Wednesday, March 30, 2016

The Flight from Here to July

I'm sitting at the dining room table, listening to the outdoor background music: deep bellowing of horns from ship traffic in the harbor. The St Lawrence Seaway officially reopens for business yesterday, and here at the extreme corner of the system, they're not hiding their light under a bushel (much less their horns in a bell jar). There are one or two hefty ore boats freshly loaded with taconite outbound for steel mills somewhere in Ohio or Indiana, and away we go.

Just as the Seaway opens, Susan and I are at the cusp of segment two our four-stage journey through the gauntlet of cancer treatment. While I'd like to tell you that all will be smooth sailing, our journey comes with no such guarantee.

For a quick review of the bidding:

Segment 1
Discovery of the cancer, diagnosis, and initial treatment, to see if the bad signs can be turned around and if my body is sufficiently responsive to treatment (did we get there in time?). In my case this included collecting all the information of a complicated and aggressive cancer and its attendant side effects. While it's turned out to be a lot, my team of doctors felt we had good reasons to be hopeful of a positive response to immediate treatment and wasted no time in going there once they'd secured my approval.

To be clear, there was no certainty I'd come through this initial phase well, but I did. Without going into details, I've been able to turn around every single marker associated with the cancer, and it appears I have an excellent  chance of being able to come out of this with functioning kidneys (read no kidney transplant; no dialysis). My sense is that I was very close to not being able to come back from the kidney damage I had already suffered (about which I was unaware until I was hospitalized in late Jan and began looking under the hood), but it appears I've dodged that bullet (at least for now--my kidneys will be challenged again by the stem-cell transplant therapy in July).

So it's wonderful news to be in my position, having successfully ridden the storm-tossed seas of Segment 1, with all its uncertainties, and finding a stretch of calm water in front of me.

Segment 2
Relatively quickly, my oncology team agreed that my best long-term chance for turning the cancer around lay in a stem-cell transplant, where the healthy remnants of my bone marrow (ravaged by the cancer) could be salvaged and harvested from my system and then reintroduced to my bone marrow after wiping out the unproductive stew that was currently dominating my marrow (so that I can resume the efficient production of red cells, white cells, and lymphocytes—the things my bone marrow should be doing).

First though, I needed to stabilize and reverse the deterioration of my system, which included courting renal failure and heavy-duty calcium leaching from my skeleton. Having turned things around (as planned) it will still take a while strengthening everything for preparation for the stress of the stem-cell transplant itself (no point in undertaking the cure of it swamps the boat).

Thus, this is a purposeful pause between Segment 1 and Segment 3. While this is a relatively "quiet" time in the overall protocol, it's a needed step.

Segment 3
This is the stem-cell transplant itself and the immediate recovery afterwards. It should only take about a week to harvest the healthy stem cells, kill off what remains in my bone marrow, and reintroduce my stem cells. Thereafter it's a battle between my body, bolstered by the judicious application of myriad meds to reboot my system. It will basically be up to my body to handle the trauma of the transplant, to regenerate the stem cells, and to take advantage of the opportunity of a clean slate to push the cancer out of the way and proceed on a healthy path.

Segment 4 
The recovery from the transplant will happen by degrees and there is an important marker after 100 days, at which point I'll be thoroughly tested and evaluated for what we've achieved. It will be at this point (probably somewhere in October) where the oncology team will be able to offer a new prognosis about how much cancer-free time all this effort has earned me. I will be given no guarantees. I will simply have purchased a chance.

Based on what I learn at that stage, I can plan accordingly.

• • •
In meeting with Dr. Alkaeid Monday (who's playing point person on my Duluth oncology team), we went over where we were and where we were headed relative to the recommendations from Mayo (secured last Thursday in my meeting with Dr Buadi).

First off, the doctors were in alignment about the treatments and their timing. Whew. They further agreed that my responses to Segment 1 were strong and positive, which was what I wanted to hear, and they gave me permission to resume any aspect of my life that I felt healthy enough to attempt between now and the July transplant. While no one's thinking about sky diving, I'm toying with a modest resumption of consulting and teaching.

This last has been a great buoy to my spirits as I can now indulge in some proactive thinking about life as a cancer survivor. While I have little clue about long-term possibilities, my life doesn't not have to be on hold as I go through the calmer waters of Segment 2.

