I Was Ariana’s Daddy.

Had a great night but maudlin now that I’m home — I guess that’s the cancer life, in a way.  It’s hard for us to have fun without immediately contrasting it with the pain of this existence at times. The pinnacles just drive home how fucking deep the depths go.

When I first got diagnosed I had a grand plan to write a book for my daughter, to make a mark somehow just for her.  Life, or this slow progression towards death with all the  chemo and hospital stops in between, just got in the way.  Perhaps this serves the same purpose, compiled someday … there are instructions to that effect so she at least has some record of how much I thought about her.

Anyhow I was going through some files on the PC tonight and found the intro I wrote for that book a few years ago. It follows, the title of this entry my working title.  Maybe I just feel like I need something personal to her here right now; I feel precarious for some reason, fragile.  My KitKat stash has also run out which is not helping.

What is this book?

That’s a good question, actually.  I suppose the best title would be a self-epitaph, if there is such a thing.  A how-to manual for being average?  A road map to the middle?  Wishful thinking?  A giant conceit by an otherwise un-noteworthy person?

That’s the problem, isn’t it.  If I were some famous actor I’d be here pontificating on how wonderful I am or whatever people like that write about.  If I was one of those annoying cancer survivors who has to blather on about how cancer was almost a good thing in their life for the changes it fomented, that’d make sense for a book (although it’d still be annoying – seriously, fuck those people and their cheery bullshit).  If I had some ironic experience, like the neurologist who discovers they have brain cancer, I could perhaps explain something.

But the question I kept asking myself most of my life, and the reason for things like why I never wrote a book even though I always wanted to (fiction), was “who the fuck am I to write anything?”

The answer, as I’ve learned, is “nobody.”  Well almost nobody – because there’s a context that becomes important here, one regarding the audience.  You might think it’s you – I mean that’s just semantics, right?  You’re reading it, so it is you.  And to you, random person, I’m nobody.  I don’t think there’s a life lesson here, or a how-to – just a prurient sort of entertainment at best.  But I didn’t write it for you.

See I wrote this only for my daughter.  In fact, this started as a series of letters I began writing her when I was diagnosed with Multiple Myeloma (I think it’s supposed to be capitalized – feels like if something murders you it deserves caps, right?), but I found that not only was that a really odd format but even worse I’d write her a letter, seal it and put it in a safe deposit box, and then promptly forget what I had written.  So I pondered maybe just putting them all together or something because as the disease, and moreso the treatment, stole my memory (“chemobrain” as they call it) I started wondering if my daughter would end up reading these and think her dead father was some idiot with Alzheimer’s.

Not really the impact I was going for.

Additionally, I was not religious about writing those letters – similar to therapy, which I ended after the first few years of my disease, when I write my soul opens and it all comes out.  Unfortunately, those letters became tantamount to opening Pandora’s Box, and since I had to be functional as both a father and sole provider I just couldn’t do it.  I realized pretty early on that, in and of itself, I didn’t care that I had a terminal disease.  Really, what else was I going to do in life?  Play in the NHL?  I’m 45 and don’t skate.  But I had a daughter, and that not only changed everything but it was my one Achilles’ heel with this – I cannot, to this day, think about leaving my daughter behind at a young age without it just wrecking me emotionally.

See this is the life I’m afraid I’m never going to be able to relate.  It’s the conversations I would have given anything to have with her but this disease stole from us.  It’s the little things I would have hoped she would have learned about me, come to understand, and maybe even loved a little.  The jokes we might have shared, the music I would have tried to get her to become a fan of, the games we never got to play.  It’s as much of me as I can figure out.

Maybe you (that’s the “not my daughter” you) get something from it too.  I have my doubts, honestly – not to play the humility card too much but one of the things I’ve learned about myself is not only am I nothing really special, per se, I think I made some critical errors somewhere in my life and went down too many wrong paths.  I think I might have been able to be someone special, at least in the way we all think of things.  A CEO, I think, or the right-hand man of one – the more I’ve learned about myself over the years the more I think I would have excelled elsewhere had I chosen differently.   But I’m not entirely sure, given the choices I’ve made, that I would have done so, so perhaps I’m just fooling myself?  Either way I can’t really point to specific events or decisions and say “see, avoid this and you’ll be richer than Oprah!” or something really useful in a book.

