On the Road

Pine forest and the Deschutes River

I’ve been traveling.

Recently, my wife and I attended the graduation of our niece from Whitman College in Washington. Tillie, the daughter of my wife’s sister, received a degree in Theatre with a minor in Spanish. She landed a much sought after two-year position at the college admission office, which will provide her income and experience as she considers grad school. Her parents work for the State Department. Their children were raised for the most part overseas. Tillie and her brother, also a Whitman student, are exceptionally bright cosmopolitan kids.

Following graduation, our two families vacationed in Central Oregon. The Cascade Mountains divide the state into yin-yang topography. To the west are brooding fir forests, the fertile Willamette River valley, and damp coastal areas. To the east, pine forests, high desert, and dry wide-open spaces prevail.

Early morning pine tree detail

When I was Tillie’s age, I spent several years in Yosemite National Park. More than the grandeur of its granite cliffs, it is its pine forests that resonate in my soul. The trees of the eastern Cascades resemble those of the Sierras in California. The species of pine are different but the smells of the needle strewn forest floor and the airiness of the pine canopy invoke memories of my youth.

Our families are compatible. We have vacationed together for 15 years or more. Normally, we rendezvous in August at the same Central Oregon resort. Due to graduation, this year we chose the week before Memorial Day when we were already gathered together on the west coast. The weather was not conducive to swimming or other summer activities. Instead, we bundled up for long walks, read books, and played parlor games in the evening. All in all, we found the time equally relaxing without the sunburn.

Back home, the lushness of spring, enhanced by late showers, gave our property a hint of abandonment. Weeds advanced on my perennials. Knee-deep grass on the lawn begged to be mowed.  I eagerly set about catching up on outside chores.

Flowering tree in my yard

Once I minimized the look of neglect in my gardens, I sat on the porch with my cat, Spanky. We basked in the sun’s warmth, sheltered from the breezes. Together, we watched as the wind wove tapestries amongst the burgeoning trees, entwining the branches on the rise of a gust, and then untangling the mass as the current lapsed. I had enjoyed our time on the road but it felt good to be home.

In addition to these domestic comforts, my mood is buoyed by recent events from the world of multiple myeloma. I have dealt with this blood cancer for 3 1/2 years. The sense of its passive/aggressive nature is palpable. In some patients, treatments struggle to hold back the progression of the disease. In others, for reasons not clearly understood, the cancer dawdles; it shows little enthusiasm to proceed as long as care is provided. In the last ten years, vigorous research into remedies made significant improvements in the lives of those patients in the 2nd group.

The first event that gave me hope came from the International Myeloma Workshop held in Paris. Long-term studies indicate that revlimid maintenance treatment following a stem cell transplant extends remissions. Furthermore, the data confirms that patients undergoing this protocol live longer.

The second promising news about myeloma came from a speech given by Kathy Giusti, the CEO of the Multiple Myeloma Research Foundation. She delivered the commencement address to the graduating class of the Harvard Business School, her alma mater. What I appreciate about her remarks is the affirmation that sound business practices can speed up the FDA’s regulatory process. Treatments move from the bench to the bedside in years, not decades. Research for solutions to MM thrives under her excellent leadership.

Bridge sign: Don't jump to conclusions.

My cancer is stable. During the last two cycles of treatment with revlimid, I did not experience any physical letdown. I sleep well. My energy is good. I work full time and pursue my favorite activities. I feel confident about my health, optimistic for my future, all the while wary of the staying power of multiple myeloma. If I can keep the disease out of my bones and kidneys, then I should be around for the graduation of Tillie’s younger brother, my nephew Joey. He’s got three years to go. That’s a realistic goal; one I expect to make.


Another wonderful stormy spring day.

Spring is putting on airs, choosing to arrive fashionably late. Each year our community celebrates its agricultural roots with Blossom Weekend. Normally, pear and apple trees, festooned with an array of white and pink blossoms, attract thousands of visitors. They arrive like bees, pollinating local merchants with disposable income. This year, nary a blossom presented itself. Instead, a cold windblown drizzle greeted the tourists. T. S. Eliot got it right when he said, “April is the cruelest month.”