I especially enjoyed a metaphor about the first three segments of my cancer protocol that Dr Alakeid passed along to me in the context of Monday's consult. He suggested that I think about it in terms of learning to fly. All parts of flying are not equally dangerous. In fact landings are the most dangerous, with the challenges there being the only times that are more stressful than take-offs. Actual in the air flying is rarely a problem. 

Mapping that onto my cancer protocol, he was pleased to report that I had successfully negotiated the take-off (Segment 1) and was in the air! Not everyone makes it this far and he was quite happy with my progress. Now we're entering the relatively safer in-flight portion of the protocol, putting ourselves into the best possible position for the most critical step: landing (represented by Segment 3, the stem-cell transplant).

So hurray for where we are Serious works remains yet my current position is as good as I could hope for. I aim to make the most of this pause to have a terrific landing (and enjoy the flying time between now and then). As far as I know, everyone is down with that.

Monday, March 28, 2016

Good News from Mayo

Thursday I was accepted for stem-cell transplant therapy at the Mayo Clinic, as a protocol for addressing and containing multiple myeloma. It was what I wanted, and it's a big deal that I got it. Now the challenge is making the most of the opportunity.

Here is what lays ahead:

o  Between now and when the transplant is performed (projected to be mid-July, but that's a soft date)), I'll likely go through 4-6 cycles of chemo-therapy, all geared toward boosting my kidney functions and eliminaing calclium leaching from my bones. While I've made significant progress on all of these markers across the board, I can do better and the doctors, understandably, want to make the best possible use of the transplant.

o  Once we get the OK for the transplant (because the markers are good), we'll temporarily relocate to Rochester for about 6-8 weeks, where the finer detailed road map looks like this:

Mayo will conduct their own blood tests, to make sure they align with the numbers coming back from test results in Duluth. According to what we were told yesterday, there are few surprises at this stage and 90% of the time the evaluation phase results in a green light.

Next step is collecting my stem cells. They will inject me with a shot every day that will cause my bone marrow to cough up its stem cells. The doctors will start collecting the stem cells five days later and continue that process until they have more than enough to do two transplants. Excess cells can be frozen for long-term storage and viability.

Once they have enough stem cells, they give me a single shot of something to kill off everything remaining in my bone marrow (the good and the bad indiscriminately). As you can imagine, we're talking about heavy-duty poison here and this begins a stretch where I might struggle again with the chemo. Let's say sterilization takes place on Day 1.

—Reintroduce my own cells
Two days later the doctors will reintroduce my own stem cells to my bone marrow, on Day 3.

For the following three weeks my job is recovery. By Day 6-7 my blood counts will be low and I'll lose my hair. There won't be many good days. I'll be taking heavy-duty chemo and just trying to ride the choppy waves without swamping my boat. This projects to be the darkest time.. Somewhere around Day 14 my blood counts should start to recover. From here on recovery tends to accelerate. Most transplant recipients are sufficiently far along that they no longer need close monitoring and can return home in the range of Days 18-21.
At this point the key question is how much the cancer has been brought under control: it could be anything from hardly any to full remission. While the transplant treatment is not dangerous per se (that is, few die of it directly), there is no guarantee that this will contain the cancer—which is the point of all this.
Huddling with my doctors after the transplant (perhaps 100 days afterwards) we should finally be able to make a reasonable assessment of my post-transplant prognosis—how much I can look forward to time with little or no pain, which opens the door for Susan and me to think about how to use that precious commodity. Until then it will be difficult to suss out exactly where I stand, yet that doesn't mean we have to stand on the sidelines until October.

No Trips Abroad
Though from this point on most of the chemo will be conducted as outpatient therapy, I will still need to remain near enough to Rochester and Duluth to have minimal complications with scheduling. That is, I'll need to be tethered to my Minnesota treatment centers. While brief forays out-of-state might be possible on rest weeks (between active cycles of chemo-therapy) they will be limited.

One Thing at a Time
Job One from now until transplant is my getting stronger (turning around weight loss, eliminating dependency on walkers and wheel chairs, managing daily needs and hygiene with minimal dependency on Susan, and continuing to push my kidney functions in the right direction). This will directly translate into my being to make the best use of the transplant.