Not only don’t I have any answers, but if you’re reading this I’m also dead, so it may be the worst self-help book ever, come to think of it.

Worst.  Ever.

But there’s one person out there I need to read this.  I’d say I hope it’s enough but it’d be pretty fucking stupid to wonder if a poorly written and badly flowing book is a substitute for a dad being there.  I’m not even sure what the point of writing this is – I keep coming back to wondering whether somehow this is an ego trip or something, some last-ditched attempt to be something for my now fatherless daughter to be able to point at and say things like “my dad, the writer.”

You know what, though?  I don’t care either.  You decide.  For me, all I can say is it’s a love letter to a relationship cancer stole from me, and that’s about as honest as I can be about it.  It’s some small attempt to steal back what this disease has taken from two people, and I know it’ll never be enough.  It’s a longer, and more thought-out, goodbye than I’m sure I got to say to her.

And it’s all I have.

I love you, Ari.

-Daddy, 2/2016

 

The Summer of 2017.

When I was a child I had a little stuffed bear.  I couldn’t tell you what he originally looked like even though I still have him — almost 47 years of wear and tear from myself and of course now my daughter, on top of being mauled by various dogs through the years, have taken their toll.  In fact he’s more triage than bear at this point.  A sad faded yellow with a white belly, a hard surface where presumably at some point the nose was attached, and covered with my father’s best attempts at sewing him back together after one of the labs would get a hold of him.  Stuffing leaks from unfixed holes in his belly sometimes and both ears could use some reconstruction work.

I’ve thought a lot about that bear recently. This just hasn’t been my year, especially physically — three surgeries have left me looking like him in my mind (with a slightly worse tan); scars across my stomach, translucent skin, no eyebrows or hair, etc.  As I write this, in fact, today marks just over a week since I was last in the ICU at the hospital and the longest I’ve been out of PSL in the last three months.

I realized something (well a lot of somethings, but one big one) during all of that time.

I have cancer.

I hope that makes sense in a non-patronizing way — obviously I know I’ve had cancer for over 4 1/2 years now. But up until this year it felt manageable, almost surreal … something you can picture, form words around, but not really understand.  As Dr. Mikhael at the Mayo Clinic pointed out to me years ago I wouldn’t even know I had a terminal disease except people kept telling me I did (and making me take drugs for it).

But this year?  This year I’ve watched, helplessly, as my health has deteriorated to the point where on a few of these visits I (and others) were convinced I wasn’t going to be leaving the hospital again.  Worst of all, at least to me, was having so much time to really think about that.  At the risk of making too broad an assumption I think most people would prefer to die suddenly, painlessly, their affairs in order.  But there’s a special Hell in just waiting and kinda wishing to die that defies me to really explain it satisfactorily, in crying yourself to sleep in an uncomfortable hospital bed thinking it wouldn’t be so bad if you just didn’t wake up tomorrow.  Even though the consequences on those around you that you care the most about would be so brutal — that tipping point, emotionally, where you just stop caring and the pain of it all trumps the logical, the kind, the caring.  Where you just don’t want to feel anymore, anything.

It’s that inflection point that really scares me about death when I think about it — when I can say to myself that I’m sorry, Ariana, but daddy just couldn’t take it any more.

I haven’t updated for a while, I should probably tell this tale.

VTD-PACE round four fucked me up pretty good.  It did its work, in terms of my numbers (which typically I don’t have handy as I type this), but the price was too high — I’ve been a medical dumpster fire since the end of the treatment and the khyphoplasty for my back fracture.

Things started like the post-PACE hospitalization week always did each cycle, with this overwhelming mental, physical and emotional sense that something was seriously wrong. Each cycle that’s gotten worse but round 4’s was impressive — I was a basket case for a few days. I can’t even put to words, were I even willing to share the thoughts and imagery, of what was going through my head. I would hazard a guess that the massive amounts of steroids in this treatment causes this reaction, but regardless it’s the death of all hope, this black pit that you can’t get yourself out of except by waiting it out.

