wastebasket. Vampiric silicone sealed in a synthetic polymer coffin. I only wish that I could have been a witness to this unceremonious funeral. (One of Daniela's Superfriends accompanied her to the medical appointment today.)

During the past few weeks, I spent many moments ignoring, cleaning, cursing, emptying, and repositioning these drains. Aided by exhaustion, and uninhibited by sleep deprivation, I kept a list of acerbic aliases for these four horsemen of medical artifice. This list could still elicit a wince or two from a drunken sailor, I'm embarrassed to say.

So, the instant this last drain died, I should have sat at my office computer and triumphantly typed its obituary. But I didn't. I waited almost 12 hours...to say farewell. When I arrived home from work, Daniela was basking in her silicone-free status. Since Ari and Gabriela were spending the night with their paternal grandparents, we decided to go out and celebrate at a wonderful Ethiopian restaurant nearby. Hours gone by and with the Amharic aromas lingering in my mind, I finally began to write.

But after saying my peace, I confess that I feel ambivalent about my disdain for the drains. My supercilious schadenfreude seems excessive when I realize their role as conduits, not only of ire and frustration, but of more delicate emotions coaxed from me. These emotions, like the vital fluids syphoned from Daniela, contained a remediating reciprocity, a nurturing and nourishing quality that fortified our friendship. I'm glad the drains are gone, but the memory of those translucent bulbs like the Amharic aromas will linger a bit longer, and that's OK.

Recent Glimpses of...

...Daniela flanked by her security detail during a neighborhood walk.






















...fait accompli, the gifted workbench assembled at last.

Betwixt and Between...Ontology and Oncology

The day after Daniela's surgery, her second and final day at the hospital, I managed to find a wi-fi oasis at the Georgetown University student center. While I checked my email and replied to many well-wishers, I overheard a conversation a few couches away. The main theme of the exchange between the two students was philosophy. The particular context was a debate on free will vs. determinism. If a man is in a room...and the door is locked...but he is not aware that it is locked....does he have free will? I scanned my email. Inbox, 22 new messages. Spam folder, 14 messages. The hypothesis of the causation of actions states that..... After thirty minutes or so, I had replied to most of the emails. The serenade of philosophical postulates continued, and I recall rolling my eyes thinking about the pleasures of the particular, the concrete, and the immediate: negative lymph nodes, validating my parking ticket, Daniela will be home tonight. The argument of abstractions between the apprentices felt so distant, until last night.

Last night, Daniela was scanning her own email's inbox. One message stood out, an email from Dr. Paul Carbone, an oncologist and friend of the family, and the son of her former oncologist who treated her Hodgkin's Lymphoma. This email message had its own menacing ganglial spurs...four attachments...articles from medical journals discussing breast cancer risk for Hodgkin's patients treated with radiation. (At that moment, I had not yet read the articles.) Daniela glanced up from her laptop, and calmly offered, "I may not live much longer...." She went on to quote statistics from the one article she was reading, frustrated that no one had told her, or no one knew about the risks inherent in her previous radiation treatment.  

Statistics. Dr. Cocilovo mentioned a few days ago that Daniela's cancer, classified as Stage I, had a 95-96% survival rate at 10 years. A good friend mentioned in an email that Stage I breast cancer has a 100% survival rate at 5 years. The articles attached to Daniela's email offered other analyses...a risk factor of developing breast cancer as high as 29%, depending on age, for Hodgkin's survivors...a radiation dose of 4 Gy or more delivered to the breast has a 3.2 fold greater risk of developing breast cancer, for Hodgkin's survivors...hormonal stimulation (pregnancy) is a significant risk factor for developing breast cancer among Hodgkin's survivors treated with ABVD Chemotherapy (a chemo cocktail that does not appear to cause ovarian damage).

I recall a quote by Mark Twain (quoting Benjamin Disraeli): Figures often beguile me, particularly when I have the arranging of them myself; in which case the remark attributed to Disraeli would often apply with justice and force: "There are three kinds of lies: lies, damned lies and statistics." - Autobiography of Mark Twain

Daniela and I both mulled over the sour forecasts...her Hodgkin's treatment plus pregnancies probably gave her a 1 in 3, or greater chance of developing breast cancer.... She is now a survivor's survivor, and she wonders about the consequences of her upcoming treatments...about mortality, about the unknown and unforeseen side-effects of her upcoming chemotherapy. She reluctantly surrenders to the idea of another oncological alchemy. She sighs. I sense her attempts at divination, her faith in the words of the medical journals' actuarial augury visibly shaken. Twelve years ago, her physician also mentioned that leukemia was a possible side-effect of her Hodgkin's treatment. Leukemia, another possibility, another set of worries distracting her. What do the oncology odds makers forecast for this risk? 

I remind her that statistics and probability are just that. She is an individual. She shouldn't dissolve herself in the data pools and acquiesce to the communal fate of chi-square tests, P values, and regression models. Adrift in the sense of the abstract, I try to bring her ashore with images of the concrete by listing some of her attributes:  athleticism, a healthy diet, a resilient Mediterranean physiology....