Resuming "Normal" Activities
I asked my doctor when I might prudently be able to return to some of my work (as a process consultant or community networker), and got an interesting response: I can resume any time it makes sense. It's simply a question of what I have the capacity and motivation for taking on. This was something of a surprise (I had been thinking that career resumption, if at all, might happen only after the transplant and we got to see what that protocol had accomplished.)
Among other things, this significantly changes how Susan and I will be viewing the months ahead in Duluth. If we aren't looking at the transplant happening sooner than July, then I have over three months to get stronger, to enhance my capacity to handle the chemo well, and start crafting the life that Susan and I want our partnership to be. I'm limited only by my energy and my body response—rather than by the calendar (I have to wait until July) or by the stigma of cancer. Though I'm still coping with back pain on a daily basis, I'm jazzed to begin this work.

We do not have to put off conversations about what we want. We can start now. I especially like how this allows us to start moving toward a rebalancing of focus after two months that have been intensely unbalanced, coping with Laird's emerging health crisis. Now we can shift to Laird & Susan's opportunities.

Sounds better, doesn't it?

Thursday, March 24, 2016

Mushing South

We've been blessed with a mild winter in Duluth (which is assessed mainly along the lines of the Ice Index: the less ice I have to navigate between house and car, the milder the winter). Given my compromised health (multiple myeloma or MM) necessitating many visits to and from doctors  for treatment and therapy, that's been fortunate.

Wednesday Susan and I traveled by car to Rochester and an important date with specialists at the Mayo Clinic to see if I'm a suitable candidate for stem-cell transplant therapy, which is one of the most promising new protocols for treating MM. Our date was at 8 am Thursday which mean arriving on location no later than Wed evening.

Wouldn't you know: even though we're in the post-equinox, tail-end-of-the-dog days of March, the US Weather Service predicts that we'll sashay through 3-5 of wet, glumpy snow to get there. I reckon winter couldn't resist taking at least one more bite of my apple.

On the other hand, Susan drives a Subaru—the official car of the North—and 3-5 inches of crystalline sunshine should be no match for all-wheel-drive. We just left a little earlier.

While Mayo has let us know that they'll orchestrate all my appointments in Rochester, and my oncology team has made sure that all the test results and their diagnostic thinking has been duly passed along, Susan and I are driving south with just about as much surety as the Fellowship of the Ring headed for Mordor—after sifting through all the choices, what remains is the best option, regardless of its improbability. Like the Fellowship (an appellation I have a strong affinity with) I head south on the wings of trust and the loving support of many. 

Beyond what room I'll be in for my first appointment and the name of the doctor that I'll be meeting, tomorrow is another exercise in letting go. I don't know what questions I'll be asked, or even the basis for Mayo's decision about whether to accept me for stem-cell transplant therapy. I don't know how long it will take them to make a decision, or my options if I get turned down. In short, there are many unknowns and I head south thankful that I am not making this journey alone, that Susan will be participating with me as a team.

We arrived in Rochester and got settled in around 6 pm, right before the spring snow started arriving in earnest. When we woke up this morning, there were 10 inches of fresh snow on the ground. Luckily, we were able to make it to all of our appointments without leaving the block of buildings that comprise the essence of the Mayo Clinic, and thus were able to avoid any nasty weather encounters. Whew.

I felt drained from the ride down and went to bed early. What's the best way to get psychically ready for the unknown? Not sure, I had a small dinner and cashed in. I figure that laagering my energy for today was the right call. No dancing; no blackout bingo.

So here were are, on the cusp of finding out what Mayo is willing to support in my effort to place my cancer into remission. I have only the vaguest sense of probabilities, but I know what my doctors have faith in, and I have faith in my doctors. While there does not seem to be a serious risk to my mortality in attempting stem-cell transplant therapy, neither is there any guarantee of a positive bounce. We'll have to do it and find out what we get. It's part of the adventure.

Monday, March 21, 2016

Redefining Home

As planned, Saturday was discharge day from Ecumen Lakeshore. Susan and I are happily sleeping at the same address now, in her house near Chester Park.

This time around is a night and day difference from the last stretch (Feb 19-26). I can negotiate trips to the bathroom solo; I can go up and down stairs without crashing my limited energy budget; I can sit upright for several hours at a stretch without any back pain. Today I walked to the car to keep a dentist appointment and didn't use the walker at all. Mostly though we're enjoying the novelty of being together, my diminished pain, and the sharp decline in the need to be chauffeured to and from doctor appointments. 

This respite will only last a few days and then it's down to Rochester for our big date at the Mayo Clinic Thursday.