Then the cold hit.  Having just been hospitalized for pneumonia I wasn’t too worried as I felt decent-ish and had just had an IViG infusion, but then the sputum I was coughing up started being mostly blood (sorry for the gross image) and other symptoms started appearing (body pains, shortness of and difficulty catching my breath, etc.).  Back to the ER and into the hospital again.  Turns out not only did I still have (or had developed a new) pneumonia, but I had mold in my lungs.  Aspergillis, if you were curious, although I prefer to call it “Bob.”  Aspergillis sounds like somewhere you have dinner in the Hamptons after beating the slaves or whatever people who live in the Hamptons do for fun.

And that, btw, is the end of the MMJ treatments for now.  Which figures — I take something like 17 medications and the only one that truly helped is now lost to me.  Yeah that warning about how immune-compromised people should probably avoid certain things?  Not bullshit apparently.

The mold thing led to a deeper problem — one of the main concerns with PACE is the damage it can do to your kidneys and other organs.  Same as Myeloma, really.  For the kidneys your doctors in the hospital look at the “creatin” number every day from the midnight blood tests (that’s when they do them at PSL anyways) as a proxy for that damage being done. On top of being already irritated, some of the tests (CT scan with IV contrast) can damage the kidneys as well, and sure enough in trying to nail down what the mold was and what it was doing my creatin shot through the roof.  All of a sudden I’m meeting kidney specialists who are assuring me we “probably” wouldn’t have to do dialysis and any damage “probably” wouldn’t be permanent while debating if it’s even safe for me to have a Tylenol.

How do you fix things before it gets permanent?  Tons of fluids.  Unfortunately when you have liquid in your lungs already from pneumonia the last thing you want to do is flood your lungs.  That diuretic treatment I’ve talked about before that makes you pee a lot, Lasix? Bad for the kidneys too.

Were that all I’m sure things would have gone smoother, but then out of nowhere I start experiencing excruciating pain in my chest that popped up one random day in the hospital and got so bad I needed painkillers to breathe.

One thing to note here, btw — if you are ever in the hospital and even remotely suggest to a nurse that you have chest pain, prepare for a lot of tests, a lot of monitoring and to meet all kinds of new and seemingly unamused doctors.  Immediately.  In my case it was diagnosed as periocarditis, an irritation of the sac surrounding the heart.  The CBCI doc rounding when this was discovered thought it was probably brought on by the chemotherapy, but either way they began treating it (I forget with what — was in there for two weeks and lost track of time) and within a day or so I was feeling better.

To deal with the mold, the infectious disease doctors (more specialists) wanted a certain level of anti-fungal medication in my system.  For some reason these drugs in pill form are super expensive so before I was discharged we had to make sure not only that my creatin (read: kidney irritation) levels were plateaued or dropping, but that I had the anti-fungals doing the work AND the pharmacies had more anti-fungals for me AND the other drugs I was taking wouldn’t interfere.  Apparently you’re on these for quite a while too.  So I get prescriptions called in and get discharged after two weeks at PSL.

Keep in mind the whole time I’m missing my daughter and freaked out about what she’s thinking — that’s a long time to be away from a 5-year-old, much less in a hospital she can’t even visit (14-year-old age restriction).  We FaceTimed every night, of course, but even sitting up and taking my oxygen out for a bit must still have been scary.  I’m still missing all of my hair, including my eyebrows, so me sitting up in a hospital bed in a hospital gown isn’t exactly the most comforting image.

On the bright side at least I knew, relatively, that I was safe.  So days pass, I felt a lot better, say 80-90%, and a’ discharging we go.

The next day we go to pick up my anti-fungals and … the insurance company refused to cover them.  For several thousand dollars of medicine too, otherwise I would have just eaten the cost.  Not thrilled since this was supposed to have been taken care of before I was even discharged, I let the doctors know and we planned to deal with it at a follow-up appointment a few days later.