It was two years ago in April, that I started back to work following a lengthy break to undergo a stem cell transplant for multiple myeloma. Other than periodic checkups, I have not missed a day. This January, I began a regimen of oral chemo with the wonder drug, revlimid. I take a daily maintenance dose of 10mg, three weeks on, one week off.

At the end of the last cycle, I experienced a significant drop in my energy level. For three days in a row, all I wanted to do was nap. At work, I felt as if I were walking uphill in sand. I attribute that slump to a low percentage of red blood cells. Soon, my energy picked up as my body replenished itself during the break.

Revlimid capsules

The drug has slowed the progression of my disease. Dr. M and I would like to see a further drop in the cancerous cells, which hold steady after months of slow growth. Accordingly, we will continue with this treatment into the fall as long as the side effects do not create more problems than the drug solves. The goal is to achieve another sustained remission.

Doubt, hope, physical side effects, remissions that tease us, and relapses that punish us; these are factors that make up the complicated equation of living with this blood cancer. I meditate about these things on my blog and my ruminations help me to work through the stress associated with a life threatening illness. The only thing, however, that truly alleviates the alienation of a cancer diagnosis is interacting with others undergoing the same experience.

Each month I attend a multiple myeloma support group hosted by the Leukemia and Lymphoma Society. The value of these meetings extends well beyond their educational promise. I leave each get together not only wiser but also spiritually refreshed. It never fails that I glean something from the two-hour session that changes the way I think about others and myself. This past week was a general meeting. Rather than listen to a medical expert enlighten us about the disease, the moderators asked each of us to give a brief history of our diagnosis, treatments, and something we had learned along the way.

One gentleman’s moment stood out. He recounted how a counselor encouraged him to participate in art therapy as part of his recovery from a stem cell transplant. This opportunity enabled him to renew his values with a focus on creativity, purpose, wonder, discipline, and courage. Then, he proceeded to introduce us to the Jewish concept of Dayenu.

The Rabbi Spanky

Dayenu is a song that is part of the Jewish holiday of Passover. The word “Dayenu” means approximately, “it would have been enough for us.” Essentially, the song is about being grateful to God for all of the gifts he gave the Jewish people, such as taking them out of slavery, giving them the Torah and Shabbat, and had God only given one of the gifts, it would have still been enough.

Attending a support group will not cure my cancer. Nevertheless, it does cure me of the dread that occasionally shadows my optimism. Catharsis often accompanies the sharing. We testify to our individual fears. We bear witness to what has been lost. In addition, we rejoice in what renews us. Together, we discover that no matter where we are with respect to the disease, diverse paths to affirming life exist. Sometimes we just need another to point the way.


Soon after the New Year I resumed my six-mile walks. Wet weather interrupted some outings; others surprised me with unexpected mid-winter sunshine. I work fulltime but my job is not physically demanding. Accordingly, these walks provide the best barometer of my health. This is especially so now that I have restarted drug treatment for cancer.

The before kitchen during demolition

Thus far, I seem to be managing the side effects of the oral chemo. The peripheral neuropathy in my feet has increased, pestering me with nerve pain. At times, it feels as if my feet are burning. I also experience muscle cramps in my lower legs. Both conditions, though, are transient; they come and they go.

If my support group is any proof, each presentation of multiple myeloma has its own temperament. Mine acts indifferently. Following my stem cell transplant, the disease remained stable for a long time. Dr. M and I watched over the last several months as the level of bad protein in my blood slouched along toward a relapse. We chose to begin treatment before the movement gathered momentum.

For oncologists, the bad protein, commonly called M-protein or the M-spike, constitutes the unique fingerprint for multiple myeloma. Remember, this is a cancer of the plasma cells in blood. Healthy plasma cells create antibodies to fight infection. Those antibodies reveal themselves in the blood as proteins.

Six weeks later

Proteins are the workhorses of a cell; they carry out the bulk of cellular functions. With multiple myeloma, the plasma cell/antibody/protein is abnormal. It occurs in conjunction with healthy plasma cells but provides no benefit. Instead, the switch for cell division is stuck in the “on” position allowing it to replicate itself at a torrid pace. Furthermore, the myeloma overrides the process of programmed cell death. Consequently, it floods the marrow environment, spills out into the bloodstream, and, well… there goes the neighborhood.