I think back to the student center days ago and wonder if those two Georgetown students, emerging philosophical sufists, have considered other logic puzzles in their study sessions, examples drawn from an interplay of the metabolic and the molecular, an ontology informed by oncology, molecular determinism vs. cancer-free will. I (re)imagine their conversation. If a young woman has Hodgkin's disease...and is treated with high dose mantle radiation...but is unaware of her severely increased risk of developing breast cancer and leukemia....is she free to consider herself a survivor? I scan my email. Inbox, 14 new messages. Spam folder, 3 messages. The hypothesis of causation of actions states that.... My impatient curiosity wonders how they would have answered. How would you answer?

Translating Pathology Prose

This morning we played a medical appointment double-header.

10:30 am, Surgical Oncologist. Dr. Cocilovo gave us a copy of the full pathology report. In summary, she stated that everything looks great. For those of you fluent in pathologese, here is the unmediated summary:
Tumor Type: Infiltrating Ductal Carcinoma, NOS, associated with a component of Ductal Carcinoma in Situ, High Grade
Tumor Size: 1 cm
Elston's Grade: Poor (Score 8)
% of DCIS: Less than 30%
Margins: Negative
Lymph Nodes: 0/2
ER/PR, HER-2/NEU: Ordered on paraffin block "A11"
pTTNM Classification: T1b N0 Mx
For those of us who are not fluent in the medical sub-dialect of pathology prose, I can offer, after speaking with Dr. Cocilovo, a tenuous translation of the pathology report summary. The Elston's grade score of "8" means that this is one ugly bad-ass type of cancer...it is aggressive. The good news is that they got it all. (There may be a cell or two of metastatic breast tissue left behind, but the chemotherapy will take care of them.) Now, back to the Elston's grade score...the most efficient visual interpretation I can offer is a portrait, in triplicate for emphasis, of the Pale Man.
The Pale Man is one of the characters in the Academy-award winning film Pan's Labyrinth, his fingers an apt metaphor for the ganglial spurs radiating from Daniela's former tumor. If you've had the experience of immersing yourself in this cinematic fairy tale, you will recall that the movie's main character, a young girl named Ofelia, does escape from the clutches of the Pale Man, albeit after a tension-filmed pursuit.

11:00 am, Plastic Surgeon.
After shrouding herself in hospital hijab couture, Daniela decides to look in the mirror. I capture the image of Daniela...looking in the mirror...looking back at me.
Daniela was hoping that today, they would remove the two remaining drains. They removed one drain, the one on the right side. This was the drain that caused the most discomfort. The appointment to remove the solitary silicone leech is this Friday...11:00 am.

Countdowns...

December 13, 2007 (Day of Surgery)
0450 hrs: Radio alarm clock wakes us up.
0453 hrs: I roll out of bed, Daniela tells me she wants to sleep 10 more minutes.
0510 hrs: Done with my shower, I head back to the bedroom. Daniela is staring at her wardrobe deciding what to wear.
0515 hrs: Daniela is still deciding what to wear.
0520 hrs: I am dressed, take vitamins with glass of water. Daniela is asking me what she should wear.
0521 hrs: I check, re-check and check again...the items I've packed in my backpack.
0525 hrs: Daniela is dressed, I tell her I'll meet her in the car.
0530 hrs: Departure Time. Daniela is still in the house. I worry.
0531 hrs: I jog back into the house...Daniela is in the kitchen. She is wearing clogs, prAna pants, her ski jacket, a scarf and a hat, and holding gloves in her hand. The only light in the kitchen is the fan light above the stove. She is carefully cradling a white bowl above the countertop, diligently herding a batch of homemade applesauce into its Ziploc corral.
0532 hrs: I raise my palms. "Take your time sweetie," I tell her.
0533 hrs: I am back in the car.
0535 hrs: Daniela joins me and we are on our way to the hospital.

December 23, 2007 (Ten Days Later)
2115 hrs: The homemade applesauce is still in our freezer, enjoying its cryogenic siesta.

Even Superheroes Have a Bad Day...

Maybe it is was the frustration, swelling steadily for the past week, unnoticed until today, the awareness of limits on everyday tasks.

Tea in a to-go mug...because her favorite mug is too heavy to lift.
Wearing a nylon belt when showering...because the two remaining drains cannot hold themselves up.
Another night sleeping in a mummified pose...because sleeping on her side is too painful.

Daniela manqué...this unwelcome fabrication colonizing her sense of space (silicone hosiery leeches) and time (calendars mottled with medical appointments), she cried this morning for no particular reason, and for every other reason imaginable.

I may (over)dress Daniela in Supergirl metaphors, but her crying, that form of emotional dispensation made intelligible to the onlooker by a script of facial contortions as unique as fingerprints, is my kryptonite. When she cries, her lips tremble with the intensity of a newborn yowl. The reflex is innocent. The effect is paralyzing.

I sat down to finish my breakfast listening to my own breathing hoping, wondering.... Within the hour, a triumvirate of close friends, Supergirls in their own right, came in succession to visit. Their presence was the simple antidote to the tearful tremors. The rest of the morning went well, so did mid-day.

By late evening, the discomfort has crept back into her mood. The drains need to be emptied. The ritual itself has become a variant couvade...instead of mimetic labor pains for the husband, I ape her sense of exhaustion...emotional and physical. Surreal...I have become mid-wife to my own wife's nightly natality of grumpiness. The drains will expire sometime before noon on Monday. I can weather the tempest. Daniela has overcome much, much more.

A few minutes before I go to sleep recalling what happened this morning, not the crying but the visitors, I smile. Imagining her as a Superhero may be cool, but knowing that she has Super friends is better.