I’m trying to get the timeline in my head right at this point but basically I got discharged on Friday the 29th of September here with a Monday follow-up appointment at CBCI. That weekend I felt fine until Sunday, when I started feeling exhausted and ended up going to bed when we put our daughter to bed around 7 pm.  Had the worst nightmares of my life that night as my health deteriorated throughout the night. Thankfully my father was able to give me a ride to CBCI but my wife had me take my in-hospital bag and laptop, because sure enough they re-admitted me that day.  Some of the CBCI personnel I know noted at later visits how bad I looked that day.

I actually thought that was kind of it again, really. I think we in general have this perception, perhaps due to the gravity of it all, that you know when the end’s come. In reality what I’ve learned and come to expect is just a slide into oblivion — the system overloads, the failures mount up and at some point it’s just too much.  Needless to say I was not in a good head-space at this point.

Spent another week in the hospital, more tests, and go home — pneumonia again plus more of the periocarditis-related issues.  A night later and I can’t breathe deeply without severe, stabbing pain and even with home oxygen canisters I had to take a few minutes after climbing stairs to catch my breath.  Freaked out but having oxygen and an appointment at CBCI that coming week I tried to grit through it but I was terrified — not being able to breathe is pretty awful, as are the thoughts that go through your head.  Is this my life now?  What do I do if one of these O2 cans fails, just die?

I emailed the oncology team the night before my appointment and told them what was going on and was admitted to the ICU the next day.  Queue tons more tests including a bunch of echoes which showed that on top of some liquid in my lungs I now had a large amount of liquid in the pericardium sac around my heart, a condition called pericardial infusion. Since there’s a limited amount of space there the heart can’t function normally which was apparently causing the pain and the inability to breathe properly, as well as my randomly going into atrial fibrillation (I think that’s how you say it).  So from 50-70 beats per minute my heart rate would suddenly jump up into the 150’s.

Oddly I didn’t notice when this would happen except that all fucking hell would break loose on the monitors attached to me and a nurse would come running.  It would self correct in about 5-10 minutes, usually before they could even get an EKG set up.

After consulting with CBCI and the specialists at PSL I ended up having surgery to fix the problem, which had ballooned into a full pericardial effusion, where the heart has so much fluid pressuring it that it can’t work correctly, and just short of a tamponade, when it stops being able to work).  The surgery was performed by this awesome guy named Dr. Parker with a ton of experience doing them and they took roughly a quart of fluid from the pericardium.  I now have a new 5″ scar between my belly button and my chest plus a hole where a grenade-shaped drain attached to the surgical site was attached for several days.  I’m on a few different antibiotics, antifungals and antivirals based on what they found when they analyzed the crap they drained out of me, but I’m alive.

Physically.

Mentally and emotionally I’m really struggling.  I relatively waltzed into 2017 by comparison, or as waltzy as you can get always knowing in the back of your head that you have a terminal disease. But after having 6″ of my colon removed, pneumonia twice, four rounds of salvage chemotherapy, mold in my lungs and now a quart of fluid drained from around my heart I just feel pistol-whipped.  I’ve lost a good 60+ pounds and look almost gaunt, a first for me, and not a good look combined with the lack of hair and eyebrows.  I get the chills out of nowhere, presumably from the weight loss, and energy drops I can’t explain.  I definitely do not feel right.

I guess I just feel like I’m cancer now, like this is some big waiting game.  Just when I’ve thought I had a grasp on my reality I’m shown this new level of horror and forced to face it and it keeps happening.  I’m tired.  God two days after I got out of the hospital the last time I had this awful Sunday where I could not stop either sweating or getting the chills and my skin was tingling and I was thanking whatever deity I could think of that I did not have a pistol in the house.  You just hit a limit.  But for some reason I just keep taking it, taking the pain, the heartbreak, the apologies to my daughter for not being able to be a more active or fun daddy sometimes.

Her hugs are about the only thing that helps, even though they break my heart.

