With Nary a Cross Word Spoken

Today is Day Zero, or Transplant Day. In a process that took about 10 hours I received back half of the stem cells that were carefully extracted from my bloodstream last week. They are the colonizers being sent back to reboot my bone marrow after wiping out the cancer lurking there with melphalan two days ago. Around 60 days from now I'll find out how much good it's done me (that is, how far the cancer has been placed into remission). 

Until then, my job is simple: recover from the chemo as quickly as possible. There are no more procedures to go through. Today was the last one (barring the unhoped for event of a setback of some kind, say an infection while my immune system is down).

While I have so far been able to proceed nausea-free (which I'm celebrating while I can—Ceilee is grilling chicken breasts for dinner tonight!), I noticed that my breathing was much more labored returning to Transplant House this afternoon. Energy loss was a predicted side effect of the chemo, and it appears that it's here. I'm concerned that loss of appetite and the onslaught of diarrhea may be next. We'll see. The nurses have assured me that there is considerable range among patients regarding side effects, and I remain hopeful that I'll be able to dodge the bullet on some of them. It's all part of the mystery.

As Joy, the Mayo dietician, has told us stem cell folks, "If you're having a good day, then you're having a good day; take it one day at a time and don't let worry about tomorrow cheat you out of enjoying the present."

I had a thoroughly good connection with my sister, Alison, this week, and today we executed anther caregiver shift change. Ceilee caught a red-eye from Los Angeles last night and arrived in Rochester around 8:30 am. While I was going through my 10-hour marathon treatment at the clinic, Alison oriented Ceilee to Transplant House routines and got him settled. Alison is now en route back to Chicago, and Ceilee is in the TLC saddle for his father. It will likely be an early bedtime for both of us tonight. given that transplants simultaneously put a lot into a person (in my case healthy stem cells) and take a lot out of a person (energetically).

• • •

The image above was take yesterday by Alison in the Transplant House dining room. It exposes one of my main coping mechanisms (and recreational pastimes): working the daily New York Times crossword puzzle. The one above was from Thursday, typically a medium level degree of difficulty. Puzzlemaster Will Shortz (of NPR weekend fame) follows a sequence whereby Monday puzzles are the easiest to solve and get harder from there, peaking out on Saturday. The larger format Sunday puzzle (a 21x21 grid instead of the 15x15 grid for all other days) is usually about the same degree of difficulty as a Thursday.

Susan and I tackle the crossword puzzle together every day (or at least every day that we're together). As we have complementary areas of arcane knowledge, there is a synergy about teasing out the answers as a team that we both enjoy and serves as so much frosting on the cake of our tasty relationship.

If we can complete the puzzle without resorting to Google searches, then we award ourselves a star (which, along with $4, can get you a really good cup of coffee). It's quite hard to get a star on Friday or Saturday, but we keep trying and we're gradually getting better.

I like crosswords for a number of reasons:

o  To be good at them you need to be able shift perspectives with ease. This skill matches up well with what you want in a professional facilitator—which happens to be my line of work.

o  While it may be of dubious cosmic value to be able to hold and access a large RAM in one's brain, you get rewarded for lateral thinking, and being able to integrate knowledge about a wide range of topics—all the while polishing one's credentials as a prototypical Renaissance person. Can we have too many people in the world who are good with general knowledge?

o  Facility with vocabulary and spelling—two underrated skills in the era of spell check and tweet speak—get rewarded.

o  Unless it's Monday or Tuesday (when we can often blast right through in one pass), it turns out that letting a roadblock incubate is a good strategy. As near I can figure out we are susceptible to mental gridlock from time to time (where we cannot get out of an unproductive rut), and pausing to let it marinate in our subconscious turns out to be a surprisingly effective strategy—when you come back an hour later or so, you can often see it differently and achieve a breakthrough. I like that I can access some portion of my intuitive brain when the rational part falters.

o  I get to work with a pencil (preferably a 2.5 HB, if you please), a tool that is otherwise falling into disuse. Thus, I'm doing my small bit to assist in its making a comeback. 

o  Doing crosswords does not promote the use of cross words—unlike reading about national politics, say. While there is no doubt that crosswords can evoke a certain amount of teeth gnashing, there is far more laughter and delight, such as when a clever clue is unmasked and interpreted appropriately.

o  You learn stuff. (If nothing else, at least how to be better at crossword puzzles, or how to think like Will Shortz.)