During this at-home interlude, I'm particularly interested in keeping my eyes open for any emerging markers, pointing the way to what my post-Mayo rhythms may look like. Given my strong attraction to writing, I've been thinking about how to set up a table and chair so that I can make the most out of each session. I won't need much, just sturdy furniture and an out-of-the-way location with adequate light and power.

The goal is to reduce my dependency on Susan's logistical support to as little as possible, so that our time together highlights the preciousness of our connection; not the precariousness of my health. While I still have an unpredictable relationship to secondary torso pain (think ribs, mainly), I'm gradually gaining better control of my breathing and am making steady progress getting in and out of bed without sharp pains.

To some extent, Susan and I sit on the edge of a precipice, waiting out the two days remaining before our date at Mayo. My prospects for successfully managing the cancer are hinged directly on Mayo's response yet I have only a vague idea what's likely. Essentially, I've cast my lot with my oncology team's assessment and recommendation. Happily, my sense is that we're all singing from the same hymnal and thus my presentation should come across (on the doctor-doctor level) as cohesive and sensible, well-backed by test results that have positioned me as a good candidate for stem-cell transplant. We'll see if the good doctors at Mayo agree with that assessment.

While there remain a large number of variables in how this will play out, the Mayo decision looms large. If accepted for their protocol, I expect the treatment to entail heavier-duty chemo-therapy than I have undergone to date, relying on the doctors and support staff at Mayo to manage the high-risk procedure of sterilizing all my bone marrow and then repopulating it with my own, healthy stem cells.

All of the little things that Susan and I are tweaking at 1014 Chester Park these few days are just so much putzing with furniture while we wait to hear for whom the large bell tolls.

To be sure, there is connection and sweetness to these light days clustered around equinox, and I am pleased that the clock beats no faster than it does. The doom of Mayo will arrive soon enough and will be no less potent for having incubated a few extra days.

The key piece is that Mayo is something I will experience with Susan; not alone. That is my lode star.

Friday, March 18, 2016

Joie de Vivre and Cancer

I'm enjoying a quiet, no-doctor-appointment Friday on my last day at the Ecumen Lakeshore Rehabilitation Center in Duluth. I've basically reached my targets for turning around my kidney functions (since being initially hospitalized Jan 31) and done all that I can to make myself a suitable candidate for stem-cell transplant after having been diagnosed with multiple myeloma.

I have an important date next Thursday at the Mayo Clinic to see if I'm acceptable for the next step. Meanwhile, I'm at a pause point, with an opportunity to reflect. My pain levels have ebbed (at least temporarily) and I've been steadily increasing my flexibility and mobility through physical therapy.

What's on top today is my relationship to the unknown. While I've written previously about how much my life spiraled into chaos after my marriage dissolved 13 months ago—just at a time when all the major elements of my life seemed familiar, welcome, settled, and productive. Rising out of the fog of chemo-therapy I see now that all has been stripped away in the tempest of my 66th year, not just my marriage, my home, and my community (which seemed like plenty at the time).

Even as I started over the summer to reinvent myself with a new base in North Carolina (with María Stawsky and Joe Cole), and was blessed to uncover a precious, though long-dormant intimacy with Susan Anderson, the cancer was already at work in my bone marrow, moving me inexorably along the path toward my current health crisis. I had naively thought that my work life (as a cooperative group consultant) was going to be spared the turmoil of the past 18 months but here I am with all work cancelled or at least on hold at least into May.

I caught myself this morning looking ahead, projecting a return (at least on some minimal level) to the work I know and love, yet am also aware of how that can be a trap—of how my holding onto that dream of recovery may be Laird's clever way to avoid the work of fully examining the ways I've become dependent on my accomplishments to define my identity. 

The universe has gone to considerable effort to shake my life up; will I be strong enough to continue to sit in the uncertainty of love as the petals of the mystery unfold in their own rhythm? Can I resist forcing a favorable interpretation on events? Will I be able to find and sustain the fortitude needed to allow life to come to me—refusing the wheel?

Of particular interest to me right now is this wild and improbable juxtaposition: on the one hand my world has been stripped down to the elements of relationship and spirit—that which remains after the flood of divorce and fire of cancer have scoured my soul. On the other hand, I have been singularly blessed to have found Susan and yet another chance at centering my life in love—even amidst the ashes. How do these two realities blend?

As I sit with this, it has bubbled up for me that the key piece remains Susan and what we create together—not the extent to which I am able to revive my beloved consulting career. Having been allowed a peek at the unknown, my prime challenge is to not be so hasty in seeking resolution. 