The recent death of Geraldine Ferraro underscores the tenacity of this disease. Ms Ferraro lived 12 years after her diagnosis. She utilized the prominence of her political career to advocate on behalf of all patients with MM. Ultimately, efforts to control the cancer’s prolific growth profile failed. Everyone in the myeloma community mourns her passing.

My personal disease profile continues its lethargic behavior. As I mentioned, the M-spike measures the concentration of the bad protein in blood. When tested two weeks ago, my number had decreased slightly. It’s too early to know if the new drug I’m taking caused the reduction. But I’m optimistic.

Spanky likes the heated ceramic tile floor

It’s easy to get hung up on one’s numbers. This is particularly so during the winter months when much of one’s activities are internalized because of the weather. The daily pill taking leading to each month’s labs kept reminding me of a reality it would be nice to forget.

Still, life goes on outside the internal workings of my blood. Recently, I found distraction from the tension of waiting for the periodic results. Our kitchen, long neglected, underwent a renovation comparable in degree to my stem cell transplant. We demolished the old and rebuilt it anew from the ground up.

We bought our home in 1978. It started out as a 600 sq. ft. bungalow but grew with our family. Over the years, we added one room after another, including a second floor. The kitchen, however, was always “next in line” for improvement. We had many setbacks to our good intentions: car repairs, college tuition, medical bills; it was always something.

Another view

Now, at last, the work is completed. The mild weather in January and February helped make the upheaval of our living space tolerable. We waited 30 years for this and six weeks of frozen dinners during construction seemed a small price to pay. In fact, the delayed gratification due to previous sacrifices only sweetens our appreciation of the finished product.

The kitchen overhaul had helped me to focus on matters other than my health. From hereon, spring will take over where the renovation left off. Yesterday, between rain showers, I scratched with a hoe at the perennial beds in my garden. Afterwards, my youngest son joined me for a therapeutic walk. All the medicine I need, at least for my soul, can be found in the verdant pastures, the activity of wildlife, and good company.


In January, I met with Dr. M. Once again, my cancer showed signs of awakening. I feel good. I am not overtly symptomatic. Nevertheless, the myeloma stretched and yawned. After a nearly 2 1/2-year nap, my drug-free remission was about to end.

When in doubt, trust your instincts.

Since last October, we’ve discussed a course of action. I digested statistics from clinical trial findings. The doctor weighed in with his experience. Opinions from several other respected sources aided me in my deliberations. Finally, I assessed my own treatment history. No doubt, the chemo I received in 2008 altered the environment of my bone marrow. Those drugs subdued the disease. Over time, though, the cancer adapted and the surviving cells began to grow.

During the intervening months while thinking about what to do, MM claimed the lives of two members of my support group and an online acquaintance. That, coupled with the undeniable activity of my disease, broke the resolve to withhold treatment. I agreed to begin a maintenance therapy of 10mg of revlimid daily, three weeks on, one week off … indefinitely.

My rationale is a gut decision as much as it is about the clinical findings. Stable disease lulls one into complacency. This creates a Hamlet-like dilemma for the patient. Do you strike out at the cancer, or wait? No matter what you decide, it’s a coin toss with your life in the balance. Heads or tails; make the call.

A pretty winter morning, then the rains came.

Elsewhere, life goes on indifferent to my stewing over the choices. Winter arrived with enthusiasm. Ski resorts opened early. The season’s frigid momentum persisted through the holidays, clenching the long nights in an icy grip. Then, with New Year’s arrival, its hold loosened when the rains of El Niño drenched the western states.

At home, our modest sized Hood River, swollen to flood stage, growled with boulders tumbling downstream. Pear farmers renewed the premiums on their crop insurance as the thawing ground awakened the roots of trees accustomed to dormancy.

Dormancy, as blood cancer patients and farmers know, is a good thing. Temporary inactivity helps plants rest and rejuvenate. Nature’s balance depends on a period of suspended animation that unleashes itself in a nurturing climate. Too early, and the plant is vulnerable; too late and it may not mature.

Sleeping trees-That's Mt. Adams to the north.