Of Shoes and Ships and Sealing Wax…

Here's a picture taken yesterday of my sister Alison and me in the foyer of the Mayo Building. Notice my ubiquitous devil bag by my feet, against the backdrop of the spectacular 13-piece Chihuly glass installation suspended from the ceiling behind us. 

[My daughter Jo took a look at this image and texted back, "Please tell Laird that he needs to pull his pants up higher so that his waistband is in his armpits. 😂😂😂" Sigh. When it comes to sartorial splendor, I've never been known as a trendsetter.]

As if the medical care wasn't amazing enough, one of the lesser known aspects of visiting the Mayo complex is that there is original art displayed on almost every floor of every building—next to elevators, in hallways, and in lobbies. I'm talking about sculptures, ceramics, paintings, lithographs, textiles… everything. When you digest that Mayo Clinic is comprised of half a dozen multistory buildings and that there are typically three banks of elevators to navigate each building, there is an incredible number of installations. As near as I can tell, most of the art has been donated over the years (by foundations and grateful patients), and all of it is available to be viewed by the public—the vast majority of which are there seeking treatment for a serious health issue, not to peruse art. Yet what could be more uplifting than seeing first class art on your way to getting first class treatment?

Alison arrived yesterday from Chicago as we negotiated a shift change among my primary care givers. After two weeks Susan went back to Duluth to crank out the monthly bulletin for St Paul's Episcopal Church (her half-time day job) and Alison is in until Friday, when Ceilee will relieve her.

Already Alison and I have had a great visit. After power napping in the late afternoon (it was good to lie down after the surgical installation of a central line catheter in the morning, and the aspiration of two fat samples from my belly in the afternoon—to assist in the hunt for evidence of amyloids) we had a leisurely dinner (corn chowder reprised from Sunday) and then sat in padded rocking chairs on the front porch for a couple hours after the sun went down. 

We talked about family, growing older (Alison is thinking about getting a hip replacement as her originally installed factory parts are wearing out), and what it's like to be living in US society today, where Donald Duck Trump could be the Republican presidential nominee. Life is full of surprises and we're taking advantage of our four days together to—in no particular order—reminisce, catch up, plot future rendezvous (think family reunions), delight in life's mysteries, and laugh a lot.

Tomorrow afternoon I get what I came for: an injection of melphalan to conduct a scorched earth campaign against my cancer by wiping out everything in my bone marrow. The chemical will be placed in my blood via the central line. The procedure is straight forward, only takes an hour, and won't hurt. It will trigger a die off of cells all over my body. In addition to my bone marrow, the fast-growing cells of my digestive tract and mouth will be hit hard, and I expect to lose my hair. It takes a number of days for that to fully play out, and I should bottom out around Monday.

Of particular interest to me is how the chemo will impact my GI system, and whether I'll be weathering nausea, diarrhea, and other fun things like that. While I've been given prescription medication to help with potential digestive side effects, if I've learned anything over the last two weeks it's how much responses vary person by person. I'm crossing my fingers (as opposed to holding my breath) that I'll get by on the light end—which has been the case so far with all other treatments I've received where a negative GI response was a known possibility (knock on wood). Obviously, if I can dodge the nausea bullet it will greatly aid my efforts to maintain (or revive) an appetite. So my mantra this week is envisioning a calm tummy.

Tomorrow's infusion of melphalan will be followed by the reintroduction of my stem cells Friday, to start the recolonization of my bone marrow with good stuff (hold the cancer cells, please). Unlike the quick in, quick out process on Wednesday, the stem cell transplant will take all day. When Ceilee arrives on site at 8:45 am that morning (via an American red eye from LAX), I'll already be tucked into a bed at Mayo getting a saline infusion that lasts for four hours, prepping my body to receive the stem cells. After the stem cells have been lovingly inserted into my bloodstream there will be another four-hour saline infusion before I head back to Transplant House. Translating this into musical metaphors, Wednesday evokes Sting, while Friday conjures up Satchmo:

Up a lazy river, how happy we could be
If you go up a lazy river with me
—sung by Louis Armstrong; lyrics by Hoagy Carmichael

As a bonus, I'm looking forward to Friday (Day Zero of the transplant countdown) as my final opportunity to indulge in Mayo's collection of in-house movies, interspersed with more rounds of free-ranging conversation with Alison and Ceilee, a satisfying admix of the thoughtful, the provocative, and the tender.