I’m quieter now.  I’ve already experienced people not recognizing me physically thanks to this year but it feels different when I talk to people.  Awkward, a little.  I mean it’s always a lil’ awkward when you have cancer to talk to friends, we all know that, but this is different.  Like I’m an observer, almost, a third-party participant that doesn’t quite fit in.  Hard to explain.

On the bright side, if you can believe there is one, we got a puppy.  I really didn’t want a dog and my wife and daughter are allergic, but they found some hypo-allergenic cute five-month-old silky / Havanese mix. Not even sure I was leaving the hospital ever again I said yes, even though I prefer cats, but it’s worked out.  Beatrix is a bundle of love and a joy to just pet, and I think it’s what our family needed right now.  Besides pets pick owners, not the other way around.

And it’s not like I wasn’t already washing my hands like I had OCD with a kindergartner in the house anyways, right?

Lastly RIP to @CultPerfectMoms, someone I’ve followed on Twitter for quite a while now.  Her last blog post can be found here but she only lasted a few more weeks.  In a small way her struggle, and final acceptance, helped me when I was in the hospital to keep just taking a step forward even not knowing (or wanting to know) what was coming tomorrow to see my daughter again.  Thoughts and prayers to her family.

 

An Unhappy Labor Day.

Just a quick Labor Day update.

I was released from the hospital after pneumonia and the back surgery in late August.  My back never stopped hurting — recently however my oncologist upgraded my drugs to OxyContin which, while not taking away all of the pain, made a significant difference.  I still cannot bend over to pick anything up and I feel like the pain hasn’t really changed a lot.

Tuesday I begin PACE round 4. I’m not entirely sure, especially with my back, that I’m ready for this but at least it’s the last one.  Unfortunately a good amount of my support here has vanished making this even more of a precarious situation — my caregiver is effectively hostile at this point and I don’t have a lot of places I feel comfortable turning.  I guess that means a lot of Uber in my future.

One of the things about cancer that I will never stop wondering at is how when you think you’ve seen how bad things can be it shows you something far more worse.  Between my back, my disease and what it’s brought out in those around me I’ve been in the darkest place I ever recall being in lately. I haven’t felt like writing or socializing. Constant pain, both physical and emotional, conspire to make each day a new exercise in discomfort within my own skin.

Each day I ask myself why I’m putting myself thought this, and each day the answer is harder to find.

Fractured Thoughts.

Last Sunday night we came home from dinner to put Ariana to bed and let Amy study a bit. Remember that cold I picked up right before getting my monthly IViG infusion (which is supposed to bolster the immune system)? I had contacted my oncologist as the week progressed and it got worse to get some antibiotics just in case — Amy, who had the same cold, had been prescribed some so it made sense for me to do so as well.

“Just in case” happened Sunday night. As the night progressed I started not being able to slow my breathing down (which is a pretty terrifying feeling if you haven’t experienced it). Weighing all of our options we had a neighbor come over to be in the house while Ariana slept while my wife took me to the ER at PSL.  Sure enough, pneumonia.  It took about six hours to get my breathing back under control during which time I’m not afraid to admit I was terrified — I may not mind the concept of death but that is most decidedly NOT how I want to go out.

Interestingly they used Lasix to get my breathing under control — the drug that makes you pee like crazy?  Apparently it also gets liquid out of your lungs.

So anyhow, during the last cycle of PACE my doctors had done an MRI to see what was going on with the back pain I’ve had for a month. By that Sunday night dinner the pain had worsened to the point where I was using a cane just to move around and popping every painkiller I had. Over the course of a few days in the hospital while getting all antibiotic-y and trying to find a painkiller that actually did anything for my back, the docs decided to do some X-rays and it turns out that what the MRI somehow missed (or just wasn’t there yet) when it was done on July 19th) was a compression fracture of my L2 vertebrae.

My life is never simple.

So, net-net is I’m sitting here watching the sun come up but instead of being discharged today I’ll be having a procedure done called kyphoplasty. I’m trying not to be nervous but, um, SPINE SURGERY. I know it’s minimally invasive and problem incidence rates are super low but yeah, SPINE SURGERY. Not something I ever wanted to explore, but hey, Myeloma’s the gift that keeps on giving, right?