Cancer, on the other hand, is more about co-existence with a situation that is out of balance. A patient, such as I, attempts to stay one step ahead. If eliminating the disease is unlikely, then perhaps suppressing it can moderate the ill effects. With luck, a durable remission is possible. In fact, given the dynamics of research into multiple myeloma, surviving until new treatments become available is a reasonable strategy.

Am I convinced about my decision? No. But I feel fortunate to have choices. The dirty little secret about revlimid is that a 21-day supply of this miraculous drug can cost over $10,000.00. That is not a misprint. Obviously, I don’t pay that. I have health insurance that happens to cover the drug. But for those that don’t, the choices about their cancer treatment are much more difficult than mine.

True Grit

True Grit

This winter, my wife and I, along with our two sons and daughter-in-law went to see the re-make of the classic western, True Grit. I liked this version of the movie more than the original. I think the Coen brothers better captured the coarseness of an era when one’s self-respect found moral value in vengeance.

The protagonist, a young girl named Mattie Ross, wants justice for her father’s murder. She hires Rooster Cogburn, a gruff hard drinking marshal, to lead her into the badlands of the old west. Off they go on a journey laden with comedy and violence, their saddlebags full of cornbread and bullets.

The theatre in our hometown of Hood River is small. My wife and I always sit in the back row. There, our older eyes and stiffer necks can relax. The rest of our family sat up front. About halfway through the movie, my oldest son, Noah, headed to the lobby. The rubber tires of his wheelchair whispered on the carpet as he rolled past our seats.

His paralysis resulted from a vehicle accident in 2002. A careless mistake on the part of an uninsured driver led to a broken neck and an irrevocably changed life.

Noah surrounded by his posse at graduation from the U of O in 2006. .

The road we’ve traveled these last eight years roughed us up pretty good. The wrong done to my family felt so egregious, I yearned for the visceral satisfaction of revenge. Like little Mattie in the movie, I too, wanted the perpetrator to face a day of reckoning.

Though the other driver erred, my son’s accident was, … well, it was an accident, unexpected and unintentional. Much of my pain stemmed from grief without closure. I wanted to indulge in the primal urge for retribution, an urge, mind you, that accounts for the popularity of movies like True Grit. My guns were loaded, revenge was mine, but I had nothing to shoot. Anger grew from the frustration, a cancer that soon metastasized into depression.

Meanwhile, Noah persevered. His success at dealing with the injury helped me heal. He painstakingly completed his degree at the University of Oregon, graduating summa cum laude with a BA in Spanish. Then he enrolled in law school at the University of California, Berkeley. He paid for his graduate education by winning a prestigious scholarship from the Jack Kent Cooke Foundation. He finished his final term last December, attaining high honors. Just this week, he accepted a position with the Environmental Protection Agency as an associate attorney in their San Francisco office.


Along the way, I managed to contract a blood cancer, multiple myeloma. Some people suggest the disease resulted from stress. Perhaps … it’s as good a theory as any. At one time, I would have happily agreed to bargain my health for the health of my son. Ultimately, it doesn’t matter. What matters is that our family can now pause to celebrate. The last eight years moved at an agonizingly slow pace but the box canyon of paralysis was not, after all, a dead end.

Celebrating was exactly what we were doing at the showing of True Grit. Following a short break, my son returned to his seat. We all watched as Mattie got her man amid a fair amount of entertaining collateral damage.

In the real world, Noah has regained much of the independence stolen from him. The true achievement, however, was his distillation of loss into purpose and anger into courage. Re-routing his life took a lot of grit. And that, is all the revenge I need.


Each month, I commute 60+ miles from Hood River to Portland, OR in order to attend a multiple myeloma support group hosted by the Leukemia and Lymphoma Society. Today’s meeting featured a speaker from my doctor’s oncology group, Northwest Cancer Specialists. The subject was an update on December’s annual conference of the American Society of Hematology.

The back of our house-blue skies before the storm

The ASH meetings provide the latest in research on all blood cancers, including, of course, multiple myeloma. I’ve already examined much of what went on at this conference but I looked forward to asking questions unanswered by the press releases. Unfortunately, winter weather prevented me from traveling through the Columbia River Gorge.