"The time has come," the Walrus said,
"To talk of many things:
Of shoes—and ships—and sealing-wax—
Of cabbages—and kings—
And why the sea is boiling hot—
And whether pigs have wings."
—excerpted from The Walrus and The Carpenter by Lewis Carroll

Gearing Up for Chemo

It's the weekend. For Susan and I that means a couple day off—as in no medical appointments—before action resumes Monday, when I get a central port placed high in my torso (to ease blood exchange for the chemotherapy to come) and a sample of belly fat taken to test for amyloids (see more about this new wrinkle below). 

Good news for ducks and flower beds. It's raining steadily as I type and that's supposed to keep up all day. That makes it a good day to not walk to the clinic, and a good day to compose a blog. Susan and I had been hoping to stroll over to the farmers market this morning, but we gave up on that idea once the skies opened up.

We saw Dr Buadi yesterday. He's the hematologist overseeing my stem-cell transplant. All systems are go for my receiving the chemotherapy Wednesday (melphalan), to be followed Friday by the reintroduction of my stem cells. In the parlance of my Bone Marrow Transplant (BMT) Team, next Friday will be dubbed Day Zero. While Susan and I had been hoping this timetable would not have been so stretched out (six days between the completion of stem cell collection and the chemo treatment), we are grateful for the down time together this weekend. 

My sister Alison is slated to arrive late Monday morning (July 25) to tag in as my primary caregiver, allowing Susan to drive back to Duluth that afternoon. She'll have 10 days or so at home to catch up on work at church, to get a break from Mayo coffee, and to convince our dog, Lucyie that she's still loved. She'll then return in time to take back the caregiver baton from my dear friend, Annie, who will be in charge of Laird duty Aug 1-8.

From Day Zero onward my routine will be the same every day. There will be a visit to the clinic so that the BMT Team can get eyes on me to make sure everything is proceeding on course. This is important because I will be immune-suppressed after taking the melphalan, and therefore susceptible to catching random germs and diseases that a normal body could shrug off easily. If there's a complication, my BMT Team wants to be right on top of it.

When I first tried to imagine what the transplant would be like, I pictured a challenge similar to what I went through in Feb and March, recovering from getting knocked flat on my ass by both severe back pain and my body's response to the early cancer treatment. Last winter I wrestled with being bed ridden and learning to walk again. After talking with Elsie Martin though, a friend who went through a stem cell transplant 2-1/2 years ago, also for multiple myeloma (MM), she reported how important it was to her to have the goal of walking at least one flight of stairs every day. I thought, huh? I didn't attempt stairs until returning home after almost seven weeks of hospital and rehab therapy last winter.
But this will be a different deal. I will be attempting to not lose the ground that I have carefully gained since Feb, and that means I need to keep moving. To be sure, it needn't be fast; I just need to keep using my legs, because that will get me home faster. Conveniently, I have one flight of stairs separating my room at Transplant House from the kitchen/dining room, so I may adopt the same post-transplant recovery goal as Elsie did. If I am able to walk to my daily appointments at Mayo (as I have so far), so much the better.

In any event, I'm looking forward to moving on to this next and final stage of the transplant process (in the spirit of, you can't get done until you get started). I have a comfortable setting, a terrific care team, and top-notch medical assistance. Let's get 'er done!

• • •

Now back to the amyloids. There was modest (inconclusive) evidence that I may have an incipient problem moving me in the direction of amyloidosis. This is a relatively rare, but serious disease that involves the accumulation of unwanted protein fragments (called fibrils) that the body has trouble disposing of. These fibrils can aggregate and interfere with normal body functions. While this disease can present in a variety of forms, one version compromises the kidneys and heart.

With that possibility in mind (because I need my heart and kidneys to be hitting on all cylinders as I continue my battle with MM), Buadi ordered tests to take a closer look for amyloids. Because they are rare and show up in many forms, they are difficult to diagnose. Nonetheless, it is a measure of my doctor's thoroughness that he's checking anyway.