So are compression fractures from what I’ve read, incidentally. There’s now an above-average chance of getting another one.  Sighville.

That’s about all I’ve got right now.  I didn’t even find out they were able to schedule it until late last night when one of the nurses told me I was on liquid restrictions after midnight — still no clue when exactly I’m having this done today but I should learn more at the shift change in an hour.  Will post updates when I can.

Jesus, ouch dude.

In a feat of typical Rich timing I managed to pick up a cold right before my IViG infusion yesterday when my immune system was at its most compromised.  On the plus side the cold seems to be moving pretty fast.  The negative?  every time I cough it feels like someone is stabbing me in the lower back.  Was up almost every hour on the hour last night coughing and then muffling a scream into my pillows.  Really wish I had some idea of what in the Hell is going on with my lower back because I have never felt pain like this before.

Oh and it was a damp evening thanks to the night sweats, which I detest. Pretty sure that’s coming from the Velcade portion of the PACE chemotherapy regimen — I used to get that all the time during year one when I was doing weekly Velcade shots.

So yeah, pretty miserable night, but I made it to work. Stoned off my ass on Oxycodone and DayQuil, but here nonetheless.

I met with my oncologist yesterday as well and, thanks to my numbers continuing to improve on this VTD-PACE regimen, we’re doing round four.  I also signed the paperwork at that meeting for my collected stem cells to be delivered here from Arizona as that is still the plan (a stem cell transplant) following this fourth cycle of PACE. I’m still concerned about the six week break between the end of round four and the start of the stem cell transplant, but sounds like there’s nothing to be done about it — Dr. Matous wants me as recovered as possible before I walk into the transplant.

Here’s to hoping that my numbers don’t go nuts like they did at the start of the year when I had to take a few months off chemo for that stomach surgery.

 

PACE round four TBD

At the oncologist today for a Velcade shot and office visit to check blood counts.  Nothing’s needed yet but I have to come back in a few days since my absolute neutra-something count and my platelets are trending down.

According to Megan the NP, the Myeloma labs drawn today will dictate whether I do a fourth round of the VTD-PACE chemotherapy — should have the numbers by the end of the week.

Mixed on what I hope for.  After making a side joke about how I wish someone would tell my wife how hard these treatments are, Megan said each round of PACE is like doing induction chemotherapy for Leukemia.  That means nothing to me but apparently it’s a way to explain things to folks in the know?

Quick PACE Round 3 Wrap-Up.

I’ve been in recovery mode for the past week after being released from the hospital last Sunday.  Although I feel like I’m on the upswing now I’m still guarded, unsure entirely who’s talking when I speak.

I’m going to keep this entry more “just the facts, ma’am,” a trend I think I’ll be adopting a bit more here. Until I get the psych meds sorted and am not taking such massive doses of steroids I have a hard time trusting my thought process and the emotional wall springs massive leaks, which lately are driving me cringing from the thought of writing.  It just gets too damned dark.

Fun fucking disease.

So, some random facts:

  • Round three was like the others, only more so. That’s something that perhaps you just have to experience chemotherapy to get.
  • The MRI on my back showed nothing.  It still hurts, although it’s not as bad.  I can’t bend without pain unless I’m on a pain medication, which I will not take regularly.  Tried Fentanyl and OxyCodone and only the Oxy made a dent.
  • Had a ton of folks visit which was awesome.
  • Talked to my doctor who confirmed that if I handle it well (so far I have) that we could do a fourth round of this prior to another line of treatment.
  • Walked into the hospital with C. diff.  The antibiotic for that bit of fun is one of the worst tasting liquids I’ve ever had.  Four times a day.

That’s really about it. I felt like I was on death’s door after getting out of the hospital and I still have little to no energy, but the physical discomfort has at least mostly passed (except for the back pain).  Emotionally I’m a wreck, but then what’s new with that lately? I was hoping to try the swap to the new brain drug this coming week so as not to complicate things with the hospital, so we’ll see how that goes starting tomorrow.