Going forward, Susan and I will make choices based on my ongoing response to cancer therapy that celebrate intimacy and joie de vivre—not the chance to author one more report.

Wednesday, March 16, 2016

Out By Friday; Hold the Mayo

My stay at Ecumen Lakeshore rehabilitation facility appears to be drawing to an accelerated close—perhaps as soon as Friday. My health insurance company (Aetna) has been in consultation with Ecumen and they've determined that I've now received a reasonable amount of benefit from my stay here and it's time on move on—which means moving in with Susan as my cancer recovery focus continues.

To be sure, I'm not out of the woods (in fact, I'll be moving right next to the woods, as Susan's house is located across the street from Chester Park and its 2.5 miles of hiking trails). I still have major cancer treatments ahead. The shift in venues simply means that my level of support no longer requires such intensive care. I have been able to make use of the regular physical and occupational therapy being offered to now be able to manage the demands of daily living (think basic grooming and hygiene) without imposing unduly on Susan once it's just the two of us at 1014 Chester Park Dr. (I'm not expecting Lucie, the seven-year-old black lab mix to be much help one way or the other.) Plus, I was able to make good use of being bivouacked at Ecumen to avoid negotiating stairs for all of my outpatient treatments at St. Luke's the past three weeks.

Barring some unforeseen curve ball arriving the next couple days, today's news means that Susan and I will be traveling the four+ hours to Rochester from her house next Wed, instead of from Ecumen Lakeshore. My body has been responding well to the various treatments aimed at enhancing my kidney functions and I expect to present as an excellent candidate for stem-cell transplant treatment when I have my consult at the Mayo Clinic a week from tomorrow. We'll see.

If accepted by Mayo, I'm still facing a long stretch of targeted treatment and recovery, the main challenge of which is harvesting my healthy stem cells, killing off everything in my bone marrow and then repopulating my bone marrow with my own stem cells. Obviously, it is essential to maintain a highly sterile environment through this procedure and I'll be imbibing some heavy duty chemicals throughout. 

I'll again be entering uncharted waters and I'm expecting to enter a period lasting several weeks where I'll simply be holding on, taking deep bites of the fruit of the unknown, letting go of the concept of control or being the master of my fate. I will simply be and see how well that goes. Scary, but I see no reasonable alternative to reentering those rapids. I will again be putting my complete faith in the hands of my optimism and in the strength of the support and love that surrounds me. Either that will be enough, or it won't.

Assuming I'm approved to proceed at Mayo and that I respond well to the treatment (two large ifs) I expect the heavy lifting to be accomplished by mid-May. Although I'll undoubtedly start by being hospitalized at or near Mayo, there will come a time (parallel to the limbo between St. Luke's and Ecumen Lakeshore that I'm in now) when I will no longer need such intensive watching and I can go home, visiting Mayo periodically for outpatient treatment and testing.

At some yet-to-be-specified point after that, there will be an assessment of where we're at and the extent to which I can resume "normal" activities. So there's still a lot of fog to cut through, yet there's a path.

From now going forward, Susan and I are lining up visits from Susan's daughter, Britta; my sister (Alison), Ceilee and Ann Shrader; Stan from Sandhill (along with long-time ex-member Julia Reed); followed by a visit from María Stawsky from Chapel Hill—all of which will go a long way toward keeping my psychic tanks topped off and my life force burning brightly. Meaningful relationships and giving myself to love will see me through.

Thursday, March 10, 2016

My Cancer Odyssey Continues

It has now been about a month since my previous blog entry—by far the longest I've ever gone between postings since I launched this site in December 2007.

I decided that this pause was necessary in order to focus all my energy on my treating a diagnosis of multiple myeloma, a cancer related to my body producing too many plasma cells. I have it in an aggressive form and—with the able assistance of a young and crackerjack team of oncologists in Duluth MN—am treating this cancer aggressively in turn. We'll see who prevails.

Happily, I now feel enough better that I am tentatively sticking my toes back in the healing waters of publishing to see what I can do—both to get clearer about what I'm experiencing and to let others in on the story. (It is an all-together different thing to simply experience a thing than it is to take the time to try to share the depth of that experience with others. Thus, my writing about my journey helps me understand it more profoundly.)

Though I am not in a position to make any promises about how much I can sustain this renewed effort, I'm intrigued enough to try to do what I can...