On the good side, my kidney functions have steadily steadily improved from their dangerous low point when my cancer was first discovered in late January (I was only functioning on 20% capacity at that time and was close to renal failure), and that kind of improvement is contraindicated in the presence of amyloids. So the early evidence is mixed, and I think the best way to see this is my doctor is being prudent. While I don't want there to be any more complications, I want my doctors to be looking in case there are. Who would want it any other way?

• • •

It looks like an all-day soaker today in Rochester—a good day to read or go to a movie as I keep building strength for the weeks ahead.

Getting Turned Inside Out

I've now completed three days of apheresis, having collected 4.4 million stem cells on my way to six. (Although the transplant will use only three million, my doctor wants double that amount in hand in case a second transplant is indicated.) While I'm getting tired of being a pin cushion (think lots of IV sticks and belly pokes) the end is in sight. With luck, I'll inch across the finish line tomorrow.

I awoke today to scary news. My brother-in-law Norm suffered a stroke yesterday, and his wife (my sister Tracey) went to bed last night with Norm in the hospital, not being able to talk. We got a brief note from her first thing in the morning apprising us of the situation. Fortunately, Norm recovered his speech later today. While they're still testing, it appears he'll have a full or nearly full recovery. Whew. It's sobering to be reminded that serious health challenges can strike any of us at any time.

On a positive note, there is a riot of flowers in bloom in downtown Rochester (after all, it's mid-July) and it's a multicolored joy to walk the pathways that Susan and I traverse between Mayo Clinic and Transplant House each day. Further, Rochester is an exceptionally clean and friendly town, and from the eighth floor of the Eisenberg Building (where apheresis is conducted) we have a nice panoramic view of the north side of the city in full green raiment. Today we got a bonus as storm clouds rolled through all morning. Though it didn't rain, the view was spectacular.

Looking back over my first 10 days in town, it's been wonderful having so much time with Susan (who is taking time off from her regular duties at St Paul's Episcopal Church to be my primary support person). Starting next Monday Susan gets relief as Alison, Ceilee, and Annie takes turns covering the next fortnight. While I'm anticipating good connections with those loved ones as well, it's been precious sharing with Susan all of my fears and joys as I surrender to the fast water of the transplant process, trusting the sturdiness of our intimate canoe to see us safely through. It is, after all, a big deal. Our future is at stake, and I hold dearly the hope of being able to enjoy substantial time together in good health.

• • •

Mayo Clinic thoughtfully offers apheresis patients access to movies while they go through the five-hour collection sessions. Monday we watched The Intern (a lovely comedy with Robert De Niro and Anne Hathaway). Being an older guy myself it was touching watching how De Niro portrayed a 70-year-old widower who was not yet done with making a contribution in the world. I admired his patience working in a company run by people who were a generation younger than himself—available to give advice if asked, but never pushing it. Without rancor or ego, he gracefully accepted the role of office intern after retiring from a successful career as a business vice president. He simply wanted to be back in the action and knew how to be a team player.

The action hinges off a personal crisis for the company founder and CEO, Jules Ostin (Anne Hathaway). She loves her company (an online fashion start-up) but the long hours take her away from her daughter and stay-at-home husband. The neglected husband has an affair, Jules finds out, and feels she has to choose between a job she loves and the family she loves. In the end, hubby repents and Jules gets to keep both, but left unexplored is how that adds up. Where are the extra hours needed to do both well going to come from? The movie got right up to the crucial question and then ducked.

Tuesday we saw Spectre (the latest James Bond thriller), and today we caught Star Wars: The Force Awakens (episode VII). Sandwiched between these two escapist thrillers (where once again, wouldn't you know it, good triumphed over you know what at the last possible moment), we enjoyed Inside Out, a delightful Pixar's release from last year. (Does Pixar ever produce a bad movie?) While I'm not sure that catching up on movies you missed first run is an even trade for having cancer, it's at least a sliver of a silver lining.

The best of the bunch was the animated film, Inside Out, which I had never heard of but Susan knew to be a winner. The concept is what's happening in the consciousness of an 11-year-old named Riley as she tries to integrate her five primal feelings: Joy, Sadness, Fear, Anger, and Disgust (think of a team of five trying to cooperatively resolve how Riley should respond in any given moment, with Joy as the team leader, but not necessarily always in control—it was hilariously insightful). 