We only received three inches of snow. However, the weather pattern consisted of a relatively warm Pacific storm with significant moisture butting up against a stationary cold front. The transition causes freezing rain and treacherous driving conditions in the Gorge.

Instead of a Q & A on myeloma, I spent the day with my new Christmas present, a Kindle. The Kindle is a brand name for a book reader sold only through Amazon. What’s a book reader? It’s a digital device into which books may be downloaded wirelessly and read from a screen similar to a book’s page.

When the weather is nice, I like to read on this bench under the Walnut tree

The Kindle does for book portability what the iPod did for music. Theoretically, I can carry around with me a personal library of reading material. Better yet, I can supplement that library wherever I find a Wi-Fi connection.

Prior to owning a kindle I deluded myself about the importance of sensual contact with printed pages. Those reservations went out the window once I put mine to use. The elegant design and simplicity of operation converted me instantaneously.

My Kindle library now contains four books. 61 Hours by Lee Child is a barnburner of a mystery, a perfect temporary remedy to crummy winter weather. Memory Wall is a collection of short stories by Anthony Doerr. The prose is excellent; the tales are compelling. The locations vary while always examining the theme of remembrance. I highly recommend this book.

Currently, I’m into The Lotus Eaters by Tatjana Soli along with another collection of short stories, What Becomes by the fascinating Scottish writer and comedian, A. L. Kennedy.

My Kindle came with a bodyguard

I read a lot. Book readers do not make reading easier or more fun. At the moment, I’ve still several questions about their shortcomings. Things such as how to loan books to friends, or what happens if you lose or break your Kindle. In time, entrepreneurs will come up with satisfactory answers.

Whether or not you find this brief review intriguing, rest assured that the way we read and access books is changing. As Kindles and their competitors develop, the utility of book readers will, for better or worse, alter the conventional necessity of bookstores and libraries. There is no going back.

PS: My favorite book of 2010 was The Art of Racing in the Rain by Garth Stein. If you’ve ever owned a dog or cat, gerbil or parrott, turtle or pet rock, read this book.

The Cat Came Back

Curly hard at work.

Recently, the cat who keeps me company at the Post Office, Curly, disappeared. She adopted our office as her home seven years ago. She spends her day sleeping in a chair atop a red, white, and blue blanket knitted for her by one of our customers. At night and when the office is closed, we place her outside to fend for herself.

This year, winter came early to the Hood River Valley. Our first snow fell on November 9th. Then, just in time for Thanksgiving, the weather turned cold, very cold. While acclimating to the season’s onslaught, I was also grappling with my doctor’s suggestion to renew treatment for my blood cancer, multiple myeloma.

I understand the proactive thrust of Dr M’s idea. Clinical trials demonstrate that low dose oral chemo can extend remissions in patients who have undergone a stem cell transplant. Nonetheless, I waver. The fact that I feel good makes me hesitate. Why set the clock ticking on treatment now? Shouldn’t I wait until I’m symptomatic?

Our home after a recent snow storm

As I contemplated what to do, the cold snap broke and torrential rains threatened to flood the valley. Last week, the snow returned. Several brief storms dusted the trees, decorating the shoulder of each branch with white epaulets. Then, the full moon joined with the solstice and bore the gift of a lunar eclipse. In years gone by, such heavenly triangulation would have prompted pagans to sacrifice an animal. After all, angry Gods must be appeased.

That was when Curly disappeared.

In a world full of unpredictability, Curly’s steadfast appearance at our back door each morning, is appreciated. Throughout my workday, the transactional banter that accompanies the selling of stamps often includes an inquiry about Curly. Customers want assurance that she is safe. In this way, she acts as a touchstone helping to forge bonds in the community that would otherwise be absent.

After four days of worrisome questions from admirers, my faithful companion reappeared. She seemed no worse for wear, just hungry and sporting a suspiciously torn claw on her back foot. I theorize that she entered a building from which she could not escape.

Curly’s return brought to mind an old folk song: The Cat Came Back. The tale it tells speaks to the resilience of cats, uncanny in their ability to land on their feet in the direst of circumstances. As the song progresses, it takes on sinister overtones. The cat not only comes back but does so with a vengeance that grows in proportion to the effort to be rid of him.