 • • •
After being hospitalized and diagnosed with cancer Feb 1, my first hurdles were large and varied:

o   I needed to come to grips with my facing a serious, life-threatening illness, which has required of me that I set everything else aside excepting considerations of my health, my intimate relationships, and my relationship to spirit—all of which are intertwined. Fortunately, I have much to draw upon in all three arenas. So the cupboard is not bare.

o  Once the diagnosis was made, I immediately embarked on an aggressive treatment of the cancer. My kidneys had been severely compromised and I needed to turn that around pronto to have a chance at recovery.

o  While it was not difficult for me to make that decision (on some level I've known for months that there was something seriously wrong with my core health and I was trying to limp into my home base in Chapel Hill for time in dry dock over the holidays, such that a thorough check-up could be scheduled nicely between consulting and networking assignments). Clearly I was selling my health short. I didn't make it past Duluth and was psychically ready to yield when the word came down.

o  That said, it was completely foreign for me to enter the world of Western drug therapy and I had almost no frame of reference with which to make sense of what was happening to my mind or body. I could barely tell what day of the week it was and I was mostly floating. I couldn't complete sentences or string together meaning. While this had a euphoric quality, it was also highly disorienting, and I have no idea how anyone could self-manage this phase of treatment without strong support.

Fortunately, the fog of February gradually lifted and I am regaining a lot of functionality, bits at a time. I can't tell how long this new phase will last, but it's been enormously reassuring to be able to place myself again on a more familiar map of reality.

For the last fortnight I have been at Ecumen Lakeshore, an assisted living facility along the North Shore of Duluth. It has been an excellent transition facility for me. I no longer need the intensive services of the hospital, yet need too much support for independent living with Susan.

At Lakeshore I am getting help in three main ways:

a) Regular physical therapy which helps me regain strength, appetite, balance, and functionality.

b) Easy access to doctor appointments and outpatient service at St Luke's in conjunction with my chemo-therapy (navigating Susan's second story every time I make a trip to the doctor's was exhausting; at Lakeshore I'm able to handle all the car trips without negotiating stairs).

c)  It is an essential bridge between the onset of chemo-therapy and my upcoming application to Mayo to be considered a viable candidate for stem-cell transplant therapy—which protocol my oncology team strongly supports.

Thus, the road map for me is to complete my last two weeks at Lakehsore and then drive down to Rochester MN with Susan for an appointment March 24. There we will meet with a transplant expert to determine if I’m a suitable candidate.

o  If this gets approved, we will be placed in a queue to get the transplant procedure done, which we anticipate may take about two months to complete (once you take into account all the careful work needed to successfully eliminate all the bad plasma in my system and replace my cancerous bone marrow with healthy stem cells). That's my most optimistic scenario.

o If Mayo turns down my application, the fall back will be to apply for this procedure to be done at the University of MN, where my oncologists also have personal connections. Obviously, there are a number of reasons why there may be delays, even if I ultimately get supported, but the essence of all this is that I cannot test my ability to place the cancer into remission until and unless I get approval for the protocol. One step at a time. The next big milestone will be the appointment in Rochester.

o  As I'm sure everyone can appreciate, there are nontrivial questions about wether the protocol will succeed even if I get approved to attempt it. That is, I may be getting to the cancer too late to turn it around—something we cannot know ahead of time. It’s a genuine test of my optimistic spirit.

o  There are also serious questions about how I’ll be able to afford all this, even with full Medicare coverage—but we’re crossing bridges one at a time and I don’t want money to stand in the way and my giving this my best shot at management (even as I perform due diligence about applications, paperwork, etc).

o  Last, I cannot complete this update without honoring the incredible upwelling of unconditional support I've been receiving from all over the world, from people who wish me well in this health odyssey. I reckon I'm only about a quarter of the way through the gauntlet so far, with many variables and speed bumps yet to be encountered before I'll fully know where I stand.

I am in awe of how much we all know that we need to stand together in times of need and am deeply touched by how many of of my friends and acquaintances have been reaching out to me in my hours of need. I am blessed.

Uncanniest of all has been my burgeoning, unconditional love with Susan, all of which has blossomed in the last nine months. Here we are committing to the unknown with each other based almost wholly on heart and trust—on being in the right place at the right time. Yes, we've known each other since our salad days in college, but that can hardly explain the strength with which we've come together in recent months, where we are facing the considerable unknowns of my health together.

It is a miracle to experience love like this and I wouldn't miss it for anything.