The film's dramatic crisis occurs when Riley (an only child) and parents leave their happy home in Minnesota to explore a new life together in San Francisco. Riley stumbles out of the blocks in her first day at her new school, and this movie brought me to tears as Joy learns to make friends with Sadness, helping Riley reunite with her parents—rather than trying to keep Sadness confined to a small circle where she doesn't touch much.

What a delightful way to introduce the concept of emotional health—something we all struggle with, not just 11-year-olds. While Riley's brain worked overtime to make sense of her conflicted feelings toward her parents (why did they take her away from the Land of 10,000 Lakes, where everything was going so well?), it triggered sympathetic tears in me about my complicated relationship with my father, where I struggled mightily to understand my emotional responses (and his).

Anyway, that's what I noticed during cancer treatment today. What's it going to be like when the hard part comes?

Prime Time in Rochester

Today I completed four rounds of priming, which chemically encourages my bone marrow to release stem cells into the bloodstream. Tomorrow the harvesting begins. Each morning—for as many as are needed to gather six million stem cells—I'll start my day with five hours of apheresis, where my blood (through intravenous ports) will be circulated through a machine that is clever enough to extract stem cells from everything else.

It's a pretty straight forward operation. After getting set up, I just relax and let the machine do its job. As I went through several rounds of this in Duluth in order to shed my excess plasma cells, I know the drill. I'll be sure to bring a book.

The staff estimates that it will take 2-4 rounds of apheresis to get enough stem cells, after which I should be all set to begin chemotherapy—which starts with the injection of a poison to kill off everything in my bone marrow.

Meanwhile, Susan and I have been settling into a routine during our first week at Transplant House, located just four blocks from the Mayo Clinic. At least at the outset of my visit here I am strong enough to walk to and fro between the two. It's a bit over half a mile one way on fairly level terrain and terrific exercise for my legs and lungs. As a bonus, I've noticed that my peripheral neuropathy (numbness and tingling in my hands and feet) has diminished since my walking has increased. Yay! Because I'm expecting my overall energy to nosedive after I receive the chemo, it's important to keep building strength now to help sustain it as long as I possibly can (I figure it's easier to retain than to recover).

One of the conundrums that Susan and I face is anticipating my food interests after I take the chemo. We've been warned that my sense of taste will be wonky after chemo and that I'm likely to suffer loss of appetite. That's unfortunate because I need to keep eating to maintain strength. My weight is down to 154 as of this morning (from a high of 206 back in October 2014, when I first experienced lower back pain) and the transplant nurses have told us that it's common for stem cell recipients to lose 10-15 lbs over the course of the protocol—an additional droppage that I am loath to shed.

Yesterday we went to a local farmer's market and bought fresh veggies, enough to make a large pot of soup, in anticipation that I'll like soup during recovery. I sure hope I do. Today we went to a grocery store and picked up more ingredients for the what-will-Laird-eat-after-chemotherapy-has-wiped-out-his-taste-buds-and-appetite sweepstakes, which we expect to begin playing sometime next week.

It was great being able to take advantage of the season (mid-July, with lots of stuff available fresh and local), the weather (lower 70s), and my burgeoning stamina to add a two-mile detour onto our walk home after my daily dose of neupogen. Susan and I then had fun cutting up in the kitchen, adding peas, corn, potatoes, carrots, onions, green beans, Great Northerns, and a couple of diced chicken breasts to a base jump-started with some garlic salt, a can of crushed tomatoes, and a box of chicken stock. Yum.

I'm anticipating that the trickiest part of the post-chemo period will be adjusting to the hygiene protocols while I'm immune compromised. Lots of hand washing, teeth cleaning 4x daily (using a sponge-like thing called a "toothette" because a regular toothbrush may cause bleeding), wearing a mask when out in public, and generally being what Elmer Fudd would describe as "wery, wery cautious."

While I'll probably be plenty tired of it by the time I'm past the danger zone (typically 2-3 weeks), there is no way around it; I simply have to go through it.

Me and Fellini

This is my 1000th blog. Wow. I figure it's an opportune moment to step back and reflect a bit on what's transpired since I launched this site in December 2007.  8-1/2 years. Me and Fellini.
 