Spanky, another cat who comes back a lot

Something similar occurs when cancers relapse. Remissions imply that one’s cancer has disappeared. With many blood cancers, however, the disease exists undetected in a dormant state. It is myeloma’s capacity to evolve that makes it, thus far, incurable. The cancer has resourcefulness equivalent to a cat with nine lives; its true regenerative force, though, may actually be infinite.

In a New York Times article, The Cancer Sleeper Cell, by Siddartha Mukherjee, the author postulates: “Chemotherapy unleashes a ruthless Darwinian battle in every tumor. A relapsed cancer is the ultimate survivor of that battle, the direct descendant of the fittest cell.”

Hence, my reluctance to begin a regimen of chemo; I wonder if doing so when my quality of life is high not only eliminates an option but also makes the cancer smarter. Like Curly, I do not want to enter a building from which I cannot escape.

I am a pragmatic optimist. I respect the ingenuity of life in all its forms, be it a life threatening cancer or a cleverly resourceful cat. I also admire the persistence of science. Right now, I’d say the brilliance of researchers is gaining on the lethality of MM. One of these days, perhaps in my lifetime, the cat, or rather, the cancer, will not come back.



“Keep a green tree in your heart and a singing bird will come.”

Chinese Proverb

Raked leaves from a sugar maple

In November, the deciduous trees on our property cover the lawn with a radiant multi-colored blanket of leaves. Each fall, I spend several hours raking them into piles. Then, I haul them to my flowerbeds where they act as nutritional mulch.

Our property was once a strawberry farm and before that, part of a forest. We purchased the land with a small house over thirty years ago but never worked it. Instead, we raised two boys who enjoyed a playground of 4+ acres.

One of our sons was born in what is currently the den, the other nearly so, though complications at the last moment precipitated a rush to the hospital. We commemorated the first-born’s birth by planting a Sugar maple tree. Two years later, our second son’s arrival was marked with a Quaking aspen. Though we stopped at two children, the tree planting was only beginning.

As our sons grew, it became a ritual for the three of us boys to plant a new tree each Mother’s Day. The value of our gift lay in the legacy tribute of a tree’s life. Furthermore, it came wrapped within the comedy of our antics. On one occasion, the boys and I broke a water pipe while planting a Japanese maple. That day may have been my sons’ first lesson in how to swear. Now, years later, it endures as a humorous anecdote in our family history. I like to imagine that tree’s delicate beauty stems from the bile spilt at its christening.

L-R, Maple, Walnut, Aspen

The first tree dedicated to my wife was a white birch. Its multiple trunks and drooping branches now reach 30 feet into the air. Many more followed one at a time, along with random plantings of bunches of Douglas fir, poplars, and Norway maples. Despite the dozens of additions, room exists for many more.

To plant a tree affirms life beyond the boundaries of our short stint on earth. While my cancer causes me to sometimes brood about mortality, the trees I’ve sown connect me to the imperishable wonder of creation. The routine chore of gathering leaves to share with my garden folds me into the mystery of how life everlasting encompasses us all.

Against that backdrop, I attempt to put my disease in perspective. Lately, it stutter-steps: one moment advancing, the next retreating. The cancer, multiple myeloma, seems reluctant. On consecutive visits, my blood labs crept upwards in a telling category. Then, at my most recent appointment, the movement stalled.

Maples in full color

Further proof of the lazy nature of my disease came from a series of X-rays on my pelvis and legs. Pain in my thigh and hip made me wary of advancing cancer. One of the sneaky ways this disease harms the patient is by causing lesions in the bones. Often, someone with myeloma does not know the extent of the damage until a bone spontaneously fractures. This development is not bone cancer, per se; rather, it is a result of the blood cancer interfering with the normal process of bone loss and replacement. Fortunately, nothing was found on the radiological exam but my renewed peace of mind.

Overall, my condition gives me reason to rejoice. I survived the first onslaught of multiple myeloma, much as an old tree endures a lightning strike. Remember, in 2007, the prognosis was five years. Given the status of my disease, its ambivalent nature and my constitution’s ability to respond to treatment, I consider that a poor estimate. No one can say how many years lie ahead. Nonetheless, I think there will be plenty of time to plant more trees.