Frederico Fellini released his autobiographical masterpiece, 8-1/2, in 1963 (I was just graduating from eighth grade), featuring a movie director (played by Marcello Mastroianni) who takes a step back from a busy, harried life to slow things down and consider what he's accomplished and where he wants to go. This movie was notorious for its examination of intimate details in the director's life. Though it would be considered tame today, it was risque at the time. Now why would that remind me of my blog... or for that matter, my life? Hah! Art foretells life.

I started this blog to help drive traffic to the FIC website through the more contemporary venue of social media. While you'll never catch me tweeting, I at least have this one oar in modern waters. While assisting the Fellowship still motivates me, that alone would not have been sufficient to have sustained my interest. I reached this milestone because my blog has also served as a place to lay out my thinking about cooperative group dynamics—strung out like so many pearls, released one monograph at a time. Finally, I personally benefit from the discipline of writing, which requires me to be more precise and complete in my thinking. I write better reports, for example, because I write regularly for my blog. (Is one ever through learning how to be more to the point?)

This auspicious date comes on the cusp of my entering a new and crucial phase in my cancer chemo-choreograhy. (I came within an ace of writing "battle" with cancer, but I'm uneasy with the martial metaphor and believe I'll ultimately have greater success learning to live with cancer, rather than attempting to "vanquish" it.) In fact, I'm polishing today's post from my second floor room at the Gift of Life Transplant House in Rochester, where Susan and I landed Monday evening for the start of my stem-cell transplant procedure at Mayo Clinic.

It's interesting to have manifested cancer just as I stepped out of FIC administrative work. I reckon it's true that nature abhors a vacuum. As a cancer survivor (since January) I now have one more powerful way to bridge to people who feel isolated, which is a set of tools you never have too many of as a group dynamics technician. I've found that being able to bridge to folks who feel isolated is an unsubstitutable skill, so it's great having another point of entrée.

After two days in Rochester, I've been poked and prodded more than a side of US Grade A beef. This afternoon I met with Dr Buadi, who will oversee the transplant procedure. He gave the green light to proceed based on my baseline test results, and I received my first shot of Neupogen, a stimulant that will cause my bone marrow to release stem cells into the bloodstream, from which they can be harvested starting Monday.

Stem cell collection is accomplished through a process called apheresis. They'll draw my blood out of an intravenous port in one arm, cycle it through a machine that separates plasma from blood cells, and then return the residue into a matching intravenous port in my other arm. A single apheresis session takes about five hours and I'll do 2-4 of them to gather enough stem cells: about 6 million.

After that I'll be injected with a poison that will kill everything in my bone marrow—good cells and bad. Two days following that, they'll reintroduce my healthy stem cells to start the recolonization of my bone marrow.

As you might imagine, my main job throughout this is to maintain a positive attitude and to recover energy, motivation, and appetite. I'll be immuno compromised right after the poison injection, will lose my hair (such as I have any), and will feel like shit. But health is on the other shore and I'm highly motivated to cross this river.
For the duration of my time in Rochester (maybe six weeks altogether) I have a terrific caregiving team lined up. In addition to Susan (my main primary support), I'll have Alison (my youngest sister), Ceilee (my son), Annie (my ex-partner and Ceilee's mother), and Jo (my daughter) all doing shifts to give Susan a break. As if that weren't enough, there are even more who volunteered for shifts, but I didn't have more spaces on my dance card! 

It's an incredibly good feeling to know that so many folks are rooting for my recovery, and are willing to suspend their regular life long enough to lend a hand. The power of being touched by this kind of love is palpable, and it appears that one of my main life lessons these days is learning to place relationships more in the center of my life.

What does that mean? Let me share the story of two unplanned visits that created delightful bookends for me last week. On Sunday afternoon River Oneida came by for a couple hours, taking advantage of being in town to visit his son's family (most of which are in Duluth) and knowing that I was going through a major health crisis, he decided to see me as well. River lives at Twin Oaks, an income-sharing community in central VA that will be celebrating its 50 birthday next June (which is a far more significant accomplishment than my posting 1000 blog entries). I have been visiting Twin Oaks off and on since 1980, and have known River for decades as a fellow traveler in the arcane word of income sharing. Though I had not seen him in 4+ years we had no trouble whatsoever picking right up with the threads of our lives, as if it had only been last week. Sharing a community bond with someone creates that kind of intimacy.

Amazingly, this was followed by a surprise visit from Jim Crowfoot & Ruth Carey, two long-time friends who live at Sunward Village, a cohousing community in Ann Arbor MI. They were in state to attend the  Quaker annual meeting (held this year in St Joseph, close to St Cloud). On whim, after the meeting ended they decide they wanted to see Lake Superior and at the same time to see me before I headed to Mayo. Saturday they made both wishes come true wish and we had a lovely visit, replete with fresh blueberry pie and ice cream. (Does it ever get better than good friends and fruit pie a la mode?)

I love that I'm moving into a lifestyle where these kinds of accidental visits can find ready oxygen.

Today we arrived at Mayo for our first appointment mid-morning and settled into the waiting room. When the escort nurse collected us and took us to an examination room, she remarked , "Welcome back." I looked at her quizzically and she replied, "I recognized your devil bag from March." Holy cow! She had remembered my canvas tote bag from four months ago. Talk about putting patients at ease with a personal touch. I was gobsmacked. 
Later, after the doctor's assistant went over the adjustments to my medication list, we asked if there was a pharmacy she'd recommend. We were told there was one in the Mayo complex. When we asked where, she began her explanation with, "You know where the Starbuck's is, right?" You know you're in America when even the directions at Mayo Clinic start by referencing Starbuck's as a universally known landmark. What a (caffeinated) country!

For the next six weeks (or so) I'll be bivouacked at:
Gift of Life Transplant House
room 238
724 2nd St SW
Rochester MN 55902

Who knows where I'll be when it's time for blog #2000?

Healthy Uses of Power and Authority

If power is the ability to get others to do something, or to agree to something, how does the equation  change if one of the two people has authority the other doesn't have?
Let's say Sandy has been authorized to make decisions about the group's anniversary party. Taylor is also a member of the group and has ideas about a new interactive game that might increase participation (which has been waning in recent years). Now let's suppose that Sandy does not share Taylor's excitement about the new game because it will take too long, making dinner start too late for parents with young kids.

Sandy appreciates that Taylor is trying to enhance participation, but Sandy is also sensitive to complaints from the parents of young kids about how few group activities are designed to work well for their family schedules. What to do? Let's suppose Taylor is a new member to the group and has been encouraged to get involved. This offering of the new game at anniversary is Taylor's first attempt to do something for the group and Taylor is baffled by Sandy's cool reception. There is a risk that if this exchange goes poorly that Taylor will back off and become cynical about the group's supposed commitment to inclusivity.

To be clear, Sandy has the authority make the call without getting buy-in from Taylor. Still, Sandy wants to be careful about proceeding in a way that is not disrespectful to the well-intended newcomer. Yet neither does Sandy want to get bogged down negotiating with Taylor over an idea that's a non-starter. After all, what's the point of having the authority to make the call unless you exercise it?

At what point is Sandy being arbitrary? At what point is Sandy being held hostage to unreasonable expectations?

By virtue of delegated authority, Sandy is not obliged to get approval from Taylor. Is it enough that Sandy makes a good faith effort to hear Taylor and explain why there will be no new games played at anniversary? What level of response from Sandy constitutes due diligence? 

These are nuanced questions, and I don't believe there is one right answer. That said, it's worthwhile to dwell here a bit to describe the lay of the land and to offer some suggestions about how to proceed.

o  I believe the hardest part of this dynamic is that people do not tend to respond openly to others raising questions about how cleanly they've used power. Thus, the biggest challenge tends to be creating a culture in which these uncertainties can be explored without anyone going ballistic.

o  One thing that will help is having a conversation about what's wanted in the situation I've described with Sandy and Taylor. What can Taylor expect in the way of consideration and an explanation from Sandy? What latitude does Sandy have to go in another direction if unpersuaded by Sandy's suggestion?

o  It might be interesting to ask other members of the group who have had experience filling roles of authority for the group what they would like the standard of responsiveness to be.

o  Caution: One known pitfall here is sloppy delegation. Just imagine how much more complicated it can get when the hand-off to the person(s) in authority has not been well defined. Ugh. When people have to guess about the limits of authority, can misunderstandings be far behind?  

o  There's a difference between being unhappy with how someone used their authority (perhaps you feel they exceeded their mandate) and being displeased with their judgment (even though they had the right). Be sure not to conflate the two. The former is a process complaint; the latter is a disagreement of substance.

While the advice above does not constitute foolproof protection against falling into the pit, it'll help.